412 post-M2

Question 1

hypomanic episode

Answer 1

• same symptom criteria as a manic episode
• lasting at least 4 days
• represents a change in functioning, but no marked impairment in social or occupational functioning

Question 1

manic episode

Answer 1

1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least ONE WEEK (or any duration if hospitalization is necessary)
2. Three or more (four if mood is only irritable) are present to a significant degree:
   - inflated self-esteem or grandiosity
   - decreased need for sleep
   - more talkative than usual or pressure to keep talking
   - flight of ideas or subjective experience of racing thoughts
   - distractibility
   - increase in goal-directed activity or psychomotor agitation
   - excessive involvement in pleasurable activities that have a high potential for painful consequences

Question 2

Bipolar I

Answer 2

• presence of a manic episode, regardless of whether depressive episodes have been present
• may show mixed features: concurrent depressive and manic symptoms

Question 3

Bipolar II

Answer 3

• major depressive episode AND hypomanic episodes
• has never had a full manic episode

Question 4

cyclothymia

Answer 4

• period lasting at least 1 year (2 in adults) of manic symptoms that do not meet feel criteria for either a manic or hypomanic episode and depressive symptoms that do not meet criteria for MDD

Question 5

bipolar in children

Answer 5

• diagnoses of BP quadrupled between 1990-2000, exacerbated by the publication of a book arguing that BP in kids was being overlooked
• in 2001, it was decided that BP could be diagnosed in kids but that there could be presentation differences
• adults typically have discrete episodes, but kids could be cycling through moods rapidly (within the same day) which could last for long periods of time (1-4 years)

Question 6

narrow phenotype BP

Answer 6

• ‘classic’ adult symptoms of grandiosity and mania
• some children do meet full adult criteria
• maybe we’re missing the kids who have BP but present differently

Question 7

broad phenotype BP

Answer 7

• including irritability, mood swings
• irritability is common in typical kids and in many other disorders (depression, ODD)
• argued that we’re losing specificity and maybe this isn’t bipolar at all

Question 8

diagnostic challenges for BP

Answer 8

• irritability rather than euphoria can be the main mood state which requires many DDx (depression, ODD, CD, ADHD)
• arguing for a more narrow phenotype in which core symptoms of mania must be present
• but decision that criteria for adults should be applied to children too (irritability should still be a marked change in state)
• children may not show discrete episodes of mood changes
• diagnostic validity of BP in kids is unclear (concerns about overdiagnosis - frequent temper tantrums and chronic irritability), so creation of DMDD diagnosis

Question 9

prevalence and course of BP

Answer 9

• BP very rare prior to puberty, then rates rise in adolescence
• lifetime prevalence of BP1, 2 is 2.9%
• 60% of people report their first episode in adolescence (before age 19), and the first episode tends to be MDD
• there may be subclinical mania or depression prior to first episode, which is difficult to identify
• mania in adolescence is associated with psychosis, mixed episodes (more severe course)

Question 10

recovery for BP

Answer 10

• recovery: 2 months without meeting DSM criteria for manic, hypomanic, depressive, mixed episode
• 40-100% of children/teens will recover within their first year, but 60-70% of them will show recurrence (another episode)
• recovery rates are dependent on age of onset
• prepubertal onset is associated with much lower rates of recovery than onset during puberty
• childhood mania is an important risk factor for adult mania (more severe and chronic) - homotypic continuity

Question 11

comorbidity bipolar

Answer 11

• ADHD: 60-90% of children, 30% of teens (stimulant medication can exacerbate bipolar symptoms)
• disruptive bx disorders: 20% of kids meet criteria for conduct disorder (could be symptom overlap or that the disruptive behaviours are a product of your bipolar presentation)

Question 12

clinical correlates of bipolar

Answer 12

• marked social impairment
• peer problems: social skill deficits, teased and victimized by peers, few friends
• families: poor relationships with siblings, hostility and conflict with parents

