Health & Medicine

PsychExchange.co.uk Shared Resource

Description
1. Chapter 4: Disorders Characteristics of Disorders Anxiety disorder - phobia Affective disorder - depression Psychotic disorder - schizophrenia Explanation of one…
Published
of 16
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Related Documents
Share
Transcript
  • 1. Chapter 4: Disorders Characteristics of Disorders Anxiety disorder - phobia Affective disorder - depression Psychotic disorder - schizophrenia Explanation of one Disorder- Depression
  • 2. Wender et al (1986) – Biological explanation – Disorders in biological and adoptive families Seligman (1975) - Behavioural explanation – Learned helplessness model Beck et al (1974) – Cognitive explanation – Cognitive distortions Treatments of one Disorder - Depression Karp & Frank (1995) – Biological treatment – Comparing drug and non-drug treatment Resinger (1975) – Behavioural treatment – Using token economy to treat depression Beck et al (1978) – Cognitive treatment – Comparing cognitive and drug therapy DSM-IV Classification for specific phobia • Marked and persistent fear that is excessive or unreasonable • Exposure to phobic stimulus provokes immediate anxiety response • The person recognises the fear as excessive • The phobic situation is avoided • The phobia disrupts the person’s normal life • The phobia has lasted more than 6 months in people under 18 years of age. ICD-10 Classification for a specific phobia Characteristics of • The psychological or autonomic symptoms must be primary manifestations of anxiety, and not secondary to other symptoms such as delusions. • The anxiety must be restricted to the presence of the particular phobic object or situation. Disorders • The phobic situation is avoided wherever possible Anxiety Disorders Anxiety disorders give a continuous feeling of fear and anxiety which is disabling and can impose on daily functioning. They can be triggered by something that may seem trivial to others; they may even be triggered by non- existent threats that nevertheless seem very real to the person. In the UK in 2000 the Office of National Statistics reported that 1 adult in 6 in the UK had a neurotic disorder anxiety or depression. Anxiety disorders encompass many different disorders including panic disorders, OCD, Phobias, Post Traumatic Stress Disorder and other generalised anxiety disorders. PHOBIAS Phobias essentially have a definite, persistent fear of a particular object or situation. A stimulus such as a snake, dog, and a man’s beard will provoke an immediate response, which may be similar to a panic attack. The individual may experience physical symptoms such as shortness of breath or palpitations, and may feel intense terror and may begin to lose control. Even though the individual knows that the fear is irrational they can still not control the immense terror the stimulus produces. This response alone is not enough to be actually diagnosed with a phobic disorder, if the fear disrupts the individuals day to day life, the disorder may be diagnosed. Affective Disorders
  • 3. DSM-IV Classification of single-episode depression • Five or more of the following symptoms • Insomnia most nights • Fidgeting or lethargy • Tiredness • Feeling of worthlessness or guilt • Less ability to concentrate • Recurrent thoughts of death • These symptoms are not caused by medication, or situations such as bereavement, and they are enough to hinder the person from important day-to-day. ICD-10 Classification of depression • Depressed mood • Loss of interest and enjoyment • Reduced energy • Other common symptoms are: • Marked tiredness after only slight effort • Reduced concentration and attention • Reduced self-esteem and self-confidence • Ideas of guilt and unworthiness • Bleak and pessimistic views of the future • Ideas or acts of self harm or suicide • Disturbed sleep • Reduced appetite. We all have different moods; sometimes we are happy and sometimes we are sad, and these are natural responses to events in our lives. However, you will see that the characteristics of mood or affective disorders are disabling moods. This means that the disorder prevents the individual from leading a normal life, at work socially or within their family, which would cause them to be diagnosed with depression or bipolar disorder. Emotional Physiological/behavioural Cognitive Symptoms • Sadness • Sleep disturbance • Poor concentration, Indecisiveness • Depressed Mood • Appetitive Disturbance • Psychomotor retardation or agitation • Sense of worthlessness or guilt, Poor Self • Anhedonia – (loss of pleasure in usual esteem activities) • Catatononia – • Irritability • Fatigue and loss of energy. • Hopelessness, Suicidal Thoughts • Delusions and hallucinations with depressing themes. Different types of depression Bipolar – mood fluctuates between manic episodes and depressive episodes, these periods are often separated with periods of ‘normality’. But some individuals experience symptoms very rapidly or very slowly and can the cycle between mania, normality and depression can be sometime days, weeks to month and sometimes years. Dysthymia- mood disorder that is not considered to be as severe as major depression, but can be thought of a chronic depression. Diagnosed if 3 or more symptoms, including depressed mood. Duration – 2 YEARS! Must never have been without the symptoms Melancholic – no pleasure, depressed mood, worse in morning, weight loss. Psychotic – Delusions and hallucinations' Atypical – Weight gain, hypersommia, Postpartum – Major depression within 4 week of delivery of child.
