module 1: mental illness

deviant, distressful, dysfunctional pattern of thoughts, feelings, behaviours that interferes with the ability to function in a healthy way

YES -> actual conditions implying cognitive, behavioural and emotional alterations caused by complex interactions between genetic predispositions and environmental factors

NO -> unclear pathophysiology + etiology, highly culturally defined (subjective)

43.8 million

1/5 adults in America

½ of all chronic mental illness begin by age 14

1.1% schizophrenia

2.6% bipolar

6.9% major depression

18.1 % anxiety -> highest one

it is unknown but there are many hypotheses

mix of genetic vulnerability + environmental factors (I.e. trauma)

diathesis stress/dual risk model: resilient and vulnerable individuals usually react positively (the same way) when they have a positive experience BUT for a negative experience, a vulnerable individual has a way more negative outcome

initial resiliency + coping skills, childhood environment, life experiences

lifestyle, growing resiliency + coping skills

ex: developments of coping skills due to life experiences can affect the epigenetics

genetic predispositions + environmental factors

frequent mental illness comorbidities

challenging diagnosis (many subjective criteria)

hypothesis for pathophysiology come from MoA of drugs used to treat mental disorders

5th edition of diagnostic + statistical manual of mental disorders

idk

positive, negative, cognitive

new features, psychotic, non occur physiologically

delusions = false beliefs, feel very strong about it (control + reference)

hallucinations = any kind of sensation that's not actually there (visual + auditory)

disorganized speech + behaviour

catatonic behaviour = moving, posture, unresponsive

reduction/removal of normal

flat affect = doesn't respond w/emotions or reaction that would be appropriate

alogia = lack of content in speech

avolition = decreased in motivation to complete goals

can't remember things, learn new things, understand others

more subtle, difficult to notice

prodromal: withdrawn, alone, isolate (looks like depression)

active: severe Sx -> delusions, hallucinations, disorganized speech/behaviours

residual: cognitive Sx, withdrawn

cycles through the 3

needs 2 of these:

- delusions

- hallucinations

- disorganized speech

- disorganized behaviour

- catatonic behaviour

OR negative Sx, one HAS to be delusion/hallucination/speech

HAS to be ongoing 6 months

don't know

majority of meds for it block dopamine D2 receptors -> decrease dopamine

-> suggest schizophrenia has to do w/an increase in dopamine

-> however doesn't work for everyone, suggests norepinephrine, serotonin, GABA are involved as well

no genes linked

environment: early/prenatal exposure to infection, autoimmune diseases

sex: men more than women

only DSM disorder w/objective diagnostic criteria -> their brain physically looks different

family history

the mesocortical DA pathway has a reduced transmission in SCZ, therefore there is a decrease in DA, and the presence of negative Sx

the mesolimbic DA pathway has a increased transmission in SCZ, therefore there is a increase in DA, and the presence of positive Sx

shows how location of brain matters, it is not simply an increase/decrease of DA

enlarged ventricles (empty space where CSF circulates) -> means you have less brain and more empty space

reduced hippocampus

PET measures metabolic activity via glucose consumption

loss of cortical tissue = less neuronal activity, less glucose consumption (mostly in temporal lobe)

measures neuronal activity via blood flow variations

decreased activity in temporal lobe

mood = sustained emotional state

emotions = transient emotional state

mood disorder marked by hyperactive widely optimistic state, makes you do crazy things that feel good at the time

emotional extremes + challenges in regulating mood

-> depressive disorders = prolonged hopelessness + lethargy

-> bipolar disorders = alternating between depression + mania

biological, genetic, environment, psychological

->stressful life event can't give bipolar but it can trigger manic/depressive episode in pre-existing

sadness + grief in extended beyond generally accepted norms (that causes dysfunction)

common cold of mental illness -> top reason for seeking mental health

at least 5 Sx of depression for > 2 weeks

- depressed mood

- weight increase/decrease

- sleep increase/decrease

- thoughts of suicide

- decreased interest

- feeling worthless, fatigued

- trouble concentrating

NEEDS TO CAUSE PROLONGED DISTRESS

mood disorder in which a person alternates between hopelessness/ lethargy of depression and overexcited state of mania

brain slows down, decreased norepinephrine, decreased serotonin

brain activity increases, increases norepinephrine, increased serotonin

same as major depressive disorder

- hopeless + discouraged

- lack of energy + focus

- physical Sx = eating/sleeping too little/much

manic episodes

- energetic

- overly happy/optimistic

- euphoric

- high self-esteem

- pressured speech (talk constantly at rapid-fire pace)

- racing thoughts

- delusions of grandeur (mission of god, super powers)

- poor decision making - no regard for consequences

unipolar -> only depression, high of mania

bipolar 1 -> >2 weeks of depression then >4 days (can be longer) of mania

bipolar 2-> same as bipolar 1 but its hypomania not mania, less extreme highs

cyclothymia -> perfect cycle between depression and mania

mixed episodes: symptoms of depression + mania at same time

rapid cycling: 4 or more episodes of depression or mania within 1 year

not known

family with bipolar disorder -> 10x more likely

drugs + medications

comorbidities: anxiety, SUDs, ADHD, personality disorders

lithium salts -> mood stabilizer

antidepressants -> can trigger manic episode

antipsychotics

anticonvulsants

benzodiazepines

all these have BAD side effects

psychological intervention -> talk therapy, CBT

dysphoric, irritable mood, loss of interests and pleasurable (anhedonia), loss/gain of appetite and body weight, fatigue or loss of energy, suicidal thoughts

elevated euphoria + self-esteem, grandiosity with extreme levels of energy, poor judgement

neurotransmission alterations

DA, NE, 5-HT decreases during depression

DA, NE, 5-HT increases during mania

HPA axis hyperactivation (stress-induced)

