Wayne State University PSY 3310: Abnormal Psychology Exam 2 Study Guide
Wayne State University PSY 3310: Abnormal Psychology Exam 2 Study Guide PSY 3310
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Study Guide – Exam 2 Multiple Choice (50 Questions worth 100 points) Chapter 7: Mood Disorders and Suicide Types of Mood Episodes: Depressive vs. Manic vs. Hypomanic Mood disorders: gross deviations in mood. Composed of different types of mood “episodes” or periods of depressed or elevated mood lasting for days or weeks. Major Depressive Disorder: Extremely depressed mood and/or loss of pleasure (anhedonia). At least 4 additional physical or cognitive symptoms: indecisiveness, feelings of worthlessness, fatigue, appetite change, restlessness or feeling slowed down, sleep disturbance Manic Disorder: Elevated expansive mood for at least one week Symptoms: Inflated self esteem, decreased need for sleep, excessive talkativeness, flight of ideas or sense that thoughts are racing, easy distractibility, increase in goal directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behaviors. Impairment in normal functioning Hypomanic Disorder: shorter less sever version of manic disorder, lasts at least 4 days, fewer and milder symptoms, associated with less impairment than manic disorder, usually occurs in the context of a more problematic mood disorder Overview and Defining features of: MDD, PDD, Bipolar I, Bipolar II MDD: one or more major depressive episodes separated by periods of remission. Single episode is highly unusual while recurrent episodes are more common. MDD occur as part of the grieving process. PDD: Persistent Depressive Disorder: At least two years of depressive symptoms. Depressed mood most of day, at least 2 depressive symptoms, no more than two months depression free, may include symptoms of more severe major depressive disorders. Types of PDD: mild depressive symptoms without any major depressive episodes, mild depressive symptoms with additional major depressive episodes occurring intermittently, major depressive episode lasting two or more years. Bipolar I: Alternations between full manic episodes and major depressive episodes. Average age 1518, tends to be chronic, can begin in childhood, suicide is a common consequence Bipolar II: Alternations between major depressive and hypomanic episodes. Onset between 19 22 yrs, can begin in childhood, tends to be chronic, 1025% of cases progress to Bipolar I Bipolar Disorder Specifiers: Rapid Cycling: at least 4 episodes (depressive or manic) in a given year. Integrative theory of mood disorders Neurobio: serotonin and endocrine system Serotonin: regulates norepinephrine and dopamine. Mood disorders are related to low levels of serotonin. Permissive hypothesis: low serotonin “permits” other neurotransmitters to vary more widely, increasing vulnerability to depression. Endocrine System: elevated cortisol “stress hormone”, stress hormones decrease neurogenesis in the hippocampus, less able to make new neurons Psychological factors: stress, learned Helplessness, depressive attribution style, cognitive triad Stress: Poorer response to treatment, longer time before remission. Context of life events matter. Geneenvironment correlation: people who are genetically vulnerable to depression are more likely to enter situations that will lead to stress. Strong relationship between stress and bipolar disorder. Learned Helplessness: lack of perceived control over life events leads to decreased attempts to improve own situation. Depressive Attribution Style: Internal attributions: negative outcomes are one’s own fault Stable attributions: believing future negative outcomes will be one’s own fault Global attributions: believing negative events will disrupt many life activities All three domains contribute to a sense of hopelessness. Cognitive Triad: Think negatively about oneself, the world and the future. Treatment SSRIs vs Lithium SSRIs: Selective Serotonin Reuptake Inhibitors, purposefully block reuptake of serotonin, so more is available to the brain. Pose some risk of suicide especially in teenagers and many negative side effects are common. Lithium: Treatment of choice for bipolar disorder. Considered mood stabilizer because it treats both manic and depressive episodes. Toxic in large amounts and effective for only 50% of the patients. o What percentage of people don’t respond to medication 50% of people don’t respond to the medication Electro Convulsive Therapy (ECT) vs. Transcranial Magnetic Stimulation (TMS) Electroconvulsive