Psychopathology Flashcards

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1
Q

What is statistical infrequency?

A

Abnormality is defined as those behaviours that are extremely rare, i.e. any behaviour that is found in very few people is regarded as abnormal. Deviation from typical value in a set of data.

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2
Q

What is an example of statisitical infrequency?

A

If you asked a group of students how scared they were of dogs on a scale of 1-10, you may expect most people to give a scale of around the middle or a low fear, so someone who says 10 is not the norm thus that is statistical infrequency.

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3
Q

What is deviation from social norms?

A

Abnormal behavior is seen as a deviation from the social norms which are like rules of how we should behave.

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4
Q

What is an example of a social norm?

A

Being polite. Thus, when someone displays anti-social behaviour or are rude to others are socially deviant and abnormal. Social norms can be implicit (unstated social rule) or explicit (a criminal offence). They are also dependent on context as social norms can change over time. A little bit of deviation is acceptable; some people are just naturally a little less polite.

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5
Q

What is an example of deviation from social norms?

A

In the past, homosexuality was classed as abnormal and regarded as a mental disorder and was illegal in the UK. This judgement was based on social deviation, because at the time, society regarded this as abnormal whereas now it is widely accepted.

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6
Q

What is cultural relativism?

A

The view that behaviour cannot be judged properly unless it is viewed in the context of the culture of which it originated.

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7
Q

What is a strength of the idea of statistical infrequency?

A

It is objective. Because it is based on mathematics, statistics and data means we can clearly define what is abnormal or what is not, and as their is no opinion involved there is no bias. However, because of this it is expected that abnormal behaviours happen rarely whereas depression is relatively common amongst adults as in 2014, almost 20% of 16-18 year olds displayed symptoms of depression.

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8
Q

What is a weakness of the idea of deviation from social norms?

A

Because it is so dependent on context and time. What is socially acceptable now may not have been socially acceptable before, for example 50 years ago, homosexuality was seen as a psychiatric disorder in the DSM whereas now it is widely socially accepted. Szasz claimed that the concept of mental illness was simply a way to exclude non-conformists from society. Thus, if we define abnormality in terms of deviation from social norms, there Is a danger of creating definitions based on prevailing current social attitudes which are always changing.

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9
Q

How are there issues with cultural relativism in the deviation of social norms idea?

A

There is cultural bias if we try to define abnormality in terms of social norms because these are defined by culture. For example, the DSM is almost entirely based on the social norms of the dominant western culture (white and middle class) and these are generalised world-wide, thus excluding and not considering other cultures or social norms. This is seen in SZ- cultural bias with spiritualism (hallucinations/religion).

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10
Q

What is failure to function adequately?

A

People are judged on their ability to go about daily life in a healthy and normal way. If they cannot do this and are feeling distressed (or others are distressed by their behaviour- e.g. in sz the individual does not realize it but other people do) then it is considered a sign of abnormality.

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11
Q

What is an example of failure to function adequately?

A

If someone has stopped showering and their room is a mess and is causing the individual or someone around them distress than this is classed as abnormality. However, if neither is distressed about this then a judgement of abnormality is inappropriate.

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12
Q

What is deviation from ideal mental health?

A

Proposed by Jahoda. Abnormality is defined in terms of mental health, behaviours that are associated with competence and happiness. Ideal mental health would include a positive attitude to the self, resistance to stress and an accurate and positive perception of reality. Having an absence of these indicates abnormality.

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13
Q

What are the 6 categories that were identified by Jahoda in ideal mental health?

A
  • self-attitudes
  • personal growth and self actualization
  • integration
  • autonomy
  • having an accurate perception of reality
  • mastery of the environment
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14
Q

What do we mean by self attitudes when we refer to ideal mental health?

A

Having high self esteem and a strong sense of personal identity.

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15
Q

What do we mean by personal growth and self actualization when we refer to ideal mental health?

A

The extent to which an individual develops their full capabilities

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16
Q

What do we mean by intergration when we refer to ideal mental health?

A

Being able to cope with stressful situations or pressure

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17
Q

What do we mean by autonomy when we refer to ideal mental health?

A

Being independent and self-regulating

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18
Q

What do we mean by mastery of the environment when we refer to ideal mental health?

A

Including the ability to love, function in work and in relationships, adjusting to new situations and problem solving

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19
Q

What is a weakness of failure to function adequately?

