PSYC300A #3.docx

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PSYC 300
Lawrence Walker

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Lecture 6: Anxiety disorder Outline: Panic disorder Without agoraphobia With agoraphobia Agoraphobia without history of panic disorder Specific Phobia Social Phobia (Social Anxiety disorder) Obsessive-compulsive disorder Posttraumatic stress disorder Acute stress disorder (shorter duration, less than one month) Generalized anxiety disorder Anxiety due to Substance induce anxiety disorder Anxiety disorder NOS (not other specified) Cognitive: “worry: concern about negative consequence Behavior avoidance Anxiety vs. fear comparison Fear: -more intense, present oriented Anxiety: -future oriented, more diffuse Function of anxiety 1. Keep away from harm 2. Increases attention and focus 3. Energy 4. Motivation Panic disorder General anxiety disorder PTSD (posttraumatic stress disorder) Most commonphobia More women tend to have anxiety disorder with the exception of OCD, socialization may be a contribute factor High rates of comorbidity Commons in anxiety disorder: pattern of avoidance 1. Panic attack Symptoms: This is not fun Trembling and dizzy Hot flushes/ cold spells Increase heart rate/ palpitations Sweating Inspiration (e.g. choking) Shortness of breath Numbness or tingling Tightness in chest Fear of: losing control, dying, going crazy Unreality (sense of) Nausea (This not fun) (4 or more, peak quickly, brief and intense) Single attack doesn’t mean disorder. Most people will experience a panic attack at some point of their life. Panic attack can occur in many anxiety disorders. (Not just panic disorder) Type of attack Situationally bound (cued) Police, bad news Unexpected uncued: out of blue. Panic disorder  Recurrent unexpected panic attack (2 or more)  Plus or more > 1 month A. Persistent concern about having another attack B. Worry about the implication (heart problem, losing my mind) C. Significant change in behavior avoidance agoraphobia Panic attack without agoraphobia Panic attack with agoraphobia Agoraphobia DSM criteria  Anxiety about being in places from which escape might be difficult (or embarrassing) or help may not be available in the event of having a panic attack or panic- like symptoms  Situations are avoided or endured with significant distress. Causes Some evidence runs in families (true of anxiety in general) Neurotransmitters = norepinephrine increase, GABA decrease  Brain areas amygdala Two competing theory 1. CO2 dioxide hypersensitivity Theory (suffocation alarm) Panic disorder CO2 panic attack No Panic CO2 no panic attack 2. Cognitive theory Disclose of information Benign physiological changes misinterpreted Catastrophic Treatment CBT  Cognitive restructuring  Relaxation  Introspective exposure  Decrease relapse rates Antidepressants (Esp. SSRIs)  Relapse often when discontinued Benzodiazepinco short term only With Agoraphobia SSRIs and exposure therapy Phobia disorder 1) Agoraphobia 2) Social phobia 3) Specific phobia - Fear of social or performance situation - Fear is that they will embarrass or humiliate themselves - Intense anxiety or even panic attacks when expose  Pattern avoidance 1. Situational- public speaking exposure 2. Generalized all social situations SSRIs and CBT 3. Specific phobia  Fears that are excessive and cued by specific objects or situations 1) Animal 2) Childhood onset, gender equal, 100 boys = 100 girls Adulthood: 10 boys and 90 girls “Socialization” forced exposure 3) Natural environment Storm height water 4) Blood injection injury Dramatic decrease in blood pressure Fainting 5) Situational Diving, elevator, close space Causes of phobia Conditioned response  Result of traumatic exposure 50% people with a phobia  Traumatic conditioning Preparedness theory  Fear can be learned by modeling CBT- exposure, relaxation Antidepressant limited use Generalized Anxiety disorder (GAD) Worry disorder Worry that is excessive and difficult to control about a whole number of things. - Far at least 6 months - Plus 3 of the 6 1) Restless 2) Easily fatigued 3) Difficulty concentrating 4) Irritability 5) Muscle tension 6) Sleep disturbance  Many people with GAD report an early onset and living with it most of their lives  More difficult to treat especially “worry”  Chronic course may be more like a personality type or personality disorder  Poorer response to treatment  CBT and Antidepressant Caffeine sometimes associates with anxiety. Consumption of coffee Lecture 7: Factitious disorder, Somatoform disorder, and Dissociative disorder Outline: Somatization Disorder: Undifferentiated somatoform disorder Conversion disorder Pain disorder Hypochondriasis Body dysmorphic disorder Somatoform disorder NOS Factitious disorder Factitious disorder NOS Dissociative disorder Dissociative amnesia Dissociative fugue Dissociative identity disorder Depersonalization disorder Dissociative disorder NOS Malingering Not a DSM diagnosis Faking for gain benefits Factitious disorder DSM category Aka Munchausen’s syndrome Faking being sick motivated by one’s desire to be in the ‘sick role’ Factitious disorder By proxy  Usually a parent makes their child look sick (faking illness in their child) Dissociative disorder  Dissociation Splitting off of consciousness from Self depersonalization Unable to remember