Clinical

Question 1

what are the 4Ds

Answer 1

-defiance
-dysfunction
-distress
-danger

Question 2

what is deviance?

Answer 2

those behaviours which re unusual, undesirable and bizarre. social norm statistics are gathered through age, gender, culture etc. and failure to conform to these norms shows psychological abnormality.

Question 3

what is dysfunction?

Answer 3

symptoms which distract, confuse or interfere with a persons ability to carry out their usual roles and responsibilities. can been seen as trouble getting up in the morning. measured through a questionnaire looking at a persons understanding on what is going on around them called WHODAS II.

Question 4

what is distress?

Answer 4

symptoms that cause emotional pain or anxiety, showing a diagnosis may be beneficial for this person. distress may be manifested as physical symptoms. distress will be looked at through a 10-item self-report questionnaire called the K10 to get an appropriate diagnosis.

Question 5

what is danger?

Answer 5

careless, hostile or hazardous behaviour which jeopardises the safety of the individual. if someone is seen to be a danger they can be detained through the mental health act which requires agreement from 3 professionals.

Question 6

strengths of the 4Ds

Answer 6

• all 4 can be used together to help avoid errors in diagnosis. this is important because a valid system needs to be neither over or under-inclusive.
• 4Ds are used in conjunction with classifications manuals such as the ICD or DSM. different disorder tend to display different combinations of Ds, meaning each of the 4Ds are used in diagnosis.

Question 7

weaknesses of the 4Ds

Answer 7

• they don’t lend themselves to objective measurement. lack of objectivity affects reliability. individuals are compared to society but it would be better if they were compared to a reference, control group. the clinician require detailed on the individual and their wider community to use the 4Ds meaningfully.
• we end up with labels for people with mental issues. Fazel (2009) people with schizophrenia aren’t more dangerous than people without the diagnosis. attitudes may become self fulfilling prophecies, stereotypes lead to people acting in the way they are stereotyped.

Question 8

symptoms of schizophrenia

Answer 8

• thought insersion
• hallucinations
• delusions
• disordered thinking

Question 9

features of schizophrenia

Answer 9

• lifetime prevalence is 0.3-0.7
• onset is earlier in males mid 20s and late 20s for females
  -prognosis hard to predict

Question 10

whais neurotransmitters as an explanation of schizophrenia?

Answer 10

• excess dopamine (hyperdopaminergia)
• dopamine deficiency (hypodopaminergia)
• serotonin causing negative symptoms
• dopamine dysregulation (striatum being the pathway to psychosis)

Question 11

what is hyperdopaminergia?

Answer 11

high levels of dopamine due to two reasons:
-low levels of beta hydrolyse- enzyme which breaks down dopamine, causing excess in synapse.
- proliferation of D2 dopamine receptors being responsible for hyperdopaminergia activity.

Question 12

what is hypodopaminergia?

Answer 12

davis et al (1991) suggests that positive symptoms of schizophrenia (delusions, hallucinations, thought insertion, disordered thinking) are from excess dopamine in the mesolimbic pathway. negative symptoms (flat effect) are from hypodopaminergia in the mesocortiyal pathway.

Question 13

what is serotonin causing negative symptoms?

Answer 13

clozapine binds to serotonin receptors and reduces positive and negative symptoms. hypothesis that negative symptoms are caused by irregular serotonin activity. serotonin also regulates dopamine levels.

Question 14

what is dopamine dysregulation?

Answer 14

Howes and Kapur (2009) states dopamine dysregualation in the striatum as the common pathway to psychosis

Question 15

strengths of neurotransmitter explanation of schizophrenia

Answer 15

• tenn et al (2003) found that rats given 9 amphetamine injections over three weeks showed various schizophrenia like symptoms. dopamine antagonists were successful in reversing these effects. shows increased dopamine levels cause schizophrenia symptoms.
• snyder (1985)- chlorpromazine acts as an antagonist at many doopamine receptors especially D1 and D2. Haloperidol is a dopamine antagonist with narrower range of biochemical effects yet more effective. this shows that excess activity of specific not all receptors causes development of schizophrenic symptoms.
• effective drug treatments- haloperidol reduce positive symptoms, clozapine reduces both positive and negative symptoms

Question 16

weaknesses of neurotransmitter explanation of schizophrenia

Answer 16

• depatie and lal (2001) showed that apomorphine agonist which stimulates D2 receptors does not induce psychotic symptoms, this challenges the suggestion that hyperdopaminergia causes positive symptoms
• cannot explain why certain groups in society are more likely to get diagnosed with schizophrenia, vexing et al (2008) showed moroccan immigrants were more likely to be diagnosed with schizophrenia than Turkish immigrants, shows environmental factors have an effect.

Question 17

cultural differences for mental disorders

Answer 17

• Gurland (1970) found that patients in the US were more likely to be diagnosed with schizophrenia or other disorders than patients in the UK. this was due to different cultural background of the clinicians affecting their interpretation of symptoms.
• Luhrmann (2015) interviewed 60 American, Indian and Ghanaian people with schizophrenia. 70% of Americans heard voices telling them to hurt people, 50% of Ghanaians had positive voices. only 20% of Ghanians has voices telling them to kill/fight. Indian people tended to hear family with guidance or scolding whereas only 10% of Americans said hearing family voices.
• Rastafarians use neologisms which re plays on English words such as overstated for understand.a clinician unaware of this may see it as disordered thinking.

Question 18

symptoms of anorexia nervosa

Answer 18

• restriction of energy intake
• fear of weight gain
• disturbed experience of body shape

Question 19

strengths of biological explanation of anorexia

Answer 19

• genetic explanation is supported by twin studies, holland (1988) found concordance rates of 56% fro MZ and 5% for DZ this shows genetic influence for disorders.
• Thorton (2010) little evidence that equal environments assumption is violated in twin studies
• understadning genetic basis of AN can help developments in prevention and treatment, early intervention and drug treatment.

Question 20

weaknesses of biological explanation of anorexia

Answer 20

• equal environments assumption, lacks validity, as we assume that MZ and DZ twins are treated equally. Joseph (2002) argues MZ are treated more similarly than DZ.
• wide variety of anorexia symptoms can’t be explained by a single gene, anorexia is polygenic, the explanation is reductionist as anorexia is a complex disorder.