clinical psychology

• THE 4 D'S OF DIAGNOSIS:

  • DEVIANCE: behaviour that is rare and abnormal in some situations, but normal in some
  • DYSFUNCTION: this is the extent to which the behaviour of an individual interferes with their everyday life and well-being
  • DISTRESS: behaviour which causes upset to an individual, stress and anxiety
  • DANGER: behavior such as poor judgement or hostility which can put an individual or those around them at risk
• THE FIFTH "D":

  • some psychologists suggest that a fifth D is necessary = duration
  • some behaviour is deviant, dysfunctional, distressing and dangerous for a short term period
  • however, it is only if it occurs for a long time that it should be considered as a symptom of an illness requiring psychiatric attention
• STRENGTHS & WEAKNESSES OF THE FOUR D'S:

  • STRENGTHS:
  • practical as all the Ds are easily recognisable and measurable
  • davis (2009) - it is a valid diagnostic tool, it is able to diagnose what it is intended to diagnose
  • WEAKNESSES:
  • diagnosis is subjective, one clinician may interpret a behaviour as dysfunctional, whereas another may not = questions reliability
  • not all dysfunctional behaviour is deviant = depression is common
• DSM: Diagnostic and Statistical Manual of Mental Disorders

  • published in america - therefore can only be used in america
  • becomes updated every so often, mental disorders are removed and added
  • e.g homosexuality was removed as a mental disorder
• DSM V:

  • SECTION 1:
  • introduction to the DSM, clear information on how to use it and major changes from previous versions
  • SECTION 2:
  • lists all the main mental disorders and lists diagnostic criteria and codes
  • SECTION 3:
  • provides self-assessment tools, provides categories and symptoms
• THE ICD: International Classification of Diseases

  • classification system of the world heath organisation
  • it is used more than the DSM across the world
  • it includes ALL known health problems (physical and mental)
  • includes 22 categories, however clinical psychologists use V and VI
  • each disorder has a description of the main symptoms
  • each disorder is given a code consists of a single letter, number and decimal = narrowing types of mental health disorders
• EVALUATION OF CLASSIFICATION SYSTEMS:

  • STRENGTHS:
  • allows a common diagnosis of clinicians = able to reach agreement
  • both classification systems are updated on a regular basis = validity
  • WEAKNESSES:
  • DSM medicalises people, some people instead use their mental health disorders to their advantage in life
  • subjective as social norm influence our interpretations of behaviour
• predictive validity is the extent to which a score on a scale or test predicts scores on the same criterion measure
• internal reliability assesses the consistency of results across items within a test
• ecological validity refers to the extent to witch the findings of a research study are able to be generalised to real-life settings
• population validity is the degree to which study results from a sample can be generalised to a larger target group of interest
• external reliability refers to the extent to which a measure varies from one use to another
• historical validity is based on the hisorian's interpretation of existing written text through the application of tools and methods developed by proffesional historians and by interpreting the texts in relation to other texts
• internal validity is a measure of whether results obtained are solely affected by changes in the variable being manipulated in a cause and effect relationship
• inter-rater reliability refers to statistical measurements that determine how similar the data collected by different raters are
• STRENGTHS OF RELIABILITY OF THE DSM:

  • DSM V went through pre-trials before being published = procedural checks
  • goldstein (1988) - re-diagnosed patients with the previous DSM version = similarity in diagnosis = high inter-rater reliability
  • brown et al (2001) - 2 interviews with 362 patients = reliability in diagnosis of anxiety
• WEAKNESSES OF RELIABILITY OF THE DSM:

  • lack of transparency = no-one was able to talk about the review process of the DSM V = decreases credibility
  • kirk & kutchins (1992) - interviews and questionnaires used to test for reliability don't relate to real settings
  • clinician often have the same training = consistent views = may not be a valid diagnosis
• STRENGTHS OF VALIDITY OF THE DSM:

  • kim-cohen et al (2005) - children who were diagnosed with conduct disorder were more likely to report their anti-social behaviour = valid diagnosis as they behaviour expected was displayed
  • to be valid, you have to have reliability
• WEAKNESSES OF VALIDITY OF THE DSM:

  • lee (2006) - compared teacher opinions of children with ADHD = boys fit the criteria better than girls
  • DSM doesn't work well for individuals with co-morbidity = multiple mental disorders
• STRENGTHS OF RELIABILITY OF THE ICD-10:

  • jakobsen et al (2005) - found reliability when comparing the ICD-10 and the DSM
  • studies to test reliability tests for inter-rater reliability = quantitative measures = objective = scientific credibility
• WEAKNESSES OF THE RELIABILITY OF THE ICD-10:

  • cheniaux et al (2009) - found the ICD-10 was more reliable than the DSM when diagnosing schizophrenia = difference in diagnosis?
  • andrews et al (2009) - found only a 68% agreement between the ICD and the DSM
• STRENGTHS OF THE VALIDITY OF THE ICD-10:

  • pihlajamaa et al (2008) - compared the ICD-10 and DSM versions usng people diagnosed with schizophrenia, corresponded around 70% = valid
  • jansson et al (2002) - gathered data on individuals with schizophrenia, 82% of the time the diagnoses corresponded between the ICD-10 and DSM = valid
• WEAKNESSES OF THE VALIDITY OF THE ICD-10:

