Clinical Psychology Flashcards
What was Rosenham’s aim?
- to test the reliability of mental health diagnosis, to see if medical professionals could tell the sane from the insane in a clinical setting.
- also investigate the affects of labelling on medical diagnosis
What was the IV and DV in Rosenhans study?
- was an observation not an experiment so no IV or DV
What is the sample for Rosenhan?
- 8 psuedopatients
- 12 psychiatric hospitals in the US
- some had good staff to patient ratios others were quite understaffed
- only one was a private hospital
Explain the procedure of Rosenhan?
- pseudo’s reported hearing voices to a clinician
- Rosenhan approached head of hospital and informed them of the deception. Staff did not know
- Rosenhan briefed lawyers to get pseudo patients out if anything went wrong
- when admitted they started acting normally and stopped reporting hearing voices.
- had notebook and pen to note down what they heard and saw
- secretly disposed of medication, otherwise polite and did every thing asked of them
What were Rosenhan’s structured interviews?
- record was kept of how many patients voiced suspicions about pseudo’s in there hospitals and how much time the staff spent on ward interacting with patients
- in four hospitals patients approached staff with scripted questions, staff answer and body language was recorded.
Rosenhan’s results?
- all 12 hospitals diagnosed the pseudo’s as mentally ill.
- 11 hospitals diagnosed schizophrenia, 1 (the private one) diagnosed manic- depression (bipolar)
- no staff recognised they were healthy
- between 7-52 days for pseudo patients to be discharged, mean was 19 days
- discharged with the diagnosis schizophrenia is remission in 7 cases, 1 was diagnosed with schizophrenia on their medical record.
What did the psuedo’s observe in the hospitals?
- staff abusing patient, being physically and verbally abused. Awakened by shouting ‘ Come on you motherfuckers get out of bed’ and one was beaten for saying ‘I like you’ to an attendant.
- patients refusing medication
- depersonalisations and powerlessness. No doors on toilets and staff would inspect their medical record and personal belongings without asking for permission.
- staff would make eye contact with patients, would discuss them in earshot.
- would abuse them when other patients were watching but not when doctors were present.
Conclusions of Rosenhan?
- cannot distinguish between sane and the insane
- private hospital diagnosed with manic depression the only different diagnosis. This is easier to treat. Wealthier people are more likely to be diagnosed with milder problems that have better therapeutic outcomes, background affects diagnosis.
- tendency toward false positives (type 1 errors) in normal diagnosis but false negative (type 2 errors) when stakes are high, ie the hospital knows its diagnosis is assessed.
- conditions in psychiatric hospitals can worsen patients
- conditions are psychologically mortifying and make healthy behaviour and healthy thoughts difficult
What are the four D’s?
- dysfunction
- distress
- danger
- deviance
What is dysfunction?
- when abnormal behaviour is significantly interfering with everyday tasks and living your life. Considered abnormal is they are unable to cope with demands of everyday life- looking after yourself- holding down a job, maintaining relationships with friends and family and making yourself understood etc.
What is distress?
- abnormality involves being unhappy; experience negative feelings like anxiety, isolation, confusion and fear. Abnormality is when these feelings occur inappropriately or persist for longer than they should/
What is danger?
- when behaviour harms or puts at risk the individual or others around them. Based on the harm principle which states that you have a right to behave in any way you like so long as you don’t cause harm. Abnormality puts yourself or others at excessive risk/
What is deviance?
- these are behaviours and emotions that are views as unacceptable
Why are the 4 D’s used?
- as an assessment tool to decide whether behaviour is abnormal. Abnormality may require investigation and diagnosis.
Statistically what is considered normal?
-normal people are wishing 1SD of the mean.
what is a social norm?
- an unwritten rule about acceptable behaviour. Behaviours and attitudes that people stick to in a society. Can differ from culture to culture and from time period to time period.
What are diagnostic systems used for?
- to diagnose people with mental illnesses
What is DSM-IVR?
- one of the main classification systems for mental health. Provides criteria from which a mental disorder can be diagnosed. Used around the world. 250 disorders included.
