Mental Health Exam 2 - Psychology PDF

Mental Health September 18th, 2024 Chapter 1 Legal and Ethical Issues - Psychology & psychiatry are intimately concerned with balancing the rights of individuals against the rights of society. - D...

Mental Health September 18th, 2024 Chapter 1 Legal and Ethical Issues - Psychology & psychiatry are intimately concerned with balancing the rights of individuals against the rights of society. - Deciding whether or not to release someone from jail if they are safe for society or not. - Overprediction Psychiatric Commitment Civil Commitment ○ Placing people in psychiatric institutions against their will Happens on an extreme basis → danger is visible, imminent, the person has symptoms that they are not able to control themselves or their behaviors ○ Deemed to be mentally disordered ○ Threat to themselves or others Legal Commitment ○ Results from an unlawful act ○ Clear evidence ○ Imminent risk ○ Limited time From the action of the person → crime, unlawful act Thomas Szasz ○ Label of mentally ill is a social construction, transforming social deviance into mental illness. ○ Focused attention on abuses in the mental health system Predicting Dangerousness ○ Before commitment, people must be judged as imminent risks to themselves or others. ○ Dangerousness tends to be Overpredicted by mental health professionals ○ Psychopathy, or personality disorder related to dangerousness Psychiatric Commitment & Patients’ Rights Patients’ rights  ○ Duty to warn: confidentiality ○ Right to treatment in the least restrictive environment You can’t confine someone who needs psychiatric help and refuse treatment ○ Right to refuse treatment: very controversial The Insanity Defence Not criminally responsible on account of a mental disorder (NCRMD) ○ Unable to appreciate the nature and quality of the act committed or omitted or of knowing that it was wrong. ○ Defense is not made if the person lacks appropriate feelings or remorse/guilt for the victim. Possible Outcomes ○ Absolute discharge: a person not a significant threat to the public ○ Conditional discharge: discharge conditional on the appropriate treatment ○ Detention: could be indefinite Chapter 2 Mood Disorders & Suicide - “It is normal; & appropriate to be uplifted by happy events. It is just as normal, just as appropriate, to feel depressed by dismal events. It might very well be ‘abnormal’ if we were not depressed by life’s miseries” (Nevid et al., 2005, p.219) - When you have variability in emotions it is good. appropriate responses to situations. Mood Disorders Mood disorders are a type of disorder characterized by disturbances of mood. They can take a variety of forms. Mood disorders are defined in terms of episodes. ○ Periods in which the person's behavior dominated by a depressed or manic mood How can we differentiate between normal sadness & clinical depression? Symptoms & Features Emotional symptoms Cognitive symptoms Somatic symptoms Behavioral symptoms Emotional Symptoms Brief negative emotions serve as a useful communication function Prolonged, intense emotions become problematic to our daily functioning. Dysphoric mood, anxiety Cognitive Symptoms Changes in the way people think Preoccupations and cognitive distortions Thinking slowed down or sped up Self-blame Somatic Symptoms → (body) Clinically-significant changes in: ○ Sleep patterns ○ Appetite ○ Hygiene ○ Bodily functions September 23rd, 2024 Behavioral Symptoms Changes in the things people do and how they do them Psychomotor retardation in depressed individuals Sped up, impulsive behavior in mania Contemporary Perspective  Unipolar Vs. Bipolar Disorders ○ Unipolar → Emotional disturbance characterized only by poor mood ○ Bipolar → Emotional disturbance involving swings between poor mood and mania Unipolar Disorders Major Depressive Disorder ○ Seasonal Affective Disorder (SAD) ○ Postpartum Depression Dysthymia (persistent depressive disorder) → one state (sadness) Bipolar Disorder Bipolar I Bipolar II Cyclothymic disorder Major Depressive Disorder: Diagnostic Features One or more major depressive episodes in the absence of manic or hypomanic episodes Depressed mood or loss of interest or pleasure in all or virtually all activities for at least 2 weeks Significant levels of distress, or impairment in at least one important area of functioning (ex: social, occupational) Not due to drug use or medications, and not better explained by another psychological disorder Not normal grief related to the death of a loved one (bereavement) DSM-V MDD The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Subtypes and Descriptors Episode specifiers  ○ Psychotic ○ Post-partum onset ○ Melancholia Severe form of depression Possible different cause Biological treatments successful Course specifiers ○ Seasonal affective disorder ○ Rapid cycling Denotes poor prognosis for bipolar disorder Course and Outcome Unipolar disorders ○ Onset generally in middle-age ○ 