Psychopathology Flashcards
1
Q
What is Statistical Inequality?
A
- Involves the use of numerical data from statistics to determine whether a behavior or trait is common among the majority of individuals (and therefore considered normal) or rare (and therefore classified as abnormal).
2
Q
What does a Normal Distribution Curve look like?
A
- The normal distribution curve shows the majority of people as being in the middle - these people are defined as ‘normal’.
- Relatively few people fall at either end. However, if they are then they are defined as ‘abnormal’.
3
Q
What are the strengths of Statistical Infrequency?
A
Real-World Application
- Statistical infrequency has proven to be a valuable tool in clinical practice. It is used to determine formal diagnoses as well as to assess the severity of an individual’s symptoms.
- For instance, a diagnosis of intellectual disability disorder requires an IQ score below 70, which is in the bottom 28%. Another example of statistical infrequency in practice is the Beck Depression Inventory (BD), where a score of 30 or higher, indicating severe depression, is considered in the top 5% of respondents. These examples demonstrate the usefulness of the statistical infrequency criterion in both diagnostic and assessment procedures.
4
Q
What are the limitations of Statistical Infrequency?
A
- Infrequent characteristics can be positive as well as negative. While someone with an IQ below 70 is considered abnormal, there is someone else with an IQ above 130 who is not seen as abnormal. Similarly, a person with a very low depression score on the BDI is not considered abnormal. These examples demonstrate that unusual characteristics do not always indicate abnormality.
- Thus, although statistical infrequency can be useful in diagnosis and assessment, it should not be the sole basis for defining abnormality.
5
Q
How is deviation from social norms connected to abnormality?
A
- Deviation from social norms is often noticed when an individual’s behavior differs from what is expected in society.
- People tend to define abnormal behavior based on their sense of what is acceptable or normal.
- This collective judgement determines what is considered right in a society.
6
Q
How are social norms culture-specific?
A
- Social norms are culture-specific, there are only a few behaviors that are universally classified as abnormal.
- For instance, homosexuality, which was previously regarded as abnormal in some cultures, is no longer deemed abnormal in many cultures.
- Similarly, behaviors that are socially unacceptable in one culture may be tolerated or even celebrated in another.
7
Q
What are the strengths of deviation from social norms to define abnormality?
A
Real world application
- Deviation from social norms is a useful criterion in clinical practice, particularly in psychiatry. Antisocial personality disorder is defined by the failure to conform to culturally acceptable ethical behavior, such as aggression, recklessness, deceitfulness, and violation of others’ rights. These behaviors are all deviations from social norms.
- Similarly, in the diagnosis of schizotypal personality disorder, the term ‘strange’ is used to characterize the behavior, thinking, and appearance of individuals with the disorder. This demonstrates that the deviation from social norms criterion is valuable in psychiatry.
8
Q
What are the limitations of deviation from social norms to define abnormality?
A
Cultural and Situational Relativism
- Social norms vary greatly across cultures and settings, and what is considered acceptable or normal in one culture may be perceived as deviant or abnormal in another.
- For instance, hearing voices can be viewed as normal in some cultures, while in most parts of the UK, it is considered a sign of abnormality. Moreover, social norms can also differ depending on the situation within the same culture, making it difficult to consistently apply the deviation from social norms criterion.
9
Q
How is deviation from failure to function adequately connected to abnormality?
A
- Failure to function adequately is a definition of abnormality where a person is considered abnormal if they are unable to cope with the demands of everyday life, or experience personal distress.
- They may be unable to perform the behaviours necessary for day-to-day living, e.g., self-care, holding down a job, interacting meaningfully with others, making themselves understood, etc.
10
Q
What are the specific characteristics of failure to function adequately?
A
Rosenhan & Seligman (1989) suggest the following characteristics that define failure to function adequately:
- Suffering
- Maladaptiveness (danger to self)
- Vividness & unconventionality (stands out)
- Unpredictably & a loss of control
- Irrationality/incomprehensibility
- Causes observer discomfort
- Violates moral/social standards
11
Q
What are the strengths of failure to function adequately to define abnormality?
