Abnormal Psychology (PSYC2011) Oct 4-6 Class Notes
Abnormal Psychology (PSYC2011) Oct 4-6 Class Notes PSYC 2011
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This 9 page Class Notes was uploaded by Jesse Catir on Sunday October 9, 2016. The Class Notes belongs to PSYC 2011 at George Washington University taught by Sherry Molock in Fall 2016. Since its upload, it has received 16 views. For similar materials see Abnormal Psychology in Psychology at George Washington University.
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Date Created: 10/09/16
October 4th Class - Mood Disorders Etiology of Dissociative Disorders • may be due to problems in connections between various brain areas, especially between sensory systems (eyesight and hearing) and the limbic system • people undergoing depersonalization have blunted reactions to arousing stimuli • neurochemical changes in serotonin, endogenous opioid, and glutamate systems that relate to depersonalization have also been noted • HINT: dissociation is also a normal response (response to being tired or stressed out, for example). if you do this as a child and keep doing this, parts of your personality will split oﬀ and compartmentalize. the goal of treatment is to integrate all of these aspects • intense negative emotions lead to key memory changes ◦ HINT: similar mechanism to PTSD ◦ compartmentalization and diﬃculty retrieving information • compartmentalization incomplete ◦ when one personality learns new information, interference in learning in another personality can occur. ◦ one personality may also retrieve information learned by another personality ◦ people with these disorders often have deﬁcits in their short-term and working memories Treatment • high % of some of disorders will spontaneously remit • medical: treat symptoms of depression and anxiety with meds • supportive therapy • hypnotherapy: get person to remember trauma under hypnosis and integrate memory into personality; mixed results (controversial. some say you should respect that the mind doesn’t want to deal with the memory. also controversy over which DID even exists. insanity defense only works about 1% of the time) MOOD DISORDERS Depressive Disorders: DSM-5 categories • disruptive mood dysregulation disorder • major depressive disorder, single episode • major depressive disorder, recurrent • persistent depressive disorder • premenstrual dysphoric disorder • substance-induced depressive disorder • depressive disorder associated with another medical condition • depressive disorder not elsewhere classiﬁed Major Depressive Disorder • HINT: disposition = mood. aﬀect is diﬀerent than disposition. • Normal: ◦ emotions: good mood ◦ cognitions: thoughts about what one has to do that day. thoughts about how to plan and organize the day ◦ behaviors: rising from bed, getting ready for the day, and going to school or work • Mild: ◦ emotions: mild discomfort about the day, feeling a bit irritable or down ◦ cognitions: thoughts about the diﬃcult of the day. concern that something will go wrong. ◦ HINT: beginning of tendency to start thinking about what could go wrong ◦ behaviors: taking a little longer than usual to rise from bed. slightly less concentration at school or work • Moderate: ◦ e: feeling upset and sad, perhaps becoming a bit teary-eyed ◦ c: dwelling on the negative aspects of the day, such as a couple of mistakes on a test or a cold shoulder from a coworker ◦ b: coming home to slump into bed without eating dinner. tossing and turning in bed, unable to sleep. some diﬃculty concentrating. • Depression - less severe: ◦ e: intense sadness and frequent crying. daily feeling of heaviness and emptiness ◦ c: thoughts about one’s personal deﬁciencies, strong pessimism about the future, and thoughts about harming oneself (with little intent to do so) ◦ b: inability to rise from bed many days, skipping classes at school, and withdrawing from contact with others. • Depression - more severe: ◦ e: extreme sadness, very frequent crying, and feelings of emptiness and loss. strong sense of hopelessness ◦ c: thoughts about suicide, funerals, and instructions to others in case of one’s death. strong intent to harm oneself. ◦ b: complete inability to interact with others or even leave the house. great changes in appetite and weight. suicide attempt or completion. Types of depression: Major Depressive Disorder (MDD) • MDD is the most common mental disorder in adults ◦ 13 million Americans or 6.6% of the pop ◦ lifetime rate = 33 million or 16.2% • 75% of suﬀerers have comorbid disorder: ◦ anxiety disorder (59%) ◦ OCD (31.9%) ◦ substance abuse (24%) are all comorbid with MDD ◦ HINT: more common to have comorbidity with substance abuse and anxiety disorder • lifetime gender diﬀerences in MD episode • 1/4 females • 1/10 males • HINT: much more common in women than men DSM-5 criteria for Major Depression • at least ﬁve of the following symptoms have been present during the same 2- week period and represent a chance from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or please (anhedonia) • at least four of the following symptoms: ◦ 1. signiﬁcant (HINT 10% up or down) weight or appetite