Exam 2 (Weeks 5 - 9) Flashcards
What is depression
low, sad state in which life seems dark and its challenges overwhelming
Mania
opposite of depression - state of breathless euphora, frenzied energy, in which people have an exaggerated belief that the world is theirs for the taking
Bipolar disorder
alternating or intermixed periods of mania or depression
How common is unipolar depression?
5% are mild forms, 8% are severe
20% of adults will have an episode of severe unipolar depression at some point in their lives
depression is higher among people of lower SES
women are 2x more likely than men
more common among transgender/nonbinary people than cisgender people
28% of Indigenous people, 23% white people – but minorities are less likely to get treatment
Symptoms of Depression?
- emotional: feel sad, dejected, miserable, empty – lose sense of humor, sense of pleasure, and anxiety/anger
- motivational: lose desire to pursue their usual activities; lack of drive and initiative
- behavioral: less active and productive; more time alone and may stay in bed for longer
- cognitive: hold extremely negative views of themselves, pessimism, feel their intellectual ability is poor
- physical: headaches, indigestion, constipation, dizzy spells, general pain, disturbances in sleep and appetite
Major Depressive Disorder
a severe pattern of depression that is disabling and not caused by factors as drugs or a general medical condition
Persistent Depressive Disorder
a chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression
Premenstrual dysphoric disorder
People who repeatedly have clinically significant depressive and related symptoms during the week before they menstruate
Postpartum depression
major depressive disorder begins within 4 weeks of delivering a child, and many cases begin during pregnancy
- affect parent-infant relationship, self-image of parent, psychological and physical health of child
What triggers unipolar depression
Stress - 80% of all severe depressive episodes occur within a month or two of a significant negative event
What is the biological model of unipolar depression?
- genetic factors: people inherit a predisposition to depression
- biochemical factors: low activity of 2 neurotransmitter chemicals, norepinephrine and serotonin are strongly linked to depression – and the interactions between serotonin and norepinephrine specifically, and when glutamate is involved
- hormones: in the hypothalamic-pituitary-adrenal axis, people with depression overly react in the face of stress, causing excessive releases of cortisol and related hormones
- brain circuits: prefrontal cortex, hippocampus, amygdala, and subgenual cingulate are all related and may be malfunctioning in depression
- immune system: under intense stress, immune systems become dysregulated and lead to slower funcitoning of important white blood cells and increase pro-inflammatory cells that cause inflammation and vairous illnesses
What are the biological treatments of unipolar depression?
- antidepressant drugs
- brain stimulation
Types of antidepressant drugs?
- MAO inhibitors that increase serotonin and norepinephrine
- tricyclics that act on the neurotransmitter re-uptake mechanism and keep serotonin and norepinphrine in their synapses for longer to properly stimulating receiving neurons
- SSRIs: Prozac, Zoloft, Lexapro
- ketamine: alleviates depression very quickly, helps people who are unresponsive to other kinds of treatments and people who are suicidal; increases activity of glutamate in the brain
Types of brain stimulations?
- electroconvulsive therapy that sends electrical currents, causing convulsions in the brain
- vagus nerve stimulation: implanted pulse generator sends regular electrical signals to a person’s vagus nerve; the nerve the stimulates the brain
-transcranial magnetic stimulation: electromagnetic coil is placed on the patient’s head, and sends a current into the brain which increases neuron activity - deep brain stimulation: a pacemaker powers electrodes that have been implanted in the patient’s subgenual cingulate, which stimulates that area
What is the psychodynamic explanation of depression?
- depression is similar to grief in people who lose loved ones
- there is then a series of unconscious processes set in motion - mourners first regress to the oral stage of development, so they merge their identity with the person they lost and symbolically regain that person. So all feelings of anger/sadness for the loved one is turned inward. This reaction is called introjection, which is temporary UNLESS the patient had various dependency needs that were improperly met during infancy and early childhood. This leads to depression.
Symbolic loss
Freudian theory
- the loss of a valued object that is unconsciously interpreted as the loss of a loved one, aka imagined loss.
What is the psychodynamic treatment for depression?
- bring underlying issues to consciousness and work them through
- free association, interpretations of the client’s associations, displays of resistance and transference, and then help the person review past events and feelings
Downside to psychodynamic treatment for depression?
