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Psychology Paper 2 > Clinical Psychology > Flashcards

Clinical Psychology Flashcards

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1
Q

Aim of Classical Study

A
  1. To investigate the reliability of mental health diagnoses by seeing whether 8 pseudo-patients would be detected as really being ‘sane’
  2. To investigate the experience of ‘being insane’ in a mental institution
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2
Q

Research methodology of Classic Study

A

Field study and naturalistic covert (secret) unstructured observation

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3
Q

Describe the observers of Rosenhan’s experiment

A
  • 3 older established psychlogists (including Rosenhan)
  • 1 housewife
  • 1 painter
  • 1 psychiatrist
  • 1 pediatrician
  • 1 20-year old psychology graduate
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4
Q

Describe the location of the Classic study

A

12 psychiatric hospitals in 5 East & West Coast states in the US which varied in terms of staff:patient ratio and whether they were well-resourced or less well-resourced.

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5
Q

Describe the procedure for study 1 of the Classical study

A
  1. 8 pseudo-patients gained admission to the hospital by saying they heard an unfamiliar, same-sex voice saying ‘empty, thud, hollow’.
  2. After admission, they acted ‘normally’ towards the staff and the other patients at the hospital, e.g., engaging in conversation in the corridors
  3. Pseudo-patients were responsbile for discharge from the hospital by convincing the doctors that they were ‘sane’ in order to get released.
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6
Q

Describe the results for Study 1 of the Classic study

A
  • None of the pseudo-patients were detected
  • 11/12 hospitals admitted patients with a diagnosis of schizophrenia
  • 71% of staff in the hospitals ignored the pseudo-patients
  • 7 patients were labelled with a diagnosis of ‘Schizophrenia in remission’, 1 with ‘manic depressive disorder’
  • Length of hospital admission was 7-52 days with an average of 19 days
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7
Q

Describe the conclusions for Study 1 of the Classic study

A

The sane cannot be distinguised from the insane.

3 reasons for depersonalisation are:
1. A lack of eye contact and avoidance of patients
2. A hierarchal structure so doctors in senior positions have little contact with patients
3. Medication of patients means contact is not always necessary

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8
Q

What was the procedure for study 2 of the Classical study?

A

3 months later in a follow-up study Rosenhan sent NO pseudo-patients for admission to a hospital.

All 193 patients were real mental health patients.

Each staff member had to ‘rate’ patients one a scale of 1-10 to reflect the likelihood of them being pseudo-patient.

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9
Q

What were the results of study 2 of the Classical study?

A

41 were judged with high confidence as pseudo-patients by at least one staff member.

‘Diagnostic labelling’ of Sz is difficult for a pseudo-patient to overcome.

(Low validity of study 2 as staff were told pseudo-patients would try to gain admission).

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10
Q

Evaluate the generalisability of the Classical study

A

+ Rosenhan included both genders from a range of backgrounds
- The sample is imbalanced (5 males, 3 females) so the findings are arguably still androcentric
- Findings may not be representative for individuals experiencing mental health conditions in other parts of the USA like Central America
- Findings cannot be generalised to collectivist cultures, because America is an individualistic society that values autonomy and freedom

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11
Q

Evaluate the reliability of the Classical study

A

+ Highly reliable due to standardised procedures used by all psueod-patients
+ All patients gained admission by claiming to hear the same thing (unfamiliar same-sex voice saying ‘empty, thud, hollow’).
+ Easy to replicate
+ High inter-rater reliability because several doctors at different hospitals repeatedly gave the same misdiagnosis

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12
Q

Evaluate the applications of the Classical study

A

+ Strong applications to training healthcare professionals
+ The conclusion that ‘the sane cannot be distinguished from the insane’ has been applied to clinical diagnosis to improve type 1 (false positive) errors, by reducing the labelling of patients
+ The study contributed to reforms of the DSM-4 where the diagnosis for ‘hearing voice’ in schizophrenia was changed from a minimum duration of 1 month to 1-6 months repeatedly

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13
Q

Evaluate the ecological validity of the Classical study

A

+ Field experiment, naturalistic observation
+ The range of hospitals in the study means that the results can be directly applied to the real-life healthcare systems
+ The REAL participants (doctors and nurses) were observed in their real-life working environment, which increases mundane realism

