Abnormal Psychology Unit 2

causes of eating disorders

Biggest factors that can cause eating disorders are social and cultural For young women being thin can be more important than being healthy because self-worth, happiness, and success can be determined by body size in some cultures The high numbers of overly thin women in media communicate the message that women have to be thin Other cultures that have lower levels of eating disorders also put less emphasis on thin bodies for women The women that internalize these media messages the most are the most at risk for developing the disorders Because the size and shape of the average woman has improved with improved nutrition the standards for size and weight are difficult to achieve Men are more likely to think their weight is ideal and rate the ideal weight in a man as heavier while women are more likely to think their weight is too heavy and that the ideal weight for women is lighter than it actually is Men tend to be heavier and more muscular and they tend to want to be heavier and more muscular than even women prefer them to be In teen girls if your friends use extreme dieting or are critical of their size you are more likely to do so too → they tend to share body image concerns and this could be because girls pick friends with the same concerns as themselves Some parents restrict their children's diets too much causing failure to thrive syndrome because of their abhorrence of fat → mothers with anorexia are more likely to do this Teenage girls that diet are 8 times more likely to develop an eating disorder one year later than those not dieting Weight reduction efforts in young girls can lead to weight gain instead of weight loss and this makes them want to be more strict with their dieting and exercise Studies have shown that sudden dieting can cause stress related withdrawal symptoms that in turn cause the person to eat more (even if it's healthy food) and gain weight People most at risk for having an eating disorder are those already binge eating and purging, those that eat in secret, those that express a desire to have an empty stomach, those preoccupied with food, and those afraid of losing control over eating Men can have body image issues in which they fear appearing too small → they don't' want to show their bodies, they do weight lifting, and they may do steroids → this also has severe psychological consequences Evidence shows a strong genetic contribution to body size so it makes achieving the societal idea of perfection basically impossible to achieve In situations in which the pressures to be thin are severe or food is taken away the person can easily become preoccupied with food and eating and develop an eating disorder Some women with eating disorders have a diminished sense of personal control and confidence in their abilities and talents → low self esteem, more perfectionistic → perfectionism must be directed at eating and body size but low self esteem or worries about body image → only then does it contribute to eating disorders Social self-deficits can increase with eating disorders and further isolate those women from society Women with bulimia are more likely to judge their body as larger after snacking while normal women don't do this as much Some people with eating disorders cannot tolerate any negative emotions and binge or engage in other behaviors to regulate their mood All eating disorders have a lot in common in terms of causal factors

neurobiological influences on schizophrenia

Dopamine system is too active in people with schizophrenia D1 and D2 dopamine receptors are important Antipsychotic drugs (neuroleptics) are effective in treating people with schizophrenia and they block the brain's use of dopamine (antagonists) → can produce side effects similar to Parkinson's (disease in which there is not enough dopamine) L-dopa used to treat Parkinson's produces schizophrenia like symptoms in some people Amphetamines also activate dopamine and ca make psychotic symptoms worse in some people with schizophrenia However some people with schizophrenia aren't helped by the use of dopamine antagonists Although neuroleptics block dopamine quickly symptoms don't subside for a few days or weeks (slower than expected) Neuroleptics are only partly helpful in reducing the negative symptoms of schizophrenia Olanzapine is a weak dopamine antagonist that for some reason is a good treatment for some people with schizophrenia Current evidence points to three specific neurochemical abnormalities in the brains of people with schizophrenia: excessive stimulation of striatal dopamine D2 receptors (striatum is part of basal ganglia, most effective antipsychotics all block D2 receptor), a deficiency in the stimulation of prefrontal dopamine D1 receptors (while some dopamine sites are overactive a second type may be underactive in the parts of the brain we use for thinking and reasoning, could be why people with schizophrenia have deficits in prefrontal cortex, hypofrontality, less frontal activity), and alterations in prefrontal activity involving glutamate transmission (NMDA receptors could be not active enough, ketamine and phencyclidine block NMDA receptors and cause schizophrenia symptoms) Many children of people with schizophrenia show subtle neurological issues like abnormal reflexes and inattentiveness Adults with schizophrenia also show deficits in ability to performs some tasks and to attend during reaction time exercises → brain damage or dysfunction may cause or accompany schizophrenia Ventricles appear to be enlarged in people with schizophrenia (lateral and third ventricles in particular) → adjacent parts of the brain may have not developed fully or have atrophied thus allowing the ventricles to become larger Enlarged ventricles are not seen in everyone with the disorder, occurs more often in men than in women → seem to be enlarged in proportion to age and to the duration of schizophrenia Being exposed to the flu prenatally could cause enlarged ventricles Risk for schizophrenia is associated with lower white matter volume and larger third ventricular volume → these differences appear to be genetically based With twins when one has schizophrenia and the other doesn't or one has more severe schizophrenia than the other this is more likely when one had a obstetrical complication that the other didn't have Dorsolateral prefrontal cortex in frontal lobes may be implicated in schizophrenia → tasks that involve this area show less activity in the area with people with schizophrenia → also less connectivity between this region and other brain regions Some people with schizophrenia have hypofrontality but this displays itself differently in different people Brain variations in people with schizophrenia appear to develop progressively beginning before symptoms are apparent (include issues with thalamus, striatum, and prefrontal cortex

serotonin and suicide

Low levels of serotonin could be associated with suicide and violent suicide attempts (since this is linked to impulsivity this could be its connection to suicide)

mood disorders etiology

Rate of mood disorders is 2-3 times greater in relatives of probands with mood disorders than in relatives of control without mood disorders Increasing severity, recurrence of major depression, and earlier age of onset in the proband is associated with the highest rates of depression in relatives An identical twin is 2-3 times more likely to present with a mood disorder than a fraternal twin if the first twin hasa mood disorder → however if one twin has unipolar disorder the chances of the other twin having bipolar disorder are almost 0 Heritability of depression is thought to be 37% and variance in depression attributed to non-shared environmental factors is 63% Higher rate of depression in women → heritability rates in women range from 36-44% but estimates for men were 18-24% → thus it is thought that environmental events play a larger role in men getting depression than in women Twin studies show that if your twin has bipolar disorder you are likely to have bipolar and not unipolar mood disorders but other studies show that in other relatives you aren't necessarily more likely to get bipolar disorder if a relative has it (can get any mood disorder) One study found that genetics of depression are the same in bipolar and unipolar depression but that the genetics of mania are distinct from depression → thus people with bipolar disorder are also susceptible to depression but uniquely susceptible to mania Mood disorders are familial and there seems to be more of a genetic vulnerability for women → some studies have started to find specific genes Genetic contributions to bipolar disorder seem to be higher than depression (depression is 40% for women and 20% for men) Now thought that there are genes that cause the cognitive and psychomotor symptoms of depression, another that causes mood, and another that causes neurovegetative symptoms Today there is an agreement that it is unique nonshared environmental triggers that cause depression to be expressed One study found that the same genetic factors contribute to both anxiety and depression → social and psych factors seem to differentiate anxiety from depression in phenotypes Thus mood disorders like depression may be a more general genetic predisposition to anxiety and mood disorders or to the basic temperament underlying them (maybe neuroticism) → specific form of the disorder is then determined by environment Research implicates low levels of serotonin in the causes of mood disorders but only in relation to other transmitters like NE and dopamine With low serotonin our impulses are greater and our mood swings more widely→ some believe that when serotonin is low other transmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities, including depression (permissive hypothesis) Balance of neurotransmitters is thus more important than any single one's levels Dopamine is thought to be involved with manic episodes, atypical depression, and or depression with psychotic features → L dopa causes hypomanic features → chronic stress reduces dopamine levels and produces depressive like behavior Another hypothesis thinks that overactivity in the HPA axis could cause depression because it produces stress hormones (patients with disease affecting the endocrine system can display depression symptoms) → neurotransmitters in the hypothalamus or neurohormones regulate the release of hormones that affect the HPA axis→ cortisol levels are elevated in depressed patients Biological test for depression→ dexamethasone suppression test (DST) → glucocorticoid that suppresses cortisol secretion in normal participants → when given to depressed patients less suppression occurs → maybe the adrenal cortex secretes enough cortisol in patients to overwhelm the suppressive effects of dexamethasone → individuals with other disorders like anxiety also show this effect Stress hormones can be harmful to neurons in that they decrease a key ingredient that keeps neurons healthy and growing → high stress hormone levels can cause hippocampus shrinkage → stress hormone over production for a long time could stop neurogenesis (this could be occurring in the hippocampus) ECT produces neurogenesis in the hippocampus which could be why it works as a depression treatment → exercise also increase neurogenesis

how to talk to a friend with an eating disorder

Remember they are a person and not a body → use language focused on them and how they may not be taking care of themself rather than focusing on them being too thin → try to plant a seed that you're concerned so that even if they're resistant and in denial they know you're there to help when they need it

mixed episodes

Research suggests that manic episodes are characterized by dysphoric anxious or depressive features more commonly than was thought and dysphoria can be severe Mixed episodes can be more severely impairing

role of weight restoration in treatment

Role of weight restoration → this is one of the goals for underweight anorexia patients but not the only focus → some patients don't want treatment because they know they'll have to gain some weight (but it isn't as significant an amount as people think) → some people that get bulimia treatment actually end up losing a little weight because they get back to listening to their hunger cues naturally

sleep efficiency

Sleep efficiency is the percentage of time actually spent asleep, not just lying in bed trying to sleep → divide the amount of time sleeping by amount of time in bed

schizophrenia stats, prodromal stage, personality factors, and in other cultures

Substance-induced psychotic disorder and psychotic disorder associated with another medical condition are different from schizophrenia Schizophrenia can occur slowly or suddenly and is normally chronic Tend not to be able to establish and maintain relationships Even when people with it improve with treatment they are likely to experience difficulty throughout their lives Lifetime prevalence of schizophrenia is equal for men and women at 0.2-1.5% Life expectancy is slightly less than average, partly because of suicie and accidents For men onset diminishes with age while onset for women increases with age Women appear to have more favorable outcome than men More severe symptoms of schizophrenia tend to occur in later adolescence or early adulthood (can be some signs in childhood) Children that go on to develop schizophrenia show mild physical abnormalities, poor motor coordination and mild cognitive and social problems Prodromal stage → 1-2 year period before the serious symptoms occur but when less severe yet unusual behaviors start to show themselves → these behaviors include ideas of reference, magical thinking, and illusions → could also include isolation, marked impairment in functioning and a lack of initiative, interests, or energy Once symptoms start it can take from 2 to 10 years before a person at high risk meets full criteria Highest period of risk is during first two years following first displays of symptoms Personality factors, amount and quality of social support, baseline functioning, amount and duration of symptoms before seeking help, and prevalence of negative and disorganized symptoms can influence chances of developing schizophrenia Once treated patients often improve but also often go through relapse and recovery patterns People with schizophrenia more commonly have relapses with periods of varying impairment in between them People in many cultures have symptoms of schizophrenia → universal, affects all racial and cultural groups → even shared neuroanatomical similarities across cultures → provides evidence that it really exists Course and outcome vary from culture to culture → stressors in some cultures can make outcomes worse→ lack of mental health infrastructure can be an issue too → expanding mental health opportunities in other countries can help In the US people in devalued ethnic groups may be more likely to get a schizophrenia diagnosis → black people in UK have been found more likely to be detained and hospitalized against their will when diagnosed with schizophrenia → thus there could be misdiagnosis → also stress associated with stigma, isolation and discrimination may influence schizophrenia etiology in different groups of people There is the possibility that schizophrenia could really be several different disorders

cultural considerations of eating disorders

These disorder can develop in immigrants that recently moved to Western countries White people tend to have higher levels of eating disorders than black people → could be because white males tend to prefer thinner figures in women than African American males However racial differences could be changing → prevalence of eating disorders is now more similar among whites, blacks, asians, and hispanics

mood disorders

characterized by gross deviations in mood → depression and mania contribute either singly or together to all the mood disorders

ego-dystonic

need them to understand that the way they were seeing the world is incorrect and thus distorted the way they were seeing themself

bulimia nervosa

out of control eating episodes or binges are followed by self-induced vomiting, excessive use of laxatives or other attempts to purge the food

cognitive errors

(Aaron Beck) → overgeneralization, arbitrary inference → people with depression tend to interpret the world in a systematic, skewed way → people with depression sometimes tend to overgeneralize things in negative ways → arbitrary inference is when you interpret things in a negative way that something is somehow your fault or because of you (blaming and judging yourself, see connections between events in the world and yourself that aren't actually there)

With anxious distress

(mild or severe) → can be anxiety symptoms or a disorder, anxiety indicates a more severe condition, makes suicidal thoughts and completed suicide more likely and predicts a poorer outcome from treatment

with psychotic features

(mood congruent or mood incongruent) → hallucinations and delusions, somatic delusions, mood congruent ones are related to depression, mood incongruent aren't consistent with depression → may progress to schizophrenia, harder to treat, cause more impairment and can cause fewer weeks with minimal symptoms over a ten year period

The Center Cannot Hold by Elyn R. Saks

(professor in psychology with Schizophrenia) Explaining disorganization is challenging → consciousness gives way → center of reality gives way and cannot hold → no sturdy vantage point to see things → random moments of time follow one another → thoughts feelings and time run together → no sense can be made → all taking place in slow motion → automatically knew she had to hide these symptoms (used masking techniques the rest of her life) → her first experience was at 7 years old

depression stats

10% rate of depressive episodes in a year Close to 20% rate of ever experiencing depression worthy of treatment in a lifetime In past 7 months there has been a triple in the amount people experiencing some depressive symptoms Substance abuse correlates with depression Almost ¾ of the class think they may have met depression criteria at some point

stats for all mood disorders

16% of population experience major depressive disorder over a lifetime 3.5% of population will have double depression over a lifetime Bipolar disorder has 1% lifetime prevalence Women are twice as likely to have mood disorders but this is only due to depressive disorders (bipolar disorder sex ratio is 1:1) Women are more likely to have rapid cycling and to be anxious and to be in a depressive phase rather than a manic phase Depression is significantly lower among blacks than whites (no difference in bipolar) Fair or poor health status was the major predictor of depression in african americans Native AMericans have a much higher prevalence of depression (however concept of depression is not always well understood in their culture) Depression is less common before puberty but rises dramatically in adolescence → 20-50% of teens experience some depressive symptoms → teens experience depression as often as adults (more common in teenage girls for major depression, but not mild depression) Mild depressive symptoms increase with age but depressive episodes decrease above 65 Bipolar disorder occurs at the same rate in childhood and adolescence as in adults

stats and causes of eating disorders generally

20% of people with eating disorders are killed by it → anorexia nervosa has highest mortality rate of any psych disorder Eating disorder affect 30-40% of people at least once during their lifetime Eating disorders in western countries increased from 1960 to 1995 and then leveled off → rates of bulimia rose the most dramatically There is a higher prevalence of eating disorders in younger groups Tend to be culturally specific → not found until recently in developing countries → run rampant in the west in the past → but now eating disorders have become a global issue Eating disorders tend to occur with mostly young females living in a socially competitive environment → tend to seek each other out on the internet and social networks where they find support and sometimes inspiration to the detriment of their health Strongest contributions to etiology are sociocultural instead of psych and biological

efficacy of antidepressants

20-30% of patients that added a second drug or switched to a different drug went into remission However repeating this with a third drug doesn't yield as good results All drugs do about the same in big studies but some individuals do better with one drug than another Drug treatments aren't as effective with kids→ tricyclics can cause sudden death during exercise in kids under 14, Prozac is thought to be safe for kids and have some efficacy with teens (especially effective if combined with CBT) Antidepressants are effective with the elderly but can be difficult to deal with side effects (may have added ones in older people like memory impairment and physical agitation) → older people need people to monitor their drug compliance and side effects and psychotherapy helps too A better goal than recovering from one episode is delaying or preventing the next one entirely→ thus drug treatments are continued after termination of an episode for 6-12 months after it is over or longer → then drug is gradually withdrawn over weeks or months (however long term administration hasn't been studied much and could have bad effects on outcomes) Some people refuse to take them or are not eligible to take them→ taking them while pregnant is bad for the baby (could cause neurological issues) → other studies found a protective effect of lower birth complications for depressed mothers on SSRIs → thus treatment is individualized based on the patient

why suicides increase after someone else does it

5% of teenage suicides reflect an imiattion, suicides tend to increase after news on one is spread, and there is a positive relationships between suicidal behavior and exposure to media coverage related to suicide It is not that suicide is contagious it is that suicide can be romanticized and people that already have a disorder may be affected by a friend's suicide or some other major stress and see another suicide as a guide for what to do

antidepressants

75% of all patients recently treated for depression were treated with antidepressants Four basic types of antidepressants used to treat depression: SSRIs, mixed reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase (MAO) inhibitors → all have about the same effectiveness with 50% of patients getting some benefit and about half of them getting close to remission Can be relatively ineffective for moderate to mild depression → only in severely depressed patients is there a clear advantage to medications SSRIs are typically the first choice → increases serotonin levels → Prozac is best known one → has side effects though of suicidal preoccupation, paranoid reactions, and occasionally violence (however the suicide risk was found not true with research) → howevre a few years ago the suicidal thoughts risk in teeangers increased and seems legit → however actual suicide rates in groups taking SSRIs were slightly decreased (findings are correlational and thus cannot be proven)--> one explanation is that SSRIs may cause increased thoughts of suicide in first few weeks taking them in teens but in the long term they prevent suicide → side effects are physical agitation, sexual dysfunction, low sexual desire, insomnia, and GI upset (however these bother patients less than side effects of tricyclic antidepressants) Mixed reuptake inhibitors → effexor is one, related to tricyclic antidepressants, block reuptake of NE and serotonin → some side effects of SSRIs are not apparent with mixed reuptake inhibitors but other typical side effects remain MAO inhibitors block enzyme NAO that breaks down NE and serotonin → same result as tricyclics, transmitters pool in the synapse leading to downregulation, less effective than tricyclics, less side effects → may be better for depression with atypical features → eating and drinking things with tyramine can cause severe hypertensive episodes and possibly death while taking this medication→ also other drugs like cold meds can interact fatally with MAO inhibitors, thus usually only prescribed when other meds don't work Tricyclic antidepressants → most widely used treatment before SSRIs introduced, now less common, Tofranil and Elavil, block reuptake of certain neurotransmitters and allow them to pool in the synapse and down regulate transmission of that transmitter → greatest effect is down regulating NE, serotonin also affected → can cause blurred vision, dry mouth, constipation, difficulty peeing, drowsiness, weight gain, and sexual dysfunction → patients stop taking it due to side effects but sometimes they go away with time → these can be lethal if taken in high doses (thus have to be careful of suicidal tendencies) St.John's wort thought to be a natural antidepressant → most popular in Europe, can work as well as low doses of antidepressant meds → has few side effects and easy to make → may also alter serotonin function → one large study found that it wasn't better than the placebo while other research contradicts this

genetic research indicates that there may as many as....

