Clinical Flashcards
1
Q
What are the 4 D’s of diagnosis?
A
Deviance
Danger
Distress
Dysfunction
2
Q
Deviance
A
Behaviours, cognitions, feelings and desires which are extreme, unusual or bizarre and which differ from social and statistical norms.
They may get negative attention from others and social exclusion and for this reason norm-breaking is seen as a useful indicator.
3
Q
Dysfunction
A
The inability to conduct everyday activities and their usual roles and responsibilities.
This is measured on the WHODAS II (world health organisation disability assessment schedule) which is a questionnaire that looks at factors such as a persons understanding of what’s going on around them, communication and deterioration in self-care.
4
Q
Distress
A
- When symptoms cause emotional pain or anxiety this is a sign that a diagnosis may be beneficial to the person. They may be manifested into physical symptom eg aches and pains, palpitations or feeling tired all the time.
- Measured using the Kessler Psychological distress scale (K10) which is a 10 item self report questionnaire on experiences in the last 4 weeks.
5
Q
Danger
A
Careless, hostile or hazardous behaviour which jeopardises the safety of the individual and/or others may be considered grounds for diagnosis.
In the UK if they are considered a danger to themselves or others they can be detained. This requires the agreement of 3 professionals.
6
Q
Give 2 strengths of the 4 Ds in diagnosing mental health disorders.
A
- Helps avoid erroneous diagnosis- If only one is used then you could diagnose people with something they don’t have and might miss other things. This means that the system is valid and not over nor under inclusive.
- Application- Used in conjunction with classification manuals such as the DSM-5 or ICD-10. As different disorders display a different combination of D’s so all of them are useful.
7
Q
Give 2 weaknesses of the 4 D model
A
- Lack of objectivity- They aim to be objective but as they are based off of feelings eg distress. This makes it unlikely. The lack of objectivity effects reliability. Also in terms of deviance its in comparison to social norms and so effects reliability as they rely on the subjective view of the clinician.
- Labelling- We end up with labels for people with mental health issues. ‘Danger’ as a criterion leads people to equate mental health with danger. Fazel says most people with schizophrenia are not actually more dangerous than people without.
8
Q
A
9
Q
What is the DSM?
A
Describes symptoms and features and risk factors of over 300 mental and behavioural disorders. Provides revenue for the American Psychiatric Association.
10
Q
Describe the 3 sections of the DSM-5
A
- Section 1: Guidance about using the new system
- Section 2: Details about the disorders and is categorised according to our current understanding of underlying causes and similarities between symptoms.
- Section 3: Suggestions for new disorders which require further investigation.
11
Q
How do clinicians gather information on an individual?
A
- Observation
- Unstructured (clinical) interviews
- Structured interviews.
12
Q
2 ways reliability is assessed
A
- Test-retest reliability
- Inter-rater reliability
13
Q
4 ways validity is assessed
A
- Descriptive validity
- Aetiological validity
- Concurrent validity
- Predictive validity
14
Q
Descriptive validity
A
When two people with the same diagnosis exhibit similar symptoms
15
Q
Aetiological validity
A
When two patients share similar causal factors
16
Q
Concurrent validity
A
When a clinician uses more than one method or technique to get a diagnosis, both giving the same diagnosis.
17
Q
Predictive validity
A
Accurately predict outcomes for an individual from their diagnosis eg prognosis and reaction to treatment.
18
Q
Give a strength and a weakness of the DSM in terms of reliability
A
Strength- REGIER: 3 disorders inc PTSD had kappa values ranging from 0.60 to 0.79. 7 more had values of 0.40 and 0.59. PTSD is significant as the criterion has changed.
Weakness- COOPER: DSM-5 task force classified levels as low as 0.2 and 0.4 as ‘acceptable’ suggesting that the DSM-5 may be less reliable than previous models.
19
Q
Give a strength and a weakness of the DSM in terms of validity
A
Strength- KIM-COHEN: Demonstrated the concurrent validity of conduct disorder. Through interviewing children and their mothers. They also found risk factors so aetiological validity. Predictive validity as the 5yr olds were more likely to display behavioural difficulties aged 7.
Weakness- Just a label: The DSM lacks validity as a psychiatric diagnosis tells us nothing about what is causing a disorder. A diagnosis is a label and tells us nothing useful.
20
Q
What is the ICD?
A
- Includes both physical and mental disorders.
- Created by the WHO.
- Provides common language so that data from many countries can be compared.
- 11 sections in chapter 5 with leftover codes.
21
Q
How is the ICD used to make a diagnosis?
A
Selects key words from an interview with a client that relates to their symptoms.
The clinician looks up these symptoms in an alphabetic index. Then uses other symptoms to locate a subcategory.
22
Q
what does HCPC stand for
A
Health and Care Professions Council
23
Q
What improvements were made to the ICD-10
A
Presentation, communication and interpretation of symptoms is shaped by language and culture. This culture bias means that clients in one culture could get a different diagnosis from clients in another culture, despite presenting similar symptoms.
The ICD-10 was made in many different languages and appropriate cultural forms. The process reveals inconsistencies, ambiguities and overlaps. The ICD-10 is now described as clear, simple and logically organised.
24
Q
Give 2 strengths of the ICD in terms of reliability
A
- PONIZOVSKY- The reliability of the ICD-9 and ICD-10. About 3000 patients assessed. They found PPV increased from 68% to 94% for schizophrenia.
- GALEAZZI- Two researchers assessed 100 patients with psychosomatic symptoms and had kappa values from 0.69 to 0.97.
25
Give 2 strengths of the ICD in terms of validity
1. ***MASON**-* The diagnosis of schizophrenia using the ICD-10 has **good predictive validity**. ‘Reasonably good’ at predicting disability in 99 people with schizophrenia 13 years later. Shows that the initial diagnosis was useful and meaningful in terms of its ability to accurately predict future outcomes.
2. **Application**- The development of the ICD-11 they aimed to improve the ‘clinical utility’ of this system. Having spoken to clinicians they will be cautious adding new disorders and will merge difficult disorders.
26
what is the HCPC
a regulator set up to protect the public.
27
how does the HCPC achieve their aim
they keep a register of professiona;s who meet their standards for their professional skills, knowledge and behaviour
28
name the 10 standards
1. promote and protect the interests of service users and carers
2. communicate appropriately and effectively
3. work within the limits of your knowledge and skills
4. delegate appropriately
5. respect confidentiality
6. manage risk
7. report concerns about safety
8. be open when things go wrong
9. be honest and trustworthy
10. keep records of your work
29
give an example of 'promote and protect the interests of service users and carers'
keep relationships professional, if a client develops feelings for the psychologist, they must decline any advances and potentially arrange for another clinician to take over.
must gain consent from client before providing care, treatment of other services.
