Clinical psychology Flashcards
What are the 5 HCPC guidelines
Act in best interest of patient
Able to maintain records appropriately
Being able to practice and follow ethical guidelines of practice
Being able to ensure quality of practice
Being able to work and communicate effectively with others
3 examples of act in best interest of patient
Not do anything that may put patients in harm or danger in anyway
If patient perceived to be a risk to themselves break confidentiality to ensure they get help they need
Not allow sex/religion to influence how they are treated
3 examples of able to maintain records appropriately
Ensure all records are kept safe and confidential by limiting access using passwords
Ensure peoples records are kept separately to others
Show patients notes so they can say if they agree
3 examples of Being able to practice and follow ethical guidelines of practice
Ensure confidentiality is not breached by storing records safely using pseudonyms
Don’t do anything to put your patient through harm
Potentially break confidentiality for safety of patients
3 examples of Being able to ensure quality of practice
Undertake regular training each year to ensure they are up to date on all current knowledge of diagnosis and disorders
Only act within limits of own skill ask for second opinion when necessary
Follow ethical guidelines including confidentiality using pseudonym to protect identity of patient
3 examples of Being able to work and communicate effectively with others
Build trust with patient to allow full communication
Communicate with other service providers like social workers
Act within own knowledge and ask for second opinion
What are the 4 D’s
Used by clinicians to determine if someone’s behaviours are abnormal and need further diagnosis
Deviance
Distress
Dysfunction
Danger
What is deviance in 4 D’s with example
Behaviours and emotions that are not seen as the norm in society and they are seen as unacceptable
E.g. Feeling like the mafia is after you is not normal in society
What is distress in 4 D’s with example
Subjective experience of the individual when the behaviour is causing high levels of negative feelings
E.g. Person who is paranoid the mafia is coming for them would feel great negative emotions as they think they will get caught or hurt
What is dysfunction in 4 D’s with example
Person is unable to partake in everyday activities due to significant interference of behaviour, however cant signal disorder on its own as it can be deliberate
E.g. Cant walk to school in fear of mafia kidnapping them
What is danger in 4 D’s with example
Putting themselves and/or others lives at risk thus requires intervention
E.g. harming a stranger due to belief the mafia are coming.
2 strengths of 4 D’s
Davis - Hard to judge when a behaviour is problematic enough to become a clinical diagnosis. 4 D’s can help by matching the DSM criteria. T/F has practical applications.
Validity of DSM - Various diagnoses using the DSM are shown to focus on specific Ds, showing each has value. EG - Factitious disorder is where the individual will fake illness or psychological trauma to get medical attention. This clearly indicates deviance from the norm. TF supports the validity of the DSM as a diagnostic classification system.
2 Weaknesses of the 4 D’s
Subjective application of 4 D’s - No clear measure, one professional may view dysfunction different to another, T/F reduces validity as requires subjective interpretation
Davis, 5th D - Duration, length of time someone has they symptoms, T/F 4 D’s are insufficient by themselves for diagnosis
Summarise the DSM-IV-TR (4)
Multi axial system of classification on an individuals mental state rated on 5 separate dimensions axis I-V
Axes I - III deal with their present condition while 4-5 provide info about there life and how likely they are to be successful at coping in life
The GAF scale represents the 5th stage and examines the psych, social and occupational areas. Scored 0-100 with the higher the better psychosocial functioning.
16 major categories where symptoms and features are listed
3 changes from DSM-IV-TR to DSM 5
No longer a multi-axial system (no axis I, II or III)
GAF has been dropped
New classifications of some disorders. Some have disappeared or been absorbed into other disorders.
4 changes to the ICD from 10 to 11
ICD 11 is more detailed and structured than 10. 55,000 codes vs 14000 in 10
French is now available as well as Chinese, Russian and Spanish
New mental behavioural and neurodevelopment conditions - gaming disorder, binge eating disorder
New specific diagnosis for sleep wake diagnosis including sleep related breathing disorders
Summarise the ICD (4)
ICD-10 is multi-lingual and multi-disciplinary diagnostic manual looking and classifying mental health disorders and general health disorders.
The ICD contains section F, which is specific for mental health disorders. Within this section it groups each disorder as being part of a family, for example mood (affective) disorders.
These disorders are coded F followed by a digit to represent the family, (F32 is depression whereas F31 is bipolar disorder).
Further categorisation comes at the next digit that follows a decimal point were the type of depression is represented (for example, F32.0 is mild depression).
What is inter rater reliability in terms of diagnosis
Present the same case study to a variety of clinicians and assess the extent of agreement. If there is agreement in diagnosis then there is inter-rater reliabilit
What is test retest reliability in terms of diagnosis
Test them 2 or more times and see if they receive the same diagnosis. Cannot be done over a long period of time
3 strengths of general reliability of DSM/ICD
Jakobsen - found good agreement in diagnosis of SZ between ICD 10 and other classification systems
Andrews - 1500 patients using DSM IV and compared to ICD and found agreement on diagnosis for depression and general anxiety
Morey - DSM 5 more reliable than DSM IV in diagnosing borderline personality disorder
Weakness of general reliability of DSM/ICD
Andrews however - 68% agreement between ICD and DSM. For PTSD was poor as ICD diagnosed 2x as many. T/F wont produce consistent diagnosis so not reliable for PTSD
Strength of inter-rater reliability of DSM/ICD
Goldstein - 199 patients with SZ re-diagnosed using DSM 3 when originally diagnosed on DSM 2. 2 experts re-diagnosed 8 patients using single-blind technique and found high level of agreement between them.
