Psychopathology Flashcards
(120 cards)
1
Q
What is the easiest way to define ‘normal/abnormal’
A
According to statistics
2
Q
What is the statistical definition of abnormal (statistical infrequency)
A
Any relatively usual behaviour/characteristics can be classed as normal and behaviours which are unusual can be classed as abnormal
3
Q
What is an example of statistical infrequency definition
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We can say that at any time only small number of people will have irrational fear of buttons
4
Q
What is an example of statistical infrequency
A
IQ and intellectual disability disorder
5
Q
When is statistical infrequency best
A
When dealing with reliably measured characteristics like intelligence
6
Q
What is normal distribution
A
In any human characteristic most people’s scores will cluster round average and further out we go above or below average, fewer people will have this score
7
Q
Give example of normal distribution in humans
A
Average IQ is 100, In normal distribution, most people (68%) have IQ scores in range of 85 to 115 and only 2% have scores below 70 (these people classed as abnormal according to statistical infrequency and often diagnosed with psychological disorder (intellectual disability disorder)
8
Q
What is deviation from social norms
A
Most people notice those whose behaviour deviates from social norms and groups of people’s behaviour can be defined as abnormal on basis that is offends someone’s sense of what is normal
9
Q
Give an example of what deviation from social norms means and how do we judge jt
A
When a persons behaves different from how we expect them to behave, we are making collective judgement as a society of what is right
10
Q
Are social norms always the same and what does this mean
A
No they may vary depending on generation or culture so relatively few behaviours classed universally as abnormal on basis of deviation from social norms
11
Q
Give an example of how culture/era can have different social norms
A
Homosexuality was considered abnormal in our culture in the past and still abnormal in other cultures
12
Q
What is an example of deviation from social norms
A
Antisocial personality disorder
13
Q
What are characteristics of someone with antisocial personality disorder (psychopathy)
A
They are impulsive, aggressive and irresponsible
14
Q
According to DSM-5 (psychological disorder diagnosis manual) what are important symptoms of antisocial personality disorder
A
They have absence of prosocial internal standard associated with failure to conform to lawful and culturally normative ethical behaviour
15
Q
Why do we class psychopathy as abnormal
A
We make a social judgement that psychopaths are abnormal as they don’t conform to our moral standards, psychopathic behaviours would be considered abnormal in a very wide range of cultures
16
Q
How is normal distribution described on a graph
A
Bell shaped curve
17
Q
What is a strength of statistical infrequency
A
Strength is its usefulness in clinical practice as formal diagnosis and access severity of patients symptoms. Eg. Diagnosis of intellectual personality disorder requires IQ lower than 70. Example of statistical infrequency as assessment tool is becks depression inventory (BDI), a score 30+ widely indicates severe depression. Shows value of statistical infrequency criterion is useful in diagnosis and assessment processes
18
Q
What is a limitation of statistical infrequency
A
Limitation is infrequent characteristics can be good as well as bad. For every person w IQ below 70, there’s person w IQ +150, but we don’t think them abnormal. Also, we don’t think someone abnormal w low score on becks depression inventory. Shows being unusual at one end of spectrum doesn’t always make someone abnormal. Means although statistical infrequency can form part of assessment and diagnosis procedure it is not sufficient as sole basis of defining abnormality
19
Q
What is a strength of deviation from social norms
A
Strength is its usefulness in clinical practice. Eg.defining characteristics of antisocial personality disorder is failure to conform to culturally normal ethical behaviour like recklessness, aggression, violating others human rights (all signs of disorder deviating from social norms). These norms help diagnose schizophrenia. Shows deviating from social norms criteria has value in psychiatry
20
Q
What is a limitation of deviation from social norms
A
Limitation is variability between social norms in different cultures and situations. Person from 1 culture may label someone from another group as abnormal using their standards rather than other persons standard. Eg. Hearing voices is norm in some cultures(message from ancestors) but is abnormal in UK. Also, even within cultures it depends on the situation. Aggression more socially unacceptable in family life than corporate deal making. Means difficult to judge deviation across different situations and cultures
21
Q
What is failure to function adequately
A
Person becomes abnormal when they can no longer cope with everyday demands
22
Q
When do we class failure to function adequately
A
When persons no longer maintains basic nutrition and hygiene standards or if they can’t hold down a job or relationship with others
23
Q
What did Rosenhan and Seligman propose
A
Additional signs to tell when someone is failing to function adequately
24
Q
What were Rosenhan and Seligman additional signs for when someone isn’t functioning properly
A
