Psychopathology Flashcards
What is psychopathology?
the scientific study of psychological disorders, including their underlying causes,diagnosis and treatment
What are the 4 definitions of abnormality?
statistical infrequency
deviation from social norms
failure to function adequately
deviation from ideal mental health
What is statistical infrequency?
suggests a person’s trait, thinking or behaviour is classified as abnormal if it is rare or statistically unusual
uses normal distribution
2 standard deviations from the mean = abnormal
What is the good thing about statistical infrequency?
abnormality is measured objectively = may be an accurate way of defining abnormality
What are the issues with statistical infrequency?
labelling - cause stress, assumptions and discrimination
ignores that some abnormality is desirable
the cut-off point for abnormality is unclear - how far from the average does it need to be to be abnormal
What is deviation from social norms?
each society has approved and expected ways of behaviour
there are implicit and explicit rules about how one ought to behave
people who break these rules or expectations are considered abnormal
context should be considered
What does explicit mean?
clearly stated
What does implicit mean?
unwritten rules
What are the good things with deviation from social norms?
distinguishes between disirable and undesrible behaviour
some norms need to be broken for social change
What are the issues with deviation from social norms?
does not take context into account - may not be accurate
cultural factors are inconsistent - does not offer universal definition of abnormality
draptomania = mental illness used against slaves trying to escape - being abnormal can be a good thing
social norms change over time so it needs to be updated
What is failure to function adequately?
a person is unable to live a normal life or engage in a normal range of behaviours
people are considered abnormal if it causes great distress and prevents them living successfully
What are Rosenhan and Seligman’s 7 features of abnormality?
(VIOLUMS)
Violation of moral and ideal standards
Irrationality
Observer discomfort
loss of control and unpredictability
unconventionality and vividness
maladaptive behaviour
suffering
What is violation of moral and ideal standards?
breaking laws and rules
What is irrationality?
unable to percieve themselves in reality
What is unconventionality and vividness?
stands out and is extreme
What is the good thing with failure to function adequately?
does attempt to include the subjective experience of the induvidual and can view the mental disorder from their POV
What are the issues with failure to function adequately?
personal distress may be normalm- grieving someone
not clear how extreme the behaviour has to be to be abnormal - some people like unpredictable and irrational behaviours
different in different cultures
induvidual differences
What is deviation from ideal mental health?
defines the normal characteristics people should possess
abnormality is the lacking of these ideals of mental healths
What are Jahoda’s ideal mental health characteristics?
(PAPERS)
positive attitude towards self
autonomy (independent and self-regulating)
perception of reality is accurate
evironmental mastery (adapt to new environments)
resistance to stress
self actualisation (capable of personal growth)
What is the good thing with deviation from ideal mental health?
very clear, covers a broad range of criteria = useful
What are the issues with deviation from ideal mental health?
most people dont meet all these ideals all the time = might not be useful
criteria are subjective so difficult to measure - difficult to apply
reflects western ideals of induvidualism - which would be abnormal and unhealthy in collectivist culture
over-demanding = lots of people lack these ideals
What are the two classification systems used for mental disorders?
ICD 11 or DSM 5
What are classification systems for mental disorders?
used for classifying and diagnosing mental health problems
provides signs and symptoms that regulary occur together which is a syndrom that is distinctive and can be identified as a disorder
What is a sign?
things you can see
What is a symptom?
things you can feel
What are the issues with classification systems?
reliablity issues = experts conflict each other as they try to make a patient fit the manual, there can be overlaps of symptoms
biologically biased = overemphasis on biological aspects of disorders
labelling = stigmatises people so it is unethical
What is a phobia?
an extreme, irrational fear leading to intense anxiety and avoidance of an object or situation
the extent of the fear is disproportionate to any danger presented by the phobic stimulus
What are the 3 types of phobias?
specific - fear of an object or situation
social phobia - fear of a social situation
agoraphobia - fear of being outside/in a public space
What are the emotional characteristics of phobias?
fear - that is marked, persistent, excessive and unreasonable
anxiety - an unpleasant state of high arousal, finds it difficult to be positive
What are the behavioural characteristics of phobias?
avoidance - interferes with the person’s normal life
panic as a response eg: crying, freezing, running away
endurance - opposite to avoidance, stays with the cause of the phobia, might be forced to
What are the cognitive characteristics of phobias?
irrational beliefs - person is thinking irrational but recognises their fear is excessive and unreasonable
selective attention - staring at it, wants to know where it is
What is the Two-process model by Mowrer?
the behavioural approach to explaining phobias:
they are learned through classical conditioning and maintained by operant conditioning
What is Watson and Raynor’s little albert exprt?
struch a metal bar when baby albert would interact with a white rat - produced an association with fur and fear
they deliberately created a phobia which was generalised to all animals with fur
How are phobias maintained by positive reinforcement?
