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The Beginning of mental health

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-In the 1950s, we began to question the ethical treatment of patient in institutions -New drugs, particularly anti-psychotics, became available that promise more freedom, less expense and outpatient treatment -As a result, a world-wide effort was made to DEINSTITUTIONALIZE the mentally ill

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Where did they go

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in 2012, there were 10x as many mentally ill persons in prisons and jails ( 356k) than in state hospitals (35k)

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Abnormal

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this field includes states of mind and behavior that deviate both from 1. the statistical average & 2. from what mental health professionals consider to be healthy psychological functioning - Classifying a behavior or stress of mind as "healthy" or "unhealthy" is arbitrary -Personal distress or impairment in function must also be present

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what is abnormal

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all fields of medicine must define what is normal and what is outside the range of normal

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Medical model of mental illness

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this model views psychological disorders as being similar to physical illnesses, having some underlying cause in the organ of the mind (e.g. the brain) and being subject toe diagnosis and treatment

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myth of mental illness

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this myth argues that mental "illness" are little more than social judgments and do not exist in the sense that medical illnesses exist - medical illness involves some sort of demonstrable, structural change and malfunction of apart of the body (.eg. broken bone, infected tissue, growth of the tumor,etc)

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diagnostics

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Clinical psychologist (Pg.D., Psy.D.) and psychiatrists (M.D) are trained in the diagnosis and treatment of mental disorders -a disorder is diagnosed only if 1) it deviates from the statistical average, 2) there is psychological dysfunction and 3) there is personal distress or impaired functioning in life

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DSM

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Diagnostic and Statistical Manual of Mental Disorders is the guidebook (now in its 5th edition) -This provides a way of classifying mental disorders

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The 8 categories of DSM-5 major mental disorders

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1. substance-use and addictive disorders 2. Schizophrenia and other psychotic disorders 3. Depressive and Bipolar Disorders 4.Anxiety Disorders 5. Obsessive-Compulsive Disorders (OCD) 6. Feeding and Eating Disorders 7.Wake-Sleep Disorders 8. Trauma and Stressor-Related Disorders

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Substance-Use and Addictive Disorders

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-Alcohol Use Disorder Symptoms: Compulsive alcohol use; consistent impaired functioning at home, school or work as a consequence of alcohol use; craving for alcohol; apparent loss of control over use -Opioid Use Disorder Symptoms Compulsive use of prescription opioid drugs; craving for opioid drugs; consistent impaired functioning at home, school, or work as a consequence of use; apparent los of control over use

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Schizophrenia and other psychotic disorders

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-Schizophernia Symptoms: Bizarre delusions of hallucinations, disorganized speech and thought; inappropriate emotional responses (including little or no emotional response); self-absorption; social dysfunction. -Schizoaffective Disorder Symptoms: Psychotic symptoms similar to those in schizophrenia alternating with mood disturbances including depression or mania

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Depressive and Bipolar Disorders

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-Major Depression Sym: Sad or listless mood; change in sleep, weight, or appetite patterns; feelings of worthlessness and guilt; difficulty experiencing pleasure; fatigue, hopelessness, thoughts of death and suicide. -Bipolar Disorder Sym: Swings b/w profound depression and highly energized mood (mania). Mania can take the form of extreme elation, creativity, and grandiosity or anger and irritability; mania and depression are sometimes experienced simultaneously (mixed state)

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Anxiety Disorders

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-Generalized Anxiety Disorder Symp: Chronic excessive worry and anxiety that is difficult to control accompanied by factors such as restlessness or tension, fatigue, sleep disturbance, difficulty concentrating -Specific Phobia Symp: Excessive fear and anxiety experience in the presence of a specific object or situation (e.g spiders, snakes, blood, etc); intentional avoidance of the feared object or situtation

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Obsessive-Compulsive Disorder

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-OCD Sym: Recurrent and persistent unwanted thoughts or mental images; combined with compulsive, repetitive, often ritualistic behaviors (e.g hand-washing) that the person feels driven to perform and that take up a substantial amount of time and cause impairment or distress and dysfunction -Hoarding Disorder Symp: Difficulty and distress in discarding or parting with possession (regardless of their lack of value); strong urge to save items, resulting in filling up and cluttering living areas)

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Feeding and Eating Disorders

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-Anorexia Nervosa Symp: refusal to maintain minimally normal body weight leading to abnormally low weigh; intense fear of gaining weight; disturbance in the perception of one's body weight or shape -Bulimia Nervosa Symp: Recurrent episodes of binge eating accompanied by inappropriate behavior (e.g. use of laxatives or induced vomiting) designed to keep the eating from resulting in weight gain.

