A level - Psychopathology

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  • Created on: 16-02-18 14:02
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  • Psychopathology
    • Definitions of abnormality
      • Statistical infrequency
        • Description
          • Considered abnormal when falls outside the range that is typical for most people. 'Average' is normal. People outside the average can be considered abnormally tall, short, thin, fat or smart
        • Example
          • IQ is tested using psychometric intelligence tests. Used to work out mental age, anything between 70-130 is considered abnormal, 'statistically infrequent'
        • Evaluation
          • Some infrequent behaviours are desirable
          • Not everyone benefits from labels, saying 'abnormal' can be insulting - leading to depression, anxiety
          • Certain cultures more/less infrequent for behaviours, less developed countries - lower IQ
      • Deviation from social norms
        • Description
          • Every society or culture has standards of acceptable behaviour or norms. Behaviour that deviates from these norms is considered abnormal
        • Example
          • Person with anti-social behaviour personality disorder (psychopathy) is impulsive, aggressive and irresponsible. lacking pro-social internal standards associated with failure to conform to lawful or culturally normative ethical behaviour
        • Evaluation
          • Social norms are culturally specific. e.g. won't swear within a church compared to at home, as it is expected of you to behave. We have learnt to adapt to different situations, UK adapted to respect other beliefs
          • Social norms vary over time, changing wider population without notice - fashion, hair
          • Social norms can be used to abuse human rights - Nazi-Germany neglected human rights for Jews cos of who they were
      • Failure to function adequately
        • Description
          • Someone can become 'abnormal' when they can no longer cope with the demands of everyday life
            • When a person(s)
              • Experiences severe personal distress to an excessive degree
              • Behaviour becomes  irrational or dangures to themselves or others
              • Shows behaviour that causes discomfort or distress to observer
              • Behaviour stops them from attaining life goals - work, relationships
        • Example
          • Depressed person may fail to get up in the morning and maintaining relationships
        • Evaluation
          • Abnormality not always accompanied by dysfunction e.g. psychopaths (dangerous personality disorder) can cause harm yet appear normal
          • Normal abnormality, there's times when it is normal to suffer distress e.g. grieving is normal to overcome loss of a loved one, this definition doesn't consider this
          • Personally rewarding behaviour - individuals apparent dysfunctional behaviour may be rewarding e.g. persons eating disorder can bring affection, attention from others
      • Deviation from ideal mental health
        • Description
          • Attempts to define what the ideal state of mental health is, therefore abnormality is anything that deviates from 'ideal'
            • Jahoda (1958) - good mental health - when criteria is met
              • No symptoms or distress
              • Can perceive ourselves accurately
              • Self-actualised
              • Can cope with stress
              • Realistic view of the world
              • Good self-esteem and lack guilt
              • Independent of other people
              • Successfully work, love and enjoy leisure
        • Evaluation
          • Over demanding criteria - most people don't meet all ideals - e.g. few people experience personal growth - according to this, most people are abnormal
          • Subjective criteria - vague n difficult to measure - measuring physical health is more objective can use scientific methods - diagnosing mental health more subjective and relies on self-report, may not be reliable
          • Emphasizes positive achievement rather than failure - takes more positive approach to mental problems
    • Phobias
      • Irrational fear of an object or situation
      • Characteristics
        • Physical
          • Inc. body temp, heart rate, feeling sick, goosebumps, hyperventilating
        • Emotional
          • Persistent anxiety - prevents sufferer from relaxing. Extreme fear in presence of phobic stimuli
        • Behavioural
          • Avoidance - to avoid negative experience. Disruption of functioning - extreme avoidance n anxiety can interfere with ability to work
        • Cognitive
          • Recognition of exaggerated anxiety - aware the anxiety experienced in relation to phobia is extreme. May have irrational beliefs e.g. social phobia 'i must sound intelligent'
      • Classification of phobias
        • Specific
          • Of an object or situation
        • Social
          • Of a social situation
        • Agoraphobia
          • Being outside/ public place
      • Behavioural approach to explaining phobias
        • Acquired through CC. Maintained through OC.
