Three Minute Review MOOD DISORDERS Major Depression emotional, cognitive, behavioral and physical symptoms diathesis-stress maintaining factors depressive realism learned helplessness explanatory style: negative, global, stable interpersonal interactions Seasonal Affective Disorder (SAD) effect of latitude Bipolar Disorder hypomania, mania, psychotic mania Relationship between mental disorders and creativity?
DISSOCIATIVE IDENTITY DISORDER not same as schizophrenia controversial: trauma-based or iatrogenic? SCHIZOPHRENIA affects 1%, can be devastating, class effects Positive symptoms disorganized thoughts delusions (persecution, grandeur, control) hallucinations esp. auditory hallucinations Negative symptoms flattened affect apathy, avolition (lack of motivation), poverty of speech anhedonia catatonia Types paranoid catatonic disorganized undifferentiated
Causes of Schizophrenia strong genetic contribution; environmental factors also contribute positive symptoms may be related to dopamine excess or imbalance negative symptoms may be related to brain damage viral infection hypothesis seasonality effect exposure to flu virus during second trimester of pregnancy may affect neural organization Rule of Thirds» hippocampal neurons much less organized in schizophrenics
Test Yourself Which part of the brain is often enlarged in schizophrenics? A. amygdala B. hippocampus C. basal ganglia D. orbitofrontal cortex E. ventricles
Final Exam Saturday April 22, 7-10 p.m., Alumni Hall 201 100 multiple choice questions, up to 3 hours 30% of course grade all material from Winter semester approx 20% on material from Lectures 1-7 approx 20% on material from Lectures 8-14 approx. 60% on material from Lectures 15-22 questions for last third similar in style to those on Term Tests 3 and 4 questions from first two thirds questions on lecture similar to Term Tests 3 and 4 questions from text will be FQ-based and less nit-picky about the details of the readings
In-Class Review Session Tuesday April 11, 12:30-1:20 Fifty minute review Focus Questions from lectures will be provided in class and online Review of some of the key slides from the semester YET ANOTHER REMINDER DON T FORGET YOUR RESERCH PARTICIPATION REQUIREMENT!
Course Evaluation Evaluate only the second (Winter) semester, not the first Evaluate only Dr. Culham, not Dr. Johnston Constructive feedback in written comments please
Happiness Survey On a sheet of paper (scrap paper available), answer the following two questions and turn it in. DO NOT put your name or ID or identifying information on the paper. A. Write down the number that corresponds to the face which represents how you feel about your life as a whole -3-2 -1 0 1 2 3 B. What changes in your life do you think would make you happier? Group results will be discussed on Thursday.
Two Major Approaches BIOLOGICAL TREATMENTS It s your neurotransmitters/brain. Psychopharmacology Electroshock Therapy Psychosurgery PSYCHOLOGICAL TREATMENTS It s your life/behavior/reaction. Psychotherapy Psychoanalysis Humanistic Therapy Cognitive Therapy Behaviour Therapy Other
Psychopharmacology: Antipsychotics DEINSTITUTIONALIZATION Antipsychotics block dopamine receptors traditional antipsychotics (chlorpromazine) may not help negative symptoms of schizophrenia side effects tardive dyskinesia patients often fight meds or go off them newer generation antipsychotics (clozapine) affects dopamine plus other NTs may help negative symptoms no motor side effects risk of serious blood disorder second generation antipsychotics fewer side effects little tardive dyskinesia
Psychopharmacology: Anti-anxiety tranquilizers, barbiturates drugs like Valium GABA, an inhibitory neurotransmitter Valium reduces excitability of neurons useful for generalized anxiety doesn t seem to help phobias, OCD or panic disorder danger of overdose, suicide addictive
Psychopharmacology: Antidepressants monoamine hypothesis depression results from reduced monoamines (esp. serotonin & norepinephrine) traditional antidepressants tricyclic antidepressants block reuptake of both serotonin and norepinephrine monoamine oxidase (MAO) inhibitors prevent the breakdown of serotonin and norepinephrine many side effects may still be valuable in severe cases
Psychopharmacology: Antidepressants second generation antidepressants SSRIs (selective serotonin reuptake inhibitors) see Gray Figure 17, p. 666 Prozac and others (e.g., Paxil, Zoloft, Celexa ) little effect on other transmitters including norepinephrine fewer side effects than tricyclics and MAOIs originally for depression, now marketed for OCD, social phobia harder to commit suicide with than traditional antidepressants most frequently prescribed psychoactive drugs in US
Miracle drug or personality pill?
Problems with the Monoamine Hypothesis Why is it that SSRIs affect serotonin levels almost immediately but don t have much of an effect on depression for several weeks? Why do drugs that work on serotonin and norepinephrine -- two very different brain systems -- have similar effects?
Depression and Sleep sleep disrupted in depressed people too much REM short REM latency lots of REM periods too little slow-wave sleep in cats, twenty different antidepressant drugs all reduced REM and increased slow-wave sleep first-degree relatives of depressives without depression symptoms themselves show reduced REM latency those with the strongest effects are most likely to become depressed = evidence for diathesis?
