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PSYC18 C13.docx

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PSYC18 Psychology of Emotion Chapter 13 – Emotions and Mental Health in Adulthood Psychiatric Disorders: symptoms & prevalence: Depression and Anxiety are referred to as Emotional Disorders when they reach states to point where person cannot do ordinary things anymore.  Both are most common non-psychotic psychiatric disorders. Depression  intense sadness/despair that persecutes/drains all meaning of from life.  Principle emotional component  ↓pleasurable foal achievement  Major Depressive Episode (MDE) - ≥ 2 weeks of unbearable sadness/loss in pleasure, and... - ≥ 4 other symptoms from: unable to sleep, slowed actions, lack E, lack concentration, worthlessness, or suicide ideation. Anxiety  overwhelming fear + avoidance of what is feared. MDE usually suffered after nervous breakdown. Psychiatric Epidemiology: Advances most important in improving health were the epidemiological discoveries of how people caught infectious diseases  i.e. to introduce preventative measures (e.g. clean water). Prevalence – %people suffering from diagnosed disorder. Epidemiological Evidence – always correlational  Discovery of preventative measures are also more valuable in psychiatry than medications.  Slow to develop due to difficultly in diagnostic criteria. Depression – most important chronic condition in middle years of life (economic impact, impairment) Women have higher prevalence of:  ≥ 1 MDE in lifetime (21% vs. 13% of men).  Anxiety Disorder (30.5% vs. 19% of men). Men have higher prevalence of:  Alcohol/drug abuse (35% vs. half of that for women).  Antisocial PD (6% vs. 1% of women). Gender Differences have larger role in the prevalence of disorders than of emotions.  E.g. boys more likely to have ED; girls more likely to have ID. Lower Income results in ↑prevalence for any psychiatric disorder. Cultural Factors play important role in emotional disorders.  Western countries have higher prevalence of depression  Some symptoms (e.g. insomnia, ↓E, ↓concentration, suicidal thoughts) are common to all countries, while others are not (e.g. ↓appetite, worthlessness/guilt). Different kinds of depression & anxiety Depression MDE is most usual form of depression. Minor depression  2-4 aforementioned symptoms; 10% population. Bipolar Disorder (Manic-Depressive Disorder)  depression preceded/followed by ≥ 1 period of mania.  Relative rare (1% prevalence). Heritability = 80% (higher than MDE). Mania  ↑happiness/exhilaration/pride/SE/grandiose. Anxiety Disorders Panic Disorder  panic attacks with dread/terror – ↑HR/BP/dizziness/resp. rate. Phobias  urge to avoid places/thing/activities  Agoraphobia – fear/avoidance of being away from home, especially places where they cannot leave without embarrassment. Can be treated successfully with CBT.  Social Phobia – fear/avoidance of social interaction; prevalence of 13%, more common than agorap.  General Anxiety Disorder (GAD) – ≥ 6 months persistent anxiety/worry; prevalence of 5.1%. OCD  Obsessions are intrusive anxious repetitive irrational thoughts that cannot be stopped  Compulsions are repeated actions/rituals that are performed to diminish anxiety  2-3% prevalence. PTSD  intense anxiety/disturbed sleep/flashbacks of traumatic event, with avoidance of anything that reminds one of it.  Trauma – anything that radically violates someone’s basic assumptions about the world.  Explained by 2 memory systems: 1. Verbal – subject to making meaningful sense of experience 2. Automatic – triggered by aspects of situation Traumas are represented in memory in both ways, which are repeatedly activated, but do not necessarily correspond to each other. Kraepelin’s Textbook of Psychiatry  13 categories; DSM originates from it. Stress & diathesis in the causation of disorders: Hypothesis  Disorder is most typically caused by stress (adversity in immediate environment – e.g. death, separation), in the presence of ≥ 1 diatheses (predisposing factors – e.g. genetic/experience in early life).  Many emotional disorders would not happen if a stress did not occur. Stresses – life events & difficulties: 89% of women with onset of depression (8% of women) had a severe life event/difficulty before it.  Severe events  bereavement, separation, & job loss.  Difficulties violent husband or looking after demanding/chronically sick relative. The Life Events & Difficulties Interview Schedule was developed that was more accurate than checklists.  Asks about 40 areas of life – each stressful event/difficult is written up, with date of recording.  Then rated by research team for degree of long term threat.  Patients suffering depression were 3X more likely to have suffered negative/uncontrollable event. - Depression is not necessarily irrational; it involves sadness/hopelessness brought on by events Loss of a role that is highly valued  event that most typically causes depression.  Those that value social relationships become depressed when social loss/disruption occurred - Related to social motivations of attachment and affiliation.  Thos that value autonomy & work most likely become depressed with failure in achievement - Related to social motivations of assertion In general, these events cause strong negative emotions:  Loss, humiliation, entrapment, and danger (future directed).  Can cause 3X↑ in episodes of anxiety.  Anxiety Disorders most precipitated by danger events.  Depressive Disorders most precipitated by loss events.  Those suffering both typically experience events involving both loss and danger. Most emotional disorders are responses to events/circumstances. Relation between emotions and emotional disorders: Severe life events elicit depression & anxiety is similar to how Lesser events elicit negative emotions.  Short-term negative emotions/moods generally caused by setbacks to projects/concerns  Emotional Disorders generally caused by severe events that threaten fundamental roles, and we cannot deal with them  negative emotions become long-lasting, & disabling. Same brain regions involved in sadness & depression. Anxiety disorders involve fear – fear elicited by appraisals from dedicated neural networks that involve the amygdala  overwhelming/disabling since impermeable to upper levels of cognition. Diathesis: vulnerability factors: The difference between responding to serious adversity with a negative emotion versus a disabling emotional disorder. Genetic Biases: Emotional Disorders (as well as emotional patterns) are genetically influenced.  Depression: MZ (29%) show higher concordance rates than DZ twins (15%)  moderate genetic risk.  Anxiety Disorder  genetic influence also exists. Genetic Influence on personality (e.g. impulsivity) may affect (↑) occurrence of life events.  I.e. more prone to bring environmental effects upon themselves. - E.g. forming more problematic relationships. 5-HTT transporter gene  Has two isoforms  short (s) and long (l) – long is more efficient at expressing serotonin  (s/s) genotype who suffers a adverse life event is most likely to become depressed - (s/l) more likely than (l/l) to become depressed.  Low serotonin production is a vulnerability factor for the impact of life event stress of depression. - Presence of s allele had no influence on depression in the absence of stressful life events. Previous episodes of depression Subsequent depression episodes can occur without obvious severe life event/difficulty.  Previous episode of depression m
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