Week5 - Psych&129C& Week&5&...

Info icon This preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Psych&129C& Week&5& Spring&2015& Depression&cont.&&& Anxiety&& Soma?c&symptoms&& •  In&the&presence&of&soma?c&symptoms,& depression&less&likely&to&be&diagnosed& –  Some&cultures&may&focus&on&soma?c&symptoms& when&they&are&distressed&rather&than&mood& features&or&cogni?ve&features& Ethnic&differences&in&soma?c& symptoms?& •  Research&supports&some&differences& –  Chinese&people&have&lower&rates&of&depression;& deny&depression&or&express&it&soma?cally& –  In&Korea&also&lower&rates& •  Same&soma?c&emphasis&when&describing& depression&in&Arab&and& Soma?c&Symptoms&cont.& •  La?nos&& –  Greater&endorsement&of&soma?c&symptoms& –  more&likely&to&report&pain&symptoms&together& with&their&depression&& –  Consider&case&of&nervios& Nervios;&cultural&idiom&that&includes& soma?c&presenta?on&& •  A&generalized&state&of&distress,&found&in&numerous&cultures& •  Both&physical&and&emo?onal&distress&that&emerges&from&conflicts&in& life&(family,&paren?ng,&marriage);&oWen&in&context&of&social& disadvantage& •  Can&represent&an&acceptable&mode&of&distress& •  Symptoms&include&headaches,&backaches,&trembling,&lack&of& appe?te&and&sleep,&fa?gue,&physical&agita?on,&menstrual& irregularity,&vomi?ng&during&en?re&pregnancy,&lump&in&the&throat,& difficulty&breathing,&chest&pain,&stomach&ache,&nausea,&diarrhea,& flatulence,&dizziness,&blurred&vision,&fevers&and&swea?ng&among& others&&& •  Psychological&symptoms&include&irritability,&anger,&sadness,& obsessive&idea?on,&overwhelming&concerns,&lack&of&concentra?on,& confusion,&crying&spells,&fears,&anxiety&and&erra?c&behavior&& •  Usually&have&higher&scores&on&measures&of&anxiety&and&depression& Why&soma?cize?& •  S?gma& •  Findings&from&Asian&and&East&Indian&samples& –  Disorders&like&anxiety&and&depression&are&treated& as&most&socially&disrup?ve&but&somatoform& disorders&are&least&social&disrup?ve&& –  Pa?ents&diagnosed&with&“only&somatoform& disorders”&compared&to&“depression&only”&had& lower&s?gma&scores&& Why&soma?cize?& •  Not&the&same&dis?nc?on&in&“mind”&and&“body”&across& cultures& –  In&Korean&medicine&vital&organs&are&associated&with&feelings&(lungs&are&related&to& worry,&liver&to&anger,&kidneys&to&fear)& –  Chinese&medicine]Disharmony&of&vital&organs&and&imbalance&of&qi& –  Indian&medicine&(Ayurvedic&system)]unique&pa_ern&of&living&force&and&energy&that& controls&various&ac?vi?es&of&the&body]disease&emerges&when&these&are&not&in& balance& »  vata&(related&to&breathing,&heartrate,&bowel/bladder&func?on)]anxiety,& aching&confusion;&pi_a&(diges?on&and&hormones)]&anger;&agita?on,& inflamma?on,&uclers;&kapha&(involves&strength&and&immunity)]lethargic,&sinus& conges?on,&upper&respiratory&problems& •  Relates&to&changes&in&self]a_en?on&with&increased& accultura?on& –  Focus&switches&from&soma?c&to&affec?ve&& Kirmayer&et&al.,&2001& styles&of&clinical&presenta/on&& Who&is&least&likely&to&get&services?& faculta?ve& soma?zer& 26%& Ini?al&soma?zer& 34%& persistent& soma?zer& 25%& psychologizer& 15%& N&=700&Canadian&pa?ents& Ini?al&soma?c&complaint]what&caused&and&half&say&psychological&reason& Faculta?ve&–when&prompted&again,&“do&you&think&it&could&be&stress,&worries&etc.& Solu?ons&to&mismanaging&soma?c& symptoms?