Psychology ABNORMALITY Paper Four

Question 1

Schizophrenia and Psychotic disorders

Answer 1

Include a range of psychotic disorders that affect all aspects of a person’s thinking, emotions, actions, along with a major break from reality.

The personal, social and occupational functioning deteriorate because of disturbed thought process, unusual emotions and motor abnormalities.

Question 2

DSM definition

Answer 2

Schizophrenic spectrum and psychotic disorders as sharing one or more of the following: e.g. delusions, hallucinations, disorganised thoughts or negative symptoms e.g. loss of speech

Question 3

When diagnosed?

Answer 3

DSM: two symptoms for at least one month one must be delusions, hallucinations or disorganised thoughts/speech

Question 4

Types of Psychotic Disorders

Answer 4

Schizotypal: difficulty developing emotionally meaningful relationships with others and showing extreme coldness and flat affect

Substance induced psychotic disorder: a psychiatric disorder featured by delusions and/or hallucinations during or soon after substances intoxication or withdrawal

Question 5

Case Study

Answer 5

Conrad, male aged 23.

First episode aged 22 while on holiday, later diagnosed with schizo-affective disorder.

At first he was reluctant to seek treatment as he was unsure of recovery. He spent eight months following diagnosis in a psychiatric hospital. Conrad eventually found the right drug treatment but struggles with maintaining a healthy weight.

Question 6

Delusional Disorder (inc. types and diagnosis)

Answer 6

Characterised by persistent delusions but whose other behaviours are ‘normal’. There is an absence of the other psychotic symptoms of schizophrenia such as hallucinations, disorganised speech or negative symptoms.

Types:
Erotomaniac: belief that another person is in love with them
Grandiose: they are convinced they have a great unrecognised skill or status
Jealous: belief their partner is being unfaithful

Symptoms for at least one month and be unrelated to physiological effects of substance use.

Question 7

Freeman Aim

Answer 7

To investigate the use of virtual reality in assessing symptoms of shizophrenia

Question 8

Freeman Procedure

Answer 8

• 200 non-clinical participants
• Multiple measures: level of paranoia, emotional distress as well as social/cognitive traits. Simulator-sickness questionnaire was given before and after the simulation.
• Participants entered a 4 min virtual reality journey of either a library or underground train scene where the person walks/rides in the presence of other neutral avatars.
• After completion, persecutory thinking was measured alongside a VAS and an assessment of immersion in the environment

Question 9

Freeman results

Answer 9

Those who scored highly on the assessment of paranoia experienced high levels of persecutory ideation during VR.

Question 10

Gottesman and Shields Aim:

Answer 10

Genes or particular combinations of genes are passed on to offspring which may cause the disorder to develop.

Carry out a twin study to look at the genetic inheritance of schizophrenia. Symptoms of schizophrenia e.g. psychosis have known genetic origins and are known as ‘endophenotypes’ meaning it is possible to inherit them.

Question 11

Gottesman and Shields Procedure:

Answer 11

• 57 pairs of twins were used - 24 sets of MZ twins and 33 DZ twins.
• Researchers interviewed the patients alongside their twins, some of whom also had a diagnosis of schizophrenia.
• Participants also undertook cognitive tests e.g. object sorting.
• Case summaries of each participant were also independently evaluated by external judges.

Question 12

Gottesman and Shields Findings

Answer 12

50% MZ twins shared schizophrenia status - DZ twins, 9%.

For MZ twins, if the illness of one twin was severe, the other twin was much more likely to have schizophrenia.

Question 13

Biochemical (dopamine hypothesis) explanation of Schizophrenia

Answer 13

• Brains of those with schizophrenia produce more dopamine than those without. Hypothesis identified a link between excessive amounts of dopamine and positive symptoms of schizophrenia.
• Supported by drug trials w/ participants diagnosed with and without schizophrenia. Amphetamines and cocaine are known to produce excess dopamine - increase in dopamine correlates with an increase in the reporting of hallucinations and delusions.
• Patients with Parkinson’s disease are often treated with synthetic form of dopamine, if their dosage is too high, it creates symptoms such as hallucinations.

