Anxiety Disorders Study Guide PDF

Anxiety Disorders: Chapter Overview: Anxiety and Fear - Purpose of Anxiety and Fear: Evolved to warn of survival threats. - Distinction: - Normal Anxiety: Linked to real threats, proportional to the danger. - Pathologic Anxiety: Present without real threats or disproportionate to the threat. Pr...

Anxiety Disorders: Chapter Overview: Anxiety and Fear - Purpose of Anxiety and Fear: Evolved to warn of survival threats. - Distinction: - Normal Anxiety: Linked to real threats, proportional to the danger. - Pathologic Anxiety: Present without real threats or disproportionate to the threat. Primary Types of Anxiety Disorders (DSM-5) 1. Posttraumatic Stress Disorder (PTSD) 2. Acute Stress Disorder 3. Specific Phobia 4. Social Anxiety Disorder (SAD) 5. Generalized Anxiety Disorder (GAD) 6. Panic Disorder (PD) 7. Obsessive-Compulsive Disorder (OCD) - Common comorbidities: depression (~50%) and substance use disorders (~15%). Specific Phobia - DSM-5 Criteria: - Intense, irrational fear of a specific situation or object. - Phobic situations are often avoided. - Recognized by the individual as excessive, affecting daily functioning. - Examples of Common Phobias: - Snakes, spiders, animals, closed spaces, heights, blood, and darkness. Social Anxiety Disorder (SAD) - DSM-5 Criteria: - Fear of social/performance situations due to possible scrutiny. - Disproportionate fear, often leading to avoidance. - Symptoms persist for 6 months or more, causing distress or impairment. - Associated Features: - Self-consciousness, feelings of social inferiority, and avoidance behaviors. - Symptoms can include blushing, sweating, and panic attacks in social settings. Panic Disorder (PD) - DSM-5 Criteria: - Recurrent unexpected panic attacks with intense fear that peaks within minutes. - Symptoms include palpitations, sweating, dizziness, fear of dying, and more. - At least one attack followed by persistent worry about future attacks. - Agoraphobia: Fear of situations where escape may be difficult, occurring in ~30-50% of cases. - Prevalence: 1.5-4% in the general population, with 15% experiencing isolated panic attacks. Obsessive-Compulsive Disorder (OCD) - DSM-5 Criteria: - Obsessions: Recurrent intrusive thoughts causing distress. - Compulsions: Repetitive behaviors to reduce distress or prevent an unwanted outcome. - Recognized as excessive and typically lasting over an hour per day, interfering with functioning. Generalized Anxiety Disorder (GAD) - DSM-5 Criteria: - Persistent, excessive worry about various topics more days than not for at least six months. - Symptoms include restlessness, fatigue, irritability, muscle tension, and sleep disturbances. Treatment Approaches for Anxiety Disorders - Therapies: - Exposure Therapy: Confronting feared stimuli. - Systematic Desensitization: Gradual exposure with relaxation techniques. - Cognitive Restructuring: Reframing thoughts related to anxiety. - Group Therapy - Medications: SSRIs, benzodiazepines, beta-blockers (e.g., propranolol). Assessment of Anxiety Disorders - Tools: - Interviews and questionnaire screeners (e.g., Beck Anxiety Inventory, MMPI). - Differential diagnosis can be challenging due to symptom overlap with depression and neuroticism. Correlations and Factor Models in Psychopathology - Correlations: Anxiety, depression, and substance use disorders often correlate. - Quantitative Models: Factor analysis is used to model correlations among disorders, helping to identify patterns and potential latent factors. Mood Disorders and Suicide: 1. Mood Disorders Overview - Two main classes: Depression and Bipolar Disorder. - Depression includes Unipolar Depression with subtypes like Dysthymia and Major Depressive Disorder (MDD). - Bipolar Disorder includes Cyclothymia, Bipolar I, and Bipolar II. 2. Manic Episode Diagnostic Criteria - Characterized by an elevated, expansive, or irritable mood lasting at least one week. - Requires at least three of the following symptoms:  - Inflated self-esteem or grandiosity - Decreased need for sleep - Pressured speech - Racing thoughts or flight of ideas - Distractibility - Psychomotor agitation or increased goal-directed activity - Excessive involvement in high-risk activities 3. Hypomanic Episode - Similar to a manic episode but shorter, lasting at least four days. - Symptoms do not cause marked impairment or hospitalization. 