A
Real world application
- This measure of abnormality provides clear guidelines for the classification and diagnosis of abnormality as it is focused on observable signs that an individual is not coping e.g. lack of hygiene, clear behavioural distress signals
- These observable signs allow for the individual to receive help
- Checklists such as those provided by Rosenhan & Seligman (1989) can be used to assess the degree of FTFA, which increases the reliability and objectivity of the measure
12
Q
What are the limitations of failure to function adequately to define abnormality?
A
Adaptive behaviour
- One limitation of this definition is that apparently abnormal behaviour may actually be helpful, functional, and adaptive for the individual.
- For example, a person who has the obsessive-compulsive disorder of hand-washing may find that the behaviour makes him cheerful, happy, and better able to cope with his day.
- Many people engage in behaviour that is maladaptive/harmful or threatening to self, but we don’t class them as abnormal: e.g. Adrenaline sports
13
Q
How is deviation from ideal mental health connected to abnormality?
A
- This means that rather than defining what is abnormal, psychologists define what normal/ideal mental health is, and anything that deviates from this is regarded as abnormal.
- This requires us to decide on the characteristics we consider necessary for mental health.
14
Q
How did Jahoda describe the speicifc characterisics of deviation from ideal mental health?
A
Jahoda (1958) defined six criteria by which mental health could be measured:
- A positive view of the self
- Capability for growth and development
- Autonomy and independence
- Accurate perception of reality
- Positive friendships and relationships
- Environmental mastery – able to meet the varying demands of day-to-day situations
15
Q
What are the strengths of deviation from ideal mental health to define abnormality?
A
Real world application
- A strength is that this definition allows for an individual who is struggling to have targeted intervention if their behaviour is not ‘normal’. For example, their distorted thinking could be addressed to help their behaviour become normal, as if their thinking is biased then their behaviour will be too.
- This idea allows for clear goals to be set and focused upon to achieve ideal mental health, and, in Jahoda’s opinion, to achieve normality.
16
Q
What are the limitations of deviation from ideal mental health to define abnormality?
A
- It is practically impossible for any individual to achieve all of the ideal characteristics all of the time. For example, a person might not be the ‘master of his environment’ but be happy with his situation.
- The criteria of autonomy makes the collectivist cultures, where the greater good and helping / relying on others is encouraged, seem abnormal. As most western cultures are individualist the criteria outlined by Jahoda seem a reasonable fit, but non-western cultures cannot relate to the criteria she outlines. This means that the definition is ethnocentric.
17
Q
What is the DSM system?
A
- There are a number of systems for classifying and diagnosing mental health problems. Perhaps the best known is the DSM. This stands for Diagnostic and Statistical Manual of Mental Disorder and is published by the American Psychiatric Association.
- The DSM is updated every so often as ideas about abnormality change. The current version is the 5th edition so it is commonly called the DSM-5. This was published in 2013.
18
Q
How is Panic described as a behavioural characteristics of phobias?
A
- A phobic person may panic in response to the presence of the phobic stimulus. Panic may involve a range of behaviours including crying, screaming or running away.
- Children may react slightly differently, for example by freezing, clinging or having a tantrum.
19
Q
How is Avoidance described as a behavioural characteristics of phobias?
A
- Unless the sufferer is making a conscious effort to face their fear they tend to go to a lot of effort to avoid coming into contact with the phobic stimulus. This can make it hard to go about daily life.
- For example, someone with a fear of public toilets may have to limit the time they spend outside the home in relation to how long they can last without a toilet. This in turn can interfere with work, education and a social life.
20
Q
How is Endurance described as a behavioural characteristics of phobias?
A
- The alternative to avoidance is endurance, in which a sufferer remains in the presence of the phobic stimulus but continues to experience high levels of anxiety. This may be unavoidable in some situation, for example for a person who has an extreme fear of flying.
21
Q
What is Flooding Therapy?
A
- The client is exposed to the feared object without the ability to escape.
- This causes them to have a panic attack but they cannot biologically maintain this state so the fear will eventually subside.
- This means they will have re-learned the fear response, so they are not phobic anymore.
- Fear is a time-limited response. At first, the person is in extreme anxiety, perhaps even panic, but eventually, exhaustion sets in, and the anxiety level decreases.
