#Clinical Flashcards
what are the 4 Ds
deviance
dysfunction
distress
danger
what is deviance
social norms= agreed ways of acting
those who break are abnormality
effected by culture; context, age and gender
eg those with sz and ocd hearing voices
what is dysfunction
intereferes with a persons everyday life is one way to disgnose mental disorders
dysfunction can affect their working life
inability to function normally, live life normally
rosenhal- failure to function
what is distress
abnormal because it upsets the individual
unhappy with symptoms - depression
can be thought to continuum ( persistant = more serious )
what is danger
danger to themselves or others
eg self harm suicide and violence
varying degrees of danger to other people and oneself
deviance strengths
effected by cultural differences
takes into account things such as gender and age making it more holistic
deviance weaknesses
subjective
Thomas szasz argues that it is a way of social control
reductionist
doesn’t consider the patients wellbeing
break in social norms which arent mental health issues
dysfunction strengths
objective through doctors tests DSM IV
definition is better as it considers life quality of the child
dysfunction weaknesses
subjective
things are dysfunctional without being a disorder- repeatedly getting drunk
distress/danger strengths
DSM IV global functioning
considers pateint life quality
distress/danger weaknesses
subjective
many behaviours are common even though they aren’t mental health issues
overal evaluation of the 4ds
DSM uses the four Ds- eg schizophrenia must have deviance and distress
not objective but used for disgnosis- issues with inter rater reliability
Timothy Davis stated that 5th D of duartion should be added
DSM description
created by APA in 1950s diagnostic criteria for mental illness ie depression 5/9 items looks at prevalance of each illness grouped by family such as psychotic illness/ affective updated every few years
ICD description
Worldwide All illnesses not just mental health Section 5- mental health issues has criteria list similar to the DSM each illness has incidence, prevalence, mortality and morbidity rates
Evaluation of DSM/ICD
G- ICD is cross cultural and worldwide so high validity
R- updates hinder the reliability of diagnosis but Rosenhan found reliability
A-entitles people to medical help
V-patients can lie lowering DSM validity (Rosenhan)
A01 Points for culture
culture=shared set of beliefs norms and values
one way in which it affects is how patients describe illness
live in a global world so we need to ensure correct diagnosis
shapes mental health of minorities- black people in UK more likely to be hospitalised
A02 Points for culture
4ds- different cultures view different things as deviant etc
DSM V ICD- later is worldwide, issues with reliabity with DSM.
Culturally BI- there are illnesses bound to specific cultures
Bias withing Cs- Black men over represented in UK mental health hospitals
A03 Points for culture- STRENGTHS
+DSM valid in korea - LEE
+high catatonia in Sri Lanka due to lack of treatment - CHANDRESA
+LIN- schizophrenia around the world shares more symptoms then what it differs in.
A03 points in culture- WEAKNESSES
- Escobar and Vega= DSM iv has strong western bias
- Burham= mexican born Americans have more auditory hallucinations
- Banyard= 5% population is black 25% of psychiatric population
Schizophrenia symptoms
two or more symptoms over a month including delusions and hallucinations
disorganised behaviour, aquditory and visual hallucinations, delusions
negative symptoms- flattened effect
features of schizophrenia
more men then women
effects men at a young age - late teens womne are mid 30s
1% chance of getting
Neuro transmitter explanation of Sz
Chemical imbalance in NT which causes excess signalling
high levels of dopamine linked
illegal drugs increase D2 receptors and produce schizophrenia like symptoms
decreased dopamine in mesocortical system causes negative symptoms
Strengths of NT theory of SZ
Anti psychotics reduce dopamine and work
Carlsson review study- linked dopamine to SZ
Amphetamines are agonist and produce SZ like symptoms
scientific and objectivce= measuring chemical imbalance
Weaknesses of NT theory of SZ
Cause and effect
only able to test through the blood or urine not brain
Amphetamines only cause pos symptoms- dopamine is reductionist
other theory such as cognitive
Carlsson found it was not just dopamine
Description of Genetic explanation of SZ
1% likelihood however this increases when related to someone with illness 48% - MZ twins
Deletion of COMT gene means D not regulated properly
deletion of section of C 22 causes digeorge syndorme in which 1/4 have SZ
c4 a specific gene. if you have it you have intensified pruning.
