PSY 395 Exam #2

Marques and colleagues (2011)

Anorexia and bulimia are relatively homoge-neous, and both—particularly bulimia—were overwhelmingly associated with Western cultures until recently. In addition, the frequency and pattern of occurrence among minority Western cultures differed somewhat in the past, but those differences seem to be diminishing.

Risk of depression in depression and bipolar in men vs. women and potential causes of the increased risk of depression in women

Approx 20% of the US population has experienced a major depressive disorder in their lifetime 6-7% of people with bipolar disorder die by suicide Bipolar disorder is distributed equally among genders Women • Twice as likely to have mood disorders than men can develop premenstrual dysphoric disorder (PMDD) or disruptive mood dysregulation disorder • Women are more likely than men to experience rapid cycling but also to be anxious and to be in a depressive phase rather than a manic phase

Cottone and Colleagues (2009)

Began feeding rats junk food, which the rats came to love, instead of a boring diet of pellets. They then withdrew the junk food but not the pellets. Based on observations of brain function com-pared with rats who never had junk food, it was clear that these rats became extremely stressed and anxious. Furthermore, the "junk food" rats began eating more of the pellets than the control group which then seemed to relieve the stress. Thus, repeated cycles of "dieting" seems to produce stress-related withdrawal symptoms in the brain, much like other addictive substances, resulting in more eating than would have occurred without dieting.

Bulimia Nervosa

Binge-eating accompanied with compensatory behaviors, on average, once a week for 3 months 1) Recurrent Binge Eating Episodes 2) Compensatory behaviors • Purging: vomiting, diuretics, laxatives • non-purging : exercise (maladaptive), fasting 3) Self-evaluation is unduly influenced by weight and body shape Not significantly low body weight • Tend to be of average weight (usually within 10% of normal weight) Comorbidity high; associated with: anxiety, depression, substance use • Sometimes its the other way around where the anxiety/depression contribute to extreme eating behaviors

Life Span Developmental Influences on Mood Disorders

Children • Children under 3 years of age might manifest depression by sad facial expressions, irritability, fatigue, fussiness, and tantrums, as well as by problems with eating and sleeping • Preschool mood fluctiations common - but prolonged depression can be a sign • Preschool depression can be a predictor of future depression, or other disorders such as ADHD/conduct disorder (aggression/destructive behavior) Older Adults • Age 56-85 • Depression in nursing homes is common • Increased illness, decreased social support • Racial/ethnic differences: people from ethnic underrepresented groups had 1.5-fold to 2-fold higher risk for experiencing anhedonia, sadness, and psychomotor symptoms as compared with non-Hispanic White participants

Major Depressive Disorder, general onset/course

Defining symptoms: at least 1 of these, most of the day nearly every day 1) Depressed mood (sad, empty, down, hopeless) 2) Anhedonia: Diminished interest and/or pleasure in activities General Onset/Course • Often develops in early teens • Rates rising (25% age 18-29 had developed depression) • 9 month episode - 90% likely to recover within 1 year • 5 year long episode - 38% likely to eventually recover • common for major depressive disorder & persistent depressive disorder to occur simultaneously (double depression)

Stice and Colleagues (1999)

Demonstrated that one of the rea-sons attempts to lose weight may lead to eating disorders is that weight-reduction efforts in adolescent girls are more likely to result in weight gain than weight loss. To establish this finding, 692 girls, initially the same weight, were followed for 4 years. Girls who attempted dieting faced more than 300% greater risk of obesity than those who did not diet.

Polysomnography; Electrocenephalography

Electroencephalography (EEG): Measures sleep based on electrical activity in the brain Objective measurement Sleep stages Problems: Can be expensive, the sleep is not generalizable to normal sleep (in a hospital bed/diff environment) Not used for the majority of sleep disorders - only a specific few

Derealization

Experiences of unreality of detachment with respect to surroundings. Loss of sense of the external world. Things seem "dreamlike, foggy, lifeless". Visual and auditory distortions such as blurriness, heightened ability to see detail, auditory distortions (sounds muted or heightened)

Depersonalization

Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body or action. Diminished agency - feeling robotic, lacking control over speech/movements, feeling like an outside observer in a dream/watching a movie. Sometimes there is more detail than would otherwise be experienced - a person may hear things more clearly than normal

Unipolar Mood Disorder

Experiencing either depression or mania

Stress and its overall relationship to the immune response and results of studies by Sheldon Cohen and colleagues

Experiment: 1) Deposited cold virus in nasal passage 2) Placed in quarantine for 5 days • They found that the chance a participant would get sick was directly related to how much stress the per-son had experienced during the past year. • Quantity & quality of social relationships (if good) makes a person less likely to develop a cold; perhaps because socializing w/ friends releases stress • Positive & optimistic cognitive style helps to protect against developing a cold • Cold likelihood compared to those without a stressor - much lower • Cortisol is supposed to decrease inflammation response, but if it is not working well, the lessened inflammation response can lead to symptoms that we have related to a cold

Secondary Insomnia

Explained by another condition Caused by pain, depression, anxiety, heart disease, etc

Definitions of health psychology and behavioral medicine and broad ways in which psychological and social factors influence health and physical problems

