Clinincal 2.0 Flashcards
(110 cards)
1
Q
What are the 4 Ds
A
Deviance
Distress
Dysfunction
Danger
2
Q
What is deviance (3 points)
A
behaviour and emotions deviate from society
Can be considered unusual and undesirable
therefore deemed as Unacceptable
3
Q
What is distress (4 points)
A
Symptoms that causes emotional pain
This can turn into physical symptoms
can be considered normal
Qualitative data can be gathered using scales
4
Q
What is dysfunction (2 points)
A
Symptoms that distract, cause confusion or interact with persons ability to carry out usual roles and responsibilities
5
Q
What is danger
A
Behaviour that is careless, hazardous and hostile which can jeopardise safety
6
Q
Strength of 4ds (application)
A
Creditworthy starting point to identify if a diagnose and treatment is needed
Helpful to identify immediate danger to ongoing distress
Therefore helpful to society because it is the first step used by clinicians
7
Q
Weakness of 4ds (not objective definitions)
A
Behaviour can be interpreted subjectively based on norms which change over time and across cultures
In New Zealand hearing voices is respected but seen as a symptom of schizophrenia in western cultures
Therefore not reliable across and within cultures
8
Q
Strength of 4ds (validity)
A
DSM considers 4ds alongside the symptoms of a disorder
Suggesting they are a valid definition which increases the accuracy of diagnosis leading to effective treatment
Therefore plays an important part in achieving accurate diagnosis
9
Q
Weakness of 4ds (labelling and medicalising)
A
Used by society o medicalise behaviour which many be unusual but not actually harmful
Some behaviour should be accepted rather than controlled and managed through labels and treatments
Therefore 4ds may have negative impacts on people’s quality of life
10
Q
What do clinical psychologists do
A
They assess, diagnose and treat individuals with mental health disorders
11
Q
What does DSM stand for
A
Diagnostic and statistical manual
12
Q
Who was the DSM published by
A
American psychiatric association (APA)
13
Q
What does the DSM describe
A
Symptoms, features and risk factors of over 300 mental health disorders
14
Q
How many categories are in DSM
A
22
15
Q
When was the lasted DSM-5 published
A
2022
16
Q
How many sections does DSM have
A
3
17
Q
What are the 3 sections in DSM
A
S1 = guidance using the manual
S2 =info about diagnosis
S3 =suggestions of new disorders
18
Q
What does the ICD both include
A
Mental and physical disorders
19
Q
Who was the ICD published by
A
World health organisation (WHO)
20
Q
When was ICD published
A
January 2022
21
Q
4 benefits of ICD
A
Multilingual
Freely available
Used globally
Available in appropriate forms for different cultures
22
Q
What is chapter 5 titled as in ICD
A
Mental and behavioural disorders
23
Q
What is the start code in each disorder in the ICD
A
F
24
Q
Describe the guidance on diagnosis in ICD
A
Clinicians left key words from clinical interviews
Key words are looked up in a index to find section
Then use other symptoms to identify a subcategory
25
Why is validity important in diagnosis
Risk if receiving wrong treatment
26
What is an example of type 1 error
Diagnosing someone as having a mental health disorder when they don’t
27
What is an example of a type 2 error
Diagnosing someone with not having a mental health disorder when they do
28
Strength reliability for classification system - rosenhan 1973
It was reliable as there was a consistent diagnosis of pseudo patients 11/12 SZ in remission and 1 bipolar based on the same symptoms (empty, hollow, thud)
However validity is low
29
Strength reliability for classification system - brown 2001
Tested reliability and validity of DSM IV for anxiety and depression and found them to be “good” and “excellent”
30
Strength of validity for classification system - jansson 2002
Checked how much agreement there was between the ICD 10 and DSM IV
Found a high rate of agreement for the same disorders between the two
Suggesting there is high concurrent validity
31
Weakness of reliability for classification system - Andrew’s et al
Found only 68% agreement between diagnosis using both the ICD and the DSM on an assessment of 1500 pseudo patients
32
Strength for validity of classification system - predictive validity
The DSM and ICD can accurately predict future behaviour
If a patient genuinely has depression then an improvement in mood is expected within 8 weeks if they are prescribed antidepressants
33
Weakness for validity of classification system - culture
Behaviour which may be common in one culture may not be common in anther and would be interpreted as a mental health disorder
34
Weakness for validity of classification system - Hoffman et al 2015
