Psych Exam 4

• Medical (‘mental illness’): treats mental health problems like physical conditions (considers symptoms, causes, outcomes —> treat symptoms)
• Biopsychosocial (“psychological disorder“): takes into account a combination of biological, psychological, and sociocultural factors to understand and treat mental health problems
• Predisposition toward a disorder is expressed when stress arises
• Myths about Psychological Disorders:

  They aren’t real illnesses, they’ll never affect me, they are an excuse for bad behaviour, they are caused by bad parenting, they result in dangerous behaviour, they cannot be cured, they arise in weak people who can’t handle stress, they prevent people from working, they only arise in adults, depression is a normal part of aging
• Impacts of Believing the Myths:

  Stereotypes & Prejudices: they are dangerous, incompetent, to blame for their disorder and unpredictable

  Discrimination: employer may not hire them, landlords may not rent to them, health care may provide a lower standard of care (public); lead to lowered self-esteem and self-efficacy (self); loss of opportunity (institutional)
• ’Normal’ vs. ‘Abnormal‘

  Difficult to be consistent in diagnosis; depends on personal experience of clinician and the unique presentation from the individual

  May be abnormal if behaviours/feelings are ‘maladaptive’, if they become ‘significantly dysfunctional‘, or experience distress
• Anxiety Disorders

  ”category of disorders involving fear or nervousness that is excessive, irrational, and maladaptive.”

  • Anxiety is more intense and lasts longer than a normal anxiety response
  • Occurs in 1 in 8 Canadians
  • Common with other disorders such as depression and substance abuse
• 4 Main Components of Anxiety Response

  • Subjective emotion: apprehension/fear
  • Cognitive: thinking about what ’could’ happen; not being able to cope
  • Physiological: increased heart rate
  • Behavioural: impaired performance; rigid control of situations around us; avoiding situations
• Generalized Anxiety Disorder

  • General, chronic, “frequently elevated“ fear
  • Not attached to specific situations or objects
  • ”Generally from normal challenges and stresses of everyday life”
• Generalized Anxiety Disorder Symptoms

  • sleeping problems, difficulties breathing, problems concentrating/paying attention, intrusive thoughts
  • Anxiety shifts from one situation to the next which makes it hard to manage
• Generalized Anxiety Disorder Causes

  • Convergence of stressors
  • Greater sensitivity to stressors (larger right amygdala- greater response to negative emotional stimuli)
  • Greater neural activity response associated with making mistakes
• Panic Disorder

  • sudden, unpredictable, intense anxiety
  • panic attacks: “brief moments of extreme anxiety including rush of physical activity and frightening thoughts
  • may occur with or without agoraphobia (resulting in fear of having a panic attack in public)
• Phobias

  • strong, irrational fears of objects/situations
  • avoid object/situation when possible
  • impairment depends on how often object/situation is encountered
• Category 1: specific phobia, “intense fear of a specific object, activity or organism“

  Causes:

  • genetic element to specific phobias (ex. heights), easily developed and have evolutionary value
  • learning, even from watching someone else demonstrating a fear
  • personality, shyness; ‘inhibitedness‘
  • greater autonomic reactivity
• Category 2: social phobia, “related to interpersonal situations and relationships“

  • ”intense fear of being judged by others or being embarrassed/humiliated in public”
  • Manage anxiety through: developing routines, establishing control so they can escape situations, limited social activities
• Obsessive-Compulsive Disorder

  • “unwanted, inappropriate, and persistent thoughts (obsessions), and engage in repetitive, often ritualistic behaviours (compulsions)”
  • Obsessions: cognitive component; repetitive and unwelcome (uncontrollable) thoughts
  • Compulsions: behavioural component; repetitive, “ritualistic” behaviours (hard to control)
  • compulsions tend to relieve the anxiety of the obsessions
• Brain & OCD & Compulsions

  • orbitofrontal cortex- decision making
  • basal ganglia- linked to “movement and reward”
  • thalamus- role in sensory information processing
• Brain & OCD & Obsessions

  • abnormal functioning in other brain regions in frontal lobe
  • area of prefrontal cortex- linked to attentional control and problem solving
  • frontal lobe area- linked to attention and emotion
• Dissociative Disorders

  • ”a category of mental disorders characterized by a split between a person’s conscious awareness and their feelings, cognitions, memory, and identity“
  • caused by “brain damage or psychological trauma“
• Types of Dissociative Disorders

  • Dissociative Fugue: “period of profound autobiographic memory loss”
  • Dissociative Amnesia: “severe loss of memory, usually for a specific stressful event, when no biological cause for amnesia is present“
  • Dissociative Identity Disorder: “split in identity such that they feel different aspects of themselves as though separated from each other… severe enough that person constructs entirely separate personalities… only one in control at a time”
• Depression - “characterized by prolonged periods of sadness, feelings of worthlessness and hopelessness, social withdrawal, and cognitive and physical sluggishness”
• Key Symptoms of Depression

  • Emotional - despair, uselessness
  • Cognitive - difficulties making decisions, concentrating, memory is negatively valenced
  • Physiological - appetite, digestive problems, sleep disturbance
  • Motivational - loss of interest/drive
• Cognitive Element of Depression

