clinical psychology Flashcards

Question

summarise the DSM IV TR

Answer 1

16 categories used to identify clinical disorders- eg anxiety disorders, sleep disorders, eating disorders multi axial systems of classification (5th most important) published in 2000 used to classify and diagnose clinical disorders contains GAF in axis 5, high rank, better functioning

Answer 2

elimination of multi axial system/GAF due to concpetual lack of clarity and questionable psychometric properties disorder reclassification (eg mood disorders is now bipolar and related disorders OR depressive disorders) eliminated disorders such as hyphocondriasis added disorders such as gender dysphoria

Answer 3

new chapters- eg sleep wake disorders allows for more straightforward coding french language now available new disorders- eg binge eating disorders harmonising with DSM

Answer 4

multilingual and multidisciplinary section F contains mental health disorders disorders coded with letters and numbers- alphanumerical EG depression (F32), mild depression (F32.0) also includes health disorders ICD 10 can classify symptoms and diagnose disorders (physical and mental) published by world health organisation used by clinicians

Answer 5

interrate reliability: present the same case study to a variety of clinicians and assess the extent of agreement, if their is agreement is diagnosis then there is inter rate reliability test re test reliability: assess the same patients two or more times and see if they receive the same diagnosis, (not over a long time period as symptoms may change due to improvement )

Answer 6

Jakobsen et al- found there was agreement is the diagnosis of schizophrenia between the ICD 10 and other classification systems, t/f suggesting diagnosis can be repeated with the ICD and other classficiation systems to establish the same diagnosis, thus improving the reliability of the ICD 10 helping to ensure correct diagnosis and thus correct treatment Andrews- assessed 1500 patients using the DSM IV and compared this to a diagnosis using the ICD, he found agreement on diagnosis for depression, substance dependence and generalised anxiety, t/f suggesting the DSM IV and ICD have established similar findings on the diagnosis of depression, substance dependence and anxiety thus increasing the reliability of these classificiation systems

Answer 7

Unstructured interviews: clinicians gather information about their patients through undtructured clinical interviews meaning patients may provide different descriptions of sypmtoms to different practicioners, t/f making it harder to establish consistent findings and leading to unrelaible diagnosis when using classification systems Subjective interpretations: the way a criterion is phrased within the DSM can be open to interpretation eg manic syndrome states that the mood must be abnormally and persistently elevated, t/f the same patient may not receive the same diagnosis when diagnosed by multiple clinicians decreasing test retest reliability

Answer 8

Concurrent validity: system is consistent in diagnosis with a manual that has already been found to be valid Predictive validity: valid system if it can predict the course of the illness accurately eg whether the patient is likely to recover Construct validity: symptoms shown by the patient match symptoms considered to be present for that disorde and thus the symptoms in the manual must be representative of the illnesss

Answer 9

Lee et al: found that for the diagnosis of ADHD there was agreement between the DSM IV and questionairre data t/f the DSM can be seen to have concurrent validity for ADHD Powers et al: found that women who had suffered complex ptsd trauma also had high levels of alchohol and substance misuse as predicted by the ICD 11, t/f suggesting that the ICD 11 has predictive validity for the diagnosis of complex ptsd

Answer 10

Rosenhan: all but one pseudo patient was diagnosed as schizophrenic and upon release 7 were given the diagnosis schizophrenic in remission using the DSM 2, t/f the DSM 2 lacks construct validity for schizophrenia as when using it 7 pseudo patients were misdiagnosed Reductionist: the DSM and ICD split clinical disorders into lists of symptoms and features, this simplifies complex behaviours and reduces it down to a list, this may not be representative of everyone's behaviour and not all individuals suffer from the disorder the same, t/f this can lead to incorrect diagnosis and ignoring opf individual differences and lack of a holistic approach, decreasing the validity of these classificiation sysrtems

Answer 11

A language barrier is where a clinician and patient have differing native languages and are using a common language which is less easy for one or both patients to understand during treatment or diagnosis Culturally bound syndromes are illnesses with a set of symptoms found and recognised as an illness in only one culture The spiritual model is an understanding that if a clincian is from a different cultural background to their patient, some behaviours may be interperetted as abnormal even though they are not Influence of cultural norms and stereorypes is where different psychiatrists may have variance in their teachings and thus may diagnose disorders differently leading to misdiagnosis

Answer 12

a language barrier may the understanding that the therapist has of the patients symptoms, if the symptoms descrivbed by the patient do not translate to the therapists native spoken language, t/f resulting in misdiagnosis or potentially no diagnosis if the symptoms are not recognised or lost in translation, suggesting culture influences diagnosis

Answer 13

culturally bound syndromes may impact diagnosis as in some cultures diagnosis of certain symptoms may vary, eg ghost sickness in native america can be characterised by obessions with death, nightmares and tremors which could be diagnosed as manic in the uk, t/f resulting in misdiagnosis and inconsistent disorders throughout cultures suggesting culture does impact diagnosis

Answer 14

the spiritual model may impact diagnosis, littlewood and lipsedge found that calvin a rastaferian in the USA was arrested sue to his abnormal appreance seen as eccentric however in his culture this would be the normal way to dress, t/f diagnosis can be ethnocentric as their is no global definition for abnormality suggesting that culture impacts diagnosis

Answer 15

cultural norms and stereotypes impact diagnosis because Cooper found that after the examinstion of 250 psychiatric admissions at hospitals in New York and London, they wwatched filmed interviews that used the DSM 2 and found in NY SZ was diagnosed 8x more than bipolar whereeas in London it was 1:1, therefore as the same syptoms did not result in the same diagnosis in the 2 countries, this suggests that culture influences diagnosis

Answer 16

primary data is information collected first hand by the researcher on mental health disorders, the researcher plans and conducts a study and collects and analyses the data specifically for their research hypoythesis, data can be qualitative or quantitative methods used to collect: unstructured interview observation first hand questionairres

Answer 17

data is fit for purpose: as the researcher conducts their own research and chooses the correct procedure they can produce data that fits their research hypothesis, t/f primary data collected on clinical disorders are fit for purpose and valid range of data can be collected: data collected on clinical disorders can be qualitative or quantitiative, so can be analysed in various ways, furthermoe clinicians have contact with patients so further info can be gathered when necessary, t/f this can produce a detailed analysis of clinical disorders, increasing the validity temporal validity: research will be conducted using the current DSM criteria to diagnose patients from the current population using methods releavnt at that point, t/f the data collected on mental health has external validity as it is releavnt to current mental health disorders

Answer 18

population validity: large populations on MH patients can be hard to find due to time and restrictions so primary research will often have small samples due to secondary data, t/f the patients will be unrepersentative and the findings on mental health cannot be generalised to the whole MH population reducing the validity practical: researchers need to pla, accquire a sample and collect and analyse the data, this can be time consuming and expensive compared to secondary data, t/f it is not an economical method for researchers to use to study mental health compared to secondary dat5a researcher effect: researcher has contact with the patients taking part and could influence the patients, features of the influencer could influencve ppants behaviour this could lead to demand characteristics, t/f behaviour displayed not be naturally occuring and cannot be generalised to everyday behaviour for that disorder reducing external validity

Answer 19

secondary data is data collected second hand on mental health disorders the researcher uses data from other people's data and research data can be quantitative (closed questionairres done by another researcher) or qualitative (hospital notes)

Answer 20

Large sample size- as the clinician is using data that has already been collected they can gather it from across multiple data sources meaning that they can have large sample sizes, t/f the patients will be more representative of the mental health population and the findings can be generalised, so the clinician can draw more meaningful conclusions on mental health Practical- as the researcher does not have to plan and conduct research it is less time consuming and expensive for the clinician, t/f it is a cheaper and quicker way to study mental health compared to using primary data Ethical- as the clinician is not interacting with the patient there is no way they can make there condition worse or impact the patient negatively and consent will have already been obtained, t/f it is a more ethical method compared to primary data as there is no contact with the patient

Answer 21

May not be fit for purpose- as the research has not been conducted by the clinician, the data may not answer the specific clinical research question thus it is less relevant to the research question than primary data, t/f secondary data collected on clinical disorders is not always fit for purpose or valid Lacks temporal validity- as the research done by the clinician was done in the past it may use an out of date version of the DSM or use methods that are no longer used, t/f the data collected on mental health lacks external validity as it may not be relevant to current mental health disorders and thus cannot be generalised to the current mental health population Internal validity issues- as the data used was not done by the clinician the clinician cannot be sure that the researcher controlled for extraneous variables, t/f the clinician cannot be sure that the research on mental health has internal validity