Therapy: effective for medication resistant depression. Brief electric shock is applied to the brain and results in temporary seizures. Usually 610 outpatient treatments are required. Side effects include short term memory loss which is usually restored, with some patients suffering long term memory loss. Transcranial Magnetic Stimulation (TMS): uses magnets to generate a precise localized electromagnetic pulse. Few side effects include occasional headaches. Can be combined with other medications. Less effective than ECT for medicationresistant depression. Psychosocial treatments: CBT and Interpersonal therapy (couldn’t find much info) o Know their view of mental illness and their common treatments CBT: Addresses cognitive errors in thinking, also includes behavioral component Interpersonal Therapy: Main focus is to improve problematic relationships, social skills o Psychological tradition: moral therapy, psychoanalytic theory, humanistic theory, behavioral model Medication, usually Lithium, is first line of defense. Psychotherapy is helpful in managing the problems (interpersonal, occupational) which accompany bipolar disorder. Family therapy can be helpful. Suicide Gender differences, risk factors, suicide contagion 11 leading cause of death in USA, common in whites and native americans. Particularly nd prevalent in young adults: third leading cause of death in teenagers, 2 leading cause of death in college students, 12% of college students consider suicide in a given year. Gender differences: Males complete more suicides than females while females attempt more suicides than males. This is because males’ methods are more lethal. Exception in China where suicide is more common amongst females as suicides are seen as an honorable solution to problems. Risk Factors: suicide in families, low serotonin levels, preexisting psychological disorder, alcohol use and abuse, stressful life event, especially humiliation, past suicidal behavior and plan and access to lethal methods. Suicide Contagion: Some research indicates that a person is more likely to commit suicide after hearing about someone else committing suicide. Media accounts may worsen the problem by romanticizing suicide and describing lethal methods used to commit suicide. Chapter 8: Eating and Sleep Wake Disorders Bulimia nervosa vs. anorexia nervosa vs. binge eating disorder Know the hallmarks and defining features of each. Know the treatments for each All disorders share a severe disruption in eating behavior. Weight and shape have a disproportionate view on self concept and many have fear of gaining weight. Overwhelmingly all encompassing drive to be thin strong Western cultural origins. Bulimia Nervosa: Reccurent Binge Eating(hallmark of binge eating disorder and bulimia nervosa):eating excessive amounts of food in discrete amounts of time, eating is uncontrollable (may be associated with guilt, shame or regret and may hide behavior from family members), consumed foods are often high in sugars and carbohydrates. Recurrent Compensatory behaviors: designed to make up for binge eating and prevent weight gain. Purging: commonly self induced vomiting or laxative/diuretic use, excessive exercise, fasting or food restriction. Binging and compensatory behaviors occur at least once a week for 3 months. Associated features: Most are within 10% of normal body weight. Purging behaviors may result in many severe medical problems including tooth decay, kidney failure, electrolyte imbalance,etc Most are overly concerned with body shape/fear of gaining weight. Most have comorbid psychological disorders such as anxiety and mood disorders. Treatments of Bulimia: Cognitive Behavioral Therapies (CBT) are the treatment of choice. 1.) Psychoeducation on physical consequences of binging, purging, etc. 2.) Start eating small manageable amounts of food frequently throughout the day. 3.) challenge maladaptive thoughts/attitudes about body weight. 4.) teach coping strategies about resisting the impulse to binge/purge. Anitdepressents can help reduce binging and purging behaviors but not effective in the long run. Anorexia Nervosa: Hallmarks: Extreme weight loss. A.) Restriction of energy intake relative to environments, leading to sig. low body weight in context of age, sex, development, and physical health. B.) Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain. C.) Disturbance in the way in which one’s body weight or shape is experienced. Two subtypes of Anorexia Nervosa: Restricting type: during last 3 months, individual has not engaged in purging or binge eating behavior. Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. Binge eating/purging: during last 3 months, individual has engaged in binge eating/purging. Associated Features: Most show marked disturbance in body image, most are comorbid with other psychological disorders (71% have depression at some point in life), AN is most deadly mental disorder, starving body sucks energy from organs leading to organ damage, most serious is cardiac damage which can lead to heart attack and death. Psychological Treatment for Anorexia: weight restoration, psychoeducation, behavioral and cognitive interventions, treatment involves entire family. Binge Eating Disorder: binge eating without compensatory behaviors, associated with distress and/or functional impairment. Associated Features: Many people with binge eating disorder are obese. Some, but not all have concerns about shape and weight. They are often older than bulimics and anorexics and have more psychopathology than non binging obese people. Treatments for Binge Eating Disorder: CBTs, interpersonal psychotherapy, selfhelp strategies Sleep Dyssomnias vs parasomnias Dyssomnias: difficulties in amount, quality or timing of sleep Parasomnias: abnormal behaviors and physiological events during sleep Overview and defining feats of: insomnia disorder, hypersomnolence disorder, narcolepsy, sleep apnea Insomnia: one of most common sleep disorders, problems falling asleep/maintaining sleep or early morning awakening with inability to fall back asleep. Fatal insomnia is a degenerative brain disorder which leads to total lack of sleep and death. Occurs at least 3 times a week. Only diagnosed as sleep disorder if not diagnosed better as something else (ex. Generalized anxiety disorder). Affects females twice as much as males. Unrealistic expectations about sleep. Believe that lack of sleep will be more harmful than it is. Hypersomnolence Disorder: Sleeping too much or excessive sleep which can become a problem. Complain of sleepiness throughout the day yet able to sleep through the night. Narcolepsy: Recurrent intense need for sleep, lapses into sleep or napping. Usually accompanied by at least one: cataplexy (loss of muscle tone), hypocretin deficieny, going into REM sleep abnormall fast). Rare, equal between males and females, onset during adolescence and typically improves over time. Sleep paralysesbrief period after waking where one cannot move/speak. Hypnagogic Hallucinations: extremely vivid dreams (include sounds, movement) Sleep Apnea: Difficulty/cessation in breathing during sleep. More common in males and associated with obesity and increasing age. Often snore/sweat during sleep and wake frequently. May experience episodes of falling asleep during the day. Treatments: Medical treatments vs. CBTI vs. relaxation and stress reduction Medical treatments for Insomnia: Benzodiazepines and over the counter sleep medications. Prolonged use can cause dependence and rebound insomnia. Best as short term solution. Medical treatments for hypersomnia and narcolepsy: stimulants (Ritalin), cataplexy is usually treated with antidepressants. Medical Treatments for breathing related sleep disorders: may include medications, weight loss, or mechanical devices. Psych treatments: CBTs, psychoeducation about sleep, changing beliefs about sleep, extensive monitoring using sleep diary, practicing better sleep habits Relaxation and stress reduction, stimulus control procedures. Nature of Parasomnias: Problem is not with sleep itself but with abnormal behaviors that occur during sleep or shortly after waking. Two classes: those which occur during REM and those which occur during nonREM. Incidence of eating and sleeping disorders are increasing and more effective treatments are needed. Chapter 9: Physical Disorders and Health Psychology What is health psychology? A part of behavioral medicine: which applies behavioral science to preventing, diagnosing, and treating medical problems. Health psychology studies psychological factors that promote and maintain good health. Not interdisciplinary. 2 paths psychosocial factors influence medical illness 1.) Psychosocial factors (such as negative emotions and stress) disrupt basic biological processes which may lead to physical disorders and disease. 