A2 Edexcel Clinical Psychology

Data that has been collected by those who witnessed an event first-hand or who collected data themselves for a specific purpose

- Easy to replicate by researcher as they know procedures so generally reliable 
- Often up to date
- Taken from population directly

- Researchers may try to fit data to their own hypotheses
- Costly and time-consuming because data is taken from scratch

Second hand analysis of primary data 

- Saves time and expense that would be spent collecting data
- Can provide a larger database e.g. a library larger than a researcher could hope to collect
- Sometimes secondary data is the only resource

- Researcher cannot personally check the data so it's reliability is questionable
- Researcher may not know how accurate the data is
- Data may be out-of-date so unsuitable for current research

A diagnosis is considered reliable if more than one psychologist gives the same diagnosis to the same individual

The extent to which a diagnosis reflects an actual disorder

Where animals are studied in their natural environment, often through naturalistic observation, or by experimentation, where some aspect of the animal's environment is manipulated

Where animals are studied in an artificial environment that allows precise control and measurement of variables

- Any harm must be justified
- Procedures causing pain/distress are illegal in the UK
- Researchers have to have knowledge of the species
- Endangered species should not be collected unless it's an attempt at conservation
- Caging conditions must take into account the social behaviour of the species

Aimed to see whether schizophrenia-like symptoms could be induced in non-human animals by giving them amphetamines which increases dopamine production. Results found that symptoms of SZ began to show, supporting the DA hypothesis

- Animals are convenient and practical, animals reproduce more quickly so can be studies across the lifespan quickly 
- Can provide evidence into evolutionary continuity
- Can be used in research that would be ethically wrong on humans

- Some reject idea of evolutionary continuity
- Often anthropomorphic 
- Cannot assess suffering
- Not ecologically valid

Animals and humans have lots of genetic similarities

Focus on MZ twins because they share 100% of their genes. If have been reared apart then it is easy to see what is nature v nurture

- Can help identify trends in families
- Provide controlled evidence for the nature side of the nature/nurture debate

- A 50% concordance rate in schizophrenic MZ twins may mask other possible causes
- Do not show cause and effect
- Difficult to find a large sample 
- Twin studies often run on the assumption that MZ twins have the exact same environment

95% of people fall in the normal category, 5% abnormal

- Does not tell the difference between desirable abnormal behaviour and undesirable abnormal behaviour
- Someone may sit just inside the normal definition but still need help
- Some clinically abnormal behaviours are classified as normal because they're common
- Gives a definitive, objective cut-off point

Behaviour that falls outside of the social norms

 Culturally biased
- Norms change over time
- Allows several behaviours to be taken into account

- American system used to diagnose and classify mental disorders
- Axis 1 looks at all disorders apart from personality disorders and mental retardation
- Axis 2 looks at personality disorders and mental retardation
- Axis 3 looks at general medical conditions
- Axis 4 looks at psychosocial and environmental problems
- Axis 5 Global Assessment of Functioning, psychiatrist assesses how the patient is able to cope with everyday life and how urgent their need for treatment is

- Brown et al (1996) found there was a 67% agreement rate for major depression, which is classed as good reliability
- Zigler and Phillips (1961) found a 54% to 84% agreement rate when looking at broad categories for disorders

Rosenhan concluded that DSM III wasn't valid as it couldn't tell who was a real patient over a pseudo-patient

Many cultural differences e.g. in Morocco it is believed that mental illness comes from evil sorcery but in the UK the DA hypothesis is more widely accepted

- Major disturbances in thought, emotion and behaviour
- It affects about 1% of the population and equally common amongst men and women 
- Can have positive or negative symptoms

Excesses in behaviour that are present in the patient

Behaviour that is missing

- Hallucinations
- Delusions
- Thought insertion
- Thought withdrawal
- Thought broadcasting

- Poverty of speech
- Social withdrawal
- The flattening effect

SZ runs in families and the common view is that SZ is caused by a number of genes rather than one in particular

- Gottesman found that the closer you were genetically to someone who has SZ, the more likely you are to have it
- Heston suggested that SZ is passed from parent to child
- Hong et al found that a variation of the TPH gene was more common in Chinese SZ than the general population

Hypothesizes that excess DA causes schizophrenia

- Lindstroem et al found that LDOPA (used to make DA) was taken up more quickly in the SZ suggesting more DA is made 
- Donnelly et al found that SZ passed more homovanillic acid which is a waste product of DA, suggesting more DA is made

- Depatie and Lal found that apomorphine which increases effect of DA did not create SZ symptoms
- Hard to know if excess DA causes SZ or if SZ causes DA

SZ is as a result of a problem with processing information

- Bentall found that memory is worst in SZ with hallucinations than SZ with no hallucinations and non-SZ sufferers
- Suggests SZ's have difficulty monitoring their own actions

- Typical developed in 1950s, atypical developed in 1990s
- Fit into DA receptors blocking DA so effects are reduced and symptoms reduced

- Allow patient to live in society, preventing institutionalisation 
- Pickar et al found that Clozapine had more effect than other antipsychotics and placebos

