Clinical

Question 1

What are the 4 D’s of diagnosis?

Answer 1

Deviance
Danger
Distress
Dysfunction

Question 2

Deviance

Answer 2

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.

Question 3

Dysfunction

Answer 3

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.

Question 4

Distress

Answer 4

• 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.

Question 5

Danger

Answer 5

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.

Question 6

Give 2 strengths of the 4 Ds in diagnosing mental health disorders.

Answer 6

1. 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.
2. 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.

Question 7

Give 2 weaknesses of the 4 D model

Answer 7

1. 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.
2. 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.

Question 9

What is the DSM?

Answer 9

Describes symptoms and features and risk factors of over 300 mental and behavioural disorders. Provides revenue for the American Psychiatric Association.

Question 10

Describe the 3 sections of the DSM-5

Answer 10

1. Section 1: Guidance about using the new system
2. Section 2: Details about the disorders and is categorised according to our current understanding of underlying causes and similarities between symptoms.
3. Section 3: Suggestions for new disorders which require further investigation.

Question 11

How do clinicians gather information on an individual?

Answer 11

• Observation
• Unstructured (clinical) interviews
• Structured interviews.

Question 12

2 ways reliability is assessed

Answer 12

1. Test-retest reliability
2. Inter-rater reliability

Question 13

4 ways validity is assessed

Answer 13

1. Descriptive validity
2. Aetiological validity
3. Concurrent validity
4. Predictive validity

Question 14

Descriptive validity

Answer 14

When two people with the same diagnosis exhibit similar symptoms

Question 15

Aetiological validity

Answer 15

When two patients share similar causal factors

Question 16

Concurrent validity

Answer 16

When a clinician uses more than one method or technique to get a diagnosis, both giving the same diagnosis.

Question 17

Predictive validity

Answer 17

Accurately predict outcomes for an individual from their diagnosis eg prognosis and reaction to treatment.

Question 18

Give a strength and a weakness of the DSM in terms of reliability

Answer 18

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.

Question 19

Give a strength and a weakness of the DSM in terms of validity

Answer 19

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.

Question 20

What is the ICD?

Answer 20

• 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.

Question 21

How is the ICD used to make a diagnosis?

Answer 21

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.

Question 22

what does HCPC stand for

Answer 22

Health and Care Professions Council

Question 23

What improvements were made to the ICD-10

Answer 23

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.

Question 24

Give 2 strengths of the ICD in terms of reliability

Answer 24

1. PONIZOVSKY- The reliability of the ICD-9 and ICD-10. About 3000 patients assessed. They found PPV increased from 68% to 94% for schizophrenia.
2. GALEAZZI- Two researchers assessed 100 patients with psychosomatic symptoms and had kappa values from 0.69 to 0.97.

Question 25

Give 2 strengths of the ICD in terms of validity

Answer 25

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.

Question 26

what is the HCPC

Answer 26

a regulator set up to protect the public.

Question 27

how does the HCPC achieve their aim

Answer 27

they keep a register of professiona;s who meet their standards for their professional skills, knowledge and behaviour

Question 28

name the 10 standards

Answer 28

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

Question 29

give an example of ‘promote and protect the interests of service users and carers’

Answer 29

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.

Question 30

give an example of ‘work within the limits of your knowledge and skills’

Answer 30

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

Question 31

give an example of ‘delegate appropriately

Answer 31

only delegate to people who have the knowledge, skills and experience required. continue to provide supervision.

Question 32

what is background question of the clincial practical

Answer 32

how do mainstream political parties in this country view mental health

Question 33

what is the aim of the research

Answer 33

to investigate the views held by 4 of the main[stream] political parties in the UK towards mental health using their 2015 manifestos

Question 34

what are the variables of our clincial practical

Answer 34

viewpoints/polices/positions regarding mental health

Question 35

what is the researhc hypothesis of our clinical paractical

Answer 35

there will be a significant difference in the viewpoints of left-leaning and right-leaning political parties in terms od mental health

Question 36

what was the sample of our clincial practical

Answer 36

4 political parties manifestos (2015) - conservative, labour, lib dems, green.

Question 37

what was the procedure of the clinical practical

Answer 37

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.

