Psych 111 - Unit 5

Psychological Disorders

Important Terms

Comorbidity: At least 2 psychological disorders at the same time, some sort of hang together (depression & anxiety).
Lifetime Prevalence Rate: How likely it is for a given person to develop a psychological disorder at any point in their lifetime.
Etiology: apparent cause and developmental history of a disorder.
Epidemiology: study of distribution of disorder in a given population.
Insanity Defense: not psychological term (legal term), idea that at the time of commission of time, person is unable to tell good/bad actions. (Headspace)
Violence Rates: Myth that those w Psychological disorder more likely to be violent (myth) 3-5% of violent crime contributed to someone w psychological disorder, more low than it should be considering how many have disorders. Those with psychological disorders are 10x more likely to be victims of a violent crime instead.

Abnormal Behavior:How we determine that behavior is abnormal that makes a disorder

Deviance: how typical their behavior is when compared to the average person. A lot of deviance = abnormal behavior. Less important than it used to be.
maladaptive: how much does this behavior interfere with the ability to lead their normal life.
Personal distress: how much distress is the person feeling related to this behavior.
Value judgements: what is personally distressing to one person may not be personally distressing to another; how much should we see in a person to see it’s abnormal.
Symptoms: what is going along w this behavior, where we’re looking for an actual diagnosis.

DSM: Diagnostic and Statistical Manual

for Psychological disorders. If it’s not in this book, typically it’s not considered a disorder.
Current Edition: DSM 5, prior it was categorized differently, now we look at things on a spectrum.
How it works: symptoms under each disorder. In order to be diagnosed, you have to exhibit a certain number of symptoms for a certain period of time.
Changes: sees the most in autism.

Neuro-Developmental Disorders: in order to be diagnosed, has to be originated in childhood.

Intellectual Disabilities: IQ falls below mean, some difficulty in everyday life.
Learning Disorders: things like dyslexia, if you end up having some issue but it doesn’t present until later it might be under a bigger issue
ADHD: Attention deficit hyperactivity disorder. Has difficulty focusing attention, high impulsivity. Symptoms present prior to the age of 12. Girls tend to be under-diagnosed
Autism spectrum disorder: issues w sociality, extends from peers to social figures. Ability to socially interact with others.

Depressive Disorders: focus is on depression

Major depressive disorder: high level of depression that lasts over an extended period of time, prevalence rate of 7% (any given time in America,
7%: of population meet criteria of diagnosis).
Seasonal Affective Disorder: see depression at different times of year. More depressed in winter compared to other seasons
Persistent Depressive Disorder: Long lasting but not as severe as MDD. You’re still depressed but it’s not as low as MDD, may not have as many symptoms as MDD. Bc it still impacts you, it’s a lighter version of it basically.
Age of onset: ppl can have depressive episode prior to depression in for example like ur 60s.
Recurrence: most ppl who have depression have between 5-6 episodes of depression across their lifetime that last between 6 months and a year.
Anhedonia: literally means an inability to feel joy. Ppl w depression no longer like the things they like.
Sleep: disruption, sleeping too much but it’s not the good sleep.
Helplessness Theory: thought pattern that traps you in your depression. Explains things and 3 attributions that people who deal with this make, essentially traps you.
Internal: it’s my fault.
Stable; it’s always going to be my fault.
Global: everything is my fault.
Depression realism: ppl that r depressed are actually more realistic abt the world than ppl who aren’t.
Depressed Brains: MRI shows there’s less activity with someone diagnosed with depression. Especially true in areas of the brain that deal with processing emotions and emotion regulation.

Bipolar Disorders: Unique component, some depression but also the opposite of depression. Much rarer than depressive (2.8% at given time meeting diagnosis)

2.8
Mania: Depression u feel bad and negative, but mania is the opposite. Tons of energy, impulsive, don’t need to sleep, you feel awesome and like an amazing person. However, it takes these emotions to an extreme.
DIGFAST: Distractibility (rlly hard to get them to focus), Indiscretion (not uncommon to make risky sexual/money decisions), Grandiosity (feel great abt urself) Flight of ideas (constantly moving to next topic) Activity increased (productive but unlikely to finish them), Sleeplessness (stay up), Talkativeness (talk for hours abt nothing and everything).
Bipolar I: High levels of mania, high levels of depression. High highs, low lows.
Bipolar II: not as manic, but still has low lows. More defined by depression but mania still there.
Cyclothymia: medium high, medium low.

Psychological Disorders: Announcements

EC appears on brightspace; will not hurt your grade. Don’t stress about that, more EC coming.
Feel free to email her.
The fifth exam is just over this section, can be dropped.

