Term
| What are the standards for what is normal versus abnormal? |
|
Definition
-Cultural relativism
-Unusualness of behavior
-Discomfort of the person exhibiting the behavior
-Mental illness |
|
|
Term
| What are some of the features of cultural relativism? |
|
Definition
-No universal standards or rules for labeling a behavior as abnormal
-Instead, behaviors can only be abnormal relative to cultural norms
Ex. In many cultures, family members sleep together in one room, often in the same bed. In the US, it is considered normal for a baby to sleep in her own bed in her own room
-Gender role Expectations |
|
|
Term
| What are some issues with the discomfort standard of normal? |
|
Definition
-Proponents of this view argue that a behavior is only abnormal if the individual suffers as a result of the behavior(s) and wishes to be rid of them
-Some therapists object to the subjective discomfort criterion because people are not always aware of problems that their behavior may create for themselves or others |
|
|
Term
| For the mental illness standard of normal, what is a question to be asked? If it is a disorder, is there a test that identifies this process? |
|
Definition
-Is this caused by and identifiable disease?
-No |
|
|
Term
| What are 3 things to look for in determining maladaptiveness? |
|
Definition
-Does the behavior prevent normal daily functioning?
-Does the person suffer distress?
-Is there emotional or physical harm? |
|
|
Term
|
Definition
DSM-IV-TR: a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom
-Can be physical or emotional distress |
|
|
Term
| What is the purpose of psychiatric diagnosis? |
|
Definition
1) To define clinical entities, so that clinicians have the same understanding of what a diagnostic category means
2) To determine treatment
-How well a diagnosis defines a disorder and guides treatment depends on it's validity and reliability |
|
|
Term
| The psychological field has shifted toward what kind of treatment? |
|
Definition
|
|
Term
| How many diagnoses are in the DSM? |
|
Definition
|
|
Term
Psychiatric classification system is similar to Linnaeus' hierarchical taxonomy (i.e. ____ and ____)
and Mendeleev's periodic table (which
orders the ____) |
|
Definition
|
|
Term
| What is a classification? It is a prerequisite for what? |
|
Definition
An overarching taxonomy of mental illness
-Classification is a prerequisite for diagnosis |
|
|
Term
| What is a diagnosis? On what is it based? |
|
Definition
The act of placing an individual into a category within the taxonomy
-Based on signs and symptoms |
|
|
Term
|
Definition
| Typically constellations of signs and symptoms that co-occur across individuals (means "running together" in Greek) |
|
|
Term
| Name two features of a syndrome and give an example |
|
Definition
-Neither pathology nor etiology is well understood
-Nor is the syndrome's causal relation to other conditions established
-Ex.: Anti-social personality disorder has signs (the use of an alias) and symptoms (lack of remorse) that tend to covary across individuals |
|
|
Term
| What is a disorder and give an example |
|
Definition
Syndromes that cannot be readily explained by other conditions
-Ex.: Disorders that are diagnosed due to the presence of sign and symptoms and ruling out other potential explanations |
|
|
Term
| What is a disease and give an example |
|
Definition
Disorders in which pathology and etiology are reasonably we understood; there are
clusters of symptoms with a particular course over time
-Ex: Alzheimer's disease
Primary pathology is known (senile plaques, neurofibrillary tangles, and granulovascuolar degeneration), while their etiology is evolving but incomplete |
|
|
Term
| What are the 3 functions of a diagnosis? |
|
Definition
-Communication: conveys important information about a patient to other professionals
-Other professionals will recognize it as referring to the same condition
-Aids in others' understanding of the case without having to include many details
-Nosology: the branch of science that deals with the systematic classification
-The nearer in the network two conditions are, the more closely related they ostensibly are as
disorders
-Information: provides a surplus of information and allows for prediction of trajectory |
|
|
Term
|
Definition
| Refers to the extent to which a diagnosis measures what it purports to measure |
|
|
Term
|
Definition
| The consistency of a diagnosis |
|
|
Term
Can high reliability exist without
validity? |
|
Definition
| Yes, because validity is not a prerequisite for reliability |
|
|
Term
| Why is high interrater reliability a prerequisite for all psychiatric diagnoses? |
|
Definition
Because different observers must agree on the presence of absence of a condition before valid research on that
condition can process |
|
|
Term
| What is a mental disorder according to the statistical model? Are there issues with this paradigm? |
|
Definition
Disorders are abnormal because they are infrequent in the general population;
i. Most are rare (like schizophrenia 1% across the world)
ii. BUT: there are no guidance on cutoffs for what is normal versus abnormal
iii. What dimensions are relevant to abnormality?
iv. Misclassifies high scores on some dimensions (like intelligence and creativity) as inherently
abnormal ergo bad |
|
|
Term
| What is a mental disorder according to the subjective distress model? Are there any issues with this? |
|
Definition
The core feature distinguishing disorder from nondisorder is psychological pain;
i. This fails to distinguish ego-dystonic conditions (those that conflict with one's self concept) from
ego-syntonic (those that are consistent with one's self-concept see little or nothing wrong with
their behavior)
ii. Ego-dystonic examples: Major depression and GAD
iii. Ego-syntonic examples: ASPD
1. They experience little or no distress in conjunction with their condition, and frequently seek
treatment only when demanded by courts or significant others |
|
|
Term
| What is a mental disorder in terms of the biological model? Are there any issues with this? |
|
Definition
A disorder can be defined in terms of a biological or evolutionary disadvantage to
the organism, such as reduced life span or fitness (like the ability to pass on genes to subsequent
generations)
i. Soldiers in front-line combat aren't considered disordered despite its average adverse effect on longevity and fitness
ii. Some relatively mild psychological conditions, such as specific phobia, are probably not associated with decreased longevity or fitness, yet are still mental disorders |
|
|
Term
| What is a mental disorder according to the need for treatment model? Are there any issues with this? |
|
Definition
Disorders are a heterogeneous class of conditions all characterized by a
perceived need for medical intervention on the part of health professions (including mental health
professionals)
i. Not specific enough |
|
|
Term
| What is a mental disorder according to the harmful dysfunction model? Are there any issues with this? |
|
Definition
All disorders are harmful dysfunctions: socially devalued (harmful)
breakdowns of evolutionarily selected systems (dysfunctions)
i. Specific phobias (like blood/injection phobias) are marked by a coordinated set of dramatic parasympathetic reactions- especially rapid decreases in heart rate and blood pressure- that were
almost surely evolutionary selected to minimize blood loss |
|
|
Term
| What is a mental disorder according to the Roschian analysis model? Are there any issues with this? |
|
Definition
A disorder is intrinsically undefinable
i. The concept of mental disorders lacks defining (i.e. singly necessary and jointly sufficient)
features and possesses intrinsically fuzzy boundaries
ii. Disorders organized around a prototype
iii. With fuzzy boundaries, how to tell if something is a disorder?