A

It is difficult to conclude the person who decides if someone is failing to function adequately. E.g. if a person is unable to eat regular meals, they may recognise that this is undesirable, feel distressed and seek help, or they could be quite unaware or content by the situation so it is up to other people to judge the behaviour as abnormal whether or not it makes them uncomfortable. E.g. offenders with cognitive delusions do not believe their crimes are wrong or feel guilt but others around them can recognise this as abnormal- same with schizophrenic patients.

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20
Q

What is a strength of the deviation from ideal mental health theory?

A

It is a positive approach which focuses on the positives rather than the negatives. It is rooted in humanistic psychology which is holistic and takes into account human emotions and drives. It offers a different perspective on mental disorder, focusing on what is desirable rather than undesirable which can help the patient to feel better about themselves and less isolated. It also has been used in therapy to help people achieve a higher and positive outlook on the self and outside world, which would be good for patients of depression.

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21
Q

What is a criticism of the deviation from ideal mental health theory?

A

That according to Jahoda’s definitions, most people would be considered as abnormal. Jahoda said they are ideal criteria, but the majority of people never have all 6 categories which would suggest very few people are psychologically healthy. Some are also hard to measure, as who can decide on how well someone can master their environment? Therefore, cannot be used in the general population.

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22
Q

What are phobias?

A

A group of mental disorders characterized by high levels of irrational anxiety in response to a particular stimulus or group of stimuli. The anxiety interferes with normal living.

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23
Q

What are the emotional characteristics of phobias?

A

Excessive fear, anxiety and panic because of a specific object or situation. This is out of proportion.

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24
Q

What are the behavioral characteristics of phobias?

A
  • avoidance of stimulus
  • fainting or freezing
    These both interfere with everyday life
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25
Q

What are the cognitive characteristics of phobias?

A
  • the irrational nature of the persons thinking and the resistance to rational arguments (e.g. someone with a phobia of sharks will not listen to someone who says they’re harmless)
  • the person can recognise that their fear is excessive or unreasonable (although this may be absent in children)
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26
Q

What are the emotional characteristics of depression?

A
  • sadness/emptiness/hopelessness
  • a loss of interest and pleasure
  • sometimes anger (to others or to self)
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27
Q

What are the behavioural characteristics of depression?

A
Reduce or increase in 
- activity levels (some feel agitated and restless)
- sleep
- appetite
also self harm in some people
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28
Q

What are the cognitive characteristics of depression?

A
  • irrational and negative thoughts

- self beliefs that are self-fufilling (e.g. if you believe you will fail a test you will not put work in)

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29
Q

What are the emotional characteristics of OCD?

A
  • anxiety and distress

- awareness this is excessive, leading to shame/embarassment

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30
Q

What are the behavioural characteristics of OCD?

A

COMPULSIONS
These are repetitive acions performed to reduce obsessive thoughts and anxiety. These are not connected in a realistic way and are clearly excessive.

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31
Q

What are the cognitive characteristics of OCD?

A

OBSESSIONS
Recurrent, intrusive thoughts or impulses that are perceived as inappropriate or forbidden. They may be frightening or embarrassing so the person doesn’t want to share them. These are uncontrollable thoughts that are recognised to be a product of the persons mind but produce extreme anxiety.

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32
Q

What are compulsions?

A

These are repetitive acions performed to reduce obsessive thoughts and anxiety. These are not connected in a realistic way and are clearly excessive.

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33
Q

What are obsessions?

A

Recurrent, intrusive thoughts or impulses that are perceived as inappropriate or forbidden. They may be frightening or embarrassing so the person doesn’t want to share them. These are uncontrollable thoughts that are recognised to be a product of the persons mind but produce extreme anxiety.

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34
Q

How are phobias acquired according to the two process model?

A

Classical conditioning

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35
Q

How are phobias maintained according to the two process model?

A

Operant conditioning

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36
Q

How does classical conditioning cause a phobia?

A

Because it is acquired through association of a NS +UCS and a conditioned fear response

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37
Q

How would someone gain a phobia of dogs if they were bitten by one?

A

before the experience, the dog (NS) –> no response
being bitten by a dog –> fear response UCS–> UCR
dog by itself –> fear response CS–> CR

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38
Q

What happened in the little albert study by watson and rayner?

