Psychological Disorders: PTSD, OCD, Depression, Bipolar

• This text provides an overview of four psychological disorders: Post-traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Major Depression, and Bipolar Disorder, including their diagnostic criteria, symptoms, biological factors, risk factors, treatments, and other relevant information.

Post-Traumatic Stress Disorder (PTSD)

• Requires exposure to actual or threatened death, serious injury, or sexual violence.
• Symptoms last for at least one month and include four clusters: intrusion, avoidance, negative alterations in cognition/mood, and alterations in arousal/reactivity.
• Key symptoms include dissociation, flashbacks, nightmares, hyperarousal, persistent feelings of unsafety or fear, avoidance of reminders, negative beliefs, and emotional numbing.
• Traumatic events can shatter core beliefs, leading to cognitive shifts and hypervigilance.
• Approximately 10% of people exposed to trauma develop full PTSD.
• Biological factors include low cortisol levels post-trauma, moderate genetic predisposition, and sensitization of the brain’s fear circuitry due to early trauma.
• Other predictors include physical violence, sexual assault, comorbid diagnoses, low social support, and prior trauma.
• Adverse Childhood Experiences (ACEs) increase vulnerability to PTSD and other health issues.
• Complex PTSD (c-PTSD) often arises from chronic interpersonal trauma and involves emotional dysregulation, identity disturbance, and interpersonal dysfunction.
• Treatments include CBT, exposure therapy, EMDR, CISD (controversial), and psychodynamic therapy.
• The term "trauma" is often used loosely in popular culture, diluting clinical definitions.
• Scientific consensus is skeptical about repressed memories; trauma is often remembered vividly, and false memories can be implanted.

Obsessive-Compulsive Disorder (OCD)

• Characterized by obsessions, which are intrusive and unwanted thoughts/images, and compulsions/rituals, which are behaviors to neutralize obsessions.
• OCD is ego-dystonic, meaning the person sees their thoughts as irrational/distressing, while OCPD is ego-syntonic, where perfectionism/orderliness is seen as appropriate.
• Neurobiological factors include an overactive anterior cingulate cortex (error detection), serotonin deficiency, and a CSTC circuit that gets "stuck" in a loop.
• Diagnosis requires either obsessions or compulsions, not necessarily both.
• Risk factors include genetics (moderate heritability), head trauma, and PANDAS (pediatric onset after strep infection).
• Treatment involves Exposure & Ritual Prevention (ERP) and SSRIs.
• Placebo treatments show some response, but less than active treatments.
• OCD spectrum disorders include Hoarding Disorder, Trichotillomania, Excoriation, and Body Dysmorphic Disorder.

Major Depression

• Core diagnostic symptoms include depressed mood or anhedonia, along with other symptoms like insomnia, appetite/weight changes, fatigue, psychomotor retardation, guilt, worthlessness, and suicidal thoughts.
• Subtypes include psychotic depression, atypical depression, and seasonal depression.
• It is the number one cause of work-related disability worldwide.
• Heritability is approximately 35%, highly polygenic.
• Neurobiological factors include decreased slow-wave sleep, early REM onset, decreased left frontal cortex activity, low dopamine, serotonin involvement, hormonal changes, increased inflammation, and decreased BDNF.
• Chronic high cortisol levels can shrink the hippocampus and accelerate aging.
• Beck’s Cognitive Model includes the negative cognitive triad and cognitive distortions.
• Ilardi’s Evolutionary Mismatch Theory suggests lifestyle factors contribute, and treatment involves light therapy, aerobic exercise, omega-3s, sleep hygiene, social support, and meaningful work.
• SSRIs/SNRIs have a 40-60% response rate, while CBT is as effective short-term and better for long-term relapse prevention.
• Common antidepressants include SSRIs (Prozac, Zoloft, Paxil, Celexa, Lexapro), SNRIs (Effexor, Pristiq, Cymbalta), Wellbutrin, St. John’s Wort, psychedelics, and Ketamine.

Bipolar Disorder

• Symptoms involve mania (elevated mood, grandiosity, decreased sleep, pressured speech, impulsivity), hypomania (less severe mania), and mixed episodes (depressive + manic symptoms simultaneously).
• Diagnosed as Bipolar I (at least one full manic episode) or Bipolar II (hypomania + depression).
• Type III is antidepressant-induced mania.
• Drug triggers include antidepressants, stimulants, THC, binge drinking, and steroids.
• Antidepressants can trigger mania or rapid cycling as an iatrogenic effect.
• Prevalence is about 4% lifetime, with a suicide risk approximately 3x higher than MDD.
• Significant impairment in work and functioning may occur.
• Associated with divergent thinking, especially in mild forms.
• Heritability is very high, around 80%.
• Biological factors include a hyperreactive amygdala, dysregulated dopamine, altered frontal cortex activity, elevated glutamate, and triggers like sleep deprivation, stress, and light exposure.
• Each episode increases vulnerability to future episodes, even without triggers according to the Kindling Hypothesis.
• Rapid cycling is defined as ≥4 episodes/year.
• Medications include Lithium, anticonvulsants (Lamictal, Topamax), and novel antipsychotics.
• Lifestyle treatments include omega-3s, exercise, and light/dark therapy.
• Family-Focused Therapy (FFT) cuts relapse risk by approximately 50%.