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Diagnosis Flashcards

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1
Q

What is clinical psychology?

A

Clinical psychology deals with diagnosing, explaining, and treating mental illness.

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2
Q

What is diagnosis?

A

Diagnosis involves a clinician assessing a patient, deciding whether they show evidence of mental disorder, and if so, whether their symptoms match those in a checklist of the features and symptoms of a mental disorder.

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3
Q

Why is it often difficult to decide whether someone actually has a mental disorder or not?

A
  1. There is no clear dividing line separating normal and abnormal behavior.
  2. The concept of abnormality can change over time.
  3. The concept of abnormality can change between societies/cultures.
  4. Many different types of behaviour can be considered abnormal.
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4
Q

What are the four Ds?

A

•Deviance
•Distress
•Dysfunction
•Danger

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5
Q

Define deviance

A

Deviance refers to behaviours or emotions that are unusual in society. To be described as deviant, a behaviour must not only be statistically rare, but also disapproved of by most in society. So extreme bravery (running into a burning building to save a child) would be unusual, but would not be classed as deviant because people in society would view it positively rather than negatively.

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6
Q

Define distress

A

Distress refers to the extent to which the individual finds their behaviour and/or emotions upsetting.

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7
Q

Define dysfunction

A

Dysfunction refers to the extent to which the behaviour interferes with the person’s day-to-day life.

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8
Q

Define danger

A

Danger refers to behavior which could harm others, or which could harm the individual themselves.

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9
Q

Give two strengths of the four Ds of diagnosis

A

•The four D are useful because they have a practical application in helping professionals decide whether a patient’s symptoms warrants a clinical diagnosis.
•They also provide a holistic way to assess someone’s mental health, as they cover a wide range of symptoms.

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10
Q

Describe weaknesses of the four D’s of diagnosis

A

•However, there is likely to be subjectivity in the application of the four Ds. For example, assessment of dysfunction can be quite subjective as to how much these behaviours inhibit someone’s life. The individual themselves may not think they have a problem, and their unusual behaviour may suit them as it provides them with a way of coping with their difficulties in life.
•Similarly, distress is subjective and difficult to measure. Also, not all mental disorders are’ distressing to the person; for example, a sociopath may be perfectly content with their
mental functioning. And the same applies to danger: the assessment of how much danger a person poses to themselves or others may be subjective.
•Because of this subjectivity, the four Ds may lack Validity. This is because diagnosis may not
be accurate.
•Subjectivity may also mean that the four Ds may lack reliability. This is because if they are used by two different professionals, they may not arrive at the same diagnosis. This reduces the scientific status of diagnosis.
•The model can also be criticised for being incomplete; Davis (2009] suggests that a fifth “D” needs to be added to the list: duration. This refers to how long the symptoms have lasted for. For example, a diagnosis of depression requires the symptoms to have lasted for at least two weeks.

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11
Q

Identify two key debates and explain why they are relevant to the four Ds.

A

•Social control. This is seen where defining behaviours as deviance could be used to discriminate against people whom the majority disapprove of and want removed from society
•Psychology as a science: subjectivity means that the four Ds will not be applied in a reliable and consistent way.

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12
Q

What is the aim of classification systems?

A

Classification systems are used by practitioners to help them make diagnoses and establish appropriate treatment regimens. Their aim is to provide clear and measurable criteria for diagnosis, which can be used in the same way by all practitioners. This should increase the reliability of diagnosis.

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13
Q

Define reliability

A

When the same results are found when the study is repeated

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14
Q

Describe what is meant by the medical model of abnormality.

A

• It is a biological approach which assumes that abnormal behaviour is caused by a physical illness.
•It also therefore also believes that the most appropriate treatment for mental disorders is biological (e.g. drug treatment).

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15
Q

Describe one strength of the medical model of abnormality

A

The medical model groups symptoms together and classifies them into syndromes, so that their cause can be discovered and appropriately treated. This is a strength because it takes scientific, obiective approach to diagnosis.

