Abnormal Psych Exam 2- Study Guide
Abnormal Psych Exam 2- Study Guide CLP4143
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This 16 page Study Guide was uploaded by Charles Joachim on Tuesday January 12, 2016. The Study Guide belongs to CLP4143 at Florida State University taught by Hillary Smith in Fall 2016. Since its upload, it has received 17 views. For similar materials see Abnormal Psychology in Psychology (PSYC) at Florida State University.
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Date Created: 01/12/16
Abnormal Psych Study Guide: Exam 2 Mood Disorders: Depression Mood Disorders are divided into Unipolar and Bipolar - Unipolar= persistent depressive disorder and major depressive disorder The criteria for a mood disorder requires the presence of at least one mood episode: Major Depressive Episode, Manic Episode, Hypomanic Episode ( different in duration) -Still use 4 D’s in diagnosis Major Depressive Episode criteria must meet 5 1)Depressed Mood* 2)Anhedonia- lack of interest in things you usually like to do* 3)Appetite or Weight Change 4)Sleep problems 5)Psychomotor changes- agitation/ pacing, slower movement 6)Loss of Energy 7)Feelings of worthlessness/ inappropriate guilt 8)Concentration problems 9)Suicidal thoughts Major Depressive Disorder- presence of MDE -Not better accounted for by another disorder -check for manic, mixed or hypomanic episode if both then not depression Persistent Depressive Disorder- more chronic and can be less severe - At least 2 of the following for at least 2 years: without a break: 1)Appetite problems 2)Sleep problems 3)Low energy 4)Low self esteem 5)Poor concentration 6)Feelings of hopelessness Persistent is a constant state of depression compared to major depression which is a single occurance which takes dips back and forth, Eeyore is PDD -can be PDD with MDE, a dip down and then back up to lower mood Depression Facts: -MDD is 1 in 5 -PDD 1 in 20 -without treatment: long lasting and reccurent -MDD leading cause of disease burden- high cost of treatment -depression twice as common in women as in men- women are more likely to go get treatment than men -adolescents through their twenties has highest rate of depression Major neurotransmitters associated with depression: - Serotonin - Norepinephrine - Dopamine Biological Treatments for Depression on Wednesday 2 Treatments for Depression - SSRI- -most widely used: relief within a couple of weeks, less severe side effects SSNRI- has more stimulant effects, difficulty getting around during the day- similar to SSRI though MAOI’s- less common, can cause liver damage and weight gain, fatal interactions with other meds Tricyclic Antidepressants- numerous side effects, rarely used Depression: Brain Differences- - Prefrontal Cortex may be smaller, issues with decision making short term memory, motivation, and self control. - Anterior Cingulate- Increased – more crying, sadden mood - Hippocampus- Decreased- Short Term Memory loss -Amygdala- Icreased- being stuck in a thought, cant get rid of it Neuroendocrine- HPA increased, Other treatments for depression- treatment resistant only - -ECT- Electroconvulsive therapy- creates brief seizures, only MDD- last resort -Transcranial Magnetic Stimulation- TMS- brain stimulation with electromagnet, for treatment resistant depression Psychological theories of depression: reduced positive reinforcers promotes behavioral withdrawal = learned helplessness = expect the worst/ unavoidable -unpredictable negative events serve as punishers, cause behavioral withdrawal 3 Cognitive Theories of depression- Negative Cognitive Triad- cycle of negative thoughts Beck’s Cognitive Distortions- 1979- 1. All or nothing thinking 2. Over generalization\ 3. Mental filter 4. Discounting the positives 5. Jumping to conclusions 6. Magnification 7. Emotional reasoning 8. Should statements 9. Labeling 10. Blame Casual Attributions- Believe causes of negative events are -stable, internal and global, I am the problem and I will never change Internal= my fault Stable= never will get better Global= no one will ever love/like me Psychological Treatments: Evidence Based Usually, time limited and individual – 10 sessions Involves work both in and out of session – homework Involve clear goals that both patient and therapist are aware of CBT- Cognitive Behavioral Therapy Cognitive- changes negative thinking Behavioral- increases positive reinforcers= behavioral activation Behavioral- Improving Social Rhythms and sleep hygiene Both- identify the triggers and problem solve Risk monitoring 4 Interpersonal Theories of Depression- Rejection sensitivity- perceiving others as being constantly rejective Excessive reassurance seeking- asking if you are okay, over apologizing Interpersonal Therapy- helpful with grief or loss, role transition, interpersonal skill deficits Bipolar Disorder Bipolar : 3 types: Bipolar 1, bipolar 2 and Cyclothymic Manic Episode Symptoms: Talkative, Lack of Social Cues, Tangential Thoughts, Confidence, Inappropriate Affect, Delusion of Grandeur, seeing meaning in things that don’t have any. -typically 7 days – distinct period of elevated or irritable mood -marked impairment, like OCD episodes -often results in hospitalization Hypomania- less severe – usually lasts for at least 4 days -most of the same symptoms of mania but less severe- not marked -no psychotic symptoms + no hospitalization Bipolar 1= Manic Episode- marked impairment or hospitalization required at least 7 days- sometimes they get arrested. 