Psychopathology lecture notes.docx

96 Pages
Unlock Document

PSY 103

Introduction 4/3/2012 12:23:00 PM  Mental health and the economy  80% Americans say economy is significant source of stress o up from 66% in April 2008 o 49% reported feeling nervous or anxious o 48% reported feeling depressed or sad  1 of 3 people undergoing foreclosure of their homes is clinically depressed  1/3 of Americans report losing sleep over the economy  the odds of violent behavior are 6x higher for people who lose their jobs  Early views of psychopathology  Trephining o Holes in skull indicate that they thought they were possessed by spirits; made holes in skull to let the spirits escape their brain o Mental illness/deviant behavior  possession by evil spirits  ~ 400BCE o humoral theory (Hippocrates)  personality imbalances  melancholic: black bile (very dark, sad, etc.)  choleric: gallbladder (angry, irritable)  phlegmatic: phlegm (stoic, stable, inert)  sanguine: blood (cheerful, can become mania)  Middle Ages o Demonic possession  Catholic church blamed for bad treatment of mental disorders (involved with inquisition)  Talked about most in psychopathology books as very detrimental, etc.  Sisters of Catholic church  more positive outlook  Gracious, kind treatment of patients with mental health issues (baths, etc.)  Aren’t talked about as much compared to negative aspects of Catholic church’s outlook  Demon possessed  Ex: Put head in oven o Malleus Maleficarum “Witches’ Hammer” 1486  Woman behaving bizarrely  if men acting weird… woman caused it  Ex: dunking in water (sink = innocent; float = witch)  Treating witches  exorcism  First manual for treating mental disorders Lecture 1 Continued/Movie 4/3/2012 12:23:00 PM  ~1700-1850 (Victorian/pre-Victorian)  mental illness as evolutionary regression  “mongolism”  down’s syndrome  known as mongoloid children  evolutionary racism  thought hadn’t evolved into British, but were stuck at the Asian level of evolution o hierarchy of human evolution  british male, british female, French, Spanish, eastern European, Slavic, Asians, negro, aboriginals, etc.  mentally ill = animal o housed as animals/human zoo o chained to walls, no drugs, known as insane asylum o Goya’s Madhouse 1810 o treatment by restraint  1800-1900 o “moral treatment” or “unchaining the insane” o Quakers  suggested people with mental disorders should be unchained/allowed a nearly normal life  “state hospital” era 1900-1960 o Napa state = current California state hospital o For mentally ill o Gated facility  Deinstitutionalization 1960-present day o The Hotel California: Camarillo, CA 1936-1997 Turned into: o Cal state University Channel Islands (est. 2003) o Occurred for a number of factors:  Expensive to run  Activist groups thought they were oppressive to the mentally ill (One Flew Over the Cuckoo’s Nest)  Attacked behavioral programs in state hospitals that were intended to get patients ready to transition into the real world o Resulted in many homeless  2/3 of people who were institutionalized then freed when the state hospitals shut down, ended up homeless  Contemporary views of psychopathology  Psychodynamic views  inner psychological conflicts caused people to become mentally ill; must free inner problems that are repressed in order to free your present mental illness o Mesmer (animal magnetism)  Iron filling cabinets, magnetically charged  Invited people to sit next to the cabinets in order to get rid of negative bodily energies (charged people to do it) o Freud  Neuroanatomist  Saw Charcot’s miracle-working seminar; starts practicing hypnosis on patients in Vienna (failed)  Digging into childhood histories of people  Psychoanalysis (conflicts over sex from early childhood that result in later appearance of mental disorder symptoms) o Charcot  Head of psychiatry at leading public hospital in Paris  Demonstrations on hypnosis  Argued the power of suggestion under hypnosis could free negative bodily energies  Made the blind see, made the paralyzed walk  Fraud  had the same patients come in with every new crop of medical professionals watching him  Behavioral views o Pavlov’s dogs  Develop bad habits through classical conditioning  Ex: child abuse o “Little Albert” Watson and Rayner (1920)  what happened to little albert?  investigators on east coast tracked him down  died at age 6  discovered had hydrocephalus at birth (gave him meningitis for experimentation)  Watson and Rayner lied about Albert being a normal child TELL NITZAN  Biological views o Prozac – first medicine safe to prescribe for a multitude of psychological disorders  Early treatment: Kill or Cure?  Lecture 3 4/3/2012 12:23:00 PM  What is a mental disorder?  Why is this issue important? o They’re everywhere  used to be a taboo topic; people now talk about their mental problems with people, on Oprah, etc. (confessional culture)  Concept of “mental illness” depends on basic philosophical assumptions o Monism – mind is equal/reducible to brain  What you do with your brain correlates to your brain itself o Dualism – mind is different from brain  What you do with your brain is different from the brain itself  Brain is a machine: it’s a piece of hardware, but the software is different  Ex: radio = hardware; classical station, rock station, Christian station, etc.  Most historical psychologists were dualists  Philosophical implications for “mental illness” o Monism: mental illness is brain illness – a type of medical illness o Dualism: mental illness is ____?  Aspects of psychopathology  Nosology – the science of disease classification; a set of disease categories within any degree of diseases o Ex: lung disease (know all about different lung diseases); like House M.D. o Scope of mental illness  Originally, “mental illness” was synonymous with “insanity” reserved for psychoses and sudden disabling or bizarre changes in behavior/thinking  Mental illness has been broadened  Now mental disorder rather than mental illness  Mental disorders now span a wide range of severity  Schizophrenia, Alzheimer’s type dementia  Controversially: homosexuality (now declassified), alcoholism, pedophilia, psychopathy, intermittent explosive disorder  Premature ejaculation, premenstrual syndrome, painful intercourse, flying phobias, gambling addiction, voyeurism, exhibitionism, insomnia, sleepwalking, nightmares  Many ways of defining mental disorder have been proposed; all have problems, and there is no consistent, logical way of defining psychopathology o Why worry about how to define mental disorder?  Mental disorder diagnoses are stigmatizing  Some places won’t hire you  Mental disorder diagnoses are sometimes used as tools of political persecution  In foreign countries, one way to get rid of enemies = classify them as crazy (Soviet Union)  Mental disorder diagnoses are used to marginalize dissent  Candidates call each other wing jobs, paranoid, etc.  Mental disorder diagnoses are used to excuse defendants and others from responsibility for their actions (Allan Dershowitz’s “excuse abuse”)  Project X guy’s parents plead mental retardation and he had 0 consequences  Hope: a valid and consistent definition of mental disorder will produce no false positives and no false negatives o Underlying dichotomies that drive attempts to define mental disorder  Is a condition normal or abnormal? Many different criteria:  Deviance (statistical, moral)  Distress (self and/or others)  Dysfunction (inability, efficiency, maladaptation)  Danger (self and/or others)  CHECK PAPER ON GAUCHOSPACE o Is a person ill or evil? (disorder or sin?)  