PSY183 Midterm1

"upside" of BD

"well" relatives of patients = higher rates of achievement, success, creativity -Akiskal: "dilute" genotypes of the illness may have evolved to subserve adaptive functions = exploration, risk taking, charm, sexual selection, territoriality

ex) Harlow's monkey depression research

'bottomless pit' = vertical chamber -monkeys began to withdraw, could not socialize after -> better after months -could tell when he threw a snake -> defensive responses = DIMINISHED RESILIENCE

OCD (Obsessive Compulsive Disorder)

(one of most brutal to deal with) -DEBILITATING, unwanted (EGO-DYSTONIC = thoughts are perceived as alien to me): 1) obsessions (intrusive thoughts, impulses, images) 2) compulsions (repetitive BEHAVIOR to ward off anxiety/unwanted impulse) = FORM A LOOP, each reinforces the other (obsessing and compulsing -> repeat) -most common: contamination, excessive doubt, symmetry, exactness -RECOGNITION that obsessions/compulsions are excessive/unreasonable -significant distress/impairment for over one hour per day

cognitive signs of anxiety

-"objectless fear"/feeling of apprehensiveness, on edge -heightened sense of vulnerability -worrying/rumination: always more to worry about -"going blank," spacing out ex) test anxiety, forgetting everything, defense mechanism = dissociation (take yourself out of whatever is stressing you" -irritability, impatience, distractibility = anxious preoccupations can look like ADHD but they are upset for what is about to happen -hypervigilance

BD: genetic evidence

-65% concordance in MONOZYGOTIC twins; 14% dizygotic -10% rate: 1st degree relatives -family history in 30% of patients -in 20% of MZ twins: when one has BD, the other has major depression = COMMON INHERITANCE -multiple routes of genetic involvement, shared other mental disorders ex) GENE LOCI = BD + schizophrenia

BD: brain structure etiology

-ABNORMAL: hippocampus, basal ganglia, cerebellum = SMALLER -LESS GRAY MATTER

1st line OCD treatments

-BEST = ANTIDEPRESSANT therapy = serotonin boosting meds (HIGH DOSES, 2-3X as much as major depression): SSRIs (prozac), tricyclics (clomipramine) -BEHAVIOR THERAPY: 1) thought stopping (yell stop, ego-dystonic voice yells at you every time later on) = obsession -neutralizing 2) response prevention = compulsion, gradually withstand more anxiety -> starts to dissipate, they tolerate more (combine therapy with meds) -NEUROSURGERY (for otherwise intractable cases): -PATHS TO/FROM FRONTAL LOBES -INVASIVE: deep brain stimulation (DBS) using implanted electrodes (more chance), cutting of pathways -NONINVASE (destruction of pathways by heat): -targeted radiation with gamma knife -newest: focused ultrasound (sound transducers, high pitched sound carries energy to heat up tissue to destroy it)

general diagnostic criteria: GAD (generalized anxiety disorder)

-DEBILITATING worry, fretfulness -worry hard to control -varied anxiety symptoms (restless, fatigue, hard to focus, mind blank, irritable, muscle tension, insomnia) -OFTEN ARISES WITH MAJOR DEPRESSION (or just before or after)

compare effectiveness of meds vs therapy

-ECT = fastest, most people, fewest side effects -meds + psychotherapy (CBT/IPT) work EQUALLY WELL for most adults, but MEDS WORK FASTER -some evidence: psychotherapy -> fewer remissions, disputed -adolescents = SSRI + CBT recommended -meds = least expensive single mode of treatment

signs/symptoms of BD

-EMOTIONAL: active/powerful emotions, euphoric joy/well-being, irritable/angry (not always happiness) -MOTIVATIONAL: want constant excitement, involvement, companionship -BEHAVIORAL: very active, move quickly, talk rapidly, loudly, verbal outbursts -COGNITIVE: poor judgment/planning, optimism to ignore input of others, inflated self-esteem/opinions of themselves

unofficial members of OCD spectrum

-Gilles de la Tourette syndrome: anxiety, tics (extreme motor), coprolalia (utter curse words) -hypochondriasis (DSM-5: illness anxiety disorder); OCD CYCLING but revs up anxieties about having a disease, tend to get diagnosed before other people -delusional disorder (erotomanic): fantasized love and stalking, exacerbated by social media, think a celebrity is in love with you but cannot access you so you stalk them -bulimia, anorexia nervosa -"homosexual OCD" (HOCD): not officially recognized/in DSM-5 -mainly in adolescents = fear/aversion to being gay/lesbian -obsessive self-questioning about one's response to own vs. opposite sex -binary (not bisexual, just gay or straight)

DSM-5 OCD related disorders (spectrum)

-HOARDING DISORDER (2-5% pop, ? M:F) -excessive shopping/collecting of possessions (animals sometimes) -anxiety about discarding possessions -possessions crowd out living space -embarrassment about showing space to others -BODY-FOCUSED REPETITIVE BEHAVIORS (2-5% pop, 10-15:1 female) -trichotillomania (hair pulling, scalp, eyelashes, eyebrows) -excoriation (skin, nail picking) -often run in families! -BODY DYSMORPHIC (2.5% pop, 1:1 M:F) -obsessive concern about appearance/body parts (usually skin, hair, nose) and compulsive acts (mirror checking, camouflaging, excessive grooming, picking) -pattern of AXIOUS AVOIDANCE of others -half of BDD = delusions of reference (they think they are focus of other people's attention)

physical disorders that can masquerade as anxiety

-HYPERthyroidism = basal metabolic rate too high, interpreted as nervousness -pheochromocytomas (adrenal tumors = over secrete adrenaline) -inner ear disease = feel imbalanced, dizzy -angina pectoris = chest pain, heart muscle not getting sufficient blood, arteries spasming -HYPOglycemia = blood sugar too low (after spike of eating sugar/carbs), feel shaky -mitral valve prolapse = blocks blood from back flowing, backwash into the ventricle, inefficient heartbeats ("innocent murmur"), brain naturally goes on red alert -cardiac arrhythmias = unstable rhythm, nervous -drug effects (caffeine, nicotine, nasal decongestants, asthma inhalers, stimulants)

endocrine theories of depression

-HYPOTHAL-PITUITARY dysfunction (HPA-axis OVERACTIVE) **master gland -thyroid dysfunction -adrenal dysfunction -sex hormone insufficiency (testosterone, estrogen) -> secrete 90%/10% of gendered hormone

physical conditions that can masquerade as major depression

-HYPOthyroidism -low test/estrogen -undiagnosed illness (infectious mononucleosis, anemia) (less hemoglobin = less energy) -chronic fatigue syndrome = differential diagnosis -systemic illnesses

bipolar disorder: neurotransmitter etiology

-MAYBE defects in metabolism of protein-kinase C (PKC) = enzyme in calcium metabolism of neurons in specific brain areas -> UNSTABLE LEVELS of neurotrans release -PKC ACTIVITY UP IN MANIC PATIENTS, normalized by anti-manic meds -PKC INHIBITORS bring acute mania under control

social anxiety disorder (social phobia)

-MOST COMMON ANXIETY DISORDER -1-year prevalence of ~8%, lifetime up to 15% -develops in late adolescence -grossly UNDER-DIAGNOSED in managed care population -when people become DISABLED by: -intense, persistent, chronic fears of being watched/judged by others -young adulthood: how you look becomes more important than who you are -doing things that will be humiliating -generalized OR in specific situations -1/3 are VERY DISABLED, more likely to be depressed, divorced, unemployed, or under-employed -AWARENESS that fears are excessive -6+ months -common "PERFORMANCE SITUATIONS" : -public: speaking (MOST; Toastmasters: supportive group -> gradually gain confidence), restroom use -going to parties -eating with others -bedroom (erectile, orgasmic) MOST COMMON TREATMENT: medications (benzos, SSRIs more), supportive/proactive psychotherapy, become aware of judgmentalism = all comes from parents condemning

major anxiety disorders

-MOST FREQUENTLY occurring psychiatric problems in general population, recent increases in adolescents -RUN STRONGLY IN FAMILIES, co-morbid with depression + stress (50-70% of people with lifetime depression have lifetime anxiety) = COMMON DISTRESS INHERITANCE (everyone in family has at least one of the two) -increased risk of alcoholism/drug abuse, SELF MEDICATION -ALCOHOL = most common anti-anxiety medication, absorbed quickly, dose yourself, addictive, dementia, fetus deforming

neurochemical disturbances + more brain changes

-NEUROTRANS ABNORMALITIES = account for side effects of antidep meds MORE THAN MAIN EFFECTS (MAIN EFFECT = FROM BDNF) -INCREASED NEUROSTEROID hormones = neuronal death, glial cell damage (HIPPOCAMP -> memory damage); destroy brain tissue -ALTERED LIMBIC SYSTEM activity levels ("old cortex" = motivation, emotion), prefrontal, other regions

behavioral account of etiology of phobias, validity

-Nature of phobic stimuli undercuts a straightforward conditioning view of specific phobia -We are not scared about the dangerous things in the world Ex: electrical sockets, falling coconuts, bathtubs -Maybe at some point, the things we are scared of were ONCE HARMFUL or dangerous to us in evolutionary terms -Conditioning; modeling, idea of phobia "preparedness" (a predisposition to develop certain fears; predispositions can be transmitted genetically through an evolutionary process)

