MT_Fair_Game_Sheet.docx.pdf

Tentative Midterm Exam Fair-Game Sheet HISTORY AND BASIC CONCEPTS ● Ways of defining psychopathology (e.g., “four D’s”). ○ Psychopathology: applied to describe the many problems that seem closely tied to the human brain or mind. 1. Deviance: different, extreme, unusual, bizarre a. Statistical, moral...

Tentative Midterm Exam Fair-Game Sheet HISTORY AND BASIC CONCEPTS ● Ways of defining psychopathology (e.g., “four D’s”). ○ Psychopathology: applied to describe the many problems that seem closely tied to the human brain or mind. 1. Deviance: different, extreme, unusual, bizarre a. Statistical, moral, cultural b. Behaviors, thoughts, and emotions = ABNORMAL when they differ markedly from a society’s ideas about proper functioning c. Judgments of abnormality depend on specific circumstances as well as cultural norms i. EX: Excessive hopelessness and unhappiness of a patient is considered abnormal, but after Hurricane Katrina, seen as a normal reaction 2. Distress: unpleasant and upsetting to patient a. One’s own and/or others’ b. Behaviors, ideas, or emotions must be distressful to be abnormal c. Some who function abnormally maintain a positive frame of mind 3. Dysfunction: interfering with the person’s ability to conduct daily activities in a constructive way a. Inability, efficiency, maladaptation b. Dysfunction alone does not necessarily indicate psychological abnormality c. Culture plays role in defining abnormality 4. Danger: behavior is consistently careless, hostile, or confused a. Planing themselves and those around at risk b. Exception not the rule ● Characteristics of “eccentrics” ○ Person who deviates from common behavior patterns or displays odd or whimsical behavior ○ 15 common characteristics: ■ Nonconformity, creativity, strong curiosity, idealism, extreme interests and hobbies, lifelong awareness of being different, high intelligence, outspokenness, noncompetitiveness, unusual eating and living habits, disinterest in others’ opinions or company, mischievous sense of humor, nonmarriage, eldest or only child, poor spelling skills ○ Do not typically suffer from mental disorders ■ Eccentricity is chosen freely and provides pleasure ○ Eccentrics had fewer emotional problems than individuals in the general population ● Mesmerism ○ Franz Mesmer - Austrian Physician ■ Opened clinic in paris in which his patients suffered hysterical disorders ■ French dilatants ■ Forces of magnetism and inducing a trancelike state that seemed to make symptoms ease or disappear (tub in the center of room filled with magnetized iron fillings) ■ Rich Parisian women would swoon over the magnetism ■ “Mesmerized” aka “hypnotized” ● Trephination ○ Ancient operation in which a stone instrument cut a circular section in the skull to perhaps treat abnormal behavior ○ Thought was that people had evil spirits in head → had a hole cut into skill to release the spirits ■ Had neuropsychological diseases ○ Earliest believed form of neurosurgery ○ No evidence that trephining works, more like placebo effect ○ Most effective treatment for extreme depression: ■ CONVULSIVE SHOCK THERAPY ● Not the barbaric ways of the past ● Humoral theory/ “Humorism” ○ Created by Hippocrates ○ Believed that fluid controlled actions and beliefs → illnesses had natural causes ■ Abnormal behavior = disease coming from internal physical problems ○ Melancholic - black bile; secreted by spleen ■ Deep, dark depression, morose, repetitive dwelling ■ Represented “Earth” element ○ Choleric - yellow bile; secreted by gallbladder ■ Hair trigger temper ■ Easily pissed off, irritable ■ Represented “Fire” element ○ Phlegmatic - excess of phlegm; secreted by lungs ■ Stoic, almost comical, things roll off back ■ Represented “Water” element ○ Sanguine - blood; secreted by liver ■ Extra cheerful person, upbeat, can be manic ■ Represented “Air” element ○ Imbalance of the four = imbalanced body & mental state ■ People had personalities/temperaments that reflected imbalance in their humans ■ Excessive imbalance explained mental disorders ● Asylums ○ 16th century ○ Institutions whose primary purpose was to care for the mentally ill ○ Overflow of patients → the inability to give quality care to all patients ■ Turned into virtual prisons ■ Filthy, cruel, inhumane living conditions and treatments ○ Many became popular tourist attractions to see the mentally ill as entertainment ● Hysteria ○ Hysterical ailments: mysterious bodily ailments with no apparent physical basis ■ Determined to be largely psychological in origin ● Demonological view ○ 1st appeared in early societies, RELIGIOUS in nature ■ Exorcism: idea and performance of coaxing evil spirits to leave or make the person’s body an uncomfortable place to live in ● Earliest form of treatment for demonological views of abnormality ○ Reappears in 500-1500 AD “The Middle Ages” ■ Why? ● Due to increase of Church power and clergy influence; HEAVY RELIGIOUS BELIEFS ● Europe hit with famines, plagues ○ Couldn’t explain natural phenomenons → turned to demonological theories to explain ■ Impact ● Abnormal behavior greatly increased ● Mass madness, delusions, tarantism, lycanthropy ■ Treatment ● Revival of exorcisms ● Treatments extremely bizarre ○ “Baking out” - head in oven ■ Go in as rambling → come out quiet & submissive ● Therefore, treatment “WORKED” ○ Demonological views eventually lead to Witch Hunt Age ■ Catholic Church lead the efforts ■ Women accused of being witches ● Either exorcised, burned, or drowned ● Moral treatment ○ The term for efforts of Philippe Pinel (Chief Physician of La Bicêtre Asylum) and William Tuke (founder of York Retreat in Northern England) ■ Argued that patients should be treated with sympathy and kindness RATHER THAN chains and beatings to cure diseases ■ Both allowed patients to move freely about, have sunny ventilated rooms, combined support, advice, rest, talk, and prayer ○ Emphasized moral guidance, humane & respectful techniques ○ Spread to U.S. by: ■ Benjamin Rush: physician at Penn Hospital; aka father of American psychiatry ■ Dorothea Dix: made humane care a public and political concern in U.S. ● Campaigned for asylum reform ● Led to new laws and greater government funding for treatment ● Each state had to have an effective public mental hospital ○ Decline of Moral treatment ■ End of 19th century ■ Factors ● Speed of movement spread → money/staffing shortages, declining recovery rate, overcrowding ● Not all patients could be cured by moral treatment ● Emergence of prejudice against mentally ill ● Somatogenic views of mental illness ○ Definitional theory of meaning ○ Abnormal psychological functioning has physical causes ○ Syphilis led to general paresis (irreversible disorder) with both physical & mental symptoms, ■ But biological approaches yielded mostly disappointing results throughout ○ Important Figures: ■ Emil Kraepelin - argued that physical factors are responsible for mental dysfunction ● 1st modern system for classifying abnormal behavior ■ Wagner-Jauregg: hella patients diagnosed w/ General Paresis (Dementia Paralytica) ● type of madness that produced loss of inhibition, antisocial behavior, impaired memory, delusions that one is all powerful & immortal/infinitely wealthy, etc -- called megalomaniacal delusions ● disease would progress until the person died, disoriented & bedridden with continual seizures ● disorder was actually late stage Syphilis that had infected the brain -- Neural Syphilis ● he infected patients with Malaria which induces a high fever (as high as 105 degrees) ● Syphilis bacterium was sensitive to heat - let patients bake with malarial fever for days, until he administered Quinine which resolved the fevers & eventually cured the Malaria ○ heat sufficient to bake the bugs that infected brain & caused Syphilis → no longer infected the brain ○ patients either did not get worse OR were significantly better ● Psychogenic views of mental illness ○ View that chief causes of abnormal functioning are psychological caused by fear, love, disappointment, and other events ○ Gained a following after studies of hypnotism ● Deinstitutionalization: ○ 1960 - Present Day ○ Releasing of hundreds of thousands of patients from public mental hospitals ■ Moving severely mentally ill people out of state hospitals and closing those hospitals ○ Rationale ■ Development and distribution of psychotropic medications lead to many signs of improvement in patients ● Introduction of Thorazine (first “major” tranquilizer”) ○ Reduced agitation in all patients, and hallucinations & delusions in psychotic ones ■ Pressed by public outcry about hospital conditions ■ Released patients immediately ■ Over-promising by psychiatric profession regarding effectiveness of medications ■ Cost impact of civil rights lawsuits on state hospitals ■ Over-selling of “community mental health” as cost-cutting solution to state hospitals ○ Outcome ■ Supposed to set up community mental health centers ■ Funding never saw these places ■ Massive discharge of severely mentally ill patients to unclear destinations ● Most released patients make up homeless population ○ Flooding of streets with mental ill homeless who have no access to treatment and are often victimized ■ Closing of many state hospitals ● EX: Hotel California aka Camarillo State Hospital ● Rationale for Multicultural Psychology ○ In response to growing diversity ○ Studies the impact of culture, race, ethnicity, gender, & similar factors on our behaviors and thoughts ○ Focuses on how such factors may influence the origin, nature, and treatment of abnormal behavior ○ How people of different cultures, races, genders may differ psychologically ● Types of Professions in Mental Health ○ Psychiatrists (M.D.’s): ■ Go to Med school ■ Treat patients with medical means ■ “Bottom” of medical hierarchy ■ Barely above witch doctors ■ “Internists of the mind” - became psychopharmacologist ● Nowadays, prescribe meds to patients ○ Clinical Psychologists (Ph.D.’s): ■ 5-6 year programs ■ Psychological research involving mental disorders, methods for diagnosis, therapy on a year’s internship, clinical training ○ Social Workers (M.S.W’s / D.S.W.’s): ■ Applied mental health workers ■ Front lines in medical realm ■ 2 year MSW program ■ Case managers in health management system ■ Go out in field, hook clients up with entitlements (food, clean housing, water, therapy) ○ Psychiatric Nurses (R.N.’s): ■ Found in mental hospitals or outpatient mental places ■ Report to psychiatrist on reactions to medications ■ Manage liaisons with relatives of patients ■ May see patients who need periodic visits ○ Marriage & Family Therapists (M.F.T.’s): ■ 1-2 yr training program = certification (not Master’s) ■ Specialize in adjustment disorders (jobs, motherhood, role problems) ● Life, career, relationships ● NOT typically psychopathology ■ Insurance will NOT pay them for psychotherapy services ○ Psych Technicians: ■ Escort patients around mental institutions ● Calm patients if agitated ● Very hands on ■ Replaced somewhat by nurse aids in mental facilities ○ MH Intake Workers, Staff: ■ Insurance, billing, assessments, intake ● How to triage patients ○ Primary Care Practitioner M.D.’s (PCP’s), Physician Assistants (PA’s), and Nurse Practitioners (NP’s) ■ PCP: everyday doctor, most likely will prescribe medicine for depression ● EX: more people started seeing PCP for patients with depression (Prozac) without the stigma of being referred to a psychiatrist (in the 80’s) ○ Psychiatrists lost the “easy-to-medicate” patients, stuck with the more severe patients ■ PA/NP: fastest growing paramedical professions in US ● Work for less money, trained more, MD’s are declining in numbers ● PA’s: work under MD (2-3 years) ○ Develop own patient-case load within a medical practice ■ But always under supervision of MD in the practice ● NP’s: are RN’s who specialize beyond the RN and become individual NP ○ 4 years for RN, then extra 2 years for NP ○ Can open own independent practice ■ Have own patients & caseload UNSUPERVISED by MD, practice as psychiatrists do ○ Doesn’t cost nearly as much as medical school ● Managed care (and GauchoSpace reading “Psychotherapy and the Pursuit of Happiness,” also listed below) ○ System of healthcare coverage in which the insurance company largely controls the nature, scope, and cost of medical or psych services ■ Determines key issues: which therapists clients may choose, cost of sessions, number of sessions for which client may be reimbursed ○ Dominant form of coverages by insurance companies ○ Typically disliked by BOTH patients and therapists ■ Shortened therapy, unfairly favor treatments whose results are not always lasting, pose a special hardship for severe mental disorder patients ○ Reimbursements for mental disorders = lower than those for medical disorders ■ People with mental disorders placed at a disadvantage RESEARCH METHODS IN PSYCHOPATHOLOGY ● Advantages/disadvantages of: ○ (a) Clinical case study (case history) ■ Detailed and interpreted description of a person’s life and psychological problems ■ Describes person’s history, present circumstances, symptoms, why problems developed, may describe application & results of treatment ■ Advantages ● Source of new ideas about behaviors ● Offers tentative support for a theory ● Challenge a theory’s assumptions ● Inspire new therapeutic techniques or describe unique applications of existing techniques ● Offer opportunities to study unusual problems that do not occur often enough to permit a large number of observations ■ Disadvantages ● Reported by biased observers (therapists) ○ Theoretical preferences may bias what psychologist sees ● Rely upon subjective evidence ○ Subjective & unsystematic collection of information ● Low internal validity (accuracy) ○ The accuracy with which a study can pinpoint one factor as the cause of a phenomenon ● Little basis for generalization ○ Cannot generalize conclusions to others ● Low external validity (accuracy) ○ The degree to which the results of a study may be generalized beyond that study ○ (b) Experimental methods ■ Research procedure where a variable is manipulated and the effect of the manipulation on another variable is observed ■ Consists of IV/DV, control/experimental groups ■ Advantages ● Analyzed statistically ● Control groups, random assignment, blind designs can be used to minimize the possible influence of confounds ■ Disadvantages ● Confounds - variables