Intro Psych - Week 10: Mental Illness History, Mood Disorders

(Briefly), what is abnormal?

- Distress or disability
- Maladaptiveness
- Irrationality
- Unpredictability
- Unconventionality and statistical rarity
- Observer discomfort
- Violation of moral and ideal standards

Distress or disability (abnormality)

An individual experiences debilitating functioning, producing risk of physical and/or psychological deterioration or loss of freedom of action.
(Behaviour is a problem for the self).

Maladaptiveness (abnormality).
Example?

An individual behaves in a fashion which hinders goal attainment, undermines well-being, or often interferes significantly with the goals of others and the needs of society.
(Behaviour is a problem for others).
Example: Lacks moral compass or empathy for others.

Irrationality (abnormality)

An individual acts or speaks in ways that are incomprehensible to others

Unpredictability (abnormality).
Example?

An individual behaves incongruently with environmental demands, often as though the person experiences a loss of control.
Example: Not showing emotion (or showing a blank face) when being told jokes - not because you're choosing not to show emotion, but because you can't.

Unconventionality and statistical rarity (abnormality)

An individual violates norms of socially acceptable behaviour in a manner that is statistically rare.
(Lower end of the normal distribution).

Observer discomfort (abnormality)
Example?
What is an issue with this?

An individual behaves in such that it makes other uncomfortable because they feel threatened or distressed.
Example: Stimming.

Issue: Someone feels threatened - this doesn't mean that they are threatened.

Violation of moral and ideal standards (abnormality)

An individual violates expectations for how one ought to behave, according to societal norms.

How did people in classical antiquity view psychological disorders?

They would attribute them to supernatural causes

How did ancient Greeks view psychological disorders?

They focused on somatogenic explanations

What is Hippocrates' humourism?

The Ancient Greek physician's view on psychological and medical balance in the body.
Issues in the body could be due to imbalances in 1+ of the four humours: Blood, phlegm, yellow bile, black bile.

Disorders were treated by 'balancing' these humours.

How did people view psychological disorders during the middle ages?
Example?

They returned to supernatural causes.
Example: Witch hunts

Why did asylums originally develop?

To keep mentally disordered people away from the public.
Overcrowding of facilities led to poor conditions and further reform to have the state take over care.

What does taxonomy or classification mean in terms of current psychological etiology?

- Grouping like elements (ex. disorders) together.
- Similar symptoms, etiology, treatment, etc.

Medical model of current psychology etiology

- Diseases have physical causes and can be diagnosed, treated, and often cured.
- Mental illnesses can be diagnosed on the basis of symptoms and cured through therapy, which may include treatment in psychiatric hospital.
- Much attention at present to identify biochemical and genetic factors that underlie mental disorders.

Who writes up the DSM?

Medical physicians (not psychologists, though they may take part in the revision process or may be consulted).

Mood disorders

- Characterized by emotional extremes.
- Major Depressive Disorder and Bipolar Disorder.

Major Depressive Disorder

Mood disorder in which a person, for no apparent reason, experiences 2+ weeks of depressed moods, feelings of worthlessness, and diminished interests or pleasure in most activities.

To meet Major Depressive Disorder criteria, someone must meet at least 1 of the following 2 criteria (along with others):

- Depressed mood (most of the day, nearly every day. Could be irritable mood in children and adolescents).
- Loss of interest or pleasure (in all, or almost all, activities most of the day, nearly every day).

Bipolar Disorder

A mood disorder in which a person alternated between hopelessness and lethargy of depression and overexcited state of mania).

What percentage of bipolar cases is due to genes?

About 80-90%

Former name of Bipolar Disorder

Manic-depressive disorder

Manic episode

Mood disorder marked by hyperactive, wildly optimistic state

Major Depressive Disorder:
Genetic influences

- Higher incidence with higher degrees of genetic relatedness.
- Linkage studies to identify relevant genes.

The depressed brain

- Norepinephrine and serotonin is low during a depressed state.
- Norepinephrine is high during a manic episode.
- Neurodegeneration: Hippocampal atrophy over time (if left untreated or unmedicated).

In a PET scan, where can we see the most activity in a depressed brain?

What does this mean?

