What is 'abnormality'? Flashcards
What is the demonic model?
A belief that mental illness was due to demonic possession. Prevalent in the Middle Ages, but remnants still exist.
What is the medical model?
Is when mental illness started to be treatable but very poorly. It was seen as a physical ailment that could be cured, leading to hospitalisation of individuals in asylums.
What is institutionalisation?
poor treatment efficacy and conditions
What is deinstitutionalisation?
More effective treatment allowed some a ‘more’ normal lives but high levels of homelessness and poverty. But we are still trying to find the right way to provide support.
Define Mental Health.
capacity of an individual to behave in a way that promotes their emotional and social wellbeing.
Define mental health problems.
wide range of emotional and behavioural abnormalities that affect people throughout their lives. May be consistent or intermittent.
Define mental disorder.
a clinically recognisable set of symptoms and behaviours that cause distress to the individual and impair their ability to function as usual.
What are the two models which help explain a number of disorders?
Biopsychosocial Model
Diathesis Model.
Explain Biopsychosocial Model.
Mental health and related disorders are influenced by a number of factors that interlink:
Biological - genetics, hormone and neurotransmitter imbalances
Psych- cognitive biases, coping skills, maladaptive thought patterns.
Social- social support, experience, trauma or stress.
If issues arise in 3 areas, there is potential risk for developing a disorder.
Explain Diathesis Stress Model.
Disorders are triggered when people with pre-existing vulnerabilities experience some sort of acute or chronic stressor.
The greater the Diathesis, the less stresses needed to trigger an event.
Diathesis- individuals possess some sort of internal factor which predisposes them to mental illness.
Stress- an environmental cue which triggers mental illness.
WHAT IS ABNORMAL
Explain statistical infrequency.
an indicator of abnormality; the behaviour/disorder in question is statistically rare in the population.
Limitation: not all rare behaviours are psychological disorders, and not all psychological disorders are rare.
WHAT IS ABNORMAL
Explain personal distress.
An indicator of abnormality;The person is experiencing relatively high levels of personal distress.
Limitation: not all distressed people are demonstrating abnormal behaviour (e.g. grief)
WHAT IS ABNORMAL
Explain impairment.
An indicator of abnormality; there is a reduced capacity to perform everyday functions.
Limitation: other non-psychological disorders, and general personality traits (e.g. laziness) can cause impairment. Can not just use this as a measure of abnormality.
WHAT IS ABNORMAL
Explain violation of norms.
An indicator of abnormality. The person is displaying behaviour that is not socially appropriate.
Limitations: not all socially inappropriate behaviour is reflective of mental illness. Can be used as social control (political dissidents in Russia) or foster prejudice (e.g. homosexuality used to be classified in the DSM. People such as protestors may just want to change norms. Disorder is dependant on normalities of society.
WHAT IS ABNORMAL
Explain biological dysfunction.
An indicator of abnormality. There is empirical evidence of neurological impairment.
Limitation: some psychological disorders (e.g. specific phobias) are learnt.
DIAGNOSTIC ISSUES
Social Context.
Labelling behaviour as psychopathological when socially inconvenient.
e.g. ‘drapetomania’ = repeated attempts to escape by slaves; with the treatment being whipping and amputation of toes.
DIAGNOSTIC ISSUES
Labelling vs. Diagnosing.
Creation of terms that allegedly describe a disorder, but have no or limited empirical support, and provide no explanation of cause of ‘disorder’.
e.g. compulsive shopping disorder.
DIAGNOSTIC ISSUES
Cultural Differences.
Some disorders are specific to certain cultures. They may also look or be described differently in different cultures.
Windigo = In Native American’s, a morbid fear of becoming a cannibal.
Bullimia Nervosa= Binging and purging to maintain weight. In cultures exposed to western media vs. Anorexia Nervosa which occurs throughout the world.
But most of disorders are universal.
DIAGNOSTIC ISSUES
What are the common misconceptions?
- Diagnosis reduces the individual to their disorder.
- Diagnoses are too unreliable to be useful.
- Diagnosis is only descriptive and therefore meaningless.
