Clinical

Question 1

What are the 4 D’s of Diagnosis?

Answer 1

Deviance
Dysfunction
Distress
Danger

Question 2

What is meant by Deviance (when discussing diagnosis)?

Answer 2

How rare/ infrequent the behaviour is within society

Does it break social norms?

Question 3

What is meant by Dysfunction (when discussing diagnosis)?

Answer 3

If their behaviour interferes with their life

Question 4

What is meant by Distress (when discussing diagnosis)?

Answer 4

Does it cause the individual to become upset?

Question 5

What is meant by Danger (when discussing diagnosis)?

Answer 5

Does it cause danger to themselves/others?

Question 6

Is Diagnosis reliable?

Answer 6

Everything is self-reported by the patient: The patient’s recall may be biased

Everything is interpreted by the clinician, which may have a biased perspective on the patient’s symptoms.problems

The subjectivity weakens reliability

Question 7

What are the Strengths + Weaknesses of the 4Ds of Diagnosis?

Answer 7

The 4D’s of diagnosis is a standardised procedure

Therapists will have to cover all 4D’s, which is a long + difficult process that leads to different views

Question 8

What are the Issues + Debates surrounding Diagnosis?

Answer 8

Social Control: Some argue that clinicians have a lot, or even too much power in making diagnoses. Once a person is labelled as ‘mentally ill’ there are serious implications + it can be difficult for them to lose that label. Many individuals who have bee sectioned under the mental health act find it to be a distressing + dehumanising process, as their power to make decisions is removed, and some are treated badly in care

Practical Issues: Research into mental health often involves data form the diagnosis of real patients. The diagnosis method of clinical interviews is subjective; due to relying on self report, ad clinician bias. This leads to inaccurate/inconsistent diagnosis between clinicians

Question 9

What are Classification Systems?

Answer 9

Comprehensive and standardised lists of known mental disorders and their symptoms.

Question 10

What 2 Classification Systems are looked at in Clinical Psychology?

Answer 10

DSM

ICD

Question 11

When was the ICD first written?

Answer 11

1948

Question 12

When was the DSM first written?

Answer 12

1952

Question 13

What does the DSM stand for?

Answer 13

Diagnostic and Statistical Manual

Question 14

What is the DSM?

Answer 14

The DSM is a multiaxial tool as it examines 5 different aspects of the patient’s behaviour and health. It is an American system.

Question 15

How many Axes does the DSM have?

Answer 15

The DSM is multiaxial - 5

Axis I: The main clinical syndrome/mental disorder

Axis II: Personality disorder and retardation- anything wrong with the personality that may influence the main disorder

Axis III: Medical conditions that may affect the main disorder

Axis IV: Psychosocial stressors - any events in a person’s life that may affect mental disorders + stress

Axis V: Global assessment of functioning- a test assessing social + occupational functioning, seeing how well they can carry out everyday activities (e.g. washing)

Question 16

What does the ICD stand for?

Answer 16

International Classification of Diseases

Question 17

What is the ICD?

Answer 17

The ICD-10 lists and categorises all diseases including mental and physical ones.

This is a European system.

Question 18

How does the ICD work?

Answer 18

Section F deals with mental health disorders.

Each mental health diagnosis is given a code the describes: the family of the disease, the particular disorder, the severity of the disorder, the severity of the disorder and any specific symptoms seen. (This doesn’t have to be learnt)

Question 19

What did Ward et al (1962) find about the diagnostic systems?

Answer 19

Disagreement between psychiatrists is due to inconsistent interpretation and inadequacy of the DSM / ICD-10

Question 20

What is meant by (inter-rater) Reliability of Diagnosis?

Answer 20

The extent to which clinicians agree on the same diagnosis for each patient

Question 21

What is Test-Retest Reliability?

Answer 21

When the same clinician makes the same diagnosis on different occasions.

Question 22

What evidence Supports that Diagnosis is Reliable?

Answer 22

Brown (2001)
Hoffmaan (2002)
Rosenhan (1973)

Question 23

How does Rosenhan’s (1972) study support the Reliability of Diagnosis?

Answer 23

Although inaccurate, 7 out of 8 pseudopatients were given a diagnosis of schizophrenia

Question 24

How does Brown’s (2001) study support the Reliability of Diagnosis?

Answer 24

He tested the reliability and validity of DSM IV diagnosis for anxiety and mood disorders and found them to be ‘good’ to ‘excellent’.

Question 25

How does Hoffmaan’s study support the Reliability of Diagnosis?

Answer 25

Hoffmaan used a computer to give structured interviews to prison inmate patient who had been diagnosed with either alcohol abuse, alcohol dependence or cocaine dependence, using the DSM-IV.

The computer diagnosis were consistent with the DSM- IV

Using a computerised diagnostic system eliminates any subjectivity that might take place in a diagnostic interview, making it objective.

Question 26

What evidence Challenges the Reliability of Diagnosis?

Answer 26

Beck (1954)
Stetka + Ghaemi
Cooper et al
Ward et al

Question 27

How does Beck’s study challenge the Reliability of Diagnosis?

Answer 27

Beck found that the same set of symptoms were only diagnosed as the same disorder 50% of times.

Question 28

How does Stetka + Ghaemi study challenge the Reliability of Diagnosis?

Answer 28

S+G suggest that under half of clinicians had started using the DSM-5 one year after its release, due to concerns that led to unreliable diagnosis.

Question 29

How does Cooper et al study challenge the Reliability of Diagnosis?

Answer 29

He reported that trials of the DSM-III showed schizophrenia had a reliability estimate of 0.81 (there’s an 81% chance another will give the same diagnosis), but for the DSM V it was 0.46

Question 30

How does Ward et al study challenge the Reliability of Diagnosis?

Answer 30

He said that disagreement between psychiatrists is due to inconsistent interpretation and inadequacy of the DSM / ICD-10

Question 31

What Patient Factors affect the Reliability of Diagnosis?

Answer 31

Issues with memory, denial and shame

Symptoms- e.g. disorganised thoughts

Personality disorders - e.g. psychopathy, manipulation

Question 32

What Clinician Factors affect the Reliability of Diagnosis?

Answer 32

Unstructured interview- can lead to clinicians focusing on different specific things (e.g. nightmares, past events, love life, etc); leading to different info being gathered

Subjectivity due to background and training; leading to different interpretations

A diagnosis may have I-R validity, bu that doesn’t mean its valid (e.g. Rosenhan)

Question 33

What is meant by the Validity of Diagnosis?

Answer 33

Whether the diagnosis given to a patient is accurate or not

Question 34

Why is the Validity of Diagnosis Important?

Answer 34

An inaccurate diagnosis leads to the wrong treatment, delayed recovery, and (in some cases) make things even worse.

Question 35

What is Concurrent Validity?

Answer 35

This could be checked by looking at another diagnostic tool (e.g. DSM with the ICD).

If there is broad agreement about which symptoms constitute which disorder, there is broad concurrent validity.

Question 36

What is Aetiological Validity?

Answer 36

When the patients history matches what’s known about the causes of the disorder

Question 37

What is Predictive Validity?

Answer 37

Where the future of the course of the disorder is known, and can be applied to the person; so the diagnosis can be checked against the outcome in order to see if it’s valid.

i.e. when the treatment is successful

Question 38

What is Implicit Bias?

Answer 38

A positive or negative mental attitude towards a person, thing or group that a person holds at an unconscious level.

Clinicians have this, affecting the interpretation of the info given to them

Question 39

What research supports the Validity of Diagnosis?

Answer 39

Hoffmaan:

Hoffmaan used a computer to give structured interviews to prison inmate patient who had been diagnosed with either alcohol abuse, alcohol dependence or cocaine dependence, using the DSM-IV.

The computer diagnosis were consistent with the DSM- IV; showing it has concurrent validity

Question 40

What research challenges the Validity of Diagnosis?

Answer 40

Aboraya:

Clinicians focus on acute symptoms and overlook others. Also, patients’ mood, memory and shame lead to inaccuracy

Question 41

What is Comorbidity?

Answer 41

When there is a presence of more than one disorder in the same person at one time.

Mandy disorders overlap with each other (e.g. depression and anxiety), making a valid + reliable diagnosis difficult.

Question 42

What was the Title of Rosenhan’s (1973) study?

Answer 42

On being sane in insane places

Question 43

What was the Aim of Rosenhan’s (1973) study?

Answer 43

To answer the question “can the sane be distinguished from the insane?”

David Rosenhan challenged the diagnostic system; putting the individuals self-reporting being the source of the symptoms compared to the environmental context in which the symptoms arose.

Question 44

Who were the pseudopatients used in Rosenhan’s (1973) study?

Answer 44

8 pseudopatients

1 psychologist
3 psych graduates
1 psychiatrist
1 housewife
1 painter
1 pediatrician

Question 45

What was the Procedure of Rosenhan’s (1973) study?

Answer 45

The 8 pseudpatients called 12 institutes across America; reporting to hear voices saying “empty” “hollow” and “thud”.

They were all went under different names to protect their identity

They recorded their experiences by taking notes

Question 46

What happened to the pseudopatients whilst in the hospital during Rosenhan’s (1973) study?

Answer 46

Whilst in the hospital; they had to try to convince the staff of their sanity, in order to be let go. Their sanity was never detected by the staff, and they were discharged with a diagnosis of ‘schizophrenia in remission’

7 out of 8 were diagnosed with schizophrenia, and 1 with manic depression with psychosis

All stayed for an average of 19 days; ranging from 9 days to 52.

Question 47

What did the patients think about the pseudpatients whilst they were in the institution in Rosenhan’s (1973) study?

Answer 47

Many patients suspected the pseudopatients were fake. One even asked if the researcher was a journalist

Question 48

How did the staff treat the pseudopatients in Rosenhan’s (1973) study?

Answer 48

The staff treated normal behaviour as symptoms consistent of diagnosis (e.g. note-taking was referred to as ‘writing behaviour’)

Patients were dehumanised by staff - when contact was initiated between the pseudopatients and nurses, they were ignored 71% of the time.

Question 49

What was the follow up experiment in Rosenhan’s (1973) study?

Answer 49

Rosenhan tested one leading hospital to a similar study - they were asked to spot the pseudopatients

Of 193 admitted over the next 3 months, 41 were thought to be fake by at least one staff member, and 19 by two

Rosenhan sent none.

Question 50

What was the Conclusion of Rosenhan’s (1973) study?

Answer 50

There is unreliability in the diagnostic process.
The diagnostic label changed the perspective of the person, so that all of their behaviour was interpreted within the context of the diagnosis.

Question 51

What were the Strengths of Rosenhan’s (1973) study?

Answer 51

G: The pseudopatients were both male and female
G: The hospitals used included old, new, public + private hospitals; which is representative to an extent

R: The pseudopatients claimed to hear voices saying “empty”, “hollow” and “thud”, which is a standardised procedure

E.V: The environment was a real life hospital; and the doctors + nurses’ behaviour was natural.

Question 52

What were the Weaknesses of Rosenhan’s (1973) study?

Answer 52

G: There was a small sample size of 8 pesudopatients
G: They only used American institutions

I.V: They weren’t able able to control any extraneous variables, and Rosenhan wasn’t able to control anything because he wasn’t there, meaning it wasn’t internally valid.
I.V: The pseudopatients claimed to have symptoms they did not, which would not usually occur in real life

Question 53

What ethical guidelines did Rosenhan’s (1973) study break?

Answer 53

P: They were kept in the mental hospital for up to 52 days, even though they were mentally sane. There was no way of controlling it; anything could’ve happened

P: The doctors had to spend time with the pseudopatients, meaning thy spent less time with the real patients; reducing the quality of their treatment

W: They couldn’t withdraw from/ leave the hospital

I: No informed consent was gained from hospitals prior to the initial experiment

D: The doctors were deceived by pseudopatients, as they believed they were real patients

D: There was no formal debrief, even though he wrote abut it in the book

Question 54

What Application did Rosenhan’s (1973) study have?

Answer 54

The study led to improvements in the psychiatry system, as well as the DSM being made multiaxial, thereby having application to society

Question 55

What are Positive Symptoms also known as?

Answer 55

Type 1 Symptoms

Question 56

What are Positive Symptoms?

Answer 56

Symptoms which add to the experience of the patients

Question 57

What types of positive symptoms can schizophrenic patients have?

Answer 57

Delusions
Hallucinations
Disorganised Thinking/Speech
Abnormal motor behaviour
Disorganised Behaviour

Question 58

What are Delusions?

