Lecture 6-Biomedical Model Flashcards
(124 cards)
1
Q
What are used to explain phenomenas in science?
A
Models (paradigms)
2
Q
What do models do?
A
Spell out assumptions, give order to the field and give structured framework for investigation
3
Q
What do models influence?
A
What investigators observe, the questions they ask, the infromation they seek and how they interpret data
4
Q
How do research findings interpreted?
A
In the context of existing scientific models
5
Q
What perspective is the bio model of mental disorders?
A
Medical and bio perspectives
6
Q
What are the assumptions of the bio model?
A
Mental disorders are biologically based brain diseases
The cause is structural and physical
Mental disorders reflect something wrong with the brain structure or function
7
Q
What is the aim of research for the biological model?
A
To uncover the bio cause of mental disorder
8
Q
What is the emphasis of the bio model?
A
On medical treatment
9
Q
What does the bio model argue?
A
There is no distinction between mental and physical diseases
10
Q
What is maladaptive behaviour considered to be?
A
A function of interaction between biological, psychological and social factors
11
Q
What has the bio model caused an increase of?
A
Use of pharmalogical agents in mental illnesses
12
Q
What do PET scans show in depression?
A
Reduced brain activity in depression
13
Q
What are the biological causes of mental disorders?
A
Neurotransmitters and hormones
Genetics
Developmental abnormalities
Physical deprivation, neglect or stress
Toxic agents
14
Q
What are the three neurotransmitter imbalances?
A
Altered production, altered reuptake and alternations in neurotransmitter receptors
15
Q
What is altered production?
A
Altered production of neurotransmitter at synapses, over or under-stimulating the target neuron
16
Q
What is altered reuptake?
A
Altered reuptake of neurotransmitters, increasing or decreasing concentration at synapses
17
Q
What is alternations in neurotransmitter receptors?
A
Alterations in neurotransmitter
receptors, so that they are abnormally sensitive or insensitive
18
Q
Who looked at hormones?
A
Carlson, 2007
19
Q
What did Carlson, 2007, find?
A
Dopamine, norepinephrine, serotonin, glutamate and GABA has been studied in relation to psychpathology
20
Q
What are the 2 types of psychotropic drugs?
A
Agonist and antagonist
21
Q
What are agonist drugs?
A
Drugs that increase neurotransmitters binding to receptors
22
Q
What are antagonist drugs?
A
Drugs that decrease neurotransmitters binding to receptors
23
Q
What do psychotropic drug increase?
A
Synaptic transmission
24
Q
What are the psychotropic drug mechanisms?
A
Increase or decreased synthesis, increase or decrease transmitter re-uptake and direct stimulation or inhibition of transmitter receptors
25
What does drug discovery allow?
Sheds light on mechanisms of disease or understanding disease mechanisms allows rational drug design
26
What does resperpine do?
Treat high blood pressure but then caused depression and depletes nerve cells of amine neurotransmitters
27
What does iproniazid do?
Was an anti-tuberculosis drug and caused euphorbia, increased appetite and improved sleep as it increased amine neurotransmitters
28
What is depression caused by?
Deficiency of amine neurotransmitters
29
How do anti-depressants work?
Correct amine brain levels
30
What do SSRIs do?
Block the re-uptake of serotonin such as sertraline
31
What are criticism of amine hypothesis?
There are inconsistent findings
Poor control of confounding variables
Used small sample sizes
An oversimplification
Based theory on disease causation
32
What is the amine hypothesis of schizophrenia?
Excess of dopamine causing delusions and hallucination
33
What is the amine hypothesis of OCD?
Symptoms due to dysfunctions of brain pathways regulated by serotonin
34
What are the problems of bio models of disease?
Simplistic and misleading
35
What are characteristics of bio disease models?
Complex and suppirted by extensive research evidence such as animal models, autopsy, fMRIs and genetics
36
What is the endocrine system?
System of glands that secrete hormones in the bloodstream
37
What are hormones?
Chemical messengers that control body functions
38
What is the main gland?
Pituitary
39
What is the pituitary controlled by?
Hypothalamus
40
What can over activity in stress states cause?
Chronic psychological stress for elevation of cortisol (leads to depression + anxiety)
41
What are the genetic vulnerabilities?
Chromosomal abnormalities and single gene defects
42
Who looked at genetic vulnerabilities?
Ploemin et al
43
What did Ploemin et al find?
