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what was the first treatment for mental health
65000BC and middle ages- trapanning
used to treat epilepsy and general madness
maddness is caused by possesion of devils/demons so treatment was to drill hopes in peoples heads using sharp instruments to exorcise demons
second treatment and how did it work
10000 BC (old treatment): music
used to treat bipolar and general maddness
the cause of mental illness was god punishing the individual→ Saul murdered 85 priests because he angered God so was suggested to play music
worked by calming patients down
third treatment and explain
ancient Chinese and Egyptian: Exorcism
used to treat any mental illness
mental illness was believed to be caused by possession of devils/demons so people were beat, restrained and starved to drive the demons out
4th treatment
460- 377 BC:bloodletting
used to treat general madness and depression
mental illness was caused by excess blood or bodily fluids (phlegm, black or yellow bile) so people were given laxatives and bloodletting was performed→ worked by creating a balance
5th treatment
300 AD: religion
used to treat madness
mental illness caused by punishment from god so treatment involved religion (prayer, confession) so god will remove punishment
6th treatment
Middle ages: burning at the stake
used to treat madness (hysteria and epilepsy)
mental illness was a punishment from god and possessed by demons so burning at the stake meant no more madness
7th treatment
19th and 20th century: prefrontal lobotomy
used to treat manic depression, schizophrenia, bipolar disorder and compulsive disorders
mental illness caused by evil spirits in brain and problems/abnormalities in frontal lobe
worked by cutting hole in head, metal instrument inserted and used to break connections in brain to release tension
final treatment
1950’s: medical model
used to treat many illnesses
mental illness caused by biological disturbance so given prescription drugs which alters chemical imbalances
the definition of abnormality 1
statistical infrequency
a behavior that is statistically not seen in society often may be considered abnormal
gaged by a normal distribution curve
for example IQ
3.45% for schizophrenia
definition of abnormality 2
deviation from social norms
a person who doesnt behave in a way society expects, may be considered abnormal→ depends on culture
example- wearing a swimsuit to work
definition of abnormality 3
failure to function adequately
if a person is unable to live a normal life adequately then they are considered abnormal
several ways they may fail to function → dysfunctional behavior (OCD), behavior that distresses a person (agoraphobia), behavior that makes observer uncomfortable, unpredictable behavior, irrational behavior
definition of abnormality 4
deviation from ideal mental health
if you lack ideal mental health you are considered abnormal
jahoda (1958) she developed a criteria for ideal mental health, so failing to meet these would mean abnormality
a few from criteria- positive attitudes towards the self, growth, self actualization
information on ICD-10
international classification of diseases
most recently revised in 1992
diagnostic classification for all general diseases and illnesses (includes medical and mental conditions)
publishes by WHO
main classification outside USA
10 categories- chapter V relevant for mental disorders
information on DSM-5
diagnostic and statistical manual of mental diseases
diagnostic classification for mental illnesses
main system in USA
published by APA
18 categories, 3 sections (e.g depressive and anxiety disorders) chapter 11- mental health
what criteria should be used to make classification valid
1) a complete system
2) classification categories should be separate
3) should be reliable (high inter rater reliability)
4) should be user friendly- ask right questions- criterion validity (how is ours associated with another), must concur with other variables predicted (self reported problems and clinical observations)
1 way catorgisation of mental disorders is not valid
manuals are regularly updates, homosexuality was removed (1973)- less scientific, reliable and useful
ford and widger(1989) found presenting same characteristic but with different gender results in different diagnosis (females- histrionic personality disorder, males- antisocial personality disorder)
krimsky and cosgrove- 69% panel working on DSM-5 had pharmaceutical links (make drugs to treat)- may be some misinterpretation of symptoms (cross over), researcher bias (more drugs- more useful)
why is it useful/valid to categorize mental disorders
DSM lists ICD code numbers to cross reference both (concurrent validity and reliable (concurrent validity)
DSM-5 created by 160 world renowned clicins and researchers who reviewed scientific literature - higher intererater reliability
what was Rosenhans aim
to investigate the reliability and validity of the nurses/psychiatrists/doctors diagnosis of mental disorders when using the DSM-5 to diagnose
what was Rosenhans aim for experiment 1
to investigate weather psychiatrists can diagnose people who are sane, as sane or do they have a tendency to diagnose sane people as insane → are they good at detecting insanity?