- Prolonged intense exposure eventually creates a new association between the feared object and something positive (e.g., a sense of calm and lack of anxiety)
22
Q
How is Flooding carried out?
A
- Flooding aims to expose the sufferer to the phobic object or situation in a safe and controlled environment for an extended period.
- Unlike systematic desensitization, which might use in virtual exposure, flooding generally involves in-vivo (real life) exposure.
23
Q
What is Systematic Desensitisation
A
- SD is a behavioural therapy designed to gradually reduce phobic anxiety. This technique is based on the basis that what the maladaptive behaviour (negative) can be unlearned
- It is based on the principles of classical conditioning.
- The aim of the therapy is to replace the associated panic/fear response with a relaxation response instead.
Replacing an old response with a new one is called counterconditioning!
24
Q
Who was systematic desensitisation created by and how is it carried out?
A
- This form of behavioural therapy was developed by Wolpe in the 1950’s and uses a classical conditioning method where the patient is gradually and systematically introduced to the phobic stimulus.
- He claimed that this form of therapy had an 80-90% success rate in treating phobias after only 25-30 sessions.
- Systematic desensitisation can be carried out in vitro, where the patient is asked to imagine the phobic stimulus or, less frequency or at the end of the sessions, in vivo which involves the patient actually being exposed to the situation or object.
25
What are the three steps to Systematic Desensitisation?
1. Relaxation: Training the patient to physically relax
2. Anxiety Hierarchy: Establishing what the patient is most scared of and what they are least scared of
3. Exposure: The patient relaxes and is introduced to their least feared response. This process is continued until they can relax during their most feared situation. At this stage the phobia has been successfully mastered.
26
What is counter-conditioning?
The sufferer is exposed to the phobic stimuli whilst they are in a relaxed state.
- **Counter-conditioning involves classical condition to associate the phobic stimulus with a new response.**
- This takes place across several sessions and allows the patient the chance to work their way up through the anxiety hierarchy.
- Every level, the stimulus is being counter conditioned.
27
What is a Fear Hierarchy?
- The client and therapist work together to develop a fear hierarchy, where they rank the phobic situation from least to most terrifying.
- The patient is gradually introduced to their feared situation one step at a time.
- Earlier stages may involve pictures of the phobic situation which may then lead to the goal of holding one.
28
What is Relaxation Training?
The therapist teaches the patient relaxation techniques that help manage their anxiety and distress levels to help them cope but also to associate these feelings of calmness towards the phobia.
- Breathing exercises
- Imagery techniques
- Calming music
- Meditation
29
What are the strengths to Flooding?
- Flooding is a very successful therapy as it means immediate exposure to the most feared situation. When the patient has to face their phobia, they realise it is harmless and it no longer becomes a problem
- Flooding can be a cost-effective treatment because the patient is free from their phobia quicker than other therapies
30
What are the limitations to Flooding?
- Flooding is rarely used as it can be classed as dangerous due to the high level of anxiety and the situations that patients are exposed to serious medical complications and even death. For example forcing a patient with a fear of water to swim out of their depth could result in them drowning.
- There are serious ethical issues with this therapy as patients are exposed to extreme distress and anxiety.
31
What are the strengths to systematic desensitisation ?
- **Wilson (1980)** claims that is effective for specific phobias, such as animals or objects
- This therapy is less stressful than flooding as it exposes patients to their phobia gradually rather than being ‘thrown in at the deep end’
- It is considered an ethical therapy as the patient has a lot of control over their treatment
- The positive effects on phobias seem to last longer than other therapies as shown in Gilroy et al’s (2002) study
32
What was Gilroy et al (2002) research into the effectiveness of systematic desensitisation as a treatment for phobias?
- 42 patients with a phobia of spiders
- Half were placed in the control group which were only given relaxation treatment
- The other group were treated using three 45-minute systematic desensitisation sessions.
- They were tested for their phobia after three months and then again 33 months later
- **Results**:
- The systematic desensitisation group were less fearful than a control group
- They concluded that systematic desensitisation is an effective long-term treatment for phobias compared to no treatment
33
What are the limitations to systematic desensitisation ?