Question 14

Test for Dopamine Hypothesis

Answer 14

• Lindstroem et al. gave 10 people with schizophrenia and 10 people without L-Dopa (drug to increase dopamine) and found that those with schizophrenia absorbed the drug quicker.

Question 15

Cognitive explanation of Schizophrenia

Answer 15

FRITH

Schizophrenia involves an abnormality of self-monitoring. Believed schizophrenia sufferers have problems with meta-representation e.g. failing to recognise hallucinations are just inner speech resulting in them attributing what they hear to someone else.

Also believed schizophrenia may be caused by a cognitive impairment which explains symptoms like disorganised thoughts.

An additional aspect was the patients may have a less developed TOM and so may develop delusions to try understand others’ actions.

Question 16

Frith supporting procedure

Answer 16

Frith tested abnormality of self-monitoring with schizophrenic patients by asking if items read out loud were done so by themselves, an experimenter or a computer. Schizophrenic patients with incoherent speech performed worst at the task. Delusional thinking may arise from misinterpretation of perception.

Question 17

Biochemical treatment of schizophrenia

Answer 17

Typical: Chlorpromazine reduce dopamine activity by blocking dopamine receptors. Reduces positive symptoms e.g. hallucinations and has calming effect.

Atypical: Clozapine block dopamine production and act on others e.g. serotonin. These are better for negative symptoms + treatment resistant. They have less side effects because block for less time.

Question 18

Research into effectiveness of drugs

Answer 18

Research into the effectiveness of drugs via randomised control trials, double-blind placebo controlled shows that 50% of those taking antipsychotic medication show significant improvement after 4-6 weeks - 30-40% show partial improvement and a small minority show 0 improvement (treatment-resistant schizophrenia).

Question 19

ECT

Answer 19

ECT is a procedure done under general anaesthesia/muscle relaxant.

The treatment involves passing electricity through the brain to induce a brief seizure.

The patient convulses, is unconscious, then wakes and recovers

Patients undergo a course of ECT ranging from 6-12 sessions, often being given twice a week or at longer intervals to prevent relapse.

It is applied to the non-dominant hemisphere to reduce memory loss.

Rarely used as there is little evidence that it is more effective than other forms of therapy.

Question 20

Token economy (Paul and Lentz) Aim

Answer 20

Investigated the effectiveness of a token economy on managing symptoms of schizophrenia.

Token economy is based on the behaviourist principles of positive reinforcement for encouraging desirable behaviours. Believes symptoms occur as a result of a learned response - focuses on helping patients unlearn symptoms.

Question 21

Paul and Lentz procedure

Answer 21

84 individuals from a psychiatric institution participated.

Over four and a half years, Paul and Lentz used an independent measures design to compare the outcomes of three different treatments: milieu therapy, traditional hospital management and a token economy.

Patients were given ‘tokens’ as a reward for appropriate behaviours e.g. self-care. The tokens could be exchanged for luxury items like clothing and cigarettes. Behaviour was monitored through time-sample observation, standardised questionnaire and individual interviews.

Question 22

Paul and Lentz findings

Answer 22

Positive and negative symptoms were reduced.

Most effective reduction was found in catatonic behaviour and less successful for hallucinations/delusions.

97% of the token economy group were able to live independently in the community for 1.5-5 years compared to 71% in the milieu group and 45% in the hospital group.

Question 23

Cognitive-behavioural therapy (Sensky) Definition and Aim

Answer 23

CBT is a talking therapy designed to help people change through recognising thoughts which underlie their behaviours.

Sensky used a RCT to compare the effectiveness of CBT with ‘befriending’ (one-to-one discussions about hobbies, sports, current affairs) with schizophrenia patients.

Question 24

Sensky procedure

Answer 24

90 patients diagnosed with treatment-resistant schizophrenia.

Received an average of 19 sessions of CBT or befriending.

Randomly allocated and independent measures used.

Intervention delivered by experienced nurses. CBT treatment followed stages, first discussing emergence of their disorder before tackling specific symptoms. Patients kept voice diaries to record what they were hearing to generate coping strategies.

