Mental Health remaining Flashcards
What is the issue with language in mental health conditions
The language that we use can actually perpetuate stigma. Especially if our language suggests certain stereotypes associated with a certain mental health condition –> makes people feel more judged?
What were mental health conditions referred to before
Abnormal psychology, however, this was changed because it suggests mental health issues is abnormal, discouraging people from speaking up
What is psychology
The scientific study of behaviour, emotion and cognition (and the potential relationship between these factors)
What is abnormal psychology
Scientific study of abnormal behaviour, emotions and cognitions
What is psychopathology
Psyche = mind, pathology = illness/disease
Study of mental illness, including classification, causes, development, treatment and outcomes
What is the empirical method
any procedure for conducting an investigation that relies upon experimentation and systematic observation rather than theoretical speculation.
It is used at different levels of mental health such as; classification/diagnosis, causation, treatment
Explain why empirical method might be used for describing mental health
To define MHC, we need to tell what is normal/healthy vs abnormal/unhealthy –> we need an empirical method of approaching this
Thus, we might try to see if there are a cluster of symptoms associated with a certain illness
Explain why empirical method might be used for identifying the causation of mental health
Causes of MHCs is complex
Involves interaction of biology, individual psychological factors, upbringing, social environment
Empirical method required to narrow down the influence of each on MHC
Explain why empirical method might be used for treatment of mental health
Critical for understanding then treating MHCs
Scientific method used in treatment through RCTs to determine if a treatment is valid (control groups, manipulations etc), placebo effect
Understand and explain key differences between “normal” and abnormal behaviour
Abnormal refers to anything whish isn’t normal –> but then what isn’t normal? (the line between the two is quite blurred)
Hard to determine as well because mental illness is subjective and varies across cultures, times etc
However, the ‘3D’s’ would help with identifying what’s considered abnormal behaviour
What are the 3D’s?
Deviates
Distress
Dysfunction
Explain how deviation can be used to recognise abnormal behaviour
Refers to deviation from statistical norm. Often the first step in identifying normality vs abnormality.
Basically looking at behaviour which isn’t the norm, and thats the first step in potentially detecting abnormal behaviour
Howeve,r important to note that sometimes a deviation from the norm could be an exception or rarit, and whats considered normal is always culturally and time bound –> we can’t use deviation as the only factor
Explain how distress can be used to recognise abnormal behaviour
This is where there is distress in oneself or others (e.g. family). Distress isn’t always necessary
However, its just when the behaviour has a negative impact on yourself and potentially others –> sign of abnormal behaviour
Explain how dysfunction can be used to recognise abnormal behaviour
if mental illness causes dysfunction in person’s ability to carry out important life goals etc, it could be classified as an illness
However, some disorders might not necessarily involve dysfunction (i.e. some people with psychopathic tendencies tned to be good CEOs - functioning well in society )
What is the biomedical model of mental illness
Dominant model in psychiatry and the underlying model of the DSM 5
Assumes that mental disroders can be diagnosed similar to physical illnsesses, and can be explained in terms of a biological disease process
Ultimately proposes that mental disorders are brain diseases and emphasises pharmacalogical treatments to target presumed biological abnormalities
What does biomedical model of mental illness believe is the best way to treat mental illness
Treat biological deficiencies (i.e. medication or electroconvulsive therapy ECT)
What are the criticisms/ limitations of the biomedical model
Need to avoid extreme reductionism (i.e. reducing the complex nature of mental health conditions into few constituents
Complexity of psychological phenomenon are impossible to explain at the neural/molecular level asw ell
What was the psychoanalytic model of mental illness
Most dominant theory in the 1st half of the 2nd century. Proposed Id (pleasure), Ego (reality satisfying both id and superego) and superego(moral self). Suggested that the Id and superego were in constant conflict, and ego tries to work out and problem solve how to meet both needs
Maladjustment/mental illness occurs when there is unresolved conflicts —> anxiety –> use of defence mechanisms –> symptoms of mental illness/ suffering
Didn’t really believe in an idea of normality
What did the treatment in psychoanalytic model of mental illness involve
Involves:
Building insight into unconscious processes
Developing awareness of unresolved conflict
Developing awareness of defence mechanisms
What was the significance of the psychoanalytic model of mental illness
Revolutionised the concept of mental illness
Made no clear dividing line between abnormal and normall
Strong influence on early stages of DSM
What was the criticisms/ limitations of the psychoanalytic model of mental illness
Lacks evidence