1. Some may seem more disorder-like than others...
2. Hard to resolve the question, even with research
With no consensus, the definition remains elusive |
|
|
Term
| What are some notable facts about the DSM I? |
|
Definition
-First official manual of mental disorders to contain a glossary of descriptions of the diagnostic
categories
-Used the term "reaction," reflecting Adolph Meyer's psychological view that mental disorders
represented reactions of the personality to psychological, social, and biological factors
-It was created as a variant to the International Classification of Diseases (ICD6) |
|
|
Term
|
Definition
International Classification of Diseases;
The standard diagnostic tool for epdemiology, health management, and clinical purposes
-First to include a subdivision on mental disorders |
|
|
Term
| Szasz (1960) wrote of the "____ of mental illness." He believed that... |
|
Definition
Myth;
-People actually suffer from "problems in living"
-Mental illness is a label given to nonconformists who jeopardize the status quo
-Only the body can become diseased |
|
|
Term
| What were some notable facts about the DSM III? |
|
Definition
-Eli Robins: developed a set of explicit criteria for point categories
-Inclusion, exclusion, and duration criteria
-Went from 163 to 224 diagnoses
-Included diagnostic criteria, algorithms, hierarchical exclusion rules
-Creates a link between clinical practice and research literature
-Neo-Kraepelinian: aimed to reaffirm psychiatry as a branch of medicine
-Laid groundwork for categorical distinctions between disorders
-Introduced the prototype model: the more characteristics an individual has, the better the fit
-Innovations of the DSM-III
1) Provided a definition of "mental disorder"
2) Presented diagnostic criteria for each disorder
3) Introduced the multi-axial diagnostic format
4)Redefined a number of major disorder (no more neurosis)
5) Added new diagnostic categories (like personality disorders)
6) Presented a hierarchical organization of diagnostic categories
7) Presented a systematic description of each disorder
8) Provided decision trees for differential diagnosis
9) Provided a glossary of technical terms
10) Published reliability data from field trials
11) Utilized a descriptive, atheoretical approach |
|
|
Term
|
Definition
-Process more grounded in research
-Moved from monothetic to polythetic approach
-Added an appendix for culture bound syndromes
-Recognized that some conditions vary in their expression across cultures |
|
|
Term
| What is monothetic versus polythetic? |
|
Definition
-Monothetic: signs and symptoms necessary and sufficient for diagnosis
-Polythetic: signs and symptoms are neither necessary nor sufficient |
|
|
Term
| Name the axes of the DSM IV TR |
|
Definition
-Axis II: Personality Disorders, Mental Retardation
-Axis III: General Medical Conditions
-Axis IV: Psychosocial and Environmental Problems
-Axis V: Global Assessment of Functioning |
|
|
Term
| What is a categorical diagnosis? |
|
Definition
All persons assigned to the same category are alike with respect to some
attribute |
|
|
Term
| What is dimensional diagnosis? |
|
Definition
| All persons rated on pre-determined dimensions |
|
|
Term
| What is a monothetic diagnosis and what are its effects? |
|
Definition
Each category is associated with specific criteria, all of which are
considered essential to that category's definition (aka classical categorization)
-Effects:
1) Comparatively few people will meet the criteria of any one category
2) For those that do, they will show a high degree of behavioral similarity |
|
|
Term
| What is a polythetic (prototypal) diagnosis and what are a few of it's advantages and disadvantages? |
|
Definition
Each category is associated with a number of criteria, only some of which are necessary for a diagnosis to be assigned
-Two advantages over the categorical approach: it requires fewer categories to classify the great variety of behavioral variation (greater simplicity) and it is more reliable (clinicians do not have to agree on every criterion to arrive at the same diagnosis)
-Disadvantage: individuals with the same diagnosis may bear little resemblance to each other, in terms of presenting complaints |
|
|
Term
| How common is comorbidity in mental disorders and what are some of its implications? |
|
Definition
Ubiquitous;
Implications:
-Having another disorder will affect presentation, course, and reaction to treatment of the
"primary" disorder (most apparent, causing the most problems)
-Since 75% of people with one disorder have another, it opens up research questions (re:
etiology)
-Challenges the classification system
-Gives clues to potentially shared etiological factors |
|
|
Term
| What factors go into an assessment? |
|
Definition
-Individual demographics
-History of illness
-Psychosocial history (including employment history)
-Present illness and clinical course
-Family history, impact on functioning
-Mental status exam
-DSM diagnosis
-Current medications
-Summary and recommendations |
|
|
Term
| What are some steps in assessing mental status? |
|
Definition
-Orientation: what is the year/season/date? Where are we now?
