PSYC 2350 Notes PDF

Chapter 7: Mood Disorders and Suicide Types of Mood Disorders Unipolar Depressive Disorders: Unipolar depression is another name for major depressive disorder. The term unipolar means that this form of depression does not cycle through other mental states, such as mania. ○...

Chapter 7: Mood Disorders and Suicide Types of Mood Disorders Unipolar Depressive Disorders: Unipolar depression is another name for major depressive disorder. The term unipolar means that this form of depression does not cycle through other mental states, such as mania. ○ Genetic Influences ○ Neurochemical factors: depression may arise from disruptions in the delicate balance of neurotransmitter substances that regulate and mediate the activity of the brain’s nerve cells ○ Abnormalities of Hormonal Regulatory and Immune Systems: Possible hormonal causes or correlates of some forms of mood disorder. ○ Sleep and Other Biological Rhythms ○ Biological Explanations for Sex Differences ○ Stressful Life Events (Psychological Causal Factor) Diff Types of Vulnerabilities ○ Personality and Cognitive Diatheses: People who have high levels of neuroticism are prone to experiencing a broad range of negative moods. ○ Psychodynamic Theories. Freud hypothesized that depression could also occur in response to imagined or symbolic losses. Ex; a student who fails in school or who fails at a romantic relationship may experience this symbolically as a loss of his or her parents’ love. ○ Behavioural Theories: people become depressed either when their responses no longer produce positive reinforcement or when their rate of negative experiences increases. Dysthymic Disorder (Persistent Depressive Disorder): When someone has a persistently depressed mood most of the day, for more days than not, for at least 2 years. (Periods of normal mood may occur briefly, but usually last for a few days to a few weeks). Premenstrual Dysphoric Disorder: This disorder is diagnosed if a woman has had a certain set of symptoms in the majority of her menstrual cycles for the past year. Major Depressive Disorder: The diagnostic criteria for major depressive disorder (also known as major depression) require that the person exhibit more symptoms than are required for dysthymia and that the symptoms be more persistent. ○ Melancholic Features: Early morning awakening, depression worse in the morning. ○ Psychotic Features: Delusions, Hallucinations ○ Atypical Features: Mood reactivity  ○ Catatonic Features: Range of psychomotor symptoms ○ Seasonal Pattern Beck’s Cognitive Theory; Beck hypothesized that the cognitive symptoms of depression often precede and cause the affective or mood symptoms rather than vice versa. Ex; Thinking that you are a failure could easily turn into a depressed mood. ○ Beck’s cognitive model of depression describes a pattern of negative automatic thoughts. Three themes; Self, world, future. Hopelessness Theory of Depression: A pessimistic attributional style and one or more negative life events will not produce depression unless one first experiences a state of hopelessness. Excessive Rumination: Pattern of repetitive and relatively passive mental activity. Bipolar and Related Disorders Cyclothymic Disorder Emotional ups and downs that are less extreme than bipolar disorder. If such symptoms persist for at least 2 years, the person may receive a diagnosis. Depressed Phase: mood is dejected, distinct loss of interest or pleasure in activities and pastimes, low energy, feelings of inadequacy, social withdrawal, and a pessimistic, brooding attitude. Hypomanic Phase: may become especially creative and productive because of increased physical and mental energy. Individuals with cyclothymia are at greatly increased risk of later developing full-blown bipolar I or II disorder. Bipolar Disorders (I and II) Distinguished from major depressive disorder by the presence of mania Mixed episode: symptoms of both full-blown manic and major depressive episodes for at least 1 week. ○ 8 studies reported that an average of 28 percent of bipolar patients at least occasionally experience mixed states ○ Many patients in a manic episode have some symptoms of depressed mood, anxiety, guilt, and suicidal thoughts Bipolar II Disorder: The person does not experience full-blown manic (or mixed) episodes but has experienced clear-cut hypomanic episodes as well as major depressive episodes. ○ Bipolar II disorder evolves into bipolar I disorder in only about 5 to 15 percent of cases. ○ Bipolar II disorder has an average age of onset approximately 5 years later than bipolar I disorder  Manic Depressive Spectrum: Spectrum of bipolarity in moods The duration of manic and hypomanic episodes tends to be shorter than the duration of depressive episodes A person who is depressed cannot be diagnosed with bipolar I disorder unless he or she has exhibited at least one manic or mixed episode in the past. Rapid Cycling: As many as 5 to 10 percent of persons with bipolar disorder