Clinical Psychology

• Define Schizophrenia

  • a psychotic disorder in which people tend to lose connection with reality
  • Can cause positive symptoms [addition of psychological traits deemed to be abnormal] hallucinations [experiences that happen in the absence of external stimuli], delusions [fixed beliefs that contrast with reality]
  • Can cause negative symptoms [reduction of psychological traits deemed to be normal] loss of speech, social withdrawal
  • Diagnosis after one month of showing core symptom
• Strength and weakness of evaluation of icd-11 for schizophrenia

  • a strength is that a diagnosis can be made after symptoms have been showing for only a month and this is a strength as it allows people to access treatment more rapidly.
  • a weakness of the icd-11 is that schizophrenia can be difficult to diagnose due to symptom overlap. For example, hallucinations can also be a symptom of depression caused by drug withdrawal and lack of sleep. Thus making diagnoses varied from different clinicians and decreases the reliability of diagnosis.
• freeman et al vr

  uses vr to create a real world setting in which ppts explore a library with neutral avatars in it and they measure their persecutory thoughts based on their experience. The conclusion was that emotional processes linked to anxiety contribute to the development of persecutory ideation. Highlighting that vr holds a great promise for helping people to evaluate and reduce persecutory ideation - weakness - low levels of presence whilst being there - strength - half ppts answered brief symptom inventory before and after vr and half completed after to see if completing it before primed ppts into having persecutory thoughts and this did not appear to be the case meaning that persecutory thoughts were solely from the avatars
• biological explanations of schizophrenia

  • classic research argues a strong heritability for this disorder as concordance rate for monozygotic twins is 42 per cent but only 9 per cent for dizygotic twins and given both twins were brought up in same household the higher concordance rate was thought to be due to higher amount of shared dna
• biochemical explanations for schizophrenia

  excess dopamine deep in brains limbic system and mesolimbic pathways thought to produce positive symptoms. Lack of dopamine in prefrontal cortex and mesocortical pathways may explain negative symptoms such as disorganised thinking and speech as this neurotransmitter is important for directing a shifting attention [kenneth davis and colleagues].
• evaluation of dopamine hypothesis in schizophrenia

  strength supported by research where rats were injected with amphetamines [known to increase dopamine activity] and afterwards showed a range of schizophrenic like behaviours like strange movements and social withdrawal. Supports role of biological factors but underlines importance of environmental factors such as drug taking.

  Weakness - only considers nature aspect and does not take into account environmental factors
• psychological explanation for schizophrenia

  cognitive both positive and negative symptoms result from faulty information processing in that people with schizophrenia do not have an internal monologue and so find it difficult to distinguish between internal and external stimuli. Difficulties in mentalising due to schizophrenia having overlaps of autism resulting in low theory of mind could explain delusions as the opinions they have of themselves they would also believe other people have the same opinion.
• evaluation of psychological explanation for schizophrenia

  weakness is as much as evidence supports cognitive malfunctions in people with schizophrenia, it is not clear why some people have them in the first place and leads to a overly reductionist approach.

  Strength - helps to explain individual differences by highlighting the differences in the ways people process information however it does not consider situational factors that may explain cognitive overload which could lead to a psychotic breakdown.
• biological treatments for schizophrenia

  typical antipsychotics work by blocking dopamine receptors on postsynaptic cell and can be effective in reducing positive symptoms. Chlorpromazine and haloperidol.

  Atypical work by blocking both dopamine and serotonin receptors which is involved in regulating arousal, alertness and mood. Clozapine and risperidone
• evaluation of biological treatments

  weakness - side effects can be unpleasant dizziness, nausea and weight gain and typical can often lead to tardive dyskinesia.

  Strength - use of biochemical treatments is supported by experimenta evidence in which 17 drugs had lower relapse rate than placebos showing that drug treatment can be an effective alternative to hospitalisation
• electroconvulsive therapy (ECT)


  Electroconvulsive therapy works by delivering electrical pulses to one or both sides of the brain via electrodes placed on scalp. Given muscle relaxant and general anaesthesia to prevent injury and recollection of event. Proves to be effective after just one session but requires 2-3 sessions per week and is most effective when used alongside drug therapy.
• Psychological treatment and management of schizophrenia

  cognitive behaviour therapy works by developing trusting relationship between client and therapist called a therapeutic alliance. Therapist helps clients to develop self-awareness through understanding links between daily events, physical sensations, thoughts and feelings and helps the client to understand how our thoughts are interlinked and how they reflect our core beliefs about the world and ourselves. Therapist helps client with coping strategies that allow them to take control of their thoughts rather than their thoughts taking control over them. Psychoeducation involves helping family members understand symptoms etc.
• evaluation of psychological treatment and management of schizophrenia

  strength working collaboratively with therapist reduces the imbalance of power which is a feature of biological treatments in which the patients role within their treatment is their responsible which is empowering in itself as it develops self-efficacy which could also help rebuild the clients self-worth. Weakness - time consuming
• Sensky et al. (2000)


  compare efficacy of one to one cbt vs befriending intervention for people with schizophrenia. Cbt was more effective as continued to show improvement post-treatment to follow up
• sensky et al evaluation


