HELL IS REAL AND ALSO FREUD IS PERSONALLY RESPONSIBLE. If the economy was better I could afford a lobotomy. This is one of the few places were I can express myself let me have this. I miss when my dad would play fortnite hatsune miku skin because it was endearing almost.

What is a disorder?

“abnormal” versions of standard emotions

The four Ds

Deviance, Distress, Dysfunction, Danger

Deviance

Changes from the social norm, social contract

Distress

Cause significant turmoil

Dysfunction

Makes everyday life difficult

Danger

Threatens yourself or others

Symptom

single sign of a condition

Syndrome

collection of symptoms

Psychopathology

Study of disorders

Abnormal psych

goal to characterize the nature of the disorder

Clinical Psych

goal is to assess and treat the disorder

Diathesis

biological predisposition to disease

To produce disease, you need right ratio of

Diathesis Environmental stressors Explains individual variability

Diathesis Stress Model

Your Diathesis and environmental stressors combine for different outcomes (upper quad for disorder)

Clinical Assessment

Procedure for evaluating psychological functioning

Components of Clinical Assessment

Interview

Self-report

Projective tests

DSM-5 (2013)

Describes 157 diagnoses

Lists out: Symptoms, Statistics, Treatment

Organized into 20 broad categories based on causes and symptoms

Strengths of Diagnosis

● Facilitates treatment

● Easy to communicate

● Facilitates research

● Maybe a relief

Weakness of Diagnosis

● May come with stigma

● Clinicians may think of diagnosis as fixed

● May not capture overlap

Dimensional approach of diagnosis

Asks “how much” instead of “yes or no”

Strength of Dimensional Diagnosis

● Acknowledges spectrum

● Captures subclinical symptoms

● Personalized treatment

● Recognizes comorbidity

Weakness of Dimensional Diagnosis

● Complex to implement

● Requires fine grain assessments

● Harder to communicate

● Not the “norm”

Emotional disorders are an issue when…

They overwhelm us

Anxiety Disorders

Excessive fear in absence of danger

Lifetime prevalence: 30%

Other symptoms: Irritability, Insomnia, Difficulty concentrating

Panic attacks: Significant bodily symptoms

Specific phobias

Automatic fear response to an object/situation that doesn’t match the actual threat

Agoraphobia

Fear of being trapped or stuck in situations where escape is not readily available

Panic disorder

Sudden extreme feelings of panic and doom: panic attacks

Social Anxiety disorder

Extreme fear of being negatively evaluated by others

Generalized Anxiety Disorder (GAD)

Anxiety is not attached to a specific stimuli

Constant, underlying anxiety

Lifetime prevalence: 6%

2x more common in women

Cognitive behavior therapy (CBT)

Teaches client to correct faulty thoughts +behaviors

Includes exposure therapy

Anhedonia

diminished interest or pleasure

Rumination

repetitive thinking

For a Major Depressive Disorders…

Must experience a “major” episode

Depressive mood for at least two weeks

Stats for Major Depressive Disorders

Affects 7-8% of Americans at one time

Lifetime prevalence: 16%

Much higher for women

Most common in adolescence and young adulthood

Information on Suicide

800,000 deaths per year worldwide

10th most common cause of death

In 90%, psych disorder at the time

Happiness a factor, but also impulsivity

Riskiest time when beginning to recover

Mood still low, but recovery means energy and motivation for an attempt

Treatment for Depression

CBT or interpersonal therapy

Various medications (SSRIs most common)

Severe approaches

Electroconvulsive therapy

Ketamine

Bipolar Disorder

Extreme fluctuations between mania and depression (I and II)

Mania

extreme euphoria and elevated mood

Hypomania

milder mania

Bipolar I

full manic episodes + some depression

Bipolar II

hypomanic episodes + major depression

Treatment for Bipolar Disorder

Important: Highest rates of suicide, 15x average Often in transition periods

Lithium is the primary pharmaceutical approach

Antidepressants can help depressive episodes, But may make mania more common

CBT does not treat symptoms, but can help adherence

Obsessive-Compulsive Disorder (OCD)

Intrusive thoughts and compulsive actions

Not just cleanliness or neatness

Intense compulsions and fear of consequences

Lifetime prevalence: 1-2%

Usually begins in early childhood

Post-Traumatic Stress Disorder

Intrusive thoughts in response to a severe trauma

Must persist more than a month

Stressor alone not enough: 1 in 10

Lifetime prevalence: 7%

Symptoms: Nightmares and flashbacks, chronic anxiety, Memory and attention deficits

Schizophrenia

Involves repeated episodes of psychosis

Very debilitating

Includes positive and negative symptoms

Positive symptoms of Schizophrenia

presence of unusual behavior

Negative symptoms of Schizophrenia

absence of usual behavior

Delusions

False beliefs based on inaccurate interpretations of reality, many different types

Hallucinations

False, but vivid sensory perceptions that have actual brain activity

Disorganized speech in schizophrenia

Incoherent speech with no meaning

Topic switching

Unusual emotional responses while speaking

Disorganized Behavior in Schizophrenia

Unusual behaviors

Lack of self care

Abnormal clothing

Sudden movements

Extreme fear response

Negative Symptoms of Schizophrenia

Flattened behavior

Catatonia: “frozen” motor functions

No startle reflex Anhedonia Withdrawal Lack of speech

Biological statistics for Schizophrenia

Lifetime prevalence: 1%

Usually diagnosed during early adulthood

Brain maturation + environmental challenges

Strong genetic component

One diagnosed parent → 13% chance

Both parents → 50% chance

Maternal ill-health during pregnancy

Dopamine Hypothesis

Abnormally high levels of dopamine in the brain

Mechanisms of Schizophrenia

Dopamine hypothesis, glutamate transmission issue or structural abnormalities in the brain

Treatment for Schizophrenia

Antipsychotics are primary treatment

Side effects + major adherence issues

Social skills training can improve functioning

Success = functioning + limited symptoms for 2+ yrs

Only 13% patients

Success depends on environment

Why might racial disparities exist in the use of psychotropic medications?

