Disorders

Affective disorder

Is described as the common cold of mental disorders. Beck and Young suggest that being depressed is normative for humans. However one could argue that there is a great deal of difference, between having a low-mood and clinical depression.

According to Memeroff one must display low-mood for at least two weeks as well as five of the following symptoms:

• Increase/decrease in weight/appetite.
• Insomnia/hypersonic (not being able to sleep).
• Severe tiredness.
• Loss of interest in previously enjoyed activity.
• Poor cognition – focus/concentration.
• Morbidity – thinking about suicide.

Schizophrenia

The word schizophrenia comes from two Greek words, schizo meaning split and phi-en meaning the mind. Diagnosis of schizophrenia is dependent on two or more of the following:

• 'First rank' symptoms.
• Passivity/thought disturbance – Thought insertion, withdrawal and broadcasting.
• Primary delusions – false beliefs of reality.

As well as first rank symptoms there are also behavioural characteristics:

• Thought process disorder (poor thinking process). E.g. word salad – thought become very loosely associated
• Disturbance of affect. E.g. blunted, inappropriate effect, lack of emotions.
• Psycho-motor disorders. E.g. stereotyping
• Lack of volition – withdraw from normal interaction (family and friends).

Anxiety disorder – OCD (Obsessive compulsive disorder)

Anxiety could well be a survival mechanism because it raises our physiological response making us react quickly to dangerous situations. However too much anxiety can interfere with normal everyday functioning and can therefore be defined as a disorder. Is the fourth most common disorder in the USA.

Clinical characteristics include:

• Obsession – recurrence thoughts/images.
• Fear of contamination.
• Depression.
• Checking behaviour.

Depression

Biological explanations for Depression

• Genetics:
  • ​Twin studies using monozygotic and dizygotic twins suggest a biological cause for depression. McGuffin et al found a concordance rate of 46% monozygotic twins compared with 20% concordance rate for dizygotic twins. This therefore suggests that there could be other factors that affect this as there was only a 46% concordance rate which can be questioned. There could be other factors such as behavioural that play a role in depression.
  • Weber et al found that adopted children whose biological parents had a history of depression were eight times more likely to suffer from depression compared with adopted children who's biological parents did not have a history of depression. Therefore this further supports a generic cause for unipolar depression (clinical).
• Biochemicals:
  • ​Research also suggests that depression is caused by low levels of serotonin (Prozac), serotonin is released naturally through urine depressed patients have been found to have lower levels of compounds in their urine associated with serotonin.
  • Anti-depressant drugs such as Prozac which is a serotonin which has proven to be very effective in treatment for depression. This therefore suggests that a biochemical imbalance may be responsible for the development of depression. It is very difficult to establish the cause and effect as if serotonin levels affect depression, vice versa.
• Hormones:
  • ​There are also psychologists that suggest that our hormones affect out mood. E.g. SAD (Seasonal effective disorder) according to research melatonin a hormone produced by the pineal gland may be responsible for SAD. Melatonin affects serotonin production, lower levels of melatonin results in lower levels of serotonin. The pineal gland only releases melatonin through the influence of direct light on the retina. Some people therefore may have poor exposure during the winter months and this affects their serotonin levels. In fact photo-therapy has proved very effective in some people with SAD.
  • Evaluation: Success rate of using photo-therapy is low and more hormones might be responsible.

Behavioural explanations for Depression

Lewinsohn et al, A behavioural approach to depression

• Aim: To compare the amount of 'positive reinforcement' received by depressed and non-depressed participants.
• Methodology:
  • ​Longitudinal study, self-reports.
  • Self-rating of depression used check their daily mood.
  • 30 participants who were diagnosed with depression.
• Findings:
  • ​Significant positive correlations between mood ratings and pleasant activities.
  • Individual differences, from a correlation of 0 to -0.66, more to depression than reinforcement.
• Conclusion: There appears to be a link between reinforcement from pleasant activities and mood, but further research is needed to identify the individual characteristics that make some people more influenced by pleasant activities than others.
• Evaluation:
  • ​Not a complete explanation too deterministic – like many behavioural theories, learned helplessness is seen to be inadequate as a complete explanation because it does not take account of cognitive explanations.
  • High in ecological validity as the participants already had depression.
  • As a longitudinal study was conducted this leads to the study being high in validity as over the days a lot of qualitative and quantitative data can be collected and enables a conclusion to be made.

Cognitive explanations

The cognitive model suggests that maladaptive thinking may cause depression. E.g. a range of cognitive therapies focus on N.A.T.S (Negative automatic thoughts).

Abramson et al, Depression

Abramson et al suggests that depression is caused by an attribution style, we either make internal or external attributions related to our behaviour. Making an attribution involves thinking about why we behave in the way we do. Abramson found that depressed individuals tend to make internal attributions concerning failure and external attributes when they are successful.

• Evaluation:
  • ​Cognitive therapy hence proved in some cases just as effective as drug therapy in treating depression.
  • Cognitive explanations of depression have stimulated a huge amount of research into the disorder over the last few decades and contributed greatly to our understanding

Biological treatments for Depression

Biological treatments include chemotherapy, anti-depressant which act upon the neurological system of the body, often varying the amount of neurotransmitters, such as serotonin, lack of which is associated with depression.

Karp and Frank, Combination therapy and the depressed woman

• Aim: To compare drug treatment and non-drug treatments for depression.
• Methodology:
  • ​Review article of previous research.
  • 9 pieces of research.
  • 529 women took part in the selected studies.
  • Independent design (single drug/psychological treatment, combined treatments or placebo groups).
• Results:
  • ​Adding psychological treatments to drug therapy didn't increase the effectiveness of drug therapy.
• Conclusion: Although it would seem logical that two treatments are better than one, the evidence does not show any better outcomes for patients offered combined therapy as opposed to only drug therapy.
• Evaluation:
  • ​This is a very effective treatment as the study shows.
  • There may be some side effects related to chemotherapy.

Behavioural treatments for Depression

Behaviourist treatments for depression are based on the assumption that depression behaviours are learned and therefore can be unlearned. The treatment includes patients being reinforced for non-depressive behaviours.

Lewinsohn, Evaluation of a course on coping with depression

• Findings:
  • ​Having been taught skill to reduce depression, adolescent showed some improvement.
  • If parents had been taught to reinforce the non-depressive behaviours their depression was lowered even further.
• Conclusion: This clearly shows that efficacy of coping with depression course, which reinforces changes negative behaviour with rewarding pleasant events, and positive parental reinforcement.
• Evaluation:
  • ​Treatment is effective as shown by the case study by Lewinsohn.
  • Unlearning therapy helps to treat depression, but not cure it.

Cognitive treatments for Depression

Cognitive treatments for depression are based on the theory of faulty cognitions which underlie the cognitive theory of dysfunctional behaviour. The aim of such therapy is to restructure patients from irrational thinking to rational thinking, which will enable the patient to perceive their world more positively and more accurately and so reduce the depression.

Ellis, Outcomes of employing three techniques of psychotherapy

• Findings:
  • ​Highest improvement rate was the rational psychotherapy group, 90% showing improvement.
  • Psychoanalysis-orientated group improvement reduced to 63%.
  • Orthdox psychoanalysis group only 50% showed improvement.
• Conclusion: Rational cognitive therapy leads to better treatment of depression than psychoanalytical based therapies.
• Evaluation:
  • ​It is hard to judge whether treatment has worked or not.
  • Shows high improvement rates by the rational psychotherapy proving to be very effective.
  • Notes were reviewed therefore the methodology is low in validity.