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  • Created on: 08-06-13 13:03

ANXIETY DISORDERS -PHOBIAS

ANXIIETY DISORDERS

Anxiety disorders can give a continous fear of anxiety and fear and they can easily become abnormal enough to interrupt with your daily life and day to day activities. Most people experience feeling worried or stressed in different situations at different levels...

PHOBIAS

Phobias are a type of anxiety disorder which very hard to deal with as it is a type that can affect your daily life and routine. Phobia is a disorder where a person has a persistent fear of an object or situation. A person with a phobia would recognise that their fear is irrational (unreasonable)...

ELEMENTS OF PHOBIAS

Cognitive (expectation of impending harm), Somatic (immediate reaction when shown phobic stimuli- nervous systme is activated and adrenaline is released), Emotional (feelings of dread, terror and panic) and Behavioural (feeling or freezing).

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CLASSIFICATION OF PHOBIAS

THE DSM CLASSIFICATION OF PHOBIAS

  • Excessive or unreasonable persistent fear
  • Immediate anxiety response is caused as a results of phobic stimuli being presented
  • The person recognises their fear to be excessive
  • The person tries to avoid the phobic situation [S]
  • The phobia distrupts a persons normal life
  • The phobia has lasted more than 6 months (for those under 18)

THE ICD CLASSIFICATION OF PHOBIAS

  • The psychological symptoms must be primary manifestations of anxiety and not secondary symptoms such as delusions
  • Anxiety must be restricted to the presence of a phobic object or situation
  • Phobic Situation is avoided wherever possible [S]

[S] - SAME IN BOTH DSM AND ISM

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AFFECTIVE DISORDER- DEPRESSION

AFFECTIVE DISORDERS

  • Affective disorders are said to affect many people.
  • Although they are a natural response, they can also become serious enough to affect a person and prevent them from living a normal life at work and socially with friends and family.
  • There are many types of affective disorders like bi-polar disorder(severe), manic depression or just uni polar depression.

DEPRESSION

  • There are two types- Bi Polar and Uni polar depression.
  • Depression is very serious
  • It is much more than "just feeling down" or miserable.
  • It can lead to death by suicide sometimes. The main symptoms include.....
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CLASSIFICATION OF DEPRESSION

THE DSM CLASSIFICATION OF DEPRESSION

  • The DSM states that either depressed mood OR loss of pleasure [S] must be shown, plus at least one of the following must also be shown during the same two week period for a diagnoses to be made;
    • Emotional Symptoms- intense feelings of sadness and guilt along with lack of enjoyment or pleasure in previous activities or company
    • Cognitive Symptoms- frequent negative thoughts- blaming themselves, low self esteem and unreasonable hopelessness [S]
    • Motivational Symptoms- passtivity and difficulty in decision making
    • Somatic- (biological)- loss of energy and relentlessness and disturbance of apetite, weight or sleep [S]
    • Thoughts of death
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CLASSIFICATION OF DEPRESSION

THE ICD CLASSIFICATION OF DEPRESSION

  • Depressed mood
  • Loss of interest and Enjoyment [S]
  • Redued Energy

Other symptoms include

  • Tiredness after slight effort
  • Reduced concentration
  • Reduced Self Esteem and confidence [S]
  • Ideas of Guilt and unworthiness
  • Pessimistic views of the future
  • ideas of self harm or suicide [S]
  • Disturbed sleep [S]
  • Reduceed appetite [S]
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PSYCHOTIC DISORDER- SCHIZOPHRENIA

PSYCHOTIC DISORDERS

Psychotic Disorders invove loss of contact with reality and and such disorders have symptoms such as delusions and hallucinations. Those suffering from this type of disorder would try and withdraw from the outside world and become confused or disortientated.

SCHIZOPHRENIA

Schizophrenia can take two forms

  • Type 1 schizophrenia- positive symptoms such as hallucinations and delusions and thought disorders
  • Type 2 schizophrenia- negative symptoms such as emotional blunting and avolition, lack of motivation

People with schizophrenia can suffer from emotional (flat unresponsiveness and insensitiveness or inappropriate and changeable beheaviour), behavioural (fixed, repetitive gestures with keeping the same position for a long time), perceptual (auditory hallucinations, usually voices commenting on behaviour and thought of a third person) symptoms.

