Exam 3 notes
Popular in Abnormal Psychology
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Date Created: 02/17/15
Bipolar 10232014 Bipolar implies alternating between mania and depression hence syndrome formerly known as quotmanicdepression One manic episode is sufficient for bipolar diagnosis even if no history of depression 0 symptoms of mania but less severe amp no functional impairment 0 symptoms of both mania depression simultaneously Bipolar Subtypes o mania with or without depression history 0 hypomania with depression history 0 mania induced by drugs antidepressants stimulants ect o Informal diagnosis Not in DSM o Mania is only triggered after in jesting drugs that are known to trigger manic behavior like antidepressants o Takes a few weeks or a month or two typically o Says that this person may have never been bipolar if they never would have started taking these antidepressants Bipolar Facts 0 Antidepressant use has increased 0 Substance abuse habits have increased 0 1 Contrast when someone experiences from hypomania to depression is profound o 2 People with bipolar are often impulsive More inclined to act on suicidal impulsesthoughts o 3 Mixed Episode Depression and mania at the same time Means they have agonysad mood of depression and also agitated energy of mania Have lots of energy to act on their depression 0 When bipolar people go into a Mixed state they are at a HUGE risk of suicide 0 Usually takes a longtime of being diagnosed with bipolar for this to happen Vast majority will try to selfmedicate with something Usually start with alcohol or weed Bipolar is being treated with antipsychotic medication more increasingly These meds are the most pro table and the most expensive Insurance usually pays for them As a result they are relentlessly pushed by drug companies Every company that makes these has been ned hundreds of millions of dollars by US government for illegally marketing these medications These drugs have never been approved for the usage by children or teens BUT they are still some of the main users of these drugs today Abilify doesn t seem to have the same negative effects of the other drugs that could potentially shorten lifespan with chronic use 00 Very different prognosis from what it used to be Increasingly difficult for them to be productive at old age Mood stabilizing Medicates slow down rate of signaling in neural circuits throughout the brain Many report its like being held under water being slowed down Kay Jamison Bipolar patients who seem to do better are typically on low doses of medication rather than higher doses of several different meds o Divergent Thinking starting from what s given and making connectionslinks that most people wouldn t make Michelangelo Beethoven Byron Coleridge Emerson Schumann Tolstoy Abraham Lincoln Dickens Mark Twain van Gogh Faulkner Hemingway Brian Wilson Kurt Cobain Russell Brand Robin Williams 0 Novel Antipsychotics Risperdal Zyprexa Seroquel Geodon Abilify Have been linked to brain shrinkage Abilify doesn t seem to have the same negative effects of the other drugs that could potentially shorten lifespan These drugs have never been approved for the usage by children or teens BUT they are still some of the main users of these drugs today When bipolar patients are depressed their dopamine signaling is very low When they re manic or hypomanic dopamine signaling is off of the charts To diagnose someone with mania all the symptoms must be present for at least a week Depressive episodes are about 3 times as common as manic or hypomanic episodes Mood stabilizing medications aren t as effective when it comes to depression but much more affective when it comes to mania Not hard to slow down the brain Much harder to keep someone from being depressed Bipolar individuals are extremely sensitive to light Too much light can send someone into full blown mania Bipolar Caus s Very strong genetic contribution heritability quotient gt70 Most have rstdegree relative with bipolarmajor depression Excessive amygdala reactivity intensity of emotion Dopamine circuitry activationarousal goaldirectedreward based Frontal cortexglutamate mania eftgtright depression left ltright 0 Over 90 of neurons in the brain have some involvement with glutamate Triggers for maniahypomania sleep deprivation major life events 0 Pulling an all nighters being jet lagged are extremely dangerous quotKindling hypothesesquot episode of depressionmania is neurotoxin episodes get more severe last longer more easily triggered Rapid cycling ultrarapid cycling 0 Have to have 4 episodes to be rapid cycling Stress is a trigger for mania or depression it can be even be good stress 0 People with bipolar when they re