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Class 13- Psychopathology
Classes 13- Psychopathology 118
Undergraduate 3

Additional Psychology Flashcards




OCD- theories of possible causes (list)
-Brain circuit theory (thalamus)
-Proinflamatory cytokines (autoimmune disease)
-Autoantibodies (as seen in Rhumatic Fever)
-Large biological component but severity is highly influenced by cognitive aspects and comorbity.
OCD- theories of possible causes

-Brain Circuit-
Brain circuits are involved with generating and controlling impulses

Begins at the FRONTAL CORTEX with thoughts and impulses (e.g. wash hands)

Travels to the CAUDATE NUCLEUS which is part of the Basal Ganglia and the GATEKEEPER- if signals are strong enough they will be allowed to pass- otherwise they will stop there

Strong signals move on to the THALAMUS which is loaded with SEROTONIN and responsible for more PRIMAL instincts such as sex, aggression and bodily excretion. If the impulse signal is strong enough, the impulse will be carried out.
OCD Causes- Thalamus
The thalamus controls our most basic, primal urges- aggression, sex, bodily excretion.

Many OCD compulsions revolve around these more basic instinct.

FMRI studies indicate that people with OCD have increased activity in the thalamus. Once those partipants were placed on SSRIs the activity level decreased.

Hoarders don't activate in the Thalamus but rather in the decision making part of the brain. When people with OCD are hoarders it is generally related to a compulsion surrounding contamination.
OCD Treatment (RX)
OCD doesn't respond to Benzos (which target the inhibiting neuron GABA). It responds best to SSRIs.

OCD needs high doses of SSRI's unlike PD which only needs low ones and depression which needs midrange.

RX helps 50-80% of patients and reduces symptoms by 40-50%

only reduce the symptoms however DOES NOT CURE
OCD Causes- Proinflamatory Cytokines
Immune function affects mental health.
Rates of OCD in Bachen's study of women with Lupus showed rates of OCD 10-11x higher than in the general population.

This high rate is possibly due to the anibodies people with Lupus produce that attack their own organs- these antibodies may also be attacking the brain - some studies have shown people with lupus to have more lesions in their basal ganglion.

People with lupus also produce more PROINFLAMATORY CYTOKINES which ramp up and maintain the body's immune response. These affect neurotransmitters which could in turn affect mood and mental health.

Stress, poor diet and lack of exercise also increases the number of proinflamatory cytokines produced suggesting that lifestyle could play a role.
OCD Causes- Rhumatic Fever
When Strep throat isn't treated it can turn into Rhumatic Fever. The body begins to produce antibodies which attack the organs- specifically the heart, brain and possibly lungs

These autoantibodies and their attack on the brain can trigger OCD symptoms which go away again once the infection is treated

The autoimmune process shows that there is more than one pathway to the disease of OCD
OCD- cognitive aspects affecting cause
OCD has a large biological component but it also has cognitive influences that can affect the severity of the disease.

A lot of people with OCD have comorbid depression which often leads to increased RUMINATION and a focus on the negative. Both these behaviors worsen OCD.

People with OCD also tend to be hyper CRITICAL of themselves and have GUILT and SHAME surrounding their ideas and impulses. SELF DEPRECATION. These types of cognition make OCD worse.

When people try to supress a though or impulse it becomes all they can think about.

OCD is a magnification of the thoughts and impulses we all have.
OCD Treatment- history
first tx developed in the 1960s England
-confronting situations that bothered or scared the patient (flooding and preventing compulsions)
OCD Treatment - today
Basically the same treatment as was first developed in the 1960s.

-Exposure: desensitization (imaginary) & Flooding (real)
-*Prevention of carrying out compulsion- very important
-Pratice: over time habituation occurs

Need to build up to it.
Therapists can MODEL the behavior first,

Homework- e.g. do one behavior one less time

CBT is considered the most effective psychological tx for OCD

60-90% of patients experience improvement and a 50-70% reduction in symptoms

People may also take SSRIs along with CBT or, if they don''t want therapy, only use the RX

50-80% of patients experience improvement with rx and a reduction of their symptoms by 40-50%
Stress disorder.

50% of people in the US have been or will be exposed to a traumatic event in their lifetime

Truaumatic events include:
assault, abuse, combat, natural disasters, accidents

Most people adjust by some don't

In the US 8% of people are living with PTSD
PTSD Film Clip
WWI soldiers were coming out of the trenches with odd physical symptoms: tremors, limps, crying, mute, blind, paralyzed - began to happen even to soldiers who hadn't been in the trenches

Shell shocked, war neurosis- sx resembled hysteria which was considered a woman's disease and unthinkable in a man- in the absence of a biological cause the military decided they were fakers and court marshaled some

80,000 soldiers were affected

Psychoanalytically, there was a conflict between the body telling the solider to run and the mind telling the soldier they had a moral duty to stay. That intense conflict and powerlessness manifests into physical symptoms. People who stayed the line were considered heroes and didn't know how to integrate that with anxiety fear and guilt- repression led to other manifestations

Freud was able to help through the "talking cure" which provided greater appreciation for his theories
PTSD Treatment
Talk therapy is still the cornerstone to treating PTSD

Helps to integrate the traumatic experience back into their lives as they had previously known them as well as their old and new visions of the world.

Helps sufferers come to terms with other feelings that may arise e.g. survivors guilt or feeling like they should have done more

Talk therapy is a form of EXPOSURE THERAPY you keep reliving it until you are desensitized. Talking or writing about the sounds, smells, thoughts etc. with the goal of eventually making it just like any other memory- habituating the event

Other treatments include mindfulness meditation.

Best outcome if you are able to give the trauma a POSITIVE REFRAMING finding something good to have come out of it will increase happiness and decrease depression.
PTSD and Military
Especially high rates of PTSD from Iraq and Afganistan wars- 30%
Due in part to '
-older reservist demographic that already had established lives
-Multiple deployments
-High rates of depression and PTSD barely being treated before redeployment (reds only no talk therapy)

Women in military have even higher rate due to sexism stress and sexual harassment on top of regular combat stressors
PTSD - DSM change
1980's the DSM changed its language and detached PTSD from the context of rape (previously named rape syndrome)

While the #1 cause of PTSD in the US is from car crashes, the category of trauma most likely to develop PTSD is sexual assault.
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