clinical

Question 1

what is diagnosis and what are the 4 D’s of diagnosis?

Answer 1

Diagnosis - a clinical assessing a patient, deciding wether they show evidence of a mental disorder.

• Deviance (behaviours unusual in society)
• Distress (find their behaviours upsetting)
• Dysfunction (interferes with day to day life)
• Danger (harm themselves or others)

Question 2

Evaluate the four D’s of diagnosis?

Answer 2

strengths:
- useful as they have practical applications in helping professionals decide wether a patients symptoms needs a diagnosis
- they provide a holistic way to asses someone mental health
- davis argues a fifth D should be added (duration)

weaknesses:
- subjectivity in the application of the four D’s
- distress is subjective and difficult to measure
- because of subjectivity, four D’s may lack validity
- subjectivity reduces reliability, overall reducing scientific status of diagnosis
- issue of social control

Question 3

What are classification systems and what are the two types?

Answer 3

• They are used by practitioners to help make diagnoses and establish appropriate treatment. Their aim is to provide clear and measurable criteria which can increase reliability.
• The international standard classification of diseases (ICD-10)
• The diagnostic and statistical manual of mental disorders (DSM 5)

Question 4

What is the medical model of abnormality?

Answer 4

a biological approach which assumes the major source of ‘disturbed’ and ‘abnormal’ behaviour is some form of medical illness.

supporters believe psychological symptoms are outward signs of the inner physical disorder

Question 5

what are three problems with using the medical model for diagnosis of mental disorders?

Answer 5

1. mental illness symptoms are much more subjective than measuring physical symptoms
2. the causes of mental illness are largely unknown, so treatments only focus on symptoms not causes
3. criticised by the anti-psychiatry movement who argue symptoms may be an understandable reaction to coping with a sick society.

Question 6

What are some similarities and differences between the ICD-10 and the DSM-5

Answer 6

Similarities:
- both are diagnostic tools
- both regularly updated to account for new research
- attempt to improve psychiatric diagnosis across cultures
- includes categories of mental disorders based on symptoms
- both rely on checklists for behaviour

Differences:
- ICD does not look at other aspects that could influence diagnosis but DSM takes into account psychosocial factors
- ICD is more reductionist than DSM
- DSM is only used for mental disorders but ICD diagnoses physical disorders too
- ICD is an open and free recourse
- DSM is more holistic

Question 7

What are three four of evidence for the reliability of diagnosis?

Answer 7

Spitzer and Williams:
- early versions of DSM were low in reliability
- experienced psychiatrists only agree on diagnosis about 50% of the time

Ward:
- studied 2 psychiatrists diagnosing the same patient
- 62.5% of disagreements occurred due to inadequacy of the classification system

Brown:
- tested the reliability and validity of DSM 5 diagnoses for anxiety and mood disorders and found them to be good to excellent.

Pederson:
- 71% of psychiatrists agreed with the ICD-10 definition of depression when assessing 116 patients

Question 8

what are three factors that impact the reliability of diagnosis?

Answer 8

patient factors:
- may give different psychiatrists different information
- lack of standardisation for interviews

Clinician factors:
- practitioners are not completely objective
- practitioner may gather insufficient information

Classification systems:
- DSM has a clear set of criteria which increases reliability

Question 9

what are three factors that could impact on validity of diagnosis?

Answer 9

patient factors:
- may not disclose all relevant information
- may be embarrasses, ashamed or don’t remember

clinician factors:
- implicit bias in clinical redices validity

classification systems:
- cochrane et al argues classification systems lead practitioners to take on a Eurocentric bias
- they cannot take into account normal behaviour of other cultures

Question 10

What is the APRC for Rosenhan 1973?

Answer 10

AIM:
- ‘can the sane be distinguished from the insane’
- wanted to see if sane people could be admitted to psychiatric hospitals and wether they would be detected

PROCEDURE:
- eight participants (3 women, 5 men)
- each phoned the admissions of 12 hospitals claiming they were hearing voices
- reported hearing ‘thud’ , ‘empty’ and ‘hollow’
- all were admitted with a diagnosis of schizophrenia expect one who was diagnosed with depression with psychosis
- once admitted, patients behaved normally and recorded their experience using notes

RESULTS:
- all diagnosed with a serious mental health disorder on minimal symptoms
- sanity was never detected - average stay was 19 days
- contact with nurses was ignored around 71% of the time
- normal behaviour was misinterpreted (e.g writing in a notebook was obsessively noting things down)

CONCLUSIONS:
- diagnostic label changed the perception of the person so all their behaviour was interpreted within the context of the label
- psychiatrists could not detect sanity.

Question 11

What is the APRC for rosenhan second study?

