Psychopathology Exam 2

fear

body’s response to an identifiable, serious threat to one’s well-being

anxiety

 is the body' s response to a vague sense of being in danger

panic

 is a random fear/physiological response with an identification

anxiety apprehension

there might be something bad that’s going to happen to me

What happens when we are in a fear situation?

Body tenses, adrenaline rush, fight or flight: biological response for survival of the species

Piloerection

hair on body stands up, body becomes more sensitive to what’s going on

Yerkes Dodson curve

shows that there’s an optimal amount of anxiety/fear and productivity. Can have too much or too little

DSM-5 Anxiety disorders

• Generalized anxiety disorder (GAD)

• Specific phobias

• Agoraphobia

• Social anxiety disorder

• Panic disorder

Generalized Anxiety Disorder (GAD) symptoms

For 6+ months, person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters. At least three: Edginess, fatigue easily, poor concentration, irritability, muscle tension, sleep problems

Cognitive perspective on GAD

Psychological problems are often caused by dysfunctional ways of thinking- including excessive worry and maladaptive assumptions. individuals feel that they need to be approved/loved by everyone

Cognitive perspective treatment of GAD

Treating individuals with GAD by helping them to recognize their inclination to worry. Helping clients to become aware of streams of thoughts, including worries, and to accept these as mind events that doesn’t mean it’s going to happen. Relaxation training.

Biological perspective & treatments on GAD

GAD caused by biology. Treatments include drugs that target NTs, though sometimes interfere with mental/psychological processes

Phobias

Persistent and unreasonable fears of particular objects, activities, or situations

Specific phobias

Used to be simple phobias, the DSM labels as an intense and persistent fear of specific objects or a situation. Most common are animals, bugs, heights, blood. Dealt with via avoidance and people usually don’t seek treatment.

agoraphobia

When a person is afraid to be in a situation where escape might be impossible. Panic usually occurs and fear of having a panic attack without an exit

How phobias differ from fears

phobias are more intense and persistent, paired with a greater desire to avoid all potential interactions.

What causes phobias

modeling of behaviors leads to adoption of fears, classical conditioning, behavioral-evolutionary perspective, stimulus generalization, or sometimes no reason

how phobias are treated

exposure treatments (imaginal vs in vivo, systematic vs prolonged), modeling, cognitive, education

Dx checklist for agoraphobia

Pronounced, disproportionate, and repeated fear about being in at least 2: public transport, parking lots, stores with a concern that it would be hard to escape or get help if a panic, embarrassment, or disabling symptoms were to occur. avoidance of situations, significant distress, and symptoms last for at least 6 months

social anxiety disorder

Have severe, persistent, and irrational anxiety about social or performance situations in which scrutiny by others and embarrassment may occur

classifications of social anxiety

• Narrow: there’s a very specific area within social domain that makes people anxious (speech, eating, bathroom, etc)

• Broad: all social domains, general fear of functioning poorly in front of others

• Both forms: have a narrow focus and a general anxiety

What causes social anxiety disorder?

People with SAD hold a group of social beliefs and expectations that consistently work against them (ex. perfectionism)

Treatments for social anxiety disorder

• Medication (antidepressants)

• Psychotherapy

  • Exposure

• Cognitive therapies

overwhelming social fear and lack of social skills must be addressed

Panic disorder symptoms

Palpitations of the heart, Tingling in hands or feet, Shortness of breath, Sweating, Hot and cold flashes, trembling, Chest pains, Choking sensations, Faintness, Fear of dying

most first panic attacks are diagnosed in ER, attacks are short lived

Dx : occur repeatedly, and proceed with at least a month of concern of it happening again, and/or dysfunctional behavior changes associated with attacks

Panic disorder unforseen characteristics

• Tends to develop in late adolescence and early adulthood

• Twice as likely to occur in women than men

• 50% more likely to appear in poor people than wealthier

• Often accompanied by agoraphobia

• Has same prevalence across various cultures and racial groups; attack features may differ

biological perspective/treatment of panic disorder

Antidepressants and anxiolytics are effective at preventing or reducing panic attacks. SNRIs, 80% feel better, require maintenance of drug

Cognitive perspective on panic disorder

theorists believe that panic-prone people have a high degree of anxiety sensitivity. cognitive therapy tries to correct people’s misinterpretations of their bodily sensations, teach coping skills. May require to go off medication

OCD

includes obsessions (thoughts that feel both intrusive and foreign that can’t be ignored or resisted which triggers anxiety) and compulsions (voluntary behaviors or mental acts that feel mandatory / unstoppable)

Most people find it comforting to follow set routines when they carry out everyday activities. Behaviors reduce anxiety and can turn into rituals, can be illogical, have common forms/themes (dirt, violence, cleaning, checking, counting, etc.)

