Is he mentally ill?

Hypertension—another correlate of atherosclerosis

Stress and cardiovascular disease

• Manuck et al 1983—monkeys who were exposed to a threatening stimulus
• Learned helplessness
• Psych factors: internal, global, stable
• Perceived control over the situation
• Belief in coping abilities
• Social isolation and a lack of social support
• Hostility component of Type A personality
• Depression increases risk

When a response to common stressor is maladaptive and occurs within 3 months of the stressor.

• When a response to common stressor is maladaptive and occurs within 3 months of the stressor.

• Unable to function as usual

• Reaction to particular stressor is excessive

• Dx is discontinued if stressor subsides or if individual learns to cope

• If it persists beyond 6 mos, change diagnosis

• Multiple types—depression, anxiety, disturbance of conduct, mixed

Difference between the two is timing—Acute Stress occurs right after the event, lasts from 2 days to 4 weeks. After 4 wks after the event, it is PTSD. Onset can also be delayed for PTSD beyond 6 months.

• Difference between the two is timing—Acute Stress occurs right after the event, lasts from 2 days to 4 weeks. After 4 wks after the event, it is PTSD. Onset can also be delayed for PTSD beyond 6 months.

• Symptoms:

• Frequent reexperiencing of the event through intrusive thoughts, flashbacks, nightmares, and dreams
• Persistent avoidance of stimuli associated with trauma and a general numbing or deadening of emotions
• Increased physiological arousal with an exaggerated startle response

Lower rates in areas with less crime and few natural disasters

• Lower rates in areas with less crime and few natural disasters

• Perception of trauma

• Social support

• Those who develop it tend to have preexisting more somatic concerns

• More social maladjustments and irresponsibility
• Be more passive and inner directed
• Be more sensitive to criticism and suspicious of others

Short-term crisis therapy—face to face discussion

• Short-term crisis therapy—face to face discussion

• Direct exposure therapy—in vivo or imagined

• Telephone hotlines

• Psychotropic medications

Anxiety—common features

• Anxiety—common features

• Relative intactness of reality testing
• Experience of anxiety
• Recognition that this is not a typical response
• Affects 25-29% of US population (over 23 million) at some point in life
• Most common category of disorders for women, second for men
• Lots of comorbidity in anxiety—suggests common mechanisms

Fear or panic activates the fight-or-flight response

• Fear or panic activates the fight-or-flight response

• Has cognitive/subjective components “I feel terrified”
• Physiological components—hr and bp
• Behavioral components-urge to run

• Anxiety is a complex blend of unpleasant emotions and cognitions that is more oriented to the future and much more diffuse than fear

• Adaptive in that it helps us prepare for a threat. At mild or moderate levels, enhances learning and performance
• Also has cognitive, physiological, and behavioral components

• Anxiety and fear can be unconditioned or learned

Unrealistic and irrational fears of disabling intensity

• Unrealistic and irrational fears of disabling intensity

• 7 different disorders in DSM-IV

• Relatively common (phobias most common)

• Commonalities in causes

• Genetic vulnerability—personality trait of neuroticism
• Limbic system commonly involved
• Neurotransmitters include GABA, norepinephrine, and serotonin
• Classical conditioning
• Those who perceive a lack of control are more vulnerable

• Commonalities in treatment

• Graduated exposure—single most effective treatment
• Cognitive restructuring
• Benzodiazepines and antidepressants

Taijin-kyofushu—Japan—similar to social phobia, fear that they will offend or embarrass, concerned with body odor

• Taijin-kyofushu—Japan—similar to social phobia, fear that they will offend or embarrass, concerned with body odor

• Nervios—Latino cultures—chronic worrying and negative thinking, expressions of anger, headaches, other somatic ailments. Tied to poverty and poor education.

• Ataque de nervios—Latino cultures—panic-like attacks dominated by trembling, heart palpitations, numbness. Tied to stress and spiritual causes.

• Shen-k-vei—China—pattern of severe anxiety or panic, accompanied by bodily complaints. Supposedly tied to excessive semen loss after frequent masturbation or intercourse, a loss believed to endanger the individual’s vital essence Similar to dhat a disorder found in India.

Disrupting fear, avoidance out of proportion to the danger posed by a particular object or situation; generally recognized as groundless by sufferer

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