experience at least four episodes (either manic or depressive) every year, a pattern. Causal Factors: Biological Factors ○ Genetic Influences: There is a greater genetic contribution to bipolar disorder than to unipolar disorder ○ Neurochemical Factors: Norepinephrine, serotonin, and dopamine all appear to be involved in regulating our mood states ○ Abnormalities of Hormonal Regulatory Systems: Bipolar patients may have abnormalities in the way ions are transported across the neural membranes ○ Sleep and biological Rhythms ○ Neurophysiologic and Neuroanatomic Influences Psychological Factors ○ Stressful Life Events ○ Other Personality variables (such as neuroticism and high levels of achievement striving) Low social support  Pessimistic attributional style Sociocultural Factors Affecting Unipolar and Bipolar Disorders Cross-Cultural Differences in Depressive Symptoms ○ Depression occurs in all cultures but in different forms ○ Ex; In China and Japan, somatic and vegetative symptoms replace psychological symptoms such as guilt and suicidal ideation ○ May stem from Asian beliefs of the unity of body and mind, or stigma attached to mental illness Cross-Cultural Differences in Prevalence ○ Rates of depression vary more than rates of bipolar disorder ○ The lifetime prevalence of depression is 17-19% in the U.S.S but only 15% in Taiwan ○ Reasons for diff rates of depression are not clear yet ○ Prevalence Rates of Depression: Demographic Differences in the United States ○ Native Americans have high rates of depression ○ African Americans were found to have relatively low rates ○ In the U.S., rates of unipolar depression are inversely related to socioeconomic status ○ Mood disorders appear relatively common in artists ○ Rates of Mood Disorders in Writers and Artists:-> Treatments and Outcomes Pharmacotherapy ○ Antidepressants, mood-stabilizing, antipsychotic drugs are used to treat mood disorders ○ SSRIs are the most recent generation of antidepressants ○ Drugs often require weeks to take effect ○ Lithium is a common mood stabilizer for bipolar Alternative Biological Treatments ○ Electroconvulsive therapy ○ Transcranial Magnetic Stimulation ○ Deep brain stimulation ○ Bright light therapy Psychotherapy ○ Cognitive-behavioural therapy ○ Behavioural activation treatment ○ Interpersonal therapy ○ Family and marital therapy Suicide: The Clinical Picture and the Causal Pattern The risk of suicide is a significant factor in all types of depression. About 50 to 90 percent of those of commit suicide do so during a depressive episode or while in recovery 90 percent of people who committed suicide had some sort of psychiatric disorder at the time. (Only about half have been diagnosed prior) Those who suffer from more than one mental disorder are at more risk Suicide ranks among the top ten leading causes of death in most Western countries Suicide attempts are most common in people between 18 and 25 years old Completed suicides are most common in the elderly (65 and older) Women are more likely to attempt suicide, but men are more likely to complete suicide  Rates of suicides for people 15-24 tripled between the mid-1950s and mid-1980s Risk factors for adolescent suicide include mood disorders, conduct disorder, and substance abuse Biological Causal Factors ○ Genetic factors may play a role in the risk of suicide ○ Reduced serotonergic activity appears to be associated with increased risk Suicide Ambivalence Some people do not really wish to die but instead want to communicate a dramatic message concerning their distress Methods are nonlethal and may include minimal drug ingestion or minor wrist-slashing Often, they arrange their action so that intervention by others is likely Only 15%-25% of completed suicides leave notes Suicide Prevention and Intervention treatment of the person’s current mental disorder crisis intervention working with high-risk groups Prevention of suicide can take the form of treatment of the underlying mental disorder(s) For depression, antidepressant medication or lithium can be helpful For anxiety, benzodiazepines can be helpful Cognitive-behavioral therapy can be helpful in reducing suicide attempts among those who had previously made an attempt  Chapter 8: Somatic Symptoms and Dissociative Disorders What are somatic symptom disorders? Must have one of the following three features: Disproportionate and persistent thoughts about the seriousness of one’s symptoms, Persistently high level of anxiety about health or symptoms, and/or Excessive time and energy are devoted to these symptoms or health concerns. Somatic Symptom disorder patterns Hypochondriasis ○ Preoccupation with fears of having or getting a serious disease ○ Not a disorder in DSM-5 and about 75% of people with hypochondriasis will meet the criteria for somatic symptom disorder ○ People with hypochondriasis are preoccupied with fears of getting a serious disease or the idea that they already have one ○ Cognitive-behavioral views of