12 / 13. Psychopathy Flashcards
what is psychopathy in relation to culture?
types of mental illness as a function of culture
differential categorisation of mental illness
concept of abnormal behaviour and functioning can depend on the cultural context
what is the labelling theory?
diagnosis of a mental illness is a way of stigmatising people who society deem as deviant
what is the barriers of the labelling theory?
not beneficial as people are dehumanised and become patients wherein many subsequent behaviours are related back to their diagnosis illness
what are the benefits of the labelling theory?
a diagnosis can really help people understand or put a name to what they may have been feeling of experiencing
mental health
capacity of individuals to behave in a way that promote their emotions and social well-being
what are the 3 domains of the labelling theory?
cross cultural illnesses (schizophrenia (Sz), depression)
problems with labelling but diagnosis may result in treatment and research knowledge
neurological evidence of illness like Sz
mental health problems
wide range of behavioural and emotional abnormalities that affect people throughout their lives
mental disorder
a clinically recognisable set of symptoms and behaviours that cause distress to the individual and impair their ability to function as usual
what is the diagnostic and statistical manual
Used in Australia and USA
descriptive diagnosis - classified terms of clinical syndromes and clusters of syptoms
what is the latest diagnostic and statistical manual?
DSM-V 2013
what diagnostic statistical manual does England use?
ICD-10
Diagnosis on a scale/contiuum
what diagnostic statistical manual does Australia work from?
DSM
what are the characteristics of a DSM?
revolution on psychiatric nosology with the co-clustering of symptoms
early versions very dissimilar - now similar
produced by a single national professional association (APA)
produced primarily my US psychiatrists
Approved by APA
generates a very substantial portion of APA’s revenue, not only from sales of the bool, but also from related products and copyright permissions
what are the characteristics of the ICD?
function of, and ratified by the WHO - less information that DSM produced by global health agency (WHO) with constitutional public health mission WHO-Focus help reduce burden of mental disorders- ICD = global multidisciplinary and multilingual approved by World Health Assembly = health ministers from 193 countries distributed broadly at a very low cost, with discounts to love income countries, free on internew
when was homosexuality removed from the DSM and why?
1973
used to be a diagnosable disorder of secual deviance
what is the most recent controversy about the DSM?
putting autism, asperger’s and pervasive developmental disorders all on the one scale of ASD (autism spectrum disorder)
what are the 4 theoretical approaches to psychopathy?
psychodynamic
cognitive-behavioural
biological systems
evolutionary
psychodynamic
3 broad classes of psychopathology = neuroses, personality disorders, psychoses
e.g. anxiety as a result of unconscious conflicts among an individual desires and fears
cognitive-behavioural
integrates classical and operant conditioning with cognitive-social approach
e. g. thoguhts that precede a panic attack, so assessment of the context or which thoughts trigger an aversive psychological reaction
e. g. anxiety, substance use disorders
other approaches
repression, denial, sublimation
repression
unconscious mechanisms employed by the ego to keep disturbing or threatening thoughts from becoming conscious
denial
blocking external events from awareness. If some situation is just too much to handle, the person refuses to experience it
sublimitation
similar displacement but in a positive defence way. Actively substituting / making something positive out of a negative way
what are the possible outcomes of repression?
leads to depression because the memory is too painful to deal with
what are the possible outcomes of denial
leads to depression because of one denies something is happening - the sad reality is still there and felt unconsciously
what are the possible outcomes of sublimitation
leads to OCD - combat negative feelings by doing something enjoyable, but instead of dealing with source of the behaviour is repeared
id
unconscious mind
suer ego
higher moral compass controlling the id
ego
organised; conscious mind - mediates between desires of the Id & control of the Super-Ego
nosology
the branch of medical science dealing with the classification of diseases
biological approach
cause determined from brain’s circuitry, such as neurotransmitter imbalances, brain structure deformities or neural pathways impacting upon behaviours etc. so move from mental to physiological level
diathesis-stress model
evidence of genetic contribution - so genetic propensity and then environmental triggers (such as hostile family communication, birth complications, intra-uterine development of nervous system of drug use)
what is an example of the biological approach
the diathesis-stress model
what is involved in the system theory
family functioning
cultural construct
what role our social groups play
evolutionary approach
psychopathy not comprehensively explained in other approaches, and its counterintuitive as mental illness is often maladaptive, but can be useful to think about
what are the three ways the evolutionary perspective explains
natural selection
emerging knowledge
interplay of genes and envirnment
natural selection
examples is where anxiety is an evolutionary mechanism gone askew - fear can be our protector against enemies / predators
but if maladaptive - often person is socially isolated and have less chance of reproducing [But many generations have evolved with mental illness so undermines this approach]
emerging knowledge
role of genes
interplay of genes and environment
normal processes go awry because of abnormal circumstances - fear is a protector but if faced with trauma a person may become preoccupied with fear and less functioning
what are the three classifications of disorders?
