Abpsy 2

• Health Psychology


  A subspecialty within behavioral medicine that is concerned with the effects of stress and other psychological factors in the development and maintenance of physical problems
• A behavioral medicine approach to physical illness is concerned with psychological factors that may predispose an individual to medical problems
• Diathesis-Stress Model


  Stress can trigger the onset of mental disorders in vulnerable people
• The power of any experience is greatest during development
• The impact of any event or experience is greatest on the most actively changing and dynamic system
• Experiences during the organization of a neural system have more impact than experiences after the system has organized

  
• An already organized and functioning neural system is less vulnerable to developmental insults than rapidly-changing developing systems
• Unipolar depression


  A person who has experienced depression and has never had a manic episode
• Toxic Stress and Trauma Impact in Neuro-Development


  • Prevents optimal integration of sensory experiences (increases sensitivity to or need for sensory stimuli)
  • Inability to modulate responses to environmental demands
  • Creates chronic internal stress
  • Alters stress-mediating system of the brain (changes in HPA axis and limbic system results in sensitized response to threat)

  
• Depressive Symptoms


  • Depressed Mood
  • Lost of Interest in almost all, if not all, activities
  • Changes in sleeping patterns
  • Changes in appetite
  • Chronic fatigue or lethargy
  • Psychomotor retardation or agitation
  • Diminished ability to think or concentrate
  • Feeling of worthlessness and inappropriate guilt
  • Recurrent thoughts of death, suicidal ideations or suicide attempts
  • SIGECAPS
• Major Depression


  The person must experience either a depressed mood or loss of interest in usual activities, and at least four other symptoms of depression. The depressive symptoms must persist for at least 2 weeks and must cause clinically significant impairment in daily functioning.
• Disruptors of Core Regulatory Networks


  • Intrauterine Insults
  • Bonding and Attachment (Compromised External Regulator)
  • Sensitized Patterns of Stress
  • Alcohol
  • Maternal Stress
  • Toxins
  • Drugs
  • Domestic Violence
  • Maternal / Paternal Isolation
  • Maternal / Paternal History of Attachment
  • Maternal / Paternal mental health
  • ACES
  • Chaos, Neglect, Unpredictability
  • Exposure to Violence
  • Discrimination, Shaming, Humiliation
  • Poverty
• Thymia (thymic)


  Depressed mood must be present, plus two of the following symptoms for at least 2 years: (A) poor appetite or overeating, (B) insomnia or hypersomnia, (C) low energy or fatigue, (D) low self-esteem, (E) poor concentration or difficulty making decisions, (F) feelings of hopelessness. The person must never have been without the depressive symptoms for longer than a 2-month period.
• In the DSM-5, both thymic and depressive episodes lasting longer than two years fall under the diagnosis chronic depressive disorder.
• DSM-IV-TR Subtypes of Major Depression


  • With melancholic features
  • With psychotic features
  • With catatonic features
  • With atypical features
  • With postpartum onset
  • With seasonal pattern
• Epigenetics


  The study of how our behavior and environment can cause changes that affect the way our genes work. It does not involve change in DNA sequence but changes how the body reacts to the DNA sequence. Carefully orchestrated chemical reactions activate and deactivate parts of the DNA at strategic times and specific locations. Epigenetic changes turn genes "on" and "off". DNA is the library, epigenetic regulation is the librarian.

  
• A subtype added to DSM-5 is premenstrual phoric disorder.
• Depression Facts


  • Comorbid with anxiety disorders, substance abuse, and eating disorders
  • Depression in older people tend to be chronic, severe, and debilitating
  • Depression is less common among children than among adults
  • Women are about twice as likely to men to experience both mild depressive symptoms and severe depressive disorders
  • People who undergo treatment for their depression recover much more quickly than they would without treatment and reduce their risk of relapse
• Genetic Factors


  People with abnormalities in the serotonin transporter gene have been found to be at an increased risk for depression when they are faced with negative life events.
• Monoamine Theory of Depression


  Monoamines are at reduced quantities at synapses in the limbic system, abnormalities in the synthesis of serotonin and norepinephrine, and impaired sensitivity of postsynaptic neuronal receptors.
• Brain Abnormalities


  • Prefrontal cortex
  • Anterior cingulate
  • Hippocampus
  • Amygdala
• Methylation


  A universal biochemical process which covalently adds methyl groups to a variety of molecular targets. It plays a critical role in epigenetic modifications and imprinting, via methyl tagging on histones and DNA. Methylation is sometimes referred to as "marking" DNA. Methylation plays a critical role in gene expression and cell differentiation and errors in methylation could give rise to disease and dysfunction. Experience shapes methylation processes.
• Neuroendocrine Factors