Not open to empirical evaluation
Unfalsifiable (unable to be proven false)
What was the humanistic model of mental illness
Significant in 60s and 70s as a reaction to negativity of psychoanalytic model (which was saying that everyone was abnormal to an extent)
Core of the model is the idea that the human being is a wholly positive figure, and the goal of the hhuman is to self actualise (involves experiencing life to the fullest, living in the present, trusting our own feeligns etc) –> every human has the potential to achieve self actualisation
Suggested that maladjustment occurred when self actualisation has been thwarted - for example the enviro imposing conditions of worth on the individual or when our experiences, emotions or needs are blocked
What is Maslows hierarchy of needs
Physiological needs –> safety needs –> love and belonging –> self esteem –> self actualsation
What was treatment in humanistic model of mental illness based on
Involves treating people with empathy and an unconditional positive regard, and trying to help them see themselves in a positive way
What were the critiques of the humanistic model of mental illness
These are important parts of therapy, but they aren’t sufficient enough (can’t just have a positive regard of them)
Difficult to research (i.e. when is self actualisation actually achievable)
What was the behavioural model of mental illness
Reaction to psychoanalysis being unfalsifiable. In comparison, this involves clasasical and operant conditioning
and suggests that maladjustment occurs as a result of our learned history/associations with negative things
What was the treatment with the behavioural model of mental illness
Involve varying treatments, in particular exposure therapy to help with extinction
What were the criticisms of the behavioural model of mental illness
Involves the overemphasis on behavioural aspects, and often excluding cognitive and emotional elements
What was the cognitive-behavioural model of mental illness
Most dominant current psychological model
Suggests that our behaviours are controlled by our cognitions, and they both work together to determine how we feel and what we do etc
WHat does the CB model of mental illness suggest is the root cause of mental illness
Negative core beliefs are the root cause of mental illness.
These are long held core beliefs or udnerstandings of the world that a person holds which influences our interaction with and interpretation of the world –> automatic thoughts coming from core beliefs. It can come from early life experiences which set blueprint for how we interpret the world
E.g. loving family = im safe, im enough , im loved
unloving family = im alone, im not worth anything
It is ultimately our automatic negative thoughts which reflect our core beliefs and might appear so quickly that we don’t notice them, leading to our mental health issues
What are some examples of cognitive distortions/ biases
All or nothing thinking
Mental filter
Overgeneralising
Disqualifying the positive
Jumping to conclusions
Magnification of catastrophies
Labelling
What does the CB model of mental illness suggest treatment involves
Psychoeducation = teaching the people about their automatic thoughts and how to catch themselves thinking those negative thoughts
Cognitive restructuring = challenging content of negative automatic thoughts
Behavioural experiments or exposure therapy can also be used
What were the criticisms with the CB model of mental illness
Too structured, which might not allow for flexibility to address unique needs
High dropout rates due to high attention needed
Oversimplifies psychological problems by focusing mainly on thought patterns and behaviours
Explain what psychoanalytic, humanistic, behavioural, and cognitive-behavioural believe the cause of mental illness is, and how to treat them?
Psychoanalytic cause = repression of unresolved conflict
Psychoanalytic treatment = insight
Humanistic cause = thwarted self actualisation
Humanistic treatment = empathy,, unconditional positive regard, self discovery
Behavioural cause = learned association
Behavioural tretment = learn new associations
CB cause = negative core beliefs, biased thinking, learned associations
CB treatment = cognitive restructuring, exposure, behavioural experiments
Describe what the DSM does/ what are its key features
It defines psychopathology, reflects the biological / medical model of mental illness and typically reflects the most agreed upon definitions / current consensus
How does DSM diagnose and classify mental illness
Uses a categorical approach to diagnosis, where mental disorders are classified into distinct categories based on specific criteira (i.e. a set of symptoms that must be present for a diagnosis to be made)
What are some changes which have happened in the DSM
Generalised anxiety disorder first introduced in DSM 3
Bing eating disorder first included in DSM 5
Asperger’s disorder removed from DSM 5
Prolonged Grief disorder removed in DSM 5
What are the benefits in DSM approaches to diagnosis and classification of mental illness?
Provides a standardised set of criteria for diagnosinng mental disorders which promotes consistency across different practitioners and settings
reflects empirical research and is often updated to reflect understandings of mental health
Supports treatment planning
Improves communication between researchers and healthcare professionals
What are the limitations in DSM approaches to diagnosis and classification of mental illness?
