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#Psychology Year 2 > #Clinical > Flashcards

#Clinical Flashcards

1
Q

what are the 4 Ds

A

deviance
dysfunction
distress
danger

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2
Q

what is deviance

A

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

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3
Q

what is dysfunction

A

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

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4
Q

what is distress

A

abnormal because it upsets the individual
unhappy with symptoms - depression
can be thought to continuum ( persistant = more serious )

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5
Q

what is danger

A

danger to themselves or others
eg self harm suicide and violence
varying degrees of danger to other people and oneself

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6
Q

deviance strengths

A

effected by cultural differences

takes into account things such as gender and age making it more holistic

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7
Q

deviance weaknesses

A

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

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8
Q

dysfunction strengths

A

objective through doctors tests DSM IV

definition is better as it considers life quality of the child

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9
Q

dysfunction weaknesses

A

subjective

things are dysfunctional without being a disorder- repeatedly getting drunk

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10
Q

distress/danger strengths

A

DSM IV global functioning

considers pateint life quality

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11
Q

distress/danger weaknesses

A

subjective

many behaviours are common even though they aren’t mental health issues

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12
Q

overal evaluation of the 4ds

A

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

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13
Q

DSM description

A 
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
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14
Q

ICD description

A 
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
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15
Q

Evaluation of DSM/ICD

A

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)

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16
Q

A01 Points for culture

A

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

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17
Q

A02 Points for culture

A

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

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18
Q

A03 Points for culture- STRENGTHS

A

+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.

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19
Q

A03 points in culture- WEAKNESSES

A
  • 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
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20
Q

Schizophrenia symptoms

A

two or more symptoms over a month including delusions and hallucinations
disorganised behaviour, aquditory and visual hallucinations, delusions
negative symptoms- flattened effect

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21
Q

features of schizophrenia

A

more men then women
effects men at a young age - late teens womne are mid 30s
1% chance of getting

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22
Q

Neuro transmitter explanation of Sz

A

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

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23
Q

Strengths of NT theory of SZ

A

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

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24
Q

Weaknesses of NT theory of SZ

A

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

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25
Q

Description of Genetic explanation of SZ

A

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.

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26
Q

strengths of genetic explanation of schizophrenia

A

tienari-7% of adoptees had biological parent with sz
Gottesman- MZ twins 48% concordance rate
used alongside NT explanation
explains links between family members

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27
Q

weaknesses of genetic explanation of sz

A

reductionist- not just genes
concordance rate is not 100% showing environmental factors
ignores cognitive
weakness of twin studies- not always equal enviroments

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28
Q

what are the symptoms of depression

A 
depressed mood
decreased interest or pleasure in most activities 
weight change 
sleep pattern changes 
change in activity
fatigue
worthlessness 
suicidal ideation
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29
Q

what are the features of depression

A

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

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30
Q

what is the biological explanation of depression

A

Neurotransmitters

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31
Q

describe the NT explanation of depression

A

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

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32
Q

what are the strengths of the NT explantion of depression

A

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

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33
Q

Weaknesses of the NT explanation of depression

A

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

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34
Q

What is the non-biological explanation of depression

A

cogntiive

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35
Q

what does the cognitive explanation of depression state

A

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

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36
Q

strengths of cognitve explanation of depression

A

CBT works suggets that it is credible
seligman- shows dogs develop learned helplessness
Beck- people with depression had negative viewpoints about themslef

37
Q

weaknesses of the cognitve explanation of depression

A

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

38
Q

what is the cognitive treatment for depression

A

CBT

39
Q

A01 CBT

A

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

40
Q

Strengths of CBT

A 
no side effects
Hollon- 47% dont relapse after CBT
tailored and individual
long lasting
Williams demonstrates effectiveness of ICBT
41
Q

weaknesses of CBT

A

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

42
Q

what was Rosenhans aim

A

to investigate whether sane people who admitted themselves to mental hospital would be diagnosed

