clinical psychology Flashcards
(132 cards)
1
Q
diagnosis definition
A
involves a clinician assessing a patient, deciding whether they show evidence of a mental disorder, and if so, whether the symptoms match those in the checklist of the features + symptoms of the mental disorder normally listed in the DSM + ICD
2
Q
Deviance
define
e.g
eval
A
define: behaviours/emotions that are not in the norm of society
e.g- paedophillia- sexualised thoughts about young children
X- REDUCTIONIST- ignoring how a person feels abt their deviant behaviour… they may enjoy social isolation
X- can change across time (homosexuality)
3
Q
Dysfunction
define
e.g
eval
A
define: behaviours that interfere with a person’s everyday life
e.g- being unable to work, insomnia
X- researcher bias + subjectivity - one clinician may diagnose and another wont, decreasing reliability
X- on its own it does not take into account reasons for dysfunction like social isolation due to grief
4
Q
Distress
define
e.g
eval
A
define: the extent to which a person perceives their own negative behaviours as upsetting
e.g- crying, panic attacks
X- not a universal feeling felt by all (restricting diet)
X- subjective , decreasing reliability especially cross culturally
5
Q
Danger
define
e.g
eval
A
define: refers to danger to others or to the individual themselves
e.g- suicidal thoughts/ self harm
X- subjective: some ppl like to skydive
X- reductionist: how a person feels about their dangerous behaviour
e.g adrenaline junky, enjoys skydiving, form of catharsis
6
Q
Strengths for 4Ds AO3
+ weakness
A
all 4 Ds have practical application when diagnosing mental disorders
all 4Ds have internal validity of DSM diagnosis for mental disorders as a ‘checklist criteria’ can be applied when diagnosing
All 4Ds can be measured using quantitative data- objective measure, increasing reliability
Considering all 4Ds might help avoid errors
weakness- 5th D?? Duration = length of time a person has had the symptoms before making a diagnosis
REDUCES CREDIBILITY
7
Q
DSM-V AO1 (2013)
A
aims to coincide with the ICD to avoid confusion with having more than 1 universal classification system
-NO LONGER MULTI-AXIAL SYSTEM
(instead there are 3 sections)
1- Introduction and explanation of changes) =guidance on how to use
- Diagnostic codes taken from ICD-9 in attempt to ‘harmonise’ the 2 systems
e.g= Sz, OCD - Emerging measures + models, self assessment by patients, cultural issues
suggestions for new disorders
e.g= internet gaming disorder is not fullt accepted as a clinical disorder
8
Q
ICD-11 (2019) AO1
A
used to monitor incidence, prevalence, morbidity
-used by the WHO
-includes ALL illnesses not just mental health disorders
-Sz code = 6A20
9
Q
DSM vs ICD differences
A
DSM- Mental health conditions
ICD- All conditions
DSM- 3 sections using ICD-9 codes to harmonise the 2 systems
ICD- 26 categories, section 6 is related to mental health
DSM- US dominated, only in English
ICD- monitors ALL incidence, prevalence + morbidity of disorders
DSM- DSM-5 Field trials were a significant test of reliability and validity
-change in language to attempt to remove stigma
ICD- Regular revisions + updates which remove and newly define disorders
10
Q
Strengths of DSM
A
- reflective of social change
-more tolerant ( removed offensive terms) e.g- ‘mental retardation’ = ‘intellectual disability’ - removal of unnecessary diagnosis
11
Q
Reliability definition
A
consistency of diagnosis when using classification systems
12
Q
Inter rater reliability definition
A
2 of more clinicians in agreement, same diagnosis
13
Q
intra rater reliability definition
A
consistency of clinical diagnosis given by the same psychologist at different times
14
Q
test- retest reliability
A
focus on DSM field trials, same patient observed separately by 2 psychologists within a specific time period
15
Q
Summary of the DSM-5 field trials
A
designed to evaluate TEST- RETEST reliability in US + Canada
The criteria for 23 diagnosis were tested
Each patient was interviewed twice by 2 different clinicians using the DSM-5 criteria
16
Q
Strengths DSM Reliability AO3
A
Brown et al- Found good reliability in clinical diagnosis using DSM-4 in 1127 outpatients. Good to Excellent consistency for most of the DSM categories foe generalised anxiety and mood disorders
Stood the test of time- Despite the revisions, it is still one of the most widely used classification systems in mental health
fine-tuned previous diagnosis e.g: ‘Eating Disorder’ became ‘Binge Eating Disorder’, more specific and reliable enabling clinicians to come to a common diagnosis
Cross-Cultural diagnosis-
DSM-5 gets rid on ‘culture bound syndromes’
increased multi-cultural perspectives
makes new conditions known outside the US
e.g ADHD is now recognised in the UK
17
Q
Weaknesses DSM Reliability AO3
A
Spitzer et al KAPPA
DSM-5 field trials only show 5/23 diagnosis to be very good (reliability of Sz low as kappa score is 0.46), below 0.6 is concerning
Cooper et al CULTURE
Showed British and American Psychiatrists the same videotaped interview and asked them to make a diagnosis
American= Sz
British = depression
Buckley et al COMORBIDITY
ppl who suffer from 2 or more mental disorders… hard to diagnose just one
Loring et al GENDER BIAS
found that some behaviour is regarded as psychotic in males but not psychotic in females
(gender and cultural bias in diagnosis of Sz… men more likely to be diagnosed)
18
Q
Stengths ICD Reliability AO3
A
- Open access, free online
-ALL illnesses
-Diff cultures
-Jakobsen et al: 100 Danish patients with a history of psychosis was assessed + concordance rate of 98% was obtained. High reliability using up to date classification
-Ponizovsky et al: Compared the reliability of the ICD 9 + 10 systems (in 3 diff years)
Positive predictive value (PPV) was used to measure the reliability of diagnosis
reliability increased each year w PPV score
19
Q
Weakness of ICD Reliability AO3
A
Nicholls et al
found low agreement with other classification systems like the ICD-10 which showed 36% agreement for eating disorders
-suggests reliability of classification systems is a universal problem and not limited to the DSM
20
Q
Internal validity definition
A
The extent to which psychologist are measuring what they intend to measure
e.g- establishing cause and effect between the symptoms and behaviours exhibited by the patient + clinical diagnosis
21
Q
Predictive validity definition
A
When the expected result matches the actual result
22
Q
Concurrent validity definition
A
When the 2 tests conducted at the same time focusing on the same clinical condition produce the same results
23
Q
Construct validity definition
A
How far the constructs (e.g-symptoms) that are being measured, represent the mental diagnosis
24
Q
Strengths of DSM Validity AO3
A
-Becks Depression Inventory
measures core symptoms of depression summing up to a depression score
this means that cause and effect can be established between a person’s symptoms and self-report scale so a suitable diagnosis and treatment plans can be made
-Keenan et al: supports predictive validity
results showed good predictive valitity for 134 twins with construct disorders in clinically referred preschool children
results showed 60% of preschoolers diagnosed with CD met the criteria for the same disorder at a follow up
-Robins + Guze:
proposed 5 formal criteria for establishing validity of clinical diagnosis and found ‘good prognosis Sz’ is a diff illness to Sz.
