Behavior Disorders: EXAM 2 terms

Fear

an adaptive response to an immediate danger (ex. About to be eaten by a shark, walking in preserve and see a snake —> activates flight or fight response)

Anxiety

a stress response from the anticipation of danger —> can lead to the exact same stress response, will continue even when the danger has passed/when there is no real danger

Describe Panic Disorder

• recurrent, unexpected panic attacks, followed by 1+ month(s) of concern/worry or behavior changes

Describe agoraphobia

Fear or avoidance of situation in which escape may be difficult or help might not be available if you begin to have panic symptoms

Describe generalized anxiety disorder

Excessive or unreasonable worry that is difficult to control

Describe social anxiety disorder

Fear of negative evaluation in social situations

Selective mutism

Lack of speech in one or more settings in which speech is socially expected

Describe Separation anxiety disorder

Fear of harm to self or attachment figure that will cause separation to be impossible

Describe specific phobia disorder

Specific object or situation (blood-injection-injury, situational, environmental, or animal)

Describe post traumatic stress disorder

Traumatic event followed by set of intrusion, avoidance, cognitive/mood, and arousal/reactivity symptoms

Describe acute stress disorder

Similar to PTSD but occurs within 1st month after trauma

Describe prolonged grief disorder

Intense longing for or preoccupation with a person who died 1+ years ago

Describe adjustment disorder

Milder anxiety or depressive reaction to life stress

Describe attachment disorder

Before age 5, unable/unwilling to form attachments with caregivers

Describe obsessive-compulsive disorder

Obsessions and/or compulsions that are consuming or impairing

Describe body dysmorphic disorder

Preoccupation with an imagined defect in appearance

Describe hoarding disorder

Persistent difficulty discarding or parting with possessions, regardless of actual value

What is trichotillomania?

Hair pulling disorder

What is excoriation?

Skin picking disorder

What disorder features the following symptoms? Recurrent episodes of fear occurring at inappropriate times accompanied by concern about additional episodes or by maladaptive behavior related to the episodes

Panic disorder

What disorder features the following symptoms? Marked fear or anxiety about situations like public transportation, open spaces, enclosed places, standing in line or being in a crowd, and/or being outside the home alone

Agoraphobia

What disorder features the following symptoms? Characterized by 6 months of excessive apprehensive expectation that must be ongoing more days than not

Generalized anxiety disorder (GED)

What disorder features the following symptoms? Marked fear or anxiety about one or more situations in which the person is exposed to possible scrutiny by others

Social anxiety disorder

Which disorder is described by the following symptoms? Characterized by unwanted thoughts, images, and /or impulses that the individual tries to completely avoid through the use of rituals like checking or counting

Obsessive-compulsion disorder (OCD)

Which disorder is described by the following symptoms? Disturbed and developmentally inappropriate behaviors in children characterized by a lack of restraint around adults

Disinhibited social engagement disorder

Which disorder is characterized by the following symptoms? The urge to pull out one’s own hair from anywhere on the body

Trichotilomania

Which disorder is characterized by the following symptoms? Preoccupation with some imagined defect in appearance

Body dysmorphic disorder

Which disorder is characterized by the following symptoms? Intrusion symptoms, avoidance, negative alterations in cognition and mood, and/or alterations in arousal and reactivit

Posttramautic stress disorder (PTSD)

What is Etiology?

The onset type and course type of the disorder

What type of onset do anxiety disorders have?

Early age of onset

What type of course do anxiety disorders tend to have?

Chronic (long-lasting without treatment)

What factors are associated with anxiety disorders?

• stress

• Family history

• Personality type

• Trauma

• Discrimination

• Biological sex

Describe what family history means.

• genetics

• Parenting type

What are the three vulnerabilities that contribute to anxiety related disorders?

1. Biological

2. Specific psychological vulnerability

3. Generalized psychological vulnerability

Describe the biological vulnerability associated with anxiety.

Heritable contribution to negative affect

• genetic influences on heightened amygdala or HPA axis reactivity

• Behavioral inhibition

Describe the generalized psychological vulnerability associated with anxiety.

