Lecture 22: Health and Disorders

Question 1

Health and Well-being

Answer 1

• Not just biological, medical: beliefs and attitudes affect health as well

Question 2

Health psychology

Answer 2

Integrates research on health and psychology, applying psychological principles to promote health and well-being

Question 3

Well-being

Answer 3

Positive state; striving for optimal health and satisfaction with life

Question 4

Biopsychosocial model

Answer 4

Health and illness result from interacting biological, psychological, and social factors

Question 5

Our perceptions shape behavior

Answer 5

• Perception as to what is “risky” - e.g. flying vs. driving - can alter behavior that increases risk of death
• Perceptions can also alter physiological responses - e.g. the placebo effect

Question 6

Placebo effect

Answer 6

• (Good example of biopsychosocial model)
• Improvement attributed to inert drug/treatment
• Psychological aspects:
– To work, the individual must believe that it does
– Part of the effect: reduced anxiety about health and treatment

Question 7

Placebo effect: physiology

Answer 7

• Placebos for pain trigger release of endogenous opioids on responders
– Effect blocked if administered naloxone, which blocks opiate receptors
• Mechanism might involve increased frontal cortex -> descending pain-regulation systems
• Reduces activity in thalamus, ACC, insula
– Reduced ACC activity associated with decreased perception of pain
– Subjects trained to reduce ACC activity based on biofeedback during scanning

Question 8

Placebo effect (continued)

Answer 8

• Effects of placebo on activation of u-opioid receptor-mediated transmission
• ACC, insula, nucleus accumbens, prefrontal cortex…pain + cognition

Question 9

Stress and coping

Answer 9

• Stress: behavioral, psychological, physiological responses that occur when events match/exceed ability of organism to respond in a healthy way
• Coping: response organism makes to avoid, escape, minimize an aversive stimulus
• Both positive and negative events can be stressful: eustress vs. distress

Question 10

Yerkes-Dodson Law: 1908

Answer 10

• Simple task: focused attention, flashbulb memory, fear conditioning
• Difficult task: impairment of divided attention, working memory, decision-making and multitasking

Question 11

Hebb’s version: Yerkes-Dodson Law

Answer 11

1. increasing attention and interest
2. optimal arousal and optimal performance
3. impaired performance b/c of strong anxiety

Question 12

Physiology of stress

Answer 12

• “stress” - nonspecific term to describe either stress response (physiological) or situation eliciting stress response
• fight or flight response
– ANS (sympathetic)
– Endocrine systems (adrenal glands secrete epinephrine, NE, steroid stress hormones such as cortisol)

Question 13

HPA axis

Answer 13

• Hypothalamus-Pituitary-Adrenal axis helps the body prepare to respond to the stressor
• Stress affects organs even after stressor has been removed

Question 14

What triggers the stress response?

Answer 14

• Several pathways activate the hypothalamus
• CRH triggers release of ACTH from anterior pituitary
• ACTH -> glucocorticoid release from adrenal medulla
– Glucocorticoids = steroid hormones
– Involved in protein and carbohydrate metabolism
– Cortisol: increases and maintain [glu] in blood; glu synthesis in liver, inhibition of uptake by muscles and fat, stimulation of fat breakdown

Question 15

Your brain, relaxed

Answer 15

• vmPFC regulates emotion
• Dorsal and lateral PFC regions regulate thought & action
• PFC connections control intelligent regulation of behavior, thought, and emotion

Question 16

Your brain, stressed

Answer 16

• Amygdala –> stress pathways (hypothalamus, brainstem) –> high NE and DA release
• Impairs PFC regulation, strengthens amygdala
• Strengthens fear conditioning
– Bias toward habitual motor responses
– Impairs WM and attention

Question 17

Gender differences in stress responses?

Answer 17

• Majority “flight or fight response” males
• Taylor and colleagues (2006) argue that women have “tend and befriend” response
– Care and protect offspring and forming social alliances to reduce risk
– Maximally adaptive
– Oxytocin levels are high for women, but not men, who are stressed

Question 18

General adaptation syndrome

Answer 18

• Consistent pattern of how body responds to stress
• Three stages:
– Alarm stage: prepares the body to fight or flee
– Resistance: defenses prepare for a longer, sustained attack against the stressor
– Exhaustion: variety of physiological and immune systems fail

Question 19

Does stress make us sick? (Psychoneuroimmunology)

Answer 19

• Interactions between environmental stimuli, nervous and immune systems
• Stress increases likelihood of infection diseases
– Increases glucocorticoid release
– Glucocorticoids suppress immune system
– Increases glucocorticoid release
• Lower levels of immunoglobulin antibodies even in response to mood changes

Question 20

Cohen says: yes!

