Abnormal Psychology Exam Two Study Guide
Abnormal Psychology Exam Two Study Guide PSYCH 3830
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Abnormal Psychology Exam Two Study Guide Introduction to Therapy Biomedical Approaches A. Drug Therapy (Psychopharmacology): psychoactive drugs work on the brain 1. Antipsychotics (Abilify, Seroquel, Risperdal) Treat psychotic disorders (most significant: schizophrenia) Used when a person shows psychotic features Helps to reduce the frequency and intensity of delusions and hallucinations Works by blocking some of the dopamine receptors About 60% of people diagnosed with schizophrenia and take medication have reduced symptoms within 6 weeks 2. Anti-Depressants (Zoloft, Paxil, Celexa, Prozac, Lexapro) Most widely prescribed “Classical anti-depressants” 2ndgeneration anti-depressants are more effective (SSRI: selective serotonin reuptake inhibitors) - Individuals have too much reuptakemore serotonin - Safe, fewer side effects, overdoes less likely to be fatal Prozac is the most widely prescribed/used drug Anti-depressants treat depression as well as bulimia nervosa 3. Anti-Anxiety Drugs (Xanax, Klonopin, Valium, Ativan…all forms of benzodiazepine, which is the most widely used) “Treatment of choice” Anxiety, agitation Biggest problem: can become dependent on them Relatively high relapse rate (return of symptoms) On part, act on GABA 4. Mood-Stabilizing Drugs (Lithium) Lithium is the most common known as the “wonder drug”, treats bipolar disorder 70-80% of people will start to get better within 2-3 weeks B. Electroconvulsive Therapy (ECT) Passes through a person’s brain Alleviate depressive and manic episodes About 100,000 people a year are treated Bad reputation back then, but today people are put to sleep and given muscle relaxers Relatively safe and effective Typically going to be used if a person is severally depressed (highly suicidal) Not the first choice of treatment Electro current, works better using 2 electros to the same side of the head Amnesia when they wake up, may experience memory loss Not a one time deal (usually 12 sessions) C. Neurosurgery Surgery on the brain Treatment for psychological problems Most common: prefrontal lobotomy (frontal lobe severed from inner part of brain) Drug therapy began to increase and overtake neurosurgery because of all the negative side effects Last resort Not as dramatic a procedure today Psychotherapy A. Psychodynamic therapy 1. Psychoanalysis: Freud’s psychoanalysis is perhaps the most widely known example of psychodynamic therapy and focuses on identifying the individual’s unconscious feelings, impulses, and conflicts and bringing them into conscious awareness Therapist is mostly passive, patient talks most Not an approach we use a lot today Long, hard & expensive (takes years) The processes: Free Association (Primary way at getting at the unconscious): Process in which patients are encouraged to talk freely about whatever comes to mind Catharsis: Release of strong and repressed emotions Interpretation: Explanation of the patient’s remarks/actions so that they can understand their own unconscious motives Resistance: Unwillingness of client to cooperate with therapist in uncovering unconscious material Negative Transference: Displacement of one’s negative feelings towards one’s parents onto the therapist Insight: Client’s awareness of what underlies their behavior patterns, motivations, or illness (why they do what they do) Personality Restructuring: Restructuring of client’s personality so that they can develop more adaptive behaviors Behavior Change: Change of client’s behavior in light of insight gained through therapy B. Behavior therapy Symptoms are the problems Learning principles: get rid of unwanted behaviors and replace with healthy behavior 1. Systematic Desensitization: type of behavior therapy in which patients learn to relax in anxiety-provoking situations Developed by Wolpe, who believed individual cannot be relaxed & anxious at the same time Most widely used method Before Therapy: Stimulus or situation Undesired Response: Fear During Therapy: Learn relaxation techniques + Create hierarchy of anxiety-provoking situations Use relaxation techniques while imagining anxiety-provoking situations After Therapy: Stimulus or situation Alternative Response: Relaxation C. Cognitive Therapy Focuses on thoughts Assumes our feelings and our behavioral responses to events are strongly influenced by our cognitions Cognitive therapist distinguishes between an observed causal relationship and an actual causal relationship (which considers the individual’s intervening cognitions) EXAMPLE: an individual who has recently lost his job becomes depressed. The observed causal relationship is losing job depression. But the actual causal relationship is losing job cognitions: “I am worthless” Depression 1. Rational Emotive Behavior Therapy (REBT): one type of cognitive therapy in which irrational or