1. Abnormality can be defined as unusual behaviour which is different from the standards, behaviour which cannot be adjust in the social societies, statistical abnormalities that is unable to function properly, existence of marked psychological problems and deviation from the mental health (Boyd N n.d.)
In this person experiences personal distress, that the person seek for help from mental health professionals. In terms of statistical norms, abnormality is defined as the how common or rare it is found in the populations, by this definition people with severe anxiety and depression are considered in abnormal behaviour because their behaviour is different from the norms (Oltmanns & Emery 2012).
According to wakefield, 2010, abnormality is defines, if it meets the two criteria that is due to impairnment in internal mechanism such as mental or physical, which leads to a condition that results in inability to perform the natural functions (that is something inside the person is not proper which causes distress in its functions) and second is the condition harm the person which estimated by the norms of the person’s civilisation. The definition of abnormal behaviour is included in the official diagnostic and statistical manual of mental disorders which published by American psychiatric association and according to this it is defined as persistent, maladaptive behaviours that are associated with personal distress, such as depression and anxiety or impairment in social functioning (Oltmanns & Emery 2012).
If a person is having difficulties in the following area than he or she is having mental disorder (Abnormal Psychology over Time, chapter 1, page no 3).
Suffering: if a person suffer psychologically than this explain the abnormality. The person who is manic and who want all the high is consider under abnormality (Abnormal Psychology over Time, chapter 1, page no 3).
Maladapativeness: maladaptive behaviour is one which interferes with our well-being and behaviour and ability to enjoy our work and work and family relationship. This indicates of the abnormality (Abnormal Psychology over Time, chapter 1, page no 3).
Deviancy: it is defined as the person who show different behaviour and does not provide any solution to the problem but simply exaggerate the things is called abnormal behaviour (Abnormal Psychology over Time, chapter 1, page no 3).
Violation of the standards of society: all the cultures have some rules and social manner which one has to follow, if you don’t than it consider as a violation of the norms of society. Example if a mother drowns her child than it would consider as an abnormal behaviour and violation of the norms of the society (Abnormal Psychology over Time, chapter 1, page no 3).
Irrationality and unpredictability: if starts to scream sitting nearby you, it wold be considered as abnormal behaviour because it was unpredictable because our perspective believes that a person can control his or her behaviour and if something against this happens then it would consider as irrational and unpredictable (Abnormal Psychology over Time, chapter 1, page no 3).
The definition which is considered in diagnostic and statistical manual of mental disorders (DSM) which published by American psychiatric association by Wakefield 1992 & 1997, he proposed the idea of harmful disorders and classify harm in terms of social values that is suffering, unable to work and dysfunction as inability to perform because some internal mechanism fails to perform according to it Oltmanns & Emery 2012 & Abnormal Psychology over Time, chapter 1, page no 5).
2. The international classification of disease (ICD), is the international standard diagnostic classification for all mental illness and mainly used in UK and Europe. The ICD codes are alphanumeric designation which are given to every diagnosis and description of symptoms on medical records. These classifications are developed and monitored by world health organisation (WHO) (OCD-UK, n.d.).
ICD is revised periodically and currently ICD10 is used which was developed in 1992 and ICD11 will about to come 2015 (OCD-UK, n.d.).
The DSM IV-TR is the counterpart of ICD10, which was developed by the Americans and Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association, which provides mental healthcare professionals with official definitions of mental illness. But in UK, in addition to ICD 10 and DSM IV, the National Institute for Health and Clinical Excellence (NICE) is present, which provides clinicians the guidelines about the mental illness (OCD-UK, n.d.).
ICD 10 and DSM IV guidelines about the depression:
The depressive episode comes in F32 guidelines which describes depression as mild, moderate and severe. They described depression as an individual’s suffering from depressed mood, loss of interest and enjoyment and reduced interest leads to increases fatigability and low activity. Other symptoms are: reduced concentration, less attentive, low self-esteem and self-confidence, suicidal intentions or self-harm intentions, disturbed sleep, low appetite and pessimistic about future (World Health Organization n.d.)
Mild depressive episodes:
The individual with mild depressive disorder is usually distressed and find difficulty in doing work, not want to socialise with people. The individual with symptoms which are described in definition and with atleast two other symptoms and minimum duration of these symptoms is about 2 weeks without much intense in the symptoms are considered as diagnostic guidelines for mild depressive disorder (World Health Organization n.d.)
Moderate depressive disorder:
The depressed mood, loss of interest and enjoyment and increased fatigability, if atleast two or three symptoms are present the person with four of the other symptoms then the person is suffering from moderate depression. These symptoms should be present for about 2 weeks. The person is also having difficulty in continuing social, work and domestic activities. All these conditions are considered in the guidelines of moderate depression (World Health Organization n.d.).
Severe depressive episodes:
In this person usually shows distress and agitations, low self-esteem and self-confidence and guilt feelings are usually prominent. The intensions of suicide are also present. If person is suffering from mild to moderate depressive episodes with four of the other symptoms and with intense severity which are present from at least 2 weeks but if symptoms are severe than diagnosis should be done after less than 2 weeks. During severe depressive episodes, patient is not able to perform social, work, or domestic activities. These all comes in diagnostic guidelines of severe depressive episodes (World Health Organization n.d.).
Severe episodes with psychotic symptoms:
If a patients shows severe depressive symptoms along with delusion, hallucinations and depressive stupor (World Health Organization n.d.).