Answer 20

• Short-term boosts the immune system; chronic stress weakens it
• Swabbed healthy volunteers’ noses w/ cold virus
• Those who reported highest levels of stress prior to exposure developed worse cold symptoms than those who reported being less stressed

Question 21

Stressed out monkeys

Answer 21

• Colony of vervet monkeys in Kenya
• Hierarchical society: “bottom” rung monkeys bullied by others
• Decreased monkeys showed gastric ulcers, enlarged adrenal glands
• Destruction of neurons in hippocampus

Question 22

Stressed out humans

Answer 22

• Signs of neural degeneration in torture victims
• Maltreatment early childhood -> decreased volume of dmPFC
• Long-term effects of increased glucocorticoids:
– Immune system suppression (initially adaptive to reduce inflammation, becomes maladaptive)

Question 23

Long-term stress and the brain

Answer 23

• Repeated stress –> remodeling connections of the amygdala –> concurrent remodeling in the PFC and hippocampus
• Chronic stress also decreases neurogenesis & neuron number in the hippocampus
• Most of these stress-induced changes in the hippocampus and PFC are reversible over time

Question 24

Psychological disorders

Answer 24

• Psychopathology: literally, sickness or disorder of the mind
• Hippocrates suspected physiological basis in relative amount of humors (bodily fluids) - imbalance –> mania, melancholia, phrenitis
• Last 200 yrs: viewed as medical condition w/ physiological (particularly neural) basis

Question 25

Disorders are common and debilitating

Answer 25

• 1:4 US adults has diagnosable disorder in any given year; nearly 1:2 at some point in life
• Account for greatest proportion in disability in developed world
• Most common disorders: mood (depression), anxiety, impulse control (attention, hyperactivity), substance abuse

Question 26

Gender differences

Answer 26

• Women: depression, anxiety disorders
• Men: antisocial personality disorders, autism, and other developmental disorders
• Reflect biology AND culture (biopsychosocial model)
– Biological predisposition
– Culture influences diagnosis, manifestation

Question 27

What makes behavior disordered?

Answer 27

• Behaviors can be normal/deviant depending on setting & degree
• Psychopathological behavior:
– Does the person act in a way that deviates from cultural norms for acceptable behavior?
– Is the behavior maladaptive?
– Is the behavior self-destructive?
– Does the behavior cause discomfort and concern to others, thus impairing a person’s social relationships?

Question 28

Categorization

Answer 28

• Late 1800s: Emil Kraepelin identified mental disorders via groups of co-occurring symptoms; biological and genetic
• 1952: American psychiatric association published first addition of DSM
• Disorders: described & diagnosed in terms of observable symptoms; patients must meet specific criteria
• Categorial vs. dimensional approach

Question 29

Assessment

Answer 29

• NOT as straightforward as most medical diagnoses
• Examination typically involves mental status exam or clinical interview
• Primary goal: diagnosis
– Appropriate treatment can be provided
– Assess course and probable outcome (prognosis)
• Ongoing assessment to monitor condition

Question 30

Assessment (continued)

Answer 30

• Clinical psychologists gather variety of info
• Self-reports
• Clinical observation, reports of others
• Interviews w/ patient

Question 31

NOT cut and dry

Answer 31

• Continuum
• Spectrum
• Range of symptoms and severity fall under umbrella of diagnosis

Question 32

Assessment: interviews

Answer 32

• Unstructured vs. structured
• Unstructured: highly dependent on interviewer’s skills; no two will elicit same information from patient
• Structured: clinicians ask standardized questions in same order each time
– Answers are coded according to predetermined formula and diagnosis based on the specific patterns of responses
– Most commonly used is Structured Clinical Interview for DSM (SCID); diagnoses made according to DSM criteria

Question 33

Observation & testing

Answer 33

• Valuable info from simply observing patient’s behavior
• Also use psychological testing
– 1000s of psychological tests available to clinicians
– Some are for specific mental disorders, e.g. Beck Depression Inventory
– Most widely used questionnaire is the Minnesota Multiphasic Personality Inventory (MMPI)
– Neuropsychological testing
• Patterns of performance dictate diagnosis

Question 34

Beck Depression Inventory

Answer 34

• Purpose: to assess severity of depression in psychiatrically diagnosed adolescents and adults.