Disorders and dysfunction (assessment 3) Feedback Disorders and dysfunction (assessment 3)

1a Outline a cognitive explanation for one disorder (10) Main points? Study? Faulty thoughts – relating to anxiety disorder Faulty thoughts: Cognitive bias – name and explain the four biases (this will provide you with enough marks Study 3 marks Link excessive worry to faulty thoughts

1b Assess the effectiveness of the explanation for one disorder (15) Effectiveness – What does this mean? What points are we going to make? Is it an effective explanation – Yes? Why? No? Why? Slapbacks are essential Assess: provide a conclusion Pairs – sort ideas on the next slide Provide a plan for the 15 marker P C E

Slap back idea -Situational Determinist Cognitive Behavioural Biological Individual Nurture Slap back idea -Situational Determinist Slap back idea: Nature Free will Slap back idea -Effective treatment Reductionist

Plan 1b -Pairs Points, evidence & comment Slapback, evidence & comment 1. 2. 3. 1. 2. 3.

2A) Describe the characteristics of a psychotic disorder Main points? The correct disorder! Use of the DSM 5 NOT DSM IV! Timeframe – symptoms (1 month of active symptoms one MUST be delusions, hallucinations or disorganised speech. ALL of the 5 symptoms need to be provided Exclusions (I.e. not due to other disorder such as autism or drugs)

2b Evaluate difficulties when identifying characteristics of psychological disorders Same Qs as mock! This was also a HW question. Points: 3 difficulties (focus on ‘strong’ points! Reliability, validity, comorbidity, debates etc.) Points: 3 counter arguments (slapbacks) Evidence – from your knowledge of DSM 5 symptoms AND studies we covered in the reliability/validity lesson. Refer to notes.

Comorbidity or overlapping of symptoms – limitation Problems with overlapping symptoms? Bipolar illness vs. schiz With this type of illness the symptoms of psychosis relate more to mood disturbance than to thought disturbance. A person will experience mood elevations (mania) and sometimes depression, which may persist or fluctuate in intensity. When psychotic symptoms arise, they often reflect the person’s mood. For example, people who are depressed may hear voices that put them down. People who are experiencing an elevated mood may believe they are special and are capable of doing amazing things. Comorbidity: the presence of two or more disorders in the same person simultaneously. What if someone had symptoms of 2 or 3 disorders? How would this effect the prognosis and treatment? Why is this a difficulty?

4. disorganised behaviour Two or more of the following present for a significant period of time over a 1 month period. One must be 1,2,or 3. 1. delusions 2.Hallucinations 3. disorganised speech 4. disorganised behaviour 5. negative symptoms (affective flattening, avolition) B. social/occupational dysfunction C Duration 6 months – continuous disturbance for 6 months. 1 month of active symptoms (1,2,3). D Schizoaffective and mood disorder exclusion Ruled out as no major depressive episodes have occurred concurrently with active phase symptoms. Or duration has been brief relative to the active symptoms duration E Substance exclusion F – Autism: additional symptom of schizpophrenia is made only if prominent delusions or hallucinations are also present for at least 1 month Over the two week period; you need to have at least five of the9 symptoms to qualify, and one of these five has to be either depressed mood or loss of interest or pleasure in activities. A. 1. Depressed mood most of the day, almost every day, 2. Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day. 3. Significant weight loss when not dieting or weight gain. 4. Inability to sleep or oversleeping nearly every day. 5. Psychomotor agitation or retardation nearly every day. 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day. 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a   specific plan for committing suicide. B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The episode is not due to the effects of a substance or to a medical conditionD. The occurrence is not better explained by schizoaffective disorder, schizophrenia E. There has never been a manic episode or a hypomanic episode Note: Symptoms are not better accounted for by bereavement : Only one Note: Deleted person's behavior or thoughts, or two or more voices conversing with each other Criterion B. Social/occupational dysfunction: For a significant portion of the time Criterion B. Social/occupational dysfunction since the onset of the disturbance, one or more major areas of functioning, such (No change) as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). Criterion C. Duration: Continuous signs of the disturbance persist for at least Criterion C. Duration of 6 months 6 months. This 6-month period must include at least 1 month of symptoms (No change) (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). Criterion D. Schizoaffective and major mood disorder exclusion Criterion D. Schizoaffective and mood disorder exclusion Schizoaffective disorder and depressive or bipolar disorder with psychotic No change features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. Criterion E. Substance/general mood condition exclusion Criterion E. Substance/general mood condition exclusion Substance/general medical condition exclusion: The disturbance is not No change attributed to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Criterion F. Relationship to Global Developmental Delay or Autism Spectru