unrealistic cognitions about life events are replaced with more constructive cognitions Most common in treating depressed individual Very confrontational, active therapist The REBT therapist helps the depressed individual replace his unhealthy cognitions with more adaptive thoughts EXAMPLE: new causal relationship becomes losing job cognitions: “I am talented”, “I will get another job” feelings of self-efficacy and contentment Makes them learn to think in a certain way D. Humanistic Therapy Very positive Focuses on strengths 1. Person-Centered (or client-centered) Therapy (AKA non-directive therapy): type of humanistic therapy introduced by Carol Rogers that emphasizes people’s potential for self-fulfillment and facilitates this by helping people grow in self-awareness and acceptance Person-Centered Therapists use active listening in order to help the individual feel more comfortable and grow in self- awareness and acceptance During active listening the therapist attempts to clarify the client’s thoughts and feelings by echoing and restating his or her words EXAMPLE: -Client: “I have been wondering why I worked so hard to try to make other people comfortable. I don’t understand why I have such a strong need for everything to go without a hitch.” -Therapist: “In other words, it is important to you to help other people feel more at ease. You put in a lot of effort in trying to make everything go along smoothly and as planned.” E. Marital Therapy (AKA couple therapy) 1. Traditional Behavior Couple Therapy (TBCT) More change focused 10-26 sessions (relatively short term) Goal is to help couples learn how to resolve conflicts, communication Effective About 2/3 people show improvement 2. Integrative Behavioral Couple Therapy (IBCT) Relatively short term Focuses on acceptance, not as much change Effective About 70-80% show improvement F. Family Therapy 1. Structural Family Therapy: Minuchin Helps family become more supportive of each other, reduce tension Child that brings family into therapist is usually the healthiest child that doesn’t cause problems G. Eclectic Therapy Draw techniques from different approaches About 50% of therapists practice this Pull in more holistic/ natural remedies more and more popular today Get people to change their lifestyle physical and mentally healthier Effectiveness of Therapy A. Outcome Research Studies: used to determine the efficacy of different treatment options for individuals experiencing psychological symptoms. Some of the more common conditions used in these studies include: Untreated Control Group: Individuals who do not receive treatment Placebo Group: Individuals who are led to believe that they are receiving the treatment but are not Paraprofessional Led Group: Individuals who receive treatment from someone who has received a limited amount of informal training Professional Led Group: Individuals who receive treatment from someone with a masters or Ph.D. in some field of counseling -Results are inconsistent so we use meta-analysis, which is a procedure for statically combining the results of many different studies as if they came from one huge study with thousands of participants B. Measuring Therapeutic Effectiveness 1. Client testimonials Problems: Crisis will go away themselves; hard to say whether it was therapy or passage of time that helped Patient needs to feel that their money and time was well worth spent Clients are likely to like their therapist, so they will listen to them 2. Clinicians’ perceptions C. Results of Outcome Research 1. Spontaneous remission of untreated individuals 40% of individuals start to get better within 3 month period Start to get better on their own 2. Effects of placebo and paraprofessional treatment Tend to show more improvement than the untreated controls 3. Treatment by professionals More likely to show improvement and more quickly *5-10% of individuals who get treated are going to deteriorate either from a bad therapist or being more troubled than others, etc. D. Variables Impacting Therapeutic Effectiveness Nature of Problem: Certain kinds of problems are harder to treat (always easier to treat someone with a clear and specific problem) Fit between disorder and therapeutic intervention: Some approaches are certain to a specific problem Client Characteristics: Therapy is most effective for people who need it the least (individuals who are young, intellectual, successful, motivated are more likely to experience improvement) Clinician Characteristics: Fit between client and therapist matters, more effective if there is a good relationship, warm, empathetic, actively involved, non-judgmental therapists tend to be more effective Trauma- and Stressor Related Disorders I. Stress 2 Kinds: Eustress: positive stress (ex: planning a wedding, having a baby) Distress: negative stress (ex: losing someone close to you) Stressors: the demand placed on an individual Stress: person’s response A. Factors affecting the