Psychological disorders Flashcards
What criteria are there for abnormality in psychological disorders?
- Statistical infrequency
- Unexpectedness of response - e.g. anorexia starves themselves
- Norms violation
- Causing personal distress
- Disabling
Flawed in isolation, useful taken together.
Advantages and disadvantages of classifying mental disorder?
Advantages:
- Helps determine clinical features
- Systematises diagnosis
- Shared understandings
Disadvantages:
- Can lead to stigma
- Pigeon holing - everyone is different and so you are just grouping people together even though they may not be exactly the same
- Natural vs constructed categories (I guess these are constructed?)
The different models for mental disorder?
Biological Behavioural Cognitive Psychodynamic Social
What is the biological model, what are the advantages and disadvantages?
Central tenet: Psychological disorder is a consequence of physical changes in brain and/or body
Advantages:
- Research into the role of heritability
- Role of Neurotransmitters
- Efficacy of some biological treatments
Problems:
- Passive patient
- Problem is situated with the persons body
- A biological treatment does not necessarily mean a biological cause
- Relapse
What is the behavioural model?
Symptoms and behaviour constitute the main features of mental disorder
The origin and persistence of the behavioural symptom can be understood through the science of learning theory
The application of learning theory removes maladaptive behavioural symptoms and in doing so removes the disorder.
The three types of learning theory in the behavioural model?
Classical conditioning - learning through association
Operant conditioning - Learning through consequences
Modelling - learning through copying
Benefits and problems with the behavioural model?
Advantages:
- Scientific
- Has Clear concepts
- Provides effective treatment (anxiety disorders in particular.
Problems
- Symptom substitution ie being scared of spiders may present in other ways and it may not tackle this as is not tackling cause.,
- Therapies crude and mechanistic e.g. flooding
- Offers poor explanation
Central tenets of the cognitive model?
Peoples view of the world is determined by their thinking (cognition)
Cognition influences symptoms, behaviour and attitudes.
Impaired cognition creates mental disorder
Significant changes in mental disorder requires significant changes in cognition
Benefits and problems in the cognitive model?
Benefits:
- Clear concepts
- Scientific
- Effective treatment options (particularly in combination with behavioural
Problems:
- Poor explanatory model
- Changed thinking does not necessarily mean changed behaviour (which came first the behaviour or the thinking)
- It is individualistic.
Central features of the psychodynamic model?
- The focus is the pattern of feelings
- We are unaware of many influential feelings
- Important feelings manifest in emotional reactions to the therapist - this is known as transference. The therapists reactions to the patient are equally important, know as counter transference.
- Troubling feelings and emotions are a part of the human condition, it is the imbalance of these negatives (against positives?) that causes mental disorder.
- Unconscious feelings are important in all relationships and can manifest themselves in symbols such as dreams.
- Emphasis on childhood experiences.
Benefits and problems with the psychodynamic model?
Benefits:
- Enduring contribution (endured for a long time, however not in academic psychology so much)
- Can be effective
Problems:
- Based on anecdotal evidence
- Findings based on small group of middle class viennese
- BIG influence of therapist - inserting own ideas etc.
- Can give insight into problems but this does not neccessarily fix them.
Central tenets of the social model?
Mental disorder is often triggered by life events, that appear independent of the disorder
Social forces such as class, occupational status and social role are precepitants of mental disorder
People with Mental disorder often become and remain disordered because of societal influences
Benefits and problems with the social model?
Benefit:
- Draws attention to the role of society and traumatic events
Problems:
- Is it the job of mental health professional to fight societal ills?
What are the central tenets of the integrated model of mental disorder?
We each have several layers of functioning, when mental disorder develops it can affect on or more levels.
At different times in the course of mental illness the predominant level of disorder may change
Each model links specifically to one level of functioning
Successful treatment involves matching the level of disturbance with the appropriate model
What is the stress-vulnerability model?
A predisposition towards mental illness is truggered by life stressors
This predisposition could be at a biological, cognitive and/or emotional level.
Major depressive disorder signs symptoms and diagnosis?