-> increase in cortisol and central stress response activation

(appetite + weight alterations, immunosuppression, energy depletion + fatigue, sleep disorders)

back and forth communication between brain-immune

1- mutual risk factors: depression increases risk of auto immune, auto immune increases risk of future mental illness

2- pro-inflammatory cytokines: depression increases TNFaplha and IL-6

3- antidepressants: have anti-inflammatory properties, ppl with higher baseline inflammation respond less to traditional treatments + more to those with anti-inflammatory

excessive + persistent worrying for 6+ months

frequent comorbidities: panic disorder + depression

self medication behaviours: alcohol + Rx of abuse

continually tense + apprehensive, experiencing unfocused, negative+ out of control feelings

multiple disabling panic attacks: short episodes (increased HR, chest pains, SOB)

teens and young adults

frequent comorbidity: agoraphobia

irrational fear of social situations leading to anxiety + avoidance behaviours

subtype of phobia: persistent, irrational fears of specific objects, activities or situations

anxiety related to interacting/being seen by others

unwanted repetitive thoughts which become obsessions, sometimes accompanied by actions which become compulsions to relieve anxiety

persistant, irrational fears of specific objects, activities or situations -> leads to avoidance behaviour

stimulus generalization

reinforcement -> avoiding it increases anxiety

cognition -> how we determine

acquired -> parents

central selection

genetics + brain chemistry -> overarousal in areas of brain that deal w/impulse

most prevalent mental illness

high comorbidity with many other mental illness

self-promoting vicious cycle of anxiety and avoidance behaviours

frequent self-medication and drug abuse (alcohol!!!)

obsession: persistent, unwanted + distressing thoughts or impulses involuntarily coming to mind despite efforts to avoid/suppress it

compulsion: repetitive behaviour or mental act in response to the obsession in order to relieve anxiety; hence it generates anxiety if they are inhibited

intense, disturbing thoughts and feelings related to traumatic experience that last long after the traumatic even has occurred/ended

top 2: sexual abuse + war

3 core Sx: sense of threat, avoidance, re-experiencing

hyperactive HPA-axis -> elevated cortisol

hyperactive SNS -> fight, flight, freeze

impaired monoamine neurotransmission -> decreased serotonin + NE

impaire inhibitory neuromodulation -> decreased GABA

heightened sensitivity to pH alterations within CSF -> panic attacks

hyperactive amygdala -> hypervigilance

hyperactive cingulate cortex -> anticipatory anxiety

network of neurons

most active when doing nothing + thinking abt social interactions, past and future

when active, serotonin and NE transmission in other brain areas declines

focusing on self within present (meditation) reduces DMN activity

reinforcement increase behaviour OR punishment decrease behaviour

both have positive and negative

escape: remove noxious stimuli following correct behaviour (declining social plans with SAD)

active avoidance: behaviour avoids noxious stimulus (leaving party early with SAD)

feels good short term but increases anxiety long-term because so much attention and energy is devoted to anxiety

aware they have problem, tend to be distressed by Sx

not aware they have a problem

inflexible, disruptive, enduring behaviour patterns that impair social + other functioning

odd and eccentric

paranoid PD (suspicious, humourless)

schizoid PD (few friends, indifferent to praise/criticism)

schizotypal PD (aloof, isolated, magical thinking, metaphoric speech)

dramatic, emotional, impulsive

antisocial PD (break laws, no remorse, appears friendly)

borderline PD (self destructive, impulse, erratic, crisis state)

histrionic PD (impulsive, dramatic, inappropriate sexual, centre of attention)

narcissistic PD (can't apologize, exploits others, grandiose)

anxious, fearful, avoidant

avoidant PD (social withdrawal, uncomfortable being social)

dependent PD (lack of self-confidence shown in posture, voice)

OCD PD (perfectionist, preoccupied w/details, rules, schedules)

personality disorder not otherwise specified

4 types that all stem from borderline

neurotic -> organization

antisocial -> extroversion

psychotic -> personality

schizoid -> introversion

borderline personality disorder = complicated learned behaviours + emotional responses to traumatic or neglectful environments, rapid and intense change in emotion and unstable mood

lack of conscious for wrongdoing, even toward friends or family

1. pattern of experiences and behaviours deviating from individuals socio-cultural norms in at least 2 (cognition, affect, social, impulse)

2. pattern is inflexible and pervasive

3. pattern causes significant distress or impairments

4. pattern is stable across time and situations and has an early onset

9-15% for any PD

1-5% for individual PD

female>male

extremely high

general anxiety is 52%

mood disorders 24%

substance abuse 22%

3+ of the following before 15 years:

respectfulness

deceitful

impulsive

aggressive

reckless

irresponsible

violence + criminal behaviours

substance use

conduct disorder

low response to emotional distress

fam history of mental health

abuse/neglect/violent fam environment

early intervention in children at risk

modify toxic environment

genetics, trauma, female

people with BPD have 10% suicide rate

women 2x more likely

5+ of following

- avoiding real or imagined abandonment

- extreme + or - emotions

- inconsistent self-image and identity

- impulsive dangerous behaviours

- instability in mood or emotion

- paranoia or excessive stress

- suicidal thoughts

- difficulty controlling anger

- feelings of emptiness