text: body integrity identity disorder

-PARALLELS WITH TRANSGENDERISM: the limbs never felt right or natural; felt like they were in the wrong body, only complete with arm/leg off on the right side -NEITHER changed from psychotherapy/medication -ETIOLOGY ETC: brain researchers propose that it should not be considered psychological, but INBORN NEUROLOGICAL = mismatch btwn internal body scheme and physical body -disturbance in body ownership -"foreign limb syndrome" xenomilia -EVIDENCE: defective body-image circuitry in SUPERIOR PARIETAL LOBULE (SPL) (in right parietal lobe); brings together touch and position info for the entire body -BIID: SPL registered tapping stimulation only to the wanted foot (while normal did both) -structural diffs: premotor cortex of frontal ("maps") and insular cortex (body boundaries, self-awareness) -psych vs neuro: overlap each other -apotemnophilia: "love for amputation" (only 15%) -TREAT: amputation showed 100% satisfaction rate, better quality of life, dont desire anymore amputations, only regret: didnt do it sooner -CONTROVERSY: fundamental "do no harm" (amputations can cause disability, compensatory injury, infect) -bound not to comply: colluding with patient's ILLNESS RATHER THAN THE PATIENT -unethical: not doing it would condemn BIID sufferer to lifelong MENTAL disability -if they dont, patients will seek unsafe, backroom amputations?

patters of MD occurrence

-POINT prevalence = 5% US diagnosably depressed -ONE-YEAR prevalence = ~10% -LIFETIME = 20.1% (26% women, 12% men); moderate-severe -15-20% US pop at any time = SUBSYNDROMAL depression (nearly equal disability; without checking every box on DSM-5)

precautions of antidepressant use

-RECOVERING patient must be watched for suicidal/violent behavior -can precipitate MANIC EPISODES in undiagnosed bipolar disorder = "switching" into manic phase from depressed (~10%) -abruptly stopping -> dizziness, tremors, zaps, anxiety, panic, nausea, vomiting, confusion

genetic evidence for depression prevalence

-TWIN studies (identical has unipolar -> 38% chance other will have the same) -fraternal = 20% chance -some evidence: unipolar tied to genes on chromosomes -elevated risk if relative has had it -BIOLOGICAL predispositions: -LOW activity in key neurotransmitters in key brain structures -overly reactive HPA-axis stress pathway -thyroid + adrenal gland dysfunction -dysfunctional depression-related brain circuit -sex hormone insufficiency

BD: ion activity etiology

-WITHIN NEURON MESSAGING (vs BTWN neuron messaging -> neurotransmitters responsible for) -studies: people with BD may have irregularities in transport of SODIUM IONS -> neurons fire TOO EASILY -> MANIA -or stubbornly RESIST firing -> DEPRESSION

explanations of 2:1 depression prevalence

-X-linked genes -hormones/premenstrual symptoms can trigger -quality of male vs female life (power vs. responsibility to raise kids) -female masochism (Freud) -cog style rumination theory (females dwell on problems; males ignore/escape them) -body dissatisfaction

specific phobia types

-animals -natural environment (storms, heights, water, Cali: earthquakes) -situation type (claustrophobia, tunnels, bridges, flying, driving) -result of imitative learning (mom tells you how afraid she is of mice -> you pick it up, predisposed) -bodily reactions (vomiting, headache, fever) = bad for women who want to have babies -blood/injury/injection (vasovagal reaction = spike in PARAsympathetic, OPPOSITE OF TYPICAL PHOBIC RXN, faint) -range of most common phobic stimuli undercuts a straightforward conditioning view of specific phobia

GABA and anxiety

-anxiety prone = DEFICITS IN GABA (inhibitory) -chemically blocking it = increases anxiety -one of many neurotransmitters involved: GABA and 5HT (serotonin) INHIBIT ANXIETY -role in reduction of normal, everyday fear reactions -EPINEPHRINE/NOR, DOPAMINE provoke physiological changes that can lead to anxiety -seesaw effect of excitatory and inhibitory neurotrans -ethyl alcohol (ETOH) + anti anxiety meds MIMIC GABA by binding to GABA receptor areas

common compulsions in OCD (%)

-checking = 63 -washing -counting -need to ask/confess -arranging/organizing -collecting/hoarding = 18 -multiple = 48 98% OF OCD SUFFERERS HAVE BOTH OBSESSIONS AND COMPULSIONS

conditions associated with depression, treated with antidepressant meds

-chronic pain -binge eating -bulimia -migraine -anxiety (panic, OCD) -trichotillomania -compulsive zit popping, shopping, gambling -hypochondria -sexual addiction -premature ejaculation -premenstrual dysphoric

DSM-5 conception of mental disorder = working def

-clinically significant (has come to clinic/referred to a professional setting) behavioral/psych syndrome or pattern: -present distress (painful symptom) -disability (impairment in important function, lose initiative) -significantly increased risk of suffering death, pain, disability, or loss of freedom (cannot care for themselves) -MUST NOT be merely expectable and culturally sanctioned response to an event (aka death of a loved one)

mesmerism

-contemporary view -inter-psych conflicts lead you to be mentally ill -belief in distortion of bodily energies + used filings to release and help them -came to be known as hypnotism

compared major(unipolar) and bipolar depression

-depression = MORE PROBLEMATIC IN BD -most cases of BD = first appear as depressed phase -40% people with BD initially diagnosed with MD -avg onst of BD = below 25, MD = late 20s (MAJOR IS LATER) -BD LASTS LONGER, recurs more often, more likely to reach PSYCHOTIC levels, can take 2x long to obtain remission with treatment = SEVERE/STUBBORN -BD = spend ~1/3 of adult lives in depression -BD = more likely includes reversed neurovegetative signs (hypersomnia, increased appetite), psychomotor retardation ~1:1 ratio in BD, 2:1 in MD >10% of people with BD eventually suicide (depression phase)

Four D's of Psychopathology

-deviance (statistical, moral, cultural) -distress (upsetting/pain to own/others) -dysfunction (inability to do normal daily activities) -danger (to self/others) 3/4 = abnormal

DSM-5: Dimensional Information

-diagnosticians required to assess the CURRENT SEVERITY of the client's disorder; how much it impairs them -for each disorder: VARIOUS RATING scales are suggested: e.g. Severity of Illness Rating Scale -if a client qualifies for a diagnosis of personality disorder, further assessment is required ex) -diagnosis = major depressive disorder with anxious stress -severity = moderate -additional info = relationship distress

unipolar depression types

-double = persistent depressive disorder + major depressive episodes -always depressed -> hit with a major episode -> lets you go back to baseline = normal chronic depression -major = episode -persistent = chronic -unipolar mania = rare -hypomania = mild

Temperamentally Blessed: characteristics

-first-degree relatives never diagnosed -embrace life, get active, get involved -DO NOT OVER REACT when bad things happen -manage stress by surrounding themselves with supportive people, reach out to build social network -NOT NECESSARILY RICH/PHYSICALLY HEALTHY -tracked subjects from birth onwards: we know that distinctive personality traits show up by elementary school years -"should copy the lifestyles of people with enduring mental health to see how to live well" -networks to help mitigate stressful life events: job loss, divorce -DBT: dialectical behavior therapy to teach emotional regulation -> tolerance/acceptance of others -> improves function in the real world = closer to blessed -more serotonin floating in synapses = mood benefits -immune to circumstance -NOT SAME AS BEING HAPPY = DO NOT SCORE HIGHER ON LIFE SATISFACTION SCALES -flourishing = completely separate -you can suffer mental illness and still retain sense that life is meaningful -knack for anticipating and avoiding most immobilizing inner tempests -group's ranks thin with age -"endowment for which the bearer cannot take full credit" BUT: depressive/anxious thoughts drive effective problem-solving: -depressed = highly analytical = good at pros and cons -could lack of intense reaction show psychological weakness? when dramatic movement is called for! ex) earthquake survivors who suffered moderate depression -> significant post-traumatic flowering, stronger relationships with others, faith in personal strength

DSM-5 classification of anxiety disorders

-generalized anxiety -panic disorder -agoraphobia -social anxiety -specific phobias -OCD GPASSO

DSM-5 ancillary info

-info from family members, physicians, employers -medical chart -previous psych testing, case summaries from therapists -discharge summaries from hospitals -obtaining this info usually requires patient to sign RELEASE FORMS (1st session) -can labeling and diagnoses cause harm? -> can lead to self-fulfilling prophecies; vary by clinician

alternatives to antidepressants

-lithium carbonate augmentation of antidep therapy (increase action) -St John's wort, Sam-e (expensive, weak) -Thyroxin -testosterone (M and F) -estrogen (F, in menopausal/post partum) -phototherapy (seasonal depression; involves exposure to fluorescent light bulbs; can improve days-weeks) -exercise (mild) -sleep deprivation (temporary)

psychophysiological tests, polygraph

-measure physical responses as indicators of psych problems (heart rate, muscle tension, breathing, etc) ex) lie detector, can be inaccurate/unreliable and many require expensive equipments

sociocultural characteristics affecting anxiety

-more likely: people faced with ongoing DANGEROUS societal conditions -threatening environments -> more likely to develop characteristics found in anxiety ex) HIGHER RATES OF GAD among people who live in crime/hostile neighborhoods -increased risk if it runs in family -alcoholism/drug abuse, self medication -POVERTY: increased chance -INVERSELY related (as WAGE decreases, anxiety increases) -RACE AND ETHNICITY -disorder takes on pattern "NERVIOS" for hispanics both in US and Latin America -NERVIOS: great emotional distress, so-called brain aches marked by poor concentration + nervousness, etc

common obsessions in OCD (%)