Question 13

etiological factors in BP

Answer 13

• highly heritable (estimates over 75%, high concordance rates in Mz twins), but not completely genetically based (environmental factors still play a role)
• genetics play a larger role in early onset cases (severe and chronic cases)
• multiple gene problem
• diathesis-stress model with exposure to stress
• stressor can be problematic family interactions (hostility, conflict) = passive gene-environment correlation

Question 14

treatment of BP

Answer 14

• medication: mood stabilizers (lithium), antipsychotics, antidepressants
• pharmacotherapy is indicated for treatment of all youth with BP (thought many do not receive it or receive the wrong medication like antidepressants on their own)
• psychosocial: family education

Question 15

lithium treatment for BP

Answer 15

• commonly used in adults, approved for kids aged 12+
• has serious side effects and can be toxic if dosage is wrong (renal problems, hyperthyroidism)
• compliance and monitoring are very important
• meta-analysis showed safety in short-term, some small side-effects WHEN compliance and monitoring were good

Question 16

atypical antipsychotics for BP

Answer 16

• wide-ranging class (many different options to try)
• ten RCTs have demonstrated good efficacy for BP in youth

Question 17

antidepressants for BP

Answer 17

• depressive episodes can be chronic and severe, but antipsychotics/mood stabilizers only help with manic symptoms
• using antidepressants alone can exacerbate/provoke manic episodes in people with BP (bipolar switch)
• rarely prescribed alone; best to prescribe in conjunction with lithium or antipsychotics

Question 18

recommendations for youth with BP

Answer 18

• begin with one atypical antipsychotic, if they don’t respond or cannot tolerate it, try a different one
• if a patient isn’t responding to 2-3 antipsychotics, switch to lithium
• if a patient partially responds to the antipsychotic, add lithium
• see about adding antidepressants afterwards

Question 19

psychosocial treatment for BP

Answer 19

• family education: understanding the disorder and symptoms, reducing conflict in the family, medication management
• multifamily psycheducational psychotherapy and family-focused therapy both emphasizing education, communication, problem-solving skills showed similar efficacy in improving mood symptoms

Question 20

RAINBOW in child- and family-focused CBT (CFF-CBT)

Answer 20

• Routine: establish a predictable routine to reduce tantrums, negativity, conflict
• Affect regulation: understanding triggers and helping parents and kids manage episodes
• I can do it: increase beliefs that kids and parents can manage symptoms
• No negative thoughts: retraining cognitive distortions associated with depression
• Be a good friend and Balanced lifestyle
• Oh, how can we solve this problem: improving problem-solving skills in parents and kids
• Ways to get support: help parents learn to access support and advocate for their child at school

Question 21

CFF-CBT for pediatric BP trial

Answer 21

• kids aged 7-13 diagnosed with BP who were treated with medication (stabilized, no acute symptoms)
• assigned to treatment as usual or CFF-CBT
• outcome measures: parent and clinician report of mania and depression
• after treatment, youth in CBT had lower mania symptoms (below the clinical cutoff)
• youth in CBT had lower depressive symptoms according to parent report, but not according to clinician report
• psychosocial therapy can further reduce symptoms for patients stabilized on medication

Question 22

definition of child maltreatment

Answer 22

• any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act, which presents an imminent risk of serious harm
• includes physical/emotional/sexual abuse, physical/educational/emotional neglect

Question 23

physical abuse

Answer 23

• punching, beating, kicking, burning, shaking, or otherwise physically harming a child
• often unintentional and resulting from severe physical punishment

Question 24

neglect

Answer 24

- child's basic needs aren't being met - physical: refusal of healthcare, inadequate supervision, lack of food - emotional: not attending to emotional needs, not providing psychological care when required - educational: not putting the child in school, not attending to special education needs or accommodation

Question 25

sexual abuse

Answer 25

- touching genitals, intercourse, exhibitionism, production of pornographic photos

