psychological disorders. affective disorders – major depression anxiety disorder ocd, ptsd ...
TRANSCRIPT
5.2 Abnormal psychology
Psychological disorders
Affective Disorders – Major Depression Anxiety Disorder
OCD, PTSD Generalized anxiety disorder (GAD), social phobia
Symptomology
Identification of the symptoms Etiology
The ‘why’ people suffer, the origin of. Understanding the origin requires holistic approach.
Prevalence rate Total number of cases of a specific disorder in a given
population Lifetime prevalence (LTP)
The % of population that will experience the disorder at some time
Onset age Average age in which the disorder is likely to appear.
Introduction to psychological disorders-
Vocab
Evaluate Psychological research relevant to the
study of abnormal behavior
Evaluate through theories and studies
Major Depression
Diagnostic Criteria
Experiences symptoms for 2 weeks Loss of pleasure or interest Depressed mood
Current research suggest that there are Biological – genetic make-up and biochemical factors Cognitive – thoughts of hopelessness, low self-esteem Sociocultural factors – stress of poverty, loneliness or
troubles personal relationships Treatment
Drug and therapy
Affective disorders: Major Depression
Affective: feeling of guilt or sadness; lack of enjoyment
or pleasure in familiar activities or company Behavior: passivity; lack of interest Cognitive: frequent negative thoughts; faulty
attribution; low self esteem; suicidal thoughts; difficulties concentrating, inability to make a decisions
Somatic: loss of energy; insomnia, weight gain/loss; diminished libido
These symptoms interfere with normal work and relationships
Symptoms Major Depression
LTP = 15% Health department 1990
2-3x more common in women then men More frequent among lower socioeconomic groups Most frequently among adults.
Prevalence rate higher in Jewish males vs other males.
80% reoccurrence rate, with a typical episode lasting 3-4 months; 12% of cases, depression can be chronic, lasing as long as 2 years.
Major Depression
1. Is Jane depressed? Support your claim2. What could be contributing to her state of
mind?3. If you were Jane’s doctor, what questions
could you ask her in order to identify possible causes of her condition?
4. What could you suggest to help Jane? State your reasons.
Be a thinker pg 149
Onset of depression can be brought about by
biological factors or an adverse social and environmental change.
Most will represent complex interactions between physiology and psychological.
Some depression is brought about by long-term circumstances, which are a continuing source of stress and disappointment.
Etiology Depression
There are important distinctions in
vulnerability: Genetic predisposition Personality and early history Cognitive style Coping skills Level of social support
Major depression is NOT caused by a single factor – there is no 1 cause of depression.
Not all people become depressed
when stressed
Twin Studies:
Concordance rate higher in MZ twins vs DZ twins Genetic factors might predispose people for
depression. Assessing seven studies Average concordance rate
MZ = 65% - this is below 100%, thus can only suggest a predisposition (genetic vulnerability)
DZ = 14% These findings do not contradict stress or
environmental aspects.
BLOA: genetic factors depression
Catecholamine hypothesis Serotonin Hypothesis Cortisol Hypothesis
Biochemical Hypothesis of depression
Caspi (2003) genetic factors could moderate responses
to the environment (findings are still premature) Neurobiology
depression may be caused by neurotransmitters and hormone deficiency
Catecholamine hypothesis: Joseph Schildkraut 1965 Depression is associated with low noradrenaline →
serotonin hypothesis Drugs that decrease NE bring about depression like symptoms Use of Physostigmine (Janawskuy et al., 1972) resulted in
individuals feeling depressed, self hate and suicidal within minutes of having taken the drug.
Addition of NE reduces symptoms.
Delgado and Moreno (2000) – abnormal levels
of NE and 5-HT. Rampello et al., (2000) – NE, 5-HT, DA and
acetylcholine may all contribute.
NT Imbalances
It is not possible to measure brain serotonin
levels Which comes first – the chicken or egg
Does depression alter neurotransmitters or does alteration in neurotransmitters create depression?
Criticism of 5-HT hypothesis
Stress hormone
Family of glucocorticoids that play a role in anxiety and fear reactions,.
High levels of cortisol in individuals with depression. Long term structural changes may be seen – hippocampus
(memory) loses neurons; reduction of glucocorticoid receptors in prefrontal cortex and hippocampus of suicide victims.
