Topic 5 Clinical - Content

Question 1

What is Deviance?

Answer 1

Behaviour that is rare and unusual going against social norms

Question 2

What is Dysfunction?

Answer 2

Behaviour that interferes with everyday life/activities

Question 3

What is Distress?

Answer 3

Behaviour causes anxiety and pain

Question 4

What is Danger?

Answer 4

Causing physical or psychological harm to themselves or others

Question 5

What are the Strengths for the diagnosis of mental disorders?

Answer 5

Using all 4D’s may help avoid errors in diagnosis

Question 6

What are the Weaknesses for the diagnosis of mental disorders?

Answer 6

Subjective
- Ratings are being made of feelings - biased by situational, cultural, and historical factors - affects reliability

Labelling
- End up with labels for people with mental health issues (using “danger” assumes mental illness is dangerous - leading to stereotypes - meaning is distorted through the media)

Question 7

What is a Classification System?

Answer 7

MHD (Mental Health Disorder)

Describe clusters of symptoms that define disorders, which should lead to better quality diagnosis.

Question 8

What’s DSM?

Answer 8

DSM = Known as DSM-V (V = 5th edition, DSM-5) or DSM-IV-TR (IV = 4th edition, TR = text revised):

• DSM-V:
  
  • Current
  • Linked disorders grouped together
  • Use info from interview + records (like ICD) Sections:
    1. Introductions to the manual with instructions on its use
    2. Classification of main MHD
    3. Future + Other assessment measures, e.g. help diagnoses from diff cultures
• DSM-IV-TR - Multi-axial tool because of its 5 axes/chapters
  
  1. Mental Health Disorders (anxiety)
  2. Described symptoms related to personality disorders
  3. Described medical conditions (brain damage) to explain the start of clinical issues.
  4. Described psychosocial/environmental problems that could be involved with MHD’s (loss of housing/employment)
  5. Scale to assess global functioning of an individual (how much a persons symptom affects their day) = score helps with diagnosis + assess need for treatment

Question 9

What’s ICD?

Answer 9

ICD = Currently ICD-10 (10th version):

• All diseases
• Section F specific to MHDs
• Groups each disorder as part of a family, e.g family: mood (affective) disorders includes: depression in all its forms
• Code: F32 (F=MHD section) (3=Family of MHD) (2=specific disorder, e.g. 2 is depression, 1 is bipolar)
• Decimal points make categorisation even more specific
• Guide diagnosis through interview

Question 10

What’s Reliability of Diagnosis?

Answer 10

Reliability - Clinicians agree on the same diagnosis for the same patient

Inter Rater Reliability Test:

- Showing 2+ clinicians the details of a patients case history
- Assess level of agreement between them - if all raters (clinicians) agree on the same diagnosis, high inter rater reliability.
- Early diagnostic symptoms had low inter-rater reliability

Patient Factors:

- Patients give inaccurate info because of memory problems, denial or shame
- Specific issues - disorganised thoughts cause issues

Clinician Factors:

- Subjective judgment - interpretation affected by different background/training or experience
- Unstructured nature of interview - Lead to clinicians focusing on different symptoms (nightmares or traumatic past event) - Thus different info gathered - different diagnosis

Question 11

What’s Validity of Diagnosis?

Answer 11

Validity - A diagnosis genuinely reflects the underlying disorder

• Construct Validity - Whether a measure is actually measuring the thing its supposed to
• Concurrent Validity - Comparing a new test with an existing test to see if they have similar results, which is done at the SAME time.
• Predictive Validity - Results from a test such as DSM or a study can predict future behaviour
• Convergent Validity - 2 tests have a strong relationship that measure the same thing

Convergent - 2 measures measure the same thing whilst Concurrent/Predictive there can be a different way of measuring each studies.

Question 12

What’s the strengths for Validity of Diagnosis on DSM?

Answer 12

Kim Cohen et al. (2005)

- Looked at the behaviour of children diagnosed with conduct disorder to see whether those children were more likely to report their own antisocial behaviour and be disruptive during assessment.
- These behaviours would be expected if their diagnosis was valid. The results of the study did find validity in the diagnosis.

