Psychopathology Exam 3
Terms
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- Becks Depressive Cognitive Triad
- Think negatively about oneself, about the world, and about the future
- Cognitive Theory of depression
- Aaron T. Beck, depressed people have cognitive errors, interpret life events negatively, arbitrary inferences are overemphasizing the negatives, overgeneralizations are negatives applying to all situations (if I fail I will die)
- Sleep Walking Disorder, Somnambulism
- Occurs during NREM sleep, in first few hours of sleep, person must leave bed, more common in children, not dangerous to wake, runs in families, resolves on its own, related to nocternal eating syndrome (sleep unaware eating)
- Suicidal ideation
- Thoughts about death and dying
- Parasomnias
- Abnormal behavioral and physiological events during sleep, no problems with sleeping
- REM Sleep
- Paradoxical sleep cause it includes beta waves, muscle paralysis, bizarre dreams, enter after ascending back through sleep stages 1.5-2 hours after falling asleep
- Atypical Depression
- Oversleep, overeat, weight gain, anxiety
- Breathing sleep disorder statistics
- More common in males, occurs in 10-20% population, usually minimally aware of sleep problem, snore, suffer morning headaches, fall asleep during day, treat with meds, weight loss or mechanical devices
- Suprachiasmatic nucleus
- Biological clock, regulates sleep schedule, stimulates the production of melatonin
- Reciprocal gene environmental model
- If you have a biological predisposition to depression, you will create a stressful environment to make you vulnerable to mood disorders
- Depression versus anxiety
- The difference is in anhedonia
- Learned Helplessness Theory of depression
- Related to lack of percieved control over life events, Martin seligman
- Breathing Sleep Disorders
- Obstructive sleep apnea (airflow stops), Central sleep apnea (respiratory system stops), Mixed sleep apnea (both), sleepiness dyring the day and disruptions at night caused by restricted air flow and cessations of breathing
- Monoamine Oxidase Inhibitors
- Monoamine Oxidase is an enzyme that breaks down serotonin and norephinephrine, Nardil, Marplan, moer effective than tricyclics, treats severe depression, must avoid food (beer, wine, cheese) make sudden increase in blood pressure that will kill you
- Catatonic depression
- Absense of movement, very serious, have cataplexy (can put in a position and stay there)
- Neurological influences of depression
- Serotonin controls dopamine and norepinephrine, low serotonin leads to mood disorder, elevated cortisol levels, sleep disturbance means skipping NREM and going to REM, still exhausted the next day
- Circadian Rhythym Disorder
- Disturbed sleep, jet lag type (crossing time zone), Shift work type (work schedule shifting), constantly changing sleep cycle lead to insomnia or hypersomnia, Phase delays (move bedtime later), Phase advances (move bedtime earlier), use of bright light to trick biological clock
- Nightmare Disorder
- Occurs in REM sleep, distressful dreams that interfere with daily functioning, often awaken sleeper, more common in children, treat with antidepressants and relaxation training
- Teen suicide
- Third leading cause of death, between 15 and 19 are greatest proportion and more than next 7 leading causes combined, 10/100,000 completed suicides each year
- Suicide
- Eighth leading cause of death in US, white and native american phenomenon, increasing in the young, females more likely to attempt, males more likely to complete
- Sleep terror Disorder
- Occurs in NREM sleep, noted by piercing scream, person looks upset with elevated arousal, more common in children, can't be easily awakened during episode, little memory of even, with severe cases treat with antidepressants or benzodiazepines, mostly gets better without treatment
- Hypersomnia
- Sleeping too much, excessive sleepiness is a problem, 39% have family with hypersomnia, associated with medical and psychological conditions, sleepy throughout day, can sleep through night, treat with stimulants
- Tricyclic Medications
- Tofranil, Elavil, block reuptake of norepinephrine and serotonin, 2-8 weeks for effects to be known, negative side effects common (dry mouth, blurred vision, st gain, sexual dysfunction, cardiac arythmias), lethal in excess
- Insomnia
- One of the most common sleep disorders, problems initiating and maintaining sleep and nonrestoritive sleep, affects females twice as often as males, associated with medical or psychological conditions as well as unrealistic expectations of sleep, treat with benzodiazopenes or sleep meds, prolonged use can rebound insomnia and create dependence
- Dysthymia
- Mild depression, slowed cognitive functioning, persists for 2 years (1 if child), can persist for 20 years, mean onset is 20 years
- Double depression
- Major depressive disorder plus dysthymia, dysthymia develops first, associated with severe psychopathology and future problems, 79% dysthymics have major depressive episode
- Social and Cultural Factors of Depression
- Marital dissatisfaction correlation is high, strong in males, moer females over males due to socialization, lack of social support predicts lower chance of recover
- Grief
- Depression following death, resolved severel months post loss, if more than one year with intrusive memories and thoughts you dont want you may have pathological grief reaction or impacted grief reaction
- Biological influences of depression
- Rate is high in relatives of probands, stronger cases have genetic contribution in twins, heritability higher for females, adoption studies show strong environmental component
- Integrative Model of Mood Disorders
- Shared biological vulnerability, exposure to stress contributes to sense of uncontrolability, helplessness and hopelessness, activatees neurotransmitter system malfunctions, social and interpersonal relationships
