Clinical Flashcards
(170 cards)
1
Q
define abnormal behaviour
A
implies something undesirable which requires change/treatment
2
Q
state the 4 D’s of diagnosis
A
deviance
dysfunction
distress
danger
3
Q
define deviance
A
when a behaviour deviates from the norm to the extent in which a behaviour is rarer uncommon in society
4
Q
define dysfunction
A
whether a behaviour interferes with a persons everyday life
5
Q
define distress
A
when the behaviour is causing distress to the individual
6
Q
define danger
A
when the individual presents a danger to the individual and/or to others
7
Q
strengths of the four D’s of diagnosis
A
useful- effective application can determine whether a clinical diagnosis is needed
reliable- all 4 D’s must be used consistently in order to decide if a behaviour is abnormal
8
Q
weaknesses of the four D’s of diagnosis
A
reductionist- Davis (2009) added a fifth D- duration. without considering duration, there may be a false-positive error
subjectivity- professional may have different views of mental illness and can falsely diagnose someone
9
Q
define schizophrenia
A
a mental health disorder which affects thoughts, feelings and behaviour, leading people to lose touch with reality (psychosis)
10
Q
common symptoms of schizophrenia
A
hallucinations
delusions
11
Q
what percentage of people will be affected by schizophrenia?
A
1%
12
Q
average onset for schizophrenia?
A
15-35
13
Q
define symptom
A
experienced by the self (thoughts, feelings and behaviours that would be told to a doctor)
14
Q
define features
A
facts (e.g. statistics and descriptions)
15
Q
define positive symtom
A
add to or change normal behaviour
16
Q
define negative symptom
A
remove something from normal behaviour
17
Q
examples of positive symptoms
A
disordered thinking hallucinations abnormal motor behaviour delusions thought insertion
18
Q
examples of negative symptoms
A
lack of energy (avolition)
lack of pleasure
flatness of emotion
social withdrawal
19
Q
define disordered thinking
A
muddled thinking that makes speech disorganised and hard to follow
20
Q
define hallucinations
A
experiencing something that is not really there. auditory hallucinations are often harsh and critical and may provide a commentary of what a person is doing or control the person by giving orders
21
Q
define abnormal motor behaviour
A
unusual physical behaviour e.g foot tapping and hair twirling
22
Q
define delusions
A
a firm belief or idea that conflicts with reality
23
Q
define grandiose delusions
A
holding false beliefs about being in a position of power
24
Q
define persecutory delusions
A
holding false beliefs that others are trying to harm them in some way
25
define referential delusions
holding false beliefs that unrelated information is directly related to them
26
define thought insertion
a person thinks their own thoughts have been implanted by someone else
27
what is avolition
no motivation for carrying out normal daily tasks
28
what is lack of pleasure
not experiencing pleasure from previously enjoyable hobbies
29
what is flatness of emotion
reduction in emotional expression
30
what is social withdrawal
avoidance of interaction with friends or family or not going out
31
what are cognitive symptoms of schizophrenia
poor working memory
poor information processing
difficulties concentrating
32
what are 3 features of schizophrenia
diagnosis tends to be between adolescence to 30
NHS says 1% of people will experience a schizophrenic episode
Goldstein- male sufferers experience more severe schizophrenia than females and have more visits to hospital
33
define neurotransmitter
chemical substance that carries messages between neurons
34
define dopamine
a neurotransmitter that regulates mood and emotion
35
define synapse
tiny space where chemical messages can be passed between two neurons
36
define receptor
sites on the dendrite that bond to and absorb a certain type of neurotransmitter
37
define antagonist drug
bind to receptor sites to prevent substance from being absorbed in large quantities, reducing effect of neurotransmitter
38
define up-regulation
mechanism where the brain produces more of something in response to a depletion
39
claim of the dopamine hypothesis
schizophrenia is caused by an excess of dopamine receptors or hypersensitive dopamine receptors, leading to high levels of dopamine in the brain
40
what does a high amount of dopamine mean
neurons fire more often and transmit more chemical messages in the brain, which leads to schizophrenia
41
what does amphetamines lead to
psychotic behaviours such as losing touch with reality
42
what did Munkvad and Randrup find
injected rats with amphetamines which led to stereotypical and aggressive behaviours
43
what did Owen et al find
post-mortems unveil a higher density of dopamine receptors in the cerebral cortex of those with schizophrenia
44
an increase in dopamine in the......... contributes to positive symptoms
mesolimbic system
45
an increase in dopamine in the........... contributes to negative symptoms
mesocortical system
46
