Psych Exam 4 Review

Mental illness perspective

Encompasses medical perspective and roles of neurological factors like brain chemistry/structures

Disease model

Medical doctors often consider psychological problems as essentially biologically based diseases and are likely to prescribe medication as the sole treatment

Mental disorder(perspective of american psychiatric association)

Syndrome characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning

Simplified → includes biological processes but is not solely due to biological processes; treatments include both medications and psychotherapy

Causes of psychological disorders

Disorders are heterogenous → complex and multi-causal and different factors may contribute to a disorder in different people

Predisposing causes

Genetic, early life experiences

Precipitating causes

Stress like loss, break ups, or trauma

Maintaining causes

Withdrawal from others, negative cognitions, or self deprecation(turns off others)

How does predisposition interact with precipitating factors?

They are inversely related

DSM-V

Classification scheme for specific categories of mental disorders

Key qualities of DSM-V

Reliability and validity

Psychosis

Person loses touch with reality and may experience hallucinations/delusions

Neurosis

Person experiences anxiety/fear/distress but knows what is real and can recognize their unreasonable thoughts/fears

Internalizing disorders

Person directs their struggle inward

ex.) depression, social anxiety, anxiety, phobias

Externalizing disorders

Person expresses their struggles outwardly through actions/behaviors

ex.) OCD or ADHD

Psychotic disorders

Mental disorders involving a loss of contact with reality through hallucinating, delusions, or disorganized thinking

ex.) schizophrenia

Psychotic features

When symptoms of psychosis occur as part of another mental disorder

ex.) person with severe depression also experiences psychosis

Hallucination

Seeing or sensing something that isn’t there

ex.) hearing voices or seeing things

Delusions

Believing something that isn’t true

ex.) believing aliens are following you

Personality disorders

Include patterns of thinking, feeling, or behaving in ways that are unhealthy in everyday life

ex.) narcissistic, antisocial, borderline, avoidant, or ocd

Two major mood disorders

Depressive(prolonged and intense feeling of too down with sadness/irritability) and bipolar(prolonged and intense feeling of too up with elation/sadness)

Major depressive disorder

5 symptoms present in same 2 week period

Symptoms include feeling sad/worthless/hopeless, low energy, unable to concentrate, sleep problems, appetite problems, no pleasure, or thoughts of death

Persistent depressive disorder(dysthymia)

Less severe but chronic at least 2 symptoms persisting over a 2 year period

Disruptive mood dysregulation disorder

Category for children 6-18

Symptoms present in at least 2 settings for at least 12 months with no more than a 3 month period without all symptoms =

Includes severe recurring temper outbursts and angry/irritable moods(3 times a week)

Premenstrual dysphoric disorder

Depressive symptoms occurring severely before menstruation

Bipolar disorder(I)

Manic periods of extreme energy/activity/racing thoughts and no sleep, prolonged elation/grandiose, risky and poorly planned behavior, and usually a major depression episode(NOT required)

Bipolar II

Hypomanic episode and a major depression episode(REQUIRED)

Cyclothymic disorder(less severe)

Milder symptoms, less impairment, and at least 2 years duration

Mood disorder seasonal patterns

Winter → depression

Spring → mania

Biochemistry of unipolar depression

Disturbance in the neural pathways that use monoamines(serotonin, norepinephrine, and dopamine) as their primary neurotransmitter

→ depression is associated with reduced activity of monoamines, especially serotonin

→ mania/bipolar may be due to increased norepinephrine/dopamine and decreased serotonin

Antidepressant drugs…

Increase post-synaptic activity of monoamines(prozac,zoloft,lexapro)

SSRIs

Selective serotonin reuptake inhibitors → increase serotonin activity

Symptom relief is delayed for about 2-3 weeks

Wellbutrin

Other drugs used to treat depressive disorder; not an SSRI but affects dopamine/norepinephrine neurons(also for smoking cessation)

Medications for bipolar disorder

Lithium → weight gain, tremors, kidney damage

Mood stabilizers like carbamazepine or abilify

Seroquel → helps lower mania and helps with depressive episodes

ECT

Electro convulsive therapy

Used for severe depression

Not used commonly as the side effects are crazy

Major depressions brain structure

Low frontal lobe(left) activity

Increased activity in the amygdala(like anxiety disorders)

Twin studies on genetic factors on depression

Genetics are important but STRESS is necessary for genetic liability to be manifested into depression

Major stressor in depression is…

LOSS(of loved one, social network, friends, health, job)

→ high social support can buffer the effects of LOSS

Loss + low social support = closely associated with depression

Beck’s Cognitive Theory of Depression

Vulnerability to depression is associated with a cognitive style characterized by a negative view of self, world or future

→ results from distorting experiences so that they always lead to negative implications

→ maxing failure, minimizing success, arbitrary inference

Seligman’s Hopelessness Theory of Depression

Tendency to attribute failures to stable(no change) and global (is widespread)

→ leads a person to person to feel like they are helpless to change anything

Best medication for depression

Combination of antidepressants(medication) and cognitive therapy(psychotherapy)

→ empirically supported therapies(cognitive CBT therapy), interpersonal therapy

→ important additional factors - increasing support, activity, exercise

Anxiety disorders

Marked by excessive feelings of fear and anxiety

Anxiety = response to a vague or less clearly specified threat

Fear = response to a specific perceived threat

Generalized Anxiety Disorder

Relatively constant experience of anxiety that is not directly associated with any specific threat

→ excessive worry, problems sleeping, nervous/physiologically aroused

Biology of generalized anxiety disorder

Overactivated amygdala and reduced neurotransmitter (GABA)

→ associated with childhood trauma/stress, inhibited temperament

Cognitive in generalized anxiety disorder

Excessive worry and increased attention to potential threat(vigilant)

Treatment with generalized anxiety disorder

Relaxation and coping skills

Drugs → benzodiazepines (mild tranquilizers) like valium and xanax(affects GABA receptors) or Buspar(affects serotonin system)

Specific phobia

Irrational fear and active avoidance of feared specific stimulus/situation

→ treat with exposure therapies

Social anxiety disorder

Treat with exposure therapies and SSRIs

Panic disorder

Treat with CBT and relaxation and SSRIs

Agoraphobia

Treat with CBT, exposure therapies, and SSRIs

OCD

Treated with SSRIs or exposure/response prevention

Positive symptoms

Adding something → like delusions and hallucinations

Negative symptoms

Missing something → absence of affect, no speech

Cognitive symptoms

Poor sustained attention and low working memory capacity

Schizophreniform disorder

Same as schizophrenia just shorter duration(< 6 months)

1/3 recover

Drugs for Schizophrenia

Drugs that block dopamine activity → most effective at reducing psychotic symptoms

Drugs that increase dopamine activity → produce a temporary schizophrenic like symptoms

LSD does NOT mimic Schizophrenia

Neuroleptics

Reduce positive symptoms → phenothiazines(chlorpromazine/thorazine) or butyrophenomes(aldol)

New generation drugs

Reduce negative symptoms → clozapine or risperidone

Dissociative identity disorder

Two+ distinct personalities that alternate dominance (multiple personalities)

Mostly occurs in women

Somatoform disorders

Occurrence of physical symptoms are not due to any physical disease process

Hypochondriasis

Preoccupied with health and worried about getting sick