8 distinct disorders within schizophrenia

suicide disorders stats

80% of people that kill themselves have a psych disorder→ usually mood substance use, or impulse control disorders → 60% associated with mood disorders

parasomnias

Abnormal events that occur either during sleep or during that twilight time between sleeping and waking Nightmares can occur during REM sleep→ to be a disorder they must impair ability to function normally → some people consider nightmares only when you wake up while bad dreams don't cause this → could be influenced by genetics, trauma, medication use, and are associated with some psych disorders (like substance abuse anxiety, borderline personality disorder, and schizophrenia disorders) → psych and med treatments could help Disorder of arousal → include motor movements and behaviors during non REM sleep like sleepwalking, sleep terrors, and incomplete awakening Sleep terrors most commonly afflict kids and begin with a piercing scream → child is upset, may sweat and have a rapid HR → occur during NREM sleep and aren't caused by frightening dreams → cannot be easily awakened and comforted like during a nightmare → kids don't remember them → prevalence drops as you get older → could be genetic because it tends to run in families → treatment is typically to wait and see if they disappear at first → can also use scheduled awakenings in which parents awaken their kids about 30 minutes before a typical episode Sleepwalking → occurs during NREM sleep → thus not acting out a dream → typically during first few hours while person is in a deep sleep → DSM criteria requires leaving bed, but can involve smaller motor behaviors like sitting up and picking at the blanket or gesturing → awakening them can be hard and the person won't remember it→ mostly a problem in kids (10% of school age kids)--> does affect a small amount of adults → course is typically short → extreme fatigue, previous sleep deprivation, use of sedative or hypnotic drugs, adn stress could cause it → occasionally there can be violent behavior → there could be a genetic component since it seems to run in families Nocturnal eating syndrome → when people rise from their beds and eat while asleep → in 6% of people with insomnia issues Sexsomnia → acting out sexual behaviors like masturbation and sexual intercourse with no memory of the event → very rare but can cause relationship issues and legal problems if it occurs without consent

onset and prevalence of schizophrenia worldwide

About 0.2-1.5% (or 1% of population) Often develops in early adulthood Can emerge at any time; childhood cases are extremely rare but not unheard of → thought the environmental mechanism cannot manifest as schizophrenia until adolescence → something during adolescence typically triggers schizophrenia

first generation antipsychotic meds

Acute and permanent side effects are common with first generation antipsychotic medications Parkinson's like side effects (motor issues and tremors) Tardive dyskinesia (symptoms that affect speech and movement) Compliance with medication is often a problem → aversion to side effects, financial cost, poor relationship with doctors

insomnia

After being awake for one to two nights a person starts having microsleeps that last several seconds or longer so cannot go forever without sleep In fatal familial insomnia the total lack of sleep eventually causes death Can have insomnia if you have trouble falling asleep at night, if you wake up frequently or too early and can't go back to sleep, or if you sleep a reasonable number of hours but are still not rested the nest day (nonrestorative sleep) Insomnia disorder or primary insomnia are insomnia not related to medical or other psychiatric problems → often have other disorders Can have accidents if you are unable to concentrate due to lack of sleep Total sleep time decreases with depression, substance use disorders, anxiety disorders, and neurocognitive disorder due to Alzheimer's disease Alcohol use is sometimes done to induce sleep but it interrupts ongoing sleep which can lead to anxiety and repeated alcohol use Women report insomnia twice as often as men→ women report more trouble initiating sleep which could be hormonal Moderate alcohol and caffeine use and following a mediterranean diet can improve sleep in women Insomnia complaints differ among the ages → teens tend to go to bed later but school demands that they still get up early resulting in sleep deprivation There are racial differences in sleep issues The amount of people that complain of sleep issues increases as they become adults

bipolar disorder stats

Age of onset for I is 15-18 and II is 19-22 (can start in childhood) → tend to develop more suddenly May be better to put all mood disorders on a continuum because up to 68% of people with depression experience a manic episode or symptoms at some point Rare to develop it after 40 Once disorder appears it is chronic Therapy involves managing the disorder with drugs that prevent recurrences of episodes When patients get treatment early mortality rate is closer to that of general population Dying from suicide is correlated with being male and having a first degree relative that committed suicide Cyclothymia is chronic and lifelong too→ 60% female and age of onset in teen years or earlier → often not recognized → subtypes based on predominance of depressive symptoms, predominance of hypomanic symptoms and another on an equal distribution of both

Adlerian therapy

Alfred Adler → thinking about how we set goals and sabotage ourselves

causes of DID and possibility of planted memories

Almost every individual with DID was horrible abused as a child; Children being abused want to escape to a fantasy world of being someone else so they tend to do it over and over again and create as many identities as they want; Sexual trauma and incest are also common However in some studies reports of abuse were found to have been made up while in other cases the abuse was varified; The extreme trauma causing it doesn't have to be abuse but abuse is most common; A lack of social support during or after the abuse seems to play a role; Chaotic unsupportive family environments seem key; Individual experience and personality factors are also thought to contribute; Studies have found that only with the appropriate genetic vulnerabilities do people dissociate and develop a disorder from it→ many people dissociate once in response to trauma and don't develop a disorder; This disorder can be considered a subtype of PTSD; Developmental window of vulnerability to abuse that leads to DID seems to close around 9 years old → after this DID is unlikely to occur but PTSD might; We know relatively little about DID → most of the info is based on case studies; Suggestibility is a personality trait distributed normally across the population → a vivid imagination can correlate with the ability to be suggested, hypnotized, or self-hypnotize/dissociate oneself; Autohypnotic model says that people who are suggestible can use dissociation as a defense against extreme trauma People with DID tend to have had imaginary friends as kids; There is some evidence of smaller hippocampal and amygdala volume in patients with DID; Temporal lobe epileptic seizures are associated with dissociative symptoms; Head injury and resulting brain damage can induce dissociative experiences Sleep deprivation produces dissociative symptoms; Symptoms of those with DID get worse when they are tired; People with DID could have repressed traumatic memories; However some clinicians think that traumatic memories of those with DID could be due to strong suggestions by therapists → however it is difficult to know this and many treatment involve the therapist going back over traumatic events; Studies have shown that memories can be planted and those individuals will believe they can actually remember them; Children are also inaccurate in reporting emotional events from childhood; Having a vivid imagination and being open to unusual ideas can make you more vulnerable to distorting memories or believing in planted fake memories; Some studies have found that the majority of people actually abused as kids did remember the event → also studies show you can forget and remember later, or forget completely; Need more research to be able to specify the processes under which false memories are implanted and how to define the presenting features that indicate a real but dissociated traumatic experience

dissociative amnesia in other cultures

Amok is a disorder not found in western cultures → mostly makes, people in this trancelike state often brutally assault and sometimes kill people or animals → tend not to remember the episode; There are other "running" syndromes in which an individual enters a trancelike state and suddenly imbued with energy runs or flees for a long time → these occur more in women → resemble fugue (except for amok); In the arctic running disorders are called pivloktoq; In the Navajo tribe it is called frenzy witchcraft; Dissociative phenomena in some areas of the world are considered a trance or possession → associated with current stress or trauma; Dissociative trances occur commonly in India, Nigeria, Thailand, and other Asian and African countries and are often related to cultural or religious practices; Culturally acceptable dissociation in the US occurs in African American prayer meetings, Native American rituals, and Puerto Rican spiritist sessions; Among Bahamians and African Americans in the south trance syndromes are called "falling out"; People in singapore that go into trances tend to be nervous, excitable, and emotionally unstable relative to average person in Singapore; When trances are considered undesirable in other cultures, like when they are considered possession by an evil spirit or another person, the individual would be diagnosed with and "other specified dissociative disorder" or dissociative trance

transcranial magnetic stimulation

Application of magnets to outside of head Doesn't hurt but may get headaches as side effects Mild memory loss so not used as first treatment (only used if therapy and meds don't work)

schizophrenia negative symptoms

Avolition → lacking motivation, no energy, not doing anything Apathy → not caring about anything, no reaction to things, not giving a crap Alogia → absence of speech Anhedonia → absence of pleasure (seen in depression), inability to feel joy, passion and interest in things that caused it before Affective flattening → visible signs of emotions like tone and facial expressions are gone, no tone in your voice no expression in your face, not happy or sad, just nothing

some people can have...

BDD and eating disorders, may increase in this overlap because more people generally don't like how they look today

how to help a friend you think may be at risk for suicide

Be honest about your concerns Ask directly about thoughts of suicide (lots of people are afraid to put the idea of suicide in your friend's head since suicides can become more frequent when someone famous or someone local does it → some people actually do become more likely to do it if suicide is glamaorized, methods are discussed, or someone close to them does it and it makes it seem more possible for them to) → however, asking someone if they have thought about suicide because you're concerned is not the same thing because you are not making it sound like a positive option → can be helpful to open a door to talk about it in a non-stigmatizing way → if someone is at risk for suicide then the idea is already in their head so there isn't the risk of being the first thing to put it into their head Listen → and offer support, understanding, and patience → offer love → you aren't supposed to be the therapist but you can help them get to treatment Convey a message of hope → that depression is real, common, and treatable Offer to accompany the friend to treatment and/or help to make the appointment With any true concerns about imminent safety you shouldn't leave the person alone → if on campus can call university counseling center → more generally you can call the suicidal support line (1-800-273-TALK) → can also go to www.afsp.org (american foundation for suicide prevention) or www.jedfoundation.org (specifically trying to reduce suicide in college student populations)

disorders that contribute to obesity

Binge eating disorder and night eating syndrome can contribute to obesity → only 7-19% of people with obesity exhibit binge eating (treatment for this can be integrated within weight loss programs) → night eating occurs in between 6-16% of obese individuals seeking weight loss treatment and in as many as 55% of those with extreme obesity seeking bariatric surgery → these people consume a third or more of their faily intake after their evening meal and get out o bed at least once during the night to have a high calorie snack → typically not hungry in the morning and don't eat breakfast → weight loss programs should target this behavior so that people eat more during the day when their energy expenditure is highest

integrative theory of etiology

Biological and psychological vulnerabilities interact with stressful life events to cause depression Biological vulnerability can be overactive neurobiological response to stress (someone may be higher in this) Psychological vulnerability can be depressive cognitive style (some people may be higher in this)

genetic causes of bipolar disorder

Bipolar disorder has a different genetic basis and reacts differently to social support than depression Bipolar disorder may be due to an overactive behavioral approach system → thus in positive but stressful events manic episode can occur Thus biological, psychological, and social factors all interact and it is the unique combo that produces a particular mood disorder rather than anxiety disorder

children and mood disorders

Bipolar disorder occurs at the same rate in childhood and adolescence as in adults Some babies can exhibit signs of depression but unsure of the cause Mood disorders are considered fundamentally similar in children and adults → however the "look" of depression changes with age Children under 3 years old show depression as sad facial expression, irritability, fatigue, fussiness, and tantrums (could also have issues with eating and sleeping) Depression issues noticed from ages 6 and under can predict later issues with depression, anxiety, and ADHD but cannot be diagnosed with depression unless it lasts 2 weeks Some manic symptoms and mood swings may be typical for children Childhood depression and mania is associated with ADHD or conduct disorders in which aggression and destructive behavior are common → may be better explained by disruptive mood dysregulation disorder Adolescent bipolar disorder may also cause aggression, impulsiveness, sexual provocativity and being accident prone Developing depression as a teen can put you at risk for anxiety, major depression, nicotine dependence, suicide attempts, and drug and alcohol abuse → extent and severity of depressive symptoms as a teen can predict extent of depression and suicidal behaviors as an adult → but CBT can prevent the onset of depressive episodes in at-risk youth

anorexia

Body image disturbance (even if people are saying they're too thin they still don't think they're thin enough) Negative self-evaluation → never really end up liking how they look, don't want to show their body, believe that their body is their worth so they have low self-esteem Intense fear of gaining weight or being fat → this is what perpetuates the restriction of food intake (doesn't matter that others think they're too thin, they're terrified of gaining weight and want to keep losing it) Restriction of food intake Significantly low body weight → in the DSM it has to be a particular BMI Excessive exercise can be part of this for some but doesn't have to be → may feel they're making up for what they're eaten but they didn't have a full binge Two subtypes of anorexia: binging/purging subtype and restricting subtype Binging/purging type shows marked differences from the binges of bulimia → they don't eat nearly as much and don't feel out of control but they believe they ate something that was too much and feel like they have to purge (for someone with anorexia it could be just a single bagel that makes them want to purge) Restricting subtype is the more classic case in which people deny themselves food People tend to hide their behaviors → may skip meals, work out in secret → may move food around on plate, spit food into napkin, claim they already ate Sometimes people try to say I could never be anorexic because I love food so much → but a lot of people with anorexia love food → they simply deny themselves it even though they love food → they may bake or cook all the time but never eat what they make → they may be interested in food and recipes and may collect them but then they deny themselves the food anyways Could have anorexia early in adolescence that eventually turns into bulimia → sometimes these people think they "failed at anorexia" and this is why they're bulimic

breathing-related sleep disorders

Breathing is disrupted during sleep and they experience several brief arousals throughout the night and don't feel rested even after 8-9 hours of sleep When respiratory muscles relax while sleeping for some people this can cause hypoventilation or short periods when they stop breathing entirely which is sleep apnea Oftentimes the person doesn't realize what's happening and it is someone they sleep with someone that notices loud snoring or episodes of interrupted breathing Other signs are heavy sweating, morning headaches, and episodes of falling asleep during the day with no resulting feeling of being rested Obstructive sleep apnea hypopnea syndrome occurs when airflow stops despite continued activity by the respiratory system → for some their airway is too narrow, in others there is an abnormality or damage that interferes with breathing → typically they snore → obesity can be associated with it and issue can increase with age → use of MDMA can cause it in young and healthy adults → most common in males, affects 20% of the population Central sleep apnea → complete cessation of respiratory activity for brief periods and is often associated with certain cCNS disorders like cerebral vascular disease, head trauma, and degenerative disorders → wake up during the night but don't report excessive daytime sleepiness and don't know they have the problem → tend not to seek treatment as a result Sleep-related hypoventilation → decrease in airflow without a complete pause in breathing → tends to cause an increase in CO2 levels All these disorders can cause symptoms similar to insomnia

eating disorders stats

Bulimia made a distinct disorder in the 1970s → most that come for treatment are women → males with bulimia have a later age of onset → large minority are gay males or bisexual → male athletes in sports requiring wieght regulation are another large group → incidence among men could be increasing → for centuries males had it more often than females → adolescent girls are most at risk (13% of them have an eating dsiorder by 20 years old) For all eating disorders lifetime prevalence is 2 to 3 times greater for females with the exception of subthreshold BED Prevalence of anorexia may be underestimated in some surveys Lifetime prevalence for anorexia is 0.3%, 0.9% for bulimia, 1.6% for BED Most eating disorder age of onset is between 18-21 years More common for bulimia to begin as early as 10 years old Bulimia tends to be chronic if untreated Strongest predictors of persistent bulimia are a history of childhood obesity and a continuing overemphasis on the importance of being thin People with bulimia don't tend to shift to another eating disorder Anorexia course is normally chronic but not as chronic as bulimia if caught early and treated → however anorexic patients tend to maintain a low BMI over a long period along with distorted perceptions of shape and weight (could still restrict their weight even if don't meet criteria) → thus anorexia could be more resistant to treatment than bulimia

medical concerns of eating disorders

Bulimia: salivary gland enlargement, electrolyte imbalances (can be due to dehydration), cardiac problems (electrolyte imbalances can cause this), kidney problems (electrolyte imbalances can cause this), dental enamel erosion (due to stomach acid), intestinal problems (constipation due to laxatives and diuretics, issues caused by binges and purges occurring over and over) Anorexia: loss of period and fertility (used to be in the DSM criteria, however may not lose period or could lose period for many other reasons like extreme exercise), sensitivity to cold (without body fat you get colder easier), lanugo (downy hair that your body grows to help keep itself warm), low blood pressure and heart rate (people fainting), cardiac problems (could have a heart attack), body shutting down (can't function anymore), death by self-induced starvation These disorders have high death rates not due to suicide (some people few anorexia as a slow suicide

general stats and attitudes on sex

By the age of 15 a quarter of males and females have engaged in sex and the prevalence rte increases steadily with the age of individuals → about 80% have oral sex but only about 30% have had anal sex About 9% of women and 10% of men reported some homosexual attractions or behaviors (oftentimes in addition to heterosexual attractions) Women are little more likely than men to have had fewer than two partners in the past year Sexual practices and determinants of sexual satisfaction are more similar around the world today Only about 1% of men engage in exclusively homosexual behavior About 30% of men and 17% of women aged 75-85 are sexually active Most people like to have only one partner at a time Much more men than women masturbate (believe this is because it is physically easier for men to do so) Men tend to express more permissive attitudes and behaviors than women Women tend to worry more and feel more vulnerable even when they choose to have multiple partners There are no gender differences in attitudes about homosexuality, he experience of sexual satisfaction, or attitudes toward masturbation Most gender differences have become smaller over time Men tend to only be aroused to females or only me aroused to men (with most transgender women being aroused by men) while women tend to be aroused by both women and men whether straight or lesbians Women tend to think of sex as more romantic and open or they are embarrassed and conservative about it while men think of it more in an aggressive way and dont tend to be self-conscious about it Men show more sexual desire and arousal, women emphasize committed relationships as a context for sex more than men, men's sexual self-concept is characterized more by power, independence and aggression and women's sexual beliefs are more plastic int hat they are more easily shaped by cultural, social, and situational factors For men that are "unsure" they have more partners and heterosexual men have the least partners → bisexual women have the most partners "Sexual revolution" of the 60s and 70s helped to remove the double standard so that women can have similar attitudes as men about sex

therapy for depression

CBT and interpersonal psychotherapy are the most common psych approaches CBT teaches clients to examine their thought processes while depressed and recognize depressive errors in thinking → not easy because these processes can be automatic → they try to correct cognitive eros and substitute less depressing and more realistic thoughts and appraisal → underlying negative cognitive schemas are targeted in the patients day to day life → therapist uses a socratic approach, therapist and client work as a team to uncover schemas → therapists must be skillful and highly trained Cognitive behavioral analysis system of psychotherapy integrates cognitive behavioral and interpersonal strategies and focuses on problem solving skills especially in the context of important relationships → designed for persistent depression Mindfulness based therapy is effective for depression and preventing future depressive relapse and recurrence → mindfulness based cognitive therapy MBCT can prevent relapse or recurrence in patients in remission from their depressive episode (can be effective for severe cases) Increased activities can improve self concept and lift depression→ could be more effective than cognitive approaches → prevents avoidance of social and environmental cues that produce negative affect or depression and result in avoidance and inactivity → individuals is helped to face the cues or triggers and work through them and the depression they cause → develop coping skills Programmed exercise can treat depression too → exercise can prevent relapse in the 6 months following treatment better than drugs or combo treatment particularly if the patient continued exercising → exercise could increase neurogenesis in hippocampus which is associated with resilience to depression Interpersonal psychotherapy focuses on resolving problems in existing relationships and learning to form important new interpersonal relationships → very structures and doesn't normally take more than 15-20 sessions (each once a week) → Identify life stressors that precipitate depression and then work with therapist on current interpersonal problems → deal with interpersonal role disputes, adjust to the loss of a relationship, acquire new relationships, or identify and correct deficits in social skills that prevent initiating or maintenance of important relationships → therapist helps patient determine stage of their dispute (negotiation stage, both aware of issue and try to negotiate it, impasse state, dispute smolders beneath the surface and results in resentment but is not resolved, resolution stage, partners are taking some action)--> then therapist helps them develop strategies to resolve it

what mania feels like

Considered the opposite of depression, but as simple as just being happy Energetic, excitability, impulsive, uncontrolled, keyed-up, lack of inhibition, euphoria, sense of invincibility, feeling on top of the world, irrational, over-confident, productive, frantic, ecstatic, feeling unstoppable, sleep deprivation, etc. If depression is slowing down then mania is a keying up → turning your central nervous system on high → person is aroused and sped up Some people feel euphoria and happiness while other people are agitated Tend to be loud, fast, etc.