  Chronic hyperactivity and regulation in the hypothalamic-pituitary-adrenal (HPA) axis → inhibiting effect on monoamine receptors, Chronic and excessive exposure to cortisol → reduction in volume of several brain areas, Early traumatic stress can also lead to some of the neuroendocrine abnormalities that probably predispose people to depression, Hormonal factors in women, especially changes in the ovarian hormones, estrogen, and progesterone
• Behavioral Theories of Depression


  Life stress results in the reduction of positive reinforcers in a person's life, Learned helplessness theory: stresses the importance of the controllability of a situation.
• Cognitive Theories of Depression


  Negative Cognitive Triad (Beck, 1967): depressed people have negative views of themselves, the world, and the future, Reformulated learned helplessness theory: Focuses on people's causal attributions for events, Ruminative Response Styles Theory: process of thinking is more likely to contribute to depression than content of thinking, A bias towards negative thinking in basic attention and memory process.
• Humans' neuro-epigenome, with all of its moving parts, is much more malleable than once thought. This malleability emphasizes the importance of interventions in the environment and early-life events that can reshape overall health and behavioral outcomes. Some epigenetic modifications that have an impact on behavior and physiology in one individual can be transferred to future unborn generations.
• Interpersonal Theories of Depression


  Depressed people may act in ways that engender personal conflict, Rejection sensitivity, Excessive reassurance seeking.
• Sociocultural Theories of Depression


  • Cohort Effects: more recent generations are at higher risk for depression than previous generations
  • Gender Differences: women are twice as likely as men to suffer from depression
  • Stress responses and coping tendencies
  • Gender socialization
  • Societal status and influence
  • Ethnicity/Race Differences
  • Cross-Cultural Differences
  • Prevalence of major depression is lower in less industrialized and less modern countries than in more industrialized and more modern countries
• Bipolar Disorder


  The classic manifestation of bipolar disorder is the alternation between periods of mania and periods of depression.
• Social influences are among the influences on brain structure and function that are most powerful in including plastic change. Early stressful and nurturing environments have robust effects on the developing brain, some of which persist for the life of the organism.

  
• Manic Symptoms


  • Unrealistically positive and grandiose self-esteem
  • Flight of ideas or subjective experience that thoughts are racing
  • Reduced need for sleep
  • Distractibility
  • Pressured speech or more talkative than usual
  • Increase in goal-directed activity
  • Excessive involvement in implusive and risky behaviors
• Mixed Episode


  A person is said to have a mixed episode if the person experiences the full criteria for manic episodes and major depressive episodes in the same day, every day for at least 1 week.
• Adaptive Neuroplasticity


  Adaptive neural plasticity might also represent vulnerability under certain circumstances. In particular, there is increasing evidence that exposure to stress at levels that overwhelm the organism's ability to manage that stress may negatively affect brain development.

  
• Hypomania


  Hypomania is a mood state that is characterized by milder manic symptoms. Unlike full mania, those suffering from hypomania do not experience symptoms that are sever enough to interfere with daily functioning.
• There is a growing literature documenting functional and structural changes in the brain with specific interventions and training regimes. The behavioral evidence in support of such interventions and training provides a reasonable foundation for the exploration of neural changes that support these behavioral outcomes.

  
• DSM Criteria for Bipolar I and Bipolar II Disorders


  • Bipolar I: Major Depressive Episodes can occur but are not necessary for diagnosis, Episodes meeting full criteria for mania are necessary for diagnosis, Hypomanic Episodes can occur between episodes of severe mania or major depression but are not necessary for diagnosis
  • Bipolar II: Major Depressive Episodes are necessary for diagnosis, Cannot be present Episodes meeting full criteria for mania, Hypomanic Episodes are necessary for diagnosis
• Posttraumatic Stress Disorder (PTSD)


  Exposure to extreme and traumatic stress may overwhelm the coping resources of otherwise apparently healthy people, and may lead to PTSD.
• Biological Treatments for Mood Disorders

  • Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs), Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Norepinephrine-Dopamine Reuptake Inhibitors, Tricyclic Antidepressants, Monoamine Oxidase Inhibitors (MAOIs)
  • Mood Stabilizers: Lithium, Anticonvulsant medications e.g., valproate and carbamazepine, Atypical antipsychotic medications e.g., olanzapine, aripiprazole,, quetiapine, and risperidone
  • Electroconvulsive Therapy
  • Newer Methods of Brain Stimulation: Repetitive transcranial magnetic stimulation (rTMS), Vagus nerve stimulation (VNS), Deep brain stimulation
  • Light Therapy: Resetting circadian rhythms, Decreasing levels of melatonin
• Behavior Therapy


  Focuses on increasing positive reinforcers and decreasing aversive experiences in an individual's life by helping the depressed person change his or her patterns of interaction with the environment and with other people.
• Cognitive-Behavioral Therapy


  Represents a blending of cognitive and behavioral theories of depression, Aims to change the depressed person's maladaptive thought patterns and behaviors.