Download Abnormal Option File

Abnormal
Psychology
Mr. Jordi Blanco
School Counselor and IB
Psychology Teacher
August 25th
What is abnormal
psychology???
We all try to understand other
people. Determining why another
person does or feels something is
not easy to do. In fact, we do not
always understand our own
feelings and behaviour.
Figuring out why people behave
in normal, expected ways is
difficult enough; understanding
seemingly abnormal behaviour
can be even more difficult’.
Abnormal psychology is the branch of
psychology that deals with studying, explaining
and treating ‘abnormal’ behaviour.
Although there is obviously a great deal of behaviour that could be
considered abnormal, this branch of psychology deals mostly with that
which is addressed in a clinical context.
WHO?
psychologist.
mental health professional, such as a psychiatrist or a clinical
Levels of
Analysis
Abnormal
Examine the concepts
of normality and
abnormality.
In groups of 2 and 3.
Discuss whether
you would consider each of the following an example of “abnormal
behavior”. What could be the possible criteria?:
1.Transvestism
2.Nail biting
3.Maths Anxiety
4.Talk to oneself
Definitions
• Normality: Something that is the majority;
Being within certain limits that define the
range of normal functioning; Being able to
hold down a job, and is not a threat to others
or themselves?
• Abnormality: Not being in the norm; Not
being able to hold down a job, and/or is a
threat to themselves and others?
What are the
characteristics of
abnormality?
Characteristics of abnormality
•
•
•
•
•
•
•
Suffering
Maladaptiveness
Irrationality
Unpredictability and loss of control
Rareness and unconventionality
Observer discomfort
Violation of standards
Questions for discussion
1. List all the psychological disorders that you
know. Try to figure out why they are
considered to be disorders
2. When can an individual be considered to be
insane?
3. Are H.M. and Clive Wearing abnormal?
Homework/Classwork
• Think about a behavior you have seen in
another culture that you think is strange .
Then think about behavior that is normal in
your culture that might be considered
strange in another.
• Why is so important to understand the
influence of culture and history on the way
we view behavior?
August 26th
Homework
Three aspects of abnormality
Three aspects of abnormality
• Diagnosis
• The cause of the problem (etiology)
• Therapy to treat the problem (related to the
abnormality criterion)
Criteria of abnormality?
Two criterion/concepts of
abnormality (and normality)
• The mental illness criterion
• The social and cultural norms criterion
The mental illness criterion
• Normality depends upon a properly
functioning physiology and nervous system
and no genetic predispositions to inherit
mental disorder.
• Really? Examples
Supporting evidence
• Studies on the relationship between physiology,
genetic make-up and abnormal behaviour (e.g. Caspi
2003, Kendler 1991, Carraso 2000.
• The universality (etics) of some disorders (e.g. eating
disorders, depression and behaviours associated
with psychosis – e.g. delusions and hallucinations)
• Sex differences in the prevalence of mental illness
(which may be due to physiological differences
between men and women)
Challenging evidence
• Different countries have different tools for
diagnosis (e.g. DSM IV-TR in United states,
CCMD-3 in China)
• The existence of culture-bound syndromes
(emics)
• Cultural variations in the prevalence of certain
disorders. Sweden?
• Ethical issues: labeling, stigmatization
Homework for next class.
Do the following tests for
psychological disorders
• www.gotoquiz.com/what_mental_disorder
_do_you_have
• http://www.allthetests.com/quiz13/quiz/111
4365326/Teen-Personality-Quiz
Essay 500 Words Max. START
NOW
With reference to research, examine the
concepts of normality and abnormality. Evaluate
one related studies with these concepts
Due: September 1st. Monday
Explain structure.
August 28th
Review Homework
• How do you feel doing a test? It is
accurate? Labeling?
Two criterion/concepts of
abnormality (and normality)
• The mental illness criterion
• The social and cultural norms criterion
The social and cultural norms
criterion
The social and cultural norms criterion:
People who are not included in the in-group are defined as
abnormal
Abnormal behaviour violates moral or ideal standards.
Abnormal behaviour differs from commonly accepted
beliefs or ways of thinking.
What is abnormal in one culture (e.g. strange visions,
speech and behaviour) might be regarded as special or
sacred in another culture (e.g. shamanism)
Supporting evidence
• Different countries have different tools for
diagnosis (e.g. DSM IV-TR in United states,
CCMD-3 in China)
• Homosexuality was considered to be
abnormal until DSM-III (1980). It is still
considered abnormal in many countries.
• Unmarried mothers in Britain and political dissidents in
the Soviet unions were once confined to institutions for
abnormality.
• The tendency for American black slaves in the 1800s to
try flee captivity was considered to be a mental illness
• Gender differences in mental health (which may be due
to differences in social expectations)
• Cultural variations in the prevalence of certain disorders
• Rosenhan’s (1973) study showed that psychiatrists had
difficulties distinguishing the sane from the insane
Challenging evidence:
Murphy’s (1976) research on Inuit tribes has indicated that
there are linguistic distinctions between “shaman” and “crazy
people” in their society.
The mental illness criterion/biomedical model/disease
model:
Normality depends upon a properly functioning physiology
and nervous system and no genetic predispositions to inherit
mental disorder
Supporting evidence:
Studies on the relationship between physiology, genetic makeup and abnormal behaviour (e.g. Caspi 2003, Kendler 1991,
Carraso 2000,
Caspi et. al. (2003)
Certain diseases based on behavior are caused by genes. In this case,
depression is found to be related to the length of the 5-HTT gene. The
shorter the 5-HTT gene is; the tendency of getting depression rises. This
experiment is one of the few experiments that have supported the theory
that the biological function of the body is interrelated with the cognitive
aspect of human beings.
