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clinical Flashcards

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1
Q

DSM reliability (4 strengths)

A
  • Regier- 3 disorderes including PTSD had a Kappa score of 0.6-0.79 in the DSM field trials
  • Rosenhan- 7 participants diagnosed with schitzophrenia
  • DSM field trials- 0.46, Sartorious- ‘excellent’ Kappa score of 0.86 for sz
  • Sysko- test/retest reliability of AN diagnoses. Participants were assesed by phone interviews and re-assessed with a different assessor. Agreement levels were “excellent”
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2
Q

DSM reliability (weakness)

A
  • cooper- Levels of agreement have decreased. The DSM-5 task force classified levels as low as 0.2-0.4 as acceptable. MDD had a score of 0.28
  • Thomas- Researchers defined cut of points for significantly low weight because none was specified in the DSM-5. Reliability estimated in research studies are higher than in real life
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3
Q

DSM validity (strength)

A
  1. Kim-Cohen- aeteological validity (low income). Interviewed children with CD and used questionairs filled by teachers
  2. Kim-Cohen- predicive validity- 5 year olds with CD were more likely to display behavioural difficulties at the age of 7
  3. Symptoms of AN (loss of periods and sexual drive) were dropped from DSM-IV to DSM-5 as it excluded adults and prepubescent children
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4
Q

DSM validity (weakness)

A

Label- DSM tells us nothing about the causes. The arguments are circular

Ethnocentric- It was made for american soldiers in ww2, orientated around western culture. This may lead to a misdiagnosis in other countries

Smith- looked at the validity of the 4 severity specifers. In AN patients a higher BMI was linked to a greater eating disorder psychopathy- opposite to expected. DSM specifers fail to accurately distinguish between people

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5
Q

Aetiological validity

A

same casual factors for a diagnosis

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6
Q

Predictive validity

A

how well the measurement of one variable can predict the response of another variable

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7
Q

validity

A

the extent to which we accurately measured what we intended to measure

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8
Q

concurrent validity

A

when more than 1 technique leads to the same diagnosis

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9
Q

reliability

A

the consistency of measurements

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10
Q

Kappa score

A

the proportion of people who recieve the same diagnosis when assesed then reassesed
written in a decimal- 0.7 is seen as a “good agreement”

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11
Q

3 sections of the DSM

A
  1. offers guidance about the new system
  2. details the disorders and categorizes them according to our current understanding of the underlying causes
  3. suggestions for new disorders which require further attention
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12
Q

2 strengths of the non biological treatment for AN

A
  1. Fairburn- 30 participants had CBT-E or interpersonal psychotherapy. After 20 weeks, 65.5% of CBT-E ppts were in remission, 33.3% of IPT
  2. Application- ‘improvements’ create high anxiety levels. (intense fear of gaining weight). Brings rise to the need of extra ethical care and support
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13
Q

2 weaknesses of the non biological treatment for AN

A
  1. Fairburn- found CBT-E was more effective than other treatments. But all the “AN” participants had a BMI above 17.5 so lack’s generalisability and validity
  2. Carter- 45% dropout rate in his study. Effectivness is low as only the “completers” are included in research samples.
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14
Q

2 strengths of the non biological explanation for AN

A
  1. Guardia- 1PP had a mean perceived pasability ratio of 1.321 for AN ppts, 1.106 for the control group. Provides evidence for the idea of distorted body schema’s- overestimated their body size when imagine passing a doorway
  2. Leads to treatments like CBT-E. Fairburn- more effective than ippt- remission rates were 60% for CBT-E, 33.3% for ippt
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15
Q

2 weaknesses of the non biological explanation for AN

A
  1. Guardia- finding support idea of distorted body schemas. However lacks mundane realism as had to stand 5.9m away from door. Findings due to lack of realism rather than body schemas
  2. Cornelissen- morphing task (adjust an image of themselves until it matched their estimate of their body shape). Found no sig. difference between AN and controls
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16
Q

Evaluate the 4D’s of diagnoses (negative)

