Clinical psychology Flashcards

Question

1 strength of concurrent validity for ICD/DSM

Answer 1

Andrews - 1500 patients using DSM IV and compared to ICD and found agreement on diagnosis for depression and general anxiety

Answer 2

Andrews however - 68% agreement between ICD and DSM. For PTSD was poor as ICD diagnosed 2x as many. T/F wont produce consistent diagnosis so not reliable for PTSD

Answer 3

If it predicts the course of illness accurately - prediction of future behaviour caused by the disorder it is predictively valid

Answer 4

Powers et al - women who had suffered complex PTSD also had higher level of substance and alcohol abuse as predicted by ICD 11

Answer 5

The precise course of many disorders has not been established yet. This is why diagnostic manuals are republished and updated as knowledge on disorders develops. T/F hard to establish predictive validity(found in powers)

Answer 6

The symptoms of the patient match those considered to be present for the disorder and fit the necessary criteria

Answer 7

Hoffman - Used a computer prompted interview to see if the findings on prison inmates with alcohol dependence/abuse matched the DSM-IV-TR. Symptoms matched DSM diagnosis. T/F DSM-IV-TR has construct validity

Answer 8

Rosenhan - All but 1 pseudo patient was diagnosed to have SZ and when released 7 were released with incorrect diagnosis of schizophrenic in remission using DSM 2.

Answer 9

Reductionist - Splits clinical disorders into list of symptoms and features, simplifying complex behaviours, some people may suffer in different ways Co-morbidity - Hard to diagnose people with multiple disorders as it relies on the clinician choosing the closest match from a list of symptoms.

Answer 10

The spiritual model Language barriers Cultural bound syndromes Influence of cultural norms and stereotypes

Answer 11

Primary data is information collected first hand by the researcher on mental health disorders. Researcher plans, conducts a study and collects and analyses the data specifically for their research hypothesis Data collected can be quant or qual Methods include Observation, experiment and interviews.

Answer 12

Temporal validity - research will be conducted using current DSM criteria to diagnose patients from current population. T/F high external validity, generalisable Data is fit for purpose - researcher can fully operationalise variables such as mental disorders so data collected is specific and relevant compared to 2nd Range of data can be collected - qual and quant so analysed in different ways. T/F can produce detailed analysis of clinical disorders so increase validity

Answer 13

Pop validity - Hard to get large population of mental health patients and primary research will have small sample due to time and money. T/F unrepresentative... Practical - The researcher has to plan, acquire collect and analyse which is time consuming and expensive compared to 2nd. T/F not economical Researcher effect - contact w patient so may influence the patient or their behaviour/response, could lead to demand characteristics.

Answer 14

Secondary data is the information that already exists where the researcher collects it second hand from an external source on mental health disorder Data collected can be qual or quant Its collected by other clinicians for a different purpose and is often readily available Methods include articles and videos

Answer 15

Large sample - Easy to collect large population of mental health patients due to range of research being able to be collected easily and efficiently. T/F representative... Practical - The researcher doesn't have to plan, acquire collect and analyse meaning its not time consuming and expensive compared to 1st. T/F economical compared Ethical - Already collected and published so consent already gained. No breach of informed consent

Answer 16

Temporal validity - research is not conducted by researcher so may not be using current DSM criteria to diagnose patients from current population. T/F low external validity, generalisable Data is fit for purpose - researcher cant fully operationalise variables such as mental disorders as they didn't collect it so data collected is not specific and relevant compared to primary. Validity issues with original data - Data already collected so if further data is needed clinician cant do this. Also data may only be quant so analysed in a specific way.

Answer 17

To investigate if sane people could be distinguished from insane people using the DSM2 classification system and if they can be differentiated.

Answer 18

8 pseudo-patients 3 female 5 male

Answer 19

Pseudo-patients said they could hear unfamiliar voices saying words like empty, hollow and thud Once admitted to the hospital the pseudo patients behaved normally and reported they were fine and free of symptoms and not schizophrenic Pseudo patients took notes on their experience covertly but later overtly When given their medication they threw away their pills or flushed them down the toilet

Answer 20

All but 1 pseudo patient was diagnosed as schizophrenic 35/118 patients recognised the pseudo patients as not crazy 7 were released with diagnosis of sz intermission Stayed in hospital between 7-52 days average of 19

Answer 21

Staff were unable to distinguish those who were sane from those who were insane Rosenhan argued that the power of a label of insanity leads to the subjective interpretation of any behaviours displayed

Answer 22

Ecological validity - natural setting of 12 varying hospitals in east and west coast of America. TF rep of wrong diagnosed sz using DSM 2 Objective measure - Quant data on pseudo patients was collected for example all but 1 was diagnosed with sz across 12 different hospitals using DSM 2 Mundane realism - took place in realistic setting of a mental hospital as clinicians were unaware so interactions with pseudo-patients were naturally occurring Changes made to the DSM - Findings show DSM 2 is not accurate for sz diagnosis so changed to 5 TR which is much more rigorous as lots of symptoms must be shown over long period of time. TF increased validity

Answer 23

Temporal validity - findings of all but 1 pseudo patients diagnosed as sz was on DSM 2. We us the 5 now. TF outdated and no longer valid Protection from psych harm - proved incorrect diagnosis using DSM 2 so clinicians may believe they aren't good enough. Doctors play safe - If unsure may diagnose them to closest thing like diagnosing hearing empty hollow thud as sz. TF misdiagnosis or admitting sane into hospitals as insane decreasing DSM 2 validity Deception - 8 pseudo patients gave wrong names, occupations and symptoms like hearing empty hollow thud so they were unaware they were in clinical research. TF deceived and not ethical

