PSYC241: Midterm 1 Flashcards
What is an alternative to the DSM-5 and where is it used?
ICD-10 (by world health organization, 1992)
Used mostly outside of North America
Psychological abnormality
Behaviour, speech or thoughts that impair the ability of a person to function in a way that is generally expected of them, in the context where the unusual functioning occurs
Mental illness
Often used to convey the same meaning as psychological abnormality, but medical not psychological cause
Psychological disorder
Specific manifestation of the impairment of functioning, as described by a set of criteria that have been established by a panel of experts
Psychopathology
Means both the scientific study of psychological abnormality and the problems faced by people who suffer from disorders
What does DSM-5 stand for?
Diagnostic and statistical manual of mental disorders (of the American psychiatric association, 2013)
Name and describe each concept in attempts of “defining abnormality”
1- statistical concept (aka behaviour does not occur frequently in the population, exceptional, Sidney Crosby)
2- personal distress (but distress not always present in people identified as abnormal; everyone distressed sometimes)
3- personal dysfunction (behaviour interferes with appropriate functioning, but what is approp functioning?; interesting link to evolutionary psych)
4- violation of norms (cultural)
5- diagnosis by an expert
“How we define abnormality is culturally relative”
The norms of a culture determine what is considered normal behaviour, and abnormality can be defined only in reference to these norms
What is the change related to culture in the DSM-5?
More explicit in encouraging consideration of cultural diversity
Clinical psychologists
Trained in general psychology and then receive graduate training in using their knowledge to better understanding, diagnosing and improving disorders of thinking/behaviour
Psychiatrists
First train in medicine
Then to specialized training in dealing with mental disorders
Focus on diagnosis/medical treatment using drugs
Psychiatric nurses
First formally trained in nursing
Specialize in psychiatric problems
Work in hospital settings, managing day to day care of mentally disordered patients
Psychiatric social workers
Focus on the influence that their social environment has on disordered clients
Graduate degree in social work
Assist in adjusting to life within families/community
Occupational therapists (OTs)
Baccalaureate degree + field-training experience
Sometimes involved in providing mental health care
Help clients to improve their functional performance (ex: community living skills)
Sexual sterilization act of 1928
Alberta
Individuals deemed feeble minded, mentally deficient, or mentally ill were involuntarily sterilized to prevent deteriorating of the intellectual level of the entire population
1999: apology and financial settlement with victims
Trephination
Ancient evidence that people tried to cure mental disorders by cutting holes in the skull to let out evil spirits that apparently caused the victim’s abnormal behaviour
OR
Actually intended to remove bone splinters or blood clots from war
Hippocrate’s thoughts on mental disorders in Greece
Hippocrates started idea that psych problems were not caused by intervention of gods or demons
Natural causes
Stress=cause
Dreams=important for understanding
Treatment of healthy lifestyle, or bleeding/vomiting
Humours=disturbances of bodily fluids
Plato’s ideas of mental disorders
Took up hipocrate’s ideas
Emphasis on socio-cultural influences in thought and behaviour
Dreams=serve to satisfy desires that can’t be satisfied in real life
Idea that disturbed people cannot be held responsible for crimes as they couldn’t understand what they had done
Started idea of community care
Aristotle’s ideas of mental disorders
Wrote a lot about mental disorders and psychological functioning
Accepted hippocrate’s bodily fluids theory
Denied influence of psychological factors in the etiology of dysfunctional thinking and behaving
Advocated the humane treatment of mental patients
What happened after Alexander the Great founded Alexandria in Egypt in 332 BC?
Temples to Saturn (sanatoriums for psychologically unwell people)
Peaceful surroundings, healthy diet, etc
Bleeding, purges and restraints used as last resort
Methodism
Mental illness=disorder resulting from construction of body tissue or relaxation of those tissues due to exhaustion
Natural bloodletting must happen or mania occurs
Who provided first clinical observations of disorders?
Greek
Galen of Rome’s ideas of mental disorder
Two sources: physical (head injuries, alcohol abuse, menstrual disturbances) and psychological (stress, loss of love, fear) Started psychotherapy (talking about problems to a sympathetic listener)
Mental health research and treatment in the Arab world
While enlightened period of research and treatment ended in Europe, it carried on in the Arab world
Followed Greco-roman traditions of investigation and humane treatment
Supportive and kind approach
Quran reflects compassionate attitudes towards the mentally ill
Asylums
Islamic physician Avicenna (the canon of medicine; behaviour therapy)
Europe in the Middle Ages (after fall of Roman Empire)
Teachings of Greeks and Romans disappeared
Supernatural explications came back
But still evidence of Galen’s theories surviving and being applied
Possession=nervous breakdown not literally being possessed?
Witchcraft problem
Treatment came from clergy (first gentle approach then exorcism became more popular)
St. Vitus’ dance (=epidemic of mass hysteria where group of people dance and convulse; tarantula bites?)
