psychopathology - all

What type of disorder is depression

- mood disorder

What type of disorder is phobia

- anxiety disorder

How many people in Britain suffer from depression

- 5-7% adults per year

How do doctors diagnose depression

- no lab tests

- based on behaviour and what patients tell them

What are the categories of depression according to DSM 5

- major depressive disorder: extreme short period of depression

- persistent depressive disorder: chronic long term depression

- disruptive mood dysregulation disorder: (usually in children), persistent, angry or irritable moods with temper tantrums disproportionate to situation

- premenstrual dysphoric disorder: severe moods & irritability during mensutruation

State behavioural symptoms of depression

- poor appetite/ weight loss/ vice versa

- sleep difficulty/ sleeping too much

- loss of energy (lethargic) - withdrawal

- psychomotor agitation - struggle to relax, pace up and down

- often irritable + can be verbally and physically aggressive - can lead to ending a relationship/job/harm to others or themselves

State emotional symptoms of depression

- lowered mood that is more pronounce, feeling worthless/emptiness

- lowered self esteem/extreme guilt

- anger towards self or others

State cognitive symptoms of depression

- poor levels of concentration and difficulty decision making

- bias towards recalling unhappy event and attending to the negative aspects of a situation and ignoring positives

- recurrent thoughts of death/suicide/suicidal behaviour

- absolutist/ black or white thinking (diachotomas)

State the 2 cognitive explanations of depression

- Beck's Cognitive theory of depression

- Ellis' ABC model

What did Beck believe caused depression?

- he believed that a person's cognition makes them more vulnerable to depression - they think in negative self-defeating ways

- 3 factors contribute to cognitive vulnerability:

Negative self schema, faulty information processing, negative triad

- pessimistic view then becomes a self-fulfilling prophecy and leads to cognitive bias. Depressed people tend to focus on negative aspects of their lives and ignore positives - so become trapped in a vicious circle of depression

Outline the role of negative schema in causing depression (Beck)

- A schema is a package of ideas and is developed through experience.

- A self-schema is the information we have about ourselves

- As we use schemas to interpret information, if we have a negative self-schema, we will interpret all information about ourselves in a negative way

What could negative self-schemas be caused by?

- overly critical family and friends etc

Outline role of faulty information processing as the cause of depression?

- depressed people are likely to misinterpret information from the world

- examples:

1. Arbitrary interference: one negative event means that everything is negative (failing a test means failing all tests in future)

2. Dichotomous thinking: seeing everything in terms of either success or failure (either going to get 100%/0%)

3. Magnification: exaggerate setbacks

4. Personalisation: blame themselves for all unpleasant events

5. Selective abstraction: focus on the negative and ingore the positive

Outline role of negative cognitive triad in Beck's explanation

- a person develops a dysfunctional view of themselves because of 3 types of negative thinking that occur automatically, regardless of reality

1. Negative views of the world (world is a cold place with no hope for anyone)

2. Negative views about future (there isn't much change that the economy will get better)

3. Negative views of the self (you are a failure)

State strengths of Beck's cognitive explanation

- research support: Grazioli and Terry

- real life application: cognitive behavioural therapy

- gives importance to role of cognition and deals with cause not just symptoms

Outline the strength of research support for Becks's explanation

E: Grazioli and terry assesses 65 pregnant women for cognitive vulnerability and depression before and after birth. Found that most women with high cognitive vulnerability were more likely to suffer from post-natal depression.

E: supports Beck's explanation of cognitive vulnerability and how faulty information processing can lead to depression

Outline strength of real life application of Beck's explanation

E: successful treatment, CBT. Helps patient identify all cognitive aspects such as negative cognitive triad. They can rationalise them and encourage the patient to decide whether they are true.

E: Since the therapy is successful, it supports the theory because it shows that internal processes play a role in depression and explanation has predictive validity

State weaknesses of Beck's explanation?

- Oversimplified

- does not establish cause and effect

- reductionist

Outline the idea that Beck's explanation does not establish cause and effect

E: Neuro imaging techniques have shown that emotional processing takes place before cognitive processing.

E: Shows that thoughts may be the symptom of depression and not the cause and undermines explanation.

