Psychological disorders. Affective Disorders – Major Depression Anxiety Disorder OCD, PTSD Generalized anxiety disorder (GAD), social phobia.

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