30
give an example of 'work within the limits of your knowledge and skills'
keep up to date with and follow the law, this guidence and other requirements relevant.
keep within the scope of your practice -- if a client requires medical attention, do not attempt to provide this if you lack the qualifications
31
give an example of 'delegate appropriately
only delegate to people who have the knowledge, skills and experience required. continue to provide supervision.
32
what is background question of the clincial practical
how do mainstream political parties in this country view mental health
33
what is the aim of the research
to investigate the views held by 4 of the main[stream] political parties in the UK towards mental health using their 2015 manifestos
34
what are the variables of our clincial practical
viewpoints/polices/positions regarding mental health
35
what is the researhc hypothesis of our clinical paractical
there will be a significant difference in the viewpoints of left-leaning and right-leaning political parties in terms od mental health
36
what was the sample of our clincial practical
4 political parties manifestos (2015) - conservative, labour, lib dems, green.
37
what was the procedure of the clinical practical
go through manifestos and use control f to find mentions of mental health within each manifesto. read over quotes and identify themes (6 - improving accessibility, reforming NHS, increasing funding for NHS, special focus groups, employment, ending discrimination/stigma) in which each mention of mental health can be categorised. tally up each mention of mental health for each party in the relevant theme. create pie charts to demonstrate the proportion of how each party mentions mental health. select quotes and analyse the way in which each party discusses the themes identified.
38
what ethical issues in the clinical practical
none.
its ethical because the info is on the public domain
39
how are we analysing data in the clincal pracical
pie chart --> qualitative
describe how each political parties talk about those things --> qualitative
40
what were the quantative results of of clinical practical
The r-wing parties mention mental health less than l-wing. r-wing = 10 mentions. l-wing = 17.3 mentions (mean).
r-wing mention MH in the context of accessibility more than the left wing parties. 30% vs 12.7%.
r-wing mention MH in the context of reforming the NHS less than the l-wing parties. 0% vs 25.3%.
41
what is a similarity between l-wing and r-wing parties' manifestos in terms of MH
they both suggest they will increase funding for mental health care for young people and children. similar intentions for future plans for funding MH for children.
c: "increasing funding for mental health... including children and young people".
l: "will increase the proportion of mental health budget that is spent on children"
ld: "revolutionize children's mental health services... with the £250 million a year"
42
what are 3 differences between r-wing and l-wing manifestos in terms of MH
- r-wing focus on economic benefits of improving MH services, l-wing focus of social benefits.
- l-wing parties want to reform certain aspects of NHS, whereas r-wing aren't looking to change the way its run, just the no. of staff and funding.
- mention MH within employment in different contexts
43
explain the difference of r-wing focus on economic benefits of improving MH services, l-wing focus of social benefits
c: "ensure proper provision of health and community based places of safety for people suffering mental health crises - saving police time"
g: "Work towards ending stigma against people with mental health problems, including discrimination in employment."
44
explain the difference of l-wing parties want to reform certain aspects of NHS, whereas r-wing aren't looking to change the way its run, just the no. of staff and funding.
c: "new access and waiting time standards" "increasing funding"
no mention of reforming
l: "current system is too fragmented" "we will create a whole person approach: a single service to meet all of a person's health and care needs."
45
explain the difference of mention MH within employment in different contexts
c: "should get the medical help they need so they can return to work" "if they refuse a recommended treatment, we will review whether their benefits should be reduced"
ld: "Support good practice among employers in promoting wellbeing" "Improve links between Jobcentres and Work Programme
providers and the local NHS"
46
what is the construct validity of our clinical practical
reasonably high
- behaviour categories worked well in terms of sorting the data
- control-f function allowed us to pick up all instances of "mental" (health, issues) but may have missed some related terms. e.g. talk of suicide
47
what is the ecological validity of our clinical practical
mixed
manifestos are real life documents not produced for the purposes of our research
- nothing artificial about the process
- findings should apply to real world
- however, what they say they will do in the manifesto and what they actually do may not be the same thing so findings may not generalise
48
what is the population validity of our clinical practical
- target pop = mainstream political parties in the uk in 2015
- sample = con, lab, lib, green
- but UKIP were 3rd highest in terms of vote share.
- we didnt study that manifesto because they were a one issue party and they disappeared post-brexit
- however, there is still a lack of generalisability and this may have left r-wing parties underrepresented
49
what is the reliability of our clinical practical
- inter-rater reliability was generally high - once we had categories it was easy to tally up as everyone had the same catgoeies
- however, it was low for the behavioural category of accessibility. this is because quite often improvements to accessibility had to be inferred from the statements made by the political parties
- some observers made the inferences, some didnt
50
what is the objectivity of our clinical practical
- opinion in terms of how you tally up
- opinion in terms of themes
- opinion in terms of quotes
- but from the point that you have your data, there is no opinion in terms of its analysis - e.g. average number of MH mentions in L-wing parties.
51
whats the conclusion of our clinical practical
In conclusion, our results support the research hypothesis that there will be a significant difference between the views held by left and right leaning parties in terms of mental health, suggesting we should accept it. This leads us to believe there are variations in the way mental health is discussed by different mainstream political parties, specifically between the left and right wing parties. left wing parties have more of an orientation towards social justice.
52
what were the results of our summative content analysis
we found that right leaning parties mention mental health less than left leaning parties; 10 mentions and 17.3 mentions on avaerage respectively. right wing parties mention mental health more in terms of accessibility (30% of their mentions) whole left wing mention it less (12.7% on average). both right wing and left wing parties discuss increasing funding to benefit mental health services for children. conservatives state "increase funding for mental health services... including for children and young people", while liberal democrats also say they will "revolutionise children's mental health services... with £250 million a year".
53
What is the aim of Rosenhan (1973)?
To investigate whether sane people could be admitted to psychiatric institution and if once admitted they would be detected. Also to find out what life was like in a psychiatric hospital and raise awareness about conditions.
54
What was the sample of Rosenhan (1973)?
The participants were the staff and the true patients as it was their behaviour that was recorded.
This stuff in the 12 hospitals representing a range of good and bad, old and new institutions across five states in the USA.
55
Who were the pseudo patients?
8 pseudo patients, including Rosenhan, were recruited. Three women and five men. None had a history of mental problems. The occupations included paediatrician, psychiatrist, painter and housewife.