Weakness of inter-rater reliability of DSM/ICD
Unstructured interviews - Gather info about patients through unstructured, clinical interviews meaning patients may provide different info to different practitioners. T/F Unreliable
2 strengths of Test-retest reliability of DSM/ICD
Stinchfield- using patients recruited from treatment program in Ontario or local community diagnosed them using DSM 5 and accurately identified 91 as having or had gambling disorder
2 weaknesses of Test-retest reliability of DSM/ICD
Subjective interpretration - Phrasing of criteria in DSM is open for interpretation. Some disorders such as hyper tension (high blood pressure) are on a continuum so not a yes or no.
What is concurrent validity in terms of diagnosis
A diagnosis will be valid if you compare the diagnosis of one diagnostic manual with a manual that has already been found to be valid and if they match the diagnosis the manual will have concurrent validity
2 strength of concurrent validity for ICD/DSM
Andrews - 1500 patients using DSM IV and compared to ICD and found agreement on diagnosis for depression and general anxiety
Lee - For diagnosis of ADHD there was agreement when using DSM IV and other measures such as questionnaire data
Weakness of concurrent validity for ICD/DSM
Andrews however - 68% agreement between ICD and DSM. For PTSD was poor as ICD diagnosed 2x as many. T/F wont produce consistent diagnosis so not reliable for PTSD
What is predictive validity in terms of diagnosis
If it predicts the course of illness accurately - prediction of future behaviour caused by the disorder it is predictively valid
Strength of predictive validity for DSM/ICD
Powers et al - women who had suffered complex PTSD also had higher level of substance and alcohol abuse as predicted by ICD 11
Weakness of predictive validity for DSM/ICD
The precise course of many disorders has not been established yet. This is why diagnostic manuals are republished and updated as knowledge on disorders develops. T/F hard to establish predictive validity
What is construct validity in terms of diagnosis
The symptoms of the patient match those considered to be present for the disorder and fit the necessary criteria
Strength of construct validity for DSM/ICD
Hoffman - Used a computer prompted interview to see if the findings on prison inmates with alcohol dependence/abuse matched the DSM-IV-TR. Symptoms matched DSM diagnosis. T/F DSM-IV-TR has construct validity
Weakness of construct validity for DSM/ICD
Rosenhan - All but 1 pseudo patient was diagnosed to have SZ and when released 7 were released with incorrect diagnosis of schizophrenic in remission using DSM 2.
2 general validity weaknesses of DSM/ICD
Reductionist - Splits clinical disorders into list of symptoms and features, simplifying complex behaviours, some people may suffer in different ways
Co-morbidity - Hard to diagnose people with multiple disorders as it relies on the clinician choosing the closest match from a list of symptoms.
4 AO1 points for cultural issues with diagnosis
The spiritual model
Language barriers
Cultural bound syndromes
Influence of cultural norms and stereotypes
What is primary data in clinical psych (4)
Primary data is information collected first hand by the researcher on mental health disorders.
Researcher plans, conducts a study and collects and analyses the data specifically for their research hypothesis
Data collected can be quant or qual
Methods include Observation, experiment and interviews.
3 strengths of primary data in clinical psych
Temporal validity - research will be conducted using current DSM criteria to diagnose patients from current population. T/F high external validity, generalisable
Data is fit for purpose - researcher can fully operationalise variables such as mental disorders so data collected is specific and relevant compared to 2nd
Range of data can be collected - qual and quant so analysed in different ways. T/F can produce detailed analysis of clinical disorders so increase validity
3 weaknesses of primary data in clinical psych
Pop validity - Hard to get large population of mental health patients and primary research will have small sample due to time and money. T/F unrepresentative…
Practical - The researcher has to plan, acquire collect and analyse which is time consuming and expensive compared to 2nd. T/F not economical
Researcher effect - contact w patient so may influence the patient or their behaviour/response, could lead to demand characteristics.
Define secondary data in clinical (4)
Secondary data is the information that already exists where the researcher collects it second hand from an external source on mental health disorder
Data collected can be qual or quant
Its collected by other clinicians for a different purpose and is often readily available
Methods include articles and videos
3 strengths of secondary data in clinical psych
Large sample - Easy to collect large population of mental health patients due to range of research being able to be collected easily and efficiently. T/F representative…
Practical - The researcher doesn’t have to plan, acquire collect and analyse meaning its not time consuming and expensive compared to 1st. T/F economical compared
Ethical - Already collected and published so consent already gained. No breach of informed consent
3 weaknesses of secondary data in clinical psych
Temporal validity - research is not conducted by researcher so may not be using current DSM criteria to diagnose patients from current population. T/F low external validity, generalisable
Data is fit for purpose - researcher cant fully operationalise variables such as mental disorders as they didn’t collect it so data collected is not specific and relevant compared to primary.
Validity issues with original data - Data already collected so if further data is needed clinician cant do this. Also data may only be quant so analysed in a specific way.
What was the aim of Rosenhan
To investigate if sane people could be distinguished from insane people using the DSM2 classification system and if they can be differentiated.
What is the sample of Rosenhan
8 pseudo-patients 3 female 5 male
What is the procedure of Rosenhan
Pseudo-patients said they could hear unfamiliar voices saying words like empty, hollow and thud
Once admitted to the hospital the pseudo patients behaved normally and reported they were fine and free of symptoms and not schizophrenic
Pseudo patients took notes on their experience covertly but later overtly
When given their medication they threw away their pills or flushed them down the toilet
What were the findings of Rosenhan
All but 1 pseudo patient was diagnosed as schizophrenic
35/118 patients recognised the pseudo patients as not crazy
7 were released with diagnosis of sz intermission
Stayed in hospital between 7-52 days average of 19
What is the conclusion of Rosenhan
Staff were unable to distinguish those who were sane from those who were insane
Rosenhan argued that the power of a label of insanity leads to the subjective interpretation of any behaviours displayed
4 strengths of Rosenhan
Ecological validity - natural setting of 12 varying hospitals in east and west coast of America. TF rep of wrong diagnosed sz using DSM 2
Objective measure - Quant data on pseudo patients was collected for example all but 1 was diagnosed with sz across 12 different hospitals using DSM 2
Mundane realism - took place in realistic setting of a mental hospital as clinicians were unaware so interactions with pseudo-patients were naturally occurring
Changes made to the DSM - Findings show DSM 2 is not accurate for sz diagnosis so changed to 5 TR which is much more rigorous as lots of symptoms must be shown over long period of time. TF increased validity
4 weaknesses of Rosenhan
Temporal validity - findings of all but 1 pseudo patients diagnosed as sz was on DSM 2. We us the 5 now. TF outdated and no longer valid
Protection from psych harm - proved incorrect diagnosis using DSM 2 so clinicians may believe they aren’t good enough.
