Psychopathology

What are the definitions of abnormality?

Statistical infrequency, deviation from social norms, failure to function adequately and deviation from ideal mental health

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What is statistical infrequency?

Abnormality is defined as those behaviours that are extremely rare

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What are the evaluation point titles?

Desirable behaviour, cut-off is subjective and sometimes appropriate

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What is the first evaluation point of statistical infrequency?

Desirable behaviour- e.g. IQ. Equally, there's normal behaviours that are undesirable e.g. depression

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What is the second evaluation point of statistical infrequency?

Cut-off is subjective- Need to decided where to separate normality from abnormality. People think different things are abnormal

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What is the third evaluation point of statistical infrequency?

Sometimes appropriate- E.g. intellectual disability is defined in terms of normal distribution using standard deviation to establish a cut off point. Any whose IQ is more than 2 standard deviations below mean has a mental disorder

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What is deviation from social norms?

In any society there are standards of behaviour set by the social group, and adhered to by those socialised into that group. Anyone who behaves differently is abnormal

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What are the evaluation point titles?

Susceptible to abuse, related to context and degree and strength

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What is the first evaluation point of deviation from social norms?

Susceptible to abuse- Varies as time changes. E.g. homosexuality used to be included under sexual and gender identity disorders in the DSM. 50 years ago, anyone who disagreed with the state might've been put into a mental institution

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What is the second evaluation point of deviation from social norms?

Related to context and degree- Deviance is often related to context. Also, there's not a clear line between what's an abnormal deviation or simply harmless eccentricity

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What is the third evaluation point of deviation from social norms?

Strength- Distinguishes between undesirable and desirable behaviour. Also takes into account the effect that behaviour has on others

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What is failure to function adequately?

Not being able to cope with everyday living. Causes distress and suffering for them and others

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What are the evaluation point titles?

Who judges, functional and strengths

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What is the first evaluation point of failure to function adequately?

Who judges?- May be the patient or they may be content and someone else judges the behaviour as abnormal e.g. Peter Sutcliffe (Yorkshire ripper). So the definition of abnormality depends on whose making it

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What is the second evaluation point of failure to function adequately?

Functional- E.g. some mental disorders may lead to extra attention. That's rewarding and thus functional for them. Or e.g. transvestism is class as a disorder but it's perfectly functional behaviour

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What is the third evaluation point of failure to function adequately?

Strengths- Recognises the subjective experience of the patient, allowing us to view it from their point of view. Easy to judge objectively as we can make a list

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What is deviation from ideal mental health?

Jahoda 1958- We define physical illness by the absence of signs of physical health. So should do that with mental health. Conducted a review of what others had written about good mental health and identified 6 categories

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What are the 6 categories?

Self-attitudes, personal growth and self-actualisation, integration (e.g. coping with stressful situations), autonomy (independent) , accurate perception of reality and mastery of the environment (love, function, adjusting to new situations etc.)

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What are the evaluation point titles?

Unrealistic, same as physical health? and positive

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What is the first evaluation point of deviation from ideal mental health?

Unrealistic- Criteria means most of us are abnormal. Also need to ask how many need to be lacking before a person would be judge as abnormal. Also difficult to measure

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What is the second evaluation point of deviation from ideal mental health?

Same as physical health?- Physical illnesses usually have physical causes so easy to detect and diagnose more. Whereas, mental orders usually are the consequence of experiences so differently diagnosed

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What is the third evaluation point of deviation from ideal mental health?

Positive- Focuses on the positive rather than the negatives and focuses on the desirable rather than the undesirable. Although, the ide was never taken up, it had some influence in the 'positive psychology' movement

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What are phobias?

Anxiety disorder. Instances of irrational fears that produce a conscious avoidance of the feared thing. Includes agoraphobia, social phobia, and specific phobias

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What are the emotional characteristics of phobias?

Fear that's marked and persistent and likely to be excessive and unreasonable. Also anxiety and panic. Cued by presence of the thing and are out of proportion to the danger posed

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What are the behavioural characteristics of phobias?

Avoidance. Or the opposite, which is to freeze or faint. 'Freezing' is an adaptive response because a predator may think the prey is dead. Avoidance interferes with their life and there's marked distress about having the phobia

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What are the cognitive characteristics of phobias?

