Clinical Psychology

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5.1 CONTENT

5.1 DIAGNOSIS OF MENTAL DISORDERS

The 4 D's

Deviance:

Clinicians look at the extent to which the behaviour is 'rare' within society

Dysfunction:

If the behaviour is significantly interfering with the person's life then a mental illness may be present

Distress:

The extent to which the behaviour is causing upset to the individual

Danger:

If the person's behaviour is putting the individual or other peoples lives in considerable danger then it may indicate that an intervention is needed

5.2 CLASSIFCATION SYSTEMS

DSM-5

Compiled by the American Psychiatric Association (first edition in 1952)

Current edition: 2013

157 categories (homosexuality isn't in it)

Reflects developmental and lifespan considerations. E.g. Where relevant it includes where certain disorders are likely to manifest (depression in adolescence)

ICD-10

Compiled the World Health Organisation (first edition in 1948)

10th edition 1994. Supposed to be updated every 10 years but the 11th edition has been pushed back to 2018

Includes diseases and mental health disorders

Evaluation

DSM helps clinicians because it classifies disorders into different types and identify the symptoms associated with them. For example, schizophrenia is classified as mild or severe based on the number of symptoms.

DSM-5 removed unreliable diagnostic categories to prevent false positives (Type I errors). For example, it removed different types of autism and replaced mental retardation with intellectual development disorder (IDD).

DSM-5 is controversial because it is believed to encourage the "over-medicalisation" of normal conditions, leading to more prescriptions of drugs. An example might be Mild Neurocognitive Disorder (MND), which might lead to old people with ordinary forgetfulness being diagnosed as ill.

On the other hand, MND might encourage doctors to focus on the first symptoms of dementia and stop it getting worse. Even though Britain's NHS uses ICD-10, DSM-5 still affects psychiatry in Britain because of the research that goes on in the US.

However, the DSM has made a positive contribution by making new conditions known outside the USA. For example, ADHD and Borderline Personality Disorder are now recognised in the UK.

In conclusion, DSM-5 might lead to social control because it creates more false positive diagnoses. Allen Francis argues that the DSM-5 will medicalise the "worried well", such as elderly people being diagnosed with dementia because they are forgetful. However its intention is to make sure people get problems recognised and treated and the new classification of MND might lead to the early stages of dementia being detected sooner, reducing false negatives.

5.1.3 SCHIZOPHRENIA

Features

1 in 100 people have schizophrenia

Symptoms

Positive symptoms: any change in behaviour or thoughts

Hallucination: where someone sees, hears, smells, tastes or feels things that don't exist outside their mind

e.g. hearing voices

Delusions: a false idea that you are convinced is true

e.g. paranoia (the belief that people are watching you and want to hurt you)

Negative symptoms: a withdrawal or lack of function that you would not usually expect to see in a healthy person

Losing interest and motivation in life and activities, including relationships and sex

Lack of concentration, not wanting to leave the house, and changes in sleeping patterns

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5.2 METHODS

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5.3 STUDIES

5.3.1 CLASSIC STUDY

ROSENHAN (1973): BEING SANE IN INSANE PLACES

Aim

Rosenhan wanted to test the reliability of mental health diagnosis, to see if medical professionals could tell the sane from the insane in a clinical setting

Iv / Dv

There is no IV or DV as it is an observation

Sample

The participants were the staff and patients in 12 psychiatric hospitals

The hospitals were in 5 different states

(The pseudo-patients were the observers, not the participants)

Procedure

The pseudo-patients went to clinical interviews and reported their symptoms

Rosenhan approached the head of the hospital he went to and informed him of the deception, but the other pseudo-patients weren't known to anyone on the staff. Rosenhan also briefed lawyers to get the pseudo-patients out if anything went wrong.

When they were admitted to a hospital, they started behaving normally and stopped reporting hearing voices. They took a notepad and pen along with them to record what they heard and saw (unstructured observation). They tried to do this covertly, but if the staff detected them they carried on recording things overtly.

They secretly disposed of any medication they were given (eg they flushed pills down the toilet) but otherwise they were friendly and polite and did everything that was asked of them

After the main study ended, Rosenhan contacted his own hospital and revealed the results. The hospital agreed to a second study, but this time they would be aware that new pseudo-patients would be seeking admission over the next 3 months. Staff were issued with a questionnaire to rate each new patient on a 10-point scale: 9-10 meant high confidence that the patient was really ill but 1-2 meant a strong suspicion that this was a pseudo-patient.