Outline the idea that Beck's explanation is oversimplified

P: theory explains the basic symptoms of depression but depression is complex and all symptoms may not be explained by this theory.

E: Some patients suffer from hallucinations and delusions or Cotard syndrome and are detached.

E: does not easily explain these cases

Outline the idea that beck's explanation is reductionist

P: lays too much emphasis on internal processes but ignored the environmental and social context. Also ignores the role of genes and neurotransmitters in development of depression

E: biological explanation suggests low levels of serotonin is the cause

Counter: but this explanation does deal with the cause and not just symptoms unlike the biological explanation as it gives importance to the role of cognition

Outline Ellis' ABC Model

- focuses on irrational beliefs as cause, not what happens to person but how they deal with it

- defined irrational thought as illogical and unrealistic and that they interfere with us being happy and free of pain

A: activating event: triggers irrational beliefs

B: beliefs: negative events trigger beliefs that can be rational irrational

C: consequences: rational beliefs lead to healthy emotion responses whereas irrational beliefs lead to unhealthy ones and result in depression

State weaknesses of ABC model

- reductionist

- oversimplified

Outline reductionist weakness of ABC model

- some kinds of depression known as reactive depression follow activating events. But other types arise with no cause.

E: there may be an alternative explanation such as biological condition caused by genes and neurotransmitters which is better

State strengths of ABC model

- real life application

-

Outline real life application as a strength of ABC

E: REBT works by challenging irrational negative beliefs

E: supports theory due to success suggesting that irrational thoughts have a role

Outline weakness of oversimplified ABC explanation

E: explains why some people are more vulnerable but not why some patients suffer from hallucinations and delusions as well as anger

State the cognitive approaches to treat depression

- Beck's CBT (cognitive behavioural therapy)

- Ellis's CBT (rational emotive behavioural therapy) = REBT

What is CBT based on

- The idea behind the therapy is to identify the negative triad ( negative thoughts about the self, world and the future) and then challenge them in order to change the patient's irrational, maladaptive thinking.

Patient and therapist work together.

- Patient plays an active role

State features of CBT

1 Identify automatic, negative thoughts of world, self and future - challenge them with a counter-statement.

2 For homework tasks, the patient acts as a scientist - carries out experiments to test hypothesis.

3. Keep a diary or journal

4. Behaviour activation: decreases avoidance, isolation, increases engagement in activities that improve mood.

5. Thought catching

Outline REBT (what is it based on)

Dispute irrational thoughts with vigorous arguments

This leads to

• Effect- new beliefs and attitudes that emerge

What are the types of vigorous arguments used in REBT?

- empirical: where is the evidence that your beliefs are true

- logical: does the way you think about the situation make sense

Outline study investigating the effectiveness of therapy for depression

- March(2007) compared the effectiveness of therapy 327 adolescents with the main diagnosis of depression. These adolescents were in 3 separate groups. CBT, antidepressants, combination.

- when the improvement of the 3 groups was compared after 36 weeks of therapy: significant improvement in 81% of CBT, 81% antidepressant, 86% combination

Conclude march study

The study suggests that CBT is just as effective as drug therapy and could be used as a first line of treatment by a public health service such as the NHS because it has no side effects and the patient is active in treatment.

- but as a combination only shows 86% success, suggests other factors are involved = reductionist

State weaknesses of cognitive therapy

• However in severe cases the patient may not be motivated to engage in therapy. They should be given drug therapy first and then cognitive therapy. This means cognitive therapy cannot be the only treatment for depression.

• Success of cognitive therapy does depend on the patient therapist relationship unlike drug therapy.

• Cognitive therapy is more time consuming and requires more effort on part of the user and is also not as cost effective as drug therapy.

• It is less readily available than drug therapy - requires more specifically trained personnel.

• Some patients may want to explore the past and may want to discuss childhood experiences which they think links to their current depression.

• This therapy focuses on the present and future- this may be frustrating for them.

• May minimise the importance of the patient's circumstances by emphasising on mental processing. In some cases circumstances may need to change - abuse, poverty. Focusing on the mind prevents this.

• Both drug therapy and cognitive therapy could lead to dependence - drug therapy on medicines and cognitive on the therapist.