When person no longer conforms to standard interpersonal rules like holding eye contact and respecting personal space, when person experiences severe personal distress, when person behaviour becomes irrational or dangerous to themselves and others
25
What is an example of failure to function adequately
Intellectual disability disorder, it is not only based on low IQ, for a diagnosis person must also be failing to function adequately
26
What is deviation from ideal mental health
It looks at what makes someone normal as a pose to abnormal, so once we have an idea of how we should be mentally we can identify those whole deviate from this ideal
27
What does ideal mental health and who suggested it
Jahoda said we have good mental health if: we have no symptoms or distress, our rational, we self actualise, can cope w stress, have realistic views on the world, good self esteem, lack guilt, independent of others, can love successfully, work and enjoy leisure
28
What other definition does deviation from ideal mental health overlap with and how
Failure to function adequately as we can think of someone’s inability to hold a job as failure to cope w pressure of work or deviation from ideal of successfully working
29
What is strength of failure to function adequately
Strength is its criterion represents sensible threshold for when people need professional help, most people have symptoms of mental health disorders to some degree (25% people in UK experience health health issue according to mind). But many people still cope w severe symptoms and it’s only point where we stop functioning that we seek help or are referred for help. This criterion means treatment and services can be targeted at those in need of them most.
30
What is limitation of failure to function adequately
Limitation is its easy to label non standard life choices as abnormal, it can be hard to say when someone is really failing and when they have chosen themselves to deviate. Eg. Not having job may indicate failure to function but those living alternate lifestyles like off grid don’t have a job. High risk leisure activities or unusual spiritual practice may also be unreasonably classed as irrational and a danger to themselves. Means people who make unusual choices are at risk of being labelled abnormal and freedom of choice may be restricted
31
What is stretch of deviation of ideal mental health
Strength is criterion is comprehensive, Jahodas concept includes a range of criteria for distinguishing mental health from illness. It covers most reasons why we may be referred for help w mental health meaning that an individuals mental health can be meaningfully discussed w a range of professionals who take different theoretical views. Eg. Psychiatrist may focus on symptoms but humanistic counsellor may focus on self-actualisation. Means ideal mental health provides checklist against which we assess ourselves and others.
32
What is limitation of deviation from ideal mental health
Limitation is elements of criterion can’t be applied cross culturally. Some of Jahodas concepts are only for western cultures, esp concepts of self-actualisation as they would be dismissed as indulgent in many places and even within western cultures there is variation over personal interdependence (high in Germany, low in Italy), also what defines success in our working, social and love lives is different in different cultures. Means it’s difficult to apply concept of ideal mental health between cultures.
33
How does the DSM-5 categorise all phobias
All phobias characteristics by excessive fear or anxiety triggered by an object, place or situations. When the fear is out of proportion to any real danger presented by the phobic stimuli
34
What does the latest version of the DSM recognise as categories of phobias and related anxiety disorders
Specific phobia, social anxiety/social phobia, agoraphobia
35
What is specific phobia
Phobia of an object like animal or body part or situation like flying or getting injection
36
What is social anxiety/ social phobia
Phobia of social situations like public speaking or using public toilets
37
What is agoraphobia
Phobia of being outside/ in a public place
38
What are behavioural characteristics of phobias
By feeling high anxiety levels and by trying to escape, the three behavioural responses to a phobia is panic, avoidance and endurance
39
What is panic in terms of behavioural characteristics of phobia
Person w phonics may panic in response to phobic stimuli, panic may involve range of behaviours like crying, screaming or running away, children may react differently by freezing, clinging or having tantrum
40
What is avoidance in terms of behavioural characteristic of phobia
Unless person makes conscious effort to face their phobia they make a lot of effort to avoid phobic stimuli and this can make it hard for someone to complete daily life. Like someone w fear of public toilets may have limit to time spent outside their home and this in turn interfere w work, education and social life
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What is endurance in terms of behavioural characteristics of phobias
Alternate behaviour response to avoidance is endurance which occurs when person chooses to remain in presence of phobic stimuli. Eg. Person w arachnophobia may stay in room w spider and keep an eye on it rather than leaving
42
What does behavioural mean
How we act
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What does emotional mean
How we feel
44
What does cognitive mean
How we think
