Mental Health Test 1

NAMI Vison

- "a world where all people affected by mental illness live healthy fulfilling lives supported by a community that cares"

NAMI Mission

- "providing advocacy education, support and public awareness so that individuals and families affected by mental illness can build better lives"

NAMI: National Alliance on Mental Illness

- 1970's found their beginnings as a small group of family members, nationwide, gathered around kitchen tables searching for support and understanding of their mentally ill family member, more often a son. - mostly meeting together were mom's blamed by medical profession that their parenting skills caused their child's schizophrenia or other mental health disorder.

Depression Causes

- A combination of genetic, biological, environmental, and psychological factors play a role in depression - Depression can occur along with other serious illnesses, such as diabetes, cancer, heart disease, and Parkinson's disease. - Depression can make these conditions worse and vice versa. - Sometimes medications taken for these illnesses may cause side effects that contribute to depression symptoms.

The Exhaustion Phase

- A prolonged effort to adapt to stress may lead to allostatic load - Occurs when the physical and emotional energy used to fight the stressor has been depleted - Continual release of cortisol and other hormones can reduce immunocompetence

Prevalence Adolescents

- About 42 million adolescents in the U.S. (10 to 19 years of age) - 3.6 million adolescents (14.7 percent) received mental health services in a specialty mental health setting (inpatient or outpatient care) - 3.2 million adolescents (13.1 percent) received mental health services in an education setting - 708,000 adolescents (2.9 percent) received mental health services in a general medical setting - 108,000 adolescents (0.4 percent) received mental health services in a child welfare setting and - 53,000 adolescents (0.2 percent) received mental health services in a juvenile justice setting

What happens in the brain?

- Amygdala - - Part of the limbic system, a group of structures deep in the brain that's associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. - Activated when a person recalls emotionally charged memories, such as a frightening situation. - Activity in the amygdala is higher when a person is sad or clinically depressed. - This increased activity continues even after recovery from depression. - Thalamus: - Receives most sensory information and relays it to the appropriate part of the cerebral cortex, which directs high-level functions such as speech, behavioral reactions, movement, thinking, and learning. - Hippocampus: - Part of the limbic system - Central role in processing long-term memory and recollection. Interplay between the hippocampus and the amygdala might account for the adage "once bitten, twice shy." - It is this part of the brain that registers fear, e.g., confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. - Ongoing exposure to stress hormone impairs the growth of nerve cells in this part of the brain

Mental Health Disruptions Impact Memory

- Anxiety and worry can hinder your working memory (Science Daily, 2016) - Depressed people have trouble remembering fine details of events they've experienced. For example, like a vacation, come to mind easily but not the specifics, like an enjoyable meal from the vacation. (Brain Facts, 2019) - Individuals with dysphoria — a persistent sense of unhappiness or dissatisfaction that is often a symptom of depression — had poorer working memory than people without any mental health problems. (Cohut, 2019) - Suppressed memory - When the brain creates memories in a certain mood or state, particularly of stress or trauma, those memories become inaccessible in a normal state of consciousness. Suppressed memories can then best be retrieved when the brain is back in that state. - Research suggests positive memories can generate positive emotions. Increasing positive emotion can have a range of benefits including reducing attention to and experiences of threat. (Science Daily, 2016)

Genetics

- Depression and bipolar disorder run in families - Strongest evidence for this comes from the research on bipolar disorder - 50% of those with bipolar disorder have a relative with a similar pattern of mood fluctuations. - Studies of identical twins, who share a genetic blueprint, show that if one twin has bipolar disorder, the other has a 60% to 80% chance of developing it, too. - These numbers don't apply to fraternal twins, who — like other biological siblings — share only about half of their genes. - The evidence for other types of depression is more subtle, but it is real. - A person who has a first-degree relative who suffered major depression has an increase in risk for the condition of 1.5% to 3% over normal. Harvard 2017

Prevalence Adults

- Estimated 44.7 million adults aged 18 or older had AMI in the past year. - Represents 18.3 percent of adults in the United States. - Estimated 10.4 million adults in the nation had SMI in the past year, and 34.3 million adults had AMI excluding SMI. - Estimated 7.6 million young adults aged 18 to 25 (22.1 percent) had AMI in the past year. - Estimated 2.0 million young adults (5.9 percent) had SMI in the past year

Brain function

- Excessive activation of the brain mechanism underlying fear and the fight-or-flight response • Amygdala may be so sensitive that it overreacts to situations that aren't really threatening • This triggers the brain circuits that provoke an emergency stress response. • Over time, anxiety becomes attached to situations, thoughts, and memories unrelated to genuine sources of danger. • The brain inadvertently create its own fears.

