Lecture 8

Question 1

what is an epistemological approach

Answer 1

the way you gather knowledge about the world and think about the world, using frameworks etc

(ie through diagnostics and formulation)

Question 1

what did schizophrenia used to be called

Answer 1

dementia preacox

Question 2

what did pinel coin the phrase “manie sans delire” for

Answer 2

19th century

pinel = french psychiatrist

“insanity without delusions”

lack of impulse control

raged when frustrated

prone to outbursts of violence

Question 3

what did pritchard say was “moral insanity”

Answer 3

j c pritchard

1835

moral insanity =”a morbid perversion of the natural feelings, affections, inclinations, habits…without any remarkable disorder or defect of the intellect or knowing or reasoning faculties and…without any insane delusion…”

Question 4

what did henry maudsley say about personality disorder

Answer 4

henry maudsley 1885

“no capacity for true moral feelings- all his impulses and desires…are egoistic…immoral motives…without any evident desire to resist them”

almost describing antisocial personality disorder

Question 5

what did JLA Koch 1891 say about personality disorder and how did Kraeplin 1911 build on that

Answer 5

coined “psychopathic inferiority” - replaced “inferiority” with “personality” to avoid sounding judgemental

Kraeplin 1911 put this diagnosis in his work on “dementia peacock (schizophrenia)”

what were six other sub-types of personality disorder at the time:
excitable
unstable
eccentric
liar
swindler
quarrelsome

Question 6

what three types of personality disorder did henderson 1939 describe

Answer 6

aggressive psychopaths = violent, suicidal, prone to substance abuse

passive and inadequate psychopaths = over-sensitive, unstable and hypochondriacal, introverts (schizoid) and pathological liars

creative psychopaths = dysfunctional people who managed to become famous or infamous

Schneider 1950 then included self harm in this

Question 7

what did the mental health act (1959) say about psychopathic disorder

Answer 7

“persistent disorder or disability of mind…which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires, or is, susceptible to medical treatment”

Question 8

what did the mental health act 1983 loosely define psychopathic disorder as?

Answer 8

a long-term disorder characterised by “abnormally aggressive or irresponsible behaviour”

it wasn’t defined as a mental health problem- it wasn’t deemed treatable as there wasn’t a pharmacological intervention or therapeutic treatment, there was an ongoing difficulty to separate out affect, mood and personality as 3 separate things

Question 9

what was wrong with how old mental health acts pre 2000s defined personality disorders?

Answer 9

talk as if there is immorality within it/they’re doing something immoral

Question 10

what are the categories of personality disorder within ICD-10

Answer 10

paranoid

schizoid

dissocial (antisocial)

emotionally unstable (explosive type, borderline type, aggressive type)

histrionic

anankastic (obsessive)

anxious/avoidant

dependent

other specific PDs

Question 11

what are the DSM-5 categories of personality disorder

Answer 11

paranoid

schizoid

schizotypal (struggling to be around people)

antisocial

borderline (emotionally unstable)

histrionic

obsessive-compulsive

avoidant

dependent

narcissistic

personality change due to a medical condition

Question 12

what are symptoms of emotionally unstable personality disorder in the DSM-5

Answer 12

impulsivity

mood swings

overwhelming fear of abandonment

extreme anxiety and irritability

anger

paranoia and being suspicious of others

feeling empty/hopeless/worthless

suicidal thoughts

self-harm

having a pattern of unstable or shallow relationships

rapidly changing your opinions of other people

dissociation (feeling as though you have lost touch with reality)

Question 13

what studies support the idea that the reliability of diagnosis is variable

Answer 13

fazel, khosia, doll and geddes 2008 = diagnosed rates of personality disorder in homeless adults (4%-70%)

loranger et al 1994 = some evidence of inter rater reliability with semi-structured interview

Question 14

what is the dimensional model in dsm-5 for personality disorder

Answer 14

enduring pattern of inner experience and behaviour that deviates markedly from expectations of individual’s culture

two or more of the following:
cognition
affectivity
interpersonal functioning
impulse control

enduring pattern is inflexible and pervasive across a broad range of situations

enduring pattern leads to distress or impairment in functioning

stable and long pattern, can be traced to adolescence or early adulthood

enduring pattern is not better explained as a manifestation or consequence of another mental disorder

not attributable to the physiological effects of substance abuse or other medical condition

Question 15

what did mikulincer, shaver and pereg 2003 say about attachment

Answer 15

measured on two dimensions (avoidant and anxious)

disruption to either one causes difficulties in establishing and maintaining relationships with others

attachment as an emotional regulation strategy

Question 16

how does childhood abuse relate to borderline personality disorder

Answer 16

Herman, Perry and Van Der Kolk 1989 found significantly more borderline subjects (81%) gave histories of trauma:
71% for physical abuse
68% sexual abuse
62% witnessing serious domestic violence

abuse histories were less common in those with borderline traits and least common in those with no borderline diagnosis

Question 17

what are therapy models of personality disorder

Answer 17

dialectical behaviour therapy

schema-focused cognitive therapy

psychodynamic psychotherapy

Question 18

what do all models of PD stress

Answer 18

the role of early relationship patterns

early life experiences and the roles/strategies we take on to survive (Ryle, 1997)

