Psychopathology Exam 3

Percentages for Unipolar Depression

- 20% of all adults

- 26% of women

- 19% men

- Average onset is 19 years old

Impacts of depression

affects all parts of life

DSM Checklist for Major Depressive Disorder

1.) for a 2 week period, displays increase in depressed mood and/or a decrease in enjoyment or interest across most activities for the majority of each day.

2.) for 2 weeks, experiences at least 3 or 4 of the following symptoms: considerable weight change or appetite change, insomnia or hypersomnia, agitation or decrease in motor activity, fatigue or lethargy, feelings of worthlessness or excessive guilt, reduction in concentration or decisiveness, repeated focus on death or suicide, suicide plan, or attempt

3.) distress or impairment

4.) no pattern of mania or hypomania

DSM checklist for Persistent Depressive Disorder

1.) experiences the symptoms of major or mild depression for at least 2 years

2.) during 2 years, symptoms not absent for more than 2 months at a time

3.) no history of mania or hypomania

4.) distress or impairment

reactive (exogenous) depression

stressful events trigger episode

- 80% of severe episodes occur after a significant event

Endogenous depression

episode is not triggered by an event (20%)

Biological Causes of Depression

Genetic Factors, biochemical factors, brain circuits, and immune system

Genetic factors of depression

family pedigree studies, twin studies, and gene studies

Biochemical factors of depression

low activity of two neurotransmitters, serotonin and norepinephrine

Brain Circuit factors of depression

- dysfunction in prefrontal cortex, hippocampus, amygdala, and subgenual cingulate

- irregular activity in various brain locations

- in addition to irregular neurotransmitter activity

Immune system factors of depression

Under intense stress, dysregulation of immune system occurs

- slower functioning of lymphocytes, increased pro-inflammatory cytokines production, and greater inflammation

- viral and inflammatory theories are receiving attention in many psychiatric disorders

biological treatments for depression

antidepressant drugs and brain stimulation

types of antidepressants

MOA inhibitors, tricyclic antidepressants, and second-generation antidepressants

MOA inhibitors

increases activity level of neurotransmitters serotonin and norepinephrine

- Iproniazid; tyramine

- cannot eat aged food on this drug (can be lethal)

Tricyclic antidepressants

prevents neurotransmitter (norepinephrine & serotonin) reuptake of key neurons

- imipramine; Tofranil

- can make you sleepy and increase appetite

Second Generation antidepressants

- selective serotonin reuptake inhibitors (SSRI) increase serotonin activity (Zoloft, Lexapro, Prozac)

- selective norepinephrine reuptake inhibitors (SNRIs) that increase norepinephrine activity only (Strattera)

- serotonin-norepinephrine uptake inhibitors increase activity of both (Effexor)

Ketamine-based antipressants

- increases activity of glutamate

- may aid in new neural pathway development

- alleviates depression quickly, used for those unresponsive to other drugs or are suicidal

- short term impact (spravato)

Brain Stimulation

biological treatments that directly or indirectly stimulate certain areas of the brain (ECT, Vagus nerve stimulation, transcranial magnetic stimulation, deep brain stimulation)

Vagus nerve stimulation

implanted pulse generator sends electrical signals to the ____ _____, which then delivers electrical signal to the brain

- helps reduce depression in many patients

Psychodynamic Model of Depression

- real or imagines (symbolic) loss

- depression is the result of when people's relationships leave them feeling unsafe and insecure (especially in early life)

Cognitive-Behavioral Model of Depression

depression results from problematic behaviors and dysfunctional thinking

Theoretical perspectives:

- behavioral dimension

- negative thinking

- complex cognitive and behavioral factor interplay

Behavioral Dimension (Lewinsohn)

- number of life rewards related to presence or absence of depression

- large reduction in positive life rewards may cause increasingly fewer positive behaviors, even lower positive reward rates, and eventual depression

- loss of social rewards are important in downward depression spiral

Negative thinking (Beck)

Unipolar depression is produced by a combination of maladaptive attitudes, cognitive triad, errors in thinking, and automatic thoughts

Cognitive triad

- negative view of experiences

- negative view of oneself

- negative view of the future

Learned helplessness

cognitive-behavioral interplay

- seligman: depression occurs when people believe they have no control over life reinforcements

