Mood Disorders: Etiology and Neurobiology
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Questions and Answers

What do case managers do for individuals with schizophrenia?

They coordinate medical and psychological services to help individuals function outside of institutions.

Residential treatment homes are suitable for individuals who are ready to live on their own.

False

Which factors are important in the development of substance use disorders?

  • Genetic factors
  • Environmental variables
  • Psychological factors
  • All of the above (correct)

    • The ability to tolerate large quantities of alcohol is a learned behavior.

    <p>False</p> Signup and view all the answers

    What is the primary goal of successful substance use disorder treatment?

    <p>Abstinence.</p> Signup and view all the answers

    What is Alcoholics Anonymous (AA)?

    <p>A self-help group for alcohol dependence</p> Signup and view all the answers

    What effect do expectancies about alcohol have on drinking behavior?

    <p>People drink because they expect it will reduce stress and anxiety.</p> Signup and view all the answers

    Which of the following methods is part of Nicotine Replacement Treatments?

    <p>Nicotine patches</p> Signup and view all the answers

    Moderation in drinking means completely abstaining from alcohol.

    <p>False</p> Signup and view all the answers

    The first step to successful treatment is admitting that there is a _____ .

    <p>problem</p> Signup and view all the answers

    Which neurotransmitter is associated with decreased levels in depression?

    <p>All of the above</p> Signup and view all the answers

    Which area of the brain is known to be elevated in individuals with Major Depressive Disorder (MDD)?

    <p>Amygdala</p> Signup and view all the answers

    Bipolar disorder is one of the least heritable mood disorders.

    <p>False</p> Signup and view all the answers

    What effect does high cortisol have on the body in relation to mood disorders?

    <p>It can harm body systems, especially damage to the hippocampus.</p> Signup and view all the answers

    The theory that hopelessness is a significant trigger of depression is called ______.

    <p>Hopelessness theory</p> Signup and view all the answers

    What psychological factor predicts the onset of depression?

    <p>Neuroticism</p> Signup and view all the answers

    Which therapy focuses on regulating circadian rhythms in bipolar disorder?

    <p>Interpersonal and Social Rhythm Therapy</p> Signup and view all the answers

    What are the two key dimensions of attributions in the hopelessness theory?

    <p>Stable vs unstable causes and global vs specific causes.</p> Signup and view all the answers

    Rumination has no effect on the risk of developing depression.

    <p>False</p> Signup and view all the answers

    What is a major focus of Cognitive Therapy?

    <p>Altering maladaptive thought patterns</p> Signup and view all the answers

    What should a person do with the nicotine patch each day?

    <p>Apply one patch and not remove it until the next one.</p> Signup and view all the answers

    How long can the nicotine patch be effective for most smokers?

    <p>After 8 weeks of use.</p> Signup and view all the answers

    Smoking while wearing the nicotine patch does not increase nicotine levels in the body.

    <p>False</p> Signup and view all the answers

    What interventions have shown effectiveness in reducing cocaine use?

    <p>Despiramine and CBT</p> Signup and view all the answers

    Which of the following is a cognitive-behavioral intervention for gambling disorder?

    <p>Imaginal desensitization</p> Signup and view all the answers

    Both Anorexia Nervosa (AN) and Bulimia Nervosa (BN) run in ______.

    <p>families</p> Signup and view all the answers

    What role does the hypothalamus play in eating disorders?

    <p>Regulating hunger and eating.</p> Signup and view all the answers

    Personality characteristics play no role in the development of eating disorders.

    <p>False</p> Signup and view all the answers

    What is a common focus for individuals with eating disorders?

    <p>Food-related words or images.</p> Signup and view all the answers

    What is an immediate goal of psychological treatment for Anorexia Nervosa?

    <p>Gain weight</p> Signup and view all the answers

    What are common treatments for sexual dysfunctions?

    <p>Anxiety reduction, skills training, and couples therapy.</p> Signup and view all the answers

    Match the following treatments with their corresponding sexual dysfunctions:

    <p>Squeeze technique = Premature ejaculation PDE-5 inhibitors = Erectile dysfunction Psychoeducation = Orgasmic disorder Systematic desensitization = Anxiety in sexual situations</p> Signup and view all the answers

    What psychological factor can affect sexual functioning?

    <p>Rape or sexual abuse.</p> Signup and view all the answers

    What is a factor contributing to paraphilic disorders?

    <p>All of the above</p> Signup and view all the answers

    What are the two steps in the development of an anxiety disorder according to Mowrer's two-factor model?

    <p>Classical conditioning</p> Signup and view all the answers

    What is the heritability percentage of panic disorder?

