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Abnormality and Health

27 important questions on Abnormality and Health

Discuss treatments for obesity (studies)

Maggard et al: meta-analysis, loss of 20/30 kg maintained for up to 10 yrs, overall health improvement, bypass better.
Stahre et al: obese women in Sweden, weight loss programme that included CBT vs physical activity, lasted 10 weeks, weight controlled for more than a year.
Berkowitz et al: appetite-suppressant or placebo,  plus counselling and food diary, main side-effect is heart rate increase.

Validity and reliability (definitions)

Validity is the correct diagnosis of a person with a disorder.
Reliability is the consistency of the same disorder towards certain symptoms.
Inter-observer, test-retest reliability.

Discuss the validity and reliability of diagnosing abnormality

Rosenhan: 1973, 8 pseudo-patients, average of stay was 19 days, teaching hospitals.
Cooper et al: NY more scizophrenia, London more mania/depression.
Nicholls: children with eating disorders, Great Ormond Street Hospital diagnostic system more reliable than DSM-IV.
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Ethical consideration of diagnosis (definition)

Essential but ethical considerations. Scheff developed the Cognitive Labelling Theory, schizophrenia is a learned social role. Behave in a manner that fits this label, self-fulfilling prophecy. Attention at hospitals reinforce perceptions/expectations. Stigmatisation, depersonalisation, confirmation bias.

Discuss ethical consideration of diagnosis (studies)

Langer & Abelson: behavioural/analytical therapists, patient or job applicant, no sound, attractive and confident vs defensive and aggressive.
Rosenhan: obsessive compulsive writing behaviour, schizophrenia in remission. 
Gove and Frain: extensive interviews with 429 former mental patients, improvement in social relationships, positive hospital experiences, felt they were better able to deal with their problems.

Cultural consideration of diagnosis (definition)

Over/underpathologization. CBS are limited to certain cultures. Amok in Malaysia (aggressive outbursts, dissociative period), Pibloqtor in Inuit Tribes (winter, irrational dangerous acts followed by amnesia). Variations of universal disorders, Western systems are applicable to all societies once clinicians are able to interpret the way disorders are expressed in different cultures. Cultural bias: through the lenses.

Discuss cultural considerations in diagnosis

Diane Li-Repac: 5CA and 5EA with mental illnesses, rated on their level of psychological functioning, therapists personal contact with researcher, similar understandings of normality, lower self-esteem, depressed, inhibited vs aggressive, severely disturbed.
Jenkins-Hall &Sacco: AA or EA women with depression or not, more negative terms like less socially confident.

Symptoms and prevalence of eating disorders

Anorexia nervosa is characterised by keeping weight low obsessively by dieting, vomiting, using laxatives and excessively exercising. Diagnostic criteria: RI, disturbance in the way in which one' body weight is experienced, Amenorrhea. ABCs symptoms. 1 in 100 women. Women 10 times more likely. Above-average income households.

Symptoms and prevalence of affective disorders

ABCs (loss of interest, sleep disturbance, negative attitude, avoidance of social company). less education, less economic stability and less insurance coverage. Lowest rates in Asian countries. 11% of adolescents a depressive episode before 18. Women twice as likely. Number affected has doubled.

Bio factors of EA

They have a genetic basis.
People with EA have a neurotransmitter imbalance, high levels of serotonin suppress appetite, increase anxiety/obsessive behaviour but are gained through food, periods of binging produce sense of well-being. Reducing intake of calories to starvation level gives a sense of regaining control so low levels of serotonin.

Bio etiologies of EA, studies

Holland et al: much more of the MZ both had anorexia than the DZ.
Bailer et al: women recovering from AN, high levels of serotonin in binge/purging type, persistent disruption of serotonin may lead to increased anxiety triggering AN.

Sociocultural etiologies of EA, definition

Family influences.
Cultural transmission: more often in prosperous Western cultures, unrealistic idealized body sizes in media and social norms.

Sociocultural etiologies of EA, studies

Pike & Rodin: mothers attitudes and behaviours, daughters with disordered eating similar with clinical samples of bulimic patients, bi-directional ambiguity.
Fearn: effect of introduction of TV in Fiji, sharp rise in indicators of disordered eating, survey 38 months after first broadcast, 74% reported feeling to big or fat, traditionally preferred a robust, well-muscled body (doesn't explain EA in blind people).

Cognitive factors of EA, definition

Focuses on disordered thinking or faulty perceptions.
Body Image Distortion theory suggest that they overestimate their body size.
Doesn't explain where they come from.

