Midterm 2 - Psychological Disorders and Treatment

Criteria to know if someone needs treatment for a mental illness

• Statistical criteria

• Social deviance

• Adaptiveness

• Personal stress

True or false: people with mental illnesses are violent and criminal

False (except for some specific illnesses) — they are more likely to be violence victims

Relationship between mental illness and life expectancy

Mental illness = risky behaviour (coping) = decreases life expectancy

The Diagnostic and Statistical Manual of the American Psychiatric Association

• current = DSM-5-TR

• Section 1: origin of the DSM5

• Section 2: 18 chapters discussing mental illnesses

• Section 3: assessment techniques and potential/ possible mental illnesses (not yet officially categorized)

• No treatments or cause information

Anxiety Disorder

• 17% of the population (most common)

• Phobic Disorder

• Generalized Anxiety Disorder

• Panic Disorder

Phobic disorder

• most common

• intense irrational fear

• causes: negative experiences earlier in life (inc. other’s fear or being told to be afraid), biological links (danger)

Generalized anxiety disorder

• 4% of population

• persistent anxiety about everything (sometimes resulting in physical symptoms due to constant stress)

• causes: neurotransmitter GABA - overactive brain (treated with tranquilizers)

Panic disorder

Anxiety not tied to a specific things - lower in frequency but higher in intensity (panic attacks)

• panic attacks at least 1/ week

• often causes a fear of public places to develop

Comorbid

2 or more mental illnesses at the same time

Obsessive-Compulsive and related disorders

• OCD

• Hoarding disorder

• Trichotillomania

• Excoriation disorder

• Body dysmorphic disorder

OCD

• Obsessive-Compulsive disorder

• uncontrollable, repeated (usually negative) thoughts } obsession

• behaviours to try and stop/ clear the obsession } compulsion

  • uncontrollable

• patients are aware thoughts aren’t normal but feel powerless

• 20% successfully recover (hard to treat)

• High heritability

• treated with exposure and response prevention therapy

  • to teach patients it’s okay to not do compulsion - very difficult for patients to go through

Hoarding disorder

• ongoing difficulty throwing things away due to anxiety

  • often rationalized

  • causes great stress and prevents functional living

Trichotillomania

• desire to compulsively pull out one’s hair due to anxiety/ depression

• earliest onset disorder (beginning in childhood)

• often doesn’t last very long and goes awaay on its as other coping mechanisms are found

Excoriation disorder

• skin picking compulsions

• early age onset

• doesn’t last very long and goes away on its own

• can lead to self harm as a anxiety management technique

Body dysmorphic disorder

• patients convinced of a “flaw” in their body (specific feature or multiple)

• diminished quality of life

• often comorbid

• can lead to “love-shyness” - avoidance of intimate relationships

Trauma and Stressor disorders

• PTSD

PTSD

• Post-Traumatic Stress Disorder

• Repeated memory of a traumatic event

• Can be comorbid with depression, insomnia, survivors guilt, etc.

• Often patients turn to substances to cope

• 10% of trauma patients experience PTSD

  • women 2x more likely to develop PTSD and socially isolate (men get aggressive and irritated)

  • more likely when a person can’t process/ understand trauma

  • More likely if there were prior mental health issues

  • More likely if IQ is lower (coping ability)

  • Smaller hippocampus (memory and retrival)

Dissociative disorders

• Dissociative amnesia

• Dissociative identity disorder

Dissociation

Mental fleeing

Dissociative amnesia

• Unable to remember some period of life due to extreme anxiety (always a loss of identity not general knowledge)

• sometimes involves actual escape from situation

• memories return suddenly

Fugue

Combination of amnesia and flight (very rare)

Dissociative identity disorder (DID)

• “multiple personality disorders”

• very rare (1%?)

• individual with 2 or more personalities (usually 3-12)

• personalities built upon a cluster of significant “memories”

• main is usually not aware of alternates (60%)

• gatekeeper personality

• possible physical differences between alters (vision, allergies)

• each personalities has its own memories

• causes: repeated sexual abuse as kids

  • women 10x more likely to develop DID

  • personalities as a coping mechanism (develop out of elaborate dissociative states due to abuse)

  • biological predisposition to dissociation

  • difficult, lengthy treatment (hypnotherapy)

    • successful if a long time passes without alters

Somatic system and related disorders

• Somatic symptom disorder

• Somatic symptom disorder with predominant pain

Somatic system disorder

• physical problems without basis (convinced sickness)

• psychosomatic illness

• not hypochondria

Somatic symptom disorder with predominant pain

The same as SSD but focused on pain and the belief of pain

Schizophrenia

• most serious (1/100 americans treated)

• develops between ages 15-40 (younger = more likely to be male)

• symptoms vary - not all necessary for diagnosis

• positive symptoms: not normal behaviour and easier to treat

• negative symptoms: lack of normal behaviour and impacts way of life more significantly

Schizophrenia symptoms

• pervasive thought disturbance (scattered thoughts)

