Clinical Flashcards
1
Q
What are the four Ds?
A
Danger
Deviance
Dysfunction
Distress
2
Q
What are the strengths of using the 4 Ds for diagnoses?
A
Using all 4 may help to avoid errors.
Can be used in conjunction to the classification manuals.
3
Q
What are the weaknesses of the 4 Ds in diagnoses?
A
there are no rules on how the 4 Ds should be used.
they are subjective measures.
4
Q
Features of the DSM
A
Diagnostic and statistical manual
The American book from the APA.
Describes symptoms, features and associated risk factors.
Contains 300 disorders in 22 categories
5
Q
Features of the ICD
A
Includes both Physical and Mental disorders by World Health Organisation.
Chapter 5 includes mental and behavioural disorders.
6
Q
How is a diagnoses made using the ICD 10?
A
Physical and mental disorders are coded in the same way.
clinicians identify symptoms of disorders through key words in an interview.
7
Q
arguments why using a manual for diagnoses is reliable/valid
A
inter-rater reliability.
concurrent validity in which two different tests produce the same sets of results.
8
Q
arguments why using a manual for diagnoses is unreliable/invalid
A
clinician factors such as bias.
cultural difference and individual difference as what counts as distress.
9
Q
what is the Kappa value?
A
A level of agreement statistic, 0.7 is ideal
10
Q
strengths of the ICD
A
has good predictive validity, Mason (97) ICD 10 was reasonably good at predicting disability.
has good inter rater reliability
11
Q
weaknesses of the ICD
A
proportion of people who retain the same diagnoses when reassessed was 55% for childhood disorders.
12
Q
what are the four key symptoms of Sz
A
thought insertion
delusions
hallucinations
disordered thinking.
13
Q
what is Grandiose
A
a delusion where the individual believed they have remarkable qualities
14
Q
what is comorbidity
A
the presence of more than one disorder.
15
Q
what are features of Sz
A
information about prevalence, age of onset, gender difference
16
Q
what is the Dopamine hypothesis
A
found Chlorpromazine was found to be helpful at in alleviating Symptoms of Sz, although tremors occurred much like Parkinson’s which is a condition caused by low levels of dopamine. Suggesting Sz symptoms are due to high levels of D
17
Q
Davis et al (dopamine hypothesis) where do the symptoms come from?
A
negative symptoms =lack of D in mesocortical pathway
positive symptoms = excess D is the mesolimbic pathway
18
Q
Clozapine and serotonin
A
Clozapine, blocks D receptors as well as serotonin receptors which greatly reduced positive and negative symptoms. suggesting Serotonin activity affects Sz symptoms.
19
Q
strengths of the dopamine hypothesis
A
Tenn (2003) gave rat 9 amphetamine injection over three weeks. rats showed Sz symptoms
cocaine induces Sz symptoms
20
Q
weaknesses of the dopamine hypothesis
A
apomorphine is a dopamine agonist and when taken should produce symptoms but does not suggesting that levels of dopamine do not induce Sz symptoms.
Veiling et al - social stress interacts with neuro chemistry making some people prone to psychosis.
21
Q
what is the other biological explanation for Sz?
A
genetic explanation
22
Q
what is the heritability of Sz (Hilker)
A
79%
23
Q
what specific genes have been linked to Sz
A
COMT gene and DISC1 gene
24
Q
how is the COMT gene linked to Sz
A
gene instructs the production of an enzyme which breaks down neurotransmitters. Deletion of this gene leads to poor regulation
25
how is DISC1 gene linked to Sz
people with an abnormality of this gene are 1.4 times for likely to develop Sz. Gene codes for GABA, which regulates neurotransmitters
26
what is the diathesis stress model in Sz
genes create a vulnerability, the condition is only caused by the triggering by another biological or environmental factor.
27
strengths of the genetic explanation in Sz
Gottesman analysed concordance rates for people with genetic similarity and found a relationship.
Research done by Dahoun found DISC1 associated with dopamine dysregulation
ATS - genetic counselling
28
weaknesses of the genetic explanation in Sz
the concordance rate for Sz is far from 100% in MZ twins.
29
what is the con ordnance rate in MZ and DZ twins for Sz
MZ = 42%
DZ = 9%
30
what is a non biological explanation for Sz
social causation theory
31
what is social causation theory in Sz
people around you is a major cause of Sz. risk factors include family dysfunction.
32
what is urbanity in Sz
long term exposure to city life makes someone more vulnerable to Sz due to criminality and noise
33
what is social adversity in Sz
some children grow up in unfavourable conditions which make them vulnerable. e.g, unemployment and poverty
34
what is a strength of social causation theory. in Sz
research shows a correlation between urban dwelling and Sz. Vassos, found people living in urban places were 2.37 times more likely to develop Sz.
ATS, housing projects.
35
weaknesses of social causation theory in Sz.
-the social drift hypothesis says it is not he socio-economic factor that develops Sz rather those with Sz cannot hold down a job which causes them to drift to poverty.
- not complete explanation of Sz.
36
what's is a biological treatment for Sz.
antipsychotic drugs.
