Mental Health PDF

sorder with Peripartum Onset: → Postpartum depression Accompanied with: disturbance in appetite and sleep, low self esteem, and difficulties in maintaining concentration or attention. Typically remits during the first three months after childbirth - although some cases persist...

sorder with Peripartum Onset: → Postpartum depression Accompanied with: disturbance in appetite and sleep, low self esteem, and difficulties in maintaining concentration or attention. Typically remits during the first three months after childbirth - although some cases persist for years. Postpartum may involve chemical or hormonal imbalances brought on by pregnancy or childbirth but also psychosocial factors such as financial problems, a troubled marriage, lack of social or emotional support from partners and family members, history of depression, or an unwanted or sick baby. This all increases a woman's vulnerability to depression. Risk factors for major depression: Greater risk: Age( more common in younger adults than older), socioeconomic status (lower incomes), marital status ( not in an intimate relationship) Major depression develops in young adulthood Women are typically more at risk because they do rumination (continue to think about it and understand the reasons) whereas men go hangout with friends to be distracted. Persistent Depressive disorder: → It is a chronic type of depressive disorder lasting at least two years. People with PDD have either chronic major depressive disorder or a chronic but milder form of depression called Dysthymia Dysthymia begins often in childhood or adolescence and tends to follow to adulthood. Persistent stressed mood and low self esteem affecting occupational and social functioning. Bipolar Disorder: Bipolar disorder I Bipolar I disorder: Bipolar disorder characterised by manic episodes. Manic episodes: Periods of unrealistically heightened euphoria, extreme restlessness, and excessive activity characterised by disorganised behaviour and impaired judgement. Manic episodes typically last a few weeks to several months , are generally shorter in duration and end more abruptly than MDD. During a Manic episode the person experiences a sudden elevation of mood and feels unusually cheerful, euphoric or optimistic. The person seems to have boundless energy and is extremely sociable. “ It's one thing to feel excited because you won the lottery; it's another to feel euphoric because it's wednesday. DSM-5 criteria for Manic Episode: A→ A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least one week and present most of the day. B→ During the period of mood disturbance and increased energy, three r more of the following symptoms are present 1. Increased self esteem 2. Decreased need for sleep (ex. Feels rested after 3 hours of sleep) 3. More talkative than usual 4. Flight of ideas 5. Distractibility 6. Increase in goal-directed activity 7. Excessive involvement in activities that had a high potential for painful consequences.(foolish business investments) C→The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning D→ The episode is not attributable to the physiological effects of a substance. Tend to speak rapidly: outpouring of speech in which words seem to surge urgently for expression, as in a manic state During manic episodes individuals generally experience an inflated sense of self-esteem: ex. They have a special relationship with god. They will feel capable of solving the world's problems More than 90% of people who experience manic episodes eventually experience a recurrence. Some people with recurring bipolar disorder attempt suicide on their “way down” from the manic phase. Rapid cycling: the individual experiences two or more full cycles of mania and depression within a year without any intervening normal periods. Bipolar II disorder Associated with a milder form of mania called hypomania (hype services from greek meaning less than). In BPII the person has experienced one or more major depressive episodes and at least one hypomanic episode, but never a full blown manic episode. Hypomanic episodes are less severe than manic episodes and are not accompanied by the severe social or occupational problems associated with full blown manic episodes. During Hypomanic episodes: People have an inflated sense of self-esteem, feel unusually charged with energy and alert,and be more restless and irritable than usual. They may be able to work long hours with little fatigue or need for sleep. Equal in men and women although women tend to have more depressive episodes. Cyclothymic disorder: This disorder involves a chronic cyclical pattern of mood disturbance characterised by mild mood swings of at least two years.  The individual with cyclothymic disorder has numerous periods of hypomanic symptoms that are not severe enough to meet the criteria for a hypomanic episode and numerous periods of mild depressive symptoms that do not measure up to a major depressive episode Begins late adolescence or early childhood When they are “up” people with cyclothymic disorder show elevated activity levels but when they are mildly depressed they find it difficult to summon the energy or interest to persevere. May be a mild early stage of bipolar disorder. Theoretical Perspectives → Biological, psychological, social and environmental factors are involved in the development of depressive and bipolar disorders. Stress: There is an association between stressful life events and major depressive episodes. Stressor such as… the loss of a loved one, prolonged employment, physical illness, relationship problems, economic hardship, pressure at work, racism, discrimination can all contribute to depressive disorders. Close relationships may provide a source of support during times of stress. Psychodynamic Perspectives: Freud: The psychodynamic theory of depression Repressed anger toward departed loved ones turns into anger. Depression represents anger directed