-Registration: Name 3 objects, then have the patient repeat them. Record how long it takes them to
learn
-Attention and Calculation: Count from to 100 by 7s
-Recall: Ask for the 3 questions above
-Language: name a pencil and watch. Follow a 3 step command. Write a sentence. Copy a picture of
a polygon. |
|
|
Term
| Name a few assessment tests |
|
Definition
| MMPI, Rorschach, Bender Gestalt, WAIS |
|
|
Term
| What assessment tools are most used in practice? |
|
Definition
-Depression measures (i.e. Beck Depression Inventory)
-Anxiety measures (i.e. Beck Anxiety Inventory)
Suicide measures
-PTSD measures
-Very few utilize personality measures like the MMPI unless the patient needs a full assessment |
|
|
Term
| Why would one require a full assessment? |
|
Definition
-Questionable Diagnosis
-Bizarre presentation
-For the court (divorce, fit for trial, insanity plea, etc)
-Treatment is failing
-For Special Education |
|
|
Term
| What is the TOMM scale and what does it do? |
|
Definition
| Assesses malingering by showing client a series of simple pictures and the client is asked to remember them (just to confirm later the visual memory that they were, in fact, seen) |
|
|
Term
| What is the prevalence of OCD? Is it more common in women or men? |
|
Definition
-Prevalence has been estimated at between 0.7% and 2.9%
-Slight preponderance in females |
|
|
Term
| When does OCD typically develop? |
|
Definition
-Onset by 25 yo, although adolescence or child onset not rare
-Mean onset is earlier for males (21 yo), females (24-25) |
|
|
Term
| Define obsessions and describe some of their features |
|
Definition
-Obsessions: intrusive thoughts, ideas, images, impulses, or doubts that the person experiences as senseless and that evoke anxiety. Examples include unwanted ideas of germs and contamination, unwanted doubts that one has been negligent, and unacceptable thoughts of a violent, sexual, or blasphemous nature
-They are unwanted, uncontrollable, and intrusive
-The thoughts or obsessions are incongruent from the individual's own belief system
-Obsessions are resisted, meaning they are accompanied with the sense that they must be dealt with, neutralized, or avoided
-Motivation to resist is activated by the fear that something disastrous will occur if action isn't taken
(this is not rational) |
|
|
Term
| What are compulsions and describe some of their features? |
|
Definition
-Compulsions: urges to perform overt (e.g. checking washing) or mental rituals (e.g. praying) in response to obsessions or to reduce anxiety or distress. The person typically perceives compulsive rituals as senseless or excessive
-Usually the most functionally impairing
-They are senseless and excessive
-They are intentional and not mechanical or robotic (not tics)
-Rituals in OCD are done to reduce distress
-NOT to be confused with addictive or impulse control disorders which are carried out because they produce pleasure, distraction, or gratification (e.g. sexual addiction, trichtotillomania)
-Can be covert (mental) or overt (physical) |
|
|
Term
| Describe some features of avoidance in relation to OCD |
|
Definition
-Present in most people with OCD
-Intended to prevent the obsessional fears and compulsive urges altogether
-Might be done to avoid contamination or illness or to avoid obsessional thoughts from occurring in the first place |
|
|
Term
| Describe some features of insight in relation to OCD |
|
Definition
-Must denote the degree of insight for the individual
-There is a continuum of insight with 4% of individuals with OCD convinced that their symptoms are realistic
-Poorer insight is usually associated with religious obsessions, fear of mistakes, and aggressive obsessive impulses |
|
|
Term
| What are 4 subtypes and dimensions of OCD? |
|
Definition
1) Contamination: specifically contamination obsessions and decontamination rituals
2) Responsibility for harm and mistakes: aggressive obsessions and check rituals
3) Incompleteness: obsessions about order or exactness and arranging rituals
4) Unacceptable taboo: violent, sexual, or blasphemous thoughts with mental rituals |
|
|
Term
| Describe some features of Tic-related OCD |
|
Definition
-Used to denote a subtype of OCD in which the individual has a history of tic disorder (i.e. Tourette's
syndrome)
-Appears to run in families
-Early onset
-Male predominance |
|
|
Term
| Describe some interpersonal aspects of OCD |
|
Definition
-Often has a negative impact
-Dysfunctional relationship patterns can emerge and promote maintenance of OCD symptoms,
creating a vicious cycle (e.g. symptom accommodation)
-Can cause relationship distress and conflict |
|
|
Term
| How is Body Dysmorphic Disorder (BDD)similar or dissimilar to OCD? |
|
Definition
-Similar to OCD in that both can involve intrusive, distressing thoughts concerning one's appearance, and repeated checking might be observed in both disorders
-However, in BDD the focus is limited to one's appearance whereas those with OCD have other obsessions |
|
|
Term
| What are some features of Hoarding disorder? |
|
Definition
-Once considered a symptom of OCD, now separate
-Many who hoard do not meet diagnostic criteria for OCD
-Hoarding involves thoughts about acquiring and maintaining
-Possessions and thoughts are usually not particularly intrusive or unwanted; in fact, thoughts are generally emotionally positive or neutral and thus do not meet criteria for obsessions |
|
|
Term
| Describe Obsessive-Compulsive Personality Disorder (OCPD) |
|
Definition
-Presence of Personality traits such as excessive perfectionism, inflexibility, and a need for control
-These traits negatively impact interpersonal relationships, occupational functioning, or other
important domains of an individual's life
-It is ego-syntonic in that they consider their behaviors and urges as rational and appropriate
-They maintain strict principles and intolerant to others who do not conform to their standards
-Can co-occur with OCD, 23%-32% may exhibit 1 or more OCD symptoms |
|
|
Term
| Describe the learning model of OCD |
|
Definition
-Behavioral (conditioning) models of OCD are based on Mowrer's (1960) two-stage theory of fear acquisition and maintenance
-Classical conditioning is when neutral stimulus is paired with an aversive stimulus
