Term
| what is the difference between Fear and Anxiety? |
|
Definition
Anxiety: negative mood state characterized by bodily symptoms of physical tension, and apprehension about the future
Fear: present oriented mood state marked by negative affect |
|
|
Term
| Which is more extreme, fear or anxiety? How so? |
|
Definition
fear
o Immediate fight or flight response to danger or a threat
o Strong avoidance tendencies or wanting to escape
o Involves abrupt activation of sympathetic nervous system: extreme changes in heart rate, hot and cold flashes |
|
|
Term
| What are 3 characteristics of a panic attack? |
|
Definition
quickly building (peak in 10 minutes),
intense experience of high degree of fear or discomfort,
combined with physical symptoms |
|
|
Term
______ panic attacks: occurs without warning, no clear explanation, difficult to predict (common in panic disorder)
_____ panic attacks: panic may or many not occur in a particular situation or setting (common in panic disorder) |
|
Definition
-Unexpected (uncued)
-Situationally predisposed |
|
|
Term
These are implicated in the eitiology of ____?
-brain circuits (GABA), noradrenergic and serotonergic systems
-Corticotrophin releasing factors (CRF) and the HPA axis
-Limbic system |
|
Definition
|
|
Term
| What is the Triple vulnerability model? |
|
Definition
Triple vulnerability model: three vulnerabilities interact to produce the anxiety disorder
• (1) general biological vulnerability (inherited tendency to be uptight)
• (2) general psychological vulnerability (early experiences created beliefs that the world id uncontrollable)
• (3) specific psychological vulnerability (learn from experience that some situations are dangerous) |
|
|
Term
| About __ of patients have 2+ diagnoses (anxiety or mood disorder) |
|
Definition
|
|
Term
| _____ suggests: common factors across anxiety disorder, relation between anxiety and depression |
|
Definition
|
|
Term
| ____ is associated with thyroid disease, gastrointestinal disease, migraines, arthritis |
|
Definition
|
|
Term
| Describe the treatment options and outcomes for GAD |
|
Definition
Benzodiazepines: common, good for short term, Long-term: they are addictive and physically dependent, Relapse if drug is removed
-Antidepressants: helpful
-Psychological interventions: cognitive behavioral therapy
• Focus on the worry process
• Works as well as drugs in adults
• For children works better than drugs
• Can restructure thoughts and improve thinking errors
• Individuals who got CBT showed some reduction in anxiety as rated by clinician and client |
|
|
Term
| Describe the treatment options and outcomes for Panic Disorder with and without Agoraphobia |
|
Definition
o Medication treatment
• Target serotonergic, noradrenergic, and benzodiazepine GABA systems
• SSRI (e.g. Prozac and Paxil) are currently the preferred drugs
• Sexual side effects
• Relapse rates are high following medication discontinuation
• E.g. 90% for benzodiazepines
o Psychological treatment: CBT is highly effective
• Gradual exposure to feared stimuli can be done with or without coping/relaxation strategies
• For exposure: they need to be exposed long enough for the anxiety to come down
o Combined treatment: do well in the short term
• Best long-term outcome is with CBT alone |
|
|
Term
| Describe the treatment options and outcomes for Specific Phobia |
|
Definition
|
|
Term
| Blood-Injury-injection: _____ response to blood, injury, or injection |
|
Definition
|
|
Term
| How is Separation anxiety disorder Distinct from developmentally-typical fears? |
|
Definition
| more extreme, causes a lot of distress and impairment, lasts more than 4 weeks |
|
|
Term
| Describe the treatment options and outcomes for Specific Phobia |
|
Definition
Cognitive-behaviour therapies are highly effective
Structured and consistent graduated exposure-based exercises |
|
|
Term
| Describe the treatment options and outcomes for Specific Phobia |
|
Definition
o Medication treatment of social phobia
• Tricyclic antidepressants and monoamine oxidase inhibitors
• SSRI: Paxil, Zoloft, Effexor are approved for treatment of social anxiety disorder
• Relapse rates are high following medication discontinuation
o Psychological treatment of social phobia
• Cognitive-behavioral treatment: exposure, rehearsal, role-play in a group setting (social skills if needed)
• Children and adolescents: you would involve the parents
• Cognitive behaviour therapies are highly effective |
|
