Mental Health

Question 1

mental illness

mental disorder

mental health problems

mental health

Answer 1

• A mental illness is a mental disorder that affects one or more functions of the mind, and can interfere with a person’s thoughts, emotions, perceptions and behaviours. It is a serious departure from normal functioning and can cause considerable stress and suffering for the person and their close friends and family.
• A mental disorder implies the existence of a clinically recognisable set of symptoms and behaviours that usually need treatment to be alleviated. Mental illness is more severe and ongoing than a mental health problem.
• A mental health problem is a state of emotional and social well-being in which individuals realise their own abilities, can cope with the normal stresses of life, can work productively and can contribute to their community.
• Mental health is a state of emotional and social well being in which individuals realise their own abilities, can cope with the normal stresses of life, can work porductively and can contribue to their community.

Question 2

What is normal?

Approaches to distinguishing normality:

Functional:
Medical:

Answer 2

What is normal?

When thoughts, feelings and behaviours help a person to assimilate appropriately into their society and culture and to function independently as expected for their age.

Approaches to distinguishing normality:

Functional: Ensuring that a person can function in a normal life and live day to day as their thoughts, feelings and behaviours are normal to cope with.
Medical: That a person’s state of mental health is determined by a set of symptoms. If a mental illness is diagnosed, then treatment is required – psychological, pharmaceutical or both.

Question 3

Disorder

Syndrome

Disease

Answer 3

Disorder

A set of symptoms that interfere with daily functioning. Symptoms are reasonably consistent between patients but origins/ causes may differ

EG Post-traumatic, stress disorder, Major depression

Syndrome

A particular profile of symptoms. The origins and clinical severity may vary

EG Dyslexia

Disease

A condition with a known cause, predictable course and standard protocols for treatment

EG Malaria; Alzheimer’s, dementia

Question 4

Diagnostic and Statistical Manual of Mental Disorders (DSM):

What are the axis?

Answer 4

Diagnostic and Statistical Manual of Mental Disorders (DSM):

• Uses a categorical approach to identify and classify symptoms of mental disorders.
• Diagnosis is based on a number of factors,
• Descriptive, it does not specify the causes of the mental disorder nor does it direct the treatment, though it also includes the onset, course and persistence of symptoms.
• The fifth edition of the DSM (DSM-5) was moved towards a less categorical structure by introducing dimensional classifications, particularly of personality disorders.

What are the axis?

The DSM uses a system of axes to attempt to standardise diagnosis and aims to increase the importance of dimensional descriptions of disorders.

AXIS 1: Clinical disorders
AXIS 2: Mental retardation and personality disorders
AXIS 3: General medical conditions
AXIS 4: Psychological and environmental problems
AXIS 5: Global assessment of functioning

Question 5

International Classification of Diseases (ICD):

Steps of intervention:

Answer 5

International Classification of Diseases (ICD):

• It is descriptive and largely based on the symptoms reported by the patient and criteria ranked as important by professionals.
• It does not consider causes or possible treatment.
• covers a wider range of illnesses than the DSM, which is more commonly used to diagnose mental health conditions.

Steps of intervention:

Step 1: Clinical interview, asses’ personality, cognitive and neuropsychological problems.

Step 2: Identify of clinical symptoms.

Step 3: Use DSM/ICD to diagnose the disorder.

Step 4: Design the interventions and implement treatment.

Step 5: Review.

Question 6

Strengths and limitations of DSM and ICD:

Answer 6

Strengths:

• Based on ongoing scientific research, regularly revised.
• Comprehensive
• Provide a common language among psychologists to communicate.
• User friendly

Limitations:

• CULTURAL VARIATION: The DSM is created based on American culture, tradition and mores and may not be appropriate.
• VALIDITY OF THE CATEGORIES: The goal of the system has been to enable and increase the consistency of diagnosis but it can be argued that this means that the validity of the categories may be overlooked. It is possible that a very precise and specific description may not truly reflect a disorder.
• WRITING BY COMMITTEE: Persuasive committee members may have a disproportionate influence on the committee listing the diagnostic criteria for a particular disorder; this could lead to new conditions being added or removed despite lack of empirical evidence to support these decisions.
• SUBJECTIVITY: Classification is based on symptoms reported by the person or behaviours they are subjectively observed to exhibit in the judgment of others. People may not disclose subjective feelings, such as intense anxiety, unhappiness or distress. People may also be indifferent to or unaware of their condition.
• HEALTH INSURANCE: The health insurance industry in the USA is very commercial and often will only pay for treatment for mental disorders that are listed in the DSM.

Question 7

Categorical approach to classification of mental disorders:

Strengths of Categorical approach:

Limitations of Categorical approach:

Answer 7

Categorical approach to classification of mental disorders:

A problem with categorical classifications is the tendency for stereotyping and labelling with a lack of flexibility in diagnosis. Patients being seen as either having the disorder or not, with no difference among individuals.