supporting evidence for the dopamine hypothesis
Owen- higher density of dopamine receptors in those with schizophrenia in a post-mortem
47
opposing evidence for the dopamine hypothesis
reductionist as it ignores the role of glutamate and its effect on schizophrenia
48
different theory for dopamine hypothesis
fails to account for the role of the environment. 50% of those with schizophrenia had a major life event in three weeks prior to relapse, suggesting role of the environment
49
application for dopamine hypothesis
has led to drug therapy, antipsychotic drugs such as phenothiazine reduce dopamine
50
what does the dopamine hypothesis explain
that schizophrenia can be treated by drugs that block dopamine receptors and reduce dopamine in the brain
51
claim of the genetic explanation of schizophrenia
the greater the genetic similarity to someone with schizophrenia, the higher the risk of developing the disorder yourself
52
general percentage of people with schizophrenia
1%
53
if you have a second degree relative, the percentage is...
increases 2-6%
54
if you have a first degree relative, the percentage is...
6-17%
55
if you have an identical twin, the percentage is..
48%
56
which gene is responsible in having a higher risk of schizophrenia?
variant of C4
57
supporting evidence for genetic explanation
sekar et al- analysed 100,000 DNA samples from participants across 30 countries. those with particular form of C4 gene showed higher risk of schizophrenia
58
opposing evidence for genetic explanation
the genetic explanation is reductionist as it does not consider the role of environment
59
different theory for genetic explanation
dopamine hypothesis, claims that schizophrenia is due to high levels of dopamine in the brain
60
application for genetic explanation
knowing there is a genetic aspect, early intervention and early diagnosis can be carried out
61
claim of social causation theory
schizophrenia is related to social class and environmental stressors, and that those from a lower social class are more at risk of developing the disorder
62
why is social class a factor of developing schizophrenia
disorder is most common amongst those from a lower class, unemployed or those living in deprived city areas
63
what are important environmental stressors
poor education, unemployment and low income
64
supporting evidence for social causation
Cooper- the rate of schizophrenia in unskilled labourers was 4.1 times higher than higher managerial workers
65
opposing evidence for social causation
it may be a diagnosis issue- individuals with a lower status job are more likely to seek diagnosis as they have more time. those with a higher manager role don't have enough time to go to the doctors and seek diagnosis
66
different theory for social causation
doesn't take biological factors into consideration- genetics and dopamine
67
application for social causation
by highlighting a social cause, this has led to social- based care in the community treatments for schizophrenia
68
claim and aim of drug therapy for schizophrenia
claims that an excess of dopamine causes schizophrenia and aims to alter balance of dopamine in the brain
69
define typical drug
well-established, older drugs that have unpleasant side effects
70
define atypical drug
newer drugs that have less side effects
71
how to antipsychotic drugs work?
reducing levels of dopamine- blocking D2 receptors
72
example of antipsychotic drug?
phenothiazines
73
supporting evidence for drug therapy for schizophrenia
practical- doesn't interfere with everyday functioning and they won't have to be committed to therapy
74
opposing evidence for drug therapy for schizophrenia
Gup- many discontinue course of drugs early due to unpleasant side effects
75
claim and aim of CBT for schizophrenia
symptoms of schizophrenia are maintained by poor coping strategies and aims to help patients cope with symptoms
76
what happens in a CBT session?
- identify irrational thoughts
- reality testing
- teach coping strategies
- give homework tasks
77
supporting evidence for CBT for schizophrenia
Bradshaw- GPI (symptom severity) went from 7-1, never re-hospitalised
78
opposing evidence for CBT for schizophrenia
not suitable for all patients as it requires motivation and organisation skills. requires positive attitude
case study evidence- low generalisability and doesn't work straight away- lead to discontinuing of treatment
79
physical symptom of anorexia
85% or below expected body weight for height and age. severely underweight
80
cognitive symptom of anorexia
distorted body perception, unable to accept severity of low body weight
81
emotional symptom of anorexia
fear of gaining weight, may refuse to eat
82
define amenorrhea
absence of 3 consecutive periods due to lack of nutrition
83
why would someone with anorexia wear baggy clothing
they feel constantly cold due to low body weight- hide their shape from others
84
why would someone with anorexia have osteoporosis
they have a lack of calcium in their diet (thinning of bones)
85
3 features of anorexia?