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Wake-Sleep Disorders

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-Primary Insomnia Symp: Chronic difficulty falling or staying asleep resulting in significant distress or impairment in important areas of life -Narcolepsy Symp: Chronic, attacks of sleep at inappropriate times (e.g. sitting at the dinner table, walking along the street)

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Trauma and Stressor-related disorders

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-Post-traumatic Stress disorder Symp: After experiencing or witnessing an even that involves actual or threating death or serious injury, one re-experiences the event in memory, nightmares or flashbacks; avoids thoughts of the event or places associated with the event; may have sleep or concentration problems and other symptoms.

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Unipolar Depression

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this type of depression consist of unremitting depression or periods of depression without mania -Affects 7% of the U.S population, within a median onset of age 32 -Affects women 2-3x more than men

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dysthymia

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a milder, more chronic version of unipolar depression

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Symptoms of depression

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this disorder is associated with a number of psychological and physical symptoms.. 1. Depressed mood 2. Loss of ability to experience pleasure 3. Restlessness, irritability and/ or anxiety 4. lack of energy and concentration 5. difficulty falling asleep or staying asleep 6. constipation, aches and pains 7. Thoughts of death or suicide * A diagnosis requires that several of these symptoms be experienced over time and significantly impact functioning

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The nucleus accumbens and depression

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In depressed people, there is less dopamine being transmitted to the receptor cell. ** loss of the ability to experience pleasure or reward is a defining feature in unipolar depression

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Suicide

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-Individuals w/ unipolar depression are 29x more likely to attempt suicide than a person in the general population -Men are at a very high risk of suicide when depression is severe b/c they employ methods that are more violent

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Bipolar Disorder

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this disorder is characterized by cyclical periods of unipolar depression and mania -episodes of mania can last a few days to several months; the depression that follows typically last much longer -affects men and women in equal numbers

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cyclothymia

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this disorder is a milder version of bipolar disorder

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Symptoms of Mania

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this part of bipolar disorder can be range from mild to severe and may be characterized by: -high energy -overly good mood -little need for sleep -feelings of power -fast, erratic talking -racing thoughts -impatience -irritability -aggression * the early stages of mania are often viewed positively as a time of creative inspiration

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Heritablity

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-close relatives of those who suffer from depressive or bipolar disorders are 10x more likely to develop a disorder of their own -the concordance rate for monozygotic twins is approximately 69% for bipolar disorder; whereas it is only 19% for dizygotic twins -The concordance rate for monozygotic twins is the same whether they are raised together or apart

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Stress and Depression

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-A person's first bout with depression is often observed after a period of extreme stress or trauma, and future depressive episodes can be re-triggered by stressors - If the combination of the genetic predisposition and the stress exceeds a threshold, then the person will develop a depressive disorder Q: Do stress and depression share a similar neurobiological signature

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diathesis stress model

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this model argues that depression arises due to 1. a genetic vulnerability to depression & 2. some stressful life event

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hippocampus in depression

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when a person is depressed the hippocampus experiences "hippocampal atrophy' in which the neurons in the hippocampus dies, decreasing hippocampal volume *A NEGATIVE correlation exists b/w lifetime depression & hippocampal volume

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The Monoamine Hypothesis

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-Depression has been loosely linked to the monoamine neurotransmitters -Reserpine, a drug used to treat high blood pressure, was reported in the 1950s to cause depression

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Monoamine neurotransmitters

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dopamine (DA), norepinephrine (NE), and serotonin (5-HT)

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Reserpine

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this drug used to treat high blood pressure in the 1950s, interferes with the storage of monoamines (DA, NE, 5-HT) in synaptic vesicles, causing depression in users