    <p>50%</p> Signup and view all the answers

    Genetic factors do not influence the development of anxiety disorders.

    <p>False</p> Signup and view all the answers

    Which brain structure has elevated activity in individuals with anxiety disorders?

    <p>Amygdala</p> Signup and view all the answers

    Which cognitive factors are involved in anxiety disorders?

    <p>Perceived lack of control</p> Signup and view all the answers

    What is the focus of Cognitive Behavioral Therapy (CBT) for addressing anxiety disorders?

    <p>Challenging and modifying negative beliefs and behaviors.</p> Signup and view all the answers

    Exposure therapy is key in the treatment of ____________ disorders.

    <p>anxiety</p> Signup and view all the answers

    Medication can effectively treat every type of anxiety disorder.

    <p>False</p> Signup and view all the answers

    What therapy focuses directly on memories and reminders of trauma in PTSD treatment?

    <p>Exposure therapy</p> Signup and view all the answers

    What form of therapy is often used for treating OCD that involves refraining from performing compulsive rituals?

    <p>Exposure and Response Prevention (ERP)</p> Signup and view all the answers

    What is a common psychological factor that can contribute to developing schizophrenia?

    <p>Low socioeconomic status</p> Signup and view all the answers

    Which neurotransmitter's excess is associated with positive symptoms of schizophrenia?

    <p>Dopamine</p> Signup and view all the answers

    What does psychophysiological assessment of a patient's sexual arousal help establish?

    <p>It makes it harder to deny sexual proclivities to the authorities.</p> Signup and view all the answers

    Which therapy involves the patient imagining situations they find inappropriately arousing and feeling ashamed?

    <p>Aversion Therapy</p> Signup and view all the answers

    Megan's Law requires the authorities to keep information about sexually violent offenders confidential.

    <p>False</p> Signup and view all the answers

    What is the heritability estimate for ADHD according to adoption and twin studies?

    <p>70-80%</p> Signup and view all the answers

    Which gene is associated with an increased risk of ADHD, especially with specific environmental factors?

    <p>DRD4</p> Signup and view all the answers

    What environmental factor has been linked to symptoms of hyperactivity and attentional problems in children?

    <p>Lead exposure.</p> Signup and view all the answers

    The most common chromosome deletion associated with ASD is found on chromosome ___ .

    <p>16</p> Signup and view all the answers

    What is the main goal of Ivar Lovaas's behavioral treatment program for children with ASD?

    <p>To mainstream children with ASD with typically developing peers.</p> Signup and view all the answers

    What is the recommended action for parents of children with childhood onset fluency disorder?

    <p>Parents are counseled about how to talk to their children.</p> Signup and view all the answers

    Phonics instruction is only used in cases of writing difficulties.

    <p>False</p> Signup and view all the answers

    What are some medical conditions that can cause delirium?

    <p>Drug intoxications, infections, and metabolic imbalances.</p> Signup and view all the answers

    What is emphasized in treatment for individuals with intellectual disability?

    <p>Enhancing productivity and independence.</p> Signup and view all the answers

    Which of the following statements about dementia is true?

    <p>Exercise has moderate benefits in cognitive function.</p> Signup and view all the answers

    Complete recovery from delirium is impossible.

    <p>False</p> Signup and view all the answers

    What is the primary goal of psychosocial intervention in treating delirium?

    <p>To reassure the individual and help them deal with agitation, anxiety, and hallucinations.</p> Signup and view all the answers

    There is no cure for ____ disease.

    <p>dementia</p> Signup and view all the answers

    Which medication is mentioned as a treatment for delirium?

    <p>Haloperidol</p> Signup and view all the answers

    What factors contribute to conduct disorder?

    <p>Neurobiological, heritable temperamental characteristics, and environmental factors.</p> Signup and view all the answers

    Aggressive behavior is generally not heritable.

    <p>False</p> Signup and view all the answers

    Which neurotransmitter's metabolism is influenced by MAOA?

    <p>Norepinephrine</p> Signup and view all the answers

    Study Notes

    Etiology of Mood Disorders

    Neurobiological Factors

    • Genetic influences indicated by twin and adoption studies, with bipolar disorder showing the highest heritability.
    • Polymorphism of the serotonin transporter gene linked to vulnerability to depression under stress.
    • Gene DRD4.2 associated with major depressive disorder (MDD), indicating mood disorders are likely polygenic.
    • Neurotransmitter levels impact mood:
      • Norepinephrine: Low linked to depression; high linked to mania.
      • Dopamine: Low linked to depression; high linked to mania. Depression may involve decreased responsiveness to dopamine-enhancing drugs.
      • Serotonin: Low levels contribute to both depression and mania; receptor insensitivity may exacerbate symptoms.