Answer 22

investigate if sane people could be distinguished from insane people using the DSM II, and if they can be differentiated how sanity can be identified also to see if the DSM II is a valid diagnostic tool

Answer 23

8 pseudo patients were sent to 12 different hospitals across the East and West coast of America hospitals were a range of new, old, private and public the pseudo patients gave the hospitals pseudonyms and false occupations when they phoned they said they could hear unfamiliar voices (same sex) saying EMPTY, HOLLOW and THUD apart from these details all other information was true once admitted pseudo patients acted normally did ward activities covertly kept notes but later overtly when asked how felt they said fine asked "Pardon me when am i likely to be discharged" pocketed/flushed medication

Answer 24

pseudo patients were identified as insane all admitted and none detected as sane all but 1 diagnosed as schizophrenic 7 released with diagnosis of sz in remission stayed in hospital 7-52 days (average 19 days) 30% of patients realised pseudo patients were sane visitors also thought pseudo patients acted normally saw other patients medication in toilet diagnosed with oral acquisition syndrome (because queue early for lunch) and pathalogical writing behaviour (because writing about experience) experienced DEPERSONALISATION due to having no privacy average therapist patient contact was 7 minutes a day

Answer 25

staff were unable to distingush those who were sane from those who were insane behaviours were interpreted via expectations from diagnosis rather than objectively from their behaviour the power of the label of insane leads to the subjective interpretation of behaviours displayed

Answer 26

Range of hospitals- used a range of 12 hospitals across the west coast of America including new old private and public, t/f findings that psychiatrists couldnt distinguish dane from insane is can be generalised to psychiatrists in America Practical applications: from Rosenhans's findings the DSM II was improved as a diagnostic tool, we can see this now with the DSM IV TR as it is a much more rigorous diagnostic tool for SZ, t/f rosenhan's findings have benefited society by improving the reliabiloity of SZ diagnosis Ecological validity- rosenhan's study took place in a natural setting within the 12 american hospitals, t/f the environment was natural for the psychiatrists and thus there diagnosis of insane for the sane pseudopatients was naturally occuring and can be generalised to their everyday diagnosis Mundane realism- diagnosing patients admitted to the hospital was an everyday familiar tasks for the clinicians and thus their diagnosis was naturally occuring, t/f the findings that clinicians couldnt distinguish the sane from the insane are representative of the clinicians everyday practice and thus the behaviour is generalisable

Answer 27

Standardised procedure- although all pseudo patients were trained before, they did not all follow the same procedure for example one pseudopatient struck up a romantic relationship with a nurse, t/f the procedure was not repeated the same for each of the 12 hospitals and thus rosenhan did not establish consitent findings throught and his findings that clinicians cannot distinguish the sane from insnane lack reliability Temporal validity- the findings that clinicians couldnt distinguish the sane from the insane is only applicable to the DSM II, the DSM IV TR is more generalisable to current mental health, t/f the findings that clinicians cannot distinguish the sane from the insane are outdated and no longer valid findings for mantal health Doctors play it safe- it is better for the doctors to misdiagnose a sane person and keep them in hospital rather than possibly release an insane patient as it could put their life in danger so the doctors could have diagnosed the pseudo patients with SZ as it was the closest diagnosis of the symptoms, t/f the clinicians may not have thought the pseudo patients were insane but may still have diagnosed them to keep them safe, decreasing the validity of rosenhans findings Deception- the 8 pseudo patients gave the doctors fake names, occupations and symptoms of auditory hallucinations (empty, hollow, thud), thus the clinicians were unaware they were paticipating in research, t/f the clinicians from the 12 hospitals were deceived by the 8 pseudo patients and rosenhan breached the ethical BPS guideline of deception, so rosenhans study is unethical

Answer 28

say something happened but it didnt

Answer 29

say something didnt happen but it did

Answer 30

- clinical interviews are typically face to face whereby the clinician will ask a range of open and closed questions about the MH patients symptoms and the patient will respond describing their symptoms - multiple clinicians could used an unstructured interview technique to gather rich detailed data about the patient and see if they give the same diagnoses eg if the patient says they hear voices the clinician could ask what gender are the voices - the interview can be videod and transcribed by the clinician and thematically analysed to determine a full understanding of the disorder to make a correct diagnosis - interviews gather in depth detailed qual data on the patients symptoms so they can be diagnosed and treated

Answer 31

Gather in depth data- as the clinician generates the questions based on the previous answer (eg if the patient says the hear voices the clinician could ask what they say) so the clinician is able to understand the depth of the symptoms t/f the clinician can use their in depth detailed knowledge of the patient to make the most accurate diagnosis and increasing likelihood of succesful treatment thus increasing the validity of clinical interviews Practical applications- by gaining an understanding of the patients symptoms this could help the clinician gain a deeper insight into the disorder and lead to future research t/f clinical interviews can lead to research into disorders which can help the patient and future patients thus lesding to more succesful diagnosis and treatment in society and increasing the validity of using clinical interviews

Answer 32

Consistency- as clinical interviews are often semi structured two patients with the same symptoms could come in but based on the wording of there answers may receive different questions which could lead to different diagnoses and potentially misdiagnosis t/f the use of unstructured clinical interviews could lead to different diagnosis of the same questions and misdiagnosis thus reducing the validity of clinical interviews Subjectivity- when the clinician analyses the transcripts of the clinical interviews they may interpret the qualitative data on the patient in a biased way (eg may be swayed towards disorders they have the greatest knowledge on), t/f the interpretation on the data gathered by the clincian about the patient may be subjetive leading to misdiagnosis, incorrect treatment and thus decreasing the validity of using clinical interviews

Answer 33

it's a method used for developing theories about mental health from research evidence. qualitative research on mental health is the focal point. research is conducted to gather info about a patient and the theory about mental health emerges from the gathered and analysed data (inductive method) how its done: 1. identify the behavioural area they're interest in and where they can gather information on this from 2. Caterogies are created from the collected data 3. they add comments to try and develop the clarity about what the data is showing them which helps identify links between different concepts emerging from the data 4. once a concept has developed researchers can review other literature and develop the theory in more detail

Answer 34

Evidence is intergrated into the theory- as the theory is generated from the evidence being used this means the theory is relevant to making a diagnosis t/f the theory on mental health will have high validity

Answer 35

Subjective analysis- theory is based on the subjective opinion of the researcher the researcher picks aspects of the data to focus on and may force the data they are using to support the emerging theory t/f the researcher is selecting information and may miss information thus reducing validity of the theory on mental health Reliability- theory is based on the subjective interpretation of the researcher and the researcher will choose to only focus in on the information that supports their emerging theory t/f when another researcher conducts the same research or codes the data different theoretical concepts may emerge so the findings will not be consistent

Answer 36

- analyses a primary source generating qualitative data - bottom up approach typically uses a two tailed hypothesis - summarises large amounts of data into themes enabling conclusions to be made - creates themes with supporting quotes 6 phases 1. familarise with data 2. generate initial codes 3. search for themes 4. reveiw themes 5. define and name themes 6. produce report

Answer 37

Primary data- clinicians use thematic analysis on patients that they have collected themselves, so it has not been interpretted or manipulated by other clinicians t/f the data used from patients is a valid source of information on clinical disorders Reduces large amount of data into a manageable summary- clinicians can generate codes and summarise further into common themes making it easier for meaningful conclusions to be drawn about the patient, their didorder and usefulness of treatment t/f as themes are carefully considered the conclusions drawn about the patient can be considered valid

Answer 38

Often uses questionairres or interviews- use of leading questions could lead to subjective data being gathered eg "are you hearing voices" t/f the data and themes gathered about the patient lack validity Researcher bias- although evidence is used to generate grounded theory, the clinician selectively picks aspects of the data they want to focus on t/f the theory is based on the subjctive opinions of clinicians reducing the validity of this theory

Answer 39

to determine the usefulness of psych educational material provided via group work for offender patients within a highly secure forensic psychiatric hospital

Answer 40

42 male patients detained in a high security prison referred for an understanding mental illness psycho educational group most had ICD 10 diagnosis of schizophrenia, schizotypical or delusional disorders