        • Little Albert study - UCS loud noise, UCR crying, NS white rat, CS white rat, CR crying
        • How are phobias maintained through OC
          • Avoiding an object acts as: Positive Reinforcement
          • Negative Reinforcement: performing a behaviour to avoid a negative consequence
        • Evaluation
          • Behaviourist treatments shown to be effective - supports idea may be behavioural cause
          • Some have phobia even though they never had traumatic experience e.g. some fear snakes yet never seen one irl
          • Bagby (1922) reported case study of woman who got phobia of running water after getting feet stuck in rocks near waterfall, gradually becoming inc. panicked
            • Supports explanation - woman associated NS with UCS
          • Di Gallo (1996) reported 20% experiencing traumatic car accident develop phobia of travelling in cars
            • Only 20% - CC cannot explain how people develop phobia
          • Mowrer (1960) Found that by just delivering a few electric shocks to rats immediately following sound of buzzer, he produced fear response by just sounding buzzer. Then trained rats to escape the shocks by jumping over barrier, repeating behaviour every time buzzer sounded
            • Supports OC - rat would do behaviour just to avoid negative consequence
      • Treating phobias
        • Flooding
          • Exposing patient directly to phobic stimuli for extended period of time in safe controlled environment
            • Fear is a time limited response - extreme anxiety state - eventually exhaustion sets - causing anxiety levels to fall
              • Cant escape, have to confront fears - coming to no harm - fear is extinguished
                • Prolonged intense exposure creates new association, and prevents reinforcement of phobia
          • 1/2 hr or one long session
        • Systematic Desensitisation
          • Behavioural therapy based of CC, aim to remove fear response n substitute a relaxation response to CS gradually using counter conditioning
            • 4-6 sessions, up to 12 for severe phobia, complete when goals are met (phobia not removed)
          • Taught deep muscle relaxation n breathing techniques, important cos of reciprocal inhibition - one response is inhibited as it is incompatible with another - fear involves tension - incompatible with relaxation
            • Create fear hierarchy, least feared to most feared - structure for therapy
              • Working up fear hierarchy, when no longer afraid move up a step, able to return to previous step
                • Imagining or confronted by phobic stimuli until it fails to evoke any anxiety - done for all steps
        • Evaluation
          • (SD) McGrath (1990) reported 75% phobic patients responded to treatment
          • (SD) Can be self-administered, proved successful with social phobia Humphrey (1973). Cheaper to CBT
          • (F) Craske (2008) Study - both equally effective
          • (F) Chloy (2007) Flooding more effective
          • (F) May not be for everyone - highly traumatic procedure, being made aware of procedure, they might quit during it - reducing effectiveness of it
          • (Both) Exposure more important than relaxation in treatment, Klein (1983) Compared SD with supportive psychotherapy for those with social and specific phobia, found no difference in effectiveness, but it was the generation of hope that the phobia could be overcome
          • (SD) Ohman (1975) suggested SD may not be as effective when there's an underlying survival component, compared to those acquired through personal experience
          • (SD) Choy (2007) Found in vivo techniques, where patients faces feared stimuli irl, more effective than pictures or imagination.
            • Number of different techniques is used, such as modelling - patient watches someone else coping well in presence of stimuli
          • (Both) Therapies may not work for certain phobias, as the symptoms are the result of a deeper, underlying issue. Removing the symptoms does not remove the cause, resurfacing later.