Describe the beginnings of a scientific approach to mental illness
Beginning to believe that mental disease and bodily disease are not different and arguing for development of scientific/humane approach to dealing with problems of the insane (St.vincent)
Asylums established in Europe (good intentions but bad conditions)
Progress towards more humane/rational approach to understanding and dealing with mentally ill during sixteenth century, went away during 17th century, came back in 18th century after the Enlightenment (European philosophical movement)
Who is Phillipe Pinel?
Leader of humanitarian reforms that swept through Europe in the late 18th and early 19th century
Transformed an asylum
Developed a systematic and statistically based approach to the classification, management, and treatment of disorders
Emphasized role of psychological and social factors in mental illness
Mental hygiene movement
Characterized by desire to protect and provide humane treatment for the mentally ill
What happened toward the end of the 18th century?
Because of studying dead bodies and discoveries about the nervous system, mental disorders started to be viewed as disruptions in nervous system functioning
Beginning of psychotherapy
Idea of being passed down by genetics
Kraeplin made first attempt at classification
Idea that infections could lead to mental disorders
What does GPI stand for?
General paresis if the insane (neuro-syphalis, result of untreated infections)
Somatogenesis
Idea that psychopathology is caused by biological factors; soma means body in Latin)
Born in 19th century
Electroconvulsive therapy (ECT)
Thought that convulsions would help cure schizophrenia and major depression
Downside: broken limbs and cracked vertebrae
Soon drug was used to help keep them calm and avoid broken bones
When did drugs become widely available for the treatment of mental disorders?
1950s (period of mental illness seen as being caused by disordered chemistry of the brain, continues still)
Agonist vs antagonist
Agonist: facilitates the production of acetylcholine
Antagonist: something that stops it’s production
What was the first big antipsychotic drug?
Chlorpromazine
When did the process of deinstitutionalization start?
1950s; movement of patients rights and encouraging society to integrate these people into the community
Describe the birth of psychoanalysis
Studying hysteria
Hypnosis to have patient talk about past event that he believed caused the hysteria (breuer’s cathartic method)
Ended up being called psychoanalysis
Behaviourism
John Watson
Early 20th century
Declared that if psych were to become a science, it must be restricted to the study of observable features, aka the behaviour of organisms
Abnormal functioning=learned therefore it can be unlearned
Took ideas from pavlov’s classical conditioning
Where was the first asylum built?
Quebec; hotel dieu
Mental Health Commission of Canada (MHCC)
2007
Stephen Harper
Goal=develop an integrated mental health system that encourages better cooperation among governments, mental health providers, employers, the scientific community and Canadians who live with it care for those with mental disorders
4 specific goals in book; need to know?
Evidence-based practice (EBP)
Scientific evidence + individual expertise in order to inform optimum client care
Improve efficient treatment of mental disorders
Maintain competitiveness of psychologists in the mental health market
Increase accountability and reduce liability
Have to use research-proved drugs
Assessment
Procedure where info is gathered systematically in the evaluation of a condition; basis for diagnosis
Ex: interviews, testing, self-reporting scales
A perfect diagnostic system would classify disorders of the basis of:
a study of presenting symptoms (patterns of behaviour)
Etiology (history of the development of these symptoms and underlying causes)
Prognosis (future development of this pattern of behaviours)
Response to treatment
Characteristics of a string diagnostic system
Reliability (same measurement every time)
Inter-rater reliability (if two clinicians agree on diagnosis of a patient)
Validity (able to predict disorders accurately)
Concurrent validity (able to predict non-diagnostic characteristics of a disorder like low income for example)
Predictive validity (ability to predict future course of a patient’s development)
Atheoretical
Later diagnostic manuals moved away from supporting one specific theory of abnormal psych and moved towards precise behavioural descriptions
Polythetic
(DSM-3-R) individual could be diagnosed with a subset of symptoms without having to meet all criteria
Describe section 1 of DSM-5
History + intro to issues and guidelines of usage
Describe section 2 of DSM-5
Clinical disorders
Collects info on patient’s life circumstances
Describe section 3 of DSM-5
Optional measures and models and diagnoses that need to be studying more before being put into section 2 as official diagnoses
Contains outline for cultural formulation (cultural formulation interview)
Alternative model of personality disorders
WHO disability assessment schedule 2.0 (WHODAS)
Assesses how well a person is able to cope with circumstances related to their problems
Can assist in figuring out treatment and in planning interventions
Neurodevelopmental disorders
ADHD autism spectrum disorder Learning disorders Communication disorders Motor skills disorders Tic disorders
Schizophrenia spectrum and other psychotic disorders
Psychosis Delusions Hallucinations Incoherent speech Loose associations Inappropriate affect Disorganized behaviour
Mood disorders
Major depressive disorder
Mania
Bipolar disorders
Anxiety and related disorders
Phobias OCD Panic disorder Generalized anxiety disorder Disorders related to trauma
Dissociation
Sudden and profound disruption in consciousness, identity, memory and perception
