Psychopathology advanced info Flashcards
Definitions of abnormality
Explain the term statistical infrequency
Is when an individual has a less common behaviour or characteristics, as they don’t fall within two standard devoations of the mean, tehy are said to be abnormal
An example of this is IQ, most people fall within 68% of the mean, this means they have a score within 85-115. Only 2% have a score below 70, who would be diagnosed with intellectual disorder,
Definitions of abnormality
Evaluate statistical infrequency (there is 3 on this page)
Real-life applications- can be used a diagnostic tool in clinical practise. Becks depression Inventory a score of 30+ means you have severe depression people with IDD and depression can access help. This shows how it useful when assessing the severity of symptoms. However, the cut of point is subjective as if someone was one point away from the threshold they would not receive help.Has negative implications etc (Is this fair)
Sometimes having uncommon characteristics is a positive thing. For example, High IQ is seen as a desirable trait. Also the same for having a low becks inventory score. SI alone is not sufficient as the sole basis of defining abnormality
According to a survey by the NHS in 2014 1 in 6 adults in the UK has depression, which suggests that it is common. Under this definition, it would be seen as common, but this doesn’t necessarily mean that it should be seen as such
Definitions of abnormality
Explain what is meant by deviating from social norms
This is when someone behaves differently from how society would expect them to behave in that setting.
- Some rules are implicit whereas others are in the law
- Norms are based on the society that we are in, but some behaviours are not universally accepted because they go against social norms
An example is an antisocial personality disorder
- a symptom of this in the DSM is that is the absence of prosocial internal standards with failure to conform to lawful and normative ethical behaviour
- as a society, we make a judgment that a psychopath’s behaviour is abnormal
Definitions of abnormality
Evaluate deviation from social norms (there’s three on this page)
-real-life application: can be used in clinical practice. Deviating from norms (aggression, recklessness, deceitfulness) these norms allow for the diagnosis of schizotypal personality disorder. Shows the value of social norms in the field of psychiatry
-Classification systems like DSM are almost entirely based on western norms but the same criteria is applied to people of other cultures. Fernando found that afro-Caribbean people are 7x more likely to be diagnosed with schizophrenia due to western definitions of illness being applied to people of non-western cultures. The DSM tried to be more culturally relativist
and now makes reference to cultural differences in areas of diagnoss
-human rights abuses: In 1950s Russia those who disagreed with the state ran the risk of being regarded as insane as being placed in institutions. Thomas Szasz claimed mental illness was used to exclude non-confromits from society carries the risk of unfair labelling. Similarly, the historical diagnosis of nymphomania, have been used to control women. his demonstrates how this definition could be harmful to people who deviate from the norms and be used as a form of social control.
Definitions of abnormality
Explain what is meant by failure to function adequately
-happens when someone is unable to cope with day to day life. Unable to maintain basic standards of hygiene and nutrition like washing or eating. Rosenhann and Seligmen say that this includes when
-someone no longer conforms to standard interpersonal rules like keeping eye contact
When someone experiences severe personal distress or brings distress to others
Definitions of abnormality
Evaluate failure to function adequately (2 on this page)
Represents threshold for health, so people can seek help when they feel like they are unable to cope with life. This shows how treatment and services are tailored to those who need them most. However, the idea of coping may be seen as subjective as it is based on the observer’s opinion. Despite this there are objective methods like WHODAS which can assess one’s level of functioning, thus showing how useful this definition is.
May cause discrimination and social control because some people may be labelled abnormal for having non-standard lifestyle choices. The definition is not culturally relativist and this criterion may be used to wrongly diagnose people. Moreover,people who enjoy thrill-seeking would be seen as abnormal as they are taking part in activities that pose a danger to themselves. Therefore this definition may not a comprehensive way to diagnose people
Definitions of abnormality
Explain what is meant by deviation from ideal mental health
-Jahoda vonducted a review about what other had written about mental health. These characteristics enable the indicual to live freely and without distress. For example
What is the ideal mental health, Jahova says
- No symptoms of distress
- rational and perceive ourselves accurately
- self actualise
- can cope with stress
- have good self-esteem and lack guilt
- independent of other people
- can work successfully
this definition proses the absence of this criteria indicates abnormality and a potential mental disorder
Definitions of abnormality
Evaluate deviation from ideal mental health (three on this page)
- Highly comprehensive, allows someone to discuss their mental wellbeing in a meaningful way. This allows people to understand ways in which they can achieve ideal mental health. Seek out therapists, life coaches etc.