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16
Q

Describe one limitation of the
medical model of abnormality

A

Whereas the classification of physical illnesses involves observation and measurement of objective symptoms such as broken bones, fever, blood pressure etc., with mental illnesses, the symptoms are much more subjective - e.g., feelings of despair, lack of energy or hearing voices.
These cannot be easily measured, so the clinician must make a judgement based largely on experience, reducing validity.

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17
Q

What are the two major classification systems?

A

•ICD 10
•DSM 5

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18
Q

Describe the purpose of the DSM 5 and the ICD.

A

•To provide a standardised, criterion based system
•to allow for accurate diagnosis of mental disorders.

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19
Q

Give two reasons why the DSM and the ICD are regularly reviewed and updated. [2]

A

• To take account of new research
• To take account of people’s changing cultural views.

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20
Q

Identify similarities between the DSM and the ICD

A

•Both regularly updated
•Both try to take account of different cultural views
•Both include categories of mental disorder based on patterns of symptoms
•Both use similar coding systems
•Both use the medical model
•Both can be considered to be reductionist as they rely on checklists of symptoms

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21
Q

Identify three differences between
the DSM and the ICD

A

•The DSM is published by the American Psychiatric Association and must be paid for whereas the ICD is published by the World Health Organisation and is free.
•The DSM only deals with mental conditions whereas the ICD also diagnoses physical illnesses.
•The DSM is considered to be more holistic than the ICD because it uses four ways to assess people: type of disorder; factors such as mental retardation and general medical conditions; psychosocial and contextual factors; and disability - whereas the ICD is purely criterion based.

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22
Q

Identify two strengths of using a
classification system for diagnosis. [2]

A

•Classification systems are regularly updated. This is a strength because it means that they take account of new research. It also means that any inconsistencies will be removed.
• Using a classification system increases reliability of diagnosis, as clinicians will be using the same clear set of criteria, meaning that they should arrive at similar diagnoses.

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23
Q

Identify two weaknesses of using a
classification system for diagnosis. [2]

A

•Even where clear criteria for a disorder are set out, clinicians must use their subjective judgement at times, reducing reliability and validity of diagnosis.
• Classification systems use the medical model, suggesting that mental disorders are caused by physical illness. However, this may not be appropriate in psychology, where, because, unlike with many physical disorders, the causes of mental illnesses are often unknown, which leads to a focus only on symptoms.

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24
Q

Provide one argument in favour of the idea that classification systems are scientific, and one argument supporting the idea that classification systems are not scientific. [2]

A

•Classification systems can be considered to be scientific because they rely on standardised checklists of observable behaviour, which are reliable because they can be used in the same way by all clinicians.
•On the other hand, they may be considered to be unscientific because there will always be an element of subjectivity when interpreting the diagnostic criteria.

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25
Q

What possible factors can impact reliability of diagnosis?

A

•Patient factors: the patient may give
different psychiatrists different information.
• Clinician factors: the practitioner may not be objective. The practitioner may not gather enough information or may use the classification system incorrectly.
•Classification systems: the new ICD-11 coding system correlates well with the DSM-5 increasing reliability.

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26
Q

One piece of evidence that suggests that diagnosis may be HIGH in reliability

A

Brown (2002) tested the reliability and validity of DSM IV diagnoses for anxiety and mood disorders and found them to be good to excellent.

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27
Q

One piece of evidence that suggests that diagnosis may be LOW in reliability

A

Spitzer and Williams (1985) reviewed the process of diagnosis and suggested that experienced psychiatrists only
agree on diagnosis about 50% of
the time.

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28
Q

define concurrent validity

A

Compares evidence from different diagnostic tests to see if they agree. The DSM and the ICD seem to have good concurrent validity.

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29
Q

Define aetiological validity

A

Aetiological validity exists when the
diagnosis reflects known causes. For
example, the cause of a disorder may
be due to a problem with damage to a
particular area of the brain.

30
Q

Define predictive validity

A

This is where the future course of the disorder is known and can be applied to the person, so the diagnosis can be checked against the outcome to see if it is valid.

