Abnormal Psych Study Guide, Test 2
Abnormal Psych Study Guide, Test 2 2500
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Study Guide: Abnormal Psych Chapters 7-10 Chapter 7- Depressive and Bipolar Disorders Depression o Low, sad state in which life seems dark and its challenges overwhelming o Depression -> Major Depressive Disorder (MDD) Mania o State of breathlessness euphoria or frenzied energy in which people have exaggerated beliefs that the world is theirs for the taking. o Mania -> Bipolar Depression ▯ Unipolar depression Major depressive disorder (MDD) is the leading cause of disability in the US for ages 15-44 o Around 8% of adults suffer each year o Lifetime prevalence rates ~19% Gender difference o Women are twice as likely to experience MDD than men o No gender difference in childhood Highly co-morbid o :If you have one, you probably have the other o Generalized Anxiety disorder o Other medical disorders 4x more likely to experience heart attack Cancer Parkinson’s disease Eating disorders Substance uses Symptoms o What may be some symptoms and criteria for depression? Loss of interest Irregular sleep (Hypersomnia and Insomnia) Eating patterns Change in weight Loss of motivation Self-harm Feelings of loathing Wanting to be alone o How would you assess it? Clinical interviews Therapy Surveys Diaries o Functional Symptoms Emotional symptoms Feeling miserable, empty, humiliates Experiencing little pleasure Motivational Symptoms Lacking drive Behavioral Symptoms Cognitive Symptoms Physical Symptoms Abnormal appetite Abnormal sleep Fatigue or loss of energy Agitation or slowing o Unipolar Depression- Symptoms (DSM) 5+ symptoms, at least one of which is 1 or 2 1. Depressed mood 2. Apathy and/or anhedonia 3. Significant weight change 4. Insomnia or hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue 7. Feelings of worthlessness or excessive guilt 8. Trouble concentrating or indecisiveness 9. Suicidal ideation or attempt Diagnosing Unipolar Disorder o DSM-5 lists several types of depressive disorders: Major depressive disorder Dysthymic Disorder changes to Persistent Depressive Disorder Premenstrual Dysphoric Disorder Disruptive Mood regulation Disorder What causes Unipolar Depression? o Stress o Biological Factors Genetic factors High degrees of heritability (twin & adoption studies) Neurotransmitters– SSRI’s Molecular Biology– 5-HTTLPR o Psychological Factors Three main models Psychodynamic view No strong research Strengths o Link between depression and grief o Early loss= greater risk for depression o Lack of need in childhood= greater risk Weaknesses o Inconsistent research o Sometimes impossible to test :what is an id? Behavioral View Strengths o Support from research Weaknesses o Largely self reported o Typically correlational and doesn’t assess the actual number Cognitive view Two main theories o Negative thinking Cognitive triad Negative views about: self, world, future Cognitive errors Unrealistic bad thoughts about the event Strengths Strong empirical support Limitations Research fails to show that such cognitive patterns are the cause of unipolar depression o Learned helplessness Strengths There has been significant research support for this model Limitations Laboratory helplessness does not parallel depression Much of the research has been dome on animals o Sociocultural Factors Family-social perspective The connection between declining social rewards and depression is a two way street Marital stress Separated or divorced= higher rates of depression The multicultural perspective The relationship between gender and depression has become particularly interesting A variety if theories has been offered o Artifact theory o Hormone explanation o Life stress theory o Body dissatisfaction theory o Lack of control theory o Rumination theory Relationship between cultural background and depression Non-western countries experience greater physical symptoms than cognitive Within US, differences have been found Living in oppressive situations ▯ Bipolar Depression Symptoms and Criteria for Bipolar Depression o Assessing for Bipolar Depression o Five main areas of functioning may be affected: Emotional symptoms Active, powerful emotions in search of outlet Motivational Symptoms Need for constant excitement, involvement, companionship Behavioral Symptoms Very active-move quickly, talk loudly or rapidly Flamboyance is not uncommon Cognitive Symptoms Show poor judgment or planning May have trouble remaining coherent or in touch with reality Physical Symptoms High-energy level- often in the presence of little or no rest. o Symptoms of Mania Abnormally, persistently elevated or irritable mood lasting at least one week Three or more of the following Grandiosity Decreased need for help Pressured speech Flight of ideas Distractibility Increased goal-directed activity/ psychomotor agitation Excessive involvement in pleasurable activities DSM-5 distinguishes two kinds of bipolar disorder o Bipolar I Full manic and major depressive