Dissociative disorders
Dissociative amnesia
Dissociative identity disorder
Depersonalization/derealization disorder
Somatic symptom and related disorders
Disorders with no known physiological cause
Conversion disorder (loss of motor/sensory function)
Illness anxiety disorder
Factitious disorders
Body dysmorphic disorder
Feeding and eating disorders
Anorexia nervosa
Bulimia nervosa
Comorbidity
Presence of one or more disorders in the same individual
ADHD
Attention deficit/hyperactivity disorder
Maladaptive levels of in attention, hyperactivity, or impulsivity
Autism spectrum disorder
Slow in development of several areas such an social interaction and communication
Learning disorder
Low academic functioning (below average)
Communication disorders
Difficulty with reception, expression, or social use of language
Motor skills disorders
Developmental problems with coordination
Includes tic disorders (verbal or movement)
Person is very sad and discouraged and shows a loss of pleasure in usual activities
Major depressive disorder
Person seems very elated, more active, doesn’t need much sleep, has disconnected ideas, grandiosity and impairment in functioning
Mania
Bipolar disorder
Depression + mania
More chronic low-grade depression
Dysthymia
Fluctuating between mild bouts of mania and less severe depressive symptoms
Cyclothymia
Fear of going crazy/having a heart attack/dying
Panic disorder
Difficulty controlling excessive worry
Generalized anxiety disorder
Recurrent, unwanted and intrusive thoughts + strongly repetitive behaviour
Obsessive compulsive disorder
Long term anxiety after a traumatic event
Acute stress disorders and post-traumatic stress disorder
Forgetting your past and/or losing your memory for a specific time period which may cause person to travel to a new place, start a new life and forget their previous identity
Dissociative amnesia
Having two or more distinct personality states with their own memories, behaviour patterns, preferences and social relationships
Dissociative identity disorder
Severe and disruptive feeling of detachment from self or unreality
Depersonalization/derealization disorder
Loss of sensory or motor function
Ex: paralysis or blindness
Conversion disorder
Extreme anxiety about having a serious illness (no symptoms present)
Illness anxiety disorder
Intentional production or complaining of either physical or psychological symptoms because of a need to take the role of a sick person
Factitious disorders
Obsession with an imagined defect in a person’s appearance
Body dysmorphic disorder
Refusing to maintain a minimally normal weight for their height and age; avoidance of eating due to intense fear of getting fat
Anorexia nervosa
Frequent episodes of binge eating coupled with compensatory activities like self-induced vomiting or using laxatives
Bulimia nervosa
Frequent episodes of eating large amounts of food in a short period of time
Binge-eating disorder
Often eating substances with no nutritional value like sand or feces
Pica’s disorder
Elimination disorders
Enuresis
Encopresis
Usually diagnosed in childhood or adolescence
Peeing in inappropriate places
Enuresis
Pooping in inappropriate places
Encopresis
Sleep-wake disorders
Insomnia Hypersomnolence Narcolepsy Breathing-related sleep disorders Parasomnias
Not being able to get enough sleep
Insomnia
Excessive sleepiness
Hypersomnolence
Disorders relating to amount, quantity and timing of sleep
Breathing-related sleep disorders
Related to abnormal behaviour or physiological events that occur during the process of sleep or sleep-wake transitions
Sleep terror disorder, sleep walking disorder, etc
Disturbance in sexual desire or in the psychophysiological changes that go with sexual response cycle (ex: inability to maintain an erection, premature ejaculation, inhibitions of orgasm, etc)
Sexual dysfunction
Characterized by sexual urges, fantasies, or behaviours that involve unusual objects or activities (ex: exhibitionism, voyeurism, sadism, masochism, etc) and that cause significant distress or impairment
Paraphilic disorders
Feeling extreme and overwhelming distress associated with their anatomy and that their biological sec and expressed gender don’t match
Gender dysphoria
Sexual disorders and gender dysphoria
Sexual dysfunctions
Paraphilic disorders
Gender dysphoria
Disruptive, impulse-control, and conduct disorders
Characterized by failure or extreme difficulty in controlling impulses despite the negative consequences
Person has episodes of violent behaviour that result in destruction of property or injury of others
Intermittent explosive disorder
Recurrent pattern of negative, defiant, disobedient, and hostile behaviour toward authority figures
Oppositional defiant disorder
Children persistently violating societal norms, rules or basic rights of others
Conduct disorder
Substance-related and addictive disorders
Brought about by excessive use of a substance which causes any type of problem in a person’s life
Person unable to control or stop the use of these substances and may or may not be physically addicted
Also includes gambling disorder
Neurocognitive disorders
Conditions where there is a decline in mental functioning
Delirium
Can be caused by med conditions like poor diet or substance abuse
Major and mild
Delirium
Clouding of consciousness, wandering attention, incoherent stream of thought
Personality disorders
Characterized by ensuring, pervasive, inflexible, and maladaptive patterns of behaviour that have existed since adolescence or early adulthood and impair functioning/cause stress
Displaying a history of continuous and chronic disregard for and violation of the rights of others
Antisocial personality disorder
Manifesting a pattern of submissive and clinging behaviour and fear of separation
Dependant personality disorder
What is the “other” category of DSM-5 called?