Basic elements of psychologically healthy people

- Feeling good about themselves. - Feel comfortable with other people and feel respect and compassion for others. - Control tension and anxiety. - Meet the demands of life. - Curb hate and guilt. - Maintain a positive outlook. - Value diversity. - Appreciate and respect nature.

Implicit vs Explicit Memories

- Long Term Memory - Implicit memories are sometimes referred to as "non-declarative" because an individual is unable to verbally "declare" these memories. - Nonconscious, and often involve memories for specific step-by-step procedures, or specific feelings/emotions. - For example, your ability to carry out the various processes involved in driving a car are largely nonconscious, they have been "proceduralized". Remembering a phone number or a conditioned emotional response to a "scary" situation is not something that you consciously or verbally recall. - Explicit memories are conscious memories that can easily be verbalized. More complex types of memories because they are often holistic involving the recall of many different aspects of a situation. - Recall the event and the context (the time of day, the place, and other objects and people that were present, etc.) - Exact nature of the relationship between implicit memory and explicit memory is still ambiguous despite much research

Memories

- Memories are formed when the body experiences a heightened stress, good or bad - It is the change in body state from something that causes good or bad stress.

Mental Health

- Mental health involves cognitive thinking and harnessing one's attention to stay focused. - Processing information, storing it in memory, and understanding this new information - Includes properly exercising reason and processing any learned information - Requires managing emotional actions and gauging the appropriate reactions to situations. - All cognitive activity is motivated by basic emotional and homeostatic needs (motivational drives) that explore environmental events for survival while facilitating secondary processes of learning and memory. (Tyng, et al., 2017)

Difference Between Mental & Emotional Health

- Mental health involves cognitive thinking and harnessing ones attention to stay focused. - processing information, storing it in memory, and understanding this new information. - Mental health also includes properly exercising reason and processing any learned information. - Mental health requires managing emotional actions and gauging the appropriate reactions to situations. - Emotional health involves expressing one's emotions appropriately for one's age.

Depressive Disorders

- Perinatal depression - More serious than the "baby blues" - Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). - Feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies. - Psychotic depression - A person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). - Psychotic symptoms typically have a depressive "theme," such as delusions of guilt, poverty, or illness - Seasonal affective disorder - onset of depression during the winter months, when there is less natural sunlight. - Generally lifts during spring and summer - Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder

Brain & Emotions

- Prefrontal cortex is responsible for planning future action. So, when considering action to an emotion, this part of the brain is involved. - Amygdala - your emotional response is generated in the amygdala. - If the amygdala is damaged, you lose control of base impulses and may begin to act in an inappropriate way. Disinhibited behavior, hyper-sexuality, and risk-taking are behavioral consequences of a damaged amygdala. - Hypothalamus controls our physical reaction to emotion. - Ever had butterflies in your stomach after you see someone you like? Or tingling in your legs after you've been scared? This is all the work of the hypothalamus. - 3 hormones responsible for many of your emotions are: Adrenaline (stress and anxiety) Oxytocin (love and affection) Dopamine (pleasure and reward) among several others

Are Internal Stressors Inescapable?

- Psychological hardiness may negate self-imposed stress with Type A personalities. - Shift and persist research has shown that with the help of positive role models, youth, in the presence of extreme and persistent adversity, are able to reframe appraisals of current stressors.

Psychological Effects of Stress

- Rates of mental disorders, particularly depression and anxiety, are associated with environmental stressors. - College students face grade pressure, stress from finding housing, becoming financially independent, career choices and employment, relationships, and family.