This resulted in the distinction between the 2 listed in DSM-3
-Kendler:
differentiated validators into concurrent (e.g: psychological tests) and predictive (e.g treatment response)
This distinction helped classify Delusional Disorder as separate from Sz
25
Weaknesses of DSM Validity AO3
RD Laing:
suggested Sz is just another way of living
Liangs Rumpus Room exp saw 12 patients with Sz improve and were discharged after 18 months but all were REHOSPITALISED within a year
OVER MEDICALISING:
It is argued that the diagnosed should fit the patient, but the DSM-5 tries to make the patient fit the diagnosis
-can lead to type 1 false positive errors
BULLUCK
argues that the DSM-5 lacks specificity + sensitivity due to its failure to incorporate neuroscience and biology, limiting its validity as a diagnostic manual
26
what is Sz?
a 'psychotic disorder' involving the loss of contact with reality and characterised by 'episodes' of hallucinations and delusions.
it has no single cause: an epigenetic process caused by the interaction between geness and a range of environmental factors like drugs, social deprivation and poverty
27
FEATURES of Sz
AO1
-Sz affects approx 24 million people worldwine
-onset of psychotic episodes = late adolescence to min 30s
-men have symptoms at an earlier age than females
-Sz patients are 2-3 times more likely to die earlier due to Cv diseases
-Prevelance is about 1%
-POSITIVE symptoms can be overcome but negative symptoms remain
-adolescents with psychotic symptoms are 70x more likely to attempt suicide
28
POSITIVE SYMPTOMS of Sz
= the addition of a behaviour which is not normally present
HALLUCINATION: false perceptions affecting out senses causing patients to hear voices, see imaginary, taste, smell things that do not exist
DELUSIONS: false belief of events and their significance. ppl may be paranoid that someone is trying to harm/manipulate them or ppl may believe they are famous or wealthy
THOUGHT INSERTION: patients believe their own thoughts have been implanted by another person
DISORDERED THINKING- patient finds it hard to organise their thoughts in a logical order which makes sense
29
NEGATIVE SYMPTOMS of Sz
=absence of a behaviour which is usually present
FLATNESS OF EMOTION- emotionless facial expressions + flat tone of voice
AVOLITION- lack of motivation and no energy to do daily activities, no pleasure in everyday life
SOCIAL WITHDRAWAL- avoiding fam + friends, not socialising
POVERTY OF SPEECH- person replies in as few words as possible
30
Diagnosis medical model of Sz
Sz is diagnosed using lists of symptoms to classify the 'mental illness'
characterised by patient suffering psychotic episodes, during which symptoms become v severe and prevent normal functioning
31
Sz DSM DIAGNOSIS DEFINITION
mental illness diagnosed by a patient experiencing 2 (or more) of the symptoms each present for 1-6 months
32
5 types of Sz in DSM-4
PARANOID- suspicion of others, delusions
DISORGANISED- speech hard to follow, moods
CATATONIC- little body movement, socially isolated
RESIDUAL- low levels of psychotic symptoms present
UNDIFFERENTIATED- patient does NOT fit any category above
33
what is the OG dopamine hypothesis of Sz
proposed Sz patients have an INCREASE in D2 receptors in their brains which has now developed to include specific brain regions: mesolimbic and mesocortical
34
Positive symptoms of Sz neurotransmitter explanation
caused by HYPERDOPAMINERGIC activity in the synapse of the MESOLIMBIC pathway
mesolimbic pathway- neuronal connections from the VTA to the NA and limbic system
35
Negative symptoms of Sz neurotransmitter explanation
caused by HYPODOPAMINERGIC activity in the synapse of the MESOCORTICAL pathway
mesocortical pathway- neuronal connections from the VTA to the prefrontal cortex
36
GLUTAMATE hypothesis of Sz
proposes that dopamine is not the only neurotransmitter associated w Sz
instead, the excitatory neurotransmitter GLUTAMATE binds to the NMDA receptors which regulates Dopamine activity
GLUTAMATE LOWERS DOPAMINE LEVELS
37
SEROTONIN hypothesis of Sz
INCREASED SEROTONIN binding to 5HT2A receptors on glutamate neurones causes a DECREASE IN GLUTAMATE release in the VTA
this activates the MESOLIMBIC pathway and causes an EXCESS OF DOP RELEASE
therefore positive symptoms
38
AO3 neurotransmitter explanation of Sz
SUPPORTING
CARLSSON et al
found that dop,ser and glut are all implicated in the development of Sz
PET SCANS
neurotransmission can be measured objectively using quantitative data so increased internal validity
APPLICATION
