3Introduction to psychological disorders- Vocab SymptomologyIdentification of the symptomsEtiologyThe ‘why’ people suffer, the origin of.Understanding the origin requires holistic approach.Prevalence rateTotal number of cases of a specific disorder in a given populationLifetime prevalence (LTP)The % of population that will experience the disorder at some timeOnset ageAverage age in which the disorder is likely to appear.
4Evaluate through theories and studies Evaluate Psychological research relevant to the study of abnormal behaviorEvaluate through theories and studies
6Affective disorders: Major Depression Diagnostic CriteriaExperiences symptoms for 2 weeksLoss of pleasure or interestDepressed moodCurrent research suggest that there areBiological – genetic make-up and biochemical factorsCognitive – thoughts of hopelessness, low self-esteemSociocultural factors – stress of poverty, loneliness or troubles personal relationshipsTreatmentDrug and therapy
7Symptoms Major Depression Affective: feeling of guilt or sadness; lack of enjoyment or pleasure in familiar activities or companyBehavior: passivity; lack of interestCognitive: frequent negative thoughts; faulty attribution; low self esteem; suicidal thoughts; difficulties concentrating, inability to make a decisionsSomatic: loss of energy; insomnia, weight gain/loss; diminished libidoThese symptoms interfere with normal work and relationships
8Major Depression LTP = 15% Health department 1990 2-3x more common in women then menMore frequent among lower socioeconomic groupsMost frequently among adults.Prevalence rate higher in Jewish males vs other males.80% reoccurrence rate, with a typical episode lasting 3-4 months; 12% of cases, depression can be chronic, lasing as long as 2 years.
9Be a thinker pg 149 Is Jane depressed? Support your claim What could be contributing to her state of mind?If you were Jane’s doctor, what questions could you ask her in order to identify possible causes of her condition?What could you suggest to help Jane? State your reasons.
10Etiology DepressionOnset of depression can be brought about by biological factors or an adverse social and environmental change.Most will represent complex interactions between physiology and psychological.Some depression is brought about by long-term circumstances, which are a continuing source of stress and disappointment.
11Not all people become depressed when stressed There are important distinctions in vulnerability:Genetic predispositionPersonality and early historyCognitive styleCoping skillsLevel of social supportMajor depression is NOT caused by a single factor – there is no 1 cause of depression.
12BLOA: genetic factors depression Twin Studies:Concordance rate higher in MZ twins vs DZ twinsGenetic factors might predispose people for depression. Assessing seven studiesAverage concordance rateMZ = 65% - this is below 100%, thus can only suggest a predisposition (genetic vulnerability)DZ = 14%These findings do not contradict stress or environmental aspects.
13Biochemical Hypothesis of depression Catecholamine hypothesisSerotonin HypothesisCortisol Hypothesis
14Caspi (2003) genetic factors could moderate responses to the environment (findings are still premature)Neurobiologydepression may be caused by neurotransmitters and hormone deficiencyCatecholamine hypothesis: Joseph Schildkraut 1965Depression is associated with low noradrenaline → serotonin hypothesisDrugs that decrease NE bring about depression like symptomsUse of Physostigmine (Janawskuy et al., 1972) resulted in individuals feeling depressed, self hate and suicidal within minutes of having taken the drug.Addition of NE reduces symptoms.
15NT ImbalancesDelgado and Moreno (2000) – abnormal levels of NE and 5-HT.Rampello et al., (2000) – NE, 5-HT, DA and acetylcholine may all contribute.
16Criticism of 5-HT hypothesis It is not possible to measure brain serotonin levelsWhich comes first – the chicken or eggDoes depression alter neurotransmitters or does alteration in neurotransmitters create depression?
17Cortisol hypothesis Stress hormone Family of glucocorticoids that play a role in anxiety and fear reactions,.High levels of cortisol in individuals with depression.Long term structural changes may be seen – hippocampus (memory) loses neurons; reduction of glucocorticoid receptors in prefrontal cortex and hippocampus of suicide victims.Cushing’s Disease – excess cortisol production - high prevalence of depression.Over-secretion of cortisol may be linked to other neurotransmitters.Lower 5-HT receptorsImpair NE receptors
18Research in Psychology page 153 Impact of poverty on child depressionFernald and Gunnar (2009) –Surveyed 639 Mexican mothers and childrenChildren of depressed mothers in extreme poverty produced less cortisolSuggest that the stress system is “worn out”
19Be empatheticProduce a list of stressors which you think poverty causes individuals.If you were in public office, what would you propose in order to alleviate some of these stressors?
20Video Depression (1) how depression changes the brain Depression (2)Impact of childhood eventsDepression (3) Role of inflammation in depressionDepression (4) The best treatment for depressionDepression (5) The effects of treatment on the brain.
21CLOA: cognitive factors, depression Cognitive theories of depression:Depressed cognitionCognitive distortionsIrrational beliefsEllis (1962) – psychological disturbances often come from irrational and illogical thinking.People draw false conclusion which lead to feelings of anger, anxiety or depression.“my work must be perfect” & “my essay did not receive top grades” → defeating conclusion, “since I did not receive the highest grade I am stupid”
22Cognitive Distortion:Beck’s theory of cognitive vulnerability factors. Distortion based upon schema processing:Stored schema about the self interfere with information processingTriggered by stressful eventsTends to overreactDepressive patients experience a negative cognitive triad:Overgeneralization based on negative eventsThe world is unfairNon-logical inferences about the selfThe self is worthlessDichotomous thinking – “black and white” thinking, selective recall of negative consequences.The future is hopeless
23“things will not improve” Cognitive Triad“I am a bad person”The Self“things will not improve”The Future“My life is terrible”Experiences
24Beck: Silent Assumptions Cognitive thoughts of depressed people are dominated by a set of assumptions that shape conscious cognitionThese assumptions are derived from our environmentParents, teachers, friend”I must get approval”“I must do thing perfectly”“I must be valued by other or I am worthless”
25Beck: Informational processing How depressed people are prone to distortion of misinterpretation.Arbitrary inferences – drawing negative conclusions based on limited informationSelective thinking – focusing on negativesOvergeneralization – jumping to conclusion based on a single incidencePersonalizing – taking blame/responsibility for all unpleasant things that happenBlack and White thinking – seeing everything in terms of success and failure
27Read page 154Is it possible that depression is mostly related to cognitive factors? Present two claims and support with evidence.Which comes first – the cognitive thinking pattern triggers depression or does depression trigger the cognitive thinking pattern?
28SCLA: social and cultural factors, depression Diathesis-stress model = interactionist approach to explain psychological disorders.Brown and Harris (1978) – social origins of depression in women.Vulnerability model.
29Sociocultural factors PovertyLiving in a violent relationshipStress of raising young childrenWarRestricted gender roles
30Brown and HarrisAim: To determine how depression could be linked to social factors and stressful events in women.Procedure: 458 women surveyed on daily life and depressive episodesResults:Working class women with children were 4X more likley to develop depression than middle-class women with children8% (37) of all women had clinical depression33/37 (90%) experienced an adverse life event (death/abuse)4/37 did not suffer adverse affect.30% of the women who did not become depressed experienced the same adverse affects
31Brown and Harris Findings: 3 major factors that effect depression Protective factors: high levels of intimacy with spouse – may induce higher self esteem/meaningful lifeVulnerability factors – loss of a mother before age 11; lack of confiding relationship; more than 3 children under the age of 14 at home; and unemployedProvoking agents – contribute to acute and ongoing stress.
32Diathesis Stress model Brown and Harris vulnerability model supports the diathesis stress model: the interactive effect of heredity and environmental factors
33Cultural Considerations WHO (1983) assessing Iran, Japan, Canada and Switzerland – Common symptoms of depressionSad affectLoss of enjoymentAnxietyTensionLack of energyLost of interestInability to concentrateFeelings of worthlessnessThese findings are consistent with earlier cultural studies done by Murphy et al., (1967)
34Culture cont.,Marsella (1979) affective symptoms are associated with individualistic cultures; somatic symptoms are associated with collectivist cultures.Kleinman (1982) China somatization served as a typical channel of expression and basic component of depression.Prince (1968) claimed there was no depression in African and Asian cultures prior to westernization.Cross Culture research - each culture experiences almost identical core symptoms, and they may exhibit symptoms that are culturally specific.
35Gender Considerations in major depression Women are 2-3X more likely to become clinically depressed than men.It is a widely held belief that women are naturally more emotional than men, and therefor more vulnerable to emotional upsepts because of hormonal fluctuations.Is this a valid argument?
36Discuss the interaction of biological, cognitive and sociocultural factors in major depression. This prompt requires you to consider a number of explanations and evidence to support your argumentThe argument should include relevant research and theory.
37Relevant studies Depression Rosenhahn (1973): On being sane in an insane placeValidity of diagnosis:DiNardo et al. (1993)Lipton and Simon (1985)Ethial ConsiderationsThomas SzaszScheff (1966) labeling brings about self-fulfilling prophecyLanger and Abelson : prejudice and discriminationCultural ConsiderationsRack (1982) – mental illness carries great stigma in China
38Relevant studies Depression Cochrane and Sashidharan (1995)Cultural blindnessBiological:Cognitive: BeckSociocultural: Brown and Harris: Elkin et al (1989) - treatment
40Biomedical approaches to treating depression If the problem is based on biological malfunctioning, then it stand to reason that treating it medically should relieve symptomsDepression is known to involve imbalances in neurotransmitters – thus treating with drugs that realign the NT balance should alleviate symptoms.Not all patients respond the same way.
41Mode of action Drugs are designed to affect the neurotransmitters Dopamine (DA) (excitatory/inhibitory neuron)Serotonin (5-HT) (inhibitory neuron)Noradrenaline (NE) (excitatory neuron)GABA (gamma-aminobutyric acid) – (Inhibitory neurons)Mechanism of actionEither inhibit or enhance the effect of the NT in question.
42SSRI’s SSRI’s Available Selective Serotonin Reuptake Inhibitors: Increase the level of 5HT at the synaptic cleftFluoxetine most common SSRI used (Prozac)Effective, Relatively safe, side effects.Kirsh et al (2008) criticize “over prescription” of SSRIsSSRI’s AvailableCelexacitalopram hydrobromideLexaproescitalopram oxalateLuvoxfluvoxamine maleatePaxilparoxetine hydrochlorideProzacfluoxetine hydrochlorideZoloftsertraline hydrochloride
43NE and 5-HT approach Increase NE and 5 HT levels Brand Name Generic NameCymbaltaduloxetine hydrochlorideEffexorvenlafaxine hydrochlorideRemeronmirtazapineIncrease NE and 5 HT levels
44Evaluation of Drug Therapy Short term treatment is successful for 60-80% of people (Bernstein et al. 1994)However, they are not equally effective in all cases.Kircsh and Sapirstein (1998) analyzing 19 studies (2318 patients treated with Prozac) found that the antidepressant was only 25% more effective than the placebos, and no more effective than other kinds of drugs, such as tranquillizers.Most psychiatrist agree that drugs provide effective long term control for mood disorders, and may help to prevent suicide in depressive patients.Drug therapy has reduced the number of hospital inpatients; but it is important to note that this also reflects changes in hospital policy.
45Side Effects and Ethical Issues Drug therapy cannot be given without consent unless it is an emergency.Drug therapy does not constitute a cureCriticism of the efficacy of antidepressants in comparison to placebo (Kirsch et al 2008)Blumenthal et al (1999) found that exercise was just as effective as SSRI’s in treating depression in an elderly group of patients.
46Leuchter and Witte (2002)Depressive patients receiving drug treatment improved just as well as patients receiving placebo Brain scans revealed changes in the brain in both cases but in different areas:Placebo – increased activity in prefrontal cortex (changes occurred 1 – 2 weeks into treatment)Antidepressant – reduced activity in prefrontal cortex (changes occurred within 48 hours)Although medication may be effective, there may be other effective ways to treat depression.
