1. Psychological disorders
5.2 Abnormal psychology
Psychological disorders

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

3. Introduction to psychological disorders- Vocab
Symptomology
Identification of the symptoms
Etiology
The ‘why’ people suffer, the origin of.
Understanding the origin requires holistic approach.
Prevalence rate
Total number of cases of a specific disorder in a given population
Lifetime prevalence (LTP)
The % of population that will experience the disorder at some time
Onset age
Average age in which the disorder is likely to appear.

4. Evaluate through theories and studies
Evaluate Psychological research relevant to the study of abnormal behavior
Evaluate through theories and studies

5. Major Depression

6. Affective disorders: Major Depression
Diagnostic Criteria
Experiences symptoms for 2 weeks
Loss of pleasure or interest
Depressed mood
Current research suggest that there are
Biological – genetic make-up and biochemical factors
Cognitive – thoughts of hopelessness, low self-esteem
Sociocultural factors – stress of poverty, loneliness or troubles personal relationships
Treatment
Drug and therapy

7. Symptoms Major Depression
Affective: feeling of guilt or sadness; lack of enjoyment or pleasure in familiar activities or company
Behavior: passivity; lack of interest
Cognitive: frequent negative thoughts; faulty attribution; low self esteem; suicidal thoughts; difficulties concentrating, inability to make a decisions
Somatic: loss of energy; insomnia, weight gain/loss; diminished libido
These symptoms interfere with normal work and relationships

8. Major Depression LTP = 15% Health department 1990
2-3x more common in women then men
More frequent among lower socioeconomic groups
Most frequently among adults.
Prevalence rate higher in Jewish males vs other males.
80% reoccurrence rate, with a typical episode lasting 3-4 months; 12% of cases, depression can be chronic, lasing as long as 2 years.

9. Be 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.

10. Etiology Depression
Onset of depression can be brought about by biological factors or an adverse social and environmental change.
Most will represent complex interactions between physiology and psychological.
Some depression is brought about by long-term circumstances, which are a continuing source of stress and disappointment.

11. Not all people become depressed when stressed
There are important distinctions in vulnerability:
Genetic predisposition
Personality and early history
Cognitive style
Coping skills
Level of social support
Major depression is NOT caused by a single factor – there is no 1 cause of depression.

12. BLOA: genetic factors depression
Twin Studies:
Concordance rate higher in MZ twins vs DZ twins
Genetic factors might predispose people for depression. Assessing seven studies
Average concordance rate
MZ = 65% - this is below 100%, thus can only suggest a predisposition (genetic vulnerability)
DZ = 14%
These findings do not contradict stress or environmental aspects.

13. Biochemical Hypothesis of depression
Catecholamine hypothesis
Serotonin Hypothesis
Cortisol Hypothesis

14. Caspi (2003) genetic factors could moderate responses to the environment (findings are still premature)
Neurobiology
depression may be caused by neurotransmitters and hormone deficiency
Catecholamine hypothesis: Joseph Schildkraut 1965
Depression is associated with low noradrenaline → serotonin hypothesis
Drugs that decrease NE bring about depression like symptoms
Use of Physostigmine (Janawskuy et al., 1972) resulted in individuals feeling depressed, self hate and suicidal within minutes of having taken the drug.
Addition of NE reduces symptoms.

15. NT Imbalances
Delgado and Moreno (2000) – abnormal levels of NE and 5-HT.
Rampello et al., (2000) – NE, 5-HT, DA and acetylcholine may all contribute.

16. Criticism of 5-HT hypothesis
It is not possible to measure brain serotonin levels
Which comes first – the chicken or egg
Does depression alter neurotransmitters or does alteration in neurotransmitters create depression?

17. Cortisol hypothesis Stress hormone
Family of glucocorticoids that play a role in anxiety and fear reactions,.
High levels of cortisol in individuals with depression.
Long term structural changes may be seen – hippocampus (memory) loses neurons; reduction of glucocorticoid receptors in prefrontal cortex and hippocampus of suicide victims.
Cushing’s Disease – excess cortisol production - high prevalence of depression.
Over-secretion of cortisol may be linked to other neurotransmitters.
Lower 5-HT receptors
Impair NE receptors

18. Research in Psychology page 153
Impact of poverty on child depression
Fernald and Gunnar (2009) –
Surveyed 639 Mexican mothers and children
Children of depressed mothers in extreme poverty produced less cortisol
Suggest that the stress system is “worn out”

19. Be empathetic
Produce a list of stressors which you think poverty causes individuals.
If you were in public office, what would you propose in order to alleviate some of these stressors?

20. Video Depression (1) how depression changes the brain
Depression (2)Impact of childhood events
Depression (3) Role of inflammation in depression
Depression (4) The best treatment for depression
Depression (5) The effects of treatment on the brain.

21. CLOA: cognitive factors, depression
Cognitive theories of depression:
Depressed cognition
Cognitive distortions
Irrational beliefs
Ellis (1962) – psychological disturbances often come from irrational and illogical thinking.
People draw false conclusion which lead to feelings of anger, anxiety or depression.
“my work must be perfect” & “my essay did not receive top grades” → defeating conclusion, “since I did not receive the highest grade I am stupid”

22. Cognitive Distortion:Beck’s theory of cognitive vulnerability factors.
Distortion based upon schema processing:
Stored schema about the self interfere with information processing
Triggered by stressful events
Tends to overreact
Depressive patients experience a negative cognitive triad:
Overgeneralization based on negative events
The world is unfair
Non-logical inferences about the self
The self is worthless
Dichotomous thinking – “black and white” thinking, selective recall of negative consequences.
The future is hopeless

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

24. Beck: Silent Assumptions
Cognitive thoughts of depressed people are dominated by a set of assumptions that shape conscious cognition
These assumptions are derived from our environment
Parents, teachers, friend
”I must get approval”
“I must do thing perfectly”
“I must be valued by other or I am worthless”

25. Beck: Informational processing
How depressed people are prone to distortion of misinterpretation.
Arbitrary inferences – drawing negative conclusions based on limited information
Selective thinking – focusing on negatives
Overgeneralization – jumping to conclusion based on a single incidence
Personalizing – taking blame/responsibility for all unpleasant things that happen
Black and White thinking – seeing everything in terms of success and failure

26. Beck Activity

27. Read page 154
Is it possible that depression is mostly related to cognitive factors? Present two claims and support with evidence.
Which comes first – the cognitive thinking pattern triggers depression or does depression trigger the cognitive thinking pattern?

28. SCLA: social and cultural factors, depression
Diathesis-stress model = interactionist approach to explain psychological disorders.
Brown and Harris (1978) – social origins of depression in women.
Vulnerability model.

29. Sociocultural factors
Poverty
Living in a violent relationship
Stress of raising young children
War
Restricted gender roles

30. Brown and Harris
Aim: To determine how depression could be linked to social factors and stressful events in women.
Procedure: 458 women surveyed on daily life and depressive episodes
Results:
Working class women with children were 4X more likley to develop depression than middle-class women with children
8% (37) of all women had clinical depression
33/37 (90%) experienced an adverse life event (death/abuse)
4/37 did not suffer adverse affect.
30% of the women who did not become depressed experienced the same adverse affects

31. Brown and Harris Findings: 3 major factors that effect depression
Protective factors: high levels of intimacy with spouse – may induce higher self esteem/meaningful life
Vulnerability factors – loss of a mother before age 11; lack of confiding relationship; more than 3 children under the age of 14 at home; and unemployed
Provoking agents – contribute to acute and ongoing stress.

32. Diathesis Stress model
Brown and Harris vulnerability model supports the diathesis stress model: the interactive effect of heredity and environmental factors

33. Cultural Considerations
WHO (1983) assessing Iran, Japan, Canada and Switzerland – Common symptoms of depression
Sad affect
Loss of enjoyment
Anxiety
Tension
Lack of energy
Lost of interest
Inability to concentrate
Feelings of worthlessness
These findings are consistent with earlier cultural studies done by Murphy et al., (1967)

34. Culture cont.,
Marsella (1979) affective symptoms are associated with individualistic cultures; somatic symptoms are associated with collectivist cultures.
Kleinman (1982) China somatization served as a typical channel of expression and basic component of depression.
Prince (1968) claimed there was no depression in African and Asian cultures prior to westernization.
Cross Culture research - each culture experiences almost identical core symptoms, and they may exhibit symptoms that are culturally specific.

35. Gender Considerations in major depression
Women are 2-3X more likely to become clinically depressed than men.
It is a widely held belief that women are naturally more emotional than men, and therefor more vulnerable to emotional upsepts because of hormonal fluctuations.
Is this a valid argument?

36. Discuss the interaction of biological, cognitive and sociocultural factors in major depression.
This prompt requires you to consider a number of explanations and evidence to support your argument
The argument should include relevant research and theory.

37. Relevant studies Depression
Rosenhahn (1973): On being sane in an insane place
Validity of diagnosis:
DiNardo et al. (1993)
Lipton and Simon (1985)
Ethial Considerations
Thomas Szasz
Scheff (1966) labeling brings about self-fulfilling prophecy
Langer and Abelson : prejudice and discrimination
Cultural Considerations
Rack (1982) – mental illness carries great stigma in China

38. Relevant studies Depression
Cochrane and Sashidharan (1995)
Cultural blindness
Biological:
Cognitive: Beck
Sociocultural: Brown and Harris: Elkin et al (1989) - treatment

39. 5.3 Treatment depression

40. Biomedical approaches to treating depression
If the problem is based on biological malfunctioning, then it stand to reason that treating it medically should relieve symptoms
Depression is known to involve imbalances in neurotransmitters – thus treating with drugs that realign the NT balance should alleviate symptoms.
Not all patients respond the same way.

41. Mode 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 action
Either inhibit or enhance the effect of the NT in question.

42. SSRI’s SSRI’s Available Selective Serotonin Reuptake Inhibitors:
Increase the level of 5HT at the synaptic cleft
Fluoxetine most common SSRI used (Prozac)
Effective, Relatively safe, side effects.
Kirsh et al (2008) criticize “over prescription” of SSRIs
SSRI’s Available
Celexa
citalopram hydrobromide
Lexapro
escitalopram oxalate
Luvox
fluvoxamine maleate
Paxil
paroxetine hydrochloride
Prozac
fluoxetine hydrochloride
Zoloft
sertraline hydrochloride

43. NE and 5-HT approach Increase NE and 5 HT levels Brand Name
Generic Name
Cymbalta
duloxetine hydrochloride
Effexor
venlafaxine hydrochloride
Remeron
mirtazapine
Increase NE and 5 HT levels

44. Evaluation of Drug Therapy
Short term treatment is successful for 60-80% of people (Bernstein et al. 1994)
However, they are not equally effective in all cases.
Kircsh and Sapirstein (1998) analyzing 19 studies (2318 patients treated with Prozac) found that the antidepressant was only 25% more effective than the placebos, and no more effective than other kinds of drugs, such as tranquillizers.
Most psychiatrist agree that drugs provide effective long term control for mood disorders, and may help to prevent suicide in depressive patients.
Drug therapy has reduced the number of hospital inpatients; but it is important to note that this also reflects changes in hospital policy.

45. Side Effects and Ethical Issues
Drug therapy cannot be given without consent unless it is an emergency.
Drug therapy does not constitute a cure
Criticism of the efficacy of antidepressants in comparison to placebo (Kirsch et al 2008)
Blumenthal et al (1999) found that exercise was just as effective as SSRI’s in treating depression in an elderly group of patients.

46. Leuchter and Witte (2002)
Depressive patients receiving drug treatment improved just as well as patients receiving placebo Brain scans revealed changes in the brain in both cases but in different areas:
Placebo – increased activity in prefrontal cortex (changes occurred 1 – 2 weeks into treatment)
Antidepressant – reduced activity in prefrontal cortex (changes occurred within 48 hours)
Although medication may be effective, there may be other effective ways to treat depression.