episodes Most experience an alternation of episodes Some have mixed episodes o Bipolar II Hypomanic episodes alternate with major depressive episodes Diagnosing Bipolar Disorders o Between 1 and 2.6% of all adults in the world suffer from a bipolar disorder at any given time, and as many as 4% over the course of their lives o The disorders are equally common in women and men o The disorders can manifest from 15-44 years Causes of Bipolar Disorders o Neurotransmitters Permissive theory Low norepinephrine in depression. High in mania Low serotonin in depression… doesn’t equal high in mania Mania= low serotonin + high norepinephrine o Ion activity Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder o Brain structure o Genetic Factors ▯ ▯ Chapter 8- Treatments for Depressive and Bipolar Disorders ▯ ▯ Mindfulness Approach Is Being o Present o Nonjudgmental The research o Decreased depression in firefighters experiencing PTSD o Long-term improvement in depressive symptoms in adults who experienced abuse as children o Decreased symptoms of depression and PTSD in veterans. ▯ Treatments for Unipolar Depression Traditional Approaches o Around half of persons with unipolar depression receive treatment from a mental health professional every year o Many other people seek support for depressed feelings Psychological Approaches o Psychodynamic- Widely used, research support not strong Psychodynamic therapy Free association Therapist interpretation Review of past events and feelings Why might these approaches be quite limited when used with people suffering with depression? o Behavioral- Primarily used for mild or moderate depression but practiced less than in the past Behavioral Therapy Reintroduce pleasurable activities Improve social skills Behavioral treatments are best for mild forms Behavioral techniques most effective when paired with cognitive strategies o Cognitive- Has preformed so well in research that it has a large and growing clinical following Cognitive Therapy Includes a number of behavioral techniques Help clients recognize and change their negative cognitive process Phases Increased activities and elevating mood Challenging automatic thoughts Identifying negative thinking and biases Changing Primary attitudes Sociocultural Approaches o Family-Social treatments Interpersonal therapy (IPT) Interpersonal loss Grief Interpersonal role dispute Couples or family based therapy What people need from others Love language survey o Five different ways that we feel loved Interpersonal role transition Transitions How major changes in life can affect our roles and us. Interpersonal deficits Social skills Studies suggest that IPT has a success rate similar to cognitive and cognitive-behavior therapies for treating depression Biological Approaches o Medicine or Medical Care Bring great relief Antidepressant drugs (MAO inhibitors or Tricyclic’s) Tricyclic’s are believed to reduce depression by affecting neurotransmitter (NT) reuptake mechanisms Sometimes includes electroconvulsive therapy or brain stimulation Second-generation antidepressants Selective serotonin reuptake inhibitors (SSRI’s) Fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro) Selective norepinephrine reuptake inhibitors and serotonin- norepinephrine reuptake inhibitors are also now available Cognitive, cognitive-behavioral, interpersonal, and biological therapies are all highly effective treatments for mild to severe unipolar depression Psychodynamic therapies = less effective than other therapies in treating all levels of unipolar depression Psychotherapy + drug therapy is modestly more helpful than either treatment alone. ▯ Treatments for Bipolar Disorder Recall the emotional roller coaster included depression and mania o Low serotonin + low norepinephrine = depression o Low serotonin + high norepinephrine = mania Treatment Medications- Lithium and Other Mood stabilizers o Lithium and Other Mood stabilizers o Lithium- side effects/ kidney, thyroid, dehydration Need to find right amount o Researchers do not fully understand how mood- stabilizing drugs operate. Treatment o Mood stabilizing drugs alone are not always sufficient o 30% or more of patients don’t respond, may not receive the correct dose, and/or may relapse while taking it o Therapy focuses on medication management, social skills, and relationship issues. ▯ ▯ Chapter 9- Suicide ▯ Suicide- an intentioned death; a self-inflicted death in which one makes an intentional, direct, and conscious effort to end one’s life. Parasuicides- unsuccessful suicide attempts. Suicide is not officially classified as a mental disorder Shneidman’s four kinds of people who intentionally end their lives o Death Seekers A person who clearly intends to end his or her life at the time of a suicide attempt. This singleness of purpose may last only a short time. o Death Initiators A person who attempts suicide believing that the process of death is already under way and that he or she is simply hastening the process. o Death Ignorers A