- Diagnoses stigmatise people; this doesn’t mean we shouldn’t diagnose, it means we should talk more.
DSM
What is the DSM?
It is the Diagnostic and Statistic Manual which contains the clinical diagnoses of mental disorders based on criteria which is consistent across countries.
Currently in its 5th edition.
DSM
What are its strengths?
- A-theoretical; doesn’t explain, just talks about how they tend to present.
- Provides strict criteria for classification.
- Biopsychosocial approach; considers other biological, physiological and social factors.
- Allows international consensus.
DSM
What are its weaknesses?
- The validity of some disorders are questionable.
- Comorbidity-does this mean there is really one underlying disorder? e.g. depression/anxiety.
- Categorical vs. dimensional model.
DEPRESSIVE DISORDERS
What are depressive disorders?
Characterised by disturbances to mood and emotion.
Mood: a general feeling, typically not directed at anything.
Emotion: a state of arousal that is typically directed at a person/object/experience
DEPRESSIVE DISORDERS
Explain the differences between depression and mania.
Depression is a negative, lowered mood state, whereas mania is an intense, but unwarranted, mood state of elation. They are on two opposite ends of the spectrum.
DEPRESSIVE DISORDERS
List some symptoms of depression.
- Sad, depressed mood, most of the day, nearly every day.
- Difficulties in sleeping (insomnia or hypersomnia)
- Poor appetite and weight loss or increased appetite and weight gain.
- Complaining or evidence of difficulty in concentrating.
- Recurrent thought of death or suicide.
DEPRESSIVE DISORDERS
Describe Major Depressive Disorder (MDD)
Requires the presence of 5 or more of the symptoms of depression for a period of at least 2 weeks.
Tends to recur 80% of those who experience a single episode will have another in a year.
DEPRESSIVE DISORDERS
Describe Dysthymic Disorder.
Less severe, but more chronic form of depression. Requiring the presence of the depressed mood for a period of at least 2 years.
Tends to start in adolescence and average a duration of 5 years but can persist as long as 20 years.
THEORIES OF CAUSES OF DEPRESSION
Life Events/Environmental Factors.
Psychosocial stressors in the environment of children and adults are associated with the development of depressive symptoms.
Risk Factors:
- death of family member.
- loss of employment.
- lack of intimate relationship.
- disruptive, hostile and negative home environment.
THEORIES OF CAUSES OF DEPRESSION
Explain the Interpersonal Model
Behaviours associated with depression lead to increased social isolation and increased depression (Coyne, 1976).
THEORIES OF CAUSES OF DEPRESSION
Explain the behavioural model.
Lack of reinforcement when engaging in social/pleasurable activities leads to withdrawal, thus reducing likelihood of reward even more.
This model suggests depression can be reduced simply by re-engaging in social/pleasurable activities (Lewinsohn)
THEORIES OF CAUSES OF DEPRESSION
Explain the Cognitive Model: Beck’s Theory of Depression.
Cognitive triad, leads to negative schemata or beliefs triggered by negative life events, leading to cognitive biases, which leads to depression.
It is the certain belief on selves, the world and the future.
THEORIES OF CAUSES OF DEPRESSION
Explain Seligman’s Theory of Learned Helplessness.
Bad things that occurred that were unavoidable led to a sense of helplessness which may lead to depression.
THEORIES OF CAUSES OF DEPRESSION
What are the biological causes?
Genetic causes are suggested
People who have copies of a stress-sensitive gene are more vulnerable to developing depression following a stressful event (Caspi et al., 2003)
Reduction/Imbalance of neurotransmitters such as serotonin, dopamine and noradrenaline.
SUICIDE
What is it?
It is a response to extreme stress which is strongly associated with Depressive and Bipolar disorders.
It accounts for 1.4% of deaths in Australia.
SUICIDE
What are the risk factors?
- Depression
- Hopelessness
- Substance Abuse
- Schizophrenia
- Chronic, painful or disfiguring illness.
- Recent loss of loved one, through divorce, death etc.
SUICIDE
What are common myths?
- Suicide is almost always completed with no warning.
