etiologies and treatments - kring-1.pdf

MOOD DISORDERS ETIOLOGY NEUROBIOLOGICAL Genetic ○ Twin studies = heritable among both MZ and DZ twins ○ Adoption studies also support modest heritability ○ Bipolar = most heritable Twins Adoption ○ polymorphism of the serotoni...

MOOD DISORDERS ETIOLOGY NEUROBIOLOGICAL Genetic ○ Twin studies = heritable among both MZ and DZ twins ○ Adoption studies also support modest heritability ○ Bipolar = most heritable Twins Adoption ○ polymorphism of the serotonin transporter gene may influence vulnerability to depression when life stress occurs ○ Gene DRD4.2 is related to MDD ○ Mood disorders may be polygenic Neurotransmitters ○ NOREPINEPHRINE Low: depression High: mania ○ DOPAMINE Low: depression High: mania People with depression are less responsive than other people are to drugs that increase dopamine levels, and it is thought that the functioning of the dopamine might be lowered in depression Some research suggests that diminished function of the dopamine system could help explain the deficits in pleasure, motivation, and energy in major depressive disorder For those naman with bipolar, one possibility is that dopamine receptors may be overly sensitive in bipolar disorder ○ SEROTONIN Low: depression and mania A person who has insensitive receptors is expected to experience depressive symptoms as levels drop. ** take note na di lang based sa absolute NT levels if one has a mood disorder or not @andistudiez  Brain Imaging Studies Episodes of MDD are associated with changes in many of the brain systems that are involved in experiencing and regulating emotion ○ AMYGDALA Elevated: MDD (even w/o meds) when shown negative words or pictures of sad or angry faces, people with current MDD have a more intense and sustained reaction in the amygdala than do people with no MDD amygdala hyperreactivity to emotional stimuli in depression might be part of the vulnerability to depression rather than just the aftermath of being depressed Elevated (responsiveness): bipolar I ○ SUBGENUAL ANTERIOR CINGULATE Elevated: depression ○ ANTERIOR CINGULATE CORTEX Increased activity: bipolar I During emo reg tasks ○ HIPPOCAMPUS Diminished: depression and bipolar ○ DORSOLATERAL PFC Diminished: depression and bipolar these 3^ (SAC, HIPPOCAMPUS, DORSOLATERAL PFC) are involved in emotion regulation ○ STRIATUM (rewards) Overly active during mania - With bipolar: have deficits in membranes of their neuro, those with MDD do NOT have So all in all: one theory is that the overactivity in the amygdala during depression causes oversensitivity to emotionally relevant stimuli. At the same time, systems involved in regulating emotions are compromised (the subgenual anterior cingulate, the hippocampus, and the dorsolateral prefrontal cortex) Neuroendocrine System: ○ Overly active HPA axis: MDD Lack of cortisol suppression is seen as a sign of poor regulation of the HPA axis (applicable for BOTH depression and bipolar disorders) Too much cortisol can cause harm to body systems (esp damage to hippocampus) Depressed: smaller hippocampus ○ Depressed: high cortisol levels Those with cushing syndrome which causes oversecretion of cortisol, frequently experience depressive symptoms Too much cortisol seem to produce depressive symptoms SOCIAL FACTORS: Life Events and Interpersonal Difficulties Neurobio factors MAY be diatheses that increase risk for mood disorders in the context of other triggers or stressors Stressful life events ○ Appear to be important in the first episode of depression but LESS likely to be involved in later episodes Diatheses could be social, biological, or psychological @andistudiez  Low social support High EE (family member’s critical or hostile comments toward or emotional overinvolvement with the person) strongly predicts relapse in depression Depressive symptoms can elicit negative reactions from others thereby creating interpersonal problems Those with depression even though they receive support and assurance, temporary lang since they have negative self concept which makes them doubt the feedback/support they receive PSYCHOLOGICAL FACTORS Neuroticism ○ predicts onset of depression ○ Also associated with anxiety and PDD Cognitive theories (negative thoughts and beliefs : MAJOR CAUSE) ○ Beck’s Theory Depression is associated w/ negative triad Develop negative schemas from experiences from ppl around them > ma trigger if have similar exp that contributed to neg schema > form cognitive biases (process info in negative way kaya overly attentive sa negative feedback abt self and fail to notice positives) ○ Hopelessness theory Hopelessness: most important trigger of depression Triggered by life events that have important consequences for the person 2 key dimensions of attributions stable (permanent) vs unstable (temporary) causes global (relevant to many life domains) vs specific (limited to one area) causes Those who believe that negative life events are stable and global are MORE likely to become hopeless then may eventually be depressed ○ Rumination Theory Rumination increase risk of depression Rumination: tendency to repetitively dwell on sad experiences and thoughts tendency for women to ruminate more may help explain the higher rates of depression among women as compared to men Integration: having at least one short allele was associated with elevated reactivity to stress thus, some people seem to inherit a propensity for a weaker serotonin system, which is then expressed as a greater likelihood to experience depression after a ✨ ✨ severe stressor genetic vulnerability could set the stage for depressive disorder after major negative life events SOCIAL AND PSYCHOLOGICAL FACTORS IN BIPOLAR DISORDER - Most people who experience a manic episode might also experience a major depressive episode Depression in Bipolar Disorder ○ Triggers seem to be similar to those of MDE (like negative life events, neuroticism, negative cognitive styles, and lack of social support) Predictors of Mania ○ Reward sensitivity Mania reflects a disturbance in the reward system Being highly sensitive to reward is shown to predict onset of bipolar disorder and a more severe course of mania after onset Life events involving attaining goals increase manic symptoms life events involving success may trigger cognitive changes in confidence, which then spiral into excessive goal pursuit and this in return may help trigger manic symptoms among those with bipolar I @andistudiez  ○ Sleep disruption Sleep deprivation can precede onset of manic episodes Hence, protecting sleep can reduce symptoms of bipolar disorder TREATMENT antidepressants - increase serotonin, norepi and or dopamine PSYCHOLOGICAL TREATMENT OF DEPRESSION 1. Interpersonal Psychotherapy (IPT) Examine major interpersonal problems Help the person identify his or her feelings about these issues, make important decisions, and make changes to resolve problems related to these issues Discuss interpersonal problems, explore negative feelings, encourage expression, improve both verbal and nonverbal communications, problem solving, and suggesting new and more satisfying modes of behavior - Helps prevent relapse when continued after recovery - Also effective among adolescents and postpartum women - Also effective in treating PDD 2. Cognitive Therapy Aimed at altering maladaptive thought patterns (replace negative depressive thoughts and attributions with more positive ones) Change his or her opinions about the self Therapist helps person look for evidence that contradicts his or her overgeneralizations Teach person monitor self talk and identify thought patterns that contribute to depression Challenge negative beliefs and learn strategies that promote making realistic and positive assumptions Cognitive restructuring Behavioral activation : engage in pleasant activities that might bolster positive thoughts about one’s self and life - Promising in treating PDD - Help decrease risk of relapse - Mindfulness based cognitive therapy (MBCT) - Focuses on relapse prevention after a successful treatment for recurrent episodes of major depression - Adopt a decentered perspective, viewing their thoughts merely as “mental events” rather than as core aspects of the self or as accurate reflections of reality - “I am NOT my thoughts” - Shows promise for patients with recurrent major depression 3. Behavioral Activation (BA) Therapy Originally developed as a standalone treatment Based on the idea that many of the risk factors for depression can result in low levels of positive reinforcement Goal is to: is to increase participation in positively reinforcing activities so as to disrupt the spiral of depression, withdrawal, and avoidance 4. Behavioral Couple’s Theory Work with both members of a couple to improve communication and relationship satisfaction Effective if the person w/ depression is also experiencing marital distress As effective as CT or antidepressant @andistudiez PSYCHOLOGICAL TREATMENT OF BIPOLAR DISORDER - Medications is necessary but psych treatments can act as supplements Interpersonal and Social Rhythm Therapy (IPSRT) ○ Regulates circadian rhythm by helping patients regulate their eating and sleep cycles Psychoeducational Approaches ○ help people learn about the symptoms of the disorder, the expected time course of symptoms, the biological and psychological triggers for symptoms, and treatment strategies ○ can help people adhere to treatment with medications such as lithium Both CT and family-focused therapy (FFT) have received particularly strong support ○ CT: almost same with depression, may addtl lang to address early signs of manic episodes ○ FFT: educate family about the illness, enhance family communication, and develop problem solving skills More intensive programs, however, do seem to help. For example, promising results have been obtained with telephone follow-ups, increased nursing care, or specific guidelines that help physicians