Other conditions that may be a focus of clinical attention
Categorical approach
Criticism of DSM as it classifies people as either having disorders or not having them, with no in-between
Doesn’t provide a meaningful description of an individual’s psychological problems
Dimensional approach suggested (continuum)
Clinical utility
Goal of DSM-5
Extent to which a diagnostic system assist clinicians in performing functions like communicating clinical info to patients/their families/other healthcare providers, selecting good treatment, predicting course of disorder
That’s why DSM-5 introduced a scale for assessing the severity of psychotic symptoms to help clinicians make a prognosis
Arguments against classification of disorders
- shouldn’t use medical model
- creates stigmatization
- loss of information
Criticisms specific to the DSM
- gender bias/sexism (diagnosis more probable for women)
- doesn’t take life circumstances into account enough
- cultural bias
- influence of politics
Single-factor explanation
States that a genetic defect or single traumatic experience causes a mental disorder
Attempts to trace origins of a disorder to one factor
Reflects primary focus of clinician not actual belief that there is one specific cause
Interactionist explanation
Views behaviour as product of the interaction of diff factors
Takes biology and environment into account
Null hypothesis
Proposes that prediction made from theory is false
4 general aims of theories about mental disorders
1- explain the etiology (cause or origin)
2- identify factors that maintain the behaviour
3- predict the course of the disorder
4- design effective treatments
Name the six main theories about etiology of mental disorders
1- biological
2- psychodynamic (Freud)
3- behavioural/cog-behavioural
4- cognitive theories examining dysfunctional thoughts or beliefs
5- humanistic/existential theories that examine interpersonal processes
6- socio cultural influences
4 general aims of theories about mental disorders
1- explain the etiology (cause or origin)
2- identify factors that maintain the behaviour
3- predict the course of the disorder
4- design effective treatments
Name the six main theories about etiology of mental disorders
1- biological
2- psychodynamic (Freud)
3- behavioural/cog-behavioural
4- cognitive theories examining dysfunctional thoughts or beliefs
5- humanistic/existential theories that examine interpersonal processes
6- socio cultural influences
Characteristics of biological theories
- borrow model from medicine
- use vocab like patients, symptoms, syndromes, treatment
- say that issues are from dysfunctions or damage in the brain (central nervous system), problems of control in peripheral nervous system (automatic/somatic nervous system), or malfunctioning of endocrine system
4 goals of a theoretical perspective
Explain etiology
Identify factors maintaining disorders
Predict course of disorders
Design effective treatments
How has historical perspective shifted?
Past: emphasis on bio OR enviro causes (nature vs nurture)
Now: interactionist explanations
Where/what causes mental disorders according to biological models?
Damage to brain Neurotransmitters Autonomic nervous system (ANS) Endocrine system Genetics
Some disorders have been linked to brain damage. How can damage occur?
Direct head injuries
Diseases
Toxins
Neurotransmitters
Chemical messengers that are released from the propagating neuron and move through the synapse to the postsynaptic neuron
4 neurotransmitters that get the most research attention
Dopamine
Serotonin
Norepinephrine
Gamma aminobutyric acid (GABA)
Dopamine vs serotonin caused behaviour
Dopamine: pleasure seeking and adventurous behaviours
Serotonin: constraint or inhibition of behaviours
How are neurotransmitters distributed in the brain?
Different neurotransmitters seem to be concentrated in diff areas of the brain
Relate to diff functions
4 disturbances in neurotransmitters that can contribute to abnormal behaviour
1- production/release at the synapse
2- receptor sites
3- transmitter deactivating substance in the synapse
4- reuptake process
Peripheral nervous system is made of two parts
Somatic nervous system
Autonomic nervous system
Somatic nervous system
Controls muscles (chronic muscle tension, symptom of generalized anxiety disorder)
Autonomic nervous system
Controls bodily functions like breathing, digestion, heart rate, etc
Split into parasympathetic nervous system and sympathetic nervous stem (fight or flight response)
Endocrine system
Endocrine glands release hormones (chemical messengers released into bloodstream)
What do disturbances in hormone balance cause?
Disruptions in behaviour, thoughts and feelings
What problem can mimic anxiety and is related to hormones and the endocrine system?
Hypoglycaemia
Pancreas doesn’t secrete balanced levels of insulin or glycogen
Genetics
Inherited characteristics
Genes interact with environment to lead to psychopathology (ex: adults with a specific gene developed depression only if they also experiences a stressful life event)
The 5 psychosocial theories
Psychodynamic theories (unconscious conflicts) Behavioural theories (learning causes normal or abnormal behaviour) Cognitive theories (thoughts cause dysfunction) Humanistic/existential theories (considers each person's idiosyncrasies, person's sense of self=important, people are in control of their actions) Socio-cultural theories (stereotypes of gender, race, poverty, labelling cause disorders
Psychodynamic theories
Sigmund Freud
Theory based on analysis of Anna o.
