A2 clinical psychology revision notes edexcel
Content
Two Definitions of Abnormality The Statistical Definition of Abnormality
About statistical infrequency. Behaviour that is statistically rare is said to be abnormal. IQ is often used as an example of the definition because it is normally distributed throughout the population and people outside the normal limits is said to be abnormal. Abnormality is anything that is statistically infrequent. This links to normal distribution. With a characteristic, it is ‘normally distributed’ if the mean average, median and mode fall in the same place- in the middle of the scores. There are roughly the same numbers of scores each side of the average. Scores are normally distributed around the average. A set of normally distributed scores will have a set percentage at each standard deviation from the mean. A person's trait, thinking or behaviour is classified as abnormal if it is rare or statistically unusual. Necessary to be clear about how rare a trait or behaviour needs to be before we class it as abnormal. Any human characteristic is spread in a normal way across the general population. When plotted on a graph, it will form a normal distribution curve. The majority of people will fall in the middle of the graph with the minority being at either extreme end of the graph. The same is true of normal and abnormal behaviour. If someone's behaviour falls in the top or bottom 2.5% then it is considered to be abnormal.
Evaluation STRENGTH - It is an objective definition, therefore one that all clinicians can use to ensure consistency in diagnosis. WEAKNESS - Does not give a clear-cut definition and takes away the subjectivity of clinicians diagnosis. WEAKNESS - Doesn't take account of cultural variations.
-
WEAKNESS - If a person's score is only one or two above what is classed as abnormal, they may not get the help that they need. WEAKNESS - Some behaviours that people show every day such as anxiety may be considered normal but abnormal in a clinical sense.
Deviation from Social Norms
Another definition of abnormality. Every society has accepted standards of behaviour, these are sometimes written as part of the law. Others are implicit: they are generally accepted but not legally binding. Social norms allow for the regulation of normal behaviour. One approach to defining abnomality is to consider deviations from social norms as an indicator of abnormal behaviour. A person's thinking or behaviour is classed as abnormal if it violates the rules about what is expected or acceptable behaviour in a particular social group. Their behaviour may be incomprehensible to others or make others feel threatened or uncomfortable. To define people's mental health in terms of deviation from social norms suggests that those who behave in a socially deviant or incomprehensible way should be regarded as abnormal because they break with conventions and so not do what is normally expected. Some roles in society also come with what is considered to be normal behaviour, such as doctors are expected to be caring towards their patients.
Evaluation
-
WEAKNESS - Can lead to an abuse of a person's rights based on what society sees as normal. WEAKNESS - It is culturally biased. What is unacceptable in one culture may be seen as acceptable in another culture.
-
WEAKNESS- At times, breaking with the dominant culture is something to be applauded (freedom fighters) STRENGTH - Allows us to consider different behaviour which may not on their own be classified as abnormal.
Primary Data- Description:
Primary data is data which has been collected by those who witnessed an event first hand or who collected the data themselves through a study etc. Presents new thinking or information and can be collected in a variety of ways e.g. questionnaires and experiments which are either quantitative or qualitative. The data may be sets of statistics which are input into a computer programme to construct frequency distributions or other descriptive statistics.
Strengths:
Reliable source as the researcher can replicate the procedures to check the results because they know the procedures and how the data was collected and analysed. The data will be more up-to-date. Using data which was gathered years previously is less likely to provide reliable answers to the question which the data needs to address. Taken directly from the population so it is best to collect for methods like surveys.
Weaknesses:
Researchers may be subjective in the data that they look for e.g. looking for data which matches their hypotheses. Because the data us gathered from scratch it involves finding a large enough sample to make the results credible and generalizable and gain a large volume of data meaning it is more costly and time consuming than collecting secondary data.
Secondary data- description:
Second hand analysis of pre-existing data. It may be analysed in a different way or be used to answer a different question from that which is addressed in the original research. Secondary analysis uses data which was collected by someone else in order to further a study which they are interested in completing. Usually interprets analyses, evaluates, explains or comments on a primary source or event. After statistical operations have been performed on primary data, it becomes secondary data. In some cases, secondary data is gathered before primary data in order to find out what is already known about a subject before embarking on a new investigation.
Strengths:
Saves time and expense which would otherwise be spent collecting data. It can provide a larger database than an individual researcher would hope to collect. Often the only resource and therefore the only way to examine large scale trends of the past e.g. historical documents.
Weaknesses:
The researcher cannot personally check the data so its reliability may be questioned. The researcher may have no knowledge of how the data was collected; therefore they do not know anything about the accuracy or bounds of error. May be out of date and therefore not suitable for current research.
