Exam 3 Study Guide!
Exam 3 Study Guide! CLP4143
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This 15 page Bundle was uploaded by Julia Marcinak on Saturday October 31, 2015. The Bundle belongs to CLP4143 at Florida State University taught by Jesse Cougle in Summer 2015. Since its upload, it has received 58 views. For similar materials see Abnormal Psychology in Psychlogy at Florida State University.
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Date Created: 10/31/15
Test 3 Study Guide Ch 7 & 11 Depression: 1. Major Depression a. Episodes Include five or more of the following during a two week period i. Depressed mood for most of the day, nearly everyday (Either feeling sad or empty) ii. Anhedonia: diminished interest or pleasure in all activities iii. Significant weight loss/gain or change in appetite iv. Insomnia or hypersomnia v. Psychomotor agitation or retardation vi. Fatigue or loss of energy vii. Feeling of worthlessness or excessive/inappropriate guilt viii. Diminished ability to think or concentrate or indecisiveness ix. Recurrent thoughts of death, suicidal ideation, attempted suicide or suicide plan b. Major depressive episodes are a change in a person's normal mood, social, occupational, educational and other important functioning. The person is negatively impaired. It causes significant social, academic and occupational impairment. It can impair judgement c. Features i. Affective 1. Depression 2. Anxiety 3. Guilt 4. Anger, hostility and irritability ii. Behavioral 1. Agitation 2. Facial Expression 3. Psychomotor retardation 4. Retardation of speech and thought 5. Crying iii. Attitude Toward Self 1. Selfreproach 2. Low selfesteem 3. Feelings of helplessness and pessimism 4. Hopelessness 5. Thoughts of death/suicide attempt iv. Cognitive Impairment 1. Decreased ability to think or concentrate v. Physiological Changes 1. Loss of appetite 2. Sleep disturbance 3. Loss of energy 4. Decreased libido 5. Inability to experience pleasure d. Core Features: i. Physical Functions: Fatigue, sleeping, eating and sexual problems, issues with overall health ii. Social Functions: Problems with family and friends, dependant behavior iii. Negative Emotion: Depressed mood, anxiety, anger, guilt iv. Intellectual Functioning: Distractibility, apathy, forgetfulness, impaired executive functioning, personal neglect, slow psychomotor functioning e. Diagnostic Criteria i. The presence of major depressive episodes ii. Symptoms are not better accounted for by another disease iii. There have never been manic or hypomanic episodes (other than substance related one's) f. Specifiers i. Severity 1. Mild: 23 symptoms are present, the patient is distressed but should be able to continue with activities 2. Moderate: 4 or more symptoms are present and the person has difficulty continuing with everyday activities 3. Severe: Several symptoms are present and distressing. Need for institutional care, phobias, panic attacks, alcohol and/or drug abuse may be present. Suicidal actions are common ii. Anxious Distress: Restlessness, tension, worry iii. Mixed Features: Manic/Hypomanic features iv. Melancholic Features: Severe anhedonia or physical features v. Psychotic Features: Delusions and hallucinations vi. Catatonic Features: Lack of movement, disturbance in speech, not reacting to environment vii. Atypical Features: Assortment of odd symptoms that are not typical to major depressive disorder viii. Peripartum Onset: Occurs during pregnancy or within 4 weeks of pregnancy ix. Seasonal Patterns: Recurrent pattern during certain times of the year (SAD) x. 15% commit suicide, 60% of those over 55 commit suicide g. Course: Generally starts in mid20’s. Once you have a first episode there is a 60% chance of a second episode. The more episodes, the more likely you are to have another episode. h. Treatments: i. Pharmacotherapy: 1. About 60% respond to SSRI’s but only 4555% recover ii. Electrocompulsive Therapy 1. 55% go into remission but relapse rates are very high iii. Psychotherapy: 1. 2025% go into remission, the relapse rate is also high 2. Persistent Depressive Disorder (Dysthymia) a. Diagnostic Criteria i. Depressed mood for most of the day for 2+ years (1 year for children) ii. More than 2 of the following 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Low energy or fatigue 4. Low selfesteem 5. Poor concentration or difficulty decision making 6. Feelings of hopelessness iii. Never without A or B for more than a two month period within the two years iv. Criteria for major depressive disorder may be present for 2+ years v. No manic or hypomanic episodes vi. Does not occur exclusively during other disorders vii. Not related to substance abuse or other medical disorders viii. Causes Impairment 3. Double Depression 4. Prevalence of Mood Disorders a. Major Depressive Disorder: 16.6% i. Recent studies claim up to 41.4% of people have experienced depression b. Bipolar: 3.9% c. Dysthymia: 2.5% d. Any