• difficulty attending selectively (deliberate focus on one thing)

• withdrawal from contact with others

  • no opportunity for social reality testing

• delusions

  • ideas of reference (belief that external events are related to you)

  • grandeur (false sense of importance/ famousness)

  • thought broadcasting (belief that others can hear your thoughts)

  • paranoia (can indicate paranoid schizophrenia) - linked to violence

• hallucinations

  • false senses (auditory = most common)

  • emotional problems

    • blunt affect (absence of emotion shown/ inappropriate to situation)

• deterioration of adaptive behaviour (no self-care)

• symptoms pertaining to movement

  • catatonic stupor - doesn’t move but can be moved

  • waxy flexibility - when moved slowly returns to original position

  • catatonic excitability - doesn’t stop moving

Biological schizophrenia causes (hypotheses)

• dopamine imbalance

• abnormal brain activity - anatomical deficit hypothesis

  • lack of frontal lobe activity (thought/ decision)

  • high level temporal lobe activity (language)

• abnormal brain anatomy

  • enlarged fluid filled cavities (neural tissue decay)

  • small thalamus (sense regulation)

• heretical aspect (closer genetics = more likely)

Environmental schizophrenia symptoms (hypotheses

• schizophrenia - poverty link (stress?)

• schizophrenia - urban areas link (stress?)

• family dynamics: paradoxical communications (conversations leaving kids confused how ‘grown up’ they should be), familial instability

• schizophrenia - marijuana use (frequency and age risk)

• neurodevelopmental hypothesis - very early, undetected brain damage

  • flu during second trimester of pregnancy

  • obstetrical complications

  • small hands and feet indicating underdevelopment

  • link with older fathers (45+)

  • abnormal (spongy) pallet

The Vulnerability Theory of Schizophrenia

Vulnerability to schizophrenia is mainly biological and people have differing degrees of vulnerability. Vulnerability is partly genetic, partly neurodevelopmental abnormalities associated with environmental risk factors, and partly psychological (instability and stress)

Schizophrenia treatments

• anti-psychotic meds (reduces hospital time)

• full recovery more likely with sudden onset, later diagnosis, and stable life

Depressive disorders

• Major depressive disorder

• Persistent depressive disorder

• Major depressive disorder with seasonal pattern

generally:

• long-lasting and significant

• women 2-3x more likely to be diagnosed (seek help)

• can occur at any time (increased risk: adolescence, middle age, and elders - 70+)

Major depressive disorder

symptoms:

• change in appetite, lethargy, etc.

• negative self image, hopelessness

• can cause reckless behaviour (usually in men)

• suicide risk

Constant depression (severe symptoms for at least 2 weeks)

Persistent depressive disorder (dysthymia)

Depressive mood for the majority of the day for at least 2 years

• less severe symptoms than major depressive disorder

Major depressive disorder with seasonal pattern

• Seasonal affective disorder

• depression that begins in the fall and ends at the beginning of spring

Treatments:

• light therapy (highly successful) - boosts melatonin and vitamin D production (stimulated by sun)

Bipolar and related disorders

• Bipolar I

• Bipolar II

• Cyclothymic disorder

Bipolar I disorder

• mood fluctuations (depression and mania)

• suicide risk

Mania

very euphoric, social, hyper, etc. along with high risk behaviour leading to a crash into depression

Bipolar II disorder

A combination of depressive episodes and mildly manic (hypomania) episodes with frequent cycling

Cyclothymia

Numerous periods with hypomanic symptoms and depressive symptoms over 2 years

Causes of depressive/ bipolar disorders

• genetic risks

• neurotransmitters

  • serotonin/ norepinephrine (too little = depressed, too much = manic)

• inadequate social skills can impact depression

• lack of close relationships makes recovery harder (worse for women)

• depression caused and worsened by negative thoughts (cognitive triad)

Cognitive triad

1. focus on self

2. focus on world

3. focus on future

Personality disorders

• don’t always require treatment but could function better without these traits

• common common (1/7 adults)

• often comorbid/ overlap with each other

specifically:

• Schizoid personality disorder

• Obsessive-compulsive personality disorder

• Narcissistic personality disorder

• Antisocial personality disorder

• Borderline personality disorder

Schizoid personality disorder

• 3% of adults

• disinterest in relationships - isolated and chill with it

• more common among men (4:1)

Obsessive-compulsive personality disorder

• 8% adults

• rigid, perfectionist, inflexible, judgemental

• anal-retentive

• equally common in men and women

• common in uni students

Narcissistic personality disorder

• 1% of adults

• grandiosity - believe they are the most important

• holds others to unrealistic standards (expects compliments, etc.)

• interferes with relationships but don’t change behaviour (they’re never the problem)

• mirroring: wanting to be told they are superior to others

• enjoy power and believe they’d be ideal leaders (false)

• causes:

  • spoiled as a child

  • emotional neglect as a child

Antisocial personality disorder

• 4% of adults

• extremely social and charming (Aiden identifies)

• more common in men

• use people to get what they want (including breaking the law)

• goal oriented

  • rejection of social norms, reckless behaviour, etc.

