Clinical Flashcards

Question

What is Prevalence as a Feature of Schizophrenia?

Answer 1

* Refers to how common a disorder is * It is a universal illness * The likelihood of developing schizophrenia is between 0.7 and 1% * This is influenced by racial/ethnic background, residence + birth country * People who experience social problems (poverty + unemployment) are more likely to develop schizophrenia

Answer 2

* Refers to likely course of the disease * 25% of people who had a schizophrenic episode recover * 50% of people have recurrent episodes * 25% of people experience schizophrenic symptoms continually * Life expectancy for person w/ schizophrenia is 10 years less than the average * Males show higher proportion of negative symptoms + have longer duration of the disorder - these factors are associated w/ a poor prognosis

Answer 3

Schizophrenia is triggered by some aspect of development during the years of late teens and mid 30s - either biological or social

Answer 4

People who experience social problems such as poverty and unemployment are more likely to develop schizophrenia

Answer 5

Males show more negative symptoms + have a longer duration of the disorder - these factors are associated with poor prognosis

Answer 6

The WHO international pilot study of schizophrenia suggests - patients w/ this disorder in developing countries have more positive prognosis than do patients in Western industrialised societies

Answer 7

Prevalence varies according to countries

Answer 8

Chemicals that allow neurons to communicate with one another which allows our brains to think and feel so that our bodies are able to do things

Answer 9

Neurotransmitter associated with functions, including motivation and feeling pleasure

Answer 10

Suggest that schizophrenia can be explained by changes of dopamine functioning in the brain

Answer 11

* Low levels of beta hydroxylase, so excess dopamine builds up in the synapses * Excess dopamine receptors at synapses in the brain * Due to hyper sensitivity of certain dopamine receptors

Answer 12

Irregular serotonin activity = negative symptoms of schizophrenia

Answer 13

Low levels of dopamine in mesocortical pathway = negative symptoms

Answer 14

High levels of dopamine in mesolimbic pathway = positive symptoms

Answer 15

* GABA | * Glutamate

Answer 16

* Explains positive + negative symptoms - increase of dopamine in mesolimbic pathway accounts for positive symptoms, decrease of dopamine in mesocortical pathway accounts for negative symptoms * Backed up by evidence from drug treatment - antipsychotic medications for work by blocking dopamine receptors * Testable evidence that excess dopamine plays a role in schizophrenia - people given Levodopa experience schizophrenic-like symptoms (e.g. hallucinations) * PET scans in investigating dopamine levels in patients provide an objective measure of neurotransmitter functioning in areas of the brain

Answer 17

Many antipsychotic medications used to treat schizophrenia work by blocking dopamine receptors

Answer 18

* It’s reductionist - Ignores other factors that may influence whether someone develops schizophrenia - biological, psychological + social factors * Cannot prove that excess dopamine causes schizophrenia, instead it may be a symptom of schizophrenia * Not all patients with schizophrenia respond to the drugs - Friedhoff (1980) found that some patients show no improvement after taking dopamine antagonists * PET scans show that blocking dopamine receptors doesn’t always remove the symptoms

Answer 19

* Found that 50% of schizophrenic patients reported a major life event in the 3 weeks prior to the relapse * Suggesting that social conditions may trigger relapse

Answer 20

* Post-mortem examinations of the brains of people with schizophrenia * Showed that they had a higher density of dopamine receptors in the cerebral cortex

Answer 21

* People who are genetically related to schizophrenics should be more likely to have schizophrenia themselves * The chances of them having schizophrenia is higher

Answer 22

* Family studies * Adoption studies * Twin studies

Answer 23

* Investigate whether close biological relatives also have schizophrenia * Problematic as the closer the relative the more likely they are to share the same environment * So it’s difficult to separate out the effects of nature with nurture

Answer 24

* Useful as a genetic factor can be looked for in adopted children who have been apart from their biological parents * Allows effects of nature to be separated from nurture which controls extraneous variable of environment * The adopted children whose biological parents are schizophrenic have a higher risk of developing schizophrenia

Answer 25

* Schizophrenia in MZ and DZ twins can be compared * If a twin has schizophrenia then the concordance rate between MZ twins should be 100% whereas it should be lower in DZ twins as they only share 50% of their genetic material

Answer 26

* Non-identical | * Share 50% of their genes

Answer 27

* Genetically identical | * Share 100% of their genes

Answer 28

* Concordance rates for schizophrenia were higher in females compared to males for MZ and DZ twins * Concordance rates higher for MZ+DZ twins for severe schizophrenia compared to mild * Concordance rates for severe schizophrenia was much higher in MZ twins (75%) compared to DZ twins (22%)

Answer 29

* Schizophrenia does have a biological basis, developing it is influenced by a persons gene * However, not totally caused by genes as concordance rate for MZ weren’t 100% •Therefore genes are a risk factor for developing it but environmental triggers are necessary

Answer 30

Whether schizophrenia has a genetic basis for looking at concordance rates for schizophrenia and MZ and DZ twins

Answer 31

* Evidence from Twin studies suggest that there is a significant genetic factor in schizophrenia (e.g. Gottesman + Sheild) * Biological approach to explaining schizophrenia is associated with the medical profession + has scientific status + credibility

Answer 32

* Research methods used to establish genetic links e.g. twin studies have flawed methodologies - as don’t take account that genes may function differently in different environments * Reductionist as environmental factors may be involved in the development of schizophrenia - e.g. concordance rate in MZ twins for Schizophrenia is only around 40-50%, so if the illness was purely down to genetics, we’d expect the rate to be 100% * Confusion as to which genes are responsible for predisposing a person to schizophrenia as there could be many, Wright (2014) suggested that 700 genes have been linked to schizophrenia

Answer 33

* Symptoms of schizophrenia are very diverse and not the same for everyone * Biological view is unlikely to be a complete one as there are likely to be different factors associated with developing the disorder that may account for the various subtypes and presentation of symptoms

Answer 34

* Diathesis-stress model argue that schizophrenia develops in those who have a biological predisposition to developing illness due to genetic’s (neurochemical or neuroanatomical factors) * But who also have some sort of environmental trigger - suggest the cause is a combination of factors

Answer 35

A genetic disposition which becomes apparent when the individual becomes stressed by factors in their environment

Answer 36

* Schizophrenia can be explained through the process of development * Thomas (2010) suggests schizophrenia stems from abnormalities in early brain development * Prenatal exposure to infection or lack of nutrition have been linked with schizophrenia (Opler and Susser (2005)) * Schizophrenia develops in late adolescence and early adulthood

Answer 37

* Both reductionist * Both are biological explanations in terms of the medical model * Both have research evidence to support their theories

Answer 38

* Explain human behaviour in terms of information processing * So, explains the symptoms of schizophrenia in terms of the patients thought processes * Cognitive impairments play an important role in the development and maintenance of schizophrenia

Answer 39

* Problems with attention | * Problems with memory

Answer 40

* People with schizophrenia have attentional processes which work in a different way * They don’t have normal functioning of these filtering processes, leading them to pay too much attention to irrelevant stimuli * Preventing them from making sense of the world in the way that most people can

Answer 41

* Inability to filter out unnecessary cognitive noise created by internal information processing * Patient is unable to self monitor effectively, resulting in hallucinations or delusions as they don’t realise that their thoughts are self generated * Patient experiences their own internal thought as an external voice * Which explains the symptoms of hallucinations and delusions

Answer 42

* People with schizophrenia aren’t able to activate relevant schemas * They experience sensory overload, so they are unable to predict what will happen next, their concentration is poor + they attend to irrelevant aspects of the environment * Their poor integration of memory + perception leads to disorganised thinking and behaviour

Answer 43

* There is a substantial breakdown in the relationship between memory and perception in schizophrenics * Which is linked to schemas, as relevant schemas are not triggered in people w/ schizophrenia

Answer 44

* Found that the larynx of patients with schizophrenia was active during the time they were experiencing auditory hallucinations * Suggesting that they mistook their own inner speech for that of someone else

Answer 45

Found schizophrenics to have reduced activity in the parts of the brain involved in monitoring inner speech

Answer 46

* Show under activity in the frontal lobe of the brain of people suffering from schizophrenia * Which is linked to self monitoring * Providing biological support for this explanation

Answer 47

* It explains some of the key problems associated with schizophrenia, e.g. it explains the symptom of delusions + hallucinations + disorganised behaviour * It is supported by research evidence * Useful in developing effective treatments which have helped many people with mental disorders by alleviating the symptoms and improving their lives - e.g. Morrison (2014) found that cognitive therapy reduced psychiatric symptoms + is safe for people with schizophrenia * It is less reductionist as it includes the idea that delusions are triggered by strange sensory experiences that arise from biological problems, suggesting a complex interaction between biological and cognitive causes of schizophrenia

Answer 48

* Difficult to find out whether the cognitive problems are a cause of their disorder or an affect, As they may play a role in causing schizophrenia or schizophrenia itself may cause the cognitive problems * It is reductionist as it underestimates genetic factors, stressful life events and social factors in the development of schizophrenia * Many brain-damaged patients have problems with attention or the relationship between memory and perception, but they failed to develop the symptoms of schizophrenia, which challenges the cognitive explanations

Answer 49

* Both supported by research evidence * Both look at human body as part of the explanation, as 1 looks at memory and the other looks at genes * Both reductionist as they underestimate the other factors into schizophrenia - such as social and environmental

