Clinical Psychology Flashcards
What are the 4 D’s?
Deviance, dysfunction, danger and distress.
Define ‘deviance’ and give an example.
Behaviour and emotions that are not normal in society.
The behaviour/emotions have to deviate from societal norms and are seen as unacceptable in society.
An example would be pedophila, characterized by recurrent fantasies, which symptoms must present significant distress and the individual must be over the age of 16 and 5 years older than their subject of desire.
Define ‘dysfunction’ and give an example.
Abnormal behaviour that leads to an inability to complete daily tasks.
An example would be Major Depressive Disorder; if an individual quits his job and runs from his family, that would be a sign of dysfunction.
Define ‘distress’ and give an example.
The individual’s subjective feelings of pain, anxiety, depression, agitation, disturbance of sleep, etc that accounts for negative feelings of individuals with psychological disorders.
An example would be social anxiety. The individual with this disorder may feel anxious about social gatherings, to the point of having a panic attack which cause distress.
Define ‘danger’ and give an example.
When an individual displays behaviour that means they are a danger to themself or to others.
An example would be smoking. It can be dangerous to the individual (lung cancer) but can also be dangerous to others (second hand smoking.)
Strengths of the 4 D’s?
Can be a useful tool for professionals when considering a patient’s symptoms.
Supports the validity of the DSM system in that various diagnosis are shown to focus on specific D’s; each has value.
Clinicians communicating with other clinicians when making diagnoses; increases inter-rater reliability.
Weaknesses of the 4 D’s?
There may be a lack of objectivity
If the 4 D’s were used by 2 different therapists, there may not come to the same conclusions.
What does the DSM describe?
It describes the symptoms, features and associated risk factors of over 300 mental and behavioural disorders.
When was the DSM-V1 published?
1952.
When was the most recent edition of the DSM published?
2013.
How many sections is the DSM made up of?
4.
What is the first section of the DSM?
It offers guidance about using the new system.
What is the second section of the DSM?
It details the disorders and is categorised according to our understanding of underlying causes and similarities between the symptoms.
What is the third section of the DSM?
It includes suggestions for new disorders which require further investigations. It includes information about the impact of culture on the presentations of symptoms.
What is the fourth section of the DSM?
It includes the impact of culture.
How is information gathered using the DSM?
Clinicians may gather info through observations but majority of the info was gathered through unsturcutured interviews.
The process involves ruling out disorders which do not match the person’s symptoms.
What is test-retest reliablity?
A measure of reliablity obtained by administering the same test twice over a period of time to a group of individuals.
What is inter-rater reliablity?
The extent to which two or more observers/raters/examiners agree.
Strength of the reliablity of the DSM?
Good level of agreement for some disorders - the field trials demonstrated impressive levels of agreement between clinicians for a variety of disorders.
Reiger and colleagues (2013) found that for 3 disorders had kappa values ranging from 0.60 - 0.79 (very good) but diagnoses of schizophrenia had kappa values of 0.40 - 0.59 (good).
It is clear that clinicians have adopted well to these changes.
Weakness of the reliablity of the DSM?
Falling standards - what counts as an acceptable level of agreement has fallen over the years.
Cooper (2014) explains that the DSM-5 task force classified 0.2 - 0.4 as acceptable. One of the least reliable diagnoses (0.28) was major depressive disorder.
This suggests that the DSM may be less reliable than previous versions and that diagnoses of MDD may have been in error.
Strength of the validity of the DSM?
Support for validity of conduct disorder - evidence supports the validity of certain disorders.
Kim-Cohen et al. (2005) demonstrates the concurrent validity of conduct disorder through interviewing kids. Specific risk factors i.e low income was common in most cases.
This suggests that accurate diagnoses could reduce adult mental health problems which are frequently preceeded by conduct disorder.
Weakness of the validity of the DSM?
Labels tell us nothing - lacking in validity; critisim from psychiatrists and psychologists believe it tells us nothing about the causes of a disorder.
What is the ICD?
The ICD is the international classification of disorders. It includes both physical and mental disorders.
Like the DSM, The ICD has seen many revisions across the years. The most recent revision was the ICD-10, in 1992.
How is the ICD structured?
Chapter 5 is titled ‘Mental and Behavioural Disorders’.
Each disorder has a code, starting with F. They are listed consecutively and there are 11 sections.
For example, schizophrenia, schizotypal and delusional disordes is one section grouped as F20 - F29.
F20 is the subcategory of schizophrenia and is further differentiated; F20.0 - paranoid schizophrenia.
How do clinicans gather info using the ICD?
The clinician selects key words from an interview with a client that relates to their symptoms like hallucinations, delusions etc.
The clinician can look up these symptoms in an alphabetic index or go straight to an obvious section such as schizophrenia.
The clinician then uses other symptoms to locate the subcategory.