etiology of eating disorders

Culture specific Thin has changed meanings in many cultures from being a negative to a positive thing But in some cultures being thing is still not positive Different subcultures and different body ideals affect etiology Beliefs about what is considered physically attractive may differ from reality → average american women think that straight men find very thin bodies attractive while the males would pick a body that is less thing, thus these women have a distortion in the reality of what most people actually find attractive Websites, social groups, and media messages can affect people's body images → beliefs about body image can spread through these places Disordered eating among men: sometimes there is classic anorexia or bulimia but it also often manifests a bit differently → men can also have muscle dysmorphia or bigarexia → obsessed with building lean muscle mass, obsessed with becoming cut or lean → may be more like body dysmorphic disorder → may overexercise, restrict eating, or take harmful supplements → sometimes sports even normalize eating disorder behavior (wrestling weight classes, crew team weights, gymnastics and figure skating body sizes) → coaches have to look out for this → some athletes dehydrate themselves to make weight → some people may go back to normal behavior and others may not Evolutionarily we find certain things attractive but there are big cultural differences with what specific body types are attractive → this is why body image ideas can spread through the internet (subcultures) In groups of people that all want to lose weight they may compete to see who can be the thinnest and this can make things worse → could occur in support groups for eating disorders → need people that actually want to get better to support each other

sexual orientations

Current categories may not fully capture the range of sexual orientations Asexual is a lack or low levels of sexual attraction to others or desire for sex Pansexual → sexual, romantic, physical, and/or spiritual attraction for members of all gender identities/expressions

deep brain stimulation

Deep brain stimulation is used with severely depressed patients → electrode surgically implanted in limbic system → connected to pacemaker

delusional disorder

Delusional disorder → persistent belief that is contrary to reality in the absence of other characteristics of schizophrenia, cannot be due to organic factors, may have flat affect, anhedonia, or other negative symptoms of schizophrenia, also may become socially isolated due to suspicion of others, delusions typically persist over several years → can have subtypes of erotomanic (delusion is irrational belief that one is loved by another person of higher status typically), grandiose (believing in one's inflated worth, power, knowledge, identity, or special relationship to a deity or famous person), jealous type (believes sexual partner is unfaithful), persecutory type (involves believing oneself or someone close to them is being malevolently treated in some way), somatic delusions (feels afflicted by a physical defect or general medical condition) → typically these delusions could be happening but aren't while in schizophrenia the delusions are more bizarre → can have a bizarre delusion but only get this diagnosis if its just one delusion → can also have shared psychotic disorder which is when you get a delusional by sharing it with someone else → affect 24-60 people in 100,000 → onset is between 35-55 normally (may not seek treatment) → more females than males → tend to do better than those with schizophrenia but not better than the other schizophrenia related disorders → can function well despite delusions → may have a hereditary component (several other disorders can cause delusions like substance abuse and brain tumors and AD)

brain activity in mood disorders

Depressed people have greater right sided anterior activation of brains in the prefrontal cortex → also found in patients no longer depressed (may also exist before the patient becomes depressed) Bipolar disorder patients show elevated relative left frontal EEG activity and this predicts the onset of bipolar disorder Areas associated with increased inhibition and decreased goals are associated with depression (anterior cingulate cortex, amygdala, hippocampus, and frontal cortex, some are more or less active)

mood disorders and martial issues

Depression and bipolar are influenced by interpersonal stress and especially marital dissatisfaction Is seems that marital dissatisfaction is a bigger risk factor for men than women Depression including bipolar disorder may lead to substantial deterioration in marital relationships → being around someone negative makes the spouse feel bad and starts arguments Depression causes men to withdraw or disrupt the relationships while for women issues in a relationship cause their depression People with bipolar disorder are less likely to be married at all and more likely to be divorced (but if they stay married they have a better prognosis) Treating marital issues with the disorder could help Gender imbalance in depression is constant around the world (similar ratio for anxiety disorders) → this may be because women are culturally expected to be more reliant on others and thus may not feel as in control of their lives as men, may feel more helpless too

adolescent risk of eating disorders

Dieting and dietary restraint Adolescent dieting leads to an 8 times greater risk of developing an eating disorder (typically when the person doesn't really need to be on a diet) Adolescents tend to internalize the standards of friendship groups (a teenager is more likely to diet if her friends also diet) May paradoxically cause weight gain (produces stress and withdrawal symptoms that increase cravings for food, typical cycle of weight gain in bulimia because the body learns to hang onto food from binges more because it gets less in between)

disorganized symptoms

Disorganized speech → word salad, words don't come together inherently, confusing, hard to understand Cognitive slippage → losing train of thought and trailing away at end of sentence Tangentiality → jumping from one idea to the next and the person is really hard to follow when people listen to them Loose associations → seeing connections between things and jumping off to them but a listener doesn't understand how you got there Inappropriate affect → breaking out into laughter when nothing is funny or crying during a happy time, dysregulation of emotional expression Catatonia → anything from repeating back what has been said to you over and over (echolalating), could be not moving at all or moving in strange ways → waxy rigidity is when muscles can move but then get rigid and stay in one position

DMDD

Disruptive Mood Dysregulation Disorder (DMDD) Childhood disorder only New disorder Created because clinicians were slapping the bipolar label on children left and right (kids that were tantruming, disruptive, out of control, and impulsive would be labeled bipolar and mood on mood-stabilizer medications) But research on bipolar disorder in children showed that we shouldn't be doing this because mania in a child doesn't really make sense → kids tend to be naturally manic Research showed that when kids got a bipolar diagnosis as a kid it turned out to be a different disorder entirely later in life such as ADHD, anxiety, antisocial personality disorder, etc. Thus, this diagnosis encapsulates kids that used to get the bipolar diagnosis → kids have mood dysregulation → impulsive, overcome with big emotions, go back and forth between emotions, may be violent, may scream, unable to regulate their emotions at all It would be very rare for a child to legitimately have bipolar disorder because its age of onset is normally later

circadian rhythm sleep disorder

Disturbed sleep (ether insomnia or excessive sleepiness during the day) brought on by the brain's inability to synchronize its sleep pattern with current patterns of day and night People have a biological clock in the suprachiasmatic nucleus in the hypothalamus → the light we see in the morning and at night tells our brain to reset this biological clock each day Jet lag type→ causes by rapidly crossing multiple time zones → traveling more than two zones westward can affect people the most → traveling eastward and/or less than three time zones are usually tolerated better → typically sleepier during the day and cannot sleep at the right time → exposure to repeated jet lag can cause shorter life expectancy and higher cancer risk in mice Shift-work type sleep problems are associated with work schedules → can have issues sleeping or experience excessive sleepiness during waking hours → could contribute to cardiovascular disease, ulcers, and breast cancer in women → working rotating shifts can predict poor sleep Other circadian rhythm disorders don't have external causes Delayed sleep phase type → sleep is delayed or there is a later than normal bedtime Advanced sleep phase type → early to bed and early to rise Irregular sleep-wake type → experience highly varied sleep cycles Non-24 hour sleep-wake types → sleeping on a 25 or 26 hours cycle with later and later bedtimes ultimately going throughout the day Melatonin contributes to setting our biological clocks that tell us when to sleep → made in pineal gland in the center of the brain → production is stimulated by darkness and ceases in daylight

drug treatment of eating disorders

Drugs are not thought to be effective for anorexia Antidepressants that are effective for mood and anxiety disorders are effective for bulimia → can reduce binge eating and sometimes stop binge eating and purging altogether at least for some time However these drugs are not very useful in the long term alone → best if used with psych treatments (may improve psych treatment)

suicide stats

Each year 4 people in every 1000 commit suicide, seven of 1000 make plans to kill themselves, and 20 out of 1000 will seriously consider suicide Suicide is the 11th leading cause of death in the US and most epidemiologists agree that the actual number of suicides may be 2 or 3 times higher than what is reported (unreported suicides occur when people deliberately crash their car) Suicide is overwhelmingly a white phenomenon → most minority groups don't commit as much suicide (except for Native Americans which have a very high rate, however there is high variability across tribes) There has been a dramatic increase in suicides in adolescence → rates of suicides in teens differ depending on ethnic group (thus must attend to cultural differences when treating depression in teens) There has been an increase in suicide rates among the elderly too (due to growing incidence of medical illness and their increasing loss of social support and resulting depression) There are even reports of suicide attempts between ages of 2-5 and suicide is the fifth leading cause of death from ages 5-14 In every country except China males are 4 times more likely to commit suicide than females → men tend to choose more violent methods leading to more suicides committed than in women More men commit suicide during old age and more women during middle age (this is in part because most attempts in older women are unsuccessful) More women in China commit suicide than men particularly in rural settings China also has some of the highest rates in the world → could be because there isn't much stigma around suicide in China, often it is portrated as a reasonable solution in classical Chinese literature → for women this is especially true in literature and often since a woman's family is her whole life if it collapses suicide is considered an honorable solution→ could also be possible that death by farm pesticides that were not meant to be suicides were deemed them mistakenly Suicidal ideation, suicidal plans, and suicidal attempts are also important indices Can distinguish attempters from gesturers → gesturers self injure with the intent not to die but to influence or manipulate somebody or as a cry for help) Suicide ideation prevalence is estimated at 9.2% → 3.1% have a plan and 2.7% attempt the plan during their lifetime Females attempt suicide at least 3 times more often than men Overall rate of nonlethal suicidal thoughts, plans, and attempts is 40-60% higher in women than men → this could be because more women than men are depressed and that depression is strongly related to suicide attempts Althought the suicide completion rate is highest amongst white people there are no differences in rates of suicide ideation, plans, or attempts across ethnic groups Between 16-30% of teens that think about suicide actually attempt it Thinking about suicide is not a fleeting thought but rather a serious contemplation of the act College students second leading cause of death is suicide → 12% had serious thoughts about suicide during the past year in a study (only 10% of this groups attempted to kill themselves and only a few suceeded) Suicidal thoughts taken very seriously by mental health professionals

eating disorder prevention

Eating disorder prevention programs could include selecting girls of age 15 or over and focusing on eliminating an exaggerated focus on body shape or weight and encouraging acceptance of one's body Also prevention programs focused on at risk women can be effective in educating them about food and eating habits and reducing the risk of developing an eating disorder Prevention programs can be effective when delivered online too

prevention of eating disorders

Eating disordered behavior growing more prevalent at younger ages More media messages to counteract Strong predictor of later eating disordered behavior is early concern about being overweight Try to get people to embrace the flexible and holistic view on eating

drug, ECT, surgery, and TMS treatments of schizophrenia

Even today some societies use crude surgeries to eliminate schizophrenia → in the 1950s they severed the connection between the frontal lobes and lower portion of the brain, calmed them but resulted in emotional and cognitive issues (prefrontal lobotomy) Treatment normally starts with neuroleptic drugs → used with psychosocial treatment to reduce relapse, compensate for skills deficits, and improve cooperation for taking the medications In late 1930s electroconvulsive therapy was invented → not actually very beneficial, but still used with limited number of people today in combo with antipsychotic meds (sometimes recommended for severe depression) Neuroleptics help people think more clearly and reduce hallucinations and delusions → affect positive symptoms and to a lesser extent the negative and disorganized ones Neuroleptics are dopamine antagonists but also affect serotonergic and glutamate systems → just starting to understand them Each drug is effective with some people and not with others → sometimes have to do trial and error The earliest neuroleptics (or conventional or first-gen ones) are effective for 60-70% of people that try them Some people may not be helped by antipsychotics or get bad side effects Atypical or second generation antipsychotics are new and some people respond to these → some research says they're better at preventing symptom reemergence while other studies disagree that they are any better Only work when taken properly and many people with schizophrenia don't routinely take meds Negative doctor-patient relationships, cost of medication, stigma, and poor social support can make people less likely to take meds → also bad side effects Antipsychotics can cause grogginess, blurred vision, and dryness of the mouth→ could also get serious extrapyramidal symptoms (include motor difficulties similar to Parkinson's) → Akinesia is expressionless face and slow motor activity and monotonous speech → tardive dyskinesia is involuntary movements of the tongue, face, mouth, or jaw and can include protrusions of the tongue, puffing of the cheeks, puckering of the mouth, and chewing movements (thought to come from long term use of high does of antipsychotics, can be irreversible Lots of people find antipsychotics side effects unacceptable → psychosocial efforts try to increase medication compliance Transcranial magnetic stimulation → uses wire coils to repeatedly generate magnetic fields that pass through the skull to the brain→ interrupts the normal communication of the brain temporarily → can stimulate areas of brain involved in hallucinations → can cause less of them (don't know if improvements last) modafinil when taken in addition to antipsychotic meds could help → cognitive enhancer with low abuse potential → may improve memory and problem solving (limited research) → may also help with emotional processing

perceptions of very thin people

Even with extremely thin people we tend to go the opposite direction saying they look so gross and like they're starving → but "diagnosing" thin people with a mental illness is problematic because we don't know what they're going through → calling thin bodies gross is just being equally as critical about thin bodies as we are about overweight bodies → this feeds into judging women only by their appearance (but this doesn't help anything)

binge-eating disorder general info

Experience marked distress because of binge eating but do not do compensatory behaviors Different patterns of heritability compared with other eating disorders Greater occurrence in males and later age of onset Greater likelihood of remission and better response to treatment than other eating disorders Often starts when they enter weight control programs Caused by separate set of factors from obesity → it is associated with more severe obesity About 20% of people in weight loss programs engage in binge eating with number rising to 50% amongst candidates for bariatric surgery Prognosis can be good but people can also become more obese or become bulimic About half start with dieting and then binge while half start with binging and then try to diet → those that start with binging are more severely affected and more likely to additional disorders Have some of the same concerns about shape and weight as other eating disorders About ⅓ binge to alleviate bad moods or negative affect (more psychologically disturbed)

factitious disorders

Fall somewhere between malingering and conversion disorders → symptoms are under voluntary control as with malingering but there is no obvious reason for voluntarily producing the symptoms except possibly to assume the sick role and receive increased attention → can extend to other members of the family → when an individual deliberately makes someone else sick it's called factitious disorder imposed on another previously known as Munchasuen syndrome by proxy (atypical form of child abuse) → can use hospital monitoring to catch this

family contributions to eating disorders

Families that are "typical" of someone with anorexia are successful, hard-driving, concerned about external appearances, and ager to maintain harmony→ often deny or ignore conflicts or negative feelings and attribute their issues to other people at the expense of frank communication among themselves Mothers of girls with eating disorders are more likely to want their daughter to be thin, are likely to diet themselves, and are more perfectionistic However family causes are not the primary issue Some families' relationships devolve quickly and can make eating disorders worse when parents get frustrated that their child won't eat Eating disorders run in families and thus are thought to have a genetic component 4 to 5 times more likely to have an eating disorder if a relative has one However there aren't any adoption studies yet so sociocultural influences could cause family heritability conclusions Thought that genetic makeup is about half of the cause of anorexia and bulimia Could inherit personality traits like emotional instability and poor impulse control → also could be a tendency to being a perfectionist

gender differences in suicide

Females are more likely to attempt while males are more likely to complete suicide May be because females are more likely to commit a suicidal gesture or a call for help Males are more likely to use firearms and this increases their chances of completing a suicide (much less likely they'll survive using this method) Suicide risk is thus heightened when guns are around → people like to say that if someone is suicidal theyll find a way to do it → but the data shows that this is wrong → suicide rates tend to go down when less readily available ways to kill oneself are around → this is because many suicide attempts are very sudden decisions and impulsive, someone thinks about it for a while and then in a sudden state of suicidal thinking that make an impulsive decision → if the method you choose is readily available and more deadly you are more likely to be successful → access to firearms make these impulsive decisions easier and quicker

prenatal influences on schizophrenia

Fetal exposure to viruses, pregnancy complications, and delivery complications are among the environmental influences that seem to affect whether or not someone develops schizophrenia → many studies link it to viral and flu or infection exposure (second trimester seems important) → could cause damage to the fetal brain which can later cause schizophrenia It is possible that prenatal and birth complications cause genetic vulnerability to schizophrenia to be expressed or that the genetic vulnerability results in the birth complications as well

therapy treatments for schizophrenia

Few people believe that psych factors cause schizophrenia so psych approaches can't cure them but psych methods of treatment still help → could be value in doing psychosocial treatment with drug treatment No version of institutions seem to help those with schizophrenia Token economy systems that promote good skills in people with schizophrenia could help Many people with schizophrenia or other serious psych disorders are homeless due to deinstitutionalization Clinicians try to reteach patients social skills like conversations, assertiveness, and relationship building → divide complex social skills into components and model each one → then patient practices it in the real world until all components can be easily combined Also trying to teach patients to take charge of their own care and live in a normal community while managing their disorder → may prevent relapse Virtual reality is being used to study and treat people with schizophrenia in safe environments → can get practice with skill using virtual reality Cognitive remediation aimed at improving cognitive processes can be done → try to improve cognitive processes to increase these individuals' functioning in the community → with cognitive learning exercises and strategies done in a strategy based approach Behavioral family therapy is used to teach families of people with schizophrenia to be more supportive → similar to classroom education → give family info and facts → help them with communication skills to become more empathetic listeners and how they should express feelings → learn problems solving skills to resolve conflicts→ can help a lot during first year but effects can fade with time so therapy should be ongoing Some programs focus on vocational rehabilitation like supportive employment → coaches give on-the-job training to help some people maintain meaningful jobs Relapse may be avoided or delayed with psychosocial therapies are done with drug treatments (should use multilevel psychosocial treatments) Services now include self-advocacy and self-help groups → focus on giving positive experiences through employment opportunities, friendship, and empowerment → these may help reduce relapse changes (but hard to prove) Assertive community treatment program → multidisciplinary team of professionals to provide broad ranging treatment across all domains including medication management, psychosocial treatment, and vocational training and support Some countries imprison people with schizophrenia, others think it has religious roots and treatments, and other use strange spiritual practices as treatment In the future could try to identify and treat children at risk early on → instability of family rearing environment could be a factor that increases chances of getting it at high risk genetically Could try to treat people in the prodromal stage → research on trying to stop progression of the disorder or preventing relapse

causes of gender imbalance in depression

Findings that younger girls entering junior high are more stressed and that girls that mature physically earlier have more distress Women put more value on relationships than men and if they are disrupted they could find it harder to cope Women tend to ruminate more about their situation and blame themselves for feeling depressed than men Men ignore their feelings more and do more activities to take their minds off them→ activating therapy is a successful style for treating depression and thus helps men Women also experience more discrimination, poverty, sexual harassment, and abuse → single, divorced, and widowed women have more depression than men in same positions while married and employed women don't have greater levels of depression than men in the same positions

bulimia psych treatment

For bulimia CBT-E starts by teaching the patient the physical consequences of binge eating and purging and the ineffectiveness of vomiting and laxative abuse for weight control → put them on a schedule to eat small amounts of food five or six times per day with no more than 3 hours in between to avoid binging → later on it focuses on altering thoughts and attitudes about body shape, weight, and eating → come up with coping strategies for resisting binging and purging → try to keep patient from being alone after eating in the beginning of treatment (can help with depression too if its present) CBT-E is thought to be more effective and act faster than other therapies Family therapy can also be helpful for bulimia

binge eating disorder psych treatment

For obese patients with binge-eating disorder adapted CBT-E can help them with their disorder and be critical for sustaining wieght loss → however interpersonal therapy is just as effective for this disorder → drugs like prozac were not effective → there is some value in weight watchers like programs with treatment but not as uch as CBT → there are some differences in outcomes depending on race so could tailor treatment to that → also males with more severe issues and females with any level of severity typically need logner treatment → research has found that CBT as a self-help program can be effective and thus should be the first option → found that IPT is effective for rapid and non rapid responders so if someone doesn't respond right away to CBT they should switch to IPT

the root of eating disorders

For people with eating disorder how they appear and their size affects their entire feeling of self-worth → their self-esteem depends entirely on their body image and size Normal eating is about balance → having days where eating is not very healthy and being okay with that and not feeling like you have to punish yourself or work it off

risks of residential treatments

Forced residential treatment could make matters worse for very resistant patients but good programs provide the patient enough autonomy that they can feel a little bit in control → these programs are never ideal but sometimes they're necessary There can be concerns with residential treatment creating a bubble → should ideally ease people out of it with a daytime treatment → go from living there to being there 6 hours a day 7 days a week then four hours a day 4 days a week and so on → involve the family too to help them transition

social/cultural etiology of depression

Gender imbalances → is this genetic, environmental, or both? → are more women than men reporting depression because more women seek treatment or because depression manifests in men more as substance abuse? → or is it a genetic risk (women do inherit it at a higher rate) → is it because women live with more poverty or more relationship violence? → men may be really lonely because women tend to have more supportive relationships but may be less likely to seek help Social support → lacking this puts you at a higher risk of depression → friends support you logistically and emotionally, they make you feel less alone → humans are very social animals → loneliness is about feeling your relationships are lacking or disconnected (not about number of relationships) → some people need a lot of social support and some need less Marital satisfaction→ particularly in men → marital satisfaction is a higher protector against depression for men than it is for women (may be because men get more social support from their marriage while women tend to have more supportive friendships in addition to their marriage, stereotype is that women want to get married more but men tend to be worse off after divorce and tend to get remarried more, this data shows men may feel they need marriages more) Societal stressors → any societal stressors can increase depression → economic difficulties → substance abuse → natural disasters → pandemic! (stressors across entire societies that can affect many different people that may not be normally affected)