Question 26

emotional abuse

Answer 26

- repeated acts by parents/caregivers that could/have caused serious behavioural, cognitive, emotional or mental disorders

Question 27

epidemiology of child maltreatment

Answer 27

- difficult to study incidence and prevalence due to people not reporting (parents unwilling, kids unable/unaware), using retrospective report - rates will depend on how you operationalize abuse and maltreatment - US has slightly higher rates than Canada, likely due to higher rates of poverty + difficult to access health care - most commonly reported experience is neglect, then physical, then sexual, then emotional abuse (studies still mostly focus on physical/sexual abuse)

Question 28

demographic characteristics of child maltreatment

Answer 28

- age: younger kids more likely to be neglected, older (12+) more likely to be sexually abused - gender: girls more likely to be sexually abused - single-parent families have higher rates of physical abuse and neglect - poverty is a risk factor - more upward social mobility = less rate of maltreatment (ease of access to education and resources = moving out of lower classes, so the stress of a lack of resources could be a risk factor for maltreatment)

Question 29

Covid and child maltreatment

Answer 29

- rates increased across the globe during lockdowns - most notable increases in low and middle income countries (LMIC) - poverty is a risk factor in individual families and nationwide (compounding risk factors) - chronosystem influence on prevalence of maltreatment and subsequent psychopathology

Question 30

developmental course of maltreatment

Answer 30

- kids must learn to cope with challenges in environment which may be adaptive in maltreatment situations, but could become maladaptive in other situations - maltreatment shapes brain development (smaller brain volumes), physiological reactivity to stress (strong spikes or blunted responses), understanding of emotion

Question 31

maltreatment and understanding of emotion

Answer 31

- maltreatment = exposed to different emotional experiences = changing your understanding and experience of emotion (hypervigilance to anger signs)

Question 32

emotion recognition task maltreatment study

Answer 32

- included physically abused or neglected kids compared to no abuse history between 3-5 years - kids presented with vignettes of stories representing happiness, sadness, fear, disgust, anger and told to point to the correct facial expression for that story - evaluating sensitivity to differences between expressions (are kids correct in their choices), bias toward choosing a certain emotion (are they always choosing an emotion) - neglected kids are less sensitive (not good at differentiating) - physically abused kids show a bias for angry faces, neglected kids show a bias for sad faces - could be due to a visual inability to discriminate between faces or these kids have different understandings of the emotional displays

Question 33

emotion discrimination task maltreatment study

Answer 33

- comparing physically abused and neglected kids and no abuse history - shown two faces and asked if they're the same or different - no differences between three groups, so it's not that abused or neglected kids can't visually discriminate between faces

Question 34

emotion differentiation task maltreatment study

Answer 34

- kids asked to rate similarity of the facial expressions by ranking them as most/least similar to the target photo - neglected kids perceived less distinction between angry, sad, fearful facial expressions (emotional experiences perceived as more similar to each other) - abused and control groups perceived anger as more distinct than other emotions - so neglected children learned emotions differently (through participation in social world through caregivers) - maltreatment changed their understanding of emotion

Question 35

physical abuse and understanding of emotion study

Answer 35

- comparing physically abused to control group - presented with images displaying angry, sad, fearful, happy faces that are gradually de-pixelated and kids must identify the emotion at every 3-second interval + how confident they are in their response (only used responses that participants were fairly confident in, not the guesses) - no differences in ability to identify happy faces - significant difference in identifying anger - when the image starts to clarify slightly, physically abused kids recognize it faster (needed less information to accurately identify anger) - fear is nonsignificant, but a slight trend toward abused kids being faster - significant difference in sadness: abused kids are slower and less confident, needed more information to identify sadness (lack of familiarity with seeing a full range of emotions in caregivers)