Person commits multiple crimes, psychiatrist says “antisocial personality disorder = born without conscience”; jury decides if he should be sent to a mental hospital to be treated, or should he be locked up as a cold-hearted killer  Born to be bad?  Choose to be bad? o Is the professional response to the condition treatment or oppression?  How a society responds to mental disorders is a way of determining how it regards mental disorders  Ex: Kennedy’s and the younger daughter being lobotomized/turning mute in attempt to save family’s name so John could become president o Current official view (American Psychiatric Association, 1994)  A mental disorder is:  A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual; and that is associated with:  Present distress (ex: a painful symptom) or  Disability (ex: impairment in one or more important areas of function) or  With a significantly increased risk of suffering death, pain, disability, or an important loss of freedom  And must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one th  This view is the basis of the DSM, current in its 4 edition (Diagnostic and Statistical Manual of Mental Disorders) o How do we learn what mental disorders look like? Prototype theory  Theories of meaning  A) Definitional theory of meaning  B) prototype theory of meaning  Definition of disorder  A) semantic definitions of mental disorders  B) prototype definitions of mental disorders  Example: We know that wiener dogs, Chihuahuas, and German shepherds are all dogs, but we think that the shepherd is the “doggiest” dog through our experience (central prototype for a dog)  Example: What’s the fruitiest fruit? Apple has the highest score.  Example: When you ask me what a show is, I picture a sneaker, but someone else can picture a sandal.  Where do people acquire these mental disorder prototypes  Repeated exposure to conditions perceived as necessitating mental health intervention  Personal and indirect (books, films, T.V.) experiences in which people are seen to have unwanted conditions requiring mental health intervention  In training as a mental health professional, through classic case studies or supervises clinical experiences  Read in textbooks, see in training materials/movies  Assessment – gathering information about a patient that may or may not have a disorder (used to diagnose)  Diagnosis – the process of assigning a nosological category to a patient o NOT PATIENT TO A CATEGORY  patients can and usually do have more than one diagnosis  Treatment  Prevention – increased focus  Basic terminology  Etiology = cause o Biology, environment, etc.  Course = trajectory o How it goes over time o Ex: big spurts of OCD then subsides with time  Prognosis = outcome o Some lethal, some end up fine after one episode of disorder  Signs = observable markers o What you see o Ex: You hear your patient yell “Shut the hell up!” to a voice in his/her head.  Symptoms = patient reports o What the symptom sees o Ex: “I hear voices in my head.”  Signs + symptoms = syndrome o hysteria  Syndrome + course = disease Lecture 4 4/3/2012 12:23:00 PM  Basic terminology (Emil Kraepelin)  Etiology = cause o Biology, environment, etc.  Course = trajectory o How it goes over time o Ex: big spurts of OCD then subsides with time  Prognosis = outcome o Some lethal, some end up fine after one episode of disorder  Signs = observable markers o What you see o Ex: You hear your patient yell “Shut the hell up!” to a voice in his/her head.  Symptoms = patient reports o What the symptom sees o Ex: “I hear voices in my head.”  Signs + symptoms = syndrome  Syndrome + course = disease  Why diagnose at all?  Prognosis o Ex: 42 year old woman Alzheimer’s Dementia (able to sign papers for sons, etc.)  Treatment implications  Communication among professions o Psychiatrist referral for medication, etc.  Establish prospects for contagion or other transmission, and possible prevention o Certain mental disorders run in family  Legal reasons o Competence  Is grandma still competent to handle monetary affairs? o Insanity determinations  May be asked as a mental health professional to testify if whether or not a defendant was suffering from a mental disorder while a crime was committed  Financial reasons o Compensation to patient and/or treatment provider o Working conditions lead to post traumatic stress  you can be awarded money from workers’ compensation  Research o Testing treatments for specific disorders  Problems inherent in the act of diagnosis  Sacrifices the uniqueness of individual patient  Can falsely imply etiology (cause) o Dissociative personality disorder  movies and books made it seem like it was always caused by sexual abuse by family member (don’t remember it = repressing it/denial)  Rigidifies treatment alternatives o “This is how this is treated.” o This disorder = this treatment. If it fails, THIS treatment  not everyone is a cookie cutter patient  Iatrogenic illness o Healer in attempting to help you, causes another illness o Risperdol = treating schizophrenia, but 50-80 pounds gained in addition  diabetes  Stigmatization o Employer/future employer looks at medical records and sees a mental disorder = at risk for a future job o Personal stigmatization  “So I hear you’re going to see a shrink, huh?”  Secondary gain o When patients are receiving treatment, they often use it for unfair advantage  Ex: off of work on worker’s comp = sneak in a second job for extra money  Two kinds of diagnosis  Phenotypic o Signs o Symptoms o Course o Outcome o Response to treatment  Genotypic o Causes (genes, germs?)  Phenotypic ---------------- Genotypic o Endophenotypic (lab tests)  In physical medicine, progress consists of moving from phenotypic to genotypic diagnosis  In mental health, nearly all diagnosis is phenotypic, with some endophenotypic evidence emerging  Ingredients of a diagnosis  Symptoms o What does the patient feel?  Signs o What do you see about the patient?  Course of illness o NOTE *Patient might be compromised and can’t tell you accurate history of self/family* o Good days vs. bad days? o When did this start? o Are there things that help you feel better?  Age of onset o How old when this started? o Have you always had these symptoms?  Family history o Depression, suicide, mental health/physical health problems, molestation/rape?  Recent events o Why are you here right now? o Have there been any flare ups that made you decided to come visit me?  Recent behavior o Have you noticed any changes in how you’ve been lately? o Have you been adhering to a normal routine? Work, home, social?  Psychological tests  Lab tests (neuroimaging, hormonal assays, genetic testing) o Always ask when the last time the patient got a physical o NOTE *Physical illness often times masks mental illness*  Response to treatment (prior or current) o Past/current medications? o Have you been to a psychologist/psychiatrist before?  