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Abnormal Psychology > (2) Biomedical model, focus on diagnosis > Flashcards

(2) Biomedical model, focus on diagnosis Flashcards

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1
Q

Guiding framework/model or paradigm are used to:

A
  • Organize the available information about the onset and development of maladaptive behaviour
  • Identify factors involved in psychological disorder and therapy
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2
Q

What is the explanation for the biomedical model?

A

Explanation: psychological symptoms caused by biological factors

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3
Q

What are the aims of the biomedical model?

A

identify the agent, or the mechanism

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4
Q

What is the treatment of the biomedical model?

A

medication, surgery, shock therapy

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5
Q

What did Kraepelin view abnormal behaviour as?

A
  • View of disordered behaviour as due to organic causes (1856-1926)
  • Emphasised the classification of abnormal behaviours into discrete disorders
  • The view was of major importance in contributing to the emphasis of the medical approach to human problems
  • Discrete disorders
  • Certain symptom patterns occurred together regularly enough to be regarded as specific types of mental diseases
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6
Q

After the 70s what was behaviour viewed as?

A

Behaviour was then considered to be a function of an interaction of biological, psychological and social variables, abnormal behaviour was due to organic causes started decreasing

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7
Q

How does Schizophrenia develop?

A

heredity

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8
Q

How does depression develop?

A

chemical imbalances within the brain

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9
Q

How does anxiety develop?

A

defect within the autonomic nervous system

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10
Q

How does dementia develop?

A

impairments in structures of the brain

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11
Q

What are the risks of brain damage?

A

risk of psychopathology

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12
Q

What is Neural plasticity?

A

Flexibility of the brain in making changes in organization/function, existing neural circuits can be modified/new circuits can be generated

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13
Q

Who is at risk of brain defects?

A

Increased risk among the elderly due to age processing itself

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14
Q

What can cause disorders?

A

A disorder can be caused by either too much or too little of a particular neurotransmitter

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15
Q

How can hormonal imbalances effect brain disorders?

A

Hormones = chemical messengers secreted by a set of endocrine glands in our bodies

  • Travel through our bloodstream affecting various parts of our body and brain
  • CNS (central nervous system) linked to endocrine system
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16
Q

What is an example of a chromosomal abnormality?

A

Chromosomal abnormalities: down’s syndrome

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17
Q

what is physical deprivation associated with?

A

-Implicated in attention deficit disorder, depression, anxiety, eating disorders

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18
Q

What is a humans basic needs?

A

food, oxygen, water, sleep, elimination of waste

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19
Q

What are some examples of medical treatment?

A
  • Brain stimulation therapies
  • Surgery
  • Pharmacological approaches
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20
Q

What is insulin shock?

A
  • Introduced by Sakel in 1933
  • Used mainly for schizophrenia in the 1940s and 1950s
  • Involved inducing repeated comas via insulin injection over weeks or months
  • Risks included obesity, seizures, brain damage or even death (mortality rate 1-5%)
  • Initially thought effective, but randomised controlled trials found that this was not the case (Ackner et al., 1957)
  • Fell out of use by the 1960s, to be replaced by medication
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21
Q

What is a Lobotomy?

A
  • Prefrontal lobotomy was a common neurosurgical procedure: from 1935-55 over 40,000 were performed
  • Involved severing the frontal lobes from the rest of the brain
  • Developed by Egas Moniz who won the Nobel prize in 1949; later shot by former patient
  • Popularised in the US by Walter Freeman
  • Result: up to 4% death, inability to control impulses…
  • Highly controversial
22
Q

The story of Rosemary Kennedy

A
  • Slow development
  • Private home tuition, good family life lead to improvement
  • At 21 became frustrated, violent, ran away
  • Prefrontal lobotomy wiped out speech and personality
23
Q

What -Brain stimulation therapies are currently used?

A
  • Electroconvulsive therapy (ECT)
  • Deep brain stimulation (DBS)
  • Transcranial magnetic stimulation (TMS)
24
Q

What surgery is currently used?

A

Surgery: Neurosurgery for mental disorder (NMD)

-Pharmacological approaches

25
Q

What is electroconvulsive therapy (ECT)?