Lee (2006):

- Teachers opinion about a child was compared with an ADHD diagnosis using the DSM-IV-TR
- Was found that there was a match between the measures, so the DSM was valid
- However, boys fit the DSM criteria better than girls - ---- - Studies show that the DSM is valid in diagnosis. Different mental health issues were chosen in the different studies cited, which reinforces this conclusion. - Claim that the DSM is valid is supported by the claim its reliable, as reliability and validity go together. If the DSM is not reliable, it will not be valid.

Question 13

What are the weaknesses for validity of diagnosis using DSM?

Answer 13

Co-morbidity = having more than one mental disorder/illness or disease

Reductionist/ism = breaking down a complex phenomenon into simpler components

• Co-morbidity is hard to diagnose using the DSM, a system which relies on the user choosing the closest match from lists of symptoms and features
• Splitting a mental disorder into symptoms & features is reductionist & studied as a whole may be more valid

Implicit Bias: Preconceived ideas
e.g. women can’t have schiz, more likely to have depression as they are emotional

Question 14

FINISH What’s the strengths for reliability of diagnosis using DSM?

Answer 14

• Brown et al. (2001) tested the reliability of the DSM-IV. They studied anxiety and mood disorders in 326 out-patients in Boston, USA. The patients underwent two independent clinical interviews and there was high level agreement for most of the DSM-IV categories.
• high level of agreement between two psychologists in two separate interviews.
• Wilson (1993) -> DSM-III developed to precisely tackle the unreliability of the previous manuals

Question 15

What’s the weaknesses for reliability of diagnosis using DSM?

Answer 15

• The reception to the new DSM-5 has been mixed. The British Psychological Society (BPS) published a largely critical response in which it attacked the whole concept of the DSM. It argued that the diagnosis should fit the patient, but the DSM-5 tries to make the patient fit the diagnosis
• Andrews et al, 1999: There has been found to be only a 68% agreement between the ICD-10 and DSM-IV on an assessment of 1500 patients.

Question 16

What’s the strengths for Reliability for ICD?

Answer 16

Jakobsen et al (2005)

• Looked at in-patients with schizophrenia & out-patients with a history of psychosis (to look at reliability of the ICD-10 focus on schizophrenia)
  
  • 93% sensitivity & 87% predicted value to a diagnosis of schizophrenia & good agreement between ICD-10 & other diagnosis using another measure
  • Concluded: gave a reliable diagnosis of schizophrenia

Hiller et al (1992):

• Compared DSM-III-R & ICD-10 - used both on same set of patients who were suffering from affective & psychotic disorders
  
  • ICD-10 gave higher reliability for all disorders except bipolar
  • Moderate agreement for schizophrenia (between DSM-III-R & ICD-10) but not for schizoaffective disorder (lack reliability)

Cheniaux et al (2009)

• Aim: looked at reliability of diagnosis between DSM-IV & ICD-10
• Concluded: Schizophrenia found more when ICD-10 was used than DSM-IV, Bipolar disorder most reliability diagnosed
• ICD-10 is a reliable measure of schizophrenia & compares well with DSM-III-R (Hiller et al 1992) & (Jakobsen et al 2005)
• Use of inter rater reliability - means more than one person uses the classification system/s with the same patients & when they come up with the same diagnosis - reliability - Also careful controls for the raters to work independently - avoid bias

Question 17

What are the weaknesses for reliability of diagnosis using ICD?

Answer 17

• Schizophrenia diagnosed more when ICD-10 used than DSM-IV used (Cheniaux et al 2009) - lack of reliability - could be due to the differences in duration (6 months = DSM, 1 month = ICD)
• Schizoaffective disorder not reliably diagnosed (Cheniaux et al 2009) & (Hiller et al 1992) - lack of reliability of disorders relating to schizophrenia
• Reliability figures around 0.50 agreement, lack of agreement to be considered

Question 18

What’s the studies for Validity of ICD for schizophrenia?

Answer 18

Pihlajamaa et al (2008)
Validity of SZ diagnosis tested using DSM-III-R and the ICD-10. 807 SZ patients from Finland diagnosed with both books. Validity for DSM was 75% and ICD was 78%. The high level of agreement makes the diagnosis more reliable.