Multifactorial nature of diagnosis  No single sign or symptom defines a mental disorder o i.e. is pathognomonic of a mental disorder  diagnosis is based on a pattern of signs and symptoms o i.e. syndrome  the patterns of syndromes and courses of illness that define mental disorders are spelled out in the nosology of mental disorders o nosologies for mental disorder: diagnostic and statistical manuals for mental disorder (DSM series); American psychiatric association  1952 DSM 1 (100 disorders 8 categories)  1968 DSM II (100 disorders 10 categories)  1980 DSM III (230 disorders in 19 categories)  1989 DSM IIIR (revised) (750 disorders in 40 categories)  1994 DSM IV  2000 DSM IV TR (text revision/update)  2013 DSM V ( o DSM 1 and II diagnosis  Consisted of brief paragraphs containing “horoscopic” descriptions of each disorder o Features of DSM III, IIIR, IV, IV-TR  Phenotypic diagnosis  Based only on observable signs/symptoms  Abandoned intrapsychic conjecture and terms like “neurosis” and “reaction”  Chinese menu decision-tree approach  Inclusion criteria  Exclusion criteria  “Must have 3 of the following 4, but can’t have any of the following 5.”  Field tested for reliability  Everyone agreed with the diagnoses, but the diagnoses weren’t necessarily valid  Multiaxial diagnosis  DSM-IV  5 axes  1: major mental disorders and V-codes o ADHD, depression, bipolar disorder, etc.  2: personality disorders and mental retardation o dependent, avoidant, unstable moods, no conscious/anti-social  3: general medical conditions o cancer, arthritis, diabetes, broken leg, etc. (chronic back pain more often than not leads to depression on axis 1)  4: psychosocial/environmental problems o recently lost job  5: global assessment of functioning o 100 point scale on which you rate how well they’re doing o DSM-V (Due May 2013)  Many disorders now considered separate categories now defined as part of disorder spectrum  ex: Asperger’s syndrome and autism  Behavioral addictions  Shopping, porn and internet  More stringent definitions based on absolute severity of signs and symptoms are used to diagnose disorders  Right now = very subjective  More quantitative features to make less subjective  There is greater recognition of “cross-cutting” symptoms that span multiple disorders  Anxiety and depression  Bipolar disorder and schizophrenia  Certain “risk syndromes” are defined as predictive of later disorders such as dementia and psychosis  Controversial  If you see _____ at young age, there’s a high chance it’ll develop into _____ at an older age.  “pre-psychotic” o clinical interview: types of information and goals  lasts about 1 hour; most valuable single source of information leading to a diagnosis  personal and family history re: medical, mental-health, social, occupational, financial problems  treatments that have worked/not worked in past  symptomatology  signs from patient’s presentation  goals:  suitability and readiness for psychotherapy (self or another therapist)  determine need for referral to:  psychiatrist or PCP primary care practitioner) for medication  neurologist for neurological testing and/or neuroimaging  social worker, vocational counselor, physical therapist, etc.  signs noted in clinical interview  attire and grooming  posture  physical characteristics  skin tone/complexion  weight/stature  symmetry/atrophy/bodily anomalies  mannerisms, spasms, or tics  speech  articulation  prosody  consciousness  level of alertness, fogginess, hypervigilance  emotional state  general attitude  defiant, compliant, guarded, defensive, sincere, plaintive, resistant, apathetic, etc.  thought content  solicited by free inquiry  thought processes  thought broadcasting, removal, insertion  general knowledge  general facts, pop culture, politics  abstract thinking  what would you do if you found a fresh piece of mail just lying in the street?  social judgment  insight  why do you think you’ve developed the problems that brought you here today?  cognitive functioning  usually, current mental status via MMSE  neuropsychological screens like clock drawing  MMSE  orientation (up to 3x)  time (year, season, date, month, etc.)  place  person  registration  slowly say the names of 3 common objects (apple, table, penny) and ask them to repeat them  attention and calculation  serial 7’s or WORLD backwards  recall  ask for names of 3 objects above  what’s round crunchy fruity juicy  language  name a pencil and a watch when pointed to  repeat “no ifs, ands, or buts”  follow a 3-stage command: “Take a paper in your right hand, fold it in half, and put it on the floor.”  Read and obey the following: close your eyes  Write a sentence  Copy the following design  Clock drawing as a neurological screen  “I’d like you to draw a clock, put in all the numbers, and set the hands for ____”  helpful ancillary diagnostic information  info from family members, physicians, employers  medical charts  family history is important in diagnosis because it influences the risk of specific mental disorders Affective Disorders - Depression 4/3/2012 12:23:00 PM  affective:  mood, motivation, emotion  depression  clinical features of major depression o cognitive  pervasive sadness, guilt, or feelings of worthlessness  recurrent thoughts of death or suicide  most people who are very depressed are too depressed to actually go through with the suicide  when people get better/medication kicks in, they think “I never want to be this depressed again” and that’s when they actually commit suicide o motivational  pervasive anhedonia  anhedonia: nothing gives you pleasure anymore  favorite foods, sex, favorite movies, etc.  pervasive: throughout entire life o neurovegetative  significant change in weight (+ or – 10 pounds/month)  sleep disturbance  usually not difficult to get to sleep, but difficult to stay asleep  psychomotor agitation or retardation  really shaky/crawling out of skin  slowly moving body through molasses  pervasive fatigue or loss of energy  getting out of a chair/bed is a huge ordeal  difficulty concentrating  usually because so preoccupied with depressive thoughts  so fatigued = hard to maintain concentration  prevalence o occurrence of a disease within a time frame  point prevalence: ~5% of U.S. population are diagnosably depressed  1 yr. prevalence: ~10%  lifetime prevalence: 15-20% (26% W 12% M)  15-20% U.S. population at any time may suffer from subsyndromal depression, with nearly equal disability  depression that doesn’t meet 5/9 DSM criteria  4/9? Still question in psychodiagnosis  have just as many issues with substance abuse, work, home, social, etc.  setting the bar too high?  depressions in non-Western countries differ from those in Western countries  western = sadness, guilt, hopelessness, moral wretchedness (U.S. = only country accordance with sadness)  religious undertones; idea that slothfulness/retreat from community duties = sin in protestant theology  non-western = don’t feel well, liver bothering them, fatigued, under the weather, spirits getting to them, etc.  risk factors for depression o genetic predisposition  evidence from adoption and twin studies  animal models  breeding animals that are much more prone to depression due to breeding/parents o personal loss  or gain! No silver lining without a cloud  lost parent, sibling, etc. early on = vulnerable to depression o prolonged psychological stress  depression = collapse?  