What is an obsession

- a persistant thought, idea, impulse/image that is experienced repeatedly, feels intrusive and causes anxiety

What type of disorder is OCD

- anxiety

What is a compulsion

- a repetitive and rigid behaviour/mental act that a person feels driven to perform

- in order to prevent/reduce anxiety

Differences between obsessions and compulsions

- obsession is an unwanted thought and compulsion is a repetitive act that one is driven to perform in order to reduce anxiety associated with the obsession

What is an obsessive compulsive disorder

- a mental health condition where a person had obsessive thoughts and compulsive activity

What percentage of the general population has OCD

2%

Men:women with OCD

Equal

Age of onset of OCD

- late adolescence to early adulthood

Behavioural characteristics of OCD

- compulsive behaviours: repetitive (hand washing/counting) & mainly to reduce anxiety produced by the obsessions

- avoidance: may keep away from situations that trigger anxiety & can interfere with leading a normal life

Emotional aspects of OCD

- Anxiety / distress - due to obsession being unpleasant & frightening = urge to repeat a behaviour

- Depression - often accompanies OCD, compulsions may reduce anxiety but they're only short term fixes

- Irrational guilt / Disgust - these can be about the self or external factors (e.g. dirt) and guilt is often irrational.

Cognitive aspects of OCD

- Obsessive thoughts - 90% of sufferers have recurring thoughts and are unpleasant

- Awareness of excessive anxiety - they are aware their thoughts / behaviours are not rational. They are hypervigilant and alert of potential hazards

- Cognitive coping strategies -They devise their own ways to cope with obsessive thoughts e.g. those with obsessive thoughts of family members dying will choose to pray (making them seem abnormal to others) and can interfere with everyday life.

symptoms of OCD defined by DSM

- Recurrent obsessions and compulsions

- Recognition by the individual that obsessions and compulsions are excessive and unreasonable

- That the person is distressed and daily life is disrupted by obsessions and compulsions

outline the biological approach

- The biological approach assumes that abnormality is caused by physiological factors such as brain biochemistry, neuroanatomy (brain structural abnormalities) and genetics. Treatments that alter physiology such as drugs are used to address the disorder.

state the biological explanations for OCD

- genetic explanation

- neural explanations

- neurophysiological-decision making systems

Outline the genetic explanation for OCD.

- Genes consists of DNA that codes the physical features and and psychological characteristics. They are inherited from parents.

- Due to this some people may be genetically predisposed to inherit a mental disorder such as OCD. This means that OCD may run in families and is inherited from a family member.

- Evidence for this comes from twin studies and family studies. This is because families share similar genes. Then if your likelihood of developing the disorder increases if your family member has the disorder it would imply that there is a genetic link.

- Candidate genes have been identified as the genes that create vulnerability to OCD. Some of these are responsible for regulating the development of the serotonin system.

E.g 5HT1-D is involved in how efficiently serotonin is transported across the synapse. Or Gene 9 which is inherited. OCD seems to be polygenic

outline research support as strength for genetic explanation

P: research support

E: Study 1: Nestadt et al ( 2010) reviewed previous twin studies and found the concordance rate for OCD to be 68% for MZ twins and 31% for DZ twins. Since the concordance rate increases as genetic similarity increases between the twins, it suggests that there is a strong genetic influence on OCD.

OCD. eg = born with the disposition to develop OCD but may need an environmental stressor to trigger it =

the Diathesis stress model and seems like a more plausible explanation.

P: There has been evidence that over half the OCD patients in a sample had a traumatic event in their past supporting this viewpoint.

E: Study 2: Lewis observed that in his OCD patients 37% had parents in OCD and 21% had siblings with compared to 2% in general population.

Outline research support as a weakness for genetic explanation

E: Nestadt study however assumes that MZ twins are more similar than DZ twins because they have greater similarity in genes but overlooks the fact that MZ twins may be more similar because they have a more similar shared environment- they are treated more similarly. This reduces the value of the support provided by twin studies for the genetic explanation of OCD.