31
Q

Possible factors that impact on validity of diagnosis:

A

Patient factors
x The patient may not disclose all relevant information, because they may be embarrassed or ashamed, or because they may not remember all relevant details. This might mean that the clinician would not be able to arrive at an accurate diagnosis.
Clinician factors
x Implicit bias (positive or negative attitudes that a person may hold at an unconscious level) in the clinician can reduce the validity of diagnosis. This is because the beliefs of a clinician (e.g. men are less likely to suffer from depression than women) might mean that s/he arrives at an inaccurate (invalid) diagnosis.
Classification system
X If the classification system itself is biased, then diagnosis will not be valid. Cochrane et al (1995) blames the classifications systems used in Britain. He argues that the classification systems themselves lead practitioners to take on a ‘Eurocentric bias’, which means they cannot take into account the ‘normal’ behaviours of other cultures because they are based on European ideas.
X Similarly, Littlewood (1992) questions the international validity of DSM-IV(R) as he says the assumptions it makes about nuclear family life are not applicable to all cultures.

32
Q

What is meant by implicit bias?

A

Positive or negative attitudes that a person may hold an unconscious level

33
Q

Explain how the patient might affect
the validity of the diagnosis given to him/her. (2)

A

•The patient may not disclose all relevant information, because they may be embarrassed or ashamed, or because they don’t remember all relevant details.
•This would mean that the clinician would not be able to arrive at an
accurate diagnosis.

34
Q

Explain why clinical interviews
may reduce validity of diagnosis.

A

Interviews tend to be subjective.
This means that they may produce the findings which the clinician expects to find.

35
Q

Give an example of possible bias within the DSM, and explain how this might affect its validity. [2]

A

•Littlewood (1992) says that the DSM is biased in favour of the traditional nuclear family.
•This means that it may not be accurate when working with non-traditional families.

36
Q

Give an example of how classification systems have improved over time

A

Another example of improved accuracy of diagnosis comes from the wars in Iraq and Afghanistan which have provided us with more insight into PTSD. The DSM-5 now covers more symptoms for this disorder, such as flashbacks. These will further aid the clinician in correctly diagnosing a patient’s symptoms.

37
Q

List the concerns which the anti-psychiatry movement had about the medical model of diagnosis.

A

1) Controversial medical practices
2) Diagnosis used as an agent of state control
3) Diagnosis used to medicalise social problems.
4) Diagnosis results in labelling

38
Q

What is your classic study in clinical psychology?

A

Rosenhan 1973

39
Q

What was the aim of Rosenhan’s study 1?

A

To see if sane people could be admitted to a psychiatric hospital and if once admitted they would be detected.

40
Q

What was the procedure for Rosenhan’s study 1?

A

•8 pseudo-patients including Rosenhan himself (3 women and 5 men).
•Phoned 12 hospitals across the USA ranging from good to bad, old to new and well and understaffed.
•Said they were hearing voices ‘thud’ ‘empty’ and ‘hollow’.
•They have a fake name but everything else disclosed was true including life events and family relationships.
•Once admitted all the pseudo patients behaved normally.

41
Q

What were the results for Rosenhan’s study 1?

A

•All pseudo patients were admitted and 7/8 were diagnosed with schizophrenia in remission.
•The staff treated the researchers in a way that was consistent with their diagnosis and frequently pathologised normal behaviour.
•Other patients in the ward however did suspect the pseudo patients were sane
•Depersonalisation of the patients by the staff

42
Q

What were the conclusions for Rosenhan’s study 1?

A

•Psychiatrists could not detect sanitv.
•The diagnostic label changed the perception of the person so that their behaviour was interpreted within the context of that label. Which he argued could lead to self-fulfilling prophecy.

43
Q

What was the aim of Rosenhan’s study 2?

A

To see if the hospitals, who had been told they were going to be approached by pseudo-patients, would be able to tell the sane from the insane.

44
Q

What was the procedure of Rosenhan’s study 2?

A

A teaching and psychiatric hospital that was aware of the findings from study 1
was informed that over the next 3 months one or more pseudo-patients would try to get admitted to their hospital.
Each member of staff was asked to rate the likelihood that the patients who sought to be admitted were pseudo-patients.
In reality, no pseudo-patients were admitted.

