Psych disorders exam 2

OCD key terms

• Exposure and response prevention

• Thought-action fusion

Exposure and response prevention (ERP)

• Type of CBT treatment for OCD

• Expose someone to obsessions and then prevent the response

• Ex: germ obsession → have someone touch doorknob → they cannot wash their hands to tolerate obsession

• KEY: cannot do compulsion anymore 

Thought-action fusion

• Belief that thoughts are equivalent to their action counterpart (“these thoughts can hurt me”)

• Think that the thoughts are just as dangerous as the action 

• Worsens the cycle

• Thought stoppage does not really work that well 

Treatment for OCD

• ERP

• Some medications → including SSRIs

• New directions of treatment involve interventions like deep brain stimulation to help reset neural pathways

  • Can be invasive

Hoarding disorder

• Now on its own a disorder

• Acquire stuff and cannot get rid of it

• Genetic predisposition/biological component

• Treatment looks different than normal treatment for OCD

• Resistance to treatment:

  • Could have been going on for years

  • Ego- syntonic : in line with what you believe (opposite of ego - dystonic)

• Difficulty making decisions

• Personifying objects

• Not many longitudinal studies out there now

• History of traumatic loss (anecdotal evidence)

• In theory → use ERP but tough

• Risk of hoarding grows over time/ age → less control you have as you get older

Body dysmorphic disorder

• Obsession with perceived flaw in appearance 

• Perception of the flaw - and outside reaction - that matters

• In our own society → probably getting easier to fall prey to this → constant feedback on appearance 

• Should not be double jeopardied from eating disorder (separate thing) symptomology 

• To the point of despair and distress 

• Facial features, skin… → does not involve change in eating/diet plans 

• Self-esteem really suffers

Other disorders in obsessive compulsive category

• Trichotillomania: hair pulling disorder

• Excoriation (skin picking) disorder

• Other types of OCD:

  • Substance/medication induced, due to other medical conditions, specified OCD like Koro (fear of retracting genitalia)

  • PANDAS/PANS

PANDAS and PANS

• PANDAS:

  • SUDDEN onset of OCD symptoms in child after strep infection

  • Brain inflammation

  • Often misdiagnosed

• PANS:

  • More general also SUDDEN

  • Can be after covid, Lyme…

• Used to write neat and tidy → not anymore

• Different than typical child with OCD because it is SUDDEN

• Important to get actual medical treatment → suffers so much might need blood treatments

OCD etiology 

• Hypothesis: early experiences taught them that some thoughts are dangerous and unacceptable because the the terrible things they are thinking might happen and they would be responsible

  • These early experiences would results in specific psychological vulnerability to develop OCD

• Thought-action fusion

• Strength of religious belief → associated with thought-action fusion and severity of OCD

• Model of Etiology:

PTSD - and what is trauma

• Still under anxiety umbrella

• One of the few disorders where a specific event must happen as part of the criteria 

• Feeling helpless appears to be a significant component

• Trauma: level of danger was significant → body goes into fight or flight mode 

Criteria for PTSD

• Exposure to trauma

• Trauma must occur in real life, not online, unless work-related (not really true now)

• Intrusion symptoms - memories, dreams, dissociations, distress at exposure, or physiological reaction

• Avoidance of stimuli, detachment, inability to recall

• Negative thoughts or mood associated with the event

• I month had to pass since trauma in order to get diagnosis

• One subtype: delayed onset → could be years after the trauma

Moral injury

• The trauma is going against your own value

• More complicated emotionally (shame, guilt, societal scrutiny)

• Hard to gear these people towards treatment

• Hyacinth fellowship → for those who had accidentally killed/injured someone

  • Maryann Gray

Social support

• Protective factor → loneliness can make it more likely to develop PTSD

Neurological predisposition to PTSD

• Genetic factors predispose individuals to be easily stressed and anxious, which then may make it more likely that a traumatic experience will result in PTSD