  Strength - selected from wide range of hospitals which helps improve generalisability of study as the sample included people living in a variety of locations. Weakness - due to longitudinal design some ppts did not complete enough therapy sessions and so were excluded and patient drop-out can reduce representativeness of sample thus limiting generalisations that can be drawn.
• mood disorders


  experience extended periods of time where either negative and or/positive emotions dominate and effect their thoughts and feelings in ways that can lead to dysfunction, distress and even danger. Episodes may be depressive, manic or hypomanic.
• unipolar


  categorised as extended periods of low moods that include depressed moods or diminished interest in activities during a period lasting at least two weeks accompanied by other feelings like worthlessness or excess guilt.
• bipolar


  both depressive and manic periods lasting at least one week to be diagnosed. Symptoms - euphoria, irritability, increased energy, rapid speech.
• measure for depression


  beck depression inventory for people over the ages of 13 and asks to refer to last two weeks when answering questions. 21 items including self-dislike, pessimism and indecisiveness and takes around 5-10 mins to complete and helps determine severity of persons symptoms
• Evaluation of becks depression inventory

  strength as a psychometric measure of depressive symptoms, evidence suggests it is both reliable and valid. It has excellent test-re-test reliability for people who completed it twice one week apart.

  Weakness - relies on self-reported data which may be collected during a semi-structured interview with a doctor in which the client may be subject to social-desirability bias. They may overexaggerate their symptoms in order to get better treatment and so this reduces the validity of the test.
• Explanations of mood disorders biological

  biochemical monoamine hypothesis - lower levels of noradrenaline levels found to be contributed to depressive symptoms. Researchers noticed that a drug used to treat high-blood pressure reserpine reduces noradrenaline levels and also causes depression as a side effect. Next researchers looked at serotonin levels as a cause and found that because serotonin controls noradrenaline levels, an imbalance of serotonin levels could cause noradrenaline levels to drop leading to depressive episodes and as they are both monoamines this is known as monoamine hypothesis.
• Evaluating biochemical explanation mood disorders

  strength - supported by research evidence. Moreno et al attempted to reduce ppts tryptophan levels by using a chocolate flavoured drink in order to reduce serotonin production. They found a significant increase in depressive symptoms measured by hamilton depression scale 24 hours later in people with history of depression. This supports the idea that depression may be related to a deficiency of serotonin. Weakness - overly deterministic suggesting that everyone responds the same way to altercations to neurochemicals such as serotonin and noradrenaline.
• Oruc et al


  determine whether specific polymorphisms of two genes associated with serotonin transmission [5-ht2c and the 5-htt gene] were more common in people with bipolar disorder. It was found that neither gene was found to play a major role in increasing vulnerability to bipolar disorder. Strength - produced similar results to another study [gutierrez et al] who also found no significant difference between people with bipolar disorder and controls with regard to allele or genotype frequency for the 5-htr2c receptor gene. This is important as replication is an important hallmark of scientific research. Weakness - small sample size.
• Psychological explanations of mood disorders

  becks cognitive theory of depression states that depressive symptoms are caused by negative thoughts linked to dysfunctional core beliefs. Depressed people hold negative thoughts about themselves, the world and the future and is known as the negative cognitive triad. Develops in childhood because of criticism and/ or rejection from important people in their lives.
• Learned helplessness


  Learned helplessness - seligman proposed that depression in humans may be a learned response to a negative experience and aimed to replicate previous research that showed a positive correlation between depressive attributional style and severity of depressive symptoms. Results - positive correlation between depressive attributions for negative events and severity of depressive symptoms before and after therapy and scores were lower pessimism in non-depressed group than depressed group. People with both unipolar and bipolar disorder share similar cognitive attributional styles of negative events than those without depression but can be altered with therapy.
• Evaluation seligman


  strength - use of method triangulation where depressive symptoms were measured on bdi by ppts but were also rated by clinicians who had observed ppts during schizophrenia interview. More valid as uses more than one technique to collect data.

  Weakness - gender imbalance
• Treatment and management of mood disorders biological

  Tricyclics - work by blocking serotonin transporter molecules and improve depressive symptoms.