Emotional: sadness or emotional numbing, may include anxiety, anger and/or agitation
Cognitive: Negative view of self, guilt and self-blame, belief that the future is hopeless
Motivational: Have trouble getting started, physical inertia, difficulty making decisions
Somatic: Loss of appetite, sleep disturbance, fatigue, loss of libido and hypochondriasis (hypochondria)
At least 5 symptoms nearly everyday for at least 2 weeks and must include daily depressed mood for most of teh day and/or daily diminished pleasure in activities (anhedonia) - may have psychotic features
What is persistent depressive disorder (briefly)?
Milder chronic depression for at least 2 years without 2 months remission.
What is the aetiology of the behavioural model’s approach to depression?
Learned helplessness
- Failure to learn that responding can be successful as it has not been successful in the past.
EVIDENCE: Hiroto (1974) respondents stop trying to stop a loud noise if previous attempts are unsuccessful.
Reduced rewards:
- Negative spiral of social rewards ie. you feel bad, and people find it harder to be around you so you feel worse etc. Constantino (2012)
Behavioural approach to treatment of depression?
Operant conditioning:
- Challenge people’s preconceptions, learn through consequence
Classical conditioning:
- Learn a new non-depressive association to personal depressive stimuli. e.g. get up and do something enjoyable, eat chocolate
What is the aetiology of the cognitive models approach to depression?
Attributional reformation of learned helplessness:
- The expectation of negative events that one can do nothing about causes depression.
Depressive attributions for negative events are:
- Internal (inherent personal failing)
- Stable (persist over time)
- Global (persist in different situations)
Cognitive approach to treatment of depression? Typical scheme?
Typically used with behavioural elements
CBT:
- Cognitive elements correct dysfunctional thinking
- Behavioural elements aim to reinforce and reality test
Typically:
Eduction phase: Teach the relationship between cognition, emotion and behaviour
Behavioural activation and pleasant event scheduling: Increases engagement and activity
Cognitive rehearsal: Develop and practice cognitive/behavioural coping strategies
behavioural hypothesis testing: test the validity of negative assumptions (conditioning)
Evaluation of the cognitive approach to depression? (3)
Is negative cognition the cause or result of depression:
- High interpersonal stress regardless of negative cognition can predict depression as much as high negative cognitions Carter and Garber (2011)
Are negative cognitions necessarily pathological:
- Depressed people have less illusion of control than non-depressed people Moore and Fresco (2012)
Therapeutic success:
- roughly similar to pharmacological approaches
The aetiology of the psychodynamic model for depression?
It is a defence mounted by the ego against intrapsychic conflict Freud (1917):
- A reaction to loss and subsequent regression to oral stage of dependency theory
- unconscious anger turned upon the self
Modern assumptions:
- Rooted in early losses
- Wound reactivation by recent trauma
- Regression to sense of helplessness
- Ambivalent feelings are a central unconscious conflict
- Overly seek self-esteem from others, the dependency can cause depression
Psychodynamic approach to treatment of depressive disorders?
Traditional psychoanalysis:
- Uncover childhood roots of depression
- Explore the ambivalent feelings (conflicting feelings) towards ‘lost object’ through free association, dream analysis and analysis of resistance and transference.
Interpersonal psychotherapy:
- Focuses more on present problems than past problems
- Focuses more on how depression is used in relationships
- Identify core problem and discuss solutions
Evaluation of the psychodynamic approach to depression?
Some depressed people are highly dependent, supports.
Poor parenting is a risk factor for depression - consistent with attachment theory
Therapeutic success with depression, cognitive therapy and IPT (integrated psychological therapy) are all effective treatments for acute major depression, no consensus on the best.
Social approach to aetiology of depressive disorders?
R/Fs:
- Recent life event
- For women: Unsupportive spousal relationship, no job outside home, 3 or more young children, no religion, loss of mother <11 yrs
Treatment of depression according to the social model? and evaluation of it?
Interpersonal psychotherapy
Couples/marital therapy
Evaluation:
Draws attention to social and societal factors, Cannot predict who can actually become depressed.
Types of anxiety disorders (in this course?)