|
Term
| describe CBT and the cognitive model |
|
Definition
(1) Thoughts, behaviours, and feelings are interrelated: Perception of an event is related to how they behave and how they feel
(2) Core beliefs (rigid beliefs) trigger automatic thoughts
(3) The same situation can lead to different thoughts which lead to different feelings
(4) When experiencing a strong feeling: pay attention to thoughts because they are likely automatic (may not be reasonable)
(5) As they are so brief we do not think about them and may accept them as facts
(6) An activating event will trigger automatic thoughts, which create a consequence (bad emotions) |
|
|
Term
| If a thought is a cognitive distortion change thinking by ______ |
|
Definition
| challenging your thoughts to create more realistic thoughts and new consequences |
|
|
Term
| What are the steps for Challenging thoughts? |
|
Definition
o Identify thought
o What is the evidence for or against the thought (what are alternative explanations)
o How bad is it really (what’s the worst that could happen? Could I live with it? How can I cope?)
• What’s the best thing that could happen
• Other potential outcomes
• What is the most likely outcome?
o Is my thought realistic? |
|
|
Term
| Describe the treatment options and outcomes for PTSD |
|
Definition
o Cognitive-behavioural treatment involves graduated or abrupt imagined or virtual exposure
o Increase positive coping skills and social support
o Cognitive-behaviour therapies are highly effective |
|
|
Term
| For OCD, how effective is Combining medication with CBT? Should medication be used? |
|
Definition
o Combining medication with CBT does not work as well as CBT alone
• If the case is very severe medication can be useful to help start CBT |
|
|
Term
| Describe the treatment options and outcomes for OCD |
|
Definition
o Medication treatment of OCD
• Clomipramine and other SSRIs: benefit up to 60% of clients
• Relapse is common with medication discontinuation
o Psychological treatment of OCD
• Exposure and response/ritual prevention is the most effective
• Expose to the thought but not allowed to perform the compulsion, over time you learn that the fear does not come true
• More focused cognitive-behavioural therapy also effective |
|
|
Term
-Major depressive episode: extremely depressed mood state lasting _____.
-Includes _____ (feeling worthless or indecisive, difficulty paying attention, decisions are overwhelming)
-Disturbed _____ are central to this disorder (altered sleep, changes in weight and appetite, loss of energy)
-Lasts approximately _____ if untreated |
|
Definition
-at least two weeks
-cognitive and emotional symptoms
-physical functions
-6-9 months |
|
|
Term
| Most common type of depression |
|
Definition
|
|
Term
| what is the duration of a manic episode |
|
Definition
-duration is at least 1 week (less if they need hospitalization)
-usually 2-6 months |
|
|
Term
| Rapid and incoherent speech (“flight of ideas”) is characteristic of |
|
Definition
|
|
Term
| _____: less severe version of manic episode, no marked impairment in social or occupational functioning |
|
Definition
|
|
Term
| What is Dysphoric mania (mixed episode)? |
|
Definition
experience of manic symptoms, but feeling depressed or anxious at the same time
In DSM V: “predominantly manic” or “predominantly depressive” with “mixed features”
Feeling out of control or down
Not necessarily the extreme end of a spectrum |
|
|
Term
| mean age of onset for depressive disorders is ____. |
|
Definition
| Mean age of onset is 25-29, but seems to be decreasing |
|
|
Term
| After ______, normal grieving becomes ______. What is this predicted by? |
|
Definition
-2+ months
-a pathological grief reaction or an impacted grief reaction
-pre-loss dependency predicted this outcome |
|
|
Term
| What is the difference between Bipolar I and II? |
|
Definition
-Bipolar II disorder: major depressive episodes alternate with hypomanic episodes
-Bipolar I disorder: major depressive episodes alternate with full manic episodes (not hypomanic) |
|
|
Term
| ___: chronic alternation of elevation and depression that does not reach the severity of manic or major depressive episodes |
|
Definition
|
|
Term
| Age of onset may be as early as 12-14 for _____ and they are High risk for developing BPD I or II (1/3 of individuals) |
|
Definition
|
|
Term
|
Definition
| do not determine a diagnosis, but help to determine the best treatment |
|
|
Term
What specifier is this?