Cushing’s Disease – excess cortisol production - high prevalence of depression.
Over-secretion of cortisol may be linked to other neurotransmitters. Lower 5-HT receptors Impair NE receptors
Cortisol hypothesis
Impact of poverty on child depression Fernald and Gunnar (2009) –
Surveyed 639 Mexican mothers and children Children of depressed mothers in extreme
poverty produced less cortisol Suggest that the stress system is “worn out”
Research in Psychology page 153
Produce a list of stressors which you think
poverty causes individuals. If you were in public office, what would you
propose in order to alleviate some of these stressors?
Be empathetic
Depression (1) how depression changes the br
ain Depression (2)Impact of childhood events Depression (3) Role of inflammation in depress
ion Depression (4) The best treatment for depressi
on Depression (5) The effects of treatment on the
brain.
Video
Cognitive theories of depression:
Depressed cognition Cognitive distortions Irrational beliefs
Ellis (1962) – psychological disturbances often come from irrational and illogical thinking. People draw false conclusion which lead to feelings
of anger, anxiety or depression. “my work must be perfect” & “my essay did not
receive top grades” → defeating conclusion, “since I did not receive the highest grade I am stupid”
CLOA: cognitive factors, depression
Distortion based upon schema processing:
Stored schema about the self interfere with information processing
Triggered by stressful events Tends to overreact
Depressive patients experience a negative cognitive triad: Overgeneralization based on negative events
The world is unfair Non-logical inferences about the self
The self is worthless Dichotomous thinking – “black and white” thinking, selective
recall of negative consequences. The future is hopeless
Cognitive Distortion:Beck’s theory of cognitive vulnerability factors.
The Self
“I am a bad person”
The Future“things will
not improve”
Experiences“My life is terrible”
Cognitive Triad
Cognitive thoughts of depressed people are
dominated by a set of assumptions that shape conscious cognition
These assumptions are derived from our environment Parents, teachers, friend
”I must get approval” “I must do thing perfectly” “I must be valued by other or I am worthless”
Beck: Silent Assumptions
How depressed people are prone to distortion of
misinterpretation. Arbitrary inferences – drawing negative
conclusions based on limited information Selective thinking – focusing on negatives Overgeneralization – jumping to conclusion
based on a single incidence Personalizing – taking blame/responsibility for
all unpleasant things that happen Black and White thinking – seeing everything
in terms of success and failure
Beck: Informational processing
Beck Activity
Is it possible that depression is mostly related
to cognitive factors? Present two claims and support with evidence.
Which comes first – the cognitive thinking pattern triggers depression or does depression trigger the cognitive thinking pattern?
Read page 154
Diathesis-stress model = interactionist
approach to explain psychological disorders.
Brown and Harris (1978) – social origins of depression in women. Vulnerability model.
SCLA: social and cultural factors, depression
Poverty Living in a violent relationship Stress of raising young children War Restricted gender roles
Sociocultural factors
Aim: To determine how depression could be linked to
social factors and stressful events in women. Procedure: 458 women surveyed on daily life and
depressive episodes Results:
Working class women with children were 4X more likley to develop depression than middle-class women with children
8% (37) of all women had clinical depression 33/37 (90%) experienced an adverse life event
(death/abuse) 4/37 did not suffer adverse affect. 30% of the women who did not become depressed
experienced the same adverse affects
Brown and Harris
Findings: 3 major factors that effect depression1. Protective factors: high levels of intimacy
with spouse – may induce higher self esteem/meaningful life
2. Vulnerability factors – loss of a mother before age 11; lack of confiding relationship; more than 3 children under the age of 14 at home; and unemployed
3. Provoking agents – contribute to acute and ongoing stress.
Brown and Harris
Brown and Harris vulnerability model supports
the diathesis stress model: the interactive effect of heredity and environmental factors
Diathesis Stress model
WHO (1983) assessing Iran, Japan, Canada and
Switzerland – Common symptoms of depression Sad affect Loss of enjoyment Anxiety Tension Lack of energy Lost of interest Inability to concentrate Feelings of worthlessness
These findings are consistent with earlier cultural studies done by Murphy et al., (1967)
Cultural Considerations
Marsella (1979) affective symptoms are associated
with individualistic cultures; somatic symptoms are associated with collectivist cultures.