Question 36

diathesis-stress model of child maltreatment

Answer 36

- MAOA gene interacting with early maltreatment: low-MAOA + maltreatment = more antisocial behaviour than low-MAOA without maltreatment or high-MAOA - short allele of 5-HTTLPR (serotonin transporter) interacting with significant life stress to produce depression - multifinality: child maltreatment is a risk factor for all types of psychopathology (may depend on the specific diathesis)

Question 37

serotonin + life stress GxE interaction

Answer 37

- people with long-long alleles of 5-HT + no/probable/severe maltreatment = mild risk depression (genotype doesn't matter for determining risk) - short-long alleles = moderate risk for depression when maltreatment increases from none to severe - short-short alleles = high risk for depression when maltreatment increases from none to severe - single gene polymorphism having a large effect - social support played a protective role: the interaction is being moderated by another factor - short alleles + maltreatment + poor social support = 2x higher risk for depression than just the short alleles (three-way interaction) - evidence for small interaction for 5-HT moderating the relationship between regular life stress and depression

Question 38

PTSD criteria adults and older kids

Answer 38

- exposure to actual/threatened death, serious injury, sexual violation (direct experience, witnessed, learned of it happening to a loved one, repeated exposure to details of the event) - repeated exposure doesn't apply to exposure through electronic media unless this exposure is work related - symptoms must persist for at least ONE MONTH - at least 1 intrusion, 1 avoidance, 2 extreme arousal, 2 negative cognitions/mood

Question 39

PTSD criteria in kids 6 or younger

Answer 39

- exposure to criterion A event - at least ONE intrusion, ONE avoidance or negative cognition/mood, TWO extreme arousal - intrusion can look different in young kids - expressing distress through behaviours, play, reenactement - feelings of detachment or estrangement from others = social withdrawal - persistent inability to experience positive emotions - irritability can include tantrums

Question 40

intrusion criteria symptoms

Answer 40

at least ONE of (1) Recurrent, involuntary and intrusive distressing memories of the traumatic event (in kids, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed) (2) Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event (in children, there may be frightening dreams without recognizable content) (3) Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event were recurring. (Such reactions occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In young children, trauma-specific reenactment may occur in play (4) Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event (5) Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event

Question 41

avoidance criteria symptoms

Answer 41

At least ONE of (for adults) (1) Avoidance of distressing memories, thoughts, or feelings about or closely associated with the traumatic event (2) Avoidance of external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event

Question 42

negative alterations in cognition or mood criteria symptoms

Answer 42

At least TWO of (for adults) (1) Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). (2) Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (3) Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. (4) Persistent negative emotional state (5) Markedly diminished interest or participation in significant activities. (6) Feelings of detachment or estrangement from others. (7) Persistent inability to experience positive emotions

Question 43

extreme arousal criteria symptoms

Answer 43

At least TWO of (1) Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects (in kids 6 or younger, can be extreme temper tantrums) (2) Reckless or self-destructive behavior. (3) Hypervigilance. (4) Exaggerated startle response. (5) Problems with concentration. (6) Sleep disturbance

Question 44

avoidance/cognition/mood criteria symptoms (6 or younger)

Answer 44

At least ONE of (1) Avoidance of activities, places, or physical reminders that arouse recollections of the traumatic event (2) Avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the traumatic event (3) Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion). (4) Markedly diminished interest or participation in significant activities, including constriction of play. (5) Socially withdrawn behavior. (6) Persistent reduction in expression of positive emotions.

Question 45

PTSD specifiers

Answer 45

- with dissociative symptoms (not attributable to a substance) (1) Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (2) Derealization: Persistent or recurrent experiences of unreality of surroundings - with delayed expression: full criteria aren't met until at least 6 months after the event (even if some symptoms may be immediate)

Question 46

prevalence of PTSD

Answer 46

- limited data with children - adolescents: lifetime prevalence is 5% - exposure to a criterion A event is associated with experiencing at least some symptoms of PTSD even if not meeting full criteria (85%, could potentially be diagnosed with adjustment disorder instead)