- As severe depression lifts, people’s suicide risk decreases.
- Most peopler who threaten suicide are seeking attention.
- People who talk about suicide a lot, almost never commit it.
- Talking to depressed people about suicide makes them more likely to commit the act.
ANXIETY DISORDERS
What is anxiety?
A negative mood state characterised by bodily symptoms of physical tension and by apprehension about the future.
ANXIETY DISORDERS
How is anxiety different to fear?
Anxiety is the apprehension about future problems where is fear is the immediate reaction.
ANXIETY DISORDERS
What is the fight or flight response?
It is an inbuilt system associated with anxiety disorders that prepares us to fight off danger or fun away from it.
When these responses become maladaptive, we need to consider if there is an anxiety disorder.
ANXIETY DISORDERS
Explain panic attacks.
It is a symptom which peaks within 10 minutes and involves at least 4 of some of these symptoms.
e.g. sweating, trembling, dizziness, fear of imminent death, hot/cold flashes, derealisation, shortness of breath (to name a few)
Having a single (or repeated) panic attack does not mean you have a panic disorder.
ANXIETY DISORDERS
What is panic disorder?
Characterised by unexpected and repeated panic attacks.
ANXIETY DISORDERS
What is Generalised Anxiety Disorder (GAD)?
Chronic, excessive anxiety that occurs for at least 6 months for more days than not.
Characterised by at least 3 of the following behaviours:
1. being easily fatigued
2. irritability
3. muscle tension
4. sleep disturbance
5. difficulty concentrating or mind going blank.
6. restlessness.
ANXIETY DISORDERS
Phobias: Explain Agoraphobia.
Fear of being in places where escape might be difficult or in which help might not be available in the event of having unexpected panic-like symptoms.
ANXIETY DISORDERS
Phobias: Explain Social Phobia.
A fear of one or more social or performance situation in which the person is exposed to unfamiliar people or to possible scrutiny by others, and feels they will act in an embarrassing manner.
ANXIETY DISORDERS
Phobias: Explain Specific Phobia.
Chronic excessive fear that is cued by the presence or anticipation of a specific object or situation. There are 4 main types:
- Animal (spiders, snakes, dogs)
- Situational (flying, bridges, elevators)
- Natural Environment (storms, heights)
- Blood Injection Injury (injections, seeing blood)
ANXIETY DISORDERS
Phobias
Anything can become an object of a specific phobia.
Exposure provokes immediate anxiety, which can take the form of a panic attack and patients can recognise the fear is excessive or unreasonable.
THEORIES OF ANXIETY
Classical Conditioning.
“A process where a previously neutral stimulus elicits a response after being paired with a stimulus that automatically elicits a response”
When paired, it becomes a trigger which can explain why phobias develop.
THEORIES OF ANXIETY
Operant Conditioning
Any event or consequence that occurs which increases the likelihood of behaviour occurring again.
Can be reinforcement or punishment. Reinforcement increases, punishment decreases the likelihood.
THEORIES OF ANXIETY
Explain cognitive processes.
Interpretation of information and/or physiological arousal as threatening.
Coping strategies and personality type.
Appear important in most anxiety disorders as they may influence how stress responses occur.
THEORIES OF ANXIETY
Explain environmental factors.
Stressful life events are associated with development of anxiety disorders such as Panic Disorder and PTSD.
THEORIES OF ANXIETY
Explain Genetic Factors.
Different gene types can influence biology/physiology of the brain, e.g. increase brain reactivity to perceived threats.
Appears importance in OCD, GAD and some phobias.
SCHIZOPHRENIA
What is Schizophrenia?
Umbrella term for a number of disorders involving some loss of contact with reality typically including delusions and hallucinations.
Schizophrenia represents disruptions between perceptions, thoughts feelings and behaviours.
SCHIZOPHRENIA
What is Psychosis?
A general term for loss of contact with reality. Not everyone who experiences psychosis has schizophrenia
SCHIZOPHRENIA
What are hallucination symptoms?
Perceptions in the absence of sensory stimulation:
Auditory: voices commenting and conversing
Somatic
Olfacotry
Visual
Isn’t imagining a persons voice or hearing thoughts, it is more like hearing actual voices.