Irrational nature of the person's thinking and the resistance to rational arguments. Person recognises the fear is excessive or unreasonable

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What is depression?

Mood disorder. DSM-V distinguishes between major depressive disorder and persistent depressive disorder which is longer term and/or recurring

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What are the emotional characteristics?

Diagnosis requires at least 5 symptoms and must include sadness or loss off interest and pleasure in normal activities. Feeling empty, worthless, hopeless, and have low self-esteem. Despair. Lack of control. Anger

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What are the behavioural characteristics?

Shift in activity level- increased or reduced. Reduced energy, tiredness and want to sleep always. Or feel agitated, restless and may pace, wring hands and tear at skin. Reduced or increased sleep and appetite

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What are the cognitive characteristics?

Negative thoughts (E.g. negative self-concept), guilt, a sense of worthlessness etc. Negative view of the world. These thoughts are irrational

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What is OCD?

Anxiety disorder. Typically begins in young adult life and has two main components- obsessions and compulsions

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What are the emotional characteristics of OCD?

The obsessions and compulsions create anxiety and distress. Aware their behaviour is excessive and this causes embarrassment and shame. An obsession with germs causes feelings of disgust

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What are the cognitive characteristics of OCD?

Obsessions- Recurrent intrusive thoughts perceived as inappropriate. Frightening or embarrassing so don't want to share them. Obsessional themes include ideas, doubts, impulses and images. Seen as uncontrollable, creating anxiety. Own thoughts

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What are the behavioural characteristics of OCD?

Compulsive behaviours are performed to reduce anxiety. Repetitive and unconcealed. May be mental acts. Feel compelled to do them otherwise something will happen. Creates anxiety. Behaviours aren't connected really to what they're trying to stop

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Who proposed the two-process model?

Orval Hobart Mowrer 1947

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What is the first stage?

Classical conditioning

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How does classical conditioning cause a phobia?

Acquire through association. E.g. Being bitten (UCS) creates fear (UCR). Dog (NS) associated with being bitten (UCS). Dog (now CS) produces fear response (now CR)

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What is the second stage?

Operant conditioning

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How does operant conditioning maintain a phobia?

The likelihood of a behaviour being repeated is increased if the outcome is rewarding, in the case of a phobia, the avoidance reduces fear and so is reinforcing. Example of negative reinforcement

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How conducted the Little Albert study?

Watson + Rayner 1920

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What was the procedure?

11 month old boy. Showed no fear to a white furry objects. Created a conditioned response to them. When he reached out for the rat they struck the bar with a hammer behind his head to startle him. Repeated it 3 times and then the same a week later

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What were the findings?

When they now showed him the rat and other furry white objects, he began to cry. They'd conditioned a fear response to furry white objects

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What are the evaluation point titles?

Diathesis-stress model, support, biological preparedness and ignores cognitive factors

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What is the first evaluation point of the behavioural approach to explaining phobias?

Diathesis-stress model- Research has found, for instance, not everyone bitten by a dog develops a phobia (Di Nardo et al). Could be explained by diathesis-stress model

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What is the second evaluation point of the behavioural approach to explaining phobias?

Support- Bandura + Rosenthal: Model acted if he was in pain every time a buzzer sounded. Later, participants who'd observed this showed an emotional reaction to the buzzer

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What is the third evaluation point of the behavioural approach to explaining phobias?

Biological preparedness- Seligman: Animals are genetically programmed to rapidly learn an association between life-threatening stimuli and fear. Ancient fears (Things that you;d've been dangerous in past). Explains why phobias don't develop always

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What is the fourth evaluation point of the behavioural approach to explaining phobias?

Ignores cognitive factors- May develop as the consequence of irrational thinking. The value of this explanation is that it leads to cognitive therapies. May be better in some situations. Engels et al: Social phobias respond better to CBT

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What is flooding?

Patient experiences their phobia at its worst whilst practising relaxation. Continues until the patient is fully relaxed

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What is the procedure of flooding?

Can be conduced in vivo or vr. First step is to learn relaxation techniques. Applied in one session in the presence of the most feared situation. Usually 2-3 hours

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Why is this done?

Person's fear response and the release of adrenaline has a time limit. As adrenaline levels naturally decrease, a new stimulus-response link can be learned between feared stimulus and relaxation

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What are the evaluation point titles?

