Psychology- mental health and well-being

Rosenhan (1973)

mentally stable people pretended to have mental illnesses, reporting they heard a thudding sound but no other symptoms to see how fast professionals would realise there is no issue

Result of Rosenhan (1973)

All but one patient was diagnosed with schizophrenia based off this one symptom

Statistically average

more people do something so it becomes normal and starts to be expected- societal standards

Abnormality

distressing to self or others, it can be dysfunctional for a person or society, or deviant and violates social norms

DSM-I (1952)

Diagnostic and Statistical Manual of Psychological Disorders

prevalence of mental health conditions

section 1: disorders with impairment in brain function

Section 2: Disorders without evidence of impaired brain function

DSM-II (1968)

10 diagnostic sections (child/ adolescence sections)

DSM-III/ DSM-III-R/ DSM-IV/ DSM-IV-R (1970s-1999)

more detail and reliable diagnosis critieria

inclusion of clinically significant distress or impairment

DSM-5

Describes 22 major categories containing more than 200 different mental disorders

Advantages of diagnosis

-There’s a name for the experience you have

-There is a community

-If there’s a label, there may be a treatment

Disadvantages of diagnosis

-forcing people into boxes

-taking away people's uniqueness

-A label doesn’t always fit everyone

-reduces responsibility

-self-fulfilling prophecy

-stigma

Krapelin (1896)

first to distinguish schizophrenia as being different from other disorders

Eugen Bleuler (1911)

coined the term “schizophrenia“: a loss of harmony between various groups of mental functions “split brain“

Prevalence of Schizophrenia

Incidence of about 1%

It is equal between men and women

occurs all over the world

Schizophrenia Onset

Men’s onset is typically around their 20’s

whereas women’s are later

What does positive symptoms of Schizophrenia mean

things that schizophrenia adds to their lives

Positive symptoms of schizophrenia

Delusions of Thought

Hallucinations

Bizarre/disorganised behaviour

Disorganised Speech

Thought Insertion (Schizophrenia)

someone or something put the thought there

Thought Broadcast (Schizophrenia)

They feel everyone can hear their thoughts

Thought withdrawal (Schizophrenia)

their thoughts are being taken away from them

Thought control (Schizophrenia)

feels like someone else is pulling the strings

Paranoia (Schizophrenia)

e.g. aliens landing

Reference (Schizophrenia)

random events or objects having a particular unusual significance to oneself

Grandeur (Schizophrenia)

delusions of status - believing their a duchess/ Jesus...etc

Hallucinations (Schizophrenia)

Auditory - parroting, arguing, commenting in their head

Visual - as real as a person actually sat in front of you

Bizarre/ disorganised behaviour (Schizophrenia)

silly, rude, sexually explicit behaviour

Disorganised Speech (Schizophrenia)

difficulty suppressing irrelevant thoughts

What does negative symptoms of Schizophrenia mean

things that Schizophrenia takes away from their lives

Negative symptoms of schizophrenia

alogia -poverty of speech content

Behavioural reclusiveness /impaired social interactions

Apathy, anhedonia - lack of interest in routine behaviours

=> often a result of antipsychotic medication

What is the Diagnostic Criteria of Schizophrenia (DSM-5)

“schizophrenia spectrum and other psychotic disorders“

2+ symptoms must exist for over 1 month

at least 1 symptom must be delusions, hallucinations or disorganised speech

Subtypes of Schizophrenia (ICD-10)

-paranoid

-catatonic

-hebephrenic

-undifferentiated

-residual

-simple

Suicidal Behaviour (Schizophrenia)

Higher risk for Males

usually committed early in the illness

not normally due to command hallucinations

approx 10% of patients die via suicide, 20-40% attempt, and 60-80% think about it

This is typically more related to negative symptoms rather than hallucinations or voices, convincing them to do it

Biological Theories of Schizophrenia

If you’re an identical twin you have a 50% chance of having Schizophrenia if your twin does

whereas if your cousin has schizophrenia you only have a 1% possibility to have it too

Heston’s (1966) adoption study

followed 47 children whose mother had schizophrenia, + 50 who had parents who didn’t have parents with schizophrenia, but then were adopted

35 years later, 5 of the children with mothers having schizophrenia developed it themselves, whilst none of the control group did

They also found that offspring were more prone to psychopathy and neuroticism

Tienari et al. (1994)

compared adopted children with and without mothers having schizophrenia

first group more likely to have a diagnosis

but all children did well in “healthy“ adoptive families - family plays a crucial role

Dopamine Hypothesis

Schizophrenia involves an excess of dopamine activity and this is what it is often attributed to causing the positive symptoms of schizophrenia

schizophrenia symptoms similar to dopamine action produced by cocaine and amphetamines