Health Psych & Behavioral Medicine Prevent, diagnosis and treatment of medical problems Psychological factors in promotion of health • Psychological and social factors 1) can affect the basic biological processes that lead to illness and disease, and 2) long-standing behavior patterns may put people at risk of developing certain physical disorders • Stress: alarm, resistance, exhaustion. Excessive cortisol secretion leads to aging of the hippocampus

Coronary Heart disease and psychological correlates of the disease, including the relationships between Type A and Type B personalities and heart disease

Heart disease: 2 types of artery damage Atherosclerosis: narrowing of arteries caused by hardened cholesterol and other substances Arteriosclerosis: hardening of arteries Factors: genetics, age, blood pressure, diet, smoking, exercise Type A and Heart Disease: Type A: Time urgency, competitiveness, hostile, angry, ambitious Type B: relaxed, easygoing Procedure: 3200 healthy young men aged 39-59 followed for 8.5 years Findings: 2x increase in developing heart disease among Type A • Replication was difficult • Difficult to categorize into 2 groups • Certain variables more important (ex. Anger, hostility contribute more) • Correlations with anxiety/depression

Narcolepsy associated features

Hypnagogic (initiating) or Hypnopompic hallucinations (waking up): Vivid, often frightening sensory experiences while falling asleep (dreams often experienced as reality) Sleep paralysis: A brief, often frightening period after awakening when unable to move or speak

Relationships between cortisol, the hippocampus and the stress response

Hypothalamic-pituitary-adrenocortical (HPA Axis) has a Cortisol release • Helps to release stored reserves of energy to enable the individual to be able to maintain behavior within the fight-flight response • Excessive cortisol release can lead to high blood sugar levels Prevents less critical functions (ex. digestion) • Helps to decrease inflammation This is a health, adaptive, and normal response, but if it happens excessively it can lead to damage to the hippocampus • Learned-helplessness • Loss of control • Lack of prediction • No outlets for frustration • Chronic threats • Social subordination • All lead to increase corticotrophin releasing --> Lead to excessive and chronic cortisol secretion --> Lead to hippocampus degeneration --> Feedback loop → hippocampal degeneration also causes excessive and chronic cortisol secretion, cycle • Also linked with a defficient/disregulated immune response

Clinical description and characteristics and causes of Narcolepsy

Irrepressible need to sleep Frequent often irresistible naps One of the following 1) Cataplexy: Sudden loss of muscle tone lasting for several seconds to several minutes Frequently triggered by strong emotions REM loss of muscle tone Not actually sleeping Hearing and awareness remain 2) Hypocretin (orexin) deficiency 3) Early REM sleep onset Associated Features: • Hypnagogic (initiating) or Hypnopompic hallucinations (waking up) • Vivid, often frightening sensory experiences while falling asleep (dreams often experienced as reality) • Sleep paralysis: A brief, often frightening period after awakening when unable to move or speak

Jet Lag Type, Shift Work Type, Delayed Sleep Phase Type, and Advanced Sleep Phase Type

Jet Lag: Caused by rapidly crossing time zones Shift Work: Associated with work schedules such as emergency personnel (police, hospital) Delayed Sleep Phase Syndrome: Late bedtimes and late rise times, Evening melatonin, Morning light vs. Advanced Sleep Phase Syndrome: Early bedtimes and early rise times

Learned helplessness theory of depression

Learned Helplessness Model of Depression Seligman: Studied Dogs & Rats 3 conditions: 1) No shock, 2) Shocked with control, 3) Shocked without control Group #3 ended up becoming very anxious dogs, passive, whiney Part II: Group #3 didn't escape when the opportunity was presented; Learned Helplessness - thought that they had no chance of escape But - not all of group 3 animals developed learned helplessness

Marital Relations and gender interaction in the risk of developing mood disorders

Marital Relations • Mood disorders are influenced by interpersonal stress, specifically marital relations/issues/dissatisfaction • Men who separated/divorced were likelier to develop depression than women • Depression can put a strain on relationships, negativity can be contagious Mood Disorders in Women • almost 70% of the individuals with major depressive disorder and persistent depressive disorder are women Why? Perceptions of uncontrollability, cultural differences with how men and women "should" be, culture may put women at a higher risk for developing depression (fragile, vulnerable mentality) • Women are at a disadvantage in in most cultures in the world: They experience more discrimination, poverty, sexual harass-ment, and abuse than do men. They also earn less respect and accumulate less power. • Disorders associated with aggressiveness, overactivity, and substance abuse occur far more often in men than in women

Pope and colleagues (2000)

Measured the height, weight, and body fat of college-age men in three countries —Austria, France, and the United States. They asked the men to choose the body image that they felt represented (1) their own body, (2) the body they ideally would like to have, (3) the body of an average man of their age, and (4) the male body they believed was preferred by women. In all three countries, men chose an ideal body weight that was approximately 28 pounds more muscular than their current one. They also estimated that women would prefer a male body about 30 pounds more muscular than their current one. most women preferred an ordinary male body without the added muscle

Ancel Keys & colleages (1950) Minnesota Starvation Study

Minnesota Starvation Study How to re-nourish and rehabilitate WWII war victims 6 months: received half their normal calories (more generous than many weight loss diets today) to reduce body weight by 25% Psychological effects: "semistarvation neurosis" Depression, anxiety, distorted body images, body harm, extreme Became preoccupied with food Binge episodes (unable to restrict) Normalization phase: insatiable appetites yet never full

Treatment for Bipolar Disorder

Mood stabilizers Lithium (lithium carbonate) Side effects: weight gain, missing manic state (they often enjoy the manic state, and then on medication, they miss it and then stop taking medication --> relapse) • 50% reduction in symptoms reported • For those patients who do respond to lithium, studies following patients for up to 5 years report that approximately 70% relapse, even if they continue to take the lithium ECT Electroconvulsive Therapy: Electric shock is administered directly through the brain for less than a second, producing a seizure and a series of brief convulsions that usually lasts for several minutes. For severely depressed inpatients with psychotic features, controlled studies indicate that approx. 50% of those not responding to medication will benefit.