oversleep, overeat, gain weight, and are anxious |
|
Definition
|
|
Term
What specifier is this?
severe somatic symptoms, more severe depression |
|
Definition
|
|
Term
What specifier is this?
major depression only, lasting 2 years |
|
Definition
|
|
Term
What specifier is this?
mood congruent/incongruent (do feelings go along with the mood or are they contrary), hallucinations/delusions |
|
Definition
|
|
Term
What specifier is this?
past episodes, past dysthymia, may indicate a patient needs a long and intense course of treatment |
|
Definition
|
|
Term
What specifier is this?
4 manic/depressive episodes in a year |
|
Definition
|
|
Term
| describe Rapid cycling patter specifiers |
|
Definition
(BP I & II only): 4 manic/depressive episodes in a year indicate a rapid cycle, more extreme treatment may be needed
• 90% female
• not long lasting, most return to slow cycle soon |
|
|
Term
Seasonal affective disorder (SAD): more common in _____.
May be related to _____ production |
|
Definition
|
|
Term
What is the prevalence of mood disorder?
-generally, gender, age, culturally, creatively |
|
Definition
-4.1 (Ontario) -11% (Toronto and Calgary)
-females are twice as likely to have a mood disorder (imbalance only major depressive disorder and dysthymia, BUT mostly equal for bipolar disorder)
-Gender imbalance disappears with age
-Depression-like behaviour has been seen in children as young as 3 months
-Mood disorders are most prevalent in 15-25 year olds
-Behaviour is easily mistaken for hyperactivity, or conduct disorder
-In the elderly: Late-onset is marked with agitation, hypochondriasis, and agitation, Diagnosis if difficult due to medical issues and dementia, Sex ratio is balanced
-across cultures: Somatic symptoms of anxiety are more focused on (e.g. stomach aches)
-In first nations people, rates are 4x higher than in the general population
-Moderately ill are more creative than the severely ill |
|
|
Term
almost everyone who is _______ is also ______, but not all _____ are _______.
(anxious, depressed) |
|
Definition
-depressed, anxious
-anxious, depressed |
|
|
Term
| What are the core symptoms of depression and anxiety |
|
Definition
-core symptoms of depression: Anhedonia and slowing of motor and cognitive functions
-core symptoms of anxiety: increased autonomic activation and muscle tension |
|
|
Term
TRUE or FALSE
major depression can follow anxiety and be a consequence of it |
|
Definition
|
|
Term
TRUE OR FALSE
Bipolar disorder may be a less severe variation of other mood disorders rather than it’s own disorder |
|
Definition
|
|
Term
TRUE OR FALSE
People with a relative with BPD are more likely to have a mood disorder, especially BPD |
|
Definition
FALSE
People with a relative with BPD are more likely to have a mood disorder, but not necessarily have BPD |
|
|
Term
| what is the Permissive hypothesis? |
|
Definition
-low levels of serotonin allow other neurotransmitters to range more widely, become deregulated, and contribute to mood irregularities
-Overall balance of transmitters may be more important than one give transmitter |
|
|
Term
| Hypothyroidism and Cushing’s disease effect the endocrine system, specifically the adrenal cortex causing _____ which may lead to depression |
|
Definition
| excessive cortisol secretion |
|
|
Term
| -Substantial disruption of _____ might be problematic for some vulnerable individuals, as Sleep and light seem to be implicated |
|
Definition
|
|
Term
| Brain function might represent a vulnerability to depression (e.g. more ______-hemisphere activation) |
|
Definition
|
|
Term
| what is the depressive attributional style? |
|
Definition
attribute things as being:
• internal: negative outcomes are own fault
• stable: future negative outcomes will be own fault
• global: applies to many contexts/issues |
|
|
Term
| what is the cognitive triad? List (4). |
|
Definition
-depressed persons engage in cognitive errors
-CT is negative thoughts about self, future, world