Question 47

trauma and related disorders in DSM-5

Answer 47

- PTSD - acute stress disorder - adjustment disorder (residual and short-term) - reactive attachment disorder - disinhibited social engagement disorder

Question 48

acute stress disorder

Answer 48

- exposure to criterion A event - at least NINE symptoms due to criterion A event from (1) intrusion (2) negative mood (3) avoidance (4) dissociation (5) arousal - essentially meeting criteria for PTSD, but symptoms last LESS than ONE month (if symptoms continue past one month, changed to PTSD dx)

Question 49

adjustment disorder

Answer 49

- children who react to less severe/more common types of stressors than criterion A events in disproportionate and inappropriate ways (but less severe symptoms than PTSD or acute stress)

Question 50

reactive attachment disorder (RAD)

Answer 50

(A) pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by BOTH of the following: - The child rarely or minimally seeks comfort when distressed. - The child rarely or minimally responds to comfort when distressed. (B) social and emotional disturbance characterized by at least TWO of the following: - Minimal social and emotional responsiveness to others. - Limited positive affect. - Episodes of unexplained irritability, sadness or fearfulness (even during nonthreatening interactions with adult caregivers) (C) experienced a pattern of extremes of insufficient care as evidenced by at least ONE of the following: - social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. - repeated changes of primary caregivers that limit opportunities to form stable attachments - rearing in unusual settings that severely limit opportunities to form selective attachments (D) care in criterion C is assumed to be the cause of symptoms in criterion A (E) not meeting criteria for autism spectrum disorder (F) disturbance occurs before age 5 (G) developmental age of at least 9 months

Question 51

disinhibited social engagement disorder (DSED)

Answer 51

(A) pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least TWO of the following: - Reduced or absent reticence in approaching and interacting with unfamiliar adults. - Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries). - Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings. - Willingness to go off with an unfamiliar adult with minimal or no hesitation. (B) behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behavior (C) experienced a pattern of extremes of insufficient care as evidenced by at least ONE of the following: - Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. - Repeated changes of primary caregivers that limit opportunities to form stable attachments - Rearing in unusual settings that severely limit opportunities to form selective attachments (D) care in Criterion C is assumed to cause the disturbance in Criterion A (E) developmental age of at least 9 months

Question 52

specifiers RAD and DSED

Answer 52

- persistent: symptoms present for at least 12 months - severe: child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels

Question 53

trauma-focused CBT (TF-CBT)

Answer 53

- psychoeducation (understanding normal reactions to trauma, transient symptoms, triggers and negative reactions - both parent and child) - cognitive techniques (changing cognitive distortions, your appraisal of the event and how you make sense of it) - relaxation skills (also for parents, skill building for how to cope with child's responses) - safety skills (understanding triggers, esp. if NSSI is involved) - graded exposure: creating a detailed trauma narrative (exposing yourself to these details by recounting the narrative to yourself) to change avoidance behaviours and habituate + exposure to trauma cues/triggers

Question 54

TF-CBT for sexual abuse efficacy

Answer 54

- TF-CBT vs. child-centered therapy (CCT; already an evidence Tx and widely used) - all comparable on PTSD diagnoses, treated for 12 weeks by the same therapists - kids and parents improved in both treatments - TF-CBT improved even more on: diagnostic recovery (not meeting criteria), child outcomes (fewer symptoms, less shame/depression, fewer total problems, greater trust), parent outcomes (less depression/self-blame, more support of the child, better parenting in general)

Question 55

TF-CBT in preschoolers

Answer 55

- TF-CBT shown to be 'well-established' (level 1) in children and teens (highest level of evidence) - meta-analysis looking at its use in preschoolers and found it to be 'probably efficacious' (level 2) - promising evidence, but not enough research yet to include it at level 1 (if we keep researching it, it will probably reach that threshold)

Question 56

child-centered therapy for trauma

Answer 56

- establishing a trusting relationship with the therapist - giving agency to kids and parents as to how to structure treatment (deciding when and how to address the trauma) - therapist provides active listening - giving strategies for coping with the trauma