Question 38

what ethical issues in the clinical practical

Answer 38

none.
its ethical because the info is on the public domain

Question 39

how are we analysing data in the clincal pracical

Answer 39

pie chart –> qualitative
describe how each political parties talk about those things –> qualitative

Question 40

what were the quantative results of of clinical practical

Answer 40

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%.

Question 41

what is a similarity between l-wing and r-wing parties’ manifestos in terms of MH

Answer 41

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”

Question 42

what are 3 differences between r-wing and l-wing manifestos in terms of MH

Answer 42

• 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

Question 43

explain the difference of r-wing focus on economic benefits of improving MH services, l-wing focus of social benefits

Answer 43

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.”

Question 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.

Answer 44

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.”

Question 45

explain the difference of mention MH within employment in different contexts

Answer 45

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”

Question 46

what is the construct validity of our clinical practical

Answer 46

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

Question 47

what is the ecological validity of our clinical practical

Answer 47

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

Question 48

what is the population validity of our clinical practical

Answer 48

• 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

Question 49

what is the reliability of our clinical practical

Answer 49

• 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

Question 50

what is the objectivity of our clinical practical

Answer 50

• 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.

Question 51

whats the conclusion of our clinical practical

Answer 51

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.

Question 52

what were the results of our summative content analysis

Answer 52

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”.

Question 53

What is the aim of Rosenhan (1973)?

Answer 53

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.

Question 54

What was the sample of Rosenhan (1973)?

Answer 54

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.

Question 55

Who were the pseudo patients?

Answer 55

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.

Question 56

What was the first thing Rosenhan had the researchers do?

Answer 56

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.

Question 57

To what extent did the researchers provide correct information about themselves?

Answer 57

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

Question 58

Were all the researchers admitted to the hospitals? And if so, what diagnosis were they given?

Answer 58

Yes, they were all admitted with a diagnosis of schizophrenia, except one who was admitted with manic depression with psychosis.

Question 59

Does Rosenhan (1973) research show the DSM to be reliable or not?

Answer 59

reliable because they were almost all given the same diagnosis.

Question 60

What happened once the researchers were admitted to the hospitals?

Answer 60

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

Question 61

What was the key finding of Rosenhan (1973)?

Answer 61

All pseudopatients were diagnosed as having a serious mental health disorder on minimal symptoms.

Question 62

Was the sanity of the researchers ever detected by staff?

Answer 62

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

Question 63

How did the staff treat the researchers?

Answer 63

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.

Question 64

What statistics were found regarding the depersonalization of patients by staff?

Answer 64

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.

Question 65

Describe the follow up of Rosenhan’s study.

Answer 65

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.

Question 66

What conclusions were made by Rosenhan?

Answer 66

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.

Question 67

what is a strength of rosenhan

Answer 67

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

Question 68

Describe the weakness of ethical issues in Rosenhan (1973).

Answer 68

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.

Question 69

define schizophrenia

Answer 69

psychotic disorders that are characterised by major distrubances in thought, emotion and behaviour

Question 70

How long must a person have symptoms until they are diagnosed with schizophrenia?

Answer 70

At least one month of active symptoms and experienced disturbance to every day functioning for at least 6 months.

Question 71

What are the 4 key symptoms of schizophrenia and explain them?

Answer 71

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.

Question 72

What are 3 features of schizophrenia?

Answer 72

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.

Question 73

What are examples of negative symptoms of schizophrenia?

Answer 73

• diminished emotional expression (flat effect)
• abolition (lack of goal directed behaviour)
• alogia (poverty of speech)

Question 74

Give a strength and a weakness of diagnosing schizophrenia

Answer 74

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.

Question 75

Why did the theory of Hyperdopaminergia gain support?

Answer 75

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.

Question 76

What were the 2 explanations for high levels of dopamine?

Answer 76

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.

Question 77

What did Davis contribute to the dopamine hypotheis?

Answer 77

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.

Question 78

What did the drug clozapine do and how did this impact the dopamine hypothesis?

Answer 78

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.

Question 79

What do Howes and Kapur say about dopamine dysregulation?

Answer 79

The interactions between genetic, environmental and sociocultural factors. That the dopamine hypothesis is an explanation of psychological proneness and not an explanation.

