03/28/2015

DepressiveDisorders:
mooddisorders
grossdeviationsinmood
o sustaineddeviations
typesofDSM5depressivedisorders
majordepressivedisorder
persistentdepressivedisorder(dysthymia)
o symptoms:
sadmoodforatleasttwoyears
atleasttwo:
poorappetiteorovereating
toolittleortoomuchsleep
fatigue
lowselfesteem
lackofconcentration
feelingsofhopelessness
o canhaveboththisANDmajordepressivedisorder
disruptivemooddysregulationdisorder
o brandnew
o designedtobeapediatricdiagnosis

childrenwerepreviouslydiagnosedwithbipolardisorderwithanger
problems
o severetemperoutburstsinconsistentwithdevelopmentallevel
o 3x/week
o irritable/angryinbetweenoutbursts
o NOTtransientmustbepresentforatleast12months
o Ageofonsetisusuallybefore10yrs
o Prevalenceisntreallyknownbecausenewdisorderbutestimatedaround2%
o Developmentallyontrackbutoutburstsarenotconsistentwithdevelopment
o Biggerquestionhowmanyofthechildrenwiththisproblemwilllaterdevelop
intobipolardisorder
MajorDepressivedisorder
Characterizedbysadmood(anhedonia)for2weeks
o Majordifferencebetweenpersistentdepressivedisorderisthattimerequirementis
muchshorter
Nohopeforthefuture,suicidal,harmfulthoughts
Disturbedphysicalfunctioning
o Toolittlesleep
o Toomuchsleep
o Slowedmovement
o Agitations(cantsitstill)
Significantweightloss
Worthlessness
Inabilitytoconcentrate

Prevalence=6%
Averageepisodelength=49months
Afterabout5yrs90%ofpplhaverecovered
Meanyrofonset=25buttrendingdownwards
Recurrentdisorder
o Peopleexperiencemultipletimes
o Sotrytopreventfirstonset
Ratesofdepressionareincreasingovertime
MDDprevalenceglobally(4%ofwordpopulationhasit)
o Hotspot=northAfrica,middleeast
o Lowspots=eastasia,mexico,japan(least)
MDDburden
o USmean
o Womenaremorelikelytobedepressed
o Highestregionareinthemiddlesoutheast
Higherbutnotdramaticallyhigher
CausesofMDD:LifeStress
o Context:howdoesevenfitintolargerlifepicture
o Meaning:interpretationofevent
o Notallunfortunateeventsareextremelystressfulsomeeventsseembadbutin
contextarenotasbadasitappearsinacertaincontext
o AretherecertainlifeeventsthatarecloselytiedtoMDD

Losteventscanbelostofmaterialisticpossessions,relationships,
employment,justsomesortofimportantlossfortheperson
Humiliationeventsomesortofrejectionorfailurethepersonperceived
that
Psychologicaltreatment:CT/CBT
o Cognitivetherapy/Cognitivebehavioraltherapy
Behavioralpiecegetpatientstoreengageinactivitiestheyusetoenjoy
o Examinethoughtprocesseswhiledepressedandcorrecterrors
o Notreplacewithpositivethoughts,butmoreaccuratethoughts
o Increaseactivitytocounteractanhedonia
o Trytoidentifythecorethoughtsthataremaintainingthedepression
Thenanalyzethesethoughtsandcomeupwithalternativesthataremore
reflectiveofrealityandwithenoughpracticesthenegativebeliefsmay
begintochangeandbecomemorepositive
o Video
Womanloseshusband
Thinksdepressedbecausehelefther
Sobringsupwouldshefeeldepressedifhewasdraftedno
Sonotsadthathelefther
Sadbecauseshethinkshedoesntloveher
ShethinkssheisUnlovable(THEKEYASPECTOFHER
DEPRESSION)
o EfficacyofCT
Mostwidelystudiedformoftherapy
Effective(notclearwhyitworks)
Moreeffectivethancomparisontreatment

