Psychopathology

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  • Created on: 01-04-17 12:36

STATISTICAL INFREQUENCY

  • Those behaviours that are extremely rare, when an individual has a less common characteristic e.g. being more depressed or having a lower IQ than the rest of the population. Normally uses mean, mode and median and can be seen on graphs.
  • Some abnormal behaviour is desirable - e.g. IQ scores over 130 are just as unusual as those below 70 but having a high IQ is considered desirable. Just because very few people display the behaviour it doesnt mean they require treatment to return back to normal. So SI cannot alone be used to make a diagnosis.
  • The cut-off point is subjectively determined - We need to decide where to seperate normality than abnormality e.g. one syptom of depression is difficulty sleeping. Someone might decide sleeping less than 80% of the population is abornal but some people may decide 90% is a better cut-off point.
  • Real life application - Used in the diagnosis of intellectual disability disorder. All assessments of patients with mental disorders include some kind of measurement to see how severe their disorder is. So SI can be useful in clinical assessment.
  • Culture relativism - Behaviours that are statsically infrequent in one culture may be frquent in another e.g. one syptom of schizerphrina is claiming to hear voices but this is an experience that is common in some cultures. So SI is culturally relative.
  • Not everyone benefits from labels - When someone is living a happy fulfilled life there is no need to label them as abnormal because this might have a negative effect on the way they view themseleves.
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DEVIATION FROM SOCIAL NORMS

  • In society there are standards of acceptable behaviour that are set by the social group, anyone who behaves differently from the socially created norms is classed as abnormal.

Evaluation

  • Suspectible to abuse - Social norms varies as times change e.g. homosexuality was unacceptable in the past but today they are acceptable. 50 years ago those in Russia who disagreed with thestate ran the risk of being reagarded as insane. Szaz claimed the concept of mental illness was simply a way to exclude non-conformists from society. To much reliance on deviation from social norms can lead to systematic abuse of human rights.
  • Deviance is related to context and degree - A person on a beach wearing next to nothing is classed as normal but doing the same in a classroom is abnormal. There is not a clear line betweem what is an abnormal deviation or what is simply more harmless eccentricity.
  • A strength - It has a real life application in the diagnosis of anti social personality disorder and it also takes into account the effect of the behaviour on others.
  • Cultural relativism - Classification systems such as the DSM are based on social norms in dominant western cultures and yet the same criteria is applied to people from different subcultures living in the West.
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FAILURE TO FUNCTION ADEQUATELY (FFA)

  • People are judged on their behaviour to go about everyday life e.g. eating, having control over your life etc. If they cant do this and are also experiencing distress or causing distress to others they are considered abnormal.
  • The DSM includes an assessment of ability to function called WHODAS. This considers 6 areas; understanding&communicating, getting around, slef care, getting along wiht people, life activities and participation in society.

Evaluation

  • Who judges - The patient may be experiencing perosnal distress and might recognise this is undesirable. On the other hand the perosnal is unaware they are not coping and it is others who are uncomfortable with the situation.So it depends whos making the judgement so not always accurate.
  • The behaviour may be quite functional - Eating disoders or depression may lead to extra attention for the individual which is rewarding and functional for the individual rather than dysfunctional.
  • Strength - FFA recognises the sunjective experience of the patient, allowing us to view the mental disorder from the point of view of experiencing it. It is also easy to judge because of WHODA, thus you can know when treatment is required.
  • Cultural relativism - The standrad of one culture is being used to measure another which explains why lower-class non-white patints are more often diagnosed with mental disorders.
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DEVIATION FROM IDEAL MENTAL HEALTH (DIMH)

Marie Jahoda (1958) defined abnormality in terms of mental health, absense of criteria of good mental health indicates abnormality. 6 catergories: 1) Self attitudes - having high self esteem 2) Personal growth 3) Integration-able to cope with stressful situation 4)Autonomy-beng indpendent 5)Having an accurate preception of reality 6) Mastery of environment-able to love,solve problems.

Evaluation

  • Unrealistic criteria - This criteira would make most of us abnormal. How many need to be lacking before a person is judged as abnormal. It is also difficult to meausure - how would you measure personal growth. This means it is not really usebale to identify abnormality.
  • Suggests menatl health is the same as physical health - Physical illnesses have physical causes and as a result make them easy to detect whereas many metal disorders not no have physical cuases. So we cant diagnose metal abnormality the same way as physical.
  • It is a positive approach - Focuses on what is desirable rather than undesirable. Jahodas ideas have had some influence and are in accord with the humanistic approach.
  • Cultural relativism - Self actualisation only applies to individualist cultures and not collectivists where people trive for the greater good of the communtiy rather than self-centered goals.
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PHOBIAS

Phobias - High levels of irrational anxiety in response to a particular stimulus, the anxiety interferes with normal living.

