Clinical Psychology notes

Page 1

Describe Rosenhan's Classic Study (4 marks)

Rosenhan took a of 8 pseudopatients, five and male and three female.

they reported hearing the words, hollow, empty and thud

they were then addmitted to one of the 12 institutions across america

one was diagnonsied with manic depression with psychosis and the others with schizophrenia

after addmission they went on to behave as their normal selves

the ppts took down qualititative data of their experiences there such as being forced to admit they had a mental disorder and take antipsychotics from staff

the average length of their stay was 19 days the shortest being 7 and the longest being 52

Describe the results of Carlsson's Lit Review

schizo ppts should more dopamine activity in the basal ganglia compared to a control group

Laruelle et al found that patients in remission had normal dopamine activities

Carlsson also points out that patients complain most about the side effects during remission which is possible due to the dopamine levels being low than average

Glutamate seems to regulate dopamine

dopamine levels seem to increase as glutamate levels decrease (Miller and Abercrombie) by blocking NDMA receptors which glutamate binds with

Describe another explanation of Schizophrenia other than biological.

the social explanation suggests that those in a low social-economic background are more likely to develop schizophrenia

people in lower classes experience more stress due to factors such as poverty, poor health and discrimination

high levels of stress make individuals more vulnerable to the onset of schizophrenia

based on the fact that the fact that immigrated individuals have a higher incidene of schizophrenia compared to individuals born here and that are in a higher class above low class

Describe a biological treatment for schizophrenia

Anti-psychotic drugs work be blocking the d2 receptors which prevents them binding to receptors on the post synaptic neuron.

this depolarises the neuron and effectively calms it down as well as decreasing dopamine levels in the brain.

all anti-psychotic drugs seem to work the same way however typical drugs tend to express worse symptoms compared to atypical drugs. This may be due to typical drugs binding too tightly to the d2 receptors

a typical drugs such as clozapine do not do this a also help reduce negative symptoms of schz by binding to serotonin receptors too.

weaknesses of using a biological treatment

The drugs can have quite serious side effects

typical drugs are associated with disturbances in movement and in the long term, can end up with a condtion called tardive dyskinesia- muscle spasms typically around the mouth

a typical drugs can causes metabolic changes including weight gain and high cholesterol

if side effects are worse than the symptoms, many may stop taking( lieberman et al) the drugs and this in the long run decreases the effectiveness of the drugs

McEvoy et al patients were given for different drugs and the most effective was clozapine as patients continously used it.

other treatment can just as effective such as family therapy

Describe a psychological treatment for schizophrenia

The person which the disorder is at down with a clinician and their family members.

the patient is encouraged to talk openly about their symptoms.

the family are also educated on the disorder and how to look or signs that suggest the patient has relapsed.

this helps to build the families understanding of the disorder

the therapy maybe be used alongside drug therapy to increase the effectiveness

Evaluate a psychological treatment

helps families cope with the disorder therefore creating a more manageable environment

improves patients quality of life

Goldstein and Miklowitz

family therapy combined with medication increases the effectiveness

Pilling et al

FT effective in reducing relapse rates and improved compliance of medication for the disorder

Not all family members will be willing to commit to the openess of the therapy- explains the dropout rates of family therapy

Not widely available on the NHS so patients who could really benefit from the therapy may not be about to access it

Page 2

Describe a disorder other than schizophrenia

Unipolar depression is a mood disorder characterised by a persistent low mood amongst a range of others that cover emotional, somatic, motivational and cognitive changes in the patient.

According to the DSM V, five or more symptoms, including a loss of interest, must be expressed for a two week period

the symptoms can cause serious distress or impairment to people's lives

can develop at various ages but more more prevelant in young adulthood

Neurticism+ stress= risk of development

females are twice as more likely to develop the disorder than men however men have higher suicide rates due to the disorder.