A

White rat NS had no response NR
Loud noise UCS created fear response UCR
Loud noise + white rat UCS+NS created fear response UCR
white rat CS created CR

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39
Q

What did watson and rayner want to demonstrate?

A

That emotional responses could be learned through classical conditioning

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40
Q

What were the findings of watson and rayner?

A

Before the study was conducted he showed no response to white fluffy things (e.g. white rat, white rabbit, white cotton wool)
After he had a conditioned response of fear and crying to all white fluffy objects

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41
Q

How is operant conditioning involved in the two process model?

A

Because this maintains phobias
Phobias are reinforced. Avoidance of the phobic stimulus leads to reduced fear, and this is negative reinforcement because anxiety is taken away

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42
Q

How is social learning theory involved in the two process model?

A

Because phobias could be acquired through the modelling of others- if a child sees their role model parent respond to a stimulus with extreme stress then the child may imitate the behaviour if they see the response as rewarding or if it gets attention from others

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43
Q

How is the two process model determinist?

A

It concludes that if a NS is associated with a fearful experience then the result will be a phobia but this is not always the case.
Not everyone who gets bitten by a dog gets a phobia of dogs so there is a limited and determinist explanation.
A diathesis stress model may give a more holistic explanation; its been proposed that we have a genetic vulnerability of developing mental disorders so the fearful experience may just be a trigger for developing a phobia

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44
Q

How could biological readiness explain the two process model?

A

it was argued that humans have a biological preparedness to develop certain phobias than others, which could also give a more holistic explanation.
We may be genetically programmed to learn association between life threatening stimuli and fear (although they’re more relevant to our evolutionary past like snakes or sharks as this adaptive and would’ve helped us to survive). People can have phobias of things they’ve never encountered before.

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45
Q

How does the cognitive approach criticise the two process model?

A

Because it doesn’t take mental processes into account. It argues that the thinking process that occurs between a stimulus and response, such as irrational thinking which has significance in OCD and depression. Thus, CBT may be a good treatment or could be used in combination with systematic desensitization/flooding.

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46
Q

What makes the two therapies ‘behaviourist’?

A

Because they both involve counterconditioning which is a form of classical conditioning

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47
Q

Outline the steps involved in systematic desensitisation

A
  • Firstly, the patient is taught about relaxation techniques, such as focusing on breathing or relaxing their muscles
  • A desensitization hierarchy is created by the therapist and patient. This is a series of imagined scenes which all cause a little more anxiety than the last one
  • Patient gradually works their way through the DH whilst doing the relaxation at each stage
  • Once the patient has mastered each step in the hierarchy, then they are ready to move on to the next
  • The patient finally masters the most feared situation
48
Q

What is reciprocal inhibition? (treating phobias)

A

The patient is classically conditioned to associate the phobic stimulus with a new response (relaxation instead of fear). This desensitizes their anxiety and relaxation inhibits the anxiety.

49
Q

What is a desensitisation heirachy?

A

This a series of imagined scenes which all cause more anxiety as they progress. It happens one step at a time so it is not overwhelming.

50
Q

What is flooding?

A

In one long session, the patient is fully exposed to their phobia at its worst. The session continues until the patient’s anxiety has disappeared. It can be done in real life or in virtual reality. The patient is also taught how to relax their muscles before.

51
Q

What is rationale in flooding?

A

A person’s fear response/release of adrenaline has a time limit. Adrenaline levels will naturally decrease so a new stimulus-response link can be learned- a non anxious response.

52
Q

What are the two types of systematic desensitization?

A
  • in vivo- patient is exposed to phobic stimulus

- in vitro- patient imagines the phobic stimulus

53
Q

What are the practical issues of systematic desensitization?

A

In in-vitro the patient is told to imagine the stimulus. This ignores individual differences between patients as some patients will be able to visualise better than others, thus limiting the effectiveness. Cost benefit analysis means it will be more effective in the long term if the patient is physically exposed to the stimulus thus we should invest in in-vivo. Also, the process is very slow but the longer the sessions are the more effective it is.

54
Q

What percent of phobic patients respond to SD well?

A

75%

55
Q

What are some issues with flooding?

A

It is rarely used because it dangerous and has ethical issues, as the participant is NOT protected from harm. It is not appropriate for treating all phobias because in some cases it actually increases the fear response after the therapy. Also, during the therapy, the patient has a right to withdraw but if they withdraw before they have reached a relaxed stage then the anxiety will never be eliminated. These all limit the effectiveness of the therapy.

