Disorders Flashcards
Phobias - Characteristics of disorders
ANXIETY DISORDER
> TYPES OF ANXIETY DISORDERS
- Panic disorder
- Generalised anxiety disorder
- Phobic disorder (Phobias)
- OCD
- Post traumatic stress disorder
> CHARACTERISTICS
- Psychological such as racing heart and disturbed breathing / sweating.
- Behaviour discomfort and nervous gesturing.
- Cognitive distraction
- Preoccupation with unwanted thoughts
> DSM-IV
- Marked and persistent fear that is excessive or unreasonable.
- Exposure to phobic stimulus provokes immediate anxiety response.
- Patient recognises fear as excessive.
- Phobic situation is avoided.
- Phobia disrupts normal life.
- Phobia has lasted more than 6 months in ppl under 18 yrs.
> ICD-10
- Psychological or automati symptoms must be primary manifestation of anxiety, and not secondary to other symptoms such as delusions.
- Anxiety must be restricted to the presence of the particular phobic object or situation.
- Phobic situation is avoided.
> EVALUATION
- Reliability - consistency of diagnosis. Same symptoms should be diagnosed in exact same way - Inter-rater reliability can improve reliability.
- Validity - Relate to Rosenhan (Sane in Insane Places)
- Type 2 errors - Safer for practitioner to assume person has illness.
- Compare ICD-10 and DSM-IV
Schizophrenia - Characteristics of disorders
PSYCHOTIC DISORDER
> TYPES OF ANXIETY DISORDERS
- Schizophrenia
- Paranoia
- Catatonic Schizophrenia
- Psychosis - drug induced.
> CHARACTERISTICS
- Major disturbances of thought, emotion and behaviour.
- Loss of touch with reality.
- Withdrawal from outside world
- Confusion and disorientation
- Hearing voices
- Hallucinations
- Problems with thinking / lack of emotional response
> DSM-IV
- Delusions
- Hallucinations
- Disorganised speech / behaviour
- Negative symptoms
- Social / Occupational dysfunction
- 6 months duration
- No other explanation (eg. medication)
> ICD-10
- Delusions of control
- Hallucinatory voices
- Persistent delusions
- Persistent hallucinations
- Incoherence or irrelevant speech
- Catatonic behaviour
- Negative symptoms such as marked apathy.
Depression - Characteristics of disorders
AFFECTIVE DISORDER
> TYPES OF ANXIETY DISORDERS
- Bipolar disorder
- Post-natal depression
- Manic depression
> CHARACTERISTICS
- Lack of concentration
- Pessimism
- Low self-esteem
- Fatigue
- Prevents person from leading a normal life
- Feelings of despair
- Mood swings
> DSM-IV
- Insomnia most nights
- Fidgeting or lethargy
- Tiredness
- Feelings of worthlessness or guilt.
- Less ability to concentrate.
- Recurrent thoughts of death
- Not caused by other factors eg. medicine or bereavement
> ICD-10
- Depressed mood
- Loss of interest and enjoyment
- Reduced energy
- Marked tiredness only after slight effort.
- Reduced concentration and attention
- Reduced self-esteem and self-confidence
- Ideas of guilt and unworthiness
- Bleak and pessimistic views of the future.
- Ideas or acts of self-harm or suicide.
Lewinshon et al - Explanation of an AD (Depression)
BEHAVIOURAL
Efficacy of a ‘coping with depression’ course.
> AIM to evaluate the efficacy of a ‘coping with depression’ course.
> SAMPLE 69 teenagers (15-18), all diagnosed with depression from Oregon. Any other treatments had to be stopped before could take part. Only collected data from 59 as 10 dropped out.
> PROCEDURE Longitudinal - Independant design.
3 groups - p’s randomly assigned
G1 - Received the course
G2 - received the course and parents enrolled in group
G3 - Control group - told they were on waiting list.
- P’s assessed by interviews before, during and up to 2 years after treatment.
- P’s on waiting list referred to other treatments if they could not wait, received the treatment at end of study.
- Treatments controlled by having detailed manuals for therapists and homework and handouts for patients.
- G2 parents taught how to enforce positive changes in their depressed children.
- G1 and G2 - 14 (2 hour) sessions over 7 weeks.
- Focused on relaxation methods, controlling irrational and negative thoughts, increasing social skills and taking part in pleasant events.
- Based on experimental learning.
> RESULTS At the end of treatment
- G1 - only 57% still showed depressed symptoms.
- G2 - only 52% still showed depressed symptoms.
- G3 - little change, 94% still depressed.
> CONCLUSION There was efficacy in the course (which reinforced change in negative behaviour with rewarding pleasant events and positive parental reinforcement).
- Although there is an element of the cognitive behavioural treatment - the behavioural reinforcement is an integral part of this treatment.
Wender et al - Explanation of an AD (Depression)
BIOLOGICAL
Genetic / environment factors in mood disorder.
> AIM to investigate the contributions of genetic and environmental factors in the course of mood disorders.
> SAMPLE adoptive and biological parents of 71 adult adoptees (mean age 43) who had a mood disorder
Control group > 71, mean age 44 - psychologically normal
- From Denmark
> PROCEDURE Psychiatric evaluation of the relative were made by independent blind diagnosis of mental hospital records and other official records in Denmark.
> RESULTS Among the biological relatives of the participant with mood disorder - there was 8 times more unipolar depression than in the adoptive relations.