43
Q

what was rosenhans procedure

A

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

44
Q

what were Rosenhans results

A

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

45
Q

rosenhan strengths

A 
various hospitals- more generalisable
standardized procedure
ecological validity as in staffs environment 
low deman characteristics
all trained by rosenhan
46
Q

weaknesses of Rosenhan

A 
validity- can't blame doctors for getting it wrong
usa only 
only 12 hospitals
bias on behalf of pseudo patients
ethical issues
47
Q

what is the HCPC

A

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

48
Q

what standards must you meet under the HCPC

A

good character, health, good standard of conduct, standards of continuing professional development, standards for education, perscribing

49
Q

what are three standards of conduct

A

1) best interest of service user taken into account
2) confidentiality
3) high standard of personal conduct

50
Q

what is a cross sectional study

A

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

51
Q

what are strengths of cross sectional studies

A

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

52
Q

what are the weaknesses of cross sectional studies

A

less in depth then longitudinal
individual differences
cause and effect
issues with cohort effect(people too similar)

53
Q

A01 for the cognitive explanation of schizophrenia

A

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

54
Q

strengths of the cognitive explanation

A

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

55
Q

weaknesses of cognitive explanation

A 
difficult to test
descriptive rather than explanative 
cause and effect 
reductionist
beck- dopamine causes struggle to underdstand information
56
Q

what are the sz biological treatments

A

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.

57
Q

what are the strengths of the drug treatment of sz

A 
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
58
Q

what are the weaknesses of the drug treatment of sz

A 
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
59
Q

what is the Schizophrenia non biological treatment

A

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

60
Q

what are the strengths for CBT for SZ

A 
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
61
Q

what are the weaknesses for CBT for SZ

A

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)

62
Q

what is the biological treatment of depression

A

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

63
Q

what are the strengths of the biological treatment of depression

A

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

64
Q

what are the weaknesses of the drug treatment of depression

A 
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
65
Q

what was the contemporary study for Schizophrenia

A

Carlsson

66
Q

what was the aim of Carlsson

A

to review relationship between NT on schizophrenia and specific brain areas
wanted to test NT to see the effectiveness in drug treatments

67
Q

what was Carlssons procedure

A

32 studies reviewed eg brain scans on studies on rodents, parkinsons patients
those in SZ and in remission observed

68
Q

what was Carlssons conclusions

A

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

69
Q

what are the strengths of Carlsson

A 
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
70
Q

what are the weaknesses of Carlsson

A

animal studies not generalisable
some studies disagree showing issues with reliability
only used 32 studies
parkinsons not exactly linked to Sz

71
Q

what is the contemporary study for depression

A

williams

72
Q

what was the aim of williams

A

to test remote forms of CBT to see if imagination based cognitive bias modification would impact positively on iCBT outcomes

73
Q

what is the procedure for Williams

A

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

74
Q

what were the results of Williams

A

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

75
Q

what are the strengths of Williams

A

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

76
Q

what are the weaknesses of Williams

A 
participants rated themselves 
data was collected over three months 
self report issues 
EVs
all from same location 
sample was filtered so less representative
77
Q

what is the case study in clinical

A

Bradshaw

78
Q

what was the aim of bradshaw

A

to see whether CBT was an effective treatment of atypical SZ in a woman

79
Q

what was method of bradshaw

A

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

80
Q

what were the results of Bradshaw

A

carol showed little distress
GPI score of one
days in hospital drops to 0
goals included starting college course, volunteering and seeing friends

81
Q

what are the strengths of Bradshaw

A 
longitudinal 
lots of data gathered
qualitative and data 
triangulation (various methods)
useful as it shows CBT effectiveness
82
Q

weaknesses of Bradshaw

A

difficult to repeat
un-generalisable because they are so small
case studies are naturally occurring

83
Q

what is a interview in clinical

A

Brown

84
Q

what was the aim of Brown

A

to see how self esteem, support and life events impacted depression

85
Q

what was browns sample

A

395 working class women with at least one child at home recruited through postal questionnaire and all were between 18-50

86
Q

what was browns method

A 
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
87
Q

what were the results of Brown

A

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

88
Q

strengths of Brown

A

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

89
Q

weaknesses of Brown

A 
sample only includes women
sample only includes people from same doctors surgery 
social desirability 
demand characteristics
semi structured interview

#Psychology Year 2 (2 decks)

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