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CLASSIFICATION OF SCHIZOPHRENIA

DSM CLASSIFICATION

  • Two or more of the follwing symptoms must be present for a significant amount of time in a one month period
    • Hallucinations (if there are extensive audiotry hallucinations of voices, then no other symptoms have to be present)
    • Delusions (if very bizare then no other symptoms required to be diagnosed)
    • Disorganised Speech - e.g. incoherent
    • Catatonic or diaorganised behaviour- e.g. repetitive movements or gestures
    • Negative symptoms- emotional blunding

ICD CLASSIFICATION

  • Thought echo, thought insertion or withdrawal and broadcasting
  • Delusions of control
  • Hallucinatory voices
  • Persistent Delusions
  • Persistent Hallucinations
  • Incoherent or irrelavent speech
  • Catatonic behaviour
  • Negative symptoms such as marked apathy
  • Significant and consistent in overall quality of some aspects of personal behaviour
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EXPLANATIONS OF AN AFFECTIVE DISORDER-DEPRESSION

BACKGROUND

Bheavioural explanations help expain that affective disorders are learnt through either operant and classical conditioning. LEWINSOHN Suggests that if people loose positive reinforcement (operant conditioning -learning through reinforcement) in thier life, they may become depressed. Lack or postive reinforcement leads to depression and makes a person less likely to perform well and therefore reduces positive feedback......

LEWINSOHN ET AL

  • Lewinsohn wanted to compare positve reinforcement levels in depressed and non depressed participants.
  • He carried out a longitudunal study over 30 days.
  •  Participants completed a self report of pleasant activities on a pleasant events schedule and a self rating of depression using depression adjective .
  • There were 30 participants diagnosed with depression and normal (control) tested using independant design.
  • It was a a quasi experiment (iv naturally occuring)
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EXPLANATIONS OF AN AFFECTIVE DISORDER-DEPRESSION

  • Participants checked mood daily using depression adjective checklist (included emotions like happy, blue, lucky). 
  • Participants ticked the emotions they felt that day. They also completed a pleasant activities scale rating of 320 activites including sports, yoga and meditation
  • These were rates twice on a scale of 3, once for pleasantness and one for frequency. This was seen as positve reinforcement
  • FINDINGS- there was a significant positive correlation between mood ratings and pleasant activities with more involvement in pleasant activites correlatated with more positive mood ratings.
  • There was an individual differences from a correlation of 0 to 0.66 which shows there is more depression than reinforcement
  • There appears to be a link between reinforcement from pleasant activities and mood but more further research is required to investigate individual characteristics which make more people influenced than others
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BIOLOGICAL EXPLANATION OF DEPRESSION

BACKGROUND

The biological approach explains depression by suggesting that the genetic disposition towards depression may explain why depression can be found in more that one person in families. There is a definite clear link between neurochemicals and depression as people with depression have lower serotonin levels. However we cant establish cause and effect. Do lower serotonin levels cause depression or does depression cuase lower serotonin levels.

WENDER ET AL

  • Wanted to investigate the contribution of genetic and envoironmental factors in the aetiology of mood
  • there was 71 adults adoptees, and thier adoptive and biological relatives. They had a mean age of 43.7 years and had a mood disorder. There was also 71 adult adoptees with a mean age of 44 who were psychiatrically normal. These adults had been removed from thier mothers at an early age
  • There was an independant blind diagnoses of mental hospitals and other records made so that psychiatric evaluations of relatives could be made
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BIOLOGICAL EXPLANATION OF DEPRESSION

  • There was an eight fold increase in unipolar deression among biological relatives of the index cases and 15 fold increase in suicide among the biological relative of the index case . (The index case is the documented case of disease in the study)
  • Very stong genetic link between unipolar depression and suicide
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COGNITVIE EXPLANATION OF DEPRESSION

BACKGROUND/EXPLANATION

Cognitive psychologists would suggest depression is cuased as a results of faulty thinking in the mind. SELIGMAN wanted to look at how quickly dogs coyuld learn through classical conditioniing by not being able to escape an electric shock to thier feet. He founf that his theory of "learned helplessness" could explain depression in humans

SELIGMAN- LEARNING HELPLESSNESS

  • Seligmans study used dogs
  • dogs were given electric shocks and they could not escape. 24 hours later they showed helplessness behaviours. These were behaviours such as trying not to escape, and not following one escape with another and passivley enduring shocks. Seligman concluded that the dogs learned that their responses and outcomes to the shocks did not relate. Thats why the dogs did not respond to the shocks and try to escape.
  • Outcomes of thier behaviour were uncontrollable and the dogs gave up trying
  • Seligman related this to depression in humans where humans think that they have done everything they could and no matter how hard they will try, nothing will change so there is no point in trying
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COGNITIVE EXPLANATION OF DEPRESSION

  • Seligman found several similarities between symptoms of depression and learned helplessness. These included passivity, lowered agression, loss of appetite, feeling helplessness, negative expectation, depleting of chemicals ets
  • Selgiman found the causes and uncontrollable events were the same and that successful therapies were the same
  • included electroconclusive shock thereapy and antidepressant drugs
  • therefore concluded that depression could be seen as a manefestation of learned helplessness.
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EVALUATION OF STUDIES OF EXPLANATION OF DEPRESSION

Sample

  • Lewinsohn- unrepresentative -30 ppts meaning 10 to each group (small sample)
  • Wender- too small so un-generalisable and took place in Denmark- part of western culture
  • Seligmen- generalisability- humans can act in a different way to animals