identify patients who should receive more intensive care (Gilbody et al., 2003). Similar programs, involving more nursing support and more patient psychoeducation, have been shown to be helpful in bipolar disorder (Simon, Ludman, Bauer, et al., 2006). @andistudiez ANXIETY DISORDERS ETIOLOGY Risk factors across Anxiety Disorders Fear conditioning ○ Mowrer’s two factor model - 2 steps in development of anxiety disorder (1) classical conditioning - neutral stimulus becomes conditioned if paired with an aversive stimulus(2) operant conditioning - gains relief when aversive stimulus is avoided Classical conditioning can be thru direct experience, modeling (seeing another person), or through verbal instruction People with panic disorder sustain classically conditioned fear longer Genetic factors ○ Twin studies heritability: 20-40% - specific phobia, social anxiety disorder, GAD, PTSD 50% - panic disorder Neurobiological factors ○ Elevated activity in the fear circuit esp amygdala ○ The structure that helps in regulating amygdala activity — medial prefrontal cortex have less activity in people with anxiety disorders ○ Poor functioning of the serotonin system ○ Higher than normal levels of norepinephrine ○ Poor GABA function contributes to anxiety Personality ○ Behavioral inhibition (infant’s tendency to become agitated and cry when faced with novel toys, people or other stimuli) Might set the stage for later development of anxiety disorders Strong predictor of social anxiety disorder ○ Neuroticism Predicted both onset of depression and anxiety disorders Highly neurotic were more than twice as likely to develop anxiety disorders as those with low levels Cognitive factors ○ Sustained negative beliefs Often report believing that bad things are likely to happen These beliefs are sustained because they think and act in ways that maintain these beliefs To protect against feared consequences they engage in safety behaviors (active avoidance, interoceptive avoidance) ○ Perceived lack of control They think they lack control Childhood exp such as traumatic events, punitive and restrictive parenting, or abuse may promote a view that life is not controllable Anxiety disorders often occur after serious life events that threaten one’s sense of control over one’s life ○ Attention to signs of threat Pay more attention to negative cures Selective attention to signs of threat SPECIFIC etiologies Specific phobia ○ Two factor model (Mowrer) ○ Behavioral factors: conditioning of specific phobias Litol Albert @andistudiez  Some do not remember developing phobia through conditioning, but the behavioral model argued that people may forget conditioning experiences genetic vulnerability, neuroticism, negative cognition, and propensity toward fear conditioning, probably operate as diatheses—in the context of a conditioning experience Only certain kinds of stimuli and experiences will contribute in the development of phobia Evolution; only to fear certain stimuli (those that are perceived as dangerous and threatening even by our ancestors) — prepared learning According to studies, fears of most types fade quickly with ongoing exposure, but fears of naturally dangerous stimuli are sustained Social anxiety disorder ○ Behavioral factors: conditioning of social anxiety disorder Classical conditioning: person could have a negative social experience (directly, through modeling, or through verbal instruction) and become classically conditioned to fear similar situations, which the person then avoids Operant conditioning: avoidance behavior is maintained because it reduces the fear ; safety behaviors Safety behaviors in social anxiety disorder: ○ Avoiding eye contact ○ Disengaging from conversations ○ Standing apart from others Avoidant (safety) behaviors, also tend to intensify problems ○ Cognitive factors: too much focus on negative self evaluations Unrealistically negative beliefs about the consequence of their social behaviors They attend more to how they do in social situations and their own internal sensations than other people do Spend more time monitoring for signs of their own anxiety Often form powerful negative visual images of how others will react to them Panic disorder ○ Neurobiological factors Misfire of fear circuit and surge in SNS activity High activity in the locus coeruleus (major source of norepinephrine > norepi has a major role in triggering the SNS) ○ Behavioral factors: classical condition Panic attacks are often triggered by internal bodily sensations of arousal Hence, panic attacks are classically conditioned responses to situations that trigger anxiety or internal bodily sensations ○ Interoceptive conditioning: person experiences somatic signs of anxiety, which are followed by the person’s first panic attack; panic attacks then become a conditioned response to the somatic changes ○ Cognitive factors Catastrophic misinterpretations of somatic changes Panic attacks develop when a person interprets bodily sensations as signs of impending doom Agoraphobia ○ Cognitive factors: fear of fear hypothesis Fear of fear hypothesis: agoraphobia is driven by negative thoughts about the consequences of experiencing anxiety in public Seem to have catastrophic beliefs that their anxiety will lead to socially unacceptable consequences Generalized anxiety disorder ○ Since it tends to be comorbid with other anxiety disorders and depression, many of the factors involved in predicting anxiety disorders in general are particularly important for understanding GAD ○ Cognitive factors: why do people worry Since worrying is said to decrease psychophysiological signs of arousal, people with GAD may be avoiding unpleasant emotions that would be more powerful than worry, but as a consequence of this avoidance, their underlying anxiety about these images does not extinguish Some anxiety evoking images that people w/ GAD might be avoiding: Childhood maltreatment (predicted fourfold increase in the risk of dev GAD) @andistudiez  Those with GAD might also be avoiding emotions Hard time accepting ambiguity and or uncertainty TREATMENT Only a small proportion of people with anxiety disorders seek treatment Commonalities across psychological treatments ○ Exposure: person must face what he or she fears Systematic desensitization (1) relaxation skills (2) fear hierarchy (list) (3) systematic desensitization proper Exposure treatment work well even w/o relaxation skills Behavioral view: works by extinguishing the fear response Cognitive view: exposure helps people correct their mistaken beliefs that they are unable to cope with the stimulus exposure relieves symptoms by allowing people to realize that, contrary to their beliefs, they can tolerate aversive situations without loss of control Key principle in avoiding relapse: Exposure should include as many features of the fears possible Phobias ○ In vivo exposure - also works better than systematic desensitization Social anxiety disorder ○ Exposure Often begin with role playing or practicing with the therapist or in a small therapy groups With prolonged exposure, anxiety typically extinguishes ○ Social skills training therapist might provide extensive modeling of behavior, can help people with social anxiety disorder who may not know what to do or say in social situations Safety behaviors might interfere with extinction of social anxiety, so usually pinapastop yung pag use ng SB ○ David Clark’s ver of CT therapist helps people learn not to focus their attention internally helps them combat their very negative images of how others will react to them more effective than fluoxetine or than exposure treatment plus relaxation ○ Family based treatment Better than indiv treatment if parents also have anxiety disorder Panic Disorder ○ Psychodynamic treatment: involves 24 sessions focused on identifying the emotions and meanings surrounding panic attacks help clients gain insight into areas believed to relate to the panic attacks, such as issues involving separation, anger, and autonomy related to diminished rates of relapse when added as a supplement to antidepressant treatment ○ Panic control therapy (PCT) Based on the tendency of people with panic disorder to overreact to the bodily sensations Uses exposure techniques: persuades the client to deliberately elicit the bodily sensations associated with panic So when they experience it, they will realize na they experienced it under safe conditions ○ CT: helps the person identify and challenge the thoughts that make the physical sensations threatening @andistudiez  more helpful than pure exposure treatment and that few people drop out of treatment Agoraphobia ○ Systematic exposure to feared situations More effective if partner is involved Partner without agoraphobia is encouraged to stop catering to the partner’s avoidance of leaving home ○ Self guided treatment Generalized Anxiety Disorder ○ Relaxation training to promote calmness Relax muscle groups More effective than non directive or no treatment ○ Form of CT: tolerate uncertainty ○ Diary (outcomes of worrying) Medications: Anxiolytics Benzodiazepines Antidepressants - preferred over benzodiazepines ○ Tricyclic ; SSRIs ; SNRIs Combining Medications w/ Psychological Treatment Adding anxiolytics to exposure treatment actually leads to worse long term outcomes than exposure treatments w/o anxiolytics EXCEPT for those with SAD @andistudiez OCD, and RELATED DISORDERS ETIOLOGY OCD, BDD, and HD share some overlap in etiology and this might be due to genetic and neurobiological risk factors ○ Example: people with BDD and hoarding disorder often have a family history of OCD OCD and BDD seem to involve some of the same brain regions ○ Orbitofrontal cortex ○ Caudate nucleus ○ Anterior cingulate cortex - OCD (when shown w/ shown objects that tend to provoke symptoms) increased activity in the three areas - BDD ( when view pictures of their own face): hyperactivity of orbitofrontal