• arbitrary inference: overemphasize the negative, goes along with missing the positive
• overgeneralization: generalize negatives to all aspects of a situation
• all or none thinking (black or white): there is no grey area, thinking is extreme (example: either ace test or fail it)
• predicting the worst |
|
|
Term
marital dissatisfaction strongly related to depression
o This link is much stronger in _______
o In ______ relationship problems cause depression
o In ______ depression causes relationship problems |
|
Definition
-males than in females
-women
-men |
|
|
Term
describe Tricyclic medications (e.g. Tofranil, Elavil)
as a treatment for mood disorders |
|
Definition
o Commonly used
o Block reuptake of norepinephrine and other neurotransmitters
o 2-8 weeks for effects to be known
o Negative side effects are common
o May be lethal in excessive doses |
|
|
Term
describe Monoamine Oxidase (MAO) Inhibitors
as a treatment for mood disorders |
|
Definition
o Enzyme that breaks down serotonin and norepinephrine
o MAO inhibitors are slightly more effective than tricyclics
o Prescribed less often as must avoid foods containing tyramine (e.g. beer, red wine, cheese) and cold medications |
|
|
Term
describe Selective Serotonergic Re-Uptake Inhibitors (SSRIs)
as a treatment for mood disorders |
|
Definition
o Lock the reuptake of serotonin
o Currently the “first choice” drug treatment
o SSRIs (vs. other meds) likely pose no unique risk of suicide or violence
o Negative side effects are common: G.I. upset, insomnia, weight gain
o 50% response rate initially
• 70% relapse even if still taking lithium |
|
|
Term
describe Lithium
as a treatment for mood disorders |
|
Definition
• A common salt
• Primary drug of choice for bipolar disorders and is effective for manic episodes
• Side effects may be severe
• Why lithium works remains unclear
o 50% response rate (initially) |
|
|
Term
describe Electroconvulsive Therapy (ECT) and Transracial Magnetic Stimulation
as a treatment for mood disorders |
|
Definition
• Only considered in extremely severe cases when someone hasn’t responded to other treatments
• ECT: involves applying a brief electrical current to the brain which causes temporary seizures
• 6-10 treatments are typically done
• “reasonably” effective for severe depression
• side effects: short-term memory loss, confusion; sometimes long-term memory loss
• uncertain why ECT works
• relapse is common |
|
|
Term
| what is the Psychological Treatment for Unipolar mood disorders? |
|
Definition
• Cognitive therapy
o Challenging cognitive errors in thinking
• Need to track and log thoughts
o Also includes behavioural components e.g. hypothesis testing
• Behavioural Activation
o Helping depressed persons make increased contact with reinforcing events
o Prescribing activities to increase in pleasurable activities
o The motivation may come after the event, not before |
|
|
Term
- _____ : exposure to two hours of very bright light on awakening, and avoidance of bright light in the evening
-Sideffects include _____ (3). |
|
Definition
-Phototherapy
-headache, eyestrain, and feeling “wired” |
|
|
Term
| What is o Hypothesis testing? What therapy is it a part of? |
|
Definition
-trying out something they think will be negative to see if it actually goes that way
-CT |
|
|
Term
| What are two Psychosocial Treatments for Unipolar mood disorders? |
|
Definition
-Interpersonal Psychotherapy: resolving problems in existing relationships and learning to form new relationships
-Hypothesis testing: trying out something they think will be negative to see if it actually goes that way |
|
|
Term
-For the treatment of unipolar disorders:
-When it comes to CBT and IPT, _____ better than placebo, control conditions, brief psychodynamic intervention
-Combined treatment approaches _____ additional benefit, ______ when depression is more severe
-______ may be particularly helpful in preventing relapse |
|
Definition
