clinical

Question 1

what are the HCPC guidelines for clinical practicioners

Answer 1

The HCPC is a regulator of health care practices (this includes forensic, clinical and counselling
psychologists). Those who wish to be a practicing Clinical Psychologist must be registered with
the HCPC to legally practice within the field. To qualify to register, and to remain registered,
practitioners need to meet the ‘Standards of Proficiency’ set for: training; professional skills;
behaviour and health, with the main focus being on safe and effective practice.

Question 2

what are 3 examples of standards if proficiency

Answer 2

being able to practice safely and effectively
being able to practice in an autonomous way and to use professional judgement
being able to communicate effectively

Question 3

what are the 4Ds

Answer 3

deviance
distress
dysfunction
danger

Question 4

2 strengths of 4Ds

Answer 4

Davis (2009), Difficult to judge when a behaviour is problematic enough to become a clinical
diagnosis. The 4 D’s can help by matching to the DSM criteria. T/F the four D’s
have practical application as they are used by practitioner and can help them to
see when a condition might need a DSM diagnosis.

validity of the DSM, Various diagnoses using the DSM are shown to focus on specific Ds, showing
each has value. EG - Factitious disorder is where the individual will fake illness
or psychological trauma to get medical attention. This clearly indicates deviance
from the norm, as well as distress felt by the individual through faking illness,
danger can be present as they may harm themselves to validate their claims and
dysfunction may incur as the individual will be focused on creating an illness they
may not sufficiently partake in the life. T/F this supports the validity of the
DSM as a diagnostic classification system as it clearly measures a diagnosis
disorders.

Question 5

2 weaknesses of the DSM

Answer 5

subjective application of the 4Ds, No clear measure of each D. What one professional views as dysfunctional, such
as not going to work, might not be considered dysfunctional by the individual
themselves or by another professional. T/F, this reduces the validity of using
the four D’s as it requires subjective interpretation of the clinician’s perceptions
and can lead to wrong labelling

Davis (2009), a fifth D, Duration is the length of time the individual has had the symptoms. For
example, having an excessive low mood for 2 days, is different to having for 3
months. T/F the four D’s are insufficient in themselves to makes a diagnosis

Question 6

what is the DSM

Answer 6

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM-IV-TR is a multi-axial system of classification; an individual’s mental state is rated on
five separate dimensions. Axes I, II and III deal with the individual’s present condition while
axes IV and V provide additional information about the person’s life situation and the probable
degree to which they are liable to be successful in coping. The five axes are as follows:

Axis I: All diagnostic categories considered except personality disorders and mental retardation. This is clinical
disorders, major mental disorders, development disorders and learning disorders. This axis enables the
disorder to be diagnosed.
Axis II: Personality disorders and mental retardation are considered. Identifies any long term problems stemming
from these conditions, these can include brain injuries.
Axis III: General medical and physical conditions – this involves any medical conditions or physical problems that may
be relevant to understanding the disorder.
Axis IV: Psychosocial and environmental problems – any stressful events that occurred in the 12 months prior to
onset of this disorder and may have contributed to the condition
Axis V: Current level of global functioning – this provides a measure out of 100 of how the patient is functioning in
such life areas as work, social relationships and use of leisure time and their ability to cope

Question 7

what is the ICD

Answer 7

The International Statistical Classification of Diseases (ICD)
This classification system is used more frequently that then DSM in some parts of the
world, and so unlike the DSM is multi-lingual and multi-disciplinary. Unlike the DSM, the
ICD is concerned with all diseases, physical and mental health. Published by the WHO,
ICD-10 was accepted in May 1990, however the current version being used is ICD 11
which was released in 2019

Question 8

what are the categories of ICD-10

Answer 8

I. Certain infections and parasitic diseases
II. Neoplasms
III. Diseases of the blood and blood-forming organs and certain disorders involving the
immune system
IV. Endocrine, nutritional and metabolic diseases
V. Mental and behavioural disorders
VI. Diseases of the nervous system

Question 9

what is inter-rater reliability

Answer 9

One way of assessing reliability is to present the same
case study to a variety of clinicians and assess the extent of agreement. If
there is agreement is diagnosis, then there is inter-rater reliability.

