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PPAM Project, Essay - Coggle Diagram

- - - - GAD
        Panic disorder
        Social Anxiety disorder
        Phobias
        OCD
        PTSD
  - - - MDD
      - Persistent depressive disorder (aka dysthymia)
      - Seasonal Affective Disorder (SAD)
- - - - Based on Sigmund Freud's psychoanalytic theory, this therapy aims to explore unconscious conflicts and unresolved issues. It involves free association, interpretation, and insight into the patient's unconscious mind.
    - - This is a modern, shorter-term version of psychoanalysis that focuses on exploring past experiences and their impact on present emotions and behavior.
  - - - CBT is based on the idea that irrational thoughts and beliefs contribute to emotional distress and maladaptive behavior. It helps individuals identify and change these cognitive patterns and develop healthier behaviors.
    - - Used for anxiety disorders, exposure therapy involves gradual and controlled exposure to feared situations or objects to reduce anxiety and desensitize the individual
    - - This therapy focuses on reinforcing positive behaviors through techniques like operant conditioning and behavior shaping.
  - - - Developed by Carl Rogers, this humanistic therapy emphasizes empathy, unconditional positive regard, and active listening to help clients develop self-acceptance and self-actualization.
    - - Rooted in existential philosophy, this therapy helps individuals explore themes of meaning, freedom, responsibility, and mortality to confront existential anxieties and make choices aligned with their values.
  - - - Developed by Albert Ellis, REBT challenges irrational beliefs and aims to replace them with rational thoughts and emotions.
    - - Combining cognitive principles with mindfulness techniques, MBCT helps prevent relapse in individuals with recurrent depression
    - - Developed by Marsha Linehan, DBT combines cognitive and behavioral techniques to treat borderline personality disorder and emotional dysregulation
  - - - Antidepressants
        Antipychotics
        Mood stabilisers
    - - used for severe depression and involves administering controlled electrical currents to induce seizures, which can have a therapeutic effect.
    - - TMS uses magnetic fields to stimulate specific brain areas and is used primarily for treatment-resistant depression.
  - - - This approach provides emotional support and guidance to individuals facing stress, life transitions, or chronic mental health conditions
    - - arious forms of group therapy, including support groups and process groups, allow individuals to share experiences, receive feedback, and learn from one another
- - - - Authors
        
        Joseph Schildkraut
        
        Irving Kupfer
    - - Seymour Kety
      - Elliot S. Gershon
    - - Eric Kandel
      - Nancy Andreasen
  - - - Sigmund Freud
  - - - Behavioral theorists propose that mental illnesses can be learned through conditioning, such as classical and operant conditioning. Phobias, for instance, may develop through classical conditioning, where a neutral stimulus becomes associated with a fear-inducing event.
    - - John B. Watson
      - B.F. Skinner
  - - - Cognitive theories posit that mental illnesses are influenced by distorted thinking patterns. Conditions like depression and anxiety may result from negative thinking styles and cognitive biases that exaggerate threats and minimize positive experiences.
      - Authors
        
        Lyn Y. Abramson
        
        Lauren alloy
    - - Some individuals may have cognitive vulnerabilities, making them more susceptible to mental disorders. For instance, a strong tendency to ruminate on negative thoughts may increase the risk of developing depression
      - Authors
        
        Aaron Beck
  - - - Humanistic and existential theories suggest that mental distress can arise from a lack of personal growth, self-actualization, or a sense of meaning in life. Existential anxiety and the search for life's purpose are central concepts in this perspective.
    - - Carl Rogers
      - Viktor Frankle
  - - - These theories emphasize the role of societal factors, such as poverty, discrimination, and social isolation, in the development of mental illnesses. The social determinants of mental health can contribute to conditions like depression and PTSD
      - Authors
        
        Robert M. Sapolsky
        
        Richard Wilkinson
    - - Some mental illnesses are seen as arising from dysfunctional family dynamics. This theory suggests that family relationships and interactions can contribute to conditions such as borderline personality disorder.
      - Authors
        
        Murray Bown
        
        Salvador Minuchin
  - - - George L. Engel
- - - - Conclusion
        
        Supportive evidence
        
        Attention-grabbing hook
        
        Call to action
        
        Validating argument point
        
        A strong conclusion
    - - Origin
      - Author
      - Subject
      - Evolution
      - Time and place of origin - cultural context
- - - - People with mental health issues
    - - Negative Childhood experiences
    - - People without mental health issues
    - - Are the roots of mental illness always in childhood and can the solutions always be found there too
    - - Culture
      - Genetics
- - - - Limitation
        