Depression Negative Attribution Style

Negative (Depressive) Attributional Style Internal: People who are depressed will attribute/interpret negative events to an internal way. Ex. "Negative outcomes are my fault." Global Stable: The person believes the cause is unchangeable Negative events are generalized

Role of chronic negative emotions and coronary heart disease

Negative Affect: Type D The Health Belief/Health Behavioral Model • People with negative affect have an unhealthy lifestyle • Ex. people with anxiety/depression are more likely to smoke, use drugs, eat unhealthy foods The Psychophysiological Reactivity Model Exaggerated and persistent stress response • Hypertension: high blood pressure puts people at risk

Clinical description and characteristics of nightmares

Nightmare disorder: Frequently being awakened by extended and extremely frightening dreams that cause significant distress and impaired functioning. Occurs during REM or Dream sleep. To qualify as a nightmare disorder, according to DSM-5 criteria, these experiences must be so distressful that they impair a person's ability to carry on normal activities (such as making a person too anxious to try to sleep at night). Nightmares are defined as disturbing dreams that awaken the sleeper; bad dreams are those that do not awaken the person experiencing them. Associated with genetics, trauma, medication, other psych disorders

Sleep Walking

Occurs during NREM sleep (not dreaming) This parasomnia typically occurs during the first few hours while a person is in the deep stages of sleep. The DSM-5 criteria for sleepwalking require that the person leave the bed, although less active episodes can involve small motor behaviors, such as sitting up in bed and picking at the blanket or gesturing. Because sleepwalking occurs during the deepest stages of sleep, waking someone during an episode is difficult; if people are wakened, they typically will not remember what has happened.

Diagonistic Criteria: Major Depressive Disorder

Physical Symptoms: 3) Sleep disturbance. Insomnia: Falling asleep easily but waking up, early morning wakening. Hypersomnia: Sleeping too much 4) Psychomotor disturbance: Agitation (restless, pacing, difficulties standing still), Retardation (behavioral shutdown, moving slowly, speaking slowly, pauses, associated with extreme depression) 5) Extreme fatigue or low energy, Extreme effort for small tasks 6) Significant weight gain or loss: Increase or decrease in appetite. Cognitive Symptoms: 7) Feelings of worthlessness or inappropriate guilt: Unrealistic evaluation of one's own worth, self-blame, very hard on themselves, extreme or delusional, may have insight on how to feel better but cannot connect it to their own lives. 8) Impaired ability to think, concentrate, or make decisions: Hard to do well in class, maintain conversations, study, higher-level tasks, problem-solving, concentration, important decisions. 9) Recurrent thoughts of death or suicide

Insomnia Causes (Triple P Model)

Predisposition Neuroticism: trouble dealing with stressful events, emotional Body biological temperature clock issues Precipitate Stress: frequently experienced as mind racing worry/life concerns/sleep Perpetuate Sleep habits: Overcompensating for a poor night's sleep with: Alcohol & other substance use (works but its problematic), Napping, Caffeine, Light exposure (going on your phone). Try to leave the bed in the bedroom if you can't sleep - you want to associate the bed with sleep onset Conditioned Bedtime Arousal: Mind racing, Heart pounding, Cognitive and physiological sensations at bedtime Catastrophize/Unrealistic Expectations (I must get 8 hours, I cannot function without sleep) → Anxiety (sleep gets worse, overestimate wake time) → Increased Nighttime Worry → Chronic Insomnia

Summary of psychosocial and social aspects of pain

Psychological Factors Related to Pain Highly subjective & difficult to quantify The adrenaline rush & endorphins Attention & distraction Overly concerned about health Meaning (Ex. WWII - I'm alive, I made it, I can go home)

Relationships between social support and depression

Risk factors • lack of close friendship • living alone • A socially supportive network helped speed recovery from depressive episodes but not from manic episodes

Treatment for Major Depression

Selective Serotonin Reuptake Inhibitor (SSRI) Ex. Prozac, Paxil, Zoloft, Lexapro, Celexa Symptom relief: ~50% Full Remission: ~25-30% Side Effects: Sexual dysfunction, desire As we study these more and more, we realize that the effects are not as good as they seem (not much different from placebo pills) Behavioral: Behavioral Activation Treatment Stress → Maladaptive Coping Ex. Avoidance, Isolation Little enjoyment, meaning People with depression are driven by negative reinforcement and not positive reinforcement Seek to avoid negative events over pursuing positive events Develop a list of goals, values Promote (schedule) positive and rewarding activities and coping skills Cognitive Approach to Treatment/CBT Cognitive Meditation Events are interpreted Those with depression have tendencies to interpret everyday events in a negative way; Focus on changing thought patterns

Measures of Sleep

Sleep Diary: tracks sleep Polysomnography (PSG)

