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