Psychopathology Flashcards
1
Q
Definitions of Abnormality- Statistical Infrequency- AO1
A
- When an individual has a less common characteristic
- IQ and intellectual disability disorder
Average IQ=100
2% people score below 70
Abnormal / statistical infrequency / IDD
2
Q
Definitions of Abnormality- Statistical Infrequency- AO3
A
- Real world application +
Used in clinical practice- formal diagnosis and assessing severity of symptoms
Intellectual disability disorder=IQ below 70
Assessment tool=Beck depression inventory- score of 30+=severe depression - Unusual characteristics can be positive -
IQ above 130
Wouldn’t think high IQ=abnormal
Don’t think low depression score on BDI abnormal
Unusual does not mean abnormal
3
Q
Definitions of Abnormality- Deviation from Social Norms- AO1
A
- Behaviour that is different from the accepted standards of behaviour in a community/society
- Norms are specific to the culture we live in- few behaviours are universally abnormal
Homosexuality considered abnormal in our past and still abnormal in some societies today - Antisocial personality disorder
Impulsive, aggressive, irresponsible
DSM-5=absence of prosocial internal standards
Psychopaths abnormal because don’t conform to moral standards
4
Q
Definitions of Abnormality- Deviation from Social Norms- AO3
A
- Real world application +
Used in clinical practice
Antisocial personality disorder=failure to conform to culturally normal ethical behaviour=deviations from social norms
Criteria had value in psychiatry - Cultural and situational relativism -
May label someone as abnormal based on own standards rather than other persons
Hearing voices=norm in some cultures (ancestors) but abnormal in UK
Even within one culture, social norms vary in situations
5
Q
Definitions of Abnormality- Failure to Function Adequately- AO1
A
- When someone is unable to cope with ordinary demands of day-to-day living
- Rosenhan+Seligman- not coping when: don’t conform to interpersonal rules / experiences severe distress / irrational or dangerous
- Intellectual disability disorder
Having a low IQ=statistical infrequency but must be failing to function adequately to get a diagnosis
6
Q
Definitions of Abnormality- Failure to Function Adequately- AO3
A
- Represents a threshold for help +
Most have symptoms of metal disorder as some point
Mind- 25% people experience mental health problem in any given year
When cease to function adequately=seek professional help
Treatment/services targeted to those who need it most - Discrimination and social control -
Hard to say when someone failing to function adequately
High-risk leisure activities could be irrational/dangerous but that doesn’t make the person failing to function
Unusual choices=risk of being labelled
7
Q
Definitions of Abnormality- Deviation from Ideal Mental Health- AO1
A
- When someone does not meet a set of criteria for good mental health
- Jahoda’s criteria:
No distress / self-actualise / copes with stress / good self esteem etc.
8
Q
Definitions of Abnormality- Deviation from Ideal Mental Health- AO3
A
- A comprehensive definition +
Jahoda’s concept=range of criteria distinguishing mental health from illness
Mental health=discussed meaningfully with professionals who might take different views
Can assess ourselves and others well - May be culture-bound -
Jahoda’s criteria westernised
Self-actualisation=self-indulgent in most of world
Europe even has variation in value placed on independence
Success in life different in cultures
Difficult to apply concept cross-culturally
9
Q
Phobias- DSM-5 Categories of Phobia
A
- An irrational fear of an object or situation
- Specific phobia
Phobia of an object or a situation - Social phobia
Phobia of a social situation - Agoraphobia
Phobia of being outside or in a public place
10
Q
Phobias- Behavioural Characteristics (APE)
A
- Ways in which people act
- Avoidance
Effort to prevent coming into contact with phobic stimulus - Panic
Panic in response to phobic stimulus - Endurance
Choosing to remain in the presence of the phobic stimulus (keeping an eye on it)
11
Q
Phobias- Emotional Characteristics (FEAr)
A
- Related to a persons feelings or mood
- Fear
The immediate and extremely unpleasant response when encountering a phobic stimulus - Emotional response unreasonable
Fear much greater and disproportionate to any other threat posed - Anxiety
An unpleasant state of high arousal, preventing relaxation and positive emotion
12
Q
Phobias- Cognitive Characteristics (SAIBCD)
A
- Refers to the process of thinking, reasoning, remembering, believing
- Selective attention
