Unit 5 Mental and Physical Health

Dr. Eaker AP Psych

4 D's of defining abnormality

Dangerous - causing physical harm to oneself or others

Deviance - different from the culture/society

Distress - causing them or others some level of upset/anxiousness

Dysfunction - interfering with one's daily life

Interaction of Theoretical perspectives

ACES (adverse childhood experiences) - Sources of stress that can affect a person throughout the lifespan (life experiences during developmental stages)

Diathesis-stress model - Genetic vulneralbility combined with stressful life (biology and life experiences)

Biophyschosocial model - Biological, psychological, sociocultural factors

ACES (adverse childhood experiences)

Sources of stress that can affect a person throughout the lifespan

Life experiences during the developmental stages

Diathesis-stress model

Genetic vulnerability combined with stressful life

Biological and life experiences

Biopsychosocial model

Biological, psychological, sociocultural factors

Anxiety disorders

Generalized anxiety

Social anxiety

Panic disorder

Agoraphobia

Specific phobia

Generalized anxiety

Symptoms: excessive anxiety and worry; 3 or more: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

Causes: Socio-cultural stress of poverty or discrimination, Cognitive dysfunctional/maladaptive thinking (low self-esteem), Biological anxiety runs in family

Treatment: Cognitive Reframe beliefs about performance which increases emotional intelligence, Socio-cultural group/integrative therapy to understand coping and advocacy skills and culturally responsive therapies, Biological medication

Social anxiety

Symptoms: a persistent, excessive, irrational fear and avoidance of public interactions and being negatively evaluated by others; physiological reactions (see gen. anxiety)

Causes: Biological inherited traits (overreactive amygdala), Behavioral children are embarrassed + confused about how to communicate due to parents’ aggressive responses, Psychodynamic receive shame from primary caregiver about id and superego as a child→ mental illness as adult

Treatments: Behaviorism exposure treatment (desensitization - slow process of gradually introducing trigger), Biological medication

Panic disorder

recurrent, unexpected panic attacks (abrupt surge of intense fear or intense discomfort that reaches a peak within minutes)

Symptoms: 4 or more - sweat, trembling, feelings of choking, derealization or depersonalization, fear of losing control or dying; consistent worry of additional panic attacks and maladaptive change in behavior to avoid attacks

Agoraphobia

Symptoms: anxiety of having panic symptoms in using public transportation, open spaces, enclosed spaces, in line/crowd, outside, home alone; because thoughts of escape would be difficult if they have panic attack

Causes: Behaviorism learned from parents’ panic attacks

Treatments: Behaviorism exposure treatment, group therapy in virtual setting

Specific phobia

a persistent, excessive, irrational fear and avoidance of some object, activity, or situation

Symptoms: immediate anxious or fearful response upon exposure to the stimuli, avoiding triggers that arouse the fear

Causes: Evolutionary as a species prepared/predisposition to develop the common phobias like heights or certain animals; Behavioral classical conditioning or modeling (imitation of others’ fears)

Treatments: Exposure therapy - systemic desensitization (gradually exposed while practicing relaxation techniques), flooding (exposure immediately and excessively), modeling (showing another person interacting with the trigger)

Depressive state

abnormal extreme of low mood

Causes:

• Biological whole body disorder (gut biome & brain), genetic disposition, biochemical imblances (low norepinephrine & serotonin)

• Cognitive assumptions (self-defeating beliefs & negative explanatory style), cognitive triad (thoughts about self, situation, future), learned helplessness (passive resignation)

• Sociocultural loneliness, gender variance (females 2x vulnerable), stressful events, developed countries

• Psychodynamic unresolved grief (early childhood loss - real, symbolic, or imagined)

Treatments:

• Biological antidepressent drugs, brain stimulation (Electroconvulsive therapy, transcranial magnetic stimulation)

• Cognitive acceptance & commitment therapy, Beck's cognitive therapy

  • increase activities & mood

  • challenge automatic thoughts

  • identify negative thinking

  • change primary attitudes

• Sociocultural family's therapy, couple's therapy, support groups

• Psychodynamic free association psychodynamic therapy

• Behavioral behavioral activation (increases pleasurable activities)

Cognitive Triad

Cognitive cause for depression:

thoughts about self, situation, future

Beck’s Cognitive Therapy

Cognitive treatment for depression:

increase activities & mood

challenge automatic thoughts

identify negative thinking

change primary attitudes

Manic state

abnormal extreme of high mood

Bipolar state

abnormal extreme of both high and low moods

Bipolar 1 and Bipolar 2; 2 has less severe mania (hypomania)

Causes:

Biological genetic disposition, biochemical imblances (irregular norepinephrine & serotonin), brain structure

Treatment:

Biological mood-stabilizing drugs (lithium, psychotropics)

Cognitive adjunctive psychotherapy (medication maintenance)

ADHD

characterized by inattention, distractibility, hyperactivity, impulsivity

Causes - biological (genetic)

Treatments - Stimulant drugs (Ritalin, Adderall) to calm hyperactivity, behavior therapy, aerobic exercise, psychological therapies

