Mental illness: Around the world

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Mental illness Around the world

• Disorders are often attributed to inaccurate
  beliefs
• e.g.,
• Windigo - an animal spirit enters your body and
  you must then consume human flesh (young
  Algonquin tribal warriors). Tx by killing the
  individual.
• Koro - belief that your genitals are retracting
  into your
• abdomen (Malaysian men - word for tortoise). Tx
  with
• pegs, clamps, concerned family members.
• Body dysmorphic disorder?
• Delusional disorder?

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Mental illness In the U.S.

• Each year there are over 2 million admissions to
  mental hospitals/psychiatric units in the U.S.
• As many as 1 in 5 are judged to need such
  services
• Deinstitutionalization in the 1950s due to advent
  of psychotropic medications
• Szaszs view (The myth of mental illness) is in
  contrast to the general medical model of
  psychiatric illness.
• Over medicating children?

3
Criteria for abnormal behavior?

• Deviant relative to norms (time and place)
• Distress ego dystonic or creates distress in
  others
• Dysfunction work, relationships
• Danger to self (the inability to care for
  self or active
• threat) or others
• All disorders in the U.S. are defined by the
  DSM-IV

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Phobias (fears)

• Anxiety results from thinking about or being
  exposed to something. Intense fear that is
  non-normative and results in a dysfunction.
• Specific phobias (e.g., arachnophobia,
  ophidiophobia, acrophobia, aerophobia) involve a
  single stimulus
• Agoraphobia (market place), social phobia
  (performance, social settings), and generalized
  anxiety disorder are not commonly associated with
  a single stimulus
• Behavioral interventions work well for specific
  phobias (tx is generally less successful for
  others)
• Anti-anxiety medications (e.g., Xanax) are
  commonly administered as tx

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Obsessive-compulsive dis.

• Obsessions intrusive thoughts (e.g., hands are
  dirty, your children are in danger, etc.)
• Compulsions behaviors intended to address the
  intrusive thoughts these rarely occur in the
  absence of obsessions (e.g., washing, checking)
• e.g., Howard Hughes?
• Also treated with behavioral interventions
  (exposure with response inhibition) in
  combination with medications to reduce anxiety

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Major Depression

• Marked by extreme sadness, crying, lack of
  motivation, isolation, disturbance of sleep,
  appetite, sex drive, may include suicide
  attempts
• 10 incidence in U.S. 25 for lifetime
• Twice as common in women with 1st episode usually
  occurring at 24-29 yrs!
• Exogenous vs. endogenous
• Differ re cause, course, and treatment success
• Tx most successfully with cognitive interventions

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Treatment for depression

• Beck/Ellis cognitive restructuring
• Errors in thinking, automatic thoughts,
  overgeneralization, learned helplessness, etc.
• Tx with medications that alter dopamine and/or
  seratonin levels (reuptake or release) e.g.,
  Prozac, recent study on SSRIs shows them to be
  minimally effective (no significant improvement
  over placebo)
• Effects of antidepressants may be due to the fact
  that they result in neurogenesis (Duman Hen,
  2003 Science)
• This would explain the 3-4 week delay in the
  effects
• ECT highest efficacy, low cost, and fewest
  side-effects

8
Past suicide attempts do not predict a successful
suicide.
0

• True
• False

9
Suicidal behavior

• 3 criteria necessary for an involuntary
  hospitalization
• 1. Thoughts thoughts about ones own death
• 2. Plan explicit plan on how to commit suicide
• 3. Access to means able to execute plan
• Gender differences females 4X more likely to
  attempt and males 3X more likely to succeed
  (similar overall rates of suicide)
• Effects of method (e.g., differences in
  lethality)
• Best predicted by past attempts, psychiatric
  conditions, presence of firearms, and
  alcohol/drugs

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Bipolar disorders

• Previously referred to as manic-depression
• Bipolar disorders involve some combination of
  depression and manic episodes (little or no
  sleep, excessive energy, spending sprees,
  hypersexual, impulsive travel).
• Onset is typically late 20s and 30s
• Mood stabilizers such as lithium are used
• Psychotic experiences can occur (manic state)
• Cycling of moods varies considerably

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Schizophrenia

• Break from reality
• Delusions - what makes a belief delusional?
• Not just an inaccurate belief
• Also conviction, resistance to change,
  normativeness, impact
• From Trekkie to nut
• Hallucinations perceptual aberrations
• Auditory, visual, tactile, and/or olfactory
• Hallucinations may be causally linked to
  delusions
• Both referred to as positive symptoms

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Schizophrenia - continued

• Types included Paranoid (persecutory, grandeur,
  erotomatic), catatonic (motor retardation),
  disorganized (cognitive behavioral confusion),
  undifferentiated
• Negative symptoms include loss of
  motivation/interest, disorganized speech, flat
  affect
• Incidence is approx 1, though higher if you
  include personality versions (milder forms)
• Onset varies, but the earlier the poorer the
  prognosis

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Delusional disorders

• Delusional disorder only symptom manifested is
  the delusion itself
• Brief psychotic episode may be associated with
  a major life change such as a postpartum
  psychotic episode (.1)
• Shared psychotic disorder more than 1
  individual sharing the same delusion
• Capgrass syndrome specific delusion involving
  the replacement of people with look-a-likes
• Psychosis proneness Chapman Chapman

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Causal Features?