something pleasent - family and friends give a person attention when they show fear, the fear response is rewarded
How are phobias maintained by negative reinforcement?
the removal of something unpleasant
they avoid the object/situation so the avoidant behaviour is repeated
What are the good things about the two-way model?
plausible explaination and supported by watson and raynor
practical applications - has good explanatory power, has important implications for therapies, explains why patients need to be exposed to feared stimulus
explains why phobias may be long-lasting
What are the issues with the two way model? (2 stuides that go against)
Bouton - evolutionary factors could have an important role = easilt acquire phobias of things that are a danger in our evolutionary past
phobias of cars/ guns - not biologically prepared to learn fear response towards them
lacks evidence of conditioning in traumatic events - Menzies and Clare = only 2% of children with water phobia reported a direct conditioning effect
does not explain the cognitive effects of phobias = cannot explain development of irrational beliefs
What is systematic de-sensitisation?
reduces the association between fear and the phobic stimulus
substitubes fear with relaxation
based on the principle of reciprocal inhibition
What is the principle of reciprocal inhibition?
two opposing physiological (fear and relaxation) cannot occur at the same time
What is counter-conditioning?
learning of a different response to a stimulus
What are the 3 stages of systematic de-sensitisation?
relaxation techniques
anxiety hierachy
exposure
What happens during the relaxation technique stage of systematic de-sesitisation?
progressive muscle relaxation tech - tense and relax
breathing exercises
mental imagery
meditation
drug Valium can be used as a medical alternative
What is an anxiety hierachy?
patient will creat a ranking of fear in different phobic situations
What are the good things with systematic de-sensitisation?
effective- Gilroy = ps showed less fearful responses with relaxation techs than without them
not as traumatic as flooding
What are the issues with systematic de-sensitisation?
ignores deeper underlying psychological/emotional issues
flooding is more effective
What is flooding?
extreme exposure to the phobic situation for lengthy periods of time. the patient is not allowed to escape until anxiety levels have been reduced substantially - until exhaustion
session may last for 3hrs
the CS will no longer produce the CR
What is exhaustion in flooding?
the body cannot sustain a fear response so the physical response reduces and therefore anxiety decreases
What are the good things about flooding?
highly effective and quick - Kaplin found 65% of patients with a specific phobia showed no symptoms 4yrs later
works quickly = more cost-effective
What are the issues with flooding?
creates high levels of anxiety = traumatic experience and ethical issues
less effective for some times of phobias (complex phobias) like social phobias that have cognitive aspects
What is depression?
a mental disorder characterised by low mood and low energy
What are the emotional characteristic of depression?
lowered mood = feel worthless, hopeless, emptiness
low-self-esteem = like themselves less than usual, some are self-loathing
anger = can be directed at themselves or at others, through self-harm / aggression
What are the behavioural characteristics of depression?
reduced energy/ low activity levels = feeling tired affecting work, education or social life
disruption to sleep = insomnia/ hypersomnia
disruption to eating = increased/ reduced appetite
aggression and self-harm = irritable and can become verbally/physically agressive, maladaptive behaviour
What are the cognitive characteristic of depression?
negative thoughts/ schemas = negative self-beliefs, focuses on the negatives
absolutist thinking = all situations are either good or bad, catasphorizes everything
irrationality = thoughts do not reflect reality
poor concentration = find it hard to stick to a task and make decisions that are normally easy to do
What does the cognitive approach focus on when explaining depression?
focused on how our mental processes affect behaviour involving thoughts, perceptions and attention
How is abnormal cognitive functionaing explained in depression?
irrational and faulty cognitions
What does Ellis’ ABC model suggest?
good mental health is a result of rational thinking
so depression is the result of irrational thinking
What does the ABC stand for in Elli’s ABC model?
A - activating event
B- beliefs
C - consequences
What is the activating event?
something that happens to you
What is the consequence in the ABC model?
you have an emotional response to the belief
What is musturbation?
the belief that we must always succeed and acheive perfection
What does Beck’s cognitive triad suggest about depression?
suggested depression stems from negative or irrational thoughts about oneself, others or the environment which creates a vulnerability towards depression
What are the 3 types of thinking in beck’s negative triad?
negative views about the world
negative views about the future
negative views about oneself
What are negative schemas?
negative packages of info that leads to cognitive biases in thinking
What was the pregnant women study on post-natal depression supporting the cognitive app to depression?
65 pregnant women assessed for cognitive vulnerablity
those who had higher cognitive vulnerablity = more likely to develop post-natal depression
supports becks idea that negative thinking comes before depression and it is not a consequence of despression
What are the practical implications of the cognitive approaches of depression?