drug treatments have shown to be an effective way of controlling symptoms so people with Sz can live in community without residential care
PCP (angel dust) and KETAMINE are NMDA receptor agonists which inhibit glutamate activity, resulting in Sz
these hallucinogenic drugs are used for min-altering effects causing hallucinations
39
AO3 neurotransmitter explanation of Sz
REFUTING
CARLSSON et al
use PET scans which have LOW ecological validity and are subject to demand characteristics
DEPATIE ET AL
found that giving ppl drugs to increase dopamine DOES NOT create Sz symptoms
CHALLENGES HYPERDOPAMINERGIA
BIOLOGICAL REDUCTIONIST
simplistic and incomplete, ignores cog process, genes, environmental factos
e.g poor family functioning in childhood
CLOPAZINE
is one of the most effective drugs for treating Sz, but this only affects SEROTONIN levels, not dop or glutamate
40
Sz is thought to be POLYGENIC. what does this mean
lots of different genes contributing to increased risk of developing Sz
41
what is C4 gene
involved in SYNAPTIC PRUNING (a natural process during adolescence, to REMOVE EXCESS symaptic connections and to prepare for new neuronal connections)
EXCESSIVE PRUNING = SYMPTOMS OF SZ
42
COMT GENE
provides instructions for the creation of an ENZYME, which BREAKS DOWN neurotransmitters like DOPAMINE in the prefrontal cortex
DELEtiON OF COMT GENE- poorly regulated dop levels = Sz symptoms
43
DiGEORGE SYNDROME
22q11.2
DELETION syndrome
= a gene mutation resulting in the phenotypic expression of Sz
LOWER IQ
1% of schizophrenics have this
44
AO3 for GENES explanation of Sz
SUPPORTING
TEST MICE
w increased levels of C4 activity lost more brain cells as they matured
this explains why Sz symptoms appear during adolescence and way Sz brains have a LOWER VOL.
APPLICATION
due to increased understanding of genetics, this has been used to inform GENETIC COUNSELLING after Sz diagnosis, psychiatrist can calculate 'reacurrance risk' so the family can be aware if Sz is heritable
HESTON
found Sz diagnosis in control group was 0% and w Sz biological mother was 10.6%
showing genetics play an impact
GOTTESMAN AND SHIELDS
MZ= 75% concordance
DZ= 22% concordance
45
AO3 for GENES explanation of Sz
REFUTING
GENERALISABILITY
humans have a more complex CNS than mice
TWIN STUDIES
small sample size, unrepresentative
GOTTESMAN AND SHILEDS
MZ twins have 75% concodrance not 100% so cant be entirely based on genes
46
what are the 4 social factors affecting Sz
SOCIAL ADVERSITY
SOCIAL ISOLATION
URBANICITY
IMMIGRATION
47
SOCIAL ADVERSITY as a social cause of Sz
growing up in environments affected by the following can make people vulnerable to mental health disorders:
-unemployment
-poverty
-stress
-poor living standard
-low economic status
they may have less access to treatment for these reasons
48
URBANICITY as a social cause of Sz
EATON- City life is more stressful than rural life
-noise
-fast pace of life
-anonymity
-competition
long term exposure to these stressors could make a person vulnerable to Sz
49
SOCIAL ISOLATION as cause of Sz
FARIS- people with Sz withdraw from contact with others to avoid stress
this self imposed isolation cuts the individual off from getting feedback about what behaviours/thoughts are innappropriate
they begin acting strange as there is NO CORRECTIVE FEEDBACK
50
IMMIGRATION as a cause of Sz
1st and 2nd immigrants are more vulnerable to Sz than the general population
however, this risk decreases when the no. of people from the same ethnic group increases- BOYDELL
this shows outgroup status is more of a risk than belonging to an ethnic group
-2nd gen immigrants may be at GREATER RISK due to WEAKER CULTURAL IDENTITY
-because they fit in with the norms of the general population, they may CLASH with their family about beliefs + expectations which causes STRESS
51
AO3 SOCIAL cause of Sz
SUPPORTING
VASOS ET AL
meta-analysis of 4 studies in SWEDEN, DENMARK and the NETHERLANDS including 24000 cases of Sz
-they found a sig correlation between URBAN DWELLING and Sz
(risk is 2.37x higher than rural environment)
APPLICATION
the social causation PROMOTES COMMUNITY SOLUTIONS ( like housing projects to reduce overcrowding and enhance cohesion) this can foster a collective social responsibiliy
52
AO3 SOCIAL cause of Sz
REFUTING
INCOMPLETE EXP
does not consider biological or genetic explanations
DATA IS CORRELATIONAL NOT CAUSATIONAL
-the Social Drift Hypothesis suggests that people with Sz may drift to a lower social class than their familites due to their inability to hold a job
-this can lead them to migrate to poorer areas.
