User:Atcovi/Psychopathology/Chapter 6

The Parts of Stress

 * Stressor: Event that creates the demand, which causes fear when you see it as a threat.
 * Stress response: Your response to these demands, consist of how you see the stress and how capable you are to react to this stress.

Stress over a limit can play a significant role in certain psychological disorders.

Stress and Arousal: Fight or Flight?
Hypothalamus sets off both autonomic nervous system (ANS) [extensive network of nerve fibers that connect the nervous system to the organs of the body] and endocrine system [a network through the body that releases hormones].

ANS & endocrine system produce arousal and fear reactions: sympathetic nervous system pathway and the hypothalamic-pituitary-adrenal (HPA) pathway (hypothalamus --> pituitary gland --> adrenal cortex --> corticosteroids [cortisol] into the blood stream).

Trauma
Exposure to violent death, injury, accident, or sexual violence. Either through direct exposure (victim), eyewitnessing, learnining of trauma, or multiple exposures.

Men are more likely than woman to be exposed to trauma. Other factors that could increase risk include being of a racial/ethnic minority, low education/income, and living directly in the city. Ages 16-25 is also the "sweet spot".

Mental problems include depression, PTSD, anxiety, and substance abuse. Physical problems include obesity, chronic pain, and heart disease. Psychosocial problems may include poverty.

What's Up With PTSD?
"Signature" disorder for trauma exposure. Exposure to a traumatic event is a REQUIRED diagnostic for PTSD. Also, one intrusion symptom (like nightmares), one avoidance symptom (avoiding trauma), two alterations in arousal/reactivity (bad sleep, hyperventilating), and two negative alternations in thinking/mood (blame, anhedonia) is needed for a PTSD diagnosis.

Symptoms must be there for at least a month.

Trauma exposure does NOT lead to the development of PTSD, hinting that other risks/protective factors exist to determine the severity of responding to said trauma.

Even though men will probably be exposed to trauma more than women, women are 2x more likely to develop PTSD. Probably due to sexual violence or traumas adding up. Minorities, like Hispanics, AA, and natives are more likely to develop trauma and stress-related disorder than whites. Confounding variables, like poverty, probably play a role in this (not necessarily just race).

Acute stress disorder
PTSD, but symptoms begin 4 weeks after a traumatic event and last only for less than one month. PTSD mostly accounted by genetic factors.

How do people develop this?

Biological Factors

 * Abnormal neurotransmitter/hormone activity (brain's stress circuit) and probably genetic predisposition.

Childhood experiences

 * Increase risk for PTSD later, includes poverty, parental conflict, catastrophe.

Cognitive factors and coping styles

 * Risk factors: rigid outlood on the world
 * Protective factors: Resiliency protects against developing stress disorders
 * Severity/nature of the trauma: Increase in severity of trauma, increase in likelihood of PTSD.

Developmental Psychopathology Perspective

 * Timing matters for overreactivity in brain-body stress routes... for example, impact is bigger during childhood than adulthood.

Stress Diathesis Model

 * Higher biological risk, less trauma exposure to get PTSD. Converse exists.
 * 1/3 PTSD improves within a year, 2/3 PTSD may persist. Trauma treatment is there to challenge bad trauma-related beliefs, and decrease trauma-related avoidance.

How do Clinicians treat acute and posttraumatic stress disorders?

 * 1) Cognitive-behavioral therapy (exposure technique [MindTech], mindfulness based techniques, EMDR).
 * 2) Couple or family therapy
 * 3) Group therapy
 * 4) Antidepressant drug therapy
 * 5) Community interventions following a trauma (psychological debriefing/first aid).

Dissociative Disorders
See slide 50 for dissociative disorders graph (goes from everyday dissociation/zoning out to depersonalization and onset of dissociative identitiy disorder).

Definition: A group of disorders triggered by traumatic events. When memory is changed without a "physical" origin (like not from trauma), its referred to as "dissociative disorders".

Dissociative amnesia
Inability to recall important info. Amnesia episode is triggered by a specifc upsetting event. Bigger than forgetting. It may be...


 * Localized: Most common, loss of all memory of events taking place in a certain period.
 * Selective: Loss of memory for certain events in a time period.
 * Generalized: Loss of memory that started with an event, but goes back further, doesn't know family, friends, or even their own self.
 * Continuous: Forgetting, goes to the future - THE RARE ONE

Dissociative Fugue
Extreme version of dissociative amnesia... they forget their identities, past and leave completely.