sample for Rosenhan
doctors (psychiatrists and nurses)
12 hospitals across 5 states across USA from east to west coast
mixture of old and new hospitals
some hospitals had good staffing levels and some had poor
11 hospitals were state hospitals and one was private
method (confederates)
Rosenhan got 8 pseudo patients (normal people who acted insane in the situation)
males and female
all normal people (housewives, doctors and Rosenhan)
all 8 acted insane temporarily then acted sanne to see if they could get out
procedure Rosenhan experiment 1
pseudo patients rang up hospital and said ‘can i have an appointment please because i am hearing voices and the voices are saying things like empty, hollow and thud’
they said voices were always same sex (female- F, male- M)
the voice was unfamiliar
all pseudo patients reported hearing exact same symptoms when trying to get diagnosed (standardized)
what did the pseudo patients do once admitted? Experiment 1 Rosenhan
only lied about the voices rest of details given were true
they acted completely normal, and were told to not show or talk about anymore symptoms (they did this)
behaved and spoke as they normally would
completely cooperative
what is the only thing the pseudo did not do? Experiment 1 Rosenhan
take there medication (flushed down toilet) 2100 pills administered but only 2 swallowed
only leave if discharged for being sane by nurses and doctors
results quantitative experiment 1 Rosenhan
average amount of time psedo patients were in hospital- 19 days
range- 7-52 days
7 discharged with schizophrenia in remission
1 discharged with depression in remission → stickiness of labels
qualitative experiment 1 Rosenhan
pseudo patients were not spotted as being sane by doctors and nurses
other patients worked it out ‘you’re not crazy’ ‘you’re a journalist or professor’ ‘you’re checking up on the hospital’
conclusions from experiment 1 Rosenhan
doctors/nurses cannot validly or reliably recognize people as sane/insane
they are wrongly saying that people were insane when they were sane TYPE 1 ERROR
Rosenhan defended doctors and nurses as it would be worse to say an insane person was healthy and send away with no treatment→ tendency to make type 1 errors to be on safe side
why was experiment 2 conducted Rosenhan
one of the hospitals doubted Rosenhans findings for study 1 and wanted to be put to the test
Aim of experiment 2 rosenhan
to investigate the ability to detect sanity → if he sent no insane patients could they detect sanity
sample for experiment 2 Rosenhan
doctors and nurses in one hospital USA
method EXPERIMENT 2 Rosenhan
told hospital over 3 months 1 or more pseudo patient would be admitted and they had to spot them
told to rate each patient who walked through the door how likely they are to be a pseudo patient (10 point scale 1 and 2 high confidence
told to treat all patients as real
NO PSEUDO PATIENTS SENT
Results experiment 2 Rosenhan
193 genuine, real patients turned up over 3 months and all admitted
at least 1 member of staff rated 41/ 193 as highly confident they were pseudo patients
23/193 were rated highly confident as being a pseudo patient by a psychiatrist
19/ 193 were rated by a psychiatrist and another member of staff as being a pseudo
TYPE 2 ERRORS WERE MADE- wrongly diagnosing the insane as healthy
Experiment 3 rosenhan aim
to compare patient staff contact with student- facility member contact
carried out during experiment 1
Method for experiment 3 Roseann IV1
in 4 hospitals the pseudo patients asked staff one of the 3 questions
‘pardon me Mr/Mrs/Dr X could you tell me when…’
‘I will be eligible for ground privileges?’
‘I will be presented at the staff meeting’
‘I am likely to be discharged’
Method for rosenhan experiment 3 IV2 and DV
at Stanford university a young female approached a faculty member on campus and asked them 6 questions e.g
‘Do you teach here?’
‘Is there financial aid?’
‘Do you know where fish Annex is?’