-multiple = 60 -contamination = 45 -excessive doubt = 42 -somatic = 36 (is there something wrong with me) -need for symmetry/exactness = 31 -fear of causing harm to self/others = 28 -fear of being sexually inappropriate = 26 -other (rituals, praying, repeating words) = 13

acute anxiety episode = panic attack

-palpitations, pounding heart -sweating, trembling -shortness of breath, choking, smothering -chest pain -nausea, abdominal stress -dizzy, lightheaded -DISSOCIATIVE: derealization (feeling of unreality), depersonalization (being detached from oneself) -fear of dying, losing control, going crazy -paresthesias (numbness/tingling) developed when breathing heavily for a long period of time -chills/hot flushes -many people admitted to ER for chest pain = panic attack

specific phobia

-persistent fears/panic attacks OUT OF PROPORTION to situation -compelling desire to avoid phobic stimulus -INSIGHT that fear is excessive (they see it but cannot help themselves) -symptoms are UNRELATED to another disorder ex) never go on a hike bc of fear of snakes -one year prevalence of 7%, lifetime of 9% in US -mean duration of specific = 20 years -females > males = 2-3:1 ratio -MOST HAVE MULTIPLE PHOBIAS

major depression = cognitive

-pervasive sadness, guilt, worthlessness -recurrent thoughts of death/suicide

anxiety actions of sympathetic NS

-pituitary release of ACTH -> adrenal cortex -> secretion of epinephrine/nor -pupils dilate -dry mucosal linings (mouth, stomach, intestines) -sweat -blood vessels CONSTRICT in skin and gut -DIVERSION of blood flow to muscles (raise BP) for potential glucose to fight/flight -tense muscles, HR up, speeded respiration, airway relaxation -EMERGENCY GLUCOSE RELEASE into circulation -relaxed urinary bladder -orgasm (sometimes)

BD prevalence

-point prevalence: historically ~1-1.5%, RECENTLY 3.5% (not misdiagnosing schizophrenia like we used to) -NO KNOWN SEX DIFF -assoc with high rates of alc/drug abuse (40-50%, HIGHER THAN ANY OTHER MAJOR DISORDER), criminal behavior, anxiety (~40%) -age of 1st diagnosis: ranges 15-45, most in 20s -SOMETIMES CHILDREN (pediatric BD, even in infancy)

psychodiagnosis: disadvantages

-sacrifices uniqueness of individual patient (stereotype) -falsely imply etiology (cause) ex) many docs today think BPD is caused by childhood abuse/problems in separation individuation = not always! -rigidifies treatment alternatives (some react poorly, others react well) -iatrogenic illness (healer causes illness, therapist encourages something that makes them commit suicide, meds side effect cause new disease) ex) chemo kills of decreased immune system = infection -stigmatization = financial -secondary gain = when one gives someone mental disorder diagnosis, they can use that to their advantage (cant come to work bc depression) -> sympathy becomes response -> individual has to do less and less; manipulation of system

infectious etiology for schizophrenia

-seasonality of schiz births (mostly winter) -fingerprint irregularities -maternal exposure to influenze virus -higher than normal prevalence in certain regions = consistent with disease spread!! -higher among born to mothers during 57 flu epidemic -20% higher risk whose mothers were exposed to rubella virus -NEURODEVELOPMENTAL disorder: brain wiring scrambled IN UTERO -consequences become pronounced in adolescence as they leave parents, fall apart and become symptomatic -neuroteratogens: fetal brain deformers (can mis-wire brain directly or create immune responses that damage developing brain indirectly) -strongest for schiz: TOXOPLASMA parasite - most healthy people not vulnerable, but with deficient immune system (pregnant) = prolonged flu -usual route = housecats (litter)

MD = neurovegetative

-significant weight change (mostly decrease) -sleep disturbance -psychomotor agitation/retardation -pervasive fatigue/energy loss -difficulty concentrating

what goes into a psychodiagnosis?

-symptoms: what is bothering the patient? -signs: what do you see/notice? -course of illness (how long) -age of onset -family history -recent events (triggering) -recent behavior -psychological tests (usually not necessary to diagnose) -lab tests (neuroimaging, hormonal assays, genetic testing) -response to treatment (prior/current)

third wave CBTs: ACT + MBCT

1) ACT = acceptance + commitment therapy 2) MBCT = mindfulness-based cog therapy, accept thoughts and pay attention to them in a non-judgmental way -BOTH USE MINDFULNESS meditation -> teach patients to become TRANSCENDING WITNESSES

symptomatic treatments for anxiety: anxiolytic, therapy

1) HABIT control (coffee, cigs, stimulants) 2) ANXIOLYTIC meds: -ACUTE: benzodiazephines (Xanax) = alcohol in a pill, GABA mimic = EXTREMELY ADDICTIVE -rarely (mostly for stage fright): BETA-BLOCKERS (relax arteries and heart = lower BP, sympathetic areas don't get worked up -> performance FLAT, prefer to work through stage fright, can be depressing chronically, memory problems) -CHRONIC: MOSTLY SSRIs, atypical antidepressants -handle anxiety as well as they handle depression -occasional: atypical anxiolytics (non addictive, not a heavy hitter, but not as effective), antipsychotics, anti-convulsant (used to treat manias) Neurontin (but turns you into space cadet, clumsy, fall risk) 3) PSYCHOTHERAPY: -supportive, cathartic -relaxation/meditation -stress mgmt training: teach to organize activities in life (make lists, priorities) -biofeedback: using technology (brain waves, listen to heartbeat, hear your own breathing, watch sweat amount) 4) FOR MILD-MODERATE: exercise, support groups

psychotherapy and the pursuit of happiness

1) NATIONAL MENTAL HEALTH ACT: not enough trained mental health personnel to deal with problems -mental health crisis in the US after WW2 -skepticism among both academic psychologists and medically trained psychiatrists toward an elevated role for less-trained psychotherapists -helped fund the training of more psychotherapists 2) EMERGENCE OF CLINICAL PSYCH: people saw them as an alternative to psychiatrists -most psychotherapy done by practitioners without medical degree (14% americans) -looked down upon by psychologists who did research, should be reserved for someone who studied scientific method -worked beneath psychiatrists -> UNTIL 50S, practiced ON THEIR OWN with NMHA -these + psychiatrists formed a duel 3) SHORT-TERM PSYCHOTHERAPY, COMMUNITY PSYCH: therapy lasting 20 sessions or less -first: when gov needed to return battle-scarred soldiers to the front ASAP -BOOM: growth of community mental health centers in 60s -response to public's urgent needs rather than expert-driven (defiance of experts) -many clients thought their problems had been solved after one/two sessions -use common sense and good humor to fix client's problem at face value (fashion of a friend = goal) -democratic invasion of therapists' interests -SOLUTION TO PROBLEM, not just explanation: requests for shorter sessions + amount of people needing help (walk-ins) 4) "CARING" ETHOS: -image change for psychotherapy -> non-university-based degree programs -> more focus on PEOPLE than research -CARING PROFESSIONAL: began to present themselves less as disinterested scientists and more as "caregivers" eager to talk to patients about their everyday problems -leaving behind freudian psych, simpler vocabulary to connect with average people -SELF ESTEEM & STRESS = 2 most important -> words became part of worldview, leaving bounds of therapy (almost in spite of professional psych, not because of it) -SHIFT IN IDEOLOGY -> "caring" -> caring professionals -not academic: part of a larger SOCIAL MVMT whose purpose is to help unhappy people feel better in a lonely world 5) RISE OF MANAGED CARE: helped to turn an established trend in American culture (rise of loneliness, depression, and other mental health ills, along with short-term psychotherapy as the preferred remedy) into a new industry -CONTAIN RUNAWAY MEDICAL COSTS -accelerated the trend toward fewer psychotherapy sessions (six sessions on average); 1/3 of patients receiving only one or two sessions; reduced individual session time -embrace of short-term psychotherapy was based more on PRACTICAL CONTINGENCIES than science, NO REAL PROOF THEY WORKED -downgraded importance of scientific expertise, extended privileges to social workers; more non-MD therapists -HAPPY HOME: ARTIFICIAL FRIENDSHIP -DISTASTE for psychoanalysis: profit, want to "feel better"

primary care practitioner MDs (PCPs), physician assistants (PAs), nurse practitioners (NP)

1) PCPs: if insurance says to see them before any other doctors, family doctors you tend to see, competent to dispense mental health meds (esp generic ones: anti-anxiety or antidepressant), mostly refer to psychiatrists 2) PAs: 2 years beyond bachelors, work under MD/always supervised by them (almost as much medicine as MDs know), diagnose, prescribe 3) NPs: qualified to see psych patients (4 years after college, extended RN), autonomous profession, almost equivalent of MD, can open independent practice without MD supervise

Mental Disorders: infectious diseases?

