Clinical Flashcards

Question

Descriptive validity

Answer 1

Individuals diagnosed with the same disorder show similar symptoms, a high DV if the symptoms are only accurate for that disorder.

Answer 2

Individuals with the same disorder have similar causes for their behaviour

Answer 3

Using more than one method or technique to diagnose

Answer 4

Used to help determine when a mental issue is considered a mental disorder, giving treatment implications. It involves deviance, dysfunction, distress and danger

Answer 5

Deviant behaviours are those that are unusual or undesirable, therefore an understanding of the social norms and context are required to evaluate it. The failure to conform to social norms may lead to negative attention so is a good indicator of psychological abnormality.

Answer 6

Symptoms which distract, confuse or interfere with a persons ability to carry out their usual roles and responsibilities (such as working or socialising). The WHODAS II is one of the main questionnaires used to measure dysfunction.

Answer 7

Symptoms that cause emotional pain or anxiety, as well as physical symptoms such as always feeling tired. However distress can be normal in some scenarios so context is important before a diagnosis can be given. The Kessier psychological distress scale (a ten item questionnaire) is used to help determine the length and intensity of the distress.

Answer 8

Careless, hostile or hazardous behaviour that jeopardises the safety of the individual or others.

Answer 9

High validity - the model is neither over or under inclusive, when all four Ds are used in the diagnosis. If only one was used (such as deviance an erratic person may be diagnosed yet somebody with depression may not be) Objective measurements e.g the Kessier psychological scale are used, increasing reliability

Answer 10

Can be subjective - deviance is subjective as it is dependent on statistical and cultural norms, decreasing validity Inconsistencies in the expression of the Ds - inconsistencies in how distress is displayed and is caused between people, clinicians need to know the context Language may result in labelling - using danger as a criterion may lead to negative labelling and ultimately self-fulfilling prophecy.

Answer 11

Good levels of agreement - Regier et al (2013) High validity - Kim-Cohen et al (2005)

Answer 12

Diagnosis says nothing about the causes of the disorder, the result of a diagnosis is simply a label that says nothing useful (such as how to treat it based on its causes) Falling standards - Cooper et al (2014)

Answer 13

Reported that three disorders had kappa values from 0.6-0.79 (very good) and seven more had values from 0.4-0.59 (good). This is important as the criterion for these disorders have changed over time, shows that the DSM-5 is reliable due to high levels of agreement

Answer 14

Demonstrated the concurrent validity of (CD) through interviewing children and mothers, observing the children's behaviour and questionnaires from teachers. Specific risk factors showed aetiological validity and predictive validity was also shown as five year olds with CD were more likely to show behavioural difficulties at age seven. Shows high validity in some orders in the DSM.

Answer 15

Showed that what counts as acceptable agreement has decreased over time. The DSM-5 taskforce classified levels as low as 0.2-0.4 as acceptable, therefore it may be less reliable than previous DSM editions, with some diagnoses being made in error or being missed

Answer 16

A psychotic disorder characterised by positive symptoms such as delusions, hallucinations and disorganised thinking. The DSM requires at least two of the four main symptoms for a diagnosis to be made and one month of active symptoms, with six months of disturbance to everyday functioning

Answer 17

Though insertion Hallucinations Delusions Disorganised thinking

Answer 18

When a person believes that their thoughts do not belong to them and have been planted by an external source, they experience a blurring of the boundaries between themselves and others believing it to be permeable.

Answer 19

Involuntary, vivid and clear perceptual experiences that occur in the absence of any external stimuli. They can be visual, olfactory, somatosensory or auditory (which are most common, with people hearing voices that are not their own inner voice).

Answer 20

Fixed beliefs that are not amenable to change even in the light of conflicting evidence. They may be related to everyday life (thinking the police are watching you) or be more bizarre (thinking an alien is trying to remove your brain).

Answer 21

Is inferred from a person's speech, which may be characterised by derailment (having a series of unrelated ideas) or tangentiality (going off on a completely different topic). The person may switch from one topic to another or jumble seemingly unrelated ideas, word salad refers to apparently random and incoherent stringing together of words and neologism to the blending of words together to create new words. Mixing up words can be common so it is only symptomatic if it leads to dysfunctional communication.

Answer 22

Lifetime prevalence 0.3-0.7% (varies with ethnicity and nationality) Onset - males (early to mid 20s), females (late 20s) Prognosis - males poorer than females (a minority recover completely but positive symptoms tend to reduce over time with the negative symptoms remaining.)

