Modules 48-9 Flashcards
stigmas and stereotypes (depression/mental illness)
- these views only come from pop culture views of mental illness, not the DSm
- DSM may contain info to correct inaccurate perceptions of mental illness
- could prevent people from seeking help, don’t want to be labeled
Jared Lee Loughner case (insanity vs responsibility)
- shot many people, including US Representative in 2011
- suffered from schizophrenia and substance abuse problems, combo associated with increased violence
- what is the appropriate consequence, should he be held responsible for his actions?
problems dealt with in the field of psychological disorders
- how do we decide when a set of symptoms are severe enough to be called a disorder that needs treatment?
- can we define specific disorders clearly enough so that we can know that we’re all referring to the same behavior/mental state?
- can we use our diagnostic labels to guide treatment rather than to stigmatize people?
Anxiety Disorders (categories)
- GAD: generalized anxiety disorder
- panic disorder
- phobias
- OCD: obsessive-compulsive disorder
- PTSD: post-traumatic stress disorder
GAD: Generalized Anxiety Disorder - physical symptoms
autonomic arousal: trembling, sweating, fidgeting, agitation, sleep disruption (must last for at least 6 mos.)
GAD: Generalized Anxiety Disorder - emotional-cognitive symptoms
worrying, having anxious feelings and thoughts about many subjects, and sometimes “free-floating” anxiety with no attachment to any subject. Anxious anticipation interferes with concentration (must last for at least 6 mos. w/ physical symptoms)
psychological disorders
patterns of thoughts, feelings, or actions that are deviant, distressful, and dysfunctional
diagnosing GAD
- commonly occurs with depression
- symptoms must last for 6+mos.
- decreases with age
disorder
refers to a state of mental/behavioral ill health
patterns
refers to finding a collection of symptoms that tend to got together, and not just seeing a single symptom
Panic Disorder - panic attack symptoms
- not just an anxiety attack
- many mins. of intense dread or terror
- chest pains, choking, numbness, other frightening physical sensations
- patients may feel certain that it’s a heart attack
- feeling of a need to escape
Panic disorder
refers to a repeated and unexpected panic attacks, as well as a fear of the next attack, and a change in behavior to avoid panic attacks
3 D’s for diagnosis
deviant
distressful
dysfunctional
specific phobia
more than just a strong fear or dislike
uncontrollable, irrational, intense desire to avoid some object or situation
- cannot even do pictures, will avoid a book if there are pictures of spiders – not a choice to avoid the book
more common fears and phobias
animals, heights, blood, flying, close spaces, water, storms, being alone
agoraphobia
the avoidance of situations in which one will fear having a panic attack, especially a situation in which it is difficult to get help, and from which it is difficult to escape
social phobial
refers to an intense fear of being watched and judged by others. visible as a fear of public appearances in which embarrassment or humiliation is possible, such as public speaking, eating or performing
Obsessive compulsive disorder (OCD) – obsessions
obsessions are intense, unwanted worries, ideas, and images that repeatedly pop up in the mind
Obsessive compulsive disorder (OCD) – compulsion
compulsion: repeatedly strong feeling of “needing” to carry out an action, even though it doesn’t feel like it makes sense
- compulsions ease obsessions
negative reinforcement
Obsessive compulsive disorder (OCD) - diagnosis
categorized as disorder when:
- distress from deep frustration when unable to control the behaviors
- dysfunction when time spent on these thoughts and behaviors interfere with everyday life
Post-Traumatic Stress Disorder (PTSD) : symptoms
10-35% who experience trauma not only have burned-in memories, but 4 wks to a LIFETIME of:
- repeated intrusive recall of those memories
- nightmares and other re-experiencing
- social withdrawal or phobic avoidance
- jumpy anxiety or hypervigilance
- insomnia or sleep problems
PTSD - conditions that make you more prone
- less control
- more frequently traumatized
- brain difference
- less resiliency
- re-traumatization
Resilience and Post-Traumatic Growth
- some lingering, but not overwhelming stress
- finding strengths in yourself
- finding connection with others
- finding hope
- seeing the trauma as a challenge that can be overcome
- seeing yourself as a survivor
common OCD obsessions
- concern with dirt, germs, toxins
