question

Dichotomous thinking:

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black and white thinking.

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In rare tragic cases, a mother suffering from major depression with peripartum onset sometimes...

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kills her child

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Recent evidence indicates a higher level of ___________ in patients with bipolar disorder that was marked by a rapid cycling pattern compared to those with a non-rapid cycling pattern.

answer

suicide

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Suicide associated with bipolar disorder almost always occurs during

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depressive episode

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Which of the following is TRUE of depression in the elderly?

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The prevalence of depression is almost equal among elderly men and women.

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Which of the following statements about suicide is correct?

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For teenagers, suicide is the third leading cause of death after auto accidents and homicide.

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Statistics on suicide indicate that approximately one-quarter to one-half of all suicides are associated with _____________.

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alcohol use

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Which of the following statements is accurate regarding the relationship between anxiety and depression?

answer

Many depressed patients are or have been anxious and many anxious patients are or have been depressed.

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All of the following statements are accurate about electroconvulsive therapy (ECT) except

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psychotically depressed patients should be treated with ongoing medication, not ECT, even when response to those drugs is poor.

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The antidepressant medication lithium is also referred to as a mood stabilizer because it

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helps to prevent manic episodes

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In Aaron Beck's depressive cognitive triad, individuals think negatively about all of the following EXCEPT ______

answer

their past

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With regard to social support

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having social support helped speed recovery from depressive episodes

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Which of the following is perhaps the best-known and widely used SSRI medication

answer

Prozac

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Which of the following statements is TRUE about tricyclics?

answer

They can be accompanied by very unpleasant side effects.

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Mood within normal limits vs. mood outside normal limits

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How do you determine this? Intensity Duration Impairment/interference in functioning Outside cultural/social norms

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Mood Episodes are...

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building blocks for a mood disorder

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Mood Episodes : (3)

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Major Depressive Episode Manic Episode Hypomanic Episode

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Mood Disorders: (4)

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Major Depressive Disorder Persistent Depressive Disorder Bipolar I and II Disorder Cyclothymic Disorder

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Major Depressive (MD) Episode :

answer

5 or more of the following during the same 2 wk period. Depressed mood by report or observation Anhedonia -loss of interest or pleasure (one or both must be met) Significant weight loss/weight gain or significant changes in appetite. Sleep problems Psychomotor agitation or retardation Fatigue/loss of energy Feelings of worthlessness or excessive guilt Problems with concentration Suicidal ideation (5 or more) Symptoms do not meet criteria for mixed episode. Cause clinically significant distress or impairment. Are not due to direct effects of substance or medical condition. R/O Grief

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Major Depressive (MD) Episode Occurs :

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5 or more of the following during the same 2 wk period.

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Manic Episode Occurs: (A)

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Period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 wk (unless hospitalized). Also increased goal -directed activity.

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Manic Episode: (B)

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B. 3 or more symptoms (during A): o Inflated self esteem, grandiosity o Decreased need for sleep (e.g., after 3 hours sleep) o Pressured speech, very talkative o Racing thoughts (flight of ideas) o Distractibility o Increase in goal -directed activity or psychomotor agitation o Excessive involvement in pleasurable activities that could result in troubling consequences Cause significant impairment or makes hospitalization necessary, or there are psychotic features Not due to a substance or medical condition

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Hypomanic Episode :

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("below manic episode" / less extreme) Same as manic episode, EXCEPT that the mood lasts at least 4 days. Unequivocal change in fx that is uncharacteristic of person and observable by others. Not marked by impairment or need for hospitalization. Not due to substance or medical condition.

