Presentation on theme: "Schizophrenia, depression, phobias, OCD"— Presentation transcript:
1Schizophrenia, depression, phobias, OCD Section ASchizophrenia, depression, phobias, OCDOverviewClinical characteristics of XXXX.Issues surrounding the classification and diagnosis of XXXX, including reliability and validity.ExplanationsBiological explanations of XXXX, for example, genetics, biochemistry.Psychological explanations of XXXX, for example, behavioural, cognitive, psychodynamic and socio-cultural.TherapyBiological therapies for XXXX, including their evaluation in terms of appropriateness and effectiveness.Psychological therapies for XXXX, for example, behavioural, psychodynamic and cognitive-behavioural, including their evaluation in terms of appropriateness and effectiveness.
2Question type no. 1. Clinical characteristics Likely to be less than 8 marks.Must describe more than one characteristic.Some depth, not just breadth.4 marks = 100 words
3Reduce ? DSM-IV-TR CRITERIA for specific phobia Marked and persistent fear that is excessive or unreasonable.Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response such as a panic attack.The person recognises that the fear is excessive or unreasonable. This feature may be absent in children.The phobic situation is avoided or endured with intense anxiety or distress.The avoidance, anxious anticipation, or distress in the feared situation interferes significantly with the person’s normal routine.In individuals under age 18 years the duration is at least six months.The anxiety, panic attacks or phobic avoidance is not better accounted for by another mental disorder, such as OCDReduce ?
4PhobiaThe DSM identifies clinical characteristics that differentiate between a clinical phobia and a mere fear. Firstly the individual must recognise that their behaviour is irrational but continue to act in that way. Secondly the phobia must encroach on everyday life, interfering with their day to day, normal activities, such as going out in public. Moreover the individual suffering from the phobic disorder will not feel in control of their actions and the anxiety associated with the disorder will have a substantial longevity – in children the disorder must have lasted for at least 6 months. Lastly panic attacks may accompany the phobia, especially when the individual is presented with situational cues of the phobia or comes into direct contact with it – this especially will lead to irrational behaviour and often crying in children words (100 words for 4 marks) Detailed and accurate = 4 out of 4 marks
5Question type no. 2. Issues surrounding classification and diagnosis Discuss issues surrounding the classification and diagnosis of phobic disorders. (8 marks + 16 marks)Issue 1(50 words)Critical point 1Critical point 2Issue 2Critical point 3Critical point 4Issue 3Critical point 5Critical point 6Issue 4Critical point 7Critical point 8Assess issues surrounding the classification and diagnosis of phobic disorders. (16 marks)Critical point 1(50 words)Critical point 2Critical point 3Critical point 4Critical point 5Critical point 6Critical point 7Critical point 8
6Issues January 2012, examiner’s report: Describe the issue and then consider consequences and/or research evidence to support this.IssuesIssueEvaluation1 (50 words)Three point rule (50 words)234
7Paragraphs and lead in phrases Each AO2 point in one paragraph – so you can see the elaboration.Organisation countsLine of argument countsTired examiner
82. Issues surrounding classification &diagnosis RELIABILITYInter-rater reliabilityThe issue is about how close raters are in their assessments. If a method of assessment is reliable we would expect ...Research evidence …Skyre et al: three clinicians assessed 54 social phobics using the Structured Clinical Interview (SCID-I). High agreement (+.72). This shows that ..May be explained …SCID requires extensive training, enhancing reliability.
92. Issues surrounding classification &diagnosis RELIABILITYTest-retestThe issue is whether a diagnostic test is likely to produce the same results on two separate occasions.Research evidence …Kendler et al: low levels of test-retest, particularly over longer-term intervals. Picon et al. found high but short-term (14 days).Low reliability may be explained …Poor recall of fears (Kendler et al.).And for inter-rater might be because interviewers differ in their interpretation of symptoms, concluding it is clinically significant.
102. Issues surrounding classification and diagnosis VALIDITYComorbidityIf anxiety disorder co-occurs with depression this suggests that they are not separate entities and therefore the diagnostic category is not very useful, e.g. when deciding what treatment to advise.Research support …Kendler found high levels of comorbidity between social phobias, animal phobias, generalised anxietydisorder and depressionEysenck reported up to 66% of patients with one anxiety disorder are also diagnosed with another anxiety disorder.The implications are that the diagnosis should simply be ‘anxiety disorder’ rather than phobia or obsessive compulsive disorder (OCD).
