PSYC 210 Lecture Notes - Lecture 21: Iatrogenesis, Learned Helplessness, Social Skills
30 Apr 2018
School
Department
Course
Professor
Diagnoses
Know+full+diagnostic+criteria,+and+what+of+those+criteria+did+this+person+meet
Give+9+symptoms+of+depression+and+which+5+this+person+had
○
DURATION+of+symptoms
○
•
Not+cumulative
Iatrogenic+origins+–initiated/caused+by+treatment
Ex:+surgeon+leaves+scalpel+in+your+stomach+and+it+causes+pain
•
DID:+highly+susceptible+individuals+to+suggestion
Don't+really+remember+childhood
○
Therapist+plants+memories+and+suggest+the+DID
○
Person+acts+like+they+have+DID+and+discovers+personality
○
•
No+one+seemed+to+know+of+having+multiple+personalities+outside+of+seeing+a+
therapist
•
Taking+a+normal+thing+in+a+person,+therapist+makes+it+a+bigger+deal,+patient+
wants+therapist+to+like+them+and+follows+through
•
Addiction
Goal+driven+–holding+in+your+mind+some+long+term/non-immediate+goal
If+you+are+trying+to+manage+some+aspect+of+your+diet+(goal)
○
Go+to+cox+and+pick+things+out+that+are+consistent+with+that+goal+(goal+
directed+behavior)
○
Do+it+even+though+you+seem+something+tempting+in+the+moment,+but+it's+
inconsistent+with+the+goal
○
•
Habitual+response+–build+up+habit+and+not+really+thinking+about+it
Could+be+inconsistent+with+goal+directed+behavior
○
Have+coffee+every+morning,+don't+really+think+about+it
○
Not+updating+what+you're+doing+even+if+it's+not+as+rewarding+as+it+had+
been+
○
Habit+formation+and+execution+relies+ on+different+parts+of+the+brain+than+
goal+directed+behavior
○
•
More+control+in+goal+driven,+harder+to+do+in+habitual+because+a+different+neural+
circuitry+has+been+initiated
•
Models+of+resilience+(PTSD)
3+rats+in+little+boxes+where+tails+are+strapped+to+wire+that+can+deliver+shocks•
Control:+no+shocks,+control+for+being+in+a+box•
Escapable:+gets+shocks,+but+can+turn+it+off+by+spinning+the+wheel,+doesn't+bother
Doesn't+bother+them+all+that+much+because+it's+controllable
○
•
Inescapable:+connected+to+same+shocks+as+escapable;+starts+when+escapable+
rat's+starts+and+turns+off+when+escapable+rat+turns+the+wheel;+gets+same+amount+
and+length+of+shock,+but+can't+control+when+the+shock+turns+off;+thinks+shocks+
randomly+turn+on,+there's+nothing+he+can+do+to+stop+them;+
induces+learned+helplessness+–uncontrollable+and+unpredictable
Creates+such+a+sense+of+lack+of+agency+that+even+when+you+make+it+
so+they+can+escape,+they+won't
§
○
•
Results:
Behavioral+effect:
If+you+take+the+inescapable+rat+and+put+it+in+the+escapable+condition,+
they+don't+do+anything+because+of+learned+helplessness
§
Take+escapable+condition,+put+in+inescapable+condition,+they+show+
resilience
Doses+that+normally+induce+learned+helplessness+do+not+
happen
□
Experiencing+it+as+controllable+before+□
§
○
•
Findings:+Exercising+controllability+is+a+real+mechanism+of+resilience+•
Experiment+2:+
Take+middle+rat+in+inescapable+condition+and+stimulate+mPFC+(medial+
prefrontal+cortex),+you+can+prevent+the+development+of+learned+
helplessness
○
For+the+escapable+shock+rat,+if+you+deactivate+mPFC,+you+can+induce+
helplessness
○
•
PDs
Dominant+symptom+presentation
Impulsivity+is+big+in+cluster+B
○
•
Don’t+need+to+memorize+all+the+diagnostic+criteria+ for+all+the+PDs•
Alogia:+poverty+or+lack+of+speech
Dopamine+hypothesis+of+SCZ
Certain+shapes+for+monkey+predict+juice
Midbrain:+get+big+spike+for+juice+because+it's+highly+salient+
○
Once+it+learns+it's+the+triangle+that+predicts+the+juice,+get+a+high+spike+for+
triangle+and+not+for+juice
○
Next+step:+what+predicts+triangles
○
•
Ex:+get+excited+ if+you+find+a+suitcase+with+$10,000+even+though+you+can't+do+
anything+with+it+at+that+moment
•
About+reward+prediction+and+importance•