Question 57

cognitive processing therapy (CPT)

Answer 57

- doesn't involve parents as much as TF-CBT - creating and reviewing a trauma narrative - adaptive unhelpful beliefs about the trauma

Question 58

prolonged exposure (PE) for trauma

Answer 58

- not as well evidenced as TF-CBT or CPT

Question 59

Dunedin study

Answer 59

- assessing internalizing, externalizing, thought disorders from birth - age 45 - by midlife, 80% had met criteria for at least one disorder - being treated for a disorder prevalence was 30%

Question 60

transdiagnostic risk factors for psychopathology

Answer 60

- adolescent period is a critical time of onset - about 30% experiences comorbidity (poorer outcomes, severity, poorer physical health and functioning) - risk factors tend to be present across diagnostic spectra (low specificity in predicting one disorder vs. another) which suggests a common underlying cause & issues with our current classification system (growing evidence of dimensionality) - comorbidity is the norm, not the exception - all disorders are correlated with each other (some more than others) - multifinality (childhood maltreatment, low SES, problems with behavioural inhibition all lead to various outcomes) - genetic risk is also nonspecific (some polymorphisms may be predicting psychopathology as a whole, fewer others predicting specific disorders) - risk factors can sometimes predict internalizing vs. externalizing BUT they are usually just risk for psychopathology in general

Question 61

heterotypic vs. homotypic continuity p-factor

Answer 61

- heterotypic continuity is common - predicting occurrence of a different disorder over time - Dunedin study: disorders tend to change into adulthood, not matching up with disorders that were previously present - heterotypic continuity is especially true in more severe populations (seeking treatment, usually psychotic disorders)

Question 62

HiTOP

Answer 62

- hierarchal-dimensional model of psychopathology - comorbidity is represented by higher-order dimensions, and at the apex there's a p-factor that represents what is common between all disorders - instead of clusters of disorders (DSM), there are groups of disorders caused by a general p - meta-analytic evidence doesn't always match up with the theoretical model (everything is still correlated, and supports a general p factor but domains aren't quite the same)

Question 63

correlated factors model of psychopathology

Answer 63

- different domains of disorders are positively correlated with each other - nothing is causing anything

Question 64

hierarchal model of psychopathology

Answer 64

- higher-order factor causes different domains of psychopathology which cause specific disorders - p = internalizing = social anxiety

Question 65

bifactor model of psychopathology

Answer 65

- specific factors cause specific disorders AND general p-factor also causes disorders - p = disorders, but there's also extra variation and association between different types of disorders - supported by Caspi and Moffit's research

Question 66

theories of p

Answer 66

- p is empirically based (statistically modelled) so we have to interpret what it means - p = trait negative emotionality - p = emotion regulation or impulse control difficulties - p = low cognitive functioning (cognitive flexibility, attention, planning, inhibition) - p = thought dysfunction/aberrant thought processes - p = underlying vulnerability to psychopathology (diathesis)

Question 67

symptom networks

Answer 67

- challenge to p-factor - symptoms of different disorders cause each other (there's no p explaining everything) - implies that if you intervene on the central symptom = domino effect of symptom reduction in general

Question 68

p = impairment

Answer 68

- challenge to p-factor - we might be assessing a common result instead of a common cause of psychopathology - impairment is a core feature of most disorders

Question 69

autism and p

Answer 69

- challenge to p-factor - not every disorder fits into this model - ASD has high homotypic continuity (very distinct and stable over time) though it does have high comorbidity - genetic risk for ASD not correlated with p factor level in infants

Question 70

correlations between disorders and p

Answer 70

- challenge to p-factor - not always the same correlations in every study - lots of variation in the strength of the correlation (not predicting every disorder or even the same disorder equally) - panic disorder ranges from 0.0 to above 0.9

