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PS Abnormal psych.docx

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John Stephens

Psychopathology: concerned with the nature and development of abnormal behavior, thoughts/ cognition, feelings/emotions Abnormal: defined by several characteristics- statistical infrequency, violation of norms, personal distress, dysfunction or disability, unexpectedness Demonology: evil being the cause of mental illness Trepanning: surgery used in Neolithic and Stone age, to relieve headaches and seizures by putting a hole in the skull Hippocrates: separates medicine from superstition Somatogenesis: explain by physical causes Psychogenesis: explain by psychological malfunction Dark Ages: demonology returns with the Church, monks cure the ill. Persecution of witches is the solution to female abnormality. Institutions are built for leprosy and once leprosy goes away these become homes for the mentally ill (asylums). These were mostly work houses and in certain cases (Bedlam) used for entertainment of the rich -drugs used as first therapy (alcohol, cannabis, opium and chloral hydrate) Philippe Pinel: advocates for better treatment of mentally ill Dorthea Dix (US and Canada): advocates for humane treatment, hospitals are built but not enough funding for support workers and soon run by doctors more interested in experimenting Emil Kraepelin: creates a classification system- this doesn’t quite work due to the grey area of mental illnesses and stigma that comes with a classification, at least course of illness can be predicted General Paresis: degredation of mind and body that can be caused by syphilis Mesmer: hysterical disorders due to distribution of a universal magnetic fluid in the body, he waved sticks to cure patients, he is considered one of the early practitioners of hypnosis Charcot: studied hysterical states suchas blindness, deafness and believed they were in the body until one of his students hypnotized someone into exerting these symptoms Breuer and the cathartic method: patients did better emotionally if under hypnosis they expressed repressed emotions Pasteur: Germ theory of disease Canada Universal health care 1970, Canadian National Committee for mental Hygiene created for screening of war recruits and helping those returning, screening of immigrants, care of the mentally deficient and prevention. Sexual sterilization act- 1928 allowed sterilization of “mental defectives”. Prison/ forensic hospital: for those who are criminally insane Romanow report: we don’t attend to mental health, suggestions like home care, support of informal support networks (family, friends) Kirby report: broader base, cheaper housing -stress has strongest correlation with mental health, as was social support. Newfoundland and Labrador and PEI has most happiness and least distress, Quebec has highest self-esteem but low happiness. -likelihood to seek help related to marital disruption and poverty Ch 2. Paradigm: frame that scientists view through Biological paradigm: mental disorders caused by abnormal biological functioning. Studies include: heredity, chemical imbalances, impairments in brain structure Behaviour genetics: genetics and environment act to influence phenotype. Molecular genetics: tries to specify particular gene involved in producing a trait. “Genetic polymorphism” is the variability between members of a species. Neuroscience and biochemistry: studies neurotransmitters and nervous system. Ridges of brain called gyri, depressions called sulci. Most of brain made of white matter (mylinated sheaths that connect to spinal cord). Four masses deep within each hemisphere; basal ganglia. Cavities are called ventricles and are filled with cerebrospinal fluid. Diencephalon contains thalamus and hypothalamus. Midbrain: nerve fibre tracts that connect cerebral cortex with pons. Brain stem: made of pons (tracts that connect cerebellum with spinal cord), medulla oblongata (main line of traffic), reticular formation (important in arousal and alertness). Cerebellum: related to posture, balance and equilibrium. Limbic system: visceral and physical expressions of emotion, contains cingulate gyrus, septal area, hippocampus and amygdala. Psychological paradigm: psychopathy results from unconscious conflicts in the individual. Neurotic anxiety: when one’s life is in jeopardy the ego’s reaction is fear. Neurotic anxiety is fear without rational cause. Moral anxiety is when the superego punishes the individual for not meeting expectations. Defense Mechanisms: Repression, denial, projection, displacement, reaction formation (converting one feeling into the opposite), regression, rationalization, sublimation (converting sexual or agressiveimpulses into socially acceptable ones such as sports). Psychoanalytic therapy: Free association, dream analysis, transference. Ego analysis: places greater emphasis on person’s ability to control the environment and select thetime and means of satisfying instinctual drives. Brief Psychodynamic theory: structured sessions with set number and date of completion, evolved from the need to respond to emergencies. Interpersonal Psychodynamic Therapy: interactions between patient and their social environment. Analyst is participant observer, empathetic listening and suggestions for behavioural changes. Role