experience of stress 1. Nature of the stressors Relevance: important aspect of your life (ex: losing a job, divorce more relevant than “it’s raining outside so I can’t play golf”) Length: the longer the problem is around, the more stressful it is Number of stressors: the more stressors, more stress Predictability: events that are unpredictable are typically more stressful 2. Characteristics of the person A. Personality: Optimistic vs. Pessimistic B. Type A vs. Type B Personality Type A: impatient, competitive, hostile Type B: relaxed, easygoing, unhurried According to Friedman and Rosenman, Type A individuals are more likely to suffer heart attacks in their 30s and 40s than Type B individuals who almost never have heart attacks before their 70s Recent Research shows that only hostility, which involves the distrust of the motives and intentions of other people, seems related to heart disease C. Coping strategies: examples include research and preparing D. Stress tolerance (tolerance level): our ability to withstand stress without becoming impaired B. Effects of Stress 1. Fight or Flight Response Emotional and physical response to a stressor that involves either attacking or avoiding the presenting threat In the short term, this response is highly adaptive If chronically aroused, this response can cause physical and emotional damage 2. Stress can impair the functioning of our immune system (more at risk for getting sick); stress can also develop symptoms of anxiety and depression C. Stress Management Aerobic Exercise: sustained exercise that increases physical and emotional well being Biofeedback: system for electronically measuring and feeding back one’s physiological state (ex: measure heart rate, muscle movement, etc.) Relaxation Training: involves teaching individuals how to tense and relax muscle groups Social Support Groups: friends and family that help one cope with stress (this technique is usually overlooked, but very effective) Write expressively, make an effort to slow down and enjoy life II. Adjustment Disorder A. What is it? The person develops emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor Once the stressor (or its consequences) has terminated, the person does not experience symptoms for more than an additional six months Least stigmatizing and mildest diagnosis you can give someone Commonly accompanies a medical disorder In adults, women get the diagnosis more B. Differential Diagnosis Other conditions that may be a focus of clinical attention: uncomplicated bereavement (losing someone close to you) Trauma- and Stressor- related disorders: adjustment disorder Depressive disorders: major depressive disorder *One form of treatment would be cognitive therapy III. Posttraumatic Stress Disorder (PTSD) A. Diagnostic Criteria The person has experienced, witnessed, or been confronted with an event that involves actual or threatened death, serious injury, or sexual violence to themselves or others. (Extreme or traumatic event) The person persistently re-experiences the traumatic event. (Dreams, flashbacks, intrusive thoughts) The person persistently avoids stimuli associated with the trauma. (Avoids talking about it, avoid people and places associated with it) The person experiences negative changes in their thought processes and mood. The person experiences persistent symptoms of increased arousal. (Difficulty sleeping, concentrating, unrealistically angry) The person experiences the disturbance for more than one month. The person experiences clinically significant distress or impairment in functioning. B. Demographics and etiological factors Diagnosed more commonly in females than in males Duration of symptoms lasts longer in females Co-occurs with anxiety and depressive disorders; they tend to go together Any age can develop PTSD (criteria is a bit different for children) Symptoms usually begin within 3 months, but that’s not part of the diagnostic criteria (sometimes delayed) Recovery typically occurs in 3 months (at least ½ of the cases) Less likely to develop PTSD if you have a higher education, in a higher socioeconomic group, good support system, good coping skills C. Differential Diagnosis Adjustment Disorder -May be triggered by a stressor of any severity -May involve a wide variety of symptoms PTSD -Must be triggered by an extreme stressor -Must involve a specific constellation of symptoms Both -Always involves the presence of a stressor IV. Rape A. What is it? Rape (also sometimes referred to as sexual assault) is the occurrence of sexual intercourse by force or threat of force without the consent of the person against whom it is perpetrated. Intercourse can be penile-vaginal, oral-genital, anal, or penetration of the vagina or anus by objects such as broom handles. Statutory rape is a legally defined form of rape that involves sexual intercourse with a person who is under the legal age of consent. For intercourse to be defined as statutory rape, overt