Clinical Psychology

• Deviance - Statistically abnormal or deviation from the social norm
• Dysfunction - Symptoms that interfere with a person's ability to carry out their usual role/ day to day life
• Distress - Symptoms that cause emotional pain or anxiety, can manifest in physical symptoms
• Danger - Careless, hostile or hazardous behaviour that jeopardises the safety of the individual and/or others
• Duration - Added by Davis 2009
• Using the 4Ds helps to avoid erroneous diagnosis and misdiagnosis
• Distress can be measured objectively using the Kessler Psychological Distress scale
• Danger is also reliable as for someone to be detained under the Mental Health Act, three clinicians must be in agreement
• Negative effect of diagnosing an individual include:

  • Labelling and self-fulfilling prophecies. E.g. The stereotype that people with schizophrenia are dangerous, when this is not true 
  • Issues of Social Control - Clinicians given a lot of power over diagnoses. It can be used to legitimise social exclusion for those that breech social norms. Also some patients could be sectioned against their will according to the Mental Health Act.
• Fazel 200 - people with Sz are not more dangerous than the general population however using labels such as 'danger' and distortion from the media lead people to equate mental illness with being dangerous
• DSM - Classification system used to identify mental disorders in the USA
• DSM - Diagnosis based on clinical interviews
• ICD - Classification system that includes both physical and mental disorders, multilingual and international
• ICD - Diagnosis based on symptom based index list
• DSM - Regier 2013 found that major depressive disorder had a poor reliability score of 0.2. This means that some patients may not be diagnosed or misdiagnosed
• ICD - Increased number of disorders does not detract from reliability
• DSM - Lacks validity because the label doesnt explain what is causing the disorder
• ICD - Good predictive validity for Sz which is shown in a study done by Peter Mason
• Rosenham 1973:

  Aim:

  • Can we tell the sane from the insane?
  • Can mental health professionals distinguish between those who are genuinely mentally ill and those who are not
• Rosenham 1973

  Sample

  • Field study using 12 psychiatric hospitals in the USA, across 5 different states
  • 8 pseudo patients
  • High ecological validity
  • Real hospitals of various sizes and real medical staff
  • Lacks generalisability
  • Ethnocentric, only generalisable to America
• Rosenham 1973

  Procedure

  • Pseudo-patients telephoned the hospital for an appointment, complaining of hearing voices. The voice was unfamiliar and the same sex as themselves, was often unclear but it said 'empty', 'hollow', 'thud'
  • High internal validity
  • All hospital staff were unaware that they were being observed
  • Standardised procedure
  • Same auditory hallucinations
  • Gave a false name and job, but all other details given were true including relationships and events of life history
  • After admission, pseudo patients no longer displayed symptoms
• Rosenham 1973

  Results

  • All patients were admitted with stays ranging from 8 to 52 days (mean 19)
  • 7 out of 8 were diagnosed with Sz, 8th with manic-depressive psychosis
  • Discharged with 'Sz in remission'
  • Note taking was seen as a symptom, walking around was seen as anxiety
  • Subjective
  • Researchers collected qualitative data, which may be open to interpretation
• Rosenham 1973

  Follow up

  • No patients were sent
  • 41/193 patients were judged to be fake by at least 1 member of staff
• Rosenham 1973

  Conclusion

  • Diagnosis is inaccurate
  • Real life applications to DSM
• Rosenham

  Evaluation

  • The study has low reliability because the results may be subjective - This is because the researchers collected qualitative data, for example the notes by the nurses and the doctors, which may be open to interpretation
  • The study has high reliability as the pseudopatients used standardised procedure - For example, all the pseudopatients said they heard the same auditory hallucinations of 'empty, hollow, thud.'
• Rosenham

  Evaluation

  • The study has high ecological validity - The study used 12 real hospitals across various sizes and over 4 states and real medical staff
  • It has high internal validity - All the hospital staff were unaware that they were being observed, and all the psuedopatients all behaved in the same way.
• Rosenham

  Evaluation

  • They have breached multiple ethical guidelines:

  1. Psychological harm
  2. Consent
  3. Deception To the hospital
  4. Psychological harm = the nurses and doctors may have felt distressed knowing that they were in an experiment, especially if their behaviour was humiliating and negative.
  5. Consent = as it was a field experiment in 12 real hospitals, they could not gather consent from the staff.
  6. Deception = the staff were not aware of the presence of pseudo patients, and were therefore unable to give their informed consent to be observed and behaviour recorded.
• Schizophrenia AO1

  Positive Symptoms

  • Hallucinations
  • Delusions
  • Thought Disorders
• Schizophrenia AO1

  Negative Symptoms

  • Lack of energy
  • Social withdrawal
  • Flatness of affect
  • Lack of self preservation
• Schizophrenia AO1

  Features

  • 1% of population over 18 diagnosed
  • Onset 15-45
  • Active phase (psychotic episode) lasts 1-6 days
  • 1/3 of patients have a single/few episodes then recover fully
• Schizophrenia AO1

  Biological Explanation - Genetics

  • Normal risk of having Sz is less than 1%
  • Risk with 1st degree relative is between 6% and 17%
  • COMT genes - breaks down dopamine in prefrontal cortex. Deletion of this gene could mean dopamine is not broken down resulting in Sz symptoms
  • DISC-1 genes - People with this abnormality are 1.4x more likely to develop Sz
• Schizophrenia AO3

  Biological Explanation - Genetics

  • Gottesman and Sheilds (1991)
  • looked at 57 participants where at least one twin had been diagnosed with Schizophrenia
  • In MZ twins, there was a concordance rate of 42% in DZ twins, there was a concordance rate of 9%
  • This shows that genes seem to make up a significant role in the likelihood of developing SZ​
• Schizophrenia AO3

  Biological Explanation - Genetics

  • Egan et al. (2001) - inheriting two copies of the 'Val-allele' form of the COMT gene (one from each parent) increases the risk of Sz by 50%
  • Dahoun et al (2017) reviewed 14 studies and concluded that the DISC 1 gene is associated with dopamine dysregulation.
• Schizophrenia AO1

  Biological Explanation - Neurotransmitters

  • Dopamine Hypothesis - The original dopamine hypothesis states that excess dopamine in the brain causes symptoms of schizophrenia
  • Revised Dopamine Hypothesis
  • Excess dopamine through D2 receptors causes positive symptoms
  • Lack of dopamine through D1 activation causes negative symptoms
  • Blocked glutamate production causes Sz symptoms
• Schizophrenia AO1

  Biological Treatment - Drug Therapy

  • The most common treatment for schizophrenia uses antipsychotic drugs
  • An important goal of antipsychotic drugs is to reduce the amount of dopamine available or reduce the amount of dopamine receptor sites by blocking them
• Schizophrenia AO1

  Biological Treatment - Drug Therapy

  • Typical Anti-Psychotic Drugs
  • Typical antipsychotic drugs are used to reduce the intensity of positive symptoms, blocking dopamine receptors in the synapses of the brain and thus reducing the action of dopamine
  • They block the D2 receptors in synapses that absorb dopamine, reducing positive symptoms
• Schizophrenia AO1

  Biological Treatment - Drug Therapy

  • Atypical Anti-Psychotic Drugs
  • Attempt to target D2 dopamine activity in the limbic system but not D3 receptors in other parts of the brain
  • Atypical antipsychotic drugs work on negative symptoms, improving mood, cognitive functions and reducing depression and anxiety
• Schizophrenia AO1

  Non-Biological Explanation - Cognitive

  • Cognitive approach argues that abnormal behaviour is cause by faulty thoughts (cognitive distortions). The thoughts are often irrational and not backed up by fact, therefore their behaviour will also be irrational
• Schizophrenia AO1

  Non-Biological Explanation - Cognitive

  • Attention
  • Schizophrenics have difficulty concentrating, impaired ability to sort relevant from irrelevant stimuli
  • They are highly sensitive to stimuli of all kinds- from both internal and external sources - and cannot integrate their perceptions into a meaningful pattern. This leads to overwhelming and unintegrated ideas and sensation, affecting their concentration
• Schizophrenia AO1

  Non-Biological Explanation - Cognitive

  • Schemas
  • Sz patients struggle to combine stored knowledge and new sensory input effectively
  • Delusions and paranoid episodes occur due to misinterpreting the events around them