L10: Psychological Disorders Flashcards
what are the general criteria for a disorder (4)
- Statistical rarity
–> Uncommon
–> exception of anxiety and depression which are very common (1 in 20) - Subjective distress
–> Associated with low quality of life, poor mental well-being - Impairment
–> Cognition, emotion regulation and attention - Biological dysfunction
–> Significant abnormalities in the nervous system
what are four common controversies of diagnosing people?
- Diagnosis is categorizing people (pigeon-holing)
* A person does not lose their individuality with diagnosis
* Better to use the term “people with XXX” - Diagnoses are unreliable (experts disagree)
* Clinicians generally agree (inter-rater reliability ~ 0.8) - Diagnoses are invalid
* Diagnoses can predict outcomes - Diagnoses negatively impact a person’s life
* In the right context (supportive environment), an effective diagnosis generally improves quality of life
what should the diagnosis of a disorder do? (5)
aka the validity criteria
- Be distinguishable from other similar disorders
- Predict performance on lab tests, personality tests, physiological tests (e.g. neurotransmitter levels, brain activity)
- Predict family history
- Predict progression over time
- Predict treatment response
what is required to diagnose disorders?
- Requires interview assessment from a professional using standardized, evidence-based guidelines
–> Diagnostic criteria from the DSM could guide diagnosis, for example (not absolute though) - Tests may be done to exclude other health problems with similar symptoms (e.g. thyroid issues)
–> there isnt a single test we can do to diagnose someone - This method is effective but time-consuming and expensive, sometimes inaccessible
–> Biological tests are not an option currently but research should be done to develop a biological test because it would be faster and cheaper
what are the features of the DSM-5 (4)
biopsychosocial approach defn
- Provides a set of criteria for guiding diagnosis
- Includes 300+ disorders
- Uses a biopsychosocial approach
–> Acknowledges biological factors, psychological factors
(thinking patterns) and societal factors (culture) - Encourages multiple explanations
–> For example, mood changes caused by hypothyroidism are different than mood changes in depression
what are some criticisms of the DSM-5 (4)
- Not all disorders meet validity criteria
- Criteria may be too vague in certain cases, perhaps leading to “pathologization” of normal behavior
- The manual uses a categorical model (binary; either/or) rather than dimensional model
- Concerns about preparation
–> lack of transparency
–> Pace of preparation
–> Conflicts of uninterest
what are three types of anxiety disorders?
what percent of people suffer from these conditions?
what are two disorders that are related but independent to anxiety disorders
* Generalized Anxiety Disorder (GAD)
* Panic Disorder
* Phobias
- ~4% of people may suffer from these conditions
- Related to anxiety disorders, but now considered independent, are obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD)
1- Anxiety disorder: GAD
what is it? who is more susceptible to it?
- Exaggerated worry/tension in day-to-day situations (generalized and not specific)
- May later lead to the emergence of other disorders
- More common in females than males
2- Anxiety disorder: Panic disorders
what characterizes it? what is the nature of panic attacks in this disorder? when does this disorder emerge?
- Characterized by episodes of intensive fear (w/sweating, dizziness, light headaches, breathing difficulty, heart irregularities)
- Many people might report a single panic attack each year (e.g. 20% of students an attack once a year)
- In panic disorder, however, the attacks are repeated and unexpected
- Emerges early in adulthood
3 - Anxiety disorder: Phobias
what is it? what other disorder could it stem from? what is a popular example of one phobia? how common is it from all the disorders?
- Intense, irrational fear of a specific thing
- May be outgrowth of panic disorder
- A popular example is agoraphobia (fear of marketplaces or crowded environments)
- By far the most common of all anxiety disorders
–> Most phobias are not highly distressing, do not impair quality of life or require treatment
4 - Anxiety disorder: OCD
what are obsessions and compulsions?
-
Obsessions are persistent thoughts that are unwanted and/or cause stress
–> Centered around topics such as sex, contamination, aggression and religion -
Compulsions are repetitive behaviors undertaken to reduce distress and relieve shame/guilt
–> Washing hands
–> Re-reading sentences
what causes anxiety? Learning/ behaviourist perspective for phobias
- Life experiences play a role in disorders
- Pairing of a stimulus (cars) with an aversive event (car accident) may lead to phobias (fear of driving) via classical conditioning mechanisms (see L05)
- Maintenance of disorder via negative reinforcement
–> If cars (S-) make you anxious, you might avoid them (R)
–> Because avoiding cars makes you less anxious, you’re motivated to continue avoiding cars (increase in R)
what causes anxiety? other factors:
genetics (what is the h2 factor, is there a specific gene involved), debate of environment (4 factors from the environment)
- Possible role of genetics
–> Anxiety disorders are heritable (h2 ~ 0.3) and run in families
–> However, no single gene is strongly associated with the disorder (many are likely involved) - Possible role of environment is currently debated
–> Use of digital technology
–> Free play in childhood
–> Occupation (see later)
–> Relationships (see later) - Rates of anxiety (and depression) have been rising
–> Environmental changes are viewed as the likely factor
what is depression? (6)
- Loss of interest or pleasure in activities normally enjoyed (e.g. anhedonia)
- Decreased energy (e.g. fatigue)
- Feelings of guilt or low self-worth
- Disturbed sleep, appetite and activity
- Inability to concentrate
- Thoughts of suicide
global burden of depression:
what percent of the population annually is depressed?
what can depression lead to?
what is the economic cost of depression?