4. Bipolar Disorder Types in DSM-5 - Bipolar I Disorder: Requires at least one manic episode, may or may not include major depressive episodes. - Bipolar II Disorder: Characterized by hypomanic episodes along with major depressive episodes. - Cyclothymia: Chronic disorder involving hypomanic and depressive symptoms (not full episodes) persisting for at least two years, with no symptom-free period exceeding two months. 5. Epidemiology of Unipolar and Bipolar Disorders (UP and BP) - Onset typically in late teens to early 20s for BP; 20s to 30s for UP. - Life risk (lifetime prevalence rate) is approximately 1% for BP and 10% for UP. - Gender distribution differs: BP shows no consistent gender difference, while UP is more prevalent in females. - UP and BP are heritable, with BP showing a stronger genetic basis. 6. Heritability and Genetic Correlations - Studies show a genetic overlap between mood disorders. - For example, monozygotic (identical) twins of individuals with BP are more likely to develop mood disorders compared to dizygotic (fraternal) twins. 7. Genetic Techniques and Polygenic Scoring - Genome-wide association studies (GWAS) explore genetic variants associated with mood disorders. - Polygenic scores aggregate multiple genetic markers to predict susceptibility to disorders like schizophrenia (SCZ) and BP. - Higher polygenic scores for SCZ and BP are associated with artistic talents. - Explain Polygenic Scoring 8. Treatment of Bipolar Disorder - Somatic treatment includes lithium (effective but with side effects requiring monitoring). - Alternatives like antidepressants and antipsychotics are often used due to fewer side effects.  - Psychosocial treatments include family therapy, which promotes medication adherence, educates family members, and helps develop coping and communication skills. 9. Suicide Statistics and Predictive Challenges - Suicide prevalence varies globally; in the U.S., suicide rates differ by age, gender, and racial groups. - Men are more likely to complete suicide, though women more frequently attempt it. - Suicide prediction is challenging; common indicators (hopelessness, social withdrawal, increased substance use) yield low predictive accuracy due to the low base rate of suicide. 10. Ethical and Clinical Approaches to Suicide - In high-risk cases, intervention might include involuntary holds. - In less imminent cases, clinicians may implement safety plans, involve family/friends, and remove lethal means. - Ethical debates include questions about the right to die and societal intervention in suicide. Got it! Here’s the study guide with all bolding removed: Eating Disorders 1. Eating Disorders Overview - Common forms: - Anorexia Nervosa (AN) - Disorder of over-control. - Bulimia Nervosa (BN) - Disorder of under-control. - Shared characteristics: - Negative body image. - Fear of weight gain. - Behaviors: food restriction, binging, purging. - Key differentiators: - AN: Extreme weight loss, high hunger tolerance. - BN: Typically, weight within normal range. 2. Anorexia Nervosa (AN) - DSM-5 criteria: - Restriction of energy intake, leading to low body weight. - Fear of weight gain, even when underweight. - Distorted self-perception of weight or shape. - Severity by BMI: - Mild (>17), Moderate (16-16.99), Severe (15-15.99), Extreme ( 30 (severe > 40). - Energy imbalance: Caloric intake > energy expenditure. - Social and genetic factors: - Environmental influence: food availability, sedentary lifestyles. - Genetic predispositions: e.g., Prader-Willi syndrome, rare protective mutations. - Health complications: - Heart disease, diabetes, cancer, sleep apnea, limited mobility. - Social stigma: - Societal bias against obesity, often leading to judgment and stereotyping. - Treatment challenges: - Limited success with dieting; extreme cases may consider bariatric surgery. - Emerging drug treatments (e.g., Ozempic). Key Takeaways - Eating disorders: Primarily affect self-perception, control, and have severe health consequences. Require tailored, often resistant treatment approaches. - Obesity: Multifaceted problem influenced by genetic, social, and lifestyle factors, with significant stigma and complex health risks. Substance Use 1. Overview of Alcoholism - Alcoholism is a chronic disease with genetic, psychosocial, and environmental influences. It is often characterized by impaired control over drinking, persistent use despite consequences, and distorted thinking patterns like denial. Lifetime rates are high, around 20%, and alcohol use is more prevalent among men. Alcohol consumption varies globally, being highest in Europe and South Korea. - Studies suggest a heritability rate between 40-60%. Genetic studies, including GWAS, are identifying loci related to alcohol dependence. 