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The structure of Mood Disorders : (Unipolar/Bipolar)

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Unipolar: Depression OR mania At one pole of a mood continuum Bipolar: Both depression AND mania Misleading terminology bc not just ONE mood continuum ▪ Person can experience mania and feelings of depression and anxiety - mixed manic episode/ dysphoric mania

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Depressive Disorders: Major Depressive Disorder (MDD):

answer

either Single episode or Recurrent - presence of 2 or more MD episodes Not better accounted by other diagnoses (e.g., Schizophrenia, Schizoaffective Disorder) Never a manic or hypomanic episode. Mean age onset - 30 yrs. Incidence increasing from previous decades Duration: average first episode 4 - 9 months (if untreated) Episodes can last from 2 wks to several years. Residual symptoms increase risk for future episode(s)

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Depressive Disorders: Persistent Depressive Disorder:

answer

Depressed mood for most of the day, on most days, for at least 2 years (1y in children/adol.) Milder than MDD, fewer symptoms, but stable course (lasts longer) Onset before 21 yrs. associated with: 1.Greater chronicity (lasts longer) 2. Poor prognosis and response to treatment 3. Stronger likelihood of disorder running in family As many as 79% of ppl with PDD have also had a MD episode at some point. More likely to attempt suicide than individuals with major depression (in a 5 yr period).

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Depressive Disorders: Double Depression

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Major Depressive Episodes with preexisting Persistent Depressive Disorder More severe, chronic course

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Bipolar I

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Alteration of major depressive episodes with FULL MANIC episodes. Avg. age of onset approx. 18 yrs. Severe mood instability as a result of symptoms. Often a high degree of job, work, or school impairment. Risky behaviors can be highly dangerous to the individual and sometimes others.

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Bipolar II

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Alteration of recurrent major depressive episodes with hypomanic episodes (so, not at same time) A. presence/ hx of one or more MD episodes B. presence/hx of at least one hypomanic episode C. NEVER a manic episode D. Crit A and B not accounted by another dx E. Clinically significant distress or impairment 10 - 13% will develop into BP I Avg. age of onset between 19 and 22

question

Cyclothymic Disorder

answer

At least 2 years (1 year in children/adolescents) of hypomanic symptoms (not full hypomanic episode) and depressive symptoms (not full MDD episode) More than half of two years, not w/o symptoms for 2 months. Not severe enough to require hospitalization or severe intervention. "Moody" to the point that it interferes with fx. At increased risk to develop bipolar disorder. Not better accounted for by substance or general medical condition. Full criteria for MDD, manic, or hypomanic episode never met.

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Bipolar Disorders History:

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Duration: Usually life - long Even with treatment 16% recover; 52% suffer from recurrent episodes; 16% chronically disabled; 8% commit suicide Medication is almost always indicated to stabilize mood!

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Course of Mood Disorders

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Salient Specifiers in DSM- V: • Rapid cycling: 4 or more episodes in one year = rapid cycling • Seasonal patterns • With Anxious Distress • With Mixed Features ; uncommon

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Prevalence of Mood Disorders

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12 Month Prevalence (in US): MDD = 7% PDD = 0.5% Bipolar I: 0.6% Bipolar II: 0.8% Cyclothymic Disorder: 0.4% - 1.0% (lifetime) Across Cultures: More somatic symptoms Subjective feelings difficult to study and compare Socioeconomic Status (SES) confounds findings and is a risk factor (have more stressors in life)

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Causes of Mood Disorders

answer

1. Biological Dimensions 2. Psychological Dimensions 3. Sociocultural Dimensions

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Familial and Genetic Influences: Biological Vulnerability

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• Family studies Rate is 2- 3 times higher in relatives of probands (i.e., the person known to have the dx) • Twin studies (Identical twins share the exact same genes. They're monozygotic) If one has it, identical twin 2- 3x's more likely than frat. Twin to also have mood d/o (partic bipolar) Severe mood disorders (severe MDD) have a stronger genetic contribution than less severe Heritability rates are higher for females compared to males.