There is evidence that disorders have genetic influence
44
What are chromosomal abnormalities?
Complete or partial duplications/deletions
45
What are single gene defect?
Abnormalities in particular genes or disease associated normal variants
46
What does polygenic mean?
Vulnerabilities to mental disorders
47
Who looked at polygeny?
Kendler, 2005
48
What did Kendler, 2005, find?
Disorders are influenced by multiple genes causing genetic vulnerability
49
What is epigenetics?
Genes being switched on and off
50
How are genes silenced?
Adding of molecular tags to parts of the DNA strand
51
What is gene methylation influenced by?
Environment such as early life experiences
52
What can adverse life experience lead to?
Epigenetic changes that influence a risk of disorders
53
What is the gene-environment interaction?
Behaviour not being determined by genes you inherit but due to genetics and the environment
54
Who looked at gene-environment interaction?
Culverhouse et al
55
What did Culverhouse et al do?
Tested 30 datasets with 40000 people
56
Who looked at the ways genotype can shape environment?
Jang et al
57
What did Jang et al find?
The three ways that genotype can shape the environment:
Genotype can have a passive effect on environment
Genotype can cause certain reactions to environment
Genotype can play a more active role in shaping environment
58
Who looked at genotype can have a passive effect on environment?
Rutter 2006
59
What did Rutter, 2006, find?
Antisocial behaviour can create a risky environment so there is a higher chance of mental disorders
60
Who looked at genotype can cause certain reactions to environment?
Lytton 1980
61
What did Lytton find?
Happy babies drawing more positive responses from passive infants
62
Who looked at genotype can play a more active role?
Plomin et al
63
What did Plomin et al find?
Extraverted children seeking the company of others which can cause them to be sociable
64
What are the methods for studying genetic influences?
Family history method, twin method and the adoption method
65
What are the aims of bio model treatment?
Target underlying bio dysfunction
66
Who looked at the goal of bio model treatment?
Moncrieff, 2008
67
What is the goal of bio model treatment?
Discover precise therapeutic agents that target the disease process without causing harm
68
What are the treatments for biomedical model treatment?
Pharmocological, brain stimulation or surgery
69
Who found insulin shock therapy?
Manfred Sakel
70
What is insulin shock therapy used for?
Schizophrenia in 40-50s to induce coma
71
What are the risks of insulin shock therapy?
Obesity, seizures and brain damage
72
Who found the prefrontal leukotomy?
Egaz Moniz
73
Who found the frontal lobotomy?
Walter Freeman
74
What does a frontal lobotomy do?
Reduce emotional distress and improved challenging behaviour. Caused flat, passive and unemotional behaviour
75
Who found electroconvulsive therapy?
Ugo Cerlatti and Lucio Bini
76
What is ECT?
Controlled induction of convulsive seizures under general anaesthesia
77
What does ECT effect?
Numerous neurochemical systems
78
What are the criticism of ECT?
High relapse rates
79
What does deep brain stimulation do?
Stimulation of area 25 in the limbic lobe associated with mood improvement in severe depression
80
What is deep brain stimulation used for?
Severe treatment resistant conditions
81
Who looked at DBS?
Mayberg et al
82
What did Mayberg et al find?
DBS can be effective
83
What are the criticisms of DBS?
It is very expensive and carries risks
84
What is TMS used for?
Treatment resistant depression and anxiety disorder
85
What happens in TMS?
Electromagnetic coil delivers magnetic pulses to the brain and can be targeted to specific areas
86
Who looked at TMS?
Slotema, Blom, Hoel and Sommer
87
What did Slotema, Blom, Hoel and Sommer find?
Meta analysis where it was found TMS is effective for acute depression but not as good as ECT
88
What are the forms of medical treatment for mental disorders?
Antidepressants, anxiolytics, anti-psychotics and mood stabilisers
89
What are the side effects of antidepressant agents?
Nausea, nervousnessm insomnia and sexual dysfunction
90
When is antidepressant agents recommended?
When there is no response to psychological treatment and depressive symptoms are severe
91
When are anxiolytics used?
If guided self-help and
cognitive-behavioural therapy (CBT) fails
92
What do benzodiazepines do?
Sedative and muscle-relaxing properties
Cause drowsiness and lethargy
Highly addictive, high relapse rates
93
What are antipsychotic drugs used for?
To treat psychotic disorders and act by
blocking brain dopamine (and/or serotonin) receptors
94
Who looked at antipsychotics with people with schizophrenia?