Behavioral Activation

- reintroduce pleasurable activities

- consistently reward nondepressive behaviors and withhold rewards for depressive ones

- improve social skills

cognitive-behavioral treatment of depression

- behavioral activation

- beck's cog-behav therapy (CBT)

- acceptance and commitment therapy (ACT)

Beck's cognitive-behavioral therapy

1.) Increasing activities and elevating mood

2.) challenging autonomic thoughts

3.) identifying negative thinking biases

4.) changing primary attitudes

Sociocultural model of depression

- depression is influenced by social context and often triggered by outside stressors

- lack of social rewards (separation, divorce, widowhood, or covid isolation)

sociocultural treatment for depression (family-social)

Interpersonal psychotherapy (IPT)

- interpersonal loss (psychodynamic)

- interpersonal role dispute (i want something but they have a different view)

- interpersonal role transition (talks about challenging transitions)

- interpersonal deficits

- success rate similar to CBT and antidepressants

sociocultural treatment for depression (multicultural perspective)

- depression is found worldwide

- precise picture of depression varies slightly

- people who are depressed in non-western countries report more physical symptoms of depression rather than cognitive (stomachache, headache, etc)

Bipolar Disorders

- involve lows of depression and highs of mania

- shifts between extreme moods

- have dramatic impact on relative and friends

symptoms of mania

people in this state typically experience dramatic and inappropriate rises in mood, energy, and risky behaviors

Mania DSM Checklist

- for 1 week or more, person displays a continually irregular, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of the day

- 3 of the following symptoms: grandiosity or overblown self-esteem, reduced sleep need, rapidly shifting ideas or sense that one's thoughts are moving very fast, attention pulled in many directions, heightened activity or agitated movements, excessive pursuit of risky and potentially problematic activities

- distress or impairment

Bipolar I DSM Checklist

- occurrence of a manic episode

- hypomanic or major depressive episodes may precede or follow the manic episode

Bipolar II DSM Checklist

- presence or history of major depressive episodes

- presence or history of hypomanic episodes

- no history of manic episodes

diagnosing bipolar disorders

- 1-2.8% of all adults have bipolar disorder at any given time

- 4.4% have some at some point in life

- onset is 15-44 years old

- no gender differences

- higher rates in low income populations

clyclothymic disorder

- numerous periods of hypomanic symptoms and mild depression symptoms

- symptoms continue for at least 2 years with typical moods for a day or weeks in between

- may evolve into bipolar I or II

Biological Model of Bipolar Disorder

Neurotransmitter activity, ion activity, brain structure and circuitry, genetic factors

Neurotransmitter activity in Bipolar Disorder

mania may be related to high norepinephrine activity with a low level serotonin activity

ion activity in bipolar disorder

improper transport of ions back and forth between the outside and inside of a neuron's membrane

brain structure and circuitry in Bipolar disorder

Brain imaging and postmortem studies have shown irregular brain structures in people with ____ ____ in particular the basal ganglia and cerebellum

Genetic factors in Bipolar disorder

people inherit a biological predisposition to develop this disorder

Biological treatment for Bipolar Disorder

Mood stabilizing drugs

- lithium (narrow therapeutic window)

- antiseizure drugs

- antipsychotic drugs

Adjunctive psychotherapy

-individual, group, or family therapy

- doubles likelihood that people with bipolar disorders continue to take their medicine properly

- helps reduce hospitalizations, improve social functioning, increase patient's ability to obtain and hold a job

Suicide

one of the worlds leading causes of death in the world

Common Predictors of Suicide

depression, substance/gambling addiction, suicidal ideation, talk or preparation, prior attempts, lethal methods, isolation, loneliness, hopelessness, impulsivity, and risk taking, being an older white male, modeling of suicide, economic or work problems, marital/family problems, stress/stressful events, psychosis, physical illness, sleep problems

older-Elderly white men (85+)

group most at risk of suicide

Biggest Indicator for suicide

Prior attempts

Treatments for suicide

- keep the patient alive

- reduce psychological pain

- achieve nonsuicidal state of mind and a sense of hope

- develop of better ways of stress management

Assessment of Suicide

- Therapists must ask about suicidality

- Ideation

- Plan

- Intent

Passive Ideation

thoughts of death, escape, or not wanting to be here

Active Ideation

specific thoughts about methods or plans, desire and intent to die

Assessing Suicide Plan

Looks at how specific it is and if they seem to be an active threat to themselves