50% will recover within 6 months ○ Of those, 50% will relapse in 3 years Bipolar disorders ○ Onset typically between 28-33 years ○ Average durations of an episode: 2-3 months Epidemiology incidence/prevalence ○ Difficult to measure as many people do not seek treatment Gender ○ Women are more likely to be diagnosed with depression (MDD) ○ Life experiences (abuse, poverty, single parenthood, sexism) ○ Differences in coping styles Culture ○ Depression is a universal phenomenon ○ Higher in some cultures (ex. Aboriginal Canadians) Socioeconomic status Marital status (more likely among those separated or divorced) Seasonal Affective Disorder (SAD) Changing weather and seasons affect mood Features include:  ○ Fatigue ○ Excessive sleep ○ Craving for carbohydrates ○ Weight gain More prevalent further from the equator because there is more variation in daylight hours Changes in the quantity of light related with biological rhythms responsible for body temperatures and sleep-wake cycles Serotonin levels may be lower during the winter months Phototherapy: ○ Exposure to 2-3 hours of artificial light per day ○ Effectiveness is uncertain Postpartum Depression (peripartum) Mood changes following the birth of the child. Accompanied by disturbances in: ○ Sleep ○ Appetite ○ Lower self-esteem ○ Difficulties with concentration or maintaining attention It lasts a few days, considered a normal response to hormonal changes If mood disturbance lasts weeks or months, it could be diagnosed as postpartum depression Subtype of major depressive disorder Most likely among single and first-time mothers Related to Psychosocial variables: ○ Financial problems ○ Lack of social support ○ History of depression ○ Relationship troubles ○ Unwanted or sick baby ○ Difficult baby Dysthymic disorder Milder form of depression but nagging, lasting years, average duration about 5 years Chronic course of development, beginning in childhood or adolescence Feel “down in the dumps” most of the time  The mood condition is often perceived as part of the person’s personality, whining and complaining. September 25th, 2024 Dysthymic Disorder Persistent depressed mood and low self-esteem could adversely affect occupational and social functioning. Double depression ○ Major depressive episodes are superimposed on a longer-standing dysthymic disorder. Bipolar disorder Cyclical changes in mood from depression to mania without external cues. Manic episodes are shorter than depression episodes. - Bipolar 1: Occurrence of one or more manic episodes, even without a depression episode. - Bipolar 2: One or more depressive episodes and at least one hypomanic episode. Cyclothymic Disorder Mild mood swings of at least 2 years, one year for children in adolescence. Normal mood periods are few, lasting for only a month or so. Begins in adolescence and early adulthood. Not severe enough to be diagnosed as bipolar disorder. The period of elevated mood is called hypomanic, less severe than mania. The difference between cyclothymic and bipolar disorder is not clear, sometimes bipolar disorder begins with cyclothymia. Etiology: Social Factors Most cases of major depression are preceded by stressful life events. Depression may also bring about more stressful life events. Coping styles & social support ○ Depression is more likely among those living alone ○ Availability of support related to faster recovery ○ Less frequent use of active problem-focused coping  ○ Lack of social/interpersonal skills Etiology: Learning Perspectives Depression results when a person receives too little reinforcement from the environment. The cycle of decreasing reinforcement (low reinforcement, reducing activity, less reinforcement, etc). ○ A spiral of decreasing reinforcement and decreasing activity which can cause depression. ○ Ex: breaking your leg and not being able to play a sport (decreasing activity) leads to decreasing reinforcement → spiral. Illness and changes in life situations can cause the initial drop in reinforcement levels Solutions: ○ Increase activity levels ○ Increase reinforcement Interactional theory ○ Less reinforcement from usual social supports because a depressed person is difficult to live with (reciprocal interaction). Etiology: Learned Helplessness People learn to view themselves as helpless and fail to control the reinforcements in the environment (perception of lack of control). “Situational factors foster attitudes that lead to depression”. Situational factors are not enough, one must also consider how people “talk to themselves” about their failures. Etiology: Attributional Style Internal attribution (blame ourselves) External attribution (blame circumstances) Stable (typical events) vs. unstable (isolated events) attribution. Global (evidence of broader problems) bs. Specific (limited shortcoming) attribution. Etiology: Cognitive Theory Aaron Beck’s Cognitive Theory ○ Developed a behavioral process to identify hidden behavior Beck’s Cognitive Theory