56
Q

What is a benefit of behavioural therapies?

A

They are generally faster, cheaper and require less effort on the patients part than other psychotherapies. As the therapy does not require the patient to think deeply about their problems, unlike CBT, then this is very useful for people who do not have an insight into their motivations, so e.g. children or people with learning disabilities.

57
Q

Who was responsible for the ABC model?

A

Ellis

58
Q

What is the A in the ABC model?

A

Activating event- e.g. you get fired at work

59
Q

What is the B in the ABC model?

A

Belief- this either rational or irrational

e.g. ‘the company was overstaffed’ vs ‘they’ve always had it in for me’

60
Q

What is the C in the ABC model?

A

Consequence
Rational beliefs lead to healthy emotions
Irrational beliefs lead to unhealthy emotions, like depression

61
Q

What is mustabatory thinking?

A

Thinking that certain ideas or assumptions must be true in order for an individual to be happy. E.g., i must pass this test or I will fail in life
If an individual has mustabatory thinking then they will probably be disappointed or at worst, depressed. This is because it is irrational.

62
Q

What are 3 key examples of mustabatory thinking?

A
  • i must be approved or accepted by people I find important
  • I must do well or I am worthless
  • the world must give me happiness or I will die
63
Q

What did Beck believe?

A

That depressed individuals feel the way they do because their thinking is biased towards negative interpretations of the world, and they lack a perceived sense of control.

64
Q

What is the role of negative schema in Beck’s theory?

A

Depressed people are thought to have acquired a negative schema during their childhood, which gives them a negative view of the world. It could be caused by criticism or rejection from parents, peers or teachers. They lead to cognitive biases in thinking.

65
Q

What does negative schema lead to in Beck’s theory?

A

Cognitive biases in thinking.
An example of this would be that if someone received a small piece of negative feedback then they would create a sweeping negative perception of themselves because of it

66
Q

What 3 things are included in Beck’s negative triad?

A

Negative view of the self
Negative view of the future
Negative view of the world

67
Q

What are some good applications of the cognitive approach of explaining depression?

A

It has great applications within therapy where it is usefully applied and utilised. Both of the theories have led to successful treatments within CBT. This is consistently found to be the best treatment of depression. It has a high effectiveness rate of around 80% but when used in addition with drugs, it is even higher. However, this shows that there must be some biological aspect to depression if drugs help treat it, so it is possible to argue that the cognitive approach by itself is reductionist.

68
Q

How does the cognitive approach of explaining depression blame the client?

A

Because it suggests that the client is responsible for their disorder, not any situational factors. However, this is actually a good thing because it gives the client the power to change the way that things are, as it is NOT out of their hands. This promotes recovery and room for improvement. This slightly ignores factors such as life events or family life that may have influenced the person’s mental disorder, so you may argue that this is a further reason why it is reductionist.

69
Q

How may biology play a role in explaining depression?

A

Because the biological approach suggests that genes and neurotransmitters may cause depression. Specifically, there are very low levels of serotonin in depressed patients; a gene related to this was 10 times more common in people with depression. Also, the effects of drug therapies which increase seratonin levels are beneficial in helping treat depression. This implies the need for a diathesis-stress model which is more holistic and therefore a more valid explanation.

70
Q

What is CBT based on?

A

The idea that the way we feel is partly based on the way we think about events so if we treat these irrational thoughts then we can develop new coping strategies to replace previous behaviour and ways of thinking.

  • challenging irrational thoughts
  • homework
  • behavioural activation
  • unconditional positive regard
71
Q

What is the aim of CBT?

A

To challenge and replace irrational thoughts with rational ones

72
Q

How did ellis adopt his ABC model in CBT?

A

He extended it to ABCDEF
D- disputing irrational thoughts and beliefs
E- effects of disputing and effective attitudes to life
F- (new) feelings (or emotions) that are produced

73
Q

What did ellis name his therapy?

A

REBT- rational emotional behaviour therapy

74
Q

What are examples of disputing in CBT?

A
  • logical: ‘does thinking in this way make sense?’
  • empirical: ‘where is the proof that this belief is accurate?’
  • pragmatic: ‘how is this belief likely to help me?’
75
Q

What is catastrophising?