1) PROBLEMS WITH NEUROTRANSMITTER ACCOUNT: SSRIs increase serotonin and help depression and anxiety but connection isn't direct -CORRELATION NOT CAUSATION -TIANEPTINE: antidep just as effective as SSRI but not it; OPPOSITE = reuptake enhancer = REDUCES serotonin neurotransmission in the brain -neurotrans changes dont seem to explain the antidep effects 2) MALARIAL CURE OF NEUROSYPHILIS: high malarial fever baked and killed syphilis spirochetes inside brains -> to recover only from malaria, which quinine controlled (fever therapy = pyrotherapy) -syphilis causes paresis (hallucinations, impaired reflexes, etc) 15-20 years after infection -many mental disorders related to earlier infections! (more serious in childhood = likelier diagnosis)

ketamine and other medication treatments for depression

1) PROCEDURE AND EVIDENCE: people who received intravenous treatments on 2 successive days showed dramatic recovery -doses low enough to keep in trace state for 45 min -> sufficient to trigger antidep effect -NIMH put it to gold standard drug test: randomized, placebo, double-blind crossover study of ketamine infusion on TRD -compared to placebo: ket showed SIGNIFICANT IMPROVEMENTS in depression that persisted through the next week = began WITHIN 2 HOURS after infusions -suicidal ideation marked lower in ketamine group 2) TRD + GENERAL ALTERNATIVES: not responded to an antidepressant -switch antideps (greater improvement when switch classes) -add second antidepressant (not strong evidence) -augmenting with lithium or thyroid hormone (enhance serotonin on diff path than antideps) -augment with atypical antipsychotic = MOST EFFECTIVE - switching from antidep to another med -TMS, VNS, DBS, ECT -ECT = highest, but memory loss concerns

blind designs

1) SINGLE-blind = participants do not know which treatment group they're in 2) DOUBLE-blind = eliminates experimenter bias, NEITHER experimenter nor participants know who's in exp/control

problems with current research practices

1) WEIRD = westernized, educated, industrialized, rich, democratic -70%+ studies come from college students 2) biases = Researchers often want to see their study "work" 3) conflicts of interest = FUNDING: to receive funding they need it to work 4) replication issues = For findings to be reliable they would need to produce similar results when the study is replicated

panic disorder 1st line treatments

1) dietary/med control (caffeine, nicotine, weed) 2) anxiolytic meds (BENZODIAZEPINES, mainly xanax) - for ACUTE USE ONLY -XANAX CAUSES REBOUND ANXIETY shown by longer-lasting benzos 3) now: going right to antidepressants is most recommended = block panic attacks fairly completely (SSRIs mainly) 4) psychotherapy: cognitive therapy: normalization, de-catastrophizing, paced metronomic breathing -> flatten curve -supportive therapy

epidemiological vs longitudinal (correlational studies)

1) epidemiological = CROSS SECTIONAL = measure incidence and prevalence of a problem (disorder) in a given pop -PREVALENCE = # OF CASES found within a specified time interval (more females than males diagnosed w mental illness = more likely to get help) -INCIDENCE = RATE of occurrence of disorder per unit time 2) LONGITUDINAL = DEVELOPMENTAL = study that observes SAME participants on many occasions over long period of time -CANNOT directly manipulate IV/randomly assign

polypharmacy = standard of care

1) mood stabilizers 2) antidepressant: bring stable level up to normal 3) sleeping pill (for insomnia)

Students, academic pressures, and mental health: nature of stressors

1) nature of stressors on college students: -SOCIAL MEDIA: "mobile devices escalate the comparisons from occasional to nearly constant" -become dangerous: student already feels sense of shame -"Penn Face" : practice of acting happy or self-assured when actually sad or stressed -Stanford: Duck Syndrome - duck appears to glide calmly across the water, while beneath the surface it frantically paddles -HELICOPTER PARENTING -sexuality when being raised Christian 2) consequences: -suicide rates increasing -thinking parents are best friends, seeking only their approval -readmission to rigorous schools

MMSE (mini mental status exam) = general cognitive screen

1) orientation (up to Ox4) -time -place -person -situation 2) registration -3 common objects and asked to repeat = working memory 3) attention + calculation -serial 7s, 3s, W-O-R-L-D backwards = mental function 4) delayed recall -ask again for names of 3 objects above 5) language -name pencil and a watch when pointed to -repeat "no ifs, ands, or buts" -follow 3-stage command: "take paper in your right hand, fold it in half, and put it on the floor" -read and obey: CLOSE YOUR EYES -write a sentence

non-med treatments for BD: ECT, psychotherapy, induced sleep

1) psychotherapy: usually REQUIRES PRIOR MED RESPONSE to be valuable -builds compliance to meds -helps patient/family understand impact -NO EFFECT ON DISORDER ITSELF 2) ECT: effective for BOTH mania, bipolar depressions + mixed episodes, used as ADJUNCT to ongoing med 3) induced sleep: FOR MANIA (rare, temporary); sleep for a few days to get through manic episode

basic interventions for suicide

1) social level = reduce glamorization, chance of obtaining lethal means, control bullying/access to social media, construct barriers to bridges/cliffs, promote connection 2) relationship level: couple therapy 3) personal level: promote awareness of mental health signs/symptoms, how to get treatment 4) therapeutic level: continued monitoring, aggressive treatment of depression, build coping skills, make a safety plan (hotline number, facility, etc)

GAD prevalence

1-year prevalence 3-4% -usually emerges during adolescence -males not diagnosed bc self-medicating with alcohol! -FEMALES > MALES = 2:1 ratio -if we would look at non-drinkers: ratio would be more even -75% GAD have another mental disorder (usually depression) -10-20% of the elderly = beset with vulnerability, frailty, medical illness, closer to death -36% self-medicate with alcohol and other drugs (marijuana, anti-anxiety meds) -substance abuse/dependence: develops with GAD, causality = BI-DIRECTIONAL (more medication to treat -> washes out -> anxiety comes back)

protective factors of suicide

1. Feelings of responsibility towards family 2. Current pregnancy 3. Religious and cultural beliefs 4. Overall satisfaction with life 5. Presence of adequate social support 6. Effective coping and problem-solving skills 7. Access to appropriate medical care

infectious etiology for OCD

1/3 of children had abrupt onset -PANDAS: chronic tic disorders, tic-related OCD, OCD -culprits in strep + abrupt onset OCD = GABHS bacteria -AUTO IMMUNE RESPONSE = immune system tries to generate antibodies to vanquish bacteria, but misfire and DAMAGE BASAL GANGLIA CELLS instead -> inhibit smooth transitions (maybe due to molecular mimicry to make us better hosts)

deinstitutionalization

1960 - present day -way to escape increasing costs of hospitals -mental health became problem of communities; moving mentally ill people out of state hospitals and closing them FACTORS: -Thorazine introduction -over promising of effectiveness -cost impact of civil rights lawsuits -over selling "community mental health" RESULTS: -massive discharge to unclear locations (jail!) -> streets flooded -> victimization, crime -insufficient budgets to community facilities

sex ratios in major depression + Amish study

2:1 ratio of women:men bc women tend to find help more (after puberty; childhood 1:1) male depression often MASKED BY ALC/DRUGS = shown by Amish study ex) AMISH = 1:1 ratio bc no access to drugs, alc, media, etc -very open to physical+mental illness and modern medicine -keep track in bibles, track medical family histories -EXCEPTIONS to 2:1 = Western uni students bc MORE ATTUNED TO MENTAL HEALTH, non-Western cultures, some elderly

suicide rates

3x as many females than males ATTEMPT, 3x as many men are SUCCESSFUL -30% INCREASE in past decade (social media?) -most increase = military vets, active members, youth in gender minorities -higher age = highest in middle aged adults, second highest = 85+ -M:F is 3-4:1 = males use more deadly METHODS aka guns vs pills, women rates now increasing faster -Caucasian or American Indian -2nd highest cause of death in adolescence (next to accidents) -why? kids less likely to die from health issues than elderly = suicide higher up the list -45-64 = highest increase since 2001 -MOST COMMON = white male in 60s with HANDGUN

psychodiagnosis: advantages

ADVANTAGES -prognosis: helps tell outcome, what patient will have to deal with -good diagnosis = good treatment -facilitates communication among professions -establish prospects for contagion/other transmission -> prevention if possible (ex: schiz can be passed down) -legal reasons (state of mind used to inform a court) -financial reasons (compensation to patient and/or treatment provider) -research!