Answer 50

* Cognitive explanation can be more useful as it leads directly to treatment * Cognitive looks at memory + attention as part of the explanation, whereas genetic looks at the biological inherited genes as part of the explanation * Genetic can show cause + effect link between genes + schizophrenia, whereas the cognitive symptoms shown may be a symptom of schizophrenia rather than a cause

Answer 51

* Clinical practitioners must register with this | * It sets standards which practitioners must meet in order to remain registered with the HCPC

Answer 52

* Character * Health * Standards of proficiency * Standards of conduct, performance + ethics * Standard for continuing personal development * Standards of education and training * Standards for prescribing

Answer 53

* Registrants provide credible character references from people who have known them for at least three years * Considering any criminal convictions and their character traits

Answer 54

* Provide info every two years when they re-register about their general health * Provide info on any health issues that they have only if it’s likely to affect their ability to practice safely

Answer 55

* There are a set of specific expectations for practitioners psychologists * E.g. professional autonomy + accountability, delivery of strategies for meeting health + social care needs * Specific requirements within each standard to be demonstrated by practitioners in different areas of psychology

Answer 56

* List of 14 guidelines that practitioners must adhere to in their clinical practice * Including points such as maintaining confidentiality in work with service users, referring on to others when necessary, and only acting within the limits of their own knowledge

Answer 57

* Professionals expected to take part in + document regular training that they undertake to develop their own practice * Including training events, evidence on how they’ve changed their practice, and an evaluation of the effectiveness of these changes

Answer 58

•Set of minimum levels of qualification specified before people can register to practice in different areas of health + care professions •Registrants must be able to evidence at least a master degree with bps qualification in the area of practice they will be working in •HCPC sets out standards for training courses

Answer 59

* These standards set out safe practice for prescribing medication by health and care professionals * Including the required knowledge and training to be able to prescribe within professional practice

Answer 60

* Drug treatment | * Cognitive treatment

Answer 61

* The medical model of mental disorder * Where mental disorders are seen as an illness + assumed they have biological causes * Treatments are physical in nature

Answer 62

Anti-psychotic drugs

Answer 63

Schizophrenia results from abnormally high levels of dopamine

Answer 64

* Blocking receptors for dopamine * So, effects of dopamine aren’t picked up by the Brain * However, there were side effects - shaking, muscle tremors, jerky movement

Answer 65

* Clozapine - acts by blocking serotonin receptors | * Olanzapine + risperidone - have fewer side effects + more effective - known as ‘atypical’ drugs

Answer 66

* Effective in reducing symptoms + more effective than any other form of therapy as reduces symptoms quickly * Useful w/ assistance of antipsychotic drugs * Allowed patients to live relatively normal lives - prior to phenothiazine, schizophrenia was considered untreatable * Appropriate as it has more of genetic basis - main drugs used to treat schizophrenia block dopamine receptors, so appropriate to use as they target parts of physiological system that function abnormally in Schizophrenia

Answer 67

Haloperidol gave significant improvements in all areas of functioning compared to placebo

Answer 68

* It’s reductionist - ignores psychological + social factors * Effectiveness + usefulness of drug therapy is limited - it is palliative - it suppresses the symptoms of the disorder without addressing the underlying causal processes - patients have to take drugs for many years * Unethical - drugs often produce side effects + some patients unable to give consent + may lead to addiction + dependency * Relapse is a problem - drugs don’t offer a long term cure as they don’t address the cause of the problem * Some patients are resistant to drugs * Most common drugs aren’t effective in treating the negative symptoms of schizophrenia

Answer 69

* Drug treatment can be looked down on in society as it’s considered that you need to alter their behaviours to become more ‘normal’ - social norms in society * Cannot assume everyone has same symptoms + severity of symptoms due to labelling them ‘schizophrenic’ * Pharmaceutical drug company’s want money

Answer 70

* Dopamine hypothesis is widely accepted explanation for schizophrenia * Suggests that schizophrenia may result from high levels of dopamine * So, it follows the most common form of biological treatment for schizophrenia is drug therapy

Answer 71

* Mental disorder is created by errors in thinking | * Thoughts influence emotions + feelings

Answer 72

Attempt to change maladaptive behaviour by changing the way people think

Answer 73

* Patients have irrational thoughts + beliefs about themselves + the world * Thoughts + beliefs are negative, self-defeating + contribute to development of mental disorders

Answer 74

* Focusing on the present symptoms * Looking at how the person thinks about how an event affected them - what they felt + how they behaved * Challenge negative thoughts + change them for more realistic + positive thoughts * Person will feel better + behaviour will change

Answer 75

Reduce the stress felt by the patient with schizophrenia + allow them to help them mange + understand their symptoms

Answer 76

* Belief modification * Focusing + reattribution * Normalising the experiences of the person w/ schizophrenia

Answer 77

Delusional thinking is challenged

Answer 78

* To help w/ hallucinations (auditory) | * Therapist aims to show that the voices are self-generated + don’t need to be feared

Answer 79

Psychotic symptoms are looked at as more normal to reduce the fear related to them

Answer 80

* Useful as effective in treating - patients show increase in coping skills + decreased hallucinations + delusions * Most ethical - empowers patients by educating them in self-help strategies + they have more control over the process - allows patients to be more independent * Strategies learned cab be incorporated into a patients life - so it’s a useful treatment

Answer 81

* Reductionist - doesn’t address the underlying cause of the mental disorder as it overlooks biological causes * Not effective - patient suffering severe schizophrenia may lack problem solving skills + don’t have an insight into their condition * Effectiveness is hard to judge - control treatments are sometimes given by non-experts, so the use of inadequate control treatment conditions may explain some of the findings

Answer 82

* He compared CBT w/ non-specific ‘befriending interventions’ for patients w/ schizophrenia * Found that CBT was more effective in reducing both positive + negative symptoms of schizophrenia

Answer 83

* CBT can be seen as an agent of social control, so patients thoughts may be changed to fit into social norms * Superficial way of trying to get patients to act normally without actually addressing the problem * But, by alleviating the symptoms, it makes the patient much more independent

Answer 84

* Both supported by research evidence - e.g. Sensky, Meitzar * Both are useful as they allow people to live independent lives * Both ignore social factors

Answer 85

* Drug Therapy is more reductionist than CBT, as it focuses purely on biological treatment , where CBT looks at cognitive + behavioural * CBT can be considered more ethical than drug therapy

Answer 86

Summarises previously published studies

Answer 87

* Looks at recent major advances + discoveries * Looks at significant gaps in research * Looks at current debates * Looks at ideas of where research might go next

Answer 88

* Generate new ideas about where research should go next * Can close significant gaps in research * Draws together wide body of data * Includes recent major developments

Answer 89

Has practical problems - validity and reliability may be interpretative if original studies had flaws

Answer 90

Review research to investigate: •Use info on psychosis + neurotransmitter functioning to produce new antipsychotic drugs that are more effective w/ fewer side-effects •Show neurotransmitter functioning in specific brain areas •Investigate neurotransmitter functioning + psychosis, beyond the dopamine hypothesis

Answer 91

* Literature review * Methods + findings of studies to do w/ neurotransmitter interactions in schizophrenia are analysed * Including studies using rodents to test neurotransmitter functioning + related brain structure functioning, studies on people w/ acute schizophrenia + people with schizophrenia in remission, studies which used brain scans to investigate psychosis

Answer 92

* PET scans provide evidence to show high levels of dopamine related to psychosis - e.g. Abi-Dargham (1998) + Breier (1997) * Supporting the dopamine hypothesis * However interactions with other neurotransmitters (e.g. noradrenaline, serotonin, acetylcholine, glutamate, + GABA) may be related w/ schizophrenia

Answer 93

* Low levels of glutamate play a role in schizophrenia * Lodge (1989) - shows that PCP can induce psychosis by inhibiting the action of glutamate in the brain * Glutamate failure in cerebral cortex may lead to negative symptoms of schizophrenia, •Glutaminergic in the basal ganglia could be responsible for positive symptoms

Answer 94

* Some research has found an interaction between dopamine and glutamate * Reduced levels of glutamate is associated with increased dopamine release

Answer 95

* Serotonin may be implicated in schizophrenia * Serotonin levels are related to dopamine * Clozapine works by reducing dopamine and serotonin levels in the brain * NMDA antagonists, which limit glutamate, seem to stimulate serotonin levels

Answer 96

* Whether high levels of dopamine (hyperdopaminergia) cause schizophrenia * Whether low levels of glutamate (hypoglutamatergia) cause schizophrenia

Answer 97

* Glutamate deficiency may explain increased dopamine responsiveness * Glutamate deficiency should be studied * Increased serotonin activity is found in people w/ schizophrenia - dopamine + serotonin contribute to the positive + negative symptoms * More focus on other neurotransmitters is needed (e.g. GABA, acetylcholine, etc) * May be different subpopulations of those w/ schizophrenia, where it’s caused by different abnormal levels of different neurotransmitters - this has implications for treatment

Answer 98

* Provides an overview of key findings in the area * generate new ideas about where research should go next * Closes significant gaps in research * Draws together wide body of data - allowing a large amount of info to be brought together quickly * Because of the extensive nature of material covered, the conclusion drawn is likely to be valid * Ethical - no direct ethical issues

Answer 99

* Studies rely on secondary data from many other studies * The validity and reliability of Carlsson’s study may be affected by any research issues in the original studies * So, any conclusions from his study may be problematic

Answer 100

* High reliability - studies cited by Carlsson are lab experiments - many are animal + PET scans using standardised procedures + controlled * High validity - Carlsson considered glutamate as a possible contribute to schizophrenia (another hypothesis), he argues both hypotheses may be true + research should continue in both (evidence seems to suggest this), he questions the validity of the dopamine hypothesis he himself developed in 1950s, Sendt (2012) literature review supports Carlsson’s findings