- Often cause unpleasant side-effects
- Non-compliance is common and a big problem, Rosa found only 50% of patients comply
- Has to be taken continuously

- Multi-disciplinary team
- Help with drug treatment
- Help to integrate into 'normal life' 
- Life-long treatment 
- Based in the community
- Often very successful

- More successful than hospital treatment 
- Prevents institutionalisation
- More chance of a normal life

- Time-consuming
- Expensive
- Not accessible to everyone

- Refusal to eat and maintain a minimum average expected body weight
- Fear of gaining weight or becoming fat
- Amenorrhea (absence of at least 3 consecutive menstrual cycles)

Developed due to rewards from the environment. May want to lose a little weight and if successful get an intrinsic reward (feel better), may then become fearful of gaining weight that was lost, this is paired with eating and a classically-conditioned anxiety response develops. Next time the individual has food they will feel anxious and believe that in order to reduce the anxiety, they must not eat. Not eating food brings attention and fasting behaviour then becomes reinforced (operant conditioning). SLT states that models who are often dangerously underweight can be role models.

- SLT explains acquisition of behaviours such as anorexia through observation, shows that we can learn through observation not just through trial and error 
- SLT has informed the debate over media influences in anorexia
- Can explain gender differences as females being more prone to anorexia due to the social pressures and stereotypes expected from them

- Difficult to show anorexia is acquired through classical or operant conditioning, person has not been studies from birth so impossible to identify specific causes
- Ignores biological factors completely
- Does not explain why out of a large % of people who are exposed to thin models, only a very small number become anorexic

Malfunctioning of the hypothalamus has been suggested as a cause of anorexia as it plays an important role in regulating hunger. Animal experiments involving lesions on the hypothalamus have either led to over-eating or starvation in the animals. The ventromedial hypothalamus depresses hunger and for anorexics it could be that their VMH is jammed on. Genetics could also play a factor and Holland and Kortegaard both found a higher concordance rate of anorexia in MZ twins than DZ twins

- Anorexic is not held responsible for their behaviour, more likely to be seen as a victim for a behaviour of which they have no control so takes away issues of blame or labelling of the person
- Genetic and neurochemical abnormalities have been found using scientific methods which can then be tested for reliability unlike other non-scientific methods

- Difficult to establish whether a biochemical imbalance in the hypothalamus causes anorexia, or whether anorexia causes a biochemical imbalance
- Twin studies often operate on the assumption that both twins have an identical environment which may not be the case
- MZ twins can be discordant for anorexia which suggests that the environment plays a significant role in the expression of the disorder
- Explanations are often not useful for anorexics as they do not offer possibilities for treatments, clinicians may then have to seek out other causes which can have issues for reliability and validity of diagnosis and treatment

Aims to help client identify negative, irrational thoughts and replace these with more positive rational ways of thinking. Involves cognitive and behavioural elements with homework between each session. Hypothesises e.g. "tell me why your friend had thought you'd put on weight?, why is it important what your friend says about you?" The therapist and client then decides how to road test these hypotheses and aim that client will recognise consequences of faulty cognitions. Realistic beliefs then replace irrational ones e.g. "your friend may be jealous of the way you look or is actually displacing fears she has about her own weight onto you." Shows that failures are an unfortunate part of life but are not always a disaster.

- Brandsma et al. (1978) reported that RET is effective in producing behaviour change amongst those who are self-demanding and who feel guilty for not living up to their own high standards
- Seen to be more effective than psychoanalytic therapies as it aims to help people get better rather than just to feel better during the session and to accept reality, no matter how bad it is

- Argumentative nature of the therapy has been questioned, particularly those who stress the importance of empathy in therapy
- Fancher (1995) argues cognitive therapists may not be capable of identifying faulty thinking, what is foolish and illogical to the therapist may not be foolish and illogical in terms of the individual's own experiences

Aim is to enable anorexic to cope better with internal conflicts that are causing disturbance so they can be dealt with at a conscious level. Freud would often ask analysand to talk freely about their childhood and relationships, occasionally they would reveal details from the unconscious

- Includes all experiences, including ones from early childhood
- Unique method needed to uncover the unmeasurable unconscious
- Analysis of what the client says in free association may provide a useful tool in psychotherapy, appears to provide access to the unconscious allowing subsequent interpretation, anorexia often seen as a manifestation of underlying unconscious conflicts between the id and superego

- May be inappropriate for some disorders, encouraging the client to talk at length about the issues on their mind may reinforce thoughts that are already obsessive
- Interpretation of what client says is subjective and therefore unscientific, any interpretation is possible making the theory unfalsifiable and therefore not possible to validate the interpretation of free association

To see if the sane could be distinguished from the insane using the DSM and if they can be differentiated, how sanity can be identified.

