Psychopathology + Probs in Living Unit 1 - Part 2

comorbidity

person has two or more disorders

other dsm limitations

List of several symptoms, need certain number of symptoms

·       Possibly for two cases to have same diagnosis – sharing one or no symptoms

·      
Fundamental core of the disorder?

·      
Any variations?

DSM limitations/criticisms

·       Real patients’ problems

·      Atheoretical: we don't know why things go together

·      Uncertain validity: is it accurate

·    Comorbidity: does i make sense for person to have multiple
disorders

·      Heterogeneity: same disorder can look different in people

Hierarchial Taxonomy of Psychopathology (HiTOP )

1.     Categorical conceptions

2.    Low reliability

3.    Heterogeneity

4.    Comorbidity

5.    Many cases people don’t technically meet diagnosis

Propose a system:

·      Based on empirical data and evidence

·      Better group based on overlapping symptoms

·      Thresholds

·      Improve reliability

·      Understanding comorbidity

·      Researchers and/or clinicians: choose which hierarchical
dimension to focus on for particular reason and purpose

Research Domain Criteria (RDoC)

a.     evolving system that understands basic human emotions, behaviors, cognitions, and functioning across development

·       Aims to understand both normal and abnormal behavior

·       May inform some future classification system

·       Emphasizes biological-brain indicator in domains

·       Allows multiple domains, level of analysis, and units of measurement

·       System and matrix: need to be updated given ongoing evidence

5 domains of RDoC

·       1) negative valence (threat danger or loss)

2) positive valence (negative and positive mtivation: how process rewards and valence

3) cognitive

4) social

5) arousal & regulation (sensitivity to internal and external stimuli e.g. increasing heart rate and how long it takes to come back down

RDoC Framework and Units of Analaysis

• Genes, molecules, cells, neural circuits, physiology, behavior, self-reports

RDoC: Limitations

• Has not made much progress:

• Assumes biological factors (esp. brain) most fundamental

-does mental health always correspond to biology?

• Not psychopathology classification system

RDoC Aim and long-term hope

-want to understand the domains of human function

-classify psychopathology

reasons why it’s hard to study causes of psychopathology

1)    Coorelation is not causation,

2) many different factors of psychopathology

3) the factors likely jointly relate to health

coorelation

coorelation: More ice cream purchased murder rates went up, summer heat means more excited and more aggression, associated but did not cause each other

causation

1.     Factor has to occur before outcome (‘temporal precedence’)

2.    Has to be association

3.    (most challengingly), have to rule out all other potential causes

-hard to measure multiple things at once

• can approximate causality

why is it difficult to study causes of psychopathology

a.  Numerous

b.  Impact at same time

c. Differ in implant

d.  And affect (have relationships) with each other

common risk factors of psychopathology

·       Genetics

·      Prenatal exposure

·      Stressful life events

·      Early exposure to life stressors

·      Lack of social support

paradigms

set of shared assumptions about:

fundamental phenomena

best theories

how to prove and what kind of proof? what data to collect?

theories

·       specific variables + relationships

e.g.- biological, psychodynamic, cognitive-behavioral,
humanistic

·      Carl Rogers: self actualization

·      People are ex-percepts on themselves

examples of paradigm domains

biological, social, psychological factors

biological factors

·       evolution, our ancestors, chemical imbalances in brain, genetics

social factors

·       social determinance, traumatic experiences, not having a lot of friends, culture, support system , education, religious beliefs

psychological factors

·       the way you think and feel, personality, emotional states, temperament, coping skills, attitude, societal and structural: poverty + wealth

·      None is fully correct

-each contributes some truth

-can combine different ways to get to truth

- combine
paradigms: approaches to therapy

joint effects: interactions

·       Relationship is fundamentally changed by another variable

-influence of gender depends on age

vulnerability

·       existing factor precedes stressor

-increases risk

-does not trigger onset of a disorder/episode by itself

stress

·       any event that triggers onset of disorder

Often but not always biological

vulnerability + stress = disorder

·       Biological factor, social factor, psychological factor + Biological factor, social factor, psychological factor= disorder