hypochondriasis are the most widely accepted ○ Cognitive-behavioral therapy can be a very effective treatment Somatization disorder ○ Lasting several years ○ Beginning before 30 years old ○ Not properly explained by independent findings of physical illness or injury ○ Somatization disorder is characterized by many different complaints of physical ailments ○ Prevalence, Rates, and Causal Factors ○ Usually begins in adolescence  ○ Is three to ten times more common in women than in men ○ Often occurs with other disorders such as major depression or panic disorder ○ There may be a genetic predisposition to the disorder ○ Other contributory causal factors may include personality, cognitive, and learning variables ○ Difficult to treat/ combo of medical management and cognitive behavioural therapy Pain disorder ○ Persistent and severe pain in one or more areas of the body ○ Now a part of somatic symptom disorder ○ The symptoms of pain disorder resemble the pain symptoms of somatization disorder, but with pain disorder, the other symptoms are not present ○ Cognitive-behavioral techniques are widely used in the treatment of both subtypes of pain disorder Conversion disorder ○ Symptoms that affect sensory or voluntary motor functions ○ This leads one to think that the patient has a medical condition ○ Freud believed that the symptoms were an expression of repressed sexual energy ○ One of the most intriguing and baffling disorders, with much left to learn ○ The primary gain for conversion symptoms is continued escape or avoidance of a stressful situation ○ Secondary gains include attention and financial compensation ○ The highest estimated prevalence is.005% of the general population ○ Occurs most frequently with major depression and anxiety disorders ○ Motor conversion symptoms have been successfully treated with behavioral therapy  ○ Psychogenic seizures have been treated with cognitive-behavioral therapy ○ Hypnosis can be successful when paired with other problem-solving strategies What is illness anxiety disorder? High anxiety about having or developing a serious illness What is the difference between factitious disorder and malingering? Malingering Disorder is motivated by external incentives Factitious Disorder is motivated by the benefits of a “sick role” It can be difficult to distinguish between malingering/factitious disorder and somatic symptom disorders such as conversion disorder Conscious intent can be a key distinction What are the primary features of dissociative disorders? A group of conditions involving disruptions in a person’s normally integrated functions of consciousness, memory, identity, or perception These disruptions include the functions of; consciousness, memory, identity, and perception Depersonalization/Derealization Disorder ○ In derealization, one’s sense of the reality of the outside world is temporarily lost ○ In depersonalization, one’s sense of one’s self and one’s reality is temporarily lost ○ If these recur and disrupt life, depersonalization/derealization disorder may be diagnosed Dissociative Amnesia and Dissociative Fugue ○ Dissociative fugue is now a subtype of dissociative amnesia ○ Dissociative amnesia involves a failure to recall previously stored personal information when that failure cannot be accounted for by ordinary forgetting ○ In a dissociative fugue, the person also departs from home surroundings What is dissociative identity disorder? Dissociative identity disorder is a dramatic dissociative disorder in which a patient manifests two or more distinct identities or personality states that alternate in some way in taking control of behavior Formerly called multiple personality disorder Alter identities are not in any meaningful sense of personalities This disorder is quite rare The disorder usually starts in childhood Childhood abuse in DID Patients; Sociocultural Factors in Dissociative Disorders Prevalence varies with acceptance of dissociative phenomena in the culture DID has been identified in all racial groups, SES classes, and cultures in which it has been studied; No systematic controlled research has been conducted In some cultures, dissociative trances or possession trances may occur Amok is a dissociative rage seen in some cultures such as Malaysia, Laos, the Philippines, Papua New Guinea, and others Treatments: Hypnosis  Chapter 6: Panic, anxiety, obsessions, and their disorders What's the difference between fear and anxiety? ○ Less obvious danger leads to anxiety ○ Obvious danger leads to fear ○ Anxiety is more oriented to the future and more diffuse than fear Anxiety disorders ○ Unrealistic, irrational fears to the point that it’s disabling Specific Phobias ○ Excessive or unreasonable strong fear that is triggered by a specific thing or situation ○ Types; Animal, Natural environment, blood-injection-injury, situational Psychological Causes ○ Learned behaviour/classical conditioning: We are all classically conditioned to things ○ Vicarious conditioning Learned by