• Shown in study of female undergraduates who witnessed a shooting, specific characteristics of what is referred to as the serotonin transporter gene involving two short alleles (SS) described as increasing the probability of becoming depressed also increased the probability of experiencing symptoms of acute stress after the shooting, even though other factors such as amount of exposure to the shooting were equalized

• Elevated/restricted CRF → heightened activity in HPA axis

• Damaged hippocampus

Treatment for PTSD

• Forced debriefings might be harmful → need to feel more autonomous

• Imaginal exposure gaining traction

  • Virtual reality being explored

• EMDR: controversial as to long term efficacy, but no known harms

  • Protocol where as someone talks about their trauma - moves eyes in specific patterns, triggering different brain activity

  • How much does eye movement really matter?

• Tetris → data that playing after trauma might prevent traumatic injury and development of PTSD → change how we encode memory

Other in trauma-stressor-related category

• Reactive attachment disorder (children) → trouble with attaching

• Disinhibited social engagement disorder → too easily attached 

• Acute stress disorder → not yet reached the 1 month mark

Somatic symptom disorder

• Somatic symptoms present, creating high anxiety

Illness anxiety disorder

• Preoccupation with having or acquiring a serious illness

• Somatic symptoms not present, or are just mild

• Hypochondriasis would now fit here

In class exercise regarding anxiety

• Gave a list of words → had a choice to chose a threatening versus non-threatening choices

• Example of kinds of ways we can measure threat sensitivity

• However there are many confounds

Somatic symptom disorder criteria

• Presence of one or more somatic symptoms

  • Symptoms are often medically unexplained

• Excessive thoughts, feelings, and behaviors related to symptoms (e.g. excessive thoughts about seriousness of symptoms, frequent complaints, requests for help, health-related anxiety, excessive research)

• Substantial impairment in social/occupational functioning

• Research to date is limited due to recent redefinition of disorder in DSM-5

Statistics of somatic symptom disorder

• Relatively rare condition

• Onset is usually in adolescence 

• More likely to affect unmarried low socioeconomic status women

• Runs a chronic course

Illness anxiety disorder criteria

• Very similar to DSM-IV hypochondriasis

• Clinical description:

  • Severe anxiety about the possibility of having/acquiring a serious disease

  • Actual symptoms are either mild or absent

  • Strong disease conviction

  • Medical reassurance does not seem to help

Illness anxiety disorder statistics

• Affects approximately 1-7% of the general population

• Affects all ages approximately equally

• Often co-morbid with anxiety mood disorders

Culturally specific disorders

• Dhat: symptoms (e.g. dizziness, fatigue) attributed to semen loss in some Indian cultures

• Kyol goeu or khyal: “wind overload” among khmer people of Cambodia

  • Fear that wind cannot circulate effectively through body

  • Dizziness, weakness, fatigue, trembling are seen as signs of illness

Etiology → somatic symptom/related disorder

• Consistent overreaction of physical signs/sensations

• Cause is unlikely to be found in isolated biological and psychological factors

• Genetic component is present

• May have learned from family to focus anxiety on physical sensations

• Other factors:

  • Illness in family during childhood

  • Stressful life events

  • Benefits of illness

Conversion disorder (functional neurological symptom disorder)

• One or more symptoms of altered voluntary motor or sensory function

• Symptoms do not match established medical conditions

• Not better explained by another mental or medical disorder 

• Causes significant impairment or distress 

• Ex: suddenly cannot see

Factitious disorder

• Manufacturing symptoms

• Need to distinguish from malingering

• Faking, but no clear external motivation, sick role perhaps

• Might be internal motivation

• Munchausen syndrome:

  • By proxy is most common → doing it someone else

  • Person physically creates the symptoms themselves

  • Ex: putting stuff on skin to create lesions

  • Ex: gypsy rose blanchard → made to believe she was paralyzed and had a terminal illness

Malingering

• Not a psych disorder

• Ex: want to win a lawsuit so you will say you have PTSD

• External motivation

Development of hypochondriasis

Freuds belief about etiology → conversion disorder

• Four basic process:

  • 1: individual experiments a traumatic event (unacceptable, unconscious conflict)