Labelling/stigma
Over medicalising reasonable reactions to stressful situations
Problems of validity, reliability and ambiguity
Reductionism (oversimplifying complex mental health issues)
What are the similarities in DSM approaches to diagnosis and classification of mental illness (with ICD - international classification of diseases)?
Both provide standardised criteria for diagnosing mental disorders and are widely used by clinicians worldwide
Both based on empirical research and periodically upadtes to reflect scientific knowledge
What are the differences in DSM approaches to diagnosis and classification of mental illness (with ICD - international classification of diseases)?
DSM is more detailed and focussed on psychiatric diagnosis, while ICD has a broader scope, including all diseases and health conditions
ICD uses a dimensional approach –> more flexible categories compared to DSM’s more rigid approach
What is anxiety
Anxiety is when an individual experiences intense, excessive and persistent worry and fear about everyday situations
This is typically activated in response to a perceived threat
Experience of anxiety is the same in normal anxiety and abnormal anxiety (severe, often and excessive)
Why does anxiety occur
Activation of physical, cognitive and behavioural systems
Explain the physical elements of anxiety (i.e. physical symptoms)
Increased heart rate and blood pressure
Stress hormones and diff neurotransmitters being released
Breathing speeds up to get more O2 for muscles
Saliva production reduces
Body tenses up
We sweat
Digestion slows down as blood flows away from stomach to muscles
Explain the cognitive elements of anxiety
Refer to how you pay attention, what you attend to, and your interpretations of the situation / object / person
1) perception of threat
2) Attentional shift towards threat
3) hypervigilance to source of threatening info –> difficulty concentrating on other tasks
Explain the behavioural elements of system (i.e. coping measures)
Avoidance behaviours
Restlessness and fidgeting as a way of releasing nervous energy
What is Yerkes Dodson Law
Suggests that there is an optimal arousal which allows for the best performance
Explain abnormal anxiety
Typically characterised by overestimation of threat (excessive and disproportionate)
Perceived higher probability of a negative outcome
Perceived cost of negative outcome is often increased as well
Differentiate between normal and abnormal anxiety
Normal anxiety is typically proportionate to the situation, and occurs out of an evolutionary need for survival
Abnormal anxiety is typically a lot more out of proportionate reaction/anxiety in response to a situation
Explain key differences between DSM 4 and DSM 5 anxiety and related disorders
Introduction of selective mutism
Got rid of Acute stress disorder, posttraumatic stress disorder, obsessive compuslive disorder as specific disorders. Instead, they reintroduced them under umbrella terms like ‘trauma and stressor related disorders’ or ‘obsessive compulsive and related disorders’
What is a panic attack
This describes a discrete period of intense fear or discomfort that appears abrupty and peaks usually within 10 mminutes
Classic symptoms of autonomic arousal (sweating, pounding heart, shaking, shortness of breath, nnausea, dizziness etc) –> could also be followed by a fear of dying, losing control, going mad etc
What is a specifier
Extensions to a diagnosis to further clarify a disorder or illness. They allow for a more specific diagnosis
What is a panic disorder? What is it characterised by?
This is recurrent unexpected panic attacks (unknown triggers)
At least one of the attacks was followed by 1 month (or more) of one or both of the following; persistent concern/worry about having another attack, significant maladaptive change in behaviour relative to attacks
What are panic related behaviourss?
Avoidance (of situations where panic is likely and of activities that produce panic like sensations)
Escape
What is the difference between panic attack and disorder
Panic attacks may be experienced in everyday situations, and fear focuses on negative evaluation by others and expected social embarassment
Meanwhile, panic disorders is when the attack itself becomes a problem, as indicated by fear of future attacks and altered behaviour in response to attacks (fear of fear)
What are some stats about panic disorder
~5% of Aus has had PD in lifetime, about 3-4% in any 12 month period
Most common in females
Onset in early adulthood
Comorbidity (depression, agoraphobia)
Describe the Clark cognitive model of panic disorder
1) Typically benign triggering stimulus
2) This stimulus is perceived as a threat and a sign of imminent physical or psychological catastrophe
3) Catastrophic misinterpretation
4) Anxiety response: misinterpretation —>heightened anxiety and activation of fight or flight response including release of adrenaline which intensifies the physical sensations like HR or shortness of breath
5) panic attack as these feelings are misinterpreted as a panic attack –> cycle continues
Describe the key treatment elements for panic disorder
CBT: Psychoeducation, exposure and interoceptive exposure (graded exercises that induce the physical responses of a panic attack, repeated and sufficient duration, challenged beliefs about physical sensations and extinguish conditioned anxiety)
What are the key features of specific phobia
A marked and consistent fear reaction to presence or anticipation of a specific object or situation
Anxiety experiences is out of proportion to the actual threat
Persistent - lasting 6 months or more
Phobic stimulus is avoided or endured with intense fear
Fear/anxiety/avoidance causes clinically significant distress or impairment in socia, occupational or other important areas of functioning
What are some examples of subjects of phobia
Could include animals, blood, injections, nature etc.