SAD: Phototherapy bright lights help SCN reset circadian rhythms? helps SAD and winter blahs Do you need the high electricity bills? A one-hour walk outside each morning reduces SAD symptoms
Electroconvulsive Therapy (ECT) Jack Nicholson as McMurphy in One Flew Over the Cuckoo s Nest undergoes ECT and ultimately a lobotomy last resort for severe depression but it often works 70% success when everything else has failed has become more humane over years anesthesia muscle relaxants unilateral stimulation to reduce retrograde memory loss why does it work????
Transcranial Magnetic Stimulation (TMS) magnetic fields create an electrical current in a focal part of the brain may hold promise for alleviating depression especially TMS to left frontal lobe
12 th c. trephination 1950s heyday of lobotomies Psychosurgery modern day cingulotomy very focal surgery to cingulate cortex can be useful in severe OCD or depression absolute last resort trephinated skull McLobotomy cingulotomy
Psychotherapy Most modern day therapists use an eclectic approach -- a bit of everything
Psychodynamic Therapy ASSUMPTIONS Behavior is driven by biological urges, interpsychic conflict and developmental fixations GOALS client seeks insight regarding unconscious conflicts and motivations METHODS free association, dream interpretation, talking cure, catharsis transference: patient s unconscious feelings about person in their life experienced as feelings toward therapist therapist extracts hidden motivations
Humanistic Therapy ASSUMPTIONS People are good and have innate worth GOALS to promote personal growth and selfactualization to help clients become aware of their own feelings and wishes and to gain control of their lives METHODS client-centred: therapist is a sounding board for clients thoughts reflection: therapist repeats client s concerns in order to help client clarify feelings empathy: therapist takes client s perspective unconditional positive regard: safe, nonjudgmental atmosphere in which client is worthy and capable
Humanistic Sample Client: I get so frustrated at my parents. They just don t understand how I feel. They don t know what it s like to be me. Therapist: You seem to be saying that the things that are important to you aren t very important to your parents. You d like them now and then to see things from your perspective.
Cognitive Therapy ASSUMPTIONS Behavior is controlled by habitual ways of thinking GOALS to replace maladaptive ways of thinking with adaptive ways of thinking about events related to self METHODS problem-centred: focused on client s specific problems thought stopping, recording automatic thoughts, refuting negative thinking, reattribution, homework assignments Rational Emotive Therapy (Ellis) Beck s Cognitive Therapy: counteract negative thoughts about self and world
Rational-Emotive Therapy Albert Ellis Examples of irrational beliefs Everyone must like me I must be perfect It s horrible when things aren t the way I expect It s easier to deny problems than face them I have no control over what happens to me Change an irrational belief to change the negative emotional reaction to an event
RET Sample Client: Life isn t fair. I shouldn t have been fired under those circumstances. Therapist: What circumstances are you referring to? Client: Being fired right after my dad died. Therapist: That your father died is unrelated to the fact that you were fired from your job. Client: It s still unfair. Therapist: That has nothing to do with fairness. These two events are related only in your mind, and putting them together is irrational. What happened is unfortunate, but there is no conspiracy here.
Behavior Therapy ASSUMPTIONS Maladaptive behaviors are acquired through learning GOALS to replace maladaptive ways of thinking with adaptive ways of coping METHODS behavior modification based on operant conditioning reward desired behaviors and punish unwanted behavior example: token economies habituation exposure treatment: client repeatedly exposed to threatening stimulus systematic desensitization: gradual exposure treatment flooding: abrupt exposure modelling: client models therapist s actions aversive conditioning (e.g., Antabuse)
Cognitive Behavioral Therapy uses both cognitive and behavioral approaches correct faulty behaviors and faulty cognitions example: social phobia train social skills understand how cognitive appraisals of others reactions may be inaccurate quite effective for anxiety and mood disorders
Systematic Desensitization
Other therapies Group Therapy cheaper than individual therapy clients can find support in others with same problem may not need formallytrained leader (e.g., AA) Marital and Family Counselling work on interactions
How effective is therapy? people tend to improve regardless people often seek help at worst times 75% of neurotic patients improve regardless of therapy any treatment is better than no treatment not that much difference among various psychotherapy types a caring therapist is essential confession is good for the spirit some support for idea of catharsis people talking about problems improves health and cognition non-specific effects support of therapist hope for improvement
Different problems, different solutions
Different problems, different solutions ANXIETY DISORDERS anxiety cognitive-behavioral therapy specific phobias cognitive-behavioral therapy social phobias behavioral therapy SSRIs may help panic disorder drugs help symptoms but not anticipatory anxiety cognitive therapy helps reduce anxiety obsessive-compulsive disorder SSRIs and related drugs cognitive-behavioral therapy conditioning
Different problems, different solutions MOOD DISORDERS depression cognitive-behavioral therapy therapy + drugs > either alone moderate: SSRIs 60-70% of patients relieved (vs. 30% for placebos) and less likely to relapse (20% vs. 80%) can require trial-and-error approach severe: MAOIs, tricyclics, ECT/TMS seasonal affective disorder phototherapy bipolar disorder lithium helps mania in ~3/4 of patients no one understands how it works unpleasant side effects psychotherapy helps keep patients on meds
Different problems, different solutions PERSONALITY DISORDERS psychotherapy can help some disorders (e.g., borderline) antisocial personality disorder drugs can reduce aggression therapy useless, possibly worse than nothing prevention may be help identify kids with conduct disorder SCHIZOPHRENIA antipsychotics social skills training training in cognitive skills (e.g., coping with voices) has not been especially successful