Psychological Disorders

PSY102

Mental Illness

Over emphasizes biological causes for disordered neurological factors such as brain chemistry. Typically perspective used by medical doctors who often treat using meds

The “Disease Model”

Mental Disorder

Perspective of APA

Described as a syndrome characterized by clinically significant disturbances in an individual’s cognition, emotion regulation, or behavior that reflects a disfunction in psychological, biological, or developmental processes.

Psychopathology

generic term w/ medical origin that is used rarely in context of treating mental disorders

Psychological-behavior Disorders

Similar to concept of mental disorders but emphasizes psychological processes.

Considers disorders as multiple interacting systems

Impairment

disability (interference w/ personal goals, health, including interference w/ others)

Factors of deviation from normal functioning

impairment

excess distress

Excess Distress are

symptoms that cause more than the expected level of stress/discomfort for the individual

Causes of disorders

• ongoing process / we dont know much about the exact causes

• there are clues about some processes

• all mental disorders are complex and different so many factors may contribute to a disorder in different people

• disorders are “heterogeneous” in symptoms and etiology

3 Types of Causes for disorders

Predisposing causes

Precipitating causes

Maintaining causes

Predisposing causes are

genetic/early life experiences like trauma/abuse

Precipitating causes

stress/loss such as a break up or loss of loved one

Maintaining causes

withdrawal from others

negative cognitions

ex: withdrawing from others due to depression actually removes source of positivity therefore is maintaining depression

Diathesis stress model is also known as

Vulnerability stress model

Diathesis stress model shows that

vulnerability influences how much stress is required to show a disorder.

person who is low in vulnerability can take more negative before it affects them and is portrayed through a disorder

DSM-V

Diagnostic & Statistical Manual of Mental Disorders (5th Edition)

DSM-V is used to

categorize and organize mental disorders —> then into subgroups like phobias, panic disorders, OCD, social anxiety disorder, etc

Key qualities of a good diagnosis system

Reliability

Validity

Reliability

Same answer many times & agreement among clinicians

Validity

Is it what we think it is?

meaningful predictions, similar causes

DSM-V has

good reliability, decent validity

Prevalence

% of population that currently has the disorder

Incidence

% of new cases

Internalizing Disorders

Anxiety/depression

Symptoms are internal

Women > men

Externalizing disorders

ADHD, behavioral issues, antisocial, substance abuse

Depressive and bipolar disorders are

a prolonged and intense disturbance in mood.

a state/longer period

dominant sadness and disturbance

DSM-V Splits disorders into 2 categories

Depressive Disorders (sadness/irritability)\

Bipolar & related (both elation and sadness, fluctuations over time in mood)

Depressive Disorders

• Major depressive disorder

• Persistent depressive disorder

• Disruptive depressive disorder

• Premenstrual dysphoric disorder

Major Depressive Disorder

5 symptoms present in 2 week period

• sadness, worthless, hopeless, negative focus

• low energy, inability to concentrate

• sleep issues, appetite issues

• no pleasure, thoughts of suicide

Persistent Depressive Disorder

less severe than MDD but is CHRONIC maintaining 2 symptoms for at least 2 years

Disruptive Mood Dysregulation Disorder

New category for children ages 6-18

• severe and reoccurring verbal temper outbursts (3x/week)

• irritable, angry mood in between outbursts

• lasts at least 12 months w/ no more than 3 month period without all symptoms

• symptoms present in at least 2 settings (school, home, w/ peers)

Premenstrual Dysphoric Disorder

essentially the same as MDD that some women experience in a 2 week period before their cycle

Bipolar Disorders

Bipolar 1

Bipolar 2

Cyclothymic Disorder

Bipolar I

Manic periods

• extreme energy, activity, racing thoughts, no sleep

• extreme prolonged elation, grandiose (delusions)

• risky, excessive, and poorly planned behavior

• also consists of MDD episodes usually but not always

Bipolar II

hypomanic episode + major depression episode

Cyclothymic disorder (less severe)

feel great for a few months, then way worse for a few months - then repeat

milder symptoms, less impairment, at least 2 year duration

Some mood disorders have seasonal patterns such as

feel worse in winter, spring mania

Biochemistry of depression

Unipolar depression is due to disturbance in neural pathways that use monoamines as their primary neurotransmitters

Monoamines

serotonin, norepinephrine, and dopamines

Depression is associated with

reduce activity in the monoamines, especially serotonin

Mania may be associated with

increased norepinephrine/dopamine and decreased serotonin

Monoamines & Drugs (4 Points)

1. Drugs that decrease monoamines can precipitate depression

2. Antidepressant drugs (Prozac, Lexapro, Zoloft) increase post-synaptic activity of monoamines

3. SSRIs increase serotonin activity

4. Symptom relief delayed for abt 2-3 weeks suggests more complicated symptoms

SSRIs

Selective Serotonin Re-Uptake Inhibitors

Drugs BESIDES SSRIs that treat depression

• Wellbutrin - affects dopamine and norepinephrine neurons and is also used for smoking cessation

• MAO inhibitors (rarely used due to many side effects)

• Tricyclics (older antidepressant that predated SSRIs)