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14
Q

Evaluate the internal validity of the Classical study

A
  • Seymour Ketty (1974) criticised Rosenhan, claiming the pesudo-patients were faking an unreal mental condition, so the study does not tell us anything about how people with genuine mental health conditions are diagnosed or treated
  • Rosenhan’s study is not an entirely valid measure of clinical diagnosis because the findings were based on the experience of pseudo-patients rather than real mental health patients
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15
Q

Evaluate the ethics of the Classical study

A

+ Confidentiality: all patients were given ‘pseudonyms’ and allocated pretend occupations and places of employment
+ Protection from harm: pseudo-patients were trained on how to avoid taking medication by pocketing or depositing drugs in the toilet.
+ Informed consent was given to take part in the study by pseudo-patients
- No right to withdraw because they were responsible for their own discharge from the hospital
- The longest stay was 52 days, which could have caused long-term psychological harm
- Deception: The real participants of the study (staff) did not give informed consent

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16
Q

Describe the 4 D’s used for diagnosis of mental health conditions

A
  1. Deviance
  2. Dysfunction
  3. Distress
  4. Danger
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17
Q

Describe ‘deviance’

A

Refers to statistically rare behaviours and emotions that are not the norm (disapproved of) in a society.

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18
Q

Describe ‘dysfunction’

A

Behaviour that interferes with a person’s everyday life, causing a person to not live a normal life, e.g., insomnia, unable to work, relationship breakdown.

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19
Q

Describe ‘distress’

A

The extent to which a person perceives their own negative behaviours/emotions as upsetting

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20
Q

Describe ‘danger’

A

Refers to danger to others or the individual themselves, e.g., violence towards others, suicidal thoughts or self-harm.

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21
Q

Evaluate ‘deviance’ in the context of a clinical diagnosis

A

+ Practical applications in helping professionals decide whether a patient’s symptoms warrant a clinical diagnosis
- Perceptions of deviance may change over time depending on societal norms (e.g., homosexuality used to be on the DSM but is considered normal today)

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22
Q

Evaluate ‘dysfunction’ in the context of a clinical diagnosis

A

+ Using dysfunction to diagnose a mental health condition provides a holistic way to assess someone’s mental health, as the 4 D’s cover a wide range of symptoms.
- Dysfunction is difficult to measure which reduces the internal validity. There is likely to be subjectivity in the applications of the 4 Ds. No universal consensus about what constitutes dysfunctional behaviour

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23
Q

Evaluate ‘distress’ in the context of a clinical diagnosis

A

+ Distress can be measured objectively using quantitative scales, like the Beck Depression INventory which indicates self-report scales of emotion and harm. Easily repeated, therefore reliable.
- Interpretations of distress are subjective based on clinicians’ biases.
- Cooper et al (1972) have demonstrated that New York and British psychiatrists shown the same videotaped interview came to different clinical diagnosis, NY psychiatrists diagnosed schizophrenia twice as often, whereas British psychiatrists diagnosed depression twice as often

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24
Q

Evaluate ‘danger’ in the context of a clinical diagnosis

A

+ Dangerous behaviours are easier to identify as they’re likely to be overt, which increases practical applications
- Davis (2009) argues that the model is incomplete, and a 5th D ‘Duration’ should be added. Duration defined as the length of time the person has experienced symptoms, in the case of schizophrenia according to the DSM-5, 2 or more symptoms should last at least 1 month.

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25
Q

Define the emic perspective

A

The Emic insider perspective ‘cultural relativism’ is based on how the local culture and native people understand a behaviour by ‘looking within’.

26
Q

Define ethnocentrism

A

Research that is centred around one culture only

27
Q

Define Eurocentrism

A

Where the Western World’s societal or cultural perspective is deemed as superior to all and the ‘gold standard’ for clinical diagnosis.

28
Q

What issues to do language and translation pose to clinical diagnoses?

A

Patients and psychologists may find themselves ‘lost in translation’ if a psychiatrist speaks a different language or if particular words cannot be directly translated from the English language to another language.