Ppts assessed by blind raters prior to treatment, at treatment completion and at a nine month follow-up. A number of standardised, validated assessment scales were used.

Question 25

Sensky findings

Answer 25

Both groups showed a significant reduction in positive and negative symptoms. However, at the follow-up, the CBT group continued to improve in reduction of positive symptoms.

Question 26

Define Anxiety Disorder

Answer 26

Anxiety disorders are characterised by persistent, frequent worry and apprehension about a perceived threat in the environment, even though the threat is minor or non-existant and causes little to no harm. Panic attacks are a very common feature of anxiety disorders.

Question 27

What can anxiety be?

Answer 27

Anxiety can occur in either many different stimulus (Generalised Anxiety Disorder) or they can be specific occurring only in relation to a particular stimulus (Phobia)

Question 28

Characteristics of Anxiety disorders

Answer 28

Alarm about surroundings

Avoidance Behaviour

Panic attacks

May develop gradually or very quickly as a result of a particular experience

Interferes with everyday activities

Duration of 6 months or more

Question 29

Case study: Little Albert

Answer 29

Little Albert was a 11-month old baby who was conditioned by Watson and Raynor to have a phobia of white rats. This was done using classical conditioning by hitting a metal bar behind Albert when presented with a white rat. Albert developed a fear which became generalised over time to include white objects and anything with fur (e.g. Santa’s beard).

Question 30

Agoraphobia

Answer 30

fear of public places - characterised by a fear of two or more of: standing in line or being in a crowd, being in open scales, using public transport, being outside the home by oneself, being in enclosed spaces.

Question 31

Haemophobia

Answer 31

blood phobia also extends to needles, injections or medical procedures. Avoid hospitals etc. Known to experience an increase in heart rate when they see blood and a drop in blood pressure, leading to fainting.

Question 32

Zoophobia

Answer 32

fear of animals (often dog, insect, bird and spider)- could be a select few or a lot. Individuals avoid contact with these animals and experience distress/panic attacks if faced with them.

Question 33

Koumpounophobia

Answer 33

button phobia: the irrational fear of buttons: cannot touch buttons, look at them, or wear them: Saavedra and Silverman.

Question 34

BIPI

Answer 34

a questionnaire that has 18 situations involving blood and injections.

The self-report asks the individual to evaluate different reactions they might have including cognitive, physiological and behavioural responses.

They rate them on a 4 point scale (0= never, 3= always)

Example:

When I see blood on my arm or finger from pricking myself with a needle (Rate 0-3) :

• I don’t think I will be able to bear the situation
• I think I am going to faint
• I think that something bad is going to happen to me

Question 35

GAD-7

Answer 35

Measures generalised anxiety disorder.

Seven item screening test questionnaire measures the severity of anxiety including feeling nervous, anxious or on edge, being so restless that it is hard to sit still and feeling afraid as if something awful might happen.

Participants score 0-3 for each item based on how frequent they experience the symptoms (0= not at all, 3=nearly every day).

A score out of 21 is generated and the higher the score the more severe the GAD. 0-5 mild, 6-10 moderate, 11-15 moderately severe and 15-21 severe anxiety.

Example:

Feeling nervous, anxious or on edge

0 - Not at all

1 - Several days

2 - More than half of the days

3 - nearly every day

Question 36

Behavioural (classical conditioning, Watson)

Answer 36

Classical conditioning. A phobia is acquired through a process of association. Develops as the neutral stimulus is paired with a frightening experience. If enough pairings occur or the initial UCS is very frightening the person will end up with a fear of the NS. The NS then becomes the CS.

Question 37

Watson supporting example

Answer 37

He was not fearful of the rat beforehand. They presented Albert with the rat and loudly hit a metal bar behind Albert which was the unconditioned stimulus (US) as it produced an unconditioned response of fear (UCR). When Albert reached for the rat, they would hit the loud metal bar. Repeated pairing led to a fearful response (crying, trying to move away) to just the white rat. The rat became a CS producing a CR of fear.

Question 38

Psychoanalytic (Freud)

Answer 38

Anxiety and fear results from impulses of the id, when it is being denied or repressed.