playing may be used to practice new behaviours in the consulting room. Humanistic and existential therapies: insight focused, emphasis on freedom of choice that can bring joy and suffering. Focus on current phenomenon and not history of patient. Roger’s humanistic: client-centred, people can only be understood from their perceptions, therapist accepts the person for who they are (unconditional positive regard). Empathy canbe primary (understanding and communicating what the clientis thinking or feeling) or advanced empathy (inference by the therapist about the thoughts and feelings behind what the client says. Existential therapy: anxiety is inevitable in important choices. Therapists help examine what is meaningful in life. Gestalt therapy: people have innate good nature but become frustrated when it is stifled. Focus on what is here and now, use “I”statements, speaking to empty chair to project a significant other,projectionof feelings on a partner to see how emotion changes situation. Therapist attends to body language and can use metaphors to explain concepts to clients. Learning Paradigm: abnormal behavior is due to responses learned. Classical conditioning, operant conditioning, and modeling. Mediational learning paradigms: environmental stimulus doesn’t cause behavior directly there is a mediator such as fear or thinking. Behaviour therapy: change abnormal thoughts and behavior using counterconditioning, systematic desensitization and aversive conditioning. Cognitive Paradigm: focuses on how peoplestructure their experiences. The learner fits new information into an organized network of accumulated knowledge (schema). Cognitive behavior therapy: blend og cognitive and learning, to modify overt and covert behavior are seen as different levels. Immigrants have lower rates of depression and alcohol dependence. Asian groups tend to show greater tendency to be ashamed of emotional suffering. Ch 3 Classification and diagnosis -1939 World Health Organization adds mental disorders to list of causes of death. American Psychiatric Association publishes its own Diagnostic and statistical manual in 1952. WHO has list of diagnostic categories that did not include symptoms. DSM-IV 1994. Axis I: all diagnostic categories except personality disorders and mental retardation. Axis II: personality disorders and mental retardation. Axis II: general medical conditions that may relate. Axis IV : psychosocial and environmental problems. Axis V: level of functioning. Possible syndromes: caffeine withdrawal, Prementstrual Dysphoric disorder (worse than PMS), Mixed anxiety-depressive disorder and passive-aggressive personality disorder (resisting demand in a passive way such as being late), depressive personality disorder (chronic gloominess). Proposed axis: Adaptation ranging from high, disavowal (keep stressors our of consciousness) and Defensive Disregulation (break in reality caused by denial). Disorders found in infancy, childhood or adolescence: Separation anxiety disorder, conduct disorder (repeatedly violate social norms), ADHD, mental retardation, pervasive development disorders (communication skills and deficits relating to other people) and learning disorders Somatoform Disorders: somatization disorders (long history of complaints they have taken medicine or seen thedoctor for), conversion disorder (loss of motor or sensory function), pain disorder, hypochondriasis, body dismorphic disorder (preoccupied with perceived defect in their appearance) Dissociative disorders: dissociative amnesia (lose memory of past or particular period), dissociative fugue (start a new life and forget identity in old one), dissociative personality disorder (2 or more personalities), depersonalization disorder (self-estrangement or feeling of unreality). Sexual and Gender Identity Disorders: paraphilias (exhibitionism, voyeurism, sadism, masochism, sexual gratification in unconventional), sexual dysfunction and gender identity disorder. Sleep disorders: dyssomnia (sleep disturbed in amount) or parasomnia (unusual sleep events such as sleep walking). Eating disorders: anorexia and bulimia. Facticious disorders: people who intentionally produce or complain of physical or psychological symptoms to assume the role of a sick person. Adjustment disorder: development of behavioural or emotional problems following a major life stressor Impulse control disorders: intermittent explosive behavior, kleptomania, pyromania, pathological gambling and trichotillomania Epidemiology: frequency and distribution of a disorder in a population Cognitive disorders: dementia (deterioration of mental capacities), delirium (clouding of counsciousness) and amnestic syndrome (impairment in memory without delirium or dementia). Ch 4 clinical assessment procedures Inter-rater reliability: extent to which multiple judges agree Test-test reliability: observed twice or taking the same test Alternate form reliability: two forms of test are consistent Internal consistency reliability: items on a test related to one another should have similar answers Content validity: measures adequate sample for the test Criterion validity: whether it is related in an expected way to another measure at the same point (concurrent) or in the future (predictive). Construct validity: extent to which study measures what it is supposed