Doctors play safe - If unsure may diagnose them to closest thing like diagnosing hearing empty hollow thud as sz. TF misdiagnosis or admitting sane into hospitals as insane decreasing DSM 2 validity
Deception - 8 pseudo patients gave wrong names, occupations and symptoms like hearing empty hollow thud so they were unaware they were in clinical research. TF deceived and not ethical
How are interviews used in clinical psych (4)
Face to face conversation between a clinician and their patient
This usually will be unstructured or semi structured to gain info on the mental health patient with questions like “what gender are the voices you’re hearing”
This conversation will be recorded and then the clinician will listen and transcribe it.
Finally this transcript will be thematically analysed in depth by clinician to aid diagnosis
3 strengths of interviews in clinical psych
In depth data - Rich detailed qual data is gathered by clinician which can be thematically analysed in detail to aid diagnosis. TF internal validity and accuracy
Practical application - Patient may explain symptoms of a mental health disorder which could give insight into new disorders. TF improving society understanding of disorder and improving patients life
Gather qual data - unstructured interviews allow patients to expand during conversations and give more details on the symptoms. TF increasing validity of CI broadening mental health understanding
3 weaknesses of interviews in clinical psych
Subjectivity - Patients transcription will be thematically analysed which may use subjective words and phrases which may be viewed as more important to some clinicians than others. TF less reliable
Time consuming - not practical as its secondary research so researcher has to plan, acquire collect and analyse meaning its time consuming and expensive compared to 1st.
What is grounded theory (4)
Glaser and Strauss devised that grounded theory focusses on developing a theory from research evidence. Typically a directional hypothesis so specific info.
Broad codes in the margin of raw data gradually becoming more specific
Data analysed one interview at a time so its possible to introduce info from prior into subsequent.
Aims to develop theories where previously there weren’t any. Often create models.
Strength of grounded theory
Evidence is integrated into the theory - as the theory is generated from the evidence being used this means the theory is relevant to making a diagnosis. Therefore, theory has high validity
2 weaknesses of grounded theory
Subjective analysis - based on subjective opinion of researcher. Researcher selectively picks aspects of the data to focus on. Some people might argue that the researchers are forcing the data to support the theory they think is emerging. TF selecting specific info so may miss crucial information reducing validity.
Reliability - The theory is based on the subjective opinion of the researcher. Although evidence is used to generate the theory the researcher selectively picks aspects of the data to focus on, and as the theory begins to emerge, focuses on only the aspects of the theory they are developing. Therefore, when another researcher conducts the same research or coding the data, different theoretical concepts could emerge, so the finding will not be consistent.
Aim of Vallentines stud
To investigate the usefulness of psych-ed material provided via group work within secure forensic psychiatric hospitals
What was the sample of Vallentines study
42 male patients detained in high security hospital under the mental health act 1983 who had been diagnosed with sz by the ICD 4 - only 21 completed interviews
What was the procedure of Vallentines study
Used the CORE-OM interview schedule during group work and the SCQ self report technique to measure self esteem in patients.
31 patients took them with a further 10 dropping out or withdrawing data ending in 21 completers.
Conclusion of Vallentines study
Overall sz patients in forensic psychiatric hospitals valued education and knowledge on their illness.
Findings of Vallentines study
Over 50% of the 21 completing patients found improvements in behaviour from group work and clinical interviews and gathered quotes like “it gave me peace of mind” and made them feel guilty.
4 strengths of Vallentines study
Standardised questions - used SCQ as self report questionnaires which had repeated questions for all 42 sz patients. TF easy to replicate with similar findings
Qualitative data gathered - semi structured interviews via CORE-OM interview schedule so sz patients could expand on answers to give in depth qual data. Themes generated such as what patients valued and why
Inter rater reliability - clinical interviews were recorded so a second clinician could listen to it.
Practical applications - Found psych ed content and group work help improve SZ patients understanding of illness. TF improving understanding and quality of life
4 weaknesses of Vallentines study
Subjective interpretation - researchers analysed interviews and found 4 main themes including what p’pants valued and why. May have been bias to pick themes to support hypothesis. TF lacks internal validity.
Spontaneous questions - semi structured via CORE-OM meant some questions were random and asked different for each sz patient.
Researcher bias - many analyse and report determined and engaging patients more favourably. TF decreased validity
Small sample size - clinical interviews often use a small sample. TF decrease validity
What are hallucinations (positive)
Cog symptoms and are false perceptions which have no basis in reality.
Can be auditory, visual, tactile or somatic.
An example of an auditory hallucination is hearing voices in your head telling you to do something.
What are delusions (positive)
Cog symptoms which are firmly held false beliefs despite being completely illogical.
Can be delusions of grandeur, persecution, reference and control.
An example of a delusion of grandeur is believing you a god or have special powers.
3 features of sz
According to Jablensky sz is found in any nation at rate of about 1.4-4.6 per 1000. However the prevalence of sz is 1% of population.
Overall there is no gender differences but males usually get it earlier than females do.
The peak incidence for onset of sz is between 17-30
What are formal thought disorders (positive)
Involving disturbing and disorganised thought patterns. Includes loose associations which are disorganised/confused ideas and are incoherent when spoken. E.g. shifting from 1 subject to another like moving topic from holiday to dinner randomly.
