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Chapter 13

PSYC18--Chapter 13: Mental Disorder and Wellbeing in Adulthood

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Simon Appolloni

PSYC18: CHAPTER 13—MENTALDISORDERAND WELL-BEING INADULTHOOD Psychiatric Disorders: Symptoms and Prevalence • Depression (sometimes called affective/mood disorder): Intense sadness diagnosed if present for min. 2 weeks. Sufferer is unbearably sad and lost pleasure in all activities. 4 other DSM symptoms must be present (insomnia, low energy etc.). • Anxiety: Moods of disabling anxiety, avoidance of what is most feared and loss of personal confidence. • Anervous breakdown is an episode of major depression with/without accompanying anxiety disorder. Psychiatric Epidemiology • Epidemiology is detective work: discovering from clues of diagnosis how people’s lives have become disordered. • Epidemiological advances are important in improving general health in were the epidemiological discoveries of how people caught diseases and prevention of infection (invention of drugs in psychology, but most importantly prevention). • Psychiatric epidemiology was slow to become established due to disagreements on diagnosis criteria. • World Health Org. (WHO) states depression=burden/leading cost of years lost in middle/high income nations • * See pg 329, figure 13.1 for prevalence rates • 16.6% prevalence rate for depression in U.S.. ANew Zealand prospective design experiment found twice this value. • Gender differences occur in normal emotions but are small in reference to disorder prevalence.  Women 1.5x more likely to suffer depression , 1.6x for anxiety and 2x for GAD. th  Alcohol abuse used to be a predominately male problem, but the gender gap has reduced in the 20 century. • Black/white prevalence gap for dvlmpt of any disorder = no race gap, BUT differences due to gender/race/ethnicity between disorders is huge (* see pg 330, figure 13.2) (e.g. black people less susceptible to emotional disorder). Different Kinds of Depression andAnxiety • Bipolar/manic depressive: depressed person must experience 1 period of mania. Has a prevalence of 1-4% with no gender difference. Heritability of 60-85% (higher for major depressive). • Anxiety disorders include panic attacks, phobias, obsessions and compulsions and PTSD. • Social phobia has prevalence of 12.1%, GAD of 5.7%. • Agoraphobics fear places they cannot leave without embarrassment. They sometimes fear going out at all, perhaps unless with a partner/attachment figure. • Obsessions=intrusive anxious thoughts (e.g. being contaminated by germs) and compulsions=repeated actions such as washing hands several times a day or checking/re-checking that a stove is turned off. It is a defect in emotional knowledge that a security motivated action has been completed. 2-3% prevalence rate. • PTSD involves intense anxiety, disturbed sleep, flashbacks in which the traumatic event is remembered and repeatedly re-experienced, together with avoidance of anything that might remind one of it. Occurs in war, natural/industrial disaster, rape, trauma (anything that radically violates ones basic assumptions about the world). • Vietnam war veterans came back with increased antisocial behavior. • Chaotic nature of PTSD flashbacks/anxiety can be explained using two memory systems (the traumas are represented in both systems, which are repeatedly activated and do not necessarily correspond with each other):  Verbal memory subject to the making of meaningful sense of experience.  Automatic memory triggered by aspects of situations, internal or external. How Disorders are Caused • Disorders are generally understood through the stress diathesis hypothesis (the hypothesis that a disorder is typically caused by a stress—an adversity of the environment—in the presence of one or more inherent factors that make person vulnerable). • Stress examples=job loss, divorce, etc. • Diathesis examples=genetic factors and difficulties in early life. • In schizophrenia, unlike emotional disorders, the diathesis is a stronger factor than the stress. Life Event Difficulties • Study in England found 89% of women with an onset of depression had a severe life event or difficulty shortly before their breakdown. Only 30% of non-depressed had negative life event/difficulty. • * See pg 333 for detailed experiment procedure + example. • An event that causes depression is typically the loss of a role that is highly valued (type of loss related to social motivations of attachment/affiliation) or failure in achievement (for people who value autonomy/work; related to assertive social motivations. • Depressive=losses, anxiety=danger events • Adversities that cause depressive/anxiety disorders: loss, humiliation, entrapment, danger (*see pg 334, table 13.3) Cross-Cultural Differences • World Health Organization (WHO) found broadly similar patterns across 14 nations. • Impulse control/substance abuse varies greatly. • U.S. has highest mental disorder prevalence, followed by Europe and lastlyAsia/Africa (trend possibly due to U.S. being more individualistic compared toAsian/African countries). • Being female/poor/uneducated associated with depression in India, Chile, Zimbabwe and Brazil. • Evidence for epidemiology is correlational (does not tell us whether poverty causes depression or vice versa). Neurophysiology of Depression • Frontal cortex: ↓ volume ↓ anterior cingulate volume • Hippocampus: ↓ volume, ↓ in basal ganglia • Amygdala: ↑ activation = greater recall of negative events • Treatment is selective serotonin reuptake inhibitors (SSRI’s) to reduce reuptake of serotonin so that it remains in synapses for longer. However, this theory is not backed up by research. • Study showed placebo reduced depression more than SRRI’s did. • Formation of new nerve cells (neurogenesis) in hippocampus reduced depression, SRRI’s shown to have promoted neurogenesis in animals, but this is not yet tried on humans. Relation between Emotions and Emotional Disorders • * See pg 338, figure 13.3 (important!!!) • New approach to emotional disorders describe disorders on a range since many people have several diagnoses at the same time (comorbidity). • Although depression is not sadness, sadness emotion is involved (same brain region) • Sadness, happiness, fear and anger correspond respectively to depression, mania, anxiety and conduct disorder. (*See pg 339, table 13.4 for more) • Disorders begin as elicitations of basic emotions from automatic appraisals; it is their intensity that is inappropriate. Vulnerability Factors Gene-Environment Interaction • Gene-environment interaction plays role. Genes predispose someone to depression, but environment determines whether they become depressed. • Monozygotic twins more likely to be depressed than dizygotic twins (genetic liability of 37%). • Twin pair study found that genetic risk of encountering a larger number of life events was higher if the events were personal (for instance, lack of social recognition), if they were negative rather than challenging, and if they were enduring. • Genetics may influence personality and in turn make people place themselves in intense situations. Neuroticism was found to increase rate of exposure to life events and correlation was found to depression. • Genomics—study of what particular genes are responsible for human traits. • Decreased serotonin production influenced by 5-HTT gene increases life events rel
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