- **Choy et al (2007)** found that this therapy is **only successful for flight and height phobia** not social or specific animal phobias. So it is not a complete therapy.
- Choy et al (2007) also found that due to the length of time it takes to treat the phobia there is a **high dropout rate**, which would affect the validity of any findings
- It can be very **time consuming and often expensive** therapy due to high number of sessions required
- It is not effective for everyone as many patients suffer from extreme anxiety when faced with their phobia, so they are in no fit state to sit down and work through the steps involved in the treatment process. Therefore, in order for the therapy to be effective anti-anxiety drugs may need to be prescribed as an interim measure to reduce the anxiety.
- It is easier to diagnose a phobia than some more complex underlying issues. Therefore, misdiagnosis means that the therapy will not be effective.
34
What are the diagnostic features of Depression?
- Depression can affect the thoughts, feelings, behaviour and physical well-being of an individual.
- **Clinical depression** for example is not merely a feeling of sadness (although this forms a major part of the illness), but rather a set of complex symptoms.
- The symptoms must be causing distress or impaired functioning in social and/or occupational roles.
35
How is depression categorised in DSM-V?
All forms of depression and depressive disorders are characterised by **changes in mood**.
**Categories of Depression**:
- **Major depressive disorder** – severe but short-term.
- **Persistent depressive disorder** – long-term and recurring.
- **Disruptive mood dysregulation disorder** – childhood temper tantrums.
- **Premenstrual dysphoric disorder** – before menstrual cycle.
36
How are Activity Levels a behavioural characteristic of depression?
- Sufferers of depression tend to have **reduced levels of energy**, making them lethargic. This has a knock-on effect as it leads sufferers to withdraw from work, education and social situations - in extreme cases, this can be so severe that the sufferer cannot get out of bed.
- In some cases, depression can lead to the opposite effect – **psychomotor agitation**. Agitated individuals struggle to relax and may end up pacing up and down in a room.
37
How are Disruption to Sleep and Eating Behaviour a behavioural characteristic of depression?
- Depression sufferers may experience **reduced sleep (insomnia)**, particularly premature waking, or an **increased need for sleep (hypersomnia)**.
- Similarly, appetite and eating may increase or decrease, leading to weight gain or loss.
- The behaviours key point here is that these behaviours are disrupted by depression.
38
How are Aggression and Self-Harm a behavioural characteristic of depression?
- Sufferers of depression are often **irritable**, and in some cases, they can become **verbally or physically aggressive**. This can have serious knock-off effects on different aspects of their life e.g. someone experiencing depression might display verbal aggression by ending a relationship or quitting a job.
- Depression can also lead to physical aggression directed against the self. This includes **self-harm**, often in the form of cutting, or suicide attempts.
39
How is Lowered Mood an emotional characterstic of depression?
- When we use the word **‘depression’** in everyday life we are usually describing having a lowered mood, in other words feeling sad. As you can see from the rest of this spread there is more to clinical depression than this.
- Lowered mood is still a defining emotional element of depression; however, it is more than just feeling lethargic and sad. Patients often describe themselves as **‘worthless’ and ‘empty’.*
40
How is Anger an emotional characterstic of depression?
- Although sufferers tend to experience more negative emotions and fewer positive episodes of depression, this experience of negative emotion is not limited to sadness.
- Sufferers of depression also frequently experience **anger**, sometimes **extreme anger** – This can be directed at the self or others.
- On occasion such emotions lead to aggressive or self-harming behaviour.
41
How is Lowered self-esteem an emotional characterstic of depression?
- Sufferers of depression tend to report **reduced self-esteem**, in other words, they like themselves less than usual.
- This can be quite extreme, with some sufferers of depression describing a **sense of self-loathing** i.e. hating themselves.
42
How do the cognitive characteristics of depression work?
- The cognitive aspect of depression is concerned with how people **process information**.
- People suffering from depression or who have suffered depression tend to process information about several aspects of the world quite differently from the ‘normal’ ways that people without depression think.
43
How is Poor Concentration a cognitive characteristics of depression?
- Sufferers of depression may find themselves **unable to stick with a task** as they usually would, or they might find it hard to make decisions that they would normally find straightforward.