GAD
Panic disorder
Phobias: Specific, agoraphobia, SAD
OCD
What is diffuse anxiety, what conditions have this and what are there diagnostic factors?
Diffuse anxiety: Anxiety surrounding no specific object or situation, yet still feeling anxious
GAD: Chronic uncontrollable worry >3months, 2 or more activities or events, restlessness/muscle tension, significant distress or impairment
PD: Suddenly repeatedly overwhelmed with brief attacks of terror, >1 month of persistent concerns about attacks and/or significant maladaptive change in behaviour.
Social approach to GAD? Aetiology, Treatment and evaluation.
Aetiology: Societal pressure
Evidence: More likely following natural disaster, more likely on low income, higher in run-down communities.
Treatment: Support system and social change (social policy), international aid, civil rights, egalitarianism (all are equal).
Evaluation: why do some develop and some do not under similar social pressure - can’t all be down to social factors
Behavioural Aetiology approach to anxiety disorders?
Avoidance conditioning formulation:
- Learned through classical conditioning
Maintained through operant conditioning
Modelling
Behavioural approach to treatment of anxiety disorders?
Exposure:
Systematic desensitisation Flooding Modelling SAD: Social skill training, relaxation and exposure Virtual reality exposure treatment OCD: Ritual/response prevention
Behavioural approach to anxiety disorders evaluation?
Benefits:
- Effective treatments - particularly for OCD and SAD
Problems:
- Non-traumatic phobias - non-pathological phobias (realistic)
- not a very good explanatory model
Cognitive aetiology approach to panic disorders?
Catastrophic misinterpretation of bodily stimuli
Trigger:
- perceived threat - Apprehension - Bodily sensations - Interpretation of sensations as catastrophic - (loop back)
Cognitive approach to treatment of panic disorders?
CBT:
Reinterpret frightening sensations as not impending doom but from stress
- Mimic the start of an attack by hyperventilating
- Make link between behaviour and sensations
- Relaxation and social support
Evaluation of cognitive approach to panic disorders?
Benefit:
- Better model for understanding diffuse anxiety disorder
- Useful in combination with other models: CBT
Problems:
- Usefulness on own depends on the disorder itself
- Behavioural can be more cost-effective.
Psychodynamic approach to OCD, aetiology?
The type of disorder depends on:
- Psychosexual stage the pt is fixated at
- Defence mechanisms used to protect id (not truly successful
e.g. OCD:
- Fixation at anal stage
- Reaction to formation of id impulses
- Obtrusive thoughts linked to unconscious id wishes
Psychodynamic approach to treatment of OCD?
Insight into the unconscious conflict through interpretations of dreams, associations and transference.
Evaluation of psychodynamic model and it’s approach to OCD?
Benefits:
- case study basis of success
- Neuroimaging may support the idea that sexual and aggressive impulses reduce processing speed in OCD
Problems:
- Little evidence of effectiveness in OCD.
Signs and symptoms of schizophrenia?
Positive symptoms: delusions, heightened perception/hallucinations, disorganised speech/thought disorder.
Negative symptoms: Behavioural deficits, avolition, alogia (poverty of speech), anhedonia
Psychomotor: Catatonia (usually associated with with a delusion - think something awful will happen if they move)
What is psychosis?
Loss of touch with reality
What is loosened associations in schizophrenia?
‘word salad’ lose associations between words:
Fruitful becomes: wine-year or apple, saurkraut.
Schizophrenia diagnosis?
First rule out mood, organic or substance induced disorder
Presence of disorder for at least 6 months
Two or more of following for 1 month:
- One core positive symptom.
- Another psychomotor or negative symptom.
Decline in self-care occupational functioning and/or social functioning.
Prevalence of schizophrenia?
1/250
Percentage of voice-hearing in public and student population?
