psychopathology

unit 2

typical mood symptoms in response to events (functional)

feeling blue or down but able to function normally; feeling happy and exuberant because something good happened

hypomania (between functional and dysfunctional)

moderate and frequent elation, inflated self-esteem, some impulsiveness, high energy

depression (between functional and dysfunctional)

moderate and frequent symptoms of sadness, apathy, fatigue, etc., that somewhat interfere with functioning

manic episode (dysfunctional

expansive mood including irritability, grandiosity, racing thoughts, and decreased need for sleep that significantly interferes with functioning

major depressive episode (dysfunctional)

severe symptoms of sadness, apathy, hopelessness, low energy, etc., that significantly interfere with functioning

Major Depressive Disorder (MDD)

episodic — typically 2-9 months if untreated

can be recurrent

recurrent

onset of a new episode of depression

probability of recurrence increases with # of past episodes, presence of comorbidities

relapse

return of symptoms within a fairly short period of time

Depression demographics

common illness

twice as common in women as in men

3x as common among people in poverty

prevalence varies among cultures

most common age of onset: early 20s

comorbidity rates for depression

high for other illnesses like anxiety

bipolar 1

requires only 1 instance of a manic episode occurring and no instance of a depressive episode

episodic and recurrent

high rates of suicide

bipolar 2

requires 1 instance of a hypomanic episode and 1 depressive episode (no manic episodes)

episodic and recurrent

high rates of suicide

demographics for bipolar disorder

~1 in 100 people in the US

average age of onset is 20s

heritability estimates

Depression: ~35%

Bipolar: ~60-85%

GWAS

Genome Wide Association Studies

new school molecular genetics

polygenic

no singular biomarker gene

5-HTT

serotonin transporter gene

Dunedin Cohort

measured correlation between likelihood of developing MDD and the exposure to adversity

study could not / would not consistently replicate

Monoamine

family of neurotransmitters formed by singular amino-acid groups

monoamine hypothesis

early focus on serotonin (and norepinephrine), especially low absolute levels of serotonin

empirical system does not support this

SSRI

selective serotonin reuptake inhibitor

SNRI

selective norepinephrine reuptake inhibitor

CAUSE: injury to left anterior prefrontal cortex

EFFECT: depression

comorbidity with depression

hypothyroidism and/or higher levels of some pro-inflammatory cytokines — overactivity of stress response system (cortisol)

Adveristy

umbrella term for hardship or circumstances in life that causes stress

stress of life + environment

early adversity — especially events related to loss and chronic stress

associated with long-term vulnerability

perinatal depression

depression associated with the time around birth — both parties in relationship can feel this, not just the individual giving birth

better term than post-partum depression

baby blues

sudden onset in days after giving birth where the person who gives birth has feeling of sadness, fatigue, etc., and end by itself w/ no functional consequences

negative affectivity (neuroticism)

trait that reflects person’s level of emotional stability

Lewinsohn - behavioral activation

absence of response-contingent positive reinforcement and/or high rate of negative experiences, low levels of activity/behavioral engagement

Seligman - “learned helplessness”

if you get punished regardless of what you do, you just “lie down and take it” aka no point in trying — this is operationally conditioned

cognitive theories of depression

negative thought patterns, beliefs cause depression

depressogenic

leading to depression

depressogenic schemas

negative views, beliefs about self, world, future

automatic cognitive biases

tendency to process information in negative ways

filters how we see/perceive the world → negative filter

Beck’s Theory — descriptive

depressed people are more likely to fall into negative cognitive triad

Beck’s Theory — causal

temporal precedence - does depressogenic schemas precede depression or come after

Beck’s negative cognitive triad

pessimistic attributional style

negative life events attributed to internal, stable, and global causes

“hi, i’m the problem, it’s me”

Helplessness/Hopelessness Theory (Abramson)

pessimistic attributional style

person perceives themselves as having no control over the situation AND certain that bad outcomes will occur or continue to occur → hopelessness

unipolar depression

negative life events, negative affectivity, negative cognitions, expressed emotion, and lack of social support

“downward spiral”

reward sensitivity

high responsivity to rewards, strong attachment to and pursuit of goals, life events that involve attaining goals

upward spiral — predictor of mania

Integrative Model of Mood Disorders

bio (vulnerability)→ psycho (vulnerability) → social (stressful life events)

social — depression: personal loss, social rejection, humiliation

social — mania: achievements, new opportunities, perfectionistic striving

→ leads to activation of stress / depression or mania / problems with interpersonal relationships

