Psychopathology AO1 Flashcards
What are the 4 different definitions of abnormality?
Deviation from social norms
Failure to function adequately
Statistical infrequency
Deviation from ideal mental health
What is a summary of deviation from social norms?
Abnormal behaviour is that which goes against/contravenes unwritten rules/expectations in a given society/culture
What are the two categories of social norms?
Implicit norms
Explicit laws
What is an example of an explicit law?
One must wear clothes in public places
What is an example of an implicit norm?
Don’t talk loud in a library
What does deviation from social norms say happens if someone does deviate or break social norms?
This is a way to identify them as abnormal
Potentially in need of a psychiatric diagnosis
What is an example of abnormality?
Anti-social personality disorder –> Absence of pro-social internal standards, failure to conform to culturally normative behaviours and do not conform to moral standards
What is a summary of failure to function adequately?
Abnormal behaviour is that which causes person distress/anguish or an inability to cope with everyday life/maladaptiveness
Who came up with the signs associated with failure to function adequately?
Rosenhan and Seligman
What are the 5 signs used to determine whether someone is not coping?
Suffering
Maladaptiveness
Observer discomfort
Unpredictability
Irrationality
What is maladaptiveness?
Behaviours stopping individuals from achieving life goals, both socially and occupationally
What is a relevant example for failure to function adequately?
Schizophrenia –> one or more major areas of functioning such as work, relationships or self care are below level achieved prior to onset
Symptoms–> hallucinations, delusions, difficulty with speech and apathy
What is a summary of statistical infrequency?
Abnormal behaviour is that which is rare, uncommon and anomalous
Which graph does the statistical infrequency definition use?
The normal distribution curve
How is the normal distribution curve used?
95% of population fall within 2 standard deviations of mean (middle region, normal)
Any individual whose score is more than 2 standard deviations away from the mean is considered abnormal –> both extremes, top 2.5% and bottom 2.5%, statistically infrequent
What is an example of the use of the normal distribution curve and statistical infrequency?
IQ –> only 2% of people have a score below 70, very unusual/abnormal, would receive diagnosis of ‘intellectual disability disorder’
What is a summary of deviation from ideal mental health?
Abnormality is that which fails to meet prescribed criteria for psychological normality/wellbeing
Who conducted research into signs of good mental health?
Marie Jahoda
What are Jahoda’s characteristics of ideal mental health?
Positive attitudes towards self
Self-actualisation of one’s potential
Resistance to stress
Personal autonomy
Accurate perception of reality
Adapting to the environment
What is a relevant example of deviation from ideal mental health?
Depression –> sufferer is likely to have a negative view of themselves, will not be resistant to stressful situations, may not accurately perceive reality
What are all phobias characterised by?
Excessive fear
Anxiety
Triggered by an object, place or situation
How is a phobia officially diagnosed?
When extent of the fear is out of proportion to any real danger presented by phobic stimulus
Must result in a disability –> preventing person from living a normal life or doing normal things
What are the 3 categories of phobia recognised in the DSM?
Specific phobia
Social anxiety (social phobia)
Agoraphobia
What is specific phobia?
A phobia of an object or a situation
E.g. animal, body part, injection, flying
What is social anxiety?
Phobia of a social situation e.g. public speaking, using a public toilet
About 7% suffer with social phobia
What is agoraphobia?
Phobia of being outside or in a public place
What are the behavioural categories of phobias?
Avoidance
Panic
Endurance
What is avoidance?
When the sufferer goes to a lot of effort to avoid coming into contact with the phobic stimulus, can make it hard to go about daily life
What is panic?
Phobic person may panic in repsonse to the presence of phobic stimulus e.g. crying, screaming, running away
What is endurance?
Sufferer reamains in presence of phobic stimulus but continues to experience high levels of anxiety
May be unavoidable e.g. flying
What are emotional characteristics of phobias?
Fear
Anxiety
What is fear?
Immediate and extremely unpleasant response experienced when phobic stimulus is encountered or thought about
What is anxiety?