Question 80

How does Tenn’s research on rats support the dopamine hypothesis?

Answer 80

Rats given 9 amphetamine injections over 3 weeks showed various schizophrenia-like symptoms. And dopamine antagonists reversed these effects.

Question 81

How does Snyder’s research support the dopamine hypothesis?

Answer 81

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

Question 82

What are the applications of the dopamine hypothesis to drug treatment?

Answer 82

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.

Question 83

What is the most recent estimate for heritability of schizophrenia by Hilker?

Answer 83

79%

Question 84

How many genes does Wright think are linked to schizophrenia?

Answer 84

700 genes have been directly linked to schizophrenia in 2014 and is estimated to be in the thousands now.

Question 85

How does DiGeorge syndrome support the hypothesis that schizophrenia is linked to genetics?

Answer 85

DiGeorge syndrome is caused by the deletion of 30-40 genes.

1% of the population normally get schizophrenia, in DiGeorge syndrome patients 25% do.

Question 86

How is the COMT gene linked to schizophrenia?

Answer 86

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.

Question 87

What is the diathesis stress model?

Answer 87

The idea that genes create a vulnerability for schizophrenia rather than causing it and environmental stressors trigger the condition.

Question 88

What is Gottesman’s research and what does it suggest about schizophrenia’s links to genetics?

Answer 88

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.

Question 89

What did Pederson and Mortensen demonstrate?

Answer 89

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.

Question 90

What did egan et al 2001 demonstrate?

Answer 90

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

Question 91

How can knowledge of biological explanation of schizophrenia be applied?

Answer 91

The knowledge can be applied to when a family member receives a diagnosis of schizophrenia. Helping to determine the risk of them developing schizophrenia.

Question 92

What is social adversity and how does it link to schizophrenia?

Answer 92

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.

Question 93

Who suggests that urbanicity increases risk of schizophrenia? and why is that?

Answer 93

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.

Question 94

What did Faris think about social isolation?

Answer 94

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.

Question 95

What impact does immigration and minority status have on a person and who supports that?

Answer 95

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.

Question 96

Who supports the theory of urbanicity?

Answer 96

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.

Question 97

What is a weakness of the social causation theory?

Answer 97

Not a complete explanation as we know that environmental triggers might only trigger the onset in those who are genetically predisposed to the condition.

Question 98

How does the social causation hypothesis help deal with schizophrenia?

Answer 98

By drawing attention to factors which effect mental health at a community level.

Question 99

What are typical or first generation antipsychotics? Give an example for schizophrenia, explain how it works and what the downsides of it are.

Answer 99

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.

Question 100

What are atypical or second generation antipsychotics? Give an example for schizophrenia, explain how it works and what the downsides of it are.

Answer 100

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.

Question 101

What protocol is used to ensure efficacy on medication of schizophrenia?

Answer 101

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

Question 102

What are additional factors that should be considered when medicating a client for schizophrenia?

Answer 102

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

Question 103

Give 2 strengths of drug treatment of schizophrenia

Answer 103

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.

Question 104

What was the aim of Carlson?

Answer 104

To review studies into the relationship between levels of neurotransmitters, especially dopamine and glutamate, on symptoms of schizophrenia.

Question 105

What research did Carlson look at?

Answer 105

He conducted a literature review of 32 studies.
The research ranged from 1978 to 1999, with an average year of 1993.

Question 106

What four types of studies did Carlson look at?

Answer 106

Effectiveness of drugs for treating schizophrenia.
Levels of neurotransmitters.
Effect of recreational drugs on inducing psychosis.
Brain scans, e.g. PET scans.