Aboutaseffectiveasmedication
Trytofindoutwhyitiseffective
SeparatethedifferentcomponentsofCTandtreatpatientswithonly
oneorboth
Behavioral
Cognitive
Bothtogether
Revealsthatbehavioralpieceisreallyimportantdoes
almostaswellasthewholetreatment
Controversialwhetheritworkswithseerelydepressedpeople
Itisgoodformildlydepressedpeople
Butpeoplearguethatforseveredepressionitisnotagoodtreatment
ItisoktocoupleitWITHmedicationbutCTaloneisnot
effective
Didanexperimentwithseverelydepressedpeople
GotCTorMedicationorplacebo
At8weeksCTandmedicationweremuchmoreeffective
thanplacebo
o Prettysimilaratthispoint
At16weeksCTandmedicationstillhadsimilarresponse
ThisexperimenttookplaceatUPennbutalsodoneat
Vanderbilt
o Treatmentresultsdifferedbasedonwhich
university/sites
o UpennhomeofCBTpeoplegivingCBThad
muchmoreexperience
o Vanderbiltoneofthetherapistswere
inexperiencedwithCBT
o Viseversaformedication

THUSrevealingthatCBTcanbeaseffectiveas
longasthetherapisthadalotofexperiencewith
CBTandwithdepression
CBTimprovement(after16weeks)followedthemfor12
months
o Peoplerandomizedsomewithplaceboandsome
withmedicationandsomewith3booster(CBT)
sessions
o CBTconditionwiththreeboostersessionshada
muchbetterfollowup
o AlsowhenlookingatrelapseCBThadthesmallest
percentofrelapse
o CBThasenduringeffectbeyondtreatment
Skillslearnedduringtreatmentstayswith
you
o

Medicaltreatment
o Differentmedications
o Eventhoughnewermedicationshavebeendeveloped
theefficacyhaventreallychanged
hoversinthe50%range
whathaschangedthesideeffectprofilesarebetterwithnewmedications
suchasdietaryrestrictions
weightgain,drymouth
SSRIsfewersideeffectsandmoretolerable
Electroconvulsivetherapy(ECT)
o Electrodesareplacedunilateral
o Currentisappliedproducingaseizure
Bodyismonitoredwithalotofmachines
Patientputtosleep

o
o
o

o
o
o

o
o
o
o
o
o
o

Bipolar

Currentisrunforlessthanasecond
Wantseizuretolastatleast30secwantaround1min
Patientwillwakeupfeelsomebriefconfusionandsomemusclestiffnessand
headacheshouldbeshortlived
Maybesomememorylossshorttermmemory
Notlonglasting
Longtermmemoryisnotlost
Verywellcontrolled
Veryeffectiveforseveredepression
Oftenusedwhenothertreatmentsdontwork
Notfirstlinetreatmentlastlinetreatment
Becausesomeriskandexpensive
Approximately8/10respond(80%)
Somememoryproblems(1/3patients)butshortlived
80%ofpatientssatisfied
1012sessionsdontwanttogobeyond12sessionsbecausedontknowtheside
effectsofinducingseizures
patientwilltakeabreakfromthesessions
costsaround800pertreatment
notlongtermthough
nodefinitivereasonwhythisworks

Thereisaspectrumforbipolardisorders
o Thevariabilityandseverityofthedepressionandmaniadetermining
whichformofbipolardisorderonehas
Spectrum
o NormalMoodvariation
o Cyclothymia
Upsarehigherthanoneexpects
Havealotofenergyandactivity
Shortlivedthough
Nottheextremesofmaniathough
Moredepressionthanonewouldexpect
Butnotseveredepression
Milderformofbipolardisorder
o BipolarII
Havehypomania
Theydonthavetheextrememania
Havefullblowndepression
o BipolarI
Classicbipolardisorder
Havebothseveremaniaanddepression

Ex:
Ifsomeoneonlyhadseveredepressionsw/omaniatheydonotnecessarilyhave
bipolardisordertheyjusthavedepression

Notbipolaruntilhavemania

BipolarI
Definingfeatures
o Alternatingmanicanddepressiveepisodes
Mightbemonthsoryearsbetweenepisodes
Manicepisode
o Onlyneed1inlifetimetobeconsideredbipolarI
Onceyouhave1manicitisexpectedyouwillhaveadepressive
episode
o Abnormallyelevatedmood(atleast1week)
o 3ormoreofthefollowingsymptoms
inflatedselfesteem
decreasedneedforsleep
pressuredspeech
racingthoughts
easilydistracted
highlygoaldirected
pleasurableactivitieswithhighriskfornegativeoutcomes
sexuallypromiscuous
gamble
mightbuythingstheycantaffordbutwant
prevalence