force or threat of force is not required. B. Statistics, demographics, and trends It is estimated that between 15% and 25% of U.S. women have been or will be raped at some point in their lives It is estimated that 3% of all men in the U.S. have been or will be rape at some point in their lives (most typically happens to a male child or prison inmate) Women between the ages of 18-21 years are the victims of more than 20% of all rapes Research suggests that 82% of women know their rapists Rape is the main reason females experience PTSD Decline of rape in the West and NE, increase in the South and Midwest C. Two kinds of Rape 1. Acquaintance Rape: rape between 2 people that know each other (82%) A. Date Rape: most common form of acquaintance rape Factors: Alcohol and drugs occur in more than ½ of all rape Communication: men overestimate their date’s interest in taking it further, women underestimate Token resistance: men have a tendency to perceive no as maybe and a desire to be convinced Most common locations: person’s apt or home, dorm room/residence hall, a parked car B. Marital Rape: husband forces wife against her will In 1857, the U.S. accepted the hale doctrine, which exempted husbands from getting arrested for raping wife, but it was removed in the late 1980s Most women don’t record it, so there’s not much data Women are afraid of repercussions from spouse 2. Stranger Rape: rape between two strangers (18%) Not a lot of specific information on the difference between acquaintance and stranger rape D. Rape Myths about women Victims provoke rape by their appearance or behavior Women want sex but later falsely cry rape Women mean yes when they say no The sexual contact did not do her any harm Most rapes are committed by strangers in dark alleys *The use of these myths by defense attorneys and their acceptance by jurors in rape cases provides evidence that they are oftentimes accepted by society E. Psychological impact of rape Symptoms do not seem to differ regardless of acquaintance or stranger rape Short term effects: difficulty sleeping, eating, lots of crying, withdrawing from other people, fearful, angry, guilt, confusion (changes in behavior and emotional experience) Long term effects: poor physical health, impact ability to perform sexually, impair relationship with family, partner, other people About 95% of women will meet symptom criteria for PTSD for 2 weeks, but for many, symptoms will go away within a month V. Treatment of Stress Related Disorders A. Treatment of Adjustment Disorders Common treatment is cognitive therapy B. Treatment of PTSD 1. Short term crisis intervention Very brief Focuses on immediate emotional problem Very pragmatic Very active therapist “Here and now” 2. Post disaster debriefing sessions Event experienced by a lot of people (ex: school shooting) Bring therapists/counselors into the community People says it helps them typically (even though there’s not much support) 3. Telephone hotlines Often times volunteers and paraprofessionals People report they have been helpful 4. Medication Used only for intense PTSD symptoms Question about whether medication really helps (research not consistent) Anti-depressants seem effective for depressive symptoms C. Treatment for Rape Counseling Hotlines Victim Advocacy Services: rape crisis center; trained volunteers that accompany a women wherever she needs to go (hospital, police, court)…most volunteers are women who have been previously raped Anxiety Disorders and Obsessive-Compulsive and Related Disorders I. Reorganization of Disorders in the DSM DSM-IV-TR Anxiety Disorders Specific phobia Social phobia Panic disorder Generalized anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder Adjustment Disorders Adjustment disorder DSM-5 Anxiety Disorders Specific phobia Social anxiety disorder Panic disorder Generalized anxiety disorder Obsessive-Compulsive and Related Disorders Obsessive-Compulsive Disorder Trauma- and Stressor- Related Disorders Post-Traumatic Stress Disorder Adjustment Disorder These are the differences that were made from the DSM-IV to the DSM- 5. Social phobia was changed to a different name of Social anxiety disorder, obsessive-compulsive disorder was no longer under anxiety disorders; It became its own category, and a new category was added called trauma- and stressor- related disorders where PTSD and adjustment disorder fall under. II. Terminology A. Fear: basic emotion that: Occurs in response to a perceived threat Is often times adaptive Involves the mobilization of the fight-or-flight response Fear is normal B. Phobia Excessive or unreasonable fear triggered by the presence of a specific object or situation C. Anxiety: blend of emotions that includes: Negative affect Concern about possible threat or danger The sense of being unable to predict or control threat III. Anxiety Disorders A. Specific Phobia Diagnostic Criteria The person has excessive or unreasonable fear or anxiety