SCHIZOPHRENIA
What are delusional symptoms?
Strange beliefs that are maintained despite the evidence to the contrary, e.g.:
Religious, somatic, delusions of mind reading, delusions of being controlled, thought broadcasting, though withdrawal.
It is a distortion in though patterns.
SCHIZOPHRENIA
What are thought disorder symptoms?
Tendency of thought to move along associative lines rather than being controlled logical or purposeful e.g.
- Derailment: ideas slip off track onto obliquely related ideas
- Circumstantiality: speech stays on track but very delayed in reaching goal.
- Distractible Speech: speech changed mid sentence in response to a stimulus.
SCHIZOPHRENIA
What are negative symptoms?
Symptoms that reflect a reduction or disappearance of abilities, emotions or drives that are usually present e.g.:
- Blunting - unchanging expression.
- Alogia- poverty of speech, very slow to respond.
- Avolition- poor hygiene, low motivation.
SCHIZOPHRENIA
What is the source of Schizophrenia?
Typically begins in early adulthood. The lifetime course varies greatly, some have a few episodes and then recover, for others it occurs the entire adult life.
THEORIES OF DEVELOPMENT OF SCHIZOPHRENIA
Genetics
The lifetime risk of developing schizophrenia is largely a function of how closely an individual is genetically related to a person with schizophrenia.
THEORIES OF DEVELOPMENT OF SCHIZOPHRENIA
Explain the Dopamine Hypothesis.
Dopamine appears to influence thought, motivation and behaviour.
It seems to be impacted in schizophrenia, as it may be caused by too much dopamine.
THEORIES OF DEVELOPMENT OF SCHIZOPHRENIA
Explain the Diathesis Stress Model.
Suggests people with underlying biological vulnerability may develop schizophrenia either directly or as a result of experiencing additional stressors.
BIPOLAR DISORDERS
What is Bipolar disorder?
It was previously called manic depressive disorder, being characterised by the presence of a manic episode and an episode of depression (extreme elation and extreme negative mood).
It is equally common in men and women.
BIPOLAR DISORDERS
What is the DSM-5 criteria for a manic episode?
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal directed activity or energy lasting at least 1 week and present most of the day nearly every day.
BIPOLAR DISORDERS
What is a Hypomanic episode?
Less severe than a manic episode, lasting at least 4 consecutive days and is present most of the day, nearly every day.
BIPOLAR DISORDERS
What behaviours are present in a manic episode?
At least 3 of the following:
- inflated self esteem or grandiosity
- decreased need for sleep
- more talkative than usual
- flight of ideas or subjective experience that thoughts are racing
- distractibility
- increase in goal directed behaviour
- excessive involvement in activities that have a high potential for painful consequences.
BIPOLAR DISORDERS
What is Bipolar I disorder?
a manic-depressive disorder that can exist both with or without psychotic episodes.
BIPOLAR DISORDERS
What is Bipolar II disorder?
is less sever than Bipolar I, consisting of depressive hypomanic episodes which alternate and are typically less severe and do not inhibit function.
BIPOLAR DISORDERS
What is Cyclothymic Disorder?
a cyclic disorder that causes brief episodes of hypomania and depression and is chronic (lasting at least 2 year)
PERSONALITY DISORDERS
What are personality disorders?
Normal vs. disordered variations in personality. There are difficulties in defining disordered personality traits, meaning low reliability in diagnosis.
PERSONALITY DISORDERS
When should they be diagnosed?
- Traits appear by adolescence.
- Traits are inflexible, stable and expressed in a wide variety of situations.
- Traits lead to distress or impairment for individual/others.
- Rarely diagnosed before age 18.
PERSONALITY DISORDERS
What are the 3 clusters?
Cluster A = odd eccentric cluster with the most common disorder being paranoid personality disorder.
Cluster B = dramatic, emotional and erratic cluster with the most common disorder being borderline personality disorder.
Cluster C = anxious and fearful cluster. Most common disorder is dependent personality disorder.
PERSONALITY DISORDERS
What are the current issues?
