Psychopathology Exam 2 Review

Anxiety

Bodies response to a vague sense of being in danger, Most common mental disorder in the United States.

Prevalence of anxiety

19% of the adult US population experiences one anxiety disorder. Onset around 11 years old, equally distributed among all races, frequent comorbidity issues.

Generalized anxiety disorder

For 6 months or more a person experiences disproportionate, uncontrollable, and ongoing anxiety and worry about multiple matters. Usually first appears in childhood or adolescence, women diagnosed more than men (2

GAD sociocultural perspective

Develops in people who face ongoing, dangerous societal conditions, who live in poverty, who face discrimination, low income, and reduced job opportunities (race).

GAD psychodynamic perspective

Childhood anxiety goes unresolved (Freud), conflict between the id and ego, use of defense mechanisms result in anxiety, may be traced to inadequacies in early parent-child relationships.

GAD Psychodynamic Tx

Free association, transference, resistance, and dreams. Object relations therapists help patients identify and settle early relationship problems.

GAD cognitive perspective

Maladaptive assumptions, Albert ellis- people are guided by irrational beliefs that lead to inappropriate actions and reactions. Aaron beck- people with GAD hold silent maladaptive thoughts. Adrian wells- individuals worry about worrying.

GAD Cognitive Tx

Recognize their inclination to worry, Albert ellis- rational emotive therapy. Beck- recognize maladaptive streams of thoughts, and to accept these as mind events and replace them with adaptive thoughts and more constructive ways of coping. Mindfulness based acceptance therapy.

GAD biological perspective

Genetics- bio relatives 15% increase in likelihood. GABA inactivity- malfunction in feedback system. Brain structure- amygdala, prefrontal cortex, and anterior cingulate cortex.

GAD Biological Tx

Anxiety drug therapy, early 1950s sedative anxiety drugs, late 1950s benzodiazepines used to mimic GABA, recently added antidepressants, and antipsychotic medication. Relaxation training, physical relaxation best when used in combination with cognitive therapy or biofeedback.

Specific phobias

Marked, persistent, and disproportionate fear of a particular object or situation, usually lasting at least 6 months. fear is produced by exposure to object, avoidance of the feared situation, causes significant distress or impairment.

Phobia etiology & Tx

Phobias develop through classical conditioning - little Albert, and modeling - Bandura. Exposure treatments- systematic desensitization (joseph wolpe) & in vivo desensitization. Other treatments- flooding and modeling. Key to success is actual contact with the feared object or situation, virtual reality has been used in recent years.

Agoraphobia

Avoid crowded places, driving and public transportation. Many are prone to panic attacks, and may receive a second diagnosis of panic disorder.

Agoraphobia Tx

Exposure approach is the most common and effective treatment, about 60-80% of clients have some success.

Social anxiety

Pronounced, disproportionate, and repeated anxiety about social situations, in which individuals could be exposed to scrutiny by others, lasts 6 months or more. Fear of being negatively evaluated, anxiety produced by exposure to the social situation, avoidance of feared situations, causes significant distress or impairment.

Social anxiety etiology

People with this disorder hold a group of social beliefs and expectations that consistently work against them.

Social anxiety Tx

Antidepressants, exposure therapy, cognitive therapies, and social skills training.

Panic disorder

Unforeseen panic attacks occur repeatedly. A least a month of continuous concern about having additional attacks, and at least a month of dysfunctional behavior changes associated with the attacks.

Panic disorder prevalence & onset

Same prevalence among all races, late adolescence and early adulthood, twice as likely to occur in women, 50% more likely to appear in poor people, often accompanied by agorphobia.

Panic disorder biological perspective & Tx

Abnormal norepinephrine, brain circuits and the amygdala as the root of the problem may also be predispositions in these areas. Antidepressants are effective at preventing or reducing panic attacks, improvement to 80% of patients, benzodiazepines (especially xanax) have also proved helpful.

Panic disorder cognitive perspective & Tx

Panic prone people have a high degree of anxiety sensitivity. Cognitive therapy tries to correct people's misinterpretations of their bodily sensations.

Obsessive-compulsive disorder

Occurrence of repeated obsessions, compulsions or both, obsession or compulsions take up significant time, causes significant distress or impairment.

Obsessions

Thoughts that feel both intrusive and foreign, attempts to ignore or resist them trigger anxiety.

Compulsions

Voluntary behaviors or mental acts feel mandatory/unstoppable, behaviors reduce anxiety, behaviors often develop into rituals.

Hoarding disorder

Save items and become very distressed if they try to discard them, resulting in an excessive accumulation of items.

Trichotillomania

Hair pulling disorder, pull hair out from scalp, eyebrow, eyelashes, or other parts of the body.

Excoriation

Pick at their skin resulting in significant sores or wounds.