• low perceived self-worth

• Belief that the world is a dangerous place

• Belied that you cannot handle stress

Describe the specific psychological vulnerability associated with anxiety.

• anxiety sensitivity (for panic disorder)

Describe behavioral inhibition.

Temperament trait characterized by a hesitancy to interact with novel people and situations.

• increases risk for anxiety disorders, particularly social anxiety disorder

• Can be identified as young as 4 months old

What is a temperamental trait?

• something one is born with

  • Eventually becomes “personality” with age

Describe Mowrer’s Two-factor model

1. Classical conditioning leads to the development of anxiety (ie. Trauma or thoughts of harm lead to fear)

2. Negative reinforcement (operant conditioning) leads to the maintenance of anxiety —> checking behaviors leads to the reduction of fear and the reinforcement that this behavior reduces anxiety

Describe habituation.

Exposure to anxiety-causing situations/things gets easier over time

• fear reduces faster and quicker with more exposures

What is the most effective psychopharmacological treatment?

SSRIs

• benzodiazepines are prescribed but are BAD

When is relapse for a disorder the highest?

Relapse following the discontinuation of meds is higher than relapse following CBT

There is some evidence that combining meds with CBT either does not improve or reduces the effectiveness of CBT. Explain.

• the mechanism of action in CBT is experiencing the anxiety go up and down without the feared outcome happening

• So, anything that interferes with this will interfere with therapy

  • Meds stop you from experiencing anxiety at all

Describe the exposure hierarchy.

Patients and therapist work together to create a hierarchy of least scary situations all the way up to the most scary (ie. Looking at pictures of dogs all the way up to letting several dogs like their face) and then they use this for CBT

How can you add the cognitive component to CBT exposure hierarchy?

By asking people to predict the outcome ahead of time and then, after nothing bad happens, emphasizing the discrepancy between the expected and actual outcome

What are part of CBT do you focus on to reduce anxiety?

• focus on the behavior (avoidance) allows the thoughts and emotions to simply fall into place

What are the three components of CBT?

1. Thoughts

2. Behavior

3. Emotions

Mood disorders are comprised of three different episodes, what are they?

1. Major depressive episode

2. Mania

3. Hypomanic episode

What is anhedonia?

Loss of interest or pleasure

What is the criteria of a major depressive episode?

1. Extremely depressed mood and/or anhedonia

2. At least four additional physical or cognitive symptoms

Lasts most of the day, nearly every day, for at least two weeks

What are the additional physical/cognitive symptoms of depression?

• Indecisiveness

• feelings of worthlessness

• fatigue

• appetite change

• restlessness or feeling slowed down

• sleep disturbance

What are the clinical features of a major depressive disorder?

• Recurrent

• Risk of recurrence increases with each additional episode

What does recurrent mean?

One or more major depressive episodes separated by periods

of remission

What are some specifiers of depression?

• postpartum depression

• Seasonal affective disorder

What is double depression?

An individual experiences both persistent depressive disorder and

episodes of major depression

What is persistent depressive disorder (dysthymia)?

• At least two years of depressive symptoms

• Depressed mood most of the day on more than 50% of days

• No more than two months symptom free

What are some examples of sympotoms of a manic episode?

Inflated self-esteem, decreased need for sleep, excessive talkativeness,

flight of ideas or sense that thoughts are racing, easy distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behaviors

What is the criteria of a manic episode?

Elevated, expansive mood for at least one week (or less if hospitalized)

What are some other types of mood episodes (besides manic and depression)?

Hypomanic episode, mixed feature episode

Describe a hypomanic episode.

Shorter, less severe version of manic episodes

What is bipolar 1 disorder?

Alternations between major depressive episodes and manic episodes

What is bipolar 2 disorder?

Alternations between major depressive episodes and hypomanic episodes

What is cyclothymic disorder?

Alternations between less severe depressive and hypomanic periods

What is Premenstrual dysphoric disorder?

• A depressive disorder that follows menstrual cycles

• Symptoms are slightly different than for MDD

What is disruptive mood dysregulation disorder?