observing ○ Individual differences in learning ○ Evolutionary preparedness Over the history of evolution, we have developed certain fears and phobias. Innate responses Treatments ○ Exposure therapy ○ Participant modeling ○ Virtual reality components ○ Cognitive techniques combos Social Phobias ○ Disabling fears of one or more specific social situations ○ Fear of exposure to scrutiny and potential negative evaluation of others ie; humiliation or embarrassment ○ Social anxiety disorder Psychological Causal Factors ○ Learned behaviour ○ Evolutionary factors; Predisposed based on social hierarchies ○ Perceptions of uncontrollability and unpredictability ○ Cognitive biases toward “danger schemas” in social situations Treatments ○ Cognitive therapy; Cognitive restructuring ○ Behavioural therapy; Exposure to social situations ○ Medication Panic Disorders ○ Characterized by the occurrence of panic attacks that often seem to come “out of the blue” ○ Recurrent, unexpected attacks and worry about additional attacks (70% of the fear) ○ 13 possible symptoms of panic attacks, 10 of which are physical and 3 of which are cognitive ○ Attacks are brief but intense Agoraphobia ○ Anxiety about being in places from which escape might be difficult or embarrassing ○ Comes from the Greek word “agora” which means a public place/marketplace ○ It is disabling for some people Comorbidity ○ 83% of people with panic disorder have at least one comorbid disorder  ○ 50-70% will experience serious depression at some point in their lives ○ Addiction to self-medication(drugs, alcohol) is more prevalent in those with depression/anxiety Panic Circle Treatments ○ Medications: Anxiolytics, Antidepressants, Antipsychotics ○ Behavioural Treatment ○ Cognitive-behavioural treatments Generalized Anxiety Disorder Chronic or excessive worry about events/activities Occurs more days than not for 6 months Causal Factors ○ The conflict between id and ego ○ Worry positive or negative ○ Automatic attentional bias towards threatening info Treatment ○ Anxiolytic drugs(benzos)- bad, highly addictive, stop working after a couple of weeks ○ Buspirone(non-benzo)- Non-sedating, non-addictive, really bad nausea, not that good, only takes away the sharpness of anxiety but you still feel it ○ Cognitive-behavioural therapy- “And then what?” OCD-Obsessive Compulsive Disorder Unwanted and intrusive obsessive or distressing thoughts Obsessions; Contamination fears, fears of harming yourself or others Compulsions; Cleaning, checking, counting Comorbidity with Other Disorders; Often co-occurs with other anxiety disorders and mood disorders. Also co-occurs with body dysmorphia Treatments; Exposure-response prevention, and medications that affect the neurotransmitter serotonin (SSRI) BDD- Body Dysmorphic Disorder Obsessed with a perceived or imagined flaw in appearance Causes clinically significant distress May focus on any body part Shares body image distortion with eating disorders Treatment- Antidepressants, CBT Hoarding Disorder Get and fail to get rid of their possessions Disorganization that interferes with daily life The poorer prognosis for treatment than OCD-Don’t respond to treatment Trichotillomania Urge to pull out hair from any part of the body Preceded by tension and followed by pleasure Must cause clinically significant distress Test: What do all mood disorders have in common What were the two key things involved- mania, depression Depressive disorders Chart on moodle Postpartum blues Dysthymia Subtypes of depression Seasonal affective disorder Diathesis Model What is cognitive diathesis Behavioural explanations for depression Cyclomania, manic episodes Diff between bipolar 1 and 2 Suicide-Who is more likely to threaten/complete suicide-gender/differences Neurotic behaviour Panic attacks-typical symptom- fear of dying 5 primary types of anxiety disorders Exposure therapy Phobias Diff between the phobias Vicarious learning/classical conditioning What is likely to maintain a fear condition over time What is the best treatment for phobias What do you need for a diagnosis of panic disorder Diff between derealization, depersonalization, dissociative Agoraphobia-where it comes from What is a panic disorder GAD OCD What is the consistent and recurring thought Diff between compulsions and obsessions What do you need for a diagnosis of OCD-Common types of obsessions- what do they have in common From a behavioural viewpoint, why are compulsions repeated? What is a somatic symptom disorder? What is hypochondriasis? If you are consciously faking symptoms-malingering What is somatization disorder Somatic symptoms What a conversion disorder Conversion disordersHysteria-Hysterical blindness The most common kind of speech-related conversion is Alexia Aphonia Apraxia Alosia Whats a pseudoseizures Factitious disorders Which disorder is more likely that a person would not want to discuss symptoms Psychoanageic amnesia Dissociative Fugue Dissociative Identity Disorder 70 questions