The Bio-medical Model and Psychopathology

Question 1

What is descriptive psychopathology?

Answer 1

An objective description of abnormal states avoiding preconceived ideas or theories, ltd to the description of conscious experienced and observable behavior.

Question 2

What is experimental psychopathology?

Answer 2

Seeks to explain and describe abnormal mental phenomena, focused on empirically measurable and verifiable conscious psychological processes using experimental methods such as cognitive & behavioural psychology and FMRI.

Question 3

What are the basic assumptions of the bio-medical model?

Answer 3

“The biomedical model assumes that mental disorders …are biologically-based brain diseases. Core tenets of this approach include: (a) mental disorders are caused by biological abnormalities principally located in the brain, (b) there is no meaningful distinction between mental diseases and physical diseases,…”

Question 4

What are the basic assumptions of the bio-medical model for psychological disorders affecting the nervous system?

Answer 4

Psychological disorders are illnesses/diseases affecting the nervous system:

• Abnormal behaviour, thinking and emotion are caused by biological dysfunctions
• Understanding mental illness involves understanding what went wrong with the brain

Question 5

What are the basic assumptions of the bio-medical model for causes of abnormal behaviour?

Answer 5

Possible causes of abnormal behaviour:

• Biochemistry – an imbalance of certain neurotransmitters or hormones might cause parts of the brain to malfunction
• Structural damage or abnormality – if the structure of the brain is damaged or improperly formed then thinking, emotion and behaviour may change

Question 6

What are the basic assumptions of the bio-medical model for factors that may affect the functioning of the nervious system?

Answer 6

Factors that may affect nervous system functioning:

• Genetics – inherited developmental abnormality
• Toxicity – chemical poisoning from e.g. drugs or environmental toxins
• Infection/disease – causing chemical or structural damage to the brain
• Stress – causing abnormal hormonal effects in the long term

Question 7

What is the Diathesis-Stress Model?

Answer 7

The diathesis–stress model is a psychological theory that attempts to explain a disorder, or it trajectory, as the result of an interaction between a predisposition vulnerability and stress caused by life experiences.

Diathesis = a tendency to suffer from a particular medical condition

Question 8

What is the strategy used for the Nomothetic approach?

Answer 8

Focus on similarities and differences between groups of individuals.

Question 9

What is the aim of the nomothetic approach?

Answer 9

To identify a basic structure or category to be able to describe personality or a disorder universally?

Question 10

What research methods are used by the nomothetic approach?

Answer 10

Quantitative methods, to ensure the structures are explored, produce valid measurements/assessments, and to explore the relationship between variables across groups

Question 11

What types of data are used to collect information for the nomothetic approach?

Answer 11

Self-report, questionnaires, physical assessments

Question 12

What is the purpose of the ICD?

Answer 12

The ICD (International Classification of Diseases) is the foundation for the identification of health trends and statistics globally. It is the international standard for defining and reporting diseases and health conditions, thus the counting of deaths as well as diseases, injuries, symptoms, reasons for encounter, factors that influence health status, and external causes of disease. It allows the world to compare and share health information using a common language.

Question 13

Important aspects of the ICD:

• Produce by global health agency of UN
• Statistic of global moraltiy and morbidity
• Free and open resource for public health benefit
• For countries; and front-line service providers
• Global, multidisciplinary, multilingual development
• Approved by World Health Assembly

Answer 13

Important aspects of the DSM:

• Produced by Psychiatric Association
• Focused on mental illness
• Intellectual property of APA
• Primarily for psychiatrists and psychologists
• Dominated by US, Anglophone perspective
• Approved by APA Board of Trustees and APA Assembly.

Question 14

What are the principles of contemporary treatment?

Answer 14

The biomedical model assumes tha tmental disorders… are biologically-based brain diseases. Core tenets of this approach include: (a) mental disorders are caused by biological abnormalities principally located in the brain, (b) there is no meaningful distinction between mental diseases and physical diseases and (c) biological treatment is emphasized.

Question 15

What are biological treatments for mental disorders?

Answer 15

• Psychopharmacotherapy - Drug Therapy/Treatment
• Electroconvulsive Therapy/Treatment
• Psychosurgery - Brain Surgery

Question 16

What is a chemical imbalance?

Answer 16

Chemical imbalance, in psychological terms, refers to variations of the neurotransmitters (serotonin, dopamine, norepinephrine, and epinephrine) of the brain.

Question 17

How can a chemical imbalance bring on a psychological condition?

Answer 17

• Neurotransmitters are responsible for transmitting messages.
• When these levels are at less than “optimum” levels it can cause physical and emotional difficulties such as depression, bipolar disorder, anxiety, and other psychological disorders.

Question 18

How is drug treatment - psychopharmacotherapy implemented in treating mental disorders?

Answer 18

• Chemical imbalance is used as justification for the prescription of neuropharmaceuticals, the drug treatments:
• Anti-depressants
  
  • Depression, Anxiety, OCD, Panic Attacks
• Neuroleptics or Typical Anti-psychotics
• Anti-psychotics
  
  • Use for psychotic presentations: delusions, hallucinations, schizophrenia, bipolar disorder.
• Anxiolytics
  
  • Anxiety

Question 19

What is the history of Antipsychotics?

