Condet

Dr Jerome Cockings

• Consultant in Intensive Care Medicine and Anaesthesia
• Royal Berkshire Hospital
• Reading

Why do some people get depressed after a relationship ends medications 247 discount 60 caps menosan free shipping, rather than bounce back? Individuals who suffered a major loss during childhood (such as the death of a parent) are more likely to get depressed after a relationship ends during adulthood treatment laryngitis purchase menosan 60caps fast delivery. Loss during childhood leads to a sense of helplessness treatment 5th disease purchase menosan 60caps with amex, which in turn predisposes people to become depressed in adulthood after a relationship breaks up treatment room buy menosan 60 caps otc, when they again feel helpless. Test people who did or did not have an uncontrollable loss during childhood by giving them increasingly difficult puzzles; as a measure of helplessness, assess how easily participants give up trying to solve the puzzles. For instance, you went from having an observation to identifying a question- about relationship breakups and depression-to stating a full-fledged theory: Children who felt helpless in response to a loss grow up to be especially susceptible to becoming depressed after a relationship fails. However, your observation could have led you down many other research paths, depending on the specific question you developed. For instance, your question might have focused not on loss during childhood, but on the degree to which the adult was not totally surprised by the breakup of the relationship. Psychologists employ different research methods when they pose and attempt to answer various questions; such methods include experiments, quasi-experiments, correlational research, case studies, and meta-analysis. As we review the various research methods, we will point out not only their strengths, but also their weaknesses. You might be tempted to conclude that the weaknesses are so severe that you can never understand anything with certainty from psychological research. Although each method has limitations, different methods have different limitations. Thus, if different methods produce the same answer to a question, we can be confident that the limitations of any one method are not responsible for the results. This method of converging evidence, where the same answer is produced using different techniques, has produced a wealth of knowledge about psychopathology. Conducting Research with Experiments Experiments Research studies in which investigators intentionally manipulate one variable at a time, and measure the consequences of such manipulation on one or more other variables. Dependent variable A variable that is measured and that may change its values as a result of manipulating the independent variable. Ideally, researchers prefer to employ experiments, which are research studies in which investigators intentionally manipulate one variable at a time, and measure the consequences of such manipulation on one or more other variables. Independent Variables and Dependent Variables You probably noticed that the definition of an experiment mentioned two kinds of variables: those that are manipulated and those that then are measured. In an experiment, researchers manipulate one variable at a time in order to observe possible changes in another variable. The variable that a researcher manipulates is called the independent variable (so named because it is free to change-it is independent). The variable that may change as a result is called the dependent variable (because its value depends on the independent variable). When the independent variable is changed, the accompanying changes in the dependent variable are the effect. Researching Abnormality 1 5 7 A researcher might separately manipulate several independent variables (always keeping all else constant while a single variable is changed), hoping to discover which ones cause the greatest effect on the dependent variable. Of course, researchers could not use an experimental design to investigate the specific question about helplessness during early loss and subsequent depression after a breakup. A researcher ethically cannot cause a person to have a major loss during childhood (or to feel helpless at the time). This is why most of the research on causes of psychological disorders does not use an experimental design. However, some aspects of psychopathology can be studied with an experimental design. For instance, an experimental design has been used to study learned helplessness in dogs (see Chapter 2; Overmier & Seligman, 1967); the independent variable was whether the dogs could escape an electrical shock, and the dependent variable was the number of attempts to escape. In that study, the independent variable was whether or not the conditioned (that is, the initially neutral) stimulus had been paired with an aversive unconditioned stimulus.