to measure Psychological tests: Personality inventories such as MMPI, projective test such as Rorschach inkblot test or Thematic Aperception test (pictures), intelligence test. Behavioural assessment: four sets of variables S- stimuli, O-organismic psychological or physicological factors, R-overt responses, C-consequent variables (events that reinforce or punish). Problem list: includes difficulties patient is having, the diagnosis is created, working hypothesis (describes relation among problems), strengths and assets and finally a treatment plan. Direct observation and contrived observation occurs. Self-observation can be in the form of ecological momentary assessment EMA (collecting data in real time) though reactivity mayt change behavior when subject knows their behavior is being tracked. Self-report inventories such as Dysfunctional Attitude Scale DAS are used. Articulated thoughts in Simulated Situations (ATSS) have the person pretend to be in a situation, complete with audio and video, and react to it. Thought listing: a person writes down thoughts prior to an event of anxiety- this may give cognitive insight. Videotape reconstruction: person is videotaped in a task and then narrates their thoughts afterward. Family can also be monitored in the Family Environment Scale, Family adaptation and Cohesion Scale, or the Parental Bonding Inventory. Biological assessment: Computerized axial tomography (CT scan) shows structural brain abnormalities giving two dimensional cross-sections. Magnetic resonance Imaging (MRI) uses a circular magnet and more recently FMRI or functional MRI can show metabolic changes or show the brain at work in real time. Positron emission tomography (PET) is more invasive, using a radioactive isotope injected into the blood stream to measure metabolic rates. Neurochemical assessment: only recently has PET scanning allowed us to see the receptors at work in a living brain. These methods are not quite strong enough for use in diagnosing psychopathology. Neuropsychological assessment: tests are based on the idea that different tasks are located in different areas of the brain, finding a deficiency can help find where in the brain damage is located. Tactile performance test –speed: blindfolded subject puts shapes into corresponding holes. Tactile performance test- memory: subject draws what the holes looked like. Category test: patient must keep track of the positive and negative responses to try and learn the rules of the test. Speech sounds perception: subject hears nonsense words and tries to pick which one they heard from a list. Luria Nebraska: believed to pick up effects of brain damage not yet detectable by neurological examination and can also control for education level. Psychophysiological assessment: concerned with bodily changes that accompany psychological events; heart rate, tension in muscles, blood flow etc. Electrodermal responding: tests skin conductance to measure sweat. EEG measures brain activity. Event Related Potential: specific brain wave potentials in response to standardized test, can show when a paralyzed person is still capable of cognition, show cognitive strategies used by the individual, very useful when brain damage is diffuse rather than local. Chapter 5 research methods in study of abnormal behavior: Case study: detailed account of an individual, useful in proving wrong a universal or generate a hypothesis that can be tested through experimental research. Epidemiology: prevalence (how common in a population), incidence (number of new cases in a period of time) and risk factors. Parental mental disorder and severe abuse are strongest risk factors of mental disorders. Correlational method: variables measured as they exist in nature, not manipulated. Correlation is measured from -1.00 to +1.00. Statistical significance relates to the likelihood that the results of the investigation are due to chance. Classificatory variables are naturally occurring such as age, sex, social class. Directionality problem: when two things are correlated it can be hard to tell which has the effect on the other, usually overcoming using the idea that causes precede effects. The third variable problem: there may be another unseen variable affecting the correlation. Confounds: inextricable variables such as the passage of time. Internal validity: when the results are confidently attributed to independent variable. External validity: extent to which results can be generalized to other instances Analogue experiment: bringing a related phenomenon into the laboratory, behavior rendered temporarily abnormal by experimenter manipulation Single subject experimental design: no control group, participants are studied one at a time experiencing manipulated variable Reversal design (ABAB): behavior is taken at base rate, with manipulation, and then returned to base conditions and then back to being manipulated Mixed design: experimental and correlational research combined, correlated with manipulated conditions Moderator variables: factors such as gender that may influence the results in a large way Meta-analysis: studying a large amount of literature and compiling into a common format Chapter 6 anxiety disorders: most common psychological disorder Chikzsendmhi- flow zone (at their best, manage stress POW spend time there and avoid PTSD, above this threshold is anxiety, below flow zone boredom). Anxiety is a powerful activator. Muscle tensing Heart Brain and cognition Phobia: fear and avoidance of objects that do not present realistic danger Psychoanalytic theory: due to repressed ID impulses, fear is displaced to object or situation with symbolic connection Behavioural theory: fear is learned by classical conditioning and avoidance is rewarded by lessened fear. Fear may be learned by modeling. Prepared learning: humans are more apt to fear certain things- dogs, snakes and not flowers. Flooding: therapeutic technique where client is directly exposed to source of phobia at full intensity. Cognitive: peoples thought process can be a diathesis Biological: overactivity of autonomic nervous system, heritable component. Drugs that are anxiolytics such as benzodiazepines Panic disorder: recurrent panic attacks with sudden onset of physiological symptoms such as dizziness, increased heart rate, trembling, accompanied by terror and impending doom. Depersonalization: feeling of being outside one’s body. Derealization: feeling of the world not being real. Biological: genetic diathesis, overactivity in noradrenergic system GABA, hypersensitivity to cholecystokinin (CCK). Generalized Anxiety disorder: persistent uncontrollable worry, often about minor things Obsessive-Compulsive disorder: uncontrollable thoughts, impulses or images followed by the need to do certain actions to dispel them Primary obsessional slowness: when the time spent on tasks such as checking, becomes the problem Psychoanalytic: overly harsh toilet training, overcome incompetence by controlling to gain mastery of something. Lifting repression to confront what the patient truly fears. Biological factors: encephalitis, head injuries, and brain tumors are associated; focus on frontal lobes and basal ganglia related to compulsions. Drugs that increase serotonin levels and ERP remains best front line approach. Exposure and response prevention Post-traumatic Stress disorder: aftermath of traumatic experience where the person relives the experience, has increased arousal, avoidance of stimuli related to the event and anxiety relating to the event. Anxiety, depression, anger, guilt, substance abuse, marital problems, poor physical health and occupational impairment may follow. Risk factors: likelihood to be involved in a trauma, perceived threat to life, early separation from parents, previous exposure to trauma, and preexisting disorder. Dissociation keeps the patient from reliving the memories but makes the trauma worse. Certain kinds of trauma are influenced by genetic and environmental factors, while others are only by environmental factors. Biology: trauma may activate noradrenergic system, may be related to smaller hippocampal volume Acute stress disorder: symptoms the same as PTSD but last 4 weeks or less CH7 somatoform and dissociative disorders Somatoform disorders: individual complains of body symptoms that suggest a physical illness when there is none Pain disorder: pain that causes impairment and distress, may have temporal connection to some conflict or stress, centers within the frontal brain, grey matter is different. Body dysmorphic disorder: person is preoccupied with an imagined or exaggerated defect, usually on the face, may spend a lot of time in the mirror or avoid it altogether, occurs mostly in women in late adolescence. Comorbid with depression and social phobia, eating disorders and thoughts of suicide. (may be a form of OCD, delusions, maybe a symptom of another disorder) Hypochondria: preoccupied with persistent fears of being ill, over reaction of symptoms, likely to have mood or anxiety disorders, may be that the person experiences more intense sensations. Contemporary researchers focus on health related anxiety (health related fears or misconceptions of bodily signs and symptoms) as this includes hypochondria (fear of being ill) with illness phobia (fear of becoming ill). Thought to be due to neurotic factors, a critical incident, previous experience with illness and negative cognitive assumptions. 5% of population, often measured on IAS Illness Anxiety Scale Conversion disorder: physiologically normal people experience sensory or motor symptoms; sudden loss of vision, paralysis, seizures, coordination deficits, sensation of prickling, insensitivity to pain (anaesthesias), loss of voice and all but whispered speech (aphonia), loss or impairment of sense of smell (anosmia). Can appear suddenly in stressfull situations. Conversion coming from Freud’s idea that repressed instinct is converted to a physical ailment (in women it was due to electra complex). Usually develop in adolescence or early adulthood after a life stress, may begin and end abruptly. Comorbid often with depression, substance abuse, personality disorders (especially borderline and histrionic). Previously often misdiagnosed when there actually was something physically wrong. Malingering: when disability is faked and under voluntary control. Sometimes tested when there is la belle indifference- many actual conversion patients seem indifferent and want to talk at length about their symptoms. Blind people may be able to receive visual info without perceiving it. Enactment of the role is rewarded. More likely to occur on left side of