- There were 15 times more suicides amongst the biological relatives of the participants with mood disorder compared to the adoptive parents.
- There was no significant difference in the incidence of mood disorder amongst the biological and adoptive parents of participants without mood disorder.
> CONCLUSION There is a significant genetic link between unipolar depression and suicide. There is obviously a significant genetic input into the onset of schizophrenia but with concordance rates of less than 100%, there must be some interaction with the environment. There is also some confusion as to whether there is one or there are many genes responsible for causing schizophrenia.
> EVALUATION Second hand data - not reliable - unable to repeat
- Sample size - generalisable
- Ethnocentric
- Useful - Can help to recognise children who are susceptible to mood disorders.
Beck et al - Explanation of an AD (Depression)
COGNITIVE
Cognitive distortions in patients w depression.
> AIM to understand the distortions
> SAMPLE - 50 patients w depression
16 men, 34 women, aged 18-48, mid-upper class, average IQ
(control group - 31 non-depressed patients)
> PROCEDURE face-to-face-interviews (self-report)
- reports of patients thoughts before, during and after interviews - some p’s kept diaries.
- records were kept of non-depressed patients thoughts
> RESULTS certain themes appeared in depressed p’s that didn’t appear in control group.
- Depressed p’s : low self esteem, self-blame, overwhelming responsibilities, desire to escape, anxiety, paranoia - stereotypical responses to situations - feel inferior in social / occupational groups.
- some patients - unlovable and depressed.
- distortions: automatic and involuntary.
> CONCLUSION Even in mild depression, patients have cognitive distortions that deviate from realistic and logical thinking - only related to depression and no other areas.
> EVALUATION - not generalisable - upper/mid class
- only 16 males - all at least av. intelligence
- wide age range
- High eco valid - quasi exp - all had depression
- self-report - may not be valid.
- therapy is a effective and useful treatment for depression
Karp + Frank - Explanation of an AD (Depression)
BIOLOGICAL
Comparing drug treatments for depression.
> AIM to compare drug treatments and non-drug treatments for depression.
> SAMPLE focused mainly on women diagnosed w/ depression.
> PROCEDURE Depression analysed using variety of depression inventories
- Patients generally tested prior to treatment and post-treatment and some after a period of time after treatment.
- Health practitioners carried out assessments of symptoms.
> RESULTS Adding psychological treatments to drug therapy didn’t increase the effectiveness of the drug treatment.
- Occasionally studies showed less attention when combination therapies were used. This means people were more likely to continue with treatment if cognitive therapy was used with drug therapy.
> CONCLUSION Although it would seem logical that two treatments would be better than one, evidence doesn’t show any better outcomes, therefore drug therapy = effective.
> EVALUATION The biological medical model has been criticised for making people become patients. There is little emphasis on self-help and getting well and more on becoming a patient = professionalised
- Chemotherapy and other biological treatments can have several side effects. eg. Prozac can cause a psychotic state.
- One could argue that drugs only treat symptoms and not the cause.
- However, a range of biological treatments have helped improve the lives of millions of people who without this treatment would not be able to function adequately.
Beck et al - Treatments of an AD (Depression)
COGNITIVE (+ DRUG therapy)
Comparing cognitive therapy and drug therapy.
> AIM to compare effectiveness of cognitive therapy and drug therapy.
> SAMPLE 44 patients diagnosed with moderate to severe depression who were attending clinics.
> PROCEDURE Patients arrived with 3 self-reports (before treatment) using Beck Depression Inventory, Hamilton Rating Scale and Raskin scale.
- For 12 weeks, patients had either two 1 hour cognitive sessions or 100 imipramine capsules.
- Therapists observed to ensure reliability.
> RESULTS Both groups showed significant decrease in depression symptoms in all 3 scales.
- Cognitive treatments group showed significantly greater improvements - Average of 78.9% improvements vs 20% of drug therapy.
> CONCLUSION cognitive therapy leads to better treatment of depression, shown by fewer symptoms being reported and observed, and also better adherence to treatment.
> EVALUATION Cognitive therapy leads to better treatment of depression.
- Fewer symptoms individs suffer from
- Biological Treatments have higher risk factor
- Rating scale - open to interpretation
- High in eco. valid - patients already depressed - already attended clinics.
Lewinshon - Treatments of an AD (Depression)
Positive reinforcement with depression.
> AIM To compare the amount of ‘positive reinforcement’ received by depressed and non-depressed patients.
> SAMPLE 30 depressed patients.
> PROCEDURE Quasi experiment
- Longitudinal (30) days
- P’s asked to check their mood daily using the depression adjective checklist - p’s ticked ones they felt that day.
- P’s asked to complete the pleasant activities scale (voting 320 activities) (eg. Yoga)
- Rated on a scale of pleasantness and frequency.
> RESULTS significant positive correlations between mood and ratings and pleasant activities - more positive mood ratings
- Individual differences, from a correlation from 0 to 0.66
> CONCLUSION Link between reinforcement from some pleasant activities and mood
- More research needed into identifying the individual characteristics that make some people more influenced by pleasant activities than others.
> EVALUATION Small sample (30)
- Usefulness > Shows that if people lose the positive reinforcement for living normally (going to work, school etc) they may become depressed - eg. people ask you how your day was most days at a new job but not so much once the novelty wears off.