For this reason medications via g tube purchase 60 caps menosan mastercard, the reward system is usually referred to as the dopamine reward system symptoms zinc deficiency husky discount 60caps menosan with mastercard. A wide range of pleasurable activities symptoms zoloft withdrawal buy cheap menosan 60caps on line, such as eating and having sex symptoms 4dp3dt discount menosan 60 caps without prescription, activate the dopamine reward system. All stimulant drugs affect the dopamine reward system directly (Tomkins & Sellers, 2001). As we shall see when talking about other types of substances, some other types of substances (such as alcohol) also activate the dopamine reward system directly, and still other types of substances activate it indirectly Figure 9 5 g 9. Dopamine Released dopamine interacts with dopamine receptors, resulting in reward. Dendrite of neuron in nucleus accumbens Reward Pleasure, euphoria Motor function (fine tuning) Compulsion Dopamine transporter recycles some of the released dopamine back into the terminal buttons. Cocaine and amphetamines block reuptake of dopamine, which accumulates in the synapse, where it can further stimulate dopamine receptors. Note: Only the axon and synapse of the interneuron are shown, and for illustration purposes, there is only one terminal button of the dopamine neurons shown. Substance Use Disorders 3 9 7 by altering other brain areas or neurotransmitters that, in turn, affect dopamine (Leone, Pocock, & Wise, 1991). Regular stimulant use (or other substance use) usually affects the dopamine reward system. Researchers have thus proposed the dopaminergic hypothesis of substance abuse: the rewarding effects of a drug arise directly or indirectly from the dopamine reward system (Koob & Le Moal, 2008; Robbins & Everitt, 1999a, 1999b; Tomkins & Sellers, 2001; Torrens & Martнn-Santos, 2000). Because of the neural changes that occur with continued abuse, after a while, the person needs the substance to feel "normal" and experiences cravings when not using the drug. As researchers have come to understand the dopamine reward system in more detail, they have begun to gain insight into an age-old puzzle: Why are some people more susceptible to becoming abusers than others? In fact, at least part of the answer is that the do amine reward system is more sensitive and responsive in some people. For example, in one study, participants were given an injection of the stimulant Ritalin. The researchers found that participants who rated the experience as pleasant had fewer dopamine receptors than those who found it unpleasant (Volkow et al. Such findings support the hypothesis that people with fewer dopamine receptors may be more vulnerable to drug use (and abuse); the smaller quantity of receptors means they have reduced activation in the reward system, which is boosted by substance use (Swanson & Volkow, 2002). In fact, rats bred so that they consume relatively high amounts of alcohol appear to have a less responsive dopamine reward system, which could explain why they drink more (McBride et al. Connections among different brain areas, such as the amygdala and hippocampus, store associations between drug use and the stimuli related to drug use. Once such associations are established, these drug-related stimuli themselves can trigger the dopamine reward system (Tomkins & Sellers, 2001). The effects of cocaine on the brain result from the way it affects dopamine levels. Specifically, cocaine binds to dopamine transporters-the molecules that take excess dopamine from the synapse and bring it back to dopamine containing sacs within the terminal buttons of the transmitting neuron (see Figure 9. Thus, relatively little stimulation can (a) No history of (b) 1 month after (c) 1 year after produce pleasurable sensations. Again, the drug binds to the molecules that transport excess dopamine back to the terminal buttons and prevents them from operating effectively-thereby leaving more dopamine in the synapse, which in turn activates the dopamine reward system. Long-term use of methamphetamine disrupts the functioning of these transporter molecules. The images in the figure show the distribution of dopamine transporters in the brain of a person who abused methamphetamine. Although the dopamine reward system plays a crucial role in leading people to abuse drugs, it is not the whole story. The glutamate system-which consists of neurons that rely on the neurotransmitter glutamate-also plays a role in the shift from drug use to abuse and dependence. Glutamate receptors abound throughout the cortical and limbic regions that play a role in drug abuse, and researchers have shown that such receptors help to produce the reinforcing effects of drugs-which lead some people to become abusers-and also the negative effects experienced during withdrawal (Kenny & Markou, 2004). In fact, drugs that block glutamate receptors have been used to treat cocaine dependence and nicotine dependence (Ait-Daoud et al. Finally, the serotonin system-which consists of neurons that rely on the neurotransmitter serotonin-plays a role in the abuse of stimulants.