112. Issues surrounding classification and diagnosis VALIDITYConstruct validityDemonstrating the extent to which performance on a test of anxiety measures the underlying construct (phobia).Research support …Beidel et al. found the Social Phobia and Anxiety Inventory (SPAI) correlates well with behavioural measures of social phobia (e.g. ease of public speaking) and lacks association with behaviours unrelated to social phobia.Not surprising …Scale items ask participants about what they think and do when in fear-producing situations.Circularity.Implications of low reliability and validity for phobias …CONTEXT
12Issues January 2012, examiner’s report: Describe the issue and then consider consequences and/or research evidence to support this.IssuesIssueEvaluation1 (50 words)Three point rule (50 words)234
13AO1 mark scheme Mark Knowledge and Understanding Range of relevant materialBreadth and depthOrganisation and structure8-7Sound, accurate and well-detailedSelectedSubstantialCoherent6-5Reasonable, generally accurate and reasonably detailedEvidence of breadth and/or depthReasonably coherent4-3Basic, relatively superficialRestrictedBasic2-1Rudimentary, muddled and/or inaccurateBrief or largely irrelevantLackingNo creditworthy material
14Analysis, understanding and intepretation Issues/debates/approaches Quality of written communication also assessedAO2/AO3 mark schemeMarkAnalysis, understanding and intepretationFocusElaborationLine of argumentIssues/debates/approaches16-13SoundWell focusedCoherentClearUsed effectively12-9ReasonableGenerally focusedEvidentReasonably effective8-5Basic. superficialSometimes focusedSome evidenceSuperficial relevance4-1Rudimentary, very limited understandingWeak, muddled, incompleteNot used effectivelyMay be mainly irrelevantAbsent, muddled and/or inaccurateNo creditworthy material
15‘In an important and influential criticism of the diagnosis of mental illness, Rosenhan (1973) showed that healthy ‘pseudopatients’ could gain admission to psychiatric hospital by pretending to have auditory hallucinations. Although systems of classification and diagnosis have changed considerably since the 1970s, many people still have concerns about their accuracy and appropriateness.’Discuss issues surrounding the classification and diagnosis of schizophrenia. (8 marks + 16 marks)There are two types of classification system. The first is the DSM, Diagnosis and Statistical Manual of mental disorders. The DSM was published in America so is only available in English. This therefore means that the rest of the world are unable to use this classification system. The DSM is used now as the 4th edition as the first editions were simplistic and vague. The DSM consists of 8 categories which 42 mental disorders fit into.The second classification system is the ICD International Classification system of mental disorders. This was first published by the WHO in 1990 so it is available world wide for all patients. The ICD is thought to be a better classification system as it is available world wide so isn’t culturally biased. It also diagnoses people with symptoms after seven months while the DSM does after 12. Lastly more people can be fitted into the ICD classification system as it has seven subtypes while the DSM has five.
16It is very easy to misdiagnose people with schizophrenia or it is difficult to tell where the normal behaviour starts and the abnormal ends. There have been many cases of misdiagnosis . Diagnosis is the classification and identification of a disorder in terms of its signs and symptoms. Signs are objective tests such as blood tests and symptoms are reports from patients. A famous case of misdiagnosis when a group of psychologists pretended to be mentally unstable to be admitted into a mental hospital. Once they were admitted they then acted normally and thought the staff would see they were medically sound and let them out. This didn’t happen as the staff believed what they were doing wasn’t right i.e. saying they were sane! After a while and after many letters were sent, the psychologists were let out. Another case of misdiagnosis was found by a psychologist in the 1960s. He found that there was a significant rise in the amount of people with catatonic schizophrenia. This type of schizophrenia is defined by muscle abnormalities. He then found that sleeping sickness had similar characteristics to this type of schizophrenia so people were being wrongly diagnosed. Another reason why people are misdiagnosed is down to cultural differences. In some countries schizophrenia is seen as a good thing whereas in England and similar cultures it is seen as different leading to different treatment of people.