A
  1. Subjective- different social norms/ cultural differences- ‘hearing voices’ is seen as a symptom of schizophrenia for us but a spiritual experience for the maori culture.
  2. Labelling- ‘danger’ as a criterion leads people to think of mental illness patients as dangerous. The patient may be treated as dangerous and it becomes a self fufilling prophecy
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17
Q

Evaluate the 4D’s of diagnoses (positive)

A

accurate diagnosis- if deviance was the only consideration, those who are eccentric yet harmless maybe seen as abnormal, but those with common but debilitating symptoms may be missed (symptoms of depression)

All 4 d’s are used. Different disorders display different combinations. Deviance from statistical norms = intellectual disabilities, deviance from social norms, dysfunction and danger = antisocial personality disorder

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18
Q

Deviance results in behaviors seen as…

A

Unusual or undesirable that go againsed social norms e.g. theft or antisocial behavior

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19
Q

Danger results in behaviors that are…

A

Careless, hostile or hazardous that jeapodise the safety of themselves or other individuals that can result in sectioning

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20
Q

Dysfunction can lead to symptoms which…

is measures using

A

Distract, confuse or interfere with the ability to carry out usual roles e.g. completing tasks at work

WHODAS II

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21
Q

Distress results in symptoms that cause…

it is measured using…

A

Emotional pain or anxiety e.g. aches or pains. Its measures using K10- a 10 item self report questionnaire focusing on experiences in the past 4 weeks

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22
Q

4 stages of CBT-E

A
  1. ‘start well’- Identify the main behaviors relating to AN. Weekly weighing and eating plans are introduced
  2. Review process over 2 sessions and plan stage 3
  3. Dietary rules are broken down- shows that breaking the rules doesn’t produce negative consequences.
  4. ‘end well’- aims to maintain progress and prevent relapse. Weekly weighing continues at home
23
Q

2 strengths of the biological explanation for AN

A
  1. Holland- found concordance rates of 56% for mz twins but only 5% for dz twins.
  2. Application- its led to developments in prevention and treatment e.g. chlorpromazine. Knowledge of genetic profiles can be used for new drugs
23
Q

2 strengths of the biological explanation for AN

A
  1. Holland- found concordance rates of 56% for mz twins but only 5% for dz twins.
  2. Application- its led to developments in prevention and treatment. Knowledge of genetic profiles can be used for new drugs
24
Q

2 weaknesses of the biological explanation for AN

A
  1. equal environment assumption- mz twins are treated more similarly due to identical looks so many elicit more similar behaviors e.g. dietary habits and similar personality’s. Social factors
  2. Reductionist- AN cant be explained by 1 gene as there are a range of cognitive, physical and behavioral symptoms. AN is highly complicated
25
Q

2 strengths of the biological treatment for AN

A
  1. Boachie- treated 4 AN patients with Olanzapine. They experienced less anxiety at meal time and gained 1 kg per week with few side affects.
  2. provides a ‘crutch’ so symptoms can be masked while having other treatments that treat the root cause e.g. CBT-E
26
Q

2 weaknesses of the biological treatment for AN

A

Lebow- saw improvements in AN participants who took SGA’s but they were not significantly different from placebo group. The drugs were more associated with anxiety than than the control group.

Treat symptoms not causes- the reduction in symptoms would be worse/ reversed when the patient stops taking the drugs. As they only mask the symptoms, CBT should be used alongside drug therapy for the most effective results.