Question 107

what two recreational drugs did carlsson find linked to psychosis

Answer 107

pcp ‘angel dust’
amphetamines

Question 108

what effect did carlsson find pcp had

Answer 108

increases levels of glutamate – glutamate antagonist for a receptor called NMDA
- increases the liklihood of psychosis

Question 109

what effect did amphetamine have found by carlsson

Answer 109

• increases level of dopamine
• linked to psychosis

Question 110

what had a greater effect: amphetamine or pcp

Answer 110

pcp

Question 111

what neurotransmitters did carlsson find played a role in schiz

Answer 111

• glutamate
• serotonin
• dopamine

Question 112

describe the findings of carlsson regarding glutamate

Answer 112

• low glutamate linked to pscyhosis
• low in cerebral cortex = neg symptoms
• low in basal ganglia = pos symptoms
• caused by pcp

Question 113

describe the findings of carlsson regarding dopamine

Answer 113

• increased levels could cause schizophrenia

Question 114

what is the relationship between glutamate and dopamine (WAS found by carlsson)

Answer 114

low glutamate is associated with high dopamine

Question 115

what does the relationship between serotonin and glutamate suggest

Answer 115

difficult to treat patients may belong to a sub-group of hypoglutaminergia

Question 116

what drug treatment did carlsson find was useful

Answer 116

clozapine
- effective
- few negative symptoms
- blocks dopamine and serotonin receptors
- good for difficult to treat patients

Question 117

what were the conclusions of carlsson et al

Answer 117

• 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

Question 118

what are 3 evaluation points about carlsson

Answer 118

questionable reliability
questionable validity
good application

Question 119

how is validity a strength in carlsson’s research

Answer 119

• 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

Question 120

how is relaibility a strength in carlsson’s research

Answer 120

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.

Question 121

why might relability and validity be a weakness in carlssons research

Answer 121

• 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

Question 122

.how can carlsson’s research be useful

Answer 122

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

Question 123

what is the purpose of family therapy

Answer 123

to help the whole family support the individual who has been diagnosed with a mental illness.

Question 124

why is family therapy necessary

Answer 124

• 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

Question 125

what is the aim of family therapy

Answer 125

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.

Question 126

what does the NICE (National Institute for Health and Care Excellence) guildelines for treating schizphrenia state regarding family therapy

Answer 126

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.

Question 127

what are the important features of family therapy

Answer 127

• 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

Question 128

explain the feaure of family therapy of speaking openly about the symptoms experienced by patient

Answer 128

• 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.

Question 129

why is it important the family understands the illness

Answer 129

so they have a better understanding of the behaviours shown - e.g. learning the symptoms cant be controlled.

Question 130

what impact can family therapy on the patient

Answer 130

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.

Question 131

what impact can family therapy have on the family

Answer 131

reduce negative emotions and blame

Question 132

what is a limitation of family therapy

Answer 132

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.

Question 133

what did goldstein and miklowitz (1995) find about family therapy

Answer 133

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.

Question 134

what did Piling et al. 2002 do

Answer 134

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.

Question 135

what does family therapy rely on

Answer 135

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.

Question 136

what is a strength of family therapy

Answer 136

it can produce positive outcomes for patients by ensuring the patient takes their medication.

Question 137

what is a weakness of family therapy

Answer 137

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.

Question 138

what is a key outcome of family therapy

Answer 138

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.

Question 140

What are 3 strengths interviews and examples of these in Vallentine’s study?

Answer 140

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.

Question 141

What are 3 weaknesses of interviews and give examples from Vallentine’s study

Answer 141

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.

Question 142

What are some of the weaknesses of case studies? and give examples from Lavarenne’s study

Answer 142

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

Question 143

3 main symptoms of Anorexia Nervosa?

Answer 143

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.

Question 144

What are the 2 subtypes of Anorexia Nervosa?

Answer 144

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.

Question 145

Give 3 features of AN

Answer 145

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)

Question 146

Which 2 genes have been linked to anorexia nervosa?

Answer 146

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.

Question 147

how is it suggested that the EPHX2 gene is linked to AN

Answer 147

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.

Question 148

what is the link between ITPR3 and AN

Answer 148

there may be a genetically-determined dysfunction of the taste pathway so people with AN are indifferent to tastes that others enjoy

Question 149

what neurotransmitters are involved in AN

Answer 149

• dopamine
• serotonin

Question 150

what gene is involed in dopamine and AN

Answer 150

dat1

Question 151

what does the DAT1 gene do

Answer 151

codes for a protein involved in the reuptake of dopamine

Question 152

whta gene is involved in serotonin and AN

Answer 152

5-HTR2A

Question 153

what does the 5hrt2a code for

Answer 153

a subtype of post synaptic serotonin receptor called the 5-HT2A receptor

Question 154

how does dopamine affect AN

Answer 154

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

Question 155

how can serotonin affect AN

Answer 155

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.