Body Dysmorphia

Believe that they have certain defects or flaws in their physical appearance, defects or flaws are imagined or greatly exaggerated.

OCD psychodynamic perspective & therapies

Played out in overt thoughts and actions, related to the anal stage of development. Therapies seek to uncover and overcome underlying conflict and defenses, use free association and interpretation, and have little research support.

OCD behavioral perspective & therapy

Concentrates of treating and explaining compulsions rather than obsessions. Stanley Rachman - compulsions do appear to be rewarded by an eventual decrease in anxiety. Therapy - exposure and response prevention, exposes a client to anxiety arousing thoughts or situations and then prevents the client from performing his or her compulsive acts.

OCD cognitive perspective & therapy

Theorists believe that everyone has repetitive, unwanted, and intrusive thoughts. Suggests that people with OCD blame themselves for normal thoughts and expect that terrible things will happen as a result. Therapy - psychoeducation, guide the client to identify, challenge, and change distorted cognitions, research suggest that a combination of cognitive and behavioral models is more effective than either intervention alone.

OCD biological perspective and therapies

Abnormal serotonin activity, abnormal brain structures and functioning. Linked to the orbitofrontal cortex, caudate nuclei, thalamus, amygdala, and cingulate cortex structures may be too active in people with disorder. Therapies - serotonin based antidepressants, bring improvement to 50-80% of those with OCD.

Acute stress disorder

Symptoms begin within 4 weeks and last for less than one month.

Posttraumatic stress disorder (PTSD)

Exposed to a traumatic event, a person experiences at least one of the following symptoms; distressing memories, trauma linked dreams, flashbacks, trauma linked cues, physical reactions when reminded of the events. May begin either shortly after the event or months or years afterward and last longer than one month. Significant distress or impairment.

Acute and PTSD prevalence, onset & etiology

After trauma around 20% of women and 8% of men develop disorders. Women to men is 2

Acute & PTSD Tx

Drug therapy, flooding, virtual reality therapy, eye movement desensitization and reprocessing (EMDR), couple, family, or group therapy; rap groups. About half of all PTSD cases improve within 6 months.

Dissociative amnesia

Person cannot recall important life-related information, typically traumatic or stressful information, significant distress or impairment, symptoms are not caused by a substance or medical condition.

Dissociative fugue

Extreme version, personal identities and details of their past are forgotten and fleeing to entirely different locations occurs.

Dissociative identity disorder

Disruption to his or her identity, at least two separate personality states or experiences of possession, one subpersonality usually dominates, transition is usually abrupt (switching), unique set of memories, behaviors, thoughts, and emotion for each, repeatedly experiences memory gaps, distress or impairment, symptoms are not caused by a substance or medical condition.

DID onset & prevalence

First reported almost three centuries ago, first diagnosed in late adolescence or early adulthood, women are diagnosed 3x as often as men, and the number of people diagnosed is increasing.

Dissociative amnesia and DID Psychodynamic view

Dissociative amnesia is a single disorder of massive repression. DID is thought to result from a lifetime of excessive repression, motivated by very traumatic childhood events.

Dissociative amnesia and DID behavioral view

Dissociation grows from normal memory processes and is a response learned through operant conditioning, dissociation is an escape behavior. Self hypnosis, hypnosis can help people remember and forget facts, events, and their personal identity.

Dissociative amnesia and DID Tx

Dissociative amnesia - psychodynamic therapy, hypnotic therapy. DID - recognizing the disorder, recovering lost memories, integrating the subpersonalities-fusion.

Depersonalization

Sense that one's own mental functioning or body are unreal or detached.

Derealization

Sense that one's surroundings are unreal or detached.

Depersonalization-Derealization disorder prevalence & onset

The disorder occurs most frequently in adolescents and young adults, comes on suddenly and tends to be long lasting.

Depression

Low, sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms.

Mania

State or episode of euphoric or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking.

Depressive disorders

Group of disorders marked by unipolar depression.

Unipolar depression

Depression without history of mania.

Bipolar disorder

Disorder marked by alternating or intermixed periods of mania and depression.

Major depressive episode

2 week period, displays depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day. for the same two weeks person also experiences at least three or four of the following symptoms, weight change or appetite change, insomnia or hypersomnia, agitation or decrease in motor activity, fatigue or lethargy, feelings of worthlessness or excessive guilt, reduction in concentration or decisiveness, focus on death or suicide, suicide plan or attempt.

Major depressive disorder

Presence of major depressive episode, no pattern of mania or hypomania.

Persistent depressive disorder

A person experiences major depressive symptoms for at least 2 years.

Premenstrual dysphoric disorder

occurs during the week before menstruation.

Disruptive mood dysregulation disorders

Combo of persistent depressive symptoms and recurrent outbursts of severe temper, child and adolescent disorder.