-Operant conditioning: avoidance behaviors develop as a means of reducing anxiety; avoidance is negatively reinforced by the immediate (albeit temporary) reduction in distress it engenders
-Plays a role in maintenance of OCD symptoms; persistence |
|
|
Term
| Describe the Cognitive Deficit Model: Memory of OCD |
|
Definition
-OCD Symptoms arise from abnormally functioning cognitive processes, such as memory
-Research has found no evidence of a memory deficit in OCD (Woods, Vevea, Chambless, & Bayen
2002)
-In fact the opposite has been found. Those with OCD have better memories for OCD-related stimuli (Radonsky, et al 2001) |
|
|
Term
| Describe the reality monitoring model of OCD |
|
Definition
-Proposed that OCD is related to problems with reality monitoring (the ability to discriminate between memories of actual events versus imagined events)
-This has not been supported by research |
|
|
Term
| Describe the inhibitory deficits model of OCD |
|
Definition
-By deficits in cognitive inhibition (ability to dismiss extraneous neutral stimuli)
-Studies examining recall and recognition suggest that people with OCD have more difficulty forgetting negative material and material related to their obsessional fears relative to other sorts of material |
|
|
Term
| What is an issue with the cognitive models of OCD? |
|
Definition
| Doesn't account for the heterogeneity of OCD symptoms, like why some people have washing compulsions and others checking |
|
|
Term
| Describe the cognitive behavioral model of OCD |
|
Definition
-Based on Becks (1975) cognitive theory that emotional disturbance is brought about not by situations and stimuli themselves, but by how one makes sense out of such situations or stimuli
-Obsessions and compulsions are thought to arise from specific sorts of dysfunctional beliefs, with
the strength of these beliefs influencing the person's degree of insight into his or her OCD symptoms
-Lots of empirical support
-The task of CBT is to foster an evaluation of obsessional stimuli as nonthreatening and therefore not
demanding of further action |
|
|
Term
| Describe the serotonin hypothesis of OCD |
|
Definition
| -Proposes that obsessions and compulsions arise from abnormalities in this neurotransmitter system, specifically a hypersensitivity of the postsynaptic serotonergic receptors (Zohar & Insel, 1987) |
|
|
Term
| Structural models of OCD claim that... |
|
Definition
| OCD is caused by neuroanatomical and functional abnormality in particular areas of the brain |
|
|
Term
| The assessment of OCD can consist of... |
|
Definition
-Diagnositc Interview
-SCID (Structural Clinical Interview)
-MIN (Mini International Neuropsychiatric Interview)
-Clinician-Rated Severity Scales
-Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
-Self-Report Measures
-Obsessive Compulsive Inventory (OCI-R)
-Vancouver Obsessive Compulsive Inventory (VOCI) |
|
|
Term
| What are some psychological treatments for OCD? |
|
Definition
-CBT (considered most effective)
-Exposure and response prevention (ERP): confrontation with stimuli that provoke obsessional fear; but that objectively pose a low risk of harm
-Cognitive therapy (CT): rational and evidence-based challenging and correction of faulty and dysfunctional thoughts and beliefs that underlie emotional distress |
|
|
Term
| What are two biological treatments for OCD? |
|
Definition
-Medications (SSRIs most common)
-Neurosurgical procedures |
|
|
Term
| All anxiety disorders share features of... |
|
Definition
| Excessive fear and anxiety and related behavioral disturbances |
|
|
Term
| Define fear and describe some of its effects |
|
Definition
-Fear: emotional response to real or perceived threat
-Fight or flight
-Thoughts of immediate danger
-Escape behaviors |
|
|
Term
| Define anxiety and describe some of its effects |
|
Definition
-Anxiety: the anticipation of future threat
-Muscle tension
-Vigilance in preparation for future danger
-Cautious or avoidant behaviors |
|
|
Term
| What are some features of anxiety disorders? |
|
Definition
-Differ from one another in types of objects or situations that induce fear, anxiety, or avoidance behavior, and the associated cognitive ideation
-Tend to be highly comorbid with each other
-Differ from developmentally normative fear or anxiety by being excessive or persisting beyond
developmentally appropriate periods
-Determination of whether it's excessive made by a clinician
-Many anxiety disorders develop in childhood and tend to persist into adulthood if not treated
-Most occur more frequently in females than males (2:1 ratio)
-Each anxiety disorder is diagnosed only when the symptoms are not attributed to the physiological
effects of a substance/medication or another medical condition or not better explained by another mental disorder |
|
|
Term
| What are some features of Generalized Anxiety Disorder? |
|
Definition
-Changing criteria have made it difficult for researchers to identify the essential biological and
psychological underpinnings of GAD
-GAD is characterized by excessive worry occurring on more days than not, about a variety of
different topics
-Worry must persist for at least 6 months on a variety of topics such as finances, health, safety, and
minor matters
-Anxious about many things, not just one thing |
|
|
Term
| What are the DSM criteria for Generalized Anxiety Disorder (GAD)? |
|
Definition
A. excessive anxiety and worry more days than not for at least 6 months
B. Difficult to control the worry
C. Three of more of the following physiological symptoms:
1. Restlessness or feeling keyed up, on edge
2. Easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance
D. These symptoms cause clinically significant distress or impairment in their everyday life
E. Not due to the effects of a substance or medical condition
F. Not explained by another mental disorder |
|
|
Term
| What is the GAD epidemiology? |
|
Definition
-Difficult to establish prevalence estimates due to changes in diagnostic criteria
-Studies show a prevalence of GAD of 5.7% in US adults
-Median age of onset is approximately 31, however earlier onset is associated with higher levels of symptom severity, comorbidity, and vulnerability to other disorders
-More common in women than men
-Minimal research has examined cultural or ethnic differences
-However studies that do exist show differences in both the content of worries as well as the focus of GAD symptoms
