Sebastian Junger's Ted Talk

The first thing we did in class today was watch a Ted Talk about PTSD from Sebastian Junger. Junger himself served a little in the military before 9/11 and experienced some PTSD himself. PTSD stands for post traumatic stress disorder and it is very common in veterans. Junger pointed out that a lot of the people that live in modern society today are more predisposed to be depressed and have a higher rate of killing themselves than someone who lives in a poor society. He also explained that after 9/11 occurred, crime rates lowered in New York, there was less violence, lower rates of suicide and veterans claimed that their PTSD symptoms lowered. Junger explained that the reason for this is that when something traumatizes a whole nation, they can heal together as a group of people that experienced the same kind of trauma. Junger concluded the Ted Talk with explaining that the reason that most veterans come home from war with PTSD is because it is easier to cope in groups and since America is such a broken society, veterans come home from the war to find that the country that the have been protecting and fighting for, isn't united. 10% of the military experience violent experiences in shooting, watching their friends get shot or getting seriously injured, but 50% of the military people experience PTSD.  It is hard for vets to come home and have to see what is happening in America, Junger believes this to be one of the main reasons for PTSD rates to be so high.

Eating Disorders

Anorexia Nervosa:

Anorexia Nervosa, or Anorexia, is an eating disorder where someone who is already thin or at a normal body weight, restricts themselves of food and has an obsessive fear of gaining weight. 1 in every 200 Americans suffer from this eating disorder. Anorexia is a very dangerous eating disorder that can result in many serious medical conditions such as slow heart rate, low blood pressure, muscle loss or weakness, reduction of bone density, dehydration, fatigue, dry hair or dry skin.

Warning Signs:

Some of the warning signs of anorexia nervosa are,

• Dramatic weight loss.
• Preoccupation with weight, food, calories, fat grams, and dieting.
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
• Frequent comments about feeling “fat” or overweight despite weight loss.
• Anxiety about gaining weight or being “fat.”
• Denial of hunger.
• Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
• Consistent excuses to avoid mealtimes or situations involving food.
• Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.
• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Treatment Options:

• If the patient's life is in immediate danger than hospitalization might be the best option. Hospitalization can be in a medical or psychiatric ward.
• Because of all the complications that come with anorexia, the patient may need frequent monitoring of vital signs to make sure that they are healing.
• The first goal in treatment is going back to a healthy weight a psychiatrist or doctor can help a patient to find the best way to do this
• There are two different kinds of therapy, family-based therapy and individual therapy. Family based therapy is best for teens because the family can help the child or teen see how much they should be eating. Individual therapy is best for adults and helps to normalize eating patterns
• Medicine is not an option for anorexia

Bulimia Nervosa:

Bulimia Nervosa is a potential life threatening eating disorder where there is a cycle of binging and then self induced vomiting to help loose weight. Bulimia can lead to many health consequences such as imbalance in electrolytes, inflammation or possible rupture in esophagus, tooth decay, chronic or irregular bowel movements and gastric rupture.

Symptoms:

• Frequent episodes of consuming large amounts of food and then vomiting
• A feeling of being out of control during the binging episodes
• self esteem overly related to body image

Warning Sings:

• Evidence of binging
• Evidence of purging
• Excessive, Rigid exercise habits
• Unusual swelling in the cheeks or jaw area
• Calluses on the back of the hands and knuckles
• Discoloration or staining on teeth
• Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.

• Withdrawal from usual friends and activities.
• In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
• Continued exercise despite injury; overuse injuries.