Answer 11

AIM:
- To see if hospitals, who were told they were going to be approached by pseudo-patients, would be able to tell the sane from the insane

PROCEDURE:
- a teaching and psychiatric hospital who were aware about the first study, were informed that over the next three months, one or more pseudo patients would try to be admitted
- each member of staff asked to rate the likelihood that the patients who sought to be admitted were pseudo patients
- no pseudo patients were admitted

RESULTS:
- 193 patients assessed
- 41 rated as pseudo patients by at least two members of staff
- 23 rated as pseudo patients by at least one psychiatrist

Conclusions:
- the staff were unable to detect insanity

Question 12

evaluate rosenhans study

Answer 12

GENERALISABILITY:
- high because it took place in a range go hospitals across the USA
- Low because it may not generate to current times or countries outside the USA

RELIABILITY:
- High because aspects were standardised such as hearing thud, hollow and empty.
- Low as it was a field experiment so not all variables can be standardised

APPLICATIONS:
- the amount of criteria used to diagnose mental illness increased after, making it more accurate
- people recognised hospitals may not be the best place to treat mental illness
- highlights the dangers of labelling

VALIDITY:
- High internal validity as demand characteristics reduced
- High ecological validity as the setting and tasks were true to life
- Low validity as as there is a lack of control due to it being a field experiment

ETHICS:
- good ethical considerations such as confidentiality. The names of individuals and doctors were not published
- Ethical issues as participants did not know they were part of a study and there was no protection for other patients

Question 13

What are the three symptoms of schizophrenia?

Answer 13

Positive symptoms - strange and bizarre additions to behaviour

negative symptoms - loss or absence of normal characters

cognitive symptoms - issues to do with information processing

Question 14

what are the four positive symptoms of schizophrenia?

Answer 14

1. DELUSIONS
   - false or bizarre beliefs
   - delusions of grandeur (I’m the king)
   - delusions of persecution (I’m being plotted against)
   - thought insertion (thoughts had been implanted by external force)
   - thought broadcasting (others can hear my thoughts
   - delusions vary across different cultures
2. HALLUCINATIONS
   - perception of stimuli that is not present
   - visual, auditory or olfactory
   - most common in schizophrenia is auditory
3. DISORGANISED THINKING/SPPECH
   - jumbled speech (word salad)
   - loose associations of thoughts
   - jump from topic to topic
   - invention of new words
4. ABNORMAL MOTOR BEHAVIOUR
   - agitated movement
   - catatonia (not moving or responding to others)

Question 15

What are 6 negative symptoms of schizophrenia?

Answer 15

1. lack of energy and motivation
2. social withdrawal
3. flatness of emotion
4. not looking after appearance and self
5. lack of pleasure in everyday things
6. speaking little

Question 16

What are three cognitive symptoms of schizophrenia?

Answer 16

1. difficulties in concentrating and paying attention
2. problems with working memory
3. difficulties with executive functioning

Question 17

What are the features of schizophrenia?

Answer 17

PROP

Onset:
- late teens and mid-30’s
- may be triggered my some aspect of development
- males peak onset in early to mid twenties
- female peak onset is late twenties

Prevalence:
- how common the disorder is
- it is a universal illness
- likelihood of developing schizophrenia is 0.7-1%
- people who experience social problems such as poverty and unemployment are more likely to develop schizophrenia

Prognosis:
- likely course of the disorder
- 25% who have an episode recover and do not have another
- 50% have recurrent episodes
- 25% have symptoms continually
- life expectancy is 10 years younger than average population
- males show more negative symptoms than females

Question 18

What are the two aspects of neurotransmitters being an explanation of schizophrenia (biological explanation)?

Answer 18

• dopamine hypothesis

1. excess dopamine (hyperdopaminergia)
   - positive symptoms
   - high levels of dopamine in the synapse due to low levels of the enzyme beta hydroxylase
   - excess number of dopamine receptors
   - hypersensitivity of certain dopamine receptors
2. Dopamine Deficiency (hypodopaminergia)
   - negative symptoms
   - low levels of dopamine in the mesocortical pathway

Question 19

evaluate the theory of neurotransmitters as an explanation for schizophrenia

Answer 19

STRENGHTS:
- evidence from drug treatment (drugs to treat schizophrenia work by blocking dopamine)
- people with schizophrenia are more sensitive to dopamine uptake
- evidence that excess dopamine plays a role as drugs used to treat Parkinson’s by increasing dopamine cause schizophrenia like symptoms
- theory explains both positive and negative symptoms

WEAKNESSES:
- not all patients respond to drugs that block dopamine (albert and freidhoff found some people did not improve)
- some drugs work by targeting serotonin not dopamine
- theory cannot prove excess dopamine causes schizophrenia but it may just be a symptom
- reductionist as it focuses purely on neurotrnasmitters

Question 20

what are five pieces of evidence of genetics being an explanation of schizophrenia?

