Abnormal Psych Unit 3

Common features of mood disorders

Disturbance of mood

Difference between mood episodes and mood disorders

mood episodes are the building blocks for most mood disorders, and the mood disorders are the actual diagnoses

key features of major depressive disorder

-A psychological disorder characterized by sad mood and/or loss of interest in activities previously enjoyed.

-One or more major depressive episodes(must last for two weeks)

-No history of manic or hypomanic episodes EVER

key features of persistent depressive disorder

-A chronic state of depression

-Depressed mood and related symptoms

-Must last at least 2 years

-Can co-occur with double depression

-No history of mania/ hypomania

Prolonged grief disorder

-New in DSM-5

-Focuses on grief that is significantly distressing/impairing at least a year later

Premenstrual Dysphoric Disorder

-Symptoms following menstrual cycle

-marked mood symptoms(depression/anger/anxiety)

-clearly linked to menstrual cycle

-present during week before period starts

-disappear or almost disappear after period

differnece between mania and hypomania

Mania- A persistent mood that is abnormally high

Hypomania- A mood elevation that is clearly abnormal yet not as extreme as frank mania

Bipolar I

-full blown mania alternates with major depressive episodes

-one or more manic episodes

-also includes a single manic episode without periods of depression

Bipolar II

-Hypomania alternates with episodes of major depression

-No manic episodes EVER

-at least one major depressive episode and one hypomanic episode

Cyclothymic Disorder

-characterized by fluctuations that alternate between hypomanic and depressive symptoms

-hypomanic and depressive symptoms, but NEVER full episodes

-Duration of at least 2 years

Dysregulation mood disorder

-recurrent temper outburst that are grossly out of proportion for the situation

-New, for ages 6-18

-Created to address rise in childhood bipolar disorders diagnoses

-multiple areas of controversy

Biological Etiology of Depressive and Bipolar Disorders

-Twin and adoption studies provide evidence of heritability

-Neuroimaging studies map out brain activity and functions that are altered in the context of mood disorders

-Neurotransmitters like GABA, Catecholamines, and Serotonin have all been implicated in the development of depressive symptoms

-Functional brain differences

Psychoanalytic Etiology of Depressive and Bipolar Disorders

-Depression: Mourning and melancholia/anger turned inward(freud)

-Mania: Defense against depression

-Role of Loss

Cognitive and Behavioral Etiology of Depressive and Bipolar Disorders

-lack of positive reinforcement(can both cause and result from depression)

-Learned helplessness(Seligman): proposes that externally uncontrollable environments are inescapable stimuli that can lead to dyspphoria and MDD

-Attributional Style: how a situation is attributed can impact how an individual thinks

-Beck: Negative triad of schemas→cognitive distortions/negative automatic thoughts-proposed that individuals with depressions have these

Biological Treatments for Depressive Disorders

Antidepressants: Trcylics (prevent the reuptake of various neurotransmitters, primarily norepinephrine and serotonin), MAOIs(prevent the action of the enzyme monoamine oxidase), SSRIs and SNRIs(inhibit the reuptake of the serotonin, but controversially the have been tied to suicidal thoughts)

Psychedelics: a new area of biological treatment which is showing promising results, but researchers are still worried about long term use

Light Therapy: Patients with seasonal affective disorder, or seasonal depression can undergo this therapy. It involves patients looking at an artificial light 10x brighter than usual so it reaches the retina

Electroconvulsive therapy(ECT): The most efficacious biological treatment, and is usually used for those who are severely depressed, have not responded to medication, or are at risk of suicide. It involves electrodes being placed on specific parts on the head that cause small seizures

Transcranial magnetic stimulation(TMS) and Deep Brain Stimulation: TMS involves a magnetic coil placed over the patients head to deliver a painless localized electromagnetic pulse to a part of the brain, this is mostly used on patients with treatment-resistant depression. DBS involves surgically implanting electrodes into specific improperly functioning areas of the brain, this is usually used for those with negative mood changes

Psychological treatments for depressive disorders

Beck’s Cognitive Therapy(CBT)- based on the premise that an individual can learn to think and behave differently, which can lead to improved mood. usually involves patients recording their thoughts and feelings, and identifying triggers

Interpersonal Therapy(IPT)- 16-20 sessions that focus on an interpersonal problem area like grief, role transition, disputes, and interpersonal development

Behavioral Activation- Emphasizes increased contact with positive reinforcement for healthy behaviors, thereby increasing positive mood

Biological treatments for Bipolar Disorders

-Bipolar disorder requires care by a physician and treatment with medication

-Lithium is the most common medication, and it works by inhibiting excitatory neurotransmitters such as dopamine and glutamate

-Anticonvulsants and some antipsychotics can also be used, but mostly in combination with lithium

-ECT can be used, but particulary for sever depressive episodes, extreme or prolonged mania, or individuals with extreme rapid cycling or mixed states. Usually when medications and psychotherapy are not effective

TMS, DBS, and tDDS have also been show to be relatively safe and effective

Psychological treatments for bipolar disorders

-Primarily adjunctive, not in place of meds

-Psychoeducation used to increase compliance with meds

-Increasing awareness of incipient manic episodes

-CBT for depressive symptoms

-Interpersonal and Social rhythm therapy(IPSRT)- promotes adherence to regular daily routines

Issues related to mood disorders

-Gender differences in mood disorders are significant, with women being roughly twice as likely as men to experience major depressive disorder and generalized anxiety disorder. While women often present with more internalizing symptoms like sadness and fatigue, men tend to exhibit externalizing behaviors, such as anger and substance misuse

