Goldstein Psychopathology - Chapters 5-9

What is the difference between fear and anxiety?

Though both have a negative affect, anxiety is future-oriented and related to the inability to predict/control upcoming events. Fear is characterized by an immediate alarm reaction in response to present danger or life-threatening emergencies

What are the three risk factors/vulnerabilities associated with generalized anxiety disorder?

Biological vulnerability, specific psychological vulnerability, and generalized psychological vulnerability

**Examples of all three:

Biological: "glass is half empty," innate irritability, having anxious parents

Specific Psychological: anxiety about health, nonclinical panic

Generalized Psychological: tendency toward lack of self-confidence, low self-esteem

True or False: Anxiety has high rates of comorbidity.

True! ~55-75%

True or False: Anxiety is less correlated with physiological challenges, and more highly correlated with psychological vulnerabilities.

False--anxiety is highly correlated with physiological challenges!

What disorder does anxiety have similar suicide rates to?

Major Depressive Disorder (MDD)

What percentage of people diagnosed with panic disorder attempt to take their own life?

~20%

True or False: Due to cultural differences, the western world tends to have higher rates of GAD than other parts of the world.

False! There are similar rates worldwide

What type of onset is GAD?

Insidious

What type of course does GAD typically take?

A chronic one!

Life Cycle of GAD: In addition to vulnerabilities, what else may contribute to stress?

Possible false alarms

Life Cycle of GAD: What does stress lead to?

Anxious apprehension

**including increased muscle tension and vigilance

Life Cycle of GAD: What follows anxious apprehension?

Worry process

Life Cycle of GAD: What is worry process as it relates to the life cycle of GAD?

A failed attempt to cope and problem solve

Life Cycle of GAD: What two things do worry process lead to?

Intense cognitive processing; avoidance of imagery

Life Cycle of GAD: What does intense cognitive processing lead to?

Inadequate problem-solving skills

Life Cycle of GAD: What does avoidance of imagery lead to?

Restricted autonomic response

Life Cycle of GAD: What do inadequate problem-solving skills and restricted autonomic response lead to?

Generalized Anxiety Disorder!

What two types of treatment may be administered for GAD?

Pharmacological and psychological

What may be prescribed for GAD?

Benzodiazepines, antidepressants

What is important to consider when prescribing GAD medication?

The risks vs. the benefits, especially with benzos; it is always important to consider the context of who the patient is and how the medication may affect their lives. That is why psychiatrists and psychologists collaborate; psychiatrists need to know more about the patient in order to make the best prescription for them!!!

True or False: Psychological treatment actually has similar benefits to drugs and better long-term results.

True!

What psychological treatment may be administered for GAD?

Cognitive-behavioral treatments; meditation

What is panic disorder characterized by?

Unexpected panic attacks; anxiety, worry, or fear of another attack

How long do panic disorder symptoms persist in order to be diagnosed?

≥1 month

What is agoraphobia characterized by?

Fear or avoidance of situations/events, can be persistent; concern about being unable to escape or get help

True or False: People suffering with agoraphobia tend to use and misuse drugs and alcohol.

True

What is interoceptive avoidance?

Seen in agoraphobic people, it is the behavioral tendency to avoid physical sensations perceived to be dangerous, like a racing heart. These misinterpretations may cause someone to avoid things like caffeine or exercise

Life Cycle of Panic Disorder: What causes stress?

Vulnerabilities(generalized psychological, generalized biological)

Life Cycle of Panic Disorder: What does the false alarm lead to?

An association with somatic sensations (interoceptive cues; e.g. a racing heart), leading to a learned alarm

Life Cycle of Panic Disorder: What happens once the false alarm becomes a learned alarm?

Specific psychological vulnerability

Life Cycle of Panic Disorder: What is specific psychological vulnerability?

A perception that unexplained physical sensations are dangerous

Life Cycle of Panic Disorder: What does specific psychological vulnerability lead to?

Anxious apprehension

Life Cycle of Panic Disorder: What is anxious apprehension characterized by?

A focus on somatic sensations

Life Cycle of Panic Disorder: What may be caused by anxious apprehension?