To explain all aspects of human behaviour, including neurosis
What are Freud’s 4 interrelated aspects that produce behaviour (psychodynamic theory)
Levels of consciousness
Structures of personality
Psychosexual stages of development
Defence mechanisms
Freud’s 3 levels of consciousness (psychodynamic theory)
Conscious: info we are aware of
Preconscious: info that is accessible although it is not in our awareness
Unconscious: stores memory/drives that would require great effort (psychoanalysis) to bring to awareness
Freud’s structures of personality (psychodynamic theory)
Id: biological or instinctual drives (ex: sexual, aggressive, etc); pleasure principle
Superego: internalization of societal values and morals
Ego: mediator between id and superego; maximize benefits against costs; reality principle
Freud’s 5 psychosexual stages of development and their manifestations (psychodynamic theory)
Oral (birth to 18 mos; focus on oral activities)
Anal (18 mos to 3 years; child may cooperate or resist toilet training by soiling or withholding)
Phallic (3-6 years; Oedipal or Electra complex)
Latency (6-12 years; consolidation of behavioural skills and attitudes)
Genital (teen-death; achievement of personal and sexual maturity)
What is the function of defence mechanisms? (Psychodynamic theory)
Express desires of the id in symbolic form (unconscious) or to manage anxiety
Ego uses defence mechanisms and the id does its best to break through these defences
Three examples of defence mechanisms (psychodynamic theory)
Denial
Reaction formation (repressing unacceptable desires by expressing the opposite to what you really mean)
Projection of feelings/beliefs onto others
Criticisms of freud’s theory
Largely speculative and hard to test
No matter what the results are, the theory can still explain it
BUT he did open up discussion about sexual research, not all reasons for human behaviour are the obvious ones, etc
Three examples of projective tests used for personality assessment
Rorschach ink blot test
Thematic apperception test (TAT)
Minnesota multiphasic personality inventory (MMPI)
What is the main belief of behavioural theorists?
All behaviour is learned (Watson)
Basis for this learning=classical conditioning (Pavlov, dog experiment)
Two types of conditioning (behavioural theories)
Classical conditioning (Watson) Operant conditioning (skinner)
Describe classical conditioning and its stimuli/responses (behavioural theories)
Unconditioned stimulus: automatically causes a response
Conditioned stimulus: neutral; does not naturally cause the response associated with the UCS
Unconditioned response: automatic response to UCS
Conditioned response: learned response to the conditioned stimulus after pairing with the Unconditioned stimulus
Describe the case of little Albert (behavioural theories)
White rat=conditioned stimulus
Loud noise=unconditioned stimulus
Elicits fear response
Problems with classical conditioning (behavioural theories)
Couldn’t explain why phobias did not go away; after using the conditioned stimulus without unconditioned stimulus- expects that the conditioned stimulus will then stop giving the response
Three main ideas of operant conditioning (behavioural theories)
Consequences of behaviour=important
Both positive and negative reinforcement increase behaviour
Punishment decreases likelihood that behaviour will reoccur
Social learning theory (behavioural theory)
Although some behaviours are acquired directly by conditioning processes, observation leads to the formation of most behaviours
Lead to development of cognitive behavioural theory
Cognitive-behavioural theory (behavioural theories)
Has roots in social learning theory because Bandura emphasized the importance of cognitive processes
Introduces idea that individuals play an active role in regulating their behaviour and thoughts
Beck=because behaviours and thinking are learned, they can be changed
Therapeutic tool=self-monitoring
Automatic thoughts -> cog distortions
Schemes -> info processing and immediate beliefs -> auto thoughts
The 4 interactionalist models
Systems theory
Diathesis-stress perspective
Biopsychosocial model
Developmental psychopathology
Systems theory (interactionalist theory)
Whole is greater than the sum of its parts
Causation as multifactorial and bidirectional (parents behaviour causes child’s behaviour and vice versa)
Diathesis-stress perspective (interactionalist theory)
According to this model, people are predisposed to develop a disorder (diathesis) but a stressor is needed start the symptoms (diathesis + stressor= symptoms)
Diathesis or stressor can be biological or psychological
Pros= encourages us to consider multiple factors in onset of a disorder; shows that reason one person gets a disorder could be different than the reasoning of another person
Biopsychosocial model (interactionalist theory)
Biological, psychological, and social factors important
Each factor must be taken into account, with the weighting of each factor depending on the disorder
Developmental psychopathology (interactionalist theory)
Crosses boundaries of social, psychological and bio sciences
Multifactorial causation
Multiple pathways to same outcomes
Profiles of risk/protective factors
Maladaption= outcome of development
Dynamic vs static (processes that underlie development always changing)
Three types of mood episodes
Major depressive episode
Manic episode
Hypomanic episode
Three types of mood episodes
Major depressive episode
Manic episode
Hypermanic episode
Describe characteristics of a major depressive episode
5+ symptoms within less than a two week period and must have either depressed mood or diminished interested pleasure (other symptoms include weight/appetite change, insomnia, motor agitation/retardation, loss of energy, worthlessness/guilt, thoughts of death or suicide attempt)