CBT is based on these approaches
young people can be detected as high risk of depression sooner by screening them for vulnerabilities
What are the issues with cognitive approaches in explaining depression?
only applies to some types of depression = doesnt include severe anger, hallucinations and delusions
ignores biological factors
What was Wender’s study on depression and genetics?
adopted children who developed depression were more likely to have a depressive biological parent
Why was it important that the kids were adopted in wender’s study?
they were not raised by their bio parent so depression was the result of bio factors
What is rational behaviour therapy in CBT?
focuses on challenging and disrupting irrational beliefs based on elli’s ABC
ABCDE
what does the D and E stand for in the ABCDE CBT treatment of depression?
D = dispute- dispute irrational beliefs
E = effect - new effective rational beliefs
What is logical disputing?
patient realises that their self-defeating beliefs do not make sense
What is empirical disputing?
patient realises that their self-defeating beliefs are not realistic
What is pragmatic disputing?
patient realises that their self-defeating beliefs are not useful
How does disputing help someone with depression?
allows the person to move from catastrophising to more rational interpretations
What is CBT based on beck’s negative triad?
the therapist identifies and challenges the automatic thoughts about the world, self and future
the therapist gets the patient to do homework
What does ‘patient as scientist’ mean in CBT based on becks?
the patient should investigate the reality of their negative beliefs in the way a scientist would
this is used as evidence to challenge their beliefs
What study supports CBT treating depression?
hollon et al = relapse rates decreases using CBT
What were all the relapse rates from Hollon’s study?
40% = 16 weeks of CBT
45% = in drug therapy
80% = placebo
What is a good thing about CBT treating depression?
it attempts to deal with the cause = long-term solution
What are the issues withh CBT treating depression?
not appropriate for all - need motivation and have to talk about sensitive issues
too much emphasis on thought processes and not circumstances = poverty, poor housing
takes a long time to complete and can be expensive
What is OCD?
an anxiety disorder that is characterised by obessions and compulsions
What are obessions?
recurring thoughts or images
What are compulsions?
repetitive behaviours
What is the OCD cycle?
obessions –> anxiety –> compulsions –> temporary relief –>
What are the emotional characteristics of OCD?
severe anxiety
guilt and disgust = they are aware that their behaviour is excessive which can cause feelings of shame
depression = lack of enjoyment in activities, feeling worthless
What are the behavioural characteristic of OCD?
compulsions = performed to reduce anxiety, repetitive
avoidance = avoids situations which may trigger their anxiety
What are the cognitive characteristics of OCD?
obsessions = recurrent intrusive thoughts or impulses
insight = they know their obessions and compulsions are irrational
cognitive coping strategies = they feel guilty if they cant carry out their obsessions and complusions
What does it mean OCD is polygenic?
it is caused by several genes
What did Taylor say on genes causing OCD?
there are 230 genes that are involved
What does the diathesis-stress model state on genes causing OCD?
there is a genetic component to OCD which predisposes (increases vulnerablilty) people to the illness
disorders are the result of the vulnerability of the disorder and the stress caused by life experiences
What does it mean if OCD is aetiologically heterogenus?
the origin of OCD has different causes
different groups of genes can cause OCD in different people
What are the 2 genes involves with OCD?
SERT gene and COMT gene
What is serotonin?
a neurotransmitter that is thought to be involved in regulating anxiety,memory, sleep
known as the ‘feel good’ chemical
What does a normal SERT gene do?
regulates the serotonin system
How does an abnormal SERT gene cause OCD?
mutation causes an increase in transporter proteins at the pre-synaptic neuron’s membrane so more SERT sites are available for reuptake of serotonin
serotonin levels decreases - increases anxiety
What does a normal COMT gene do?
instructs an enzyme to breakdown dopamine in the synapse, regulating dopamine levels
What is dopamine?
reinforces feelings of pleasure by connecting sensations of pleasure to certain behaviours
known as the reward chemical
linked to the desire to repeat behaviours
What happens if the COMT gene is mutated?
doesn’t breakdown dopamine, decreases in COMT activity so higher levels of dopamine and people repeat behaviours = compulsions
What was Pauls study supporting genetic explainations?
up to 10% of first-degree relatives of those with OCD were more likely to develop the disorder
there is a 2% prevalence in the general population
What was Nestadt’s twin study supporting genetic explainations of OCD?
compared concordance rates = the likelihood that both twins had OCD
identical twins CR = 68%
fraternal twins CR = 31%
What are identical twins also known as?
monozygotic twins
What are fraternal twins also known as?
dizygotic twins
What are the issues with Nestadt and Pauls?
family study = no control of the environments - may have had similar experiences
no studies show 100% Concordance rate for MZ twins = other factors may be involves, diathesis-stress model
What are the issues withe the genetic explainations of OCD?
difficult to separate the effects or nature and nurture
biologically reductionist = ignores other factors
What are the 2 neural explainations of OCD?
abnorma levels of neurotransmitters
abnormal brain circuit
What are neurotransmitters?
chemical messengers in the brain and nervous system that send messages to nerve cells
What is evidence that low levels of serotonin causes OCD?
