Investigating Mental Health - Assignment Example

INVESTIGATING MENTAL HEALTH QUESTION Research Methods Strand Part Evaluating research methods Full reference forarticle: Kandris, E. and Moulds, M. L., (2008). “Can imaginal exposure reduce intrusive memories in depression? A case study”. PubMed: Cognitive Behaviour Therapy. 2008;37(4):216-20. doi: 10.1080/16506070802117950. Section One: Evaluation of an article using PROMPT guidelines Presentation Is the information presented in a clear and readable way? The articles is presented in a clear and readable way. The structure of the article is highly professional with a formal layout of headings such as “Abstract”, “methods”, “results”, “discussion” and so on. The language of the article is highly scientific making the article more reputable as an academic journal. Relevance Is the information appropriate and relevant to the purpose in hand? The article is relevant in SDK228 as it covers the intervention of depression and PTSD by reducing intrusive memory through imaginal exposure. Objectivity Is the content balanced or is there some bias? The content of this article is very balanced as there are no instances of bias or conflict of interest. The work is presented as an investigation of a scientific phenomenon through application of standard procedure devoid of manipulation. The objectivity of the article can further be established by the fact that it is published in PubMed, which a highly reputable scientific peer reviewed journal. Methodology How was the information gathered together? The information was gathered through identification of a single case participant who was suffering from depression after a breakup. Data from this case design was gathered through self-report and clinical interviews. Provenance Who or what originated the information and are they reliable sources? The authors of this research are Kandris E, Moulds ML.Both are reputable professionals in educational and psychiatric institutions. Their approach to study and the conclusion reached in this study are therefore very reliable and credible. Timeliness Is the information up to date and does this matter in our context? The article was published in 2008 and therefore does not appeal to the concept of currency. This is because emerging issues in psychiatry is possible to take place in six years. Section Two: Evaluation of different research methods (see the Research Methods boxes in Book 1 for guidance) Type of research This is a quantitative research. This is because statistical data is analysed in numerical from in the measurement of frequency which determines the progress of the participant. Type of study/method used The study was epidemiological. This is because it is used to study the determinants of reduction of intrusive memories in depression by focusing on a specific population. Advantages of this type of study It shows the occurrence of a disease, the trends of the disease and why. As such, it helps draw conclusions on the issue investigated so that a researcher can effectively define the population at risk of the disease with aim of coming up with a solution. Disadvantages of this type of study Epidemiological requires a large sample of participants to be investigated. This research investigates one participant thereby posing a limitation in this case. Furthermore, the study only shows correlations between the participants and the disease under investigation but is limited to indication of causality. Aim of study The aim of this research was to investigate the effectiveness of application of imaginal exposure to target intrusive memories associated with a dangerous life event that led to occurrence of a disease or disorder such as depression. Scope of study Number of participants; population studied The study investigated a single participant suffering from depression as a result of a painful life event caused by a heartbreak. How data was collected What scale was used; what was measured The data was collected through self-reports to indicate the progress in correlation between the frequency of good mood and intrusive memory. Clinical interviews were another source of data which was performed during the follow-up period which was 6 month following diagnosis. QUESTION 2 a) The participant in the Kandris and Moulds study was treated for depression using an imaginal exposure approach. Explain how the participant’s expectations may have influenced the results of the study. The tendency of patients to expect some effects from the treatment can be induce beneficial or harmful effects on the healing process of the patient. “placebo effect” is a term used to describe the situation where a patient expected to derive positive outcome from the treatment. Positive expectation promotes faster healing while negative expectations delays the healing process. This is because expectations have implications on the brain and therefore serve as an input to the healing process. The expectations of the participant may have contributed to the healing process either positively leading to fast recovery or the recovery got delayed due to negative expectations. Expectation is a factor that is not taken into consideration when analyzing the effects of imaginal exposure on reducing depression, but it plays a huge role. b) The authors state that they lacked the means to control for ‘nonspecific treatment factors’ in their study. They are implying that the response to the treatment may be partly or wholly due to a factor unrelated to the imaginal exposure. Using supporting information from SDK228, describe an aspect of this study that may have affected depression and/or mood, other than the imaginal exposure. The participant’s response to the treatment may be influenced by use of thought suppression to reduce the manifestation of intrusive memories. The participant may be receiving treatment and therefore consider suppressing intrusive memories as a way of getting rid of the memories. This will results in variation in the occurrence of intrusive memories while at the same time compressing the quality of their memory. A patient therefore experiences a false positive while the situation has not improved at all. A false positive effect indicates that the patient has improved but in effect treatment has not taken place and there is a great likelihood of a relapse after the 6-motnhs follow-up period. c) Describe in