Question 19

what is dialectical behaviour therapy

Answer 19

linehan 1993

early invalidating environment

sexual, physical, emotional abuse or neglect

high genetic predisposition to emotional arousal

characterised by high likelihood of arousal and slow return to baseline

treatment = teach emotional regulation, cognitive and interpersonal skills

Question 20

evaluation of dialectical behaviour therapy for personality disorder

Answer 20

NICE 2009 = reduces self-harm behaviours for women with borderline personality disorder

Question 21

what is schema-focused cognitive therapy for PD

Answer 21

jeff young 1994

18 schema identified by factor analysis of case-notes

now identified by young schema questionnaire (YSQ)

coping styles maintain schema ie avoidance/overcompensation/surrender

Question 22

what is the psychodynamic model of PD

Answer 22

arrested development of a particular point in childhood

modern = object relations theory, making use of attachment theory

the way we learn to relate to others becomes ‘etched’ neurologically (Gabbard, 2005)

Question 23

what is the mode/mean ages of death for those homeless

Answer 23

mode age = 44 (CRISIS, 2013)
mean age = 47

Question 24

what are causes of homelessness

Answer 24

mental health drug use child poverty housing education geography (more common in north of england, seaside towns and certain central london boroughs)

Question 25

what are problems behind homelessness

Answer 25

fragmented services (third sector, LAs, some NHS traditionally seen as a "housing"problem population of mainly men who repeatedly lose tenancies for antisocial behaviours and non-payment of bills etc undiagnosed, untreated mental health problems (patchy access to primary care and little access to secondary care)

Question 26

Maguire, Hughes and Munwar, Levell, McClean and Matthews 2013

Answer 26

homeless sample: 69.9% had emotional abuse 66.3% physical abuse 65.1% parental separation household substance abuse in 56.6% AND results from the Millon Clinical Multiaxal Inventory (MCMI-III) using an 85th percentile cut off for those in three diff hostel services, two in southampton and one in london for the whole sample, 57.1 have indications of personality disorder depressive was the most common (21.4%), then antisocial and borderline (13.1% respectively)

Question 27

how did coudrey 2010 test specific mediation models in homeless hostel residents

Answer 27

used 80 hostel-dwelling homeless people (64 male, 16 female) childhood trauma is associated with emotion dysregulation (.44**) so is the predictor emotion dysregulation is associated with aggression (.46**), emotion dysregulation is the mediator and aggression is the outcome direct path from childhood trauma to aggression is weaker (.31*) or non-significant (.11) if taking away the bit that is accounted for through emotion dysregulation trauma doesn't directly cause aggression, it leads to emotion regulation issues which then increase aggression

Question 28

how did day 2009 test specific mediation models in homeless hostel residents

Answer 28

sample of 59 hostel-dwelling homeless people 53 male, 6 female childhood trauma is associated with emotion dysregulation (.28*), it's the predictor emotion dysregulation is correlated with maladaptive behaviours (.54**) childhood trauma is associated with maladaptive behaviours (.35* directly, or .20 if minusing how much is due to emotion dysregulation within this) emotion dysregulation is the mediator and maladaptive behaviour is the outcome

Question 29

what is the proposed multi-level model of complexity

Answer 29

Maguire, 2017 individual factors ie genetic/behavioural genetic/epigenetic historical factors (attachment abuse) which influence psychological factors (cognitive, emotional, impulse, relational), which influence behavioural factors (substance use, maladaptive), which influence repeat homelessness societal factors (gov policy, housing/health/social care, poverty)

Question 30

what is the role of early experiences and attachment theory in homelessness

Answer 30

attachment theory responsible for: emotion dysregulation behavioural impulse regulation relationships negative cognitive content and process

Question 31

what is Bodley-Scott et al proposing as individual interventions for personality disorder

Answer 31

Bodley-Scott et al is still in the process of making this CBT interventions around metacognition DBT motivational interviewing mindfulness-based cognitive therapy BCBT cognitive skills training lifestyle coaching resilience and self-determination theory social action theory

Question 32

what is maguire et al currently prepping results for

Answer 32

'phoenix' study RCT results for treatment effectiveness received for: CORE = clinical outcomes in routine evaluation (psychological distress, functioning etc), effect size = 0.26 from time 1 to time 2 (post-treatment assumably) AUDIT = alcohol use identification, effect size =.07 so no real effects post-treatment DAST = drug abuse measure, effect size 0.15 for time 1 to time 2 so very small improvement DERS = difficulties in emotion regulation measure, d=0.15 so small improvement IES = impact of event scale (trauma-related symptoms), looks like a modest improvement? MBQ = mindfulness-based questionnaire, looks like a good improvement

Question 33

what are issues with treatments for PD

Answer 33

psychological therapy is expensive usually provided by health services need to scale psychological knowledge and practice psychologically-informed environments (PIES)

Question 34

what is maguire et al in the process of finding about staff burnout

Answer 34

uses Maslach Burnout Inventory to assess burnout levels at time 1, 2 and 3 for PD workers found at time 3 burnout inventory rating had reduced lots after teaching them how to think about homelessness as burnout decreases, beliefs about how effective they are for facilitating change (small increments) increase and negative beliefs about those who are homeless go down