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Clinical Psychology Flashcards

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1
Q

What is clinical psychology

A

it looks at understanding and explaining mental disorders. It concerns the classification and diagnosis of mental disorders and how mental disorders such as schizophrenia are treated.

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2
Q

what are the 2 ways in defining abnormality?

A

statistical abnormality and deviation from the social norms

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3
Q

What is statistical abnormality

A

looking at how often something occurs. If it rarely occurs then it is defined as abnormal. An example is IQ. People with an IQ of below 70 and above 130 are seen as abnormal. 10 and 130 are 2 standard deviations away from the average which is 100.

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4
Q

2 Advantages of statistical abnormality

A
  • quantitative so objective and reliable

- can be repeated and will get the same results

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5
Q

4 Disadvantages of statistical abnormality

A
  • people with high IQ’s are considered abnmormal which suggests it is a bad thing
  • the cut off point Is bad. an IQ of 71 of normal but an IQ of 69 isn’t
  • disorders such as depression are not rare so wouldn’t come up as abnormal
  • not valid
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6
Q

what is deviation from the social norms

A

A social norm is a behaviour or belief that most people stick to in society. when people go against the social norm it attracts attentions and people judge them as abnormal.
an example is paedophilia

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7
Q

2 advantages of the social norms definition?

A
  • the majoirty of society share the same norms

- valid

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8
Q

4 disadvantages of the social norms definition?

A
  • not reliable
  • if a groups is disliked they could be labelled as abnormal
  • subjective
    some behaviours go against the norms but it doesn’t mean they are abnormal
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9
Q

what is the difference between classification and diagnosis?

A

classification - taking sets of symptoms and categorizing them under disorders
diagnosis - looking at a patients symptoms and deciding what disorder they have

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10
Q

Before diagnosing someone what do you have to rule out

A

that it is not caused by any medication they are taking

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11
Q

what 2 systems are used for classification and diagnosis

A

DSM and ICD

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12
Q

what 3 reasons are there to classify and diagnose disorders

A
  • patients then receive help
  • patients and family receive a piece of mind
  • researchers can work on treatments
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13
Q

what is reliability?

A

the consistency in which a mental disorder is diagnosed as

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14
Q

what is inter rater reliability?

A

different clinicians all reaching the same diagnosis

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15
Q

what us test re test reliability?

A

retesting a patient

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16
Q

what does the PPV calculate?

A

the percentage of people who keep the same diagnosis over time

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17
Q

what does the cohens Kappa do?

A

it is a scale of 0-1. It looks at the correlation between 2 diagnosises. a kappa of 1 means complete agreement so its reliable.

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18
Q

what did Pontizovsky (2006) find?

A

found 94% of patients had the same diagnosis on admission and release from hospital so the ICD is reliable

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19
Q

What did Nicholls et al (2000) find?

A

looked at the diagnosis of eating disorders within children and found neither the DSM or ICD had inter rate reliability

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20
Q

what is validity?

A

the extent to which a measure of a variable measures what it set out to measure

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21
Q

when is a diagnosis system valid?

A

if the diagnosis successfully identifies a condition

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22
Q

what is predictive validity?

A

identifying a condition that will respond a certain way to treatment

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23
Q

what is criterion validity?

A

the diagnosis agrees with a diagnosis made another way

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24
Q

what is construct validity?

A

the extent to which the category of a mental disorder really exists

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25
Q

what experiment was conducted testing the validity of diagnosis?

A

Rosenhan (1973) on being sane in insane places’

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26
Q

what was the aim of Rosnehans study?

A

to see how well psychiatrists could dictinguish between real and fake patients and see how valid the DSM2 is

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27
Q

what was Rosenhans (1973) procedure?

A
  • Rosenhan and 8 volunteers arrived at 12 hospitals and said they were hearing the words ‘empty, hollow and thd
  • once admitted they acted normal and said they had no other symptoms
  • thye recorded the staffs responses when they spoke to them
  • nurses were only on the ward 10% of the time and gave low quality care
  • they were given 2,100 tablets, all of which they flushed down the loo like the real patients
  • in a follow procedure staff were told a pseudo patient would turn up in the next 3 months and they had to rate from 1-10 how likely it was to be each patient. There was no pseudopatient.
28
Q

what were the results of Rosenhans study?