Features - 2x more in boys than girls

Autism

characterized by exceptional skill or talent in a specific area, lack of motivation and ability to interact socially, oftne distracted by irrelevant stimuli, struggle to use language

Causes - biological prenatal environment (maternal infection, drug use, stress hormones), heritability, brain function

Treatments - Behavior therapy, medication

Features - 4 boys for every 1 girl, boys are systemizers while girls are empathizers

Hans Selye’s General Adaptation Syndrome (GAS)

Phase 1 - Alarm Reaction

Phase 2 - Resistance

Phase 3 - Exhaustion

Post-Traumatic Stress Disorder (PTSD)

Treatments: in conjunction with psychotherapy

• MDMA

• Ketamine

• Cannabis

• Classical psychedelics

Dissociative Identity Disorder (DID)

a mental health condition where a person experiences two or more distinct identities or personality states that alternate in controlling their behavior

• Switching of identities with distinct thoughts, behaviors, and memories

• Dissociative amnesia - memory gaps

• Dissociate as a coping mechanism from trauma

Eating disorders

Anorexia nervosa - restrict food intake

Bulimia nervosa - cycles of binge eating episodes followed by extreme behaviors to compensate or punish (vomiting, laxative use, fasting, exercise)

Causes - Behavioral competitive, high achieving, protective families → higher prevalence of anorexia; Sociocultural poverty rates can affect society’s image on plump v thin, weight-obsessed cultures pressure women to diet; Biological identical share EDs, up to 60% heritability

Treatments - Behavioral counterconditioning, behavioral modification, exposure therapy; Cognitive Rational-emotive behavior therapy, stress inoculation training (

Schizophrenia

Psychosis - loss of contact with reality

Symptoms

Positive symptoms - pathological excesses

Hallucinations (5 senses) - sensory experiences

• Olfactory, gustatory, tactile, visual, auditory

Delusions - beliefs

Disorganized thinking & speech

• Loose associations - rambling with no sense

• Neologisms - using made up words

• Perseveration - repeating the same activity/thought

• Clang - rhyming randomly without sense

Inappropriate affect - when one’s facial expression does not match their emotions

Negative symptoms - pathological deficits

Poverty of speech (alogia) - no speech

Restricted affect - missing emotional expression

Loss of volition (avolition) - no desire to change; no motivation

Social withdrawal

Psychomotor symptoms - movement, grimaces, gestures

• (various types of catatonia: a neuropsychiatric syndrome characterized by abnormal movements, behaviors, and withdrawal)

  • Catatonic stupor

  • Catatonic rigidity

Causes

Biological views

• Genetics - more than 100 gene sites linked to schizophrenia

• Biochemical abnormalities - dopamine hypothesis (D-2 receptor, too often & too many)

• Brain structure & circuitry - flawed interconnectivity between various structures

Treatments

Before 1950’s - institutionalization in state hospitals, restraint, lobotomies, abuse

Since the 1950’s - humane treatments, proper medication, modern CBT techniques

Antipsychotic drugs

• First generation antipshycotics (1960s-80s)

  • extrapyramidal effects, tardive dyskinesia

Second generation (1980s+)

Therapeutic treatments

Milieu therapy - Humanistic

• a safe, structured, group treatment method;

Hallucinations

sensory experiences

• Olfactory, gustatory, tactile, visual, auditory

Delusions

Beliefs

Disorganized thinking & speech

• Loose associations - rambling with no sense

• Neologisms - using made up words

• Perseveration - repeating the same activity/thought

• Clang - rhyming randomly without sense

Loose associations

rambling with no sense

Neologisms

using made up words

Perseveration

repeating the same activity/thought

Clang

rhyming randomly without sense

Token Economy

Behavioral treatment for schizophrenia:

system in which an individual is rewarded for demonstrating the desired behavior

Obsessive-Compulsive disorder

2 important parts:

• Obsessions - intrusive thoughts that are disturbing and graphic, causes anxiety or distress

  • Tends to get worse without treatment

• Compulsions - behaviors or mental acts developed to prevent the obsessive thoughts, usually repetitive and time-consuming

Causes

• Psychodynamic

  • Id impulses → obsessive thoughts

  • Ego defenses → compulsive actions

• Cognitive

  • Thought-action fusion - cognitive error

OCD’s related disorders

Hoarding disorder - individuals feel compelled to save items, becoming distressed if they try to discard them, resulting in excessive accumulation of items

Trichotillomania - people repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body

Excoriation disorder - people repeatedly pick at their skin, resulting in significant sores or wounds

Body Dysmorphic disorder - individuals become preoccupied with the belief that they have certain defects or flaws in their physical appearance, the defects/flaws are imagined or freatly exaggerated

Hoarding disorder

individuals feel compelled to save items, becoming distressed if they try to discard them, resulting in excessive accumulation of items

Trichotillomania

people repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other parts of the body

Excoriation disorder

people repeatedly pick at their skin, resulting in significant sores or wounds

Body dysmorphic disorder

individuals become preoccupied with the belief that they have certain defects or flaws in their physical appearance, the defects/flaws are imagined or freatly exaggerated