• Cognitive deficits no real reasoning deficits,
  but such individuals do show a bias for arriving
  at conclusion based on less evidence and then
  maintaining those delusions (colored beans in a
  jar study)
• Psychosis proneness predicts the endorsement of
  abnormal attributions in college students
• Genetic features incidence is 48 if both
  parents or an identical twin has schizophrenia,
  but only 17 if fraternal twin or 1 parent has it

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Treatments - continued

• Almost always involve psychotropic meds
  especially to treat the positive symptoms
• Dopamine hypothesis (excess dopaminergic
  activity)
• These drugs typically have very strong side
  effects
• Complete resolution is not common, though
  individuals can lead functional lifestyles
• Other models? (enlarged ventricles so less brain
  matter, eye tracking problems, inadequate early
  reinforcement, latent homosexuality, etc.)

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Eating disorders

• Anorexia nervosa extreme weight loss with
  persistent belief that one is fat, intense
  fear/guilt of gaining weight, 90 of cases occur
  in females
• When emaciated females are amenorrhea
• Typically occurs in 1 of females aged 12-18yrs
  (early college late high school)
• Largely limited to Western cultures
• Bulimia nervosa combination of binging and
  purging (the latter can be vomiting, laxatives,
  or excessive exercise)
• With expanded definition it is almost as common
  in males (45)

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Causal factors?

• Major emphasis is on social and cultural factors
• Physiological effects can occur as a result of
  semi-starved diet
• Observed in rats that are placed on such diets
  and given an exercise wheel
• Prisoners on semi-starved diets likewise
  displayed preoccupation with food
• Effects of excessive exercise and diets?

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Somatoform disorders

• Hypochondriasis preoccupation and fear of
  illness
• Somatization disorder endorsement of many
  symptoms with no apparent physical cause
• Body dysmorphic disorder preoccupation with a
  perceived physical deficit
• Conversion disorder (indifference, selective
  symptoms, selective demonstration, neurological
  nonsense)
• Pseudocyesis false belief of being pregnant
  with physical consequences (enlarged abdominal
  area and lactation)

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DID (formerly MPD)

• Dissociative identity disorder loss of time
  (amnesia), and a minimum of two distinct
  identities.
• How many identities?
• Knowledge between identities?
• 1-4 incidence (small percentage of doctors
  diagnose virtually all cases)

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Which is NOT a symptom of conversion disorder?

• Indifference
• Relief from responsibility
• Neurologically impossible
• Lack of awareness of the symptom
• Selective presentation

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Stages of Memory
0
22
You witnessed an accident
0

• How fast were the cars going when they smashed
  into each other?
• Was there any damage? If so, describe it?

23
You witnessed an accident
0

• Estimate, in miles per hour, the rate at which
  the cars moving when they bumped into each other?

24
Recall affected by context
0

• Questions can serve as the context for
  information recall
• e.g., How fast were the cars going? vs. estimate
  in miles per hour the rate they traveled?
• As time passes, memory integrity decreases
• Confabulate contextual information with actual
  memory (disruption at the level of retrieval)

25
Encoding Failures
0

• Garbage in, Garbage out
• We ignore or distort most information we are
  presented

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Memory types
0

• Effort of recall
• Implicit recollection occurs without knowledge
  (e.g., write name slowly)
• Explicit effortful recall (e.g., previous phone
  )
• Information type
• Declarative facts (easy to learn forget)
• Procedural a skill (harder to learn forget
  e.g., finger movements for dialing your phone)
• Some well rehearsed declarative info can become
  procedural

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Memory stores

• Sensory register
• very large capacity
• iconic (1-3s), echoic (3s)
• short duration
• lost unless rehearsed
• Use of errors in recall to determine how info is
  stored (visually, semantically, etc.)