Answer 23

Regier et al (2013) reported a kappa score of 0.46 (good) using the DSM-5 while Sartorius et al (1995) used the ICD-10 to quote a score of 0.86. Only 3.8% of clinicians said that they lacked confidence in their diagnoses using the ICD-10. However it is not easy to diagnose as many symptoms are shared e.g. hallucinations with drug withdrawal

Answer 24

It can be difficult to diagnose if the client is from a different cultural background to the clinician. For example, Rastafarians often use neologisms that are a play on English words, however a clinician that was unaware of this may think that they showed disorganised thinking , reducing the accuracy of diagnosis.

Answer 25

Specific genes - EPHX2, ITPR3, DAT1, 5-HTR2A Twin studies - Holland et al (1984)

Answer 26

Studied 192 families, where one family member had received an AN diagnosis and another had been diagnosed with an eating disorder. No significance until they looked at the sub-group of 37 families with two members diagnosed with restrictive AN.

Answer 27

Heritability of AN is 70%

Answer 28

Anorexia nervosa is rare in first-degree relatives of those that have never had an eating disorder, but is 11.3 times more likely in those that did.

Answer 29

Codes for the enzyme epoxide hydrolase, a mutation may lead to a change in the active site of the enzyme, disrupting the metabolism of cholesterol. People with anorexia likely to have high cholesterol (maybe less impulse to eat)

Answer 30

Codes for a taste receptor (sweet and bitter). Mutation may lead to faulty receptor, people with AN may have less motivation to eat because it tastes weird.

Answer 31

Codes for a dopamine transporter protein (re-uptake channel), a mutation may lead unusually levels of dopamine desensitising the reward pathway and leading to down regulation. Less motivation to eat

Answer 32

Codes for a serotonin receptor, a mutation may lead to less motivation to eat

Answer 33

EPHX2 gene was faulty in people with anorexia compared controls (1200 compared to 1900). However no cause and effect

Answer 34

Polygenic - not solely down to the influence of a single gene, AN is a complex disorder three different criterion New science and technology (isolating genes), reductionist approach and needs to be developed

Answer 35

30 female pairs (16Mz, 14Dz), four male pairs and one set of male triplets, selected as one member was diagnosed with AN. High concordance (55%) for Mz female twins compared to 7% for Dz twins. Significant Equal environment assumption decreases validity

Answer 36

Distorted body schemas Irrational beliefs Impaired global and enhanced local processing

Answer 37

Gadsby (2017). Our body schema is our mental image of what our body's own shape and size, people with AN have a distorted one seeing themselves as bigger than they actually are

Answer 38

Steinglass (2007) suggests that people with AN have the dominant core belief of fearing gaining weight or becoming fat, for some this is so extreme that it is delusional. This can make them resistant to treatment

Answer 39

Enhanced local processing - have an eye for detail, readily perceiving and focusing on tiny flaws Impaired global processing - the ability to integrate details into a meaningful overall pattern, people with AN find it difficult to see the bigger picture and are unable to perceive their overall body shape accurately

Answer 40

Guardia et al (2012) Sachdev et al (2008)

Answer 41

Tested brain activity levels using fMRI, finding a difference between activity levels in AN patients when looking at images of their own bodies.

Answer 42

Long et al (2016) - explanation lacks validity as it does not explain the causes of AN Cornelissen et al (2013) - challenges the role of body image distortion

Answer 43

No difference between recovered AN patients and non-AN control participants on the ROCFT, a measure of global and local processing. Concluded that weak central coherence could be due to starvation in AN rather than causing it, explaining why it may disappear after recovery.

Answer 44

Compared AN and control participants on a morphing task, adjusting a computerised image of themselves until it matched their own estimate of body size. No significant difference between AN participants and controls.

Answer 45

CBTE - enhanced cognitive behavioural therapy

Answer 46

Used to tackle behaviours associated with distorted behaviours towards food and eating Usually 20 sessions with four defined stages (Murphy et al 2010) Fairburn (2008) adjusted CBT to CBTE as a therapy for all eating disorders on an outpatient basis

Answer 47

Introduces a weekly weigh in (they cannot weigh anywhere else) and regular eating (by creating an eating plan, giving a daily routine). Usually takes four weeks with two sessions a week

Answer 48

Reviewing progress over two sessions Barriers identified and planning for stage 3

Answer 49

The main stage of treatment that will take approximately 8 sessions Identify the ways that the clients self-evaluation is dependent on body weight and shape, learning how to focus on other parts of life Dietary rules (current) are identified and the therapist helps the client to break them

Answer 50

Aims to maintain progress and prevent relapse Weekly weigh ins continue at home and working together in a plan for the next twenty weeks, before a follow up session The client continues with strategies such as rule breaking and avoiding body checking.