17A reason why it is hard to diagnose people with schizophrenia is that it is difficult to put people into the subtypes. This is because of individual differences, as some people may have symptoms of more than one subtype of schizophrenia. This is due to schizophrenia being heterogenous, the ability to be linked to other disorders. Schizophrenia is mainly linked to depression, which is why the treatments for the two disorders are similar.A way the classification systems overcame diagnosis is making it multi-racial. This means that the doctor has to assess 5 different areas before diagnosing the patient.In evaluation, since 1970 there have been many improvements made on the classification and diagnosis of schizophrenia. There have been many improvements yet still many faults in the systems. For example individual and cultural differences are still not taken into account. A psychologist found more cases of schizophrenia in African and Caribbean cultures than European countries. There are still many areas of misdiagnosis of schizophrenia as it is still a fairly new mental disorder.So although improvements have been made since 1970 there is still a long way to go until the classification systems are flawless and there are no more cases of misdiagnosis.600 words
18Question type no. 3 Explanations and therapies Outline one explanation/therapy of XXXX. (4 marks)Outline one explanation/therapy of XXXX. (8 marks)Outline two or more explanations/therapies of phobic disorders. (8 marks)Evaluate one explanation/therapy of XXXX. (16 marks)Evaluate two or more explanations/therapies of XXXX. (16 marks)Could specify psychological or biological.Mix & match
1910 essays Psychopathology Describe and evaluate marks, 4 +8 marksClinical characteristics of XXXXIssues surrounding the classification and diagnosis of XXXX, including reliability and validityBiological explanations of XXXX, for example, genetics, biochemistryPsychological explanations of XXXX, for example, behavioural, cognitive, psychodynamic and socio-culturalBiological therapies for XXXX, including their evaluation in terms of appropriateness and effectivenessPsychological therapies for XXXX, for example, behavioural, psychodynamic and cognitive-behavioural, including their evaluation in terms of appropriateness and effectivenessClinical characteristics (AO1 only)Issues surrounding the classification and diagnosis of their chosen disorderOne biological explanation2nd biological explanationsOne psychological explanationTwo psychological explanationsOne biological therapy (appropriateness and effectiveness)Two biological therapiesOne psychological therapyTwo psychological therapies10 essays
20The 1 ½ theory rule Student has Theory 1 Wherever the specification says ‘theories’ or explanations this means you have to cover two, BUT …Student has Theory 18 marks description16 marks evaluationStudent produces cut down Theory 15 marks description10 marks evaluationTheory 23 marks description6 marks evaluationDescribe and evaluate one explanation of … (24 marks)Describe and evaluate two explanations of … (24 marks)
21What you need to know Psychological explanation 8 + 16 4 + 8 Biological explanationPsychological therapyBiological therapy
222 Range of relevant material 8 marks AO1About 10 minutes of writing (20 minutes for AO2).About words of writing.8 points of words for each possible essay.For each point remember one KEYWORD.
23For exampleGenetic explanations propose that an individual inherited a gene or possibly a cluster of genes. These genes are shared with their closest relatives.23 words x 8 = 184Schizophrenia8 marks AO1Genetic explanationFamily studies (e.g. Gottesman)Greater the degree of genetic relatedness, greater the risk.Children with two schizophrenic parents have 46% risk of developing the disorder, one schizophrenic parent a 13% risk.Twin studies MZ vs DZJoseph – MZ concordance 40%, DZ 7%.Adoption studies disentangle genetic and environmental influences.Tienari et al. – 6.7% adopted schizophrenics had biological schizophrenic mothers vs 2% adoptees born to non-schizophrenic mothers.
24For example 8 marks AO1 Schizophrenia Genetic Family – Gottesman Genetic relatedness46% vs 13% risk.Twin studies40% vs 7% - JosephAdoption studiesTienari et al. – 6.7% vs 2%.
25For example 8 marks AO1 Depression Neurotransmitter explanation Serotonin low.SRRIs work and they increase serotonin levels.Delgado et al. gave low tryptophan diets and symptoms returned.Amr et al. organophosphate insecticide exposure to serotonin disturbances in the brain.Noradrenaline low.Bunney et al. waste products show low levels.Post-mortem studies show increased densities of receptors in suicide cases, compensatory attempt to pick up whatever signals are available (a process known as ‘up-regulation’).
