psychopathology Flashcards
(124 cards)
1
Q
what is psychopathology?
A
the scientific study of psychological disorders, psychiatrists identify signs and symptoms
2
Q
how can abnormality be defined?
A
- deviation from social norms
- failure to function adequately
- deviation from ideal mental health
- statistical infrequency
These definitions provide a framework for identifying abnormal behaviour. They do not diagnose abnormality or categorise it. They are clues that someone’s behaviour may need monitoring or need further investigation.
3
Q
what are social norms?
A
- created by people within society, specific to that society
- standards of acceptable behaviour within a given society, those within that social group adhere to these standards
- rules of behaviour, some are implicit where others are governed by law
4
Q
examples of types of social norms
A
Examples of implicit norms: shaking hands when greeting someone, forming a queue to pay for something, not being late.
Examples of explicit norms: Animal Welfare Act 2006, Equality Act 2010.
5
Q
deviation from social norms - a definition for abnormality
A
- Anyone who deviates from the socially/culturally created norms is classed as abnormal under this definition.
- Eg. those with antisocial personality disorder (APD) would be quickly picked up by this definition for their impulsive, aggressive, irresponsible behaviours
6
Q
evaluation of deviation from social norms as a definition for abnormality
A
+ practical applications, quick and easy to use, successful framework, EG. impulsive acts caused by APD
- changing society, individuals deemed abnormal under one set of norms may find themselves considered normal by later norms, eg. homosexuality, lacks temporal validity
- cultural bias due to significant differences in normal between cultures, eg. the desirability of hearing voices or self harm, guilty of focusing on Western norms
- some people would be classed as abnormal despite choosing not to follow norms, eg. punks, the definition does not allow for differentiation between mentally abnormal and anti-conformist people
7
Q
the sun dance
A
- the greatest religious ceremony of the Native Americans
- held every summer and lasted 4 days
- to secure the help and support of the supernatural powers
- towards the end of the ceremony, the dancers attached rawhide ropes through slits cut in their chests.
- The ropes were attached to a pole and the dancing continued until they were torn loose from the flesh.
- Any dancer who had a vision or heard voices was thought to be favoured by the spirits.
8
Q
sharmans
A
- obtained their power from the spirits
- able to cure the sick, discover the whereabouts of an enemy, and recover lost/stolen property
- often the cause of illness was diagnosed as a foreign object in the patient’s body
- Bull All The Time, a Sharman of the Native American Cree people, cured several patients by sucking at the afflicted parts and pulling out respectively a bone, a black beetle, and a morsel of meat.
9
Q
the dobuans
A
- Ruth Benedict’s description of the culture of the Dobuan islanders of Melanesia detailed how their society was characterised by a distrust of others, verging on what we would call paranoia.
- Eg. no one would leave a cooking pot unattended for fear of poisoning.
- Benedict describes one man as pleasant and helpful but was considered crazy by other members of society.
10
Q
hallucinations, Nigel Copsey
A
- Nigel Copsey is a psychologist and ordained minister who spent two years studying the churches, temples, and mosques of ethnic minority groups in London’s East End.
- He found that many African Caribbean an Asian people refuse to talk about their religion to health workers for fear of being diagnosed as suffering from a psychological disorder.
- One pastor told him that many members of his congregation ‘heard voices’ and believed they were possessed by evil spirits. The pastor prayed alongside them to break the ‘spell’. Only if the voices continued did he admit the possibility of psychological disorder.
11
Q
John Slater
A
- an eccentric (someone who deviates from established patterns of behaviour)
- once walked from Lands’ end to John O’Groats in his bare feet, wearing only striped pajamas and accompanied by his pet Labrador, Guinness
- has had a range of jobs from Royal Marines bandmaster to social worker to waiter
- For most of the past ten years, he has lived in a cave that is flooded by seawater at high tide. He says that he enjoys the ‘cathedral-like silence in caves’ as it helps him to think.
- his behaviour is unusual but it doesn’t indicate a psychological disorder.
