clinical psych

• Deviance


  Examines how rare or infrequent the behaviour is within society. This could be because it is statistically rare - a small percentage of the population experience it. Alternatively it could be that it breaks social norms and makes people feel uncomfortable e.g. shouting or talking yourself in public.
• Dysfunction


  If the person's behaviour is interfering with their life, then this could be the sign of a mental disorder. For example, if their personal relationships, personal hygiene, household maintenance, occupation or school work are suffering or made impossible this means they might be diagnosed with a mental disorder.
• Distress


  This relates to how far the behaviour is causing the individual to become upset. The actual experience of the patient / client must be assessed, as some people become distressed when facing minor difficulties that others view as unimportant, and others might face major difficulties, but not feel much distress.
• Danger


  The patients / clients behaviour must be assessed in 2 ways: danger to themselves and danger to others. For example, nicotine dependence endangers the health of both the smoker, and those around them through passive smoking. If an individual is placing their own life or the life of others in danger, then intervention may be needed (some mental health patients can be" sectioned" under the mental health act– this is when they are taking into care forcibly and consent is no longer needed to administer drugs and keep them hospitalised).
• The four "Ds" of deviance, dysfunction, distress and danger are used together, rather than in isolation when defining abnormality and making diagnoses.
• ICD-10


  • Lists and categorises all diseases including mental and physical ones
  • One section (F) is concerned with mental health disorders
  • Each mental health diagnosis is given a code that describes the family of disease, the particular disorder, the severity of the disorder, and any specific symptoms seen
• ICD-10 use


  The clinician uses the system to guide their clinical interview and make a diagnosis, moving from the general to the specific
• DSM 5


  • Disorders are grouped into families, with linked disorders grouped together
  • The clinician can move from the general to the specific, with guidance shown on severity of symptoms and their common combinations
  • Clinicians should use the DSM in combination with other information from clinical interviews and medical records
• Sections of the DSM 5


  • Introduction and instructions
  • The classifications of mental disorders e.g. schizophrenia, depression etc
  • Other assessment measures to aid diagnosis such as information to support diagnosis with individuals from a different culture. Disorders that are being considered for future DSMs are also included here, for example "Internet addiction disorder"
• DSM IV-TR


  • A "multiaxial" tool as it examines 5 different aspects of the patient's behaviour and health
  • Axis I = The main clinical syndrome / main mental disorder e.g. Depression, Schizophrenia, Anorexia
  • Axis II = Personality disorder and retardation. Anything wrong with the personality that might influence the main mental disorder
  • Axis III = Medical conditions that may affect the main mental disorder
  • Axis IV = Psychosocial stressors. These are events in a person's life that may affect mental disorders and cause stress
  • Axis V = Global assessment of Functioning (GAF). This is a test to assess social and occupational (work or school) functioning
• Reliability


  Diagnosis is consistent
• Inter-rater reliability


  • When two or more clinicians use the diagnostic tool and come to the same diagnosis
• Test-retest reliability


  • The same clinician makes the same diagnosis on different occasions
• Validity


  Diagnosis is accurate
• Validity


  Diagnosis is accurate
• Concurrent validity


  • Diagnosis between 2 different systems is consistent e.g. DSM-V has cross referenced the coding system of ICD-10 to improve diagnosis
• Aetiological validity


  • The causes of a disorder match a person's history e.g. if a disorder is known to be partly genetic, and a patient has a family history of the disorder they are diagnosed with
• Predictive validity


  • A diagnosis predicts the outcome of a disorder e.g. when the treatment is successful
• General issues with diagnosis


  • Patient factors
  • Clinician factors
  • Comorbidity
  • Cultural issues
• Patient factors


  • Issues with memory, denial, shame may prevent accurate descriptions of symptoms and therefore diagnosis
  • Symptoms e.g. disorganised thoughts, Personality disorders e.g. psychopathy, manipulation
• Clinician factors