Describe one negative symptom
Social withdrawal - Schizophrenic will not want to interact with other people. This could include not attending school
Summarise the diagnosis criteria from the DSM IV-TR for sz
Characteristic symptoms - 2 or more of the following must be present for a significant portion of time during 1 month period: delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour and negative symptoms
Social/occupational dysfunction - failure to achieve expected level of academic or occupational achievement
Duration - disturbance must persist for at least 6 months. Must include at least 1 month of symptoms
Substance/general medical condition exclusion - disturbance not due to direct physiological effects or a general medical condition.
What is the aim of Carlsson
To conduct a review of current research to study the relationship between neurotransmitters other than dopamine that could be implicated in causing schizophrenia, specifically glutamate
What is the procedure of Carlsson
Used meta analysis and Reviewed various research findings investigating neurochemical levels in patients diagnosed with sz, drugs used to treat sz and drugs used to induce symptoms of psychosis. Looked at rodents and used PET scans
What is the findings of Carlsson
Low levels of glutamate is linked to development of psychosis symptoms, associated with increased dopamine levels.
Glutamate failure in cerebral cortex = negative symptoms
Clozapine is very effective at reducing dopamine
What is the conclusion of Carlsson
Schizophrenia may have different types that could be caused by abnormal levels of different neurotransmitters and not just dopamine.
4 strengths of Carlsson
Pop validity - Used meta analysis means large and varied sample reviewed such as impact of drugs on their psychosis and treatment. TF increasing generalisability and is representative
Scientific - studies used PET scans when investigating neurotomical levels in sz patients which re very scientific. TF increasing validity o findings that low levels of glutamate links to high dopamine causing sz symptoms
Practical application -
No consent required
3 weaknesses of Carlsson
Secondary data - Carlsson doesn’t know og hypothesis of studies he researched and may have been different to his. No way of knowing it produced valid findings on glutamate and dopamine relationship. TF lacks validity
Anthropomorphic - Used rodents in research not humans.
Publication bias - only publish results that fit hypothesis
Explain how function of NTs can explain sz (Dopamine hypothesis)
Vesicles release neurotransmitters (dopamine) and travel across the synaptic cleft and bind with receptors on post synaptic neuron, dopamine fires across
Increase in dopamine in 1 site of the brain, contributes to positive symptoms. Whilst problems in the passages connecting the midbrain and frontal lobes contributes to negative sz symptoms.
As well as DA, serotonin, glutamate and GABA all relate to sz. Carlsson found that hypo glutamatergic activity (low levels) of glutamate leads to sz
Genetic explanation of sz
If you have a second degree relative (aunt, uncle, grandparent) with sz the risk increases to between 2-6%. If you have a first degree relative risk increases to 6-17%.
MZ concordance rates are a 48% chance you would both be diagnosed compared to 17% concordance rates between DZ
Tiwari suggests rare gene variation of Xq23 has been linked to sz
4 strengths of genetic explanation of sz
Gottesman - reviewed 40 twin studies found 48% concordance for MZ and 17% for DZ. Also reported concordance rates for identical twins raised apart and together was very similar. TF not due to being treated same increasing validity
Tienari - adoption studies found 10.3% of adopted children who had sz bio mother developed sz in childhood compared to 1.1% of adopted kids with no sz mother. TF validity
Schneider - up to 40% adults affected by 22q11DS are diagnosed with psychotic disorder. TF argued sz due to specific gene mutation
Arinami - 22q11DS found in 0.3-2% of patients with sz. TF suggesting 22q11DS is linked to sz
2 weaknesses of genetic explanation of sz
Reductionist - only bio genetic factors not nurture like downward drift hypothesis. TF too simplistic
Wahlberg - added on to Tienari saying sz risk was higher if adopted family was high in communication deviancy. TF suggesting influence of environment / nurture
Used of twin studies - concordance rates are never 100%
Torey - 8 studies with representative samples found concordance rates of 28% for MZ and 6% for DZ. TF much lower than Gottesman suggesting unreliable evidence to support genetic explanation
Describe social causation hypothesis
Higher incidence of sz in urban settings and in low social classes so those in this category are at more risk of sz
William Eaton suggested city life is more stressful than rural life and long term exposure may make them more vulnerable to sz
The prevalence of sz in immigrant population is higher due to language barriers, stress of moving and employability options
Downward drift hypothesis says those with sz drift to lower class due to the difficulties of sz like attaining jobs and education
Explain a bio therapy for sz (4)
Anti-psychotic drugs are drugs which block the effect of dopamine by blocking dopamine receptors
They can be either typical which strongly blocks dopamine or atypical which affects serotonin also
One example of a typical drug is chlorpromazine which blocks dopamine receptors and has side effects of dizziness, dry mouth and blank facial expressions
One example of an atypical drug is risperidone which balances levels of dopamine in brain and works on serotonin to control mood. Side effects of insomnia, severe anxiety and dizziness
4 strengths of drug therapy
Schooler - randomly allocated 555 sz patients to treatment of either haloperidol or risperidone and both showed 75% reduction in symptoms. TF increased validity
Fast and effective - Fast and effective compared to CBT in treating sz. Drugs can reduce symptoms within couple of week suggesting cause is biochemical. TF effective for treating first episode of sz
Pickar - compared clozapine with other neuroleptics and placebo to find clozapine most effective.
Barlow and Durand - chlorpromazine is effective in reducing sz symptoms in about 60% of cases mainly positive symptoms.
4 weaknesses of drug therapy
Reductionist - reduces treatment to NTs like chlorpromazine and not social causes like social class/living conditions TF too simplistic
Only treats symptoms not the cause - If they cease to take medication a lot of symptoms return. TF not effective therapy as need to be on it for rest of life unlike CBT
Guo - high drop out rates across 7 different sz drugs ranging from 30% to 46.9%
Side effects - large health side effects e.g. Clozapine causing drowsiness, blurred vision and troubled thinking.