So in this case, Sz would lead to urbanicity
53
ANOREXIA FEATURES
AO1
-multifactorial eating disorder, involving biological, psychological, development factors
-age of onset = 10-19 years old
-1.25 million people suffering in the UK
- affects 5% of girls and woman in the UK
-more woman affected than men (10:1 ratio) but men are more likely to be underdiagnosed
-an estimated 10-20% of anorexia sufferers die from cardiac arrest of suicide
54
ANOREXIA SYMPTOMS
A- limited calorie intake + ritualistic food habits
B- intense fear of gaining weight: excessive exercising, laxatives
C- distortion of body image
PHYSICAL- exhaustion, insomnia, feeling cold
PSYCHOLOGICAL- co morbidity w depression, social withdrawal
HEALTH RISKS- Osteoporosis (lack of vit D and calcium)
-kidney damage
-Anaemia ( low iron levels)
-Amenorrhoea (infertility)
55
BIO cause of ANOREXIA
(Brain Abnormalities)
AO1
LH and VMH function as the 'weight thermostat'
Lateral Hypothalamus = hunger centre
when LH is stimulated, ppl feel hungry so EAT
Ventromedial Hypothalamus= full centre
when VMH is stimulated people feel full so STOP EATING
LESIONS in LH and VMH cause abmormal neurone signalling
LH LESIONS- rats lose appetite so dont eat
VMH LESIONS- rats will continue to eat = obsesity
56
BIO cause of ANOREXIA
(Brain Abnormalities)
SUPPORTING
THORNHILL AND SAUNDERS
investigated anorexic affects of VMH and LH injections in food deprived rats uding NALOXONE
-these rats that recieved these injections ATE LESS than those given saline, showing that the VMH and LH regions of the brain help regulate diet + dysfunctions can lead to anorexia
WHITING
conducted a review of studies for human DEEP BRAIN STIMULATION (DBS) treatment in anorexia
- the largest trial, involving 16 human patients undergoing DBS in the VMH and LH regions showed significant IMPROVEMENT in BMI
57
BIO cause of ANOREXIA
(Brain Abnormalities)
REFUTING
THORNHILL AND SAUNDERS
experiments used MICE, have diff CNS to humans so cant be generalised
BIOLOGICALLY REDUCTIONIST
simplistic and incompletes
ignores the role of genes, cog, environmental factors
58
NON BIO cause of ANOREXIA
AO1
SOCIAL LEARNING THEORY
behaviour is learnt from the environment through observation and immitation of others'behaviours
ATTENTION
RETENTION
MOTOR REPRODUCTION
MOTIVATION
role model- status, influentials
vicarious reinforcement- learning through observation of the consequences of others behaviours
e.g: observing a role model being rewarded by 'likes' on social media for exercise routines
59
AO3 NON BIO cause of ANOREXIA
SUPPORTING
BANDURAS BOBO DOLL EXP
boys copied 25.8 aggressive acts from male role model
girls copied 5.5 aggressive acts from female role model
BECKER ET AL
EAT 26 scores increased from 12.7% in 1995 to 29.2% in 1998 for female adolescent patients who also felt that TV content had influence their own body image in a negative way
DANE
systematic review of research on social media use and body concerns
-evidence from 50 studies in 17 countries indicate that social media leads to body image concerns, ED;s and poor mental health
60
AO3 NON BIO cause of ANOREXIA
REFUTING
SOCIALLY REDUCTIONIST
ignores genes, neurotransmitters and brain regions
GYNOCENTRIC EXPS
becker used an unrepresentative sample size of FIJI ADOLESCENT GIRLS (age 17
not generalisable
ALTERNATIVE EXP
Bailar et al: found a neurotransmitter imbalance in AN sufferes (increased dop and decreased ser)
Lopez et al: observed higher D2 and D3 receptors in the restrictive type of AN
61
Sz BIOLOGICAL TREATMENT
ANTIPSYCHOTICS
how do they work
a biological treatment which functions by ALTERING BRAiN CHEMISTRY
-they function by blocking dopamine receptors and reducing the activity of dop
-administered through TABLET and SYRUP form
- can be injected (2-4 weeks)
1st gen only blocks dopamine
62
Typical Antipsychotics AO1
-around since the 1950s and include CHLOROPROMAZINE
-this can be taken as either syrup, tablet or injection
-if taken orally, administered daily up to max 1000mg
-BUT initially smaller and dosage gradually increased to 400-800mg
63
Atypical Antipsychotics AO1
2nd gen block both DOP AND SER
-around since the 1970s and include CLOZAPINE AND RISPERIDONE
-2nd gen is aimed to maintain or improve upon the effectiveness of drugs in suppressing the symptoms of psychosis and to MINIMISE SIZE EFFECTS
64
CLOZAPINE AO1
daily dosage = 300-450mg a day
-clozapine binds to DOP, SER, GLUT
-NOT available as injections
-helps to improve mood, reduce sleep and anxiery
-MOOD ENHANCING effects so good to be perscribed when patient is considered high risk of SU!cide
65
RISPERIDONE AO1
-aimed to have NO serious side effects
-can be taken as a tabet, syrup and injection
-small initial dose and built up to daily dose of 4-8mg
-Risperidone binds strongly to dopamine receptors than clozapine
therefore risperidone is more effective in smaller doses
66
AO3 ANTIPSYCHOTICS as treatment for Sz
SUPPORTING
1st gen
-deemed to be more ethical than past methods (electroconvulsive therapy) so allows patients to integrate into society instead of being institutionalised
QUICK FIX
EMSLEY
78% of newly diagnosed Sz patients administered RISPERIDONE and had at least 50% reduction in symptoms of Sz
MELTZER ET AL
Sz patients administered Haloperidol or a placebo for 6 weeks
-results showed sig improvements in all areas of functioning for experimental group suggesting GEN 1 antipsychotics work
67
AO3 ANTIPSYCHOTICS as treatment for Sz
REFUTING
ROSA ET AL
an average of only 44% of patients complied with taking antipsychotic drugs
NON ADHERANCE occured because patients lacked knowledge abt their disordered
HARTLING ET AL
meta-analysis of 144 studies comparing the efficacy of 1st and 2nd gen antipsychotics found FEW DIFFS in core symptoms + inconclusive benefits of 2nd gen being better than first