45
Q

What was the results of Rosenhan’s study 2?

A

Staff members rated ‘new patients’ on scale 1 - 10 as ‘how likely to be a fraud’
193 patients ‘assessed’
x 41 rated as a pseudo-patient (by at least two members of staff)
x 23 rated as pseudo-patient (by at least one psychiatrist)
x 19 rated as pseudo-patient (by a psychiatrist and one other member of
staff)

46
Q

What was the conclusion of Rosenhan’s study 2?

A

The staff were unable to detect insanity. Type 2 error.

47
Q

What was the aim of Rosenhan’s study 3?

A

To investigate patient/staff contact

48
Q

What was the procedure of Rosenhan’s study 3?

A

In 4 of the hospitals pseudo-patients approached a member of staff and asked~
“Pardon me, Mr/Mrs/Dr X, Could you tell me when I will be eligible for ground privileges?” The pseudo-patient did this as normally as possible and avoided asking the same member of staff more than once a day.
Rosenhan compared the responses given to the patients to those given to a
student at Stanford University when she asked staff for help, such as how to find an area of campus.

49
Q

What was the results of Rosenhan’s study 3?

A

0.5% of nurses stoped and talked to the patients compared to 100% of the faculty.

50
Q

What was the conclusion of Rosenhan’s study 3?

A

Rosenhan concluded that psychiatric patients are treated differently to non-
psychiatric patients. He suggested that Patients are powerless while on the mental ward and that the lack of eye contact between staff and patients depersonalises the patients.

51
Q

Evaluate Rosenhan’s classic study in relation to High generalisability

A

• Study 1 took place in a range of hospitals (12) across the USA. (old/new hospitals; well-staffed/understaffed)
• This means that the findings should be generalisable to the USA of the 1960’s

52
Q

Evaluate Rosenhan’s classic study in relation to low generalisability

A

• But may not generalise to current times
• And may not generalise outside the USA

53
Q

Evaluate Rosenhan’s classic study in relation to low reliability

A

•The research method used was a field
experiment
•This means that variables such as patient-staff interactions could not be standardised, which means that the research could not be repeated in a consistent way.
•Therefore the reliability of this research is low.
•The study also used participant observation
•This tends to have low reliability because participant observers find it difficult to observe all details, and may get distracted or over-involved.

54
Q

Evaluate Rosenhan’s classic study in relation to high reliability

A

•Certain aspects of the study were
standardised, leading to high reliability.
• For example, all the pseudo-patients
presented with the same,single symptom (hearing a voice that said hollow, thud, or empty)
•All pseudo-patients behaved normally as soon as they were admitted to hospital, and said that they did not have any symptoms.
•The questions asked by the pseudo-patients and the control in study 3 were
standardised

55
Q

Evaluate Rosenhan’s classic study in relation to practical applications

A

• Number of criteria used to diagnose mental illnesses increased: diagnosis is now more accurate as a diagnosis of schizophrenia cannot rely on only one symptom - led to changes in the DSM-III
•People recognised that hospitals may not be the best place to treat mental illness.
•Highlighted danger of labelling
•Reduce abuse of power in mental institutions by staff - CCTV

56
Q

Evaluate Rosenhan’s classic study in relation to high validity

A

Very high ecological validity
• Setting (hospital) and tasks (hospital activities; life as a
patient) both true to life
• Process of being admitted to a hospital, the experience of life
in a hospital, interactions with staff, and discharge, was true to life.
•Covert observation increases validity as reduces demand characteristics: nurses and doctors likely to act as they
normally would.