3. Patient with psychiatric disorders have cognitive, emotional, physical and behavioural problems. According to Dr. Becks cognitive models of depression explained, that these depressed patients feels negative thoughts which are self-generated. He researched on depressed peoples and found that patient had negative thoughts about himself/herself or about world or about future. These automatic arise of thoughts are called as cognitions. The physical symptoms associated with emotional and cognitive responses are loss of appetite, lethargic, disturbed sleep, insomnia and no interest in work. The emotional responses which likely to occur in depression are crying, anger, fear, hopelessness, anxiety and loneliness. As these symptoms are not seen by common people but likely to affect patient’s physical and mental conditions (Thoolena& Riddera 2008).
It evaluated from the scientific literatures that about 70-90% patients experienced depression and anxiety (Spencer 2010). Another profound emotional response is hopelessness, as shown in Oshwambo Namibian and Sesotho South African patient (Van Oers 2013).
The behavioural problems such as mood swing, anger, crying, loneliness and these symptoms are not recognised by patients but causes harm to their family. These neuropsychological problems related to physical, emotional, behavioural and cognitive responses critically affect patient’s well-being and quality of life (Weiten 2012). The behavioural problems causes feeling of exhaustion and frustration and person lack of help. (Baqutayan 2012).
The emotional responses are sometimes expressive and sometimes non-expressive. The patient with severe depressive episodes emotional breakdown, the power of assessment and problem solving skills are lost. This loss is comes under cognitive problems. The cognitive responses are problem solving skills, intellectual skills, decision making power, memory loss and differentiating between right or wrong (Gil, F., 2012). Patient go through emotional turmoil and mourning after diagnosis.
Biochemical explanation suggests that depression is due to abnormal levels of neurotransmitters in the monoamine group (noradrenaline, serotonin, and dopamine). These neurotransmitters act at the synapses or junctions between neurons in the brain. The functions of neurotransmitter is to facilitate or block nervous transmission. Noradrenaline and serotonin have functions are related to arousal and sleep and increases in serotonin generally reduce arousal. A theory proposed by Kety 1975, that level of noradrenaline and dopamine are controlled by serotonin, and low levels of serotonin causes increase of noradrenaline and dopamine which leads to depression and high levels with mania. The biochemical system depends on genetic factors therefore the genetics and biochemical explanations are inter-linked (Biological explanations of depression n.d.).
Antidepressant drugs such as the monoamine oxidase inhibitors (MAOIs) increase the levels of noradrenaline and serotonin and alleviate the symptoms of depression which provide explanation of biochemical on moods. The SSRIs inhibit the re-uptake of serotonin and the resulting increase in the level of serotonin which provide evidences on improved mood. The post-mortem studies on patients were conducted who committed suicide and they also showed low levels of serotonin. The Rampello, Nicoletti, and Nicoletti found that patients with severe depressive disorder and had improper levels of neurotransmitters such as noradrenaline, serotonin, dopamine, and acetylcholine. These evidences evaluated that neurochemicals are involved in the severe depressive episodes (Biological explanations of depression n.d.).
The involvement of genetic factors involved family, twin, and adoption studies. The prevalence of depression in the random population is found about 7% for major depressive disorder and 1% for bipolar disorder. Berrettini, 2000 linked bipolar disorder to genes on chromosomes 4, 6, 11, 12, 13, 15, 18, and 22 (Biological explanations of depression n.d.).
This explains that depression provides a social impairment function because the person think all the time about their problems and what to do about them and also these person seek helps from others and need social motivation (Biological explanations of depression n.d.).
The hormones changes can results in depression like premenstrual syndrome (PMS), postpartum depression (PPD) in a women after delivering a child, and seasonal affective disorder. In women, menstrual cycle involves changes in the levels of oestrogen and progesterone hormones. Greater the change in hormone more they linked to depression like in pregnancy and post-birth. A stress hormone produced during stress called cortisol which linked to depression and it has been seen that increased levels of cortisol are found in the depressed patients (Biological explanations of depression n.d.).
Beck explained depression is the result of negative thinking and catastrophizing, which he called ‘cognitive errors’. He gave three components of depression in 1991 which are called cognitive triad:
These three components interact with each other and interfere with normal cognitive processing and causing impaired thinking, loss of memory and problem solving skills becomes less which were overshadowed by negative thoughts 9The Psychological, Social, and Biological Foundations of Behaviour, n.d.)
Negative Self-thoughts: In this a person start to think about himself/ herself negatively. He or she lives in guilt, and becomes negative and pessimistic. He or she may experience childhood abuse or trauma like death of parent or sibling, abuse or criticism, bullying, expelled from peer group, these trauma causes this condition (The Psychological, Social, and Biological Foundations of Behaviour, n.d.).
People with negative thoughts makes logical errors and focus on other aspect of situation rather than solving it. Sometimes they totally ignore the important aspects of an information. These are due to irrelevant thinking about oneself like I am not worth of anything, thinking on single perspective of situation rather than the whole like in office your team did not project because of you, rather than thinking what are problems which lead into this condition. Stretching unnecessarily a situation rather than solving it (The Psychological, Social, and Biological Foundations of Behaviour, n.d.)
4. The problems associated with the efficacy of treatment for depression is that the psychotherapies such as cognitive behavioural therapy and interpersonal therapy works only for the mild to moderate depressive disorders. But for the patient with severe depression it may not be enough (National institute of mental health, n.d).
The anti-depressant medications are marked as black box by the FDA, because these medication increased the potential risk of suicidal intension and self-harm attempts. As these drugs linked to the side effects such as worsening of the depression, sleeplessness, agitation, no link to social life. To avoid these symptoms patient should monitored all the time especially by the care givers and family (National institute of mental health, n.d.).
The electroconvulsive therapy is given to patients with severe depression but this also has side effects like confusion, memory loss and disorientation (National institute of mental health, n.d.).
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