Jansson et al (2002)

- compared ICD-10 & DSM-IV
- Data gathered by interviews then compared to check validity of the diff classification systems
- Concluded: Diagnostic agreement between ICD-10 & DSM-IV (0.823)
- Generally diagnostic classification is valid but in depth there is differences - ------ - When the ICD-10 is used to diagnose schizophrenia the diagnosis matches a diagnosis using a different system, suggests ICD-10 is valid (Pihlajamaa et al 2008)

• (Jansson et al 2002) ICD-10 & DSM-IV gave 80% agreement in diagnosis - high validity

Question 19

What are the weakness for validity of diagnosis using ICD?

Answer 19

• (Jansson et al 2002) different classification systems focused on different features & symptoms in schizophrenia (ICD-10 & ICD-9) - lack validity
  ICD-9 = ‘more conservative’
  ICD 10 = ‘more liberal’
• Complexity of disorders:
• schizophrenia spectrum disorder
• schizoaffective disorder (both psychotic & mood disorders are present)
• Bipolar disorder has symptoms of schizophrenia.

Question 20

How do cultural issues affect diagnosis?

Answer 20

• Symptoms of schizophrenia (hearing voices) in Western countries can be interpreted in different countries as possession of spirits, special & unique - positive view
• Evrard (2014) - hearing voices is either a mental disorder or an individual difference/interpreted as an experience. Cultural Interpretation = DSM not always valid. Clinician from one culture must be aware of a patient from a diff culture to be influenced by their culture.
• Malgady - costa rica - hearing voices is your ancestors talking to you

Question 21

How do cultural issues not affect diagnosis?

Answer 21

• Mental disorders (depression or schizophrenia) are clearly & scientifically defined with specific symptoms/features, that present the same all over the world - DSM not only used in America but also else where
• Study: Lee (2006) used DSM-IV-TR in korea to see if it was valid and found valid

Question 22

What is Schizophrenia?

Answer 22

Characterised by abnormalities; distortion of thoughts, perception & emotion & social withdrawal

Question 23

What is Positive (Type 1) symptom?

Answer 23

Additions to behaviour (symptoms that can be seen & noted)

Question 24

What is Negative (Type 2) symptom?

Answer 24

Lack of normal behaviour/functioning

Question 25

What are examples of Positive Symptoms & what do they mean?

Answer 25

- Hallucinations Seeing/Hearing/Smelling on something that's not there - Delusions False beliefs that conflict with reality (thinking their movements are being controlled by someone) - Thought Insertion Individual thinks someone else is putting thoughts into their head - Disorganised Thinking Thoughts are not in logical order - doesn't make sense - Catatonia Abnormality of movement & behaviour - not a lot of physical movement

Question 26

What are examples of Negative Symptoms?

Answer 26

- Diminished Emotional Expression Showing less emotion in non verbal communication (eye contact, facial expression) - Avolition Lack of motivation to complete usual, self motivated tasks (work)

Question 27

What are features of Schizophrenia?

Answer 27

- Prevalence - 0.3-0.7% of developing schiz - Male: - Higher amount of negative symptoms. - Longer duration of disorder - Diagnosed during adolescence to mid 30s - Episodes develop gradually over time - Prognosis - 20% of diagnosed respond well to treatment - Large % remain ill with regular treatment - Other - Many patients show cognitive functioning deficits (working memory, language functioning & speed of info processing - Mood abnormalities are common - patients describe low moods as depressive episodes - Average life expectancy 10 or more years

Question 28

What's the main neurotransmitter that is associated with schizophrenia/psychosis?

Answer 28

Dopamine

Question 29

What's Amphetamine?

Answer 29

Drug which increases dopamine activity

Question 30

What's a study on Amphetamine?

Answer 30

Randrup & Munkvad (1996): Injecting amphetamines into rats to raise high dopamine levels - became aggressive + isolated. DOPAMINE LEVEL CHANGE = PSYCHOTIC BEHAVIOUR [Evidence lead to the dopamine hypothesis.]

Question 31

What's the Dopamine Hypothesis (who was it proposed by & what does it explain?

Answer 31

- Who was it proposed by? Carlsson et al - What does it explain? Schizophrenia is caused by too much dopamine receptors

Question 32

What are the 2 ideas Dopamine Hypothesis focuses on?

Answer 32

Hypersensitivity of certain dopamine receptors (D2 receptors) - Patients with the disorder are likely to "overreact" to the presence of neurotransmitter Higher Density of dopamine receptors - Higher density links to a higher chance of schizophrenia

Question 33

How are the dopamine pathways relevant to schizophrenia symptoms?