  • 2. Because the conflict and the resulting anxiety are unacceptable, the person represses the conflict, making it unconscious

  • 3. The anxiety continues to increase and threatens to emerge into consciousness, and the person “converts” it into physical symptoms, thereby relieving the pressure of having to deal directly with the conflict

    • The reduction of anxiety is considered to be the primary gain or reinforcing event that maintains the conversion symptom

  • 4. The individual receives greatly increased attention and sympathy from loved ones and may also be allowed to avoid a difficult situation or task

    • Freud considered such attention or avoidance to be the secondary gain, the secondarily reinforcing set of events

What was freud right and wrong about

• Correct on three counts but not on the fourth, although firm evidence supporting any of these ideas is sparse and Freud’s views were far more complex 

• Getting sick on purpose is also unacceptable, so this motivation is detached from the person’s consciousness 

• Because the conversion symptoms is successful to an extent in obliterating the traumatic situation, the behavior continues until the underlying problem is resolved 

• Freud thought that because symptoms reflected an unconscious attempt to resolve a conflict, the patient would not be upset by them

  • But there is little empirical evidence to support, and many actually show depression and anxiety

Social and cultural influences → conversion disorder

• Tend to occur in less educated, lower socioeconomic groups where knowledge about disease and medical illness is not well developed 

• Incidence of these disorders has decreased over the decades

  • Most likely explanation is that increased knowledge of the real causes of physical problems by both patients and loved ones eliminates much of the possibility of secondary gain so important in these disorders

Treatment → conversion disorder

• Identify and attend to the traumatic or stressful life event if it still present (either in real life or in memory)

• Work to reduce any reinforcing or supportive consequences of conversion symptoms (secondary gain)

In class exercise → body sensations

• Told to mark down what you noticed in your body in one minute

• Shows that attention matters

• Hyper focus on bodily sensations

• Hypersensivity to threats

• Different than being mindful → no negative interpretation

Dissociation

• Detaching, zoning out, not fully there, normal to a point

Dissociative identity disorder

• Not schizophrenia 

• Representation in popculture 

• Etiology: severe childhood trauma 

  • “scab” metaphor

  • As a way to not have an open wound anymore

• Perhaps an extreme version of PTSD

• Involves high levels of suggestibility

• Alters: other identities

• Typically a host alter → might not be original identity

• Some involuntarily bodily actions might change

• Likely connected to dissociation as a whole

False memory syndrome 

• Memories can be planted, sometimes inadvertently 

• Even the way questions are asked - suggestibility

• Source monitoring error:

  • Specific cognitive error when someone remembers information correctly, but no not remember where it came from

• In context of DID, have to be careful of childhood trauma, law reinforcement

Other dissociative disorder

• Depersonalization - derealization disorder:

  • No drugs or substance

  • People slipping into states → distressing/cannot control

• Dissociative amnesia:

  • No traumatic brain injury, no organic cause

  • Cannot remember or learn new information

• Dissociative fugue: (now subtype of dissociative amnesia)

  • You traveled, do not remember how you got there

Psychosis

• Delusions and hallucinations

Positive symptoms of schizophrenia

• Delusions:

  • Grandeur → elevated sense of self

  • Persecution → paranoia, people are out to get you, idea of gang stalking

  • Capers → people believe their loved ones were replaced by a double

  • Cotards → bodily delusions, ex: believe they are dead or believe they are missing an arm

• Hallucinations

  • Auditory is most common

  • Can also be visual, taste, smell, tactile…

Negative symptoms of schizophrenia

• Avolition → lost energy

• Apathy → lack of caring

• Alogia → absence of speech

• Anhedonia → absence of pleasure

• Affective flattening → not facial expressions, completely monotone, everything is compressed (emotional expression)