29
Q

Describe Luhrmann et al’s (2015) support for cultural differences:

A
  • Compared 20 people from different cultural backgrounds with serious psychotic disorder who meet the inclusion criteria for schizophrenia and hear voices.
  • California sample: people were more likely to describe their voices as ‘intrusive unreal thoughts’.
  • South Indian sample: people were more likely to describe voices as providing ‘useful guidance’.
  • West African sample: people were more likely to describe voices as ‘morally good and causally powerful.’
  • Hearing voices was seen as a negative experience in ‘Westernised’ society like America but a positive one in more Eastern societies like India and Western Africa
  • This could change the way psychologists treat patients who are saying they can hear voices.
30
Q

Describe Tortelli et al’s (2015) support for cultural differences

A
  • A systematic review of black Caribbean-born migrants in the UK since the 1960’s.
  • Results showed that 16 out of 18 studies demonstrated statistically significant elevated incidence rates in the black Caribbean group, for major psychotic disorders, including schizophrenia and bipolar disorder. 
  • This shows higher incidence rates of psychotic disorders diagnosed in ethnic minority populations in England for over 60 years.
31
Q

Describe Andrade et al’s (2012) support for cultural differences

A
  • São Paulo Metropolitan Area (SPMA) a mega city within an urban setting using 5037 participants who were interviewed face to face.
  • Explored aspects of urban living such as, internal migration, exposure to violence, and neighbourhood-level social deprivation.
  • Results showed high social deprivation was associated with substance disorders in Sao Paulo, demonstrating that socioeconomic background can affect individual mental health disorders.
  • Gender differences were also found, with 29.6%  women more likely to have mood, anxiety and severe/moderate disorders than men.
32
Q

Describe Philips (2001) support for cultural difference

A
  • In China, higher level of schizophrenia were found in urban areas than in rural areas and a higher prevalence was also diagnosed in woman than in men.
  • In China suffering from a mental health disorder is often seen as ‘failure in society’ as the person is not following the social norms.
  • With this research, Western classification systems could become more accessible as we can translate the new findings into better outcomes for the untreated or poorly treated patients suffering from schizophrenia. 
33
Q

Describe Lin (1996) refuting cultural differences

A
  • Lin (1996) argues when studying the symptoms of schizophrenia, there were more similarities across different cultures than differences.
  • This suggests cultural differences would NOT lead to a difference in diagnosis. Therefore, for the clinical condition schizophrenia, cross cultural perspectives may be inefficient or even redundant. 
34
Q

Describe the overcompensation argument, refuting cultural differences

A

Psychiatrists can over compensate for cultural differences (by considering the local cultural beliefs ‘too much’ when using an ‘emic’ standpoint).
This can lead to clinicians NOT diagnosing a mental disorder when in fact there was one, so cultural differences may not have caused any difference in the disorders but have impacted the diagnosis.

35
Q

DSM

A

The Diagnostic and Statistical Manual of Mental Disorders.

36
Q

ICD-11

A

International classification of diseases version 11

37
Q

Describe the DSM-IV

A
  • DSM 4th edition revised
  • Multi-axial system
  • Each diagnosis of a disorder is split into 5 levels called axes.
  • A patient is assigned a category based on their symptoms which informs the diagnosis.
38
Q

Describe the DSM-V

A
  • Aims to coincide with the ICD to avoid confusion with having more than one universal classification system.
  • No longer a multi-axial system instead there are 3 sections:
    1 = Introduction and explanation of changes.
    2 = Diagnostic codes taken from ICD-9 in an attempt to ‘harmonise’ the two systems. For example, schizophrenia, depressive disorders, OCD, anxiety, trauma and stress.
    3 = Emerging measures and models, self-assessment by patient, cultural issues.
39
Q

Describe ICD-11

A

Used to monitor: incidence, prevalence, morbidity
WHO (World Health Organisation) use ICD figures.
ICD is for all illnesses not just mental health issues.

40
Q

Define reliability of clinical diagnosis

A

Refers to the consistency of a clinical diagnosis when using a classification system

41
Q

Define inter-rater reliability of clinical diagnosis

A

The extent to which two or more different clinicians are in agreement and arrive to the same clinical diagnosis when diagnosing the same patient

42
Q

Define intra-rater reliability of clinical diagnosis

A

When the same clinician diagnoses the same patient with the same symptoms as having the same disorder at two different points in time.

43
Q

Define test-retest reliability of clinical diagnosis

A

The same patients are observed separately by two or more clinicians within a period of time where the clinical conditions of the patients are unlikely to have changed. It is test-retest reliability that reflects the effect of the diagnosis on clinical decision making and that is the focus of the DSM-5 field trials.

44
Q

Outline the DSM field trials

A
  • The DSM-5 field trials were designed to evaluate the test-retest reliability.
  • 2246 patients and 279 clinicians were involved in 11 centres in the US and Canada
  • The criteria for 23 diagnosis were tested: 15 adults and 8 children
  • Each patient was interviewed twice by 2 different clinicians using the DSM-5 criteria.
45
Q

What was the measurement used to assess diagnosis in the DSM field trials?