• Short term Memory
• limited capacity
• chunking into meaningful groups (chess study)
• no limit on chunk sizes
• 7 /- 2
• Long Term Memory
• limitless capacity and long lasting
• Semantic encoding

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Herman Ebbinghaus (late 1800s)

• 1) amount remembered depends on time spent
  learning
• 2) when recalling lists, 1st (primacy effect) and
  most recent or last (recency effect) things are
  recalled best. This is the serial position
  effect.
• Change order of info to improve recall. Advantage
  of going 1st or last in job interviews.
• Most info lost in the first 1-2 days, then a
  gradual slope for forgetting

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Forgetting

• Decay as time passes, we lose info. Faster rate
  of forgetting when awake (assuming no rehearsal)
• Interference new info interferes with old
• 1. Retroactive info occurring afterwards
  interferes
• 2. Proactive previous info interferes with new
  info
• Sleeper effect forget messenger but recall the
  message (increases message salience when
  messenger was poor source)

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Amnesia

• Results from injury, stressor, or toxicity
• Anterograde cant recall info after injury
• Retrograde cant recall anything prior to
  injury
• Episodic amnesia a specified period of time
• Generally affects declarative, but not procedural
  memories
• Psychogenic fugue state (memory loss flight)
• Alzheimers dementia (degraded short term new
  memories)

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Sleep

• Approx. a 24.3 hour cycle for circadian rhythms,
  but synchronized to external cues to stay on 24
  hr cycle (called entrainment)
• At birth 17hrs/day 6 mos. 13hrs 5-7 yrs
  adopt adult pattern of 7-9 hrs
• 4.5 10.5 hrs per day for most people
• Outside this range results in shorter life span
• Sleep deprivation results in abnormal experiences
  and can even result in death
• Internal desynchronization can occur when
  changing time zones, taking sleep medications, or
  even as a consequence of depression

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Sleep stages (approx 90 min cycle)

• Stage 1 relaxed transitional sleep
• Stage 2, 3, 4 move from relatively fewer alpha
  waves to more delta waves
• REM most dreaming occurs, restorative sleep,
  improves memory, approx. 50 of babies sleep
  time, occurs after about 1 hour, paradoxical
  sleep, REM rebound, essential to survival.
• Sleep medications and alcohol can reduce REM
  sleep, but increase overall sleep time.
• Lack of sleep can result in delusions and
  hallucinations after 2-3 days

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Sleep disorders

• Narcolepsy (sleep attacks)
• Sleep apnea (stop breathing)
• Night terrors (intense nightmares in children in
  stage 4 sleep)
• Insomnia (note people generally underestimate
  how much they sleep)
• Improve sleep by using bed only for sleeping and
  only when tired

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Altered states of consciousness

• Hypnosis a heightened state of suggestibility
  (Mesmer)
• Used in clinical settings to facilitate memory
  recall, treat disorders such as phobias, reduce
  or eliminate problematic behaviors (e.g.,
  smoking, over eating, etc.), and even create
  experiences such as age regression, past life
  channeling, etc.
• Limited empirical support for effectiveness in
  reducing smoking, stress, pain.
• Known facts Its not sleep effectiveness is
  determined by subject not the skill of the
  hypnotist, cant do things against your will
  motivated un-hypnotized people can do the same
  things and it does not improve memory accuracy.
• Dissociative theory (Hilgard) vs. social
  cognitive theory (Spanos Kirsch Lynn).

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Classes of Drugs

• Stimulants CNS activators e.g., cocaine,
  nicotine, caffeine, amphetamines, etc.
• Depressants CNS suppression e.g., alcohol,
  sedatives, Xanax, etc
• Hallucinogens altered states of consciousness
  e.g., LSD, mescaline, Hashish, PCP
• Narcotics numbness and stupor (pain relief)
  e.g., opium, morphine, heroin, codeine, Demerol,
  Darvon, etc.

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Regular use of drugs/alcohol

• Leads to tolerance it takes more of the drug to
  have the same physiological effect
• Tolerance is one of the criteria of substance
  dependence (as are withdrawal symptoms)
• Reverse tolerance it takes less of the drug to
  achieve the same physiological effect
• Cross tolerance use of some substances can
  result in tolerance for similar substances
• Substance abuse use problem behaviors
• Substance dependence tolerance, withdrawal
• Substance-induced psychiatric disorders (e.g.,
  mood, psychotic, etc.)

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Expectancy effects and treatment

• Expectancy effects stronger than the
  pharmacological properties of some drugs when in
  low to moderate doses
• e.g., alcohol experienced as a stimulant and
  nicotine experienced as a depressant
• Studies in Barlab expectancy with no alcohol
  results in greater intoxication than low to
  moderate alcohol without expectancy.
• Treatment begins with abstinence and may move to
  controlled use if it is a legal substance
• In NA, AA (12 steps) is the most common
• In UK controlled drinking is most common (gt
  success)
• Controlled drinking after abstinence, change
  gulping to sipping, reduce frequency, and no
  straight drinks

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Exam is Wed Dec. 8 at 7pm

• Enjoy your holiday and good luck on finals!