Long-term pscychodynamic therapy is only occasionally helpful in cases of unipolar depression b/c:
1. depression clients may be too passive and feel too weary to join fully in the subtle therapy discussions
2. clients may become discouraged and end treatment early when long-term approach isn’t able to provide quick relief
What is the cognitive-behavioral model of depression?
combo of maladaptive behaviors and dysfunctional ways of thinking. Theories fall into 3 groups:
1. Explanations that focus mostly on the behavioral realm
2. give primary attention to negative thinking
3. feature a complex interplay between cognitive and behavioral factors
What is the behavioral dimension to depression, according to the cognitive behavioral model?
- rewards people receive in life is related to the presence/absence of depression, and especially social rewards
What is the negative thinking dimension to depression, according to the cognitive behavioral model?
- people develop maladaptive attitudes as children that are a result of their experiences, judgments of people around them, and society
- thinking takes the form of a cognitive triad
- errors in their thinking
- automatic thoughts that are a steady train of unpleasant thoughts that keep suggesting to them that they are inadequate and have a hopeless situation
- ruminative responses to their depressed mood – dwell on it, instead of acting to change it
What is a cognitive triad?
individuals repeatedly interpret their
1. experiences
2. themselves
3. and their futures
in negative ways that leads them to feeling depressed
What is the learned helplessness in depression, according to the cognitive behavioral model?
people become depressed when they think
1. they have no control over the reinforcements (rewards/punishments) in their lives and
2. they themselves are responsible for this helpless state
What does cognitive-behavioral therapy do with patients with depression?
- behavioral activation: therapists work systematically to increase the number of constructive and rewarding activities and events in a client’s life.
- 3 key components:
1. reintroduce depressed clients to pleasurable events and activities
2. consistently reward nondepressive behaviors and withhold rewards for depressive behaviors
3. help clients improve social skills
What is cognitive therapy and how does it help patients with depression?
a therapy developed that helps people identify and change the maladaptive assumptions and ways of thinking that help cause their psychological disorders.
- increasing activities and elevating mood
- challenging automatic thoughts
- identifying negative thinking and biases
- changing primary attitudes
What is the sociocultural model of depression?
- depression is strongly influenced by social context that surrounds people, depression is triggered by outside stressors
2 models:
1. family-social perpsective
2. multicultural perspective
What is the family-social perspective of depression?
- research shows that people with limited social support, isolation, and lack of intimacy are likely to become depressed
What are family-social treatments for depression?
- interpersonal psychotherapy: based on the belief that clarifying and changing one’s interpersonal problems helps lead to recovery
- couple therapy: therapist works with 2 people who share a long-term relationship
What is the multicultural perspective of depression?
There are links between gender and depression
- transgender/nonbinary people internalize society’s stigmatizing messages
- hormones can trigger depression, especially during puberty, pregnancy, and menopause
- body dissatisfaction explanation: most females in Western society become dissatisfied with weight/body and show signs of depression
- lack of control theory: women feel like they have less control over their lives
- rumination theory: women are more likly to ruminate that men
as well as cultural background and depression
- Depressed people in non-Western countries are more likely to be troubled b physical symptoms
- white people appear to have higher rates of depression, but black people more likely to have recurrent episodes of depression
What is the multicultural treatment of depression?
- culturally responsive therapies are designed to draw on a person’s cultural strengths and address the unique issues faced by people of color and other marginalized persons
What are the symptoms of mania?
- active, powerful emotions in search of an outlet
- seem to want constant excitement, involvement, and companionship (little awareness that their social style is overwhelming, domineering, and excessive)
- very active behavior, move very quickly, talk loudly and rapidly, flamboyance
- show poor judgment and planning, inflated opinions of themselves
- remarkably energetic – typically get little sleep, but feel/act wide awake
Ways to diagnose bipolar disorder?
People are considered to be in a full manic episode when for at least 1 week they display the symptoms
- people with bipolar I disorder have full manic and major depressive episodes – there is an alternation, weeks of mania followed by a period of wellness, followed by an episode of depression
- people with bipolar II disorder have hypomanic (mildly manic) episodes with alternating major depressive episodes
- in both, people’s depressive episodes last longer than the mania
Cyclothymic disorder?
A disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms
What causes bipolar disorders?
- neurotransmitters (irregular activity)
- ion activity (irregularities in the transport of ions cause neurons to fire too easily or stubbornly resist firing)
- brain structure and circuitry: smaller hippocampus, basal ganglia, and cerebellum
- genetic factors: people inherit a biological predisposition to develop bipolar disorder
What are the treatments for bipolar disorders?
- mood stabilizing drugs and strategies
- adjunctive psychotherapy
What is a parasuicide vs suicide?
- parasuicide: a suicide attempt that does not result in death
- suicide: a self-inflicted death in which the person acts intentionally, directly, and consciously
What is a subintentional death?
A death in which the individual plays an indirect, hidden, partial, or unconscious role
What is nonsuicidal self-injury (NSSI)
Direct and deliberate destruction of one’s own body that is not accompanied by an intent to die
How is suicide studied?
retrospective analysis: a kind of psychological analysis in which clinicians piece together information about a person’s suicide from the person’s past
studying people who survive their suicide attempts
What are the patterns and statistics of suicide?
- South Korea, Russia, South Africa, and Ukraine have very high rates; Columbia, Egypt, Peru have very low rates; USA falls in between
- countries that are largely Catholic, Jewish, or Muslim have very low rates but there are exceptions
- at least half of people who commit suicide have a low number of close friends and contacts
- also people who are single/never married; or are in violent, distressing relationships
- LGBTQ+ people die at a higher rate of suicide
What triggers a suicide?
- Stressful events and situations: more stressful events; like immediate stress (loss of loved ones, jobs, natural disasters) and long term (social isolation, serious illness/injury, abusive environment, occupational stress
- Mood and thought changes: preoccupied with problems, lose perspective, see suicide as the only effective perspective, develop sense of hopelessness and use dichotomous thinking (viewing problems and solutions in rigid either/or terms)
- Alcohol and other drug use: 1/4 of people who commit are legally intoxicated or have extended drug use
- Mental Disorders
- Modeling: if people around an individual commit, that person is now more at risk to commit
What is the underlying cause of suicide in the psychodynamic view?
- results from depression
- results from anger at others than is misdirected at oneself
- early parental loss is related to suicide risk
What is the sociocultural view of suicide?
Probability of suicide is attached to how attached a person is to such social groups as the family, religious institutions, and community. The more thoroughly a group belongs, the lower the risk. 3 categories of suicide:
1. Egoistic: carried out by people over whom society has little or no control — people not concerned with norms/rules
2. Altruistic: people who are so well integrated into social structure that they intentionally sacrifice their lives for its well-being
3. Anomic: people who’s society fail to provide stable support, such a s family and religion
What is the interpersonal view of suicide?
People will be inclined to pursue suicide if they hold 2 key interpersonal beliefs:
1. Perceived burdensomeness — existence places a heavy burden on their family, friends, and even society
2. Thwarted belongingness — feeling isolated and alienated from others
And have the psychological capability to carry out suicide, which they’ve acquired through life experiences
What is the biological view of suicide?
- higher rates of suicide among parents and close relatives of suicidal people than among those of suicidal people
- serotonin levels are low in people who die by suicide
Is suicide linked to age?
- children: infrequent, but has been increasing. Linked to recent/anticipated loss of loved ones, family stress, parent’s unemployment, parental abuse, bullying, clinical level of depression
- adolescents: tied to clinical depression, low self-esteem, feelings of hopelessness, and have persistent anger and impulsiveness as well as serious drug/alcohol problems. Under great stress like challenging relationships with parents, family conflict, history of abuse, inadequate peer relationships, social isolations, repeated bullying. Falling out with friends, loss of loved one, stress for school, LGBTQ teenager
- older adults: become ill, lose close friends and relatives, lose control over their lives, and lose status in society — this results in feelings of hopelessness, loneliness, depression, ‘burdensomeness’, or suicide
What treatments are used after suicide attempts?
- most need medical care, and need to go to the ER — some immediately go into psychotherapy/drug therapy, but as many as 46% don’t get any treatment
- CBT may be particularly helpful: change harmful thoughts
What is suicide prevention?
