Psychopathology Flashcards
(8 cards)
four definitions of abnormality
Statistical infrequency:
+ive RWA: A strength of statistical definition is it has real-life application in diagnosis of intellectual disability disorder. There is place for statistical infrequency in thinking about what are normal and abnormal behaviours and characteristics. All assessment of patients with mental disorders includes some kind of measurement of how severe symptoms are as compared to statistical norms (as distinct from social norms). Statistical infrequency is thus useful part of clinical assessment.
-ive Stigma: Another problem with statistical infrequency is that, where someone is living happy fulfilled life, no benefit to them being labelled as abnormal regardless of how unusual they are. Someone with very low IQ but who was not distressed, quite capable of working, etc., would simply not need a diagnosis of intellectual disability. If that person was ‘labelled’ as abnormal, might have negative effect on way others view them and way they view themselves.
Deviation from social norms:
+ive RWA: A strength of DSN definition is it has real-life application in diagnosis of antisocial personality disorder. Therefore there is a place for deviation from social norms in thinking about what is normal and abnormal. But even in this case there are other factors to consider, e.g. distress to other people resulting from APD (FFA) which means that in practice, DSN is never the only reason for defining abnormality.
-ive Cultural relativism: Problem with using DSN to define behaviour as abnormal is that social norms vary generationally and culturally. This means for example, that a person from one cultural group may label someone from another culture as being abnormal according to their standards rather than standards of person behaving that way. E.g. hearing voices is socially acceptable in some cultures but would be seen as sign of mental abnormality in UK. /this clearly creates problems for people from one culture living within another culture group and can lead to the overdiagnosis of e.g) Schizophrenia (Sz) for people of certain cultures.
Failure to function adequately:
+ive Patient’s perspective taken: One strength of FFA is it does attempt to include the personal experience of the individual. Although it is difficult because distress is hard to assess (e.g delusions in Sz) but at least this definition acknowledges that the experience of patient (and/or others) is important. In this sense FFA definition captures experience of many of people who need help which suggests FFA is useful criterion for assessing abnormality.
-ive Subjective judgements: One issue with FFA is that someone has to judge whether patient is distressed or distressing. Some patients may say they are distressed but may be judged as not suffering. Methods for making such judgments as objective as possible, including checklists like Global Assessment of Functioning Scale. However, principle remains someone (e.g. a psychiatrist) has right to make judgement and this can lead to inconsistencies and poor reliability in diagnosis
Deviation from ideal mental health:
+ive Comprehensive definition: Strength of deviation from ideal mental health is it is very comprehensive. Covers broad range of criteria for mental health. Probably covers most reasons someone would seek help from mental health services or be referred for help. This is important because a range of factors discussed in relation to Jahoda’s ideal mental health make it good tool for thinking about mental health and earlier diagnosis.
-ive Unrealistic standard: One issue is that few people attain all Jahoda’s criteria for mental health, and few achieve all of them simultaneously. Approach would see everyone as abnormal. This though makes it clear to people ways in which they could benefit from treatment — like counselling — to improve mental health. However, clearly has limited value in thinking about who might benefit from treatment against their will.
behavioural, emotional, cognitive charactesistics of phobias, OCD, depression
Phobias:
Behavioural: avoidance; however, if a person is unable to avoid their phobia, this causes panic, which may result in crying, screaming or running away. Endurance: is sometimes possible if they have to put up with and tolerate the phobia.
Emotional: excessive and unreasonable fear and anxiety.
Cognitive: selective attention and irrational beliefs
Depression:
Behavioural: loss of energy (avolition), disturbances with sleep, changes in appetite and self harm.
Emotional: low mood, feelings of sadness, and feelings of worthlessness.
Cognitive: poor concentration and difficulties with attention; cognitive characteristics also include negative thinking finding the worst things in the situation.
Obsessive Compulsive Disorder:
Behavioural: compulsions
Emotional: anxiety and distress caused by obsessions
Cognitive: obsessive thoughts ; this also includes the knowledge the behaviour and beliefs are irrational.