12
Q
study of eccentrics
A
According to a study of 1000 eccentrics - based on in-depth interviews, personality questionnaires and a range of tests which reveal psychological disorders - they had fewer disorders than the general population. Most eccentrics were happy and well-adjusted.
13
Q
failure to function adequately - a definition for abnormality
A
Anything that interferes significantly with normal routine is considered abnormal. Distress or harm to the individual or others is also classed as abnormal. An individual may be aware or unaware of their failure to function adequately.
- the GAF scale
14
Q
the GAF scale
A
The DSM-V includes a scale of 1-100 that measures how adequately a person is functioning. This is known as the Global Assessment of Functioning (GAF) scale. 1 represents serious risk to self/others and 100 represents perfect health.
15
Q
evaluation of failure to function adequately as a definition for abnormality
A
- abnormality is not necessarily linked to dysfunction, people are capable of functioning whilst being abnormal which the definition does not account for
- sometimes there are exceptions where people appear to be failing to function but are not necessarily abnormal such as whilst grieving, while ill or in the run up to exams
- cultural differences/bias where someone seems to be demonstrating signs of failing to function in one culture but in their culture are behaving normally - definition is not comprehensive enough
- subjective interpretation, lack of inter-rater reliability eg. Rosenhan’s research in psych wards
16
Q
deviation from ideal mental health - a definition for abnormality
A
- This definition was devised by Marie Jahoda (1958).
- also provided characteristics that an individual should exhibit in order to be normal.
- She said that an absence of good mental health should be used to judge abnormality. The more criteria someone fails to meet, the more abnormal they are.
- perceives abnormality in a similar way to how physical health is assessed
- looks for signs of an absence of wellbeing in mental health terms
17
Q
Jahoda’s six criteria for ideal mental health
A
Pessimistic Snakes Are Really Acting Everyday:
- Positive attitude towards oneself
- Self-actualisation
- Autonomy
- Resisting stress
- Accurate perception of reality
- Environmental mastery
18
Q
positive attitude towards oneself
A
- one of Jahoda’s six criteria for ideal mental health
- high self-esteem, self-respect, and a positive self-concept
- eg. self-harm, self-loathing, suicide attempts, lack of self-care
19
Q
self-actualisation
A
- one of Jahoda’s six criteria for ideal mental health
- experiencing personal growth and development; ‘becoming capable of everything one is capable of becoming’
- eg. not setting goals or setting unrealistic/unachievable goals
20
Q
autonomy
A
- one of Jahoda’s six criteria for ideal mental health
- being independent, self-reliant, and able to make personal decisions
- eg. anxiety over simple decisions, disability, unable to make decisions about anything without someone else or someone else having complete control over elements of your life
21
Q
resisting stress
A
- one of Jahoda’s six criteria for ideal mental health
- having effective coping strategies and being able to cope with everyday anxiety-provoking situations
- eg. regular panic attacks, inability to think ahead without extreme anxiety
22
Q
accurate perception of reality
A
- one of Jahoda’s six criteria for ideal mental health
- perceiving the world in a non-distorted fashion. Having an objective and realistic view of the world
- eg. believing controversial or damaging things, paranoia, delusions of grandeur, hallucinations
23
Q
environmental mastery
A
- one of Jahoda’s six criteria for ideal mental health
- competence in all aspects of life and able to meet the demands of any situation; having the flexibility to adapt to changing life circumstances
- eg. balancing how to act in certain situations, unable to deal with/adapt to small changes, very rigid view
24
Q
evaluation of deviation from ideal mental health as a definition for abnormality
A
+ comprehensive
+ positive, focusing on what meets normality
+ holistic
- exceptions to the rule with people meeting all of these but still being abnormal
- ‘autonomy’ doesn’t differentiate between disability and poor mental health
- subjectivity
- cultural bias - autonomy in collectivist cultures
25
normal distribution curve
also known as 'bell curve', represents the most probably event. All possible occurrences are equally distributed around the most probable event.
26
standard deviation
the measure of how spread out the data is.
27
statistical infrequency as a definition for abnormality
Statistically rare behaviours are considered abnormal; using the bell curve - those 2 standard deviation points from the mean (roughly 5% of the population) are considered abnormal.