A

Thinking the worst of something- an irrational thought which is much worse than reality. Links to ABC model or negative schema in negative triad

76
Q

What is ruminating?

A

When negative thoughts repeatedly go round your head

77
Q

What is homework in CBT?

A

Clients are often asked to complete assignments between sessions, such as looking for a new job. This replaces the irrational beliefs and puts the new rational beliefs into practice.

78
Q

What is behavioural activation in CBT?

A

Encouraging depressed patients to become more active and engage in pleasurable activities (especially ones they used to enjoy before their depression). This is because being active will lead to rewards/pleasure.

79
Q

What is unconditional positive regard?

A

The therapist provides respect and appreciation regardless of what the client does/says, this will encourage a change in behaviour and attitudes because they will feel better about themself and less worthless.

80
Q

How is there research support for CBT?

A

Because Ellis claimed that with 27 sessions of therapy, there was around a 90% success rate which is very impressive and thus implies great mental health benefits for the patient. Ellis recognised that it was not always effective because some clients did not put their new rational beliefs into action, as behavioural action is a key factor in treatment. In the long term this may have good economic implications because the NHS will have to invest less in repeated less effective treatments like drug therapies.

81
Q

How is there individual differences within CBT?

A

Because some people may be more suitable than others- people who have high levels of irrational beliefs that are rigid and resistant to change struggle to benefit from CBT. There is also a lot of effort required from the patient and in some cases of severe depression, CBT may have no effect or even a bad effect as they have to get involved with the cognitive effort associated with recovery. Limitation- individual differences affects the effectiveness.

82
Q

What alternative treatments are there to CBT?

A

As there is research support that depression is influenced by biological factors, such as low levels of seratonin, it is reductionist to treat depression just in terms of cognitive aspects. If we use therapy alongside drug treatments, there is a very high efficacy rate of above 80%, where drug treatments alone only have a success rate of just over 50%. This shows that there is an interaction and possibly a diathesis-stress so we should consider more factors rather than just faulty thinking.

83
Q

What are the three aspects of genetic explanations of OCD?

A
  • the comt gene
  • the sert gene
  • diathesis-stress
84
Q

What does genetic explanations of mental disorders imply?

A

That they are inherited- specific genes are related to specific disorders

85
Q

What is the role of the COMT gene?

A

It is involved with the production of COMT. COMT regulates the production of the neurotransmitter dopamine. In OCD patients, one form of the COMT gene has been found to be more common; lower COMT activity and high levels of dopamine.

86
Q

What does COMT do?

A

Regulates the production of dopamine

87
Q

What is the role of the SERT gene?

A

It affects the transport of serotonin thus creating lower levels of the NT. Low levels of serotonin are associated with OCD.

88
Q

What is the idea of a diathesis-stress in OCD?

A

It is unlikely that the disorder is solely caused by biological factors, because the disorder is so complex. Genes such as the SERT gene are also involved in other disorders like depression. Thus, perhaps the individual gene creates a vulnerability for disorders, but the stress/external factor causes the disorder to develop. People may have the genes but not the disorder.

89
Q

How are dopamine levels implicated in OCD?

A

They are abnormally high

90
Q

How do we know dopamine levels in OCD are high- animal study?

A

In animal studies, high doses of drugs that enhance levels of dopamine induce stereotypical movements seen in compulsions in ocd

91
Q

How are serotonin levels implicated in OCD?

A

Lower levels are associated with OCD

92
Q

How do we know serotonin levels in OCD are low- drug impacts?

A

Anti-depressants that increase serotonin activity have been shown to reduce OCD symptoms

93
Q

Explain how the worry circuit works?

A

The caudate nucleus normally supresses signals from the orbitofrontal cortex (OFC). In turn the OFC sends signals to the thalamus about ‘worries’, like e.g. germs. However, when the caudate nucleus is damaged it cannot suppress minor worries so the thalamus is alerted, which then sends signals to the OFC, making it a worry circuit.

94
Q

How is there brain scan support for the worry circuit?

A

PET scans of OCD patients demonstrated that there is heightened activity in the OFC when their symptoms are active (so a person with a germ obsession may have been holding a dirty cloth)

95
Q

How may serotonin be implicated in the worry circuit?

