Clinical Psychology

• Deviance: from the norm in terms of behaviour.
• Dysfunction: cannot function in society.
• Distress: causes distress.
• Danger: to themselves or others.

Used in the DSM to diagnose mental health patients.

DSM IV:

Uses the 4Ds from before in addition to being placed in axis:

• Disorders, personality, medical conditions, environment, global functioning.

Pos: Davis: suggested there should be a 5th D for duration, but that the basics were good and easy to use.

• DSM with 4Ds as diagnosed many, so valid.
• Goldstein: rediagnosed people with 85% consistency.
• Steinonfield: using a questionaire and the DSm was able to discern the gamblers from the non gamblers in a blind test.

Neg: Subjective, meaning not as reliable.

• Needed a 5th D added, questions validity.
• Lee: Korean children and ADHD, match not as good for girls as for boys - lacks validity.
• Rosenhan (see later) diagnosed health PP, lacks validity.

Features:

• Men:Women = 1:1.
• Age of onset in men = 18, women = 25.
• 1% of population affected.
• Low predictive validity: after 30 days 25% recover, 15% die.

Symptoms:

Positive: hallucinations, delusions, disorganised speech, disorganised behaviour.

Negative: affective flattening (loss of emotions), alogia (speech), catatonic behaviour (loss of movement), avolition (loss of motivation).

Subtypes:

• Paranoid, disorganised, residual, undifferenciated, catatnoic.

The function of neurotransmitters:

Carlsson: dopamine hypothesis states that dopamine can be the cause of SZ due to it causing abnormal brain functioning from too much dopamine.

Pos: Amphetamines release dopamine and produce psychotic-like symptoms.

Post mortems - give evidence for.

Anti-psychotic drugs (chlorapromazine) block dopamine and work to combat the effects of dopamine.

Neg: Amphetamines only reduce positive symptoms, not negative.

Chlorapromazine only reduces positive symptoms,not negative.

Serotonin is also linked to SZ, so dopamine hypothesis is too simple.

Genetics:

The C4 gene. Genetic analysis of 65,000 showed certain forms of the C4 gene meant people were more likely to have SZ.

C4 plays a role in synapse pruning in early development, but over pruning could lead to symptoms of SZ.

Pos: Gottesman and Shields: twin study of 62 PPs showed twins were more likely to inherit SZ together, especially likely in identical twins (80% in MZ compared to 45% in DZ).

Kety et al: 34 SZ patients and 33 controls traced families and got a diagnosis for them, finding 8.7% to 1.9% SZ likelihood in SZ compared to controls.

Neg: Not 100% concordance therefore not 100% genetics.

Freuds psychodynamic theory:

Freud argued that if the world of the SZ is particularly harsh, a child may become fixated at a particular stage of development (e,g, if the child's parents are cold and uncaring).

If a child becomes fixated at the oral stage it could explain the sense of 'loss of reality' experiences by schizophrenics - because the Ego has control, auditory hallucinations could be the Ego trying to regain control.

Prior to the Ego developing the child is ruled by the ID (selfish desires) - SZ can, therefore, represent a regression to this time.

The use of drugs:

Typical: older, reduce positive symptoms e.g. chlorapromazine.

Atypical: new, treat a range of symptoms e.g. cloazpine.

D: clinician.

E: Kane: ineffective on 20%, better for positive symptoms.

Meltzer et al: effective over and above the placebo.

S: 50% don't take beyond a year due to side effects, tremors and ticks.

E: cheap to install.

R: blocks, not treats, symptoms.

T: Doesn't work on 20% or for those displaying negative symptoms.

CBT:

• 1. Behavioural phase: plan to manage and cope
• 2. Cognitive phase: cognitive restructuring techniques
• 3. Maintenance and relapse prevention
  

Pos: Tarrier et al: group of SZ patients, split to take drugs or CBT. 3 months after treatment, CBT group showed fewer symptoms.

Bradshaw: effective at preventing relapse.

Neg: Time consuming, potentially very expensive.

Features:

• 10:1 = females:males
• Usually develops in adolescence
• Prevalence in entertainment industries
• Restricting and binging types

Symptoms

• Loss 15% body weight
• Fear of gaining weight
• Amenorrhoea

Genetics:

Pos: Scott Van Zeeland et al: found the EPHX2 gene associated with anorexia through cholesterol disruption affecting mood and behaviour.

Holland: found higher concordance of AN in MZ than DZ twins.

Neg: MZ twins share similar environments

Work in this area is new

Not 100% concordance in MZ twins.

The Social Learning Theory:

• Attention
• Retention
• Repetition
• Motivation

Pos: Mumford et al: Arab and Asian women more likely to develop eating disorders after moving to the west.

Becket et al: Fijian girls developed eating disorders after the introduction of American TV.

Neg: Not only West have anorexia.

Everyone has these influences in Western culture, not everyone gets AN.

The use of drugs:

Olanzapine can help adolescent patients with anorexia gain weight faster than therapy and nutritional support alone.

It is an atypical drug.

SSRIs: Selective Serotonin Reuptake Inhibitors, block serotonin reuptake and are used as a treatment.

D: Clinician gives the drug out, patient can choose to take it.

E: Jensen et al: patients treated with Olanzapine found they gained weight and had a better self-concept and views of body image.

S: headache, stomachs.

