Pychopathology Flashcards
What is statistical infrequency?
Abnormality is any behaviours considered unusual or only done by a small sample of people e.g. any one with an IQ lower than 70 would be ‘abnormal’
evaluate statistical infrequency
+ real world application
> It can be used in diagnosing e.g. Intellectual disability disorder (IQ lower than 70) or the Beck depression inventory (score of 30+)
- unusual characteristics can be positive (e.g. very high IQ, very low depression score) but they are not considered abnormal despite being statistically infrequent
± some people benefit from being classed as abnormal, others don’t
what is deviation from social norms?
abnormality is when a person behaves differently to how you would expect them too. This changes culture to culture meaning there are no universal abnormal behaviours e.g. antisocial personality disorder
evaluate deviation from social norms
+ real world application
> Its used in clinical practice e.g. in diagnosing psychopathy (failure to conform to socially acceptable behaviour: recklessness aggression and in some of the Schizophrenia diagnosis)
- Cultural relativism
> social norms vary across cultures so judging deviation from social norms across cultures is difficult.
± leaves a chance for human rights abuse for example with nymphomania (a woman’s uncontrollable sexual desire) BUT it may be necessary for some disorders like antisocial personality disorder
what is failure to function adequately?
abnormality is when you can no longer cope with demands of every day life. Rosenhan and Seligman’s list of signs for when someone’s not coping:
- no longer conforms to interpersonal rules (like eye contact)
- experiences severe personal distress
- becomes irrational or dangerous to themselves or others
Evaluate failure to function adequately
+ represents a sensible threshold for when people need professional help
> 25% of people in the UK will experience a mental health problem in any given year, this gives them a criteria for when they should find help for it
- non-standard, healthy lifestyles may be labelled as abnormal
> for example not having a job or permanent address could be abnormal or just living off the grid
- there are situations where people do just fail to function for a bit. giving them a label that may affect them in the future could be unfair
what is deviation from ideal mental health
abnormality is when your not psychologically healthy according to Jahoda’s list:
- no symptoms of distress
- rational and accurately perceive the self
- self actualise (or strive to)
- can cope with stress
- have a realistic world view
- good self esteem and lack of guilt
- independent of others
- can successfully work, love and enjoy leisure
evaluate deviation from ideal mental health
+ criteria is highly comprehensive
> Jahoda’s list covers a range of criteria including the majority of reasons someone may seek professional help
- culture bound
> some of the criteria is based on USA and European standard of mental health e.g. value of independence in high in Germany, but low in Italy
± Jahoda’s list has very high standards few of us will ever attain BUT it can be helpful for people looking to improve and understand their mental health
what are the DSM-5 categories?
specific phobia: phobia of an object (e.g. animal or body part) or situations (e.g. flying)
social anxiety (social phobia): phobia of social situations (e.g. public speaking, using a public restroom)
Acrophobia: fear of being outside or in public spaces
what are the behavioural characteristics of phobias?
panic: A person may panic in response to a phobic stimuli. they may scream, cry, run away. Children may react by freezing, clinging or having a tantrum
Avoidance: going through effort to stay away from the phobic stimuli
Endurance remaining in the presence of the phobic stimuli e.g. staying in the presence of a spider to keep an eye on it
what are the emotional characteristics of phobias?
Anxiety: Phobias are classed as anxiety disorders. It involves an unpleasant state of high arousal preventing a person from calming down.
Fear: the immediate and extremely unpleasant response we experience when we encounter our phobia. shorter and more intense than anxiety
emotional response is unreasonable: anxiety/fear is more than ‘normal’ and disproportionate to the threat.
what are the cognitive characteristics of phobias?
selective attention to phobic stimulus: If a person can see a phobic stimulus, they cant look away. this gives the best chance of being able to quickly retreat from it but is not rational in this case
irrational belief: may hold unfounded thoughts about the phobic stimuli that are not based in reality
Cognitive distortions: their perception of the phobic stimuli may be inaccurate or unrealistic.
what are the DSM-5 categories of depression?
major depressive disorder: sever but often short term depression.
persistent depressive disorder: long term or reoccurring depression including sustained major depression .
