Clinical Flashcards
What are the 4ds of diagnosis?
Dysfunction
Distress
Deviance
Danger
What is the 5th d that was added later?
Duration
What are the books used to diagnose mental health problems from?
DSM and ICD
Where is the DSM used?
America as its created by the American associations
What is descriptive validity?
2 individuals suffer the same symptoms and should get same diagnosis
What is ateological validity?
When 2 individuals have similar diagnosis due to having similar causal factors
What is concurrent validity?
When clinician uses more than one method to diagnose, each method came to the same conclusion
How does a reliable diagnosis occur?
Through concurrent validity
How is a valid diagnosis drawn?
When symptoms shown are the same as the book. If treatment works then the correct diagnosis was given
What is the kappa value?
Reliability of diagnosis, level of agreement 0.7
State the findings of Regnier 2013
Found PTSD 0.69
Personality disorder 0.75
General anxiety disorder 0.2
What was Regier trying to prove?
If the DSM accurately diagnosed people from volume 4 to volume 5
Who proved the validity of the DSM?
Cohen 2005
How did Cohen find the DSM to be valid?
Had concurrent, predictive and ateological validity
How was concurrent validity proved by Cohen?
Interviews
Questionnaire
How was predictive validity shown by Cohen?
Children then had learning difficulties
How was ateological validity shown by Cohen?
Having similar causal factors
What mental health problem did Cohen study?
Conduct disorder
How is the DSM not valid?
Individual differences may effect cause of mental disorder
Can’t identify specific causal factors
Outline the ICD
11 editions
Published by WHO
Different code for each disorder
What did Ponizovsky show in terms of reliability? Schizophrenia
Schizophrenia went from 68% in 1989 using ICD volume 9 to 94.2% in 2002 using ICD 10
Why is the ICD not reliable?
Doesn’t account for individual differences
How does the ICD show validity?
Predictive validity where the diagnosis was able to predict later struggles
How is validity a weakness for the ICD?
Application it needs to be simplified and be more user friendly
What are the 4 symptoms of schizophrenia?
Thought insertion
Hallucinations
Delusions
Disorders thinking
When is a diagnosis of schizophrenia given?
After 6 months with at least 1 symptom effecting daily function
What other conditions can schizophrenia be confused with?
PTSD
depression
What gender gets diagnosed with schizophrenia earlier?
Males
Outline Lurmann study
Interviewed 60 American, Ghanaian people with schizophrenia
Found 70% Americans extraneous voices were telling then to hurt others
But on 50% Ghanaians.
Ghanaians said positive voices where more powerful with only 20% negative.
10% Americans said voices were family members
What are the 2 assumptions of the dopamine hypothesis of schizophrenia?
- Excess dopamine at receptors in the mesolithic pathway cause positive symptoms like hallucinations. Hyperdopaminertia
- Lack of dopamine in the mesocortical pathway with pre frontal cortex causes a flattened effect. Hypodopaminertia
What are the 2 assumptions of the dopamine hypothesis of schizophrenia?
- Excess dopamine at receptors in the mesolithic pathway cause positive symptoms like hallucinations. Hyperdopaminertia
- Lack of dopamine in the mesocortical pathway with pre frontal cortex causes a flattened effect. Hypodopaminertia
Who conducted the contemporary study for schizophrenia?
Carlson
What were the aims of the schizophrenia contemporary study?
Show neurotransmitter functioning between Neurones and brain areas
Provide explanation for schizophrenia
Produce new drugs which are more effective
What were the findings of the contemporary study for schizophrenia?
People with schizophrenia had higher dopamine levels in mesolymbic pathway
Dopamine in high then glutamine is low so the thalamus becomes overactive and the cerebral cortex is starved of activity
Outline the evaluation points for carlsons contemporary study for schizophrenia
G + range of research and comparisons as well as using animals
R + inter rater, meta analysis identified thematic analysis
A + new more effective drugs can be made
V- range of methods with different aims lacks internal validity
Bias as well as only pick out findings which are relevant
What was the aim of Shields experiment?
To investigate how far schizophrenia was genetic
What was the procedure of Shields experiment?
Used secondary data from 1 hospital where a set of twins were diagnosed with schizophrenia
What was the sample in Shields experiment?
31 males and 31 females aged between 19 and 64
What were the 3 results of Shields experiment?
High risk of inheriting schizophrenia in identical twins 42% compared to 9% in non identical twins
Schizophrenia may also be caused by environments
What causes genes to cause schizophrenia?
Mutation or deletion
What is digeorges syndrome?
When deletion causes 30 to 40 genes to be deleted on chromosome 22
What percentage of people with digeorges syndrome develop schizophrenia?
25%
What does the COMT gene control?
The production of COM enzymes which breakdown neurotransmitters leading to an increase in dopamine
What does the diathesis model suggest?
