CLP MODULE 2 STUDY GUIDE

Mood states relating to anxiety

• Generalized Anxiety Disorder (GAD): Characterized by excessive worry and tension, often accompanied by physical symptoms such as restlessness and fatigue.

• Panic Disorder: Involves recurrent panic attacks, leading to fear of future attacks and significant changes in behavior.

• Social Anxiety Disorder: Marked by intense fear or anxiety in social situations, which can hinder daily functioning.

What is anxiety and fear?

Anxiety: A mood state characterized by marked negative affect and bodily symptoms of tension in which a person apprehensively anticipates future danger or misfortune.

Fear: The emotion of an immediate alarm reaction to present danger or life-threatening emergencies.

Fear - activation, flight-or-flight, neurotransmitter

Perceived Threat → Fear → Amygdala → Fight-or-Flight

Fear activates the body's fight-or-flight response, preparing an individual to either confront or flee from the perceived threat.

Fear activates the amygdala, which signals the sympathetic nervous system to trigger the body's "fight-or-flight" response. This response prepares the body to either fight or flee from a threat

The primary neurotransmitter that activates during the "fight or flight" response is norepinephrine (noradrenaline), which is released alongside epinephrine (adrenaline)

What part of the brain is most associated with anxiety symptoms?

The part of the brain most associated with anxiety symptoms is the amygdala, a part of the limbic system, which plays a crucial role in processing emotions and fear responses.

Diathesis-stress model

The mood disorder stress model, also known as the diathesis-stress model, posits that mood disorders arise from an interaction between an individual's predisposition (diathesis) and environmental stressors.

Behavioral Inhibition System

Jeffrey Gray’s behavioral inhibition system is a brain circuit in the limbic system that responds to threat signals by inhibiting activity and causing anxiety.

The more primitive brain stem monitors and senses changes in bodily functions and relays these potential danger signals to higher cortical processes through the limbic system.

Generalized Anxiety Disorder - Prevalence

About twice as many individuals with GAD are female than male in epidemiological studies , which include people who do not necessarily seek treatment

In the United States, the prevalence of the disorder is significantly lower among Asian Americans, Hispanic, and Black adults compared to White adults (Grant et al., 2005).

GAD is quite prevalent among older adults in the United States. In the large national comorbidity study and its replication, GAD was found to be most common in the group over 45 years of age and least common in the youngest group, ages 15 to 24

Anxiety disorders - Comorbidity

Rate of Comorbidity: 55% to 76%

55% of the patients who received a principal diagnosis of an anxiety or depressive disorder had at least one additional anxiety or depressive disorder at the time of the assessment. This may be due to the shared vulnerabilities of these disorders.

Major depressive disorder - 50% of those diagnosed with anxiety

Specific Phobias - Agoraphobia, etc.

agoraphobia is characterized by an intense fear of being in situations where escape might be difficult or help unavailable in the event of a panic attack, often leading to avoidance of public spaces.

Blood–injection–injury phobia

Situational phobia

Natural environment phobia

Animal phobia

More Disorders - Separation anxiety and PTSD

Separation anxiety: Characterized by unrealistic and persistent worry that something will happen to self or loved ones when apart (e.g., kidnapping, accident) as well as anxiety about leaving loved ones

Post-Traumatic Stress Disorder: A mental health condition triggered by experiencing or witnessing a traumatic event, leading to symptoms such as flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event.

Illness Anxiety Disorder

Severe anxiety about the possibility of having or acquiring a serious disease, with actual symptoms being very mild or absent

Medical reassurance does not seem to help

Severe illness anxiety has a late age of onset, possibly because more physical health problems occur with aging

Often comorbid with anxiety and mood disorders

What’s the difference between panic disorder and PTSD?

Panic disorder involves recurrent and unexpected panic attacks, which are sudden periods of intense fear or discomfort that peak within minutes, while PTSD is specifically related to the aftermath of a traumatic experience and includes symptoms that can persist for months or years after the event.

What is OCD and its common obsessions and compulsions?

OCD is a disorder involving unwanted, persistent, intrusive thoughts and impulses, as well as repetitive actions intended to suppress them.

Symmetry obsessions: Accounts for most obsessions and involves keeping things in perfect order or doing something a specific way.

Forbidden obsessions: urges to harm self or others.

Cleaning/contamination obsessions: Fear or germs or contaminants.

Hoarding obsessions:

Somatic Symptom Disorder and its Prevalence

Somatic Symptom Disorder: Disorder involving extreme and long-lasting focus on multiple physical symptoms for which no medical cause is evident.

It is more likely to affect unmarried, low SES women

Hypochondriacs, Somatization, Body dysmorphic disorder

• Hypochondriasis: A condition where individuals are excessively worried about having a serious illness despite medical reassurance.

