P3 - M.H. - The Medical Model - Gottesberg

Question 1

Overview of BIO Explanations of M.H.

Answer 1

• Biological explanations suggest ALL Mental Illnesses arise from physical processes.
• 3 explanations are: Genetics, Brain Structure, and Biochemical (neurotransmitter) Activity.

You can use EITHER depression or schizophrenia as examples in your work but you MUST talk generally about ALL mental illness.

Question 2

Genetic Factors of Schizophrenia

Answer 2

• Schizophrenia has a genetic basis but is Polygenetic (multiple genes involved).
• No single gene causes schizophrenia; multiple genes increase risk.
• Research identified 108 gene loci linked to the disorder.
• More research is needed for the Specific Genes

Question 3

Genetic Factors of Depression

Answer 3

• Depression - 1 Gene called the Serotonin Transporter Gene, but also Interaction with Other Genes.
• Short / Short version of the S.T. Gene = highest risk for the development of depression.
• Long / Long version = lowest risk.

Question 4

Genetics - Family Studies Evidence

Answer 4

• Family studies show Higher Rates of Schizophrenia among relatives
• Concordance rates help measure this Relationship
• Identical Twins (MZ) have a Higher Concordance Rate than Non-Identical Twins (DZ)
• Similar in Depression, but not as high
• INTERACTIONIST Results

Question 5

Concordance Rates Explained

Answer 5

• Concordance Rate indicates how often both Individuals Share the Condition.
• Example - Schizophrenia: 48% in MZs vs. 17% in DZs
• General Population Rate for Depression: 1%, ~43% in MZs and 36% in DZs
• Schizophrenia Very Genetics Related
  (Higher % of general population than Schizophrenia)

Question 6

Genetics - Adoption Studies Evidence

Answer 6

• Adoption studies show Children of Schizophrenic Mothers have Higher Risk
• 5.8% of children raised in Healthy Environments developed Schizophrenia
• 36.8% developed it in dysfunctional families, highlighting Environmental Influence

Adoption studies on Depression have found similar results, but not as high as the Schizophrenia Results.
INTERACTIONIST

Question 7

Limitations of Genetic Studies

Answer 7

• A 100% Concordance Rate is expected for purely genetic traits, but it never is
• Environmental factors also play a role in Schizophrenia and Depression Development (Adoption Studies)
• Genetic Predisposition does not guarantee any disorder will manifest at any point in life

Question 8

Genetics in DSM

Answer 8

• DSM-1 & DSM-2 made definitions of M.Illmess from how it effects patients
• DSM-3 Defined it through what causes it aswell
• Robert Spitzer

Question 9

Genes, DNA & Chromosomes

Answer 9

• 23 pairs of chromosones
• 10,000s of Genes
• DNA < Genes < Chromosomes < Cells

Question 10

Genetics - Current Understanding

Answer 10

• Human Genome discovered from 1990-2003
• Genetics is the most recent of the Background areas (Biochemical is oldest)
• Still at early stages of Understanding - not yet falsifiable

Question 11

Genetics - Shizophrenia Research Definitions

Answer 11

• Inheritance - A Trait passed on down from prevous generations of BIO family
• MZ - Identical Twins
• DZ - Non-Identical Twins
• Polygenic - A condition cuased by Many Genes
• Predisposed - Genetic Increased chance to develop a Condition
• Environmental Influence - Features of an individual’s environment that can provoke the development of a Condition
• Relatives - Individuals connected by Blood and Marriage
• General Population - The average amount of people who have no relatives with a condition without relation to a given condition
• Concordance rate - measure of the proportion of pairs that share a given trait (only including pairs w/ one that has the given trait)

Question 12

BIOCHEM - Schizophrenia Hypothesis

Answer 12

Positive Symptoms - DAI
* Dopamine
* Acetylcholine
* Inflammation

Negative Symptoms - SGG
* Seretonin
* Glutamate
* GABA

Cognitive Symptoms - SGA
* Seretonin
* Glutamate
* Acetylcholine

Question 13

GOTTESBERG - Aims

Answer 13

• How vulnerable are the children of two parents with mental illnesses?
• Specifically schizophrenia suffering parents and bipolar disorder suffering parents
• Rist of developing mental illness from 10-52

