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PSYA3 Essay Planning Pack
Sub-sections Have I read the text book? Do I have notes / hand outs? Do I understand this? Diagnosis of schizophrenia Naming the symptoms of SZ Differentiating Type 1 and Type 2 symptoms Validity of diagnosis Does using DSM-IV make diagnosis more reliable? Aetiology of Schizophrenia Genetics (inheritance) - Bio The dopamine hypothesis – Bio Abnormal brain structure – Bio It is learnt -Behavioural Faulty cognition of the biologically-based initial symptoms - Cognitive It is a Psychodynamic defence (Regression to pre-ego stage) Family relation - Double Bind -Expressed Emotions Life Events Diathesis-stress model Therapies for Schizophrenia Drugs to reduce the effects of dopamine (bio) ECT (bio) Behavioural Therapy CBT Psychanalysis PSYA3 Essay Planning Pack Schizophrenia
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Question: Discuss issues surrounding the classification and diagnosis of SZ, including reliability and validity AO1 Ladder There are a range of validity and reliability issues surrounding the classification system of SZ (i.e. defining what the disorder is) and the diagnosis of it (i.e. deciding who has it) Diagnosis Inter-rater reliability issues: When it comes to diagnosis any particular case, there are often disagreements between therapists as to: Whether a person is SZ What the prevalent/current symptoms are, and consequently What ‘type’ of SZ is exhibited Comorbidity issues (diagnosis validity): Because SZ symptoms may look like other disorders, and SZ often co-occurs with other disorders (e.g. depression), the ‘correctness’ of diagnosis (i.e. validity) is in question as it may not actually reflect a ‘true’ case of SZ Aetiological validity (classification validity) – we can even question the assumption that a ‘thing’ called ‘SZ’ exists, because we have no common cause for the supposed disorder in all patients: The causes may be one of biological or psychological or both, and within each there are a number of factors that may be present or not depending on case. This is also reflected in the lack of homogeneity in SZ symptoms. If different cases ‘look / act’ different, why assume the same disorder is underling them? On one basic level, one cane differentiate between positive & negative symptoms and argue for 2 separate diagnostic disorders – Type1 SZ & Type2 SZ The issues above adds up to a difficulty of being able to predict outcome of disorder or response to treatment, so the diagnosis system lacks predictive validity too and makes treatment –at times- a case of ‘trial and error’ Write 10 AO1 points in the ladder Write an reminder for the MRI parts of your AO2 points in each of the smaller tables. Join the AO2 to relevant AO1 with arrows AO2 Point Study/reason Implication Relibaility of diagnosis is in question. If psychiatrists disagree on a diagnosis, who do we accept? One or all could be wrong, can’t all be right! Whaley (2001) – showed a low inter-rater reliability of = 0.11 between psychiatrists assessments of patient case filed Lack of inter-rater reliability means any specific case of diagnosis is under suspicion because a diff psychiatrist could disagree AO2 Point Study/reason Implication AO2 Point Study/reason Implication Validity of diagnosis is also in doubt. Patients who are sometimes misdiagnosed are labelled & that can impact their lives Rosenhan (1973) : Mental health institute misdiagnosed confederates AND did not recognise them getting ‘better’ ! Misdiagnosis DOES occur through human error. HOWEVER, systems of diagnosis have changed considerably since the 1970s AO2 Point Study/reason Implication Blaney (1975): Having a Classification system is beneficial even if it’s not perfect argued that the tendency to think of abnormal behaviour, as an illness is more humane. “Ill” sounds better than “mad” – so classification system is a ‘kinder’ / more beneficial perception of patient AO2 Point Study/reason Implication Scheff (1999) promoted the labelling theory of schizophrenia, where the label itself can cause issues is ‘patients’ life rather then their supposed SZ disorder Social groups create the concept of psychiatric deviance by constructing rules for group members to follow, and marginalises ‘Unusual’ behaviour and actors SZ label applied may becoming a self fulfilling prophecy promoting the development of other symptoms of SZ (e.g. social withdrawal, delusion of persecution) AO2 (IDA) APPLICATION Study/reason Implication Gross(1992): Diagnosis of a patient is beneficial for them - Provides a medical language with agreed meanings. - Diagnosing a patient allow for treatment plans! Diagnosis leads to intervention to help them manage better in their lives AO2 Point Study/reason Implication Reliability of classification also in question du to : ICD vs DSM 5 editions of the DSM Different editions of DSM (and the classification differences between it and the ICD means they can’t all be right Which classification should we consider ‘correct one’? Who do we know the current is the ‘best’ / most accurate? AO2 (IDA) DEBATE Study/reason Implication Debate about Universality vs Cultural differences in relation to understanding human experience (relates to Dr. Szaz) What our society / medical profession considers ‘mentally ill’ may be understood differently through history or between cultures Unless we just assume “they’re all wrong”, our system only applies to our social context – can a real ‘disease’ be understood so subjectively?
