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UCONN / Psychology / PSY 2300 / How is obsessive compulsive disorder manifested?

How is obsessive compulsive disorder manifested?

How is obsessive compulsive disorder manifested?

Description

School: University of Connecticut
Department: Psychology
Course: Abnormal Psychology
Professor: Inge-marie eigsti
Term: Fall 2016
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Cost: 50
Name: PSYC 2300 Exam Two Outline
Description: Exam Two
Uploaded: 10/14/2016
31 Pages 55 Views 5 Unlocks
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Abnormal Psychology Exam Two Notes September 29, 2016 Anxiety Disorders


How is obsessive compulsive disorder manifested?



Overview 

1. anxiety disorders

a. generalized anxiety disorder

b. panic disorder and agoraphobia

c. specific phobias

d. social anxiety disorder

2. trauma and stress related disorders

a. PTSD, adjustment disorder

b. attachment disorder

3. obsessive compulsive and related disorder

a. OCD

b body dysmorphic disorder

c. hoarding, trichotillomania  

Focus on the contrast between fear versus anxiety  

Fear 

1. state of alarm about a known threat  

2. Example  

a. tiger coming into class


Is anxiety adaptive?



Anxiety 

1. alarm about a vague sense of a threat (generalized state of apprehension) 2. not adaptive  

Panic attacks 

1. abrupt onset of fear and discomfort  

2. peak at 10 minutes  

3. at least FOUR of these symptoms to be experiencing this:

a. palpitations, pounding heart and rapid heart rate

b. sweating

c. trembling/shaking

d. sensation of smothering

e. feeling of choking

f. chest pain

g. nausea We also discuss several other topics like What are the general rules for accento?
We also discuss several other topics like What sort of interpretations we make of cues in the environment even when they are deceptive?

h. dizziness, lightheadedness and fainting

i. parathesia (numbness, tingling)

j. chills or hot flashes

k. derealization (feeling of unreality) and depersonalization (detached from self) l. lear of losing control, being crazy


How is panic attack exhibited?



m. fear of dying  

Physiological changes during a panic attack (slide with graphs) 

1. changes in muscular activity in frontal (EMG)

2. heart rate (BMP)

3. body temperature  

Panic disorder and agoraphobia 

1. prevalence is 2.7% (year); 4.7% (lifetime)

2. unexpected panic attacks

3. anxiety, worry, or fear of another attack

4. persists for one month or longer

5. agoraphobia

a. fear or avoidance of situations or evens

b. concern, about being unable to escape or get help in the event of panic symptoms or  other unpleasant physical symptoms If you want to learn more check out What are the 3 types of sti?

c. common learned situations  

6. the root of agoraphobia is (“agora”) marketplace  

a. originally meant fear of the marketplace (being in open spaces and not being able to  escape it)

Both panic and agoraphobia are characterized by similar things, however you can have one or  another  

HPA Axis Activation and Negative Feedback 

1. hippothalimus, adrenal and pituitary  

2. set by cortisol (stress hormone)

3. to end process rely on inhibitory neurotransmitters

Biological contributions to anxiety  We also discuss several other topics like What are the main characteristics of a perfectly competitive market?

1. poly genetic influences

a. corticotropin releasing factor: when this turns on this affects the HPA axis and fight or  flight responses are turned on Don't forget about the age old question of Why is irreversible inhibition also called as suicide inhibitors?

2. Brain circuits and neurotransmitters

a. GABA (inhibitory system, can be thought of as the breaks)

1. less GABA leads to more anxiety (broken breaks, keep going)

b. Noradrenergic (norepinephrine) and serotonergenic system (systems that are  cleaning that is too strong)

1. less of these chemicals equals more anxiety  

3. Limbic system

a. behavioral inhibition system (BIS)

1. brain stem (sense changes in bodily functions, sends danger signals to the  cortex)

2. septum and hippocampus

b. fight/flight (FFS) system

1. panic circuit

2. alarm and escape responses  

People who experience panic disorders show markedly different results in each of these  components (not all)

An integrated model 

1. biological vulnerability We also discuss several other topics like What makes nicolaus copernicus a significant figure in history?

a. glass is half empty (not enough chemicals)

b. irritable

c. driven  

2. Specific psychological vulnerability (physical sensations are potentially dangerous) a. anxiety about health

b. non clinical panic?

