clinical psychology

Question 1

what is clinical psychology

Answer 1

applied psychology
understanding, explaining, treating clinical disorders
used to increase quality of life for individuals

Question 2

what is the HCPC

Answer 2

organisation that regulates clinical psychologists practice
set standards that clinicians must adhere to ensure their quality of practice is regulated, vulnerable patients are protected and receiving best possible care

Question 3

5 main HCPC guidelines for clinicians

Answer 3

act in the best interest of the patient
being able to ensure quality of practice
able to maintain records appropiatley
work and communicate effectively with others
practice and follow ethical guidelines of practice

Question 4

explain hcpc guideline act in best interst of patient (5)

Answer 4

dont allow sex/religion to influence how theyre treated
invlove patients in decisions of care if possible
dont do anything that could put patients in danger
break confidentiality if patient is at risk
communicate with other providers such as mental health team so patient is fully undertstood

Question 5

explain hcpc guideline ensure quality of practice (4)

Answer 5

follow ethical guidelines including confidentiality
only act within limits of knowledge, second opinion when necessary
regular training each year to ensure they’re up to date on knowledge
need masters degree with BPS qualification and a doctorate

Question 6

explain hcpc guideline able to maintain records appropriately (6)

Answer 6

initials to keep anonyminity
online notes must be kept secure
in person notes must be locked
consent/informed about records
give necessary people access
accurate and comprehensive records

Question 7

explain hcpc guideline work and communicate effectively with others (5)

Answer 7

if you feel the person is danger to themselves or others report to higher authority
talk about accurate information with team eg education
be welcoming for the patient
speak clearly and explain reason for each treatment
only act within limit of own skills

Question 8

explain hcpc guideline practice and follow ethical guidelines of practice (7)

Answer 8

protection from harm
know ethical guidelines
competence
maintain anonyminity
protection from harm
involve patients in decisions
gain consent for treatment if not sectioned

Question 9

what is used by clinicians to determine if someone’s behaviours are abnormal and need further diagnosis

Answer 9

4 D’s

Question 10

list the 4 D’s

Answer 10

deviance
distress
dysfunction
danger

Question 11

explain deviance

Answer 11

behaviours and emotions that are not seen as the norm in society and thus are seen as unacceptable
eg someone who is paranoid may experience hallucinations

Question 12

explain distress

Answer 12

subjective experience of the individual when the behaviour is causing high levels of negative feelings
eg someone who is paranoid will experience extreme anxiety

Question 13

explain dysfunction

Answer 13

person is unable to partake in everyday activities due to significant interference of behaviour
eg a paranoid person may not leave the house due to fear of persecution

Question 14

explain danger

Answer 14

putting themselves or others lives at risk, thus requires intervention
eg someone who is paranoid may hurt others to protect themself

Question 15

2 strength of the 4 D’s

Answer 15

DAVIS- difficult to measure when a behaviour is problematic enough to become a clinical diagnosis. the 4 D’s can help by mathcing to the DSM criteria t/f practical apps as used by clinician to decide when a condition may need a DSM diagnosis
VALIDITY OF DSM- various diagnosises using the DSM are shown to focus on specific Ds indicating each one holds importance, t/f supports validity of the DSM as a diagnosis

Question 16

2 weaknesses of the 4 D’s

Answer 16

Subjective application- no clear measure of each D, what one professional views as dysfunctional such as not going to work might not be considered dysfunctional by another, t/f reducing the validity of using the 4 D’s as it requires subjective interpretation which could lead to misdiagnosis
Davis (2009) a 5th D- Duration is the length of time an individual has the symptoms eg having low mood for 2 days is different to 3 moths, t/f the 4 D’s are insufficient in themselves to diagnose

Question 17

A01 classifying abnormal disorders

Answer 17

classifying mental health disorders involves grouping of symptoms into mental disorders in order to provide effective treatment
a classification system is a comprehensive list of categories including detailed descriptions of the symptoms
2 of the main classification systems are the DSM and ICD

Question 18

what does DSM stand for

Answer 18

diagnostic and statistics manual of mental disorders

Question 19

what does ICD stand for

Answer 19

international classification of disorders

Question 20

what edition of DSM am i focusing on

Answer 20

DSM-IV-TR

Question 21

how many categories in DSM IV TR

Answer 21

16 major categories

Question 22

3 examples of categories in DSM IV TR

Answer 22

anxiety disorders
sleep disorders
eating disorders

Question 23

what type of system is the DSM IV TR

Answer 23

multi axial system
individuals mental state is rated on 5 seperate dimensions
axes 1-3 deal with the individuals current condition
whereas 4-5 is about their life situation

