Anxiety Disorders
What are the 3 categories of Anxiety symptoms?
subjective distress (self-report), physiological response, avoidance or escape behavior: this is a characteristic feature, almost always present
What's the difference between Bipolar 1 and Bipolar 2?
Bipolar 1 - must have: mania; can have: hypomania, major depressive episodea
Bipolar 2-must have: hypomania, major depressive episode; cannot have: mania
What % of people with PD or Agoraphobia were receiving some financial assistance?
50%
What does data gathered by Swann et al. (2013) indicate about mixed states?
Indicates that mixed states emerge with 2-3 symptoms of the opposite polarity
- mixed states is when depressive and manic symptoms combine in the same episode
- manic episodes with 2+ nonoverlapping depressive symptoms were found to have a poorer response to lithium than those with less depressive symptoms
- mixed states occur in the context of early-onset, frequent episodes or prolonged affective instability, and increased stress-related and substance use disorders
What are criterion A through D of panic disorder
Check DSM-5 (sorry too lazy to type)
What is the lifetime prevalence of GAD?
9%
What are the main differences between mania and hypomania?
hypomania - systems persist for 4 days; episodes are not severe enough to cause severe impairment - just a distinct, observable change in functioning; also no hospitalization and no psychotic features
**mania lasts a week or requires hospitalization and is severe enough to cause impairment, can have psychotic features
What are the three types of panic attacks? And which disorders are they associated with?
unexpected (uncued) -> panic disorder
situationally bound (cued) -> social phobia, specific phobia
situationally predisposed -> GAD, PTSD, OCD
Whta are the differences in suicide attempt between BD1 and BD 2? (holma et al., 2014)
approx 1/2 of all individuals who die by suicide have MDD or BD
research suggests that individuals with BD (especially BD2) are at higher risk of suicide attempts than MDD)
Suicide attempts increased 5x during subthreshold depression, 25x during MDE and 65x during a mixed episode compared to euthymic mood
What is the full criteria for a Manic episode?
A - a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy, last at least 1 week and present most of the day, nearly every day
B - During the period of mood disturbance and increased energy or activity, 3(or more) of the following symptoms (4 or more if the mood is irritable only) are present to a sig degree that represents a noticeable change from usual behavior
B1 - inflated self-esteem or grandiosity; B2 - decreased need to sleep; B3 - more talkative than usual or pressure to keep talking; B4 - flight of ideas or subjective experience that thoughts are racing; B5 - distractability as reported or observed; B6- increase in goal-directed activity or psychomotor agitation; B7 - excessive involvement in activities that have a high potential for painful consequences
C - mood disturbance is sufficiently severe to caused marked impairment in social or occupational functioning or to necessitate hospitalizations to prevent harm to self or others or there are psychotic features
D - the episode is not attributable to physiological effects of a substance or another medical condition
What is the vicious cycle in social phobia?
anticipatory anxiety - poor performance (Actual or perceived) - embarrassment - back to anticipatory anxiety
What is Cyclothymia?
The Bipolar version of dysthymia
- for at least 2 years, presence of numerous periods of hypomanic and depressive symptoms that do not meet full criteria for either hypomania or major depressive episode; have not been symptom free for longer than 3 months; has been no major depressive, manic, or hypomanic episodes during those 2 years
possible specifier: with anxious features
What is the core feature of panic disorder?
recurrent, unexpected panic attacks
What did Morrison et al. (2016) find that was correlated to social anxiety? What were the sig findings from this study?
Social anxiety correlated with increased negative and decreased positive "affective experience"
Pt. with SA were worse at sharing the positive emotions of others
- this study demonstrated that interpersonal difficulties are at the heart of social anxiety
What are criterion A through G of social anxiety disorder?
Check DSM-5 (sorry too long to type)
What is the performance only specifier for?
Social phobia; limited to speaking or performing in public
Is bipolar 1 or bipolar 2 "easier"? Why?
- individuals w BP2 spend a sig amount of time in MDES (MDEs are more debilitating than the hypomanic episodes)
- BP2 experience greater number of episodes than BP1
What is the lifetime prevalence of panic symptoms?
15%
What are the main points from the Newman article about GAD?
- GAD is an important, stand-alone disorder that leads to significant impairment acrossmultiple domains. These include role impairment, occupational problems, interpersonaland emotion regulation difficulties, and physical health problems, leading to substantialpersonal and societal cost.
A synthesis of data on the mechanisms of GAD indicates that it is a disorder associatedwith emotional and neurobiological hyperreactivity and a fear of negative emotional contrasts.
Evidence points to worry as a compensatory mechanism that creates and prolongs negative emotionality, thereby reducing contrasting emotional experiences.
We argue that this emotional and neurobiological dysregulation is caused or maintained by developmental vulnerabilities (environmental stress, insecure attachment, negative parenting behaviors), temperamental vulnerabilities (behavioral inhibition), and inter-personal processes (sensitivity to social threats and problematic interpersonal behaviors)
Although CBT is an empirically supported treatment for GAD, many clients fail to fully benefit from this treatment, and various attempts to modify standard CBT have not led to significant improvement. These realities suggest the need to reconsider maintenance factors for GAD, which have not been treated explicitly, such as avoidance of negative emotional contrasts.
CP09CH10-Newman ARI 24 February 2013 12:156. Although worry reduction is a primary therapy outcome goal, current treatments thatchallenge worry patterns may attempt to dismantle the cognitive defense without treatingthe underlying fears. Therefore, treatments could be usefully explored that personalizeintervention techniques and/or target behaviors and interpersonal patterns that maintaincontrast avoidance.
Changes from DSM-4 to DSM-5 for anxiety disorders
a big change - DSM-4 required self-recognition that the fear is excessive or unreasonable whereas DSM-5 replaced that with "the fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context"
**SM is now a separate disorder
**generalized is now used to refer to social anxiety that was present in nearly all social situations
In DSM-5 there are now three separate, but related categories of disorders: Anxiety disorders, obsessive-compulsive related disorders, trauma-and stressor-related disorders
DSM-4 had an "anxiety disorders" category that included - most of the current anxiety disorders, OCD, and PTSD
What is the word for fear of giving offense to others instead of being embarrassed?
- a cultural-bound disorder
Taijin Kyofusho
Deaths by suicide with Bipolar ______ higher than the general population
15x
What were the DSM-4 to DSM-5 changes for Panic disorder?
DSM-4 - agoraphobia was a specifier for panic disorder and now in DSM-5 it is a separate disorder
Wood and Tracey's (2009) article on diagnostic overshadowing found
the tendency to make the diagnostic overshadowing error can be minimized through training and feedback. Specifically, diagnostic overshadowing is reduced by either principle-based feed-back or content-based feedback, but only when the training task is highly similar to the target task
What are the DSM-5 revisions relating to Bipolar Disorders?
Bipolar disorders are now in their own category
increased energy/activity has been added as a core symptoms of manic and hypomanic episodes (down to help the problem of under-detection of BDs)
there is no longer a Bipolar Disorders NOS
- the new names are: MDE and Short Hypomanic Episodes, MDE and Hypomanic Episodes characterized by insufficient symptoms; Hypomanic episodes without prior MDE; short duration (less than 2 years); cyclothymia; uncertain bipolar conditions
ALSO - with rapid cycling specifier was added (at least 4 episodes of a mood disturbance in the previous 12 months have met criteria for a MD, manic, or hypomanic episodes; episodes are demarcated either by partial or full remission of at least 2 months or a switch to an episode of opposite polarity)
Mixed Episode was removed