MBB2

Mental health

is a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life and is able to make a contribution to his or her community.

Stigma

the negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency

Approaches to reducing stigma

Contact- being in contact with somone with a mental illness reduces stigma and is particularly effective in adults

Education- informing people increases their knowledge and understanding thereby reduces fear that stems from not knowing
- dispels myth
- increases likelihood of people seeking help as it starts social discussion
HOWEVER a biological explanation can lead to perception of uncontrollability which has opposite of desired effect

Perceived stigma

The experience of being aware of/perceiving the prejudice emotions, discriminatory behaviour or practices that arise from stigma

- can cause anxiety/fear of stigmatisation

Structural stigma

-Ingrained stigma that manifests at the societal level

- is maintained through institutions, through policy, law and ideologies that restrict opportunities for particular groups.
- varies across society, time, culture and topics

Public stigma

Stigma exhibited by the public towards those with a mental health disorder

Experienced stigma

having been the target of negative steriotypes, prejudice and discrimination in relation to ones mental health

- can be subtle or insidious/overt

Anticipated stigma

the extent to which individuals living with mental health illness expect to experience stigma, stereotyping, prejudice and discrimination in future due to their mental health status

- can result in withdrawal from opportunities

How does public stigma manifest?

1. attitudes and beliefs - stereotypes.
2. emotional response - fear
3. behaviours - avoidance of interaction or social exclusion.

Social Cognitive pathway of stigma and discrimination (corogan)

proposes that diagnostic labels and observable indicators of person experiencing mental health concerns act as stimuli/signals that illicit stereotypes, stigma, prejudice and discrimination

self stigma

societal and interpersonal stigmatised attitudes are internalised affecting individuals.

Corrogans model of self stigma

Awareness of stigma
agreement with stigma
application of stigma to self
damage to self esteem

5 Types of stigma

- self stigma
- public stigma
-perceived stigma
- anticipated stigma
- experienced stigma

Attribution questionnaire

Measure public stigma towards people with mental illness through stereotyped beliefs and prejudicial emotional responses

6 factors indicating stigma (high score=high stigma)
- fear / dangerousness
- help / interact
- responsibility
- forcing treatment
- empathy
- negative emotion

Mental disorder?

a clinically significant disturbance in an individuals cognition, emotion regulation or behaviour... usually associated with significant distress or disability in social, occupational or other important activities.

Wakefield's Harmful Dysfunction

failure of internal mechanisms to perform their natural function.

Categorical system

presence of absence of a disorder
- person is either in a state of mental health or mental disorder there's no overlap
- DSM 5 is categorical

Strengths of categorical systems

better for clinical application as it allows more dichotomous decisions to be made

Strength of dimensional system

has a greater capacity to detect change/fluctuation in peoples mental health and allows treatments to be developed that target symptoms not specific disorder

Dimensional system

rank on a continuous quantitative dimension/sliding scale

diagnostic approach DSM 5

- clinical interview
- text descriptions
- diagnostic criteria
- clinician assesment

mood disorders

- mood is a persons subjective emotional state
- mood disorders involve a depression or elevation of mood as the primary disturbance.

mania

a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level or activity level.

- may feel invinsible

dysthymia

persistent mild depression

euthymic

the state of living without mood disturbances being 'ok'

Major depressive episode DSM-5

Need 5 or more symptoms present for two or more weeks.
- depressed mood (must have)
- anhedonia (must have)
- decrease/ increase in appetite or significant weight loss/gain
- increased or decreased sleep
- agitation or retardation
- fatigue or low energy
- feelings of worthlessness or inappropriate guilt
- decreased concentration or indecisiveness
- suicidal thoughts

3 critiria for depression diagnosis

1. presence of majour depressive episode
2. the episode cant be explained by other diagnosis
3. no history of mania, hypomania or mixed episode (medical ilness)

mood

a persons sustained experience of emotion

risk factors in development of major depressive disorder

- family history increases risk of onset by 1.5-3x
- 20-25% of patients with major medical commodities develop MDD
- commodity with anxiety increase chance
- females are more at risk then males

What are the anxiety disorders?