Answer 51

Fairburn et al (2015) Cooper et al (2016)

Answer 52

Randomly allocated 130 participants with eating disorders to either CBT-E or IPT. After 20 weeks 65.5% of CBT-E patients and 33.3% of IPT patients were judged to be in remission. After 60 weeks 69.4% for CBT-E and 49% for IPT.

Answer 53

The people with the longest duration of the disorder, as well as the people with the greatest pre-occupation for body shape had worse outcomes.

Answer 54

Soderston et al (2017) High drop out rates - (Carter et al 2012) it is a demanding therapy that requires commitment from the client (homework and attending sessions) as well as making difficult changes to their thoughts and behaviours. Not effective on everyone - NICE recommends it for use on adults, and all of Fairburn's participants had a BMI of over 17.5

Answer 55

Compared CBT and a 'normalisation of eating' procedure. They found a remission rate of 75% and relapse of 10% over five years compared to 45% and 30% for CBT.

Answer 56

Found a 45% dropout rate for a CBT-E programme. This decreases the effectiveness as only the participants that complete a course are included in the results

Answer 57

Drug treatments - biochemical mechanisms (such as neurotransmitters) are known to underly the disorder therefore altering or stabilising these mechanisms may benefit AN symptoms Antipsychotics Antidepressants Second generation antipsychotics (SGAs)

Answer 58

Dopamine antagonists as dopamine levels are thought to be abnormally high in people with AN. They block some post-synaptic dopamine receptors reducing the activity of the dopamine symptom. This helps to counter the distorted cognitions of fatness (similar to schizophrenic delusions) and reduced appetite

Answer 59

Reduce the uptake of serotonin at the synapse, increasing its availability in neurotransmission, extending the appetite enhancing effects of serotonin. This would help as low serotonin is thought to play a role in the disorder.

Answer 60

Affect the activities of several other neurotransmitters apart from dopamine and are a current, promising research focus. This includes the drug olazapine, which has the well known side effect of weight gain. It is a powerful antagonist of dopamine as well as a weak antagonist of serotonin

Answer 61

Boachie et al (2003) Application to managing drug side effects - knowing about side effects means that they can be managed, increasing the likelihood of sufferers continuing treatment

Answer 62

Used olanzapine to treat four children with AN, these children gained significant amounts of weight (a kilo a week) and experienced less anxiety at mealtimes when on the treatment

Answer 63

Kafantaris et al (2011) Lebow et al (2013) Drugs treat symptoms and not causes - they may treat the symptoms but not the causes, therefore it is only a temporary fix that could be reversed if they stop taking the drug

Answer 64

Found that 15 adolescents given olanzapine gained weight and showed improved eating attitudes but so did the control group at the same rate

Answer 65

People with AN that took SGAs showed increases in BMI and body satisfaction, however these were not significantly different from the placebo group. Drugs were also associated with greater anxiety and worse overall symptoms than controls

Answer 66

To reveal what he saw as flaws in the process of psychiatric diagnosis. To provide evidence that mental health disorders did not lie within the individual but within the diagnosis

Answer 67

Eight pseudo patients (5 male, 3 female including a psychology student, paediatrician, painter and three psychologists) Each presented themselves at a psychiatric hospital complaining of the same symptoms (hearing a same sex, unfamiliar and unclear voice that said words such as 'empty', 'hollow' and 'thud' that are not normally associated with schizophrenia) Pseudonyms used to protect the pseudo patients and those involved with psychology or medicine gave false professions to avoid suspicion, all other information provided was true and if asked they said the voices had stopped. In total they approached twelve hospitals in five states Once admitted they behaved normally, as in order to be released they had to convince staff that they were sane They kept records of their observations, initially in private but later in public

Answer 68

After the initial study hospitals wanted to show that they couldn't be tricked so Rosenhan agreed to send more pseudopatients to see if they would be identified (none were sent) Staff had to rank all patients 1-10 where 1 was high confidence that the patient was fake