How is the DSM-IVR organised?
- axial system
What is meant by the term multi-axial?
- each diagnosis is split into five levels called axes that relate to different aspects of the disorder. Each level is part of the diagnosis.
Name each axis 1 on the DSM-IVR?
- Axis 1: clinical disorders, major mental disorders, developmental disorders and learning disorders.
Name each axis 2 on the DSM-IVR?
- underlying personality conditions, mental retardation
Name each axis 3 on the DSM-IVR?
- physical conditions, general medical conditions
Name each axis 4 on the DSM-IVR?
- psychosocial and environmental factors
Name each axis 5 on the DSM-IVR?
- global functioning
What is ICD-10?
- international classification or diseases
How is ICD-10 organised?
- by codes, each disorder has a code starting with F, for example F20 is schizophrenia
- disorders are listed consecutively and there are 11 sections
- sub categories are further differentiated
- there are left over codes for new disorders to be added
How are patients diagnosed using the ICD-10 system?
-0 clinicians select key words from the interview such as: hallucinations, delusions, incoherent speech, lack of emotion
- the clinical looks up these symptoms in alphabetic index or may go straight to the obvious sections
- clinician uses other symptoms to locate a subcategory
Advantages of DSM and ICD?
- universal so allowed clinicians to communicate about their patients, report, record and monitor mental illness.
- eg schizo in England means the same as Schizo in France
- uniformity
Disadvantage of DSM or ICD?
- Oversimplifies human behaviour
How do you evaluate diagnostic systems?
- validity: are diagnosis correct?
- reliability: do psychiatrists agree?
- cultural issues: cultural and gender bias?
Name 7 HCPC guidelines?
- character
- health
- conduct, performance and ethics
- continuing professional development
- education and training
- prescribing
- proficiency
What is clinical psychology?
- study of mental health disorders. Assessment and diagnosis of people with MHD’s
what is the classic study in clinical?
- Rosenhan
What is double bind theory?
Contradictory signals given by the primary care giver, usually lead to internal conflict.
What is high EE?
- High expressed emotion.
- increases the stress levels of the patient beyond their coping mechanisms
What percentage of the population are resistant to the benefits of drug therapy for SZ?
30%
Why do we have family intervention therapy?
Because patients are more likely to relapse if they come from families where they experience high levels of criticism, hostility and over involvement
Where does family therapy take place?
Usually within the people’s home
What is the minimum number of family intervention sessions recommended by NICE
10
How does Family intervention therapy work
- therapists work with the family and patient to develop strategies to cope better with the mental disorder and its symptoms
- relatives are made aware of information regarding psychosis and the particular diagnosis their relative has been given
- relatives encouraged to ask questions
- patient also asked to discuss their symptoms
- provide family with practical coping skills
- learn more constructive ways of communicating
- trained to recognises the early signs of relapse so they can respond rapidly to reduce the severity of it
What did Hogarty do?
Looked at 103 patients who lived in high EE households, and compared relapse rates of those reviewing family intervention compared to medication.
What did Hogarty find?
- at a 2 year follow up 25% of those receiving FI had relapsed compared to 62% on medication only.
What does the genetic hypothesis state?
That the more closely related a family member is to a relative with SZ the greater their chance in developing SZ.
How is the C4 gene linked to SZ?
- an over active C4 gene seems to attack the brain, mistaking it for an infection.
- this can result in over pruning of neural pathways, synaptic pruning, leading to disorder thoughts.
What was Gottesmans aim?
To find out if there is a genetic basis for SC. Look for concordance rates in MZ and DZ twins.
What was Gottesmans procedure?
- independent groups design
- naturalistic
- 62 SZ patients half male half female
- age 19-64
- all been at a large London hospital and all had a twin
- 24 MZ and 33 DZ
- mental health of the twin was tested using things like hospital notes, questionnaires and semi structured interviews, personality testing and psychometric testing.
What were Gottesmans conclusion?
- The MZ concordance rate was a lot lower than 100%, 21% of MZ twins with a SZ brother or sister.
- suggests that genetics are not the only cause of SZ
What were Heston results?