Psychological processes that distinguish stress, anxiety, depression, and excitement

Stress • tense, irritable • under too much pressure • Feeling like you could handle a task if only you had the time and resources you need, but you are lacking this Anxiety • Something is threatening you and you feel like there is little you can do about it • Incessant worry • Certain aspects of our lives feel out of control Depression • Loss of hope • View of life as threatening • Depression is the state in which you are no longer trying to cope with the stressors; you've lost hope Excitement • Rapid heartbeat • Burst of energy • jumpy stomach • a good feeling; excitement may enhance performance

Overall relationships between stress and depression and stress and bipolar disorder

Stressful events are strongly related to the onset of mood disorders Particularly humiliation, social rejection, relationship description Bipolar (more positive events) Cortisol (stress hormone) results in damage to the Hippocampus (memory; regulates cortisol)

Cross-cultural Considerations of eating disorders including the results from Nasser (1998)

Survey of 50 Egyptian women in London universities and 60 Egyptian women in Cairo universities (Nasser, 1988). There were no instances of eating disorders in Cairo, but 12% of the Egyptian women in England had developed eating disorders. Mumford, Whitehouse, and Platts (1991) found comparable results with Asian women living in the United States.

Striegel-Moore and colleagues (2003)

Surveyed 985 White women and 1,061 Black women who had participated in a 10-year government study on growth and health and who were now 21 years old on average. Risk factors: being overweight, higher social class, and acculturation to the majority. compared to White women, African American women feel less pressure to lose weight and are more satisfied and comfortable with their bodies, which may contribute to the somewhat lower incidence of eating disorders in African American women.

Pain behaviors definition & implications

Taking pain medicine Grimacing Avoidance of activity Rubbing a painful area Operant conditioning: dysfunctional behaviors are shaped Pain behavior: laying in bed, show distress, activity avoidance Reinforcement: attention, access to drugs, avoid work Increase in pain behaviors Operant model: decrease pain behaviors Distract from pain, improve psychologically, greater strength Stress, fear of activity, and pain behaviors Negative emotion; stress → decreased activity; muscle tension → increased pain

Sleep Terrors

The child is extremely upset, often sweating, and frequently has a rapid heartbeat. On the surface, sleep terrors appear to resemble nightmares—the child cries and appears frightened—but they occur during NREM sleep and therefore are not caused by frightening dreams. During sleep terrors, children cannot be easily awakened and comforted, as they can during a nightmare. Child often screams upon waking up Children often do not remember their own sleep terrors

Genetic influences on overall mood disorders and Unipolar vs. Bipolar Mood Disorders

The genetic contributions to depression in both disorders are the same or similar but that the genetics of mania are distinct from depression. Thus, individuals with bipolar disorder are genetically susceptible to depression and independently genetically susceptible to mania. This hypothesis still requires further confirmation. McGruffin & Colleages

Aaron Beck, the role of cognitive errors and the depressive cognitive triad and its relationship with depression

Theory: depression may result from a tendency to interpret everyday events in a negative way • "cognitive errors" - thinking about things in a negative way arbitrary interference: emphasizing the negative overgeneralization • Aaron Beck - Depressive Cognitive Triad: when people make cognitive errors in thinking about their immediate world, their future, and themselves • develop a "negative schema" - these cognitive errors are automatic; unconscious, but can be fixed CBT = solution

Gate Control Theory of pain

There are a lot of psychological dimensions that affect how we feel pain Neural structures in the spinal cord and brain stem function like a gate The brain plays a role in opening/closing gate (top-down processing) The more open the gate, the greater the pain sensations

Good vs Poor Sleep

Total sleep time 18-25: Good 7-9 hours (Poor <6 >11) 25-64: Good 7-9 hours (Poor <6 >10) Sleep Onset Latency (how long it takes you to go to bed) >30 minutes to fall asleep tend to report it/complain about it Wake Time after Sleep Onset >30 minutes Sleep efficiency Ratio = Time sleeping/Time in bed x 100 (5/10 = 50%)

Bipolar Mood Disorder/Bipolar I Disorder, general onset/course

Two poles - alternations between full manic episodes and major depressive episodes Manic episode (one week or hospitalization) Specifiers of Bipolar I Disorder: Psychotic Features: Delusions and/or hallucinations, Poorer response to treatment Anxious distress: Keyed up, tense, worry, feel my lay control Mixed features (for Major Depressive Disorder): At least 3 symptoms of mania Atypical: Oversleep and overeat Peripartum Onset: "Baby blues" common (occurs in most women) Seasonal pattern: Sesonal pattern to mood disorder, Begins in fall or winter and ends in the spring, Sleep excessively, increased appetite and weight gain • Average age of onset is 15-18 years for Bipolar I and 19-22 years for Bipolar II • Develop quite suddenly

Actigraphy

Wristwatch-sized monitor that measures sleep based on movements Objective measurement Problems: Can be awake while lying and this can get misclassified as sleep

Overall description and Characteristics of Dissociative Identity Disorder (DID)