Answer 69

Pseudopatients approached a staff member at a hospital and asked a courteous question about their release, compared to asking a member of staff a question at Stanford university campus

Answer 70

All pseudopatients were admitted to hospital (seven with schizophrenia and one with bipolar disorder) When released they were said to have schizophrenia in remission The length of stay ranged from 7-52 days with an average of 19 30% of patients in the wards voiced suspicions on the pseudopatients

Answer 71

At least one member of staff (psychiatrist or nurse) reported with high confidence that 41/193 were fake, 23/193 were reported by at least one psychiatrist and a further 19 were reported by both

Answer 72

Only 4% received an answer from a psychiatrist and 0.5% from a nurse, compared to 100% on university campus

Answer 73

We cannot distinguish between the sane and insane in psychiatric hospitals, the hospital creates situational factors that led to the depersonalisation and segregation of patients. Overdiagnosis was because clinicians avoided calling sick people healthy, however in the follow up they learnt that a more benign environment may lead to less distorted perceptions of participants

Answer 74

High ecological validity - covert participant observation increased the validity of the findings. Application to the DSM - the study led to changes being made to the DSM, through the defining of mental disorders.

Answer 75

Demand characteristics - the psychiatrists would not expect anybody to pretend that they had symptoms, assuming that everyone that seeks admission would have a good reason to do so. This may challenge some of the conclusions. Low generalisability - a limited sample of hospitals were used and only a small number of individuals were pseudo patients, limiting the generalisability as culture has been shown to affect diagnosis.

Answer 76

An excess of the excitatory neurotransmitter dopamine, caused when vesicles release dopamine too easy and often. Amphetamines are agonists (increase the action of) dopamine, if normal people take them then they suffer similar symptoms to schizophrenics including hallucinations. This shows that schizophrenia may be the result of excess dopamine. Antipsychotics reduce the mode of action of dopamine (binding to their receptor sites on the post-synaptic neurone) and have been found to reduce schizophrenic symptoms

Answer 77

Hyperdopaminergia - reduced beta hydroxylase (enzyme that breaks down dopamine in the synapse) leads to an increased likelihood of binding to the proliferation of D2 receptors on the post-synaptic neurone

Answer 78

Hyperdopaminergia explains positive symptoms of schizophrenia (hallucinations, distorted thinking, delusions and thought insertion), finding that schizophrenics with positive symptoms have increased dopamine in the meso-limbic pathway. Hypodopaminergia explains the negative symptoms (flat affect, alagia)

Answer 79

Carlsson et al (2000) reviewed the findings of other studies finding that clozapine (antipsychotic) binds to D1 and D4 receptors but weakly to D2 receptors to reduce positive symptoms, however from existing knowledge we know that schizophrenics have high levels of D2 receptors suggesting that dopamine as a cause is reductionist. It also binds to serotonin receptors reducing both positive and negative symptoms as serotonin regulates dopamine in the meso-limbic pathway

Answer 80

Tenn et al (2003) Zhao et al (2016)

Answer 81

Veling et al (2008) Insel (2010)

Answer 82

Rats given nine amphetamine injections over three weeks showed schizophrenic symptoms, which can manifest itself as social withdrawal or stereotypical movements. Dopamine antagonists were successful in reversing these effects

Answer 83

Conducted a meta-analysis comparing 18 antipsychotics from 56 randomised control trials with over 10,000 participants. They found that the antipsychotics tested had significantly lower relapse rates than placebos

Answer 84

Showed that Moroccan immigrants were more likely to be diagnosed with schizophrenia than Turkish immigrants in the Netherlands, this correlates with the amount of actual and perceived discrimination received by each group. The neurotransmitter explanation could not explain this.

Answer 85

Individuals with early onset schizophrenia often exhibit similar pre-diagnosis symptoms, specifically not hitting cognitive milestones. There is also a genetic overlap between individuals developing autistic symptoms from age three and schizophrenic ones from age 18, supporting an epigenetic role

Answer 86

To look at the relationship between schizophrenia and dopamine To look at glutamatergic deficiency

Answer 87

Using secondary data (meta-review) A number of studies used PET scans Overactivity of a neurotransmitter, would lack radioactivity, underactivity would appear yellow and red

