Exam 2 Study Guide

Question 1

Major Depressive Disorder

specific diagnostic criteria

Answer 1

• depressed mood most of the day
• anhedonia
• weight or appetite change (5+%)
• sleep disturbance
• fatigue
• difficulty concentrating and indecisive
• feelings of worthlessness or excessive guilt
• recurrent suicidal ideation
• Prevalence is: 7%
• Onset: ave. 25 years old
• Duration: varies
• Gender difference: females 2:1
• Ethnicities: White, Hispanic and Native American-Indian
• Co-occurring: SUD, Anxiety Disorders
• Presenting problem: Cultural diffs
• Bereavement consideration
• psycho motor agitation (slower)

Amish: norms have equal numbers within both genders (no alcohol use = positive effects)

• Mild still manageable
• Moderate: everything in between
• Severe: totally unmanageable
(Asian culture: no energy)

Question 2

Sad or grief reaction

Answer 2

• Despair, mourning, sadness
• Fatigue or low energy
• Tears
• Loss of appetite
• Poor sleep
• Poor concentration
• Happy and sad memories
• Mild feelings of guilt

Question 3

Persistent Depressive Disorder

Answer 3

• depressed most of the day on most days
• 2+ symptoms during 2+ year
• never without symptoms for 2+ months
• poor appetite / overeating
• sleep disturbance
• low energy or fatigue
• low self-esteem
• difficulty concentrating or making decisions
• feelings of hopelessness
• Not as severe: no suicidal ideation
• lasts 5-20 years
• affects white and latino the most

Diff from Major depressive disorder

Question 4

Anhedonia

Answer 4

• lack of pleasure or of the capacity to experience it

* loss of interest

Question 5

Manic episode

Answer 5

• Persistently elevated mood for 1+ week
3+ symptoms:
• inflated self-esteem or grandiosity
• decreased need for sleep
• talkative, pressured speech
• flight of ideas
• distractibility
• goal-directed activity or restlessness
• excessive involvement in pleasurable/risky activities
• men 1st

Question 6

Flight of ideas

Answer 6

• During both manic and hypomanic episodes
• rapid flow of thought
• accelerated speech with abrupt changes from topic to topic
• symptom of some mental illnesses, especially manic disorder.

Question 7

Bipolar I Disorder

Answer 7

• alternate between Major Depressive and manic episodes
• impairment
• Prevalence: <1%
• Onset: 18-22 years old
• Lifelong
• No ethnic differences
• Comorbidity: SUD (50%), Anxiety Disorders (75%), ADHDc
• high high-low low

Question 8

Rapid cycling specifier

Answer 8

• 4+ episodes in 12 months

* Partial or full remission for 2+ months between episodes

Question 9

Peri-partum specifier

Answer 9

• Onset is within 4 weeks of childbirth
• Different from baby blues
• severe thoughts

Treatment:
• phototherapy

Question 10

Seasonal onset specifier

Answer 10

• Episodes occur at certain time of year
• Full remissions also occur at certain time of year
• melatonin deficiency
• Rule Out any other dx (heart disease or alcohol)
• Onset: ovaries

Treatment:
• phototherapy

Question 11

Learned helplessness

Seligman’s theory

Answer 11

condition in which a person suffers from a sense of powerlessness/helplessness and giving up control
• arising from a traumatic event or persistent failure
• underlying causes of depression.
• Onset early 20s

Causes:
• thinking patterns and learning

Related
• Cognitive errors
• Social support
• Depressive cognitive triad: view future as bleek and negative. 
• feeling constant judgment

Question 12

Facts about suicide

Answer 12

• 10th leading cause of death in U.S.
• 3rd leading cause of death for adolescents
• Desire for publicity about suicide media coverage
• ages 15-24 and 54-84
Native American: culture and land
Men

Question 13

Suicide among children and adolescents

Answer 13

• 3rd leading cause of death for adolescents

* 15-24

Question 14

Suicide among the elderly

Answer 14

54-84 and increasing

Question 15

Number of stressors

Answer 15

Five Stressors

1. Life Changes: life events that require some adjustment in behavior or lifestyle
2. Chronic Stressors: ongoing, long lasting, unpleasant events
3. Hassles: small, everyday problems that accumulate
4. Frustration: unpleasant tension resulting from a blocked goal
5. Conflict: forced choice between two or more incompatible goals or impulses