Medication for treating Bipolar

• Lithium (side effects: weight gain, tremors, kidney damage) so carefully monitored

• Mood Stabilizers: Abilify (the go-to)

• Seroquel

• Electro-convulsive therapy (ECT): only used when antidepressants do not work. VERY dramatic causing memory loss

How brain structures are affected in Major Depressive Disorder

low left frontal lobe activity

increased activity in the amygdala

Twin studies indicate that genetic factors are important

true

Research indicates that WHAT is necessary for a genetic cause to be manifested and present

stress

Highest Risk for genetic factors

Identical twins of ppl w/ history of major depression

High risk for genetic factors

Non-identical siblings of ppl w/ a history of major depression

Low risk for genetic factors

Identical twins of ppl w/ no history of major depression

Lowest risk for genetic factors

Non-identical twins w/ no history of major depression

Major precipitating factor of depression

LOSS (of loved one or break up/loss of social network, job, friends, etc)

T or F? High Social support can buffer the effects of loss on depression

True

Beck’s Cognitive Theory of Depression

Vulnerability to depression is associated w/ cognitive style characterized by a negative view of self, world, and the future.

Maximization of failure

thinking “oh I am just so stupid” when failing a test. automatically assuming you are just dumb/incapable

Arbitrary infrence

going to an event where you know people, but they do not approach you when you arrive, so you assume they do not like you. This is not logical.

Seligman’s Hopelessness Theory of Depression

Tendency to attribute failure to

• stable causes that will not change (“Ill always just be bad at math.”)

• global causes that are widespread (“I am bad at math, but I am bad at everything. Like I cant even get a job” even though the two are unrelated)

• BOTH lead to person feeling helpless and unable to change anything

T or F? Medication alone is the best treatment for depression.

FALSE - the combination of psychotherapy and medication are optimal. Additional factors such as increasing social support, activity, and exercise also help.

Anxiety disorders are marked by

excessive feelings of fear and anxiety

fear- response to a specific perceived threat

anxiety- response to vague or less clearly specified threat

Generalized Anxiety Disorder

Individual experiences anxiety pretty much at all times (not associated w/ specific threat)

Symptoms: excessive worry, issues sleeping, nervous, and physiologically aroused

Biological implications of generalized anxiety disorder

over activated amygdala

reduced neurotransmitter GABA

GAD is associated w/ childhood stress or trauma

Inhibited temperament

Cognitive implications of generalized anxiety disorder

excessive worry

increased attention to potential threat

Treatment for generalized anxiety disorder

relaxation + coping skills

medications: (benzodiazepine) such as Xanax to inhibit GABA receptors IMMEDIATELY / buspirone (affects serotonin system) taking weeks to take effect

Specific Phobia

something highly specific that a person is afraid of

2 parts: irrational fear and avoidance of feared situation

both parts must be present to be a phobia

What is the best treatment for Specific Phobias

Exposure therapy

Social Anxiety Disorder (social phobia)

fear of social situations (usually embarassment/rejection)

avoidance is not always present

treat w/ exposure therapy and SSRIs

Before doing exposure therapy

individual must learn:

• muscle relaxation techniques

• rank fears related to stimulus (1. being most feared scenario w that stimulus to least feared)

• get them to imagine the fear starting w/ least feared up to highest feared

Systematic Desensitization

Imagining the feared stimuli

Graded “in vivo” exposure therapy

Actually place individual into the feared situation, starting with least feared on their list, allowing them to stay in the situation until calm and no longer fearful.

Flooding (total exposure)

Individual is immediately put into most feared situation

Rarely used method / not recommended due to cardiovascular risks/panic attacks

Prepare them using tactics and make sure they stay for full duration

Panic Disorder

more than 1 panic attack per month w/ ongoing concern of more attacks happening

treated with CBT and SSRIs

Panic attack

experience of intense anxiety and terror w/ extreme physiological arousal (high heart rate, sweaty palms, high blood pressure, dizzy, unable to process info)

Agoraphobia

fear of open spaces (public, crowds, public transport)

avoid these contexts and eventually become housebound

often associated w/ panic attacks

often confined to a house

treated w SSRIs and CBT

How is agoraphobia treated

CBT and SSRIs

Help them do tasks, then assign to do on their own/ with safe person.

Usually partial recovery

OCD

Obsessions - intrusive, reoccurring, disturbing thoughts that cause intense anxiety

Compulsions- urges to engage in senseless ritual, usually a repetitive actin to ease anxiety

Caudate Nucleus in the ____ of the brain is overactive in OCD

basal ganglia

T or F? OCD consists of lower serotonin activity

True

Treatment for OCD

SSRIs (very effective)

Behavior Therapy

Features of Schizophrenia

1. Disorder of thought content (wild/untrue delusions)

2. Disorder of thought form (way they think is disorganized- rambling/unclear)

3. Disorder of perception (hallucinations- mainly hearing voices)

4. Disordered attention/sensory filtering (inability to filter out irrelevant info and block out others

Positive Symptoms

presence of abnormal function like delusions or hallucinations

Negative symptoms

lack of normal function such as

• absence of affect

• no speech

• poor self-care (no bathing or brushing teeth)

cognitive symptoms

poor sustained attention and low working memory capacity