Mental illness: Around the world

1. Mental illness: Around the world 0 “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?

2. Mental illness: In the U.S. 0 • 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 • Szasz’s view (“The myth of mental illness”) is in contrast to the general medical model of psychiatric illness. • Over medicating children?

3. 0 Criteria for abnormal behavior? Deviant – relative to norms (time and place) Distress –creates distress in self or others Dysfunction – work, relationships Danger – to self (the inability to care for self or active threat) or to others All disorders in the U.S. are defined by the DSM-IV-TR

4. Phobias (fears) 0 • 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

5. Obsessive-compulsive dis. 0 • 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

6. Major Depression 0 • 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

7. Treatment for depression 0 • 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. Suicidal behavior 0 3 criteria necessary for an involuntary hospitalization • 1. Thoughts – thoughts about one’s 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

9. Bipolar disorders 0 • 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). (Bipolar I – manic; II – dep) • 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

10. Schizophrenia 0 Break from reality Positive symptoms are most prominent: • 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

11. Schizophrenia - continued 0 • 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 • Types included: (1) Paranoid (persecutory, grandeur, erotomatic), (2) catatonic (motor retardation), (3) disorganized (cognitive & behavioral confusion), & (4) Undifferentiated See video clip

12. Delusional disorders 0 • 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

13. Causal Features? 0 • Cognitive deficits – no real reasoning deficits, but such individuals show a bias for arriving at conclusion based on less evidence and then maintain those conclusions (colored balls in a jar; Hemsley & Garety, 1986) • 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

14. Treatments - continued 0 • 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.)

15. Eating disorders 0 • 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%)

16. Causal factors? 0 • 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?

17. Somatoform disorders 0 • 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)

18. DID (formerly MPD) 0 • 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)

19. Storage Encoding Retrieval Stages of Memory 0

20. Recall affected by context 0 • Questions can serve as the context for information recall • e.g., How fast were the cars going when they “Hit” vs. “Smashed” each other? • As time passes, memory integrity decreases • Confuse contextual information with actual memory (disruption at the level of retrieval)

21. 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

22. 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 Memory stores 0

23. Herman Ebbinghaus (late 1800s) 0 • 1) Amount remembered depends on time spent learning • 2) Serial position effect: When recalling lists, 1st (primacy effect) and most recent or last (recency effect) things are recalled best. • 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

24. Forgetting 0 • 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 not a good source)

25. Amnesia 0 • Results from injury, stressor, or toxicity • Anterograde – can’t recall info after injury • Retrograde – can’t 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) • Alzheimer’s dementia (degraded short term & new memories)

26. Sleep 0 • 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

27. Sleep stages (approx 90 min cycle) 0 • 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

28. Sleep disorders 0 • 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

29. Altered states of consciousness 0 • 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: It’s not sleep; effectiveness is determined by subject not the skill of the hypnotist, can’t 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).

30. Classes of Drugs 0 • 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.

31. Regular use of drugs/alcohol 0 • 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.)

32. Expectancy effects and treatment 0 • 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 (> success) • Controlled drinking = after abstinence, change gulping to sipping, reduce frequency, and no straight drinks