1- emotions.pdf

Stress, Emotions & motivation Samah Rabei MD Psychiatry, MRCPsych Stress is the change that challenges of adaptability (measured by Holmes & Rahe scale) Effect of stress Short term: sympathetic over-activity Long term: increased cortisol life events could be: loss- humiliation - entr...

Stress, Emotions & motivation Samah Rabei MD Psychiatry, MRCPsych Stress is the change that challenges of adaptability (measured by Holmes & Rahe scale) Effect of stress Short term: sympathetic over-activity Long term: increased cortisol life events could be: loss- humiliation - entrapment Factors determining the effect of stress Individual: as to physical, emotional state and mental expectations (prepared mental set by antecedents) Stress: Type – Severity – Frequency - duration Coping with stress Problem solving, but impaired by cognitive errors (table 1) Emotional coping (defensive mechanisms) and this is impaired by (pathological defenses) (table 2) Else mental and psychosomatic illnesses occurs (lethal as angina and cerebrovascular insufficiency, or decrease the quality of life as spastic colon, bronchial asthma, urticharia and rheumatoid arthritis).  Table1: cognitive errors Cognitive error definition Clinical implications 3 Perfectionism Assumes everything Obsessive traits3 (should, fair) should be perfect 2 Black & white Assumes things are Borderline traits2 (approval seeking) all good or all bad (impulsive - moody) 7 Catastrophization Assumes a negative Depressive traits7 (mag. min. gen. event as a filter, sel-per, disq+) catastrophe 8 Personalization Assumes events is Paranoid traits8 (victim, selfrighteous, related him emotional reasoning, personally temp-cause, arb-interfer, jump to conc, label)  Table 2: Defensive mechanisms childish defense definition Clinical implications denial Don’t see Poor reality problems testing distortion problems seen distorted Projection See own problem in others  Cont. Table 2: Defensive mechanisms Adolescent Identification Imitate significant others Imitating parents or stars Projective Provoke others to assume a role Assume others as decent, they identification in your mind tend to Act out Impulsive expression of Aggressive outbursts unconscious wishes Seductive style Passive aggression Expression of aggression by Punish by being uncooperative being passive somatization somatic symptoms symbolic to A weak limb symbolizes psychic state helplessness Blocking affect Transient repression Traumatic event Turning against oneself Blame own self instead of Apologize even without aggressor mistakes fantasy Imagine better conditions imagination regression Behave as in earlier stages Childish behaviors  Cont. Table 2: Defensive mechanisms Pathological Repression Exclude conflicts from awareness All neurotic disorders Dissociation Transient amnesia to an event or identity Dissociative disorders Isolate/ split affect/ Avoid emotionality & focus on intellectual Obsessive Intellectualize details compulsive Inhibition-Undo Consciously limit impulse (eat) conflicting disorder & another (lose weight) Eating disorders Controlling Regulate environment to relief inner chaos Displacement Direct unaccepted emotion from high rank Antisocial person to a weaker or lower rank one personality Reaction formation Express the opposite of an unaccepted emotion disorder Rationalization Justify criminal behaviors Sexualization Give sexual meaning to non-sexual objects paraphilia  Cont. Table 2: Defensive mechanisms Mature anticipation Realistic plan for future inner Dynamic discomfort psychotherapy suppression Consciously delay impulse aims to help patients to Sublimation Change unaccepted impulses develop (arts) to accepted ones mature humor Comedy to express unaccepted defenses to impulses use instead of altruism gratified through others pathological happiness asceticism Moral limit to base pleasure Sensory deprivation is reduction of sensory input, used in relaxation and meditation, but if prolonged leads to: Slow EEG - Disrupt sleep & vital function - Hormonal changes -Weak muscles - Increase pain sensitivity -Decrease concentration - Impaired thinking & suggestibility -Illusions & hallucinations - Anxiety & depression High risk groups: Blind or deaf -Institutionalized geriatric, psychiatric & special needs patients Patients with quadriparesis, hemiparesis & paraparesis - Patients in intensive care or dialysis units  Emotions subjective experiences managing our responses The limbic system (limbic cortex - amygdala -hippocampus - diencephalon)  Theories to explain emotions: 1. James-Lange: stimuli evoke physiologic response perceived as an emotional state 2. Cannon-Bard: events (stimulus as seeing a bear) evoke emotional state (fear) causing physiologic response (fight or flight response). 