P3 - M.H. - The Medical Model Flashcards
Physical Malfunctions lead to Mental Illness (etc.)
Overview of BIO Explanations of M.H.
- Biological explanations suggest ALL Mental Illnesses arise from physical processes.
- 3 explanations are: Genetics, Brain Structure, and Biochemical (neurotransmitter) Activity.
You can use EITHER depression or schizophrenia as examples in your work but you MUST talk generally about ALL mental illness.
Genetic Factors of Schizophrenia
- Schizophrenia has a genetic basis but is Polygenetic (multiple genes involved).
- No single gene causes schizophrenia; multiple genes increase risk.
- Research identified 108 gene loci linked to the disorder.
- More research is needed for the Specific Genes
Genetic Factors of Depression
- Depression - 1 Gene called the Serotonin Transporter Gene, but also Interaction with Other Genes.
- Short / Short version of the S.T. Gene = highest risk for the development of depression.
- Long / Long version = lowest risk.
Genetics - Family Studies Evidence
- Family studies show Higher Rates of Schizophrenia among relatives
- Concordance rates help measure this Relationship
- Identical Twins (MZ) have a Higher Concordance Rate than Non-Identical Twins (DZ)
- Similar in Depression, but not as high
- INTERACTIONIST Results
Concordance Rates Explained
- Concordance Rate indicates how often both Individuals Share the Condition.
- Example - Schizophrenia: 48% in MZs vs. 17% in DZs
- General Population Rate for Depression: 1%, ~43% in MZs and 36% in DZs
- Schizophrenia Very Genetics Related
(Higher % of general population than Schizophrenia)
Genetics - Adoption Studies Evidence
- Adoption studies show Children of Schizophrenic Mothers have Higher Risk
- 5.8% of children raised in Healthy Environments developed Schizophrenia
- 36.8% developed it in dysfunctional families, highlighting Environmental Influence
Adoption studies on Depression have found similar results, but not as high as the Schizophrenia Results.
INTERACTIONIST
Limitations of Genetic Studies
- A 100% Concordance Rate is expected for purely genetic traits, but it never is
- Environmental factors also play a role in Schizophrenia and Depression Development (Adoption Studies)
- Genetic Predisposition does not guarantee any disorder will manifest at any point in life
Genetics in DSM
- DSM-1 & DSM-2 made definitions of M.Illmess from how it effects patients
- DSM-3 Defined it through what causes it aswell
- Robert Spitzer
Genes, DNA & Chromosomes
- 23 pairs of chromosones
- 10,000s of Genes
- DNA < Genes < Chromosomes < Cells
Genetics - Current Understanding
- Human Genome discovered from 1990-2003
- Genetics is the most recent of the Background areas (Biochemical is oldest)
- Still at early stages of Understanding - not yet falsifiable
Genetics - Shizophrenia Research Definitions
- Inheritance - A Trait passed on down from prevous generations of BIO family
- MZ - Identical Twins
- DZ - Non-Identical Twins
- Polygenic - A condition cuased by Many Genes
- Predisposed - Genetic Increased chance to develop a Condition
- Environmental Influence - Features of an individual’s environment that can provoke the development of a Condition
- Relatives - Individuals connected by Blood and Marriage
- General Population - The average amount of people who have no relatives with a condition without relation to a given condition
- Concordance rate - measure of the proportion of pairs that share a given trait (only including pairs w/ one that has the given trait)
BIOCHEM - Schizophrenia Hypothesis
Positive Symptoms - DAI
* Dopamine
* Acetylcholine
* Inflammation
Negative Symptoms - SGG
* Seretonin
* Glutamate
* GABA
Cognitive Symptoms - SGA
* Seretonin
* Glutamate
* Acetylcholine
GOTTESBERG - Aims
- How vulnerable are the children of two parents with mental illnesses?
- Specifically schizophrenia suffering parents and bipolar disorder suffering parents
- Rist of developing mental illness from 10-52
GOTTESBERG - Background
Research into Duel Mating studies previously had small samples
GOTTESBERG - Method & Procedure
- Cohort study; a cogort of the population born before ‘97
- ICD used to Diagnose - children & parents with Sz, Bplr or related Psychotic conditions
GOTTESBERG - Findings: Schizophrenia
Risk MUCH higher for children with TWO parents diagnosed
* 27.3% children had developed it themselves by age 52
* 39.2% children had schizophrenia related conditions
* 67.5% children has SOME form of mental illness
ONE parent
* 7% children had schizophrenia by age 52
* 11.9% had SOME mental illness
NO PARENTS
* 1.1% of general population had developed it by 52
GOTTESMAN - Findings: Bipolar
Risk MUCH higher for children with TWO parents diagnosed
* 24.9% children had developed it by age 52
* 36% had developed bipolar or depression
* 44.2% SOME type of mental illness
ONE parent
* 4.4% developed bipolar
* 9.2% SOME type of mental illness
NO PARENTS with bipolar
* 0.63% developed it by 52
GOTTESBERG - Conclusions
DID NOT:
* Suggest Pair Mating should be stopped or advised to stop
DID:
* Suggest to Educate and give Genetic Counsiling to Pair Maters so that they understand their decision
* So that they can decrease the child’s risk of developing the disorder
* Factors that increase risk:
* Family History
* Mother over 35
* Conception difficulties
* Disease Exposure
GOTTESMAN - Sample
- Sample - 2.7 million Danish people born pre 1997
- The data was sampled in 2007 so the minimum age would be 10
- 196 couples selected from this dataset - both had schizophrenia
- 270 children of these couples
- 83 couples both having bipolar disorder
- 146 children from these couples
GOTTESMAN - Design
- Natural experiment
- 2 naturally occurring IVs (Bipolar or Schizophrenia)
- DV = diagnosis on mental illness in child
ICD used to Diagnose the Cohort
**EVALUATION - Ethnocentrism
- Denmark - cannot be generalised outside of Denmark/Europe
- Race can have an impact on the risk of inhereting conditions, and Denmark is majority white
EVALUATION - Free Will/Determinism
- mainly DET - conditions outside the individuals control, determined by genetic vunrability, you cannot choose to pass on Genetic Disorders, decided also by family decisions
- FW - ppl have the free will to understand the risks of it & take precautions - CAN influence their genetic expression
**EVALUATION - Socially Sensitive
- May be interpreted as evidence for preventing couples from having a family
- Gottesman does NOT suggest this, just for Couples to understand/be educated on their risks
EVALUATION - Reductionism/Holism
-
mainly RED - Biological Reductionism: the mind is reduced to the brain - doesn’t take into account all factors, but can be seen as neccessary for the Scientific Process
A STRENGTH & WEAKNESS - Justified in scenerios?