about a specific object or situation The phobic stimulus almost always provokes immediate fear or anxiety The phobic stimulus is avoided or endured with marked fear or anxiety The fear or anxiety is out of proportion to the actual danger The fear or anxiety typically lasts for 6 or more months The person experiences clinically significant distress or impairment in functioning Subtypes 1. Animal (ex: spiders, snakes, birds) 2. Natural Environment (ex: storm, heights, water) 3. Situational (ex: public transportation, driving a car, crossing a bridge, being in a closed space) 4. Other: anything that doesn’t fit into the other subtypes (ex: choking, fear of falling when walking down stairs) 5. Blood-Injury-Injection (ex: afraid of seeing blood, getting a shot, seeing someone in a wheelchair) Phobic object encountered initial heart rate acceleration dramatic drop in heart rate and blood pressure nausea, dizziness, and/or fainting (only for blood-injury-injection) Demographics and Etiological Factors Those who have a phobia usually have more than one Symptoms typically begin early on; 7-11 is the median age of onset “Waxing and Waning”: symptoms come and go If the phobia persists into adulthood, it’s unlikely to remit without treatment Females are more likely to develop a specific phobia Greater risk if family member has a phobia Those who have a phobia are at increased risk for developing other anxiety and mood disorders Caused by traumatic experience, observing someone else go through a traumatic experience, hearing information from mom or dad B. Social Anxiety Disorder Diagnostic Criteria The person experiences an excessive and unreasonable fear of one or more social or performance situations in which he or she is exposed to unfamiliar people or to possible scrutiny of others The individual fears that he or she will act in a way that will be humiliating or embarrassing Exposure to the feared social situation almost invariably provokes a fear response (exposure always produces fear) The feared social or performance situation is avoided or endured with great distress or anxiety (If individual only demonstrates fear during performance, specifier of performance is tacked onto social anxiety disorder) The fear or anxiety typically lasts for six or more months The person experiences clinically significant distress or impairment in functioning Demographics and Etiological Factors More common in women than men Median age: 13 Significant cases tend to be persistent Someone with this disorder is more likely to drop out of school, have a poorer quality of life, lower socioeconomic group, more likely to be unemployed Can be learned If a family member has it, more likely to develop it Hard to determine whether its genetic or environmental Behavioral Inhibition Behavior inhibition is a temperamental predisposition characterized by shyness and fearfulness; those born with this disposition are at greater risk for developing an anxiety disorder. Behaviorally inhibited infants are easily distressed by unfamiliar stimuli they are increasingly fearful and anxious in childhood they are at risk of developing an anxiety disorder. C. Panic Disorder First we must know what a panic attack is in order to diagnose a panic disorder. Panic Attack (not a diagnosis) Diagnostic Criteria for Panic Attack A discrete period of intense fear or discomfort in which four (or more) of the following symptoms developed abruptly and reached a peak within minutes: 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feeling of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, lightheaded, or faint 9. Chills or hot flashes 10. Paresthesias (numbness or tingling sensations) 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 12. Fear of losing control or going crazy 13. Fear of dying Two Kinds of Panic Attacks 1. Expected: obvious cue with trigger 2. Unexpected: out of the blue (when watching TV or when sleeping Demographic and Etiological Factors -Usually reaches peak within 10 minutes -Usually last about 20-30 minutes (relatively short term) Panic Disorder (actual disorder) Diagnostic Criteria The person experiences recurrent, unexpected panic attacks At least one of the attacks is followed by at least one of the following for a period of at least a month: o Persistent concern or worry about additional attacks or their consequences o A significant maladaptive change in behavior related to the attacks The person experiences clinically significant distress or impairment in functioning Demographics and Etiological Factors Typical age of onset: 20-24 years of age If left untreated, symptoms come and go Chronic (long-lasting) Highly comorbid with other anxiety disorders and mood disorders More common in women than men More common in individuals who have a parent that has it D. Generalized Anxiety Disorder (GAD) Diagnostic Criteria The person experiences excessive anxiety and worry about a number of events or activities for