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1. Module 4 Psychopathology Name ................................................................................................................ The learning objectives…
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  • 1. Module 4 Psychopathology Name ................................................................................................................ The learning objectives for this topic are: • Understand issues surrounding the classification and diagnosis of depression. • Describe the clinical characteristics of depression. • Describe and evaluate biological explanations of depression. • Describe and evaluate psychological explanations of depression. • Describe and evaluate biological therapies for depression. This booklet • Describe and evaluate psychological therapies for depression. 1|Page
  • 2. Biological Therapies Drug Therapy Drug therapy (also known as chemotherapy) is the most widely used treatment for depression. Effective drugs were rapidly developed in the 1960s with 3 main groups of antidepressants proving successful. Make notes on these 3 main antidepressants;  Monoamine-oxidase inhibitors (MAOIs)  Tricyclic antidepressants  Selective serotonin reuptake inhibitors (SSRI’s) 2|Page
  • 3. Commentary In the exam you will be asked to evaluate the treatments in terms of their effectiveness (do they work?) and their appropriateness (should they be used?) Effectiveness Appropriateness Monoamine- oxidase inhibitors (MAOIs) Tricyclic antidepressants Selective Fisher and Greenberg (1995) • Suicide (Prozac) serotonin o Steiner (1991) reuptake inhibitors (SSRI’s) o Geoffrey (1991) General Drug Therapy • Reducing severe symptoms • Treating symptoms not causes • Drugs & Psych Treatments • Children & Adolescents 3|Page
  • 4. Extension activity Read about the Prozac phenomenon in Gross on page 322 and the newspaper articles about the Prozac nation. http://news.bbc.co.uk/1/hi/health/7264460.stm Electro-convulsive shock therapy (ECT) The original rationale for ECT was as a treatment for schizophrenia and depression based on research by Sakel in the 1930s. He found that when he injected insulin into schizophrenic patients inducing convulsions and a coma some of them improved! ECT was first introduced in the 1930’s and was frequently misused causing physical and emotional damage. Patients are first given a muscle relaxant and sedative then electrodes are placed on their temple/s and an electric current of 70-150 volts is passed through the brain for 0.04-1 second. This causes a convulsion that lasts around a minute. Typically 2-3 treatments are given a week for 3-4 weeks. There are two forms of ECT: BILATERAL and UNILATERAL. Current passed through Current only passed through Both hemispheres One hemisphere There is no one accepted explanation of how ECT works, but the most popular is that it increases the availability of serotonin in the brain. The use of ECT began to decline with the introduction of anti-depressants in the 50s and 60s. However it is still used today but in much safer and controlled conditions. In England and Wales in 1999 11,340 patients were treated with the technique. These days it is no longer seen as an effective treatment for schizophrenia but is successfully used for those with severe depression (Sackheim and Rush 1995). Effectiveness of Electro-Convulsive Therapy ♦ Fink (1985) reviewed a range of studies on ECT and concluded that it is effective in over ..........% of severe depressives. ♦ It seems to be more likely to work than drug treatment. Janicak (1985) found ...... % of his patients responded well to ECT whereas only ....... % responded to drug treatment. ♦ One of the positive aspects of ECT is that its effect is immediate so for someone contemplating suicide it will be more effective than giving anti-depressants that take several weeks to work. ♦ However, Sackheim (1993) found that there was a high relapse rate within a year. What does this suggest? 4|Page
  • 5. Appropriateness of ECT ♦ One of the major criticisms is that it is used without any real knowledge of why it works. Some argue it is comparable to kicking the TV when it doesn’t work properly! There are 3 main hypotheses as to how it works: - 1. Patients see it as a punishment for their behaviour and so the use of ECT encourages them to reduce the depressed behaviour. However, the use of sub- convulsive shocks are equally unpleasant but do not produce the same positive effects. What does this suggest about ECT? 2. That it works because of the amnesia that accompanies it as a side effect. However, unilateral ECT (a shock to just one side of the brain) doesn’t cause much memory loss is as effective as bilateral ECT. Explain this:- 3. That it causes biochemical changes i.e. it increases levels of noradrenaline and serotonin. This is probably the most likely reason. ♦ The other main criticism is that it inappropriate to put a person through such unpleasant therapy. However, the way it is administered these days is much less traumatic than it used to be – people used to sometimes break bones when they had a convulsion! Nowadays, the treatment is more humane with an......................... and a ................................used before the shock is administered so the patient is unconscious and doesn’t hurt themselves. ♦ Despite these improvements many people still see ECT as a form of abuse which a patient is encouraged to go through at a time when they are very vulnerable and can’t stand up for themselves. 5|Page
