LO12 - Disorders And Treatment

Question 1

Abnormal vs. Normal Behaviour

Answer 1

Abnormality suggests a failure to adapt to your environment.

Abnormality refers to deviance, dysfunction, distress and danger.

It is important to take context into account as social norms change over time.

Question 2

Definition of a disorder according to the DSM

Answer 2

Syndromes or clusters of symptoms that occur simultaneously. It is a clinically significant disturbance in an individuals cognition, emotional regulation or behaviour. It is usually associated with with significant distress or disability in social, occupational or other important activities.

Question 3

Disorder - Deviance

Answer 3

Behaviours, thoughts and feelings that are not in line with normal or usually accepted standards.

Society decides what the norms are and if you stray from these, you are considered to have a disorder.

Question 4

Disorders - Dysfunction

Answer 4

Thoughts, feelings and behaviours that are disruptive to ones regular routine or interfere with day-to-day functioning.

When internal mechanisms fail to perform their functions, this harms the person’s wellbeing as defined by social values.

Question 5

Disorders - Distress

Answer 5

Behaviours, thoughts and feelings that are upsetting and cause pain, suffering and/or sorrow.

The social norms determine what harm results from dysfunction. This is distress.

Question 6

Disorders - Danger

Answer 6

Thoughts, feelings and behaviours that may lead to harm or injury of oneself or others.

This is usually visible.

Question 7

Cultural sensitivity in diagnosis

Answer 7

Some mental illnesses are culturally bound. This makes diagnosis subjective. It is important to be culturally sensitive when considering what constitutes a mental disorder.

Other mental illnesses are universal across cultures but the context differs. E.g. anorexia nervosa.

Question 8

Psychopathology

Answer 8

The study of mental illnesses and disorders

Question 9

Medical model

Answer 9

This has developed though history but it retains the idea that mental illness is due to a physical disorder that requires mental treatment. It used to involve blood letting and institutionalisation.

Question 10

Theoretical views of mental illness - Moral treatment

Answer 10

This approach to mental illness called for dignity, kindness and respect for the mentally ill. This is associated with Humanistic psychology and Karl Rogers.

Humans are unique beings and individuals who require recognition and to be treated as such.

Question 11

Deinstitutionalisation

Answer 11

Government policy change in the 60s and 70s that focused on releasing the hospitalised psychiatric patients into society.

Benefitted patients who got more individualistic treatment and the government who didn’t have to pay so much.

Question 12

Biopsychosocial model

Answer 12

It is interactions of a person’s biological makeup, psychological experiences and social environment that determines their risk for a psychological disorder.

Not a single factor or event causes psychological disorders.

Question 13

Epigenetics

Answer 13

The study of changes in organisms caused by gene expression rather than the alteration of the genes.

Biological factors interact with environmental factors. Environmental factors cause biological expression.

Question 14

DSM-5

Answer 14

Provides a list of symptoms, with a decision rule on the number of symptoms present for a diagnosis.

It acknowledges the interplay between biological, psychological and social influences with the biopsychosocial approach.

Organised in a lifetime development scheme, starting with disorders usually diagnosed in childhood.

Question 15

DSM - 5 organisation

Answer 15

There are 19 major areas of psychological disorders.

Gives information about the age of onset, predisposing factors, course of disorder, prevalence of disorder, sex ratio, cultural issues and differential diagnosis (details about what distinguishes one disorder from another).

Differential diagnosis information is useful for comorbid disorders.

Question 16

Comorbiity

Answer 16

When disorder typically occur together

Question 17

ICD-10

Answer 17

An alternative to the DSM published by the WHO. It covers medical diseased as well as mental disorders.

They have been quite different at times but attempts have been made top align the two to improve communication and a common use of diagnosis across the books

Question 18

Issues with classification

Answer 18

Subjectivity - diagnosing mental disorders is inherently subjective.

Fosters over diagnosis - serious mental disorders can be confused with normal parts of living.

Stigmatisation - a diagnostic label can have negative consequences.