detail whether the measures used in the study were objective, subjective or both, giving reasons for your answer. Both Subjective and objective measures are widely used in clinical practice or research. Subjective measurement is the type that produces different results when the same investigation of a particular phenomenon is replicated. On the other hand, objective measures have the benefit or replication as they produce the same results even when the experiment is performed by another researcher under the same conditions. The investigation of the effects of imaginal exposure on intrusive memories incorporated both subjective and objective measures. The subjective measures were used during treatment and follow up period as the participant was involved in filling out the data about the effects of imaginal exposure as manifested through good moods. The data filled by the participant was filled in self-report after which it was analysed to reach to conclusions about the participant’s diagnosis and treatment. The data from self-report leads to subjectivity in the research as it cannot be replicated in another investigation. This is because the data is prone to bias and may be affected by other factors besides imaginal exposure. In this case, every research will produce independent results. The research utilizes objective measures during diagnosis and treatment as diagnosis is made is made from clinical reports maintained from the clinical interviews with the participant. This data produces objective measures since it is standardised and a similar research in the future will result in the same conclusion as in this research. d). There are several brain chemicals mentioned in SDK228 that may be implicated in depression and/or mood. Identify two of these chemicals and describe the evidence from SDK228 that supports the idea that they may be implicated in mood. Select one of these chemicals and explain how activity at the synapse would be expected to change in the context of an improvement in mood. Noradrenalin and endorphin are two hormones which are considered neurochemicals. The two neurochemicals may be implicated in depression and mood of the participant. Intrusive memories are considered self-harm that stimulate the production of neurochemicals which in turn alters the emotional state of the participant leading to changes in mood or depression. The endocrine system is an important feature in the brain as it is responsible for production of hormones that serve the purpose of signaling different responses to the brain resulting in changes in mood and other mental states. According to Morgan (1985), endorphin is a major hormone that influences mood alternation. Endorphin activity at the synapse is triggered by a sequence of events arising from the arrival of an action potential at one neurons which is then transferred to the next neuron at the synapse. At the synapse, endorphin is released which in turn closes the gap rapidly. Efficient occupation of receptors by the hormone causes transition of the signal to the next neuron. At the synapse, endorphin produces either an excitatory or inhibitory effect that produces a calming or bonding effect. e). Make four comparisons between the BDI measures shown in Table 1 of the article and those shown in SDK228, Book 1, Figure 3.6(b), on the impact of exercise, including approximate data in your comparisons. For each study, you should consider the scores at each stage of treatment and the percentage changes from the initial scores. From the comparisons you have made, which intervention seems to be the most effective for depression? Why do you think this conclusion might not be justified? The pre-treatment phase in the book shows that exercise reduces depression by enhancing good mood. In this case, the group doing the exercise has a better mood compared to the control group. However, in the Table 1 of the article, the pre-treatment phase shows that patients taking the treatment are more depressed that the control group. In the mid-treatment phase, the group performing the exercise as a means of treating depression show a great different in reduction of depression compared to the control group. The percentage improvement in mood is estimated to be around 20%. On the other hand, the treatment of depression in Table 1 of the article is at an equivalent position with the control group. There is a slight improvement in mood marked by an estimated percentage of about 8%. The post-treatment phase is also different between the book and the article. The phase is more pronounced in the book with a very effect in mood enhancement. Exercise works effectively as seen in the post-treatment with an estimated mood depression reduction of about 46%. On the other hand, Table 1 of the article shows considerable improvement as the deviation becomes more pronounced in the post-treatment phase. The percentage reduction in depression is estimated to be 35%. At the follow-up period, the book shows a slight change in the reduction of depression with a change of about 10%. However, Table 1 of the article shows a considerable improvement in the treatment of the participant as the mood change in higher than the other phases. The estimated improvement in mood at this phase is estimated to be about 25%. Imaginal exposure seems to be the most effective treatment for depression. This is because positive results continue to be experienced even after the follow-up phase. This conclusion may not be justified as other factors besides imaginal exposure could have contributed to the results. QUESTION 3 Speak Out Against Psychiatry (2013) DSM-V background and critical response (Online). Available at www.speakoutagainstpsychiatry.org/dsm-v-background-and-critical-response/ (Accessed 13 August 2014). This extract is a response to the DSM-5 proposed a manual of diagnosis of mental diseases using a set of signs and symptoms. A group of psychiatrists are concerned that the DSM-5 manual lacked empirical grounding an therefore was likely to cause vulnerability in patients due to inappropriate medical treatment, lead to introduction of labels for many mental disorders that cause tension to patients and most importantly, the threshold for diagnostic for multiple disorders would be lowered. The main point of criticism for the DSM-5 is the application of medical patterns of mood and behaviour in patients. In an open letter