cortex and caudate nucleus Obsessive Compulsive Disorder ○ Moderate genetic contribution (30-50%) ○ We stop thinking or be preoccupied with diff things is we feel that it’s enough — Yedasentience (subjective feeling of knowing) ○ So those with OCD, seem to have deficit in yedasentience because they fail to gain internal sense of completion ○ They know that there’s no need to do things again and again, but they suffer from an anxious internal sense that things are not complete ○ Cognitive behavioral models: operant conditioning of compulsions compulsions are reinforced because they reduce anxiety ○ Mistrust of their memory (even though they don’t have deficits in their memory) drives them to repeat rituals ○ try harder to suppress their obsessions than other people and, in doing so, may actually make the situation worse ○ tend to believe that thinking about something can make it more likely to occur ○ likely to describe especially deep feelings of responsibility for what occurs And due to these, they are more likely to engage in thought suppression But may have paradoxical effect Body Dysmorphic Disorder ○ more attuned to features that are important to attractiveness, such as facial symmetry ○ appear to focus on details more than on the whole ○ many people with BDD seem to believe that their self-worth is exclusively dependent on their appearance Hoarding Disorder ○ Evolutionary perspective: store any vital resources you can find ○ Cognitive behavioral model: poor organizational abilities, unusual beliefs about possessions, and avoidance behaviors ○ different types of cognitive problems interfere with organizational abilities among people with hoarding disorder ○ Have difficulties w/ attention, categorize, decision making ○ hoarders demonstrate an extreme emotional attachment to their possessions ○ Animal hoarders often describe their animals as their closest confidants ○ Avoidance is one of the key factors that maintains the clutter @andistudiez TREATMENT Each of these disorders, responds to serotonin reuptake inhibitors Exposure and Response/Ritual Prevention (ERP) ○ Meyer; originally as an approach for OCD ○ OCD people expose themselves to situations that elicit the compulsive act and then refrain from performing the compulsive ritual Explanation for this approach: Not performing the ritual exposes the person to the full force of the anxiety provoked by the stimulus The exposure results in the extinction of the conditioned response (the anxiety) ○ Also effective for children and adolescents ○ sessions lasting upwards of 90 minutes, with 15 to 20 sessions within a 3-week period, and with instructions to practice between sessions as well Cognitive approaches: focus on challenging people’s beliefs about what will happen if they do not engage in rituals Hence they use exposure Also focuses on: overestimation of threat, importance and control of intrusive thoughts, sense of inflated responsibility, need for perfectionism and certainty ○ BDD Exposure: might be asked to interact with people who could be critical of their looks Response prevention: clients are asked to avoid the activities they use to reassure themselves about their appearance, such as looking in mirrors and other reflective surfaces Several trials have shown that cognitive behavioral treatment (CBT) produces a major decrease in body dysmorphic symptoms compared to control conditions ○ Hoarding Disorder Exposure: getting rid of their objects many people with hoarding disorder don’t recognize the gravity of problems created by their symptoms Assign different values to objects Many resort to coercive strategies, including removing the hoarder’s possessions while the person is away—strategies that typically create mistrust and animosity Family approaches to hoarding begin by building rapport around these difficult issues urged to identify the aspects of hoarding and clutter that are most dangerous for safety use their concern regarding these issues to begin dialogue and set priorities with the person with hoarding disorder ○ Trichotillomania Habit reversal training: patients are carefully taught to be more aware of their repetitive behavior, particularly as it is just about to begin, and to then substitute a different behavior @andistudiez TRAUMA - RELATED DISORDERS ETIOLOGY PTSD appears related to genetic risk of anxiety disorders ○ High levels of activity in areas of the fear circuit such as the amygdala ○ Childhood exposure to trauma ○ Tendency to attend selectively to cues of threat ○ Neuroticism and negative affectivity predict onset of PTSD Two Factor model of conditioning ○ Initial fear in PTSD is assumed to arise from classical conditioning ○ Operant conditioning contributes to the maintenance of the avoidance behavior This avoidant behavior interferes with the chances for the fear to extinguish Nature of the trauma: severity and type of trauma matter ○ Severity influence whether one will develop PTSD ○ Beyond severity, nature of trauma matters Traumas caused by humans are more likely to cause PTSD than natural disasters (Charuvastra, 2008) Neurobiological factors: hippocampus and hormones ○ Greater activation of amygdala ○ Diminished activated of medial PFC ○ Uniquely related to hippocampus (memory, esp memories related to emotions) Smaller hippocampal volume - those with PTSD Also smaller than average hippocampal volume probably proceeds the onset of the disorder Coping ○ People who copy by avoiding are more likely to develop PTSD ○ Dissociation and memory suppression may keep the person from confronting memories of the trauma and are more likely to develop PTSD ○ Other protective factors that may help a person cope with severe trauma more adaptively High intelligence and strong social support ○ For some, trauma awakens an increased appreciation of life, renews a focus on life priorities, and provides an opportunity to understand one’s strengths in overcoming adversity TREATMENT Medications: SSRIs ; relapse is common if meds are discontinued PTSD ○ Exposure therapy Focus is on memories and reminders of trauma Encouraged to confront trauma to gain mastery and extinguish anxiety Can be in vivo or imaginal exposure ET is more effective than medications and unstructured psychotherapy ○ Also used virtual reality (VR) technology because this can provide vivid exposure ○ Treatment is likely to be particularly hard and to require more time when the client has experienced recurrent traumas, which is often the case with child abuse ○ Cognitive strategies @andistudiez  Cognitive processing therapy: help victims of rape and childhood sexual abuse dispute tendencies toward self blame ○ Psychoanalytic therapy Catharsis: relieving emotional trauma Acute Stress Disorder ○ Short-term (five or six session) cognitive behavioral approaches that include exposure appear to prevent ASD from developing to PTSD Reduced the risk to 32% in comparison to the 58% Exposure treatment appears to be more effective than cognitive restructuring in preventing the development of PTSD @andistudiez DISSOCIATIVE DISORDERS ETIOLOGY Psychodynamic: ○ Traumatic events are repressed ; memories are forgotten (dissociated) because they are so aversive Cognitive: ○ Extreme stress usually enhances rather than impairs memory Dissociative disorders involve unusual ways of responding to stress ○ Ex: extremely high levels of stress hormones could interfere with memory formation Severe dissociation can interfere with memory ○ in the face of severe trauma, memories may be stored in such a way that they are NOT accessible to awareness later when the person has returned to a more normal state Almost all patients with DID report severe childhood abuse 2 major theories of DID: (both suggest that severe physical or sexual abuse during childhood sets the stage for DID ○ Posttraumatic model - some people are particularly likely to use dissociation to cope with trauma ○ Sociocognitive model - DID as a result of learning to enact roles Alters appear in response to suggestions by therapist, exposure to media reports, or other cultural influences DID could be created within therapy — iatrogenic DID (as a role play): people with histories of trauma may have a rich fantasy life, considerable practice at imagining they are other people, and deep desire to please others Clearly, when the situation demands, people can adopt a second personality Alters share memories, even when they report amnesia ○ even though different alters report being unable to share memories, they actually do share memories ○ findings are supportive of a role-playing explanation of DID—people with DID demonstrated more accurate memories than they had acknowledged The detection of DID differs by clinician ○ Therapists who are most likely to diagnose DID tend to use hypnosis (to urge clients to try to unbury unremembered abuse experiences, or to name different alters) ○ Sociocognitive: extremes in diagnostic rates support the idea that certain clinicians are likely to elicit DID in their patients ○ Posttraumatic: those w/ DID may be referred to clinicians who specialize in treating this condition Many DID Symptoms Emerge after Treatment Starts ○ as treatment progresses, they tend to become aware of alters, and they report a rapid increase in the number of alters they can identify ○ Posttraumatic: most alters began their existence during childhood and that therapy just allows the person to become aware of and describe alters @andistudiez TREATMENT Empathic and gentle stance, with the goal of helping the client function as one wholly integrated person Goal: convince person that splitting into different personalities is no longer necessary to deal with traumas (need to identify cues or triggers that provoke memories of trauma) Often times, those w/ DID, are hospitalized to avoid self harm and to begin the treatment in a more intensive fashion Psychodynamic treatment is probably used more for DID