Homework / Classwork
1.
2.
3.
4.
5.
6.
Read the following article.
Highlight the psychological terminology
State the name of the main study
State the goal of the study
Explain the research method.
Explain the findings
http://www.bio.davidson.edu/genomics/2003/mccord/
5-HTT.html
August
th
29
Discuss validity and
reliability
of
diagnosis
But first…
What is the the purpose of
diagnosis?
• To identify groups of similar sufferers so that
psychiatrists and psychologists may develop
explanations and methods to help those
groups.
• Billing purposes. The government and many
insurance companies require a diagnosis for
payment.
What do you think about it? Is it ethical? Is it
moral? Do I want a label on my personal
history? Work on pairs
Classwork
Be a critical thinker. Answer the
following questions individually:
• Why could it be a problem to diagnose active
children with “ADHD”. Remember to provide
evidence to support your answer.
• Do you think this is a condition that should be
treated with medication? Why or why not?
Techniques of diagnosis
•
•
•
•
Observation
Interview
Psychological tests (e.g. IQ tests)
Brain scans
2 Main Diagnostic Manuals
• DSM-IV TR. Diagnostic statistical manual
• ICD-10: International Classification of Diseases
published by World Health Organization.
DSM-IV-TR
• The classification system used in the United
States. It does not identify causes of
psychological disorder. Only describes
symptoms.
• Lists more than 300 mental disorders
• The diagnosis of one individual is based on
five dimensions
The five dimensions of DSM-IV-TR
• Axis I
• Axis II
• Axis III
• Axis IV
• Axis V
• Axis I: The major diagnostic classification, e.g. major
depressive disorder, anorexia
• Axis II: Related to developmental and personality
disorders (e.g. autism, anti-social personality)
• Axis III: Physical and medical conditions that may
worsen the disorder (e.g. brain injury, drug abuse,
viruses)
• Axis IV: Psychosocial stressors, all stressful events
that may be relevant to the disorder (e.g. poverty,
divorce, loss of job)
• Axis V: Global assessment of functioning. Rates the
highest level of social, occupational and
psychological functioning on a scale of 1 (persistent
danger) and 90 (good in all areas) currently and
during the last year
Video introduction to DSM
• https://www.youtube.com/watch?
v=Oif3xDjlV5I
Class work
• Find 3 DSM diagnoses with the full criteria and
symptoms.
Axis I,II, III, IV, V.
• Do you agree with this criteria? Yes, no, why?
September 1st
Review Classwork.
First of all…
Are you able to define validity
and reliability?
How can we measure the
effectiveness of the diagnosis?
The effectiveness of diagnosis can be measured
in terms of
two variables.
• Reliability
• Validity
Reliability and validity of diagnosis
• Reliability of diagnosis: Will different
diagnosticians using the same classification
system arrive at the same diagnosis. Means
that the clinician should be able to reach the
same diagnostic procedure. This is called
inter-judge reliability.
• Validity of diagnosis: Does the person
diagnosed have real symptoms with a real
underlying cause? (the illness is not socially
constructed, the person is not faking). It refers
to receiving the correct diagnosis.
Reliability of diagnosis
• The reliability of earlier systems for
diagnosis, e.g. DSM-II, was very poor, but
it has been improved in revisions of the
systems, e.g. DSM-IV-TR
Reliability of diagnosis / Studies
• Beck (1962): Agreement between two psychiatrists
on diagnosis for 153 patients was 54 %. This was due
to vague criteria for diagnosis and different ways of
psychiatrists to gather information.
• Cooper et. al. (1972): When shown the same video
clips, New York psychiatrists are twice as likely to
diagnose schizophrenia than London psychiatrists.
London psychiatrists were twice as likely to diagnose
mania or depression than New York psychiatrists
Validity of diagnosis
• There is a tendency of practitioners of overemphasizing
dispositional rather than situational causes of behaviour
when diagnosing patients (Fundamental attribution
error).
• The labelling of patients with certain disorders may affect
the practioners perceptions of them (compare with
researcher bias), patients may act the label that has
been given to them (self fulfilling prophecy). The label
itself may simplify a problem that is highly complex
• People may fake mental illness in order to avoid
punishment (The insanity defense)
• Szaz 1967: Many disorders may be culturally constructed. If
the biological causes of the mental disorder are known, the
individual may be diagnosed with mental disorder (the mental
illness criterion). If there is no biologically underlying cause of
the disorder, it is better to claim that the individual has
problems with living or adapting
• There are significant individual differences for mental
disorders. An individual may have multiple mental disorders
Validity of diagnosis
• Rosenhan (1973): 8 sane people could get
admitted to mental hospitals merely by
claiming to hear voices.
• Rosenhan (1973): When a teaching hospital
was told to expect pseudo-patients, they
suspected 41 out of 193 genuine patients of
being fakers
Validity of diagnosis
• Temerline (1970): Clinically trained psychiatrists
were influenced in their diagnosis by hearing the
opinion of a respected authority. (expert influence).
Participants watched a video-taped interview of a
healthy individual. The authority claimed, even
though the person only seemed to be neurotic
(distress where behaviour is not outside social norms,
patient has not lost touch with reality) he was
actually psychotic (behaviour is outside social norms,
loss of touch with reality)
Read Page 152 IB Psychology
• Write a short paragraph to summarize the
problems of validity illustrated by Caetano
and Rosenhal studies.