Answer 33

Mesolimbic Pathway - (increase of dopamine in this pathway) contributes to POSITIVE SYMPTOMS Mesocortical Pathway - (increase of dopamine in this pathway) contributes to NEGATIVE SYMPTOMS

Question 34

What are the Strengths for the Dopamine Hypothesis?

Answer 34

``` - Antipsychotic drugs work by blocking dopamine receptors: Solomon Snyder (1985): Chlorpromazine = acts as an antagonist at dopamine receptors (D1 & D2) ``` - Amphetamine - treatment of rats; Randrup & Munkvad (1996): Injected rats with Amphetamine, displayed psychotic symptoms of aggression & isolation - Parkinson's disease - L-Dopa: People with Parkinson's disease (with low lvl of dopamine in the brain) given L-Dopa (to increase dopamine) and show psychotic symptoms (Type 1)

Question 35

What are the Weaknesses for the Dopamine Hypothesis?

Answer 35

- Not all schizophrenic people respond to typical antipsychotic medication Alpert & Friedhoff (1980) →some patients don't show any improvement after taking dopamine antagonists - Modern antipsychotic drug - Clozapine - Block serotonin receptors - Increase dopamine levels - contradicting the dopamine hypothesis - Second-generation Immigrants - can't explain why certain groups are more likely to have schizophrenia Wim Veling → Moroccan immigrants more likely to have schizophrenia than Turkish immigrants - environmental factors; social stress/discrimination → more prone to psychosis

Question 36

What's the Glutamate hypothesis (who was it proposed by & what does it explain & how is this supported by angel dust)?

Answer 36

- Proposed by? Carlsson et al. (1999/2000) - Explanation? There is more to the neurotransmitter explanation than excess dopamine - How is this supported by PCP (angel dust)? NMDA = glutamate receptor, activated when glutamate binds to it - Angel dust produce psychotic symptoms but doesn't activate dopamine, activates glutamate receptors (NMDA) - Release of dopamine is increased, by decreasing glutamate (blocking NMDA receptors which glutamate binds with)

Question 37

What are the Strengths for the Glutamate Hypothesis?

Answer 37

Glutamate Hypothesis = Dopamine Hypothesis - Both hypothesis work together & expand on it rather than replacing it - Evidence from the dopamine hypothesis can be incorporated into the glutamate hypothesis - More knowledge to be built together - adding to its scientific credibility Evidence from Neuroimaging & Animal studies - To show that blocking glutamate relates to psychotic symptoms (negative affect in schizophrenia) - Findings of the studies tend to support one another - suggests they're reliable

Question 38

What are the Weaknesses for the Glutamate Hypothesis?

Answer 38

Animal studies - Lack validity - Erratic behaviour/psychotic symptoms might not relate to psychotic behaviour in humans PET scanning - Carlsson et al (1999) → when scanning humans might feel under pressure (responding differently than normal) - findings lack validity (esp on brain activity)

Question 39

What evidence is there for the link between disorder and genetics?

Answer 39

Evidence of a strong heritable factor in the development of the disorder

Question 40

What's the general population chance of getting schizophrenia?

Answer 40

less than 1%

Question 41

What's the difference between MZ twins & DZ twins in schizophrenia?

Answer 41

- Identical twins (MZ) are more likely to both have schizophrenia than non-identical twins (DZ) - e.g. Gottesman (1991) 48% chance of schizophrenia in MZ twins whilst DZ twins is 17%

Question 42

What's the overall explanation of the biological theory on schiz?

Answer 42

Higher genetic relatedness = Higher risk of Schizophrenia

Question 43

What's the Gottesman and Shields study (1966)?

Answer 43

Aim? - How far schizophrenia was genetic & replicate other studies that found a genetic link in schizophrenia Procedure? - 62 schizophrenic patients - half male & half female - aged 19-64 - all had been at a hospital - Used blood & visual tests to check whether the twins were MZ & DZ - 24 MZ identified & 33 DZ twins identified - Gottesman looked at the concordance rate within MZ & DZ twins to see what % of cases when one was diagnosed with schizophrenia, the other one was too. - MZ twins had a higher concordance rate - DZ twins had a lower concordance rate Results? - Concordance rate for MZ twins for schiz: 54% and DZ is 18%

Question 44

What's the strengths for the Gottesman and Shields study (1966)?

Answer 44

Replicates other studies - Replicates Inouye (1961) - found 74% concordance rate with progressive chronic schiz & 39% with mild transient schiz - reliable Care when measuring both the twin situation & diagnosis - Addresses criticisms of previous studies by detailing the sample carefully so that it was understood which twins were included & why - Great detail on the diagnosis - schiz, other psychosis, some abnormality

