Diathesis Stress Model and Brain Structures

• The Diathesis Stress Model, also known as the neurodevelopmental model, explains the development of disorders through the interaction of a predisposition or vulnerability (diathesis) with a trigger (stressor).
• This interaction converts the predisposition into an actual disorder because the individual has to adapt to the stressor.
• The specific diathesis is unique to the particular disorder.

Brain Structures and Their Roles

• Limbic System: functions include emotional response, memory and behavior regulation and is an emotional nervous system
• Hypothalamus: regulates the 4 Fs (hunger, thirst, temperature, sex drive), receives data from the autonomic nervous system about internal organ functions, and responds to chemical messengers and is a part of the limbic system
• Hippocampus: This regulates smells, emotions, memories, and autonomic behaviors and is a part of the limbic system
• Sympathetic Nervous System: Escalates quickly for coping with danger, releases cortisol and adrenaline to excite organ systems, monitors the body for anxiety signs, and escalates signaling.
• Parasympathetic Nervous System: This is involved in resting and digesting and therapies for anxiety disorders often focus on activating this system to calm the body

Prefrontal Cortex Functions

• Decision making
• Reasoning
• Personality expression
• Maintaining social appropriateness
• Complex cognitive behavior

Historical Eras in Mental Health

• Contain and exclude (1400s-1700s): Spiritual failures were believed to cause mental illness, leading to exclusion and banishment due to fear of spiritual "infection."
• Asylum Period (1700s to 1880s): Weakness of mind and will was believed to cause mental illness, resulting in exclusion via asylums, where work was used as therapy.
• Prevailing theory during the Asylum Period: Insanity was due to a weak mind, akin to beasts and children, thus calling for compassion and housing the mentally ill.
• Containment in asylums often targeted already marginalized individuals.
• The concept of Liberte from the French Revolution influenced Philippe Pinel to symbolically free those in asylums.
• Early 1960s: California, under Ronald Reagan, moved to close long-term hospital systems with the introduction of drug therapy for mental illness.
• In the early 1960s with the the introduction of drug therapy for mental illness funding for new community-based clinics wasn't granted, leading to growth in the population of homeless people with mental illness
• Medication reduced asylum populations.
• Drs. Rosenhan findings: Doctors resisted changing the views of their patients.
• Modern Medical Era Neurology (1890s-1952): Mental illness was attributed to the nervous system, leading to continued asylum use and experimental therapies like lobotomy and psychoanalysis.
• Prevailing theory in the Modern Medical Era: Abnormality is a medical issue; society should help and repair the mentally ill.
• Attributing mental illness to neurological problems led to the belief that it could be cured, coinciding with the discovery of psychiatric medication.
• Freud's talking cure briefly explained the physical structure of the mind, similar to the nervous system.
• 1920s: the eugenics movement pushed for involuntary prevention of mental illness.
• Reductionist Pharmacology (1953-2000): Molecular imbalance causes mental illness, leading to assumptions that medication could "control" mental illness.
• During Reductionist Pharmacology: the “mental health industry” grows, the Economic and media forces influence public opinions.
• Economic Psychopharmacology and diagnostic trending supports a 3+ billion dollar pharma industry.
• A pharmacology “industry” was founded, along with more openness and the discussing of mental health conditions.
• Robert J. DeRubeis, Greg J. Siegle, and Steven D Hollon researched cognitive therapy vs. medications for depression and their treatment outcomes.
• Carl Jung was a pioneer of talk therapy.
• Drug treatments: They proved to be no more effective than “talk” therapy treatments.
• Advocacy and recovery (2000-present): Focus on de-stigmatizing mental illness and supporting community inclusion.
• There are three factors that encompass the current prevailing model:
  • Increased social diversity should also apply to the acceptance of mental health recovery.
  • Recovery of meaningful life pursuits is a reasonable goal for most people with mental differences.
  • Biological and mind-based views can enhance well-being.
• Due to current emphasis there is a value of the person regardless of mental illness and re-engaging with social connection.