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What does behavioural approach emphasise
The role of learning in acquisition of behaviour
46
What does behavioural approach focus on and how does it link to phobias
Approach focuses on behaviour and key behavioural aspects of phobias are panic, avoidance and endurance
47
What is behavioural approach geared towards explaining
Behavioural aspects of phobias rather than cognitive and emotional aspects
48
Who proposed the two-process model and what is it
Mowrer proposed two process model based on behavioural approach to phobias which states phobias are acquired (learnt in first place) by classical conditioning and continue due to operant conditioning
49
What is classical conditioning within phobias
Classical conditioning involves learning to associate something of which we initially have no fear (neutral stimulus) with something that already triggers a fear response (unconditioned stimulus)
50
What did Watson and Rayner do which showed acquisition by classical conditioning
They created a phobia In 9 month old baby ‘little Albert’, he showed no unusual anxiety at start of the study
51
What was Watson and Rayners little Albert procedure and findings
when showed a white rat he tried to play with it, but experimenters then set out to give Albert a phobia. When rat presented researcher made a loud, frightening bang w an iron close to Alberts ear. Noise was unconditioned stimulus which creates unconditioned response of fear, when rat (neutral stimulus) and unconditioned response encountered in close time the NS becomes associated w UCS and now both produce fear response and Albert displayed fear when he saw rat
52
What did the rat become in little Albert study after it had finished
Rat became conditioned stimulus that produces conditioned response
53
Was little Albert just scared of rats after the experiment
No, it was generalised to similar objects like non-white rabbits, fur coats, Watson wearing a Santa beard (little Albert showed distress at all these stimuli)
54
Why are phobias long lasting when responses acquired by classical conditioning decline overtime and who said it
Mowrer said it was the result of operant conditioning
55
What is operant conditioning
Takes place when our behaviour is reinforced or punished, reinforcement increases frequency of a behaviour in both positive and negative reinforcement. In case of negative reinforcement an individual avoids unpleasant situation which results in desirable consequence so behaviour is repeated
56
How did Mowrer link operant conditioning to maintenance of phobias
He suggested when we avoid a phobic stimulus we successfully escape fear and anxiety that we would have experience if we remained there. This reduction in fear reinforces avoidance behaviour so phobia is maintained
57
What does the two process model involve
Acquisition through classical conditioning and maintenance through operant conditioning
58
What is a strength of 2 process model
Strength is real world application in exposure therapies like flooding and systematic desensitisation. Distinct element of 2 process model is idea that phobia maintained by avoidance which is important in explaining why people w phobias benefit from being exposed to stimuli. Once avoidance behaviour stops being reinforced by experience of anxiety and reduction and so avoidance declines. In behavioural terms phobia is avoidance and when that stops phobia cured. Shows value of 2process model as it helps w treating phobias
59
What is a limitation of 2 process model
Limitation is doesn’t account for cognitive factors of phobias, behavioural explanations like 2 process model are geared to explain behaviour. Phobias key behaviour is avoidance but we know phobias aren’t just avoidance responses, they also have a cognitive component. Eg. People hold irrational beliefs of their phobic stimuli but the 2 process model doesn’t explain these phobic cognitions. Mean 2 process model doesn’t completely explain symptoms of phobias
60
What is a further strength of the 2 process model
Strength is evidence of link between bad experiences and phobias. Little Albert shows how frightening experiences involving stimuli can lead to phobia of that stimuli. Also Jongh et al found 73% people who fear dental treatment had experienced a traumatic dentistry involving event or victims of violent crimes compared to control group w low dental anxiety and only 21% experiences traumatic event. This confirms association between stimulus and unconditioned response does lead to development of a phobia
61
What is the counterpoint to 2 process model having research support
Not all phobias appear following bad experiences, some common phobias like snakes occur in populations where few people have bad experiences w snakes. Also, not all frightening events lead to phobias. This means that association between phobias and frightening experiences is not as strong as we would expect if behavioural theories provide a complete explanation
62
What is systematic desensitisation
SD is a behavioural therapy designed to gradually reduce phobic anxiety through principles of classical conditioning
63
When is a person cured of a phobia
If a person can learn to relax in presence of phobia
64
How does systematic desensitisation work in general
New response to phobic stimulus is learned (phobic stimulus paired with relaxation instead of anxiety), learning new response is known as counterconditioning
65
What three steps are involved in systematic desensitisation
Anxiety hierarchy, relaxation, exposure
