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Mental Illness – Part 1. Intro to Psych 5/6/14. Mental illness . What are we going to talk about today? How modern clinical psychology looks at mental disorders Some of the ways we think about what makes a mental disorder Characteristics common across mental disorders

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mental illness part 1

Mental Illness – Part 1

Intro to Psych

5/6/14

mental illness
Mental illness
  • What are we going to talk about today?
    • How modern clinical psychology looks at mental disorders
    • Some of the ways we think about what makes a mental disorder
    • Characteristics common across mental disorders
    • How we think about mental disorders
      • Mood disorders
        • Depression
        • Bipolar Disorder
    • Theories
    • Treatments
abnormality
Abnormality
  • Most basic and foundational question in clinical psych: “What is abnormality?”
    • Where do we draw the line between healthy behavior & unhealthy behavior?
      • Psychologists don’t have an easy way to diagnose abnormality
      • They use a series of 3criteria to help them diagnose different mental disorders
        • Behavioral criteria: Set of symptoms the person reports
          • How they feel
          • How they think
        • What the psychologist observes about their behavior and how typical or atypical it is
        • These observed & reported criteria get matched against the clinical criteria psychologists know go with different disorders
abnormality1
Abnormality
  • Many of these criteria are very subjective and can be influenced by many factors
    • Social Norms: what your society or culture views a normal
      • Example: A Muslim woman wearing a veil is typical behavior in a Muslim community
        • A woman wearing a veil in a non-Muslim community appears atypical
    • Characteristics of the target person
      • Example: Gender
        • A man crying in our culture is often seen as unusual, but a woman crying is much less unusual
        • A woman beating the crap out of someone is unusual but less so for a man
      • Stereotypes for acceptable behavior can influence whether something is normal or abnormal
abnormality2
Abnormality
  • Influences on normal vs abnormal, continued
  • Context
    • Example: Paranoia
      • Paranoid and hyper-vigilant and live in downtown Kabul, that’s adaptive behavior and not necessarily abnormal
      • Paranoid and hyper-vigilant in a tiny farm town in Western MA, that’s not as normal or adaptive
abnormality3
Abnormality
  • Three characteristics of abnormality:
  • 1) Distress
    • Behaviors that cause the person or others around them distress
      • Example: Depression
        • You’re unhappy, sad, may even feel bad enough to want to kill yourself
      • Example: Antisocial Personality Disorder
        • The person has no regard for the rights of others, has no hesitation to steal or hurt other people, has no empathy or sympathy for others’ feelings – harms other people
abnormality4
Abnormality
  • 2) Dysfunction
    • A set of behaviors that prevents the person from functioning in daily life
      • Example: Depression
        • People who are depressed often become non-functional: can’t get up & go to class, can’t go to work, can’t hang out with their friends. They withdraw and become totally isolated and cease to function
  • 3) Deviance: highly unusual behaviors and feelings
    • Most controversial of the 3 – heavily influenced by social norms. What’s deviant in one culture may not be in another
abnormality5
Abnormality
  • How is all of this pulled together to make a diagnosis?
    • Diagnostic & Statistical Manual (DSM)
      • Been around since the 1950’s
      • Currently in its 5th edition
      • Early editions were HIGHLY subjective
      • Since the 80s, there has been an effort to make it more objective
      • The DSM gives lists of symptoms required for diagnosis and the number of symptoms that have to be present
        • Notions of distress, dysfunction, and deviance are built in to the symptoms
mood disorders
Mood Disorders
  • One of the most common problems people face
  • 22% of women will have an episode of serious depression in their lives
  • 13% of men will
  • Late adolescent years and the early 20s are the peak time for first onset of mood disorders such as depression and bipolar disorder
  • Divided in to 2 categories:
    • Unipolar Depression Disorders
      • Depression only
    • Bipolar Disorders
      • The person cycles between depression and mania
unipolar disorders
Unipolar Disorders
  • DSM criteria for Major Depression
  • Sadness or diminished interest or pleasure in usual activities (anhedonia)
  • At least 4 of the following symptoms:
    • Significant weight or appetite change
    • Insomnia or hypersomnia
    • Psychomotor retardation or agitation
    • Fatigue or loss of energy
    • Feelings of worthlessness or excessive guilt
    • Diminished ability to concentrate, indecisiveness
    • Suicidal Ideation or behavior
  • Duration of at least 2 weeks (average length of a depressive episode is 6 months, if not treated)
unipolar disorders1
Unipolar Disorders
  • It’s important to understand the difference between an everyday sad mood and the debilitating, overwhelming depression of Major Depression
  • You may be bummed because you got dumped or bombed a test, but it’s very different from the non-functional, vegetative experienced of MD
  • This doesn’t mean nothing is wrong though. Depression runs on a continuum
    • There are many people who may not be severely depressed, but that doesn’t mean they wouldn’t benefit from help
  • Moderate forms of depression can morph into more severe forms if left untreated
bipolar disorders
Bipolar Disorders
  • Bipolar Disorder is characterized by a periods of depression and periods of mania
  • DSM Criteria for a Manic Episode
  • Abnormally and persistently elevated, expansive, or irritable mood for at least 1 week
  • 3 or more of the following:
    • Inflated self-esteem or grandiosity
    • Decreased need for sleep
    • More talkative than usual, pressure to talk
    • Flight of ideas, racing thoughts
    • Distractibility
    • Increase in goal-directed activity, agitation
    • Excessive involvement in pleasurable but dangerous activities
bipolar disorders1
Bipolar Disorders
  • Here is an example of a guy who is pressured to speak. He’s just talking and talking even though there’s no one there to talk to or prompting him to talk http://youtu.be/Lm0VZX2_Ir8