Dissociative Identity Disorder
2+ personalities in response to extreme trauma. Primary personality appears most. Switching is sharp.

Subpersonas interact through mutually amnesic relationships (subpersonas don't know each other), mutually cognizant patterns (they know each other), and one-way amnesic relationships (only one knows the other). These personas are different, from age, abilities, to even blood pressure levels and allergies.

DID has increased due to doctors willing to diagnose and better diagnostic procedures. Common in NA, but non-existant elsewhere. See slide 60 for DSM-5 Dx Criteria.

Explanation between dissociative amnesia and dissocviative identity disorder

 * Psychodynamic perspective: Caused by repression (fighting off anxiety by painfully repressing memories/impulses from reaching conciousness) + trauma during childhood. Support for this comes from case studies, but only a small amount of abused children develop this disorder.
 * Cognitive-behavioral view: State-dependent learning (learning is associated with conditions under which they've occured), in certain levels of arousal, you may attach certain events, thoughts and skills to it. They got state-to-memory links that are rigid/narrow.
 * Self-hypnosis: For dissociate amnesia, people may hypnotize the hell out of themselves in order to forget; "fugue" occurs when person's past + identitiy is gone. For dissociate identitiy disorders, children who may experiene abuse may 'escape' through self-hypnosis.

How do therapists help with dissociative amnesia?


 * Psychodynamic therapists guide the patients deep into their unconscious so they can bring about 'forgotten experiences'.
 * Hypontic therapy: patients are hynotized, then told to recall forgotten events.
 * Drug therapy: injections of barbiutrates used so patients can remember forgotten memories.
 * people with DID do NOT recover without treatment, its difficult

Therapists try to really understand the nature of their disorder, recover gaps in memory, and integrate their subpersonas into 1, functional persona.

DSM-5-TR categorizes this [depersonalization (separate from self)-derealization disorder (world is not real)] as a 'dissociative disorder', but not as one characterized by the memory difficulties found in the other dissociative disorders. 2% of population and is triggered by extreme fatigue, pain, stress, and survivors of life-threatening situations.

Transient depersona and dereal are common, but not to level of psychopathology.

Effective program for trauma, stress, and psychological dysfunction include bio, CB, family and group interventions.


 * Multicultural treatment: Aimed towards minority groups and what they face.

Integration of all the models is the Developmental Psychopathology Perspective, where unipolar depression is caused by a number of factors and can be treated through various models. Inherited, brought out by early life trauma, timing is cruicial.

Bipolar disorders
Low of depression, high of mania; crazy shift in mood.

Symptoms of mania include:


 * Emotional: Powerful emotions
 * Motivational: Constnat need for motivation
 * Behavioral: Very active at times, hella loud.
 * Cognitive: Poor judgement/planning
 * Physical: High energy level

What is a manic episode? Person has uncontrollable, odd mood patterns, which usually consist of abnormal activity patterns. They also may experience (at least of...) reduce sleep, overblown self-esteem, bad focus, or willingness to do dangerous/risky stuff.

Bipolar disorder comes in two forms, according to the DSM-5-TR:


 * Bipolar I disorder: Manic episode, depressive episode could follow
 * Bipolar II disorder: History of depression and hypomanic (less severe version of mania) episode, BUT NO MANIC EPISODE.
 * Cyclothymic disorder: A number of hypomanic periods, mild depression; 2+ years, normal moods every now and then. Could evolve into type I or type II.

Without the necessary treatment, rapid cycles may take place (4+ episodes in one year). Depression could be worse than mania and last longer.

Cause?

 * Neurotransmitter activity: Mania --> high norepinephrine activity, low serotonin activity is for depression... low serotonin, but low norepinephrine activity is mania.
 * Ion activity: Ions ain't coming back and forth between the outside and inside of a neuron's membrane properly.
 * Brain structure and circuitry: Abnormal brain structures, specifically the basal ganglia and cerebellum.
 * Genetics: Inherit biological predisposition to develop bipolar disorders.

Treatments?

 * Mood-stabilizing drugs and strategies: Lithium, antiseizure drugs, antipsychotic drugs, could be combined with antidepressants.
 * Adjunctive psychoterapy: Take your meds + talk to people you love.

SEE SLIDE 51 FOR GRAPH COMPARING DEPRESSIVE AND BIPOLAR DISORDERS ON VARIOUS STATS/DEMOGRAPHICS.