In+SCZ,+often+see+a+failure+to+have+appropriate+dopamine+responses+that+are+
actually+due+to+salient+things
Negative+symptom+–do+something+and+don’t+care+you+get+a+reward
○
Positive+symptom+–dopamine+spikes+when+it+shouldn't+be+because+there's+
nothing+salient
Telling+you+something+that's+ordinary+is+important
§
Use+this+to+make+a+delusional+belief
§
Ex:+intense+feeling+something+bad+will+happen,+look+for+what+they+
might+be
§
○
•
You+can+induce+these+symptoms+by+elevating+dopamine•
Medication+SCZ
First-generation:+
Heavily+and+primary+antagonists+of+the+dopamine+D2+receptor
○
Really+block+positive+symptoms
○
Not+help+cognition
○
Side+effects
Tend+to+make+negative+symptoms+worse+because+you+totally+block+
the+ability+to+be+motivated+or+experience+ things+as+salient+at+all
§
Lead+to+passive+way+of+functioning
§
○
•
Second+generation
Made+to+try+to+have+less+side+effects
○
Dopamine+antagonists+but+not+as+potent
○
Have+other+receptor+targets+
○
Fewer+motor+related+side+effects
Milder+side+effects
§
○
Side+effects
Impacts+immune+system
§
Significant+weight+gain
§
○
•
Clozapine+can+decrease+white+blood+cells+and+need+regular+monitoring+on+it
But+best+for+treatment+resistant+SCZ
○
•
Treatment+SCZ
Psychotherapy
Social+skills+training
○
Family+therapy+–support
○
CBT+
Can+be+effective+without+medication+
§
Help+identify+hallucinations+and+delusions
§
○
•
All+addictive+substances+release+dopamine
Drugs+hijack+your+natural+salience+system•
Create+an+artificial+salience+ signal•
Drug+itself+pharmacologically+changes+release+of+dopamine•
D-cylco+in+PTSD
Helps+NMDA+receptors+which+drive+long+term+potentiation+(learning)•
Helps+them+learn+quicker•
BPD+as+coping
Collection+of+9+symptoms+in+personality+
Seem+all+over+the+place
○
•
Have+a+few+symptoms+that+are+core+to+the+disorder+and+others+that+are+common+
obvious+coping+solutions+to+that+problem
Have+strong+emotions+that+you++can't+control+very+well,+you'll+probably+like+
drugs+because+they+can+control+your+internal+state
○
•
Coping+with+fear+of+abandonment
Afraid+of+being+abandoned,+need+to+find+that+perfect+person+who+will+
never+abandon+me+(idealization/devaluation)
But+they+don't+exist+and+always+end+up+being+disappointed+
§
○
•
PD+comorbidity
A+lot+of+comorbidity•
Depression+and+anxiety+for+all+(except+maybe+antisocial+personality+disorder)•
Could+develop+social+phobia+later+in+life,+which+isn't+really+avoidant+personality+
disorder
•
Benzos+don't+work+for+PTSD
Good+for+anxiety
Especially+acute+floods+of+it
○
•
Problem:
It+is+on+the+GABA+A+receptor+and+acts+like+a+big+GABA+blast+to+the+brain
○
Make+it+hard+to+engage+in+any+extinction+learning+(an+active+process)
Need+mPFC+to+tell+the+amygdala+that+this+preconditioned+stimulus+is+
causing+bad+things
§
○
Shutting+both+fear+and+learning
○
If+you+just+take+one+every+time+you're+anxious,+it+reinforces+the+anxiety
Leads+to+psycho-dependence+on+benzo
§
○
•
No+testing+on+role+of+reconsolidation+in+PTSD
SCZ+brains
Different+starting+in+the+womb•
Issue+is+that+it+is+not+evident+until+you+reach+a+certain+level+of+maturity+of+brain+
pruning
•
Very+subtle+changes+to+brain+development•
Hormones+in+puberty+trigger+new+brain+development
Where+this+mostly+becomes+evident+and+unmasks
○
•
Can't+see+behaviorally+markers+of+the+difference+until+a+certain+age•
Exam%2%Review%Day
Thursday,+April+5,+2018
11:30+AM
Diagnoses
Know+full+diagnostic+criteria,+and+what+of+those+criteria+did+this+person+meet
Give+9+symptoms+of+depression+and+which+5+this+person+had
○
DURATION+of+symptoms
○
•
Not+cumulative
Iatrogenic+origins+–initiated/caused+by+treatment
Ex:+surgeon+leaves+scalpel+in+your+stomach+and+it+causes+pain•
DID:+highly+susceptible+individuals+to+suggestion
Don't+really+remember+childhood
○