12%lifetime(US)
recurrentepisodesarecommon
o raretoonlyhave1manicepisodeevenw/effectivetreatment
o timebetweenmanicepisodesdecreaseswithmanicepisodes
sowanttogetgoodtreatmentafterfirstepisode
o 1/3willrelapseafter3yrs
evenw/goodtreatment
relapseismanicordepressiveepisode
o onset=18yrs
youngerthanMDD
MDDismid20s
maniausuallyoccursbeforedepressiveepisodes
hugeeconomiccosts
o lostproductivity
o medicalcosts
CausesofBD:biological
BDappearstobehighlyheritable
o 60%Heritable
o geneticsplaysalargerole
o doesntsaypsychosocialthingsdontplayarole
o ifatwinhasamooddisorderverylikelytheotherwilltoo
o

twinstendtohavesametypeofdisorder80%concordant
ifonehasMDDotherwillhaveMDD
ifonehasBDotherwilllikelyhaveBD
o uniquegenesforMDDandBD
evidenceliesw/intwins
twinshaveconcordantdisorders
ifgenesdidntplayaroletheconcordant%shouldbe50%
PredictorsofBDsymptomcourse
o Maybeeffectedbyenvironment
o Stressfullifeevents
w/orecoveredin100days
w/events3xaslongtorecover
sostresscanprolongsymptoms
o Positivelifeevents:Goalattainment
Caninfluencemanicsymptoms
Formostindividualswhoachieveagoalyousavorandcoastbut
forthosewithBDtheydonotcoastitenhancestheirgoalseeking
givesthemadditionalgoaldesire
BAS(behavioralactivationsystem)ismoresensitiveandonceachieve
onegoalmoveontonext
Positivelifeeventsaffectmaniabutitisgoalattainmentthatplays
largestrole
o Familyfunctioning(expressedemotion)
Expressedemotion(EE)referstocritical,hostile,oremotionally
overinvolvedattitudestowardafamilymemberwithpsychiatric
disorder
Patientsaremorelikelytorelapse

 Correlation=.4(veryhigh)
TreatmentofBD:familyfocus
FamilyFocusTreatment(FFT)
o Focusedoncommunicationinfamily
o Trytoreducenegativeinteractions
o InvolvedalotofeducationofBD
Trytotellthemwhatthepatientisexperiencingisnotuncommonfor
peoplewithBD
o Helpingpersonidentifytriggers
o Talkingaboutcompliancewithmedicationtreatment
o Fairlyflexibletreatment
o Shorttermtreatment
o Challengeneedpeopledocommunicatewithfamilyonaregularbasis
o Reducesrelapsein30%
Crisismanagement(CM)
o Designedtoemulatecommunitycare
Comparedthetwotreatmentsinefficacycomparison
o SurvivalratewasmuchbetterforFFtreatmentoverCMtreatment
o GreatersymptomstabilitywithFF
o EveryonegetsmedicationbutFFinconjunctionisverygoodtreatment
TreatmentofBD:meds
Lithiumandanticonvulsantlamotrigine(lamictal)areonlyFDAlongtermefficacy
drugs

Anticonvulsantsandantiepilepticsarealsoused
o Divalproexandcarbamazepine
o Divalproexmainlyusedmoodstabilizer
Formania
Sideeffectprofileisbetterthanothermeds
Lithiumisbetterforpreventingsuicide
Majorsideeffects
o Lithium
Nausea
Diarrhea
Treatmentsdontreallydifferineffectivenessbutmainlyinsideeffects
Canoverdosew/lithiumsoneedtobecareful
Eatingdisorders
MajorDSM5eatingdisorders
o Anorexianervosaandbulimianervosa
o Pica
Eatingonnonfoodsubstances
Commonforchildren
Atleastamonth,anddaily
o Ruminationdisorder
Repeatedregurgitationoffood