Question 71

implications of p-factor for aging

Answer 71

- relationship between p-factor and mortality and physical health (psychopathology in general related to physical health problems) - high p-factor = faster biological aging (more wear and tear on cells, especially when psychopathology is more severe or has comorbidities) - if you can measure p and intervene, you could slow/reverse the cell aging process (intervening on the common cause = improvements in all domains of functioning)

Question 72

implications of p-factor for psychotherapy

Answer 72

- therapists tend to see lots of morphing disorders over time (problems with emotion regulation are manifesting as a variety of disorders over time - theory of p-factor = negative emotionality/emotion regulation) - treating the underlying cause (emotion regulation) would improve all those manifestations - targeting general dysfunctions using one common treatment (transdiagnostic treatments) like targeting childhood maltreatment and promoting early brain health - trandiagnsotic treatment could be the first-line therapy, then those who don't improve can move to specialized treatment - similar thought for pharmacotherapy: antidepressants and antipsychotics have broad effects associated with improvement in a wide range of disorders

Question 73

Unified Protocol (adult and child/teen versions)

Answer 73

- typically used for emotional disorder presentations (MDD, OCD, anxiety) - targeting emotional distress - incorporates CBT + acceptance + mindfulness strategies but formatted to be applicable to multiple disorders (and comorbid conditions) - motivational enhancement + goal setting + psychoeducation + opposite actions for emotions + awareness (present moment, nonjudgmental) + interoceptive/situational/response prevention exposure + cognitive component (reappraisal, problem-solving) + relapse prevention - includes a parent component for responding to child emotions

Question 74

efficacy of transdiagnostic treatments

Answer 74

- UP-CA showed moderate to large effect sizes across anxiety and depression (didn't look at other outcomes) - most evidence for internalizing symptoms

Question 75

modular treatment

Answer 75

- Match-ADTC for anxiety, depression, trauma, conduct problems - choose a starting point based on presenting problem, then follow a flowchart

Question 76

p = response style

Answer 76

- individual differences in the tendency to report on oneself in a generally negative or positive way

Question 77

p = diffuse affective state

Answer 77

- nonspecific risk marker - p = neuroticism or negative emotionality (both of which are highly predictive of many disorders)

Question 78

p = poor impulse control

Answer 78

- deficits in response inhibition (impulsive speech and action), cognitive impulsivity (rumination and overgeneralization of negative events)

Question 79

p = intellectual function deficits

Answer 79

- poorer attention, concentration, mental control, processing speed, etc. - low cognitivie ability is a marker of neuroanatomical abnormalities that increase vulnerability to disorders - low cognitive ability increases exposure + vulnerability to stressors - low cognitive ability decreases mental health literacy (not seeking treatment)

Question 80

p = disordered form/content of thought

Answer 80

- illogical, unfiltered, tangential, and reality-distorted and -distorting cognition - delusions, hallucinations, rumination, decision-making difficulties, body image disturbances, irrational fears, intrusive thoughts, dissociation, thought-action fusion, hostile attributions, global/stable/internal attributional style

Question 81

splitting

Answer 81

- dividing disorders into fine categories and subtypes - current diagnostic practice

Question 82

lumping

Answer 82

- grouping things together based on similarities - reflective of the p factor (common genetic influences, shared genetic factors in many disorders) - polygenic influences + pleiotropic influences (having more than one effect) - many disorder share neuroanatomical differences and functional connectivity abnormalities

Question 83

etiological chain comprising four factors (p factor)

Answer 83

- fundamental threats to one’s physical and psychological safety broadly increase the risk of mental disorder - stress embedding: neural changes in threat systems (initially adaptive changes) = vulnerability to later disorders - stress generation: maltreatment = behaving in ways that contribute to the occurrence of other negative events in their lives - stress sensitization: early maltreatment = more vulnerable to disorders that are triggered by later, proximal stressors - stress sensitivity: some individuals are more or less sensitive to stress due to a likely genetically mediated trait