Question 45

What's the weaknesses for the Gottesman and Shields study (1966)?

Answer 45

Concordance rate - scale - Only notes whether if one twin has some abnormality, the other has it too - Been useful to have info about the degree of the abnormality, e.g. scale showing "schiz" through "other psychiatric diagnosis", to "some abnormality" to "normal" Different forms of schiz - Suggests that some of the disorders diagnosed might come from life experiences (prisoner from war) rather than genes - Study did not distinguish between reasons for schiz

Question 46

What are the strengths for genetic explanation for schizophrenia?

Answer 46

Adoption studies - Tienari (2002) - Account for environmental factors - E.g. Tienari (2002) found 7% of adoptees with schiz had biological mothers with schiz Family studies & Twin studies - multiple methods - Family studies can help identify gene issues, e.g. deletion, which shows symptoms of psychosis - Twin studies shows that genes explain schizophrenia - DNA pooling used to compare DNA with those that have schizophrenia against controls to look for gene variants - Many methods help if there's the same findings - reliability

Question 47

What are the weaknesses for genetic explanation for schizophrenia?

Answer 47

Complex - Complexity in variants - variations exist within individuals rather than seeing it in patterns of families - are sub microscopic - e.g. Harrison & Owen (2003) - 6 different genes involved in developing the disorder Family studies - Does not recognise that findings of schiz could be due to environmental factors - E.g. Schiz may be a result of stress caused by negative emotions of families

Question 48

What's the Cognitive explanation for schiz?

Answer 48

- Attributing Type 1 symptoms of schiz to biological causes - e.g. Hallucinations + delusions - associated with bio factors due to increased dopamine levels BUT when they try to understand the experience, they begin to show other symptoms of the illness

Question 49

What's evidence for the Cognitive theory for schiz?

Answer 49

Frith (1979) - Schizophrenic patients have increased self awareness - Can't filter out unnecessary cognitive noise from internal info processing

Question 50

What's the strengths of Cognitive theory for schiz?

Answer 50

Gold and Harvey (1993) - Ppl with schiz score lower on attention, memory, problem solving tests - Shows cognitive deficits McGuire et al (1966) - During hallucinations there's reduced activity in temporal lobe (monitors inner speech) - Thus experiencing an internal conversation, but were more likely to perceive the voice belonging to someone else [Support Frith's explanation of schiz patients unable to distinguish their thoughts]

Question 51

What's the weaknesses of Cognitive theory or schiz?

Answer 51

Beck et al (2009) - Reduced dopamine levels causes brain to struggle with info processing Sitskoom et al (2004) - Cognitive deficits found in patients with schiz was also found in their relatives who do not have the disorder - May be a genetic component causing the cognitive deficit

Question 52

What's the Social Causation hypothesis?

Answer 52

Environmental factors have a massive impact on schizophrenia or contribute to it

Question 53

What are the specific aspects for Social Causation?

Answer 53

Social Adversity - Basic needs such as nutrition, warmth, shelter, intellectual, emotional & social needs are not met by an individual Social Class - Social class shows someone's position in society = stress levels related to position in society - Lower social classes have a higher chance of getting schizophrenia or involved in its development Immigrant & Minority Status - Tends to be disadvantaged in educational factors, social class, housing + discrimination - Boydell et al (2001) →first & second generation immigrants are at greater risk of schiz than the general population Social Isolation - An individual becomes isolated from social situations - Robert Faris (1934) → ppl with schiz withdraw because they feel that contact with others is stressful. Isolation cuts the individual off from feedback about what behaviours are inappropriate, they begin behaving strangely Urbanicity - The impact living in an urban environment has on an individual - William Eaton (1974) → City life is more stressful than rural life & long exposure to stress causes schizophrenia

Question 54

What are the strengths for Social Causation hypothesis?

Answer 54