- there are many prevention programs
- suicide hotlines that contain paraprofessionals that have training but without a formal degree
- the two programs respond to people in crisis to help them calm down
Do suicide prevention programs work?
Yes! They can be effective and should be widely implemented. They do help most people who call them.
Schizophrenia
A psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor irregularities
Psychosis
A state in which a person loses contact with reality in key ways
Symptoms of Schizophrenia?
Positive symptoms delusions, disorganized thinking/speaking (formal thought disorders) and loose associations (common thinking disturbance in schizophrenia characterized by one shift in thought to another), heightened perceptions/hallucinations, and inappropriate affect (displays of emotion that are unsuited for the situation)
Negative symptoms: poverty of speech, restricted affect (flat affect - still face, poor eye contact, monotonous voices), loss of volition (drained of energy and for goals), social withdrawal
What are positive and negative symptoms?
Positive symptoms: ‘pathological excesses’ or bizarre additions to a person’s cognition and behavior
Negative symptoms: ‘pathological defects’ or characteristics lacking in a person
What are psychomotor symptoms?
Move relatively slower and more awkward movements that seem odd
- sometimes take extreme forms like catatonia (remain motionless and still for long periods of time)
What is the course of schizophrenia?
first appears in person’s late teens and mid-thirties
3 phases:
1. Prodromal phase: symptoms are not yet obvious but deterioration is already beginning - person withdraws socially, speak in vague or odd ways, develop strange ideas, express little emotion
2. Active phase: symptoms become apparent - may be triggered by stress or trauma in the person’s life
3. Residual phase: return to prodromal phase; may retain negative symptoms
What are the biological views of Schizophrenia?
- genetic factors
- more closely related to schizophrenia, higher chance to get it
- biological irregularities: neurons that used dopamine fire too often and transmit too much
- dysfunctional brain structures and circuitry: hippocampus, thalamus
- viral problems: poor nutrition, fetal development, birth complications, immune system response in the mother is passed on to the fetus and impacts developing brain
Antipsychotic drugs
Corrects gross misthinking
What are the psychodynamic views of schizophrenia?
- the mothers of people with schizophrenia are cold, domineering, and uninterested in their children’s needs
What is the cognitive-behavioral explanation of schizophrenia?
Could be
1. Operant conditioning: in our lives, people because good at reading/responding to cues, and people who respond in socially acceptable way are better able to satisfy their own needs. Some people are not reinforced for their attention to social cues, so they start focusing on irrelevant cues and that creates bizarre responses that then get reinforced instead. So eliminating these responses = crucial to helping with schizophrenia
2. Misinterpretations: misinterpreting symptoms of depression, and when people try to understand their disorder, then more features of this disorder emerges.
What are the sociocultural views of schizophrenia?
- multicultural factors: higher for LGBTQ+ people, and populations that have marginalized experiences,
- social labeling: label can become a self-fulfilling prophecy, and there is a power over the life.
- family dysfunction: some families are high in expressed emotion (members frequency express criticism, disapproval, and hostility)
What is Milieu Therapy?
Type of therapy for schizophrenia. Type of humanistic therapy — where institutionalized patients deteriorate because they are deprived of opportunities to exercise independence, responsibility, and positive self-regard. So this therapy’s premise is that institutions cannot be of help to patients unless they can somehow create a social climate (or milieu) that promotes productive activity, self-respect, and individual responsibility
What is the token economy program?
Patients are rewarded when they behave acceptably and are not rewarded when they behave unacceptably. The tokens can be exchanged for food, cigarettes, hospital priveledges, etc.
How effective is the token economy program?
Does help reduce the psychotic and related behaviors
What are the limitations of the token economies?
- many studies on it are uncontrolled
- ethical and legal concerns, b/c administrators have to control important rewards
How effective are antipsychotic drugs?
- reduce symptoms around 70% BUT have unwanted effects and are caused by the drugs’ impact on the extrapyramidal areas of the brain that help control motor function
What are the unwanted effects of antipsychotic drugs?