Randrup & Munkvad (1966)

administered L-Dopa to rats

-symptoms of schizophrenia

-then gave them anti-psychotics which reduced their symptoms

Anti Psychotics (Schizophrenia)

Relieve many symptoms by blocking dopamine receptors

Neurological causes of Schizophrenia

enlarged ventricles (especially in males) are seen very often in people with schizophrenia

overall smaller brain volume

there’s also often brain tissue loss in adolescent schizophrenia

Auditory Hallucinations

The most common positive symptom of Schizophrenia

McGuire et al. (1993) FMRI

Revealed increased activity in Broca’s area during auditory hallucinations (the part of the brain that processes languages)

Geisel et al (2012)

FMRI pre TMS: activation in gurys of Heschl

TMS stimulation to left superior temporal gyrus (primary auditory cortex)

FMRI post TMS sessions: no activation in gyrus of Heschl

Effect not long-term, hallucinatins returned to baseline after 1 week

Cole et al (2015) TMS

Treatment for positive and negative symptoms

most effective as a treatment for auditory hallucinations

Stress-vulnerability model

people genetically vulnerable to schizophrenia seem to demonstrate higher sensitivity to stressors and negative events

Horan et al (2006) responses to 1994 CA earthquake

Avoidance: lowest in control, highest in schizophrenia and bipolar

Coping: highest in control, lowest in schizophrenia

Social support and self-esteem: highest in control, lowest in schizophrenia, bipolar in between

Gene-environment interaction model

dysfunctional adoptive families positively correlated with likelihood of developing psychiatric disorders (whether or not there was a genetic risk)

the risk was more prominent in high genetic risk adoptees: vulnerability increases sensitivities to stressors

Expressed Emotion

emotions and attitudes expressed by relatives/ caregivers towards a family member with schizophrenia

1) emotional over-involvement

2)criticism

3) hostility

Is a strong predictor of relapse

Misattribution

High expressed emotion families tend to attribute behavioural changes to the person “hes lazy“ rather than to the illness (negative symptoms)

How is Bipolar Disorder classified

DSM IV: mood disorder (with depression)

DSM 5: Bipolar and related disorders

How common is Bipolar Disorder

prevalence - 1% in society

average onset is early 20’s

average number of episodes in a lifetime = 4

Bipolar disorder between gender

even between genders

however women are more likely to experience the mania

Symptoms of Bipolar Disorder

-depression

-elation

-hyperactivity

-impractical flight of ideas/grandiose plans

-distractibility

-sometimes inappropriate/ intrusive to others

Diagnostic Criteria of Bipolar Disorder

DSM-5 requires symptoms of both mania and depression

Prevalence of depression

4% of the population at any one time

adults - 5.7%

5.9% of older adults

third leading cause of death in people aged 15-29

Gender differences in depression

females are 1.5 times more likely to be clinically depressed than males

biological make up

hormone levels

rumination

internalising vs externalising

Depression and Minority Stress

LGBTQ community reports higher rates of bullying, family rejection, and internalised stigma

Racism is a predictor of poorer mental health

Diagnostic Criteria of Depression

2+ weeks of depressed mood

with a presence of 4+ additional symptoms

General Characteristics of Depression

Profoundly sad mood over weeks or months

Loss of interest in activities & relationship

disturbance of appetite, weight, sleep, activity

suicidal thoughts

possible delusions

Cognitive Theory of Depression

uncontrollability » passiveness » depression

Becks Cognitive Theory of Depression

1. patients experience specific types of thoughts that they are not aware of

2. unless told to direct their attention to these thoughts they can remain unaware

3. thoughts are not under conscious control, and can arise very quickly

4. thoughts are followed by low mood which the patients are aware of

Cognitive Triad

-negative views of self

-negative views of current experiences

-negative views of future

arise automatically without warning

Schemata (Beck)

“a consistent organised script“

stable patterns by which we conceptualise the world

acquired throughout our lives e.g. adolescence, adulthood

Faulty Information processing/ Cognitive Biases

arbitrary inference: drawing unjustified conclusions, personalisation : assuming that things/ comments are directed at oneself

Over-generalisation: seeing things as “always“ or “never“

The three main parts of Becks Cognitive Theory of Depression

Cognitive Triad

Schemata

Faulty Information processing/ cognitive biases

Becks Depression Inventory

an inventory for measuring depression

provides quantitative assessment of the severity of the depression

not a tool for diagnosis

13 Item version of Beck Depression Inventory

sadness, pessimism, sense of failure, dissatisfaction, guilt, self-dislike, social withdrawal , indecisiveness, self-image, work difficulty, fatigue, appetite, self-harm