bulimia nervosa general information

Hallmark is eating a larger amount of food (typically junk food) than most people would eat under similar circumstances (actual caloric intake of binges varies) Eating must be experienced as out of control Individual must attempt to compensate for binge eating and potential weight gain almost always by purgining techniques → include self induced vomiting immediately after eating and using laxatives and diuretics Some exercise excessively (but this is more characteristic of anorexia) Some fast for long periods between binging There are purging subtypes and nonpurging subtypes (exercising and fasting) → non purging type turned out to be rare so not in DSM 5 (only 6-8%) → little difference between the two subtypes Vomiting reduces about 50% of calories just consumed and less it if is delayed at all Laxatives and related procedures have little effect since they act so long after a binge Also tend to have an over concern with body shape and weight Chronic bulimia with purging can cause salivary gland enlargement (makes face look chubby), erosion of the dental enamel on the inner surface of the front teeth, tearing of the esophagus, upset of the chemical balance of bodily fluids including sodium and potassium (electrolyte imbalance) → electrolyte imbalance can cause cardiac arrhythmia, seizures, and renal failure which can all be fatal → young women with bulimia also tend to develop more body fat → can also have intestinal issues from laxative abuse (like severe constipation or permanent colon damage) → can also get calluses on fingers and backs of hands from sticking fingers down their throat Bulimia is comorbid with anxiety and mood disorders → 80% get anxiety disorders at some point → but patients with anxiety disorders don't have elevated rates of eating disorders → 50-70% of bulimic patients will meet mood disorder criteria at some point Depression and anxiety tend to follow bulimia Substance abuse also accompanies bulimia → 35% of people with bulimia had substance abuse issues when interviewed Shared risk factors of novelty seeking and emotional instability account for comorbidity between bulimia anxiety and substance use disorder (these factors differ between males and females though) Bulimia seems most strongly related to anxiety Most people with bulimia are within 10% of their normal weight

depersonalization-derealization disorder more info

Have symptoms of depersonalization and derealization (normal when under severe stress, having a panic attack, or not getting enough sleep → considered a disorder when it happens on its own enough

things that predict suicide

Hopelessness strongly predicts suicide whether the person has depression or not Think that a perception of oneself as a burden on others and a diminished sense of belonging are powerful predictors of hopelessness and thus suicide too Alcohol use and abuse is associated with 25-50% of suicides → particularly amongst college students → one third of adolescents that commit suicide were intoxicated when they died A combo of substance abuse and mood disorders in adults or mood and conduct disorders in kids predict suicides better than any one disorder alone Depression combined with impulse control issues and anxiety/agitation predicts suicide better than depression alone Substance abuse with risk taking behaviors is associated with teenage suicide Sensation seeking also predicts teenage suicidal behavior Past suicide attempts are a strong risk factor → 30 times more likely to actually kill yourself later People with borderline personality disorder are known for making manipulative and impulsive suicidal gestures without wanting to kill themselves but often do so on accident → combining this with depression is especially bad Most important risk factor for suicide is a severe stressful event experienced as shameful or humiliating like a failure in school or work, an unexpected arrest, or rejection by a loved one→ physical and sexual abuse are also big ones → also natural disasters → given preexisting vulnerabilities like psych disorders, impulsiveness, and a lack of social support stressful events can push people over the edge

physical vs. psychological hunger

Hunger is contextual → what you want to eat depends on the meal and the time of day and context of what you're doing Americans tend to lean sweet for breakfast but in other culture seafood is common for breakfast Can't totally separate out hunger in physical vs. psychological ways (hunger is often shaped by both) → if you can convince someone that they've already eaten it can make them physically feel less hungry → can lose our appetite when we are upset or emotional (psychological override of hunger cues) The more that we trust our bodies and allow the physical cues to win out over time the "healthier" we tend to eat → these people listen more to their physical cues but if they do eat more or less due to emotions then their bodies normally make up for it People like to say emotional eating is so bad but this isn't always bad as long as you normally listen to your bodies physical cues Sometimes people like to eat certain things because they remind them of happy things → so this isn't inherently bad What can be bad is when we only eat based on emotional cues In eating disorders people stop listening to their physical cues and only eat for emotional reasons → they get used to ignoring their physical cues and associate hunger with being thin and healthy → in bulimia people may not pay attention to the fullness/satiation cues during binges because they're eating due to emotions Hunger and satiation cues like lecithin and ghrelin can be affected by distortions in our genetics → epigenetics changes in past generations of ancestors can change how our bodies react to these cues and produce these cues → why everyone has a different set point → if ancestors experienced a famine they may have a lower set point in their future offspring Each of our bodies set a baseline for hunger based on trying to maintain homeostasis Psychological things can manifest physically in making us eat more or less

manic episodes DSM criteria

Hyperactivity (physically and mentally) Grandiose plans (excited to try to do things they wouldn't normally try to do) Rapid speech Flight of ideas Impulsivity (make decisions that aren't the most functional and healthy, not thinking things through, just acting, doing things you wouldn't normally do, may make decisions you regret later) Irritability (can especially occur near the end as you come down from some of the euphoria and positivity, still agitated physically but more tired mentally, might get into flights and have lots of rage, may commit crimes) Could look sort of psychotic with some delusions Can be diagnosed if it lasts a week or longer (or doesn't even need to be a week long if you have to be hospitalized due to it, could be a danger to yourself or others) Mania can come on very strong so even 2 days of it can be a huge deal for someone (but it cannot be feeling keyed up for just a few hours at a time) → doesn't have to last very long at all compared to other disorders (because it can be so disruptive in such a short time) Typically episodes don't last as long as depressive episodes can (normally not months at a time) because the human body can't really sustain the mania and speed of things for too long → also why many people crash afterwards into depression

biological causes of eating disorders

Hypothalamus and NE, dopamine, and serotonin acting on it could be malfunctioning in eating disorders → low serotonin levels of the system are implicated → associated with impulsivity and binge eating Ovarian hormones have be implicated in impulsive eating Binge and emotional eating peak in the postovulatory phase of the menstrual cycle of women Puberty hormones could make eating disorders more likely too Unsure if biological differences are the cause of eating disorders or if they occur after getting the disorder and help to maintain it

family risks of suicide

If a family member committed suicide there is an increased risk that someon else in the family will too ⇒ offspring of family members that tried suicide had 6 times the risk of suicide attempts compared to people without parents that tried suicide → if a sibling also tried suicide the risk increased more→ could be a biological component of a mood disorder and aggressive or impulsive traits (shown with adoption studies that suicide risk could be genetic, but unsure if its same genes as depression or a different one)

psychosocial treatment of schizophrenia

Illness management and recovery Engages patient as an active participant in therapy Continuous goal setting and tracking (to help you keep symptoms under control) Modules include: social skills training, stress management, substance use issues addressed

obesity general info

In 2000 the number of humans considered overweight surpassed the number of those who were underweight There is a direct relationship between obesity and dying prematurely Recent research suggests that the distribution of fat tissue could be more important than BMI when predicting health outcomes Some public education campaigns could be helping rates to drop off in children The stigma of obesity has a major impact on quality of life → prejudice and discrimination can be associated with increased mortality risk → obesity can be made worse as a result of depression and binge eating as a result of teasing Rates of obesity are increasing in developing countries Obesity is the main driver of type 2 diabetes which is reaching pandemic status Rates of obesity among black and hispanic americans are higher than caucasians for adults and adolescents

DID prevalence, sex ratio, age of onset, course, comorbidity, and misdiagnoses

In DID the ratio of females to males is 9:1 but this data is based on case studies rather than surveys; Onset is almost always in childhood often as young as 4 years old → normally about 7 years after the appearance of symptoms the disorder is identified; Disorder tends to last a lifetime in absence of treatment Frequency of switching may decrease with age; Different personalities may emerge in response to new life situations; Prevalence rates thought to be between 3-6% in North America (but done on inpatients); Prevalence rate in a year in the general population was found to be 1.5% DID patients often have other disorders like anxiety, substance abuse, depression, and personality disorders; Seven additional diagnoses are given to these patients on average; Tend to have severe comorbid personality disorders like borderline features; Some people thinking that DID's symptoms are better accounted for by borderline personality disorder; Because people with DID often get auditory hallucinations it can be misdiagnosed as a psychotic disorder DID has been found in 21 other countries → in some countries it is considered possession

dissociation

In a moment when someone is detached from a current awareness of what is happening → people do this in a mild way all the time → zoning out while driving, while reading, or while in class Daydreaming and zoning out are technically forms of dissociation Dissociation becomes an issue when it occurs so much or so frequently that it impairs your ability to function

poverty and obesity

In some places poverty and obesity can go hand and hand due to food deserts (can't get healthy food) and not having enough time to cook (because have to work long hours)

inpatient treatment and treatment following for anorexia

Inpatient treatment is recommended for anorexia if body weight has been lost rapidly or the individual continues to refuse food → starvation can induce loss of gray matter and hormonal dysregulation in the brain which are reversible changes once you gain weight again → knowing that they can't leave until they gain weight motivates people in inpatient programs to gain it quickly → focus of treatment after this is on anxiety over becoming obese and losing control of eating and their emphasis on thinness as a determinant of self-worth, happiness, and success (this treatment is similar to bulimia) → must treat them to have better emotional regulation in order for them to stay better → also should include the family in these goals (eliminate negative talk about weight in the family and attitudes about body shape and image should be discussed with the family) → family based therapy for anorexia could make the outcomes for anorexic patients more promising and similar to those of bulimic patients

causes of insomnia

Insomnia occurs with medical and psych disorders including pain and physical discomfort, physical inactivity during the day and respiratory problems Some people that cannot fall asleep may have a delayed temperature rhythm → their body temperature doesn't drop and they don't become drowsy until later at night → higher body temperature and less fluctuation may contribute to lack of sleep People may have a hard time sleeping due to changes in the environment and due to drug use Other disorders like sleep apnea or periodic limb movement disorder can interrupt sleep and seem similar to insomnia Our thoughts alone could disrupt our sleep→ learned anxiety and frustration with sleeping can make insomnia worse→ sleep can also be affected by cultural norms Both biological and psychological factors can be present in some sleep disorders → these can interact reciprocally to produce and maintain sleep issues Biological factors can be being a lighter sleeper, having a family history of sleeping issues, etc. → these are predisposing conditions → can combine with other factors to produce issues Sleep stress → number of events can negatively affect sleep, can include poor bedtime habits can interfere with falling asleep → interact switch biological predisposing conditions Rebound insomnia → in which sleep problems reappear sometimes worse after withdrawing medication Naps that alleviate fatigue during the day can disrupt sleep that night → anxiety can also extend the problem → lying in bed worrying interferes with sleep Kids that receive positive attention after waking up in the night will have this behavior reinforced

hypersomnolence disorders

Involves sleeping too much Some people that sleep all night fall asleep several times the next day Hypersomnolence includes excessive sleepiness and the subjective impression of this problem (must rule out insomnia and sleep apnea) Some genetic influences may be involved → also may be because of previous exposure to a viral infection like mono, hepatitis, and viral pneumonia

dissociative fugue subtype

Involves travel → the person went somewhere → typically end up somewhere and don't know how they got there (people do try to fake this but it is real too) People in a dissociative state actually travel and don't remember doing so

what depression feels like

Isolation (when you're depressed you stop keeping up with your friendships and they can drift away, or you just feel disconnected from everyone), numbness, sorrow, no drive to do anything, can't enjoy anything, apathy (don't care about anything), general moodiness, hopelessness, nothing to look forward to, loss of interest, difficulty figuring out why you feel a certain way, feeling empty, despair, lack of self-worth, etc.

what should clinicians do

It is more important for clinicians to check for secret suicidal ideation than to do nothing because the risk of inspiring suicidal thoughts is small to nonexistent and the risk of leaving them undiscovered is enormous → however sometimes suicidal thoughts are implicit or outside of awareness → so now there are implicit tests → people that demonstrate an implicit relationship between death/suicide and self were 6 times more likely to try it, Mental health professionals also check for recent humiliations and determine whether any of the factors are present that might indicate a high probability of suicide → should determine if they have a plan or not and if the plan has a specific time, place, and method → this is high risk → if plan includes giving away possession and final acts then risk is higher → generally the more lethal and violent the method the greater risk it will be used → is the person aware of the risks if it doesn't work? Did they try to keep it secret? → if so then the risk is extreme → must assess for desire to commit suicide, suicidal capability, suicidal intent and if all three are present immediate action is needed, If a risk is present some clinicians try to get person to sign a no suicide contract → promise not to do anything connected to suicide without contacting the mental health professional first → if person refuses the contract and the risk is high then immediate hospitalization is indicated even if its against their will → then they need treatment

bipolar disorders

Key identifying features is the tendency of manic episodes to alternate with major depressive episodes in an unending roller coaster rise from the peaks of elation to the depths of despair A manic episode may occur only once or repeatedly Bipolar II disorder → major depressive episodes alternate with hypomanic episodes rather than full manic episodes (up during hypomanic episodes but can function well) Bipolar I disorder → same but individual experiences a full manic episode Must be two months of another mood in between one episode and the next for them to be distinct During manic episodes patients often deny they have a problem → so wrapped up in enthusiasm and expansiveness that their behavior seems reasonable to them → may feel so good that they stop taking their medication while in depressive states in an effort to bring on a manic one

comorbidity with mood disorders

Later onset depression is associated with marked sleep difficulties, illness anxiety disorder, and agitation → can be hard to diagnose depression in elderly because having an illness may cause it Anxiety disorders accompany depression in one third to half of elderly patients (particularly GAD and panic disorder) → typically makes patient more depressed → clinicians must identify presence of severity of anxiety with depression, important for treatment One third of elderly with depression also have alcohol abuse Entering menopause can increase depression rates among women (could be hormonal or due to physical symptoms or other life events) Depression can contribute to physical disease and death in the elderly → being depressed doubles the risk of death in elderly patients that have had a heart attack or stroke → as people become frailer and more alone the psych result is depression which increases the chance that we become even frailer and more alone Death of a spouse, caregiving burden for an ill spouse, and loss of independence due to illness are strong risk factors for depression in elderly → suicide rates higher in elderly Optimism prevents depression after medical illnesses and promotes longevity Sex ratio for depression is balanced in the elderly

bipolar disorder treatments

Lithium and other mood stabilizers are used → lithium tends to be the gold standard for bipolar disorder → can raise people out of depression and stabilize a manic episode Medication (usually Lithium) is still first line of defense Psychotherapy helpful in managing the problems (interpersonal, occupation) that accompany bipolar disorder Family therapy can help

drug treatments for bipolar disorder

Lithium carbonate → antidepressant salt found in natural environment → in our drinking water in small amounts → side effects are more serious than for other antidepressants → dosage must be carefully regulated to prevent toxicity and lowered thyroid functioning (could make depression more intense) → can also cause weight gain → however it can often prevent and treat manic episodes → called a mood-stabilizing drug (other antidepressants can induce manic episodes Other treatments for acute bipolar depression include antidepressants, anticonvulsants and antipsychotics 50% of bipolar patients respond well to lithium initially → 50% reduction in symptoms → has inadequate therapeutic benefit → other drugs have antimanic properties like anticonvulsants and calcium channel blockers Calcium blockers have recently overtaken lithium has most popular mood stabilizers for bipolar disorder → equally effective for rapid cycling symptoms Other drugs are less effective than lithium at preventing suicide → this keeps lithium the preferred drug for bipolar disorder → other mood stabilizers may be combined with low doess of lithium (can add SSRIs to lithium) However when patients responds to lithium about 70% relapse even if they keep taking it → lithium is still recommended to prevent relapse People often stop taking lithium because they like the feeling of their euphoric high → this causes an even greater risk of relapse → psych treatments are used to increase compliance

psychological components of eating disorders

Low sense of personal control and self-confidence Perfectionistic attitudes Distorted body image Preoccupation with food Mood intolerance → this shows up in a lot of different disorders (also called distress intolerance) → have difficulty sitting with uncomfortable feelings (cannot deal with sadness, shame, anger, etc.) → this makes them more likely to engage in behaviors that try to mask those emotions → some people may have eating disorder behaviors after a trauma or stressor → or someone with bulimia may binge more when they are upset and people anorexia may restrict more when upset

prevalence and prognosis of bulimia

Majority are female (about 90% or more) Some binge eating symptoms are relatively common in men (even if they don't have the full disorder) → prevalence in men could be increasing (about 0.8% of people with bulimia are men and about 2.9% of people with BED are men) 6-7% of college women suffer from bulimia at some point Onset typically in adolescence Tends to be chronic if left untreated (some people can grow out of it but it tends to flare back up without a solid treatment)

prevalence and prognosis of anorexia

Majority are female and white Majority are from middle to upper-middle class families Usually develops around early adolescence More chronic and resistant to treatment than bulimia (people with bulimia don't like binging and purging so they want help but people with anorexia just want to keep losing weight Lifetime prevalence is about 1% Cross cultural factors → may develop in non-western women after moving to Western countries (thus cultural factors matter) → the more women identify with white culture in the US the more likely they can be to develop anorexia (due to the body types and ideals of more western cultures) → cultures in which body ideals are curvier, rounder, or thicker tend to have lower rates of anorexia In places where people are starving there doesn't tend to be anorexia because it is not ideal to be thin → it is ideal to be healthy and not starving

unconscious mental processes

Malingerers and people with factitious disorders will go over board to appear that they have an ailment while someone with conversion therapy will not appear as if they have the ailment (can pass a sight test even if they cannot "see") but still report having it (they are not pretending they simply don't know they are healthy)

depression across cultures

Many people in other cultures describe depression as somatic symptoms → tiredness and mental or physical slowing or retardation are common → some cultures have own idioms for depression (heartbroken in Native American tribes, Australia aboriginal men think depression is weakness or injury of spirit) Harder to compare subjective feelings in depression across cultures → this is influenced by cultural view of individual and role the individual plays in society → people in more collectivist societies describe depression as the group losing meaning Conditions and culture could greatly affect the prevalence of mood disorders Terrible social and economic conditions on reservations could cause the high rates of depression in Native Americans