change ◦ 2. insomnia (diﬃculty falling asleep OR fall asleep but wake up early) or hypersomnia ◦ 3. psychomotor retardation or agitation (HINT: speech is a motor behavior!) ◦ 4. fatigue or loss of energy ◦ 5. feelings of worthlessness or excessive guilt ◦ 6. diminished ability to concentrate, indecisiveness ◦ 7. suicidal ideation or behavior • HINT: by deﬁnition the symptoms cause clinically signiﬁcant distress or impairment in social, occupational, or other important areas of functioning Developmental Aspects • mood disorders related to anxiety and depression are common during adolescence • clinical depression occurs in 3-5% of the population of adolescents • prior to this age the rates are 1-2% • gender diﬀerences in depression emerge by age 13-14 ◦ by age 18, females show a 2 to 1 prevalence which remains stable through adulthood • although diagnostic symptoms for adolescents are similar to adults, depressed children are more likely to describe physical symptoms • environmental factors also appear to be a critical factor in the development of depression • attachment relationships have also been linked to a cognitive vulnerability to depression Chronic Disorder • depression is a recurrent illness • likelihood of having another episode of depression increases with each subsequent episode ◦ 1 episode, likelihood of another - 50% ◦ 2 eps, likelihood of another - 70% ◦ 3 eps, likelihood of another - 90% • HINT: period of feeling well to feeling well again is about 6 months (average episode = 6 months). one of the reasons why this is diﬃcult to treat. people stop taking meds because they think they’re going into remission but they are not going into remission yet. Persistent Depressive Disorder • depressed mood for most of the day, for most days for at least 2 years • HINT: major depression = 2 weeks, persistent depressive disorder = 2 years • HINT: not mild depression. might be more disabling because it’s always there • at least 2 of the following ◦ poor appetite or overeating ◦ insomnia or hypersomnia ◦ low energy or fatigue ◦ low self-esteem ◦ trouble concentrating, making decisions ◦ feeling hopeless • no manic, mixed or hypomanic episodes • no major depressive episode in 2 years • no remission of symptoms for more than 2 months Manic Episode • excessive happiness, excitement, HINT: irritability (not always happy) • increased energy, psychomotor agitation • decreased need for sleep, racing thoughts, ﬂight of ideas, very talkative, pressured speech, tendency to make grandiose and unattainable plans • engaging in high-risk behaviors: shopping sprees, hyper sexuality, gambling, etc. • can cause signiﬁcant impairment which may require hospitalization • symptoms occur for at least 1 week • HINT: delusion is a false belief that you believe even in the face of contrary evidence • more likely to be hospitalized than major depressive disorder because they can get into more dangerous situations Types of Manic Disorders • Bipolar I: have at least one manic episode; alternate between manic and depressive episodes ◦ mixed episode: experience mania and depression at the same time or in rapid sequence ◦ rapid cycling: frequent switching from manic to depressive episodes (at least 4 cycles/yr); no period of “normal mood" • Bipolar II: manic episodes are hypomanic, never reach full manic episode (may confuse with someone simply having a bubbly personality) • cyclothymic: milder symptoms of bipolar disorder • HINT: diﬀerence between bipolar II and cyclothymic: bipolar II depressive episodes very intense, cyclothymic both are milder. will not ask about cyclothymic on test. Epidemiology of Mood Disorders • Lifetime prevalence rate for any mood disorder very high: about 20% Risk Factors: Biological • Monoamine Hypothesis: ◦ depression caused by deﬁciency in NT’s called monoamines ▪ decreased levels or serotonin and carecholamines: dopamine, norepinephrine, epinephrine • HINT: monoamine hypothesis: a group of transmitters are called monoamines. MAO inhibitors aﬀect monamines Risk Factors: Genetic • temperament: avoidance, emotionally reactive, dependent, impulsive personalities more prone to depression • does run in families ◦ bipolar: one parent - 27%; both parents: 50-75% ◦ concordance rates for mono zygotes: ▪ 50-67% for bipolar ▪ 27-40% for MDD October 6th Class Risk Factors: Environmental • Environmental ◦ stressful life events ◦ Cognitive factors: ▪ negative expectations ▪ catastrophizing ▪ overgeneralizing: focus on small, insigniﬁcant TEST: will give scenarios of patients’ symptoms and ask for diagnosis or treatment. Tell ALL possible treatments, not just the ones you likes. Also side eﬀects. Treatment: Pharmacotherapy • HINT: the treatment of choice for severe mood disorders is a combination of medication plus therapy • Three major classes of antidepressants ◦ tricyclics:, tofranil (Imipramine), Elavil: Anticholinergic side eﬀects associated with acetylcholine rich places in your brain. dry mouth, tremors in hand, constipations, dizziness. Tricyclics mostly produce these side eﬀects. ◦ MAOIs: drugs that tend to have milder anticholinergic side eﬀects. go into remission faster and stay in it longer. have