Classwork
• Explain what is validity of diagnosis.
Evaluate one study related to this concept.
• Explain what it reliability of diagnosis.
State one study related to this concept
September 2nd
• Difference between classwork and
homework and essays.
Review Classwork
• Explain what is validity of diagnosis.
Evaluate one study related to this concept.
• Explain what it reliability of diagnosis.
State one study related to this concept
Evaluation of Validity
• There is a large amount of research supporting the
view that the reliability and validity of diagnosis are
poor. This is due to many reasons, e.g. a possible
social construction of mental illness, poor diagnostic
tools, the possibility of faking, social influence, errors
in attribution by practitioners and labeling
• There are significant individual and cultural
differences for the symptoms of mental disorders.
• A wrong diagnosis may lead to a social stigma (an
ethical issue)
Evaluation of Validity
• Possible social construction of mental illness, poor
diagnostic tools, social influence, errors in attribution
by practitioners and labeling
• Significant individual and cultural differences for the
symptoms of mental disorders.
• Wrong diagnosis may lead to a social stigma
Counter argument
• There are methodological problems with the studies
on validity and reliability (researcher bias,
generalizability, ecological validity).
• Revised than earlier versions, e.g. DSM-IV-TR.
Diagnostic tools are higher in reliability
• Many people do seek help voluntarily for disorders
(which may mean that the disorder is valid)
• The reliability of diagnosis is high for some disorders,
e.g. obsessive compulsive disorder.
• There are many similarities of disorders across
cultures. Depression.
• Diagnostic systems do not classify people, but
the disorders that they have.
Validity of diagnosis
•Rosenhan (1973): 8 sane
people could get admitted
to mental hospitals merely
by claiming to hear voices.
Classwork about Rosenhal (1973)
• https://www.youtube.com/watch?v=_sO7orq
hWto
Write down:
•
•
•
•
•
•
•
Definition
Aim of the experiment
Target population
Procedure
Ethical considerations
Evaluation
Conclusions
Class work
• Find 3 DSM diagnoses with the full criteria and
symptoms.
• Do you agree with this criteria? Yes, no, why?
Sept 4th
Review classwork and
homework
Classwork about Rosenhal (1973)
• https://www.youtube.com/watch?v=_sO7orq
hWto
Write down:
•
•
•
•
•
•
•
Definition
Aim of the experiment
Target population
Procedure
Ethical considerations
Evaluation
Conclusions
Discuss cultural and
ethical considerations
in diagnosis (for
example, cultural
variation,
stigmatization).
Ethical considerations
1.No Personal Responsibility. Being mentally ill
may mean that the individual is not to be held
responsible for his or her actions.
2.Labeling
3.Institutionalization
1.No personal responsibility
• May avoid punishment (e.g. the insanity
defense).
• May lose his/her rights, such as the right to
consent to treatment, institutionalization or
the right to vote (e.g. United kingdom’s
mental health act)
2.Institutionalization
• Feelings of powerlessness
• Depersonalization (Compare with Rosenhan
& Zimbardo’s prison experiment)
• Dependency on doctor’s and nurses
• No normal interaction with staff members of
the institution. Experience in hospitals.
3.Labeling
• Self fulfilling prophecies: People may act as
they are expected to (similar to stereotype
threat)
• Prejudice/stereotyping/discrimination:
People with psychological disorders may be
discriminated
• Patient may think the “cure” is around the
corner.
Classwork .
Video and article about psychiatry
and antipsychiatry
• https://www.youtube.com/watch?v=tTCSfx47
R1w
After watching the documentary, explore the
following links
• http://www.antipsychiatry.org/
• https://www.youtube.com/watch?v=1n46ohB
srPI
Essay 750 Words
• Discuss ethical considerations in diagnosis.
Compare 2 different studies. Use
psychological terminology.
• Due Date: September 11th Thursday
Be a researcher. Homework
• Find
two
different
psychological
disorder
on:
www.mentalhealth.com/p20.html and read the descriptions
of them and suggestions for treatment.
• Why do think that there are both a US and a European
description of the description of the disorders? Compare
• Now search the Internet for the same disorders in another
culture, for example Chinese and compare the description to
other ones. Discuss your findings.
• Compare and contrast treatments for the disorder you have
chosen.
• Due: September 12th
Studies for ethical considerations in
diagnosis
• Rosenhan (1973)
• Farina (1980)
• Langer & Abelson (1974)
Sept 9th
Classwork .
Video and article about psychiatry
and antipsychiatry
• https://www.youtube.com/watch?v=tTCSfx47
R1w
After watching the documentary, explore the
following links
• http://www.antipsychiatry.org/
• https://www.youtube.com/watch?v=1n46ohB
srPI
Test will be on Sept 15th
• Abnormal Psychology
• Focus on learning outcomes.
• Pay close attention to open essay
questions.
Discuss cultural
considerations in
diagnosis
Volunteer?
Is there any cultural considerations in diagnosis? What
kind of cultural considerations do we need to be aware
with the following countries?
Egypt
Spain
Korea
America
Indonesia
Madagascar
• Cultural variations in the prevalence of disorders.
Anorexia in US. Anorexia in Morocco?
• Possible stereotyping of ethnic groups may affect the
validity of diagnosis.
• Abnormality may be culturally constructed.
• Culture blindness: The problem of identifying
symptoms of a psychological disorder if they are not
the norm in the culture. If it is not normal, there is a
problem.
How can psychologist avoid
cultural bias influencing a
diagnosis?
• Clinicians should make an effort to learn about the
culture of the patient/client.