Answer 58

Any beliefs they hold that they won’t change, even if there’s facts to prove it wrong

Question 59

What are Persecutory Delusions?

Answer 59

Believing someone is out to get them/ is harming them

Question 60

What are Grandiose Delusions?

Answer 60

Believing they are of a high status

Question 61

What are Referential Delusions?

Answer 61

Believing certain behaviours/language from others are somehow directed to them

Question 62

What are the 3 Types of Delusions?

Answer 62

Persecutory
Grandiose
Referential

Question 63

What are Hallucinations?

Answer 63

Extra perceptions that occur without them actually being present

Question 64

What are Visual Hallucinations?

Answer 64

When you see something that is not present

Question 65

What are Auditory Hallucinations?

Answer 65

Where you hear things that are not here. It may consist of two or more voices conversing with each other, or there might be a running commentary.

This is thought to be the most common type of hallucination associated with schizophrenia.

Question 66

What is meant by Disorganised Thinking/Speech?

Answer 66

When they jump from topic to topic with no connection

Question 67

What is meant by abnormal motor behaviour?

Answer 67

Unpredictable reactions

Question 68

What is meant by Disorganised Behaviour?

Answer 68

Behaviours that appear bizarre and have no purpose, a lack of inhibition and impulse control, unpredictable or inappropriate emotional responses and a decline in overall daily functioning

Question 69

What are Negative Symptoms also known as?

Answer 69

Type 2 symptoms

Question 70

What are Negative Symptoms?

Answer 70

Symptoms which take away from the experience of the patients

Question 71

What are the Types of Negative Symptoms?

Answer 71

Catatonic Behaviour
Diminished Emotional Expression
Avolition

Question 72

What is Catatonic Behaviour?

Answer 72

A reduction in activity, where all movement stops

Question 73

What is meant by Diminished Emotional Expression?

Answer 73

Individuals show less and less emotions in their use of non-verbal communication (facial expression, eye contact, physical gestures)

Question 74

What is Avolition?

Answer 74

A lack of motivation to complete usual and self-motivated activities

Question 75

What symptoms must be displayed to be diagnosed with schizophrenia?

Answer 75

To be diagnosed with schizophrenia, the patient must display two characteristic symptoms for at least one month. Also, there must be signs of disturbed behaviour for 6 months, no evidence of drug used causing symptoms, and no depression.

Question 76

What is the Prevalence and Onset of Schizophrenia?

Answer 76

The likeliness of a person developing schizophrenia is 0.3% - 0.7%.

It depends on racial/ethnic background, and gender.

Episodes of psychosis associated with schizophrenia tend to appear in late adolescence - mid for males, with the peak of onset being around 20-25. For females, onset happens later, typically from 25 until 30.

Question 77

What is meant by Prognosis?

Answer 77

How long the disease will last

Question 78

What is the Prognosis of Schizophrenia?

Answer 78

It is difficult to predict the course of illness.

Around 20% of those diagnosed will respond well to treatment. A large number will remain chronically ill needing regular treatment + intervention.

Doctors, as yet, haven’t found a way to accurately predict an individuals prognosis after diagnosis.

Question 79

What are some Other Features of Schizophrenia?

Answer 79

Many patients will show general cognitive functioning deficits in areas such as working memory, language functioning and speed of information processing.

Mood abnormalities are also common.

Question 80

When did Carlsson et al’s study take place?

Answer 80

2000

Question 81

What was the Title of Carlsson et al’s (2000) study?

Answer 81

Network interactions in schizophrenia - therapeutic implications

Question 82

What was the Aim of Carlsson et al’s (2000) study?

Answer 82

To investigate high dopamine and low glutamate on symptoms of schizophrenia

This is important to investigate, to try and reduce negative side effects

Question 83

What 2 camps of neurochemical explanations for schizophrenia did Carlsson et al investigate?

Answer 83

High dopamine

Low glutamate

Question 84

Why did they believe it was important to investigate these 2 views?

Answer 84

This is important to investigate, to try and reduce negative side effects

To try to develop drugs that reduce negative side effects with drugs that reduce dopamine

Question 85

What 3 areas of research did Carlsson et al (2000) review?

Answer 85

1. Brain Scans showing link between high dopamine and schizophrenia
2. Recreational Drugs that induce psychosis
3. Research on Drugs that Treat Schizophrenia, and the neurotransmitters of the brain that they effect

Question 86

What Recreational Drugs did Carlsson look at in his 2000 study?

Answer 86

1. amphetamines/speed (increases dopamine, causes hallucinations)
2. PCP/angel dust (reduces glutamate, causes

Question 87

What were the 3 Key Findings in Carlsson et al’s (2000) study?

Answer 87

Recreational drugs that reduce glutamate (PCP) are more likely to induce psychosis than those that increase dopamine (amphetamine)

Glutamate failure in the Cerebral Cortex may be linked to Negative symptoms, and that in the Basal Ganglia is Positive symptoms

Schizophrenic patients who are resistant to treatment have a disorder better explained by low glutamate. This may be why they respond better to Clozapine, which reduces serotonin + has an effect on glutamate

Question 88

What was the Conclusion of Carlsson et al’s (2000) study?

Answer 88

There are many types of schizophrenia which may be caused by abnormal levels of different neurotransmitters, and not just dopamine.

Further research needs to be conducted in developing drugs to treat schizophrenia that avoid negative side effects, possibly by considering the role of their neurotransmitters in the development of schizophrenia

Question 89

What are the Strengths of Carlsson et al’s (2000) study?

Answer 89

G: Carlsson et al had combined the finding of many studies in their review meant a large overall sample size

R/V: Carlsson used statistical analyses, giving their findings a degree of objectivity, credibility + validity

R/V: The brain scans used are standardised and objective methods

E: No ethical guidelines were broken

Question 90

What are the Weakness of Carlsson et al’s (2000) study?

Answer 90

G: Many of the studies reviewed were completed on rats

R/V: The validity + reliability of the original data is unknown

R: The original data may have been cherry picked

Question 91

What is the Dopamine Hypothesis for Schizophrenia?

Answer 91

People with schizophrenia will have higher levels of dopamine in the synapses of the neurones in their brains

Raised levels can be caused by increased release into the synapse

People with schizophrenia may also have increased sensitivity to dopamine

Question 92

Increased dopamine in what areas of the Brain are linked to what Symptoms of Schizophrenia?

Answer 92

Increased dopamine in:

Mesolimbic pathway (mid brain) = Positive Symptoms

Mesocortical pathway (frontal lobe) = Negative Symptoms

(Give examples of symptoms)

Question 93

What is the Glutamate Hypothesis for Schizophrenia?

Answer 93

Research suggests there are strong links between low levels of glutamate and psychotic symptoms including schizophrenia

Question 94

What research evidence supports the biological explanation of schizophrenia?

Answer 94

Randrup + Munkvad

Lieberman

Question 95

What did Randrup and Munkvad find in support of the biological explanation of schizophrenia, and what was a problem with the study?

Answer 95

They injected rats with amphetamine, which raises dopamine levels.

The rats became more aggressive and isolated.
These are similar symptoms to schizophrenia.

• Animal studies aren’t generalisable to humans

Question 96

What did Lieberman find which supports the biological explanation of schizophrenia, and what was a problem with the study?

Answer 96

75% of those with schizophrenia experienced further symptoms or psychotic episodes after taking dopamine imitators, like amphetamines and methylphenidate

• The patients already had schizophrenia, so they won’t vulnerable to the effects of dopamine. This doesn’t necessarily so that it caused the disorder.

Question 97

What drug research supports the biological explanation of schizophrenia?

Answer 97

Amphetamines are dopamine agonists which can cause amphetamine psychosis, which has symptoms similar to positive symptoms of schizophrenia

• However it doesn’t show why negative symptoms occur

Question 98

What is an Alternative Theory to the biological explanation of schizophrenia?

Answer 98

Some genes are associated with dopamine production and sensitivity are found more in those with schizophrenia.

It may be that genes are the cause, rather than the dopamine

Question 99

What Gene is known to possibly link to Schizophrenia?

Answer 99

C4

C4 is the for pruning. Excessive pruning can lead to positive symptoms, like hallucinations + delusions.

Therefore C4 can possibly lead to schizophrenia

Question 100

What is Pruning?

Answer 100

Pruning is when the brain gets rid of information that’s deemed of not being important

Question 101

What is the Genetic Hypothesis for Schizophrenia?

Answer 101

The more closely related to family member to the individual with schizophrenia, the higher the chances of developing the disorder

Question 102

What is the Genetic Risk of getting schizophrenia for the General Population?

Answer 102

1%

Question 103

What is the Genetic Risk of getting schizophrenia with a Second Degree Relative having it?

Answer 103

2.5%

Question 104

What is the Genetic Risk of getting schizophrenia with a First Degree Relative having it?

Answer 104

Parent: 3.8%

Sibling: 8.7%

One Parent: 8.7%

Two Parents: 12%

Question 105

What is the Genetic Risk of getting schizophrenia with a DZ twin or MZ twin having it?

Answer 105

DZ Twin: 30-40%

MZ Twin: 40-50%

Question 106

What Research Evidence supports the genetic explanation of schizophrenia?

Answer 106

Gottesman
Tienari
Gottesman’s Family studies

Question 107

How does Gottesman’s study Support the genetic explanation of schizophrenia?

Answer 107

Gottesman’s 1991 analysis of twin studies revealed a 48% concordance for MZ twins and only 17% for DZ twins.

He also reported that the concordance rate for identical twins brought up apart was very similar to that for identical twins brought up together

• However, critics have argued that the twins did not spend all of their childhood apart.

Question 108

How does Tienari’s study Support the genetic explanation of schizophrenia?

Answer 108

10.3% of adopted children who had a schizophrenic mother developed schizophrenia

Only 1.1% of adopted children who did not have a schizophrenic mother developed it

Question 109

How does Gottesman’s family studies Support the genetic explanation of schizophrenia?

Answer 109

The risk of developing schizophrenia more closely related to the schizophrenic.

If both parents have schizophrenia, there is a 46% chance, with one schizophrenic parent there is a 16% chance, and with a sibling it is 8%

Question 110

What research evidence Challenges the genetic explanation of schizophrenia?

Answer 110

Torrey
Wahlberg
Joseph

Question 111

How does Torrey’s study Challenge the genetic explanation of schizophrenia?

Answer 111

Torrey argued that many twin studies were inadequate due to small samples and biased allocation of twins and fraternal. (There weren’t equal amounts of MZ and DZ twins)

He reviewed eight studies with representative samples and a reasonably certain allocation of twins; and found concordance rate of 28% for MZ twins and 6% for DZ twins.

Similarly Joseph 2003 reported from nine studies, finding a concordance rate of 22.4% for MZ and 4.6% for DZ twins

This shows that when twins aren’t cherry picked, there is a lower concordance rate

Question 112

How does Wahlberg’s study Challenge the genetic explanation of schizophrenia?

Answer 112

Wahlberg reported additional findings from the study started by Tienari, which show that environmental factors are important.

They found the genetic risk of schizophrenia increased significantly if the adoptive family was high in communication deviance (tendency to communicate in unclear and confusing ways

Question 113

What Evidence suggests that schizophrenia due to the Environment, rather than Genes?

Answer 113

The higher concordance rate in MZ twins may be due to the fact that MZ twins tend to be more treated more similarly than DZ twins

Fewer than 50% of children where both parents have schizophrenia developed the order

Question 114

How does Joseph’s study Challenge the genetic explanation of schizophrenia?

Answer 114

The fact that concordance rate increase with genetic relatedness may be because they’re also likely to spend more time together, meaning environmental factors may be influential.

Joseph found higher concordance is in fraternal twins than ordinary siblings.

Question 115

What Evidence suggests that schizophrenia due to Our Biology, rather than Genes?

Answer 115

Throughout all countries, 1% of people are at risk developing schizophrenia

Therefore without any genetic influence, you could still develop schizophrenia

Question 116

What is the Neuroanatomical Theory of Schizophrenia?

Answer 116

A lot of research has found that individuals with schizophrenia have enlarged ventricles in the brain

Question 117

Which schizophrenic symptoms are enlarged ventricles associated with?

Answer 117

Enlarged ventricles almost associated with negative symptoms of schizophrenia, and also with patients who have the worst outcomes.

Question 118

What research evidence supports the neuroanatomical theory of schizophrenia?

Answer 118

Johnstone et al: Compared the CAT scans of schizophrenic patients, and matched controls. They found that those with schizophrenia had significant enlargement in ventricular areas.