Brain Stem

- Regulation - Regulates breathing, heart rate, sleeping, eating

Types of Memory

- Sensory - Shortest-term element of memory. Ability to retain impressions of sensory information after the original stimuli have ended. Acts as a kind of buffer for stimuli received through the five senses of sight, hearing, smell, taste and touch - Short-term - Acts as a kind of "scratch-pad" for temporary recall of the information which is being processed at any point in time. The ability to remember and process information at the same time. - Holds a small amount of information (typically around 7 items or even less) in mind in an active, readily-available state for a short period of time (typically from 10 to 15 seconds, or sometimes up to a minute). - Long-term memory - Memories stored in the brain over a more extended period. They are several short-term memories organized to form a long memory that is stored permanently. Depending upon the importance and number of recalls, depends on whether you keep it or it fades away. - Implicit - Procedural - the previous experiences help in performing a task better without explicit and conscious awareness of previous experiences. Procedural memories are formed when there is a reinforcement of synapses. The procedural memories are the forms of linking connections between the nerve cells. - Explicit - Episodic -comprise the events of one's life. For example, the graduation day, a particular Christmas morning, etc. These memories are edited by brain overtime when we recall them in specific contexts. They are not very reliable. - Semantic - General facts and knowledge of things around us, e.g. elephants are mammals. These memories get updated with new pieces of information. The phenomenon of forgetting is involved in making a place for new facts without cause cognitive dissonance.

The Alarm Phase

- Stressor disrupts body's stability temporarily lowering resistance - You first experience the fight-or-flight-or-freeze response - Occurs as the body prepares to combat or escape the real or perceived threat. - Cerebral cortex trigger the ANS response that prepares the above response

Common Symptoms of Physical Stress

- Tension headaches, migraine, dizziness - Oily skin, skin blemishes rashes, blushing - Dry mouth, jaw pain, grinding teeth - Backache, neck stiffness, muscle cramps, fatigue - Tightness in chest, hyperventilation, heart pounding, palpitations - Stomachache, acid stomach, burping, nausea, indigestion, stomach "butterflies" - Diarrhea, gassiness, constipation, increased urge to urinate - Cold hands, sweaty hands and feet, hand tremor

Mental Health America

- Twentieth Century: 1900's - Established by Clifford W Beers - Recent Yale Graduate and newly minted Wall street financier

Depression

- Two of the most common forms of depression are: 1. Major depression—having symptoms of depression most of the day, nearly every day for at least 2 weeks that interfere with your ability to work, sleep, study, eat, and enjoy life. -An episode can occur only once in a person's lifetime, but more often, a person has several episodes. 2. Persistent depressive disorder (also called dysthymia) - Depressed mood that lasts for at least two years - A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.

Genetics

- Variation in a specific gene predispose people to develop anxiety disorders. • There is a gene that regulates the neurotransmitter serotonin • Serotonin - feelings of well-being and happiness • Actual biological function is complex and multifaceted, modulating cognition, reward, learning, memory, and numerous physiological processes

Emotional Health

- refers to the feeling, or subjective, side of psychological health. - people respond appropriately to upsetting events.

Anxiety Disorders

- research on these types of disorders has expanded dramatically since the 1970s. - Clinical sense - presence of fear or apprehension that is out of proportion to the life situation occurring

Social Health 2

- social bonds reflect the level of closeness and attachment we develop with individuals. - social support refers to the networks of people and services with whom you interact and share social connections.

Emotional intelligence

- the ability to identify, use, understand, and manage one's emotions in positive and constructive manner. - it consists of self- awareness, self- management, relationship management, and social awareness.

MHA Goals

1. To improve attitudes toward mental illness & people living with mental conditions. 2. To improve services for people with mental health conditions. 3. To work for the prevention of mental illness and the promotion of mental health.

Mental Health

A mentally healthy person.... - perceives life realistic ways. - can adapt to change. - can develop rational strategies to solve problems. - can carry out personal and professional responsibilities.

Physical Effects of Stress (2)

Alcohol Dependence - New research has found that a specific stress hormone, the corticoptropin- releasing factor, is key to development and maintenance of alcohol dependence in animals. Hair Loss - Too much stress can lead to thinning hair, and even baldness, in men and women. Diabetes - Controlling stress is critical for preventing weight gain and other risk factors for type 2 diabetes as well as for short- and long-term diabetes management.

Internal Stressors

Appraisal and Stress - Appraisal helps us recognize and evaluate stress based on past experiences and emotions. Self-esteem and Self-efficacy Self-esteem is how you feel about yourself. - Low self-esteem and stressful life events significantly predict suicide ideation, the desire to die, and thoughts about suicide. - Self-efficacy is the belief or confidence in your skills and performance abilities. - High self-efficacy predicts a number of health behaviors in college students, and developing self-efficacy is vital for coping with and overcoming academic pressures.