Mood disorder: 20.8% 5. Demographic Trends: a. Women are 2x as likely to experience mild and severe depression than men i. Differences appear during puberty ii. Could be because of higher rate of sexual abuse in women, selfconcept, coping styles, sociocultural strains and differences in functioning of the HPA axis b. Rate of depression in elderly is less than half of the general population c. Depression rates have increased across generations d. Rates are lower among blacks e. Enviormental factors: i. ¾ of depressed people have experienced a negative event before the depression started ii. Only 1 in 5 people that experience a negative event develop depression 6. Risk Factors a. Low self esteem b. Low social support c. Ruminative response style d. Physical/Emotional illness e. Previous episodes of depression f. Heredity g. People are more likely to recall negative events and attend to negative information once a sad mood has been induced 7. Interpersonal Therapy a. Disturbances in people's roles in their close relationships are the main causes of depression b. Maladaptive “ifthen” rules c. Excessive Reassurance seeking d. Interpersonal Sources of Depression: i. Grief/Loss: Help the client accept feelings and evaluate the relationship with the lost person. Help the client develop new relationships ii. Interpersonal Role Disputes: Help client compromise and communicate iii. Role Transitions: Help client be more realistic about roles that are lost and embrace new roles iv. Interpersonal Skills Deficit: Help client review past relationships , understand how they affect current relationships and teach social skills 8. Learned Helplessness a. If a negative event is uncontrollable we become depressed b. Seligman’s experiment with shocking dogs c. The type of event that most commonly leads to depression d. Depression results from frequent, chronic, uncontrollable events e. Believing in helplessness leads to reduced motivation, reduced actions in controlling environment, inability to learn how to control situations that are controllable. 9. Cognitive Therapy: a. Individual, short term, clientcentered therapy session b. Cognitive Theory: People who are depressed have negative thoughts which lead them to interpret their situations negatively i. Cognitive triad: Negative views of self, world and future c. Cognitive Techniques: i. Identify negative, automatic thoughts ii. Challenge negative thoughts iii. Identify core concerns iv. Automatic thoughts, thinking errors (Labeling, mindreading, allornothing) v. Goals are to change negative thinking d. Behavioral Techniques: i. Monitor activities throughout the week ii. Assign activities that give a sense of pleasure/mastery iii. Goals are to increase positive activities, develop skills and solve problems iv. Strategies: 1. Selfmonitoring mood, daily activities and routines 2. Identify activities that give sense of pleasure or mastery 3. Schedule these activities v. This is more effective for severe depression than CT 10. Biological Approaches a. Focuses on neurotransmitter system i. Lower serotonin levels in depression, b. Treatment with SSRI’s but has many side effects, very effective short term but CBT is better have discontinuation Bipolar 1. Bipolar Mood Episodes: a. Includes major depressive episodes, manic episodes, hypomanic episodes b. Prevalence: i. 12% of population ii. Men and women are equally affected iii. Usually developed in late adolescence or early adulthood iv. Chronic course v. Average experience symptoms 47% of time, mainly depressive. c. Suicide: i. 2550% report an attempted suicide ii. 19% die from suicide iii. Accounts for 25% of all suicides d. Genetics i. More genetic variability than depression ii. Concordance rate: 1. Bipolar: 67% MZ 19% DZ 2. Depression: 46% MZ 20% DZ e. Impact of Negative events i. Patients are 4.53 times more likely to relapse after a serious event, the rate of recovery is much lower for those who experienced a negative event during an episode f. Mixed episodes alternate between depressive and manic moods in the same day/week g. Causes significant academic, occupational and social impairment 2. Manic Episodes a. A distinct period of elevated, expansive or irritable mood and increased energy/activity lasting 1+ week (unless hospitalized) b. Includes at least 3 of the following i. Inflated selfesteem and grandiosity ii. Decreased need for sleep iii. Talkative or pressured speech iv. Racing thoughts v. Distractibility vi. Increased goal directed activity or psychomotor agitation vii. Excessive involvement in pleasurable activities that have a high potential for painful consequences (buying sprees, sexual indiscretions) c. Impairment, hospitalization or psychotic features d. Not due to substance abuse e. Generally deny that there is a problem 3. Hypomanic episodes a. A distinct period of elevated, expansive or irritable mood and increased energy/activity lasting 4+ days and different from usual mood