47. Elkin et al. (1989) National Institute of Mental Health:
28 clinicians who worked with 280 patients diagnosed with depression
Patients randomly assigned to treatment groups:
Antidepressant + clinical management (imipramine) (double blind)
Interpersonal therapy (ITP) or Cognitive behavioral therapy (CBT)
Control = placebo with weekly therapy (double blind)
All patients were assessed at the start, 16 weeks of treatment and 18 months

48. Elkin cont.,
Results:
50% patients recovered in IPT and CBT as well as in the drug group
29% recovered in the placebo group
Drug treatment produced fastest results
The study suggests that it does not matter which treatment patients received, all treatments had the same result.
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.

49. OK Doctors – what do you think?
Would it be acceptable to give a patient placebo pills instead of antidepressants?
What arguments could you make for and against?

50. Individual approaches to treatment of depression
Aaron Beck pioneered the idea of cognitive restructuring, the core of cognitive behavior therapy.
Approach to Cognitive restructuring:
Identify the negative, self critical thoughts that occur automatically
Note the connection between negative thought and depression
Examine each negative thought and decide whether it can be supported
Replace distorted negative thoughts with realistic interpretations of each situation.

51. Cognitive behavior Therapy
“a persons beliefs contribute to automatic thoughts” based on schema” Beck
Negative self schemas bias a persons thinking.
CBT – focuses on current issues and symptoms.
weekly sessions
Daily practice exercises
Behavior modification

52. Aim of CBT
Identify and correct faulty cognitions and unhealthy behaviors.
Identify what thoughts are associated with depressed feelings and to correct them – reconstruction – based on the foundation that assumptions may be distorted.
6 patterns of faulty thinking:
Arbitrary inferences
Selective abstraction
Overgeneralization
Exaggeration
Personalization
Dichotomous thinking

53. Arbitrary Inference
Drawing wrong conclusions about oneself by making invalid connections
You think that only you have bad luck and that the world is against you.

54. Selective 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.

55. Overgeneralization Applying a single incident to all similar incidents
Assuming a relationship problem with a friend means you are unsuccessful in all relationships

56. Exaggeration
Overestimating the significance of negative events.

57. Personalization
Assuming that others’ behavior is done with the intention of hurting or humiliating you.

58. Dichotomous thinking
All or none approach

59. Psychological problems are often prone to negative automatic thinking that they CANNOT control.
Example: the negative thought, and exaggeration, “I never do anything right,” may be filtered through a cognitive schema, which processes the information to fit the biased self-perception.
In short, the schema provides the resource for a form of conditioning

60. 2nd Aim CBT Behavioral Component
Encourage individuals to increase rewarding seeking activities.
Sports
Music
Gardening
Cooking
Sewing
Teasdale (1997) the important feature of cognitive therapy is to teach the client meta-awareness – the ability to think about their own thoughts.
The aim of therapy is to teach each client to monitor thought processes and then to test them against reality so they can eventually change the behavior on their own.

61. How effective is cognitive therapy in treating depression?
Rush et al (1977): highly effective
Dobson (1989): superior to no treatment or to a placebo.
Elkins et al (1989): no significant difference between CBT and Rx (tricyclic)
Riggs et al (2007) : Looked at CBT with SSRI or placebo
67% CBT + placebo
76% CBT + SSRI
Both groups were found to be - much improved or very much improved.
Conclusion: treatment with drug is effective, treatment without drug is almost as effective.

62. Nemeroff et al. (2003), CBT in combination with drugs was the most effective in chronic depression in people suffering traumatic childhood experiences.
Ethically speaking – it is clear that the therapist is making judgments concerning which thought are acceptable.

63. Group approaches to treatment of depression
Couples Treatment
Focus is on teaching couples how to communicate and problem solve more effectively while increasing positive interactions and reducing negative exchanges.
More effective for women suffering from depression related to marital distress.

64. Social Learning/interpersonal model
Cases in Abnormal psychology pg 113

65. Describe symptoms and prevalence of one psychological disorder.
Evaluate the use of one approach to the treatment of the disorder
[22 Mark]

67. Discuss the interactions of biological, cognitive, and sociocultural factors in abnormal behavior

68. Describe the symptoms and prevalence of PTSD & Depression

69. Analyze etiologies of PTSD and Depression

70. Discuss cultural and gender variations in disorders