Question 16

Type A personality

Answer 16

• outgoing
• constantly stressed (high cortisol = heart attack)
• driven
• controlling
• demanding
• perfectionist
• self centered
• cynical hostility (immediately negative)

Predictor of: 
• heart disease 
• social isolation
• road racers/mean/shaming
• unapproachable, diff to treat and help

Question 17

Impact on body and brain when Cortisol levels are excessive

Answer 17

Hypothalamus activates the Sympathetic Nervous System:
• Pituitary gland elevates cortisol
• May damage cells in the hippocampus
(memory impairment)
• May impair immune system (cancerous cells)
• May lead to heart disease (heart attack)
• May decrease testosterone (infertility)
• Stress, anxiety, anger
• Poor coping skills
• Low social support
• Lifestyle factors (e.g., smoking, poor diet, lack of exercise)
• Classic Type-A behavior pattern l Hereditary

Question 18

Internal locus of control

Answer 18

Belief: one can influence events and outcomes

Question 19

Depersonalization

Answer 19

feeling detached from one’s mental processes or body; outside observer; feel like one is in a dream
• adult receiving treatment of childhood trauma
• out of body experience
• can lead to death w/o treatment
• panic attacks

Question 20

Derealization

Answer 20

lose a sense of the reality of the external world
• response to traumatic experience
• disorientation
• not knowing

Question 21

Dissociative fugue

Answer 21

sudden and unexpected travel away; unable to recall how they arrived at new location; inability to recall one’s past; confusion about one’s identity or assumption of a new identity

Question 22

Dissociative Identity Disorder

Answer 22

Daydreaming, disoriented to place and time, on a continuum. Personality, language pattern, preferences, and all other behaviors. Completely different person

Presence of 2+ symptoms:
• loss of control in person’s behavior
• Inability to recall important personal information
• Significant impairment of functioning
• Not due to substances or medical issues
• Rule-out malingering
• childhood trauma

Question 23

alter

Answer 23

• different identities or personalities

* identities display unique behaviors, voice and posture

Question 24

Host

Answer 24

The identity that keeps other identities together

Question 25

Switch

Answer 25

quick transition from one personality to another (blink, facial change, voice change)

Question 26

Dissociative Identity Disorder | Treatment

Answer 26

``` Integration Techniques: • Cognitive-Behavioral • Interpersonal Therapy • Identify alters and purpose of each • Internal communication • Foster cooperation • Medication (for comorbidity dx) • Increase stability • Reduce symptoms • Increase safety, decrease S/I and S/A ``` Psychodynamic: • Work through the trauma(s) • Identify triggers

Question 27

Anorexia nervosa (diagnostic criteria, thought patterns, health risks)

Answer 27

* less than normal appetite * Distorted body image * Refusal to maintain weight * Relentless pursuit of thinness * Begins with dieting * Death risk * Comorbidity: MDD, anxiety, Bipolar I

Question 28

Bulimia nervosa (diagnostic criteria, health risks)

Answer 28

Binge • eating excess amounts of food within 2 hour period • Sense of lack of control over eating ``` Purge •self-induced vomiting, diuretics, laxatives, fasting, excessive exercise • Binge and purge weekly for 3+ months • Distorted body image → self-evaluation • Mild: 1-3 times per week • Moderate: 4-7 times per week • Severe: 8-13 times per week • Extreme: 14+ times per week ``` ``` Can cause severe medical problems: • erosion of dental enamel • electrolyte imbalance • amenorrhea • kidney failure • cardiac arrhythmia • seizures • intestinal problems • permanent colon damage • osteoporosis ```

Question 29

Binge Eating Disorder (diagnostic criteria, health risks, treatment)

Answer 29