Temporal Lobe

Auditory Processing - Tells us what we hear. - Helps keep your balance.

Cerebellum

Auto Pilot - Balance and coordination of muscles and the body. - Enables talking & walking w/o thinking about it.

Physical Effects of Stress

Cardiovascular Disease - Long-term stress impacts heart rate, blood pressure, heart attack, and stroke. Stress is one of the key modifiable risk factors for heart attack. Weight Gain - Higher stress levels may drive us toward food because they may increase cortisol levels in the bloodstream.

Parietal Lobe

Connection - Communicates with other lobes. - Multitasks and is responsible for sensory integration. Activated each time a thought changes.

Physical Effects of Stress (3)

Digestive Problems - Causes for digestive disorders are often unknown, but it is assumed that an underlying illness, pathogen, injury, or inflammation is present when stress triggers nausea, vomiting, stomach cramps, and gut pain or diarrhea. - Some relaxation techniques are particularly helpful in coping with stressors that make digestive problems worse. Stress and Impaired Immunity - Psychoneuroimmunology (PNI) analyzes the relationship between the mind's response to stress and the immune system's ability to function effectively. - Too much stress over a long period can negatively affect various aspects of the cellular immune response.

Resistance Phase

During the resistance phase, the body tries to return to homeostasis. - Adaptation resources are activated to combat stressor - Body maintains higher level of resistance to stressor Some perceived stressor still exists during this phase - Body does not achieve complete calm or rest - Tt stays activated, causing a higher metabolic rate in some organ tissues.

DSM-V Definition

GAD is excessive anxiety and worry that is difficult to control and causes serious distress or interferes with daily activities. • Symptoms occur more days than not for at least six months, along with at least three of the following: • restlessness or feeling on edge • tiring easily • difficulty concentrating • irritability • muscle tension • sleep problems. • Symptoms are not the result of a medical condition, a medication, or a nonmedical drug, and they don't occur only during a mood disorder, a psychotic disorder, or post- traumatic stress disorder.

Frontal Lobe

High level learning - Helps weigh risks and reward. - Regulates thoughts and emotions with good connection to other areas of the brain

Mental Health Disorders

ICD-11 is the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO) ICD-10 is the "go to" for Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines & Research DSM-5 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Product of more than 10 years of effort by hundreds of international experts in all aspects of mental health. Both DSM and ICD codes are used for diagnosis, and they are actually the same codes: the DSM is simply a guide to picking the right ICD code.

What is Memory?

Memory - ability to encode, store, retain and subsequently recall information and past experiences in the human brain. - Encoding - Initial learning of information and first step in creating a new memory. - How the information coming from sensory input is changed to be stored in the brain. - Memory encoding converts the perceived item or event into a construct that can be stored and recalled later from the brain

Mental Health 2

Mental health includes emotional, psychological, and social well-being. - Affects how we think, feel, and act. - Determines how we handle stress, relate to others and make choices. - Important at every stage of life- childhood and adolescence through adulthood. Many factors contribute to mental health problems. - Biological factors, such as genes or brain chemistry. - Life experiences, such as trauma or abuse. - Family history of mental health problems.

Agoraphobia

Not what you think! • Feeling of intense anxiety about being in places or situations from which escape might be difficult (or embarrassing) OR... • Where help is not available in case of a panic attack • Typical - being outside the home alone, being in a crowd or standing in a line, being on a bridge, or travel mediums

Occipital Lobe

Optical Processing - Processes visual info from the eyes

Lifetime Effects of Stress

Physical Effects of Stress - Stress and cardiovascular disease - Stress and weight gain - Stress and alcohol dependence - Stress and hair loss - Stress and diabetes - Stress and digestive problems - Stress and impaired immunity

What is Psychological Health?

Psychological health is the sum of how we think, feel, relate, and exist in our day-to-day lives. - includes mental, emotional, social and spiritual dimensions.

What Causes Stress?

Psychosocial Stressors - Adjustment to change - Hassles: Little things that bug you - The toll of relationships - Academic and financial pressure - Frustrations and conflict - Overload - Stressful environments - Bias and discrimination

Social Health

Socially healthy individuals - enjoy a wide range of interactions with family, friends and acquaintances. - able to have healthy interactions with an intimate partner. - listen, express themselves, and for healthy attachments. - act in socially acceptable and responsible ways and find the best fit for themselves in society.