Question 10

what is test-retest reliability

Answer 10

Another way of assessing the same patients two or
more times and sees whether they receive the same diagnosis. This is test-
retest reliability. (This cannot be done over too long period of time or the
change may reflect improvement in the person)

Question 11

2 strengths of general reliability of ICD and DSM

Answer 11

Jakobsen et al. (2005)
Found there was good agreement in the diagnosis of schizophrenia between ICD
10 and other classification systems

Andrews assessed 1500 patients using the DSM IV and compared this to a
diagnosis using the ICD. He found agreement on diagnosis for depression,
substance dependence and generalised anxiety.

Question 12

2 weaknesses of general reliability of ICD and DSM

Answer 12

HOWEVER.. Andrews only found 68% agreement between the ICD and the DSM.
For post-traumatic stress disorder there was poor agreement with the ICD
diagnosing twice as many cases. Therefore, suggesting that the DSM IV will not
produce a consistent diagnosis so in not reliable for PTSD.

Morey (2019
Found that the DSM 5 was more reliable than the DSM IV in diagnosisng
borderline personality disorder.

Question 13

strength of inter-rater reliability of ICD and DSM

Answer 13

Goldstein (1988)
 199 patients with Schizophrenia were re-diagnosed using the DSMIII when
they had been originally diagnosed using the DSM-II. She asked two experts to
re-diagnose a random sample of 8 patients. They were both given the case
histories, but reference to the original diagnosis was removed. The experts
carried out the re-diagnosis separately, using a
single-blind technique (where
the only person who knows the hypothesis is the researcher – so no bias is
caused). Goldstein found high level of agreement between the two experts in
the diagnosis given.

Question 14

weakness of inter-rater reliability of ICD and DSM

Answer 14

Unstructured interviews
Clinicians gather information about their patients through unstructured, clinical
interviews meaning patients may provide different descriptions to different
practitioners.
Therefore, this is why the process may lead to unreliable diagnosis

Question 15

strength of test-retest reliability for ICD and DSM

Answer 15

Brown et al (2001)
Set out to test the reliability of the DSM-IV. They studied anxiety and mood
disorders in 326 out-patients in Boston, USA. The patients underwent two
independent interviews using the anxiety disorder interview schedule for the
DSM-IV, known as the lifetime version. There was high level agreement for most
of the DSM-IV categorises

Question 16

weakness of test-retest reliability of ICD and DSM

Answer 16

Subjective interpretation
The way a criterion is phrased within the DSM can be open to interpretation.
For example, with Manic Syndrome (mood disorder) the DSM states that mood
must be abnormally and persistently elevated. Furthermore, some other
disorders, such as hyper tension (high blood pressure) are on a continuum so it is
not a yes or no diagnosis.

Question 17

what is concurrent validity

Answer 17

Concurrent validity is that a diagnosis will be valid if you compare the diagnosis of one
diagnostic manual with a manual that has already been found to be valid and if the
same diagnosis is given to the patient then the manual will have concurrent validity. For
example, the ICD may have been found to be a valid measure of depression. A patient
will be diagnosed using the ICD and is given the diagnosis of depression. The same
patient will then be diagnosed using the DSM, if the DSM diagnoses the patient with
depression then the DSM is valid for the diagnosis of depression

Question 18

2 strengths for concurrent validity of ICD and DSM

Answer 18

Andrews (1999)
Andrews assessed 1500 patients using the DSM and compared this to a
diagnosis using the ICD. He found agreement on diagnosis for depression,
substance dependence and generalised anxiety.
Therefore, the DSM can be seen to have concurrent validity for these
disorders.