Answer 41

lead researcher carried out semi structured interviews with the patients after each group therapy session interviews investiagted patients view of group therapy, gained insight of pos and neg aspects of group, feedback on how it could be improved and what they felt theyd gained interview sechdule used CORE-OM to asses the effectiveness of psych ed therapies and wellbeing, the SCQ is a self report questionairre used to assess self esteem all interviews were recorded to allow researchers to check the accuracy of the data they report on and the data was transcribed and then stored virtually number of violent incidents were noted ranging from minor verbal comments to interpersonal violence, changes in medication and staff using other therapies

Answer 42

31/42 completed therapy, 21 had interviews all 21 found group useful identified themes: clinical implications (gives peace of mind) what was unhelpful (felt guilty about past) patients reported increased confidence completees had a lower admissions duration of 6 years vs 9 years for non completers over 50% reported increased self esteem 1 claimed negative impact

Answer 43

there is usefulness of psych ed material provided via group work for offender patients within a highly secure forensic psychiatric hospital interviews showed offenders valued knowledge about their illness interviews outlined the lack of previous knowledge overall semi structured interviews were useful and their data could inform future practuce

Answer 44

Standardised procedure: all 21 chizophrenic patients received the same predetermined SCQ questions to assess self esteem and thee same questions in the semi strutured t/f easy to replicate to establish similar findings on offenders response to the usefulness of psych ed increasing reliability Qualitative data: clinicians asked open questions to the 21 offenders generating qualitative data such as "it give you peace of mind" on the usefulness of psych ed material t/f the qual data collected gave a detailed insight into psych ed therapy increasing validity Videoed interviews- clinicians videoed and stored the interviews so they could be interpretted by other clinicians to establish similar findings on the usefulness of psych ed t/f increasing the interrate reliability of the findings gained from semi structured interviews about the usefulness of psych ed material Rapport- researchers use of semi structured interviews meant the questions answered regarding usefulness of psych ed material could be more conversational meaning the prisoners are likely to be more comfortable discussing their mental health t/f the findings on the usefulness of psych ed material have high internal validity

Answer 45

Spontaneous questions- clinicians asked the 21 schizophrenic offenders questions based on previous answers due to the semi structured nature of the interview t/f the interview is hard to replicate fully to establish similar findings on the usefulness of psych ed material thus decreasing reliability of vallentines findings Subjective interpretations- researchers analysed the semi structured interviews and found 4 main themes including what patients valued and why however there could have been bias in the themes in order to support the hypothesis that psych ed would be useful for offenders t/f themes generated about usefulness of psych ed gained from clinical interviews lack internal validity Researcher effect- may have caused validity issues because patients are more aware that the researcher is observing them so they may alter their behaviour t/f decreasing the validity of psych ed material being useful for schizophrenics Small sample- vallentine only interviewed 21 schizophrenics as semi structured interviews take a long time to conduct and analyse so the sample may not be representative of the wider SZ population t/f the findings that psych ed material is useful for shizophrenics cannot be generalised to all schizophrenics

Answer 46

Jablensky - schizophrenia is found in any nation at a rate of 1.4 to 4.6 per 1000 people

Answer 47

10 or more years less than average Duerr suggests adolecents with psychotic symtpoms are 70 times more likely to attempt suicide

Answer 48

overall no gender differences but males more likely to develop ages 16-25 whereas women late 20s Lindmer et al- patients with late onset SZ are more likely to be female and have a shorter period of illness

Answer 49

50% of schizophrenics have periods of recovery 25% have it continually with no breaks David Lewis claims children who later develop SZ have premorbid behaviour such as learning difficulties and behavioural problems

Answer 50

positive adds to behaviour

Answer 51

negative takes away from behaviour

Answer 52

hallucinations delusions formal thought disorders

Answer 53

hallucinations are a cognitive symptom and are false pereceptions that have no basis in reality Auditory- hear sounds that arent there (eg voices) Visual- see things that arent there (eg dead people) Tactile- feel touch/movements on body (eg tingling) Somatic- bodily sensations inside body in absence of objectifiable cause (eg creatures in you)

Answer 54

cognitive symptom and are a firmly held false belief with no basis in reality of Grandeur- idea you are important individual/hold power (eg jesus) of Persecution- belief others want to harm or manipulate you (eg chased by mafia) of Reference- idea that everything has personal significance (eg TV talks to you) of Control- other things trying to take control of you (eg government)

Answer 55

disturbances in thought patterns Thought insertions- person thinks their own thoughts are not their own and are put there by someone else Disorganised thinking- hard to put thinking into logical order Loose associations- disoranised confused ideas and when spoken sound incoherent to listener such as shufting between unrelated subjects

Answer 56

lack of motivation social withdrawal lack of emotion inappropriate emotions behavioural disturbances

Answer 57

schizophrenic has no drive or direction to accomplish something eg not getting out of bed in the morning

Answer 58

will not want to interact with other people eg one word responses

Answer 59

not showing any emotion eg told someone has died and having no reaction

Answer 60

behaviour that is bizarre disorganised and purposeless such as catatonic stuppor where they remain immobile

Answer 61

- 2+ of: delusions, hallucinations, disorganised speech, disorganised behaviour and negative symptoms - below level of function in at least two areas eg work or self care - 6+ months of continuous disturbance including 1 month of symptoms - if there's history of developmental disorders additional diagnosis of SZ must only be made if there are prominent delusions or hallucinations for at least 1 month - must disprove schizoaffective or mood disorders - disturbance shouldnt be due to physical symptoms or a general medical condition

Answer 62

- 5 says one symptom must be positive - 5 no longer recognises the subtypes of SZ as seperate categories as there was too much overlap - 5 places greater emphasis on dimensional assessment of symptoms (indicating severity) - 5 places greater emphasis on the need for 2+ core symptoms for a significant time period

Answer 63

- suggets SZ is a result of excess dopamine activity in parts of the brain - it is the increased sensitivity and density op dopamine receptors at the synapses that cause the symptoms - this leads to increased dopamine activity at synapses - schizophrenics have a higher number of D2 receptor sites which are more likely to pick up dopamine than other dopamine receptor sites meaning dopamine is more likely to have an effect as more of it stimulates the receptor sites - Weinberger argues that too much dopamine in the mesolimbic pathway is linked to positive symptoms - Whereas too little dopamine is the mesacortiol pathway is associated with negative symptoms - increased dopamine activity is associated with increased feelings of paranoia - and as the brain is too active this leads to hallucinations

Answer 64

Seeman et al- found increased density of dopamine D2 receptor in postmortem brain tissue of schizophrenia sufferers, t/f suggesting that D2 receptors are linked to SZ and increasing credibility of dopamine hypothesis Research using amphetamines- control groups who were given amphetamine drugs (increases dopamine activity in brain) showed schizophrenic symptoms such as paranoia and hallucinations, t/f supporting the role of dopamine in schizophrenic symptoms as suggested by dopamine hypothesis Wong et al- PET scans showed greater density of dopamine receptors in unmedicated schizophrenics compared to medicated schizophrenics, t/f suggesting the density of dopamine receptors contributes schizophrenic symptoms increasing validity of dopamine hypothesis Carlsson et al- brain scanning showed that if schizophrenics took amphetamines there is a greater release of dopamine than if non schizophrenics took them, t/f suggesting those with schizophrenia are more sensitive to excess dopamine than others

Answer 65

Jackson- reviewed evidence from various studies and found no consistent differences between levels of dopamine in untreated schizophrenics and normal control groups, t/f casting doubt on the role of dopamine in the development of schizophrenic symptoms Cause and effect- excess dopamine activity is only measured in schizophrenics after they have been diagnosed with the disorder , t/f it is not clear if excessive dopamine activity is the result of schizophrenia or the cause of it thus reducing the validity of the dopamine hypothesis Reductionist- the dopamine hypothesis only considers nature- SZ as a result of excessive dopamine activity and fails to consider nurture- SZ as a result of growing up in an urban area t/f the dopamine is too simplistic of an approach for a complex disorder thus reducing the validity of the dopamine hypothesis Carlsson- found that high levels of serotonin linked to positive and negative symptoms , glutamate failure in the cereberal cortex led to neg and glutamate failure in the basal ganglia led to pos t/f increased dopamine activity alone cannot fully explain schizophrenia and thus reducing the validity of the dopamine hypothesis

Answer 66

a form of secondary data researcher combines findings from multiple studies about the same topic and analyses them as a whole if a number of studies seperately find the same answer and then those studies are analysed together the answer becomes stronger as the studies support each other it is a statistical approach generally uses quantitative findings IV has to be coded into a data base and DV is the effect size

Answer 67

Finds trends in data- as multiple studies are analysed this allows trends/relationships to be found in symptoms, a meta analysis involves statistical analysis and because it uses more data than single studies, the power of the statistical result is larger than the original studies, t/f the patterns can be found to aid diagnosis of clinical disorders and generate a direction for further research Large sample size- although initial research studies may have had small sample sizes of patients, meta analysis combines findings which ensures a large sample is generated to draw conclusions from, t/f the sample in the meta analysis will be representative of the mental health population and thus the findings on clinical psych drawn from the meta analysis can be generalised to the wider mental health population

Answer 68

Secondary data- meta analysis uses reserach that has been conducted by other researchers and may not all have use the same aim furthermore the researcher cannot be sure that the original studies on clinical psychology were valid, t/f we cannot be sure the secondary clinical data used has internal validity thus decreasing the validity of using meta analysis in clinical psychology Publication bias- a meta analysis only uses published studies which can distort the findings of the meta analysis as studies that show negative or non significant result are less likely to be published t/f reducing the findings on clinical psychology from the meta analysis.