Strengths of Categorical approach:

High detail for mental disorders
User friendly guidelines that help diagnose with the yes or no approach
Helps communication of clinicians

Limitations of Categorical approach:

Labelling causes stigmas
High degree of overlap
Fails to determine severity of symptoms

Question 8

Dimensional (graded and transitional) approaches to classification of mental disorders:

Graded AND TRansitional

Strengths of Dimensional Approach:

Weaknesses of Dimensional Approach:

Answer 8

Dimensional (graded and transitional) approaches to classification of mental disorders:

The DSM-5 and proposed ICD-11 have moved towards a less categorical structure by introducing dimensional classifications, especially of personality disorders. This would mean that mental health professionals would rate an individual.

Graded: the mental health professional profiles the patient by grading the severity of symptoms from number of dimensions in comparison to a level characteristics that we all possess.

Transitional: Changes in symptoms in response to clinical treatment can be monitored overtime to determine the effectiveness of treatment.

Strengths of Dimensional Approach:

Emphasises the uniqueness of each individual
No stigmas are attached as nobody is put into a ‘box’
Richer and more detailed description of a person’s mental condition

Weaknesses of Dimensional Approach:

No standard scale
Therefore hard for professions & time consuming to make their own tests
Disagreement among psychologists on the “right” scale

Question 9

What is the biopsychosocial framework?

Answer 9

What is the biopsychosocial framework?

The biopsychosocial model was first developed by George L. Engel who believed that to truly understand and treat a person’s mental and/or physical illness, it was important to consider their condition in terms of biological, psychological and social influences. Engel also believed that the clinician/doctor/ psychologist had an important role in influencing the course of both treatment and the person’s recovery.

Question 10

Biological factors:

Psychological factors:

Social factors:

Answer 10

Biological factors: This aspect of the biopsychosocial model considers a person’s functioning in terms of bodily structures such as the brain and nervous system, biochemical processes and genetic predisposition.

Types of assessment/treatment include:

Neuroimaging

Computerised axial tomography (CAT scan)
Positron emission tomography (PET scan)
Electroencephalogram (EEG)
Magnetic resonance imaging (MRI)
Functional magnetic resonance imaging (fMRI)

Medication

Antidepressants (for depression)
Psychotropic drugs (to manage delusions and hallucinations)
Mood stabilising drugs (to assist with anxiety).

Neuropsychological testing

Questionnaires
Intelligence quotient tests

Medical procedures

Psychological factors:

Personality: An individual’s personality predisposition. Are they outgoing (extroverted) or reserved (introverted)? Are they confident or fearful? What coping strategies do they use?
Behaviour: What the individual’s behaviour says about them. Is it conscious or unconscious? Are they aware of what they are doing or what consequences their actions might have for themselves or others?
Perception: The individual’s awareness of themselves and the universe around them.
Cognition: The way in which they process information and their intelligence and decision-making skills.
Attention: What incoming information do they focus on and what do they ignore?
Motivation: What drives them to behave or think in a particular way?

Social factors: A range of social and cultural influences can either increase a person’s resilience or contribute to their ill health.

These influences can include:

School environment or pressures
Work environment or pressures
Level of education
Availability and access to appropriate medical and support facilities
Socioeconomic factors such as poverty and homelessness.

Question 11

Name two advantages of using this model compared to looking at health from a single perspective.

Why is the sociocultural aspect of the biopsychosocial model important in dealing with a person with either a physical or mental illness?

Answer 11

Name two advantages of using this model compared to looking at health from a single perspective.

It is a holistic option that combines all aspects of the body, mind and social aspects of life.
Emphasis on health and illness combined.

Why is the sociocultural aspect of the biopsychosocial model important in dealing with a person with either a physical or mental illness?

It is an aspect because it demonstrates how social aspects of life can affect and alter a person’s psychological and mental states therefore they have a massive impact on individuals. The older model tended to treat the individual from a purely physiological and molecular or cellular level in a distant and impersonal manner that ignored human distress.

Question 12

Define stress:

What is a stressor?

Explain the difference between a psychological and physical stressor:

Answer 12

Define stress: A psychological and physical response of the body that occurs whenever we must adapt to changing conditions, whether those conditions be real or perceived.

What is a stressor?

Internal or external sources of tension (stressors) that challenge a person’s ability to cope. These stressors can be positive or negative, environmental, psychological or social/cultural in nature.

EG - Homework or a SAC

Explain the difference between a psychological and physical stressor:

PHYSICAL:

• hunger, thirst, hot, cold

PSYCHOLOGICAL:

• anexity, grief, happiness

short term : first date, sky diving, public speaking

Long term: family problems, illness,

high intensity: terminal illness, death

low intensity: formal, debating, disagreeing with a friend.