who you are, feeling changed in some way Environment de-realization Everything feels like in slow motion as if though you were in a dream Dissociative types of experiences  Zoning out 85% undergrads  Diving one’s car not remembering part of trip auto-pilot 50%  Seeing oneself as if though another person 30%  Being in a familiar place and feeling it is unfamiliar 30%  Finding oneself in clothes, doesn’t remember putting on 15% Individuals who are likely to dissociate 1. Prone to fantasy and day dreaming 2. Have vivid imaginations 3. Are easier to hypnotized Hypnosis Hypnosis to be induced required a deep state of relaxation  Induction of hypnosis Pharmacological e.g. barbiturates Psychological e.g. relaxation Hypnosis is state of dissociation with mental absorption and suggestibility Ability to imagine Ability to remember Responsiveness to suggestion Not related to IQ or measures of gullibility Therapeutic techniques Quit smoking Cure phobias Weight loss  Pain management acute and chronic  Somatoform disorder and dissociative disorder Depersonalization disorder  Episodes of depersonalization occurring frequently and cause distress or impair functioning Teens and 20s Most often goes away on its own, reassurance, stress management, and identity trigger Need to monitor Small may indicate decompensating into psychosis Dissociative amnesia Aka psychogenic amnesia memory loss for autobiographical details Organic amnesia, head trauma Dissociative fugue Dissociative identity disorder Aka Multiple personality disorder Alter Patchy patters of amnesia across host and alters More females than males with DID 2-9 female to 1 male Post-traumatic theory Metal disorder caused by severe childhood trauma Dissociative process occur during the trauma Internalized different identities  90% of those DID report childhood trauma  Dramatic differences between alter host Sociocognitive theory 1. DID is either faked for gains or it is iatrogenic 2. Induced by the therapist 3. The majority of causes are only detected after therapy begins Lecture 8: Mood disorders Outline: Mood disorder Depressive disorder Major depressive disorder Dysthymic disorder (less severe symptoms than MDD) Depressive disorder NOS Bipolar disorder Bipolar I Bipolar II Cyclothymic disorder Bipolar disorder NOS Mood disorder due to general medical conidition Substance induced Mood disorder Mood disorder NOS ----------------------------------------------- Mood disorder First cover mood episode Episodes need to know these to diagnose the proper disorder Psychosis can occur in MDE manic and mixed but not (hypomanic) Symptoms: 1. Sad images 2. Sleep changes 3. Appetite weight changes 4. Depressed mood 5. Indecisiveness (concentration) 6. Movement, psychomotor, agitation or retardation 7. Anhedonia 8. Guilt or worthlessness 9. Energy and fatigue 10. Suicide MDE severity Rating scale e.g. Beck depression Elderly- geriatric inventory Focus on thoughts Manic episode Elevated expansive, euphoric (3 of 7) or irritable (4 of 7) mood Sleep down Ideas flying, flight of ideas Distractibility Talkativeness pressure of speech Activity or agitation Grandiosity or self-esteem Mixed episode Dysphonic mania MDE manic episode  Higher rate of suicide  Poorer prognosis Hypomanic episode aka mild mania Similar to manic episode but no impairment in functioning no need to hospitalize and no psychosis Functioning increase Duration 4 days Dysthymia Chronically dressed mood that may occurs most days for at least 2 years (long time, milder than major depressive disorder) Often will experience a MDE on top of this, worry most of the time, but not all the time. Dysthymia is treatment resistant, More female than male MDD Age of onset to be 30~50 Melancholic-> anhedonia Lack of mood reactivity Sleep early waking up Twice females than males Appetite down Psychomotor change One episode lasts less than one year Atypical Depressed mood Mood reactivity Sleep increase fatigue persist Appetite increase Female > male Younger age of onset 20s Severity Mild moderate severe Rating scales Chronic >2 years Postpartum onset Psychotic treating psychosis- first focus Seasonal pattern Seasonal affective disorder Light therapy MDD outline 1. Melancholic 2. Atypical 3. Severity 4. Postpartum onset (after giving birth to a baby) 5. Psychotic 6. Seasonal pattern 7. Melancholic depression is characterized by a loss of pleasure in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, ex[132]ve weight loss (not to be confused with anorexia nervosa), or excessive guilt. 8. Atypical depression is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite (comfort eating), excessive sleep or sleepiness (hypersomnia), a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection. 9. Catatonic depression is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here the person is mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms also occur in schizophrenia or in manic episodes, or may be caused by neuroleptic malignant syndrome. 10. Postpartum depression, or mental and behavioural disorders associated with the puerperium, not elsewhere classifirefers to the intense, sustained and sometimes disabling depression experienced by women after giving birth. Postpartum depression has an incidence rate of 10–15% among new mothers. The DS
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