-Once considered a minor disorder, it has now been shown that there is significant impairment associated with it (across domains but particularly in romantic relationships) |
|
|
Term
| What does epidemiology mean? |
|
Definition
| The study of the patterns, causes, and effects of health and disease conditions in defined populations. |
|
|
Term
| What are the GAD comorbidity rates? |
|
Definition
-Comorbidity is common
-Often occurs with panic disorder with or without agoraphobia (41%)
-Social phobia (42%)
-MDD (29%)
-Higher rates of comorbidity are associated with more severe and chronic course of the disorder
-Rates are higher when studying lifetime GAD |
|
|
Term
| Which 3 neurotransmitters are thought to contribute to GAD? Hint: only one in particular has been definitively implicated |
|
Definition
-GABA: Increased activity of GABA which leads to less inhibition of threat-activated structure
-Benzodiazepine receptor binding facilitates GABA binding
-Norepinephrine (responsible for "fight or flight")
-Mixed/inconclusive of effects
-Serotonin
-Mixed/inconclusive of effects |
|
|
Term
| High ________ levels are hallmark biochemical markers of stress and anxiety |
|
Definition
|
|
Term
| Individuals with GAD have a ___________ central nervous system that may take longer to recover from a stressor |
|
Definition
|
|
Term
| Is there a relationship between life events and GAD? |
|
Definition
| Some research indicates that early life experiences of at least one stressful life event defined as unexpected, negative and very important and was associated with increased risk of developing GAD symptoms |
|
|
Term
| What does someone's thinking have to do with GAD? |
|
Definition
-Problem solving: GAD is likely influenced by the thoughts and feelings individuals have toward their
problem solving abilities and the purpose they attribute to the use of time
-Feeling like one cannot solve their problems may be a warning sign of developing GAD
-Overestimation and catastrophizing: individuals with GAD exhibit probability overestimation (thinking a feared consequence is more likely to occur than it really is) and catastrophizing (assuming that an outcome will be much less manageable than it actually is)
-Information processing biases: Heightened attentional and memory biases for threats |
|
|
Term
| Theorists state that worry is a way of responding to what? |
|
Definition
|
|
Term
| Cognitive Avoidance Theory of Worry states that... |
|
Definition
Worry is an attempt at cognitive avoidance, similar to behavioral avoidance. The verbal activity of worry distracts the individual from the full experience of fear and other negative states.
-Evidence suggests that worry involves more future-oriented, threat-relevant content and associated with greater feelings of insecurity |
|
|
Term
| What does intolerance and uncertainty have to do with GAD? |
|
Definition
-Individual's tendency to react negatively to uncertain or ambiguous situations
-This theory has been increasingly recognized as a feature across anxiety and mood disorders |
|
|
Term
| Describe the metacognition model of GAD |
|
Definition
-Wells (1999) proposed that it isn't the typical worry per se that is the most significant problem in GAD but rather the way one thinks about and reacts to this typical worry
-Negative beliefs that worry is uncontrollable or dangerous appear to be central to maintenance of GAD symptoms |
|
|
Term
|
Definition
| The act of thinking about one's thought processes |
|
|
Term
| How are emotions related to GAD? |
|
Definition
| Evidence suggests that individuals with GAD experience more intense emotions than others, have a more negative reaction to those emotions, and have fewer strategies to manage their emotions |
|
|
Term
| Describe the relationship between family/interpersonal relations and GAD |
|
Definition
-Inconclusive
-It is not understood whether interpersonal difficulties are a cause or a consequence of excessive worry and anxiety
-Studies suggest that individuals with GAD may have experienced unpleasant, negative, and rejecting family environments |
|
|
Term
| Describe some treatments for GAD |
|
Definition
-CBT is the most effective. It involves:
-Psychoeducation
-Relaxation training
-Monitoring of cues and triggers for worry
-Imaginal exposure
-In vivo exposure (if necessary)
-Cognitive restructuring
-Combination of CBT and mindfulness
-Benzodiazepines
-SSRIs |
|
|
Term
| SAD (aka social phobia) is characterized by... |
|
Definition
| A "marked fear or anxiety about one or more social situations" |
|
|
Term
| About __% of adults with SAD experience panic attacks in response to social or performance situations |
|
Definition
|
|
Term
| What are the DSM criteria for SAD? |
|
Definition
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to
possible scrutiny by others
B. Individual fears that he or she will act in a way or show anxiety symptoms that will be negatively
evaluated
C. The social situations almost always provoke fear or anxiety
D. The social situations are avoided or endured with intense fear or anxiety
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the
sociocultural context
F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more
G. The fear, anxiety, or avoidance causes clinically significant distress
H. Not attributed to physiological effects of a substance
I. Not better explained by another mental disorder
J. If another medical condition is present, the fear anxiety or avoidance is unrelated or excessive |
|
|
Term
| What is the difference between SAD and GAD? |
|
Definition
| SAD is specific to social situations |
|
|
Term
| What is the prevalence of SAD? |
|
Definition
-12 month prevalence in US is about 7%
-In the general population, there are higher rates of SAD found in females than in males
-In clinical samples, rates are equivalent or slightly higher for males
-In the US, prevalence is higher in American Indians and lower in persons of Asian, Latino, African American, and Afro-Caribbean descent compared with non-Hispanic whites |
|
|
Term
| Describe the development and course of SAD |
|
Definition
-Median age of onset is 13 years, and 75% of individuals have an onset between 8 and 15 years
-SAD sometimes emerges out of a childhood history of social inhibition or shyness in US and
European studies
-Onset can follow a stressful or humiliating experience or be insidious, developing slowly