schizophrenic disorders - disorderd thinking
depressive disorders - disturbances in emotion and mood
anxiety disorders - anxiety states - intense fear - internal alarm bell that warns perceived potential danger
how are schizophrenia spectrum and psychotic disorders characterised?
loss of contact with reality
marked disturbances of thought (delusions)
marked disturbances of perception (hallucinations)
disorganised thinking
abnormal motor behaviours
what do schizophrenia spectrum and psychotic disorders include?
delusional disorders
belief psychotic disorder
schizophreniform disorder - Sz symptoms but for
what are the negative (something missing or absent) symptoms of schizophrenia?
flat affect . blunted emotional responses
lack of motivation (avolition)
socially inappropriate behaviour
withdrawal from relationships
peculiar/withdrawn interpersonal behaviour
sometimes intellectual impairment
what are positive symptoms of schizophrenia
delusions
hallucinations
loosening of associations
delusions
false beliefs firmly help despite evidence to the contrary
unfortunate often persecutory delusions - someone out to get me
hallucinations
perceptual experiences that distort or occur without external stimuli
e.g. auditory hallucinations - most common (hearing voices)
visual hallucinations - distortions of reality or complete new perception
loosening of associations
not controlled or logical thought… one thought leads to another –> disorganised speech
dopamine (DA) & Glutamate model
perceptual increased amphetamine use –> DA00 > Psychosis
antipsychotics –> decrease DA in the brain (positive Sz)
different neural circuits –> different clusters of symptoms (e.g. negative symptoms BUT it is all due to glucamate?
recent evidence about PCP or angle dust which alters glutamate levels produces positive and negative symptoms
what are the complications of schizphrenia
often lack of insight
sometimes reluctance to take medication
social withdrawal (sometimes quite expert at hiding symptoms)
bipolar
episodes of mania/maniac AND OR episodes of depressive mood
experience both poles of depression and mania
episode of mania / maniac
feelings of excessive happiness or euphoria
inflated sense of self = a belief that one can do anything - can result in people taking risks - such as unrealistic ventures on a grandiose scale
episodes of depressive mood
persistent or severe feelings of sadness and hopelessness
unipolar
major depressive disorder
depressed mood
loss of interest in pleasurable activities
disturbances i appetite, sleep, energy levels and concentration
what is anhedonia
loss of interest in pleasurable activities
dysthymia or persistent depressive disorder
less severe type of depression
chronic low level depression lasting more than 2 years with intervals of normal mood that never last more than a few weeks or months
effect on functioning more subtle (e.g. deminished self confidence)
can be punctuated with episodes of major depressive episodes
seasonal affective disorder (SAD)
depressed mood as a result of lack of sunlight in winter
mood and behavioural changes with season change
treatment with high-intensity fluorescent light
1/4 townsville residents have this
what are the genetic factors of bipolar?
high heritability - biological predisposition
e.g. 80-90% people with bipolar have a family history of mood disorder
neural transmission 5-HT and norepinephrine - involved in capacity to be aroused or energised
bipolar influence of cognitive aspects
dysfunctional patterns of thinking - cognitive disorders
learned helplessness
pessimistic explanatory style
cognitive content + the way that information is processed
negative triad
anxiety disorders
contemplation of new DSM V category was Mixed Depression Anxiety
highlights the comorbidity - or how often depression is associated with anxiety disorders
women have higher rates than men
OCD
not categorised under anxiety disorders but are a range oh disorders where often the person has / carries out unwanted obsession and compulsions to alleviate feelings of anxiety
what are examples of anxiety disorders?