 Rechewedorreswallowed
Notpurging
Rareinchildren
Pleasurableforthem
Atleastamonth
o Avoidant/restrictivefoodintakedisorder
Pickyeating
Sensorydislikeoffood
Sometextureorsmelltheydontlike
Lackofinterestinfood
Resultloseweightandnutritionaldeficiency
Relyonsupplements
o Bingeeatingdisorder
Compulsiveeating
Powerlesstostop
Criteria
1perweekfor3months
eatmuchlargerformostpeople
notbeingabletocontrol
eatingrapidly
eatinguncomfortablyfull

 eatinglargeamountswhentohungry
eatingalone
feelingguiltywithself
usuallyhappensafteradiet
twomajortypesofeatingdisorder
o anorexiaandbulimia
o severedisruptionineatingdisorder
o extremeanxietywithgainingweight
BulimiaNervosa
Bingeeating
Compensatorybehavior
o Purgingselfinducedvomiting,diuretics,laxatives
o Someexerciseexcessively,whereasotherfast
Occursatleastonceaweekfor3months
Usuallyw/innormalweightrange
o Sodontgetexcessivelythin
o Sohardertodeterminewhetheronehasit
Othermedicalcomplications
o Dentistscandetect
Acidfromthrowingup
o Electrolyteimbalance

Kidneyproblems
Colondamagefromlaxatives
Selfevaluationisundulyinfluencedbybodyshapeandweight
Correlatedwithanxietyandsubstanceuseandabuse
Usuallyeffectmorewomenthenmen
12%inwomen
.1%formen
5%ofwomenincollege
chronicifleftuntreated
1618onsetage
muchmorecommoninCaucasiansthaninAfricanAmericans
o socultureplaysarole
o moreofawesternphenomenon
o MissAmerica
Cultureemphasizesthinness
TrendforBMIhavedecreased
o Girlswhoreceivefashionmagazinesvswhodont
Girlswhodidhadhigherbodydissatisfaction
o TVshows
Girlswhowatchtv(Friends)morelikelytohavebodydissatisfaction
o Cartoons
o
o

Menoverweight
Womenslimmer
Largegapbetweenwherewomenbelievetheirbodytypeisandtheiridealbodyis
o Menbelieveidealwomanbodytypeisnotasthinaswomenbelieve
Cognitivebias
o Womenw/eatingdisorderspendmoretimeontheirbodythattheyaremost
dissatisfiedandspendmoretimeonthebodypartsofotherwomentheyfind
satisfactory
CBTTreatment
o Beginsw/patienteducation
o Physicalconsequencesofbingeeating
o Ineffectivenessofvomitingandlaxativeuseforweightcontrol
o Mealscheduling
5to6smallmeals
nomorethan3hrsbetweenmeals
stopcravingforfoodtopreventbinging
o cognitivetherapy
alteringdysfunctionalthoughtsandattitudesaboutbodyshape,weight,
eating
copingstrategiesdeveloped
donotspendtimealoneaftereatinginearlystagesoftreatment
copingstrategiestodealw/setbacks
shorttermtreatment
trial:

70bulimiapatients
comparedCBTtoPsychodynamictreatment
psychodynamictreatmentfocusesonnegativeaffect
o needtowardoffinnerfeelingsbutdifficulty
doingso
o reflectonandtoleratenegativeaffect
o examinehoweatingcontributestoaffect
20sessionsofCBTvs.weekly50minsessionsfortwo
yrsofpsychodynamictreatment
o CBThadalotlesstreatmentvsalmost72
treatmentsessionsofpsychodynamictreatment
in30dayscheckedrelapse
CBThadmuchlessrelapse
o Medicationtreatment
FDAapprovedProzac
Switchingtoadifferentformoftreatmentseemstobeeffective
FailatCBTswitchtomed
FailatmedswitchtoCBT
Antidepressantsseemtoworkforbulimiainshortterm
Lessevidenceaboutlongtermefficacy
AnorexiaNervosaandObesity
Restrictionofenergyintakeleadstolowbodyweight(85%orlessofwhatis
expected)
o Intensefearofgainingweight
o Lossofappetiteduetoanxiety