Found the diagnosis between the DSM V and ICD 10 differed when it came to mild to moderate alcohol disorders
About 1/3 of those with mild alcohol disorder according to DSM 5 received o diagnosis from ICD 1 suggesting low concurrent validity
35
Aim of rosenhans experiment
Investigate reliability of staff in psychiatric hospitals to identify the sane from insane
36
What was the sample for rosenhans study
8 pseudopatients, 5 men and 2 females
In 12 psychiatric hospitals across 5 states in the USA
37
What was the procedure for rosenhans study
All 8 pseudopatients had a single symptom of hearing voices “empty, hollow and thud”
Didn’t swallow medication given and recorded responses doctors and nurses when they spoke to them
38
What were the results for rosenhans classical study
All 8 pseudopatients were never detected
The average stay was 19 days (started from 7-52 days)
Released with diagnosis of SZ remission
39
In rosenhans classical study was percentage of doctors ignored the pseudopatients hen they tried talking to them
71%
40
In rosenhans classical study was percentage of NURSEs ignored the pseudopatients hen they tried talking to them
88%
41
Rosenhan - reliability +
Small amount of standardisation
Empty hollow and thud, and all behaved normally once admitted = replicable
42
Rosenhan - ecological validity +
Real hospital, wide range of pseudopatients with different occupations, real staff and patients
Accurate measurement of diagnosis and treatment in everyday life
43
Rosenhan - generalisability of MH and care in the USA +
12 hospitals, 5 states
Understaffed, private hospital and good funding = representative to an extent
44
Rosenhan - ethnocentric (-)
Biased towards USA
Cannot generalise to china for eg
And only done in 5 states so cannot generalise the whole of USA
45
Rosenhan - inter rater reliabilty (-)
Only 1 pseudopatients per hospital gathering data bc can’t check results for consistency and agreement
46
3 features of SZ
- 1/100 of the population have SZ
- episodes usually appear between late adolescence and mid thirties - men (teens) women (20-30s)
- males most likely to have poor development of disorder and develop higher proportion of negative symptoms and have longer duration
47
4 positive symptoms of SZ
Hallucinations
Delusions - grandiose and persecutory
Disordered thinking / speech
Thinking insertion / thinking broadcasting
48
Define grandiose delusion
When individual believe they have remarkable qualities such as being famous or having special powers
49
Define persecutory delusions
Individuals belief someone is ‘out to get them’ or harm them
50
Define hallucinations
Hearing / seeing / smelling things that are not there but feel real
Critical and controlling voices
51
What are controling voices
Tell you what to do
52
What Are critical voices
Commentary of things
53
What is thought insertion
Belief that thoughts are put there by someone
54
What is though broadcasting
Thoughts can be heard by others
55
What are 3 examples or negative symptoms
Lack of energy and empathy
Social withdrawal
Not looking after appearanc
56
What 5 things does dopamine do
Regulate mood
Learning
Attention
Movement
Memory
57
What is SZ caused by (neuro)
Excess dopamine activity
58
What is hyperdopaminergia
Excess dopamine activity
59
What is 2 things hyperdopaminergia caused by
Small amounts of beta hydroxylase which leads to build up to excess dopamine in synapse
Large amounts of d2 receptors in the brain, so more dopamine binds to receptors
60
What type of symptom causes excess dopamine activity
Positive symptom
61
What type of symptom leads to low dopamine activity
Negative and cognitive
62
Which pathway does positive symptoms travel on
Mesolimbic pathway
63
What is the mesolimbic pathway made by
VTA and NA
64
What pathway do negative symptoms use
Mesocortical pathway
65
What is the mesocortical pathway made from
VTA and cortex
66
What 2 things does serotonin do
Regulates dopamine activity
Excess serotonin leads to excess dopamine activity
67
What are negative symptoms caused by (serotonin)
Irregular serotonin activity
68
What does clozapine do
Reduce both positive and negative symptoms
69
How does clozapine work (2 things)
Binding loosely to dopamine receptors (D1.D1.D4) which reduces dopamine activity and serotonin receptors which reduces serotonin activity
70
What type of investigation did Carlson do
A review
71
What was the aim of carlssons study
Investigate relationship between SZ and doperminergic dysfunction
72
What was result 1 of carlssons study and what did patients do
SZ showed more dopamine activity especially in the basil ganglia
Patients taking antipsychotics complain about most side effects while their symptoms are on remission.