A
  • Inducing seizures under general anaesthesia & with muscle relaxants
  • Passing electrical currents (150 volt for one second) through a patient’s head
  • Every neurotransmitter system is affected by ECT, but not entirely clear how it works
  • Each year around 100 000 patients treated in USA
  • Now used with patients who have not responded to other treatments. Very effective for acute treatment
  • Relatively safe; side effects include: headache, muscle ache, nausea and temporary memory loss
  • High relapse rate (e.g. Kellner et al., 2006)
26
Q

What is Transcranial magnetic stimulation (TMS)?

A
  • Used for treatment-resistant depression and anxiety
  • Electromagnetic coil sends magnetic pulses through the patient’s scalp into the brain
  • These affect the function of neural circuits involved in mood, though unclear how
  • Pulses are more focused than ECT: can stimulate brain regions involved in mood
  • Meta-analysis by Slotema et al. (2010): TMS is effective for acute depression
27
Q

What is Deep brain stimulation (DBS)?

A
  • Involves implanting electrodes in specific parts of the brain to deliver electrical stimulation
  • Used for severe, treatment-resistant depression and OCD
  • Currently only used experimentally, but seems effective (e.g. Mayberg et al., 2005)
  • Patients reported a “lifting of the void” and “connectedness”
  • BUT DBS requires brain surgery, so should be a last resort
28
Q

What are Neurosurgery for mental disorder (NMD)?

A
  • Involves destroying or ablating minute areas in the brain that might contribute to mental illness.
  • Much more focused than prefrontal lobotomy/leucotomy
  • Used very rarely for treatment-resistant depression and OCD
  • Adverse effects: transient headaches, but no change in skill or personality
29
Q

What are antipsychotics?

A
  • Psychotropic medication – any medication capable of affecting the mind, emotions & behaviour
  • Antipsychotics - reduce delusions and hallucinations by blocking dopamine receptors
  • Used for schizophrenia, mania, Tourette’s syndrome, and psychotic episodes
  • Introduced in 1955; powerful impact on quality of treatment and interaction with patients
  • Persistent use / high dosage = side effects (e.g. involuntary twitching); new expensive types less side effects
  • Not serious side effects, however there are some
30
Q

What are Antidepressants ?

A
  • Several types, acting on different neurochemicals
  • Most common: tricyclics and selective serotonin reuptake inhibitors (SSRIs)
  • Equally effective
  • Extremely popular; on the increase
  • Some side effects (nausia, insomnia, sexual problems)
  • Used in other disorders such as bulimia, anxiety disorders, OCD, chronic pain…
31
Q

What are Anti-anxiety (anxiolytics)?

A
  • Sedative and muscle-relaxing properties, but highly addictive
  • Patients become drowsy, lethargic
  • Efficacy and side effects vary between individuals
32
Q

What is Lithium?

A
  • Used for the treatment of bipolar disorder
  • Lightest of metals; inorganic salts; unknown mechanism
  • Dosage crucial (toxic), and very individual (close monitoring)
  • Very effective (70-80%) in Bipolar
  • Also effective sometimes with unipolar depression
  • Side effects: thirst, gastro problems, weight gain, tremor and fatigue
33
Q

Advantages of Biomedical approach

A
  • Suggests a clear mechanism for most disorders: discredited ‘possessions’ or supernatural explanations
  • Has been particularly effective in delivering insights into disorders with a clear biological cause, e.g. Alzheimer’s
  • Absolves patients of responsibility, guilt and blame for their condition, since there is an objective biological explanation
  • Drug treatment has revolutionised patient care: it is generally effective and is faster than other therapies
  • Treatment based on the scientific method: in theory this means treatments should only be adopted if proven effective
  • Can be quick but doesn’t treat the cause
34
Q

Example: antidepressants

A
  • One recent meta-analysis suggested SSRI anti-depressants were no more effective than placebo, except in severe cases (Kirschal., 2008)
  • But another showed that the picture is more complicated: patients are either responders or non-responders (Gueorguieva et al. 2011) Gueorguieva et al. (2011) analysed data from 7 trials (2515 patients)
  • 76% responded to SSRI/SNRIs, but 24% did not
  • Looking at the whole sample, the treatment efficacy would not have been clear.
35
Q

What are some Limitations to the biomedical approach?