  Maois - monoamine oxidase inhibitor work by preventing the breakdown of serotonin, dopamine and noradrenaline. Only used if other drugs have not worked as can cause harmful interactions with other drugs and certain foods.

  Ssris - selective serotonin reuptake inhibitors work by increasing amount of serotonin available to bind with 5ht receptors on postsynaptic cell which means it serotonin can not be used for recycling and remains in synapse.
• Evaluation of biological treatment of mood disorders

  strength - research evidence suggests that they are effective treatment for many people. Cipriani found that all 21 drugs investigated in meta-analysis were more effective than placebos suggesting that drug treatments are effective for treating depressive symptoms. Weakness - unpleasant side effects for ssris.
• Psychological treatments and management of mood disorders

  three basic musts - people must approve everything i do, other people must treat me well, i must get what i want and not what i dont want
• Becks cognitive restructuring


  Aaraon beck believed depression comes from irrational beliefs about the self, the world and the future. Psychoeducation - therapist teaches client about links between thoughts, feelings and behaviour and the problems that can arise from cognitive distortions. Socratic questioning and homework.
• Rational emotive therapy


  Elliss cognitive explanation of depression is based on abc model - activating events, beliefs and consequences. Focuses on present and actively challenge self-defeating thoughts. Therapist identifies whether any of three basic musts are affecting clients day-day life. Musturbation - allowing three musts to control thoughts, feelings and behaviour. Disputing - ask client to provide evidence for why everything must be as their beliefs demand such as why must you win everyones approval? Client will then realise that this does not lead to a logical answer and so they work on other ways of thinking about their lives that do not lead to sadness.
• Evaluating cognitive restructuring


  Strength - risk of relapse following drug treatment is lower when the person has also recieved cognitive therapy than when anti-depressants are used without cognitive therapy. Weakness - may depend on clients motivation to complete activities between sessions, time should be invested in making homeworks more rewarding in order to maximise benefits.
• impulse control disorders


  Kleptomania - recurrent, irresistible urge to steal

  Pyromania - fascination with fire

  Gambling disorder
• Measuring impulse control disorders

  kleptomania symptom assessment scale 11-item self-report scale, during past week how many times did you experience urges to steal, scored 0-4. Strength - only take 10 mins to complete so diagnosis can be made quickly meaning person can access treatment with little delay.

  Weakness - self-report so people may not answer truthfully
• Biological explanation: dopamine

  anticipation - researchers noted that animals have an increased level of dopamine activity before they perform a behaviour that has previously been rewarded so euphoric feeling is due to the release of high levels of dopamine. Reward deficiency syndrome - low dopamine levels cause people to find little pleasure in life and so seek out ways to give themselves a dopamine rush. Evaluation - strength - application to real life as can explain why people with Parkinson's disease develop impulse control disorders as it is associated with low levels of dopamine and is often treated by using drugs that elevate dopamine levels so helps people make informed decisions about their medication. Weakness - overly reductionist view which mean people underestimate the role of cognitive and social factors in driving impulsive behaviour in terms of inheriting certain genes that lead to dopamine deficiency. Weakness - biological apprpoach overlooks peoples role of free will as if people with impulse control disorders receive professional therapeutic help, they can get better. This is a weakness as it is overly pessimistic and gives people with this disorder little hope that they can get better.
• Psychological explanations


  behavioural: positive reinforcement - skinners theory of operant conditioning states that behaviours that are rewarded will most likely be repeated.
• Evaluation of behavioural explanation

  Weakness - fails to acknowledge role of negative reinforcement.

  Strength - focus on nurture explains findings that cannot easily be explained by biological explanations alone. Research found that carrying allele 1 is associated with impulse control disorders however not everyone with impulse control disorders have this allele suggesting that environmental/learning experiences may also be necessary for a person with a genetic vulnerability to actually develop an impulse control disorder.
• Cognitive explanation


  Millers feeling-state theory - state-dependant memory refers to the idea that when we are in a certain emotional state we start to retrieve memories from when we were last in that emotional state...
• Evaluating cognitive explanation


  Weakness - much of the evidence come from case studies which is hard to generalise to other people.

  Strength - acknowledges individual and situational factors in triggering impulsive acts which provides a more holistic perspective and is often helpful in identifying a variety of possibilities for treatment.
• Grant et al


  Investigate factors that predict effectiveness of opiate antagonists in treatment of gambling disorder. Hypothesised that opiate antagonists would be more effective for treating people with a family history of gambling and alcoholism than those without this family history. Conclusions - family history of alcoholism and strength of urges to gamble are associated with a positive response to opiate antagonists as a treatment for gambling disorder. Evaluation - strength - nalmefene ppts recruited from 15 different treatment centres making results more representative of target population. Weakness - family history was self-reported in semi-structured interview.