56
What was the first thing Rosenhan had the researchers do?
They each had to phone the admissions office of one of the 12 hospitals to make an appointment because they were "hearing things". they used the words 'empty' 'thud' 'hollow'
in defence of the psychiatrists, hearing thud wasn't only symptom, they were nervous from lying and insisted on being hospitalised.
Psychiatrist tend to play it safe and go for the most serious diagnosis before ruling it out.
Discharging pseudo patients with a diagnosis of schizophrenia in remission is evidence that the psychiatrist thought the patients were completely asymptomatic. Schizophrenia in relation is a rare diagnosis.
57
To what extent did the researchers provide correct information about themselves?
Each patient gave a false name in order to protect themselves.
Those who profession was psychology related also gave a fake job, but everything else they disclosed to the staff, including the significant life and family relationships, was correct.
Once they were in the hospital they acted normally
58
Were all the researchers admitted to the hospitals? And if so, what diagnosis were they given?
Yes, they were all admitted with a diagnosis of schizophrenia, except one who was admitted with manic depression with psychosis.
59
Does Rosenhan (1973) research show the DSM to be reliable or not?
reliable because they were almost all given the same diagnosis.
60
What happened once the researchers were admitted to the hospitals?
Once admitted, they stopped feigning symptoms and behaved normally, answering all questions from staff and patients honestly except about being part of a study.Once settled in, they observed life on the ward, were friendly and cooperative, and recorded their experiences by taking notes. They had to try and convince the staff of their sanity in order to get out.They had daily visitors who indicated that they were behaving normally.
they were all eventually discharged with schizophrenia in remission. shortest stay was 7 days, longest 52, average 19
61
What was the key finding of Rosenhan (1973)?
All pseudopatients were diagnosed as having a serious mental health disorder on minimal symptoms.
62
Was the sanity of the researchers ever detected by staff?
No. However, patients did suspect the pseudo patients were saying.One asked whether the researcher was a journalist.In three hospitals where records were taken, about a third of the patients challenged the pseudo patients (35/118)
researchers discharged with schizophrenia in remission
63
How did the staff treat the researchers?
In a way that was consistent with their diagnosis, an frequently pathologic sized normal behaviour.For example, note taking was referred to as writing behaviour. Pacing from boredom was interpreted as nervousness and waiting outside the none too early was labelled by 1 clinician as Oral Inquisitive Syndrome.
Depersonalization of the patients by staff.
64
What statistics were found regarding the depersonalization of patients by staff?
When contact was initiated towards the nurses by the pseudo patients, 71% of times were ignored.Eye contact was made 23% of the time, verbal responses 2% of cases.This was worse from the contact was directed towards senior staff members. Of 185 reasonable questions, directed at staff none were answered.
65
Describe the follow up of Rosenhan's study.
Some institutions reacted with a challenge as they did not believe their systems would be so easily fooled. Rosenhan agreed with one leading hospital to do another similar study and set up a test.Every staff member who dealt with admissions had to rate all patients in terms of probability that they could be pseudo patients.Over a three month period, 193 patients were admitted and of those, 41 were thought to be fake by at least one staff member, and nineteen of those were classed as fake by two members.In fact, Rosenhan sent no pseudopatients to the hospital.This confirms his initial result that there is unreliability in the diagnostic process.
66
What conclusions were made by Rosenhan?
He was concerned about the effect of the label made when a diagnosis was attached to a person and the way a person was subsequently treated by the staff in institutions.
He contended that the diagnostic label changed the perception of the person so that all their behaviour was interpreted within the context of the label.He argued this could lead to the self-filling prophecy, as the person is then treated in a way that is consistent with the label and their behaviour in response to this consistent with the label, thus confirming the validity of the label.
67
what is a strength of rosenhan
population validity
- 12 hospitals spread over a wide geographical area (5 different states)
- variety of type of insitution (research and teaching hospitals to private ones to older shabbier ones)
- findings not limited to one type of hospial or area
- but was only tested in 1 culture and in the early 1970s
68
Describe the weakness of ethical issues in Rosenhan (1973).
Only permission that was gained was for Rosenhan's own admission, and even then it was only with the hospital administrator and the chief psychologist in one institution. None of the other staff in any of those tools were aware of the ruse.
It could be argued that their actions affected the amount of attention given to those who are genuinely ill
However, testimonies of pseudo patience suggested this was not true as the staff had very limited contact with the patients.
This was measured as an average of 6.8 minutes per day pursuit patient to include admission, discharge and will medication, suggesting this was not the case.Arguably, the breach of ethical guidelines is justifiable in the public interest.
69
define schizophrenia
psychotic disorders that are characterised by major distrubances in thought, emotion and behaviour
70
How long must a person have symptoms until they are diagnosed with schizophrenia?
At least one month of active symptoms and experienced disturbance to every day functioning for at least 6 months.
71
What are the 4 key symptoms of schizophrenia and explain them?
1. **Thought insertion**- When a believes their thoughts to not belong to them and have been implanted by an external source.
2. **Hallucinations**- Involuntary, vivid and clear perceptual experiences that occur in the absence of any external stimuli. These can be visual or auditory.
3. **Delusions- '**Fixed beliefs that are not amenable to change in the light of conflicting evidence' eg ***persecutory*** believing someone is trying to harm you. ***Referential*** believing that social or environmental queues have special personal meaning. ***Grandiose*** believing you're exceptional.
4. **Disorganised thinking-** inferred from a person's speech. A person might switch from one topic to another jumbling seemingly unrelated ideas together. Word salad.
72
What are 3 features of schizophrenia?
1. Lifetime prevalence of 0.3-0.7%
2. Onset is later in women. early-mid 20s men and late-20s in women.
3. Positive symptoms reduce over time but debilitating negative symptoms often remain.
73
What are examples of negative symptoms of schizophrenia?
* diminished emotional expression (flat effect)
* abolition (lack of goal directed behaviour)
* alogia (poverty of speech)
74
Give a strength and a weakness of diagnosing schizophrenia
**Strength**- Sartorius et al quoted high kappa of 0.86 and only 3.8% of clinicians said they lacked confidence in their diagnoses of schizophrenia using the ICD-10.
**Weakness**- Different cultural differences to the psychologist can make diagnosis difficult. Rastafarians use neologisms which are a play on English words. If a clinician was unaware this could be a symptom of schizophrenia.
75
Why did the theory of Hyperdopaminergia gain support?
In the 1950s two antipsychotic drugs called *chlorpromazine* and *reserpine* were found to be helpful in alleviating the symptoms of schizophrenia.