    Brain Imaging Studies

    • MDD shows alterations in brain areas regulating emotion:
      • Amygdala: Hyperactivity observed in MDD and bipolar I individuals, indicating a heightened emotional response.
      • Subgenual anterior cingulate: Elevated activity associated with depression.
      • Anterior cingulate cortex: Increased activity during emotional regulation tasks in bipolar I.
      • Hippocampus and dorsolateral prefrontal cortex: Diminished size/function in both depression and bipolar disorders, affecting emotion regulation.
      • Striatum: Overactivity linked to manic episodes.

    Neuroendocrine System

    • Hyperactivity of the HPA axis noted in MDD; poor cortisol suppression can damage body systems, particularly the hippocampus.
    • Higher cortisol levels in individuals with depression, with conditions like Cushing syndrome causing depressive symptoms due to cortisol overproduction.

    Social Factors

    • Life stressors play a crucial role in initiating mood disorders; their impact declines in subsequent episodes.
    • Low social support and high levels of expressed emotion (EE) increase the risk of relapse in depression.
    • Depressive symptoms can provoke negative responses from others, compounding interpersonal challenges and leading to a negative self-concept that undermines received support.

    Psychological Factors

    • Neuroticism is a strong predictor of depression onset and is associated with anxiety and persistent depressive disorder (PDD).
    • Cognitive theories emphasize negative thought patterns as a major cause of depression:
      • Beck’s theory identifies a negative triad impacting self-perception.
      • Hopelessness theory posits that perceptions of stability and globality of negative events increase hopelessness, a precursor to depression.
      • Rumination theory suggests repetitive dwelling on negative experiences escalates depressive risk, particularly among women.

    Social and Psychological Factors in Bipolar Disorder

    • Individuals with bipolar disorder often experience both manic and depressive episodes.
    • Factors triggering depression in bipolar disorder mirror those for major depressive episodes.
    • Predictors of mania include:
      • Reward sensitivity indicating disturbances in the reward system; goal attainment can trigger manic episodes.
      • Sleep disruptions increasing susceptibility to manic episodes, with sleep protection advised as a management strategy.

    Treatment of Mood Disorders

    • Antidepressants target neurotransmitters: serotonin, norepinephrine, and dopamine.

    Psychological Treatments for Depression

    • Interpersonal Psychotherapy (IPT): Focuses on resolving interpersonal issues and enhancing communication; effective for various populations.
    • Cognitive Therapy: Addresses maladaptive thoughts, promotes positive thinking, and encourages engagement in rewarding activities. Includes mindfulness-based cognitive therapy for relapse prevention.
    • Behavioral Activation Therapy: Increases participation in rewarding activities, disrupting depressive cycles.
    • Behavioral Couple’s Therapy: Enhances communication and relationship satisfaction, particularly for depressed individuals with relationship stress.

    Psychological Treatments for Bipolar Disorder

    • Medication is essential, but psychological strategies support treatment.
    • Interpersonal and Social Rhythm Therapy (IPSRT): Regulates circadian rhythms and establishes stable routines.
    • Psychoeducational approaches improve understanding of symptoms and encourage treatment adherence.
    • Cognitive therapy incorporates early signs of manic episodes; family-focused therapy enhances communication and coping strategies.

    Intensive Support Programs

    • Increased nursing care and structured follow-up improve outcomes for individuals with bipolar disorder. Various programs have shown effectiveness in providing additional resources and support.### ANXIETY DISORDERS: ETIOLOGY
    • Anxiety disorders are influenced by fear conditioning through Mowrer’s two-factor model: classical conditioning creates fear responses, while operant conditioning maintains avoidance behaviors.
    • Genetic factors:
      • Twin studies show 20-40% heritability for specific phobias, social anxiety disorder (SAD), Generalized Anxiety Disorder (GAD), and PTSD; 50% for panic disorder.
    • Neurobiological factors include:
      • Increased activity in the fear circuit, especially in the amygdala.
      • Reduced activity in the medial prefrontal cortex.
      • Dysfunctions in serotonin, norepinephrine, and GABA systems.
    • Personality traits:
      • Behavioral inhibition in infancy can predict later anxiety disorders, particularly social anxiety.
      • Neuroticism predicts both anxiety and depression onset.
    • Cognitive factors:
      • Negative beliefs maintain anxiety; safety behaviors exacerbate issues.
      • Perceived lack of control stems from childhood trauma or restrictive parenting, increasing vulnerability to anxiety disorders.
      • Heightened attention to threat cues intensifies anxiety.