37
what are typical drugs
drugs made around the 1950s, such as chlorpromazine which has lots of side effects
38
what are atypical drugs
drugs created around 1990s, such as clozapine that has fewer side effects and can treat both positive and negative symptoms.
39
how do antipsychotic drugs work in Sz
help reduce the levels of dopamine in areas of the brain associated with symptoms.they block dopamine receptors.
40
what do atypical drugs do different to typical drugs
they do not bind to receptors as tightly and also block serotonin receptors. this reduces the side effects.
41
strengths of drug treatment in Sz
17/19 of drugs better than placebo allows people to avoid emotional and financial costs of treatment
allows Sz people to have a life
42
weaknesses of drug treatment in Sz
research done on animals.
treatment may be selectively reported, showed that there is a publication Bias towards studies that show a positive outcome can lead doctors to making poor choice n treatment
43
what is a non biological treatment for Sz
CBT
44
what is CBT in Sz
a therapy that combines a cog approach with learning theory which aim to change behaviours
45
what is the aim of CBT in Sz
to help clients identify irrational thoughts and differentiate between 'confirmed reality' and 'perceived reaity'
46
how is CBT done in Sz
by questioning the clients delusions and hallucinations and rewarding positive behaviours such as being socially active.
47
strengths of CBT
for Sz
Nice (2014) showed that CBT reduced rehospitalisation rates for up to 18 months and also reduced the time in hospital
no side effects so people can go back to a normal life
48
weaknesses of CBT in Sz
McKenna compared CBT with other treatments and was only better 2 out of 9 times.
49
what is the aim of Rosenhans study
to demonstrate that psychiatrists were unable to distinguish the sane from insane.
50
what was the procedure of rosenhans study
3 females and 5 males presented themselves at psych hospitals hearing same sex, unfamiliar voice saying 'thud' and 'empty'
once admitted they acted normally and kept observations
51
what were the results of rosenhans study
7 diagnosed with Sz and 1 with bipolar.
average stay was 19 days and 30% of actual patients became suspicious.
52
what is the conclusion if Rosenhans study
that clinicians are unable to distinguish the sane from the insane
53
what is the contemporary study for Sz
Carlsson et al (2000)
54
what was the aim of Carlsson's study
to review evidence for and against the dopamine hypothesis of Sz
and explore the role of other neurotransmitters.
55
what does Carlsson say 'beyond dopamine'
it is unlikely that D is the only neurotransmitter that is associated with Sz, glutamate found in PCP induces Sz symptoms.
56
what does Glutamate do? - Carlsson
affects the release of GABA which acts as a 'brake' to reduce D activity
57
what are symptoms of unipolar depression
-feeling hopeless
-suicidal thoughts
-insomnia/hypersomnia
-loss of appetite
58
according to the DSM what are the requirements for diagnoses of depression
must present at least 5 symptoms for 2 weeks or longer
59
what are somatic symptoms
changes to physiological patterns such as sleep
60
what are prevalence rates
the number of people in a given population that have the disorder at any one time
61
what are some features of depression
-can occur at any age
- 3.3% in 2014of the population have it which is an increase from 2.7 in 2007
-more common in women than men
-23% of women getting treated for ovarian cancer have depression
62
weaknesses of diagnoses of depression
- is unreliable, full agreement pf diagnoses between clinicians is between 4-15%
-cultural difference, western clinicians may incorrectly diagnose
63
strengths of diagnoses of depression
-Shankman found substantial reliability of diagnoses when using the SCID to diagnoses severity of major depression
64
what is the monoamine depletion theory in depression
low levels of monoamines lead to depression.
65
what are the three monoamines
serotonin, dopamine and noradrenaline
66
what is a reason for low levels of monoamines
caused because the reuptake mechanism recaptures the neurotransmitters before they have a chance to reach the receptor
67
what is receptor sensitivity in depression
that drugs to not increase the level of neurotransmitters rather they increase the sensitivity of the receptors
68
what is the BDNF hypothesis in depression
a chemical that feeds neurons with nutrients. the lower the chemical in the hippocampus and prefrontal cortex, the more severe depression
69
what does BDNF stand for in depression
brain derived neurotrophic factor
70
how does BDNF link depression and stress
a gene for BDNF is switched off when stressed leading to shrinkage or death which is observe in depression
71
strengths of the monoamine hypothesis in depression
-made development in biochemistry and treatments to improve peoples quality of life
-evidence to support BDNF in post mortem brains, showed low levels of BDNF of people who has depression
72
weaknesses of the monoamine hypothesis in depression
-reductionist
-there is a delay in drug taking and symptom improvement
73
what is becks negative triad for depression
1-negative view of one self
2-negative views of the world
3-negative views about the future.
