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Terms in this set (69)

A. Exposure to trauma
• directly experiencing traumatic event • witnessing, in person, as trauma occurred to others • learning that traumatic event occurred to loved one • repeated exposure to aversive details of traumatic event (e.g. first responders)
B. Intrusion (reexperiencing) symptoms (one or more) • recurrent, intrusive recollections
(images, thoughts, perceptions) • recurrent, distressing dreams of the event • reliving the experience (acting it out, hallucinations,
(flashbacks)
• intense psychological distress when confronted with internal or external cues or symbols of the event
• physiological reactivity to cues or symbols
C. Avoidance symptoms (one or more)
• efforts to avoid thoughts, feelings, or conversations associated with trauma
• avoidance of activities, places, or people that arouse recollections of the trauma
D. Cognition and mood symptoms (two or more)
• inability to recall an important aspect of the trauma
• exaggerated negative beliefs about oneself, others, or world
• distorted cognitions about the event that leads to self-blame
• persistent negative emotional state (e.g. fear, horror, anger, guilt, shame)
• markedly diminished interest in significant activities • feelings of detachment or estrangement from others • persistent inability to experience positive feelings (numbing)
D. Arousal symptoms (two or more)
• difficulty falling or staying asleep
• irritability or outbursts of anger • difficulty concentrating
• hypervigilance • exaggerated startle response
With Anxious Distress
At least 2 of the following during most days of a depressive episode • feeling keyed up/tense • restlessness • difficulty concentrating due to excessive worry • fear that something awful may happen • feeling that you might lose control of self
With Mixed Features
At least 3 of the following manic/hypomanic features occur most days of a depressive episode • elevated expansive mood • inflated self-esteem or grandiosity • more talkative than usual • racing thoughts • increased energy •Involvement in activities with potential for negative consequences • decreased need for sleep
With Catatonic Features
• motoric immobility (catatonic stupor) • excessive purposeless motor activity (catatonic excitement) • extreme negativism or mutism • posturing or stereotypical movements • echolalia or echopraxia
With Melancholic Features
• loss of pleasure in all or almost all activities • lack of reactivity to pleasurable activities • profound despondency or emptiness • depression worse in the morning • early morning wakening • marked psychomotor agitation or retardation • extreme weight loss • excessive or inappropriate guilt
With Atypical Features
• mood reactivity (mood brightens with positive events) • weight gain or increase in appetite • hypersomnia • leaden paralysis (heavy feeling in arms or legs) • long-standing pattern of interpersonal rejection sensitivity
With Peripartum Onset
• onset of depression within weeks of delivery • may include psychotic features (delusions/hallucinations) • may include anxiety and panic attacks • risk is 1 in 500 - 1 in 1,000 births • risk of psychotic postpartum depression increases to 30-50% if previous episode
With Psychotic Features
• presence of delusions and/or hallucinations • mood-congruent - consistent with depressive themes of personal inadequacy, guilt, disease, death, or punishment • mood-incongruent - psychosis does not involve depressive themes
With Seasonal Pattern
• presence of delusions and/or hallucinations • mood-congruent - consistent with depressive themes of personal inadequacy, guilt, disease, death, or punishment • mood-incongruent - psychosis does not involve depressive themes
Interpersonal Therapy (IPT)
• short (16 sessions) • addresses current rather than past problems • addresses following interpersonal difficulties: • role loss (grief and mourning) • role disputes (incompatible expectations of partner) • role transition (change of role) • interpersonal deficits (skills education and training) • one of most effective therapies for depression, especially mild-moderate symptoms (non-melancholic)
Cognitive Behavioral Treatment (CBT)
• behavioral activation (make pleasurable behavioral changes) (running, going out with friends)
• recognize automatic thoughts and negative self-talk use hypothesis testing
• work on changing negative cognitive distortions • develop positive coping styles
Can we predict CBT success? Siegle et al. (2006)
Biological therapies
Tricyclics
MAOIs
• block reuptake of serotonin, norepinephrine, dopamine • probably also downregulate sensitivity of receptors • especially effective on melancholic depression • side effects: drowsiness, blurred vision, tachycardia, weight gain, dry mouth, orthostatic hypotension • examples: imipramine (Tofranil) and amitriiptyline (Elavil)
• inhibit MAO (the enzyme that breaks down , SE, NE, DA • more effective with atypical depression • usually NOT first line of defense because of side effects (must eliminate tyramine from diet) • side effects: chance of hypertension, heart problems • examples: phenylzine (Nardil)

SSRIs
Antidepressants
• inhibit reuptake of serotonin Examples: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) • usually first drug of choice • may have beneficial effects on comorbid disorders including OCD, eating disorders, anxiety disorders, panic disorder • fewer side effects: drowsiness or insomnia, maybe weight loss or weight gain, sexual dysfunction • less chance of overdose
Ketamine
• NMDA receptor antagonist • side effects include hallucinations, dreamlike states, amnesia • effects may be rapid but short-acting
Additional Therapies
Additional Treatments
Electroconvulsive Therapy (ECT)
Transcranial Magnetic Stimulation (TMS)
Deep Brain Stimulation (DBS)
Light therapy
Dissociative Identity Disorder
formerly Multiple Personality Disorder
• the presence of two or more distinct personality states (may in some cultures be described as an experience of possession). The identity disruption involves marked discontinuity of sense of self, and may include alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.
• recurrent gaps in recall or everyday events, important personal information, or traumatic events inconsistent with ordinary forgetting
• significant distress or impairment in social/occupational functioning
• disturbance is not due to substance abuse (e.g. blackouts due to drinking) or general medical condition (e.g. partial seizures)
Note: in children, symptoms are not attributable to imaginary playmates or other fantasy play.
The Classic Case
• host personality plus at least two fully developed personalities • each personality has on unique memories, behavior patterns • host personality is usually depressive, retiring, ineffectual • alters may be more aggressive, sexual, fun-loving
• sudden "switching" • alter personalities may be aware of each other but host is not • lost time
• personalities may differ • biologically • intellectually • talents
Dissociative Identity Disorder
The Medical Model (diathesis/stress model)
Diathesis = high hypnotizability Stress = repetitive inescapable stress or trauma
Note: Lenore Terr's Two Types of Trauma
Type I a single traumatic event pathology associated with: PTSD
Type II recurrent inescapable traumatic events pathology associated with: DID