dreams come true or have a huge achievementaccomplishment that can trigger their mania 0 Have to be aware that anything that takes them out of their routine can put them in danger of their mania being triggered 0 Life stress can also be a trigger for depression not in bipolar For regular unipolar depression Anything that stresses the brain can be a trigger for any psychiatric disorder Stress management is a huge factor for preventing relapse Bipolar Treatment 0 1 Lithium 1 year full remission rate 3050 not much higher than placebo 0 turns down neural ring o in low doses it seems to have very mild mood stabilizing effects Kinda chills people ut 0 Recent study found that in communities where there are higher levels of lithium in people s natural drinking water there are lower levels of depression bipolar and suicide Commonly found in natural spring water 0 Lots of side effects Lithium tremor Excessive thirst sweat O o 2 Depakote 1 yearfull remission rate 3050 o 3 Other anticonvulsants Lamictal Trileptal Topamax 0 Help reduce neural ring to prevent seizures 0 Most bene cial of these is LAMICTAL o A Omega3s EPA effective for bipolar depression higher dose 2000 6000 mgday 0 Not effective for mania Higher dose than normal depression is useful B Magnesium antimanic antianxiety antiinsomnia typically 200 600 mgday Trace element is found in food water 0 Has all crucial roles in the brain like 0 1 glutamate major excitatory NT in brain and magnesium sits right at the glutamate receptor site and regulates it so it does get 39red hot39 or out of control 0 2 CRH stress response magnesium helps regulate CRH release when we are more de cient we are more vulnerable to manic episodes 0 3 Green leafy vegetables most Americans are de cient So you should supplement a Check with doctor b It makes you sleepy for several hours c Potent laxative C Psychotherapy o Miklowitz39 Family Focused Therapy FFT may cut relapse risk in half The Bipolar Disorder Survival Guide 0 1 Reduces stress with family and friends D Chronotherapy dawn simulation therapy and temporary sleep deprivation to shift circadian rhythm E No MONEY to fund that research Anxiety Disorders Panic disorder Agoraphobia Speci c Phobia Social Phobia Obsessive Compulsive Disorder 0CD Post Traumatic Stress Disorder PTSD What is anxiety Biologicaly Activation of sympathetic nervous system SNS runs on noradrenalineadrenaline gets you active and alert to threat Works together with parasympathetic nervous system this puts you back to homeostasis and stops the adrenaline rush quotFIGHT OR FLIGHTquot Vasovagal Re ex primary nerve from brain to the rest of body and visceral organs is the Vagus Nerve So when we are really aroused and puts the brakes on everything At the sight of blood especially our own The Vasovagal re ex will drop our blood pressure because it will slow blood ow and help clot Some have a very high vasovagal re ex and they pass out This is part of the parasympathetic nervous system SNS is regulated by brain circuits that include Prefrontal cortex perception of threat Amygdala primitive appraisal fear circuit nexus assigns emotional signi cance Hypothalamus triggers quot ght or ightquot response Fight Flight Feeding Reproduction Locus coeruleus way down in the brainstem directly controls SNS Anxiety is a battle between all of these quot Cognitivey Perception of threat something bad might happen Narrowing of attention Interpretive bias Rumination Anxiety Disorders Panic disorder Agoraphobia Speci c Phobia Social Phobia Obsessive Compulsive Disorder 0CD Post Traumatic Stress Disorder PTSD What is anxiety 0 A Activation of sympathetic nervous system SNS runs on noradrenalinadrenaline gets you active and alert to threat 1 Works together with parasympathetic nervous system this puts you back to homeostasis and stops the adrenaline rush 2 quotFIGHT OR FLIGHTquot n alarm is going off but nothing is really going on 3 Vasovagal Re ex primary nerve from brain to the rest of body and visceral organs is the Vagus Nerve So when we are really aroused and puts the brakes on everything a At the sight of blood especially our own The Vasovagal re ex will drop our blood pressure because it will slow blood ow and help clot n b Some have a very high vasovagal re ex and they pass out n c This is part of the parasympathetic nervous system 0 B SNS is regulated by brain circuits that include 1 Prefrontal cortex perception of threat 2 Amygdala primitive appraisal fear circuit nexus assigns emotional signi cance 3 Hypothalamus triggers quot ght or ightquot response a a Fight a b Flight n c Feeding n d Reproduction 4 Locus coeruleus way down in the brainstem directly controls SNS 5 Anxiety is a battle between all of