Personality disorders

Personality comes from…

• Genetic predispositions

  • Process emotions

  • Anger response

• Modeling / learned behavior

General personality disorder

• Enduring pattern of inner experience and behavior that deviates from cultural expectations, 2 or more

  • Cognition: ways of perceiving and interpreting self, others, events

  • Affectivity: range, intensity, appropriateness of emotional response

  • Interpersonal functioning: relationships

  • Impulse control: behavior, thought, emotion

• Traits are inflexible and pervasive

• Creates distress for others and themselves (but do not realize it)

• Patterns are stable and long-term

Cluster A - “Odd” types

Paranoid PD

Schizoid PD

Schizotypal PD

Cluster B - “Dramatic” types

Antisocial PD

Borderline PD

Histrionic PD

Narcissistic PD

Cluster C - “Anxious” types

Avoidant PD

Dependent PD

Obsessive-Compulsive PD

Paranoid PD (A - Odd)

suspicious and mistrusting of everyone, thinking that all others have insidious intent

Causes: cognitive maladaptive assumption, or childhood experiences as a defense mechanism

Treatments: cognitive therapy

Schizoid PD (A - Odd)

(Batman) pattern of detachment from relationships and emotional affect, chooses solitary activities, no innate desire to be in relationships

Causes: psychodynamic parents were neglectful or abusive, cognitive-behavioral deficits of thought

Treatments: cognitive list emotions, behavioral roleplay in social situations

Schizotypal (A - Odd)

eccentric behavioral, paranoia, oddity with thinking and superstition (closer to schizophrenia and more biological basis, but no psychosis)

Causes: behavioral family conflicts and psychological disorders in parents, biological predispositions

Treatments: biological medication, etc

Antisocial (B - Dramatic)

sociopath/psychopath, disregard and violation of rights of others, impulsivity, aggressiveness, recklessness, lack of remorse

Causes: psychodynamic no parental love = emotional distance and mistrust, behavioral learned through modeling parents’ aggressive behavior

Treatments: ineffective

Borderline PD (B - Dramatic)

instability in relationships, self-identity, emotions and emotional expression, job

Causes: psychodynamic parental rejection and childhood abuse, biological hyperactive amydala and underactive frontal cortex and hippocampus

Treatments: cognitive-behavioral dialectical behavioral therapy (DBT) reframe thoughts, develop better behaviors / coping mechanisms, and lots of empathy

Dialectical behavioral therapy (DBT)

cognitive-behavioral reframe thoughts, develop better behaviors / coping mechanisms, and lots of empathy

Histrionic PD (B - Dramatic)

hysteria, emotional attention-seeking, pattern of excessive emotion, exaggerated expression of emotions

Causes: psychodynamic cold and controlling parents, cognitive-behavioral assume they cannot care for themselves so seek others to cater for their needs, behavioral/sociocultural tendency to reward attention-seeking behavior

Treatments: cognitive-behavioral assertiveness therapy

Narcissistic PD (B - Dramatic)

need for admiration, grandiose sense of self, lack of remorse and thougt for others

Causes: psychodynamic cold/rejecting parents so insecure thus overcompensation, cognitive children treated too positively/permissively which encourages entitlement

Treatments: none

Avoidant PD (C - Anxious)

feelings of inadequacy and inferiority, scared of not being accepted thus choose to isolate from society, even though they really want relationships

Causes: psychodynamic parents shame children

Treatments: cognitive changing distressing beliefs and thoughts, behavioral social skills training and exposure therapy

Dependent PD (C - Anxious)

feelings of inadequacy and inferiority, scared of not being accepted thus choose to isolate from society, even though they really want relationships

Causes: psychodynamic parents shame children

Treatments: cognitive changing distressing beliefs and thoughts, behavioral social skills training and exposure therapy

Dependent - pattern of submissive and clinging behavior, related to need to be taken care of, difficulty making decisions without others’ input

Causes: behavioral parents reward children for clingy behavior, psychodynamic over-involved and controlling parents

Treatments: cognitive-behavioral help clients change belief that they are helpless and become more self-reliant

Obsessive-Compulsive (C - Anxious)

perfectionism, orderliness, morality, control, excessively devoted to work, high expectations of these things in themselves and in others to the point that it interferes with their life

Causes: psychodynamic overly hard potty training

Treatments: psychodynamic accepting underlying feelings and insecurities, cognitive changing all-or-nothing thinking

Exposure therapy

Systemic desensitization - gradually exposed to trigger while practicing relaxation techniques

Flooding - exposure immediately and excessively

Modeling - showing another person interacting with the trigger

Panic disorder is usually accompanied with…

Agoraphobia

Comorbidity

Brain stimulation therapies for depression and schizophrenia

Transcranial magnetic stimulation (TMS) and Electroconvulsive therapy (ECT)

Compensatory behaviors for bulimia

Actions done to get rid of calories taken in during binge

EX: fasting, misusing laxatives, vomiting