inward rather than against significant others. Anger may become directed against self following either the actual or threatened loss of these important others. Freud believed that mourning is a healthy process which one eventually comes to psychologically separate oneself from a person who is lost through death, separation, divorce etc. Results from self blame and guilt From a psychodynamic viewpoint, bipolar disorders represent shifting dominance of the individual's personality by the ego and superego. In the depressive phase the superego is dominant, producing a lot of wrongdoings with later turns to guilt. After, the ego comes back and asserts supremacy, producing feelings of self-confidence that comes to the manic phase. The excessive display of ego eventually triggers a return to guilt putting the person back into the depressive stage. Self focusing model: depression prone people experience a period of self focusing following major disappointment. Become preoccupied with thoughts of the loss. Interactional theory: Proposes that the adjustment to living with a depressed person can become so stressful that the partner or family member becomes progressively less reinforcing toward the depressed person People who are depressed push away their loved ones. Their demands start to become annoying for others. ALthough loved ones may keep their negative feelings to themself these feelings may surface in subtle feelings like rejection. This rejection deepens the depression triggering a cycle of profound depression Aaron Beck's cognitive theory: Cognitive theorists relate the origin and maintenance of depression to the ways in which people see themselves and the world around them. Beck relates the development of depression and the adoption early in life of a negatively biassed or distorted way of thinking - the cognitive triad of depression: negative views of oneself, the world, and the future. Greater risk of becoming depressed in the face of a disappointing or stressful experience. Such as losing a job. The cognitive triad of depression → Negative view of oneself: piercing oneself as worthlessness, unlovable and lacking the necessary skills to achieve happiness. → Negative view of environment: Thinks the environment as imposing excessive demands and obstacles that are impossible to overcome leading to continued failure. → Negative view of the future: Perceiving the future as hopeless and believing that you are powerless to change things for the better. Habitual style of negative thinking The tendency to magnify the importance of minor failures is an example of cognitive distortions: → All or nothing thinking → overgeneralization → mental filter → Disqualifying the positive → Jumping to conclusions → Magnification and minimization → emotional reasoning → Should statements → Labelling and mislabelling → Personalization Learned Helplessness (Attributional theory): Martin Seligman People may become depressed because they learnt to view themselves as helpless to control the reinforcements in their environments or to change their lives for the better.  Seligman says people learn to perceive themselves as helpless because f their experiences. Behavioural and cognitive Situational factors foster attitudes that lead to depression. The reformulated helplessness theory: Seligman recast the helplessness theory in terms of the social psychology concept of attributional style. An attributional style is a personal style of explanation. When failures occur we explain them in various ways: We blame ourselves (internal attribution) or our circumstances ( external attribution) 1. Internal factors: failures reflect their personal inadequacies, rather than external factors 2. Global factors: failures reflect sweeping flaws in personality 3. Stable factors: failures reflect fixed personality factors, rather than unstable factors Biological Perspective: Genetics and neurotransmitter functioning in the development of depressive and bipolar disorder. These disorders tend to run in families Treatment: Behavioural approaches Behavioural treatment approaches presume that depressive behaviours are learned and can be unlearned. Behavioural therapists aim to directly modify behaviours rather than seeking to foster awareness of possible unconscious causes of behaviour. They focus on increasing participation in pleasurable activities. The coping with depression course: helps clients have relaxation skills, increase pleasant activities and build social skills ( participants are taught to generate a self-change plan, think more constructively and develop a lifetime plan) Behavioural activation: is the most idly used behavioural treatment model → encourages patients to increase their frequency of rewarding or enjoyable activities. Behavioural therapy has produced substantial benefits in treating depression in both adults and adolescents Behavioural approaches are often used along with cognitive therapy in a broader treatment model called cognitive-behaviour therapy which is the most used psychological treatment for depression today. Cognitive approaches: Cognitive theorists believe that distorted thinking plays a key role in the development of depression.  