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Iproniazid

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a drug use to treat tuberculosis, it is an monoamine oxidase (MAO) inhibitor which prevents the breakdown of monoamines, leading to alleviate depression

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MAO

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monoamine oxidase inhibitor, prevents the breakdown of monoamines

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Tricyclic anitdepressant

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TCA - non-specific inhibitors of the reuptake of NE & 5-HT (e.g. Imipramine, Desipramine)

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Modern Antidepressants

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-Nearly all of these target one or more of the monoamines (DA, NE, 5-HT) Ex include: 1. Tricyclic antidepressants (TCAs) 2. Selective Serotoin Reuptake Inhibtors (SSRIs) 3. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) 4. Norepinephrine-Dopamine Reuptake Inhibitors

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Selective Serotonin Reuptake Inhibitors

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SSRIs -specific for the 5-HT system (e.g Prozac, Zoloft, Paxil, Lexapro, Celexia)

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Serotonin-Norepinephrine Reuptake Inhibitors

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SNRIs -Targets 5-HT and NE equally (e.g Effexor, Pristiq, Cymbalta)

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Norepinephrine-Dopamine Reuptake Inhibitors

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NDRIs -no affinity for 5-HT (e.g Wellbutrin)

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Chemical Imbalance

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-It is TRUE that monoamine-enhancing drugs (e.g. basically all modern antidepressants) can in some, but not all cases alleviate depression -But that doesn't mean that depression is caused by an "imbalance" in monoamine neurotransmitters in the brain *Antidepressant medications may alleviate depression by some other mechanism, and there is good evidence to suggest this is true

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Antidepressant: Acute vs. Chronic

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All antidepressant medications typically take 2-4 weeks of chronic, daily use for depression symptoms to remit -But their effects on the neurotransmitter systems is immediate -this suggest that these drugs are affecting depression in a more complex way that simply increasing neurotransmitter levels at the synapse *Studies in rodents have linked successful anti-depressant effects to increased hippocampal neurogenesis

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Chronic, not Acute, Prozac treatment

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-this treatment is statistical proven increases hippocampal neurogenesis

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Mood Stabilizers

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- these are used to treat mania -they include: 1. the naturally-occurring salt lithium 2. anticonvulsant drugs (e.g. Depakote, Tegretol, Lamictal) 3. new generation anti-psychotics (e.g. Abilify, Seroquel) - Their mechanisms are largely poorly understood

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Side Effects

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All antidepressant and antimanic meds come with side effects; some mild, others not - Side effects exist because of non-selectivity and because neurotransmitters do many things win the brain and the body -As with all medications, it comes down to a cost-benefit analysis *Is the drug helping me enough to justify

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Trial & Error

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For some, finding the right antidepressant ( or combination of antidepressants) often requires trail and error

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Do antidepressants really work

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- Anti- depressants fail to work in up to 50% of the individuals who take them - A 2002 meta-analysis of data reveled that 70% -90% of antidepressant effects were duplicated by placebos - Antidepressants do appear to work better than placebo in severely depressed patients

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The Publication Bias

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- The FDA reviews all findings ( both positive and negative0 when approving new drugs - but that doesn't mean that all the negative findings find their way into published journals - Approximately 1/2 of the studies of 12 different antidepressants reviewed by the FDA found them to be no more effective than placebos * if they work for you, then they work

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Ketamine

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this drug is atypical psychedelic and sedative - Antagonist of glutamate receptors, increasing inhibition in the brain - DOES NOT TARGET MONOAMINES - Promotes sedation, mild to moderate hallucinations, and "out of body" experiences * Ketamine also appears to have rapid antidepressant properties

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Psilocybin

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a serotonin agonist and psychedelic found in the mushroom Psilocyb semilanceata, has recently been shown to have long-lasting antidepressant properties

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Electroconvulsive Therapy (ECT)

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- the use of seizure-inducing electrical currents *** ECT is a last resort for treatment-resistant depression, but it can be very rapid and effective * causes memory loss

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Transcranial Magnetic Stimulation

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TMS - Relatively new treatment for depression that passes more directed current to specific parts of the brain using magnetic pulses - Approved by the FDA in 2008 - Still under study, but early findings suggest that it may be at least as effective as ECT for treating depression

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