Answer 24

Face to face conversation between a clinician and their patient This usually will be unstructured or semi structured to gain info on the mental health patient with questions like "what gender are the voices you're hearing" This conversation will be recorded and then the clinician will listen and transcribe it. Finally this transcript will be thematically analysed in depth by clinician to aid diagnosis

Answer 25

In depth data - Rich detailed qual data is gathered by clinician which can be thematically analysed in detail to aid diagnosis. TF internal validity and accuracy Practical application - Patient may explain symptoms of a mental health disorder which could give insight into new disorders. TF improving society understanding of disorder and improving patients life Gather qual data - unstructured interviews allow patients to expand during conversations and give more details on the symptoms. TF increasing validity of CI broadening mental health understanding

Answer 26

Subjectivity - Patients transcription will be thematically analysed which may use subjective words and phrases which may be viewed as more important to some clinicians than others. TF less reliable Time consuming - not practical as its secondary research so researcher has to plan, acquire collect and analyse meaning its time consuming and expensive compared to 1st.

Answer 27

Glaser and Strauss devised that grounded theory focusses on developing a theory from research evidence. Typically a directional hypothesis so specific info. Broad codes in the margin of raw data gradually becoming more specific Data analysed one interview at a time so its possible to introduce info from prior into subsequent. Aims to develop theories where previously there weren't any. Often create models.

Answer 28

Evidence is integrated into the theory - as the theory is generated from the evidence being used this means the theory is relevant to making a diagnosis. Therefore, theory has high validity

Answer 29

Subjective analysis - based on subjective opinion of researcher. Researcher selectively picks aspects of the data to focus on. Some people might argue that the researchers are forcing the data to support the theory they think is emerging. TF selecting specific info so may miss crucial information reducing validity. Reliability - The theory is based on the subjective opinion of the researcher. Although evidence is used to generate the theory the researcher selectively picks aspects of the data to focus on, and as the theory begins to emerge, focuses on only the aspects of the theory they are developing. Therefore, when another researcher conducts the same research or coding the data, different theoretical concepts could emerge, so the finding will not be consistent.

Answer 30

To investigate the usefulness of psych-ed material provided via group work within secure forensic psychiatric hospitals

Answer 31

42 male patients detained in high security hospital under the mental health act 1983 who had been diagnosed with sz by the ICD 4 - only 21 completed interviews

Answer 32

Used the CORE-OM interview schedule during group work and the SCQ self report technique to measure self esteem in patients. 31 patients took them with a further 10 dropping out or withdrawing data ending in 21 completers.

Answer 33

Overall sz patients in forensic psychiatric hospitals valued education and knowledge on their illness.

Answer 34

Over 50% of the 21 completing patients found improvements in behaviour from group work and clinical interviews and gathered quotes like "it gave me peace of mind" and made them feel guilty.

Answer 35

Standardised questions - used SCQ as self report questionnaires which had repeated questions for all 42 sz patients. TF easy to replicate with similar findings Qualitative data gathered - semi structured interviews via CORE-OM interview schedule so sz patients could expand on answers to give in depth qual data. Themes generated such as what patients valued and why Inter rater reliability - clinical interviews were recorded so a second clinician could listen to it. Practical applications - Found psych ed content and group work help improve SZ patients understanding of illness. TF improving understanding and quality of life

Answer 36

Subjective interpretation - researchers analysed interviews and found 4 main themes including what p'pants valued and why. May have been bias to pick themes to support hypothesis. TF lacks internal validity. Spontaneous questions - semi structured via CORE-OM meant some questions were random and asked different for each sz patient. Researcher bias - many analyse and report determined and engaging patients more favourably. TF decreased validity Small sample size - clinical interviews often use a small sample. TF decrease validity Eco validity - high secure hospital of detained patients. Cant generalise to all sz as some people aren't detained in hospital

Answer 37

Cog symptoms and are false perceptions which have no basis in reality. Can be auditory, visual, tactile or somatic. An example of an auditory hallucination is hearing voices in your head telling you to do something.

Answer 38

Cog symptoms which are firmly held false beliefs despite being completely illogical. Can be delusions of grandeur, persecution, reference and control. An example of a delusion of grandeur is believing you a god or have special powers.

Answer 39

According to Jablensky sz is found in any nation at rate of about 1.4-4.6 per 1000. However the prevalence of sz is 1% of population. Overall there is no gender differences but males usually get it earlier than females do. The peak incidence for onset of sz is between 17-30

Answer 40

Involving disturbing and disorganised thought patterns. Includes loose associations which are disorganised/confused ideas and are incoherent when spoken. E.g. shifting from 1 subject to another like moving topic from holiday to dinner randomly.

Answer 41

Social withdrawal - Schizophrenic will not want to interact with other people. This could include not attending school

Answer 42

Characteristic symptoms - 2 or more of the following must be present for a significant portion of time during 1 month period: delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour and negative symptoms Social/occupational dysfunction - failure to achieve expected level of academic or occupational achievement Duration - disturbance must persist for at least 6 months. Must include at least 1 month of symptoms Substance/general medical condition exclusion - disturbance not due to direct physiological effects or a general medical condition.

Answer 43

To conduct a review of current research to study the relationship between neurotransmitters other than dopamine that could be implicated in causing schizophrenia, specifically glutamate

Answer 44

Used meta analysis and Reviewed various research including: findings investigating neurochemical levels in patients diagnosed with sz, drugs used to treat sz and drugs used to induce symptoms of psychosis. Looked at rodents and used PET scans

Answer 45

Low levels of glutamate is linked to development of psychosis symptoms, associated with increased dopamine levels. Glutamate failure in cerebral cortex = negative symptoms Clozapine is very effective at reducing dopamine

Answer 46

Schizophrenia may have different types that could be caused by abnormal levels of different neurotransmitters and not just dopamine.