Hostage situation o History of early abuse or neglect  Childhood/adolescence  Infidelity in relationship o Being in an industrialized nation  People = less depressed in non-industrialized  Could be pace? Could be effects of crowding? Still not 100% sure o Overall, not race or social class o Age of first onset in latter 20’s o Physical illness/chronic pain  Need to exclude undiagnosed other illnesses  May be causes of depression o Giving birth  Frequent “baby blues” can lead to post-partum depression  Baby blues usually lasts a couple days  Post-partum depression can lead to psychotic episodes of thinking the baby is the devil/wanting to kill it, etc. o Female: male ratio is 2:1 after puberty  In children the ratio is 1:1 o Previous depression “kindles” later depressions  Depression is a recurrent disorder  A single episode will go away by itself in 3-4 months (usually)  Odds of having another episode is 50%  Odds of having a third episode is 75%  Odds of having a fourth episode is 85-90%  Harry Harlow’s monkey depression research o Artificial mothers made of terrycloth vs. chicken wire o “bottom of a bottomless pit with no way out”  put baby monkeys at the bottom  monkeys became immensely depressed, internalized, less responsive to environment  became clingy and immature o could mainstream them back with normal monkeys  if put stressor in cage, would regress and freak out  “kindling” increases risk of later depression, regardless of life stress o depressive episodes  higher risk for depression in future o stressful life events matter to some extent, but it plateaus  previous depressive episodes = more important than stressors in life  why are women diagnosed with depression twice as much as men? o Some possibilities  X-linked depression gene(s)  Premenstrual symptoms  Statistical problem  Prevalence of depression = same as finding prevalence of any disorder  Elevation in depressive symptoms linked to PMS  Quality of female vs. male life  F is more responsibilities, but less power and choice on how to handle them  M has more power/choice  Female masochism (Freud)  Regarded depression as part of female nature  M naturally rule world because have penis, anatomy is destiny; clitoris is shrunken penis that mirrors F’s lesser subordinate relationship in the world  Cognitive style  Females dwell on problems  Males ignore or escape them  Male depression masked by alcohol/drug abuse (Amish study) st  1 line depression treatments o psychotherapy  especially interpersonal or cognitive therapy  interpersonal  central themes in interpersonal therapy o grief – delayed mourning, developing replacement relationship o fights – building skills in communication, negotiation, and assertiveness o role transitions – reevaluating the lost role, building a new role, developing new social supports  ex: leaving home, divorce, retirement o social deficits – using role playing to learn new behavior in relationships  ex: failure patterns in past relationships  cognitive  invented in 1960’s Aaron Beck  uncovering automatic self-defeating thinking patterns  developing new ways to interpret setbacks o normalization, analyzing logically, decastrophizing  replacing old “automatic” thoughts with new ones  prime areas of concern: o self o life events o future  ex: yell hi at Kristen from across the street; she ignores you o she hates me, I’m worthless, everyone doesn’t like me, etc. o normalization/analyzing logically: there was traffic, she was wearing headphones, maybe it wasn’t Kristen, she’s late and not paying attention, maybe she thinks you don’t like her, maybe she’s depressed o decastrophizing: you’ll meet plenty of people in your lifetime that like you/don’t like you… so what?  Issues: you can be too depressed to make cognitive therapy work o antidepressant medication  general use  effective for both anxiety and depression  do not cure depression, only hold it in check for so long as they are taken  take 2-3 weeks after first dose to produce an antidepressant response  not addictive or habit-forming, but must be tapered slowly to avoid rebound symptoms  are not euphoriants  all have some unpleasant side effects  no known “time bomb” effects or damage to fetus  can be taken for life  recovering patient must be watched for suicidal or other violent behavior  work only so long as taken  depression may relapse afterward  can precipitate manic episodes in bipolar patients  feeling better with medication should take 2-3 weeks; if better in 2-3 days, red flags should go up for bipolar disorder  wide use throughout the U.S.  antidepressants are the most frequently prescribed medications in the U.S.  antidepressant use has tripled from 1988 to 2000  over 12% of people in the U.S. obtain prescriptions for antidepressants each year  highest usage state is Utah at 18.4% and lowest usage state is New York at 9.1%  CA’s usage rate is 9.9% o phototherapy for seasonal depression o ECT for treatment-refractory depression  Neurochemical theories of depression o Neurotransmitter theories  Major transmitters implicated  Norepinephrine, epinephrine  Dopamine  Serotonin (5HT)  Also  Substance P  NMDA  Neurosteroids  Endocrine  Hypothalamus-pituitary  Thyroid  Adrenal (cortisol)  Sex hormone  Neurotrophic (neuronal growth) factors such as BDNF *brain-derived Neurotrophic factor) that promote neuronal growth and axonal and dendritic sprouting o Neurochemical disturbances in depression  Neurotransmitter abnormalities in depression represent just one part of the neurobiological changes in depression; they probably account for the side effects of antidepressant medications more than the main effects  Depression is also associated with  Reductions of BDNF and other growth factors  Altered levels of activity in the limbic system, prefrontal area, and other brain regions, observable by neuroimaging  Increased levels of neurosteroid hormones, which promote neuronal death and glial cell damage  Regardless of the mode of action, remission of depression with antidepressant medication results in restoration of normal levels of BDNF and neurosteroids, and return of normal neural activity  Reduced gray matter volume is seen in chronic depression, and appear to be restored with successful antidepressant therapy; people with lower amounts of gray matter in the right-hemisphere neocortex carry a greater risk of later depression o Physical conditions that can masquerade as major depression  Hypothyroidism  Blood test  Low testosterone or estrogen levels (both M and F)  Undiagnosed illness  Ex: infectious mononucleosis  Anemia  Chronic fatigue syndrome  Suicidality and antidepressants o 40% of people with major depression make at least one suicide attempt, and 50%-60% have suicidal ideation  F used to use pills (ineffective) while M used to use guns (effective) o as of 2004, all antidepressants in U.S. must now carry warnings about suicidality o although some studies show that suicidal ideation is increased with antidepressant medication, various studies have shown no link between antidepressant medication and actual suicides  more likely to commit suicide while recovering, whether