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Treatments for children and elderly patients that target social factors may need to be modified for those specific populations treatment breast cancer discount 60caps menosan overnight delivery. Therapists should try to be aware of- and discuss with patients-any cultural medications before surgery menosan 60 caps online, demographic treatment zoster order menosan 60 caps with mastercard, or other significant difference between themselves and their patients that could affect the goals and expectations of treatment or create miscommunication and misunderstanding symptoms anxiety menosan 60caps sale. If the psychiatrist recommends a treatment that targets neurological factors, what is it likely to be and why? What would be the goal-in terms of neurological factors-of that particular type of treatment? What, in particular, should the psychiatrist want to know about Nita before making a recommendation? List the types of questions a therapist with each theoretical orientation that targets psychological factors-psychodynamic, humanist, behavioral, and cognitive-might ask of Nita. What specific types of information would each therapist want, based on his or her orientation? Summary of Treatments That Target Psychological Factors Psychodynamic therapy and psychoanalysis are intended to help each patient more adaptively manage unconscious conflicts that Thinking like a clinician Community Psychiatric Hospital has had its budget slashed dramatically and thus is trying to help its highest functioning inpatients move into supervised housing in the community. Why might the hospital want to offer group Foundations of Treatment 1 5 1 th therapy to those living outside the hospital? Some patients will live with their families; why might family therapy be offered to those families? Although any given treatment targets only one factor, changes brought about by an effective treatment in turn affect other factors. He has been spiraling downward since the breakup, feeling irritable and sad, sleeping a lot, and without appetite. During your sessions with Carlos, he seems preoccupied with his relationship with Liana and worries that no other woman will ever love him. Research Challenges in Understanding Abnormality Challenges in Researching Neurological Factors Challenges in Researching Psychological Factors Challenges in Researching Social Factors Researching Treatment Researching Treatments That Target Neurological Factors Researching Treatments That Target Psychological Factors Researching Treatments That Target Social Factors Feedback Loops in Action: the Placebo Effect Carlos is not the only student on campus to have this type of problem. Like Carlos, these students frequently report feeling hurt, rejected, and unlovable. You wonder, though, whether the depression that many of these students are experiencing is a result specifically of their breakups. Perhaps they were depressed before the breakup-and that contributed to the failure of the relationship. On the other hand, maybe a lot of the students would not have become depressed if their relationships had not ended. How could you determine whether the students are depressed because their relationships ended, or whether their relationships ended because they were depressed (and this soured their relationships)? In this chapter, we explore specific methods that psychologists use to study psychopathology and its treatment, the challenges associated with the use of the different research methods, and the ways in which researchers address those challenges. The process of research on psychopathology often begins with observations that lead to a hypothesis about either the factors that may contribute to psychological disorders or the aspects of treatment that may be particularly helpful. Many of the depressed students coming to the counseling center have had prior bouts of depression. In such cases, a breakup would not necessarily be the culprit, because those individuals might have had another bout of depression regardless. Alternatively, there may be a causal connection between breaking up and depression-but it could go either way, with either one leading to the other. To determine whether your idea that the breaking up of a relationship can lead to depression is correct, you would use the scientific method, which is the process of gathering and interpreting facts that can lead to the formulation of a new theory or the validation or refutation of an existing theory. The steps of the scientific method normally are: observing relevent phenomena; identifying a question to be answered; developing a hypothesis that might answer the question; collecting new observations to test the hypothesis; drawing on the evidence to formulate a theory; and testing the theory. Rachel Watson/Getty Images the Scientific Method Suppose that your casual observation is correct: Students who seek help for depression are more likely to have had a relationship breakup before the depression began. Knowing this, you are interested in understanding why some people get clinically depressed after a breakup (like Carlos), whereas other people bounce back. How can the scientific method help researchers learn more about the association between breakups in relationships and depression or, more generally, about how a psychological disorder such as depression arises? Collect Initial Observations the first step in the scientific method is observation. Sometimes the initial observations lead immediately to the next steps, but other times they lead the researcher to describe the phenomenon more carefully and systematically by collecting data. Data are methodical observations, which include numerical measurements of phenomena.