-Older adults express social anxiety at lower levels but across broader range of situations
-Younger adults express higher levels for specific situations |
|
|
Term
| What are the risk and prognostic factors of SAD? |
|
Definition
-Predisposed individuals have underlying traits such as behavioral inhibition and fear of negative
evaluation
-No causative role of increased rates of childhood maltreatment or other early-onset psychosocial
adversity in development of SAD
-SAD is heritable
-1st degree relatives have 2 to 6 times greater chances of having SAD |
|
|
Term
| What are some culture-related diagnostic issues with SAD? |
|
Definition
-Taijin Kyofusho (in Japan and Korea) is a syndrome that is often characterized by social evaluative concerns, fulfilling criteria for SAD that are associated with the fear that the individual makes other people uncomfortable, sometimes expressed with delusional intensity
-Other presentations of taijin kyofusho may fulfill criteria for body dysmorphic disorder or delusional disorder |
|
|
Term
|
Definition
-SAD most frequently co-occurs with other anxiety disorders
-Occurrence of SAD is significantly related to the occurrence of panic disorder, agoraphobia, specific
phobia, PTSD, and separation anxiety disorder
-Co-occurrence of SAD and depression is associated with greater impairment |
|
|
Term
| Name a few assessment tools used for SAD |
|
Definition
-Most commonly used is the Liebowitz Social Anxiety Scale (LSAS), 24 items pertaining to 11 social interaction situations and 13 pertaining to performance situations
-Brief Social Phobia Scale (BSPS)
-Social Interaction Anxiety Scale (SPS)
-Brief Fear of Negative Evaluation Scale (BFNE) |
|
|
Term
| What are 3 treatments for SAD with brief descriptions? |
|
Definition
-CBT:
-Exposure
-Cognitive restructuring
-Homework assignments
-Cognitive Behavioral Group Therapy
-5 or 6 people
-12 weeks, 2.5 hour long sessions
-Same CBT model as individual CBT
-Medications
-SSRIs
-Benzodiazepines |
|
|
Term
|
Definition
| An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the listed 13 physical and cognitive symptoms occur from the DSM-5 |
|
|
Term
| What is the prevalence of panic attacks? Are men or women more likely to be at risk? |
|
Definition
-12 month prevalence estimate is about 2-3% in adults and adolescents
-Females are more frequently affected than males (by 2:1) |
|
|
Term
| What is the course for major depressive disorder? |
|
Definition
-Current average age of onset is mid-20s, classically was mid-40s
-50% recover within 6 months (longer periods increase chance of not recovering
-70% within first years
-20% are still depressed after 2 years
-Average episode duration is about 5 months
-1/2 to 2/3 will have recurrence
-4-6 episodes average over a person's lifetime
-15% of those with mood disorder (not specifically MDD) will commit suicide (from inpatient samples) |
|
|
Term
| What are three predictors of prolonged time to recovery? |
|
Definition
-Longer episodes
-Older age
-Low socio-economic status |
|
|
Term
| What are some factors that predict recurrent episodes of MDD? |
|
Definition
-Greater than or equal to 3 prior episodes
-Longer episodes
-Any substance use
-Being older than 60
-Female
-Never married
-Family history |
|
|
Term
| The stress sensitivity model of MDD states that... |
|
Definition
| People become overly sensitive to stress, such that even minor stressors can trigger an episode of depression |
|
|
Term
| The role transitions model of MDD states that what can trigger depressive episodes? |
|
Definition
-Depression before high school graduation predicted high school dropout (1.5x more likely), no college
-Depression at high school graduation predicted college dropout (2.5x more likely)
-Early onset depression predicted 2.2x the odds of teenage pregnancy and less contraception use
-Depression history before marriage predicts lower quality of marriage and higher chance of divorce |
|
|
Term
| Describe some of the genetic factors of MDD |
|
Definition
-MDD runs in families
-Heritability of MDD ranged from 31-42%
-Genetic influences found to be relevant in twin studies assessed and most adoption studies (account for 37% of variance in liability to depression)
-Thought to be an underestimate
-Bipolar/schizophrenia heritability is about 70% (sometimes estimated as being higher)
-Environmental influences may matter to a specific individual, but general environmental factors common to family members were not significant
-Complex disorder- affected by environmental and genetic influences |
|
|
Term
| Studies on the heritability of bipolar disorder have shown that it is... |
|
Definition
-Sometimes estimated as high as 90%
-Mania specifically has a distinct heritability from depression (71%)
-Twin studies (McGuffin)
-Mood disorders are universally more comorbid among monozygotic twins rather than dizygotic twins, with bipolar disorder being more comorbid than MDD
-Endophenotypes (clear genetic connection)
-Attention deficits
-Circadian rhythm instability
-Dysregulation of motivation/reward system |
|
|
Term
| Studies on mood disorders and the prefrontal cortex have shown that... |
|
Definition
-L-PFC (pre frontal cortex) involved in approach-related, appetitive goals
-R-PFC involved in maintenance of goals that requires withdrawal in subjects that involve strong alternative response options to approach
-Depressed patients
-Difficulty starting goal-directed behavior and overriding automatic reactions that involve perseveration of NA and dysfunctional attitudes
-Decrease in size and density of some neurons in those with MDD
-Involved in reward and punishment
-Decreased brain volume in some PFC regions
-Decreased activation in PFC |
|
|
Term
| Name some features of the anterior cingulate cortex |
|
Definition
-Bridge between attention and emotion
-Critical for self-regulation and adaptability
-Assesses and responds to behavioral significance of external stimuli
-Has cognitive and affective regions |
|
|
Term
| Studies on mood disorders and the anterior cingulate cortex have shown that... |
|
Definition
-Involved in effortful motion regulation in subjects in which behaviors fail to achieve desired outcome or when affect is elicited in abnormal contexts
-MDD has reduced activity and volume in the ACC
-Has an output to the PFC (PFC trouble related?)