3. generalized psychological vulnerability (sense that events are uncontrollable/unpredictable) a. tendency towards lack of self confidence

b. low self esteem

c. inability to cope  

there is a correlation between teen cigarette smoking and later panic attacks (nicotine is altering  the operation of your lungs and heart, because you are getting different amounts of oxygen. it  also includes changes in brain)

Etiology of Panic Disorders 

1. misinterpreting slight changes in bodily changes  

2. feeling scared and anxious  

3. feeling scared elicits physiological effects of pounding of heart, shortness of breath 4. “i’m having a panic attack?”

5. panic attack

6. fear of future panic attacks

7. next time they experience these slight bodily changes they are more anxious

People who have panic attacks 

1. attend to bodily sensations

2. misinterpret these sensations

3. “snowballing” assumptions  

How to deal with this? 

“Whistle a happy tune” song which states that you should help convince your body that there is  no need to be afraid

1. cognitive behavioral treatments

a. challenge/change, maladaptive, irrational assumptions  

1. daily diary (example of slide)

2. piece of paper with headings that clients can fill in (“situation, what was the  negative automatic thought, initial level of anxiety, what was the alternative  thought, subsequent level of anxiety)

b. exposure paired with relaxation (note that this does seem to require the help of a  mental health professional, it is hard to do it on your own)

1. “pretend” to be brave while encountering fear stimulus (teaches you and your  body not to be afraid in this context)

2. learn how to relax yourself (making positive statements etc)

c. stress inoculation (small amount of stress that you can handle successfully to help  patients learn how to handle this outside of the office)

1. prepare for feared situation, respond to bodily sensations  

Treatment of Panic Disorder 

1. cognitive scheemas

a. identify catastrophizing cognitions about bodily sensations  

b. understand fight/flight response

2. relaxation techniques

a. deep breathing

b. progressive muscle relaxation

3. interoceptive challenge  

4. medication to target multiple systems  

a. SSRIs (prozac, paxil) to target serotonergic system)

b. SNRIs (cymbalta, effexor) to target soradrenergic system)

c. bexodiazepines (ativan, valium) to enhance GABA

1. be careful they are very powerfully effective for the first week but then drop off 2. can be addictive

d. but there are very high relapse rates once drugs are stopped  

Interoceptive exposure (biological challenge)

1. shake head side to side for thirty seconds

2. run in place for 30 seconds

3. spin in a chair 60 seconds

4. body tension for 60 seconds

5. hyperventilate for 60 seconds

6. straw breathing 120 seconds  

7. hot stuffy room for 5 minutes

Generalized anxiety disorders (GAD)

1. 3.1% (year) of population; similar rates worldwide  

2. excessive anxiety and uncontrollable worry (duration 6mo or more) 3. hard to control their worrying it feels out of their control

4. associated with at least three symptoms

a. restlessness

b. fatigue

c. difficulty to concentrate (mind thinking about worries)

d. irritability

e. muscle tension  

f. sleep disturbance  

5. clinical features

a. move from crisis to crisis

b. heightened worry about minor and every day concerned (job, family, chores,  appointments

c. accompanied by sleep disturbance irritability

d. leads to behaviors like procrastination or over preparation

6. GAD children

a. need only one physical symptom

b. worry center on academic, social or athletic performance

7. GAD in the elderly

a. worry about failing health, loss

b. up to 10% prevalence

c. use of minor tranquilizers overprescribed (17-50%)

1. sometimes prescribed for medical problems or sleep problems

2. increase risk for falls and cognitive impairments (make people more clumsy)

Model of risk process for GAD 

1. generalize biological vulnerability or generalized psychological vulnerability can be triggered  due to stress

2. leading to anxious apprehension (increased muscle tension and vigilance are) 3. worry process (a failed attempt to cope and problem solve)

4. leads to…

1. intense cognitive processing

2. avoidance of imagery

3. inadequate problem solving skills

4. restricted autonomic response

5. combine to generalized anxiety disorder

Similarities between GAD and panic disorders however, they are not the same process

Anecdote about GAD 

Family comes in because daughter has many tantrums. Meets with family asks daughter to go  outside. Father begins asking questions (can you go outside? are you okay? I can walk you  there). She was 11 and she did not need that much attention. Findings that madeline and her  father struggled with this.  

