PSYC1002(Lecture(+(Textbook(Notes( ( Abnormal(Psychology( ( Lecture(1( Models of Mental Illness ( Lecture(2(

Transcription

1 PSYC1002Lecture+TextbkNtes AbnrmalPsychlgy Lecture1 Abnrmal psychlgy is the scientific study f abnrmal behaviur. Use empirical methd t study descriptin, causatin, treatment). Psychpathlgy is just descriptin and causatin. Abnrmal is unusual r deviant behaviur that causes distress and is ften unacceptable in the culture. Neither ne n its wn is necessary r sufficient. Psychlgical abnrmality is nt as readily definable as physical illness. It exists n a cntinuum with nrmality. The definitin f abnrmal ften reflects culture values and scial nrms. Mdels f Mental Illness - Supernatural: caused by spirits, stars, mn r past lives and treated with exrcism, prayer - Bilgical: caused by internal physical prblems Oldest and currently mst dminant mdel in psychiatry. Assumes that psychlgical disrders can be diagnsed similarly t physical illness, explained in terms f bilgical disease prcess and are best treated with medicatin/surgery, ECT. Criticisms and limitatins include:! Need t avid extreme reductinism Certain cmplex psychlgical phenmena may be impssible t explain at the neural/mlecular level! Need t avid ver-extraplatin frm animal research! Need t avid assuming causatin frm treatment! The medical mdel may nt be applicable t cnceptualizing and diagnsing mental illness Clear bundary between physical health and illness but cntinuity between mental health and disrder Clear bundaries between different physical illnesses but psychlgical disrders cmmnly c-ccur - Psychlgical: caused by beliefs, perceptins, values, gals, mtivatin - Scicultural: caused by pverty, prejudice, cultural nrms Lecture2 The integrative apprach says that psychpathlgy is multiply determined. One-dimensinal accunts f psychpathlgy are incmplete; cnsider reciprcal relatins between bilgical, psychlgical, scicultural factrs i.e. nature and nurture). Psychlgical mdels include: - Psychanalytic Emerges frm the repressin f unreslved cnflict Treated with insight Mst dminant mdel during first half f the 20 th century Id, eg, supereg and stages f psychsexual develpment Maladjustment frm:! Unreslved cnflicts resulting in anxiety, defense mechanisms! Critiques include lack f empirical evidence and unfalsifiability - Behaviural Due t learned respnses frm stimuli! Classical cnditining Pavlv! Operant cnditining Skinner Maladjustment results frm:! Faulty learning There are many treatment applicatins Critique: cgnitin imprtant. Bandura 1974) incrprated this with his bservatinal learning/mdeling! Incrprated cgnitin t behaviurism - Humanistic Caused due t thwarted self-actualisatin Psychlgical health derived frm fully functining, self actualized persns Maladjustment results frm:! Envirnment impses cnditins f wrth! Own experience, emtins, needs are blcked! Self-acutalisatin thwarted Treated with empathy, uncnditinal psitive regard Critique: difficult t research rgers pineered treatment evaluatin research) - Cgnitive Due t negative cre beliefs, biased thinking - Cgnitive-Behaviural Mdel Currently the dminant mdel in psychlgy What we think influences what we feel and d Maladaptive behaviur results frm:

2 ! Latent cre negative beliefs Aarn Beck) Interpretatin f experiences: cnsistent with cre negative beliefs Cgnitive biases vergeneralizatin, selective attentin, etc ) Negative autmatic thughts Classificatin Systems: - Imprve cmmunicatin between researchers Lk fr causes, test treatments - Imprve cmmunicatin between health prfessinals - May imprve cmmunicatin and understanding f mental health in the cmmunity - May reduce scial stigma - Diagnstic and Statistical Manual f Mental Disrders DSM) Prblematic reliability! Inter-rater reliability: hw much depressin? Prblematic validity! Based n unprven theries abut etilgy DSM ) acknwledges limitatins f categrical system, planned t intrduce dimensinal measures t cmplement diagnstic categries! Allws assessment f severity! Retained categrical system Lecture3 Why classify and diagnse? - Imprve cmmunicatin between researchers - Imprve cmmunicatin between health prfessinals - May imprve cmmunicatin and understanding f mental health in the cmmunity - May reduce scial stigma Classificatin systems: - Diagnstic and Statistical Manual f Mental Disrders DSM) Reliability and validity prblematic Majr develpments in classificatin 1980s+)! Majr depressin: 5 r mre symptms present in 2 week perid fr diagnsis! DSM-5 acknwledged limitatins f categrical systems but retained it It allws fr assessment f severity, nt just presence - Internatinal Classificatin f Diseases and Health Related Prblems ICD) Anxiety and Anxiety disrders - Anxiety is activated in respnse t a perceived threat. The experience f anxiety is the same in nrmal and abnrmal anxiety - Three interrelated anxiety systems are: Physical system. Includes:! Fight/flight respnse sympathetic nervus system Mbilises resurces t deal with threat. Symptms include sweating, heart rate increase, trembling, etc. These are the classic systems f autnmic arusal Cgnitive system. Includes:! Perceptin f threat. Attentin shifts t threat. Hypervigilance i.e. difficulty n cncentrating n ther tasks/things apart frm threat) Behaviural system. Includes:! Escape/avidance This may include aggressin r freezing arund thers - Abnrmal anxiety r anxiety disrders are nt qualitatively different frm nrmal anxiety. They have the same physical, cgnitive and behaviural aspects. Hwever, ccurrence is excessive/inapprpriate! i.e., anxiety ccurs in the absence f bjective threat and is mre intense than bjective level f threat Typically characterised by verestimatin f threat! i.e., prbability f negative utcme verestimated, cst f negative utcme verestimated - DSM 4 anxiety disrders are categrized accrding t fcus f anxiety hwever experience f anxiety is same/similar in each. The disrders include: Separatin anxiety disrder! Being away frm primary caregiver Specific phbias! Animal, natural envirnment, bld-injectin injury, situatinal, ther Scial phbia! Fear f negative scial evaluatin Generalised anxiety disrder! Excessive and uncntrllable wrry abut a range f utcmes Obsessive-Cmpulsive disrder

3 ! Obsessins: intrusive thughts r impulses! Cmpulsins: ritualized behaviurs t relieve the anxiety causes by the bsessins Psttraumatic and Acute Stress Disrders! Thughts/memries f traumatic experience Panic disrder! Unexpected/spntaneus panic attacks! Anxiety abut having anther attack With/withut agraphbia Anxiety disrder nt therwise specified! Anxiety disrders are highly cmrbid with each ther and with depressin Lecture4 The diagnsis f anxiety disrders changed frm DSM 4 t DSM 5. - These changes include: Trauma and Stressr related disrders! Reactive attachment disrder! Disinhibited scial engagement disrder! Psttraumatic stress disrder! Acute stress disrder! Adjustment disrders Obsessive cmpulsive and related disrders! Obsessive-cmpulsive disrder! Bdy dysmrphic disrder! Harding disrder! Trichtillmania hair-pulling disrder)! Excriatin disrder skin-picking) - Panic attacks have als been reclassified. Symptms include:! Abrupt and intense fear r anxiety! Peaks within 10 mins! Classic symptms f autnmic arusal! Other physical symptms! Fear f dying, lsing cntrl, ging mad may cause: Situatinally bund r cued panic Occurs in the presence r anticipatin f feared stimulus Situatinally predispsed panic Unexpected r uncued panic Panic disrder! Unexpected/spntaneus panic attacks! Anxiety/wrry abut having anther attack! Symptms persist ne mnth r mre Agraphbia! Fear r avidance f situatins r events assciated with panic Avidance f physical activity, quit jb, becme huse bund etc 30-50% with Panic disrders als have agraphbia Scial Phbia! A fear f scial situatins in which the persn is expsed t unfamiliar peple r t pssible scrutiny! Expsure t feared scial situatin invariably prvkes anxiety, which may take the frm f a situatinally bund r situatinally predispsed panic attack! The persn recgnises that the fear is excessive r unreasnable! The feared situatins are avided r else are endured with intense anxiety r distress! Interferes significantly with the persn s nrmal rutine, ccupatinal functining, r scial activities, r there is a marked distress abut having the phbia Specific phbias! Fear f animals, natural envirnment, etc May results frm Classical cnditining Butn) May nt be a cmplete accunt Menzies & Clarke, 1995) Cnditining event is nt sufficient r necessary t cause phbia Sme stimuli are mre likely t becme phbic than thers Hammer/needle/drill relatively rare Phbia fears: significant threat t survival Genetic preparedness Seiigman, 1971)! Easier t learn Generalised Anxiety Disrder! Excessive and uncntrllable wrry! Abut wide range f utcmes Clark s1988)cgnitivetheryfpanicdisrdersdemnstrates hwamisinterpretatinfsensatinstriggersanxietyand autnmicarusalresultinginpanic.