66
What is anxiety hierarchy in systematic desensitisation
Put together by client w phobia and therapist. It’s a list of situations related to phobic stimulus that provokes anxiety in order from most to least frightening. eg. Person w arachnophobia may say picture of spider is low anxiety and holding a tarantula is highest on their list
67
What is relaxations in systematic desensitisation
Therapist teaches client to relax deeply as possible as it’s impossible to be relaxed and afraid at the same time, one emotion prevents the other, known as reciprocal inhibition. Relaxation many involve breathing exercises or mental imagery techniques like clients taught to imagine themselves in a relaxing situation or may learn meditation
68
What is exposure in systematic desensitisation
Client is exposed to phobic stimuli while in relaxed state, takes place over a few sessions, starting at bottom of anxiety hierarchy. When client relaxed in presence of lower anxiety levels of phobic stimuli they can move up. Treatment successful when client stays relaxed in situations of high anxiety on hierarchy
69
What does flooding involve
Involves exposing people to their phobic stimulus but without gradual build up in anxiety hierarchy, instead there is immediate exposure to very frightening situation, eg. Person w arachnophobia may have a spider crawl on them for a long time
70
How long are flooding sessions compared to systematic desensitisation sessions
They are longer than SD session but often only need one session to be cured
71
How does flooding work
It stops phobic response quickly as without option of avoidance client quickly learns phobic stimulus is harmless (in classical conditioning terms called extinction). A learned response is extinguished when conditioned stimulus is encountered with unconditioned stimulus, the result is conditioned stimulus no longer produces conditioned response
72
As well as extinction why do some people become relaxed in presence of phobic stimuli in flooding
Client achieves relaxation as they become exhausted by their own fear response
73
What are the ethical tales on flooding
Flooding isn’t unethical but often unpleasant experience so important client gives full informed consent to this traumatic procedure and is fully prepared before flooding session. This is why Client normally given choice of systematic desensitisation or flooding
74
What is a strength of systematic desensitisation
Strength is evidence for its effectiveness, Gilroy et al followed up 42 people who had SD for arachnophobia in 3 45min sessions at both 3 and 33 months. SD groups were less fearful than than control group who were treated w relaxation techniques but no exposure. Also, a recent review by Wechsler et al concluded SD is effective for specific phobias, social phobias and agoraphobia. Means SD is likely to be helpful for those w phobias
75
What is a further strength of systematic desensitisation
Strength is it can be used to treat those w learning disabilities, some people require treatment for phobias and have learning disabilities so alternate methods aren’t suitable. People w learning disabilities often struggle w cognitive therapies as they require high levels of rational thought and they may also feel confused or distressed by traumatic experiences of flooding. Means SD is most appropriate treatment for those w learning disabilities and phobias
76
What is a strength of flooding
Strength is highly cost effective, clinical effectiveness is how effective a therapy is at tackling symptoms but when we provide therapies in Health systems like NHS need to think about cost. Therapy is cost effective when it’s clinically effective and not expensive. Flooding can work in little as 1 session compared to SD which requires 10 sessions for same result which even allows for flooding sessions to be longer (3h). Means more people can be treated at same cost w flooding than SD or other therapies
77
What is a limitation of flooding
Limitation is its highly unpleasant experience, confronting someone’s phobic stimulus in extreme form provokes high anxiety. Schumacher et al found participants and therapists rated flooding significantly more stressful than SD which raises ethical issues for psychologists of knowingly causing stress to their clients, but not big issue if they provide informed consent. More seriously, traumatic nature of flooding means drop out rates are higher than SD. Suggests overall therapists may avoid using this treatment
78
What do all OCD disorders have
Repetitive behaviour by obsessive thinking
79
How is OCD characteristics by DSM-5
Characterised by obsessions (reoccurring thoughts) and/or compulsions (repetitive behaviours)
80
What is trichotillomania
Obsessive hair pulling
81
What is hoarding disorder
Compulsive gathering of possessions and inability to part w anything
82
What is the OCD cycle
->Obsessive thoughts->anxiety-> compulsive behaviour-> temporary relief->
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what approach is used to explain OCD
Biological approach
84
What is 1 form of biological explanation
Genetic explanation
85
What is the genetic explanation of OCD
Genes involved in individual vulnerability to OCD
86
What was Lewis classic study into genetic explanation of OCD and what did this mean
Lewis observed OCD patients, 37% had parents w OCD and 21% had sibling w OCD which suggests OCD runs in families but what is probably passed on through generation is genetic vulnerability, not certain OCD.
