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PSYC 500: FINAL EXAM
Before 1880 |
only very extreme behaviors were considered psychopathology; assumption of biological etiology
|
Freud & Behaviorists (1880) |
1. Early experience is important
2. "Anxiety" can cause neurosis - introduction to idea of environment as important player
3. Anyone with sufficient anxiety can have psychopathology
|
Bowlby (1960s) |
Early experience is important - measures attachment around the world |
Hubel and Wiesel (1960s) |
researchers who investigated critical periods for vision |
Geneticists (& Neuroscientists 1960s) |
researchers who said inherited biological conditions are the 'foundation' of psychopathology |
Temperament (1960s/70s) |
heritable brain structures and functions that render some children susceptible to feelings and actions that, on occasion, become symptoms of psychopathology
|
Jerome Kagan |
said all biology is inherited (& unaffected by environment) |
temperament |
consistent pattern of behavioral and emotional response tendencies; measured by direct observation in young children |
uninhibited reaction to the unfamiliar |
spontaneous approach to new or unexpected things; "liking surprises" |
inhibited reaction to the unfamiliar |
- Cautious avoidant reactions to unfamiliar objects, people, or settings
- Withdraws/hides behind mom when new things appear
- "hates surprises" |
short/short allele of 5HTTLPR gene |
allele possibly associated with inhibited temperament |
high reactive infants |
more vigorous limb movements, back arching and distress cries in response to stimuli
3-4 months: stronger negative response to novelty
1&2 years: more likely to be fearful and avoidant of novel social & non-social positive stimuli - "slow to warm up and get involved in novel activities later one"
7 years: more likely to be afraid of animals, dark, thunderstorm, etc.
11/15 years: more likely to be quieter, express more worries, and spontaneously report being worried about uncertainty/strain
18: higher prevalence of depression, social phobia, generalized anxiety disorder |
low reactives |
lowest rates of any disorder, including externalizing disorder, 60% report no disorder of the kinds measured
|
amygdala |
Kagan asserts that inhibited temperament is the result of an overactive _______________ |
amygdala |
- more active when observing threatening faces of fearful faces
- more active in situations of uncertainty - going beyond fear |
right/left alpha asymmetry |
- refers to the amount of power in the a______ spectrum (~8-12 Hz) in electrical activity records at the scalp or brain waves
- comparing the two hemispheres
- negative attitude - more distressed by novelty - greater right than left |
ventromedial orbital frontal cortex |
thicker in individuals with inhibited temperament/ high amygdala activation |
anxiety |
cognitive process which prepares the individual for future danger, accompanied by strong feelings of fear |
dysregulation of the anxiety response
|
core feature of anxiety disorders |
secondary features |
include
1) the thing you are worried about |
Primary features |
1) Dysregulation of the anxiety response
accompanied by - distress/impairment, avoidance of situations which arouse anxiety or distress, difficulty concentrating, interpersonal impairment |
33% |
behavioral genetics of anxiety: ______% heritability
|
Serotonin & GABA |
neurotransmitters as risk factors for anxiety disorders |
serotonin system |
5-HT is produced in the raphe nuclei of the brainstem --> main targets are hippocampi and amygdala in both hemispheres |
limbic system |
hippocampus + amygdala |
Hippocampus |
important for:
1) LTM
2) Fear Learning
3) Reduction of the stress response
4) Regulation of HPA axis
5) Reduction of cortisol |
hypothalamic pituitary adrenal axis |
HPA axis |
cortex |
amygdala and hippocampus are highly interconnected, and are modulated by the __________ |
causal risk factor |
if you change that factor, it will change the outcome (still a precursor) |
learning and cognitive styles |
intrapersonal risk factors for anxiety disorders |
fear conditioning |
increased fear learning following traumatic exposures or predisposition
- learning without intending to acquire it --> UCS becomes CS to trigger CR |
