Mental Health and Distress Flashcards
How does WHO define mental health?
A state of welling being where an individual can realise their potential, cope with the normal stresses on life, be productive and contribute to the community
What is distress?
A generic term describing a range of experiences in a person’s life that are troubling and confusing
These experiences may lead someone to seek support
Has a wider scope that “mental illness” - may have symptoms of mental illness without being “ill”
What is psychiatry?
A medical speciality
Focus on study, diagnosis, treatment and prevention of mental disorders including affective, behavioural, cognitive and perceptual abnormalities
What does psychiatry use to give a diagnosis?
DSM-5
What does the DSM-5 define a mental disorder as?
A syndrome characterised by dysfunction in the processes of underlying mental functioning (psychological, biological and developmental)
usually associated with significant distress/disability
What is clinical psychology?
The use of psychological theory, methods and clinical knowledge to understand, reduce and prevent distress and promote psychological well-being
Define psychological distress (clinical psych)
State of emotional suffering associated with stressors and demands that are difficult to cope with in daily life
What are the 5 defining characteristics of psychological distress (clinical psych)
- perceived inability to cope
- changes in emotional status
- discomfort
- communication of discomfort
- harm
What are categorical classifications associated with?
Psychiatry
How does the DSM-5 categorise a mental disorder?
- significant behaviours associated with distress/disability
- unexpected response to common stressors/losses
- manifestation of behavioural, psychological or biological dysfunction
- the deviance/conflict has to be a symptom of dysfunction in the individual
Did homosexuality use to be included in the DSM-5? Is it still included? What does this suggest?
Yes
Now changed to distress by homosexuality
Shows DSM can pick and choose what is considered a disorder
What are dimensional approaches associated with?
Clinical psych
What are the characteristics of the dimensional approach?
- no sharp defining line between normal and abnormal
- describe distressing experiences on a continuum with normal functioning
- inter-related
- Mental health = dynamic, fluctuates and responds to what is happening to us
Give examples of which mental health disorders the dimensional approach is better used for
- anxiety
- depression
- psychosis
- mania/grandeur
What word is often used instead of “patient”
Service users
Client
People with lived experience
Why is the term “patient” not used?
- often not useful
- may not have illness
- may not be accessing treatment
- may not be “help-seeking”
When does an issue with mental health become a problem?
When it is:
- prolonged
- uncontrollable - can’t cope
- causes disruption
What are the 3 approaches to distinguishing between normality and abnormality? (Psychiatry)
Social approach - approved vs. disapproved behaviours in culture
Medical approach - well being vs. endangering behaviours
Statistical approach - statistically usual vs. unusual behaviours
What is the categorical model? (psychiatry)
- assume sharp distinction between normal and abnormal
- rigid way of separating people
- yes/no approach into what is considered abnormal
What are 2 limitations of the categorical model?
- doesn’t work/apply to everyone
- leads to contradictions and arbitrary exceptions
How common are “common” mental health difficulties e.g., low mood and anxiety?
- 20% experienced in last year
- 30% experienced in lifetime
What is the medical (biomedical) model? (Laing)
- set of procedures in which all doctors are trained
- assume mental health difficulties are a result of physical problems and should be treated medically
- biological emphasis with medical treatments e.g., medications, electroconvulsive therapy
Name an alternative to the biomedical model
the bio-psycho-social model (Engel)
What are the 3 components of the bio-psycho-social model? Give examples
Biological - genetic vulnerabilities, physical health, disability, effect of medication
Psychological - cognitive style, personality, attachment style, emotion regulation
Social - social support, family env., culture, life events/trauma
Explain the bio-psycho-social model
Components are entwined and have complex interactions
Interventions should address all components
What is a critique of the bio-psycho-social model?
Possibly better as an approach rather than a model as mapping of this interaction is rarely specified
What are the 2 types of recovery?
Clinical recovery
Personal recovery
What is clinical recovery?
Symptoms disappear
This sometimes happens without treatment
What is personal recovery?
Building resilience, having control over problems, leading a meaningful life
“post-traumatic growth” - enriched experience
recovery-orientated approached used by many services - argues against treating symptoms but rather focusing on building resilience and supporting emotional distress
Was there recent concern at the over-medicalisation of mental disorder? What was this called?
yes
the bio-bio-bio model
Why is it important to consider the validity of different models of mental health and distress?
- scientific duty
- the approach we use to conceptualise mental health and distress influences how we relate/interact with people in distress in:
- clinical practice
- society as a whole (e.g., stigma)
What is a psychiatric diagnosis?