DV- responses if there is one
Rosenhan results E3 for eye contact
IV1
psychiatrists 23%
Nurses 10%
IV2
100%
Rosenhan results E3 walks on, head averted
IV1
psychiatrist- 71%
nurses- 86%
IV2
0%
length of reply
IV1- brief
IV2- full 6/6
stopped and talk
IV1
psychiatrists 4%
nurses- 0.4%
IV2
100%
conclusion 1 for rosenahn E3
the experience of psychiatric hospitalization
spent 11.3% of time outside cage
nurses spent immeasurable amount of time with patients → segregation
examples of stickiness of labels experiment 3 Rosenhan
patients were sitting outside the dining room 30 mins before lunch and talking
the psychiatrist said they showed the oral- acquisitive nature of their illness
7 discharged with schizophrenia in remission (labels stick)
ALWAYS DEFINE STICKINESS FIRST
conclusion 2 rosenhan results E3
powerlessness
no one believed the patient if complained
monitored during bath and toilet time
staff members could enter and examine at any time
depersonalisation
nurse undid bra infront of male patients (objectified)
physically examined in public places
definition of mood disorder/ effective and common symptoms AFFECTIVE DISORDER
depression is an all encompassing low mood (accompanied by low self esteem and loss of interest or pleasure in normal enjoyable activities)
reduced concentration
pessimism
low self esteem
disturbed eating
self harm
prevalence of depression
2019/2020- 11.6% of population
women twice as likely to suffer than men
onset- teen/adolescence
special fact for depression and how long for
3 types of depression- emotional, behavioral, cognitive
emotional DSM- depressed mood most of the day (impairment of feelings)
behavioral DSM - body weight loss of more than 5% not due to diet, decrease or increase in appetite (something observable)
cognitive DSM- lack of ability to think/ make decisions(impaired thinking)
5 or more symptoms over a 2 week period
definition of anxiety disorder (SPECIFIC PHOBIA)
persistent fear of particular object or situation
anxiety response (increase heart rate, dilated pupils, hyperventilation)
phobic situation avoided
prevalence of anxiety disorder
most common
affect 5-12% of the population (2 in 100)
females affected more
onset- teenage or young adult but can onset at any age
special fact for specific phobia 5 types
animal (most common)
blood/injection/ injury
natural environment (storms)
situational (flying, public transport)
other
DSM-5 symptoms
F. in individuals under 18 duration is atleast 6 months
C. person recognizes fear is excessive and unreasonable (in children, may be absent) not logical (OTT)
D. the phobic situation is avoided or else is endured with inetnse anxiety or distress
B. exposure to phobic stimulus provides anxiety response
ALWAYS EXPLAIN
definition of psychotic disorder
schizophrenia- a profound disruption of cognition and emotion which effects language, thought, perception and sense of self.
prevalence of schizophrenia
around 1% of population (stable around world)
males onset sooner than females (18-25 males and 25- 35 females)
special fact for schizophrenia
characteristics split into positive and negative symptoms
positive- symptoms have been added (e.g hallucinations and delusions) - EXPLAIN
negative- lack ‘normal mental function (e.g blunted affect/ lack of emotion and aviation-lack of drive to peruse meaningful goals, alogia- poverty of speech and movement
DSM-5 characteristics
pos and neg
hallucinations- seeing, hearing, smelling or feeling things that don’t exist outside the individuals mind in the absence of sensory input
delusions- believing things not based on reality
disorganized speech- collection of speech abnoralities that makes a person difficult or impossible to understand→ E.g neologisms (made up words), loose associations (shifting topics with no connections)
LASTS SIGNIFICANT PERIOD OF TIME OVER A 1 MONTH PERIOD
what is a neuron
a nerve cell that transmits nerve signals to and from the brain at up to 200 mph
typical neuron has 1000- 10,000 synapses
brief definition for each parts of neuron
dendrite- branch from cell body and brings info to all the body
nucleus- contains DNA and receives info from dendrites
axon- takes info away from cell body
Myelin- coats and insulates axon
synapse- gap between axon and receiving information
define the close up parts of a synapse
presynaptic ending- closest to the axon and contains neurotransmitters
postsynaptic ending- contains receptor sites for neurotransmitters to bind to
synaptic left- space between pre and post endings
neurotransmitters- chemical messengers that allow the neurons to communicate with another neuron
what is biochemical explanation for mental illness
biochemical for a predisposition towards phobic attitudes and behavior is a neurotransmitter imbalance in the brain
particularly serotonin lack
bodies have balance of chemicals and an imbalance leads to mental illness
what is serotonin responsible for
mood, social behavior, appetite, digestion, sleep memory and sexual desire
an association has been made between serotonin and social phobia and depression
research for the biochemical (lazenburger) Aim, method
Lazenberger et al (2007)
aim- to investigate 5-HT1A binding potential in social phobia
method- used PET scans to look at serotonin receptor binding potential
IV- social phobia diagnosis, control
DV- binding potential or serotonin receptor sites
sample for lazenberger
12 unmediated males with social phobia
18 healthy controls
results and conclusion
Results - there is a lower binding potential of serotonin receptors in social phobics than control group particularly in the amygdala
Conclusion- the results are consistent with 1) pre- clinical findings of elevated anxiety in mice with lower serotonin receptor binding potential and 2) a human PET study in patients with panic disorder showing reduced serotonin receptor binding potential
Therefore should target serotonin receptors on treatment of human anxiety disorders such as social phobia.
