Clinical Psychology Flashcards

Question

What are 2 strengths of rosenhans study?

Answer 1

Standardised words of “empty, hollow, thud” mean each hospital admission is reliable and consistent Quantitative data of % of being ignored or number of pills taken recorded which can objectively be analysed so more accurate

Answer 2

Low in generalisability, only used hospitals in USA not representative of hospitals in rest of world Low in controls as it is natural hospital setting so extraneous variables like nurses own expectations of mental illnesses so less accurate

Answer 3

Cluster analysis where groups or clusters of symptoms are identified and labelled

Answer 4

Section 1: introduction and explanation of how to use the manual Section 2: diagnostic criteria and codes with 20 diff categories. Explains what symptoms must be present and others that must be ruled out to diagnose Eg to be diagnosed with schizophrenia must have experienced 2 of symptoms like delusions, hallucinations, negative symptoms or disorganised speech

Answer 5

Ways to evaluate patients like cultural formulation with uses interviews to understand someone’s culture to get accurate diagnosis Has emerging disorders that need more study like internet gaming disorder Uses assessment measure to focus on general mental functioning or severity of disorder to get dimensional approach of disorder.

Answer 6

Rosenhan study found 7 out of 8 pseudo patients diagnosed with schizophrenia showing it can be reliable Brown found using DSM-5 criteria more patients diagnosed with anorexia rather than eating disorder not otherwise specified compared to DSM 4 so more valid and accurate Standardised method of cluster analysis for diagnosing disorders in same way so more reliable and consistent

Answer 7

Cheniaux found when psychiatrists assessed 100 in-patients ICD-10 more likely to diagnose sz than DSM-IV suggesting its not consistent with other classification systems Schwartz found Afro Americans 3-4 more times likely to be diagnosed as psychotic than euro Americans so less accurate as affected by ethnicity Interpretation bias of the psychiatrist when selecting symptoms based on their understanding of cluster analysis based on their training of the Manual so less accurate diagnosis as depends on experience of psychiatrist

Answer 8

External validity: how much disorder can be generalised to patients with same symptoms or causes Internal validity: whether diagnosis is due to symptoms listed and not other factor like gender or culture Concurrent validity: amount research is similar to other research at same time Predictive validity: amount research is similar to other research in past to predict future outcomes Aetiological validity: if sufferer of disorder has same casual factors/symptoms as other people

Answer 9

External reliability: how much diagnosis varies each time it’s tested using classification system Internal reliability: how reliable it is compared to itself over time Test-retest reliability: Tested using cohens kappa which says amount of ppl receive the same diagnosis when re-assessed Inter-rate reliability: extent that same diagnosis given by diff psychiatrist for same patient

Answer 10

5. Be aware of impact of culture, equality and diversity on practice 7. Understand importance and Maintain confidentially 13 understand key concepts of knowledge base relevant to profession 14. Draw on knowledge or skills to inform practice

Answer 11

WHO estimated that around 1 in 300 people have sz 50% of those in mental hospitals have sz diagnosis but only 31% receive specialist help

Answer 12

Rena says Males have earlier onset schizophrenia (21-25) compared to women (25-35) Bushe says suicide rates are higher in males than females

Answer 13

Lifetime suicide rates in sz is 10% and is largest contributor to decreased life expectancy in sz patients WHO says sz patients 2 or 3 times more likely to die early than general pop

Answer 14

Hallucinations: auditory or visual experiences which are real to suffer and often negative but can be positive Delusions: Paranoia-someone is against them, delusions of grandeur-they hold power over others, thought insertion-thoughts given to them by someone else Disordered thinking: hard to put thoughts in order and easily distracted known as ‘word salad’ can also make up words

Answer 15

Negative symptoms: something missing from normal behaviour Emotional disturbance: ‘blunting’ which involves reacting inappropriately or not at all emotionally Psychomotor disturbances: Become mute or unmoving or over excited Lack of volition: social withdrawal, not talking to family or friends and lack of motivation for daily tasks

Answer 16

Paranoid: hallucinations, delusions of grandeur or persecution Catatonic: little movement, staying in one position Residual: low positive and high negative symptoms Schizoaffective disorder: patients have episodes of sz but also has features of mood disorders. Undifferentiated: category for anyone who doesn’t meet other categories

Answer 17

Changes to neurotransmitter levels in diff pathways can lead to sz symptoms. Schizophrenia is caused by fluctuation in levels of dopamine in brain.