Class Notes October 4, 2016

Treatment for GAD 

1. learning to confront worries “head-on” (rather than avoiding them)

1. cognitive behavior theory (trained relaxation techniques)

2. acceptance of distressing thoughts and feelings

3. meditation/mindfulness techniques potentially helpful  

4. specific anxiety diagnosis (not talking about whole class of anxiety(

Phobias (5 categories) 

1. persistent and intense fears, impacts functioning

1. natural environmental (heights, storms, swimming)

2. animals (snakes or dogs)

3. situational (claustrophobia, public transportation)

4. blood injury injection

5. other  

2. exposure leads to intense and excessive anxiety  

3. exposure provokes a fear response

4. person recognizes that the fear is excessive (children” not necessary) 5. situation is avoided, or endured with intense distress  

6. symptoms cause impairment in functioning (often at this point where individuals come in for  help)

Preparedness 

1. we fear spiders and snakes more than busses (latter are more dangerous; why?) 2. through evolution we have been “prepared” to handle  

Phobias and classical conditioning 

1. neurural object paired with frightening situation which produces fear of the neutral object 2. dog bites girl (US), girl experiences fright/pain (UR)

3. dog (US) is associate with fright and pain (UR)

4. dog (CS) leads to dog phobia (CR)

Phobias and operant conditioning 

1. when they have developed this conditioned response the person avoids or escapes the  conditioned stimulus (if you see a dog, stay away)

2. escaping the conditioned stimulus provides relief  

3. negative reinforcement for avoidant behavior

4. therefore, the avoidance of CS makes extinguishing it hard

Treatment: fear hierarchy

1. least feared item: ______

2. __________

3. __________

4. __________

5. most feared item: ______

*similar to how we help those with panic attacks

Snake example 

1. start with a black and white drawing of a snake (not particularly scary or threatening) 1. meditate while looking at this picture

2. look at photograph of a real snake

1. help the individual endure this

3. look at a real snake in the cage

1. help them practice staying calm  

4. look at a snake, 3 feet away (out of cage)

5. touch a live snake  

Video in class: elevator phobia  

Separation anxiety disorder  

1. 4.1% of children meet criteria, 6.6 for adults

2. unrealistic, persistent worry that something will happen to loved ones when apart  (kidnapping, accident)

3. anxiety about leaving loved ones  

Social anxiety disorder (social phobia) 

1. 12% o population will experience it in their lives; 6.8 in year  

2. extreme, irrational worry of being negatively evaluated by others 1. can manifest as shyness  

3. significant impairment and /or distress

4. avoid feared situations or endure with great distress

5. subtype, performance anxiety: anxiety only in performance situation (public speaking) 6. in Japan— taijin kyofusho

1. fear of ordering others or making them uncomfortable due to aspects of personal  appearance (stuttering, blushing, body contact

2. more common in males  

Treatment of social anxiety disorder 

1. medications

1. beta blockers

2. benzodiazepines (enhance GABA)

3. SSRI (paxil, zoloft, effexor)

4. d-cycloserine antibiotic originally treated tuberculosis; sometimes called cognitive  enhancer (potentially effective new treatment)

2. psychological

1. cognitive behavioral treatment

1. challenging of anxious thoughts about the consequences if sick judgement 2. exposure to anxiety provoking situations

3. rehearsal

4. role play

3. highly effective  

CBT for social anxiety seems like the best cure

Selective mutism 

1. rare childhood disorder characterized by lack of speech  

2. duration of >1 most (not first month of school)

3. high comorbidity (sick with two things at same time) with the separation anxiety *50% 4. treatment

1. CBT is the most efficacious, similar to treatment for SAD  

Post traumatic stress disorder (PTSD): originally shell shock syndrome  1. exposure to a traumatic event (involving possible injury, death)

2. trauma is re-experienced via flashbacks, dreams, high physiological arousal and distress  when cued)

3. avoidance of stimuli is associated with the trauma via, forgetting, social withdraw  4. increase arousal (hypervigilance)

5. most people who experience traumatic events do not develop PSD (4% of troops do, 7%  with combat experience

1. history of repeated sexual issue (2-3x increase in PTSD)

2. proximity: more likely to develop PTSD if it is closer to the trauma  

Vietnam vets 

1. almost 30 years after the war (experienced more communication)

2. Iraq vets: lesser prevalence in PTSD (more recent)

1. 1 of 3 vets seek care for mental heard concerns (PTSD, anxiety, depression) 2. second duty 1 out of 5 (20% on second tour of study to experience anxiety disorer) 3. 10 oer 100,000 suïcide in 2005