Dissociative Identity disorder

May adopt as many as 100 new identities all simultaneously coexisting, although the average number is closer to 15; Sometimes the identities are complete, each with its own behavior, tone of voice, and physical gestures; Many times only a few characteristics are distinct because the identities are only partially independent so there are not multiple complete personalities (why the name was changed from multiple personality disorder; Alters is the shorthand for separate identities or personalities Sometimes the alters know about each other and sometimes they don't; Can lose memory while the other personalities take over; Defining characteristics is that the identity is fragmented and dissociated; The person that becomes the patient and asks for treatment is the "host" identity normally → usually attempt to hold various fragments of identity together but end up being overwhelmed → first personality to seek treatment is not normally the original personality of the person; Many patients have one impulsive alter who handles sexuality and generates income sometimes by acting as a prostitute In some cases all alters abstain from sex; Cross-gendered alters can occur Transition from one personality to another is called a switch → can be instantaneous → physical changes like posture, facial expressions, patterns of face wrinkling, and even physical disabilities may occur (one may be left handed while other is right handed

therapy for bipolar disorder

Medication is thought to be necessary for treating bipolar disorder but many clinicians also emphasize the need for psych interventions to manage interpersonal and practical issues → must also use therapy to increase compliance with drug treatment One therapy regulates circadian rhythms by helping patients regulate their eating and sleep cycles and other daily schedules as well as cope more effectively with stress in life and particularly interpersonal issues → called interpersonal and social rhythm therapy (IPSRT) → these patients go longer without a new manic or depressive episode compared with patients undergoing standard, intensive clinical management (also helps teens) Family tension is associated with relapse in bipolar disorder → thus treatments directed at helping families understand symptoms and develop new coping skills and communication styles do change communication styles and prevent relapse → go longer without relapsing and have a lower chance of relapsing when receive this therapy → shown to work well for prevention strategies for teens with early bipolar symptoms

dissociative amnesia more info

Memory problems without any organic reason for it Can be issues learning new info or remembering past things Trauma or stressor can make a person block out a memory

medical treatments of sleep wake disorders

Most common treatments for insomnia are medical Can be prescribed benzodiazepine or related medications → can be short-acting (cause only brief drowsiness, typically preferred) or long acting (sometimes don't stop working by morning and people report more daytime sleepiness) When short acting drugs cause negative effects like daytime anxiety long acting medications are preferred New medications that act on melatonin are being produced Benzodiazepines can cause excessive sleepiness and people can became dependent on them → also these meds shouldn't be used for longer than 4 weeks (long use can cause dependence and rebound insomnia)--> could also increase likelihood of sleepwalking issues → thus meds shouldn't be used for long term chronic issues To help with hypersomnolence or narcolepsy doctors prescribe a stimulant → cataplexy can be treated with antidepressant meds because they suppress REM sleep For breathing related issues you may need to lose weight or use a CPAP which improves breathing (provides slightly pressurized air during sleep to help them breath more normally throughout the night) → severe issues may require surgery to remove blockages in airways → to deal with CPAP issues you may need to treat claustrophobia, educate the patient and partner, or do motivational interviewing → use of a didgeridoo can reduce daytime sleepiness For circadian rhythm disorders a phase delays treatment can be easier than phase advances → scheduling shifts in a clockwise direction can help → can also use bright light to trick the brain into readjusting the biological clock (phototherapy)

sleep-wake disorders general info

Most people don't get enough sleep and 28% of people in the US report feeling excessively sleepy during the day → even minor sleep deprivation over 24 hours impeded our ability to think clearly→ if you can never sleep well your relationships suffer, it is difficult to do work, and your efficacy and productivity at work is diminished → also affects you physically (can get sick easier because immune system is reduced) Some sleep disorders are physiologically based and others have psych components Sleep issues can cause issues in everyday life or they may be due to a psychological disorder Connections between people with borderline personality disorder and genes associated with circadian rhythms Thought that anxiety and sleep are related because the same circuit in the limbic system is involved in anxiety and REM sleep → insufficient sleep can stimulate overeating and REM sleep seems related to depression Sleep abnormalities are preceding signs of serious depression CBT can improve depression symptoms and normalize sleep patterns Sleep deprivation can have temporary antidepressant effects but could bring on a depressed mood in people not already depressed

grief

Most people that experience grief progress from acute grief (experienced for around 6 months) to integrated grief in which the finality of death and its consequences are acknowledged and the individual adjusts to the loss → typically recurs at significant anniversaries → when grief lasts beyond a normal time, clinicians become concerned → after 6 months to a year the chance of recovering from severe grief without treatment is considerably reduced → for about 7% of people grief can become a disorder → in this stage suicidal thoughts increase, person focuses on joining the loved one, ability to imagine the future is impaired, cannot regulate emotions (become rigid and inflexible) → psychological and social factors related to mood disorders and a past of depressive episodes can predict the development of complicated grief → in kids and young adults the sudden loss of a parent makes them very vulnerable to severe depression beyond the normal time for grieving, need treatment → strong yearning in complicated grief is linked to dopamine system (while this system is reduced in major depressive disorder) → more active in areas of the brain associated with close relationships and grief → persistent complex bereavement disorder is a diagnosis under the section requiring further study → can treat by helping the person re experience the trauma under close supervision, encouraged to talk about loved one, death, and meaning of the loss until they can come to terms with it, incorporate positive emotions associated with memories of relationship into negative emotions

DID

NOT schizophrenia (people use schizophrenic as an adjective to describe things that change a lot but that's not at all what schizophrenia is) → not a lot of overlap between DID and schizophrenia Used to be called multiple personality disorder but called dissociative identity disorder now because we now longer consider it completely separate personalities → rather it is a splintering of one identity in a person into different parts DID is very frequently used in pop culture Etiology → severe childhood trauma → "scab metaphor" → a child subjected to child abuse over a long period of time starts to convince themself in the moment that you are some place else and someone else → child almost trains themself to dissociate in order to escape the abuse and their reality → child starts to build a world where you can be several different people → becomes a coping mechanism that you use a lot → can escalate to the point where as an adult you have several different alters that you still become → instead of always living with an open wound you scab it up, harden it up, and escape somewhere else altogether → creating alters is a way to try to heal and survive Average number of alters is about a dozen The idea is that DID could be an extreme version of PTSD → maybe one day DID will become a subtype of PTSD People really do show physiological changes between their alters → pupil changes, differences on life detector tests, changes in HR and BP → this suggests that people really do feel they are fundamentally different people when they move in between alters when this becomes severe enough Some people do try to fake it and it may be overdiagnosed but there is compelling physiological evidence that some people really do become someone else in their mind → thus it is a real disorder We understand dissociation enough that we know this realistically could happen The host alter is normally the person that goes and seeks treatment but it doesn't have to be the original identity of the person → host alter can be aware of different personalities Some alters may be more aware of the other identities and may have memories from them, while other alters may be completely unaware of each other and their memories Treatment focuses on treating the trauma and consolidating the alters → trauma causes the existence of the alters so treating the trauma can decrease the need for the alters → the goal is for the alters not to be needed anymore and for them to be integrated into one whole personality Alters often have different traits that when combined can make a more homogenous personality → one alter is for when they're sad, one for when they're angry, one to protect them, one for when they're happy etc. Patients could pick up on characteristics of someone they know and combine them into the traits of an alter → however the person doesn't actually become someone else (if they think this is happening it could be a more psychotic disorder) Could be possible that trauma in adulthood can cause this → less common because their original identity is already set in stone when the trauma occurs

neurobiological influences on mood disorders

Neurotransmitter systems → serotonin and its relation to other neurotransmitters → serotonin regulated NE and dopamine Mood disorders are related to low levels of serotonin (low serotonin seems to pre-date depression, acts as a risk factor) Permissive hypothesis: low serotonin "permits" other neurotransmitters to vary more widely, increasing vulnerability to depression (combined influence of multiple neurotransmitters) The endocrine system → elevated cortisol → stress hormones decrease neurogenesis in the hippocampus (less able to make new neurons) → hippocampus becomes less able to turn off stress response (normally regulates it) Sleep disturbance → hallmark of most mood disorders → depressed patients have more intense REM sleep and go into it more quickly → sleep deprivation may temporarily improve depressive symptoms in bipolar patients (big difference between unipolar and bipolar depression, but this could kick a bipolar patient into a manic episode too, so often isn't recommended for just anyone to try) → teenagers often have disrupted sleep due to smartphones and blue light and this makes them more vulnerable to depression (so sleep issues can cause depression and depression can cause sleep issues)

normal eating

Normal eating is trusting your body → listening to your hunger cues and your being full cues → being flexible with how you're allowed to eat depending on what happens in your day → eating until you are satisfied → moderate restraint but not too restrictive → giving yourself permission to eat because you're happy, sad, bored, or because it feels good → trusting your body to make up for mistakes in eating → doesn't take up too much of your time and attention → normal eating varies in response to emotions, schedule, hunger, and proximity to food "Normal" healthful eating → healthy relationships with food → are the answer for both eating disorders and obesity → should exercise to feel strong, powerful, and good about yourself (not just to lose weight)

False Memory syndrome

Not a DSM disorder Considered a cognitive error Memories can be planted Source-monitoring error → when you remember info you normally also think about where that information came from, this error is when we get a piece of information right but mis-remember the source → this is how you can be convinced that something happened to you just because enough people asked you about it (because you create the idea of it enough times in your mind and might remember the idea of it later on as what you think is a real memory) → this is very common when you misremember where you know someone from In order to make a DID diagnosis you have to be careful of this because it is possible that therapists could plant traumatic memories in a patient that they believe has DID When we remember something we remember of construction of the events → the more times we remember something the more altered it becomes each time because of our remembering a memory Another example of source-monitoring error is when you dream a conversation with a friend and then think that the conversation actually happened in real life When dealing with memories of abuse or trauma clinicians have to be careful not to plant false memories (law enforcement could do this too when they ask about something enough times on accident)

orthorexia

Not a DSM disorder Someone who is so rigid with healthy eating that is becomes an obsession (can look a little like OCD) → overly rigid fixation on health food or a specific diet that intrudes on or impairs your everyday life Could be that they don't want to go out to eat with others anymore because they can't eat what others eat → maybe it gets in the way of work → maybe it causes them to alienate others There isn't any binging or purging and these people may be normal weight and eating well but they lack the flexibility of normal eating Feeling like you have to eat "clean" or follow a diet all the time

hypomania

On its own this is not a disorder, but it can be a building block for a disorder Low-level mania that does not cause marked impairment in functioning Elevated, semi-manic state that could last indefinitely If combined with depression it is considered a disorder These tend to be people that we actually want to be around because they're energized, up for anything, and fun → we tend to admire them → they have plans and move fast through life If mania causes a disruption in functioning or a substantial impairment then it is not hypomania

serotonin

One study found that lowering tryptophan with dietary changes can lower serotonin → caused depressive symptoms in only those with cognitive vulnerabilities

binge-eating disorder more info

Out of control binges, but without compensatory behavior About half of the patients seeking bariatric surgery suffer from BED Tend to be older than those with other eating disorders Emotional differences from people who are obese without BED → also are more likely to suffer from mood disorders, low self-esteem, etc. → the mechanism of the out of control binge has to do more with emotion and feeling like you can't regulate your emotions properly These people may first discover their disorder when they go to a doctor for their weight

family influences on eating disorders

Parents with distorted perception of food and eating may restrict children's intake too (put toddlers on unnecessary diets) Families of individuals with anorexia are often high achieving, concerned with external appearances, and overly motivated to maintain harmony → leads to poor communication and denial of problems (less likely to get help) We pick up so many cues about eating and food and body image from our families for years that can affect us → how our parents relate to food and eating affect us and how they talk about our bodies affect us Family influences could be different for everyone Families of people with bulimia often have more outward conflict and emotional turmoil (but could have aspects of both typical anorexia families and typical bulimia families) Disordered eating also strains family relationships → causes parental guilt and frustration → parents may try to force their kids to eat because they want control but then the child may be less likely to eat

cognitive aspects of depression

People become anxious and depressed when they decide that they have no control over the stress in their lives → learned helplessness theory of depression→ anxiety is produced first and depression may follow marked by hopelessness about coping with difficult life events → person attribute negative events to personal feelings (internal), this remains for a long time after (stable), and these attributions extend across many situations (global) → negative events early in life may lead to negative attributional styles, making kids more vulnerable to future depressive episodes when stressful events occur → negative cognitive styles precede and are a risk factor for depression Thus in someone with a genetic predisposition a stressful life event activates a psych sense that life events are uncontrollable and this negative attributional style leads to depression or anxiety The unique feature about depression is the learned hopelessness which doesn't happen with anxiety Depression could also result from a tendency to interpret everyday events in a negative way → arbitrary inference and overgeneralization are two cognitive errors of this kind → arbitrary inference is when someone emphasizes the negative rather than the positives of a situation → overgeneralization is when you assume something bad will happen because of one small bad event → Beck believed that depressed people think this way all the time about themselves, their immediate world, and their future → this is the depressive cognitive triad → thought that after negative events these people may develop a deep seated negative schema (enduring negative cognitive belief system about some aspect of life), self-blame schema is when you feel responsible for all bad things, negative evaluation schema is when you think you can never do anything right) → thought this happened automatically and the person may be unaware of them → people prone to depression recall negative events more when they are depressed → thus thinking of depressed individuals is consistently more negative than that of non depressed people → recognizing cognitive errors and schemas allows us to correct them and alleviate depression→ beck became father of cognitive therapy People with bipolar disorder exhibit negative cognitive styles but their cognitive styles are characterized by ambitious striving for goals, perfectionism, and self-criticism in addition Some people with depression may have a negative outlook and others may explain things negatively (can be hopeless or have dysfunctional attributes or both) Evidence suggests that depression is always associated with pessimistic explanatory style and negative cognitions → could have cognitive vulnerabilities that predispose people to view events negatively → negative cognitions indicate a vulnerability to later depression Kids with depressed mothers showed more negative cognitive styles when under minor stress compared to kids without depressed moms Also cognitive vulnerability to depression can be contagious→ people that live with people vulnerable to depression develop similar cognitive styles and are also vulnerable to depression

dissociative amnesia

People that cannot remember anything, including who they are, that suffer from generalized amnesia → can be lifelong or for a particular period in the past; Localized or selective amnesia is a failure to recall specific events, usually traumatic, that occur during a specific period; Dissociative amnesia is common during war; Sometimes patients can have amnesia for just the emotions associated with an event; In most cases the forgetting is selective for traumatic events or memories rather than generalized; Subtype dissociative fugue occurs when memory loss revolves around a specific incident which is an unexpected trip or trips → individuals just take off and later find themselves in a new place, unable to remember why or how they got there→ usually they leave behind an intolerable situation → sometimes they assume a new identity or become confused about their identity; Dissociative amnesia rarely appears before adolescence and usually occurs in adulthood; Rare for it to appear for the first time when person is over 50; But once they appear it may continue into old age; Prevalence estimated are between 1.8-7.3% → most prevalent dissociative disorder; Fugue states usually end abruptly and the person goes home and remembers what happened;

DID controversy

People with DID tend to be suggestible so it is possible that alters are formed when a therapist asks leading questions during psychotherapy or while the person is in a hypnotic state; Can try to tell if someone is faking DID by doing personality tests (each personality should score differently) and investigating the history of other personalities experienced by friends and family; Memory assessments done on people with DID focusing on implicit memory show no different to average people Patients with DID report that they have no memory between alters but studies have shown that things can be remembered across alters; If the possibility of identity fragments and early trauma are reinforced by a therapist this could cause someone to develop alters; Only about ⅓ of psychiatrists thought DID should be included in the DSM Some tests have found that people with DID are not consciously and voluntarily simulating these personalities; Another study found that alters in DID patients tend to have 4.5 times the average number of changes in optical functioning in their alter identities than control patients who simulated alter personalities → optical differences like visual acuity, manifest refraction, and eye muscle balance would be difficult to fake Also found that a DID patient had different physiological responses to emotionally laden words; Can use fMRI to witness changes in brain function when a patient switches between alters → changes in hippocampal and medial temporal activity after the switch; Other studies have shown that alters have unique psychophysiological profiles; Malingerers tend to be eager to demonstrate their symptoms and do so fluidly while real patients are more likely to try to hide symptoms

anorexia nervosa general information

People with anorexia are so successful at losing weight that they put their lives in danger Have a morbid fear of gaining weight and losing control over eating People with anorexia are proud of their diets and extraordinary control while people with bulimia are ashamed of their eating issues and lack of control Many countries have instituted bans on models with a BMI of less than 18 Less common than bulimia but many people with bulimia have a history of anorexia Must have an intense fear of obesity and relentlessly pursue thinness Commonly begins in adolescence who are overweight or who perceive themselves to be → then they start to diet and it escalates into an obsessive preoccupation with being thin Punishing amounts of exercise are common Weight lost through severe caloric restriction or by combining caloric restriction and purging Two subtypes: restricting type individuals diet to limit calorie intake; eating-purging type rely on purging to lose weight Binge-eating-purging anorexics binge on smaller amounts of food and purge more consistently and sometimes do so everytime they eat About half the people with anorexia binge and purge Subtyping may not predict the future course but instead reflect a certain phase or stage of anorexia (subtyping refers only to the past 3 months for this reason) People with anorexia are never satisfied with their weight loss → staying the same weight or gaining weight causes intense panic, anxiety and depression → only continued weight loss is satisfactory BMI tends to average close to 15.8 by the time they seek treatment There is a marked disturbance in body image (tend to see themselves differently from how other people see them) People with anorexia become good at saying what people expect to hear about being underweight and needing to gain a few pounds but they don't believe it Usually don't seek treatment on their own → usually need pressure from family Some people with anorexia show increased interest in cooking or food as a demonstration of absolute control over their eating → some hoard food in their rooms to look at Medical consequences are cessation of menstruation (occurs in bulimia too), dry skin, brittle hair or nails, sensitivity to or intolerance of cold temperatures, downy hair on limbs and cheeks (lanugo), cardiovascular issues, low BP, low HR, electrolyte imbalance and resulting cardiac and kidney issues too if purging involved Anxiety and mood disorders are often comorbid → 71% get depression at some point in life → OCD seems to co occur with anorexia a lot → substance abuse is common (when combined with anorexia it is a strong predictor of mortality and suicide)

prodromal stage

Period of time before what is considered the psychotic break Doesn't meet criteria yet but have some symptoms of schizophrenia See this in retrospect Not everyone goes through this course

dysthymia

Persistent Depressive Disorder) → chronic mild depression that lasts 2 years or longer → these people tend to hover around mild depression (or halfway down to full depression on the mood vs. time graph) → has to be that you don't really feel okay during a period of 2 years or longer → can even go on for a lifetime (mild depression could be that you only meet some of the criteria or that you meet all of the criteria in a milder way that doesn't cause impairment in daily life)

positive symptoms of schizophrenia

Positive symptoms (presence of something that shouldn't be there) → delusions and hallucinations → can include delusions of grandeur (believe you are of a higher status than you really are) or persecution (very common, paranoia without cause), Capgras (when people think loved ones have been replaced with a double), Cotard's (more somatic delusions, feeling like you are dead or have a bad injury, called "Walking Corpse Syndrome", can be diagnosed on its own) → hallucinations (auditory most common, but can be taste, smell, tactile, and visual) (have to be careful because brain injuries and illness can cause these things)

major depressive disorder

Presence of depression and absence of manic or hypomanic episodes before or during the disorder Two or more major depressive episodes occurred and were separated by at least 2 months during which individual was not depressed then it is recurrent (rare to have just one episode) In first year following an episode recurrence risk is 20%, rises to 40% in second year Unipolar depression is often a chronic condition that waxes and wanes over time but seldom disappears Median lifetime number of major depressive episodes is 4-7 Median duration of episodes is 4-5 months (this is shorter than the average length of the first episode)

bulimia

Presence of out of control and food binges (person subjectively felt out of control during it) → you feel like you cannot stop eating → should be a discrete period of time (2 hours or less, can't just be a day where you ate a little more than normal) → oftentimes they stop because you can't hide it anymore, you run out of food, or you feel extremely sick → don't quantify the amount or type of food → DSM says it is "an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances" The DSM says this has to happen on average once a week for at least 3 months to get the diagnosis Typically they feel ashamed and sick afterwards Also there must be compensatory behaviors → at least once a week on average for 3 months → can be fasting, purging, excessive exercise, laxatives, or diuretics → tend to follow the binges because they're trying to compensate for the binge (the stereotype of bulimia is that they must vomit but a lot of people with bulimia compensate in other ways and never purge) → can have a mix of these behaviors Fasting → your metabolism may hold onto the calories of the binge more because it knows you tend to fast afterwards so it doesn't even really end up helping them Purging → forcing yourself to vomit after binging, however by the time people vomit a lot of the calories of the binge were already absorbed so it's not very effective Excessive exercise → attempt to burn off all of the calories of the binge → cannot be that the person just enjoys exercising or has other reasons to exercise so much → it must be specifically because the person wants to make up for binging → this is typically very inflexible or even acts as a punishment Laxatives → can cause GI issues over time → people want to flush things out of their system but they don't really help Diuretics → also trying to get things out of their system but only really succeed in making you dehydrated

psychological treatments for sleep wake disorders

Psych treatments can include relaxation treatments to help people fall asleep, cognitive treatments to address anxiety, using the bedroom only for sleep, and internet based treatments Psych treatment of insomnia can be a package of different skills known as CBT for insomnia CBT may be better than drug interventions For kids treatment can include setting up bedtime routines like a bath and a story to help them fall asleep → graduated extinction of bad bedtime behavior can help Things that can prevent sleep issues are sleep hygiene changes in lifestyle → setting a regular bedtime, avoiding use of caffeine and nicotine, etc. Efforts to educate parents on how to handle children sleep difficulties can be very helpful because so many kids have sleep issues

psych treatment for eating disordes

Psych treatments target low self esteem and disordered family interaction and communication Short term cognitive behavioral treatments can be better for bulimia because they target problem eating behavior and associated attitudes about the overriding importance and significance of body weight and shape A variety of new procedures have been added to improve outcomes Treatment recently has become applicable to all eating disorders with some minor alterations → this is helpful because many people used to be diagnosed with a non specific eating disorder and they can now be treated the same way