- the act of classifying a disorder
- each disorder category is divided into types and subtypes that are distinct
- a set of criteria which define each diagnosis
- a minimum threshold must be met for someone to fit criteria for diagnosis
e. g., minimum number of symptoms, time frame, change in daily functioning
What are the 2 most common classification system in psychiatry?
ICD - 11
DSM - 5
What is the ICD - 11?
published by WHO, used by NHS
can be accessed online and is free to use
contains codes for all physical diseases, illnesses, MH problems but is also descriptive e.g., bitten by crocodile
What is the DSM - 5?
published by APA, can purchase online
lists all currently recognised mental disorders (157) and their characteristic symptoms needed for a diagnosis
mainly used in US
first published in 1952
What are the uses of a psychiatric diagnosis for health services and clinicians?
facilitating clinical assessment (mainly psychiatrists) communication shorthand guiding treatment decisions organising mental health services research
What are the uses of psychiatric diagnosis for individuals?
gives name to difficulties
allows individuals to look it up online
offers meaning, understanding, relief and explanation
facilitates communication with and understanding from others
provides access to care and support e.g., benefits
facilitates process of finding and forming support groups (peer/carer)
What was the Rosenhan experiment?
8 pseudo-patients gained access to 12 psychiatric hospitals by faking the same single symptoms of hearing a voice saying “dull, empty, thud”
were admitted with Sz and then acted normal but weren’t allowed to leave for between 8-52 days
Discharged with “remitted paranoid Sz” - diagnostic labels stick
Patients in hospital weren’t treated - staff more like babysitters
follow up study - hospitals asked Rosenhan to send more pseudo patients, identified 41/193 as pseudo-patients but no one was ever sent
Is the DSM reliable? (inter-rater reliability)
no
field tests for DSM-5 diagnoses were conducted using professionals with reliability being determined using a kappa statistic (measure of agreement from -1 to 1)
originally found many diagnoses present unreliable kappa values so changed to boundaries to make them reliable to the extent were it barely exceed the level of agreement you might get by pure chance (0)
Are diagnostic categories valid? (measuring what they mean to)
Research suggests that specific diagnoses aren’t the best predictor of outcomes under circumstances
presence and severity of symptoms are more important
Do diagnostic categories have construct validity? (do symptoms of specific psych diagnoses correlate with each other?)
no
e.g., there are at least 3 clusters of Sz symptoms but people have these in different severities or may not have all 3
implications - people receiving some diagnosis have different problems and need different treatments
What is the issue of comorbidity with diagnostic categories?
Comorbidity is the norm
suggests that diagnoses aren’t distinct and separate
raises significant questions about underlying structure and assumptions of classification
Does diagnosis predict treatment response?
different illnesses should respond to different treatments but this is not the case
e.g., Johnstone found that drug response is symptom-specific rather than diagnosis-specific
delusions + hallucinations - neuroleptics
mood difficulties = lithium carbonate
Does the NHS use diagnosis as inclusions criteria?
Mostly no
- services using diagnosis = ED, learning difficulties
- services responding to specific needs/severity (largest) = IAPT services, secure services, crisis team
- services working with specific problems but non-diagnostic = traumatic stress, alcohol + drug misuse, early intervention in psychosis
- services supporting specific life circumstances = military vets, homeless + traveller team, perinatal MH
How is the language used a critique of diagnosis categories?
- language from biomedical model means difficulties are seen as problems belonging within the individual
How is the labelling used a critique of diagnosis categories?
Pathologies normal responses to adverse events e.g., trauma, grief
How is the stigma used a critique of diagnosis categories?
associated with perceptions of dangerousness and unpredictability
fear and desire for social distance
True or false?
psychiatric diagnoses contribute to power imbalances between clients and clinicians
true
as it is the clinicians giving the diagnosis
Do psychiatric diagnosis have an embedded bias for race and culture?
yes - psychiatry = ethnocentric and western
leads to overdiagnosis and greater detention of minority groups compared to white people
Do psychiatric diagnosis have an embedded bias for gender?
yes
women more likely to be diagnosed with BDP - disorder which has been linked to sexual trauma
should see women’s distress as a response to social violence and oppression instead
Do psychiatric diagnoses take context into account? Is this right?
no
but should as context is key
Are adverse life experiences only lead PTSD? Is this recognised in psychiatric categories? What are the implications of this?
no can also lead to anxiety and depression
Trauma is only recognised as a symptom of PTSD
implications - people don’t always receive support and treatment that addresses underlying issues
What are the 2 ways that trauma can be defined?
a distressing reaction - resulting from adverse life experiences that exceeds a person’s ability to cope short and long term
exposure to events and circumstances - experienced as harmful/life threatening - lasting impacts on mental, physical, emotional and/or social well-being
Is trauma due to single or multiple events that occur over time?
both
What are the 6 types of trauma?