&& Limita?ons&of&research& –  Methodological&issues& •  Self&report& •  Instrumenta?on&–&psychometric&proper?es& •  Need&more&mixed&methods&research& & Depression&Measurement& •  Construct&validity?& •  Are&the&same&words&being&used&to&describe& depression& –  Structured&interview&say&“depressed,&sad,&down&in& dumps,&blue”& •  In&study&with&Na?ve&Americans,&they&preferred&phrased& such&as&lonely,&empty,&and&feeling&like&crying&& •  Reliability&& •  Is&factor&structure&equivalent&across&groups& Mixed&Methods&Research& •  Qualita?ve&studies&combined&with& quan?ta?ve&studies&& •  Provides&in]depth,&contextualized,&and&natural& but&more&?me]consuming&insights&of& qualita?ve&research&coupled&with&the&more] efficient&but&less&rich&or&compelling&predic?ve& power&of&quan?ta?ve&research.& What&about&anxiety?&& •  •  •  •  Panic&A_acks/Disorder& Social&Anxiety&Disorder& Generalized&Anxiety&Disorder& Post]trauma?c&Stress&Disorder& scientific skepticism must be at play with the Choy article, and assumptions cannot be made Panic&A_acks&& •  No&consistent&differences&in&life?me&prevalence&rates& across&epi&studies&& –  Differen?al&rates&appear&in&response&to&a&stressor&such&as& 9/11& •  African&Americans&(13.4%),&Puerto&Ricans&(16.8%)&and&non]La?no& Whites&(5.5%);&significant&aWer&controlling&for&covariates&& –  Some&differences&in&symptoms& •  More&numbness&and&?ngling&in&AA,&dizziness&in&Asian&groups,&fear& of&dying&in&Arab&and&AA,&depersonaliza?on&among&Puerto&Ricans&& •  Context&may&influence&varia?on&& –  African&americans&have&high&rates&of&diabetes,&more&a_en?on&focused&on& feared&symptoms&& more stressful life events might explain how you react to stressful stimuli Cultural&explana?ons&& Culture may affect how we conceptualize, interpret, and explain panic attacks •  Ethnophysiology& –  E.g.&wind&a_acks,&khyal,&Cambodians& •  Dysregula?on&in&the&flow&of&wind&like&substance&in&the& body,&resul?ng&in&dizziness,&?nnitus,&and&neck&soreness& •  Connected&to&view&that&surge&of&khyal&during&anxiety& may&rupture&neck&vessels,&cause&ear&damage,&and& misdiagnosis can occur if you do not have this fain?ng& knowledge of ethnophysiology b/c you have to understand how people perceive their own body –  E.g.&neck&soreness&& neck soreness/ sore neck syndrome - Khmer refugees - sore neck and person fears that wind and BP may burst vessels in this area - Headachce, blurry vision, buzzing in the ear, dizziness, palpitations, trembling Ataques&de&nervios& •  Ataque&de&Nervios6Uncontrollable&shou?ng,&crying,&trembling,& depersonaliza?on,&suicidal&behavior,&and&verbal&or&physical&aggression.&& •  Prevalent&among&La?n&American&women;&puerto&ricans&rates&range&7]15%.& •  &Most&common&in&those&with&significant&marital&problems&and&those&more& acculturated&to&the&US.&&& •  Usually&precipitated&by&stressor&such&as&rela?onship&loss&or&death&of&a& loved&one&& •  Higher&rates&of&anxiety,&depression&and&substance&use&(Guarnaccia&et&al.,& 2010).