and other dissociative disorders ○ Goal: overcome repressions Hypnosis (to access unconscious memories and bring various alters into awareness) ○ DID patients are unusually hypnotizable ○ Age regression: is hypnotized and encouraged to go back in his or her mind to traumatic events in childhood ○ Treatment involving age regression and recovered memories, though, can actually worsen DID symptoms Even though the use of antidepressants is used if DID is comorbid w/ anxiety and depression, these medications actually have no effect on DID itself @andistudiez SOMATIC SYMPTOM - RELATED DISORDERS ETIOLOGY NO concordance among twins for somatic symptom disorder or conversion disorder Excessive attention to somatic symptoms and disproportionate anxiety about one’s health Neurobiological Factors: increase awareness of distress over somatic ○ Focus on brain regions activated by unpleasant body sensations ○ Pain and uncomfortable physical sensations: increase activity in the anterior insula and anterior cingulate these 2 have strong connections with the somatosensory cortex Heightened activity in these regions = greater propensity for somatic symptoms ○ pain and somatic symptoms can be increased by anxiety, depression, and stress hormones Cognitive behavioral factors that increase awareness of and distress over somatic symptoms ○ Focus on mechanisms that could contribute to the excessive focus on and anxiety over health concerns ○ Once a somatic symptom develops, two cognitive variables appear important: attention to body sensations and interpretation of those sensations (attributions) ○ people with excessive distress about their somatic symptoms may automatically focus on cues of physical health problems ○ Exhibit cognitive bias Believes that symptoms are a sign of an underlying long-term disease ○ people with somatic symptom-related disorders report that as children they often missed school because of illness Conversion Disorder ○ Psychodynamic: people could be unconscious of certain perceptions and be motivated to have certain symptoms Blindness: two stages: (1) people can process visual information outside of their conscious awareness modules of the vision system may not be coordinated in an overarching conscious fashion, so individuals can do well on some tests, so it is possible for people truthfully to claim that they cannot see, even when tests suggest that they can Perceptions formed outside of consciousness can influence behavior There is disruption in consciousness, such that the person fails to have an explicit awareness of sensory and motor information (2) motivation People because of their personality, are motivated to appear blind ○ Social and Cultural Factors symptoms of conversion disorder are more common among people from rural areas and people of lower socioeconomic status TREATMENT They are hesitant to consult MH professionals The goal is to establish a strong relationship that allows the person to have a sense of trust and comfort, so that the patient will feel more reassured about their health to reduce the frequency of help seeking behavior Other health care system interventions involve informing physicians when a patient appears to be an intensive user of health care services so that they can minimize the use of diagnostic tests and medications CBT ○ Help people: identify and change the emotions that trigger their somatic concerns change their cognitions regarding their somatic symptoms change their behaviors so they stop playing the role of a sick person and gain more reinforcement for engaging in other types of social interactions @andistudiez  ○ Psychoeducation programs can help patients recognize links between their negative moods and somatic symptoms ○ patients may learn to reframe their experience of a somatic symptom ○ Assertiveness training and social skills training ○ Behavioral and family approaches ○ operant conditioning approaches with family or friends to reduce the amount of attention they give the person’s somatic symptoms Antidepressant Treatment for Somatic Symptom Disorder with Pain ○ Antidepressants are likely to be helpful when pain is a dominant symptom ○ low doses of some antidepressant drugs, most especially imipramine (Tofranil), are superior to a placebo in reducing chronic pain and related distress ○ Preferred over opioid meds as opioids are highly addictive Conversion Disorder Identify and attend to the traumatic or stressful life event, if it is still present (either in real life or memory) Reduce any reinforcing or supportive consequences of the conversion symptoms (secondary gain) @andistudiez SCHIZOPHRENIA ETIOLOGY GENETIC FACTORS Current evidence indicates that schizophrenia is genetically heterogeneous (genetic factors vary from case to case) Behavior genetics research ○ Family studies relatives of people with schizophrenia are at increased risk, and the risk increases as the genetic relationship between proband and relative becomes closer People with schizo na may fam history = more negative symptoms than those na walang family history Which might suggest na negative symptoms may have stronger genetic component Higher incidence if both parents have schizo or one has schizo and the other has bipolar Can suggest that there might be shared genetic vulnerabilities between the 2 disorders ○ Twin studies Higher risk for MZ twins (44.3%) than DZ twins (12.08%) but not amounting to 100% so ibig sabihin magkakaron agad yung kakambal Negative symptoms: stronger genetic component than positive symptoms ○ Adoption studies Higher risk of schizo if bioparent/s had schizophrenia ○ Familial high risk studies fhrs: type of study that begins with one or two biological parents with schizophrenia and follows their offspring longitudinally in order to identify how many of these children may develop schizophrenia and what types of childhood neurobiological and behavioral factors may predict the disorder’s onset Positive and negative symptoms may have different etiologies Predominantly negative: history of pregnancy ; birth complications ; failure to show electrodermal responses to simple stimuli Predominantly positive: history of family instability, such as separation from parents ; placement in foster homes or institutions for periods of time Israeli study: poor concentration, poor verbal ability, lack of motor control and coordination, earlier interpersonal problem predicted schizophrenia spectrum outcomes New England study: children of a parent (mother or father) with a schizophrenia spectrum disorder were six times more likely to develop schizophrenia spectrum disorder by age 40 than children without a parent with schizophrenia Molecular Genetics Research ○ Genes associated w/ SZ: DTNBP1 (chromosome 6) and NGR1 (chromosome 8) DTNBP1: Encodes dysbindin impact the dopamine and glutamate neurotransmitter systems throughout the brain According to postmortem: people with SZ had less dysbindin in frontal cortex, temporal cortex, hippocampus,and limbic system structures NGR1: Linked to glutamate’s NMDA receptor (w/c is helpful with myelination, which is also found to be associated with SZ) ○ Genes associated w/ cognitive deficits of those w/ SZ: COMT (chromosome 22) and BDNF COMT: Associated w/ cognitive functions that rely on the PFC (and ppl with SZ seem to have deficits in EF) BDNF: Linked to cognitive function in ppl with or without SZ Has a polymorphism called Val66Met (people can either have both Val (Val/Val), combination of the 2 (Val/Met) or both Met (Met/Met) @andistudiez  ○ Those with Val/Val have better verbal memory ROLE OF NEUROTRANSMITTERS Dopamine theory: ○ Excess in dopamine (since drugs effective in treating schizo reduce dopamine activity) ○ Also, dopamine receptors in people who had SZ had greater and or hyperactive dopamine receptors (since greater receptors lead to an overactive dopa system) ○ Excess of dopamine = POSITIVE symptoms (kaya antipsychotic meds lessen PS but not NS) ○ Excess of dopamine activity that is most relevant to SZ is localized in the mesolimbic pathway ○ Mesocortical pathway: Projects to the PFC > PFC projects to areas innervated by dopamine PFC: underactivity of dopamine neurons may contribute to negative symptoms (since anti psychotic meds don’t work on the PFC) Other neurotransmitters ○ Low levels of glutamate have been found in the CSF of people with SZ Illicit drug called PCP can induce BOTH positive and negative symptoms in ppl w/ or w/o SZ by interfering with one of glutamate’s receptors a decrease in glutamate inputs from either the prefrontal cortex or the hippocampus (both of these brain structures are implicated in schizophrenia) to the corpus striatum (a temporal lobe structure) could result in increased dopamine activity BRAIN STRUCTURE AND FUNCTION Enlarged Ventricles ○ Having larger fluid spaces = loss of brain cells ○ Enlarged ventricles may increase over the course of the illness (over and beyond what occurs in typical aging) ○ Enlarged ventricles = impaired perf on neuropsych tests ; poor functioning prior to onset ; poor response to drug treatment ○ Not specific to schizophrenia (bipolar w/ psychotic features) Factors involving the PFC ○ Functions of the PFC are disrupted in people w/ SZ ○ Reductions in gray matter (also in the temporal cortex) ○ People with SZ have low metabolic rates in the PFC ○ Failure to show frontal activation is related to the severity of negative symptoms ○ Loss of dendritic spines = disrupted communication among neurons (disconnection syndrome) = speech and behavioral disorganization Temporal cortex and brain surrounding regions ○ Structural and functional abnormalities in the temporal cortex , including areas such as temporal gyrus, hippocampus, amygdala and anterior cingulate ○ Reduction in cortical gray matter in temporal and frontal brain regions ○ Reduced hippocampal volume among twins w/ schizophrenia ENVIRONMENTAL FACTORS INFLUENCING THE DEVELOPING