b. Includes at least 3 of the same symptoms of a manic episodes c. Change in functioning that is not characteristic to that person d. Observable by others e. NOT severe enough to cause hospitalization f. Not due to substance abuse 4. Bipolar 1 Disorder a. 1+ Manic episode b. Depressive episodes frequently occur but are not necessary for diagnosis c. Not better accounted for by another disorder d. Typically becomes more frequent and severe over lifetime e. Bipolar 1 has more severe manic episodes and less frequent/severe depressive episodes 5. Bipolar 2 Disorder a. Episodes of major depression that alternate with hypomanic episodes (less severe than manic) b. No manic episodes, only hypomanic c. Are generally depressed for longer periods of time d. Bipolar 1 has less severe hypomanic episodes and longer more severe depressive episodes 6. Cyclothymic Disorder a. 2+ years of numerous hypomanic symptoms and depressive symptoms (do not meet criteria for major depressive or hypomanic episodes) b. No more than 2 months without symptoms c. Criteria for MDE, manic or hypomanic episodes have never been met d. Not due to another disorder or substance abuse e. Causes impairment and distress f. Goes through similar phases of highs and lows but they are not severe enough to be classified as manic or depressive 7. Treatments a. Can not be cured but treatment can make moods more stable b. Psychoparmancy i. Lithium or alternative mood stabilizers are used to reduce the risk of cycling 1. They have a slight antidepressive effect ii. 3050% respond to this iii. Antidepressants are added if depressive episodes don’t respond to mood stabilizers iv. Deals with the biological aspect v. Medication is important to stabilize mood and keep symptoms under control, it generally is not enough on it’s own though c. Psychotherapy i. Is necessary for learning what the symptoms are and how to deal with them ii. Helps repair relationships, cope with stress, and regulate your mood d. Education and Lifestyle Management i. It is important to be educated about the symptoms and effects of your disease ii. It is easier to prevent complications if you know what they are and what causes them iii. By carefully regulating your lifestyle, it is easier to control symptoms, this includes regulating sleep, avoiding drugs and alcohol, exercise, keeping sunlight exposure regular year round and minimizing stress e. Family/Social Support i. Affective Style: Direct interaction with the patient ii. Expressed Emotion: The emotions expressed while discusses the person with the disorder. Being critical or overly emotionally involved leads to a higher chance of relapse Suicide 1. Suicide a. CDC is a death, injury, poisoning or suffocation that is selfinflicted and intended to kill themselves b. There is less than one suicide for every 25 attempted suicide, ½ of those who attempt never seek help after c. In the U.S. 88 people commit suicide a day which is 32,000 a year. Worldwide about a million every year which is 1 every 40 seconds d. Majority who contemplate do not commit, only ¼ leave notes e. Gender Differences: i. Females are 3x more likely to attempt ii. Males are 4x more likely to complete 1. Men are more likely to shoot, hang and stab themselves as well as drink alcohol, which impairs judgment and lowers inhibitions f. Enviormental Factors i. Race 1. White males account for almost 70% of suicides 2. American indians and alaskan natives have the second highest rate 3. Blacks, hispanics and asians have lowest rates ii. Age 1. Highest between 4565 and those over 85 years 2. About 10% for ages 1524 iii. Geographic location: 1. Highest in Alaska and Montana 2. Lowest in New York and New Jersey g. Methods i. Firearm is the most common route (over 50%) ii. Suffocation (including hanging is next) h. Toxicology i. ⅓ had alcohol ii. 16% had opties iii. 9.4% had cocaine iv. 7.7% had marijuana v. 3.9% had meth i. Risk Factors i. Mental Illness: 95% had at least one psychological illness 1. Depression 2. Bipolar 3. Anxiety 4. PTSD 5. Borderline Personality disorder 6. Anorexia ii. Rates are lower among african americans iii. Elderly are at a higher risk, elderly men have highest rate (60+ years) iv. Single people are more likely to die by suicide 2. Suicide Clusters and Contagion a. Suicide Clusters i. 2 or more nonrandom bunches of suicide attempts ii. Either local or linked by media exposure iii. Collective trigger iv. Multiple suicides over a discrete period of time and area that seem to have a contagious effect v. Usually occurs among adolescents b. Contagion i. Others are influenced to kill themselves by exposure of other killing themselves ii. Suicide media exposure potential influences people to kill themselves iii. Exposure to suicide of suicidal behavior within family, friends or through media which results in an increase in the suicide rate or suicidal behaviors iv. Media reports should not include detailed descriptions, simplify the reasoning or glorify the victim 3. Interventions a. Risk Assessment: Determining imminent dangerousness b. Crisis Intervention: i. Deciding on a quick course of action ii. ‘Quick fix’ to alleviate distress iii. This is not a treatment c. Therapy i. Longterm, skill based ii. Resolve the underlying causes of crisis 4. InterpersonalPsychological Theory of Suicide a. A person will not die by suicide unless they have the desire to die by suicide and the capability to do so. i. Acquired Capability 1. People develop competence and fearlessness by repeatedly engaging in painful and provocative activities. The pain can either be from selfharm or accidental injuries. 