& –  33%&of&ataques&fulfill&DSM&criteria&for&panic&a_acks;&17%&fulfill&panic&disorder&criteria& Patterning of behavior that, to a certain extent, can be normalized within the culture. Can be an okay reaction to stress in this culture, but more severe forms of the behavior can overlap with mire clinical disorders, like panic attacks DSM&5&considera?ons& •  Add&culture&specific&symptoms&to&list&and&see& if&it&improves&detec?on&cross&culturally& –  Tinnitus,&neck&soreness,&headache,&uncontrollable& screaming&of&crying& –  Encourage&use&of&specified&symptoms&as& illustra?ve&instead&of&required/cons?tu?ve&of&PA& –  Unexpected&criteria&for&panic&disorder&may&not&be& culturally&appropriate&(e.g.,&standing&up,&going&out& this type of criteria, you will miss on&a&windy&day,&& with culturally-expressive symptoms Social&Anxiety&Disorder& •  US&rates&are&higher&than&non]European& countries&& –  US&rates&range&from&2.8]6.8%& –  Asian&countries&range&from&.2].8%& –  European&countries&range&from&1.1]4.8%& •  In&US,&being&American&Indian,&and&low&income& increases&risk&& •  Immigrant&status&is&associated&with&lower& rates&in&La?no&and&non]La?no&whites& fear of embarrassment, being the center of attention, participating in class, being in groups, going to parties Taijin]kyofu]sho& •  What&is&TKS?& –  Fear&that&others&will&no?ces&some&perceived&physical& defects&such&as&blushing&or&trembling,&unpleasant& body&odor,&too&much&direct&eye&to&eye&contact,&staring& at&others&body&parts&etc.&& –  Person&will&embarrass,&offend&or&harm&others&& •  Hypothesized&mechanism;&Allocentric& interpersonal&focus&of&fear/&interdependent&self] construal& • Data&also&suggest&that&this&disorder&is&found&in& western&cultures&& being concerned about doing something that makes other people feel other people feel embarrassed or uncomfortable mechanism makes sense because many eastern cultures emphasize interpersonal harmony where others should be felt comfortable or okay, rather than one’s self TKS&ques?onnaire& Fear&of&offending&others& •  Endorsement&fear&of&offending&other&due&to& 10&sxs&(Choy&et&al.,&2008)& –  15.5]39.2%&in&US& –  6.3]25%&in&Korean&sample& •  Study&found&surprisingly&high&level&of&TKS&fear& of&offending&symptoms&in&US&pa?ents& & Choy&et&al.&2008& Fear&of&embarrassment&is&greater&than&fear&of&offense&for&each&symptom&& Social&Anxiety&and&self]construals& •  Social&anxiety&symptoms&are&endorsed&by& individuals&collec?vist&countries&(Japan&and&South& Korean)&more&frequently&than&individualis?c& countries& –  Greater&acceptance&of&socially&re?cent&and&withdrawn& behaviors&& •  Social&anxiety&may&also&be&associated&with& mismatch&between&person’s&own&self]construal& and&cultural&defined&social&role& –  In&Us&born&white&men&and&women& •  Men&with&interdependent&self&construal&and&women&with& independent&self]construal&had&higher&social&anxiety&& DSM&5&recommenda?ons& •  Consider&the&inclusion&of&allocentric&fear&as&an& alterna?ve&way&of&expressing&fear&of&nega?ve& evalua?on&& •  DSM&and&clinicians&should&consider& excessiveness&in&context&of&cultural&values&& Generalized&Anxiety&Disorder& •  Life?me&rates&are&higher&for&non]La?no& Whites&than&for&Asian&American,&African& Americans,&Caribbean&Blacks&and&La?nos.&&& –  Non]La?no&whites&had&2x&the&prevalence&than&US& born&Mexican&Americans&and&over&4x&prevalence& compared&to&Mexican&immigrants&& •  Non]western&samples&(Asia,&Africa,&etc)&tend& to&show&much&lower&rates&of&GAD&than& individuals&from&European&backgrounds& Why?& ...
View Full Document

  • Winter '16
  • The Culture, •  Research&supports&some&differences, •  Can&represent&an&acceptable&mode&of&distress, •  Usually&have&higher&scores&on&measures&of&anxiety&and&depression

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern