* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Abnormal Option File
Survey
Document related concepts
Moral treatment wikipedia , lookup
Lifetrack Therapy wikipedia , lookup
Mental status examination wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
History of psychiatric institutions wikipedia , lookup
Dodo bird verdict wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Mental disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Major depressive disorder wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Externalizing disorders wikipedia , lookup
Child psychopathology wikipedia , lookup
Transcript
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