Big T - major distressing life event (rape, domestic violence)
Small T - more common events that have potential to negatively affect MH
Childhood trauma type 1 - single events e.g., rape, serious accident
Childhood trauma type 2 - repeated exposure to external events e.g., ongoing sexual abuse
Complex childhood and developmental traumas - e.g., bullying, SA, war, abandonment etc.
Social trauma - e.g., inequality, racism and poverty, historical trauma, legacy trauma e.g., Holocaust, slavery
When are trauma responses more likely to develop?
When they are: repeated/prolonged escape is difficult/ impossible interpersonal multiple or occurring at critical stage of development e.g. during life transitions
What is the neurodevelopmental impact of neglect in childhood?
abnormal brain development following sensory neglect in early childhood
led to smaller than average brain, enlarged ventricles and cortical atrophy
Can children benefit from early removal from sensory neglect?
Yes but the later the removal is left the less beneficial it becomes
by 4 years there is no significant benefit to be found
What are adverse childhood experiences (ACE)
a set of 10 traumatic events occurring before age 18
they increase the risk of adult MH problems and serious disease
5 related to forms of childhood abuse and neglect
5 relate to forms of family dysfunction that increase a child’s exposure to trauma
What are the 10 ACEs?
physical, sexual and psychological abuse
physical and psychological neglect
witnessing domestic abuse
having close family misusing drugs/ alcohol
having close family with MH problems
having close family spend time in prison
parental separation/ divorce on account of relationship breakdown
What did a study find about ACEs and the relationship to serious disease?
experiencing 4 or more ACEs before 18 predicted onset of life threatening diseases e.g., heart failure, diabetes, cancer
strong + cumulative impact
What does the dose-response relationship suggest?
suggests for each increase in the dose of a risk factor, there is a corresponding increase in the probability of developing a certain problem
What is the dose-response relationship important for?
important when trying to establish causal relationships
How does the dose-response relationship link to ACEs?
many studies have shown that greater doses of ACE (>4) lead to a heighted risk of a range of health outcomes
What is the link between ACEs and the likelihood of engaging in health harming behaviours?
if >= 4: 2.5x more likely to engage in sexual risk behaviour and have STIs 5x more likely to use drugs 7x more likely to be addicted to alcohol 12x more likely to attempt suicide
What is the link between ACEs and the likelihood of engaging in health harming behaviours? - UK specific
2x more likely to binge drink and have poor diet
3x more likely to smoke
5x more likely to have sex before 16
6x more likely o have had/ caused unplanned teenage pregnancy
7x more likely to have been involved in violence in past year
11x more likely to have used heroin or been incarcerated
How common are adverse, potentially traumatic life experiences in the UK?
47% reported at least 1 adverse childhood life experience
9% reported four or more adverse childhood life experience
How common are adverse, potentially traumatic life experiences in the Wales?
47% reported at least 1 adverse childhood life experience
13% reported four or more adverse childhood life experiences
ACEs lead to an increased risk of which physical health conditions? (name 5)
physical inactivity and severe obesity ischemic heart disease cancer chronic lung disease skeletal fractures
ACEs and a typical life course?
Uninterrupted, exposure to toxic stress childhood has a cumulative impact = excessive load on the immune + hormonal systems.
Brain adapts to the threat + fear in the environment
Learning at school = impossible due to heightened physiological arousal + hypervigilance to threat.
Coping strategies developed - relieve distress temporarily (eg, smoking, drugs, alcohol) but repeated use = health harming and disease burden increases.
Social problems go hand in hand and with 6 ACEs premature morbidity of 20 years is likely.
What did a meta-analysis find between ACEs and common MH difficulties?
Found strong associations between ACEs and the risk of developing common MH difficulties
Is there a link between ACEs and psychosis?
Yes - increased risk o developing psychosis (3x more likely)
up to 1/3 of cases of psychosis could be attributed to impact of childhood adversities
What evidence is there for a dose-response relationship between childhood trauma and psychosis
People exposed to 1 type of childhood trauma (e.g. sexual abuse) were 2.5 times more likely to have experienced psychosis
People exposed to 5 types of childhood trauma (e.g. sexual abuse, physical abuse, neglect) were 53 times more likely to have experienced psychosis
Is there a link between ACEs and bipolar disorder?