Question 24

what and how is the Global Assessment Functioning used in the DSM IV TR

Answer 24

axis 5 of DSM IV TR
determines psychological functioning
assigned number based on severity
areas examined include:
- psychological
- social
- occupational
ranked 1-100 in groups of 10 in relation to current period
increaesd score = better functioning

Question 25

summarise the DSM IV TR

Answer 25

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

Question 26

changes from DSM IV TR to DSM 5

Answer 26

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

Question 27

changes to the ICD from manual 10 to 11

Answer 27

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

Question 28

summarise the ICD 10

Answer 28

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

Question 29

reliability of classification systems (2)

Answer 29

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 )

Question 30

2 strengths of reliability of classification systems

Answer 30

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

Question 31

2 weaknesses of reliability of classification systems

Answer 31

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

Question 32

validity of classificiation systems (3)

Answer 32

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

Question 33

2 strengths of the validity of classification systems

Answer 33

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

Question 34

2 weaknesses of the validity of classification systems

Answer 34

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

Question 35

A01 culturural issues with diagnosis

Answer 35

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

Question 36

how may language barriers impact diagnosis (A03)

Answer 36

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

Question 37

how may culturally bound syndromes impact diagnosis (A03)

Answer 37

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

Question 38

how may the spiritual model impact diagnosis (A03)

Answer 38

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

Question 39

how may cultural norms and sterotypes impact diagnosis (A03)

Answer 39

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

Question 40

A01 primary data in clinical psychology

Answer 40

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

Question 41

strengths of primary data used in clinical psychology

Answer 41

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

Question 42

weaknesses of primary data used in clinical disorders

Answer 42

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

Question 43

A01 secondary data in clinical psychology

Answer 43

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)

Question 44

3 strengths of secondary data in clinical psychology

Answer 44

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

Question 45

3 weaknesses of using secondary data in clinical psychology

Answer 45

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

Question 46

aim of rosenhan

Answer 46

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

Question 47

rosenhan procedure

Answer 47

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

Question 48

rosenhan findings

Answer 48

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

Question 49

rosenhan conclusion

Answer 49

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

Question 50

4 strengths of rosenhan

Answer 50

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

Question 51

4 weaknesses of rosenhan

Answer 51

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

Question 52

false positive

Answer 52

say something happened but it didnt

Question 53

false negative

Answer 53

say something didnt happen but it did

Question 54

A01 clinical interviews

Answer 54

• 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

Question 55

2 strengths of clinical interviews

Answer 55

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

Question 56

2 weaknesses of clinical interviews

Answer 56

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

Question 57

A01 grounded theory

Answer 57

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

Question 58

1 strength of grounded theory

Answer 58

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

Question 59

2 weaknesses of grounded theory

Answer 59

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

Question 60

A01 thematic analysis

Answer 60

• 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

Question 61

2 strengths of thematic analysis in clinical psychology

Answer 61

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

Question 62

2 weaknesses of thematic analysis in clinical psychology

Answer 62

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

Question 63

aim of vallentine

Answer 63

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

Question 64

vallentine sample

Answer 64

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

Question 65

vallentine procedure

Answer 65

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

Question 66

vallentine findings

Answer 66

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

Question 67

vallentine conclusion

Answer 67

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

Question 68

4 strengths of valetnines methodology

Answer 68

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

Question 69

4 weaknesses of valentines methodology

Answer 69

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

Question 70

feautures of SZ- culture

Answer 70

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

Question 71

feautures of SZ- life expectancy

Answer 71

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

Question 72

feautures of SZ- gender/age

Answer 72

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

Question 73

feautures of SZ- behaviours

Answer 73

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

Question 74

first rank symptom

Answer 74

positive
adds to behaviour

Question 75

second rank symptoms

Answer 75

negative
takes away from behaviour

Question 76

list positive symptoms of SZ (3)

Answer 76

hallucinations
delusions
formal thought disorders

Question 77

hallucinations (SZ)

Answer 77

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)

Question 78

delusions (SZ)

Answer 78

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)

Question 79

formal thought disorders (SZ)

Answer 79

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

Question 80

list of negative symptoms SZ (5)

Answer 80

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

Question 81

lack of motivation (SZ)

Answer 81

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

Question 82

social withdrawal (SZ)

Answer 82

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

Question 83

lack of emotion (SZ)

Answer 83

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

Question 84

behavioural disturbances (SZ)

Answer 84

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

Question 85

diagnosis criteria of DSM IV TR for schizophrenia

Answer 85

• 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

Question 86

differences in diagnosis of SZ fro DSM IV TR to DSM V

Answer 86

• 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

Question 87

dopamine hypothesis of SZ A01

Answer 87

• 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

Question 88

4 strengths of the dopamine hypothesis

Answer 88

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

Question 89

4 weaknesses of dopamine hypothesis

Answer 89

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

Question 90

meta analysis A01

Answer 90

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

Question 91

2 strengths of meta analysis in clinical psychology

Answer 91

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

Question 92

2 weaknesses of meta analysis

Answer 92

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.