Kleinman (1982) China somatization served as a typical channel of expression and basic component of depression.
Prince (1968) claimed there was no depression in African and Asian cultures prior to westernization.
Cross Culture research - each culture experiences almost identical core symptoms, and they may exhibit symptoms that are culturally specific.
Culture cont.,
Women are 2-3X more likely to become
clinically depressed than men. It is a widely held belief that women are
naturally more emotional than men, and therefor more vulnerable to emotional upsepts because of hormonal fluctuations. Is this a valid argument?
Gender Considerations in major depression
This prompt requires you to consider a number of explanations and evidence to support your argument
The argument should include relevant research and theory.
Discuss the interaction of biological, cognitive and
sociocultural factors in major depression.
Rosenhahn (1973): On being sane in an insane place Validity of diagnosis:
DiNardo et al. (1993) Lipton and Simon (1985)
Ethial Considerations Thomas Szasz Scheff (1966) labeling brings about self-fulfilling
prophecy Langer and Abelson : prejudice and discrimination
Cultural Considerations Rack (1982) – mental illness carries great stigma in China
Relevant studies Depression
Cochrane and Sashidharan (1995)
Cultural blindness Biological: Cognitive: Beck Sociocultural: Brown and Harris: Elkin et al
(1989) - treatment
Relevant studies Depression
5.3 Treatment depression
If the problem is based on biological
malfunctioning, then it stand to reason that treating it medically should relieve symptoms
Depression is known to involve imbalances in neurotransmitters – thus treating with drugs that realign the NT balance should alleviate symptoms.
Not all patients respond the same way.
Biomedical approaches to treating depression
Drugs are designed to affect the
neurotransmitters Dopamine (DA) (excitatory/inhibitory neuron) Serotonin (5-HT) (inhibitory neuron) Noradrenaline (NE) (excitatory neuron) GABA (gamma-aminobutyric acid) – (Inhibitory
neurons) Mechanism of action
Either inhibit or enhance the effect of the NT in question.
Mode of action
SSRI’s
Selective Serotonin Reuptake Inhibitors: Increase the level of 5HT
at the synaptic cleft Fluoxetine most common
SSRI used (Prozac) Effective, Relatively safe,
side effects. Kirsh et al (2008) criticize
“over prescription” of SSRIs
SSRI’s Available
Celexacitalopram hydrobromide
Lexapro escitalopram oxalate
Luvox fluvoxamine maleate
Paxil paroxetine hydrochloride
Prozac fluoxetine hydrochloride
Zoloft sertraline hydrochloride
NE and 5-HT approach
Brand Name Generic Name
Cymbalta duloxetine hydrochloride
Effexor venlafaxine hydrochloride
Remeron mirtazapine
Increase NE and 5 HT levels
Short term treatment is successful for 60-80% of
people (Bernstein et al. 1994) However, they are not equally effective in all cases.
Kircsh and Sapirstein (1998) analyzing 19 studies (2318 patients treated with Prozac) found that the antidepressant was only 25% more effective than the placebos, and no more effective than other kinds of drugs, such as tranquillizers.
Most psychiatrist agree that drugs provide effective long term control for mood disorders, and may help to prevent suicide in depressive patients.
Evaluation of Drug Therapy
Drug therapy cannot be given without consent
unless it is an emergency. Drug therapy does not constitute a cure
Criticism of the efficacy of antidepressants in comparison to placebo (Kirsch et al 2008)
Blumenthal et al (1999) found that exercise was just as effective as SSRI’s in treating depression in an elderly group of patients.
Side Effects and Ethical Issues
Depressive patients receiving drug treatment
improved just as well as patients receiving placebo Brain scans revealed changes in the brain in both cases but in different areas: Placebo – increased activity in prefrontal cortex
(changes occurred 1 – 2 weeks into treatment) Antidepressant – reduced activity in prefrontal
cortex (changes occurred within 48 hours) Although medication may be effective, there
may be other effective ways to treat depression.