Answer 18

Associated with rewards and pleasure. More dopamine leads to positive symptoms high dopamine may be caused by low glutamate which causes GABA to stop inhibiting dopamine. This can also cause thalamus to stop filtering sensory info causing hallucinations D2 receptors higher density in sz patients and more sensitive making more dopamine bind to them Excess of serotonin can increase serotonin receptors reducing glutamate and increasing dopamine.

Answer 19

Little dopamine here can lead to negative symptoms Runs through cortex of brain and important for emotion and higher cognitive functioning. Low dopamine in this pathway may be cause by low glutamate which acts as brake causing negative symptoms Blocking D2 receptors in mesocortical lead to lack of sensitivity to dopamine

Answer 20

Carlssons study found ppl given amphetamines had high dopamine in basal ganglia than control=more likley to exhibit sz symptoms Seeman, density of D4 receptors is 6x more in schizophrenics so more sensitive to dopamine and psychotic symptoms Reductionist as simplifies sz to just neurotransmitters so can predict positive and negative symptoms of sz and use drug treatment to intervene.

Answer 21

Depatie & Lal found giving ppl drugs that increased dopamine didn’t create sz symptoms so not only explanation Hickling, stress of urban living made African carribean immigrants in Britain 8 to 10x more likely to experience sz so more to do with environment Ignores other factors like genetics and DRD2 gene or environment so hard to establish cause and affect

Answer 22

Wanted to review relationship between dopamine and sz by looking at other neurotransmitters like GABA, serotonin and glutamate Method was meta analysis of 33 studies. 14 of them done by Carlssons and many involving PET scans and animal research

Answer 23

Dopamine supported: PET scans of when ppl given amphetamines higher dopamine release in basal ganglia than controls and more likely to have positive sz symptoms Dopamine criticised: not all schizophrenics had high dopamine some had normal levels

Answer 24

Acts as both accelerator and brake in different parts of the brain so not just dopamine In meso-limbic if glutamate low then low GABA which means it can’t inhibit dopamine=positive symptoms In the meso-cortical pathway if glutamate levels low, doesn’t accelerate dopamine and levels drop leading to negative symptoms PCP drugs inhibits NMDA receptors (a glutamate receptor) Cause high dopamine levels and sz symptoms NMDA receptors also stimulate 5-HT (serotonin receptors) suggesting serotonin is linked to low glutamate and contributes to negative symptoms in meso-cortical

Answer 25

2 experimental models: excessive dopamine model and inhibited glutamate model Useful for drug therapy as they focus on certain neurotransmitters rather than combination, suggesting drugs may be effective for certain individuals

Answer 26

Carlsson suggested further study of glutamate deficiency to understand sz and serotonin as it and dopamine both contribute to symptoms of sz

Answer 27

PET scans of peoples brains on amphetamines which are objective as we can see which neurotransmitters activate in different pathways Reductionist as only focuses on neurotransmitters like glutamate as cause of sz so can use to predict symptoms of sz Secondary data used which allows for in depth understanding of how neurotransmitters affect symptoms of sz so more holistic view

Answer 28

Restricted sample of animals used in some of collected studies- less generalisable data to humans about sz Interpretation bias of PET scans and levels of neurotransmitters so results less valid Used meta analysis and 14 of Carlssons own studies so may be researcher bias in what studies are picked to support the hypothesis so lower val results

Answer 29

Schizophrenia inherited from parents- variation of genes increases risk of sz Schizophrenic runs in families if one of parents has sz inheritance chance 1 in 5 If both have it it’s 1 in 3

Answer 30

DRD2 gene codes for D2 receptors and involved in the reinforcement and reward system D2 receptor activity is associated with the production positive symptoms in schizophrenics as it affects cognitive dysfunction.

Answer 31

Gives instructions to make enzymes that are used to breakdown neurotransmitters The MB-COMT enzyme mostly in the prefrontal cortex, problems with its production can both increase, and decrease dopamine. Located on chromosome 22 and people with a defect in this gene are 30x more likely to develop schizophrenia.

Answer 32

People are born vulnerable to developing schizophrenia due to genetics but need to be raised in a stressful environment for it to trigger.