28
evaluation of statistical infrequency as a definition for abnormality
+ it is objective and quantitative - more reliable
+ gives an overall view of a population
+ can be used as evidence in receiving treatment, to help people get support
- not all statistically infrequent behaviours are undesirable/abnormal eg. high IQ
- doesn't consider cultural factors
- it's not always clear where to draw the line for abnormality
29
guides for diagnosis
The ICD-10 (International Classification for Diseases) and the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) guide diagnosis. The ICD-10 is more widely used in Europe and the DSM-5 is frequently used in America but is focused on by the AQA spec.
30
history of diagnosis
1900 - roughly a dozen (12) recognised illnesses eg. hysteria, melancholy, broken heart syndrome, etc.
2013 - more than 300 recognised disorders (including many variations of the same illness/disorder)
31
types of characteristics and examples
- cognitive - thinking - eg. concentration, obsessions, intrusive thoughts
- emotional - feeling - eg. anxiety, lowered self-esteem, heightened emotional reactions
- behavioural - doing - eg. self-harm, panic attacks, sleeping patterns
32
what are phobias?
Phobias are characterised by excessive fear and anxiety. The fear is out of proportion. It is generally irrational. It interrupts the ability to lead a 'normal' life.
33
DSM-5 phobia definition
it gives three categories:
1. Specific Phobia - eg. needles, flying, spiders
2. Social Anxiety - eg. speaking to others, using a public toilet
3. Agoraphobia (fear of open spaces)
34
cognitive characteristics of phobias
- selective attention - looking for the phobic stimuli
- irrational belief - extreme beliefs/disordered thinking eg. 'no one likes me' - often leads to increased pressure on the phobic person (they're generally about the phobic person)
- cognitive distortion - thinking things that aren't necessarily realistic attributes of the phobic stimuli (generally about the phobic stimuli) eg. 'spiders are evil'
35
emotional characteristics of phobias
- anxiety - unpleasant state of high arousal a person experiences in the presence of their phobic stimulus, can't think positively, can't feel any positive emotions, fear is immediate and extremely unpleasant
- unreasonable emotional responses - fear experienced is out of proportion with the danger posed
36
behavioural characteristics of phobias
- panic - crying, screaming, hyperventilating, freezing, etc
- endurance - remains in presence of stimulus and experiences high anxiety (an alt. to avoidance)
- avoidance - changing behaviours to avoid the stimulus eg. staying at home to avoid phobic stimulus
37
behavourist explanation of phobias
- The Two-Process Model (Mower, 1960)
- acquired through classical conditioning and maintained through operant conditioning
- learnt as a result of association then continue to exist due to negative reinforcement
38
process 1 in the two-process model
classical conditioning
Eg. for a fear of a dog:
US (pain) --> UR (fear)
US (pain) + NS (dog) --> UR (fear)
CS (dog) --> CR (fear)
39
process 2 in the two-process model
operant conditioning
Eg. for a fear of a dog:
1. Phobic response creates intense unpleasant feelings (anxiety/fear)
2. Escaping from the dog (avoidance) causes a reduction in anxiety/fear
3. A reduction in anxiety/fear, due to escape, is rewarding
4. Avoidance, therefore, acts as negative reinforcement
5. Leads to an increased likelihood of avoiding dogs in the future
40
generalisation
when a fear of one thing (eg. one dog because it bit you) generalises to a fear of all similar things (eg. all dogs)
41
extinction
the associated fear goes away, usually after exposure therapy
42
spontaneous recovery
for no apparent reason, the associated fear is reformed (after extinction)
43
evaluation of the two-process model
+ practical applications (identifying avoidance allows us to treat using exposure - credibility and usefulness)
- ignores cognitive factors like perception and interpretation which may explain why some people don't develop a phobia despite a bad experience (eg. DiNardo)
- neglects the evolutionary aspect (preparedness)
- genetics may also play a role (eg. Ost, 1992)
- genetic may also play a role in explaining phobias
44
DiNardo
- the two-process model ignores cognitive factors like perception and interpretation
- DiNardo found that 56% of individuals with a dog phobia had had an unpleasant experience with a dog
- 50% of a control population without a dog phobia had also had an unpleasant experience
45
Seligman's concept of preparedness
- suggests that we acquire phobias of things that have been dangers in our evolutionary past eg. animals rather than because of association
- we don't develop fears of things that are current threats to us like guns despite their association with negative experiences, two-process model is only a partial explanation
46
Ost (1992)
- genetics may also play a role in explaining phobias
- found that 62% of ppts with a blood/injection phobia had a first degree relative with the same disorder despite prevalence in the general population being 3%
47
what is systematic desentization?