Assessing Suicide Intent

seeing if the person can agree to not kill themselves for at least 24 hours, if not then they need hospitalization

Goals of Suicide Prevention initial contact

- establishing positive relationship

- understanding and clarifying the problem

- assessing suicide potential

- assessing and mobilizing the caller's resources

- formulating a plan for getting help

Longer-term prevention for suicide

- referral

- therapy (establishing support and hope)

- reduction of access to common suicide means (gun control, or car emission detectors)

Stats of substance use disorder

- 16.5% of all people over the age of 11 in the US have this disorder

Substance intoxication

changes in behavior, emotion, thinking caused by substances

substance use disorders

maladaptive behavior patterns and reactions caused by repeated substance use

tolerance

need for increasing doses of substances to produced desired effect

withdrawal

unpleasant and sometimes dangerous symptoms occurring with drug stopping or cutting back

Substance Use Disorder DSM Checklist

- displays maladaptive pattern of substance use leading to significant distress or impairment

- two of the following symptoms within a year:

a.) substance often taken in larger amounts or over a longer period than intended

b.) unsuccessful efforts or persistent desire to reduce or control substance

c.) much time spent trying to obtain, use, or recover from substance use

d.) failure to fulfill major role obligations at work, school, or home as a result of repeated use.

e.) continued use of substance despite persistent social or interpersonal problems caused by it

f.) cessation or reduction of important social, occupational, or recreational activities because of substance use

g.) continuing to use in situations where poses physical risk

h.) continuing to use despite awareness that is causing or worsening a physical or psychological problem

i.) craving for substance

j.) tolerance effects

k.) withdrawal reactions

depressants

slows the activity of the central nervous system

- reduce tensions and inhibitors

- may interfere with judgement, motor activity, and concentration

(alcohol, sedative-hypnotic drugs, opioids)

Alcohol

increases GABA

Alcohol use disorder

- 10.6% of population over age 11

- 4:3 men to women

- tolerance increases consumption level

- variety of negative withdrawal symptoms (delirium tremens (DTs))

- regular consumption affects cognition, social life, and work behaviors

- damage in the brain, liver, fetal alcohol syndrome, motor vehicle accidents

sedative-hypnotic (anxiolytic) drugs effects

- produce feelings of relaxation and drowsiness to reduce anxiety and help people sleep

- low doses = calming or sedative effect

- high doses = sleep inducers or hypnotics

types of sedative-hypnotic drugs

barbiturates and benzodiazepines

barbituates

widely prescribed for first half of twentieth century; largely replaced

Benzodiazepines

- increases GABA activity

- long term use can cause cognitive impairment

- in high doses, can cause intoxication and lead to sedative-hypnotic use disorder

- can be prescribed for anxiety

- tolerance and withdrawal

opioids

- include natural (opium, heroin, morphine, codeine) and synthetic (methadone) drugs

- know collectively as narcotics

- causes CNS depression

- attack to endorphin-related brain receptors

- used for pain relief (morphine, codeine, oxycodone)

Stats of opioids

- each drug has a different strength, speed of action, and tolerance level

- about 13% over age of 11 have taken illicit opioids in the past year

Opioid use disorder

- after a few weeks, user may become caught in a pattern of abuse/dependence

- tolerance for the drug quickly builds

- withdrawal occurs when drug ingestion stops

- risk of overdose, impure drugs, dirty needles

Stimulants

- increase the activity of the central nervous system

- increases blood pressure, heart rate, and alertness

- rapid behavior and thinking

- common stimulants: cocaine, amphetamines, caffeine

cociane

- increases dopamine at key neurons throughout brain as well as norepinephrine and serotonin

- risk of psychosis

amphetamines (amphetamine, dextroamphetamine)

- prescribed for ADHD

- Misuse common among college students

- 1 of 10 undergraduates acquire this drug without prescriptions (stimulant diversion)