- **Poor concentration and poor decision-making** are likely to interfere with the individual’s work.
44
How is Dwelling on the Negative a cognitive characteristics of depression?
- When suffering a depressive episode people are inclined to pay more attention to negative aspects of a situation and ignore the positives. In other words, they tend to see a **glass half empty** as opposed to half full.
- Sufferers also have a bias towards recalling unhappy events rather than happy ones – the opposite bias that most people have when not depressed.
45
How is Absolutist Thinking a cognitive characteristics of depression?
- Most situations are not all good or all bad, but when a sufferer is depressed, they tend to think in these terms.
- This is sometimes called ‘black and white’ thinking. This means that when a situation is unfortunate, they tend to see it as an absolute disaster.
46
What is OCD?
- OCD is a long-term mental health condition that is usually associated with two things: Obsessive thoughts and compulsive behaviours.
- **Obsessions**: An unwanted, unpleasant thought, image or urge that repeatedly enters a person's mind. It's usually frightening or upsetting and, because they can't shake it, it makes them feel incredibly anxious.
- Obsessions take the form of intrusive, persistent thoughts e.g.:
'Germs are everywhere; they could harm me and my family'
'The outside world is a terrifying and dangerous place so I must do what I can to protect myself and my family'
- We all experience such thoughts from time to time but for people who have OCD these thoughts consume their daily life.
47
What are the behavioural characteristics of OCD?
- Some common obsessions include a fear of harming themselves or others either deliberately or by mistake, the fear of contamination by disease or germs and even the need for everything to be in perfect order.
- **Compulsions**: These are the repetitive behaviours or mental acts that a person feels compelled to perform to try to avoid or undo the effect of the obsession. These help to reduce anxiety
- Most people are aware that their behaviour is unrealistic or out of control but can't stop acting on the compulsion.
48
What are some common types of compulsive behaviour in OCD?
- Excessive cleaning and hand washing
- Checking - such as checking doors are locked or that switches and appliance are off
- Counting and doing the same thing many times
- Ordering and arranging
- Hoarding
- Asking for reassurance
- Repeating words in their head
- Thinking 'neutralising' thoughts to counter the obsessive thoughts
- Avoiding places and situations that could trigger obsessive thoughts
49
How is Avoidance a key behavioural characteristic of OCD?
- Someone with OCD is likely to try and avoid situations that may trigger their obsessive thoughts and compulsive behaviours
- People may avoid all social engagements due to their fear of contracting a germ-borne disease
- Avoidance may lead to the OCD person becoming cut off from friends, family and contact with the outside world
50
What are the emotional characteristics of OCD?
- Extreme levels of anxiety, fear, and feelings of being overwhelmed
- Guilt directed towards themselves or as a result of neglecting friends, family, work etc.
- Disgust directed towards themselves or the outside world
- Depression (having more than one mental illness at a time is known as comorbidity) due to feeling 'trapped' by their obsessions and compulsions
51
What are the cognitive characteristics of OCD?
- Obsessive thoughts (these affect 90% of people with the illness)
- The use of **coping mechanisms** to deal with the obsessive thoughts, e.g.:
- identifying the obsessive thought as it occurs (e.g. 'There's that feeling of panic about germs again’); using a grounding object such as a pebble or wristband to remind the person that they should stop their obsessive thoughts
- **Awareness** that their anxiety and fear are **irrational**
- This awareness may help to control the fear (but not necessarily; fear can spiral regardless of the application of logic)
- **Catastrophising** around their OCD, e.g.:
'I can't find anywhere to wash my hands properly, this is terrible, I might die'
52
What are the contributing factors to OCD?
- OCD doesn't discriminate and there is no single, proven cause of OCD.
- **Can sometimes run in families**, although no specific genes have been linked to it. Childhood-onset OCD tends to run in families. When a parent has OCD, there is a slightly increased risk that a child will develop OCD. It is the general nature of OCD that seems to be inherited, not specific symptoms.
- Stress alone isn't thought to cause OCD but a **particularly stressful or upsetting life event may trigger** the condition in someone who already has a tendency for it.
- The chemical **serotonin** also seems to play a part in OCD.