• "Multiple Personality disorder" • Clinical Description: Presence of 2 or more distinct identities, or personality states or "alters" (2 to 100) • Inability to recall personal information (gaps in memories; failure to integrate identities) • There are different parts of the self that are controlling the self • They may not be fully formed personalities • The different identities (alters) may have unique behavior, tone of voice, ages, sexual orientations, etc. • Switch: often brought on by dress and usually instantaneous but sometimes gradual • Primary (host) personality frequently is depressed, passive • Alters are frequently controlling, hostile. Alters may or may not know each other, or may even be in open conflict • Comorbidity is common (the presence of 2 or more disorders) • Onset is often childhood and lasts a lifetime if untreated • Treatment: therapy to confront trauma

Dissociative Fugue

• "fugue" = flight • Individuals take off and find themselves in a new place, unable to recall how they got there and why they are there. Usually, they have left behind an intolerable situation. • Person assumes a new identity or, at least, become confused about their old identity • Abrupt end with the individual usually remembering everything and returning home

Genetic relationships between depression and anxiety

• 1st Degree relatives with a Mood Disorder are 2-3x more likely to develop a mood disorder • Identical vs. Fraternal Twins: identical 2-3x more likely for any mood disorder as compared to fraternal twins • Mania vs. Depression: Major Depressive Disorder (unipolar) serves as no risk for Bipolar (identical twin). But, Bipolar disorder serves a risk for any mood disorder (Mania is genetically distinct from depression) • Anxiety & Depression: Go hand-in-hand, exist together, Similar genetic vulnerability • Temperament: Neuroticism, worriers, overly responsive to stress, emotional are more susceptible

Demographic statistics and the general course of eating disorders

• 90-95% of individuals with bulimia are women • Transgender individuals, male athletes • over 13% of adolescent girls experienced an eating disorder by age 20 • 29-34% college women attempted to limit food intake, 14-18% binge eating, 14-17% attempted to limit binge eating, 6-7% bulimic tendencies • median onset age for all eating disorders is 18-21 years • anorexia and bulimia started as early as age 10, 10-16 years old onset more common

Munchausen Syndrom: factitious disorder

• A diagnosis of Munchausen syndrome suggests that the person is faking an illness, just as the original Münchhausen lied about his adventures. • The symptoms in factitious disorder 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. • factitious disorder imposed on another/Munchausen Syndrome by proxy: A mother may make her child sick on purpose, for example

Hypomanic episode

• A 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 full week•

Description of Biofeedback

• A process of making patients aware of specific physiological functions that, ordinarily, they would not notice consciously, such as heart rate, blood pressure, muscle tension in specific areas of the body, electroencephalogram rhythms (brain waves), and patterns of blood flow • Clinicians use physiological monitoring equipment to make the response, such as heart rate, visible or audible to the patient. The patient then works with the therapist to learn to control the response. A successful response produces some type of signal. For example, if the patient is successful in lowering their blood pressure by a certain amount, the pressure reading will be visible on a gauge, and a tone will sound.

Advantages and Disadvantages of benzodiazepine treatment for insomnia

• Can cause excessive sleepiness • Dependency on the drug • Misuse of drug • Meant for short-term treatment (shorter than 4 weeks) • May increase likelihood of sleepwalking-related problems

Description of psychological treatments for insomnia

• Cognitive treatment for anxiety related to insomnia • Sleep hygiene (changing sleep habits) • Only using the bed for sleeping (not work)

Relationships between mood disorders and creative individuals

• Creativity is linked with mood disorders • Manic states may foster creativity • The genetic patterns associated with Bipolar Disorder may also carry the "creativity gene"

Malingering

• Deliberate faking of a physical or psychological disorder motivated by gain • Full awareness of what they are doing

Dissociation

• Detachment or alteration in consciousness, identity, memory • Some dissociation is common/normal • Not better explained by drug use, medical condition, or other mental disorder

Progressive muscle relaxation and the relaxation response

• Devised by Edmund Jacobson in 1938 • People purposely tense different muscle groups in a sequential fashion (lower arm, upper arm, and so on) followed by relaxing each specific muscle group. In this way they learn to recognize tension in different muscle groups and how to reduce it. • Herbert Benson: the relaxation response - a person repeats a mantra to minimize distraction by closing the mind to intruding thoughts • Relaxation has generally positive effects on headaches, hypertension, and acute and chronic pain, although the results are sometimes relatively modest • Appears to be effective for a range of problems, including stress and especially anxiety and depression

Cultural influences on Mood Disorders

• Difficult to compare subjective feelings across cultures • The way people think of depression may be influenced by the cultural view of the individual and the role of the individual in society • Focus on individual vs group • 28% of same village of Native Americans had depression, conditions & culture differ greatly from tribe to tribe

Findings and conclusions from Sapolsky's work with baboons involving cortisol, the stress response, and social rank

• Discovered that dominant males in the baboon hierarchy ordinarily had lower resting levels of cortisol than subordinate males. In an emergency, cortisol levels rose more quickly in the dominant males than in the subordinate males. • Subordinate animals, unlike dominant animals, continually secrete cortisol, probably because their lives are so stressful. • Their HPA system is less sensitive to the effects of cortisol and therefore less efficient in turning off the stress response. • Subordinate males have fewer circulating lymphocytes (white blood cells) than dominant males, a sign of immune system suppression • Top of social hierarchy: most predictability and controllability; control of social situations & ability to cope w/ tension that arises is a large contributing factor in stress

Somatic Symptom Disorder: Overall description, Characteristics, Statistics, Causes and Treatments

