History of Mental Health Treatment
Ancient• Chinese, Greeks, Egyptians, Hebrews --> Spirits/Gods• Hippocrates --> Medical model / Humors• Plato/Aristotle/Galen --> Socio-Cultural / Scientific Categories / Consciousnesses • Chinese --> Stress / Natural Remedies • Middle East --> First psych hospital 700 AD• Dark Ages --> Gods/Demons16th Century and Beyond• 16th century:Weyer --> Asylums• 18th century: Pinel --> No Chains!, Tuke --> Medical Staff, No Treatment Avaliable• 19th century: Rush --> Humane Treatment, Moral Management of the "insane", Dix --> Mental Hygeine Movement + Wellbeing. Drugs for control of individuals.20th century: • Public mental health hospital (bad), • 60's Reform Movement toward community programs, • 80's (Reagan) De-institutionalization leads to homlesnessKey Discoveries of 20th Century• Biology• DSM• Science-Informed• Experimental (Wundt)
4 factors of Biological viewpoint
Genetic vulnerabilitiesBrain dysfunctionNeurotransmitter & hormonal abnormalities in brain and CNSTemperament
Necessary, Sufficient, Contributory cause
Necessary --> Must existSufficient --> GuaranteesContributory -> Probability Increases
DSM-5 definition of mental disorder
a syndrome that is present in an individual and that involves clinically significant disturbance in (1) behavior, (2) emotion regulation, or (3) cognitive functioningDisturbance = Dysfunction of Biology, Cognition, or Development.Culturally appropriate responses (Historically Grief) are excluded.
Advantages and Disadvantages of DSM
Advantages: RINDS ResearchNomenclatureInsuranceDomainStructureDisadvantages: CARDSCombinations (dual diagnosis)A Respect (lack of)Details (lack of)Self-Identification + Stigma
Acute Stress Disorder
Stressors = External Demands• Develop shortly after experiencing a traumatic event and last for at least 2 days• People with symptoms don't have to wait a whole month to be diagnosed with PTSD• If symptoms persist beyond four weeks, the diagnosis can be changed to PTSD• PTSD is not the only psychiatric disorder that can develop after a traumatic experience
Adjustment Disorder
Response to a common stressors (e.g., divorce, death of a loved one, loss of a job)1. Results in clinically significant behavioral or emotional symptoms2. Symptoms must begin within 3 months of the onset of the stressor for a diagnosis to be given3. Symptoms lessen or disappear when the stressor ends or when they learn to adapt to the stressor
PTSD
TRAUMATraumatic Event (Experiencing, Learning to of close family member, Repeated Exposure, NOT Via TV)Recurring/relivingAvoidanceUnable to function Mood (Negative alterations) / 1 MonthArousalNo longer in anxiety disorders - now grouped with trauma and stressors related disorders.Defined by symptoms don't abate after stressful event(s) is overPrevalence: 7% (lower in places w/ less disasters)Risk Factors: Minority Group, WomenTreatment: CBT, Prolonged Exposure + Medication
Factors That Impact Serious of Stressors
CLEATS - Control- Length- Expectedness- Affects you closely- Timing- Severity
Difference between Anxiety and Fear
With fear, there is a triggering stimulus, not always so with anxiety (where it is more so the anticipation of the threat rather than the threat itself)
3 Components of Anxiety
1. Bodily Sensations2. Cognition --> Worry4. Emotion --> Fear
Phobia
persistent and disproportionate fear of some specific object or situation that presents little or no actual danger and yet leads to a great deal of avoidance of those feared situationsAt least: 6 MONTHSLifetime Prevalence: 12%Genetic Contribution / Learned BehaviorExposure TherapyMedication not effective unlike other anxiety disorders
Social Anxiety Disorder
Symptoms:1. One or more specific social situations.2. Underlying fear of exposure to scrutiny and potential negative evaluation by othersAt least: 6 MONTHSSubtypes: Performance + NonperformanceLifetime Prevalence: 2-5% Onset: AdolescenceComorbidity: AlcoholRisk Factor: Inhibited Temperament as childCausal Factors:1. Being or witnessing someone else being a target of anger or criticism2. Experiencing or witnessing a perceived social defeat or humiliationCognitive Biases: expected to be rejected or negatively evaluated.