4. rates increasing: some data suggesting 30 for

Risk Factors: PTSD 

1. biological responsitivity (bang on desk) the more you had a reaction, the mire biological  responsivity

2. risk factors are heavily monitored by social support sources and coping skills 3. severity of trauma

4. degree of exposure

5. passive vs. active coping style

6. social support  

7. additional stresses  

Treatment 

1. cognitive behaioral treatment

1. imagine exposure to memories of traumatic event

2. graduated or massed

3. increase positive coping skills

4. increase social support

5. highly effective  

2. group therapy

3. social skill training

4. SSRIs can be helpful  

1. receive heightened anxiety and panic attacks that are common to PTSD Cannot diagnose someone with PTSD unless it has been 6 mo

Adjustment disorders 

1. anxious or depressive reactions to life stress

2. milder than PTSD/acute stress disorder

3. occur in reaction to life stressors like moving, new job, divorce

4. clinically significant distress or impairment  

5. distinguish normal responses for life events with unexpected responses 6. clinical significant degree of impairment

7. clinically significant degree of stress

Attachment disorders 

1. disturbed and developmentally inappropriate behaviors in children

2. child is unable or unwilling to form normal attachment relationships with caregiving adults 3. occurs as a result of inadequate or neglectful care in early childhood  

Class Notes October 6, 2016

Obsessive compulsive disorder (OCD) 

1. obsessions are intrusive and reoccurring thoughts

1. need for symmetry

2. forbidden thoughts or actions

3. cleaning and contamination

2. compulsions are repetitive behaviors or mental actions that are repeated over and over in  order to reduce anxiety

3. prevalence: 1.6% to 2.3% (life); 1% (year)

Example:

think you left door unlocked, you can go check the door multiple times  

Common Compulsions

1. cleanliness

2. avoiding particular objects (ex. cracks in the sidewalk)

3. performing repretitive, magical, protective practices  

4. checking (is the door locked, is the gas off, is there a kid behind my car?) 5. performing a particular act (ex. chewing slowly, tapping a glass against your teeth in a  particular way)

Move in class about OCD

1. obsession around son jake (she must look at him at stop lights because she is scared he will  be taken)

2. when she is driving she doesn’t have to do it because she doesn’t think they could get him 3. scared of contamination either  

4. scared of AIDS or something contracted through bodily fluids  

Risk factors 

1. thought-action fusion: “if i think it, it will occur”

2. inflated responsibility: I can cause this event by doing XY and Z

Treating OCD 

1. cognitive behavior therapy  

1. exposure and ritual prevention (ERP)

2. highly effective

1. one study found that 86% of patients benefit  

3. no added benefit from combined treatment with drugs

4. SSRIs: 60% of patient benefit  

1. high relapse rate when discontinued  

Summary 

1. anxiety and related disorders occur when natural and adaptive processes (anxiety, fear and  panic) become disproportionate to the environment  

2. these disorders occur as the result of generalized biological vulnerabilities, generalized  psychological vulnerabilities and specific psychological vulnerabilities  

3. the most effective treatment for most anxiety disorders is cognitive behavioral therapy 1. medications may also be helpful

Affective and Mood disorders

Mood

1. “I am troubled; I am bowed down greatly; I go mourning all the day long… i am feeble and  sore broken… my hearth panteth, my strength faith me; as for the light of mine eyes it also is  gone from me” (King Solomon)

2. talks about some troubles of depression

Mood disorders

1. Hippocrates (400 BC): melancholia due to imbalance of humors, particularly the  overbalance of black bile  

1. there are four humors, blood, phlegm, black bile and yellow bile

2. Robert Burton (1621): Wrote the “anatomy of melancholia”  

1. hypothesized etiology included  

1. position of saturn

2. melancholy parents

3. intense love

4. ruddy complection

3. Emil Kraepelin (1800): separated schizophrenia from bipolar  

4. Karl Leonhard (1957): argued for bipolar vs. unipolar

Bad news: extraordinarily disabling

The good news: responds well to treatment

Overview (affective disorders)

Unipolar 

1. major depressive disorder

2. persistent depressive disorder

Bipolar 

1. Bipolar 1 and 2 (manic depression)

2. cyco

International epidemiology  

1. disease burden in economically developed countries (% of burden) 1. unipolar major depression (6.8)