treatments for specific phobias

ALL COMPLICATED BY AVOIDANCE BEHAVIOR -anxiolytic/antidepressant meds (SSRI preferred) EXPOSURE 1) systemic desensitization (in-office procedure: come up with scale of phobia to tolerate thinking about each thing in hierarchy) -in vivo = REAL LIFE, actual confrontation -covert = imagined confrontation 2) FLOODING: early evidence for effectiveness, but low treatment acceptance, high therapy dropout rate, possibility of retraumatization -forced to face their feared objects without relaxation training, not gradual 3) MODELING: therapist confronts feared object while fearful patient observes -APPLIED TENSION for blood-injection (problem of not sufficient arousal -> teach them to tense up, force blood pressure up, able to not faint) -experimental: VR therapy for flying/height = can become a substitute for in vivo -self-help groups

MD: cultural specificity

ALL show NEUROVEG + COG signs -Westernized: predominance of guilt+wretchedness (possibly = Catholicism, where depression = sin) -less Westernized: more PHYSICAL complaints = SOMATIZATION

autonomic arousal and the brain

AMYGDALA = registers emotional aspects (threat), can tag many things as threatening, signals go out to all parts of brain -> overdrive LOCUS COERULEUS = activation of neocortex, part of brainstem, HPA-axis, ANS FEAR CIRCUIT: -PFC, ACC, insula, amygdala -very active in GAD

anxiety physiological signs

AUTONOMIC ACTIVATION = SYMPATHETIC (PARAsympathetic is counterbalancing, brings you back to neutral) -trembling, twitching, shaky -fatigue, restlessness -muscle tension, jitters -dizziness, lightheadedness -fast heartbeat, breathing rate -sweating, cold/clammy hands -dry mouth, nausea, diarrhea (sympathetic NS, body "dump and run") -altered appetite/sleep -OPPOSITE TO DEPRESSION: depressed can go right to sleep but wake up, anxious cant go to sleep bc so worried = delay onset insomnia

Other disorders associated with bipolar disorder

Anxiety, Panic Attacks, Alcoholism, Stress, Schizophrenia, Drug Abuse, Borderline Personality Disorder, ADHD, Eating Disorders

brain in OCD

BASAL GANGLIA (intermeshed with old cortex, limbic system) -putamen, caudate/lenticular nuclei -several functions -> SMOOTH mvmts of axis of the body, smooth pursuit eye mvmts -thinking = smooth transition -BASAL GANGLIA = BRAIN LOCK (with pfc), no longer able to make smooth transitions -> ceased by obsession and cannot let go until act of compulsion -OVERACTIVITY in basal ganglia + orbito-frontal cortex = high orbital glucose metabolism, stuck in loop

neurotrophic factor theories of depression

BDNF (brain derived neurotrophic factor) = promote neuronal growth and axonal/dendritic sprouting -STRUCTURAL CHANGES in depression = DECREASED BDNF -medication/recover = BNDF increase, areas regrow from thinning

BD course prognosis

BIPOLAR I: -FULL MANIC/major DEPRESSIVE episodes -alternations: weeks of mania followed by period of wellness -> episode of depression -experience mixed features: display both manic + depressive symptoms within same episode BIPOLAR II: -HYPOMANIC (mild) episodes alternate with major DEPRESSIVE episodes over course of time NO TREATMENT: -mood disorders RECUR in both types -4+ episodes in a one year period = RAPID CYCLING VARIANT, 15% of BD, more common in women, assoc with coexisting endocrine problem CYCLOTHYMIC: MILD bipolar depression with HYPOMANIA

evidence for "contagiousness" of suicide

CONTAGION EFFECT (increased risk factor if someone close to them has done so) who can increase odds? -family members, friends -celebrities: rates increase after suicide of a celebrity ex) rose by 12% after Monroe's suicide -highly publicized cases -coworkers/colleagues

gray matter volume in depression

DECREASED; but RESTORED with successful antidepressant therapy -lower amts of gray matter in RH NEOCORTEX -> more risk of later depression -issue of RESERVES

semantic diagnosis

DEFINITIONAL theory of meaning, LIST of attributes, ex) trying to define a dog

atypical depression

DSM-5 "depression with atypical features" -REVERSED NEUROVEGETATIVE signs/symptoms -weight GAIN/carb binging -hypersomnia (sleepy all the time) -leaden paralysis -interpersonal rejection sensitivity -OFTEN: histrionic (attn-seeking); self-medication with caffeine or chocolate

DSM-5 development

Diagnostic and Statistical Manual of Mental Disorders (1883) -Emil Kraepelin: his categories of abnormal behavior formed foundation -APA wrote current DSM (2013) -greater reliability than past versions, but STILL ISSUES -generally GOOD PREDICTIVE VALIDITY (accuracy) -organized: in sequence with DEVELOPMENTAL lifespan (diagnosed in childhood first -> adolescence -> adulthood

psychiatrists (MDs)

FIRST involved in mental health -descended from priesthood (Pastoralist - cared for ill) -early 90s: prescribed Prozac but deprived of favorite clients -> now treat severely mentally ill, ADHD, etc

psychodynamic account of MD

Freud: there is a similarity between clinical depression and the loss of a loved one; one directs all the sadness and anger they feel for losing a loved one towards themselves (INTROJECTION) -symbolic/imagined loss: person equates other kinds of events with loss of a loved one ex) failing a math course w the loss of parents (they'll only love you if you pass) MODERN VIEW: -depression results when relationships (esp early) leave them feeling unsafe, insecure, dependent

IRBs

Institutional Review Boards of APA must approve research, watch over rights/safety of human participants -MUST ENLIST VOLUNTARILY, end at any time, benefits>costs, protected from harm, access info about study, privacy ** problems with informed consent = -disclosing purpose in advance may distort results -may bias sample of participants taken from the population -full provision of information not always required -Many are too long and contain too much advanced technical language

neurotransmitter theories of depression

MAJOR: -nor/epinephrine -dopamine -serotonin (5HT) ALSO: -substance P -glutamate + NMDA (N-methyl D-aspartate) receptors; ketamine = antagonist -neurosteroids

bipolar disorder: gene etiology

MANY GENES in BD -> can occur in several forms -some regulate calcium channel regulation in neurons -release of neuroprotective proteins -circadian rhythms -estrogen release

antimanic meds = mood stabilizers

MED IS 1ST LINE TREATMENT (but compliance only 30%, "revolving door" patients) = only thing than can handle BD over long term! 1) LITHIUM CARBONATE: maybe BEST anti-suicide (anti-impulse), careful dosing, close monitoring -weak anti-dep, GREAT ANTIMANIC -too much = lithium toxicity -weight gain 2) ANTICONVULSANTS: fairly effective, only moderate antidep -Lamictal (currently preferred BD i and ii med, FEWEST SIDE EFFECTS, weight-neutral) 3) ANTIPSYCHOTICS: moderate antimanic, weak antidep

drug class: atypical

MOST PRESCRIBED class currently -LESS sexual side effects, varied in actions/side effects *work on more varied systems -predict which is best = may be assisted by family

clinical interview: info solicited or observed

MOST VALUABLE SINGLE ASSESSMENT TOOL in diagnosis -current symptomatology -sings from patient's presentation -personal/family history -history of mental health involvement; treatments that have worked/not worked GOALS = 1) suitability + readiness for psychotherapy (must be able to have conversation, reasonably good memory to report back to you) 2) determine need for referral to meds, PCP, neurologist, social worker, etc SIGNS NOTED: -attire/grooming, posture, physical characteristics (meds can cause skin discolorations), mannerisms/spasms/tics, speech, consciousness (alertness, fogginess), emotional state, attitude, thought content/processes (general questions to see where they go with it), knowledge, abstract thinking, social judgment, insight, cog functioning (current mental status via MMSE, verbal fluency w FAS/animals, neuropsychological screens aka clock drawing) LIMITATION = LACK VALIDITY (accuracy), RELIABILITY, mistakes in judgment by interviewer

clock drawing

NEUROLOGICAL SCREEN = RIGHT hemisphere function -various dementias -encephalopathy (brain infection/toxicity) -left neglect -"draw clock, put all numbers, set hands for ... ten after eleven" -not used as much anymore = analog clocks less common now ex) UTI = most common cause for dementia -antibiotics -> think clearly again

depression diffs in ethnicity

NOT race/social class diff for first episodes, but minorities likelier to have RECURRENCES = less access to care

phenotypic vs genotypic diagnosis

PHENOTYPIC: -signs, symptoms -course -outcome -response to treatment GENOTYPIC: -causes = genes, germs, tissue breakdown -medicine: progress is moving from pheno -> geno diagnosis -mental health = NEARLY ALL PHENO

Natural remission of major depression

REGARDLESS of the mode of action, remission of depression with antidepressant medication follows restoration of normal levels of BDNF and neurosteroids -> return of NORMAL neural activity -GRAY MATTER also restored -most remit with NO TREATMENT in 3-4 mos

signs, symptoms, signs + syptoms

SIGNS = observable markers SYMPTOMS = patient REPORTS (ex: telling you they feel angry) SIGNS + SYMPTOMS = SYNDROME

meds: how long?