10:1 female to male gender ratio
90% diagnosed are females aged 13-18
mortality rate once hospitalised is 10%
86
claim of hypothalamus dysfunction theory
anorexia is caused by a malfunctioning hypothalamus as it plays a role in eating
87
what does the hypothalamus do?
regulates thirst and hunger
88
what does the lateral hypothalamus do?
produces hunger
89
what does the ventromedial hypothalamus do?
depresses hunger
90
someone with anorexia will have an overactive...
ventromedial hypothalamus, which constantly depresses hunger
91
someone with anorexia will have a damaged...
lateral hypothalamus, leading to absence of hunger signals
92
supporting evidence for hypothalamus dysfunction
Anand and Brobeck- damaging the LH in rats stops feelings of hunger and reduces eating
93
opposing evidence for hypothalamus dysfunction
many anorexic individuals do feel hungry, and use the hunger as motivation to starve themselves. this theory is very reductionist as it doesn't represent the complexity of anorexia
94
application for hypothalamus dysfunction
highlights another cause of anorexia, but no useful treatments
95
social learning theory claim for anorexia
claims that anorexia is caused by imitation of underweight role models in the media
96
ARRM for anorexia
A- young females need to pay attention to role models due to frequent exposure
R- may retain info due to frequent exposure, might remember dieting tips
R- if able to, they will replicate this body shape
M- motivated through positive reinforcement of compliments
97
supporting evidence for social learning theory for anorexia
forehand- 27% of girls felt pressure from media to have the 'perfect' body shape
98
opposing evidence for social learning theory for anorexia
can place blame on the individual, leads to stigmatisation of the disorder being self-inflicted
99
application of social learning theory for anorexia
reduction of size 0 models and have to say on insta if the photos have been edited
100
claim and aim of drug therapy for anorexia
anorexia is often comorbid with other mental health disorders, drugs aim to make patients commit to psychological treatment
101
what are SSRI's
antidepressant that block reuptake of serotonin, increasing mood of client
102
what is olanzapine
antipsychotic drug that blocks absorption of dopamine and serotonin in the brain
103
supporting evidence for drug therapy for anorexia
Jensen and Majhede- did improve body perception, but experienced weight gain and hunger which was hard to deal with
104
opposing evidence for drug therapy for anorexia
SSRI's and Olanzapine cause weight gain. this is the ultimate goal but will be traumatising for the patient, maybe leading to discontinuing the drugs
105
claim and aim of CBT-E
anorexia is due to distorted thinking, aims to make clients make gradual changes to eating behaviours
106
overall process of CBT-E
weekly weighing, progress praised, personalised plan
107
supporting evidence for CBT-E
Byrne- 2/3 of those with eating disorders using CBT-E showed significant improvement in symptoms
108
opposing evidence for CBT-E
more suited towards older individuals who are able to attend sessions independently. 90% are between 13-18, meaning they'll be at school still- not enough time
109
example of a culture-bound syndrome
koro- fear of genital retraction
110
2 pieces of evidence that culture does impact diagnosis
Malgady- hearing voices in Costa Rica is a sign of being connected to spirts
Morocco- mental health disorders caused by evil sorcery
111
2 pieces of evidence that culture does not impact diagnosis
Lee- used DSM-IV to diagnose ADHD in Korean children. it was a valid tool in non-Western cultures
Lin- reviewed schizophrenia in multiple cultures and found frequency was similar
112
2 pieces of evidence that there is a genetic cause to mental health disorders
Sekar- analysed 100,000 DNA samples across 30 countries. those with particular C4 gene have higher risk of schizophrenia
Gottesman- concordance rates between MZ twins is 48% suggesting genes can cause schizophrenia
113
2 pieces of evidence that there are non-genetic cause to mental health disorders
concordance rates amongst MZ twins are less than 50%, must be a non-biological aspect to schizophrenia (GOTTESMAN)
high concordance rates of disorders amongst family members/ twins may be due to shared environment
114
what is the DSM
diagnostic manual used in America
115
what edition is the DSM in
5th
116
what are the three sections of the DSM
intro and instructions
diagnostic criteria