High levels of comorbidity - often a high level of 2 or more PDs.
Frequency of unspecified diagnosis - person doesn’t meet sufficient number of criteria for one PD
PERSONALITY DISORDERS
Describe Paranoid Personality Disorder (Cluster A).
It is the pervasive distrust and suspiciousness of other. Assuming others’ intentions are malevolent. Requires 4 of the criteria.
PERSONALITY DISORDERS
Describe Borderline Personality Disorder (Cluster B).
Long term instability of relationships, self image and mood, requiring at least 5 of the listed criteria.
It has a high comorbidity with mood disorders, ED and substance disorders. Often associated with childhood abuse and/or trauma.
PERSONALITY DISORDERS
Describe Antisocial Personality Disorder (Cluster B).
Long term disregard for, and the violation of, the rights of others with at least 3 of the listed criteria. It is most common in males.It is similar to psychopathic/sociopathic but not identical.
PERSONALITY DISORDERS
Describe Dependent Personality Disorder (Cluster C).
Constant and extreme need to be taken care of, that leads to submissive/clingy behaviour and fear of separation, requiring at least 5 of the listed criteria.
It is the most frequently reported PD.
DISSOCIATIVE DISORDERS
What do they involve?
Disruptions in consciousness, memory, identity and perception which can disrupt awareness of self and/or sense of self.
DISSOCIATIVE DISORDERS
What is derealisation?
The feeling of your surroundings are not real, or that familiar places are new/unknown.
DISSOCIATIVE DISORDERS
What is depersonalisation?
The feeling that you are not real, living in a dream or movie, or are watching yourself from the outside
DISSOCIATIVE DISORDERS
What is Depersonalisation Disorder?
Recurrent experience of derealisation and/or depersonalisation, often associated with panic attacks.
May feel detached from self, emotions, thoughts or specific parts of the body.
May feel robotic or as if lacking control.
May be impairment to sensation or sense of time
DISSOCIATIVE DISORDERS
What is Dissociative Amnesia?
The forgetting of personal information, particularly surrounding a stressful event.
There are some criticisms as we have gaps in memory normally, and the debate of intentional forgetting vs. amnesia.
DISSOCIATIVE DISORDERS
What is Dissociative Identity Disorder (DID)?
Experiencing two or more discrete identity/personality states, which alternate in control of behaviour.
Typically there is a primary ‘host’ personality and one or more alters.
DISSOCIATIVE DISORDERS
DID Causes: Posttraumatic Model
Suggests that early trauma such as abuse lead the person to develop multiple personalities to cope with stress.
e.g. mistreatment happened to someone else.
DISSOCIATIVE DISORDERS
DID Causes: Sociocognitive Model
Questions the validity of having numerous personalities, suggests DID develops as a result of psychotherapeutic techniques due to:
- therapy often reinforces the idea that there are multiple personalities
- Most DID cases show few, if any signs prior to therapy.
- A small number of therapists are responsible for the majority of diagnoses.
DISSOCIATIVE DISORDERS
What are the controversies of DID?
In 1970 there were only 79 cases, after a best selling movie was released that number had jumped to 6000+ by 1986 with the number now being at tens of thousands.
NOTE social impact does not equal faking
POST TRAUMATIC STRESS DISORDER
How many factors does it require?
5
- Person was exposed to death, threatened death, actual or serious injury or sexual violence
- Persistent re-experiencing of the traumatic event.
- There is persistent avoidance of the stimuli associated with the traumatic event and a numbering of general responsiveness.
- Negative alterations to cognition or mood.
- Persistent symptoms of heightened arousal.
POST TRAUMATIC STRESS DISORDER
Describe PTSD.
Usually symptoms begin within 3 months of the trauma, but longer delays have been reported.
7.8% of people have experienced PTSD at some point, but 60-70% of people experience trauma so most people do not develop PTSD after trauma.
OBSESSIVE COMPULSIVE DISORDER
Describe OCD.
Is a disorder in which the mind is flooded with persistent and uncontrollable thoughts or the individual is compelled to repeat certain acts again and again causing significant distress and interference with everyday functioning.