Characteristics of a manic episode
1- abnormal/irritable mood and increased energy or goal-directed activity in min 1 week
2- 3+ symptoms (includes inflated self-esteem, less need for sleep, more talkative than usual, flight of ideas, easily distracted, more goal-directed activity or fidgety, involved in a lot of risky but pleasurable activities)
Hypomanic episode
Same symptoms as manic episode but lasts less than 4 days (vs 1 week) and episode not serious enough to cause marked impairment at work/social activities, no need for hospitalization, no psychotic features
What kind of episodes go with each of the three main mood disorders
Major depressive disorder= only major depressive episode
Bipolar 1= 1+ manic episodes and with or without depressive episodes
Bipolar 2= 1+ hypomanic episodes and with 1+ depressive episodes
Characteristics:
- depressed mood most days
- two or more symptoms (appetite issues, sleeping issues, low energy, low self esteem, bad concentration, hopelessness)
- 2+ years (or 1 for kids and teens)
Persistent depressive disorder
Characteristics:
- 2+ years (1 for kids and teens)
- periods of hypomanic symptoms and depressive symptoms but doesn’t match criteria for major depressive episode
- during 2 years, not without symptoms for more than 2 mos at a time
- be careful with antidepressants because can cause mania in sensitive patients
Cyclothymia
Unipolar vs bipolar nods disorders
Unipolar: major and persistent depressive disorder
Bipolar: bipolar 1 and 2, Cyclothymia
Premenstrual dysphoria disorder (PMDD)
- 5+ symptoms week before period and improve a few days after period starts
- 1+ of: marked affective instability, irritability, depressive mood, anxiety
- 1+ of: decreased interest, sleep and appetite changes, physical symptoms
- must be determined by watching for symptoms for two months before actual diagnosis
Gender bias in PMDD?
Callaghan study: when describe in sex-specific form, 20% of women met criteria
When described in sex-neutral form: only 8% of women and also 4% men
Cognitive theory of depression
- How individuals think about and see their world impacts feelings and behaviour
- schemas of depressed people are highly negative
- cognitive triad: negative core beliefs about self world and future
- longitudinal studies show that people with negative cognitive style were more likely to develop depression
Beck’s diathesis-stress model of depression.
Negative cognitive schemas (diathesis) are inactive until individuals face a life stressor that matches the theme of their schema
Ex: I’m a failure activated by failing a course
Cognitive-behavioural therapy for depression (3 stages of treatment)
1- behavioural activation by activity scheduling, etc
2- identifying accuracy of automatic thoughts (all or nothing thinking, over generalization, magnification/catastrophizing, jumping to conclusions)
3- challenge a patient’s core beliefs and schemas (behaviour experiments that view thoughts as hypotheses that can be tested, collect evidence for and against auto thoughts)
Three main points of evidence for cognitive behaviour therapy for depression
- better than no treatment and psychodynamic therapy
- comparable to meds
- lower relapse rates compared to people just taking meds
Interpersonal characteristics of depression
- deficits in social skills
- more negative interactions
- less eye contact/face animation/modulation of tone of voice
Do deficits in social skills cause depression?
No
Risk factors are actually negative feedback seeking and excessive reassurance seeking
Describe interpersonal psychotherapy (IPT)
Developed in 1980s by klerman and Weismann
Roots in psychodynamic theory but a brief treatment (12-16 sessions)
Suggests that depression develops in an interpersonal context and therefore addressing people’s difficulties in relationships should help improve the depression
IPT’s four domains that are targeted sources of interpersonal dysfunction
1- interpersonal disputes
2- role transition
3- grief
4- interpersonal deficits
Tricyclics (depression)
Block reuptake from synapse of NE (catecholamine norepinephrine) and indolemine serotonin (5-HT)
Causes more neurotransmitters to be available in the synapse to bind to post-synaptic receptors and trigger new action potentials
Effective but has many side effects
Lethal in overdose
Monoamine oxidase inhibitors (MAOIs; depression)
Inhibit monoamine oxidase (an enzyme) that breaks down monoaminergic neurotransmitters in the presynaptic cell. This causes more monoamines to be released into synapse to bind to post-synaptic receptors and trigger new action potentials
Has potentially dangerous side effects
Selective serotonin reuptake inhibitors (SSRIs)
First choice in treatment of depression
Mild side effects
Only need to take once a day
Block the reuptake of serotonin into the presynaptic cell. More serotonin in the synapse to bind to post-synaptic receptors and trigger new action potentials.
50-70% of patients response to antidepressants. How do you choose which one to use?
Decision based on: Side effects Ease of administration History of response with the person or members of the family Medical issues Depressive subtype Cost
Is combined CBT, IPT and medication effective?
Not for mild to moderate depression, but yes for severe depression or depressed teenagers
Etiology of bipolar disorder
Heritability is .75 (vs .36 for major depressive disorder)
Sleep deprivation triggers mania for many patients
Medication is the best way to treat bipolar disorder, but has high rates of relapse. What are the drugs typically used?
