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FlashCards por Becca Sidley, atualizado more than 1 year ago
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Criado por Becca Sidley
quase 9 anos atrás
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| Questão | Responda |
| Psychosis and the Enviroment | - |
| 6 key environmental /social factors: | 1. Poverty and social disadvantage 2. Social inequality 3. Urbanicity 4. Discrimination and victimisation 5. Family 6. Trauma * they are often interlocking; it is difficult as researchers to pick these things apart. E.G: although looking at evidence that focus on certain parts things like social inequality could be seen as more likely to happen in urbanicity and related to social disadvantage. |
| Can we assume causation? | In this lecture we are trying to use best available data/evidence, but we still CANNOT assume causation – we can’t say this caused psychosis. * The best available data does show a strength of association: strong associations and some would argue they are causal but cannot be assumed. |
| 1) POVERTY | Generally defined and measure by income but extend broader; e.g. not having a quality of living that is acceptable in modern day society e.g. damp housing, no access to social welfare, lack of access education can also be classed as poverty. |
| How did the government redefine poverty? | They abolished ‘The end child poverty by 2020 act’: As they wanted to re define it in way that was based on consequences not just income E.G: un-employment, addiction, consequences of poverty rather than just poverty. |
| What has evidence suggested that being at the lower range of socio-economic status can lead to? examples of outcomes? | s leads to worse physical, mental health social outcomes Low SES, poverty and disadvantage lead to a range of negative psychological, physical and social outcomes: e.g » High mortality rates » Chronic illness » Poor physical health » Poor mental health » Limited access to education » Lower living standards » Social exclusion * Link between poverty and low cognitive function, most likely as a consequences of lack of resources. |
| Moratlity rates and location? | Studies have found that expected age can depends on where abouts you live. = Generally the poorer more disadvantages the areas the lower mortality – this is a pretty consistent finding. - so not just poorer outcomes its also killing people. |
| Link between deprivation and psychosis Wickham et al | Wickham et al, 2014: Investigated the association between deprivation and psychosis using the index of multiple deprivation (IMD) *Looked at IMD = index of multiple deprivation (IMD): this is a derived measure of experiencing deprivation; this included not just income but employment, disability, access to resources etc. *Each area has own IMD score = = Found that IMD score predicts psychosis. |
| Specific symtoms? Wickham et al *Why may this be? | Then looked at specific symptoms = IMD also Predicted paranoia and depression but not hallucinations or hypomania Why: may this be? has been argued that living in deprives areas/poverty could increase threat perception which can increase levels of paranoia? *This may impact on poverty experience/paranoia and depression but not have a link to hallucinations |
| 2) SOCIAL INEQUALITY | Social inequality is defined in terms of: "unequal distribution of resources and opportunities within a population, as reflected in wealth, income, education, occupation, and social and cultural participation” = Poverty is included in that a social unequal society = un equal distribution of resources. Social inequality is looking at the whole bigger picture x Other areas don’t do this such as: Relative deprivation = only looking at those on the left the deprived ones |
| Wilkinson and Picket (2008) | = Looked at association between income inequality in many countries and lots of other health outcomes. = gathered together an impressive array of evidence showing that social inequality (not wealth) is related to almost all forms of negative outcomes e.g including crime, teenage pregnancies, physical health and mental health. X however this study for some reason didn’t include psychosis. |
| What happens when we look at social inequality and psychosis? Burns and esterhuizen (2008)– | In general what we find is that where there is inequality there are higher rates of mental health problems e.g psychosis. Burns and esterhuizen (2008)– looked at poverty and inequality found that they were associated with first episode of psychosis |
| Genetic and social risk Wick, hjern and dlaman (2010): | Looked at comparing impact of social risk and genetic liability e.g. children with a mother with SZ who had been adopted away and the social risks of the social environment they were adopted away too = They compared to adopted away control study who don’t have parent with SZ. = found children adopted away with mothers of a diagnosis of psychosis that them being in a environment that was secure and less unequal and with higher socio-economic status was a protective factor from development psychosis. = so found that Independently of whether someone had a genetic liability or not; being in a greater social un-equal areas with a lot of poverty was greater risk of psychosis. |