  • 6. Issues and Debates According to biological therapies what is more important nature or nurture? Most drug therapies were developed using animals. Why is this a problem? Why are these treatments reductionist? Why are these treatments deterministic? 6|Page
  • 7. Psychological Therapies Think back to the AS topic of abnormality and brainstorm what you can remember about cognitive behavioural therapy. Cognitive Behavioural Therapy Cognitive Behavioural Therapy (CBT) CBT was first developed in the 1960s, there have since been two key therapies based on CBT, these are, rational-emotive behaviour therapy (REBT, by Albert Ellis) and Aaron Beck’s cognitive therapy for depression. The aim of CBT is to identify the patient’s negative and irrational thoughts so they can be replaced with more positive rational ways of thinking. The therapy includes behavioural and cognitive elements with homework between sessions The Cognitive Element The Behavioural Element 7|Page
  • 8. A: Activating Event Cognitive Behavioural Therapy (Beck, 1976) 4 phases of CBT B: Beliefs (about A) Rational Thoughts Irrational Thoughts C: Consequences (of B) Desirable Emotions Undesirable Emotions Desirable Behaviour Undesirable Behaviour ABC Model in Action Evaluation of Cognitive Behavioural Therapy (CBT) Using the information on pages 356 and 357 of Cardwell, Clark, Meldrum and Wadeley take notes on the evaluation of CBT Effectiveness Clear Goals Use and effectiveness of CBT Difficulty in evaluating therapies 8|Page
  • 9. Appropriateness Appeal of CBT Extension Activity Read and make notes on the study by Jarrett (1999) and Hollon (1992) on page 359 of Cardwell, Clark, Meldrum and Wadeley Behavioural Therapies Lewinsohn (1974) developed a behavioural therapy based on clients taking up .................................................... and............................................ The therapist works with the patient to develop an ...........................for trying new activities. The therapist then ensures that all positive behaviours are ................................while....................... behaviours are................... Family members are also involved to ensure this occurrs outside of the therapy sessions. The therapist also teaches the patient different social skills including basic........................................................................................ They also learn how to recognise ................in other people and how to respond more ........................... The practice gained in ......................tasks is essential for the success of the treatment. Why do you think this treatment works? 9|Page
  • 10. Evaluation of Behavioural Therapies Whole package required Combination of therapies Which Therapy is best? Read and make notes on the study by Elkin (1989). 10 | P a g e
  • 11. Questions 1. What are some of the problems associated with drug therapy? 2. Give a brief outline of the procedures of ECT. 3. What is the goal of CBT and how is it achieved? 4. It can be very difficult you assess the effectiveness of therapies. Explain some of the methodological and ethical problems that occur in the treatment outcome research for depression. Issues and Debates According to psychological therapies what is more important nature or nurture? Why are such treatments reductionist? Exam Questions (a) Explain the use of one cognitive-behavioural therapy as applied to the treatment of depression (10 marks) (b) Outline and evaluate biological therapies as treatments of depression (15 marks) a. Outline clinical characteristics of depression. (5 marks) b. Explain issues associated with classification and diagnosis of depression. (10 marks) c. Outline and evaluate one or more explanations of depression outlined in your answer to question 1(a). Refer to research evidence in your answer. (4 marks + 6 marks) 11 | P a g e
  • 12. Explanation Strengths Weaknesses Treatments Effectiveness Appropriateness Biological alBehaviour Cognitive 12 | P a g e
  • 13. Similarities and Differences between Therapies Comparison Point Biological Cognitive Behaviourist Drugs and ECT Use for specific disorders or patients Dealing with underlying causes Side effects Patient control/ responsibility Ethics Speed of improvement 13 | P a g e
  • 14. 14 | P a g e
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