Answer 47

Pop validity - Used meta analysis means large and varied sample reviewed such as impact of drugs on their psychosis and treatment. TF increasing generalisability and is representative Scientific - studies used PET scans when investigating neurotomical levels in sz patients which re very scientific. TF increasing validity o findings that low levels of glutamate links to high dopamine causing sz symptoms Practical application - No consent required

Answer 48

Secondary data - Carlsson doesn't know og hypothesis of studies he researched and may have been different to his. No way of knowing it produced valid findings on glutamate and dopamine relationship. TF lacks validity Anthropomorphic - Used rodents in research not humans. Publication bias - only publish results that fit hypothesis

Answer 49

Dopamine hypothesis suggests sz is a result of excess dopamine activity due to increased sensitivity and density of dopamine receptors (D2) Another NT thought to be involved is glutamate as low levels = higher dopamine activity which = sz. Increase in serotonin also linked to sz symptoms Too much dopamine in mesolimbic pathway = + symptoms, so increased activity can explain how hallucinations may occur when brain too active. Glutamate failure in basal ganglia also linked to + symptoms Too little dopamine in mesocortisol pathway = negative symptoms. Glutamate failure in cerebral cortex also linked to neg symptoms

Answer 50

If you have a second degree relative (aunt, uncle, grandparent) with sz the risk increases to between 2-6%. If you have a first degree relative risk increases to 6-17%. MZ concordance rates are a 48% chance you would both be diagnosed compared to 17% concordance rates between DZ Multiple genes thought to be responsible for sz, rather than one specific gene. Deletion of 22q11DS has been linked to a higher risk of sz Tiwari suggests rare gene variation of Xq23 has been linked to sz

Answer 51

Gottesman - reviewed 40 twin studies found 48% concordance for MZ and 17% for DZ and concordance rates for identical twins raised apart and together was very similar Tienari - adoption studies found when bio mother had sz 10.3% of adopted children had sz in childhood compared to 1.1% with no sz mother. Prac app Arinami - 22q11DS found in 0.3-2% of patients with sz. TF suggesting 22q11DS is linked to sz

Answer 52

Reductionist - only bio genetic factors not nurture like downward drift hypothesis. TF too simplistic Wahlberg - added to Tienari saying sz risk higher if adopted family was high in communication deviancy. TF suggesting influence of environment Used of twin studies - concordance rates are never 100% Torey - 8 studies with representative samples found concordance rates of 28% for MZ and 6% for DZ was much lower than Gottesman. TF ...

Answer 53

Higher incidence of sz in urban settings and in low social classes so those in this category are at more risk of sz William Eaton suggested city life is more stressful than rural life and long term exposure may make them more vulnerable to sz The prevalence of sz in immigrant population is higher due to language barriers, stress of moving and employability options Downward drift hypothesis says those with sz drift to lower class due to the difficulties of sz like attaining jobs and education

Answer 54

Anti-psychotic drugs are drugs which block the effect of dopamine by blocking dopamine receptors They can be either typical which strongly blocks dopamine or atypical which affects serotonin also One example of a typical drug is chlorpromazine which blocks dopamine receptors and has side effects of dizziness, dry mouth and blank facial expressions One example of an atypical drug is risperidone which balances levels of dopamine in brain and works on serotonin to control mood. Side effects of insomnia, severe anxiety and dizziness

Answer 55

Schooler - randomly allocated 555 sz patients to treatment of either haloperidol or risperidone and both showed 75% reduction in symptoms. TF increased validity Fast and effective - Fast and effective compared to CBT in treating sz. Drugs can reduce symptoms within couple of week suggesting cause is biochemical. TF effective for treating first episode of sz Pickar - compared clozapine with other neuroleptics and placebo to find clozapine most effective. Barlow and Durand - chlorpromazine is effective in reducing sz symptoms in about 60% of cases mainly positive symptoms.

Answer 56

Reductionist - reduces treatment to NTs like chlorpromazine and not social causes like social class/living conditions TF too simplistic Only treats symptoms not the cause - If they cease to take medication a lot of symptoms return. TF not effective therapy as need to be on it for rest of life unlike CBT Guo - high drop out rates across 7 different sz drugs ranging from 30% to 46.9% Side effects - large health side effects e.g. Clozapine causing drowsiness, blurred vision and troubled thinking.

Answer 57

Look at how CBT was used to treat a woman with sz including its effectiveness. Use CBT when drug treatment was previously preferred.

Answer 58

Carol a 26 year old white female

Answer 59

Bradshaw conducted a longitudinal case study of Carol, as it tracks Carols progress over 3 years of CBT Carols symptoms were measured on four scales: Psychosocial functioning was measured by a Role-Functioning Scale (RFS). Attainment of treatment goals was measured by a goal-attainment scale looking at how she was functioning. Hospitalisations were measured by the number of times in hospital. Development of a therapeutic relationship was also measured. Stage 1: Rapport developed – self disclosures from therapist used to build rapport over 3 months Stage 2: Understanding CBT – 2 months – coping mechanisms of stress taught using ABC model enabling her to understand emotions Stage 3: Treatment – Completed weekly activity schedule gradually increased activity & stress management techniques to reduce hallucinations.

Answer 60

At the end of the study Carol reported few symptoms and little distress. After 1 year, her RFS score was stable at 27 (she scored 6 at the start) symptoms. Pre test had 60 hospitalisations in last 3 months but post test was 0

Answer 61

CBT can successfully treat sz when changing automatic negative thoughts and changing responses to stressful situations.