Cognitive triad ○ Negative view of oneself ○ Negative view of the environment ○ Negative view of the future Cognitive distortions set the stage for depression (examples) ○ All-or-nothing thinking (black and white) ○ Overgeneralization ○ Mental filter (focus on negative events) Automatic thoughts, just pop into your head September 30th. 2024 Etiological Considerations: Interpersonal Factors People create difficult circumstances that increase stress. Self-critical people elicit criticism and rejection from others. A person’s behavior causes negative life events. Biological Factors: Genetics Mood disorders tend to run in families The concordance rate for major depression ○ MZ twins 45-70% ○ DZ twins half of MZ twins Biological Factors: Neurotransmitters Catecholamine hypothesis (not enough norepinephrine) SSRIs (selective serotonin reuptake inhibitors) ○ Block re-uptake of serotonin Treatment: Unipolar Disorders Cognitive therapy ○ Identify and change distorted thoughts/beliefs ○ Relatively brief therapy, 14-16 weeks ○ Combination of behavioral and cognitive techniques Interpersonal therapy ○ Focus on relationships Antidepressant medications ○ SSRIs Proven to produce substantial benefits in treating depression among adults and adolescents. Treatment: Behavioral approaches Directly modify behaviors Not focused on awareness of unconscious causes Increase pleasant activities Relaxation training Social skills building self-change plan Brief therapy, about 14-16 weeks Biological Approaches Antidepressant Drugs ○ It may be most effective when psychotherapy fails, or if treating people with severe depression. Lithium ○ Used in bipolar disorder ○ 30-40% of patients do not respond or do not tolerate it well (side effects). Electroconvulsive Therapy (ECT) Severe cases/last resort Reason for effectiveness not understood Ethics of ECT controversial Generally safe and effective when alternative treatments fail  Significant improvement in 50-60% of people with major depression who did not respond to medications Really a short-term treatment Introduction to Cognitive Behavior Therapy Men are disturbed, not by things, but by the principles and notions which they form concerning things. The Approach Is: Collaborative (builds trust) Active Based on open-ended questioning Highly structured and focused ‘Common Sense’ Model Event → Emotion Cognitive Model Event → Meaning we give the event → Emotions Cognitive Principle ○ It is interpretations of events, not events themselves, which are crucial. Behavioral Principle ○ What we do has a powerful influence on our thoughts and emotions. The Continuum Principle ○ Mental health problems are best conceptualized as exaggerations of normal processes. ‘Here and now’ Principle ○ It is usually more fruitful to focus on current processes rather than the past. Interacting Systems Principle ○ It is helpful to look at problems as interactions between thighs, emotions, behavior and physiology, and the environment in which the person operates. Cognitive Model of Depression Negative cognitive triad ○ Biased views od  Oneself: am I bad, useless, unlovable, worthless, a failure. Negative filter ○ Remembering events ○ Interpreting current events/situations. ○ Overgeneralizing from a small negative event to a broad negative conclusion. Course of Treatment Identify specific problem list (&priorities) ○ Ex: poor sleep, relationship difficulties, etc Introduce the cognitive model - how it might apply to the client Goals Reduce symptoms through behavioral or simple cognitive strategies Identify and challenge NATs Relapse prevention Suicide: Who? 10% of men and 13% of women have thought of suicide. 2% of men and 6% of women have attempted suicide. Men are much more likely to kill themselves (4 times more likely to succeed). Accounts for 25% of all deaths among 15-24 year olds, and 16% among 25-44 year olds. Most likely among older men, with few social support, chronic and life-threatening diseases (poor quality of life). Men are more likely to have a history of substance abuse and less likely to have children in the home (fewer reasons for staying alive). People who attempt suicide are not crazy (are not out of touch with reality). Perceive it as the only remaining option for dealing with their problems. Mostly associated with major depression or bipolar disorder. It is also associated with other psychological problems (leading to cause of death among persons with schizophrenia). October 2nd, 2024 Suicide: Why?  