Disorganized symptoms

• Disorganized speech → not making sense, word salad

• Cognitive slippage → losing train of thought

• Tangentiality → leaping from one thing to another

• Loose associations → unclear connections

• Inappropriate affect → ex: laughing at upset news

• Catatonia → not moving, speaking, reacting

  • Echolalia: repeating what someone else does

• Waxy rigidity → can move muscles, but harden in certain poses

Prodromal stage

• Period before diagnosis where things started to get strange, but does not meet criteria

• Adolescent/early teen years → bring genetic predispositions out

• Psychotic break: when someone becomes truly detached from reality

Findings from SPECT studies

• Neuroimaging shows that the part of the brain most active during auditory hallucinations is Broca’s area

  • Involved in speech production (not comprehension)

• Having thoughts → instead of speaking, they hear them

Onset and prevalence of schizophrenia worldwide

• About 0.2% to 1.5% (or about 1% of population)

• Often develops in early adulthood 

• Can emerge at any time: childhood cases are extremely rare but not unheard of 

Important points regarding schizophrenia

• Schizophrenia covers a wide range of symptoms; two different people might have very different behaviors

• In fact, new research into genetic markers may indicate eight distinct disorders

• Medication treatment needed for psychotic symptoms, but side effects can be problematic 

• Homeless is common

• Risk of violence is very exaggerated in media 

• Schizophrenia is generally chronic 

  • Most suffer with moderate to sever lifetime impairment

  • Life expectancy risk for suicide

  • Increased risk for accidents

  • Self care may be poorer

What was schizophrenia previously divided into 

• Subtypes based on content on psychosis 

• This is no longer the case in DSM-5, but outdated terms are still in partial use

• Included paranoid, catatonic, residual (minor symptoms persists after past episode), disorganized (many disorganized symptoms) and undifferentiated

Other psychotic disorders

• Schizophreniform disorder

• Schizoaffective disorder

• Delusional disorder

• Brief psychotic disorder

• Attenuated psychosis syndrome

Schizophreniform disorder

• Psychotic symptoms lasting between 1-6 months 

• >6 = schizophrenia

• Associated with relatively good functioning 

• Most patients resume normal lives

• Lifetime prevalence: approximately 0.2%

Schizoaffective disorder

• Symptoms of schizophrenia and who exhibited the characteristics of mood disorders (for example, depression or bipolar disorder)

• In addition to the presence of a mood disorder, delusions or hallucinations for at least two weeks in the absence of prominent mood symptoms

• Such persons do not tend to get better on their own

Delusional disorder

• Delusions: beliefs that are not generally held by other members of a society

• Persistent belief that is contrary to reality, in the absence of other characteristics of schizophrenia

• Persistent delusion that is not a result of an organic factor (such as brain seizures) or of any sever psychosis

• Tend not to have flat affect, anhedonia, or other negative symptoms o schizophrenia, but they may become socially isolated because they are suspicious of others

• The delusions are often long-standing. sometimes persisting over several years

Delusional subtypes

• Erotomanic

  • Irrational belief that one is loved by another person, usually of higher status

• Grandiose

  • Believing in one’s inflated worth, power, knowledge, identity, or special relationship to a deity or a famous person

• Jealous

  • Believes sexual partner is unfaithful

• Persecutory

  • Believing oneself (or someone else) is being malevolently treated in some way

• Somatic

  • Person feels afflicted by a physical defect or a general medical condition

Separate delusional disorder

• Condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual 

• Content and nature of the delusion originate with the partner and can range from the relatively bizarre to the fairly ordinary 

Brief psychotic disorder

• Characterized by the presence of one or more positive symptoms such as delusions, hallucinations, or disorganized speech or behavior lasting one month or less

• Often precipitated by extremely stressful situations

Attenuated psychosis syndrome

• Disorder involving the onset of psychotic symptoms such as hallucinations and delusions, which puts a person at high risk for schizophrenia

Schizophrenia etiology

• Multiple gene variances combine to produce vulnerability

• Frank Kallmann published major study of the families of people with schizophrenia

  • Severity of the parent’s disorder influenced the likelihood of the child having schizophrenia

  • All forms of schizophrenia were seen within the families (you may inherit a general predisposition for schizophrenia that manifests in the same form or differently from that of your parent)