• lack remorse for actions

• develops from a young age

• causes:

  • genetic connection

  • very little brain arousal around guilt/ emotion - no fear of consequence

Borderline personality disorder

• unstable interpersonal relationships

• mood swings (hate v. love)

• fear of abandonment - emotional manipulation (incl. suicide and self harm)

• appear normal (often split their world into all good or all bad)

• causes

  • attachment issues as a child

demographic most likely to see treatment

younger people and women

Biological mental illness treatments

1. Electroconvulsive shock therapy (ECT)

   • Magnetic seizure therapy (MST)

2. Medication

Electroconvulsive shock therapy (ECT)

Electromagnetic energy send through the right hemisphere of the brain - induces a brief seizure

• for depression

• painless and safe

• last resort

• 80% success rate

• risks:

  • a month of memory loss when applied to both hemispheres

  • relapses possible (but allow for meds)

  • brain damage

Magnetic seizure therapy (MST)

The same as ECT but using magnetic energy

Medication treatments for mental illness

• antipsychotics (neuroleptics)

• antidepressants

• lithium

• depakote

• anxiolytic

general:

• everyone reactions differently (ex. side effects)

• potential for severe relapse if meds are stopped too early

• treatments not cures

Antipsychotics (neuroleptics)

• most developed before the 2000s treated the positive symptoms (and had side eeffects) - targets dopamine neurons

• newer drugs treat all symptoms with few side (blood pressure risk) - target dopamine and serotonin neurons

• clozaril - most effective but potential for WBC issues

Antidepressant medication

• very common

• helpful for 70% of people (take 2-4 weeks to work)

• will help restore personality, not change it

• not researched for but prescribed for kids

• non addictive but possible side effects (ex. tyramine and high BP)

• applicable to other mental illnesses (panic disorder, OCD, etc.)

Lithium

Somehow (no literally they don’t know) it counteracts the bipolar symptoms

• possible side effect of lithium poisoning

Depakote

• anti-convulsant (originally for epilepsy)

• alternative for lithium but without the poisoning (but more expensive)

• for rapid mood cyclers

Anxiolytic drugs

• anti-anxiety/ tranquilizers

• over-prescribed

• immediately effective but short lived effects (highly addictive)

• increases the levels of GABA (slows down brain activity)

• shouldn’t be mixed with alcohol

• BuSpar = non addictive, slower working alternative

Maintenance dose

a dose of medication to keep patient stable long term

Psychological treatments (psychotherapy)

1. Classical psychoanalysis

2. Modern psychoanalytic therapy

3. Person centred therapy

4. Behaviour therapy

5. Cognitive therapy

general:

• over 250 types (eclectic)

Classical psychoanalysis (Freud)

Unconscious becomes conscious to it can be dealt with

1. Free association - no filter, free yap

   • chosen topics indicate what is buried

2. Dream analysis (dream logs)

   • dream = symbols

   - Freudian slips - speech mistakes (sexual focus)

   - Catharsis - outpouring of subconscious memory memory and emotion when probed

   - Transference - emotions transferred from subject to therapist (important milestone)

Modern psychoanalytic therapy

Less emphasis on past - current conscious matters too (and less sex emphasis)

Person centred therapy

Carl Rogers

• goal to bring real and ideal self together

• involves active listening (validation)

Behavioural therapy

general

• only cares about behaviours (not motives)

therapy

• graduated exposure therapy (flooding)

• systematic desensitization therapy

• aversion therapy

Graduated exposure therapy (flooding)

Forced confrontation with phobias to prove unfounded fears (real life)

• VR graded exposure - similarly effective

Can backfire and result i intensified fear, not guaranteed to work

• works better on more recent fears

Systematic desensitization therapy

Attempts to replace fear response with calm response (might not work but won’t hurt)

1. Anxiety hierarchy

2. Progressive/ deep muscle relaxation training

3. Patient attached to machine to measure physical fear symptoms and then told to imagine the beginning of their hierarchy - 15 sec no fear = next scene

• 60-70% successful (better for recent fears)

Aversion therapy

Last resort therapy for addictions - involves “breaking” attraction to addictive substance and replacing with aversion

• addiction and negative stimuli combined

• ex. antibuse and apomorphine

• often therapy must be repeated years later

Addiction

for alcoholism) - harmless but induces nausea with alcohol (pill in morning - last 18 hours)

• very successful

Apomorphine

for smoking additions - cigarettes dipped in mild toxin

• effective

Cognitive therapy

Attempts to replace negative thoughts with better thoughts

1. didactic stage - talk with patient and blame thoughts

2. make patient defend thoughts and realize their illogical nature

3. practice replacing bad thoughts with better ones

• effective as meds for mild-mid depression

• equips patient with lasting skills