phobias panic disorder agoraphobia social anxiety disorder generalised anxiety disorder
phobias
irrational fear
panic disorder
attacks of intense fear and impending doom
agoraphobia
fear of being in places / situations from which escape might be difficult (e.g. crowded grocery store, festivals)
can be triggered from having panic attach and wanting to avoid another one
social anxiety disorder
fear of ‘performing’ in a social situation or performance (e.g. public speaking meetings, casual social events)
generalised Anxiety disorder
persistent anxiety at a moderate but disturbing level
excessive and unrealistic worry about life circumstances
panic attacks - physiological systems
shortness of breath dizziness heart palpitations trembling chest pains
panic attacks psychological
fear of dying or going crazy
when and who was responsible for psychotherapy
19th century and Freud
what does psychotherapy focus on
insight and therapeutic alliance
insight
therapeutic change needs an understanding of one’s internal workings of the mind
therapeutic alliance
the degree of comfort that the client has with the therapist in order to disclose personal information
what are the 3 main therapies
free association
interpretation
transference
free association
attempt to make the unconscious conscious - investigation of fears and desires –> flow of the Id - say whatever comes to mind
interpretation
explaining the meaning of the client behaviours n dreams, unconscious and conscious behaviours etc - therapist helps the translate and help the client understanding an make sense of their life
transference
client reacts to therapist as though they were significant others (so positive or negative feelings - cathartic release)
what are the 2 main types of psychodynamic treatment
psychoanalysis
psychodynamic psychotherapy
both address repetitive interpersonal patterns or difficulties
psychoanalsis
patient on couch, therapist behind so that the patient doesnt have to look
3-5 times per week for several days
psychodynamic psychoterapy
still exploration of the unconscious, but therapist & patient sit opposite each other without the couch
1-3 times a week for several years
cognitive behavioural therapies
short term
more directive
behavioural analysis
stimuli + thought = symptom (unwanted behaviours / feelings)
i.e. what are the antecedents to the behaviour
what is the process of the cognitive behavioural therapies?
Activating event beliefs consequences disputations of beliefs effective new beliefs
activating event
something happens to your or in the environment around you
e.g. a work colleague walks past and doesn’t say
beliefs
you are a belief or interpretations regarding the activating event
e.g. you think “Oh no, why didnt she talk to me? I have just upset her. maybe she doesnt like me?”
consequences
your belief has consequences that infuse feelings and behaviours
e.g. you feel awful - lonely, anxious and sad. YOu avoid that person for the next day or two ruminating why you were ignored
disputations of beliefs
challenge your belief to create new consequences
e.g. “there could be a lot of reasons why she walked past. Am i assuming the worst? maybe she was busy?”
Effective new beliefs
adoption and moderation of new adaptive beliefs
e.g. “assuming the worst isnt helpful” “I hope that person is okay” “I can go and check later if she is okay”
reality checking, social skills
what is the behavioural aspect of the cognitive behavioural therapy?
systematic desensitisation
exposure therapy
modelling and skill training
mindfulness
treatment for panic attacks?
psychoeducation
behavioural
cognitive
psychoeducation
increases awareness
what happens during attack
investigations of triggers (if any)
behavioural treatment for panick attacks
deep breathing techniques
pratctice of techniques
exposure to hear racing experiences
cognitive treatment for panick attacks
refuting of thoughts about dying
what are the aims of humanistic therapies
reducing mechanistic and dehumanising aspects of therapy
helps people get in touch with their feelings - their true selves - and with a sense of meaning in their lives
what are the 2 main therapy types for the humanistic perspective?
gestalt
client-centerred
gestalt therapy
focuses on here and now
what is someone experiencing
empathy chair technique
client-centreted therapy
think abut psychodynamic and CBT
psychodynamic - the therapist itnerprets someone’s life for them and are needed to do so on a regular basis
people seek assistance when life problems occur. These life problems occur when someone’s concept of self is incongruent with their actual experience
CBT
cognitive behavioural therapy
the therapist can assess and diagnosis and are quire directive
Carl Rogers OR Rogerian approach
rejected disease model - “patients” - people come seeking therapy to solve problems not cures for disorders
innate actualising tendencies is interrupted by –> external conditions of worth - standard were have placed on us by others in order to achieve positive regard
problems arise because of a tension between who we are and who we want to be
unconditional positive regard is key to therapeutic change
narrative therapy
tries to have less power imbalances (client has power not expert)
uses externalising techniques
externalising
externalising
separating the person from identifying with the problem
process of narrative therapy
- therapist invites the person to tell the dominant story
- naming and externalising
- exploration / mapping of an alternative story
- thickening the alternative story
eclectic approach
incorporates a variety of therapeutic principles and philosophies -> ideal treatment to meed the specific needs of the client
integrative or holistic therapy
many therapists dont tie themselves to anyone appraoch, instead they blend elements from different appraches ->
integrative stranger theoretical basis to choosing the therapy
biological treatment
treatment to alter the functioning of the brain
targets psychological disorder as a pathology of the brain
what do biological treatments include?
psychotropic medications
electroconvulsive therapy (ECT)
psychosurgery
psychotropic medication
drugs that act on the brain to affect mental processes
personality disorders
chronic, severe disturbances that substantially impair ability to love or work
neuroses
enduring problems in life that cause distress or dysfunction
psychoses
gross disturbances involving a loss of tough with reality