A
  • Historically, some treatments were unsafe and ineffective Even now, most treatments have side effects
  • We still do not know exactly how medications work
  • Most importantly, are we treating the underlying cause, or just symptoms? Are drugs used as a ‘chemical straitjacket’ to subdue patients rather than cure them?
  • Usage in children controversial, as interactions with brain development are still unknown
  • Drug development depends on rigorous methods and the integrity of researchers and drug companies
36
Q

Example: antipsychotics in childhood

A
  • Controversial rise in paediatric bipolar diagnosis, mostly in US: 40-fold increase between 1994 and 2003 (Moreno et al., 2007)
  • Treated with atypical antipsychotic drugs
  • Administration Report: 500,000 children prescribed these in US
  • These drugs also frequently used for ADHD and conduct disorder
  • Use is controversial: side effects (drowsiness, nausea, weight gain, diabetes…) and unknown effects on developing brain
  • Increased risk of sudden cardiac death (Ray et al., 2009)
37
Q

What is the DSM?

A
  • Summarizes all the diagnoses
  • Specifies what must be present to make a given diagnosis
  • Organises the diagnoses into a classification system
  • Constantly revised
  • There have been several revisions since it was first published in 1952; currently in its fifth edition DSM-5
  • Gradually including more mental disorders
  • Some have been removed and are no longer considered to be mental disorders, e.g. homosexuality
38
Q

DSM 1 (1952) 132 pages:

A

Contained vague criteria heavily influenced by psychoanalytic theory & an attempt to standardize diagnostic practices in use among military personnel in WWII.

39
Q

DSM 2 (1968) 119 pages:

A

included some new disorders but it was not much different from first edition

40
Q

What did DSM 1 and 2 have in common?

A

Vague and unclear criteria for the diagnostic classification - Lack of homogeneity within categories, low reliability and validity, for instance: Beck et al. (1962) found that 4 experienced clinicians using DSM-I to diagnose 153 patients agreed on their diagnosis only 54% of the time

41
Q

DSM 3 (1980) 494 pages:

A

Lists and describes over 200 specific diagnostic categories or disorders
-Increase in the specificity of criteria: e.g. specified for HOW long the person must show the symptoms of the disorder to be given the diagnosis

42
Q

What was wrong with DSM 3?

A
  • Clinicians agreed on their diagnosis only about 70% of the time (Kirk & Kutchins, 1992)
  • The criteria were still vague and required clinicians to make inferences about the client’s symptoms
43
Q

DSM 4 (1994):

A

Conservative approach: The reasons for changes in diagnosis would be explicitly stated and clearly supported by data

44
Q

DSM 4 TR (2000) 943 pages:

A

Changes related to prevalence rates, course, and etiology Cultural and ethnic considerations included

45
Q

Categorical approach:

A

Disorders are discrete –Are they really? What about comorbidity? Assumes that: All human behaviour can be divided into the categories of ‘healthy’ and ‘disordered’.

46
Q

Dimensional approach:

A

Person’s behaviour is a product of deferring strengths and intensities of behaviour along several definable dimensions such as mood, emotional stability, etc.

47
Q

DSM 5:

A
  • The boundaries between many disorder categories are fluid over the life course – DSM-5 claims to be based on, or, at least is moving towards dimensional approach
  • Symptoms assigned to one disorder may occur in many other disorders
  • The client’s cultural and social context must be considered
  • Making diagnoses requires clinical judgment, not just checking off the symptoms in the criteria
48
Q

Diagnoses are made based on:

A
  • The clinical interview
  • DSM-5 text descriptions
  • DSM-5 criteria
  • Clinician judgment
  • Need to take symptoms into account
49
Q

Controversy over DSM 5

A

-Can lead to over-diagnosis and over-medication

50
Q

Advantages of DSM

A
  • Clarifies concepts
  • Diagnosis have clinical utility - helps clinicians to determine prognosis and treatment plans
  • Enables treatment – advantage for patient
  • Enables research, etc
51
Q

Disadvantages of DSM

A
  • Overlap between disorders (comorbidity)
  • Proliferation of disorders
  • Human error
  • Stigma associated with having a psychiatric diagnosis Etc.
  • Stigma despite information being provided
  • Stereotyping and labelling
52
Q

International classification of diseases (ICD) – 10

A
  • ICD-10 chapter V: Mental and behavioural disorders
  • Part of the International Classification of Diseases
  • Produced by the World Health Organization (WHO)
  • Another commonly used guide (Europe and other parts of the world)
  • DSM coding systems corresponds with the codes used in the ICD
  • This not true always because the two publications are not revised synchronously

Abnormal Psychology (7 decks)

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