Answer 62

Eco validity - Bradshaw documented Carols CBT sessions including her symptoms and the effectiveness of CBT. This was Carol’s genuine treatment and naturally occurring so in the natural setting Practical application - in knowing a 3 year course of CBT can considerably improve carols functioning we can use this to treat sz. TF improving quality of life for sz Confidentiality - true name of participant wasn't revealed only pseudonym Carol. TF is ethical as confidentiality wasn't breached Demand characteristics -

Answer 63

Pop validity - studied 26 year old middle class woman but only 1 person completed it. TF sample was unrepresentative of total sz population cant be generalised further as unique case. Reductionist - only considers role of cognition and how to deal with stress using meditation not bio like hormones. TF too simplistic Researcher bias - Carol and therapist built rapport which could lead to bias by therapist when reporting Carols symptoms Longitudinal - Over a long period of time (3 years) so other variables may have led to her improvements not just the CBT

Answer 64

Assumption of CBT when treating sz is that individual have irrational thoughts and beliefs about themselves and world around them. The aim is not to cure sz but allow patient to function normally Role of therapist is to accept patients perception of reality and to use it to help manage them. Sessions last 15-60 mins for roughly 2 months. Socialisation phase is where development of rapport takes place between sz and therapist. Disclose interests and problems to find common ground. Therapy phase understands CBT and focus on coping with stress via ABC. End phase is 3 months focussed on life without treatment. for homework they have to record beliefs and feelings.

Answer 65

Chadwick -studied 22 sz who heard voices and gave them 8 hours of CBT and all had reduced negative belies about how powerful the voices were. TF effective Empowers the schizophrenic - in control so they decide on goals they want to achieve and speed of progress. Bradshaw - concluded CBT can be successful in treatment of sz in controlling negative automatic thoughts and changing behaviour in response to stressful situations Long term

Answer 66

Time consuming and expensive Kingdom and Turkington - 30% deteriorate during CBT Bradshaw however - Case study so only one single unique case so not generalisable or representative Reductionist

Answer 67

Lack of understanding of one culture to another If clinician is from a different cultural background to patient some of their behaviours may be interpreted as abnormal when they aren't Malgady found the difference in hearing voices in costa Rica vs USA as in Costa Rica its interpreted as ancestors speaking to you and you will be admired but in US its a symptom off SZ. Littlewood and Lipsedge found cultural bias can lead to subjective interpretation as Rastafarian Calvin was arrested and seen as eccentric and abnormally behaved however normal in his culture. TF no universal definition of abnormal as definition is ethnocentric

Answer 68

When clinician and patient have different native languages and are using a common language which is less easy for one or both to understand during diagnosis May impact clinicians understanding of the symptoms if they description doesn't translate to the therapists native language. TF resulting in misdiagnosis or potentially no diagnosis

Answer 69

Illnesses with a set of symptoms found and recognised as an illness in only 1 culture leading to different diagnosis in other cultures. E.g. native americans tribes see symptoms of nightmares, obsession with death and loss of appetite is ghost sickness but this isnt recognised universally. TF misdiagnosis or no diagnosis if not recognised universally.

Answer 70

Leads do different diagnosis in different countries due to different beliefs about mental health disorder which leads to individual differences when diagnosing. Cooper examined 250 psychiatric admissions in NYC and London. DSM 2 found NYC schiz is 8x more frequent than bipolar but London was 1:1. TF same symptoms result in different diagnosis.

Answer 71

Marked anxiety or distress caused by obsessions and compulsions disturbing the persons behaviour

Answer 72

According to Grohol OCD tends to start in childhood or adolescence and affects males and females equally Ranked by the WHO as top ten most disabling illnesses in terms of impaired quality of life and loss of earnings National institute of health suggests in USA over 12 month period around 1% of population will have OCD and 50% of those being severe

Answer 73

Obsessions are recurring persistent thoughts, impulses or images that are experienced causing marked anxiety or distress Compulsions are repetitive behaviours or acts sufferers feel must be carried out to temporarily remove the distress caused by obsessive thoughts Excessive anxiety

Answer 74

According to this explanation, OCD is caused by problems in certain areas of the brain. The main brain regions where the problems have been found are: The Orbitofrontal cortex The Caudate Nuclei. The Thalamus The Cigulate Gyruis The four regions of the brain above form a circuit that coverts sensory information into thoughts and actions. It is dysfunctions in this neurological loop that is thought to be the cause of OCD. Each area is over active so must state when describing each region

Answer 75

Region responsible for decision making, converting any sensory information PET scans found this are for OCD patients brains to be overactive, increasing the conversion of sensory information to actions (behaviours) leading to increased worry/panic leading to obsessions E.g. initial panic of touching door handle

Answer 76

OFC sends message of panic/worry to the caudate nucleus. Is responsible for repetitive behaviours and focussing attention. Acts as a filter for messages between OFC and thalamus Caudate nucleus is overreactive so irrational messages of worry aren't filtered out. E.g. sends worry of touching door handle to thalamus

Answer 77

Respond to sensory and motor signals, carrying out necessary required action. OCD patients overreactive thalamus leading to behaviours that emerge as compulsions. Thalamus directs messages back to part of brain that can interpret them like cingulate gyrius E.g. washing hands after touching door handle

Answer 78

Focusses attention on emotionally significant events so emotional response to compulsion that has been created which will be relief from compulsion acted on However cigulate gyrius pass on relief message to OFC and dysfunctional neuronal loop will start again E.g. relief of hand washing

Answer 79

Menzies - when conducting brain scans of OCD patients there is less grey matter in orbitofrontal cortex, compared to healthy control group Max et al - When caudate nucleus is disconnected from orbitofrontal cortex in surgery OCD symptoms reduced McGuire - people with OCD were shown objects that bring on symptoms such as dirty clothes for cleaning compulsion activity increased in orbitofrontal cortex and caudate nucleus Feng - bred mice to show OCD symptoms. Anxious behaviour, when a certain gene is missing that is expressed in brain areas associated with planning and initiation of actions, showing a clear link to the formation of compulsions.