Panic disorder; development of agoraphobia

Life Cycle of Panic Disorder: What determines the development of agoraphobia in PD?

Cultural, social, and pragmatic factors, moderated by presence of absence of safety signals

What types of treatment may be administered for PD?

Medications, psychological intervention, combines psychological and drug treatments

What medications may be prescribed for PD?

Benzodiazepines or SSRIs

**SSRI: Selective serotonin reuptake inhibitors

True or False: PD has high relapse rates after discontinuation of medication.

True

What psychological intervention may occur for PD?

Cognitive Behavioral Therapy (CBT)

True or False: Combined treatment is not as effective as CBT or drugs alone as they may interfere with one another when administered together.

False

True or False: PTSD does not develop for most people who experience traumatic events.

True!

What determines whether PTSD will manifest in someone who experienced a traumatic event?

Type of trauma and proximity to trauma

Life Cycle of PTSD: What leads to the experience of trauma?

Vulnerabilities(generalized psychological, generalized biological)

Life Cycle of PTSD: What does an experience of trauma lead to?

A true alarm (or alternative intense basic emotions e.g. anger or distress)

Life Cycle of PTSD: What does the true alarm turn into?

A learned alarm (or strong, mixed emotions)

Life Cycle of PTSD: What occurs after development of the learned alarm?

Anxious apprehension focused on re-experienced emotions

Life Cycle of PTSD: What does anxious apprehension lead to?

Avoidance or numbing of emotional response

Life Cycle of PTSD: What moderates the avoidance/numbing of emotional response post anxious apprehension?

Social support and ability to cope

Life Cycle of PTSD: What occurs after the avoidance or numbing of emotional response?

Manifestation of PTSD

What treatments may be administered for PTSD?

Cognitive-behavioral treatment, medications

What kind of CBT may be administered for PTSD?

Imaginal exposure to memories of traumatic event(graduated or massed), increasing of positive coping skills, increasing of social support

True or False: CBT is not very effective for PTSD without emotionally regulative medication.

False! It is highly effective!

What medications may be prescribed for PTSD?

SSRIs

**SSRI: Selective serotonin reuptake inhibitors

What are obsessions in regard to OCD?

Intrusive and nonsensical thoughts, images, or urges that one attempts to resist or eliminate

What are compulsions in regard to OCD?

Thoughts or actions that provide relief from obsessive thoughts

True or False: OCD is more prevalent in females than males.

False! It occurs about equally for each gender

Is OCD acute or chronic?

Chronic

What is the onset of OCD?

Childhood to 30s

Life Cycle of OCD: What causes stress?

Vulnerabilities(generalized psychological, generalized biological)

Life Cycle of OCD: What does stress of life events lead to?

Intrusive thoughts, images, or impulses

Life Cycle of OCD: What do intrusive thoughts, images, or impulses lead to?

Specific psychological vulnerability

**thoughts are dangerous and unacceptable

Life Cycle of OCD: What two outcomes can occur after specific psychological vulnerability?

False alarms; anxious apprehension

Life Cycle of OCD: What do false alarms associated with unacceptable thoughts lead to?

Learned alarms and, thus, anxious apprehension

Life Cycle of OCD: What can anxious apprehension focused on recurring thoughts lead to, if not straight to the manifestation of the disorder?

Cognitive or behavioral traits to neutralize or suppress thoughts

Life Cycle of OCD: What do cognitive or behavioral rituals to neutralize or suppress thoughts lead to?

Manifestation of OCD

What does treatment look like for OCD?

Medications and CBT

What kind of medications may be prescribed for OCD?

SSRIs

True or False: SSRIs for OCD are highly effective in that patients manage medication use temporarily until they can cope with their disorder.

False--they have a high relapse rate when discontinued; OCD tends to require medication management services for life.

In intractable cases of OCD, what treatment may be administered?

Psychosurgery (cingulotomy)

**A cingulotomy is a neurosurgical procedure that creates precise lesions on the brain to alleviate the emotional "suffering" component of pain, used to treat resistant chronic pain or psychiatric disorders(like OCD!!)