Aaron beck developed cognitive therapy: which is a form of psychotherapy in which clients learn to recognize and change their dysfunctional thinking patterns. Cognitive therapy helps clients identify and change dysfunctional thoughts and develop more adaptive behaviours. Selective abstraction: The tendency to judge oneself entirely on the basis of specific weaknesses or flaws in character Electroconvulsive therapy: Also known as shock therapy ECT involves the administration of an electrical current to the head. Between 70 to 130 volts to induce a convulsion that is similar to a grand mal epileptic seizure. Suicide Men are more likely than women to actually kill themselves (men firearms and women pills) Stigm associated with male depression and suicide preventsthem from seeking help Suicide and psychological disorders: to observers suicide seems extreme that only “nsane” people” would do or out of touch with reality they are just discouraged and see no way out Many suicides are associated with major depression or biopolar disorder. Role of stress: suicideattemptsoften occur during very stressful life events especially “Exit events” like death of someone you love. Rate of suicide among elderly are increasing Risk factors in suicide: Suicide is one the leading causes of death in both men and women from adolescence to middle age Factors associated with increased risk of suicide among children and adolescence: 1. Gender: Girls like women are 3x more likely than boys to attempt suicide. Boys like men are more likely to succeed because they use more lethal weapons like guns. 2. Age: Young people in late adolescence or early adulthood (15-24) are at greater risk than young adolescence. 3. Ethnicity: The suicide rate for candian first nations youth is five to seven times higher than the general population. 4. Depression and hopelessness: Especially when both combined with low self esteem, are major risk factors among adolescents and adults 5. Previous suicidal behaviour: A quarter f adolescence who attempt suicide are repeaters. 6. Family problems: Family instability or conflict, physical or sexual abuse, loss of a parent because of death or separation , and poor parent-child communication 7. Stressful life events: traumatic events → breakup, unwanted pregnancy, getting arrested, problems at school, moving to a new school, taking an important test 8. Substance abuse: Addiction in the family  9. Social contagion: when a suicide or a group of suicides receives widespread publicity. Theoretical perspective on suicide; Durkeim: noted that people who feel anomie (whofeel lost, without identity) are more likely to die b suicide. Psychodynamic model: Suicide represents inward directed anger that turns murderous. Learning theories: Learning theorists point to the reinforcing effects of prior suicide threat and attempts and to the effects of stress, especiall when combined with inability to solve personal problems. Threats of suicide or not the asking for attention they should always be taken seriously. People who dies from suicide often tell others of their intentions or leave clues beforehand Social cognitive theories: Suggest that suicide maybe be motivated by positive expectancies and by approving attitudes toward legitimacy of suicide. People who kill themselves expect they will be missed or eulogised after death and that the survivors will feel guilty for mistreating them. Biological factors: Reduced serotonin activity in people who die or attempt by suicide. Serotonin deficits have been implicated in depression, so the relationship with suicide is not surprising. The greater number of family members with a history of suicidal behaviour, the earlier the age of the appearance of suicidal acts in offspring. Predicting suicide: Hopelessness Telling others about their suicidal thoughts Disposing their possessions Sort out their affairs such as drafting a will or buying a cemetery plot Purchase guns despite lack of prior interest in firearms. Troubled people are suddenly at peace and this sudden calm may be misinterpreted as a sign of hope Suicide prevention: 1. Draw the person out: so the person can verbalise thwarted psychological needs and offer some relief. “What's going on?” “Where do you hurt?”  2. Be sympathetic: Don't say you are just being silly you don't actually mean it 3. Suggest that means other than suicide can be discovered to work out the persons problems even if they are not apparent at the time: People who are suicidal usually only see two solutions to their predicament– suicide or a magical resolution. 4. Ask how the person expects to die by suicide 5. Propose that the person accompany you to consult a professional right now. 6. Don't say something like “you are talking crazy” 7. Dont press the suicidal person to contact specific people such as parents or spouse. 10.1: Clinical Features of Schizophrenia: Schizophrenia: A chronic psychotic disorder characterised by acute episodes involving a break with reality, as manifested by such features as delusions, hallucinations,illogical thinking, incoherent speech, and bizarre behaviour Phases of schizophrenia: People who develop Schizophrenia are disengaged from society. Disorder usually develops in late teens or early twenties at time which the brain reaches full maturation. Men have a slightly higher risk of developing schizophrenia and tend to develop it at an earlier age. Some cases: The disorder is acute… It occurs suddenly within a few weeks or months. Most cases: slower, more gradual decline in functioning. → The period of deterioration: The prodromal phase → 1)Stage in which the early features or signs of the disorder become apparent 2) in schizophrenia, the period of decline in functioning that precedes the development of their first acute psychotic episode. → characterised by not having interest in social activities and difficulty meeting the responsibilities of daily living. Signs: Fail to bathe regularly, don't care about appearance, lapses in job or school performances, behaviour biomes odd. Their speech becomes vague and rambly. More bizarre signs begin like hoarding food, collecting garbage, or talking to oneself on the street that means that acute phase of the disorder begins Acute phase: the phase when hallucinations, delusions and disorganised speech and behaviour begin. Following cute episodes, people who develop schizophrenia may enter the residual phase which is the phase characterised by return to a level of functioning typical of the prodromal phase Major features of schizophrenia:  Marked decline in occupational and social functioning. Difficulty holding a conversation, forming friendships, holding a job, or taking care of personal hygiene. No single behaviour pattern is unique to schizophrenia Delusions: 1. Delusions or false beliefs that remain fixed in the person's mind despite their illogical bases and lack of supporting evidence. 