Neurobiologic and psychopathologic theories

Neurobiologic Theories

• The central nervous system consists of the brain and the nerves that control voluntary acts.
• Brain components include the cerebrum, cerebellum, brain stem, and limbic system.

Neurotransmitters

• Neurotransmitters facilitate neurotransmission.
• They are important to relay messages in the right proportions.
• Studies show neurotransmitter variations in the brains of people with some mental disorders.
• Neurotransmitters play a role in psychiatric illness and psychotropic medications, including actions and side effects

Excitatory Neurotransmitters:

• Dopamine helps complex movements, motivation, cognition, and mood.
• Norepinephrine triggers fight or flight, mood regulation, cognition, memory, sleep, and wakefulness.
• Epinephrine produces fight-or-flight response.
• Glutamate has neurotoxic effects at high levels, and affects learning and memory.

Inhibitory Neurotransmitters:

• Serotonin regulates mood, food intake, sleep, wakefulness, temperature, pain control, and sexual behaviors.
• Gamma-aminobutyric acid (GABA) is a major inhibitory neurotransmitter, which modulates other neurotransmitters.
• Acetylcholine affects the sleep-and-wakefulness cycle, and signals muscles to become alert.
• Histamine and neuropeptides are also neuromodulators.

Neurotransmitter Imbalances

• Increased dopamine levels are associated with schizophrenia, mania, and addiction.
• Decreased dopamine levels are associated with depression, Parkinson's disease, and ADHD.
• Increased norepinephrine is associated with schizophrenia, mania, and anxiety.
• Decreased norepinephrine is associated with depression, social withdrawal, and memory loss.
• Increased serotonin is associated with schizophrenia and anxiety.
• Decreased serotonin is associated with depression.
• Increased acetylcholine is associated with depression.
• Decreased acetylcholine is associated with Alzheimer's disease, Huntington's, and Parkinson's.
• Increased glutamate is associated with depression, anxiety, Huntington's, and Alzheimer's disease.
• Decreased glutamate is associated with schizophrenia.
• Decreased GABA is associated with schizophrenia, anxiety, and Huntington's.
• Medications that increase GABA function treat anxiety and also induce sleep.

Neurobiologic Causes of Mental Illness

• Genetics and heredity play role in mental illness, along with non-genetic factors.
• Twin, adoption, and family studies are used to study the role of genetics and heredity

Twin Studies

• Twin studies compare the rates of certain mental illnesses between identical and fraternal twins.
• Genetic vulnerability is supported in autism, PTSD, substance abuse (alcoholism), schizophrenia, bipolar disorder, major depression, OCD, and risk for suicide.

Adoption Studies

• Adoption studies compare genetics and environment in development of a psychiatric disorder.
• Studies involve adopted children whose:
  • Biological parents had/adoptive parents didn't have a psychiatric disorder.
  • Adoptive parents had/biological parents didn't have a psychiatric disorder.
  • Biological and adoptive relatives of adopted children developed a psychiatric disorder.
  • Monozygotic twins were raised apart by different adoptive parents.
• Possible genetic links include alcoholism, schizophrenia, major depression, bipolar disorder, ADHD, and antisocial personality disorder.

Infections

• Infections may alter human genes or occur during fetal development.
• Unresolved elevated cytokines
• Toxoplasma gondii is associated with schizophrenia, bipolar disorder, and suicidal/aggressive behaviors.

Brain imaging techniques include:

• CT Scan
• Magnetic Resonance Imaging
• PET Scan

Psychopathologic Theories

• Theories to consider are psychoanalytic (Freud), developmental (Erikson, Piaget), interpersonal (Peplau), humanistic (Maslow), and behavioral (Pavlov, Skinner).