-both are
-don’t seem to offer, Except
-Cognitive therapy |
|
|
Term
Order these from least relapse to most relapse:
• Cognitive therapy
• Combined cognitive-pharmacotherapy
• Drug, no continuation |
|
Definition
• Combined cognitive-pharmacotherapy: 15% relapse
• Cognitive therapy: 21% relapse
• Drug, no continuation: 50% relapse |
|
|
Term
Psychosocial Treatments for Bipolar Disorder
-Important to control manic episodes and maintain medication
-Family tension is associated with _____
-Medication is the _____ treatment
-Psychological interventions are helpful to stop problems related to relapse |
|
Definition
|
|
Term
| Who is at higher risk of completing suicide? |
|
Definition
-Alberta, Quebec, and the Northwest Territories
-Males
-aboriginal communities |
|
|
Term
TRUE OR FALSE
suicide rates are high in newfoundland and Labrador |
|
Definition
|
|
Term
TRUE OR FALSE
Females attempt suicide more often than males |
|
Definition
|
|
Term
| why are Rates of suicide high in aboriginal communities? |
|
Definition
| connected with history of discrimination and upheaval |
|
|
Term
| What are the (4) kinds/reasons for suicide? |
|
Definition
• Altruistic suicide: In the past “formalized” suicides were accepted for those who had brought dishonour to themselves
• Egoistic suicide: loss of social support (common in the elderly)
• Anomic suicide: sudden marked disruptions (e.g. job loss)
• Fatalistic suicide: loss of control over own destiny |
|
|
Term
| Neurobiological risk factors for suicide: low levels of _____, other neurotransmitters vary more: leading to _____. |
|
Definition
-serotonin
-impulsivity and a tendency to overreact |
|
|
Term
Existing psychological disorders are a risk factor for suicide: 90% of suicides have a psychological disorder
-60% have a _____ disorder |
|
Definition
|
|
Term
| Substance and alcohol abuse involved in _____ of suicides |
|
Definition
|
|
Term
| _____: general term to describe characteristics and behaviour |
|
Definition
|
|
Term
-personality disorders: enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts
-Pattern evident in at least 2 of (4) areas: _____ |
|
Definition
-cognition
-affectivity
-interpersonal functioning
-impulse control |
|
|
Term
Name that cluster!
Paranoid, schizoid, schizotypal |
|
Definition
| Cluster A: odd or eccentric cluster |
|
|
Term
Name that cluster!
Antisocial, borderline, narcissistic, histrionic |
|
Definition
| Cluster B: dramatic, emotional, erratic cluster |
|
|
Term
Name that cluster!
Dependent, avoidant, obsessive-compulsive |
|
Definition
| Cluster C: fearful or anxious cluster |
|
|
Term
| what is the prevalence of personality disorders |
|
Definition
| 0.5%-2.5% of the general US population |
|
|
Term
Personality disorders:
o Thought to begin in _____ (but little known about developmental trajectory)
o Tend to run a _____ course if untreated |
|
Definition
|
|
Term
TRUE OR FALSE
PD are Diagnosed more frequently in males as ASPD is common |
|
Definition
|
|
Term
FOR PD TUR OR FALSE
• Although comorbidity rates are high with other disorders people tend to be diagnosed with only 1 pd |
|
Definition
FALSE
• Comorbidity rates are high
• People tend to be diagnosed with more than 1 pd |
|
|
Term
| Personality traits are talked about for _____ vs. observable behaviour is talked about for _____ |
|
Definition
-Hare and Cleckley
-the DSM |
|
|
Term
-Robert Hare made _____
-Cleckley criteria made _____ |
|
Definition
-an original psychopathy checklist
-the revised psychopathy checklist (PCL-R) |
|
|
Term
| Not all psychopaths have criminal, most psychopathic criminals _____ |
|
Definition
|
|
Term
ASPD
Young boys with the personality trait ______ predicted a more stable and long term pattern of _____ |
|
Definition
-“psychoticism” (high impulsivity + low empathy)
- aggression, theft, and vandalism |
|
|
Term
| Gray’s model of behaviour inhibition: |
|
Definition