A

Because serotonin plays a key role in the functioning of the OFC and caudate nucleus, its possible that as serotonin levels are low that this is the reason they malfunction

96
Q

How may dopamine be implicated in the worry circuit?

A

Dopamine is the main neurotransmitter of the basal ganglia, so high levels of dopamine lead to overactivity of this region

97
Q

What percent of the general population have OCD, compared to people whose parents have it?

A

2% compared to 10%

98
Q

What is the concordance rate of MZ twins for OCD?

A

Almost 90%

99
Q

How is there research support for the genetic explanation of OCD?

A

Family studies- 2% of general population compared to 10% when an individual has a OCD parent
Twin studies- for MZ is around 85%, for DZ twins its around half of that
Concordance rates are not 100% so diathesis stress model may be needed?

100
Q

What are the real world applications of the biological approach of explaining ocd?

A
  • gene therapy, which means its possible to switching genes off so that the disorder is not expressed in the fetus. Ethical and moral issues and is also reductionist as it implies genes are the only cause
  • drug treatments- SSRIs that contain high serotonin levels can reduce symptoms
101
Q

How is the bio approach of OCD reductionist and what is an alternate explanation?

A

Only considers bio elements
The two process model can be applied here
- neutral stimulus like dirt associated with anxiety via classical conditioning
- compulsions like cleaning the house to get rid of dirt gets rid of anxiety produced- operant conditioning, negative reinforcement
- this has led to treatment mirroring systematic desensitisation

102
Q

What are the three drug therapies for OCD?

A

SSRI antidepressants
Tricyclics antidepressants
Benzos anti-anxiety

103
Q

What are the most common drugs for depression and OCD?

A

SSRIs

104
Q

What is the aim of SSRIs?

A

As low levels of serotonin are associated with OCD, especially with creating a faulty worry circuit, the drugs work to increase serotonin levels

105
Q

How do SSRIs work?

A
  • Serotonin is released into a synapse from the pre-synaptic neuron
  • It targets receptor cells on the receptor sites at the receiving neuron
  • It is reabsorbed by the initial neuron sending the message
  • Therefore to increase serotonin levels at the synapse and increase stimulation to the receiving neuron, it inhibits the re-uptake
106
Q

What is a name of an SSRI?

A

Prozac

107
Q

What is the aim of tricyclics?

A

They target serotonin and noradrenaline

108
Q

How do tricyclics work?

A

They block the transporter mechanism that re-absorbs both serotonin and noradrenaline in the pre-synaptic cell, after it has fired. Because they are not re-absorbed, the NT are left in the synapse and their activity is pro-longed

109
Q

What is a name of a tricyclic?

A

Anafranil

110
Q

How do benzos work?

A

They react with special sites called GABA receptors on receiving neurons. When GABA locks into these receptors, it increases the flow of chloride ions into the neuron and these make it harder for the neuron to be stimulated by other NTs, therefore the person feels more relaxed.

111
Q

What is an example of benzos?

A

Xanax and valium

112
Q

What is the main aim of benzos?

A

To reduce anxiety- effectively shuts off/calms down the nervous system

113
Q

Evaluation point- what is the effectiveness like of drug therapies for OCD?

A

There is evidence that supports the efficacy of these drugs; in controlled studies, compared with placebos, OCD patients who were taking SSRIs improved significantly and their symptoms were reduced, compared to the people on the placebo. However, these experiments are short term and do not demonstrate how effective they may be after a few months. They are also not really a long-lasting treatment and may result in future relapse as they do not address the root of the problem

114
Q

Why are drug therapies of OCD better than the other treatments?

A

Mainly because it doesn’t require a lot of effort from the individual, which can be hard when they are suffering so much. CBT requires regular meetings and considerable thought into the root of the problem. Drug therapies are also cheaper and do not require as much monitoring. Thus in the short term drug therapies have good economic benefits for the NHS but in the long term, relapse is possible so if we invest in CBT it may be better economically in the long term.

115
Q

What are the problems with side effects of these drugs?

A

All 3 drugs have side effects. SSRIs can cause headaches or insomnia. These aren’t as severe as tricyclics or benzos. Tricyclics can cause nasty side effects like hallucinations and irregular heartbeat which is very unpleasant for the patient. Benzos can cause long term memory problems or aggression, and are actually quite addictive. BZs tend to be used as a last resort. These side effects all limit the usefulness of these drugs.