        Based on perception of mental health
  - - - IPT is a form of psychotherapy that focuses on relieving symptoms by improving interpersonal functioning. It addresses current problems and relationships rather than childhood or developmental issues. Therapists are active, non-neutral, supportive and hopeful, and they offer options for change.
  - - - fluoxetine plus cognitive behavioural therapy (CBT) was more effective than CBT alone (–0·78, 95% CrI −1·55 to −0·01) and psychodynamic therapy (–1·14, −2·20 to −0·08) but not more effective than fluoxetine alone (–0·22, −0·86 to 0·42)
        
        No pharmacotherapy alone was more effective than psychotherapy alone
        
        only interpersonal therapy was more effective than all psychological controls (–1·37 to −0·66)
        
        In terms of acceptability, nefazodone and fluoxetine were associated with fewer dropouts than sertraline, imipramine, and desipramine (ORs ranged from 0·17 to 0·50); imipramine was associated with more dropouts than pill placebo, desvenlafaxine, fluoxetine plus CBT, and vilazodone (2·51 to 5·06).
        
        Despite the scarcity of high-quality evidence, fluoxetine (alone or in combination with CBT) seems to be the best choice for the acute treatment of moderate-to-severe depressive disorder in children and adolescents.
      - Limits
        
        Most of the results were rated as “low” to “very low” in terms of confidence of evidence according to Confidence In Network Meta-Analysis.
        
        However, the effects of these interventions might vary between individuals, so patients, carers, and clinicians should carefully balance the risk-benefit profile of efficacy, acceptability, and suicide risk of all active interventions in young patients with depression on a case-by-case basis
      - Drugs (16)
        
        tricyclic antidepressants (amitriptyline, clomipramine, desipramine, imipramine, and nortriptyline)
        
        selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, paroxetine, and sertraline)
        
        serotonin norepinephrine reuptake inhibitors (desvenlafaxine, duloxetine, and venlafaxine)
        
        other drugs (mirtazapine, nefazodone, and vilazodone)
- - - - Quantitative empiracal study
      - Felitti, Vincent J, et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine, vol. 14, no. 4, 1998, pp. 245–258, https://doi.org/10.1016/s0749-3797(98)00017-8.
      - Results
        
        Graded relationship found between the number of categories of childhood exposure and each of the adult health risk behaviours and diseases that were studied
        
        Persons who had experiences four or more categories of ACE, compared those who had experienced none, had 4-12 fold increased risks for alcoholism, drug abuse, depression and suicicide Attempts
        
        Persons who had experiences four or more categories of ACE, compared those who had experienced none, had2-5 fold increases in smoking, poor self-rated health, >= 50 sexual intercourse parteners, STIs
      - 13,494 adult participents
      - 1998
    - - Quantitative empirical study
    - - Quantitative empirical study
    - - Longitudinal Study
    - - Longitudinal Study
      - Ongoing
      - n= 1037
      - Preceded by pilot study of n =250 5 yrs olds
        The pilot sample was drawn from a larger study of perinatal health conducted by paediatrician Dr Patricia Buckfield between 1968 and 1974
      - Findings
        
        1200 publications
    - - Empirical evidence
  - - - Results
        
        Evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour
        
        All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world
        
        The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence
  - - - What's going on
        
        indicate an association between maltreatment and atypical development of the hypothalamic–pituitary–adrenal axis stress response, which may predispose to psychiatric vulnerability in adulthood
        
        selectively review the magnetic resonance imaging (MRI) studies that have investigated possible structural and functional brain differences in children and adults who have experienced childhood maltreatment
        
        Differences in the corpus callosum identified by structural MRI have now been reliably reported in children who have experienced abuse
        
        differences in the hippocampus have been reported in adults with childhood histories of maltreatment
        
        there is preliminary evidence from functional MRI studies of adults who have experienced childhood maltreatment of amygdala hyperactivity and atypical activation of frontal regions
        
        we consider research that has indicated that the effect of environmental adversity may be moderated by genotype, reviewing pertinent studies pointing to gene by environment interactions
      - Results
        
        Support a growing consensus that matreatement contributes to stress-induced changes in a child's neurobiological systems
        
        While changes may be adaptive in the short term - it is hypothesised that they contribute to heightened risk for psychopathology ove the long term
        
        Stress exposure promotes CRH release, stimulating ACTH synthesis , and adreno-cortical cortisol synthesis
        
        A pattern of increased cortisol response was reported in the context of a failure of the glucocorticoid-mediated negative feedback to adequeately control the HPA activation
        
        These studies suggest that MDD subsequent to childhood maltreatment is associated with inadequate inhibitor feedback regulation of the HPA axis
        
        Reduced amygala volume in female patients with dissociative identity disorder
        
        Too early to draw conclusions - primiminary findings suggest that the amygdala is vulnerable to early and severe stress (in the context of parental loss and istitutionalization)
        
        However it appears that less severe, time limited and developmentally later exposure has a weaker impact on amhygdala volume
      - Limits
        