``` Binge includes 3+: • eating too fast • over-eating • eating when not hungry • eating alone • feeling disgusted after eating • Marked distress about binging • Binge weekly for 3+ months • No purging • Mild: 1-3 times per week • Moderate: 4-7 times per week • Severe: 8-13 times per week • Extreme: 14+ times per week • eating excess amounts within 2 hr period • Sense or lack of control over eating ```

Question 30

Neurotransmitter related to eating disorders

Answer 30

Dopamine Norepinephrine Serotonin

Question 31

Obesity (diagnostic criteria, health risks)

Answer 31

* Not a DSM-5 disorder * 40% of adults in the U.S. are obese * Increasing rapidly Mortality rates: • Teen obesity is at epidemic level Risks: • heart disease, diabetes, stroke, hypertension, sleep apnea, depression Causes: • Lifestyle and technology • Genetics • Impulse control; numbing feelings; history of sexual abuse ``` Treatment: • Self-directed weight loss programs • Commercial self-help programs • Behavior modification programs • Psychotherapy • Bariatric surgery (last resort) ```

Question 32

Treatment for Depression

Answer 32

* Cognitive Therapy * Interpersonal Psychotherapy * Exercise * Mindfulness-Based Therapy * Phototherapy for Seasonal onset only * Medication * ECT: electro convulsive therapy (last resort) * Restricts enzyme that creates a synapse * SSRI side effects: low libido, dry mouth, drowsiness

Question 33

Hypomanic Episode

Answer 33

* Persistently elevated mood for 4+ days * 3+ symptoms: * inflated self-esteem or grandiosity * decreased need for sleep * talkative, pressured speech * flight of ideas * distractibility * goal-directed activity or restlessness * excessive involvement in pleasurable/risky activities * shorter than manic

Question 34

Bipolar II Disorder

Answer 34

* alternate between Major Depressive and Hypomanic episodes * never had a Manic episode * mild impairment of functioning * low low

Question 35

Treatment for Bipolar Disorders

Answer 35

* Education about diagnosis * Cognitive Therapy * Interpersonal (relationships/conflict resolution) * Psychotherapy * Family Therapy * Social Rhythm Therapy (same time every week) * Medication: (lithium, anti-epileptics, & anti-psychotics) * ECT last resort (not used for mania)

Question 36

Lithium medication compliance for Bipolar I disorder

Answer 36

anti-depressants Side effects • tremors • sluggish • increased appetite

Question 37

Suicide: Risk Factors

Answer 37

* Past suicidal behavior * Extremely low Serotonin levels * Pre-existing psychological disorder * Rejected by family when “coming out” * Alcohol use and abuse * Suicide in the family * Shameful / humiliating stressor * Publicity about suicide and media coverage

Question 38

Suicide: Protective Factors

Answer 38

* Clinical care * Family and community support * Coping skills * Cultural and religious beliefs * Resilience * Restricted access to highly lethal means v*** * San Diego Crisis Line

Question 39

Type B personality

Answer 39

* passive * quite * easygoing * relaxed/mellow/lazy * follower * not driven

Question 40

External locus of control

Answer 40

blames outside forces for everything

Question 41

Bulimia Nervosa Treatment

Answer 41

* Medical Evaluation * Antidepressants * Insight Therapy to identify triggers * Cognitive-behavior therapy * Interpersonal psychotherapy * Relapse prevention * Family Therapy

Question 42

Trycyclic

Answer 42

* anti-depressant & norepinephrine | * side effects, people can overdose

Question 43

MAO inhibitors

Answer 43

slows down neurotransmission | “clean up crew”

Question 44

SSRI's

Answer 44

* prozac | * takes whatever it wants “not clean up crew”

Question 45

Dissociative amnesia

Answer 45

classic Hollywood portrayal

Question 46

Causes of Major Depressive Disorder and what to rule out:

Answer 46

* colon * hypothyroid * diabetes * hypertension * alcohol use * substance abuse (SUD) * vitamin deficiency * anemia

Question 47

Persistent Depressive Disorder Treatment

Answer 47

* cognitive behavioral therapy | * optimism

Question 48

Binge Eating Disorder Treatment

Answer 48

* Medical Evaluation * Insight Therapy to identify triggers * Cognitive-behavior therapy * Interpersonal psychotherapy * Relapse prevention