- It's a neurotransmitter, which is a chemical that the brain uses to transmit information from one brain cell to another. Experts still aren't sure exactly what role it plays but medications that increase the serotonin levels in the brain, such as certain antidepressants, have successfully helped to treat the symptoms of OCD.
53
Why is Drug Therapy used to treat OCD?
- Drug therapy aims to increase or decrease levels of **neurotransmitters** in the brain - this will in turn increase or decrease certain activities or behaviours.
- Low levels of serotonin are associated with OCD. Therefore, drug treatments work in various ways to **increase** the levels of serotonin in the brain.
54
What are Selective Serotonin Reuptake Inhibitors (SSRIs)?
- The most used antidepressant used to treat the symptoms of OCD is called a **selective serotonin reuptake inhibitor (SSRI)**.
- SSRIs work by blocking (or inhibiting) reuptake, meaning more serotonin is available to pass messages between nearby neurons.
55
How do SSRIs work to treat OCD?
- When serotonin is released from the **pre-synaptic** cell into the synapse, it travels to the receptor sites on the post-synaptic neuron.
- Usually, serotonin which is not absorbed at the post-synaptic neuron is **reabsorbed** into the sending cell (the pre-synaptic neuron).
- SSRIs **increase** the level of serotonin available in the synapse by preventing it from being reabsorbed into the sending cell. This increases the level of serotonin in the synapse and results in more serotonin being received by the receiving cell (**post-synaptic neuron**).
56
What are the aims of SSRIs?
- SSRIs aim to compensate for whatever is wrong with the serotonergic system in OCD.
- Dosage and other advice vary according to which SSRI is prescribed. A typical daily dose of **Fluoxetine** is 20mg (although this may be increased if it is not benefitting the patient).
- The drug is available as capsules or liquid. It takes three to four months of daily use for SSRIs to have much impact on symptoms.
57
How could we combine SSRIs with CBT?
- Drugs are often used alongside **cognitive behaviour therapy (CBT)** to treat OCD.
- The drugs reduce a patient’s **emotional symptoms**, such as feeling anxious or depressed. This means that patients may be able to engage more effectively with the CBT.
- In practice, some people respond best to CBT alone whilst others benefit more from drugs like Fluoxetine. Occasionally other drugs are prescribed alongside SSRIs.
58
What are some alternatives to SSRIs?
- **Tricyclics**: (an older type of anti-depressant) are sometimes used, such as Clomipramine. These have the same effect on the serotonin system as SSRIs however they have more severe side effects, therefore, they are only used if a patient doesn’t respond to SSRIs.
- **SNRIs aka Serotonin-noradrenaline reuptake inhibitors**: A relatively new form of treatment for OCD, these are also a second form of treatment for patients who don’t respond to SSRIs, they increase the levels of serotonin and noradrenaline.
59
What are some evidence that supports Drug Therapy?
- **Soomro et al** (2009) reviewed studies which compared SSRIs to placebos when treating OCD. All 17 studies showed significantly better results for the SSRIs than the placebos. Effects are even greater when the SSRIs are combined with other forms of treatment like CBT. Typically, symptoms decline significantly for around 70% of patients taking SSRIs.
- Drug treatments are **cheaper** than other psychological treatments for OCD. Using drugs to treat OCD is therefore good value for a public health system like the NHS.
- Also, when compared to other drug treatments, SSRIs are also **non-disruptive** to patients’ lives. For some patients, they can take drugs until they feel better without the need to engage with the ‘hard work’ needed for other forms of therapy like CBT.
60
What are some evidence that dont - support Drug Therapy?
61
What are some evidence that dont support Drug Therapy?
- Although drugs like SSRIs can be helpful to sufferers of OCD, a significant minority will get no benefit. Some patients also suffer **side effects**.
- E.g. for those taking **Clomipramine**, side effects are more common and can be more serious. More than 1-in-10 patients suffer erection problems, tremors and weight gain.
- OCD is widely believed to be **biological in origin** therefore it makes sense that treatments are biological.
- Some psychologists believe the evidence favouring drug treatments is biased because the research is sponsored by **drug companies** who do not report all the evidence (Goldacre, 2012).