Sharif et al, 2007
95
What did Sharif et al find?
Antipsychotics had positive results on people with schizophrenia
96
What are the side effects of antipsychotics?
Weight gain, diabetes and reduced white blood cell count
97
What is lithium used for?
Bipolar affective disorder
98
What are the risk of lithium?
Mechanism uncertainty and risk of toxicity
99
How effective is bipolar disorder?
70-80%
100
Who looked at lithium on bipolar disorder?
Keck and McElroy, 2007
101
What did Keck and McElroy find?
High rates of discontinuaton, 50% at 6 months
102
What are the side effects of lithium?
Thirst, weight gain,
gastrointestinal difficulties, tremor, fatigue
103
What are the advantages of the biomedical approach?
Suggests clear mechanism for most disorders
Effective in delivering insights into disorders with a clearer bio base
Drug treatment has revolutionised patient care and is more effective
Treatment is based on the scientific method
104
What research evidence is used for the biomedical approach?
A randomised control trial with double blind studies
Meta analysis to use results from different trials
105
What are the limitation of the biomedical approach?
Assumes universality (no room with its framework for social, psychological disorders)
Reductionism
Low causality
Claims mental disorders are brain disease cause by ntm genetic anomalities and defects in brain stricture but scientists have no identified a biological cause
Stigma from mental disorders
106
What is diagnosis based on?
Classification system with specified symptoms
107
What may the symptoms do to qualify for mental disorders?
Cause clinical distress and impairment in social, occuptational or important areas of function
108
Who developed classification system for mental disorders?
Emil Kraepelin
109
What did Emil Kraepelin emphasise?
The importance of brain pathology in mental
disorders (medical model)
110
Has mental disorders increased or decreased in the DSM?
Increased
111
What was the DSM I characteristics?
No diagnostic criteria
Grounded in psychodynamic formulations of mental disorders
Established by psychoanalysts
Disorders described with prototypes that are narrative descriptions of disorders
112
What was the DSM II characteristics?
Psychoanalysis still dominated
Psychoneurotic problems redefined as
‘neurotic’ disturbances
No clear descriptions of ‘disorders’
All ‘symptoms’ defined as ‘symbolic’ of
unconscious processes
113
What was the DSM III characteristics?
Relied to a much greater extent on empirical data
Included specific diagnostic criteria
Dropped allegiance to a particular theory of therapy or psychopathology
Introduced the multiaxial assessment that remained until the DSM IV-TR
114
What was the DSM III-R
characteristics?
Renamed, added, and deleted categories
Pressure groups had an influence
Changes to diagnostic criteria
Increased reliability
115
What was the DSM IV
characteristics?
The term ‘neurosis’ was dropped
Conservative approach
Inclusion of a clinical significance criterion to almost half of all the categories, which required that symptoms cause: “clinically significant distress or impairment in social, occupational, or
other important areas of functioning"
116
What was the DSM V
characteristics?
Most substantial revision in the last 20 years
Clearly influenced by the (bio)medical model of mental disorders
The DSM-5 does not include all possible mental disorders
The cultural and social context must be considered
Making diagnoses requires clinical judgment, not just checking
off the symptoms in the criteria
Diagnoses are made on the basis of: Clinical interview., DSM-5 text descriptions and criteria, clinical judgment
117
What are the DSM V disorders?
Premenstrual dysphoric disorder, binge eating disorder, mild neurocognitive disorder, somatic symptom disorder, hoarding disorder
118
What are the DSM V revisions?
Major depressive disorder bereavement exclusion dropped
Autism spectrum disorder (Asperger's)
119
What is the international classification of diseases?
Comprehensive classification system for all diseases
120
What are the advantages of classification?
Facilitating communication between researchers and clinician providing common professional language
Enables consistency in empirical research
Provides framework for discussing difficult topics and offering help
Labels helps define groups
Helps inform decisions of rational allocation of limited health services
Provides comfort and relief that they don't feel alone
121
What are the limitations of classification?
Some people feel disempowered by diagnosis People seen as mentally ill are often mistreated
Medicalisation of mental health problems may deflect attention from underlying social problems
122
Who looked at distress of classification?
Horn et al, 2007
123
What did Horn et al find?
Being seen as ‘mentally ill’ can cause more distress for some people than their original problems
124
What has the DSM been criticised for?
Pathologising aspects of normal life
Arbituary cut offs
Insufficient attention to questions of gender and culture