person who attempts suicide without recognizing the finality of death. Believe they are trading their lives for a better or happier existence. o Death Darers A person who is ambivalent about the wish to die even as he or she attempts suicide. Subintentional deaths- when people play indirect, covert, partial, or unconscious roles in their own deaths. o Drug, alcohol, or tobacco use, promiscuous sexual behavior, recurrent fighting, are behaviors that may contribute to Subintentional deaths. How is suicide studied? o Retrospective analysis Researchers and clinicians piece together data from the victims past by using past conversations, and behaviors from friends and relatives. Suicide notes o Studying people who survive their suicide attempt Differences in Suicide attempts o Countries that are largely Catholic, Jewish, or Muslim have low suicide rates o 3x as many women attempt suicide as men, yet men succeed at more than 4x the rate of women. o Divorced persons have a higher suicide rate o In the US, the overall suicide rate of white Americans is twice as high as African Americans, Hispanic Americans, and Asian Americans. What Triggers a Suicide? o Stressful events and Situations Social Isolation People without loving families or supportive social systems are particularly vulnerable to suicidal thinking and actions. Serious Illness People whose severe illness causes them great pain or severe disability may try to commit suicide as they view death as unavoidable and imminent. Or they believe death is preferable to the pain they are living with. Abusive environment Victims of an abusive or repressive environment from which they have little or no hope or escape sometimes commit suicide as they believe they can no longer endure their suffering and there is not hope for improvement in their situation. Occupational stress Some jobs create feelings of tension or dissatisfaction, which may trigger suicide attempts. o Mood and thought changes Hopelessness A pessimistic belief that their present circumstances, problems, or mood will not change. Dichotomous thinking Viewing problems and solutions in rigid either/or terms. o Alcohol and other drug use As many as 70% of people who attempt suicide drink alcohol just before they do. o Mental disorders The majority of all suicide attempts do have a psychological disorder o Modeling Family member or friends A recent suicide by a family member or friend increase the likelihood that a person will attempt suicide Celebrities Suicide by entertainers, political figures, and other well known people are followed by unusual increases in the number of suicides across the nation. Common predictors of suicide o Depressive disorder and certain other mental disorders o Alcoholism and other forms of substance abuse o Suicidal ideation, talk, preparation, certain religious ideas o Prior suicide attempts o Lethal methods o Social withdrawal, isolation, living alone, loss of support o Hopelessness, feeling trapped, cognitive rigidity o Impulsivity and risk taking behavior o Being an older white American male o Modeling, suicide in the family, genetics o Work problems o Marital or family problems o Dramatic changes in mood o Anxiety o Stress and stressful events o Anger, aggression, irritability o Psychosis o Physical illness o Sleep problems Explanations for suicide o Psychodynamic theorists Believe that suicide usually results from depression and self-directed anger o Durkheim’s sociocultural theory Defines three categories of suicide based on the person’s relationship with society Egoistic suicides Committed by people whom society has little or no control over. They are isolated, alienated, and nonreligious. Altruistic suicides Committed by people who are well integrated into society that they intentionally sacrifice themselves for its wellbeing. I.e. Soldier throwing themselves on top of a grenade to save others Anomic suicides Committed by people whose social environment fails to give meaning to life. o Biological theorists Suggest that the activity of the neurotransmitter serotonin is particularly low in people who commit suicide. Suicide in Different Age groups o The likelihood of suicide varies with age. It is uncommon among children, although it has been increasing in that age group. o Adolescents and young adults More common than in children Decreasing in the past decade Linked to: Clinical depression Anger Impulsiveness Major stress Adolescent life itself Suicide attempts are numerous o Elderly More likely to commit suicide than any other age group. The loss of health, friends, control, and status may produce feelings of hopelessness, loneliness, depression, or inevitability in this age group. Treatment and Suicide o Treatment may follow a suicide attempt. Therapists will help the person achieve a non-suicidal state and develop better ways of handling stress and solving problems. o Shifted to suicide prevention. o Need long-term therapy. o Suicide education for the public. ▯ Chapter 10-Disorders Featuring Somatic