Lazenberger critic and what they believed
Frick Et al (2007)
‘serotonin can increase anxiety and not decrease as was previously often assumed’
suggests individuals with social phobia make too much serotonin in the amygdala (fear center)
more serotonin= more anxious
used PET camera
how does the biochemical explanation link to schizophrenia
receptors on dendrite take up too much dopamine from pre synaptic ending
dopamine is involved with perception
anti psychotics block dopamine
evaluation of the BC explanation
S- scientific equipment
contruct validity
useful/ applications
reductionist
deterministic (cause and effect)
reliable
W- reductionist/deterministic
qualitative data
not as many applications
conflicting evidence
PET scans don’t isolate neurons/ transmitters
how can genetic explanation be researched
identical twins raised together or apart
non identical twins raised together or apart
siblings raised together or apart
cousins raised together or apart
whats one way of finding out if a disorder has a genetic component
weather is runs in families
if relatives of sufferers have higher than average risk of getting the disorder themselves then the disorder may be genetic
families often share the same environments so increased risk among close relatives may indicate they are exposed to same environmental risks
another way to find out if disorders have a genetic component
twin study
looks at concordance of twins with respect to the disorder being considered
concordance rates expressed as a percentage= probability of one twin having disorder if one already has it
MZ and DZ twins are compared as both types of twin pair grow up in identical environments so if MZ have higher concordance than DZ it must be genetic as environments are similar
interpenetrating twin study data
MZ concordance is significantly higher than DZ= disorder has a genetic component
MZ concordance same as DZ- disorder environmentally caused
MZ concordance is 100%- disorder genetically caused
MZ significantly less than 100%= disorder has environmental component
supportive evidence for genetic explanation of mental illness
all twin study data (simple phobia using DSM-111)
carey and gottesman
Kendler et al 1992
kendler et al 2001
carey and gottesman research
sample- 98
blind- NO (researcher bias)
sex- both
MZ concordance 13.0%
DZ concordance 8.0%
kendler et al 1992
sample- 2,163
blind- YES
sex- female
Mz concordance- 25.9%
DZ concordance- 11.0%
Kendler et al 2001
sample- 2,396
blind- YES
sex- male
MZ concordance- 15.9%
DZ concordance- 7.7%
problems with kendler (2001+1992) and carey and gottesman
Quasi IVs- no manipulation and less control
what do all these studies (kendler, carey, gottesman) tell us about genetic contribution to phobias
genetics play a role in contribution to phobias as MZ concordance is higher than DZ
BUT percentages for MZ are not 100% so nurture and environments is contributing to phobias
evaluation points for twins studies
one twin is typically larger more robust than the other and this difference is first observable during pre-natal developments
MZ twins have a closer relationship than DZ
parents accentuate similarity by dressing similarity which may account for greater similarity (environment)
DZ can be made and female but MZ are same sex so gender could cause similarity
Gottesman et al aim
the probability of the child having a mental disorder when both parents do
the probability of the child having a mental disorder when just one parent has it
sample for gottesman
all danish
2.7 million
all participants born or alive after 1968 (atinson and shiffrin)
age- maximum cut off was 52 (range 10-52)
where was information gathered from for gottesmen et al
civil registration
psychiatric register
→ secondary data
needed to be evidence of biological parents and their children having the disorder (needed medical diagnosis)
what 3 disorders did gottesman measure
schizophrenia
bipolar affective disorder (extreme mood swings)
Impolar affective disorder (just laws)
the IV and DVs of gottesman
IV1- 2 parents having a diagnosis
IV2- one parent having a diagnosis
DV- childs diagnosis
how were parents and children diagnosed in Gottesman and why is it a problem?
parents used ICD-8
children used ICD-10
(also secondary data so was it a controlled collection of data?)