2.) Risky behaviors (such as smoking, alcohol) cause or contribute to a variety of physical disorders or disease. Stress Selye (1936): General adaptation syndrome Proposed that body goes through several stages in response to sustained stress Phase 1: alarm response (sympathetic arousal) Phase 2: resistance (mobilized coping and action) Phase 3: exhaustion (chronic tress, permanent damage) Was correct that chronic stress can lead to permanent bodily damage and contribute to disease. How does chronic stress impact the HPAstress response cycle? The hippocampus helps to turn off the HPA cycle and stress response. Chronic stress my damage cells in the hippocampus which interferes with the stopping of the HPA loop and thus the hippocampus becomes less effective at shutting off the stress response. Social influences on stress o Know about the primate study High resting cortisol associated with low social status and low resting cortisol associated with high social status. During emergencies, high social status baboons’ cortisol rose more quickly. Low status HPA system is less sensitive because continuously produce cortisol. Low social statusfewer lymphocytes (immune suppression). When multiple baboons at the top competing for supremacyhad hormone levels similar to subordinate. The key is a sense of control and predictability. Stress and the immune system o What is psychoneuroimmunology? Studying the psychological functions contributing to the neurobiological influence on immune system. o Studies by Cohen Stress dramatically and quickly alters immune function Gave participants dosages of cold virus and discovered that: Sickness directly related to the amount of stress in the past year Sickness was inversely related to the quantity and quality of social relationships. Positive and optimistic cognitive style protects against developing the cold. Autoimmune disease: immune system is over reactive and attacks body’s own cellsless able to fight off external threats. Disease Treatment of AIDS and Cancer and Chronic Pain o Cognitive behavioral stress management High stress and low support system speeds disease progression. Reduce stress=improve immune system functioning and disease progression. Lower anxiety, stress, anger and depression. Higher T cell levels and decreased viral load. o Psychedelic psychotherapy o Pain: psychological and social factors, phantom limb and mirror treatment Perceived control over pain and its consequences, negative emotion, poor coping skills, low support, potential compensation. Social reinforcement for pain. Phantom Limb Pain: extreme pain in lost limbs, person is aware that the limb is amputated, treatment: uses mirrors to alter sensory cortex. o Biofeedback: Patient learns to notice and control bodily responses. Used with chronic headache and hypertension. Relaxation and meditation, progressive muscle relaxation Chapter 10: Sexual Disorders, Gender Dysphoria, and Paraphillic Disorders Know the phases of sexual activity Desire: sexual urges occur in response to sexual cues or fantasies Arousal: A subjective stage of sexual pleasure and physiological signs of sexual arousal. Ex. Blood pools to penis and vaginal wall, etc. Plateau: Brief period before orgasm occurs. Orgasm: In males, feelings of inevitability of ejaculation, followed by ejaculation. In females, contractions of the walls of the lower third of the vagina. Resolution: decrease in arousal after orgasm, occurs particularly in men Know the differences between the following disorders o Male hypoactive sexual desire disorder; female sexual interest/arousal disorder; female orgasmic disorder; premature ejaculation; erectile disorder; genitopelvic pain penetration disorder Male hypoactive sexual desire disorder: little or no interest in any type of sexual activity. Masturbation, sexual fantasies and intercourse are very rare. Accounts for half the complaints at a sexuality clinic, affects 5% of males and increases with age. Female sexual interest/arousal disorder: Lack of significantly reduced sexual arousal/interest typically manifesting in: reduced sexual interest, reduced sexual activity, fewer sexual thoughts, reduced arousal to sexual cues, reduced pleasure or sensations during almost all sexual encounters. Affects 2240% of women, reduces with age. Female orgasmic disorder: marked delay, absence, or decreased intensity of orgasm in almost all sexual encounters. Not explained by relationship distress or significant stressors. 