Aim of Bradshaw
Look at how CBT was used to treat a woman with sz including its effectiveness. Use CBT when drug treatment was previously preferred.
Sample of Bradshaw
Carol a 26 year old white female
Procedure of Bradshaw
Bradshaw conducted a longitudinal case study of Carol, as it tracks Carols progress over 3 years of CBT
Carols symptoms were measured on four scales:
Psychosocial functioning was measured by a Role-Functioning Scale (RFS).
Attainment of treatment goals was measured by a goal-attainment scale looking at how she was functioning.
Hospitalisations were measured by the number of times in hospital.
Development of a therapeutic relationship was also measured.
Stage 1: Rapport developed – self disclosures from therapist used to build rapport over 3 months
Stage 2: Understanding CBT – 2 months – coping mechanisms of stress taught using ABC model enabling her to understand emotions
Stage 3: Treatment – Completed weekly activity schedule gradually increased activity & stress management techniques to reduce hallucinations.
Findings of Bradshaw
At the end of the study Carol reported few symptoms and little distress.
After 1 year, her RFS score was stable at 27 (she scored 6 at the start) symptoms.
Pre test had 60 hospitalisations in last 3 months but post test was 0
Conclusion of Bradshaw
Considerable improvements in all 4 measures after a 3 year
course T/F CBT can successfully treat schizophrenia when
changing automatic negative thoughts and changing
responses to stressful situations.
4 strengths of Bradshaw
Eco validity - Bradshaw documented Carols CBT sessions including her symptoms and the effectiveness of CBT. This was Carol’s genuine treatment and naturally occurring so in the natural setting
Practical application - in knowing a 3 year course of CBT can considerably improve carols functioning we can use this to treat sz. TF improving quality of life for sz
Confidentiality - true name of participant wasn’t revealed only pseudonym Carol. TF is ethical as confidentiality wasn’t breached
Demand characteristics -
4 weaknesses of Bradshaw
Pop validity - studied 26 year old middle class woman but only 1 person completed it. TF sample was unrepresentative of total sz population cant be generalised further as unique case.
Reductionist - only considers role of cognition and how to deal with stress using meditation not bio like hormones. TF too simplistic
Researcher bias - Carol and therapist built rapport which could lead to bias by therapist when reporting Carols symptoms
Longitudinal - Over a long period of time (3 years) so other variables may have led to her improvements not just the CBT
CBT in clinical AO1 (4)
Assumption of CBT when treating sz is that individual have irrational thoughts and beliefs about themselves and world around them. The aim is not to cure sz but allow patient to function normally
Role of therapist is to accept patients perception of reality and to use it to help manage them. Sessions last 15-60 mins for roughly 2 months.
Socialisation phase is where development of rapport takes place between sz and therapist. Disclose interests and problems to find common ground. Therapy phase understands CBT and focus on coping with stress via ABC.
End phase is 3 months focussed on life without treatment. for homework they have to record beliefs and feelings.
4 strengths of CBT for sz
Chadwick -studied 22 sz who heard voices and gave them 8 hours of CBT and all had reduced negative belies about how powerful the voices were. TF effective
Empowers the schizophrenic - in control so they decide on goals they want to achieve and speed of progress.
Bradshaw - concluded CBT can be successful in treatment of sz in controlling negative automatic thoughts and changing behaviour in response to stressful situations
Chadwick and Lowe - CBT reduced delusions in 10/12 patients
3 Weaknesses of CBT for sz
Time consuming and expensive
Kingdom and Turkington - 30% deteriorate during CBT
Bradshaw however - Case study so only one single unique case so not generalisable or representative
Reductionist
Cultural issues - the spiritual model
Lack of understanding of one culture to another
If clinician is from a different cultural background to patient some of their behaviours may be interpreted as abnormal when they aren’t
Malgady found the difference in hearing voices in costa Rica vs USA as in Costa Rica its interpreted as ancestors speaking to you and you will be admired but in US its a symptom off SZ.
Littlewood and Lipsedge found cultural bias can lead to subjective interpretation as Rastafarian Calvin was arrested and seen as eccentric and abnormally behaved however normal in his culture. TF no universal definition of abnormal as definition is ethnocentric
Cultural issues - Language barriers
When clinician and patient have different native languages and are using a common language which is less easy for one or both to understand during diagnosis
May impact clinicians understanding of the symptoms if they description doesn’t translate to the therapists native language.
TF resulting in misdiagnosis or potentially no diagnosis
Cultural issues - Culturally bound syndromes
Illnesses with a set of symptoms found and recognised as an illness in only 1 culture leading to different diagnosis in other cultures. E.g. native americans tribes see symptoms of nightmares, obsession with death and loss of appetite is ghost sickness but this isnt recognised universally. TF misdiagnosis or no diagnosis if not recognised universally.
Cultural issues - cultural norms and stereotypes
Leads do different diagnosis in different countries due to different beliefs about mental health disorder which leads to individual differences when diagnosing. Cooper examined 250 psychiatric admissions in NYC and London. DSM 2 found NYC schiz is 8x more frequent than bipolar but London was 1:1. TF same symptoms result in different diagnosis.
What is OCD
Marked anxiety or distress caused by obsessions and compulsions disturbing the persons behaviour
3 features of OCD
According to Grohol OCD tends to start in childhood or adolescence and affects males and females equally
Ranked by the WHO as top ten most disabling illnesses in terms of impaired quality of life and loss of earnings
National institute of health suggests in USA over 12 month period around 1% of population will have OCD and 50% of those being severe
3 symptoms of OCD
Obsessions are recurring persistent thoughts, impulses or images that are experienced causing marked anxiety or distress
Compulsions are repetitive behaviours or acts sufferers feel must be carried out to temporarily remove the distress caused by obsessive thoughts
Excessive anxiety
Neuroanatomical explanation of OCD
According to this explanation, OCD is caused by problems in certain areas of the brain.