2. schizophrenia (2.3)

3. bipolar mood disorder (1.7)

4. obsessive compulsive disorder (1.5)

5. panic disorder (.7)

6. PTSD (.3)

7. self inflicted injuries (ex. suicide) (2.2)

8. ex. financial cost, mortality, morbidity or other indicator  

Unipolar mood disorders 

1. typical variation (stays on the positive side of the neutral x axis, don’t dip too far into the  negative side)

2. persistent depressive disorder (most time there is a constant on the bottom side of the x  axis)

3. major depression (constantly changing; person sits in a sad mood state for a while, just  going between very sad and sad)  

Epidemiology 

1. rates of depression

1. increasing over last 5 decades (from 5.2% to 16%

2. women are twice as likely to develop symptoms of depression (very interesting and puzzling  phenomenon)

1. responsible for taking care of children, more role related stress

3. higher rates in young adults, and individuals with lower economical status, and elderly when  compared to general population

1. stress for students, elderly struggle with uncertainty and stress

Features of Depression 

1. emotional symptoms

1. low mood (how are you feeling today? not good)

2. crying, tearfulness

3. irritability  

2. behavioral symptoms  

 1. loss of experience of pleasure in life: anhedonia

 2. social withdraw  

 3. loss of motivation (“i don't care”)

3. cognitive symptoms

 1. self esteem  

 2. self blame, guilt, shame

 3. hopelessness

 4. ineffectual, indecisive

 5. poor concentration

 6. suicide  

4. bodily (vegetative) symptoms

 1. psychomotor retardation: people move more slowly (“walking through jello”)  2. low energy, fatigue

 3. sleep changes (increase or decrease)

 4. appetite changes (increase or decrease)

Depression and positive effect 

1. usually we feel happier seeing a positive face  

2. depressed individuals

1. display fewer positive expressions: smile study  

2. report experiencing less pleasant emotion in response to pleasant stimuli 3. physiologically less responsive to positive but not negative stimuli  4. do get the same response for negative stimuli  

Diagnosing a Major Depressive Episode

1. depressed mood or  

2. anhedonia  

1. must have one of these  

3. change in appetite/weight

4. insomnia, hypersomnia nearly every day

5. agitation, motor retardation (lethargy)

6. fatigue, loss of energy

7. feeling worthless or guilty

1. must have 5 or more  

Major Depressive Disorder

1. 2+ major depressive episodes

2. no history of manic episodes  

3. in 5-10% of people with MD epidote, the episode lasts 2 years or more

Risk factors for depression

1. gender (role stress)

2. age

3. sociocultural factors

4. life events  

5. social supports  

6. seasonal factors (S.A.D)

1. no sunlight sometimes

From Grief to Depression

1. in previous editions of the DSM, depression could not be diagnosed during periods of  mourning  

2. now recognized that major depression may occur as part of the grieving process 3. acute grief: occur immediately after loss  

4. integrated grief: eventual coming to terms with meaning of the loss

5. complicated grief: persistent acute cried and inability to come to terms with the loss  (continue to experience acute grief for extended periods of time, they are unable to come to  terms with their loss)

Class Notes October 11, 2016

Suicide and MDD (major depressive disorder)

1. people with mood disorders are 20 times more likely to commit suicide than the general  population  

2. bipolar disorder: 15X  

Persistent depressive disorder  

1. unremitting and unrelenting low mood (graph)

2. depressed mood most days, for at least two years  

3. while depressed, presence of 2 or more symptoms:

1. change in appetite

2. sleep change

3. fatigue, lack of energy

4. poor concentration, indecision

5. low self esteem

6. hopelessness  

Types of PDD (persistent depressive disorder)

1. mild depressive symptoms without any major depressive episodes (with pure dysthymic  syndrome)

2. mild depressive symptoms with additional major depressive episodes occurring intermittently  (previously called double depression)

3. major depressive episodes lasting 2 or more years (with persistent major depressive  episode)

Bipolar disorder

1. bipolar disorder I and II (manic depressive disorder  

2. alternating episodes of mania and depression

3. “if i see the light at the end of the tunnel, its the light of the oncoming train” (Robert Lowell)