3. Schachter-Singer: emotions are labeling of simultaneously physiologic and cognitive response 4. Lazarus cognitive appraisal theory 5. Plutchik: mentions that emotions aims equilibrium i.e. seeing a bear -feeling fear -run -be safe -be calm. Also, he created a wheel of emotions. Figure: Plutchik’s wheel of emotions  Disorders of emotions Expression as a physical symptom as in conversion and somatization Experience: Reactivity of emotions is exaggerated as in affective disorders Quality of emotion is incongruent to situation as in psychotic disorders Quantity of emotions is blunt or even flat as in psychotic disorders Motivation is initiating, guiding and maintaining goal-oriented behavior. Figure 7: Maslow’s hierarchy of needs Abraham Maslow Yerkes-Dodson Law: inverted u-shaped curve relating performance and arousal Motivators: 1. Instincts: universal inborn programmed behavioral patterns as (curiosity & playing - food seeking – aggression - sex) 2. Drives reduction of Hull: internal tension relieved by desired behavior (thirst – hunger) 3. Incentives: external rewards (salary – bonus…etc) 4. Needs: the humanist Maslow designed a hierarchy of needs with basic needs at the bottom and higher level needs above.  Disorders of motivation Addiction: craving to seek pleasurable experience even if destructive due to neurotoxicity by dopamine surge in the 1st pleasurable experience that render the brain vulnerable for any cue reminding of it Amotivation syndrome: burn out of the brain reward system due to recurrent neurotoxic dopamine surges or degeneration Clinical Psychology Clinical psychology is to use psychology in assessment, understanding, preventing and managing psychological distress in clinical settings. {class: causation vs labeling - sick role - doctor role – family} A. Psychometrics and neuropsychology: standardized tests as: intelligence quotient - personality assessment - structured interview. It consumes 90 % of work of clinical psychologists B. Psychotherapies and counseling: Approaches are psychodynamic, cognitive behavioral & humanistic schools mainly. Counseling involves couple therapy and family therapy. Psychosomatics is the study of mind body relation.  Mind affects the body: 1. Stress model: psychological stress renders a person liable for bodily disorders as stress affects the sympathetic nervous system (elevate blood sugar and pressure), endocrinal and immune systems (increase allergies). The brain, glands and immune system speak the same chemical languages (neurotransmitters, hormones and cytokines). Change in one system affects the other two. 2. Somatoform & Pain model: Perception of bodily symptoms is affected by psychological state. When symptoms symbolize internal feelings this is somatoform. Pain Perception could be heightened with depression and lowered in severe stress as war when one maybe gunshot but still wouldn’t perceive pain. 3. Placebo effect: treatment effects, side effects and placebo (simulated form of medication) elicit the effect expected by patient through autosuggestion.  Body affects the mind: 1. The body health influences the brain where mentation processes occurs. The old expression organic brain syndrome was used to describe this situation. 2. Coping with disabilities, chronic & terminal illnesses: In response to adversities generally one would experience these stages: a. Denial: refuse to believe one is ill b. Anger: feel angry about his illness impact upon his life c. Bargaining: if I do some measures would this make me in control over my body and life again? d. Depression: e. Acceptance: getting health education about illness and its management, feeling in control and moving on with life Some may be entrapped in one stage for a long time. This may complicate their physical condition, worsen their compliance on treatment and affect their mental health. 3. Hospitalization and invasive maneuvers: Hospitalization disrupts daily life routine and that of family also. Privacy and familiarity with surrounding environment is lost. The trend nowadays is to minimize hospital stay as minimum as possible. Invasive maneuvers disrupt body’s privacy and sometimes integrity. Simple education about maneuvers reduces anxiety and pain. Thank you 