other assessment measures- cultural context
117
strength of DSM
standardised and operationalised criteria allows consistent and reliable diagnosis across clinicians
118
weakness of DSM
considers role of social norms- professional needs to make a judgement of abnormal behaviour- subjectivity in diagnosis
119
what is the ICD
diagnostic manual used across the world
120
what edition is ICD in
10th
121
what is section F in the ICD
mental and behavioural disorders
122
strengths of ICD
precise sub-types allow valid and accurate diagnosis- appropriate treatments will then be given
123
weakness of ICD
medicalises mental health, seeing it as a 'illness' that needs to be 'cured'
124
2 pieces of evidence that diagnosis is reliable
Goldstein- 169/199 agreement between DSM-II and DSM-III. Evidences high reliability over time
Tarrahi- 0.95 inter-rater reliability for both DSM-IV and ICD-10
125
2 pieces of evidence that diagnosis is unreliable
Rosenhan- despite giving all the same symptoms (voice saying empty-hollow-thud), 1 was diagnosed with manic depression, the others diagnosed with schizophrenia. therefore DSM is unreliable in terms of inter-rater reliability
DSM is subjective as it takes social norms into account- professional makes the decision of normal and abnormal behaviour
126
evidence that diagnosis is valid
Jansson- ICD and DSM had agreement of 0.82. high concurrent validity of schizophrenia
127
evidence that diagnosis is not valid
Rosenhan- 7/8 patients received diagnosis of schizophrenia- low validity of diagnosis using DSM as pseudo-patients given disorder when they didn't have one at all
128
aim of Guardia
whether individuals with anorexia would misjudge their own body size and whether they would also misjudge the body size of another individual
129
procedure of guardia
25 females with anorexia
25 in control group
sample from Lille, France
anorexia group had lower average BMI and shoulder width compared to control group
ppts presented with different size door frame shapes projected onto a wall
total of 51 different widths, each presented 4 times
ppt asked if they think they could walk through the doorway (not sideways)
ppt then asked to predict if the female researcher could fit through too
130
results of guardia
those with anorexia overestimated their body size
ppts with anorexia were much more accurate when predicting body size of the researcher
131
conclusion of Guardia
patients with anorexia will overestimate their body size
132
generalisability of Guardia
small sample of 25
all ppts from the same area, cultural influences
can't generalise to males as all female ppts
sample representative of those with anorexia due to young age and gender
133
Reliability of guardia
standardised procedure used e.g. same 51 door frames presented 4 times. procedure can be easily replicated
134
Application of guardia
informs treatments of anorexia, focusing upon body perception accuracy
135
validity of guardia
control group provides a baseline for comparison, researchers can confidently conclude body perception of anorexics are different to those who don't have anorexia
experiment lacks mundane realism due to artificial test of predicting whether they could walk through door frames projected onto a wall- could improve by placing real doorframes
136
Ethics of guardia
focusing on body size, especially in comparison to others could be potentially distressing
137
what study is guardia?
contemporary for anorexia
138
aim of carlsson
to present the existing dopamine hypothesis as an explanation of schizophrenia, and the role of glutamate
139
procedure of carlsson
conducted review of 33 studies
reviewed research about drugs that induce psychosis and effectiveness of drugs on schizophrenia
he referred to lots of studies that use brain scans (PET)
reviewed only secondary data
140
results of carlsson
- when glutamate increases, dopamine decreases. when dopamine increases, glutamate decreases
- future research should focus on new drugs to lower dopamine levels, as well as ones to raise glutamate levels
141
conclusion of carlsson
lack of glutamate can cause exaggerated response to dopamin, leads to schizophrenia
142
generalisability of carlsson
reviewed data from 33 different studies- wide range of data from various ppts, increasing generalisability
used several animal studies, conclusions drawn about neurotransmitters may not be generalised to humans with schizophrenia
143
reliability of carlsson
analysed secondary data, can't be sure on credibility and if standardised procedures were used.