• You have the greatest chance of having schizophrenia if it has affected your identical twin

• Quadruplet studies → outcomes all differed

• Presence of de novo mutations in family members (mutation in germ cell)

• Appears to be a protective factor if children are brought up in healthy supportive homes

• Can still pass on the genes to children as carrier

Acute and permanent side effects are common with first generation meds

• Parkinson’s like side effects

• Tardive dyskinesia

• Compliance with medication if often a problem

  • Aversion to side effects

  • Financial cost

  • Poor relationship with doctors

New directions: Avatar therapy

• Avatars → patients interact with a digital embodiment of their auditory hallucination, represented by a computer-generated face, with a personalized series of dialogues

• Patients can customize how the face looks and sounds

• Therapist helps the process, can be empowering for the patient

Psychological treatment of schizophrenia

• Illness management/recovery

  • Engages patient as an active participant in care

  • Continuous goal setting and tracking

  • Modules include: social skills training, stress management, substance use issues addressed

Depression

• “Slowing down”

• Most of the day, nearly everyday

• At least two weeks - will be diagnosed with major depression disorder - also a building block

• Cognitive symptoms:

  • Thought processes

  • Sense of worthlessness, hopelessness, helplessness, difficulty making decisions, concentrating

• Disturbed physical function:

  • Eating, sleeping (either too much or too little

• Emotional symptoms - anhedonia (this is key):

  • Sadness, loss of pleasure, feeling numb, irritable

  • “unable to engage with the fabric of life”

Mania

• Opposite pole of depression

• High energy and motivation 

• Nervous system turned up 

• Only needs to last one week to meet criteria (even less if hospitalized)

• Manic episode is typically a building block → body crashes afterward

• “Marriage plot” → good representation of mania in fiction, feels good in the moment

Typical signs of mania

• Hyperactivity

• Grandiose plans, ex: max out credit card

• Rapid speech, flight of ideas

• Impulsivity - where danger might come in

• Irritability - especially near end of manic episode

• Difficulty sleeping, concentrating, staying still

• Writing really fast

• Increased fights, alcohol consumption, productivity, creativity, sex, appetite, sensitivity, noise, driving dangerously

• Poor judgment

Hypomania

• Not itself a disorder

• Low level of mania

• Does not cause marked impairment in functioning

• Building block

Unipolar vs. Bipolar (just name types)

• Bipolar I

• Bipolar II

• Cyclothymia

• Dysthymia

• Double depression

Bipolar I

• Full mania and full depression

Bipolar II

• Hypomania and full depression

Cyclothymia

• Chronic cycles of hypomania and mild depression; few periods of euthymia (never exist normally) (at least two years)

Dysthymia (persistent depressive disorder)

• Chronic mild depression, 2 years or longer

Double depression

• Major depressive disorder episode on top of baseline of persistent depressive disorder

• Higher risk of suicide

Graph of unipolar vs bipolar

Case study of persistent depressive disorder

• 1st year student with roommate problems 

• “Laura” → flat affect 

  • No sadness or irritability

  • No autism

• She did not meet criteria for major depressive disorder

• Emptiness to her, nothing there, does not really care, not getting excited about things, zero typical emotional functioning

• Needed to find something to giver her a spark → had her be open to exploration

• Gradually realized, one time she felt something was when she was with animals

  • Changed major, volunteering, started to build a life

• She had never felt typical, but still had a meaningful life

Kids: DMDD (disruptive mood dysregulation disorder) vs bipolar

• Constantly diagnosed bipolar as kids → medicated incorrectly 

• Did not have bipolar disorder 

• Cannot regulate mood → really worked up

• More tailored treatment now 

Premenstrual dysphoric disorder (new to DSM)

• Significant depressive symptoms occurring prior to menses during majority of cycles, leading to distress and impairment

• Controversial:

  • Advantage: legitimizes difficulties people face

  • Disadvantage: pathologies an experience many consider to be normal

Mood disorders across US subcultures

• Similar prevalence among US subcultures but experience of symptoms may vary

• E.g. some cultures are more likely to express depression as somatic concern 

• Higher prevalence among Native Americans: 4x rate of general population 

Genetic contributions to mood disorders

• Twin studies:

  • Concordance rates high in identical twins

    • 2-3 times more likely to present with mood disorders than fraternal twin of a depressed co-twin\

• Severe mood disorders have strong genetic contribution

• Heritability rates are higher for females compared to males

• Some genetic factors confer risk for both anxiety and depression

Neurobiological influences - mood disorders (name them)

• Neurotransmitter systems 

• Endocrine system

• Sleep disturbance

Neurotransmitter systems - mood disorders

• Serotonin and its relation to other neurotransmitters

  • Serotonin regulates norepinephrine and dopamine

• Mood disorders are related to low levels of serotonin

• Permissive hypothesis: low serotonin “permits” other neurotransmitters to vary more widely, increasing vulnerability to depression

Endocrine system - mood disorders

• Elevated cortisol

• Stress hormones decrease neurogenesis in the hippocampus: less able to make new neurons

Sleep disturbance

• Hallmark of most mood disorder

• Depressed patients have more intense REM sleep (less time in restful stage) and go into it more quickly

• Sleep deprivation may temporarily improve depressive symptoms in bipolar patients - some causal effect

Psychological etiology of depression

• Stress, trauma, context of memories

• Reciprocal gene-environment model

• Cognitive errors (Aaron Beck)

  • Overgeneralization → one thing wrong, everything is bad

  • Arbitrary inference → idea that two things are connected through arbitrary inference

• Depressed thoughts becoming “sticky”

  • Ruminating, cycling

Learned helplessness

• Do not confuse with overcoming societal barriers 

• Martin selgman to explain findings 

• Learning under stress → dogs 

  • Mild shock - run a maze, some would just stop trying

Martin Selgman’s “Depressed Attributional Style”

• Could be considered symptomology/etiology

• 3 ways of thinking (cognitive, about negative things, cognitive distortions) in depressed people:

  • Internal → internal causes to bad things

    • “It’s me”

    • Can measure this distortion in a lab

  • Global → about everything

    • Mountains out of mole hills

    • Similar to overgeneralization

  • Stable → believe things will not change

    • Ex: fail a test, think you will never improve

Role of attention

• Ex: selective attention test → gorilla example shown in class

• What you pay attention to dictates what evidence you have 

Social and cultural etiology of depression

• Gender imbalances - genetic, environmental, or both?

• Social support - can become a cycle

• Martial satisfaction - particularly in men

  • Emotional and support needs in marriage basket, less outside marriage

  • After divorce, men tend to get remarried quicker

• Societal stressors: trauma, poverty, job less, etc.

Integrative theory of etiology

• Biological and psychological vulnerabilities interact with stressful life events to cause depression 

  • Biological vulnerability: e.g. overactive neurobiological response to stress

  • Psychological vulnerability: e.g., depressive cognitive style

8 specifies to describe depressive disorders

• With psychotic features (mood-congruent or mood-incongruent)

  • Hallucinations, delusions, somatic delusions

• With anxious distress (mild to severe)

  • Makes suicidal thoughts and fatal suicide a more severe condition

• With mixed features

  • At least three symptoms of mania

• With melancholic features

  • Most severe somatic symptoms, like weight loss, low sex drive, anhedonia

• With atypical features 

  • Consistently oversleep, overeat (higher incidence of diabetes)

• With catatonic features 

  • Absence of movement (catalepsy)

• With peripartum onset

  • Peri: surrounding

  • Period of time just before and after birth

  • Manic episodes important to recognize

  • Present with fathers too

  • CBT and interpersonal therapy

  • More minor: baby blues

  • Difficulty understanding why they are depressed

  • Rapid decline in reproductive hormones

• With season pattern 

  • SAD

  • Late fall - beginning spring

  • Must have occurred for at least two years with no evidence of nonseasonal major depressive episodes