However they also induced tremors and muscle rigidity.
Which are symptoms of Parkinson's disease which is caused by low levels of neurotransmitter dopamine.
76
What were the 2 explanations for high levels of dopamine?
1. Low levels of ***beta hydroxylase***, which is the **enzyme** that breaks down dopamine. Causing a build up of excess dopamine in the synapse.
2. Proliferation (**duplication**) of *D2 dopamine **receptors*** on the post synaptic cells may be responsible for hyperdopaminergic activity.
77
What did Davis contribute to the dopamine hypotheis?
**Positive symptoms** of schizophrenia may be the result of **excess dopamine** in the **mesolimbic** pathway.
**Negative symptoms** may be the result of **hypodopaminergia** in the **mesocortical** pathway.
78
What did the drug ***clozapine*** do and how did this impact the **dopamine hypothesis**?
**Clozapine binds** to **D1** and **D4** dopamine receptors, and only **weakly** on **D2** receptors.
(The **original** dopamine hypothesis focused on **D2** receptors)
**Clozapine** also **binds** to **serotonin** receptors and greatly **reduces** both positive **and** negative symptoms.
Therefore hypothesised that **negative** symptoms are caused by **irregular serotonergic activity**.
**Serotonin regulates** dopamine levels in the **mesolimbic** pathway.
79
What do Howes and Kapur say about dopamine dysregulation?
The interactions between genetic, environmental and sociocultural factors. That the dopamine hypothesis is an explanation of psychological proneness and not an explanation.
80
How does Tenn's research on rats support the dopamine hypothesis?
Rats given 9 amphetamine injections over 3 weeks showed various schizophrenia-like symptoms. And dopamine antagonists reversed these effects.
81
How does Snyder's research support the dopamine hypothesis?
He found that chlorpromazine acts as an antagonist and has an antipsychotic effect. Another drug is a dopamine antagonist with a narrower range of biochemical effects yet is more effective in reducing symptoms.
This suggests that excess activity on specific but not all dopamine receptors is implicated in the development of symptoms
82
What are the applications of the dopamine hypothesis to drug treatment?
The knowledge of the biological symptoms of schizophrenia and possible treatments means that people with schizophrenia can live in the community without need of residential care because their symptoms are controlled.
83
What is the most recent estimate for heritability of schizophrenia by Hilker?
79%
84
How many genes does Wright think are linked to schizophrenia?
700 genes have been directly linked to schizophrenia in 2014 and is estimated to be in the thousands now.
85
How does DiGeorge syndrome support the hypothesis that schizophrenia is linked to genetics?
DiGeorge syndrome is caused by the deletion of 30-40 genes.
1% of the population normally get schizophrenia, in DiGeorge syndrome patients 25% do.
86
How is the COMT gene linked to schizophrenia?
The COMT gene provides instruction for the creation of an enzyme which breaks down neurotransmitters such as dopamine in the prefrontal cortex.
Deletion of the COMT gene would mean that dopamine levels are poorly regulated resulting in schizophrenic symptoms.
87
What is the diathesis stress model?
The idea that genes create a vulnerability for schizophrenia rather than causing it and environmental stressors trigger the condition.
88
What is Gottesman's research and what does it suggest about schizophrenia's links to genetics?
A concordance rate of 42% for MZ twins and 9% for DZ twins. It suggests that it plays a part but is not a complete explanation.
89
What did Pederson and Mortensen demonstrate?
That the longer a person has been exposed to city life and the denser the population in that city, the greater the risk of them developing schizophrenia.
90
What did egan et al 2001 demonstrate?
Found a link between decreased dopamine activity in the prefrontal cortex and one form of the comt Gene, the 'val' allele.
inheriting two copies of this allelle increass schizophrenia risk by 50%. this shows how genetic variations underpin neurotransmitter differences
91
How can knowledge of biological explanation of schizophrenia be applied?
The knowledge can be applied to when a family member receives a diagnosis of schizophrenia. Helping to determine the risk of them developing schizophrenia.
92
What is social adversity and how does it link to schizophrenia?
Social adversity is when basic human needs eg nutrition, warmth, shelter and love, are not met for example families from lower socioeconomic groups as they might have more problems with unemployment, poverty and poorer standard of living.
Giving them a higher chance of developing schizophrenia.
93
Who suggests that urbanicity increases risk of schizophrenia? and why is that?
Eaton suggested that city life is more stressful than rural life and long term exposure may trigger an episode of schizophrenia.
Noise, light pollution, criminality, faster pace and greater anonymity, make a person more vulnerable to schizophrenia.
Increased population density makes life more competitive which increases chronic social defeat.
94
What did Faris think about social isolation?
He suggested that people with schizophrenia withdraw because they think contact with others is stressful.
Self imposed isolation cuts the individual off from feedback and therefore begins to act more strangely.
95
What impact does immigration and minority status have on a person and who supports that?
1st and 2nd generation immigrants are more likely to develop schizophrenia than the general population.
***Veiling*** supports this as he found that Moroccan immigrants were more likely to be diagnosed with schizophrenia than Turkish immigrants. This correlated with the amount of actual and perceived discrimination faced by each group.
He found that those with strong ethnic identities may be a protective factor against schizophrenia.
96
Who supports the theory of urbanicity?
1. ***Eaton***- suggested that city life is more stressful than rural life.
2. ***Vassos***- performed a meta-analysis from 4 studies and found that people in an urban dwelling were 2.37x more likely to develop schizophrenia compared to rural.
97
What is a weakness of the social causation theory?
Not a complete explanation as we know that environmental triggers might only trigger the onset in those who are genetically predisposed to the condition.
98
How does the social causation hypothesis help deal with schizophrenia?
By drawing attention to factors which effect mental health at a community level.
99
What are typical or first generation antipsychotics? Give an example for schizophrenia, explain how it works and what the downsides of it are.
Typical or first generation antipsychotics are well-established drugs. Chlorpromazine was the first antipsychotic medication that worked by blocking the post synaptic dopamine receptors without activating them.
FGAs are effective in reducing positive symptoms in many people but 40% don't benefit at all and many still experience negative symptoms along with side effects.
100
What are atypical or second generation antipsychotics? Give an example for schizophrenia, explain how it works and what the downsides of it are.
Drugs created later on and are newer, Clozapine works on dopamine receptors but additional work on serotonin and glutamate receptors.
The downsides are a potentially fatal blood clot.
101
What protocol is used to ensure efficacy on medication of schizophrenia?
