Abnormal - Martyn Flashcards
What is a phobia?
An ‘irrational’ fear of an objectively ‘harmless’ stimulus or situation
Phobia example: Koumpounphobia
- Fear of buttons
- Surprisingly common (approx. 1 in 75.000)
- Fear factor: hygiene, aesthetics
Classification of phobias in DSM-5
Type of anxiety disorder
3 broad categories of phobia:
Agoraphobia - public places/ outside home (complex)
Social phobia - being watched / appraised by others (complex)
Specific phobia - fear of a specific object/item or situation (simple)
What is agoraphobia
- Complex disorder
- Typically develops during adulthood (late 20s)
- Often viewed as fear of open spaces but is more complicated
- Better thought if as a fear of places which are difficult to escape is a panic attack is experienced (shopping malls, cinema etc.)
What is a social phobia?
- Complex disorder
- Typically develops during teenage years
- Fear of embarrassment/humiliation in presence of others
- Leads to avoidance of social situations (often comorbid with agoraphobia)
What are specific phobias?
- Simple phobia
- Fear of a particular object or situation
- Occurs during childhood/teenage years
5 broad categories according to DSM-V:
- Animals
- Natural environment
- Medical/injury related
- Situational (e.g. airplane, driving, lifts)
- Other types (clowns, vomiting, pope)
What causes a phobia?
Behavioural account
- Acquired through experience of phobic stimulus paired with frightening/painful event
- i.e. acquired through classical conditioning
- ‘Little Albert’ most prominent example
Little Albert experiment
Watson & Rayner (1920)
- Albert presented with a rat (conditioned stimulus) and various other animals = no fear
- Albert presented with surprising loud noise (unconditioned stimulus) = fear (unconditioned response)
- Albert presented rat, this time paired with loud noise = fear
- Albert presented with rat = fear (conditioned response)
What is generalisation (phobias)
When stimuli similar to the phobic stimulus also produce a fear response
Social approach to the behavioural account of phobias
- Bandura
- Phobias can be learned from others not just the individual’s own experiences (vicarious learning)
Modelling - watching someone without phobia model behaviour with phobic stimulus can help those overcome fear
Problems with the behavioural account of phobia
- Doesn’t always happen (getting a dog bite doesn’t always mean the person will have a phobia)
- Many people with phobias can’t remember acquiring them
- Small set of stimuli seem to form most phobias (spiders, snakes)
What causes a phobia?
Evolutionary explanation
- Seligman (1971) introduced the preparedness theory of phobias
- Agreed that conditioning was important
- Suggested that evolution has rendered some stimuli more susceptible to phobias (spiders and snakes) than others (plug sockets, pylons)
- Things that were dangerous to humans a while ago causes us to have more phobias towards them
Evolutionary evidence for phobias
- Ohman et al, 1976
- Paired images of neutral stimuli (flowers and mushrooms) and common phobias (spiders and snakes) with a mild electric shock
- During an extinction phase spiders and snakes still produced fear, whilst flowers and mushrooms didn’t
Problems with the evolutionary account of phobias
- Not all stimuli ‘prepared’ for learning actually pose a threat (e.g. small % of spiders actually harmful)
- How do we determine the evolutionary origin of fears
What causes a phobia?
Cognitive account
- We have faulty cognitions about a situation or object (Beck, 1976)
- Overestimate the inherent danger in objects/situations
We demonstrate an attentional bias to these stimuli
Treatments for phobias
- Mostly behavioural
- Systematic desensitisation
- Flooding
- Modelling
What is systematic desensitisation
- Developed by Joseph Wolpe (1958) based on work with cats
Three key stages:
1. Relaxation training (using Jacobsonian progressive relaxation)
- Fear hierarchy - develop list of fearful situations (low-high)
- Counter-conditioning (pair phobic stimulus with relaxation)
What is flooding or implosion therapy
- Extreme version of systematic desensitisation
- Immediate/rapid exposure to either real (flooding) or imagines (implosion) version of phobic stimulus/situation
- Phobic stimulus presented until maximum tolerable anxiety begins to diminish (patient habituates)
- Rapid and effective according to Marks (1975) but can produce intense anxiety and induce panic attacks
What is modelling as a therapy
- Social approach
- Patient observes a therapist/peer ‘model’ successful interactions/behaviour with phobic stimulus
- Bandura used his observations of those with snake phobias to form social learning theory (1977)
- Mineka and Cook (1986) found that when young monkeys observed their parents display fear towards snakes, they too developed the fear
What is Schizophrenia?