Answer 69

- conduct a review of current research to study the relationship between neurotransmitters other than dopamine that could be impilicated in causing schizophrenia - research role of glutamate in causing SZ, neurochemical explanations for SZ such as hypoglutamergic and hyperdopaminergic - aimed to use understanding of psychosis to produce anti psychotic drugs with fewer side effects and relapse rates

Answer 70

looked at various studies eg rodents, PET scans and people with parkinsons reviewed various findings about neurochemical levels in patients diagnosed with SZ as well as studies about drugs that induce psychosis symptoms and drugs used to treat SZ previous studies linked SZ and amphetamines but theres other research linking PCP with pychosis

Answer 71

Dopamine, noradrenaline, serotonin, acetylcholine, glutamate and GABA all relate to SZ. Low glutamate = high DA = SZ and h igh levels of serotonin are linked to positive and negative symptom. PCP (phencyclidine) more heavily linked to psychosis than amphetamine users. Glutamate failure in the cerebral cortex may lead to negative symptoms, whereas glutamatergic failure in the basal ganglia could be responsible for positive symptoms. Clozapine most effective treatment for reducing serotonin & DA with fewer negative side effects. Effective for those previously unresponsive to treatment. Difficult to treat SZ patients may have especially low levels of glutamate (hypoglutametergic).

Answer 72

Carlsson concluded not just DA but other neurotransmitters linked to psychosis including low levels of glutamate. Further research in this deficiency is required for effective treatment of SZ to avoid negative side effects by considering the role of other neurotransmitters in the development of SZ.

Answer 73

Carlsson used a meta analysis which means large and varied samples were reviewed. He reviewed various research findings investigating neurochemical levels in patients diagnosed with schizophrenia, and the impact of drugs on their psychosis and treatment. This would have includes large a varied sample sizes from various areas across the world giving his review population validity. Therefore this increases the representativeness and generalisability of his findings that low levels of glutamate is linked to high dopamine activity and schizophrenic symptoms. Practical application. Found that dopamine & glutamate interact, with glutamate influencing dopamine activity levels. Therefore, as drug therapy only targets dopamine is not affective for all, drugs should also target glutamate to reduce deficiency and avoid negative side effects Reliable as Carlsson used a meta analysis where he reviewed various research findings investigating neurochemical levels in patients diagnosed with schizophrenia, which included a large sample size. This means others can use the originally primary data Cralsson reviewed and conduct his analysis again. Therefore, his findings that low levels of glutamate is linked to high dopamine activity and schizophrenic symptoms are reliable Many studies used scientific methods such as PET scans. PET scans are objective measure of neurotransmitter function on psychosis, as other psychologists can check findings and analyse the levels of dopamine and glutamate. Therefore, the role of neurotransmitters in schizophrenic symptoms are valid

Answer 74

Secondary data. Carlsson has no way of knowing if the original research he reviewed produced valid findings on the relationship between hypoglutamatergic and hyperdopaminergic. Equally, the original hypothesis of the research studies may have been different from Carlssons. Therefore, basing further conclusions on the role of neurotransmitters and therapeutic intervention is problematic and could lack validity Carlsson et al. reviewed science as it stood in 1999 but the review might be time-locked and unrepresentative of scientific theories today. For example, Sekar et al. (2016) have discovered the C4 genes causes synaptic pruning, which is linked to schizophrenia. Carlsson cites one study (Laruelle et al.) that was unpublished at the time and therefore hadn't been peer-reviewed which may make it unreliable Used anthropmorphic research

Answer 75

There is evidence that SZ is hereditary and thus a result of our genetics, as it runs in families SZ prevelance rate in population is 1% but the more closely related you are to a schizophrenic, the increased likelihood of developing the disorder - 2nd degree (aunt/grandpa), 2-6% - 1st degree (parent/sibling), 6-17% - MZ concordance is 48% - DZ concordance is 17% this shows the more genetic relation the higher the risk GENES RESPONSIBLE suggestions - deletion of 22q11.2 (22q11Ds) - Tiwari et al suggests Xq23 variation links to SZ

Answer 76

Gottesman: found that If both parents have schizophrenia there is a 46% chance, with one schizophrenic parent there is a 16% chance, and it is 8% if a sibling has schizophrenia. t/f suggesting since SZ runs in families, there is a genetic explanation Tienari: found 10.3% of adopted children who had a schizophrenic mother developed schizophrenia in adulthood, compared with only 1.1% of adopted children who did not have a schizophrenic mother t/f suggesting genetic relation to SZ increases risk of developing thus can be explained by genetics Schneider et al: found that up to 40% of genetically sensitive adults are diagnosed with a psychotic disorder t/f suggesting SZ could be a conseuqence of gene mutations Arinami: found 0.3 – 2% of SZ’s have 22qs11Ds deletion syndrome t/f suggesting 22qs11Ds links to SZ

Answer 77

Torrey: Argued that many twin studies were inadequate, due reviewed eight studies in which the samples were representative and the allocation of twins was reasonably certain. He found a concordance rate of 28% for MZ and 6% for DZ twins t/f suggesting evidence from twin studies in unreliable and cannot support genetic explanation Wahlberg: found the genetic risk of schizophrenia was increased significantly if the adopted family was high in communication deviance (a tendency to communicate in unclear and confusing ways). t/f suggesting nurture influences SZ development Concordance rates arent 100%: if SZ was due to only genetics we would expect MZ twins to have 100% concordance and they dont, t/f suggesting there are also other factors involved Reductionist- doesnt consider nurture

Answer 78

Research shows higher incidence of SZ in urban settings and lower social classes so those who are in these categories are more at risk It is thought this is due to stress factors, Urban setting stress factors include: busy, loud, pollution, Lower social class stress factors include: bad diet, stress about money, less time for leisure hours Ethnic minorities including immigrant population has higher prevalence of SZ than non immigrant population, stress factors could be: less access to healthcare, language barriers, employability H/E there is also the downward drift hypothesis which argues that those who have schizophrenia drift down to lower social classes because of the difficulties associated with schizophrenia such as: struggle to get job, hospitalisation and loose support system

Answer 79

Harrison et al: schizophrenics show clustering in inner city declining areas t/f suggesting urban low class could cause schizophremia Cooper: rate of SZ in unskilled labour workers was 4.1 times higher than managerial workers, t/f suggesting low social classes lead to development of SZ Fearon et al: found there are 4x more incidences of schizophrenia in black immigrants than in the white population t/f demonstrating that the immigrant population are more at risk of developing SZ Neale et al: found SZ often occupy a lower job status than their fathers t/f suggesting SZ causes them to drift down social classes

Answer 80

Data is correlational: data suggests a relationship between urban settings and SZ however there could be other variables involved thus we cannot establish cause and effect Kirkbride: found rates of SZ were lower for afro caribbeans when they lived in ethically integrated areas, t/f suggesting not all ethnic minorities are at risk of developing SZ Reductionist- doesnt consider nature Other theories: diathesis stress model suggests SZ is genetically predisposed and will be triggered by environmental factors thus is a holistic approach and better than social explanation

Answer 81

a biological treatment is drug therapy Typical drugs tend to focus on dopamine, they mimick dopamine and block dopamine receptors in the brain to decrease dopamine activity in the brain, which can help reduce positive symptoms such as delusions of grandeur, eg chlorpromazine is a typical drug however it has side effects such as tremors, agitation and diziness Atypical drugs focus on dopamine and serotonin by mimicking them and filling receptors sites to reduce dopamine (pos symptoms eg hallucinations) and serotonin (neg symptoms eg social withdrawal) levels in the brain, for example risperidone is an atypical drug however it has side effects such as drowsiness, dizziness and anxiety and there is a 45% relapse rate Antipsychotic drugs are prescribed by the clinician and can be administered orally or injected if the patient refuses

Answer 82

Fast and effective- can be administered quickly and as they impact neurotransmitters they can have a fast impact on reducing symptoms t/f it is useful Barlow & Durand (1995): chlorpromazine is effective in reducing schizophrenic symptoms in about 60% of cases. Most impact on positive symptoms. Pickar et al (1992) compared clozapine with other neuroleptics and a placebo and found clozapine to be the most effective in reducing symptoms, even in patients who had previously been treatment resistant Emsley (2008) found that patients who were injected with risperidone early in course of disorder had low relapse rates and high remission rates; 84% of patients showed at least a 50% reduction in both +ve and –ve symptoms

Answer 83

Drug therapies have side effects. For example, Chlorpromazine can include sleepiness, shaking, increased heart rate blurred vision and tardive dyskinesia which is neurological damage leading to uncontrollable limb and facial movement t/f schizophrenic may stop therapy Guo et al: Found a high drop out rate across 7 different schizophrenic drugs, ranging from 30%-46.9%. t/f schizophrenics may drop out thus not a valid treatment Treats symptoms not cause: A lot of schizophrenic’s symptoms return if they cease to take the medication. t/f ineffective LT compared to CBT Reductionist: Reduces the treatment of schizophrenia to neurotransmitters e.g. chlorpromazine reduces symptoms to DA and a need to block receptor site. t/f cannot treat schizophrenia as a result of social factors

Answer 84

A case study in clinical psychology is the study of an individual MH patient with a clinical disorder, griup of MH patients or a MH institution It is often longitudinal so the patients mental health is studied over a long period of time eg symptoms Clinician will use a range of methods (triangulation) to study the patients MH for example using hospital notes observations and interviews Case studies gather qualitative eg behaviour and quantitative eg GAF score data

Answer 85

Case studies gather rich, detailed, qualitative data about an individual’s experiences of clinical disorders and therapeutic interventions. Use a variety of methods, such as observations, interviews and experiments, to collect data on the patient. Therefore, triangulation can be used to improve the validity if the findings, if all methods generate the same findings then the data can be considered as valid. Ecological validity: Case studies are the documentation of an experience of clinical patients and their disorder and experiences of treatments. Therefore, the researchers have had no control over the disorder, thus it has occurred in ‘real life’. Therefore, case studies of clinical patients have high external validity, the patient’s behaviour is naturally occurring and can be generalised to an everyday setting.

Answer 86

Researcher bias: The researcher may become too involved with the individual or group of individuals, and become too close to those with a clinical disorder. Thus the researcher will lose objectivity, analysing and recording data in a subjective way. Therefore, this will reduce the reliability of the data – if the study was repeated similar findings will not be recorded and another researcher will interpret the data differently. Retrospective data: Some of the data collected can be based on past events that have happened to the patient, and therefore information may be collected from interviews and may not have been accurately recalled. Therefore reducing the internal validity of the data gathered as there is no way to test/ know what they are saying is true Not a controlled setting: Cases studied have occurred naturally, thus there are many extraneous variables that could have influenced the patient’s behaviour and not just the clinical disorder, or therapy they are receiving. Therefore, you cannot establish cause and effect, thus reducing the internal validity of the findings. Population validity: Case studies are based on a single, one-off unique case, or small group of a clinical patients that would be very different from any other. For example someone suffering with OCD may have very different obsessive thoughts to another. Therefore, case studies lack external validity, this is an unrepresentative sample and cannot generalise findings to all clinical patients.

Answer 87

To look at how CBT was used to treat a woman with schizophrenia, including its effectiveness. This is the study of an attempt to use psychotherapy to treat schizophrenia where drug treatment had previously been preferred — there has been little evaluation of the use of CBT for schizophrenia.

Answer 88

Bradshaw conducted a prospective (longitudinal) case study of Carol, as it tracks Carols progress over 3 years of CBT and follows up her progress 6 months after the therapy and again a year after the therapy. Carols symptoms were measured on four scales: - Psychosocial functioning was measured by a Role-Functioning Scale (RFS). This is a checklist that gives a score for work, social, family and independent living subscales. - 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. Sessions lasted from 15 minutes to 1 hour and the therapist and client often went for a walk together Stage 1: Rapport developed – self disclosures from therapist used to build rapport over 3 months (each session 15 minutes -1 hour). Stage 2: Understanding CBT – 2 months – coping mechanisms of stress taught using ABC model enabling her to understand emotions (meta-cognition techniques). Stage 3: Treatment – Early phase (completed weekly activity schedule) gradually increased activity & stress management techniques) to reduce hallucinations. Middle phase (16 months) coping with social situations & fear of relapse. End phase (3 months) plans to maintain therapy techniques beyond sessions using cue cards.

Answer 89

at the one year follow up from the 3 year CBT treatment compared to pre test: - psychosocial functioning had increased from 6 to 27 - symptomatology had decreased from 7 to 1 and she had reported little distress - hospital days in previous 3 months had fallen from 60 to 0 - goal attainment had increased from 19.85 to 80.15

Answer 90

there were considerable improvements in Carols functioning in 4 measures after a 3 year course of CBT therefore we can conclude CBT can be succesful in treating SZ by controlling negative automatic thoughts and changing behaviour in response to stressful situation Bradshaw & Roseborough (2004) carried out a meta-analysis of case studies of 22 patients and suggest that 86% improved their psychosocial functioning and 82% had reduced severity of symptoms. All 22 clients achieved more than was expected with regard to goals of the treatment. These findings support the claim that CBT is effective with regard to schizophrenia.

Answer 91

Ecological validity: As carol was a case study being treated in her normal clinic and practicing her CBT at home, the environment was familiar for Carol, thus Carol's reduction in schizophrenic symptoms were naturally occuring in result of the CBT, t/f Carol's improvements can be generalised to everyday CBT for schizophrenics thus increasing the validity of CBT being effective in treating SZ Test-retest reliability: at the begining of the study Carol was measured against the DSM IV and used measures such as GAS, GPI and RFS, this was also done 3 times throughout the study and twice afterwards, t/f Bradshaws findings that CBT is effective in treating SZ have test re test reliability as Carols behaviour was measured consistently throughout the study thus increasing reliability of Bradshaw Practical applications: In knowing that Carol responded better to CBT than drug therapy we can use this to help treat other SZ patients who behave similarly to Carol, and in knowing CBT is effective long term we can be less reliant on antipsychotics that produce side effects to treat SZ, t/f Bradshsaw's findings that CBT is effective in treating SZ can help treat SZ patients with side effects and thus can be practically applied to society Demand Characteristics: As Bradshaw studied Carol for over 4 years (longitudinal) we can be sure that the improvements in Carol were real and were not for the benefit of the researcher t/f Bradshaw's findings thta CBT is effecrive in treating SZ were due to CBT not demand characteristics thus increasing validity

Answer 92

Population validity: Bradshaw's case study was on Carol a 26 year old white female from an upper middle class family being treated for undifferentiated schizophrenia and thus Carol does not represent the entire schizophrenic population and the sample is a single case, ethnocentric and gynocentric t/f Bradshaws findings that CBT is effective in treating SZ cannot be generalised to the wider schizophrenic population thus decreasing population validity Cause and effect: as Bradshaw studied Carol within the time that she was living at home the setting was not a highly controlled artificial lab setting and thus extraneous variables that may have affected Carol's symptoms were not eliminated t/f we cannot be sure that it was the CBT that caused the reduction in schizophrenic symptoms as it could have been something at home thus reducing the validity of the findings that CBT is effective in treating SZ Hard to replicate: as this was a single case it would be difficult to replicate for example replicating the rapport between Carol and therapist, t/f we cannot replicate the case exactly to establish similar findings on the effectiveness of CBT to treat SZ thus reducing reliability Retrospective data: Data was collected on Carols past and present experiences of having SZ thus Carol may have remembered her past experiences of SZ incorrectly t/f the data used may be inaccurate and thus reducing the validity of the findings on CBT being effective in treating SZ