Emotional characteristics - Excessive fear/anxitey/panic cued by a specific object or situation and are out of proportion to the actual danger posed.

Behavioural characteristics - Avoidance e.g. a person with a phobia of social situations avoids being in groups of people. People also freez/faint/panic. Also endurance -  the person remains in the presense of the phobic stimulus but still has high levels of anxiety.

Cognitive characteristics - The phobics perception of the phobic stimulus would be disstorted. The person recognises that their fear is excessive or unreasonable. This charcteristic distinguishes between a phobia and a delusional mental illness (schizorphrenia). They also have a resistance to rational arguments.

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DEPRESSION

Depression - A mood disorder where the individual has a low mood/feels sad and lacks interest in their usual activities.

Emotional chracteristics - Sadness, feeling empty, feeling worthless, low self esteem. Loss of interest in usual hobbies. Also anger directed towards others and self.

Behavioural characteristics - Normally patients with depression have a low energy level, always tired and wish to sleep all the time. However some may become very restless. Sleep is affected, some people sleep alot whereas others experience insomnia same as appetite.

Cognitive charcteristics - Poor concentration. Depression leads to people having negative views of the world, their own lives and relationships. Such expectations can be self-fulfilling e.g. if you believe you are going to fail an exam, the belif will reduce the effort you make to revise and increase your anxiet and thus you will fail. In general such thoughts are irrational.

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OBSESSIVE COMPULSIVE DISORDER (OCD)

OCD - an anxiety disorder where anxiety arrises from both obsession (persistent thoughts) and compulsions (behaviours that are repeated over and over again). Compulsions are a response to obsessions and the person believes the compulsion will reduce anxiety.

Emotional characteristics - Anxiety and distress. Sufferers are aware their behaviour is excessive and this causes feelings of embarassment and shame.

Behavioural characteristics - There are 2 elements to compulsive behaviours :                      1) compulsions are repetitive e.g. hand washing or counting.                                                    2) compulsions reduce anxiety . OCD patients try to avoid the situations that trigger anxiety e.g. taking out trash.

Cognitive characteristics - Obsessions are recurrent, intrusive thoughts or impulses that are percieved as inappropriate or forbidden. Common themes include germs, doubts (worry that something important has been overlooked). These thoughts,doubts,impulses are seen as uncontrollable which creates anxiety. The person recognises that that thoughts and impulses are a product of their own mind.

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THE BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS

Mowrer(1947) proposed the two-process model to explain how phobias are learnt and continue.

  • Classical conditoning - a phobia is acquired through asscication between ta NS and a UCS. For little Albert the NS was a white rat and the UCS was a loud sound when paired the white rat was then feared by little Albert.
  • Operant conditioning - this mantaines the phobia. The avoidance of or escape from the phobic stimulus reduces fear and is thus reinforcing. This is an example of negative reinforcment (escaping from an unpleasnt situation). Avoids anxiety created by avoding the situation or object entirely.
  • Social learning is not part of the 2 process model. Phobia may be acquired through modelling of the behaviour by others. e.g. seeing a parent respond with extreme fear to a spider may lead to the child to acquire similar behaviour.
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EVALUATION OF THE BEHAVIOURAL APPROACH TO EXPLAINI

Evaluation

  • The importance of classical conditioning - people with phobias often do recall a specific incident when their phobia appeared Sue 1994. However, it is possible that the incident did happen but has since been forgotten Ost 1987. Sue suggests that different phobias may be the fear of differnt processes. e.g. agoraphobics (fear of situations where escape miht be difficult) were likely to explain thier disorder by a specific incident, whereas people who are scared of spiders were most likely to cite modelling as the cause
  • Diathesis-stress model - Research has found that not eveyone who has been bitten by a dog devlops a phobia. This could be explained by the diathesis-stress model which proposs that we inherit gentic vunerablilty for devloping mental disorders. A dog bite will only lead to a phobia in those with such vunerbaility.
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EVALUATION OF THE BEHAVIOURAL APPROACH TO EXPLAINI