Disturbanceinwayinwhichonesbodyweightisexperienced,undue
influenceonselfevaluation,lowrecognitionaboutlowweight
Majordistinctionfrombulimiaisthislowweightdifference
o Bulimianearhealthyweight
o Anorexiaextremelyfarfromhealthyweight
Restrictingsubtyperestrictcalorieintake
Consequences
o Thinningofthehair
o Brittlenails
o Yellowingofskintone
o Fluffyhaironarmsandleg
Signofstarvationandbodysattempttoinsulateitself
o Vitamindeficiency
o Lowbloodpressure
o Cantregulatebodytemp
Prevalence.5%lifetime
Chronic
Medicalattentionbecauseitisfairlyobvious
Cooccurwithdepressionandsubstanceabuse
SomeaspectsofOCD
Longtermoutcome
o 20yrslater
o

50%hadrecovered
25%partiallyrecovered
25%stillhadnegativeoutcomesordied
Etiology
o Complexinteractionofbiological,sociocultural,andindividualvariables
o Somegeneticfactors
o Otherbiologicalfactors
Maternalage
Havingayoungermotherandnotgoingtofulltermin
pregnancycorrelatedw/futuredevelopmentofanorexia
Prenataldevelopmentmayplayaroleineatingdisorders
Perfectionismisariskfactor
o Highstandards
o Needtobehighlyorganized
o Concernedtomakemistakes
o TrytotargetthisinCBT
Familyenvironment
o Childhoodsexualabuse
Metaanalysisweakpositivecorrelation
o Toxicfamilyenvironment
Dominant,intrusive,overbearingparents
Poorconflictresolution
o
o
o

Emphasisondietingandthinnessandrulefollowing
Especiallyiffathersfocusonthis
Emotionalcoldparents
Treatment:inpatient
o Anorexia:below70%ofbodyweight
Involuntaryhospitalizationnotuncommon
Involuntarybecausepatientdoesntviewtheproblem
Firststepisweightcontrol
Supervisedmeals
Supervisedpostmealssonotpurging
Tubefeeding
o Notfirstlineapproach
Antidepressantandantipsychoticmedication
Secondarybenefitantipsychoticsideeffect=weightgain
Wontletpatientleavehospitaltillweightgain
o Surprisinglyfewstudiesofoutpatientanorexiatreatments
RecentstudycomparedCBTtonutritionalcounseling
Results/relapserevealedthatrelapsemuchhigherinnutritional
counseling
Familytreatment
o Seemtobehelpful
o Focusoncommunicationaroundfood

o
o

Attitudestowardbodyshape
Needmorestudiestoseehowhelpful

Obesity
Readintextbook
Ratesofobesity
Sleepdisorders
Readintextbook
Differenttypes
Alcoholabuse
Definitionofterms
Substanceabuse
o Leadstohazardousbehaviororcontinuedusedespitepersistentsocial,
psychological,occupationalorhealthproblems
Substancedependence
o Physiologicalneedforincreasedrugamounttoachievesameeffect(tolerance
o Associatedw/withdrawalsymptomswithdiscontinuation
Alcoholusedisorder
2ormoreduring12monthperiod
o alcoholtakeninlargeramountsthanintended
o persistentdesireorunsuccessfuleffortstocutdown
o timespendobtaining,usingorrecovering
o craving,strongdesiretouse

recurrentsubstanceuseresultsinfailuretofulfillmajorobligations
recurrentuseinsituationinwhichhitisphysicallyhazardous
recurrentsubstancerelatedlegalproblem
likedrinkinganddriving
o continuedsubstanceusedespitepersistentsocialproblemscausedby
substanceuse
o tolerance
o withdrawal
indicatemild(23symptoms);moderate(45),severe(+6)
alcoholdependence
lifetimeprevalence:913.4%
alcoholdependentpeopledie12yrsearlier
88000peoplediedfromalcoholrelatedproblems
o relatedtoalcoholdrivingcasualties
1/3ofarrestsrelatedtoalcohol
tremendouseconomiccost
o 3/4ofcostduetobingedrinking
36%comorbidityespeciallydepression
morecommonlyeffectsmen
collegestudents
o 60%collegestudentsdrankalcoholcomparedto52%ofsameagepeersnotin
college
o 40%ofcollegestudentsengagedinbingedrinking(5ormoredrinks)
comparedto35%notincollege
o
o
o