Successes of Becks Depression Inventory

positive correlation between score and suicidal behaviour, alcohol abuse, and anxiety

positively correlates with other measures of depression

cognitive therapy is efficient at preventing relapse

reduced bias after treatment

Cognitive Restructing

Monitoring negative thoughts

require their effect on feelings

substitute more positive ones in their place

Gender and Suicidal Behaviour

Women attempt more often than men; however, men use more lethal methods, so are more likely to die by suicide

How common is Suicide

720,000 people die by suicide each year

3rd leading cause of death in people aged 15 to 29

4% of people treated for depression died by suicide

Risk Factors for Suicide

depression

family with poor mental health

previous suicide attempts

hopelessness

substance abuse

anxiety

personality disorder

Suicide Risk with Bipolar disorder

Higher risk for:

-males

-live alone

-divorced

-age <35, >75 yrs

-unemployed

-previous suicide ideation

-depression (not mania)

Prevalence of OCD

1% in men 1.6% in women

The World Health Organisation ranks OCD as one of the 10 most handicapped conditions

Obsessions

recurrent/ persistent thoughts, urges, or images, that are as intrusive and unwanted, causing marked anxiety or distress.

Compulsions

repetitive behaviours/ acts done in response to an obsession or “rules“

behaviours acts aim to reduce distress or prevent a situation: however these behaviours/ acts are not connected in

Diagnostic Criteria of OCD

presence of obsessions, compulsions, or both

time consuming (more than 1 hour a day) or cause clinical distress or impairment in social, occupational, or other important areas of functioning, not due to another medical or psychological condition

Trichotillomania

compulsive pulling of hair

irresistible urges to pull one’s hair

more common in adult females

Automatic trichotillomania

there is no awareness that they’re doing this

Focused Trichotillomania

they are aware and focused on what they are doing- may have tweezers, could be used as emotion resolution

thought to occur more frequently in response to negative mood states

Rituals Trichtillomania

before hair is pulled- searching for different textures, hair out of place

after hair is pulled - rarely is just discarded, tactile sensory uses, eating hair, storing the hair

Dermatillomania (Excoriation)

compulsive picking of skin

can be automatic or focused

Supernatural treatments

flogging - beat them to try to get the spirits out

Trephining: drilling holes in the prefrontal cortex

prayer or exorcism

Theory of humours based on body fluids

Yellow Bile Choleric- angry, irritable

Black Bile Melancholic - depressed

Blood Sanguine – hopeful, confident, cheerful

Mucus/ phlegm Phlegmatic – cold, self-possessed, apathetic

Electroconvulsive Therapy

emulate people with epilepsy

works for short periods

cognitive function side effects

only used in severe cases now

Transcranial Magnetic Stimulation (TMS)

magnetic pulse stimulates nerve cells in the brain

non invasive

mild side effects

only used when treatment resistant

Free Association

relay every fleeting thought out loud

Dream analysis

underlying meaning of dreams sought through analysis of surface desrcriptions

Humanistic Treatment

client centred therapy

a consistent, safe, supportive space - no matter what the patient is going through

paraphrasing, open questions to encourage sharing, prompting the client to continue sharing

Cognitive Therapy

challenge negative dysfunctional thoughts with more positive and realistic thoughts

Aversion Therapy

disulfiram for alcoholism

gay conversion therapy

Exposure Therapy

Patients approach “stimulus“ of fear with the aim of reducing the fear

systematic desensitisation

State Anxiety

temporary feelings of anxiety triggered by specific events

Trait Anxiety

stable individual difference in proneness for anxiety. Demonstration of state anxiety in a variety of threat situations

Test Anxiety

situation specific personality trait

Prevalence of Test Anxiety

25-40% of the population will experience symptoms

12-18% have high test anxiety

higher prevalence in women and ethnic minorities

-does not lead to a performance difference

Relation between test anxiety and suicide

pressure from exams named as cause in 15% of Coroner’s reports

Academic pressures generally in 27%

Factors negatively effecting Test anxiety and success

evaluative settings

speeded time conditions

negative feedback

difficulty of task

Factors positively effecting Test anxiety and success

structured settings

social support

provisions of reassurance

Sarason’s Test Anxiety Scale

27 items with true or false

higher score = higher test anxiety

General Adaption to Stress Model (GAS)

Hans Selye’s early model based on physiological aspects of stress

acute stress → defensive mechanisms → illness/death

Stress conceptualised as universal, non-specific physiological response  

Physical side effects of stress

cortisol hormone levels

heart rate

blood pressure

respiration

perspiration