The main brain regions where the problems have been found are:
The Orbitofrontal cortex
The Caudate Nuclei.
The Thalamus
The Cigulate Gyruis
The four regions of the brain above form a circuit that coverts sensory information into thoughts and actions. It is dysfunctions in this neurological loop that is thought to be the cause of OCD.
Each area is over active so must state when describing each region
The Orbitofrontal cortex(OFC)
Region responsible for decision making, converting any sensory information
PET scans found this are for OCD patients brains to be overactive, increasing the conversion of sensory information to actions (behaviours) leading to increased worry/panic leading to obsessions
E.g. initial panic of touching door handle
The caudate nuclei
OFC sends message of panic/worry to the caudate nucleus.
Is responsible for repetitive behaviours, reward experiences and focussing attention. Decides whether messages are important or not so acts as a filter for messages between OFC and thalamus
Caudate nucleus is overreactive so its impaired function means irrational messages of worry aren’t filtered out.
E.g. sends worry of touching door handle to thalamus
The thalamus
Message passed to thalamus whose role is to respond to sensory and motor signals, carrying out necessary required action.
OCD patients overreactive thalamus leading to behaviours that emerge as compulsions.
Thalamus directs messages back to part of brain that can interpret them like cingulate gyrius
E.g. washing hands after touching door handle
The cigulate gyrius
Message passed from thalamus to here
Responsible for focussing attention on emotionally significant events so is the emotional response to the compulsion that has been created which will be relief from compulsion acted on
However cigulate gyrius pass on relief message to OFC and dysfunctional neuronal loop will start again
E.g. relief of hand washing
4 strengths of neuroanatomical explanation of OCD
Menzies - when conducting brain scans of OCD patients there is less grey matter in orbitofrontal cortex, compared to healthy control group
Max et al - When caudate nucleus is disconnected from orbitofrontal cortex in surgery OCD symptoms reduced
McGuire - people with OCD were shown objects that bring on symptoms such as dirty clothes for cleaning compulsion activity increased in orbitofrontal cortex and caudate nucleus
Feng - bred mice to show OCD symptoms. Anxious behaviour, when a certain gene is missing. This gene is one that is expressed in the brain areas associated with planning and initiation of actions, showing a clear link to the formation of compulsions.
4 weaknesses of neuroanatomical explanation of OCD
Feng However - Feng used mice to research OCD which is anthropomorphic. TF cant be generalised and unrep of human OCD
Reductionist - only considers bio of overactivity of brain areas causing OCD. No nurture like life experiences leading to faulty cognition and compulsions.
Cause and effect - Findings of overreactive thalamus linked to OCD has only been investigated after diagnosis so only correlational. TF reduced validity
Sanematsu - Found differences in other brain areas in OCD patients like cerebellum. Tf not just isolated to parts suggested by neuroanatomical theory.
What are the 4 A01 points for cognitive explanation of OCD
Assumptions of cog approach linking to OCD
External factors/feedback
Lack of confidence in memory
Inflated sense of personal responsibility
Cog assumptions linked to OCD
Input–>Processing—>Output
Hard wiring is the biology and programming us nurture and environment
Hard wiring - predisposed risk
Programming - traumatic experience causing the OCD
External factors/feedback
Faulty info processing stems from experiences within life
Perceptions or thoughts we have about our experiences will trigger an emotional response which triggers behaviour to deal with the emotion.
Pace et al suggested criticism from others is perceived as negative judgement and may lead to vulnerability that leads towards development of OCD
Inflated sense of personal responsibility
Salkovskis suggested OCD arises from having an inflated idea of ones own responsibility
The sufferer overestimates the importance of their own thoughts and actions in respect of specific outcomes; leading to self blame if something does occur, so they see themselves as responsible for preventing harm to themselves and others
Compulsions are self-fulfilling as they reduce anxiety but they reinforce ideas that thoughts are doing harm and so are repeated.
Lack of confidence in memory
There is also evidence that memory systems might be impaired, either the OCD sufferer does not have the memory of doing a particular behaviour, or they do not trust the memory they have and so feel compelled to do the behaviour again.
Sher et al found that people with OCD had poor memories for their actions, for example, they really could not remember if they had turned the light off.
4 strengths of dopamine hypothesis
Research of amphetamine users - control groups given amphetamine shown similar symptoms to sz as it increases DA in brain resulting in hallucinations
Carlsson - brain scans showed sz patients given amphetamines release more dopamine than control. TF sz more sensitive to excess dopamine
Wong - PET scans show greater density of dopamine receptors in unmedicated sz’s than medicated. TF dopamine receptor density contributes to sz symptoms
Seeman - increased density of D2 receptor in sz post mortem brains than non sz. TF D2 receptors linked to sz increasing validity
4 weaknesses of dopamine hypothesis
Jackson - Reviewed various studies and found no consistent differences between levels of dopamine in untreated schizophrenics and control groups. TF cast doubt on role of dopamine
Cause and effect - Excess dopamine activity is only measured in schizophrenics after they have been diagnosed with the disorder. TF, it is not clear if it is an effect or cause; reducing validity
Reductionist - Only considers role of neurotransmitter dopamine in the role of the development of schizophrenia no social aspects like social causation.
Carlsson - Carlsson also found low glutamate → high DA activity levels = high sz. Also, glutamate deficits in the cerebral cortex and basal ganglia can cause negative + positive SZ symptoms, respectively. Therefore, dopamine hypothesis too simple
4 strengths of social causation theory
Neale et al - found schizophrenics occupy lower status jobs compared to their fathers. TF increasing validity of downward drift
Harrison et al - Found that schizophrenics show clustering in declining inner city areas. TF supporting downward drift
Cooper - Found that the rate of schizophrenia in unskilled labour workers was 4.1 times higher that managerial workers. TF supports idea that coming from lower social class increases risk of developing schizophrenia.