Answer 20

Hilker: 79% heritability rate for schizophrenia

• 25% of people with DiGeorge syndrome (deletion of 30-40 genes) develop schizophrenia

Wright: as many as 700 genes have been linked to schizophrenia
such as:

The COMT Gene:
- deletion of the comt gene which regulates dopamine levels
- if its deleted there is too much dopamine

The DISC1 Gene:
- people with an abnormality in the DISC1 gene are 1.4 times more likely to develop schizophrenia.

Question 21

What are the three major types of research that have investigated the role of genetics in schizophrenia?

Answer 21

Family studies:
- wether close biological relatives also have schizophrenia
- difficult to seperate nature and nurture

Adoption studies:
- genetic factor can be looked for in adopted children who are ‘reared apart’ from biological parents
- effects of nature can be separated from nature

Twin studies:
- schizophrenia in monozygotic and dizygotic twins can be compared
- degree to which twins are similar on a particular characteristic is the concordance rate.

Question 22

What is the APRC of gottessman and sheilds?

Answer 22

AIM:
to see wether schizophrenia had a genetic basis by examining records of patients in a psychiatric hospital over a 16 year period

PROCEDURE:
- identified 57 schizophrenic patients who were a twin
- 24 mz and 33 dz
- collected data from hospital notes, self report questionnaires, interviews and personality tests
- patients split into four categories

RESULTS:
- concordance rates for schizophrenia were higher in females than males
- concordance rates were higher for both mz and dz twins for severe schizophrenia compared with mild schizophrenia
- concordance rate for severe schizophrenia was higher id mz twins (75%) than dz twins (22%)

CONCLUSIONS:
- schizophrenia does have a biological basis as its influenced by genes
- it is not entirely caused by genes as the concordance rates in mz twins was no 100%

Question 23

evaluate genes as an explanation for schizophrenia

Answer 23

STRENGTHS:
- evidence from twin studies show there is a genetic factor (gottessman and shields)
- more recent research id identifying which specific genes may be linked to schizophrenia (comt gene)
- biological approach has scientific status and credibility
- used to provide genetic counselling (likelihood of family members developing it can be calculated)

WEAKNESSES:
- research methods have flawed methodologies (twin studies, jospeh said mz twins may be raised more similarly than dz twins)
- reductionist. it is not the only factor involved
- confusion into exactly what genes are responsible
- genetic explanation does not lead directly to new treatments.

Question 24

what is the social causation hypothesis?

Answer 24

It suggests that schizophrenia may be caused by factors within the environment

Question 25

What are the five environmental risk factors for schizophrenia?

Answer 25

SOCIAL ADVERSITY: - if a child grows up in an eniroemnt where their needs are not med, may be more likely to develop mh issues - e.g. poverty, unemployment URBANICITY: - schizophrenia is more associated with living in cities that rural. - Eaton argues city life is more stressful and long term exposure to stressors can trigger schizophrenia - vassos meta analysis found risk of schizophrenia was 2.37 times high for people living in the most urban areas compared to most rural areas SOCIAL ISOLATION: - Faris suggested cultural isolation may lead to symptoms - people don't get any feedback on their behaviour (what's normal or not) IMMIGRATION AND MINORITY STATUS: - immigrants are at greater risk of developing schizophrenia - may be due to stress due to discrimination and poorer living conditions FAMILY DYSFUNCTION + CHILDHOOD TRAUMA: - popovich suggests childhood trauma may interact with other pre existing risk factors to trigger schizophrenia in vulnerable individuals

Question 26

Evaluate the social explanation of schizophrenia

Answer 26

STRENGHTS: - helps to explain some features of schizophrenia (why black immigrants are more likely to be diagnosed than white british) - supported by research evidence (vassos) so higher scientific credibility - useful applications (importance of community) - helps explain how biological factors can interact with environmental factors (diathesis-stress model) WEAKNESSES: - some of the reproach is correlational so no cause and effect (vassos) - it is difficult to isolate specific environmental factors to see if they cause schizophrenia - it is not a complete explanation as it claims environmental factors can only trigger onset.

Question 27

what are the seven standards which the HCPC set out for clinical practitioners?

Answer 27

- character - health - standards of proficiency - standards of conduct, performance and ethics - standards of continuing personal development - standards of education and training - standards for prescribing

Question 28

What are the two treatments we look at for schizophrenia?