Giedd et al: Found that patients with early onset schizophrenia showed significant developmental increase in ventricular size throughout a longitudinals study

Question 119

What Criticism is there for the Neuroanatomical Theory of Schizophrenia?

Answer 119

It is difficult to identify the cause and effect relationship, as brain abnormality rather than the cause of the illness

Question 120

What does the Diathesis-Stress Model argue about schizophrenia?

Answer 120

Those who have a biological predisposition to developing schizophrenia also have some kind of environmental trigger.

These include relationship/job problems, trauma, abuse and neglect

They say that the genetic explanation shows how the individual may be predisposed to developing schizophrenia.

Question 121

How does the Cognitive Theory of Schizophrenia incorporate Biological references?

Answer 121

Raised dopamine levels cause symptoms like hallucinations and delusions. When the patient tries to process and understand the symptoms, other symptoms also occur

When the patient has to make sense of their experience, they may ask others if they also saw what they saw/heard. When they can’t confirm it, the patient may believe they’re keeping information from them. These are persecutory delusions

Therefore, when trying to make sense of the symptoms initially experienced, they create further symptoms

Question 122

What did Firth (1979) say about schizophrenia?

Answer 122

First suggested that schizophrenia results from the patients increased self-awareness, where they can’t filter out typically unnecessary information (cognitive noise)

We do not consciously process all thoughts/decisions/perceptions, as this would become exhausting and isn’t necessary.

Frith argued that schizophrenic patients are unable to ignore these processes, and so experience an increased level of cognitive awareness they can’t make sense of

For example, we would normally just check a watch; but schizophrenic people may experience this thought as a voice telling them to check their watch, as they might be late

Question 123

What is Meta-Representation?

Answer 123

Implies the ability to represent mental representations

A faulty meta-representation would seriously disrupt ability to recognise one’s own actions and thoughts as being carried out by themselves, rather than someone else.

This would lead to delusions and hallucinations, as the patient would be unable to distinguish speech heard externally from a thought generated in their own mind. This makes them wonder if they said it or if someone else did.

Question 124

What research evidence supports the Cognitive explanation of schizophrenia?

Answer 124

McGuigan
Corcoran
Gold + Harvey

Question 125

How does McGuigan’s study support the cognitive explanation of schizophrenia?

Answer 125

He found that immediately before episodes of auditory hallucinations, some schizophrenic patients showed high levels of activity in the vocal centres of the brain

This supports Frith’s theory of self awareness

Question 126

How does Cocoran’s study support the cognitive explanation of schizophrenia?

Answer 126

He found that patients with schizophrenia so deficits in the theory of mind – the ability to read and interpret others intentions

This supports how they may think people are out to get them when they deny experiencing their experiences

Question 127

How does Gold and Harvey’s study support the cognitive explanation of schizophrenia?

Answer 127

They reported that people with schizophrenia often score lower on tests of attention, memory and problem-solving than similar people without the disorder

Question 128

What research evidence challenges the cognitive explanation of schizophrenia?

Answer 128

Sitskoom et al

Beck et al

Question 129

How does Sitskoom’s study challenge the cognitive explanation of schizophrenia?

Answer 129

He found that cognitive deficit were found in the relatives of patients, and they did not have schizophrenia.

This suggests genes are involved

Question 130

How does Beck’s study challenge the cognitive explanation of schizophrenia?

Answer 130

They summarised that reduced levels of dopamine causes the brain to struggle more in processing information. This leads to cognitive insufficiency (difficulty in processing info), setting the person on the pathway to developing psychosis.

This suggests there is a pre-existing biological risk factor, which then affects the persons cognitive abilities. A significant stressor in the individual’s life will lead to continuing decline in cognitive processing, eventually resulting in schizophrenia

Question 131

What is Social Drift Theory?

Answer 131

Schizophrenia is more prevalent in lower social classes in society.

Symptoms of schizophrenia make it difficult to hold down jobs, achieve well in education + maintain relationships, and so they drop down to lower socio-economic classes.

Consequently there are more schizophrenic patients in deprived areas then affluent areas.

Also urban areas have better access to support services then in rural areas

Question 132

What is the Biological Treatment of Schizophrenia?

Answer 132

The frontline treatment offered to patients with schizophrenia is often antipsychotic medication

Question 133

What do Antipsychotics do?

Answer 133

Helps alleviate the symptoms associated with a psychotic episode, such as delusional thoughts and hallucinations.

The symptoms can adversely affect the quality of life for patients, and make accessing other forms of treatment difficult; so the drugs are offered to try to control these symptoms

Question 134

How do Antipsychotics work?

Answer 134

Antipsychotic drugs work by helping to reduce the level of dopamine in areas of the brain associated with the symptoms.

The primary mechanism of action (the way they work in the brain) is through the blocking of dopamine receptors in those areas of the brain, which effectively prevents the dopamine binding to the receptors in the signups and therefore depolarises the neurons, calming them down

Question 135

How can Antipsychotics be given?

Answer 135

In tablet form, or in some cases they can be administered by injection by a nurse, especially if there is a risk that the patient will not comply with the treatment regimen themselves

Question 136

What are the two types of Antipsychotics?

Answer 136

Typical

Atypical

Question 137

What are Typical Antipsychotics?

Answer 137

Developed in the 1950s

These were the first antipsychotic drugs which were developed
These lead to unpleasant side effects

Question 138

What are some Examples of Typical Antipsychotics?

Answer 138

Chlorpromazine
Haloperidol
Fluphenazine

Question 139

What are Atypical Antipsychotics?

Answer 139

Developed in the 1990s

The atypical drugs seem to have reported fewer side-effects while still being effective, making them preferable for many patients

Question 140

What’s the difference between how Typical and Atypical drugs Work?

Answer 140

All antipsychotic drugs seem to act by locating mostly D2 receptors within those areas.

However, there is also evidence that atypical antipsychotics do not bind to the receptors quite so tightly; and that they also block 5-HT2A receptors, which are serotonin receptors

Question 141

What research evidence shows the the Biological Treatment for Schizophrenia is Effective?

Answer 141

Hartling et al
Meltzer et al

Clozapine effectiveness

Question 142

How does Meltzer et al show the Biological Treatment for Schizophrenia is Effective?

Answer 142

They found that haloperidol gave significant improvement in terms of positive symptoms, negative symptoms, severity of illness and the scoring on a psychiatric rating scale, in comparison to a placebo

This demonstrates that drugs are an affective treatment

Question 143

How does Hartling et al show the Effectiveness of the Biological Treatment for Schizophrenia?

Answer 143

They conducted a meta analysis of 114 randomised trials, investigating antipsychotics to compare the efficacy of typical and atypical antipsychotics

They found that the core illness symptoms (positive/negative symptoms and general psychopathology) there wasn’t much difference between typical and atypical antipsychotics:

There was some evidence that haloperidol (typical) was more affective than olanzapine (atypical) for positive symptoms.
The reverse was true for negative symptoms

Question 144

What is an advantage of the Biological Treatment for Schizophrenia?

Answer 144

Clozapine is considered to be one of the most effective antipsychotics. This might be because it has less side-effects; therefore, compliance amongst patience is higher and it therefore is able to reduce symptoms

Question 145

What limitations show the the Biological Treatment for Schizophrenia is not Effective?

Answer 145

Side effects

Lieberman et al

Question 146

What are the Side Effects of Atypical Antipsychotics?

Answer 146

Weight gain and metabolic changes that can increase the risk of diabetes + high cholesterol

Question 147

What are the Side Effects of Typical Antipsychotics?

Answer 147

Disturbance of movement and posture (e.g. tremors and muscle spasms)

Patient to use typical antipsychotics in the long term can end up with tardive dyskinesia. This causes in voluntary muscle spasms usually around the mouth which can affect speech. It also can be irreversible

Question 148

What are the Side Effects of Drugs in general?

Answer 148

Drugs are known to have serious side-effects for some patients, that include blurred vision, drowsiness and a rapid heart rate

Question 149

How does Lieberman et al show the Biological Treatment for Schizophrenia is Not Effective?

Answer 149

They found that many patients stop taking the medication because of the side-effects, which prevents drug treatment from working for many patients

Question 150

What are the Ethical Issues with Antipsychotics?

Answer 150

Antipsychotics can be prescribed without consent of the patient if they are sectioned under the mental health act, due to posing risk to themselves or others

Some argue this is unethical, however others argue that this is ultimately for the benefit of the patient

Question 151

What are the Issues and Debated surrounding the Biological Treatment to Schizophrenia?

Answer 151

Social Control:

ECT was used to treat people with schizophrenia. This involves a current of electricity being passed through the bra to induce a temporary seizure. Retraints and mouth guards must be used to avoid injury. A course can be up to 12 sessions n the 1960s ECT was criticised by the antipsychiatry movement for being barbaric and a method often used to render troublesome patients docile and easy to handle rather than being therapeutic. Now ECT is used successfully in extreme cases of mood disorders such as depression. However some research suggests it can be effective for catatonic symptoms in schizophrenia if used in conjunction with antipsychotics. However, some argue it is not possible to conduct research of the quality necessary to establish efficacy (double blind, placebo controlled) and this is a problem for any research suggesting it is effective.

Question 152

What is the Cognitive Treatment for Schizophrenia?

Answer 152

Cognitive Behavioural Therapy

Question 153

What is Maladaptive Thinking, and how does CBT aim to change it?

Answer 153

Maladaptive thinking is thinking that is not helpful in the situation and is not suitable (it doesn’t help someone to function, or adapt to the situation). It maintains emotional distress and behavioural problems

Maladaptive thinking comes from schemas and general beliefs about the world and oneself and about the future. CBT acts to focus on these thoughts and schemas, to change them so that the emotions and behaviours that arise from the maladaptive thoughts also change.

CBT tends to take the view that disorders and distress are down to cognitive factors.

Question 154

What does CBT for Schizophrenia focus on?

Answer 154

CBT for schizophrenia, consistent with CBT in general, focuses on the way someone structures their world cognitively and challenges the difference between psychosis and normality

It is assumed that normal cognitive processing is involved in the maintenance of some psychotic symptoms. Normal cognitive mechanisms are thought to be helpful for someone coping with the symptoms of schizophrenia.

CBT is an individual therapy to strengthen coping, and focusing on the persons life at the time. CBT also targets psychotic symptoms

Question 155

What is the Process of CBT for Schizophrenia?

Answer 155

CBT focuses on the individual, with one-to-one sessions weekly over a number of weeks or longer.

Question 156

Why is collaboration and the relationship between the patient/therapist important for CBT for Schizophrenia?

Answer 156

The therapist has to be nonthreatening and supportive to keep the pace and relaxed. They work together to discuss specific symptoms. There is focus on the subjective experience and then specific symptoms and problem areas are targeted to work on them.

The patient’s symptoms are focused on rationally, accepting them and the patients experience of them

Question 157

What 3 things does CBT for Schizophrenia include?

Answer 157

Reattribution + Focusing
Normalising
Belief Modification

(RNB)

Question 158

What is meant by Focussing + Reattribution?

Answer 158

It looks at auditory hallucinations; to reduce the frequency of the voices, and the distress they bring

The therapist first looks at physical attributes (number, volume, tone, gender, etc)
They then look at the content of what is being said: The patient writes it down for homework
The first focus is on the patient’s beliefs and thoughts about the voices

The aim is to show that the voices are self generated; and they’re to be accepted, not feared

Question 159

What is meant by Normalising?

Answer 159

It involves de-stigmatising the psychotic experience

They examine the evidence, looking for alternative explanations and challenging faulty thinking
Relaxation techniques and activity planning may also be used
They look at psychotic symptoms is more normal and less of a catastrophe; to reduce the fear and distress related to them

Question 160

What is meant by Belief Modification?

Answer 160

It’s where delusional thinking is challenged directly and there is testing against reality

Evidence for the delusional belief is challenged and exploration of the delusional belief being only one version of the events is carried out

Question 161

What are the four different procedures of cognitive therapy following an acute phase?

Answer 161

Cognitive therapy to challenge and test key beliefs, with a supportive and non-threatening relationship between the patient and the therapist

Group therapy, where members of the group are encouraged to see the irrationalities and inconsistencies of the other group members. Coping strategies are encouraged in the group

The third approach involves sessions with family so that patients do not become absorbed in their psychotic symptoms

The fourth part involves structured activities

Question 162

What does the National Institute for Health and Care (NICE) recommend about CBT for Schizophrenia?