If they can see the phobic stimulus, it is hard to look away from it- can react quickly to any threat - Irrational beliefs
Holding unfounded thoughts in relation to the phobic stimulus - Cognitive distortions
A person with a phobia may have inaccurate and unrealistic perceptions
13
Q
Depression- DSM-5 Categories of Depression
A
- Characterised by changes to mood
- Major depressive disorder
Severe but often short-term depression - Persistent depressive disorder
Long-term depression - Disruptive mood dysregulation disorder
Childhood temper tantrums - Premenstrual dysphoric disorder
Disruption to mood prior to and/or during menstruation
14
Q
Depression- Behavioural Characteristics (AAD)
A
- Ways in which people act
- Activity levels
Reduced levels of energy- lethargy
Knock on effect withdrawal from work, social life
Psychomotor agitation- struggle to relax and will pace up and down - Aggression and self-harm
Irritable, verbally/physically aggressive
Knock on effects aspects of personal life
Physical aggression directed against the self - Disruption to sleep/eating behaviour
Insomnia=reduced sleep
Hypersomnia=increased need for sleep
Appetite may increase/decrease=weight loss/gain
15
Q
Depression- Emotional Characteristics (ALL)
A
- Related to a persons feelings or mood
- Anger
Directed at self or others
Emotions can lead to aggressive/self-harming behaviour - Lowered mood
Feeling sad
Mostly worthless and empty - Lowered self-esteem
Liking themselves less than usual
16
Q
Depression- Cognitive Characteristics (AAP)
A
- Refers to the process of knowing
- Absolutist thinking
Black and white thinking - Attending to/dwelling on the negative
Pay more attention to negative and ignoring positive
Bias toward recalling unhappy event - Poor concentration
Unable to stick with a task
Hard to make straightforward decisions
17
Q
OCD- DSM-5 Categories of OCD
A
- Range of related disorders- repetitive behaviour accompanied by obsessive thinking
- OCD
Obsessions and/or compulsions - Trichotillomania
Compulsive hair-pulling - Hoarding disorder
Compulsive gathering of possessions and inability to part with anything - Excoriation disorder
Compulsive skin picking
18
Q
OCD- Behavioural Characteristics (ACC)
A
- Ways in which people act
- Avoidance
Avoiding situations that trigger anxiety - Compulsions are repetitive
Compelled to repeat a behaviour - Compulsions reduce anxiety
Compulsive behaviours performed in attempt to manage anxiety produced by obsessions
19
Q
OCD- Emotional Characteristics (AAG)
A
- Related to a persons feeling or mood
- Anxiety and distress
Obsessive thoughts are unpleasant and frightening and the anxiety can be overwhelming - Accompanying depression
Anxiety can be accompanied by low mood and lack of enjoyment - Guilt and disgust
Irrational guilt or disgust directed against something external
20
Q
OCD- Cognitive Characteristics (ICO)
A
- Refers to the process of knowing
- Insight into excessive anxiety
Aware that obsessions and compulsions not rational
Hyper-vigilant - Cognitive coping strategies
To deal with obsessions
Help manage anxiety but may appear abnormal to others - Obsessive thoughts
Thoughts that recur over and over again and are always unpleasant
21
Q
Behavioural Approach Explaining Phobias- AO1
A
- Two-process model=explanation for onset and persistence disorders- CC and OC
- Acquisition by CC=association
UCS -> UCR
UCS + NS -> UCR
CS -> CR
Watson+Rayner=Little Albert / white rat / loud noise / fear that generalised to similar objects - Maintenance by OC=consequences
Mowrer=NR avoiding phobic stimulus=desirable so behaviour repeated
Avoiding=escaping fear and anxiety, reinforcing behaviour so phobia mantined
22
Q
Behavioural Approach Explaining Phobias- AO3
A
- Real-world application +
Phobias maintained by avoiding phobic stimulus
Once avoidance prevented=no reinforcement and anxiety decreases too
Identifies means of treating phobias - Cognitive aspects -
Phobias not simply avoidance responses- significant cognitive component
Irrational beliefs
Does not offer adequate explanation of phobic cognitions - Phobias and trauma +
Little Albert
Jongh=73% fear of dental treatment=traumatic experience with dentistry
Control group of low dental anxiety=21% experienced trauma
23
Q
Behavioural Approach Treating Phobias- Systematic Desensitisation- AO1
A
- Behavioural therapy utilising classical conditioning
Counterconditioning=phobic stimulus paired with relaxation instead of anxiety - Anxiety hierarchy=list of situations least to most anxiety
- Relaxation- reciprocal inhibition=cannot be afraid and relaxed at same time