What are the potential causes of specific phobias
Could be due to classical conditioning (bad experience –> fear response –> phobia). However, conditioning isn’t the only cause
Some stimuli is more likely to become phobic than others (i.e. knives, guns)
Some phobias are threats to survival during evolution (i.e. phobias related to survival, such as snakes, spiders and heights are common)
Explain the prevalence and course of specific phobia
COmmon in children and more intense in adults
7-9% of adults have a specific phobia
More common in females (2:1) - particularly animal, environment, situational (blood/injection/injury)
Sometimes develops after a traumatic event, observing trauma, information transmission
Can develop in childhood and adulthood as well
What is the difference between normal fears and specific phobia as a mental health condition
Normal anxiety = feeling queasy while climbing a tall ladder
Phobia = avoiding climbing stairs because its tall and you’re scared of heights
Normal anxiety = worrying about taking off in a plane during a storm
Phobia = turning down a big promotion because it involves air travel
What is Generalised Anxiety Disorder(GAD)
The key symptom for a diagnosis of Generalised Anxiety Disorder is excessive worrying about a variety of different outcomes (rather than about one feared outcome, as in the other anxiety disorders).
The person finds it difficult to control their worrying and experiences a number of other symptoms, such as muscle tension, irritability, or sleep problems. The worries tend to be related to everyday life, such as work, study or relationship. However, as in the case in all other anxiety disorders, the worrying is out of proportion to the actual threat involved.
DSM 5 classification of GAD
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
The individual finds it difficult to control the worry.
The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Restlessness or feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
The disturbance is not better explained by another mental disorder.
Explain GAD prevalence and course
6.1% of people get it within their lifetime
Age of onset at around 31-39 years
Higher prevalence of females
Clinical course: most people w/ GAD dont seek help from mental health professionals, and those that do delay by over 10 years. Fluctuations in severity over time
Explain the diagnostic features of GAD
Associated with 3+:
Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
Excessive and uncontrollable worry (about wide range of events or activities)
Constant negative stream of consciousness - tihings that could go wrong, worrying about worrying, “what if?”
What are the features and associated thought processes of GAD
Excessive and uncontrollable worry, which could be based on but not limited to; professional worries, finances, personal health, world events, minor matters
The focus of worry may shift fro one concern to another. Typically the intensity/duration/frequency of worry is out of proportion to actual likelihood or impact of anticipated event
Process of catastrophising can occur automatically and quickly escalates
Associated with high trait anxiety, intolerance of uncertainty, reduced ability to tolerate distress, reduced problem solving confidence
What is obsessive compulsive disorder (OCD)?
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that an individual feels driven to perform. OCD can significantly impact daily life and functioning, as individuals experience intense distress over their obsessions and often perform compulsions to reduce the anxiety caused by these thoughts.
A key feature is the idea of a THOUGHT-ACTION FUSION - where they may think their thoughts are more than just thoughts and instead think that thoughts = action (i.e. thinking of killing someone means you actually kiilled them)
What are obsessions in ocd?
Repeated, intrusive, irrational thoughts or impulses which cause severe anxiety or distress
What are compulsions in ocd?