• Evaluation of bilingual patients should really be
undertaken in both languages.
• Diagnostic procedures should be modified to ensure
that person understands the requirement of the
task.
Explain cases in California.
Read page 155
What would be the information that you can
use discussing the cultural considerations? Think
about Paper 2. Use your critical thinking.
CLASSWORK. Examples of studies for cultural
considerations in diagnosis
Choose one the following studies and investigate the
cultural considerations.
•
•
•
•
•
•
Okello and Ekblad (2006)
Tabassum et. al. (2000)
Kleinman (1984)
Marsella (2003)
Jaeger (2002)
Jenkins-Hall & Sacco (1993)
Sept 11th
Describe symptoms and prevalence of
one disorder from two of the following
groups:
– anxiety disorders
– affective disorders
– eating disorders
Affective Disorder:
Major Depression
Code for Major Depression 296.36
To have a general idea about depression.
psychcentral.com/disorders/sx22-c.htm
http://psychcentral.com/depquiz.htm
Symptoms
Major Depression
•
•
•
•
•
Symptoms
Prevalence
Etiology
Evaluation
Conclusion
Classwork. Symptoms of
Depression (DSM-IV-TR).
Volunteer on the board.
• Physiological:
• Cognitive:
• Emotional:
• Behavioural:
Classwork. Symptoms of
Depression (DSM-IV-TR).
• Physiological: Fatigue, loss of energy. Significant weight loss
or gain, loss of appetite, headaches and general pain.
• Cognitive: Feelings of worthlessness or excessive guilt
difficulties concentrating. Negative attitudes towards the self,
the world and the future
• Emotional: Distress and sadness, loss of interest in the world.
• Behavioural: Disturbed sleep patterns, self-destructive
behavior ( suicidal thoughts) and avodiance of social
company.
Share File PDF about
Depression criteria.
Videos about depression
https://www.youtube.com/watch?v=GOK1tKFFI
QI
Documentary
https://www.youtube.com/watch?v=F5YubjEqb
Z8
Prevalence?
Describe symptoms and
prevalence of major depression
The word 'prevalence' of depression usually
means the estimated population of people who
are managing Depression at any given time.
Prevalence
* National
Institute of
Mental Health.
2012
Prevalence Review data with
Book
• Life time prevalence for the disorder: Women – 1025% Men – 5-12%
• The average age to have the first major depression:
Mid 20s
• The onset age is decreasing
• Two or three episodes: 70-90 % of a following
episode
• One year after diagnosis: 40 % are free of
symptoms, 20 % have some symptoms, 40 % meet
full criteria of the disorder
Classwork. In terms of percentage
Seattle, Washington:
China:
Verona, Italy:
Groningen, Germany:
Manchester, United Kingdom:
Ankara, Turkey:
Nagasaki, Japan:
Prevalence
More common in individualistic than collectivistic
cultures.
Seattle, Washington: 6.3 %
China: 4 %
Verona, Italy: 4.7 %
Groningen, Germany: 15.9 %
Manchester, United Kingdom: 16.9 %
Ankara, Turkey: 11.6 %
Nagasaki, Japan: 2.6 %
Sept 16th
Major Depression
•
•
•
•
•
Symptoms
Prevalence
Etiology
Evaluation
Treatment
Etiology
What is etiology?
• Means
the
scientific study of
causes or origins
of diseases or
abnormal behavior
Etiology
• Biological
• Cognitive
• Sociocultural
Biological Factors
• Serotonin Hypothesis: Suggest that
depression is caused by low levels of
serotonin (Copen, 1967)
• Anti depressant in the form of selective
serotonin reuptake inhibitor (SSRI) block
the reuptake process for serotonin.
• SSRI Drug such as Prozac, Zoloft and Paxil
are
the
most
common
sold
antidepressants.
Evaluation of the serotonin
•
There is some evidence that serotonin may be
involved in depression and it can be linked to
stress and stress hormones such cortisol.
•
Research has failed to show a clear a link between
serotonin levels and depression. Anti-depressant
drugs like the SSRIs can regulate serotonin levels
produce and effect not mean that low serotonin
levels cause depression.
•
Major Depression is complex disorder and
environmental factors can play an important role in
the development of the disorder as well.
Biological Factors
• Genetic
and
biochemical factors in
depression. Chemical
imbalance. Dopamine
and serotonin related.
• E.g.
Caspi
(2003),
Lykken & Tellegen
(1996)
There are several genetic and
biochemical
factors
in
depression. There are certain
genes that have found to have
links with depression such as
the short allele of the 5-HTT
gene
(Caspi
2003).
Video about Biological Factors
• https://www.youtube.com/watch?v=m4P
XHeHqnmE
Brief discussion
• If you have depression, would you like to have
medication? What else would you do or try?
Classwork
• Genetic Predisposition. Please explain to
the class how this affect/influence MD.
•
Sept 22nd
Classwork
• Genetic Predisposition. Please explain to
the class how this affect/influence MD.
Genetic Predisposition
• This theory is based on the assumption that
disorders have a genetic origin. Simple.
• 2 studies to be aware:
1. Twin studies: Nurnberger and Gershon (1982) reviewed the results of
7 twin studies and found that the concordance rate for major depressive
disorder was consistently higher for MZ twins than for DZ twins genetic
factors
might
predispose
people
to
depression
Average concordance rate for MZ twins was 65%, while for DZ twins it
was 14%. The fact that the concordance rate is way below 100 indicates
that depression may be the result of genetic predisposition/genetic
vulnerability.