on medication or not o suicidality is associated with improvement from depression, regardless of the presence of antidepressant medication  suicide and antidepressant use in Sweden  1990’s = skyrocketed sales of antidepressants  suicide = slightly negative slope  teen suicide in U.S. 2000-2005  2004, FDA demanded that “black box” warnings be included with all anti-depressants, resulting in a downturn in medication prescriptions to adolescents  stopped prescribing anti-depressants as willingly  suicide rate skyrocketed  started prescribing again  suicide went way down  classes of antidepressant medication o monoamine oxidase inhibitors (MAO inhibitors) – marplan, parnate, nardil  introduced in late 1950’s  had severe dietary restrictions and very unpleasant side effects  rich in amino acids = blood pressure skyrockets  can stroke out and die o tricyclics – Elavil, norpramin, tofranil, anafranil  introduced in early 1960’s  eliminated the dietary restrictions of the MAO inhibitors but still had very unpleasant side effects (weight gain, dry mouth, constipation, dizziness, blurred vision) and are cardiotoxic  dry gut  constipation  weight gain  very poisonous medicines of OD on them  “cardiotoxic” o selective serotonin reuptake inhibitors (SSRI’s) – Prozac/serafem, Zoloft, celexa, Lexapro, paxil, luvox  30-40% patients on SSRI’s suffer from sleep and sexual symptoms  older people especially, younger people not so much  insomnia problems (insomnia caused by depression, but when depression is lifted, insomnia left by SSRI)  female orgasmic difficulty  male ejaculation difficulty (more intense and longer stimulation)  F/M slight loss of sexual interest  children on paxil may develop suicidal ideation (but not suicide)  paxil = worst withdrawal symptoms because it goes in and out of your system very quickly; heavy agitation  people who do not respond to one SSRI have a 40-70% chance of responding to a second one; answer may lie in pharmacogenomics (matching medications to your genome)  Prozac = very safe  People have swallowed 4-8 GRAMS of prozac, and don’t die… o atypical antidepressants – Effexor, Cymbalta, wellbutrin, pristiq, remeron, trazodone  together, the most prescribed “class” of current antidepressants  fewer sexual side effects; varied in actions and side effects o atypical depression – hysteroid dysphoria (reversed neurovegetative signs/symptoms)  weight gain/carbohydrate binging  hypersomnia  leaden paralysis  feeling like slogging through the day  moving through life = a lot of effort  interpersonal rejection sensitivity  hypersensitivity to compliments, rejection, etc.  often  histrionic traits  always imagine you’re on a stage and everyone is watching you perform  acutely aware of “do I look okay? Am I acting okay?” o history of being performers (choir, drama, theater, etc.)  self-medication with caffeine or chocolate  sometimes  uniquely responsive to MAOI’s o special use antidepressants  wellbutrin  very stimulating and it used to treat adult ADHD and nicotine cravings  sold as Zyban for nitotine cravings  Cymbalta  Activating but has good anti-anxiety effects and helps in patients with chronic pain  Current best-selling antidepressant  Trazodone and Remeron  Both sedating and are used widely in elderly patients with insomnia  Remeron promotes appetite and is especially indicated in patients with excessive weight loss o How long should people take antidepressant meds?  Most depressions remit with no treatment in 3-4 months st nd  However adds are >50% of 1 recurrence, >75% 2 recurrence, etc.  Each recurrence tends to be longer and leaves the person with greater disability  Ex: depression is often progressive  Depression that is aggressively controlled early (by high doses and multiple, or multiple-action, medications) predicts less recurrence  Medication can be tapered and then resumed if depression re-emerges, but there  is a slight risk of acquired medication immunity if the medication is tapered then resumed  Medication for life? Medication is “unnatural”, but so is depression? o Increased risks associated with antidepressant meds?  Modern antidepressants are quite safe, but  SSRI’s may be associated with heart and long defects in the infants of mothers taking some SSRI’s while pregnant  Serotonin syndrome (confusion, hallucinations, fever, seizures) can occur in people who are taking SSRI’s along with MAOI’s or other serotonin-raising drugs  Abruptly stopping any antidepressant can result in a discontinuation syndrome:  Zaps, tremors, etc. o Alternative depression treatments  Medications  Lithium augmentation of antidepressant therapy  St. John’s Wort  Sam-e  Thyroxin  Testosterone (M/F)  Estrogen (F, in menopausal and post-partum depression)  Phototherapy (seasonal depression)  Exercise (mild depression)  Sleep deprivation (temporary) o Conditions associated with major depression and often treated with antidepressant meds  Chronic pain  Binge eating disorder  Bulimia nervosa  Migraine headache  Misc. anxiety disorders (panic disorder, OCD)  Trichotillomania  Compulsive zit-popping  Compulsive shopping  Compulsive gambling o ECT – old and new  Old  Retrograde amnesia  Caused seizures  1930’s-1950’s  medieval, traumatizing, etc.  New  Anesthetics, sedatives to lessen seizures  Facts  Works fastest of any therapy for depression  Mechanism of action unknown  Has fewest side effects of any therapy for depression (very high satisfaction ratings)  Sometimes causes spotty memory losses (episodic > semantic)  Usually applied only to right hemisphere to minimize speech disturbance  Abused in past, and now used only as a last resort, and for most severe cases  Comparative efficacy of depression treatments  ECT works fastest, for most people, and with fewest side effects  Meds and psychotherapy work equally well for most adults, but medication works faster  For adults, a combo of therapy and medication seems no more beneficial than either one alone  Adolescents, current recommendation is an SSRI plus cognitive-behavior therapy  Medication is the least expensive single mode of treatment  Treatment resistant depression  Up to 305 of patients do not respond to standard treatments  Strategies  Medication augmentation o Lithium or abilify o A second antidepressant o Thyroid medication o Stimulants (Ritalin, Straterra) o Side-effect management (sleep, sexual response) o Estrogen, testosterone  Risks of medication augmentation o Serotonin syndrome (agitation, euphoria/delirium, fevers, muscle contractions, seizures) o Precipitation of manic states  Medication + ECT  Vagal nerve stimulation  Experimental therapies for treatment-resistant depression  Transcranial magnetic stimulation/magnetic seizure therapy o Stimulate brain with magnetism o Some + effects from magnetic stimulation (repeated every day) o Could replace ECT within the next decade  ECT is reliable/has been studied/can be predicted = reluctant to give it up  Vagus nerve stimulation o Most confident of experimental therapies o Pacemaker device wires wrapped up and around vagus nerve o Only side effect observed = person immediately gets raspy voice o Use for when already tried combos, augmented meds, anti-depressants, ECT o Delivers ~20 pulses per second to electrodes wrapped