2. Risk Assessment: a. Previous attempts b. Current and past selfinjuries c. Experiences that result in habituation to pain d. Trait levels of impulsivity e. Reporting absence of physical pain when selfinflicting harm 3. Crisis Intervention a. Acquired capability is not malleable b. Limiting access to resolved plans/preparations 4. Psychotherapy a. Targets cognitive behavioral risk factors b. Emotion regulations and distress management c. Problem solving abilities d. Impulsive response style ii. Desire for Death 1. 2 Interpersonal Threats: are Burdensomeness and Belongingness, these determine lethality. When a person holds both of these ideas in their heads for long enough it can lead to a desire for death 2. Perceived Burdensomeness and Thwarted Belongingness a. Risk Assessment i. The number and nature of relationships and frequency of social contact ii. Recent interpersonal losses iii. Ability to care for self b. Crisis Intervention i. Interpersonal coping strategies ii. Challenging distorting beliefs iii. Coping to include activities that foster connectedness and effectiveness 3. Perceived Burdensomeness a. Person believes that their death will be a relief to those around them b. Those who feel they are a burden to their family are at risk to die by violent suicide 4. Thwarted Belongingness a. Feeling alienated from others b. Suicide rates go down during times of celebrations and after tragedies because people pull together for support more Substance Use Disorders 1. Alcohol Use Disorder AKA Alcoholism a. A problematic pattern of alcohol use leading to significant impairment and distress. Typically includes a strong desire to consume alcohol, difficulty controlling alcohol intake, use results in harmful consequences and failure to complete obligations, increased tolerance and withdrawal symptoms b. Problematic pattern of use with 2 or more of these symptoms in a 12 month period i. Alcohol taken in larger amounts or over longer periods of time than intended ii. Persistent desire/failed desire to reduce intake iii. A lot of time spent obtaining, recovering or using iv. Craving v. Use results in failure to fulfil obligations vi. Continued use despite recurrent social problems due to use vii. Important social, occupational, or recreational activities given up or reduced due to use viii. Recurrent use in hazardous situations ix. Use continues despite physical or psychological problems due to use x. Tolerance: Need for more to get same effect, diminished effect with same amount xi. Withdrawal symptoms or using alcohol to cover up withdrawal symptoms c. Severity: i. Mild: 23 symptoms ii. Moderate: 45 symptoms iii. Severe: 6 or more symptoms d. Prevalence: i. 29.1% lifetime ii. Higher for men iii. Higher for never married or previously married men e. Course: i. Most have episode in late 30’s ii. Among those who were priortopast year dependent 1. 25% were still dependent 2. 27% were in remission 3. 12% were high risk drinkers 4. 18% were low risk drinkers 5. 18% were abstainers f. Problems: i. Alcohol affects the brain in two phases 1. Low doses: Self confident, more relaxed, slightly euphoric, disinhibitory effects, sexual dysfunction. 2. High doses: Symptoms of depression, fatigue, lethargy, decreased motivation, sleep disturbances, depressed mood, confusion g. The Controlled Drinking Theory i. Evidence support abstinence works better h. Biological Theories i. Concordance rates: 48% MZ 32% DZ ii. Environmental factors are more influential for women than genetic factors iii. Genes may affect vulnerability to substances by 1. Influencing neurotransmitters involved in metabolism, biosynthesis of substances a. ADH2 and ADH3 control the enzymes that breakdown alcohol b. Variations in these genes affect alcohol abuse and dependence risk 2. Influencing the CNS receptors for whatever the substance is so it is more sensitive i. Psychological Theories i. Behavioral Theories: Substance abuse is modeled by parents and peers ii. Cognitive Theories: Expectations about effects and beliefs about appropriateness affect coping motives in the use of alcohol iii. Personality Trait Theories: Behavioral undercontrol, impulsivity, sensationseeking and antisocial behavior increase risk j. CNS Stimulants i. Activate the central nervous system ii. Affect