2.Caspi (2003) et al short variant of the 5-HTT gene may be associated
with higher risk of depression. This gene plays a role in serotonin
pathways which scientists think are involved in controlling mood,
emotions,
aggression,
sleep,
and
anxiety.
Evaluation
• There seems to be a genetic vulnerability to
depression BUT depression is a complex
disorder and environmental factors such as
continuous stress seems to play an important
role in the development of the disorder.
Etiology
• Biological
• Cognitive
• Sociocultural
Cognitive
• A depressed mood may lead to depressed
thoughts.
• Depressed cognitions, cognitive
distortions, and irrational beliefs produce
disturbances in mood
• E.g. Goldapple (2004), Lyon & Woods
(1991)
Goldapple (2004).
The aim of this study was to investigate how cognitive therapy affects brain
changes.
In this study, the brain activity before and after 15-20 therapies of cognitive
therapies over seven weeks of fourteen different patients were
documented using a PET scan. PET scans from a previous study on
participants taking antidepressants were used as a control group. Other
controls were that participants were screen to ensure that they had no
substance problems or antidepressant treatment within one month prior
to the study. The
results were fascinating as there were
significant changes in glucose metabolism in
prefrontal-hippocampal pathways.
• The changes to the brain were similar as those
patients who took antidepressants. This
experiment is difficult to replicate. However, it
is highly valid and high in ecological validity
because PET scans are used in everyday life.
• Antidepressants
Therapy?
=
Cognitive
Behavioral
Beck (1976) Cognitive Theory of
depression
• Depression is caused by inaccurate cognitive
responses to the events in form of negative
thoughts. Examples?
• People’s conscious thoughts are influenced by
negative cognitive schemas about the self and
the world. We called this negative thoughts
and dysfunctional beliefs.
Beck (1976) Cognitive Theory
of depression
• Beck’s theory can be seen within the
diathesis-stress model of depression
• Depressive thinking and beliefs are
assumed to develop during childhood
and adolescence as a function of
negative experiences with parents or other
important people. This events tend to
produce negative automatic thoughts.
Evaluation of Beck’s theory
• This theory has generated a large amount of
research.
• This theory is effective describing many
characteristic of depression.
• Limitation is difficult to confirm that is the
negative thinking patterns that cause
depression but there some empirical support
of the causal aspects of theory.
Sept 23th
Volunteer?
• Does the sociocultural factors will influence
on MD?
Sociocultural
• Social and cultural
factors affect the
prevalence and
manifestation of the
disorder
Social factors such as poverty or living in a violent
relationship have been linked to depression.
Women are more likely to be diagnosed with
depression than men and one reason could be
linked to the stress of being responsible for many
young children and lack of social support.
There are many studies that support the existence of this factor.
One
of
those
is
Brown
and
Harris
(1978).
Examined the relationship between social factors and depression in a group
of women from Camberwell in London. They studied women who had
recieved hospital treatment for depression or consulted a doctor about
depression. They also studied a general population sample of 458 women
aged
between
18-65
years
old.
90%
Findings: they found that on average,
of those who became
depressed recently had encountered a traumatic life event. In the normal
group however, only 33% of the women had encountered a serious life event
recently. The study also found that working women were at a greater risk of
depression than women who stayed at home.
It was also found out that women with
children have a greater risk of depression
as well. Women that were recently
widowed, divorce or separated also have a
relatively higher chance of suffering from
depression.
One of the most protecting factors against
depression was found to be the presence
of a partner.
Evaluation of the sociocultural
factor.
+Can be used for therapy
+Supporting research
-Methodological problems with research. How
do you measure this?
-Simplistic: Each perspective emphasizes one
factor.
Classwork: The impact of
poverty on child depression
Time to work on your IA
Sept 25th
Treatment of
Depression
Biomedical treatment
Types of biomedical treatments
• Drug therapy
• Electroconvulsive therapy (For severe cases of
depression)
• Psychosurgery (Rare, for severe cases, if all
other treatments have failed)
• Exercise
• Acupuncture
• Herbal medicine
The biological depression treatments are familiar to many people in that they
usually include antidepressant medications and ECT (electroconvulsive
therapy) or shock treatments. Antidepressant medications have grown
significantly in their level of effectiveness and have an improved side effect
profile over the earlier medication treatments.
The earliest antidepressants included tricyclic antidepressants which are now
increasingly being replaced by the SSRI's (selective serotonin reuptake
inhibitors) which include Prozac, Paxil and Zoloft.
One of the most controversial forms of depression treatment is
electroconvulsive therapy
or ECT. These treatments for
depression have been around for several decades but have improved
significantly over the years in terms of both safety and effectiveness.
STUDY: Use your critical
thinking!
Name and year of study
Kirsch et al (2002)
Aim
To find out whether new generation anti-depressants Selective Seratonine
Reuptake Inhibitors (SSRI) is effective in treating depression or not.
Research method
Experimental
Procedure
Using the Hamilton Scale for Depression on patients of different severity of
depression taking the SSRI and placebo to see if the SSRI is effective or not.
Findings
The effects on the SSRI did not seem effective on patients with mild and
moderate symptoms of depression; only severe depression patients experience
some positive effects.
Classwork. 10-15 Minutes
Evaluate the methodology in the study Kirsch
(2002). Possible ethical considerations.
• Strengths
• Weakness
Conclusion…
Methodological strength
Make people more aware of the real effects of the new generation
drugs.
Ecological validity is high as drugs are being tested for their real effects.
Methodological weakness
Employed too many participants of the milder depression with fewer
participants with severe depression. Creates a bias. (Low generalizability.