26For example 8 marks AO1 Depression Neurotransmitter explanation Serotonin low.SRRIs.Delgado et al. tryptophan.Amr et al. organophosphate.Noradrenaline low.Bunney et al. waste products.Post-mortem densities of receptors, up-regulation.
27For example 8 marks AO1 Phobia Genetic explanation Family studies (e.g. Fryer et al.) 3x as many relatives a normal controls.Solyom et al. 45% phobics have one phobic relative.Relatives have same phobia e.g. 64% blood phobics (Ost).Twin studies MZ vs DZTorgersen – 5x more in MZ than DZ.What is inherited? Oversensitive fear response (adrenogenic theory).Some people more readily conditioned (higher dopamine levels).
28For example 8 marks AO1 Phobia Genetic explanation Family (e.g. Fryer et al.) 3xSolyom et al. 45%64% blood phobics (Ost)Twin studies MZ vs DZTorgersen – 5xAdrenogenic theoryConditioning and dopamine
29Why it works A prècis is a summary where one cuts out less important material leaving the key bits.golden nuggets.Produces a précis of text.Gives you the coat pegs.Ensures you learn just the right amount (not too much or too little).
30Why it works YOU select your points Levels of processing theory E.g. Mandler (1967)Processing increases recall.Processing increases understanding.Cues help recall (cue retrieval theory).Organises your exam answer.Revise by rehearsal (MSM) and elaborating the points (leads to enduring memories).
31Your turn8 marks AO1One psychological explanation of XXXX.
32Approach 1 Six ELABORATED critical points would get you a Grade A. 8 x 25 words = 200 words8 x 50 words = 400 wordsAO112345678AO212345678
33Approach 2 A2 Exam Companion 50 words x 12 = 600 words An alternative psychological explanation is that stressful life events cause the onset of schizophrenia. Events such as the death of a close relative act as a trigger. The individual may have a biological predisposition for schizophrenia but only some people with such a predisposition will develop the disorder – those who experience stressors.52 wordsIn general the biological explanations probably have better research support than psychological ones. There is a large body of evidence, for example, supporting the role of genetic factors such as the research by Gottesman (1991) which showed that the greater the degree of genetic relatedness, the greater the risk of schizophrenia.51 wordsA2 Exam Companion
35Range of relevant material 8 marks AO1About 10 minutes of writing.About words of writing.8 points of words.OR 4 paragraphs of about 50 words.For each point/paragraph remember one KEYWORD.16 marks AO2About 20 minutes of writing.About words of writing.About 8 ELABORATED critical points (50-60 words).
36FOUR POINT RULE Psychological explanations POINT EVIDENCE Top and bottom your paragraphs.POINTThere is physiological evidence to support the cognitive explanation of schizophrenia.EVIDENCEMeyer-Linderberg et al. found a link between excess dopamine in the prefrontal cortex and working memory.EXAMPLE / EXPLAINWorking memory dysfunction is associated with the cognitive disorganisation typically found in schizophrenics.LINKThis shows that the cognitive explanation makes sense even at a physiological level.51 words
37AO1 mark scheme Mark Knowledge and Understanding Range of relevant materialBreadth and depthOrganisation and structure8-7Sound, accurate and well-detailedSelectedSubstantialCoherent6-5Reasonable, generally accurate and reasonably detailedEvidence of breadth and/or depthReasonably coherent4-3Basic, relatively superficialRestrictedBasic2-1Rudimentary, muddled and/or inaccurateBrief or largely irrelevantLackingNo creditworthy material
38Analysis, understanding and intepretation Issues/debates/approaches Quality of written communication also assessedAO2/AO3 mark schemeMarkAnalysis, understanding and intepretationFocusElaborationLine of argumentIssues/debates/approaches16-13SoundWell focusedCoherentClearUsed effectively12-9ReasonableGenerally focusedEvidentReasonably effective8-5Basic. superficialSometimes focusedSome evidenceSuperficial relevance4-1Rudimentary, very limited understandingWeak, muddled, incompleteNot used effectivelyMay be mainly irrelevantAbsent, muddled and/or inaccurateNo creditworthy material
39Outline and evaluate one biological therapy for schizophrenia and one psychological therapy for schizophrenia. (8 marks + 16 marks) One biological therapy used for schizophrenia is the use of drugs. A schizophrenia patient is likely to have hallucinations and other delusions, 73% of schizophrenics do. Research findings indicate that the cause of this is too much dopamine in the brain that the individual cannot deal with. The drug that the patient takes blocks some of the dopamine receptors and therefore reduces the amount of dopamine that the brain receives. The delusions and hallucinations are reduced or stopped in an easy and short time space. A major strength of this approach is that it can be tried and used if other methods have not worked such as ECT. There is large evidence that this method of treating schizophrenia works in 90% of cases. This therapy reduces the level of hallucinations the patient experiences. This therapy is used worldwide, in many cultures and therefore it does not suffer from a cultural bias but can be applied to everyone. However, these drugs have shown that tardive dyskinesia is a common result of this kind of therapy, 78% of patients are permanently damaged and cannot be reversed.