Answer 162

The NICE produces guidelines under the heading ‘preventing psychosis’:

The first recommendation is that individual CBT is offered, with or without family intervention

The second recommendation is to offer interventions for the present and anxiety disorders and/or related disorders

For the first episode, medication is recommended and it is for subsequent acute episodes that CBT is mentioned again, as well as family intervention this time

The guideline also contains recommendations about cultural and ethnic differences. It also indicates that CBT is recommended as a treatment for schizophrenia, as is medication

Question 163

What Research evidence Supports CBT as an effective Treatment of Schizophrenia?

Answer 163

Kingdon + Turkington

Drury et al

Question 164

How does Kingdon + Turkington show the Effectiveness of CBT for Schizophrenia?

Answer 164

Research evidence by Kingdon and Turkington (1991) found that 35 out of 65 patients with schizophrenia (54%) in a five-year follow-up were free of symptoms when normalising and standard CBT techniques were used. This evidence shows that more than 50% of patients were eventually free of symptoms, which indicates that CBT is useful in treating patients with schizophrenia. Therefore this supports the use of CBT as a form oftreatment for schizophrenia

Question 165

How does Drury et al show the Effectiveness of CBT for Schizophrenia?

Answer 165

Research evidence by Drury et al. (1996a and 1996b) looked at CBT in an acute phase and found that CBT patients showed fewer psychotic symptoms at week 7 of a 12-week intervention than those in a comparison group. The CBT group average (median) stay in hospital was 49 days compared with 108 days for the comparison group which had another therapy involving activities and informal support.

This is strong evidence to support the use of CBT as a form of treatment for schizophrenia as it has been proven to show improvements in patients with schizophrenia in a short amount of time.

Question 166

What are the Advantages of using CBT for Schizophrenia?

Answer 166

CBT can be useful for more than just treatment for schizophrenia, in the sense that it need not only focus on schizophrenia but also on any stress, distress, depression and anxiety that the patient is experiencing alongside schizophrenia. The therapy is used for many different disorders and as someone with schizophrenia is likely to be experiencing at least distress, it is useful to use one therapy for more than on their symptoms. This supports the use of CBT as a treatment for schizophrenia as it proves to be an effective method in tackling more than one symptom experienced by a schizophrenic patient.

Therapists and patients work collaboratively on issues of concern to the individual and the relationship between them is non-threatening and supportive. This gives power to the patient, perhaps more than when drug therapy is involved. This is a strength for ethical reasons as the patient themselves have more control over what happens to them and they are involved in their therapy more directly. It could be argued that it will be more tailored to their needs, and therefore more likely to be successful. This supports the use of CBT as form of treatment for schizophrenia.

Question 167

What are the Weaknesses/Disadvantages of using CBT for Schizophrenia?

Answer 167

CBT can however raise ethical issues. form of treatment can be distressing for an individual as they have to focus on distressing symptoms such as hallucinations and delusions. They must also question their own belief, which includes questioning their own sanity, and this too can be stressful. This therefore suggests that CBT is not as straightforward and effective as described in the by Beck.

When considering CBT reliability and validity issues can be raised. When testing for effectiveness in schizophrenia, mostly this is not done using controls or competing therapies as mentioned when we considered its effectiveness. Without randomised controlled traits it is hard to claim effectiveness. Furthermore, evidence tends to come from self-report data after therapy, and such data might not be reliable or valid. Therefore this suggests that the effectiveness of CBT as a treatment for schizophrenia is subjective

Question 168

What did Barrowclough et al find about Schizophrenia?

Answer 168

Barrowclough et al. (2006) found no significant differences between CBT and their usual treatment (which was the control); however, when they looked at group CBT they did find reductions in feelings of hopelessness and low self- esteem.

Perhaps the weakness here is that some of the studies claiming effectiveness did not use controls or comparison groups and findings about effectiveness are perhaps not as strong as findings about drug therapy.

Question 169

What is required for someone to be Diagnosed with Depression?

Answer 169

Presence of five or more symptoms for a 2 week period, one of which must be a depressed mood or loss of interest or pleasure

These symptoms must cause significant distress or impairment to the person’s life and must not be attributable to the effect of a substance or to another medical condition

The occurrence of the symptoms cannot be better explained as being due to a disorder from the schizophrenic spectrum, and the sufferer had never had a manic/hypomanic episode

Question 170

What are the 4 Types of Symptoms?

Answer 170

Emotional Symptoms
Motivational Symptoms
Cognitive Symptoms
Somatic Symptoms

Question 171

What are Emotional Symptoms?

Answer 171

Those that deal with subjective states such as mood; typically in major depression the mood would be low and/or negative

Question 172

What are Motivational Symptoms?

Answer 172

To do with behaviour and the willingness to engage with the world; a persistence or determination to achieve is often missing if a person feels apathy

Question 173

What are Cognitive Symptoms?

Answer 173

Systematic changes in the way a person processes information from the world leading to a negative view of their circumstances

Question 174

What are Somatic Symptoms?

Answer 174

Changes to physiological patterns such as sleep or appetite

Question 175

What are some Other Symptoms of Depression?

Answer 175

Significant change in weight (loss or gain)
Changes in sleeping patterns
Observable psychomotor agitation
Fatigue
Feelings of worthlessness or excessive inappropriate guilt
Loss of concentration
Recurrent thoughts of death or suicidal ideation

Question 176

What Age is most likely to get Depression?

Answer 176

More likely to occur in young adulthood

However, it can occur at any age

Question 177

What is the Course/Duration of Depression?

Answer 177

It varies:

Some experience it, then don’t, then do again
Some experience it for a long time; especially if they have increased anxiety/personal disorders

Question 178

What is the Risk of getting Depression?

Answer 178

The risk is affected by temperament

Neuroticism is a well-established risk factor, especially when combined with stressful life events

Risk is increased by having negative effects in childhood, and having a 1st degree relative with depression

Question 179

What is the Prevalence Rate of Depression?

Answer 179

There are high prevalence rates; but this varies across cultures
It may be due to cultural differences, and reporting how you actually feel

Females are more likely to get it than males

Question 180

What is meant by Neuroticism?

Answer 180

Emotional instability with anxiety, fear, depression and envy

Question 181

What is meant by a Prevalence Rate?

Answer 181

The number of people in a given population that have the disorder at any one time

Question 182

What is Endegenous Depression?

Answer 182

Linked to internal biological factors, rather than being caused by an environmental trigger such as a stressful event

Question 183

What is Borderline Personality Disorder?

Answer 183

A pattern of instability in interpersonal relationships and self-image and marked impulsivity

Question 184

When did Kroenke’s study take place?

Answer 184

2008

Question 185

What is the Aim of Kroenke’s (2008) Study?

Answer 185

To test whether the PHQ-8 is an accurate measure of depression by comparing it to existing diagnosis rates and the traditional psychiatric interview.

To test the idea that a score of 10 or more on the PHQ would reliably indicate the presence of depression

Question 186

What is the Procedure of Kroenke’s (2008) Study?

Answer 186

Data was gathered by incorporating the PHQ-8 into a large nationwide phone survey done regularly by the USA government (the survey is called the BRFSS-the behavioural risk factor surveillance survey).

The BRFSS examines health issues in the USA to help the government improve health care. In the BRFSS respondents were also asked about their quality of life, and whether they had even been diagnosed with depression.

The researchers compared the PHQ-8 questionnaire to the DSM-IV structured psychiatric interview in order to test the accuracy of the PHQ-8.

Question 187

What is the PHQ-8 way of Measuring Depression?

Answer 187

The PHQ-8 is a questionnaire that assesses depression using 8 questions. The questionnaire has a maximum score of 24.

A score of 10 or more indicates depression, and a score of less than 10 indicates no depression.

It is quick and easy to administer. The questions ask the respondent how often they have experienced certain events/items over the last 14 days

Question 188

What types of Events does the PHQ-8 ask respondents if they’ve experienced over the past 14 days?

Answer 188

1) Little interest of pleasure in doing things
2) Feeling down, depressed or hopeless
3) Sleep troubles (too much, difficulties falling or staying asleep
4) Feeling tired or having a lack ofenergy
5) Poor appetite or over eating
6) Feeling guilty, that you are a failure, that you have let yourself and your family down
7) Trouble concentrating e.g. reading or watching TV
8) Moving or speaking so slowly that others notice, or the opposite being much more fidgety and restless than usual

Question 189

What is the DSM-IV Method of Measuring Depression?

Answer 189

The DSM-IV method of measuring depression involves a structured psychiatric interview based on similar ideas to those above.

However it is more time-consuming than the PHQ-8.

Question 190

What were the Results of Kroenke’s (2008) Study?

Answer 190

There was high concordance between the PHQ-8 and the DSM-IV structured psychiatric interview. For example:
o 176,141 (out of 198,678) participants who scored less than 10 on the PHQ-8 also showed no depression when diagnosed with the DSM structured psychiatric interview.
o 8,476 people scored more than 10 on the PHQ-8 and were also diagnosed with major depression using the DSM structured psychiatric interview. Whereas none of the participants who scored less than 10 in the PHQ-8 were diagnosed with major depression using the psychiatric interview.

In addition, the PHQ-8 and the DSM structured psychiatric interview were consistent with measures of quality of life.

For example, those diagnosed as depressed using the psychiatric interview estimated that for 9 days out of 14 (on average) there activity was limited, whereas those with a score of 10 or more on the PHQ-8 estimated that their activity was limited for 10 days out of 14.

Question 191

What is the Conclusion of Kroenke’s (2008) Study?

Answer 191

The 2 ways of measuring depression gave similar results in terms of quality of life, social demographic characteristics and prevalence of depression.

The PHQ-8 is therefore an accurate measure of depression where a score of 10 or more on the PHQ indicates the presence of depression

Question 192

What were the Advantages of Kroenke’s (2008) Study?

Answer 192

G: The sample was over 198,000 participants consisting of males and femal which is large and therefore to some extent representative of society. Therefore thefinding that the PHQ-8 is an effective way of measuring depression is generalizable to society to some extent

R: Kroenke et al (2008) referenced other findings which confirm the reliability of their findings since consistent data was gathered. Martin et al found that in Germany, 7.2% of respondents had a PHQ-9 score of equal to or more than 10, which is similar to Kroenke et al’s score of 8.6 and 9.1 of the two scores used. The PHQ-9 is a similar questionnaire with one additional question related to suicidal thoughts /thoughts of self-harm).

Practical Application

Question 193

What were the Disadvantages of Kroenke’s (2008) Study?

Answer 193

G: However, the sample consisted of those with phones, which excludes members of society more likely to have depression (low income, perhaps no phone) and therefore is not fully representative of society. Therefore the finding that the PHQ-8 is an effective way of measuring depression is not generalizable to the entire population

R: The procedure involved comparing the PHQ-8 to the DSM structured psychiatric interview which is is not standardised. Therefore the finding that the PHQ-8 is an accurate test of depression can be replicated to achieve similar results and is not reliable

V: The study and the PHQ-9 focussed on symptoms from the last 14 days, therefore it might criticised as measuring events in the respondents life rather than depression itself, and therefore lacking validity.

V: All of the methods involved in the study involve self-report, and this method of gathering data has been criticised as lacking objectivity and validity.

V: The researchers hadto alter the phasing of the questions of the PHQ-8 to make them consistent with the BRFSS. They changed the wording from “how often” to “for how many days out of the last 2 weeks”. This change from a qualitative to a quantitative response was not tested to see if it was valid, thereby undermining the validity of the study

Question 194

What was the Application of Kroenke’s (2008) Study?

Answer 194

The finding that PHQ-8 is effective as a method of measuring depression in populations is useful to society as it allows for the quick and relatively easy gathering of information on the mental health of society without intruding into people’s lives.

This in turn allows for governments to make informed decisions in terms of where there are high levels of depression and therefore where to allocate more money to mental health services for treatments, therefore the study has application to society

Question 195

What is the Title of Kroenke’s (2008) Study?

Answer 195

The PHQ-8 as a measure of current depression in the general population

Question 196

What is the Monoamine Hypothesis for Depression?

Answer 196

The monoamine hypothesis proposes that depression results from a chemical imbalance in the monoamine neurotransmitters in the brain, more specifically serotonin and noradrenaline.

Question 197

What was the Problem with the Monoamine Hypothesis?

Answer 197

However, although the levels of noradrenalin and serotonin increase within hours of the administration of these antidepressant drugs, the symptoms often do not improve for a period of up to six weeks in some cases.

This challenged the simple monoamine hypothesis and led to a more complex alternate explanation

Question 198

What is the More Complex Biological Explanation of Depression?

Answer 198

It suggests that the low levels of noradrenalin and serotonin causes an up-regulation in the sensitivity of the receptor sites on the synapses in relevant pathways.