Question 13

Explain the key difference between eustress and distress.

What is involved in the fight-or-flight response?

Explain the physiological processes involved in autonomic arousal (fight-or flight response) / HPA Axis:

Answer 13

Explain the key difference between eustress and distress.

Eustress refers to a positive psychological response to a perceived stressor

EG - Promotion at work, getting married etc.

Distress refers to a negative psychological response to a perceived stressor.

EG - Unemployment, death of a spouse etc.

What is involved in the fight-or-flight response?

The fight-or-flight response is an innate and evolutionary phenomenon critical for our survival. It is referred to as an ‘adaptive response’ because, in the early days of human and animal evolution, those with quick instinctual responses that were activated by the sympathetic nervous system had a greater chance of survival. So we either stay and fight or flee and fight.

Explain the physiological processes involved in autonomic arousal (fight-or flight response) / HPA Axis:

1. Stress is caused by physical, psychological or the environment.
2. Hypothalamus is activated and triggers the release of CRH.
3. Pituitary gland is activated and releases ACTH which is carried in the blood to the…
4. Adrenal glands which are activated and release stress hormones (cortisol/adrenalin/noradrenalin) to assist the body to deal with the stressor.

*Cortisol suppresses our immune system and more susceptible to illnesses and diseases if prolonged.

Question 14

Is stress bad or good for us? Explain

Answer 14

Is stress bad or good for us? Explain

If there is too little arousal/stress, we tend to do very little. As the level of stress increases to a moderate level, we experience optimal physiological and psychological arousal and perform at our peak. However, if the level of arousal is sustained and we experience greater levels of stress, we become more anxious and disorganised.

Question 15

Explain Lazarus and Folkman’s transactional model of stress and coping:

Answer 15

Explain Lazarus and Folkman’s transactional model of stress and coping:

Lazarus and Folkman’s model outlines two main stages during the cognitive assessment of a situation: primary appraisal and secondary appraisal. Transaction (interaction) occurs between a person and the environment. This model suggests that it’s how we interpret the stressful event which is more important than the event itself.

Question 16

PRIMARY APPRASIAL

SECONDARY APPRASIAL

Answer 16

Primary appraisal is the initial evaluation process where the person considers whether they have a personal stake in the encounter and will evaluate the significance. If the situation be perceived as a stressor, the person will then work out what should be done about it during secondary appraisal. It is relevant to our well-being.

During primary appraisal, the significance of a situation can be classified as:

Harm/loss – as assessment that some type of damage has been done such as an illness or poor test result. For example: ‘I just failed a major test.’
Threat – an assessment that there may be a future harm or a loss. For example, ‘I might fail the next major test.’
Challenge – an assessment that there is opportunity for personal growth or something might have a positive outcome. For example, ‘I didn’t do well for the practice test but with a bit of hard work I’ll do better.’ An upcoming marriage or a change of employment with a pay rise and greater status can also be perceived as a challenge.
Neutral/irrelevant/benign - an assessment that this event is of little or no personal importance or relevance to the person and therefore does not go beyond primary appraisal. For example, ‘My neighbour did poorly on his test’

Secondary appraisal is the stage where the person considers what options are available to them and how they will respond to work out how to best deal with the situation. They will evaluate the internal and external coping options to make a positive environment.

For example, a student who fails a major assessment task might consider asking their teacher if they can resubmit the task and accept a penalty for repeating it or perhaps do an alternative task.

Question 17

problem and emotion focused

Answer 17

Lazarus and Folkman’s transactional model of stress and coping also outlined methods of coping.

These were problem-focused and emotion-focused coping strategies.

Problem-focused coping – looks at the causes of the stressor from a practical perspective and works out ways to deal with the problem or stressful situation with the objective of reducing that stress.

Problem-focused strategies include:

Taking control - For example, a student who has performed poorly on an assessment task may decide to spend less time on Facebook and redirect that energy into preparing more comprehensive notes and revising more thoroughly. Or someone who has just lost their job may prepare a new résumé and go online to look for a new position.
Information seeking – looking for additional information to know how to deal with the stressor. For example, someone who has just been diagnosed with an illness may seek a second opinion, or see a specialist. They might even look up the symptoms, treatment and prognosis of their illness on the internet. Knowledge can sometimes reduce the level of stress.
Evaluating the pros and cons – taking a sheet of paper and dividing it so that on one side, the person writes down the positives about the situation/stressor and the negatives on the other side. For example, a person wanting to leave their job or change a relationship may use this to help reduce their level of stress.