other than the IV that are also affecting the DV (that can provide alternative explanation for effect) ○ (c) Correlational methods ■ Research procedure used to determine how much events or characteristics correspond with each other ■ Variables described by +/-/0 correlation and magnitude ■ Advantages ● High external validity ● Researchers in better position to generalize their correlations to people beyond the ones they have studied ○ b/c measure their variables, observe large samples, and apply statistical analyses ■ Disadvantages ● Lack internal validity ● Do not explain relationships between variables ● Nature of Correlation in Clinical Studies ○ (+) Correlation: ■ When variables in a correlation study change in the same way ● As one goes up, so does the other ■ Have (+) direction ○ (-) Correlation: ■ Value of one variable decreases while the other value increases ● As one goes down, the other goes up ■ Have (-) direction ○ Unrelated correlation: ■ No relationship between them ○ Magnitude: ■ How closely the two variables correspond (strength) ■ High or low ○ Correlation Coefficient: ■ Symbolized by r ■ Sign of coefficient shows direction ■ Number represents magnitude ● Correlational studies: ○ Epidemiological (cross-sectional) ■ Reveal the incidence and prevalence of a disorder in a particular population ● Incidence: # of new cases that emerge in period of time ○ Measures the risk of developing some new condition within a specified period of time ● Prevalence: total # of cases in the population during a period of time (includes both existing and new cases) ○ Proportion of a population found to have a condition ■ Goal: describe the incidence/prevalence of a disorder WITHOUT trying to predict/explain when and why it occurs ● Many also refer to these as descriptive studies ■ Info is collected over long term ■ **Epidemiological studies: how information is obtained; prevalence / incidence. (NOTE: you will not need to know any incidence/prevalence percentages for the Exam) ● Interviews & surveys help identify groups at risk for particular disorders ○ Longitudinal (developmental) ■ Study that observes the same participants on many occasions over a long period of time ■ Reports the order of events, so correlations provide clues about which events are more likely to be causes and which are to be consequences ● Experimental studies: ○ Experimental groups: ■ The participants who are exposed to the IV ○ Control groups: ■ Group of participants who AREN’T exposed to the IV ○ Blind designs: ■ Experiment in which participants do not know whether they are in the experimental or the control condition ● Double blind design: ○ NEITHER participant or the experimenter know whether the participant has the experimental treatment or placebo ● Placebo therapy: ○ Sham treatment that a patient in an experiment believes to be genuine ○ Experimenter bias: ■ Experimenters have expectations that they are unintentionally transmitting to the participants in their studies ■ Aka Rosenthal Effect ● EX: drug therapy study: the experimenter might smile and act confident while providing real medications to the experimental participants but frown and appear hesitant while offering placebo drugs to the control participants ○ Alternative Experimental Designs ■ Matched Design ● Matches the experimental participants with control participants who are similar on key characteristics ■ Naturalistic ● Experiment where nature, RATHER THAN AN EXPERIMENTER, manipulates an IV ● Participants are selected by an accident of fate rather than conscious design ● Can’t be repeated at will ○ Broad conclusions from single events must be concluded which can be incorrect ● Identified patterns of reactions that occur in such situations ■ Analogue ● Experimenter produces abnormal-like behavior in laboratory participants and then conducts experiments on participants ● Manipulate IV relatively freely ● Often used on animals ● Major limitation: researchers can never be certain that the phenomena they see in lab are the same as the psychological disorders they are investigating ■ Single-subject experiments ● Single participant is observed and measured BOTH before and after the manipulation of an IV ● IV is manipulated systematically so that the investigator can confidently draw conclusions about the cause of an observed effect ● Has greater internal validity than case study, but limited external validity ● Rely on baseline data (info collected prior) ● ABAB Design - reversal design ○ Reactions measured and compared not only during a baseline period (condition A) and after the introduction of IV (condition B), but after IV has been removed (condition A) and yet again after it has been reintroduced (condition B) ○ Participant = compared to themselves under different conditions ● Multiple-Baseline Design ○ Experimenter picks 2+ behaviors (DV’s) displayed by participant and observes effect that manipulation of an IV has on each behavior ● Problems with current research practices (WEIRD participants, biases, conflicts of interest, replication issues) ○ WEIRD participants ■ Nearly 70% psychology studies use college students as participants ● Overwhelmingly from societies that are: ○ White, educated, industrialized, rich, democratic ■ Distinct breed → raising doubts about how generalizable WEIRDrelated findings are ■ WEIRD individuals are more: ● Educated ● Individualistic ● Narcissistic ● Self-satisfied ● Happiness-driven ● Reward-focused ● Concerned about personal choice ■ WEIRD individuals are: ● Younger ● Less cooperative & conforming ● Greater risk takers ○ Biases ■ Almost 75% of authors refused requests for their data ● American Psychological Association requires authors of articles accepted for journal publication to share their data with peers for reanalysis or republication ■ Scientific journals more likely to publish “positive” studies that support the tested hypothesis than “negative” (unsupportive) studies ● 85% of published studies are positive (as of 2014) ■ More researchers are conducting studies online, but online research participants are different from in-person participants Online Participants In-Person Participants 57% females 71% females More racial diversity Less racial diversity Less educated More educated Older Younger Poorer Wealthier More geographical diversity Less geographical diversity ● ○ Conflicts of interest ■ More than ⅔ of drug efficacy studies are conducted by private researchers who are paid directly by pharmaceutical companies ● 80% of published pharmaceutical company studies report favorable outcomes ● In contrast, 50% of the published studies sponsored by nonpharmaceutical companies report favorable outcomes ○ Replication issues ■ Replication: repetition of studies with different investigators, participants, & situations ● Replicated studies help determine accuracy & generalizability of the original studies ■ Fewer and fewer replication studies are being conducted in psychology ■ Contradictory replicated studies are rarely published ■ Once an initial study’s findings are accepted, contradictory replication findings rarely change public or scientific opinions ● IRB’s, basic rights of research participants, and problems with “informed