around vagus nerve in back of throat, stimulator implanted in chest  Direct brain stimulation o Still very experimental, but could eventually be an alternative for these others Affective Disorders – Mania 4/3/2012 12:23:00 PM  Clinical features of mania  Euphoria or irritability o Intensity at any emotional state  Purposeless or reckless behavior  Persistent insomnia  Pressured speech, flight of ideas o Brain switches back and forth from ideas VERY quickly o Can’t follow their thoughts “do you have a pen I need a place to put my cattle”  Poor insight or frank psychosis  Sometimes, assaultiveness or suicidality o “I want to see what’s after death”  not time to think before plunging off a bridge  major depression and bipolar disorder  depression only = major depression (unipolar depression)  depression + mania = bipolar disorder o almost always find that patient has had background of deep, dark depression  unipolar and bipolar disorders  unipolar mood history o unipolar (major) depression o hypomania (mild mania)  very creative, write a lot very quickly, can’t slow down (people say they should get some rest)  sometimes goes undiagnosed  usually a judgment call o unipolar mania (rare)  ex: spotting UFO  bipolar mood history o cyclothymia  mild depression with hypomania o bipolar I disorder (worst)  bipolar depression with mania  very frank manic periods with deep, dark depressions o bipolar II disorder  bipolar depression with hypomania  deep, dark depressions; manic periods restrained o mixed episodes  bipolar depression and mania simultaneously  bipolar disorder  point prevalence (historically) ~ 1-1.5% but more recent studies suggest 3.5%  probably no sex difference in prevalence  associated with high rates of alcohol/drug abuse (40-50% higher than any other axis I disorder), criminal behavior, and anxiety disorders (~40%) o many people try to drown/sedate depression/mania with alcohol and drugs  age of first diagnosis ranges from 15-45 with most people diagnosed in their 20’s o college age = many first diagnoses  but sometimes seen in children (pediatric bipolar disorder) o spells of being rev’d up/slowing down with no explanation o SPELLS is what differentiates between BPD and ADHD  runs in families o family history of bipolar disorder in 30% of B.D. patients o 65% concordance rate in MZ twins, 14% in DZ twins o 20% of MZ twins in which one has BPD, the other will have major depression, suggesting some common inheritance o 10% concordance rate in 1 -degree relatives o probably multiples routes of genetic involvement  bipolar depression compared to major (unipolar) depression  depression is the more problematic state in bipolar disorder  most cases of bipolar disorder first appear as depressed phase  40% persons with bipolar disorder are initially diagnosed with major depression o must be very safe while diagnosing o if given antidepressants, will quickly become manic o how do you tell?  Usually ask about family history (bipolar/mania/talking fast, staying up all night?)  Watch very carefully to see if they start to switch  average age on onset is below age 25 compared to late 20’s for major depression  bipolar depression lasts longer, recurs more frequently, is more likely to reach psychotic levels, and can take twice as long to obtain remission with treatment  people with bipolar disorder spend up to 1/3 of their adult lives in depression  more likely to include reversed neurovegetative signs/symptoms and psychomotor retardation  ~1:1 sex ratio of diagnosis, as opposed to ~2:1 F:M ratio in major depression  more than 10% of people with bipolar disorder eventually suicide, mostly in depressed phase  many gene loci have been associated with bipolar disorder  shared loci between BPD and schizophrenia (2007)  manic vs. paranoid schizophrenic? o Ex: idea of aliens implanting in brains and stealing thoughts o Sometimes can only tell from family history o Responds to anti-manic depression (lithium, etc.)  bipolar… otherwise schizophrenic  Brain mechanisms in bipolar disorder  Brain mechanism is unknown, but may reflect defects in the metabolism of protein-kinase C (PKC), an enzyme involved in the calcium metabolism of neurons in specific brain areas; result is unstable levels of neurotransmitter release by these neurons  PKC activity is increased in manic patients and is thought to be normalized by anti-manic medications o Anti-manic medications AKA mood stabilizers  Specific PKC inhibitors (ex: tamoxifen, used to treat breast cancer) quickly bring acute mania under control  Many other hypotheses are under investigation  Pediatric bipolar disorder  Occurs in about 1% of children, sometimes as early as infancy o Infant bipolar: mood instability  rages, deep crying spells, Hypersexuality, pressures speech, racing thoughts, impaired judgment, delusions and hallucinations (imaginary friends NOT CONSIDERED delusional/psychotic for kids)  Up to ½ of severe childhood depressions become adult bipolar disorder  About ½ of children treated for depression with SSRI’s develop manic or hypomanic episodes  Typically a 10-year lag between occurrence of first signs/symptoms (sx) and onset of treatment  Often confused with ADHD due to shared symptoms (sx) of distractibility and hyperactivity o Distinction between episodic nature o ADHD = there all the time o PBD = more spell-like (come on and go away)  Mixed episodes (mania and depression ARE NOT opposites)  Crying  Irritability/anger  Suicidal ideation  with  euphoria  Hypersexuality  Racing thoughts  Severe insomnia  Auditory hallucinations  NOTE: many mixed episodes are actually “switches” or manias emerging out of depressions (half way point between switching) o Many suicides occur during mixed episodes o Handle mixed episodes with sedatives (mellow them out as quickly as possible)  Rapid cycling bipolar disorder  DSM IV: four or more episodes (depression or manias/hypomanias) per year  Cycling can occur within days or hours  About 15% of bipolar patients are rapid cyclers, more frequent in women  Treatments for bipolar disorder st  Medication is 1 -line treatment, but med compliance only ~30% o Acute management (with antipsychotic medications) followed by introduction of a mood stabilizer for chronic management  Psychotherapy o Usually requires prior medication response to be valuable o Builds compliance to medication o Helps patient (and family) understand impact of disorder o No effect on disorder itself  ECT (rarely used, but somewhat effective) o Rely on ECT to get over deep, dark depression  Induced sleep (very rarely) o Sleeping med in height of mania  keep them asleep for 2-3 days = wake up no longer manic; yet awake for 1-2 days = manic again  Medications for chronic management of bipolar disorder  Antimanic action (top of list)  antidepressant action (bottom of list) o Lithium carbonate (strong antimanic and anti-suicide but weak antidepressant actions)  Toxic to kidneys long term (must have kidney dr. watch your kidneys for functionality)  Deforms fetuses (don’t take if pregnant)  Cardiotoxic (can’t have much lithium around suicidal patients) o Anticonvulsants (moderate antimanic and antidepressant actions/ decent mood-stabilizing qualities)  Lamictal – has uniquely strong antidepressant properties, and appears weight-neutral (favored med for bipolar disorder)  Tegretol, Neurontin  For rapid cycling bipolar disorder, Depakote and Topamax (typically give good mood stabilizer, along with antidepressant)  Antimanic med 1 st nd  Antidepressant med 2 o Antipsychotic agents (moderate antimanic and antidepressant actions)  Abilify (weight-neutral), Zyprexa, Risperdal o Antidepressants (strong antidepressant actions but increase risk of “switching” into mania or mixed states) o Standard of care: Polypharmacy (more than one medication)  Affective disorders may be associated with creativity  “no one has ever written, painted, sculpted, modeled, built, or invented except literally to get out of hell.” – Artaud  bipolar disorder and creativity o Nancy Anderson  study of writers at Iowa’s writing workshop o Kate Jamison  study of writers and artists  70% of writers cyclothymia  likely sufferers of bipolar disorder o Lincoln, etc.  