clinical

• 4D's 


  the four d's are a measure used to help diagnose mental disorders. They are used to identify abnormal behaviours, however the identification of a mental disorders using the four d's is based on the therapist's judgement.
• deviance 


  behaviours that are unusual and undesirable. As a result , an understanding of statistical and societal norms is needed to determine how unusual the behaviour is, as well the desirability of a behaviour within a particular social group. Social norms are dependant on the culture, age and gender of the individual. Failure to adhere to social norms can be viewed as abnormal
• dysfunction 


  symptoms which intefere with a person's ability to carry out usual roles and responsiblities. Psychologists use a vary of objective measures to assess dysfuncttion, such as the WHODAS questionnaire which looks ata person's understanding of what is going on around them and self care.
• distress 


  when symptoms cause emotional pain or anxiety, which can someone's manifest as physical symptoms such as aches , pains and palipitations. psychologists can measure this through observation as well as quantative data derived from questionnaires such as the Kessler psychological distress scale
• danger 


  hazardous behaviour which jeopardises the safety of the person and or others , can be identified through an individual's history of aggression.
• strength of the four d's

  it helps avoid errors in diagnosis as it provides a variety of factors to take into account while diagnosing so that it is neither under nor over inclusive
• weakness of 4 D's

  Lacks objectivity as the conclusions being drawn are based on the psychologists view on the patient , this can be improved via clinicians sharing their conclusionds on diagnosis and treatment of a patient with one another to provide inter rate reliability and therefore increase validity of the study
• weakness of the 4 D's

  diagnosis creates labels for people. Using danger as a criterion for mental disorders can equate mental disorders with being dangerous , therefore formulating dangerous stereotypes , which can lead to self fuflfilling prophecies of people ascting a certain way because it is what is expected of them
• application of the 4D's

  used by mental health clinicians in conjunction with classification mannuals, such as ICD- 10 , to see whether a diagnosis is appropriate and to identify which disorder it is . Different disorders show different levels of the 4d's , this suggests that the 4d's are useful in clinical diagnosis
• DSM


  describes the symptoms, features and associated risk factors of over 300 mental and behavioural disorders catergorised into 22 categories . It is used primarily in the US as well as other nations across the world.
• DSM-5 


  reviewed DSM released in 2013 , is split into three sections
• section 1 


  offers guidance on the using new system
• section 2 


  details disorders and categories them based on our current understanding of underlying causes and similarities between symptoms , i.e schizoprenia previously had 5 subtypes, one was removed an a dimensional assessment was added
• section 3 


  includes suggests for new disorders, such as internet gaming disorders , which currently still require further investigation . Also includes the impact of culture on the presentation of symptoms and the way that they are communicated, especially when the clinician is from a different cultural background .
• diagnosis through the DSM

  clinicians may gather information through observation of an individual, however much of diagnosis will be done via unstructured interview. Although , there are many structured interview scedules avaliable based on symptom lists. The most common approach is to rule out dsisorders which do not match a person's symptoms before deciding which disorder is the best fit .
• How reliability is assessed

  Spitzer introduced the use of Cohen's Kappa to improve the reliability of the dsm. This is a statistic which is written as a decimal and refers to the proportion of people that receive the same diagnosis when assessed and re- assessed at a later time, or by an alternative practioner. 0.7 would indicate good agreement.
• How to assess validity

  • descriptive validity: when two people with the same diagnosis experience similar symptoms
  • concurrent validity: when a clinician uses now than one method of techniques to reach a diagnosis , and both methods leads to the same diagnosis and are able to accurately predict the outcomes for an individual from their diagnosis, we can say that the diagnosis had good predictive validity
• Strength of dsm


  a strength of dsm-5 is that field trials showed impressive levels of agreement between clinicians for a variety of disorders . Regier found that three disorders including PTSD had kappa scores of 0.6 to 0.79, which suggests the validity of the newly reviewed dsm-5
• weakness of dsm 


  a weakness is that what counts as an acceptable level of agreement has plummeted over time , Cooper explains that the dsm-5 task force classified levels as low as 0.2-0.4 as acceptable , this suggests that the current use of dsm may be less reliable than previously, and therefore certain diagnosis have been made in error
• strength of dsm


  supported by the study of Cohen et al who demonstrated the validity of conduct disorder by testing concurrent validity through : interviewing the children and their mothers, observation of the children, questionnaires. Furthermore , predictive validity was demonstrated as it was able to be suggested that 5 year old children with CD would be more likely to display behavioural and educational difficulties at 7 . By having high levels of validity, an accurate diagnosis can be given
• weakness of dsm


  a weakness of dsm is that it is often viewed by psychologists as an incomplete means of diagnosis as it doesn't give us any information on what causes a disorder, but rather just classifys it.
• anorexia nervosa 


  three key symptoms :

  1: restriction of energy intake : limits what they way to the point where they have significantly low body weight, taking into account the person's , weight , age and sex . The ICD defines low body weight as anything at least 15 % below expected BMI
• symptom 2 : fear of weight gain

  intense fear of gaining weight or becoming fat, may engage in behaviours which prevent them from gaining weight, this could be avoiding fatty food, purging or excessive exercise
• symptom 3 : disturbed image of body shape

  body image distortion . Weight and or shape of their bodies has an influence on the persons self evaluation and how they view themselves. They may fail to recognise how seriously low their body weight is.
• subtypes of AN