- Chronic depression
- Lasts over two years
- Suicide Risk Factors
- Suicide in the family, low serotonin levels, evidence and number of preexisting psychological disorders, alcohol abuse, past suicidal behavior, shameful stressor, publicity about suicide and media coverage (cluster suicides, happen regionally)
- Interpersonal Psychotherapy for Depression
- Focuses on problematic interpersonal relationships, start working on ways to repair relationships
- Two types of Parasomnias
- Those that occur during REM sleep and those that occur during NREM sleep
- Suicidal attempt
- Actually having a plan in mind for suicide
- Bipolar One Disorder
- Full manic and depressive episodes, average onset is 18 years, chronic, suicide common
- Cyclothymic Disorder
- Alternate long hypomanic and dysthymic states for two years (1 for child), average onset is 13 years, most female, chronic, high risk for worse cases
- Selective Serotonin Reuptake Inhibitors
- Block reuptake of of serotonin, prozac (1988), zoloft (most popular), No risk of suicide except in younger people (get energy back before better), can't overdose,
- Electroconvulsive therapy
- Applying electical current to brain, 6-10 treatments, temporary siezure, relapse is common, invasive and tiring, given on nondominant side to offset memory loss
- Polysomnographic (PSG) Evaluation
- Includes Electroencephalograg (EEG), Electrooculoograph (EOG), Electromyography (EMG), detailed history, assessment of sleep hygiene and sleep efficiency
- Manic Episode
- Exaggerated joy, increased activity, decreased sleep, irritability, delusional ideas, average duration of one week, 2-3 month long episode,
- Rapid cycling
- Switching between unipolar mood disorders more than four times a year, more common in teens
- Major Depressive disorder
- At least one but mostly recurrent depressive episodes, 85% 2nd episode, mild to severe with psychotic features, median of 4 episodes, mean onset is 25 years
- Psychological intervention for Dyssomnias
- Relaxation and stress reduction, modify unrealistic expectations, improve sleep hygiene, set bedtime routine for children, combined treatment works well only with insomnia
- Dexamethasone Suppresion test
- Dexamethasone depresses cortisol secretion and persons with mood disorders show less supression, doesn't work cause not only depression supresses it
- Narcolepsy
- Daytime sleepiness and cataplexy, .03% to .16% of population, affects sexes equally, onset in adolescence, sleep paralysis and hypnagogic hallucinations, syptoms improve over time, daytime sleepiness continues without treatment, treat with stimulants, cataplexy with antidepressants
- Bipolar Two Disorder
- Alternate major depressive and hypomanic states, average onset is 22 years, 10-13% progress to worse case, chronic
- Mood Disorder Statistics
- 16.1% worldwide depression, 1.3% bipolar, 3.6% dysthymia, females have more, sex difference disappears at age 65 and under 12, bipolar affects both equally, no variance cross culture
- Psychological influences of depression
- If experiencing major stress have poorer response to treatment and spend longer time in remission, do things that push people away from them
- Depressive Attributional Style
- Internal attributions are negative outcomes are one's own fault, stable attributions are believing future negative outcomes will be one's fault, Global attributions are believing negative events disrupt many life activities, all three contribute to a sense of hopelessness
- Dyssomnias
- Difficulties getting enough sleep, problems in timing of sleep and complaints about quality
- Seasonal Affective Disorder
- Only depressed in winter when no sunlight available, go to phototherapy
- Anhedonia
- General loss of interest in once fun activities
- Atypical Antidepressants (SNRIs)
- Wellbutrin selectively inhibits dopamine reuptake and used for smoking cessation, Effexor selectively inhibits serotonin and norepinephrine that is good for severe depression, cymbalta is new SNRI approved fro depression and neuropathic pain
- Lithium
- For bipolar disorders, can be severe side effects, unclear how it works, used to stabalize mood, only medicine effective specifically for suicide
- Psychotic Depression
- Mood congruent hallucinations and delusions are depression leading you to think that bad things are your fault
- Psychological Treatment of Mood Disorders
- Cognitive Behavioral therapy and Interpersonal psychotherapy, both work equally good as drug, see results in 2-3 months, neurotransmitter levels increase, relapse after 3-4 years versus meds after .5 years, no benefits combining meds and treatment
- Cognitive Behavioral Therapy for Depression
- Addresses errors in cognitive errors in thinking, behavioral activation includes creating a list of pleasurable events to do some each day, taught to identify automatic thoughts that predict mood and affect how you feel, increased contact with reinforcing events,
- Depression course specifiers
- Longitudinal course, past history of mood, history of mood disorder recovery, rapid cycle patterning, seasonal patterning
- Major Depressive Episode
- Depressed mood or anhedonia lasting two weeks, cognitive symptoms of feeling worthless and indecisive, disturbed physical functioning of psychomotor retardation and suicidal ideation or thought
- Hypomanic episode
- Exagerrated joy without suicidal ideation or dangerous activity (impairment)
- Melancholic depression
- Severe depressive and somatic syptoms, undereat, lose weight, insomnia
- NREM Sleep
- Stage one is trasition from awake to sleep with alpha and beta waves, stage two is slightly deeper stage with alpha waves, stage three begins to produce delta waves, stage four is deepest stage of sleep