- lithium (don’t know how it works, requires regular monitoring, therapeutic dose is just less than toxic dose)
- anticonvulsants
- antipsychotics (short term, risk of tardive dyskinesia)
- antidepressants (risk for triggering mania, used usually with mood stabilizers like ones listed above)
CBT for bipolar disorder
Similar to treatment for depression PLUS
Problem solving around sleep difficulties
Mood monitoring to identify triggers for mania
Support taking meds regularly
Interpersonal and social rhythm therapy (IPART) for bipolar disorder
Focus on regulating daily routines and teaching coping methods for stressful events
Few relapses compared to clinical management
Electroconvulsive therapy for bipolar disorder (ECT)
Used today for people with severe mood disorders when no other treatment has worked for them
Risk of memory loss
Vocab:
1- thoughts of death/suicidal plans
2- non-fatal attempt at suicide with intention to die
3- death by suicide
1- suicidal ideation
2- suicide attempt
3- completed suicide
Suicide stats
Almost 1 million people die of suicide every year
Men complete suicide more than women, but women attempt it more
2nd leading cause of death in young people in Canada and leading in Canadian males aged 15-19
The two high risk groups for completed suicide
1- males 19-24 and over 70
2- First Nations living in reserves
Primary prevention of suicide
Population based
Focus on changing situations/attitudes/conditions that predispose individuals towards suicide
(Public education has had little success and restricting access to suicide means has had some success)
Secondary/tertiary prevention of suicide
Target individuals high in suicidal ideation or behaviours
Suicide hotlines are most helpful for suicidal ideation; helpful in reducing female suicide rates but not so much in general rates
What are the American association of suicidology’s warning signs of suicide?
IS PATH WARM
Deliberate harm to ones own body tissue (ex: cutting, burning, head banging; no suicidal intent)
Non-suicidal self-injury (NSSI)
4 high risk groups for most risk to least risk
Forensic populations, undergraduates, psych patients, adolescents
Course of NSSI
Onset typically in adolescence, can be chronic
Risk factors for NSSI
Childhood maltreatment Depression Difficulty regulating emotions Self-criticism Parental criticism Social conflict and isolation
5 reasons why people self-injury
Emotion regulation Reduce anger Communicate distress to others Self-punishment End dissociative experiences
Clinical concerns of self-injury (4)
Associated with increase risk of suicide attempts and completion
Associated with shame, guilt and regret
Disrupts relationships
Can lead to scarring and infection
Biological factors of anxiety
- genetic influence: 4-6 times more likely if family member had it
- neural fear circuit: thalamus, amygdala, hypothalamus, mid-brain, brain stem and spinal cord
- seratonin and norepinephrine systems
- GABA=most pervasive inhibitory neurotransmitter in the brain
Mowrer’s two factor theory (anxiety)
Fears are acquired through classical conditioning
Fears are maintained through operant conditioning
Ex: escaping= negative reinforcer that stops classically conditioned fears from being unlearned
Limitations: can’t explain the development of all phobias (we are biologically made to be afraid of dangerous things)
Beck’s cognitive model (anxiety)
Anxious people think the world is dangerous, the future is uncertain, and the self is helpless/vulnerable
Interpersonal factors in anxiety
Relationships we make with our parents early in life can lead to the development of general belief systems about relationships
Anxious-ambivalent style is most likely to lead to anxiety in adulthood
Criteria for a panic attack
At least 4 of the 13:
- fast heart beat
- sweating
- shaking
- shortness of breath
- feelings of choking
- chest pain
- nausea
- feeling dizzy or faint
- derealization/depersonalization
- fear of losing control or going crazy
- fear of dying
- paresthesias (numbness/tingling)
- chills/hot flashes
Panic disorder
Two or more unexpected panic attacks
Attack must develop suddenly and randomly (uncued)
Always worrying about having another attack or altering behaviour because of them
Medical conditions or other anxiety disorders mimic these symptoms but here the attacks are for no apparent reason
Can be assessed with symptom induction test
Panic disorder: etiology (2 cognitive theories)
Catastrophic misinterpretation
Alarm theory
Agoraphobia
Anxiety about having an anxiety attack in a place where help cannot easily reach the person or they cannot escape (ex: public transit, open spaces or enclosed spaces, standing in line or crowds, etc)
What’s it called when you have a fear of one thing ex: spiders
Specific phobia
Social anxiety (social phobia)
A marked/intense fear or anxiety of social situations where one might be judged by others
A fear of negative evaluation
Found in men and women equally
Generalized anxiety disorder (GAD)
1- excessive anxiety or worry occurring more days than not for at least 6 mos about diff things in life 2- difficult to control the worry 3- 3 of 6 symptoms: Restlessness Tired easily Difficulty concentrating Irritable Muscle tension Sleep disturbance 4- focus of anxiety not confined to another anxiety or axis 1 disorder
Obsessive compulsive disorder (OCD)
Thoughts/images/impulses that always come back and that cause distress=obsessions
Repetitive behaviours due to obsessions=compulsions (goal of reducing anxiety)
Thought-action fusion
Related to OCD
Belief that the more you think about about something, the more likely it is to come true
Also thoughts = action in this person’s head (same moral goodness or badness)
Posttraumatic stress disorder (ptsd)
Happens after traumatic experience Constantly repeats in a person's head Avoiding things that remind the person of the trauma Changes in mood or ways of thinking Ongoing symptoms of being on edge
Name for anxiety disorder treatment that thinks anxiety is due to bad thinking patterns and that changing overestimations of risk and underestimations of coping abilities will help treat the anxiety
Cognitive restructuring
Describe the exposure technique called systematic desensitization
1- develop a hierarchy (ranking) of experiences that cause the person anxiety (using subjective units of distress)
2- gradually go through the list and teach the person how to cope with their anxiety in each situation through demonstration
Describe relaxation through guided imagery
Develop an image that make one feel calm and relaxed
Involve all the senses
Use affirmations (aka say things that affirm your ability to relax like peace is within me etc)
Describe relaxation through progressive muscle relaxation
Tense and relax different muscle groups
Notice how it makes you feel
Teaches you how to relax tension in your muscles in a purposeful way
What type of breathing does deep breathing involve?
