Abnormal Psych Exam 3

DSM5 for Major Depressive Episode

depressed mood*, anhedonia*, increase or decrease in appetite/weight, hypersomnia, insomnia, psychomotor retardation/agitation, fatigue, worthlessness/guilt, problems concentrating, and reoccurring thoughts of death/suicide.

PDD with MDE vs PDD

PDD with MDE has 2+ years of depressed mood, while PDD is 2+ years of depressed mood but with allows two months recovery into normal mood.

PDD vs MDD

Longer lasting and less severe than MDD

Gender Differences in MDD

twice as common in women than men, differences appear at puberty

Age Differences in MDD

highest in ages 15-29, and 85+. Lowest in ages 65+

Neurotransmitters in depression

serotonin, NE, and dopamine

Serotonin Transport Gene

Abnormalities in the gene impact mood stability. Having two short alleles is related to higher likeliness of MDD

Brain Function in Depression

Chronic hyperactivity of HPA axis and elevated cortisol

Medication types in Depression

SSRIs, SSNRIs (stimulating side effects) , MAOIs, and tricyclic antidepressants

Side effects of MAOIs used for depression

fatal interactions and liver damage

Behavioral Activation in Depression

Generating activities in line with correct values and tracking behaviors/mood

Cognitive Restructuring (CBT) in Depression

restructuring of thinking errors through challenging thoughts and generating rational responses.

Cognitive errors in depression

black and white thinking, fortune-telling, mind-reading, and discounting the positive.

DSM5 Criteria for Bipolar I

marked impairment/hospitalization + at least 7 day manic episode

DSM5 Criteria for Bipolar II

No marked impairment/hospitalization/psychosis + subthreshold symptoms of MDE+ more than half the time for at least 2 years

DSM5 Criteria for Cyclothymia

symptoms of hypomanic episode + subthreshold symptoms of MDE + more than half the time for at least 2 years

Mania

7+ days; marked impairment, hospitalization, and psychosis

Hypomania

4-6 days; no marked impairment

Symptoms of mania/hypomania

grandiosity, reduced need for sleep, talkativeness, racing thoughts, distractibility, goal-directed activity, impulsive/risky behavior

Course of Bipolar I

(1 in 100) 90% have 2+ mood episodes; 60% of episodes followed by MDE

Course of Bipolar II

(1 in 200) Starts with MDD diagnosis then change in diagnosis to Bipolar I

Demographics of Bipolar

No gender differences or prevalence by race/ethnicity. Sexual orientation minorities at higher risk./

Suicide risk and Bipolar

25-50% have lifetime history of suicide attempt; accounts for ¼ of suicides and often happens during depressive state.

Brain Differences in Bipolar

Larger and more active amygdala, smaller and less active prefrontal cortex, and dysfunction of dopamine.

Meds helpful for manic/depressive symptoms in bipolar

Mood stabilizers

atypical antipsychotics (psychotic-like symptoms of mania)

anticonvulsants (not as helpful for depressive symptoms)

Psychological factors in Bipolar

stressful life events and changes in social rhythms= triggers new episodes

greater sensitivity to rewards

Interpersonal and Social Rhythm Therapy

combines interpersonal and behavioral techniques to maintain regular routines and stability in personal relationships for people with bipolar.

Family-Focused Therapy

goal to reduce interpersonal stress by including family in therapy and using psychoeducation and communication traning.

Depressants

Alcohol, benzodiazepines and barbiturate

stimulants

cocaine, nicotine, caffeine and amphetamines

Opioids

morphine, heroin, codeine, meth, and fentanyl

Hallucinogens

LSD, peyote, PCP, and molly

Inhalants

solvents, nitrites, and medical anesthetic gas

All drug classes

depressants, cannabis, stimulants, opioids, hallucinogens, and inhalants.

Stage 1 Alcohol Withdrawal

hangover, weakness, nausea

Stage 2 Alcohol Withdrawal

convulsive seizures

Stage 3 Alcohol Withdrawal

delirium tremens, delusions, fever, agitation, irregular heartbeat

Stimulants on CNS

Activates CNS- increases blood pressure and heart rate

Increased risk of heart attack & seizures

blocks dopamine reuptake, affects levels of NE and serotonin

Alcohol on CNS

slows CNS activity

Increased GABA activity

dysregulation of serotonin

Opioids Low Dose

euphoria, lethargy, slurred speech, and sense of warmth

Opioids High Dose

coma, seizures, unconsciousness, reduced cardiovascular function

Opioids Withdrawal

dysphoria, anxiety, agitation, and vomiting/diarrhea.

Insula

Implicated in drug cravings

How many symptoms need for be present for Substance Abuse Disorder

2+ symptoms for 12 months

Marijuana High Dose

Hallucinogenic effects, perceptual distortions, depersonalization, and paranoia

Hallucinogens Effects

perceptual changes, sense of clarity/connectedness, euphoria, and sometimes anxiety/paranoia

Marijuana Withdrawal

anxiety, sweating, loss of appetite, and hot flashes

Mesolimbic Pathway and Nucleus Accumbens

dopaminergic pathway

Antabuse

Antagonist that makes substance uncomfortable to consume

Opioid Antagonist

reducing reinforcement properties

Nicotine Replacement

Antagonist- Reduces withdrawal effects

Motivational Interviewing

client centered style for eliciting behavior change by helping clients explore & resolve ambivalence. Client makes own reasons to change or not.