Bipolar mood disorders

1. Orange line: depicts typical variability of mood

2. Bipolar I (previously called manic depressive): very high highs and very low low’s  1. most severe form of depression

2. break dancer example in class  

Manic episode

1. abnormally and persistently elevated or irritable mood, lasting at least a week 2. during this period at least 3 of them:

1. inflated self esteem (grandiosity)

2. decreased need for sleep

3. more talkative

4. flight ideas (racing thoughts)

5. distractibility

6. increased goal-directed activity, energy

7. high-risk activity  

3. marked by impairment in functioning, risk of self-harm  

Hypomanic episode

1. less severe version of manic episode: lasting 4 or more days (manic: 1 week), does not  impair functioning (manic: does impair functioning)

Bipolar I

1. both manic and major depressive episodes

2. one-year prevalence: 0.7%

3. equal gener ratio

4. typical onset: late adolescence or early adulthood

1. but also diagnosed in children— different presentation  

5. if untreated, episodes occur

Bipolar II (look at graph)

1. at least one amor depressive and one hypomanic episode but no manic episodes 2. one year prevalence: 0.5%

3. equal gener ratio

4. typical onset: late adolescence, early adulthood

1. in children too

5. if untreated episode reoccur  

DSM-5 Bipolar Disorders (FILL IN)

1. bipolar I

2. bipolar II

1. all between major depressive  

3. cyclothymic disorder

1. alternations between less severe depressive and hypomanic periods  

Cyclothymic disorder 

1. chronic version of bipolar disorder

2. alternating between periods of mild depressive symptoms and mild hypomanic symptoms

1. episodes do not met criteria for full major depressive episode, full hypomanic episode or  full manic episode)

3. hypomanic or depressive mood states may persist for long periods of time (ex. weeks at a  time)

4. must last for at least two years (one year or children and adolescents)

Other depressive disorders

1. premenstrual dysphoric disorder

1. significant depressive symptoms occurring prior to menses during the majority of cycle,  leading to distress or impairment

2. controversial diagnosis

1. advantage: legitimizes the difficulties some women face when symptoms are very  severe

2. disadvantage: pathologizes an experience may considered to be normal  3. symptoms (above “typical’ level) of: mood swings, irritability, depressed mood, or tension  as well as struggles with all of the following activities

1. decreased interest in normal activities, concentration, lethargy, sleep change,  appetite change, loss of sense of control, sense of lethargy or fatigue, and discomfort  4. distress

Disruptive mood dysregulation disorder  

1. severe temper outbursts occurring frequently, against a backdrop of angry or irritable mood 2. diagnosed only in children 6-18

3. criteria for manic/hypomanic episode are not met

4. intended to combat over diagnosis of bipolar disorder in youth

5. symptoms:

1. sever temper outbursts 3X a week for at least a year

2. generally angry or irritable mood  

Biological correlates of unipolar depression  

1. neurotransmitter abnormalities, especially monoamine system concentration in synaptic  cleft:

1. differences in concentration in seratonin (5HT)

2. norepinephrine(NE) - catecholamine hypothesis (depletion associated with stress), 3. dopamine (DA)

2. endoctrine dysfunction

1. abnormalities in HPA axis, excess cortisol levels  

3. genetic influence in depression: weak (unipolar)

4. Familial risk of bipolar

1. in contrast there is a strong genetic component of bipolar disease: adoption, family and  twin studies links to the 5-HTT gene (“mood gene”)

2. Alfred Lord Tennyson family pedigree studies (he was a poet and this history was found  in his poems and writing)

1. 4 of 12 had no symptoms  

2. 8 had bipolar and manic depressive or recurrent depression  

3. George Gordon or Lord Byron

1. if you look at his personal pedigree, you can see that many of his relatives struggled  with suicide, grandeur, murder,  

Robert Schumann: mania and creativity  

1. classical composer  

2. died because he starved himself to death as an inmate in an insane asylum  3. 1833: severe depression, 1840: hypomanic, 1844: severe depression, 1849: hypomanic,  suicide 1854

4. productivity in his art is tied to periods of low moods (producing very little) and periods of  hypomania or mania (producing a lot)

Cognitive schemes underlying depression

1. hopelessness: desired outcomes will not occur no matter what action is taken 1. learned hopelessness: a sense that it does not matter whether i move i will be shocked  either way  

2. global, stable, internal attributions: predict a sense of hopelessness  

Sample attributions

1. non depressive attribution

1. this is out of my control, i may as well relax (external vs, internal)