·      neither is enough on its own

E.g. is marujuana can trigger schizophrenia development, ptsd in siblings: family history, if theres traumatic exposure then disorder

equifinality

multiple different causes for the same disorder

-family history, lost job, end relationship, deficit of serotonin = can all lead to major depressive disorder

multifinality

different out comes one common casual factor

-history
of child abuse= leads to increased risk of ptsd, substance abuse disorder,
bipolar disorder

risk factors

predicts (come before) psychopathology

maintenance factors

predicts continuation of symptoms over time amoung these with symptoms

protective factors

reduce effect of risk factor, or makes psychopathology less likely

MDD symptoms

5 or more symptoms: 

A.  Depressed mood OR anhedonia - have to have one of these symptoms:
weight loss or gain, psychomotor agitation, fatigue, loss of energy, feelings
of worthlessness, guilt, recurrent thoughts of death

B.    Cognitive, vegetative, motivational

MDD Duration

at least two weeks, must be nearly everyday, most of the day

MDD Clarifiers

·       severity: mild moderate, severe, 

·      remission status: person does not have clinical levels of the
disorder. Could have 2 months of no symptoms

·     Potential subtypes: 

-MDD with
anxious distress: really tense or unusually restless, can’t concentrate,
individual loses control of themself

-parapartium
onset depression (postpartum) : occurs during pregnancy

-seasonal
depression

-subthreshold
is a specialized diagnosis

*MDD is EPISODIC

 

PDD symptoms

depressed mood, most of the day, more days than not

-at least two of additions sxs: poor appetite or over eating, insomnia, low self esteem, poor concentration, can’t make decisions, low self-esteem

PDD duration

two years, without a two month break

PDD course

-less severe in symptoms, have only one core symptom

-low self
esteem, feelings of hopelessness

*chronic

etiologies

scientific study of causes, orgins or reasons for disease or abnormal condition

Depressive cognitive style and components that make up a cognitive style

1.     Negative attributional style: make inferences about the cause and failure, it’s about me

the cause and reason, internal+stable+global reasons: internal-I’m stupid, stable: thinking I will fail other tests and exams, global:harder to do future exams

-internal: i failed the test because the road was closed

2.  Negative inferences about consequence: thinking other bad things
will happen

-then think you wont get a job, wont get married

3.  Negative inferences about self: interpreting that failing a test
makes me worthless or flawed, negative inferences about the causes

-after failing think I’m worthless, flawed, horrible

·   stable, internal, global

 

Beck’s cognitive theory and its three components

negative thoughts about the self, the world, and the future

depressive schema

·       how people interpret their environment, risk factor of depression

-affects
someone's reaction to failure. E.g. I didn’t get a job or failed a test - I’m a
loser, stupid, ugly

cognitive distortions

are irrational thought patterns, that cause someone to think inaccurately -all or nothing thinking, mental filter, shoots down positive experiences

-assuming you or others cause things beyond your control

dysfunctional attitudes

: intermediate beliefs, reflecting one's negative schema. I’m nothing if this person doesn’t like me, If I’m at work / school I’m a failure as a person. Negative event happens and immediately

interpersonal

self propagatory processes

negative feedback

seeking tendency towards relationships that give negative feedback. 

-want feedback that matches the view of themselves, which would be negative. 

-Self verification can be so strong they don’t care about experiences. This need is from interpersonal stress, will not help someone with depression

excessive reassurance seeking

constant need for positive association. 

-May get positive reassurance, but wont believe it

conflict avoidance

•   (interpersonal) lack of assertiveness, avoiding, socially withdrawn, submissive, lack of social support

-social support is helpful

stress exposure

life events

-e.g. Divorce, financial problems, illness, fight with friend or family member

stress generation

·       independent vs. dependent stressors

-fateful
stressors can come out of nowhere

-dependent happen from a person characteristics, losing a job, break up

-can have lung cancer if smoked or if you didn’t

neurotransmitters

serotonin, dopamine, norepinephrine

serotonin

a big part of SSRAs and depression, reduces anxiety, calmness, and the neurotransmitter we associate with depression. If you have low levels of serotonin have a risk of depression

dopamine

pleasure / reward

epinephrine / norepinephrine

fight or flight response

glutamate

excitatory, stimulates nerve cells to pass info in the brain, too much of it causes neurons to die. Chronic stress enhances glutamate distress

-Need a balance of all neurotransmitters

genetic factors

Identically and fraternal twins have high chance of sharing depression

·  Twin studies: depression is moderately heritable

-mild genetic influence for unipolar depression

·      Do not know which specific genes affect MDD

·      No single gene responsible for mood disorders

-Polygenic:

polygenics

a psychological or physical trait is influenced by two or more genes working together rather than a single gene

selective serotonin reuptake inhibitors (SSRIs)

are antidepressant medications. They work by blocking the reuptake of serotonin by neurons, which increases the amount of serotonin available in the synapse.