Individual differences, effectiveness and symptom substitution

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What is the first evaluation point of flooding?

Individual differences- Can be highly traumatic. Patients are may aware before but may still quit during which reduces the treatment effect

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What is the second evaluation point of flooding?

Effectiveness- Choy et al: Reported SD and flooding were effective but flooding more so. Craske et al: concluded SD and flooding were equally effective

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What is the third evaluation point of flooding?

Symptom substitution- Only the tip of the iceberg and symptoms may return. Freud: Found Little Hans' fear of horses was actually an intense envy of his father and they cured this. Psychodynamic approach says phobias develop because of projection

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What is systematic desensitisation?

Phobias may persist as phobics avoid the phobic stimulus and so don't learn it's not fearful. Wolpe (1958) developed SD. A treatment where a client is gradually exposed to the thing under relaxed conditions until no longer scared

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What is the first step?

Counter conditioning- Taught, through classical conditioning, to associate the stimulus with a new response i.e. relaxation. So anxiety is reduced

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What is the second step?

Relaxation- Taught relaxation techniques. Can be through focusing on breathing and taking slow, deep breaths as anxiety quickens breath. Being mindful helps. Focusing on an object or visualising a peaceful scene. Progressive muscle relaxation

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What is the third step?

Desensitisation hierarchy- Gradually introducing the feared thing one step at a time so its not as overwhelming. At each stage they practise relaxation so the situation becomes more familiar, less overwhelming and their anxiety diminishes

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What are the evaluation point titles?

Effectiveness, not appropriate for all and strengths

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What is the first evaluation point of systematic desensitisation?

Effectiveness- McGrath et al: Abut 75% of patients respond to SD. Key to success is in vivo according to Choy et al. Often a number of exposure techniques are involved- in vivo, in vitro and modelling (Comer)

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What is the second evaluation point of systematic desensitisation?

Not appropriate for all- Öhman et all: Suggest it's not as effective for phobias with an underlying evolutionary survival component, than those acquired through person experiences

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What is the third evaluation point of systematic desensitisation?

Strengths- Relatively fast and require less effort than other psychotherapies. CBT requires willpower in trying to understand their behaviour and harms those who don't know the cause. Also can be self done. Tarik Al-Kubaisy: Found it was as effective

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Who made the ABC model and when?

Ellis in 1962

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What is the ABC model?

Stated the key to mental disorders lay in irrational beliefs. 3 parts: Activating event, belief and consequence. Rational beliefs lead to healthy emotions whereas irrational beliefs lead to unhealthy emotions

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What is musturbatory thinking?

Thinking certain ideas or assumptions must be true for an individual to be happy. This is the source of irrational beliefs. A person who holds such assumptions is bound to be disappointed and at worst, depressed. 'Musts' need to be challenged

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What were the most important irrational beliefs?

I must be approved of or accepted by people I find important. I must do very well or well, or I am worthless. The world must give me happiness, or I will die

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Who made the negative triad and when?

Beck 1967

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What did Beck believe?

Depressed people feel as they do because their thinking is biased towards negative interpretations of the world and they lack a perceived sense of control

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What is the negative schema part?

Acquire this during childhood- a tendency to adopt a negative view of the world. May be caused by anything, including parental and/or peer rejection and criticisms by teachers. Activated when a person encounters a new situation that resembles initial

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What is the negative triad?

A pessimistic and irrational view of 3 key elements in a person's belief system: the self, the world (life experiences), and the future

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What are the evaluation point titles?

Support, blames them, application and alternative explanations

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What is the first evaluation point for the cognitive approach to explaining depression?

Support- Hammen + Krantz: Found depressed participants made more errors in logic when asked to interpret written material. Bates et al: Found this given negative automatic thought statements became more depressed. Doesn't mean thoughts are the cause

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What is the second evaluation point for the cognitive approach to explaining depression?

Blames them- May lead the client or therapist to overlook situational factors. The disorder is simply in their head and recovery is in changing that

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What is the third evaluation point for the cognitive approach to explaining depression?

Application- Both applied to CBT. Consistently found to be the best treatment especially with drug treatments

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What is the fourth evaluation point for the cognitive approach to explaining depression?