Some drugs experimented were still in the experimental phase, and
not yet approved by the FDA.
Ethical considerations
Requires human testing on drugs, but consent forms are given.
Brief Debate.
Would you NOW take
medication for
depression?
Sept 26th
Presentation for Tuesday October
7th
• Find 3 effective different ways to treat
depression. Please use your critical thinking
and bring empirical evidence.
• This activity would be graded.
Treatment of
Depression
Individual Therapy Treatment
• The therapist works one-on-one with a client.
Widely used CBT ( Cognitive Behavioral
therapy)
• CBT includes around 12 to 20 weekly session
combined with daily practice exercises
• Example:
https://www.youtube.com/watch?v=0Tt1IDj
mito
Group Treatment
The therapist meets with a group of people. Is
based on mindfulness and is becoming very
popular. Less expensive.
Real example of group therapy.
Oct 6th
Presentation for Tuesday October
7th
• Find 3 effective different ways to treat
depression. Please use your critical thinking
and bring empirical evidence.
• This activity would be graded.
Describe symptoms and prevalence of
one disorder from two of the following
groups:
– anxiety disorders
– affective disorders
– eating disorders
Bulima Nervosa
•
•
•
•
Symptoms
Etiology
Evaluation
Treatment
Volunteer?
What are the
symptoms of
Bulima Nervosa?
Symptoms of Bulima Nervosa
(DSM-IV-TR).
• Physiological:
• Cognitive:
• Emotional:
• Behavioural:
Classwork. Symptoms of Bulima
Nervosa (DSM-IV-TR).
• Physiological: Nutritional deficiencies and hormonal
changes could lead to disturbances in the menstrual cycle,
fatigue, digestive problems, muscle cramping.
• Cognitive: Distorted body image, low self-esteem, sense of
lack of control during binge-eating episodes
• Emotional: Fear of becoming fat (fat phobia), body
dissatisfaction and depressed mood.
• Behavioural: Self-starvation in combination with recurrent
binge eating episodes and compensatory behavior such us
vomiting and misuse of laxative to avoid weight gain
Share PDF Symptoms.
Bulimia is an emotional disorder
characterized by a distorted body
image and an obsessive desire to lose
weight, in which bouts of extreme
overeating are followed by fasting or
self-induced vomiting or purging.
BBC Documentary about Bulimia.
Homework. Gather the 5-7main ideas of the documentary.
https://www.youtube.com/watch?v=OWmhl1z9cPs
Oct
th
20
People continually compare
themselves to other people
and doing so affects their
self-esteem.
Media
The media has made us accustomed to firm and
uniform standards of beauty.
Media exposes us to “beautiful people” and makes
exceptionally good looking individuals seem
“normal” “real” and attainable which is ironic as
standards of beauty are becoming more difficult to
attain.
Current media ideal of women’s weight is achievable
by less than 5% of the female population.
Most eating disorders start with a young women
who is not considerably overweight believe she
“needs” to go on a diet.
The media reflects & shapes a strong cultural
pressure towards thinness.
The rise in eating disorders throughout Europe, US,
& Japan has been attributed to an increased
cultural emphasis on ideal body shape
Women are more likely than men or children
to be affected by the propaganda put forth by
the media supporting thinness.
The ideal female being thin is even apparent
in children’s fashion and in doll design so that
young girls are vulnerable to distorted
models of the ideal body shape.
Classwork. Debate
What is the “The Perfect Body Figure” ?
Bulima Nervosa
•
•
•
•
Symptoms
Etiology
Evaluation
Treatment
Etiology
• Biological
• Cognitive
• Sociocultural
Biological etiology of Bulimia
Nervosa
Research suggests that a genetic
predisposition to bulimia may run in
families. If a girl has a sibling with
anorexia, she is 10 to 20 times more likely
than the general population to develop
anorexia herself. Brain chemistry also
appears to play a significant role.
Serotonin also appears to play a role in bulimia.
Increased serotonin levels stimulate the medical
hypothalamus and decrease food intake.
Carrasco (2000) found lower level of serotonin
in bulimic patients.
Cognitive etiology of Bulimia
Nervosa
Cognitive mind: trying to deal with
perfectionism, control things by strictly
controlling amount of food intake and weight
Self esteem is tied to their weight (how thin
they are)
Could be caused by emotional stress or severe
trauma (sexual abuse, death of loved ones)
during times before or during puberty.
Body-image distortion hypothesis” : 1962,
Bruch.
Overestimation of body size
Slade and Brodie 1994 : those who suffer
from an eating disorder are UNCERTAIN
about the size /shape of their body
Make judgment in which
overestimation of body size.
results
in
Sociocultural etiology of anorexia
nervosa
More common in western society, but it is increasing in the eastern
societies because of globalization
Media exposure
Social learning that people mimicking the action of their parents and low
self-esteem
Family interaction Places(social or environment) where they take the
importance on physical appearance. Example of hair and Indian.
Places where people who are thin achieve success.
Generally speaking Bulimia is
due…
•
•
•
•
•
•
•
Media /social pressures
Anxiety and/ or stress
Low self-esteem and unhappiness
Controlling by family members
Family emphasis on physical appearance
Mother had an eating disorder
Perfectionism
Classwork.
Independent reading. Read
page 161-165.
Nov 6th
Bulima Nervosa
•
•
•
•
Symptoms
Etiology
Evaluation
Treatment
Treatment and evaluation of
Bulimia
Treatment
• Treatment options depend on each person
and their families, but many treatments
incorporate journaling, talking to therapists,
and working with dietitians and other
professionals.