strengths of genetic explanation of schizophrenia
tienari-7% of adoptees had biological parent with sz
Gottesman- MZ twins 48% concordance rate
used alongside NT explanation
explains links between family members
weaknesses of genetic explanation of sz
reductionist- not just genes
concordance rate is not 100% showing environmental factors
ignores cognitive
weakness of twin studies- not always equal enviroments
what are the symptoms of depression
depressed mood decreased interest or pleasure in most activities weight change sleep pattern changes change in activity fatigue worthlessness suicidal ideation
what are the features of depression
1/5 affected each year
7-12% of population experience it in the year
7% but variation with age
more women effected 2:1 but more men commit suicide
what is the biological explanation of depression
Neurotransmitters
describe the NT explanation of depression
imbalance of NT such as serotonin and dopamine
low levels of serotonin linked to symptoms such as high anxiety and low mood
there may be too much reuptake of serotonin which has functional effect of lowering levels
low serotonin effects levels of other monoamines, like noradrenaline and dopamine
what are the strengths of the NT explantion of depression
Objective and empirical
antidepresseants increase monoamine levels and reduce depression symptoms
Drevets- found reduced serotonin receptor binding potential in depressed people
rosen et al- enzymes involved with breakdown of serotonin higher in depressed people
Weaknesses of the NT explanation of depression
cause and effect
Cognitive explanation
difficult to measure blood and urine levels reduces v
drugs dont work for everyone
Treatment aetiology drugs work but not necessarily the cause
Delgrado- monoamine depletion in depressed people didn’t make them feel worse
What is the non-biological explanation of depression
cogntiive
what does the cognitive explanation of depression state
depression is caused by faulty thinking which interprets how they view the world
catastrophising, all or nothing thoughts
maladaptive thought through learned experience
Beck’s negative triad- negative thought about oneself, future and the world
negative attributes are internal
strengths of cognitve explanation of depression
CBT works suggets that it is credible
seligman- shows dogs develop learned helplessness
Beck- people with depression had negative viewpoints about themslef
weaknesses of the cognitve explanation of depression
issues with empiricism
cause and effect issues
reductionist ignores monoamines
drugs work suggesting biological underpinning
lewishon et al- little evidence to suggest cognitve attitudes present before depression
what is the cognitive treatment for depression
CBT
A01 CBT
depression caused by faulty thinking so CBT is a method of changing that
1:1 with therapist
16 weeks roughly
identify negative thoughts and disproves them, diaries completed to note down behaviour
teaches you ability to get rid of negative thoughts
Strengths of CBT
no side effects Hollon- 47% dont relapse after CBT tailored and individual long lasting Williams demonstrates effectiveness of ICBT
weaknesses of CBT
doesn’t include biology- reductionist
requires motivation which depressives often lack
socially controlling
March et al- suggested best to combine treatments
Jones - CBT is not as effective as other psychosocial treatments
what was Rosenhans aim
to investigate whether sane people who admitted themselves to mental hospital would be diagnosed
what was rosenhans procedure
5 men 3 women, 12 hospitals in 5 states
pseudo patienst claimed to hear voices which said ‘thud’
all gave their own real life stories
natural covert observation
what were Rosenhans results
100% diagnosis 7 with schizophrenia
7-52 days 19 days was average stay
released as schizophrenia in remission
35/118 patients detected they weren’t really ill
rosenhan strengths
various hospitals- more generalisable standardized procedure ecological validity as in staffs environment low deman characteristics all trained by rosenhan
weaknesses of Rosenhan
validity- can't blame doctors for getting it wrong usa only only 12 hospitals bias on behalf of pseudo patients ethical issues
what is the HCPC
offers guideline for clinical practitioners
ie must provide character references
must re register and give details about their health so it doesn’t disturb their work
what standards must you meet under the HCPC
good character, health, good standard of conduct, standards of continuing professional development, standards for education, perscribing
what are three standards of conduct
1) best interest of service user taken into account
2) confidentiality
3) high standard of personal conduct
what is a cross sectional study
data is collected at one period of time
like longitudinal they often look at development of something but do this in a different manner
instead of one person over time,two groups ie adults and teenagers with sz
what are strengths of cross sectional studies
cheaper and easier then longitudinal
participants more eay to gather as it does not last years
more ethical as right to withdrawl is easier to do
what are the weaknesses of cross sectional studies
less in depth then longitudinal
individual differences
cause and effect
issues with cohort effect(people too similar)
A01 for the cognitive explanation of schizophrenia
1)disease characterised by disturbance of language and behaviour-theory this is caused by faulty thinking
2)positive symptoms explained by biological however other symptoms can linked to own experience
3)frith- inability to generate willed action
inability to monitor willed action
inability to monitor intentions of others
4)Helmsley breakdown in relationship between memories and new information
strengths of the cognitive explanation
useful for cbt.
used alongside biological- helmsley- hippocampus maybe at fault
explains negative symtpoms
mcguire et al- auditory hallucinations saw reduced activity in part of brain which recognises inner speech
frith and done- video game study. sz find it harder to monitor own actions
weaknesses of cognitive explanation
difficult to test descriptive rather than explanative cause and effect reductionist beck- dopamine causes struggle to underdstand information
what are the sz biological treatments
drug treatments for sz are antipsychotics - work by reducing dopamine- adjusted to level required for patient and can be injection, tablet or syrup. drugs block receptors reducing positve symptoms like hallucinations. roughly takes 10 days to work and sometimes several different drugs need to be taken to find the right one.