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Familial and Genetic Influences: Biological Influences

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•Neurotransmitter systems (chemical messengers allowing different nerve cells or neurons to communicate w/ one another) Low levels of serotonin in its relation to other neurotransmitters (NTs) Norepinephrine and dopamine (low levels) •Permissive hypothesis - When serotonin low, other NTs are "permitted" to range more widely, become dysregulated, and contribute to mood irregularities •The endocrine system Stress hypothesis - Elevated cortisol levels ("stress" hormone)

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Psychological Dimensions: Cognitive Theory of Depression

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Negative coping styles. Depressed persons engage in cognitive/thinking errors. Tendency to interpret life events negatively. Depressive cognitive triad: 1. Think negatively about oneself 2. Think negatively about the world 3. Think negatively about the future

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Depressive cognitive triad:

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1. Think negatively about oneself 2. Think negatively about the world 3. Think negatively about the future

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Psychological Dimensions (Stress) Diathesis- stress model:

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Diathesis- stress model: Stressful, severe, traumatic life events strongly related to Onset of depression Poorer response to tx Longer time before remission Context and meaning of life events important!! Same event may mean different things to different people (e.g., divorce) Not all stressful events are independent of depression In ~1/3 of cases, stress does not precede depression Bipolar disorder: Stressful events trigger early mania and depression Can trigger relapse or prevent recovery Lack of sleep may precipitate manic episodes Disturbed circadian rhythms (e.g., jet lag)

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Psychological Dimensions: Cognitive Theory of Depression: Learned Helplessness

answer

Depressive attributional styles maintain symptoms Interpretation of negative events: 1. Internal attributions: Negative outcomes are "all my fault" 2. Stable attributions: situation/future will "always be this way" 3. Global attribution: "just like everything else" All three domains contribute to a sense of hopelessness Depressive attributional style for positive events External - not because of me, luck Specific - just this situation Unstable - will never happen again Maladaptive assumptions: Ideas about what one thinks they SHOULD be doing. "I should get the approval of everyone" Negative self-concept: Focus on shortcomings, exaggerate them, minimize positive qualities. See self as unlovable, ugly, weak.

question

Psychological Treatment of Mood Disorders

answer

Interpersonal Psychotherapy (IPT) Emphasizes ID and resolution of interpersonal problems and stressors. Ex: death of loved one, divorce. Learn to form important new relationships Cognitive Behavioral Therapy (CBT) ID and modification of distorted thoughts, feelings, and maladaptive behaviors

question

Sociocultural Influences

answer

Marital relations- Marital dissatisfaction is strongly related to depression. Particularly strong in males . Disruption found to precede depression Mood in women. Females over males for MDD and PDD (70%) Bipolar disorders evenly divided. Gender imbalance likely due to sex roles & perception of uncontrollability for females. Social support- Lack of s.s. is related to onset of depression 10% of women who had close friend developed vs. 37% of who did not have supportive friend

question

Goal of Cognitive Behavioral Therapy:

answer

Event → thoughts → feel → behavior • Increase logical thinking • Understand relationship: how we think about or interpret events determines the way we respond emotionally and behaviorally • Cogns intervene in how we feel about events; Events do not directly influence how we feel. Instead, the way we think about those events does. • Thoughts, feelings and behaviors are inter-related, so altering one can help to alleviate difficulties in another

question

Revising cognitions and behaviors in CBT:

answer

If cognitions determine feelings → revising illogical cognitions can → more appropriate emotional reactions → more adaptive behaviors. If cognitions are more extreme than warranted, unwanted feelings and maladaptive behaviors can unnecessarily occur Steps to revising cognitions: 1. ID illogical cognitions (automatic thoughts) 2. Challenge them 3. Replace them with more logical cognitions 4. Do behavioral experiments to test/confirm the more logical cognition

question

Psychological Tx: Bipolar disorder

answer

Psychotherapy can help manage how disorder interferes w/ daily life. • Can help regulate sleep cycles and daily schedules • Increase family support and understanding of pt to help prevent relapse Medication compliance essential • Clients may sometimes skip during manic episodes • Self-monitoring log