Panic Disorder
SURP-riseSuddenUnexpectedRepeatedPanic attacksgive RISE to Behavior change/worry (lasting 1 month or longer)Not due to substances4 of 13 symptoms The majority of people with panic disorder have at least one comorbid disorder: Most often generalized anxiety disorder, social anxiety, specific phobia, PTSD, depression, and substance-use disorders• Panic disorder is associated with increased risk for suicidal ideationAmygdala: collection of nuclei in front of the hippocampus; critically involved in the emotion of fear
Cognitive Theory of Panic
• Proposes that people with panic disorder are hypersensitive to their bodily sensations• Tendency to catastrophize about the meaning of bodily sensations (thinking one is having a heart attack if one's heart is racing)Automatic thoughts - triggers of panicSafety Behaviors are Maintaining factors
Agoraphobia
• Anxiety about being in places that would be difficult to escape, or where immediate help would be unavailable• At most debilitating, may involve inability to leave home• A frequent complication of panic disorder±However, many patients with agoraphobia do not experience panic (onset is 20s - 40s)• Prolonged exposure treatments are effective in 60-75 percent of people with agoraphobia.Atleast 6 months prevalence: 1.3%
GAD
• Anxiety is most common category • 3% of PopulationEGADS I'm MISERAbleExcessiveGeneralizedAnxietyDailySix monthsMuscle tensionIrritabilitySeepEnergyRestlessnessAttention issues
Summary of Types of Mood Disorders
Unipolar depressive disorder: a person experiences only depressive episodesBipolar disorder: a person experiences both depressive and manic episodesDepressive episode: when a person is markedly depressed or loses interest in formerly pleasurable activities for at least 2 weeksManic episode: markedly elevated, expansive, or irritable mood for at least a weekHypomanic episode:abnormally elevated, expansive, or irritable mood for at least 4 days; the person must also have at least 3 other symptoms similar to those involved in mania
MDD / Depression
Most common diagnosis with panic and SUDSSIGECAPS (5/8)SleepInterestGuiltEnergyConcentrationAppetitePsychomotor SlowingSuicideAlso one must have depressed mood or anhedonia causing social or occupational impairment2 Blue Weeks• most often occurs during late adolescence up to middle adulthood• Rates of depression are inversely related to socioeconomic status• Recurrence: Occurs in about 40-50 percent of people who experience a depressive episode. • SAD - 2 episodes in past 2 years at same time of year.• MDD can has psychotic features• Post-Partum - Symptoms occur in up to 50-70 percent of women within 10 days of giving birth (vs. 10-20% who experience +6 months)
Persistent Depressive Disorder
a form of depression that is not severe enough to be diagnosed as major depressive disorder (2/8)2 years at leastDouble Depression: MDD + PDD
Grief
Peaks 2-6 months after the loss
Beck's Model of Depression (the Cognitive Triad)
negative view of selfnegative view of worldnegative view of future
Mania
DigFast (3-4/7)Euphoria / Irritability + DistractabilityImpulsivityGrandiosityFlight of IdeasActivitySleep DisturbanceTalkativeness
Bipolar
Bipolar 1: Mania + MDD (1 week, intermixed or alternating daily).- Genes account for about 80-90 percent of the variance in the likelihood of developing bipolar I disorderBipolar II: Hypomanic episodes + Depressive EpisodesNeuroticism has been associated with symptoms of depression and mania
Mood Treatment
SSRIs - 3-5 weeks (can cause mania)Lithium - Manic EpisodesECT - High risk individualsCBT, Behaviorial Activation, FMT Even without formal therapy, the great majority of patients with mania and depression recover from a given episode in less than a year
Suicide + NNSI