CBT:

• 1. Behavioural phase: plan to manage and cope
• 2. Cognitive phase: cognitive restructuring techniques
• 3. Maintenance and relapse prevention

Pos: Butler and Beck: reviewed 14 meta-analyses investigating the effectiveness of CBT and concluded 80% of adults benefited from it.

Holistic.

Neg: expense and time.

Individual differences

● Cultural effects can lead to individual differences in mental health disorders, e.g. Freud

● Cultural effects can lead to different diagnoses of mental health disorders affecting reliability and validity (Lee, Rosenham, for example).

Developmental psychology

● Issues around genes and mental health, such as a genetic or biochemical explanation for schizophrenia, can affect development.

• Standards for education and training: For clinical psychologists, the minimum qualification required is a Master’s degree with BPS qualification and a doctorate.
• Standards for prescribing: There are standards for prescribing medication. This includes the knowledge and training to be able to prescribe appropriately and safely.
• Standards for counselors: Therapists offering counseling must understand the importance of empathy and imagination as well as the philosophy behind psychological therapies

• SPECIFIC: The Standards refer to well-defined achievements that can be understood howerever can be subjective.
• ATTAINABLE: The Standards aren't impossible to meet/
• RELEVANT: The Standards have specific expectations for clinical psychologists and other types of psychologists. Are they equally relevant?
• TIME-BOUND: Members have to re-register every 2 years and show that they still meet the Standards. Is 2 years not often enough or too often? HCPC takes a fee to re-register - is it for money?

Meta-analysis:

A gathering of all data to research and make conclusions from, such as Carlsson.

Primary and secondary data:

Primary: data collected by the researcher themselves.

Secondary: data collected by the researcher that is not theirs, someone else's or research from articles.

Containing psychotic patients with fragile boundaries: a single group case study

'Thursday group', 6 patients suffering from SZ who meet every week. After sessions leaders note key points.

Case study reports before Christmas shows patients suffered break down between real and unreal, suggested group may react to potential change in routine by having a break from the group for more than the usual week.

Psycho-educational group for detained offender patients: understanding mental illness.

Semi-structured interviews as part of a treatment programme on 42 males detained at Broadmoor high-security hospital.

Most received diagnosis under SZ, aimed to help them cope with their illnesses.

Key findings were that patents valued knowing and understanding their illness, groups sessions allowed them to understand how others were similar.

Many reported increased confidence in dealing with illness, so were more positive about the future.

Being sane in insane places.

A: see if psychiatrists can accurately diagnose mental illness.

P: 8 pseudo-patients in 12 hospitals, said they heard voices saying 'hollow' and 'thud', then gave everything else true to themselves. Once in hospital, they stopped displaying symptoms and acted normal.

F: All but one were diagnosed with SZ, sanity never detected though was recognised by other patients. Only 4% of the time were spoken to. Max stay 52 days. Found drugs flushed down the toilet, were treated poorly. Normal behaviour written as symptoms of SZ e.g. writing.

Rosenhan told hospitals to expect more pseudo-patients, though none ever came. After 20% of patients suspected fake.

C: showed invalidity of the DSM.

C: G: Only America, R: lack of controls. A: DSM needs changing. V: high ecological. E: deceptions, the potential for psychological harm to doctors and nurses who are exposed.

 Evidence for the role of EPHX2 gene variants in anorexia nervosa.

A: Is there link between the EPHX2 gene and its involvement with cholesterol, and AN?

P: Studied DNA from 1200 with AN and 1900 without, starting with just white European women with a BMI of 15 or less during their lifetime.

Test and retest: another 500 AN cases and 500 controls studied.

F: EPHX2 showed strongest association with anorexia in all conditions and found it was related with BMI and how cholesterol levels changed over time.

The gene was active in some areas of the brain related to behaviours, anxiety and depression.

C: identified a novel association of gene variants within EPHX2 and provided foundation for further study.

C: G: very large sample, only female. R: test and re-test reliability. A: treatments for AN. V: huge sample, high internal validity with standardised scientific procedure. E: Little.

 Network interactions in schizophrenia – therapeutic implications.

A: review relationship of neurotransmitters (dopamine, glutamate) and SZ.

P: looked intro studies on the effectiveness of drugs for treating SZ and links of neurotransmitters and psychosis.

F: decrease of glutamate showed psychotic symptoms.

Glutamate failure in the cerebral cortex caused negative symptoms, in the basal ganglia positive symptoms.

C: further research needed, other neurotransmitters can cause or effect SZ too.

C: G: Yes, many studies. R: Not if the studies collected are not reliable. A: Yes, treatments of SZ. V: Yes, though secondary research means if studies aren't it won't be. E: Yes.

How are mental health issues portrayed in the media?

Issues:

• Poor perception means poor perception in the public.
• Stigmatisation in the workplace.
• Won't talk about mental health.
• Mental health sufferers get bullied/can't find work.
• E.g. Rosenhan's second addition to his study.
  

A: Comparing how attitudes of mental health have changed over time through content analysis.

P: two articles, read the articles and get a sense of context, then identify key terms and count their frequency, do it again and compare.

F: earlier article had more harsh articles about mental asylums, stating they're a good use, later article looked at care outside hospitals more.

C: attitudes have changed.

C: G: only two articles. R: higher inter-rater. A: use of media. V: real life. E: none.