Methamphetamine

- serious negative effects on physical, mental, legal and social life

- increased ER visits

- induced psychosis

Stimulant use disorder

- drug dominates the individual's life

- leads to poor functioning in social relationships and at work

- tolerance and withdrawal

- Annual rates among people older than age 11

- cocaine 0.5%

- methamphetamines 0.6%

other amphetamines 0.5%

Hallucinogens (psychedelic drugs)

- produce powerful changes primarily in sensory perception (trips)

- natural ___: Lysergic acid diethylamide (LSD), mescaline, psilocybin, MDMA (ecstasy)

Lysergic Acid Diethylamide (LSD)

- one of the most powerful of this drug

- increased and altered sensory perception, psychological changes, and physical symptoms

- hallucinations and synesthesia

- produces these symptoms by binding to serotonin receptors

- tolerance and withdrawals are rare

- dangers: self-injury, bad trips, and flashbacks

cannabis

- produced from hemp plant

- major active ingredient (THC)

- hallucinogenic, depressant, and stimulant effects

- binds to cannaboid receptors (brain and gut)

Cannabis use disorder

- influenced by regular use

- about 6% of people in the US

- current weed is strong

- Dangers: tolerance and withdrawal symptoms, panic reactions, accidents, long-term health problems/reproductive problems

Cannabis's role in society

- medical use is allowed in majority of states

- reduces nausea and vomiting

- stimulates appetite

- recreational use legal in nearly half the states

polysubstance use

people who often take more than one drug at a time

synergistic effects of polysubstance use

- similar actions lead to potentiated effects

- heightened risk of overdose

- opposite (antagonistic) actions

- does not cancel the other out so heavy loads

Sociocultural view of Substance use disorder

poverty, stress, and families that value/tolerate drug use

Psychodynamic view of substance use disorder

have powerful early years dependency needs

Cognitive-Behavioral view of substance use disorder

operant conditioning

- positive reward of getting high

- positive punishment of withdrawal

- negative reward of relief from withdrawal

Classical Conditioning

- triggered by people, cues, or objects are present during drug use

Cannot have a substance use disorder without use = behavior

Biological view of substance use disorder

genetic predisposition

- Irregular form of dopamine-2 (D-2) receptor gene in people with substance use disorder

neurotransmitters

brain circuits

Neurotransmitter- focused explanation of drug tolerance and withdrawal symptoms

- cutbacks in the brain's production of particular neurotransmitters during chronic drug use

- changes in receptors lead to cravings

Brain Circuits for Substance use disorder

- reward circuit (reward center)

- pleasure pathway

- dopamine is the key neurotransmitter

- drugs stimulate structures directly and indirectly

Psychodynamic therapies for Substance use disorder

- clients helped to become aware of and correct underlying needs and conflicts related to drug use

- not highly effective; more useful when combined in multidimensional treatment program

Cognitive-behavioral treatment for substance use disorder

- clients are helped to identify and change behaviors and cognitions that contribute to patterns of substance misuse

- interventions: contingency management, relapse-prevention training, acceptance and commitment therapy (ACT)

Biological treatments for substance use disorder

- help people withdraw, abstain, or maintain level of use without further increases

- detoxification

- drug maintenance therapy

detoxification

- systematic and medically supervised withdrawal

- antagonist drugs

- intended to help the person resist falling back into a pattern of substance use disorder or dependence

- opioid antagonist drug is naloxone (narcan)

drug maintenance therapy

methadone maintenance programs are designed to provide a safe, legally and medically supervised substitute for heroin

Sociocultural therapies for substance use disorder

- believe psychological problems emerge in a social setting and best treated in a social context

- self-help and residential treatment programs

- culture and gender-sensitive programs

- community prevention programs

Self-help programs for substance use disorder

groups like AA (#1 group for all types of addictions)

- no therapist help them

- run by people who are longer term sober

- help each other to reach sobriety

- tokens are a positive reward

- getting a sponsor is someone you can call and be a model of sobriety for you

Gambling disorder

- addictive nature of the behavior

- genetic predisposition

- heightened dopamine activity when gambling

- impulsive, novelty-seeking personality style

- repeated cognitive errors

- men are much more likely to be addicted

treatment for gambling disorder

- relapse-prevention training

- biological approaches (opioid antagonists)

- self-help programs (gamblers anonymous)