Mental Illness – Part 1

Mental Illness – Part 1 Intro to Psych 5/6/14

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 3criteria to help them diagnose different mental disorders • Behavioral criteria: Set of symptoms the person reports • How they feel • How they think • What the psychologist observes about their behavior and how typical or atypical it is • 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 Depression • Sadness or diminished interest or pleasure in usual activities (anhedonia) • At least 4 of the following symptoms: • Significant weight or appetite change • Insomnia or hypersomnia • Psychomotor retardation or agitation • Fatigue or loss of energy • Feelings of worthlessness or excessive guilt • Diminished ability to concentrate, indecisiveness • Suicidal Ideation or behavior • 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 Episode • Abnormally and persistently elevated, expansive, or irritable mood for at least 1 week • 3 or more of the following: • Inflated self-esteem or grandiosity • Decreased need for sleep • More talkative than usual, pressure to talk • Flight of ideas, racing thoughts • Distractibility • Increase in goal-directed activity, agitation • 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

Mental Illness – Part 1