Answer 28

- drug treatment - cognitive treatment

Question 29

why is drug treatment used for schizophrenia and how does it work

Answer 29

WHY? - based on the medical model - if schizophrenia is due to a biological basis such as genes or neurotransmitters, treatment should also have a biological basis HOW? - typical drug block the receptor site for the neurotransmitter dopamine so the effects of dopamine are not picked up by the brain - more recent frugs block serotonin receptors and have fewer side effects

Question 30

evaluate the use of drug therapy for schizophrenia

Answer 30

STRENGHTS: - drug treatment has been effective in reducing symptoms (Meltzer found haloperidol gave significant improvements in all areas of functioning compared to a placebo) - more effective than other forms of therapy as it reduces symptoms more quickly - useful to help people manage symptoms and hopefully avoid hospitals - helped patients live relatively normal lives (not have to live in hospitals) - appropriate due to it being a biological basis for a genetic condition WEAKNESSES: - reductionist as it ignores all psychological or social factors - effectiveness is questionable as it surpasses systems without addressing the cause - relapse is an issue so drugs are not a long term cure - ethical issues as drugs often have unpleasant side effects - patients are often reluctant to take drugs - not effective in treating negative symptoms

Question 31

describe cognitive behavioural therapy

Answer 31

- assumes patients have irrational thoughts and beliefs - CBT helps to challenge these thoughts and therefore change a patients behaviour

Question 32

how is CBT used to treat schizophrenia?

Answer 32

- it can help target cognitive symptoms swell as delusions and hallucinations - aim to help reduce the stress felt by the patient and help them manage an understand their symptoms 3 techniques: - belief modification (delusional thinking is challenged directly) - focussing and reattribution (help with auditory hallucinations) - normalising the experience of the person (look at their experience rationally and not as a catastrophe)

Question 33

evaluate the use of CBT as a treatment for schizophrenia

Answer 33

STRENGTHS: - research shows CBT can be helpful in treating schizophrenia (sensky compared CBT with non specific befriending therapy and found CBT was more effective in reducing both positive and negative symptoms) - CBT can work well for those who did not respond to medication - CBT is the most ethical treatment (empowers patients, self help strategies they can use on their own and become independent) WEAKNESSES: - reductionist as it focuses on thought processes but does not address underlying cause - effectiveness may be limited as patients need good insight into their condition and have good problem solving skills - effectiveness is hard to judge as most studies compare CBT to a control treatment. CBT may not be superior rather than control treatment is inadequate.

Question 34

What are the two aims of Carlson's study?

Answer 34

- to investigate the role of glutamate in the causation of schizophrenia - to investigate wether any other neurotransmitters besides dopamine play a role in schizophrenia

Question 35

What type of study was Carlson's research and who did they study?

Answer 35

Literature review - studies using rodents - studies on people with acute schizophrenia - studies on people with schizophrenia in remission - studies on people with Parkinson's - studies on people with huntingtons

Question 36

What were the four key findings from Carlsson's Research?

Answer 36

1. PET scans provided evidence to show that high levels of dopamine are related to psychosis (Breier et al) and that changes in dopamine may be a result of other changes in neurotransmitter such as noradrenaline and glutamate. 2. low levels of glutamate play a role in schizophrenia - Lodge et al found PCP (angel dust) induces psychosis by inhibiting the action of glutamate in the brain. Glutamenergic failure in the cerebral cortex leads to negative symptoms whilst failure is the basal ganglia leads to positive symptoms. 3. reduced levels of glutamate are associated with increased dopamine release 4. Thalamus plays a role in schizophrenia - the thalamic filter. The thalamus filters off neurotransmitters to stop the cerebral cortex from overloading. Indirect pathway has too much dopamine or too little glutamate with causes positive symptoms. Direct pathway has abnormal levels of dopamine and glutamate and causes negative symptoms.

Question 37

What are the five conclusions from Carlssom's research?

Answer 37

- there are different subpopulations of those with schizophrenia due to many neurotransmitters being involved - glutamate deficiency should be studied to explain schizophrenia - glutamate deficiency may explain increased dopamine responsiveness - increased serotonin levels are found in people with schizophrenia - more focus on other neurotransmitters in schizophrenia is needed.

Question 38

Evaluate Carlson's study

Answer 38

Generalisability: - 33 studies reviewed, 14 Carlson took part in - representative sample - research done on animals not generalisable to humans - may be time locked and not representative of today Reliability: - studies all lab experiments - many methods used like pet scans and animals - techniques are controlled and standardised Applications: - useful in developing better anti-psychotic drugs (glutamate and dopamine antagonists) - improved dopaminergic drugs with fewer side effects Validity: - Sendt et al literature review supports Carlson increasing concurrent validity - Carlson considered glutamate a possible contributor to schizophrenia- - brain scans can be stressful for patients so neurotransmitter activity may have changed Ethics: - review article so no direct ethical issues - uses studies with animals which could harm them - studies on humans - some given drugs to increase psychotic symptoms

Question 39

What is OCD?

Answer 39

- an anxiety disorder - characterised by the presence of obsessions and compulsions obsessions: - persistent, irrational, unwanted thoughts (being contaminated, going to harm someone etc) compulsions: - tasks people do to relive themselves of the obsession. Acting on these does not give them pleasure but reduces anxiety or stress (washing hands many times)

Question 40

What are the features of OCD?