Reptitive/ritualised behaviours or mental acts to neutralise obsessions / reduce anxiety
What are some common compulsions
Washing/cleaning
Checking
Repeating
Ordering and arranging
Mental compulsions
What are some common obsessions
Contamination
Symmetry/order
Doubt/harm
Forbidden/taboo
What is the (potential) link between obsessions and compulsions
Can have one without the other but both are normally connected
OCD might be connected (contamination obsessions –> cleaning compulsion)
OCD might not be connected (forbidden obsessions –> cleaning compulsion)
What is OCD commonly associated with
Intolerance of uncertainty
Inflated responsibility
Thought action fusion (thinking about something is as bad as doing it) (thinking abt something makes it more likely to happen)
Medical ideation (If i dont step on the cracks, I will pass the exam)
What are the treamtnets for anxiety disroders
CBT, Psychoeducation, cognitive, behavioural, and biological treatments
Explain how CBT is used to treat anxiety disorders
Aims to reduce threat appraisals. Involves:
Encouraging patients to have a decreased likelihood of perceived harm, encouraging patients to decrease their perceived cost of the harm. Exposure gradual is also an essential ingredient
Likelihood + cost + exposure = effective treamtent (hopefully)
Also acceptance and treatment therapy is effective as CBT
Explain how psychoeducation is used to treat anxity disorders
Person’s specific triggers, responses and impacts on their life is written down
Involves explaining to the person the idea of anxiety in general
Role of avoidance is taught (taught that anxiety can worsen with avoidance)
teach relaxation tehcniques to address fight or flight response
Explain how cognitive techniques are used to treat anxiety disorders
Involves cognitive restructuring and challenging thoughts
thought diaries: to recongise automatic thoughts
Socratic questioning (am I making assumptions? COuld I misinterpret things? Am I looking at all the evidence or just what supports my thoughts? )
Explain how behavioural techniques are used to treat anxiety disorders
Exposure therapy - graded exposure (very important)
Could be imaginal (making the person imagine the scenario and walking them through that experience)
In vivo (do it live)
Involves development and progression through fear hierarchy (i.e. ranking different things from 1-100, with 100 being the most scary thing, and then walking through the differnt parts of the hierarchy)
Normally coupled with relaxation techniques
These ultimately also influence cognition (exposure to feared stimuli/situation reduces judgement of probability of harm, and exposure to feared outcomes reduces judgements of cost and harm)
Explain how biological treatments are used to treat anxiety. WHat are the issues of this?
Treats the symptoms and NOT the cause
Can be useful in STT
Barbituates: Quick acting - addictive, risk of OD, interacts with alc, and high relapse rate
Benzodiazepines: Quick acting - addictive, interacts with alc, high relapse rate
Antidepressants - SSRIs: Slower effects - fewer side effects, however relapse is still common
Ultimately the gold standard would be CBT + medication to treat an issue
What are mood disorders characterised by
These are characterised by a disturbance in mood
They are episodic.
What are mood disorders
Mood disorders are a category of mental health conditions characterized by significant disturbances in a person’s emotional state or mood, which can severely impact their daily functioning and quality of life. Mood disorders primarily involve prolonged periods of extreme sadness, elevated mood, or a combination of both. The most common mood disorders include major depressive disorder, bipolar disorder, dysthymia (persistent depressive disorder), and cyclothymic disorder.
What is the difference between a unipolar and bipolar mood disorder
Unipolar is where the patient only experiences a certain extreme of a type of mood (i.e. only depressive)
Bipolar is where the patient experiences the two extremes of mood –> i.e. being both manic and depressive
What are the key differences between DSM 4 and DSM 5 mood disorders classification
DSM 5 had the addition of ‘disruptive mood dysregulation disorder’ and ‘premenstrual dysphonic disorder’
In DSM 4, it categorised ‘bipolar disorders’ under mood disorders, however, in DSM 5, ‘Bipolar and related disorders’ now form a distinct category, separate from depressive disorders
DSM 5 had the new addition of persistent Depressive Disorder which combined Dysthymia and chronic major depressive disorder (?!)
Explain sadness as a life experience
It is mild and temporary, and is an almost universal experience
Involves feeling blue, sad, discouraged, apathetic, lack of joy
Sadness is common after -ve experiences such as death, illness, relationship breakdown, lost/missed experiences
Feelings usually fade, and people become accustomed to the new norm
Differentiate normal sadness from depressive disorders as a mental health condition
If the frequency, intensity and duration of depressive symptoms are out of proportion to person’s life situation –> depressive disorder
Responses to significant loss might include feelings of sadness, insomnia, poor appetite - resmbles depressive episode. Although these responses may be understandable or appropriate to loss, we don’t want to underdiagnose depression in people who experience loss –> clinicians use judgement based on patient history, personal and cultural context
What is a major depressive episode
A major depressive episode is a period of at least two weeks during which a person experiences a pervasive and intense depressive mood or a noticeable loss of interest or pleasure in most activities. This period is marked by significant changes in emotional, cognitive, and physical functioning that differ from the person’s usual state. Major depressive episodes are central to the diagnosis of major depressive disorder (MDD) but can also occur in other conditions, such as bipolar disorder.