5 Bipolar 2= hypomania –plus a depressive episode - no hospitalization required Cyclothymia = Hypomania + NO full depressive episode, at least 4 days You can have a Major Depressive Disorder and be diagnosed with Bipolar 1 -cannot have a full manic episode and be diagnosed with Bipolar 2 or Cyclothymia -can be diagnosed with Bipolar 1 if you only have a hypomanic ep, not full manic Bipolar is considered chronic- can have remissions of manic episodes -regular medication adherence = way to regulate -high economic status =likely to do better= higher access to health care Treatments: Mood Stabilizers – Lithium= slow onset time -anticonvulsants- for mania -atypical antipsychotics- Seroquel- helpful if they show psychotic symptoms Theories- -Genetically prevalent -amygdala larger and more active / prefrontal cortex smaller and less active -striatum- high dopamine -MZ twins have a 60% concordance rate – genetic influence 6 Psychosocial Theory- greater sensitivity to reward -sparked by stressful life events, may be a trigger - changes in social rhythms or routines Psychological Treatments for bipolar- -Interpersonal and social rhythms therapy- helps patient maintain routines -a lot of self reporting -Cognitive Behavioral Therapy- addresses problematic thoughts – helps patient re learn how to think -only done while on medication Suicide Non Suicidal Self Injury= NSSI= no intent to die, non fatal 1 million lives lost a year to to suicide, more than accidents, war and homicide combined- every 40 seconds -33000 annually in US- 10 leading cause of death- 3 in 15d to 24 year olds, 90 per day die Suicide Attempts by gender- women 3 times more likely to attempt suicide -men 4 times more likely to actually die by suicide Risk Factors: -Anhedonia- stop caring about what you used to care about- loss of pleasure 7 -Hopelessness -Suicidal Ideation- thinking of suicide and death -Impulsivity -Agitation -Social Isolation -Access to Lethal Means -Past suicide attempts -recent divorce, separation or spouse loss Interpersonal Theory of Suicide- Thomas Joiner -Thwarted Belongingness- “I don’t belong anymore” -Perceived Burdensomeness- “people would be better off without me” -Desire for Suicide= overlap- Hopelessness -Capability for Suicide- level of pain tolerance, fear of death, recklessness -results in suicide attempt -to treat with this you ask questions to gauge these points Treatment and Prevention- -Interpersonal Theory= targets social isolation- make people socialize and decrease their burdensomeness= interpersonal coping skills Challenging distorted beliefs Increase feelings of self efficacy- boosting worth -Behavioral Activation = the most impactful with suicidal patients 8 Crisis Intervention- access coping skills in the moment- Hospitalization, suicide hotlines, medication Dialectical Behavioral Therapy –DBT- relies on behavioral analysis -increase mindfulness, emotional regulation, distress tolerance, interpersonal effectiveness CAMS- risk management- collab assessment and management of suicidality Gould et al- is assessing suicide risk dangerous? - individuals assessed for suicide no more distressed than those not assessed -no increase in suicidal ideation- some evidence of decrease among previous attempters Social Issues: Access to Guns -most common method of death by suicide in US -most people don’t buy a gun with intentions but if they have access they would be more likely to use it -restricted gun access LOWERS suicide rates Be aware: Learn the warning signs IS PATH WARM- warning signs I - Ideation S- sleeplessness P- Purposelessness 9 A-Agitation T- Trapped H- Hopelessness W- Withdrawal A-Anger R- Recklessness M- Mood Changes Eating Disorders -Anorexia Nervosa- may have amenorrhea =no menstrual cycle 3 characteristics= 1 refusal to maintain body weight 2 intense fear of weight gain 3 disturbances in evaluation of weight and shape = distortions Perfectionism- no gray area between good and bad weight Food Rituals- not eat all the food given, separating foods Cold Fidgety and Restlessness – no body fat High comorbidity with depression and anxiety Heavy influence of body weight on self image Two Subtypes: 1)Restricting – restrict the amount of food taken in 2)Binge/ Purge – restricting is combined with this = difference from bulimia Anorexia affects 1 to 2% of people – slightly more common with Caucasian women- high death rate 10 Medical complications Starvation- lanugo, constipation and cold intolerance Major organ failures- mainly cardiovascular complications Osteoporosis and bone fractures Impaired immune functioning Bulimia Nervosa- grew exponentially