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Question: Discuss issues surrounding the classification and diagnosis of SZ, including reliability and validity AO1 Ladder Inter-rater reliability issues Rest-retest reliability issues Comorbidity issues ‘Multiple definitions’ (i.e. validity) issues Write 10 AO1 points in the ladder Write an reminder for the MRI parts of your AO2 points in each of the smaller tables. Join the AO2 to relevant AO1 with arrows AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 (Methods) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication
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Question: Outline and evaluate biological explanations of SZ (including genetics and biochemistry) (this came up in the June 2013 paper) AO1 Ladder Write 10 AO1 points in the ladder Write an reminder for the MRI parts of your AO2 points in each of the smaller tables. Join the AO2 to relevant AO1 with arrows AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 (Methods) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication
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Question: Outline and evaluate the cognitive explanations of SZ (this Q can come up as “psychological explanations”, but cognitive would still be your main one for discussion) AO1 Ladder Write 10 AO1 points in the ladder Write an reminder for the MRI parts of your AO2 points in each of the smaller tables. Join the AO2 to relevant AO1 with arrows AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 (Methods) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication
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Question: Discuss the role of LIFE EVENTS in Schizophrenia (e. g
Question: Discuss the role of LIFE EVENTS in Schizophrenia (e.g. Family dynamic [EE, Double-bind], socio-cultural factors [e.g. living in stressful environments / Diathesis –stress theory]) AO1 Ladder Write 10 AO1 points in the ladder Write an reminder for the MRI parts of your AO2 points in each of the smaller tables. Join the AO2 to relevant AO1 with arrows AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 (Methods) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication
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Question: Discuss biological therapies for schizophrenia, including their evaluation of appropriateness and effectiveness AO1 Ladder Write 10 AO1 points in the ladder Write an reminder for the MRI parts of your AO2 points in each of the smaller tables. Join the AO2 to relevant AO1 with arrows AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 (Methods) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication
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Question: Discuss psychological therapies for schizophrenia, for example psychodynamic and cognitive-behavioural including their evaluation in terms of appropriateness and effectiveness AO1 Ladder Write 10 AO1 points in the ladder Write an reminder for the MRI parts of your AO2 points in each of the smaller tables. Join the AO2 to relevant AO1 with arrows AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 (Methods) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication
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BONUS Question: “an argument can be made for separating Sz into two separate disorders” – Discuss AO1 Ladder [HINTS: talk in this essay about different type1 / typ2 symptoms, the seemingly different causes for those symptoms, and the differing success of treatments on those symptoms] Write 10 AO1 points in the ladder Write an reminder for the MRI parts of your AO2 points in each of the smaller tables. Join the AO2 to relevant AO1 with arrows AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 Point Study/reason Implication AO2 (Methods) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication AO2 Point Study/reason Implication AO2 (IDA) Study/reason Implication
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