Disorders Notes

Here are my notes on this topic:

1. Emotional Disorders

A. Depression

• Major Depressive Disorder
• Lasts for weeks at a time
• Symptoms
  • lack energy & pleasure
  • helpless
  • sad
  • little pleasure from sex or food
  • trouble concentrating
  • trouble sleeping
  • suicidal thoughts
  • don’t enjoy usual activities
  • feel worthless, sad, guilty
  • pull away from friends
• Findings
  • react normally to sad images
  • react normally to fearful images
  • rarely smile are happy images
  • rarely laugh at jokes
  • decreased R to likely reward
• 5% of US adults
• Childhood depression
  • equal for boys and girls
  • beyond 14, more common in females
• Range
  • long-term depression
  • more common to have episodes
  • periods of normal mood
  • first episode longest
  • more intense first episode
  • easier to start another

Causes

1. Genetics

• • Early-onset (before age 30)
  • more relatives with depression
  • bulimia, irritable bowel syndrome
  • alcohol or marijuana abuse
  • anxiety & migraines
  • ADHD & OCD
  • Late onset (after 45 to 50)
  • relatives have circulatory problems
  • viral infections in farm animals?
  • Borna disease
  • 1/3 have it

2. Infections

• • Borna disease
  • infectious neurotropic virus
  • abnormal behavior
  • death

3. Estrogen

• • estrogen connection
  • more women than men
  • postpartum depression
  • 20% of mothers
  • recover quickly

4. Brain Abnormalities

• • hemisphere Dominance
  • decreased activity in left hemisphere
  • increased activity in right prefrontal cortex

Treatment

1. Do nothing

• • • untreated
    • recover within few months
    • episodes

2. Drugs

• • • some respond to one drug and not another
    • antipsychotic drugs
    • antidepressant drugs
    • takes effect minutes to hours
    • weeks before mood elevation
    • Antidepressant Drugs

1. Tricyclics

• • • prevent reuptake of serotonin+

2. SSRIs

• • • prevent reuptake of serotonin
    • fluoxetine (Prozac)

3. SNRIs

• • • block reuptake of serotonin & norepinephrine

4. MAOIs

• • • monoamine oxidase inhibitors
    • block enzyme from metabolizing

5. Atypical antidepressants

• • • bupropion (Wellbutrin)
    • inhibits reuptake of dopamine & some norepinephrine

6. atypical

7. Placebo

• • • placebo vs drug
    • mild to moderate depression
    • no clear benefit
    • severe depression
    • often overlap with drug group
    • no benefit of drug over placebo
    • antidepressants don’t always work

3. ECT

• • electroconvulsive Therapy
  • seizures with electric shock
  • every other day for two weeks
  • invented by Ladislas Meduna
  • 1930’s for schizophrenia
  • ineffectual on schizophrenia
  • overused in 1950’s
  • major side effect = memory loss
  • lasts for several months
  • 50% relapse within 6 months, iif used alone

4. Sleep

• • altered Sleep Patterns
  • sleep problems precede mood changes
  • more eye movements in REM
  • enter REM within 45 minutes
  • 80 minutes for non-depressed
  • like jet lag
  • change sleep cycle
  • stay awake all night
  • alternate sleep schedule