Symptoms ▯ ▯ Disorders focusing on Somatic Symptoms Somatic disorders are characterized by physical complaints without medical cause Disorders: o Factitious Disorder When physicians cannot find a medical cause for a patients symptoms Known commonly as Munchausen syndrome Commonly among people who: A. Received intensive medical treatment as children B. Carry a grudge against the medical profession C. Have worked as a nurse, lab technician, or medical aide Munchausen syndrome by proxy Someone else makes you sick, or convinces you that you are sick for a gain Most commonly done by parents for attention or some other gain. Example: woman claimed her child had cancer to get money from people. Told her child, and everyone in her sons life that the boy had cancer. Community rallied around the boy and raised money, but it was revealed that he did not have cancer. o Conversion Disorder and Somatic Symptom Disorder Conversion Disorder People with this disorder display physical symptoms that affect voluntary motor or sensory functioning, but the symptoms are inconsistent with known medical diseases Hard to distinguish from genuine medical problems Example: temporary paralysis Generally happens for a short period of time due to a stressor Somatic Symptom Disorder Excessively distressed, concerned, and anxious about bodily symptoms that they are experiencing Pain symptoms, gastrointestinal symptoms, sexual symptoms, and neurological symptoms. What causes conversion and somatic symptoms disorders? Psychodynamic theorists Propose conversion of underlying emotional conflicts into physical o Primary gain o Secondary gain We get things from other people Sympathy and support Behavioral theorists Bring reward to sufferers Cognitive theorists Provide a means for people to express difficult emotions o People are more sympathetic to people with physical disorders than with mental. Treatment for conversion and somatic symptoms disorders Insight Exposure- client thinks about traumatic event(s) that triggered the physical symptoms Hypnosis Confrontation o Confronting the stressor Drug therapy- especially antidepressant medication. o Illness Anxiety Disorder Previously known as hypochondriasis Chronic anxiety about their health and are concerned they are developing a serious medical illness, despite absence of somatic symptoms. Theorists explain this disorder much as they explain various anxiety disorders: Behaviorists: classical conditioning or modeling Learned that how other were treated when they were sick and realized they could be treated like that if they were sick. Cognitive theorists: oversensitivity to bodily cues Get a brain freeze and think it is more than just a brain freeze. Receive the kinds of treatments applied to OCD o The Physical Stress Disorders Psychophysiological disorders In addition to affecting psychological functioning, stress can also have great impact on physical functioning Psychophysiological disorders bring about actual physical damage Ulcers, asthma, insomnia, chronic headaches, high blood pressure, and coronary heart disease. Biological factors Defects in the Autonomic Nervous System (ANS) Weak body systems Psychological factors Perceived needs, attitudes, emotions, coping styles Sociocultural Factor Poverty Ethnic or cultural minority groups = more prone to stressors that affect the body. Support- support is not given to all New Psychophysiological Disorders What are some of the most stressful life events Adults o Death of spouse o Marriage o Children o Divorce o Jail term o Work o Money Students o Death o Tests o Finals o Applying o The future o Relationships o Psychoneuroimmunology Researchers have increasingly looked to the body’s immune system as the key to the relationship between stress and infection. This study is called Psychoneuroimmunology Will stress result in the slowing of the immune system? Increased norepinephrine may slow down immune system Changes in behavior/lifestyle Personality Social support The people around you. Positive people will make you feel good, others can give you more stressors. o Psychological treatments for physical disorders The field of treatment that combines psychological and physical interventions to treat or prevent medical problems is know as behavioral medicine Behavioral medicine: treatments Behavioral medicine include: o Relaxation training o Biofeedback Understanding your bodily clues: heart rate, temperature, sweats. Use these clues to figure out how you feel and then using relaxation techniques to calm down. o Meditation o Hypnosis Cognitive interventions Stress inoculation training: patients are taught to rid themselves of negative self- statements and to replace these with coping self-statements Emotion expression and support groups Mindfulness/ Yoga Nidra Yoga Nidra for 1 hour is like 3 hours of sleep Good for: o Fibromyalgia o Chronic fatigue syndrome o Depression o PTSD o Anxiety o Insomnia o Restlessness o Chronic pain ▯
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