2. oh well its only one appointment (specific vs. global)

3. the traffic jam will clear up eventually (unstable vs. stable)

2. depressive attributions

1. this is completely my fault (external vs. internal)

2. my whole day is ruined i am going to fail because i missed this class (specific vs. global) (far reaching)

3. the traffic will never clear and i will miss class (unstable vs. stable)

Aaron Becks Cognitive Triad

1. depressed people tend to have negative thoughts and interpretations of: 1. themsleves

2. the environment

3. the future

2. depressed individuals experience distorted (irrational) interpretations which are especially  triggered by upsetting situations

Interpersonal model of depression

1. interpersonal relations tend to:

1. elicit rejections from others

2. exhibit fewer/reduced social skills

3. seek reassurance from others, but it does not “stick”

4. limited social support networks  

5. challenge is causality

1. are their social skills caused by depression or the outcome of their depression 2. researches are still trying to understand this

What do we do about it

1. social skill training: address interpersonal skills

2. cognitive-behavioral approach (ex. beck and cog. triad) to change though patterns and  activity levels  

1. effective

Cognitive Behavioral Therapy (CBT)

1. trying to help people get over irrational and negative thoughts about themselves, the world  around them and the future

2. goal is to identify, monitor, challenge and replace irrational thoughts

1. increase activities to elevate mood

2. identify negative thinking and biases  

3. monitor negative thoughts

4. challenge these thoughts

5. replace them with more adaptive and positive attitudes  

Effective: 5-6/10 people have near elimination of symptoms

1. fast (fewer than 20 sessions)

2. cheap (group therapy)

Class Notes October 13, 2016 Situation

1. what happened?

Emotion collum: what was the emotion you were feeling?

1. understand their emotions

2. rate how strong the emotion was

Automatic thoughts

1. what was the belief or thought you had in the moment  

2. how did it make you feel

Rational response

3. rethink the belief, write down alternatives

4. rate how convinced  

Outcome

1. how do you feel now do you feel a little less negative about this finding?

Transmission at the synapse

1. axon receives nerve impulse

2. charge causes it to open and release neurons into presynaptic gap 3. release serotonin or norepinephrine  

4. post synaptic receives enough neurotransmitters and then if enough fires message 5. reuptake  

6. in people with depression, reuptake is too constant and there is not enough  neurotransmitters to reach the post synaptic neuron

7. what antidepressants do is block the reuptake sights in the presynaptic neuron, leaving  more neurotransmitters for the postsynaptic neuron

Biologically oriented interventions

1. catecholamines (epinepherine, norepinephrine, dopamine)

1. decreased norepinephrine associated with stress, mania and depression 2. serotonin

1. presence of serotonin metabolite (precursor) associated with depression severity 3. MAOIs bind to MAO: this prevents MAO from breaking down catecholamines and other  monoamines

1. tricyclics and MAO inhibitors: block reuptake of NE and seratonin; increased presence in  the synapse

Antidepressants: change neurotransmitter levels in the synaptic cleft 

1. older medications (from 1950ss)

1. MAO inhibitors (Nardil, Parnate)

2. slows down production of MAO, which breaks norepinephrine  

3. MAOIs potentially pose a serious danger

1. blood pressure may rise to a potentially fatal level if one eats food with tyramine  (cheese, bananas, wine) while taking MAOIs

4. Newer MAOIs (reversabile and selectedtive) are less dangerous  

2. tricyclic antidepressants (amitriptyline, imipramine)

1. effective and show improvement in 60-65% of patients

1. 6-8 week lag before effects are seen (2 mo)

2. BUT these improvements are short lived: if discontinued when symptoms improve,  relapse in a year

1. continuation therapy (continue medication 5 mo after symptoms remit) then there is a  decreased risk of relapse  

1. maintenance therapy (take medicine for 3 or more years) there is a decrease in  relapse  

3. side effects: dry mouth, constipation, sedation, weight gain

4. tricyclics mechanism

1. 3 ring molecular structure: “TRI”

2. tricyclics block reuptake and there are increased amount of neurotransmitters in the  synapse (looks like image before)

3. selective serotonin reuptake inhibitors (SSRIs)

1. 2nd generation antidepressants: SSRIs, S-norepinephrine-RI’s (SNRI’s) 1. structurally different from MAOIs and tricyclics  