Creates an illusion of objectivity despite us knowing that mental illness is inherently subjective.

Overemphasises separation of disorders rather than comorbidity.

Question 19

Pros of classification

Answer 19

Diagnosis can inform treatment plans. Different disorders can respond better to different types of therapy, for example.

Diagnosis can rule out other disorders as the cause of behaviour.

Question 20

Stigma (labelling)

Answer 20

This is a negative social attitude of those with mental illnesses involving disapproval, poor treatment, discrimination or isolation. A diagnosis can have negative consequences. It is fuelled by a lack of knowledge and discomfort.

Stigmas can be anticipated, experiences, perceived or internalised.

There is a belief that mentally ill people are making a conscious choice and that they could solve it themselves.

They may internalise the stigma by absorbing messaged and stereotypes from others. This increases the barrier to accessing healthcare.

Question 21

Ethical issues in the DSM

Answer 21

Homosexuality was a mental disorder (deviant) until 1973. It was removed due to social change and the anti-psychiatry movement.

Gender dysphoria is kept in the manual but doesn’t contain the word disorder. It is so that transgender people can access services needed through a medical diagnosis.

Question 22

Pros of labelling

Answer 22

Provides a common language for clinicians, researchers and insurance companies.

This may enable research and funding.

Labelling can be empowering as it gives a greater understanding of the problem being faced. An idea of the problems being faces can help them to acquire knowledge, get help and take action to better their situation.

Question 23

Structural Clinical Interview for DSM (SCID)

Answer 23

People are diagnosed using clinical interviews (SCID).

It is based on symptoms from the DSM. There are different versions (researcher version, clinical version, clinical trial version or core configuration).

Question 24

Anxiety disorders

Answer 24

Social Anxiety Disorder, Generalised anxiety disorder, panic disorder and phobias all fall under the umbrella of anxiety.

There is a lot of comorbidity among these disorders.

All anxiety disorder involve symptoms of heightened fear and anxiety.

Question 25

Panic Disorders

Answer 25

Panic attacks is a sudden onset of symptoms that reaches a peak within 5-10 minutes and resolves soon.

If symptoms take an hour or so to reach a peak and take more time to resolve, this is an anxiety attack.

Panic attacks are followed by worry of additional attacks and results in avoidance.

People with social anxiety disorder may be triggered to have a panic attack in a social situation, this is different to a panic disorder.

Question 26

Phobias

Answer 26

These cause out of proportion fear of an object or situation. It must be in a social/cultural context.

Stimuli is either avoided or endured with distress.

Agoraphobia has its own category (fear of situations where escape is difficult).

Avoidance behaviours are displayed to avoid future panic attacks by staying in safe places.

Question 27

Social Anxiety Disorder

Answer 27

Causes a person to feel symptoms of anxiety/fear in social situations due to worry about negative evaluations.

Fear of being judged, rejected or humiliated.

Similar to GAD.

Fears involve difficulty speaking publicly, eating in public or having to perform.

Question 28

Generalised anxiety disorder

Answer 28

Characterised by continuous, chronic anxiety and worry that is hard to control and interferes with daily functioning.

People tend to believe that working is helpful in preparing them for various situations.

Content of thoughts distinguishes between SAD and GAD. GAD involves worry about a range of topics.

Question 29

OCD

Answer 29

OCD can be either obsession, compulsion or both.

Obsessions are recurrent, unwished for thoughts or images. This is more mental.

Compulsions are repetitive, ritualised behaviours that a person feels unable to control. These are more externally obvious.

Engaging in compulsion reduces anxiety.

OCD is no longer classified with anxiety disorders as the prefrontal straital cortex is important in executive functioning and malfunctioning in this areas causes OCD.

Anxiety disorders are more a result of emotional processing issues. Treatment of OCD and Anxiety also differs.

In OCD, regions that suppress thinking about irrelevant things and preventing behaviour are impaired.

Question 30

PTSD

Answer 30

Also removed from anxiety disorders. It entails multiple emotions outside of simply fear and anxiety, including guilt.