  • Biological preparedness - Seligman 1970 argues that animals incl humans are genetically programmed to learn an association between life threatening stimuli and fear. These stimuli are referred to as ancient fears - things that wouldve been dangerous in our evolutionary past. It would have been adaptive to learn to avoid such stimuli. This concept would explain why people are less likely to develop fears of modern objects such as toasters or cars which pose a higher threat than spiders. Such items were not a danger in out evolutionary past. This suggests that behavioural explanations alone cannot be used to explain the development of phobias.
  • The 2-process model ignores cognitive factors - The cogntive approach proposes that phobais may develop as the consequence of irrational thinking such thoughts create extreme anxiety. Cogntive therapies such as CBT are sometimes more sucessful than behavioural treatment for ceratin situations such as social phobia (Engels 1993).
  • The application to therapy is a strength of the 2-process model. because the patient is prevented from practising their avoidnace behaviour so it declines.
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THE BEHAVIOURAL APPROACH TO TREATING PHOBIAS

  • Systematic desensitisation -  Wolpe 1958 devloped a technique where phobics were introduced to their feared stimulus gradually.
  • Counterconditioing - The patient is taught through classical conditioning to associate the phobic stimulus with a new response i.e. relaxation instead of fear.
  • Relaxation - The therapist teaches the patient relaxation techniques which can be acheived by the patient focusing on their breathing, or visualing a peaceful scene.
  • Desensitisation hiearchy - The patient and the therapist together construct a desensistisation hierahcy from least to most fearful stimuli. Exposed to each  stage slowly.

Flooding is when you have one long session where the patient experiences thier phobia at its worst whilst practising relaxation.

In practice the first step is to learn relaxation techniques the is exposed to their feared stimulus, a persons fear response has a time limit. As adrenaline levels naturally dcerease, a new stimulus-response link can be learned between feared stimulus and relaxation. The patient quickly learns that the feared stimulus is harmless, in classical conditioning this is called extinction.

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EVALUATION OF THE BEHAVIOURAL APPROACH TO TREATING

  • Effectiveness of SD - McGrath 1990 reported that ablout 75% of patients with phobias respond to SD. The key lies with actial contact with the feared stimulus (Choy 2007). Gilroy (2003) followed up 42 patients who had been treated for a spider phobia in 3 45 minute sessions of SD. A control group were treated with relaxation without exposure. After 33 months the SD group were less fearful than the relaxation group. However iit appears to be less effective for more complex phobias such as social phobia which may be because it has cognitive aspects since the sufferer experiences negavtive/irattional thoughts about the social situation. This type of phobia may benefit more from cognitive therapies.
  • Strengths of behavioural therapies - Behavioural therapies for dealing with phobias are genrally fast and require less effort on the patients part than say CBT. SD can also be self-administrated and is still equally as sucessful for example with social phobia (Humphrey) this makes it cost effective.
  • Symptom substitution - Behavioural therapies may not work because the symptoms are only the tip of the icebeg. If the symptoms are removed the cause still remains and the symptoms will resurface possibly in another form.
  • Flooding can be a highly traumatic procedure. Some patients do quit during the procdure and that could result in their phobia worsening. Howver those who do stick through with it find it is effective and relatively quickly. Choy said flooding was more effective at treating the 2 phobias. Craske reported SD and flooding were equally as effective.
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THE COGNITIVE APPROACH TO EXPLAINING DEPRESSION

Ellis' ABC model (1962)

  • A - activating event e.g. you get fired at work
  • B - belief which may be rational or irrational e.g. they hated me so they sacked me
  • C - consequence which may be rational or irrational e.g. acceptance or depression
  • Mustabatory thinking - e.g. i must be liked whcih causes dissappointment and depression.

Becks negative triad (1967)

  • If we have a negative schema we interpret all information about ourselves in negative ways.

The negative triad:

  • The self - "i am unattractive"
  • The world - "I can understand why people dont like me, they prefer someone elses company"
  • The future - "i am always going to be alone"
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EVALUATION OF THE COGNITIVE APPROACH TO EXPLAINING

Support for the role of irrational thinking - Hammen and Krantz (1976) found that depressed participants made more errors in logic when asked to interpret witten material than non depressed participants. Bates (1999) found that participants who were givem negative automatic thought statements became more and more depressed. However  negative thoughts thoughts may not cause depression. It may be that a depressed person develops a negative way of thinking because of their depression rather than the other way round.

