MENTAL ILLNESS – PART 1Intro to Psych5/6/14

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 How we think about mental disorders

Mood disorders Depression Bipolar Disorder

Theories Treatments

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 3 criteria to help them diagnose

different mental disorders1. Behavioral criteria: Set of symptoms the person

reports How they feel How they think

2. What the psychologist observes about their behavior and how typical or atypical it is

3. These observed & reported criteria get matched against the clinical criteria psychologists know go with different disorders

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

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

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

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

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 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 DSM criteria for Major Depression1. Sadness or diminished interest or pleasure

in usual activities (anhedonia)2. At least 4 of the following symptoms:

1. Significant weight or appetite change2. Insomnia or hypersomnia3. Psychomotor retardation or agitation4. Fatigue or loss of energy5. Feelings of worthlessness or excessive guilt6. Diminished ability to concentrate,

indecisiveness7. Suicidal Ideation or behavior

3. Duration of at least 2 weeks (average length of a depressive episode is 6 months, if not treated)

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 Disorder is characterized by a periods of

depression and periods of mania DSM Criteria for a Manic Episode1. Abnormally and persistently elevated,

expansive, or irritable mood for at least 1 week2. 3 or more of the following:

1. Inflated self-esteem or grandiosity2. Decreased need for sleep3. More talkative than usual, pressure to talk4. Flight of ideas, racing thoughts5. Distractibility6. Increase in goal-directed activity, agitation7. Excessive involvement in pleasurable but

dangerous activities

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 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 There are 3 different categories of theory and

treatment: Biological Theories and Treatments Cognitive Behavioral Theories and Treatments Interpersonal Theories and Treatments

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 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 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 TREATMENTS

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 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 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 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 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 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