Answer 19

• Hallucinations, schizophrenia, Bi-polar presentations (France, 1950)
• A new anti-histamine called chlorpromazine was developed and accidentally discovered to have sedative effects when tested on psychiatric patients.
• This started the pharmacological revolution: a few hundred kg/year in 1952 to over one million in 1957
• These drugs began to be marketed by pharmaceutical companies as a treatment addressing the underlying biological disorder.
• Drugs named as neuroleptics (meaning taking hold of one’s nerves) and major tranquillisers, later called antipsychotics.

Question 20

What are anti-psychotic drugs used for?

Answer 20

• Use for psychotic presentations: delusions, hallucinations, schizophrenia and bipolar disorder
  
  • Typical (old):
    
    • Chlorpromazine, Haloperidol, Trifluoperazine & depot injections.
  • A-Typical (new):
    
    • Clozapine, Olanzapin, Risperidone, Quetiapine.

Question 21

What are the side effects for Antipsychotic drugs?

Answer 21

For Typical (old) and A-typical (new):

• sedation
• cognitive imparment
• emotional blunting
• decreased motivation
• induced parkinson’s disease (due to dopamine reduction).
• blurred vision
• drowsiness
• weight gain
• restlessness
• constipation
• loss of libido
• Tardive dyskinesia (involuntary body movement)

Question 22

What steps are involved in Electroconvulsive Therapy/Treatment (ECT)

Answer 22

1. Muscle relaxants and an anaesthetics are administered
2. Electrodes are placed on the person’s head
3. Epileptic seizure are induced via electricity-shocks to the brain
4. Multiple administrations

Question 23

How often is electroconvulsive therapy/treatment (ECT) used?

Answer 23

Department of Health (2003), between January und March 2002: 2272 people (1608 women and 664 men) in the UK.

Question 24

Electroconvulsive Therapy/Treatment (ECT)

Answer 24

Side effects: 
Retrograde Amnesia (short and long term)
Anterograde Amnesia (short and long term)
Depressive symptoms, headaches, sore muscles, fearful (short term)

Question 25

Describe the treatment of psychosurgery?

Answer 25

Involves severing areas of the brain to treat a personality and behaviour disorder, or other mental illness.

Modern psychosurgical techniques target the pathways between the limbic system (the portion of the brain on the inner edge of the cerebral cortex).

That is believed to regulate emotions, and the frontal cortex, where thought processes are seated.

Question 26

Describe the history of Psychosurgery?

Answer 26

Peaked between 1940-1950
Leucotomy or Frontal Lobotomy
Developed by the Portuguese neurologist Egas Moniz, who hypotheses that surgically removing frontal lobe’s white matter fibers would improve a patient’s mental illness.
Walter Freeman (USA) performed about 3600 FLs, often using a cocktail cabinet ice pick inserting through the eye socket

Question 27

How is psychosurgery used in present day health care?

Answer 27

Used Today still, but seldom used
Highly regulated; one request in England and Wales 2009-10

Used for (on?) people who are severely depressed, anxious, with sever obsessive behaviours, manic depression or are bipolar - and where other treatment has failed.

Severs irreversible connection to the prefrontal cortex via micro/surgical techniques

Question 28

Does research define the success of anti-depressants work?

Answer 28

Meta-analysis and systematic review of double-blind RCTs
How effective is the 2nd generation antidepressant (fluoxetine) compared to others and to placebo, when taking it for 8 weeks?

(effective defined as the number of patients with a reduction of depression symptoms of >50%)

How accepted is the drug?

(defined by number of drug treatment drop-out)

Question 29

What were the findings in the efficacy of anti-depressants?

Answer 29

The Lancet Publication, findings:
All 21 antidepressants more likely to work than placebo with varied effectiveness between drugs.

People equally likely to stop taking antidepressants or placebo with variation between different drugs and placebo.

Question 30

What are the limitations/conflicts of interest in studies looking to find out if anti-depressants are useful?

Answer 30

• What does ‘more likely to work’ mean for the person who is sad?
• 78% of studies drug manufactures funded
  Could this influence outcomes?
• Does not allow conclusion about drug vs talking therapy
• Idiosyncrasy of participants not considered
• Could there be a problem with the idea that there is an adequate placebo for an antidepressant?

Question 31

What other models are used apart from the bio-medical model?

Answer 31

Disease-centre model:

• Drugs help correct an abnormal brain state
• Therapeutic effects of drugs derive from their effects on an underlying disease process
• Paradigm: insulin for diabetes

Drug-centred model:

• Drugs create an abnormal brain state
• Therapeutic effects derive from the impact of the drug-induces state on behavioural and emotional problems
• Paradigm: alcohol for social anxiety

Question 32

What research evidence is there for psychosurgery?

Answer 32

Leucotomy or Frontal Lobotomy

• Had no supporting evidence.

Beside grave personality changes, the surgery caused:

• epilepsy in 10–35% of the patient and patients died due to bleedings

Egas Moniz was given the Nobel Prize in 1949 for physiology and medicine for ”his discovery of the therapeutic value of leucotomy in certain psychoses”
Walter Freemen was called the “Man with the golden ice pick”, by TIME magazine.

Question 33

What are the benefits and risk of Electroconvulsive Therapy?

Answer 33

“although ECT has been used since the 1930s, there is still no general accepted theory that explains its mechanics of actions” (NICE, 2003, p.9)

ECT seems to have positive effects during the course of treatment but does not seem to keep away suffering after the course of ECT treatment