Spiritual Health

Spirituality - Broader in meaning than religion. - An individual's sense of peace, purpose, and connection to others, and beliefs about the meaning in life. - Goes beyond material values and is practiced in many ways. - Refers to the sense of belonging to something greater than physical or personal dimensions of existence.

Defining Stress

Stress is the mental and physical response and adaptation by our bodies to real or perceived change and challenges. - A stressor is any real or perceived physical, social, or psychological event or stimulus that causes our bodies to react to stress.

Intellectual Effects of Stress

Stress, Memory, and Concentration - Acute stress has been shown to impair short-term memory, particularly verbal memory. - New research in rats has linked prolonged exposure to cortisol to shrinking the hippocampus, the brain's major memory center.

Internal Stressors (2) Personality Types

Type A & B - Type A personalities are hard-driving, competitive, time-driven perfectionists at increased risk for heart disease. - Type B personalities are relaxed, noncompetitive, and more tolerant of others. - None of us is wholly type A or B. Type C - Stoic and tend to deny feelings; they are conforming, lack assertiveness, and may feel helpless or hopeless. This may lead to greater susceptibility to asthma, multiple sclerosis, autoimmune disorders, and cancers. Type D - Exhibit excessive negative worry, irritability, and gloom, and are socially inhibited. They may be eight times more likely to die of heart attack or sudden death.

General Adaptation Syndrome (GAS)

When stress levels are low, the body is often in a state of homeostasis. - Balanced physiological state in which all the body's systems function smoothly, typically - Stressors trigger a crisis mode physiological response - After which the body tries to return to homeostasis by means of an adaptive response.

Spiritual Health

a sense of meaning and purpose in one's life

Emotional Health

ability to express emotions and maintain a level of self-confidence

Intellectual Health

ability to think clearly and make responsible decisions

Environmental Health

appreciation of one's external environment

Physical Health

body size and functioning

Prefrontal cortex

both sides serve as a store for short-term memory

Hippocampus

catalyst for long-term episodic memories. Essential for short-term memory storage. If the hippocampus gets damaged or surgically removed the brain becomes incapable of forming and storing new memories.

Social Health

interpersonal network and successful interaction with others

Cerebellum

involved in creating implicit memory

Basal ganglia

keeps the memories that are implicit; provides automatic or involuntary learning from the information provided to the brain in the past.

Amygdala

located on the temporal lobe; one of the most important parts of the brain for memory function. Believed to create sentimental and emotional responses linked to the memories which helps create long-term episodic memories.

Neocortex

serves as an information processor. Part of the cerebral cortex involved in reasoning and learning. Extracts information from the explicit memories stored in the hippocampus to create reasoning and logic.

Types of Stress Cont.

~ Episodic acute stress occurs when regularly reacting with wild, acute stress about one thing or another. ~ Chronic stress - ongoing state of physiological arousal in response to ongoing or numerous perceived threats. ~ Traumatic stress - physiological and mental response that occurs for a prolonged period of time after a major stressful event in which one may be seriously hurt, killed, or witness horrible things.

Types of Stress

~ Eustress - a positive stress, presents opportunities for personal growth. ~ Distress - negative stress that can have a detrimental effect on health. ~ Acute stress - short-term physiological response to an immediate or perceived threat.

Limbic system and emotion

~ Hypothalamus- Controls the endocrine system. The effects on your body are a faster heartbeat, dilated pupils, and quicker breathing. ~ Amygdala- Related to feelings of fear, anxiety, and anger. In collaboration with the hypothalamus, the amygdala is responsible for the fight-or-flight response. ~ Thalamus- Responsible for directing sense into the corresponding areas in the cortex. In the context of emotions, senses influence them immensely. This is why certain nostalgic songs may trigger an emotional response. ~ Hippocampus- Processes sensory input and helps the limbic system produce an appropriate reaction. It converts short term to long term memory and ties emotions into memories.

