5.2 psychological disorders

Report
Psychological disorders
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 Affective Disorders – Major Depression
 Anxiety Disorder
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OCD,
PTSD
Generalized anxiety disorder (GAD),
social phobia
Introduction to
psychological disorders- Vocab

 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.
Evaluate Psychological
research relevant to the study
of abnormal behavior

Evaluate through theories and studies
Major Depression

Affective disorders:
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
Symptoms 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
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.
Be a thinker pg 149

1. Is Jane depressed? Support your claim
2. 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.
Etiology Depression

 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.
Not all people become
depressed when stressed
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 There are important distinctions in vulnerability:
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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.
BLOA: genetic factors
depression

 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.
Biochemical Hypothesis of
depression
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 Catecholamine hypothesis
 Serotonin Hypothesis
 Cortisol Hypothesis
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 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.
NT Imbalances

 Delgado and Moreno (2000) – abnormal levels of NE
and 5-HT.
 Rampello et al., (2000) – NE, 5-HT, DA and
acetylcholine may all contribute.
Criticism of 5-HT
hypothesis

 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?
Cortisol 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
Research in Psychology
page 153

 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”
Be empathetic

 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?
Video
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 Depression (1) how depression changes the brain
 Depression (2)Impact of childhood events
 Depression (3) Role of inflammation in depression
 Depression (4) The best treatment for depression
 Depression (5) The effects of treatment on the brain.
CLOA: cognitive factors,
depression

 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”
Cognitive Distortion:Beck’s theory of
cognitive vulnerability factors.

 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 Triad

The Self
“I am a bad person”
Experiences
“My life is terrible”
The Future
“things will not
improve”
Beck: Silent Assumptions

 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: Informational processing

 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 Activity

Read page 154

 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?
SCLA: social and cultural
factors, depression

 Diathesis-stress model = interactionist approach to
explain psychological disorders.
 Brown and Harris (1978) – social origins of depression
in women.
 Vulnerability model.
Sociocultural factors

 Poverty
 Living in a violent relationship
 Stress of raising young children
 War
 Restricted gender roles
Brown and Harris
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 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 depression
1. 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.
Diathesis Stress model

 Brown and Harris vulnerability model supports the
diathesis stress model: the interactive effect of
heredity and environmental factors
Cultural Considerations
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 WHO (1983) assessing Iran, Japan, Canada and
Switzerland – Common symptoms of depression
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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)
Culture cont.,

 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.
Gender Considerations in
major depression

 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?
Discuss the interaction of
biological, cognitive and
sociocultural 
factors 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.
Relevant studies 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
Biomedical approaches to
treating 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.
Mode of action
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 Drugs are designed to affect the neurotransmitters
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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.
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
Celexa
citalopram
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
Evaluation of Drug Therapy

 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.
Side Effects and
Ethical Issues

 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.
Leuchter and Witte
(2002)

 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.
Elkin et al. (1989)

 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 cont.,

 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.
OK Doctors – what do
you think?

 Would it be acceptable to give a patient placebo pills
instead of antidepressants?
 What arguments could you make for and against?
Individual approaches to
treatment of depression

 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.
Cognitive behavior Therapy

 “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
Aim of CBT

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:
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Arbitrary inferences
Selective abstraction
Overgeneralization
Exaggeration
Personalization
Dichotomous thinking
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.
Selective Abstraction

 Drawing conclusions by focusing on a single part of
a whole.
Overgeneralization

 Applying a single incident to all similar incidents
Exaggeration

 Overestimating the significance of negative events.
Personalization

 Assuming that others’ behavior is done with the
intention of hurting or humiliating you.
Dichotomous thinking
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 All or none approach

 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
nd
2
Aim CBT
Behavioral Component
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 Encourage individuals to increase rewarding seeking activities.
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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.
How effective is cognitive
therapy in treating depression?

 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.

 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.
Group approaches to
treatment of depression

 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.
Social Learning/interpersonal
model

 Cases in Abnormal psychology pg 113
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


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