consent” ○ Participants enlist voluntarily ○ Before enlisting, the participants are adequately informed about what the study entails (“informed consent”) ■ Problem with “informed consent:” ● Fewer than half of all participants may fully understand the informed consent forms they are signing ○ Most forms deemed acceptable by IRBs are too long and/or are written at an advanced college level, making them incomprehensible to a large percentage of participants ● Only around 10% human participants carefully read the informed consent forms before signing ○ Only 30% ask questions of the researchers during the informed consent phase of their studies ○ Participants can end their participation in the study at any time ○ Benefits of the study outweigh its costs/risks ○ Participants are protected from physical and psychological harm ○ Participants have access to information about the study ○ Participants’ privacy is protected by principles such as confidentiality or anonymity ● Types of data validity and reliability ○ Interrater (interjudge) reliability: if judges independently agree on how to score and interpret it ○ Validity: external, internal, statistical ■ Face validity: when a given assessment tool may appear to be valid simply because it makes sense and seems reasonable ■ Predictive validity: a tool’s ability to predict future characteristics or behavior ■ Concurrent validity: the degree to which the measures gathered from one tool agree with the measures gathered from other assessment techniques Assessment and Diagnosis ● Semantic vs. prototype conceptions of diagnosis and how prototypes arise. ○ Semantic conceptions of diagnosis ■ Definitional theory of mental disorders ■ The study concerned with the relations between signs and their referents; between the signs of a system; and human behavioral reactions to signs ● Including unconscious attitudes, influences of social institutions, and epistemological and linguistic assumptions ○ Prototype conceptions of diagnosis ■ Making typical identifications based on characterizations ■ However, not all subjects in that category have all those characteristics ● EX: a dog = fur, tail, 4 legs, bark, loyal ○ BUT, some dogs don’t have all these traits ○ How prototypes arise ■ Exposure to real-life situations in which mental health services were involved ■ Indirect experiences (via books, films, TV, friends) where people are seen to have unwanted conditions requiring mental health intervention ■ In training as a mental health professional, through classic case studies/supervised clinical experiences ● DSM-5 conception of “mental disorder” ○ Syndrome characterized by significant disturbance in an individual’s cognition, emotion, regulation, or behavior that reflects dysfunction in psychological, biologic, or developmental processes underlying mental functioning ○ Must not be merely an expectable and culturally sanctioned response to a particular event, such as death of a loved one ● Philosophical viewpoints and their relevance for different conceptions of mental disorder ○ Monism ■ The mind and the body are inseparable (the world is made of one stuff) ● Can be either all “mental” (Idealism) or all “physical” (Materialism) ● They are one and the same ● This would mean that mental illness is a brain illness, and therefore a medical illness ■ Most psychiatrists doing psychopharmacology act as monists ○ Dualism ■ Mind and brain are two different things (the physical and mental worlds are separate domains) ● They closely interact, but they are different things ● This would mean that mental illness is not a brain illness because the mind being ill would not imply that there is anything wrong with the brain ■ Most psychotherapists act as dualists ● Phenotypic vs. genotypic diagnosis ○ Phenotypic diagnosis ■ Signs: observable traits ■ Symptoms: what patient feels ■ Course: how long symptoms and signs persist ■ Outcome: results of disorder ■ Response to treatment: how successful was recovery using prescribed treatment ○ Genotypic diagnosis ■ Cause: genes and germs ■ Laboratory tests ○ In physical medicine, progress = phenotypic → genotypic diagnosis ○ In mental health = all diagnoses is phenotypic with some endophenotypic evidence emerging ● Endophenotypic signs in diagnosis ○ Lab tests that look for markers of something going on deep down (internal manifestation) ○ “Subclinical” biomarkers ○ EX: early dementia can measure glucose levels and metabolism of the brain to detect it in a PET scan - Internal phenotypic sign ○ Separating behavioral symptoms into stable phenotypes with clear genetic connections ● Advantages and disadvantages of psychodiagnosis ○ Advantages ■ Prognosis (the likely course of disorder) ● Good prognosis or poor ■ Treatment ● Different medications, predict better responses, different counseling approaches ■ Communication among profession ● Shorthand communication, gives medical/psychological jargon, understand condition ■ Prospects for contagion or other transmission, and possible prevention ■ Legal reasons (e.g., competence, insanity determinations): ● Judge wants to know if accused or juror or persons involved in the case are mentally stable ■ Financial reasons (compensation to patient and/or treatment provider) ● Worker’s comp, insurance companies have big interest ■ Research: ● Can work towards a cue ○ Disadvantages ■ Sacrifices the uniqueness of individual patient: ● People get fed into the system, life stories/special factors are lost, fit into categories ○ EX: Bipolar I, 23 yr old male ■ Can falsely imply etiology (cause): ● Went looking for causes that psychologists believed were true ○ If wasn’t there, must be repressed ■ Rigidifies treatment alternatives ● “Cookbook treatment styles” ■ Iatrogenic illness: “healer” “beginnings” ● The healer causes the patient to become ill ● Therapy backfires (psychologists), medicine backfires (psychiatrists) ● Fail to understand cultural differences and advice gives rise to new problems ● When tx designed to help the patient actually hurts the patient ■ Stigmatization: ● People don’t want others to know they are getting help ■ Secondary gain: ● Benefits patients get from diagnosis ● Disability is more profitable than working ● Kinds of information that go into a psychodiagnosis ○ Signs: ○ Symptoms: ○ Course of illness: ○ Age of Onset: ○ Family History: ○ Recent events/behavior: ○ Psychological tests: ○ Laboratory tests (e.g. neuroimaging, hormonal assays, genetic testing) ○ Response to treatment (current or prior) ● Clinical interview: kinds of information solicited or observed ○ ~1 hr; most valuable single source of info leading to a diagnosis ○ Personal & family history: medical, mental health, social, occupational, financial problems ○ Treatments that have worked/not worked in the past ○ Symptomatology: ■ What brings you here today? What have you been feeling? ○ Signs from patient’s presentation? ■ Attire & grooming ■ Posture ■ Physical characteristics (skin tone, weight, stature, symmetry, bodily anomalies) ■ Mannerisms, spasms/tics ■ Speech (articulation, prosody) ■ Consciousness (level of alertness, fogginess, hypervigilance) ■ Emotional state ■ General attitude (defiant, compliant, guarded, defensive, sincere, plaintive, resistant, apathetic) ■ Thought content (solicited by free inquiry) ■ Thought processes (thought broadcasting, removal, insertion) ■ General knowledge (facts, pop culture) ● EX: What is your option of… ? ■ Abstract thinking ● EX: Is your life how you imagined it would be when you were 10? ■ Social judgment ■ Insight ■ Cognitive functioning ○ Goals: ■ Suitability and readiness for psychotherapy (self or another therapist) ■ Determined need for referral to: ● Psychiatrist or PCP for medication ● Neurologist for neurological testing and/or neuroimaging ● Social worker, vocational counselor, physical therapist ● Basic diagnostic concepts: ○ Nosology ■ Process of categorization and classification of disease ● Science or scheme of disease categorization and classification ■ Scheme of possible labels ● EX: If lung nosologist, study all the causes and diseases ■ Neural Nosology: List of mental disorders that people are diagnosed with ○ Diagnosis ■ Assigning a nosological category to a patient ■ Collection of all the possible labels from nosology ○ Signs ■ Observable markers patients give off ○ Symptoms ■ Patient reports ○ Syndromes ■ Signs AND symptoms ○ Prognosis ■ Outcome ● Endpoint of disorder ● Normally good or poor prognosis ● EX: Alzheimer's type dementia = poor prognosis ○ Course of illness ■ Trajectory ● Some have a smooth course: chronic ● Others: acute flare ups, chronic deteriorating, acute course then never again ○ Etiology ■ Cause/origins of disease ● All the risk factors added together, that predispose someone to develop a mental disorder ○ Co-morbidity ■ The presence of 1+ disorder or diseases in addition to the primary one ■ In psychiatric classification, comorbidity doesn’t necessarily imply presence of multiple diseases, but instead can reflect our current inability to supply a diagnosis that accounts for all symptoms ● Cognitive tasks commonly used in the clinical interview and Mini-Mental Status Exam (MMSE) ○ Set of questions and observations that systematically evaluate the client’s awareness, orientation with regard to time and place, attention span, memory, judgment and insight, thought content and processes, mood, and appearance ○ Almost all have both unstructured and structured portions, many clinicians favor one kind over the other ○ Clinical interview ■ Projection Tests ● Patient must interpret vague stimuli ○ Theoretically, when clues and instructions are so general, people will project aspects of their personality into the task ● Used to be more popular, now used largely to gain “supplementary insight” ○ Not very interreliable, sometimes biased against minority ethnic groups ● EX: ○ Rorschach Inkblots: interpret an inkblot on paper ○ Thematic Apperception Test: 30 B&W pictures and asked to make up dramatic story about each ○ Sentence-completion tasks: complete unfinished sentences ○ Drawings: draw a human figure and discuss ■ Follow open-ended instructions ■ Personality Inventories ● Ask wide range of questions about their behavior, beliefs, & feelings ● EX: ○ Minnesota Multiphasic Personality Inventory (MMPI): asks 500+ self-statements, made of 10 clinical scales, earn score from 0-120 ■ Response Inventories ● Focus on specific areas of functioning in personal questions ○ Asked people to provide detailed info about themselves, but focused on one specific area of function ● Affective inventories: measure severity of emotions ● Social skills inventories: another ● Cognitive inventories: reveal person’s typical thoughts and assumptions ■ Psychophysiological tests ● Measure physiological responses of possible indicators of psychological problems ● EX: ○ Polygraph ■ Neurological and Neuropsychological Tests ● Measure brain structure and activity directly ● EX: ○ EEG, CAT, PET, MRI ■ Intelligence Tests ● Series of tasks requiring people to use various verbal and nonverbal skills ● EX: ○ Wechsler Adult Intelligence Scale, Stanford-Binet Intelligence Scale ○ MMSE ■ Orientation: (up to 3x) ● Time, place, person, situation ■ Registration: ● Names of 3 common objects, ask patients to repeat them ■ Attention & calculation: ● Serial 7’s or WORLD backwards ■ Recall: ● Ask again for the names of 3 common objects ■ Language: ● Write a sentence ● Copy a design ● Nature of projective tests vs. structured inventories ○ Projective tests: ■ Tests consisting of ambiguous material that people interpret or respond to (inkblot, ambiguous pictures, “draw a person”) ● Used by psychodynamic clinicians to help assess the unconscious drives & conflicts they believe to be at the root of abnormal functioning ■ Used to be more popular, now used largely to gain “supplementary insight” ■ Not very interreliable, sometimes biased against minority ethnic groups ○ Structured inventories: ■ Clinicians ask prepared-mostly specific-questions ● May include mental status exam (set of questions/observations that systematically evaluate client’s awareness, orientation with regard to time/place, attention span, memory, judgment, etc) ■ Greater test-retest reliability ■ Greater validity or accuracy, but not that great ■ Cultural limitations ● Reliability / validity of diagnosis or assessment ○ Diagnosis are informed guesses about the disorders that best fit patients ■ Never set in stone, but are opinions that may change at any time with new info/as patients change how they present to the practitioner ○ Reliability: Measure of the consistency of test or research results ■ A good assessment tool will always yield similar results in the same situation ● Assessment tool must accurately measure what it is supposed to measure ■ Interrater (interjudge) reliability: if judges independently agree on how to score and interpret it ○ Validity: measure of the accuracy of a test’s or study’s results ■ Face validity: when a given assessment tool may appear to be valid simply because it makes sense and seems reasonable ■ Predictive validity: a tool’s ability to predict future characteristics or behavior ■ Concurrent validity: the degree to which the measures gathered from one tool agree with the measures gathered from other assessment techniques ● Overview of TAT and Rorschach administration, interpretation, and value ○ TAT: Thematic Apperception Test ■ Personality test that reveals a respondent’s underlying motives, concerns, and the way they see the social world through stories and pictures of people ■ Pictorial projective test ■ 30 B&W pictures of people in vague situations ● Patients must make up dramatic story about each card ● Patients always identify with 1 character, the hero ○ Stories reflect the individual's own circumstances, needs, emotions, etc. ■ Clinicians who use TAT believe that people always identify with one of the characters and the stories are reflections of the individual’s circumstances, needs, and emotions ○ Rorschach: ■ Ink blots are dropped on a paper, folded in half creating a symmetrical design → found that everyone saw images in these blots ■ Patient describes “image” they see ● Image = corresponds in important ways with their psychological condition ● Thematic content = themes and images that the inkblots evoked ■ Rorschach Psychodynamic Inkblot Test ● Selected 10 inkblots and published them with