The phobic object symbolises the conflict typical of the stage.

A fear is repressed into the unconscious to protect the ego.

The phobia can be a redirected fear during an intensely frightening experience (e.g. a physical attack) onto an object.

Question 39

Freud supporting example

Answer 39

Little Hans: Five years old.

At three, Hans developed an intense interest in his penis. He frequently played with his penis resulting in his mother threatening to cut it off.

Around this time he was also separated from his mother and witnessed a distressing event of a horse dying in the street. After this, his horse phobia emerged.

Conflict emerged at this time between Hans and his father who denied him from getting into his parents’ bed in the mornings to sit with his mother.

Freud believed the object (the horse) represented Hans’ father. The anxiety was related to castration and the banishment of Hans from his parents’ bed.

Question 40

Biomedical/genetic (Ost)

Answer 40

Born genetically prepared/set up to fear certain objects for survival

Question 41

Ost procedure

Answer 41

140 blood phobic or injection phobic patients compared to samples of patients with other phobias.

Participants underwent a screening interview and completed a self-report on their phobia and its history. They also did a behavioural test where they watched a surgery video and had their gaze tracked.

Then completed a questionnaire on their thoughts during the video and had their blood pressure + heart rate monitored.

Question 42

Ost findings

Answer 42

Ost found that blood-phobic subjects had more first degree relatives with the same phobia compared to injection-phobic participants (49% vs 27%).

Participants with blood phobia and injection phobia had a history of fainting when exposed to their respective phobic stimuli (70% blood phobics and 56% of injection phobics).

These results are much higher than those participants with other specific phobias or anxiety.

Concluded that there appears to be a strong genetic link and more likely to lead to a strong physiological response (fainting).

Question 43

Cognitive (DiNardo et al.)

Answer 43

We have irrational thoughts about an object due to a previous experience that we believe will be repeated.

Question 44

Cognitive (DiNardo et al.) Procedure

Answer 44

37 women, student population, fearful or non-fearful.

Self-report (of fear of dogs) and behavioural test (approached by and had to touch dog) they monitored heart rate and rated anxiety

Participants discussed unpleasant encounters with dogs. They also discussed the expectation of harm upon encountering a dog and the likelihood of harm.

Question 45

DiNardo results

Answer 45

Dog-phobic group rated fear higher than non-dog phobic

56% of people dog phobic could recall frightening past experience with a dog. However, 66% of the group with no dog phobia also had memories of being bitten by dogs and yet had not developed any anxiety about seeing dogs in the future.

Question 46

DiNardo conclusions

Answer 46

This shows that not everyone who is exposed to conditioning would end up developing a phobia, and it may be explained more through our thought processes after an event than the event itself.

Question 47

Systematic Desensitisation (Wolpe)

Answer 47

Behavioural therapy based on classical conditioning.

Unlearn phobic reactions and turn the stimulus to become neutral.

Place fearful feelings associated with phobic stimulus directly in conflict with feelings of deep relaxation - reciprocal inhibition.

Question 48

Systematic Desensitisation (Wolpe) Procedure

Answer 48

1. Patient is taught muscle relaxation and breathing exercises.
2. A fear hierarchy created with the most feared item/experience at the top down to the least feared at the bottom.
3. The patient works their way up the hierarchy practising the relaxation techniques at each level till they reach the highest fear.
4. Fear and calm are incompatible, the fear eventually becomes unlearned.

Question 49

Applied Tension (Ost et al.)

Answer 49

This involves tensing the muscles in the body to raise blood pressure and makes it less likely the person will faint. Developed to help people who have a phobia of blood and/or needles and faint at the sight of them.

Question 50

Ost et al. procedure

Answer 50

30 patients from same hospital who had a phobia of blood, wounds and injuries.

Independent measures:
Applied tension: 5 sessions
applied relaxation (9 sessions)
Combined: ten sessions.

Before treatment, they were assessed via self-report and behavioural/physiological measures to assess tendencies for fainting.