| What are the underlying mechanisms/ explanations for this effect of social inequality on peoples well beings? . Wilkinson & Pickett *Michael Marmets work = | Wilkinson and picket argue; • That the mechanism is the effect of negative social comparison on the HPA axis. *HPA axis =Hypothamili piturary adrenal axis Our stress system; there argument is being in a social unequal society enacts a stressed response from people and one of the reasons that it stresses us out because we not comfortable with situation and want to be the next stop up = what is interesting about this hypothesis it is not just effected those at the poorer age effects everyone on the continuum; E.G Michael Marmets work – ‘the health gap’: argues that every step up the ladder they are less well of health wise and mental health wise than the people still above them *Interesting point: people at the lower tend to have more severe response to mental health issues e.g. psychosis and those higher socio-economic wealth have more common diagnosis depression anxiety. |
| 3) URBANICITY | "The physical growth of urban areas, and the degree to which a geographical unit is urban” - The impact that the city has on us has been found to be toxic to mental health and stress * In particular with psychosis. X Although unsure how can untangle urbanity and social inequality and poverty ; as in all urban areas there are social inequality and poverty |
| Faris and Dunham’s (1939) famous study of Chicago; Why? | Faris and Dunham’s (1939) showed that inner city environments are associated with a high risk of psychosis -Looked at areas of Chicago and incidents of psychosis = More dense areas had higher rates of psychosis Why? - Attributed this to downward social drift; argument that people seek out areas that will best facilitate them. e.g lower socio-economic people may seek out a urban environment as more likely have access to needs. E.g. the more mentally distressed are will want to seek cheaper housing |
| Why may this not be the case???? • Pedersen and Mortensen (2001) | Because a dose response relationship is found: meaning the longer time they spend in urban areas their higher risk or psychosis • Pedersen and Mortensen (2001), in a survey of nearly 2 million Danish adults, found a dose-response relationship between exposure to an inner city environment 15+ years and risk of psychosis. |
| • Wiset et al - cognitive functioning & urbaniciyu. | looked at additional importance of cognitive functioning & and place of birth as predictors of psychosis in Israel. = increased urbanicity found to be associated with people with lower cognitive functioning, *if added povetry level in this could probably find a relationship |
| • Kirkbride et al (2012) Population density? | - Did a lot of work on this, find that they map out different areas based on population density. = found that non-affective psychosis (not-bipolar) was independently associated with increased deprivation, income inequality and population density = Indicates that how close we are to people stresses us out – increase stress and mental health issues. |
| 4) Discrimination & Victimisation | Discrimination: the unjust or prejudicial treatment of different categories of people, especially on the grounds of race, age, or sex.” Victimisation: Unwarranted singling out of an individual or group for subjection to crime, exploitation, tort, unfair treatment, or other wrong **Difference is categories of people being discriminate again on base of categories or victimised because their individual. |
| Ethnic groups and psychosis: x (2) | Many studies looking at experience of different ethnic groups; • Findings that Afro-Caribbean’s living in the UK have a high risk of paranoid and mania related psychosis. X This may partly be due to misdiagnosis and cultural insensitivity of white psychiatrists X Culture reasons; tends to be in first and second generation individuals Littlewood & Lipsedge, 1989) overall = more people who are moving to the UK who are ethnic minorities are having a higher rate of psychosis * most likely reason could be discrimnation |
| Is it just in the UK this is happening to ethnic groups? (Boydell et al, 2001; Veling et al. 2008 ). | Recent studies have shown that: • Immigrants in other countries are effected the same; not just the UK: -Immigrants in other countries are affected too = Immigrants living in white neighbourhoods are especially vulnerable (Boydell et al, 2001; Veling et al. 2008 ). = can understand on how these experiences can impact on mental health as feeling disconnected form the culture they have come from and also disconnected from the culture they are currently in. |