73
What was result 2 of carlssons study
Drugs like PCP ‘angel dust’ and ketamine produce psychotic symptoms
74
What was result 3 of carlssons study
Glutamate seeems to regulate dopamine
Carlssons describes how it acts as an accelerator increasing dopamine or a break, decreasing dopamine
75
What do low levels of glutamate link to
Positive and negative symptoms of SZ
76
What was carlssons conclusion
There are probably different groups of SZ patients whose symptoms have different biological explanations
Dopamine hypothesis isn’t the only explanation
77
One strength of one biological explanations of SZ
Has supporting evidence
Gottesman and shield 1996 found that 9% of DZ twins had SZ in comparison too 42% f MZ twins. This is import and as it highlights the genetic element of SZ
78
One weakness of one biological explanation of SZ + evidence
It’s reductionist
Only focuses on biological factors and doesn’t fullly consider role of culture
Lurhman found that Ghanaians heard different voices to American people therefore suggesting that biological explanation is not a full explanation and other factors such as culture neeed to be considered
79
What do typical antipsychotics bind to + causing what
D2 receptors causing lower levels of dopamine
80
What do atypical antipsychotics bind to
D1, D2, D4 and work to regulate serotonin and dopamine reducing negative and positive symptoms
81
How long is the atypical antipsychotics course be taken within
7 days
82
What are typical antipsychotics
1st gen drugs introduced in 1950s
83
What do typical antipsychotics do
Block dopamine receptors to reduce positive symptoms and unwanted side effects
84
What is an example of a typical antipsychotic drug
Chlorpromazine
85
What are atypical antipsychotics
2nd gen
Introduced in 1960s
86
What do atypical antipsychotics do
Block dopamine and serotonin
Reduce positive and negative symptoms and side effects
Bind loosely to receptors
87
What is an example of an atypical antipsychotic
Clozapine
88
What does clozapine do
Weaken immune system
89
What is a cross sectional study
Takes measurements of one group of pps at a specific time and compares it with another group
90
What does PCP angel dust stimulate
stimulate glutamine receptors called NMDA
91
How is generalisability a strength is carlssons study
He studied 33 and took part in 14 reviews therefore shows a representative selection
92
How is reliabilty a strength for carlsson
All lab experiments, many of them on animals which use modern PET
This technique is standardised and replicable making them reliable
93
How is application a strength for carlsson
Development of new antipsychotics drugs - improved dopaminergic drugs that have fewer side effects based on better understanding of dopamine activity
94
How is generalabilty a weakness for carlsson
Based in 1999 so can be considered time locked as research has moved on since the so it may no longer be representative and scientific
95
How much of the population inherit SZ
79%
96
How may genes have been linked to SZ
700
97
What are 4 explanations of SZ - genes
1. SZ is inheritable
2. Can be caused by mutation eg digeorge syndrome
3. COMP gene providing instructions for enzyme
4. DISC 1 gene association
98
Describe 1 finding of carlssons
Glutamate acts as a break in the mesolimbic pathway because it signals
to GABA to inhibit dopamine production
however if this process isn’t working properly and the levels of glutamate are too low, this causes low levels of GABA which causes excess levels of dopamine which causes positive symptoms.
99
What was the key question for clinical
How is the diagnosis of MHD affected by cultural differences
100
3 ways MHD is affected by culture
1. Different cultural norms
2. Cultural bias of diagnostic manuals
3. Language barrier
101
Key question evidence for difference in culture
Lurhaman found difference of auditory hallucinations between cultures
70% Americans - hurt ppl
20% Ghanians - good voices
Indian people heard family offering guidance for scalding them
102
Key question evidence for cultural bias of diagnostic manuals
DSM acknowledges cultural differences
Section 3 - cultural concept of distress - aims to explain how culture can affect presentation and communication
103
Key question evidence for language barriers (ICD)
ICD published different languages so diagnostic error due to language barrier or mistranslation can be reduced
104
What are antidepressants
Drugs developed to target specific neurotransmitter which are prescribed to treat depression and prevent relapse
105
How do antidepressants work
Increase serotonin and noradrenaline in the brain
106
What do monoamine oxidase inhibitors do
Stop enzymes that break down monoamine neurotransmitters in synapse so it’s available for longer
107
What do monoamine oxidase inhibitors require
Strict diet due to interactions
108
When were SSRIs / SNRIs made
1970s
109
What do SSRIs/SNRIs do overall
Reuptake inhibitor and serotonin levels increase which causes fewer negative side effects
110
What do SNRIs do
Block reuptake of serotonin and noradrenaline