57
Q

Evaluate Rosenhan’s classic study in relation to low validity

A

•Lack of controls due to nature of research (field experiment) reduces the validity of the research: impossible to standardise things such as patient/staff interactions or reactions of other patients.
•Observer bias may reduce validity: Rosenhan had strong opinions about psychiatry and the medical model; his opinions may have intluenced his observations

58
Q

Evaluate Rosenhan’s classic study in relation to Ethical strengths

A

• Confidentiality: names
of individual doctors/nurses not
published

59
Q

Evaluate Rosenhan’s classic study in relation to Ethical problems

A

Ps did not know they were part of a study so the following are all problems:
• Informed consent:
• Deception
• Right to withdraw
• Protection
• Undermine confidence of doctors and nurses
• Protection of other patients
• Staff wasting time on pseudo-patients instead of looking after genuinely ill people

60
Q

Explain how Rosenhan’s study relates to the use of psychology in social control

A

Rosenhan and other members
of the anti-psychiatry movement suggested that mental hospitals were not used to cure mental illness, but instead were places where disruptive or troublesome people could be kept away from society.
This is shown in his study where the average amount of doctor/patient interaction provided to the pseudo- patients was less than 7 minutes per day - not long enough to deliver any meaningful psychiatric care.

61
Q

Explain how Rosenhan’s study relates to Psychology as a science

A

• Field experiments a lack of controls e.g. participant/patient interaction and lack of standardisation reduces reliability.
•Mainly qualitative data (pseudo-patient’s experiences) reduces scientific status.
•Covert observation increases validity as demand characteristics reduced, meaning that doctors and nurses don’t alter their behaviour.

62
Q

Explain how Rosenhan’s study relates to How psychological understanding has changed over time

A

•At the time when Rosenhan’s pseudo-patients were incorrectly diagnosed with schizophrenia, the classification system in use was the DSM 11, which did not use a criterion-based system for diagnosis.
•Currently, the DSM 5 and ICD 10 give very specific symptoms which means that diagnosis should be both more reliable (consistent between clinicians) and more accurate

63
Q

Explain how Rosenhan’s study relates to The use of psychological knowledge in society

A

•Number of criteria used to diagnose mental illnesses increased: diagnosis is now more accurate as a diagnosis of schizophrenia cannot rely on only one symptom
•People recognised that hospitals may not be the best place to treat mental illness.
•Highlighted danger of labelling
•Reduce abuse of power in mental institutions by staff CCTV

64
Q

Explain how Rosenhan’s study relates to socially sensitive research

A

Studying mental health issues is considered an area of socially sensitive research. The research involves labelling people with an illness in order to investigate treatments. On the one hand Rosenhan was able to provide an account of the quality of care in psychiatric hospitals. However, Spitzer has criticised the study as sensationalist & causing great harm to the psychiatric profession by casting doubt on the treatment of mental health.

65
Q

Was the study high in INTERNAL validity?

A

•Rosenhan’s study may have low internal validity due to experimenter bias.
•This is because Rosenhan and the other pseudo-patients were interested in the antipsychiatry movement and had negative opinions about psychiatric hospitals and staff
•Therefore, they may have been biased when they interpreted interactions between staff and patients.
•But because the observation of the nurses and doctors was covert, there were no demand characteristics which increases internal validity.

66
Q

Was the study high in RELIABILITY?

A

•Certain elements of the procedure were standardised. For example, all the
pseudopatients reported the same symptoms (hearing a voice that said
hollow/empty/thud).
•But most of the other elements could not be standardised - e.g. the interactions with real patients and staff as it was a field experiment.
•So, on the whole reliability is low.

67
Q

Describe how Individual Differences can be linked to the diagnosing of mental disorders.

A

• Different people may show different
symptoms - e.g. different hallucinations; different levels of distress, different levels of dysfunction
• Different people may react differently to practitioners

68
Q

Describe how developmental psychology can be linked to the diagnosing of mental disorders.

A

Schizophrenia usually develops in a person’s late teens / early twenties, after an apparently normal childhood.

69
Q

How did Rosenhan try to get a representative sample of psychiatric institutions to study?

A

They went to 12 psychiatric hospital in
5 states of the USA. The hospitals were a mixture of public & private, old & new; under and well-staffed.

70
Q

What symptoms did the pseudo patients fake?

A

Hearing voices. Said ‘hollow,” ‘empty’ &
‘thud’

71
Q

What two experimental methods were
used?

A

Field experiment with participant observation

Psychology (2) (15 decks)

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