in the 80’s -Binge Eating and Compensatory Behaviors= purging, over exercising, laxatives, fasting -1 time per week minimum of 3 months and cannot occur during anorexia nervosa = cant have both at the same time -bulimia is either normal body weight or overweight, anorexia is underweight -undue influence of weight/shape on self image –not underweight Binge= eating within a 2 hour period an amount of food that is definitely larger than most people would eat in similar conditions –subjective Also a sense of loss of control required over eating during the episode Eating past the point of control within a 2 hour period Depends on the context of the person and the situation Subjective binges= not a large amount of calories but loss of control Objective Binge= large amount of food and loss of control - 1 to 3% found in population – 2 times as common in women than men 11 -high comorbidity with depression and NSSI- non suicidal self injury -anorexia has a higher suicide rate than bulimia Bulimia= Medical Complications Electrolyte imbalance Erosion of dental enamel Hypersensitive gag reflex GIRD Enlarged salivary gland- puffy face less than 85% of expected body weight is usually considered too thin- BMI under 18.5= you can see their skeletal structure but no clear line Substance Abuse Biological Theories -Genetic Influence .48 MZ, .32 DZ Family at 8x risk of developing Substance use disorder Increase in reward sensitivity = heightened response to presence of substance= children will also develop this, increased heart rate -Neurotransmitter Effects Dopamine: reward pathways are augmented universally with all drugs/ substances abuse – nucleus accumbens and VTA= pleasure pathway Serotonin- elevated mood: MDMA, LSD and cocaine 12 Norepinephrine: Cocaine and amphetamine -brain areas Mesolimbic pathway- the main dopamine pathway in the brain Psychological Theories -Behavioral Theories Substance abuse is modeled from parents/peers usually- social learning -Cognitive Theories Expectations about effects, beliefs about coping with substance abuse -Personality Trait Theories Trait disinhibition- someone who does crazy things, increases risk Sensation seeking people more likely to abuse -Sociocultural Theories People under constant stress more likely to abuse substances Biopsychosocial model- exposure to a substance is necessary to have disorder -early age of first use -genetic factors – someone in family who is abusing= likelihood of getting “hooked” -social stressors and beliefs might change likelihood of using Peer pressure and education 13 2 Treatment Theories -Disease Model- assumes individual cannot modify use- AA -must abstain from use, no drinking -Harm- Reduction Model- assumes individual can modify the use -moderation over abstention Biological Treatments- Antagonist drugs- drugs that block or change the effects of addictive drugs by – causing vomiting, dizziness- associates it with bad things -blocks dopamine receptors, reducing reinforcement -prescribe antidepressants to get through withdrawals -methadone given for heroin addicts- less intense but same sensation- blocks dopamine also Methadone Maintenance Program- -methadone is a synthetic orally administered opiate -taper off of heroin and then off of methadone Behavioral Treatments- -Cue Exposure and Response Prevention Exposure to cues for substance use, prevent actual drinking/drug use Social aspect makes it very hard -Aversive classical conditioning- pavlov’s dogs Antabuse creates an aversion with taking a substance Covert sensitization therapy- imagery to associate alcohol with something unpleasant 14 Cognitive Treatments- -helps clients identify situations where they are most likely to use substances -challenges expectations about how substances will actually help them cope Other psychotherapies -Motivational Interviewing- doesn’t challenge the substance use but promotes why change is possible – inception -Alcoholics Anonymous- based on disease model -harm reduction programs Daily recording of consumption Learn to calculate BAL Risks vs benefits of moderate use Trans Diagnostic Approaches Psychologists currently use the DSM 5 -comorbidity still remains a issue- double diagnosis - not culturally sensitive Symptoms combine to form Syndromes Different levels of analysis are used to diagnose psychological disorders: -behavioral- behavioral activity -social- social engagement with family and friends -mental- cognition -neurological/physiological – brain abnormalities 15 -neurochemical- neurotransmitters and hormones -molecular- genes, epigenetics -all levels add up to diagnosis = a clear use of the Biopsychosocial approach Blind men and the elephant example- all diagnoses will be different depending on what is being looked at -may be diagnosed as bipolar because of genetic factors but actually be just depressed when looking at social factors Overall easier to test a symptom over a syndrome – like sleeplessness over depression- seen with RDoc- the dimensional nature of symptoms 16
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