Applied tension taught patients to tense their arm, chest and leg muscles until they experienced a feeling of warmth rising to their face. They were exposed to videos of blood donations + photos of wounds and had to apply the technique.

Compared with patients using applied relaxation and a combination of applied tension and applied relaxation.

After completion and six months later they were given same measures to evaluate changes.

Question 51

Ost et al. findings

Answer 51

73% of all participants showed noticeable improvement - tension 50% of time, so more appropriate.

Question 52

Cognitive-behavioural therapy (Ost and Westling)

Answer 52

This therapy is where the patient and therapist identify faulty thinking about the object/experience that the patient has a phobia about.

Question 53

Ost and Westling procedure

Answer 53

12 weekly sessions comparing CBT with applied relaxation.

38 ppts with panic disorder.

The patients were assessed before, after and at one year.

The applied relaxation group received standardised deep muscle relaxation training and the CBT group received training on restructuring thoughts associated with panic attacks. They practised coming up with these alternative thoughts between sessions.

In order to draw a comparison, they were rated using a self-report scale as well as through self-observation of panic attacks

Question 54

Ost and Westling findings

Answer 54

Both the CBT and the applied relaxation group had a reduction in symptoms, however there was no significant difference, showing CBT is effective.

Question 55

OCD

Answer 55

Obsessive compulsive disorder is a mental health condition where you have recurring thoughts and repetitive behaviours that you cannot control

Question 56

DSM Diagnosis

Answer 56

The DSM-V diagnosis for OCD requires:

• Presence of obsessions and/or compulsions
• Suppress unwanted thoughts by performing behaviours
• Behaviours carried out to relieve anxiety
• Extremely time-consuming

Question 57

Obsessions

Answer 57

thoughts that are persistent, worrying, intrusive and disturbing. Common examples include: fear of illness or infection, strong desire for order and symmetry

Question 58

Compulsions

Answer 58

behaviours that are repetitive and give temporary relief to the anxiety/obsessions. Engaging in these compulsions is a means of suppressing obsessions. Examples: frequent and excessive handwashing; checking repeatedly e.g. checking front door is locked 20 times before leaving home.

Question 59

Hoarding disorder

Answer 59

a disorder where the sufferer excessively collects things and has extreme trouble getting rid of them. They will collect things regardless of their material or sentimental value.

Question 60

Body dysmorphic disorder (BDD)

Answer 60

A disorder where the sufferer has persistent negative thoughts about their appearance, often involving some kind of fault or defect around the face and head. May include repetitive mirror-checking, grooming and comparison to others.

Question 61

Examples and case studies (‘Charles’ by Rappaport)

Answer 61

Charles was 14 years old, diagnosed with OCD who spent 3+ hours showering plus at least another two getting dressed.

He had elaborate repetitive routines. He had to leave school because the rituals made it impossible for him to attend on time. He had received some treatments but was obsessed with the thought he had something sticky on his skin. He was given clomipramine which relieved his symptoms, however after a few years, he developed a tolerance for his medication causing him to relapse.

Question 62

Maudsley Obsessive-Compulsive Inventory (MOCI)

Answer 62

Assess OCD symptoms.

Self-report questionnaire using a forced choice ‘true’ or ‘false’ format.

There are 30 items leading to a total score between 0 and 30. The 30 items are divided into 4 sub-scales (symptoms): Checking, Cleaning/washing, Slowness, Doubting. Takes about 5 mins to complete.

Example:

I frequently have to check things several times

Question 63

Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

Answer 63

Measure the nature and severity of symptoms.

It involves a semi-structured interview, taking about 30 minutes and involves a checklist of different obsessions and compulsions, with a 10-item severity scale.

Obsessive categories include contamination and aggressive.

Compulsion categories include counting, and washing.

Individuals can rate the time they spend on obsessions, how hard they are to resist and how much distress they cause.

Scores range from 0 (no symptoms) to 40 (severe symptoms). Those above 16 are in the clinical range.

Question 64

Genetic Matthiessen et al.

Answer 64

OCD occurs due to faulty inherited genes that affect the synapses in the brain.

Matthiessen et al. conducted a study with 1406 ppts analysing genes that may be linked to OCD.