the brain reward system through dopamine and norepinephrine release iii. They activate fight or flight reactions which increase metabolism, body temp and blood pressure iv. Includes cocaine, meth, nicotine, and caffeine v. Amphetamines are also used to make adderall vi. The psychological effects of caffeine and nicotine are addictive but not as severe 2. Cocaine a. Is a white powder made from coca plant, it can be snorted, smoked (freebase) or injected b. It is a dopamine antagonist which means it blocks the reuptake of DA c. It initially increases energy, alertness and a feeling of euphoria d. In high doses it causes grandiosity, hypersexuality, impulsiveness, compulsions, agitation, anxiety, paranoia and perceptual illusions e. Withdrawal involves depression, exhaustion and anxiety f. More addictive than other drugs 3. Nicotine a. 70% of people over age 12 have smoked i. 61% of 12th graders have smoked ii. 10% smoke ½ pack a day iii. 95% of those who continued smoking past age 20 became daily smokers iv. 70% of smokers wish they could quit v. 6080% of those who have been treated relapse and smoke again b. Smoking is the leading cause of preventable death c. Nicotine is the addictive chemical in tobacco, it produces an urge to smoke d. Cigarettes deliver nicotine to the brain in a few seconds and it acts as an antagonist to several neurotransmitters e. Smoking increases the risk for anxiety and depression f. Those with psychiatric disorders are twice as likely to smoke g. Smoking Cessation Treatment i. Session 1: Provide reinforcement and support for quitting, discuss past quitting experiences and set a quit date ii. Sessions 24: 1. Identify and anticipate high risk situations 2. Develop coping strategies for high risk situations 3. Discuss Abstinence violation effect 4. Avoid or reduce alcohol consumption 5. Enlist social support (Tell friends and family they are quitting and ask them to avoid smoking in their presence) 6. Lifestyle changes to encourage abstinence 4. Opioids a. Class of drugs derived from the sap of the opium poppy b. Used and abused for thousands of years for analgesic purposes c. We have opioid receptors in our brain, endogenous opioid receptors are called endorphins and help us deal with pain d. Can be injected (mainline), snorted or smoked e. Initially causes euphoria, tingling feeling, sensation of warmth and dilated pupils f. Followed by lethargy, drowsiness, slurred speech, and vivid dreams g. Serve intoxication causes unconsciousness, coma, seizures, and suppresses the brainstem which controls breathing and cardiovascular functions h. Withdrawal causes dysphoria, anxiety, agitation, craving, achy feeling and sensitivity to pain i. Heavy users must use every 46 hours to avoid pain 5. Cannabis a. The dried resin from hemp plants b. The most widely used illicit substance in the world c. 40% report use in US d. Initially causes grandiosity, relaxation, dizziness or lethargy. Impairs short term memory and motor skills e. Larger doses cause hallucinations, perceptual distortions, depersonalization, and paranoid thinking f. Physically affects the heart, increases metabolism and causes dry mouth g. Increases risk for lung problems, chronic cough, emphysema, lower sperm counts, ovulation irregularities, potential link to lung cancer h. 1 in 11 users are dependent i. Can produce anxiety and panic, increases risk of psychosis j. Social anxiety is highly comorbid with cannabis and alcohol dependence (6.5 more likely with cannabis use and 4.5 times more likely with alcohol use) 6. The Disease Model of Addiction a. Views disorders as incurable physical diseases i. Affects how society views substance abuse and underpinning of treatments ii. Supported by genetics and biology 7. Biological Treatments for Addiction a. Medication: i. Antidepressants and benzos are used to reduce urge to smoke ii. Antagonist drugs block or change the effects of drugs by reducing the positive effects, making it uncomfortable to consume, or reducing the withdrawal effects b. Methadone Maintenance Program i. Synthetic heroin is orally administered ii. Taken when discontinuing heroin use to reduce negative withdrawal effects and blocking euphoric feeling iii. The goal is to first taper off the heroin and then taper off of the methadone 8. Behavioral Treatments for Addiction a. Goals: i. Motivation to quit ii. New coping skills iii. Change reinforcement iv. Enhance social support v. Foster pharmacotherapy adherence b. Aversive conditioning i. Medications: Taking disulfiram with alcohol to induce vomiting ii. Covert Sensitization Therapy: Use imagery to associate alcohol with unpleasant images iii. Cue exposure and response prevention: Exposure to things that would usually cause drug/alcohol use but prevent use 9. Cognitive Treatments a. Helps clients identify high risk situations, autonomic thoughts, healthy coping strategies and solutions
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