A
  • all 8 were admitted to hospital and stayed 7-52 days, the average being 19
  • in 30% of cases the real patients saif the fake patients had nothing wrong but the staff never said that
  • 71% of doctors ignored the patienets when they spoke to them
  • in the follow up study 41 patients were believed to be fake patients
29
Q

Evaluate Rosenhans (1973) study (12 points)

A

+useful as it raised that standards in psychiatric hospitals and staff got better training
+ ecological validity because done in a hospital
+ good data open to interpretation
x only 8 Americans so not generalisable
x Spitzer said its very rare to be diagnosed with schizophrenia in remission so they musy have notced soemthing odd in order to discharge them
x decieved staff
x rosenhan didn’t protect his participants
x fiels study so cant be replicated
x low temoral validity - now pn DSM5
x its hard for the fake patients to act normal in those circumstances
x insanity is a subjective concept so hard to judge it

30
Q

what are 3 cultural issues in diagnosis?

A
  • language barriers
  • culture bound syndromes e.g koro in south east asia
  • if the clinician is from a different culture they will interpret it differently
31
Q

what case study did Littlewood and Lipsedge (1997) do?

A

the case of Calvin

32
Q

Describe the case of calvin

A
  • a jamaican man who was a rastafarianwas accused of cashing a stolen postal order and arrested
  • a psychiatrist had a hard time assessing him becuase of his rastafarian characteristics
  • his appearance was described as eccentric but it was normal for a rastafarian
  • this shows how a psychiatrist can have difficulty assessing someone with a different cultural background
33
Q

what are 4 ways a psychiatrist can reduce cultural effects?

A
  • understand the culture so you can distinguish between that and symptoms
  • use an interpreter to reduce language barrier
  • use the dsm
  • get a second opinion
34
Q

What is schizophrenia?

A

a split mind personality disorder

35
Q

what are the 4 features of schizophrenia?

A
  • 1% of the population have it
  • equally common between men and women
  • more frequent in poor urban areas
  • most people who suffer a bad attack make a full recovery
36
Q

what age do men and women on average get schizophrenia

A

men - 20s

women - 30s

37
Q

what is the difference between positive and negative symptoms?

A

positive experiences are bizarre experiences that don’t happen in normal life and negative experiences are abnormalities in behaviour

38
Q

what are 3 positive symptoms of schizophrenia?

A

hallucinations
delusions
confused thoughts

39
Q

what are hallucinations and delusions?

A

hallucinations - hearing voices

delusions - being convinced something happened when it didn’t

40
Q

what are 6 negative symptoms of schizophrenia?

A
  • poverty of speech
  • social withdrawal
  • lack of expression in face and voice
  • lack of energy
  • enter a catatonic stupar where they stay immobile for lengthy periods
  • bad at social interaction which leads to isolation
41
Q

when can you be diagnosed with schizophrenia according to the DSM?

A
  • depression, drug abuse and previous medical conditions have to be ruled out
  • have 2 symptoms for a month, one of which has to be a positive symptom
42
Q

What is the schizophrenia study in detail?

A

Goldstein (1988) - gender differences in the course of schizophrenia

43
Q

what was the aim of Goldstein (1988)

A

to compare the first 10 years of schizophrenia in men and women, in particular looking at hospitalisation

44
Q

what was the method in Goldstein (1988)

A
  • 10 year longitudinal study
  • 90 participants 32F/58M, most came from a private hospital in NY
  • aged 18 - 45 mean age of 24
  • 52 were first time admissions
  • patients were diagnosed in the 70’s under the DSM2 and then again under the DSM3. inter rater reliability of re diagnosis was 80%
  • the patients stints hospital were recorded and their functioning during childhood and adolescence assessed
45
Q

what were the results of Goldstein (1988)