Bipolar Disorders

Creativity: strong correlation between creativity and BD. Evidence suggests many artists had this.
Heritability: strong rate, if you have the genetics for bipolar you have a great likelihood of developing it.

Anxiety

Involves
Strong negative emotions: fear, disgust, grief, panic.
Physical apprehension: feel afraid of doing something physiologically (breathe might increase, flight or fight). Can feel things such as shakiness.
Generalized Anxiety Disorder (GAD): general feeling of dread or something is going to go wrong.

Phobias: anxiety is tied to certain triggers, feel anxiety response when there’s no actual threat.

Acrophobia: fear of heights.
Claustrophobia: fear of small or contained spaces.
Brontophobia: fear of storms, thunder, lightning.
Hydrophobia: fear of water.

OCD: the video.

2 parts to OCD: the obsession (internal cognitions, no control over this/intrusive thoughts), the compulsion (behavioral responses to obsessions).
People with OCD are aware they’re being irrational but because of what their brain is telling them they still feel driven to engage in these behaviors.

Anxiety

Body Dysmorphic Disorder: you have an unrealistic perception of your physical flaws.
Considered an anxiety disorder because you’re preoccupied with how others see those flaws.
PTSD: Affects anyone that has had a traumatic experience. Has a singular cause (a traumatic event).
2 symptoms, Hypervigilance: hyper aware of your surroundings. Reliving their traumatic event many times because it is intrusively coming to mind at inappropriate times.
Disordered cognitions
Misinterpreting harmless situations: ppl w anxiety disorders interpret them as HARMFUL.
Focusing on perceive threats: over focusing on it.
Selective recall: recall info that fits with their anxious cognitions.
Origins
Learning: If you have a parent that has an anxiety disorder, you as a child can learn those same anxious triggers.
Anterior Cingulate Cortex: part of the brain that monitors and checks for errors in those behaviors. Overactive in people with anxiety.
Genetic: if a family member has anxiety disorder, you have a higher likelihood to develop an anxiety disorder.
GABA: ppl with anxiety disorder have a deficiency in GABA.
-19%: about 1 in 5 ppl experience some sort of anxiety disorder in their lifetime.

Schizophrenia

“Split mind”: an error in your perception of reality.
1%: of the population experience it, it is a very rare disorder. Because they’re misperceiving reality, it's their truth even though it's factually untrue in reality.
Hallucinations: having a sense experience without external stimuli.
Delusion: you’re holding a false belief or exaggeration that is distant from reality.
Catatonia: you get in a physical position that looks like it would be really uncomfortable, but they maintain that position for an extended period of time. Basically means a lack of movement.
Types: 4 types based on symptoms, but was abandoned in most recent DSM, separated into acute and chronic disorders.
Acute vs Chronic: Acute is where someone who was a typical person develops very extreme schizophrenia in a very quick period of time, chronic is a slower development of schizophrenic symptoms. Easier to treat acute. Additionally, schizophrenic episodes are longer in chronic than acute.
Genetics: strong component in it. partially driven
Dopamine: neurotransmitter that gets the blame for schizophrenia (too much dopamine).

Personality Disorders: disorders relating to personality

Cluster
Odd-Eccentric: ppl with it that fall under this cluster tend to feel different from others, as well as having difficulty relating to others.
Schizoid: typically have lack of interest in forming relationships, not much emotional response, kind of just like a cold fish.
Dramatic-Emotional/Erratic: lots of impulsivity in ppl that have them, as well as attention seeking behaviors.
Borderline: People have a hard time regulating their emotions, hard time maintaining relationships, inconsistent self image. Historically diagnosed more in women than men. Blank space music video is a good example of BPD.
Antisocial: more likely in men than women, tend to have little care for social norms or expectations. Quick temper
Anxious-Fearful: high level of anxiety and artificially restricting their behavior to deal with that anxiety.
Obsessive-Compulsive Personality Disorder: tend to be very rigid in their patterns/rituals, obsession component and intrusive thoughts are missing and don’t think their behaviors are irrational.

Somatic Disorders: disorders that focus on issues relating to bodily awareness and illness.

Illness Anxiety Disorder: preoccupation with illness symptoms and behaviorally you’re constantly checking for those symptoms.
E.g. Take temperature, blood pressure every morning, convinced they have some sort of illness.
Factitious Disorder: someone enjoys the attention they get when they’re sick. In order to maintain/get that attention, they fake illness.
Introducing blood into urine
Using stuff they know they’re allergic too
Going to multiple doctors to get the diagnosis they want.
Factitious Disorder Imposed on Another: Rather than the attention you get, you like the attention you get from the nurse role (basically you like getting someone else sick and the attention from helping them).
E.g. Gypsy Rose case

Dissociative Disorders: disorders marked by extreme issues with memory and/or identity.