- Limitation is that this is unrealistic and according to this definition many people would be classed as abnormal. This is based on humanistic ideals and may be seen to ignore how environmentalism determinism may prevent people from achieving ideal mental health. There are high standards for people but sometimes life may not allow them to always achieve this. Therefore this definition may not be a comprehensive way of measuring abnormality.
- might be ethnocentric. ideas of self-actualisation are not common in some cultures. The concept of ideal mental health seems like an emic construct that is being used an etic way, for example in Europe there is a variation on the value of personal indépendance (high in Germany, low in Italy) can be hard to apply the concept from one culture to another
Phobias
What is the two process model
Developed by mowrer
Behaviourists believe all behaviour is learnt
Can be learnt (acquired) through association
And maintained through reinforcement
Phobias
Classical conditioning
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Behaviourists believe that phobias can be acquired through classical conditioning
If a cat scratched you, you may associate cats with pain. As a result, every time you see a cat you have a feeling of fear. This can be generalised to other four-legged animals like dogs.
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SLT
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Phobias
Outline Operant conditioning for phobias
Operant conditioning is when you learn through consequences.
example with cat, a person may avoid scenarios with a phobia like the zoo or times when people walk dogs
Doing this decreases the feeling of anxiety (the unpleasant feeling)
It is then through negative reinforcement that the phobia is maintained
Phobias
There is supporting evidence for the acquisition of phobias
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Strengths: supporting evidence
Watson and Rayner paired loud sound with the stimulus of mouse
Little Albert was scared of the mouse and generalised fear to other objects
Demonstrates how phobias can be learned as a result of association, thus providing supporting evidence for the acquisition of phobias
Counterpoints: case study we don’t know whether other albert fear was maintained over the years as contact was lost with the family,
-found that little albert had died of hydrocephalus
-hard to know whether little alberst reactions were affected by this condition
Therefore this research teaches us little about how phobias remain.
Phobias
Conflicting evidence about how phobias are acquired
AO3 evaluation
DiNardo et al gave the example that not everyone who is bitten by a dog acquires a phobia, this could be explained by the diathesis-stress model. As people may have a vulnerability for having phobia, but it may be triggered by an event like being bitten by a dog
This shows how the behaviourist explanation may be an incomplete explanation for phobias.
As a result, other explanations like diathesis stress model may explain the acquisition of phobias
Phobias
Evaluation: Treatments based on behaviourist explanation
The behaviourist explanation behind phobias led to the development of systematic desensitisation and flooding
These techniques are successful which demonstrates how phobias can be learned through association and unlearned in the same way.
Studies by choy et al have shown how well these treatment work
Therefore the behaviours approach has real-world application when treating phobias
Phobias
Evaluation: behaviourist explanation ignores mental processes involved
The behaviourist approach ignores mental processes.
Explanations ignore irrational thinking, which may be key to maintaining phobias.
Supported by Tomarken et al who showed phobics and non-phobics snakes in a picture
Phobics overestimated number of snakes in the picture
Shows how important cognition and mental processes is to explaining how phobias can be maintained
Phobias
Evaluation: a better explanation for phobias is biological preparedness
Menzies and Clarke
Ask children with fear of water about the traumatic experience in which they obtained it . Only 2% could give an answer
OST and Hugdahl say that half of people with phobias have never had an anxious experience with the object or ever seen the object
This suggests that some phobias may be innate. The explanation of biological preparedness may better explain the acquisition of phobias that helped us survive in the era of evolutionary adaptiveness
Treatments of phobias
What is flooding
How does it work?