PTSD Symptoms

• 3 Areas or Categories • Re-experiencing the trauma (Flashbacks) • Avoiding stimuli associated with the trauma • Experiencing symptoms of increased autonomic arousal

Prevalence & Demographic Impact

• Affects about 5% to 6% of Americans at some point in their lives • Women are 2x as likely as men to develop generalized anxiety disorder • Research suggests prevalence of this disorder increases with age • GAD usually first appears from young adulthood through the mid-50s — a later onset than seen with other disorders

Phobia Definition

• An excessive fear of a specific object, circumstances, or situation • Classified based on the nature of the feared object or situation

Anxiety Treatment - Pharmaceutical

• Antidepressants. Act on neurotransmitters involved in many regions of the brain, affecting anxiety, mood, and arousal. • SSRIs - fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa). • SNRIs venlafaxine (Effexor) and duloxetine (Cymbalta) may also be effective. • Side effects of antidepressants include sexual problems, weight gain, and insomnia. There may be a mild (and usually preventable) reaction when antidepressants are discontinued, but they present no risk of abuse. • Benzodiazepines. Rapid relief of anxiety disorders and cause few side effects. • Main risks are drowsiness, loss of coordination, and physical dependence (especially in people dependent on alcohol or other drugs). • Alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan) • Other options. Buspirone (BuSpar) less likely to cause physical dependence than a benzodiazepine but may not be as effective.

OCD

• Anxiety disorder affects 2-3 % of the population • Overwhelming thoughts and urges of OCD take up considerable time and energy and interfere with daily life and relationships. • People with OCD typically experience a combination of obsessive thoughts, ideas, images or impulses that they can't control, along with the drive to do certain repetitive behaviors or actions in response to the dread or fear associated with the obsessions.

Onset of PTSD

• Appears to be a dose-response relationship between the intensity of the trauma and the onset of symptoms • The higher the proximity and the greater the intensity of the trauma, the greater the likelihood of PTSD

GAD Description

• Characterized by debilitating worry and agitation about nothing in particular or anything at all • Constant and continually changing worries of people are mostly about everyday matter • Can't shake the feeling that something bad will happen and they will not be prepared. • May worry to excess about missing an appointment, losing a job, or having an accident. Some people even worry about worrying too much.

PTSD Definition

• Characterized by the onset of psychiatric symptoms immediately after exposure to a traumatic event • DSM-V definition • Experiencing or witnessing events that involve actual or threatened death or injury • Threats to the physical integrity of oneself or others • Individual's response to the traumatic event must involve intense fear or horror

Anxiety Disorders - Therapy

• Cognitive Behavioral Therapy (CBT) - Talk therapy and skill building to help people recognize when they are misinterpreting events, magnifying difficulties, and making pessimistic assumptions on little evidence. • Applied relaxation. Helps patients learn relaxation techniques to lessen the nervous system arousal that occurs during stress. Starts with controlling rapid breathing. • Psychodynamic therapy. Recognizes that early relationships and life history continue to affect people as adults, that behavior reflects both unconscious and conscious motivations, and that gaining insight into these factors in the context of a helping relationship can provide relief.

Behavioral Treatment for OCD

• Cognitive behavior therapy is a helpful treatment for OCD • Helps client challenge their assumptions that something bad will happen if they don't perform the compulsive behavior of OCD • Asked to imagine or directly face the feared situation or idea (e.g. touching an object believed to be "contaminated") and then encouraged not to engage in the compulsive behavior associated with the anxiety that arises (e.g. prevented from washing his or hands)

OCD Common Obsessions

• Contamination Fears - e.g. fear of picking up germs from touching someone/something • Doubts: e.g. Did I turn off the stove? Did I lock the door? • Imagining causing harm to someone or to oneself: e.g. fears of having run someone over, fears that one could jump off of a high place • Imagining behaving in socially inappropriate ways: e.g. impulse to shout out in church, images of sexual behavior with another person • Need for order or symmetry: e.g. preoccupation with things being organized in a particular way

Diagnosis & Treatment

• Diagnosis is only made when symptoms persist for at least 1 month • In the absence of the requirement above, the diagnosis is acute stress disorder • Characterized by similar symptom categories

PTSD Symptoms (3)

• Experiencing symptoms of increased autonomic arousal • Insomnia, irritability, hypervigilance, exaggerated startle, • Avoiding stimuli associated with the trauma • Efforts to avoid thoughts or activities related to the trauma • Inability to remember all or part of the details related to the trauma • Feelings of detachment or de-realization (remember definition from Anxiety Part I slides) • Sense of foreshortened future

Co-occuring with GAD

• GAD often occurs in conjunction with other psychiatric disorders • Approximately two-thirds of people with GAD also have major depression • Approximately one-quarter have panic disorder • Many have substance use disorders or alcohol dependence