Because of the low levels of serotonin and noradrenalin there is too little stimulation of postsynaptic receptors.

Therefore, in order to compensate more receptors are made, but when more of the neurotransmitter becomes available through the administration of antidepressant drugs, there is a down-regulation where the receptors are desensitised.

Question 199

What have more recent theories suggested about depression?

Answer 199

More recent theories have refined the idea that depression results from a pathological alteration in receptor sites caused by too little stimulation by monoamine neurotransmitters.

They now look in more detail at the interaction between serotonin and noradrenalin. In this explanation, serotonin controls the levels of noradrenalin so when there are low levels of serotonin, the levels of noradrenalin are affected.

If these are too low then the person will experience feelings of depression. if too high then they may experience mania (as in bipolar depression).

Question 200

What is Serotonin?

Answer 200

A chemical created by the body that works as a neurotransmitter. It is responsible for managing moods.

Question 201

What is Noradrenalin?

Answer 201

(also known as norepinephrine) is a catecholanine hormone and neurotransmitter with multiple roles including maintaining concentration.

Question 202

What are Receptor Sites?

Answer 202

Areas on the postsynaptic neuron that allow neurotransmitters to lock onto the membrane.

Question 203

What is Down Regulation?

Answer 203

A homeostatic mechanism where the brain produces less of something in response to an increase.

Question 204

What research Supports the Biological Explanation of Depression?

Answer 204

(Most evidence comes from drug research)

Versaini et al
Andreoli et al

Question 205

What Drug Research supports the Biological Explanation of Depression?

Answer 205

MDMA (ecstasy) increases the amount of serotonin in the synaptic gap, and are associated with a feeling of euphoria. This supports the link between high/low serotonin and high/low mood

SSRIs/NRIs block the reuptake of monoamines, and support the link.

Question 206

What is the issue with using drug research to support the Biological Explanation of Depression?

Answer 206

Drug research can be problematic in that, because of drug is effective in treating a disorder, it doesn’t mean indicates the cause of the disorder

Question 207

How does Versaini et al support the Biological Explanation of Depression?

Answer 207

They did a double-blind trial with NRIs and a placebo. They found a marked mood improvement in depressed patients

Question 208

How does Andreoli et al support the Biological Explanation of Depression?

Answer 208

They found that antidepressants that increased noradrenalin levels are just as effective as those that increase serotonin levels

Question 209

What was found about NRIs that Challenge the Biological Explanation of Depression?

Answer 209

NRIs are not successful for all depressed patients

Question 210

What research Challenges the Biological Explanation of Depression?

Answer 210

Perez et al

Sullivan, Neale + Kendler

Question 211

How does Perez et al challenge the Biological Explanation of Depression?

Answer 211

They bred mice lacking the gene for tryptophan (enzyme precursor of serotonin production)

They didn’t show any signs of depression; they weren’t respondent to antidepressants; and when put under stress, the mice didn’t respond any differently to normal mice

(Animal Studies)

Question 212

Is the Biological Explanation of Depression Credible?

Answer 212

Yes

Serotonin + noradrenaline levels in synapses can be objectively measured with PET scans

Question 213

What is Treatment Aetiology Fallacy?

Answer 213

We assume that if a treatment is effective in reducing symptoms, the target of the treatment must be the cause of the disorder.

However, this isn’t the case: because serotonin + noradrenalin can be treated with antidepressants, it doesn’t prove they cause it

Question 214

How does Sullivan, Neale + Kendler challenge the Biological Explanation of Depression?

Answer 214

They undertook a meta analysis of family, twin and adoption studies

They found a 40% increased risk of developing depression when a 1st degree relative has it

This suggests genetic vulnerability to neurotransmitter dysfunction, rather than neurochemicals

Question 215

What do behaviourist theories say about Depression?

Answer 215

Depression is a result of environmental factors causing faculty learning, which leads to set behavioural responses

Question 216

What is the Behavioural Explanation for Depression?

Answer 216

Depression is due to:

Lack of Positive Reinforcement
Learned Helplessness

Question 217

How is Depression due to Learned Helplessness?

Answer 217

Maker + Seligman:

They found that dogs exposed to inescapable electric shocks learned to give up trying to escape; and didn’t take the chance to escape, even when an opportunity was offered.

This reflects the behaviour of ‘learned helplessness’; the inability to initiate coping strategies

Question 218

What is the Cognitive Explanation for Depression?

Answer 218

Depression is due to:

Maladaptive Attributional Style
Cognitive Triad
Negative Schemas
Cognitive Distortions

Question 219

What are the Types of Attributional Biases?

Answer 219

Internal: We are responsible for what happens to us

External: Events are beyond our control

Stable: Consistent thinking it will often/always happen (e.g. I always get lost)

Unstable: Thinking it will not always happen/will be inconsistent (e.g. this is a one off event)

Global: Happens for many things/all places, everything in general (e.g. My navigational skills are awful)

Specific: Happens for few/one things/places, incidents are isolated (e.g. I get lost in Seven Kings)

Question 220

How is Depression due to a Lack of Positive Reinforcement?

Answer 220

Lewisohn (1974):

Depression occurs due to a lack of positive reinforcement from the environment.

The person either does not engage with the social environment, or they lack the social skills to engage with social environments in a way that leads to reinforcement

Question 221

What is an Attribution Bias?

Answer 221

Attributions Bias: How we habitually locate causes for events

Question 222

How is Depression due to Negative Schemas?

Answer 222

Beck’s Theory of Depression:

Depression and a depressed mood is a product of pessimistic schemas we hold about how the world works.

Negative schemas develop during childhood as a result of early trauma and unhappy experiences, leading to a cognitive triad about themselves seeing themselves as useless and worthless.

Question 223

What is the Cognitive Triad?

Answer 223

Depressed people hold negative views about themselves, the world and the future

Question 224

What are the two types of schema that operate in depression?

Answer 224

Negative Interpersonal
(generalised representation of self relationships)

Depressonegenic Schemas (Negative life events have an impact on cognitive behaviour)

Question 225

How is Depression due to a Maladaptive Attributional Style?

Answer 225

Those with depression have an internal, stable and global attributional biases.

Therefore they may believe that everything that happens to them is due to them being the way they are, and everything is their fault.

People with a maladaptive attributional style tend to put more emphasis on fault within themselves as a casual factor of their failure. They internalise failure in a way that suggests they can’t change, and that will affect everything they do

Question 226

How is Depression due to Cognitive Distortions?

Answer 226

Depressed people interpret information in a biased and inaccurate way; focusing on the negative and ignoring the positive (selective abstraction)

Question 227

What is Polar Reasoning, and how can it Link to Depression?

Answer 227

Unless everything is absolutely perfect, it is considered a dismal failure

For example, getting an A instead of an A*

If people have polar reasoning, they may always see themselves as a failure (even when they’re not)

Question 228

What is Overgeneralisation, and how does it Link to Depression?

Answer 228

One aspect of an experience is extrapolated from, in order to form a belief about what happened

For example, failure on one essay means that failure on the course is inevitable

Question 229

What research evidence Supports the Cognitive Behavioural Theory for Depression?

Answer 229

D’Alessandro

Lewinsohn et al

Question 230

How does D’Alessandro’s study support the Cognitive Behavioural Theory of Depression?

Answer 230

D’Alessandro (2002) found that students’ negative views about their futures were did not get into their an increase in depressed mood:

Those with dysfunctional beliefs about themselves, who did not get into their first choice college, then doubted their futures and developed symptoms of depression.

This supports idea that cognitive distortion is linked to a negative belief about the future.

Question 231

How does Lewinsohn et al’s study support the Cognitive Behavioural Theory of Depression?

Answer 231

Support of the concept that pessimistic schema about how the world works is a supported by Lewinsohn et al. (2001) who researched adolescent depression.

They found that stressed, dysfunctional attitudes rather than environmental factors was the strongest predictor of adolescent major depressive disorder

This therefore supports the cognitive explanation rather than the behavioural explanation

Question 232

What are the Weaknesses of the Cognitive Behavioural Theory for Depression?

Answer 232

There is little evidence that shows negative thinking was present before depression. The behaviourist model fails to explain the root causes of depression. It doesn’t clarify if, for example, the poor social interactions or isolation that limits a reinforcing experience is a cause or symptom of depression.

The learned helplessness view doesn’t explain why someone may be suicidal. It states that the individual would adopt a passive acceptance to a situation rather than an active with to die which is a symptom of depression.

It doesn’t explain causes of endogenous depression.

The cognitive aspect of the approach suggests that a pessimistic explanatory style leads to depression; however it does not make clear how it develops.

Question 233

What are the Similarities between the 2 Explanations of Depression?

Answer 233

Both explanations have led to the development of treatments: CBT and antidepressants.

Both have research that supports them: Versiani’s (1999) double blind trial showed NRIs improved mood more than placebo and D’Alessandro (2002) supports the link between cognitive distortion and negative beliefs about the future

Both suffer from aetiology fallacy neurochemicals and faulty thinking might be associated with depression, rather than being the cause of it.

Question 234

What are the Differences between the 2 Explanations of Depression?

Answer 234

The neurochemical explanation suggests low levels of monoamine neurotransmitters cause depression whereas the cognitive behavioural explanation suggests learned helplessness and faulty schema causes depression.

The neurochemical explanation is more credible than the cognitive as neurochemicals can be empirically measured with PET scans whereas negative schema and learned helplessness cannot.

The cognitive behavioural explanation is more holistic as it considers how thoughts, feelings and behaviours interact, whereas the neurochemical explanation is more reductionist as it breaks the disorder down to being caused by neurochemicals without considering the interaction between brain chemistry and social and environmental factors such as past trauma

Question 235

What is the Cognitive Treatment for Depression?

Answer 235

Cognitive Behavioural Therapy

Question 236

What is CBT for Depression designed for?

Answer 236

CBT is the first line psychological treatment for depression and anxiety disorders, especially for those with mild to moderate symptoms

Designed to achieve quick+lasting results with treatment

Question 237

What is CBT as a therapy for depression?

Answer 237

CBT for depression consists of weekly/fortnightly sessions lasting about an hour for a period of about three months (depending on the nature of the depression)

CBT is an active and directive therapy, first developed by Beck in 1967.

Question 238

What does CBT for Depression focus on, and aim to do?

Answer 238

CBT focuses on the here and now of the clients life.

Consistent with the cognitive theory, it aims to challenge the irrational beliefs that may be at the root of the depression.

It combines aspects of behavioural therapy with cognitive restructuring + problem-solving.

The therapist helps the client recognise faulty cognition that the client uses to process information about the world, and encourages them to challenge these cognitions

Question 239

What are the ways that CBT for Depression can be Delivered?

Answer 239

One-to-One Therapy
Group therapy
Computerised therapy (iCBT)

Question 240

What does the Course of Treatment look like, regarding CBT for Depression?

Answer 240

Typically the course of treatment will start with an education phase, where the client learns about the relationships between thoughts emotions and actions.

They can be taught techniques, such as ‘thought catching’, where they analyse events have happened, and map the emotional response that follows the thought that was associated with this event. This then allows the therapist to help the client to challenge the thoughts triggered by the event.

Clients are encouraged to keep a daily mood diary and to do exercises (homework) outside the sessions, and then reflect + report back on their effectiveness

Question 241

What is an Example of how CBT for Depression may work?

Answer 241

For example, the activating event might be a chance encounter in the street with an acquaintance who does not respond to your greeting and keeps on walking.

The negative thought that follows could be that you are unlikeable and that the person deliberately snubbed you; this triggers an emotional response of sadness and unworthiness, which then goes on to cause you to withdraw from other social situations.

The therapist would help you to identify these irrational thoughts (thought catching) and explore more rational explanations, thus disputing the negative belief that leads to the depressive behaviour

Question 242

What is the Behavioural Aspect of CBT for Depression?

Answer 242

The behavioural aspects of the therapy comes through hypothesis testing using a behavioural action plan.

The client is set to do work outside therapy that is aimed at changing the experiences they are having, and therefore challenging the negative beliefs about themselves.

For example, the therapist may set a task to socialise with someone, and, hopefully, a positive experience would boost their self-esteem.

Therapists only set tasks that the client can engage with successfully, because failure at a task would be a major setback that would deflate self-esteem

Question 243

What Research evidence supports CBT for Depression?

Answer 243

Otto et al: Undertook a recent large-scale study, and found that CBT was a good add-on for people not responding to drugs.