It is important to start medication use quickly in order to be most effective.
In the first 7 days after a psychotic episode, the objective is to reduce hostility and return client to normal function. The individual is monitored for changes in symptoms and side effects
aims to and is shown to reduce relapse (18-32% in medicated, 60-80% in those not medicated)
Continue for up to 12 months after remission
102
What are additional factors that should be considered when medicating a client for schizophrenia?
Amphetamines, alcohol, caffeine and nicotine can all disrupt the effectiveness of antipsychotic medication.
Patel et al 2014 also says that drug treatments often fail to bring relief to people who have had experienced symptoms for over five years which can lead to more significant brain changes
103
Give 2 strengths of drug treatment of schizophrenia
1. **Large meta-analysis** Zhao 2016 conducted a metanalysis comparing 18 antipsychotics and utilising data from over 10,000 people. They found that 17/18 psychotics had significantly lower relapse rates than the placebo.
2. **Applications to de-institutonalisation** In the past those with schizophrenia would have had to stay in care. Antipsychotics means that people with a diagnosis had the chance to remain in the community.
104
What was the aim of Carlson?
To review studies into the relationship between levels of neurotransmitters, especially dopamine and glutamate, on symptoms of schizophrenia.
105
What research did Carlson look at?
He conducted a literature review of 32 studies.
The research ranged from 1978 to 1999, with an average year of 1993.
106
What four types of studies did Carlson look at?
Effectiveness of drugs for treating schizophrenia.
Levels of neurotransmitters.
Effect of recreational drugs on inducing psychosis.
Brain scans, e.g. PET scans.
107
what two recreational drugs did carlsson find linked to psychosis
pcp 'angel dust'
amphetamines
108
what effect did carlsson find pcp had
increases levels of glutamate -- glutamate antagonist for a receptor called NMDA
- increases the liklihood of psychosis
109
what effect did amphetamine have found by carlsson
- increases level of dopamine
- linked to psychosis
110
what had a greater effect: amphetamine or pcp
pcp
111
what neurotransmitters did carlsson find played a role in schiz
- glutamate
- serotonin
- dopamine
112
describe the findings of carlsson regarding glutamate
- low glutamate linked to pscyhosis
- low in cerebral cortex = neg symptoms
- low in basal ganglia = pos symptoms
- caused by pcp
113
describe the findings of carlsson regarding dopamine
- increased levels could cause schizophrenia
114
what is the relationship between glutamate and dopamine (WAS found by carlsson)
low glutamate is associated with high dopamine
115
what does the relationship between serotonin and glutamate suggest
difficult to treat patients may belong to a sub-group of hypoglutaminergia
116
what drug treatment did carlsson find was useful
clozapine
- effective
- few negative symptoms
- blocks dopamine and serotonin receptors
- good for difficult to treat patients
117
what were the conclusions of carlsson et al
- more research needed in developing drugs that dont have neg side effects, consider the role of other neurotransmitters
- currently a number of potential compunds which reduce dopamine correctly (not too low)
- may be different types of schiz that care caused by abnormal levels of diff neurotransmitters
118
what are 3 evaluation points about carlsson
questionable reliability
questionable validity
good application
119
how is validity a strength in carlsson's research
- lots of info brought together quickly
- provides overview of core findings
- long time to do this first hand
- allows mass info to be used to draw more valid conclusions
120
how is relaibility a strength in carlsson's research
Much of the evidence used within this review comes from very reliable methods such as PET scans, which take objective measures of the activity in different areas of the brain.
121
why might relability and validity be a weakness in carlssons research
- secondary data used by researchers, which means that the reliability and validity of research itself can be brought into question. There is no way of knowing how valid or reliable the original study was and therefore basing further conclusions about therapeutic options for schizophrenia could be problematic
122
.how can carlsson's research be useful
helps the development of effective treatments for schiz for patients not responsive to current medications
- lots of patients dont respond quickly to current medicaitons so takes a while for an effective treatment regime or may never happen
- carlsson suggests there is new drug compounds that may help this by working on other neurotransmitters as well as doapmine
123
what is the purpose of family therapy
to help the whole family support the individual who has been diagnosed with a mental illness.
124
why is family therapy necessary
- living with someone who has experienced or is experiencing psychosis can be difficult
- demands of living with someone schizophrenic can be very high. challenging behaviour can be emotionally draining and people can feel embarrassed discussing it
125
what is the aim of family therapy
to develop a support network within the family and also build up a collaborative relationship between the family and the professionals who will be providing treatments for the patient.
people can air their concerns in a supported environment and work together to find solutions.
to achieve long term maintenance of mental health.
126
what does the NICE (National Institute for Health and Care Excellence) guildelines for treating schizphrenia state regarding family therapy
family therapy should be offered to patients during their course of treatment, and there is a great deal of evidence that it can help to reduce relapse rates and increase treatment compliance in patient groups.
127
what are the important features of family therapy
- encourage the family to talk opening about the symptoms being experienced by the patient
- drug therapy included in the treatment given and family will be offered information on how the medication works and side effects
- family members encouraged to talk about the other day-to-day concerns
128
explain the feaure of family therapy of speaking openly about the symptoms experienced by patient
- have the patient as the 'expert' on schizophrenia as they explain what they expereince
- family will be educated on the causes of the illness so as to break down any concerns about 'blame' of psychosis.
129
why is it important the family understands the illness
so they have a better understanding of the behaviours shown - e.g. learning the symptoms cant be controlled.
130
what impact can family therapy on the patient
make the patient feel more supported in the home and this is thought to have a big impact on the chance of drug treatment being successful.
131
what impact can family therapy have on the family
reduce negative emotions and blame
132
what is a limitation of family therapy
its not a treatment for schizophrenia and will not cure the disorder. it is there to help families cope with the disorder, create more manageable family environments, offer support and medication compliance.
133
what did goldstein and miklowitz (1995) find about family therapy
they reviewed the studies into the effectiveness of family therapy and found that family interventions combined with medication were much more effefctive in reducing relapse rates than medication alone. they also point out that the level of effectiveness in family interventions was determined by the type of interventions offered.
134
what did Piling et al. 2002 do
he conducted a meta analysis and compared the effectivness of family therapy with CBT as a treatment for schizophrenia and found that there were some differences in the effects of each type of therapy. family therapy was effective in reducing relapse rates for episodes of psychosis, as well as improving the compliance with the medication prescribed.
135
what does family therapy rely on
the whole family being open and honest as well as being willing to work with the therapists in supporting the patient.
not all families or family members will be willing ot able to commit to this, which could account for the drop out rates associated with family thearpy.