Provides assessment of child distress and functional impairment caused by symptoms symptoms checker menosan 60 caps fast delivery. Checklist of potentially traumatic events to which a child may have been exposed ­ treatment hypothyroidism menosan 60 caps with amex. Established norms and clinical cut-offs based on standardisation sample (containing only a small number of 3 & 4 year olds) symptoms 7 days post iui 60 caps menosan free shipping. Acceptable scale internal consistency world medicine buy menosan 60 caps with visa, moderate convergent and discriminant validity on the Trauma Symptom Checklist completed by 8­12 year olds. Caregivers indicate whether their child has experienced any of a range of trauma events (ranging from accidental injury to sexual assault). Allows for identification of lifetime or present exposure to specified traumatic events. Generates six clinical scales (depression, anger, anxiety, posttraumatic stress, sexual concerns and dissociation). Generally speaking, although many of the clinical interviews require training and are quite time-intensive, a structured interview is regarded as a better assessment measure for diagnostic purposes than a questionnaire. Children and adolescents are typically dependent upon an adult to present them for assistance. Assessment of children and adolescents should include assessment of the system (typically the family) in which they live, as their symptoms will both influence and be influenced by what else is happening within the system. The rate of agreement between parents/caregivers and children in relation to internalising symptoms of posttraumatic mental health problems may be very low. Where assessment involves very young children (aged 0­3) this should include an evaluation of the behaviour of the child with particular reference to developmental stage and attachment status. In children, the range of potential posttraumatic mental health problems includes behavioural and attentional problems (such as oppositional defiant disorder and attention deficit hyperactivity disorder) as well as anxiety disorders (such as separation anxiety disorder) and affective disorders. However, there are some additional considerations in working with children and adolescents outlined in this section. For instance, of traumatised children and adolescents living in urban settings, up to 90 per cent have been reported to terminate treatment early. One of the most promising strategies for engaging and keeping children, adolescents and families in treatment has been found to be the delivery of services in schools. Although the core principles of each of the major therapeutic approaches used is very similar when applied to either children, adolescents or adults experiencing posttraumatic stress, there are several considerations that need to be kept in mind when working with children and adolescents. There are many reasons for this: o As previously discussed, the significant adults around children and adolescents function as gatekeepers in terms of access to and continued engagement in therapy. In order to ensure that children and adolescents return for therapy sessions, parents/caregivers need to be convinced that the work proposed is worthwhile. Time spent explaining the rationale for this kind of strategy, as well as answering any questions parents might have is essential for the successful engagement of families. Thus, parents or caregivers can play a crucial role in helping children and adolescents to generalise and maintain any gains they make in a therapy situation. It is important for clinicians to regularly (if informally) assess how parents are functioning. Parents are experts when it comes to their children (although, as previously discussed, this expertise may be compromised if parents themselves are struggling). It is not usually appropriate to simply take an adult treatment protocol and try to modify it for a child or adolescent. Wellvalidated protocols designed specifically for children and adolescents of all ages now exist, and these should be used in preference to attempting to modify an adult program. At all times, the developmental stage and capabilities of the child should be kept in mind ­ remembering that chronological age does not necessarily equate to levels of cognitive functioning and developmental mastery. Educationalists also recommend the use of different media in working with adolescents, who are used to being exposed on an everyday basis to a variety of media. Thus, there are different questions to be considered depending on the type of trauma exposure examined. In the child sexual and physical abuse literature, the focus is on how three distinct types of treatment (parent-only, child-only, and parent + child) compare. In other literatures, the focus is on whether involving parents in treatment enhances outcomes for children and adolescents.

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