55% improved in CBT and drugs, whereas 31% improved with drugs alone

Question 244

What are the other strengths of CBT for Depression?

Answer 244

CBT has been tested empirically and shown to be effective, it is widely recommended (e.g. by NICE)

There are no side-effects, so it is more ethical for patients as well as being effective

Question 245

What Research evidence challenges CBT for Depression?

Answer 245

Elkin (1989): Found that CBT is less effective than active drug treatments with clinical management

Question 246

What are the other weaknesses of using CBT for Depression?

Answer 246

Does not explore issues from the past that might have influenced onset of depression but just changes thinking – some say CBT is therefore to simplistic and superficial for depression caused by complex issues

Psychoanalytic techniques might be better investigating the root cause of depression in those with complex and traumatic histories that have contributed to that disorder

Question 247

What is the main Biological Treatment of Depression?

Answer 247

Antidepressants

Question 248

What are Agonists?

Answer 248

Agonists are drugs that mimic neurotransmitters

Question 249

What are SSRIs, and how do they work?

Answer 249

Selective Serotonin Reuptake Inhibitors

They block the reuptake of serotonin, by blocking the transporter cells
e.g. Fluoxetine

These are safer, and generally cause if you are negative side effects. Doctors often start by prescribing an SSRI

Question 250

What are SNRIs, and how do they work?

Answer 250

Serotonin + Norepinephrine Reuptake Inhibitors

They block the reuptake of both serotonin and norepinephrine
e.g. Duloxetine

For some, they may be the best choice for safety and tolerance issues

Question 251

What are Tricyclic Antidepressants, and how do they work?

Answer 251

They block the reuptake of serotonin and noradrenaline, so they remain in the synapse for longer, and have a greater effect
e.g. Imipramine

These are older medications that have more severe side-effects, and more serious consequences if overdosed
They aren’t normally prescribed as a first choice, but only when SSRIs are proven ineffective

Question 252

What are MAOIs, and how do they work?

Answer 252

Monoamine Oxidase Inhibitors

They stop the enzymes that break down amine neurotransmitters in the synapse, thus making them available for longer
e.g. Tranylcypromine

Using MAOIs requires a strict diet, because of dangerous (or deadly) interactions with foods that contain tyramine (e.g. certain cheeses, pickles and wines). They also must not be taken in combination with many common drugs/SSRIs

Question 253

What are ECT, and how can it treat Depression?

Answer 253

Electroconvulsive Therapy

Also known as electric shock therapy
It is a treatment for depression, and often used as a treatment of last resort for those with severe depression who don’t respond to other medication

Question 254

How do Antidepressants work?

Answer 254

They stop the reuptake (reabsorption) of receptors, and thus they stay in the synapse and get attached to the receptor

Question 255

What are the Strengths of using Drug Therapy to treat Depression?

Answer 255

Research from the Royal College of Psychiatrists: They reported that 50%-65% of those treated with antidepressants showed improvement, compare to only 25%–30% of those treated with a placebo
(however there is still a placebo effect)

Geddes et al: Using drug treatment for
depression showed a relapse rate of 18%, compared with 41% for a placebo group group - suggests treatments work

Antidepressants provide relief from debilitating symptoms, which allows them to access other types of therapy (e.g. CBT)

Antidepressants appear to treat the symptoms of depression

Question 256

What Research evidence shows that using Drug Therapy to treat Depression is Ineffective?

Answer 256

1. Holland longitudinal study: found that 76 per cent of depressed patients who did not take any antidepressant drugs recovered and never relapsed.
2. A Canadian study: found that people got better quicker without antidepressants.
3. NHS (2003- a major study): used meta-analysis to find that the difference between placebos and antidepressants is very small, for mild to moderate depression.
4. Kirsch (2009): conducted a meta-analysis; and found that All Groups Improved, including those who had psychotherapy, a placebo, and even no treatment.
5. Medical Research Council (1965): found that there was no difference in patient outcome between those who took imipramine (tricyclic) and those who took a placebo.

Question 257

What are the Side Effects of using Drug Therapy to treat Depression?

Answer 257

Side effects that accompany drugs include nausea, insomnia, blurred vision, dizziness and sexual dysfunction.

The older types of drug are dangerous if taken in overdose
SSRIs have been linked to suicidal ideation in young people.

The World Health Organisation found that non-medicated patients with depression enjoyed better heath than those who took antidepressants.

Question 258

What is the problem with the cost of producing the Drug Therapy for Depression?

Answer 258

Drug trials are expensive and are often funded by drug companies with a vested interest in proving that a drug that has cost them millions of pounds to develop is an effective treatment.

Question 259

How are Antidepressants Agonists?

Answer 259

Agonists are drugs that mimic neurotransmitters.

They fit onto receptor sites, making the post synaptic dendrite believe the drug is a neurotransmitter. A substance that acts like another substance and therefore stimulates neural action; making the neuron fire about serotonin.

They make the stimulation of one neurone by another much easier

Question 260

What are the Similarities between the Treatments of Depression?

Answer 260

Drugs and CBT are both prescribed under NHS guidelines

Both may have a time delay of a few weeks between treatments starting and symptoms alleviating. However some patients also report feeling better after only one week of both treatments

Both have research that supports them

Both have been criticised for not treating the root cause of the problem- drugs as they may mask symptoms, and CBT as it does not explore the past that might have influenced the onset of depression

Question 261

What are the Differences between the Treatments of Depression?

Answer 261

Side Effects: Drugs have unpleasant side-effects and can cause death by overdose, where as CBT does not have dangerous or unpleasant consequences

Type of Therapy: CBT is a talking therapy based on cognitive principles, whereas drugs are biological treatment based on the monoamine hypothesis

Combining the two: Antidepressants might be necessary in order for those with severe depression to access CBT, but CBT is not needed for antidepressants to improve mood

Empowerment: CBT tries to tech the patient skills to enable them to deal with their depression so empowers the patient, whereas drugs do not empower the patient but instead may cause them to feel dependent on them to feel okay

Question 262

What was the Title of the Clinical Practical?

Answer 262

A summative analysis of a classic and contemporary depiction of mental health

Question 263

What was the Aim of the Clinical Practical?

Answer 263

To investigate whether media depictions is of mental health issues and treatments have changed over the years

We did this by looking at two sources (a classic from the 1960s, and a contemporary film from 2007) that deal with people suffering from mental illnesses. We will be looking at keywords, as well as depictions and whether they are in a positive or negative context

Question 264

What is a Summative Content Analysis?

Answer 264

Summitted content analysis involves counting the frequency of keywords/terms of content in the data.

These keywords can be determined before or during the analysis of the raw data.

Then the frequency of the key terms are further assessed in terms of the context

Question 265

What is the Alternative Hypothesis (one-tailed) for the Clinical Practical?

Answer 265

Analysis of the movie ‘Booked for Safe Keeping (1962)’ will show a more negative contest related to mental health such as “crazy” or “dangerous”, in comparison to the movie ‘Lars and the Real Girl (2007)’, which will show a greater positive context such as “comforting” or “supportive”

Question 266

What was the Pilot Study of the Cognitive Practical?

Answer 266

In order to decide what we would look for in the sources, in terms of clear keywords and depictions, we conducted a pilot study first. This is a small-scale study

During this, we look to find keywords or clear depictions that were showing on both sources also multiple times in one source. This with make up our manifest content (themes and main ideas of the sources)

Question 267

How did we select the Sample of our Clinical Practical?

Answer 267

We chose to look at once classic form of media, which is ‘Booked for Safe Keeping’; and one contemporary phone witches.

We will be watching a selected 10 minute clip from each film.

Question 268

What was the Procedure of the Cognitive Practical?

Answer 268

Since our research question is about the changes in attitude, I wanted to investigate whether things have become more positive or not.

For this, we chose to a look in further depth at the context in which the word or are used.

We chose to look at the positive or negative context for our latent content (the underlying meaning of the manifest content)

Question 269

What was the Result of the Cognitive Practical?

Answer 269

Our analysis showed that in the 1st/classic source, there were 8 counts of positive comments and 24 counts of negative comments. Examples of positives were confident and accommodating; as the old lady was helped out of the shop by the police officers, and examples of negative were crazy/not/disturbed, strange/abnormal/bizarre

Our analysis showed that in the 2nd/contemporary source, there were eight counts of positive comments and 11 counts of negative comments. Examples of positives were the friends pretending that girl was real and involving her (comforting/accommodating to his life) and examples of negatives were him being called crazy/nuts

Question 270

What Inferential Statistics were used in the Clinical Practical?

Answer 270

Chi Squared Test

The calculated value was 1.6214, which is less than the critical value of 2.71 for a one tailed test at (P<0.05). Therefore the difference of how mental health is depicted over time is not significant

Question 271

What were the Strengths of the Clinical Practical?

Answer 271

R: Good inter-rater reliability by taking the mean tally of 20 researchers in terms of how many times each word (e.g. crazy or theme was observed in the films and whether it was in a positive or negative context.

R: We carried out the analysis of words and themes twice for each film. This means we did have test retest reliability to ensure out interpretations were consistent on different occasions.

V: Our summative content analysis did have good validity in some respects as we spent some time discussing the context, meaning and messages of the films and wrote up our ideas. This led to rich + detailed conclusions about representations of mental health in classic and contemporary media.

R/V: The use of the chi squared test made our content analysis more credible and objective in determining whether there is a difference in depictions of mental illness in classic and contemporary media

Question 272

What are the Weaknesses of the Clinical Practical?

Answer 272

R: Our summative content analysis involved inevitable subjectivity in deciding whether a word or a theme in a positive or negative context.

I.V: This would therefore imply there were some issue truly represented what they intended to measure.

E.V: Our content analysis illustrated media depictions of mental illness, however this may not reflect reality, as often things are exaggerated in the media and dramatic events are overrepresented

Question 273

What was the Application of or Clinical Practical?

Answer 273

Our content analysis was useful in showing that representations towards mental health have not changed in recent decades, suggesting policy has been ineffective in normalising mental illness. Therefore, more policy needs to be carried out in normalising mental illness

Question 274

What is the Clinical Key Question?

Answer 274

How are mental health issues portrayed in the media?

Question 275

What is the impact in Society of mental health issues are shown in a negative way?

Answer 275

If mental health issues are shown in a stigmatised way, then those with the illness may experience prejudice and discrimination from their friends, family and employees as a result.

This might also lead to them not receiving the correct support and treatment

Those with a mental illness might become alienate it from society as a result of their suffering.

This might lead to their illness worsening, as they do not get the social support and motivation to carry on with their treatments.

Question 276

What is the impact in Society of mental health issues are shown in a positive way?

Answer 276

If mental health issues are shown in the positive way in the media, this will reduce stigma and prejudice.

This will enable people to receive better support a better care, as they will not be afraid to talk about their mental illness

Question 277

What affects the public’s perceptions of mental health?

Answer 277

The portrayal of mental health issues and health in the media is extremely powerful in educating the public and influencing their view of mental health

“Time to Chance” is an organisation set up to improve issues with public perceptions of mental illness. A quote from their website is:

“The attitudes of others stop people with mental health problems getting the help and support they need. Too many people with mental health problems are made up to feel isolated, ashamed and worthless. Together we want everyone to open up to mental health; to talk and to listen. “

Question 278

How does Lopez Levers’ (2001) study show media portrayal of mental health as negative?

Answer 278

He conducted a content analysis of 50 years of Hollywood film.

They found that mental illness is often showing as passive, pathetic or comical, and most frequently as dangerous, requiring invasive procedures or restraints

Question 279

How does Granello and Pauley’s (2000) study show media portrayal of mental health as negative?

Answer 279

They found a positive correlation between the amount of TV viewed, and intolerant attitudes towards those with mental health disorders

Question 280

How does Penn et al’s (2003) study show media portrayal of mental health as negative?

Answer 280

They found that given people a biological/medical cause for mental illnesses such as schizophrenia lead them to being more likely to avoid those with the disorder in the future.

This means media portrayals of mental illnesses as biological might be harmful

Question 281

How does Tartakovsky’s (2009) study show media portrayal of mental health as positive?

Answer 281

The media often portrays depression as a chemical imbalance. This removes the view that depression is a “moral failing”

(although the biological model of mental illness has been criticised as inaccurate and responsible for taking antidepressants)

Question 282

How do celebrities show media portrayal of mental health as positive?

Answer 282

Celebrities such as Stephen Fry and J. K. Rowling have been very vocal regarding their experiences of bipolar disorder and unipolar depression.

Since these individuals are role models to many others might be inclined to imitate their open attitudes to go to the mental illness (either their own, or someone they know

Question 283

How does a 2013 study show media portrayal of mental health as positive?