Blames clients rather than situational factors - The cognitive approach says it is the client who is responsible for their disorder. This may lead the client or therapist to overlook situational factors such as family problems or life events which have contributed to the mental disorder.

Practical applications in therapy - These cognitive explanations have both been applied to CBT. CBT is found to be the best treatment for depression ecspecially when used with drugs (Cuijpers 2013).

Irrational beliefs may be realistic - Alloy and Abrahmson (1979) suggest that depressive realists tend to see things for what they really are and normal people think the everything is better than it seems. Found depressed people gave accurate estimates of liklihoods of disasters.

Alterantive explanation -The biological apporach suggests that genes and neurotransmitters may cause depression. Zhang (2005) found low levels of serotonin in depressed people and found the gene related to this is 10x more common in depressed people. The sucess of drug therapies suggest that neurotransmitters do play a part.

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THE COGNITIVE APPROACH TO TREATING DEPRESSION

CBT - cognitive behavioural therapy

CBT Becks cognitive therapy - First you have to identify the negative automatic thoughts about slef,world and future and then challenge them. This is the central component of the therapy. The therapist might ask the clients to test the reality of their thoughts by setting them homeowrk which could be to record when people complimeneted them so if in the future they say im ugly the therapist can give them evidence so show they are not.

CBT Ellis' rational emotive behaviour therapy (REBT) - REBT extends the ABC model to ABCDE D stand for dispute and E for effect. REBT focuses on challenging the irrational thoughts which would involve a vigorous argument, the effect is to change the irrational belief. Ellis identified different method of disputing -                                                       1) Logicial argument- If this way of thinking make sense, is it logical.                                                                                2)Empirical argument - Is there actual evidence to support this belief.                                                                       3)Pragmatic argument - Emphsises the lack of usefulness of self defeating beliefs.

Behavioural activation - The therapist may also encourage the patient to be more active and enagnge in enjoyable activities. Being active leads to rewards that act as an antidote to depression.

Unconditonal positive regard - Ellis came to realise that an important ingridient in successful therapy was convincing the client of their value as an human being this will facilitate a change in their beleifs and attitudes.

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EVALUATION OF THE COGNITIVE APPROACH TO TREATING D

Research support - March et al 2007 compared the effects of CBT with anti-depressant drugs and a combination of the 2 in 327 adolescents with depression. After 36 weeks 81% or the CBT group, 81% of the anti-depressant group and 86% of CBT plus anti-depressant group were significantly improved. CBT is just as effective as anit-depressants.

Individual differences - CBT apprears to be less suitable for those who have severe cases of depression and are resitant to change (Elkin 1985). When this is the case it is possible to treat patients with anti-depressants first and commence CBT when the patient feels more alert and motivated. CBT cannt be used as the sole treatment for all cases of depression.

Support for behavioural activation - Babyak 2000 studied 156 adult volunteers with depression. They were randomly assigned to a 4 moth course of aerobic exercise, drug treatment or a combination of the 2. Clients in all 3 groups showed improvment. Six months after the end of the study, those in the exercise groups had significantly lower relapse - some people continued the exercise on their own.

Alternative treatments - The most popular treatment for depression is the use of anti depressants such as SSRIs. Drug therapies require less effort from the client in REBT requires alot of commitment. Cuijpers found that CBT was effective if it was used in conjunction with drug therapy.

Some patients was to explore their past - The focus of CBT is on the present and the future. But some patients are aware of the link between their childhood experiences and depression and would want to talk about it.

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THE BIOLOGICAL APPROACH TO EXPLAINING OCD

Genetic explanations - The COMT gene - COMT regulates the production of dopamine (drive and motivation) that has been implicated in OCD. All genes come in different form and one form of the COMt gene has been found to be more common in OCD patients than people without the disorder - this variation produces lower activity of the COMT gene and higher levels of dopamine (Tukel 2013)

The SERT gene - Affects the transport of serotonin by creating lower levels of it, because higher levels are implcated in OCD.

Diathesis-stres - The idea of a simple link between one gene and OCD is unlikely. The SERT gene are also implicated in other disorders such as depression. What this suggest is that rach individual gene only creates a vunerability  for OCD. Other factors then affect what condtion develops. So people could pocess the COMT or SERT gene but have no illness. OCD is polygenic so its not caused by one gene but several genes.