68
AO1 NON BIO treatment of Sz
CBT
humanistic therapies, such as person-centered counselling looks at how the CORE of the person ca be at odds w self concept
CBT is based on the ABC model of Cognition, Emotion, Behaviour and Consequence
Cog therapies focus on maldaptive thinking + how these can be readjusted through counselling
69
what is ELLIS's ABC model (part of CBT)
it identifies irrational beliefs + persuades the patient to challenge and modify the false beliefs
client writes down the:
1. ACTIVATING EVENT which has led to high emotional response or negative dysfunctional thinking
2. BELIEFS + negative thoughts
3. CONSeQUENCES- the negative emotions that are caused by this event
70
outline CBT (treatment of Sz)
how many sessions etc
5-20 sessions
group therapy can be used
coping strats (meditation)
involves HW e,g: diary
POSITIVE REINFORCEMENT can be used
71
AO3 NON BIO treatment of Sz
CBT + AN
STRENGTHS
-NO SIDE EFFECTS
-ADDRESSES UNDERLYING CAUSE
- Freuds ideas support the role of psychological treatment like CBT to reduce depression symptoms by talking about early childhood experiences
-LESS REDUCTIONIST as it considers how the person feels and their relationships
NICE
- meta-analysis showed CBT reduced hospitalisation rates for up to 18 months and reduced Sz symptoms
72
AO3 NON BIO treatment of Sz + AN
CBT
WEAKNESS
CAN BE THREATENING
TALKING through reasons of anxiety can have a poor impact on mood (may not show an improvement in anxiety levels)
4TH D = DISPUTE
reducing credibility of ABC model
DROP OUT RATE= high
patients need to be highly motivatied which requires effort and commitment
LONG TERM TREATMENT
73
AO1 Biological Treatment
(Antipsychotic drugs)
ANOREXIA
OLANZAPINE (2nd gen)
focus on interactions of serotonin and dopamine systems
REDUCES overall DOP activity
-helps w disordered cognitions
-increases appetite
5-20mg a day dosage
D2 + 5H2TA antagonisst
FLUOXETINE 'prozac'
SSRI's block the transport proteins causing increased serotonin levels in the synapse of patients
ENHANCES APPETITE
74
AO3 Biological Treatment
(Antipsychotic drugs)
ANOREXIA
SUPPORTING
BRAMBILLA et al
using 30 AN patients being treated w Olanzapine
-found that the Olanzapine treated group reported increased in weight and decrease in depressive symptoms
APPLICATION
knowledge of side effects can help improve treatment
ETHICS
-less stigma around AN + more of a focus on medicinal side (as it is not their fault)
BOACHIE ET AL- treated 4 AN children w Olanzapine
they gained weight, had less anxiety at meals and improved sleep
75
AO3 Biological Treatment
(Antipsychotic drugs)
ANOREXIA
REFUTING
FOCUSES ON SYMPTOMS
not the underlying cause like CBT would
short term
KAFANTARIS ET AL
15 adolescent girls gained weight and showed improved eating attitudes but so did the control group
MITCHEL- works better with bullemic patients than anorexics
76
AO1 Non-Biological Treatment
(CBT)
ANOREXIA
based on ABC model
focused on maldaptive thinking and how these are readjusted through counselling
ELLIS ABC MODEL
Activating event, Beliefs, Consequences
CBT-E ---> highly individualised (DALLE GRAVE)
- initial assessment appt followed by 20x50 min treatment sessions over 20 weeks
HW given
77
Cross cultural research AO1
= study of human behaviour between diff cultures, gathers data to identify similarities and differences between cultures regarding mental health disorders across cultures
enables universal behaviours which are common to many cultures to be identified as well as culturally specific behaviour
aims to MOVE AWAY from research focused on western, educated, rich cultures
can use a VARIETY OF RESEARCH METHODS
EMIC: looking within, in the culture
Etic: looking from the outside, for universal behaviour from many cultures
78
Cross cultural research AO3
SUPPORTING
LUHRAM
study compares ppl from diff cultures and the 'voice hearing experience'
---> voices heard as BAD in Western societies but GOOD in South Asian/ African ones
REDUCES ETHNOCENTRICISM
therefore more generalisable research
allows investigation of universal patterns
TORTELLI
higher rate of psychotic disorders in Black Caribbean mirgrants in the UK accros 16 of 18 studies since 1960s
shows higher incidence rates of psychotic disorders diagnosed in ethnic minority populations
PHILLIPS
in China, Sz rates were higher in urban areas and women
mental illnesses are often stigmatised as a Social Failure
so findings may help ADAPT western classification for better care in diverse cultures
79
Cross cultural research AO3
REFUTING
TIME CONSUMING + EXPENSIVE
LANGUAGE BARRIERS
psychiatrists could overcompensate for cultural differences 'considering local culture beliefs too much', leading to TYPE 2 ERRORS in DIAGNOSIS
LIN
found MORE similarities than differences in Sz symptoms across cultures, suggesting cultural factors do not sig affect diagnosis
...making cross-cultural perspectives inefficient
80
what are HCPC standards
who set them up?
set up by the UK government to develop and maintain standards among professionals working in health related proffesions
-replaced BPS in 2009
81
what does HCPC stand for?
and what does it provide?
Health and Care Professions Council provides statutory regulation to ensure good clinical practise to protect public from harm and danger
82
HCPC AO1
-A psychologist needs to be registered with the HCPC to get a job and must reregister every 2 years
-registration requires the HCPC to check
1. psychologist has accredited degrees
2.character reference and health practise
-first published in JULY 2009, standards are regularly reviwed and ammended with current practise
-the revised standards are now based on 15 generic statements
83
what are the HCPC top 5 guidelines?