- something terrible happening (fire, death, illness)
- symmetry, order, or exactness
common OCD compulsions
- excessive hand washing, bathing, toothbrushing, or grooming
- repeating rituals (in/out of a door, up/down from a chair)
- re-checking doors, locks, appliances, car brakes, homework
explanations from different perspectives on disorder development
classical conditioning: overgeneralizing a conditioned response
operant conditioning: rewarding avoidance
observational learning: worrying like mom
cognitive appraisals: uncertainty is danger
evolutionary: surviving by avoiding danger
classical conditioning and anxiety (Little Albert and the rabbit)
Watson and Rayner trained Little Albert to feel fear around a rabbit – associated buny with loud scary sound
– conditioned response can become overgeneralized: fear all animals, everything fluffy, any location similar to original, fear that those items could appear soon with the noise
- results in phobia or generalized anxiety
operant conditioning and anxiety
- lifted feelings from leaving an uncomfortable/anxious situation reinforces our decision to leave/avoid
- re-checking gives relief of locked door
– reuslt is an increase in anxious thoughts and behaviors
observational learning and anxiety
- anxiety can be acquired through observational learning (humans and monkeys)
- pick up someone else’s avoidance/fear and adopt it even after the original scared person is not around
- fears can get passed down in families this way
cognition
includes worried thoughts, as well as interpretations, appraisals, beliefs, predictions, and ruminations
- includes mental habits such as hypervigilance (persistently watching out for danger) – accompanies anxiety in PTSD
cognitions in anxiety disorders
- cognitions appear repeatedly and make anxiety worse
hypervigilance: cognitive error
ex: believing that we can predict that bad events will happen
hypervigilance: irrational beliefs
bad things don’t happen to good people, I must be a bad person – commonly relates delusions about self
hypervigilance: mistaken appraisals
thinking that something is worse/more dire than it is
hypervigilance: social misinterpretations
misinterpretations of facial expressions and actions of others
evolutionary human phobias
snakes, heights, closed spaces, darkness
evolutionary human non-phobic objects
fish, low places, open spaces, bright light
- evol. psychologists believe that ancestors prone to fear these were less likely to die before reproducing
evolutionary dangerous, non-phobic subjects
guns, electric wiring, cars
- evol. psychologists believe that not enough time has passed for innate fear to spread in population
twin studies : phobias
same genetics, even raised separately, develop similar phobias (more similar than two unrelated people)
anxiety genes and neurotransmitters
anxiety: problems with gene associated with serotonin levels (NT involved in regulating sleep and mood) – too high
anxiety: have gene that triggers high levels of glutamate, excitatory neurotransmitter involved in the brain’s alarm centers
distress and dysfunction
symptoms must be sufficiently severe to interfere with one’s daily life and well being
deviant/deviate
differing from the norm
for culture – different from what would be expected in that culture
could also be deviation from a typical developmental pathway
treating disorder: requirements
- helps to understand the nature/cause of the psychological symptoms
- diagnosing a disorder is one step of treatment
- based on older understandings, treatments included: exorcising evil spirits, beatings, caging/restraint, drilling holes in the skull
Diagnostic and Statistical Manual (DSM)
provides the clear definition of a disorder for diagnosis, consistent with diagnoses used by medical doctors worldwide
benefits of diagnoses
- create a verbal shorthand for referring to a list of associated symptoms
- allow us to statistically study many similar cases, learning to predict outcomes
- can guide treatment choices
DSM: axis I
is a clinical syndrome present?
using specifically defined criteria, clinicians may select none, one, or more syndromes
DSM: axis II
is a personality disorder or mental retardation (intellectual developmental disorder) present?
clinicians may or may not also select one of these two conditions
DSM: axis III
is a general medical condition, such as diabetes, arthritis, or hypertension also present?
DSM: axis IV
are psychosocial or environmental problems, such as school or housing issues, also present?
DSM: axis V
what is the global assessment of this person’s functioning?