Question 156

what research evidence supports the role of serotonin in AN

Answer 156

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.

Question 157

what is supporting evidence of the biological explanation of AN

Answer 157

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.

Question 158

what is conflciting evidence of the biological explanation of AN

Answer 158

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.

Question 159

what is the usefulness of the biological explanaiton of AN

Answer 159

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

Question 160

what is another explanation for AN other than the biological one

Answer 160

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’

Question 161

what is the simplicity of the biological explanation of AN

Answer 161

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.

Question 162

Aim of Guardia?

Answer 162

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.

Question 163

Give the sample of Guardia et al ‘s study

Answer 163

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

Question 164

procedure of guardia

Answer 164

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.

Question 165

what were the results of the guardia et al study

Answer 165

• 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

Question 166

what was the conclusion drawn by guardia et al

Answer 166

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

Question 167

what are strengths of guardia et al 2012

Answer 167

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.

Question 168

what are weaknesses of guardia

Answer 168

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.

Question 169

in which social or cultral groups is AN more likely to occur

Answer 169

• 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.

Question 170

decribe the research of Schwartz, Thompson and Johnson (1982)

Answer 170

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.

Question 171

what were the findings of Hoek et al (2005) and what does this support

Answer 171

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.

Question 172

what is/explain a strength of the sociocultral explantion

Answer 172

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.

Question 173

what is a weakness of the sociocultral explanation

Answer 173

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.

Question 174

What are the two types of drugs used to treat AN?

Answer 174

Anti-psychotics and anti-depressants

Question 175

What are antipsychotics?

Answer 175

Drugs that work on the dopamine system

Question 176

What are antidepressants?

Answer 176

Drugs that work on the serotonin system

Question 177

What are the two types of antidepressants?

Answer 177

• 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.

Question 178

Why might antipsychotics be used to treat anorexia nervosa?

Answer 178

1. They counter the distorted cognition about fatness experienced by people with AN.
2. They counter the reduced appetite from a disrupted dopamine system.

Question 179

What antipsychotic is looking promising for treating AN?

Answer 179

olanzapine

Question 180

Give 2 strengths of the biological treatment for AN?

Answer 180

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.

Question 181

Give 2 weaknesses of the biological treatment?

Answer 181

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.

Question 182

What is enhanced CBT? and how does it help patients with Anorexia nervosa?

Answer 182

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.

Question 183

What are the stages of CBT-E?

Answer 183

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.

Question 184

Give 2 strengths of the non-biological treatment of anorexia nervosa

Answer 184

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.

Question 185

Give 2 weaknesses of the non-biological treatment of anorexia nervosa

Answer 185

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.

Question 186

what are the 3 things to discuss within individual differences in clinical psychology (includes culture within this topic)

Answer 186

• 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

Question 187

describe the case of calvin

Answer 187

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.

Question 188

describe the point of how cultural influence on the “expression of” MHDs –> different cultures experience the voices differently

Answer 188

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.

Question 189

describe the evidence backing up the idea that personality can affect mental health disorders

Answer 189

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.

Question 190

what 3 ways are mental health disorders affected by development

Answer 190

• lifespan / developmental processes affect the severity of schizophrenia
• role of genetics in the development of schizophrenia
• role of neurotransmitters in the development of schizophrenia

Question 191

what did the research of goldstein (1988) involve and find

Answer 191

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

Question 192

.explain the point of ‘women have a less severe course of schizophrenia than men’ in terms of developmental psychology

Answer 192

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.

Question 193

explain the findings of gottesman (1991) in relation to developmental psychology

Answer 193

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.

Question 194

explain what is shown by gottesman (1991) in relation to developmental psychology

Answer 194

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

Question 195

how has the role of development pf mental health disorders been incorporated into the latest version of the DSM

Answer 195

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.

Question 196

what did Opier and Susser 2005 find

Answer 196

prenatal exposure to infection or lack of nutrition can also increase the risk of schizophrenia.

Question 197

what is the conclusion of the role of development in mental health disorders.

Answer 197

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.