Answer 88

Neurotransmitters interact and affect each other (looked at glutamate and serotonin as well as dopamine) Focused on glutamate because drugs like PCP and ketamine produce psychotic symptoms but affect glutamate receptors (NMDA) instead of dopamine ones. Lodge et al (1989) Glutamate seems to regulate the behaviour of dopamine in the brain, when glutamate is high dopamine is low. Miller and Abercrombie (1996) showed that the release of dopamine is increased if glutamate activity is reduced Low levels of glutamate seem to relate with both positive (low levels in the striatum) and negative symptoms (low levels in the cerebral cortex)

Answer 89

Found that glutamate activity at the NMDA receptors produces psychotic responses in rats and humans

Answer 90

Suspect that there are different sub populations of schizophrenia patients whose symptoms have different biological explanations, including a particular attention to those with glutamatergic deficiency

Answer 91

Application to the development of new drug treatments - glutamate agonists used to reduce both positive and negative symptoms of schizophrenia. By tackling neurotransmitters more directly side effects are also reduced, reducing dropouts from treatment High reliability - Svensson and Carlsson (1990)

Answer 92

Gave mice a drug to reduce motor activity and then one to reduce glutamate and increase serotonin and dopamine levels. This resulted in highly abnormal psychotic like behaviour

Answer 93

Gogos et al (2015) Low generalisability - a person in remission is more likely to complain about side effects than during acute episodes, research needs to consider a wider range of phases Luhrmann (2018)

Answer 94

The experience of woman may be different due to the neuroprotective role of oestrogen which appears to regulate glutamate, serotonin and dopamine. Woman also have a later average onset and better prognosis

Answer 95

70% of American people said their voices told them to hurt people, whereas 50% of Ghanaians said that their voices were mainly positive and only 20% said they told them to kill or fight. This shows that the symptoms present differently dependent on culture

Answer 96

Hilker et al (2018) Wright (2014) COMT gene DISC1 gene Diathesis stress model Epigenetics

Answer 97

Heritability of schizophrenia is 79%, there is a high genetic influence

Answer 98

As many as 700 genes are linked to the development of schizophrenia

Answer 99

The COMT gene codes for the enzyme catechol-O-methyltransferase, which breaks down neurotransmitters, including dopamine in the pre-frontal cortex. The deletion of this gene would result in the production of the enzyme stopping, leading to less dopamine regulation and hyperdopaminergia (linked with positive schizophrenic symptoms)

Answer 100

Egan et al (2001)

Answer 101

Found a link between decreased dopamine in the pre-frontal cortex and the 'val' allele of the COMT gene. Concluded that having two copies of the allele increased the risk of schizophrenia by 50%

Answer 102

Codes for the creation of GABA, a neurotransmitter that regulates dopamine and glutamate. Dysfunction of the gene can lead to hyperdopaminergia, which has been linked to positive schizophrenic symptoms

Answer 103

Kim et al (2012) Dahoun et al (2017)

Answer 104

People with an abnormality in the DISC1 gene are 1.4 times more likely to develop schizophrenia

Answer 105

Conducted a review of 14 studies concluding that DISC1 was associated with pre-synaptic dopamine regulation.

Answer 106

Schizophrenic correlated genes may be present but the development of the disorder only occurs due to the presence of other biological or environmental factors. These include cannabis, seven times more likely to develop schizophrenia due to interference with the dopamine system.

Answer 107

Tienari et al (1994)

Answer 108

Conducted a 21 year longitudinal adoption study, supporting the diathesis stress model. Adopted children whose biological mother had schizophrenia were more sensitive to family dysfunction in the adoptive home than those from low risk matched backgrounds

Answer 109

Suggests that genes can be turned on or off due to environmental stressors, changing the way that the genetic code is expressed.

Answer 110

Sussar and Shang Lin (1992) Pederson and Mortenson (2006)

Answer 111

Found that pregnant women during the Dutch famine of 1944 went on to have low birth weight babies, which were more than twice as likely to develop schizophrenia than normal.

Answer 112

Stated that the longer a person is exposed to city life and a higher population density, the more likely they were to develop schizophrenia

Answer 113

Gottesman and Shields (1966) Application to genetic counselling - recurrence risk can be calculated to determine the risk of the heritability of the disease, affecting family planning

Answer 114

Identified a concordance rate of 42% for Mz twins compared to 9% for Dz twins, showing the genetic role in the development of schizophrenia.