            • Freud (1909) Reported case of Little Hans suffering horses phobia, Freud concluded the actual problem was intense envy of his father which he could not express, so the anxiety was projected onto horses. Phobia was cured once boy accepted feelings towards father
        • Patient directly exposed to phobic stimuli - experiencing high anxiety - body cannot sustain high anxiety levels for long - it exhausts to feeling calm - realising the feared object is harmless - forming new association
    • OCD
      • Condition characterised by obsessions (cognitive) and compulsive (behaviour)
      • Characteristics
        • Emotional (feel)
          • Anxiety and distress, often accompanied by depression, guilt over minor moral issues
        • Behavioural (do)
          • Compulsive behaviour - feeling the need to repeat behaviour, as they reduce anxiety
        • Cognitive (think)
          • Obsessive thoughts, they are aware it is irrational (if not they have different disorder)
      • Categories of OCD
        • Trichotillomania
          • Compulsively pulling out ones own hair
        • Hoarding disorder
          • Persistent difficulty of parting with possession cos of a perceived need to save them
        • Excoriation disorder
          • Repetitive and compulsive picking of skin resulting in tissue damage (dermatillomania)
      • Obsessive thought (catching flu)
        • Anxiety (anxious you might catch flu)
          • Compulsive behaviour (wash hands repetitively)
            • Temporary relief (feel better for a while)
      • Biological approach to explaining OCD
        • Genetic
          • Genes consisting of DNA that make-up chromosomes coding for physical and psychological features
          • Lewis 1936 observed that of his OCD patients 37% had parents with OCD and 21% had siblings with OCD
            • May be some genetic element but must be due to other factors
          • Diathesis-Stress Model genes make you more likely to inherit mental disorder, still need certain experience to trigger it
          • Genes
            • COMT
              • Regulates production of neurotransmitter dopamine
              • One form of COMT gene found more common in OCD patients
            • SERT
              • Affects transporter of serotonin,  therefore decreasing levels of this neurotransmitter
              • Study found a mutation of this gene in two unrelated families where 6/7 family members had OCD
        • Neural
          • Physical and psychological characteristics are determined by the behaviour of the NS, brain and individual neurons
          • Neurotransmitters
            • Dopamine
              • Abnormally high in people with OCD
              • Animal studies - drugs that enhance dopamine induce stereotyped movements resembling the behaviors of OCD patients
            • Serotonin
              • Antidepressant drugs that increase serotonin have shown to reduce OCD, while antidepressants that have less effect on serotonin do not reduce symptoms
            • Brain circuits
              • Caudate nucleus (located in basal ganglia) normally suppresses signals from orbitofrontal cortex, in turn the OFC signals the thalamus about 'worrying' things
              • Worry circuit
                • If the caudate nucleus is damaged, it fails to suppress minor 'worry' signals, alerting the thalamus, sending a signal back to OFC (acting as a worry circuit)
              • PET scans of OCD patients, taken while symptoms active (holding dirty cloth) showed increased activity in OFC
            • Both neurotransmitters are linked to these regions of the frontal lobes
              • Serotonin plays key role in operation of OFC and caudate nuclei, therefore abnormal levels of serotonin might cause areas to malfunction
              • Dopamine is the main neurotransmitter of basal ganglia, high levels of dopamine lead to overactivity in the region
            • Evaluation of explanaions
              • Menzies (2007) used MRI to produce images of brain activity in OCD patients and first degree relatives without OCD, as well as healthy unrelated people
                • OCD patients and their relatives had reduced grey matter in key areas of the brain including the OFC
                  • Supports that anatomical differences that may lead to OCD are inherited
                  • Mothers fertilized eggs can be screened, thus giving her choice to abort the egg with the COMT gene
              • Support for genetic basis, Nestadt (2000) identified 80 OCD patients and 343 of their first degree relatives, comparing them to 73 control without mental illness and 300 of their relatives
                • Found that those with a first degree relative have 5x greater risk of having illness themselves at some time in their life, compared to population
                  • However concordance rates are never 100% meaning there's an environmental factor
              • Billett (1998) conducted meta-analysis of 14 twin studies of OCD calculating concordance rates for MZ and DZ. Found that MZ more than twice as likely to develop OCD if co-twin had it
                • However concordance rates are never 100% meaning there's an environmental factor
        • Biological approach to treating OCD
          • Drug Therapy
            • Aims to inc/dec levels of neurotransmitters in the brain or to inc/dec their activity
            • Low levels of serotonin associated with OCD, therefore drugs are used to block the re-uptake pumps, increasing the amount of neurotransmitters passing through the receptor
            • SSRIs (selective serotonin reuptake inhibitor)