Therapist+plants+memories+and+suggest+the+DID
○
Person+acts+like+they+have+DID+and+discovers+personality
○
•
No+one+seemed+to+know+of+having+multiple+personalities+outside+of+seeing+a+
therapist
•
Taking+a+normal+thing+in+a+person,+therapist+makes+it+a+bigger+deal,+patient+
wants+therapist+to+like+them+and+follows+through
•
Addiction
Goal+driven+–holding+in+your+mind+some+long+term/non-immediate+goal
If+you+are+trying+to+manage+some+aspect+of+your+diet+(goal)
○
Go+to+cox+and+pick+things+out+that+are+consistent+with+that+goal+(goal+
directed+behavior)
○
Do+it+even+though+you+seem+something+tempting+in+the+moment,+but+it's+
inconsistent+with+the+goal
○
•
Habitual+response+–build+up+habit+and+not+really+thinking+about+it
Could+be+inconsistent+with+goal+directed+behavior
○
Have+coffee+every+morning,+don't+really+think+about+it
○
Not+updating+what+you're+doing+even+if+it's+not+as+rewarding+as+it+had+
been+
○
Habit+formation+and+execution+relies+ on+different+parts+of+the+brain+than+
goal+directed+behavior
○
•
More+control+in+goal+driven,+harder+to+do+in+habitual+because+a+different+neural+
circuitry+has+been+initiated
•
Models+of+resilience+(PTSD)
3+rats+in+little+boxes+where+tails+are+strapped+to+wire+that+can+deliver+shocks
•
Control:+no+shocks,+control+for+being+in+a+box
•
Escapable:+gets+shocks,+but+can+turn+it+off+by+spinning+the+wheel,+doesn't+bother
Doesn't+bother+them+all+that+much+because+it's+controllable
○
•
Inescapable:+connected+to+same+shocks+as+escapable;+starts+when+escapable+
rat's+starts+and+turns+off+when+escapable+rat+turns+the+wheel;+gets+same+amount+
and+length+of+shock,+but+can't+control+when+the+shock+turns+off;+thinks+shocks+
randomly+turn+on,+there's+nothing+he+can+do+to+stop+them;+
induces+learned+helplessness+–uncontrollable+and+unpredictable
Creates+such+a+sense+of+lack+of+agency+that+even+when+you+make+it+
so+they+can+escape,+they+won't
§
○
•
Results:
Behavioral+effect:
If+you+take+the+inescapable+rat+and+put+it+in+the+escapable+condition,+
they+don't+do+anything+because+of+learned+helplessness
§
Take+escapable+condition,+put+in+inescapable+condition,+they+show+
resilience
Doses+that+normally+induce+learned+helplessness+do+not+
happen
□
Experiencing+it+as+controllable+before+
□
§
○
•
Findings:+Exercising+controllability+is+a+real+mechanism+of+resilience+
•
Experiment+2:+
Take+middle+rat+in+inescapable+condition+and+stimulate+mPFC+(medial+
prefrontal+cortex),+you+can+prevent+the+development+of+learned+
helplessness
○
For+the+escapable+shock+rat,+if+you+deactivate+mPFC,+you+can+induce+
helplessness
○
•
PDs
Dominant+symptom+presentation
Impulsivity+is+big+in+cluster+B
○
•
Don’t+need+to+memorize+all+the+diagnostic+criteria+ for+all+the+PDs
•
Alogia:+poverty+or+lack+of+speech
Dopamine+hypothesis+of+SCZ
Certain+shapes+for+monkey+predict+juice
Midbrain:+get+big+spike+for+juice+because+it's+highly+salient+
○
Once+it+learns+it's+the+triangle+that+predicts+the+juice,+get+a+high+spike+for+
triangle+and+not+for+juice
○
Next+step:+what+predicts+triangles
○
•
Ex:+get+excited+ if+you+find+a+suitcase+with+$10,000+even+though+you+can't+do+
anything+with+it+at+that+moment
•
About+reward+prediction+and+importance•
In+SCZ,+often+see+a+failure+to+have+appropriate+dopamine+responses+that+are+
actually+due+to+salient+things
Negative+symptom+–do+something+and+don’t+care+you+get+a+reward
○
Positive+symptom+–dopamine+spikes+when+it+shouldn't+be+because+there's+
nothing+salient
Telling+you+something+that's+ordinary+is+important
§
Use+this+to+make+a+delusional+belief
§
Ex:+intense+feeling+something+bad+will+happen,+look+for+what+they+
might+be
§
○
•
You+can+induce+these+symptoms+by+elevating+dopamine•
Medication+SCZ
First-generation:+
Heavily+and+primary+antagonists+of+the+dopamine+D2+receptor