1. Be able to practise safely and effectively within their scope of practise
(know their limits and when to seek advice)
2. Be able to practise within the legal and ethical boundaries of their profession
(act in the best interest of service users)
3.Be able to maintain fitness to practise
4.Understand the key concepts of the knowledge base relevant to their profession
(understand more than 1 evidence based model of formal psychological therapy)
5.BE AWARE OF THE IMPACT OF CULTURE, EQUALITY and DIVERSITY OF PRACTICE
(understand requirement to adapt practise to meet the needs of different groups)
84
AO3 of HCPC guidelines
SUPPORTING
SMART TARGETS
specific, measureable, achievable, relevant, time-based
STATUTORY REGULATION is required to ensure patients with mental disorders are not abused or neglected
85
AO3 of HCPC guidelines
REFUTING
ETHNOCENTRIC AND EUROCENTRIC
based on Western societies values of mental health, maybe not applicable to collectivist societies
TOO VAGUE
critics would say the standards are too vague and that the HCPC acts as a 'MORAL POLICE FORCEC', intruding upon the psychologists private lives
86
LONGITUDINAL research in clinical psychology AO1
the study of the same cohort of ppts at several points over time (basically a repeated groups design with age)
baseline data at start
several test points within the set period of time
final test point
3 main types
Repeat cross-sectional studies
Retrospective 'looking back' on ppts and how they end up developing Sz
Prospective 'looking forward' babies born with a gene to see how they develop in the future
LAVERENNE's clinical CASE STUDY was a part of a longitudinal psychotherapy group of 7 years
87
LONGITUDINAL research in clinical psychology AO3
ADVANTAGES
HIGH INTERNAL VALIDITY
-same ppts used throughout the study so ppt variables fo not affect results
REPEAT DATA SETS
at regualr intervals so increased RELIABILiTY of data to allow developmental trends to be studies
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LONGITUDINAL research in clinical psychology AO3
DISADVANTAGES
-Time consuming and expensive
-researcher bias
-'sample attrition' as ppts may drop out
'ETHICAL ISSUES: presumptive consent for young ppts
INTRUSIVE
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CROSS-SECTIONAL (snapshot) in clinical psychology
AO1
the study of different groups of ppts at one point in time (basically an independent groups design)
several different groups of ppts: child, adolescence, adult, elderly
-COMPARISON of the data between the group, with the assumption that the 'young' will eventually turn into the 'old'
e.g: case study of ppts just starting CBT and another group of ppts who has just finished CBT.
90
CROSS-SECTIONAL (snapshot) in clinical psychology
AO3
DISADVANTAGES
-ppts used are not the same, so results are subject to PARTICIPANT VARIABES
-INDIVIDUAL DIFFERENCES MY REDUCE VALIDITY (cohort effects)
-data collected is for a snapshot in time, so HARDER TO ANALYSE developmental trends over long periods
-data is LESS RICH and insightful REDUCING INTERNAL VALIDITY
90
CROSS-SECTIONAL (snapshot) in clinical psychology
AO3
ADVANTAGES
-less time consuming and more cost effective as ppts only need to be tested once
-no follow up required
-easier to recruit and retain ppts as the study is short
-fewer ethical considerations compared to longitudinal
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CROSS-CULTURAL in clinical psychology
AO1
the study of human behaviour between different cultures, to identify similarities and differences accross cultures
EMIC- how ONE culture understands behaviour 'looking within'
ETIC- how MANY cultures understand behaviour 'looking from the outside'
studies UNIVERSAL BEHAVIOURS common to cultures
studies CULTURALLY SPECIFIC behaviours
e.g ICD-10, DSM-5 cross cultural section, becker (fijian girls)
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CROSS-CULTURAL in clinical psychology
AO3
ADVANTAGES
HIGH GENERALISABILITY as a range of diverse cultures and individuals are being studied
allows UNIVERSAL BEHAVIOURS to be studies
nature vs nurture
expands our knowledge of human behaviour
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CROSS-CULTURAL in clinical psychology
AO3
DISADVANTAGES
researcher could be CULTURALLY INSENSITIVE as they do not know much about individual societies
ETHNOCENTRISM = belief that a society, group, or culture is SUPERIOR to others
=== subejctive researcher bias
LANGUAGE BARRIERS may exist or lost in translation
e.g'purge' in beckers study
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META-ANALYSIS in clinical psychology
AO1
a statistical technique for combining the findings of several studies within a certain research area
e.g: CARLSSON's (Sz)
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META-ANALYSIS in clinical psychology
AO3
ADVANTAGES
LESS TIME CONSUMING (no need for new studies)
FEWER ETHICAL CONSIDERATIONS
LARGE DATA SETS so conclusions would be MORE GENERALISABLE esp if the studies have been conducted in different countries
94
META-ANALYSIS in clinical psychology
AO3
DISADVANTAGES
LOW RELIABILITY as procedure in retrospective 'looking back' studies so difficult to replicate currently due to BPS guidelines
LOW INTERNAL VALIDITY as no control over details on how the research was carried
LOW CREDIBILITY due to not knowing how data was obtained and so limitations are unknown
PUBLICATION BIAS as studies which lead to non-significant finding are often NOT published
SELECTION BIAS
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PRIMARY DATA in clinical psychology AO1
information observed or collected directly from first hand-researchers. 'empirical evidence'
original thinking and that involves both qualitative and quantitative data
often CLINICAL INTERVIEWS and OBSERVATIONS
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PRIMARY DATA in clinical psychology AO3
ADVANTAGES
researcher has CONTROL over the methodolgy, control variables and data collection INCREASING RELIABILITY
OPERATIONALISED VARIABLES (IV/DV) so HIGH VALIDITY
