Adult Psychopathology Notes 3/15-3/17
Adult Psychopathology Notes 3/15-3/17 PSYCH 3250
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This 8 page Class Notes was uploaded by Ashley Notetaker on Sunday March 20, 2016. The Class Notes belongs to PSYCH 3250 at Cornell University taught by DR. HARRY SEGAL` in Spring 2016. Since its upload, it has received 17 views. For similar materials see ADULT PSYCHOPATHOLOGY in Psychlogy at Cornell University.
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Date Created: 03/20/16
3/17: Finishing up last week’s lecture: Reuptake inhibitors: allow neurotransmitters to stay in the synapse When you’re taking SSRIs, your neurons are downregulating in order to get used to the new amount of serotonin in the system TCA: Tricyclic Antidepressant It does lift depression for some people BUT it does cause a lot of unpleasant side effects This was what was prescribed a bunch in the 80s The 2nd Gen of Reuptake Inhibitors SSRIs There are people who think that all medication is bad, then there are people who want to be able to take pills all the time. It’s best to just be in the middle of that. The best treatment is to be able to use the medium to regulate properly Table of Various Antidepressants and Their Associated Functions This Week’s Lecture Hamlet: Act 2.2.222 There is a character in this play that will have a psychotic reaction to trauma Rosen. & Guilden. Enter Hamlet and the two engage in “wit” and basically are referring to fortune as a woman/prostitute Hamlet knows why the two of them are there Description of depression “ What a piece of work is a man! how noble in reason! how infinite in faculty! in form and moving how express and admirable! in action how like an angel! in apprehension how like a god! the beauty of the world! the paragon of animals! And yet, to me, what is this quintessence of dust? man delights not me: no, nor woman neither, 3 though by your smiling 0 1 you seem to say so. Next lines: He’s telling them that he’s not crazy. (but also that he kinda is..but mostly because of the trauma that he’s feeling from knowing that he’ll die once he goes after his uncle Stimulating the Depressed Brain The Newest Approach: Area 25 in the Limbic System Story of Deanna ColeBenjamin: An example of almost purely organic causes for depression 4 years of varied treatment including hundreds of sessions of ECT Deep Brain Stimulation Planting Electrodes: Has been helpful for some patients suffering from Parkinson’s The operation: Description is in the slide Patient is kept awake for the whole thing “you can hear it and see it and smell it) Deanna’s case description Looking for a depression “network” in the limbic system Mayberg was trying to evaluate a hypothesis: found a new way of looking at psychiatric conditions “Carpet bombing” the brain Sidebar: the success rate is more like 35% than 50% Deanna actually did recover (at least for the first year, as far as he knows) There are many ways of getting to depression, it’s not like breaking a leg. Mood is a part of consciousness Is mediated by experience, hormones, other parts of your physical system (eg low thryoid can cause depression) Instead of thinking “depression” we need to think “the variety of depression” This also affects the success/failure of different types of treatment Approaching Suicide When Depression leads to Suicidal Thoughts It used to be the protocol in high school, when a suicide happened you used to have a big assembly where you talked about it But they found that this just led to more suicides Now, the protocol is that just the faculty gets together and then they talk about who else is vulnerable What many people suffering from suicidal “ideation” say: 1. It seems as though the pain will never end… 2. My life will never change… 3. I can’t stand the guilt anymore… 4. Suicide is something I keep in my back pocket Suicide is actually an act of violence (in that it is technically an act of aggression) The Subjective Experience of Suicidal IdeationRoy Baumeister The person is that the suicidal person deliberately stays away from thinking about meaningful things in his/her life Time perspective narrow Concreteness over broad Proximal goals over distal goals The suicidal person is not associating to things in the future (long term goals, things that give meaning). Instead they are narrowing their view in preparation for killing himself Suicide & NonSuicidal Depressed Teenagers 1. 2 groups of depressed adolescent girls matched by age, family composition, social class, and level of depression (all done through interviews/selfreport questionnaires). One group was suicidal, the other was not 2. Parents filled out questionnaires about their mood, life satisfaction, and quality of marriage 3. Hypothesis: If mom is depressed, that makes the depressed girl more likely to be suicidal a. It wasn’t 4. But fathers a. POWERFULLY predicted suicidal thoughts or attempts Three Kinds of Suicide 1. Thoughtfully planned out 2. Impulsively with hope of being stopped 3. Committed because of a psychotic thinking episode What prevents suicide? 1. Love and attachment to others 2. A sense that one can change one’s life 3. Restored hope in a wished for future self 4. An ability to take the “long view” to appreciate life philosophically 5. Learning that loss is an inherent part of life, and that mourning is part of wisdom *Sidebar: Cornell DOESNT have the most number of suicide of universities Mania, hypomania, and bipolar variants Bipolar Depression 1. Strong heritable coponent 2. BiPolar I features “full blown mania”” which necessarily includes psychotic elements 3. BiPolar ii is more variable, with periods of major depression...seems to have some sort of heritable component Diagnostic Criteria for Manic Episode Treating (and living with) bipolarity Treating Bipolar I 1. Lithium (John Cade)mode stabilizer 2. Anticonvulsive 3. Gabapentin (GABA agonist) The hardest thing about treating bipolar patients: when they’re manic, they don’t believe they’re sick