Question 14

GOTTESBERG - Background

Answer 14

Research into Duel Mating studies previously had small samples

Question 15

GOTTESBERG - Method & Procedure

Answer 15

• Cohort study; a cogort of the population born before ‘97
• ICD used to Diagnose - children & parents with Sz, Bplr or related Psychotic conditions

Question 16

GOTTESBERG - Findings: Schizophrenia

Answer 16

Risk MUCH higher for children with TWO parents diagnosed
* 27.3% children had developed it themselves by age 52
* 39.2% children had schizophrenia related conditions
* 67.5% children has SOME form of mental illness

ONE parent
* 7% children had schizophrenia by age 52
* 11.9% had SOME mental illness

NO PARENTS
* 1.1% of general population had developed it by 52

Question 17

GOTTESMAN - Findings: Bipolar

Answer 17

Risk MUCH higher for children with TWO parents diagnosed
* 24.9% children had developed it by age 52
* 36% had developed bipolar or depression
* 44.2% SOME type of mental illness

ONE parent
* 4.4% developed bipolar
* 9.2% SOME type of mental illness

NO PARENTS with bipolar
* 0.63% developed it by 52

Question 18

GOTTESBERG - Conclusions

Answer 18

DID NOT:
* Suggest Pair Mating should be stopped or advised to stop

DID:
* Suggest to Educate and give Genetic Counsiling to Pair Maters so that they understand their decision
* So that they can decrease the child’s risk of developing the disorder
* Factors that increase risk:
* Family History
* Mother over 35
* Conception difficulties
* Disease Exposure

Question 19

GOTTESMAN - Sample

Answer 19

• Sample - 2.7 million Danish people born pre 1997
• The data was sampled in 2007 so the minimum age would be 10
• 196 couples selected from this dataset - both had schizophrenia
• 270 children of these couples
• 83 couples both having bipolar disorder
• 146 children from these couples

Question 20

GOTTESMAN - Design

Answer 20

• Natural experiment
• 2 naturally occurring IVs (Bipolar or Schizophrenia)
• DV = diagnosis on mental illness in child

ICD used to Diagnose the Cohort

Question 21

**EVALUATION - Ethnocentrism

Answer 21

• Denmark - cannot be generalised outside of Denmark/Europe
  
  • Race can have an impact on the risk of inhereting conditions, and Denmark is majority white

Question 22

EVALUATION - Free Will/Determinism

Answer 22

• mainly DET - conditions outside the individuals control, determined by genetic vunrability, you cannot choose to pass on Genetic Disorders, decided also by family decisions
• FW - ppl have the free will to understand the risks of it & take precautions - CAN influence their genetic expression

Question 23

**EVALUATION - Socially Sensitive

Answer 23

• May be interpreted as evidence for preventing couples from having a family
  
  • Gottesman does NOT suggest this, just for Couples to understand/be educated on their risks

Question 24

EVALUATION - Reductionism/Holism

Answer 24

• mainly RED - Biological Reductionism: the mind is reduced to the brain - doesn’t take into account all factors, but can be seen as neccessary for the Scientific Process
  A STRENGTH & WEAKNESS - Justified in scenerios?

Question 25

EVALUATION - Nature/Nurture

Answer 25

Overall BIOMEDical: more **NAT -** emphasis on *Genetic Vunrability* to M. Illness, result of Genetic factors, * however includes Environmental Factors in Genetic (dev of Sz: **5.8%**>**36.8%**) & Br. Struc. (larger Ventricles), so some **NUR**

Question 26

EVALUATION - Ethical Issues

Answer 26

SIG. Issues * AntiPsychotic drugs have been given to patients in hospitals to make them easier for Doctors to deal w/, rather than for the patients' benifit * Human Rights Abuse Side effects: * AntiPsychotics have side effects from mild to fatal (older A-Ps associated w/ dizziness, agitation, itchy skin, weight gain) * Long-term use can result in Central Nervous System damage; supersensitivity to dopamine - serious face twitches/movements * considered incurable & hard to treat * Ocassionaly produce fatal reactions