Answer 283

Have reported 2013 used 18 years of survey data and public perception of mental health and found attitudes (especially women attitudes) have improved since 1994.

This may be as a result of improving media depictions

Question 284

What do the Individual differences mainly look at in Clinical Psychology?

Answer 284

Cultural Differences

Question 285

What shows that Cultural Effects can lead to Individual Differences in Schizophrenia?

Answer 285

Diathesis-Stress model
Kirkbride et al (2012)
Schizophrenia in Afro-Carribean people

Question 286

How does the Diathesis-Stress Model show that Cultural Effects can lead to Individual Differences in Schizophrenia?

Answer 286

The diathesis-stress model of schizophrenia explains how an environmental trigger is necessary to activate a biological predisposition to schizophrenia; demonstrating social factors and cultural factors can be part of the cause

Question 287

How does the Kirkbride et al (2012) show that Cultural Effects can lead to Individual Differences in Schizophrenia?

Answer 287

Kirkbride et al (2012) found three environmental factors predicted risk of schizophrenia in 427 participants aged 18-64 years old increased deprivation (which includes employment, income, education and crime) increased population density, and an increase in inequality (the gap between the rich and poor).

Question 288

How does Schizophrenia and Afro-Carribean people show that Cultural Effects can lead to Individual Differences in Schizophrenia?

Answer 288

There are proportionately more people of Afro-Caribbean origin treated for schizophrenia in the UK than white people. This could be because those of Afro Caribbean descent are more likely to live in deprived areas with higher population densities.

Question 289

What shows that Cultural Effects can lead to Individual Differences in Depression?

Answer 289

De Graaf et al (2002)
Prevalence rates of depression
Bromet et al (2011)

Question 290

How does De Graaf et al (2002) show that Cultural Effects can lead to Individual Differences in Schizophrenia?

Answer 290

Personality can affect mental disorder vulnerability.

De Graaf et al. (2002) followed 7076 Dutch adults for 12 months and those who developed mood disorders (including depression) had scored higher for N (neuroticism) than those who remained healthy. This suggests that personality traits (or at least N) might explain and predict depression.

Question 291

How does Prevalence rates of depression show that Cultural Effects can lead to Individual Differences in Schizophrenia?

Answer 291

Clinical depression is also a worldwide problem but affects from 2% to 19% in different countries. This suggests factors like poverty and exposure to violence play a role in the onset of depression

Question 292

How does Bromet et al (2011) show that Cultural Effects can lead to Individual Differences in Schizophrenia?

Answer 292

A cross-cultural study by Bromet et al. (2011) sampled 90,000 people in 18 countries. France and the USA were the most depressed and the poorer countries showed less rather than more depression. This supports the idea that depression is a disorder of Western nations, not just a psychological response to poverty, crime or war.

Question 293

What shows that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 293

Davison and Neale
Interpretations of symptoms
Cinnerella and Loewenthal
DSM V
DSM and ICD
Kanazawa et al
Japanese Americans
Medical Model of Mental Disorders

Question 294

How does Davison and Neale show that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 294

Davison and Neale (1994) revealed that Asian-Americans can be wrongly diagnosed as having a mental disorder by the Western diagnostic system.

This is because this group displays withdrawn behaviour (which is actually desirable in the Asian-American culture).

Therefore diagnosis is not valid

Question 295

How can the Interpretations of Symptoms show that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 295

Some argue clinicians should be sensitive to the culture of the patient when making diagnoses.

If the patient is from a culture where visions of god are common and seen as a blessing, the such experiences should not be seen as hallucinations and so they should not be diagnosed with schizophrenia.

The DSM V now includes guidance on how to conduct a clinical interview with someone from a different culture.

Therefore diagnosis is improving in validity

Question 296

How does the DSM V show that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 296

The current DSM V has been designed to have cross cultural application.

This means using cross cultural research (examining different cultural groups and how they experience mental disorders) to identify different symptom patterns of disorders in different cultural groups, and adding these to each mental disorder category.

Therefore diagnosis is improving in validity.

Question 297

How does Cinnerella and Loewenthal show that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 297

Cinnerella and Loewenthal (1999) investigated the influence of religion and culture on mental disorder.

In Black Christian and Muslim Pakistani groups, depression and schizophrenia carried social stigma and there was a belief in the power of prayer.

Question 298

How does the DSM and ICD show that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 298

Differences in the American and European DSM and ICD 10 also suggest there are cultural differences in mental disorders. These systems sometimes lead to different diagnosis.

However DSM V has been modified to be more consistent with the ICD 10. In the current DSM, disorders are grouped into families, with linked disorder grouped together. The clinical can move from the general to the specific.

Question 299

How does Kanawaza et al show that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 299

Kanazawa et al (2007) found that Native Hawaiians reported higher levels of depressed mood and somatic (physical) symptoms in comparison to European Americans. This implies depression varies with culture

Question 300

How do Japanese Americans show that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 300

Japanese Americans showed more depressed mood but the same level somatic syptoms as European Americans.

They therefore concluded that this may be due to the norms of the Japanese collectivist cultures, where avoiding expressing positive mood, specifically individual happiness, is thought be encouraged in order to maintain a group harmony.

Therefore the depression itself did not vary with culture, only the expression of mood

Question 301

How does the Medical Model of Mental Disorders show that Cultural Effects can lead to Different Diagnosis of Mental Health Disorders, affecting reliability + validity?

Answer 301

The medical model of mental disorders suggests they are universal in the same way that physical disorders are.

However this is challenged by the existence of culturally disorders such as “genital retraction syndrome”. This is a mental health condition that exists in Africa and Asia only. This is where men have an anxiety that their penis will retract into their body. Women may suffer the same anxiety, but about their breasts

Question 302

How are Schizophrenia and Depression both Developmental Disorders?

Answer 302

Issues around genes and mental health, such as a genetic or biochemical explanation for schizophrenia, can affect development

Both schizophrenia and depression are developmental disorders as they do not exist from birth, but develop over time. However both are thought to have genes that increase susceptibility

Question 303

What research shows a Genetic component to Schizophrenia, and how does this link to developmental psychology?

Answer 303

Schizophrenia has been found to have a genetic component. Gottesman found higher concordance for MZ twins (42%) in comparison to DZ twins (9%) showing there is a genetic component to Schizophrenia

It may be that certain genes lead to abnormal neurochemical levels in particular of dopamine and glutamate, and contribute to schizophrenia in this Way.

Question 304

What is the Onset of Schizophrenia?

Answer 304

Schizophrenia may be classed as adolescent onset (10-17), early-adult onset (18-30), middle-age onset (30-45) and late-onset (45+).The disorder does not suddenly “strike” and the obvious psychotic episode comes after less noticeable problems that might have existed for years. This makes it difficult to diagnose exactly when schizophrenia begins.

Question 305

What research evidence support the onset of Schizophrenia?

Answer 305

Lindmer et al. (2001) found that patients with late onset schizophrenia are more likely to be female, with less negative symptoms and have a shorter period of illness.

Question 306

How do Genes link to Depression?

Answer 306

Depression has also been linked to genes. MZ twins have higher concordance for depression than DZ twins.

Question 307

When are people most likely to suffer from Depression?

Answer 307

People are most likely to suffer their first depressive episode between 30-40 and there is a second, smaller peak of onset between 50-60

Question 308

How can Depression affect you when you’re older?

Answer 308

Depression can be an effect of dementia in the elderly. It can also be caused by loneliness and social isolation which can happen in old age.

Question 309

What has been found about Depression + Teenagers?

Answer 309

There is growing concern about depression in teenagers. Twenty years ago, depression in children was almost unknown. Now the fastest rate of increase in depression is among young people. There are several explanations for this lack

Question 310

What 3 things are looked at for the HCPC Guidelines for Clinical Practitioners?

Answer 310

Character
Health
Standards of Proficiency

Question 311

What is Character as a HCPC Guideline for Clinical Practitioners?

Answer 311

Registrants have to provide credible character references from people who have known them for at least three years, to give an idea of the character traits they have that make them suitable for the role.

The standard also considers any criminal cautions or convictions given to the professionals and whether they affect their suitability to practise

Question 312

What is Health as a HCPC Guideline for Clinical Practitioners?

Answer 312

People on the register must provide information every two years when they read register about their general health.

They are required to provide information on any health issues that they have only if they are likely to affect their ability to practice safely.

If a professional feels at any time that the health is impairing their ability to practice then they must limit or stop their work and declare this to the HCPC

Question 313

What is Standards of Proficiency as a HCPC Guideline for Clinical Practitioners?

Answer 313

For each profession there is a set of specific expectations for the ability to practice effectively

For practitioner psychologist there are specific requirements within its standard to be demonstrated in different areas of psychology, for example clinical psychologist and forensic psychologists

Question 314

What are the 8 Standards of Proficiency for Practitioner Psychologists?

Answer 314

Be able to practice safely and effectively within their scope of practice

Be able to practice within the legal and ethical boundaries of their profession

Be able to maintain fitness to practice

Be able to practice as an autonomous professional, exercising their own professional judgement

Be aware of the impact of cultural, equality and diversity of practice

Be able to practice in a non-discriminatory matter

Understand the importance of and be able to maintain confidentiality

Be able to communicate effectively

Question 315

What is Primary Data?

Answer 315

Information on mental health that researchers gather themselves. This can take the form of experiments, interviews, questionnaires etc

This might be concordance rates of twins when assessing the extent to which mental disorders are genetic.

Interviews and questionnaires that ask patients about their symptoms comparisons can be drawn regarding differences/similarities between particular groups

Primary data can be collected for a case study on a patient suffering from a particular mental disorder

Question 316

What is an Example of using Primary Data to research mental health?

Answer 316

Rosenhan (1973) field study into mental health a in institutions.

Question 317

What are the Strengths of Primary Data?

Answer 317

More valid conclusions surrounding the reason for a particular mental disorder can be gathered if the experimenter collects their own data relevant to their aim. The experimenter can ensure trustworthy d has been collected (in secondary data, some researchers have manipulated data by rounding statistics u or down), leading to valid conclusions. relevant to the aim of the study as variables will have been operationalised with the aims

Primary data will in mind e g. to measure how effective therapy or medication is. However secondary data might ha been gathered for a different reason (e.g. government statistics on prescription rates in GP practices) s might not be focussed on the aim of the study

Question 318

What are the Weaknesses of Primary Data?

Answer 318

Primary data is more expensive because money will be required for paying for brain scans on mental health patients, genes to be analysed, neurochemicals to be tested etc

Mental health patients may be unwilling to let researchers investigate about their mental illness or may not be in touch with reality to consent to be investigated.

It will take a long time to analyse primary data this may be through statistical analyses or subjective interpretation of interview/questionnaire scripts when describing their mental illness.

Question 319

What is Secondary Data?

Answer 319

Information on mental health that is collected by someone other than the researcher for a different purpose. This can include previous studies research /medical records government statistics.

Peer-assessed/reviewed articles or public statistics.

Meta-analysis meta-analysis uses a statistical approach (inferential statistics) to combine the results from multiple studies related to mental disorders to gain more valid and generalizable conclusions. (see below)

Government statistics on how many people have been diagnosed with a mental disorder or institutionalised.

Question 320

What is an Example of Secondary Data used to research mental health?

Answer 320

Gottesman and Shields (1966) Schizophrenia concordance in MZ and DZ twins from medical records showing there is a genetic cause

Question 321

What are the Strengths of Secondary Data?

Answer 321

It is cheaper to use secondary data as there are already statistics on mental disorder rates and concordance rates of mental illnesses. Researchers can simply do a meta analysis with the data, which requires less funding. “

Using a meta analysis means comparisons regarding the conclusions on mental health research can be made, making conclusions more valid. “

Question 322

What are the Weaknesses of Secondary Data?

Answer 322

Data may have been gathered for another aim (looking at a range of mental disorders), so may not fit the needs of the secondary investigation (if you are just looking at one disorder) “

The data could be outdated-with DSM changing, the population might be diagnosed differently today, meaning comparisons with studies regarding concordance rates may be outdated. “

Researchers aim to get a significant result-researchers often round statistics up or down to make results significant. Therefore if a researcher investigating mental illness uses secondary data, their conclusions regarding mental illness may be invalid

Lack of knowledge on the reliability or validity of original research means this can reduce the validity of the findings on mental disorders.

Potential of cherry-picking which is when researchers only publish studies that show positive results leading to a bias in the literature, for example only publishing studies that show antidepressants to be effective

Findings are produced after the research has taken place, decreasin validity.

