UNIT 4 PSYCH

1. UNIT 4 PSYCH Area of study 2: Normality. Mental health & mental illness Chapter 11

2. Myths about mental illness http://www.youtube.com/watch?v=jjZgoe0fDIw

3. Normality and abnormality • Normal is … Often defined as a pattern of thoughts, feelings or behaviour that conforms to a usual, typical or expected standard depending on the approach • Abnormal … May be defined as a pattern of thoughts, feelings or behaviour that is deviant (inappropriate), distressing (upsetting) and dysfunctional (affect one’s ability to perform daily activities effectively)

4. Approaches used to define Normality SOCIO-CULTURAL - Behaviour that is accepted in a particular society or culture, but not in others FUNCTIONAL - Normal behaviour is if the individual can function effectively in society HISTORICAL - Behaviour that is accepted, however it depends on the period of time SITUATIONAL - Behaviour that is accepted in a particular situation MEDICAL - Abnormal behaviour has a biological cause and can be diagnosed and treated STATISTICAL – behaviour/characteristics of a large group are placed into a normal distribution. Majority of people are called “statistically average”

5. Abnormal? By which measure?

6. Abnormal? By Which measure?

7. Abnormal? By which measure?

8. HEALTH & ILLNESS • Health: state of complete physical, mental & social wellbeing and not merely the absence of disease (WHO) • Mental Social • Physical • The health triangle represents the 3 aspects of health as equally important in overall health

9. Illness: refers to a person’s subjective experience of feeling unwell in relation to one more aspects of their health • Illness involves how a person thinks/feels about their physical, mental &/or social wellbeing • Involves an individual’s interpretation of some aspect of their overall health, their description of their symptoms, & what they can & cannot do as a consequence of their condition

10. Disease: refers to identifiable physiological changes assoc with an abnormal bodily condition • It is a medical doctor’s objective findings of physiological changes that are common to all ppl with a particular disease & have been documented by the medical profession • Disease often accompanies illness but this is not always the case e.g. someone may have a brain tumour but not feel ill

11. Physical illness vs physical health • Physical health: refers to the body’s ability to function efficiently and effectively in work and leisure activities, to be in good condition, to resist disease and to cope in threatening or emergency situations • Physical health problem: when the body doesn’t function as well as it could and therefore often also underline physical illness • Physical illness: refers to our subjective experience of a disease or physical health problem that interferes with the normal functioning of our body & adversely impacts on our ability to function effectively in everyday life • This term is usually used when physical problems experienced by a person are more serious than a headache; are likely to persist for a long time and require some form of treatment plan

12. Continuum of mental health and mental illness

13. Mental health vs mental illness • Mental health – capacity to interact with others, cope effectively with problems and stress • Mental health problem- when the difficulties experienced by a person are mild, temporary and able to be treated within a relatively short period of time • Mental illness– psychological dysfunction that usually involves impairment in coping ability with feeling and behaviours that are atypical and inappropriate within their culture • Mental illnesscan sometimes be referred to as a psychological dysfunction or mental disorderexperienced by an individual and usually involving : • Emotional distress • Impairment in the ability to cope with everyday life • Thoughts, feelings and/or behaviour that are not typical of the person or appropriate within their society and/or culture

14. Mental illness in Australia box 11.1, p.550 • Incidence of mental illness is 1 in 5 in Australia • The most common forms of mental illness are non-psychotic illnesses (remember yr 11 psych??, what are some examples ?) • Incidence of mental illness is around about the same for males & females but there are gender differences in the type of mental illness experienced e.g. men are more likely to experience substance abuse disorders than women and women are more likely to experience anxiety disorders than men • Age group of 16-24 have the highest incidence of mental illness

15. Video - Mental health in Europehttp://www.youtube.com/watch?v=DyNW4z3FP348.55 minEuropean experts talk about a new model, a biopsychosocial model, of mental health while reflecting on how mental illness was dealt with in the past. Video - 7.30 Report with Patrick McGorryhttp://www.youtube.com/watch?v=PoaQ9PjSDUQ

16. Victoria's Mental Health Serviceshttp://www.health.vic.gov.au/mentalhealth/index.htmThis is an important site for teachers and students to be aware of: it lists all mental health services available in Victoria. • SANE Australiahttp://www.sane.org/information/factsheets-podcastsThis is a fantastic website that provides fact sheets, podcasts and video clips relating to many different mental disorders, their symptoms and treatments and how individuals and families are affected by them.