Answer 40

ONSET: - late teens and early twenties. - 25% of males suffer before the age of 10 PREVELANCE: - how often or widespread it occurs - 1.1-1.8% of the population. - in adults, OCD is more common in females - in children, OCD is more common in males PROGNOSIS: - likely course of the disorder - symptoms usually develop gradually, but can be extreme from onset - 70% of people experience a chronic lifelong course RISK FACTORS: - family history - stressful life events

Question 41

what are the three parts of the brain associated with the biological explanation for OCD

Answer 41

THALAMUS - primitive checking and cleaning behaviours. - if this is overactive, it triggers a compulsion ORBITOFRONTAL CORTEX - alerts the brain to potential worries in the environment - if this is overactive, person will experience anxiety CINGULATE GYRUS - connects orbitofrontal cortex to thalamus BASAL GANGLIA NUCLEI - inhibits the thalamus - if not working properly, thalamus becomes overactive and causes compulsions

Question 42

evaluate the biological explanation of OCD

Answer 42

STRENGTHS: - supporting evidence (McGuire found when people with OCD are shown objects that bring on symptoms, there is an increase in activity in their obitofrontal context) - brain scans show differences in brain structure in people with OCD and healthy individuals (Menzies found people with OCD had a different amount of grey matter in the orbitofrontal cortex than those without OCD) - brain scans show differences in functioning in those with OCD and those without (Whiteside found the cingulate gyrus, basal ganglia and orbitofrontal correct are active when at rest in people with OCD) - Salloway and Duffy found that pet scans of OCD patients had increased activity in the pre frontal cortex. - brains scans are a scientific way of investigating OCD and have high scientific credibility - Surgical lesioning of cingulate gyrus has been a successful treatment for OCD WEAKNESSES: - surgical lesioning sometimes does not work (Kireev suggested the functions usually performed by the cingulate gyrus can be taken over by other parts of the brain) - difficult to show cause and effect. Differences in brain activity may be a symptom not a cause - Brain activity and thoughts are related do it hard to separate the two - biological factors may also be sue to genetics not just brain structure and activity.

Question 43

What are the three aspects of the cognitive explanation of OCD?

Answer 43

FALSE BELEIFS: - people with OCD misinterpret their thoughts due to false beliefs - patients may exaggerate the importance of their thoughts and believe it is an actual threat - they may have beliefs about: exaggerated responsibility, certain thoughts are very important, having a thought will increase the chance of it becoming true, overestimate the likelihood of danger MEMORY PROBLEMS: - Sher et al found people with OCD have poor memories for their actions (can't remember if they tuned the light off) - Trivedi et al found people with OCD had low confidence in their memory ability - Woods did a meta analysis and found people with OCD had slightly worse memories for recalling stimuli HYPERVIGILENCE: - people with OCD have an attention bias and are overly sensitive to threat - may have rapid eye movements to scan environment and may focus selectively on threat related stimuli not neutral stimuli.

Question 44

Evaluate the cognitive explanation of OCD

Answer 44

STRENGHTS: - supporting evidence (Sher et al) - this gives it scientific credibility - therapy based on the cognitive explanation has been successful as a treatment (Van Balkom found it was effective as drug treatment) - cognitive biases like hyper-vigilance account for individual differences WEAKNESSSES: - does not provide cause and effect link, faulty cognitions could be a symptom not a cause - reductionists as it ignores the role of biology and learning.

Question 45

What are the three drug treatments used for OCD?

Answer 45

ANTI-DEPRESSANTS - used to raise serotonin levels - done by blocking its reuptake so more serotonin is available for longer periods ANTI-ANXIETY DRUGS - increase the effectiveness of GABA in regulating anxiety - GABA lowers physiological arousal and returns body to a resting state BETA-BLOCKERS - blocking stress hormone which create symptoms of anxiety - beta blockers prevent physiological responses from occurring - because people feel less physiological stress, they may have fewer obsessional thoughts

Question 46

Evaluate the use of drug treatment for OCD

Answer 46

STRENGTHS: - useful as it can be used to treat cases of OCD that have not responded to CBT - empirical evidence to show its effective (Soomro found anti depressants were more effective than placebo in reducing OCD symptoms) - scientific credibility - Pots found drug treatment could be combined with CBT for best results - Koran found anti-depressant medication did have long term effects and was effective at preventing relapse compared to placebo WEAKNESSES: - drugs may cause side effects, may limit the usefulness as people may not want to take them - in some cases, medication can increase anxiety rather than decrease it - drugs alone can't always treat people with OCD, its most effective when combined with other therapy - drugs usually need to be taken for 12 months before it can be reduced or stopped - patients likely to relapse if drug treatment stops - individual differences in people responding to drugs (Ravizza et al found SSRI's were not effective for 40% of people)

Question 47

describe the cognitive component of CBT for OCD and describe the behavioural component of CBT for OCD