Unpleasant state of high arousal
Prevents sufferer relaxing, makes it difficult to experience any positive emotion
Can be long term
What are cognitive characteristics of phobias?
Irrational beliefs
Cognitive distortions
Selective attention/fixation
What are irrational beliefs?
Increase pressure on sufferer
E.g. ‘I must always sound intelligent’
What is cognitive distortions?
Phobic’s perceptions of phobic stimulus may be distorted
What is selective attention/fixation?
When sufferer sees phobic stimulus and finds it difficult to look away from it
Keeping attention on it gives person best chance of reacting quickly to a threat –> not useful when fear is irrational
What is the behavioural explanation of phobias?
The Two-Process Model/Learning Theory
Phobias are acquired by classical conditioning and maintained due to operant conditioning
What is classical conditioning?
States that a person’s actions are result of a stimulus and response link which has become habit due to association
What is classical conditioning in terms of phobias?
Claims that person has become fearful of a stimulus as they have learnt to associate with a negative feeling or other negative stimulus at some point in the past
What is operant conditioning?
Shaping of behaviour through consequences
What is operant conditioning in terms of phobias?
Phobias maintained as they are negatively reinforced
Individual avoids a situation which may involve the phobic stimulus –> results in no fear (desirable)
Avoidance behaviour repeated and phobia maintained
What is a behavioural treatment of phobias?
Systematic desensitisation
What is systematic desensitisation?
Based on behaviourist assumption that abnormality has been learned through association or reinforcement so can be unlearned on same principles
What is counterconditioning?
Learning a new response of relaxation to feared stimulus
What is reciprocal inhibition?
If sufferer can relax in presence of phobic stimulus then they will be cured
Impossible to be afraid and relaxed at same time –> one emotion prevents other
What are the three steps of systematic desensitisation?
The fear hierarchy
Relaxation
Exposure
What is the fear hierarchy step?
Hierarchy put together by patient and therapist, list of situations relating to phobic stimulus that provoke anxiety
Move from least to most frightening
What is the relaxation step?
Therapist teaches patient to relax as deeply as possible by imagining themselves in relaxing situations or learning breathing or meditation techniques or drugs e.g. Valium
What is the exposure step?
Patient is exposed to first phobic stimulus whilst in relaxed state
Takes place across several sessions and move up hierarchy
When is systematic desensitisation deemed successful?
When patient can stay relaxed in situations high up on their anxiety hierarchy
What is the other behavioural treatment of phobias?
Flooding
What is flooding?
Involves immediate exposure to a very frightening situation
Stops phobic responses very quickly
Sessions usually longer than SD sessions
How does flooding work?
Patient quickly learns phobic stimulus is harmless as there is no option for avoidance behaviour
Learned response is extinguished when conditioned stimulus is encountered without uncondtioned stimulus
What is depression?
Characterised by changes in mood
Divided into bipolar and unipolar
What is required for someone to be given a depression diagnosis?
Display at least 5 symptoms, every day, for at least two weeks
What do patients with bipolar also have?
High moods (mania)
May experience increased energy, euphoria, insomnia and impulsive behaviours
What do patients with unipolar have?
Only experience low mood for long periods of time, not related to external circumstances
What are behavioural characteristics of depression?
Disruption to sleep and eating behaviour (insomnia or hypersomnia, weight loss or gain)
Aggression and self harm (verbally/physically aggressive, suicidal thoughts)
Activity levels (withdrawal from work, education, social life)
What are emotional characteristics of depression?
Anger
Lowered mood (hopelessness, worthlessness)
Lowered self-esteem (sense of self-loathing)
What are cognitive characteristics of depression?
Focussing on the negative (bias towards recalling unhappy events rather than happy ones)
Poor concentration (hard to make decisions)
Absolutist thinking
What are the cognitive explanations of depression?
Beck’s negative triad
Elllis’ ABC model
What did Beck believe about depression?