Answer 93

- assumptions when using CBT to treat SZ is that the schizophrenic have irrational thoughts and beliefs about themself which are typically negative, and these thoughts contribute to the development and maintenance of SZ, the aim of CBT is to help schizophrenics make sense of how their including delusions and hallucinations impact their feelings and behaviours, It doesn’t aim to cure schizophrenia but to allow that patient to function normally - the role of the therapist is to establish rapport, help set goals, teach cognitive and behavioural therapies and monitor progress - Focuses on present behaviour and thoughts instead of focusing on how those thoughts developed. sessions are 30-60 minutes once or twice a week, socialisation phase (therapist and schizophrenic share understanding of problem), therpay phase (work together to implement cognitive and behavioural strategies to adress the patients thoughts), end phase (focus on relapse prevention and develop plan for termination) - homework is set which include tasks for the patient to complete outside of sessions, for example breathing exercises

Answer 94

Chadwick- 22 schizophrenics who heard voices had 8 hours of CBT, they all had reduced negative beliefs about how powerful the voices were and how much the voices controlled them, t/f suggesting CBT can reduce the severity of auditory hallucinations and thus increasing the validity of using CBT to treat SZ Chadwick and Lowe- found CBT reduced delusions in 10/12 of the patients in their study, t/f suggesting CBT can reduce delusions in schizophrenics and thus increasing the validity of using CBT to treat SZ Kingdom and Turkington- found 54% of patients in a five year follow up study were free of symptoms when CBT was used, t/f suggesting that CBT has long term benefits in treating patients thus increasing the validity of using CBT to treat SZ Empowers the schizophrenic:- schizophrenic is in control of the therapy, they decide on the goals they wish to achieve, the speed they progress and how they progress t/f CBT helps the schizophrenic to be in control so they may be more open to this compared to drug therapy thus increasing the validity of using CBT to treat SZ Bradshaw- Carol improved

Answer 95

Bradshaw- Carol was a case study Kingdom and Turkington- found whilst it helps 70% of patients it has made the other 30% of patients, t/f suggesting CBT will be ineffective and worsen the condition of some SZ patients thus decreasing the validity of using CBT to treat SZ Inpractical- changing the irrational thinking of the schizophrenic and teaching coping strategies, normally one session a week for 5-20 weeks which requires greater comitment from the schizophrenic, t/f the SZ patients may not be up to the comitment of CBT and may choose drug therapy as its quicker thus decreasing the validity of using CBT to treat SZ Reductionist- if SZ is a result of dopamine

Answer 96

a marked anxiety or distress caused by obessions and compulsions disturbing the persons behaviour

Answer 97

Prevalence rate: Sasson et al (1994) estimates 2% on the population has OCD at any given time. Ages: Grohol (2005) - OCD tends to start in childhood or adolescence (late teens/early 20’s) Gender: Grohol (2005) - affects males and females equally. However some researchers suggest that females are more frequent suffers as adults although males are more commonly affected as children, with 25% male suffers start before age 10. Culture: There is a similar symptom structure involving cleaning, hoarding, taboo thoughts and symmetry; however there are regional differences suggesting that cultural factors can affect the nature of the symptoms.

Answer 98

Obessions: recurring and persistent thoughts, impulses or images that are experienced causing marked anxiety or distress for example obessed with everything being clean, obessed with accidentally harming someone and obsessed with symmetry Compulsions: repetitive behaviours that the sufferer feels must be carried out to temporarily remove the distress caused by the obsessions for example clean home for 3 hours everyday, excessive hoarding, constant hair pulling

Answer 99

thinking for a long time in a way that is not productive and the thoughts are disturbing

Answer 100

Obsessions and compulsions cause marked distress, are time consuming (more than 1 hour a day) or interfere with normal routine Gage individual insight– do they recognise obsession and compulsions are excessive If have another disorder – the obsession/compulsions are not restricted to it. Symptoms are not explained by substance use or another medical condition.

Answer 101

In the DSM-IV-TR OCD was classified under anxiety disorders. Has its own chapter Obsessive-Compulsive and Related Disorders, to reflect the increasing evidence that OCD and other related disorders listed (such as hoarding disorder, excoriation (skin-picking) disorder & body dysmorphia disorder) are related to one another in terms of a range of diagnostic criteria. The “with poor insight” specifier has been refined in DSM-V to allow a distinction between individuals with good or fair insight, poor insight, and “absent insight/delusional” obsessive-compulsive disorder beliefs (i.e., complete conviction that obsessive-compulsive disorder beliefs are true).

Answer 102

Orbitofrontal cortex Caudate Nuclei Thalamus Cigulate gyrius

Answer 103

Responsible for decision making, converting any sensory information into thoughts, notices when something is wrong and alerts the brain to any potential worries or panics in the environment. PET scans have found this area in OCD patients brains to be overactive, increasing the conversion of sensory information to actions (behaviours), leading to increased worry/panic and results in compulsions. The increased activity also prevents patients from stopping their behaviours eg initial panic of touching door handle

Answer 104

OFC sends the message of panic/worry to the caudate nucleus. It is responsible for responsible for repetitive behaviours, reward experiences, and focusing attention. It decides whether the message are important or not and so acts as a filter for messages between the OFC and the thalamus. The caudate nucleus is overactive. Faulty messages of worry/panic are not filtered out or supressed. Therefore the messages are not recognised as faulty and so are passed onto the thalamus. This drives the individual to think about their obsession more and take action. eg cannot stop worring about germs and it is passed on

Answer 105

The caudate nucleus passes on the faulty message of worry/panic to the thalamus. The thalamus’s responds to sensory and motor signals, carrying out the necessary required action. The thalamus is overactive, leading to behaviours that emerge as compulsions. The thalamus then directs messages back to the parts of the brain that can interpret them, such as the cingulate gyrius. eg washing hands after touching door handle

Answer 106

Is responsible for focusing attention on emotionally significant events, and so is the emotional response to the compulsion that has been created, the emotional response will be relief from the compulsion being acted on. However, the cigulate gyrius will pass on this message of relief to the OFC and the dysfunctional neuronal loop will start again. It is overactive eg relief of handwashing

Answer 107

Menzies et al. (2007) When conducting brain scans of patients with OCD found that there is less grey matter in brain areas, including the orbitofrontal cortex, compared to healthy control groups brains. Max et al. (1994) Found that when the basal ganglia (caudate nuceli in) is disconnected from the frontal cortex during surgery, OCD-like symptoms are reduced McGuire et al (1994) Found that when people with OCD were shown objects that bring on their symptoms, such as a dirty piece of clothing in someone with a cleaning compulsion, activity increased in the orbitofrontal cortex, the caudate nucleus and the anterior cingulate. Hou et al (2012) Conducted research using fMRI scanning when OCD patients were at resting state compared to and unaffected control group. They found that those with OCD had increased activity in the bilateral orbitofrontal cortex, the anterior cingulate cortex, the cerebellum and parietal cortex.

Answer 108

Sanematsu et al (2010) Found differences in other brain areas in OCD patients compared to healthy controls, such as the parietal cortex and cerebellum. Kireev et al (2012) Looked at activity of the anterior cingulate cortex in OCD patients and found that the function of that brain region in patients takes place in other brain areas instead. Cause and effect. Only found relationships, no direct of correlation and could be other variables involved Reductionist. Only considers nature

Answer 109

information processing stems from experiences within life perceptions or thoughts we have about our experiences will trigger an emotional response which triggers the behaviours to deal with the emotional response Paul Salkovski argues that this will then generate a general negative belief system about how the world works, for example the world is full of threats. This leads to intrusive thoughts (obsessions) in response to events that happen. To deal with the anxiety the person adopts counterproductive behavior such as thought suppression, or they feel compelled to perform rituals (compulsions) that give temporary relief from the anxiety; this serves to reinforce the faulty thinking at the root of the sequence.

Answer 110

Cognitive bias is the tendency that some people have to think/process information in an illogical, way, leading the judgement made to deviate from the norm. Rachman (1998) suggests there are two biases that lead to misinterpretations of thoughts, and result in OCD: * Thinking about something unpleasant increases the chances that it will happen and the * Belief that having an immoral thought is the same as behaving in an immoral way. These two biases are what make intrusive thoughts so distressing for someone with OCD; they reveal something about the self that is threatening an lead to ‘thought-action fusion’ (TAF).