clinicians assign a code from 0-100
brain areas and anxiety disorders
overarousal of brain areas involved in impulse control and habitual behaviors
amygdala - fear circuits
traumatic experiences can burn fear circuits into the amygdala; these circuits are later triggered and activated
criteria of major depressive disorders
must be depressed most of the day, markedly diminished interest or pleasure in activities and 3+ other symptoms, lasting more than 2 wks
major depressive disorder symptoms
1) depressed mood most of the day, and/or markedly diminished interest or pleasure in activities
& 3+ of:
- significant increase or decrease in appetite or weight
- insomnia, sleeping too much, or disrupted sleep
- lethargy, or physical agitation
- fatigue or loss of energy nearly every day
- worthlessness, or excessive/inappropriate guilt
- daily problems in thinking, concentrating, and/or making decisions
- recurring thoughts of death and suicide
depression stats worldwide
1 reason people seek mental health services
- 6% men, 9% women /yr
- in a lifetime, 12% Canadians, 17% Americans experience depression
Depression vs Common Cold – why we can’t compare them
depression:
- is more dangerous because of suicide risk
- has fewer observable symptoms
- is more lasting than a cold, and is less likely to go away just with time
- is much less contagious
- depressive pain much greater
Seasonal affective disorder
more than simply disliking winter
- involves recurring seasonal pattern of depression, usually during winter’s short, dark, cold days
survey: “have you cried today?” result: more people answer “yes” in winter (4x vs 8x men; 7x vs 21x women)
DSM-V: no longer a unique mood disorder; seasonal qualifier
bipolar disorder: mania
refers to a period of hyper-elevated mood that is euphoric, giddy, easily irritated, hyperactive, impulsive, overly optimistic, and even grandiose
- mind racing
- little desire for sleep
bipolar disorder: depressed
stuck feeling “down” with:
- exaggerated pessimism
- social withdrawal
- lack of felt pleasure
- inactivity and no initiative
- difficulty focusing
- fatigue and excessive desire to sleep
mood disorders: men vs women depression
risk of depression: women almost 2x greater than men
- around the world, women are more susceptible to depression
Depression: emotional symptoms
- feelings of sadness, hopelessness, guilt, emptiness, or worthlessness
- feeling emotionally disconnected from others
- turning away from other people
Depression: behavioral symptoms
- dejected facial expression
- makes less eye contact; eyes downcast
- smiles less often
- slowed movements, speech, and gestures
- tearfulness or spontaneous episodes of crying
- loss of interest or pleasure in usual activities, including sex
- withdrawal from social activities
Depression: cognitive symptoms
- difficulty thinking, concentrating, and remembering
- global negativity and pessimism’
- suicidal thoughts or preoccupation with death
Depression: physical symptoms
- changes in appetite resulting in significant weight loss or gain
- insomnia, early morning awakening, or oversleeping
- vague but chronic aches and pains
- diminished sexual interest
- loss of physical and mental energy
- global feelings of anxiety
- restlessness, fidgeting
time vs mood disorder
often, time heals a mood disorder, especially when the mood issue is in reaction to a stressful event. However, a significant proportion of people with major depressive disorder do not automatically or easily get better with time
sucide and self-injury statistics
1 mil people/yr commit suicide
- when people feel frustrated, trapped, isolated, ineffective, and see no end to these feelings
non-suicidal self-injury has other functions such as sending a message, or self-punishment
understanding mood disorders: biological perspective vs social-cognitive perspective
biological aspects and explanations: evolutionary, genetic, brain/body
social-cognitive aspects and explanations: negative thoughts and negative mood, explanatory style, the vicious cyle
Depression: evolutionary perspective
potential survival value in mild non-disorder form of social emotional hibernation:
- conserves energy
- aviods conflict and other risks
- let go of unattainable goals
- take time to contemplate
genetic biology of depression
1) DNA linkage analysis reveals depressed gene regions
2) twin/adoption heritability studies
brain biology of depression
- activity diminished in depression and increased in mania
- structure: smaller frontal lobes in depression and fewer axons in bipolar disorder
- brain cell NT’s: more norepineprhine in mania, less in depression, reduced serotonin in depression
prevention/reducing depression: treatment options
1) adjust NT levels with medication
2) increase serotonin levels with exercise
3) reduce brain inflammation with a healthy diet, especially olive and fish oils
4) prevent excessive alcohol use
understanding mood disorders: social-cognitive perspective (depression)
depression is associated with:
- low self-esteem
- rumination
- learned helplessness
- depressive explanatory style
low self-esteem
discounting positive info and assuming the worst about self, situation, and the future
learned helplessness
self-defeating beliefs such as assuming that oneself is unable to cope, improve, achieve, or be happy
rumination
stuck focusing on what’s bad
depressive explanatory style
analyzing bad news by putting blame on self and not coping
stable style: I’ll never get over this
temporary style = I will get over this
global style = without him I can’t do anything
specific style = he improved these things in my life but other parts are fine
internal style = it was all my fault
external style = it takes two to tango – also his fault
ex: break-up
problems: can’t get over it, I can’t do anything w/o partner, our breakup was all my fault –> depression
depression’s vicious cycle
a depressed mood may develop when a person with a negative outlook experiences repeated stress
depressed moods changes a person’s style of thinking and interacting in a way that makes stressful experience more likely
stressful experience –> negative explanatory style –> depressed mood –> cognitive and behavioral changes –> stressful experience again –>
OCD brain
prefrontal cortex and (acc) anterior cingulate cortex
brain activity in depression and mania
- decreased in depression (less epinephrine) less serotonin
- increased in mania (more epinephrine)
- depression has smaller frontal lobe