- named by Wolpe (1958)
- aims to extinguish an undesirable behaviour by substituting the conditioned response with another
- a form of counter-conditioning based on the principles of classical conditioning
- the key principle is reciprocal inhibition
48
what is reciprocal inhibition?
- where the fear response is substituted with relaxation
- it is impossible to experience two opposite emotions at once since one emotion prevents the other. Based on this, someone cannot be fearful and relaxed at the same time.
49
what are the aspects of systematic desentization?
1. Relaxation - techniques taught/drug therapy given
2. Anxiety Hierarchy - least to worst feared event
3. Gradual Exposure - having the phobic stimuli present in accordance to the anxiety hierarchy and remaining relaxed
50
What is an anxiety hierarchy? How is one used?
- step-by-step goals that need to be achieved in order to reach an ultimate goal eg. no longer having a phobia
- patient/client works with therapists to form a list of fears or anxieties
- this list is then slowly worked through using relaxation techniques taught beforehand
- move to the next goal or step when sufficient relaxation has been reached at each point
- individual always starts with the least feared situation from which things will get progressively more fear provoking before ending with the most feared situation.
51
Newman and Adams (2004)
- case study of MV a 17 year old boy with moderate learning difficulties
- aim was to reduce his phobic response to dogs (would freeze when he and his carer met one)
- taught to relax using breathing exercises and by averting his focus onto his mother
- exposed to dogs according to an anxiety hierarchy
- treatment was originally considered successful but MV returned after 18 months due to fear of off-lead dogs
- more time was spent achieving relaxation at the higher end of the hierarchy
- after 26 sessions, MV was able to remain relaxed in the presence of strange, loose dogs
52
interpretation of Newman and Adams (2004)
- MV was desensitised to dogs, learning to stay relaxed at each level in the anxiety hierarchy in tur
- the first course of treatment did not work enough on the situations at the top end of the hierarchy so MV remained of dogs off a lead
- in the second course of treatment, it took several exposures to achieve relaxation at the top end of the anxiety hierarchy
53
MV's hierarchy (Newman and Adams, 2004)
1. introduction to our dogs via photographs
2. dog introduced - no contact/access
3. access to dog provided
4. dog on lead brought into personal space
5. loose dog introduced - no access (other side of window)
6. loose dog introduced - limited access (in another room, entry door to client's room blocked by a waist-high object
7. loose dog introduced - complete access provided (loose dog in the same room)
8. generalise to other dogs (introduce new dogs to avoid familiarity)
9. generalise the environment - stages 1-8 were performed at MV's home (observe dogs loose and leashed from a distance at local parks)
10. generalise the environment (close proximity to loose and leashed dogs at parks)
54
what is flooding?
A form of therapy in which patients are immediately exposed (bombarded) to the object or situation they fear for lengthy periods of time, until their anxiety level has reduced substantially (extinction) . It is often known as exposure therapy.
55
How does flooding work?
- conditioned stimulus (eg. dog) is encountered without the unconditioned stimulus (eg. pain)
- conditioned stimulus no longer produces the conditioned response (fear).
- there is no option of avoidance behaviour, the individual therefore very quickly learns that the stimulus is harmless - extinction
- Sometimes, patients may achieve relaxation in the presence of the stimulus simply because they become exhausted by their own fear response.
1. bombarded by immediate exposure
2. prevent avoidance
3. reach extinction
56
Wolpe (1960)
helped a girl who had a phobia of cars by forcing her to get into the back of his car. He drove her around non-stop for four hours. Initially she was hysterical, however eventually she calmed down when she realised the situation was safe. From then on, she associated a sense of ease with cars and the phobia was gone.