Answer 101

* Low generalisability - some findings come from animals - so may not generalise to humans, culture may influence the type of auditory hallucinations (Luhrman, 2015), may be time locked (1999/2000) so research may no longer be representative of state of scientific ideas * Unethical - issues of deception + risk as patients don’t know if they’re being given the real drug or placebo, studies use humans - with or without schizophrenia being given amphetamines or PCP or other drugs that increased psychotic symptoms

Answer 102

* Useful in developing antipsychotic drugs * Glutamate antipsychotics are still in development (Papanastasiou et al, 2013) could bring relief to people who don’t respond well to typical antipsychotics * Improved dopaminergic drugs that have fewer side-effects based on better understanding of dopamine pathways + new atypical drugs that affect other neurotransmitters, like serotonin and glutamate

Answer 103

* Use of scientific methods- e.g. PET scans * High validity - looks at a wide range of studies * Uses animal studies which aren’t generalisable * Not valid data - review article uses secondary data which might have flaws * High validity + credibility- Breier et al (1997) produced objective data

Answer 104

* Difficult to study functioning of neurotransmitter in the brain * So, neurotransmitters which are easiest to study (dopamine + serotonin) tend to be most researched and others which are important tend to be ignored

Answer 105

* This research is purely biological as only focuses on neurotransmitters, so it ignores social + cognitive factors * But, research uses many different studies to draw its conclusions (rodent studies, PET scans), as it generates such a wide range of evidence it can be considered somewhat holistic, also looked at many different neurotransmitters

Answer 106

* Further research suggested by the article will lead to more changes * Methods of investigating neurotransmitters have become more sophisticated overtime * Further research found that there is an interaction between dopamine + glutamate, as reduced level of glutamate is associated with increased dopamine levels

Answer 107

* The research suggests areas for further research which can be used to inform further treatments for schizophrenia * Future research as different sub populations have abnormal levels in different transmitters, not just dopamine

Answer 108

Compare cognitive behavioural therapy (CBT) w/ non-specific ‘befriending interventions’ for patients w/ schizophrenia in effectively reducing positive symptoms of schizophrenia

Answer 109

* Randomised controlled design * Patients allocated to one of two groups: A cognitive behavioural therapy group or an non-specific befriending control group

Answer 110

* 90 patients - 57 from clinics in Newcastle, Cleveland and Durham and 33 from London * They had a diagnosis of schizophrenia that had not responded to medication * Aged 16 to 60 years

Answer 111

* Both interventions resulted in significant reductions in positive and negative symptoms and depression * At the 9 month follow-up evaluation, patients who had received cognitive therapy showed greater improvements on all measures

Answer 112

CBT is effective in treating negative + positive symptoms of schizophrenia that are resistant to standard antipsychotic drugs, w/ its efficiency sustained over 9 months of follow-up

Answer 113

* Normal routine of CBT used - engaging with patient, examining antecedents of psychotic disorder, developing a normalising rationale + treatment of other disorders * Specific techniques for positive symptoms of schizophrenia used * Patients helped to change their beliefs + taught coping strategies to deal with the voices

Answer 114

* Patients had same time allocation at the same intervals as the patients in the CBT * Therapists were empathetic + non-directive * No attempt at therapy, the sessions focused on hobbies, sports + current affairs

Answer 115

* Assessed by blind raters at baseline, after treatment (lasting up to 9 months), and a 9 month follow-up evaluation * Assessed using comprehensive psychiatric rating scale, the scale for assessment of negative symptoms and a depression rating scale * Patients continued to received routine care throughout the study * Patients received a mean of 19 individual treatment sessions over 9 months

Answer 116

* Clinician assessing a patient •Decides whether they show evidence of mental disorder * Decides whether their symptoms match those in a checklist of the features + symptoms of a mental disorder

Answer 117

* No clear dividing line separating normal + abnormal behaviour * Concept of abnormality can change over time * Concept of abnormality can change between societies/cultures * Many different types of behaviour can be considered abnormal

Answer 118

* Deviance * Distress * Dysfunction * Danger

Answer 119

* Behaviours/emotions that are unusual in society | * Behaviour must be statistically rare + disapproved of by most in society

Answer 120

Extent to which the individual finds their behaviour and/or emotions upsetting

Answer 121

Extent to which the behaviour interferes with the persons day-to-day life

Answer 122

Behaviour which could harm others or the individual

Answer 123

* Clinicians have a lot of power and influence in the diagnosing of mental health problems * This has implications for patients who are labelled as mentally ill * As it’s possible to treat patients against their will if their sectioned by the mental health act + considered at risk to themselves or others * But, antipsychotic medication is critical for alleviating the distress associated with schizophrenia + enabling quality of life to be restored

Answer 124

* Useful - they have practical applications in helping professionals decide whether a patient symptoms need a clinical diagnosis * Holistic way to assess someone’s mental health - cover a wide range of symptoms * Davis (2009) - suggests a 5th D needs to be added - duration to increase validity

Answer 125

* Low validity - as diagnosis may not be accurate * Low reliability - if used by 2 professionals, may not get same diagnosis - reducing scientific status of diagnosis * Subjectivity in the application of the 4 D’s - E.g. dysfunction is subjective as individual may not think they have a problem + their unusual behaviour may suit them * Distress + danger is subjective + difficult to measure - not all mental disorders are distressing * Model criticised for being incomplete - Davis (2009) suggests that duration needs to be added

Answer 126

* Issues of reliability + validity- diagnosis process conducted through unstructured or semi-structured interviews * When gathering highly sensitive data about someone’s mental health - there are problems with the self-report method

Answer 127

* Diagnosing disorders relies on unstructured/semi-structured interviews * Involving the clinicians subjective interpretation of data * Which reduces scientific status of the diagnosing of mental illness as it’s objective, lacks reliability and validity

Answer 128

To help them make diagnosis + establish appropriate treatment regimes

Answer 129

Provide clear + measurable criteria for diagnosis, which can be used in the same way by all practitioners - increasing the reliability of diagnosis

Answer 130

* Biological approach assuming that the major source of abnormal behaviour is a form of medical illness * Believes that the best treatment for mental disorders is biological - e.g. drug treatment

Answer 131

* Scientific + objective approach to diagnosis - has a lot of scientific credibility * It group symptoms together + classifies them into a syndrome - so, their cause can be discovered + treated

Answer 132

* Limited - criticised for just focusing on the symptoms + not causes of this disorder - e.g. the model was criticised by anti-psychiatry movement in the 1960s * Symptoms cannot be easily measured, so clinician must make a subjective judgement

Answer 133

* Thomas Szasz + R.D. Laing suggested that psychiatric symptoms is an understandable reaction to coping with a sick society * They felt that mental hospitals were not designed to cure people + they function as a prison, where disruptive people could be removed from society * Concerned that diagnosis could be used as an agent of state control + diagnosis results in labelling + could be used to medicalise social problems * Concerned about controversial medical practices in psychiatry - e.g. use of lobotomies as a treatment

Answer 134

* ICD 10 | * DSM-5

Answer 135

* Diagnostic tool is designed to enable practitioners to identify + treat particular disorders * To provide a standardised, criterion based system to allow for accurate diagnosis of mental disorders

Answer 136

* To take into account new research * To take account of peoples changing cultural views * To show that psychological understanding changes and develops over time

Answer 137

* Both regularly updated * Both attempt to make diagnosis accurate across cultures * Both rely on checklists + can be criticised for being reductionist * Both criticised as use the medical model * Both designed to enable practitioners to identify + treat particular disorders * Both include categories of mental disorders based on characteristic patterns of symptoms

Answer 138

* DSM less reductionist than ICD - so it’s more holistic than ICD * ICD used in many countries in the world, but DSM used in America * ICD is free + an open resource, but DSM generates profits for the American psychological Association * DSM only deals w/ mental conditions, but ICD also diagnoses physical illness

Answer 139

* DSM and ICD rely on checklists * Can be criticised for being reductionist * But, DSM takes account of psychological factors + disability, so it’s less reductionist than the ICD

Answer 140

* Late 19th Century - Kraeplin argued that pychiatric disorders are physical in nature + should be studied as a branch of medical science + it is possible to classify specific mental health disorders by their symptoms, diagnose them + predict their course * Both DSM + ICD are regularly updated

Answer 141

* Reliable - rely on standardised checklists of observable behaviour - used in the same way by all clinicians * But, there will always be an element of subjectivity when interpreting the diagnostic criteria

Answer 142

* DSM +ICD are regularly updated | * So, they show that psychological understanding changes and develops over time

Answer 143

* DSM and ICD attempt to make diagnosis accurate across cultures * But, some argue that they still have a western bias

Answer 144

* The type of disorder from which they suffer - e.g. psychotic disorders * Psychological + contextual factors - as it can influence the well-being of the individual - e.g. unemployment * Disability - looks at overall level of functioning of the individual * Co-existing factors - e.g. medical conditions

Answer 145

* Clinical interviews * Observations of the client * Medical records of the client * Focuses on assessing patients along the spectrum

Answer 146

* Latest version of DSM reflects developmental + lifespan considerations * Reflects developmental processes that occur early in life (e.g. schizophrenia) and those that are more commonly developed during adolescence (e.g. depression) * Highlighting understanding that some psychiatric illnesses occur during certain periods of our development