1 in 4 women have significant difficulty in achieving orgasm. Premature ejaculation: ejaculation occurring within 1 minute of penetration and before it is desired. Most prevalent sexual dysfunction in adult males, affects 21% of adult males, most common in younger inexperienced males and declines with age. Genitopelvic pain penetration disorder: in females, difficulty in vaginal intercourse associated with one or more of the following: pain during intercourse or penetration attempts, fear/anxiety about pain during sexual intercourse, tensing of pelvic floor muscles in anticipation of sexual activity. Erectile Disorder: difficulty achieving or maintaining an erection. Sexual desire is usually intact. Most common problem for which men seek treatment. Prevalence increases with age and 60% of men over 60 experience erectile dysfunction. Causes Psychological contributions to these disorders People with sexual dysfunctions are more likely to experience anxiety and negative thoughts about sexual encounters. May actively avoid awareness of sexual cues, so not in touch with their own sexual response. Social/cultural contributions: Erotophobia: learned negative attitudes about sexuality. Negative or traumatic sexual experiences. Deterioration of interpersonal relationships, lack of communication. Treatment Masters and Johnson’s treatment: education, sensate focus, nondemand pleasuring Education alone can be surprisingly effective. Focuses on education about foreplay, sexual response, etc. Sensate focus and non demand pleasuring: sexual activity with the goal of focusing on sensations without trying to achieve orgasm or even erection. Decreases performance anxiety. Additional Psychosocial Treatments: Squeeze techniquepremature ejaculation. Masturbatory training – female orgasm disorder. Use of dilators – genitopelvic pain/penetration disorder. Exposure to erotic material – low sexual desire problems Paraphilic disorders Know the general clinical description Misplaced sexual attraction or arousal. Focused on inappropriate people or objects. Often multiple paraphilic patterns of arousal. High comorbidity with anxiety, mood, and substance use disorders. Manifests in fantasies, urges, arousals or behaviors. o When are they considered disorders?? Only considered disorder when the individual experiences clinically significant distress or impairment or threatens to harm others. Know the object of sexual attraction for each (Study the yellow chart!) Fetishistic disorder: sexual attraction to an inanimate object such as a body part Frotteuristic Disorder: pattern or seeking sexual arousal by rubbing up against unwilling others. Often occurs in crowds or confined spaces where the other person cannot escape. Voyeurism: sexual arousal from observing unsuspecting individual undressing, naked or engaged in sexual activity. And risk associated with “peeping” may intensify arousal. Exhibitionism: Arousal of genitals to unsuspecting others. Element of thrill or risk is necessary for sexual arousal. Transvestic disorder: pleasure from crossdressing. Only considered disordered if causes significant distress or impairment. Sadism: inflicting pain for arousal Masochism: suffering pain or humiliation to attain sexual gratification. Rapists: some rapists are sadists, but most are not. Mostly done for power. Most rapists don’t show paraphilic patterns of arousal. Rapists tend to show sexual arousal to violent sexual and nonsexual material. Pedophilia: sexual attraction to prepubescent children. Vast majority of sufferers are male and many sufferers do not act on their desires and some instead engage in moral compensatory behaviors. For some, pedophilic urges are limited to incest (members of one’s own family) Associated features of pedophilia: incestuous males may be aroused by adult females, while most pedophiles are not usually aroused by adult women. Some rationalize the behavior by considering it to be an act of affection or a teaching experience. Treatment Most psychosocial interventions are behavioral. o Covert sensitization Imagining aversive consequences to form negative associations with deviant behavior (ex. Pedophilia) o Orgasmic reconditioning Masturbation to appropriate (adult) stimuli Gender dysphoria What is it? Trapped in the body of the wrong sex and have a desire to assume the identity of the desired sex. The goal is not sexual. Causes are unclear with gender identity developing around 18mo.3yrs. of age. How is it treated? What’s the success of these treatments? Sex reassignment surgery: must be psychologically/socially/financially stable and live as desired gender for several years. 