- the person with the phobias has been immersed in a long session, experiencing the phobia at its worst
- stops phobic responses quickly, as there is no option of avoidance behaviour
- client learns that phobic stimulus is harmless this is called extinction
- the phobic stimulus no longer produces the conditioned response of fear
- sometimes clients may achieve relaxation as they became exhausted by their own fear response
- so new new stimulas response link is learnt
Evaluation of flooding
Flooding is cost-effective
highly cost-effective
- Flooding can work in as little as one session
- Choy et al reported that both SD and flooding were effective but flooding was more effective
- which is cost-effective for the NHS
- this means more people can be treated at the same cost ith flooding than SD
Evaluation of flooding
Flooding can be highly traumatic for the patient
Highly unpleasant experience
Schumacher et al said Ppts and therapists rated flooding more stressful than SD
Raises ethical issues
Higher dropout rates than SD because of traumatic nature
Suggest therapists should avoid it
Evaluation of flooding and SD
Symptom substitution
All behaviour therapies
Do not tackle underlying causes of the phobias
Persons reported a case with a women who feared death
Using flooding her fear declined but her fear was substituted by the fear of being criticised being criticised worsened
CP- came from case study so hard to generalise
Treatments of phobias
What is systematic desensitisation?
It is a behavioural therapy that gradually reduces phobic anxiety through CC
Three professes
1. Anxiety hierarchy: list of situations that may cause anxiety rated from least to most frightening
- Relaxation: it is impossible to be relaxed and afraid (reciprocal inhibition). So therapist teaches the client to relax. This involves breathing exercises, relaxing situations or drugs like Valium
- Exposure: the therapist exposes the client to phobic stimulus while in a relaxed state. They start from the bottom of the hierarchy from top
This is called countercondiyoning because the patients new association counteracts the old one
Evaluation of SD
SD is an effective treatment
Gilroy et al followed up 42 people that had SD for a spider phobia.
- At 33 months people who had SD were less fearful than control group
- Similarly: Reported that 75% of people with phobias who did SD responded to the treatment. This was more successful in in vivo compared to when using pictures
- this shows how SD is useful when treating people with phobias
Evaluation of SD
some parts may not be necessary
Studies have shown that neither relaxation nor hierarchies are necessary,
-the important factor is just exposure to the feared object or situation.
-Choy et al reported that both SD and flooding were effective but flooding was more effective
So therapies like flooding may be more effective in terms of treating phobias and being cost-effective
Evaluation of SD
May not work on social phobias
-SD used on people with agoraphobia and social phobias don’t show much improvement
-as they may have not acquired through CC
-Wechsler et al found that SD worked for people with specific phobias but not social
It may be more useful to teach people social skills than just using SD alone
-questions whether treatments based on behavioural explanations are effective for all people
OCD
What is the genetic explanation of OCD
OCD may be a polygenic condition, where a number of genes are involved in its development.
Taylor found that 230 genes may be implicated in OCD
Researchers have found candidate genes that may be implicated in OCD
SERT gêne: Affects the transport of the neurotransmitter Serotonin
-Transportation issues cause lower levels of serotonin to be active
within the brain and are associated with OCD
Ozaki et al found a Mutation in this gene in two families, where 6 of 7 members had OCD
Ozarki found a mutation in this gene in a family where 6 out of 7 people had OCD
The COMT gene may also be mutated in individuals with OCD, this causes higher levels of dopamine
OCD
AO1: Outline the neural explanation of OCD
Seratonin
- serotonin helps regulate mood
- if a person has low levels of serotonin can lead to having a low mood
- High levels of dopamine have been thought to influence concentration.
- This may explain why OCD individuals experience an inability to stop focussing on obsessive thoughts and repetitive behaviours.
Decision-making systems
- the prefrontal cortex (PFC), is involved in decision making
- Another brain region associated with OCD is the orbitofrontal cortex, this sends signals to the thalamus about things that are worrying. When caudate nucleus is damaged it fails to suppress minor worries. and the thalamus is alerted which sends it back to the OFC which creates a worry circuit
OCD
AO3: There is research support for the genetic explanation of OCD
- There is a strong evidence base for OCD
- Nestdat et al: found that monozygotic twins shared OCD 68% of the time whereas dizygotic it was 31%
- Another piece of supporting evidence is Lewis et al who found that 37% of patients had a parent with OCD and 21% of patients had a sibling in OCD
- This suggests that there is a genetic basis for OCD, but the concordance rate was never 100%, so this suggests that there is environmental influences as well
OCD
A limitation of the genetic model of OCD
- Strong evidence that there are environmental risk factors
- genetic variation can make someone less vulnerable
- but environmental factors can trigger or increase the risk of developing OCD
- Cromer et al found that OCD clients in sample had experienced a traumatic event in the past, and that OCD was more severe for those with multiple traumas
- this means genetic vulnerability only provides a partial explanation for OCD
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There is research support for the neural model of OCD
- antidepressants that work purely in serotonin are effective in reducing OCD symptoms
- Piggot et al found antidepressants that increase serotonin, decrease symptoms of OCD
- which suggests that serotonin may be involved in OCD
- This suggests that biological factors like serotonin may be responsible for OCD
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Serotonin link at not be unique to OCD
- many people with OCD experience clinical depression
- depression probably involves disruption to the action of serotonin
- this means we don’t know whether serotonin is the basis of OCD
- this means serotonin may not be relevant to OCD symptoms
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There are alternative explanations for OCD
-the two processes model
two-process model can be applied to OCD. Initial learning occurs when a neutral stimulus is associated with anxiety.