| Skin colour and discrimantion Veling et al (2007) | Interesting is that it seems to be difference and rates of psychosis vary according to how different our skin colours are: So as individuals if see someone who is different than us; more likely to experience discrimination *Then there is association between discrimination and mental health issues. Veling et al (2007) investigated perceived discrimination in immigrants living in the Hague. = The lighter skin the less discrimination experienced and lower rates of psychosis |
| Worst in first generation or second? | There has been arguments between whether this happens more in first generation individuals or second generation individuals = argument for first generation people is that moving to the UK for example there is a loss of connection to the culture they’ve experienced and also not interacting with current culture Second degeneration = don’t know who the couture is, little connection to own culture and little to current culture. |
| Has victimization been specifically linked with paranoia or hallucinations? Mirowski and Ross (1981) Janssen et al. (2003), | Victimisation has been specifically linked with paranoia, not hallucinations • Mirowski and Ross (1981) reported data on paranoid beliefs from a community survey of residents of El Paso and Juarez. Paranoia was associated with an external locus of control and experiences of victimization and powerlessness. • Janssen et al. (2003), in an epidemiological study of 7000+ Dutch citizens, found that experiences of discrimination predicted the later development of paranoid symptoms |
| Bullying & Psychosis? Bebbington : | = nearly half (46.4%) of the psychotic group had been exposed to bullying; which was much higher than the exposure rate for bullying from any other group = bullying was the second highest type of victimisation experienced in the psychosis group. * Additionally looked at experience of being both bully and victim individually and by being both bully & victim and its risk of psychosis = roughly the same but the odds ratio if both bully and victim very high likelihood of psychosis |
| 5) FAMILY | Peoples families in relation to psychosis is important Schreber (1903): wrote about his 9 years nervous illness; later analysed by Freud. Talked about his experiences; e.g. god pressing on his head, wanting to be a woman, wanting to have sex as a woman Described lots of pressures on his body; relating that to god was speaking to him through these pressures on his head, stomach, X Freud concluded that he way gay |
| Niederland (1959) analysed the writings of Schreiber: | - Analysed the writings of Schreiber looking at the other possible causes for his problems. E.G looking into shcreber father had written about ‘taming the beast in a child’. - he had designed as contraption to keep child still at the table; wooden thing around them to have a straight back = Neiderland convincingly demonstrated that Schreiber’s psychosis could be explained by his relationship with his father, a physician who devised various restraints to control children’s’ posture = These environmental factors should be considered when thinking about peoples experiences/symptoms of psychosis. *Pressures on body; contraption built to control their child can be linked to these feelings of pressure on areas of the body = argument there is meaning to peoples experience that need to be explored. |
| Attachment styles: | Something that develops in childhood and continue into adulthood. These are the adult attatchment styles: Secure: comfortable with intimacy and autonomy Pre occupied: dismissive of attachment – counter dependent Dismissing: pre-occupied with relationships, high emotional reacitivty Fearful – afraid of intimacy and rejection, believes self to be worthy of rejection, high emotional re activity *in general can view ourselves as mix of categories; so its OK to be a little bit of all of them. *certain types of attachment have been found to be related to psychosis |
| Separation and attachment styles: (4studies) | • Cannon and Mednick (1990): 6/8 high-risk children who became psychotic in Copenhagen had 1.5+ years early separation from parents. • Dozier at al. (1991, 1995) found that schizophrenia patients, especially with paranoia, most likely to have dismissing-avoidant attachment style. - Dozier: SZ patients who were paranoid most likely to have dismissing avoidant styles • Community surveys of 8000 adults (Mickleson et al., 1997) and 1500 adolescents (Cooper at al., 1998) also show psychosis associated with insecure attachment. • Berry et al. (2006) found correlations between insecure attachment and psychosis proneness in a large student sample. |