136
what is a strength of family therapy
it can produce positive outcomes for patients by ensuring the patient takes their medication.
137
what is a weakness of family therapy
despite evidence of its effectiveness, its not widely available on the NHS. patients who could benefit from the therapy may not have access to it.
138
what is a key outcome of family therapy
reduced relapse rates. this could improve the quality of life of many patients diagnosed with schizophrenia and could save the NHS money as fewer relapses mean that fewer patients will be admitted to hospital at considerable expense.
139
140
What are 3 strengths interviews and examples of these in Vallentine's study?
1. Useful way to **find out what people think and feel in contrast to observations** which is what people do. *eg a semi structed interview was conducted to evaluate the participants experience of the group.*
2. Semi-structured interviews are especially useful because they allow the interviewer to **probe deeper and therefore gain greater understanding**
3. If interviews are recorded then data can be **re-analysed which increases objectivity.** *eg interviews were analysed by identifying themes and conducting a content analysis. A second repeated analysis showed 60% average level of agreement.*
141
What are 3 weaknesses of interviews and give examples from Vallentine's study
1. Interview may **lack validity** because of **social desirability bias**, people may wish to present themselves in a good light and underplay their problems *eg as Vallentine's study was in a high security mental health clinic detained against their will they might try and illustrate change when there isn't any to be able to leave.*
2. Semi-structured and unstructured may **lack reliability** as no one has the same questions. eg
3. If the questions are open the psychiatrist may have to **decide themes** which can be subjective. *eg how the outcomes were assessed in 4 main domains, subjective wellbeing, problems/symptoms. social/life functioning and risk to others.*
142
What are some of the weaknesses of case studies? and give examples from Lavarenne's study
1. May be difficult to generalise. *eg last session before Christmas so may be unusual behaviour.*
2. Recollection of past events may be unreliable. *eg the psychologists didn't tape or video record so it is reliant of the psychologists interpretations at the time and their coding system.*
3. Researchers may lack objectivity as they are often involved in the case *eg the therapists had been working with the group ever since it first began*
143
3 main symptoms of Anorexia Nervosa?
1. **Restriction of energy intake-** to the point of very low body weight of a BMI of 17.5 or less
2. **Fear of gaining weight-** They may as a result engage in behaviours that prevent them gaining weight eg purging, excessive exercise and using appetite suppressants.
3. **Disturbed experience of body weight/shape-** The person has a distorted image of themselves and may fail to recognise how seriously low their body weight is.
144
What are the 2 subtypes of Anorexia Nervosa?
1. Restricting- weight loss is achieved through dieting and/or excessive exercise.
2. Binge-eating/purging- the person has binged or purged in the previous 3 months, usually as well as restricting their energy intake.
145
Give 3 features of AN
1. Lifetime prevalence ranged from 1.7% to 3.6% in women and 0.1% in men.
2. There are almost 6 times as many deaths as expected for females with AN, the highest mortality of all mental disorders.
3. Being younger and staying in hospital predicted better outcomes (i.e. survival and recovery)
146
Which 2 genes have been linked to anorexia nervosa?
1. **EPHX2 gene-** Gene that codes for the enzyme that regulates cholesterol metabolism. As people with anorexia have abnormally high levels of cholesterol.
2. **ITPR3 gene-** Gene codes for a protein which is a receptor for something that is involved in detecting tastes such as sweet and bitter. So therefore tastes don't motivate eating.
147
how is it suggested that the EPHX2 gene is linked to AN
it may be that an inherited variant of EPHX2 gene may cause overactivity of epoxide hydrolase, disrupting metabolism of cholesterol and other fatty acids.
scott-van zeeland et al (2014) sequenced 152 candidate genes - EPHX2 significantly linked with AN.
148
what is the link between ITPR3 and AN
there may be a genetically-determined dysfunction of the taste pathway so people with AN are indifferent to tastes that others enjoy
149
what neurotransmitters are involved in AN
- dopamine
- serotonin
150
what gene is involed in dopamine and AN
dat1
151
what does the DAT1 gene do
codes for a protein involved in the reuptake of dopamine
152
whta gene is involved in serotonin and AN
5-HTR2A
153
what does the 5hrt2a code for
a subtype of post synaptic serotonin receptor called the 5-HT2A receptor
154
how does dopamine affect AN
mutation in the DAT1 gene disrupts the movement of dopamine, leaving abnormally high dopamine. this disregulates the brains reward systems (mesocorticolimbic dopamine circuit) so eatings normal rewarding function is impaired
155
how can serotonin affect AN
mutation in the 5-HTR2A gene affects the structure of the serotonin receptors, resulting in less binding between serotonin and the recptor. this means that appetite related information is no transmiteed normally.
156
what research evidence supports the role of serotonin in AN
Kaye et al (2005) who found significantly decreased 5-HTR2A activity in the serotonergic system in the brains of people with AN. This shows that serotonin has an important role in the development of AN.
157
what is supporting evidence of the biological explanation of AN
It is supported by research from twin studies. For example, Holland et al. (1988) found AN concordance rates of 56% for MZs and 5% for DZs.
This provides good support as the twin study method is a convincing means of demonstrating genetic influences on disorders such as AN.
158
what is conflciting evidence of the biological explanation of AN
Twin studies depend on the equal environments assumption. We assume MZ and DZ twins are treated with equal levels of similarity. But Joseph (2002) argues that MZs are treated more similarly than DZs. MZs look more similar to each other and have more similar personality traits, so they elicit more similar behaviours from parents (e.g. dietary habits). This greater environmental similarity means heritability estimates are inflated and genetic influences are not as studies suggest.
159
what is the usefulness of the biological explanaiton of AN
Understanding genes helps with prevention and treatment of AN. Knowing someone's genetic profile could mean prevention and treatment (e.g. new drugs) are targeted more effectively at people most vulnerable to developing AN. This is a long way way in the future, but recent findings are a step in this direction and may help to improve current treatments. This shows the value of the genetic explanation because treatments based on it may improve quality of life, reduce distress and avoid needless deaths
160
what is another explanation for AN other than the biological one
The prevalence of anorexia nervosa appears to be much higher in high-income countries that are highly industrialised such as the USA, Europe, Australia, New Zealand and Japan. The genetic explanation of anorexia nervosa cannot easily account for this.
The sociocultural explanation of anorexia can account for this; women in Western, industrialised nations are far more exposed to the cultural ideal of 'slim is beautiful'
161
what is the simplicity of the biological explanation of AN
oversimplifies
No one gene can explain the wide range of physical. cognitive and behavioural symptoms of AN (e.g. as defined by the DSM5 or ICD-10).