Immigrant groups show higher rates of schizophrenia - The 1991 and 2001 censuses show a higher incidence of schizophrenia in the
Afro-Caribbean and Black immigrant population. This could be because migrant populations are in lower class with high stress. TF supports coming from ethnic minority increases prevalence of sz
4 weaknesses of social causation theory
Veling et al - found when immigrants were in neighbourhoods where their ethnic group didn’t predominate there was a higher rate of psychotic disorders compared to ones where it did. Suggests social factors can affect the development of sz, not the cause. TF correlation only
Kirkbride - Found rates of sz were lower for Afro-Caribbeans when they lived in ethnically-integrated neighbourhoods. Therefore, suggesting not all ethnic minorities that are at higher risk of developing the disorder.
Reductionist - Only considers nurture and social setting like urban settings no biology like dopamine hypothesis. TF too simplistic
Diathesis stress model - The diatheses stress suggests that schizophrenia is genetically predisposed, and will be triggered by environmental factors. Therefore, accounting for all explanations and the complexity of schizophrenia.
What is thematic analysis
It is a method that identifies, analyses and reports patterns within qualitative data known as themes. Thus, it allows researchers to reduce data in a flexible way to produce a short summary of the main features of a data in which conclusions can be drawn from.
According to Braun and Clarke there are 6 phases of conducting a thematic analysis.
1. Becoming familiar with the data.
2. Generating initial codes.
3. Searching for themes.
4. Reviewing themes.
5. Defining and naming themes.
6. Producing the report.
2 strengths of thematic analysis
Qualitative data - Thematic analysis summarises large amounts of qualitative data collected from patients, yet still maintaining the richness and detail of what the patient has said through themes. TF valid themes produced to truly reflect patient’s experiences
Clinicians use primary data - Clinicians use thematic analysis on data on patients that they have collected themselves, so it has not been interpreted or manipulated by other clinicians. TF data used from patients is a valid source of information on clinical disorders.
2 weaknesses of thematic analysis
Researcher bias - Clinician selectively picks aspects of the data to focus on, and as the theory begins to emerge, focuses on only the aspects of the theory they are developing. TF theory is based on the subjective opinion of the clinician reducing validity
Time consuming - Because the clinician will know their data best; they will need skill in order to establish codes and themes; whether to split, collapse or delete different themes when reviewing the data. TF not the most practical or cost effective research method available to clinicians.
3 Strengths of cog explanation of OCD
Stekett et al - Found OCD patients scored higher on cognitive measures than people with anxiety disorders. Overall found correlation between severity of OCD symptoms and level of dysfunctional thinking experienced. TF suggesting OCD is a consequence of faulty cognition
Libby et al - Found those with OCD had higher scores than other groups regarding raised responsibility and thought-action linking. They also had higher concerns over mistakes, which is an aspect of perfectionism TF supports the idea that guilt & faulty cognitions lead to OCD
POTS - CBT alone showed higher effectiveness than SSRI, which helps show that CBT can help the symptoms of OCD. T/F, supporting cognitive explanations that OCD is caused by faulty thinking.
CBT alone = 39.3% p’pants entered remission
Drug alone = 21.4% p’pants entered remission
4 Negatives of cog explanation of OCD
POTS However - Shows CBT and SSRI together have a higher effectiveness than CBT alone, showing other factors also influence symptoms of OCD. TF cog explanations not most effective method of treating OCD
Rachman - Developed exposure and response therapy (ERP) which involves elements of flooding and training a person to experience a different response to their obsession. ERP is an effective therapy for people with OCD. TF suggests faulty cog not only factor of OCD
Abramowitz - Suggests for average OCD patient cognitive therapy does not help any more than exposure and response therapy which is not a cognitive therapy, but a behavioural therapy. TF reduce validity of cog explanations as not only contributing factor
Reductionist - only considers faulty cognition like life experiences no bio like over active thalamus
Explain drug therapy for OCD(4)
Anxiety is regulated by the brains GABA an amino acid that works at the synapses to lower physiological arousal and return the body back to a regular resting state
There’s evidence that low serotonin is linked to OCD symptoms so the majority of drugs used to treat OCD are anti-anxiety medication and target neurotransmitters associated with anxiety and OCD symptoms.
SSRI’s block reuptake of serotonin. Increases serotonin levels in synaptic cleft potentially alleviating symptoms of depression and anxiety.
Beta Blockers block the effect of adrenaline reducing HR and blood pressure. Inhibit action of hormones do help decrease heart work load
3 strengths of drug therapy for OCD
Soomro et al - Used individual randomised trials using antidepressants for the treatment of OCD comparing SSRI’s with a placebo showing drugs were more effective than placebo in reducing the symptoms of OCD. TF supporting drugs are effective treatment
Stanford School of Medicine - suggests 40-60% of OCD patients respond to SSRIs or clomipramine, though it is not possible to know which patient will respond to which drug. TF drug therapy effective at reducing OCD symptoms
Supporting research use randomised trails - p’pants randomly assigned to placebo, control or real drug condition so good as they don’t know what category they in. TF there is a careful control group adding objectivity and credibility to findings, making them scientific.
4 weaknesses of drug therapy for OCD
Koran et al - Some of the patients continued on sertraline while others were given a placebo. Found a relapse rate of 21% in those remaining on the drug and 59% on the placebo. TF drug therapy is not fully effective in treating OCD patients.
Ravizza et al - Found SSRI drugs were not effective for 40% of patients with OCD. TF, drug therapy is not effective for all OCD patients.