One strength of the reliablity of the ICD?
Improvements between ICD-9 and ICD-10 - research evidence by Panizovsky et al. (2006) found that in a large-scale longditudinal study, the PPV scores (the scores of the proportion of people who retain the same diagnosis when reassessed) increased by 26% for schizophrenia, 16%° for mood disorders and 8% for anxiety disordes. This shows improved reliability and suggests that the increased number of disorders from ICD -9 to ICD-10 hasn’t detracted from the reliability of the diagnoses.
Another strength of the reliablity of the ICD?
Inter-rater reliability: good consistency when 2 clinicians assess the same client using the ICD – 10. Galeazzi et al. (2004) arranged for two researchers to conduct a joint interview to assess 100 client for psychosomatic symptoms. The kappa values showed very high agreement (0.69 - 0.97)
Strength of the validity of the ICD?
Good predictive validity - Mason et al. (1997) showed that the diagnosis of schizophrenia using the ICD-10 has good validity.
The ICD-9 and ICD-10 were ‘reasonably good at predicting disability’ in 99 people in schizophrenia 13 years later.
This shows that the initial diagnosis was useful.
Weakness of the validity of the ICD?
Application to diagnosis - The WHO’s approach was that they aim to improve the clinical utility of this system. They conducted a huge international survey of clinicians and found a preference for simplicity. They believe that the system should become more user-friendly.
What is schizophrenia?
Schizophrenia is a psychotic disorder.
Psychosis is a general term for disorders which involve a loss of contact with reality and their ability to perceive process and respond to environmental stimuli is impaired.
List the positive symptoms of schizophrenia.
Disorganised thoughts - the ability to form coherent sentences is affected.
Hallucinations - perception of something being real that doesn’t exist like voices/seeing things.
Catatonic behaviours - are characterised by a reduced reaction to the immediate environment.
Delusions - beliefs that have no basis in reality, like delusions of thought, persecution, grandeur.
List the negative symptoms of schizophrenia.
Anhedonia - a loss of interest or pleasure in all activities.
Speech poverty - characterised by brief replies, questions, and minimal elaboration. There is a reduced speech, quality and frequency.
Affective flattening - the flattening of emotions and the reduction of the intensity of emotions.
Avolition - a general lack of energy resulting in a loss of gold directed behaviour.
What is a key feature of schizophrenia?
The lifetime prevalence which is 0.3 - 0.7%, which varies by nationality, ethnicity, and geographic origin in immigrants.
Describe the onset of schizophrenia.
Onset is the time span between the first symptom and developing a full diagnosable syndrome.
Onset is slightly earlier in males (early to mid 20s) than females (late 20s).
Males tend to have a poor prognosis than females.
Females are over-represented in late onset cases (40+)
What is the prognosis of schizophrenia?
Prognosis is a prediction of the outcome or severity of the condition/disease/disorder.
The prognosis of schizophrenia is varying and hard to predict. A minority, 25%, only have one episode and recover completely.
However, most experienced chronic impairment and some progressive deterioration with increasingly brief periods of remission and severe cognitive deficits.
How is the life expectancy affected?
The life expectancy is 10 years less than the population average.
What is excess dopamine?
Hyperdopaminergia.
How is hyperdopaminergia (excess dopamine) an explanation of schizophrenia?
In the 1950s, two drugs (chlorpromazine and reserpine) were helpful in alleviating the symptons of schizophrenia.
Both drugs induced tremors and muscle rigidity which is symptomatic of Parkinson’s disease, a condition caused
by low levels of dopamine.
It was therefore argued that schizophrenic symptoms could be linked to high levels of dopamine.
What were the two explainations for excess dopamine?
Low levels of beta hydroxylase (the enzyme which breaks down dopemine) - may be respansible for a build up of excess dopamine in the synapse.
A proliferation (rapid increase) of D2 dopamine receptors on the post-synoptic cells - may be responsible for hyperdopaminergia.
What is the term for dopamine deficiency?
Hypodopaminergia.
What did Davis et al. (1991) suggest about hypodopaminergia and positive symptoms?
He suggested that the positive symptoms of schizophrenia (delusions and hallucinations) may result from an excess of dopaminergic activity in the mesolimbic pathway.
What did Davis et al. (1991) suggest about hypodopaminergia and negative symptoms?
He suggests that the negative symptoms (flattening and mutism) may result from a lack of dopaminergic activity in the mesocortical pathway.
What had research started to focus on by the 2000s?
The role of other neurotransmitters, like GABA, glutamate and serotonin.
Attention had turned to a newer drug called clozapine. What is clozapine and what does it do?
Clozapine is an anti-psychotic drug which binds to D1 and D4 dopamine receptors, but only weakly to D2 receptors.
As clozapine binds to serotonin receptors and greatly reduces positive and negative symptoms may be caused by irregular serotonergic activity.