An individuals probability of developing schizophrenia is higher is you are exposed to stressful situations and childhood trauma
What is social causation theory?
Schizophrenia is caused by the way people interact with each other and who you are around
What is social adversity?
When family disfunction and childhood trauma causes symptoms of schizophrenia as needs are not met
What is urbanity?
Eaton suggested city life is more stressful than rural life as it increases social defeat
Name some city stressors
Competition
Crowding
What is social defeat hypothesis?
When exposed to hostility stress increased
What did Selton find in social defeat hypothesis?
When an invading rat entered another’s home the resident rat attacked the intruder as stress increased. This lead to submission and increased dopamine to end hostility
What did Boydell find in people with Schizophrenia risk?
1st and 2nd generation immigrants were at more risk of developing disease
Why are immigrants at a greater risk of inheriting schizophrenia?
Due to prejudice and discrimination and the parental and cultural norms
Why are immigrants at a greater risk of inheriting schizophrenia?
Due to prejudice and discrimination and the parental and cultural norms
What are the 2 types of antipsychotic?
Typical and Atypical
List some side effects of antipsychotics
Weight gain
Blurred vision
Lack of sex drive
Outline how typical anyipsychotics work in the synapse
Bind to D2 receptors in the mesolymbic pathway. This means less dopamine can enter and more metabolites are present to breakdown neurotransmitters. Less dopamine less symptoms of schizophrenia
Outline how Atypical antipsychotics work in the Synapse
Binds to the dopamine and serotonin reuptake channels. Therefore dopamine is reduced and glutamate and serotonin increased. Reduces both positive and negative symptoms of schizophrenia
Outline Meltzers experiment
Studied 481 patients with schizophrenia.
3 groups, no treatment, 4 atypical drugs and an typical group
Outline the findings of Meltzer experiment
Haloperidol typical drug improved all areas of functioning
2 out of 4 atypical drugs showed improvements
What is tardive dyskinesia?
Abnormal movements of the face
What percentage of people on antipsychotics developed tardive dyskinesia?
15%
What does publication bias of antipsychotics effectiveness show?
Gain for anyone who created or produced drug.
Bias shows drug may not be effective for all
What are the effects of antipsychotics on istitutuonalising those with schizophrenia?
Enhances protection in society and quality of life for individual
What are the effects of antipsychotics on istitutuonalising those with schizophrenia?
Enhances protection in society and quality of life for individual
What percentage of people had no response to antipsychotic drugs?
55%
What negative ethical issue may there be with antipsychotic treatments?
Takes away the individuals right to choice as they are incapacitated so consent for treatment is given on their behalf
What negative ethical issue may there be with antipsychotic treatments?
Takes away the individuals right to choice as they are incapacitated so consent for treatment is given on their behalf
What does CBT believe symptoms of schizophrenia are caused by?
Thoughts,beliefs,perception
How does CBT help treat schizophrenia?
Delusions create fear and anxiety which lead to isolation
Outline how CBT works
Identifies stressor to normalise behaviour to prevent relapse
How does CBT help individuals with schizophrenia?
They are made to feel their symptoms are as a result of theor disorder so are not an outcast
Outline how behavioural treatments help schizophrenia patients
Make individual create a situation where their delutions are tested to show proof of reality
Outline the NICE findings
Showed reduction in hospitalisation,
Reduction in amount of time spent in hospital, reduction in severe symptoms
Give evidence to show CBT is ineffective
Only 2 out of 9 trials showed CBT helped symptoms.
May be relationship formed woth disorder which helps individuals
Give evidence to show CBT is effective
55% don’t respond to antipsychotics alternative treatment
Skills are life long with no side effects
Give evidence to show CBT is effective
55% don’t respond to antipsychotics alternative treatment
Skills are life long with no side effects
Outline some issues with diagnosis
Subjectivity- symptoms may be viewed differently in cultures
Reliability- diagnosis is not consistent between DSM and ICD
Ethnocentric- DSM based on western cultures
Reductionist- simplifies diagnosis into symptoms
Validity- Bias diagnosis, doesn’t account for causal factors so lacks both aeteological and concurrent validity
What was the aim of Rosenhans classic study?
Can professionals recognise if someone is faking a disorder
What was the sample of Rosenhans classic study?
Professionals, doctors, staff at 12 hospitals in 5 different states
What was the method in Rosenhans classic study?
To fake a diagnosis by claiming to hear voices then when in a hospital to act normal
What were the results of Rosenhans classic study?
11/12 were diagnosed with schizophrenia. 1/12 diagnosed with bipolar
Length of hospital stay 7-52 days
35/118 actual patients thought fake ones were faking it
All discharged with symptoms in remission
Give the evaluation points for Rosenhan classic study
G+ representative sample as diagnosis consistent but invalid
R+ standardised procedure
A+ created training for professionals
V+ ecological natural setting
- internal may create bias
E- socially sensitive