Answer 47

Cognitive component: - focusses on the obsessions - intrusive thoughts cause beliefs that activate the negative emotion of anxiety - cbt aims to change the beliefs these thoughts trigger - cbt aims to prevent catastrophising - habituation training (franklin) is about thinking repeatedly about the obsessive thoughts so they become less anxiety provoking Behavioural component: - exposure and response prevention therapy - focusses on the compulsions - expose the patient to objects or situations that cause anxiety - resist performing the compulsive behaviour four steps: 1. inform the client about ERPT and what it will involve 2. use exposure hierarchy starting from mild anxiety to highest level 3. repeated exposure until the anxiety reduces 4. get client to resist and refrain from performing compulsive behaviour - between 55-75% people using ERPT show improvement (Franklin)

Question 48

Evaluate CBT as a treatment for OCD

Answer 48

strengths: - supported by evidence - endorsed by the National institute for health and clinical excellence - CBT has no side effects - CBT has lower relapse rate than medication when discontinued - CBT is an ethical from of treatment as patients feel empowered and use on their own Weaknesses: - POTS found drug treatment was also effective for OCD - combination of drug and CBT is most effective - difficult to decide which benefits are from the congivitve comments and which are from the behavioural - for some people it is ineffective (Overbeek found people with depression and OCD showed less improvement when treated by ERPT)

Question 49

What is the aim and participants of POTS study?

Answer 49

AIM: to compare the following three treatments - CBT on its own - An SSRI (sertraline) on its own - CBT and sertraline combined to see which is most effective in tearing young people with OCD Participants: - 112 volunteers - all american, 92% white - 7-17 years old - all diagnosed with ocd using DSM IV - those with co morbid ocd with other disorders and ADHD were excluded - all taken off any medication

Question 50

What was the procedure of POTS study?

Answer 50

4 conditions: - drug only - placebo pill only - CBT only - combination of drug and cbt - kids randomly allocated using a computerised system - all children interviews and a baseline measurement using the CY-BOCS was taken - study lasted 12 weeks - each child had a specialist psychiatrist assigned to them to monitor progress and offer support throughout DRUG AND PLACEBO: - children had to attend very week for 6 weeks and then every other week - dose was established and changed if needed - parents would monitor medication was being taken and kept medication diary - if they had adverse side effects they would change medication or stop it CBT: - 14 clinical sessions steps: 1. psychological education 2. cognitive training 3. mapping ocd target symptoms 4. exposure and response ritual prevention - consisted of setting goals, review of previous week, therapy assisted practice and homework COMBINATION: - drug and cbt sessions were time linked and provided simultaneously - participants assessed at 4 and 8 weeks and then finally at 12 - independent evaluators who were trained assessed them - 87% of ordinal sample completed the study

Question 51

What were the results of POTS study?

Answer 51

CBT: - 39.3% entered remission at the end of 12 weeks DRUG ALONE: - 21.4% entered remission at the end of 12 weeks - placebo showed smallest drop in symptoms - combination showed greatest drop in symptoms

Question 52

What were the conclusions of POTS study?

Answer 52

- CBT leads to a higher improvemtb rate than drugs - first line of treatment should be CBT - drugs can compensate fro less effective therapy - drugs require careful monitoring - minimal gain is added by including the drugs where CBT is provided

Question 53

Evaluate POTS study

Answer 53

Generalisability: - large sample with low drop out rate - representative of target population (children with OCD) - only in USA - 92% were white Reliability: - evaluators who assessed children symptoms were trained to reliable standard - scale used to asses symptoms was a standardised measure - study was conducted over there centres but one centre had better results in CBT (could be therapist effect) Applications: - strong evidence about the most effective treatment for ocd in kids - shows value of clinical treatments - findings show effectiveness of CBT and sertraline - shoes usefulness of phycological therapies Validity: - assessment scale used (CY-BOCS) had been validated as an accurate measurement - assessors were blind to what condition the participants were in - participants in placebo were unaware the drug was not active Ethics: - all participants gave full written consent along with one parent - volunteer sample - each participants assigned a psychiatrist to support them - those in drug treatment were regularly checked

Question 54

What are the 5 methods for researching mental health?

Answer 54

1. longitudinal methods 2. cross-sectional methods 3. cross-cultural methods 4. meta-analysis 5. primary and secondary data

Question 55

Describe the use of longitudinal methods in researching mental health

Answer 55

- takes place over an extended period. Could last for weeks, months or years - allows us to see change and development over time 2 types of design - Retrospective ( individuals are sampled and information collected about their past) - Prosepective (individuals followed over time and data about them is collected as their characteristics and circumstances change) EXAMPLES - monitoring changes in symptoms undergoing a certain treatment - POTS - Sensky (9 months, compared CBT and befriending, cbt is effective for treating both positive and negative symptoms) - Vallentine (usefulness of group work and cbt for patients in high security hospital)

Question 56

What are the strengths and weaknesses of the longitudinal method?