Diaphragmatic breathing
Two points of empirical support for relaxation strategies
1- they provide immediate (but short term) relief
2- exposure is the most important part of the treatment
Obsessive compulsive disorder (OCD)
Thoughts/images/impulses that always come back and that cause distress=obsessions
Repetitive behaviours due to obsessions=compulsions (goal of reducing anxiety)
Thought-action fusion
Related to OCD
Belief that the more you think about about something, the more likely it is to come true
Also thoughts = action in this person’s head (same moral goodness or badness)
Posttraumatic stress disorder (ptsd)
Happens after traumatic experience Constantly repeats in a person's head Avoiding things that remind the person of the trauma Changes in mood or ways of thinking Ongoing symptoms of being on edge
Name for anxiety disorder treatment that thinks anxiety is due to bad thinking patterns and that changing overestimations of risk and underestimations of coping abilities will help treat the anxiety
Cognitive restructuring
Describe the exposure technique called systematic desensitization
1- develop a hierarchy (ranking) of experiences that cause the person anxiety (using subjective units of distress)
2- gradually go through the list and teach the person how to cope with their anxiety in each situation through demonstration
Describe relaxation through guided imagery
Develop an image that make one feel calm and relaxed
Involve all the senses
Use affirmations (aka say things that affirm your ability to relax like peace is within me etc)
Describe relaxation through progressive muscle relaxation
Tense and relax different muscle groups
Notice how it makes you feel
Teaches you how to relax tension in your muscles in a purposeful way
What type of breathing does deep breathing involve?
Diaphragmatic breathing
Two points of empirical support for relaxation strategies
1- they provide immediate (but short term) relief
2- exposure is the most important part of the treatment
Name 4 ways that disturbances in neurotransmitter systems can cause abnormal behaviour
1- too much or too little neurotransmitter produced or released into the synapse
2- too few or too many receptors in the dendrites
3- excess or deficit in the amount of substances that stop neurotransmitters in the synapse
4- reuptake process could be too fast or too slow
Humanistic/existential theories
Husserl/merleau-ponty
People form their view of the world through experience which sense of self guides
Involves free will
Humanistic=Rogers and Maslow (experience=basis for improving oneself; must trust experience)
Hierarchy of needs to reach self-actualization
Existential=possibility of death or loss of meaning in our lives along with the responsibility for our actions makes us anxious
Both have little research
Name some examples of socio-cultural influence
Stigma (labelling theory)
Social support
Race
Poverty
Psychodynamic theories of mood disorder
Parents styles can have an effect
Role of personality (dependency/self criticism)
Cognitive theories of mood disorders
Beck
Emotional responses
Cognitive distortions (all or nothing thinking, over generalization, catastrophizing, jumping to conclusions)
Schemas (cognitive triad= self future and world)
Diathesis-stress model
Candidate gene for depression
Gene that regulates serotonin aka serotonin transporter gene HTT
How is stress modulated in mammals?
Hypothalamic-pituitary-adrenal axis
Stress releases CRH which leads to ACTH Being released from the pituitary gland and cortisol from the adrenal gland
Benzodiazepines
Treatment for anxiety disorders before antidepressants were discovered
Binds to receptor sites for the neurotransmitter GABA which temporally stops a lot of activity in the brain, including ones that are involved in fear and anxiety
Many bad side effects
Tricyclic antidepressants (anxiety treatment)
Block reuptake of norepinephrine and serotonin
Specifically good for OCD
SSRIs are the best ones
Best treatment for specific anxiety disorder
Exposure; Meds only dampen anxiety and make this less effective
Treatment of social anxiety disorder
Cognitive-behavioural group therapy (CBGT); same results as Meds with less chance of relapse
D-cyclocerine helps social anxiety
Treatment of generalized anxiety disorder
Benzos=good short term but not so much long term , can develop tolerance or dependance
CBT=best results
Treatment of OCD
Exposure and ritual prevention (ERP)
Serotonin based Meds
CBT still recommended most of the time
Treatment of PTSD
Facing the trauma through imagining it and discussing it in detail
Psychological debriefing right after a traumatic event
Recommended general treatment for anxiety disorder
Cognitive behavioural therapy (CBT)