question

Psychotropic Treatment of Mood Disorders

answer

Antidepressants Selective serotonergic reuptake inhibitors (SSRIs) Lithium (lithium carbonate) Primary choice of drug for bipolar disorder Often effectively treats manic episodes 50% respond well Potentially severe side effects, must carefully be followed by physician

question

Electroconvulsive Therapy (ECT) (biological treatment)

answer

For severe depression w/no response to other less invasive tx's. Brief (<1s) electric shock to brain leading to convulsions lasting few min. 6-10 tx's, once every other day 50% benefit, ~60% of cases relapse stressful events are strongly related to the onset of bipolar d/o and depression.

question

The physical symptoms of a major depressive disorder include

answer

changes in appetite or weight.

question

One of the symptoms of a mood disorder is called anhedonia, which means

answer

an inability to engage in pleasurable activities.

question

Most individuals who experience a single episode of major depressive disorder will

answer

probably have several episodes throughout their lives.

question

When manic episodes alternate with depressive episodes, the disorder most correctly diagnosed would be

answer

bipolar disorder

question

Bipolar II disorder consists of

answer

depression and hypomanic episodes

question

Symptoms of severe depression are generally NOT considered a psychological disorder when they are associated with ____

answer

a greif reaction

question

Recent research suggests that

answer

the same genetic factors contribute to both anxiety and depression.

question

A child raised by depressed parents is likely to

answer

struggle with depression as well.

question

Martin Seligman's theory that people become anxious and depressed because they believe that they have no control over the stress in their lives is called

answer

learned helplessness theory

question

According to recent research on the development of depression, dysfunctional attitudes (a negative outlook) and hopelessness attributes (explaining things negatively) constitute a _____________ vulnerability to depression.

answer

cognitive

question

A student who has been doing very well in her psychology class receives a minor critical comment on an essay that she wrote as part of an exam. The student thinks, "This is terrible. I'm probably going to fail the course." This type of cognitive error in thinking is called ____

answer

overgeneralization

question

Eating Disorders: (3)

answer

Severe disruptions in eating behavior. Extreme fear and apprehension about gaining weight (Preoccupation with thinness) with AN and BN. All marked with difficulty controlling eating behaviors 1. Anorexia nervosa (AN) 2. Bulimia nervosa (BN) 3. Binge-eating disorder

question

Anorexia Nervosa

answer

An eating disorder in which a person is obsessed by thoughts of an unattainable image of "perfect" thinness

question

Anorexia Nervosa: Diagnostic Criteria:

answer

A. Significantly low weight due to energy intake restrictions. Severity is specified by current BMI (mild, moderate, severe, extreme) B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain even when underweight. FASTING. C. Distorted idea of body image, denial of seriousness of current weight.

question

Anorexia Nervosa (2 types)

answer

Anorexia: Two subtypes 1. Restricting Limit caloric intake via diet and fasting No recurrent binging/purging in the past 3 months. 2. Binge-eating/purging (Binge- eating large amnt of food within short amnt of time) Laxatives, self-induced vomiting, diuretics. Eat smaller amounts of foods and purge more frequently than those with bulimia. Binging or purging in the past 3 months.

question

Anorexia Statistics

answer

12 Month prevalence rates • 0.4% of population among females • >90% adolescents and young adult females (typically higher SES(higher income bracket)) • About 10% males More chronic and resistant to treatment compared to bulimia. Successful weight loss hallmark of anorexia- different than bulimia because of ability to keep weight off and very low BMI. Not only dealing with physiological lack of intake but also real psychological variables at play w/ hospitalization.