Genes, such as PTPRD, SLITRK3, were implicated with both being related to the regulation of synapses in the brain. Other studies identified DRd4 as being an influence as it is related to the uptake of dopamine.

Question 65

Biochemical Leckman et al.

Answer 65

Oxytocin dysfunction - increase worries and fear of certain situations/stimuli with the belief that survival could be threatened. Leckman et al. found that some forms of OCD were related to oxytocin dysfunction.

Question 66

Neurological

Answer 66

Abnormalities of brain structure and function. Specifically, defects in the basal ganglia may cause OCD.

The basal ganglia and two associated regions (orbitofrontal cortex and anterior cingulate gyrus) work together to check warning messages, in individuals with an impaired function, it does not work as it should, meaning the basal ganglia continuously receives worrying messages.

Question 67

Cognitive

Answer 67

Obsessive thinking is based on faulty reasoning that causes compulsive behaviours as the person attempts to alleviate their obsessions.

For example, the thought that hands are covered in harmful germs that could kill is due to errors in thinking. These thoughts worsen under stressful conditions. Compulsive behaviours attempt to alleviate the unwanted thoughts.

Question 68

Behavioural

Answer 68

Operant Conditioning. Faulty thinking leads to compulsive behaviour which reduces/alleviates the obsessive thoughts for a time and acts as the negative reinforcer of the behaviour (as something unpleasant is removed). Also positive reinforcement e.g. the reward of knowing hands are clean.

Question 69

Psychodynamic

Answer 69

Symptoms develop as a result of an internal conflict between the id and the ego.

OCD develops due to difficult experiences in childhood during the psychosexual stages of development.

These difficult experiences/situations have led the person to develop OCD as an ego defence mechanism.

The obsessive thoughts which come from the id disturb the rational part of the self, the ego, to the extent that it may lead to compulsive cleaning and tidying rituals later in life, in order to deal with the earlier childhood trauma.

Question 70

Biomedical (SSRIs)

Answer 70

If OCD is caused by low serotonin levels, then drugs can be used to increase serotonin in the brain.

Works by increasing the amount of serotonin, a natural substance in the brain that is needed to maintain mental balance. This seems to then cause a lessening of anxiety experienced by the patient and therefore they do not need to engage in the OCD behaviours in order to relieve their anxiety (such as hand washing). A higher level dose tends to be given to OCD patients as it proves more effective.

Question 71

Cognitive (Lovell et al.):

Answer 71

Cognitive behavioural therapy is designed to help people change their behaviour through recognising thoughts which underlie their negative behaviours.

Lovell et al. compared telephone versus face to face treatment of CBT for OCD.

72 ppts randomised control trial underwent ten weekly sessions of therapy either delivered face-to-face or over the phone.

Change was measured via the Y-BOCS, BDI and a client satisfaction questionnaire.

Question 72

Lovell et al. Findings

Answer 72

Both showed a significant improvement in symptoms, however there were no significant differences found at six months. Concluded both face to face and telephone treatment are equally as effective in treating OCD

Question 73

Exposure and response prevention (Lehmkuhl et al.):

Answer 73

A therapy that encourages you to face your fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralising’ them with compulsions. Case study with a 12 year old boy, called Jason, who had OCD and autism. He spent hours engaging in compulsive behaviours and reported severe anxiety when prevented from completing rituals.

Question 74

ERP Procedure

Answer 74

ERP consists of: 1. Gathering information about existing symptoms 2. Therapist-initiated ERP and 3. Generalisation and relapse training. Jason attended 50 minute CBT sessions over 16 weeks. Used exposure response prevention:

Exposure: getting Jason to touch objects he felt were contaminated and produced feelings of anxiety (elevator buttons, door handles, etc…) He touched them until his anxiety levels dropped - the exposures became increasingly difficult.

Response prevention: reducing the anxious response by using coping statements (e.g. I know that nothing bad will happen).

Question 75

Lehmkuhl et al. results

Answer 75

After therapy, Jason’s Y-BOCS score dropped from 18 to 3 and at a three month check up his score remained low with both parents reporting a significant improvement.