○
Really+block+positive+symptoms
○
Not+help+cognition
○
Side+effects
Tend+to+make+negative+symptoms+worse+because+you+totally+block+
the+ability+to+be+motivated+or+experience+ things+as+salient+at+all
§
Lead+to+passive+way+of+functioning
§
○
•
Second+generation
Made+to+try+to+have+less+side+effects
○
Dopamine+antagonists+but+not+as+potent
○
Have+other+receptor+targets+
○
Fewer+motor+related+side+effects
Milder+side+effects
§
○
Side+effects
Impacts+immune+system
§
Significant+weight+gain
§
○
•
Clozapine+can+decrease+white+blood+cells+and+need+regular+monitoring+on+it
But+best+for+treatment+resistant+SCZ
○
•
Treatment+SCZ
Psychotherapy
Social+skills+training
○
Family+therapy+–support
○
CBT+
Can+be+effective+without+medication+
§
Help+identify+hallucinations+and+delusions
§
○
•
All+addictive+substances+release+dopamine
Drugs+hijack+your+natural+salience+system•
Create+an+artificial+salience+ signal•
Drug+itself+pharmacologically+changes+release+of+dopamine•
D-cylco+in+PTSD
Helps+NMDA+receptors+which+drive+long+term+potentiation+(learning)•
Helps+them+learn+quicker•
BPD+as+coping
Collection+of+9+symptoms+in+personality+
Seem+all+over+the+place
○
•
Have+a+few+symptoms+that+are+core+to+the+disorder+and+others+that+are+common+
obvious+coping+solutions+to+that+problem
Have+strong+emotions+that+you++can't+control+very+well,+you'll+probably+like+
drugs+because+they+can+control+your+internal+state
○
•
Coping+with+fear+of+abandonment
Afraid+of+being+abandoned,+need+to+find+that+perfect+person+who+will+
never+abandon+me+(idealization/devaluation)
But+they+don't+exist+and+always+end+up+being+disappointed+
§
○
•
PD+comorbidity
A+lot+of+comorbidity•
Depression+and+anxiety+for+all+(except+maybe+antisocial+personality+disorder)•
Could+develop+social+phobia+later+in+life,+which+isn't+really+avoidant+personality+
disorder
•
Benzos+don't+work+for+PTSD
Good+for+anxiety
Especially+acute+floods+of+it
○
•
Problem:
It+is+on+the+GABA+A+receptor+and+acts+like+a+big+GABA+blast+to+the+brain
○
Make+it+hard+to+engage+in+any+extinction+learning+(an+active+process)
Need+mPFC+to+tell+the+amygdala+that+this+preconditioned+stimulus+is+
causing+bad+things
§
○
Shutting+both+fear+and+learning
○
If+you+just+take+one+every+time+you're+anxious,+it+reinforces+the+anxiety
Leads+to+psycho-dependence+on+benzo
§
○
•
No+testing+on+role+of+reconsolidation+in+PTSD
SCZ+brains
Different+starting+in+the+womb•
Issue+is+that+it+is+not+evident+until+you+reach+a+certain+level+of+maturity+of+brain+
pruning
•
Very+subtle+changes+to+brain+development•
Hormones+in+puberty+trigger+new+brain+development
Where+this+mostly+becomes+evident+and+unmasks
○
•
Can't+see+behaviorally+markers+of+the+difference+until+a+certain+age•
Exam%2%Review%Day
Thursday,+April+5,+2018 11:30+AM
Document Summary
Know full diagnostic criteria, and what of those criteria did this person meet. Give 9 symptoms of depression and which 5 this person had. Ex: surgeon leaves scalpel in your stomach and it causes pain. Person acts like they have did and discovers personality. No one seemed to know of having multiple personalities outside of seeing a therapist. Taking a normal thing in a person, therapist makes it a bigger deal, patient wants therapist to like them and follows through. Goal driven holding in your mind some long term/non-immediate goal. If you are trying to manage some aspect of your diet (goal) Go to cox and pick things out that are consistent with that goal (goal directed behavior) Do it even though you seem something tempting in the moment, but it"s inconsistent with the goal. Habitual response build up habit and not really thinking about it. Have coffee every morning, don"t really think about it.