        Need to specify with more precision the psychologica facots that mediate the assocaition with poor behavioural outcome, both in terms of internal respresentation of self and pthers
        
        Caution how evidence is interpreted
        
        Research is based on very mixed samples of childrena and adults with diverse experience os early adversity
        
        Greater precision and homogeneity in how groups are chatacterized in relation to maltreatment are required
        
        Need for longitundial and intervention studies
      - HPA axis
        
        HPA axis represents one of the body's core stress response systems
        
        Exposure to stress triggeres release of CRH and AVP
        
        This stimulates ACTH secretion, acting on the adrenal cortex to synthesis Cortisol
      - Points
        
        Effects on the size of the amygdala
        
        Increased cortisol secretion and failure of negative feedback loop
        
        Decreased anisotropy values (indicative of whitematter fibre tract coherence, or lower density of white matter fiber tracks
        
        Decreased size of prefrontal cortex
- - - - Results
        
        3 genome-wide significant loci identified, 2 in european and 1 in african-ancestry analyses
        
        PARK2 (a parkinson's gne involved in dopamine regulation) is associated with PTSD
        
        Demonstrates the role of genetic variation in the biology of risk for PTSD, and highlight the necessity of conducting sex-straified analyses and expanding GWAS beyond European ancestyr populations
      - multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls
    - - Results
        
        Neither adulthood trauma exposure nor PTSD were associated with differences in HPA-axis functioning,
        
        although adulthood trauma may augment cortisol suppression after the DST
      - Limits
        
        More evidence on other dynamic tests of HPA-axis functioning in PTSD and adulthood trauma exposure is needed.
      - Thesis
        
        assessed the association of adulthood trauma exposure and HPA-axis functioning in healthy subjects with and without PTSD
    - - The cumulative incidence of PTSD was determined to be 27.8% in veterans, combatants, and freed soldiers
  - - - Results
        
        Much of the heritability of Schizophrenia is unexplained, and the reoprted environmental risk factors do not explain
        
        Our understanding is in its infancy
        
        Solid evidence for postnatal environmental exposures that increase the risk of schizophrenia. They include urbanicity, micgration, childhood trauma / adversity and cannabis abuse
        
        It is also now clear that environmental exposures that increase the risk of schizophrenia can occur at any point across the life span and probably include pre-conceptional exposures
      - Limits
        
        obtaining good individual rather than population-based data is very difficult, especially for early exposures
        
        we think that classical genetic and environmental risk studies cannot capture the sheer complexity of the nature and nurture interactions that contribute to the schizophrenia phenotype
    - - Results
        
        Characterised by neuropsychological deficits
        
        Heritability ranged across phenotypes, likely due to differences in genetic and environmental effects
        
        results confirm that many cognitive phenotypes are under strong genetic influences
        
        environmental factors and illness-related moderators (eg, medication) do not substantially decrease heritability in schizophrenia samples, and that genetic studies in schizophrenia samples are informative for elucidating the genetic basis of cognitive deficits
        
        Substantial genetic overlap between cognitive phenotypes and schizophrenia liability (average rg = -.58) in twin studies supports partially shared genetic etiology
      - family heritability studies of >800 000 nonpsychiatric and schizophrenia subjects
    - - Results
        
        The site in Chromosome 6 harboring the gene C4 towers far above other risk-associated areas on schizophrenia’s genomic “skyline,” marking its strongest known genetic influence.
        
        Versions of a gene linked to schizophrenia may trigger runaway pruning of the teenage brain’s still-maturing communications infrastructure
        
        People with the illness show fewer such connections between neurons, or synapses
        
        The gene switched on more in people with the suspect versions, who faced a higher risk of developing the disorder, characterized by hallucinations, delusions and impaired thinking and emotions
        
        Affecting about 1 percent of the population, schizophrenia is known to be as much as 90 percent heritable
      - A team of scientists led by Steve McCarroll, Ph.D.(link is external), of the Broad Institute and Harvard Medical School, Boston, leveraged the statistical power conferred by analyzing the genomes of 65,000 people, 700 postmortem brains, and the precision of mouse genetic engineering to discover the secrets of schizophrenia’s strongest known genetic risk.
- - - - Exposure to lifetime PTE was associated with a higher probabiluty of psychiatric morbidity than no PTE exposure
        
        A PTE with childhood onset relative to adult onset was related to lifetime panic disorder, independent of the number of lifetime and demographic differences between the 2 groups
        
        Childhood interpersonal trauma compared with interpersonal trauma in adulthood was significantly associated with lifetime panic disorder, agoraphobia, and posttraumatic stress disorder
        
        Our findings suggest that specific disorders are linked to interpersonal trauma and PTEs that occur in childhood rather than later in life.