Question 93

aim of carlsson

Answer 93

• 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

Question 94

procedure carlsson

Answer 94

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

Question 95

carlsson findings

Answer 95

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).

Question 96

carlsson conclusion

Answer 96

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.

Question 97

4 strengths of carlsson

Answer 97

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

Question 98

4 weaknesses of Carlsson

Answer 98

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

Question 99

A01 genetic explanation of SZ

Answer 99

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

Question 100

4 strengths of genetic explanation of schizophrenia

Answer 100

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

Question 101

4 weaknesses of genetic explanation of schizophrenia

Answer 101

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

Question 102

A01 social explanation of SZ

Answer 102

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

Question 103

4 strengths of social explanation of SZ

Answer 103

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

Question 104

4 weaknesses of social explanation of SZ

Answer 104

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

Question 105

A01 biological treatment for schizophrenia

Answer 105

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

Question 106

4 strengths of drug therapy for schizophrenia

Answer 106

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

Question 107

4 weaknesses of drug therapy for schizophrenia

Answer 107

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

Question 108

A01 case studies in clinical psych

Answer 108

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

Question 109

2 strengths of case studies in clinical psych

Answer 109

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.

Question 110

4 weaknesses of case studies in clinical psych

Answer 110

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.

Question 111

aim of bradhsaw

Answer 111

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.

Question 112

bradshaw procedure

Answer 112

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.

Question 113

bradshaw findings

Answer 113

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

Question 114

bradshaw conclusion

Answer 114

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.

Question 115

4 strengths of Bradshaw

Answer 115

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

Question 116

4 weaknesses of Bradshaw

Answer 116

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

Question 117

A01 CBT to treat SZ

Answer 117

• 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

Question 118

4 strengths of CBT to treat SZ

Answer 118

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

Question 119

4 weaknesses of CBT to treat SZ

Answer 119

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

Question 120

What is OCD

Answer 120

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

Question 121

4 features of OCD

Answer 121

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.

Question 122

Symptoms of OCD

Answer 122

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

Question 123

obession: ruminations

Answer 123

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

Question 124

diagnosis of OCD in DSM IV TR

Answer 124

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.

Question 125

changes from DSM IV TR to 5

Answer 125

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).

Question 126

4 areas of brain in neuroanatomical explanation of ocd

Answer 126

Orbitofrontal cortex
Caudate Nuclei
Thalamus
Cigulate gyrius

Question 127

neuroanatomical explanation of ocd- Orbitofrontal Cortex

Answer 127

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

Question 128

neuroanatomical explanation of ocd- Caudate Nuclei

Answer 128

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

Question 129

neuroanatomical explanation of ocd- The thalamus

Answer 129

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

Question 130

neuroanatomical explanation of ocd- The Cigulate Gyrius

Answer 130

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

Question 131

4 strengths of the neuroanatomical explanation of ocd

Answer 131

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.

Question 132

4 weaknesses of the neuroanatomical explanation of ocd

Answer 132

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

Question 133

A01 cognitive explanation of OCD: External factors/feedback

Answer 133

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.

Question 134

A01 cognitive explanation of OCD: Cognitive Bias

Answer 134

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).

Question 135

A01 cognitive explanation of OCD: Lack of confidence in memory

Answer 135

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.

Question 136

4 strengths of the cognitive explanation of OCD

Answer 136

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

Question 137

4 weaknesses of the cognitive explanation of OCD

Answer 137

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

Question 138

overall A01drugs to treat OCD

Answer 138

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

Question 139

3 drugs used to treat OCD

Answer 139

benzodiazepines
beta blockers
SSRIs

Question 140

benzodiazepine to treat OCD A01

Answer 140

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.

Question 141

beta blockers to treat OCD A01

Answer 141

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

Question 142

SSRIs to treat OCD A01

Answer 142

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

Question 143

benzodiazepines side effects

Answer 143

drowsiness
dizziness
memory impairment

Question 144

beta blockers side effects

Answer 144

fatigue
dizziness
clod hands and feet

Question 145

SSRI side effects

Answer 145

nausea
sleep disturbance
headaches

Question 146

4 strengths of drug therapy to treat OCD

Answer 146

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

Question 147

4 weaknesses of drug therapy to treat OCD

Answer 147

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

Question 148

A01 CBT to treat OCD

Answer 148

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.

Question 149

4 strengths of CBT to treat OCD

Answer 149

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

Question 150

4 weaknesses of using CBT to treat OCD

Answer 150

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