40Further criticism is that the drugs, if they block other receptors, other problems could happen. If this happens weight gain will be a result and symptoms similar to Parkinson’s disease. Drugs are the most up-to-date and reliable method of treating schizophrenia and do not suffer from a historical bias. This therapy does not take into account any biological or individual differences between schizophrenia patients and therefore should not be administered to everyone. One psychological therapy for treating schizophrenia is carried out by Tarrier (1971). He conducted what is known in the psychological profession as CBT, cognitive behavioural therapy. During this therapy the patient is asked to think of thoughts and ideas they have in their head and locate the cause. The therapist helps the patient change the way the patient interprets these thoughts into a much more productive way. An example of this and applying it to schizophrenic patients would be looking at a thought they get e.g. ‘Everybody hates me’. The therapist would help the patient to see that this really means ‘Even people who like me sometimes get made at me’. This therapy has been ongoing since 1971 and has developed in ways on conducting this therapy and making it more reliable. Although it originated back in the 70s there is not historical bias here because the process has been used in to the 21st century.
41A major strength of this type of therapy is that there are no negative effects in the outcome, unlike other therapies such as ECT and drugs. CBT has no memory impairment or long term damage. However weaknesses of this therapy are, it does not account for hallucinations. It cannot explain why people hallucinate or have delusions and cannot focus on reducing these symptoms. This therapy has face validity, it makes sense, the patient has negative thoughts, the thoughts are changed, the patient no longer has negative thoughts. 499 words
42A* AO2A major strength of this approach is that it can be tried and used if other methods have not worked such as ECT.There is large evidence that this method of treating schizophrenia works in 90% of cases. This therapy reduces the level of hallucinations the patient experiences.This therapy is used worldwide, in many cultures and therefore it does not suffer from a cultural bias but can be applied to everyone.A major strength of this approach is that it is a useful alternative to psychotherapy.Many people prefer drugs because they don’t require the same effort on the patient’s part.You just have to remember to take the drug each day instead of attending weekly sessions where you have to think about your behaviour and take control.This means that many people opt for drugs even though they have to tolerate unpleasant side effects.
43A* AO2A major strength of this approach is that it can be tried and used if other methods have not worked such as ECT.There is large evidence that this method of treating schizophrenia works in 90% of cases. This therapy reduces the level of hallucinations the patient experiences.This therapy is used worldwide, in many cultures and therefore it does not suffer from a cultural bias but can be applied to everyone.There is large evidence that antipsychotics work.In one study using placebos 55% relapsed if they were using placebos compared to 19% using conventional antipsychotics (Davis et al.).A particular strength of conventional antipsychotics is that they reduce the level of hallucinations the patient experiences.Such effectiveness increases the appeal of antipsychotic drugs.
44A* AO2A major strength of this approach is that it can be tried and used if other methods have not worked such as ECT.There is large evidence that this method of treating schizophrenia works in 90% of cases. This therapy reduces the level of hallucinations the patient experiences.This therapy is used worldwide, in many cultures and therefore it does not suffer from a cultural bias but can be applied to everyone.This therapy is used worldwide, in many cultures.Studies that compare success rates show that they are broadly similar in many different countries.For example, the study by Davis et al. concerned mainly American sample.A study by Avasthi et al. looked at data from Indian samples and reported the usefulness of antipsychotics there.This supports the view of a biological, universal disorder.