OCD Pharmaceutical Treatment

• High dosages of certain anti-depressant medications (e.g. Luvox, Anafranil, Paxil, Prozac, Zoloft ) have proved very effective in treating OCD • Effectiveness of specific anti-depressants suggests that imbalances in the brain neurotransmitter serotonin may be common to both depression and OCD

Specific Phobia

• Marked and persistent fear that is excessive or unreasonable • Cued by the presence or anticipation of an object or situation • Exposure to the phobic stimulus provokes an immediate anxiety response

DSM-5 PHOBIA Categories

• Natural - e.g. fear of thunder and lightning (astraphobia) or water (aquaphobia) • Mutilation- e.g. fear of the dentist (dentophobia), or injections (trypanophobia) • Animal - e.g. dogs (cynophobia), snakes (ophidiophobia), and insects (entomophobia) • Situational - e.g. washing (ablutophobia) and enclosed spaces (claustrophobia)

OCD Characteristic features

• Obsessions and compulsions • Obsessions - persistent ideas, thoughts impulses or images that are experienced as intrusive and inappropriate • More than excessive worrying about everyday life situations • For example, contamination where the individual as thoughts that he or she may be dirty or unclean.

Social Phobia

• Persistent fear of one or more social or performance situations • Person is exposed to unfamiliar people • Possible scrutiny by others • Afraid of acting in a manner that will be humiliating or embarrassing

PTSD Traumatic Experiences

• Physical assault • Violent accident • Crime • Natural disasters • Military combat • Being abducted • Diagnosed with a life-threatening illness • Systematic physical or sexual abuse

GAD Physical Symptoms

• Racing heart • Dry mouth • Upset stomach • Muscle tension • Sweating • Trembling • Irritability

PTSD Symptoms (2)

• Re-experiencing the trauma (Flashbacks) • Flashbacks - sudden, usually powerful, re-experiencing of past trauma experience or elements of a past trauma experience • Manifest in distressing recall or dreams • Physiological or psychological stress reactions on stimuli linked to trauma

Panic Disorder

• Recurrent panic attacks represent a panic disorder • Panic attack - discrete period of intense fear or discomfort that develops abruptly and peaks with in 10 minutes

OCD Compulsions

• Repetitive acts, behaviors, or thoughts that are design to counteract the anxiety associated with an obsession • Main feature of a compulsion - lessons the anxiety associated with the obsession • For example, handwashing interferes with the contamination anxiety • Bringing own silverware to restaurant • Compulsions can manifest as thoughts • For example, someone obsessed with having sinned may choose to lessen his or her anxiety by compulsively repeating a prayer

Root Causes of OCD

• Research suggests that the causes of OCD may be largely genetic • Stressful life circumstances can trigger the onset or recurrence of OCD • For about 50% to 66% of OCD sufferers, the disorder starts in childhood • There is evidence to suggest that difficulties with information processing in the brain of the person with OCD leads to "getting stuck" on specific worried thoughts. • Individuals with OCD are also frequently diagnosed with depression.

Characteristics of a Panic attack

• Subjective feelings of heart beating • Increase heart rate • Sweating • Shaking • Shortness of breath • Chest pain • Fear of losing control or dying • Derealization • Depersonalization • Paresthesias • Dizziness

What Causes Phobias? Brain Function

• Symptoms of mood and anxiety disorders are result partly from disruption in the balance of activity in the emotional centers of the brain • Limbic System

DSM-5 Criteria for a Specific Phobia Diagnosis

•Unreasonable, Excessive Fear: Exhibits excessive or unreasonable, persistent and intense fear triggered by a specific object or situation. •Immediate Anxiety Response: Fear reaction must be out of proportion to the actual danger and appears almost instantaneously when presented with the object or situation. •Recognition the Fear Is Irrational Not Required: Adult patient no longer has to recognize the irrationality of their behavior to receive a diagnosis. •Avoidance or Extreme Distress: Goes out of the way to avoid the object or situation, or endures it with extreme distress •Life-Limiting: Significantly impacts the sufferer's school, work, or personal life. •6 Months Duration: In children and adults, the duration of symptoms must last for at least six months. •Not Caused by Another Disorder: Many anxiety disorders have similar symptoms. Therefore, your therapist must rule out other disorders before diagnosing a specific phobia.