Answer 80

Feng However - Feng used mice to research OCD which is anthropomorphic. TF cant be generalised and unrep of human OCD Reductionist - only considers bio of overactivity of brain areas causing OCD. No nurture like life experiences leading to faulty cognition and compulsions. Cause and effect - Findings of overreactive thalamus linked to OCD has only been investigated after diagnosis so only correlational. TF reduced validity Sanematsu - Found differences in other brain areas in OCD patients like cerebellum. Tf not just isolated to parts suggested by neuroanatomical theory.

Answer 81

Assumptions of cog approach linking to OCD External factors/feedback Lack of confidence in memory Inflated sense of personal responsibility

Answer 82

Input-->Processing--->Output Hard wiring is the biology and programming is nurture and environment Hard wiring - predisposed risk Programming - traumatic experience causing the OCD

Answer 83

Faulty info processing stems from experiences within life Perceptions or thoughts we have about our experiences will trigger an emotional response which triggers behaviour to deal with the emotion. Pace et al suggested criticism from others is perceived as negative judgement and may lead to vulnerability that leads towards development of OCD

Answer 84

Salkovskis suggested OCD arises from having an inflated idea of ones own responsibility The sufferer overestimates the importance of their own thoughts and actions in respect of specific outcomes; leading to self blame if something does occur, so they see themselves as responsible for preventing harm to themselves and others Compulsions are self-fulfilling as they reduce anxiety but they reinforce ideas that thoughts are doing harm and so are repeated.

Answer 85

There is also evidence that memory systems might be impaired, either the OCD sufferer does not have the memory of doing a particular behaviour, or they do not trust the memory they have and so feel compelled to do the behaviour again. Sher et al found that people with OCD had poor memories for their actions, for example, they really could not remember if they had turned the light off.

Answer 86

Research of amphetamine users - control groups given amphetamine shown similar symptoms to sz as it increases DA in brain resulting in hallucinations Carlsson - brain scans showed sz patients given amphetamines release more dopamine than control. TF sz more sensitive to excess dopamine Wong - PET scans show greater density of dopamine receptors in unmedicated sz's than medicated. TF dopamine receptor density contributes to sz symptoms Seeman - increased density of D2 receptor in sz post mortem brains than non sz. TF D2 receptors linked to sz increasing validity Practical applications

Answer 87

Jackson - Reviewed various studies and found no consistent differences between levels of dopamine in untreated schizophrenics and control groups. TF cast doubt on role of dopamine Cause and effect - Excess dopamine activity is only measured in schizophrenics after they have been diagnosed with the disorder. TF, it is not clear if it is an effect or cause; reducing validity Reductionist - Only considers role of neurotransmitter dopamine in the role of the development of schizophrenia no social aspects like social causation. Carlsson - Carlsson also found low glutamate → high DA = high sz. Also, glutamate deficits in the cerebral cortex and basal ganglia can cause negative + positive SZ symptoms, respectively. Therefore, dopamine hypothesis too simple

Answer 88

Neale et al - found sz's occupy lower status jobs compared to their fathers. TF increasing validity of downward drift Harrison et al - Found that sz's show clustering in declining inner city areas. TF supporting downward drift Cooper - Rate of sz in unskilled labour workers was 4.1X higher that managerial workers. TF supports idea that coming from lower social class increases risk of developing schizophrenia. Immigrant groups show higher rates of schizophrenia - The 1991 and 2001 censuses show a higher incidence of schizophrenia in the Afro-Caribbean and Black immigrant population. This could be because migrant populations are in lower class with high stress. TF supports coming from ethnic minority increases prevalence of sz

Answer 89

Veling et al - found when immigrants were in neighbourhoods where their ethnic group didn't predominate there was a higher rate of psychotic disorders compared to ones where it did. Suggests social factors can affect the development of sz, not the cause. TF correlation only Kirkbride - Found rates of sz were lower for Afro-Caribbeans when they lived in ethnically-integrated neighbourhoods. Therefore, suggesting not all ethnic minorities that are at higher risk of developing the disorder. Reductionist - Only considers nurture and social setting like urban settings no biology like dopamine hypothesis. TF too simplistic Diathesis stress model - The diatheses stress suggests that schizophrenia is genetically predisposed, and will be triggered by environmental factors. Therefore, accounting for all explanations and the complexity of schizophrenia.

Answer 90

It is a method that identifies, analyses and reports patterns within qualitative data known as themes. Thus, it allows researchers to reduce data in a flexible way to produce a short summary of the main features of a data in which conclusions can be drawn from. According to Braun and Clarke there are 6 phases of conducting a thematic analysis. 1. Becoming familiar with the data. 2. Generating initial codes. 3. Searching for themes. 4. Reviewing themes. 5. Defining and naming themes. 6. Producing the report.

Answer 91

Qualitative data - Thematic analysis summarises large amounts of qualitative data collected from patients, yet still maintaining the richness and detail of what the patient has said through themes. TF valid themes produced to truly reflect patient’s experiences Clinicians use primary data - Clinicians use thematic analysis on data on patients that they have collected themselves, so it has not been interpreted or manipulated by other clinicians. TF data used from patients is a valid source of information on clinical disorders.

Answer 92

Researcher bias - Clinician selectively picks aspects of the data to focus on, and as the theory begins to emerge, focuses on only the aspects of the theory they are developing. TF theory is based on the subjective opinion of the clinician reducing validity Time consuming - Because the clinician will know their data best; they will need skill in order to establish codes and themes; whether to split, collapse or delete different themes when reviewing the data. TF not the most practical or cost effective research method available to clinicians.