Emotion-focused coping - involves trying to reduce the negative emotional feelings associated with the stressor such as embarrassment, fear, anxiety, depression, excitement or frustration.

Emotion-focused strategies include:

Meditation / relaxation
talking to friends and family about your problem
denial – pretending the event did not occur
ignoring the problem in the hope that it will disappear
Distraction – finding other methods to keep your mind busy and not on the problem. For example, watching TV, playing video games or eating
expecting a worse-case scenario so that you are ready for the worst
Physical exercise – to reduce the feelings of stress.

Question 18

The strengths of the transactional model of stress and coping include:

The limitations of the transactional model of stress and coping include:

Answer 18

The strengths of the transactional model of stress and coping include:

It used human subjects in developing the model
It used a cognitive approach to stress with a focus on how people cope with psychological stressors
It took both mental processes and emotions into account when examining how an individual interprets a situation as stressful or not.

The limitations of the transactional model of stress and coping include:

The greater focus on psychological factors meant that less emphasis was placed on the physiological elements of the stress response
It did not include cultural, social or environmental factors in looking at how individuals perceive a stressful event.
Lack of empirical evidence.

Question 19

Social, cultural and environmental factors that exacerbate and alleviate the stress response:

Answer 19

Question 20

Allostasis:

Allostasis load:

Allostasis overload:

Outline the difference between homeostasis and allostasis:

Answer 20

Allostasis: the body can meet and cope with the internal/external demands. The brain tells the body to maintain physiological stability by adapting to changes caused by stress. Thus the body can cope with large changes.

Allostatic load: The cumulative effects of our body trying to re-establish allostasis in response to frequent and intense stressors.

Allostatic overload: Represent the point at which a person actually develops a serious health problem, such as a physical disease and/or mental disorder.

Outline the difference between homeostasis and allostasis:

Homeostasis:

• normal baseline
• no illness
• no adjustment
• no anticipation
• physical balance
• no price

Allostasis:

• changing baseline
• variable balance
• anticipation of demand
• adjustment based on past
• price of stressor
• leads to illness (potentially)

Question 21

Strategies for coping with stress including biofeedback, meditation/relaxation, physical exercise, social support:

What are the psychological changes that occur when a person meditates/relaxation?

Is there a difference between meditation and relaxation?

Answer 21

Biofeedback: Technique enables person to gain control over their physiological response to a stressor through relaxation techniques they can reduce the severity of the response. This is achieved by a patient receiving feedback about a biological response.

Process

1. Feedback on physiological response that records fight or flight when exposed to a stressor.
2. They are taught strategies to lower the biological responses and receive feedback on how the exercises change their response. E.g. imagine yourself in a tranquil scene.
3. Continued presentation of information that can prolong desirable physiological changes.

Meditation: An attempt to bring about a deeply relaxed state in order to reduce one or more effects of stress related symptoms. Meditation redirects a person’s usual flow of conscious thought to a more focused pathway that leads to a deep state of calmness and relaxation. Most health professionals acknowledge the benefits of meditation in developing effective stress-management programs. This is because many meditation techniques are able to reduce baseline levels of physiological and psychological arousal and assist people to better deal with the stressors of day-to-day life. Meditation has also been successfully used in psychotherapy to treat other conditions, especially in the management of phobias and other anxiety-based mental disorders.

Relaxation: Any activity that brings about a state of reduced psychological and/or physiological tension. This is usually done using methods such as visualisation, breathing techniques and graduated muscle tensing and relaxing sequences where each part of the body is systematically tensed and relaxed until the person experiences a release of physical and psychological tension.

What are the psychological changes that occur when a person meditates/relaxation?

This is reflected in brainwave activity, heart rate, respiration rate, blood pressure and temperature.

Is there a difference between meditation and relaxation?

Meditation actively alters conscious thoughts by focusing the mind on either a single stimulus or automatic physiological processes such as breathing. In contrast, relaxation can be described as a process of releasing one’s muscles and thoughts. Interestingly, both meditation and relaxation can induce an alpha brainwave pattern; however, meditation also generates theta waves, normally seen in stages 1 and 2 of NREM sleep

Physical exercise: An activity that is usually planned/performed to improve or maintain one’s physical condition. Physical exercise has been referred to as ‘moving meditation’, where some forms of exercise such as jogging, swimming and cycling require repetitive motions that can change a person’s state of consciousness. The body’s production of endorphins also increases when people exercise for more than 20 minutes per session. As these naturally produced chemicals are similar to morphine, they provide pain relief and a sense of euphoria. This in turn improves a person’s mood and helps reduce stress-related tension.

Social support: Refers to the network of family, friends, neighbours and community members that are available during difficult times to provide emotional, physical and financial assistance. Social support is therefore considered a protective factor that is important in maintaining both mental and physical health.