Mental Health and wellbeing Flashcards
Rosenhan (1973)- USA mental health institutions
Insanity and sanity cannot be distinguished.
Diagnosis impacted further observation - normal behaviour was seen as abnormal. Diagnosis acted as an unchanging label.
They were not released even when they acted normally and stated they no longer hear voices. Considered them pathological even when they were not.
This raises questions about whether we should classify mental health disorders as it is difficult to diagnose.
Things considered or people considered abnormal depends on….
Sociocultural influences as norms vary (e.g. sexuality used to be viewed differently before)
Personal suffering
All handle emotions differently; not standard
Not all abnormal behaviour leads to personal suffering
Suffering is subjective (depends on expereinces)
When is a behaviour defined as abnormal?
1) When the behaviour is distressing for the individual
2) When that behaviour is dysfunctional for a person/society
3) When the behaviour is considered deviant (which violates social norms)
Statistics
1:6 people suffering from mental health disorder right now
What is the purpose of diagnosis ?
To identify and hence treat the problem
To understand the prevalence and symptoms
To observe patterns and understand people
DSM- I (1952)
Contains 2 sections
Section 1 -> Disorders with impairment in brain function
Section 2 -> Disorders without evidence of impaired brain function
DSM- II (1968)
First revision when 10 diagnostic sections added
- Includes child & adolescent section
Other DSM
DSM-IV/DSM-IV-TR (1994/1999): more detail and reliable diagnoses, inclusion of of “clinically significant distress or impairment
DSM-5 (2013):
22 major categories containing more than 200 different mental disorders
Challenges in labelling mental health
- Removing their uniqueness
- One diagnosis may not fit all
- Reduces responsibility
- Self- fulfilling prophecy
- Stigma
- Normal to feel grief sometimes
Kraeplin (1896) : Schizophrenia
First to distinguish schizophrenia as being different from other disorders
“A loss of harmony between various groups of mental functions” - Schizophrenia
Eugen Bleuler (1911)
Schizophrenia : Statistics
- Equal prevalence for men and women
- Later onset for women
- Incidence: 1 %
- Approximately equal frequency
- Some countries show variation in occurrence and outcomes
- Stable pattern worldwide
- Environment affects prognosis
Schizophrenia : Positive symptoms
- Delusion of thought (Mellor, 1970):
Thought insertion (thought that comes from somewhere else)
Thought broadcast (to believe people can hear what you are thinking )
Thought withdrawal
Thought control - Paranoia
- Delusion of reference ( afraid their thoughts are harming other people ; caused by them or reference to them)
- Grandeur delusion ( believing they are a famous ; god)
- Hallucination
1) Auditory (parroting, arguing and commenting)
2) Visual
3) Gustatory
4) Somatic
5) Olfactory - Bizarre/ disorganized behaviour (silly, rude)/ catatonic behaviour
-Disorganized speech
Schizophrenia : Negative symptoms
- Alogia (reduction in the amount of speech and / or increased pausing before the initiation of speech)
- Behaviour seclusiveness
- Apathy
- Anhedonia (lack of interest in routine behaviours or actions that result in positive outcome) - > usually due to anti-psychotic meds
Catatonia
Behaviour that seems to reflect a reduction in responsiveness to external environment (slow or purposeless motor activity)
Schizophrenia: Diagnostic criteria (DSM -5)
- 2 or more symptoms should exist for more than 1 month
- At least one symptom should be;
Delusions,
Hallucinations,
Disorganised speech
ICD -10 subtypes for symptoms of schizophrenia
Paranoid
Catatonic
Hebephrenic
Undifferentiated
Residual
Simple
Like DSM -IV
ICD -10
International Classification of Diseases (10th revision)
Schizophrenia and suicidal behaviour : Statistics
- 60-80% think about it
- 20-40% attempt
- 10% die
- Command hallucination is NOT the common cause of suicide
- Committed usually in the early stages
- High risk for males in isolation
What are the different theories of Schizophrenia?