• Persistent irritability/anger (> 1 year) and temper outbursts

• Only diagnosed in kids/adolescents (age 6-18)

Describe the epidemiology of depressive disorders.

• Risk increases in adolescence and young adulthood, decreases in middle adulthood, increases again in old age (U-shaped pattern)

• Depressive episodes are variable in length (months, years)

What are some risk factors of mood disorders?

• sleep

• Environmental influences

• Famailial and genetic influences

• Cognitive influences

Worldwide lifetime prevalence of major depressive disorder is __%

16%

Describe the sex differences for the prevalence of mood disorders.

• Women are twice as likely to have major depression (only 1st onsets)

• Bipolar disorders affect men and women equally

•

How do different cultures affect mood disorders?

• Similar prevalence across subcultures, but experience of symptoms may vary

• Some cultures more likely to express depression as somatic concern

Which subculture has the highest prevalence of mood disorders? N

Native Americans: 4x more likely than general population

What are the environmental risk factors of mania?

“goal-attainment events” like finishing finals, getting a new job, etc

What are the environmental risk factors for MDD?

“loss events” like getting fired, breaking up

• Targeted rejection seems to be a particular risk factor

The relation between negative events and depression is transactional over time. Explain what this means.

Stress increases depression, which increases future stress (stress

generation)

Describe negative inferential style.

• Attribute the causes of negative events to (internal), stable, and global factors (e.g., “The reason I failed the test is that I’m stupid”)

• Associated with Learned Helplessness

Describe Beck’s negative cognitive triad.

Having negative views of self, world and future

Describe Rumination.

Passively thinking about why you are depressed without any active

problem solving or distraction

Sleep disturbance is a symptom of which disorder(s)?

MDD and (hypo)mania

What is insomnia in terms of MDD?

Less sleep

What is hypersomnia in terms of MDD?

More sleep

What is sleep disturbance in terms of mania?

the person sleeps much less and still feels rested

What is one core feature of treatment for MDD/hypomania?

helping the person to have a consistent sleep schedule

What are some interventions to reduce suicide risk?

• behavior therapy

• Ketamine

• Lifelines

What are the four classes of antidepressants?

1. Selective serotonin reuptake inhibitors (SSRIs)

2. Tricyclic antidepressants

3. Monoamine oxidase inhibitors (MAOIs)

4. Mixed reuptake inhibitors

What are some examples of mixed reuptakes inhibitors?

serotonin/norepinephrine reuptake inhibitors

What percentage of patients benefit from antidepressant medication? And what percentage achieve normal functioning?

• 50% benefit

• 25% achieve normal functioning

What is lithium carbonate?

A mood stabilizer treatment for bipolar disorder that is toxic in large amounts (ie. Doses are monitored carefully)

What percentage of patients benefit from lithium carbonate medication for bipolar?

50% of patients

What is a mood stabilizer?

it treats depressive and manic symptoms

What is Electroconvulsive therapy?

Brief electrical current applied to the brain leading to seizure that is effective for severe medication-resistant depression

What are the side effects of electroconvulsive therapy?

Headaches, memory loss that may be permanent

What are some side effects of Transcranial magnetic stimulation?

occasional headaches

What is Transcranial magnetic stimulation?

uses magnets to generate a precise localized electromagnetic pulse

Compare Transcranial magnetic stimulation and electroconversion therapy?

Transcranial magnetic stimulation is less effective than Electroconversion therapy for medication-resistant depression

What are the psychosocial treatments for depression?

• cognitive behavioral therapy

• Interpersonal psychotherapy

• Relapse prevention

• Prevention of onset of disorder

Describe Cognitive-behavioral therapy for depression?

Addresses errors in thinking

• Also includes behavioral components including behavioral activation (focusing specifically on “pleasure” and “mastery” events)

Compare psychosocial treatments for depression with medication.

Psychosocial treatment may have longer-lasting effects than medication

Describe Interpersonal psychotherapy for depression.

A focus on improving problematic relationships

What does relapse prevention for depression look like?

May include both medication and psychosocial approaches