Breathing exercises / mental imagery - Gradual exposure to phobic stimulus- only move up hierarchy when completely relaxed
24
Q
Behavioural Approach Treating Phobias- Systematic Desensitisation- AO3
A
- Evidence of effectiveness +
Gilroy=42 people SD for arachnophobia
SD group less fearful than control
Wechsler=SD effective for specific phobia, social phobia and agoraphobia - People with learning disabilities +
Alternatives to SD not suitable
Struggle with cognitive therapies as require complex rational thought
Confused and distressed by trauma of flooding
25
Behavioural Approach Treating Phobias- Flooding- AO1
- Immediate exposure to phobic stimulus / long sessions but small number of them
- Without avoidance option=learn phobic stimulus is harmless
Extinction=learned response extinguished when CS encountered with UCS- CS no longer produces CR (fear)
Achieve relaxation as exhausted by own fear response
- Important to give informed consent as traumatic so need to be fully prepared- given choice of SD or flooding
26
Behavioural Approach Treating Phobias- Flooding- AO3
- Cost effective +
Therapy=cost-effective if clinically effective (tackles symptoms) and inexpensive
Can work in as little as one session, whereas SD takes a lot more
- Traumatic -
Promotes tremendous anxiety
Schumacher=flooding rated as significantly more stressful than SD
Ethical issue of psych harm although not issue if informed consent
Attrition (dropout) rates higher than SD
27
Cognitive Approach Explaining Depression- Beck's Negative Triad- AO1
- Faulty information processing=attend to negative aspects of situation and ignore positives
Black and white thinking
- Negative self-schema=mental framework of beliefs and expectations derived from experience linked to the self
Interpret info about themselves in a negative way
- Negative triad
=Negative view of the world- no hope anywhere
=Negative view of the future- reduce hopefulness and enhance depression
=Negative view of the self- enhancing depressive feelings as confirming existing emotions of low self-esteem
28
Cognitive Approach Explaining Depression- Beck's Negative Triad- AO3
- Research support +
Cognitive vulnerability=ways of thinking that predispose depression
Clark+Beck=cognitive vulnerabilities more common in depressed people and they preceded depression
Cohen=cognitive vulnerability predicted later depression
- Real-world application +
Cohen=assessing cognitive vulnerability allows screening of young people to identify most risk of depression
Applied in CBT=altering cognitions that make vulnerable to depression- more resilient to negative life events
29
Cognitive Approach Explaining Depression- Ellis' ABC Model- AO1
- Good mental health=result of rational thinking- allow people to be happy and free from pain
Poor mental health=result of irrational thoughts- interfere with us being happy and free from pain
- A=Activating event
Depressed when experience negative events that trigger irrational beliefs
- B=Beliefs
Musturbation- belief must always achieve/perfection
I-can't-stand-it-itis- major disaster when something goes wrong
Utopianism- life is always meant to be fair
- C=Consequences
Emotional and behavioural
30
Cognitive Approach Explaining Depression- Ellis's ABC Model- AO3
- Real-world application +
Rational emotive behaviour therapy=arguing with depressed person so as to alter irrational beliefs
David=support REBT changing negative beliefs and relieving depression symptoms
- Reactive and endogenous depression -
Depression triggered by activating event=reactive
Many depression cases not traceable to life events and not obvious what leads to depression=endogenous
Ellis's model only explains reactive depression
31
Cognitive Approach Treating Depression- AO1
- Cognitive behaviour therapy
Cognitive element=client and therapist clarify client's problems / where irrational thoughts that will benefit from challenge
Behaviour element=change irrational thoughts and put more effective behaviours in place
- Beck's cognitive therapy=identify negative triad and challenge them
Client as scientist=investigating reality of beliefs in way scientist would
Therapist uses client's finings to disprove their beliefs
- Ellis's REBT=ABCDE model- D=Dispute and E=Effect
Identify and dispute irrational thoughts
Vigorous argument=challenge irrational belief and break link between negative events and depression
Empirical argument- evidence to support negative belief
Logical argument- negative thought logically follows from facts