-Association is maintained because the anxiety-provoking stimulus is avoided.
This reduces anxiety.
explanation supported by the success of a treatment called exposure and response prevention (ERP)
Albucher et al. (1998) report that between 60 and 90% of adults with OCD have improved considerably using ERP.
This suggests that OCD may have psychological causes as well as, or instead of, biological causes.
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There are real world applications
Mapping of the human genome has led to the hope that specific genes could be linked to particular mental and physical disorders.
For example if parent has COMT gene,
-fertilised eggs could be screened,
-giving parents the choice of whether to abort those eggs with the gene
-gene therapy can be sued to turn certain gene off, so they are not expressed .
-ethical issues, genes may have other benefits. assumes that there is a relatively simple relationship between a disorder, such as OCD, and genes, w.
AO1 OCD
What are SSRIs and how do they work
-standard medical treatment used to tackle OCD
-The daily dose of SSRI called Prozac is 20mg
-this can be taken as liquid or capsules
-and it takes 3-4 months of daily use of SSRIs have much impact symptoms
SSRIs act on the serotonin symptom on the brain
-SSRIs work by blocking the re-uptake and reabsorption of serotonin at the pre-synaptic membrane
-this increases the serotonin concentration at receptors on the post-synaptic membrane.
-Also anti anxiety drugs like benzodiazepines slow down the nervous system by increasing the neurotransmitter GABA which quietens down the CNS
OCD
AO1: What can you combine SSRI with what are the alternatives to SSRIs
- Drugs can be used in conjunction with CBT. These help reduce the persons emotional symptoms which allow people with OCD to engage more effectively with CBT
Alternatives to SSRIs
Tricyclics block the transporter mechanism that re-absorbs both serotonin and noradrenaline.
Tricyclics have the advantage of targeting more than one neurotransmitter.
But they have greater side effects
SNRIs- also used to treat OCD. Used a second defence for people who don’t respond to SSRIs. SNRIs increase levels of serotonin as well as another neurotransmitter called noradrenaline
OCD
AO3: there is research support for the effectiveness of SSRIs
There is evidence for the effectiveness of drug treatments.
Soomro et al. (2008) reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective than placebos.
-typically symptoms reduced for 70% for people taking SSRIs
However Koran et al said is that most studies are only of three to four months’ duration
Therefore, while drug treatments have been shown to be effective in the short term,
the lack of long-term data is a limitation
OCD
AO3: A strength of SSRIs d that they are cost effective and non disruptive
- drugs are cost effective and non disruptive
- cheap compared to other psychological treatments
- Using drugs to treat is good for public health systems like NHS
- SSRIs are also non disruptive to peoples lives, this is different to therapy where time has to be spent attending therapy session
- So drug therapies are more economical for the health service than psychological therapies
OCD
AO3: A limitation of drugs is that it can have side effects
The most common side effects of SSRIs nausea, headache and insomnia Although not necessarily severe, they are often are enough to make a patient stop taking the drug.
However, Tricyclic antidepressants tend to have more side effects like hallucinations and irregular heartbeat
There are also problems with addiction, so Ashton et al said that the recommendation is that BZ use should be limited to a maximum of four weeks
These side effects, and the possibility of addiction, this limits the usefulness of drugs as treatments for OCD
OCD
AO3: Drugs aren’t a cure for OCD
An issue with drug treatments is that they are not a lasting cure for people with OCD.
Maina et al. (2001) found that patients relapse within a few weeks if medication is stopped.
Koran et al. (2007), suggested that, although drug therapy may be more commonly used, psychotherapies such as CBT should be tried first.
Although drug therapies are useful in the short term, it does not provide a cure for OCD.