at least a six month period The person finds it difficult to control the worry The person experiences at least three of the following symptoms: o Restlessness or feeling keyed up or on edge o Easily fatigued o Difficulty concentrating o Irritability o Muscle tension o Sleep disturbance The person experiences clinically significant distress or impairment in functioning Demographics and Etiological Factors Median age at onset: 30 years (this onset is later than that for any other anxiety disorder) GAD is generally chronic (long-lasting) with symptoms that wax and wane throughout the lifespan Full remission is unlikely GAD is believed to have a genetic component Behavioral inhibition is an innate temperamental risk factor associated with GAD More common in women than men IV. Obsessive-Compulsive and Related Disorders A. Obsessive-Compulsive Disorder (OCD) Diagnostic Criteria Presence of obsessions, compulsions, or both The obsessions or compulsions are time-consuming (e.g. take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning Demographics and Etiological Factors About 90% of individuals with OCD will experience both obsession and compulsions Range in severity (mild, severe) Average age of onset: 20 years 25% of cases have started by the age of 14 Onset is gradual Tends to be long-term (waxes & wanes) Comorbid with other anxiety disorder and/or mood disorders In adulthood, slightly higher in females than males In childhood/adolescents, OCD is more common in boys than girls Early onset tends to be more severe Tends to be related with individuals getting a divorce Abused individuals are at greater risk for developing There is a genetic component (concordance rate is stronger for monozygotic than dizygotic twins) What are Obsessions and Compulsions? Obsessions Compulsions Recurrent thoughts, impulses, or Repetitive behaviors or mental acts images that: that: Are experienced as intrusive and unwanted The person feels driven to Typically cause marked anxiety perform in response to an obsession or according to rules or distress Are suppressed with some that must be applied rigidly other thought or action Are aimed at preventing distress or some dreaded Most Common Obsessions: event (purpose of engaging in compulsive behavior is to Contamination fears (afraid of getting sick, germs) reduce anxiety) Fear of harming oneself (not Are not connected in any suicidal, doesn’t want to harm realistic way with what they oneself) are designed to neutralize OR are clearly excessive Fear of harming others (as well, doesn’t want to harm others) 5 Primary Compulsive Behaviors: Pathological doubt: abnormal Cleaning Repeated checking concern about having failed to perform a particular action (ex: Repeating (ex: washes hands can’t remember if you locked over and over again) the door) Ordering/Arranging Counting V. Treatment of Anxiety Disorders Some combination of behavioral and cognitive therapy Some conditions are easier to treat than others (specific phobia: shows most improvement) Medication is sometimes helpful when treating short-term effects, but symptoms often reappear. In the long run, improvement is not continuous Exposure therapy: gradually place patient in situations that are potentially more and more frightening to them (can occur in one session) o Participant modeling: therapist will model ways Cognitive therapy: used to treat social anxiety disorder; identify irrational fears Mood Disorders and Suicide I. Mood Episodes (building blocks for the disorder diagnoses) A. Major Depressive Episode (Most common) Diagnostic Criteria Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure o Depressed mood most of the day o Markedly diminished interest or pleasure in all, or almost all, activities most of the day o Significant weight loss when not dieting or weight gain, or decrease or increase in appetite o Insomnia or hypersomnia o Psychomotor agitation or retardation (can’t sit still or act very slowly) o Fatigue or loss of energy o Feelings of worthlessness or excessive or inappropriate guilt o Diminished ability to think or concentrate, or indecisiveness o Recurrent thoughts of death, recurrent suicidal ideation (thinking about suicide), or a suicide attempt The symptoms cause clinically significant distress or impairment in functioning B. Manic Episode Diagnostic Criteria A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week (or any duration if hospitalization is necessary) During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms have persisted and have been present to a significant degree: o Inflated self-esteem or grandiosity o Decreased need for sleep o More talkative than usual or pressure to keep talking (pressured speech) o Flight of ideas or subjective experience that thoughts are racing o Distractibility o Increase in goal-directed activity o Excessive involvement in pleasurable activities that have a high potential for painful consequences (ex: driving too fast, shopping