57
similarities between flooding and systematic desensitisation
- both successful at breaking the connection (either through replacement or extinction)
- both involve exposure to the phobic stimuli
- both are behavioural treatments that prevent avoidance
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differences between flooding and systematic desensitisation
- exposure is immediate rather than gradual
- drop out (attrition) rates are higher for flooding, it also has higher non-start rates
- anxiety levels are higher for flooding
- relaxation emphasis (flooding has it as an end result rather than core part)
59
comparison of flooding and systematic desensitisation
- SD is gradual using agreed hierarchy (patient has more control)
- flooding is immediate
- relaxation are taught in SD and not in flooding
- systematic takes longer but is much gentler
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flooding and systematic desensitisation summary
SD:
- relaxation
- anxiety hierarchy
- gradual exposure
F:
- immediate exposure
- prevention of avoidance
- fear extinguished
61
evaluation of systematic desensitisation
+ supporting evidence eg. Lisa Gilroy et al. (2003) - usefulness
+ practical applications helping those with learning disabilities - often struggle with cognitive therapies, SD is gradual and gives them control
+ virtual reality can be used to aid exposure with reduced risk, eg. heights, it is also more cost effective
> could be argued that it lacks realism
62
Lisa Gilroy et al. (2003)
- followed up on 42 people who had a spider phobia treated with SD (3x45 min sessions)
- at both 3 and 33 months, the experimental group were less fearful than a control group treated with relaxation without exposure
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evaluation of flooding
+ flooding is cost-effective, it can work in as little as one session (in contrast to ten for SD)
- highly unpleasant experience (Sara Schumacher et al, 2015) - ethical issues and increased attrition
- potentially only masks the problem rather than treating the cause (symptom substitution)
64
how is OCD characterised?
- being an anxiety disorder
- sufferers experience persistent and intrusive thoughts occurring as obsessions (thinking) and compulsions (doing as a result of the thinking)
- most realise that their thinking and behaviour is excessive
- daily life is disrupted due to distress
- overlaps with other disorders and has therefore been questioned as an illness in its own right (comorbidity)
65
DSM-V specifics for OCD
There are two behaviours associated with OCD:
Obsessions - forbidden/inappropriate ideas/images not based on reality which lead to feelings of anxiety
Compulsions - intense/uncontrollable urges to repetitively perform tasks/behaviours, these are an attempt to reduce stress or prevent feared events
66
common obsessions and compulsions in OCD
Losing control (causing something bad to happen)
- checking appliances, doors, etc.
Contamination (germs, dirt, etc.)
- excessively washing hands/clothes/house compulsively
Harm ("I need to do this or someone is going to get hurt")
- counting (objects, letters, words, actions) and doing things multiple times
Perfectionism (wanting everything right/fear of losing something)
- re-ordering and hoarding
67
cognitive characteristics of OCD and examples
- Recurrent and persistent thoughts (obsessions) eg. thinking about germs
- Recognising self-generation and inappropriateness eg. knowing obsessions are self-invented and not based on external forces
- Attentional bias eg. thinking about the stimuli that evokes anxiety
68
emotional characteristics of OCD and examples
- Guilt and disgust eg. guilt over minor moral issues based on intrusive thoughts
- Accompanying depression eg. low mood
- Anxiety and distress eg. unpleasant emotional experience, can be frightening/overwhelming
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behavioural characteristics of OCD and examples
- Avoidance and social impairment eg. keeping away from anxiety triggering situations
- Repetitive behaviours (compulsions) eg. Washing hands because of an obsession with germs
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Lewis (1936)
- of his OCD patients, 21% had siblings with OCD, 37% had parents with it
> genetic/hereditary factor (however you share the same amount of DNA with parents as siblings so why is parents higher?)