Describe the biological explanation of the cause of depression

the monoamine hypothesis suggests that depression is a result of chemical imbalance between serotonin and norepinephrine.

in the 50's drugs that decreased the levels of these amines caused depressive symptoms so t was assumed that low levels of them caused depression.

the simpler explanation was challenged which lead to the more complex hypothesis that suggested that low levels of the amines caused up-regulation in the sensitivity of the receptors sites. more receptor sites are made to compensate for the low levels of the amines due to the little stimulation they received. when more NT is administered through drugs there is a down regulation so the receptors become desenstied. <---- explains the delay in the effect of the drugs and interferes with getting rid of symptoms

more recent theory is that low serotonin levels effects norepinephrine. if too low they experience depressive symptoms, if too high the experience manic symptoms.

Evaluate the biological explanation of depression

MDMA studies: MDMA works by increasing the levels of serotonin and norepinephrine and gives individuals feelings of euphoria. this is how antidepressents intend to work

Kirsch et al: antidepressants cause a placebo effect

aetiological fallacy: reduction in symptoms does not man the way the drug works targets the cause.

Angoa-Perez et al.: mice lacking a precursor for serotonin production did not show depressive symptoms- suggestes that drepression is caused by more than just low serotonin levels

Neale and Kendler: 40% increased risk when a 1st degree relatives has it.

Page 3

Describe a biological treatment for a disorder other than schizophrenia

Antidepressants work by increasing norepinephrine and serotonin.

SSRIs work by inhibiting the re uptake of serotonin so they are left in the synaptic for longer and have a longer lasting effect

similarly, NSRIs work by inhibiting both the re uptake of norepinephrine and serotonin - despite this there is no evidence for it being effective.

tricyclic anitdepre4ssants work the same wasy however they have more severe side effects and no serious consequences if overdosed

monoamine oxidase inhibitors also have serious side effects and work by stopping the enzymes that breakdown amine NTs. a strict diet is needed due to the effects if the drugs interact with tyramine

Evaluate the treatment

the drugs have been proven to quickly relief depressive symptoms- Royal college of Psychiatrists 50-60% showed improvements compared to those given a placebo

older type of drugs are particularly dangerous if given to patients that are already suicidal so needs to be monitored very closely

treats the symptoms but does not treat the cause.- more costly to treat than to cure

study in Holland found that 76% of patients fully recovered and never relapsed without taking any medication. non-medicated patients had a better health than their counterparts.

Page 4

Describe the ICD

the icd is concerned with all disorders however mental health disorders are section F

within the sections, disorders are grouped together to make a family of disorders such as mood or psychotic disorders and a digit is used to represent the family followed by another digit to represent the specific disorder

F32 is for depression, F31 is for bipolar

another digit is presented after a decimal point to show futher categorisation

F32.0 is mild depression

sepcification can go further with another decimal and digits to show very specific categorises

F32.0.01 is mild depression with somatic symptoms

Describe the DSM V

it is a manual that is divided into 3 sections and adopts a similar system of grouping disorders into families to allow clinicans to go from a very general diagnosis to a specific one with guidance

section one: introduction and instructions on how to use the manual

section two: contains the classifications of common MHDs

section three: other assessment measures; cultural formulation guide to help disagnosis people from other cultures

Page 5

Describe another biological explanation for schizophrenia

the genetic explanation suggests that the MHD is caused by the person's genetics due to evidence of strong hertible factors assiocated with the development of the disorder

the explanation also suggests that the closer the relation with someone that has the disorder the more likely one is to develop it.

researchers have found over 700 genes to be associated with the MHD in particular the disc 1 gene

concordance rates of twin studies found that MZ twins had a 48% chance compared to DZ twins at 17%

Evaluate the genetic explanation

the concordance rates in twins was only 48% not 100% despite them sharing the exact same DNA. it leads reaserchers to believe there are other confounding variable that lead to the onset of the MHD such as environment factors

Tienari et al found that 7% of adoptees had parents with the same disorder compared to 2% who didn't have mothers with the same disorder.- the small difference is assumed to be down to genetics/ in contrast, the adoptees are usually matched up with families of similar backgrounds

Tamminga and Schulz: failed to isolate a single recessive or dominant gene that causes the illness and Harrison and owen found six genes to be responsible for the disorder/ implications for this is that genetics may not be a suitable way of determining who may develop the disorder.

dysfuntional family and schizophrenic relapse rates have found that the disorder may be due to stress caused by negative emotions with in the family

