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Konstantine Zakzanis

PSYB32 – Lecture 02 (Chapter 2) WebOption – Summer 2013 Current Paradigms and the Role of Cultural Factors Slide 3  ***(threw a hint at the following definition)  Paradigm: A general perspective that defines how to conceptualize and study a patient, how to gather and interpret relevant data or even how to think about a particular patient o A set of basic assumptions that a clinician will make o ways in which we might come to understand a patient that is before us  To elaborate on paradigms, think about if you go see a Psychiatrist. What do you think they’re going to treat you with? Medication.  So what Paradigm are they coming from if they believe that altering your neurochemistry will alter your behaviour (by giving you medication)? A biological approach  You know what paradigm they’re working from based on what their degree/specialty is  If you see a Psychtherapist, what paradigm do they come from? o Humanistic, existential, cognitive, behavioural o These paradigms run under the assumption that there is a more psychogenic origin to abnormal behaviour, as opposed to (neuro) biological  These are the types of paradigms to be discussed this lecture  We’ll be going over 4 paradigms (technically 5 but two of them are very related so discussed as 1) Slide 4 – Biological Paradigm  This paradigm typically follows a medical model  Biological Paradigm: A belief among clinicians that mental disorder arises because of some sort of neuro-biological antecedent (problem) o ie If you suffer from hallucinations, anxiety, depression, etc, the reason for these disorders can be found in the body o a very reductionist type approach  ***(hinting at some terms he wants us to know for exam and later parts of the course)  One approach to researching these types of disorders in order to understand them, which people who come from a biological paradigm will use is called: Behavioural Genetics  *Behavioural genetics: the study of individual differences in behaviour that are attributable in part to differences in genetic make-up o Researchers look at genetics to see if they can provide a clue as to whether or not a disease/mental illness has a genetic component o They often refer to genotype and phenotype  *Genotype: what you’re born with – the inherited and unobservable aspects of your genetic make-up o Can’t see em, but they’re there. Aspects of your genetic make-up which you inherited from your parents  *Phenotype: the individual’s observable behavioural characteristics o Ex: the person’s level of anxiety o The phenotype is a product of both a) the genotype, and b) the environment  What’s key in understanding abnormal behaviour is that a disorder (ie Schizophrenia, anxiety, depression, etc) is not inherited genetically o You can have inherited the genetics which leave you predisposed with the phenotype of one of these disorders, but these disorders are not inherited o Prof says there’s 1 disorder that is inherited – Huntington’s disease (but don’t need to know this yet)  So it’s key to keep in mind that these disorders are not inherited, but what happens when you have a genetic predisposition to a disorder? You’re at a greater risk of having that disorder o How do we know this? Based on 4 types of methods (1 of which he will discuss only briefly): Family method, Twin method and Adoptees method, and (briefly) Linkage analysis  The first method by which we know that genes can play a role in the phenotype of a certain disorder is…  *Family method: if a predisposition for a mental disorder can be inherited, a study of the family should reveal a relationship b/t the number of shared genes in the index case (the person with the disorder) and the prevalence of the disorder in probands (relatives) o In other words, take an individual who has Schizophrenia o Via the Family Method, we learn that if you have a 1 degree relative with schizophrenia, you have a 10% more likely chance (than the general population) of having schizophrenia  Ex of 1 degree relative: brother, parents st  So if mom has Schizophrenia, then she’s the index case. Her probands (1 degree relatives, ie her sons) thus have a 10% higher chance of suffering from Schizophrenia  More support that genes play a role is the *Twin Method  Monozygotic twins: share 100% of their DNA (identical twins)  Dizygotic twins: share 50% of their DNA  If both twins have (for example) Schizophrenia, we call this Concordance: the twins are similar diagnostically  Based on this information, we come to understand an important sentence from the textbook:  **To the extent that a predisposition for a mental disorder can be inherited, concordance for the disorder should be greater genetically in identical (monozygotic) pairs than in dyzogotic pairs o So if monozygotic twins show a higher concordance rate than dizygotic twins for a certain disorder, then that’s a strong argument that genetics are playing a role o Or, more formally: when the monozygotic concordance rate is higher than the dyzogotic rate, the characteristic being studied is said to be heritable  Adoptee Method: Sometimes researchers find twins (adoptees) who have been raised by non- biological parents o This method can reinforce heritability by ruling out environmental factors. o Ex: if the biological parent of the twin has schizophrenia and the twins raised by other parents develop this schizophrenia as well, it shows a strong support