-Is there a distinction between ACC-MDD and PFC-MDD? |
|
|
Term
| The hippocampus is involved in... |
|
Definition
-Declarative, episodic, and contextual learning
-Works with amygdala to process emotional significance of stimuli (Pavlovian fear conditioning) |
|
|
Term
| Studies on mood disorders and the hippocampus have shown that... |
|
Definition
-Depression decreases hippocampal volume (which could be due to hypercortisolemia [high amounts of cortisol], though no causal data)
-Direct correlation with length of depression
-May account for cognitive differences in MDD
-Individuals can't match affect to context |
|
|
Term
| What are a few things the amygdala does? |
|
Definition
-Directs attention to salient stimuli and issues a call for further processing of important stimuli
-Recruits cortical and sensory attention, especially to uncertain stimuli |
|
|
Term
| Studies on mood disorders and the amygdala have shown that? |
|
Definition
-Hyperactivation in MDD; associated with fear/anxiety/hypervigilance, as opposed to sadness/anhedonia
-Rumination, expectation of adversity
-Not known if hyperactivation is a cause or consequence of MDD |
|
|
Term
| What are some factors contributing to neurotransmitter function? |
|
Definition
-Availability of neurotransmitters
-Density/sensitivity of receptors
-Efficiency of metabolizing neurotransmitters in the cleft
-Efficiency of reuptake from cleft |
|
|
Term
| What happens in a challenge study of neurotransmitters? |
|
Definition
Drug is administered to manipulate receptor level
-See if those with mood disorders are more reactive to changes in the neurotransmitter system |
|
|
Term
| Serotonin or 5HT is a __________ neurotransmitter. What are some of its functions? |
|
Definition
Monoamine;
-Regulates sleep, appetite
-Cognitive control over emotion-based reactions
-Inhibits automatic reactions to emotional stimuli (in prefrontal cortex)
-Thought to be a contributor to feelings or well-being and happiness
-Also regulates other systems, including dopamine reward pathway |
|
|
Term
MDD has a ______ reaction to 5HT in serotonin challenge, even after recovery
-Indicates a ____ sensitivity of 5HT receptors |
|
Definition
|
|
Term
| What does an acute tryptophan depletion challenge test involve? What are its effects on people with and without mood disorders? |
|
Definition
-Give subjects an amino acid milkshake to lower L-tryptophan (5HT precursor) within 4-12 hours
-Little effect on nonaffected controls
-Leads to temporary MDD symptoms in individuals with MDD history, or people with family members with MDD
-Same effects in bipolar disorder
-Improves cognitive control over emotion-based reactions
-ATD studies have shown increased attention to negative words on emotional Stroop test among remitted MDD patients |
|
|
Term
| Describe some features of norepinephrine |
|
Definition
-Released in reaction to stress
-Promotes general arousal, attention and concentration, and memory consolidation
-Norepinephrine changes occur with depressive and manic states, but part of the stress related reactions
-Strong feedback from cortisol system
-Chronic stress can diminish norepinephrine density in the cortex (as seen in animal studies) |
|
|
Term
| Studies on norepinephrine and mood disorders have shown that... |
|
Definition
-NE levels may not be risk factors in etiology of mood disorders
-Adequate NE function is needed for effective antidepressant treatment
-NRIs work as well as SSRIs
-Dual reuptake inhibitors (5HT, NE) work slightly better than SSRIs |
|
|
Term
| Describe a couple of features about dopamine |
|
Definition
-Facilitates motivation and energy in the context of reward opportunities
-Chronic stress reduces dopamine levels and results in depression-like behavior (lower levels of dopamine have been shown to create depression-like symptoms in rats) |
|
|
Term
| Efforts have been made to create a "triple reuptake inhibitor" but it may be _____ and there is an increased potential for ______ |
|
Definition
|
|
Term
| Dopamine agonists triggers what? |
|
Definition
|
|
Term
| Describe psychodynamic, cognitive, and biological approaches to explain mood disorders |
|
Definition
-Psychodynamic approaches
-Vulnerable self-esteem, punitive superego
-Cognitive approaches
-Invoke trait-like constructs, e.g. depressogenic schemas
-Biological approaches
-Temperamental substrates in mood disorders |
|
|
Term
| What are the five factors that go into a person's personality? |
|
Definition
| Neuroticism, openness, agreeableness, extraversion, conscientiousness (OCEAN or CANOE) |
|
|
Term
| Personality studies always find differences between those with depression and controls. What are some of those differences? |
|
Definition
-Certain personality traits predispose to depression
-Certain personality traits may be subclincial forms of depression
-Expression of personality traits may be state-dependent
-Depression may cause an individual to respond to different personality traits in a particular way
-Certain personality characteristics may develop as a scar from having been depressed
-Personality may influence how depression is expressed (over time) through directly causing depression itself (pathoplasticity) |
|
|
Term
|
Definition
| The tendency toward anxiety, moodiness, worry, envy, and jealous |
|
|
Term
| Personality studies have shown that neuroticism is... |
|
Definition
-Predictive of depressed episode in individuals who have never been depressed
-Neuroticism overlaps with subclinical depressive symptoms, so may already be experiencing a form of depression |
|
|
Term
| There is some evidence that _________ may predict depression, but these results are ____ |
|
Definition
|
|
Term
| Studies looking at the ratings of childhood temperament predicted depression in adulthood. What are some of the results from these studies? |
|
Definition
-After recovery, those who have been depressed are high on neuroticism (NE) and lower on extraversion (PE)
-Does not answer whether this is a cause/consequence of depressive episodes
-After recovery, personality normalizes (evidence for state-dependence)
-Lots of evidence that personality influences the course of depression
-Higher negative emotionality predicts longer course, more relapse
-Little evidence that depressed individuals' personality deteriorates- works against scar hypothesis |
|
|
Term
| How can insomnia contribute to the maintenance of depression? |
|
Definition
| The lack of sleep means less serotonin being produced, which is part of why a person has depression in the first place |
|
|
Term
| What is one way hypersomnia can be caused? |