• Distress/impairment associated with somatic symptoms or fears of having a serious disease, but there is no detected medical problem or distress over and above what is expected • symptoms include pain and fatigue - real pain but severity of the pain is unexplained. People think they are very ill but they are not. • Similar features of anxiety disorders • former name is "Briquet's Syndrome" • compared to Illness Anxiety Disorder, Somatic Symptom disorder has more severity of pain • Experience excessive thoughts, feelings, or behaviors that are related to the somatic symptoms, which are manifested by at least one of the following: 1) Anxiety about symptoms 2) Disproportionate and persistent thoughts about the seriousness of the symptoms • The emotional part also contributes to the symptoms; the pain the patient is experiencing is real

Somatic Symptom Disorder/Illness Anxiety Disorder Treatments, Statistics, Causes

• Educational & supportive: Detailed and sensitive • Cognitive Behavioral Treatment (CBT): Identify and challenge illness-related misinterpretations, Show how to create symptoms, Stress reduction techniques • Psychotherapy (few successful results), SSRI's & depression medications have been used • 1-5% of population, severe Illness Anxiety is more prevalent in aging people • Causes - warped cognition & perception with strong emotional contributions, increased anxiety produces more physical symptoms which in turn worsens the anxiety, stressful life event, higher instances of disease in the family, potential "benefits" a person sees of being sick (attention, avoidance of work/responsibilities), anxiety

Major Depressive episode

• Extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms and disturbed physical functions to the point that even the slightest activity or movement requires an overwhelming effort. • Accompanied by a gen-eral loss of interest in things and an inability to experience any pleasure from life, including interactions with family or friends or accomplishments at work or at school. • Physical changes & behavioral/emotional shut-down

Illness Anxiety Disorder: Overall description, Characteristics, Statistics, Causes and Treatments

• Former name is "hypocondriasis" • Preoccupation with fears of having or developing a serious disease - concerned primarily w/ the idea of being sick. • No symptoms or mild symptoms • If sign is present (dizziness, belching, brief ringing of the ears) or if family history exists, the preoccupation is clearly excessive • Convince themselves that they have a serious disease with no real symptoms • High level of anxiety about health and easily alarmed about health status • Highly reactive to news stories/another person's illness, preoccupied with health • Excessive health-related behaviors (checking, research their disease, doctor shopping) or maladaptive avoidance (exercise, socializing) • Avoid normal things such as leaving the home out of fear of getting sick • Similar to panic disorder but: Illness Anxiety- focus on persistent thoughts about a disease that they feel like they already have. Not as focused/concerned about panic/outcome of panic.

Dissociative Amnesia

• Generalized Amnesia: Unable to remember anything, including who they are. Can be lifelong or extend from a prior time. • Localized or Selective Amnesia: Failure to recall specific events, usually traumatic, that occur during a specific period • Common during war • Forgetting is selective for traumatic events. Sometimes people will remember the event but wonder why they had been crying about it - the emotional response part gets forgotten. • Usually in adolescence, rarely occurs in adulthood • 1.8-7.3% of population • Treatment: therapy to recall what happened during amnesic state/often get better on their own

Mania

• Individuals find extreme pleasure in every activity • Persistently elevated, expansive, or irritable moods (3 or more of the following) 1) Out-of-the-ordinary behaviors 2) Inflated self-esteem or grandiosity (thougths that their abilities are much greater than what actually exist) Ex: special relationship with God, can be delusional in this aspect 3) Hyperactive symptoms. No need for sleep, no tiredness. More talkative or pressured speech, can say things that are irrelevant and go on and on • A flight of ideas: thoughts are going into individual's mind so fast that they cannot organize them. Incoherent, can go from topic to topic, sometimes irrelevant to overall topic Distractible: difficult to tune out irrelevant stimuli within the environment 4) Excessive Involvement in Goal-Directed activity (socially, sexually, work, school) 5) Excessive involvement in activities that have a high potential for painful consequences. Ex. Buying sprees, sexual indiscretions, investments, drug

Psychological dimensions associated with eating disorders

• Low self-esteem • Mood intolerance: Difficulty tolerating negative emotions may binge or purge to regulate mood • Associations w/ OCD and anxiety: Restrict weight/purge to reduce obsessive thoughts

History and efficacy of Selective serotonin reuptake inhibitors (SSRI's) for depression and relationships between SSRI's and suicidal behavior, overall efficacy of all classes of medications for depression, and overall side-effect profile of SSRI's vs. other medications

• Main goal is to delay the next depressive episode or prevent it entirely • Selective-serotonin reuptake inhibitors (SSRIs), mixed reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase (MAO) inhibitors • with treatment: The percentage of patients receiving at least some benefit increases to between 60% and 70%, but it's indicated that antidepressants were relatively ineffective for mild to moderate depression compared with placebo. • SSRI's associated with a small but statistically significant decrease in suicides among adolescents (but correlational, not causational) • Prozac and other SSRIs have their own set of side effects: physical agitation, sexual dysfunction, low sexual desire, insomnia, and gastrointestinal upset. • Venlafaxine is one that may reduce cardiovascular damage associated with SSRI's • Monomine oxidase (MAO) inhibitors: block the enzyme MAO that breaks down such neurotransmitters as norepinephrine and serotonin

Bipolar II disorder

• Major depressive episodes alternate with hypomanic episodes rather than full manic episodes • Hypomanic: less severe manic episodes

Findings regarding the overall relationships between stress and psychological problems and chronic physical illness

• Mental disorders of all kinds are linked with an increased risk of developing chronic physical conditions • The same types of stress-related psychological factors that contribute to psychological disorders may contribute to the later development of physical disorders and stress, anxiety, and depression are closely related.