Answer 115

Gottesman and Shields (1966) - equal environment assumption, correlational study (not causal, diathesis stress model shows that other factors may account for this difference)

Answer 116

Social adversity Urbanicity Social isolation Immigration and minority status

Answer 117

Some children grow up in environments that are less favourable than others, making them more vulnerable to mental health disorders. For example, families exposed to unemployment and poverty may be exposed to more stress. People from lower socioeconomic groups may also not have access to treatment for schizophrenia.

Answer 118

Eaton (1974) Increased population density makes life more competitive, increasing the stressor of chronic social defeat, a stressor which may elicit schizophrenic symptoms.

Answer 119

City life is more stressful than rural life and long term exposure to such stress may trigger an episode of schizophrenia. These stressors include, noise, pollution, criminality and greater anonymity

Answer 120

Faris (1934)

Answer 121

Suggested that people with schizophrenia withdraw because they feel that contact with others is stressful. This self-imposed isolation cuts the individual off from feedback about what behaviours or thoughts are inappropriate and in the absence of corrective feedback they begin to behave weirdly.

Answer 122

Boydell et al (2001) Veling (2008)

Answer 123

Research in many countries has shown that first and second generation immigrants are at greater risk of schizophrenia than the general population. However, this risk decreases as the number of people from that same ethnic background increases.

Answer 124

Schizophrenia may be a reaction towards the chronic experience of prejudice and discrimination. Second generation immigrants have a greater risk because they have a weaker cultural identity.

Answer 125

Vassos et al (2012) Veling et al (2010) Application to treating schizophrenia - can help deal with schizophrenia by drawing attention to factors affecting mental health at the community level. Housing projects reduce overcrowding and encourage neighbourhood cohesion.

Answer 126

Not a complete explanation - Gottesman and Shields show a genetic contribution to the development of schizophrenia, suggesting that environmental factors may only trigger the onset of the disorder in those that are genetically predisposed Data is correlational - no causation between urbanicity and adversity and the development of schizophrenia. Social drift hypothesis suggests the opposite, people with schizophrenia find it hard to hold down a job, leading them to drift into lower social classes.

Answer 127

Performed a meta-analysis of data from four studies conducted in Sweden, Denmark and the Netherlands, including nearly 24,000 cases of schizophrenia. They found the risk was 2.37 times higher for people living in the most urban areas compared to those in the most rural.

Answer 128

Found that people classified as marginalised (weak national and ethnic identity) and assimilated (strong national but weak ethnic identity) were at greater risk of schizophrenia than those that were classed as integrated (strong national and ethnic identity) or separated (weak national but strong ethnic identity). Suggests that a strong ethnic identity may be a protective factor against schizophrenia.

Answer 129

Drugs - antipsychotics

Answer 130

Dopamine agonists which greatly reduce positive symptoms by blocking post-synaptic dopamine receptors. FGAs also have some unpleasant side effects such as tardive dyskinesia, potentially leading to poor compliance and subsequent relapse Barlow and Durand (1995) E.g. chlorpromazine

Answer 131

Although FGAs are effective in reducing positive symptoms, as many as 40% see no effect at all. Many others also experience negative symptoms

Answer 132

Block dopamine receptors but also act upon serotonin and glutamate receptors. This reduces both positive and negative symptoms. E.g. clozapine Lally and MacCabe (2015)

Answer 133

One side effect is the blood condition agranulocytosis, however the drug is still useful with treatment resistant clients. It provides up to 60% relief for such people

Answer 134

Patel et al (2014)

Answer 135

Review on the efficacy of medication for schizophrenia, explaining that it is important to start medication use quickly to be effective. In the first seven days after a psychotic episode the objective is to decrease hostility and return the client to normal functioning. The individual is carefully monitored for side effects and changes in symptoms. Once the symptoms have begun to subside a maintenance dose is prescribed to combat relapse (18-32% in those that do and 60-80% in those that don't).

Answer 136

Amphetamines, alcohol, caffeine and nicotine can all disrupt the effectiveness of anti-psychotic medications, therefore support for substance use may also be considered through treatment.

Answer 137

Zhao et al (2016) Application to deinstitutionalisation - drugs have meant that people with schizophrenia have been able to live in society instead of living in institutional care

Answer 138

A meta-analysis comparing 18 anti-psychotics utilising data from 56 randomised control trials with over 10,000 people. They found that 17 of the anti-psychotics tested had significantly lower relapse rates than placebos.