Neurotransmitters and Their Roles

• Dopamine: Linked to several types of mental disorders and is prominent in several areas of the brain. Associated with reward, pleasure, and motivation.
• GABA: Inhibits postsynaptic activity, reduces neural activity, promotes calmness.
• Serotonin: Influences emotion, sleep, and behavioral control.
• Glutamate: Allows chemical messengers to be sent between nerve cells and is excitatory.

Tardive Dyskinesia

• Tardive means delayed or late.
• Dyskinesia refers to abnormal, involuntary, or repeated muscle movements.
• Cause: Drug-induced, prolonged use of drugs (typically antipsychotic drugs).
• Symptoms: Movement disorder, uncontrollable movements in the face and body.

Medications

• SSRIs (selective serotonin reuptake inhibitors) increase serotonin levels in the brain by inhibiting its reuptake.
• Antipsychotics are used to treat mental health conditions characterized by psychosis, such as schizophrenia or bipolar disorder.

Criticisms of Biological Therapies

• Criticisms of Drugs:
  • Treats symptoms and not the cause of a condition
  • Negative symptoms like social withdrawal aren't effectively treated by drugs.
  • Medication doesn't help patients, it just makes them socially acceptable.
• Criticisms of Lobotomy:
  • Major loss of memory
  • Personality change
  • Emotional disturbance and inconsistent outcomes
  • Destruction of the brain cannot be justified.

Children in Dependency Care

• Children in foster and group homes experience increased medication rates compared to children outside these settings.
• Overuse of powerful medications on young children.
• Used when not needed so they were easier to control and manage.

Psychodynamic Terms

• Id: Driven by primal instinct and seeking immediate gratification.
• Ego: The rational part of the psyche that mediates between the Id and superego.
• Superego: The moral component of the psyche, representing internalized social values and standards.
• Defense Mechanism: Processes operating unconsciously to protect from anxiety arising from unacceptable thoughts or feelings.
• Projection: Unconsciously attributing unacceptable thoughts, feelings, or desires to someone else, projecting them outwards to avoid internal confrontation.

Definitions for Mental Health

• Diagnosis: Identifying and classifying a mental health condition based on a patient's symptoms, history, and examination.
• Mental Disorder: Patterns of thoughts, feelings, or behaviors that cause significant distress or impairment to functioning.
• Assessment: Process used to gather and interpret information about an individual's mental health.

Subjective Distress

• An individual's personal level experience of discomfort, unease, or emotional distress.
• Assessed by a subjective measure based on their perception of their situation and how it affects them.

Thomas Szasz

• A critic of psychiatry he once stated that society that defines people in a way that isolates them and makes them seem less.
• In his view, a psychiatric diagnosis was meaningless without neurological disease or damage.

Criticisms of Early DSM Editions

• Descriptions were short, leaving meaning up to the clinicians to interpret.
• Focused on cause of disorders rather than symptoms.
• Lacked a uniform principal for assigning diagnosis.
• Diagnoses were based on theories of causation.
• Concentrated on symptoms that tended to cluster, making it difficult to maintain adequate reliability.
• Low validity for many diagnoses.
• Relied on a single label.
• Failed to consider background factors influencing severity and prognosis, such as medical problems, psychological stress, and cultural influences.

Sympathetic and Parasympathetic Nervous Systems in Panic Disorder

• Sympathetic: Experiencing accelerated heart rate, chest pain, sweating, trembling, shortness of breath, dizziness, choking sensation, nausea, lightheadedness, numbness, chills or heat, feeling detached, fear of losing control.
• Parasympathetic: Rest and digest activities are essential for recovery and needed for long term survival.

Flooding and Feedback Process

• The sympathetic nervous system escalates to cope with danger.
  • Brain releases cortisol and adrenaline to organ systems.
  • The body watches for signs of anxiety and escalates signaling.