87
What is the diathesis stress model
A model which explains that certain genes leave people more likely to develop mental disorders but it isn’t certain as some environmental factors like stress is necessary to trigger the condition OCD
88
What are candidate genes
Researchers identified genes which create vulnerability for OCD (candidate genes), some of these genes involved in regulating development of serotonin systems
89
Give an example of a candidate gene
Gene 5HT-D beta is implicated in transport of serotonin across synapses
90
What does it mean that OCD is polygenic
Means OCD isn’t caused by a single gene but combination of genes that together significantly increase vulnerability
91
Who analysed studies to find OCD is polygenic
Taylor analysed findings from OCD studies and found evidence of 230 different genes involved in OCD
92
What kinda of genes can use vulnerability to OCD
Genes studied in relation to OCD includes ones associated with role of dopamine and serotonin, both neurotransmitters have role in mood regulation
93
Why can we not say what exact genes cause OCD
As 1 group of genes may cause OCD in one person but another group may cause OCD in another person- term to describe this is etiologically heterogeneous (meaning origin of OCD varies from person to person)
94
What may different types of OCD also be a result of
Certain genetic variations like hoarding disorder and religious obsessions
95
What is the neural explanation from OCD
Genes associated w OCD likely to affect levels of key neurotransmitters as well as brain structures
96
What is one neural explanation of OCD
Role of neurotransmitter serotonin which helps regulate mood, neurotransmitters responsible for relaying info from 1 neurone to next and if a person has low levels of serotonin normal transmission of mood relevant info doesn’t occur and person may experience low moods, some cases of OCD explained by reduction in functioning of serotonin system in Brain
97
What do some cases of OCD like hoarding disorder seem to be associated w in neural explanation
Impaired decision making, this in turn may be associated w abnormal functioning of lateral frontal lobes of brain. Frontal lobes are responsible for logical thinking and making decisions
98
What role does left parahippocampal gyrus have on OCD
It’s associated w unpleasant emotions and functions abnormally in OCD
99
What is a strength of the genetic explanation
Strength is research support showing some are more vulnerable to OCD due to their genetic makeup. 1 source is twin studies, Nestadat et al reviewed twin studies and found 68% identical twins shared OCD but only 31% of non identical twins. Also family studies show person w family members w OCD are 4x more likely to develop OCD than a person without. These studies suggest there must be some genetic influence on development of OCD
100
What is a limitation of the genetic explanation of OCD
Limitation is it doesn’t take into account environmental risk factors, there is strong evidence for idea that genetic variation can make someone more/less vulnerable to OCD. But, OCD doesn’t appear to be entirely genetic and seems environmental factors can trigger development of OCD. Eg. Cromer et al found over half of OCD clients in their sample had experienced traumatic event in their past and OCD also more severe in those w more than 1 trauma. Means genetic vulnerability only provides partial explanation of OCD
101
What is a strength of neural explanation of OCD
Strength is some supporting evidence. Antidepressants that work purely on serotonin are effective in reducing OCD symptoms suggesting serotonin may be involved in OCD, also, OCD symptoms form part of conditions that are of biological origin like degenerate brain disorder, Parkinson’s disease (which cause tremors and paralysis). If biological disorder produces OCD symptoms then we may assume biological processes underlie OCD. Suggests biological factors like serotonin and underlying disorders may also be responsible for OCD
102
What is a limitation of the neural explanation
Limitation is that serotonin OCD link may not be unique to OCD. Many people w OCD also experience clinical depression, having 2 disorders together is co-morbidity. This depression probably disrupts action of serotonin so it leaves us with logical problem when it comes to serotonin as possible basis for OCD. It could simply be that serotonin activity is distrusted in many people w OCD as they’re depressed too. Means serotonin may not be relevant to OCD symptoms
103
What does drug therapy for mental disorders aim to do
Increase or decrease levels of neurotransmitters in brain to increase or decrease their activity
104
What are low levels of serotonin associated w and what does this mean for drug therapy