Disruptive mood dysregulation disorder: childhood temper tantrums
premenstrual dysphoric disorder: Disruption to mood prior to/during menstruation
What are the behavioural characteristics of depression?
Activity levels: people typically have reduced energy levels, withdraw from work, education and social life or in some cases a person may struggle to relax, they may pace for example
Disruption to sleep and eating behaviour: a person may experience reduced sleep (insomnia) or increased need for sleep (hypersomnia). similar with appetite. Key point, behaviours are disrupted by depression
Aggression and self harm: people with depression may be irritable, verbally or physically aggressive. This aggression could also be turned on themselves
what are the emotional characteristics of depression?
Lowered mood: More pronounced than the day to day kind. Depressed people may think of themselves as ‘worthless’ and ‘empty’
Anger: they may experience extreme anger at themselves or others. this can lead to aggressive or self harming behaviours
Lowered self esteem: people with depression have lowered self esteem. this can be quite severe
What are the cognitive characteristics of depression?
Poor concentration: They may find themselves unable to stick to one task or make decisions that used to be straightforward.
Attending to and dwelling on the negative: glass halve empty, bias towards recalling unhappy memories (opposite is true for no depression)
Absolutist thinking: think in black and white. situations are either all good or all bad. something unfortunate may be seen as an absolute disaster
what are the DSM-5 categories of OCD?
OCD: characterised by obsessions and/or compulsions, most have both
Trichotillomania: compulsive hair pulling
Hoarding disorder: compulsive gathering of possessions, inability to part with anything regardless of value
Excoriation disorder: compulsive skin picking
what are the behavioural characteristics of OCD?
** Compulsions are repetitive:** feel the need to repeat the behaviour e.g. handwashing, praying, tidying objects etc
compulsions reduce anxiety: about 10% of people with OCD show compulsive behaviour alone, but for most it is done to reduce anxiety, it is a response to an obsessive thought left unsecured
avoidance: attempting to stay away from anxiety inducing situations to try manage their OCD. This can lead to avoiding every day tasks like taking out the bins
what are the emotional characteristics of OCD?
anxiety and distress: anxiety accompanies the obsessions and compulsions. Obsessive thoughts can be frightening and overwhelming
accompanying depression: anxiety can be accompanied with low mood, lack of enjoyment in activities. compulsive behaviours can bring temporary relief from the anxiety
Guilt and disgust: may feel guilt or disgust and minor things like minor moral issues or dirt. disgust can also be directed at the self
What are the cognitive characteristics of OCD?
Obsessive thoughts: Around 90% of people with OCD have obsessive (reoccurring) thoughts. they vary but are always unpleasant
Cognitive coping strategies: people may cope by adopting coping strategies e.g. a religious person may pray. it may help to reduce anxiety but make them seem abnormal to others and distract from every day tasks
Insight to excessive anxiety: people with OCD are often aware there obsessions and compulsions are not rational but feel there anxiety about the consequences of not doing it is justified. they also tend to be hypervidgilant.
what is the two process model?
> geared towards explaining behavioural rather than emotional/cognitive characteristics
Classical conditioning (forms):
- a neutral stimuli is paired with an unconditioned stimuli causing a fear response to create a conditioned stimuli with a conditioned fear response (Watson and Rayner with the ‘little Albert’ experiment)
Operant conditioning (maintains):
- avoiding the phobia is reinforced through the positive consequence of reduced anxiety (and Visa versa)
- Mower: if we escape the stimuli we escape the fear
Evaluate the two process model
+ real world application
> identifies a means of treating phobias (staying in close proximity to them)
- ignores cognitive factors like irrational belief
+ research support
> little albert
> Ad De Jongh et al: 73% of people with a dental phobia had a traumatic experience at the dentists compared to 21% with no dental phobia
CA not all phobias come from bad experiences (snakes, spiders)
what is systematic desensitisation?