27
Q

ICD reliability (strengths)

A
  1. Ponizovsky- compared reliability of the ICD-9 and ICD-10, it was measures using positive predictive value (PPV is the proportion of people who get the same diagnosis when reassessed) For sz, PPV increased from 60-94.2%
  2. Galeazzi- 2 researchers conducted a joint interview to asses clients for psychosomatic symptoms. The Kappa values ranged from 0.69-0.97 showing high levels of agreement.
28
Q

ICD reliability (weaknesses)

A
  1. Reliability is meaningless without validity- reliability on its own tells us nothing without the true meanings of diagnosis. A patient can have more than one clinician diagnose them with the same disorder but if it is inaccurately diagnosis, reliability is useless.
29
Q

ICD validity (strengths)

A
  1. Mason- ICD was good at predicting disability in 99 people with schizophrenia 13 years later. This shows the initial diagnosis was meaningful in its ability to accurately predict future outcomes. Predctive validity
  2. Application- WHO- survey of clinicians, found a preference for simplicity and flexibility. ICD-11 will be cautious when adding new disorders and merge difficult to diagnose disorders which will make it more user friendly
30
Q

3 symptoms of anorexia nervosa

A
  1. reducing energy intake resulting in a BMI of <17.5
  2. intense fear of gaining weight leading to prevention behaviors e.g. excessive exercise or binge-purge
  3. body dismorphia- a distorted view of body size and shape
31
Q

3 features of anorexia nervosa

A
  1. highest mortality rate of all mental disorders
  2. females are 6X more likely to die from AN than males
  3. prevalence of 0.1% males and 1.7-3.6% in females
32
Q

EPXH2

A

codes for protein enzyme that metabolizes cholesterol. A mutation in this gene leads to higher cholesterol levels.

33
Q

DAT-1

A

Codes for a protein that regulates the transport of dopamine between the neuron and synaptic cleft.

A mutation leads to high levels of dopamine available for transmission, causing down regulation of receptors so eating is no longer a motivational behavior

34
Q

5- HTR2A

A

Codes for the serotonin receptor 5-HT2A. A mutation affects the structure of the receptor so less serotonin binds. This means that appetite related info is not transmitted

35
Q

ITPR3

A

Codes for a protein receptor involved in detecting taste such as sweet and bitter. A mutation means the person will not gain normal taste sensations so eating is not a pleasurable behavior

36
Q

3 positive symptoms of schitzophrenia

A
  1. hallucinations- involuntary, vivid experienced that occur in absence of any external stimuli e.g. visual= seeing a clown that isn’t there in real life
  2. thought insertion- believes their thoughts dont belong to them and have been implanted by an external source.
  3. delusions- fixed beliefs that don’t change with conflicting evidence e.g. their movements are being monitored by the police
37
Q

3 negative symptoms of schitzophrenia

A
  1. effective flattening- no ups and downs of emotion
  2. catatonic bebaviour- lack of mobility
  3. lack of motivation
38
Q

3 features of schizophrenia

A
  1. equally common in men and women
  2. prevelent in 1% of the population
  3. onset of 18 in men, 25 in women
39
Q

what is hyperdopaminergia

what drug can be used to treat it and what side affects does it cause

A

positive symptoms- excess dopamine in the mesolimbic pathway. chlorpromazine reduces schitzophrenic symptoms but caused sideeffects of parkinsons- tremors and muscle rigidity

40
Q

what is hypodopamenergia

A

negative symptoms- lack of dopamine in the mesocorticle pathway

41
Q

evaluate neurotransmitters as an explanation of schizophrenia (SODA)

A

S. Tenn- rats given 9 anphetamine injections showed schitzophrenic symptoms e.g. social withdrawal. Dopamine antagonists reversed the effects.

O. can’t explain why 2nd g immigrants are more likely to be diagnosed with sz. in the Netherlands, morrocan imigrants were more likely to be diagnosed with sz than than turkish immigrants

D. social explanation- highly populated urban areas

A. drug treatment- dopamine antagonists (bind to d2 receptors) can reduce positive symptoms, chlozapine can reduce both positive and negative symptoms.

42
Q

Evaluate genes as an explanation for schizophrenia- SODA

A

S. Gottersman- analysed concordance rates for people with different genetic similarity. Found that mz twins were highly correlated with both having sz.

O. equal environment- above lacks validity as mz twins are more likely to be treated more similarly because they are identical

D. Social- The longer a person is exposed to city life and the denser the population, the greater the risk of developing sz. Rural dwelling may protect a person from a disorder to which they are genetically predisposed.

