Diathesis Stress Model

What stressors can contribute to MDD?

- Negative life events (e.g., divorce, unemployment) - Minimal social support - Decreased engagement in activities, ↓ reinforcement - ↓ SES - Rumination

What stressors can contribute to panic disorder?

- Threatening or traumatic events - Observing fear in others - Catastrophizing misinterpretation of physical sensations

What diatheses can contribute to panic disorder?

-Genetic predisposition (Neuroticism, Neurotransmitter activity (GABA, 5-HT, NE) - Enhanced sensitivity to feelings of suffocation or threat - Anxiety sensitivity

What diatheses can contribute to MDD?

-Genetic predisposition (Neurotransmitter irregularities (5-HT, NE), Brain abnormalities (↓ metabolic activity & size of prefrontal cortex), Neuroticism (+↓ positive affect or extraversion) - Depressive cognitive distortions - Learned helplessness (attributions)

What is the DSM5 definition of a mental disorder?

Clinically significant disturbance in cognition, emotion regulation, or behavior and reflects dysfunction in psychological, bio, developmental processes

A model of mental disorders that recognizes the roles and interactions of both predispositions and environmental or situational factors.

Diathesis Stress Model

60yof CC: exhausted bc problems sleeping, affecting her work. concerned about getting a bad performance review from her supervisor (hasn't happened yet) can fall asleep by 10 but wakes up by 3AM then cannot fall back to sleep. going on for 6 mo and occurs nightly. She learned 6mo ago that there were cut-backs at work and she may be offered an early retirement package What are the diatheses and stressors?

Diathesis: older female Adjustment disorder (clear stressor and continuation of stressor), GAD, depression

45yof saying her daughter is getting married and she cant sleep bc shes nervous about wedding. Her own mother had a nervous breakdown at her wedding and doesnt want that to happen to her daughter Always has been a nervous nellie but is now worse while planning for the wedding. Constantly worries about something going wrong with the wedding -- makes her more irritable, worries about finances, family health, something going wrong with her job Dx

GAD (irritability, fatigue,

41yom who hasn't been sleeping well. Tired all the time, can't focus since he lost a considerable sum of money in a bad investment 3mo ago. Reports mom and sister both take meds to help them sleep, wonders if you'll rx something to help. family takes SSRI (Paxil). patient lost interest in things he likes, no appetite, lost weight, feels so restless since he can't sit still. Discusses that he feels like a failure and the loss of money confirms. Has become more isolated Dx?

MDD

Diathesis/stress: Trauma, Abuse, Family or interpersonal conflict, Significant life changes

Stress

25yof brought in by wife. Pt sleeps only a few hours each night due to laboring on projects, wife concerned about depression. Pt feels fine after taking antidepressant and now talks rapidly about her new ideas to make more money and she says you probably are surprised to see someone as smart as she is as young as she is Dx?

bipolar type II (grandiosity, sleep change, hyperfocused, increased productivity, no psychotic features-- not I)

DSMV is descriptive/phenomenological

descriptive (describes disorders but does not explain why they occur)

25yof brought in by wife. Pt sleeps only a few hours each night due to laboring on projects, wife concerned about depression. Pt feels fine after taking antidepressant and now talks rapidly about her new ideas to make more money and she says you probably are surprised to see someone as smart as she is as young as she is Diathesis and stressors

diatheses: age, hx of depressive episode stress: starting SSRI, recent lack of sleep

45yof saying her daughter is getting married and she cant sleep bc shes nervous about wedding. Her own mother had a nervous breakdown at her wedding and doesnt want that to happen to her daughter Always has been a nervous nellie but is now worse while planning for the wedding. Constantly worries about something going wrong with the wedding -- makes her more irritable, worries about finances, family health, something going wrong with her job Diatheses and stressors

diatheses: family history, enhanced sensitivity to anxiety stressors: daughter's wedding

41yom who hasn't been sleeping well. Tired all the time, can't focus since he lost a considerable sum of money in a bad investment 3mo ago. Reports mom and sister both take meds to help them sleep, wonders if you'll rx something to help. family takes SSRI (Paxil). patient lost interest in things he likes, no appetite, lost weight, feels so restless since he can't sit still. Discusses that he feels like a failure and the loss of money confirms. Has become more isolated What are the diatheses and stressors?

diatheses: family hx of depression, generalized thinking stressors: lost money

22yom comes in after recommended from academic advisor. Sleeping poorly but won't tell you why. tells you his mom, aunt, grandma are "loony" and doesn't want people to think he is too. admits that he was sexually abused by an uncle at the age of 5-7. For the past 8 mo, pt has been hearing his now deceased uncle's voice through the electrical outlets telling . him to end it all. He reports getting messages from tucker carlson. stressors and diatheses?

diatheses: family hx of mental illness, hx of trauma, age stress: school stress, recent onset of auditory hallucinations

Diathesis/stress: Inherited genetic predisposition, Dysfunctional thinking patterns, Personality traits

diathesis

Diathesis/stressor for panic disorder: those with high anxiety sensitivity for most of their lives

diathesis

a predisposition or vulnerability

diathesis

60yof CC: exhausted bc problems sleeping, affecting her work. concerned about getting a bad performance review from her supervisor (hasn't happened yet) can fall asleep by 10 but wakes up by 3AM then cannot fall back to sleep. going on for 6 mo and occurs nightly. She learned 6mo ago that there were cut-backs at work and she may be offered an early retirement package Dx? what risk factors?

insomnia

an idealized representation of reality that highlights some aspects and ignores others

model

What are the models and mechanisms of explaining why mental disorders occur?

neurobio, psychological, sociocultural, biopsychosocial

Mental disorder/not a mental disorder: an expectable or culturally approved response to a common stressor or loss

not a mental disorder

Mental disorder/not a mental disorder: socially deviant behavior or conflict between individual and society

not a mental disorder

22yom comes in after recommended from academic advisor. Sleeping poorly but won't tell you why. tells you his mom, aunt, grandma are "loony" and doesn't want people to think he is too. admits that he was sexually abused by an uncle at the age of 5-7. For the past 8 mo, pt has been hearing his now deceased uncle's voice through the electrical outlets telling . him to end it all. He reports getting messages from tucker carlson. Dx?

schizophrenia

events or situations to which people must adjust

stress

Diathesis/stressor for panic disorder: those with recent onset of anxiety sensitivity

stressor