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55 Cards in this Set

  • Front
  • Back

What are the seven criteria for abnormal behaviours?

Rosenhan and Seligman (1984)


1. Suffering - distress and discomfort


2. Maladaptiveness - behaviour that makes life more difficult for themself


3. Irrationality - unable to communicate in a reasonable manner


4. Unpredictability - actions that are unexpected


5. Vividness or unconventionality - experience things differently


6. Observer discomfort - actions that make observers embarrassed or uncomfortable


7. Violation of moral or ideal standards - habitual breaking of accepted ethical and moral standards of the culture

Define the mental health criterion

Jahoda (1958)


1. Efficient self-perception


2. Realistic self-esteem and acceptance


3. Voluntary control of behaviour


4. True perception of the world


5. Sustaining relationships and giving affection


6. Self-direction and productivity

Outline the mental illness criterion

Psychological disorders are viewed as psychopathology (illness of the psyche), and can thus be treated with medicine.

Evaluate the mental illness criterion

1. Being diagnosed as "sick" shows people are not responsible for their actions (good)


2. There is a stigma associated with mental illness (bad)


3. It is not always possible to identify the biological correlates of mental illness (bad)

Outline some ethical concerns in the mental illness criterion/ the medical model

Since responsibility is removed from the patient, the model may be misused under the influence of culture and politics.


- Political dissidents in the former Soviet Union diagnosed as schizophenic


- In the last century, women pregnant outside of marriage could be placed in asylums

Evaluate the theory of abnormality as deviation from social norms

- Not objective or stable, since it is related to socially based definitions that change across time and culture.


- Could lead to discrimination against minorities with mental illnesses


- It is impossible to set universal standards for abnormal behaviour

Define diagnosis

Identifying and classifying abnormal behaviour on the basis of


- Clinician's observations


- Patient's self-reports


- Clinical interviews and tests


- Diagnostic manuals


- Information from relatives

Define reliability of diagnosis

Clinicians should be able to reach the same correct diagnosis consistently if they use the same diagnostic procedure.


Reliability is improved by standardised clinical interview schedules and manuals.

Copper et al.


1972

Aim:


Investigate reliability of diagnosis of depression and schizophrenia




Procedure:


American and British psychiatrists were asked to diagnose patients by watching videotaped clinical interviews.




Results:


British psychiatrists were twice as likely to diagnose the patients to be clinically depressed, while American psychiatrists were twice as likely to diagnose schizophrenia. This indicates problems of reliability as well as cultural differences in interpretation of symptoms.




Reliability of diagnosis

Rosenhan


1973

Aim:


To test reliability of psychiatric diagnoses




Procedure:


Field experiment - five men and three women, all healthy gained admission to 12 different psychiatric hospitals, complaining that they heard unclear and unfamilar voices of the same sex, saying "empty", and "thud". 7 of them were diagnosed with schizophrenia, and as soon as they were admitted, they said symptoms had stopped. It took an average of 19 days for them to be released, with the label "schizophrenia in remission". This showed that normal people could be classified as abnormal.




Rosenhan then told a hospital that he would send pseudo-patients to try to gain admission. No pseudo-patients were sent, but 41 real patients were judged to be pseudo-patients with great confidence by at least one staff member. 19 of these were suspected of being frauds by one psychiatrist and another staff member.




This illustrates the lack of scientific evidence on which medical diagnoses can be made.




Reliability of diagnosis and ethics in diagnosis, as well as confirmation bias

Outline the ABCS

Affective: emotional elements, like fear, sadness, anger


Behavioural: observational behaviours, like crying, physical withdrawal from others, pacing


Cognitive: Ways of thinking, like pessimism, personalization, self-image


Somatic: physical symptoms, like facial twitching, stomach cramps, amenorrhoea

Define validity in diagnosis

The extent to which the diagnosis is accurate. For a classification system to be valid, it should be able to classify a real pattern of symptoms which can lead to an effective treatment.

Define overpathologization

When a person is diagnosed a certain way because the group they are a member of is more prone to that diagnosis.

Outline ethical concerns in diagnosis

1. Social stigma against people with a diagnosis; a diagnosis leaves people with a label for life (disorder in remission)


2. Self-fulfilling prophecy, people may begin to act as they think they are expected to, leading to an increase in symptoms. (Scheff 1966)


3. If the diagnosis is not correct, it will lead to incorrect treatment (validity). This raises concerns of bias in diagnosis.

Doherty


1975

Those who reject a mental illness label recover more quickly than those who accept it.




(Self-fulfilling prophecy/ethics in diagnosis)

Langer and Abelson


1974

Aim:


To test social perception of mental illnesses




Precedure:


Showed a videotape of a younger man telling an older man about his job experience.




Results:


Participants who were told the man was a job applicant described him as attractive and conventional-looking. If they were told he was a patient, he was described as tight, defensive, dependent, and frightened of his own agressive impulses.




Stigma/ ethics in diagnosis

Jenkins-Hall and Sacco


1991

Aim:


Study the effect of client race and depression on evaluations by European-American therapists.




Procedure:


European-American therapists were asked to watch a video of a clinical interview and evaluate the female patient. The patient was either depressed or non-depressed, and European American or African American.




Results:


Their ratings of the non-depressed women did not differ much. However, they rated the depressed African American woman with much more negative terms, and saw her as less socially competent that the depressed European American woman.




Bias in diagnosis

Outline confirmation bias in diagnosis

Clinicians believe that if a patient consults them, there must be a disorder to diagnose. (Rosenhan)

Outline cultural concerns in diagnosis

1. Cultural groups have different attitudes to disorders that might influence the reporting of symptoms (e.g. due to stigmatisation)


2. Different cultures may express distress in different ways, leading to different symptoms


3. There may be disorders that are specific to a certain culture (culture-bound syndromes)

Outline the case study of Neurasthenia

Neurasthenia is a common Chinese diagnosis signifying a "weakness of the nerves". Could be seen as a Chinese variation of depression that is less stigmatising in Chinese culture because it is more focused on bodily symptoms (exhaustion, sleep problems, concentration difficulties, headaches, lower back pain).


This means that Chinese people with mood disorders in foreign countries may be misdiagnosed. They seek help for the physical aspects of their illness, but try to sort out emotional distress within their family.

Define reporting bias

Diagnostic data is based on admission statistics, which may not be accurate due to the heightened stigma around mental illnesses in some countries, like India or China. Low admission rates can also reflect on a minority's limited access to healthcare.

Define somatization

The bodily symptoms of a psychological dysfunction.


High rates of somatization are found in collectivist cultures, where symptoms such as headaches are dominant. This means that there are real differences between cultures in symptoms of disorders.

Define culture blindess

Diagnosis is difficult if the symptoms of a disorder are not the norm in the clinician's culture.


If a member of a minority ethnic group shows the same symptoms as a British person with depression, they might be diagnosed with depression, even though it may not actually be the case.

List the ABCS of major depressive disorder

A: Feelings of guilt and sadness, anhedonia


B: Passivity, lack of initiative


C: Negative thoughts, faulty attribution of blame, low self-esteem, suicidal thoughts, irrational hopelessness, difficulties in concentration and decision-making


S: Loss of energy, insomnia or hypersomnia, weight loss or gain, diminished libido

Outline the prevalence of major depressive disorder

Lifetime prevalence rate: 15%


Two to three times more common in women than in men, and occurs more frequently in members of lower socio-economic groups.


Most frequent among young adults.




80% of people experience a second episode, each episode lasting 3 to 4 months. The average number of episodes is 4, and in 12% of cases, depression becomes a chronic disorder with a duration of about 2 years.

Nurnberger and Gershon


1982

Reviewed the results of 7 twin studies and found the average concordance rate for major depressive disorders was 65% for MZ twins and only 14% for DZ twins. This indicates a genetic predisposition to depression.


(Biological factors in depression)

Janowsky et al.


1972

Participants were given a drug called physostigmine and experienced feelings of self-hate and thoughts of suicide within minutes.

Describe the serotonin hypothesis

The idea that low levels of the serotonin neurotransmitter causes depression. Anti-depressants often block the reuptake process of serotonin

Evaluate the serotonin hypothesis

1. Depression may cause abnormal levels of neurotransmitters, and not the other way around


2. Scientific research has failed to show a clear link between serotonin levels and depression

Kirsch et al.


2002

Found a publication bias in research on the effectiveness of serotonin reuptake blockers.


If all articles, including unpublished ones, were taken into account, the placebo effect accounted for 80% of the anti-depressant response.


Of the articles funded by pharmaceutical companies, 57% failed to show a significant difference between placebos and anti-depressants.

Outline the cognitive style theory (Ellis)

Psychological disturbances come from irrational and illogical thinking.


People draw false conclusions based on dubious evidence, leading to feelings of anger, anxiety, or depression.


Irrational belief: "My work must be perfect"


Observation: "My last essay did not recieve top grades"


Conclusion: "I must be stupid"

Outline Beck's theory of cognitive distortions

Biases in information processes based on:


- overgeneralisation and exaggeration


- non-logical inferences about the self (similar to cognitive style theory)


- dichotomous (black-or-white) thinking


- personalization (assumption that others' behaviour is intentionally against you)




Related to schema theory

Alloy et al.


1999

Tested Americans in their twenties on their thinking style (positive or negative), and then followed them for 6 years. After 6 years, 1% of those in the positive thinking group had developed depression, compared to 17% of the negative thinking style group.


Indicates that there may be a link between cognitive style and development of depression.

Brown and Harris


1978

Study concerning the social origins of depression in women. Of 458 women in London, 8% had been depressed in the past year. Of these, 90% had experienced an adverse life event (like being working class, lack of social support, more than 3 children under 14). However, only 22% of women who had had an adverse life event developed depression.




(Used for the diathesis-stress model)

Outline the diathesis-stress model of depression

Depression is caused by a genetic predisposition, which is then triggered by a stressful event.

What are the main gender considerations in depression?

1. Men are less likely to come forward with symptoms because of the stigma against showing emotions.


2. Women are more likely to be exposed to violence, a predisposition for depression


3. Women's social roles are largely looked down on and unappreciated, and women often experience constrained choices, sexual abuse, and lack of respect.

Outline the biomedical treatment of depression

Based on the assumption of biological malfunctioning, so the cure is to restore the biological system with drugs.


Serotonin hypothesis: anti-depressants aim to regulate serotonin levels

Neale et al.


2011

Meta-analysis of published studies on the outcome of anti-depressants versus placebo.




1. patients who swapped from anti-depressants to placebo


2. patients who only recieved placebo


3. patients who only recievec anti-depressants




Patients who did not take anti-depressants had a 25% higher rick of relapse, compared to 42% who had been on medication and then stopped.




This indicates that anti-depressants may interfere with the brain's natural self-regulation, reducing symptoms short-term, but increase the risk of relapse when the drug is stopped, because the brain has become used to not having to supply the serotonin levels itself.

Kleinman


1982

Aim:


Invetigate if neurasthenia in China could be similar to depression DSM-III




Procedure:


Interviewed 100 patients diagnosed with neurasthenia using structured interviews based on DSM-III criteria.




Results:


87% of patients could be classified as suffering from depression, 90% complained of headaches, 78% of insomnia, 73% of dizziness, and 48% of various pains. Only 9% stated depressed mood.




Shows one of the concerns in cross-cultural diagnosis.

Outline cognitive behavioural therapy

Linked to Beck's theory of cognitive distortions.


1. Identify and correct faulty cognitions and unhealthy behaviour (false beliefs are challenged)


2. Increase activity such as sport or meeting people, and learn alternate problem solving strategies

Paykel et al.


1999

158 patients who had experienced one episode of major depression recieved anti-depressants, and some of them also recieved cognitive behavioural therapy. The group who did not recieve CBT relapsed 3 times as often as those who did.

Outline biomedical treatment for PTSD

1. Antidepressants, since many PTSD patients also suffer from depression


2. Tranquilizers, in order to regulate anxiety levels

Outline the use of individual treatment of PTSD

Cognitive Behavioural Therapy with a focus on slowly reexposing them to their trauma. Goals:


- Create a safe environment that shows the trauma cannot hurt them


- Show that remembering the trauma is not the same as experiencing it again


- Show that anxiety is alleviated over time


- Acknowledge that experiencing symptoms does not lead to a loss of control




Patients may initially become worse in the first stages of therapy, and therapists themselves could become upset by the patient's story.

Outline traumatology

The practice of intervention based on knowledge of how people react in traumatic situations. Crisis intervention has the goal of preventing PTSD by sending teams of psychologists to the scene to help survivors and witnesses.


However: The majority of people who experience trauma never develop PTSD, and survivors may be more helped by familiar support (family and friends) than by strangers right after the event. Crisis intervention may even help make memories of the event more concrete rather than removing them.

Outline testimonial psychotherapy

Deactivating networks of fear in the psyche by creating an oral history archive to collect, study, and disseminate the survivors' memories. This gives meaning to the experience of the survivor , and allows them to consider how their experience has affected their current lives.

Weine


1998

Bosnian refugees: patients were diagnosed using the PTSD symptom scale which had been translated into Bosnian. The patients gave testimonies which were translated into English and then back, in order to correct mistakes and add new recollections and details. The final document was signed by the survivor to verify its accuracy. Since Bosnians view trauma as a matter of collective as well as individual experience, testimonial psychotherapy should work well.

Friedman and Schnurr


1996

325 veterans.


Psychoeducational groups (anger and axiety management and conflict resolution) helped veterans in later, more intensive group therapy. This was followed by trauma-focused therapy (exposure to memories, cognitive restructuring, and coping skills). This was compared to a group that only discussed daily issues without addressing the trauma. More people left the trauma-focused group, but those who worked through the trauma improved more than the non-trauma group.

State the ABCS of PTSD

Affective: anhedonia, emotional numbing


Behavioral: hypervigilance, passivity, nightmares, flashbacks, exaggerated startle response


Cognitive: intrusive memories, inability to concentrate, hyperarousal


Somatic: lower back pain, headaches, stomach aches and digestion problems, insomnia, regression in some children, loss of already acquired developmental skills such as speech or toilet training

Outline the prevalence of PTSD

Prevalence rate: 1-3%


Lifetime prevalence: 5% in men, 10% in women


It affects 15 to 24% of people who are exposed to traumatic events.


3% of those who experience a personal attack, 20% of wounded veterans, and 50% of rape victims develop PTSD.


The most common cause is the loss of a loved one.

Outline the biological factors of PTSD

Hauff and Vaglum (1994):


Twin research has shows that a possible predisposition for PTSD is genetical


Geracioti (2001):


- noradrenaline, a neurotransmitter which plays an important part in emotion arousal


- Higher levels in PTSD patients


- stimulating adrenal system in PTSD patients induces panic attacks in 70% and flashbacks in 40%


- PTSD patients have increased sensitivity noradrenaline receptors

Outline the cognitive factors of PTSD

People with self-blaming thinking patterns are at higher risk

Sutker et al.


1995

Gulf war veterans who had a sense of purpose and commitment to the military had a lower risk of suffering from PTSD

Outline the cognitive factors of PTSD

- Racism and opression may lead to a predisposition for PTSD


- fear of rape could also be a factor that gives predisposition of PTSD (73% of girls and 35% of boys suffered from PTSD in Bosnia)


- kids might develop PTSD from observing domestic violence

Roysircar


2000

20.6% of black and 27.6% of hispanic veterans met the criteria for PTSD, compared to only 13% of whites.

Geracioti


2001

Found that PTSD patients had higher levels of noradrenaline than average. Stimulating the adrenal system in PTSD patients induced a panic attack in 70% of patients, and flashbacks in 40%. No control group experienced these symptoms.