- Behavioural activation=gradually decrease avoidance and isolation / increase engagement in activities that improve mood
32
Cognitive Approach Treating Depression- AO3
- Evidence for effectiveness +
March=compared CBT to antidepressants and combo of both
36 weeks=81% CBT, 81% antidepressants, 86% both=significantly improved
CBT just as effective alone and more so when in combo
CBT cost effective as 6-12 sessions
- Suitability for diverse clients -
Depression so severe that no motivation to engage with CBT
Complex rational thinking in CBT=unsuitable for learning disability clients
Sturmey=any form psychotherapy unsuitable for learning disabilities
- Relapse rates -
Concerns over how long the CBT benefits last
Recent studies suggest long-term outcomes not as good as assumed
Ali=depression 439 clients every month 12 months following course CBT
42% relapsed within 6 months and 53% within a year
33
Biological Approach Explaining OCD- Genetic- AO1
- Genes=individual vulnerability to OCD
Lewis=37% parents with OCD, 21% siblings with OCD
Diathesis-stress model=certain genes more likely develop mental disorder but not certain- environmental stress necessary to trigger condition
- Candidate genes=specific genes cause OCD
5HT1-D=transport of serotonin across synapses
- Polygenic genes=combination of genes increase genetic vulnerability
Taylor=230 different genes involved in OCD- associated with serotonin and dopamine=role in regulating mood
- Different types of OCD
One group genes cause OCD in one person but different group genes cause OCD in another
Aetiologically heterogenous=origins of OCD vary from one person to another
Different types OCD result of particular genetic variations
34
Biological Approach Explaining OCD- Genetic- AO3
- Research support +
Some people vulnerable to OCD as a result of genetic makeup
Nestadt=68% MZ shared OCD, 31% DZ twins
Family studies=family member with OCD 4x likely develop it as someone without
- Environmental risk factors -
Not entirely genetic in origin and environmental factors increase risk developing OCD
Cromer=over 1/2 OCD clients= traumatic event
OCD more severe in those with more traumas
35
Biological Approach Explaining OCD- Neural- AO1
- Role of serotonin
Helps to regulate mood
Low serotonin=mood-relevant info doesn’t take place=low moods
Some cases OCD=reduction functioning serotonin system
- Decision-making systems
Some cases OCD=impaired decision-making
Abnormal functioning lateral frontal lobes (logical thinking and making decisions)
Left parahippocampal gyrus=unpleasant emotions=functions abnormally in OCD
36
Biological Approach Explaining OCD- Neural- AO3
- Research support +
Antidepressants work on serotonin=reduce symptoms OCD suggests serotonin involved in OCD
OCD symptoms form part of conditions known to be biological- Parkinson’s
If bio disorder produces OCD, assume bio processes underline it
- No unique neural system -
People OCD also clinical depression
Two disorders=co-morbidity
Depression probably involves disruption to action of serotonin
Serotonin possible basis OCD but could be that serotonin activity disrupted as depressed as well
37
Biological Approach Treating OCD- AO1
- Drug therapy=increase/decrease neurotransmitters to increase/decrease activity
- SSRI’s=selective serotonin reputake inhibitor via synaptic transmission
Preventing reabsorption and breakdown=increase serotonin in synapse=stimulate postsynaptic neuron
Dosage and advice vary to which SSRI prescribed- 3/4 months daily=impact
- Combining SSRI’s with treatments
Drugs and CBT- drugs reduce emotional symptoms=engage more effectively CBT
- Alternatives to SSRI’s
Tricyclics=same effect SSRI’s more severe side effects- reserve for those don’t respond SSRI’s
SNRI’s=serotonin noradrenaline reuptake inhibitor (increase serotonin and noradrenaline)- different class antidepressants and reserve for those don’t respond SSRI’s
38
Biological Approach Treating OCD- AO3
- Evidence of effectiveness +
SSRI’s reduce symptom severity and improve QoL for OCD
Soomro=compare SSRI’s to placebos
All studies=better outcomes SSRI’s
Symptoms reduce 70% people taking SSRI’s
Remaining 30%=alternative drugs/combinations/therapies
- Cost-effective and non-disruptive +
Cheap compared to psych treatments as thousands tablets manufactured in time one session
Drugs=good value for health systems
Non-disruptive to peoples lives
- Serious side effects -
Indigestion/blurred vision/loss sex drive
Usually temporary, quite distressing and minority are long lasting
Tricyclic=more common and serious
Reduced QoL and some stop taking them so cease to be effective
