5.2 Abnormal psychology

5.2 Abnormal psychologyPsychological disordersAffective Disorders Major DepressionAnxiety Disorder OCD, PTSD Generalized anxiety disorder (GAD), social phobiaSymptomologyIdentification of the symptomsEtiologyThe why people suffer, the origin of.Understanding the origin requires holistic approach.Prevalence rateTotal number of cases of a specific disorder in a given populationLifetime prevalence (LTP)The % of population that will experience the disorder at some timeOnset ageAverage age in which the disorder is likely to appear.Introduction to psychological disorders- VocabEvaluate Psychological research relevant to the study of abnormal behaviorEvaluate through theories and studiesMajor DepressionDiagnostic CriteriaExperiences symptoms for 2 weeksLoss of pleasure or interestDepressed moodCurrent research suggest that there areBiological genetic make-up and biochemical factorsCognitive thoughts of hopelessness, low self-esteem Sociocultural factors stress of poverty, loneliness or troubles personal relationshipsTreatment Drug and therapy

Affective disorders: Major DepressionAffective: feeling of guilt or sadness; lack of enjoyment or pleasure in familiar activities or companyBehavior: passivity; lack of interestCognitive: frequent negative thoughts; faulty attribution; low self esteem; suicidal thoughts; difficulties concentrating, inability to make a decisionsSomatic: loss of energy; insomnia, weight gain/loss; diminished libido

These symptoms interfere with normal work and relationshipsSymptoms Major DepressionLTP = 15%Health department 19902-3x more common in women then menMore frequent among lower socioeconomic groupsMost 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 DepressionIs Jane depressed? Support your claimWhat could be contributing to her state of mind?If you were Janes doctor, what questions could you ask her in order to identify possible causes of her condition?What could you suggest to help Jane? State your reasons.

Be a thinker pg 149Onset 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 DepressionThere are important distinctions in vulnerability:Genetic predispositionPersonality and early historyCognitive styleCoping skillsLevel of social supportMajor depression is NOT caused by a single factor there is no 1 cause of depression.Not all people become depressed when stressedTwin Studies:Concordance rate higher in MZ twins vs DZ twinsGenetic factors might predispose people for depression. Assessing seven studiesAverage 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 depressionCatecholamine hypothesisSerotonin HypothesisCortisol HypothesisBiochemical Hypothesis of depressionCaspi (2003) genetic factors could moderate responses to the environment (findings are still premature)Neurobiologydepression may be caused by neurotransmitters and hormone deficiencyCatecholamine hypothesis: Joseph Schildkraut 1965Depression is associated with low noradrenaline serotonin hypothesisDrugs that decrease NE bring about depression like symptomsUse 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 ImbalancesIt is not possible to measure brain serotonin levelsWhich comes first the chicken or eggDoes depression alter neurotransmitters or does alteration in neurotransmitters create depression?Criticism of 5-HT hypothesisStress hormoneFamily 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.Cushings Disease excess cortisol production - high prevalence of depression.Over-secretion of cortisol may be linked to other neurotransmitters.Lower 5-HT receptorsImpair NE receptorsCortisol hypothesisImpact of poverty on child depressionFernald and Gunnar (2009) Surveyed 639 Mexican mothers and childrenChildren of depressed mothers in extreme poverty produced less cortisolSuggest that the stress system is worn outResearch in Psychology page 153Produce 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 empatheticDepression (1) how depression changes the brainDepression (2)Impact of childhood eventsDepression (3) Role of inflammation in depressionDepression (4) The best treatment for depressionDepression (5) The effects of treatment on the brain.

VideoCognitive theories of depression: Depressed cognitionCognitive distortionsIrrational beliefsEllis (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, depressionDistortion based upon schema processing:Stored schema about the self interfere with information processingTriggered by stressful eventsTends to overreactDepressive patients experience a negative cognitive triad:Overgeneralization based on negative events The world is unfairNon-logical inferences about the selfThe self is worthlessDichotomous thinking black and white thinking, selective recall of negative consequences.The future is hopelessCognitive Distortion:Becks theory of cognitive vulnerability factors.Cognitive TriadCognitive thoughts of depressed people are dominated by a set of assumptions that shape conscious cognitionThese assumptions are derived from our environmentParents, teachers, friendI must get approvalI must do thing perfectlyI must be valued by other or I am worthlessBeck: Silent AssumptionsHow depressed people are prone to distortion of misinterpretation.Arbitrary inferences drawing negative conclusions based on limited informationSelective thinking focusing on negativesOvergeneralization jumping to conclusion based on a single incidencePersonalizing taking blame/responsibility for all unpleasant things that happenBlack and White thinking seeing everything in terms of success and failureBeck: Informational processingBeck ActivityIs 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 154Diathesis-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 PovertyLiving in a violent relationshipStress of raising young childrenWarRestricted gender rolesSociocultural factorsAim: To determine how depression could be linked to social factors and stressful events in women.Procedure: 458 women surveyed on daily life and depressive episodesResults:Working class women with children were 4X more likley to develop depression than middle-class women with children8% (37) of all women had clinical depression33/37 (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 affectsBrown and HarrisFindings: 3 major factors that effect depressionProtective factors: high levels of intimacy with spouse may induce higher self esteem/meaningful lifeVulnerability factors loss of a mother before age 11; lack of confiding relationship; more than 3 children under the age of 14 at home; and unemployedProvoking agents contribute to acute and ongoing stress.Brown and HarrisBrown and Harris vulnerability model supports the diathesis stress model: the interactive effect of heredity and environmental factors