BRAIN Damage during gestation or birth ; those with delivery complications = may have reduced supply of O2 = loss of cortical gray matter Maternal infections (toxoplasmosis) Exposure to influenza or have had flu virus esp during first trimester Reasons why the probable onset of SZ symptoms is in adolescence / EA ○ PFC typically matures during these time ○ Dopamine activity also peaks during adolescence ○ loss of synapses due to excessive pruning Since excessive pruning would result in loss of necessary communication among neurons ○ elimination of synaptic connections @andistudiez  ○ Use of cannabis (marijuana) which actually worsens the symptoms PSYCHOLOGICAL FACTORS Stress SES and Urban Living ○ Low SES + urban living ○ Sociogenic hypothesis: stressful social conditions, such as living in impoverished circumstances, are major contributors to and causal agents of the disorder ○ Social selection/drift hypothesis: posits that mental illness can inhibit socioeconomic attainment and lead people to drift into the lower social class or never escape poverty Family related factors ○ Schizophrenogenic mother: cold, dominant, conflict inducing ; rejecting, self sacrificing, impervious to feelings of others, rigid and moralistic about sex, and fearful of intimacy ○ Disturbed family environment ○ Expressed emotions (EE): critical comments, hostility, emotional overinvolvement Relapse are higher if the patient goes home w/ his or her family with high EE DEVELOPMENTAL FACTORS Children who later developed SZ ○ Lower IQs, more often delinquent, and withdrawn ○ Poorer motor skills, more expressions of negative emotions ○ Boys: disagreeable ○ Girls: passive TREATMENT often include a combination of short-term hospital stays (during the acute phases of the illness), medication, and psychosocial treatment a problem with any kind of treatment for schizophrenia is that some people with schizophrenia lack insight into their impaired condition and refuse any treatment at all Medications Antipsychotic drugs are an indispensable part of treatment for schizophrenia and will undoubtedly continue to be an important component @andistudiez Psychological Treatments Combined treatments = lower rates of relapse and treatments discontinuation Social skills training : teach people with schizophrenia how to successfully manage a wide variety of interpersonal situations ○ involves role-playing and other group exercises to practice skills, both in a therapy group and in actual social situations ○ New social behaviors = fewer relapses, better social functioning, higher QOL Family therapies ○ Common features: Education about schizophrenia—specifically about the genetic or neurobiological factors that predispose some people to the illness, the cognitive problems associated with schizophrenia, the symptoms of schizophrenia, and the signs of impending relapse Information about antipsychotic medication Blame avoidance and reduction - encourage family members to blame neither themselves nor their relative for the illness and for the difficulties all are having Communication and problem-solving skills within the family - express both positive and negative feelings in a constructive, empathic, non demanding manner rather than in a finger-pointing, critical, or overprotective way Social network expansion Hope - instill hope that things can improve CBT ○ maladaptive beliefs of some people with schizophrenia can in fact benefit from CBT ○ can also reduce negative symptoms, for example, by challenging belief structures tied to low expectations for success (avolition) and low expectations for pleasure (anticipatory pleasure deficit in anhedonia) ○ along with medication, can help reduce hallucinations and delusions Cognitive Remediation therapies ○ concentrates on trying to normalize such functions as attention and memory ○ seek to enhance basic cognitive functions ○ Enriched supportive therapy (EST) ; Cognitive remediation/enhancement training (CET) CET was more effective than EST in improving cognitive abilities in problem solving, attention, social cognition, and social adjustment, while symptom reduction was the same for both treatments ○ associated with a reduction in symptoms and an improvement in everyday functioning Psychoeducation Case Management ○ Assertive Community Treatment model and Intensive Case Management model both entail a multidisciplinary team that provides services in the community, such as medication, treatment for substance abuse, help in dealing with stressors people with schizophrenia face regularly, psychotherapy, vocational training, and assistance in obtaining housing and employment. ○ Case managers hold together and coordinate the range of medical and psychological services that people with schizophrenia need to keep functioning outside of institutions with some degree of independence and peace of mind Residential treatment ○ Residential treatment homes, or “halfway houses,” are sometimes good alternatives for people who do not need to be in the hospital but are not quite well enough to live on their own or even with their family ○ Vocational rehabilitation - residents learn marketable skills that can help them secure employment and thereby increase their chances of remaining in the community Integrating therapy with gainful employment is important in keeping people with schizophrenia out of hospitals Supportive employment – involves providing coaches who give on-the-job training @andistudiez SUBSTANCE USE DISORDERS ETIOLOGY Becoming physiologically dependent on a substance is a developmental process Factors that contribute to SUD may depend on the point in the process that is being considered The Frontal Cortex (decision making, judgment, novelty seeking, and impulse control) is still developing at the time adolescents are beginning to experiment with drugs and alcohol ○ And that neural systems important for reward — dopaminergic, serotonergic, and glutamatergic ALL pass through the developing frontal cortex GENETIC FACTORS Relatives and children of problem drinkers have higher than expected rates of alcohol abuse or dependence Greater concordance for MZ twins for alcohol use disorder, smoking, heavy use of marijuana, and drug use disorders in general ○ TRUE for BOTH genders Among adolescents, peers and parent appear to be important environmental variables The ability to tolerate large quantities of alcohol may be inherited for AUD ○ If deficient in alcohol dehydrogenase = physiological intolerance = low rate of alcohol probs Nicotine: stimulate dopamine release and inhibit reuptake SLC6A3 gene: regulates reuptake of dopamine (one form: lower likelihood of smoking, and greater likelihood of quitting) NEUROBIOLOGICAL FACTORS Nearly all drugs, including alcohol stimulate the dopamine systems in the brain Some people dependent on the drug or alcohol have deficiency in the dopamine receptor DRD2 Vulnerability model: probs in the dopa system increase vulnerability to become dependent Toxic effect model: probs in the dopa system are the consequence of taking substancesk People take drugs either to feel good OR to feel less bad ○ People continue to take drugs to avoid the bad feelings assoc with withdrawal This explains why relapse is common Incentive-sensitization theory: dopamine system linked to pleasure or liking becomes super sensitive not just to the direct effects of drugs but ALSO to the cues associated with drugs (needles, spoons, rolling paper) ○ This sensitivity induces craving or wanting, and people go through extreme lengths to seek out and obtain drugs Those who responded “no go” than “go” showed greater activation in these brain areas: (1) basal ganglia (2) interofrontal gyrus and (3) premotor areas was linked to less linkage between craving and smoking PSYCHOLOGICAL FACTORS Mood alterations ○ Drug use is reinforced because it enhances positive moods or diminish negative ones Alcohol lessens neg emo, but it also lessen positive emotions in response to anxiety provoking situations ○ Smoking: it may not be nicotine that lessens negative affect but the sensory aspects of smoking ○ Alcohol may reduce tension by altering cognition and perception (using distractions) Alcohol impairs cog processing and narrows attention to the most immediately available cues — alcohol myopia intoxicated person has less cognitive capacity and tends to use that capacity to focus on an immediate distraction, if available, rather than on tension-producing thoughts, which might result to decrease in anxiety @andistudiez  Expectancies about alcohol and drug effects ○ People drink because they expect that it will reduce stress and anxiety ○ High expectations = greater drinking and vice versa (alcohol use maintains greater expectancies) Personality factors ○ Those with negative affect or negative emotionality = higher risk ○ Low constraint & high negative emotionality predicted the onset of substance use disorders ○ Anxiety and novelty seeking predicted the onset of getting drunk, using drugs, and smoking SOCIOCULTURAL FACTORS Alcohol - most used ; marijuana - second most used Also higher rates of amphetamines, ecstasy, and cocaine Ready availability of the substance is also a factor Exposure to alcohol use by parents = increased likelihood Psychiatric, marital, or legal problems in fam, and lack of social support Social setting of the individual, social networks ○ Social influence model : a person's social network predicted individual drinking, but individual drinking ALSO predicted subsequent social network drinking ○ Social selection model : people often choose social networks with drinking patterns similar to their own Media associate alcohol or cigarettes with excitement, relaxation ganon TREATMENT First step to successful treatment is admitting that there is a problem; help someone through the withdrawal process ; ultimate goal: abstinence ALCOHOL USE DISORDER Inpatient Hospital treatment ○ Detoxification (removing the substances) - may be less unpleasant in supervised settings ; some have to go multiple times ○ More expensive than outpatient ○ Necessary if the persona has less social support and living in envt that encourage alcohol abuse Alcoholics Anonymous (AA) ○ Largest and most widely used self help group ○ provides emotional support, understanding, and close counseling as well as a social network ○ tries to instill in each member the belief that alcohol dependence is a disease that can never be cured and that continuing vigilance is necessary to resist taking even a single drink, lest uncontrollable drinking begin all over again Couples therapy CBTs ○ Contingency management therapy - teaching people and those close to them to reinforce behaviors inconsistent with drinking ○ Relapse prevention - help people avoid relapsing back into drinking or drug use once they have stopped Can be a standalone treatment or part of other interventions Motivational interventions ○ Intervention contained: (1) a comprehensive assessment that included the Timeline Follow Back (TLFB) interview (carefully assesses drinking in the past 3 months) and (2) a brief motivational treatment that included individualized feedback about a person’s drinking in relation to community and national averages, education about @andistudiez  the effects of alcohol, and tips for reducing harm and moderating drinking. Results from the study showed that the TLFB alone decreased drinking behavior, but that the combination of the TLFB and motivational intervention was associated with a longer-lasting reduction in drinking behavior, up to 1 year after the interview and intervention Moderation in drinking ○ Controlled drinking - pattern of alcohol consumption that is moderate, avoiding the extremes of total abstinence and inebriation ○ people with less severe alcohol problems can learn to control their drinking and improve other aspects of their lives as well ○ guided self-change : people have more potential control over their immoderate drinking than they typically believe and that heightened awareness of the costs of drinking to excess as well as of the benefits of abstaining or cutting down can be of material help SMOKING people are more likely to quit smoking if other people around them quit peer pressure to quit smoking appears to be as effective as peer pressure to start smoking once was Psychological treatments ○ Telling the person to STOP ○ Scheduled smoking : reduce nicotine intake gradually over a period of a few weeks by getting smokers to agree to increase the time between cigarettes ○ Project EX : training in coping skills and a psychoeducational component about the harmful effects of smoking Nicotine replacement treatments ○ Nicotine may be supplied in gum, patches, inhalers, or electronic cigarettes. ○ The idea is to help smokers endure the nicotine withdrawal that accompanies any effort to stop smoking. ○ Although nicotine replacement alleviates withdrawal symptoms, the severity of withdrawal is only minimally related to success in stopping smoking ○ Nicotine patches - polyethylene patch taped to the arm serves as a transdermal (through the skin) nicotine delivery system that slowly and steadily releases the drug into the bloodstream and then to the brain. person need only apply one patch each day and not remove it until applying the next patch, making compliance easier can be effective after 8 weeks of use for most smokers, with smaller and smaller patches used as treatment progresses people who continue smoking while wearing the patch risk increasing the amount of nicotine in their body to dangerous levels DRUG USE DISORDERS Detoxification - first way and easiest part of the rehab process Despiramine and CBT: effective in reducing cocaine use and improving a person’s family, social, and general psychological functioning Those who received CBT learned how to avoid high-risk situations Contingency management with vouchers has shown promise for cocaine, heroin, and marijuana use disorders motivational interviewing or enhancement therapy - involves a combination of CBT techniques and techniques associated with helping clients generate solutions that work for themselves ○ effective for both alcohol and drug use disorders ○ motivational enhancement combined with CBT and contingency management was an effective treatment package for young people (ages 18–25) who were dependent on marijuana GAMBLING DISORDER Gambler’s Anonymous ○ Incorporates the Twelve Step program Cognitive-behavioral interventions ○ Setting financial limits ○ Planning alternative activities ○ Preventing relapse ○ Imaginal desensitization @andistudiez EATING DISORDERS ETIOLOGY GENETIC FACTORS Both AN and BN run in families (esp first degree relatives at pag babae) Higher concordance rate for MZ than DZ twins ○ Non shared/unique environmental factors contribute to developing EDs Common genetic factors such as personality characteristics (negative emotionality and constraint) NEUROBIOLOGICAL FACTORS Hypothalamus since it is a key brain center for regulating hunger and eating ○ Hence abnormal level of cortisol Opioids are released during starvation and may play a role in AN and BN ○ Starvation may increase levels of endogenous opioids = positively reinforcing euphoric state ○ Excessive exercise may also release opioids ○ Low levels of beta endorphins - bulimia (but not sure if its bec of bulimia or due to changes in food intake) Serotonin deficits = EDs because serotonin is related to eating and satiety ○ Antidepressants used for those w/ AN and BN are known to increase serotonin activity ○ Can also be linked to depression since common ito na comorbid ng AN and BN Dopamine ○ Those with AN or BN have greater expression of the DAT (dopamine transporter gene) COGNITIVE BEHAVIORAL FACTORS ANOREXIA NERVOSA Fear of fatness and body image disturbance Perfection and sense of personal inadequacy Media portrayals of thinness Criticism from peers and parents BULIMIA NERVOSA AND BINGE EATING DISORDER Over concerned with weight gain and body appearance Self worth based on weight and shape = may have low self esteem Negative mood stages Negative affect and stress are relieved by purging Both focus their attention more to food related words or images Focus more on their body and others’ as well SOCIOCULTURAL FACTORS Standards set by the society Women are more likely than men to be dieters People with both high BMI and body dissatisfaction are at higher risk for developing EDs Pressure to be thin @andistudiez  Unrealistic thin models Objectification of women’s bodies OTHER FACTORS Personality influences ○ Anorexia: perfectionistic, shy, compliant ○ Bulimia: histrionic features, affective instability, and outgoing social disposition Family characteristics ○ High levels of family conflict ○ Parents were more self disclosing and lack some communication skills Presence of child abuse TREATMENT Hospitalization for those with AN Electrolyte imbalance also require treatment Antidepressants (fluoxetine) Psychological treatment (AN) ○ Therapy appears to be a two tiered process Immediate goal: gain weight to avoid further med conditions Second goal: maintain weight gain ○ Operant conditioning therapy : providing reinforcers for weight gain ○ CBT ○ Family therapy - interactions among members of the patient’s family can play a role in treating the disorder Some conduct family lunch sessions (with three major goals) Change the patient role of the person with AN Redefining the eating prob as an interpersonal problem Preventing the parents from using their child’s anorexia as a means of avoiding conflict New ver: FBT in England Focus is on helping the parent work on restoring their daughter to a healthy weight and also building up family functioning in the context of adolescent development Psychological treatment (BN) ○ CBT: people are encouraged to question society’s standards for physical attractiveness Uncover and then change beliefs that encourage them to starve (distorted evaluation of body shape and weight, and maladaptive attempts to control weight) @andistudiez  Helped to see that normal body weight can be maintained w/o excessive or severe dieting and that unrealistic restriction of food intake can often trigger a binge Overall goal is to develop normal eating patterns Some studies have examined whether adding exposure and ritual prevention (ERP) to CBT for bulimia might boost the treatment effects of CBT This ERP component involves discouraging the person from purging after eating foods that usually elicit an urge to vomit CBT alone is more effective than any available drug treatment Guided self help CBT - patients are given self help books/materials and are guided by a therapist ○ IPT ○ Family therapy Psychological treatment of Binge eating disorder ○ CBT Targets (1) binges (2) restrained eating (through self monitoring, self control, and problem solving regarding eating) ○ IPT, guided self help CBT More effective than behavioral weight loss programs Behavioral weight loss programs may promote weight loss but DO NOT curb binge eating ○ Therapist led group CBT had the greatest reduction in binges @andistudiez SEXUAL DYSFUNCTIONS ETIOLOGY Two tier model of immediate and distal causes on the etiology of human sexual inadequacies Immediate causes: ○ (1) fears about performance How one is performing during sex ○ (2) spectator role Being an observer > participant in a sexual experience Sexual functioning is complex and multifaceted BIOLOGICAL FACTORS Diseases such as: ○ Atherosclerosis, diabetes, MS, spinal cord injury Low levels of testosterone or estrogen Heavy alcohol use before sex; chronic alcohol dependence; and heavy cigarette smoking Antihypertensive and SSRIs ○ Delayed orgasm ; decreased libido; diminished lubrication Vascular conditions (for erectile dysfunctions) PSYCHOSOCIAL FACTORS Rape, sexual abuse, or other degrading encounters ○ Abuse