PEOPLE WITH BIPOLAR DISORDER ARE 2.5 TIMES MORE LIKELY THAN ‘CONTROLS’ TO REPORT CHILDOOD ADVERSITIES IN GENERAL
4 TIMES MORE LIKELY TO REPORT CHILDHOOD EMOTIONAL ABUSE
Is there a link between ACEs and BPD?
PEOPLE WITH BORDERLINE PERSONALITY DISORDER ARE 13 TIMES MORE LIKELY THAN ‘CONTROLS’ TO REPORT CHILDOOD ADVERSITIES IN GENERAL
38 TIMES MORE LIKELY TO REPORT CHILDHOOD EMOTIONAL ABUSE
Are individuals belonging to minorities at higher risk of MH difficulties? Give and example and a potential explanation
Yes
Meta-analyses have linked exposure to discrimination to many physical and mental health conditions in these groups
Higher rates of psychosis have been found, likely explained by greater levels of life adversities that members of these groups face in their daily lives
Greater exposure to discrimination may be associated to greater risk for psychosis in a dose-response fashion.
Is social inequality a robust predictor of health and well-being?
Yes
The extent to which wealth and social resources are unequally distributed in given population (e.g. those with a lower social status have less access to them) is correlated with the incidence of many mental health issues
What are the biological impacts of adverse experiences?
Sensitivity to stress
Impact on key brain areas involved in emotion and stress regulation (frontal cortex, amygdala) and memory (hippocampus) etc.
What are the psychological impacts of adverse experiences?
- Negative beliefs about self, others and the world
- Sense of threat
- ‘Maladaptive’ thinking styles (rumination and worry) etc.
What are the social impacts of adverse experiences?
- Difficulties in relationships
- Lack of social support
- Reduced access to opportunities (education, work etc.) etc.
Is trauma a fact of life?
No
Many people exposed to adversities show resilience
Positive life experiences + relationships across the lifespan can buffer the impact of life adversities (i.e., protective factors)
Access to ‘corrective experiences’ can help survivors even after they have developed MH problems as a result to life experiences and circumstances
What is behaviour genetics?
Studies variation among individuals on traits to distinguish a genetic component
Study design involves a measure of heritability
What is heritability?
Proportion of variation between individuals in a population on a given characteristic that is attributed to genetic factors
What are family studies?
Assess the first-degree relatives of an affected individuals for a particular disorder
Compare with prevalence in a control group
What are twin studies?
Look at concordance rates of a MD between Mz and Dz twins
Mz twins share 100% of genes
Dz twins share 50% of genes
What is a concordance rate?
% of cases in which both members of a pair have a particular attribute
What is a heritability estimate?
Derived from comparing Mz and Dz twins’ likelihood of being affected by the same disorder when one twin is affected
What are adoption studies?
A child is either born to a parent with or without a MD and then adopted at/near birth to an unaffected parent
Compare prevalence of disorder in adulthood
Enables disentangling of environment from genetic influence
What was Heston’s adoption study?
Adoptees born to Sz mothers
10.6% of index group compared to 0 of match CG were diagnosed with Sz in later life
What are the 4 limitations of behaviour genetic studies?
- family and twin studies likely to overestimate genetic contributions (non-genetic psychological factors that affect Mz more than Dz twins include being treated more similarly and having similar rates of negative life events)
- unable to consider shared environmental factors
- twin studies involve mostly “Euro-Austro-American” samples
- adoption study designs are methodologically superior but are relatively rare and adoptees are often placed in families resembling the biological family
What are polymorphic genes?
Have different variants that commonly occur in population
More than 1 allele occupies that gene’s position in the chromosome as opposed to just 1 allele
What are molecular genetic association studies?
focus on identified genetic polymorphisms that:
- naturally vary in population - no direct adverse effect on individual
- code for a protein that could be linked to MD
What is a case control design?
Index individual with a specific MD vs. induvial without the specific MD
What is a family based design?
Index individual with specific MD vs. An unaffected sibling
How many genes have been associated with Sz?
128
What did Lee find about gene clusters and MDs?
Common clusters of common gene variants across 8 disorders
Multiple genes of small effects interact together = polygenic
Consistent with the different ways in which a MD can manifest
What are the limitations of Genetic association studies?
- effects are often very small
- many failed replications (false +ves likely due to very large samples, most studies dont consider environmental stress)
- Most DNA data comes from European ancestries
What are brain imaging studies?
suggest differences in structure/function of brain areas between ppts with MD compared to without MD
comparatively heightened/reduced activation in specific brain areas (often when completing a specific task) implicates brain dysfunction