144
application of carlsson
helped those who dont respond to antipsychotic drugs targeting dopamine. he highlighted the role of glutamate, and these drugs are in production targeting glutamate
145
validity of carlsson
brain scanning can have poor validity, as brain scanning environments can cause stress, altering neurotransmitter function to differ from their normal functioning
146
ethics of carlsson
animal experiments- unethical to give animals drugs that give them psychosis. inducing harm
147
what is carlsson?
contemporary for schizophrenia
148
aim of Rosenhan
whether 8 sane individuals who gained admission to 12 hospitals could be distinguished from the insane
149
procedure of Rosenhan
8 pseudo-patients of various careers
gained admission to 12 hospitals across 5 states
reported hearing unfamiliar voice saying 'empty-hollow-thud'
all other information given was true- apart from if they worked in mental health
one admitted, they acted normally
it was up to them to get themselves released
all took notes of their experiences
150
results of Rosenhan
- 7 diagnosed with schizophrenia, one with manic depression
- nurses only gave verbal responses 2% of the time
- 35/118 other patients voiced suspicions e.g. you're a journalist
151
conclusion of rosenhan
staff unable to distinguish sane from insane. DSM-II isn't valid for schizophrenia diagnosis
152
Generalisability of rosenhan
- gained admission to variety of US hospitals, some private, some public. results representative of a wide range of hospitals
153
reliability of rosenhan
standardised procedure in terms of symptoms e.g. 'empty-hollow-thud' reported. admission process can be replicated
154
application of rosenhan
highlights poor validity of DSM-II as 1 patient got diagnosis of manic depression. need more vigorous diagnostic criteria
155
validity of rosenhan
field experiment- high in ecological validity, staff didn't know it was an experiment
experiences of pseudo-patients can be seen as subjective and influenced by anxiety and stress
156
ethics of rosenhan
sending 8 pseudo-patients wasted valuable hospital resources and staff time.
confidentiality maintained as hospitals used werent mentioned. this could cause patents to have lack of confidence in care
157
what is rosenhan
classic study
158
aim of Bradshaw
investigate effectiveness of CBT, used to treat an individual (carol) with undifferentiated schizophrenia
159
Procedure of Bradshaw
- carol was 26
- had undifferentiated schizophrenia
- 3 year course of CBT
- symptoms measured on 4 scales
- number of hospitalisations and symptom severity (GPI)
- developed report by having shared interest in softball
- taught coping strategies and she wrote them on cue cards
160
results of Bradshaw
she was never re-hospitalised
improved in all 4 measures of symptoms GPI went from 7-1
161
conclusion of Bradshaw
CBT can be effective to treat schizophrenia, without side-effects of drug therapy
162
generalisability of Bradshaw
poor generalisability due to only using 1 person with a particular type of schizophrenia
can't generalise to males as only female used. they experience schizophrenia more severely (Goldstein)
163
reliability of Bradshaw
elements of standardised procedure- 4 scales can be replicated
rapport was unique due to shared interest in softball. other patients may not have good relationships with therapists
164
application of Bradshaw
demonstrates success of CBT in order to treat schizophrenia without unpleasant side effects
165
validity of Bradshaw
rich in-depth data was gathered, allowing researcher to triangulate data to check validity
166
ethics of Bradshaw
pseudonym 'carol' used to protect anonymity and confidentiality
informed consent had to be given at the beginning by friends and family. but she consented at the end of the study
167
aim of vallentine
improve the effectiveness of a psycho-educational group programme for offenders with schizophrenia in high security hospital
168
procedure of vallentine
- semi-structured interview
- 42 males from Broadmoor high security hospital
- programme aimed to help them cope with disorder
- interviews focused on positive and negative
comments about treatment
- content analysis highlighted key terms in qual data. e.g. what they found helpful and what was unhelpful
169
results of vallentine
31 completed programme, 21 were able to be interviewed
patients valued knowing and understanding their disorder
they valued 'knowing about my illness is important for recovery'
170
conclusion of vallentine
psycho-educational group treatment was effective in increasing confidence and understanding their disorder