75% report satisfaction with new identity. Female to male conversions adjust better. Chapter 11: SubstanceRelated, Addictive and ImpulseControl Disorders Key Terms Psychoactive substances; substance use/intoxication/abuse Substance use: Taking moderate amounts of substance in a way that doesn’t interfere with functioning. Substance intoxication: physical reaction to a substance (ex. Being drunk, getting high) Substance abuse: use in a way that is dangerous or causes substantial impairment (ex. Affecting jobs and relationships) Substance dependence: sometimes defined as drug seeking behaviors (ex. Spending too much money on substance) May be defined as physiological dependence (tolerance and withdrawal). o Withdrawal vs. Tolerance Tolerance: Needing more of a substance to get the same effect/reduced effects from the same amount. Withdrawal: physical symptom reaction when substance is discontinued after regular use. Substance use disorders Diagnostic history of substance use disorders Evolution of the DSM’s conceptualization Early DSM: characterized as “sociopathic personality disturbances”, a symptom of other disorders and considered a moral weakness. DSM III: Separate category for substance abuse disorders. Began to acknowledge the complex bio/psych/social influences. DSM IV: Had substance abuse and substance dependence as separate categories. DSM V: Now spells out criteria as: substance intoxication for different types of substances, substance use disorders for different types of substances, and withdrawal from different types of substances. 5 main categories of substances defined in the DSM Depressants: behavioral sedation (alcohol, sedative, anxiolytic drugs) Psychological and physiological effects of alcohol: central nervous system depressant. Influences several neurotransmitter systems, specific target is GABAincreases inhibitory effects and makes neural cells worse at firing. Glutamate systemimportant in learning and memory and may lead to blackouts. Stimulants: increase alertness and elevate mood. Opiates: produce analgesia and euphoria (ex. Heroine, morphine and codeine) Hallucinogens: alter sensory perception (ex. Marijuana, LSD) Other drugs of abuse: include inhalants, anabolic steroids, and medications o Depressants vs. Stimulants: NT targeted and their effect on CNS Alcohol Related Disorders: Effects of chronic alcohol use: withdrawal: delirium tremenshallucinations and body tremors. Associated brain conditions are dementia and the WernickeKorsakoff syndromeconfusion, loss of muscle coordination, unintelligible speech, dementia. Fetal Alcohol Syndrome: developmental problems due to mother’s consumption of alcohol when the child is in the womb. Alcohol Facts and Statistics: most Americans consider themselves light drinkers. Alcohol use is highest among Caucasian Americans and males abuse alcohol more than females, 23% of Americans report binge drinking, and violence is associated with alcohol. Sedative, Hypnotic or Anxiolytic Related Disorders: sedativescalming, hypnoticsleep inducing, and anxiolyticanxiety reducing. Effects are similar to large doses of alcohol, all exert their effects via the GABA neurotransmitter system, DSM criteria for this disorder is the same as other classes of drugs. Stimulants: most widely consume drug in US, increase alertness and energy and examples include cocaine, amphetamines, nicotine and caffeine. Stimulant intoxication means recent stimulant use leading to significant impairment or psychological changes. Amphetamine Use Disorder: effectsproduce elation, vigor, reduce fatigue. Such effects are usually followed by extreme fatigue and depression. Stimulate CNS by enhancing the release of norepinephrine or dopamine and reuptake is subsequently blocked. Some ADHD drugs such as Ritalin and aderall are mild stimulants. Ecstasy and crystal meth have amphetamine effects but without the crash and have a high risk of dependence. Cocaine Related Disorders: short lived sensations of elation, vigor, reduce fatigue, effects result from blocking reuptake of dopamine. Highly addictive but develops over the year. Most cycle through patterns of tolerance and withdrawal which is characterized by apathy and boredom and leads to the desire to use again. NicotineRelated Disorders: Causes Pleasure pathway Role of positive and negative reinforcement; opponent process theory 2 traditional societal views about drug abuse Treatment agonist vs antagonist treatment Aversive treatment Is inpatient treatment better than outpatient? Controlled use vs. complete abstinenct o Harm reduction: Video of Vancouver needle exchange program for heroine addicts What is contingency management? Motivational enhancement therapy o Stages of change o Meeting client where they are
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