Lecture 11 Flashcards
What side-effects do anti-depressants have?
It can cause sleeplessness, nausea, sexual dysfunction and agitation. Some studies have even found that they reduce affective well-being.
Discuss 4 different causes of distress
Poor social conditions such as poverty, homelessness and overcrowding
Family issues such as parents who are mentally ill or abusive
Psychological problems such as stress or learning disorders
Biological factors such as poor prenatal care, head injuries or chronic physical illness.
There is currently a lot of emphasis on biological factors being behind mental illness, causing people to either seek out biological treatments or have a lack of faith in interventions.
Discuss 4 different perspectives into exploring cause of psychological distress
The psychoanalytical perspective claims that distress is caused from early developmental influences like child neglect.
The cognitive-behavioural perspective explores how thinking affects behaviour.
The phenomenological perspective believes that distress is one’s own responsibility.
The family dynamics view focuses on familial influences.
However it could be a combination of causes. For example, the more vulnerable one feels, the more stressed they feel - the stress-vulnerability model. Many different things could cause one to feel vulnerable.
Discuss the DSM 5 and abnormal behaviour
The DSM 5 has significantly more disorders in it than any other version of the manual. It leads one to question if there are that many disorders around or is it just over-diagnosis.
One is classified as having a mental illness if they have disorder of mind or brain that is either permanent or temporary. It causes an impairment in mental functioning.
Someone is deemed abnormal if they are unhappy or dissatisfied, other people have concerns for them, they have legal problems, they are a danger to themselves or they are unable to carry out basic functions.
Comer suggests that one is abnormal if they have some or all of the 4 Ds; Deviance, Distress, Dysfunction and Dangerous.
Discuss the issues with diagnosing someone with schizophrenia
When people are informed that they are diagnosed with schizophrenia, then their social functioning can deteriorate. For example, people who thought their conversational partner knew of their diagnosis, began failing to communicate effectively. Thus, it leads one to argue that the symptom of a lack of social functioning associated with schizophrenia, might be down to the impact of being labelled rather than the disorder itself. In regards to hearing voices, this is not as abnormal as the label makes them feel. For example, many people have had an imaginary friend or have thought they heard someone call their name in a shop, with the absence of schizophrenia. In contrast of issues with schizophrenia diagnosis, the diagnosis of OCD is very well understood.
Additionally, 2 people can be diagnosed with schizophrenia and not have any of the same symptoms, yet the treatment for both would be the same. The rigidity of diagnosis causes a lack of flexibility in treatment. Furthermore, symptoms associated with schizophrenia can be found in other disorders, thus the disorder may actually comprise of several distinct syndromes.
Discuss the diagnosis of OCD
This is when someone’s concerns become overpowering and take over normal functioning. People try and relieve themselves from these obsessions by performing rituals called compulsions. The mechanism behind this is well understood and thus the diagnosis is clear. It develops from a situation causing certain feelings of apprehension and physical reactions like increased heart rate. This then causes someone to perform a behaviour that results in feelings of relief as they solved the situation that arose. Thus, when the situation arises again, they feel that they must react in the exact same manner as it is the only way to resolve one’s apprehensive feelings.
Discuss the issues with the diagnosis of antisocial personality disorder
One must have at least 3 of the following; failure to conform to social norms, conning others for personal profit, failure to plan ahead, irritability, reckless regard to safety, irresponsibility and a lack of remorse. However, many people can show signs of irritability, conning others and a lack of remorse and thus could be diagnosed as antisocial. Therefore, it leads one to believe that the diagnostic criteria for this disorder can be quite broad and the same issue as the diagnosis of schizophrenia arises. For example, one may believe that common behaviours are in fact abnormal as they associated with a mental illness that is referred to as abnormal. Furthermore, it may lead someone who is diagnosed with APD to feel abnormal as they believe no one else has these behaviours when they actually do.
Discuss the idea of using formulations instead of diagnosis
Discuss the prototype model of diagnosis
Formulations summarise one’s core problems, show how the problems are related in relation to psychological theory, suggest why these problems developed and create a plan of intervention that is open to revision. This attitude is a lot less rigid than diagnosis and does not have the stigma of labeling with it. Furthermore, it does not have to follow specific symptoms that can sometimes result in misdiagnosis and ineffective treatment. Unlike diagnosis, formulations include all social contexts, are culturally sensitive, collaborative, non-stigmatising and has no medical or social consequences.
People should focus on symptoms rather than diagnosis as it would allow one to focus on phenomena that diagnosis can ignore, help theoretical development and recognise that some symptoms are just normal behaviour rather than clustering it with a diagnosis.
The prototype model only sees diagnostic categories as concepts and the categories are not discreet. Symptoms aren’t necessary NOR sufficient to determine membership.