2. they are more specific in that they act on only serotonin or NE

3. ex. fluoxetine (prozac), sertraline (zoloft), paxil, luvox, celexa

4. effectiveness is similar to tricyclics but more popular (newest thing on the scene and  more expensive)

5. side effects: less energy, reduced sex drive

4. atypical antidepressants

1. wellbutrin, effexor, serzone, remeron

2. tackle both serotonin and NE systems  

Treating bipolar disorders 

1. mood stabilizing medication

2. most people rely on:

1. lithium  

2. depakote, depekene (valproic acid)

1. primarily used for seizure disorders

2. discovered accidentally  

3. psychotherapy alone not effective but helpful for:

1. family intervention; medication arrangement; social skills, relationship issues; circadian  rhythms or mood cycles (Ellen Frank)

4. long term treatment to reduce relapse rates

Lithium therapy  

1. discovered as a treatment in 1949

2. seems to be quite effective but finding correct dose is extremely difficult: 1. no therapeutic effect: <0.5 m Eq/L

2. effective dose: 0.5-0.7m Eq/L

3. mild toxic effect: 1.0m Eq/L

4. poisoning: 2.0m Eq/L

5. (milliequivilents per liter)

3. 60% of manic patients see improvements  

4. cycling is less rapid

5. may be a prophylactic (may prevent systems from emerging)

6. most experience fewer new episodes

7. lithium helped a little for symptoms with depressive episodes  

Suicidality

Suicide 

1. the intentional ending of one’s own life

1. 11th leading cause of death in the US (2001)

1. twice as many as for AIDS/HIV

2. many are unreported and there is likely a higher rate

2. 3rd leading cause of death for adolescents

3. 4th leading cause of death for 9-12 yo

2. for psychologists, suicide is one of the most serious assessment problems 3. firearms account for 55% of all suicides

Suicide myths 

1. people who talk about suicide won’t do it

2. suicidal people act without warning (in reality they usually show signs of pulling away) 3. people who commit suicide are always depressed

4. suicide is a lonely event

5. suicide people clearly want to die

6. thinking about suicide is rare

Demographic factors 

1. Age

1. highest rate: men ages 74 or higher (lack of social support)

2. fastest increase of suicide in teen and young adults (3rd leading cause of death) 2. gender

1. 4:1 (males are more likely to complete suicide)

1. because men are more likely to use firearms

2. 3:1 (females are more likely to attempt)

3. ethnicity

1. 2:1 (white are more likely than african americans)

1. driver of this difference is social connection  

2. extremely high rates of suicide in native americans in the US

1. alcohol rates 80%

Red flags for adolescents 

1. 9-20% of college students contemplate suicide in a given year

2. indicators  

1. fatigue

2. sleep loss, change in sleep patterns

3. decline in school performance

4. writing goodbye letters to friends

5. giving away possessions

6. social withdraw

7. loss of appetite

Psychological risk factors 

1. loss of interest/ pleasure (anhedonia)

2. hopelessness/helplesness

3. feelings of shame, anger, worthlesness, sadness

4. poor problem solving skills  

5. poor self soothing skills

6. limited conception of the future

7. impulsivity

8. fantasies of death

Biological/genetic risk factors  

1. family history of suicide (6X higher to commit)

2. family history of mood disorders

3. personal history of psychological illness

1. higher for those with mood disorder or schizophrenia

4. changes in activity level, sleeping patterns, appetite

5. low serotonin (increased impulsivity)

6. substance abuse/ dependance

1. alcohol in teens

Social risk factors 

1. previous attempt (39X more likely to complete suicide later on)

1. seems to be that you are training yourself out of that instinctual revoltion 2. lack of social support and social withdrawal  

1. seen especially in recent loss of important relationships (highest in those who are  recently divorce)

3. acute stressors (loss of job, natural disaster)

4. long term stresses (economic hardship, chronic illness, history of abuse) 5. increase risk taking behaviors (injection of drugs, sexual risky behaviors) 6. suicide contagion: experience of someone committing suicide is covered heavily (modeling) 1. suicide romanticized in media

2. little information about incomplete attempts

Protective factors 

1. positive life events

2. social support

3. feelings of self efficacy

4. cognitive flexibility and problem solving skills 5. hope

6. strong religious beliefs  

7. treatment

When someone is suicidal

1. let others know… despite pleas to “keep it a secret” 2. stay in personal contact

3. hospitalization may be necessary

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