HISTORICAL CONTEXT OF MENTAL HEALTH

Question 1

6500 BC

Answer 1

Due to witchcraft, religion and demonic possession
Ancient Egyptians and early Chinese believed it was punishment for wrong doings
Trepanning used up until WW1 to treat migraines, epilepsy and insanity- drill into skull to relieve pressure

Question 2

800-7000 BC

Humoral Theory

Answer 2

Hippocrates believed mental illness was caused by physiology
Human body composed of four bodily fluids:
-blood, phlegm, black bile, yellow bile (produce personality)
Mental illness occurred if one humour was in excess
Treatment:
-diet/exercise, bloodletting, laxatives

Question 3

1247-1500s

Asylums

Answer 3

Late 13th century to 16th mental hospital established
Meant to be a safe place, intact dehumanising
Places where new treatments were tested
-hydrotherapy (sprayed with water to stimulate them)
-convulsion therapy (stimulates senses)

Question 4

A moral view

Answer 4

Late 18th century ‘moral treatment’ advised good nutrition, hygiene and a productive day
Px allowed out of their rooms

Question 5

Psychogenic (talking therapy)

Answer 5

Mental illness seen as psychological rather than physiological or spiritual
Freud- talking therapy
Treatment focussed on psychoanalysis

Question 6

Mid-late 1900s

Medical view

Answer 6

Caused by genes, neurotransmitters, hormones, etc
Mental illnesses have external symptoms
Treated with drugs, electroconvulsive therapy

Question 7

Explain deviation from social norms as an abnormality

Answer 7

Standards of acceptable behaviour that are set by the social group and adhere to those norms but if you deviate from them you are abnormal

Question 8

Strengths of deviation of social norms

Answer 8

Distinguish between desirable and undesirable behaviour, society determines what is desirable
Deviance is related to context and degree

Question 9

Weaknesses of deviation from social norms

Answer 9

Cultural relativism- social norms vary in culture

Question 10

Explain statistical infrequency

Answer 10

Anybody who is above or below the norm/average will be classed as abnormal (bell curve, standard deviation greater than 2)

Question 11

Strengths of statistical infrequency

Answer 11

Clinical diagnosis- objective, can be compared against statistical norms

Question 12

Weaknesses of statistical infrequency

Answer 12

Cut off points may be subjective

Hard to distinguish between desirable and undesirable behaviour

Question 13

Factors of categorising mental disorders

Answer 13

Classification system
List of symptoms a Px needs to exhibit for a certain period of time
Two types of diagnostic tool- DSM-5 and ICD-10

Question 14

Factors of the DSM-5

Answer 14

2013
Fifth edition= latest scientific thinking
Allows clinicians to make accurate consistent diagnosis
Based on Western culture

Question 15

What are the sections of the DSM-5

Answer 15

How manual should be used
20 categories of disorders |(e.g. psychotic and anxiety), listed in lifespan order, may have spectrums or severity
Assessment tools and discussion of cultural concepts or disorders to reduce cultural bias

Question 16

Factors of the ICD-11 (International classification of diseases)

Answer 16

Identifies trends and statistics relating to injuries, sickness and death
Each disease has a description of main features and any important associated features
Indicates how each feature and balance required between each different type needed to make accurate diagnosis

Question 17

What are validity issues with using technology to diagnose mental disorders
Ford and Widgier

Answer 17

Does label given reflect an accurate measure of symptoms?
Ford and Widgier (1994) found that presenting same symptoms but changing gender results in diff diagnosis
Females- histrionic personality disorders
Males- anti-social disorders

Question 18

Cheniaux (2009)- validity of mental disorder classification

Answer 18

2 psychiatrist’s independently diagnosed 100Px using both DSM and ICD
1- 26 diagnosed with Sz (DSM) and 44 (ICD)
2- 13 Sz (DSM) and 24 (ICD)
Poor criterion validity (whether similar measurements arrive at the same result)

Question 19

Evidence for high inter-rater reliability

Answer 19

Anxiety and mood disorders- 362 outpatient
2 independent interviewers using anxiety interview using DSM-4
High levels between them
Disagreements- whether symptoms severe enough to meet criteria/gain a diagnosis
Hard to classify boundaries particularly regarding depression and anxiety

Question 20

Aim of Rosenhan

Answer 20

Test the hypothesis that psychiatrists cannot reliably tell the difference between people who are sane and those who are insane

Question 21

Sample and procedure Rosenhan

Answer 21

P observation
8 sane people (3F and 5M), acted as pseudo Px
-fake names, symptoms, etc
Px arranged appointments at hospital, complained they heard ‘thud, empty, hollow’
Once admitted, told to get out on their own, by convincing staff they were sane
Px were observers