It is characterised by intrusive symptoms (nightmares and flashbacks) and results in avoidance of internal feelings and external reminders.

Negative alternations in mood and cognitions e.g. exaggerated negative beliefs about others.

Alterations in arousal and reactivity (irritability, insomnia, hyper vigilance)

Contingent on the experience of trauma.

Question 31

Risk factors of PTSD

Answer 31

Genetic vulnerability - deregulation of the HPA axis. HPA axis is altered and hyper responsive to cortisol feedback.

There are also specific genes that predict resilience to trauma.

Predisposition to other psychological problems (comorbidity) is another risk factor. PTSD individuals are more than 80% likely to meet criteria for another disorder.

Those who have a lack of social and cognitive resources are likely to develop PTSD.

gene-environment interaction. Some people experience extinction to the fear response after the same event but others get sensitised to the tigger and this can be generalised to other stimuli over time.

Question 32

Depressive disorders

Answer 32

Main symptoms: persistent depressed mood and/or lack of interest/pleasure in activities. (One of these needed for a diagnosis)

Other symptoms: change in sleep and/or appetite and movement, loss of energy, cognitive difficulties (brain fog), worthlessness and guilt, suicidal ideation.

Loss of pleasure is also called anhedonia.

These symptoms cause significant stress or impairment in functioning.

Question 33

Origins of depression

Answer 33

Stressful experiences (loss of loved one, failure in school, loss of job) and genetic predisposition (history of avoidant attachment styles and negative thinking) can result in depression.

An interaction between individual vulnerabilities and stress experiences (vulnerability-stress models).

Genetics and neurotransmitters also have an influence (depression is heritable - serotonin transporter gene etc)

SSRIs treat depression due to low levels of serotonin being fixed by the re-uptake of serotonin being limited in the brain.

Stress can lead to depression due to the mechanism of anhedonia and how the brain responds to positive rewards.

Question 34

Maintaining factors of depression.

Answer 34

Cognitive vulnerability: rumination (focusing repetitively on symptoms of distress, causes and consequences of this) and attribution theory (the way in which an individual processes negative events).

Internal style - you look inwards and blame yourself.
Stable - opposed to temporary, belief that something will last forever
Global - opposed to specific, you generalise a negative event to your whole life.

There is a gender difference as girls are more likely to get depressed due to more interpersonal engagement and also hormones.

Question 35

Bipolar 1

Answer 35

This kind doesn’t require a depressive episodes but they are still common. It requires full manic episodes.

This involves feeling high (abnormally elated or irritable mood) and having racing thoughts, inflated self-esteem and increased activity, risk-taking and goal-directed action. Less need for sleep. A full manic episode is very extreme.

Question 36

Bipolar II

Answer 36

Requires a depressive episode and features hypomania.

Hypomania is not as severe as a full manic episode and tend not to last as long. You will still have higher energy levels.

Question 37

Schizophrenia

Answer 37

Grouped with other psychotic disorders in the DSM. It involves either positive symptoms, negative symptoms or both.

Positive - adding things (delusions, hallucinations and disorganised thinking)

Hallucinations - a sensory perception of something that isn’t there

Delusions - false beliefs

Negative - losing things (Avolition (loss of motivation), flat affect (numbness) and alogia (reduction in speech)).

Question 38

Origins of schizophrenia

Answer 38

Thalamus - relays sensory and motor signals as well as regulating consciousness and awareness. Abnormalities found here in schizophrenics.

Deficits in Broca’s/Wernicke’s areas in the auditory cortex.

Enlarged ventricles and neurotransmitter abnormalities (overactive dopamine and serotonin system) more of these neurotransmitters than usual.

Question 39

Schizophrenia over time

Answer 39

Abnormalities become evident through development. Tissue loss is shown in reduction of grey matter density in adolescents.

greatest tissue loss in regions controlling memory, hearing, motor functions and attention.

Genetic predisposition, birth complications and biological changes during adolescence are all factors contributing to development of schizophrenia.

Link to biopsychosocial model.