2. Substance Use Disorders - This category includes disorders with cognitive, behavioral, and physiological symptoms, where individuals continue using substances despite significant related issues. Symptoms include impaired control, social impairment, risky use, and pharmacological issues like tolerance and withdrawal. - Alcohol Use Disorder involves a pattern of problematic use leading to impairment or distress, marked by excessive intake, craving, and withdrawal symptoms. 3. Withdrawal Symptoms - Withdrawal from alcohol includes symptoms such as autonomic hyperactivity, tremors, nausea, and in severe cases, seizures and hallucinations. These symptoms cause significant distress or impair daily functioning. 4. Drug Use Disorders Beyond Alcohol - Other substances include caffeine, nicotine, cannabis, opioids, and stimulants. These disorders follow similar diagnostic criteria, tailored to the specific drug. 5. Cannabis Legalization and Usage Trends - Cannabis legalization studies offer insights into normative drug use. Studies comparing cannabis use across states like Colorado and Minnesota show that legalization is linked to increased use. This legalization effect appears modest and affects cannabis use frequency more than other health or behavioral domains. 6. ALDH2 Deficiency and Alcohol Metabolism  - ALDH2 enzyme deficiency, especially in East Asian populations, impacts alcohol processing, often causing a flushing response that includes symptoms like heart palpitations and facial redness. The ALDH2 gene has protective alleles against alcoholism, seen predominantly in East Asians. - This deficiency has broader implications for addiction studies, as it potentially protects individuals from progressing through the "gateway" drug sequence. 7. The Gateway Theory - This theory posits that initial drug use (like tobacco or alcohol) can lead to harder drug use. ALDH2 deficiency studies offer a quasi-experimental view of the gateway theory, as individuals with this genetic protection have reduced alcohol use and potentially reduced progression to other drugs. 8. Comorbidity and Externalizing Psychopathology - Alcoholism is highly comorbid with other substance use disorders and is genetically linked with antisocial behaviors and impulsivity-related personality traits. Krueger et al. (2002) examined this comorbidity, noting that externalizing liability is particularly high in adolescence and young adulthood. 9. Treatment Options - Treatments for substance use vary by drug type. Some, like methadone for opioids or nicotine replacements, are more effective, while talk therapy shows limited success across substances. There is no systematic method to match patients to treatments likely to work best for them, although some individuals respond well to specific interventions. Here’s the study guide with the same content and no bolding: Psychosis Schizophrenia Overview - Major impacts on health, longevity, and economy: - Leading cause of disability (WHO, 2004) - Suicide: 1/3 attempt, 1/10 succeed (much higher than general population) - Life expectancy reduced by 12-15 years - Economic cost: lifetime estimate of $1.4 million per person - Significant burden on families and caretakers Course of Illness 1. Prodrome: Mild, early symptoms before full onset 2. Onset: Worsening of symptoms (e.g., hallucinations, delusions) 3. Recovery/Maintenance: Treatment can aid recovery, but full pre-onset functioning is rare; recurrence may happen Disrupted Domains of Functioning - Schizophrenia affects: - Cognition (thinking) - Perception (sensory processing) - Emotion - Motor abilities Abnormalities in Thinking - Two primary types: 1. Form of Thought (disorganized thinking): - Tangentiality: responses diverging from main topic - Loose associations: sequence of unrelated ideas - Word salad: incoherent mix of words - Neologisms: made-up words - Clanging: word choice based on sound, not meaning 2. Content of Thought (delusions): - Erroneous beliefs, maintained despite evidence - Common types: persecutory, grandiose, religious, control-related Types of Delusions - Persecutory: Belief of being targeted or harmed - Grandiose: Belief of having special powers or fame - Religious: Spiritual content in delusions - Delusions of Reference: Interpreting events/objects as having unique