START LOW, GO SLOW -most depressions remit with no treatment in 3-4 months -odds greater than 50% of 1st recurrence, greater than 75% of 2nd, etc -each recurrence = LONGER, leaves with greater disability, often progressive -aggressively controlled early (high doses, multiple meds) -> less recurrence -can be tapered+resumed if depression re-emerges -> slight risk of ACQUIRED MED IMMUNITY if tapered then resumed -meds are "unnatural," but so is depression

projective test vs structured inventories

STRUCTURE: clinicians prepare specific questions/utilize standard questions -mental status exam = set of interview questions, observations designed to reveal degree/nature of abnormal functioning -clinical test = device for gathering info about psych functioning to infer broader info UNSTRUCTURED = PROJECTIVE -personality test, such as the Rorschach or TAT, that provides AMBIGUOUS STIMULI designed to trigger projection of one's inner dynamics -PATIENT LED

psychiatric technicians

Work under the supervision of psychiatrists or psychologists; help patients and families follow treatment and rehab plans; assist with physical care; observe and report behavior -part of outpatient staffs, escort, supervise

persistent depressive disorder + double depression

a CHRONIC form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression, episodes are long/deep and blend into the next, life stress can never be pinned on this bc always depressed -brain imaging = loss of matter (more space btwn brain and skull) -experiences symptoms of major/minor depression for at least 2 years where symptoms are not absent for 2 months or more at a time -NO HISTORY of mania or hypomania -DOUBLE = PERSISTENT depressive disorder + MAJOR depressive episodes

clinical study

a form of case study in which the therapist investigates the problems associated with a client; detailed description of person's life and psych problems -ADVANTAGES: source of idea for behavior, tentative support for theories, challenge theories, new treatment techniques, opportunity to study unusual problem -DISADVANTAGES: LOW INTERNAL AND EXTERNAL validity; no statistical analysis

baby blues

a mild postpartum mood disorder that goes away on its own -crying spells, fatigue, anxiety, insomnia, sadness -50-80% of women, resolves in 2 weeks! ETIOLOGY (why?): genetic predisposition (family history), hormonal changes, stress -treatment: meds (antidep, estrogen) or therapy (CBT, psychotherapy)

rapprochement movement

a movement to identify a set of COMMON factors/strategies that run through all successful therapies -META ANALYSIS: suggest there is LITTLE DIFF in overall effectiveness of different forms of therapy

TAT (Thematic Apperception Test)

a projective test in which people express their inner feelings and interests through the stories they make up about ambiguous scenes; pattern of thought; observational capacity -20 cards with people in ambig situations -thought people would reveal need for achievement, sex, power, affiliation in answers to requests to tell what is happening in the picture, what led up to it, how people feel, how situation turns out -Clinicians pay attention to which character the participant identifies the most with and stories are thought to reflect that person's own circumstances, needs, and emotions

analogue experiment

a research method in which the experimenter PRODUCES ABNORMAL-LIKE behavior in laboratory participants and then conducts experiments on the participants

naturalistic experiment

a study in which randomly selected people are manipulated in a relatively controlled environment -NATURE rather than experimenter manipulates IV

internal validity

accuracy with which a study can pinpoint one factor as cause of phenomenon -cause and effect relationship btwn treatment and outcome

Body Integrity Identity Disorder (BIID)

belief (usually from early childhood) that limbs (usually legs) do NOT BELONG TO BODY, amputation will achieve "wholeness" -CERTAINTY regarding limbs involved and amputation desired (all means necessary) -rehearsal activity (pretending) during which they imitate amputated state in private and in public -pursuit of elective amputation or attempts at self-amp -(less often) can include non-amputation bodily changes (one should be deaf/blind/paralyzed) -AMPUTATION = ONLY KNOWN TREATMENT -doctors vow to do no harm to patients (are you doing harm to them by amputating a healthy limb or making physical body conform to psychological image?)

somatogenic view

believing that all mental illnesses had a PHYSICAL (organic or biological) cause -rebirth from early times caused by: -work of German researcher: fatigue responsible for mental dysfunction -new biological discoveries: syphilis -> delusions -did not pay off until 50's = effective meds discovered

psychiatric nurses (RNs)

care of patients with mental disorders (esp psych wards) -monitor for progress, report to psychiatrists/physicians on reactions to meds -source of friction: MD deliver medication orders but nurses know patients best

2 main types of psychotherapy for major depression + 4 IPT

cognitive behavioral therapy (CBT), interpersonal therapy (IPT) IPT: -central themes = sources of INSUFFICIENT SOCIAL CONNECTION/support 1) GRIEF: delayed mourning, replacement relationships 2) FIGHTS: building skills in communication, negotiation, assertiveness -> conflicts evaporate 3) ROLE TRANSITIONS: (leave home, divorce, retirement) reevaluating lost role, building new one, new spports 4) SOCIAL DEFICITS: (failure patterns in past relationships) use role playing to learn new behavior in relationships

Genesight test

combinatorial pharmacogenomics to narrow down med choices = interactions of people's genetic makeup with pharmacologies of meds they take -doesn't match patient to med, but ELIMINATES MEDS THAT DONT WORK -match 12 genes of patient's genotype to pharm of 56 depression-related meds (do NOT want gene-drug interaction) -patients improved significantly compared to meds prescribed without it

humoral theory

concept of health proposed by Hippocrates that considered wellness a state of perfect equilibrium among four basic body fluids (humors) = 4 temperaments -sanguine = blood (liver) -choleric (reactive/prone to anger) = yellow bile (gall) -melancholic = black bile (spleen) -phlegmatic (non-reactive) = phlegm (lungs) BALANCE = BODY + MIND -sickness = disturbance in balance

asylums

converted hospitals or monasteries; institutions whose primary purpose was to care for people with mental illness; overflow of patients led to virtual prisons with filthy conditions and cruelty -restraint treatment = locking people in cages -wealthy would pay to go watch people like animals

external validity

degree to which results may be GENERALIZABLE to population beyond study

correlational methods

determines how much events/characteristics vary along with each other -magnitude of correlation (strength) = how closely resembles (+,-, none) ex) neg = negative slope ADVANTAGES = HIGH EXTERNAL validity (generalizability) -helps clinician make connections DISADV = LOW INTERNAL validity (DONT give causation, only correlate) -no info about individual

characteristics of eccentrics

deviates from common behavior patterns or displays odd or whimsical behavior -15: Nonconformity, creativity, strong curiosity, idealism, extreme interests and hobbies, lifelong awareness of being different, high intelligence, outspokenness, non-competitiveness, unusual eating and living habits, disinterest in others' opinions or company, mischievous sense of humor, nonmarriage, eldest or only child, and poor spelling skills

kindling

each depression INCREASES RISK of later one REGARDLESS of life stress = more vulnerable -each episode makes you more vulnerable to next (odds = first -> 50% -> 75% -> 80s) ex) not as simple as single life event = depression; more recurrences -> the LESS WE CAN PIN ON A LIFE EVENT ex) lost job + diagnosed with depression = maybe depression was causing them to have less productivity at work -> fired

antidepressant meds

effective for BOTH anxiety + depression (given out by primary care doctors bc they're SAFE) -best = MODERATE - SEVERE, explains meta-analyses used to show "ineffectiveness" -multiple uses: work best with most sever forms bc this gives them the most to work on -DO NOT CURE depression, only hold it in check for as long as they're taken -> can relapse! ex) potholes -take 2-3 weeks after 1st dose to produce antidepressant response (FAST RESPONSE MAY MEAN MANIA) -NOT ADDICTIVE, but must be tapered slowly to avoid rebound symptoms -NOT EUPHORIANTS (raise mood to normal, not elevated) -highest: women age 40-60, 23% -MOST = non-Hispanic whites -most prescribed med in the US -ALL have same unpleasant side effects (lower sexual interest/reponse, low libido, insomnia, harder to orgasm) -no known "time bomb" effects/damage to fetus (can be taken for life; better for baby to not have stressed pregnancy)

etiology, course, prognosis ECP

etiology = cause (complex web of risk factors that predispose) course = trajectory (downward course = increasing disability) prognosis = ultimate OUTCOME (ex Alz: poor prognosis, die from complications)

multicultural psychology

examines impact of culture, race, ethnicity, gender on behaviors/thoughts -focuses on how these factors influence origin, nature, treatment of abnormal behavior RATIONALE = the need to address multiculturalism and diversity, specifically those involving racial/ethnic interactions, in addition to reviewing relevant research and providing standards for integrating cultural concerns; Growing racial and ethnic diversity from shifts in IMMIGRATION trends and higher racial and ethnic BIRTH RATES in the US

experimental methods

experimental = receives treatment; control = does not receive treatment ADVANTAGES = HIGH external validity (generalizability) HIGH internal validity May provide causal information (cause and effect relationship) DISADVANTAGES = 1) experimenter bias: expectations about outcome influence results; statistical significance DOES NOT EQUAL clinical significance! ; no info about the individual

clinical psychologists (psychotherapy, PhDs)

experts in human behavior, factors that influence human behavior (specifically ABNORMAL that forms psychopathology) -psych research, assessment of disorders, psychotherapy (diagnosis) -organizing clinical trials, setting up to permit good stat analysis to assess evidence = new meds better than old meds or not -PSYCH DESCENDED FROM PHILOSOPHY, NOT PRIESTHOOD (victorian, 1900s) = moral philo