Lee et al (2006)
Found that for the diagnosis of ADHD there was agreement when using the
DSM IV and other measures such as questionnaire data.
Therefore, the DSM can be seen to have concurrent validity for ADHD

Question 19

what is predictive validity

Answer 19

Diagnosis is valid if it predicts the course of the illness accurately; prediction of
future behaviour caused by the disorder. You should be able to say whether a person is
likely to recover, whether the symptoms will continue and whether the treatment will
be effective, thus the treatment/therapy put in place after diagnosis should be
effective if the diagnosis is valid
For example, the drug lithium carbonate is an effective treatment for
bipolar disorder, but no other disorder. Therefore, is an individual is
diagnosed with bipolar disorder their symptoms should reduce when given lithium carbonate and so has predictive validity. But, if their symptoms do
not decrease then the diagnosis lacked predictive validity

Question 20

weakness of concurrent validity for ICD and DSM

Answer 20

HOWEVER,… Andrews only found 68% agreement between the ICD and the
DSM. For post-traumatic stress disorder there was poor agreement with the
ICD diagnosing twice as many cases. Therefore, suggesting that for this
PTSD the DSM-IV lacks concurrent validity.

Question 21

strength of predictive validity for ICD and DSM

Answer 21

Powers et al. (2017)
Found that women who had suffered complex post traumatic disorder also
had higher levels of alcohol and substance misuse as predicted by ICD 11.
Therefore, showing that ICD 11 does have good predictive validity.

Question 22

weakness of predictive validity for ICD and DSM

Answer 22

However, with the DSM and ICD the precise course of many disorders has not
yet been established yet. This is why the diagnostic manual are republished and
updated, as our knowledge develops on the disorders. Equally, some patients may
not respond to some treatment methods given, but still have the disorder that
that treatment treats. Therefore, establishing predictive validity is
problematic

Question 23

what is construct validity

Answer 23

Validity in diagnosis means that the symptoms of the patient match those considered
to be present for that disorder. Thus, the symptoms listed for diagnosis need to be
representative enough to measure what they are supposed to be measuring.
 For example, a client diagnosed with schizophrenia using DSM should have at
least two symptoms continuously for at least two months or the diagnosis
does not fit the necessary criteria so lacks validity

Question 24

strength of construct validity for ICD and DSM

Answer 24

Hoffman (2002)
 Looked at the different diagnosis of alcohol abuse, alcohol dependence and
cocaine dependents in prison inmates, to see if such differences showed up using
a structured interview that was computer-prompted, and to see if they
corresponded to the DSM-IV-TR. It was found that the DSM diagnosis was valid
and the interview data supported the idea that dependence was a more severe
syndrome than abuse (both alcohol and cocaine abuse). These symptoms from
the automated interview matched the DSM diagnosis

Question 25

what was the aim of rosenhans study

Answer 25

to investigate if sane people could be distinguished from insane people using the DSM II classification system, and if they can be distinguished how can sanity be identified.

to see if the DSM II is a valid diagnostic tool

Question 26

what was the sample of rosenhans study

Answer 26

8 pseudo-patients (3 female, 5 male) sent to 12 different psychiatric hospitals across the East + West coasts of America.

Question 27

what was the procedure of rosenhans study

Answer 27

• 12 hospitals range from old, new, privately funded and publicly funded.
• psuedo patients had fake names and false occupations
• when phoning for and appointment psuedo patients said the could hear an unfamiliar voice same sex as themselves saying words like ‘hollow’, ‘thud’ and ‘empty’.
• apart from this all details were true e.g. childhood, relationships and education
• as soon as the patients were admitted to hospital they behaved normally and reported they were fine, free of symptoms and not schizophrenic
• took part in ward activities, spoke to other patients and staff, responded to instructions from staff
• took notes covertly but later overtly
• if asked said they felt fine and free of symptoms
• in some cases approached staff asking when they were likely to be distinguished
• when given medication would pocket it or flush down the toilet

Question 28

what was the findings of rosenhans study

Answer 28

• psuedo patients were identified as insane and admitted to hospital
• all but one were diagnosed as schizophrenic and when released 7 were released with the diagnosis of schizophrenia in remission
  stayed in hospital between 7-52 days with the average being 19 days
• 35/118 patients recognised that the psuedo patients were not ‘crazy’ as did those visiting other patients
• ## while flushing medication psuedo patients saw actual patients medication