is assoc with diminished arousal and desire Men: double the rate of premature ejaculation Relationship problems Depression and anxiety Low general physiological arousal Negative cognitions or attitudes abt sex, AIDS, pregnancy etc ○ Usually from social and cultural surroundings TREATMENT The multifaceted nature of sexual dysfunctions often require the use of combination of techniques Anxiety reduction ○ many clients with sexual dysfunctions needed gradual and systematic exposure to anxiety-provoking aspects of the sexual situation ○ Sys desensitization and in vivo desensitization have been successful esp when combined with skills training ○ Psychoeducation programs also help in reducing anxiety (esp for male erectile disorder and for women with orgasmic disorder or low levels of sexual arousal) @andistudiez ○ Sex therapists advise couples to expand their repertoire of activities to include techniques not requiring an erect penis, such as oral or manual manipulation, so that gratification of the partner is possible after the man has climaxed. When the exclusive focus on penile insertion is removed, a couple’s anxieties about sex often diminish enough to permit greater ejaculatory control. ○ Direct masturbation To enhance women’s comfort with and enjoyment of their sexuality Examine her nude body Touch genitals and find areas to produce pleasure Increase intensity of masturbation using erotic fantasies If orgasm is not achieved, use a virbrator ○ Procedures to change attitudes and thoughts Encouraged to focus on the pleasant sensations that accompany arousal Help the person be more aware of and comfortable with sexual feelings challenge the self demanding, perfectionistic thoughts that often cause problems for people with sexual dysfunctions ○ Skills and communication training therapists assign written materials and show clients explicit videos demonstrating sexual techniques communicate their likes and dislikes to each other ○ Couples therapy training in nonsexual communication skills Some therapists focus on nonsexual issues, such as difficulties with in-laws or with child rearing—either in addition to or instead of interventions directly focused on sex for women with sexual dysfunctions occurring in the context of relationship distress, behavioral couples therapy has been found to improve many aspects of sexual functioning ○ Other treatments Premature ejaculation : squeeze technique (with and without insertion) ; but prone to relapse kaya sinasabayan ng SSRIs Erectile disorder: phosphodiesterase type 5 (PDE-5) inhibitor, such as sildenafil (Viagra), tadafil (Cialis), or vardenafil (Levitra). PDE-5 inhibitors relax smooth muscles and thereby allow blood to flow into the penis = erection @andistudiez PARAPHILIC DISORDERS ETIOLOGY NEUROBIOLOGICAL FACTORS High levels of androgens (hormones like testosterone that plays a role in regulating sexual desire) ○ But some men, do not appear to have high androgen levels So ang bio factors, part lang sya ng causes PSYCHOLOGICAL FACTORS Set of risk factors Dominant models emphasize: ○ (1) conditioning experience Classical conditioning: associated arousal with an unusual or inappropriate stimuli Usually this is for pedophilic, voyeuristic, and exhibitionistic disorders Operant conditioning: outcome in inadequate social skills Usually for pedophilic (na may poor social skills) and exhibitionistic disorders paraphilias may be the activities that substitute for more conventional relationships and sexual activity ○ (2) relationship histories (3) abuse Those with the disorders were exposed to physical abuse, sexual abuse, and poor parent–child relationships ○ (4) cognition In disorders that involve non con women, may have hostile attitudes and a lack of empathy toward women may have distortions in the ways they think about their sexual behavior Nakaopen lang blinds nung girl, feel nung voyeurs kase gusto nung babae panoorin or silipan sya ○ Some research suggests that alcohol and negative affect are often the immediate triggers of incidents of pedophilic disorder, voyeuristic disorder, and exhibitionistic disorder Deviant sexual activity, like alcohol use, may be a means of escaping from negative affect @andistudiez TREATMENT Outcomes for incarcerated juvenile and adult sex offenders are highly variable across studies Strategies to enhance motivation (since offenders often lack motivation to change their illegal behavior) ○ Some deny, minimize the consequences or do victim blaming ○ So to enhance motivation, therapists can do the following 1. Empathize with the offender’s reluctance to admit that he is an offender and to seek treatment, thereby reducing defensiveness and hostility 2. Point out that treatment might help him control his behavior better 3. Emphasize the negative consequences of refusing treatment and of offending again 4. Explain that the psychophysiological assessment of the patient’s sexual arousal will make it harder to deny sexual proclivities to the authorities CBT ○ Some used aversion therapy based on imagery: covert sensitization (person imagines situations he finds inappropriately arousing and also imagines feeling sick or ashamed for feeling and acting this way) reduces deviant arousal, but little evidence is available that these techniques alone actually change the behavior ○ Cognitive procedures are often used to reduces deviant arousal, but little evidence is available that these techniques alone actually change the behavior Supplemented by social skills training and sexual impulse training ○ Empathy training : teaching the sex offender to consider how his or her behavior would affect someone else may lessen the tendency to engage in such activities Orgasmic reconditioning ○ Patients are instructed to masturbate to their usual fantasies but to substitute more desirable ones just before ejaculation Megan's Law is the federal law that “require(s) the release of relevant information to protect the public from sexually violent offenders.” @andistudiez NEURODEVELOPMENTAL DISORDERS ETIOLOGY ADHD Genetic factors ○ Adoption and twin studies = 70-80% heritability estimates ○ DRD4 (receptor gene) DAT1 (transporter gene) But not a single gene will ultimately account for ADHD recent studies have found that the DRD4 or DAT1 genes are associated with increased risk of ADHD only among those who also had particular environmental factors—namely, prenatal maternal nicotine or alcohol use Neurobiological factors ○ Smaller caudate nucleus, smaller and have deficits in the frontal lobe ○ Low dopamine levels ○ Perinatal and prenatal factors Low birth weight (but can be mitigated by maternal warmth), use of tobacco and alcohol ○ Environmental toxins Additives and food coloring : Feingold (1973) proposed that additives and artificial colors in foods upset the central nervous systems of children who were hyperactive, and he prescribed a diet free of them Lead: higher blood levels of lead may be associated to a small degree with symptoms of hyperactivity and attentional problems blood levels of lead were associated with both deficits in cognitive control and with the hyperactivity symptoms of ADHD Nicotine (esp maternal smoking): 22 percent of mothers of children with ADHD reported smoking a pack of cigarettes per day during pregnancy twin study found that maternal smoking predicted ADHD symptoms even after controlling for genetic influences and other environmental risk factors maternal smoking can affect the dopaminergic system of the developing fetus, increasing the risk of developing behavioral disinhibition and ADHD Psychological factors ○ Parent child relationships Those who give more commands and have negative interactions ○ Parent’s own history of ADHD ; parental psychopathology were less effective parents ○ little evidence to suggest that families actually cause ADHD (one of the contributors lang) DYSLEXIA Family and twin studies: there is heritable component to dyslexia genes that are associated with dyslexia are the same genes associated with typical reading abilities evidence so far suggests that heritability of reading problems varies depending on parental education Problems in phonological awareness DYSCALCULIA There is some genetic influence esp math disability that involves poor semantic memory any genes associated with dyscalculia are also associated with mathematics ability INTELLECTUAL DISABILITY Genetic or Chromosomal Abnormalities ○ Trisomy 21 (down syndrome) ; Fragile X @andistudiez  Recessive Gene Disease ○ PKU Parents are encouraged to introduce the special diet as early as possible and to maintain it indefinitely Studies have indicated that children whose dietary restrictions stop at age 5–7 begin to show subtle declines in functioning, particularly in IQ, reading, and spelling Infectious diseases ○ Cytomegalovirus, toxoplasmosis, rubella, herpes simplex, HIV, and syphilis are all maternal infections that can cause both physical deformities and intellectual disability ○ Infectious diseases can also affect a child’s developing brain after birth Encephalitis and meningococcal meningitis may cause brain damage and even death if contracted in infancy or early childhood Environmental hazards ○ Pollutants (lead, mercury) ASD Genetic factors ○ 80% heritability ; higher esp among siblings ○ 47-90% concordance rates between MZ ○ Deletion on chromosome 16 Neurobiological factors ○ Larger brains (lumalaki between ages 2-4 pero di na lumaki after 4 or 5 y/o) If larger, pwedeng neurons are NOT pruned correctly = hence deficits in brain maturation ○ areas of the brain that are “overgrown” in ASD include the frontal, temporal, and cerebellar, which have been linked with language, social, and emotional functions TREATMENT ADHD Stimulant medications: to reduce disruptive behavior and improve ability to concentrate ○ Meds alone > behavioral alone (initially lang) ○ Combination > meds alone Psychological treatment ○ Improving