Associated w OCD so drugs to treat OCD work in many ways to increase serotonin levels in the brain
105
What is the standard medical treatment for OCD symptoms
Involves antidepressants called selective serotonin reuptake inhibitors (SSRIs)
106
How do SSRIs work
SSRIs work on serotonin systems in brain, SSRIs prevent the reabsorption and breakdown of serotonin in presynaptic neurone. SSRI effectively increase levels of serotonin in synapse and so continues to stimulate postsynaptic neurone which compensated for what’s wrong w the serotonin system in OCD
107
How does serotonin work in Brain
serotonin released by certain neurones in the brain, especially presynaptic neurones and travel across a synapse. Neurotransmitter chemically conveys signal from presynaptic to postsynaptic neurone and then its reabsorbed by presynaptic neurone where it’s broken down and reused
108
What does dosage of SSRIs depend on
Depends on which SSRI is prescribed, typical daily does of Prozac is 20mg but may increase if not benefiting patient
109
How long does it take for effects of SSRIs to kick in
3-4 months daily use
110
What are SSRIs often used alongside to treat OCD
Used with CBT to treat OCD
111
Why is drug therapy and CBT often combined to treat OCD
Durga reduce person’s emotional symptoms like feeling anxious or depressed, so people w OCD can actively engage with CBT
112
Is CBT or SSRIs more effective in treating OCD
Some people respond better to CBT alone while others benefit more when additionally using drugs like fluoxetine (SSRI)
113
What happens is SSRI isn’t effective after 3-4months of daily usage
Dosage can be increased to 60mg daily or combined w other drugs
114
Why are different antidepressants tried to treat OCD when SSRIs don’t work
Sometimes different antidepressants tried as people respond very differently to different drugs and alternatives work well for some people and not for others
115
What are tricyclics
Older type of antidepressants which are sometimes used to treat OCD (like clomipramine), this acts on various systems including serotonin system where it has same effect as SSRIs, but has more severe side effects than SSRIs so only used in those unresponsive to SSRIs
116
What are SNRIs (serotonin noradrenaline reuptake inhibitors)
Have more recently been used to treat OCD, they’re different class of antidepressants and like clomipramine they are a second line of defence for those who don’t respond to SSRIs. SNRIs increase levels of serotonin as well as another different neurotransmitter (noradrenaline)
117
What is a strength of drug treatment for OCD
Strength is evidence for its effectiveness. Clear evidence to show SSRIs reduce symptom severity and improve life quality for those w OCD. eg.Soomro et al reviewed 17 studies that compared SSRIs to placebos in treatment of OCD, all 17 conditions showed better outcomes for SSRIs than placebos and symptoms reduced for 70% of people, for other 30% drugs+ therapy can be used. Means drugs appear to be helpful for most people with OCD
118
What is the counterpoint to research support of drug therapy effectiveness in OCD
Some evidence suggests even if drug treatment is helpful in treating OCD, it may not be most effective treatment available. Skapunakis et al carried out systematic review of outcome studies and concluded both cognitive and behavioural exposure therapies were more effective than SSRIs in treatment of OCD. Means drugs may not be optimum treatment for OCD
119
What is a further strength of drugs in treatment of OCD
Strength is they’re cost effective and non disruptive to people’s lives. Drugs are cheap compared to psychological treatments as many thousands of tablets can be manufactured in time of one psychological therapy session. So using drugs to treat OCD is good value for NHS and represents good use of limited funds. Compared to therapy SSRIs are non disruptive to people’s lives as you can just take the drug till symptoms decline which is different from therapy which involves time spent attending sessions. Means drugs popular with many people w OCD and their doctors
120
What is a limitation of drugs for treating OCD
Limitation is drugs serious side effects. Although SSRIs help most, they don’t help everyone and some people also experience side effects like indigestion, blurred vision, loss of sex drive and although they’re usually short term they can distressing and for a minority these are long term symptoms. For those taking tricyclics they have even worse side effects like more than 1 in 10 people have erection problems, weight gain and 1 in 100 become aggressive or have heart problems. Means some people have reduced quality of life as result of taking drugs and may stop taking drugs all together so drugs cease to be effective