4. disorganised behaviour Two or more of the following present for a significant period of time over a 1 month period. One must be 1,2,or 3. 1. delusions 2.Hallucinations 3. disorganised speech 4. disorganised behaviour 5. negative symptoms (affective flattening, avolition) B. social/occupational dysfunction C Duration 6 months – continuous disturbance for 6 months. 1 month of active symptoms (1,2,3). D Schizoaffective and mood disorder exclusion Ruled out as no major depressive episodes have occurred concurrently with active phase symptoms. Or duration has been brief relative to the active symptoms duration E Substance exclusion F – Autism: additional symptom of schizpophrenia is made only if prominent delusions or hallucinations are also present for at least 1 month Over the two week period; you need to have at least five of the9 symptoms to qualify, and one of these five has to be either depressed mood or loss of interest or pleasure in activities. A. 1. Depressed mood most of the day, almost every day, 2. Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day. 3. Significant weight loss when not dieting or weight gain. 4. Inability to sleep or oversleeping nearly every day. 5. Psychomotor agitation or retardation nearly every day. 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day. 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a   specific plan for committing suicide. B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The episode is not due to the effects of a substance or to a medical conditionD. The occurrence is not better explained by schizoaffective disorder, schizophrenia E. There has never been a manic episode or a hypomanic episode Note: Symptoms are not better accounted for by bereavement : Only one Criterion A symptom is required if delusions are bizarre or Note: Deleted hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other Criterion B. Social/occupational dysfunction: For a significant portion of the time Criterion B. Social/occupational dysfunction since the onset of the disturbance, one or more major areas of functioning, such (No change) as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). Criterion C. Duration: Continuous signs of the disturbance persist for at least Criterion C. Duration of 6 months 6 months. This 6-month period must include at least 1 month of symptoms (No change) (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). Criterion D. Schizoaffective and major mood disorder exclusion Criterion D. Schizoaffective and mood disorder exclusion Schizoaffective disorder and depressive or bipolar disorder with psychotic No change features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. Criterion E. Substance/general mood condition exclusion Criterion E. Substance/general mood condition exclusion Substance/general medical condition exclusion: The disturbance is not No change attributed to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Criterion F. Relationship to Global Developmental Delay or Autism Spectru

Restlessness or feeling keyed up or on edge. Being easily fatigued. over the two week period; you need to have at least five of the 9 symptoms to qualify, and one of these five has to be either depressed mood or loss of interest or pleasure in activities. A. 1. Depressed mood most of the day, almost every day, 2. Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day. 3. Significant weight loss when not dieting or weight gain. 4. Inability to sleep or oversleeping nearly every day. 5. Psychomotor agitation or retardation nearly every day. 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day. 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a   specific plan for committing suicide. B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The episode is not due to the effects of a substance or to a medical condition D. The occurrence is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders E. There has never been a manic episode or a hypomanic episode Note: Symptoms are not better accounted for by bereavement A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms. Restlessness or feeling keyed up or on edge. Being easily fatigued. Difficulty concentrating or mind going blank. Irritability. Muscle tension. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder)

Restlessness or feeling keyed up or on edge. Being easily fatigued. over the two week period; you need to have at least five of the 9 symptoms to qualify, and one of these five has to be either depressed mood or loss of interest or pleasure in activities. A. 1. Depressed mood most of the day, almost every day, 2. Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day. 3. Significant weight loss when not dieting or weight gain. 4. Inability to sleep or oversleeping nearly every day. 5. Psychomotor agitation or retardation nearly every day. 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day. 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a   specific plan for committing suicide. B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. The episode is not due to the effects of a substance or to a medical condition D. The occurrence is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders E. There has never been a manic episode or a hypomanic episode Note: Symptoms are not better accounted for by bereavement A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms. Restlessness or feeling keyed up or on edge. Being easily fatigued. Difficulty concentrating or mind going blank. Irritability. Muscle tension. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder)

Counter-arguments (slapbacks) However…..? In pairs construct a slap back Focus on the symptoms, timeframe and exclusions

Points, evidence & comment Slapback, evidence & comment 1. P Limitation: Comorbidity E GAD and Depression symptoms 2. Validity - 3. Reliability 1. 2. 3.

3a) Describe one way (e.g. classification system) in which dysfunctional behaviour can be categorised (10) You could describe how any of the disorders we have covered can be classified. DSM 5 ALL symptoms provided in DSM 5 – including time period Mention of other criteria i.e. social functioning problems Exclusions

3b) Discuss the limitations of diagnosing dysfunctional behaviour Same as 2b

4a) Describe how dysfunctional behaviour could be treated cognitively (10) Main points? 70%/30% or 30%/70%? Intro CBT (not applied relaxation!) Refer to slides not just the textbook as we have provided you with the information you need for this! CBT needs to be explained in enough detail for 7 marks 3 marks on the study – Ost and Westling (refer to slides it compares CBT with applied relaxation – not drugs) Also use the results from after one year – this shows the effectiveness of the treatment 89% of those that went through CBT were panic free after one year This shows that?

4b) Discuss the effectiveness of treatments for dysfunctional behaviour (15) What does effectiveness mean in this context? Structure? E.g. Treatment – effective Treatment – not effective x 3 Using Strengths and weaknesses

Effectiveness of treatments Cognitive Effective: Not effective: Biological Not effective: Effective: Effectiveness of treatments Behavioural Effective: Not effective:

4b) Discuss the effectiveness of treatments for dysfunctional behaviour (15) Pairs –In note form produce a plan PCEC

Ideas Cognitive – effective: Holistic - long term effectiveness Cognitive – not effective: motivation needed Bio – change level of hormones symptoms not cause (not effective at dealing with cause) therefore short term not long term treatment. If they stop taking the drug they will be likely to relapse Bio – effective – quick, easy, a huge amount of motivation isn’t needed Behavioural: not effective - reductionist – down to changing association from negative to positive Effective participant is in control – choice to move through hierarchy at their own pace. Asked for feedback throughout. More comfortable – may see benefits more than costs and be likely to complete the treatment. This will lead to effective treatment