Kay Redfield Jamison Touched with Fire (1993)  Bipolar I  Many suicide attempts  Discovered bipolar disorder in college  The upside of bipolar disorder  The “well” relatives of people with BD appear to have higher rates of achievement, success, and creativity Anxiety Disorders – Formerly “Neurosis” 4/3/2012 12:23:00 PM  Midterm Stuff  SQ3R method of studying o Look it up  Parscore pink 100 ? size  Common signs/symptoms of anxiety  Cognitive o Objectless fear or feeling apprehensiveness o Heightened sense of vulnerability o Worrying and rumination (obsessive thinking of something) o Going blank or spacing out o Irritability, impatience, distractibility o Hypervigilance  Physiological o Trembling, twitching, feeling shaky o Fatigue, restlessness o Muscle tension, jitteriness o Dizziness, lightheadedness o Fast heartbeat, breathing rate, can describe heart palpitations (skipping a beat) o Sweating, cold or clammy hands o Dry mouth, nausea, diarrhea o Altered appetite and sleep  Typically getting to sleep = issue  Signs/symptoms of panic attack (acute anxiety episode)  Palpitations, pounding heart, or accelerated heart rate  Sweating  Trembling or shaking  Sensations of shortness of breath, choking, smothering  Chest pain or discomfort  Nausea or abdominal distress  Feeling dizzy, unsteady, lightheaded, or faint  Derealization (feelings of unreality)  Depersonalization (being detached from oneself) o Out of body experiences  Fear of dying, losing control or going crazy  Paresthesias (numbness or tingling sensations)  Chills or hot flushes  Autonomic arousal and the brain  Amygdala – registers situations as threatening  Locus Coerculeus – governs activation of neocortex, hypothalamic- pituitary axis, and autonomic nervous system (“get ready for an emergency” message sent out)  Anxiety-related actions of the sympathetic nervous system  Pituitary release of ACTH  Adrenal secretion of epinephrine and norepinephrine  Pupillary dilation  Drying of mucosal linings (mouth, stomach, intestines, etc.)  GABA and anxiety  Sites related to anxiety in animals involve the neurotransmitter GABA (gamma-amibonutyric Acid)  Anxiety-prone people have deficits in GABA  Chemically blocking GABA increases anxiety  GABA is only one of many neurotransmitters involved in anxiety o GABA and 5HT (serotonin) inhibit anxiety o Epinephrine, norepinephrine, and dopamine provoke the physiological changes that can lead to anxiety  Ethyl alcohol (ETOH) and common anti-anxiety medications bind to GABA receptor areas and mimic GABA  Major anxiety disorders  Most frequently occurring psychiatric problems in the general population  Overall, they run strongly in families, and are co-morbid (multiple disorders simultaneously) with depression and stress disorders (50- 70% of people with lifetime depression also have lifetime anxiety disorders) – suggesting a common “distress” inheritance  Carry increased risk of alcoholism/drug abuse and “self-medication”  DSM-IV-TR classification of anxiety disorders o Generalized anxiety disorder o Panic disorder, with and without agoraphobia o Social anxiety disorder (social phobia) o Specific phobias o Obsessive-compulsive disorder o Stress disorders  Acute  Post-traumatic  Some common physical disorders that can mask as “anxiety disorders”  Hyperthyroidism  Pheochromocytomas (adrenal tumors that over-secrete adrenalin)  Inner ear disease  Angina pectoris  Hypoglycemia  Mitral valve prolapse  Cardiac arrhythmias  Drug effects (caffeinism, nicotine addiction, nasal decongestants, asthma inhalers or other stimulants)  General diagnostic criteria for generalized anxiety disorder (GAD)  Description o Debilitating worry, fretfulness o Worry is hard to control o Varied anxiety symptoms: restlessness, fatigue, difficulty concentrating or mind going blank, irritability, muscle tension, insomnia o Often arises with, or just before or after, major depression  Facts about GAD o 1-year prevalence 3-4% o usually emerges during adolescence o F > M 2:1 ratio o 75% of GAD sufferers have another mental disorder, usually major depression o affects 10-20% of the elderly, who are beset with frailty, medical illness, and losses – which lead to vulnerability and fear o 36% of GAD sufferers self-medicate with ethyl alcohol (ETOH) and other drugs (marijuana, for example) o substance use often develops with GAD and so causality may be bi-directional  symptomatic treatments for anxiety o habit control (ex: coffee, cigarettes, stimulant medications) o anxiolytic (anti-anxiety) medications  for acute use  benzodiazepines (Xanax [habit forming], Ativan, klonopin, valium)  rarely: beta-blockers (Tenormin, Inderal)  help with body issues of anxiety, not mind issues  for chronic use  most often SSRI’s (Prozac, Lexapro, etc.) or atypical antidepressants (Cymbalta, Effexor)  occasionally for intense, psychotic anxiety:  atypical anxiolytics (buspar)  antipsychotics (abilify, Seroquel, Risperdal, zyprexa)  psychotherapy  supportive, cathartic  relaxation and medication techniques  stress management training  biofeedback  exercise  for mild – moderate anxiety  support groups  panic disorder  description o occurrence of panic attacks without warning o pattern of avoidance and disability as a result o ritualized avoidance becomes panic disorder with agoraphobia (when avoiding, automatically diagnoses agoraphobic)  home or room within the home, becomes “safety zone”  reluctance to venture outside safety zone without “escape route”  facts o one year prevalence ~ 2.3% o lifetime prevalence ~ 3/5% o develops mostly during late teens (15-19) o female : male ratio ~ 2:1 o increased risk with background of child abuse/neglect, and with mitral valve prolapse o panic attacks can be triggered in susceptible people by:  yohimbine (sympathetic NS stimulant)  sodium lactate (exercise waste-product)  caffeine, nicotine (sympathetic NS stimulant)  marijuana st  1 line panic disorder treatments o dietary/medication control (caffeine, nicotine, marijuana) o anxiolytic medications (benzodiazepines, mainly Xanax) – for acute use only o antidepressant medication (mainly, SSRI’s), chronically as preventative o psychotherapy  cognitive therapy  make sure don’t have cardiac med issues FIRST  normalization, de-catastrophizing, paced metronomic breathing  supportive therapy o in vivo