Answer 33

Gottesman found for severe sz concordance rate for MZ twins was 75% but 24% for DZ twins showing genetics involved in sz Virgos found significant difference in frequency of DRD2 gene in sz patients and control suggesting defect in this gene increase sz Reductionist as simplify development of sz into just genetics so can use to predict who will get sz based on their genetics-useful

Answer 34

Hickling found stress of urban living made Afro Caribbean immigrants 8-10x more likely to develop sz so more to do with environment Carlssons study found ppl given amphetamines had high dopamine in basal ganglia than control so more to do with neurotransmitters than genetics Hard to establish causes and effect between genetics and sz as could be factors like environment so less valid explanation of sz

Answer 35

Sz is reaction to social environment. More sz in lower classes/unemployed/deprived areas More likely to be taken to police or social services for treatment of sz in poor stress leading to more long term cases

Answer 36

Unemployment and poverty: more stress could lead to poor working memory and decision making=paranoia Adversity to adult life: childlike state to avoid adult responsibilities=blunting Social isolation: life in urban area lead to negative symptoms=social withdrawal Poor housing/overcrowding: sensory overload and hallucinations/paranoia High crime areas: lead to social withdrawal or taking drugs=paranoia or delusions Separation from parents as child: no one to teach responses lead to emotional disturbances=blunting

Answer 37

Hickling found stress of urban living made Afro Caribbean immigrants 8-10x more likely to develop sz, supports social situation plays a role in sz Veiling found immigrants in isolated neighbourhoods had higher sz rates than mixed neighbourhood communties- where you live affects development of sz Reductionist as focuses simply on social situation as reason for sz so can predict and change housing policy

Answer 38

Gottesman found for severe sz concordance rate for MZ twins was 75% but 24% for DZ twins-suggests genetics has bigger role to play than environment Carlssons study found ppl given amphetamines had high dopamine in basal ganglia than control so more to do with neurotransmitters than social situation Seeman, density of D4 receptors is 6x more in schizophrenics more sensitive to dopamine and psychotic symptoms-more to do with neurotransmitters like dopamine than social situation

Answer 39

Aims to change biochemistry of brain to reduce symptoms of sz Mostly given in tablet form and can be injected but not a cure only manage symptoms They antipsychotic drugs and block receptors and reduce neurotransmitters in brain. Come in typical and atypical form and which one works for a patient found out through trail and error

Answer 40

Reduce dopamine only and treat positive symptoms by being antagonist Work by blocking D2 receptors in post synaptic neuron by stopping dopa from binding to receptors. Blocking D2 reduces dopamine between neurons to normal and reduces positive symptoms

Answer 41

Reduce dopamine and serotonin and treat negative and positive symptoms as they both antagonist and agonists =increase/decrease dopa In Meso-limbic pathway bind to D2 receptors and reduce dopa activity Meso-cortical, stimulate serotonin receptors which are on GABA neurons. This low GABA activates glutamate which changes dopa levels=better cognitive functioning like learning

Answer 42

Hartling did meta analysis of effectiveness of drugs and found typical antipsychotics treat + symptoms and atypical treat negative symptoms showing they’re effective at treating sz Reductionist as give simple treatment only focusing on changing neurotransmitter levels so useful as can predict and apply drugs to people Scientific as you can check levels of neurotransmitter in the brain when testing if drugs treat symptoms

Answer 43

?: 100 to 1 day treatment for sz Rector found CBT and routine care together more effective than other therapies for schizophrenia symptoms Ignores individual differences like environment eg where someone lives so less effective treatment

Answer 44

Identifies stressful situations/emotions leading to faulty cognitions of patient and behaviour techniques to cope with sz symptoms Adapted to meet needs of individual and takes 12/20 sessions in 3 stages

Answer 45

Stage 1: build trust between patient and therapists and that they understand CBT Therapist then listens to their thoughts about their symptoms, they ask questions to understand their vulnerabilities to stress to deal with faulty thoughts and stress triggers Goals for therapy agreed upon which must be attainable for patients and consequences used as motivation

Answer 46

Therapists teaches strategies for stressful situations and benefits of are reviewed in therapy like structuring day into blocks and improving daily living skills Identify tress using stress thermometer to identify early symptoms ABC model used where patients categorise consequences (C) of symptoms and the activating events (A) emphasising connection between A and C then patients false beliefs (B) discussed as actual cause of these events Hallucinations/delusions not directly challenged but seen as reaction to stress and verbally challenge their perceived reality encrouaging patient to collect evidence through activites outside of therapy Develops self esteem by educating person about their sz and trying to de-stigmatise by making them recognises there more than one person with a diagnosis reducing their loneliness

Answer 47

Involves dealing with anxiety about treatment ending and ways to maintain goals oustide therapy Reviews progress and again identifies the early warning signs and stressors and how to deal with them in real world and in emergency situation Gradually reduce sessions over time but if still needed can do booster sessions