Cognitive styles |
- a risk factor for anxiety disorders
includes: (JIMA)
attentional bias towards threat, memory bais towards threat, interpretive bias, and judgement bias
|
attentional bias towards threat |
in novel situations, attention is captured by negative stimulus |
memory bias towards threat |
memories of these situations may focus on the fear-evoking/threatening aspects of experience |
interpretive bias |
ambiguous stimuli are interpreted as threatening |
judgment bias |
interpreting situations as not in one's control --> can increase anxiety |
observing fear behavior in others, hearing others speak fearfully, and escape conditioning |
how do children acquire difference in cognitive style and learning about anxiety? |
escape conditioning |
children learn to avoid fearful stimuli as a method of emotion regulation (very effective and may limit the degree to which they learn other ways to manage anxiety) |
poverty, over-controlled parenting, parental psychopathology, trauma, violence
|
interpersonal risk factors for anxiety
(POPTV) |
overcontrolled parenting |
anxiety in children may be result of an anxious parent; promote escape conditioning and model threatening stimuli |
depression |
childhood anxiety predicts adult anxiety and __________ |
childhood anxiety predicts adult anxiety and __________ |
changes across specific anxiety disorder categories |
5-70% |
comorbidity among anxiety disorders with both externalizing disorders and depression |
2x |
girls ____ more likely to have an anxiety disorder than boys |
socialization, trauma, genes? |
likely causes of sex differences in anxiety disorders (STG)
|
Anxiety Disorders, Obsessive-Compulsive & Related Disorders, Trauma and Stressor-related Disorders |
Categories of disorders in DSM-V that relate to anxiety |
the anxiety disorders |
(SA, SM, SP, SP, PD, A, GAD) |
specific phobia |
marked fear or anxiety about a particular object or situation (almost always immediate )
- situation is avoided
- fear out of proportion to the actual danger posed by stimulus
- anxiety must be limited to that situation or object |
culture |
what you are afraid is largely dictated by your _________ |
3 |
on avg, ___ or more specific phobias are common if one exists |
5, 16, 3-5 |
prevalence of specific phobia in kids ___%, adolescents ___%, and adults ___-___? |
10 years |
average age of onset for a specific phobia
|
panic attack |
surge of intense fear/discomfort reaches a peak within minutes where 4 or more of the following occur |
GAD |
A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number or events or activities
B. It is hard to control the worry
C. Associated with 3 or more of 6 symptoms (restlessness, easily fatigued, difficulty concentrating, irritability , muscle tension, sleep disturbance)
D. Worry causes significant distress
E. not due to effects of substance or medical condition
F. Not better explained by another disorder |
0.4-3.6
|
prevalence of GAD
|
30 |
median age for onset of GAD |
symptom substitution |
specific anxiety disorders are unstable (shift from one to another) |
OCD, BDD, hoarding disorder, trichotillomania, excoriation disorder |
OCD and related disorders |
19.5 |
avg age of onset of OCD |
25% |
percentage of OCD cases that begin in childhood |
obsessions |
recurrent, unwanted, intrusive thoughts, impulses, or images |
compulsions |
patterns of behavior to reduce anxiety |
body dysmorphic disorder |
perception that your body is very different than other people experience it as |
hoarding disorder |
keeping lots of stuff to reduce anxiety about letting go of it
|
trichotillomania |
disorder involving pulling out hair |
excoriation disorder |
disorder involving picking your skin
|
reactive attachment disorder |
lack of attachment |
disinhibited social engagement disorder |
"non-selective attachment" - engage with strangers as though they were attachment figure
|
PTSD |
a set of anxiety reactions where you become afraid of the memories and of re-experiencing a traumatic event |
acquiring PTSD |
Exposure to actual or threatened death, serious injury or sexual violence through:
1) Direct experience
2) Witnessing
3) Learning that the event occurred to someone close
4) Repeated or extreme exposure to adverse details of traumatic events |
1.2% |