Behavioural explanation of phobias (A03)
-ive Safety a better explanation: There is evidence to suggest that at least some avoidance behaviour appears to be motivated more by positive feelings of safety instead of anxiety reduction. Agoraphobia is not to avoid phobic stimulus but because house is safe. Explains why some patients with agoraphobia are able to leave house with trusted person with relatively little anxiety but not alone (Buck, 2010). This is clearly a problem for the two-process model, which suggests that avoidance is motivated by anxiety reduction.
-ive Preparedness: One big issue for TPM are that it can’t explain how people easily acquire phobias of things that have been source of danger in evolutionary past, like snakes or darkness. These are adaptive (aided survival for ancestors) so Seligman (1971) called this biological preparedness — an innate predisposition to acquire certain fears. However, quite rare to develop fear of cars or guns, which are actually much more dangerous today. This is a problem for TPM, shows there is more to acquiring phobias than simple conditioning.
-ive Cognition not accounted for: One issue with behavioural explanations of phobias is that they do not account for the thought processes and perceptions that clearly have an impact on phobics. Catastrophic thinking like ‘it will kill me (spider)’ clearly feeds back on emotions and behaviour. CBT addresses faulty thinking and can help in many cases, therefore suggesting that learning and reinforcement alone can’t solely explain phobias.
+ive RWA: A massive strength of TPM is that it has been used as the basis for exposure therapies. It clearly explains how phobias could be maintained over time, which is why patients need to be exposed to feared stimulus. Once patient is prevented from their avoidance behaviour the behaviour ceases to be reinforced practicing and so it declines. The effectiveness of these therapies is clearly support for the theory as a whole and continues to benefit people everyday who were previously trapped by their fears.
behavioural treatments of phobias (A03)
+ive Effective: One supporting study by Gilroy et al. (2003) followed up 42 patients who had been treated for spider phobia in three 45-minute sessions of SD. Spider phobia was assessed on several measures including Spider Questionnaire and by assessing response to spiders. Control group was treated by relaxation without exposure. At both three months and 33 months after treatment SD group were less fearful than relaxation group. Strength because shows SD is helpful in reducing anxiety in spider phobia and that effects are long-lasting.
-ive Fail on social phobia: One issue with flooding is that it appears to be less effective for more complex phobias e.g. social phobias. This may be because social phobias have cognitive aspects. E.g. sufferer of social phobia does not simply experience an anxiety response but thinks unpleasant thoughts about social situation. Type of phobia may benefit more from cognitive therapies because such therapies tackle the irrational thinking.
+ive Cheap: Flooding is at least as effective as other treatments for specific phobias. Studies comparing flooding to cognitive therapies (such as Ougrin 2011) found flooding is highly effective and quicker than alternatives. This quick effect is strength because it means that patients are free of their symptoms as soon as possible and that makes the treatment cheaper.
+ive Suitable for a range of patients: Flooding and cognitive therapies are not well suited to some patients. E.g. some sufferers of anxiety disorders like phobias also have learning difficulties. Learning difficulties can make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies that require the ability to reflect on what you are thinking. For these patients systematic desensitisation is probably the most appropriate treatment.
cognitive explanations of depression (A03)
+ive Triad support: There is a range of evidence supports idea depression is associated with faulty information processing, negative self-schemas and cognitive triad of negative automatic thinking. E.g. Grazioli (2000) assessed 65 pregnant women for cognitive ability and depression before and after birth and found those judged to have high in cognitive vulnerability were more likely to suffer post-natal depression. This is important because cognitions can be seen before depression develops, suggesting that Beck may be right about cognition causing depression, at least in some cases.
-ive Limited explanation of ABC: One issue with Ellis’ theory is that it’s a partial explanation. Whilst it’s clear that some cases of depression follow activating events. Psychologists call this reactive depression and see it as different from the kind of depression that arises without an obvious cause. This is important because it means that his explanation only applies to some kinds of depression and is therefore only partial explanation.
-ive One issue for both theories is that they can’t explain all types of depression. E.g) some depressed patients are deeply angry and the theories struggle to explain this. Rarely patients may get Cotard syndrome: delusions they are zombies (Jarrett 2013), and although Ellis explains why some people appear to be more vulnerable to depression they don’t easily explain these unusual symptoms which is a weakness of both models.
+ive RWA: One of the strengths of both theories is that they have practical application in CBT. Elements of both are used where aspects of depression can be identified and challenged. This means therapist can challenge and encourage patient to test whether they are true. Which is a strength as it is the main therapy for depression on the NHS, supporting the cognitive basis of depression.
cognitive treatments of depression (A03)
-ive Minimises circumstance and past events: One issue with CBT is that its emphasis on what‘s happening in mind of individual patient CBT does not account for the environment in which patient is living (McCusker 2014). For example, poverty or abuse can’t be changed in the mind of the patient so CBT techniques used inappropriately can demotivate people to change their situation.
+ive Effective: A strength of the treaments is that they are effective. A study by March et al (2007) compared the effects of CBT with antidepressant drugs and combination of two in 327 adolescents with main diagnosis of depression. After 36 weeks 81% of CBT group, 81% of antidepressants group and 86% of CBT plus antidepressants group were significantly improved. Thus CBT emerged as just as effective as medication and helpful alongside medication. This suggests there is good case for making CBT first choice of treatment in public health care systems like NHS.
-ive Therapist-patient relationship?: Some have criticized all face to face therapies on the basis that differences between different methods might actually be quite small and that the therapist-patient relationship creates the effect not the methods. This means the quality of this relationship determines success rather than particular technique that‘s used. The small differences in comparison studies potentially suggests the view that simply having opportunity to talk to someone who will listen could be what matters most.
-ive Less effective for intractable cases: A big issue with CBT is that for those with severe avolition or long term intractable depression it is very difficult to engage in the discourse that is needed to make the therapy effective. This means that often long courses of drug therapies, ECT or newer therapies such as psychedelics may be the only course prior to accessing cognitive therapies which might then alter long term thinking.
biological explanations of OCD (A03)
+ive Genetic supporting evidence: reviewed previous twin studies and found 68% of identical twins shared OCD as opposed to 31% of non-identical twins which strongly suggests genetic influence on OCD. PealH.. However issues with family studies and particularly twin studies
+ive Neural evidence support: Evidence to support a serotoninergic neural basis for OCD comes from E.g. some antidepressants work purely on serotonin system, which are effective in reducing OCD symptoms and suggests serotonin system is involved in OCD. Evidence for the overactivity in brain areas such as the basal ganglia and PFC come from a range of brain scanning studies, using controlled lab studies to show differences under lab conditions also supporting a neural basis of OCD.
-ive: Studies of decision making have shown similar neural systems function abonormally in OCD (Cavedini et al. 2002). However other research research has identified other brain systems that may also be involved but the results are inconclusive. We cannot therefore really claim to understand the neural mechanisms involved in OCD.
-ive Biological and environmental combo: environmental factors can also trigger or increase the risk of developing OCD E.g. Cromer et al. (2007) found over half OCD patients in their sample had traumatic event in past, and OCD was more severe in those with more than one trauma. This suggests that OCD cannot be entirely genetic in origin.
biological treatments for OCD (A03)
+ive Cost-effective and non-disruptive; One advantage of drug treatments in general is they are cheap compared to psychological treatments. Using drugs to treat OCD is therefore good value for public health system like National Health Service. As compared to psychological therapies, SSRIs are non-disruptive to patients’ lives. If you wish, you can simply take drugs until your symptoms decline and not engage with hard work of psychological therapy which means that doctors and patients like drug treatments.
-ive Side effects: Although drugs like SSRIs are often helpful to sufferers of OCD, significant minority will get no benefit. Some patients also suffer side-effects like indigestion, blurred vision and loss of sex drive. Side-effects are usually temporary. Over one in ten patients can get tremors and weight gain.
+ive Supporting effectiveness: Soomro et al. (2009) reviewed studies comparing SSRIs to placebos in treatment of OCD and concluded that all 17 studies reviewed showed significantly better results for SSRIs than for placebo conditions. However, effectiveness is greatest when SSRIs are combined with psychological treatment, usually CBT suggesting an interactionist approach to treatment is the most beneficial.
-ive Suppressing symptoms not cure: Although SSRIs are fairly effective and any side-effects will probably be short term, there is often relapse when they are stopped which suggests they are supressing symptoms and not addressing the cause.