> learning/copying parents - role models
71
genetic explanations for OCD
- thought to be partly down to genetics - suggesting that they predispose an individual to OCD rather than cause it
- Candidate genes
> Taylor (2013) suggested that there is up to 230 genes involved
- genes associated with action of mood regulating neurotransmitters eg. serotonin tend to be the focus of research
72
candidate genes
- identified (through extensive research) as creating a possible vulnerability to OCD
> Taylor (2013) suggested that there is up to 230 genes involved
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what does it mean to say that OCD is polygenic?
it has more than one origin (not just a single gene influencing vulnerability to the disorder)
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SERT
Serotonin Transporter Gene (5-HTT)
- a transporter protein responsible for removing excess serotonin from the synaptic cleft
- in a person with OCD, SERT removes too much, creating lower levels of serotonin
- lowered mood potentially accompanying depression
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COMT
Catechol-O-methyltransferase enzyme
- an enzyme that breaks down catecholamines in the synaptic cleft eg. dopamine and noradrenaline (makes them more easily recycled)
- low activity of the enzyme leading to heightened neurotransmitters in synaptic cleft
- too much noradrenaline - increased anxiety
- too much dopamine - the seeking of reward behaviours eg. compulsions
76
evaluation of the genetic explanation for OCD
+ supporting evidence is available and scientific (twin studies - if it was purely genetic, you'd expect a high concordance rate between MZ twins than DZ twins)
> Nestadt et al. (2010)
- too many candidate genes (can't predict OCD or do anything with the information, less practical value)
- there may be other non-biological factors involved (Diathesis-stress model)
77
Nestadt et al. (2010)
reviewed twin studies and found 68% of MZ twins shared the OCD diagnosis in contrast to 31% of DZ - this supports a strong genetic influence
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diathesis-stress model as an evaluation point for the genetic explanation for OCD
> more comprehensive explanation for OCD
> explains why some people have the COMT and SERT gene but do not develop OCD (whereas the biological model cannot)
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the diathesis-stress model (OCD)
- Certain genes leave some people more 'prone' to suffer a mental health disorder
- having these genes does not mean you will definitely develop a disorder
- environmental experience is necessary for 'triggering' a condition
80
neural explanations for OCD
Genes may affect:
A) levels of key neurotransmitters
B) structures of the brain
These two make up the neural explanation.
81
neurotransmitters
As nerve impulses reach the end of one neuron, a chemical message called a neurotransmitter is released. It travels from the pre-synaptic terminal to the post-synaptic terminal (one neuron to the next) via the synaptic cleft. There are many different types of neurotransmitters. Sometimes a neurotransmitter will trigger a receiving neuron to send additional impulses (excitation), other times it will prevent it from doing so (inhibition).
82
Serotonin (neurotransmitters as an explanation for OCD)
- many roles, including mood regulation, healthy sleep patterns, etc.
- levels are too low (mood and many mental processes are affected)
- abnormal transmission of mood which may explain accompanying depression in OCD
83
dopamine (neurotransmitters as an explanation for OCD)
- multi-functional eg. motivation, feelings of reward, etc.
- neuroimaging/chemical studies show the dopaminergic system to be involved in inducing/aggravating the symptoms of OCD
- levels may be associated with obsessive thoughts and/or reward seeking behaviour - compulsions
84
Basal Ganglia (OCD)
- involved in multiple processes (eg. motor movement, habit learning, cognition, emotion, etc.), it is believed to facilitate wanted and stop unwanted behaviours (including thoughts)
- people who suffer head injuries in this region often develop OCD-like symptoms
- explains obsessive thoughts
- Max et al. (1994)
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Max et al. (1994)
found that when the basal ganglia is disconnected from the frontal cortex during surgery, OCD-like symptoms are reduced
86
orbitofrontal cortex (OCD)
- converts sensory information into thoughts and actions
- one suggestion is that the heightened activity of the orbitofrontal cortex increases the conversion of sensory information into actions (or behaviours) which may result in compulsions
- explains compulsions and their repetitive nature, increased activity may prevent a person from stopping these behaviours
- PET scans have found higher activity in the orbitofrontal cortex in patients with OCD
87
evaluation of the neural explanation of OCD
+ success of drug treatments suggest neural involvement in OCD eg. SSRIs and their action on serotonin
- however, not all respond to drug treatments which casts doubt
- it is not clear which neural mechanisms are involved (neurotransmitters or brain function), neural mechanisms are not always presented in all cases
> overly simplified, incomplete/incomprehensive
> decreased credibility
- cannot assume cause and effect, neural differences could be causing OCD or caused by it
> decreases the explanatory power
88
areas of the brain that you need to be able to label
frontal lobes, occipital lobes, temporal lobes, parietal lobes
89
areas of the synapse you need to be able to label
pre-synaptic neuron
post-synaptic neuron
electrical impulse
vesicles
neurotransmitters
the synapse
reuptake
diffusion
enzymes
receptors
90
drug therapies as a treatment for OCD
- generally the first point of call for mental illnesses
- considered palliative rather than curative (treat and easy symptoms rather than combatting the cause of an illness)
- primarily work on the brain but some other body systems can be targeted
- often intended as short-term however - due to an average 80% relapse rate - many people remain on drug therapy for extensive periods of time, sometimes life
91
three categories of drug treatments for mental disorders
1. anti-psychotics
2. anxiolytics
3. anti-depressants
Only anti-depressants that potentially inhibit presynaptic reuptake of serotonin appear to be effective in treating OCD.