Binge Eating Disorder

• New in DSM V • Hunger before, restricting of eating prior to binge, restricting of eating around others Recurrent episodes of binge eating: 1) Discrete period (wihtin 2 hours): Eat an amount of food clearly larger than most would eat during the same period. On average, 1 per week for 3 months. Typically high fat, high sugar foods, snack foods but it does not have to be 2) Lack of control: Rapid eating. Cannot stop urge once it's begun. Out-of-body experience/automatic. Without much conscious thought process or awareness. Dissociative quality. Frequently stopped by running out of food or they are interrupted. Typically in secrecy, in private 3) Marked distress about binge eating • Intense hunger/bad mood → binge (to cure feelings of sadness/other) → relief → disstress • Not underweight • Similar psych features common to other eating disorders, but... No compensatory behaviors, No extreme restriction of eating (purging)

Depersonalization/Derealization

• Persistent or recurrent Depersonalization and/or Derealization • Not separated by the DSM, but a person can experience one or both of Depersonalization or Derealization • Episodes are brief (hours to days) or prolonged (weeks to years) • Cause is unknown: Associated with severe stress, anxiety, and depression. It is thought by some that the body creates a coping mechanisms to detach from themself (short-term reinforcement that becomes problematic). Maybe these are strong psychological experiences that an individual can incur, and the anxiety and depression is a side effect. Severe trauma • Treatment: confronting/dealing with the experience, address the anxiety/depression/stressors. Medicine treatments have not been accurately studied. • 0.8-2.8% of population

Insomnia: Clinical description and characteristics

• Problems initiating, maintaining sleep, or early morning awakenings • 3 nights per week for 3 months • Causes distress or impairment • Not adequately explained by a substance or other mental/physical health condition • Problems: an individual that will catastrophize their sleep may inaccurately report, how do you know whether or not the distress/impairment is due to sleeping difficulties or anxiety/depression

Neurotransmitter systems and the permissive hypothesis and endocrine systems and their relationships with mood disorders

• Serotonin & depression: A chemical imbalance? Drugs cause an immediate increase of serotonin but delayed improvement Other successful drugs that do not target Serotonin Lower levels of serotonin in the blood, potential lower levels of serotonin in the brain Cause and effect: is depression causing low serotonin levels, or do low serotonin levels cause depression? We do know serotonin plays a role but it's complicated • Permissive Hypothesis: Current theory With low serotonin, other neurotransmitters are allowed to vary more widely (causes emotional dysregulation)

Potential causes of DID and potential links between DID and PTSD

• Severe abuse/trauma history (almost all report early trauma 97%). Main cause is severe childhood trauma resulting in the need to escape one's own mind. • Autohypnotic Model: Escape into a fantasy world and this is experienced as a separate personality; coping mechanism • The more you use this coping mechanism, the more the different personalities emerge • Extreme subtype of PTSD • Dissocation rather than anxiety

The role false memories in development of DID

• Severe trauma at childhood and have "repressed" the memory • But some clinical scientists suggest that many such memories are simply the result of strong suggestions by careless therapists who assume people with this condition have been abused. • One of the most controversial issues in the field of abnormal psychology today concerns the extent to which memories of early trauma, particularly sexual abuse, are accurate.

Overall evidence for the faking of DID/Suggestibility/Contraversy

• Sociocognitive model: Evidence indicates that therapists "suggest" multiple personalities to patients • leading questions, during psychotherapy or when patient is in a hypnotic state • little consensus on the scientific validity of DID • Children unable to distinguish between fantasy & reality • Only a small minority present to clinical attention with observable alternation of identities • Movies (3 faces of eve, sybil) and then cases exploded after

Family influences associated with eating disorders

• The "typical" family of some-one with anorexia is successful, hard-driving, concerned about external appearances, and eager to maintain harmony. • Mothers wanted daughters to be thin • Mothers likely dieting themselves • Family relationship strains after a child develops and eating disorder

Mixed features: unipolar & bipolar mood disorder

• The rate of depressed individuals later experiencing a manic episode is close to 25%, and as many as 67% of patients with unipolar depression experienced some manic symptoms - suggests that these disorders may exist on a continuum/spectrum and be interconnected

Efficacy of Biofeedback

• To focus successfully on the task at hand, we may have found it necessary to ignore our internal functioning and leave it to the more automatic and less aware parts of the brain. Still, internal sensations often take control of our con-sciousness and make us fully aware of our needs. • Some people benefit more from biofeedback and others benefit from relaxation procedures • Several reviews have found that 38% to 63% of patients undergoing relaxation or biofeedback achieve significant reductions in headaches compared with approximately 35% who receive placebo medica-tion

Developmental considerations of eating disorders

• Typically begin in adolescence • Differential patterns of physical development • Glamorized idea for male to have lots of muscle • Girls primarily gain weight and fat tissue but its glamorized if they are thin • Early dieting starts • Negative attitude toward being overweight emerges as early as 3 years of age, and more than half of girls age 6 to 8 would like to be thinner (Striegel-Moore) • By 9 years of age, 20% of girls reported trying to lose weight, and by 14, 40% were trying to lose weight • Generally, concerns about body image decrease with age