the body. Stimulating a numb hand doesn’t activate somatosensory region of the brain where the non-numb side does. Factitious disorder: patients intentionally produce symptoms, as far as injuring themselves. Factitious disorder by proxy or Munchausen disorder by proxy: intentionally making the child ill. Somatization disorder: recurrent, multiple somatic complaints, no apparent physical cause for which medical attention is sought, four pain symptoms in different locations, two gastrointestinal symptoms (vomiting), one sexual symptom other than pain, one pseudoneurological symptom. Symptoms of the disorder may vary across cultures. Begins in early adulthood, comorbidity with anxiety and depression, behavioural and interpersonal problems. May have a memory bias for information that is a physical threat. Has decreased as people become more aware of medical information, may vary in culture which is more tolerant of physical problems than anxiety. More common among poorer or less educated people. Resolutions include talking cure, family therapy, physician shouldn’t dispute the validity of the illness but not use so much diagnostic material or medications and stay in touch with patient even when they are not complaining of illness. A reinforcement approach reinforces improvement. Dissociative disorders: Dissociative amnesia: unable to recall important personal information, it is not permanently lost, during a limited period of time following a traumatic experience. In total amnesia the person does not recognize friends or relatives but retains all life skills and previously acquired knowledge. Five factors in dissociation: depersonalization, derealization, disengagement, emotional constriction, identity dissociation, memory disturbance, caused by stress and fatigue or hypnotic induction Dissociative fugue: person is totally amnesic, suddenly leaves home and work and assumes a new identity, it is brief in duration with short but purposeful travel, occur after a person has experienced severe stress Depersonalization disorder: person’s perception or experience of self is altered, triggered by stress they lose sense of self, limbs may seem changed in size, voice sounds unusual, they may feel outside their bodies or mechanical, often connected to sexual abuse. Derealization: things aren’t real, desomatization: body does not feel like it belongs Dissociative Identity Disorder: the person has one or more personalities or alters that exist independently of each other, usually one primary personality unaware of the others and treatment is typically sought by the primary alter. Gaps in memory occur, chronic and severe. Alters may have different handedness, wear glasses with different prescriptions, different allergies. Voices of the others may sometimes echo into an alter’s consciousness. Rarely diagnosed until adulthood, recovery may be less complete, more common in women, comorbid with depression, borderline and somatization disorder, and attachment related trauma. Person may have created the alters to escape trauma, high hypnotizablity, prone to engage in fantasy. May be an unconscious enactment of learned social roles. Therapies are similar to those of PTSD, hypnosis, helping them gain access to hidden portions of their personality, best to bring the personalities together. Hypnosis to regress to a time before the other alters. There may be a Traumatic Identity State that the body goes into and sections off to protect. Typically alters break the law, or are violent and can thus cause disruption in one’s life. Canada has outlawed post-hypnotic evidence CH 8 Psychophysiological disorders: characterized by genuine physical symptoms caused by or worsened by emotional factors. Ex asthma, headaches, hypertension, gastritis Coded in DSM IV as “other conditions that may be a focus of clinical attention” Diagnosis is applicable to any disease. “stress” environmental condition that triggers psychopathology, change in life, created by Hans Selye (GAS- general adaptation syndrome Phase 1: alarm reaction, Phase 2: resistance damage occurs or adapts to stress, Phase 3: Exhaustion organism suffers irreversible damage). Distress- bad stress, ustress- good stress Autonomic nervous system: endocrine glands, heart, smooth muscles, digestive system. Sympathetic: alarm reaction Parasympathetic: calm, reversal Voluntary system Chronic activation of sympathetic nervous system is bad for health Stressors are either psychogenic (from psychological factors) or neurogenic (from physical stimulus) Allostatic load: impact of too much stress or poor coping strategies. Coping: Problem focused coping: taking direct action to solve the problem or seeking information that will be relevant to the solution, most adaptive Emotion focused coping: efforts to reduce the negative emotions of stress, the best way when there is nothing one is able to do about the situation Goodness of fit hypothesis: the adaptability of a particular response is a match between the response and where it fits best to the situation Measuring stress: Social readjustment scale, quantify the changes in life, a point system for stress, an addition of the points can predict if someone is going to have a disorder. Assessment of daily experiences: the little things that stress you on a daily basis, typically balanced by uplifts, The