academic performance ○ Decreasing disruptive behavior ○ Social skills training Teaching the child how to interact appropriately with peers ○ Reinforcement programs Rewarding the child for improvements Punishing misbehavior with loss of rewards ○ Parent education programs Teaching families how to respond constructively to their child’s behaviors and how to structure the child’s day to help prevent difficulties ○ Cognitive-Behavioral Therapy (CBT) For adults with ADHD To reduce distractibility and improve organizational skills @andistudiez  ○ Parent training and changes in classroom management short-term success in improving both social and academic behavior children’s behavior is monitored at home and in school, and they are reinforced for behaving appropriately Point systems and daily report cards (drc) training teachers to understand the unique needs of these children and to apply operant techniques in the classroom ○ intensive behavioral therapies can be very helpful to children with ADHD LEARNING DISABILITIES SLD - Educational Intervention ○ Specific skills instruction Vocabulary Finding the main idea Finding facts in readings ○ Strategy instruction Includes efforts to improve cognitive skills through decision making and critical thinking ○ Direct Instruction A program Components: systematic instruction (using highly scripted lesson plans that place students together in small groups based on their progress) and teaching for mastery (teaching students until they understand all concepts) Traditional linguistic approaches, used primarily in cases of reading and writing difficulties, focus on instruction in listening, speaking, reading, and writing skills in a logical, sequential, and multisensory manner Phonics instruction involves helping children master the task of converting sounds to words Communication disorder ○ Special computer games and audiotapes that slow speech sounds INTELLECTUAL DISABILITY Treatment of individuals with ID parallels that of people with more severe form of Autism Spectrum Disorder ○ Teaching individuals the skills they need to become more productive and independent For individuals with mild ID, intervention is similar to that for people with learning disorders ○ Specific learning deficits are identified and addressed to help the student improve such skills are reading and writing Residential treatment ○ adults with intellectual developmental disorder live in small to medium-sized residences that are integrated into the community ○ medical care is provided, and trained, live-in supervisors and aides help with residents’ special needs around the clock ○ encouraged to participate in household routines to the best of their abilities Behavioral treatments ○ Improves the level of functioning esp if early intervention ○ specific behavioral objectives are defined, and children are taught skills in small, sequential steps Operant conditioning principles are then applied — applied behavior analysis (used to reduce inappropriate and self-injurious behavior) Communication training ○ Can be challenging for individuals with the most severe disabilities because they may have multiple physical or cognitive deficits that make spoken communication difficult or impossible Augmentative communication strategies – alternative system; may use picture books, teaching the person to make a request by pointing to a picture (e.g., pointing to a picture of a cup to request a drink) @andistudiez  Cognitive treatments ○ Self-instructional training teaches these children to guide their problem solving efforts through speech Computer assisted instruction ○ well suited to the education of people with intellectual disability ○ visual and auditory components of computers can help to maintain the attention of distractible students ○ the level of the material can be geared to the individual, ensuring successful experiences ○ the computer can meet the need for numerous repetitions of material without becoming bored or impatient, as a human teacher might ASD Most promising are psychological treatments ○ The earlier the interventions, the better the outcome Communication and socialization Naturalistic teaching strategies ○ Includes arranging the environment so that the child initiates an interest (e.g., placing a favorite toy just out of reach) Incidental teaching Pivotal response training Milieu teaching Behavioral treatment ○ Ivar Lovaas conducted an intensive operant conditioning–based program of behavioral treatment with young (under 4 years old) children with ASD encompassed all aspects of the children’s lives for more than 40 hours a week over more than 2 years parents were trained extensively so that treatment could continue during almost all the children’s waking hours goal of the program was to mainstream the children, the assumption being that children with ASD, as they improve, benefit more from being with typically developing peers than from remaining by themselves or with other seriously disturbed children ○ Pivotal response treatment - parents could be more effective when taught to focus on increasing their children’s general motivation and responsiveness rather than being taught to focus on changing individually targeted problem behaviors in a sequential manner based on the notion that intervening in a key, or pivotal, area may lead to changes in other areas ○ Other interventions seek to improve children’s problems in joint attention and communication CHILDHOOD ONSET FLUENCY DISORDER Psychosocial intervention ○ Parents are counseled about how to talk to their children Behavioral intervention ○ Regulated-breathing method Person is instructed to stop speaking when a stuttering episode occurs and then to take a deep breath (exhale, then inhale) before proceeding ○ Altered auditory feedback Electronically changing speech feedback to people who stutter Can improve speech, as can using forms of self-monitoring, in which people modify their own speech for the words they stutter LANGUAGE DISORDER May be self-correcting and may not require special intervention SOCIAL (PRAGMATIC) COMMUNICATION DISORDER Individualized social skills training (e.g., modeling, role playing) with an emphasis on teaching important rules necessary for carrying on conversations with others (e.g., what is too much and too little information) TOURETTE’S DISORDER Psychological intervention : Self-monitoring ; Relaxation training ; Habit reversal @andistudiez NEUROCOGNITIVE DISORDERS ETIOLOGY Delirium Caused by medical conditions ○ drug intoxications and drug-withdrawal reactions ○ metabolic and nutritional imbalances (as in uncontrolled diabetes, thyroid dysfunction, kidney or liver failure, congestive heart failure, or malnutrition) ○ infections or fevers (like pneumonia or urinary tract infections) ○ neurological disorders (like head trauma or seizures) ○ stress of major surgery Why are older adults so vulnerable to delirium? ○ physical declines of late life ○ increased susceptibility to chronic diseases ○ many medications prescribed for older people, ○ greater sensitivity to drugs ○ brain damage and dementia also greatly increase the risk of delirium TREATMENT DEMENTIA There is no cure for dementia most efforts at prevention of Alzheimer’s disease have failed cognitive deficits continued and even worsened after the plaques were removed classifying biological markers of disease before symptoms emerge in order to facilitate prevention Supportive psychotherapy can help families and patients deal with the effects of the disease Exercise have moderate benefits in cog fxn DELIRIUM Complete recovery from delirium is possible if the underlying cause is treated promptly and effectively Patient must be examined thoroughly for all possible reversible causes of the disorder Medical care in a hospital setting along with an intervention Haloperidol or other antipsychotic medication ○ Treatment for delirium brought on by withdrawal from alcohol ○ Can have a calming effect Psychosocial intervention ○ Recommended first line of treatment ○ Goal is to reassure the individual to help them deal with the agitation, anxiety, and hallucinations of delirium ○ Patient who is included in all treatment decisions retains a sense of control NCD DUE TO ALZHEIMER’S DISEASE No cure so far, but hope lies in genetic research and amyloid protein Management may include lists, maps, and notes to help maintain orientation New medications that prevent acetylcholine breakdown and vitamin therapy delay but do not stop progression of decline @andistudiez DISRUPTIVE, IMPULSE CONTROL AND CONDUCT DISORDERS ETIOLOGY CONDUCT DISORDER Interaction of the three: (1) neurobiological (2) heritable temperamental characteristics (3) environment Genetic factors ○ criminal and antisocial behavior is accounted for by both genetic and environmental factors ○ Twin and adoption studies on antisocial behaviors: 40-50% ○ Aggressive behavior: HERITABLE ○ Delinquent behavior: MAY NOT BE HERITABLE ○ aggressive and antisocial behaviors in childhood = more heritable ○ aggressive and antisocial behaviors in adolescence = less heritable ○ MAOA (metabolizes a number of neurotransmitters, including dopamine, serotonin, and norepinephrine) Maltreated and have LOW MAOA = more likely to develop CD Maltreated but have HIGH MAOA = less likely Not maltreated but have LOW MAOA = less likely ○ being maltreated was linked to later antisocial behavior only via genetics Neuropsychological factors and the Autonomic NS ○ poor verbal skills, difficulty with executive functioning (the ability to anticipate, plan, use self-control, and solve problems), and problems with memory ○ Early onset: IQ = 1 sd below age matched peers ○ Abnormalities in the ANS Lower levels of skin conductance and heart rate = lower arousal levels adolescents who exhibit antisocial behavior may not fear punishment as much as adolescents who don’t exhibit such behavior Psychological factors ○ Deficiency in m