What are the key symptoms of a major depressive episode
At least 5 or more of the following symptoms during 2 week period (need 1 and 2)
1) Depressed mood most of the day, nearly everyday
2) Markedly diminished pleasure.interest in activity
3) Significant weight loss/gain
4) Insomnia or hypersomnia nearly everyday
5) Psychomotor agitation
6) Fatigue or loss of energy nearly everyday
7) Feelings of worthlessness and excessive guilt
8) Diminished ability to concentrate
9) recurrent thoughts of death, suicide, suicide attempts
What is a major depressive disorder
A diagnosed mood disorder with recurring MDEs
Single or recurrent depressive episodes? Not accounted for by other disorders?
How is Major depressive episode different to major depressive disorder
Different to MDE in the idea that it is the ongoing disorder that cause episodes across individuals life. MDE just describes one episode
There could be a single or recurrent depressive episode
Explain the prevalence and course of MDD
Prevalence = 5-25%
Onset is typically after puberty, peaking in 20s but could happen later on in life
Females are 2x more likely to have unipolar mood disorder vs males
Comorbidity w/ anxiety and substance taking
Course variable - remission from symtpoms, number and length of episodes
Depression has 3r highest burden of all diseases
Number one cause of non0fatal disability
What is persistent depressive disorder
Depressed mood for most of the days, for at least 2 years
Explain the symptoms of persistent depressive disorder
Presence of two (or more of the following)
Poor appetite or overating
Insomnia or hypersomnia
Low energy or fatigue
Low self esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
Individuals havent been without these symptoms for more than 2 months at a time
No manic or hypomanic episodes
Not better explanation by ther psychotic disorders or isn’t attributed to substane abuse or medical conditions
Explain the prevalence and course of PDD
Prevalence = 1-2%
Early onset
Chronic course, might be milder than MDD but still causing distress
Lacks symptom free periods
What are the differences between MDD and PDD (Duration, severity)
Duration: MDD has discrete episodes ofdepression lasting at least 2 weeks, and can experience periods of normal moods, meanwhile PDD is chronic, long term version of depression, lasting for at least 2 years with rare periods of normal mood
Severity: MDD is more severe symptoms, whereas PDD is milder but more chronic
Outline the biological theories of depression
Genetic vulnerability
Neurochemistry
Neuroendocrine
Vulnerability Stress motives
Explain genetic vulnerability as a theory of depression
SUggests that depression was heritable
Heritability: 35-60%. Heredity causes vulnerability to mood disorders
Explain neurochemistry as a theory of depression
Low levels of nroadrenaline and/or serotonin
No good evidence for causal mechanism though
Explain the neuroendocrine system as a theory of depression
Excess cortisol in response to stress
increased stress correlated to mood disorders
Explain vulnerability stress models as a theory of depression
Biological vulnerability + stress –> depression
Outline the psychological theories of depression
Diathesis stress models
Schema theory
Ruminative response styles
Explain the diathesis stress model as a theory of depression
Cognitive vulnerability (likely from childhood –> trauma) + stress –> depression
Explain the schema theory as a theory of depression
Schema = stable memory structure which guides info processing
Pre existing negative schemas could result in info processing biases (i.e. only focussing on bad things)
Explain ruminative response styles as a theory of depression
Thoughts cycling over and over in our mind
What are some biological treatments for depression
Drug treatments - SSRIs block reputake of serotonin, and is effective in 70-80% of the cases
Electroconvulsive therapy (ECT) - brief electrical currents to brain, and it can be effective for severe depression (80%+)
However, it is common for relapse w/ biological treatments as it is treating the symptoms, not the cause
What is the aim of CBT in depression
Aim is to modify dysfunctional cognitions and related behaviours
Involves psychoeducation, behavioural activation, cognitive restructuring
Explain the cognitive aspect of CBT in treating depression
Address cognitive errors
Develop realistic view
Remove lens of negative schemes
NOT positive thinking, as it doesn’t normally work - patients need to know whats going on in their mind
Explain the behavioural aspect of CBT in treating depression
Behavioural experiments; testing the persons beliefs, and gathering evidence to disconfirm negative beliefs
Behavioural activation: increase reinforcing/postiive events (things to look forward to, identifying goals and values, building upward spiral of motivation + energy through mastery
Outlne the vicious cycle of depression
Feel depressed –> -ve thinking about self and world –> increased lethargy –> reduction of activity and social withdrawl –> loss of pleasure and achievement –> feel depressed
cycle continues
What are the differences between DSM4 and DSM 5 feeding and eating disorders
DSM 5 added the avoidant/restrictive food intake disorder, pica and rumination disorder
DSM 4 had EDNOS (eating disorder not otherwise specified) - broad category for eating dosorders that didn’t meet full criteria for anorexia or bulimia nervosa. DSM 5 replaced EDNOS w/ two more specific categories (other specific feeding or eating disorder, unspecified feeding or eating disorder)
Binge eating disorder became an official, distinct eating disorder in DSM 5, whereas DSM 4 it was in EDNOS
What are the key/diagnostic features of anorexia nervosa (AN)
Restriction of energy intake –> significantly low body weight in context of age, sex, developmental trajectory and physical health
Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes w/ weight gain, even at a low weight
Disturbance in way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or persistent lack of recognition of seriousness of current low body weight
What is the severity of AN
Level of severeity depends on the BMI
Mild (BMI 17-18)
Moderate (BMI 16-17)
Severe (BMI 15-16)
Extreme (BMI <15)
Level of severeity may be increased to reflect clinical symptoms, the degrees of functional disability and need for supervision to eat
WHat are the subtypes of AN
Restricting and binge-eating/purging type
Explain AN restricting type
During last 3 months, individuals has not engaged in recurrent episodes of binge eating or purging –> if not it is a different diagnosis
It is the presentations in which weight loss is accomplished primarily through dieting, fasting and/or excessive exercise
Explain AN binge-eating/purging type
During last 3 months, individual has engaged in recurrent episodes of binge eating or purging behaviours (i.e. self induced vomiting or misuse of laxatives, diuretics or enemas)
What are the associated psychological problems with AN
Depressed mood, irritability, anger, social withdrawl, preoccupation w/ food, poor concentration
Often associated with ‘starvation syndrome’ –> tough emotional experiences
Comorbid: Mood disorder, anxiety disorder, substance use disorder, personality disorder
What are the associated physical problems with AN
Low body temp, brittle hairs/nails, hair growth
Osteoporosis (brittle bones)
Metabolic disturbances, heart failure
Malnutrition, anemia, immune system suppression
Mortality rate = 5-10% over 10 year period (cardiovascular complications, suicide)
What is the prevalence of AN
Affects 0.5-1.0% of females
90% of individuals w/ AN are female
Rates are increasing in Aus
Age of onset is typically mid-late adolescence - appears to be getting younger
What is the course of AN
Chronic, slow recovery (up to 10 years)
Treatment seeking challenges
20% remain chronically ill
Recovery depends on the definition (right BMI? right thinking?)
About 56% go on to develop Bulimia nervosa
It also has the highest mortality rate of all psychiatric diseases
What are the key/diagnostic features of bulimia nervosa (BN)
Recurrent episodes of binge eating, characterised by:
Eating in a discrete period of time an amount of food that is definitely larger than what most people would eat during a similar period of time and circumstances
Sense of a lack of control over eating during the episode
Recurrent inappropriate compensatory behaviours in order to avoid weight gain –> laxative abuse, excessive exercise, fasting
Has to occur at least once a week for 3 months
Self evaluation unduly influenced by body shape
What are the associated psychological problems with BN
Comorbid mood disorders, anxiety disorders, substance abuse, personality disorders (bipolar)
What are the associated physical problems with BN
Associated with binges (e.g. stomach problems)
Most physical problems are associated w/ compensatory behaviours (I.e. vomiting: stomach acid –> loss of dental enamel, scarring, ulceration of oesophagus, laxatives: loss of normal bowel function, dehydration, electrolyte imbalance)
What was the prevalence of BN
Affects 1-3% of females; becoming more recognised in males
90% of individuals w/ BN are female
Males - purging is less frequent, instead they normally undertake exercise as compensatory behaviours
What was the course of BN
LT outcome is better than for AN
10% still affected after 10 years
What were the key/diagnostic features of binge eating disorder (BED)
Recurrent episodes of binge eating (eating in a period of time, an amoun of food that is larger than what most people would eat in a similar period and circumstance)
Marked distress regarding binge eating is present
Binge eating at least once a week for 3 months
No association w/ BN or AN
Lack of control over eating during the episode. ALso includes association w/ 3 or more of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone bc of embarrassment of how much they are eating
Feeling discussed with oneself, depressed or guilty afterwards
What is the difference between BED and BN
BN has active actions to try compensate for their excesive eating, wheras BED is not
What was the prevalence of BED
Affects 2.5% of population (2:1 female/male ratio)
Onset is adolescence to early adulthood
Explain the course of BED
Remission rates higher for BED than AN/BN
Associated w/ higher rates of obesity –> more blood pressure, more cholestrol, type 2 diabetes and heart disease
Explain the biological theories of causation in eating disorders
Genetic factors; moderate heritability of AN and BN, increased depression, personality disorders and substance use in families of people w/ eating disorders
Neurotransmitter disturbances; serotonin involved in appetite regulation –> mixed findings regarding direction of causation
Explain the psychological theories of causation in eating disorders
AN and BN have many features in common:
Tendency to base self worth on weight/shape
Intense fear of gaining weight
Desire to attain unrealistic levels of thinnness
Transdiagnostic model
Explain the transdiagnostic model
Core low self esteem, distress tolerance, interpersonal difficulties, perfectionism
Explain the pscyhosocial theories of causation in eating disorders
Family factors: High parental or sibling criticism, control and conflict, comments on eating behaviours, low parental empathy
Peer factors: Peer group w/ eating disorders, social approbal
Sociocultural factors: Cultural emphasis on thinness which emerged in the late 20th century
Ultimately, the idealisation of thinness is seen as a contributing factor to normative body dissatisfaction that females experience in western cultures.