- panic disorder
- specific phobia
- social anxiety disorder
- generalised anxiety disorder
-PTSD
- OCD

OCD

maladaptive perfectionism, preoccupation with rules and details, excessive focus on work and rigidity of ways things are done, hoards, overly concise and inflexible

What is a panic disorder?

recurrent unexpected panic attacks for a one month period or more of;
- persistent worry about having attacks
- worry about the implications of attack s
- significant change in behaviour because of attacks.

Symptoms of a panic disorder

- palpitations or rapid hear rate
- sweating
- trembling or shaking
- shortness of breath
- feeling of choking
- chest pain
- chills of hot flushes
- nausea
- Dizzy/faint
- fear of dying

What is a generalised anxiety disorder?

- excessive worry more days than not for at least 6 months about a number of events. Find it difficult to control worry.

Symptoms of generalised anxiety disorder?

Need 3 or more.
- restlessness
- easily fatigues
- difficulty concentrating
- irritable
- muscle tension
- sleep disturbance

What is obsessive compulsive disorder?

- recurrent persistent thought, impulses or images that are intrusive inappropriate and cause marked anxiety.
- impulses or images are not simply excessive worries about real life problems.

what are compulsions?

- repetitive behaviour or mental acts that the person feels driven to perform in response to an obsession or according to rigidly applied rules.
- The behaviours or acts are aimed at reducing distress or preventing some dreaded situations.

What is post traumatic stress disorder?

The person was exposed to a traumatic event and both of the following were present:
1. the event involved actual or threatened death or serious injury to self or others.
2. the persons response involved intense fear, helplessness or horror.

Symptoms PTSD

- duration of symptoms is greater than a month and cause significant distress or impairment in functioning
- the traumatic event is re experienced
- nightmares, flashbacks, intense distress
- persistent symptoms of increased arousal marked by two or more of the following;
- sleep difficulty
- irritability or anger
- difficulty concentrating
- hyper vigilance
- exaggerated startle

Persistent avoidance behaviours marked by three or more of the following:
- thoughts about trauma
- activities, places or people that arouse recollections of the trauma
- diminished interest in activities
- feelings of detachment from others

comorbidities of PTSD

- Depression
- Anxiety
- Substance use disorders
- dissociative disorders

Dissociative personality disorder

one host's personalities that interchange with one or more alter personalities

- host personality is not always the original but just the one most present
- formerly called multiple personality disorder
- may experience amnesia, depersonalization/ derealization and/or absorption

- may result from experiencing extreme repeated trauma often during childhood so dissociating during traumatic event result in splitting personality as defense mechanism

The tripartite model of depression and anxiety

negative affect is common to both anxiety and depression therefor psychological overlap between the two moods

- depression has low levels of positive affect accounting for symptoms like adonia and melancholia
- anxiety has anxious arousal which contributes to feelings of psychological arousal

Explain the case of Louis Wain

- his experience of reality was becoming very different to which was generally agreed upon.
- visual world was changing as he got sick.
- continued to produce art during his illness of schizophrenia

psychosis?

It is an umbrella term meaning referring to a cluster of symptoms involving disconnect from reality.
- can refer to group of disorders

What does psychosis refer to at a disorder level?

- refers to a group of disorders distinguished from one another in terms of;
1. symptom configuration - non-bizarre delusions vs bizarre delusions
2. Duration - less than or more than 6 months
3. relative pervasiveness - duration and clinical picture of psychotic symptoms vs. affective symptoms

Explain schizophrenia

the term schizophrenia refers to split mindedness or mind torn asunder. ( IT IS NOT MULTIPLE PERSONALITIES).
- involved disruption in various aspects of perceiving, thinking, feeling and behaviour.

positive symptoms of schizophrenia

Additive to normal experience - hearing a voice
1. Hallucinations: a percept in the absence of environmental stimuli that may occur in any sensory modality
2. delusions: a false belief both bizarre and non-bizzare

negative symptoms of schizophrenia

deficit in normal function.
1. Avolition: lack of motivation to achieve goals.
2. Algoia - though blocking, poverty of speech and content.
3. anhedonia: inability to experience pleasure
4. Affective flattening - dulled emotional expression
5. inattention - disturbance in selective attention

- other symptoms include; catatonia, incongruent or inappropriate affect and bizarre behaviour

What are hallucinations?