> through the principle of classical conditioning
create and anxiety hierarchy of situations related to the phobic stimulus in order of least to most anxiety inducing
learn relaxation techniques for deep relaxation (or valium)
client is exposed to phobic stimulus while in a relaxed state starting at the least on the AH moving on when they can stay relaxed in each situation
Evaluate systematic desensitisation
+ evidence of effectiveness
> Gilroy et al: after 33 months the SD group were more relaxed around the phobic stimuli than a control group
+ Can help people with learning disabilities
> some people with phobias also have learning disabilities. they may struggle with Cognitive therapies and be overwhelmed by flooding
what is flooding?
- one long (often 2-3 hr) session
- No anxiety hierarchy or build up
- The client cannot avoid the phobic stimuli so can quickly learn it is not dangerous
- They may achieve relaxation because of simple exhaustion
INFORMED CONSENT IS A MUST
Evaluate flooding
+ cost effective because its only 1 session
- can be traumatic
> drop out rates are higher than for SD
> informed consent is very important
What is Becks negative triad?
Faulty information processing attending to negative and ignoring positives of a situation
Negative self-schema self- schema is the package of info people have about themselves. people with depression interpret info about themselves negatively
Negative triad negative world view, negative view of the future, negative view of the self
Evaluate beck’s negative Triad
+ research support
> In a review by Beck and Clark, they concluded these were cognitive vulnerabilities more common in depressed people and preceded it
> cohen confirmed in a study tracking development of 473 adolescence, regularly measuring cognitive vulnerability
+ real world application
> Can be used for screening and treatment of depression and identifying people at risk of depression
> applied in CBT altering kinds of cognitions making people more prone to depression
± People do show specific cognition patterns before depression BUT there are bits of depression it doesn’t explain (anger, hallucinations)
what is Ellis’s ABC model?
A activating event
- situation that triggers irrational thoughts
B Beliefs
- He Identified a range of beliefs including:
>’Musterbation’: having to always achieve perfection/succeed
>’I-can’t-do-it-itis’: belief anything not going smoothly is a disaster
>’utopianism’: belief life is always meant to be fair
C Consequences
- behavioural and emotional consequence to A and B. If someone believes they must always succeed and fails it may trigger depression
Evaluate Ellis’s ABC model
+ real world application
> Ellis’s approach to cognitive therapy (rational emotive behaviour therapy or REBT) arguing with depressed person to alter their beliefs
> David et al is research support
- only explains reactive depression not endogenous
> depression isn’t always caused by a definable life event so ABC model is only a partial explanation
± controversial because it puts the depressed person at fault BUT used appropriately REBT can help
How does CBT work?
conative element: begins with an assessment to figure out the clients problems and identify goals and plan how to achieve them. CENTRALLY identify negative or irrational thoughts
Behavioral element: working to change negative/irrational thoughts and put more effective behaviours in place
What is Beck’s cognitive therapy?
- Identify negative triad in the client and challenge them.
also aims to test the reality of their beliefs so they may be set homework e.g record when people were nice to them
what is Ellis’s rational emotive behaviour therapy?
rational emotive behaviour therapy
works by challenging/ disputing irrational thoughts to break the link between negative life events and depression
what is behavioural activation?
as people become depressed, they tend to avoid difficult situations and become Isolated
BA works to decrease avoidance and isolation gradually and increase mood boosting activities
Evaluate the cognitive approach to treating depression
+ supporting evidence
> March et al compared CBT to antidepressant drugs for 327 depressed adolescence. after 36 weeks, 81% of CBT or antidepressants and 86% of both were significantly improved
- unsuitable for diverse range
> may be difficult for depressed people, they may struggle to pay attention/ motivation to go
> unsuitable for people with learning disabilities
CA: Lewis and Lewis concluded CBT and antidepressants were just as effective for severe depression
Taylor et al concluded CBT is good for people with Learning disabilities when used appropriately
- High relapse rates
> ali et al: assessed 439 depressed clients every month for a year after CBT
> 42% relapsed within 6 months and 53% within a year
_ what is the genetic explanation of OCD?_
Genes are involved in a person’s vulnerability to OCD
Lewis: 37% of her OCD patients had parents with OCD and 21% had siblings with OCD
Diathesis stress model: certain genes make someone more likely to get a disorder but environmental factors are also necessary
what are candidate genes?