47Elkin et al. (1989) National Institute of Mental Health: 28 clinicians who worked with 280 patients diagnosed with depressionPatients randomly assigned to treatment groups:Antidepressant + clinical management (imipramine) (double blind)Interpersonal therapy (ITP) or Cognitive behavioral therapy (CBT)Control = placebo with weekly therapy (double blind)All patients were assessed at the start, 16 weeks of treatment and 18 months
48Elkin cont.,Results:50% patients recovered in IPT and CBT as well as in the drug group29% recovered in the placebo groupDrug treatment produced fastest resultsThe study suggests that it does not matter which treatment patients received, all treatments had the same result.Arch Gen Psychiatry Nov;46(11):971-82; discussion 983.National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments.
49OK Doctors – what do you think? Would it be acceptable to give a patient placebo pills instead of antidepressants?What arguments could you make for and against?
50Individual approaches to treatment of depression Aaron Beck pioneered the idea of cognitive restructuring, the core of cognitive behavior therapy.Approach to Cognitive restructuring:Identify the negative, self critical thoughts that occur automaticallyNote the connection between negative thought and depressionExamine each negative thought and decide whether it can be supportedReplace distorted negative thoughts with realistic interpretations of each situation.
51Cognitive behavior Therapy “a persons beliefs contribute to automatic thoughts” based on schema” BeckNegative self schemas bias a persons thinking.CBT – focuses on current issues and symptoms.weekly sessionsDaily practice exercisesBehavior modification
52Aim of CBTIdentify and correct faulty cognitions and unhealthy behaviors.Identify what thoughts are associated with depressed feelings and to correct them – reconstruction – based on the foundation that assumptions may be distorted.6 patterns of faulty thinking:Arbitrary inferencesSelective abstractionOvergeneralizationExaggerationPersonalizationDichotomous thinking
53Arbitrary InferenceDrawing wrong conclusions about oneself by making invalid connectionsYou think that only you have bad luck and that the world is against you.
54Selective Abstraction Drawing conclusions by focusing on a single part of a whole.Focusing on a single bad grade and ignoring the fact that you actually have an A in the class; you are fat because you think you have fat thighs.
55Overgeneralization Applying a single incident to all similar incidents Assuming a relationship problem with a friend means you are unsuccessful in all relationships
56ExaggerationOverestimating the significance of negative events.
57PersonalizationAssuming that others’ behavior is done with the intention of hurting or humiliating you.
59Psychological problems are often prone to negative automatic thinking that they CANNOT control. Example: the negative thought, and exaggeration, “I never do anything right,” may be filtered through a cognitive schema, which processes the information to fit the biased self-perception.In short, the schema provides the resource for a form of conditioning
602nd Aim CBT Behavioral Component Encourage individuals to increase rewarding seeking activities.SportsMusicGardeningCookingSewingTeasdale (1997) the important feature of cognitive therapy is to teach the client meta-awareness – the ability to think about their own thoughts.The aim of therapy is to teach each client to monitor thought processes and then to test them against reality so they can eventually change the behavior on their own.
61How effective is cognitive therapy in treating depression? Rush et al (1977): highly effectiveDobson (1989): superior to no treatment or to a placebo.Elkins et al (1989): no significant difference between CBT and Rx (tricyclic)Riggs et al (2007) : Looked at CBT with SSRI or placebo67% CBT + placebo76% CBT + SSRIBoth groups were found to be - much improved or very much improved.Conclusion: treatment with drug is effective, treatment without drug is almost as effective.
62Nemeroff et al. (2003), CBT in combination with drugs was the most effective in chronic depression in people suffering traumatic childhood experiences.Ethically speaking – it is clear that the therapist is making judgments concerning which thought are acceptable.
63Group approaches to treatment of depression Couples TreatmentFocus is on teaching couples how to communicate and problem solve more effectively while increasing positive interactions and reducing negative exchanges.More effective for women suffering from depression related to marital distress.
64Social Learning/interpersonal model Cases in Abnormal psychology pg 113
65Describe symptoms and prevalence of one psychological disorder. Evaluate the use of one approach to the treatment of the disorder[22 Mark]