instructions, died 8 months later, but became well known for projective tests ● General makeup of MMPI-2 (not specific scales) ○ Minnesota Multiphasic Personality Inventory 2, 567 self-statements, updated version ○ 10 scales that indicate a person’s general personality ○ Standardized & objectively scored ○ More valid indicator of personality and abnormal functioning ■ Sampled people who more properly represent the diverse population of Western society ○ Scores on revised test thought to be more accurate indicators ○ CONS ■ Cultural limitation ■ Responsive inventories: focuses on separate area of functioning ■ Affective inventories: measure only to severity (skewed) ● Psychophysiological tests & polygraphy ○ Psychophysiological tests ■ Measure physiological responses as possible indicators of psychological problems ● Physiological changes include: ○ HR, body temp, BP, skin reactions, and muscle contractions ○ Polygraph - lie detector ■ Electrodes are attached to different part of subject’s body ● Detect changes in breathing, perspiration, heart rate when answering questions ● When sharp increases occur, suspected of lying ○ Drawbacks ■ Expensive equipment ■ High maintenance ■ Measurements can be inaccurate and unreliable ● Major types of brain imaging ○ EEG - electroencephalogram ■ Records brain waves, the electrical activity that takes place within the brain as a result of neurons firing ■ Electrodes placed on the scalp send brain-wave impulses to a machine that records them ○ CAT/CT Scan - computerized axial tomography ■ The x-rays of the brain’s structure are taken at different angles then composed into a single image ■ 3D ○ PET Scan - positron emission tomography ■ Shows the functioning of different areas in the brain ■ Administered harmless radioactive compound which travels to the brain ● Performs a cognitive task ● Higher radioactivity in brain areas = higher blood flow and neuron activity in those areas ● Converted into motion picture showing activity ○ MRI - magnetic resonance imaging ■ Computer gathers info about magnetic properties of hydrogen atoms in the brain and produces very detailed picture of the brain’s structure ■ fMRI - functional MRI ● Produces detailed picture of the functioning brain ○ Converts MRI pics of brain structures into detailed pictures of neuron activity → offering picture of functioning brain ● MRI scanner detects rapid changes in blood flow or volume of blood across brain while patient is emotional or performing a task ● Computer generated images of which brain areas were active during tests ● IQ testing and use of IQ ○ Series of tasks requiring people to use various verbal & nonverbal skills ○ Very high reliability and validity ○ Intelligence Quotient (IQ): general score from intelligence tests ■ Termed IQ b/c initially represented the ratio of a person’s mental age to his/her chronological age, multiplied by 100 ○ Among most carefully produced of all clinical tests ○ Clinicians have a good idea of how each person’s score compares with others ○ Validity: Children’s scores correlate with performance in school ○ EX: Wechsler Adult Intelligence Scale, Wechsler Intelligence Scale for Children ● Neuropsychological tests ○ Measure cognitive, perceptual, and motor performances on certain tasks & interpret abnormal performances as an indicator on underlying brain problems ○ Bender Visual-Motor Gestalt Test: ■ 9 cards displaying simple designs ■ Patients look at design, copy on paper then redraw designs from memory later ■ Notable errors in accuracy may reflect organic brain impairment ● History, development and construction of DSM-5 – general principles and organization ○ Created in 1883 by Emil Kraepelin, DSM-5 published in 2013 ○ Lists more than 500 mental disorders ■ Each entry describes the criteria for diagnosing the disorder & the key features of the disorder ○ Requires clinicians to provide both categorical and dimensional info as part of a proper diagnosis ■ Categorical info: the name of the category (disorder) indicated by the client’s symptoms ○ Additional info: other useful info, medical conditions or psychosocial problems ● Dimensional and ancillary information in DSM-5 ○ A rating of how severe a client’s symptoms are and how dysfunctional the client is across various dimensions of personality & behavior ○ Dimensional diagnosis: ■ Acknowledgement of importance of medical and psychosocial factors ○ Ancillary Medical Psychosocial Information: ■ Medical: lung adenocarcinoma diagnosed 1/14, hypertension, back surgery for lower back injury 2 years previous ■ Psychosocial/Contextual: child with autism spectrum disorder, marital conflicts, job stress ○ Helpful Ancillary Diagnostic Info: ■ Info from family members ■ Info from physicians, employers ■ Medical chart if available ■ Previous psychological testing, and case summaries from previous therapists ● ● ● ● ● ● ■ Discharge summaries from hospital stays Evidence-based treatment guidelines ○ Therapy that has received clear research support for a particular disorder & has corresponding treatment guidelines Psychotherapy: general effectiveness and meta-analysis ○ General effectiveness ■ Therapy = more helpful than no treatment/placebos ○ Meta-analysis ■ There is little difference in the overall effectiveness of the different forms of therapy ■ Special statistical technique where you combine findings of studies ■ Results: those who receive treatment were 75% better ○ Uniformity myth: a false belief that all therapies are equivalent ■ There’s an alternative approach that examines the effectiveness of particular therapies Common factors in effective psychotherapy, and the “rapprochement movement.” ○ Rapprochement movement: a movement to identify a set of common factors, or common strategies, that run through all successful therapies, regardless of the clinician’s particular orientations ○ Highly successful therapists: ■ Give feedback to clients ■ Help clients focus on their own thoughts and behavior ■ Pay attention to the way they and their clients are interacting ■ Try to promote self-mastery in their clients ○ Common factors treatment approach contends that successful therapies share common components that greatly influence the outcome of therapy Pharmacogenomics ○ Study of how genetic variations can affect individual responses to drugs ○ Combines pharmacology (science of drugs) and genomics (study of genes and their functions) to develop effective, safe medications and doses that will be tailored to a person’s genetic makeup ○ Impacts therapeutic effects ○ Impacts adverse effects ○ Clinically relevant for several drugs thus far, though testing is required for only a few Co-morbidity ○ The presence of 1+ disorder or diseases in addition to the primary one ○ Emerged as a major clinical, public health and research issue over the past few decades Types of brain imaging ○ CAT/CT Scan - computerized axial tomography ■ The x-rays of the brain’s structure are taken at different angles then composed into a single image ■ 3D ○ PET Scan - positron emission tomography ■ Shows the functioning of different areas in the brain ■ Administered harmless radioactive compound which travels to the brain ● Performs a cognitive task ● Higher