Significant correlation between urban dwelling & schizophrenia - Evangelos Vassos et al (2012) → Correlated location (urban to rural) with schiz risk & found a link - Found a link - risk was 2.37 times higher for ppl living in urban areas Ethnic Identity - Veiling et al (2010) → ppl classed as marginalised (weak national & ethnic identity) were at greater risk of schiz than ppl classed as strong national & ethnic identity)

Question 55

What are the weaknesses for Social Causation hypothesis?

Answer 55

Not a complete explanation of schizophrenia - There is genetic contribution to schiz - Suggests environmental factors may only trigger schiz in ppl who genetically already have it Social factors - Not having social support, instability in community, leading to social isolation. - Social factors can help explain schiz but its hard to know which social factors are involved as social factors interact & hard to isolate for study.

Question 56

What are the 2 type of antipsychotic drugs?

Answer 56

Atypical - Newer drugs, better and more effective - Reduce some negative symptoms (as well as positive symptoms) which typical doesn't - E.g. Clozapine Typical - Well established, old, established in 1950s - lots of unpleasant side effects - Does not work negative symptoms - E.g. Chlorpromazine

Question 57

What are the side effects associated with antipsychotic drugs?

Answer 57

- Sleepiness & Tiredness - Shaking & Muscle spasms - Low blood pressure - Problem with sex drive - Weight gain

Question 58

How do antipsychotic drugs work?

Answer 58

- Reduce the level of dopamine in areas associated with psychotic symptoms - Block D2 receptors which prevents dopamine binding - Depolarising the neuron

Question 59

What's a study from Meltzer et al (2004)? [Bio treatment for schiz]

Answer 59

Aim? - Looked at the effectiveness of drug treatment? Procedure? - Used 481 patients with schizophrenia & randomly assigned into groups - Groups given a placebo (pill looked like an antipsychotic but had no effect), typical antipsychotic; haloperidol or investigational drugs (4 new drugs) Results? - Haloperidol & 2 of the new drugs had reduced symptoms - Placebo & the 2 of the other new drugs were still the same [There are atypical antipsychotic drugs that are successful]

Question 60

What's a study from Guo et al (2011)? [Bio treatment for schiz]

Answer 60

Aim? - Look at 7 antipsychotic drugs used in the early stages of schizophrenia to establish their effectiveness & safety Procedure? - Involved with 1,133 people with schizophrenia - 7 drugs were used - Individuals were only taking one of the drugs - Measured the rate of discontinuing the treatment & clinical outcomes Results? - Similar % for all 7 drugs that stop taking the drugs - quetiapine being the largest & clozapine being the lowest - Chlorpromazine & sulpiride shows more extrapyramidal symptoms - Weight gain was more common in clozapine & olanzapine [Concluded: no drug was more effective than another]

Question 61

What's a study from Hartling et al (2012)? [Bio treatment for schiz]

Answer 61

Aim? - Looked at first & second generation medications for schiz Procedure? - Looked at studies using randomised trials - lasted for 2 years Results? - Haloperidol improved more positive symptoms than olanzapine, though olanzapine improved negative symptoms compared to haloperidol - Evidence of a higher risk of tardive dyskinesia for chlorpromazine as against clozapine → reflects Guo et al (2011): chlorpromazine showed more extrapyramidal symptoms

Question 62

What are the strengths for drug therapy for schizophrenia?

Answer 62

Pre-1950's treatments for schiz - Drugs are better compared to treatments for schiz before 1950s - more ethical & effective - E.g. Insulin shock therapy Rests on biological evidence - Rests on biological evidence about the causes of schiz so is supported by theory, helps considering the effectiveness - e.g. antipsychotic drugs target dopamine at the synapse - Carlsson et al (2000) Effectiveness of drug - clozapine is effective (improve delusions & hallucinations) even though it can have serious side effects (lower white blood cells count)

Question 63

What are the weaknesses for drug therapy for schizophrenia?

Answer 63

Discontinuing medication - Schizophrenic patients often don't continue taking the drugs that's prescribed - Guo et al. → over 30% - WHY? schizophrenic ppls might forget to take it regularly or side effects are too uncomfortable Ethical - Drugs described as "chemical strait jacket" & some think it the control by society is unacceptable Side effects - Side effects are unpleasant & the side effects itself can require medication - Typical drugs → tardive dyskinesia - Atypical drugs → weight gain - E.g. Clozapine (atypical) - people closely monitored with blood tests every 2 weeks to check their white blood cells (because white blood cells are lowered)