145engagedinheavydrinking(4ormoredrinkingon4ormoreoccasions
permonth)
o Consequences
1825studentsdiefromalcoholrelatedinjuries
696000studentsassaultedbystudentwhohadbeendrinking
97000studentsexperiencesalcoholrelatedsexualassaultordaterape
20%ofstudentsmeetcriteriaforAUD(alcoholusedisorder)
1in4reportacademicconsequencesfromdrinking
globalprevalence
o Russiaisinleadw/disabilityduetoalcoholuse
Effectsofalcohol
CNSdepressant
o Degreedependsondifferentfactors
Age
Gender
Physicalcondition
Howmuchfoodyouatebeforeyoudrank
Drugsyoutakew/alcohol
Ingestalcoholandabsorbedintobloodstream
Heartdistributesthroughoutbody
o Somegoesintolungsthuswhyyoucandobreathalyzertest
o Somegoestobrain
o

Passesthroughliver
o Metabolize710gramsperhr
Cellmembraneishighlypermeabletoalcohol
o Alcoholcandiffusetoanypartofbody
Releasesendogenousopioids
o Stimulatespleasureregionsinbrain
Selfconfidencegoesupandinhibitiongoesdown
Inabilitytolearnandselfjudgment
Motorcoordinationimpaired
Discriminationofcoldandhotisimpaired
o Riskofhypothermiabecausecanttellitscold
Brainscan
o Foldsbigger
o Largerventricles
o Overallreductioninbrainsize
o Chronicalcoholuse
Prefrontalregionofbrainshowseffectofbrainshrinkage
Lesscorticaltissue

o Brainshrinkagecanbereversedandsomeimprovementovertimeifperson
stopsdrinking
Canseedifferencesrelativelyquickly

Memory
o Blackouts:timewhenintoxicatedpersoncannotrecallkeydetailsofevents
o 51%ofcollegestudentsreportblackoutsatonepoint
40%inpastyr
10%inpasttwoweeks
o fragmentaryblackoutsandenblocblackouts
enbloccantrememberentireepisode
fragmentarycantremembersometimeblocksofdrinking
rememberotherpartsoftheevening
o drinksneededforblackout=11.5drinks
usuallyliquor
unusualfrombeer
o

DrugAbuse

Heroin
Smack,H,ska,junk
Actsonnaturallyopioidsystem
Effectsappearandleavequickly
o SurgeofFeelingsofeuphoriaaccompaniedbywarmflushingofskinanddry
mouthandheavyextremities

Cloudymentalfunctioning
Withdrawalisreallyunpleasant
o w/in12hrsofstopusing(chronicusers)
experiencevomiting,chills,insomnia
o whatisbestwaytogetthroughwithdrawal?
Treatment
o Methadonetreatment
Syntheticopioid
Actsonsameopioidreceptorsasheroin
Doesntproducesamerushofeuphoria
Shouldreducehighsexperiencefromheroin
Bluntedresponseofheroin
Hopefullyhelpingpeoplegetoffheroin
Thenpeoplehavetroublegettingoffofmethadone
Ifsomeoneusesforlessthan30daysrelapseforheroinis
reallyhigh
Usuallytreatment12yrs
Methadonedoesnotgetyouhigh
Mightfeellightheadedatfirstbutwilldeveloptolerance
Longtermvsshortterm
Mostprogramsusemoreshortterm
Study
o

3monthsofmethadonew/3mothsoftaperingoffof
methadone+6monthsupport
Shorttermtreatmentassociatedw/greaterlikelihood
relapse
o Peopledetoxingfrommethadoneafter6months
hadhighlikelihoodofrelapse
Comparedtootherformsoftreatment:methadone
Decreasesdruguse
Reducesmedicalcomorbidity
DecreasestransmissionofHIB
Reducesmortality
Improvessocialfunctioning

HealthPsychologymindbodyrelationships,howdoes
stressinfluencepsychologicalfunctioning

Ex:
Presentingsymptoms
Sadmod
Fatigue
Weightgain
Irritability
Coldintolerance
Slowspeech
o Mightthinkdepressionbutreallyproblemcouldbethyroidissues
o