Treatment Options

• Therapies like support groups, Cognitive behavior therapy, Counseling and other forms of therapy
• Medications
• Self Care like physical exercise
• Specialists like doctors and psychologists can help

Binge Eating Disorder:

Binge eating disorder is a eating disorder of episodes of binging until the point of discomfort where the person feels out of control. Binge eating can cause

Symptoms:

• Lack of control once one begins to eat.
• Depression.
• Grief.
• Anxiety.
• Shame.
• Disgust or self-hatred about eating behaviors

Warning Signs:

• Eating large amounts of food
• Eating even when full
• Eating rapidly during binge episodes
• Frequent dieting without weight loss
• Frequently eating alone
• Hoarding food
• Hiding empty food containers

Treatment Options:

• Psychotherapy like individual counseling that focuses on changing the behavior and thinking of the patient
• Medication
• Nutrition Counseling with a specialist can help get the eating habits back on track
• Group and family therapy is very important because it helps the family members understand what is going on

Symptoms:

• Lack of control once one begins to eat.
• Depression.
• Grief.
• Anxiety.
• Shame.
• Disgust or self-hatred about eating behaviors

Depression Webinar

In class today we listened in on a Webinar about depression by Dr. Stringaris. A webinar is exactly what it sounds like, a seminar on the web. Webinars are a very common thing for people to tune into, especially when their profession involves constant new discoveries of new information like scientists and nurses. 

Stringaris starts the webinar discussing some evolutionary theories of depression:
Protection from negative outcomes, Psychic Pain, A way to change one's own environment and protection from infections.

To find out if someone has depression are if if five or more of the following symptoms have been present during the same time:

• Depressed mood
• Diminished interest in pleasure
• Significant weight loss
• Insomnia or oversleeping
• Agitation or retardation
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness of excessive or inappropriate guilt (may be delusional) nearly every day
• Recurrent thoughts of death (not fear of dying) but suicidal thoughts

Adolescents and Depression:

Suicide is one of the main causes of death in adolescents, adolescents with major depression are 30 times more likely to die of suicide.

Aetiology of Depression

Genes: 30-50% of the liability to depression is due to genetic factors. 

Gene-environmental correlation: Increased genetic liability for lifetime traumas

Gene-environmental interaction: different genotypes respond to environmental variability in different ways

Development and Depression:

Girls are more likely to develop depression during puberty possibly due to the changes in the body and also hormonal changes. 

Girls who experience puberty earlier are more likely to develop depression possibly to hormones,  being so young, being subjected to stress and being exposed to girls who are order and are experiencing adult things. 

Continuities, homotypic:

Childhood depression does not predict adult depression

Anxiety: early on anxiety precedes depression though the links are bidirectional by mid-late adolescence

Alcohol: probably and internalizing pathway to depression

ODD/CD: the strongest predictors of later depression

Behavior Problems and depression:

40% of depressed young adults have had serious disruptive problems during development

Early onset and persistence show the highest depression risk in girls 

Neurology of Depression

Depression is probably a heterogeneous syndrome,

It is useful to think of two core abnormalities

Negative Bias and missing the positive: 

More common to spot the negative or misinterpret a neutral face as sad or angry

People who suffer from depression are more likely to pick up the negative and show an increase of negativity in the amygdala in the brain. Missing the positive, a depressed person may be more likely to miss something positive in their environment like a smile, antidepressants seem to help with this. 

Disrupted Hedonic Processing:

Anticipatory anhedonia: Someone with depression may not think they deserve anything like an award, depression is being unable to see why something might be rewarding

In the brain, processing an award in an area of the brain, it is important in the path of genesis in depression, they are much more likely to become depressed.

Diagnosis

Parents focus on the irritability/oppositionality

Teachers focus on the academics

Person cannot bring themselves to talk about is, patients can be perplexed 

Awareness is key in diagnosis, knowing that adolescence is a peak period 

Screening is only appropriate in samples that are relatively high risk

Diagnosis should also address:

Presence of manic symptoms

Underlying medical causes (e.g. anemia, thyroid disease) 

Risk assessment! (have they cut before, have they tried to kill themselves, etc.)

Treatment

the downstream effect of genes and environment

Medical treatment and psychological targets behavior feelings and thoughts

The first line treatment of depression is simple:

Pharmacology

serotonin reputake inhibitors (SRI's)

fluovetine, serttaline, citalopram

Psychological therapy:

cognitive behavior therapy (CBT)

inter person therapy (IPT)

In mild cases, start with CBT/IPT if you have access to trained therapists

About 60% of young people respond to antidepressant but 50% also respond to the placebo possibly because related to the severity of the depression, the higher the severity of the depression, the lower the response to the treatment.