what are the strengths of the drug treatment of sz
emsley- 84% patients had 50% reduction in symptoms allows functioning into society drugs act relatively quick;y kane- 80% are helped from antipsychotics relapse rates are lower
what are the weaknesses of the drug treatment of sz
low compliance rate- 50% Rosa severe side effects does not help with the negative symptoms - tardive dyskinsea roughly 60% of pateints are not helped drugs don't cure the disorder not instant
what is the Schizophrenia non biological treatment
cbt aims to challenge maladaptive thought. one or two sessions a week. collaboratively work to discuss symptoms. focused upon rationally. operates on the ABC model
normalising- destibmatises psychotic experience
belief modification- tests hallucinations against reality
attributing- looks at auditory hallucinations- gender and age makes it seem like it was pateint
what are the strengths for CBT for SZ
collaborative- works with patient tailored to individual needs no side effects can assist in the acute phases in sz. chadwick - 10/12 found lowered belief in their delusions
what are the weaknesses for CBT for SZ
Sensky- found no difference between cbt and bonding BUT this did change after follow up period
CBT - distressing when focusing on certain symptoms
social control can be seen as an issue
difficulties in measuring congnition ( not empirical)
what is the biological treatment of depression
drug treatments are psychoactive- balance NT in the brain. AD increase the levels on monoamines in brain. psychiatrists will monitor dosage and how patient is respondings. SSRIs stop reuptake of serotonin making there more in synapse. MAOIs stop MOA doing its job of breaqking down monoamines
what are the strengths of the biological treatment of depression
60% improvement in condition compared to those given placebo
act relitavely quickly
allows a return to normal functioning
jarrett et al- showed effectiveness at MAOIs atv treating depression
what are the weaknesses of the drug treatment of depression
Muller- netherlands study which found that 76% who weren't given drugs did not relapse side effects and poor compliance effects are not instantaneous do not cure the disorder CBT is effective
what was the contemporary study for Schizophrenia
Carlsson
what was the aim of Carlsson
to review relationship between NT on schizophrenia and specific brain areas
wanted to test NT to see the effectiveness in drug treatments
what was Carlssons procedure
32 studies reviewed eg brain scans on studies on rodents, parkinsons patients
those in SZ and in remission observed
what was Carlssons conclusions
dopamine hypothesis too simplistic
too hard to choose between models of what causes SZ
low glutamate dopamine rises
serotonin turnover linked
clozapine found as highly effective, antidopamingeric and antiserotonergic
what are the strengths of Carlsson
Sendt et al- dopemine does not explain all negative symptoms broad amount of study types review study gives a broader view brain scans are objective and reliable ethical- not directly due to him useful for drug therapy
what are the weaknesses of Carlsson
animal studies not generalisable
some studies disagree showing issues with reliability
only used 32 studies
parkinsons not exactly linked to Sz
what is the contemporary study for depression
williams
what was the aim of williams
to test remote forms of CBT to see if imagination based cognitive bias modification would impact positively on iCBT outcomes
what is the procedure for Williams
69 patients who were recruited from online applications
diagnostic interview from DSM
randomised on control group 31 and treatment group 38
measured on tests such as BDI
20 minutes a day of CBT and later iCBT
what were the results of Williams
pre treatment there was no significant difference
after the first week there was a treatment group with lower depression scores
therapy was evaluated as good easy and logical by participants
what are the strengths of Williams
internet recruitment from all over Australia
right to withdrawl and medication access to everyone
other mental disorders excluded to increase reliability
participants who could not take part were referred to other services
measured through DSM IV high validity
what are the weaknesses of Williams
participants rated themselves data was collected over three months self report issues EVs all from same location sample was filtered so less representative
what is the case study in clinical
Bradshaw
what was the aim of bradshaw
to see whether CBT was an effective treatment of atypical SZ in a woman
what was method of bradshaw
case study of carol 26 years old to start
studied for three years for CBT
first stage- building rapport with therapist
second stage- was understanding how CBT would work
Third- undergoing CBT
various measurements
what were the results of Bradshaw
carol showed little distress
GPI score of one
days in hospital drops to 0
goals included starting college course, volunteering and seeing friends
what are the strengths of Bradshaw
longitudinal lots of data gathered qualitative and data triangulation (various methods) useful as it shows CBT effectiveness
weaknesses of Bradshaw
difficult to repeat
un-generalisable because they are so small
case studies are naturally occurring
what is a interview in clinical
Brown
what was the aim of Brown
to see how self esteem, support and life events impacted depression
what was browns sample
395 working class women with at least one child at home recruited through postal questionnaire and all were between 18-50
what was browns method
women were assessed twice a year apart prospective study initially interviewed about self esteem and social support they had assessments done by interview questioned about stressful life events
what were the results of Brown
33% had negative evaluation
crisis core support does not impact depression
having core support but not in a crisis makes people feel let down so they can get depression
strengths of Brown
large sample
very similar group minimises individual differences
prospective study no retrospective bias
standardised questions
can ask follow up questions
eliminated women at second stage who turned out to have depression all along
weaknesses of Brown
sample only includes women sample only includes people from same doctors surgery social desirability demand characteristics semi structured interview