  • pessimistic explanatory style
  • associated with “making the worst” of situations
  • Attributions: “my fault” (internal), “always this way” (stable), “everything” (global)
• Depression - Brain Regions

  • Amygdala: “overactive in depressed brain”
  • increases activity of cortisol and, as a result, can lead to damage to hippocampus and frontal lobes and can negatively impact new neuron growth (neurogenesis)
  • long term impact: greater sensitivity to stressors, negative impact on flexibility of thought and learning
• Depression - Sociocultural and Environmental Factors

  • Poorer neighborhoods - greater stress, reduced educational/social connections and opportunities and social networks also affected
  • Social Media Impacts - greater amount of total time on social media and greater number of times checking social media associated with greater depression (comparison issue)
• Depression - Genetic Vulnerability

  • greater concordance rates for identical twins
  • link between 5-HTT gene and risk of depression
  • diathesis-stress model says genetic predisposition + accumulation of stressors makes risk more likely
• Bipolar Disorder - “characterized by extreme highs and lows in mood, motivation, and energy”

  • depression alternates with mania
  • manic state: euphoric mood, grandiose cognitions, high energy (fast talking, racing thoughts, impulsive decisions)
• Challenges of Bipolar Disorder

  • individuals may stop taking meds while in manic state
  • change from depressed to manic state can lead to acting on negative thoughts (suicide rate slightly higher in bipolar disorder vs. depression)
• Schizophrenia - ”brain disease that causes the person to experience significant breaks from reality, a lack of integration of thoughts and emotions, and problems with attention and memory”

  • symptoms may arise gradually or rapidly
• Distinct Stages of Schizophrenia

  • Prodromal - confusion, disorganized thinking, disengagement socially and reduced motivation
  • Active - delusions, hallucinations, disorganized thought/emotions/behaviour patterns
  • Residual - symptoms have lessened or disappeared, but still may be withdrawn, have trouble concentrating and have low motivation
  • General Guidelines - stress can ’trigger’ short term periods of recurrence of symptoms
• ”Positive“ Symptoms in Schizophrenia

  • Positive (added) symptoms means presence of maladaptive behaviours
  • Delusions - beliefs that are not based in or integrated into reality
  • Hallucinations - sensory experience without exposure to a stimulus
  • Inappropriate emotional reactions
• “Negative“ Symptoms in Schizophrenia

  • Negative symptoms (what is ‘lost’) refer to the absence of adaptive behaviour
  • disorganized behaviour - difficulties completing daily tasks
  • absent of ‘flat’ emotional reactions
  • lack of motivation
  • poor social interactions with others
  • movement disturbance
• Additional (possible) Symptoms of Schizophrenia

  • Excessive eye blinking (in response to stimulation)
  • cognitive difficulties - working memory deficit (difficulties following a train of thought or a conversation)
• Schizophrenia Subtypes

  • Catatonic - severe motor disturbance for extended periods (ex. motionless for hours - may demonstrate ‘waxy flexibility‘)
  • Disorganized - disorganization of thoughts, speech, emotions, and behaviours
  • Paranoid - delusions (persecution and grandeur)
• Causes of Schizophrenia

  • Genetic Vulnerability: evident in genetic relatedness
  • Brain abnormalities: destruction of neural tissue linking to 20-30% larger ventricles in those with schizophrenia
  • Lower Brain Functioning in Frontal Lobes - both when at rest and when performing cognitive tasks (may be linked to problems like ‘disorganized thinking’
  • Neurodevelopmental hypothesis - variables during pregnancy (high stress, malnutrition) impacts brain development in child and subsequent schizophrenia risk
• Social/Environmental Causes of Schizophrenia

  • head injury before age of 10
  • living environment with interpersonal conflict, social isolation, poverty - linked to greater stress
  • high expressed emotion (more critical and controlling rather than supportive, accepting, nonjudgemental)
  • return to high expressed emotion environment can lead to future episodes of schizophrenia after recovery, but living with schizophrenia is stressful for family
• Who Seeks Treatment

  • 18% of Canadians 12 yrs + reported they need mental health assistance
  • 55% of those felt their needs were met
  • 22.5% needs were partially met
  • 22.5% need unmet
  • highest perceived need was for 18-34 yr olds
• Who Seeks Treatment

  • Why care was unmet:
  • didn’t know where to get help
  • not able to get care
  • not able to leave work
  • too expensive
  • fear of what others would think
  • lack of trust; lack of insurance coverage
• Barriers for Treatment

  • line between illness and health
  • stigma
  • attitudes about treatment
  • gender roles
  • cultural differences
  • geographic barriers
  • cost of treatment
• Providers and Settings

  • Clinical Psychologists - PHD’s, diagnose and treat
  • Psychiatrists - MD, psychiatric specialization - diagnose, treat, and prescribe meds
  • Counselling Psychologists - MA or PHD prepared - everyday problems/issues
  • Social Workers and Psychiatric Nurses - training in therapeutic practices