5. Exercise

• • regular, non-strenuous exercise
  • increase blood flow to brain

B. Bipolar

• Unipolar
  • between depression & normal
• Bipolar disorder
  • (also called manic-depressive)
  • between depression & mania
• Manic
  • side effects of steroids & SSRIs
• drug intoxication
• (cocaine & amphetamine)
• tumors
• mood disorder
• Presence of mania = bipolar
• don’t need to have been depressed
• cyclical changes in mood
• even if never hit depression
• sleep (too much, too little)
•  
• Bipolar I
• large swings
• switch between
•   good moods (happy, highly active, up)
•   bad moods (irritable, angry, depressed)
• men & women (about equal)
• starts early: 15-25 years old
• also called manic-depression
• at least 1 manic episode
• often many depressive episodes
• mania can last for day or months
• Cause
  • unknown
  • more likely among relatives
• Triggers
  • medications (antidepressants, steroids)
  • sleeplessness
  • drug abuse
  • childbirth
• Manic Symptoms
  • elevated mood; boost of energy
  • don’t sleep much (not tired)
  • easily distracted
  • racing thoughts
  • bursts of cleaning, doing
  • talking more or faster
  • overestimate abilities
  • poor self control
  • binge eating, drinking or drugs
  • promiscuity
  • spending
  • temper
  • excitement & laughter
  • self-confidence
  • rambling speech
  • loss of inhibitions
• Bipolar
  • I = large swings
  • II = sad and guilty
  • Cyclothmia = “bipolar light”
• Bipolar II
  • alternate between sad and guilty
  • never had manic episode
  • high energy-impulsiveness
  • depression
  • milder episodes
  • Also called hypomania
  • more common in women
  • more depression
  • more “mixed” episodes
  • mania & depression at same time
  • women 3x more likely to also have:
  •   alcoholism
  •   anxiety disorder
  • Women more likely to be rapid-cyclers
  • 1+ episode per year
  • Genetics
  • strong hereditary basis
  • twin studies
  • two genes increase probability of bipolar II
  • same genes
  • predispose major depression
  • predispose bipolar disorder
• All Types
  • high risk of suicide
  • both when manic & depressed
  • manic & depressive moods can overlap
  • drugs for mood stabilization
  • carbamazepine (anti-convulse)
  • lamotrigine (anti-seizure)
  • lithium (anti-manic)
  • valproic acid (anti-seizure)

Treatment

1. 1. lithium salts

• • • most effective therapy
    • don’t know why

1. 2. consistent sleep schedule

Seasonal Affective Disorder (SAD)

• • • usually in winter
    • most common closest to poles
  • Treatment
    • expose to very bright lights
    • for about an hour
    • early in morning or evening

C. Anxiety

• Generalize Anxiety
  • extremely worried
  • little or no reason to worry
  • anxious about getting thru day
  • fear things will go bad
  • develops slowly, often starts as teen
  • symptoms come & go
  • worse under stress
• Symptoms
  • headaches
  • trouble falling asleep
  • excessive worry
  • aware you’re worrying
  • easily startled, can’t relax
  • unexplained pain
  • stomach aches
  • difficulty swallowing
  • tremors, twitches
• Can run in families
  • No clear genetic link
• Treated with combo of:
  • Medications
  • Anti-anxiety
  • Anti-depressants
  • Therapy
  • Thinking, breathing

Obsessive-Compulsive

• episodes
• • obsessions: upsetting thoughts
  • compulsions: stress reducers
  • development
    • starts in childhood or teen
    • most diagnosed by age 19
  • Symptoms
    • need to repeatedly check things
    • repeated thoughts or images
    • fear of dirt, gems, intruders
    • routines & rituals
    • spend 1+ hrs per day
    • prefer round numbers (lucky)
    • count lines in paragraph
    • wash hair three times
    • morning routine
• Runs in families
  • no direct genetic link
• Cognitive therapy
  • fear without obsessive thoughts
• Exposure-Response prevention
  • see image, change response
• Medication
• anti-anxiety medications
• antidepressants
• work better than anti-anxiety
• 2-3 months to work
•  
• Panic Disorder
  • frequent periods of anxiety
  • occasional attacks
  • Symptoms
  • rapid breathing
  • increased heart rate
  • sweating
  • fear for several minutes
  • fear of disaster
  • fear losing control
  • may feel like heart attack
  • worry about next attack
  • young women
  • More common in women
  • more in adolescent & young adult
  • GABA
  • main inhibitory NT in amygdala
  • GABA blockers induce panic
• Benzodiazepines
  • Diazepam
  • Chlordiazepoxide
  • Alprazolam
  • bind to GABAA receptor
  • receptor changes shape
  • attach easily & bind more
  • affect amygdala, midbrain & hypothalamus+
  • can be addictive
  • temporary relief
  • beta-blockers
  • less sweat & pounding heart
• Propranolol
  • affects synapses in amygdala
  • interferes with protein synthesis
  • weakens emotional R
  • persisting decrease in fear intensity
• Runs in families
  • no direct genetic link
•  
• Social Phobia
  • strong fear of being judged
  • strong feeling of embarrassed
  • fear gets in way of work, etc
  • afraid of doing common things in front of others
  • sign a check in front of a cashier
  • eat or drink in front of others
  • use a public restroom
  • Know its irrational
  • can’t control the fear
  • Starts as child-adolescent
  • diagnoses if symptoms last 6 months+
  • can last for many years
  • Symptoms
    • anxious being with other people
    • hard time talking to others
  • self-conscious
    • afraid others will judge them
  • worry for days before an event
  • avoid groups & crowds
  • blush or sweat around people
  • feel nauseous when with others
  • afraid of being called on in school
  • hate to meet with my boss
  • don’t eat lunch with co-workers
  • worried about being stared at
  • heart pounds if go to meeting
  • can’t eat or sleep for days before staff meeting