• It is common to engage a multidisciplinary
treatment team consisting of a medical-care
provider, a dietician or nutritionist, and a
mental-health-care provider.
• Weight gain can be achieved using schedules
for eating, decreased physical activity, and
increased social activity
• Hospital treatment must initially focus on
correction of malnutrition
Discuss cultural and gender
variation in prevalence of
disorders
Can you name some of the cultural
differences that may lead to a higher a
prevalence of disorder in some cultures?
Cultural and gender variation in
prevalence in Depression
Social problems/pressures and cultural
differences may lead to higher a prevalence of
disorders in some cultures.
• Becker (1995): After the introduction of television in
Fiji, eating disorders in women increased.
• Suicide is more common in poorer countries.
• Chiao & Blinsky (2010): Depression is associated
with individualism. Individualism is negatively
correlated with the frequency of the short allele
related to serotonin transporters.
• In cultures with high levels of community,
religiosity, and traditional family roles,
depression is less prevalent (e.g. Wu and
Anthony 2000)
Do you think it is there any gender
differences in gender in prevalence
of disorders?
Why are there gender differences in
prevalence of disorders?
• The are genetic differences between men and
women in susceptibility for a disorder
• There are cultural differences in expectations
of men and women which contribute to
different disorders
The are genetic differences between
men and women in susceptibility to a
disorder
• Zubenko: Some chromosomes are more
likely to contain genes that promote
depression. These chromosomes are more
common in women than men.
There are cultural differences in expectations of
men and women which contributes to different
disorders
• Becker (1995): After the introduction of
television in Fiji, eating disorders in women
increased
• Bulimia and anorexia are most common
among upper and middle class Caucasian
women.
Biological Factors: Hormones
According to Nolen- Hoeksema (2001) suggest
that women and men experience the same
stressors but women seems to be more
vulnerable to develop depression because of
gender differences in biological responses to
stressors, self-concepts or coping skills.
Experiences of continuous stress could increase
physiological and psychological reactivity to
stress and lead to hyperactivity of the stress
system,
Classwork. Lebanon & depression.
Tomorrow.
•
•
•
•
•
Research and work in groups of 2.
Rates
Studies
Location
Check your sources.
Time to work on your IA .
• Work on the Internal Assessment.
Nov 9th
China & depression
The apparent rarity of depression in China was noted
by Western observers in the early 1980s. A psychiatric
survey of mental disorders was undertaken in seven
regions in 1993. The 1993 data suggest the community
rate of depression was several hundreds of times lower
than in the United States. Research shows a number of
different reason…
What are possible
reasons for this
difference in
prevalence between
China and U.S ?
Psychological symptoms are primarily reported as physical
symptoms.
This is partly because a long-standing attachment to the
diagnosis of shenjing shuairuo, (neurasthenia) which translates
as ‘neurological weakness’. Patients presenting with a
clinical picture of insomnia, dizziness, headache, poor
concentration, and related complaints commonly receive a
diagnosis of neurasthenia as patients often prefer to interpret
their illness as physical in origin and report only somatic
discomforts to their doctors. However although diagnoses of
neurasthenia is becoming less common, and there has been a
shift to more psychological symptoms, based on western criteria
might ignore culturally valid experiences of physical distress.
Stigma
Mental illness is stigmatized in traditional
Chinese culture, as in many parts of the world.
It is seen as evidence of weakness of character
and a cause for family shame, a "collective loss
of face" for the extended family. The family
may deny a family member’s mental
illness, while fear that others may find out
about mental illness in the family may prevent
the family from obtaining adequate outside help
.
Differences in diagnostic practice
A number of publications have outlined differences in
diagnostic practices that may influence the reported
rates of depression among the Chinese.
Chinese psychiatrists have tended to take a
broad diagnostic view of schizophrenia and in
some cases of depression may be diagnosed as
schizophrenia.
In a study comparing DSM-III diagnoses with
diagnoses made by Chinese psychiatrists using
the Chinese diagnostic criteria in 116 patients
in Shanghai, one-half of those who received
a DSM-III diagnosis of depression received a
different diagnosis, including schizophrenia,
from the Chinese psychiatrists ( Parker 1988)
However, whilst this indicates differences in
diagnostic practice it does not mean one
diagnosis is any more valid than the other, as
the DSM is a western diagnostic tool.
Resilience
Certain Chinese socio- cultural factors may provide some
protection against becoming depressed. Parker et al (2001) list
several factors that promote resilience in the Chinese. These
include
a
strong
sense
of
interdependence with family and social
support, collective responsibility and a
tendency towards fate and stoicism may
mean the Chinese are more able to both
manage
and
accept
depression.
Classwork. Use your critical
thinking. Working individually
• Please write down 5 possible reasons for the
prevalence in depression.
1.
2.
3.
4.
5.
Discuss cultural and gender
variation in prevalence of bulimia
Cultural beliefs and attitudes have been
identified as factors leading to the development
of eating disorder. Prevalence of eating
disorders varies among different ethnic and
cultural groups and across time within such
groups. Bulimia nervosa was identified and
classified as specific disorder in 1979.
Different Studies
Makino (2004) compared prevalence of eating
disorders in Western and Non-Western
countries based on a review of published
medical articles.
• Western: 0.3 to 7.3% in females
0 to 2.1% in males
• Non- Western: 0.46 to 3.2% in females
Western hypothesis
• Rubinstein and Caballero (2000) eating
disorders seem to have become more
common among young females after the
Second World War, where female beauty
ideal have gradually become thinner.