Results

All 12 hospitals diagnosed the pseudo patients as mentally ill. It took between 7 and 52 days for the pseudo-patients to be discharged; the mean length of stay was 19 days.

What the pseudo patients observed:

Patients often flushed medication down the toilet or put it in bin

Patients were verbally and psychically abused by staff

Follow on study: Rosenhan sent no pseudo-patients in the follow-on study, so ALL the patients seeking admission were genuine. 193 patients arrived at the hospital: 41 were rated as pseudo-patients by at least one member of staff

Conclusion

Cannot distinguish the sane from the insane in psychiatric hospitals

Evaluation

Generalisability -

There's been a lot of progress in mental health care since the 1970s so cannot be generalised to psychiatric diagnosis and care today

Reliability -

Unreliable as each pseudo patient didn't follow the same standardised procedures (E.g. the graduate student asked his wife to bring in his college homework to do, revealing he was a psychologist)

Application -

It caused psychiatric hospitals to review their admission procedures and how they trained their staff to interact with patients

Ethics -

May have prevented people who genuinely needed help from seeking it during the follow up study

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5.4 KEY QUESTION

5.4.1, 5.4.2KEY QUESTION RELEVANT TO TODAYS SOCIETY

WHAT ARE THE ISSUES SURROUNDING MENTAL HEALTH IN THE WORKPLACE?

I investigated the issues surrounding mental health in the work place. This is important for today society because 1 in 6.8 people experience mental health problems in the workplace. The Mental Health Foundation states that evidence suggests that 12.7% of all sickness absence days in the UK can be attributed to mental health conditions and better mental health support in the workplace can save UK businesses up to £8 billion per year.

Firstly, mental health could arise in a work place due to more than one reason. A workplace is typically an environment in which people with different personalities and views interact. These differences are one potential source of workplace issues, and can ultimately lead to stress and tension for those involve. It can also lead to someone feeling isolated and alone which has the potential to lead to mental health issues, such as depression. Also, people may become stressed about problems at work or about their work load and, by hiding how they truly feel they bring that stress home. It then negatively impacts their life and relationships outside of work, as well as within. This could also lead to mental health issues.

A campaign called ‘Heads Together’ run by Prince William, Prince Harry and Kate Middleton aims to challenge mental health. This campaign provides days where people with different mental health issues are able to gather and talk about their issues, as well as have conversations outside of the mental health topic with one another. This encourages social interaction and helps to prevent people feeling alone or isolated, as they are able to talk to people in a comfortable environment. This campaign has so far been a success and the feedback from this campaign has been positive.

Additionally, mental health can be prevented in the work place by employers introducing the PHQ-8 into their workforce. The PHQ-8 stands for “Personal Health Questionnaire” and consists of 8 questions. It is based on criteria for diagnosing depression using the Diagnostic Manual. The PHQ-8 could be used in workforces in order to regularly check mental state of employees. This would lead to a reduction in sick leave, as less employee’s would need to take time off due their mental state, and a reduction in a firms labour turnover, as employees are less likely to leave a firm as they would have better mental health, which would overall increase efficiency.

Kronke et al. (2009) wanted to assess the validity of a shortened version of a questionnaire based on the DSM IV criteria as a measure of depression in a large scale population study. It was a large scale random dial national telephone survey which was conducted in the USA using nearly 2 million participants. There was good construct validity as it was compared to other measures of depression and was found to have an agreement.

Furthermore, mental health can be treated by psychotherapy, this is a type of therapy which involves talking to a trained therapist, usually one-to-one. Drug treatment combined with psychotherapy therapy creates a greater recovery. If psychotherapy is introduced within the workplace then employees suffering from mental health can feel more supported at work and thus, helping them to maintain focus at work as well as their lives outside of work.

Cognitive behavioural therapy is a talking therapy that can help you manage your problems by changing the way you think and behave. Its most commonly used to treat anxiety and depression, but can be useful for other mental health problems. It can be completed in a relatively short period of time compared to other talking therapies and, it is easily assessable as can come in the form of computer programmes. This would benefit a workforce as all employees who are suffering from mental health can get help whilst at work and, it would benefit the employer as employees who require CBT are able to access it whilst at work and therefore do not require days off.

In conclusion, employees are afraid of discussing their mental health condition within their workplace .They don’t want to lose their jobs, be missed out for opportunities for things such as promotions or risk future employers learning of illnesses and judging them. The stigma of mental illness keeps them silent.

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5.5 PRACTICAL INVESTIGATION