Clinical

• What are the 4Ds.

  1. deviance
  2. dysfunction
  3. distress
  4. danger
• whats the 5th D and who was it added by

  duration added by Davis
• what are the classification systems

  • DSM
  • ICD
• FACTS ABOUT THE DSM:

  • classification of mental disorders
  • used mostly in the USA
  • has symptoms for disorders and guidelines for clinicians to use to help make a diagnosis
• FACTS ABOUT THE ICD:

  • classification of mental and physical disorders
  • used internationally
  • for each disorder it gives the clinician the main features and symptoms to make a diagnosis
• evaluating the use of classification systems

  + Both have similar symptoms for disorders in their newest editions meaning less variation in their views.

  + Clinicians can identify particular symptoms which should increase the reliability and validity of the diagnoses.

  -differences between the two systems mean that the use of one of the manuals can affect whether a disorder is diagnosed or not.

  -concern that classifying mental disorders may have led to over medicalisation.
• what is the classic study for clinical psychology?

  Rosenhan
• What were the three aims of Rosenhan's study?

  1. if we could tell the sane from the insane
  2. Test the reliability and validity of diagnostic systems (DSM II).
  3. Observe and report on the experience of being a patient in a psychiatric hospital.
• What was the diagnostic system used at the time of the Rosenhans?

  DSM II
• Rosenhan: sample

  12 psychiatric hospitals in the USA across 5 different states 
• Rosenhan: procedure

  • 8 sane people (5 men, 3 women )
  • complained of hearing voices - empty, thud, hollow
  • only thing they lied about was symptoms, name and job
  • Pseudopatients secretly made notes about their observations however in some cases it was taken abnormal writing behaviour
• Rosenhan: results

  • Pseudo-patients stayed in hospital for a range of 8-52 days
  • 35 out of 118 of the real patients thought that the pseudo-patients were fake
  • 80% of nurses ignored pseudo-patients when questioned
  • normal behaviours were interpreted for abnormal behaviours
  • in follow-up study 41 patients were seen as being fake even tohugh Rosenhan sent no patients
• schizophrenia symptoms

  • delusions
  • hallucinations
  • disorganized speech
  • disorganized behaviour
  • affective flattening
• schizophrenia features

  • equally common in males and females, but for males, it usually occurs 4-5 years before it occurs in females.
  • 1/3 of patients have a single episode and then recover fully
  • 1/3 of patients have a few episodes through their life but function normally between them.
  • 1/3 of patients deteriorate over a series of increasingly worse episodes
• schizophrenia biological explanation -neurotransmitters - what is the original dopamine hypothesis 


  The original Dopamine Hypothesis states that the brain of schizophrenic patients produces excess dopamine compared to the brain of a “normal” person.​
• schizophrenia biological explanation -neurotransmitters - what is the original dopamine hypothesis

  • schizophrenia is linked to over activity of dopamine at D2 receptors in the brain.
  • excess dopamine in the metabolic areas through D2 receptors causes positive symptoms.
  •  Too little dopamine in the mesocortical system is thought to cause negative symptoms
• What did Randrup and Munkvad's experiment with rats demonstrate about dopamine?

  It showed that amphetamines, which mimic dopamine, can induce psychotic behavior similar to schizophrenia.
• How does an increase in serotonin activity relate to schizophrenia symptoms?

  It can lead to both positive and negative symptoms associated with schizophrenia.
• How do anti-psychotic drugs function in the treatment of schizophrenia?

  They work by blocking dopamine receptors, which helps reduce symptoms.
• What does the effectiveness of anti-psychotic drugs suggest about the role of dopamine in schizophrenia?

  It suggests that excess dopamine may explain the development of schizophrenia.
• What did Alpert and Friedhoff's findings reveal about the treatment of schizophrenia with anti-psychotics?

  Not all patients with schizophrenia respond to anti-psychotic treatment, suggesting dopamine is not the only cause.
• what is the biological treatment for schizophrenia

  • antipsychotic drugs to reduce the amount of dopamine available or reduce the amount of dopamine receptor sites by blocking them.​

   
• what are the two types of antipsychotic drugs

  • first generation antipsychotics (FGA's)
  • second generation antipsychotics (SGA's)
• what are FGA's (treating schizophrenia )

  • used to reduce the effects of dopamine.
  • they block dopamine receptors without activating them.
  • reduce positive symptoms
  • cause side effects such as muscle stiffness or uncontrollable mouth movement
• what are SGA's (treating schizophrenia )

  • temporarily block the dopamine receptor sites
  • and act on serotonin and glutamate receptors.
  • reduces positive and negative symptoms.
  • side effects include weight gain and insulin resistence.
• evaluation of antipsychotic drugs as a treatment for schizophrenia 


  + quick and easy to administrate in tablet, liquid or injection from Meltzer et al (2004) found patients using antipsychotics had reduced symptoms of SZ and showed improvements in day-to-day functioning within 6 weeks.

  -Side effects such as weight gain can impact the patient's adherence to their medication programme.
• what is the non-biological explanation for schizophrenia

  the cognitive explanation
• The non-biological explanation for schizophrenia: underlying principle

  • Beck proposed a cognitive triad.
  • this is the idea that our thoughts and beliefs shape our feelings and our feelings direct the way we behave. our behaviour influences the way people treat us and that in turn backs up our thoughts and beliefs.
• The non-biological explanation for schizophrenia: attention deficit theory

  • proposed by Firth
  •  symptoms such as hallucinations are caused by too much sensory information  Schizophrenics pay too much attention to information we would usually filter from the senses, creating cognitive overload  
• The non-biological explanation for schizophrenia: failure to activate schemas

  • proposed by Hemsley
  • SZ patients struggle to combine stored knowledge and new sensory input effectively
  • Our schemas help us to predict what is going to happen next.  Sz are unable to make these predictions. 
  • A poor link between memory and perception can lead to disorganized thinking, as people will not know what to expect from a situation- leading to paranoid episodes
• The non-biological explanation for schizophrenia: Meta- representation dysfunction

  • Meta – representation is the cognitive ability in healthy people to be able to reflect on thoughts, have self-awareness and recognise other people's intentions.
  •  Sz have meta-representation dysfunction and so have difficulty recognising thoughts and actions as their own.
• The non-biological explanation for schizophrenia: central control dysfunction

  • Those with SZ lose the ability to suppress automatic actions  affecting goal-directed behaviours.
  • Disorganised speech occurs because they cannot suppress automatic thoughts and responses.
• What did McGuire et al. (1996) find about the temporal lobe during hallucinations in schizophrenia?

  The temporal lobe is less active during hallucinations.
• How does the cognitive explanation relate to the monitoring of inner voice in schizophrenia?

  People with schizophrenia are less able to monitor their inner voice.
• What therapeutic approach has been developed from the cognitive explanation of schizophrenia?

  Cognitive behavioral therapy.
• What does the effectiveness of cognitive behavioral therapy suggest about the cause of schizophrenia?

  It suggests that the cause of schizophrenia is cognitive.
• What is a potential limitation of the cognitive explanation regarding sensory overload in schizophrenia?

  Sensory overload could be a result of having schizophrenia, not a cause.
• What neurotransmitter did Carlsson et al. (2002) identify as causing symptoms like hallucinations?

  Glutamate.
• How does the finding of Carlsson et al. (2002) challenge the cognitive explanation of schizophrenia?

  It shows that the cognitive explanation is not a full explanation of schizophrenia.
• what is the Non-biological treatment for schizophrenia?

  CBT