A debilitating psychiatric condition which is characterised by the individual demonstrating a loss of contact with reality
Early accounts of schizophrenia (Haslam)
John Haslam (1810)
- Provided detailed notes of patient James Tilly Matthews
- Patient believed he was being controlled by a mind machine, named ‘the air loom’
Early accounts of schizophrenia (Morel)
Benedict Morel
- Case of 13 year old boy whose previously brilliant intellect underwent rapid decay
- Boy became withdrawn & displayed homicidal thoughts to his father
- Termed the disorder “dementia praecox” (premature dementia)
- Believed brain had degenerated –> hereditary
Early accounts of schizophrenia (Kraepelin)
Emil Kraepelin
- Described “dementia praecox” in detail
- Believed mental deterioration in early life
- Focused on aetiology –> suggested its hereditary
- Considered physical abnormalities as signs of markers for conditions e.g. deformities of fingers and toes
Early accounts of schizophrenia (Bleuler)
Eugen Bleuler
- Disagreed with term “dementia praecox”
- Believed it can appear before/after adolescence
- Deterioration is not the only outcome
- Focused on the psychological aspects of the condition and provided us with the diagnostic term ‘schizophrenia’
Bleuler’s 4 fundamental psychological aspects of schizophrenia
- Blunted affect (reduced emotional response to stimuli)
- Loosening of associations (disordered/contradictory responses)
- Ambivalence (unable to make decisions)
- Loss of awareness of external events (preoccupied on internal world)
Prevalence of schizophrenia
- Affects approx. 1% of the population
- Typically onset during 20-30
- Affects men (tens/20s) and women equally (20s/30s)
Positive symptoms of schizophrenia
An excess of experience (hearing thing that aren’t there)
- Delusions (fixed beliefs that have no basis in fact)
- Hallucinations (‘perceptions’ without external stimulus)
- Disorganised thinking/speech/behaviour
What are delusions in relation to schizophrenia
An erroneous belief held with conviction despite contradictory evidence
Different types of delusions e.g.:
- Persecution (people plotting against individual)
- Grandiose (person has great fame, power, wealth)
Very common approx. 90% diagnosed experience there (Cutting, 1995)
What are hallucinations in relation to schizophrenia
A sensory experience without an external stimulus to provoke it
- Auditory hallucinations are most common; approx. 70% (Sartorius, Shaprio & Jablensky, 1974)
- Visual less common; approx. 40%
- Other types approx. less than 10%
Not uncommon to hear voices at some point but not persistently (Crowe et al., 2011)
Disordered thoughts, speech and behaviour (schizophrenia)
Thoughts: difficulty in concentrating - hard to complete tasks
Speech: difficulty in making sense - may jump around in conversation or appear to present logical sentences but have made up words (e.g. ‘air loom’). Sometimes may become a word salad
Behaviour: may dress oddly to others, demonstrates odd reactions
Negative symptoms of schizophrenia
The absence of normal behaviour/experiences (appearing emotionless)
5 As
- Blunted affect: reduced emotional response to stimuli
- Alogia: diminished speech output, difficult to communicate with others
- Anhedonia: inability to feel pleasure during enjoyable activities (emotionless)
- Asociality: reduction in social initiative
- Avolitation: inability to complete goal directed tasks due to lack of motivation or drive
Cognitive symptoms of schizophrenia
Deficits in cognitive abilities (working memory, attention)
- Difficulty in sustaining attention
- Impaired working memory
- Poor abstract thinking
- Poor problem solving
- Low psychomotor speed (e.g. reaction time tasks)
What is the prodromal phase (schizophrenia)
- Most (not all) go through a prodromal phase
- Development of symptoms such as social withdrawal, loss of interest in normal activities
- Occur before active-phase symptoms which marks the disturbance as schizophrenia
What causes schizophrenia?