genes identified to create a vulnerability for OCD
some are involved in development of serotonin system e.g. 5HT1-D beta (transporting serotonin across synapses)
what does polygenic mean (OCD)?
ocd is caused by a combination of genes
taylor found up to 230 genes may be involved and many are associated with the action of dopamine and serotonin, both neurotransmitters (maybe) involved in regulating mood
explain the different types of OCD
Different groups of genes could cause OCD in different people (aetiologically heterogenous)
some evidence suggests different types of OCD is caused by certain genetic variations e.g. hoarding, religious obsession
evaluate the genetic explanations of OCD
+ research support
> Twin studies, Nestadt et al: 68% of identical (verses 31% of non-identical) twins share OCD
> a person with family diagnosed with OCD is 4x more likely to be diagnosed (Marini and Stebnicki)
- Environmental factors
> Cromer et al found over halve of her patients with OCD had traumatic experiences and it was more severe
± Animal studies have proven certain genes are associated with repetitive behaviours
CA: we may not be able to generalise animal studies to humans
What is the neural explanation of OCD?
Genes associated with OCD are likely to effect neurotransmitters as well as brain structure
What is the role of serotonin in OCD?
In some cases, OCD is caused by reduction of function of the seritonin system in the brain
What is the role of decision making in OCD?
In some cases of OCD, it is associated with impaired decision making, in turn associated with abnormal functioning of the side of the frontal lobes
evidence also suggests the area called the Parahippocampal gyrus associated with processing unpleasant emotions works abnormally in people with OCD
Evaluate Neural explanations of OCD
+ research support
> antidepressants working on seritonin reduces OCD symptoms
> Nestadt et al: OCD symptoms form parts of conditions known to be biological in origin
- No unique neural system
> seritonin OCD link may not be unique to OCD. People with OCD may also have clinical depression also likely caused by disruption in seritonin. Seritonin disruption could therefore be because of depression
What are SSRIs (OCD)?
Type of antidepressant
seritonin is released by the presynaptic neuron and travels across the synapse. The neurotransmitter chemically conveys the signal from pre to post synaptic neuron then it is reabsorbed by the presynaptic neuron, broken down and reused.
The SSRI prevents the reabsorbsion so there is more seritonin in the synaptic cleft stimulating the postsynaptic neuron and compensating for whatever is wrong with the seritonin
how are drugs used with CBT (for OCD)
The drugs are used to reduce the emotional symptoms making CBT more effective
In practice some people benefit from both while others benefit from just CBT or SSRIs with other drugs
What are alternatives to SSRIs?
Tricyclics older type of antidepressant
same effects as SSRIs with more side effects so is only for people who don’t react to SSRI’s
SNRIs more recently used for OCD
increase levels of seritonin and other neurotransmitters
last line of defence for if SSRIs
Evaluate the biological approach to treating OCD
+ effective
> Soomro et al reviewed 17 studies comparing SSRIs to placebos and found SSRIs had significantly better out comes every time
CA there is evidence to suggest that drug treatments don’t work for everyone
> Skapinakis et al reviewed studies and found behavioural and cognitive therapies were more effective than SSRIs
+ cost effective, non- disruptive
> drug therapies are generally quite cheap because thousands of tablets can be manufactured at a time
> you don’t have to attend therapy sessions
- side effects
> some people can get indigestion, blurred vision, loss of sex drive from the drugs
> 1/100 people become aggressive and gain heart conditions