|
Definition
| The increased cortisol levels due to stress |
|
|
Term
| Depressive speak and move very _______, and can experience difficulty making _______ and reading |
|
Definition
|
|
Term
| What are some differences between grief and MDD? |
|
Definition
-In grief, the predominant affect is feelings of emptiness and loss while in MDD it is the persistent depressed mood and the inability to anticipate happiness or pleasure
-In grief, the dysphoria is likely to decrease over days or weeks and occurs in waves and is associated with thoughts or reminders of the deceased
-MDD is more persistent and not tied to specific thoughts or preoccupations. Moreover those in grief can still find humor in things and experience positive emotions unlike those with MDD |
|
|
Term
| What are some differences in DSM IV and V classifications regarding persistent depressive disorder? |
|
Definition
-In DSM 4, separate diagnostic labels of dysthymic disorder and major depressive episode, chronic were utilized
-In DSM 5, these categories were combined under persistent depressive disorder (PDD)
-In DSM 4, a person with double depression would receive both MDD and dysthymic disorder diagnoses
-In 5, one diagnosis of PDD would be given and specifiers indicate type of current episode |
|
|
Term
| Most individuals with dysthymic disorder meet criteria for a what? |
|
Definition
|
|
Term
| Superimposed major depressive episodes on a dysthymic disorder is referred to as... |
|
Definition
|
|
Term
| What are some differences between MDD and dysthymic disorder? |
|
Definition
-Individuals with dysthymic disorder have greater comorbidity than individuals with non-chronic MDD
-Dysthymic D is associated with
-Extreme normal-range personality traits
-Lower self esteem
-Higher levels of at least some depressive cognitive biases
-Higher suicidality
-High likelihood of having family history of depression
-Relatives of individuals with dysthymic disorder have significantly higher rates of dysthymic disorder than the relatives of individuals with non-chronic major depression |
|
|
Term
| Compared with those with non-chronic, people with chronic MDD exhibit... |
|
Definition
-Earlier onset of major depression
-Higher rate of attempted suicide
-Greater comorbidity with anxiety disorders
-Higher levels of neuroticism
-Lower self-esteem
-Poorer work and social functioning
-More likely to have a family history of depression |
|
|
Term
| Describe some of the information studies have revealed about the prevalence of PDD? |
|
Definition
-12-month prevalence rates of dysthymic disorder ranging from 0.5% to 2.5% and lifetime ranging from 0.9% to 6.4% in the US
-According to the World Mental Health Surveys, dysthymic disorder is higher in developed countries than in developing countries
-Prevalence of both dysthymic disorder and chronic MDD is almost two times greater in women than in men
-Both dysthymic disorder and MDD are associated with lower income, with inconsistent data regarding effects of race and ethnicity |
|
|
Term
|
Definition
-Anxiety
-Substance use
-Personality disorders (avoidant, borderline, dependent) |
|
|
Term
| Describe the PDD course and prognosis |
|
Definition
-Dysthymic disorder and double depression have been found to occur (with few exceptions) less than 2 years in duration
-Est. 10 yr recovery rate for dysthymic was 74% with median time of 52 months (about 4.3 yrs)
-Of those who recovered, the estimated risk of relapse into another episode was 71%
-84% experienced superimposed major depressive episodes
-6% developed manic or hypomanic episodes |
|
|
Term
| What factors predicted higher levels of depressive symptoms 10 years later? |
|
Definition
-Concurrent anxiety disorder
-Greater familial loading of chronic depression
-History of poorer maternal relationship in childhood
-History of childhood sexual abuse |
|
|
Term
| What are two changes the DSM V made in regards to chronic depression in youth? |
|
Definition
-Minimum duration is 1 year (instead of the previous 2) for children and adolescents
-Irritable mood can substitute for depressed mood |
|
|
Term
| Risk of mania or hypomania is _______ for youth (__% risk) |
|
Definition
|
|
Term
| Name a few unique factors regarding chronic depression in the elderly |
|
Definition
-Prevalence of dysthymic disorder in individuals over age of 65 is estimated to be between 2% and 6%
-Older adults with dysthymic disorder exhibit lower rates of Axis I and II comorbidity and higher rates of recent life events and more concomitant general medical conditions than younger people with dysthymic disorder
-12% to 38% of elderly with dysthymic disorder recover |
|
|
Term
| How does early adversity contribute to chronic depression? |
|
Definition
-Number of studies have shown that forms of maltreatment and early adversity predict poorer course and outcome of depression
-Individuals with chronic depression report high levels of adversity and maltreatment in childhood
-However early adversity is also associated with other disorders
-Most maltreated children do not subsequently develop chronic depression |
|
|
Term
| What are some similarities and dissimilarities between chronic stress and chronic depression? |
|
Definition
-Chronic depression is associated with higher level of chronic stress and daily hassles than is non-chronic depression
-Some studies have found that those who reported a reduction in ongoing difficulties had a recovery from chronic depression
-It has also been found that life events that reduced or neutralized an ongoing difficulty and fresh-start events predicted recovery from chronic depression |
|
|
Term
| What goes into an assessment of chronic depression? |
|
Definition
-Sometimes difficult to assess chronic depression because patients experience it as "normal" or part of their "self"
-Take a careful history (life charts or timelines are useful)
-Use the SCID
-Recommend using semistructured diagnostic interview (incorporate structured and open questioning)
-General Behavior Inventory (GBI): only self-report measure developed to screen for chronic mood disorders |
|
|
Term
| Name and describe 3 treatments for chronic depression |
|
Definition
-Antidepressant medications found to be more effective than in non-chronic MDD
-Cognitive Behavioral Analysis System of psychotherapy: highly structured and uses behavior and cognitive techniques to develop better interpersonal problem solving skills
-Interpersonal therapy: short term psychodynamic approach focusing on current interpersonal problems (grief, social isolation) |
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