4 ! Physical symptms are different frm panic Tensin, irritability, restlessness, sleep prblems! May be assciated with: High trait anxiety, intlerance f uncertainty, reduced ability t tlerate distress, reduced prblem slving cnfidence/success Obsessive-Cmpulsive disrder! Obsessins: repeated, intrusive, irratinal thughts r impulses. Cause severe anxiety! Cmpulsins: ritualized behaviurs t relieve the anxiety caused by bsessins! Assciated with: Intlerance f uncertainty, Inflated respnsibility, Thught-actin fusin, Magical ideatin Psttraumatic Stress Disrder! Stressr: an event in which The persn has experienced, witnessed, r been cnfrnted with an event that invlves actual r threatened death r serius injury, r a threat t the persn s physical integrity The persn s respnse invlved intense fear, helplessness, r hrrr! Re-experiencing Intrusive images, memries, and dreams Acting r feeling as if the event were recurring Psychlgical distress, physilgical arusal! Avidance and numbing Avidance f reminders f the trauma Pervasive numbing f general respnsiveness! Persistently increased arusal Sleep disturbance, anger, irritability, pr cncentratin, hypervigilance, startle! RISK fr PTSD 50-60% f peple experience traumatic events PTSD prevalence: 5-11% Critical t identify peple wh need assistance t prevent pst-trauma prblems Risk factrs Pre-trauma i.e. cping style), trauma i.e. meaning), and pst-trauma i.e. scial supprt) - Treatment f Anxiety Disrders Cgnitive Behaviural Treatment! Aim t reduce biased) threat appraisal Hw likely/bad that the event will ccur! Cgnitive techniques Thught-diaries t identify autmatic thughts Thught challenging! Behaviural techniques Expsure t feared stimuli/utcmes is essential Expsure t phbic bject, scial situatin, bdy sensatin, intrusive thught, traumatic memry Lecture5 DSM 4 als diagnses md disrders. These include: - Depressive disrders Uniplar: depressive md/episdes nly! Depressive episde: abnrmally lw md Biplar disrders! Manic episde: abnrmally elevated md Including 3 r mre f inflated self-esteem, grandisity, etc Extremes in nrmal md Majr Depressive Disrder! One r mre majr depressive episdes including depressed md mst f the day, weight lss r gain, fatigue/lss f energy, etc 5 r mre episdes are needed in a 2-week perid fr diagnsis Affective symptms: Depressed md, anhednia lss f pleasure/interest) Cgnitive symptms: Indecisiveness, lack f cncentratin Smatic symptms: fatigue, sleep r appetite change! Single r recurrent depressive episde, nt accunted fr by ther disrders.! Recurrent episdes are cmmn Dysthymic disrder! Persistently depressed md that cntinues fr at least 2 years! Symptms f depressin are milder than majr depressin! Symptms can persist unchanged ver lng perids! Duble depressin bth MDD and dysthymia) - Bilgical theries Genetic vulnerability

5 ! Heritability: 35-60%, creates a vulnerability t md disrders N evidence fr specific genes Bilgical vulnerability + stress = depressin Neurchemistry! Lw levels f nradrenalin and/r sertnin N gd evidence fr mechanism Neurendcrine system! Excess crtisl in respnse t stress! Increased stress is strngly related t md disrders - Psychlgical theries Cgnitive vulnerability + stress = depressin! Schema thery Beck 1976) Pre-existing negative schemas - Bilgical Treatments Activated by stress Result in infrmatin prcessing biases:! Biased attentin, memry, interpretatins Negative thughts becme dminant in cnsciusness! Distrted view f self, wrld, future! Learned helplessness thery Seligman, 1974)! Ruminative respnse styles Nlen-Heksema, 1991)! Interpersnal factrs such as negative thinking) Drug treatments! Selective sertnergic reuptake inhibitrs SSRIs) Effective in 70-80% Electrcnvulsive therapy ECT)! Invlves applying brief electrical current t the brain Uncertainty as t hw this wrks! Last resrt: effective fr severe depressin 80%) - Psychlgical Treatments Cgnitive Behaviural Therapy CBT)! Addresses cgnitive errrs in thinking Aims t develp mre realistic view Nt psitive thinking! Includes behaviural cmpnents Behaviural activatin: increase reinfrcing events Behaviural experiments: test beliefs Outcmes cmparable t drug therapy! Lwer relapse rates than bilgical treatments Meta-analysis: 29 vs. 60% Glaguen et al., 1998) Lecture6 Eating disrders are als listed in the DSM 4. They include: - EDNOS Subclinical AN r BN Binge Eating disrder Purging disrder Night eating syndrme Grazing - Anrexia Nervsa Refusal t maintain bdy weight at a minimally nrmal weight fr age and height! Weight less than 85% f that expected Intense fear f gaining weight r becming fat even thugh underweight Bdy image disturbance! Denial f seriusness f lw bdy weight! Undue influence f bdy weight/shape n self-evaluatin Amenrrhea! Restricting vs. binging/purging type Assciated features f AN include:! Psychlgical prblems Depressed md, irritability, anger, etc Often assciated with starvatin syndrme