Obsessive Compulsive Disorder

• Symptoms: -Symmetry, handwashing, guilty thoughts, making mistakes -Obsessive: -Recurrent and persistent thoughts, urges, or images -Individuals attempt to ignore or suppress such thoughts, urges, or images or to neutralize them with contrary thought -Compulsive: -Repetitive behavior or mental acts that the individual feels driven to perform. -They are aimed at preventing or reducing anxiety or distress; however, these behaviors are not connected realistically with what they are designed to prevent

Agoraphobia

• Involves fear and avoiding places or situations that might cause panic and feelings of being trapped, helpless, or embarrassed.
• Fear that you won't be able to escape find help if you panic.
• Disproportionate anxiety and fear in relation to the situation.

Exposure with Response Prevention (ERP)

• Cognitive behavioral therapy can reduce symptoms
• Begins with guided breaths and relaxation.
• When the parasympathetic response is strong enough, exposure begins.
• This involves small changes that have a high chance of success.

PTSD

• Sensory registration stages or processes.
• “Snapshot” registration (how a person perceives an event).
• Precipitating event occurs → I saw parts of the airplane heading straight towards us
• Encoding via limbic system: -The sensory register of events leads to subjective crisis → it was like it was slow motion. -Remember the screeching noise
• Recollection with “crisis narrative” -Poor coping leads to formulating a crisis narrative → I can't sleep. I just keep hearing people screaming.

DSM-V

• DSM-III said: a traumatic event was conceptualized as a catastrophic stressor that was outside the range of usual human experience.
• Now a traumatic experience is a core criterion for diagnosing PTSD, is defined as exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing, learning about a violent or accidental death of a close family member or friend, or repeated exposure to aversive details of the event.

Trauma

• Trauma that causes PTSD includes significantly complex/relational trauma and people with past trauma are at higher risk of vulnerability.
• HPA Axis includes the Hypothalamic-pituitary-adrenal axis and is in response to sudden stressors, so the hypothalamus jump sarts a chain of coordinated physiological and biomechanical defenses against the stresser.
• Signals the pituitary to secrete a hormone that direscts the cortical outer portion of the adrenal glands to release corticosteroids such as cortisol and other glucocorticoids.
• These chemical messengers intensity the alarm and prepare the body to cope with the stresser

Differences Between PTSD and Relational/Complex Trauma

• Compounded trauma, chronic, unrelated trauma, multiple abuse.

Types of Dissociation

• DID: The presence of two or more distinct personality identities, each with a unique name, personal history, and characteristics.
• Derealization/depersonalization: Feelings of losing touch with the world or oneself, evoking anxiety and instability.

Manic Phase of Bipolar Episode

• Mania: A mood state characterized by periods of great excitement, euphoria, delusions of greatness, and overactivity.

Positive and Negative symptoms

• Positive symptoms: Things that are there that shouldn't be: Hallucinations, body posture and poses, talking to one's self, odd reactions and mannerisms, problems thinking in a linear or cohesive way.
• Negative symptoms: Things that are missing: Flattened emotions, withdrawal, pulling away from relatives, loss of self-care behavior, loss of stable self-identity.

Symptoms

• Limited verbal responses, remaining still, appearing statue-like, maintaining a position someone else puts them in, waxy face.

SSRI Medication

• SSRIs slow the reabsorption of serotonin by neurons that secrete it, keeping more serotonin in the synaps longer.

Biological vs. Psychotherapy Treatments

• Biological:
  • Medication: only effective for some individuals and takes several weeks to show improvement. Alters brain chemistry. A dual therapy approach is best.
  • ECT: Renewed interest but still causes memory problems. Require multiple treatments and rapid response. Has seizures to changes brain chemistry.
• Psychotherapy:
  • Tries to eliminate troubling symptoms to improve functioning. Maybe it is more effective than medication alone.