74
what is Ellis' ABC model for depression
Activating event
Belief about the event (irrational)
Consequence, anxiety
75
explanation of Becks cognitive explanation for depression
irrational thinking is a symptom of depression. if someone believes they are disliked they will reinforce negative views of themselves and their fore their future and the world
76
strengths of the cognitive explanation for depression
-Brown showed that there is a lot of evidence that link negative thoughts and depression
-have lead to effective therapies
77
what is the basis for the cognitive explanation for depression
irrational thinking
78
weaknesses of the cognitive explanation for depression
-Brown found symptoms rather than causes
-evidence from CBT show a fault in information processing not negative thought
- no identifiable risk factors
79
what do monoamine oxidase inhibitors do in depression
they remove enzymes that reuptake monoamines so they raise the levels of monoamines in the synapse
80
what do selective serotonin reuptake inhibitors do in depression
they block reuptake transporters so less serotonin is recaptured
81
what do serotonin-noradrenaline reuptake inhibitors do in depression
block both the rue-taker transporters for serotonin and noradrenaline
82
what do noradrenergic and specific serotonergic antidepressants do in depression
they bloc certain receptors so there is increased activity at certain receptor points that are associated with depression if reduces serotonin activity is seen
83
strengths of a biological treatment for depression
-meta analysis (Cipriani) found that these antidepressants did better than the placebo
-drug treatment authenticated depression as a medical disorder and not a person who is lazy reducing stigma
84
weaknesses of a biological treatment for depression
-help relieve symptoms but do not treat the cause making therapy more helpful
-induvidual difference inhibit the equality of antidepressants to all patients
85
What was the aim of carlsson
Provide more of an explanation for Sz that the dopamine hypothesis
86
What were the conclusions of Carlsson
Neurotransmitters aside from dopamine need more research
87
What were the results of carlsson
- as glutamate lowered dopamine increased
- glutamate failure in the cerebral cortex lead to negative symptoms
88
strengths of Carlsson
-Meta analysis was used
-used PET scans
-leads to new drug treatments
89
weaknesses of Carlsson
-used lots of animal studies
-secondary data
90
what are the key features of a case study
quan and qual data
study of individuals or multiple individuals
triangulation
91
strengths and weaknesses of a case study
- not generalisable
-is longitudinal
-in depth rich data
92
what are key features of an interview
semi structures, structured or unstructured
quan and qual data (open and closed questions)
93
strengths and weaknesses of interviews
-allows a relationship
-can ask follow up questions
however social desirability
94
what is an example of a case study
Lavarenna
95
what was the aim of Lavarenna et al
aims to explore sone of the groups core therapeutic actions against psychosis
96
what was the procedure of Lavarenna
a single session was carried out for 6 individuals with fragile ego boundaries and sz. they were called the Thursday group
97
what were the conclusions of Lavarenna
the individuals report that the sessions enable development of stronger ego defence which enables a relationship between self and others.
98
In Lavarenna what did the patients behaviour siuggest
Brett divides humanity into 'white' 'black' and 'yellow' so he can structure his fragmented his inner world
99
what are three features of Sz
-gender difference
-age of onset
-information about prevalence
100
what is the contemporary study on depression
Williams et al
101
what was the aim of the contemporary study on depression
investigate the effectiveness of a brig 7 day internet delivered CBM as a stand alone intervention for depression
102
what was the procedure of Williams et al
-69 Pp's randomly allocated to intervention group (38) or control (31)
- baseline measures were complete such as questionnaires T1
- intervention group carried out CBM and did measures again T2
- then they did 10 week CBT T3
- after the control group did their CBT.
103
what happened in CBM and the CBT for Williams et al
CBM - 20 min sessions over 1 week
CBT - six online lessons over 10 weeks with hw
104
what were the results of wiliams et all
Intervention BDM score from 28 - 18
While waiting was 28 to 24
105
strengths of Williams et al
various questionnaires lead to in depth data
ATS showed that their is not a need for costly face to face therapy
106
weaknesses of Williams et al
no active control group testing other therapy
used self report data which may not be valid
107
what is a cross sectional study
compares groups of Pp's at one moment in time, similar to independent measures.
108
what is meta analysis
a statistical analysis that combines the results of multiple studies
109
what are strengths of meta analysis
generalisable
rich data
110
weaknesses of meta analysis
researchers need to be sure results are reliable
all studies have different research methods so may not be comparable
111
what is the cognitive treatment in depression
CBT
112
how is CBT used in depression
questionnaires and interviews are used to measure levels of depression then goals are made to identify specific issues. the therapist will suggest and explain techniques to help the client.
113
strengths of CBT for depression
CBT was found to be just as effective as medication or interpersonal therapy.
CBT learns skills and techniques
114
weaknesses of CBT in depression
higher relapse rates that interpersonal therapy
lots of commitment
115
what was an interview study
Goldstein
116
what was the aim of Goldstein
to see if there was nay gender difference on readmission and length of hospital stays with people with Sz
117
procedure of Goldstein
199 men and women matched on age, marital states, occupation from New York
they were studied for 10 years
Goldstein used secondary data to find out the severity of the Pps disorder
Pps did not have a secondary mental issue
trained interviewers were uses to go over their diagnoses
118
results of Goldstein
women had fewer readmissions into the hostpital and has shorter stays if admitted
119
strength of Goldstein
longitudinal
men and women were matched to make finding valid
secondary and primary data was used
Repeated in Germany and similar results found in
120
weaknesses of Goldstein
-interviewer can affect answers by how they phrase questions
-only in New York and no one over the age of 45 was involved