D. PTSD

• Anxiety disorder
  • some get, not most
  • see event (observer)
  • in event (participant)
• Who gets PTSD?
  • anyone
  • any age
• Symptoms
• Three categories:

(1) Re-experiencing symptoms

• flashbacks
• bad dreams
• frightening thoughts

(2) Avoidance symptoms

• stay away from places, events
• avoid reminders of experience
• emotionally numb
• guilty, depressed or worried
• loss of  interest hobbies, etc
• difficulty remembering event

(3) Hyperarousal symptoms

• relatively constant symptoms
  • not triggered
  • easily startled
  • feel tense or “on edge”
  • trouble sleeping
  • angry outbursts
• Diagnosis
  • 1 month+
  • 1+ re-experiencing symptom
  • 3+ avoidance symptoms
  • 2+ hyperarousal symptoms
• Risk
  • some get it but not all
  • most don’t
• Risk factors
  • previous dangerous events
  • history of mental illness
  • getting hurt
  • seeing people hurt or killed
  • lack of resilience factors
• Resilience factors
  • support group
  • feeling did right thing
  • coping strategies
  • respond even though afraid
  •  social support after event
• Medications
• Antidepressants
•   sadness, worry, anger & numb
  • Zoloft
  • Paxil
  • side effects
  • annoying but go away (few days)
  • headaches, nausea, sleepy
• Other medications
  • 1. Benzodiazepines
    • relax and sleep
    • may cause memory problems or become dependency
  • 2. Antipsychotics
    • tend to gain weight
    • Prozac & Celexa
      • feel less tense or sad
      • co-occurring depression

E. Too happy?

2. Personality Disorders

A. Revisiting personality

• Difficulty defining personality
• Difficulty defining personality disorders

Causes

• trait theories = stars, genes, etc.
• psychodynamic theories = inability to uncover unconscious urges, structures and processes, and fixation
• behaviorist theories = lack of conditioning, reinforcers and dissimilative stimuli
• humanist & existential theories = restrictive influences of self or others that hold you back from congruence and self-actualization
• cognitive theories = not confronting false beliefs and assumptions

B. What are personality disorders

Karen Horney

• 10 neurotic needs
• Exaggerated need for…

Normal Plus

Dis-ability

Why personality disorders

• deeply ingrained
• can’t easily change

Characteristics

• order vs. disorder
• extreme inflexibility
• internal subjective distress
• external social distress

10 Disorders, 3 Overlapping Clusters

• fuzzy edges

C. Cluster A

• 1 or 3 disorders
• rare or non-existent
• odd or eccentric patterns of thinking
• extreme social detachment
• unusual beliefs
• “uncovered” diagnosis

1. Paranoid personality disorder

• distrust and suspicion of others
• on guard
• doubt commitment of others
• hold grudges
• hypersensitive to criticism

2. Schizoid personality disorder

• detachment and limited emotion
• avoid activities
• stilted speech
• lack of joy
• schizophrenic-like
• autistic-like

3. Schizotypal personality disorder

• difficulty with close relationships
• abnormal thinking & behavior patterns
• eccentric
• digressions in thought and speech
• magical thinking
• belief in clairvoyance
• bizarre fantasies
• witchcraft, aliens