Answer 56

STRENGHTS: - same people are used so participant variables are controlled for - reliable way to measure effect of time on the behaviour studied - clinicians can evaluate effectiveness of treatments WEAKNESSES: - participants may drop out as it takes so long, reducing sample size - may be other factors than influence individuals development so conclusions may be hard to draw - takes a long time and can be expensive - by the time dats can be used to draw conclusions, the data be be irrelevant

Question 57

Describe the use of cross-sectional method in researching mental health

Answer 57

- taking a quick snapshot of behaviour in a given population in a set period of time - large group of people used so a good cross section from the whole target population is studied - e.g. experience of people at different ages suffering from schizophrenia so they take a sample of participants from different ages to investigate at the same time EXAMPLE: - Crawford - examine the quality and assent of treatment of physical health problems in people with sizophrenia - in the UK, like expectancy of people with schizophrenia is 20% lower than general population - collected data on 9 key aspects of psychical health on 5091 patients - sensation and hernandez gill - digit span and phonological loop in Spanish children, english children and elderly people

Question 58

What are the strengths and weaknesses of cross-sectional method?

Answer 58

STRENGHTS: - data is gathered quickly so conclusions can be drawn and acted on more rapidly - results more likely to be valid as they will be reported at the same time they have the most application - economical as it requires less commitment then longitudinal design WEAKNESSES: - cohort effect as study looks at different people at the same moment in time and those people will belong to a different cohort - not good for finding the cause of something because they are descriptive research - unlikely to include any historical information

Question 59

Describe cross-cultural methods in clinical psychology

Answer 59

- compare some behaviour or attitude in different cultures - look for similarities or differences - universality can be studied, if behaviour is the same in many cultures it may be in our nature EXAMPLES: - Lurhmann studied differences in voice hearing experiences of people with psychosis in USA. India and Ghana - are the symptoms of schizophrenia the same across different cultures and are treatments as effective in different cultures

Question 60

What are the strengths and weaknesses of cross-cultural methods?

Answer 60

STRENGHTS: - allows us to gain understanding of how culture plays a role in the validity and reliability of diagnosis - identify elements of abnormal behaviour that can be attributed to biological factors - reduce the level of ethnocentrism in psychological studies - improve generalisability of research - aid clinicians understanding of the cultural factors they should consider when diagnosing and treating patients WEAKNESSES: - participants will be different in different cultures - conflict between the cultures (interpretation of the patients behaviour does not consider their cultural background)

Question 61

Describe a meta analysis in clinical psychology

Answer 61

- using the findings of different studies so data can be pooled and reanalysed - data is pooled and findings are analysed - researchers seek out studies from a variety of places, cultures and times - gives an overview of results - gives a larger sample and more findings EXAMPLE: - Vassos (compared urban and rural locations in different countries and the risk of schizophrenia) - Carlsson

Question 62

What are the strengths and weaknesses of a meta analysis?

Answer 62

STRENGHTS: - conclusions drawn from huge sample - results can be generalised to larger population - more data used so more accurate analysis - quick and cost effective WEAKNESSES: - researchers are not involved in gathering the data so may be issues of reliability and validity - publication bias which impacts validity (can only study research that has been published)

Question 63

describe primary and secondary data in clinical psychology

Answer 63

Primary - gathered first hand from source - Milgram, Bandura, rosenhan, POTS Secondary - already been gathered by researchers - carlsson, gottessman and shields

Question 64

What are the strengths and weaknesses of primary data in clinical psychology

Answer 64

STENGTHS: - high validity as operationalism is done - more credible because they are gathered foe the purpose of the chosen research method WEAKNESSES: - expensive - limited to time, place and number of participants

Question 65

What are the strengths and weaknesses of secondary data in clinical psychology?

Answer 65

STRENGTHS: - cheap - large quantities of data - different sources so can compare data to check for reliability and validity WEAKNESSES: - may not be valid as data may be gathered to suit another aim - when allayed originally the data may have been analysed subjectively - may not be in a relevant time period

Question 66

What are the use of case studies in clinical psychology

Answer 66

- involve studying individuals or small groups with an unique characteristic or experience - may be people with rare symptoms or an individual taking part in a specific therapy - data is usually qualitative and high in validity

Question 67

Who did a case study about Carol and who was she?

Answer 67

BRADSHAW Carol: - 26 year old white female - started first year at uni - upper middle class family - began experiences auditory hallucinations and delusions in college - carol hospitalised many times - diagnosed with schizophrenia

Question 68

What was the aim of the case study on carol?

Answer 68

To investigate how CBT can be used to treat a woman with schizophrenia. Used an attempt of talking therapy to treat schizophrenia where drug treatment had been previously preferred

Question 69

What was the procedure of the case study with carol?