Answer 139

Kapur et al (2000) Turner et al (2012) Drugs treat symptoms and not causes, the effects will be reversed once the client has stopped taking them

Answer 140

Cautions against overgeneralising from animal studies. High doses of medication can be given to animals so that D2 receptors can be effectively blocked out, but this would lead to severe side effects in humans. Such research may show how symptoms are reduced but not how side effects would interfere with everyday life.

Answer 141

There is publication bias towards studies that show a positive outcome for anti-psychotic drugs, therefore the effectiveness is exaggerated. Drug companies have a strong interest in the continuing success of antipsychotics and fund much of the research

Answer 142

Thoughts identified as irrational The therapist teaches the patient coping skills to cope with their symptoms Decompensation - preventing schizophrenics from retreating into their delusions

Answer 143

A - activating event (first experience) B - leads to either rational or irrational beliefs C - leads to consequences The ABC model traces the origin of the patients symptoms helping them to understand them

Answer 144

Evaluating and disrupting the content of irrational thoughts - done by assuming the thought is true and breaking down the rational

Answer 145

The therapist sets tasks for the patient to do and feedback on

Answer 146

Directive - the patient decides whether to complete the homework or not Effectiveness - NICE (2014) Side effects - Kuipers et al (1997) Expense - more cost effective than other talking therapies due to limited umber of sessions (16), solves problems payment for drugs is constant Reasons - looks at underlying reasons for the disorder Types of people - Addington and Addington (2005)

Answer 147

Meta analysis showed that CBT reduced rehospitalisation rates for 18 months and reduced the amount of time in hospital. Symptom severity and psychological functioning also improved

Answer 148

Randomised control of CBT, finding that drug resistant clients improved when given CBT.

Answer 149

In the acute phase (sever symptoms) self reflection is not appropriate, however once stabilised CBTp is an effective treatment

Answer 150

Directive - therapist is in control of the tasks set and determine which beliefs are irrational Effectiveness - Jauhor et al (2014) Side effects - behavioural experiments may cause high levels of stress and anxiety. Expense - more expensive than drug therapies due to high levels of training Reasons - reductionist - focuses on thought processes controlling the behaviour (not all of which are conscious) Types of people - Kingdon aand Kirschen (2006)

Answer 151

Large scale meta-analysis found a small therapeutic effect on key symptoms, however these disappeared when the study was blind (researchers did not know who was getting CBTp)

Answer 152

Investigated 142 schizophrenic patients within a psychiatry hospital, finding that many were not suitable for CBTp because they have to want to change

Answer 153

Lavarenne et al (2013)

Answer 154

Used an outpatient therapy group to describe how a group can provide a firm boundary within which individuals can explore their own fragile ego boundaries

Answer 155

The therapy group met consistently and usually consisted of ten members that had a vulnerability to psychosis. Four members were not present at the session used as the casestudy. All members were receiving drug treatments, and the sessions were not taped or recorded but the emotions expressed and verbal content was coded

Answer 156

Earl - rejected gifts from Brett, potentially representing his fear of being annihilated. He responded by discussing a multi-national oil project that was interpreted as an attempt to hold the pieces of his self together, identifying a boundary between himself and the others Dan - had been silent for the first six months attending the group, but did not stop talking. Told the group that he had an out of body experience

Answer 157

The notes from sessions show that all patients were working hard to hold themselves together. Interactions with other people threaten their fragile boundaries, so they cut themselves off from human relations

Answer 158

In depth look at one group (outpatient therapy group) Looked at unusual behaviours (all had vulnerability to psychosis) Emotions expressed and verbal content were coded (qualitative data collected and turned into quantitative data) Focused on one individual session

Answer 159

Confidentiality may be impaired (named Brett, Earl and Dan in findings) No before and after comparison (lack of generalisability) Therapists conducted the group (may lock objectivity)

Answer 160

Vallentine et al (2010)

Answer 161

Investigated the usefulness of psycho-educational material provided via group work for offender patients in a high security psychiatric hospital

Answer 162

42 male patients detained under the mental health act, referred to understanding mental illness psycho-educational group as they were judged to be able to gain from further information. Using ICD-10 80% diagnosed with schizophrenia, they took part in four 20 session groups over three years. Two outcome measures given to pre and post group: Self concept questionnaire - 30 item questionnaire measuring self esteem Semi-structured interview - to evaluate patients experience of the group

Answer 163

Used content analysis, subjective identification of themes Recorded data - reanalysed by a second researcher, 60% level of agreement Semi-structured interview - different experience for each participant