these quot OOOOO Perception of threat something bad might happen Narrowing of attention Interpretive bias Rumination o Motoragitation o Harmrisk avoidance 0 Anxiety quotthreatening event MAY occurquot 0 Panic quotthreatening event 5 occurringquot 0 Body s adaptive alarm response ght or ight but it s a false alarm no genuine danger present Can occur in any anxiety disorder Exaggerated reaction to something you re afraid of DMS Diagnostic Symptoms n 1 Palpitations pounding heart or accelerated heart rate a 2 Sweating n 3 Tremling or shaking 8 9 Sensations of shortness of breath or smothering o hyperventaliating and they don t know it Feeling of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy unsteady lightheaded or faint Derealization feeling of unreality or depersonalization being detached from oneself two major varieties of Dissociation splitting off part of your conscious awareness or perception o Derealization this is not real life Things feel dreamlike Altered sense of time 0 Been suggested that in the face of danger it s an adaptive response YerkesDodson Law Inverse correlation with performance and arousal Peak level in most situations that isn t too low and isn t too high If your level of arousal is too high mist dissociate n 10 Fear of losing control or going crazy n 11 Fear of dying a 12 Paresthesias numbness or tingling sensations n 13 Chills or hot ushes Just having one panic attack doesn t make you diagnosable for panic disorder 0 Recurrent unexpected panic attacks false alarms lasting one moth or longer Not the same thing as Panic Attack Someone who is tormented by unexpected panic attacks that keep happening 0 Prevalence of panic disorder 0 5 of adult population 0 Gender ration FM 21 0 Doesn t mean guys don t have it o This gender ration exists for every anxiety disorder EXCEPT for 0CD This one is more equal Comorbid diagnoses O O a Depression b Alcohol abusedependence majority of people with panic disorder if it doesn t get treated will eventually become depressed People try to selfmedicate with alcohol and drugs Hypothesized causes of Panic Disorder A Medical Model 00 0 Monitor level of oxygen in your blood If you re oxygen levels get low carbon dioxide levels get high Have receptors that monitor carbon dioxide If it gets too high then they say breathing must have stopped or is about to stop we should trigger the suffocation alarm This triggers fullblown panic response We we stop breathing and carbon dioxide builds up in the blood the acidity in blood goes up There are receptors in the amygdala that detect how acidic your blood is When they see this level go up they start to freak out too 0 Lactate acid to make blood more acidic This can cause them to have full blown panic attack 0 Genetic contribution B Cognitivebehavioral model 0 Revised lactate infusion challenge cognition matters 0 Panic results from faulty learning maladaptive thoughts o 1 Patients misinterpret body sensations interceptive cues think they re about to have an attack because something in their body tells them they are even if they re really not 0 2 Catastrophic thoughts lead to panic o 3 Modify thoughts reduce panic o 4 Exposure to interceptive cues extinction of conditioned alarms panic attack is a false alarm that has been classically conditioned o In most anxiety disorders Cognitive Behavioral Therapy has the highest longterm success rate out of any form of treatment o No matter the stimulus if we are continually exposed our response diminishes 0 To make optimal exposure you have to start off by putting them in fully catastrophic exposure Slow and steady Have to keep attention completely focused on anxiety reducing stimulus Want you making it as bad as you possibly can Most people after about 1530 minutes amygdala hypothalamus start to calm down Realize it s not a huge threat Amygdala realizes this and the level of anxiety drops 0 Does this last a lifetime Success rate for exposure for phobias in the short term is over 90 In the long term there s a chance for spontaneous recovery If we re not careful the person may start to unknowingly avoid anxious situations and all of the treatment will essentially go out of the window Need to make sure to constantly make an effort to expose yourself to phobias quotllardi rulequot of anxiety 0 nontraumatic exposure always makes it better and avoidance always makes it worse 12 of people with panic disorder end up with depression StressEnvironmental Triggers lnteroceptive Cues Catastrophic Thoughts PANIC alarm Noctornal Panic Waking up in the middle of the night and having a panic Treatment for Panic Disorder A Drug Treatment 0 Prozac Paxil Zoloft Celexa Lexapro o EffexorPristiq Cymbalta o SSRISNRIimipramine 