•Healthcare access

•Provider bias

•Cultural stigma

Pros of Psychotropics

-Increased outpatient treatment

-Effective Symptom Management

-Reduced Hospitalization Rates

Cons of Psychotropics

-side effects

-overprescription

-Dependency/withdrawal

Psychosurgery

•Brain surgery, removes or disconnects brain sections

•Lobotomy: Historical method, severs connection between frontal lobe and subcortical structures

•Inconsistent, devastating side-effects

•Now, lesions more precise, techniques refined

•Reserved for severe disability

Electroconvulsive Therapy

•Mild electric current administered to specific brain area (usually right side)

•Used to treat depression

•Outperforms placebo, quicker than antidepressants

•Patients under anesthesia and muscle relaxants

• Some memory impairments

Provide two examples of future directions in the treatment of mental illness.

Vagal Nerve Stimulation and Repetitive Transcranial Magnetic Stimulation

Stress

Physiological Response to evironment

=Demands of event exceed abilities

=Body trying to keep you alive

Three Components of Stress

Evironmental, Subjective, Physiological

Environmental Component of Stress

External Trigger

Subjective Component of Stress

Perception and Interpretation

Physiological Component of Stress

Biological Changes

General Adaptation Syndrome (GAS)

-Hans Selye

-Emphasized Generic Response

Alarm, Resistance and Exhaustion

Critiques of GAS

-Too Simplistic

-Humans can function under larger range of conditions

-Ignores situational and psychological factors

Stress Appraisal Theory

-Richard Lazarus

-Explains variability

-more accepted

-Perception is a key component

Steps of SAT

Primary Appraisal, Secondary Appraisal, Response and Reappraisal

Challenge Reactivity

Sympathetic Response with expansion of arteries (Better preformance)

Threat Reactivity

Sympathetic Response, but constricting arteries (Better protection)

Sympathetic-Adreno-Medullary (SAM) Axis

-Immediate Stress Response (Fast/short)

-Triggers sympathetic nervous system

-Strong Cardio component

-Depends on apprasial

Autonomic System (sympathetic) and Endocrine System

Adrenal Medulla with Epinephrine

Hypothalamic-Pituitary-Adrenal (HPA) Axis

-Only triggered if appraised as a threat

-Slower, more prolonged stress response (chronic stress)

-More immune changes

Endocrine System

What is the “stress hormone”, which axis is it involved in, and what does it do?

HPA- Adrenocorticotropic Hormone (ACTH) Adrenal Cortex

Cortisol

A type of glucocorticoid

Peaks 20-40 Mins after a stressor

Increases blood sugar. decreases inflammation

Stressors

Events most likely to be stressful

Catastrophic Events

Extreme, life-threatening, often devastating loss

(Natural disasters)

Depends on proximity, time, and intention

Major Life Events

Disruptions to social safety net

Chronic or Temporary

Appraisal and Coping Resources

Can be positive

Daily Hassles

Constant Minor Stressors. Largest Source

Minor but accumulates

Can Create an allostatic load

Amplify other stressors

Biopsychosocial Model of Health

Biological, Psychological, Social (tackling public health at all three levels)

How Stress effects the Immune System

-Inhibits

-Decreases T-Cells and lymphocytes

-lowers efficacy of vaccines

-slower wound healings

-builds cortisol resistance (does not reduce inflammation

Stress on Cardiovascular health

CVD

-Prolonged SAM activation increases plood pressure—-artery damage and plaques

-Stressors trigger SAM more—-Heart attack and stroke

-impairs parasympathetic NS and exit SAM

Stress and Risky Bheaviors

-Maladaptive coping strategies (substance use)

-Unhealthy eating

-prone to distraction

Epigenetics

Changes DNA activity, on or off (ex: methyl turns genes off)

Changes can pass to next generation

Impact of Social Economic Status (SES)

High SES= More access to a healthier and stable life

Low SES= More instability and stressors

Impact of Marginalization

Discrimination, historical adversity, lasting impacts from lower SES

Impact of Genes

Some genes increase sensitivity to stress

Impersonality

Appraisals and coping can change impact of stressor

Neuroticism increases stress response

Stress correlates with hostility

Stress Buffering Hypothesis

Social Support reduces negative impact of stress

(Emotional, Instrumental, Informational support)

Coping Mechanisms

Humor, Healthy Lifestyle, Relaxation, Mindset

Problem-Focused Coping

Approach stressor with belief it can be changed

More common when controllable

effective for chronic stress

Emotion-Focused Coping

People try to understand or make some reason the event was good, change how you feel about stress

effective when stressor is uncontrollable

But can promote avoidance otherwise

Negative Symptoms of Schizophrenia

-Flattened behavior

-Anhedonia

-Withdrawal

-Lack of Speech

Positive Symptoms of Schizophrenia

Presence of unusual behavior (ex, disorganized speech, delusions)

Delusions

False beliefs based on inaccurate interpretations of reality

Hallucinations

-false sensory perceptions

-vivid sounds, smells, visions, feelings

-Mostly auditory and aggressive

-Actual brain activity

Biological causes for schizophrenia

Genetics or High levels of dopamine in the brain

Treatment for Schizophrenia

Antipsychotics and Social skills trainning