17. Biopsychosocial framework Mental health and wellbeing depends on a combination of biological, social and psychological factors

18. Biological factors eg. Genes, brain chemistry/function, NS activity and neurotransmitters, hormones, immune system, gender, age • Psychological factors eg. Thinking & reasoning skills, learning & memory, emotions, personality traits, perceptions, unique behaviour • Social factors eg. Social skills, social isolation or support, cultural factors & expectations, stressors & trauma, life events, socioeconomic conditions, family, friends, level of education • Aim - All three influences are considered in the assessment and treatment of mental and physical health – a “collaborative pathway to health” • Holistic view of health

19. Biopsychosocial model of mental illness

20. Assessment /treatment • Neuroimaging devices (CAT, PET, EEG, MRI, fMRI) • Medication (antidepressants for depression, psychotrophic drugs to manage delusions and hallucinations, mood stabilising drugs to assist with anxiety) • Neuropsychological testing – such as questionnaires and IQ tests • Medical procedures • Emphasis on developing a professional but also caring relationship between Doctor/Psychologist and patient/client • Research has shown that social support networks are important for recovery

21. Case study - Anne • 27 years old • Went to hospital via an ambulance di=e to severe abdominal pain • Diagnosed with twisted bowel – painful condition requiring surgery and several weeks of recovery • Anne’s parents are divorced and live in different states • Contacted her mother but said she was too busy – Anne was devastated • Anne found her time in hospital more difficult • When released her recovery was further complicated with depression. She spent her days crying and withdrew from people. Neither one of her parents visited her that year. • Biological – she was operated and given medication to manage her pain • Psychological – her state of mind was ignored • Social – lack of support from family and friends

22. Case study - Yani • Australian-Greek born • Year 12 student • Pressure from family to maintain A grade average • Constantly fighting with his family • Broken up with Japanese girlfriend primarily due to parental interference and cultural expectations from both sides • Yani goes to a party and has a whole “joint” of marijuana • Has a family history of Schizophrenia • Starts to have hallucinations, paranoia and acts bizarre • Consider the biological factor? • Consider the psychological factor? • Consider the social factor?

23. Limitations • While the biopsychosocial framework does contribute to a more holistic approach to treating mental illness, it is not a perfect model. The biopsychosocial framework does not acknowledge the developmental, historical or biographical context. For example, parental divorce could be a psychosocial stress that contributes to the development of schizophrenia. However, the effect of the stress on the individual will depend in the timing of the divorce, that is whether it occurred during childhood or adolescence.

24. Another limitation of the biopsychosocial framework when looking at the causes of mental illness is that it fails to identify causation factors as predisposing factors (circumstances that lead a person to be more vulnerable to developing an illness than others, such as genetics), precipitating factors (factors that can trigger onset, but do not themselves cause the illness, such as stress) and perpetuating factors (factors that maintain an illness state, such as rumination). These labels are important as it helps a mental health practitioner to know which factors are beyond their control (predisposing factors) and which factors should be targeted as part of therapeutic treatment (Bloch and Singh, 1999).

25. In terms of treatment, the biopsychosocial framework is limited by its inability to address all aspects of the biopsychosocial framework all the time. For example, it is pointless to treat a patient with cognitive behavioural therapy if they are too depressed to eat or drink.

26. Connexions: Educational Unitshttp://cnx.org/content/m13589/latest/This article provides an brief outline of the biopsychosocial (BPS) model and shows how this integrated model provides a better health care response. • WellWays PDF http://www.mifa.org.au/sites/www.mifa.org.au/files/documents/BiopsychosocialModel_001.pdfThis PDF (from an Australian website) shows an example of how the BPS model is applied through different phases of a mental disorder.

27. Systems of Classification of mental conditions & disorders Steps to intervention when a person presents to a Psychologist with a mental health problem 1. Clinical interview • Assessment of personality • Cognitive assessment • Neuropsychological assessment 2. Identification of symptoms 3. Use DSM or ICD to diagnose the disorder 4. Design the intervention 5. Implement treatment 6. Review 7. Clinical interview

28. Systems of Classification of mental conditions & disorders • Classification – organising items into groups based on their shared characteristics • Categorical approaches– organises mental disorders into categories, each with specific symptoms and characteristics. • Diagnosis involves a comparison of patients symptoms to the listed symptoms within each category • Check your patients list against the lists in the DSM-IV (Diagnostic manual, see p.561-565) to find a fit – then make diagnosis • Dimensional approaches – classifies symptoms quantitatively • Diagnosis involves asking how much of a characteristic is normal, numerical values are assigned to each characteristic score • Measure all characteristics and the combination of scales that are statistically extreme might point to the type of illness being suffered

29. Categorical approaches - assumptions • Mental disorders can be diagnosed from specific symptoms reported by the patient or observed by the professional • Thoughts feelings and behaviours can be categorised – certain categorisation relates to specific disorders • There are distinct sub categories within each disorder • “All or nothing principle” – they either have it or they don’t. You cant kind of have schizophrenia • The system must be valid (leads to a diagnosis) and reliable (consistency with Health professionals making diagnosis)