→ calls towards mood disorder

File Drawer Probllem

Researchers can choose to not publish some results — negative or null — selection and publication bias

lithium

common medication used to treat bipolar disorder and also as a maintenance treatment

mood stabilizers

seroquil, quetiapine

used in combination and in replacement of lithium

self harm

umbrella term for self injurious behavior

suicidal ideation

thoughts or wishes to die, ranging from comparatively passive ideation to images of ending one’s life to concrete planning

suicide attempt

deliberate, self inflicted hard at least party intended to end one’s life (regardless of actual suicide completion)

suicide

death resulting from a suicide attempt

non-suicidal self injury (NSSI)

deliberate, direct destruction of body tissue without any intent to die — some people will completely deny the intent

ambivalent

having mixed feelings / contradictory ideas about something / someone

gender expectations

reinforces the gender gap when looking at rates of suicide

“psychache”

psychological / emotional pain — viewing life as painful

substitution of planning with ideation

most people who ideate about suicide will not go on to attempt suicide

Theoretical model flow chart

interpersonal theory of suicide (Joiner)

simultaneous presence of “thwarted belongingness” and “perceived burdensomeness” produce the desire for suicide, but the capability is required for an actual attempt to come to fruition

Direct Treatment for suicidality

Cognitive Therapy for Suicidal Patients

Indirect Treatment for suicidality

Targeting Depression via therapy or medication

barrier for suicidality treatment

most people do not receive mental health care for suicidality when they seek out help from their doctors and confidants

Stepped Care Model

in-patient hospitalization

partial hospitalization or intensive outpatient programs

outpatient care

brief intervention + follow-up

crisis support + follow-up

gatekeeper

someone who facilitates getting you connected to care

means restriction

reducing access to firearms, suicide deterrent nets on bridges, etc

Specific Phobia

Marked fear or anxiety about a specific object/situation — fear is disproportionate to actual danger posed — 6+ months

social anxiety disorder

fear of unfamiliar people or social scrutiny

panic disorder

anxiety about recurrent panic attacks

agoraphobia

anxiety about being in places where escaping or getting help would be difficult if anxiety symptoms occurred

generalized anxiety disorder

uncontrollable worry

panic attack

abrupt surge of intense fear or intense discomfort that reaches a peak within minutes

should not be a reaction to an event — should not be expected

“fear of fear” hypothesis

expectations of catastrophic consequences of having a panic attack in a crowded public space

key shared features of anxiety disorders

“excessiveness” — disproportionate

clinically significant distress or impairment

avoidance

no universal, objective demarcating line — no binary

Conditioned Learning of Fears (Mowrer)

Associative learning

the process through which organisms acquire information about relationships between events or entities in their environment

prior learning

all the knowledge one has before learning about a particular topic

social and vicarious learning

a way of learning that allows individuals to learn from the experience of others

“The fear circuit”

amygdala → hippocampus → prefrontal cortex

Corticotropin releasing factor

neuropeptide that regulates the HPA axis

Cognitive biases

information processing, preferential attention to and recall of fear-relevant stimuli, overestimation of likelihood of danger

rumination

dwelling

locus coeruleus

major source of norepinephrine

anxiety sensitivity

tendency to focus on bodily sensations, have difficulty interpreting bodily sensations, and interpret of bodily sensations as potentially harmful

panic circle

“problem orientation”

tendency to view challenges as threats

contrast avoidance model

worry produces sustained, modest negative affect and so protects from dramatic shifts in emotion

functional anxiety model

simultaneously believing that worrying is useful AND that worrying is harmful + uncontrollable → “meta-worries”

worrying suppresses physiological arousal

worrying distracts from/avoids more unpleasant emotions and thoughts

Exposure therapy - habitual model

do it until you become bored and unbothered

Exposure therapy - inhibitory learning model

learning to feel safe

close replications and multiple settings for generalizability

“Unified Protocol”

you may be able to come up with a singular modular treatment for a range of anxiety disorders

Benzodiazepines

targets GABA

ex. xanax, alprazolam

Obsessions

cognition

persistent and recurrent intrusive thoughts, images or impulses experienced as disturbing, inappropriate, or uncontrollable

usually persistent and recurrent

Compulsions

behavioral

repetitive behaviors or rituals that a person feels driven to perform, often according to very specific or rigid rules

unable to deviate from rules

can be excessive — logically and intellectually understood by the individual as unnecessary, but still compelled to follow through

impulsivity

the tendency to act without thinking

tichotillomania

compulsive hair pulling

excoriation

compulsive skin picking

body dysmorphia disorder

preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others

clinically significant distress or impairment

hoarding disorder

persistent difficulty discarding or parting with possessions, regardless of actual value

perceived need to save items and distress associated with discarding them

congests and clutters active living areas and compromises living spaces

pre-potent actions

the thing you are most inclined to do and you would need to inhibit that initial impulse/inclination

trouble and failure to inhibit the impulse/inclination

glutamate

primary excitatory neurotransmitter

GABA

primary inhibitory neurotransmitter

Thought-Action Fusion (Rachman)

thoughts are morally equivalent to actions → guilt, self blame, self recrimination, shame, as well as efforts to neutralize the thoughts and to seek reassurance