Answer 111

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 (1989) 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.

Answer 112

POTS: found CBT alone (39.3%) was more effective than drug therapy (21.4%) t/f suggesting treating faulty cognition treats OCD (compared to treating NT levels), thus increasing validity of the cog explanation Pace et al: suggested criticism from others is perceived as a negative judegment and may lead to vulnerability that contributes to the development of OCD. t/f suggests external feedback contributes to OCD thus increasing the validity of the cog explanation of OCD Salkovskis: thought-action fusion leads to compulsion and compulsions are rewarded with the immediate reduction in anxiety t/f suggesting the OCD sufferer never gets to realise their faulty thinking thus increasing the validity of the cognitive explanation of OCD Sher et al: found OCD had poor memories for their actions for example they really couldnt remember if they had turned the lights off

Answer 113

POTS: found the most effective treatment for OCD sufferers was a combination of CBT and drug therapy, thus suggesting OCD is a result of biology and cognition, t/f the cog explanation cannot fully explain OCD thus reducing the validity of the cog explanation of OCD Rachman: developed ERP which involves flooding and conditioning a different response to the therapy so suggesting OCD could be the result of learning, t/f suggesting that OCD may be due to learning too and thus the cognitive explanation is not sufficient thus reducing validity Abramowitz: suggested that for the average OCD patient, cognitive therapies are no more effective than behavioural therapies such as ERP t/f suggesting cognition is not the only contributing factor to OCD thus reducing the validity of the cognitive explanation Reductionist: cognitive explanation only considers OCD as the result of faulty cognition and thus fails to consider OCD as a result of an overactive thalamus t/f the cognitive explanation of OCD is too simplistic thus reducing the validity of OCD

Answer 114

Anxiety is regulated by the brains GABA. GABA is an amino acid that works at the synapses to lower physiological arousal Most the drugs used to treat OCD can take up to 12 weeks to work and tend to be taken for about a year before reviewed

Answer 115

benzodiazepines beta blockers SSRIs

Answer 116

Benzodiazepines (BZs) are a range of anti-anxiety drugs, which include trade names like Valium and Diazepam. BZs work by enhancing the action of the neurotransmitter GABA (gamma-aminobutyric acid). GABA tells neurons in the brain to ‘slow down’ and ‘stop firing’ and around 40% of the neurons in the brain respond to GABA. This means that BZs have a general quietening influence on the brain and consequently reduce anxiety, which is experienced as a result of the obsessive thoughts.

Answer 117

block the effects of adrenaline and noradrenaline which are involved in the body's stress response so beta blockers can reduce the physical symptoms of anxiety that arise from OCD such as: rapid heart rate, tremors and sweating

Answer 118

prevent the reuptake of serotonin which increases serotnonin activity this helps to improve the mood and reduce the anxiety of the OCD symptoms

Answer 119

drowsiness dizziness memory impairment

Answer 120

fatigue dizziness clod hands and feet

Answer 121

nausea sleep disturbance headaches

Answer 122

Soomro et al: Used individual randomised trials using antidepressants for the treatment of OCD. They compared an SSRI antidepressant drug with a placebo, reviewing 17 studies (3097 participants), which showed that drugs were more effective than a placebo in reducing the symptoms of OCD, t/f suggesting SSRI is effective in treating OCD and thus increasing validity of drug therapy Stanford school of medicine: Suggests that 40-60% of OCD patients respond to SSRIs or clomipramine, though it is not possible to know which patient will respond to which drug. t/f suggesting drug therapy can help treat some OCD patients thus increasing validity of drug therapy Supporting evidence uses randomised trials: so we can easily compare the effects of the drug to a placebo, controlling for demand characteristics t/f increasing validity of supporting evidence and thus also of drug therapy Practical: compared to CBT and ERP drug therapy is a much faster relief of the OCD symptoms and less comitment from the patient thus drug therapy is practical incrasing usefulness of it

Answer 123

Romano et al: looked at OCD sufferers on fluoxetine, Those continuing on fluoxetine had a relapse rate of 17.5% compared to 38% if in the placebo group. Although, when on the drug the relapse rate is lower, there is still a relapse rate, and a high relapse rate when taken off the drug. t/f drug therapies aren't effective LT thus reducing the validity Ravizza et al: Found that SSRI drugs were not effective for 40% of patients with OCD, t/f suggesting drug therapy cannot treat all OCD sufferers thus reducing the validity of drug therapy POTS: found CBT alone had effecriveness of 39.3% compared to drug therapy had 21.4%, t/f suggesting CBT is more effective tha drugs in treating OCD thus reducing the validity of using drug therapy to treat OCD Side effects: as drugs have side effects such as dizziness and nausea OCD patients may not want to take these so may refuse treatment t/f reducing the validity of using drug therapy to treat OCD

Answer 124

CBT can include ERP- exposure and response prevention Hieararchy of situations which provoke obessional fears from least to most Patient is exposed to a situation that will cause anxiety and lead to a compulsive behaviour. They will resist completing their compulsion for a set period of time. After the set time they can choose to complete their compulsion of not. This exposure is very structured, with the support of the therapist. The patient is trained to monitor their anxiety levels in order to record how they feel accurately and to notice differences as they emerge.

Answer 125

Balkom: has suggested ERP is more effective than other treatments when treating OCD with a lower chance of relapse t/f suggesting ERP is most effective at treating OCD thus increasing validity of CBT to treat OCD Whittal et al: found lower scores on the Y-BOCS for CBT compared to wait list controls as well as lower OCD related cognitions and less depression. t/f suggesting CBT is effective in reducing OCD symptoms thus increasing validity of using CBT to treat OCD Ethical: as the patient is in control of how quickly they progress and are exposed to their obession they do not have social control over them ,t/f suggesting CBT is more ethical at treating OCD thus increasing validity of using CBT to treat OCD POTS: found CBT alone (-12 ob CY BOCS) had a greater reduction in symptoms than drugs alone drugs alone (-7 on CY BOCS) t/f suggesting CBT is more effective than drugs thus increasing validity of using CBT to treat OCD

Answer 126

Cordioli: claims CBT is effective for 70% of patients but the rest do not respond to it, t/f CBT cannot treat all OCD sufferers reducing validity of using CBt to treat OCD Masellis et al: found 75% of OCD sufferers also suffer with comorbid depression which lessens the effectiveness of ERP,t/f suggesting CBT cannot treat all patiebts thus reducing validity pf using CBT to treat OCD Requires comitment: CBT is a time consuming therapy which requires comitment from the sufferer which may deter them from therapy t/f suggesting sufferers may not want to complete CBT reducing validity of using CBT to treat OCD POTS: overall, the most effective treatment for the OCD sufferers was a combination of CBT and drug therapy as it was more effective than CBT alone, t/f suggesting CBT alone cannot treat OCD thus reducing validity of CBT treating OCD

Answer 127

investigate if CBT on its own is more or less effective than using SSRIs alone or if CBT will be more effective if you combine it with SSRIs when treating children and adolescents with OCD

Answer 128

recruited by advertisements in media, in print and on the radio or by referrals from MH clinicians volunteer sample 112 outpatients aged 7-17, mean age 11.7 diagnosed with OCD using the DSM 4 only score 16+ on CY-BOCS were included comorbid in disorders such as tourettes and major depression were excluded to avoid interaction effects children with ADHD who weren't on stimulant medication and were stable were included children weren't on anti-obessional medication at outset all patients including one parent gave informed consent 1. drugs only= 28 2. placebo= 28 3. cbt= 28 4. combo= 28

Answer 129

conducted over 12 weeks across Duke, UPenn and Brown screened via telephone on severity of symptoms using Childrens Yale-Brown Obsessive Compulsive Scale drugs/placebo condition required child to attend weekly sessions for first 6 weeks, and then every other week for the next 6 weeks dose established and changed as necessary during clinical session, parents monitored the medication being taken and kept a medication diary, adverse effects meant meds were changed or stopped CBT only required 14 sessions over 12 weeks, based on CBT manual, involved psych ed, cognitive training, mapping OCD target symptoms and ERP, sessions involved setting goals and reviewing previous weeks, manual was used flexibly according to developemntal age of the child combined condition was the two conditions time linked and provided simultaneous equations assessed at initial screening and again at weeks 4, 8, 12 by independent evaluators who did not know childs condition

Answer 130

97 completed study all showed improvements at 12 weeks however placebo was not significant CBT alone, 39.3% entered remission, compared to 21.4% in drugs alone combined was better than cbt alone which was better than drugs alone which was better than placebo Differences: - cbt: -12 - drugs: -7 - combined: -12.6 - placebo: -4.7

Answer 131

clear effect of CBT having higher improvement than drugs so CBT should be first line of treatment minimal gain can be added by including drugs where effective CBT is provided drugs require careful monitoring as SSRIs have been linked to suicide ideation in young people.