Answer 93

Stekett et al - Found OCD patients scored higher on cognitive measures than people with anxiety disorders and correlation between OCD symptoms and dysfunctional thinking experienced. TF suggesting OCD is a consequence of faulty cognition Libby et al - OCD had higher scores than other groups regarding raised responsibility. TF supports the idea that guilt & faulty cognitions lead to OCD POTS - CBT alone showed higher effectiveness than SSRI, which helps show that CBT can help the symptoms of OCD. T/F, supporting cognitive explanations that OCD is caused by faulty thinking. CBT alone = 39.3% p'pants entered remission Drug alone = 21.4% p'pants entered remission Prac app

Answer 94

POTS However - Shows CBT and SSRI together have a higher effectiveness than CBT alone, showing other factors also influence symptoms of OCD. TF cog explanations not most effective method of treating OCD Rachman - Developed exposure and response therapy (ERP) which involves elements of flooding and training a person to experience a different response to their obsession. ERP is an effective therapy for people with OCD. TF suggests faulty cog not only factor of OCD Abramowitz - Suggests for average OCD patient cognitive therapy does not help any more than exposure and response therapy which is not a cognitive therapy, but a behavioural therapy. TF reduce validity of cog explanations as not only contributing factor Reductionist - only considers faulty cognition like life experiences no bio like over active thalamus

Answer 95

Anxiety is regulated by the brains GABA an amino acid that works at the synapses to lower physiological arousal and return the body back to a regular resting state There's evidence that low serotonin is linked to OCD symptoms so the majority of drugs used to treat OCD are anti-anxiety medication and target neurotransmitters associated with anxiety and OCD symptoms. SSRI's block reuptake of serotonin. Increases serotonin levels in synaptic cleft potentially alleviating symptoms of depression and anxiety. Beta Blockers block the effect of adrenaline reducing HR and blood pressure. Inhibit action of hormones do help decrease heart work load

Answer 96

Soomro et al - Used individual randomised trials using antidepressants for the treatment of OCD comparing SSRI's with a placebo showing drugs were more effective than placebo in reducing the symptoms of OCD. TF supporting drugs are effective treatment Stanford School of Medicine - suggests 40-60% of OCD patients respond to SSRIs or clomipramine, though it is not possible to know which patient will respond to which drug. TF drug therapy effective at reducing OCD symptoms Supporting research use randomised trails - p'pants randomly assigned to placebo, control or real drug condition so good as they don't know what category they in. TF there is a careful control group adding objectivity and credibility to findings, making them scientific. POTS - Combination initially measured at 23.8 but after 12 weeks 11.2. TF effective when used together with something

Answer 97

Koran et al - Some of the patients continued on sertraline while others were given a placebo. Found a relapse rate of 21% in those remaining on the drug and 59% on the placebo. TF drug therapy is not fully effective in treating OCD patients. Ravizza et al - Found SSRI drugs were not effective for 40% of patients with OCD. TF, drug therapy is not effective for all OCD patients. POTS study - found drugs most effective when combined with CBT rather than when used alone. There was 12.6 decrease in mean CY-BOCS score compared to 7 decrease alone. TF drug therapy is not a fully effective treatment alone and needs to be combined with other therapy to fully treat OCD. Side effects - SSRIs used to treat OCD patients can have large amounts of serious side effects. For example, fluoxetine has side effects of nausea, headaches, and dizziness, which could lead to dropout rates. T/F: Drug therapy cannot safely treat OCD patients without subjecting them to harm.

Answer 98

Works on the assumption that OCD suffers has irrational thoughts and beliefs in the form of obsessions and compulsions will help with these. Aim is to help identify why obsessions develop, challenge these and challenge the use of compulsions e.g. checking. Therapist challenges obsessive thoughts through questioning and providing coping strategies. Use ERP to expose to a situation that causes anxiety, create a hierarchy but will resist performing checking compulsions. Trained to monitor own anxiety levels. Socialisation phase – building a rapport with the therapist and the patient understanding their obsessions and compulsions. End phase - anxiety about relapse.

Answer 99

Balkom et al - Has suggest ERP is more effective than other treatments when treating CBT, with lower chance of relapse. TF is long term effective as relapse is reduce, so effective therapy for treating OCD. Whittal et al - found lower OCD related cognitions and less depression for the two treatment groups. However CBT did show larger changes than SMT on most OCD related cognitions. TF effective treatment for OCD. Ethical - OCD patient has control. Decide what to focus on in each session and how fast to progress. The diary also allows for reflections. TF empowered the OCD patients, reducing social control. POTS - Found that treating OCD using drugs alone lead to 21.4% of patients entering remissions. Therefore suggesting OCD have a biological cause as drugs therapy is successful, supporting the neuroanatomical explanation of OCD

Answer 100

POTS however - CBT alone led to greater reduction of symptoms compared to drugs alone with 39.3% of participant entering remission compared to 21.4% of drugs alone. Therefore cognitive therapy was more successful Cordioli - Claims that CBT is effective for about 70% patients with OCD, however the others do not respond to it. TF not effective for all cases of OCD Requires commitment - aim is to change the patients cognitions through challenging their obsessive thoughts which can take many sessions, ranging over many months. TF need to be committed and may have high drop out rates. Reductionist - only considers cognition no bio like neurotransmitters like serotonin. TF too simplistic

Answer 101

To investigate if CBT on its own is more or less effective than using SSRI alone.