issued by the Society for Humanistic Psychology, the new proposed definition of mental disorder implies that all mental disorders have an interesting point due to their biological connection and therefore can be treated by focusing on the underlying psychobiological dysfunction”. However, the use of a manual with signs and symptoms for diagnosis of mental disorders has not been taken well by the National Institute of Mental Health who withdrew their support for the manual citing issues which invalidity. The labels in the DSM-5 proposed manual have also been termed as unhelpful to patents according to The British Psychological Society. Most patients suffering from mental disorders do not derive any hope from knowing the label of the disease they are suffering from. This is because the label is always perceived as mirage with empty promises. This scenario is particularly so given the fact that people with two contradictory diseases may share about two common symptoms. As such, the labels serve no purpose in practice apart from describing mental problems. In this case, diagnosis is seen to serve no purpose at all. However, proponents of DSM-5 have come out to support mental diagnosis as it is based on objective statement of facts and clinical judgement of the patient. Supporters of DSM-5 have come out to a support the need for a completely new way of looking at diagnosis of mental disorders by linking their underlying biological components. I do not support the arguments presented by the groups of psychiatrists and the National Institute of Mental Health. I fell that proper diagnosis of mental disorders is the beginning of a successful treatment process. The DSM-5 offers a diagnostic guide that helps doctors with a point of reference when diagnosing different mental problems with intersecting symptoms. It is imperative to note, just like nothing created is flawless, the DSM-5 may not be perfect o be accepted by everybody in the clinical practice and psychiatry, but is the best guide that is invaluable for practitioners dealing with mental patients. In most cases, assessment and diagnosis of mental health is a responsibility of a team of experts such as psychiatrists, mental health nurses, clinical psychologists, occupations therapists, social workers and support groups. DSM-5 has a great potential to integrate the roles of the different teams involved in the assessment, diagnosis and treatment of a mental patient by providing them with a new diagnosis criteria through a maul with spelt out labels. This improves the conversation in the consulting room as there is a clear consensus of the nature of disorder the patient is suffering from. The guide is also helpful as a point of reference for other agencies that may take interest in the patient’s illness including courts of law, policy makers, pharmaceutical companies, psychiatric drug regulation agencies and health insurance companies among others. DSM-5 transformation has the potential to revolutionise the care and treatment extended to mental patients in relation to improved diagnosis in terms of validity and reliability. Diagnosis is very important in the treatment of mental illnesses as it identifies the discrepancies in the mental health of the patients thereby giving the psychiatrist a clear path on how the successful treatment for the disorder should be planned. As such, diagnosis is a clear assessment of the signs and symptoms that a patient manifests with a view of fitting the symptoms to a particular syndrome. Therefore, the importance of correct diagnosis cannot be emphasised as it is the beginning of correct treatment and elimination of the disorder. If proper diagnosis is not carried out, treatment will not be effective and therefore, the patient will not be helped. The concepts of validity and reliability are very important in the assessment and diagnosis of mental patients. This is because they are central to making the right diagnosis judgement by maintaining absolute objectivity. DSM-5 improves validity and reliability by improving the evaluation procedure. Validity ensures that the measures used to measure a particular trait actually measures it. This mean that the results are expected to be truthful and useful. DSM-5 improves validity by enhancing objectivity of diagnosis. This is because the labels of mental disorders are clearly defines and distinguished from each other, it becomes easy to measure objectively a particular trait and end up with a true and useful result. On the other hand, reliability has been improved by making the description of mental disorders very clear and precise so that practitioners are not faced with any uncertainty during diagnosis. The new criteria sets out clear cut definition that replaced the vague old diagnostic criteria. This has made the DSM-5 a clinically significant reform in psychiatry. References APA (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR). Beck, A.T. (2006) Depression: Causes and Treatment, Philadelphia, University of Pennsylvania Press. Beecher, H.K. (1955) ‘The powerful placebo’, Journal of the American Medical Association, vol. 159, pp. 1602–6. Bower, G.H. (1981) ‘Mood and memory’, American Psychologist, vol. 36, pp. 129–48. Canino, G. and Alegria, M. (2008) ‘Psychiatric diagnosis – is it universal or relative to culture?’, Journal of Child Psychology and Psychiatry, vol. 49, no. 3, pp. 237–50. Kandris, E. and Moulds, M. L., (2008). “Can imaginal exposure reduce intrusive memories in depression? A case study”. PubMed: Cognitive Behaviour Therapy. 2008;37(4):216-20. doi: 10.1080/16506070802117950. Open University, (2010). Core concepts in Mental Health. SDK228 The science of the mind: investigating mental health. Maj, M. (2005) ‘Psychiatric comorbidity’: an artefact of current diagnostic systems?, British Journal of Psychiatry, vol. 186, pp. 182–4. Temerlin, M.K. (1970) ‘Diagnostic bias in community mental health’, Community Mental Health Journal, vol. 6, pp. 110–17. Toates, F. (2010) ‘Understanding drug treatments: a biopsychosocial approach’, in Barker, M., Vossler, A. and Langdridge, D. (eds) Understanding Counselling and Psychotherapy, London, Sage Publications, pp. 45–75. Speak Out Against Psychiatry (2013) DSM-V background and critical response (Online). Available at www.speakoutagainstpsychiatry.org/dsm-v-background-and-critical-response/ (Accessed 13 August 2014). Read More