A. Genetic counselling- family may want to know if the condition is heritable. ‘recurrence risk’ can be calculated and support can be provided.

43
Q

2 positives and 2 negatives of the biological treatment for schizophrenia

A

+ Empirical - meta analysis compared 18 antipsychotics. 17/18 had lower relapse rates than the placebo

+‘crutch’- enables patients diagnosed with sz to access other treatments and reduces the chances of hospitalization to allow patients to live independently

  • side effects- 20% sz sufferers will suffer from some form of disordered motor movement e.g. tremors or involuntary ticks. Newer drugs have less obvious everyday side effects but serious long term ones e.g. blood disorder
  • directive- clinition chooses the drug and dosage-they cant know which drug will be the most effective so it is a long process. Patients are likely to lose motivation and stop taking the drugs. Dropout rates are 50% in the first year
44
Q

rosenhan aim

A

aimed to reveal deep flaws in the process of psychiatric diagnosis by demonstrating that psychiatrists were unable to distinguish the sane from the insane

45
Q

rosenhan procedure

A
  • 5 male 3 female pseudopaients all complained of the same symptoms (same sex voice that was empty and hollow)
  • pseudonyms were used to protect the pseudo patients and those involved in psychology/ medicine gave fake info to avoid suspicion
  • if asked they said they no longer heard voices
  • approached 12 hospitals- east and west coast, some old , new, well staffed, understaffed, private
  • once admitted the pseudo patients behaved normally. in order to be released they had to convince staff they were sane, therefore behaved coorpiratively- followed orders from staff and chatted to patients
46
Q

rosenhan findings

A
  • all pseuodopatients were admitted, 7 diagnosed with schizophrenia, 1 with bipolar disorder
  • length of hospitalisation ranged from 7 to 52 days
  • 30% of patients on the ward voiced suspicions about the pseudo patients saying they were sane and perhaps journalists checking up on the hospital
47
Q

evaluate rosenhans study (positive)

A

+ecological validity- covert participant observation. pseudopatients observed physical abuse that stopped when other staff appeared.

+generalisability- 12 hospitals in 5 states on both east and west coast, including private, public, over and understaffed, old and new

+szas- mental illnesses are problems in living not diseases so its inappropriate to use a medical model. Rosenhan study supports this- patients were diagnosed even though they didn’t have anything

+Slater replicated study at 9 psychiatric wards- she was consistently diagnosed with psychotic depression

+reliability- all reported same symptoms

48
Q

Evaluate Rosenhan’s study (negative)

A
  • Reliability- only 1 pseudo patient per hospital
  • Demand characteristics- willingness to admit patient-psychiatrist wouldn’t suspect that someone might be pretending, so assumes everyone seeking admission has a good reason to do so
  • Ethics- clinicians made to feel incompetent, real patients may have been discriminated against due to clinicians believing they were fake, reputation of the psychiatry was damaged, potentially leading to vulnerable people failing to seek support
  • Slater- published in a non-fictional book. 96% psychaetrists said they would not have made this diagnosis
49
Q

guardia aim

A

test the hypothesis that people with anorexia overestimate their body size even when it is in action

50
Q

guardia procedure

A
  • 25 females with AN, 25 controls
  • matched for age and educational level
  • image of a 2 meter high door was projected onto a wall
  • 1PP- 5.9m from wall, turned sideways if they thought they couldn’t fit through the door
  • 3PP- participant had to decide if experimenter could fit through door without turning sideways
51
Q

guardia findings

A
  • mean perceived possibility ratio higher in AN than controls- 1.321- 1.106
  • 3PP- higher in AN but not significantly
  • AN scored higher on body dissatisfaction score
52
Q

guardia evaluation

A

+validity- matched for age and educational level

+reliability- all stood 5.9m away from door, all had a 2 meter tall door projected infant of them

  • ecological validity- lab study, 5.9 meters away from projection
  • validity- 3PP researcher’s body closer to controls

psychology (9 decks)

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