3 brain systems influence learning and emotional behaviour: behavioural inhibition system (BIS), reward system (REW), and the fight/flight system (F/F)
• In ASPD two systems are out of balance BIS and REW
• in ASPD inhibition in a new situation is reduced, fear and anxiety produced by the BIS is less apparent
• activation of the reward system is increased, positive feelings caused by the REW are more prominent
• may explain why psychopaths are not anxious about their anti-social behavior |
|
|
Term
|
Definition
fail to respond with fear to cues of danger
• Example: psychopaths did not show a galvanic skin response (sweat) in anticipation of a small shock |
|
|
Term
cerebral cortex (important for inhibition) is not fully developed
• However some do not commit impulsive crimes, they are sometimes really thought out |
|
Definition
| Cortical immaturity hypothesis: |
|
|
Term
cortical arousal is too low, so they seek out dangerous situations to increase this arousal
• When they seek risks this hypothesis is supported
• U shaped relationship between arousal and performance, very high or very low arousal tend to experience negative affect |
|
Definition
|
|
Term
| What are the psychological and social dimensions of psychopathy? (2) |
|
Definition
o psychopaths may fail to abandon unattainable goals
o they may learn this from a “coercive family process” e.g. negative behaviour is accidentally reinforced |
|
|
Term
| antisocial behaviour tends to decline around age ____ |
|
Definition
|
|
Term
| long-term prognosis for BPD is somewhat promising: do better in _____ |
|
Definition
|
|
Term
| What is the medication treatment for BPD? |
|
Definition
| antidepressant medications offer some short-term relief |
|
|
Term
| what are the 4 components of dialectical behaviour therapy? |
|
Definition
-individual outpatient therapy
-skills training
-phone consultation with therapist
-case consultation for therapists |
|
|
Term
| _____: nature of reality and also dialogues and relationships |
|
Definition
|
|
Term
| What is the aim of dialectical behaviour therapy ? |
|
Definition
-aim is for synthesis of ideas rather than polarity
-reality is interconnected, context is important
-reality as consisting of “internal opposing forces” |
|
|
Term
| describe the cause bpd from a biosocial model perspective |
|
Definition
| core deficit/disorder in BPD = emotional dysregulation which stems from biology, people have been invalidated in their environmental context (or validated but inconsistently), and their interaction (esp. over development) |
|
|
Term
| What are the (4) psychosocial skills taught in dialectical behaviour therapy? |
|
Definition
(1) mindfulness:
-reasonable mind, emotion mind, wise mind: integration of emotions and reasonable mind
-what skills: observing interactions and describing the experience, wholly participating in the experience (not distracted by other things)
-how skills: non-judgmental stance of your reaction to a situation, being effective- doing exactly what the situation calls for instead of being willful and doing whatever you feel like or doing nothing at all
(2) interpersonal effectiveness skills (e.g. balancing priorities vs. demands, building mastery and self-respect)
(3) emotion regulation: identifying and labeling emotions
(4) distress tolerance: distract with more positive thoughts, self-soothe, improve the moment, helps you to be mindful because maybe in the moment you can’t be mindful but you can |
|
|
Term
| _____ may be helpful for BPD as they tend to have intense and unstable relationships |
|
Definition
|
|
Term
| for BPD, what subtypes is couples therapy (not) recommended for? |
|
Definition
-recommended for identity disturbance subtype (unstable self-image) and for affective cluster (mood swings, and no anger control)
-not recommended for impulsive subtype (self-destructive behaviour) |
|
|
Term
| What are (2) Personality Disorders Under Study? |
|
Definition
• Depressive personality disorder
• Passive-aggressive personality disorder |
|
|