| Other big studies: Mhyrman et al., 1996: Morgan et al. (2007) - seperation from parents | Mhyrman et al., 1996: Finnish birth cohort study 11,000 children, born in 1966, followed-up 28 years later: ** Adds element of causation because we cos can follow up over time. = found that unwanted pregnancy = high risk of later psychosis. Morgan et al. (2007) Separation from parents associated with a 2-3 x increased risk of psychosis. X They are not looking at the range of things people experience over a life time. ;there can be other influences that may not of been measured by these studies. X |
| Communication deviance; Singer and Wynne (1965) *ancy Docherty et al. (1994, 1998) | • Singer and Wynne (1965): found that parents of thought-disordered children had speech that was persistently vague, fragmented or contradictory, “communication deviance.” -This has been replicated many times, notably in a series of studies by Nancy Docherty et al. (1994, 1998) The way we learn speech – we are learning language patterns based on our families – so if they have communication deviance this can have an big impact. E.G = Not being able to understand what someone else is meaning; not understanding thoughts or being able to get them across. |
| Expressed Emotion & Communication deviance. Goldstein, 1998), | - In 1965 65 nonpsychotic children attending a child guidance clinic selected for study. - At 15 year follow-up (Goldstein, 1998), schizophrenia spectrum symptoms were predicted by levels of: • Parental communication deviance (CD) • Parental expressed emotion (EE) *Important to note that it’s less about these definitions and more about how children learn to behave and how we learn our language and talk with each other. |
| 6) TRAUMA | Trauma is a deeply distressing or disturbing experience – but is not objective trauma is very personal to people and can vary from person to person. E.g. sexual abuse is key one to mental health but bullying can also be classed as a trauma. **A lot of resistance to the research into trauma and psychosis which we will come to at the end |
| l abuse and psychosis | Goodman (1997) - Looking at individuals with psychosis and found rates of early abuse both in men and women 51-97% in women had experienced early life abuse Muser, Goodman et al. (1998) =53% of women who mentally ill had been sexually abused in childhood 35% of men =64% women sexually abused in later life, 26% of men **can become victims due to their diagnosis in later life |
| Symtoms related to abuse? Goodman et al., (1997 | Goodman et al., (1997) = Abuse seems to be linked specifically to positive symptoms, especially hallucinations. Paranoia = victimisation link (can be linked to lack of trust, social inequality discrimination) Where as... Sexual abuse = related to hallucinations (in particular hearing voices) |
| Important study: Varese et al (2012) | Varese et al (2012) Collected a lot of evidence looking at early adverse, exposure to trauma bullying, parental death and many more then looked at its association with psychosis. *Important about this is looked at different types of studies so cross sectional studies, patient control studies, quasi studies (range of different studies/lots of different methods) = found a significant association between trauma and psychosis across all different research designs = this study also found a 9/10 studies investigated dose response – so how long they experienced it for = multiple traumas etc. and from this found a cumulative effect of trauma *Means that the odds ratios increased dramatically when more than 1 type of trauma. |
| Associations found between hallucinations = ? paranoia = ? | Associations found between Childhood sexual abuse = hallucinations Emotional neglect = paranoia |
| CRITICISMS OF THESE FINDINGDS OF TRAUMA: Sussser and widom (2012 x ? Fisher. | : × Sussser and widom (2012); argued that the findings are 'too consistent' so must be down to reported bias; e.g. they must be lying? (These criticisms can be detrimental and toxic to people with these experiences.) *However: Fisher et al. (2011) = Found that patients reports of childhood experience did not change when their symptoms remitted, and were concordant with reports by other sources (sibs). |
| × Sideli et al. (2012) | × Sideli et al. (2012) “Specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated….” “The possibility cannot be ruled out that a child destined to develop schizophrenia may show characteristics in childhood that increase the risk of abuse” *** Particularly worrying comment: victim blaming? Something about that child that makes it more abuse-able. X need to battle with these thoughts/ways of thinking. |
| The gene environment interaction | So far covered the very social factors But we cannot exclude genes out of this relationship like genes can’t exclude the social impacts. = even within womb exposed to environment – this impacts on what nutrients you get etc. So needs to be considered that even before given birth the environment can impact on genes and how they respond to the environment. = all of these things will make up mental wellbeing/health. |
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