-noncompliance

-suicide

Features of psychotic disorders

-characterized by unusual thinking, distorted perceptions, and odd behaviors

-loss of contact with reality

Key features of Schizophrenia

-A severe psychological disorder characterized by disorganizations in thought, perception, and behavior

-People with Schizophrenia often do not think logically, perceive the world accurately, or behave in a way that permits everyday life and work

It IS experiencing delusions/hallucinations that cause someone to act odd. It is NOT experiencing different personalities

-It involves POSITIVE and NEGATIVE symptoms that could cause cognitive impairment

DSM-5 Criteria for Schizophrenia

-symptoms over minimum of 6 months( other than 1 month active phase and can include prodromal and residual phases

-Plus one other symptom, either another positive one, or negative symptoms

-Must include functional impairment

Positive symptoms

-Behaviors that people most often associate with schizophrenia; it consist of unusual thoughts, feelings, and behaviors

-Positive does not mean good, it denotes the presebce if behavioral excesses

-Delusions: fixed beliefs that are not changeable when presenting with conflicting evidence(PERSECUTORY or other content-related delusions is the belief that someone is harming the person. DELUSIONS OF INFLUENCE are beliefs that others control one’s behavior or thoughts

- Hallucinations: perception like experiences without an external stimulus

-Disorganized speech/thinking: An abnormality of speech(LOOSE ASSOCIATIONS: thoughts that have little or no logical connection to the next thought. CLANGING: speech is governed by words that sound alike rather than their meaning. ECHOLALIA: repeating verbatim what others sa. THOUGHT BLOCKING: unusually long pauses in the patients speech)

-Disorganized/bizarre behavior(CATATONIA: A person is awake, but nonresponsive. WAVY FLEXIBILITY: parts of the body remain frozedn in a position when someone else puts them there)

Negative Symptoms

-Behaviors, emotions, or thought processes that exist in people without a psychotic disorder, but are absent in people with schizophrenia

-Negative does not mean bad, it is the absence of behaviors that exist in the general population

Avolition: apathy, an inability to initiate or follow through with plans

Alogia: decreased quality/ quantity of speech

Anhedonia: a lack of capacity for pleasure, feeling no joy or happiness

Emotional Numbing

Cognitive impairments

-troubles with memory/attention

-troubles with abstract reasoning

-troubles with executive functioning

-trouble with processing speed

-troubles with social cognition(the ablity to accurately identify and interpret other people’s emotions

Epidemiology of schizophrenia

-Age of onset: typically late teens, early adulthood. Early onset schizophrenia, before age 18, has much worse prognosis

-Gender- Women tend to have later onset than men, this could be due to hormonal differences such as estrogen

-Racial Bias: Black americans diagnosed more than twice rate of white americans. Diagnosed based on transcript rather than in-person could solve this

-SES: Disproportionately seen in lower SES

-Comorbidity: Higher rates of nicotine use and high rates of other medical problems

Where the terms Schizophrenia and dementia praecox came from

Schizophrenia: A swiss psychologist named Bleuler studied four core symptoms: ambivalence, disturbances of affect, disturbances of association, and preference for fantasy over reality coined the term schizophrenia by combining the greek words for split and mind

Dementia Praecox: A german psychologist named Krapelin highlighted pervasive disturbances of perceptual and cognitive faculties(dementia) and its early life onset(praecox) to distinguish it from the dementia associated with old age

biological Etiology of schizophrenia

-Neurotransmitters: It is mostly agreed upon that several different abnormalities in different neurotransmitters can be the cause

-Dopamine hypothesis: emerged from clincial observations that chemical compounds such as amphetamines increase the amount of dopamine availible in the neural synapse, which in turn can lead to the development or worsening of psychotic symptoms

-Genetic predispositions: strong evidence from family, twin, and adoptions studies showed that a person was 13% more likely to have schizophrenia is one parents has it, and 46% more likely if both do

-Structural and biological factors: enlarged ventricles in the brain, ventricles are cavities in the brain that contain cerebrospinal fluid, which act as a cushion to prevent brain damage. Reduced cortisol matter. Maternal exposure to flu. Faster rates of synaptic pruning

Psychosocial etiology of schizophrenia

Family impact:EE describes a family’s emptional involvement and critical attitudes toward people with a psychological disorder. A family with high EE is at a higher risk of their family relapsing

Biological treatment for schizophrenia

-Antipsychotic medication: Typical and atypical. Typical APs effectively reduced the positive symptoms of schizophrenia, but produced serious side effects. Atypical Aps are the preferred treatment because they effectively treat positive symptoms, and are less likely to cause side effects

-Impacts positive symptoms mostly

-Don’t work for everyone

-Side effects similar to parkinsons

Side effects like tardive dyskinesia(abnormal and involuntary motor movement

-Non-adherence a frequent problem

-ECT and TMS- ECT is effective but is used as a last resort. TMS is good for hallucinations, but has mixed results when it comes to reducing positive symptoms

Psychosocial Treatment for schizophrenia

-Family Therapy: does not affect symptoms directly, but helps family members understand patient

-CBT approach: appears to be an effective addition to antipsychotic medications for people with moderately severe schizophrenia who have primarily positive symptoms(psychoeducation, token economies, problem solving training, social cognition treatment, and recovery-oriented cognitive therapy)

-Supported living and employment: provides needed life and job skills

-Comprehensive Integrated Care: addresses medication and psychological skill building