·       Nausea or upset stomach

·       Headache

·       Sleep problems or drowsiness

·       Increased or decreased appetite

·       Sexual side effects (such as decreased libido or difficulty reaching orgasm)

·       Feeling restless or anxious, especially when first starting

tricyclic antidepressents (TCAs)

increase levels of serotonin by blocking their reuptake, nausea and dizziness

monoamine oxidase inhibitors (MAOIs)

not as common, increase levels of serotonin, epinephrine, and dopamine by blocking neuro transmitters.

-enhance
effects of serotonin and TCAs also do this

-can have
severe reactions with certain foods and can die. Meat, cheese, soy, beans

how well do antidepressants work

-Works for some people but not all

-People are all different and sometimes have to try different
things

-Even when meds work, relapse is the problem

-some
people stop taking meds when they feel better

-TAKE MEDS FOR LIFE

psychotherapies

CBT, IPT

Interpersonal psychotherapy (IPT)

·       Focuses on improving relationships and addressing interpersonal problems, life changes, and loss that contribute to depression.

-interpersonal stress or lack of interpersonal support leads to MDD

·   Improve communicator

·  Improve problem solving

4 problems for IPT

1.     Grief: loss of a relationship, someone passes away, breakup

2.    role dispute: conflict due to disagreement or views of roles, e.g. disagreement with mom 

3.    role transition: major life changes that alter expectations of roles e.g. becoming a college student

4.    interpersonal deficits: longstanding problems and patterns in relationships, problem with friend that never gets resolved

cognitive behavioral therapy (CBT)

Identifies and changes negative/unhelpful thoughts and behaviors that contribute to depression.

-focuses on thoughts, feelings, and behaviors

-negative thoughts - behavior

 enforcing thoughts - depression

·   Making maladaptive thoughts more realistic

-inform patients of patterns to avoid relapse

therapy vs. antidepressants

·       All research finds these treatments are effective but there's no difference between them. What works for an individual they should use

overall treatment response, when, how long they last (e.g. Relapse)

-Across all RCTs for major depression:

-moderate
(60%) patients recover

-no
significant difference in recovery for SSRI vs. therapy vs placebo

-Good news/bad news

Treatment for depression is generally effective, but not everyone responds or reaches remission. Improvement is usually evaluated over first 4-8 weeks, and treatment often continues for several months after symptoms improve to prevent relapse. Psychotherapy can have effects that persist after treatment ends, while stopping antidepressants can increase relapse risk. For people with recurrent or chronic depression, maintenance treatment may be needed for a longer period

cost benefit analysis of meds vs. therapy

Medications can be convenient and effective for reducing symptoms, but they may cause side effects and usually need to be continued to maintain benefits. Psychotherapy can take more time, effort, and money, but it can teach lasting coping skills and address the underlying thoughts, behaviors, and interpersonal problems. Overall, the costs and benefits depend on the individual and the severity/type of the problem.

mania vs depression

Manic pole + depressive pole

• Mania is high mood

• Where depressive i very dark

-course of weeks, months, or years of fluctuation of emotions

mani symptoms

Mood: elevated, expansive, or irritable mood. AND goal-directed behavior or energy

-3 (or more) of additional symptoms (4 if mood is only irritable)

1.    Inflated self esteem or grandiosity - overly self confident

2.    Decreased need for sleep 

3.    More talkative than usual - pressured speech

4.    Flight of ideas - subjective experience that ones thoughts are racing

5.    destructability 

6.    increase in activity: socially, work, sexually, 

7.    Pacing back and forth

8.    impulsive hedonistic activities: gambling

manic duration

7 days or until hospitalization, 

·      Sometimes people are put on medication

·      Or if the behavior is super risky

·      Allow for someone to be diagnosed

-too manic for their own safety or others

hypomanic episode symptoms

·       Symptoms: creativity: more ideas, decreased sleep

-grandiosity

-decreased need for sleep

-increased talkativeness

-flight of ideas

-distratctibility

-impulsive activities

-more social and higher energy

*some meds for depression can launch manic episode 

hypomanic severity

·       lesser degree than mania, not as impaired

-can be risk factor for mania

hypomanic duration

4 consecutive days

both clinicians and patienents have a hard time identifying hypomania… why?