radioactivity in brain areas = higher blood flow and neuron activity in those areas ● Converted into motion picture showing activity ○ MRI - magnetic resonance imaging ■ Computer gathers info about magnetic properties of hydrogen atoms in the brain and produces very detailed picture of the brain’s structure ■ fMRI - functional MRI ● Produces detailed picture of the functioning brain ● MRI scanner detects rapid changes in blood across brain while patient is emotional or performing a task ● Computer generated images of which brain areas were active during tests Major Depression ● Major (Unipolar) Depression, and cultural specificity ○ Cognitive ■ Pervasive sadness (feeling washed out and dead), guilt, or worthlessness ● Guilt = main factor (in EUROPEAN definition) ■ Recurrent thoughts of death or suicide ■ Extremely negative self-views ○ Motivational ■ Pervasive anhedonia (inability to feel pleasure) ● Nothing brings you pleasure or enjoyment ■ Less active/productive, don’t want to do anything ■ Lack of drive, initiative, and spontaneity ○ Neurovegetative ■ Significant change in weight ● 15-20 lbs average loss ● Exceptions: carbohydrate cravers ■ Sleep disturbance ● Go to bed at normal time but wake up at odd hours ● Feel wrung out, exhausted, can’t go back to sleep ● Exceptions: hypersomnias ■ Psychomotor agitation or retardation ● Can’t sit still ● Others can’t move at all, almost painful, energy expending, exhausting ■ Pervasive fatigue or loss of energy ● Even small activities are going to exhaust them ■ Difficulty concentrating ■ Too much of an effort, so can’t complete thoughts ○ Cultural specificity ■ Depressions in non-Western countries differ from those in Western countries overall, not race or social class ■ Risk factor: being in an industrialized nation ■ non-Westerners are treated like they are ill and Westerners are made to feel guilty ● Psychodynamic account of Major Depression w/ problems ○ Believing that major depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people ■ Encourage the depressed client to associate freely during therapy ● Suggest interpretations of client’s associations, dreams, displays of resistance & transference → help person review past events & feelings ● Psychodynamic therapists expect that in the course of tx, depressed clients will eventually gain awareness of the losses in their lives, become less dependent on others, cope with losses more effectively, and make corresponding changes in their functioning ○ Problems: ■ Only occasionally helpful in cases of Major Depression ■ Two features may help limit its effectiveness: ● Depressed clients may be too passive & feel too weary to join fully in subtle therapy discussions ● They may become discouraged and end tx too early when this long-term approach is unable to provide the quick relief that they desperately seek ● Post-partum depression vs. “baby blues,” incl. possible etiologies of post-partum depression ○ Post-partum depression: ■ Depression in the mother that starts within 4 weeks after the birth of a child ■ Can last up to a year ■ Symptoms: extreme sadness, despair, tearfulness, insonnia, anxiety, intrusive thoughts, compulsions, panic attacks, feelings of inability to cope and suicidal thoughts ■ Etiologies: ● Could be hormonal changes from childbirth that triggers the depression ● Levels of thyroid hormones, prolactin, and cortisol also change ● Also genetic disposition to depression ● Enormous psychological & social changes that bring stress and pressure → fatigue ○ “Baby Blues” ■ Short-term dips in mood caused by all of the changes that come with a new baby ■ Common, as many as 80% women experience → considered normal ■ As new mothers try to cope with the wakeful nights, rattled emotions, other stresses that accompany the arrival of a new baby, they may have crying spells, fatigue, anxiety, insomnia, sadness ● Symptoms usually disappear within days or weeks ● Atypical depression - Hysteroid Dysphoria ○ Reversed neurovegetative signs and symptoms ○ Symptoms: ■ Mood reactivity ■ Weight gain/carb binging ■ Hypersomnia (excessive sleep) ■ Leaden paralysis (sluggishness) ■ Interpersonal rejection sensitivity (social impairment) ● Super attuned to other people’s facial expressions, comments, actions ○ Often: ■ Histrionic traits (drama/attention-seekers) ■ Self medication with caffeine or chocolate ● Keep mood propped up ■ Sometimes, uniquely responsive to MAO-inhibitors ● Patterns of Major Depression occurrence (episodes, persistence, recurrence, etc.) ○ Episodes occurred by rekindling, personal loss, prolonged psychological stress, later 20s, giving birth ■ 80% all severe episodes occur within a month of two of a significant negative effect ■ Reactive (exogenous) depression: follows clear-cut stressful events ■ Endogenous depression: response to internal factors ○ Prevalence for one year = 8% ● Sex ratios in prevalence of Major Depression, possible explanations, and implication of Amish findings ○ Prevalence ■ Childhood - 1:1 ratio ■ 2:1 F:M sex ratio after puberty ■ Lifetime - 26% F, 12% M ○ Possible explanations ■ X-linked depression genes ■ Premenstrual symptoms ● Elevate to some degree the prevalence of depression of women ■ Quality of female vs. male life ● Men have more privileges in society while women have more responsibilities, fewer freedoms ● Problems with sociological critic: ○ Female lifespan = longer than males ■ Female masochism (Freud): ● Early in upbringing, realized that they did not have male genitals ○ Which meant they don’t have the thing to make it in the world ● Instead, had a consolation prize: a baby ○ Tendency to derive pleasure from one’s own pain ■ Cognitive style ● Females dwell on problems ● Males ignore or escape them ○ Amish Study Findings ■ Male depression masked by alcohol/drug abuse (Amish Study) ● Genetic evidence on prevalence of depression ○ DNA linkage analysis reveals depression gene regions ○ Twin studies ■ Identical twins have a 46% chance of both having the same disorder, but fraternal twins only have a 20% chance ○ Adoption studies: ■ Biological parents of adopted children had a higher incidence of severe depression ○ Higher risk of becoming depressed if: ■ A family member is depressed ■ A twin, particularly identical ■ Adopted and biological parents have a higher incidence of severe depression ● “Kindling” and depression risk ○ First major depressive episode by be slow to start/require a lot of stressors/a lot of dysregulation ○ Each depression increases the risk of later depression, regardless of life stress ■ Brain already dysregulated → takes much less for another episode to ● ● ● ● ● occur ● b/c there is already disequilibrium ○ You can be the least stressful person ever, but if you’ve had 3 depressive episodes, it is very likely for it to happen again Differences in ethnicities in rates of single-episode vs. recurrent Major Depression and possible explanation ○ Hispanic Americans & African Americans are 50% more likely than non-Hispanic white Americans to have recurrent episodes of depression ■ Around 54% of depressed non-Hispanic white Americans receive treatment for their disorders (meds and/or psychotherapy) ● Compared with 34% of depressed Hispanic Americans ● Compared with 40% of depressed African Americans ○ Minority groups in the US more vulnerable to repeated experiences of depression partly because many of their members have more limited treatment opportunities then they are depressed ■ Depression more common among Hispanic & African Americans born in the US than among Hispanic & African American immigrants Persistent depressive disorder and “double depression.” ○ Persistent depressive disorder aka Dysthymic Disorder ■ A mood disorder that is similar to, but longer lasting and less disabling than a major depressive disorder ● If case of unipolar depression is chronic ● Experience less severe & less disabling symptoms ■ Some people with this chronic pattern experience major depressive episodes ○ “Double depression” ■ When persistent depressive disorder/dysthymic disorder LEADS TO major depressive disorder Psychotic features in severe Major Depression ○ Delusions, hallucinations, paranoia paired with severe depression Natural remission of Major Depressions and relevance for theories of depression ○ Depression naturally lifts after several months (3-4 months), but unknown as to why ■ With each subsequent untreated episode, the chances of having another episode of depression increases Cognitive behavior therapy and learned helplessness accounts of Major Depression and limitations ○ Cognitive behavior therapy ■ Focuses on thinking to combat depression ■ Uncovering automatic self-defeating thinking patterns ● Believed this is why patients were depressed ■ Developing new ways to interpret setbacks (normalization, analyzing logically, decatastrophizing) ● Goal of Cognitive Therapists: counter negative self-thinking, taking sting out of the situation ■ Replacing old “automatic” thoughts with new ones ■ Prime areas of concern: ● The self → see themselves as worthless ● Life events → victims of bad luck ● The future → see future as hopeless and powerless to change it ■ Became popular after WWI ● Focused on symptom removal and goal specification ○ Learned helplessness model of depression and limitations ■ The perception based on past experiences that one has no control over one’s reinforcements and therefore become depressed ● People feel they no longer have control over the reinforcements and rewards/punishments in their lives ● Feel they are responsible for helpless state ■ Limitations: laboratory helplessness does not parallel depression in every aspect and much of the learned helplessness research relies on animal subjects and not humans ● Types of psychotherapy for Major Depression – rationales, evidence for effectiveness ○ Cognitive behavior therapy ■ Focuses on thinking to combat depression ■ Uncovering automatic self-defeating thinking patterns ● Believed this is why patients were depressed ■ Developing new ways to interpret setbacks (normalization, analyzing logically, decatastrophizing) ● Goal of Cognitive Therapists: counter negative self-thinking, taking sting out of the situation ■ Replacing old “automatic” thoughts with new ones ■ Prime areas of concern: ● The self → see themselves as worthless ● Life events → victims of bad luck ● The future → see future as hopeless and powerless to change it ■ Became popular after WWI ● Focused on symptom removal and goal specification ○ Interpersonal Therapy ■ Focuses on social support to combat depression ■ Central Themes: ● Grief: delayed mourning, developing replacement relationships ● Fights: building skills in communication, negotiation, and assertiveness ○ Need to know how to “fight” ● Role transitions: reevaluating the lost role, building a new role, developing new social supports ○ EX: leaving home, divorce, retirement ○ Saying goodbye to people and behaviors that characterize the old position ● Social deficits: using role playing to learn new behavior in relationships ○ Failure patterns in past relationships ○ Psychodynamic Therapy ■ Seek to help clients bring underlying issues to consciousness and work through them ○ Behavioral Therapy ■ Reintroduce depressed clients to pleasurable events/activities ■ Appropriately reinforce depressive and non-depressive behaviors ■ Help them improve their social skills ● ACT and MBCT: “third-wave” variants of Cognitive Behavior Therapy ○ ACT (Acceptance and Commitment Therapy) ■ Help clients become aware of their stream of thoughts as they are occurring and to accept such thoughts as mere events of the mind ● By accepting such thoughts rather than trying to eliminate them, the clients are expected to be less upset by them & less likely to act on them ■ More effective than placebo tx ○ MBCT (Mindfulness Based Cognitive Therapy) ■ Treating individuals with GAD by helping them recognize their inclination to worry ■ Therapists help clients become aware of their stream of thoughts including their worries as they are occurring to accept such thinking as mere events of the mind ■ Borrows heavily from mindfulness meditation: teaches people to pay attention to the thoughts & feelings that flow through their mind during meditation and to accept such thoughts in a nonjudgmental way ○ Help depressed clients recognize & accept their negative cognitions simply as streams of thinking that flow through their minds, rather than as valuable guides for behavior and decisions ■ As clients increasingly accept their negative thoughts for what they are, they may better work around thoughts as they navigate their way through life ■ Ongoing procedures help prevent recurrences of depression once individuals recover from an episode ● Brain changes in depression, and possible mechanisms of action of major classes of antidepressant drugs ○ BDNF - brain derived neurotrophic factor ■ Promote neuronal growth, & axonal and dendritic sprouting ■ Spur growth of connections between neurons ■ A depressed brain = loses connections, brain gets lighter, brain wastes away, less active ■ Deficiencies in BDNF impairs health of neurons and leads to depression ● Deficient neurotransmitters ○ Neocortical disturbances ■ Consists of a brain circuit that is believed to trigger depression ■ Prefrontal Cortex: plays critical role in depression but HOW is not clearly defined ● Altered levels of activity in the limbic system, prefrontal area, & other brain regions, observable by neuroimaging and increased levels of neurosteroid hormones which promote neuronal death and glial cell damage ■ Hippocampus: produces new neurons throughout life ● Neurogenesis decreases dramatically when individuals become depressed ● Important role in controlling reactions to stress and formation/recollection of emotional memories ■ Amygdala: involved in expression of negative emotions and memories ● Activity and brain flow is 50% greater in depressed patients in amygdala ■ Brodmann Area 25: smaller in depressed people and much more active in depressed people ● “Depression switch” (believed) ● Filled with 5-HTT’s which makes people prone to depression ■ Reduced gray matter volume is seen in chronic depression, but is restored with successful antidepressant therapy ○ Antidepressants take about 2-3 weeks after the first dose to produce an antidepressant response ■ They must be tapered slowly to avoid rebound symptoms ■ Work only so long as taken b/c