Mood disorder prevalence, onset & course

MDD- 8%, female to male 2

Unipolar depression biological etiology

Genetic, immune system, anatomical, biochemical.

Unipolar depression psychological etiology

Cognitive- learned helplessness, negative thinking. Psychodynamic- symbolic or imagined loss. Behavioral- rewards.

Unipolar depression sociocultural etiology

Multicultural- rewards, variety of theories offered. Family-social- symbolic or imagined loss.

Postpartum depression

For between 10-30% of new mothers, the weeks and months after childbirth bring clinical depression. Symptoms may last a year or more.

Unipolar depression biological Tx

Electroconvulsive therapy (ECT) targeted electrical stimulation causes brain seizures. Brain stimulation, vagus nerve stimulation, deep brain stimulation. Transcranial magnetic stimulation (TMS), increases neuron activity in the prefrontal cortex.

Unipolar depression meds

1950s- MAO inhibitors and tricyclics. In recent years- second generation antidepressants, SSRIs & SNRIs, ketamine based.

Psychodynamic treatment

Free association, therapist interpretation, review of past events and feelings

Behavioral treatment

Behavioral therapists use a variety of strategies to help increase the number of rewards experienced by their clients. Reintroduce clients to pleasurable activities and events, often using a weekly schedule, appropriately reinforce their depressive and nondepressive behaviors, help them improve their social skills.

Cognitive treatment

High correlation between the level of depression and the number of maladaptive attitudes, errors in logic are seen in people with depression, automatic thinking

has been linked to depression.

Beck’s cognitive therapy

CBT- Includes a number of behavioral techniques. It is designed to help clients recognize and change their negative cognitive processes.

Manic episode

For 1 week or more a person displays abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most every day. At least three of the following symptoms, grandiosity or overblown self esteem, reduced sleep need, increased talkativeness, rapidly shifting ideas, attention pulled in many directions, heightened activity, exercise pursuit of risky and potentially problematic behaviors.

Bipolar I disorder

Occurrence of a manic episode, hypomanic or major depressive episodes may follow the mani episode.

Bipolar II disorder

Presence or history of major depressive episode, presence or history of hypomanic episode, no history of manic episode.

Mood disorder prevalence and onset bipolar disorder

Between 1 to 2.8% of all adults in the world suffer from bipolar disorder, equally common in men and women, common among people with low incomes, usually occurs between the ages of 15-44.

Bipolar disorders biological etiology

Ion activity, genetic, anatomical, biochemical.

Bipolar disorders biological Tx

in the 1970’s use of lithium was approved followed by introduction of mood stabilizing drugs. Significant body or research to the effectiveness of lithium and other mood stabilizers. Provides improvement for 60% of patients with mania.

Bipolar disorder Tx psychotherapy

Both therapy and meds are needed, clinicians often use psychotherapy as adjunct to lithium or other medication based therapy. Focuses on medication management, social skills, and relationship issues. Research suggests that it helps reduce hospitalization, improves social functioning, and increases clients ability to obtain and hold a job.

Suicide

Self inflicted death.

Statistics

Suicide is one of the leading causes of death in the world. 48,000 suicides per year in the US estimated 1 million worldwide deaths yearly.

Parasuicide

Superficial cutting and OD on non lethal meds, suicide ideation. Thoughts of suicide, passive- wish to be dead without a plan. Active- thoughts and includes detailed plan.

Suicide Dx

Sucidal behavior disorder (no diognostic yet). Subintentional death indirect, covert, partial, or unconscious. Non-sucidal self injury (NSSI) studied for future DSM-5 diagnosis.

Risk factors

Degree of religious devoutness, age differences in western society the elderly are more likely to commit suicide than people in any other age group, social environment and marital status, gender differences women have more attempts while men have more compilation rates, race highest rates among white and american native indians, family history generations have committed suicide, psychiatric illness 90% of attempted suicides had a mental illness 70% with major depression and approximately 50% with bipolar disorder, biological factors low levels of serotonin, impulsivity and pathological aggression.

What trigger suicide?

Stressful events, mood and thought changes, alcohol and other drugs (70% who attempted suicide drink alcohol), mental disorders (severe depression, substance use, schizophrenia, and modeling).

Etiology suicide sociocultural view

How attached a person is to social groups.

Etiology suicide psychodynamic view

Depression and anger at other that is redirected toward oneself. Freud- self hatred, based on experiences of loss, either real or imagined.

Etiology suicide biological view

Higher rates of suicide among the parents and close relatives, low serotonin levels.

Suicide Tx

Medical care, drug therapy, psychological intervention, and psychiatric follow up care.

Suicide prevention

24 hour a day telephone services, crisis intervention although longer term therapy is needed for most, limit the publics access to common means of suicide.