60 acute efficiency 40 for placebo high relapse risk 30 recovered at 1year 0 Biggest study of antidepressants vs therapy for panic found that Rate of recovery on antidepressant had no advantage of rate of recovery on placebo o Tranquilizers immediate relief but addictive very high relapse 1 Hit neurotransmitters for GABA very strongly This is the major inhibitor in the brain Causes an instant chilling out effect 2 Hit GABA neurons that feed into other neurons that feed into our brains rewardpleasure circuits Motivational circuits that light up when we do something that is supposed to be rewarding and pleasurable Ramp up activity in our brains pleasure centers Circuits that run on Dopamine Every addictive substance light up the brains reward centers Terribly high rate of relapse 0 Single most widely prescribed psych med in the US is Xanax Also one of the most addictive potentiay destructive meds ever prescribed Not every person that takes it becomes addicted or ends up with bad side affects I Benzodiazepine Fact Sheet Xanax Ativan Klonopin Valium o 90 million prescriptions per year Xanax 1 bestselling psych drug 0 Highly addictive light up brain s reward centers 0 Important side effects 0 Sedation Impaired memory concentration reasoning Motor incoordinationimpairment Reduced insight patient unaware of impairment Loss of restorative phase of sleep slowwave Can trigger depression Increased dementia risk latest study gt50 Painful withdrawal syndrome Jill was put on Klonopin Told her it wasn t addictive and she should be ne on it Psychiatrist increased her dosage over time and as he did her ability to function decreased Got told she was Bipolar and was put on Abilify and hospitalized Tried to come off of Klonopin but suffered awful withdrawal symptoms OOOOOOO CDNOWU39lbULJNI I None of them are currently Paton protected All available in generics Drug companies aren t making a ton of money from these for this reason 0 These meds are very effective for people in the short term Most people who take them within an hour they feel dramatically less anxious Taken everyday bene t of the meds goes away 0 Reports that it s easier to come off of Heroin than to come off of a Benzo Prescribed so much because they do work well in the short term Doctors often think they re short term drugs and not long term ones o The shorter the half life in the body the more addictive The longer the half life the more addictive 0 Longterm use potential brain damage GABA receptors hippocampus o B Psychological Treatments CBT appears to be treatment of choice gt12 outcome studies 0 Exposure habituation to feared stimuli extinction of conditioned alarms 0 Modify irrational catastrophic thoughts 0 75 acute ef cacy 50 recovered at 2year follow up Agoraphobia o Literally means quotfear of the market 0 In severe cases the person may become completely homebound 0 Panic with agoraphobia considerably more difficult to treat 0 Effective treatment for agoraphobia graded exposure hierarchy Roughly 12 0 all Panic patients end up with this Example graded exposure hierarchy case study Driving on interstate rush hour alone Driving on interstate 7pm alone Driving on 4Iane road alone Drive on 4Iane road with spouse Backing down driveway Sitting in driver s seat with engine running Sitting in driver s seat with key in ignition engine off Speci c Phobia Eg snakes spiders other animals heights water blood needles 0 Speci c Phobia Lifetime Prevalence 125 Natl Comorbidity Survey Hypothesized causes of speci c phobia Biological model preparedness hypothesis Mineka s studies also genetic vulnerability h30 0 We ve been shaped by natural selection to be afraid of certain things when we come out of the womb o worked with monkeys and showed them lm clips of adults reacting fearfully to a rubber snake or rubber duck Able to show that a single exposure to the sight of adults reacting fearfully is enough to make the baby monkey afraid of the same thing 0 Some of us seem to be genetically vulnerable to picking up phobias and some seem to be genetically resilient Psychodynamic model phobic object is symbol of inner con ict Behavioral model classical conditioning 0 Turns out that the core active ingredient in treatment for anxiety disorder includes some behavior disorder Anxiety disorders as a group the only set of disorders for where psychotherapy is clearly the treatment of choice over any medicine 0 0 Cognitive observational learning 0 We see someone else experiencing something and then make interpretations of that 0 When little kids observe their parents reacting fearfully to something they usually start acting the same way 0 Treatment 0 Exposure 90 cure rate 0 sadly only 12 of practicing