    SPECIFIC ANXIETY DISORDERS

    • Specific Phobia:
      • Conditioned through direct experiences or learned behaviors.
      • Evolutionary predispositions create persistence for fears of inherently dangerous stimuli (prepared learning).
    • Social Anxiety Disorder:
      • Developed through negative social experiences; avoidance is maintained as it reduces fear.
      • Excessive focus on negative self-evaluations intensifies fear of social situations.
    • Panic Disorder:
      • Characterized by misfiring of the fear circuit and high norepinephrine levels.
      • Panic attacks can become conditioned responses to internal bodily sensations.
    • Agoraphobia:
      • Driven by fear of having anxiety in public spaces and negative beliefs about anxiety's consequences.
    • Generalized Anxiety Disorder:
      • Comorbid with other anxiety disorders and depression; individuals worry to avoid unpleasant emotions.

    TREATMENT OF ANXIETY DISORDERS

    • Low treatment-seeking rates: Many individuals with anxiety disorders do not pursue therapy.
    • Common features across therapies:
      • Exposure therapy is critical to confront fears and alleviate anxiety without reliance on safety behaviors.
    • Phobias:
      • In vivo exposure is preferred over systematic desensitization.
    • Social Anxiety Disorder:
      • Involves role-playing and social skills training to reduce avoidance behaviors.
    • Panic Disorder:
      • Panic control therapy uses exposure techniques to counteract panic triggers.
      • Cognitive therapy is effective in restructuring thoughts related to bodily sensations and panic.
    • Generalized Anxiety Disorder:
      • Relaxation training and cognitive therapy focused on tolerating uncertainty are crucial for managing symptoms.
    • Geared by genetic and neurobiological factors: Family histories indicate strong links with OCD.
    • Cognitive and behavioral models imply compulsions are reinforced by reducing anxiety.
    • Body Dysmorphic Disorder (BDD): Focus on specific features linked to attractiveness can lead to distorted self-perception.
    • Hoarding Disorder: Cognitive Behavioral models emphasize organizational difficulties and attachment to possessions.
    • Serotonin reuptake inhibitors are effective across OCD, BDD, and hoarding disorder.
    • Exposure and Response Prevention (ERP) is the gold standard for OCD, involving gradual exposure to anxiety triggers while preventing compulsive responses.
    • Cognitive approaches challenge beliefs surrounding compulsions and intrusive thoughts.
    • Hoarding Treatment addresses emotional attachments to possessions and involves gradual exposure to decluttering.
    • PTSD correlates with genetic predispositions, selective attention to threats, and neuroticism.
    • Degree and type of trauma heavily influence the likelihood of developing PTSD; human-caused traumas are more severe than natural disasters.
    • Neurobiological connections: Reduced hippocampal volume is consistently observed in PTSD patients.
    • SSRI medications are standard but have risks of relapse upon discontinuation.
    • Exposure therapy is more effective than traditional psychotherapy for PTSD by allowing individuals to confront trauma memories.
    • Cognitive strategies help process trauma and combat self-blame.

    DISSOCIATIVE DISORDERS: ETIOLOGY

    • Traumatic events often lead to repression of memories, resulting in dissociative symptoms.
    • Dissociative Identity Disorder (DID) theories focus on trauma coping mechanisms and role-playing behavior shaped by therapeutic influences.
    • Nearly all patients report severe childhood abuse as a critical factor in DID development.

    TREATMENT OF DISSOCIATIVE DISORDERS

    • Treatment aims for integration of identities and addressing traumatic memories.
    • Psychodynamic therapy, hypnosis, and cognitive-behavioral strategies are useful in treating DID.
    • Individuals commonly display excessive health anxiety with minimal concordance among twins.
    • Neurobiological responses involve increased activity in regions associated with distress from somatic sensations.
    • Building trust between healthcare professionals and patients reduces anxiety surrounding health concerns.
    • Cognitive-behavioral therapy (CBT) effectively addresses emotional triggers and alters perceptions regarding somatic symptoms.

    SCHIZOPHRENIA: ETIOLOGY

    • Genetic risk is heterogeneous; twin studies indicate a higher risk among monozygotic twins for developing schizophrenia.
    • Dopamine theories suggest a key role in the manifestation of symptoms, with medications targeting dopamine receptors.
    • Neuroanatomical changes such as enlarged ventricles and reduced gray matter in key brain regions correlate with disorder severity.

