chapter 14

Pussin

treat patients with kindness and care

Philippe Pinel

removed chains and physical punishment, moral treatment (close contact and observation therapy)

Dorothea Dix

spread moral treatment in America

Kraepelin

not all patients w/ psychological disorders have the same one, categories based on similar symptoms

Categorical approach

ex DSM, either you have the disorder or not, cut off

Comorbidity

two+ psychological disorders usually occur together

Why categories?

patients rarely ever fit into precise diagnostic categories

Dimensional Approach

psychological disorders are along a continuum, vary in degree/severity

P factor

involved in all psychological disorders, higher = worse outcome and more life impairment

Hypothyroidism

an endocrine disorder that must be ruled out before a psychological disorder like depression or anxiety is treated because symptoms are similar

Diathesis Stress Model

an individual has an underlying vulnerability or predisposition to the specific disorder (either environmental or biological called the diathesis) but not enough along to trigger the disorder, the additional stressful circumstances can finally tip the scale enough to be classified as a disorder (the stress)

Cognitive Behavioral Approach

abnormal behavior is learned and therefore can be unlearned

Internalizing Disorders

focused on negative emotions (fear vs distress) (depression, anxiety, panic), common in women ex. Anorexia nervosa

Externalizing Disorders

impulsive, out of control behavior (alcohol, antisocial personality disorder), common in men ex. Alcoholism

Schizophrenia and bipolar disorder are equally likely in both sexes and highly genetic/biological

cultural syndromes

disorders that include a cluster of symptoms that are found in specific cultural groups or regions

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Anxiety disorders

excessive fear and anxiety in the absence of true danger, shrinks hippocampus

Specific phobia

fear of something that is disproportionate to the threat, exaggerated

1 in 8 people

Social anxiety disorder

Fear of being negatively evaluated by others in a social setting

1 in 8 people and 7%, often begins to develop around age 13

Likely to also have depression and substance abuse problems

Generalized anxiety disorder

Nearly constant anxiety not associated with a specific thing

6 percent of the U.S (Women > men)

Panic disorder

Sudden attacks of overwhelming terror

are cued by external stimuli or internal thought processes

Or can come from nowhere

Agoraphobia

Fear of being in a situation from which one cannot escape

Can cause panic attacks

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Major Depressive Disorder

loss of interest in pleasurable activities every day for at least 2 weeks, EXTREME depression for SHORT periods

7–8 percent of Americans at any one time

Lifetime Prevalence

13%

treated with increase in norepinephrine or serotonin (monoamines) SSRIs

dysthymia / persistent depressive disorder

less intense, longer periods of mild depression, 2–3%, more days than not or most of the day for 2 years, A personality not mood disorder

Women are x2 twice more likely to experience depressive disorders than men

Concordance rates for identical twin is 2-3 times higher than fraternal twins'

Aaron Beck

the causes of depression are negative thoughts and beliefs about oneself, the world and the future (cognitive triad)

Seligman’s Learned Helplessness

believe they are unable to have any effect on the events in their lives, expect bad things to happen to them and believe they are powerless to avoid them

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Bipolar I

manic episodes, depressive episodes NOT required for diagnosis, often = hospitalization

Mania

elevated mood, increased activity, not needing sleep, grandiose ideas, risky behavior

Bipolar II

hypomania (less extreme elevated mood) = creativity/productivity but at least one depressive episode

For both = 4% life prevalence

Equally prevalent in both genders

Concordance rate for identical is 70%, 20% for fraternal

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Joiner

people desire death when the need to belong and need for competence is not fulfilled

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Psychosis

break from reality, unable to distinguish between reality and imaginary

Schizophrenia

6+ months, 2+ symptoms

Positive Symptoms

present in schizophrenia, absent in normal people USUALLY TREATED BY ANTIPSYCHOTICS

Delusions

false beliefs

Persecutory

belief that others are trying to harm or spy on them

Referential

belief that objects/events/other people have particular significance to them

Grandiose

belief that they have great power, knowledge or talent

Identity

belief that they are someone else

Guilt

belief that they have committed a terrible sin

Control

belief that their behavior or thoughts are being controlled by some outside force

Hallucinations

vivid false sensory experiences

Disorganized Speech

incoherent hard to follow or understand

Word Salad

speech is entirely incomprehensible

Disorganized Behavior

strange unpredictable behavior, aggression, child silliness

Catatonic Behavior

non responsive, immobilized, echolalia (repeating words)

Negative Symptoms

daily normal people behaviors that are nonexistent in people with schizophrenia (they lack this) (common in men)

Isolation/Withdrawal

Lack of eye contact

Apathetic

Long Pauses

Slowed Speech/Movement

Monotone Voice

No interest in initiation of social interaction

Causes

rare DNA mutations, enlarged ventricles and reduced brain tissue, dysfunctional family, heavy cannabis use, living in an urban area (x2 risk), schizo virus

pregnant mothers find abnormal antibodies in their blood (inflammation)

Treated by

drugs that block dopamine activity

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OCD

obsession with a thought/idea AND compulsion repeated behavior to reduce the anxiety temporarily 1-2%, Women > Men, fears what they WILL do or might have done, contributed by classical and operant conditioning

Pure Obsession

a mental ritual or second thought is used to reduce the anxiety/distress, NOT a behavior

Causes

OCD related genes appear to control the neurotransmitter glutamate (excitatory, increases neural firing), a streptococcal infection apparently can cause a severe form of OCD in some young children (appears to be overnight, autoimmune response that damages reward learning brain areas)

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Anorexia nervosa

fear of gaining weight, men = women, starving to death

Bulimia Nervosa

alternates b/w dieting, binge eating, purging (self induced vomiting) and compensatory behavior Women > men

Binge Eating Disorder

at least once a week, does not purge

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Insula

craving for addiction, patients with insula damage report quitting smoking easily

Only about 5-10% of drug takers become addicted

Lee Robins

soldiers from the Vietnam War were addicted to heroin but were no longer using the drugs when they returned to the US, why? because addiction is created and maintained within a specific environment, no same motivations or opportunities or triggers to take the drug = no addiction

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Adjustment disorder

difficulty adjusting to the stressor for about 6 months

Posttraumatic Stress Disorder (PTSD)

negative reactions long after the danger has passed, frequent and recurring unwanted thoughts related to the trauma (nightmares, intrusive memories, flashbacks)

7% (women > men)

Genetic markers related to serotonin

Overconsolidated event = burned into memory

No extinction in fear learning

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Dissociative Disorders

disruptions of identity, memory or conscious awareness, a self protective purpose by splitting the traumatic event off from the rest of the person's life and identity

Usually paired with stress, trauma and PTSD

Dissociative Amnesia

a person forgets an event had happened or loses awareness of a substantial block of time

Dissociative Fugue

rarest most extreme form of dissociative amnesia, loss of identity and travel to another location and assumption of a new identity, fugue state often ends suddenly and unsure how they ended up in unfamiliar surroundings