2. They remain unshakeable even in the face of disconfirming evidence. 3. Delusions of persecution: The police are out to get me 4. Delusions of reference: The people on tv are laughing at me or people on the bus are talking about me 5. Delusions of being controlled: Believing that one's thoughts, feelings, impulses, or actions are controlled by external forces, such as agents of the devil. 6. Delusions of grandeur: believing oneself is Jesus or to be on a special mission or having plans to save the world. Common delusions: 1. Thought broadcasting: believing one's thoughts are somehow transmitted to the external world so that others can overhear them. 2. Thought insertion: believing that one's thoughts have been planted in one's mind by an external source 3. Thought withdrawal: believing that thoughts have been removed from one's mind. Disorganised speech: Regular people's thoughts are logical and coherent but schizophrenia they tend to be disorganised, illogical, which is then reflected in their speech patterns. Thought disorder: Disturbances in thinking characterised by various features, especially a breakdown in logical associations between thoughts. As a result of thought disorder the speech pattern of people with schizophrenia is often disorganised or jumbled with parts of words combined incoherently or words strung together to make meaningless rhymes. Speech jumps from one topic to another with little interconnectivity. They are unaware that their thoughts are not normal and in severe cases their speech may become completely incomprehensible. Another sign of thought disorder: poverty of speech which is speech that is coherent but is so limited in production or vague that little informational value is conveyed. Less common signs include: → neologisms: words made up by the speaker that have little or o meaning to others,  →preservation: inappropriate but persistent repetition of the same words or train of thought → Clanging: stringing together words or sounds on the basis of rhyming such as “I know who I a, but I don't know sam” → Blocking: involuntary abrupt interruption of speech or thought. Not all people with schizophrenia have thought disorder. Some speak clearly but have disordered content of thought as seen by the presence of delusions. Hallucinations: The most common form of perceptual disturbance in schizophrenia More common: 1. Auditory hallucinations: hearing voices are most common in 60-80% of cases. Command hallucinations→ instruct them to perform certain acts like harming themselves and they usually go undetected because hallucinators are unwilling to discuss them. 2. Tactile hallucinations: tingling, electrical or burning sensations also common 3. Somatic hallucinations: feeling like snakes are crawling inside your belly also common Rarer: 1. Visual hallucinations: seeing things that aren't there 2. Gustatory hallucinations: tasting things that aren't present 3. Olfactory hallucinations: sensing odours that are not present. Hallucinations of other types: Not unique to schizophrenia people with depression or mania sometimes experience hallucinations Sometimes hallucinations are not a bad thing in cultures 1. Dreams is a form of hallucination 2. During religious experience or ritual 3. Hallucinogenic drugs tend to be visual 4. Grief induced hallucinations Causes of hallucinations: Cause of psychotic hallucinations is unknown but there are speculations Disturbances in brain chemistry is suspected to play a role Hallucinations may represent a subvocal inner speech: projections of their own voices Grossly disorganised or catatonic behaviour:  Emotional responses may be inappropriate like giggling at bad news. Some cases, individuals with schizophrenia may show catatonic behaviour which involve severely impaired cognitive and motor functioning. Catatonia: gross disturbances in motor activity and cognitive functioning People with Catatonia may become unaware of the environment and maintain a fixed rigi posture- even bizarre, apparently strenuous positions for hours as their limbs become stiff or swollen. They may show highly excited or wild behaviour or slow to a state of stupor which is a state of relative or complete unconsciousness in which a person is not generally aware of or responsive to the environment, as in a catatonic stupor. A striking but less common feature of catatonia waxy flexibility which is a feature of catatonia involving adopting a fixed posture into which people with schizophrenia have been positioned by others. Positive symptoms: are characterised by the presence of abnormal behaviour such as hallucinations, delusions, thought disorder, disorganised speech and disorganised behaviour. Negative symptoms: Negative symptoms are characterised by the absence of normal behaviour. Deficits or behavioural deficiencies such as social skill deficits, social withdrawal, flattened affect, poverty of speech and thought, psychomotor retardation or failure to experience pleasure in pleasant activities. Negative symptoms impair the ability to function in meeting demands of daily life and may persist for months or years after positive symptoms lessen, sometimes even lasting through most of a patient's lifetime. They tend to withdraw from social interactions and become absorbed in private thoughts and fantasies or cling to others and make them uncomfortable They become so dominated by their owen fantasies they essentially lose touch with the outside world. Blunted effect: reduction in emotional expresion Flat affect: absence of emotional expression. Other types of impairemnent Loss of ego boundaries: fail to recognize themselves as unique individuals and be unclear as to how much of what they experience is part of themselves.