postpartum depression

extreme sadness, despair, insomnia, intrusive thoughts, panic attacks, suicidal thoughts, etc -months, year, more -25-50% more likely to have AGAIN in another birth -10-20% of women, 1-2/1000 have psychotic symptoms that may be lethal to mom/child -up to 40% more likely to have pp if past history of depression -premature baby risk up when mom is depressed

agoraphobia + treatment

fear of leaving safe places -prevalence + age of onset about same as panic disorder = ACCOMPANIMENT TO PANIC DISORDER -RITUALIZED AVOIDANCE OF PANIC ATTACKS -> co-diagnosed with panic -home/room within the home = safety zone -> if they leave, panic -SAFE SPACES START TO SHRINK -reluctance to venture outside safety zone without "escape route" TREATMENT: -antidepressants (insurance policy to block panic attacks -> confidence to break out of space) -IN VIVO desensitization (start with small, escort them out, practice relaxation until they can sit out of bedroom) -PARADOXICAL SUGGESTION (panic attack to have good practice -> can master it; prescribing symptom = take anxiety away about having it)

phobia preparedness

fear-relevant stimuli are contraprepared for safety-signal conditioning -explain why certain associations are learned more readily than others -phobias = MUCH MORE COMMON; HIGHLY RESISTANT TO EXTINCTION = limited set of stimuli (while lab fear conditioning is extinguishable = unlimited range of stimuli)

ECT (electroconvulsive therapy)

for treatment-refractory depression (TRD) = VERY EFFECTIVE -OLD method: fully conscious, dangerous, across temples, no restraints (tongue can bite through) -MODERN: right side of head, quicker, muscle relaxant to decrease convulsions, light anesthesia -WORKS FASTEST of any standard therapy, fewest side effects of any standard therapy -MECHANISM = UNKNOWN -effective in bipolar -only R side = minimize speech disturbance -side effects can sometimes cause spotty memory loss (episodic > semantic) -abused in past, now only used as last resort/for most severe -MOST SATISFACTION

verbal fluency test (FAS - animals)

great assessment of EXECUTIVE FUNCTION = cog flexibility = FRONTAL LOBE activity -"say names of as many words beginning with letter [F,A,S] as you can in next 60 seconds" -"say names of as many animals as you can in next 60 secs" -normative scores: letters FAS - 13 for people in 80s, 14+ for below 80 -animals - 16 for 80s, 19 for 70s, 20+ for below 70

managed care program

health care coverage in which the insurance company largely controls the nature, scope, and cost of medical or psychological services -ISSUES = 1) reimbursement for mental disorders mostly LOWER than for physical disorders 2) bad for people with SEVERE mental disorders -> treatment determined by insurance rather than therapist

evidence-based treatment guidelines

identify which therapy that has received clear research SUPPORT for a particular disorder; propose corresponding treatment guidelines; support info to clinicians

endophenotypic diagnosis

in between pheno -> geno -LAB TESTS, "subclinical" biomarkers -intermediate stage; SPECIFIC RESULTS OF GENES -PHENOTYPE appearing IN THE BODY -indicates accompaniment of disorder "OFFSHOOTS" not causal (ex: changes in blood for someone in depression) ex) tests for B-amyloid protein in Alz-type dementia; genomic 5-HTT assoc w/ major depression and suicide; circadian rhythm instabilities with bipolar

Rorschach administration

inkblot test with 10 bilaterally symmetrical -> express what they see -4 steps: 1) Introduction: allay anxiety 2) Instructions: tell all you see, non-directive such as handing the card 3) Responses: free association, verbatim recording & time spent 4) Inquiry: after all ten, clarify responses, gather any additional data -some interpretation manuals indicate that more than four sexual responses out from the ten cards will indicate schizophrenia -test person has too few sexual responses, it may indicate sexual frustration -VALUABLE: because data might suggest that people with different psychological conditions answer differently (people diagnosed with schizophrenia tended to see different images from those with depression)

psychotherapy

interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth -general effectiveness: 5-10% people WORSE OFF from it -other studies: average person was BETTER OFF THAN 75% of untreated -major therapy forms = superior to no therapy/placebo -COMMON EFFECTIVE FACTORS: alliance, empathy, expectations, cultural adaptation, and therapist differences

infectious etiology for depression

main pathogen candidate: Borna disease virus -during period of infection: periods of lethargy, excitable behavior, disturbed gait, coordination, vision -rapidly travels to and INFECTS CENTRAL NERVOUS SYSTEM -immunological markers of BDV more common in patients with affective disorders -levels of these markers = track course of depressive/manic episodes -virus itself could be isolated from subset of patients with the disorder -not clear cut findings!! -depression patients given AMANTADINE: antiviral influenza drug -> DISORDERS IMPROVED SIMILAR TO ANTIDEPRESSANT standard! -but also showed same effect on neurotrans and BDNF -Swedish study: individuals whose mothers had INFECTION DURING PREGNANCY -> elevated risk of both depression and autism (24%)

validity of diagnosis

measure of ACCURACY of test/study results -FACE: validity that makes sense, seems reasonable -CONCURRENT: degree to which measures gathered from one tool agree with measures gathered from others -PREDICTIVE: tools' ability to predict future characteristics/behaviors

reliability of diagnosis

measure of CONSISTENCY of test/research results -high test-retest reliability = yielding similar results each time it's administered to the same people -Interrater (interjudge) reliability: if judges independently agree on how to score and interpret it

reliability

measure of the CONSISTENCY of the test or research results

psychogenic view

mental disorders are PSYCHOLOGICAL disturbances; originates in the psychology of an individual -HYPNOTISM showed its potential -> hysterical disorders can be induced when in a trance state (normal to paralysis, deaf/blindness) -hypnotic = both cause and cure

marriage and family therapists (MFTs)

mental health professionals who are trained and licensed to diagnose and treat a number of issues, including marital problems -in maladjustment situations (life, careers, relationships, not typically psychopath)

monism

mental illness = BRAIN ILLNESS (neurotransmitters, firing) -all mental (idealism) or physical (materialism) -most common = REDUCTIVE MATERIALISM (mental events = brain events; mind reducible to brain)

demonological view

middle age Europe -abnormal behavior or mental illness = work of evil spirits -treatment: trephination, exorcism -religious beliefs = highly superstitious, rejected scientific forms of investigation/controlled education

brain imaging, neuropsychological tests

neuropsychological screens: test cognitive functioning, ex) clock drawing -brain imaging: -EEG: measures brain waves via electrical activity of neurons; electrodes placed on scalp send brain-wave impulses to a machine that records them -CAT/CT, MRI: brain image and scanning, 3D -fMRI: detects rapid changes in flow/volume of oxygen in blood in the brain while an individual is experiencing emotions or performing tasks -PET: reveals functioning of diff areas, radioactive compound

antidepressant meds BD

normalize mood ONCE STABLE; increase risk of SWITCHING into mania/mixed states UNLESS mood stabilizer already in place!!

nosology vs diagnosis

nosology = science/scheme of disease categorization and classification diagnosis = act of ASSIGNING NOSOLOGICAL CATEGORY to a patient, PERSONAL

Thorazine

obsoleted prefrontal lobotomy = first major tranquilizer -relaxation without sedation -decreased: agitation, hallucinations, delusions -"chemical straitjacket"

panic disorder

occurrence of panic attacks WITHOUT WARNING; no reason whatsoever ex) panic bc you didnt know about a final = not the same thing! ex) driving in a car = random panic attack = panic disorder -MORE THAN 1 MONTH OF: -apprehensiveness about further attacks -pattern of avoidance and disability as a result

social workers (MSW/DSW)

on front line of mental health (some masters, some doctorates) -connect people with mental disorders with benefits that they deserve in social support network (aftercare arrangements) -see if there is a way to improve life of patient -to live normal life, attach to community resources -professors/researchers

trephination

one of first surgical procedures in history = boring of hols into skull to release demons, cure headaches (abnormal behavior = work of evil spirits) -men lived after surgery: skull bone regrowth -discs used as good luck (stone age into ancient Egypt)

OCD prevalence

one year = 2% -80% of sufferers have COEXISTING MAJOR DEPRESSION -1/2 cases BEGIN IN CHILDHOOD, these are mostly MALES = more severe -> persist into adulthood with ticks -beginning in adolescence/adulthood = less severe, FEMALES = MALES in this ratio -20% cases have 1st degree relatives with it -females = later and less severe, males = earlier and more severe

panic disorder prevalence

one-year: 2.3% -lifetime 3.5% -develops mostly during LATE TEENS (15-19) -female: male = 2:1 -increased risk: background of child abuse/neglect, mitral valve prolapse -can be triggered in susceptible people by: -yohimbine (sympathetic NS STIMULANT) -sodium lactate (exercise waste product) -caffeine, nicotine (sympathetic NS) -marijuana -TRIGGER MAY NOT BE DUE TO THE SUBSTANCE but to the fact that sufferers seem to be more attuned to bodies/internal sensations -> notice changes!