HIGH CREDIBILITY due to data being more trustworthy as researcher knows exactly what data is being collected and the LIMITATIONS OF RESEARCH
HIGH ETHICS as researcher is gathering ppts themselves and making sure they follow the BPS ETHICAL GUIDELINES
97
PRIMARY DATA in clinical psychology AO3
DISADVANTAGES
-time consuming
RESEARCHER BIAS as results are based on a SUBJECT INTERPRETATION of researchers interest
-LOWER SAMPLE SIZE due to recruitment of ppts, decreases population validity and generalisability of limited data collected
98
SECONDARY DATA in clinical psychology AO1
information that someone else has already collected and is used by the researcher
e.g: Carlsson (Sz study)
patient medical records or interview observation transcripts
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SECONDARY DATA in clinical psychology AO3
ADVANTAGES
-less time consuming and less expensive
rich, insightful data from a range of sources increases INTERNAL VALIDITY
PUBLISHED WORK has already been PEER-REVIEWED BY EXPERTS in the field INCREASING CREDIBILITY
100
SECONDARY DATA in clinical psychology AO3
DISADVANTAGES
data might not exactly fit the needs of the study
SUBJECTIVITY when analysing results may cause researcher bias
NOT TIME-RELEVANT as could include studies from a long time ago
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the use of CASE STUDIES in clinical psychology
AO1
-explores one event, a group of people or a person in depth
-in depth data is collected because the complex interaction of many factors can be studied
-useful for RARE or UNUSUAL behaviours
-QUALITAITVE data can be collected which can be turned into QUANTITATIVE
-a case study may include a CASE HISTORY, which is a record of an individuals previous experiences
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define case study
an in depth analysis of an individual/group that uses multiple data collection methods to gain comprehensive insights into complex behaviour or conditions
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define ego boundary
the mental line that separates your thoughts, feelings and experiences from those of others, helping you know where you end and others begin
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define weak ego boundary
hard for someone to tell where their own thoughts and feelings end and where others begin
-they might easily take on other peoples emotions or feel overwhelmed by them
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what is 'auxillary ego'
'helping the ego' - a coping strategy
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LAVERENNE OVERVIEW (case study)
- sessions not tape recorded or videotaped but are coded where therapists record: verbal expressions, emotions (qualitative)
3 researchers, therapists (inter-rater reliability)
progress recorded for each patient over 7 years (longitudinal)
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INTERVIEWS in clinical psychology
AO1
the interviews can be in the form of open questions
they can also be in the form of closed questions
interviews can be recorded to allow researchers to measure qualitative data
interviews can be UNSTRUCTURED where the psychiatrist decides what questions to ask based on the patient's previous answers
108
INTERVIEWS in clinical psychology (including VALENTINE)
AO3
if the questions are open, the psychiatrists may need to decide on important themes and this can be SUBJECTIVE
open questions allow the patient to express how they are truly feeling which can lead to further insight into their problems
closed questions allow data/responses to be compared easily
VALENTINE et al recorded interviews so others can PLAY BACK the recordings to check the interpretation of results, increasing RELIABILITY
unstructured interviews have a lack of reliability as NO PATIENT will have exactly the SAME Qs
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CLASSIC STUDY clinical
ROSENHAN
AO1
aim:
methodology
ppts
observers
aim- to investigate the reliability of mental health diagnosis by seeing whether 8 pseydo=patients would be detected as really being sane
methodology- FIElD, naturalistic covert (secret), unstructured observation
ppts: the staff and real patients in the hospital being observed by observers
-8 pseudo patients: 3 women and 5 men
all pseudo patients were given 'pseudonyms' and 'pretend occupations'
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CLASSIC STUDY clinical
ROSENHAN
AO1
location and procedure
location
12 psychiatric hospitals
5 US EAST and WEST coast states which varied
procedure:
1. ADMISSION
all pseudo patients claimed to HEAR VOICES saying 'empty, hollow, thud' from an unfamiliar same-sex person.
2.Once admitted, they behaved normally
e.g: engaged in normal conversation in the corridors
3.DISCHARGE
pseudo-patients were responsible for convincing the doctors they were 'sane' in order to get released
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CLASSIC STUDY clinical
ROSENHAN
AO1
RESULTS and conclusions
11/12 hospitals admitted the patients with Sz
71% staff in hospitals IGNORED the pseudopatients
length of admission in hospital was 7-52 days with an average of 19 days
in 3 patients, the writing behaviour was seen as part of SZ PSYCHOPATHOLOGY by the nurses: 'patient engages in writing behaviour'
CONCLUSIONS:
the sane cannot be distinguished from the insane
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CONTEMPORARY STUDY clinical
CARLSSON
aims
aim- they aimed to see if neurotransmitters other than dopamine were implicated in causing Sz
they also aimed to see what role glutamate has in causing Sz
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CONTEMPORARY STUDY clinical
CARLSSON
methodology
sample
procedure
methodology: LITERATURE REVIEW in SWEDEN
sample: DID NOT HAVE THEIR OWN SAMPLE
they reviewed previous studies involving MICE and Human Sz patients, exposed to different drug therapies + PET/SPECT scans
procedure: Not Empirical Research so did not involve primary data
instead, a review of literature was conducted, including 32 STUDIES of which 11 were Carlssons himself
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what is a research review