Leuchter and Witte (2002)
National Institute of Mental Health: 28 clinicians who worked with 280 patients
diagnosed with depression Patients randomly assigned to treatment groups:
Antidepressant + clinical management (imipramine) (double blind)
Interpersonal therapy (ITP) or Cognitive behavioral therapy (CBT)
Control = placebo with weekly therapy (double blind) All patients were assessed at the start, 16 weeks of
treatment and 18 months
Elkin et al. (1989)
Results:
50% patients recovered in IPT and CBT as well as in the drug group
29% recovered in the placebo group Drug treatment produced fastest results
The study suggests that it does not matter which treatment patients received, all treatments had the same result.
Elkin cont.,
Would it be acceptable to give a patient
placebo pills instead of antidepressants?
What arguments could you make for and against?
OK Doctors – what do you think?
Aaron Beck pioneered the idea of cognitive
restructuring, the core of cognitive behavior therapy.
Approach to Cognitive restructuring: Identify the negative, self critical thoughts that occur
automatically Note the connection between negative thought and
depression Examine each negative thought and decide whether it
can be supported Replace distorted negative thoughts with realistic
interpretations of each situation.
Individual approaches to treatment of depression
“a persons beliefs contribute to automatic
thoughts” based on schema” Beck Negative self schemas bias a persons thinking.
CBT – focuses on current issues and symptoms. 12-20 weekly sessions Daily practice exercises Behavior modification
Cognitive behavior Therapy
1. Identify and correct faulty cognitions and unhealthy
behaviors. Identify what thoughts are associated with depressed
feelings and to correct them – reconstruction – based on the foundation that assumptions may be distorted.
6 patterns of faulty thinking: Arbitrary inferences Selective abstraction Overgeneralization Exaggeration Personalization Dichotomous thinking
Aim of CBT
Arbitrary Inference
Drawing wrong conclusions about oneself by making invalid connections
You think that only you have bad luck and that the world is against you.
Drawing conclusions by focusing on a single
part of a whole.
Selective Abstraction
Applying a single incident to all similar
incidents
Overgeneralization
Overestimating the significance of negative
events.
Exaggeration
Assuming that others’ behavior is done with
the intention of hurting or humiliating you.
Personalization
All or none approach
Dichotomous thinking
Psychological problems are often prone to
negative automatic thinking that they CANNOT control.
Example: the negative thought, and exaggeration, “I never do anything right,” may be filtered through a cognitive schema, which processes the information to fit the biased self-perception. In short, the schema provides the resource for a
form of conditioning
Encourage individuals to increase rewarding seeking activities.
Sports Music Gardening Cooking Sewing
Teasdale (1997) the important feature of cognitive therapy is to teach the client meta-awareness – the ability to think about their own thoughts.
The aim of therapy is to teach each client to monitor thought processes and then to test them against reality so they can eventually change the behavior on their own.
2nd Aim CBT Behavioral Component
Rush et al (1977): highly effective Dobson (1989): superior to no treatment or to a
placebo. Elkins et al (1989): no significant difference between
CBT and Rx (tricyclic) Riggs et al (2007) : Looked at CBT with SSRI or
placebo 67% CBT + placebo 76% CBT + SSRI Both groups were found to be - much improved or very
much improved. Conclusion: treatment with drug is effective, treatment
without drug is almost as effective.
How effective is cognitive therapy in treating
depression?
Nemeroff et al. (2003), CBT in combination
with drugs was the most effective in chronic depression in people suffering traumatic childhood experiences.
Ethically speaking – it is clear that the therapist is making judgments concerning which thought are acceptable.
Couples Treatment Focus is on teaching couples how to
communicate and problem solve more effectively while increasing positive interactions and reducing negative exchanges.
More effective for women suffering from depression related to marital distress.
Group approaches to treatment of depression
Cases in Abnormal psychology pg 113
Social Learning/interpersonal
model
Describe symptoms and prevalence of one psychological
disorder.
Evaluate the use of one approach to the treatment of the disorder
[22 Mark]
Discuss the interactions of biological, cognitive,
and sociocultural factors in abnormal behavior
Describe the symptoms and
prevalence of PTSD & Depression
Analyze etiologies of PTSD and Depression
Discuss cultural and gender variations in
disorders