Dissociative Identity Disorder (DID): Multiple personality disorder, patient says they have many different personalities living within themselves, lots of controversies relating to this disorder on people debating whether it exists.
Dissociative Amnesia: someone is going to forget important details about a specific event. Can be a very traumatic event (repression component that Freud talked about, details lost for perpetuity).
Dissociative Fugue: occurs when a person basically becomes confused about their identity and ends up traveling to a new place with no memory of how they got there. (Recognized now as more of an amnesia disorder but has been discussed as a dissociative disorder for a while).
Doesn’t include some brain injury or trauma, just a sort of behavioral reaction they seem to have.

Treatments for Disorders

Important Terms/People

Dorothea Dix: activist who focused on the treatment of patients at psychiatric hospitals. Discovered poor treatment that patients were experiencing, published it and was critical for acknowledging how to treat people who suffered in an ethical way.
Anna O & Josef Breuer: actual name was Bertha Pepinheim, brought to Josef Breuer who was not a strict doctor and had difficulty w hearing, speech, and not being able to move right side. Diagnosed w hysteria because they thought women went crazy. Breuer is recognized as being one of the first to do psychological therapy.
Bradmann’s Area 25: Area in prefrontal cortex, tends to be overactive in depressed patients. Deep brain stimulation helps treat it (zaps area and gets it to reset and causes depression to alleviate). Potential salvation if other methods of treatment aren't working.
PsyD: focuses on counseling and training. The PhD program focuses on research, while PsyD focuses on clinical term.

Important Terms

Incongruence: the difference between someone's self concept/how they think about themselves and reality.
Most of therapy is about bringing these 2 concepts together: shifting your perception about yourself and promoting your personal growth.
Ecological momentary assessments: tools so that your therapist is getting consistent data about how you’re thinking and how you’re feeling.
Usually through text from the phone where you fill out a survey so your therapist has a clear idea of what's happening when you’re not in therapy.
Insight therapies: therapy best way to improve someone’s psychological functioning is giving them insight on why they’re having those thoughts and acting/feeling that way.
Active listening: process which the therapist is echoing, restating, or seeking clarification on what the patient is saying.

1.) shows the therapist is actively responding to what the patient is saying, so the patient feels heard.

2.) making sure the therapist is essentially interpreting the patient correctly.

Cognitive Therapy: different types of therapies that are focused on cognition.

Socratic Method: therapist poses questions that are intended to highlight lack of logic in a patient’s cognitions.
Effective for depressive genic thinking (helplessness theory), highlights how not everything is the patient’s fault, hope for the future.
Depressogenic Thinking: thinking patterns that keep patient trapped in that depressive mindset.
Cognitive Restructuring: a patient is going to start replacing their irrational beliefs with more rational beliefs + tools to restructure those thoughts.
Cognitive Behavioral Therapy (CBT): cognitions affect behaviors, behaviors affect emotions, emotions affect behaviors.
Rational Emotive Behavioral Therapy: kind of unique and combative, rather than presenting questions the therapist is more explicit/confrontive/combative when it comes to their disagreement to the client’s thought processes.
Mindfulness-based cognitive therapy: basically just CBT but adding in a mindfulness component.
Uses things such as meditation to change disordered cognitions.
Teaches how to express themselves in a non-judgmental way while still promoting change.

Other Therapy

Applied Behavioral Analysis (ABA): focuses on applying learned techniques (usually operant conditioning) and create plan in order to change behaviors so negative cognitions change with it.
Flooding: when someone has a phobic response to stimuli, you sort of overlook them with that stimuli. Theoretically, that stimuli is harmless so the patient is being exposed to that stimuli phobia and the patient can come out unscathed.
“Flooding” that patient with that stimuli to show nothing bad will happen. Isn’t particularly effective.
Systematic Desensitization: used with phobias, starts by having a patient come up with a phobic pyramid (what abt that stimuli causes u to be afraid of it). Starts w attributes not typically triggering, and builds up to most triggering aspects.
Social Skills Training: primarily used for ppl that have some sort of social phobia, also those with autism that have a hard time connecting/associating with others.
Modeling: you’re watching someone engaging in social behavior you want to engage in, trying to learn from their examples.
Behavioral Rehearsal: trying to practice those skills you observed/learned in a safe environment (usually a therapist’s office).
Shaping: starting to take those techniques you practiced and use them in the real world. You kind of start small/easy, as you feel more comfortable with those smaller actions you move to more complex actions.
Unconditional Positive Regard: the therapist is unconditionally accepting that the patient has worth just by being a person.