Answer 147

* 1 - Intro to manual w/ instructions on its use * 2 - Contains classification of the main mental health disorders - e.g. OCD, schizophrenia, bipolar, anxiety, etc * 3 - Contains other assessment measures to aid diagnosis - cultural formulation interview guide to help diagnose individuals from a different culture from the clinician + includes other conditions that are being assessed for possible future diagnosis

Answer 148

* If different practitioners arrive at same diagnosis of a patient * When clinicians agree on a diagnosis there is high inter-rater reliability for the system of diagnosis

Answer 149

* Reviewed process of diagnosis | * Suggested that experienced psychiatrists only agree on diagnosis about 50% of the time

Answer 150

Argued reliability is in doubt for some disorders related to schizophrenia

Answer 151

* Tested reliability + validity of DSM-5 diagnosis for anxiety + mood disorders * Found them to be good to excellent

Answer 152

* Through a random sample of Danish in-patients + outpatient’s w/ a history of schizophrenia * Showed that ICD 10 is a reliable measure of schizophrenia + compares well in terms of reliability with the DSM-111-R

Answer 153

* Found 71% of psychiatrists agreed with the ICD 10 definition of depression when assessing 116 patients * This indicates high inter-rater reliability

Answer 154

* Improved w/ the use of standardised interview schedules specifying symptoms to ask about + giving instructions as to how to rate their severity * DSM + ICD have specific diagnostic operational criteria for diagnosis to increase objectivity + reliability - e.g. clear definitions are given for each disorder + a list of symptoms

Answer 155

* Patients may give different psychiatrists slightly different info * E.g. lack of standardisation in assessment + interview techniques * Leading to different practitioners giving different diagnoses to the same person

Answer 156

* Practitioners using the classification systems aren’t completely objective * Practitioner may not use the categories of the classification system correctly or they may gather insufficient info

Answer 157

* Studied 2 psychiatrists diagnosing the same patient * Found that disagreement occurred because of the inconsistency of info provided by the patient (5%), psychiatrists interpretation of symptoms (32.5%), inadequacy of the classification system (62.5%)

Answer 158

The extent to which a diagnosis is accurate

Answer 159

* Compares evidence from different diagnostic tests to see if they agree * The DSM + ICD seem to have good concurrent validity

Answer 160

* Exists when the diagnosis reflects known causes | * E.g. cause of disorder may be due to a problem w/ damage to a particular area of the brain

Answer 161

* Future course of the disorder is known and can be applied to the person * So, the diagnosis can be checked against the outcome to see if it’s valid

Answer 162

* Implicit bias in clinician as the beliefs of them mean that they arrive at an inaccurate diagnosis * Patient may not disclose all info as they may be embarrassed or they don’t remember all details - so, clinician not able to arrive at an accurate diagnosis * Interviews are subjective - producing findings that the clinician expects to find * If the classification system is biased then diagnosis will not be valid

Answer 163

* Blames classification systems used in Britain * Argues that they lead practitioners to take on a Eurocentric bias * So, they cannot take into account the normal behaviours of other cultures as they are based on European ideas

Answer 164

* Questions international validity of DSM-5 | * Suggests that the assumptions it makes about nuclear family life aren’t applicable to all cultures

Answer 165

Positive or negative attitudes that a person may hold at an unconscious level

Answer 166

* Diagnosis was not accurate * Being given a psychiatric diagnosis would negatively affect a persons life * As, they would be left with a psychiatric label which others could judge them negatively on + misinterpret their behaviour

Answer 167

* See if psychiatrists could differentiate between sane + insane people * Investigate life for patients in psychiatric hospitals * Raise awareness about conditions in psychiatric hospitals

Answer 168

Hospital staff and patients

Answer 169

* Field experiment with participant observation * Participant observation by 8 sane people (a student, 3 psychologists, a painter, housewife, psychiatrist, paediatrician)

Answer 170

Symptoms (lack of symptoms)

Answer 171

Diagnosis they’re given

Answer 172

* Phoned 12 psychiatric hospitals giving a false name + address •All complained of hearing unclear voices saying “hollow, empty, thud” - chose these words as they aren’t associated with a particular disorder * Apart from hearing voices, the pseudo patients behaved normally * Once admitted, they stopped simulating any symptoms + took part in ward activities -took notes of their experiences in the hospital * They had daily visitors who found that they were acting normally

Answer 173

* All admitted to hospital + all but 1 diagnosed with schizophrenia * Normal behaviour was misinterpreted - writing notes described as “patient engaged in writing behaviour”, arriving early for lunch described as “oral acquisitive syndrome” * No staff suspected that they were sane * Average stay in hospital was 19 days, shortest stay = 7 days, longest stay= 52 days * Given a total of 2100 medication tablets * 35/119 real patient has voiced their suspicions about the pseudo patients * Nurses stayed in ward offices 90% of the time, each real patient spent less than seven minutes per day with psychiatric staff + patients treated with no respect

Answer 174

* Psychiatrist couldn’t detect sanity * The psychiatric hospitals weren’t useful for people with mental disorders * Diagnostic labels change the perception of the person so that all their behaviour was in interpreted within the context of the label - lead to self-fulfilling prophecy as the person is treated in a way that is consistent with the label which confirms the validity of the label

Answer 175

See if the hospitals who had been told they were going to be approached by pseudo patients would be able to tell the sane from insane people

Answer 176

* A teaching + psychiatric hospital was informed that over the next 3 months 1 or more pseudo patients were trying to get admitted to their hospital * Each staff member was asked to write the likelihood that the patients who sought to be admitted were pseudo patience * In reality, no pseudo patients were admitted * Staff members rated new patients on a scale of 1 to 10 as ‘how likely to be a fraud’, where 193 patients were assessed

Answer 177

* 41/193 rated as pseudo patient by at least 2 members of staff * 23/193 rated as pseudo patient by at least 1 psychiatrist * 19/193 rated as pseudo patient by a psychiatrist + 1 other member of staff

Answer 178

* The staff were unable to detect insanity | * This confirmed Rosenhan’s initial results that there is poor validity in the diagnosis process

Answer 179

Investigate patient/staff contact

Answer 180

* In 4 of the hospitals, pseudo patients asked a member of staff when they will be eligible for ground privileges * Avoided asking the same member of staff more than once a day * Rosenhan compared responses given to the patients to those given to a student at Stanford university

Answer 181

* 71% psychiatrists ignore + 4% stop and talk * 88% nurses ignore + 0.5% stop and talk * But, 0% faculty at the Uni ignore + 100% stop and talk

Answer 182

* Psychiatric patients are treated differently to non-psychiatric patients * Patients are powerless while on the mental ward * Lack of eye contact between staff + patients depersonalises the patients

Answer 183

Where people aren’t treated as unique individuals, worthy of respect

Answer 184

* Study took place in a range of hospitals * 12 hospitals across the USA * So, the results are generalisable to the USA of 1960s

Answer 185

* Sample was very small and was unrepresentative - only 12 hospitals * May not generalise outside the USA as there may be cultural differences * May not generalise to current times

Answer 186

* Certain aspects were standardised * E.g. All pseudo patients presented with the same single symptom of hearing voices saying “hollow, empty thud” * All pseudo patients behaved normally as soon as they’re admitted to hospital + said they didn’t have symptoms * Questions asked by pseudo patients and controls were standardised

Answer 187

* It was a field experiment * Variables such as patient-staff interactions couldn’t be standardised * So, research couldn’t be repeated in a consistent way * Study used participant observation so this is low reliability - as participant observers find it difficult to observe all details + may get distracted or over-involved

Answer 188

* Highlighted danger of labelling * People recognise that hospitals may not be the best place to treat mental illness * Reduce abuse of power in mental institutions by staff (e.g. CCTV) * Number of criteria used to diagnose mental illness increased - diagnosis now more accurate/valid, as a diagnosis of schizophrenia cannot rely on only 1 symptom

Answer 189

* High ecological validity * Pseudo patients able to gather 1st-hand data about the treatment of the patients * Setting (hospital) + tasks (hospital activities, life as a patient) are true to life * Process of being admitted to hospital, interactions with staff, discharge + experience of life in a hospital was true * Covert observation increases validity as reduces demand characteristics - nurses + doctors likely to act as they normally would

Answer 190

* Low ecological validity * Lack of control is due to nature of research (field experiment) - so, impossible to standardise things such as patients/staff interactions or reactions of other patients * Observer bias may reduce validity - Rosenhan had strong opinions about psychiatry + the medical model - his opinions may have influenced his observations

Answer 191

* Raised awareness of poor conditions in psychiatric hospitals * Confidential - names of individual doctors/nurses were not published

Answer 192

* Hospital staff deceived * No consent given * No right to withdraw * Participants didn’t know they were part of the study * No protection of other patients - staff are wasting time on pseudo patients instead of looking after genuinely ill people * No protection - undermine confidence of doctors + nurses

Answer 193

* Labelling behaviours as abnormal leads to diagnosis, which pathologies the behaviour * Those in anti-psychiatry movement would argue that this forces people to conform to the standards set by society + if they don’t then they must receive treatment that will normalise their behaviour * Argued that if we don’t label the behaviour as abnormal than people would be free to behave how they like * E.g. in Rosenhan’s research - pseudo patients were treated for schizophrenia with tablets for their ‘symptoms’

Answer 194

* Field experiment so lack of controls - e.g. standardisation reduces reliability * Low validity - participant observation means that there is observer bias - e.g. Rosenhan had strong opinions about medical model * Mainly qualitative data (pseudo patients experience) reduces scientific status * Covert observations increase validity as demand characteristics are reduced