Question 22

Results from Rosenhan:

Diagnosis

Answer 22

Px were admitted and were eventually discharged with a diagnosis of Sz in remission
None of the pseudo Px were suspected by staff but some actual Px had suspicions

Question 23

Results:

Distortion of behaviour

Answer 23

Note taking was recorded by nurses, implying it was part of the disorder
Waiting outside of cafe before lunch was interpreted as ‘oral-exquisite nature of the syndrome’

Question 24

Lack of normal interaction

Answer 24

Doctors ignored requests about being discharged

Doctors and nurses spent 7 minutes per patient a day

Question 25

Powerlessness (Rosenhan)

Answer 25

Medical records available to all staff- lack of privacy and personal hygiene monitored

Question 26

Attitude to medication

Answer 26

2100 tablets administered in total 2 swallowed
Flushed down toilet, bound tablets from real Px
As long as cooperative, behaviour went unnoticed

Question 27

Conclusions from Rosenhans

Answer 27

Doctors cannot reliably tell the difference between sane and insane, failure or identifying illness may be worse than classifying a healthy person as sick
Expectations that people are ill due to context, therefore suggesting diagnosis is invalid as it relies on situation not behaviour
Stickiness of psychodiagnostic label- once pseudo Px had been labelled there was nothing they could do

Question 28

Aim for study 2 by Rosenhan

Answer 28

Once aware of participating in study, the doctors and nurses would be under caution when diagnosing pseudo Px
Therefore, whether the Ps would make type 2 errors- missing diagnosis when a mental disorder exists

Question 29

Sample and procedure for exp 2

Answer 29

Staff asked to rate on a 10 point scale each new patient as to the likelihood for them being a pseudo patient

Question 30

Results from exp 2 (pseudo)

Answer 30

One member of staff- 41
One psychiatrist- 23
Psychiatrist and member of staff- 19

Question 31

Strength of Rosenhan

Answer 31

Field exp- eco validity (psychiatric hospital)
Long period of time
Exp 2- inter rater reliability
Large sample- 193, exp 2

Question 32

Weaknesses of Rosenhan

Answer 32

Not a balanced sample- 3 females, 5 males, not representative
Exp 2- one hospital used- cannot compare

Question 33

What are behavioural characteristics/symptoms of specific phobias

Answer 33

Avoidance of specific object/situation

When they can’t avoid it they panic- fight or flight

Question 34

Emotional symptoms of phobias

Answer 34

Excessive and unreasonable fear

Triggered by specific object

Question 35

Cognitive symptoms of phobias

Answer 35

Selective attention

Causes person to be fixate on the object they fear due to irrational beliefs about potential danger

Question 36

What is a psychotic disorder

Answer 36

Characterised by abnormal perception and thinking
Px lose touch with reality, meaning they are not aware of their mental state
E.g. schizophrenia

Question 37

Positive symptoms of schizophrenia

Answer 37

Presence of symptoms
Hallucinations (hear/smell things)
Auditory 
Visual 
Tactile- feeling of movement on the body

Question 38

Negative symptoms of Sz

Answer 38

Absence/lack of normal mental functioning
Trouble with speech
Withdrawal- no longer making plans
Lack of pleasure

Question 39

Cognitive deficits of Sz

Answer 39

How well the brain learns, stores + uses info
Hard time with working mem
E.g. may not keep track of different things at the same time
Trouble paying attention/organising

Question 40

Example of an affective disorder

Answer 40

Depression

Question 41

Behavioural characteristics of major depression

Answer 41

Changes in appetite/weight
Moving slower than usual
Trouble interacting with people/avoidance

Question 42

Emotional characteristics of major depression

Answer 42

Low self-esteem
Thoughts of death or suicide
Isolating yourself

Question 43

Cognitive characteristics of major depression

Answer 43

Harder to problem solve
Poor memory
Cant control impulses/concentration
Indecisive

Question 44

Task- Asses one difficulty that Lena could experience in trying to confirm that her Px is experiencing a psychotic disorder
STRUCTURE

Answer 44

Understanding- abnormal thinking and perception, Px lose touch with reality, not aware of mental state
Difficulty- overlap of symptoms can be problematic, hard to diagnose accurately- e.g. withdrawal= depression and Sz
How to overcome- further tests, second opinion

Question 45

Define an affective disorder

Answer 45

Symptoms for uni-polar disorder can come and go in cycles but during a depressive episode symptoms cane severe

Question 46

What is an anxiety disorder

Answer 46

E.g. phobias

Introduce fight or flight response