  • 4. Seasonal – 2 years – only in one season Psychotic Disorders  In 3’s one person whisper a long story to second person. Second person tell third person what they did at weekend at the same time. How difficult is it to maintain logical thought processes while hearing something different? Psychosis is the general term for disorders that involve a loss of contact with reality. It covers many disorders, which may involve delusions (hallucinations that cause a person to lose their sense of what is really happening in their life). It can therefore lead to withdrawal from the outside world as the person becomes more confused and disorientated. Psychotic disorders tend to be characterised by delusions and disorganised speech or behaviour, they include all types of schizophrenia. Schizophrenia has positive and negative symptoms. Positive Symptoms – present symptoms Negative Symptoms – considered to be the loss or absence of normal characteristics. Delusions Losing emotional responses Auditory hallucinations Inability to feel pleasure Disorganised speech Lack of motivation Disorganised aspect DSM-IV Classification of Schizophrenia -Two or more of the ICD-10 Classification of Schizophrenia following • Thought echo, thought insertion or withdrawal broadcasting. • Delusions • Delusions of control • Hallucinations • Hallucinatory voices • Disorganise speech and Disorganised behaviour • Persistent delusions • Negative symptoms • Persistent hallucinations Plus • Incoherence or irrelevant speech • Social occupational dysfunction, at least 6 months duration – • Catatonic behaviour no other explanation can be found- such as medication, or • Negative symptoms such as marked apathy developmental disorders. • A significant and consistent reduction in the overall quality of some aspects of personal behaviour.  Check key symptoms of the three disorders then see who can list the most correctly Jan 2010 Exam Question (a) Describe the characteristics of a psychotic disorder. (10)
  • 5. (b) Evaluate difficulties when identifying characteristics of psychological disorders. (15) Point Explain Example Link back to Q (Hint: Reliability) lack of consistent ‘Two or more’ symptoms characteristics in any for schizophrenia from a particular disorder list (Hint: Validity) Some characteristics ‘Delusions’ can be common apparent in depression to a range of disorders and schizophrenia making diagnosis precarious (Hint: objectivity) ‘Social dysfunction’ in schizophrenia – vague (Hint: Usefulness) Is it useful, appropriate and applicable? Culture? Conclusion… Explanations of Depression Biological Explanation The biological approach to depression suggests that a genetic disposition towards depression may explain why depression can be found in more than one member of a family. The famous account of ‘tainted blood’ in a family suffering from bipolar depression, gives support to the idea that there may be a link between biology and depression. Alfred Lord Tennyson attributed his debilitating depression to the tainted blood of the Tennyson’s. His father, his grandfather, two of his great-grandfathers, and five of his seven brothers suffered from insanity, depression, uncontrollable rage, or bipolar disorder. Lionel Tennyson, one of Alfred’s two sons, displayed mood swings, as did one of his three grandsons. Key Study: Biological explanation of depression Wender et al (1986) Psychiatric disorders in biological and adoptive families
  • 6. Aim: to investigate the contribution of genetic and environment factors in the cause of mood disorders Methodology: Psychiatric evaluations of the relatives were made by independent blind diagnoses of mental hospital records and other official records in Denmark. Participants: Adoptive and biological relatives of 71 adult adoptees, with a mean age of 43.7, who had a mood disorder, plus 71 adult adoptees with a mean age of 44, who were psychologically normal. The adults had been removed from their mothers at an early age. Findings: Among the biological relatives of the participants with mood disorder there was eight times more unipolar depression than in the adoptive relatives. There were 15 times more suicides amongst the biological relatives of the participants with mood disorder compared to the adoptive parents. There was no significant difference in the incidence of mood disorder amongst the biological and adoptive parents of participants without mood disorder. Conclusion: There is a significant genetic link between unipolar depression and suicide. Evaluation: second hand data – reliability, validity Sample size - Generalisability - Ethnocentric usefulness? Recognise depression in children of those susceptible Behavioural Explanation The behavioural explanations would suggest that affective disorders are learned through operant conditioning, classical conditioning or social learning. Classical conditioning would suggest that we make associations between events or circumstances and mood change, and this leads to learned behaviour which is then diagnosed as depression. Operant conditioning on the other hand would suggest that a lack of positive reinforcement is directly linked with depression. Key Study: Behavioural explanation of depression Seligman (1975) The Learned Helplessness Model of Depression
  • 7. The original learned helplessness model of depression was based on animal learning studies. Seligman began by looking at how dogs could learn very quickly, by classical conditioning, that they could not escape an electric shock to their feet. Seligman found that dogs given an electric shock which they could not escape would show learned behaviours 24 hours later. In subsequent trials despite now being able to escape the dogs did not try to escape and passively endured the shocks. He concluded that the dogs learned that their responses and the outcomes were not related so did not bother to respond to the shocks by trying to escape. If the outcomes of their behaviour are uncontrollable, dogs will give up trying Seligman related this to depression in humans. The core depressive symptom is the expectations that whatever you do, nothing will change. This is learned helplessness. He looked at symptoms of depression and the symptoms of learned helplessness and found several similarities. These included passivity; lowered aggression; loss of appetite; feelings of helplessness; negative expectations; depletion of chemicals such as catecholamine. He also found that the causes, uncontrollable negative events, were