Alternative explanations- Biological approach suggests genes and neurotransmitters. Zhang et al: Showed role of low levels of serotonin and found a gene related to this that's 10X more common in depressed people. Also drug treatments suggest it

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When was cognitive behaviour theory?

1950s. Ellis was one of the first to develop a form. Called it rational emotional behaviour therapy

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What is the challenging irrational thoughts part?

Extended the ABC model: Disputing irrational thoughts and beliefs, effects of disputing and effective attitude to life and feelings produced. Focuses on disputing irrational beliefs and replacing them with rational ones

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What are different types of disputing?

LogicalL Self-defeating beliefs don't follow logically from the information available. Empirical: Self-defeating beliefs may not be consistent with reality. Pragmatic- Emphasises their lack of usefulness

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What is the homework part?

Might be doing things they were scared to do before or couldn't due to the depression e.g. getting a job. Or asking friends what they really think about them. Vital in testing irrational beliefs against reality and practicing new rational beliefs

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What is the behavioural activation part?

Focus on encouraging clients to be more active and engage in pleasurable activities. Leads to rewards and then acts as an antidote. Many stop liking previously pleasurable activities. Client and therapist look for activities and deal with obstacles

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What is unconditional positive regard?

If they feel worthless, they'll be less willing to consider change. But if the therapist provides respect and appreciation regardless of what the client does and says, this will facilitate a change

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What are the evaluation point titles?

Support, individual differences, support for BA and alternative treatments

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What is first evaluation point for the cognitive approach to treating depression?

Support- Ellis: 90% success rate for REBT. Cuijpers et al: Review of 75 studies found CBT was superior to no treatment. Variation is mainly explained by therapist competence (as much as 15%, Kuyken + Tsiurikos)

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What is second evaluation point for the cognitive approach to treating depression?

Individual differences- Elkin et al: less suitable for people with high levels of irrational beliefs that are rigid and resistant to change. Simone et al: Less suitable where high levels of stress reflect realistic stressors therapy can't resolve

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What is third evaluation point for the cognitive approach to treating depression?

Support for BA- Babyak et al: 156 adult volunteers diagnosed. Randomly assigned 4 month course of aerobic exercise, drugs or a combination. All 3 exhibits improvements at end. After 6 months exercise group had lower relapse rates

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What is fourth evaluation point for the cognitive approach to treating depression?

Alternative treatments- Antidepressants. Most popular. Require less effort. Can also be used with. May be useful because a depressed client may be unable to focus on CBT demands without drugs. Cujipers: Combo was best

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What is the COMT gene?

Involved in the production of COMT. COMT regulates the production of dopamine that has been implicated in OCD

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Why is the COMT gene involved in OCD?

All genes come in different forms and one form of the COMT gene has been found to be more common in OCD patients than people without OCD. Produces lower activity so higher levels of dopamine

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What is the SERT gene?

Affects the transport of serotonin, creating lower levels of it. These lower levels have been implicated in OCD

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What did Ozaki et al (2003) find?

A mutation of the gene in 2 unrelated families where 6/7 family members had OCD

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What is the diathesis-stress model?

Each gene creates a vulnerability for OCD and other factors affect what condition develops or if any do develop

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How does dopamine cause OCD?

Dopamine levels are thought to be abnormally high in people with OCD. Szechtman et al 1998: Animal study. High does of drugs that enhance levels induce stereotyped movements resembling the compulsive behaviours

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How does serotonin cause OCD?

Lower levels of serotonin are associated with OCD. Pigott et al 1990: Antidepressants that increase serotonin activity have been shown to reduce symptoms. Janice: Antidepressants that have less effect on serotonin don't reduce symptoms

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How do abnormal brain circuits cause OCD?

Caudate nucleus (in the basal ganglia) suppresses signals from the orbital frontal cortex. OFC sends signals to the thalamus about worries. When CN is damaged, fails to suppress minor worries so thalamus is alerted which sends signals back to OFC

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What is this supported by?

PET scans of patients, taken while their symptoms are active. Scans showed heightened activity in the OFC

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How are serotonin and dopamine linked?

Comer: Serotonin plays a key role in the operation of the OFC and the caudate nuclei, and it would therefore appear abnormal levels might cause these areas to malfunction. Dopamine is main transmitter of basal ganglia. High levels led to overactivity

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What are the evaluation point titles?