job experience: stress, spillover, burnout Assessing coping: use of humor, self-distracting, positive re-framing, planning, restraint, active coping, denial, acceptance, religion, use of social support, suppression of competing activities, behavioural disengagement Interactional model of anxiety, stress and coping: personality traits interact with situational factors to produce behaviors State anxiety: only anxious for a condition Coping inventory for stressful situations: emotion oriented, task oriented, avoidance oriented Coping with health injury problems: emotional preoccupation, distraction, instrumental coping (task- oriented), palliative coping ( attempts to feel better via self-soothing, and self-help by doing things like staying in bed or resting when tired) Social support -structural basic network -functional social support- quality of relationships, higher levels are linked to better health -emotional support -instrumental support- concrete action Stress on the body: Somatic-weakness theory: weakness in a specific body organ (genetically) can cause stress to have an effect on it Specific reaction theory: given one stressor someone reacts differently than to another Prolonged exposure to stress hormones: this has a significant impact on the immune system, links to HPA axis of hypothalamus pituitary gland and adrenal cortex, stress hormones such as cortisol. Increased negative mood leads to lowered sigA antibody which leads to increased risk of infection. Psychoanalytic theory: anger-in, repressed anger can make a person ill Women live longer but report being less healthy, they are more obsess, more disabilities, greater morbidity. Mortality gap is decreasing Number one factors impacting health of men: smoking and alcohol Women: caring for a family, social support, higher income Cardiovascular disorders: Hypertension-high blood pressure without evident biological cause, known as the silent killer, normal blood pressure is 120/80, first number is when heart is pumping, second when heart is resting, highly genetic, hypertension is related to race and social class, obesity, excessive alcohol, family history of hypertension Coronary heart disease Angina: periodic chest pains due to constriction of oxygen supply to heart (one cause is cholesterol) Myochardial infarction: heart attack, permanent damage to the heart. Factors: smoking, age, gender, obesity, inactivity, diabetes, elevated cholesterol, alcohol. Chronic stress leads to inflammation by activating the immune system. Type A behavior: perfectionist, intense and competitive, exaggerated sense of urgency, aggressive. Type D distressed personality: negative affectivity, social inhibition, inhibition of anger, anxiety and depression. High heart rate reactivity to stress events Socioenomic status: associated with higher rates of mortality from all causes, high fat diet, alcohol, drugs, stress, decreased sense of perceived controllability Drugs can be used to decrease cholesterol levels, lower anxiety, depression or anger, cardiac rehabilitation efforts are useful Stress management: relaxation, cognitive restructuring, mindfulness to be in the moment and notice how you are currently feeling, behavioural skills training to learn and practice required skills such as assertion Pain management: Most common disabilities are linked with pain. Gate-control theory: nerve impulses connoting pain reach spinal column and spinal column controls pain sensations sent to brain, Gate- area of the spinal column known as the dorsal horns managing the small nerve fibers, sometimes the body uses the gate control to stop the body from feeling the full sensation of pain, some medical offices use this. Maladaptive strategy to chronic pain is catastrophization. Ch 10 Mood disorders: disabling disturbances in emotion, often associated with other psychological problems such as panic attacks, substance abuse, sexual dysfunction and personality disorders Depression:10 times more common than mania, most common complaint of those seeking mental health treatment. Emotional state marked by great sadness and feelings of worthlessness and guilt, withdrawal from others, loss of sleep, appetite, sexual desire and interest and pleasure in usual activities. Depression in children is often somatic complaints such as headaches or stomach aches, older adults it is distractibility and memory loss, most people tend to emphasize the physical symptoms. Depression is recurrent but tends to dissipate with time. Affective- depressed mood, dejection, excessive and prolonged mourning, worthlessness, lack of joy Cognitive- pessimism, decreased energy, disinterest, loss of motivation Behavioural: social withdrawal, lowered work productivity, lack of personal cleanliness, slow speech. Psychomotor retardation: slowing of bodily movements, expressive gestures, spontaneous responses Physiological: loss of appetite, weight, constipation, sleep disturbance, menstrual disturbance Psychologizers- emphasize the psychological symptoms of depression Mania: (not diagnostic disorder) intense but unfounded in elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility and impractical, grandiose plans, comes on suddenly and lasts a period of a day or two. Mania may serve a protective function. Noticed by others due to loud and incessant remarks, sometimes