Often follows highly stressful life events, more common among survivors of natural disasters (related to poorer coping strategies). Suicide: Psychoanalytic Perspective Suicide is inward-directed anger. The death instinct, wanting to return to the tension-free state that preceded the birth. Suicide: Existential and Humanistic Perspective The perception that life is meaningless and hopeless Suicide: Sociocultural Perspective Anomie (Durkheim) → feeling lost, without identity, rootless, alienation in modern society. ○ Anomie → lack the usual social or ethical standards in an individual or group. Suicide: Learning Theory Suicide attempts wish to escape unbearable psychological pain Threatening suicide results in sympathy and support from loved ones increasing the likelihood of future attempts Suicide: Social-Cognitive Theory Suicide is motivated by positive expectancies, and by approving attitudes regarding the legitimacy of suicide, e.g, ○ Suicide will solve my problems ○ People will miss me ○ Those who mistreated me will feel guilty It is more prevalent in younger people because they care about making people feel guilty. Social contagion (modeling) → important among teenagers ○ If people broadcast a suicide, people may follow and makes people do it faster and closer to the day of the person that's broadcasted about Suicide: Biological Factors  Reduced serotonin activity among suicide attempters Serotonin inhibits nervous system activity → reduced levels lead to disinhibition of impulsive behavior. Tends to run in families, 25% of suicide attempters have a family member who has committed suicide. Suicide attempters are also more likely to have family members with other psychological disorders. Predicting Suicide Very difficult to do! Hopelessness is very predictive. Tend to signal intentions by telling others. 90% leave clearer clues ○ Disposing of possessions ○ Sorting out their affairs ○ Drafting a will ○ Buying a cemetery plot ○ Purchase a gun despite no prior interest After deciding to commit suicide, troubled people may seem at peace, feeling that their problems will soon be resolved → could be misinterpreted as a sign of hope. Suicide Prevention 1. Draw the person out. Get them to talk about what’s troubling them 2. Be sympathetic. Don’t say, “You’re not really going to do it.” 3. Suggest that means other than suicide can be discovered to work out their problems. 4. Inquire as to how the person expects to commit suicide 5. Propose that the person accompany you to see a professional right now 6. Don’t degrade the individual (“You’re talking crazy…”) October 9th, 2024 Chapter 3 Schizophrenic Disorders Overview  Socially devastating problem 221,000 Canadians had Schizophrenia in 1996 A group of related disorders Key feature: psychotic symptoms - profound disturbance in thought, reality-testing, and affect. ○ Psychosis is the primary symptom → also in other disorders but is not the primary symptoms Course of Schizophrenia Prodromal ○ (Usually in adolescence) - decreased level of functioning, social withdrawal, peculiar behaviors, neglect hygiene, changes in emotion Active ○ Full spectrum of psychotic symptoms ○ More severe Residual ○ Return to prodromal but may also be mild delusions/hallucinations/continuing negative symptoms ○ Can have hallucinations and paranoia ○ Can be in the residual phase for the rest of their life Symptoms and Features Positive symptoms ○ Look for the presence of delusions and hallucinations Negative symptoms ○ Look for absence: poverty of speech, thought, hygiene, movement Positive Symptoms Hallucinations Auditory: often insulting or instructing ○ The most common hallucinations (auditory) experienced by people who have schizophrenia Tactile (e.g., something crawling under the skin) Somatic (e.g., an alien residing in the stomach)  ○ Somebody living inside, and harm (trying to kill or make someone sick) Visual: very rare ○ Often a toxic reaction to the drugs you take Delusions Persecutory (e.g., “others are spying on me”) ○ Follow the themes of watching movies (about the CIA, Russians, and Government Agencies) Those themes become the stories that they use in their lives when they are not well and their brain is not working properly Reference ○ Objects, people, and events given personal significance (e.g., “the radio announcer is mocking me”) ○ It gets people to isolate themselves in a way that is not healthy ○ Some kind of information is being sent or talked about from the individual's personal life Grandeur (e.g., “I am Jesus”) Other Types of Delusions Delusions of being controlled ○ Think less = solution Thought Broadcasting Thought Insertion → Who’s inserting the thoughts Thought Withdrawal → think the thought is taken out by someone else Negative Symptoms 1. Affective disturbance 2. Social and linguistic deficits Affective Disturbance Flattened affect Inappropriate affect Anhedonia ○ Inability to experience pleasure from normally pleasurable life events Social and linguistic deficits  Apathy ○ Absence of interest or concern with certain aspects of emotional, social, or physical life. Avolition ○ General lack of desire, motivation, and persistence Alogia ○ Poverty of speech Disorganization Thinking ○ Thought disorder ○ Disorganized speech ○ Neologisms: the creation of words which only have meaning to the person who uses them Behavior ○ Cotatonia: extreme loss of motor ability or constant hyperactive motor activity