92
re-uptake definition
the process in which neurotransmitters are naturally reabsorbed back into the presynaptic neuron
93
SSRIs
prevent 'reuptake' so the neurotransmitter stays (at least temporarily) in the synaptic gap, keeping levels higher which could improve communications between the neurons and strengthen circuits in the brain which regulate mood
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Selective Serotonin Reuptake Inhibitors
- newest, most used form of anti-depressants
- started to be used in the 1980s
- eg. Fluoxetine (or Prozac)
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SSRIs - how they work
They work by blocking reuptake of serotonin allowing higher levels to be left within the synapse. Continued stimulation of the post-synaptic neuron is thought to compensate for low serotonin levels.
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SSRIs - dosage
SSRIs generally take 2-8 weeks to work (up to four months). They can be taken in liquid or capsule form with a common dosage of 20mg. Usually an individual would be required to take one a day and begin on the lowest possible dose. Through trial and error and careful tweaking/monitoring under medical supervision, an individual might end up on 60mg a day before they see benefits.
97
what can be used when SSRIs don't work?
individuals may find relief in older or slightly different drugs eg. Tricylics (an older, more dangerous class of anti-depressant) or Serotonin Noradrenaline Reuptake Inhibitors (SNRI).
98
Serotonin Noradrenaline Reuptake Inhibitors
- first used in the 1990s eg. Venlaflaxine (AKA Efexor)
SNRIs do much the same job as SSRIs but target Noradrenaline reuptake alongside serotonin. We aren't entirely sure why these work when SSRIs do not.
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SNRIs - dosage
In general, SNRIs take 4-6 weeks to work. The usual dosage is 75mg to be taken with food daily. If necessary, a doctor may gradually increase this to a maximum of 375mg.
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side effects of SSRIs/SNRIs
- agitation, dizziness, headaches, insomnia, sexual dysfunction, constipation, loss of appetite, stomach pains, suicidal thoughts, wish to self harm, etc.
Serotonin syndrome: confusion, muscle twitching, sweating, shivering, diarrhoea, etc.
101
how is depression characterised?