Answer 195

* When Rosenhan’s pseudo patients were incorrectly diagnosed with schizophrenia, the classification system in use was the DSM 11, which didn’t use a criterion based system for diagnosis * Currently the DSM-5 + ICD 10 give very specific symptoms which means that diagnosis should be both more reliable (consistent between clinicians) and more accurate

Answer 196

* More respect for patients * More validity of diagnosis - criterion based system * Awareness of the dangers of labelling * Recognition that hospitals aren’t necessarily the best place to treat mental illness - move to care in the community

Answer 197

* Different people may react differently to practitioners * Different people may show different symptoms - e.g. different hallucinations, different levels of distress + dysfunction

Answer 198

Schizophrenia usually develops in a persons late teens/early 20s, after an apparently normal childhood

Answer 199

* Studying mental health issues is socially sensitive research * Involving labelling people with an illness in order to investigate treatment * Rosenhan able to provide an account of the quality of care in psychiatric hospitals * But, Spitzer criticised the study as sensationalist + causing harm to the psychiatric profession by casting doubt on the treatment of mental health

Answer 200

* An anxiety disorder * Causing distress and has a major impact on the patient’s functioning * Characterised by the presence of obsessions and/or compulsions

Answer 201

Persistent, irrational, unwanted thoughts

Answer 202

* Afraid of hurting themselves * Afraid of hurting others * Unwanted sexual thoughts, images, or urges * Contaminated or contaminating someone else * Fear of not having done a specific act that could result in harm

Answer 203

* Tasks that people do to relieve themselves of the obsessions * The person feels driven to perform these tasks * This makes them feel less anxious or distressed * They can be mental or physical * They are extreme beyond reason or they are not realistically connected with what they are meant to stop

Answer 204

* Cleaning or washing * Checking that you haven’t made a mistake * Ordering or arranging things in a particular way * Repeated checking behaviours

Answer 205

* Eye blinking * Facial grimacing * Shoulder shrugging * Head jerking * Repeated clearing of the throat, sniffing, or grunting sounds

Answer 206

* Starts with obsessions * Which causes strong feelings of anxiety - the person feels compelled to act + remove the discomfort * So, compulsions occur as a result * Leading to a feeling of relief from the anxiety * But, the obsessive response has been strengthened for the future

Answer 207

* Obsessions cannot be ignored/suppressed + cause anxiety * Obsessions and compulsions are time-consuming - they take up more than 1 hour per day * Symptoms cannot be explained by substance use, another medical condition or mental disorder * Clinician determine if individual has fair or poor insight into the disorder, recognising that their obsessive compulsive beliefs are not true or if they have poor insight, true * Find out if the individual has a current or past history of a tic disorder

Answer 208

* The age of onset is late teens + early 20s | * But, in 25% of male sufferers, it is before the age of 10

Answer 209

* The prevalence rate is between 1.1 and 1.8% of the population * In adults, OCD is more common in females * In children, OCD is more common in males

Answer 210

* Symptoms develop gradually but they can be extreme * 70% of people experience a chronic and lifelong course * 5% have episodic symptoms * But, the content of obsessions doesn’t determine prognosis

Answer 211

* Milder symptoms * Brief duration of symptoms * Good functioning before full onset

Answer 212

* Family history - having a family member w/ the disorder can increase the risk of developing OCD * Stressful life events - people who have experienced traumatic or stressful events have an increased risk of getting OCD

Answer 213

* Everyone doesn’t necessarily develop the same symptoms - cultural differences, males + females differ in symptoms/features * Not everyone responds to treatment in the same way * Genetic + environment factors can affect a persons risk of developing OCD

Answer 214

* Females + males are diagnosed differently depending whether they are a child or adult * OCD occurs across cultures at a similar rate, show a similar age at onset + show similar structure of symptoms * But, there are cultural differences in how some of these symptoms can be expressed

Answer 215

* Current or past history of tic disorder can affect severity of disorder * Obsessions cannot be ignored or suppressed * Obsessions + compulsions consume at least 1 hour per day + have a great impairment to daily life

Answer 216

* Risk is higher for people with higher negative emotionally * In adults, OCD is more common in females * The prevalence rate is between 1.1 and 1.8% of the population

Answer 217

OCD affects about 1.2% of the population

Answer 218

Suggest about 2.3% of US population has OCD in one year

Answer 219

Estimates that about 2% of people have OCD worldwide

Answer 220

* Biological explanation | * Cognitive explanation

Answer 221

Neuro-circuitry in the brain is not working correctly

Answer 222

* Contains primitive checking + cleaning behaviours hardwired in the brain * If this is overactive, it triggers a compulsion to engage in these behaviours

Answer 223

* Alerts the brain to potential worries in the environment | * If overactive, the person would experience anxiety

Answer 224

Connect the orbitofrontal cortex to the thalamus

Answer 225

* Basal ganglia malfunctions * So, thalamus becomes overactive, causing compulsions to occur - so cleaning + checking behaviours are more likely * Overactive thalamus causes a cascade reaction in the orbitofrontal cortex, then this becomes overactive * Orbitofrontal cortex alerts the brain when something seems odd, causing anxiety which leads to the obsessions in OCD

Answer 226

* Aims to inhibit the thalamus * If not working properly, it can’t inhibit the thalamus * Thalamus becomes overactive, causing compulsions to occur

Answer 227

* A lot of supporting evidence * Brain scans show differences in brain structures + functioning between people who have OCD + healthy controls * High scientific credibility - brain scans are a scientific way of investigating OCD + many studies of brain activity have come up with similar findings * Surgical reasoning of the cingulate gyrus has been used as treatment for OCD - so, it’s correct that OCD result from faulty feedback loop between thalamus + orbitofrontal cortex - since breaking the loop can cure OCD

Answer 228

* It’s reductionist - doesn’t fully explain OCD -surgery sometimes doesn’t work as OCD is more complex than this theory suggests * Difficult to show cause+effect - differences in brain activity in people with OCD may be a symptom of their OCD rather than the cause * Brain activity + thoughts are related, so can’t say if brain activity altered the thoughts or the thoughts altered the brain activity as they cannot be separated * Support for the biological link comes from genetic link as it suggests that physiological factors underlie the development of the disorder in many people - e.g. twin studies

Answer 229

* Isolating mental health to biological processes in the brain simplifies a complex behaviour * This may not be an appropriate way to view mental disorders

Answer 230

* Use of brain imaging helps investigate relationship between brain structures + behaviour * It’s very scientific + adds reliability to the findings * This increases the scientific credibility of the theory

Answer 231

* Some people have a family heredity risk, but some don’t * Some people respond to surgery, but some don’t * People suffering from OCD can develop different individualised symptoms

Answer 232

* Supports the nature side of the debate - as it looks at structure + functioning of the brain and is supported by genetic factors * But, the concordance rate in MZ twins was not 100% for OCD, so it is not a full exclamation

Answer 233

* Brain scans show differences in brain structure * Found that people suffering from OCD had a different amount of grey matter in orbitofrontal cortex to those without OCD

Answer 234

* Brain scans show differences in brain functioning between people who have OCD + healthy controls * In patients with OCD, the cingulate gyrus, basal ganglia + orbitofrontal cortex are active when at rest - they become more active as OCD symptoms are stimulated

Answer 235

Found that PET scans of OCD patients had increased activity in the prefrontal cortex

Answer 236

* When people w/ OCD are shown objects that bring on their symptoms * There is an increase in activity in the orbitofrontal cortex + caudate nucleus

Answer 237

* He bread mice to show symptoms consistent with OCD (excessive grooming + anxious behaviour) when a targeted gene is missing * This gene is associated with planning + initiation of action * Showing a link to formation of compulsions * Genetic explanation for OCD can be used to support the wider biological explanation in general

Answer 238

Found from a review of 70 studies that the concordance rates for MZ twins was between 27 to 47%, which is higher than for DZ twins

Answer 239

Found 87% concordance rate in MZ twins for obsessive symptoms + features compared to 47% for DZ twins

Answer 240

* OCD is more complex than this theory suggests | * He suggests that the functions usually performed by the cingulate gyrus can be taken over by other areas of the brain

Answer 241

* Thoughts lead to emotions | * Which in turn trigger behaviours

Answer 242

The role that thoughts play in the disorder

Answer 243

* It is the thought processes of people that explain OCD | * As, people who suffer from OCD have obsessive thoughts

Answer 244

* Tendency to overestimate the likelihood of danger * Exaggerated responsibility that 1 is responsible for preventing misfortunes * Belief that certain thoughts are very important + should be controlled * Belief that someone having a thought or urge will increase the chances that it will come true * Belief that 1 should always be perfect + mistakes are unacceptable

Answer 245

* People with OCD misinterpret their thoughts, due to false beliefs * OCD is due to memory problems * OCD sufferers may be hypervigilant

Answer 246

* Individuals prone to developing OCD exaggerate the thought + respond as if it was a real threat * Causing high level of anxiety + guilt * People interpreting intrusive thoughts as catastrophic will believe that thinking holds truth + will be distressed, so they practice ritual behaviours * People who fear their own thoughts attempt to neutralise feelings by avoiding situations and engaging in rituals * The anxiety produced by the thoughts lead to the compulsive behaviours seen in OCD

Answer 247

Because of false beliefs learned earlier in life

Answer 248

Found that people with OCD had poor memories for their actions

Answer 249

* Found people suffering from OCD had low confidence in their memory ability * Also, their non-verbal memory was impaired

Answer 250

* He conducted a meta-analysis | * Found that patients with OCD had slightly worse memories for recalling stimuli