- ~5% of the population (1/20) annually
- Rates increasing in young cohorts (e.g. millennials, iGen)
- Can lead to suicide and is associated with poor outcome of other health disorders
- Serious economic cost, associated w/absenteeism and poor work quality (~30-50 billion in the US)
- Leading cause of disability worldwide
what are the 4 types of depression, and two subtypes in one of them?
what is another disorder depression is present in?
- Unipolar depressive disorder
–> Major Depressive Disorder (MDD; chronic)
–> Major Depressive Episodes (MDE; acute but often recurrent) - Post-partum depression
- Dysthymia
- Seasonal affective disorder
Depressive episodes also occur in bipolar disorder, but bipolar disorder is considered separately
what causes unipolar depression?
epidemiology of depression (6)
- Gender
- Country/Culture
- Socioeconomic status
- Occupation
- Education
- Life history
1 factor: describe gender differences in depression
- suicidal attempts?
- why is the disparity a thing?
- what is the burden of depression in different countries
- More common in women (~2x) than in men1 though the severity does not differ by gender
- Suicide attempts more common in women, though these attempts less frequently result in fatalities
- Reasons for disparity are complex, not fully understood
–> Some disorders related to hormones (e.g. post-partum depression)
–> Prevalence in males may be too low due to stigma (“act tough”) - Some data suggests higher burden in developed countries
why is depression a higher burden in more developed countries
- Economic + environmental factors (diet, stress…)
- More awareness + less stigma
- Better diagnostic criteria + health care system access (more diagnoses)
- Beliefs about the efficacy of emotional regulation
- Valuation of happiness in Western cultures
–> value happiness leads to depression because people have higher expectation
–> Higher valuation is associated w/higher risk (cultural effect); may be relevant to downward social comparison (L08)
3 factor: describe social economic status on depression
- high or low SES?
- is this relationship true in all communities?
- what is the income + well-being complex
- why?
- Low SES (i.e. low income) increases risk
- This relationship holds in Eastern and Western communities, even after controlling for other variables
- Most scientists argue that low income leads to depression rather than the contrary
–> Relationship between income + well-being complex - Low income may be associated with increased risk for many reasons (e.g. lack of insurance, health care…)
describe the difference between burden and risk in different countries with different developments and SESs?
Burden may be higher in developed countries with stronger economies (more inconvenient), but risk is lower in people of higher socioeconomic status (less to worry about).
4 factor: describe occupations and the correlation with depression
- If you don’t have a job, the risk of depression is also higher (nearly x2, according to one poll)
why does the risk of depression vary by job? (4)
- Social interaction plays a role but its complex
–> Frequent and/or difficult interactions (service) increases risk
–> Lack of social interactions (trucking/transport) increases risk - high stress level
- low physical activity
- Jobs offer varying degrees of validation (skills), feelings of meaning/status/acceptance, income, and access to vital services (e.g. health care)
5 factor: describe educational level and depression
- Rates higher in University students, particularly medical students
- sleep disruption is also more common
6 factor: how does life history correlate with depression (stress)
- Risk for mental disorders increases with stress frequency
theoretical models of how depression works:
1. Interpersonal model
- Proposed by Coyne
- If you feel down, you look to others for assurance
- Others respond negatively to your need (hostility + rejection)
- Poor interactions increasing need for reassurance
- if you tell your friend your sad and they say you always complain, so you feel worse
theoretical models of how depression works:
2. Behavioural models
defn learned helplessness
- proposed by Lewinsohn
- Low rate of reinforcement: try many things w/no success increases depression
- Learned helplessness is a related concept (Seligman)
- defn: if you learn that your actions don’t matter, you won’t take action to make your situation better
theoretical models of how depression works:
3. Cognitive model
- popularized by beck
- Cognitive distortions affect the ability to acknowledge reality or interpret it properly (always negative)
- “everything is hopeless, and i’m so faulted” when in theory your normal but you have negative self talk
- Best describes people with serious depression
biological differences in people with depression
- you wont take a brain scan or do a physiological test to test for depression
- however when comparing the brain of many people with depression they found that people with depression have:
brain region ——-
volume
- smaller hippocampus
- smaller orbitofrontal cortex
- smaller anterior cingulate cortex
activity
- greater orbitofrontal cortex activity
- greater amygdala activity
compound———
concentration
- less 5-HT serotonin
- less Noradrenaline
- less GABA
- more Cytokines
- more cortisol
what is bipolar disorder?
what are experiences that may associate with elevated mood?
- Episodes of depression and elevated mood (previously called manic depression)
- During periods of elevated mood (mania/hypomania) the individual feels extremely energetic, happy and/or irritable
- They may experience reduced need for sleep and make poor decisions with little regard for consequences