AN is polygenic - many genes make modest but important contributions. It is likely that genes contribute to the various symptoms of AN to differing degrees.
This shows that the true picture of the causes of AN is complex, and any theory that seeks to explain the disorder in terms of one cause risks oversimplification.
162
Aim of Guardia?
Wanted to test the hypothesis that people with AN overestimate their body size even when it’s in action.
They also wanted to test if people with ANs over estimation of body size extended to bodies in general or was limited to their own.
163
Give the sample of Guardia et al ‘s study
People with AN and health controls. Two groups matched for age and educational level. 25 females with AN (12 restricting and 13 purge) and 25 controls.
Each underwent a psychiatric evaluation which showed no impairments to perception, attention or intelligence.
mean bmi and shouldre width for AN group 15.6 37.7 cm
mean bmi and shoulder width of control group 22.1 41.5
164
procedure of guardia
1. a door frame shape was projected in to a wall to give the illusion of an opening that the participants could possibly walk through
2. 51 different width shapes were projected onto the walls varying from 30cm wide to 80 cm.
3. projections presented in a random order and each one was presented 4 times to each participant
4. every participant (tested alone) was asked to predict if they could walk at normal speed through each door frame without turning to the side --> first person perspective
5. they were then asked whether another female researcher with similar bmi and shoulder width to controls standing in the room could fit through the frame --> third person perspective.
165
what were the results of the guardia et al study
- the group of AN patients overestimated their own body size. they thought they wouldn't be able to fit through door frames that were considerably bigger than themselves.
- however, the were much more accurate in estimating whether the researcher could
- for AN patients, door had to be (on average) 30% bigger than them before they say they can pass through
- for control group, door has to be 10% bigger than them before they say they can pass through
166
what was the conclusion drawn by guardia et al
pateints havent adapted their internal body image to take into account their new body size after developing the disorder but 3rd person perspetive is okay
- brain still perceives the body to be a larger size despite contradictory visual information
- patients who had lost weight in the 6 months before the study was conducted showed a greater difference between their own and the other person passability perceptions, his suggests when anorexics lose weight their central nervous system cant update the body image quick enough to provide an accurate representation of current body size. this might explain why patients with AN continue to see themselves as bigger than they are and strive to continute to lose weight because their brain doesnt percieve their current size accurately
167
what are strengths of guardia et al 2012
the use of door frames is ecologically valid becasue doors are a part of the real world which people pass through every day.
The researchers identified that using a 'third person' who had a similar body size to that of the anorexic group could mean selecting someone who had body size related issues. Despite being better methodically, it would be unethical to have a person experiencing these issues be judged by a group of people in terms of their body, as it could trigger their body-image related issues. Instead the same researcher of a healthy weight was used for both control and anorexic group.
168
what are weaknesses of guardia
The sample is limited in terms of size. only 25 participants studied in the experimental group and 25 in the control group so this is perhaps not sufficient to support a generalised conclusion. A small sample size, all of whom are female, provides very limited data from which to generalise to the target population. male sufferes of anorexia are not represented
The researcher used in the third person perspective condition had a body size that was more closely matched to the control group than the patient group. This may have meant that the control group had an advantage at estimating her ability to pass through the door frame projected on the wall.
169
in which social or cultral groups is AN more likely to occur
- groups that place emphasis on the ideal that 'slim is beautiful'.
- e.g. working in an occupation where there is a strong emphasis on body weight -- (diagnoses are considerably higher for professional dancers, models and elite atheletes)
Garner and Garfinkel, 1980 found that AN is most likely to occur in dance or modelling students compared to other female university students. this is because these groups value the slim body image as part of their image
Rackoff and Honig (2006) highlighted the 'female athete triad' of 'anorexia, athletics and amenorrhea' to illustrate the association between these 3 features in young women participating in intense levels of physical activity.
170
decribe the research of Schwartz, Thompson and Johnson (1982)
after conducting a review of Miss America beauty pagent over a 20 year period, they found the average weight of contestants decreased but at the same time in America they actual average weight of females was slightly increasing. body type that was being hailed as 'ideal' and 'beautiful' was actuallt incongruent with reality, which could make women see themselves as unfairly 'fat' compared to these images.
171
what were the findings of Hoek et al (2005) and what does this support
found that on the island of Curacao where it is seen as culturally acceptable to be overweight, there is a lower overall incidence of AN.
no cases were reported in the majority black population. incidence rates in the majority white/mixed race population were comparable to that of the US.
this supports the idea that the influence of cultral ideas is strong becasue even when immersed in a culture when its acceptable to be a larger size, the cultural norm of a smaller body size can still affect people.
172
what is/explain a strength of the sociocultral explantion
research evidence from the fact that diagnoses of anorexia have increased hugely since the 1950s, which marked the beginning of the change towards slimmer mdoeals and the preoccupation with body image and the media.
in recent years, more men have been diagnosed with anorexia which coincides with changes in mens magazines to include more diet, fitness and body image articles.
this suggests there is a relationship between changes in cultral views and increased diagnoses of anorexia.
173
what is a weakness of the sociocultral explanation
there are many people within cultures that promote 'slim is beautiful' that arent inlfuenced by these ideals to the extent of developing the disorder. this suggests sociocultral factors are just one of a number of risk factors that combine to cause the anorexia rather than an explanation in itself.
other factors may only influence the body image of people who already have a predisposition to develop the disorder such as the result of biological factors.
174
What are the two types of drugs used to treat AN?
Anti-psychotics and anti-depressants
175
What are antipsychotics?
Drugs that work on the dopamine system
176
What are antidepressants?
Drugs that work on the serotonin system
177
What are the two types of antidepressants?
* **SSRIs selective serotonin reuptake inhibitors-** They treat depression by reducing the reuptake of serotonin at the synapse, increasing its availability in neurotransmission.
* **SNRIs serotonin-noradrenaline reuptake inhibitors-** Targets noradrenaline and serotonin, inhibiting the reuptake of both.
178
Why might antipsychotics be used to treat anorexia nervosa?
1. They counter the distorted cognition about fatness experienced by people with AN.
2. They counter the reduced appetite from a disrupted dopamine system.
179
What antipsychotic is looking promising for treating AN?
olanzapine
180
Give 2 strengths of the biological treatment for AN?
1. **Boachie**- He found that using olanzapine to treat 4 children with AN. They experienced less anxiety at meal times and improvements sleeping, with few side effects.