- If OCD was purely genetic then the concordance rate between MZ twins should have been 100% and not 68% since they share 100% of their genes. This implies that there must be environmental factors that increase the risk of developing

- However this finding could also be explained by other factors. Close family members also share the same environment and this could explain the higher concordance rates, rather than genetics.

- reductionist explanation

outline weakness of genetic explanation: reductionist

- findings could also be explained by other factors. Close family members also share the same environment and this could explain the higher concordance rates, rather than genetics.

- Social learning theory could argue that OCD runs in families because people may observe obsessive compulsive behaviour in family members and then imitate the behaviour instead of a genetic predisposition.

strength of research support for candidate genes

Taylor (2013) analysed findings of previous studies and found evidence of up to 230 genes involved in the development of OCD. Genes associated with both the action of dopamine and serotonin has been implicated in the development of OCD.

- This implies that the origin of OCD has different causes - it is aetiologically heterogenous since one group of genes may cause OCD in one person and another group of genes may cause it in another person.

evaluate candidate genes as genetic explanation

However Psychologists have not been able to identify all the genes involved and because it is aetiologically heterogenous, the genetic explanation is unlikely to be very useful because it is difficult to predict if someone will have the disorder based on it + limited treatment (treat symptoms not cause)

E: social sensitivity- could cause parents to feel guilty

state evaluative points of genetic explanation

- research support: but diathesis stress model is better

- reductionist

- social sensistivity

outline neural explanation

- Neural explanation -the view that physical and psychological characteristics are determined by the nervous system - brain and neurotransmitters.

- Neurotransmitters are important in maintaining communication between neurons. An imbalance can affect behaviour. OCD may be because of low levels of the neurotransmitter serotonin may be associated with anxiety (low levels of serotonin means that normal transmission of mood related information does not take place) and high levels of dopamine are linked to compulsive behaviour.

state evaluative points of neural explanation

- used for treatments

Evaluate neural explanation of OCD

- Drugs e.g. SSRI anti-depressants that increase the amount of neurotransmitter Serotonin in the brain also reduce obsessive compulsive symptoms.

E: supports for the theory that the serotonin system is involved in OCD + successful treatments gives biological explanation predictive validity

P: diathesis model is better explanation

E: However Serotonin may be responsible for OCD. Drugs such as SSRI's which increase the levels of serotonin in the brain only report a 50% improvement. This suggests that there are other explanations of OCD. It may be that one is born with a genetic predisposition to develop OCD but only develops it if there are environmental stressors. = diathesis stress model

- There is a time delay - the drugs affect levels of serotonin within hours but the effect on serotonin takes weeks so other factors must be involved.

- Also it is very difficult to establish cause and effect. Low levels of serotonin may cause OCD or it may be that OCD caused the low levels of serotonin.

outline neurophysiological-decision making systems

- Results from PET scans have shown that people with OCD have very abnormal functioning of the lateral ( sides) part of the frontal lobes of the brain. The frontal lobe is responsible for logical thinking and making decisions.

- This may explain hoarding disorder that seems to be due to impaired decision making.

- Brain scans have also linked a part of the brain called the basal ganglia to OCD. This brain area controls psychomotor functions and it is suggested that hypersensitivity of the basal ganglia explains the repetitive actions seen in OCD sufferers.

evaluate neurophysiological-decision making systems

- However this theory is not supported in a meta analysis by Aylward who found no significant differences in basal ganglia structures between OCD patients and controls.

- Also this theory only accounts for the repetitive behaviours in OCD and does not explain the obsessional thoughts that are thought to give rise to the behaviours in the first place.

overall evaluation of biological explanation

This explanation is biologically deterministic. It suggests that biological factors outside of the individual's control are responsible for OCD. This will limit the treatment options for OCD.

biological approach to treating OCD

- drug therapy

What is drug therapy?

- treatment involving drugs - chemicals that have a particular effect on the functioning of the brain- in psychological disorders they usually affect neurotransmitter levels.

- Drug therapy involves attempting to change the level of implicated neurotransmitters in the brain.

state drugs used to treat OCD

- antidepressants

- SSRI's: fluoxetine

- tricyclics

- SNRI's

role of antidepressants in treating OCD

- Antidepressants are the main medications

prescribed for OCD because it is frequently accompanied by depression.

