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PSYCH 101 (695)


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University of Waterloo
Richard Ennis

PSYCHOPATHOLOGY – UNIPOLARDEPRESSION Depression Patterns - Depression will affect 10% of people in lifetime - The earlier the onset of depression, the greater likelihood to have recurring episodes - The periods between recurring episodes become shorter and episodes more frequent - 10% chronic depression – won’t get back to person was before - If no intervention, 90% of people will recover, 4-6 month recovery - Want to shift 50% group (episode recurrence) to 40% group (no recurrence) Medical Model - Model for physiological disorders and apply to psychological disorders - 4 possible causes: 1) Infection – not applicable to psychological disorders 2) Genetics - new exciting research 3) Neurostructural – structural problems to brain or CNS (from injury, disease, birth defect), not a big area of interest 4) Neurochemical – imbalance of neurotransmitters, big area of interest, drug therapy treats neurochemical components of brain Biology of Depression: Genetics - Strong genetic link - Use twin/adoption studies -> biological parents and adoptive parents, is it nature or nurture? The 5-HTT Gene - Codes for serotonin transporter cell - The “mule” for serotonin -> carries serotonin through synaptic gap - If have mutation -> more of transporter, so serotonin is moving through the synaptic gap at a higher rate Therefore, there is a lack of serotonin in CNS - Most people with mutation will not develop depression -> environmental trigger? - Manuck believed triggered by socioeconomic problems (eg. financial problems, marital problems) Biology of Depression: The Brain - Electrical brain activity is diminished during depression - Some neurostructural evidence that there are smaller frontal lobes in depression. Though, the evidence is not solid. Neurochemistry of Depression - At first, too low norepinephrine was thought be reason for depression - Serotonin was thought to be reason for suicide Depression Drugs - Drug for serotonin showed great results and so focused on serotonin - Greatest drug impact was tricyclic anti-depressants -> block, slow down reuptake of norepinephrine. This showed to alleviate symptoms of depression. 40-50% of people would respond positively. Side effect problems -> addiction. As people take tricyclic anti-depressants over time, require more drug to get same effect. - The modern treatment is SSRI’s. Selective Serotonin Reuptake Inhibitor. Selective means drug only affect serotonin. Tricyclic Antidepressants did not just affect norepinephrine. Popular drug now is Prozac. Not addictive. Minimal side effects. Does not require increase of dosage to get same effect. - Therapy routine : 1) Try SSRI 2) if doesn’t work, try tricyclic antidepressants 3) If doesn’t work, try MAO inhibitors (MAO breaks down neurotransmitters) MAO inhibitors have serious side effects. If combine with certain foods, can be lethal (eg. poultry, alcohol, cheese) If put on MAO, it is because they are not responding to other therapies, pharmacology and psychotherapy and only given to in-patients so can watch diet Electroconvulsive Therapy (ECT) - Low voltage to brain causes a seizure - Given muscle relaxants - Have amnesia after treatment (can’t remember moments before treatment) - Don’t know what is taking place but can dramatically eradicate symptoms - Not common now, a last ditch effort, PSYCHODYNAMIC MODEL HUMANISTIC MODEL Psychoanalysis - “Anger turned inwards” - Develop sense of shame and worthlessness - Psychotherapy looks to find what caused feelings of worthlessness - Freud focused on guilt and shame-> significant components to depression Humanistic Therapies - Person is failing to grow to human potential - Then start to feel guilt, shame and loss ofmotivation - Look to show patient their personal growth - “Client-centered therapy” -> used for interview techniques to get person to open up and talk - Carl Rogers disagreed with authoritative, medical model approach -> wanted to work with patient, allow insight and discussion - Rogers focuses on present ( not past like Freud) - Biggest critique: long therapies when depression usually resolves by itself in 6 months Positive: decreases recurrences Cognitive- Behavioural Therapies - Best statistical effect of psychotherapies but usually combined with SSRIs - Find 3 flaws in depression 1) Negative thoughts about self (like Freud) 2) Negative thoughts about ongoing experiences 3) Negative thoughts about the future Depressive attributional pattern Non-depressed people give credit to self when good things happen Eg. if get good mark on test, credit self Non-depressed people distance themselves from failure Eg. if get bad mark on test, blame professor saying exam is hard Depressive people flips Mastery Experiences - Or goal setting - Person is totally demotivated - Try to set outcomes to patient to achieve Eg. Goal to have a shower-> split up into several goals eg. put feet on floor - Person has to complete tasks to have self-efficacy or else will contribute it to someone else - Person has to take credit to have effica
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