Depressed individuals thinklike they do as their thinking is biased towards negative interpretations of themsleves, the world and the future
Negative info processing occurs automatically in dperessed people due to a negative self schema
What is Beck’s negative triad?
Negative views about world
Negative view about oneself
Negative views about future
What did Beck say about the ‘self-schema’?
Developed in childhood
Become negative if child experiences negative things –> e.g. criticism from parents and peers
Will expect to fail, feel responsible for misfortune, undervalue themselves due to schema
What are some of the common cognitive bias experienced by depressed people?
All or none thinking (classify into one of two extreme categories)
Arbitary inferences (negative conclusions without evidence)
Overgeneralisation (incorrect conclusion from little evidence)
Catastrophising (normal event seen as disaster)
Selective abstraction (person only pays attention to certain feautres of event and ignores other features)
Excessive responsibility
What did Ellis suggest about depression?
Good mental health is result of rational thinking
So poor mental health is result of irrational thoughts
What did Ellis define irrational thoughts as?
Any thoughts that interfere with us being happy and free of pain
What did Ellis use his ABC model for?
To explain how irrational thoughts affect our behaviour and emotional state
What does the A, B and C stand for?
A= Activating event
B= Beliefs
C= Consequences
What does activating event mean?
When irrational thoughts are triggered by external events
We get depressed when we experience negative events and these trigger irrational beliefs
What does beliefs mean?
Range of irrational beliefs
E.g. mustaboatory thinking is centred on unacheivable assumptions, must be true for individual to be happy
What does consequences mean?
When an activating event triggers irrational beliefs there will be emotional and behavioural consequences
What is the cognitive treatment of depression?
CBT
What is CBT?
Umbrella term for number of different therapies
Central idea = to challenge and restructure maladaptive ways of thinking into adaptive, rational ones
What is the aim of CBT?
Aims to challenge and replace irrational and dysfunctional thoughts with rational ones
What are the general steps of CBT?
Therapist to build a strong, trusting relationship with patient so that they feel comfortable in therapy
Identify goals with patient, make plan to achieve them
Some use techniques from Beck’s cognitive therapy or from Ellis’s rational emotive behaviour therapy
What is Beck’s CBT technique for challenging irrational thoughts?
Reality testing
Identify automatic thoughts about world, self and future (negative triad)
Challenge thoughts by helping patient to test reality of negative beliefs
E.g. set homework, ‘patient as scientist’
What is Ellis’ CBT technique for challenging irrational thoughts?
Rational emotive behaviour therapy (REBT)
Extends the ABC model to ABCDE model
What does the D and E stand for in ABCDE model?
D = dispute
E = effect
What is central technique of REBT?
To identify and dispute irrational thoughts
e.g. empirical argument (disputing whether there is evidence to support negative beliefs) or logical argument (disputing whether negative thought logically follows from facts)W
What does the A mean in Ellis’ REBT technique?
A= activating event, therapist engages with patient in identifying sources of depression for individual
What does the B mean in Ellis’ REBT technique?
B= beliefs, patient and therapist work through irrational thoughts and therapist identifies them
What does the C mean in Ellis’ REBT technique?
C= consequence, patients record negative behaviours/consequences that follow beliefs
What does the D mean in Ellis’ REBT technique?
D= dispute, vigorous argument by therapist, aims to show irrationality of beliefs, logical or empirical argument
What does the E mean in Ellis’ REBT technique?
E= effect, restructure belief into a rational one to create effect of lowered depression levels
What does OCD stand for?
Obsessive Complusive Disorder
Most people with OCD have obsessions and compulsions
What are obsessions?
Reoccurring and persistent
Always unpleasant but vary from person to person
What are compulsions?
Repetitive behaviours e.g. hand washing, counting, tidying up
Normally performed in attempt to manage anxiety produced by obsessions
What is trichotillomania?
Compulsive hair pulling
What is excoriation disorder?
Compulsive skin picking
What are behavioural characteristics of OCD?
Compulsions
Avoidance
What are emotional characteristics of OCD?