streptococcus and OCD: PANDAS

pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections -ACUTE OCD CAUSED BY STREP INFECTION -seen in school-age children who develop strep throat/rash (fever and urinary incontinence) -sudden onset of tic disorder or OCD signs/symptoms, most commonly hand-washing and preoccupation with germs -RAPID REMISSION of symptoms = ANTIBIOTICS -ONLY SMALL % of childhood -> is it a window into possible mechanisms by which regular OCD may arise? (auto-immunity, neurotoxicity?) -parallel events? same infected cells?

learned helplessness

perception (based on past experiences) that one has NO CONTROL OVER REINFORCEMENT in their life -people become depressed when they think they no longer have control over reinforcements/punishments in their life; responsible for helplessness ex) dogs stuck in a box, if they jump over a barrier they won't receive shocks -previous day: strapped and received inescapable shocks -> learned helplessness in shock situation and DID NOT TRY TO ESCAPE shocks when stuck in box (assumed they were helpless as before) -ASSOC WITH: -scoring HIGH on depressive scales -LOW serotonin + norepinephrine -LOW interest in sexual/social activities -LIMITATIONS: Laboratory helplessness does NOT PARALLEL depression in every aspect and much of the learned helplessness research relies on ANIMAL subjects, not humans

MD = motivational

pervasive anhedonia (pleasure loss)

example endophenotype

phenylketonuria (phenotype) -> genetic anomaly in the PAH gene (genotype) results in an inability to metabolize the amino acid phenylalanine, resulting in an accumulation of ingested phenylalanine (the ENDOPHENOTYPE, detectable in BLOOD as both the buildup of the amino acid/deficient levels of enzyme required to metabolize it) -> result of that accumulation = phenylketonuric syndrome (cognitive disabilities and seizures = phenotype)

dualism

physical + mental worlds = SEPARATE DOMAINS -mental illness is not a disease but a set of disordered BEHAVIORS -material world is evident in HARDWARE of the brain, while ideas are evident in brain's SOFTWARE = manifest as behavior ex) you can have same brain as mentally disabled person -disease is something you HAVE, behavior is something you DO

hysteria

physical ailment with NO CAUSE; "cured" by mesmerism -sexual dysfunction, depression, weakness, disinterest in life (attributed to not enough sexual pleasure) -treatment = vibratory or putting people in trances (faint -> feel refreshed after)

leading risk factors for suicide

presence of mental disorder (1/2 who die by suicide have been in poor physical health during months prior) -illnesses = linked to higher suicide deaths -chronic illness/pain -history: personal, family, abuse/neglect -current oppressive environment: bullying, unemployment, rejection, divorce/loss of child custody -religious/philo/cultural values that consider it (even tho many traditions think its sinful) -SOCIAL MEDIA -ready availability for means of completion (drugs, guns)

prototype diagnosis

prototype theory of meaning; ESSENCES DERIVED FROM INSTANCES; ex) is there a perfect dog that should represent them all? -Eleanor Roche = only perfect concepts exist in the mind -creates prototypes = COMMONALITY, OBSERVED ARISE? -exposure to real life situations where mental health services are involved -indirect experiences (media) where people are seen to have unwanted conditions requiring intervention -in training as mental health professional: classic case studies/supervised clinical experience -prototypes start to blend -> nuances

psychiatrists vs psychotherapists in philo viewpoints

psychiatrists doing psychopharmacology = monists pyschotherapists = dualists

drug class: SSRI

selective serotonin reuptake inhibitors -prozac -> serafem (premenstrual dysmorphia), zoloft, etc -30-40% = suffer from sleep/sexual symptoms -children on paxil may develop ideation MAYBE ASSOC WITH: -more heart/lung defects in infants -reduction of premature birth complications -drastic risks to pregnancies when mothers are depressed -SEROTONIN SYNDROME: confusion, hallucinations, fever, seizures when taken with other serotonin-raising drugs -people who dont respond to one SSRI have 40-70% chance of responding to a second one or an atypical, or combo

IQ testing and use of IQ

series of tasks requiring people to use various verbal and nonverbal skills -> intellectual ability -represents the ratio of a person's "mental" age to his or her "chronological" age, multiplied by 100 -standardized LIMITS: -factors that don't have anything to do with intelligence (anxiety, low motivation) can influence test scores -cultural biases -LOW VALIDITY, HIGH RELIABILITY

single-subject experiment

single participant is observed both before and after the manipulation of IV -relying on BASELINE

MH Intake Workers, Staff

staf diff facilities (filing, billing): receive mental health patients when they arrive at facility (initial assessments and screening) -may determine best treatment location

creativity: association with BD/MD

studies linking manic depression + creativity = much higher in creative professions compared to general pop (writers had 5x cyclothymia + bipolar I creativity than pop) -cyclothymia = minor depression + hypomania (NOT QUITE BIPOLAR II) = still functional! -possible correlation between them

pharmacogenomics

study of how genetic inheritance affects the body's response to drugs -impacts therapeutic effects, adverse effects, clinically relevant for many drugs (testing only required for few)

syndrome + course vs. disorder + tissue damage

syndrome (diagnosing) + course = DISORDER disorder + tissue damage = DISEASE (very few mental disorders meet this criteria)

warning sign of suicide

talking about it, withdraw from normal activities, secretive, not talking about future, giving away possessions, obtaining weapons, hoard meds instead of taking them as prescribed, if someone is thinking about it = BEST TO ASK

moral treatment

the 19th century approach to treating the mentally ill with dignity in a caring environment = asylum reformation; "unchaining insane" RESULTS: -money and staffing shortages -> hurt recovery rates, insufficient $ for community facilities -streets flooded with mentally ill homeless -> victimization, crime, massive discharge to unclear locations -not every person is healed by only humane treatment!

co-morbidity

the presence of one or more disorders (or diseases) in addition to a primary = co-occur -> patients usually require more than one diagnosis ex) anxiety + chronic pain -> depressed + self medication = dual-diagnosis patients (COMMON, SELF MED IS COMMON)

TMS

transcranial magnetic stimulation -magnetic field sufficient to produce twitches in fingers -1-2 weeks, short daily sessions -WEAKLY EFFECTIVE

cognitive behavior therapy

uncovering automatic SELF-DEFEATING thinking patterns -develop new ways to interpret setbacks (normalization, analyze logically, decatastrophizing) -REPLACING old "automatic" thoughts with new ones -focus on patient's view of: him/herself, important life events, future

VNS

vagal nerve stimulation ~20 pulses per sec to electrodes wrapped around vagus nerve (back of throat with stimulator implanted in chest) -came from findings of epileptic depressed patients -approved for recurrent treatment-resistant dep -effects ACCUMULATE over months, 1/3 to 1/2 show substantial improvement over a year -exact mechanism = unknown

rationales and evidence for effectiveness of psychotherapy

very diff explanations of causation + diff kinds of therapies based on those -> DIFF THERAPIES APPEAR EQUALLY EFFECTIVE

Psychotic features of MDD

visual or auditory HALLUCINATIONS or presence of DELUSIONS (bizarre ideas without foundation)

period of suicide risk

when people start to get better from depression -when it's worse they dont have enough energy to plan -> better = enact plan -NEEDS MOST MONITORING! -40% of people with MD make at least one suicide attempt, 50-60% ideation (passive = better off without me, active = PLAN) -studies show NO link btwn meds and actual suicides = associated with IMPROVEMENT form depression REGARDLESS of meds

ketamine treatment for TRD

widely used "off-label" throughout US in clinics, most exciting depression news in 50 years -slow infusion (dissociative anesthetic) at sub-anesthetic dose over 6-12 sessions in 10-14 days (45 min) -sufficient to place in twilight state, mild hallucinations, depersonalization + derealization (can't be happening, must be dreaming) -confusion, hangover hallucinations, fuzzy vision -antidepressant effects within hours, days-weeks -> booster infusions as needed -VALUE = chronic pain, anxiety, stress -MECHANISM UNKNOWN = probably NMDA-receptor antagonism -> spikes glutamate -> RAPID BDNF RELEASE -nasal spray version (esketamine): long term effects uncertain

MMPI-2 (minnesota multiphasic personality inventory-2)

widely used personality assessment instrument that gives scores on ten important clinical traits -SELF-REPORT, requires test taker to describe feelings, attitudes, beliefs, values, opinions, physical/mental state -567 items, tests on more DIVERSE group of people, scores on REVISED test thought to be more accurate -nine validity scales (or 'lie' scales), assessing for lying, defensiveness, faking good and faking bad and among others = HARD TO FAKE = higher validity + accuracy than projective

pediatric bipolar disorder

~1% of children (sometimes infancy) -manifested by: mood INSTABILITY (rages, despondency), hyper-sexuality, pressured speech, racing thoughts, impaired judgment, delusions, hallucinations ~1/2 severe childhood depressions -> adult BD ~1/2 children treated for MD with SSRIs -> develop manic/hypomanic episodes = SWITCHING -> strong indication child is suffering from BD (but not foolproof) -10 year lag btwn occurrence of first signs + treatment onset -OFTEN CONFUSED/CO-MORBID WITH ADHD: shared sx of distractibility, impulsivity, hyperactivity, irritability