Answer 251

* They have attentional bias, so they’re overly sensitive to threat * They use rapid eye movement to scan the environment + attend selectively to threat related stimuli * So, they feel very anxious * The threat perceived become the basis of their obsessions * The compulsive behaviours are designed to reduce their anxiety

Answer 252

* Female patient had severe fear of diseases * Had catastrophic thoughts about the probability of harm * She overestimated the seriousness of contact with anyone * When in public she rapidly scanned the environment + people on the lookout for evidence of blood * Her hypervigilant scanning meant that she could recall the blood related items she had encountered over many years

Answer 253

Suggested that OCD sufferers suffer from hypervigilance, so they have an attentional bias + become very anxious

Answer 254

* Found that therapy based on the cognitive explanation was as affective as drug treatment * This supports the cognitive theory because if OCD were purely biological, then the biological treatment should work better than the cognitive treatment

Answer 255

* Backed up with supporting evidence - which gives it scientific credibility * Therapy based on the cognitive explanation has been successful as a treatment for OCD * Cognitive biases (hypervigilance) give a good account of individual differences in susceptibility to OCD - the cognitive approach is easily adapted to individuals’ unique symptoms

Answer 256

* Reductionist - it ignores the role of biology + learning in the development of faulty cognitions * Doesn’t prove a cause+effect link - doesn’t show that the faulty cognitions are the cause of OCD, instead they could be a symptom - If the cognitive model was complete, treatments would always be useful

Answer 257

* OCD can be considered from a biological point of view + also a cognitive point of you * Both approaches have different strengths and weaknesses

Answer 258

* Everyone may have similar biological structures in common with people, but no one is exactly the same * Menzies (2007) provides biological support * Trivedi (1996) provides cognitive support * Interactive effect which causes OCD, as the brain is shaped by its environment + the environment is shaped by the brain of the person experiencing it

Answer 259

* Drug treatment | * Cognitive behavioural therapy (CBT)

Answer 260

When cognitive behavioural therapy doesn’t work

Answer 261

* They raise serotonin levels * By blocking it’s reuptake from the synapse back into the releasing neurone * So, more serotonin is available for longer

Answer 262

* Fluoxetine | * Sertraline (SSRI - selective serotonin re-uptake inhibitor)

Answer 263

* Up to 12 weeks for drugs to be effective | * But, some people don’t respond to medication

Answer 264

* Increasing the effectiveness of GABA in regulating anxiety | * GABA lowers physiological arousal + returns body to a resting state

Answer 265

* They’re called benzodiazepines | * E.g. Valium

Answer 266

* Block the stress hormone that are released into the bloodstream by adrenal glands * They prevent this physiological response (e.g. increased heart rate) from occurring * They feel less stressed, so they have fewer obsessional thoughts + less compulsive behaviour

Answer 267

Propranolol

Answer 268

* It’s useful - as it can be used to treat cases of OCD which have not responded to CBT * There’s empirical evidence to show that drug treatment can be effective in OCD - e.g. Soomro (2007) - there’s scientific credibility * Drug treatment can be combined with CBT which may raise the effectiveness of CBT * Modern drug therapy with psychological therapy has reduced the need to resort to neurosurgery which was unethical

Answer 269

* Drug treatments alone cannot treat most people with OCD * Lasts for 12 months before medication can be reduced or discontinued * May increase the patient’s anxiety * Can cause side-effects (e.g. nausea + headaches) - limiting the usefulness of drugs as people don’t want to take them * Can relapse if treatment is stopped * There’s individual differences in the way that people respond to drugs * Have to be sensitive to individual differences

Answer 270

Found that antidepressants were more effective than placebo in reducing the symptoms of OCD

Answer 271

Drug treatment can be combined with CBT and has been shown to raise the effectiveness of CBT

Answer 272

* Antidepressant medication did have long-term affects compared to a placebo * It was effective at preventing relapse over an 80 week trial

Answer 273

SSRIs were not effective for 40% of people

Answer 274

Differences in the metabolism in the right compared to the left orbitofrontal cortex predicts whether a person will respond better to drugs or CBT

Answer 275

* Prescribing drugs to patients, needs to be tailored to individual needs * Especially important with patients with refractory OCD * E.g. may be given a combination of SSRI drug with an antipsychotic drug

Answer 276

OCD that is very difficult to treat

Answer 277

* Cognitive component | * Behavioural component

Answer 278

* Changing thought processes | * Helping people to deal with obsessions found in OCD

Answer 279

Changing actions/behaviours

Answer 280

Focus on their thoughts, and emotional + behavioural responses to those thoughts

Answer 281

Change the beliefs that they trigger

Answer 282

* Start with thoughts that are least anxiety provoking | * Client encouraged to test the beliefs that the thoughts activate until they don’t generate anxiety

Answer 283

* Person predicts a negative outcome | * Then, jump to the conclusion that if the negative outcome did happen, it would be a catastrophe

Answer 284

* Client thinks repeatedly about their obsessive thoughts * By deliberately thinking about obsessions, they’ll become less anxiety provoking * With the consequence that compulsive behaviour is not required to reduce high levels of anxiety

Answer 285

Exposure and response prevention therapy (ERPT)

Answer 286

The compulsions found in OCD

Answer 287

* Exposes clients to objects/situations that cause anxiety * Requires the client to resist performing the compulsive behaviour * The therapist helps the person develop ways in which they can resist performing the compulsive behaviours

Answer 288

* Informing clients about exposure + response prevention, and what therapy involves * Using exposure hierarchy - starting with mildly anxiety raising situations + goes to the highest level of anxiety * Repeated exposure to situations that cause high anxiety, until anxiety reduces * Getting the client to resist from performing the compulsive behaviour

Answer 289

Practice exposing themselves to feared situations + reframing from the compulsive behaviour

Answer 290

* After ERPT, clients showed between 55% and 75% improvement | * The improvement lasts for 5 to 6 years

Answer 291

* Supported by evidence which shows that it’s effective in reducing the symptoms of OCD * Doesn’t have any side-effects * Has lower relapse rates than medication * Ethical form of treatment - patients are empowered as they are taught techniques which they can use on their own

Answer 292

CBT empowers a patient - implying that they are less controlled by others in society

Answer 293

* CBT is endorsed by the National Institute for health and clinical excellence * So, it’s effective in reducing symptoms of OCD

Answer 294

* Limited treatment which should ideally be used in combination with other forms of therapy * Difficult to disentangle which of the benefits from CBT are due to the cognitive or behavioural component * Individual differences means that therapy needs to be tailored to the needs of the particular person - can be ineffective * ERPT wouldn’t be effective for clients that don’t have compulsions

Answer 295

* Found that up to 44% of clients only suffer from obsessions * Up to 75% had co-morbid depression, which lessons effects of ERPT * So, ERPT may not be effective

Answer 296

Recurrence of their disorder/disease

Answer 297

* Both useful and effective as treatment for OCD | * Both have supporting evidence to show treatment is effective - drug treatment = Soomro (2007), CBT = NICE (2006)

Answer 298

* CBT more ethical - it empowers patients as they’re taught techniques which they can use on their own + has lower relapse rate * Individual differences * Drug treatment with CBT combined as effective - POTS (2004)

Answer 299

Compare 3 treatments to see which is most effective in treating young people w/ OCD: •CBT on its own •An SSRI (sertraline) on its own •CBT + sertraline combined

Answer 300

* Volunteer sample * All diagnosed using DSM-IV * Study ran across 3 centres in the USA

Answer 301

* 112 participants * All American * 92% white * Aged 7-17 years - average age of 11

Answer 302

* A standardised test - the Children’s Yale-Brown Obsessive Compulsive Scale * Only those with a score of 16 or above on the scale were included

Answer 303

* Children who were comorbid w/ other disorders (e.g. Tourette’s) * This would avoid interaction effects - to control confounding variables

Answer 304

To ensure that their ADHD wouldn’t affect the treatment for OCD

Answer 305

* To ensure that any in the Ps was due to the treatments offered in the study * Controlling confounding variables

Answer 306

* Drugs only * Placebo pill only * CBT only * CBT + drug treatment

Answer 307

Randomly, using a computerised system

Answer 308

* They were interviewed | * The baseline measure was taken using the CY-BOCS using independent evaluators

Answer 309

* To monitor their progress | * To provide them with support

Answer 310

* Children attended weekly sessions for 6 weeks, then attended every other week (9 sessions in total) * Dose established +changed during sessions * Parents would monitor that children took their medication + kept a medication diary * Any adverse reactions would result in the medication being changed or stopped

Answer 311

14 clinical sessions over the 12 week period

Answer 312

* Psychological training * Cognitive training * Mapping OCD target symptoms * Exposure + response ritual prevention

Answer 313

* Goal setting * Review of the previous week * Therapist assistant practice * Homework * Monitoring

Answer 314

* Drugs and CBT in conjunction | * Sessions were time linked and provided simultaneously

Answer 315

At baseline, 4 weeks, 8 weeks, 12 weeks

Answer 316

Independent evaluators trained to a reliable standard

Answer 317

* Evaluators carefully trained | * Evaluation process was strictly supervised + reviewed

Answer 318

97 out of 112

Answer 319

Children’s Yale-Brown obsessive compulsive scale

Answer 320

* Looked at how much the participants improved on the CY-BOCS over the 12 week period * Gathered quantitative data

Answer 321

Where the person has no signs + symptoms of the disorder

Answer 322

A drop below 10 on the CY-BOCS

Answer 323

* All conditions showed improvement at 12 weeks as measured on CY-BOCS, but placebo improvement wasn’t significant * In CBT alone condition, 39.3% entered remission, compared to 21.4% in the drugs alone condition * Combination treatment (drugs + CBT) was most effective in reducing symptoms