• Somatization: The process by which psychological distress is expressed as physical symptoms.

• Body Dysmorphic Disorder: A mental health condition characterized by an obsessive focus on perceived flaws in physical appearance.

Conversion, factitious disorders and la belle indifference

(Functional Neurological Disorder): A condition where patients experience neurological symptoms, such as paralysis or seizures, that cannot be explained by medical evaluation.

Factitious disorder: Nonexistent physical or psychological disorder deliberately faked for no apparent gain except possibly sympathy and attention.

Freud’s la belle indifference: a term used to describe a patient's lack of concern regarding their symptoms, often seen in conversion disorders.

What is the best way to treat conversion disorder?

If onset after a trauma, may need to process trauma or treat posttraumatic symptoms

Remove sources of secondary gain (any reinforcing or supportive consequences of the conversion symptoms)

Derealization-depersonalization disorder

Recurrent episodes in which a person has sensations of unreality of one’s own body or surroundings, such feelings of depersonalization are so severe they dominate the client’s life and prevent normal functioning.

Dissociative amnesia and dissociative fugue

Amnesia: A dissociative disorder featuring the inability to recall personal information, usually of a stressful or traumatic nature.

Fugue: Type of dissociative amnesia featuring sudden, unexpected travel away from home, along with an inability to recall the past, sometimes with assumption of a new identity.

Dissociative Identity Disorder and prevalence

Formerly known as multiple personality disorder; a disorder in which as many as 100 personalities or fragments of personalities coexist within one body and mind.

Prevalence is not well known, perhaps 1.5%, but more common in females

How do you know if someone’s faking DID?

Signs of feigned DID may include inconsistent or exaggerated symptoms, a lack of genuine amnesia for traumatic events, and the ability to recall personal information that the individual should not know. Additionally, individuals faking DID may display a dramatic change in personality that occurs too rapidly or fails to align with typical dissociative patterns.

Major depressive disorder - physical symptoms

can include fatigue, changes in appetite or weight, sleep disturbances, and psychomotor agitation or retardation. These symptoms often overlap with emotional symptoms, such as persistent sadness or loss of interest in activities.

Major depressive, manic, and hypomanic episodes

Extremely depressed mood and lack of pleasure for more than two weeks

Extremely elevated mood for more than one week

Hypomanic episodes resemble manic episodes but are less severe and have a shorter duration.

Dysphoria

Dysphoria is a state of profound unease, dissatisfaction, or low mood.

Persistent Depressive Disorder

At least two years of depressive symptoms with a depressed mood most of the day on more than 50% of days, with no more than two months symptom free.

Postpartum depression: another name

Another name for those experiencing postpartum depression is the "baby blues," which refers to the emotional fluctuations and mood changes that many women experience after giving birth.

Catatonia

A state marked by a lack of movement, response, or communication, often associated with severe mental disorders such as schizophrenia.

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD): A mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring during the winter.

Increased production of melatonin may cause depression in vulnerable people.

Bipolar I vs. Bipolar II disorders and cyclothymic disorder

Bipolar I disorder: Alternations between major depressive episodes and manic episodes

Bipolar II disorder: Alternations between major depressive episodes and hypomanic episodes

Cyclothymic disorder: Alternations between less severe depressive and hypomanic periods

Bipolar disorder: suicide rates

15-20% of people with bipolar disorder die by suicide.

30-60% attempt suicide at least once in their lifetime.

The risk of suicide is highest during manic or depressive episode.

Rapid cycling

An individual with bipolar disorder who experiences at least four manic or depressive episodes within a year is considered to have a rapid-cycling pattern, which appears to be a severe variety of bipolar disorder that does not respond well to standard treatments

Treatment for mood disorders

SSRIS

Tricyclic antidepressants

Monoamine oxidase inhibitors

Aaron Beck and his contribution

Dr. Aaron Beck is globally recognized as the father of Cognitive Behavior Therapy (CBT) and is one of the world's leading researchers in psychopathology.

Bipolar disorder - treatment and medication

Lithium carbonate

Treatment of choice for bipolar disorder

Considered a mood stabilizer* because it treats depressive and manic symptoms

Anticonvulsants and calcium channel blockers may be used if lithium not effective

Electroconvulsive therapy* effective for severe medication-resistant depression

Brief electrical current applied to the brain leading to seizure

Electroconvulsive therapy: A treatment option involving the induction of controlled seizures to alleviate severe psychiatric symptoms, particularly in cases where other treatments have failed.

Suicide

Tenth leading cause of death in the US

More prevalent among white and native Americans

Those 65 and older

More recent adolescent suicides have occurred

Men complete suicide more than women due to using more lethal methods, but women attempt suicide more

Individuals with borderline personality disorder are the most likely to commit suicide on impulse with 10% doing so by mistake