A percept in the absence of environmental stimuli. Occur in any sensory modality of which auditory is the most common.

delusions types

persecutory delusions - unable to recognise reality

idea or reference delusions- believe there special or find hidden meaning

grandiose delusion - believe they have special power/characteristics

Somatic delusion - beleive internal/external bodily functions are abnormal

passivity phenomena - thought insertion or with-drawl where its believed someone is adding/deleting thoughts (mind reading)

positive thought disorder

about disordered cognition

Clanging - speech pattern based on phonological association rather than semantic of syntactic.

Circumstantiality - speech including unnecessary or irrelevant detail.

Flight of ideas - sequence of loosely associated concepts are articulated.

Derailment - speech train steers off-topic to unrelated things

Incoherence - word salad.

pressure of speech - excessive spontaneous speech production at rapid rate.

What is the DSM5 criteria for schizophrenia?

1. Two or more of the following for a one month period;
-delusion
- hallucination
- disorganised speech
- grossly disorganised or catatonic behaviour
- negative symptoms

2. For a significant proportion of time since onset a disturbance in functioning.
3. continuous signs of disturbance for at least 6 months with 1 month of active symptoms
4. schizoaffective disorder/ bipolar ruled out
5. rule out substance or medical condition

History of Schizophrenia

Benedict Augustine Morel - dementia that was happening early.
Emil Keaepelin - early onset
Paul Eugen Bleur - named schizophrenia
Schneider - first rank symptoms delusions and hallucination

Biological approach to Schizophrenia

- neurotransmitter pathway such as dopamine linked to development
- reduced cortical volume and structural abnormalities of the brain
- cortical activation in auditory cortex occurs when hullucination

What are the three ways personality relates to abnormality?

- Vulnerability
- Personality disorder
- other personality related disorder

3 forms of Vulnerability

susceptibility or tendency to develop a mental disorder

- genes
- environmental stress
- personality

Diathesis stress model

Most mental disorders involve combined action of a personality, vulnerability (diathesis) and environmental stress.

- no disorder without diathesis
- no expression of diathesis without stress

Specific diatheses: depression

- Dependency = interpersonal dependent personality style where worth is defined by relationships and
the need to be well-liked

- Autonomy = personal achievement, goal-oriented and defines self-worth by achievements often
academic where failure is a major stressor

- self-criticism = perceived self-criticism is confirmed and are major stressor

- pessimistic attributional style:
1 - internal = low self esteem
2. stable = hopelessness
3. global = helplessness

Specific diatheses: schizophrenia

Schizotypy
- social anhedonia - inability to derive pleasure from interactions with other people
- physical anhedonia - no pleasure from physical sensation
- perceptual abberation - hallucination and subtle allusion
- magical thinking- dellusion

Personality disorders: dramatic cluster

- antisocial
- borderline
-histrionic
- narcissistic

linked to acting out, substance abuse

Borderline personality disorder

difficulty regulating mood, impulsive, unstable relationships, inappropriate and intense emotions, increasing suicidality or self mutalation, identity disturbances, mania, depression etc

personality disorder

arise when personality attributes become too extreme, inflexible and maladaptive

Personality disorders: odd cluster

- paranoid
- schizoid
-schizotypal

linked to risk of psychosis

Personality disorders: Anxious cluster

- avoidant
- dependant
- obsessive compulsive

linked to anxiety and depression

Cognitive behaviour therapy

operates on the premise that maladaptive patterns of thinking influence the way we feel and behave.

ABC cognitive model of emotion and behaviour

A= activating event
- what was happening when negative feelings were experienced

B=belief
- beliefs or thoughts about activating event

C=consequence
- feelings
-behaviour performed

Maladaptive

person finds it hard to adapt to the demands of day-to-day living

What is cognitive behaviour therapy?

CBT is a relatively short term therapy that is active, directive and collaborative.
The goal of CBT is to assist in changing their maladaptive thinking patterns and over behaviour by acquiring more adaptive ways of responding within themselves and others.
Usually conducted according to an explicit treatment manuel

Core beliefs - CBT

Are developed in order to understand ones place in the world
- Begin in childhood
- are viewed as truths

Intermediate beliefs - CBT

attitudes rules and assumptions

CBT for depression

3 phases of therapy;
1- treatment often includes a concentration on psychoeducation and n on cognitive techniques.
2- treatment focuses on cognitive techniques and problem solving.
3- generalisation and relapse prevention

stimulus control - CBT

- convert and overt behaviours often occur in the presence of specific triggers meaning that the behaviours are under 'stimulus control'

Hallucination

- to wander naturally or be absent minded
- hallucination has historically been defined as aberrant perception .
- can be experienced in any modality

Mental health and hallucination

- hallucinations occur across a range of mental disorders.
- schizophrenia is most commonly associated with hallucination.
- voices can manifest in a positive or negative manner.