  • restricting subtype: the person has not binged, purged or used laxatives during the three months before diagnosis, instead weight loss is achieved through dieting and excessive exercise.
  • Binge/purging subtype: the person has binged or purged in the previous three months, usually as well as restricting their calorie intake
• severity of AN


  according to the DSM, severity can be assessed in terms of BMI . AN with a BMI above 17 is mild , 16-16.99 is moderate , 15-15.99 is severe and below 15 is severe
• features of AN

  • Dahlgren found the lifetime rate for females being diagnosed with AN ranged from 1.7% to 3.6% and was 0.1% in males
  • Zerwas found that the incidence of AN new cases in the 16-20 year old age group was 6.05 new cases per 10,000 person years, this was an overall figure and the prevelance was much higher for females than males.
  • Highest mortality rate of all mental disorders
• reliability strength


  diagnosis of AN using the DSM-5 is reliable. Sysko et al measured the test retest reliability of AN diagnosis by assessing participants via a telephone interview using the DSM as a criteria, between 3 and 7 days a different assessor telephoned the participants and interviewed then again to repeat the assessment. Th estent of the agreement was seen as excellent, this associates that the use of the DSM to accurately diagnose individuals is reliable.
• reliability weakness


  Sysko's study does not necessarily support the idea of the DSM being reliable in diagnosis of anorexia . Thomas found that many studies go beyond the official DSM-5 criteria in defining anorexia, i.e the defined cut off point for low weight is not defined in the DSM-5 and as a result reliability estimates would be higher than they would be in real life clinical practice, as there is no defined criteria to adhere to .
• validity weakness


  Smith et al found that in 109 adults diagnosed with anorexia, those with a higher BMI which is linked to less severe cases of anorexia were linked to greater reading disorder psychopathology , this suggests that DSM-5 severity specifiers fail to accurately distinguish levels of severity and Therefore lack validity
• Genetic explanation of anorexia

  Strober et al looked at the first degree relatives of individuals with and without Anorexia, he found that AN was rare in relatives of people who had never had An eating disorder but was 11.3 times more prevelant in the relatives off those who had.
• EPHX2 gene 


  Candidate gene study. this gene codes for the enzyme epoxide hydrolase which regulates cholesterol metabolism. Many people in the acute phase of AN , when symptoms are severe, have abnormally high levels of cholesterol.
• ITPR3 gene


  this gene codes for a protein receptor for inositol triphosphate , which is involved in detecting tastes sick add sweet and bitter. This mechanism is not yet fully understood but it is possible that a dysfunction in the taste pathway means that people with AN are indifferent to tastes that others enjoy which partly motivate them for eating
• DAT1 gene 


  The DAT1 gene codes for a protein caller the dopamine transporter, this is embedded in the membrane of the pre synaptic neurons and regulates the transportation of dopamine between the neuron and the Synaptic cleft. Mutation of the DAT1 gene disrupts this process resulting in high amounts of dopamine available for synaptic transmission, deregulating the brain's reward system, meaning that eatings normal rewarding function is impaired

  Avena and Bocarsly more dopamine avaliable in the mesocortiolimbic pathway reward circuit which impairs the

  motivation for eating
• 5-HTR2A gene


  codes for a subtype of post synaptic seratonin receptor called the 5-HTR2A, which is most implicated with AN. A mutation in 5-HTR2A gene affects the structure of the 2A receptor which results in less binding between the receptor and seratonin, which results in appetite related neural information not being transmitted normally.
• Strength for genetic explanations

  Supported by the study of Holland et al , who conducted a study using 45 pairs of female twins and one set of triplets, he found a concordance rate of 56% for MZ and 5% for DZ twins which supports the idea of genetic linkage being a means for explaining the development of AN.
• weakness of genetic explanations

  a weakness of twin studies is that they rely on the equal environment assumption and therefore lack validity. We are assuming that MZ and DZ twins are treated with degrees of similarity. Joseph found that MZ are treated more similarly than DZ twins particularly by their parents, the greater environmental similarities means that heritability estimates are inflated and genetic influences are not as significant as twin studies suggest .
• weakness of biological explanations

  a wide variety of anorexia symptoms cannot be explained solely by one gene. Anorexia is a polygenic disorder and it is likely that that varying genes contribute to the various symptoms of AN to differing degrees, therefore any theory which seek to explain the disorder with one cause risk over simplification.
• application of biological explanations of anorexia

  understanding the genetic basis of AN could lead to useful developments in prevention and treatment as knowledge of a person's generic profile could allow for prevention and treatment to be targeted more effectively at people most vulnerable to developing AN. This is a strength as treatments based on a person's genetic profile can improve quality of life , reduce distress and aviod death
• cognitive explanation for anorexia: distortion and bias

  the core cognitive psychopathology of anorexia nervosa is distorted perception of shape and size. Murphy et al suggested that all other clinical features of AN arise from this mental state. People with AN may misinterpret their emotional state with feeling fat. Gadsby states that body dysmorphia is the result of a distorted body schema, a mental representation of a body's shape and size , which represents the body bigger than it is.