A
  • average amount of those rehospitalised: men 2.24 women 1.12
  • average amount of days spent in hospital over 10 years men 417 and women 206
  • DSM3 was more reliable
  • men were had worse functioning during childhood and experienced schizophrenia the worst
46
Q

the conclusion of Goldstein (1988)

A

males have a poorer outcome than females suggesting men have a more severe experience

47
Q

evaluation of Goldstein (1988) (9 points)

A

+ secondary data from the hospital is reliable because its objective
+ a double blind procedure was used making it more reliable
+ angermeyer sound similar findings in Germany which makes it more valid and provided support
x small sample form a small area
x dsm 3 lacks temporal valididty
x ethncantric
x men develop schizophrenia in their 20s, women in their 30s. the mean age is 24 do men will be worse in the study
x age limit may disrupt the findings as 9% of women get it over 50
x we don’t know how reliable the secondary data was in the first place

48
Q

what 2 explanations am I using for schizophrenia?

A

biological and cognitive

49
Q

what is the biological explanation for schizophrenia?

A
  • the dopamine hypothesis
  • it states people with schizophrenia prodcue more dopamine than those without
  • this causes the neurons that use dopamine to fire too often and therefore transmit too may messages
  • an increase of dopamine in the mesolimbic pathway contributes to positive symptoms
  • an increase of dopamine in the mesocortical pathway contributes to negative symptoms
50
Q

what are the 2 pathways in the dopamine hypothesis?

A

mesolimbic - positive

mecortical - negative

51
Q

evaluation of the dopamine hypothesis (10 points)

A

+ falkai et al did autopisies and found those with schizophrenia have more dopamine receptors
+ post mortems of schizophrenics have revealed they have more dopamine receptors
+ lindstroem et al gave gave 10 people with and 10 people without schizophrenia l-dopa 9 drug that increases dopamine levels. The schizophrenics took it up quicker because they have more dopamine receptors
+ anitispsychotic drugs that reduce dopamine are an effective treatment
+ amphetamines are a drug that increases dopamine. when given to those with schizophrenia symptoms get worse and when given to those without they have symptoms
+ schizophrenics have genes that increase sensitivity to dopamine
x depatie and Lal gave apormorphine ( a drug that increases dopamine) to normal people and found it didn’t create schizophrenic symptoms
x don’t know is excess dopamine causes it or schizophrenia causes excess dopamine
x doesn’t explain an increase in positive symptoms well
x the explanation is not sufficient alone. Maybe people have a tendency which is triggered by the environment

52
Q

who came up with the cognitive explanation for schizophrenia?

A

Frith (1992)

53
Q

what were the two areas of Friths theory?

A

metarepresentation and central control

54
Q

what is metarepresentation?

A
  • it is the ability to reflect on our thoughts, behaviour and experiences
  • it allows self awareness of our own intentions and allows us to interpret the actions of others
  • problems with it leads to not being able to recognise our own actions as being carried out by ‘me’ or someone else
  • this explains positive symptoms
  • e.g when people hear voices they generate a voice in their head but don’t know whether they or someone else said it
  • it also explains delusions as patients believe their thoughts come from someone else
55
Q

what is central control?

A
  • the ability to suppress our automatic response to stimuli while we perform actions that reflect our wishes and intentions
  • this explains negative symptoms
  • all behaviour is either chosen willed or stimulus driven
  • whenever normal people talk they suppress stimulus driven behaviour but schizophrenic people can’t
  • e.g when schizophrenics talk their speech is interrupted because they try to rhyme words and group them together. The rhyming is in response to what they are saying.
  • “the boy went to school” tuns into “the boy toy went to school scam scum”
56
Q

evaluation of the cognitive explanation of schizophrenia (6 points)

A

+ explains both positive and negative symptoms
+Bental et al gave schizophrenics and a control group a group of plants beguinning with ‘c’. They were asked to add their own words too. a week later they were asked which words were theirs but the schizophrenics couldn’t do it. This is because of metarepresentation problems.
+McGuigan found the voice box of patients was active during auditory hallucinations showing they mistook their own voice for someone elses
+ McGuire et al found schizophrenics found schizophrenics have less activity in the part of the brain that monitors internal speech
+PET scans show underactivity in the frontal lobe which is linked to self monitoring which is biological support
x Frith suggests biology is to do with it, not just cognitive functioning BUT + this means it is not redcutionalsit

57
Q

What is the biological treatment for schizophrenia?