              • Standard medical treatment, type of antidepressant
              • Serotonin is released by certain neurons in the brain, released by the presynaptic neuron it travels across the synapse and passing the signal to the postsynaptic neuron, then being reabsorbed by the presynaptic neuron where it is broken down and re-used
                • SSRI prevents the re-absorption and breakdown of serotonin, thus allowing it to continue stimulating the postsynaptic neuron
              • Fluoxetine (common SSRI) typical does is 20mg daily, taking  3-4 months to have much impact on symptoms
              • Often used alongside CBT, drugs reduce patients emotional symptoms meaning the patient can engage effectively in CBT
              • Alternatives - increase dose to 60mg (after 3/4 months). Tricyclics such as clomipramine (have more severe side effects). SNRIs these increase levels of noradrenaline as well as serotonin
          • Evaluation
            • Causes side effects
              • Minority get no benefit, some may suffer side effects: blurred vision, loss of sex drive
                • Clomipramine side effects are more common and serious, more than 1 in 10 suffer erection problems and tremors, more than 1 in 100 suffer disruption of blood pressure and heart rhythm
                  • Matters as reduces effectiveness of drug, as patient will stop using them
            • Cost effective and non disruptive
              • Good value for NHS
                • Take drugs until symptoms decline, not engage with hard work of therapy
                  • Patients more likely to engage in treatment
            • Evidence to support effectiveness of SSRIs in reducing OCD symptoms
              • Soomro (2009) compared studies using SSRI and placebo, found all 17 studies showed significant results
                • Treatment better when combined with CBT
                  • Matters as drugs improved the lives of many
    • Depression
      • Mental disorder characterised by low mood and energy levels
      • Characteristics
        • Emotional
          • Lowered mood - more than just feeling sad, describe themselves feeling worthless or empty, anger - directed at self or others, lowered self esteem
        • Behavioural
          • Reduced energy levels, disruption to sleep (less - indomnia, more - hyersomnia) and eating habits, aggressive and self-harm
        • Cognitive
          • Poor concentration, address the negative, absolutist thinking - tend to see things in black and white
      • DSM-5 categories of depression
        • Major depressive disorder
          • Severe, often short-term
        • Disruptive mood regulation disorder
          • Childhood temper tantrums
        • Persistent mood regulation disorder
          • Long-term or recurring
        • Premenstrual dysphoric disorder
          • Disruption to mood prior and during menstruation
      • Cognitive approach to explaining depression
        • Believed to be a disturbance of thinking, focusing on an individuals negative thoughts, irrational beliefs and misinterpretation of events
        • Aaron Beck
          • Suggests a cognitive explanation why some people are more vulnerable to depression than others
            • There are three parts to this vulnerability
              • Faulty information processing
                • Those depressed make fundamental error in logic
                  • They tend to selectively focus on the negative aspects of a situation, ignoring the positive aspects
              • Negative self-schemas
                • Schema is a 'package' of ideas and information that develops with experience
                  • Self-schema is a package of ideas we have about ourselves
                    • Those depressed develop a negative self schema, interpreting information about themselves in n negative way
              • The negative triad (triangle)
                • Negative view of the self (i am incompetent)
                  • Negative view of the future (problems will not disappear)
                    • Negative view of the world (its a hostile place)
          • Evaluation
            • Supporting evidence
              • Research supports that depression is associated with faulty information processing, negative self schemas and the triad of impairments
                • Grazioli and Terry (2000)  assessed 65 pregnant women for cognitive vulnerability and depression before and after birth, those judged positive were more likely to suffer post-natal depression
            • Practical application in CBT
              • Forms basis of CBT, all cognitive aspects of depression can be challenged
                • Including the components of the negative triad that are easily identifiable, meaning a therapist can challenge and encourage the patient to test whether they are true - leading to successful therapy
            • Does not explain all aspects of depression
              • Only explains basic symptoms, as it is a complex disorder with a range of symptoms, not all of which can be explained
                • Some patients are deeply angry and Beck cannot explain these extreme emotions, some suffer hallucinations and bizarre beliefs, occasionally suffering Cotard syndrome - the delusion that they are already dead
        • Albert Ellis
          • Proposed good mental health is the result of rational thinking
            • Argued there's common irrational beliefs that underlie depression (poor mental health) and sufferers base their lives on these beliefs
              • E.g. I must be successful in everything i do.
                • Uses ABC model to explain how irrational thoughts effect our behaviour and emotional state
                  • A - an activating event can trigger
                    • We get depressed when we experience negative events and these trigger irrational thoughts
                  • B - irrational beliefs which result in
                    • E.g. believing we must always succeed
                  • C - a consequence
                    • When an activity event triggers irrational thoughts there are emotional and behavioural consequences
          • Evaluation
            • Only offers partial explanation
              • Some does occur due to activating event, however not all arises as result of obvious cause
                • Only applies to some depression, therefore only a partial explanation for depression
            • Practical application in CBT
              • Has led to successful therapy, challenging irrational negative beliefs, reducing depressive symptoms, suggesting irrational beliefs has some rile in depression
                • Lipsky (1980) Supports basic theory as it suggests that irrational beliefs had some role in depression
            • Does not explain all aspects of depression
              • Does not explain why some individuals experience anger asociated with their depression, nor hallucinations or delusions
                • Explains why some more vulnerable than others as result of their cognition's, has same limitations as Beck
        • Cognitive approach to treating depression
          • CBT
            • Treating mental disorders based on both behavioural and cognitive technique
              • Therapist aims to make relationship between clients thought, emotion and action
                • CBT changes the way people think and what they do - resulting in feeling better
                  • Encourages patients to be active and engage in pleasurable activities, breaking the 'vicious circle' of maladaptive thinking, feeling, behaviour
                    • Focuses on present problems rather than past
                      • Set hw to test irrational beliefs
            • 5-20, weekly, fortnight 30-60 min sessions.
              • Assessment
                • Goals
                  • Treatment
                    • Hw
                    • Monitoring
                    • Treatment complete
                • Formula
          • Becks cognitive therapy
            • Challenge negative beliefs
              • Assessed on severity of condition
                • Establish starting point to help monitor improvement
                  • Use 'reality testing' e.g. Client: 'I'm useless', therapist would ask if they have been successful at something
                    • Asked to do something to show their ability to succeed 'patient as scientist'
          • Ellis rational emotive behaviour therapy
            • ABCDE model
              • D=Dispute (challenge thoughts) E=Effect (see beneficial effect on though, behaviour)
            • REBT used to identify n dispute clients irrational thoughts
              • Based on when we become upset, its not the events in our lives upsetting us, its the beliefs that we hold
                • Ellis believed irrational beliefs make impossible demands on an individual - leading to anxiety
                  • REBT challenges these statements to replace them with reasonable realistic ones
          • Evaluation
            • May not work for severe cases
              • patients may be unable to motivate themselves to engage with the hard work of CBT, may not even pay attention to what is happening in session
                • Although you can work round this, it is a limitation as CBT cannot be used as the sole treatment for all cases of depression
            • Success may be due to therapist - client relationship
            • Effective
              • March (2007) compared effects of CBT with drugs, and combination of both in 327 adults with depression
                • After 36 weeks, 81% in CBT, 81% in drugs, and 86% in both improved
                  • CBT just as effective as drugs, suggests a good case for making CBT first choice in public health care systems

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