Abnormal Psychology DSM 5 Flashcards Preview

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Flashcards in Abnormal Psychology DSM 5 Deck (152)
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1

Major Depression

2 wks.(to exclude normal lows)
5 symptoms -- must include depressed mood and loss of pleasure (universal symp)
- Core symptoms- mood-sadness, despair and emptiness, anhedonia, low self esteem, apathy-low motivation, excessive emotional sensitivity, neg. pessimistic thinking, irritability, Suicidal ideation
- appetite; loss, gain weight. decrease appetite
sleep early wake (reduce stage 3 and 4: slow wave sleep, decreased REM latency-earlier onset of REM and increase during of REM in early night)
Fatigue: expressed as tiredness, low energy; slowed speech and physical movement, pause before answering
Psychomotor retardation: quiet speech, stop talking completely unless directly questioned
agitation (become anxious) handwringing, pacing, inability to sit.
low self esteem, guilt
poor concentration (sometimes misdiagnosed with dementia
Suicidal thoughts
(other symptoms: crying spells, phobias, obsessions and compulsions, feeling hopeless, helpless worthless, Anx symp. panic attack: increase drinking, loss of reality-mood congruent (feelings of quilt-imagined he committed a sin) mood incongruent

2

Types of Depression

Reactive: Mild to moderate: occurs in response to an identified stressor, acute/intense, insidious - gradual (poor relationship) or past abuse.
Biological_ no stressor
medical or illness
female sex hormone- post partum
medication/drug
Bio genes: limbic
-sym appetite, fatigue, decrease sex, restlessness agitation, poor concentration

3

Depression
Theories

Lewinsohn's behavioral theory of depression operant conditioning - low rate of response-contingent reinforcement for social and other behaviors. Reduced frequency of adjustive behavior-or behavior that maximizes reinforcement increases escape and avoidance behaviors in situations where positive reinforcement is attainable. thus failing to escape punishment
Seligman: Avoidance/escape of shock: those that couldn't became passive and accepted : learned helplessness: circumstances of reinforcement contingency-inescapable punishment Attribute it to internal, stable and global factors
Beck" negative cognitive biases-selective abstraction, over generalization negative self attributes. depressive cognitive triad: interpret their interactions with the environment as defeating, deprivation or disparagement. view self as deficient, inadequate or unworthy and attribute unpleasant experiences to physical, mental and moral defects in themselves and tend to reject themselves because of it. . View the future in a negative way and anticipate current sufferings will continue indefinitely

4

Etiology of Depression

genetic component: 1.5 to 3 times more common among first degree relatives; does not matter if one or two parents have the diagnosis.
link between depression and neurotic personality trait.
-catecholamine hypothesis- deficiency in norepinephrine.
-indolamine hypothesis: Low Serotonin (sensitive receptors)
-high cortisol (stress hormone) cause atrophy of neurons in hippocampus

5

Treatment for Depression

Tricyclics: "classic depression" veg body symptoms worsening symptoms on the AM, acute onset and short duration, symptoms of moderate severity.
-Amitriptyline/Elavil; Doxepin/ Adapin, Sinequan/Silenor ( most sedating; insomnia); Trimipramine/Surmontil; Nortriptyline, Pamelor/Aventyl; Desipramine/Norpramin; Protriptyline/Vivactil; Clomipramine/Anafranil (OCD too)
SSRI (moderate to severe) Fluoxetine/Prozac, Serafem (MDD, OCD, bulimia, PMDD, panic, BPD-depressive) Sertraline/ Zoloft (OCD, Panic, PTSD, PMDD, social anxiety); Paroxetime/ Paxil (GAD, OCD, PMDD, PTSD, pain & Social anxiety)Fluvoxamine/Luvox (OCD, Social anxiety, MDD, Anx., PTSD, panic); Citalopram/Celexia (Depression; SE); Escitalopram/ Lexapro (MDD, GAD, SE: insomnia, Sex dys. nausea)
-Others: Trazodone/Desyrel, Nefazodone/Serzone, Vilazodone/Viibryd, Bupropion/Wellbutrin (smoking, soc. anx, )
(SNRI) Venlafaxine/Effexor (GAD, Soc. Anx., Panic)
Duloxetine/Cymbalta (MDD, GAD, chronic pain, fibromyalgia) Desvenlafaxine/Pristiq; Milnacipran/Remeron,
ECT: delusions/hallucinations; temp. anterograde, retrograde amnesia

6

Premenstrual Dysphoric Disorder

week before and symp improve few days after the onset of menses and absence or presence of minimal symptoms during the week post Menses. At least one symptom-affective lability, and one -loss of interest, concentration, appetite, insomnia/hypo. feeling out of control, or physical (breast swelling)

7

SSRI's

Fluoxetine (Prozac), Fluvoxamine, Paroxetine, Sertraline
Melancholic Dep, OCD, Bulimia, Panic, PTSD
Blocks reuptake of Serotonin
less cardiotoxic, safer overdose, less cognitive deficits, improve depressive symptoms,
Linked to suicide and violent act -Fluoxetine-
MAOI (monoamine oxidase inhibitors_ isocarboxazid, phenelzine and tranylcypromine)- results on serotonin syndrome-headache, nystagmus, tremor, dizziness, unsteady gait; irritability, confusion, delirium_ cardiac arrhythmia and coma/death

8

MAOI

isocarboxazid, phenelzine, tranylcypromine
non-endogenous and atypical depression that involves anx, reverse vegetative symptoms and interpersonal sensitivity.
MAOI inhibits enzyme monoamine oxidase-deactivates dopamine, norep, serotonin.
SE: Hypertensive Crisis-when in conjunction with barbiturates, amphetamines antihistamines, or with foods containing tyramine (cheeses, meats, beer, red wine, avocados, bananas,

9

Treatment for ADHD

neurofeedback (EEG biofeedback) is effective for inattention and impulsivity and ok for hyperactivity and effects are similar to stimulants ( Methylphenidate (Ritalin) CNS
Behavioral interventions
Teacher training and classroom management: positive reinforcement, time out, ect. Parent Training in Behavioral Management
Medication treatment alone and combined community and intensive behavioral treatment produced similar reduction in core symptoms.

10

ADHD

6 mos. before 12 yrs. in two settings 6 to 6 subtypes
Cognitive Control theory _ Top Down Theory -Delay aversion (dopamine: BX. reinforcement-delayed aversion) - inhibition, self-awareness, working memory, self directed attention.
impaired reward learning, difficulties adaptively processing rewards, and heightened delay discounting motivational control-executive dysfunction- cog to em/

11

ADHD Differential D/O

An att. Hyperactivity, and impulsivity can be found in Anx., Stress, and in Mood D/o
Learning D/o- poor concentration
Substances Adult/adolescence- impair exe. func. mild cognitive impairment and increases with age.
Health Conditions: Inatt. and impulsive-seizures-autoimmune, thyroid, concussion
Chronic sleeplessness
Co-occur- 44% with Disruptive BX
ODD (against authority, interpersonal sensitivity and EM. reactivity)
Learning D/O
Anx, and Dep. (Dep. earlier onset)
Tic_core inhibitory
Autism: imp. communication, social reciprocity and stereotype. / repetitive Bx.
Personality_ Borderline. Antisocial

12

Tics

Tourette's D/O multiple vocal and motor tics occur frequently throughout the day
Persistent (chronic) motor or vocal tic: patient has either motor or vocal tics but not both
Provisional tic D/O tics occur for no longer that 1 year
--Appear early around 2 yrs. mean onset 5 to 7 yrs.
vocal begin sometime later- barks, coughs, throat clearing, sniffs, and single syllables-can be suppressed more so in adulthood, disappear during sleep -they are persistent but can disappear entirely for weeks - frequency increases when one is sick, tired, or stressed.10% boys and 15% girls most motor tics disappear in adulthood, -poor prognosis_ comorbid MH, chronic physical illness lack of support at home and drug use. - strong familial and concordance rate over 50% in mono twins and 10% in Dis. twins- Fam. Hx for OCD
Typically begins by age 6- most severe by ages 10 to 12, AFTER IMPROVE 75% 25% WILL CONTNIUE TO HAVE TICS that ARE mod. or worse-comorbid OCD and ADHD
TD-Both at least 1 vocal and 2 motor-
Persistent Motor or Vocal
--longer than a yr.
Before 18 yrs.
-elevated Dop. antipsychotic drugs - haloperidol and pimozide
SSRI left OCD hyperactivity and inattention treated by clonidine and desipramine

13

Communication D/O

Childhood Onset Fluency D/O Stuttering-begins in early childhood, distress, diff. speech motor deficits, neurological cond. Ex. stroke, or other mental D/O

14

Gender differences between rates of Major Depressive D/O

does not become evident until puberty. Prior to that time, the rates between boys and girls are equal.
Adults rates females are 1.5 to 3.0 times the rate for men
Unipolar depression: .5 or 50% in Mono and .2 or 20% in diz. both or one parent with the D/O does not matter.

15

Panic Attack

recurrent unexpected panic attack with at least one being followed by concern about having another or consequences and change in adaptive behavior.
prepubertal children may experience physical symptoms of panic (hyperventilation) they rarely receive the diagnosis. belief that children do not make catastrophic interpretations of their body symptoms.

16

Differentiate Panic and agoraphobia

-All involve avoidance
-how many panic attacks and what type (cued, uncued, situationally predisposed) uncured attack suggest panic. cued attacks suggest specific phobia or social anx. (but can be intermixed)
-in how many situations did they occur? Limited situations suggests specific phobias or social anxiety; attacks that occur in a variety of situations suggest panic D/O and agoraphobia
-Does the Pt. awaken at night with panic attacks? This is more typic of panic d/o
-what is the focus of the fear? having a subsequent attack then it's panic D/O, unless it occurs only in one situations suggest as riding a horse then specific phobia situational type.
- Does the pt. constantly worry about having a panic attack even when in no danger of facing a feared situation- this would suggest panic and agoraphobia,

17

Most effective intervention for GAD

CBT
SSRI or SNRI ( Venlafaxine (Effexor) Duloxetine (Cymbalta) if not benzo an anxiolytic ( Diazepam, alprazolam, oxazepam, triazolam, chlordiazepoxide, lorazepam) stimulate the inhibitory action of GABA= enhance GABA
-

18

Rates of OCD for males and females

Common for males and females, but onset earlier in males -OCD is more prevalent in males

19

How does medication and behavioral therapies treat OCD?

SSRI block the reuptake of Serotonin that is believed to be low in OCD PT.
reduces activity in the caudate nucleus that involves converting sensory input into cognitions and actions, and is overactive in people with OCD- other areas include, orbitofrontal cortex, and cingulate cortex which mediates emotional reactions.

20

How does medication and behavioral therapies treat OCD?

SSRI or Tricyclic (Clomipramine) block the reuptake of Serotonin that is believed to be low in OCD PT.
reduces activity in the caudate nucleus that involves converting sensory input into cognitions and actions, and is overactive in people with OCD- other areas include, orbitofrontal cortex, and cingulate cortex which mediates emotional reactions.
Exposure with Response Prevention

21

Logan was an 12 yr old boy who was reffered for long standing anxiety about losing his parents and recent fear about getting sick. Recently Logan watched a TV show about deadly diseases. He had 3 panic attacks in the past, has frequent headaches and stomachaches. Insists he is not scared about having another panic attack. His physical complaints are caused by fears of being ill and is petrified about being left sick and alone. Logan had intense separation difficulties starting in kindergarten. His most persistent fear centered around the safety of his parents. He was fine when they were both at work but in transit or somewhere else, he was afraid they would get in a car accident. What is the diagnosis?

Separation Anx with panic
Fear since young child. requires 3 of 8 symptoms.
-long standing excessive and disturbing fears of anticipated separation, to harm to his parents or event that could lead to separations, and of being left alone. physicals complaints that are traced to fear of dying or separation.

22

This brief treatment that incorporates psychoeducation, relaxation training, cognitive restructuring, and interoceptive exposure (exposure to physical symptoms) treats what disorder

Panic disorder-
Named Panic Control Therapy.
Also treatment includes, TCA, SSRI, SNRRI and benzo. high relapse with discontinued use (70%)

23

Agoraphobia requires marked fear or anxiety about at least two of the following.. because escape might be difficult and help unavailable in case he/she develops panic like symptoms, incapacitating, or embarrassing symptoms.

using public transportation, being in open spaces, standing in line or being part of a crowd, and being outside the home alone.
Requires presence of a companion
persistent 6 mo.

24

How do you differentiate Specfic Phobia situational type and social anxiety from Agoraphobia?

Specific Phobia involves fear or anxiety about a single situation that is characteristic of Agoraphobia and is related to something other than concern of experiencing panic like symptoms, incapacitating and embarrassing symp.
Social Anxiety i is anxiety related to being scrutinized by others and increases in the presence of others particularly family or friend while Agoraphobia decreases when accompanied by a family or friend.

25

What are the clinically significant symptoms of PTSD that one experiences for at least 1 mo ?

intrusion, avoidance, negative alterations of cognition and mood and alterations in arousal and reactivity.

26

Specific phobias are characterized by intense fear or anxiety about a specific object or situation that persists (6 m. or longer) what are the subtypes?

animal, natural environment (heights, storms), blood-injection-injury, situational and other (loud noises, costumed characters)

27

What are the causes of Specific Phobias and other anxiety disorder?

Biological factors- abnormal levels of serotonin, norepinephrine and GABA
cognitive factors
Classical Conditioning. Mower's two factor theory: avoidance conditioning (classical and operant conditioning) learn to fear a neutral stimulus (conditioned) stimulus (loud noise and bunny) because it is paired with an intrinsically fear-arousing stimulus and avoidance is negatively reinforcing because it eliminates anxiety

28

What differentiates PTSD and Acute Stress Disorder?

PTSD requires the presence of symptoms from each of 5 symptoms clusters: intrusion symptoms(re-experiencing, dissociation ect.) avoidance symptoms, negative alterations in cognition and mood and arousal.
ASD can have at least 9 of 14 symptoms meaning that one person could have all 4 intrusion symptoms while another might have one.
Duration PTSD persists at least 1 mo after the external event and ASD lasting no more that 1 mo.

29

Adriana was a 4.5 yr old girl referred for mental health evaluation of dangerous behaviors particularly poor boundaries, impulsivity, and "too quick to trust strangers." Adriana was adopted from an Eastern Europe orphanage at age 29 mo. Medical records at that time were normal. After adoption, Adriana would seek out her mother for comfort when distressed, however, she did not distinguish between strangers and family. In the grocery store she would hug who ever was in line next to them. Once in a mall she tried to leave with another family. She had trouble taking turns and sitting in a circle. She interrupted, intruded in classmate's space and occasionally hit others. she had trouble self soothing and could generally calm down when held by her teacher or mother. What is the D/O?

Disinhibited social engagement disorder
Preschool aged child with dangerous behaviors that related primarily to excess physical familiarity with strangers= risk for predation
trouble regulating her proximity to other people- going too far away from her mother and getting too close to stranger.
2 symptoms are required out of 4 core symptoms
-reduced or absent reticence in approaching and interacting with unfamiliar adults: overly familiar behavior; diminished or absent checking back with an adult caregiver after venturing away. and willingness to go off with an unfamiliar adult with minimal or no hesitation.
developmental age of at least 9 mo
Child with this disorder can approach caregivers when stressed or hurt.
Comorbid ADHD is common but DSED is specific to relationships.

30

Traumatic event Bethany and Charles witnessed a shooting at a movie theatre. two days later both Bethany and Charles considered themselves nervous and on edge. They jumped at the slightest noise and kept watching TV for the latest information on the shooting but every time they saw footage, they experience panic attack, brake out in sweats, unable to calm down and couldn't stop thinking about the traumatic event. they both had nightmares and had intrusive thoughts of the shootings
2 wks later. Bethany reclaimed her peritraumatic thoughts, feelings and behaviors. Although reminders of the event resulted in brief panic or physiological reactions these did not dominate her life. Charles did not recover, but felt emotionally constricted and unable to experience positive emotions, he jumped at the slightest sound and was unable to focus, poor sleep with nightmares. He avoided reminders and recalled the sound of shootings, He felt disconnected from his surroundings and self.

Betheny- no diagnosis
Charles - Acute Stress disorder

Normal response to traumatic event- transient reactions will resolve within 2 to 3 days.
Normal response usually presents with emotional reaction- shock, fear, grief, resentment. guilt. shame. helplessness, hopelessness and numbing
Cognitive reactions: confusion, disorientation, dissociation, indecisiveness, difficulty concentrating, memory loss, self blame and unwanted memories
physical reactions-tension, fatigue, insomnia, startle, racing pulse, nausea. loss of appetite.
Interpersonal reaction
Acute is more intense and occur during the month after the event. - minimum of 9 of 14 symptoms spread across 5 categories.
When evaluated individually symptoms may look like, Panic, anxiety, depression, dissociation, and intrusive, obsessional thoughts,