A
  • antisychotics
  • there are first (old) generation drugs and second generation drugs (typical/atyical)
  • they aim to decrease the levels of dopamine and serotonin
  • the first generation drugs work by blocking the receptors in synapses that absorb the dopamine
  • the second generation work by binding to the receptor sites of a neuron and releasing in a more flexible way
  • antipsychotics can be taken in tablet or syrup form
  • some people are on them for life and others on them for a course and their symptoms never return
58
Q

Evaluation of the biological treatment for schizophrenia? (7 points)

A

+ david et al performed a meta analysis of over 100 studies that compared antipsychotics with placebos. Over 70% improved on antipsychotics after 6 weeks fewer than 25% improved on placebos
+ Schooler et al randomly allocated 555 patients to either the first or second generation drugs. In both groups 75% had improved. The second genereation drugs were better as there were fewer side effects and 42% had relapses compared to 55% on the first generation drugs.
x many people relapse
x there are potential serious side effects such as constipation and weight gain
+ the second drugs were made to reduce these 2 things
x 10% of cases lead to long term neurological problems
x tardive dyskinesia is a common side effect which causes involuntary movements in the face and limbs

59
Q

What is the cognitive treatment for schizophrenia?

A
  • cognitive behavioural therapy
  • you firstly identify irrational and unhelpful thoughts and then try to change them
  • this involves drawing diagrams for patients to show them the link between their thinking, behaviour and emotions
  • it can’t get rid of symptoms but helps them cope with them
  • Turkington said et al (2004) said the purpose of cbt is to help patients make sense of how their environment, including delusions and hallucinations, impact on their feelings and behaviour
  • therapists can share other patients stories to show them that it does get beter
60
Q

Describe the Bradshaw (1998) case study of CBT

A
  • carol, a 26 year old American who had schizophrenia for 7 years
  • first 3 months: therapist gained trust
  • next 2 months: focused on getting used to cbt and the cognitive understanding of her symptoms
  • next year: she had to rediscover her hobbies and was taught stress management techniques
  • following 16 months: she dealt with stressful situations and the negative comments he heard. Carol started socialising and doing voluntary work
  • end phase: focused on fear of relapsing
  • one year later: Carol started work and education an had less symptoms. After 4 years she had not relapsed
61
Q

Evaluation of the cognitive treatment for schizophrenia (7 points)

A

+ Bradshaw (1998) case study showed it worked
+ Pilling et al (2002) found cbt was successful in all cases used
+ Morrison et al gave 6 months of cbt to patients showing early signs of schizophrenia. A year later they had less symptoms than the control group so it is good at preventing schizophrenia
+ gives patients an understanding of where symptoms originated
+ it can normalise schizophrenia for people
x expensive so not available to everyone - especially as most people diagnosed are in a lower socio economic group
x gaining an understanding of the condition can cause some people depression

62
Q

what method is used to research scizophrenia

A

twin studies

63
Q

why are twins studies used to reseach schizophrenia

A

to see if theres a genetic component

64
Q

what are the 2 strengths of twins studies

A

+ the IV is already naturally manipulated and twins share the same environment so you can see the effect of nature over nurture
+ there are so many twins it can be repeated and done all over the world

65
Q

what are 3 weaknesses of twin studies

A
  • mz twins are reared ina more shared environment than dz twins becuase they are identical and same gender
  • genes turn on and off so one mx twin might have an enviromental trigger to schizophrenia but the other doesnt
  • the dsm which diagnoses shcizophrenis isnt always valid
66
Q

what study can be used for twin studies and schizophrenia

A

gottesman and shields (1966)

67
Q

LLOK UP GOTTESMAN AND SHIELDS

A

NOW

Psychology (12 decks)

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