Social dimensions of eating disorders including Fallon and Rozin (1985)

• the glorification of slenderness in popular culture Fallon and Rozin • found that men rated their current size, their ideal size, and the size they figured would be most attractive to the opposite sex as approximately equal • rated their ideal body weight as heavier than most females would find attractive • Women, however, rated their current figures as much heavier than what they judged the most attractive, which in turn, was rated as heavier than what they thought was ideal

Parasomnias

Abnormal sleep events or abnormal activity during sleep or time between sleep and wake Nightmare Disorder, Night Terrors, Sleep Walking

Acute vs Chronic Pain

Acute <1 month Typically follows an injury and disappears once the injury heals Useful, functional type of pain vs. Chronic, Persistent pain (3, 6 months) Does not decrease over time even when the injury has been healed or effective treatments have been administered Strongly related to psychological factors

Sleep-Wake Disorders

Comorbid with mental health (depression, generalized anxiety, mania, PTSD) and various physical health conditions Persistent, causes stress/dysfunction

Dyssomnias

Difficulties in getting enough sleep, problems with sleeping when you want, complaints about the quality of sleep Insomnia, Circandian Rhythm Disorders, Narcolepsy

Persistent Depressive Disorder, general onset/course

Persistently depressed mood for at least 2 years Fewer symptoms (2 or more) Patient cannot be symptom free for more than 2 months at a time. Longer duration Less responsive to treatment Often unable to remember a time of happiness, excitement, being inspired Often inactive Varying presentations with Major Depressive Disorder

Primary Insomnia

The distress/impairment is caused by the insomnia and is unrelated to the other condition Difficult to determine & alleviation of "primary" often doesn't cure insomnia

An integrated model of insomnia disorder

• Biological and psychological factors both present in most cases • Multiple factors are related to one another • A parent's behavior can influence a child's sleep • personality characteristics, sleep difficulties, parental reaction interact • Biological vulnerability to insomnia • light sleeper • family history of insomnia, narcolepsy, or obstructed breathing • Sleeping habits

Conversion Disorder

• Physical malfunctioning, such as paralysis, blindness, or difficulty speaking (aphonia), without any physical or organic pathology to account for the malfunction. Most conversion symptoms suggest that some kind of neurological disease is affecting sensory-motor systems, although conversion symptoms can mimic the full range of physical mal-functioning • Seizures, sensation of a lump in the throat, "blindness", paralysis of the legs but then they are able to get up and run in an emergency (and shocked at their abilities) • People can typically function normally but they seem truly unaware of their ability or of sensory input 1) Individual experiences traumatic event 2) Person represses the conflict, making it unconscious 3) Anxiety continues to increase, person "converts" it into physical symptoms. Gain = reduction of anxiety. 4) Individual receives attention/sympathy from others/allowed to avoid a difficult task or difficult situation. = Secondary gain

Persistent Depressive Disorder Diagnostic Criteria

1) Depressed mood majority of the time for at least 2 years 2) Presence of 2+ of the following: Poor appetite/overeating, insomnia/hypersomnia, low energy/fatigue, low self-esteem, poor concentration/decision-making, feelings of hopelessness 3) No end in symptoms for over 2 months at a time 4) Criteria for major depressive disorder present for 2 years 5) There has never been a manic episode 6) Not better explained by schizophrenia or other delusional disorder 7) Not attributable to drug use or other physical illness 8) Symptoms cause clinically significant distress or impairment

8 Specifiers for Depressive Disorders

1) Psychotic features: hallucinations, delusions 2) Anxious distress specifier: accompanying anxiety 3) Mixed features specifier: Predominantly depressive episodes that have several (at least three) symptoms of mania 4) Melancholic features specifier: physical symptoms such as early-morning awakenings, weight loss, loss of sex drive, excessive guilt, anhedonia (diminished interest) 5) Catatonic features specifier: absence of movement (catalepsy) or random movement 6) Atypical features specifier: Oversleeping, overeating, can react with interest/pleasure to some things, associated with women at younger age. Often more severe symptoms. 7) Peripartum onset specifier: Before and after giving birth to a child 8) Seasonal pattern specifier: seasonal affective disorder (SAD) for 2 or more years

Anorexia Nervosa

1) Restriction of energy intake leading to significantly low body weight • BMI < 18.5 guideline • Mild BMI is > 17, Extreme BMI is < 15 2) Intense fears of gaining weight or behaviors that interfere with weight gain (this fear is not alleviated by weight loss) • If the individual gains weight, extreme negative emotion/panic/fear leads to 1) Restrictive and 2) binge eating (lesser degree than bulimia) and purging (more than bulimia) 3) Body image disturbance or undue influence of weight or shape on self-evaluation and/or lack of recognition of seriousness • An extremely thin person may report feeling fat • Warped conception of self-view Associated with depression, OCD features • Odd rituals related to food, obsessions with food • Consequences can be fatal

Clinical description and characteristics of Circadian Rhythm Sleep Disorders

A mismatch between a person's endogenous sleep-wake schedule and that required by social or professional schedule Melatonin: Follows slightly > than a 24 hour schedule, Regulated or "entrained" by light or dark Brought on by the brain's inability to synchronize its sleep patterns with the current patterns of day and night.