risk factors for suicide

Psychological disorders (but only 15% of suicide vitcims were in treatment before commiting suicide) → depression, double depression, bipolar disorder, and other severe psychological disorders can really increase the risk → there is a big gap between people who need help and people who actually get help Suicide in the family → the closer the amily member and the more the suicide affected your life the greater the risk → can be genetic heritability of a disorder or the environmental affects of losing someone to suicide → could think differently about suicide (survivor's guilt, deserve to join them, think suicide was the right choice for their family member and could be for them too) Loss of a significant relationships → could be death, breakup, divorce, loss of a close friendship Firearms in the home Substance abuse → could put you in proximity to things that can kill you and may make you more impulsive → also goes with other disorders Stressful life event, especially humiliation → why we see suicide a lot with bullying or an embarrassing event Past suicidal behavior → once you've attempted it before it makes you more likely to try it again → the suicidal frame of mind may cause people to consider it more Abuse or neglect → very important with children and teens → also adults in abusive relationships Academic/disciplinary crises or loss of a job or being prosecuted for a crime → not being able to achieve a goal or being disappointed in yourself for doing something Concerns about sexuality (hopefully decreasing) Lack of achievement → can be someone that is high achieving and puts everything into their goals or someone that hasn't achieved very much

psychotherapy and drug treatments

Psychotherapy and drug treatments seem to have similar effectiveness immediately following treatment Severity of depression doesn't make CBT or drugs more or less effective but adding CBT to drugs or vice versa can improve outcomes for severe and non chronic depression IPT is thought to be the best first voice for pregnant women or women who are breastfeeding (CBT may work just as well, but these women shouldn't take drugs) IPT has also had success with administration to teens in schools by clinicians More patients with chronic depression respond to treatments that contain a drug and CBT → thus combined treatment could provide an advantage→ however since combining treatments can be so expensive some clinicians recommend using a sequential strategy Thought that drugs when they work do so more quickly but that psych treatments increase long range social functioning and protect against relapse or recurrence We still don't know if the differences in effectiveness between treatments are due to individual differences and still don't really have a way to test this One important question has to do with maintenance treatment to prevent relapse or recurrence over the long term Some studies found relapse is less common with CBT while others find CBT and drugs to equally prevent it Cognitive therapy done at any point is thought to have the same effect as continuing on meds General conclusions are that with more chronic or severe cases CBT is thought to prevent relapse more when all forms of treatment are stopped CBT is more effective at preventing depression than other forms of care

schizophreniform

Psychotic symptoms lasting between 1-6 months (if you meet 6 months you get schizophrenia diagnosis) Associated with relatively good functioning Most patient resume normal lives Could go on to have schizophrenia (this is normally what happens) Lifetime prevalence is only 0.2% because of this

biological components of eating disorders

Relatives are 4-5 times more likely than general population to develop eating disorders themselves (could be confounded by similar environments but there is still thought to be some biological component in addition to shared environments) Could inherit emotional instability or poor impulse control Could inherit hypothalamus features (plays a role in regulation of eating) Could low serotonin cause it or occur after it? Perfectionism and personality could contribute to anorexia → these personality factors could be inherited → being slightly obsessive may allow you to be more rigid in your eating Hormones may also influence eating behavior → maybe they're causing epigenetic changes that affect hunger cues or make you more emotionally unstable or feel like you're out of control Once you learn an eating disorder behavior you can become conditioned to it Some cases may have a higher genetic component than others (which is the case for most disorders)

environmental factors on schizophrenia

Research shows that early high does cannabis use can increase chances of developing schizophrenia with the CNR1 genotype Also people with schizophrenia are more likely to have a cannabis use disorder (don't understand link yet) Lots of stressors have been associated with schizophrenia → living in a large city, combat high numbers of various stressful events → retrospective nature of this research creates issues (asked about it after they already have schizophrenia) People with schizophrenia are more likely to show higher levels of stress Poverty, homelessness, early life adversity, growing up in a city, minority group position, and stress of being in a new country have all been shown to contribute to onset and development of schizophrenia → impacts of stressors may be most important during sensitive periods → stressors in early life may influence development of psychosis by increasing stressors later in life, making people more sensitive to later stressors or both Stress can also trigger people with schizophrenia to relapse Schizophenogenic mother → mother whose cold dominant and rejection nature was thought to cause schizophrenia in her children Double blind communication → used to portray a communication style that produced conflicting messages which in turn caused schizophrenia to develop (communication with parents) Recent research focuses more on how families contribute to relapse instead of onset → expressed emotion (EE) → study showed that some patients did better after treatment when not with their families as much → could be because they avoided high levels of criticism, hostility, and emotional overinvolvement by family members → ratings of high EE are good predictors of relapse for people with schizophrenia → high EE means the family views schizophrenia as controllable and hostility arises from this → cultural studies show different levels of EE across cultures and indicate that EE doesn't cause schizophrenia because schizophrenia rates are similar across cultures (also means cultures vary in how they express emotion) → also what is considered over-involvement in one culture may seem helpful in another

effects of social support on depression

Risk of depression for people living alone is much higher → thus social support can be very important (social support can prevent depression in every country) Social support can speed recovery from depressive episodes (doesn't have the same effect with manic episodes) Interpersonal psychotherapy is derived from need for social support

states of depression

Risk of developing major depression is low until early teens when it begins to rise in a steady (linear) fashion → symptoms are typically highest in young adults, decreased in middle adulthood and then increased again in older age Incidence of depression and suicice seem to be increasing Possibility of remission of a depressive episode within one year is close to 90% Sometimes episodes may not entirely clear up, leaving residual symptoms → when this happens once the chance of incomplete recovery occurring again is higher → treatment should be continued longer in this case Persistent depressive disorder can last 20-30 years or more but the median duration is 5 years in adults Patients with persistent depressive disorder with less severe symptoms are more likely to attempt suicide than nonpersistent groups Double depression starts off more severe, tends to recover from major depressive episode but then remains most severely depressed after 10 years Non-chronic major depressive group has the highest rates of recovery

seasonal affective disorder

SAD may be related to daily and seasonal changes in the production of melatonin → exposure to light suppresses melatonin production, thus it increases in the winter, increased melatonin production could trigger depression in vulnerable people, melatonin increase has been shown to occur in the winter only in people with SAD → or circadian rhythms which are delayed in winter could have a connection to mood → "phase shift hypothesis" → SAD is due to phase delayed circadian misalignment → there are more autonomous negative thoughts throughout the year and greater emotional reactivity to light (low light associated with lower mood), worrying occurs too in the fall in people with SAD → prevalence is higher in extreme northern and southern latitudes, less winter sunlight, it is a stable disorder, depressive episodes can start to occur in other seasons too → for kids it is more common in postpubertal girls → exposure to bright light may slow melatonin production in individuals with SAD, thus in phototherapy patients are exposed to 2 hours of bright light immediately upon awakening, when effective mood can lift within 3-4 days and depression may be in remission by 1-2 weeks, patients told to avoid bright lights in the evening, but treatment can have side effects such as headaches, eyestrain, and feeling "wired" → CBT could be more effective in causing symptoms to be less severe, to have less people relapse, and to have more remission in total

treatment of eating disorders

SSRIs can be more helpful in bulimia (more emotional component and possibly lower serotonin) CBT and IPT → interpersonal therapy shows promise with eating disorders because they are often relational (how you feel about yourself in relation to others, power struggles with parents, how you compare yourself to others, how you think your partner feels about your body) Group therapy is helpful mostly when there are a few members that have been getting treatment for longer and can provide a healthier voice Sometimes residential treatment is needed if the disorder has caused significant physical danger or because the disorder is severe enough that they need supervision to get better Behavioral components → postponing binges → a lot of people binge because they feel it is their only coping mechanism when they have negative emotions → want to up the person's coping mechanisms but also want them to learn how to sit with the discomfort and not resort to the binge → can tell patients that the next time they get the urge to binge they should try to postpone it for half an hour (don't even have to not binge entirely) → however this often allows their negative emotional state to calm down a little and the urge may go away is the binge is put off long enough → being able to sit with the urge long enough and not give into it will allow it to eventually go away if you can do it for long enough → teaches the patient how to manage the mood → called "surfing the urge" → doesn't mean they should ignore the urge, they should acknowledge it but not give into it → better than telling them not to binge at all because then they'll feel helpless and just end up doing it and giving up Relationships issues and self-esteem issues mean that the patient has to develop a self-worth outside of weight and size → get patient to acknowledge value, skills, and what they have to offer the world → have to get their other value to matter more to them Coping mechanisms have to be taught → for bulimia these are for avoiding binges and for anorexia it has to do with having a greater sense of control over things (want them to exercise because it feels good and not because they have to lose weight) (anorexia can be much harder to treat because they don't believe they have a problem at first and don't have a reason to want to get treatment) → need to find a way to feel okay enough in the moment that you choose healthy behaviors (sometimes need to put energy into something else) Role of family in treatment and preventing relapse Addressing underlying issues: trauma, mood disorders, anxiety disorders, substance abuse → have to treat this too or they will continue to exacerbate the eating disorder → sometimes eating disorders are symptoms of trauma disorders

schizoaffective disorder

Schizoaffective disorder → exhibit symptoms of schizophrenia and mood disorders → similar prognosis to schizophrenia→ need a mood disorder and delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms

Schizophrenia symptoms

Schizophrenia has a number of behaviors or symptoms that aren't all shared by all people with the diagnosis → causes also vary Psychotic behavior → term used to characterize many unusual behaviors although in its strictest sense is involves delusions and/or hallucinations Traits like anger and antisocial personality are better predictors of violence than schizophrenia Schizophrenia spectrum disorder contains all of the diagnoses related to schizophrenia → all schizophrenia related disorders in the DSM contain extreme reality distortion Positive symptoms of schizophrenia → refer to symptoms around distorted reality Negative symptoms → involve deficits in normal behavior like areas of speech, blunted affect, and motivation Disorganized symptoms include rambling speech, erratic behavior, and inappropriate affect Need 2 or more positive, negative, and/or disorganized symptoms to be present for at least a month with at least one of the symptoms including delusions, hallucinations and/or disorganized speech to get the diagnosis DSM also includes dimensional assessments to rate severity of symptoms (from 1-4) Positive symptoms are more obvious signs of psychosis 50-70% of people with schizophrenia have delusions, hallucinations or both delusion= disorder of thought content, belief that would be seen by most members of society as a misrepresentation of reality Can have delusions of grandeur, delusions of persecution, Capgras syndrome (person believes someone he or she knows has been replaced by a double), Cotard's syndrome (person believes he or she is dead) Motivational view of delusions looks at these beliefs as attempts to deal with and relieve anxiety and stress → distracts individual from upsetting aspects of the world like hallucinations Deficit view of delusion sees these beliefs as resulting from brain dysfunction that creates these disordered cognitions or perceptions hallucinations=experience of sensory events without any input from the surrounding environment Auditory hallucinations are the most common form, 70% of people with schizophrenia have them Some think that hallucinations have to do with metacognition (thinking about your own thoughts) → have intrusive thoughts that they think came from somewhere or someone else → then worry about these thoughts which is meta-worrying, increases depression and anxiety Broca's area is part of brain most active during hallucinations → Broca's area is involved in speech production → supports theory that people hallucinating are listening to their own thoughts or their own voices and cannot recognize that they are theirs → thought that issues of emotional prosody comprehension cause this (less able to understand emotional tone of others and your own thoughts) Negative symptoms include apathy, poverty of thought or speech, and emotional and social withdrawal → 25% of people with schizophrenia have these symptoms avolition= inability to initiate and persist in activities (also called apathy) → little interest in performing day to day functions alogia= relative absence of speech → may respond to questions with brief replies with little content and appear uninterested in convo → may have trouble finding the right words to speak anhedonia= presumed lack of pleasure experienced by some people with schizophrenia asociality= lack of interest in social interactions, can be made worse when isolated Affective flattening= flat affect is when they don't show emotions, may be responding to life only on the inside, don't change facial expressions but still experience the appropriate emotions → difficulty expressing emotion but not a lack of emotion → children at high risk of schizophrenia were shown to have higher chances of developing it when they had less positive and more negative affect early on Disorganized speech= people with schizophrenia can lack insight or an awareness that they have a problem, tend to jump from topic to topic and other times they talk illogically → tangentiality is going off on a tangent instead of answering a specific question → loose association or derailment is changing the convo topic to unrelated areas Inappropriate affect= laughing or crying at improper time → sometimes comes with other bizarre behaviors like hoarding or acting unusual in public Catatonia is separate disorder in DSM 5→ some people pace excitedly or move in a stereotyped way while others hold unusual postures of hav waxy flexibility in which they keep their bodies and limbs in the position they were put in by someone else (can also be one symptom of general schizophrenia, disorganized symptom) Three historic divisions of schizophrenia: paranoid, disorganized, and catatonic → not used in DSM 5 because nature of symptoms can change over time for one individual → severity assessment is now used instead of divisions

schizophrenia course

Schizophrenia is generally chronic → most suffer with moderate-to-severe lifetime impairment → life expectancy is slightly less than average (some reasons for this are increased risk of suicide, increased risk for accidents self care may be poorer)

Schizophrenia history

Schizophrenia → characterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disorganized speech and behavior and inappropriate emotions (can disrupt perception, thought, speech, and movement) More likely to be stigmatized and discriminate against than other people Fully recovery only occurs in every 1 in 7 patients Affects every 1 of 100 people at some point in their lives Research has expanded rapidly Costs of having schizophrenia are very expensive There are subtypes Onset of disorder can be during adolescence Emil Kraepelin built on writings of Haslam, Pinel, and Morel and others to give the most enduring description and categorization of schizophrenia → combined catatonia (alternating immobility and excited agitation), hebephrenia (silly and immature emotionality), and paranoia (delusions of grandeur or persecution) → used term dementia praecox to describe it → also distinguished it from bipolar disorder → noted symptoms like hallucinations, delusions, negativism, and stereotyped behavior Eugen Bleuler → first used term schizophrenia → thought that the disorder was due to an associative splitting of the basic functions of personality → destruction of forces that connect one function to the next → thought people couldn't keep a consistent train of thought

distorted body image

Seeing yourself as more overweight than you are People after a binge tend to think they're much bigger than they are

serious undernourishment and obesity BMIs

Serious undernourishment is BMI less than 18.5 and obesity is BMI over 30

premenstrual dysphoric disorder more info

Significant depressive symptoms occurring prior to menses during the majority of cycles, leading to distress or impairment New and controversial diagnosis → disadvantage is that it could pathologize an experience that many consider to be normal (and our society tends to stigmatize women's emotions while on their periods) but the advantage is that it legitimizes the difficulties some women face when symptoms are very severe Can be empowering to have a label in order to seek treatment and know that other people struggle with this too Have to be significant depressive symptoms that occur like clockwork leading up to your period each month (after ovulation and before your period) Not very common We know that biology and hormones could be causing this → could be that these people could be treated with oral contraception to mitigate the symptoms → addresses hormonal fluctuation cause Classically this is just about depressive symptoms but in the real world she sees anxiety occurring with this a lot too (especially because in the real world anxiety and depression are so often connected) Thought is that this is more hormonally and biologically driven than other depressive disorders PMS is technically about all symptoms including purely physical ones while this disorder focuses on a more significant emotional change

mood disorders across the US, subcultures

Similar prevalence among US subcultures, but experience of symptoms may vary → some cultures are more likely to express depression as somatic concern → sometimes latino cultures tend to express depressive symptoms as somatic because it could be more culturally acceptable However there is a higher prevalence among Native Americans → four times the rate of the general population → could be due to history of cultural oppression against them → this has resulted in high poverty levels, severe mistreatment, etc. → the high rates of substance abuse in these communities could be due to depression or contribute to the cause of depression or both

treatment fo binge eating disorder

Similar to treatment for bulimia including IPT, CBT and treating underlying emotional issues Role of medical treatment for obesity itself too (maybe bariatric surgery is obesity is severe enough) → treating the disorder can help them lose weight too as binging decreases Being overweight could cause people with binge eating disorder to be more ostracized and have more social issues that contribute to the psych disorder

sleep disturbance and mood disorders

Sleep disturbance is a hallmark for mood disorders There is a shorter period of time after falling asleep before REM sleep begins in depressed people → experience more intense REM activity and the deepest stages of sleep don't occur until later → even when people with depression are not depressed these sleep issues may occur → unusually short and longer sleep durations are associated with increased risk for depression in adults Sleep disturbances are more severe among depressed older adults → insomnia can occur → this is a risk factor for onset and persistence of depression Treating insomnia in depressed patients may enhance the effects of depression treatments In bipolar patients they have same sleep issues along with severe insomnia and hypersomnia → negative mood predicts sleep disruption and sleep disruption predicts negative mood Bipolar disorder prognosis can be improved by treating sleep issues too Depriving depressed patients of sleep during the second half of the night causes temporary improvement in their condition (especially for bipolar patients in a depressed state) → depression then returns when the patients start sleeping normally again→ disrupting circadian rhythm could be a huge issue in mood disorder patients Sleep difficulties predict a poorer response with treatment

why a suicidal person is not always at rock bottom

Sometimes people at "rock bottom" don't even have the energy to plan to commit suicide (can't even get out of bed) → so when they start to get treatment or start to feel a little better they may still be in a suicidal frame of mind and now also have the energy to act on it and become more likely to do it → this could be one reason why sometimes people start taking SSRIs and die by suicide after → SSRIs allow them to get just enough energy back to actually do it Sometimes once people decide to do it they feel and appear more calm → they've decided on a solution that is not optimal but in their mind they see relief coming and an end to their suffering so they may seem like they're doing better while they're actively planning to commit suicide → thus when someone starts to do better they could still be at a high risk of suicide

OCD related to eating

Sometimes people can have OCD about contamination or about how food is prepared or about being grossed out when two foods touch each other → this can cause enough OCD related anxiety that you eat less and ignore your hunger cues → so this isn't anorexia nervosa but its OCD related instead

stress and mood disorder etiology

Stress and trauma are the biggest contributions to the etiology of all psych disorders → have to look at events that happened before depression, the context of them, and what they meant for the patient → however the only good way to study effects of life event sis to follow people prospectively (because reporting on an event after becoming depressed typically casts a negative spin on it) Research indicates that stressful life events are strongly related to mood disorder onset (also trauma too) Kids that experienced sexual abuse are likely to get depression as a young adult Having a stressful event before or early in the latest episode are less likely to respond well to treatment, take longer to get to remission and have a higher likelihood of recurrence Events particularly likely to lead to depression: breakups, death of loved ones, humiliation, loss, and social rejection Gene-environment correlation model predicts a lot of depression etiology Genetic factors seem to matter more in childhood and environmental factors matter more as you get older Negative stressful events tend to trigger depression in bipolar disorder but more positive and still stressful events trigger mania → if you are vulnerable striving to achieve something that causes stress and finally getting it can cause mania In bipolar disorder stress may trigger the first episodes but the episodes eventually develop a life of their own Some precipitants of manic episodes are related to loss of sleep or due to jet lag (disruption of circadian rhythms) Stressful events can provoke relapse and prevent recovery in bipolar disorder It is thought that you still need a genetic vulnerability for stress to trigger mood disorders

psychological etiology of depression

Stress and trauma can affect how we view the world (can make us feel helpless or hopeless)→ context of memories impacts how an experience changes your worldview and does or does not make you more vulnerable to depression → interpreting a negative event in a way that makes you feel more hopeless and helpless can make you continue to feel this way → looking at an event in a hopeful and positive light can make you less vulnerable to depression (helpless, catastrophizing lense can be a risk factor) Reciprocal gene-environment model → genes that make you more vulnerable to depression can also make you more likely to seek out environments that exacerbate your risk of depression → traits like pessimism or timidness could get you into bad situations that bring out depression