What does CBT for OCD entail?

Exposure and ritual prevention (ERP)

**Has patients face fears(exposures) whilst resisting compulsions(rituals)

True or False: Exposure and ritual prevention (ERP) is highly effective for OCD.

True! It is actually the gold-standard treatment!

OCD-Related Disorders: What is body dysmorphic disorder?

Preoccupation with some imagined defect in appearance

OCD-Related Disorders: What is hoarding disorder?

Excessively collecting and keeping items with minimal value, leading to cluttering and disruption of living space

OCD-Related Disorders: What is trichotillomania?

The urge to pull out one's own hair from anywhere on the body

OCD-Related Disorders: What is excoriation?

Repetitive and compulsive picking of the skin, leading to tissue damage

What are somatic symptom disorders?

Disorders involving excessive or maladaptive response to physical symptoms or health concerns

What are somatic symptom disorders categorized by?

The presence of one or more somatic symptoms that may or may not have known medical causes with excessive thoughts, feelings, and behaviors related to the symptoms and substantial impairment in social/occupational functioning

True or False: Somatic symptom disorders are relatively common.

False--they are relatively rare!

When is the usual onset of somatic symptom disorders?

Adolescence

Who is more likely to be affected by somatic symptom disorders?

Unmarried, low SES women

True or False: Somatic symptom disorders are relatively chronic.

True

True or False: There is extensive and ongoing research on treatment effectiveness for somatic symptom disorders.

False--there is limited research on treatment effectiveness to date

What may benefit mild cases of illness anxiety disorder?

Cognitive behavioral treatments, detailed education, reassurance from medical professionals, exposure treatment

True or False: Antidepressants may be helpful in treating somatic symptom disorders.

True

Why might someone with a somatic symptom disorder be assigned a "gatekeeper" physician?

To limit excessive use of medical services and reduce supportive consequences of illness

**supportive consequences are a type of positive reinforcement in which a behavior encourages someone to do something again--in this case, illness would ultimately encourage someone with illness anxiety disorder to continue to exhaust their medical resources. So:

Occurrence: illness

Supportive consequence: a need to go back to the doctor

Reinforcement: going to doctor = reassurance and attention from doctor that encourages continued use of medical services

What is illness anxiety disorder?

Severe anxiety about the probability of having or acquiring a serious disease despite actual symptoms being very mild/absent

What DSM-IV disorder is illness anxiety disorder very similar to?

Hypochondriasis

True or False: Medical reassurance provides relief of symptoms of illness anxiety disorder.

False

What disorders are illness anxiety disorder often comorbid with?

Anxiety and mood disorders

Life Cycle of IAD: What causes the perceived threat?

A trigger--information, event, illness image

Life Cycle of IAD: What does the perceived threat lead to?

Apprehension

Life Cycle of IAD: What are the three outcomes of apprehension?

Increased focus on body, increased physiological arousal, checking behavior and reassurance seeking

Life Cycle of IAD: A preoccupation with perceived alteration/abnormality of bodily sensations/state. What occurs as a result?

Misinterpretation of body sensations and/or signs as indicating severe illness and thus, a perceived threat

Why is it important to consider psychological factors impacting medical conditions?

The diagnostic label is useful for clinicians as it can indicate that psychological variables may be impacting a general medical issue (e.g. concentration difficulties making it hard to take medication on time). Also, there is a strong connection between psychological wellbeing and physical illness!!

What is another name for conversion disorder?

Functional neurological symptom disorder

What is conversion disorder?

Altered motor or sensory function that is inconsistent with neurological or other medical conditions.

This is often suggestive of a neurological problem, but no such problem is detected.

What is La Belle Indifference?

A clinical phenomenon characterized by an apparent lack of concern or distress about significant physical symptoms, e.g. paralysis, blindness, or seizures. This is a symptom of conversion disorder!

True or False: Conversion disorder may or may not include malingering as a symptom.

False--in fact, the disorder is characterized by the fact that the person is not faking symptoms for the purpose of concrete gains

True or False: Conversion disorder is a rare condition.

True

What is the course of conversion disorder?

Chronic and intermittent