  • jansson et al (2002) - the ICD-9 and 10 focus on different features and symptoms of schizophrenia = one or both may not be valid
  • ellason and ross (1995) - those with a multiple personality disorder suit some features and symptoms of schizophrenia than those actually diagnosed with schizophrenia = difficult to distinguish between different disorders = co-morbidity
• symptoms are behaviours an individual with a specific disorder displays
• features are notable characteristics of the disorder
• POSITIVE AND NEGATIVE SYMPTOMS:

  • positive: add to the experience of the patient (e.g delusions, hallucinations)
  • negative: subtract from normal behaviour (e.g lack of energy and enthusiasm, social withdrawal)
• SCHIZOPHRENIA SYMPTOMS:

  • delusions - beliefs that a person holds can't be changed by anyone even if evidence is presented that challenges that belief
  • GRANDIOSE: belief of having remarkable qualities
  • PERSECUTORY: belief that others are trying to cause them harm
  • THOUGHT INSERTION: belief that thought has been inserted into their mind by an external force
  • hallucinations - seeing or hearing things not present
  • disorganised behaviour & speech - motor movements and loosely connected words
  • catatonia - decrease in response to the environment
• SCHIZOPHRENIA FEATURES:

  • affects 1% of the population
  • psychotic disorder, patients become separated from reality
  • often diagnosed between ages of 15-35, men develop symptoms earlier
  • men generally develop negative symptoms for longer
  • no single test for schizophrenia
  • approximately 20% of patients respond well to treatment
  • if diagnosed earlier than chances of recovery increase
• ROSENHAN (1973) - classical study:

  • AIM: investigate how situational factors affect a diagnosis of schizophrenia, if staff didn't identify their sanity = implications for methods of diagnosis & show situational factors do affect diagnosis
  • METHOD: 8 confederates = pseudopatients, 12 different hospitals, complained about hearing "thud, empty & hollow" = same sex voice = all diagnosed with schizophrenia, once admitted they stopped symptoms and made notes on their experience
• ROSENHAN (1973) - classical study RESULTS:

  • RESULTS: average length was 19 days of stay, normal behaviour was seen as abnormal = note taking referred to as writing behaviour and pacing due to boredom was referred to as nervousness, patients were questioned by real patients, they were also depersonalised by staff and ignored 71% of he time, 185 direct questions ignored by nurses
• ROSENHAN (1973) - classical study CONCLUSION:

  • psychiatric staff cannot always distinguish sanity from insanity
  • however physicians may not identify sanity because it is less risky to diagnose a healthy person as sick than vice versa
  • suggests the DSM was flawed
• ROSENHAN FOLLOW UP STUDY:

  • hospitals rejected his findings and claimed their systems could not be so easily fooled
  • every staff member who dealt with admissions was asked to rate all patients in terms of the probability that they could be pseudopatients
  • over a 3 month period 193 patients were admitted, nursers thought 41 were fake
  • however rosenhan had actually sent no pseudopatients
• SLATER SUPPORTING EVIDENCE:

  • when she presented herself at 9 hospitals claiming to hear the same 3 words, she was diagnosed with depression and psychosis - she was diagnosed with anti - psychotic and depressant medication
• BIOLOGICAL EXPLANATION FOR SCHIZOPHRENIA: neurotransmitter theory

  • chemical imbalances in the brain = neurons fire = too many messages transmitted = symptoms
• RESEARCH FOR BIOLOGICAL EXPLANATION FOR SCHIZOPHRENIA: neurotransmitter theory

  • rossum (1967) - found a link between overestimulation & dopamine receptors
  • owen (1978) - postmortem examinations show people with schizophrenia = higher density of dopamine receptors in cerebral cortex
  • davis et al (1991) - positive symptoms may be a result of excess dopaminergic activity in the mesolimbic pathway & hyodopaminergia (lack of activity) in mescortical pathway = negative symptoms
  • seeman (2013) - may be caused by hypersensitivity of D2 receptors = patients ore likely to overreact when dopamine is present
• STRENGTHS OF BIOLOGICAL EXPLANATION OF SCHIZOPHRENIA: dopamine hypothesis

  • people given l-dopa for parkinsons can experience schizophrenia like symptoms
  • can also explain negative symptoms, a reduction in dopamine in mesocortisal pathway
  • brain scans of people with schizophrenia show grey matter differences in the frontal and temporal lobes = linked to sensitivity to dopamine
• WEAKNESSES OF BIOLOGICAL EXPLANATION OF SCHIZOPHRENIA: dopamine hypothesis

  • albert & friedhoff (1980) - some patients showed no improvement when given dopamine antagonists, PET scans show it is least useful for 10 + year patients
  • haracz (1982) - high levels of dopamine may lead to results of schizophrenia = NOT the cause, dopamine antagonist may cause up-regulation
  • dopamine antagonists block receptors immediately, however results seen over a few days = suggests another factor causing symptoms
  • ignores environmental factors = documented link between social class and schizophrenia
• META-ANALYSIS:

  • involves looking at secondary data from multiple studies conducted by other researchers to draw overall conclusions
  • conducted when there is a large amount of research where findings may be inconsistent
• META-ANALYSIS EVALUATION:

  • STRENGTHS:
  • relatively practical - quick and costs much less than collecting primary data
  • no ethical concerns
  • WEAKNESSES:
  • issues with reliability and validity of studies being analysed
  • results published are often biased against research where no effects were found
• CARLSSON ET AL (2000): schizophrenia contemporary study

  • AIM: review studies into relationship between schizophrenia and levels of neurotransmitters
  • METHOD: meta-analysis
  • PROCEDURE: looked at a range of evidence = studies into neurochemical levels of patients, studies int drugs that induce psychosis brain scans and effectiveness of drugs to treat schizophrenia