Howstressinfluenceshealth
o Studies
Dailystressors
Assessmentofdailyhealth
Lookatnumberofdesirableeventswithinrelationtoepisode
ofrespiratoryinfectionthenlookatnumberofundesirable
eventsinrelationtoepisodeofrespirationinfection
Foundthat58daysbeforecoldpatientexperienceda
stressor
Socialfactorsandhealth
Injuresubjects(punchwound)
Andlookhowlongittakesforittoheal
Chronicstress
o Mayinfluencehealth
o CaregiversofAlzheimerspatientstakelonger
forwoundtohealthancontrols
o 48vs39days
o alsopoorerimmunefunctioning
o thisdifferenceseemstopersistevenafterstress
hasended
chronicstressmayhavechronic
consequences
stressandinfluenza
measurestressoverpastmonth
exposepeopletoinfluenzavirus
seewhogetsthesickest
findpeoplewhohadalotofstressinpastmonththeyshowthe
mostsymptoms

 mucusweighsthemost(gross)
SocialSupport
Seemtobuffertheeffectsofstress
Lonelypeoplearemorevictimtostress
Poorersleeptoo
Lonelinessisassociatedwithalotofpoorerhealth
Cognitiveprocessingandhealthstudy
o 40HIVmeninterviewedfollowlossoffriendtoAIDS
howtheycopewithdeathoffriend
followhealthoutcomesafter2years
measuredcognitiveprocessinganddiscoveryofmeaningbehinddeath
oftheirfriend
didtheirprioritieschange,waysofthinkingchange?
PeoplewhowerehighinCPandHighwithmeaningtheirimmune
systemfunctioningremainedprettyflatandstable(BIGDEAL)
PeoplewhowerehighinCPbutlowinmeaningshoweddeclinein
immunesysteminfollowup
Makingmeaningoutofstresseventcanhaveaneffectonbody
Psychologicalinterventionsandhealth
o Mainlycorrelationalstudiesuptothispoint
o Canpsychologicalinterventionsactuallyslowillnessprogression
Cancer
HIV
o Datafromstudy
o

Cansupportivegrouptherapyslowbreastcancer
Womeninsupportgrouplivedsignificantlylonger
Everyonewasreceivingcarebutonlysomereceivedgroup
psychotherapy
Almostlivedtwiceaslong
Atthetimebreastcancerwasaterminaldisease
Butillnessprogressedslowerinsupportgroup
Studyhasnotbeenreplicatedsince
Nolifeextendingbenefitinfollowupstudy
Didhaveaneffectonqualityoflifelessdepressionandbetter
coping
o Acquiredimmunodeficiencyvirus(AIDS)
CoursefromHIVtoAIDSisvariable
HighstressandlowsocialsupportspeedsAIDSprogression
Reducestressandimproveimmunefunction?extendlife?
CBSMstudy
10weeklymeetings
stressmanagement
relaxation
resultssignificantgainsinanxietyanddepressionand
improvementsinimmunesystemfunctioning
mayenhancephysicalfunctioning
BUTnoevidencethatithelpedmortality
unclearifithelpsHIVprogression

butDOESHELPimmunesystemfunctioning
Psychologicaltreatmentofphysicaldisorders
o Biofeedback
Patientlearnstocontrolbodilyfunctions
Heartrate
Bloodpressure
Brainregions(neurofeedback)
Askpatientshowtheydoit
Theydontknoweveniftheycansuccessfullydoit
Thatiswhyfeedbackisimportant
Overtimew/alotofpracticepersoncanengagein
thiscontrol
Differentfordifferentindividuals
Useforchronicheadachesandhypertension
Notalotofevidencethatitworkswithotherdisorders
Ex:ADHD(notalotofstudiesanddoesntreally
suggestithelps)

Cognitivedisorders:delirium,dementia,
andamnesia
Somesortofcognitiveability(memory,attention,perception,problemsolving)is
impaired
o Alsochangeinpersonality,behavior,emotionregulation,depression
DeliriumDisorders

Impairedconsciousnessandcognitionduringcourseofseveralhoursordays
canbeconfusedanddisoriented
o whereami?
o whatdayoftheweekisit?
Troublesustainingattention
Focusshiftsquickly
Onsetisveryrapid
o Canhappenw/inhrs
o Maywakeupindeliriousstate
Canbeveryalarming
Leadingcauseofemergencyvisits
o 1030%ofemergencyroomcases
causes
o changesinmedication
cantriggerdeliriuminelderlypopulation
o impropermedicationuse
useincorrectdosage
o headtraumaorinjury
VERYDIFERENTfromdementiawhichismorelongcourse
o Deliriumisveryquick
o Butusuallytheycooccurthushardtodiagnose