Other therapy

Stress Inoculation Training: teaching people to change their thought processes that occur during specific stressful times.
Fairly common for people with jobs such as nurses, EMTs, doctors to go through this process. You don’t necessarily have to have these jobs to go through this.
Technological: technology advancing
Virtual reality: typically helpful for people with phobias by exposing them in a safe environment (virtual). Good starting place.
Apps: some better than others, use apps that connect with therapists that are more specialized. Mindfulness apps
Group: group therapy can be just as effective as individual therapy. Usually a facilitator, sometimes a therapist/involved with the group for a very long time, the people in the group share some sort of problem that they can solve.

-E.g. AA (Alcohol’s Anonymous) It provides a high level of social support, acceptance, you start to see you’re not alone in experiencing these thoughts/feelings.

Common Denominators

Therapeutic Analysis: The therapist/expert is providing external insight to patients' thoughts or behavioral patterns.
Providing Emotional Support/Empathy: emotional support can be a critical element that you’re potentially only getting in therapy.
Provides external support/validation that's important in order to feel comfortable to make those changes.
Hope and Positive Expectation: Therapists can help dispel the notion that change is futile and provide concrete steps that can bring you to a more positive growth.
Rationale: Help you have clarity by providing reasoning to those irrational thoughts to alleviate those anxieties.
Opportunity for Expression: Can say things you can't say to anyone else. Therapy gives you clarity to express emotions you might not be able to express externally.

Barriers to Therapy

Lack of Insurance: mental health is often not covered in traditional health insurance, and unlike vision and dental it's not very common to get that coverage. Even when you are covered, there’s usually a large co pay. Especially when you start out you’re supposed to go regularly, it often becomes something unattainable.
Cost Concerns: another barrier, even with insurance it can still be expensive, especially if you go multiple times in a week.
Time Concerns: “do you have the time to do this?” Compared to other medical needs, therapy typically last 45 mins-1 hour, so you have to be able to take time off for session/travel/doing external things the therapist asks you to do. TIme costs can prohibit those people from therapy.
Stigma: specifically around men getting help, make it ok to not be ok to see change in yourself and seek health.

Medication: another way of dealing with those symptomatology.

Psychiatry: different from psychology, the process of using medication to cause psychological changes.
Typically the psychiatrist goes to med school.
Length of Time: some ppl only need to be on medication for a short period of time, when life gets stressful you can get off those medications. Others might need to be on them for the rest of their life.. It is variable and depends on symptoms.
Joint treatment: doing therapy as well as medication.

Anti-Depressants: misnomer, used for more than just depression disorders. Also used for anxiety disorders as well as depression.

SSRIs: Selective Serotonin Reuptake Inhibitor, newest most commonly prescribed.
Tricyclic: focus on serotonin as well, but also look at norepinephrine.
Side effects include Dry mouth, weight gain, irritability.
MAOI: least commonly prescribed (don't have to know what it stands for) because it largely affects neurotransmitters. Affects norepinephrine, epinephrine, dopamine, and serotonin. Changes the largest amount of things.
Different peoples' depression can be dependent on different neurotransmitters, which is why they might be prescribed this. Usually starts with SSRIs and if it doesn’t work, they try the next.
Treatment Time: takes about a month to see the therapy effects. Has built up in system to cause changes in the brain.
Shared side effect: increased suicidal risk. Depression can zap you of energy, depressants helps get energy back, thus can cause an increased risk during the beginning of time.

Other Medications

Anti-psychotics: most commonly prescribed for schizophrenia, also bipolar.
Positive Symptoms: (excess) e.g. hallucinations. Work more w positive symptoms than negative. Negative Symptoms: (lack) e.g. catatonia [the weird positions to stay in for long period of time]
Adherence: not taking the medication as prescribed (e.g. feeling like the doctor is out to get you so you don’t, mania makes you feel so amazing you feel like you don’t need to take the medication).
Time Delay: depends on how you’re getting those medications. Take about a week to show change. Some antipsychotics are liquid rather than pills so they work quicker but can have more extreme side effects (goes back to balancing fact).
Tardive Dyskinesia: side effect that manifests as uncontrollable movements or ticks typically of the mouth or hands (too effective).
Stimulants: primarily used for ADHD. Work in opposition to ADHD. Legal and illegal (e.g. cocaine).
Lithium: for a long time only medication that worked as a mood stabilizer. Potentially dangerous (monthly withdrawals to make sure no toxic buildup in kidneys). More synthetic drugs that don’t have those potentially fatal side effects.

Announcements/Reminders: No class tuesday, thursday review session.