question

Anorexia: Medical Consequences

answer

• Dry skin • Damage to teeth and hair loss • Damage to vital organs (heart and brain) • Pulse rate and blood pressure drop • Nutritional deprivation causes calcium loss from bones, which can become brittle and prone to breakage • Can cause infertility (hormonal imbalance) • Lanugo-downy hair on limbs and cheeks lol • Death from starvation (15 -20%)

question

Anorexia: (Comorbidity- having 2+ diagnosable disorders)

answer

Anxiety and mood disorders often present. Depression in 33% of current cases; 60% experience it at some point in life. *OCD most common anxiety disorder that co-occurs with anorexia. Intrusive thoughts about weight gain, body image Preoccupation with food -cooking for others, constantly talking about it, hoarding it. Behaviors often ritualistic. Excessive control of food intake. Strict and excessive exercise regimens; obligatory.

question

Bulimia Nervosa

answer

An eating disorder characterized by binges on large quantities of food, followed compensatory behaviors to make up for binge. More common than anorexia.

question

Bulimia: Diagnostic Criteria

answer

A. Recurrent episodes of binge eating characterized by both: Eating an amount of food in a discrete period of time (e.g. 2 hours) that is larger than most people would eat during a similar period of time and under similar circumstances. 30 times the calories for a single meal. Sense of lack of control of what is eaten during the episode. B. Recurrent inappropriate compensatory behavior to prevent weight gain. Provides equilibrium (rid of shame, guilt, disgust), temporary relief, hunger, and restriction again. C. Binge eating and inappropriate compensatory behaviors both occur at least 1x a week for 3 months (on average) D. Self-evaluation unduly influenced by body shape and weight Distorted body image. E. The disturbance does not occur exclusively during episodes of anorexia

question

Bulimia: Subtypes

answer

Severity depends on number of inappropriate compensatory behaviors per week (mild, moderate, severe, extreme)

question

Medical consequences: Bulimia

answer

(Even when normal weight) • Intestinal problems from laxative abuse. • Electrolyte imbalance and dehydration can occur and may cause cardiac complications. • Rare instances, binge eating can cause the stomach to rupture • Heart failure due to the loss of vital minerals like potassium • Calluses in back of hand from induced vomiting (gag reflex) • Erosion of dental enamel due to stomach acid • Kidney failure, cardiac arrhythmia, seizures, permanent colon damage

question

Binge-eating disorder (BED)

answer

Now an official diagnosis in DSM-V Engage in food binges without compensatory behaviors (^different from bulimia because!) Associated features • Many persons with B-ED are heavier or obese • Concerns about shape and weight • Often older than bulimia and anorexia pts • More psychopathology vs. non-binging obese people

question

Binge Eating Disorder Criteria

answer

A. Recurrent episodes of Binge Eating (Binges are the same as other eating disorders) that includes a lack of control and large amount of food w/in discrete time period. B. Other symptoms (3 or More): -Eating much more rapidly than normal -Until uncomfortably full -Eating large amounts of food when not physically hungry -Eating alone due to embarresment -Feeling disgusted w/ oneself, depressed/ very guilty afterward. C. Marked distress regarding binges D. Binges occur at least 1x a week for 3 months E. BE does not occur exclusively during AN or BN and is not associated with recurrent compensatory behavior

question

Causes of Bulimia and Anorexia:

answer

Media and cultural considerations Being thin = success, happiness....really? Cultural glorification of thinness (Western cultures) Standards of ideal body size Change constantly, as much as fashion! Media standards of the ideal

question

Cultural Considerations of Bulimia and Anorexia:

answer

ED's more prevalent among females Compared to Caucasians, prevalence lower among African American and Asian females Equal to Hispanics More common among Native Americans Cultural factors influence rate of ED's Inc. prev. of ED's is related to changes in cultural standards of thinness. Acceptance of bigger body sizes in some cultures may contribute to lower incidence of ED's African American adolescents

question

Body Image Dissatisfaction

answer

Males tend to rate ideal body weight as heavier Women rate current body figure as heavier than what they thought would be most attractive Discrepancy between cultural ideals and current self may lead to: depression, self-doubt, low self-esteem