to watch meds you use and talk to your doctor. Tyramine found in aged food, smoked meats, beer, wine. if you take MAOI with a food that has tyramine in it, it could cause a hypertensive crisis or stroke. not typically prescribed to teenagers or homeless people. ◦ SSRIs: newest group of drugs. prozac, zoloft, etc. block reuptake of serotonin. have milder anticholinergic side eﬀects. all three groups take about 3 to 4 weeks to work. • Alternative Treatments ◦ St. John’s Worts ▪ eﬀective in mild-to-moderate depression • Augmentation strategies ◦ use 2nd med to augment one that’s not working as well ◦ could probably do it with up to 3 ◦ tricyclic and SSRI most common ◦ SSRI most widely prescribed class of antidepressants Treatment: ECT • best treatment for severe depression • pass electric current through brain to induce seizure • give muscle relaxants and put to sleep • seizure changes neurochemical functioning of brain • most people receive 2-3 treatments/week for 5-10 treatments • is the most eﬀective treatment for sever MDD, esp. when person unresponsive to meds or is suicidal or acute psychotic • psychosis: having hallucinations and/or delusions • side eﬀects: short term memory loss (whole day or few hours before treatment), long term impairment (those memories don’t come back), Treatment • cognitive-behavioral: help people change way they think ◦ CBT teaches patient to: ▪ identify negative, self-critical thoughts, ▪ see their connection with depression, ▪ examine distorted thoughts, ▪ replace them with realistic interpretations ▪ 12-16 weeks • Interpersonal: ◦ IPT: short term; focus more on relationships, 12-16 weeks, dev. Assertiveness and social skills ◦ short term, psychodynamic eclectic treatment ▪ targets interpersonal relationships ◦ depression occurs within interpersonal context ◦ focus is on current problems/conﬂicts within these relationships • Eﬃcacy: ◦ mild to moderately severe MDD: meds, CBT, and IPT equally eﬀective ◦ severe MDD: therapy and meds (ECT) ◦ bipolar and psychotic depression: meds required Treatment for Bipolar Disorders • Typical treatment for bipolar patient involves lithium carbonate, which is 60-80% eﬀective ◦ negative physical side eﬀects: ▪ nausea, diarrhea, dizziness, muscle weakness, fatigue, and a dazed feeling ▪ ﬁne tremor, frequent urination, thirst and weight gain, lack of compliance or self-regulation of dosage ◦ anticonvulsant drugs are also being used ▪ typically used to treat epilepsy but can also be used to treat bipolar disorder ▪ same side eﬀects as lithium ◦ psychotherapy and family therapy have also proven helpful ◦ psychoeducation, family-focused, interpersonal, and cognitive-behavioral therapy reduce symptom severity and relapse, and enhance psychosocial functioning ◦ social rhythm method: creation of day-to-day routines HINT: MDD and Bipolar will be focused on most HINT: always treating symptoms, not disorders. HINT: if a person has bipolar disorder, have to be careful about using tricyclics because they can cause a manic episode. Suicide in Adolescents and Young People Introduction • suicide is not a disorder, it’s a symptom • suicide is 2nd leading cause of death among youth aged 10-24 • more teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, inﬂuenza, and chronic lung disease, COMBINED • each day in our nation there are an average of over 5,400 attempts by young people grades 7-12 • between 7-9% of high school aged students attempt suicide in the US each year • sometimes hard to tell if suicide or accidental death. a lot of suicides among young people occur while substances are in their system. Factors associated with suicide • Age: ◦ in whites, suicide rate highest amongst elderly ◦ in blacks, suicide rate highest among 25-34 year olds • Season: ◦ more suicides occur in spring and summer • Gender: ◦ males have higher rates of completions; females have higher rates of attempts (males most likely use more lethal methods, ﬁrearms or suﬀocation) (men also tend to be more impulsive) • SES: suicide occurs across all SES levels • Marital Status: suicide occurs most amongst divorced persons • Method: ◦ men are more likely to choose guns or hanging ◦ women more likely to use pills • Ethnicity: ◦ native americans have highest suicide rate, followed by whites, Mexican americans, african americans, Japanese americans, and Chinese americans (this is across all age groups) Cultural Issues in Suicide • we know very little about suicide in other cultural/ethnic groups (very important not to group people) • often assumed that other groups did not experience depression and suicide because they were too intellectually or psychologically unsophisticated • assumption that mental illness is expressed the same in all cultures • led to social scientists being unaware of the marked increase in suicidal behaviors among african americans and latinos Cultural diﬀerences in Suicidal Behaviors • AAs are less likely to use drugs during suicide crisis • behavioral component of depression more pronounced in AAs • Some AAs and Latinos express little suicide intent or depressive symptoms during suicidal crisis
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