In/around the amygdala.

This is the area associated with "negative" emotions such as stress and anxiety (which is why depression and anxiety are often related).

Which hormone is associated with decreased activity in the depressed brain?

Which hormone may be associated with increased activity in the depressed brain?

Cortisol.

Deeper limbic structures such as the amygdala.

True or False:
Major depressive episodes often self-terminate

True

How does excessive activity in stress systems produce depression-like alterations in the brain?

- Stress activates the HPA axis to release CRH, ACTH, and cortisol (part of the "fight or flight".
- The PFC, amygdala, and hippocampus receive feedback on cortisol levels and regulate/inhibit (PFC, hippocampus) or stimulate (amygdala) further activity of the HPA axis.

The longer that depression goes untreated/unmedicated, the higher risk there is of developing ________________ atrophy

Hippocampal

Social-cognitive perspective(s) of depression (brief)

- Learned helplessness/hopelessness.
- Negative explanatory style
- Pessimistic view of self, world, and future; irrational beliefs; errors in thinking

Who highlighted the idea of a pessimistic view of self, world, and future, irrational beliefs, and errors in thinking (in terms of depression)?

Beck

Learned helplessness/hopelessness

Seligman.
- Lack of positive and negative reinforcement.
- Learn to give up because behaviour is inconsequential (you feel like you don't have control over your own life, or ineffective as a person).

True or False:
Cortisol activates itself.

True

Negative explanatory style

Explain bad events that are Stable ("I won't be able to fix this"), Global ("this will always happen"), and Internal ("this is all my fault").

Our brains are built to experience short-term stress which resolves itself within a few minutes.
How can it damage the brain if we experience 8+ hours of stress a day from hating our jobs?

Over time, this long term stress degrades our prefrontal cortex and hippocampus.
This increases activity in the amygdala, and overall wears down the brain and predisposes you to even more future stressors.

First generation of antidepressants.
Types and what they do

- Monoamine Oxidase Inhibitors (MAOIs)
- Tricyclic antidepressants
Break down neurotransmitters.

Second generation of antidepressants.
Type and what it does

Selective Serotonin Reuptake Inhibitors (SSRIs).
Make transmitters work harder by causing reuptake in synaptic terminals.

Third generation of antidepressants
What is a unique trait about these antidepressants?

- Norepinephrine Reuptake Inhibitors
- Serotonin-Norepinephrine Reuptake Inhibitors (NARIs/SNRIs)
- Norepinephrine and dopamine reuptake inhibitors (NDRIs)
These antidepressants aren't only used for depression. For example, bupropion can be used for both depression and helping ease withdrawal symptoms of smoking.

Methods of old and new antidepressants.

Compare the both in terms of side effects.

Old antidepressants: Increase brain activity via a broad (i.e. non-specific) mechanism of action.
Newer antidepressants: Tend to primarily target NE and 5-HT.

Newer ones tend to produce fewer side effects.

What does the monoamine theory of depression predict?

That the underlying pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine, and/or dopamine in the CNS

When does the pharmacological effect of drugs such as antidepressants begin?

Immediately

When do the therapeutic effects of drugs such as antidepressants begin?

It could take one to six weeks to reach maximum effectiveness

Approximately where is serotonin produced?

In brainstem nuclei

Brain imaging results consistently show diminished ____________ activity in patients suffering from clinical depression

Cortical

How do effective non-pharmaceutical treatments for depression work?
Examples?

By increasing brain activity.
Ex. rTMS (magnet. Internal current generation. Targets certain parts of the brain) and ECT (electroconvulsive therapy)

Positives and negatives of ECT

(Electroconvulsive therapy).
- Positive: Alleviates depression.
- Negative: Widespread side effects.

In bipolar disorder, what can the use of antidepressants increase the risk of?

Manic episodes

What is the standard treatment for bipolar disorder?
Traits of this disorder?

Lithium.
A mood stabilizer, has multiple side effects.

Other treatments of bipolar, other than lithium.
What form of bipolar are these medications typically used for?

- Antidepressants (bipolar 2 - mainly for depressive episodes).
- Antipsychotics (mainly bipolar 1).
- Anticonvulsants (mainly bipolar 1).
- Benzodiazepines (mainly bipolar 1).