Psychoanalytic Theory (Sigmund Freud)

• All human behavior is caused and explainable.
• The personality has three components.
  • Id is the source of instincts.
  • Ego is the sense of reality.
  • Superego is morality.
• Freud believed that behavior is motivated by subconscious thoughts and feelings.
• Conscious thoughts are those a person is aware of.
• Preconscious thoughts are just below the surface.
• Unconscious thoughts are those outside of awareness.
• Dream analysis and ego defense mechanisms
• Oral, anal, phallic/Oedipal, latency, and genital are the psychosexual stages of development.
• Patients may experience transference and countertransference.
• Transference is when the patient displaces feelings to nurse
• Countertransference is when the nurse displaces feelings to patient

Developmental Theory (Erik Erikson)

• Focuses on stages of psychosocial development

Developmental Theory (Jean Piaget)

• Focuses on cognitive stages of development

Humanistic Theory (Abraham Maslow)

• Maslow's theory helps nurses understand how clients' motivations and behaviors change during life crises.
• The hierarchy of needs includes physiologic needs, safety and security, love and belonging, esteem, and self-actualization.

Behavioral Theories

• Classical conditioning (Ivan Pavlov).
• Operant conditioning (B.F. Skinner).

Ego Defense Mechanisms

• Ego defense mechanisms use methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events.
• Compensation is overachievement in one area to offset real or perceived deficiencies in another.
  • An example is Napoleon complex or the student who excels to compensate for feelings of loneliness.
• Conversion expresses an emotional conflict through development of a physical symptom, usually sensorimotor in nature.
  • An example is a man becomes blind after seeing his wife enter a hotel room with another man.
• Denial fails to acknowledge an unbearable condition, or admit the reality of a situation, and is common in alcoholics.
  • An example is reacting to the recent death of a loved one by saying "No, I don't believe you."
• Displacement is ventilation of intense feelings toward persons less threatening than the one who aroused those feelings.
  • An example is person who is mad at the boss yells at their spouse
• Dissociation deals with emotional conflict by a temporary alteration in consciousness or identity, with a short-lived gap in consciousness
  • An art student mentally separating herself from a noisy environment as she becomes absorbed in her work
• Fixation results in immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage.
  • An example is never learning to delay gratification
• Intellectualization separates the emotions of a painful event or situation from the facts involved, acknowledging the facts but not the emotions.
  • An example is person shows no emotional expression when discussing serious car accident and focus on the technical details of the accident
• Identification models actions and opinions of influential others while searching for identity or aspiring to reach a personal, social, or occupational goal.
  • An example is a nursing student becoming is inspired to become a critical care nurse because that that is the specialty of the instructor who they admire
• Introjection accepts another person's attitudes, beliefs, and values as one's own.
  • An example is a child is told by his mother that he is an idiot and will not go to college will still pass the entrance exam
• Projection is unconscious blaming of unacceptable inclinations or thoughts on an external object
  • An example is Man who has thought about same-gender sexual relationship but never had one beats a man who is gay
• Rationalization excuses own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect.
  • An example is student blames failure on teacher being mean
• Reaction formation acts the opposite of what one thinks or feels.
  • An example is person who despises the boss tells everyone what a great boss they are
• Regression is moving back to a previous developmental stage to feel safe or have needs met.
  • An example is Adult pouts like a 4-year-old if they are not the center of their partner's attention
• Repression excludes emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness. It's a an unconscious exclusion
  • An example is Person has no memory of the mugging they suffered yesterday
• Suppression is conscious of the exclusion unacceptable thoughts and feelings from conscious awareness
  • As an example, studnt decides not to think about a parenyt's illness to study for a test
• Resistance is overt or covert antagonism toward remembering or processing anxiety-producing information.
  • An example is person who is in therapy who has experienced significant trauma might resist discussing certain events or feelings at first.
• Sublimation substitutes a socially acceptable activity for an impulse that is unacceptable.
  • An example is person who has quit smoking sucks on hard candy when they are overcome by the urge to to do smoke
• Substitution replaceing the desired gratification with one that is mor eadily available
  • An example a person who would like to have their own children opens a day care center
• Undoing exhibits acceptable acceptable behavior to make up for or negate unacceptable behavior
  • An exampl eof whic is, person who is engaging in a ritualistic pattern of undoing that reinforces obsessive thinking and compulsive behaviors
• Splitting is inability of integrate the positive and negative qualities of oneself or others into a cohesive image.
  • An example of which is, A 26 year old who initially values an aquaintance only to become distillusioned later on when they turn out to be flawed

A self assessment on psychological disorders and neurotransmitters and their relation to disorders like Alzheimers, Schizophrenia and anxiety. Also includes questions about defense mechanisms.