  • Unstructured interview
  • Clinicians may focus on different pieces of information, leading to different diagnosis e.g. nightmares vs traumatic event example
  • Different clinicians may interpret same information differently e.g. hallucinations example
  • Subjectivity due to background and training
  • Implicit bias of clinician in interpretation of information
• Comorbidity: disorders overlap e.g. depression & anxiety
• Cultural issues in diagnosis


  • Behaviours can be interpreted differently in different cultures, e.g. being withdrawn and quiet could be seen as abnormal in the USA but normal in cultures such as Japan
  • Visions of God could be a hallucination / religious experience depending on culture
  • DSM and ICD-10 are based on Western culture and could lead to inaccurate diagnosis in those from a different country – ethnocentric to use them
  • Culture bound systems exist in only one culture e.g. "Ghost sickness" in Native American culture has symptoms of obsession with death, nightmares, suffocation and terror - do diagnostic tools recognise cultural differences in disorders?
• Classification systems is reliable/valid

  • Brown (2001)): DSM IV has good/excellent reliability & validity for anxiety and mood disorders. 
  • Rosenhan (1973) – diagnosis of schizophrenia was consistent  and reliable (although inaccurate)
  • Hoffman (2002) used a computer to give structured interviews to prison inmate patients who had been diagnosed with either alcohol abuse, alcohol dependence or cocaine dependence using DSM–IV.   The computer diagnoses were consistent with the DSM-IV.
• Diagnosis is unreliable/invalid

  • Brown  (2001)– Post-traumatic disorder diagnosis has poor reliability due to having overlap with other disorders.  
  • Aboraya (2006) clinicians focus on acute symptoms and overlook others.  Patients mood, memory and shame lead to inaccuracy
  • Davison and Neale (1994) revealed that Asian-Americans can be wrongly diagnosed as having a mental disorder by the Western diagnostic system.  This is because this group displays withdrawn behaviour (which is actually desirable in the Asian-American culture).   
• • Rosenhan aimed to test whether the diagnosis was invalid and affected by observer bias, causing the clinician to see all behaviours as evidence of the mental disorder because of the context. (1)
  •  He wanted to test whether clinicians and the system could differentiate between the sane and the insane once they had been admitted.(1)
  • He wanted to find out what life was like in a psychiatric hospital and raise awareness about conditions (1)
• • 5 men and 3 women (the pseudopatients) called up the admissions office of hospitals that were a mixture of good, bad, old and new across five states.
  • They asked to make an appointment because they heard voices saying “empty, hollow, thud”.
  • They used false names and jobs to protect their identity
  • Once admitted into hospital they stopped acting abnormally and were friendly and cooperative, recording the experiences in notes.
  • They had to convince doctors that they were sane to leave, and they had daily visitors who confirmed their normal behaviour.
• • All the pseudo patients were admitted to the hospital with a serious mental health disorder, most were diagnosed with schizophrenia, and their sanity was never detected by staff.
  • The average stay was 19 days.
  • The real patients realised the pseudo-patients were sane and one-third challenged them e.g. for being a journalist.
  • The staff mainly ignored the patients, 71% of attempts to start conversations with nurses were ignored.
  • The staff misinterpreted normal behaviour as abnormal e.g. “writing behaviour” or “oral inquisitive syndrome”.
• primary data

  • Information on mental health that researchers gather themselves. This can take the form of experiments, interviews, questionnaires etc
  • This might be concordance rates of twins when assessing the extent to which mental disorders are genetic.
  • Interviews and questionnaires that ask patients about their symptoms – comparisons can be drawn regarding differences/similarities between particular groups.
  • Primary data can be collected for a case study on a patient suffering from a particular mental disorder
• secondary data

  • Information on mental health that is collected by someone other than the researcher for a different purpose.  This can include previous studies/research / medical records/government statistics.
  • Peer-assessed/reviewed articles or public statistics.
  • Meta-analysis – meta-analysis uses a statistical approach (inferential statistics) to combine the results from multiple studies related to mental disorders to gain more valid and generalizable conclusions. (see below)
  • Government statistics on how many people have been diagnosed with a mental disorder or institutionalised.
• longitudinal studies