What is one of the main focuses of antidepressants?

Explain the process of what happens if someone ceases to take their antidepressants?

To increase brain tissue and reverse hippocampal atrophy.

The patient is fine for a while because they've built up this brain tissue, but as more time passes, their old feelings will catch up as brain tissue degrades once again.

Psychotherapeutic approach to bipolar treatment

Rhythm therapy (enforcing routine).
Get consistent and adequate sleep, mitigating sleep disruptions which could contribute to manic episodes, maintain a healthy work-life balance, etc.

If depressed, medications serve to:

Increase brain activity

If manic, medications serve to:

Decrease brain activity

What are some traits of anxiety disorders?

- Distressing and persistent anxiety
- Maladaptive behaviours that reduce anxiety

Generalized anxiety disorder

- Person is tense, apprehensive, and in a state of autonomic nervous system arousal.
- Unable to identify cause of anxiety. (No apparent cause to the anxiety, but we can attribute it to numerous things, although it is likely not a correct association).
* It's human nature to find reasoning for things, even if they have no cause.

Panic disorder

- Minutes-long episode of intense dread in which a person experiences terror, chest pain, choking, etc.
- Perceived as a heart attack, come to fear fear itself.
* Intense, but short.

Why might antipsychotics be used to treat bipolar disorder?

Because mania (often bipolar 1) often has accompanying delusions. Antipsychotics decrease hallucinations and delusions.

How long do you need to experience anxiety symptoms in order to qualify for a diagnosis?

At least 6 months (of "excessive anxiety and worry")

What are two important factors to consider when considering a diagnosis?

- Whether the symptoms presented in a patient are due to another mental disorder (if they might be secondary to something else).
- The condition is not due to a substance or medical issue.

How can alcohol affect anxiety?

Alcohol is a depressant. This means that ceasing to use alcohol (such as experiencing withdrawals) can significantly increase anxiety levels.

How long do you need to present symptoms in order to be considered for a generalized anxiety disorder diagnosis?

At least 6 months (with excessive anxiety and worry)

Someone presents with the following symptoms:
- Feeling would up, tense, or restless
- Fatigue or restlessness
- Irritability
- Concentration problems
What are they most likely to be diagnosed with?

Generalized anxiety disorder

Panic attack definition

Abrupt surge of intense fear/discomfort that reaches a peak within minutes and 4+ common panic attack-categorized symptoms occur

Someone presents with the following symptoms:
- Palpitations
- Feeling of overheating
- Tingling and numbness
- Derealization
- Fear of dying
- Fear of "going crazy"
What are they most likely to be diagnosed with?

Panic attack

Panic disorder

- Recurrent and unexpected panic attacks.
- Persistent worry about an incoming panic attack and its consequences.
- Maladaptive change in behaviour related to the attacks

Explain the maladaptive aspect of panic disorders.
Example?

They're rational despite being maladaptive.
Making changes in order to prevent the effects of anxiety.
Example: Skipping or quitting school in order to avoid a panic attack from occurring there.

Someone presents with the following symptoms:
- A fear of public transportation.
- A fear of public speaking.
- A fear of theatre and cinema environments.
- Standing in line
What are they likely to be diagnosed with?

Agoraphobia

What does lactic acid trigger in individuals with panic disorder?

Panic attacks

Traits of agoraphobia

- Triggering situations are avoided, or are endured with marked distress and anxiety about having a panic attack or panic-like symptoms. Or, the situations require the presence of a companion.
- Fear of panic attack despite, potentially, there being no history of one.
- Fear of anxiety is out of proportion to the actual danger.

How long must someone present symptoms of agoraphobia before being diagnosed?

At least 6 months

Symptoms of a specific phobia

Persistent, irrational fear of a specific object or situation.

How do phobias arise?

They stem from a prior learning experience. (Negative reinforcement mechanism).

Traits of social anxiety disorder

- Greater sensitivity than shyness.
- Maladaptive avoidance to social situations.
- Likely arises in situations of performance such as public speaking, rather than participating in small group activities.

True or False:
Fears are not diagnosable

True

Do social anxiety patients have a difference in brain function or in behaviour?
Explain.