Diathesis Stress modelWHO (1983) assessing Iran, Japan, Canada and Switzerland Common symptoms of depressionSad affectLoss of enjoymentAnxietyTensionLack of energyLost of interestInability to concentrateFeelings of worthlessnessThese findings are consistent with earlier cultural studies done by Murphy et al., (1967)Cultural ConsiderationsMarsella (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 depressionThis prompt requires you to consider a number of explanations and evidence to support your argumentThe 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 placeValidity of diagnosis:DiNardo et al. (1993)Lipton and Simon (1985)Ethial ConsiderationsThomas SzaszScheff (1966) labeling brings about self-fulfilling prophecyLanger and Abelson : prejudice and discriminationCultural ConsiderationsRack (1982) mental illness carries great stigma in ChinaRelevant studies DepressionCochrane and Sashidharan (1995) Cultural blindnessBiological: Cognitive: BeckSociocultural: Brown and Harris: Elkin et al (1989) - treatmentRelevant studies Depression5.3 Treatment depressionIf the problem is based on biological malfunctioning, then it stand to reason that treating it medically should relieve symptomsDepression 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 depressionDrugs are designed to affect the neurotransmittersDopamine (DA) (excitatory/inhibitory neuron)Serotonin (5-HT) (inhibitory neuron)Noradrenaline (NE) (excitatory neuron)GABA (gamma-aminobutyric acid) (Inhibitory neurons)Mechanism of actionEither inhibit or enhance the effect of the NT in question.Mode of actionSSRIsSelective Serotonin Reuptake Inhibitors:Increase the level of 5HT at the synaptic cleftFluoxetine most common SSRI used (Prozac)Effective, Relatively safe, side effects.Kirsh et al (2008) criticize over prescription of SSRIs

SSRIs AvailableCelexacitalopram hydrobromideLexaproescitalopram oxalateLuvoxfluvoxamine maleatePaxilparoxetine hydrochlorideProzacfluoxetine hydrochlorideZoloftsertraline hydrochlorideNE and 5-HT approachBrand NameGeneric NameCymbaltaduloxetine hydrochlorideEffexorvenlafaxine hydrochlorideRemeronmirtazapineIncrease NE and 5 HT levelsShort 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 TherapyDrug therapy has reduced the number of hospital inpatients; but it is important to note that this also reflects changes in hospital policy.44Drug therapy cannot be given without consent unless it is an emergency.Drug therapy does not constitute a cureCriticism 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 SSRIs in treating depression in an elderly group of patients. Side Effects and Ethical IssuesDepressive 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 depressionPatients 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 monthsElkin et al. (1989)Results: 50% patients recovered in IPT and CBT as well as in the drug group29% recovered in the placebo groupDrug treatment produced fastest resultsThe study suggests that it does not matter which treatment patients received, all treatments had the same result.Elkin cont.,Arch Gen Psychiatry. 1989 Nov;46(11):971-82; discussion 983.National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments.

48Would 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 automaticallyNote the connection between negative thought and depressionExamine each negative thought and decide whether it can be supportedReplace 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 BeckNegative self schemas bias a persons thinking.CBT focuses on current issues and symptoms.12-20 weekly sessionsDaily practice exercisesBehavior modification

Cognitive behavior TherapyIdentify 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 inferencesSelective abstractionOvergeneralizationExaggerationPersonalizationDichotomous thinkingAim of CBTArbitrary InferenceDrawing wrong conclusions about oneself by making invalid connectionsYou 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

Focusing on a single bad grade and ignoring the fact that you actually have an A in the class; you are fat because you think you have fat thighs.54Applying a single incident to all similar incidentsOvergeneralization

Assuming a relationship problem with a friend means you are unsuccessful in all relationships55Overestimating 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 conditioningEncourage individuals to increase rewarding seeking activities.SportsMusicGardeningCookingSewingTeasdale (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 ComponentRush et al (1977): highly effectiveDobson (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 + placebo76% 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 TreatmentFocus 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 depressionCases in Abnormal psychology pg 113Social Learning/interpersonal modelDescribe 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 behaviorDescribe the symptoms and prevalence of PTSD & DepressionAnalyze etiologies of PTSD and DepressionDiscuss cultural and gender variations in disorders