OBSESSIVE COMPULSIVE DISORDER
What are obsessions?
Persistent, intrusive ideas, impulses or images that are unwanted and inappropriate, and that cause distress.
OBSESSIVE COMPULSIVE DISORDER
What are compulsions?
Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation.
OBSESSIVE COMPULSIVE DISORDER
What are the common types?
Cleaning and contamination
Forbidden thoughts or actions
Symmetry.
AUSTISM SPECTRUM DISORDER
What is a neurodevelopmental disorder?
A class of disorder that commence during childhood or prenatal development including Intellectual disability, Communication disorders, ASD, Learning disorders and attention deficit disorder.
AUSTISM SPECTRUM DISORDER
What does it require?
1- Persistent deficits in social communication and interaction (difficulty understanding and forming relationships, difficulty expressing and interpreting non-verbal behaviour).
2-Restricted repetitive behaviours, interests or activities (insistence on sameness, inflexibility, ritualised behaviour; narrow, fixated interests; extreme or limited sensitivity to environmental stimuli).
ALZHEIMERS DISEASE
What is a neurocognitive disorder?
A class of disorders in which the predominant symptom is cognitive impairment (deficits in memory, learning, thought).
ALZHEIMERS DISEASE
What is the difference between Dementia and Alzheimers?
Dementia is an umbrella term that covers a range of disorders in which there is a steady, usually irreversible pattern of cognitive decline. So Alzheimers is a common type of dementia.
ALZHEIMERS DISEASE
What is Alzheimer’s?
A degenerative brain disorder that involves progressive cognitive decline.
It is the most commonly diagnosed form of dementia but can technically only be confirmed post-mortem.
The average lifespan after diagnosis is 10 years.
ALZHEIMERS DISEASE
What is the difference between probable and possible Alzheimers?
Probable is when there is family history and there is significant cognitive decline.
Possible is when there is no family history but there is a steady cognitive decline which cannot be explained by other medical history.
ALZHEIMERS DISEASE
What are neurofibrillary tangles?
threads of protein that occur within a neutron that damage the brain cell.
ALZHEIMERS DISEASE
What are senile plaques?
Deposits caused by debris from degenerating neutrons and build-up of protein outside the cell.
ALZHEIMERS DISEASE
What is the neuroanatomical progression?
Usually commences in specific brain regions and then spreads in a predictable pattern (parts associated with memory and language)
ALZHEIMERS DISEASE
What is the cognitive progression?
Often starts with general confusion and irritability, speech deficits.
As it progresses memory impairments become increasingly noticeable.
Memory loss follows a pattern of structural deterioration.
Occurs in episodic, semantic and procedural memory.
Recent memories are the first to be lost and there’s a chronological progression backwards.
ALZHEIMERS DISEASE
What are the other types of progression?
Mood:
Depression seen in early stages and can become combative and argumentative.
Language impairment
Restlessness/Motor agitation
Motor Impairment:
Difficulty walking
Psychosis
Local social inhibitions.
ALZHEIMERS DISEASE
What are the causes?
Genetic factors:
Strong evidence that a number of genes influence likelihood of developing AD
Medical History:
Previous experience of traumatic brain injury increases risk of developing AD.
CULTURAL DIFFERENCES
What are the differences in the experience of symptoms?
Most research originates from western cultures (WEIRD) samples; which can restrict understanding of the way disorders may present and the way we treat disorders.
e.g. Depression:
Nigeria is more physiological (heaviness or heat in the head).
US is more a sense of worthlessness or loss of motivation
CULTURAL DIFFERENCES
What is the Cultural Formulation Interview?
There are 16 questions that cover 4 domains of assessment:
1- Cultural definition of the problem
e.g. how they would describe the problem to others in their community.
2- Cultural perceptions of Cause context and support
e.g. beliefs around what they believe cause the problem.
3-Cultural Factors affecting self-coping and past help seeking
e.g. may cope in different ways based on what is acceptable and appropriate.
4- Cultural factors affecting current help seeking.
e.g. where if and how they are likely to seek help (herb, medication, therapy, religion etc.)
