symptoms
dissociative disorders
types, what it is
disorders due to separation of consciousness and/or loss of certain portions of memory
dissociative amnesia
dissociative identity disorder
dissociative amnesia
dissociative identity disorder
Dissociative Amnesia
loss of extensive personal information
Dissociative Identity Disorder (formerly known as multiple personality disorder)
coexistence of two or more personalities (not to be confused with schizophrenia)
expressed amnesia for the other personalities but other memory tests suggest awareness of the other personalities
alters may be very different from the original personality
transitions may be sudden
have the # of diagnoses of dissociative identity disorder increased or decreased over the years?
increased- iatrogenic effect?
stress? past?
Stress – but why does stress affect some people in this way and not others?
iatrogenic
severe emotional trauma during childhood
ability to dissociate? but lack of independent verification very controversial; etiology is very unclear
what is dissociative fugue
dissociative fugue is a subtype of dissociative amnesia- Definition: Dissociative fugue involves memory loss for personal autobiographical information along with unexpected travel or wandering. People may appear normal to others but are unaware of their true identity or past
major depressive disorder
so many but what is loss of interest in pleasurable things called?
-persistent sadness and/or loss of interest in previously pleasurable things (i.e. anhedonia)
weight loss or weight gain
insomnia or hypersomnia
psychomotor retardation or agitation
fatigue
feelings of worthlessness or guilt
can’t concentrate
recurrent thoughts of death
how many symptoms must one exhibit?
Diagnostic criteria:
(5 or more)
onset? what does an earlier onset mean? how many episodes does one typically have? how long are the episodes? lifetime prevalence? cohort effect? gender?
Onset: around puberty & highest incidence around 20s (your chapter says differently – but ignore)
earlier onset = worse severity and prognosis
40-50% have recurrences: avg. of 5-6 episodes
Average duration: 6 mos.
Tends to be episodic but some have persistent depression for many years; corre. with ↑ risk of physical health problems and ↑ mortality risk
Lifetime prevalence: 13-16% (at least 40 million people in the US)
Cohort effect
But some suggest this is inflated to include normal sadness in response to severely stressful situations
women 2x greater: men
genetic vulnerability, interpersonal roots, stress (FOR BIPOLAR TOO)
Genetic vulnerability
Large ↑ concordance rate for MZ twins
65-80% of variance for bipolar disorder
40% of variance for bipolar disorder
Predisposition not determination
Actual manifestation may be different among family members
Interpersonal roots
Poor social skills → punishing social experiences → worse mood/depression
Stress: Can trigger onset of depression and bipolar. With more occurrences, stress plays less of a role
what are hypotheses for the gender ratio?
genetics unlikely
tied to reproductive cycle/hormones?
greater stress & adversity (environmental factors)
rumination
bipolar disorder
inflated self-esteem/grandiosity
decreased need for sleep
more talkative
flight of ideas/racing thoughts
distractibility
psychomotor agitation and/or ↑ goal-oriented behavior
excessive involvement in pleasurable activities
what is necessary and how many symptoms are necesary?
at least one manic episode (persistently elevated, expansive or irritable mood, lasting at least 1 week)
(3 or more)
prevalence, gender ratio, onset
Prevalence: 1% of population
women: men = equitable
Onset: late teens or early 20s
Neurochemical and neuroanatomical factors (FOR MAJOR DEPRESSIVE DISORDER TOO)
NE & 5-HT (but other monoamine neurotransmitters have been implicated as well)
↓ volume of hippocampus/↓ neurogenesis assoc. with depression
Stress → ↑ HPA(C) activity → ↓ neurogenesis in hippocampus? → ↓ hippocampal volume?
Hyper-reactivity of the amygdala
Hypo-reactivity of the reward system
Correlation or causal?