  • Just like depression, mania runs on a continuum from mild to extremely severe or psychotic. This guy’s mania may not be on the severe end of the continuum, but you can see it still affects him
  • Those on the severe end may lose touch with reality and they'll believe that they are a supernatural being. They may believe that they are the Messiah or that they are Albert Einstein come back to life, or that they have supernatural powers
bipolar disorders2
Bipolar disorders
  • Mania can get people into trouble
    • Sexual promiscuity with the risk of STDs
    • Illegal drug activity and/or arrest
    • Bankruptcy for them and/or their families
  • These negative consequences are what motivate people to get help
    • Mania itself isn’t usually what drives a person to help; mania can be pleasurable to have
  • The eventual cycle into debilitating depression also drives people to seek help – the mania will eventually end
  • Bipolar disorder occurs in 1% of the population
theories and treatments
Theories and Treatments
  • There are 3 different categories of theory and treatment:
    • Biological Theories and Treatments
    • Cognitive Behavioral Theories and Treatments
    • Interpersonal Theories and Treatments
theories and treatments1
Theories and Treatments
  • Biological
    • Genetics play a big part in mood disorders, especially bipolar disorder
      • Identical twins: if one twin has bipolar disorder, the other twin has over a 60% chance of also having the disorder
      • Fraternal twins: if one twin has bipolar disorder, the other twin has a 12% chance of also having it
      • The farther away you are on the family tree from a relative with bipolar, the lower your genetic chances of having it are
    • Genetics and major depression
      • Some versions of depression have higher genetic likelihood
      • “Early Onset Depression” begins in childhood and has a higher genetic component to it
      • Depression trigger by a major life event (trauma, loss) is less clearly linked to genetics
theories and treatments2
Theories and Treatments
  • Biological, continued
    • Neurotransmitters and mood disorders
      • Serotonin
      • Norepinephrine
      • Dopamine
      • An imbalance of any of these 3 neurotransmitters can lead to depression or bipolar disorder
theories and treatments3
Theories and Treatments
  • Biological, continued
    • Prefrontal Cortex is where complex thinking, problem solving, and goal-directed behavior happens
      • In people with depression, there is lowered activity in the prefrontal cortex
    • Amygdala is where the processing of emotion info happens
      • People with mood disorders (both bipolar & depression) have overactive amygdala responses to emotional info
    • Hippocampus has a big role in memory and concentration
      • People with chronic depression have hippocampi that have shrunk, which may be related to their problems with concentration and paying attention
theories and treatments5
Theories and Treatments
  • Biological Treatments
    • Medications
      • Monoamine oxidase inhibitors (MAOI)
      • Tricyclic antidepressants
        • 60% of people who take these do well
        • Lots of side effects, can be fatal in overdose
      • Selective serotonin re-uptake inhibitors (SSRIs)
        • Paxil, Prozac, etc
        • Most commonly prescribed, have fewer side effects
      • Lithium for bipolar disorder
        • Tons of side effects
        • Dangerous for women to take while pregnant
        • Only treats manic episodes, does not treat depression
theories and treatments6
Theories and Treatments
  • Cognitive Behavioral Theories
    • Applies mostly to depression
    • People who are depressed have a negative view of the self, the future, and the world
    • These beliefs are fed by biases in the person
    • People who are depressed show distortions in thinking
      • “All-or-nothing” thinking: things are good or bad only
      • “Emotional Reasoning”: if I feel like a loser, I must be a loser
      • “Personalization”: Self-blame
  • These distortions in thinking & interpreting situations feed the general negative view of the self and hopelessness about the future
theories and treatments7
Theories and Treatments
  • Cognitive Behavioral, continued
    • People with depression make attributions for negative internal events (they blame themselves)
    • They see bad things as lasting forever
    • They see bad events as affecting many areas of their life
    • All of these feelings feed their depression and their general belief that life is terrible
theories and treatments8
Theories and Treatments
  • Cognitive Behavioral Therapy (CBT)
    • Identify themes in negative thoughts and triggers for them
    • Challenge negative thoughts
      • What is the evidence for this interpretation?
      • Are there other ways of looking at the situation?
      • How could you cope if the worst did happen?
    • Help clients recognize negative beliefs or assumptions
    • Change aspects of environments related to depressive symptoms
    • Teach person mood-management skills that can be used in unpleasant situations
    • CBT is extremely effective
theories and treatments9
Theories and Treatments
  • CBT, continued
    • CBT has been shown to be effective in helping people out of a current depressive episode and also in preventing future episodes
    • Patients learn new coping skills for dealing with new stressors and are better able to keep from falling into a depressive state again
    • One of the most important parts of CBT is that what happens in therapy is important, but what happens OUTSIDE of therapy that’s most important
    • The patient must practice the skills CBT has taught them so they can learn how to use them once therapy has concluded
theories and treatments10
Theories and Treatments
  • Interpersonal Therapy
    • Based on the theory that negative views of the self and expectations about the self and relationships are based on upbringings in environments that fostered these kinds of negative self-views
    • Interpersonal therapy works to help the patient understand that their negative self-views are rooted in past relationships
  • Interpersonal Therapy is very focused on the past
  • CBT is focused only on the present and future

The good news is there are many medications and therapy treatments to help people overcome their depression