- parkinsonism: muscle tremors and muscle rigidity
- neuroleptic malignant syndomre: fatal reaction, consists of muscle rigidity, fever, profuse perspiration, altered consciousness, and improper functioning of the autonomic nervous system
- tardive dyskinesia: late-appearing movement disorder, appears after consuming antipsychotics for 6+ months; involuntary moving and can be very difficult to eliminate
What are the cognitive-behavioral therapies for schizophrenia?
- cognitive remediation
- hallucination reinterpretation and acceptance
Cognitive remediation?
- focuses on the cognitive impairments that often characterize people with schizophrenia, and particularly their difficulties in attention, planning, and memory
- in cognitive remediation, clients are required to complete increasingly difficult information-processing tasks on a computer
Hallucination reinterpretation and acceptance?
- provide clients with education/evidence about biological causes of hallucinations
- help clients learn more about the ‘comings and goings’ of their own hallucinations/delusions
- therapists challenge their clients’ inaccurate ideas about the power of their hallucinations
- teach clients to reattribute and more accurately interpret their hallucinations
- teach client’s coping techniques
What is the community approach to treating schizophrenia?
- you need assertive community treatment, which is a team providing medication, psychotherapy, numerous patient-staff contacts, and help in handling daily pressures and responsibilities, guidance in making decisions, social skills training, and supervision/counseling
- coordinated services
- short-term hospitalizaiton/partial hospitalization
- supervised group houses
- occupational training and support
How has community treatment failed?
- poor coordination of services
- shortage of services
What is the diathesis-stress model of depression?
Diathesis is some kind of underlying vulnerability to experience clinical depression
- More likely to present itself as depression if person also experiences significant life stressors
- Combination of two factors that really elevates risk of developing depression
What is the role of stress in depression?
- Severe stressful life events are related to depression onset
- “Independent” stressful life events (LE) predict depression
- “Dependent” stressful LE are even more strongly predictive of depression
- Chronic stresses are associated with chronic depressed mood
Rumination
cognitive process induced by low mood. Cognitively, repetitive process and thinking about how to explain what I’m feeling, what I could maybe do about it → generally feeling stuck. Spending a lot of time thinking about what’s going on, but not doing anything about it. It is ineffective in helping a person feel better → person actually feels worse
What is the prevalence of bipolar disorder among men vs. women?
- Equally common in men and women, fairly equal in prevalence across different societal groups; not a very common disorder
- Misdiagnosis is fairly common → first diagnosed as something else and then it gets corrected
What is the role of dopamine in biopolar disorder?
- Dopaminergic pathways involved in reward sensitivity
- Dopamine is enhanced during mania and diminished during depression
- Communication cascades within the neuron (ion activity)
What is the behavioral inhibition system (BIS) and behavioral activation system (BAS)
The systems in the behavioral activation model:
Behavioral Inhibition System (BIS)
Children who are very risk-averse, it’s an early sign that they are prone to more anxious experiences and are protective of themselves
Someone a bit more extreme is vulnerable to anxiety
Behavioral Activation System (BAS)
Those seeking out rewarding/pleasurable experiences, it might be a vulnerability to experiencing bipolar
Behavioral Activation Sensitivity is a vulnerability to BD
- Excessive BAS activation in response to goal- and reward-relevant cues
- BAS deactivated in response to failures, losses, non-attainment of goals
- Same vulnerability, but polarity-specific triggers
if someone tried to kill themselves once, there is a much smaller chance that they will try again True or false?
False.
- Suicide attempts are a strong predictor of continued
- Higher risk if there is more than 1 attempt
Talking to someone about suicide might given them the idea that suicide is an option. True or false?
False.
This is a common myth, but not true.
Someone who wants to kill themselves will find a way to do it, whether they have access to a firearm or not. True or false?
In some ways this is true, because people utilize different methods.
But in other ways it is false, because limiting access to firearms limits the possibility of suicide. It removes access to firearms in times of crisis
Young men are at the highest risk of killing themselves. True or false?
False.
- Men are more likely to die by suicide than women, but it is OLDER men. Suicide risk elevates as a man gets older, as chronic pain, illness, loss of significant others, etc.
- But the group of young, adolescent men is concerning, because they are rising in rates of death by suicide
People who talk about killing themselves will never do it. Those who kill themselves don’t normally talk about it. They just go ahead and do it. True or false?
False.
Vast majority of people will give some kind of indication in advance