Behaviour.
Example: Social anxiety patients fixate more on eyes than mouths when speaking to someone.
There is a higher proportion of looking at eyes if socially anxious. This is in expectation/anticipation of some form of stress - even if the person presents happy.

Someone presents with the following symptoms:
- Nightmares
- Jumpy anxiety
- Withdrawal from social situations
What are they most likely to be diagnosed with?

Posttraumatic stress disorder

Stroop task

A colour is written, but the colour of the word does not match the colour which is written.
A patient's task is to read the word (colour) with disregard to the colour it is.
Example: The word "red" written in the colour green. The patient is to read the word "red".
If "black" is written in black, the word will be read quicker.

Emotional Stroop test

In people with anxiety, there will be a slight delay in reading a more "threatening" word.
Example: Reading "pillow" quicker than reading "assault".
This is because they're scanning for potential harm accompanying the word.

Why might GABAa (antagonist) be a treatment for anxiety disorders?

The amygdala has lots of GABAa receptors

Why might NMDA receptor (glutamate receptor) be a treatment for anxiety disorders?

There are lots of opportunities for this receptor in the hippocampus (associated with making memories).

True or False:
Schizophrenia spectrum disorder is a personality split.
Why is this?

False.
It's a split between reality and non-reality, not a personality split.

What are the most common type of hallucination in those with schizophrenia?

Auditory-type

True or False:
PTSD is an anxiety disorder.
Why is this?

False.
It's a mood disorder.

True or False:
In an individual with PTSD, their brain tissue level (hippocampal atrophy) is associated with the amount of symptoms they present.

True

Obsessive-compulsive disorder

Unwanted repetitive thoughts (obsessions) and/or actions (compulsions).
Could be somewhat rational.

What is psychosis?

A break from reality

Schizophrenia spectrum disorders are a group of severe disorders characterized by:

- Disorganized and delusional thinking
- Disturbed perceptions
- Inappropriate emotions and actions

Positive symptoms associated with schizophrenia

- Hallucinations (false sensory experiences such as seeing or hearing something without external physical stimulus).
- Delusions (false beliefs)

Negative symptoms associated with schizophrenia

- Attentional deficits.
- Flat affect (little emotion expressed when others would often express it).
- Other cognitive deficits related to working memory and executive function.

Too little dopamine often contributes to:

Parkinson's

Too much dopamine often contributes to:

Schizophrenia

What was one of the main issues of the first antipsychotics (ex. schizophrenia medication) in the 1950s?

The drugs were effective against most positive symptoms, but also produced motor impairments such as Parkinson's (little dopamine due to drug), and are ineffective against negative symptoms.

Psychotherapy for anxiety disorders

Cognitive behavioural therapy:
Examine automatic initial appraisals, behavioural techniques, etc. to avoid situations that elicit anxiety.

Pharmacotherapy for anxiety disorders

* Traditionally, benzodiazepines (GABAa receptor agonists) that reduce activity in parts of the brain that process negative emotion.
* More recent focus is on treatments to enhance learning (ex. d-cycloserine facilitates activity at the NMDA/glutamate receptor).

The dopamine hypothesis

Schizophrenia is caused by an excess of dopamine activity in the brain.
Early schizophrenia drugs correlated with their affinity for dopamine D2 receptors.

In schizophrenia, explain what the following phenomenon is for:
The mesolimbic system from the ventral tegmental area (VTA) to the Nucleus Accumbens (NAcc) and cortex.

(Dopamine-produced) incentive learning

When is the VTA to NAcc normally activated?
Examples?

(Primary or conditioned reinforcers).
When you encounter stimuli or conditioned cues/contexts which have incentive value.
Examples: Cake, cocaine, sex, etc.

Why might someone with schizophrenia become randomly obsessed with a certain object?
What is this an example of?

There is random firing of dopamine in the brain, even if there is no stimulus.
For example, dopamine randomly fires while looking at a door. The brain then makes up a story about why the door is important (ex. the government is watching you through the key hole).
This is an example of a delusion.

What system contributes to the nigrostriatal system from the substantia nigra (SN) to the basal ganglia?

Extrapyramidal motor system.