DSM criteria of major depresive episode

Symptoms must be experienced most of the day, nearly every day, for at least 2 weeks Cognitive symptoms → classic slowing down, difficulty concentrating, thoughts of worthlessness, thoughts of hopelessness, difficulty making decisions (overwhelmed by simplest decisions), etc. Disturbed physical function → fatigue, exhaustion, changes in eating or sleeping (can go either direction, eating more or less, sleeping more or less, can be insomnia or hypersomnia), many different physical aspects of the body are slowing down (physiological functions depressed) → if you have anxiety too the physical symptoms could be a little different Emotional symptoms → despair, loss of pleasure (anhedonia, where there used to be pleasure and excitement there is none), sadness (don't have to be sad but can be), lack of engagement with life, an emptiness, not getting excited about the future anymore, not caring about anything, feeling cut-off, anger, guilt, shame, grief, weepiness, etc.

schizoaffective

Symptoms of schizophrenia and an additional experience of a major mood episode (depressive or manic) Psychotic symptoms must also occur outside the mood disturbance (not just during the mood episode) Prognosis is similar to people with schizophrenia Such person do not tend to get better on their own But the treatment is different because the mood aspect has different implications

warning signs of suicide

Talking about it, indirectly, or directly → making jokes or using slang can be warning signs Increased risk-taking and impulsivity → being in a suicidal mindset makes your less likely to avoid dangerous things and act more recklessly because you feel like nothing matters → but also the more impulsive behavior you're engaging in the more it can increase you suicidal mindset too Having a plan → thinking more about method, think about how they would want to do it → imagining doing it → more progressed (close to doing it), more imminent danger when you have a plan Severe hopelessness → thinking of things as not worth it, not improving, and not getting better Giving away things/tying up loose ends → only do this if you really think you are going to end your life Severe shame → can be cultural or just that you feel you don't deserve to be alive Expressing that you feel you are a burden to others → this is important because most people think of their relationships as a barrier to suicide because you couldn't do that to them → but if you think you are a burden to others then this removes the barrier and turns it into an additional motivator Severe agitation, insomnia → agitation combined with an inability to sleep can make people more likely to do it or be due to suicidal thoughts any significant changes in a loved one's behavior can be warning signs

sex in different cultures

The Sambia people in Papua New Guinea have traditions in which boys at the age of 7 and on must receive homosexual oral sex from teenage boys, then they switch roles and become "semen providers" to younger boys→ later on are supposed to be exclusively heterosexual Munda in India have kids and teens live together and engage in heterosexual acts In about half the world's societies premarital sex is culturall accepted and encourgaed and in the other half it is unacceptable and discouraged There is even variation in what is "normal" within ethnicities in the US

risks of doing medication only for depression treatment

The band-aid effect → putting a band-aid on the problem without actually getting to the root of the issues Higher risk of relapse No one monitoring side effects Not giving a sense of autonomy that you can get through it yourself (some people want this sense of autonomy and to not have to rely on the medication while other people are comfortable with the fact that it helps them and own it) Not changing the thoughts and behaviors that need to be changed (medication can help a little but no permanent changes)

causes of obesity

The spread of modernization and technology is implicated in obesity spread → promotion of an inactive, sedentary lifestyle and the consumption of high fat energy dense diet is the largest contributor to obesity → "the toxic environment" Immigrants in the US tend to double their prevalence of obesity in the 15 years after living in the US Genetics, physiology, and personality can determine who becomes obese in the toxic environment → genetic contribtions are a smaller portion of the cause of obesity than cultural factor but they are still important → genes determine the number of fat cells an individual has, the likelihood of fat storage, saiety, and activity levels → genes are thought to be 30% of the cause of obesity (however it takes a toxic environment to turn on these genes) Hormonal regulation of appetitie can play a big role → for people that have addictive obese eating behavior they can show similar reward neurocircuitry to those addicted to substances Psych processes of emotional regulation, impulse control, attitudes and motivation toward eating, and responsiveness to the consequences of eating are also important Obesity can also be more likely if you have lots of close family and friends that are obese

biological component of sexual orientation

There could be a genetic component to sexual orientation → thought that in men genes account for about 34% of the cause and in women it is just 18% Hormone exposure could be another cause which could impact the brain→ theory of differential hormone exposure in utero But because 50% of twins with the sae environment and genes don't share sexual orientation it is not entirely genetic Fraternal birth order hypothesis came form a study that found that each additional older brother increases the odds of being gay by one third → could be environmental or due to the mom's response during pregnancy to Y linked proteins Epigenetic effects could influence sexual orientation Women also commonly broaden their sexual identities so it could be malleable over time

connection between mood disorders and creativity

There is some evidence that the independent and sometimes rebellious qualities associated with creativity might be more stressful in a society that puts demand on people to act a certain way and result in higher prevalence of mood disorders among artists and leaders → something in manic states may foster creativity → or perhaps the genetic predisposition to creativity is accompanied by a predisposition to mood disorders → evidence seems to suggest that bipolar disorders are correlated with creativity (and not so much depression) → may be some truth to belief that genius is allied to madness

persistent depressive disorder

There may be fewer symptoms than in major depressive disorder but depression remains relatively unchanged over long periods (can be 20-30 years or more) Depressed mood that continues at least 2 years during which the patient cannot be symptom free for more than 2 months at a time even though they may not experience all of the symptoms of an episode Less symptoms are required by it is more chronic → considered more severe because there are higher comorbidity rates with other mental disorders, patients are less responsive to treatment and show a slower rate of improvement About 20% of people with a depressive episode meet criteria because it lasts at least 2 years Some people that suffer persistent depression with even fewer symptoms (pure dysthymic syndrome) eventually experience a full episode People that suffer from major depressive episodes and persistent depression with fewer symptoms are said to have double depression → more severe and has a bad course Relapse rate is 71.4% So persistent depressive disorder is either "with pure dysthymic syndrome" or "with intermittent major depressive episodes" (double depression)

factitious disorders more info

Things are being manufactured in these disorders → manufacturing symptoms Contains all of the people faking symptoms but there are different kinds of fakers Malingering → garden-variety faking, people making up their symptoms, trying to cheat the system, some external reinforcement is driving this → examples are faking trauma for a lawsuit, faking depression to get out of work → don't consider malingering a psych disorder because given the right reinforcement a lot of people may fake something (may not be a good person but not atypical) Factitious disorders are psych disorders because in these cases the person is faking but we aren't sure why → more internal motivation → may be for attention or because they like the sick role → unclear why someone would do it if it weren't for some psychological dysfunction happening Munchausen Syndrome (by proxy most common) → person physically creates the symptoms themselves → do something to physically manifest the symptoms (specific kind of factitious disorder) A general factitious disorder can be when you report symptoms and they may be somatic or severe mental symptoms but don't have to create physical symptoms (don't have to create them because you convince people you have them) Munchausen by proxy is a form of child abuse many times → parents or cargeivers that harm children to make it seem like the children are sick → could be because the person likes the attention, likes being in the hospital, or likes being the heroic parent of a sick child → can be prosecuted for this (sometimes they end up killing the child)

developmental considerations of eating disorders

Thought that anorexia and bulimia are strongly related to development Different developmental patterns in boys and girls interact with cultural influences to create eating disorders → girls tend to gain weight in fat tissue after puberty while boys develop muscle and lean tissue → puberty takes women further from ideal body type while it takes men closer Eating disorders occasionally occur in kids under 11 → can restrict fluid intake, and food intake because don't understand the difference → negative attitudes about being overweight can emerge as early as 3 years old and more than half of girls 6-8 would like to be thinner → by 9 years old girls report trying to lose weight and this increases as you get older → extremity of weight control behaviors can increase into young adulthood Bulimia and anorexia can occur in later years after the age of 55 especially → these people tend to have had an eating disorder their whole life but sometimes it develops later and they aren't sure why since body weight concerns typically decrease with age

integrate model of eating disorder etiology

To get an eating disorder you may have some biological vulnerabilities like people with anxiety disorders and negative emotions could trigger binge eating → eating disorders seem to be anxiety disorders focused on eating and body size → social and cultural pressures to be thin motivate restriction of eating and severe dieting → emphasis on achievement and looks can reinforce these attitudes

TMS

Transcranial magnetic stimulation (TMS)--> magnetic coil placed over head to generate a precisely localized electromagnetic pulse → don't need anesthesia, side effects are just headaches → could treat depression → however with severe depression with psychotic features ECT is much better → could be an advantage to combining TMS with meds

DID treatment

Treatment for dissociative amnesia or fugue state normally involves therapeutic resolution of distressing situations and increasing the strength of personal coping mechanisms → can focus on recalling what happened during the amnesic states with the help of friends or family that know what happened so the person can confront it; No research on controlled experiments on DID treatment but there are documented successful efforts to reintegrate identities through long-term psychotherapy; Prognosis for most people remains guarded → 5 out of 20 patients found to integrate personalities in one study; Use treatments used with PTSD; Goal of treatment is to identify cues or triggers that provoke memories of trauma, dissociation, or both, and neutralize them → patient must confront and relieve the early trauma and gain control over the horrible events as they recur in their mind → therapist helps the patient visualize the event until they can process it as only a memory → oftentimes have to use hypnosis because memories are implicit DID without treatment tends to be chronic with not improvement so this is some evidence that treatment helps; Sometimes medication is combined with therapy but there is little evidence that this helps → the little evidence says that antidepressants could help; There is a risk that reemerging memories could trigger further dissociation so therapist must be careful to avoid this

treatment of obesity

Treatment of obesity is only a little successful at the individual level → can be better for kids if done early Organize treatment from least intrusive to most intrusive → start with self directed weight loss program → these are often dieting programs that can work in the short terms but not the long term → then can try commercial self help programs (can be more effective) → programs and food provided free of charge can act as powerful incentive keeping people in them and causing better outcomes → most successful programs are professionally directed behavior modification programs (combo of a diet, more exercise, and behavior therapy is the best) → having a therapist to talk to to help stay on a program in the years after the initial program can help too For dangerous obesity very low calorie diets and drugs combined with behavior modification programs are recommended → right now there aren't many approved drugs due to cardiovascular side effects → bariatric surgery is becoming increasingly popular for people with a BMI of at least 40 → can be more successful than diets and more maintainable → associated with lower mortality for up to 14 years after the procedure → typically must have one or more obesity related physical conditions to have the surgery → part of the stomach is removed to create a sleeve or tube like structure → gastric bypass creates a bypass of the stomach → about 15% of patients fail to lose significant weight or regain lost weight after surgery → small percentage don't survive the operation and 15-20% experience severe complications → most surgeons require the patient try all other options and undergo a psych evaluation to make sure they can stick to the diet after surgery → need more research to know long term effects and benefits Most individuals gain back 50% of the weight they lost after programs Some states are trying to remove soft drinks from many places The idea of food taxes could be used to make consumption of healthier foods cheaper → this money could be put toward obesity treatment Another public health approach is choice architecture → designing different ways in which choices can be presented to consumers Behavior modification programs that include children and parents can produce a 20% reduction in overweight children or teens and this change can be maintained → kids' habits are less engrained, involving their parents an change their behaviors, and they tend to be more active when given the chance → currently evaluating a less intrusive bariatric surgery for kids

antidepressant medication

Tricyclics (risk of overdose) MAOIs (MAO inhibitors) → lifestyle annoyances/side effects → eating certain foods with high levels of certain things can cause blood pressure issues Tricyclics and MAOIs not used as much because they have drawbacks SSRIs → selective serotonin reuptake inhibitors → Zoloft, Paxil, Prozac, Celexa, Lexapro → if you have an issue with one you may not have the same issue with others → Prozac tends to be more activating so may be good for getting out of bed but not good for anxiety (most of these besides Prozac can be prescribed for anxiety disorders) → normally prescribed first for depression → very common side effect with sex drive lowering or erectile dysfunction → they aren't habit forming but should wean off them if you stop taking them because you get used to being on them → these drugs have to build up and your system has to adjust before changes occur, should give them a few weeks to work SNRIs/mixed reuptake inhibitors act on NE/dopamine as well → Welbutrin (Zyban name used to wean people off of smoking, same drug), Pristiq, Effexor → can help people when SSRIs aren't good for them → fairly common medications with similar efficacy to SSRIs

prevention of mood disorders

Trying to prevent disorders in teens and children → universal programs (applied to everyone), selected interventions (target individuals at risk for depression because of factors like divorce, family alcoholism, and so on) and individual interventions (which individual is already showing mild symptoms of depression) → research has shown it could be possible to psychologically immunize at risk children and adolescents against depression by teaching appropriate cognitive and social skills before they enter puberty → have found that CBT prevention can decrease chances of depression but that living with a depressed parent can significantly decrease the effectiveness (may have to treat depression in the whole family) → meeting in an integrated fashion with families that included parents who had a history of depression and their children was successful in preventing depression in these families during a follow up period → can prevent depression in older adults in primary care settings and in poststroke patients (a very at risk group) → continuation CBT reduces the risk for relapse and maintenance CBT reduces the risk for recurrence

genetic contributions to mood disorders

Twin studies show that concordance rates are high in identical twins → 2-3 times more likely to present with mood disorders if you have an identical co-twin with depression than a fraternal twin of a depressed co-twin Severe mood disorders have a strong epigenetic contribution too Heritability rates are higher for females compared to males → genetic piece may matter more for women and environmental piece may matter more for men Some genetic factors confer risk for both anxiety and depression

universal programs

Universal programs on how to handle life stress or increase social support are not very effective at preventing suicide Programs targeted to at risk people (like kids in a school where someone committed suicide) can be helpful → should make services available and limit access to lethal weapons → telephone hotlines and other crisis intervention services can help too There are also specific treatments for people at risk → suicide prevention programs for elderly focus on decreasing risk factors and specific interventions target mental health issues associated with suicide → cognitive behavioral interventions can help decrease suicide risk → this approach reduced suicidal ideation and behavior and caused improvements in problem solving 10 sessions of cognitive therapy for recent suicide attempters cuts their risk of additional attempts in half over the next 18 months

vagus nerve stimulation

Vagus nerve stimulation by implanting a pacemaker device could change transmitter production in brain stem and limbic system → FDA approved but weak results (not used a lot)

anorexia vs. bulimia

Weight → technically to get the anorexia nervosa diagnosis you have to be significantly underweight in terms of BMI while with bulimia you don't need to be a particular weight → this is because anorexia specifically is an added concern that the person is significantly underweight → people with bulimia tend to be about their normal weight Presence/absence of out of control binges → someone with bulimia must feel out of control when they binge but these out of control binges don't occur with anorexia (if they did people with anorexia wouldn't be so underweight) Some people can start with anorexia and then it becomes bulimia or others can seem more anorexic for a few days and then more bulimic for the next few For both: your self-image must be unduly influenced by shape/weight (worried about being too fat, trying to lose weight, etc.)

depersonalization-derealization disorder

When feelings of unreality are so severe and frightening that they dominate an individual's life and prevent normal functioning, clinicians may diagnose this; During intense panic attacks about 50% of people feel a sense of unreality; Many people with acute stress disorder may experience these symptoms too; Feelings of depersonalization and derealization are part of several disorders; However when these things are the main issue then the person has this disorder; Exists in 0.8-2.8% of the population; About equal between men and women; Typical symptoms include the surroundings seeming unreal, looking at the world through a fog, body not belonging to you, did not hear part of conversation, finding familiar place strange and unfamiliar, staring off into space, unaware of time, can't remember if just did something or thought it, do usually difficult things with ease/spontaneity, act so differently/feel like two different people, talk out loud to oneself when alone; Mean age of onset is 16 years; Course tends to be chronic; Anxiety, mood and personality disorders co occur with this; People with this disorder tend to have a distinct cognitive profile → specific cognitive deficits on measures of attention, processing of info, short term memory, and spatial reasoning → easily distracted and slow to perceive and process new info → could correspond with tunnel vision and mind emptiness symptoms; Tend to have less emotional responsiveness → may selectively inhibit emotional expression; Also brain imaging studies show deficits in perception and emotion regulation; Some studies note dysregulation in the HPA axis which could be more deficits in emotional responding; Not a lot of research on treatments → one study showed that Prozac didn't help

dissociative disorders

When individuals feel detached from themselves or their surroundings, almost as if they are dreaming or living in slow motion they are having dissociative experiences; could be likely to occur after a stressful event → also more likely when you're tired or sleep deprived; Transient experiences of dissociation will occur in about half of the general population at some point in their lives → if a person experiences a traumatic event 31-66% of them are likely to have this feeling at this time; Can be very scary for people; Some people feel estranged from other people and distant from their emotions and themselves during these experiences, sometimes people don't remember these episodes and the influence of social and cultural factors is strong

ECT

When someone doesn't respond to drugs or has a very severe cause clinicians may use ECT → today it is safe and reasonably effective for severe depression that don't improve with other treatments → today patients are anesthetized to reduce discomfort and given muscle relaxing drugs to prevent bone breakage from convulsions during seizures → administered directly through the brain for less than a second producing a seizure and a series of convulsions that last for several minutes → typically done once every other day in 6-10 total treatments → side effects ae short term memory loss and confusion that disappear after a week or two although some patients have long term memory issues → for severe depression with psychotic features not responding to meds about 50% benefit → must then continue treatment with meds or therapy in order to avoid relapse Repeated seizures are thought to cause massive functional and structural changes in the brain which could be therapeutic → could increase serotonin levels, block stress hormones and promote neurogenesis in hippocampus → but the treatment is controversial and has declined since the 70s

anorexia psych treatment

Women with a dangerously low BMI are treated for that first and then can starts CBT → thus CBT focuses on the distorted evaluation of body shape and wight and maladaptive attempts to control it → called cognitive behavioral therapy-enhanced (CBT-E)

meeting criteria for a manic episode is considered...

a disorder but almost always a depressive episode occurs after it resulting in bipolar disorder

anorexia can be...

a symptom of other physical conditions where you have a loss of appetite but the anorexia nervosa diagnosis is specifically a psych disorder

manic episode

abnormally exaggerated elation, joy, or euphoria, extreme pleasure found in every activity, are hyperactive, require little sleep, and may develop grandiose plans, persistently increased goal-directed activity or energy can occur, speech is typically rapid and may become incoherent because person wants to say so much at once (flight of ideas), only needs to be a week long and can require hospitalization, irritability can occur and being anxious or depressed can be a part of mania, can last 3-4 months if left untreated

Gestalt therapy

about how we relate to others and fit into social circles → how we see ourselves reflected in others

psychotic break

active break with reality, typically occurs during late adolescence and early adulthood

with melancholic features

applies only if the full criteria of a major depressive episode have been met whether in the context of a persistent depressive disorder or not, includes early-morning awakenings, weight loss, loss of sex drive, excessive or inappropriate guilt, and anhedonia

with catatonic features

applies to both disorders, can also apply to mania, absence of movement or catalepsy in which arms or legs are waxy and semirigid and remain in position they're placed, may include excessive but random or purposeless movement, may be an "end state" reaction to feelings of imminent doom

with atypical features

applies to both, oversleep, overeat, and gain weight, can cause diabetes, can react with interest or pleasure to some things but have anxiety, associated more with women and an earlier age of onset, has more symptoms, more severe symptoms, more suicide attempts, and higher rates of comorbid disorders

with seasonal pattern

applies to recurrent major depressive disorder and bipolar disorders, episodes occur during certain seasons, most typical pattern is a depressive episode beginning in the late fall and ending in the beginning of spring (in bipolar disorder individuals may be depressed during the winter and manic in the summer), must occur for at least two years with no evidence of nonseasonal major depressive episodes, called seasonal affective disorder (SAD), majority involves winter depression, 15-25% of the population have some vulnerability to this, tend to sleep excessively, have increased appetite, have weight gain

formalized suicides

approved of, such as the ancient custom of hara-kiri in Japan in which a person who brought dishonor to himself or his family was expected to impale himself on a sword → also considered altruistic suicide

good sleep hygiene habits

bedtime routines, regular bedtime and wake time, eliminating caffeine 6 hours before bedtime, limiting alcohol or tobacco use, trying milk before bedtime, eating a balanced diet, limiting fat, going to bed only when sleepy and getting out of bed if you can't fall asleep or back asleep in 15 minutes, not exercising or participating in vigorous activities in the hours before bedtime, including a weekly program of exercise during the day, restricting activities in bed to those that induce sleep, reducing noice and light in the bedroom, increasing exposure to natural and bright light during the day, avoiding extreme temperature changes in the bedroom