Page 6

Positive symptoms of schizophrenia

they add tot he experience of the patient

Hallucinations

a perceptaul experience that happens with the absence of external stimulation of the corresponding organ

can be visual or auditory

must occur when the patient is fully concious

Delusions

beliefs that are contrary from fact

grandiose- having remarkable qualities

referential- certain behaviour/language is directed at them

peseructroy- people are out to get them/ trying to arm them

Disorganised speech

speech where ideas are loosely connected/ not connected at all

word salad

Negative symptoms of schizophrenia

they subtract from normal behaviour

Avloition

general lack of motivation

Diminished emotional expression

showing less emotion through facial expression, eye contact and physical gestures

Page 7

Research Methods

The HCPC

Standards of conduct, performance and ethics

-this is how they expect there registrants to behave and what the public shoud expect from their health care professionals

- helps them make decisions on the character of their health care professionals

communicate appropriatley and effeciently- being polite, listening and providing necessary information

working within the limit of your own skills you have knowledge and confidence in

respect confidentiality and only disclose information under certain occasions

Standards of Proficiency

- threshold standards that are needed to protect the public

- must meet the standards that meet their scope of work

being able to practice safely and effectively

maintaining their fitness to practice including their own health

able to practice with no prejudices against others

Standards of education and training

must be qualified

learning to be integrel to the programme

appropriate selection and entry criteria based on their practice

Evaluation

the 15 standards are credible framework and are SMART targets ( specific, measurable, attainable relevant and time bound)

the standards may not be appropriate- uncertainty when dechipering where legal and ethical boundaries lie; should psychologists be struck off when breaking a standard despite it causing no harm?

helps to see when ethics amongst psychologists is broken- prevent vulnerable people from bein explioted or carelessly treated

allows boundaries to be set

might be intrusive for the psychologists themselves

Page 8

Clinical key question

'How are mental haelth issues portrayed in the media?'

Describe

450 million people around the world suffer from mental health issues

represnetation of mental health issues in tv and other forms of media greatly influence and educate how the public percieve these diorders - For example signorielli found that 72% of characters in primetime tv shows were shown as violent

this could lead to the wider popualtion holding prejudices towards people with mental health disorders

as a result we must moderate the representaion of MHD in order to properly educate viewers of media

Discussion

new zealand study that used thematic analysis found common themes of aggression, childlike and unpredicable nature associated with MHD.- negative

Rosenhan- once the MHD label was applied it was hard to remove despite it being false- Back in the 50's

the negative stigma around mental health disorders can make it hard for people to want to seek out treament- 25% don't due to it

stereotyping/ diagnosising: depression is more associated with women- explain why clinicans are more resilient in diagnosing men with the disorder despite representing the same symptoms. - leads to men being unwilling to seek help due to being seen as feminie

in contrast to all the negative perceptions, there are postive potrayals of mental health disorders. campaigns online bring awareness to MHD

famous suffers can make it trendy

Page 9

Research Method

Longitudinal

comparing a single sample with a particular characteristic with their performance over a long period of time

can be used to monitor symptoms as they change

able to see a reduction or increase in symptoms too

Evaluate

not effected by individual differences so easier to compare

reliable way of measuring the effect of time

very time consuming (patients could drop out or die)

the research could therefore be outdated

Cross-sectional

use a large scale of a target population

draw conclusion on the information gathered

used to compare

Evaluate

quick

results are more likely to be valid for the time frame

affected by individual differences

cohort effect- being born or brought up in a different time or place could effect results

Cross-cultural

sample is taken from different cultures and backgrounds - culture in the IV

look at the similarites and differences of the cultures

can be used to show the effectiveness of drugs across cultures

Evaluate

can be used to see how culture impacts the validity and reliabilty of diagnosis

can tell us if abnormal behaviour is due to biology

reduced ethnocentrisim

Meta-analysis

collection of a large body of secondary data containing a sum of psychological knowlegde

findings from this can be used to draw an overall conclusion

firm conclusion can be drawn from were there may be inconsistancies

can show which drugs are most effective- carlsson

Evaluate

quick and effective

no ethical concerns

publication bias

unpublished research may have no peer review