<8% in public
<40% in student population
Aetiological approach to schizophrenia in the cognitive model
Cognitive deficits approach:
- Impairments in perception, memory and attention make it hard to cope with environmental stress
Cognitive biases:
- Traumatic events in childhood affect the way one interprets info later in life:
Verbal hallucinations may be due to:
- Difficulty distinguishing internal thoughts from external voices
- Beliefs and explanations affect distress level
Delusions:
- Normal resistance to change
- Normal bias towards confirmatory evidence
- Normal thinking errors e.g. jumping to conclusions
Evidence for the existence of persecutory thoughts in everyday life?
Virtual reality study (Freeman & Garety 2004)
10 - 25% of the population experience persecutory thoughts (think that harm has occured or is going to occur)
Explanations for delusions?
As an attempt to explain experience:
- Ambiguous social information
- Coincidences
- Negative, irritating, stressful events (leading to vulnerability & anxiety)
- Importance of internal feelings (heightened state of arousal, feelings of significance, depersonalisation)
- Reasoning processes (reduced data gathering, externalising attributional biases, theory of mind difficulties (understand that mental states can be due to oneself and that others have separate, beliefs desires and perspectives different from ones own.))
Cognitive-behavioural approach to treatment of schizophrenia?
Token economy programmes:
- Operant conditioning to reduce presentation of symptoms.
Social skills training:
- Role playing
- Modelling
- Positive reinforcement
Reattributional therapy
- Questioning of where voices are coming from
- Explore alternative beliefs about explanations to reduce stress
- test reality of unusual beliefs and their supporting evidence
- Develop coping strategies
ACT:
- Accept troubling thoughts rather than judging or trying to change them
- Become detached observers of hallucinations
Evaluation of cognitive-behavioural approach to schizophrenia?
Usually used in conjunction with medication
Token economy programmes, and social skills are relatively successful, but may not last or generalise.
CBT is not always available however hospitalisation reduced by 50% when CBT is used.
Psychodynamic approach to schizophrenia in terms of aetiology and treatment?
Freud - Regression to pre-ego stage, with efforts to reestablish control.
Fromm-Reichmann - Schizophrenogenic mothers, statements of love but only with constraints
Jung - Dreams being brought to life
Treatment aims to increase insight:
- Interpret the covert meaning behind the symptoms
- Explore past experiences & seek connections with the present
- Intensive in time and emotion
Evaluation of psychodynamic approach to schizophrenia?
Freud felt SZ pts were unsuitable for psychoanalysis
Little evidence for schizophrenogenic families - (Willick 2001)
Treatment may expose pts to memories and insights they are unable to deal with.
Insight may mean agreeing to stigmatisation and dubious diagnosis.
Meta analysis suggests comparable improvement rates of schizophrenia with psychoanalysis compared to CBT.
Social approach to SZ in terms of aetiology and treatment?
Acceptance of a mental illness is associated with low mood and low self-esteem.
Sociogenic hypothesis - something about being on the lowest rung of the ladder
vs
Social selection theory - people fall to lower rungs because of their condition (evidence supports this)
Treatment, (rehabilitation) - focus on improved real-world functioning
- Milieu therapy (group stay for long periods), therapeutic communities and community care
- Family intervention - can be efficacious
- Occupational therapy
EValuation of the social approach to SZ
Draws attention to cultural differences, research has suggested black people are more likely than white people to receive a diagnosis of SZ even if expereinces are described as the same.
Vocational recovery and success are viable outcomes for those diagnosed with SZ spectrum disorders
Community care shows promise but is too often poorly resourced and co-ordinated.
What is the stress-vulnerability model of schizophrenia?
Vulnerability will result in the development of problems only when environmental stresses are present, prime environmental suspects are: (1) urban upbringing and (2) migration due to:
- Disintegration of family networks
- Social fragmentation - people think they are abnormal
Two forms of tissue pathology?
Organic pathology - a structural/morphological abnormality, sometimes observable to the naked eye
Functional pathology - functional or physiological abnormality detectable with biological/pharmacological techniques.
Contemporary view on the nature vs nurture argument, (interactionism) ?
Nonsensical argument, the two extensively interact, Tyrer and Steinberg have said that models should be complimentary and not oppositional.
Interactionism states that biological and environmental factors alone or in combination can cause mental dysfunction (each can also protect against each other).
