Abnormal Psych

Mowrer’s two-factor model

1. Classical conditioning: the phobic object/situation is associated with an unconditioned stimulus leading to a fear response

2. Operant conditioning: avoidance of the phobic object/ situation is negatively reinforced and prevents extinction

Behavioral Theory for Social Anxiety Disorder

Development of phobia:

A. Direct exposure- negative experience with the object/situation

B. Associative learning- having a panic attack in an elevator will associate elevator with fear.

C. observational/learning transfer: Learning fear by someone else’s fear or negative experience.

Behavioral treatment for Social Anxiety Disorder

Systematic desensitization: contract & relax

graduated exposure: creating a fear hierarchy to gradually be exposed to fear

Flooding: the thing you fear being present (not gradually)

Modeling: observing how someone else handles your phobia

Special case for blood-injury injection: Applied tension technique

Panic disorder

A. recurrent, unexpected panic attacks

B. for atleast 1 month following at least 1 panic attack, person experiences 1 or both of the following:

• concern or worry about additional attacks or their consequences

• significant change in behavior due to panic attacks

  • “fear of the marketplace”

  • actually the fear of the fear

    • phobic avoidance of the places that in which a panic attack is likely to occur

PTSD Criteria A

A. exposure to serious injury, sexual violence, or death in 1 or more of the following ways:

1. direct experience

2. in person witness as event occurs to others

3. Learning that event occured to close family member or friend (violent or accidental)

4. experiencing repeated exposure to these aversive events (military, police, first responders)

PTSD Criteria B

B. One or more Intrusion symptoms

1. repetitive, involuntary memories

2. reoccurring distressing dreams

3. Dissociative reactions (flashbacks)

4. Intense or prolonged distress to internal/external cues that resemble part of trauma

5. Physiological reactions to internal/external cues that resemble part of trauma

PTSD Criteria C

C. Avoidance of stimuli associated to event, evidence by 1 or more of the following:

1. Distressing memories, thoughts, and feelings of event

2. external reminders that arouse distressing memories, thoughts, and feelings of events

PTSD Criteria D

D. negative alterations in cognition or mood, as evidenced by 2 or more of:

1. Inability to remember aspect of event

2. Negative belief about self, others, or world

3. Inappropriate blame

4. Negative emotional state

5. Diminished interest in activities

6. feelings of detachment

7. Inability to experience positive emotions

PTSD Criteria E

E. Alterations in arousal and reactivity, as

evidenced by 2 or more of:

1. Irritable Behavior and angry outbursts

2. Reckless or self-destructive behavior

3. Hyper vigilance

4. Exagerrated startle

5. problems with concentration

6. Sleep disturbance

PTSD Criteria F

Criteria B,C,D,E met for 1 month

OCD Criteria A

Obsessions

1. Images, thoughts, or urges —> distress anxiety

2. ignore/supress—> neutralize with another thought

OCD Criteria B

Compulsions

1. Mental Acts or Repetitive behaviors —> rigid rules

2. Behaviors → decrease distress/anxiety, prevent dreaded event, → not connected to what trying to neutralize or clearly excessive

OCD Criteria C

C. Obsessions and compulsions are time consuming, cause distress/anxiety, or impair functioning

OCD Biological Treatment

1. Anafranil

2. SSRI

3. 5HT antagonist

4. Surgery (Singulotomy)

Body Dysmorphia

1. Preoccupation with perceived defects not observable to others

2. Repetitive behaviors or mental acts in response

3. Distress/anxiety (includes muscle Dysmorphia)

Hoarding Disorder

1. Difficulty discarding items

2. Saving items —> distress about discarding them

3. Accumulation of items —> clutter (if not, due to 3rd party)

4. Causes distress in social, interpersonal or occupational functioning

Symptoms of Schizophrenia

Delusions: Bizarre and strangely held beliefs despite significance evidence to contrary

Hallucinations: Bizarre sensory perceptions that do not exist in reality

Disorganized Speech: Problems w/ verbal communication

Grossly Disorganized or catatonic behavior: agitation

Negative symptoms: absence or insufficiency of normal behavior (flat affect, Avolition, Alogia, Anhedonia)

2 of above symptoms for atleast a month

Total course of disorder at least 6 months

Biological contributions of Schizophrenia

Dopamine hypothesis: proliferation of D2 receptors in striatum, underactivity of D1 receptors in prefrontal cortex