    TREATMENT OF SCHIZOPHRENIA

    • Treatment typically involves a combination of antipsychotics, psychosocial therapies, and family education.
    • Cognitive-behavioral therapy (CBT) helps manage maladaptive beliefs and negative symptoms.
    • Social skills training and family therapies provide support and long-term management of the disorder.### Case Management and Treatment for Schizophrenia
    • Case managers coordinate medical and psychological services for individuals with schizophrenia, helping them live independently outside institutions.
    • Residential treatment homes, also known as "halfway houses," support those not needing hospital care but requiring assistance for daily living.
    • Vocational rehabilitation programs in residential settings teach marketable skills, promoting employment and community integration.
    • Supportive employment provides job coaching and training to maintain employment.

    Substance Use Disorders (SUD)

    Etiology and Risk Factors

    • Physiological dependence on substances develops over time and is influenced by various factors.
    • The frontal cortex develops during adolescence, making decision-making and impulse control vulnerable during substance experimentation.
    • Genetic predisposition plays a significant role; relatives of problem drinkers exhibit higher rates of alcohol abuse.
    • Monozygotic (MZ) twins show greater concordance for various substance use disorders compared to dizygotic (DZ) twins.
    • Environmental influences, like peer and parental behaviors, significantly impact adolescent substance use.

    Neurobiological Factors

    • Most substances, including alcohol, activate dopamine systems associated with pleasure.
    • Deficiency in dopamine receptors, particularly DRD2, contributes to substance dependence.
    • People may use drugs to alleviate withdrawal symptoms, leading to relapse.
    • Incentive-sensitization theory explains heightened craving for drugs due to increased sensitivity to drug-associated cues.

    Psychological Factors

    • Drug use reinforces positive emotions and diminishes negative ones.
    • Expectancies about drug effects influence usage; high expectations lead to increased consumption.
    • Specific personality traits, like high negative emotionality and low constraint, heighten the risk for SUDs.

    Sociocultural Factors

    • Alcohol is the most widely used substance, with marijuana as the second; social availability influences usage rates.
    • Family dynamics, such as parental alcohol use, affect the likelihood of developing drinking problems.
    • Social influence and selection models indicate that drinking behaviors within peer groups influence individual consumption.

    Treatment Approaches for SUD

    • Acknowledgment of the addiction problem is crucial for effective treatment.
    • Detoxification is often the first step, particularly in inpatient settings, followed by ongoing support like Alcoholics Anonymous (AA).
    • Cognitive-behavioral therapies (CBT) focus on reinforcing positive behaviors and preventing relapse.
    • Moderation in drinking can be achieved through guided self-change and controlled drinking strategies.

    Smoking Cessation

    • Peer influence is significant in quitting; those whose peers quit are more likely to follow suit.
    • Strategies to quit smoking include gradual nicotine reduction and psychoeducational programs.
    • Nicotine replacement therapies, such as patches and gum, assist in managing withdrawal symptoms.

    Treatment for Drug Use Disorders

    • Detoxification marks the initial stage of treatment; interventions like CBT are effective in combating cocaine use.
    • Contingency management approaches, rewarding positive changes in behavior, show promise in treating various substance dependencies.
    • Motivational interviewing combines CBT techniques with client-driven solutions to enhance engagement in treatment.

    Gambling Disorder

    • Gambler’s Anonymous employs a Twelve-step program for recovery.
    • Cognitive-behavioral interventions focus on financial limits and preventing relapse.

    Eating Disorders

    Etiology

    • Anorexia nervosa (AN) and bulimia nervosa (BN) show familial patterns, particularly among first-degree relatives.
    • Neurobiological factors implicate the hypothalamus, serotonin, and dopamine regulation in the development of eating disorders.

    Cognitive Behavioral Factors

    • AN is characterized by a fear of fatness, perfectionism, and media influence.
    • BN centers on weight concerns and self-worth tied to body image; purging relieves negative emotions.

    Treatment for Eating Disorders

    • Hospitalization may be necessary for AN to address medical complications.
    • Psychotherapy, including CBT and family therapy, aids in weight restoration and addressing underlying psychological issues.
    • For BN and binge eating disorder, CBT targeting binge behaviors and guided self-help strategies are effective.

    Sexual Dysfunctions

    Etiology

    • Immediate causes include performance anxiety and the spectator role during sexual experiences.
    • Biological factors, like hormonal imbalances and chronic health issues, affect sexual functioning.

    Psychosocial Factors

    • Previous trauma and relationship problems contribute to dysfunction; negative attitudes towards sex may arise from social influences.

    Treatment Approaches

    • A combination of techniques is often required to address sexual dysfunctions.
    • Anxiety reduction techniques, including systematic desensitization, help clients cope with sexual anxieties.
    • Couples are encouraged to explore a variety of sexual activities to alleviate performance pressure.

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