DSM-5 symptoms of OCD

• Feel excessive or unreasonable

• Cause great distress

• Take up much time (1+ hr / day)

• Interfere with daily functions

• Can be one or the other, or both

Behavioral treatment of OCD

Exposure and response prevention (ERP):

• Exposure to fear, don’t let them engage in ritual

• Break association between obsession and compulsion

• Individual or group formats

• May involve self-help procedures in home settings

Cognitive treatment of OCD

psychoeducation (why you do what you do) guide client to identify, challenge, and change distorted cognitions with obsessions. realize irrationality and slim chances

OCD-related disorders

hoarding, trichotillomania, excoriation, body dysmorphia

Hoarding disorder

• Individuals feel compelled to save items and becomes distressed if they or someone else tries to discard them

• Keep things because you might have a use for it, when it’s unrealistic

• House can become unsafe

• Results in excessive accumulation of stuff

Trichotillomania (Hair-pulling disorder)

• Disorder in which people repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of their body

• Don’t always pull- fidget  until they break off

Excoriation disorder

• Disorder in which people repeatedly pick at skin

• Results in sores or wounds

Body dysmorphic disorder

• In when an individual has a belief that they have a certain defect or flaw in their appearance

• They think everybody’s looking at it

Trait anxiety

general level/baseline of arousal and anxiety day to day. seems to be genetic

State anxiety

how do you feel, what do you sense in a particular situation. How threatening individuals find a certain situation-based incident

Trait and state anxiety relationship

are interconnected, higher trait anxiety leads to higher state anxiety compared to someone with lower trait anxiety in the same situation

PTSD

when a person is exposed to some type of event they perceive as traumatic. During and immediately after trauma, high levels of arousal and upset may be temporarily experienced, or long lasting. symptoms may begin either shortly or months/years after the event

Acute stress disorder

symptoms begin immediately or soon after an event and last for less than 1 month. 80% move to PTSD

triggers for acute and PTSD

how prevalent the trauma is, how each person reacts (differences), combat, disasters, victimization, SA

what is more likely to cause PTSD?

combat

how did veterans contribute to research around PTSD?

was able to gather more information and was the foundation of treatments used today

Rape trauma symptoms

Continued anxiety, severe mood swings, sense of helplessness, persistent fear, depression, rage, difficulty sleeping - insomnia, nightmares-, eating difficulties, nausea, withdrawal, hypervigilance, reluctance to leave house, difficulty concentrating, sexual problems

behavioral theorist POV on DID

• Dissociation grows from normal memory processes and is a response learned through operant conditioning

• Dissociation is an escape behavior

Depersonalization

sense that one’s own mental functioning or body are unreal or detached

Doubling

 perception that you’re floating outside of your body and observing what’s going on

Derealization

a sense that one’s surroundings are unreal or detached

two key emotions in mood disorders

depression and mania

Depression

An individual that feels low, sad state where life seems dark, and its challenges seem overwhelming

Mania

State of euphoria or frenzied energy

major depressive episode symptoms

2 weeks, person experiences an increase in depressed mood and/or a decrease in enjoyment, considerable weight/appetite change, daily insomnia or hypersomnia, agitation, decrease in motor activity, fatigue, lethargy, feelings of worthlessness, excessive guilt, reduction in concentration or decisiveness, repeated focus on death or suicide, significant stress or impairment

Major Depressing disorder

• Presence of a major depressive episode

• No pattern of mania or hypomania

Persistent depressive disorder

• When a person experiences symptoms of major depressive disorder, or dysthymic disorder, for at least 2 years

  • During 2 year period, symptoms not absent for more than 2 months at a time

  • No history of mania or hypomania

  • Significant distress or impairment

5 main areas of affected functioning during depression

emotional (anxiety, anger), motivational symptoms (loss of desire, withdrawn, avoid engagement, consider or attempt suicide), behavioral symptoms (less activity, productivity), cognitive symptoms (hold negative views, blame themselves for everything), physical symptoms (headaches, dizziness, GI issues, general pain)

Major depressive disorder subtypes

Seasonal, catatonic, peripartum/postpartum, melancholic

seasonal (SAD) depression

Depressive symptoms appearing in the winter/colder months

catatonic depression

remains speechless or motionless

peripartum/postpartum depression

depression post delivery

melancholic depression

anhedonia or lack of mood reactivity (“I don’t care”)

Premenstrual dysphoric disorder

A diagnosis given to women who repeatedly experience clinically significant depressive symptoms during the week before menstruation

Disruptive mood dysregulation disorder

Characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper

biological treatments for unipolar depression

antidepressant drugs and brain stimulation

brain stimulation types

vagus nerve, transcranial, deep brain

vagus nerve stimulation

An implanted pulse generator sends electrical signals to the vagus nerve, which then delivers electrical signals to the brain. Likely to decrease depressive symptoms in many patients. Not a first line of treatment

Transcranial magnetic stimulation

Where you use a technique to stimulate the brain without the undesirable effects or electroconvulsive therapy. Using magnets to encourage neuroactivity, rewire, and direct. Has been shown to be effective in 2-4 weeks of daily treatments

depp brain stimulation

Somewhat related to the vagus nerve, however we are planting an electrode in the brain (Boardman's area 25). If we can stimulate particular parts of the brain, can we decrease symptomology of depression

electroconvulsive therapy

• One of the most controversial forms of treatment

• Targeted stimulation causes brain seizure

• Effective in unipolar treatment, especially severe depression with delusions 60-80% of patients

• Particularly effective with those who have severe depression

• 6-12 sessions, spaced out by 2-4 weeks

• Not sure why it works

behavioral treatment of unipolar depression

reintroduce clients to pleasurable activities and events every week in manageable steps, reinforce non-depressive behaviors, improve social skills

two components of state of stress

stressor, stress response

stressor

The event that creates some type of demand (do something differently)

stress response

how person responds to stressor, everyone reacts differently by how we judge the event and our capacity

threatening stressor

arousal and fear-evoking stimuli

coping

the ability to take stressors in stride and respond well