Answer 102

Sample of 112 outpatients of children and adolescents aged between 7 and 17 years (average age 11.7 years) were recruited from those who had been diagnosed with OCD using DSM IV from USA

Answer 103

P'pants were screened on the severity of their symptoms using the CY-BOCS where only scores of 16 and above were included P'pants randomly selected into groups: drugs, CBT, placebo, both Each child had psychiatrist to monitor their progress Assesses initially to establish symptoms and anxiety Assessed them further at 4 weeks, 8 weeks, 12 weeks

Answer 104

97 completed All conditions showed improvements at 12 weeks as measured by CY-BOCS however placebo improvement was not significant In the CBT alone 39.3% entered remission 21.4% in drugs alone Combination initially measured at 23.8 but after 12 weeks 11.2

Answer 105

Combined treatment of CBT and sertraline was the most effective treatment. Study showed clear effect of CBT leading to higher improvement rate than drugs, suggesting that the first line of treatment should be CBT

Answer 106

Right to withdraw Practical applications - concluded combined CBT and drugs is most effective as mean CY-BOCS score decreased by 12.6. TF can improve patients life and benefit society Objective data - used Childrens Yale brown obsessive compulsive scale which provides quant data on their improvement of symptoms. TF no subjective interpretation and bias so reliable and valid Mundane realism - for an OCD patient receiving treatment is naturally occurring as is something they would have done in everyday life. TF naturally occurring and representative and can be generalised to everyday OCD behaviour.

Answer 107

Temporal validity - Study on CBT and SSRI treating uses DSM4 but the up to date is DSM 5TR. TF findings om CBT alone causing 39.3% remission are not relevant so reduced validity Pop validity - All 112 students were from 3 universities across America meaning it was ethnocentric. TF unrep and cant be generalised Demand characteristics - Recruited from a volunteer sample from 3 US universities meaning they may have known what the study was about and not shown true behaviours. TF findings may not be valid Deception - Placebo group thought they were actually getting treatment. TF breached ethics

Answer 108

A meta-analysis is a form of secondary data, where a researcher combines the findings from multiple studies about the same topic and analyses theses as a whole If a number of studies separately find the same answer, and then those studies are analysed together the answer becomes stronger as the studies support one another For example, if one study finds that being overweight means less likelihood of developing dementia and other studies have found the opposite, then it might be worth conducting a meta-analysis of current research to see what the overall findings suggest

Answer 109

Find trends data - As multiple studies are analysed this allows trends/relationships to be found in symptoms, therapies of issues generated by clinical disorders studied so the statistical result is larger than the result of the single studies Large sample size - The meta-analysis combines findings and so ensures that a larger sample is generated to draw clinical conclusions from. Furthermore, some studies can be from different cultures allowing universality of a disorder to be found

Answer 110

Secondary data - The studies a meta-analysis draws on are unlikely to be identical in their hypothesis. Collating findings of patients from different studies together needs careful decision making to make sure that the data can be compared. Publication bias - A meta-analysis only uses published studies, meaning unpublished studies on patients are not used. This can distort the findings of the meta-analysis, as studies that show negative or non-significant results are less likely to be published

Answer 111

Longitudinal designs follow the same participants who are suffering from a clinical disorder over a long period of time. Used to study how a person’s symptoms of a disorder develops over time Detailed data on a participant’s symptoms is collected at the onset then collected at different intervals throughout the study Often researchers will use triangulation, so a range of methods such as observations, interviews and experiment. Often do not manipulate the IV, this is because one of the aims is to see how the disorder develops over time, so the researcher does not wish to interfere with the behaviours observed to make it unnatural

Answer 112

Study individual with clinical disorder over time - Track same patient over time, so not just a snapshot of clinical disorder allowing long term effects to be examined, E.g. long term effect taking part in therapy has had. TF this produces in-depth detailed data on the patient’s clinical disorder increasing internal validity Control over participant variables - Factors such as personality and backgrounds are minimised as the same patients are used so participant variables such as the type of compulsions someone has, or the delusions someone believes, are minimised from affecting outcomes. TF reducing confounding variables and increasing the internal validity of the clinical disorder data

Answer 113

Lack of control of extraneous variables - Tracking patients over long period of time means number of possible variables that can influence and change their experience of their disorder, and not just the aspect the researcher is considering. TF hard to establish cause and effect, reducing the internal validity. Time consuming - The same patients are tracked over a long period of time. This takes the researchers a lot of time and resources to complete. TF not an economical or practical method to use.

Answer 114

Unlike longitudinal designs, cross sectional designs collect data from one moment in time, providing a ‘snapshot’ of the researched clinical disorder. Cross-sectional designs study different groups of people at the same moment in time and compares data collected from these. The participants are tested once, usually to find a simple relationship between one variable and another. The difference in people is what will be of interest. E.g. if a clinical psychologist was interested in severity of schizophrenic symptoms in age, 3 groups of schizophrenics could be used: one group at 16-20 years, one group of 21-30 years and a final group of 31-40 years. Then comparison can be made about what each groups symptoms are and the severity of them

Answer 115

Practical method - provides a useful way of studying a population that might take a long time to study naturally, and can be done in a short spec of time. TF an efficient method to use to study a clinical population to be able to draw meaningful conclusions. Economical compared to other methods (longitudinal) - As opposed to longitudinal research, the researcher sets up the study, gathers the data and writes up the findings and moves on. TF compared to longitudinal research reduced cost of research

Answer 116

Findings may be distorted by the cohort effect - The study looks at different people at the same moment in time and those people will belong to a different cohort. This could generate extraneous variables that influence the DV being studied. For example, females are more likely to seek medical help then men, therefore if the different cohorts being studied are females and males, and gender of participants could influence the findings and not the IV being studied. TF cause and effect cannot be established, reducing the internal validity of cross sectional research. Snapshot of patients with a clinical disorder - as this method only studies that with clinical disorders at one moment in time it is unlikely to include any historical information about a patient, and do not gather any future information about the patient. TF this is not a useful method to see the course of a mental disorder, or how it began, what might have caused it, or how a treatment might work for an individual, thus providing limited data

Answer 117

Cross cultural research is used to gather detailed data to investigate the similarities and differences in behaviour thoughts and attitudes regarding mental health disorders between different cultures. The cross cultural research uses participants from a range of different cultures rather than participants from the same culture to get a more holistic idea of how mental health disorders are perceived. Cross cultural research on mental health disorders aims to move research away from the focus on western, educated, rich democratic cultures. A variety of research methods could be used within research across different cultures such as experiments, interviews and questionnaires to assess cross-cultural differences.