Eating disorders are prevalent in subcultures where thin ideal is amplified
Explain the biological treatment of eating disorders
Medical management (i.e. medicines)
“Re feeding”
Dietician
Inpatient/outpatient depending on severeity
Explain the psychological treatment of eating disorders for adults
Stage 1 (Starting well) - personalised formulation, psychoeducation, behavioural focus (self monitor and regularly eat)
Stage 2 (Taking stock) - Joint review of progress, identify problems to address and barriers to change
Stage 3 (Addressing maintaining factors) - Main body of treatment, involves addressing key maintaining factors (weight/shape, mood related eating behaviours)
Stage 4 (ending well) - Ensuring progress is maintained, relapse prevention
Explain the psychological treatment of eating disorders for children/adolescents
Key emphasis on parental involvement/responsibility in home setting
2/3 are fully weight restoed, and 75-90% restored at 5 year followups
Phase 1: Parents in charge of weight restoration - “re feeding”
Phase 2: Parents transition control over eating back to adolescent (very therapeutic)
Phase 3: Discuss adolescent developmental issue, establish health identity
Path to become psychiatrist
Fully-qualified medical doctor
Specialist training and qualifications in the diagnosis, treatment and prevention of mental illness
Specialised knowledge of neurobiological changes/causes of mental disorders
In general, treat people with a diagnosed mental disorder
Can prescribe medication for mental health conditions
Treatment takes a bio -medical approach (some also take a psychological approach)
- Medical degree
- 4-6 years (depending on whether you are
coming into the degree as a university
undergraduate or graduate - Internship
- 1 year of hospital rotations/placement
- Residency
- 1 year of specialised hospital
rotations/placements - Vocational Training
- 5 years to complete a Fellowship of the Royal
Australian and New Zealand College of
Psychiatrists (FRANZCP)
Path to become clinical psycholgist
Look at book - should be common sense
What do social workers do? What are the qualifications and training involved
- Work in direct services (e.g., healthcare, welfare, housing etc.)
* Helping people cope with problems related to social cultural issues including
but not limited to poverty, legal issues or human rights - Work in the clinical field (more similar to psychologists)
* Diagnose and treat mental, behavioural or emotional health issues
* Focus: environment and cultural factors (sociological approach) rather than
psychological or personal characteristics (i.e. Family Therapy)
* Help clients develop practical plans to improve personal well well-being and make
referrals for services
Qualifications & Training
Bachelor of Social work (4 years)
Masters of Social Work (2 years + other 3 year Bachelor degree)
What do counsellors do? What are the qualifications and training involved
Assist people to gain understanding of themselves and make changes in
their lives:
May simply provide a non-judgmental ‘listening ear’
May work in a particular area (e.g. marriage/family/school counsellors)
Qualifications & Training:
Level of training is wide and varied
Ranging from weekend correspondence course to Bachelor degree
The term ‘counsellor’ can be used without any particular qualification
To register as fully qualified:
Bachelor of Counselling (3 years)
Graduate Diploma in Counselling (2 years) + previous Bachelor degree
What are the restricted titles
Psychologist is a restricted title. Can only use this if you are registered with the psychology board register
What are some unrestricted titles
Counsellor, Therapist, Psychotherapist, Life
Coach, Spiritual Advisor