Answer 48

Rector found CBT and routine care more effective than any other therapy for sz showing it’s effective in reducing schizophrenic symptoms Standardised procedure of phases all clinicians follow so more reliable way to apply for patients to reduce sz symptom Also Bradshaw found it was effective as reduced days in hospitals from 60 to 1 day

Answer 49

Hartling did meta analysis of effectiveness of anti psychotic drugs and found typical better at reducing + symptoms and atypical better for negative Interpretation bias from researcher as sz patient has to self report beliefs which open to interpretation meaning them challenging them will be less effective Doesn’t treat biologal factors for sz like genetics or neurotransmitters so less useful treatment for sz symptoms

Answer 50

Investigated effectiveness of CBT of long term outpatient care care of women with schizophrenia using a case study

Answer 51

Clinical outcomes like severity of symptoms and hospitalisation were assess periodically over 3 years of treatment and patient followed up one year later CBT sessions master from 15 mins to 1 hour or more depending on condition of client. Therapist could go for walks if carol agitated 4 stages, building rapport, understanding CBT and what is sz treatment and maintenance strategies

Answer 52

Number of days spent in hospital changer from 60 to 1 day after year of treatment Goal attainment increased like starting college course, and volunteer job Concluded CBT useful in treatment of sz and to help with stress management to prevent relapse, can help with treatment of symptoms and problems experienced in recovery

Answer 53

Diff cultures have diff attitudes affecting how mental disorders are diagnosed culture creates bias as diff people will diagnosis differently based on their own belief systems and attitudes of what's normal or abnormal Western cultures see body and mind as separate other cultures don't so is a problem with symptoms like hallucinations. psychiatrists may identify symptoms that aren't there based on their schema of social stereotype rather than behavior abnormality Eating disorders occur overwhelmingly in countries with ad driven mass media and less in cultures with less media showing disorders culture based Issues with translation as patient and psychiatrist may speak diff language which can cause issues when diagnosing as symptoms become misinterpreted.

Answer 54

Both based on medical model that abnormalities treated similar to other health problems which doesn't fit with other cultures who have more spiritual explanation May lead to over-diagnose of schizophrenia amongst males of west Indian/afro Caribbean's than white men Some disorders are culture bound (only in certain cultures) like Pa-Leng (fear of cold) in China or Koro (fear genitals are retracting) also in China or Malaysia. This leads them to show anxiety and depression

Answer 55

Lin found when looking at symptoms of sz there were more similarities across cultures than differences suggesting they would not lead to diff diagnosis. Makes diagnosis of health disorders more reliable ICD and DSM5 now take into culture with annex-2 and cultural formulation so more valid diagnosis using classification systems Racial discrimination less likely to happen in modern classification systems as it collects info on cultural variations so more valid as groups like afro Caribbean's less likely to be over diagnosed with sz

Answer 56

Boogra found Afro Caribbean's 2x as likely to be diagnosed as schizophrenic than white or Asian based on same symptom-less reliable Luhrnman found hearing voices in USA is seen as negative is negative whereas it seen as positive in India so what seen as abnormal diff across cultures and ay not be reported by patient-lower validity Due to new classification systems means diagnosis of disorders not consistent over time=low reliability as diagnosis not consistent regardless of culture

Answer 57

Anorexia is a growing issue in westernised countries where media is prominent in advertising the perfect body which is unachievable instant access to media has been a rise in pro ana websites talking about how little they eat and encouraging others to keep going 1 in 20 of the sufferes die from it, highest rate of all mental health Anorexia is defined as having a BMI of. Less than 17.5 in an adult and being less than 85% normal body weight WHO says men are 25% of AN patients and women in westsern countries 10x more likely to have AN AN is bed king more of an issue for males as media portraying more muscular/thin physique which is more available due to men’s health magazines=excessive exercise

Answer 58

Powers found women with PTSD had higher alcohol and substance abuse as predicted by ICD- had good predictive validity Pihlajamaa found ICD-10 was valid as it produced diagnosis of sz that was consistent with other classification systems Brown found DSM-5 more patients diagnosed with AN rather than eating disorder not otherwise specific suggest it more accurate and valid

Answer 59

Researcher bias in different values of the psychiatrists like western interpretations of disorders so less valid Swartz found Afro Americans more 3-4x more less to be seen as psychotic compared to euro-Americans showing DSM cultural section less accurate and less internal