A

Kappa score

46
Q

Describe the adult schizophrenia score for the DSM field trials

A

0.46 = ‘good’ level of reliability and agreement

47
Q

Describe the adult PTSD score for the DSM field trials

A

0.67 = ‘very good’ level of reliability and agreement

48
Q

Describe the adult MDD score for the DSM field trials

A

0.28 = ‘questionable level of reliability and agreement

49
Q

Describe Regier et al (2013) supporting reliability of the DSM

A

The DSM-5 field trials show reliability of the DSM-5 is very good for disorders like PTSD which have some of the highest levels of agreement and reliability between clinicians resulting in scores of 0.67.

50
Q

Describe Brown et al (2001) supporting reliability of the DSM

A

Brown et al (2001) found good reliability in clinical diagnosis when using DSM-4 in 1,127 outpatients. There was good to excellent consistency for most of the DSM categories for generalised anxiety disorders and mood disorders.

51
Q

Describe the concept of time supporting reliability of the DSM

A

The DSM has stood the test of time; despite the revisions it is still one of the most widely used classification systems in mental health. The DSM-5 has fine-tuned previous diagnoses, for example ‘eating disorder’ has becoming ‘binge eating disorder’, which is more specific and reliable, enabling clinicians to come to a common diagnosis.

52
Q

Describe Jakobsen et al (2005) supporting reliability of the DSM

A

Jakbosen et al (2005) tested the reliability of the ICD-10 classification system in diagnosing schizophrenia. 100 danish patients with a history of psychosis were assessed, a concordance rate of 98% was obtained. This demonstrates the high reliability of the clinical diagnosis of schizophrenia using up-to-date classification.

53
Q

Describe culture supporting reliability of the DSM

A

DSM-5 gets rid of the list of ‘culture-bound syndromes and replaces it with advice on ‘cultural concepts of distress’, which has increased multi-cultural perspectives. This has resulted in positive contributions to cross-cultural diagnosis by making new conditions known outside of the USA. For example, ADHD and Borderline Personality Disorder are now recognised in the UK.

54
Q

Describe the Kappa score refuting the reliability of the DSM

A

The DSM-5 field trials show only 5 out of 23 diagnoses were found to be ‘very good’. This raises questions about the reliability of conditions like schizophrenia where the kappa score was still quite low (0.46). This suggests that there are many clinical diagnoses which remain unreliable amongst different clinicians.
Spitzer & Colleagues (2012) argue that a kappa score below 0.60 would be concerning, even considering the DSM-5’s test-retest methodology.

55
Q

Describe Cooper et al (1972) refuting the reliability of the DSM

A

Cooper et al (1972) showed American and British psychiatrists the same videotaped interview and asked them to make a diagnosis. New York psychiatrists said it was schizophrenia twice as often, whereas the London psychiatrists said it was depression twice as often.

56
Q

Describe Buckley et al (2009) refuting the reliability of the DSM

A

Comorbidity describes people who suffer from two or more mental disorders, For example, schizophrenia and depression are often found together, This makes it more difficult to confidently diagnose schizophrenia. Comorbidity occurs because the symptoms of different disorders overlap. For example, major depressive disorder and schizophrenia both involve very low levels of motivation. This creates problems of reliability. Buckley et al (2009) found that 50% of schizophrenia patients also had a diagnosis of depression, 29% had a post-traumatic stress disorder diagnosis, and 23% had an OCD diagnosis.

57
Q

Describe Loring and Powell (1988) refuting the reliability of the DSM

A

Loring and Powell (1988) found that some behaviour which was regarded as psychotic in males was not regarded as psychotic in females. There Is gender and cultural bias present in the diagnosis of schizophrenia.
Men are far more likely to be diagnosed, potentially because women experience the symptoms differently to men and much of the clinical research remains androcentric.

58
Q

Define the etic perspective

A

The Etic outsider perspective does not adapt to local cultural beliefs and understands a behaviour by ‘looking from the outside.’
If psychologists adopt the ‘Etic standpoint’ when conducting cross-cultural research this lends itself to subjective cultural bias as Western cultures tend to see the mind and body as separate entities.

59
Q

Why is cross-cultural research carried out?

A

Cross-cultural research enables universal behaviours (nomothetic laws of universality) which are common to many cultures to be identified, as well as, culturally specific behaviours.

60
Q

Define cross-cultural research

A

The study of human behaviour between different cultures to identify similarities and differences across cultures.

Psychology Paper 2 (4 decks)

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