Question 323

What are Cross Cultural Studies?

Answer 323

Samples are taken from different cultural groups to draw comparisons about the similarities and differences between them in terms of how they experience mental disorders.

It looks at whether the experience of patients suffering from schizophrenia or other mental illnesses is the same in different cultural groups.

Question 324

What are some Examples of using Cross Cultural Studies to research mental health?

Answer 324

Tsuang et al. (2013) explored the relationship between schizotypy and handedness and looked at how this relationship stands up between different cultures by comparing western cultures to eastern cultures.

Mandy et al. (2014) chose to test the DSM-5 diagnosis of autism spectrum disorder to see ifthe diagnosis in the USA and UK would generalise to other cultures.

Question 325

What are the Strengths of using Cross Cultural Studies?

Answer 325

Allows clinicians to understand how culture plays a role in the validity and reliability of diagnoses:

Can identify elements of abnormal behaviour that can be attributed to purely biological factors by identifying trends in mental disorders that are unaffected by cultural variation.

Aids in the understanding of cultural factors that should be taken into account when diagnosing and treating patients. This can reduce ethnocentrism (bias towards one culture, which in mental health, is usually the Western European or American culture)

Question 326

What are the Weaknesses of using Cross Cultural Studies?

Answer 326

Conducting research across cultures is likely to create conflict between the cultural values of some of the participants and those of the researcher

Question 327

What is a Meta Analysis?

Answer 327

Involves looking at secondary data from multiple studies and drawing the findings together to make overall conclusions.

Conducted when there is a large amount of psychological research where firm conclusion on mental disorders or treatments cannot be drawn without comparing the research or where findings may be inconsistent.

A large amount of information gathered from a large overall sample can be easily considered.

Meta-analysis of research looking at the effectiveness of CBT will focus its analysis on the size of the effect of CBT found by ALL of the research gathered.

Question 328

What is an Example of using a Meta Analysis to research mental health?

Answer 328

Stafford et al. (2015) used it to look at treatments of psychosis and schizophrenia in children, adolescents and young adults by using studies that compared any drug, psychological or combined treatment for psychosis or schizophrenia that looked at children, adolescents or young adults. In total, 27 trials were used which had 3,067 participants.

Question 329

What are the Strengths of using a Meta Analysis?

Answer 329

Conclusions regarding treatment and mental disorders can be drawn from a vast array of different areas and a huge overall sample

Time and cost-effective due to the fact that data already exists and must only be combined and analysed using statistical analyses

No ethical concerns as the researchers do not have direct contact with the patients /participants.

Question 330

What are the Weaknesses of using Meta Analysis?

Answer 330

Much like secondary data, the research has not had direct involvement so issues in reliability andlor validity are unknown and may cause inaccurate conclusions on mental health to be drawn.

Publication bias cherry picking may impact validity researchers only publish studies that show positive results leading to a bias in the literature, for example only publishing studies that show antidepressants to be effective.

A way of finding out trends about a mental health issue and any relationships that might exist.

Research method, procedure, sampling and decision-making are likely to differ between studies. This makes analysis difficult and perhaps in accurate.

Question 331

What are Longitudinal Studies?

Answer 331

Takes place over a long period of time for example a group of people with a mental disorder might be tracked over many years.

Often compares a single sample group of people with a mental illness with their own performance over time, allowing for time- based changes to be seen. Clinicians may be interested in monitoring changes in symptoms in a patient group undergoing treatment

Allows the psychologist to see how effective the treatment is over time.

Includes questionnaires and observations to patients taken at intervals over many years.

Question 332

What is an Example of using Longitudinal Studies to research mental health?

Answer 332

Hankn et al. (1998) carried out a ten-year longitudinal study looking at gender differences in how depression emerges in young people from pre-adolescence to young adulthood, using structured interviews which they administered five times over ten years.

Question 333

What are the Strengths of using Longitudinal Studies?

Answer 333

Allows clinician to see if treatments have the ability to significantly improve a patient’s quality of life in the long term.

Only way to reliably measure the effect of time on the behaviour or mental illness.

A good way of finding out how development of mental illnesses can occur.

Question 334

What are the Weaknesses of Longitudinal Studies?

Answer 334

Expensive and time consuming due to needing to gather data repeatedly, track patients over many years and keep in communication in between interviews etc

Even as have very different symptoms and experiences even if suffering from the same illness, there is no difficulty i making comparisons between different people that could be affected by individual differences.

Patients may drop out, die, lose contact, making the final outcome less valid.

Ethical considerations: following people for a long period of time may be intrusive especially those suffering from mental disorders

Question 335

What are Cross Sectional Studies?

Answer 335

This is a quick snap-shot of a group of people suffering from a mental disorder where a sample is taken and tested and conclusions are drawn for the target population.

Patients might be tested using methods such as interviews, questionnaires, tests of cognitive functioning, brain scans, blood tests and other methods

For example, researchers might be interested to know about the experience of people with schizophrenia at different ages, and so take a large sample of participants suffering from schizophrenia of various ages (rather than conducting a longitudinal study over many years)

Question 336

What is an Example of using Cross Sectional Studies to research mental health?

Answer 336

Wijesundera et al. (2014) looked at tobacco use and antipsychotic medication in out-patients with schizophrenia in one hospital in Sri Lanka, using systematic sampling (every third patient diagnosed with schizophrenia was chosen).

Question 337

What are the Advantages of Cross Sectional Studies?

Answer 337

Data can be collect much more quickly and therefore acted upon allowing for more immediate benefits for those suffering from mental disorders

Results on symptoms and the efficacy of treatments are more valid as they are reported at the time rather than years later

Question 338

What are the Disadvantages of Cross Sectional Studies?

Answer 338

Individual differences are likely to have an effect on the results due to the fact that comparisons are made between different people

Cohort effects can be an issue whereby the results of results might be due to being raised in a certain time and place, for example those affected by war, famine, recession or other socio-economic factors.

When researching mental health, not all groups would have been exposed to the same cultures and such which means they cannot be comparable because they were exposed to different environments. For example when studying anorexia, groups are not comparable as they have been influenced by different cultures and social environments

Question 339

What are Case Studies?

Answer 339

Case studies investigate detail about a mental health rather than cause and effect relationships

Individuals / small groups are studied, they will have a particular mental disorder, or a unique trait or experience connected to the disorder.

Researchers use a range of methods in case studies, for example interviews, questionnaires, observations. These might be given to those suffering from a mental disorder and their families.

Researchers triangulate data from different methods they draw them together and form overall conclusions about mental health.

Researchers use mainly qualitative data on mental health in case studies, but there can be some quantitative data too.

Question 340

What is an Example of using Case Studies to research mental health?

Answer 340

One case study by Lavarenne et al. (2013) referred to a session known as the Thursday group a group of patients, most of whom suffer from schizophrenia or schizoaffective disorder, who meet every week. The purpose of the group is to support the patients by giving them some structure to help them cope with their illness, and encourage a sense of connection with others for a group who are generally quite isolated in everyday life. There are ten members of the group who are referred from various local out-patient and in-patient services in the local area. The group is currently made up of members who have been attending for between 3 weeks and 22 years. The sessions themselves are never recorded but, immediately afterwards, the group leaders note down key points about the patients’ behaviour, expressions and comments. The case study reports on one specific session with six patients present, which was just before Christmas, where the group members were facing a break of more than seven days before their next meeting because of the holidays. The key theme the leaders noted in this session was that of ‘fragile ego boundaries a breakdown in the line that people draw between the real and the unreal, or their own thoughts and those of other people. They suggested that the group may be reacting to the potential change in routine by having a break from the group for more than the usual one week.

Question 341

What are the Strengths of Case Studies?

Answer 341

Valid as in depth and detailed information about the individuals and groups i gathered so a detailed understanding of mental health is obtained.

Case studies can be used to find out information about rate situations and individuals for example those with rare kinds of brain damage leading to mental health issues. These individuals often cannot be researched using experimental methods due to the fact that a large sample is not obtainable

Triangulation of data can be used to test for reliability through consistency between different methods, and this therefore helps establish whether findings about mental health are valid/accurate and credible trustworthy.

Question 342

What are the Weaknesses of Case Studies?

Answer 342

Samples are not representative as they are small or atypical, therefore findings about mental health may not generalise to society

Researchers involved in case studies often get to know the individual (s) very well which might causes bias in the recorded data, and subjectivity in the interpretations and conclusions about mental health

Question 343

What are Interviews?

Answer 343

Interviews involved verbal questioning of patients to gather information about mental health.

They can be structured with specific questions about the mental disorder, unstructured with no questions but a general theme that is explored with spontaneous questions, or semi structured which has a range of possible themes and questions that can be followed and adapted.

All interviews will have some standardisation in terms of the instructions, the aims of the interview and ethical issues.

The interviewer will also find out about personal data needed for the study such as gender, age, employment, marital status.

The responses can be recorded as an audio recording, video, or in written note form.

Question 344

What is an Example of using Interviews to research mental health?

Answer 344

Research reported by Vallentine et al. (2010) used semi structured interviews to gather nformation from a patient group on their experiences as part of a psycho-educational group treatment programme. The patients were 42 males detained in Broadmoor high-security hospital, most of whom had received a diagnosis of schizophrenia or a similar disorder. They were part of a programme aimed at helping them understand and cope with their illness, and several measures were taken to assess the impact of this on their symptoms. The aim of the interviews was to understand their experience better, but also get information about how the group could be improved in the future Following the interviews, a content analysis was conducted on the data gathered to pick out key hemes in the responses. Four core themes were identified in the data: “what participants valued and why, wiat was heipful about the group, clinical implications’ and ‘what was difficult/unhelpful ome of the key findings were that patients valued knowing and understanding their illness, and he group sessions allowed them not only to understand their own symptoms, but also how other eople’s experiences were similar Many aiso reported increased confidence in dealing with their iness, which made thern more positive about the future

Question 345

What are the Strengths of Interviews?

Answer 345

Interviews allow patients to fully explain their point of view which helps researchers to understand the experiences of those suffering from mental disorders more clearly.

Unstructured interviews are useful for obtaining rich detailed qualitative data that therefore is considered to provide valid information about mental health.

Structured interviews are considered reliable due to the fact that they are highly standardised and therefore questions about mental health are exactly the same for all patients

Question 346

What are the Weaknesses of Interviews?

Answer 346

Interviewer bias might occur where the researchers affect the findings on mental disorders due to the way they ask questions or other aspects of their appearance tone and personal beliefs. This reduces the validity of findings regarding mental health

Subjectivity can affect the analysis of answers to any open questions about mental disorders from interviews, as the researchers’ personal judgements and experiences might shape the way they identify categories and themes within the qualitative data

Question 347

What is Grounded Theory?

Answer 347

This is a method of developing theory from research evidence (inductive method), rather than testing existing theory using research evidence (deductive method) developed in Glaser and Strauss in the 1960s

This method is very useful in Clinical psychology to research the beliefs, opinions and experience of service users of the NHS or mental health professionals, since the themes in people’s experience are only known once data is analysed

Grounded theory involves thematic analysis, in which first, “codes” and “categories” are identified in qualitative data. These codes are general at first, and become more specific as patterns emerge. Concepts are then grouped according to their similarities and differences, and the researcher takes notes on this process, allowing their thought processes to be followed (this is called “memo-ing”) Once clear concepts become obvious, the researchers start to selectively code only the relevant data, and they will move to sampling that gathers more evidence to support what they have started to see (e.g. by to particular of people)

After the researcher has conducted the thematic analysis, they will attempt to create a theory or model that can explain the data. This might also involve looking at other literature and research. This is the part that makes the process “grounded theo (rather than just thematicanalysis)

Question 348

What are the Advantages of using Grounded Theory?

Answer 348

Grounded theory means that evidence is integrated into the theory, therefore the theory should be an accurate explanation of the experiences of patients with mental health issues.

Question 349

What are the Disadvantages of using Grounded Theory?

Answer 349

Grounded theory has issues with subjectivity and bias, since the researchers might selectively sample and use data that supports a theory about mental he lth that is emerging and unintentionally miss any vital evidence that challenges their emerging theory

Since the researchers opinions are used to identify the themes in the qualitative data, this process is also highly subjective and open to interpretation. There might be issues with reliability since it is possible that another person conducting the same research might come to different conclusions about mental health.

Grounded theory does not promote falsification as a means of testing the accuracy of theories regarding mental health (and falsification is considered to be an important feature of science). This is because the theory evolves from the data so by definition the research supports the theory.