prevalence of OCD |
time-consuming, distress |
OCD criteria B;
The obsession or compulsions must be ________, or cause ________ |
presence of obsessions, compulsions, or both |
OCD criteria A |
dissociative reactions |
flashbacks |
play
|
a useful way of understanding what is going on inside of a child's head |
1 month |
can't give diagnosis of PTSD until symptoms have persisted for at least ________ |
10-30 |
_____% of individuals who experience trauma receive a diagnosis of PTSD |
8.7% |
lifetime risk of PTSD overall |
5% |
lifetime risk of PTSD for males |
10.4% |
lifetime risk of PTSD in females |
3.7, 6.3 |
lifetime risk in children for developing PTSD:
Boys _____%
Girls ____%
|
MDD |
at least a 2 week period which is a marked change from normal with 5 or more symptoms present for most of the time nearly every day
A. Depressed or irritable mood
B. Diminished interest or pleasure in all or nearly all activities
C. significant weight change
D. Insomnia or hypersomnia
E. Psychomotor agitation
F. Fatigue or loss of energy
G. Feelings of worthlessness
H. Diminished ability to concentrate
I. Recurrent thoughts of death or suicide
CAN NEVER HAVE BEEN IN A MANIC OR HYPOMANIC EPISODE
|
Persistent depressive disorder |
MDD episode for at least 1 year (children only) |
18.5% |
prevalence of MDD in mid-late adolescence |
2.8% |
prevalence of children with MDD |
anhedonia |
lack of enjoyment of positive events |
1-2, 2.8, 4.8, 18.5 |
Prevalence of depression changes across age:
Preschool -
Middle childhood -
Early adolescence -
Mid to late adolescence - |
affiliative needs |
girls have increased ________ __________ because they are socialized into a role where they need strong relationships |
8.2 |
depressed youth are _______ times more likely to have an anxiety disorder |
ODD, CD, anxiety disorders |
comorbid with MDD |
cyclical |
depression is ______ in nature, avg. 7-8 months in duration |
40-70 |
percent of adolescents who have a depressive episode and will have another in adulthood
|
CASSED |
what predicts length of MDD episode |
negativity emotionality, lack of positive emotionality |
tempermental correlates/risk factors for MDD |
low self-esteem, negative attributional style, rumination, attentional bias |
LNRA - cognitive risk factors/correlates for depressive disorders
|
negative attirbutional styles |
likelihood to believe that negative events have internal, global, and stable causes |
rumination |
less like complete cognitions, more like what might underlie certain cognitive experiences
- not moving to active coping (problem solving, distraction)
|
attentional bias |
increased attention to ssad faces, megative emotion/self perceptionbias in memory
|
Limbic system and PFC, lack of reward circuitry, HPA axis (cortisol) |
biological risk factors/correlates of depressive disorders |
abusive parenting, high expressed emotion in parenting, peer relationships |
interpersonal risk factors for depressive disorders
|
30-40% |
heritability of depressive disorders |
serotonin, BDNF (important for plasticity) |
genes encoding for these two things likely interact with environment to increase risk |
social support |
critical for girls going through early onset puberty - without it, early onset jumps to risk factor |
bipolar I disorder |
must have distinct period of abnormally persistent elevated, expansive, or irritable mood and abnormally and persistently goal-directed activity lasting at least a week - present most of the day, nearly every day |
pressured speech |
speech is coming out, can't stop it |
depressive episode |
common but not required for bipolar I disorder criteria |
bipolar II |
hypomanic episode that can be followed/preceded by depression
must have depression and hypomania |
hypomania |
same symptoms as mania, but not severe enough to cause marked impairment in social or occupational function, or hospitalization
*can even be adaptive
|
cyclothymia |
"rapid cycling" - numerous periods of hypomanic and depressive symptoms that don't meet criteria for hypomania/depression |
0.6% |
bipolar I prevalence over the last 12 months |
2.5% |
prevalence for bipolar spectrum over last 12 months
|
85% |
heritability of bipolar disorders |
15x |
individuals with bipolar disorders are ____x as likely to attempt suicide |