EVALUATION - Nature/Nurture
Overall BIOMEDical: more NAT - emphasis on Genetic Vunrability to M. Illness, result of Genetic factors,
* however includes Environmental Factors in Genetic (dev of Sz: 5.8%>36.8%) & Br. Struc. (larger Ventricles), so some NUR
EVALUATION - Ethical Issues
SIG. Issues
* AntiPsychotic drugs have been given to patients in hospitals to make them easier for Doctors to deal w/, rather than for the patients’ benifit
* Human Rights Abuse
Side effects:
* AntiPsychotics have side effects from mild to fatal (older A-Ps associated w/ dizziness, agitation, itchy skin, weight gain)
* Long-term use can result in Central Nervous System damage; supersensitivity to dopamine - serious face twitches/movements
* considered incurable & hard to treat
* Ocassionaly produce fatal reactions
EVALUATION - Usefullness
- Found effective treatments: drugs & ECT
- Aroll reviewed studies about effectiveness of prescribed anti-depressants, 56-60% of patients improved - compared to 42-47% w/ the Placebo
- Thronley reviewed AntiPsychotics vs Placebo studies under controlled conditions - data from trails w/ 1.1K participants showed that the AntiPsychotic was associated w/ better overall functioning and lesser symptoms than Placebo
- Conditions cannot be entirely removed/fixed
EVALUATION - Drug Treatment: Schizophrenia/Anti-Psychotic Drugs
TYPICAL:
* 1st to be developed
* Block dopamine receptors, reducing amount of dopamine and so reduces Positive Symptoms pf Schizophrenia
ATYPICAL:
* Can also increase Seretonin at the same time
EVALUATION - Drug Treatment: Depression/SSRIs
- Stops Seretonin from being ‘reuptaken’ across synaptic gaps (go back across) forcing it to transmit properly
EVALUATION - Anti-Psychotic Drugs +s and -s
STRENGTHS:
* Relatively effective at treating these serious conditions and improve QoL to a significant extent
WEAKNESSES:
* Effects people differently
* Muscle supersensitivity to Dopamine can cause serious problems: involintary facial movements that can make social interaction difficult
EL DOPA STUDY
El Dopa Study Summary
- Trial for treating Parkinson’s disease, increased Dopamine levels
- Side effect included the patients experiencing Positive Symptoms of Schizophrenia
- Temporary (2 weeks)
- Led to the Dopamine Hypothesis for Schizophrenia
EVALUATION - Validity
Cause and Effect Established
- ICD used - standardised, scientific procedure
- (diff. IV levels for 2parents, 1parent, 0parents)
- Diff. doctors were used to diagnose the parents (decades ago) and their children
EVALUATION - Internal Reliability
If all the measures would measure the desired thing the same if repeated
YES - Procedure very standardised: ICD used for all patients, but Parents’ diagnosis may be based off out-of-date definitions
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EVALUATION - External Reliability
supports previous studies & theories
YES
* Concludes that there is a significant Genetic factor to developing genetic disorders
* The less relatives/parents someone has, the less likely they are to inherit the Condition
* They are not purely Genetic; if so, Concordance Rate would be 100%
EVALUATION - Practical Applications
- Parents with conditions can be given Genetic Counciling
- There are ways to reduce the risk of developing disorders
- Antidepressant Drugs
- ECT
**Outline the Genetic explanation of Mental Illness
The genetic explanation of Mental Illness suggests mental illnesses can be inherited from relatives, and are Genetic Expressions. Genes from our biological parents are responsible for alterations in the physical processes of the brain, including the physical structure of the brain, adn Neurotransmitters.
3/3
**Outline the Biochemical explanation of Mental Illness
**Outline the Brain Structure explanation of Mental Illness
**Evaluate the Genetic explanation of Mental Illness
The Key Research finds that Mental Illnesses, such as Schizophrenia, can be inherited; if an individual’s family has a history of a condition they are predisposed to develop the disorder. Twin Studies also find that MZ twins are significantly more likely to share the same disorder than DZ Twins, suggesting that Mental Illness is tied to Genetics.
**Evaluate the Biochemical explanation of Mental Illness
**Evaluate the Brain Structure explanation of Mental Illness