desensitization if agoraphobia is present  master things that are just outside comfort zone  in vivo = real life  social anxiety disorder (social phobia)  most common anxiety disorder o 1 year prevalence of ~8%; lifetime prevalence up to 15% o more common in females ratio of 1.5 : 1 o develops in late adolescence or young adulthood o grossly under-diagnosed in managed care population  occurs when people become disabled by o intense, persistent, and chronic fears of being watched and judged by others, and of doing things that will be humiliating or embarrassing o can be generalized or occur in specific situations (non- generalized) o 1/3 are sufferers are very disabled, and are more likely to be depressed, divorced, unemployed or under employed  awareness that fears are excessive  common “performance situations”  life is constantly a performance “Did I say good morning okay? Did I seem cheerful enough?” Etc. o public speaking (toastmasters) o public restroom use o going to parties o eating in front of others o bedroom (some erectile dysfunction, some orgasmic dysfunctions)  most commonly treated with medications (benzodiazepines and/or SSRI’s) plus supportive and proactive psychotherapy  specific phobias  description o persistent fears or panic attacks out of proportion to situation o compelling desire to avoid phobic stimulus o insight that fear is excessive o symptoms are unrelated to another disorder  facts o have a one year prevalence of ~7% and a lifetime prevalence of ~9% in the U.S. o mean duration of a specific phobia is about 20 years o females > males 2:1 to 3:1 ratio  types of specific phobias o animal type o natural environment type (storms, heights, water) o situation type (claustrophobia, tunnels, bridges, flying, driving) o bodily reactions (vomiting, headache, fever) o blood-injury-injection type (vasovagal reaction)  light headed, faint, blood pressure drop, nausea o nature of phobic stimuli undercuts a straightforward conditioning view of specific phobia  treatment for specific phobias o all treatment are complicated by avoidance behavior o anxiolytic or antidepressant medication (preferably SSRI) o systematic desensitization o in vivo desensitization – effective, but low treatment acceptance and high therapy dropout rates o applied tension for blood-injection phobias o experimental: VR therapy for flying and height phobias o self-help groups  Obsessive Compulsive Disorder (OCD)  Description o Debilitating, unwanted (ego-dystonic)  Obsessions (intrusive thoughts, impulses, images)  Compulsions (repetitive behavior to ward off anxiety or an unwanted impulse) o Recognition that one’s obsessions and compulsions are excessive or unreasonable o Significant distress or impairment for one hour per day  Facts o One year prevalence ~ 2% o About 80% ocd sufferers have coexisting major depression o ½ of OCD cases begin in childhood, and these childhood cases are mostly males and are more severe o ocd cases beginning in adolescence of adulthood are less severe, and females = males in prevalence o 20% of ocd cases have 1 degree relatives with ocd  Causes? o Basal ganglia + frontal cortex = areas of brain involved  Usually regulates brain thought “listening to professor, what’s my homework? Remember to check the mail.”  OCD = stuck on what’s my homework? o Frontal cortex and ocd  Prefrontal areas of brain with OCD = massively overworking  Cannot smoothly shift attention from one item to the next item  Common obsessions and compulsions o obsessions  Multiple obsessions  Contamination, excessive doubt  Fear of causing harm to self or others  Fear of being sexually inappropriate  Need for symmetry or exactness  Other (praying, repeating words, etc.) o Compulsions  Multiple compulsions  Checking  Washing  Counting  Arranging/organizing  Collecting/hoarding o 98% of OCD sufferers have both obsessions and compulsions  disorders related to OCD (OCD spectrum disorders) o Gilles de la Tourette syndrome  Anxiety (great deal of anxiety building, and if they don’t let the tic or involuntary sound out, the anxiety will be unbearable)  tics (mild form)  coprolalia (involuntary uttering sounds/cuss words) o trichotillomania (pulling/twisting of hair, picking scabs on scalp, etc.) o onychophagia (severe, chronic nail-biting) o hypochondriasis (obsessing you have a disease; repeatedly go to doctor for it) o bulimia nervosa, anorexia nervosa (resemble OCD cycle)  desire to binge, purge, etc.  obsessive counting of calories, foods, etc. o body dysmorphic disorder  obsessive concern about appearance and body parts (skin, hair, nose)  compulsions (mirror checking, camouflaging, grooming, skin picking)  half of BDD individuals are delusional  pattern of anxious avoidance of others  body integrity identity disorder (BIID) – an OCD spectruym disorder? o Belief, usually from early childhood, that one or more limbs (usually legs) do not “belong” to one’s body, and that amputation of the limbs will achieve “wholeness” o Certainly regarding the limbs involved and the level of amputation desired o Rehearsal activity (pretending) during which they imitate the amputated state in private and in public o Pursuit of elective amputation or attempts at self-amputation o BIID can include non-amputation bodily changes, such as beliefs that one “should” be deaf  Streptococcus and OCD: PANDAS o Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections o Seen in school age children who develop strep throat or strep rash, usually with fever and urinary incontinence o Sudden onset of tic disorder, or ocd signs/symptoms, most commonly hand washing and preoccupation with germs o Rapid remission of symptoms usually occurs with antibiotic therapy o PANDAS accounts for only a small % of childhood ocd  1 line ocd treatments o antidepressant therapy with serotonin-boosting medications  ssri’s  tricyclics (especially clomipramine) o behavior therapy  thought stopping  response prevention  knock stack of books over, but tie their hands behind their back o psychosurgery (cingulatomoy) for otherwise intractable cases Leftover 4/3/2012 12:23:00 PM  Reactions to Extreme Trauma  Intrusive recollections (daytime flashbacks, nightmares, illusions) and acute distress upon cues suggestive of the trauma  Dissociative symptoms (psychic numbing) o Emotional detachment o Being in a daze o Dropping out of usual activities o Avoidance of topics related to trauma o Forgetting or “fogginess” re: key aspects of trauma o Feeling that the current setting is not real (Derealization) o Feeling detached from one’s body (depersonalization)  Chronic hyperarousal: exaggerated startle, insomnia, hypervigilance, motor restlessness  Irritability and aggressiveness (esp. males)  Survival guilt (suffer trauma with people  best friend dies in war, should’ve been you)  Traumas that can precipitate stress disorders  Most common traumas: o Rape, attempted rape, an assault (>300,000 rapes and attempted rapes per year in U.S. 15:1 W:M) o Military combat (usually men)  Other precipitants: o Accidental human calamities (motor vehicle accidents, plane crashes) o Floods, earthquakes, fires o Deliberate human calamities (bomb
More Less

Related notes for PSY 103

Log In


Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.