1) Biological
- Dopamine hypothesis theory
- Neuroanatomy
2) Psychological
- Stress vulnerability model
- Gene-environment interaction model
Biological theory of Schizophrenia related studies:
Heston’s (1966) adoption study
47 offspring of mothers with schizophrenia
50 control children
Follow up carried out approx 35 years later (longitudinal):
5 offspring had schizophrenia
0 controls had schizophrenia
Offspring also more prone to psychopathy & neuroticism
Biological theory of Schizophrenia related studies:
Tienari et al. (1994):
Compared adopted children of mothers with schizophrenia, with control children mothers
First group more likely to have diagnoses, BUT
All children did well in “healthy” adoptive families
Family plays crucial role
Dopamine hypothesis theory.
Study on rats : Randrup & Munkvad (1966)
High levels of dopamine activity seen in schizophrenia patients
Study :
Administered L-Dopa (traditionally used to treat Parkinson’s disease) to rats
- Produced symptoms of schizophrenia
- then gave anti-psychotics
- this reduced symptoms
What other drug produces symptoms similar to that of schizophrenia?
- Cocaine
- Amphetamines
How do anti- psychotic drugs work?
They work by blocking the dopamine receptors
Neurological theory of Schizophrenia
- Decrease in brain volume as a result of schizophrenia
- Enlarged brain ventricles (in males)
–> Brain tissue loss in adolescent schizophrenia
Neurological theory : Study on auditory hallucination
McGuire et al. (1993):
fMRI revealed increased activity in Broca’s area during auditory hallucinations
Temporary treatment for auditory hallucination in schizophrenia
Giesel et al. (2012):
- Activation in gyrus of Heschl
- TMS stimulated the left superior temporal gyrus (primary auditory cortex)
- fMRI after TMS: no activation in the gyrus of Heschl
- No long-term effect
What is the stress vulnerability model?
People genetically vulnerable to schizophrenia seem to demonstrate higher sensitivity to stressors and negative life events
Study in Support of stress vulnerability model: Horan et al. (2006)
Categorised responses of participants with 1) schizophrenia, 2) Bipolar disorder, 3) Controls
-Avoidance was highest in schizophrenia and bipolar
-Coping was highest in the controls, bipolar second
-Social support and self-esteem was highest in controls, bipolar second
Gene-environment interaction model
This model explains the development of schizophrenia both as a result of gene and environment.
For instance, if there is predisposed genetic vulnerability (biological parent with schizophrenia) it increases sensitivities to stressors (such as dysfunctional family).
However, if a child grew up in a healthy family that would reduce exposure to psychologically harmful stressors so the likelihood of developing schizophrenia decreases.
The impact of a family member/relative’s expressed emotion on the person suffering from schizophrenia
Emotional over-involvement, criticism and hostility by the family member are a strong predictors of relapse.
This is a form of misattribution where the family member accuses the person for all the behavioural changes rather than the disease.
What factor increases the likelihood of relapse of schizophrenia in patients? How do we resolve this?
- Expressed emotion by the family member
Leff and Vaughn - Those with low expressed emotion are much more likely to have experienced undesirable life events
Therapy/intervention for high EE
- Family therapy: effective
- Delays relapse
- Drugs still necessary
Symptoms of bipolar disorder
Depression
Elation (polar opposite of depression)
Hyperactivity
Impractical flight of ideas/grandiose plans
Distractibility
Sometimes inappropriate/intrusive to others
What is ‘bipolar disorder’ called in DSM-5 ?
Bipolar and related disorders (bridging schizophrenia and related disorders and depression)
Mood disorder in DSM- IV
What percentage of population is diagnosed with bipolar disorder?
1%
Average onset of bipolar disorder and the average tendency to recur in a lifetime
Early 20s
4 episodes in a lifetime
Gender prevalence of bipolar disorder
Equal prevalence in males and females
Females experience more depression & less mania
Diagnostic criteria of bipolar disorder
DSM-5 –> Symptoms of both mania and depression
What are the symptoms of mania?
Abnormally elevated mood- sufficient enough to impair social and occupational functioning