results for Gottesman- Schizophrenia
Risk of developing schizophrenia if both parents have the disorder= 27.3%
→ increased to 39.2% if schizophrenia related disorders were included
Control (neither parent) = 0.86%
7% for one
General population risk of schizophrenia= 1.12% (in Denmark)
How much higher for 2 parents (schizophrenia results gottesman)
31.2x higher for both parents having schizophrenia than neither parents having schizophrenia
Risk of bipolar (results gottesman)
if both parents have it= 24.9% → increased to 36% if impolar was undivided
If one parent= 4.4%
Control=0.48%
General population risk of Denmark = 0.63%
What were the 2 conclusions gottesman
Supports previous research done for genetic inheritance of those mental disorders
Study is useful because we can make plans based upon it
Ethical considerations of gottesman
no participants knew they were part of it
→ but none identified so confidentiality
Evaluation of the genetic explanation strengths
quantitative data
Useful- applications
Reductionist- can predict
Quasi- high ecological
Parents consented- ethical
Secondary data
Ethical as no manipulation it’s just measured
Weaknesses of genetic explanation
qualitative
Reductionist
Deterministic
Less applications
Socially sensitive (distressing)
Quasi (less scientific)
Can’t establish cause and effect
No consent from twins- can’t withdraw
Only application is parents with mental illness shouldn’t have kids- socially sensitive
Secondary data- reliable?
Part of brain in explanation for a specific phobia
Emotional responses including fear and panic- a set of structures LIMBIC SYSTEM- relies on neurotransmitter serotonin
AMYGDALA- size of almond, lateralised (one in each hemisphere) right responds to emotional signals from others
→ responds to startling and fearful stimuli (activity increases when shown pictures of others making angry or fearful expression)
First piece of supportive evidence for the brain abnormality explanation for mental illness
pine et al (1999)
Compared amygdala responsiveness in social phobics and clinically normal controls using an FMRI
Social phobics produced greater amygdala activity in response to fear and startle inducing stimuli than controls
Social phobics are more susceptible to fear evoking stimuli because of abnormalities in amygdala
Second supportive evidence
Haniur (2002) et al
identified a group of people with abnormality of the gene that codes for some of the serotonin receptors in the brain
FMRI data= abnormal receptor groups right amygdala more responsive to pictures of angry and fearful faces than controls
Phobias caused by abnormality in the brain (serotonin receptors)
Evaluation of the brain abnormality explanation of mental illness strengths
scientific equipment used to measure brain abnormality
Reductionist
Useful
Quasi IVs
Qualitative data (rich and meaningful)
Deterministic
Applications
evaluation of brain abnormality mental health weaknesses
no control brain (less scientific)
reductionist
less applications (brain surgery)
quasi
qualitative data (has to be interpreted)→ time consuming
socially sensitive (creates a stigma but also takes stigma away)
deterministic
Extraneous variables (scans affected by breathing, head motion ect)
BIOLICAL phenelazine
used to treat chemical imbalance
15mg treats social phobia and depression
inhibits activity of Menominee oxidase inhibitor enzyme- increases concentration of serotonin and dopamine
increase of serotonin and dopamine reduces symptoms of social phobia
Leiboitz
leibowitz aim sample
aim- to investigate if the drug phenelazine can help treat patients with social phobia
sample- 80 patients meeting DSM criteria for social phobia, medically healthy, no phenelazine for at least 2 weeks before the trial
method leibowitz
IVs→ 8 weeks of treatment
→ 20 treated with phenelazine
→ 20 treated with placebo
DV- measuring social phobia before and after treatment
→ 2 self reports for social phobia (hamilton rating scale for anxiety and lieboitz social phobia scale
→ clinical assessment for social phobias using double blind
Lab, independent measures
result leibowitz
the phenelezine group had significantly better scores on social phobia tests than the placebo group
conclusion leibowitz
phenelezine is effective at treating social phobia after 8 weeks of treatment
biological treatment for schizophrenia
anti- psychotics block dopamine receptors by mimicking shape of dopamine neurotransmitter so less is transmitted
evaluation for phenelzine
Strengths
effective
quick
cheap for government and patients
easy to take
reductionist
improves quality of life
weaknesses
just treats symptoms, not understanding the cause
reductionist
have to remember to take it (1-3 times a day)
SIDE EFFECTS (serious fainting, weight gain, nausea, hypertensive crisis) (drug and food interactions can increase side effects)