Treatment
o Medicationchangethattriggereddelirium
o Butifdeliriumpersists
Useofantipsychoticmedicationinshortterm
Haloperidol
o Psychosocialtreatment
Supportivetreatment
Keeppersoninsamesettingratherthanmovingthemtoanew
place/facility
Familiarbelonging
Includeintreatmentdecisions
o Somecomboofmedw/psychosocialtreatment
Dementia
Casestudy:
o Findclumpsofproteinandtanglednervesinpatient
7millionhavesomeformofdementia
dementiaisnotaspecificdisease
o impairedintellectualfunctioning
o difficultlycontrollingemotions
o delusions
o hallucinations
o irritabilityandagitated

problemsolving
NOTjustmemoryloss
MUSTbepresentfor6months
Nervecellsstopfunctioning
o Lossconnectionandcausingthemtodie
o Neuronsdiewithagebutwithdementiaacceleratsneuronalloss
Treatment
o NOeffectivetreatmentfordementia
o DrugsDONOThaltdiseasebutmayslowprogression(ifcaughtearly)
Cholinesteraseinhibitors(Aricept)
MayhelpqualityoflifeBUTDOESnotreverseeffects,haltdisease,
orcuredisease
o Cognitivetraining
Ifcancatchearly
Workingmemorytrainingmayhelpslowprogressionofdementia
Norealevidencethough
o Behavioralmodification
Changebehaviortohelpyouremember
Memoryaids
HelpyouCOPEwithdisease
Alzheimers
Atypeofdementia
o
o
o

Majorcauseofdementiain65+
Dementia=deprivedmind
Lossofcognitivefunctionbeyondnormalaging
4millionpeopleinUS
1in10over65(usuallyoccursinpeopleover60)
o asearlyas30usuallyoccursmorerapidly
onceonsetslowprogressionincognitiveability
changesinmemory,language,judgment,movement
o effectslargerovertime
o inearlystagespatientmightexperiencememorylapsesandsubtlechanges
inpersonality(alittlemorehostile)
o butasitprogressessymptomsbecomesmuchworse
becomedisoriented
delusional
hostilityworsens
andeventuallycancontrolmotorfunctions
bowelcontrol
loseabilitytospeak
oftendiefromaspirationpneumoniamaysuffocatefromswallowingincorrectly
50,000diefromADeachyear
onaveragepatientwithADlivefor810yearsafterdiagnose
o someliveaslongas20yrs

Alzheimersbrain
o Cerebralcortexmuchsmaller
o Ventriclesarelarge
o Foldsareenhanced
Spacesw/infoldsareenhanced
o Overallshrinkageofbrain
o Neurofibrillarytangles(interfereswithabilitytotransportnutrientssonerve
cellsdie)andAmyloidplaques(proteinbuildupinterferewithnervecells
communicationsonervecellsdie)
Contributetoneuronaldeath
Dontknowiftheycausealzheimers
Oraretheyconsequenceofalzheimers
Knowtheyarecorrelated
Butcharacteristicofpeoplewithalzheimers
Notabiggenderdifferencebutwomenlongersomorelikelytogetalzheimers
Treatment
o Cholinesteraseinhibitors
Slowdownbreakdownofacetylcholine
Acetylcholineisimportantinformationofmemories
Targethippocampusandcerebralcortex(tworegionsaffectedbyAD)
DONOTHALTDISEASE
o Timingiscritical
Soonercatchitthemoretimeyouhave
Amnesticdisorder
Specifictomemory
Cantcreatenewmemoriesorcantrecallamemory
Language,perceptionusuallyfinesoissueusuallyw/onlymemory
Retrograde
o Cantrecallmemories
Intergrade
o Cantmakenewmemories
Mostformsareoftenduetosomesortofinfectionorheadtrauma
o Notsomethingthatisaprogressiveillness
o Usuallyclearcauseofdisorder
Onecausethatismoregradual=WernickeKorsakoffSyndrome
o Profounddifficultyrecallinginformationpresentedseveralminutesearlier
o Problemsw/shorttermmemory
o Causedbydamagetothethalamus
o Exposuretochemicalscancause
o Relaystationforotherpartsoftherain
o OftenduevitaminB1deficiency(associatedw/heavyalcoholuse)