a form of secondary data that considers existing supporting and opposing research studies and suggests new areas for research
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SPECT vs PET scans
both are major functioning imaging tools
SPECT= cheap, low resolution and tells us where blood is flowing
PET= expensive but higher resolution
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CONTEMPORARY STUDY clinical
CARLSSON
TOP 3 REVIEW FINDINGS
1. THE DOPAMINE HYPOTHESIS REVISITED
1. THE DOPAMINE HYPOTHESIS REVISITED
the dopamine hypothesis has been reviewed for falsifiability
SUPPORTING: PET scanning shows an increase in dopamine in patients with Sz compared to controls in the basal ganglia of the brain
REFUTING: Correlation does not mean Causation
there might be a 'subpopulation' of Sz patients with a dopamine dysfunction
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CONTEMPORARY STUDY clinical
CARLSSON
TOP 3 REVIEW FINDINGS
2.BEYOND DOPAMINE
2. BEYOND DOPAMINE
Carlsson proposed that it is unlikley that dopamine is the only neurotransmitter involved in Sz
others such as noradrenaline, serotonin, glutamate and GABA may be
SUPPORTED BY: glutamate NMDA receptor antagonist PCP which causes an increase in amphetamine- induced dopamine release in humans, which is demonstrated using SPECT scanning techniques--- suggesting glutamate is also involved
118
CONTEMPORARY STUDY clinical
CARLSSON
TOP 3 REVIEW FINDINGS
3. GLUTAMATERGIC CONTROL OF DOPAMINE RELEASE
3. GLUTAMATERGIC CONTROL OF DOPAMINE RELEASE
Carlsson describes how glutamate acts as an 'accelerator' or 'brake' for regulating dopamine activity
SUPPORTED BY: treating awake rats with MK-801 (glutamate NMDA antagonist) causing increased dopamine which suggests a regulatory relationship between dop and glut
REFUTED BY: M100907, which selectively inhibits serotonin 5H2TA receptors, this caused a decrease in behavioural abnormalities and psychosis
suggesting a need for new clinical therapy using serotonin antagonists instead of glut and dop antagonists
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CONTEMPORARY STUDY clinical
CARLSSON
CONCLUSIONS
a relationship between GLUTAMATE DEFICIENCY and INCREASED DOPAMINE is indicated
-subpopulations of Sz exist who may have different causes of Sz NOT linked to dopamine and serotonin activity
-other neurotransmitters need further investigation for new clinical therapy targets
e.g: ser, acetylcholine, GABA
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STRENGTHS of RESEARCH REVIEWS
1. TRIANGULATION
range of studies + methodologies reviewed
therefore many studies came to the findings so HIGHER CREDIBILITY
2.SAMPLE SIZE= large
as 32 studies were reviewed so HIGH POPULATION VALIDITY
3.brings together what has been accomplished without repetition and instead identifies gaps/ommisions all within a summary
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WEAKNESSES of RESEARCH REVIEWS
1. SUBJECT TO RESEARCHER BIAS
no specified selection process to make sure all the literature on the topic was considered (11 studies were his own)
2.INCONCLUSIVE FINDINGS
3.TIME-LOCKED
research reviewed was from the 1990s (20 years ago so may not be generalisable to current specific world)
122
CONTEMPORARY STUDY
clinical psychology
Guardia
aim
sample
to see whether problems in judging body actions (fitting through a space) occur in AN only when judging one's own body or whether it is a problem in judging overall (compared to controls)
to test a hypothesis that people with AN overestimate their body size even when in action
sample: 25 females with AN from an eating disorder clinic (12 restricting, 13 binge purging)
25 normal female students
matched for AGE and EDUCATION
123
CONTEMPORARY STUDY
clinical psychology
Guardia
methodology
IV
DV
methodology = LAB
IV- whether the ppts were imagening body action from 1pp or 3pp
DV: PERCIEVED PASSABILITY RATIO= at which point ppts said they could pass through a door without turning sideways
124
CONTEMPORARY STUDY
clinical psychology
Guardia
MEASURES
all AN patients fulfilled DSM-4 criteria
body weight was measured 6 months before, 1 month before and again at the start of the study
psychiatric evaluation: interviewed to ensure no co-morbidities and no impairments in perceptions of intelligence
BODY SHAPE QUESTIONAIRE: body disatisfaction
EATING DISORDER INVENTORY-2 (EDI-2): weight gain and body concerns
3 SCORES FROM THIS:
total score
drive for thinness
body dissatisfaction
125
CONTEMPORARY STUDY
clinical psychology
Guardia
BMI of ppts and controls
ppts: 15-16
control:18-25
126
CONTEMPORARY STUDY
clinical psychology
Guardia
PROCEDURE
1. BODY-ACTION SIMULATION TASK
image of a 2m high door projected on a wall (width 30-80cm)
51 images shown 4 times each
2. 2 EXPERIMENTAL CONDITIONS
1pp: ppt stood 5.9m from the wall and imagined self walking through the door
-she had to decide if she could do this at normal speed without turning sideways
3pp: experimenter stood 5.9m from the wall and the ppt had to decide if the experimenter could walk through the door without turning sideways
127
CONTEMPORARY STUDY
clinical psychology
Guardia
what is perceived critical aperture
and
perceived passibility ratio
Perceived Critical Aperture
PCA= the point at which the ppts said they could pass the door without turning sideways
Perceived Passibility Ratio
PPR= PCA/shoulder width to measure the ppts perceived body size
the higher the ratio, the larger perceived body size
128
CONTEMPORARY STUDY
clinical psychology
Guardia
RESULTS
AN ppts scored significantly higher than controls on
-median EDI-2, drive for thinness, body dissatisfaction, and BSQ scores
1PP: mean PPRs SIG higher in AN group (1.321 vs 1.106)
3PP: mean PPRs SLIGHTLY higher in AN group (1.227 vs 1.128)
129
CONTEMPORARY STUDY
clinical psychology
Guardia
CONCLUSIONS
control groups judgement same in 1PP and 3PP
AN ppts made MORE errors when judging own passibility but SLIGHT error when judging experimenter passibility
POSSIBLY from an overestimation of their own body schema + issues with integrating info from various senses.