- These are not given in an attempt to change the behaviours exhibited, but to reduce the anxiety experienced.

how do SSRI's treat OCD

- They prevent the reuptake or reabsorption of serotonin by the pre- synaptic neuron, where it is broken down and re-used.

- This prevention of reabsorption and breakdown of serotonin increases its levels in the synapse and allows it to continue stimulating the post synaptic neuron.

- This compensates for whatever is wrong with the serotonin system in OCD. These drugs also cause the frontal cortex to operate more normally.

outline dosage of fluoxetine

typical daily dose is 20mg ( liquid or capsule) - but advice and dosage varies. It takes 3-4 months of daily use to have much impact on the symptoms.

why might alternatives to SSRI's be used

-sometimes different antidepressants are tried since patients respond differently to different drugs and alternatives might work better for some OCD patients.

How do tricyclics work?

prevent the reuptake and breakdown of serotonin at the presynaptic neuron.

issues with tricyclics

- They have more common and sometimes severe side effects than SSRIs

- Example: 1/10 suffer from tremors and weight gain (common) or 1/100 can become aggressive or have disruption to their heart rhythm.( serious).

How do SNRIs work?

They prevent the reuptake of serotonin and noradrenaline and are also used as second line of defence if the patients do not respond to SSRIs.

evaluate drug therapy as being more effective than psychological treatments for severe cases of OCD

P: more effective than psychological treatments for severe cases who lack insight or motivation.

E: not dependent on a client therapist relationship for it to be effective unlike psycho therapy. C: However a patient is passive in the treatment unlike psycho therapy in which they are active. + takes 4-12 weeks before any benefit is noticed and this together with the side effects might cause people to stop using them causing a relapse.

state strengths of drug therapy

- research support

- improves quality of life

- requires little effort from patient

- more effective than psychological treatments

Evaluate research support for drug therapy

P: research support

E: symptoms. Soomro reviewed 17 studies comparing SSRIs and placebos in the treatment of OCD and found significantly better results for SSRIs than placebos.

evaluate improved quality of life because of drug therapy

P: improved quality of life

E: Symptoms reduce significantly in 70% of the patients taking SSRIs. less disruption since the obsessive thoughts and compulsive behaviours do not dominate ( do not have to be homebound or hospitalised and can socialise, be in employment, go to school).

evaluate drug therapy as requiring less effort for patient

P: less time consuming and non-disruptive to the patient's lives than cognitive therapy in which the patient has to attend regular meetings with a therapist and be active in tackling their problems

E: Using drugs is therefore good value for a public health service like the NHS.

C: is expensive to produce

state weakness of drug therapy

- treats symptoms not cause

- biased evidence

evaluate the fact that drug therapy treating symptom not the cause

P: Drug therapy treats the symptoms and not the cause.

E: It also does not teach any skills to deal with the disorder, so the effectiveness is short term. It lasts as long as the treatment lasts (causes dependency). Patients may relapse once the treatment stops, leading to a revolving door syndrome.

E: Due to this the best line of treatment for long term effectiveness is the combination of drug therapy and cognitive therapy. Drug therapy will help reduce the emotional symptoms such as anxiety and depression and cognitive therapy will try and get to the root cause as well as teach the patient long term coping skills. This is even more beneficial if the OCD has been triggered by some trauma.

what is the revolving door syndrome

- never ending cycle

- taking drug, stop, relapse, taking drug etc

evaluate the biased evidence of drug therapy

P: some psychologists feel that the evidence favouring drug therapy is biased.

E: because most research into their effectiveness is sponsored by drug companies who do not report all the evidence.

E: file drawer effect

file drawer effect

- Studies that do not support drug therapy are less likely to get published than studies that do

- because funding is from pharmaceutical companies

state types of abnormality

- statistical deviation/infrequency

- deviation from social norms

- failure to function adequately

- deviation from ideal mental health

Outline statistical infrequency

when a person's trait, thinking, behaviour is found to be numerically or statistically rare or uncommon it would be considered an indication of abnormality

what is an example of an abnormality diagnosed through statistical deviation?

intellectual disability disorder

(deviation of IQ)

how is IQ measured?