  • Excessive sleep, increased appetite/weight gain

  • Changes of melatonin production (increase in winter)

  • Circadian rhythm misaligned

Integrated grief vs complicated grief

• Integrated grief: grief that evolves from acute grief into a condition in which the individual accepts the finality of death and adjusts to the loss 

• Complicated grief: associated with activation of dopamine neurotransmitter system

  • After 6 months

  • Suicidal thoughts increase substantially

  • Areas of brain associated with close relationships and attachment are active in grieving people, in addition to areas of brain associated with more general emotional responding

  • Prolonged grief disorder

Stress and depression

• Dependent on context, even with same stressful life event, context might make things worse

• Also dependent on meaning → how the person sees the stressor

• One crucial issue is the bias inherent in remembering events

  • Current moods distort memories

• Only useful way to study stressful life events is to follow people prospectively to determine more accurately the precise nature of events and their relation to subsequent psychopathology

• Humiliation, loss, and social rejection are the most potent stressful life events that likely lead to depression

• Gene-environment correlation model

Parenting styles and rigid gender roles

• Parenting styles encouraging stereotypic gender roles are implicated in the development of early psychological vulnerability to later depression or anxiety 

• Specifically, a smothering, overprotective style that prevents the child from developing initiative 

• “Sudden surge” in depression among girls that occurs during puberty

  • Younger girls just entering a new school find it stressful and girls who mature early physically have more distress and depression

• Women place greater value on intimate relationships

• Women ruminate more and blame themselvesTr

Treatment for depression 

• Therapy

• Can alter neurobiology 

Risk of medication only - mood disorders

• “Bandaid effect”

• Higher risk of relapse

• No one monitoring side effects

• Not giving a sense of autonomy that you can get through it yourself

• Not changing the thoughts/behavior that need to be changed

Common types of therapy - mood disorders

• CBT

• Psychodynamic psychotherapy - relationships/attachments  - deep history 

• Interpersonal psychotherapy - relationships 

• Existential therapy - search for meaning 

• Algerian therapy - looking at barriers and assessment of yourself

• Gestalt therapy - how you fit into the world around you 

New directions branching off CBT

• Acceptance and commitment therapy (ACT):

  • Mindfulness and accepting and moving on from thoughts rather than fighting them

• “Happiness trap”: is a great primer on this

• Diffuse → sense of separation

Antidepressant medication (not 1st line of defense)

• Tricyclics (rise of overdoses)

• MAOIs (MAO inhibitors) - lifestyle annoyances and side effects 

SSRIs (1st line of defense)

• Selective serotonin reuptake inhibitors

• General sexual side effects

• Zoloft

• Paxil

• Prozac

• Celexa

• Lexapro

SNRIs

• Mixed reuptake inhibitors: act on norepinephrine and dopamine as well

• Wellbutrin (zyban)

• Pristiq

• Effexor

TMS

• Transcranical magnetic stimulation)

• Magnets on outside of head

• Decent data on helpfulness

• Reset neural pathways

• Might have more side effects

• Usually do meds first

Newer directions for treatment of mood disorders

• Esketamine (nasal administered ketamine) and also ketamine infusions 

• Psychodelics - psilocybin, MDMA

  • The environment matters a lot, need to be guided

  • Some try micro-dosing

  • Not a good control, if you are high you know you are high

• Gut bacteria - high fibers, fermented, no sugar or salt or processed foods

• Modified ECT (electroconvulsive therapy which is very invasive)

  • More localized

  • Resetting neural pathways

• Deep brain stimulation

  • Invasive

  • Electrode in localized area

Treatment for bipolar disorder

• Lithium 

• Other mood stabilizers 

• Med (usually lithium) is still first line of defense

• Psychotherapy helpful in managing the problems (e.g. interpersonal, occupational) that accompany bipolar disorder

• Family therapy can be helpful 

Suicide stats

• More than homicides

  • 3:2 in US

• 1100 per year on college campuses

• 4/5 young adults give clear warnings

• Second leading cause of death among college students

• May even be underreported