Cognitive factors
Learned helplessness
Reformulated learned helplessness theory – pessimistic explanatory style (esp. internal, global)
Rumination
May explain differences in gender rates
May also contribute to generalized anxiety disorder, eating disorders, substance-abuse disorders
Hindsight bias
Correlation or causal? Can it be both?
talk about suicide
amish too
are you more likely to get disorder or predispositon?
10th leading cause of death; 45,000 deaths per year
perhaps underestimation
suicide attempts (25): suicides (1)
attempts: women (3-4x): men
successful: men (4x): women
90% likely have a type of psychological disorder
50-60% may be major depressive & bipolar disorders
↑ severity of depression → ↑ chance of suicide
-amish suicide rates are very low (much lower depression rates) suggests that something is running down family that leads to depression
-predispostion- disorders can manifest differently across generations
schizophrenia (positive + negative)
positive: delusions, hallucinations, disorganized speech or thought, grosly disorganized or catatonic behavior
negative: affective flattening, alogia, avoliution
how many symptoms must one exhibit
2 or more
when males? when females? what does ealier onset mean for prognosis? lifetime prevalence?
Males: mid-20s
Females: later 20s/early 30s, possibly also peri-menopausal age
Earlier onset → worse prognosis and ↑ risk of suicide or early death (e.g. variety of physical diseases)
Lifetime prevalence: 1% of US population
genetic vulnerability, neurochemical factors, structural abnormalities, neurodevelopmental hypothesis, expressed emotion, stress
Genetic vulnerability
Concordance rate: 48% MZ twins vs. 17% DZ twins
2 parents with schizophrenia = 46% risk of schizophrenia vs. 1% risk
Low IQ corre. with increased risk
Predisposition
Neurochemical factors
DA hypothesis
Updated DA hypothesis
Dysregulation (e.g. too low in prefrontal area, too high in nucleus accumbens area)
5-HT, GABA, glutamate also implicated
Marijuana use during adolescence + genetic vulnerability may ↑ risk
Structural abnormalities
Enlarged ventricles, ↓ Volume of both gray and white matters
Synaptic pruning gone awry?
Correlation or causation?
Neurodevelopmental hypothesis
e.g. viral infection (which may lead to inflammation), malnutrition, obstetrical complications
minor physical anomalies support this theory
Q for you – if the problem is negative conditions during prenatal development, why do symptoms show up at a later age?
Expressed emotion
Affects course of disorder, after onset
Relapse 3x greater for those with schizophrenia returning to families with high expressed emotion
Stress
Can trigger first episode and subsequent episodes
define catatonic behavior, affective flattening, alogia, avolition,
Catatonic behavior → Abnormal motor activity, ranging from complete immobility and mutism to bizarre movements or postures.
Affective flattening → Very limited outward emotional expression (flat voice, minimal facial expressions, reduced gestures).
Alogia → Poverty of speech; very brief, sparse, or empty verbal responses.
Avolition → Severe lack of motivation, difficulty initiating or sustaining purposeful activities.
austism spectrum disorder
Diagnostic criteria:
Social communication and interaction deficits in multiple contexts
Repetitive/restrictive behaviors and/or interests
how many don't develop speech? how do they react to change? IQ? Onset? Diagnosis age? prevalence? gender ratio? Who has more severe impairments?
30-40% may not develop speech; others may have unusual characteristics of speech (e.g. echolalia)
possible extreme reactions to relatively minor changes in environment
1/2 have sub-normal IQ scores
Onset: symptoms generally appear between 15-18 mos.
Diagnosis usually at a young age (e.g. before age 2-3)
Prevalence: 1.5%
80% of cases are males; females may have more severe impairments
genetics? brain abnormalities? mercury?
Etiology
Genetic
Brain abnormality
e.g. brain enlargement by age 2 yrs. (overgrowth in various areas of cortex), beginning possibly prenatally
Study suggesting mercury involvement has been deemed fraudulent
what are outcomes?
Outcomes:
20% good (high level of independence)
31% fair (some independence but support/supervision still necessary)
48% poor (residential supervision or hospital care needed)
Increasing #s are entering college and workforce