Magazine and media.
• Social pressure to conform to the standard of
female beauty imposed by modern industrial
society or Western Culture.
Different beauty
• https://www.youtube.com/watch?v=AGUKCVINKQ
• https://www.youtube.com/watch?v=DQqm
nFMgY4s
Nasser (1994)
• He found that 1.2% of the girls fulfilled the
criteria for diagnosis of bulimia nervosa and
3.4% qualified for a partial diagnosis.
• Results indicate that eating disorders are
emerging in cultures that did not know such
disorders in the past where a round female
body was still considered attractive and
desirable and was associate with prosperity,
success and economic security. India example
Nov 11th
Discuss the use of
eclectic approaches to
treatment.
Depression and Bulimia are
complex disorders, with multifaceted etiologies. With this in
mind it could be argued that
therapists should use an eclectic
approach in the treatment of
disorders.
An eclectic approach incorporates principles or
techniques from various theories.
Eclectic therapy recognizes the strengths and
limitations of the various therapies, and tailors
sessions to the needs of the individual client or
group.
In the case of a depressive patient who is
suicidal, cognitive-behavioural therapy (CBT)
may take too long to take effect, or the
individual may not be in a state that would
allow for discussions about his or her cognitive
processes. Drug therapy may be used in order
to lessen the symptomology of the disorder;
then, once the individual is stabilized, CBT might
be used. Also, as the individual becomes more
self-reliant,
group
therapy
may
be
recommended in order to help him or her
develop strategies to avoid future relapse, as
well as a support system.
Although nearly 50% to 60% of depressed
outpatients experience an improvement in
mood to the first trial of antidepressants,
only 1 in 3 patients will experience a full and
complete recovery with no symptoms (Keller
2004). The risk of relapse is also high and there
is risk of repeated depressive episodes. The
combination of psychotherapy and drugs
seems to be particularly valuable in the
prevention of relapse.
Why eclectic
approaches could be
more efficient than
medication alone?
• There is always a risk that patients stop their
medicine. This could be because the patient
feels somewhat better after a while and then
stops, or could be because he or she
experiences too many side effects.
• Pampallona ( 2004) this could be very
good reason for the clinician to combine
antidepressants with psychotherapy. Their
review randomized controlled trials show
that the combination of drugs and
psychotherapy generally leads to greater
improvement.
It
showed
that
psychotherapy helps to keep patients in
treatment.
Evaluation of this approach
• Brainstorming. Volunteer on the board.
Advantages
1. Eclectic approaches have a broader theoretical base and may be more
sophisticated than approaches using a single theory.
2.Eclectic approaches offer the clinician greater flexibility in treatment.
Individual needs are better matched to treatments when more options are
available.
3. There are more chances for finding efficacious treatments if two or more
treatments are studied in combination.
4.The clinician using eclectic approaches is not biased toward one treatment
and may have greater objectivity about selecting different treatments
Disadvantages
1.Sometimes clinicians use eclectic approaches in place of a clear theory. Eclectic
approaches are not substitutes for having a clear orientation that is supplemented with
other tested treatments.
2. Sometimes eclectic approaches are applied inconsistently. It takes knowledge and skill
to deliver eclectic approaches effectively.
3. In general there are very few efficacy studies at this stage to support the approach,
partly because it is difficult to judge the relative value of each treatment in an eclectic
approach.
4. However it is important to remember that eclectic approaches may be too complex for
one clinician. There is always a danger that clinicians might call themselves "eclectic"
when they really have no clear direction for treatment.
Nov 17th
Discuss the relationship
between etiology and
therapeutic approach in
relation to one disorder.
Etiology
• Cause of the disorder. There no simple
explanation of complex psychological
disorders.
Scientific research has failed to show a clear link
between serotonin levels and depression. The
fact that antidepressant drugs like SSRI can
regulate serotonin levels and produce an effect
does not mean that low serotonin levels cause
depression.
Etiology and therapeutic
approach in major depression
• Treatment of major depression often involves
antidepressant medication that interferes
with neurotransmission in the the brain. Can
be seen as attempt to regulate what is
believed to be an imbalance in the serotonin
system.
Some psychiatrist question the usefulness of
antidepressants that interfere with serotonin
balances in the brain on the grounds
• Serotonin system in he brain is very complex and not much is
known about the drugs long term effect.
• The drugs do not CURE depression and have side effects.
• Studies show that placebo might be as effective.
• Psychotherapy (CBT) is just effective and in some causes
more effective.
Etiology: The serotonin
hypothesis
• Serotonin hypothesis suggest that depression
is caused by low levels of serotonin in the
brain (Coppen, 1967)
• Anti-depressants in the form SSRI block the
re-uptake process for serotonin. This results in
increased amount of serotonin in the synaptic
gap.
What about the medical
industry?
SSRI
• Prozac, Zoloft and Paxil are among the most
sold anti depressant and the drug companies
spent million of dollars on advertising
campaigns all over the world.
Lacasse and Leo (2005)
Assumptions about the cause of depression are
based on how people respond to a treatment
and this is logically problematic.
It is clear that aspirin can cure headaches but
this does not prove that low levels for aspirin in
the brain cause headaches??
Classwork. Read
• http://www.appsychology.com/IB%20Psyc
h/IBcontent/Options/abnormal/Abnormal%
20Q/10Abnormal.htm
Mind map. Project on PTSD OR
Bulimia or Depression
•
•
•
•
Symptoms
Etiology
Evaluation
Treatment
• Talk about 2 or more studies.
Due date: December 1st