Martin Seligman's depressed attributional style

built on Aaron Beck's work → idea is that people prone to developing depression tend to view the attribution of things in a particular way (attribution of a thing is the cause of the thing) → depressed people tend to have an internal attributional style (when something bad happens you assume it has to do with you or is your fault, think the attribution of all bad things is internal) → also tend to take something specific and make it global (one specific bad thing happens and you think it applies to everything, your whole life, etc. ) → also tend to think things are stable or will remain the same and never change (bad things will never improve)

psychadelics

can be used to treat depression sometimes → ketamine, LSD, psilocybin mushrooms (typically given with a guide, which is like a therapist) → LSD runs the risk of a bad trip so could be traumatic (can microdose LSD to alter perspective only slightly) → some psychedelics could calm down death anxiety and depression linked to this

psychological autopsy

can reconstruct the psych profile of the person who committed suicide through extensive interviews with friends and family members that are likely to know what the person was thinking and doing before death

health risks with being overweight

cardiovascular disease, diabetes, hypertension, stroke, gallbladder disease, respiratory disease, muscular skeletal problems, and hormone related cancers

specifiers for bipolar disorders

catatonic features normally apply to depressive episodes but may apply to manic ones too, psychotic features typically apply to manic episodes, anxious distress specifier also occurs, mixed features specifier says that depressive episodes have manic features and manic episodes have depressive features → seasonal specifier when it occurs is typically depressed in the winter and manic in the summer → manic episodes may occur surrounding, but mostly after, childbirth for the peripartum period

cyclothymia

chronic cycles of hypomania and mild depression; few periods of euthymia (a normal mood, in between mania and depression) → these people tend to go about halfway up to mania and then about halfway down to depression with few periods of the "normal" mood → has to last at least 2 years to be a disorder → the issue for these people is that you rarely have a stable, normal, functional mood → the level of instability and moodiness makes it a disorder → this tends to be a more female disorder and tends to have a slightly earlier age of onset (could be tied to hormonal changes that occur in adolescence)

treatments for insomnia

cognitive (reversing unrealistic expectations of sleep), guided imagery relaxation (meditation and imagery to help with relaxation), graduated extinction of behaviors that keep kids up at night, paradoxical intention (telling people to lie in bed and stay awake as long as they can), progressive relaxation (relaxing muscles of the body)

college population vs. US as a whole

college students are much more likely to be affected by eating disorders rather than obesity-related health issues → eating disorders are rampant on college campuses

homelessness and schizohrepnia

common → schizophrenia could be the cause of homeless or make a bad situation worse → can also lead to substance abuse

integrative theory of etiology of mood disorders

considers the interaction of biological, psychological, and social dimensions and notes the strong relationship of anxiety and depression

course or temporal patterning of episodes

do they recur, can the patient recover fully for two months in between or not (full remission vs. partial remission), do depressive episodes alternate with manic/hypomanic ones or not?

learned helplessness

dogs exposed to negative, uncomfortable, uncontrollable situations can make them worse at problem solving → eventually they learn that they are completely helpless and don't even try to problem solve to escape a bad situation → human beings that are up against a lot of hardship they couldn't control tend to believe that they have no control and learn a sense of helplessness → you view the world more negatively and feel unable to cope and escape these negative parts of the world (studies done by Martin Seligman)

two categories of sleep wake disorders

dyssomnias and parasomnias → dyssomnias involve difficulties getting enough sleep, problems with sleeping when you want to, and complaints about quality of sleep → parasomnias are characterized by abnormal behavioral or physiological events that occur during sleep like nightmares and sleepwalking

manic depressive episode

extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms like feelings of worthlessness and indecisiveness and disturbed physical functions like altered sleeping patterns, significant changes in appetite and weight, or a notable loss of energy to the point that even the slightest activity or movement requires an overwhelming effort → loss of interest in things and an inability to experience any pleasure from life → research indicates that physical changes are the biggest indicators (somatic or vegetative symptoms) along with the behavioral and emotional "shutdown" which causes low behavioral activation → anhedonia (loss of energy and inability to engage in pleasurable activities or have fun) is characteristic of severe episodes of depression → state of low positive affect and high negative affect → can last 4-9 months if untreated

schizotypical personality disorder

falls under personality disorders but it is related → similar characteristics to schizophrenia but less severe → may be related to schizophrenia genetically

sexual dysfunction

find it difficult to function adequately while having sex

existential therapy

finding a sense of meaning → feeling closer to something greater than yourself → self-actualization → finding a purpose

interpersonal psychotherapy

focuses on relationship dynamics, making them healthier, understanding your role in them

spectrums of sexuality

from heterosexual to homosexual in terms of who people are attracted to (spectrum from only the opposite gender to only the same gender, in between could be equally attracted to both genders) and from sexual to asexual in terms of how much interest/ sex drive (spectrum from complete lack of sex drive to very high sex drive, in between may be people that are only sexually driven when romance is involved)

bipolar I

full mania and full depression → typically more severe, depression normally follows the manic episode, need a history of both full episodes → on a graph of mood versus time with euthymia in the middle these people spike all the way to mania and then crash all the way down to depression → emerges in young adults and late teens typically

sex vs. gender

gender identity is how you understand your gender to be (on a spectrum too, may be somewhere in between male and female or non-binary), gender expression is how you choose to express you gender on the outside (may or may not match your identity, some people may be unable to live in congruence with who they feel they are, on a spectrum from feminine to masculine with androgynous in the middle) → biological sex is what your sex organs/chromosomes/hormones are at birth (spectrum from male to female with intersex in between) → sexual orientation is who you are attracted to (can be romantic, spiritual, or sexual attraction, spectrum from heterosexual to homosexual with bisexual somewhere in between) → each of these things can be independent of each other or interact with each other

etiology of dissociative disorders

genetic vulnerability, trauma or stress, and suggestibility can be components → the more suggestible you are the more easily you can dissociate (if more easily hypnotized then you're more suggestible)

psychodynamic psychotherapy

has to do with underlying patterns → gain insights into relationships and upbringing → figuring out how thoughts came to be and challenging them

bipolar II

hypomania and full depression → having the potential to go up to hypomania tends to have more bipolar-like symptoms than someone with just depression → on the mood vs. time graph you go about half-way up past euthymia to mania and then crash all the way down to full depression

depressed people relate to their thoughts...

in particular way (and anxious people do too) → both depressed and anxious people tend to fuse with their thoughts, think their thoughts are very true, we thinking depression an anxiety are due to negative thoughts becoming sticky or sticking around, you can't get them to go away, giving power to thoughts, believe they are true, get exhausted trying to fight your thoughts → mindfulness can help with this

gender dysphoria

incongruence and psychological distress and dissatisfaction with the gender one has been assigned at birth

binge-eating disorder

individuals may binge repeatedly and find it distressing but they do not attempt to purge the food

hypomanic episode

less severe version of a manic episode that does not cause marked impairment in social or occupational functioning and need last only 4 days rather than a whole week, not an issue in and of itself but can occur with many mood disorders

egoistic suicide

loss of social supports that provoke suicide → only 13% of people that commit suicide have an adequate social network → suicide attempters tend to perceive themselves as having less social support

double depression

major depressive episode on top of a baseline of persistent depressive disorder → these people hover around mild depression and then crash all the way down to full depression for some time, then they come back up to their baseline of mild depression → tend to be at higher risk for suicide when the depressive episode hits because their baseline was already low and it may be even harder to remember what its like to feel okay or it may be harder to seek treatment → they aren't as motivated to get back to normal because normal for them is still pretty bad

gender differences in sexual behavior

masturbation is the biggest gender difference (more men masturbate more often than females) → there are a lot of stereotyped gender differences with sex but most of them are exaggerated, masturbation is the one that is true → males due tend to be more permissive with premarital sex but gap is shrinking → frequency of sex and number of partners is slightly greater in males (however women may lie because this is seen as negative) → females more likely to report passion and romance important for sexuality → females more likely to have self-conscious/negative shcema about sex (this is likely because of what we teach women about sex)

for mild to moderate depression therapy beats....

medication

can be hard to do therapy for people with schizophrenia without...

medication treatment

for moderate to severe depression...

medication with therapy is better (should not use medication alone)

cyclothymic disorder

milder but more chronic version of bipolar disorder → chronic alternation of mood elevation and depression that does not reach the severity of manic or major depressive episodes → tend to be in one mood state or the other for years with relatively few periods of neutral or (euthymic) mood, pattern must lsat 2 years (one for children and teens), alternate between mild depressive symptoms and hypomanic episodes → a lot of times these people are just considered moody, but if this interferes with functioning they can be treated → have an increased risk of getting bipolar disorder, having this before bipolar disorder decreases the chance that an individual will recover completely in between episodes

acceptance and commitment therapy

mindfulness and accepting and moving on from thoughts (becoming aware of them, not the same as believing they're true, acknowledging them and letting them go in efforts to relax, makes the thoughts less powerful and over time they come less, being curious and non judgmental about your thoughts) rather than fighting them (which happens more in cognitive behavioral therapy) → "The Happiness Trap" is the greatest primer on this → can help people that feel they have to constantly fight their thoughts (because some people end up in a never ending fight with them) → we don't have to be afraid of our thoughts, can acknowledge them and not feel bad about them, can have negative thoughts and not let them become sticky, don't empower the thoughts

current understandings of gender

more complicated than just boys having a penis and girls having a vagina → both biological and psychological gender if complicated → some people have male and female sex organs (could have an extended clitoris or shortened penis, could have chromosomal differences, could have both kinds of internal sex organs) and some people feel they are a different gender than the one they were born as

suicide statistics

more suicides than homicides worldwide in the US by a factor of 3:2 Almost 1,100 suicide per year on college campuses 4 out of 5 young adults who attempt suicide have given clear warnings before attempting Second leading cause of death among college students (may be underreported due to car crashes and overdoses that weren't accidental)

cognitive behavioral therapy

most common and may be most empirically validated → cognitive steps challenge your negative thoughts and distortions → behavioral part can include behavioral activation (daily goals that get them out of bed), this can include exercise (getting your HR up on a regular basis can help with depression) → more quantitative and think about goals and homework → may be more short term than others

with mixed features

need at least three symptoms of mania (applies to both major depressive and persistent depressive)

obesity

not an official disorder in DSM but it is considered in book because it is a public health epidemic → 70% of US is overweight with more than 35% meeting obesity criteria → rates have been increasing for decades but now be leveling off → definitions of under and overweight based on BMI → BMI can be inaccurate when you have a lot of muscle or when you weigh a normal amount but have too much fat, Because obesity can be genetic and has a tendency for overeating some think it should be considered a disorder

with peripartum onset

occurs around time of a pregnancy in women, can be after birth (more common at this time), can happen with fathers too and odds go up for both fathers and mothers a year after pregnancy, "baby blues" are minor reactions to childbirth and last a few days, very common, typically have a hard time understanding why they're depressed, extreme stress can cause it, rapid decline in reproductive hormones could cause it too, or may have higher levels of corticotrophin releasing hormone, treatment approach is same

narcolepsy

one of the hypersomnolence disorders Experience daytime sleepiness and cataplexy (sudden loss of muscle tone) → occurs while the person is awake and can range from slight weakness in the facial muscles to complete physical collapse → can last from a few seconds to several minutes → usually preceded by a strong emotion → is due to a sudden onset of REM sleep (sleep in which muscles don't move) Commonly report sleep paralysis (brief period after awakening when they can't move or speak) and hypnagogic hallucinations (vivid and often terrifying experiences that begin at the start of sleep and are very realistic because they include both visual aspects and touch, hearing and sensations of body movement) Occurs in 0.03-0.16% of the population → equal among males and females Typically starts in teenage years Excessive sleepiness usually comes first and then cataplexy → cataplexy, hypnagogic hallucinations and sleep paralysis can decrease over time while sleepiness normally doesn't Sleep paralysis and hypnagogic hallucinations can occur in people without insomnia and account for UFO stories → sleep paralysis can be associated with anxiety disorders in which case it is called isolated sleep paralysis Narcolepsy could be associated with a cluster of genes on chromosome 6 and it may be an autosomal recessive trait → significant loss of hypocretin neurons occurs in these people (these neurons secrete peptides that are important in wakefulness

new psychotic disorder for further study, attenuated psychosis syndrome

people may have some symptoms but are aware of the troubling and bizarre nature, may be in an early stage of schizophrenia and would benefit from early treatment

bipolar mood disorder

people that alternate between depression and mania → people can be having a manic episode while also feeling somewhat depressed or anxious or can be depressed while also having mania symptoms → these kinds of episodes have mixed features, People that only experience mania meet criteria for bipolar disorder because research predicts they will eventually experience depression → new models view bipolar disorder as an evolving condition

unipolar mood disorder

people who suffer from only depression or mania → mood remains at one pole of the spectrum

anorexia nervosa

person at only minimal amounts of food or exercises vigorously to offset food intake so body weight sometimes drops dangerously

brief psychotic disorder

presence of one or more positive symptoms lasting one month or less, regain previous ability to function well, often precipitated by very stressful situations

psychotic disorders

psychotic = delusions/hallucinations → someone out of touch with reality and experiencing delusions, hallucinations, or both (this word is used incorrectly all the time, people use it to mean violent, unstable, mean, crazy, or wacked out on a substance) Delusions are thoughts out of touch with reality Hallucinations are sensory experiences out of touch with reality (can occur with all 5 senses, auditory is the most common kind) Hallucinations can occur when you haven't slept enough, when under the influence, or even when there is nothing wrong People aren't called psychotic if they're only had a few brief hallucinations Schizophrenia symptoms can be truly terrifying for the patient, need to have sympathy for them → try to see ourselves in their shoes rather than seeing them as so different from us in order to have empathy

one unique specifier to bipolar disorder

rapid-cycling specifier → move more quickly in and out of episodes → needs to have experienced at least four manic or depressive episodes within a year → severe form that doesn't respond as well to standard treatments → higher chance of suicide attempts and more severe episodes of depression → symptoms more severe → may need to treat with anticonvulsants and mood stabilizers instead of antidepressants → 20-50% of patients experience rapid cycling (60-90% are female) → rapid cyclin tends to increase over time and can reach severe states in which person cycles between mania and depression without any break → when direct transition from one mood to another happens it is called rapid switching or rapid mood switching (very resistant form) → rapid cycling frequency is higher among those taking antiderpessents (maybe this is a cause) → rapid cycling isn't permanent (only 3-5% continue with it for a 5 year period) → ultra rapid cycle lengths may only be a few days or weeks and ultra-ultra -rapid cycling may have cycles of less than 24 hours (may be depressed at night and manic in the day)

premenstrual dysphoric disorder

recently added, small group of women (2-5%) that suffer from severe and sometimes incapacitating emotional reactions during premenstrual period, controversial due to issues of stigma, but these women differ from most other women, need physical symptoms, severe mood swings, and anxiety for diagnosis, best considered a mood disorder rather than a physical disorder based on research, creation of diagnosis is meant to help this women, not stigmatize them

fatalistic suicides

result from a loss of control over one's own destiny

anomic suicides

result of marked disruptions like the sudden loss of a job, name comes from feeling lost and confused

schizophreniform disorder

schizophreniform disorder is when symptoms of schizophrenia occur for just a few months and disappear on their own (0.2% lifetime prevalence) → requires onset of psychotic symptoms within 4 weeks of first change in behavior, confusion at height of psychotic episode, good premorbid social and occupational functioning, and the absence of blunted or flat affect

genetic influences of schizophrenia

severity of parent's schizophrenia has been shown to influence the likelihood of child having schizophrenia → people appear to inherit a general predisposition for schizophrenia that manifests in the same form or differently from that of your parent (can have any of the related forms) → there also may be familial risk for spectrum of psychotic disorders related to schizophrenia → the closer you are to the family member with schizophrenia genetically the greater the chance you have of getting it one group of quadruplets all had schizophrenia but acquired it at different times with different severities either due to de novo mutations or the slightly different environments they experienced growing up → adopted kids with moms with any of the schizophrenic disorders still had a 22% chance of developing any of the related disorders → however a healthy home environment seemed to be protective → a study showed that if your parent had an identical twin with schizophrenia you had an equal chance of getting the disorder as the child of the aunt/uncle with schizophrenia (indicates that you can be a carrier for schizophrenia genes, not show the disorder but pass risk on) → overall 17% inheritance of schizophrenia from parents genes on chromosome 8, chromosome 6, and chromosome 22 have been implicated in schizophrenia → one of these is COMT gene (important in dopamine metabolism which is disrupted in schizophrenia endophenotyping is done in which they find processes that contribute to the symptoms of the disorder and find genes that cause these difficulties → have researched smooth-pursuit eye movement or eye tracking (people with schizophrenia cannot track objects with eyes as well, also an issue for relatives of people with schizophrenia) → specific cognitive deficits have been shown to be inherited in families along with schizophrenia

whether or not you have a sleep wake disorder can be...

subjective and depend on how your react to a hard time falling asleep or bad quality of sleep during the day → daytime sequelae is your behavior while awake

schizophrenia used to be divided into...

subtypes based on content of psychosis → no longer the case in DSM-5 but outdated terms are still in partial use → included paranoid, catatonic, residual (minor symptoms persist after past episode), disorganized (many disorganized symptoms), and undifferentiated

Freud thoughts on suicide

suicide indicated unconscious hostility direct inward to the self rather than outward to the person or situation causing the anger → could be psychological punishing other that rejected them or caused them some other personal hurt

second generation antipsychotic meds

tend to have less side effects

paraphilic disorders

term for sexual deviation, in which sexual arousal occurs in the context of inappropriate objects or individuals, tend to focus on something specific that doesn't include normal consenting adult partners

the highest functioning people with schizophrenia may fall under...

the paranoid type

disruptive mood dysregulation disorder

there have been increasing numbers of kids mistakenly diagnosed with not otherwise specific bipolar disorder because they are chronically irritable, angry, aggressive, hyperaroused, and have frequent temper tantrums → found recently that they show no signs of elevated mood and have an increased risk of developing additional depression and anxiety disorders instead of bipolar disorder as adults, it is more common than normal bipolar disorder, typically due to suffering of the children due to negative affect and disrupted family life, intense negative affect drives irritability and an inability to regulate mood, so kids under 12 years old can now get this diagnosis instead of bipolar disorder (treatments for which could be harmful to kids), adults with a history of this disorder are at increased risk for other mood and anxiety disorders and other adverse health outcomes, need to develop treatments

most forms of sexual behavior are nor disorders unless...

they involve children or substantially impair functioning

the phrase "commit suicide"

think it pathologizes it or makes it sound more like a crime and want to lower the stigma around talking about it so people will seek help → more use of phrase "die by suicide"

obesity vs. over-thin ideals

two sides of the same problematic coin? → in the US there is a really problematic relationship with body image and size → some of the things that cause eating disorders could be connected to some of things that cause obesity → our cultural relationship with food and bodies is one in which we demonize obese bodies and idolize thin bodies → can perpetuate a cycle of shame and embarrassment that leads to obesity and eating disorders → if we had a healthier more-accepting culture there may be fewer eating disorders and decreased rates of obesity

polysomnographic evaluation

when a patient spends one or more nights sleeping in a sleep lab and being monitored on a number of measures like respiration and oxygen saturation, leg movements, brain wave activity, eye movements, muscle movements, and heart activity → daytime behavior and typical sleep patterns are also noted → important for accurate diagnosis and treatment plan

eight depressive disorder specifiers

with psychotic features, with anxious distress, with mixed features, withe melancholic features, with atypical features, with catatonic features, with peripartum onset, with seasonal pattern

actigraph

wrist watch sized device that records the number of arm movements→ can detect when someone falls asleep when they wake up and how restful sleep is, can also use similar smartphone apps to track sleep

ego-syntonic

you see yourself one way because it is matched with how you see the world in general, don't realize you see the world in a different way

episode of depersonalization

your perception alters so that you temporarily lose the sense of your own reality, as if you were in a dream and you were watching yourself, tend to be part of a serious set of conditions in which reality, experience, and even identity disintegrate,

episode of derealization

your sense of reality of the external world is lost, things may seem to change shape or size, people may seem dead or mechanical