Guilt and disgust
Accompanying depression
Anxiety and distress
What is guilt and disgust?
Irrational guilt or disgust which may be directed against something external e.g. minor moral issues, dirt or self
What is accompanying depression?
Mood and lack of enjoyment in activities
What are cognitive characteristics of OCD?
Obsessive thoughts
Cognitive strategies to deal with obsessions
Insight into excessive anxiety
What are cognitive stategies to deal with obsessions?
E.g. praying, meditating, motivational self-talk
Help manage anxiety
Make person appear abnormal, distract them from everyday tasks
What is insight into excessive anxiety?
Sufferers of OCD are aware their obsessions and compulsions are not rational but they still experience catastrophic thoughts about worst case scenario
Hypervigilant, keep attention focused on potential hazards
What are the biological explanations of OCD?
Role of serotonin
Decision making systems
Genetic explanation
What is a nerotransmitter?
Responsible for relaying information from one neuron to another
What are main neurotransmitters associated with OCD?
Serotonin
Dopamine
What is the role of serotonin?
To help regulate mood
What happens if someone has low levels of serotonin?
Normal transmission of mood relevant information does not take place so mood and other mental processes can be affetced
How are low levels of serotonin related to OCD?
As some antidepressants that increase serotonin levels are effective in reducing OCD symptoms
Suggests serotonin system is involved in OCD
How is OCD related to the decision making systems?
Abnormal functioning of the frontal lobe of brain
What is the frontal lobe?
Front part of brain, responsible for logical thinking and decision making
What is the orbitofrontal cortex?
Region which converts sensory information into thoughts and actions
What have PET scans found about activity in brains of OCD patients?
Higher activity in orbitofrontal cortext in patients with OCD
Suggestion that the heightened activity in this area increases need to respond to sensory information and prevents patients from stopping the behaviours
Results in compulsions
What is genetic explanation for OCD?
If neurotransmitters such as serotonin are faulty in OCD sufferers then this could be result of mutated genes
Explanation focuses on trying to find specific candidate genes which are implicated in OCD
How many genes are believed to be involved in OCD?
Up to 230
Polygenic condition
What are candidate genes?
Genes which create vulnerability for OCD
What could the different candidate genes be involved in?
Regulating development of serotonin system
Action of dopamine
What is the SERT (5-HTT) gene?
Affects transport of serotonin, creating lower levels of serotonin
Mutation of this gene can result in OCD
What is the COMT gene?
Regulates dopamine
Variation which leads to higher levels of dopamine is more common in those with OCD
What is the biological treatment of OCD?
Drug therapy
What is drug therapy?
Reduces/controls symptoms to allow for some degree of functioning
Not a cure
How does drug therapy work with OCD?
Drugs work in various ways to increase level of serotonin in brain
What are agonists?
Drugs that increase the effect of neurotransmitters
What is the standard medical treatment used to tackle OCD symptoms?
SSRIs
What does SSRI stand for?
Selective serotonin reuptake inhibitor
What do SSRIs do and how do they work?
Work on the serotonin system in the brain to increase the amount of serotonin being communicated
Prevent re-uptake of serotonin by blocking re-uptake channels
Allows receptor sites to absorb more serotonin so it stays in synapse for longer
What are alternatives to SSRIs?
Anti-anxiety drugs
Trycyclics
Why are anti-anxiety drugs used for OCD?
To reduce anxiety or stress which may arise with sufferers obsessive thoughts which can cause high levels of anxiety
What is an example of an anti-anxiety drug?
Benzodiazepines (Bz)
How do Bzs work?
Increase levels of GABA which is the body’s natural form of stress relief
Makes person feel relaxed by slowing down other nerve activity
What are trycyclics?
Older type of anti-depressant
How do trycyclics work?
Block channel which reabsorbs serotonin and noradrenaline once it is fired
More of these neurotransmitters left in synapse so activity is prolonged
Why should trycyclics be used carefully?
More severe side effects than SSRIs
Generally kept for patients who do not respond to SSRIs
