Psychopathology

4 definitions of abnormality

4 definitions of abnormality

deviation from ideal mental health

failure to function adequately

deviation from social norms

statistical infrequency

who established criteria for deviation from ideal mental health

Jahoda in 1958

what were Jahoda’s criteria

• No distress

• Rationality

• Self-actualising

• Cope with stress

• Realistic world view

• Good self-esteem

• Independent

• Success in work and relationships

Evaluation

Deviation from ideal mental health

POS

• Comprehensive understanding

NEG

• Cultural relativism

  • Some ideas can be culture bound

• Unrealistic standard of ideal mental health

  • Everyone has one failing or another

Statistical infrequency

Analyse the distribution, at any time, there will be a small proportion at the higher and lower ends

Evaluation

Statistical infrequency

POS

• Real life application, in diagnosis

NEG

• No need to label someone abnormal

• Uncommon or abnormal ≠ bad

• Stigma of label

Example for use of statistical infrequency

Intellectual disorders

Define deviation from social norms

Behaviour the offends sense of normality

Example for use of deviation from social norms

Antisocial personality disorder

Evaluation

Deviation from social norms

POS

• Not the only explanation, compatible with others

NEG

• Cultural relativism

  • Schizotypal personality disorder = some cultures hearing voices is a norm, but it is a marker for SPDs

• Can lead to abuse of human rights

  • Drapetomania = Psychological disorder when slaves would run away

Define failure to function adequately

Cannot cope with the demands of everyday

Who came up with the criteria for failure to function adequately

Rosenham and Seligman in 1989

Criteria for failure to function adequately

• Unpredictability

• Maladaptive behaviour

• Distress to self or others

• Irrationality

• Unconventionality

• Violation of morals

Evaluation

Failure to function adequately

POS

• Considers the individual

  • Inclusion of subjective experience

NEG

• Categorising behaviour may limit freedom

  • Just because it is one of the criteria, doing it doesn’t mean it is inherently a sign of failure to function

• Too subjective

  • How different people define distressing

Behavioural characteristics of phobias

• Panic

• Avoidance

• Endurance

Cognitive characteristics of phobias

• Irrational beliefs

• Selective attention to stimulus

• Cognitive distortions

Emotional characteristics of phobias

• Anxiety

• Unreasonable emotional response

Who came up with idea for acquisition through classical conditioning

Watson and Reyner (1920)

Little Albert and the white rat

What happened with Little Albert and the white rat

No fear initially

Paired rat (Neutral stim) with loud noise (unconditioned stim) to produce fear (unconditioned respo)

Overtime rat becomes a conditioned stimu and produces a conditioned response

Who suggested operant conditioning maintains phobias

Mowrer

Operant conditioning and phobias

Reinforcement increases behaviour

Negative reinforcement (screaming etc) = avoid situation

EVAL

Two process model for phobias

POS

• Explanatory power

NEG

• There are other reasons for avoiding stimuli

  • Some evidence points to positive feelings that are elicited by avoidance e.g. agoraphobia

• Incomplete explanation

  • Bounton 2007 = Points out the evolutionary need for fears

  • Seligman 1971 = Biological preparedness, e.g. fear of snakes

Two treatment types for phobias

Systematic desensitisation and flooding

How does systematic desensitisation work

• Utilises idea of classical conditioning, trains brain to have another response (counterconditioning)

• Reciprocal inhibition = Brain cannot have panic and relaxation occur at the same time

3 processes in systematic desensitisation

1. Anxiety hierarchy

2. Relaxation

3. Exposure

What is the anxiety hierarchy (SD)

-Patient ranks situations involving stimuli

-Rankings go from least anxiety inducing to most

What is relaxation (SD)

-Patient learns relaxation techniques

-Breathing techniques, visualisation

Sometimes drugs are used to aid

What is exposure (SD)

-Patient is exposed to stimuli in their relaxed state

-They work up their hierarchy, attempting to stay relaxed

EVAL

Systematic desensitisation

POS

• Effective

  • Gilroy et al. (2003) = Control group vs SD group treating their arachnophobia

  • SD group had lower fear and anxiety

• Diverse and suitable for many types of patients

  • Anxiety often goes alongside learning difficulties

• Preferred over flooding by patients

NEG

• Symptom substitution = Phobia is replaced with new fear

What does flooding need

Longer sessions, 2/3 hours

Extinction of response= Learning quickly that stimulus is actually safe

Flooding in terms of conditioning

Response is eradicated when conditioned stimulus is encountered without unconditioned stimulus