full of puns, jokes, rhyming, high need for activity, shifting from topic to topic, may seem annoying. MDD (major depressive disorder) needs five of the following symptoms for at least two weeks, depressed mood or loss of interest must be one of the five: sad, depressed mood, most of the day, loss of interest and pleasure, difficulties sleeping, shift in activity level- lethargic or agitated, poor appetite and weight loss or increased and weight gain, loss of energy- fatigue, negative self-concept, self- reproach, self-blame, feelings of worthlessness and guilt, difficulty concentrating, recurrent thoughts of death or suicide. Twice as common in women than men, gender difference does not appear until mid- adolescence, may be due to ruminative coping in females-focus on depressive symptoms. First episodes have stronger link with stressful life events than the following bouts. Some melancholic symptoms: no pleasure in any activity and unable to feel better even when good things happen. Freud: needs insufficiently or over sufficiently gratified as a child, anger turned inward, or at loss of loved one- identify with loved one and become angry at themselves, resents being deserted and feels guilt for real or imagined sins against the lost person. Beck: (beck depression inventory most widely used psychological tool) thinking is biased toward negative interpretations, negative triad: negative views of self, world and future. Arbitrary inference- conclusion with no evidence, selective abstraction- conclusion based on only one element of a situation, overgeneralization- sweeping conclusion based on only one event, magnification and minimization- exaggerations in evaluating performance. Stroop task (participants provided with coloured words, supposed to identify the colour and not the word) non-depressed individuals have a protective bias diverting their attention away from negative stimuli and focusing on positive stimuli. Depressed individuals have interconnected negative self-representational system and lack well organized positive template of self. Sociotropy: dependent on others, avoiding disapproval, pleasing others. Autonomy: achievement-related construct, unrealistically high goals, self-critical. Martin Seligman: positive psychology, A- adverse situation, B-belief about why it happened C- consequence ,what you chose to do about it D-dispute, denial E-energy, overcoming all these steps Learned helplessness: individual’s passivity and sense of being able to control their own life is acquired through unpleasant experiences that the individual tried unsuccessfully to control, the sense of helplessness impairs performance in situations that can be controlled. Depressive paradox: feeling helpless but blaming oneself. Attributions: explanation for a behavior, global attributions (generality of effects of failure), attributions to stable factors (make them long term), attributions to internal characteristics (diminish self-esteem). Depressed people actually score lower on peripheral vision scores. Hopelessness theory: expectation of helplessness creates anxiety. Biology: norepinephrine, serotonin and dopamine most studied. Tricyclic drugs: three ringed molecules, prevent some uptake of the three leaving more of the neurotransmitter in the synapse Monoamine Oxidase Inhibitors (MAO): keep the enzyme monoamine oxidase form deactivating the neurotransmitters and increasing levels of the neurotransmitters in the synapse. (has worst side effects so least prescribed) Selective serotonin reuptake inhibitors (SSRIs): most commonly prescribed. Specifically inhibiting the reuptake of serotonin. Because this works it provides a strong link between serotonin and depression. -after several days of these medications the levels of neurotransmitters return to normal, but it takes up to 14 days for them to have an emotional effect -recurrent depression related to decreased hippocampal volume, induction of dysphoria in healthy volunteers increases glucose metabolism -levels of cortisol are high in depressed patients, causes enlargement of adrenal glands, biological test for depression tests for low levels of dexamethasone which suppresses cortisol Bipolar I disorder: episodes of mania, or mixed episodes of mania and depression, average onset is in the 20’s, equally often in men and women and likely to recur; full range of symptoms almost every day. Bipolar II disorder: major depression accompanied by hypomania, less extreme than full blown mania Bipolar- strong heritable component. Lithium- treats both the manic and depressive symptoms; may have to do with the G-proteins. May have serious, even fatal side-effects. Effects begin gradually so usually begun with combination of lithium and antipsychotic for calming. Discontinuation increases risk of recurrence. Post-partum depression: predicted by levels of depression in pregnancy period and reported warmth of parents in childhood, lower socio-economic status, low perceived social support, having an infant with a difficult temperament. This may be a form of adjustment disorder. The depression in the mother affects the development of the child and the newborns show similar biochemical profile to their mothers during pregnancy. Cyclothymic disorder: frequent periods of depressed mood and hypomania, separated by periods of normal mood