Mcarthy Jones et al. subtypes of AVH (auditory verbal hallucinations)

1. hypervigilance
2. autobiographical memory
3. inner speech
4. epileptic
5. deafferentation

Cognitive models of hallucination

1. executive function - top
2. perception
3. sensory processing - bottom

Bottom up influences

- sensory processing deficits
- impairments in sensory auditory processing; pitch, duration of tones, amplitude.

Top down influences hallucination

- impaired verbal working memory

Developmental psychology

the study of change and continuity in the things that fundamentally affect how we understand and interact with the world

helps us:
- shape social policy
- understand human nature
- enrich human life

two branches:
- childhood developmental psychology
- lifespan development

social psychology

the scientific study of how peoples thoughts, feelings and behaviours are influenced by the actual, imagined or implied presecence of others

Childhood development psychology

what happens in early life effects the rest of one life

- how genes and environment play a role
- how research can be conducted that protects human/child rights
- what psychology tells us about effective child- rearing and child mental health

lifespan developmental psychology

wants to understand:
- how we change or stay the same over our lifespan
- how people recover from trauma and what supports are effective
- to what extent do we actively shape our lives or are we passively responding to our surroundings

7 Enduring themes of developmental psychology - MUNT RIC

1. continuity and discontinuity
2. mechanisms for change
3. universality and context specificity
4. individual differences
5. Research and child welfare
6. Nature and Nurture
7. Active child

1. continuity and discontinuity

- all types of change impact the way people perceive and interact with others

There is 4 types of change:
- continuity = stability
- discontinuity = change
- continuous change = quantitative and reversible such as memory capacity
- discontinuous change = qualitative and irreversible such as learning and puberty

2. mechanisms for change

two models of mechanisms for change: mechanisms for evolutionary change and transtheoretical models

Evolutionary change involves: migration, genetic factors and natural selection
transtheoretical model is also known as mechanisms of change and recovery

Transtheoretical model

pre-contemplation - not thinking about making a change
contemplation - thinking about making a change
preparation - start planning to make the change
action- carrying out change and making planned change
maintenance - keep preforming change action
relapse - change falls out of routine and revert to self before change

3. universality and context specificity

to what extent is development universal across all context and culture and to what extent is it specific to context and cultures
- values, norms etc

4. individual differences

how children with shared backgrounds become diffrent from each other

5. research and child welfare

- how can researchers conduct meaningful research with infants and young people?
- how do we protect infants and young peoples welfare in research?

6. Nature and Nurture

how genes and the environment interact to shape development

7. Active child

how do children shape their own development through their decisions which are governed by someone else

What makes a good theory?

- possible to find out its wrong
- internal consistent
- falsifiable
- supported by data

When selecting a sample what must it be?

- representative of the population of interest
- randomly drawn from the population

What are the 3 major methods of data collection?

- self reports
- behavioural observations
- psychological measurements

How does developmental diversity occur?

- Development results from the close and continual interplay of genes and experience.
1. genotype - the genetic material a person inherits
2. phenotype - the observable expression of the genotype
3. environment - all other aspects other then genetic material itself eg. physical, social, cultural

3 ways child shapes own environment

passive; children engage in activities that are encoraged by others
active; children seek out environmental niches that are most compatible with their predisposition
evocative; children attributes affect how other interact with them

4 relationships -nature v nurture

1. epigenetic effects of the environment on genes
2. variations in heritability due to environmental circumstances
3. gene environment correlations.
4. gene environment interactions

-Michael Rutter

indirect influences on heritability

indirect- genetic information expressed as a persons propensity for a particular activity or environment
eg. some people gravitate towards hot weather while others like cold
- studied through selective breeding and family studies (adopted design)

Culture

a culture is socially transmitted or socially constructed constellation consisting of practises, competencies, ideas, schemas, symbols, values. norms, institutions, goals and modifications of the physical environment.

general intelligence

a person possesses a certain amount of general intelligence that influences their ability on all intellectual tasks.