E.G. encountering a big dog without it biting

Ethics of flooding

Not unethical, informed consent MUST be given

Patient often given a choice between SD or flooding

EVAL

Flooding

POS

• Effective

  • Ougrin (2011) = Flooding as effective as other types, quicker

NEG

• Less effective for specific types e.g. social phobias

• Can be traumatic, patients are less likely to see all the way through

  • Waste of time and money

• Symptom substitution = Phobia is replaced with a new fear

Behavioural characteristics of depression

• Change in activity levels

  • Lower activity = withdrawing

  • Psychomotor agitation = High energy, pacing and restlessness

• Disruption to sleep and eating

  • Insomnia or hypersomnia

• Aggression/ self-harm

Cognitive characteristics of depression

• Poor concentration

  • Leads to poor decision making

• Dwelling on negative thinking

• Absolutist thinking

Emotional characteristics of depression

• Lowered mood

• Anger

• Lowered self-esteem

Aaron Beck = Cognitive vulnerability

Beck believed some people were more vulnerable to depression

It is their cognition that make them more vulnerable

BECK

Faulty information processing

Blown out of proportion

Black and white thinking

Focusing on the negative

BECK

negative triad

Negative triad is a person’s outlook

• Negative view on world

• Negative view on future

• Negative view on self

EVAL

Beck’s approach to depression

POS

• Supporting evidence

  • Graziolo & Terry (2000) : Study of mothers before and after birth, increase cognitive vulnerability = more likely to develop post-natal depression

• Practical application in CBT → Neg triad can be challenged

NEG

• Doesn’t explain all aspects of depression e.g. hallucinations

Ellis = ABC

Albert Ellis thought that depression could be as result of irrational thoughts

ELLIS

what does ABC stand for

A - Activating event

B - Beliefs

• Irrational interpretations of event

C - Consequences

• Emotional and behavioural events

EVAL

Ellis ABC

POS

• Application to CBT → challenge negative beliefs to prevent further consequences

NEG

• Partial explanation → some depression occurs without an activating event

• Doesn’t explain all aspects e.g. hallucinations

What does CBT do

Tries to identify negative thoughts and challenge them

Beck’s CBT

• Specifically aims to identify NEGATIVE TRIAD and challenge it

• Patient as scientist : Therapist will aim to make patient identify evidence against their negative beliefs

What is Ellis’ REBT

REBT = Rational Emotional Behavioural Therapy

Extends ABC to ABCDE

D : Dispute E: Effect

How does Ellis’ ABCDE REBT

• Identify B and C, and challenge them

• Involves vigorous argument (hallmark of REBT)

Ellis’ therapy involves many types of argument

• Vigorous argument - Actively argue against ideas

• Empirical argument - Dispute beliefs w/ evidence

• Logical argument - Argue whether their logic tracks

EVAL

CBT POS

POS

• Effective

  • March et al. (2007)

  • 327 teens doing therapy for 36 weeks

  • 81% improvement in CBT vs 81% improvement in meds vs 86% in CBT and meds

  • Helpful with meds and as alternative approach

EVAL

CBT NEG

NEG

• Not helpful in severe cases

  • People don’t want to engage, don’t want to do the active work

  • POS : Give meds, works alongside CBT

• Success may just come from the therapist-patient relationship

  • Rosenzwerg (1936) suggests the key component in all therapies is relationship between therapist and patient

Behavioural Characteristics of OCD

Compulsions

• Repetitive = Compelled to repeat

• Reduce anxiety

Avoidance

• Avoiding situations that trigger OCD

Cognitive Characteristics of OCD

Obsessive thoughts

Insight into irrationality

• Excessive anxiety and hypervigilance

Cognitive coping strategies

Emotional Characteristics of OCD

Anxiety and distress

• Accompanies obsessions, compulsions and intrusive thoughts

Accompanying depression

Guilt and disgust

Explanations for OCD

Neural explanation and Genetic explanation

Lewis - Genes for OCD

Of his OCD patients, 37% had parents with OCD, 21% had siblings with OCD

• Genetic vulnerability not certainty

Diathesis-Stress model

• Certain genes leave people more likely to suffer from mental disorder

What are candidate genes

• Genes that create vulnerability for OCD

  • Some involved in regulating development of serotonin system

Named candidate genes

5HT1-D beta gene

COMT gene

SERT gene

5HT1-D Gene

Function = Transporting serotonin across synapses

COMT gene

• Regulates dopamine production

  • One form of COMT found more commonly in OCD patients

  • Variation means lower COMT gene = lower regulation = higher dopamine

  • Tukel et al.