Validity

  • Lewinsohn- Low in Validity as it is measuring the effects of mood rather than effects of pleasant actitvities on depression
  • Wender-Based on some records that may not be valid today
  • Seligman- Low in Ecological validity- Lab experiment

Reductionist

  • Wender et al- ignores envoironmental factors. Concordance rates are never 100 % or consistent suggesting that there may be some envoironmental factors.
  • Seligman- not much reductionst- actually holistic. Dogs learned behaviour (behavioural) and many congitive elements when dogs changed thier thinking.
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BEHAVIOURAL TREATMENT OF DEPRESSION

EXPLANATION

Behavioural treatments of depression are based on the idea that if depression and depressed behaviours are learned, they can also be unlearned. The treatments teach patients that they will be reinforced for all the non depressive behaviours shown...

LEWINSOHN- COURSE IN COPING WITH DEPRESSION

  • Lewinsohn wanted to assess the efficacy of a course called "coping with depression"
  • He carried out a longitudunal study with teenagers aged 15-18 with depression. These adolescents were assessed using interview in many measures such as BECKS DEPRESSION INVENTORY
  • There were 69 adolescents with depression recruited using letters and anouncements in schools, doctors and media. Students were from Oregon. Drug therapy had to be stopped so they can take part so 59 were left as 10 decided not to carry on
  • it was an independant measures design with 3 groups. Group 1 was where only adolescents recieved the course. Group 2 was were adolescents recieved the course and parents enrolled on to a seperate parents group and Group 3 was the control group where adolescents were told they were on a waiting list
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BEHAVIOURAL TREATMENT OF DEPRESSION

  • Participants were assessed using interviews- before and after the start of treatments and then 1,6,12and 24 months after it finished
  • Participants on the waiting list were given treatment at the end of the study. Treatment was controlled and had handouts and homework for participants. Parents were thaught how to reinforce positive change in thier depressed children. During the treatment time for those treated, the teens were given training which focused on relaxation techniques, controlling negative thoughts and increasing social skills and more
  • group 1 showed 43 % reduction in depression. Group 2 showed 48% reduction in depression ad group 5 showed 5% reduction in depression
  • The course is very effective. There is also support for the use of behavioural techniques combined with cognitive, biological and social methods
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BIOLOGICAL TREATMENT OF DEPRESSION

BACKGROUND/EXPLANATION

Treatments such as drugs and antidepressants which affect the neurological system. Neuro transmitters such as serotonin are associated with depression. Karp and Frank proved how viological treatments are effective alone

THE STUDY- KARP AND FRANK- COMBINATION THERAPY AND DEPRESSED WOMAN

  • Karp and Frank wanted to compare drug treatment with non drug treatment.
  • The study was a review article of previous research looking at effectiveness of single treatment, combined drug and psychotherapeutic treatments of depression
  • 529 woman with depression took part in 1 of 9 peices of research
  • Independant measures deisgn. Patients either had single drug treatment, combined drug treatment, single psychological treatment or placebo.
  • depressive inventories were used to analyse depression in the patients before the treatment, after the treatment and to follow up, after a period of time. There was also some health practitioner assessment of symptoms used in some research .
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BIOLOGICAL TREAMTMENT OF DEPRESSION

  • It was found from the studies that adding psychological treatment to the drug treatetns would NOT increase the effectiveness of the drug therapy. There was less attrition shown in combination therapies suggesting people were more likley to continue with their drug therapy if cognitive thereapy was also given in addition to drug therapy.
  • The two treatments are better than one. Evidence does not show any better outcomes for patients offered in combined therapy as apposed to only drug therapy. This shows the effectiveness of drug therapy on depression. This supports the biological approach
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COGNITVE TREATMENT OF DEPRESSION

BACKGROUND

Cognitve therapy is based on the idea iof faulty cognition in mind. Cognitve theory aims to rearrange and restructure thoughts of patients to make them think positivley rather than negativley or irrationally. This reduces depression in patient as it is their negative thoughts that are said to have been contributing to depression according to cognitive psychologists

ELLIS

  • Wanted to compare the effectiveness of three techniques of psychotherapy- 1) rational therapy, 2)psychoanalysis, 3) Psychoanalytically orientated therapy
  • It was a review of patients cases from therapist notes
  • Independant measures design - participants allocated to one of 3 conditions
  • 3 types of participants 1)78 patients treated with rational analysis 2) matched with 78 patients treated with psychoanytically orientated psychotherapy 3)16 participants with orthadox psychonalysis
  • Outcomes of therapes were compared
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COGNITVE TREATMENT OF DEPRESSION

  • Rational analysis group improved depression by highest (90%). Psychoanalytically orientated imporved by 63%. Psychonalysis group showed 50% considerable improvement. From detaisl fo the case it was shown that each client hd several irrational ideas and that the most improvement shown was in people who changed most of thier irrational thoughts
  • Rational cognitve therapies are better treatment of depression than psychoanalytical theories
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