the same and that successful therapies were the same. These included: ECT –electroconvulsive shock therapy an antidepressant drugs. He concluded therefore that depression could be seen as a manifestation of learned helplessness. Evaluation: Generalisability – animals to humans Reductionist Deterministic Usefulness Cognitive Explanation The cognitive approach using the ideas of Beck’s theory (1967) would explain depression as a result of faulty negative thinking. Dear Deirdre, Key Study: Cognitive explanation of depression I’ve been feeling(1974) Cognitive distortions in patients with depression look in chapter 3 Beck et al very down recently; I haven’t wanted to spend time with friends or family, I  YOUR TASK – summarising the keep staring into can’t concentrate at work and I explanations space. These days I don’t even want to get out of bed. I spoke with my doctor and he has said it sounds like I have depression. I have heard of this before, but can you tell me exactly what this is, and what has caused this? It seems to have come out of nowhere and I want to know why it has happened to me. From Annie in Dundee
  • 8. Using all the information you have been learning about the explanations of disorders, write back to Annie explaining what depression is and what might have caused it. Include all three explanations in your letter. Dear Annie,
  • 9. Evaluation of Explanations of Depression Evidence Approach strength/weaknesses? Issues which issues relevant? Method strength/weaknesses? Wender Seligman Beck
  • 10. Treatments of Depression Treatments of disorders are a contentious issue in that different psychologists approach treatment differently. The issue surrounds whether we try and cure the cause, or whether we try and manage the symptoms so the individual can lead a normal life. Biological Treatment Biological treatments are probably the ones most people will think of when talking about treating depression. Antidepressants vary in their action, but all act upon the neurological system of the body, often varying the amount of neurotransmitters, such as serotonin, a lack of which is associated with depression. Karp & Frank (1995) Comparing drug and non-drug treatment –look in chapter 3 Exam practice: Outline what biological psychology tells us about treating depression (10)
  • 11. Behavioural Treatment Behaviourist treatments for depression are based on the assumption that depressed behaviours are learned and therefore can be unlearned. The idea is that some people may be depressed because they are rewarded in sense that they receive a great deal of attention from their friends, family and their therapist. Behaviourists would argue that the best course of treatment should be one that teaches the patient that they will be reinforced for non- depressive behaviours. Reisinger (1975) Use of token economy to treat depression Aim: To find out whether a behavioural therapy: token economy, could be used to help treat an inpatient with a diagnosis of depression. Methodology: A case study of inpatient in institution who had previously failed all other types of treatment. Participants: A white female, 20 years old who had been an inpatient for 6 years. Procedure: The participant was informed of how she could gain or be fined tokens. She was instructed that the value of each token meant it could be traded in to purchase better sleeping facilities, to watch television, to go on trips etc. The participant received a token from staff at the hospital when she was observed smiling. Social reinforcements were also given alongside the token such as ‘well done’. A fine, which resulted in the removal of a token was also applied if the participant cried. Staff kept records of the tokens in a ‘bank account’ and the participant was allowed to trade in the tokens for desired things or to pay fines. In total, the procedure lasted 20 weeks, with various other more complex elements being introduced throughout the weeks. Inter-rater reliability was used with more than one person recording responses. Findings: At baseline, the participant was reported smiling 0 times a week, and crying 30 times a week. In the final week of treatment, the participant was recorded as smiling 27 times, and only crying twice. A follow up at 14 months indicated that the patient had no recommendation for hospitalisation or further treatment. Conclusion: Behavioural therapies can be very effective in the treatment of depression. Evaluation: Ethics determinism reliability Case study strength & weaknesses longitudinal
  • 12. Cognitive Treatment Cognitive treatments for depression are based on the theory of ‘faulty’ cognitions which are the basis for the cognitive theory of dysfunctional behaviour. The aim of any cognitive therapy is to change the negative thoughts into positive ones – irrational thinking to rational thinking. This will help the individual to perceive the world as being more positive and reduce the occurrence of depression. Beck et al (1978) Comparing cognitive and drug therapy –look in chapter 3 In the space below design a ‘picture pathway’ to summarise Beck et al’s study. P A M F C
  • 13. The studies in this section on the treatment of depression are from a variety of approaches. Try to give at least one strength and one weakness using the evidence you have about the approaches in this section. A What issues would be best to use to evaluate studies on the treatment of depression? What about ethics? Determinism? Reductionism? I Using examples from each study identify strengths and weaknesses of methods used in evaluating the treatment of depression M
  • 14.  Synoptic Checklist for ‘Disorders’ ethics Cognitive Correlation observation experiment Ecological validity Behaviourist Case study Self report Longitudinal & snapshot Reductionism & holism Determinism & free will ethnocentrism Individual / situational usefulness Nature / nurture Psychology as a science Physiological Wender Seligman Beck (74) Karp Resinger Beck (78) Revision Tips!!! 1. Making crosswords might be one good way of testing your knowledge 2. Making revision cards as small as possible of key terms from evidence 3. Practising sample examination answers against the clock 4. Using pictures and colours to remind yourself of important details in the evidence 5. Sticking post-it notes on your wall and moving them around
  • We Need Your Support
    Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

    Thanks to everyone for your continued support.

    No, Thanks