Question 27

EVALUATION - Usefullness

Answer 27

* Found effective treatments: drugs & ECT * **Aroll** reviewed studies about effectiveness of prescribed anti-depressants, **56-60%** of patients improved - compared to **42-47%** w/ the Placebo * **Thronley** reviewed AntiPsychotics vs Placebo studies under controlled conditions - data from trails w/ 1.1K participants showed that the AntiPsychotic was associated w/ **better overall functioning and lesser symptoms than Placebo** * *Conditions cannot be entirely removed/fixed*

Question 28

EVALUATION - Drug Treatment: Schizophrenia/Anti-Psychotic Drugs

Answer 28

**TYPICAL:** * 1st to be developed * Block dopamine receptors, reducing amount of dopamine and so reduces Positive Symptoms pf Schizophrenia **ATYPICAL:** * Can also increase Seretonin at the same time

Question 29

EVALUATION - Drug Treatment: Depression/SSRIs

Answer 29

* Stops Seretonin from being **'reuptaken'** across synaptic gaps (go back across) forcing it to transmit properly

Question 30

EVALUATION - Anti-Psychotic Drugs **+s and -s**

Answer 30

**STRENGTHS**: * Relatively effective at treating these serious conditions and improve QoL to a significant extent **WEAKNESSES**: * Effects people differently * Muscle supersensitivity to Dopamine can cause serious problems: involintary facial movements that can make social interaction difficult | EL DOPA STUDY

Question 31

**El Dopa** Study Summary

Answer 31

* Trial for treating Parkinson's disease, increased Dopamine levels * Side effect included the patients experiencing Positive Symptoms of Schizophrenia * Temporary (2 weeks) * Led to *the Dopamine Hypothesis* for Schizophrenia

Question 32

EVALUATION - Validity | Cause and Effect Established

Answer 32

* ICD used - standardised, scientific procedure * (diff. IV levels for 2parents, 1parent, 0parents) * *Diff. doctors were used to diagnose the parents (decades ago) and their children*

Question 33

EVALUATION - Internal Reliability | If all the measures would measure the desired thing the same if repeated

Answer 33

YES - Procedure very standardised: ICD used for all patients, *but Parents' diagnosis may be based off out-of-date definitions* ## Footnote search button + C might = speach>text

Question 34

EVALUATION - External Reliability | supports previous studies & theories

Answer 34

YES * Concludes that there is a significant Genetic factor to developing genetic disorders * The less relatives/parents someone has, the less likely they are to inherit the Condition * They are not purely Genetic; if so, *Concordance Rate* would be 100%

Question 35

EVALUATION - Practical Applications

Answer 35

* Parents with conditions can be given Genetic Counciling * There are ways to reduce the risk of developing disorders * **Antidepressant Drugs** * **ECT**

Question 36

****Outline** the Genetic explanation of Mental Illness

Answer 36

The genetic explanation of Mental Illness suggests mental illnesses can be inherited from relatives, and are Genetic Expressions. Genes from our biological parents are responsible for alterations in the physical processes of the brain, including the physical structure of the brain, & Neurotransmitters. ## Footnote 3/3

Question 37

****Outline** the Biochemical explanation of Mental Illness

Question 38

****Outline** the Brain Structure explanation of Mental Illness

Question 39

****Evaluate** the Genetic explanation of Mental Illness

Answer 39

The Key Research finds that Mental Illnesses, such as **Schizophrenia**, **can be inherited**; if an individual's family has a history of a condition they are predisposed to develop the disorder. **Twin Studies** also find that MZ twins are significantly more likely to share the same disorder than DZ Twins, suggesting that Mental Illness is tied to Genetics.

Question 40

****Evaluate** the Biochemical explanation of Mental Illness

Question 41

****Evaluate** the Brain Structure explanation of Mental Illness