Answer 324

* CBT lead to more improvements than drugs - so, should be the 1st line of treatment * Drugs may compensate for less effective therapy, but minimal gain if CBT is effective * Drugs require careful monitoring, as SSRI’s are linked to suicidal ideation in young people * But, drug treatment was well tolerated * Early intervention effective for children and young people with OCD

Answer 325

* Large sample - 112 children + low dropout rate * Representative of target population - young people w/ OCD * Analysis of sample showed there was no difference in groups - so, any difference in group would be down to the IV

Answer 326

* Excluded children who were co-morbid * Not generalisable to adults - Ps only aged 7-17 years * Conducted in USA - may not be generalisable to non-western societies - as, other societies may respond differently to CBT and other medication

Answer 327

* The evaluators who assessed the children symptoms had been trained to a reliable standard * The scale used to assess their symptoms was a standardised measure * All participating centres (3) used the CBT manual in order to maintain consistency in treatment

Answer 328

* This study was conducted over 3 centres, but 1 centre had better results on the CBT only condition * This may be due to the therapist effect, as 1 therapist may have been more proficient at CBT than the others

Answer 329

* Provides strong evidence about the most effective treatment for OCD in children + young people * Shows value of clinical treatments - cause + effect * Show usefulness of psychological therapies * SSRI’s can lead to suicidal ideation in some individuals which needs to be taken into account * Findings have shown effectiveness of CBT + sertraline combined - but individual differences mean therapies need to be tailored to the person

Answer 330

* Study conducted over a long period of time - 12 weeks | * Studying people in their real life

Answer 331

* The assessment scale (CY-BOCS) had been validated as an accurate measurement of OCD symptoms * Ps randomly allocated into conditions - can infer cause-and-effect * The assessors were blind to the condition that the Ps were in - so, they couldn’t be biased in the evaluation of improvements * Ps in placebo condition were unaware that the drug wasn’t active, as was the therapist - this controlled for demand characteristics

Answer 332

* All Ps + 1 of their parents gave full written consent * Volunteer sample - Ps wanted to do the study * Each participant was assigned psychiatrist to monitor and support them * Those in the drug treatment condition were regularly checked + dosages changed as necessary - protecting them from harm

Answer 333

* Use of deception in placebo condition * But, this was necessary in order to ensure validity of the study * Everyone in placebo condition was offered therapy on completion of the study

Answer 334

* Could have problems with attrition - but, there is actually a low dropout rate * Training of assesses to a reliable standard is costly and time-consuming * Longitudinal study - carried out over 12 weeks = time-consuming + expensive * There are difficulties in recruiting Ps w/ similar symptoms of OCD - but when tested, all groups are homogeneous * Volunteer sample - Ps may be more motivated, so CBT results may be better than in the general population + didn’t have co-morbid Ps, so don’t know how effective for children with multiple issues

Answer 335

* Less reductionist as it looks a different treatments to explain OCD - cognitive, behavioural + medication * So, more holistic * But, it ignore social + environmental factors

Answer 336

* Comparison of explanations + treatment for OCD * CBT assumes faulty thinking * Drug treatment assumes faulty brain functioning * The study took account of different explanations

Answer 337

* Drug treatment is objective - controls (e.g. evaluators + ADHD medication) - controlled confounding variables * The children’s version of the Yale-Brown obsessive compulsion scale is standardised to give quantitative data that is objective - therefore, it’s scientific

Answer 338

* OCD occurs in most cultures, but POTS study can only be applied to children in the USA * E.g. children were 92% white * So, lacks cultural variety

Answer 339

* OCD is distressing for the sufferer, so change may be in their best interest * However, drug treatment may be criticised for trying to correct someone’s behaviour to go along with social norms

Answer 340

* POTS gives treatment for OCD that’s effective * This helps patients that suffer * Leading to the relief of symptoms + helped them lead relatively normal lives

Answer 341

* Mental health is a sensitive issue * Issues of abnormality - once labelled, it’s hard to get rid of that label * From POTS - CBT is the 1st treatment that should be used + its socially acceptable

Answer 342

* Practice changed as a result of POTS study * Before 2004, CBT wasn’t routinely used for children - but, this study has helped change this * So that CBT is now the 1st line of treatment that OCD, + shows that CBT and drug treatment are very effective in combination * So, we are using less drastic measures like drugs with side-effects or brain surgery to help relieve OCD

Answer 343

Study the usefulness of psycho education within group work for offender patients in a high security forensic hospital setting

Answer 344

* 42 males * Detained in Broadmoor high security hospital * Most received a diagnosis of schizophrenia * They were part of a program that aimed at helping them understand and cope with their illness

Answer 345

* Participants interviewed using a semistructured interview technique * This was to understand their experience better + get info as to how the group could be improved in the future * Group run for 20 sessions over a 3-year period * Psycho education program considered symptoms, treatment options and coping mechanisms * Then, a content analysis was conducted on the data gathered to pick out key themes in the responses

Answer 346

* What participants valued + why * What was helpful about the group * Clinical implications * What was difficult/unhelpful about the group

Answer 347

* Patients valued knowing and understanding their illness * Group sessions allowed them to understand their symptoms + how other peoples experiences were similar * Increased confidence in dealing with illness, making them more positive about the future * Patients valued the group + would recommend it

Answer 348

* There were positive + negative changes in measures taken after psycho education group * Qualitative data showed how Ps valued knowledge about their illness which gave them power * So, semi-structured interviews are useful in gathering detailed rich data which can be used to inform future practice

Answer 349

* Ps very severe + had complex needs * This is shown as they were in a high security institution * So, can’t generalise the findings to another population

Answer 350

* Semi structured interviews used - so, questionnaires are not standardised * E.g. some questions weren’t standardised * So, difficult to replicate

Answer 351

* Some questions were standardised- e.g. pre-post test scores * Researchers recorded their interviews to allow them to play back + check accuracy of data * So, they can also get other researchers to check the data, which increases interrater reliability

Answer 352

* Data can inform future practice | * Results showed that Ps did benefit from psycho educational program, as valued knowledge about illness

Answer 353

* Semi structured interviews allowed more detailed data to be gained from patients * Info from patients interviews allowed them to fully express their own point of view, helping the researchers to understand their perspective more clearly

Answer 354

* Ps allowed to withdraw from the study/request for their data not be included * Ps gave consent

Answer 355

* Ps still vulnerable + not easy for them to refuse consent/withdraw from study * Given confinement

Answer 356

* Different insight into their illness * So, may respond differently to the programme from each other * Usefulness of programme may not apply to everyone

Answer 357

* Observing or analysing something | * Then, drawing a set of principles from it or a model of how things might be from the data

Answer 358

* Researcher specifies themes they’ll search for * Going from a theory to predict what might happen * Using the data to test against the theory * Starts with a hypothesis

Answer 359

* A way of analysing qualitative data * Finding theory from the data, the theory is grounded in the data * This theory is analysed using the inductive method

Answer 360

* Retain the richness of the data * Produce coding that captures those meaning in a manageable form * Show new ways of understanding behaviour, including shared meanings between people

Answer 361

* Coding is done * Codes collected into concepts, which groups data together * Concepts grouped into similarities and differences, theory starts to develop * Theory comes from collecting the categories together, it’s about forming a model that can explain the data

Answer 362

* Rich + detailed data collected - showing new ways of understanding behaviours * Able to develop a theory to explain the data - uses specific terms to explain how it’s done and is explicit in its guidance * Theory should have high validity - as, evidence is integrated into the theory

Answer 363

•Low validity - if the data gathered to develop the theory was problematic •Time-consuming to gather + analyse data •Theory may be based on a subjective opinion - researchers may be biased in the way they interpret data •Researchers may force data to support the theory - so, may miss crucial evidence that contradicts the concepts they believe - as, they selectively sampling data as a theory begins to emerge

Answer 364

* Flexible way of analysing qualitative data + doesn’t always need a theory to drive the analysis * Maintains richness in data + summarising a large amount of qualitative data in a manageable way * Allows insight into data which isn’t always anticipated by the researcher + yield more detailed and meaningful info than quantitative data

Answer 365

* Hard to find themes in data that aren’t driven by the questions asked by the researcher in the interview * Unscientific - themes are highly dependent on the subjective opinion of the researcher - so, can lead to researcher bias

Answer 366

* Familiarise with data * Generate codes * Look for themes in codes * Review the themes * Define + name the themes * Produce the report

Answer 367

* The use of longitudinal methods * The use of cross-sectional methods * The use of cross-cultural methods * The use of meta-analysis * The use of primary and secondary data

Answer 368

* Investigate impact of different treatment methods | * Find out how disorders progress in patients

Answer 369

* Takes place over a long period * Involves comparing a sample group with their own performance overtime * So, developmental changes can be seen through patterns of measurement

Answer 370

Psychologists to see if there is any reduction in the symptoms to help them to assess how effective the treatment is

Answer 371

How the symptoms present themselves over a time period at certain intervals

Answer 372

* Compared the use of CBT with the use of sertraline in children with OCD * Study lasted for 12 weeks, patients assessed at weeks: 4, 8 and 12 * Showed change and development in OCD symptoms overtime

Answer 373

* Compare that CBT vs befriending for schizophrenia * Treatment lasted 9 months + patients assessed 9 months after treatment ended * Found that CBT is effective in treating negative and positive symptoms in schizophrenia that are resistant to drugs