Neural explanations - Abnormal levels of neurotransmitters - Dopamine levels are thought to be abnormally high in people with OCD - based on animal study, gave animals drugs that raised levels of dopamine whcih induced sterotyped movements resembling the compulsive behaviours found in OCD patietents (Szechtman 1998). Low levels of serotonin are associated with OCD. Anti depresant drugs that incraese serotonin have been shown to reduce OCD symptoms (Pigott 1990).                                                                                                                                                                Abnormal brain circuits -  Damaged caudate nucleus doesnt supress worry signals from OFC to thalamus, the OFC sends worry signlas to the thalamus. Supported by PET scans of patients with OCD, when their symptoms are active the scans show heightened activity in the OFC. Abnormal levels or serotonin may cause the OFC and caudate nuclei to malfunction (Comer 1998).

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EVALUATION OF THE BIOLOGICAL APPROACH TO EXPLAININ

Effectiveness - Nestadt 2010 reviewed previs twin studies and found that 68% of identical twins shared OCD as opposed to  31% of non identical twins. This strongly suggest the genetic influence on OCD. However these concordance rates are never 100% which suggests that environmental factors must also play a role too ( the diathesis stress model).

Tourettes sydrome -  Pauls and Leckman 1986 studied patients with Tourettes sydrome and their families and concluded that OCD is one form of expression of the same gene that determines Tourettes. The obsessional behaviour is also found in children with autism. This supports the view that their is not one speceific gene unique to OCD.

Real world application -  If one parent to be has the COMT gene, the mothers fertilised eggs could be screened and thus giving parenst the choice to abort the egg. This raises ethical issues. An issue for genetic explanations is that they lull people into thinking that there may be simple preventive measure when in fact there is not since there isnt a imple relationship between a gene and a complex disorder like OCD.

We should not asuume that neural mechanisms cuse OCD because these biological abnormalities could be the results of having OCD.

Alternative explanations -  The 2 process model could be applied to OCD. When the NS(dirt) is associated with anxiety. This is maintained becasue the stimulus is avoided thus an obsession is formed. Treatmenst such as exposure which is similar to SD. Patienst experience their feared stimulus but are at the same time prevented from perfroming their compulsive behaviours.

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THE BIOLOGICAL APPROACH TO TREATING OCD

Antidepressants: SSRIs - Low levels of serotonin are associated with OCD, so drugs to increase levels of serotonin are used. SSRIs are the preferred drug for treating, they work because serotonin is released into the synapse from the pre synaptic nerve ending and targets the receptor sites on the post synaptic nerve ending, afterwards it is re-absorbed by the initial neuron, the SSRIs inhibit the serotonin from being re-absorbed, so levels at the synapse are  increased. It take 3-4 months for impact on symptoms to show.

Tricyclics -Tricyclics work in the same way as SSRIs but as well as blocking re-absorbtion of serotonin it also blocks noradrenaline. Trylics attack more than one neurotransmitter but have greater side effects.

Anti anxiety drugs - Benzodiazepiines  (BZ) slow down the activity of the CNS by enhancing the activity of the neurotransmitter GABA, a neurotransmitter that when released has a genral quitening affect in the brain. It does this by reacting with special sites called GABA receptors . When GABA locks into these receptors it opens a channel that increases the flow of chloride ions into the neuron which makes it harder for the neuron to be stimulated by other neurons thus slowing down its activity and makiing the person feel more relaxed.

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EVALUATION OF THE BIOLOGICAL APPROACH TO TREATING

Effectiveness- Soomro 2008 reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective them placebos in reducing the symptoms of OCD up to 3 months after the treatments i.e. short term. One of the issues regarding the evaluation of traetment is that most sudies are onlu 3 to 4 months duration therefore little long term data exits (Koran 2007).

Drug therapies are preferred to other treatments  - They require little effort from the user and dont use up much time; much less than CBT. They are also cheaper because they require little monitoring.

Side effects - Nausea, headache and insominia are side effects of SRRIs . These may make some patients not take the drugs. Tricyclics tend to have more sideffects such as hallucinations and irregular heartbeats. So tricyclics ae only used when SSRIs are not effective. BZs include aggressiveness and long term memory impairment. There are also problems with addiction.

No lasting cure -Drugs do not provide a lasting cure as indicated by the facts that patients relapse within a few weeks if medication is stopped (Mania 2001). So CBT should be tried first.

Publication bias - Turner claims there is evidence of a publication bias towards studies that show a positive outcome of antidepressant treatments. They also found that studies that were not positive were often published in a way that conveyed a positive outocme. A lot of the research is funded by drug companies. This could lead to doctors making inappropriate treatment descions.

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