Support, other disorders, application and alternative explanations

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What is the first evaluation of the biological approach to explaining OCD?

Support- Nestadt et al: 80 patients and 343 of their 1st degree relatives compared to 73 controls and 300 of their relatives. People with 1st degree relatives with OCD were 5X more likely. Billett et al: Analysed 14 twin studies. MZ twins 2x likely

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What is the second evaluation of the biological approach to explaining OCD?

Other disorders- Pauls + Leckman: Studied Tourettes patients and families. Concluded OCD is one form of expression of the same gene. Obsessions are also in autism. Also typical of anorexia. Also likely to get depression. So gene causes obsession only

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What is the third evaluation of the biological approach to explaining OCD?

Application- Mapping of the human genome may show specific genes could be linked to disorders. Fertilised eggs can be screen and possibly aborted. Or gene therapy can turn genes off

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What is the fourth evaluation of the biological approach to explaining OCD?

Alternative explanations- Two-process model. Supported by success of exposure and response prevention treatment. Experience feared stimulus whilst compulsions are prevented. Albucher et al: 60-90% improved with ERP

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What does SSRI stand for?

Selective serotonin re-uptake inhibitors

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Why are SSRIs used?

Low levels of serotonin are associated with depression and OCD so drugs to increase are used. Low levels are implicated in the 'worry circuit' so increasing levels may normalise the circuit

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Why are antidepressants used for OCD?

They reduce the anxiety

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What are brand names of SSRIs?

Zoloft, paxil and prozac

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How does serotonin usually work?

Serotonin is released into synapse from a neuron. Targets receptor cells on the receiving neutron at receptor sites and after is re-absorbed by the initial neuron

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How do SSRIs work?

To increase levels at the synapse and stimulation to the receiving neutron, re-uptake is inhibited

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What was the first antidepressant used for OCD?

The tricyclic clomipramine (brand name Anafranil)

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What do tricyclics do?

Block the transporter that re-absorbs serotonin and noradrenaline into the pre-synpatic cell after its fired. So more these neurotransmitters are left in the synapse, prolonging activity and easing transmission of next impulse

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What are the advantages and disadvantages over SSRIs?

They target more than one neurotransmitter. But they have greater side effects so are used as a second-line treatment for patients were SSRIs aren't effective

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What are benzodiazepines?

Anti-anxiety drugs so used to reduce anxiety

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What re some trade names?

Librium, Xanax, Valium and Diazepum

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What do benzodiazepines do?

Slows down the activity of the central nervous system by enhancing the activity of the neurotransmitter GABA, that when release, has a quietening effect on many of the neurons

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How does it do that?

Reacts with GABA receptors on outside of receiving neurons. GABA locks into them. Opens a channel that increases the flow of chloride ions into the neuron. Ions make it harder for the neuron to be stimulated by others, relaxing the person

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What other drugs are used??

D-Cycloserine has an effect on reducing anxiety and thus may be an effective treatment. It's an antibiotic used in tuberculosis treatment. Kushner et al: Enhances GABA transmission so reducing anxiety

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What are the evaluation point titles?

Effectiveness, preferred, side effects and publication bias

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What is the first evaluation point of the biological treatment to treating OCD?

Effectiveness- Soomro et al: Reviewed 17 studies. SSRIs more effective than placebos in reducing symptoms up to 3 months. However, most are only 3-4 months long. Koran et al: Should use therapy as well. Maina et al: Relapse few weeks after stop

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What is the second evaluation point of the biological treatment to treating OCD?

Preferred- Requires little effort and time compared to other therapies. For health service it's cheaper because they require little monitoring and are cheap in comparison

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What is the third evaluation point of the biological treatment to treating OCD?

Side effects- Soomro et al: Nausea, headaches and insomnia for SSRIs. Tricyclics have more (hallucinations, irregular heartbeat). BZS cause aggression and long term impairment of memory

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What is the fourth evaluation point of the biological treatment to treating OCD?

Publication bias: Turner et al: Bias towards positive studies and negative ones are spun to seem positive. Drug companies have a strong interest in drug success and research is funded by them so doctors may make inappropriate treatment decisions

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Psychopathology

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