Answer 69

Stage one: development of rapport - CBT sessions lasted 15 min - 1 hour - carol and therapist often went on a walk together - shared common love of baseball Stage two: understanding CBT - 2 months - carol was educated in CBT, schizophrenia and treatment - ABC model used Stage three: treatment - first year focussed on managing stress and anxiety - carols beliefs that things were hopeless needed to be challenged - weekly activity schedule gave her structure after leaving hospital - built more strategies to cope with stressful social situations - ending phase focusses on maintaining the treatment without the therapist

Question 70

What were the results and conclusions of Carols case study?

Answer 70

RESULTS: - carol showed improvement in psychological functioning, achievement of goals, reduction of symptoms - never re-hospitalised - reported little distress - improvements still in evidence a year after therapy finished Conclusions: - CBT can be successful in treating schizophrenia

Question 71

Evaluate the case study of Carol

Answer 71

Generalisability: - only one participant - female - undifferentiated type of schizophrenia Reliability: - high - CBT uses standardisation - used standardised measures to asses symptoms and functioning - facts such as report between her and therapist is hard to replicate Applicability : - prompted the use of CBT to help patients with schizophrenia - clients lower their dependency on anti-psychotic drugs - treatment only available to around 10% of sufferers in the uk Validity: - quantitive data such as her scores of RFS, GPI and GAS - qualitative data from her job and change is self esteem ETHICS: - respect young woman dignity and privacy keeping her anonymous - carol healthier at the end - issues of consent as carol was in too bad of a state to fully consent at start

Question 72

What is a peer review in clinical psychology?

Answer 72

Publishers use peer who are experts in the relevant field of research to review the report, recommend any changes needed and advise wether the repot should be published

Question 73

What are three strengths and three weaknesses of peer reviews?

Answer 73

STRENGHTS: - ensures that published psychological knowledge is not invalid, biased or fraudulent - helps to maintain standard within the discipline and prevent unsubstantial claims being made by researchers - ensures the best quality of contemporary search as it is subject to rigorous review of content WEAKNESSES: - it can involve many amendments being made to the original submission which can be frustrating and costly - some research is never published and the process fails to publish null findings leading to bias of positive outcomes - peer reviewers may use their anonymity to assert their own opinions

Question 74

What are the three types of interviews used in clinical psychology

Answer 74

1. Structured 2. semi structured 3. unstructured

Question 75

What was the aim and participants of Vallentine study using clinical interviews in clinical psychology?

Answer 75

Aim: to study the usefulness of psycho-education within group work for offender patients in a high security forensic hospital setting (Broadmoor) Participants: - 42 males at broad moor - all received diagnosis of schizophrenia or something similar - part of a programme aimed to help them understand and cope with their illness

Question 76

What was the procedure of Vallentine study using clinical interviews in clinical psychology?

Answer 76

- participants interviewed using semi-structured technique - aim to understand their experience better - groups ran for 20 session over a three year period - psycho-education programme considered symptoms, treatment options and ways of coping with the illness - content analysis was then conducted

Question 77

What were the results and conclusions from Vallentine study using clinical interviews in clinical psychology?

Answer 77

RESULTS: - patients valued knowing and understanding their illness - many reported increased confidence in dealing with their illness - more positive about the future - p's said they valued the group and would recommend it CONCLUSIONS: - semi structured interview gave qualitative dates about how they valued the group - semi structured interviews are useful in gathering rich data which could be used to inform future practice

Question 78

What is the title of your practical in clinical psychology?

Answer 78

a content analysis of how different online news sources portray mental illness

Question 79

What is the aim of your practical in clinical psychology?

Answer 79

To investigate wether news articles in online newspapers portray schizophrenia in negative, neutral or positive terms

Question 80

What is the hypothesis of your practical in clinical psychology?

Answer 80

schizophrenia will be portrayed differently (positively, negatively, neutrally) in a tabloid newspaper (the daily mail) to a broadsheet paper (the guardian)

Question 81

What are two strengths and two weaknesses of your practical in clinical psychology?

Answer 81

STRENGTHS: - changed qualitative data into quantitive data which allowed us to use statistical analysis - did not use human participants so it is ethical WEAKNESSES: - data collected from small and potential biased sample - researcher effects as we chose the three categories

Question 82

What was your key question is clinical psychology?

Answer 82

How do attitudes towards mental health disorders very cross-culturally?

Question 83

What four points should you use when discussing your key question in clinical psychology?

Answer 83

Differences in amount of stigma: - Cheon found asians and asian Americans have more negative attitudes towards mental health than with European and caucasian Americans Different beliefs about causes of mental illness: - stefanovics found people from ghana and nigeria had the highest number of beliefs about supernatural causes Less likely to seek treatment: - Twesigife found patients suffering from bipolar in uganda were deterred from seeking help due to high levels of stigma Different attitudes affect type of symptoms: - lurhaman found participants in the use more likely to report negative commands than people in ghana and india reported having rich relationships with their voices