- Genetics
- Biology
- Environment
- Psychosocial factors
- Gene x environment
Role of genetics in schizophrenia
Greater % of genes share = greater risk of developing schizophrenia
- 12.5% genes shared (3rd degree relatives e.g. cousins)
- 25% genes shared (2nd degree relatives e.g. nieces, grandchildren, half siblings)
- 50% genes shared (1st degree relatives e.g. siblings, parents)
MZ (identical) twins have concordance rates of 40-50%
- Contenders for liability include DISC1, DTNBP1, NRG1 and RGS4 (Sullivan, 2005)
Dopamine-hypothesis of schizophrenia
- In 1950s, Chlorpromazine was used in clinical practice. Researchers noted tranquillising effect then noted anti-psychotic effect
- Chlorpromazine prevents excess dopamine = reduce symptoms of disorder
- L-Dopa given to Parkinson sufferers (linked with low levels of dopamine) = produce symptoms of schizophrenia
Neurological damage with schizophrenia
- Schizophrenics with negative and cognitive symptoms exhibit neurological damage
- Enlarged ventricles commonly seen; correlated with decrease in volume of other areas e.g. Thalamus (Gaser et al., 2004)
Neurological damage with schizophrenia - causes
- Greater risk of schizophrenia if born in winter months
- Greater risk of child experiencing schizophrenia if mother experiences influenza in 2nd trimester
- Pregnancy complications: low birth weight, prolonged labour, umbilical cord around the neck
- Maternal stress: High levels of stress to the mother during pregnancy = more likely to develop schizophrenia
- Nutritional deficiency: lack of nutrients also implicated; those deprived of essential nutrients show greater rise of developing
Psychosocial factors of schizophrenia: Family and emotional expression (EE)
- Brown (1958) better to live alone or with siblings than parents or spouse after hospitalisation
- Due to emotional expression = hospitality, criticism and emotional overinvolvement (based on interview with researcher)
- Families with high EE = higher relapse (Vaughn & Jeff, 1976)
Psychosocial factors of schizophrenia: Urban living
- Pederson and Mortenson 2001
- 1.9 mill Danish in sample
- Registered on a national database which updates if they move
- Children who lived in urban environments for their first 15 years were 2.17x more likely to develop schizophrenia
- Unknown why urban living is bad in this contxt
Psychosocial factors of schizophrenia: Immigration
- Cantor-Grace and Selton 2005
- First generation immigrants 2.7x more likely to develop schizophrenia
- Second generation 4.5x greater risk
Psychosocial factors of schizophrenia: Drug use
- Certain drugs increase risk . of schizophrenia e.g. cannabis (amphetamines also induce symptoms of psychosis
- A meta-analysis (Henquet et al., 2005) revealed that young heavy cannabis users were 2x as likely as non-users to develop schizophrenia
Treatments for schizophrenia
- Primarily treated as a biological disorder
Pharmacological approaches
- Typical antipsychotics
- Atypical antipsychotics
Psychosocial approaches
- Family therapy
- Social skills training
- Cognitive remediation therapy
- Cognitive behavioural therapy
Pharmacological treatments for schizophrenia
Front line treatments consists of anti-psychotic drugs
2 main types:
- Typical anti-psychotics (first generation) developed during 1950s e.g. chlorpromazine; reduce positive symptoms
- Atypical anti-psychotics (newer generation) developed during 1990s e.g. clozapine; reduce positive and negative symptoms
Side effects of pharmacological treatment
Typical anti-psychotics - extrapyramidal side effects e.g. movement disorder such as tremor, facial movement
Atypical anti-psychotics - Reduction in extrapyramidal side effects, but weight gain
Non-adherence - issue with both treatments up to 74% of patients stop taking medication resulting in relapse
Psychosocial treatments for schizophrenia: Family therapy
- One of the most effective
- As effective as anti-psychotics (McFarlane, 2016) in terms of preventing relapse
- Includes elements of CBT
- Family-patient partnership at heart of treatment; family act as collaborator (not the source of treatment)
- Reduce levels of EE and educate about the disorder
- Looks at coping skills
Psychosocial treatments for schizophrenia: Social skills training
- Social adjustment and obtaining employment are still low even with anti-psychotics
- Goal is to provide training on improving social interactions
- Uses some behaviour and modelling techniques with corrective feedback and role play
Psychosocial treatments for schizophrenia: Cognitive remediation therapy
- Cognitive performance tends to be poor over course of disorder thus aim is to provide training on improving cognitive performance
- Teaches individual methods of strategic information processing
- Individualises therapy and focuses on implementing strategies in the real world
- Meta-analysis revealed that therapy not only produced effects in cognitive performance, but also in symptoms experienced and psychosocial functioning (McGurk et al., 2007)
Psychosocial treatments for schizophrenia: Cognitive behavioural therapy
- Not historically used but has been researched more recently
- Goal is to explore nature of patient’s delusions and hallucinations and asses their validity
- Evidence mixed, may help positive symptoms but not negative