What are the claimed benefits of diagnosis?
It facilitates communication, it allows comparisons among treatment groups to be carried out and it helps research that explores the processes and mechanisms underlying certain disorders. However, this may not be the case.
Discuss problems with diagnosis in general
60% of psychiatrists claimed that someone was severely disturbed after watching a tape of them being interviewed. However, when the introduction was emitted, almost all of the viewers thought he was normal and none of them believed him to be severely disturbed. Furthermore, 75% of doctors claimed that individuals that had overdosed were mentally ill, whereas less than half of mental nurses believed they were mentally ill. Rosenhan sent sane people into mental hospitals and all but one were admitted as having schizophrenia, showing that diagnosis is not always accurate.
Diagnosis suggests that something is wrong with that person or that their brain is diseased. However, some people suggest that symptoms associated with mental illness are actually a break through rather than a break down as that person is using these symptoms to cope with the distress they have experienced.
Labeling can cause maladaptive behaviour to persist, it can cause prejudice to occur and the blanket categories can mask the uniqueness of the problem. Furthermore, diagnosis fails to understand that the same symptoms can arise from different experiences, that it can cause inconsistencies and ambiguities and that a patient’s symptoms may change throughout treatment.
It is hard to know whether a disorder actually exists. For example, homosexuality and internet addiction used to be in the DSM. Also, due to diagnosis, a disease can vary among cultures but they could be the same disease. Furthermore, misdiagnosis can cause someone to take harmful drugs that they do not need.
Diagnosis also excludes all demographic information which may explain a lot of the symptoms.
As a result of the issues with diagnosis, the BPS released a document about the language used in the DSM. The claim that language in relation to functional psychiatric representations should be avoided, biomedical terms used should be changed to psychological equivalents and the problematic nature of diagnostic terminology should be indicated.
Discuss issues with the diagnosis of PTSD
The fact that the DSM and ICD range so drastically for PTSD shows that the same people could receive different help depending on where they live. Thus, it leads one to question which diagnosis is most appropriate if any. The DSM requires someone to experience a stressor and have an emotional reaction to it, whereas the ICD only requires you to experience it. Furthermore, the ICD only requires you to have only symptom of avoidance unlike the DSM which requires you to have at least 3. As a result, PTSD is much more prevalent where the ICD is based.
Discuss Tsuang’s study
They found that with diagnosis, the symptoms of psychosis, such as hallucinations, are tied to the etiology of schizophrenia. However, they then discuss how a substantial amount of research proves that this is not the case, these symptoms are in fact a common end-state of a variety of disorders including schizophrenia, rather than a cause. Furthermore, the symptoms present before the development of psychosis, seem to be mainly genetic predispositions, which shows that researchers should focus on biological pathways when exploring the diagnosis of the disorder. This ties in with research discussed earlier about social functioning developing after the onset of schizophrenia rather than being part of the disorder, highlighting further the amount of issues that are currently attached to this diagnosis.
Discuss Abramowitz’s study
They discuss the recent changes to the diagnosis of OCD and explain how some of the changes might not be appropriate. For example, earlier OCD was discussed as people relieving themselves from feelings of apprehension or anxious responses (increased heartrate). Thus, it seems clear that it should be considered as an anxiety disorder. However, the most recent update of the DSM has created a separate section called obsessive-compulsive and related disorders such as body dysmorphia, hoarding and excoriation (skin picking), even though OCD has more common features with disorders such as phobias, social anxiety and panic disorder. Thus, this shows that even though the diagnosis of OCD is not very controversial, it still has its issues and the grouping of the disorder or over-looking the anxiety aspect of it, may result in misdiagnosis.
Discuss Lam’s study
They found that a significant issue with the diagnosis of disorders is that it is a subjective opinion of the clinician. They explored how clinician’s rated a woman’s symptoms, with one group being informed that in the past she had borderline personality disorder. The one’s that were informed that she used to have BPD, rated her symptoms as more negative than the other groups. This shows that diagnosis can sometimes be unreliable because clinicians can be overly influenced by past diagnoses.
Discuss Mitchell’s study
They explored how the ICD has recently reduced the amount of symptoms for the diagnosis of PTSD so that it is just 6 core factors. This is because the ICD argue that the DSM has too many symptoms that overlap with other disorders. However, Mitchell argues that this reduced amount of symptoms may not actually be accurate for the symptoms associated with the disorder. They used the network models of PTSD (many symptoms overlap with other disorders but there are core ones that are specific to a disorder) on Iraq soldiers and found that 3 of the most common symptoms of the disorder are going to be eliminated from the revision of the ICD. This shows that diagnosis can be very unreliable as symptoms are constantly being changed or revised, meaning misdiagnosis can occur if the changes are inappropriate.