Antidepressants offer a good risk benefit ratio:

Numbers needed to treat: 10

Numbers needed to harm: 112

 This is important in the context of the suicidality debate and the black box warning.

Project Success

What is a mental disorder?

A mental disorder can be something that affects a person's thinking, emotional state and behavior
It can disrupt the person's ability to work or attend school, carry out daily activities or engage in satisfying relationships

How do you diagnose?

Books can be useful, they are used by professionals, social workers, forensic and legal specialists



What is Anxiety?

There's good anxiety and problematic anxiety it's a normal response to certain situations
Good: Keeps you on your toes and makes you read like before a test or performance
Problematic: A persistent and severe or worry that becomes difficult to control or manage, it is often far more extreme. To be diagnosed you should have it for at least six months

What are some anxiety symptoms? 

Emotional symptoms: apprehension, difficulty concentrating, tense, nervous, being on edge, expecting the worst, restless, lack of sleep, watching for danger
Physical: upset stomach, nausea, hyperventilation, pounding heart, sweating





When is anxiety bad?

Normal: keeps you aware and focused to help you complete tasks
Problematic: After getting through the test or performance, the anxiety continues or when it interferes with everyday tasks

What are the different types of anxiety?

General, Social, Specific Phobias, Panic Disorder and others like OCD and PTSD

What are some causes of anxiety?

Biological Reasons: Genetics, Substance abuse, Medical conditions/medications, Brain chemistry
Environmental Reasons: abuse, truama, high stress, violence
Life Circumstances: Significant losses, Divorce in family, Stressful situations, Unresolved family conflict

What is depression?

Either characterized by a depressed mood, lack of interest in activities that they once were really interested in

What are the symptoms?

Depressed mood, irritability, decreased interest or pleasure, change in sleep patterns, loss of weight or gain in weight, apathetic, guilt, worthlessness, feeling unworthy, difficulty in concentrating




What is the difference between sadness and depression?

Sadness: normal human response to events  Depression: No cause or reason

What causes depression?

Hereditary, Brain chemistry, Environment, Stress, Medication, Alcohol/Drugs

What are some treatment options?

Psychotherapy or medication, an accommodation of the two is the best option. To receive medication it requires a doctor visit

Why is it necessary to receive treatment?

Symptoms can worsen if there is no treatment which can cause problems at school, running away, social addiction, drug and alcohol abuse, reckless behavior, violence, low self esteem, self harm behaviors and suicide

What are the warning signs of suicide?

Giving away possessions, self harm, claiming that they will see dead relatives soon, someone with depression is suddenly really happy,  threats to hurt or kill themselves, saying they want to kill themselves, previous attempts, looking for guns or pills, writing goodbye letters,



QPR

Question... A person about suicide
Persuade... The person to get help
Refer... The person to the appropriate resources

Romeo and Juliet Films - Self Reflection

There were 10 Nutrition groups during the first semester of the school year. Two teams grouped up together to make 5 big groups and each of them tackled a Romeo and Juliet act to reenact but with a new theme. For example, my group had to reenact Act II of Romeo and Juliet but do it Keeping Up With the Kardashians style. Juliet was Kim Kardashian, Romeo was Kanye West and so on. Other groups had themes like The Hunger Games, Western and The Real Housewives of Wherever. Watching all these movies was very entertaining and also humorous.
My role in this project was to help write the script and film the movie along with wardrobe and makeup. I did not want to participate in the acting so instead I took up those roles in this project. After watching the final product of our video I sadly regret not taking more of a lead role in the script writing because the video didn't turn out the exact way I wanted it to be.
I was not a part of the editing process but I wish I was because the scenes in our video were out of order as well.

Keeping Up With Romeo and Juliet

Although the video didn't turn out the way I wanted, I don't regret being a part of it because it was a fun experience where everyone could be creative and have fun together.