question

Psychological and Behavioral Considerations of Bulimia and Anorexia:

answer

• General psychological vulnerabilities • Learn inappropriate coping skills when faced with stress • Low sense of personal control and self-confidence • Perfectionistic attitudes • Distorted body image perception • Preoccupation with food

question

Medical and drug treatments- Bulimia & Anorexia

answer

Bulimia- Antidepressants (Prozac) Can help reduce binging and purging behavior Are not efficacious in the long-term Anorexia- No drug has been found effective Medical intervention likely needed to restore nutrients, fluid. VERY psychologically driven

question

Bulimia: Psychosocial treatments

answer

CBT is the treatment of choice • Normalize eating patterns: meal planning • Self-monitoring of food intake, binges, purges • Psychoeducation about the disorder and its potential consequences • Expanding food choices, adding "forbidden" foods • Cognitive restructuring -distorted thoughts of food intake, weight, shape, self • Problem solving; adaptive coping skills • Weight and shape concerns, body image dissatisfaction • Relapse prevention CBT produces better and more immediate outcomes in the short-term compared to other txs Similar long-term effects as IPT

question

Interpersonal psychotherapy (IPT) (for ED)

answer

At first, discuss relationship between interpersonal events and the ED Eventually, focus shifts to (problematic) interpersonal relationships, as these can lead to negative affect that triggers binge eating. Results in long-term gains similar to CBT

question

Psychological Treatment of Anorexia Nervosa

answer

General goals and strategies Weight restoration • First and easiest goal to achieve, but poor predictor of outcome • Medical intervention recommended when weight is <70% of expected wt Behavioral and cognitive interventions • Target food intake, body image perceptions • Dysfunctional attitudes about body shape, anxiety about weight gain, uncontrollability, self-worth Tx often involves the family Long-term prognosis for anorexia is poorer than for bulimia

question

Treatment of Binge Eating Disorder

answer

CBT Similar to that used for bulimia Appears efficacious IPT: Interpersonal psychotherapy (focuses on interpersonal relationships and functioning) Equally as effective as CBT Self-help techniques Also appear effectious.

question

An Integrative Model (ED)

answer

No single cause of ED's. Combo of biological, psychological, and sociocultural factors influence the development of ED's. ED's share similar biological and psychological vulnerabilities as mood and anxiety disorders.

question

Although the "alarm reactions" experienced in both PTSD and panic disorder are very similar and result in conditioned responses, in panic disorder the alarm is __

answer

false

question

An individual who suffers from panic disorder might become anxious about climbing stairs, exercising, or being in hot rooms because these activities produce sensations similar to those accompanying a panic attack. In psychological terms, the exercise and hot rooms have become __

answer

conditioned stimuli

question

anxiety is closely related to

answer

depression

question

Anxiety is thought to be a____________ state, while fear is more______

answer

future-oriented; immediate

question

For generalized anxiety disorder (GAD), the pharmacological treatment of choice has been the category of drugs known as _______

answer

benzodiazepines

question

In regard to a type of thinking pattern found in some patients with OCD, which of the following would be an example of thought-action fusion?

answer

Believing that thinking about an abortion is the moral equivalent of having an abortion

question

Individuals suffering from posttraumatic stress disorder (PTSD) display a characteristic set of symptoms including all of the following EXCEPT

answer

decreased startle response and chronic under-arousal.

question

Mrs. Pan has an anxiety disorder in which she has occasional panic attacks when shopping at the mall. This type of panic attack is referred to as _________

answer

cued

question

People tend to have their best performance on tasks when they are _____

answer

a little anxious

question

People with GAD tend to worry about

answer

mostly minor things.

question

People with a psychological vulnerability to panic attacks tend to ________ normal physical sensations.

answer

catastrophize

question

Research suggests that anxiety and depression frequently

answer

co-occur

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