Bipolar I: at least 1 manic episode, MDE not necessary, Manie: at least one week

Bipolar II: at least 1 hypomanic episode AND 1 MDE, Hypomania: at least 4 days

bipolar I symptoms

·       The symptoms cause social / occupational distress or impairment

·      A history of depressive episodes is NOT required for diagnosis

bipolar I duration

7 days of consecutive symptoms OR hospitalization

bipolar I persistence

• at least 1 manic epsiode

- depressive episode not required

bipolar II symptoms

·       At least 1 major depressive episode

·       At least 1 hypomanic episode

-patient can NOT have any manic episodes

-hypomanic

-changes
in function but is not as severe in manic

-not sever enough

-doesn’t always need hospitalization

bipolar II duration

·       Hypomanic episodes: at least 4 consecutive days, though they can last longer.

·       Depressive episodes: typically at least 2 weeks; they can persist for months.

·       Between episodes: some people have long periods of remission, while others have persistent or recurring symptoms.

bipolar II persistence

Without treatment, episodes may recur over years. Treatment can substantially reduce episode frequency, severity, and duration

cyclothymia symptoms

-numerous periods of hypomanic and subthreshold depressive symptoms

-distress or impairment

cyclothymia duration

-At least 2 years (1 year for children), at least half the time:

-without 2 month break

cyclothymia persistence

chronic, can be for years and can later develop bipolar I or II

MDD is…

major depressive episodes for 2 weeks: no manic or hypomanic

bipolar is …

·       Bipolar: Major depressive episode and manic

·      Bipolar Disorder Courses

neuro trasnmitters

serotonin, dopamine, glutmate

brain areas

amygdala, prefrontal cortex, basal ganglia

amygdala

region with emotion and emotion expression / regulation, diff doing these processes because of fluctuation in mood states

prefrontal cortex

impulse control, attention, planning, and memory

basal ganglia

reward, hypersensitivity with reward, associated with reward system in brain

goal dysregulation

those may be more reactive to rewards, biologically more drawn to life events that seek success

sleep and circadian rhythms

*can trigger bipolar disorder, onset of manic and hypomanic episodes, sleep deprivation correlated to episodes, bright lights can trigger episodes, routine is important in preventing / treating bpd

-circadian rhythms

*Maintain regularity in schedule + sleep to decrease the chance
of relapse

lithium

·       is chemical element by itself, but actually is paired with other molecules to be safe and suitable

-lithium carbonate treats BPD and mood stabilization, gold standard for treating BPD

-Manages acute media, stabilizes mood shifts

-can be toxic in high does, needs to be monitored by blood tests to see lithium toxicity

-can mess up thyroid, hypothyroidism, and lower hormone levels, kidney damage

atypical antipsychotics

serqual (katiapine), orlanzophen, resparital, lituda. Used for psychotic disorders like schizophrenia but can also stabilize mood like acute manie. 

mood stabilizers

help reduce relapse, daily side affects like sleepiness, nausea, dry mouth, tartive disconesia (TD)

tartice disconesia

movement disorder, can’t be reversed, uncontrollable body movements

anti-seizure mediations

·       40-60% of bpd patients are noncompliant with medication

-more
beneficial when meds and therapy work together

CBT

·       restructure thought patterns, provide psychoeducation for families 

-mood monitoring: process of individual keeping track of their mood early on before
it progresses

-used with medication for best results

psychoeducation

·       providing information to patients with BPD and families to better understand their components of illness

-family focus therapy to address issues and make healthy supportive home environment

-warning signs before person gets in an episode

interpersonal and social rhythms therapy (IPSRT)

-stressful events, disruptions in circadian rhythm, and conflicts have

-interpersonal conflict and disruptions leeds to relapse of mood systems

-daily routines like sleeping, waking, eating, can help quality of life and identifies themse of social stressors to maintain regulatory in life

dialectical behavioral therapy (DBT)

·       first developed to help with borderline personality disorder, comprehensive cognitive treatment with those who are suicidal and can’t manage or regulate emotions

-substance use, treatment drop out

-tools used: help keep safe, address nonproductive behaviors like blocking your own progress, mindfulness

-learn to be okay with distress and symptoms

-interpersonal skills: advocate for yourself and set boundaries without getting very upset

-symptom monitoring and relapse prevention