  • Takes place over a long period for example a group of people with a mental disorder might be tracked over many years.
  • Often compares a single sample group of people with a mental illness with their performance over time, allowing for time-based changes to be seen.
  • Clinicians may be interested in monitoring symptom changes in a patient group undergoing treatment.
  • Allows the psychologist to see how effective the treatment is over time. 
  • Includes questionnaires and observations of patients taken at intervals over many years.
• cross-sectional studies

  • This is a quick snapshot of a group of people suffering from a mental disorder where a sample is taken and tested and conclusions are drawn for the target population.
  • For example, researchers might be interested to know about the experience of people with schizophrenia at different ages, and so take a large sample of participants suffering from schizophrenia of various ages (rather than conducting a longitudinal study over many years)
• cross culture methods

  • Samples are taken from different cultural groups to draw comparisons about the similarities and differences between them in terms of how they experience mental disorders.
  • It looks at whether the experience of patients suffering from schizophrenia or other mental illnesses is the same in different cultural groups.
• meta-analysis

  • Involves looking at secondary data from multiple studies on mental health and drawing the findings together to make overall conclusions. 
  • This refers to the process of comparing large amounts of psychological research to draw definitive conclusions on mental disorders or treatments.
  • Meta-analysis of research on CBT effectiveness focuses on the effect size found by all studies, excluding those lacking scientific credibility. Inferential statistics are used to analyze data and conclusions, determining significant differences.
• Case studies focus on mental health details, using methods like interviews, questionnaires, and observations to study individuals or small groups with specific disorders. Researchers triangulate data from various methods, mainly using qualitative data, but can also use quantitative data.
• Interviews are conducted to gather information about mental health, ranging from structured to unstructured. They can be structured, unstructured, or semi-structured, with standardization in instructions and ethical issues. Personal data, such as gender, age, and employment, is collected. Responses can be recorded.
• Grounded theory is an inductive method developed in the 1960s to develop a theory on mental health from research evidence. It is useful in clinical psychology to research the beliefs, opinions, and experiences of service users or mental health professionals. The process involves thematic analysis, where codes and categories are identified in qualitative data, grouped according to similarities and differences, and then selectively coded and analyzed. The goal is to create a theory or model explaining the data.
• Features of Schizophrenia

  • The likelihood of an individual developing schizophrenia is 0.3%-0.7% depending on demographics such as ethnicity and living conditions.
  • Males are more likely to develop more negative symptoms than positive ones and suffer longer.
  • Schizophrenia episodes typically start earlier in males, peaking around 20-25 years, and later in females, typically from 25-30 years.
  • Schizophrenia's prognosis is uncertain, with 20% responding well to treatment and a small number regaining quality of life, while a large number remain chronically ill.
• Symptoms of Schizophrenia

  Schizophrenia is diagnosed when a patient exhibits two or more characteristic symptoms in a high proportion of the last month, categorized into two groups. Positive symptoms include delusion, hallucinations, disordered thinking/speech, and abnormal motor behavior. Delusion involves believing something is not true, while hallucinations involve seeing or hearing something that is not there. Disordered thinking involves rapid switching topics without clear connections, and abnormal motor behavior involves bizarre actions and emotional responses.
• • Schizophrenia is caused by excessive dopamine use due to the higher number of D2 receptor sites in the brain, which are more likely to pick up dopamine.
  • Schizophrenia is believed to be caused by excessive dopamine in the mesolimbic system, leading to positive symptoms like delusions, and inadequate dopamine in the mesocortical system, causing speech difficulties.
  • Glutamate, a neurotransmitter, can affect symptoms like psychosis by controlling dopamine release. A decrease in glutamate can increase dopamine release, while an increase in serotonin activity can cause schizophrenia symptoms.