SERT gene

• Affects transport of serotonin = lower levels of serotonin

• Mutation found in 2 families, where 6 of 7 members per family had OCD

• Ozaki et al.

Why would you describe OCD as aetiologically heterogeneous?

Means that the origin of OCD is different in each person

• Evidence suggests different types of OCD (hoarding, religious) have different genetic variations

Why is OCD polygenic?

OCD not caused by a single gene, multiple

• Taylor = Found 230 genes that could be responsible for OCD

What does the neural explanation of OCD identify as cause

Transmitters and structure of brain

Parts of brain for OCD in neural explanation

OFC (Orbital Pre-Frontal Cortex)

Thalamus

Caudate nucleus

Orbital Pre-Frontal Cortex

Send signals to thalamus about things that are worrying

Thalamus

Acts on impulse sent by OFC, stop actions when impulses from OFC lessen

Caudate Nucleus

In normal brain, suppresses unnecessary signals from OFC to thalamus

In OCD brain, doesn’t suppress, so thalamus is triggered by minor ‘worry’ signals

Neurotransmitters in OCD

Dopamine and Serotonin

What is wrong with the neurotransmitters in OCD

Increased dopamine

Lowered serotonin

Eval POS

Genetic explanation OCD

• Twin studies using monozygotic (identical) vs. dizygotic (non-identical)

  • Nestadt et al. = 68% identical twins shared OCD vs. 31% non-identical

• Diathesis-Stress model - Genes make someone predisposed for OCD, not entirety

Eval NEG

Genetic Explanation OCD

• Too many candidate genes to pin specific ones to OCD

  • Taylor = 230 potential genes

• Environmentally triggered = Trauma increases risk of / triggers OCD

  • Cromer = Over half of OCD patients in a sample had trauma, OCD more severe

  • Doesn’t mean there’s not a genetic cause, just not entirety

How does drug therapy work

Regulates the neurotransmitters in the brain

• OCD: Would attempt to increase serotonin and decrease dopamine

What is most common drug for OCD drug therapy

SSRIs = Selective Serotonin Reuptake Inhibitors

How does synaptic transmission of serotonin work

1. Electrical impulse along pre-synaptic neuron, triggers serotonin to carry the message across gap

2. Serotonin leaves axon and carries impulse across to dendrite by stimulating receptors on it

3. Serotonin is reabsorbed by the pre-synaptic neuron, broken down to be used again

Why do SSRI’s help OCD

• After serotonin stimulates receptors on post-synaptic neuron, it’s re-absorbed by pre-synaptic neuron to be used again

• SSRIs block re-absorption of serotonin into the pre-synaptic neuron

• TMT serotonin can continue to stimulate post-synaptic receptors

  • EFFECTIVELY INCREASES AMOUNT OF SEROTONIN IN SYNAPTIC GAP

Dosage of SSRIs and length to work / up

Daily = 20mg Fluoxetine

Usually takes few weeks to impact behaviour / thoughts

Must be taken for 3-4 months before upping dosage

SSRI side-effects

• Dizziness

• Nausea

• Lethargy

• Headache

• Anxiety

Drugs + other treatment

Often used with CBT

Treats immediate symptoms e.g. anxiety

• Means patient can engage more

CBT treats cognitive issues e.g. thinking patterns

Alternatives to SSRIs

Tricyclics

SNRIs

Tricyclics

• Works on increasing serotonin

  • Same side-effects as SSRIs + heart problems and hallucinations

  • Kept for patients who don’t respond to SSRIs

SNRIs

Increase serotonin and noradrenaline

• Same side effects as SSRIs + chest pain

What does noradrenaline do

Monitors stress responses, attention, emotional fluctuations

Eval POS

Drug therapy for OCD

• Evidence for effectiveness

  • Soomro et al.

  • Compared 17 studies using SSRI vs placebo

  • All showed better for SSRIs

    • More effective when combined with CBT

  • Sansone and Sansone

  • 70% of patients had symptoms reduced

• Cheaper to provide from NHS

• Can help extreme cases

Eval NEG

Drug therapy OCD

• Skapinakis et al. = Systematic review found cognitive and behavioural therapies were better'

• Evidence for drug therapy sponsored by pharmaceutical companies

  • Ignore evidence that’s negative

• CBT may be cheaper overall, overall may be more effective

• Side effects = Neurotransmitters have multiple functions

• Some OCD has activating event that CBT would be more beneficial for

• Maina et al. = Patients relapse within few weeks if drugs aren’t taken