Answer 118

Allows psychologists to determine if clinical disorders are universal - Comparisons are made between cultures to build a full body of knowledge on clinical disorders. For example, if schizophrenia is diagnosed using the ICD-10, which is used in many different cultures and countries, then knowing that schizophrenia is found universally is important to aid diagnosis. Cross cultural designs can use scientific methodology - When looking for the universality of behaviours the procedure used across cultures will generally be standardised. The same study using the same tools can be used in different cultures, and provided controls remain the same, similarities in findings can be attributed to similarities between the cultures

Answer 119

Understanding of procedure could differ between cultures - Procedures are developed within one culture to research that certain culture. It could be that there could be misunderstandings between cultures on conducting the procedure. For example, 6 session of CBT may be delivered different in westernised compared to Eastern cultures. Ethnocentric – etic research - Etic research universal behaviours by taking an aspect of behaviour/research and comparing cultures to see if there are similarities. However, these behaviours are generally defined in one culture and applied to all in comparisons. The main diagnosis criteria are taking from the DSM in western cultures, whereas the ICD is used more universally

Answer 120

Should clinical disorders be treated in mental institutions

Answer 121

Clinical institutions are specialised healthcare facilities that focus on providing patient care, conducting clinical research. They use psychotherapy, medication, hospitalisation, and support groups. Clinical disorders are treated to alleviate symptoms, improve functioning + enhance overall quality of life. Clinical institutions are able to monitor everything. Being sectioned is being admitted to hospital whether or not you agree under mental health act. Being treated in a clinical institution could be an issue due to stigmas and discrimination from people towards those in clinical institutions, also issues of social control where the doctor has power over them, as they have no free will

Answer 122

Drug treatment X2 CBT X2

Answer 123

+ Bradshaw: Case study so cant geberalise to all cases + Vallentine: Over 50% of the 21 completing patients found improvements in behaviour from group work and clinical interviews and gathered quotes like "it gave me peace of mind" and made them feel guilty. + Chadwick - 22 sz patients did 8 hours of CBT in clinical institution and all decreased negative belief about power of voice in head + Requires clinician to monitor drug treatment

Answer 124

- Bradshaw - Carol took CBT outside clinical institution and found Pre test had 60 hospitalisations in last 3 months but post test was 0 - Rosenhan - Rosenhan found that the pseudo patients were depersonalised; had no privacy(doors removed from toilet) and not listened to, and often ignored by the staff, with 71% of psychiatrists totally ignoring questions asked - POTS - outpatients took CBT and drugs with CY-BOCS 23.8 but after 12 weeks 11.2 outside institution - Carlsson - Found clozapine to be a highly effective drug with few negative side effect sin treating schizophrenia

Answer 125

Malgady - costa Ricans hearing voices is good and admires as ancestors talking to you and in US voices are sign of sz Cooper - UK compared to US UK 1:152 for bipolar, USA 8:1 in favour of sz Culturally bound syndrome Spiritual model

Answer 126

High N individuals are prone to mood swings and stress and easily feeling anxious and have also been linked to sz High E are outgoing and crave excitement and absence of this has been linked to sz Means sz personality is neurotic introvert

Answer 127

P added to E+N: Eysenck added psychosis as breaks from reality rather than inability to feel empathy. TF weakens construct validity of personality theory explaining individual differences for sz No cause and effect - people with sz struggle to maintain social relationships and suffer negative symptoms which may present as mood swings so not a result of N. TF personality differences doesn't explain sz

Answer 128

Van Os & Jones - 5362 sz patients aged 16 were found to have increased risk of sz if scored high for N Birantes - Vidal et al: Showed N predicted positive sz symptoms

Answer 129

To investigate if the attitudes of staff towards patients in mental health institutions have changed over time

Answer 130

IV - Time 1940’s, 2010’s DV - Attitude of staff in mental health institution towards patients (positive or negative)

Answer 131

Extract transcribed from: BBC documentary first shown in 2011: A history of the Madhouse Extract transcribed from: BBC documentary first shown in 2013. episode 1: Don’t call me crazy.

Answer 132

Using previous research operationalised positive and negative attitudes so we had coding units Used the key word list and counted the number of times these appear in the sources chosen. Did a separate table for each source and then combine the quantities at the end. Read each source, highlight any comments related to attitudes and practices of clinical institutions, focusing on your keywords you have identified, but also highlight any other mentions of practices of interest. At the end of each article, write a summary of your findings, this will make it easier to draw conclusions at the end

Answer 133

Results show the mot negative category words in "don't call me crazy" with 'harm' appearing 4 times(compared to none in other 2) Results also show most positive category words tied between 2dont call me crazy" and "mental hospitals treat patients like prisoners" both having 4 positive words overall the most common being 'happy'

Answer 134

Rosenhan would argue that patients are treated negatively as the pseudo patients were often ignored by staff with 71% of psychiatrists ignored questions they were asked. This is supported by my content analysis as attitudes have become more positive overtime. Vallentine would argue that patients are treated positively as over 50% of patients reported improvements in self esteem after group therapy. This is supported by my content analysis as attitudes have become more positive over time.

Clinical psychology Flashcards

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