2. **Application**- Drugs used have side effects however knowing those side effects means that they can be managed. They can be controlled through drug dosage and sometimes additional medication.
181
Give 2 weaknesses of the biological treatment?
1. **Poor effectiveness-** Lebow found that people with AN who take SGAs showed increases in BMI and increased body satisfaction but this wasn't significantly different to the placebo group.
2. **Symptoms not causes-** Drugs focus on the symptoms not the causes and may just temporarily reduce those symptoms that maintain that disorder.
182
What is enhanced CBT? and how does it help patients with Anorexia nervosa?
It uses recently developed strategies that are rooted in cognitive theory to change behaviour. Helping them overcome low self esteem and perfectionism.
Significantly underweight (BMI of 17.5 or less) clients have 40 sessions over 40 weeks otherwise clients have 20 sessions over 20 weeks.
183
What are the stages of CBT-E?
1. **Stage 1:** The client and therapist work together to identify the main AN-related cognitions and behaviours. Two crucial elements: 1. Weekly weigh ins and do not weigh themselves at any other time. 2. The division of an eating plan.
2. **Stage 2:** The client and therapist review progress over two sessions. They identify barriers to change. A decision to switch to broad CBT is taken if there are external symptoms eg low self esteem.
3. **Stage 3:** The client and therapist identify the ways the clients self evaluation is based on body weight and shape and they learn to focus on other aspects of their lives. Dietary rules are identified and helped to be broken.
4. **Stage 4:** Maintain progress and prevent relapse.
184
Give 2 strengths of the non-biological treatment of anorexia nervosa
1. **Fairburn**- CBT-E is more effective than interpersonal psychotherapy. After 20 weeks, 65.5% of CBT-E and 33.3% of IPT patients were viewed to be in remission.
2. **Application**- Successful therapy means that they no longer have a fear of gaining weight. Knowledge about AN helps researchers know how to better support participants when they are taking part in research.
185
Give 2 weaknesses of the non-biological treatment of anorexia nervosa
1. **Challenging research**- Improvement in AN symptoms in CBT may not be due to cognitive changes. **Sodersen** compared CBT and a ‘normalisation of eating' procedure. They encouraged normal eating through feedback. Remission was 75% compared to 45% of CBT.
2. **Treatment adherence-** Dropout rates area high with CBT. CBT for AN is demanding and requires commitment. **Carter** found dropout rates of 45% for CBT.
186
what are the 3 things to discuss within individual differences in clinical psychology (includes culture within this topic)
- Cultural influence on the diagnosis of MHDs > Case of Calvin
- Cultural influence on the "expression of" MHDs > Different cultures experience the voices differently
- Ind. diffs like personality factors can affect the likelihood that someone has a MHD > Perfectionism X Anorexia
187
describe the case of calvin
rastifarian culture led to misdiagnosis due to clincians unfamiliar with his cultural norms
suggesting that individual differences in culture can be an issue when the culture of the person being diagnosed is unfamiliar to the psychiatrist.
188
describe the point of how cultural influence on the "expression of" MHDs --> different cultures experience the voices differently
Luhrmann (2013) carried out a study on 60 people with schizophrenia from America (20 participants), India (20) and Ghana (20). She found that in America and western cultures, the auditory hallucinations (voices) heard by individuals are interpreted to be violent, hostile and threatening. This is due to western cultures being individualist, meaning they view their mind as their own private space, so an intrusion of a voice is immediately explained to themselves as an unfamiliar threat. However, in Ghana and Indian culture, they are collectivist, meaning they view their minds as 'connected' and are more spiritual in their beliefs.
189
describe the evidence backing up the idea that personality can affect mental health disorders
81 pps with an, 72 controls. an pps spent longer and produced higher quality results in text replication. an pps checked work more and took longer in bead sorting. higher perfectionism in an.
190
what 3 ways are mental health disorders affected by development
- lifespan / developmental processes affect the severity of schizophrenia
- role of genetics in the development of schizophrenia
- role of neurotransmitters in the development of schizophrenia
191
what did the research of goldstein (1988) involve and find
women on average have a lower rate of hospitalisations and shorter stays over a 10 year time frame.
the differences in premorbid functionings such as isolation, poor relationships and interests/hobbies affected re-hospitalisations.
social functioning such as marital and occupational status affect the length of stays.
the onset of schizophrenia for men tends to be late adolesence into early adulthood (18 - 21). for women, it tends to be late 20s. it explains why men experience schizophrenia more severely as they are less likely to have a stable job and relationships at 18 than women at 28
192
.explain the point of 'women have a less severe course of schizophrenia than men' in terms of developmental psychology
the social and emotional changes that typically occur for men during late adolesnce / early adulthood are different to those that occur for women and it is these differences that drive the different outcomes in terms of the sverity of the disorder for each gender. this is an example of lifespan / developmental processes affecting the occurrence of mental health disorders.
193
explain the findings of gottesman (1991) in relation to developmental psychology
they found that there is a relationship between the genetic similarity and probability of developing schizophrenia. he looked at 41 european studies. he found a concordence rate of 48% for MZ twins and 17% for DZ twins.
194
explain what is shown by gottesman (1991) in relation to developmental psychology
the greater concordence rate for MZs he identified shows that while schizophrenia is not entirely a genetic disorder, biology certainly plays a significant role as the more related you are, the greater the concordance rate. this suggests the potential for someone to develop schizophrenia may be present from the moment of contraception. if in later life the environemnt triggers the necessary genes, the person will develop the mental health disorder
195
how has the role of development pf mental health disorders been incorporated into the latest version of the DSM
to reflect developmental and lifespan considerations, starting with the diorders that occur in early life such as neurodevelopmental disorders (e.g. autism) and those on schizophrenia spectrum come first, followed by depression as developed late adolescents.
196
what did Opier and Susser 2005 find
prenatal exposure to infection or lack of nutrition can also increase the risk of schizophrenia.
197
what is the conclusion of the role of development in mental health disorders.
developmental processes can have a big impact on the occurence of mental health disorders.
some people may inherit the genes for schizophrenia. this doesnt automatically mean they are predisposed to develop it. if the person experiences environmental stress during their development, the genes for schizophrenia may be switched on, and one of the outcomes of that could be a proliferation of D2 dopamine receptors. this will then cause hyperdompaminergia and schizophrenia. once someone has schizophrenia, the social, emotional and cognitive changes that they undergo during the different stages of their development can cause them to experience differnt courses and outcomes of the disorder.