Glutamate hypothesis: Possibly NMDA receptor deficiency

Brain structure (large ventricules) and perinatal development

Biological treatment for Schizophrenia

1. Nueroleptics ( Thorazine)- blocks dopamine receptors

2. Antipsychotics (Clozaril)

3. Muscarinic agonists (Cobenfy)

4. ECT

Psychosocial Contributions

Schizophrenogenic family (mother) - cold, rejecting mother

Social drift hypothesis

severe mental illness leads to a decline in socioeconomic status

Cognitive- behavior theory for schizophrenia

thoughts influence behavior (interpretation)

beliefs are possibilities not facts

Schizophrenia Spectrum Disorders

Brief Psychotic disorder- at least one day, less than a month

Schizophreniform- about one month

Delusional disorder: eretomanic type, grandiose type, jealous type, persecutory type, and somatic type

Shared psychotic disorder- one person delusional → another

Schizoaffective Disorder- schizo + mood disorder

Panic Attack

A. increased fear or discomfort for which 4 of the following develop and reach a peak within 10 minutes

1. Palpations/Tachycardia

2. Fear of Dying

3. fear of losing control/ going crazy

4. feeling dizzy, unsteady, lightheaded

5. sweating

6. Shortness of breath

7. chest pain

8. choking feeling

9. chills or hot flashes

10. Nausea/ gastrointestinal issues

11. Trembling/ shaking

12. tingling/ numbness

13. derealization/ depersonalization

Parsons and Rizzo (2008)

Virtual reality Expsoure therapy is effective in reducing symptoms of anxiety and specific phobias

Hofmann et al., 2006

low dose (50 mg) of D-Cycloserine (DCS), a partial agonist at the NMDA receptor, significantly enhanced the effects of exposure therapy for Social Anxiety Disorder (SAD).

Mayo-Wilson et al. (2014)

individual Cognitive-Behavioral Therapy (CBT) had the largest effect size

(Foa et al., 2002)

exposure therapy is the most effective treatment for social anxiety and PTSD, its results can be significantly boosted by the drug D-Cycloserine, which helps the brain "unlearn" fear faster.

JAMA (2007) by Milliken et al.

mental health problems often increase significantly several months after soldiers return home.

Preti and Cella (2010)

Focused treatments (therapy, community care, and even fish oil) significantly lower the risk of "crossing the line" into full psychosis

Hamann et al

medical decision-making is often subjective.

Specific phobias criteria

A. Marked fear about a specific phobia/situation

B. Phobic/siituation almost always provokes fear

C. Phobic/situation is actively avoided

D. the anxiety is out of proportion to the actual danger the situation poses

E. The anxiety/fear lasts longer than 6 months

D. the anxiety causes significant distress/anxiety

Types of Specific phobias

Animal types

Natural type

Blood-injury injection type

Situational type

other types

Social Anxiety Disorder criteria

A. excessive fear of performance situation where the person may be exposed to possible scrutiny or unfamiliar people -fear of acting in an embarassing way

B. Provoke fear

C avoid

d 6 months

c significant distress

Biochemical Treatments for SAD

Benzos

Mao inhibitors

5HT agonists

SSRIs

Beta Blockers

Psychodynamic theory for SAD

poorly resolved Oedipus complex

Biological treatment for Panic disorder

Tricylcics

SSRIS

5HT agonists

Benzos

GAD Criteria

A. Persistent worry (6 month duration)

B. Worry is difficult to control

C. 3 or more of: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

Biological treatment for GAD

1. Benzos

2. Gabapentinoids

3. SSRI’s

4. 5HT agonists

Trauma and Stressor Disorders

Reactive Attachment Disorder: early neglect, avoidant

Disinhibited Social Engagement Disorder:early neglect, overly social

Adjustment Disorder: Distressed or "stuck" due to a specific event

Biological Treatment PTSD

SSRI

Atypical Antipsychotics

Beta Blockers

Behaviorial Theory for PTSD

PTSD- Two- factor model

Treatment: exposure (gradual)

Psychodynamic theory for PTSD

repression of traumatic event

Nothing is at it seems

Biological Theory for Hoarding Disorder

Genetics: 1st degree relatives 2x more likely

Caudate nucleus, overactive thalamus