- psychometric intelligence tests

- tests give you a mental age and this is compared to you actual age expected IQ

- shown as a normal distribution curve - 100 is the norm

how is intellectual disability disorder diagnosed?

- between 70 and 130 is norm

- below 70 is abnormal

what percentage of the population have intellectual disability disorder?

2.1%

what are strengths of statistical infrequency?

P: real life application

E: helps thinking about what is normal and abnormal and this helps in the diagnosis of disorders such as intellectual disability disorder

E: therefore useful part of clinical assessment P

what are limitations of statistical deviation?

P: unusual characteristics can be positive

E: just because it is statistically abnormal doesn't mean it is undesirable and so needs treatment - IQ over 130 is statistically abnormal but means super intelligence

E: so definition can't be used alone to diagnose

P: not everyone unusual benefits from a label

E: statistical deviation labels the individual as abnormal and this may have a negative impact on the way the individual views themselves and how they are viewed by others. This does not benefit an individual who otherwise was living a happy fulfilled life without distress to themselves or others. Such a label can instead lead to a poor self image and a self fulfilling prophecy. It may become an invitation for discrimination.

E: This means that being labelled as statistically infrequent could cause the person more harm than the condition itself.

Outline deviation from social norms as a definition of abnormality

- abnormal behaviour is that which goes agains the accepted standards if behaviour in a given society or culture.

- they do not conform to our moral or social standards

Give an example of a deviation from social norms

- antisocial personality disorder: do not conform to out social/moral standards

State limitations of deviation from the social norm

- not a sole explanation

- culture relativism

- can lead to human right abuses

- incomplete explanation

Outline Limitations of 'Deviation from Social Norms' as a definition of abnormality.

P: not a sole explanation

E: anti social personality disorder - May be considered abnormal not only because it deviates from social norm but also because of the stress caused to other people because of that behaviour

E: would better be explained by failure to function adequately

P: culture relativism - social norms vary over time from one generation to another and also vary over cultures. So behaviour that is defined as abnormal can vary.

E: homosexuality - in many countries is still illegal and considered abnormal. /kids out of wedlock

E: no global standard for defining behaviour as abnormal and so abnormality is not standardised

P: can lead to human right abuses

E: drapetomania - running away - targeted slaves, nymphomania - sexual attraction to working class men - women targeted

E: diagnosis can be used to maintain control over minority ethnic groups and women

Outline a strength of deviation from social norms

P: includes issue of desirability of a behaviour

E: a genius is statistically abnormal but we would not include it in out definition of abnormal behaviour

E: might be more useful definition of abnormality than statistical infrequency

Outline failure to function adequately as a definition of abnormality

- refers to abnormality when a person is unable to cope with ordinary demands of day to day life. And live independently in society

- signs: not conforming to standard interpersonal rules (eye contact), experiencing severe personal distress, irrational or dangerous behaviour to themselves or others

Give an example of an abnormal behaviour diagnosed with failure to function adequately

- intellectual disability disorder

- diagnosed by statistical infrequency but in order to give the diagnosis individual must also be failing to function adequately

Outline limitations of failure to function adequately

P: behaviours might be explained by other factors

E: failure to keep a job may be due to recession

E: doesn't always explain abnormality

P: context dependant

E: not eating may be considered as failing to function adequately but prisoners on hunger strike making a protest can be seen in a different light

E: reduces usefulness

P: not differentiating between eccentric and abnormal behaviour

E: not meeting nutrition standards

E: we risk limiting personal freedom and discriminate against minority groups

Outline a strength of failure to function adequately

P: considers the subjective personal experiences of the patient

E: personal distress - considers the thoughts and feelings pf the person experiencing the issue an does not make a judgement without taking the personal viewpoint of the sufferer in to consideration

E: useful definition in assessing abnormality

Outline deviation from ideal mental health as a definition of abnormality

There are prescribed criteria that a person should be able to meet to be classed as mentally healthy. If they cannot meet these, they may be able to be classed as abnormal

- no symptoms of distress

- rational

- can self actualise

- can cope with stress

- good self esteem

- independent

- can successfully work, love and enjoy our leisure