POTS study - found drugs most effective when combined with CBT rather than when used alone. There was 12.6 decrease in mean CY-BOCS score compared to 7 decrease alone. TF drug therapy is not a fully effective treatment alone and needs to be combined with other therapy to fully treat OCD.
Side effects - SSRIs used to treat OCD patients can have large amounts of serious side effects. For example, fluoxetine has side effects of nausea, headaches, and dizziness, which could lead to dropout rates. T/F: Drug therapy cannot safely treat OCD patients without subjecting them to harm.
Explain how CBT can be used to treat OCD (4)
Works on the assumption that OCD suffers has irrational thoughts and beliefs in the form of obsessions and compulsions will help with these.
Aim is to help identify why obsessions develop, challenge these and challenge the use of compulsions e.g. checking.
Therapist challenges obsessive thoughts through questioning and providing coping strategies. Use ERP to expose to a situation that causes anxiety, create a hierarchy but will resist performing checking compulsions. Trained to monitor own anxiety levels.
Socialisation phase – building a rapport with the therapist and the patient understanding their obsessions and compulsions. End phase - anxiety about relapse.
4 strengths of CBT for OCD
Balkom et al - Has suggest ERP is more effective than other treatments when treating CBT, with lower chance of relapse. TF is long term effective as relapse is reduce, so effective therapy for treating OCD.
Whittal et al - found lower OCD related cognitions and
less depression for the two treatment groups. However CBT did show larger changes than SMT on most OCD related cognitions.
TF effective treatment for OCD.
Ethical - OCD patient has control. Decide what to focus on in each session and how fast to progress. The diary also allows for reflections. TF empowered the OCD patients, reducing social control.
POTS - Found that treating OCD using drugs alone lead to 21.4% of patients entering remissions. Therefore suggesting OCD have a biological cause as drugs therapy is successful, supporting the neuroanatomical explanation of OCD
4 weaknesses of CBT for OCD
POTS however - CBT alone led to greater reduction of symptoms compared to drugs alone with 39.3% of participant entering remission compared to 21.4% of drugs alone. Therefore cognitive therapy was more successful
Cordioli - Claims that CBT is effective for about 70% patients with OCD, however the others do not respond to it. TF not effective for all cases of OCD
Requires commitment - aim is to change the patients cognitions through challenging their obsessive thoughts which can take many sessions, ranging over many months. TF need to be committed and may have high drop out rates.
Reductionist - only considers cognition no bio like neurotransmitters like serotonin. TF too simplistic
Aim of POTS
To investigate if CBT on its own is more or less effective than using SSRI alone.
Sample of POTS
Sample of 112 outpatients of children and adolescents aged between 7 and 17 years (average age 11.7 years) were recruited from those who had been diagnosed with OCD using DSM IV from USA
Procedure of POTS
P’pants were screened on the severity of their symptoms using the CY-BOCS where only scores of 16 and above were included
P’pants randomly selected into groups: drugs, CBT, placebo, both
Each child had psychiatrist to monitor their progress
Assesses initially to establish symptoms and anxiety
Assessed them further at 4 weeks, 8 weeks, 12 weeks
Findings of POTS
97 completed
All conditions showed improvements at 12 weeks as measured by CY-BOCS however placebo improvement was not significant
In the CBT alone 39.3% entered remission
21.4% in drugs alone
Combination initially measured at 23.8 but after 12 weeks 11.2
Conclusion of POTS
Combined treatment of CBT and sertraline was the most effective treatment.
Study showed clear effect of CBT leading to higher improvement rate than drugs, suggesting that the first line of treatment should be CBT
4 strengths of POTS
Eco validity - took place in a hospital setting which is a common setting to receive therapy in. TF naturally occurring and can be generalised
Practical applications - concluded combined CBT and drugs is most effective as mean CY-BOCS score decreased by 12.6. TF can improve patients life and benefit society
Objective data - used Childrens Yale brown obsessive compulsive scale which provides quant data on their improvement of symptoms. TF no subjective interpretation and bias so reliable and valid
Mundane realism - for an OCD patient receiving treatment is naturally occurring as is something they would have done in everyday life. TF naturally occurring and representative and can be generalised to everyday OCD behaviour.
4 weaknesses of POTS
Temporal validity - Study on CBT and SSRI treating uses DSM4 but the up to date is DSM 5TR. TF findings om CBT alone causing 39.3% remission are not relevant so reduced validity
Pop validity - All 112 students were from 3 universities across America meaning it was ethnocentric. TF unrep and cant be generalised
Demand characteristics - Recruited from a volunteer sample from 3 US universities meaning they may have known what the study was about and not shown true behaviours. TF findings may not be valid
Deception - Placebo group thought they were actually getting treatment. TF breached ethics
What is a meta analysis
A meta-analysis is a form of secondary data, where a researcher combines the findings from multiple studies about the same topic and analyses theses as a whole
If a number of studies separately find the same answer, and then those studies are analysed together the answer becomes stronger as the studies support one another
For example, if one study finds that being overweight means less likelihood of developing dementia and other studies have found the opposite, then it might be worth conducting a meta-analysis of current research to see what the overall findings suggest
2 strengths of meta analysis
Find trends data - As multiple studies are analysed this allows trends/relationships to be found in symptoms, therapies of issues generated by clinical disorders studied so the statistical result is larger than the result of the single studies
Large sample size - The meta-analysis combines findings and so ensures that a larger sample is generated to draw clinical conclusions from. Furthermore, some studies can be from different cultures allowing universality of a disorder to be found
2 weaknesses of meta analysis
Secondary data - The studies a meta-analysis draws on are unlikely to be identical in their hypothesis. Collating findings of patients from different studies together needs careful decision making to make sure that the data can be compared.
Publication bias - A meta-analysis only uses published studies, meaning unpublished studies on patients are not used. This can distort the findings of the meta-analysis, as studies that show negative or non-significant results are less likely to be published