31. ICD – 10 • Diagnosis and classification of mental disorders based on recognised symptoms • Includes detailed description of each disorder listed • Identifies symptoms that indicate the presence of a disorder • The original text covered all of medical practice • Chapter V covered mental disorders • Chapter V now printed as a separate book • Less detailed than the DSM -IV

32. Read BOX 11.7 Versions of the ICD-10 • And BOX 11.8 Mental and behavioural disorders in chapter V of the ICD-10 • Pgs: 569-70

34. The diagnostic and statistical manual of mental disorders iv-r • The system most widely used by mental health professionals throughout the world to identify and classify mental illnesses for the purposes of diagnosis is the Diagnostic and Statistical Manual of Mental Disorders, or the DSM as it is more commonly called • An important feature of the DSM-IV-TR is that it does not suggest causes of specific disorders unless a cause can be definitely established • It simply names the disorders anddescribes them in specific terms

35. DSM – IV - TR • 365 disorders comprehensively described (one for every day of the year!) • Grouped into 16 categories see BOX 11.5 pg 562 • Diagnosis matches patient symptoms to the disorder symptoms • Symptoms are considered characteristics of disorders to looking at these enables diagnosis • Inclusion criteria – symptoms that must be present for diagnosis • Exclusion criteria – symptoms that must not be present • Polythetic criteria – only some symptoms not all need to be present for diagnosis – eg. 3 0f the following 8 • Provides info on the typical course of the disorder

36. The diagnostic and statistical manual of mental disorders iv-r • Axis I: clinical disorders Symptoms that cause distress or significantly impair social or occupational functioning (such as anxiety disorders, depression) • Axis II:personality disordersandmental retardation Chronic and enduring problems that generally persist throughout life and impair interpersonal or occupational functioning (such as multiple personality disorder) • Axis III: general medical condition Physical disorders that may be relevant to understanding or treating a psychological disorder • Axis IV: psychosocial and environmental problems (such as interpersonal stressors and negative life events) that may affect the diagnosis, treatment and prognosis (prediction of the course of a disease) of psychological disorders • Axis V: global assessment of functioning The individual's overall level of functioning in social, occupational and leisure

37. Read BOX 11.6 An example of using DSM-IV-TR Pgs: 566-7 • And BOX 11.9 ADHD Pgs: 576-7

38. Strengths / Weaknesses • Comprehensive expert knowledge: diagnosis, treatment, management • Revised regularly • Helps communication between professionals • Historically low inter-reliability • Much better now with DSM-IV-R 70% agreement between mental health professionals • Lots of overlap between symptoms can make diagnosis difficult • Stigma and labelling – Rosenham study! Video - Rosenhan's investigations in mental healthhttp://www.youtube.com/watch?v=hqaptRYjhq4&feature=related

39. Dimensional approaches • A dimension viewed as a cluster of related psychological/behavioural characteristics that occur together • Quantifies persons symptoms and other characteristics with numerical values • These values are compared with the statistically ‘normal’ expected values for each characteristic • Lower scores equate to lower impairment • Higher scores equate to higher impairment • Produce a Profile

40. THE MMPI

41. Scales on the MMPI • Hs Hypochondriasis Concern with bodily symptoms • D Depression Depressive Symptoms • HyHysteria Awareness of problems and vulnerabilities • Pd Psychopathic Deviate Conflict, struggle, anger, respect for society's rules • MF Masculinity/Femininity Stereotypical masculine or feminine interests/behaviors • Pa Paranoia Level of trust, suspiciousness, sensitivity • Pt Psychasthenia Worry, Anxiety, tension, doubts, obsessiveness • Sc Schizophrenia Odd thinking and social alienation • Ma Hypomania Level of excitability • Si Social Introversion People orientation

42. MMPI – the t scores • Asking how different is each score is from the mean score • Is the difference big enough to be significant? • Statistical normality is the key here!

43. Strengths / Weaknesses • Take into account a wider range of factors than categorical approaches • More detailed information on each symptom – quantifying • Reduced stigma as labelling not used instead a profile is created • There is no standard inventory to compare scores to, thus diagnosis is difficult • Time consuming

44. Which is best? • Read BOX 11.10 Distinguishing between the categorical and dimensional approaches Pg: 577 • Often both are used • Categorical approach used to classify the symptoms • Dimensional approach used to determine the degree/severity of these symptoms

45. AllPsych Onlinehttp://allpsych.com/disorders/dsm.htmlThis website provides a summary of how clinicians use the DSM-IV for assessment. • World Health Organisation: ICD-10http://apps.who.int/classifications/apps/icd/icd10online/This website houses the 2007 publication International Statistical Classification of Diseases and Related Health Problems (10th Revision) or ICD-10. Mental and behavioural disorders can be found by following the link to Chapter V.