Answer 132

practical applications: allows clinicians to give the best treatment to OCD patients increasing their quality of life ecological validity: in either hospital or at home objective analysis: assessed by independent evaluators who did not know the condition of the patient using the Y-BOCS right to withdraw: ppants went from 112 to 97 due to not wanting to take part in psychological reasoning

Answer 133

population validity: 112 outpatients aged 7-17 from USA diagnosed with OCD using DSM IV temporal validity: used 7-17 year olds diagnosed with OCD using the DSM IV, however this is not the most up to date version of the DSM standardised procedure: as the CBT treatment and drug dosage were adjusted to each patient it is hard to repeat to establish reliability demand characteristics: involved a volunteer sample so knew they were participating in research so may have acted in a certain way

Answer 134

High N individuals are prone to mood swings and stress and easily feel anxious. High N scores have been linked with schizophrenia. High E individuals are outgoing and crave excitement and this has been linked to the absence of schizophrenia This means that the schizophrenic personality is a Neurotic (or Unstable) Introvert

Answer 135

Van Os and Jones: 5362 SZ patients aged 16 were found to have increased risk of SZ if they scored highly for neuroticism. Therefore, supporting that personality types increase the likelihood of a SZ diagnosis. Birantes- Vidal et al: Results indicated that neuroticism predicted positive symptoms of schizophrenia Therefore, supporting that personality explains a diagnosis of SZ.

Answer 136

No cause and effect: People with SZ struggle wo maintain social relationships and suffer negative symptoms which may present as mood swings and so not a result of neurotic introversion. Therefore, personality differences does not explain SZ Additional of P: Psychosis is a break from reality rather than the inability top feel compassion or empathy described by Eysenck. Therefore, weakening the construct validity of the personality theory explaining individual differences of SZ.

Answer 137

Interpretation of symptoms e.g. Malgady – Costa Rica V’s Western views of hearing voices. Ethnic group of practitioner and/or patient – Cineralla & Lowenthal. Social explanations of SZ e.g. social causation is not relevant to rural SZ. Etic research – DSM is westernised. Andrews DSM & ICD.

Answer 138

Genetic explanation Born with ‘schizophrenic gene’, inherited from parents This gene could then lead to increased activity in dopamine & sensitivity of receptors. Schizophrenia leads to: Development issues or regression in social skills (negative symptoms), Social withdrawal, Lack of emotions, Inappropriate emotions, Behavioural disturbances, Lack of motivation Lewis (1996) claims children who later develop schizophrenia have 'premorbid' behaviour (i.e. unusual behaviour before they get ill) such as learning difficulties and behavioural problems. By age two, they are less likely to be walking and talking than other children. Talking delays, late/unusual crawling & late walking, unusual movements like arm flapping or rocking Parents of teens might notice: Not spending as much time with friends and family, unable to decipher reality, dreams or stories, intense fear, hallucinations, lack of emotional expression when they sleep, drop in school performance and using drugs/alcohol.

Answer 139

follows same participants with a clinical disorder over a long period of time see how symptoms develop over time detailed data on a patients progress at onset of the study and then collected at intervals throughout the study so progress can be recorded often uses triangulation researcher does not manipulate the IV cohorts can also be used (group with similar experience)

Answer 140

allows long term effects to be examined control over participant variables as the same participant is used only age changes allowing direct comparisons

Answer 141

lack of control over extraneous variables as they are monitoring over time time consuming and takes a lot of resources drop out rate as they may decide later on that they don't want to talk about their disorder informed consent must be gathered every time patient is revisited for data

Answer 142

collect data from one moment in time collects data on different groups of people usually finds a relationship between two variables difference in people is the interest eg severity of SZ symptoms in different age groups

Answer 143

practical as you can study a population without taking to long economical as researcher gathers data etc and then moves on

Answer 144

findings may be distorted by cohort effect, eg women are more likely to seek help than men so gender could distort the cohorts only gathers a snapshot and thus does not generate any data on how disorder progresses

Answer 145

conducting same study with same standardised procedure on clinical patients in more than one country so we can see if their are similarities or differences in the disorder between cultures if same- nature, if differ- nurture as DSM and ICD are used cross culturally it would suggest clinical disorders are due to nature

Answer 146

allows psychologists to determine if clinical disorders are universal which can aid understanding of cause and thus treatment use scientific methodology meaning valid and reliable conclusions can be drawn

Answer 147

procedures are developed within one culture and work with that culture, there could be misunderstandings within cultures of the procedures so may lack validity as comparisons aren't valid diagnoses criterias are taken from DSM which is westernised and thus the research is ethnocentric

Answer 148

should clinical disorders be treated in mental institutions

Answer 149

healthcare facilities which provide patient care for a length of time

Answer 150

drugs and behavioural therapies can be done under the supervision of clinician

Answer 151

because they improve the quality of life of the patients

Answer 152

when someone is admitted to hospital whether they are willing to or not

Answer 153

eg Aston hall can lead to ethical issues, social control, costly etc

Answer 154

- drug treatment of SZ can be easier monitored - CBT of OCD can be carried out and patient can have more support with tasks - valentine found patients in a clinical institutions improved confidence in psych ed therapy - patients with severe symptoms such as wanting to end their life need 24/7 supervision which can only be done in a clinical institution T/F clinical disorders should be treated in clinical institutions

Answer 155

- drug treatment can be done in community with a MH team check in - CBT can easily be done through weekly sessions and it is better if the patient practices in the real world - rosenhan found pseudopatients weren't idetified as sane suggesting mental institutions may be used for patients who do not require them - bradshaw found carol had improvements in RFS and GAS after 3 years of CBT not in an institution suggesting clincial institutions arent required for recovery T/F clinical disorders should not be treated in mental institutions

Answer 156

To investigate if the attitudes of staff towards patients in mental health institutions have changed over time.

Answer 157

Time 1949’s, 2010’s

Answer 158

Attitude of staff in mental health institution towards patients (positive or negative)

Answer 159

Extract transcribed from: BBC documentary first shown in 2011. Mental: A history of the Madhouse Extract transcribed from: BBC documentary first shown in 2013. Episode 1: Don’t call me crazy. Newspaper article from: The independent. Published 20th January 2013. ‘Mental hospitals treat patients like prisoners’.

Answer 160

using previous research we operationalised positive and negative attitudes, looked for them and tallyed counted number of times they appeared in each source seperate tables for each source and combined quantities at the end each source was read we highlighted words related to attitudes and practices of clinical institutions then we summarised our findings

Answer 161

history of madhouse: 3 negative words (ill appearing the most (2)), we found one positive term (nice appearing most times (1)) thus suggesting 1940s had negative attitudes dont call me crazy and mental hospitals treat patients like prisoners: we found 8 negative terms (harm appearing most (4)) we found 8 positive terms (happy appearing most (2)) suggesting 2010 had neutral attitudes

Answer 162

- rosenhan would argue patients are treated badly (1973) which is supported by our findings - valentine would argue that mental institutions are good for patienrs (2010) which is opposed by our findings - labelling theory would suggest that attitudes wont have changed as patients always have the label of mentally ill which is opposed by ourfindings overall there was a slight imrpovement in positive attutides from 1940 to 2013 but not overly noticeable

Answer 163

ecological validity inter rater reliability ethical practical applications

Answer 164

subjective interpretations small sample internal validity ethnocentric

Answer 165

indirect observation of secondary data on clinical disorders eg diary or documentary it takes qualitative data on mental health and converts it to quantitative data on mental health researcher creates categories to measure clinical themes researchers will read through the qualitative data on mental health and analyse this to uncover themes about mental health researchers count frequency of coding units by tallying the number of times a coding unit appears within the source on mental health

Answer 166

ecological validity ethical practical interrater reliability measures trends over time

Answer 167

researcher bias ethnocentric validity words taoen out of context

clinical psychology Flashcards

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