for heritability of the mental illness  He talks about a case study where one monozygotic twin remained with the biological parents and the other twin (adopted) lived in a different family environment o Such a situation can teach a lot about the genetic components of mental illnesses and disorders o (but he said we’ll get back to it later)  Another method through which researchers try to understand how genetics play a role in the phenotype of these different disorders…  Linkage analysis (not on slide): Scientists look at a large collection of individuals within a family unit who might have the disorder o So you observe the family and see which ones have or don’t have a disorder, and then you look at biological markers (blood samples, urine samples, etc) o The purpose is to look at what might be common amongst all the individuals in the family who suffer from the disorder vs those who do not Slide 5 – Biological Paradigm: Biochemistry  Clinicians working from the Biological Paradigm are also interested in the neurochemistry of the brain  In terms of this course, this is important because we’ll be looking at different types of medications, ie psychoactive drugs  **Two important concepts due to their pertinence to the drugs we’ll be talking about: 1) Neurotransmission and 2) Reuptake o Shows the two clips on the slide o Watch the two video clips on the slide. **Hints that they’ll (may) be on the midterm  Neurotransmitter clip: o Change the level of a single neurotransmitter and it could upset the entire chemical balance of the brain, resulting in mood disorders and mental illness Slide 6 – Biological Paradigm: Structure and Function of the human brain  Looking at the brain now to determine how abnormalities may arise due to disturbed brain functioning  Prof wants us to be familiar with a few of the following important structures of the brain that can play a part in different behavioural, cognitive and emotional disorders  The main lobes (seen on the slides) are called the Cortical structures, cortical meaning the outer layers of the brain o Important for higher order cognition  Inner layers of the brain consist of Subcortical structures o Involved more in movement related impairments/disorders  However, cortical and subcortical structures are not two distinct and unique structures. They all work hand in hand together Slide 8  **Wants us to be familiar with the following structures and the behaviours they’re involved in:  Frontal lobes: responsible for executive functioning (ie planning, inhibition and emotion) o Specifically, lesions to the Right side can cause – manic episodes o (lesions to the) Left side – depressed-like states (ie apathy, lack of motivation)  There are also differences b/t the right and left frontal lobes in terms of Cognition: o In terms of Cognition, the Frontal Lobes are responsible for Learning (oncoding) and Memory o Left side (left frontal lobe):  Oncoding(?) I think he means encoding: learning, or absorbing information  Speech – recall from last week when damage is suffered to Broca’s Area (left frontal lobe) o Right side – Memory, information retrieval  Temporal lobes: known as the language centers (recall Wernicke’s Area) o Left side – Wernicke’s Area (comprehension of verbal sounds) o Right side – Comprehension of non-verbal sounds  ie if we hear a vicious dog barking at us, what does our brain tell us? Run! If we hear a train chugging, what does that tell us? That a train is coming. It’s this sort of stuff that the right temporal lobe is involved in o People with seizures sometimes report hallucinations, and in this case neuroimaging will often reveal problems in the temporal lobes  Parietal lobes: integrates sensory information (involved in touch, visual-spatial functioning) o Left side – Apraxia (difficulty understanding movement)  ie if you tell a patient to brush their teeth they may comb their hair with the toothbrush instead o Right side – Visual-spatial Neglect (patient neglects the left side of their visual field)  Ie if patient may only eat food on the right side of their plate  Occipital lobe: Vision Slide 9  People (ie clinicians) working from a Biological Paradigm will employ neuroimaging instrumentation (ie MRIs) to investigate the brain for these lesions  Different neuroimaging techniques to be aware of:  1) – Structural Neuroimaging techniques o What type of imaging would constitute a structural neuroimaging technique?: o CT scans, MRIs o Provides direct (ie xray) images of the brain or particular parts of the brain that are of interest  2) Functional Neuroimaging techniques o PET scan, SPECT scan o You’re not looking at the brain per say (like an xray), but you’re looking at blood running through the brain  Shows video: what an MRI can tell us of the brain of a Schizophrenic (very short) o Ex of how a Psychiatrist would use an MRI to see whether there’s something abnormal in the person’s brain, and then come to a conclusion on what (structural) deficiency of the brain is contributing to their disorder Slide 10 – Biological Paradigm: Approaches to treatment  How would someone coming from a Biological Paradigm approach treatment? – Pharmacology (most common approach).  **For now, prof wants us to be familiar with the following different classes of drugs and what they’re commonly used for:  Anxiolytics: used to treat anxiety. o Can also be used to treat: sleep or pain disorders, people with phobias  Antidepressants: used to treat depression o Can also be used to treat: eating disorders (ie anorexia nervosa and bulimia), pain disorders (anxiolytics also prescribed but antidepressants are more frequently turned to for this), and dementia  Antipsychotics: used to treat behavioural disorders (ie Schizophrenia) o Can be prescribed after a major brain injury, to people with dementia, Lewy Body disease (will talk about in final lecture), and even to treat depression when psychotic features are apparent  Psycho-Stimulants: used to improve cognition (ie ability to focus, memory, executive functions) o Often prescribed to ppl with Alzheimers and other cognitive disorders (ADHD)  Although there are these different classifications of drugs, Psychiatry uses a shotgun approach o They’ll prescribe the drug known to best treat the particular disorder, but may also prescribe many different drugs at the same time until they stumble upon the one that’s most effective at treating the patient’s symptoms Slide 14 – Psychoanalytic Paradigm  Sigmund Freud o Controversial because many of his theories were untestable, and his ideas were pushed after the emergence of the Biological Paradigm o However, many of his principles formed the building blocks of modern psychology  3 Components of the mind he believed to be responsible for Neurosis (anxiety) (but we’ll just refer to Neurosis as abnormal behaviour)  According to him, mental illness is a result of an unconscious conflict within the individual between these 3 forces:  Id: works on the Pleasure Principle o The Pleasure Principle is an unconscious force driven by an immediate need for gratification  It requires the immediate fulfillment of basic drives such as: hunger, sex, thirst o When the Pleasure Principle is unsatisfied (ie does not get sex or food right away) this results in tension o This tension manifests itself as anxiety  If you can’t get what you want you start feeling anxious o Primary Process Thinking: The mind engages in this type of thinking to (at least temporarily) alleviate this anxiety from not being able to immediately satisfy our needs  Textbook gives ex of a baby who engages in sucking its thumb because what it really wants is milk from the mother’s nipple  Note that these are all unconscious processes (below our conscious awareness) o After the Id develops, so begins the development of the…  Ego: mediates between the demands of reality and the immediate gratification desired by the id o Is primarily conscious and is basically who we are in the simplest of terms o We obviously can’t operate solely on the Pleasure Principle and get away with it, so the Ego’s task is to deal with Reality. Functions on the Reality Principle o Ego engages in Secondary Process Thinking: Allows us to plan and make decisions so to come to the conclusion that operating on the Pleasure Principle at all times is not the most effective way at maintaining life  ie Prof acting solely under the Pleasure Principle would attempt to have sex with everyone in the room and eat all their food, but the Ego would determine that this isn’t the way to go about satisfying these needs  Superego o As we age, we begin to realize that there’s more to just deciding what’s right and wrong at a personal level o In other words, we begin to realize that there are social morays (or rules of society) which we begin to incorporate into the way we live our lives o Thus with the development of the superego, we become aware of a higher level of consciousness that guides our behaviour  The interplay of these 3 structures of the mind is what Freud called the Psychodynamics of personality  The interplay of these forces is what a therapist will try to understand in order to bring insight to the patient and make them healthier Slide 16  When the Id’s desire for immediate gratification creates tension, the mind will employ various Defense Mechanisms to protect ourselves from the anxiety associated with the tension  Thus, Defense Mechanisms: a strategy (unconscious to us) used to protect the ego from anxiety  **Some Defense mechanisms. He hints that one or a few of these may appear on exam:  *Repression (most important): pushing unacceptable impulses and thoughts into the unconscious o When we unconsciously don’t want to realize something we push it away so it’s not at our level of awareness  Denial: refusing to admit or accept to something o Ex: I didn’t fart just now o Denial can even serve an adaptive function sometimes, for ex if you lose a loved one (convince yourself they’re still alive).  However, denial for too long can end up being maladaptive  Projection: when we take what behaviour we have and rather than admit it to ourselves, we assume that another person has/does it rather than us o ie you cheat on your spouse but rather than admitting it, you accuse your spouse of cheating on you o (remember that these defense mechanisms are working below our level of awareness)  Displacement: redirecting emotional responses from perhaps a dangerous object to a substitute o ie mad at the prof, but I won’t yell at him because he’ll lower my grade so instead I go home and yell at a safer object (ie spouse, parents, dog)  Tells us to read the rest in the textbook Slide 17 – Psychoanalytic Therapy  Again, a psychoanalytic therapist tries to bring insight to the individual so that they can understand the interplay within the patient’s mind and why they’re feeling anxious  Different techn
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