Cognitive etiologies of EA, studies

Fairburn et al: low self-esteem and an extreme need for control at core, doesn't explain why people adopt a pathological strategy.
Fallon & Rozin: large sample, college students, men's perception was much more closely rated.

Bio factors of affective disorders, definition

The Human Genome Project discovered up to 11 markers correlated with MDD (5-HTT)., can actually locate genetic variation.
Abnormal levels of serotonin, development of SSRIs, treatment aetiology fallacy.
Cortisol released from adrenal cortex, leads to degradation of neurons and lack of regeneration (neurogenesis) and low levels of serotonin, Hypothalamus Pituitary Adrenal axis controls body's response, high activity of HPA in depressed patients.

Bio etiologies of affective disorders, studies

Numberger and Gershon: small meta-analysis, concordance rates higher for MZ than DZ.
Videbech: scanned brain of depressed patients, up to a 10% hippocampus reduction, explain common symptom of memory problems cessation of neuron birth of hippocampal cells too.

Cognitive factors of AD, def

Aaron Beck, result of faulty or maladaptive thinking patterns. 3 components: negative schemas (unhappy experiences in life), negative cognitive triad, cognitive biases (overgeneralisation, minimization, maximization, arbitrary inferences, selective abstraction).
Albert Ellis, ABC model that explains depression, it is our interpretation of things, Activating event that we experience, Belief or thought regarding the situation, Consequence.

Cognitive etiologies of AD, studies

Alloy et al: longitudinal, thinking style tested, positive/negative thinking group.
Boury et al: monitored students thoughts using the Beck Depression Inventory, positive correlation between number/frequency of automatic negative thoughts and severity/duration of depression.

Sociocultural etiologies of AD, studies

Brown and Harris: 458 women from South London, survey, working class more likely, 90% of those who had become clinically depressed had experienced adverse life event.
Identified 3 main influencing factors: protective, vulnerability, provoking. Negative effect between social status and vulnerability to provoking factors.
Nicholson et al: men in the most socially disadvantaged group in Poland/Russia/Czech Republic, five times more likely to report symptoms of depression.

Discuss cultural and gender variations in prevalence of disorders

Nolen-Hoeksema: exposed to same stressors but different biological responses to stressors, self-concepts and coping styles, hyperactivity of stress system.
Cochrane: hormonal fluctuations associated with menstrual cycle, childbirth, menopause, oral contraceptives.
Weissman et al: meta-analysis, estimated rates and patterns, measured age of onset/symptom profile/rate/demographics, high results in Lebanon/US, low levels in China. 
Social stigma, reluctance to endorse mental symptoms.
Nesse and Williams: mass communication and disintegration of communities, compare ourselves to unrealistic images of success, not favourable.

Examine biomedical treatments (studies)

Leauhter et al: EEG, brain functions, placebo had increased activity in prefrontal cortex, different patterns but both improvements.

Examine individual treatments (studies)

Neale et al: meta-analysis, lower risk of relapse.
Nemeroff et al: chronic depression, sometimes drugs are needed for a patient to be able to psychologically access therapy by relieving the most serious and paralyzing symptoms.

Examine group treatments (studies)

Bolton et al: rural Uganda, 30 villages, those who were believed by themselves or others to have a depression-like illness were interviewed, locally adapted Hopkins Symptom Checklist, 16 weeks of sessions, led by same sex local person who had received intense training, reviewed their symptoms, discussed their week and suggested changes in behaviour, reduction in depression severity much higher than in control group.

Eclectic approach (def)

Lazarus proposed that treatment should be based on 6 criteria: Behaviour, Affect, Sensation, Imagery, Cognition, Interpersonal relationships, Biology. Not one cure, complex disorders.
A more multicultural society,  approach in which cultural and spiritual needs are integrated.
In Malaysia, religious beliefs and behaviours are added into therapy such as prayers and focusing on verses of the Koran addressing "worry", more culturally relevant.
Greater flexibility, adapts to patient, recognises individual differences, benefits of both, difficult to test effectiveness.

Discuss the use of eclectic approach to treatment (studies)

Pampallona et al: meta-analysis, just antidepressants or combined.
Keller et al: large sample, chronic MDD, 12 weeks of nefazodone, cognitive behavioural-analysis system of psychotherapy or both. Much higher rates of remission in combined.
Nemeroff et al.

Discuss the relationship between etiology and therapeutic approach

We are yet to ascertain the specific causes of disorders, no cure.
Serotonin hypothesis, placebo problem, Leauhter et al, neurogenesis.

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Abnormality and Health

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