D. Cluster B

• unstable emotional states
• erratic behavior
• aggression toward
• manipulation of others

1. Antisocial personality disorder

• disregard for others
• impulsiveness & aggression
• encounter with police

2. Borderline personality disorder

• instability in relationships, emotions, and sense of self, and impulsiveness
• intense & divergent moods
• impulsive anger
• melancholic and mania
• 1684, Bone
• 1890, Rosse
• 1921, Kraepelin
• Emotionally Unstable Personality Disorder
• on the edge (border) on insanity
• self harm; risk of suicide
• splitting = all-none thinking
• see self as bad
• 3 distinguishing symptoms
•   sensitivity to minor rejection
•   alternating idealism & devaluation
•   mood regulation problems

3. Histrionic personality disorder

• over-the-top expressiveness and attention-seeking
• excessive attention-seeking
• inappropriate seduction
• excessive desire for approval
• based on hysteria
• wandering womb
• www.himsteria.com (Links to an external site.)

4. Narcissistic personality disorder

• unusually strong desire for admiration
• inflated self-image
• lack of empathy
• exaggerated self-importance
• crave admiration
• struggle with empathy
• excessive daydream (power, success, looks)

E. Cluster C

Anxious or fearful thinking

1. Avoidant personality disorder

• avoidance of social closeness
•  fear of what others think

2. Dependent personality disorder

• overly reliant on others
• afraid to disrupt relationships

3. Obsessive-compulsive personality disorder

• rigid fixation on details
• personal standards

3. Psychological Disorders

• Common disorders everyone has
• Déjà vu
•   been here before
•   best-known memory anomaly
•   usually passes in seconds
•   can last for minutes or hours
•   characterized by
•     sensitivity or anxiety
•     overly fatigued
•   explanations
•     reincarnation (past lives)
•     special ability (clairvoyance or telepathy)
•     psychoanalytic process (now like childhood)
•     partial recognition (clue confusion)
•     physiological (changes in temporal lobes, epilepsy)
• Jamais vu
•   don’t recognize people you know (aliens)
•   don’t recognize familiar situations
•   see person out of normal context
•   fatigued or intoxicated
• Time gap
•   no conscious recollection of trip
•   late at night; well-traveled route
•   highway hypnosis
• Cryptomnesia
•   unintended p lagiarism
•   believe it’s a novel creation
•     but based on earlier works
•     usually others’ work
•   Nietzsche, Freud, Helen Keller
•   George Harrison
•     My Sweet Lord (Beatles)
•     He’s So Fine (Chiffons)
•   failure to recognize it as familiar
•   minimize by
•     searching literature
•     peer review
• Transient Global Amnesia
•   rare (1 in 10k)
•   appears suddenly
•   lasts for minutes, hours, days
•     4.5 hrs average
•   disoriented to time and place
•     Where am I? repeatedly
•   no loss of personal identity
•   brief period of RA & AA
•     can’t remember last few minutes
•     can’t form new memory traces
•   most frequent in older people
•     over 50
•   more men than women
•   other memory systems work (working, semantic, procedural)
•   many triggers (cold shower, physical stress, large meal, sex)
•   cause = temporary lack of blood flow to hippocampus
•   recovery is complete
•     can’t recall details during attack
•   not uncommon to reoccur
•     25% second attack
•     3% have third attack