- an affective mood disorder involving lengthy disturbance of emotions persistently present in everyday life
- low mood and low energy levels
- a disorder that can occur in cycles with each episode generally lasting from 2-6months
- endogenous - relating to internal biochemical and hormonal factors
- exogenous (reactive) - relating to stressful experiences
- usually begins between 20-40 years of age
102
sub-divisions of depression
There are two major sub-divisions that can be split further:
1. Unipolar depression
2. Bipolar depression
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unipolar depression
occurs without mania therefore sufferers only experience depression and not manic episodes. usually occurs in cycles and in severe cases patients experience delusions
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bipolar depression
less common than unipolar. Characterised by mixed episodes of mania and depression, though mania can occur without depressive phases
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cognitive characteristics of depression
- absolutist thinking
- dwelling on the negative
- poor concentration
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emotional characteristics of depression
- lowered self-esteem
- anger
- lowered mood
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behavioural characteristics of depression
- self-harm and aggression
- activity levels
- disruption to sleep and eating
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Beck's understanding of depression
- some are more prone than others to depression
- the manner in which our cognitions function, make this vulnerability
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Beck's explanation for depression
1. Faulty information processing
2. Negative self schemas
3. The Cognitive Triad
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Beck - faulty information processing
- when depressed we attend to the negative aspects of a situation and ignore positive, we also tend to blow small problems out of proportion and think in 'black and white' terms
> minimisation (belittling successes)
> maximisation (failure is given important no matter how trivial)
> selective abstraction (focusing on the negative)
> absolutist thinking
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Beck - negative self schemas
- the package of information we have about ourselves that we use to interpret the world, meaning if it is negative we interpret all information about us in a negative way
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Beck - the cognitive triad
- a person develops a dysfunctional view of themselves because of three types of negative thinking that occur automatically, regardless of the reality of the events.
A) Negative view of the world (creates the impression that there is no hope anywhere)
B) Negative view of the future (reduces hopefulness)
C) Negative view of the self (confirms existing low self-esteem)
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Evaluation of Beck's explanation for depression
+ good supporting evidence eg. one study of pregnant women before and after birth for cognitive vulnerability and depression, they found that women who had been judged to have high cognitive vulnerability were more likely to suffer post-natal depression
+ practical applications (CBT) - cognitive aspects of depression can be identified and challenged, especially the negative triad
- doesn't explain all aspects of depression (eg. anger, hallucinations, etc.)
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Ellis' understanding of depression
- poor mental health results from irrational thoughts
- not illogical or unrealistic but interfere with happiness and freedom from pain
- how irrational thoughts actually affect our behaviour
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Ellis' ABC model for depression
A - Activating event (experience negative events which trigger irrational beliefs)
B - Belief:
Musturbation - belief that we must always succeed
I-can't-stand-it-itis - belief that it is always a major disaster whenever something does not go smoothly
Utopianism - life is always meant to be fair
C - Consequences (emotional and behavioural consequences eg. depression)
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evaluation of Ellis' model for depression
+ has practical applications in CBT - by challenging irrational beliefs, a person can reduce their depression (its success also supports the theory)
- partial explanation (only applies to reactive depression)
- doesn't explain all aspects of depression such as anger, hallucinations, delusions, etc.
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CBT treatment for depression
- change a person's negative schema/automatic negative thoughts/irrational thoughts
- therefore alleviating the depression they are experiencing
- ideas is that thoughts, feelings, and behaviours are all interrelated
- CBT gains both a behavioural and cognitive change by treating the thought processes behind behavioural choices
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behavioural activation
gradually reduce the avoidance and isolation that a person might have been experiencing by encouraging activities that have shown to improve mood eg. exercising
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Beck's cognitive therapy
- focuses on present experience and challenges negative and irrational thoughts through:
> "Thought Catching"
> "Patient as a scientist"
> "Cognitive Restructuring"
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"thought catching"
- Beck's cognitive therapy
- identifying and monitoring automatic negative or irrational thoughts eg. by identifying a person's negative triad
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"patient as a scientist"
- Beck's cognitive therapy
- involves reality testing of the negative beliefs in the same way a scientist would test a hypothesis.
- homework tasks:
1. generating hypotheses to reality test irrational thoughts
2. gathering data
3. keeping daily records to monitor events and identify trigger situations
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"cognitive restructuring"
- Beck's cognitive therapy
- providing a more rational interpretation of experiences/behaviour and reinforcing these positive thoughts
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Ellis' Rational Emotive Behavioural Therapy
- abcDE: Dispute irrational beliefs, Effective new beliefs
- Dispute involves "rational confrontation" in which a therapist challenges underlying irrational beliefs
- used a few techniques to do this
1. Empirical arguments
2. Logical arguments
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empirical vs logical arguments (Ellis)
Empirical - disputing whether there is evidence to support the negative beliefs
Logical - disputing whether the negative thought logically follows the facts that have been presented