meanings for oneself - Delusions of Control: Feeling controlled by outside forces Disorganized Behavior - Behavioral disorganization: Unconventional clothing, poor hygiene, erratic behavior - Alogia: Limited or unprompted speech, sparse replies - Social isolation: Often severe, withdrawal from social interaction Hallucinations - Definition: Sensory experiences with no external cause - Types: - Auditory: Voices, most common (often commenting or conversing) - Visual: From mild distortions to clear figures - Tactile: Rare, e.g., feeling bugs on skin - Gustatory/Olfactory: Rare, disturbing smells/tastes Flat Affect and Anhedonia - Flat Affect: Lack of facial expressions, monotone voice, minimal gestures - Anhedonia: Diminished pleasure in enjoyable activities; some evidence suggests retained emotional response Motor Abnormalities and Catatonia - Catatonia: Abnormal movement and behavior related to schizophrenia; DSM-5 criteria include: - Stupor, mutism, posturing, stereotypy, agitation - Waxy flexibility (resistance to positioning by examiner) Symptom Classes 1. Positive Symptoms: Hallucinations, delusions, disorganized thinking/behavior 2. Negative Symptoms: Flat affect, anhedonia, lack of motivation, poverty of speech DSM-5 Diagnostic Criteria - Two or more of the following for one month: - Delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms - Functional impairment required - Continuous disturbance for six months Related Disorders - Schizophreniform Disorder: Symptoms similar to schizophrenia but non-chronic - Schizoaffective Disorder: Schizophrenia symptoms with mood disorder - Delusional Disorder: Delusions without other schizophrenia symptoms - Brief Psychotic Episode: Short-term psychotic symptoms - Substance/Medication-Induced Psychotic Disorder: Symptoms caused by substances Associated Features - High rates of substance use (80% smoke, 24% comorbid substance abuse) - Cognitive deficits: Issues with attention, memory - Violence: Generally low risk, more likely victims than perpetrators Epidemiology - Prevalence: Affects approximately 1% of the population globally - Incidence and Lifetime Morbid Risk: Higher than general population - Onset: Typically early adulthood, with slight gender differences Important: you will also be tested on the journal articles. Be prepared to be tested on the take/home findings/ideas. Articles Kendler et al. (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156(6), 837-841. https://doi.org/10.1176/ajp.156.6.837 Take home:  - Examined associations between stressful life events and the onset of major depression in a sample of female twins. Distinguished between dependent and independent events. Examined contextual threat level of event as well. - Used a discrete-time survival analysis with co-twin controls to look at causal relationships between event dependence and the risk of major depression. - Both dependent and independent events significantly positively associated with depression onset. However, when threat level (event severity) was controlled for, dependent events had a stronger association. - Found lower associations between stressful life events and major depression in MZ than DZ, implicating shared genetic factors. Not all of the association between stressful life events and onset of major depression is causal; rough estimate = 65% causal. Saunders et al. (2022). Longitudinal effects and environmental moderation of ALDH2 and ADH1B gene variants on substance use from age 14 to 40. Development and Psychopathology, 34(5), 1856-1864. https://doi.org/10.1017/S0954579422000712 Take home: - Do not focus on ADH1B, findings were negligible - Asked: - Is there an effect of ALDH2 (ALDH2*2; the minor allele that encodes the inactive ALDH2 enzyme) status on drinking behavior? - Does this effect change with age? - Is there an ALDH2 x environment interaction in ALDH2’s effect on drinking/other substance use? - Using ALDH2 as a quasi experiment, is there an association between alcohol use and other substance use? (is the gateway hypothesis supported?) - Sample of N = 412 adoptees from E/NE Asia, ascertained ALDH2 status and measured drinking and other drug use behavior. Used mixed effects models to look at associations. - ALDH2 status significantly influenced alcohol use, with effects increasing with age; peer alcohol use predicted drinking behaviors, but not moderated by ALDH2 status; no causal link found between alcohol use and other substances, contradicting the gateway hypothesis.