Answer 374

* A 6 week study that compared placebo, 4 new drugs + haloperidol * Found that haloperidol was better than placebo in improving positive + negative symptoms of schizophrenia * So, study showed change + development in schizophrenia

Answer 375

* High validity - participant variables are controlled for - as, same Ps used * High reliability - reliable way to measure the effect of time on behaviour - enabling clinicians to evaluate the effectiveness of treatments in terms of improving the quality of a patient’s life

Answer 376

* Low validity- Ps may drop out, reducing the sample size * May be factors which affect individuals development, making it hard to draw conclusions * Take a long time + can be expensive * By the time data can be used to draw conclusions in the study, the data may be irrelevant

Answer 377

* Useful when researchers want to take a quick snapshot of behaviour in a given population in a set period of time * Uses a large sample * Conclusions are drawn from the data gathered

Answer 378

* The aim was to compare auditory hallucinations in the USA, India and Ghana * It was an interview based study

Answer 379

* Data gathered quickly - so, conclusion can be drawn + acted on more rapidly * High validity - results more likely to be valid, as they will be reported at the same time when they have most application * Can be economical - as, it requires less commitment in terms of time from a researcher compared to the longitudinal design

Answer 380

* Not good for finding out the cause of something like a mental disorder as they’re descriptive research * There might be a cohort effect - as, the study looks at different people at the same moment in time + those people will belong to a different cohort * They’re unlikely to include any historical info about a patient, or info about the future - this is because they’re a snapshot

Answer 381

The difference in social and cultural groups that change with age and time

Answer 382

The way a group of people share their decisions + behaviour, such as sharing norms in society

Answer 383

* Carried out by researchers who want to compare some behaviour or attitudes in different cultures - similarities + differences * Universality can be studied - if a result is found in many different cultures, then it may be in our nature

Answer 384

* It identifies elements of abnormal behaviour that can be attributed to biological factors * They aid clinicians understanding of the cultural factors they should consider when diagnosing + treating patients from different cultural groups * Allows researcher to gain an understanding of how culture plays a role in the validity and reliability of diagnosis in clinical psychology

Answer 385

* In conducting research across cultures, there is likely to be a conflict between the cultures * So, conclusions drawn may lack validity if the interpretation of the patient’s behaviour doesn’t consider their cultural background

Answer 386

* Found that Ps in the USA were more likely to report negative commands * Whereas, patients from India + Ghana were more likely to report rich relationships with their voices

Answer 387

* Using the findings of different studies - secondary data * Findings are analysed * Focuses on effect sizes

Answer 388

To find out about the effectiveness of therapies and treatments across different patient groups

Answer 389

* Conclusions drawn from a huge sample and different areas * Results can be generalised to a larger population due to the large sample * More data used - so, there is likely to be more precision in the analysis * Quick and cost-effective * Research generally focuses on using peer-reviewed publications - so, data has been scrutinised

Answer 390

* Researchers don’t gather data directly - so, may be on identified issues of reliability + validity in the methods of data gathering * Low validity due to publication bias * E.g. research that produce null effects may not be published + therefore would be ignored by meta analysis

Answer 391

* Used meta analysis in combining the results are various neurotransmitters studies * To investigate the role of neurotransmitters including dopamine, serotonin and glutamate in schizophrenia

Answer 392

Gathered first-hand from source directly by researcher

Answer 393

Data already gathered by others to use for future research

Answer 394

Gathered primary data from first-hand observations

Answer 395

Used data from one of the group sessions, which were primary data

Answer 396

* The use of meta analysis/secondary data for neurotransmitter functioning * E.g. studies w/ rodents, studies that used brain scans, studies on people w/ acute schizophrenia + people w/ schizophrenia in remission

Answer 397

* Used secondary data for their twin studies | * E.g. hospital notes

Answer 398

* More credible than secondary data - as, they’re gathered for the purpose with chosen research method, design etc * Operationalisation is done with research in mind, so there’s likely to be validity with regard to the aim

Answer 399

* Cheap - as, data is already collected * Can be large quantities of data, so there might be detail * Can be from different sources - so, there is a possibility of comparing data to check for reliability + validity

Answer 400

* Expensive - as, data gathered from the start | * Limited to time, place and number of participants

Answer 401

* When analysed originally, there may have been subjectivity * Likely to be gathered to suit another aim, so may not be valid for the study * May have been gathered some time before, so not in a relevant time period

Answer 402

* Studying individuals or small groups with a unique characteristic or experience * Often evidence gathered will be qualitative, allowing an in-depth analysis of the group * Researchers triangulate the data to draw conclusions

Answer 403

* Case studies may be of people with rare symptoms or individual taking part in a specific therapy * A full understanding of the patient’s problems can be assessed + all the factors that may have an affect on them can be taken into account

Answer 404

* Investigate how CBT can be used to treat a woman with schizophrenia * An attempt to use psychotherapy to treat schizophrenia where drug treatment had previous been preferred

Answer 405

* Carol had 3 years of CBT + follows up her progress 6 months and a year after therapy * Carol symptoms were measured on 4 scales: roll functioning scale (RFS), goal attainment scale (GAS), hospitalisation, global pathology index (GPI) * Carol had three stages of treatment

Answer 406

* Development of rapport - honest + trusting communication * CBT sessions lasted for 15mins to 1hour * Carol + therapist often went for a walk * They shared their love of baseball

Answer 407

* Understanding CBT - took 2months * Carol was educated in CBT, schizophrenia and treatment * The focus was on improving ways of coping with stress * The ABC model (Ellis, 1957) was used

Answer 408

* 1st year - focus on managing anxiety + therapy was on faulty attributions * A weekly activity schedule gave her structure after leaving the hospital - Carol recited what she did during the day to help therapist recognise signs of stress * Middle phase - 16months of building more strategies to cope with stressful situations - e.g. the use of a ‘stress thermometer’ + the use of meditation * End phase - 3months - Carol developed plants to maintain the treatment without therapist - e.g. she wrote cue cards w/ coping strategies

Answer 409

* Carol improved in psychosocial functioning, achievement of goals, reduction of symptoms, little distress + never re-hospitalised * After 1 year - RFS was stable at 27, whereas at the start she scored 6 * At end of study - GPI score of 1 indicated that there were few symptoms present * GAS increased from 19.85 to 80.15 - shows that treatment goals had been attained - goals were: starting a college course, taking a volunteer job + going out once a week w/ friends

Answer 410

* Improved in Carols functioning in all 4 measures after a 3 year course of CBT - so, CBT can be successful in treating schizophrenia * Bradshaw + Roseborough (2004) carried out a meta-analysis of case studies of 22 patients - they suggested that 86% improved their psychosocial functioning + 82% had reduced severity of symptoms - this supports CBT as an effective treatment for Schizophrenia

Answer 411

* Unusual case - Carol is much younger than most females with schizophrenia, comes from a supportive background + has no family history of mental illness * She is female + the disorder presents differently in males * Her type of schizophrenia (undifferentiated type) isn’t the only type of schizophrenia - CBT may not be affective with other types

Answer 412

* Many details of the study are hard to replicate * E.g. the rapport between Carol + her therapist * Case study - can’t replicate the study in the exact same way

Answer 413

* CBT follows standard procedure by Aaron Beck * The measures used (e.g. GAS, GPI, RFS) are well established tools by psychiatrists * Carols symptoms were checked against DSM-IV * The same measures used at start of study, 3x during therapy + 2x afterwards = test- retest reliability

Answer 414

* Promotes the use of CBT to help treat patients with schizophrenia * So, clients lower their dependency on antipsychotic drugs (biological treatment/side-effects/compliance) * But, treatment of CBT is only available to 10% of sufferers in the UK

Answer 415

* Real patient receiving real treatment was used | * E.g. CBT and coping methods

Answer 416

* Supported by other case studies in the meta analysis - Bradshaw + Roseborough (2004) * 86% improved psychosocial functioning and 82% had to reduce symptoms

Answer 417

* Use of scales to accurately measure her progress increases internal validity - e.g. GAS, GPI, RFS * Gained quantitative data - e.g. her scores on RFS, GPI and GAS * Gained qualitative data -e.g. her walks, volunteer job, change in self-esteem + view of herself with someone in the future * Real changes are seen over a period of 4 years

Answer 418

* All the clients were taking antipsychotic medication alongside CBT * So, this could be the real reason there was improvement in the study which supported the case study of Carol

Answer 419

* Bradshaw respected the young woman’s dignity + privacy by concealing her real identity + using the pseudonym ‘Carol’ instead * At the end of study, Carol was much healthier + could give full informed consent for her data to be used * Her therapist developed rapport by being genuine + having empathy * CBT helped her live a less stressful life as improvement was still in evidence a year after therapy * Carol was empowered - using a stress thermometer + a pat on the back technique - allowed her to feel in control of her treatment

Answer 420

* There are issues of consent * As, Carol was in too bad a state at the start of study to consent to share details of her progress with the researcher * So, consent was obtained from family and therapist instead

Answer 421

•She was a good student, shy but with several friends •But, when she started to experience hallucinations, she withdrew from people + acted in a bizarre manner •She was hospitalised + diagnosed with undifferentiated type schizophrenia using the DSM-IV

Answer 422

* It helps to maintain standards within that area of research * It can attract funding

Answer 423

* The actual findings may not be relevant by the time it’s published * There are practical issues - peer review can involve many amendments, so may be costly + take a long time * Some research is never published - as, research with null findings isn’t published - there is a publication bias for positive outcomes, leading to a distorted view of a subject area