Men at 4x as likely to die by suicide, women are more likely to think and make attempts.More commonly linked to depressionPerceived burdensomeness and thwarted belongingness interact to produce suicidal thoughts - having both result in the desire to dieOnly in the presence of a third factor, acquired capability for suicide that a person has the desire and ability to make a lethal attempt
Personality Disorders
General features of personality disorder include chronic interpersonal difficulties, problems with one's identity or sense of self, and an inability to function adequately in society.Diagnosed when the person's enduring pattern of behavior or inner experience is pervasive and inflexible, as well as stable and of long duration.Also causes either clinically significant distress or impairment in functioning and is manifested in at least two of the following areas: cognition, affect, interpersonal functioning, or impulse control.How they act at a party:Cluster A (PaSS) - Don't show up- Paranoid- Schizotypal <-- Schizophyrenia "Lite"- Schizoid <--Avoid Cluster B (BAHN) - Get Kicked OutBorderline - cognitive symptoms, including episodes in which they experience psychotic-like symptoms such as hallucinations, paranoid ideas, or severe dissociative symptomsAnti-socialHistrionicNarciccistic - grandiose and vulnerableClusters C (DOA) - Dead on arrivalDependentObsessive CompulsiveAvoidantHighly comorbid with borderline, antisocial, narcissistic, and dependent personality disorder diagnoses
Borderline
I DESPAIRIdentity DisturbanceDysphoriaEmotional instabilitySuicidePsychoticAngerImpulsiveRelationships (Bad)
Schizophrenia
Loss of touch with realityHi-Def BS NetworkHallucinations (sensory experience)Delusions (Erroneous Beliefs)Behavior (Disorganized)Speech (Disorganized)Negative Affect2-4-6-ophreniaAt least 2 Symptoms a month for 6 monthsYoung adult / adult onset, more severe in menPrevalence: 1% Causal/Risk Factors-Viral Infection- Hypoxia- Genetics- Head Injury- Immigration- Cannabis AbuseOutcomes38% - 50% return to function12% need long-term care
What is the difference between:(1) Brief Psychotic Disorder and (2) Schizophreniform(3) Schizoaffective
(1) last less than 1 month (2) last at least 1 -6 months(3) Schizophrenia + Mood Disorder
Anorexia Nervosa
(1) the restricting type, where every effort is made to limit the quantity of food consumed, and (2) the binge-eating/purging type.Late Teen OnsetBinge - 2%, higher in womenBulimia - 1%Anorexia - .3 (Men) vs .9 (Women)Mortality rate for people with anorexia nervosa is more than five times higher than that for young females ages 15-34 in the general U.S. population.Individuals with anorexia are 18 times more likely to die by suicide than comparably aged women in the general population.Treatment: Antihistamines are used - stimulates appetite
Bulimia Nervosa
Bulimia nervosa is characterized by uncontrollable binge eating and efforts to prevent resulting weight gain by using inappropriate behaviors such as self-induced vomiting and excessive exercise.Normal/Above Average Weight
Binge-Eating Disorder
Does not have compensatory behavior
Addiction
Most Common with depression and phobiasTime 2 CUT DOWN PALTime Spent using or looking2 or more of 11CravingUnable to stopDangerousOthers affectedWithdrawl Neglect of responsibilitiesProblems made worse Activities stoppedLarger and longer usage
Alcohol Medication
Disulfiram (Antabuse) causes vomiting when followed by ingesting alcoholNaltrexone helps to reduce the cravings for alcohol
OCD
I-MURDER? & CALMIntrusiveMind-basedUnwantedResistantEgo DystonicRecurrentTo CALM-pulisions
ADHD
FIDGETYFunctional ImpairmentInattentionDisquisition Greater than normalExclude other diagnosisTwo or more settingsYoung onset (12)
malingering vs factitious disorder
Malinger (doesn't linger one gains needs)Factious (Attention)