therapists have training in exposure 0 KC Treatment of Anxiety Clinic 0 No drug treatments even come close not widely used 0 promotes formation of new memories faster therapy 0 If you take it and can tolerate it you learn things faster Nearly 1 in 3 Americans will meet diagnostic criteria for one of these anxiety disorders Social Anxiety Disorder Intense fear of embarrassment andor humiliation 0 Usually these people have always been shy o BUT just because someone is introverted doesn t mean they have social anxiety 0 Estimated prevalence 12 lifetime 0 Two subtypes o 1 Performancelinked public speaking singing tests sports ect Anxious when they have to perform in public Roughly 70 of population report some form of anxiety when it comes to speaking in front of strangers Treat like any other phobia with graded exposure OR use beta blocker medication a Beta blockers block adrenaline Some self medicate with alcohol or drugs but they don t help because they interfere with performance Flooding taking exposure to the extreme right away Has a lot of downsides but if they can handle it they have a higher chance of getting better 2 Generalized pervasive social anxiety 0 a Role of serotonin signaling social drive error detection 0 B Rumination Largely driven in the moment by this Over themes of defectiveness rejection low self esteem awkwardness o 1 Cognitivebehavior therapy CBT 4060 response 75 in Clarks Clark developed something that focuses on helping socially anxious people to not ruminate o 2 SSRI 4050 response versus 1530 for placebo o 3 Nardil MAO inhibitor 6080 response Risk of hypertensive crisis aged foods like cheese sausage wine a This can cause death Most effective drug for Social Anxiety MAO inhibitor enzyme that breaks down neurons and can be recycled for other stuff Also Emsam MAO inhibitor patch 0 Many of our best performers have Social Anxiety Generalized Anxiety Disorder 0 Diagnostic criteria high anxiety amp excessive worry for gt6 months 0 Other symptoms restlessness fatigue insomnia irritability concentration difficulties muscle tension 0 4 of these core symptoms are also core symptions of Major Depression 0 Problem because you ll probably get diagnosed with both of these disorders 0 At east12 of people with GAD also have a diagnoses of Depression 0 90 GAD patients have another Axis I disorder 0 Lifetime prevalence 6 GAD Treatment 0 1 SSRI s average 30 reduction of symptoms 0 2 Benzo s 3050 reduction shortterm 3 CBT 4050 reductin better with imaginal exposure 4 Excersize 2050 reduction few studies varying quotdosequot 5 ObsessiveCompulsive Disorder 0CD Frequently misdiagnosis o 2 Disorders that start with OC 0 0CD this takes over a persons life thoughts are disturbing o OCPD Obsessivecompulsive personality disorder someone who is a perfectionistanal etc 0 They know this is wrong but they keep doing it because it feels real Obsession recurrent intrusive thought impulse or image that causes anxiety and cannot be dismissed or put out of one39s mind This causes anxiety because you try to not think about it and they make it worse 0 Common themes aggression contamination dirty lthy amp have to wash it off right away religiousblasphemy centered around religious themes pathological doubtloss very common they think they are going to lose something important sexuality symmetry 0 How common Every one has these disturbing thoughts sometimes but they aren39t repetitive about 80 Compulsion repetitive actionritual a person feels compelled to do 0 For diagnosis eitherobsession or compulsionsboth not required Stimulus something they see gt obsession gtAnxietygt compulsion ritual circes back 1 gt Anxiety Average person has 0CD for 10 years before they get treatment 0 They are really good at hiding this As a rule of thumb the quicker we can catch an onset of disorder the quicker we can treat it 50 are much more susceptible because of hereditary Most people with OCPD don t develop with 0CD they are very truly independent Negative reinforcement not punishment its reinforcing because they are taking away something that s the negative Not everyone has compulsive rituals as an 0CD patient They can have mental rituals Lifetime prevalence 2 Fairly high genetic loading for 0CD 50 Neurobiology anterior cingulate error detection 0 Orbitofrontal cortexbasal ganglia base of the brain attention xation Possible strep infection link autoimmune response PANDAS 0 Take out cells on basal ganglia o BUT if you take antibiotics then you kill microbiomes 0CD Treatments 1 Exposure amp Ritual prevention ERP 86 response largest study 2 Anafranil 48 response 3 SSRISNRI 40 response 0 VERY LOW PLACEBO RESONSE RATE
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