lasting as long as two months Dysthymic disorder: chronically depressed, more than half the time for at least two years, many people also have periods of major depression, in conjunction this is referred to as double depression. Specifiers: describe major depressive episodes in terms of severity, presence or absensce of psychotic symptoms, information such as melacholia, catatonia, in remission. Course sprecifiers asuch as rapid cycling (4+ times during the past 12 months), seasonal pattern (accentuated during certain times), postpartum (within 4 weeks of giving birth) Mood disorder due to general medical condition: medical condition is characterized by having a depressed mood as direct result of a general medical condition Substance induced mood disorder: mood disorders generally with alcoholism, substance abuse Therapies: IPT (intrapersonal therapy), CBT to change negative patterns of thought, MCBT (mindful based Cognitive behavioural therapy), social skills therapy, for bipolar patients the crucial part is to get them to realize the effects of their behavior to have them continue their medication, ECT (electroconvulsive therapy) works faster than other treatments, used for resistant types of depression, used to be bilateral (through both hemispheres), now unilateral (only right hemisphere) reduces metabolic activity and blood circulation to the brain and may inhibit unusual brain activity, may cause confusion and memory loss, no detectable difference in brain structure. Suicidal ideation- thoughts and intentions, relatively common Suicidal attempts- do not result in death, protracted suicide attempts- like nicotine addiction, longterm suicidal path Suicide gestures- cry for help, no intent of death Suicide- the actual result of self-caused death -when someone starts to feel better is when they are most likely to commit an act -many suicides related to drugs and alcohol because they are disinhibitors Durkehim’s theories of suicide: Egotistic: committed by people who have few ties to family, community or society Altruistic: response to societal demands, sacrifice themselves for what they see as the good of society Anomic: sudden change, no longer see a way to live their life, ex stock broker losing all their money Most suicidal people are ambivalent about life or death Predisposing factors: enduring factors that make a person vulnerable (disorder, abuse) Precipitating factors: acute factors creating a crisis (job loss) Contributing factors: increase exposure to precipitating or predisposing (personal resilience) Protective factors: decrease the risk Baumeister’s escape theory: strong desire to escape from aversive self-awareness, unrealistic perfectionism especially socially Shneidman’s approach: the key feature is not a mental illness it is an effort to seek a solution to intolerable suffering, psychache Perfection and moderator: each component of perfectionism (social, self, other) connected to a moderator that prevents or enhances risk of suicide Additional factors: narrow range of alternatives for problem solving Suicide prevention: RFL- reasons for living: survival and coping beliefs, responsibility to family, concerns about children, fear of social disapproval, fear of suicide, moral objection Treating underlying mental disorder Treating suicidality directly: reduce intense psychological pain and suffering, lift the blinders, encourage the person to pull back even a little from the self-destructive act Suicide prevention centers: mostly volunteer run 24 hour centers, using complete empathy CH 9. Eating disorders: appeared for the first time in DSM 1980 Anorexia Nervosa (AN): restricting type -refuses to maintain normal body weight -intense fear of gaining weight, fear not reduced by weight loss -Distorted sense of body shape, link self-esteem to self-evaluation -in females usually amenorrhea- the loss of menstrual period Blood pressure often falls, heart rate slows, kidney and gastrointestinal problems, lower bone mass, skin dries out, nails get brittle, hormones change, some lose hair and develop laguna a fine hair on the body. Tiredness, weakness, cardiac arrhythmias, brain size declines. Recovery takes six or seven years. AN typically in early to middle teens, unsuccessful dieting and exposure to life stress Frequently also diagnosed with depression, OCD, phobias, panic disorder, alcoholism, oppositional defiant disorder, personality disorders Binge eating-purging type: More psychopathological- more personality disorders, impulsive behavior, stealing, alcohol and drug abuse, social withdrawal, suicide attempts. Binge: eating excessive amount of food within less than two hours, typically occur in secret, may be triggered by stress, feels a loss of control over amount of food being consumed, following binge there is a feeling of disgust, discomfort and fear of weight gain that lead to the binge. Purging in DSM constitutes purging at least twice a week for three months. Bulimia is genetic. Potassium depletion that can cause irregular heartbeat, tearing of tissue in stomach and throat and loss of dental enamel. Binge eating disorder: recurrent binges- twice a week for at least six months. Loss of control, absence of weight loss and absence of compensatory behaviours. More prevalent than AN o
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