regulate sleep/wake cycle |
one of the main things you can do for someone who you think is prodromal for bipolar disorder |
ADHD |
most common comorbid disorder with childhood bipolar disorder |
grandiosity, psychotic symptoms |
For BP diagnosis --> difficult to distinguish _____ from cognitive immaturity in children, and _______ ______ from unrealistic thinking |
psychomotor agitation |
more agitation than just moving more (Different from ADHD)
|
Disruptive Mood Dysregulation Disorder (DMDD) |
Temper outbursts grossly out of proportion to events 3x a week for a year or more
Persistently angry or irritable mood in more than one setting for at least a year
Symptoms onset before the age of 10
Diagnosis can occur between 6 and 18 years
Bipolar disorder was being diagnosed too young
This diagnosis better captures what people were seeing in these young children
|
Intermittent Explosive Disorder |
more CD-like, less mood dysregulation |
risk factors for bipolar disorder |
- Perinatal events (obstetrical complications like fetal hypoxia)
- Disturbances in sleep-wake cycle
- Deficits in inhibitory control and executive function
- Dysfunction/size difference of the amygalda & anterior cingulate cortex
- stressful life events |
schizophrenia diagnosis |
- Delusions
- Hallucinations
- Disorganized Speech
- Grossly Disorganized or Catatonic behavior
- Negative symptoms
|
delusion |
a belief that is unrealistic |
hallucination |
a "perceptual"and unrealistic experience
|
disorganized speech |
saying lots of words, but they don't make sense - thoughts can become tangential
|
negative symptoms |
"flat affect" or diminished emotional expression; social withdrawal; "deficits"
|
6 months |
symptoms of schizophrenia must persist for _________ or longer to merit a diagnosis |
positive symptoms |
extra/"excess" - i.e. hallucinations or delusions |
.005% or 5/1000 |
estimates of onset of schizophrenia prior to age 13
|
early to mid 20s |
peak of onset of schizophrenia |
kindling hypothesis |
once a psychotic episode has occurred, it is more likely that the individual will have another --> compounding effect
- the longer it goes untreated, the more likely you'll be to have another one
|
prodromal phase |
period where they display some negative and positive symptoms but not enough to meet criteria
|
pervasive developmental disorder (PDD) |
- delays in language and communication
- delayed motor milestones
- a "global" nature to the deficit |
68% |
likelihood that a child with COS will meet criteria for another disorder |
risk factors for COS |
- families with increases in thought and language disturbances (strangeness to the way their language functions)
- parents with negative or positive symptoms
- Meeting criteria for PDD or ASD |
prodromal schizophrenia |
if left untreated, often converts to a full episode of psychosis |
Cannabis, LSD, Amphetamines, Cocaine |
drugs to avoid if you suspect someone to be in a prodromal phase |
dopamine |
flooding brain with ___________ increases likelihood of developing psychosis |
neural correlates of schizophrenia |
- Gross reductions in grey matter volume
- Highest amount of volume loss in the amygdala, hippocampus, and parietal cortex
|
high expressed emotion |
high amount of hostility, emotional over-involvement, and critical comments
|
low expressed emotion |
feel patient does not have control over illness, more reserved with criticism, not responsible for ("not your job to...") |
24-55% |
genetic risk for adolescent/adult onset schizophrenia (range) |
smooth pursuit eye tracking |
an endophenotype for schizophrenia |
trail making test |
alternating between numbers and letters and connecting the dots (require switching) - an endophenotype for schizophrenia |
endophenotype |
something that you can measure that is not the full-blown disorder or even symptoms of the disorder, but presents in people with the disorder |
span of apprehension |
number of dots you can say without having to count them
-endophenotype associated with schizophrenia |
degraded stimulus CPT |
show degraded stimuli - having to use all attentional resources
- another endophenotype |
anti-psychotics and CBT |
treatment for schizophrenia |
lithium/mood stabilizers and CBT |
treatment for bipolar disorders |