OCD is relieved by using anti-depressants which increase serotonin levels
How can OCD be caused by a disruption to serotonin levels?
the disruption has a knock-on effect on regulating other neurotransmitters
eg= GABA, glutamate, dopamine
How is the worry circuit created?
- orbitofrontal cortext = involved with converting sensory info into thoughts
- (normal) = OFC sends info to caudate nucleus in the basal ganglia, this filters and supresses info on a subconscious level
(abnormal) = damaged basal ganglia = no filtering iin CN - the messages passes straight to the thalamus which gets over-excited and sends powerful messages to the OFC - worry circuit created
What is the worry circuit?
OFC (senses) —> thalamus (over-excited) –> OFC (interprets)
What study supports abnormal levels of neurotransmitters cause OCD?
Zohar = drugs that increase serotonin were beneficial for up to 60% of patients
What are the issues with using neurotransmitters as an explaination for OCD?
aetiology fallacy = just because serotonin recuces the symptoms doesnt mean the symptoms were caused by a lack of serotonin
low levels of serotonin could be a result of depression not OCD
What study supports abnormal brain circuits cause OCD?
MacGuire et al = patients were shown items to tigger obsessions while undergoing PET scans
found there was increased activity in the OFC and CN
only an association - doesnt show it causes it
What is an issue of using abnormal brain circuits to explain OCD?
the relationship between the brain parts and OCD is not clear
some people with a damged basal ganglia do not have OCD and vice versa
OCD may be more than damaged brain areas
What are SSRI’s? (name)
selective serotonin reuptake inhibitors
What do SSRI’s do?
they block the re-uptake ports for serotonin which enables serotonin to remain active at the synapses and can reduce the symptoms of anxiety
what shoukd you do if the drugs are not effective after a couple months?
up the dosage
use against CBT
use a different anti-depressant
What does SNRI’s stand for?
serotonin-noradrenaline re-uptake inhibitors
What do SNRI’s do?
they block the transporter mechanism that reabsorbs both serotonin and noradrenaline into the presynatic nerve
have more side-effects than SSRI’s
What is noradrenaline?
neurotransmitter associated with flight or fight repsonses
What do benzodiazepines do for treating OCD?
slow down the activity of the central nervous system by enhancing the activity of GABA
What is GABA?
neurotransmitter that has a quietening effect on many neurons in the brain, it locks onto receptor sites outside the neuron
How does GABA calm the nervous system?
it opens a channel which allows Cl- ions to flow into the neuron
cl- ions make it harder for the neuron to be stimulated by other neurotransmitters
so it slows done the activity and makes the person more relaxed
What study supports the effectiveness of drug therapy for OCD?
soomro et al = reviewed 17 studies of the use of SSRI’s
they were found to be more effective than placebos so OCD is biological
SSRI’s reduced the symptoms of OCD up to 3 months after treatment
What % of clients did not benefit from SSRI’s?
30-50% large minority didnt benefit
What issues with relapse rates did drug therapy face?
90% relapse rates
drugs do not provide a permenant ‘cure’
as the treatment stops, the symptoms return
relapse rates were lower when drugs are combined with CBT
What are the issues wsith effectiveness of drug therapy?
relapse rates
no permenant cure
dehumanise patients and take away sense of responsibility
some people with OCD are disruptive so may not be able to consent fully aware
side-effects
based on biological approach which is deterministic
What are the good things about the appropriateness of using drugs to treat OCD?
drugs reduce anxiety and symptoms = increasing evidence that OCD is associated with abnormalities of serotonin and dopamine
OCD is biochemical and drug therapy is appropriate because drugs produce a biochemical change
What study goes against the appropriateness of using drugs to treat OCD?
Moreno = there’s no general agreement on the function of serotonin and other neurotransmitters in the cause of OCD
drugs that increase these chemicals should be avoided
What did Koran say on therapy and drugs being used to treat OCD?
psychotherapy should be tried first as drugs do not provide permenant ‘cure’
What is a good thing about using drugs to treat OCD?
they are cheap and manufactured easily = good for the economy and people can afford them
What effect on the economy does using drug therapt to treat OCD have?
effective treatments would reduce the number of days off work and improve productivity
What did Bounton say on how phobias are acquired through evolutionary factors?
we easily acquire phobias of things which have been a source of danger in our evolutionary past
this is adaptive and seem to have an innate predisposition towards developing fears
we are not biologically prepared to learn fear towards modern dangers like cars and guns