too much, gambling) The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features (delusions & hallucinations) *People having a manic episode experience lability (mood completely changes, is all over the place). People having a manic episode also don’t recognize that they need treatment C. Hypomanic Episode Diagnostic Criteria A distinct period of persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least four days During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms have persisted and have been present to a significant degree: o Inflated self-esteem or grandiosity o Decreased need for sleep o More talkative than usual or pressure to keep talking o Flight of ideas or subjective experience that thoughts are racing o Distractibility o Increase in goal-directed activity o Excessive involvement in pleasurable activities that have a high potential for painful consequences The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features D. Manic Episode and Hypomanic Episode: Differential Diagnosis Similarities: 1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy. 2. During the period of mood disturbance and increased energy or activity, three (or more) of the seven possible symptoms have persisted and have been present to a significant degree. The symptoms for hypomanic and manic episodes are identical. Differences: Manic Episode Hypomanic Episode Duration: the episode Duration: The episode lasts at least one week lasts at least four days Severity: The mood Severity: The mood disturbance is disturbance is not sufficiently severe to sufficiently severe to cause marked cause marked impairment in impairment in functioning, or to functioning, or to necessitate necessitate hospitalization, or to hospitalization, or to involve psychotic involve psychotic features features II. Depressive Disorders A. Persistent Depressive Disorder (Dysthymia) Diagnostic Criteria Depressed mood for most of the day, for more days than not, for at least two years (at least one year for children and adolescents) Presence, while depressed, of two (or more) of the following: o Poor appetite or overeating o Insomnia or hypersomnia o Low energy or fatigue o Low self-esteem o Poor concentration or difficulty making decisions o Feelings of hopelessness There has never been a Manic Episode or a Hypomanic Episode and the criteria have never been met for Cyclothymic Disorder The symptoms cause clinically significant distress or impairments in functioning Other Average duration: 4-5 years Chronic (long-lasting) B. Major Depressive Disorder (Two Kinds) 1. Major Depressive Disorder, Single Episode Diagnostic Criteria Presence of a single Major Depressive Episode There has never been a Manic Episode or a Hypomanic Episode 2. Major Depressive Disorder, Recurrent (Has had a major depressive episode before) Diagnostic Criteria Presence of two or more Major Depressive Episodes There has never been a Manic Episode or a Hypomanic Episode Important Terms within Major Depressive Disorder Double Depression: meets criteria for Dysthymia & Major Depressive Disorder Seasonal Affective Disorder (SAD): experiencing at least 2 major depressive episodes within the same season consecutively (acts as a specifier, for example, Major Depressive Disorder with SAD) Demographics Older people are less likely to develop this Lifetime prevalence is 17% for depression Depression is known as “the common cold” for psychological disorders More common in women than men Episodes are time limited (with no treatment, 40% of individuals start to recover in a 3 month period, 80% start to recover in a year) Course of Major Depressive Disorder The individual meets the diagnostic meets the diagnostic criteria of Major Depressive Disorder, and then can either go into partial remission or full remission. If in partial remission, individual can relapse. If in full remission, individual can either experience recurrence or become healthy. Partial Remission: the individual experiences a period of improvement after an episode during which the criteria of the disorder are only partially fulfilled Full Remission: the individual experiences a period of improvement after an episode during which the criteria of the disorder are not fulfilled Relapse: the individual experiences a return of the symptoms of the Major Depressive Episode within a fairly short period of time Recurrence: the individual experiences a new occurrence of the symptoms of a Major Depressive Episode after a period of full remission (About 80% of cases will experience a 2 ndepisode) Healthy: the individual no longer meets the diagnostic criteria for the disorder C. Depressive Disorders and Pregnancy 1. Baby Blues (50-70% of births): Not a disorder After giving birth, women have a lot of emotional lability (seems to be caused by drop of estrogen, change in hormones) Symptoms will begin within 3-7 days, goes away fairly quickly 2. Major Depressive Disorder with Peripartum Onset (3-6% of births): Developed either while women was pregnant or a month after baby is born In the DSM-IV, it was known as postpartum onset, but in the DSM-5, they have extended the time period Symptoms are the same as major depressive disorder, “Peripartum Onset” is a specifier that can be added on Risk is more common in women who have previously had an episode 3. Major Depressive Disorder with Peripartum Onset and Psychotic Features (0.1-0.2% of births) “Psychotic Features” is another specifier that can be added on Mothers have delusion and hallucinations (ex: hearing commands to kill their child, hearing voices and believing that their child is a devil) Infanticide: term used for when the mother kills the child Risk is more common in women who have previously had an episode III.Bipolar Disorders A. Cyclothymic Disorder Diagnostic Criteria For at least two years, there have been numerous periods with hypomanic and depressive symptoms (one year for child and adolescents) Criteria for a Depressive, Manic, or Hypomanic Episode have never been met The symptoms cause clinically significant distress or impairment in functioning Facts Symptoms of hypomania and depression, but not full-blown episodes Chronic (long-lasting) Can be symptom-free for a period of time, but can’t be more than 2 months or else they wouldn’t have this diagnosis Onset is insidious (unforeseen/unpredictable) Equally common in males and females Less serious version of bipolar disorder B. Bipolar I Disorder Diagnostic Criteria Presence (or history) of one or more Manic Episodes The symptoms cause clinically significant distress or impairment in functioning Facts Mean age of onset: 18 years No gender difference Bipolar disorder used to be called manic depressive illness in the DSM-IV About 90% of those that have a manic episode will experience another mood episode Majority of individuals will become fully functional in between episodes C. Bipolar II Disorder Diagnostic Criteria Presence (or history) of one or more Major Depressive Episodes Presence (or history) of at least one Hypomanic Episode There has never been a Manic Episode The symptoms cause clinically significant distress or impairment in functioning Facts Cases typically begin with a major depressive episode and are often misdiagnosed as depression, but over the course of time, the individual has a hypomanic episode and it is recognized as Bipolar II 5-15% who begin with a diagnosis of Bipolar II will have a manic episode and diagnosis will become Bipolar I No gender difference Typically associated with other disorders, especially anxiety disorders Majority of individuals are fully functional in between episodes D. Bipolar I and Bipolar II: Differential Diagnosis Similarities Difference Recurrent Bipolar I: manic episode (more severe and disabling) Occur equally in males & females Bipolar II: hypomanic (more chronic) Lifetime prevalence rate: equally In Bipolar II, depressive episodes common tend to be more severe than May experience rapid cycling (5- depressive episodes in Bipolar I 10%): experience 4 or more Suicide risk in Bipolar II is higher mood episodes every year DSM-5 states that both disorders (I o Rapid cycling added on as a and II) are equally as serious specifier IV.Causal (Etiological) Factors of Mood Disorders A. Biological Examples: Moderate genetic component in depression In bipolar disorder, the genetic contribution is strongest out of all psychological disorders Neurotransmitters & hormone imbalances B. Psychological Examples: Childhood factors (parents getting divorced) and significant stress are causal factors for mood disorders The most common reason youths go to a mental health center on campus is for depression C. Social Examples: People in a lower socioeconomic group are more likely to develop depression V. Treatment of Mood Disorders A. Drug Therapy Medicine SSRI’s most commonly prescribed class of anti-depressants (Prozac, one of the SSRI’s is the most commonly prescribed drug worldwide) Use mood stabilizing drugs for bipolar (most common: lithium) B. Cognitive Therapy Preferred way of treating depression (pretty effective) C. Electroconvulsive therapy (ECT) Used for severe episodes of depression Last resort VI. Suicide More than ½ who commit suicide are going to do so during a depressive episode or during the recovery phase 90% who either attempt and/or are successful have some kind of psychological disorder at the time In the US, it’s the 8 or 9 leading cause of death Average age for suicidal attempts (don’t succeed): 18-24 years of age Average age for successful suicides: elderly (especially men) Women are more likely to attempt suicide than men Suicide attempts are more likely in those who have been recently divorced or separated Men are significantly more likely to be successful at suicide because women usually take drugs, while men are more proactive (ex: shooting oneself)
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