8 pseudo patients sent to 12 different hospitals. 3 women, 5 men, all gave false names and those in the medical profession gave a false occupation. All said they could hear an unfamiliar voice of the same sex saying 'empty', 'hollow' and 'thud', all other details were true. As soon as they admitted to the psychiatric ward they stopped abnormal symptoms although some acted nervously. Took part in ward activities, spoke to staff and fellow patients as they normally would and responded to instructions from staff. Some wrote down observations and if asked how they were feeling they said fine and that they didn't have any symptoms. In some hospitals, pseudo patients asked when they were going to be discharged.

All pseudo patients were admitted and none were classed as sane. All but one had a diagnosis of schizophrenia in remission, stayed in hospital for between 7-52 days. Average stay was 19 days. In 3 hospitals, 35/118 patients were suspicious about the insanity of the pseudo patients.

Staff unable to distinguish sane from insane. DSM not a valid measurement for mental illness at that time.

+ Carried out in real psychiatric hospitals with real, unaware staff so has ecological validity
+ Different types of hospital around the country used to can generalise findings to other hospitals 
+ No. of days in hospital is an objective measurement
+ Could see what life was like from a patient's perspective, validity
- Emotions of pseudo-patients could have introduced subjectivity
- No informed consent from staff
+ Staff and hospitals not identified
- Drs will always play safe and go for most serious diagnosis until it is disproved
- Didn't act completely normal when admitted
- Insisted on being admitted, a symptom in itself 
- DSM has been upgraded since the study, unlikely to gain similar results
- Spitzer argues diagnosis of schizophrenia in remission is rare in real patients so psychiatrists knew something was different, just were unsure exactly what was different

To see if there is any difference between age of onset of schizophrenia between the two sexes and to see if women have a less severe course of the disorder than men

199 men and women all diagnosed with SZ in the 70s on admission and discharge from hospital, all expected to live with a family member, 18-45 y.o., no organic brain disorder such as epilepsy, no substance abuse. All re-diagnosed 10 years later using the revised version of the DSM, 169 still had SZ, 30 deemed to be misdiagnosed. 52 of the 169 were 1st time admissions, 38 had one previous hospitalisation in the 70s and the remainder were patients studied by Goldstein. Marital status, occupational status, peer relationships, isolation and interests measured every day functioning. Course and severity of illness was measured by no. of and length of stays in hospital over a 10-year period.

Women had significantly lower rehospitalisations and shorter hospital stays, especially when looking at the 5-year period.

Gender differences in the course of SZ are present in the early stages of the disorder, poorer premorbid functioning in men being responsible for poorer outcome.

+ Pps did not 'drop out', data about their health was easily obtainable
+ Men and women well-matched in terms of marital status, age, education, religion, socio-economic status
+ Inter-rater reliability of 80%
+ Large sample size, generalisable to most schizophrenics
+ Angermeyer et al (1987) replicated the findings, increase reliability
- Employment varied greatly between men and women
- Can't generalise to schizophrenics without families
- Sample age limit of 45 y.o. 
- If DSM isn't valid, questions validity about diagnoses of SZ

To investigate whether there is a genetic basis for anorexia by studying MZ and DZ twins where at least one twin in each pair suffered from anorexia.

30 female twin pairs (16 MZ and 14 DZ pairs), 4 male twin pairs and 1 set of male triplets. The twins and triplets were selected because one of the twins (and one of the triplets) had been diagnosed as suffering from anorexia nervosa. Data was collected on the other twin and triplets to check for concordance.

High concordance rates were found for MZ female twins; 55% compared to 7% for DZ female twins. 5 of the non-anorexic female co-twins either had one psychiatric illness of minor eating disorders. None of the male co-twins (or triplets) had anorexia. The anorexic male twins tended to have been disadvantaged at birth and to be the less dominant of the pair.

Results support the view that there is some genetic basis for anorexia among females, since identical twins had 55% concordance, while DZ twins showed only 7% concordance. No conclusion can be drawn from the data from the male twins owing to small numbers.

- The higher concordance rates among identical twins may be caused by the similar ways in which they were treated by family and friends rather than by their genetic similarity 
- Holland acknowledged that if genes do contribute to anorexia, their role is small
+ The fact that the concordance was not 100% provides hope to sufferers that their condition isn't an inescapable result of their biological make up
- The sample size is very small and so is probably unrepresentative; other studies have not supported a genetic basis e.g. Wade (1998) studies both genetic and environmental risk factors in 325 female twins and found a significant environmental influence in shaping women's attitudes towards weight, shape, eating and good but little evidence of a genetic component
- This study was a natural experiment because the independent variable (genetic relatedness) was not directly manipulated by the experimenter. This means we cannot claim that genetics was the cause of anorexia but it is strongly implicated
- It could also be that one twin imitated the other twin who developed the disorder first. This is unlikely though because some of the twins developed the disorder when living in separate countries and concealing it from each other. This would not also account for the difference between MZ and DZ twins

I created a leaflet with the purpose of understanding SZ. It was directed at people who may think they have SZ are have been recently diagnosed with the disorder. It contained key facts such as what is SZ, what are the symptoms and causes, how to deal with disorder and where to get help as well as what treatments are available. I then wrote a commentary on my leaflet, evaluating what was good and bad, effectiveness and what other people though about my leaflet.