- 10.6% of ppts with SZ mothers also developed SZ compared to 0% whose mothers did not have SZ.
What did Heston conclude?
Support the influence of genes of SZ
What kind of study was Heston?
- adoption study
What is the dopamine hypothesis?
States that hyperactive dopamine transmission reluctance in schizophrenic symptoms.
Who came up with the dopamine hypothesis?
Carlson
Name two reasons for too much dopamine in the brain?
- lack of the enzyme that breaks down the leftover dopamine in the synaptic gap.
- dendrite has more receptors than normal, so higher levels of dopamine are absorbed into the brain
What is too much dopamine in the Mesolimbic pathway responsible for?
Positive symptoms
What is too much dopamine in the mesocortical pathway responsible for?
Negative symptoms
What does L-dopa do?
- used to treat Parkinson’s
- boosts domaine levels in the brain
Carlson found that when given to humans it reduced Parkinson’s symptoms but gave them psychotic symptoms that were similar to SZ
What was Carlsson et al aim?
To present the current view of the relationship between SZ and dopamine dysfunction
What kind of study was Carlsson et al?
- literature review of 33 studies
What did Carlsson find?
- it’s unlikely that dopamine is the only neurotransmitter in the brain associated with SZ. Focused on glutamate
- low glutamate may cause an increase or decrease of dopamine
- dopamine and glutamate pathways interact and affect the striatum
- people with different symptom sets would be treated with different drugs
What did Carlsson conclude?
- more attention should be focused on other neurotransmitters and other pathways in the brain
What was Lavarenne’s aim?
To see how a group can provide a firm boundary within which individuals can explore their own fragile ego boundaries
What was Lavarenne’s procedure?
- met regularly and consisted of ten members usually
- all had vulnerability to psychosis
- coding system had been developed whereby the therapist recorded the emotions expressed
- verbal contents were also coded
- the session that was documented was the last one before Christmas, which meant that the group would be having a break from their usual meetings.
What did Lavarenne find?
- Earls rejection of the gift may have shown his fear of self-disintegration. He showed an attempt to identify boundries between Earls self and the selves of others.
- Dan expressed that he was scared he would not be able to get his spirit back in his body, this may be related to the fact that he is currently coping with demands from his girlfriend to clearly define the boundaries between them in their relationship.
What did Lavarenne conclude?
- all group members were working hard to hold themselves together
- interactions with others threaten their fragile boundaries
- they cut off from human relations
- drive themselves more into an inner world of isolation
- an impressive amount of tolerance, acceptance and containment form group members
What is the HSERT gene?
Codes for proteins that transport serotonin
What is wrong with a abnormal HSERT gene?
- causes the transporter to act too quickly and take up the serotonin before it has a chance to transmit its message to the next neuron. Meaning their is not enough left at the synapse resulting in OCD symptoms.
What is the prevalence of ocd in the random population?
1.2
What is the orbifrontal cortex
A region responsible for decision making, converting sensory information into thoughts, noticing when somethings wrong and alerting the brain to any potential worries or panics in the environment.
What’s the bio chemical theory of OCDA
That suffers have over activity in the orbifrontal cortex
Explain how OCD and classical conditions are linked?
- a connection is made between the object and the fear
- the NS then becomes paired with the experience and starts to produce the anxiety all by itself
Explain OCD in terms of operant conditioning?
- the person sees that the anxiety is reduced by avoiding the stimulus and so develop elaborate strategies to help with the avoidance of the behaviour (compulsion)
- this avoidance in negatively reinforced
How do antidepressants work?
- they raise serotonin levels by blocking its re uptake from the synapse back into the releasing neuron. This makes it available for longer.
What were the side effects of drugs?
- dizziness
- fatigue
- suicidal thoughts
Which is more effective Typical or Atypical antipsychotics?
- atypical
How does a dopamine antagonist work?
- binds to but does not stimulate the dopamine D2 receptors, blocking their action so that no signal goes through to the post-synaptic cell.
Which symptoms are drugs effective for in SZ?
Positive symptoms