4. Schizophrenia

• The Schizophrenias
• 1% incidence
• more likely in US & Europe
•   10-100 times
• slightly more common in men?
•   earlier onset
•   more severe
• Originally: dementia praecox
• 1911, Eugen Bleuler called it schiz
• starts as teens or early adult
•   typical onset: 16-30
•   uncommon onset over 45
• Symptoms
•   symptoms vary
•   seem OK until share thoughts
•   sit without moving…for hours
• Episodes
•   typical, not more than 6 weeks
•   symptoms come and go
•   lasts a few days
•     feel agitated
•     hallucination
•   lasts a few months
•     delusions
• Range of severity
•   hospitalized
•   meaningful lives in communities
• 3 factors
•   disconnected mind-motor
•     spontaneous movement
•     fluid speech
•     self-control
•   disorganized thinking
•   distorted thinking
•     delusions
•     hallucinations
• Positive Symptoms
•   unique to schizophrenia; not schiz without them
•   Delusions
•     unusual false beliefs
•       Martians are controlling me
•       reading my mind
•       thought insertion
•       I killed someone
•       behavior controlled by
•         people on TV or movies
•         special messages
•         magnetic waves
•     believe you are someone else
•       often historical person
•     someone out to get you
•       paranoid delusions
•       spying, plotting, cheating
•   Hallucinations
•     false sensory experiences
•       hear voices not there
•       see things not there
•     any sense (sight, touch)
•     voices are most common
•     invisible objects or people
•   Thought Disorders
•     Disorganized thinking
•     Thought blocking
•     Nonsense words, rambling sentences
• Semi-positive & negative
•   Movement disorders
•     agitated movements
•     catatonic (immobility); rare, treated with drugs
•     can be caused by drugs
• Negative
•   occur in other disorders
•   flat affect
•     face immobile
•     monotonous voice
•   similar to brain damage
•     poor control of eye movements
•     unusual facial expressions
•   negative = lack of
•     lack of pleasure
•     lack of affect
•     lack of initiative & planning (poor hygiene)
•     lack of patience
•     lack of social connection (withdrawal)
•     lack of fluidity (poverty of speech)
• Cognitive Symptoms
•   difficult to notice
•   executive functioning
•     trouble switching tasks
•     trouble paying attention
•     trouble with working memory
• Types of Schizophrenia
•   Disorganized
•   Catatonic
•   Paranoid
•   Undifferentiated
• Causes
•   Genetics
•     1% general population
•     10% when parent or sibling
•     15% in fraternal twins
•     50% in identical twins
•     Children of schiz patients
•       Less than half
•     Adopted children
•       12% siblings in same environment
•       0 adopted had schiz
•     People without family history can develop schiz
•   Dopamine
•     All treatment drugs block DA receptors
•     cocaine, amphetamines, LSD aggravate schiz
•   Glutamate
•     release less glutamate
•     have fewer glutamate receptors
•   Drugs can make things worse
•     nicotine
•   Relapse
•     feel better, stop taking
•   Brain abnormalities
•   Environment
•   Infection

5. Fake Disorders

A. Medical model

B. My fake disorder

• hysteria
• himsteria

C. More fakes (Dissociatives)

• Psychogenic amnesia
•   caused by extremely stressful
•   unable to recall personal info
•   usually lasts a few hours
•     can last years
•   always
•     can always remember past abilities
•     may not recognize friends & relatives
•     recall how to play poker
•     aware can’t remember key info
•   usually
•     distressed by inability to remember
•     recovery is complete
•       disappears quickly
•       can remember what couldn’t
•     doesn’t usually reoccur
• Psychological fugue
•   from Latin “to flee”
•   intolerable stress or anxiety
•   hours or years
•     like Holden Cauldied (Catcher in the Rye)
•   amnesia for personal memories
•     move away from home
•     assume new identity
•       marry another person & have kids
•       new personality
•       new friends, name and job
•   when fugue ends
•     memory of past life returns
•   sometimes not completely
•   can’t recall events during fugue state
• Multiple personalities
•   not schizophrenia
•   severely disturbed thinking
•   personality divided into 2 or more distinct identities
•     average is 13
•   more often in women than men
•     Three Faces of Eve
•   Assumed to be:
•     related to childhood experiences
•     rarely diagnosed until adolescence
•     defense mechanism to banish upsetting memories
•       send them to alternate self
•     response to severe physical abuse
•       often sexual
•       by close relative
•   each identity can be different
•     different sex, age or race
•     each has own likes and dislikes
•   can suddenly appear and take control
•   can suddenly disappear
•   can be aware of each other
•      carry on conversations
•   no conscious recall for events when other personality is dominant
•     what one learns can influence another
•     one looks at pictures, other says looks familiar
•   doesn’t exist
•   never did
•   made it up