The DSM Diagnostic and statistical manual of mental disorders used by psychiatrists to aid in the diagnosis of mental disorders. It is regularly updated and multi-axial i.e. it considers a number of factors (e.g. health and social factors) in making a diagnosis.
AXIS I- Disorders, clinical and mental e.g. schizophrenia Diagnostic category with appropriate sub-classification e.g. schizophrenia; paranoid type. Include substance related disorders e.g. drug and alcohol abuse, schizophrenia and other psychotic disorders, mood disorders, anxiety, sexual and gender identity disorders and sleep disorders. AXIS II- Personality (underlying including mental retardation) Personality and developmental disorders are listed here if presen.t These include: paranoid, schizoid, anti-social, dependent, obsessive-compulsive.
AXIS III- Medical and physical conditions A list of any current physical disorders that may be relevant to understanding and treating the person. Any relevant general medical condition from which the person is currently suffering.
AXIS IV- Environmental factors Documentation of preceding stressful events. These include: emotional problems, occupational, housing, finance, access to healthcare, legal/criminal problems, other psychosocial problems e.g. death of a loved one or divorce. AXIS V- Global functioning An evaluation of how well the individual had functioned socially and occupationally prior to onset of illness. Here, social, psychological and occupational functioning is considered on a scale from 0-100, 1-10 severe danger of self-harm or harm to others or a persistent lack of personal hygiene or serious suicidal acts with clear expectation of death.
Validity of the DSM
Construct validity If the DSM is to define mental disorders, then mental disorders have to be operationalised. Lists of symptoms and behaviour are the result of making a mental disorder measurable. Some people argue that by operationalising mental disorders such as depression, something is lost from the understanding of the experience of depression meaning that the DSM is not a valid tool. There is a lack of construct validity in that the constructs drawn up to represent depression etc. may not be representative enough. Etiological validity If it has etiological validity, a group of people who have been diagnosed with the same disorder will have the same symptoms or factors causing it. E.g. schizophrenia is sometimes caused by too much of the neurotransmitter dopamine, to have etiological validity; everyone diagnosed with schizophrenia should have excess levels of dopamine in their brain. Concurrent validity To have concurrent validity, symptoms that form part of the diagnosis but are not part of the actual disorder should also be the same in those that are diagnosed with the disorder. E.g. schizophrenics often have problems with personal relationships but this isn’t a diagnostic criteria according to the DSM’s classification.
Predictive validity Present if a diagnosis can lead to a prediction of future behaviours caused by the disorder. If a diagnosis has predictive validity we should be able to say whether the person is likely to recover or whether symptoms will continue, it should also be possible to predict how someone with a specific disorder will respond to particular treatments. E.g. the drug lithium carbonate is effective for bipolar disorder, but not for other mental disorders. If a classification system has good predictive validity and diagnoses someone with bipolar disorder, they should respond to lithium carbonate.
Convergent validity When tests results converge or get close to another test result that measures the same thing. A correlational test would be carried out. If two scales measure the same construct, for example, then a person’s score on one should converge with (correlate with) their score on the other. The difference between convergent validity and predictive/concurrent validity is that in convergent validity the two measures should be measuring exactly the same thing, whereas in the other two types of validity there can be a different way of measuring each case.
Studies into validity of the DSM
KIM COHEN (2005) - longitudinal study looking at conduct disorder in over two thousand five year olds. Supports predictive validity of the DSM IV as children who received a diagnosis of conduct disorder based on a questionnaire were more likely to display behavioural and educational difficulties at age 7. However this could be a result of self-fulfilling prophecy rather than the DSM’s predictive validity. LEE (2006) – Aimed to see whether the DSM criteria for ADHD would be useful for Korean children. 1663 large sample of children. Match between the features of ADHD outlined in the DSM and the responses to questionnaires, an ADHD test and teacher assessments. Supports the concurrent validity of the DSM however the match was not as good for girls so there could be a validity issue. HOFFMAN (2002) - Hoffmann studied prison inmates to look at diagnoses of alcohol abuse, alcohol dependency and cocaine dependency, to see if differences would occur in a computer-prompted structured interview, compared to the DSM-IV-TR criteria. It was found that the DSM-IV-TR diagnosis was valid and that the interview data supported the idea that dependence was more a severe syndrome than abuse. The symptoms from the automated interview matched those of the DSM criteria. Supports validity of the DSM.
The reliability of the DSM
To be reliable as a diagnostic classification system, there would have to be consistency with the DSM. This means that the DSM is reliable if the clinicians using it consistently arrive at the same diagnoses as each other. The term inter-rater reliability is used to describe the extent to which different clinicians agree on the same diagnosis for the same patient.
Traditionally, reliability is calculated mathematically, often using a measure known as positive predictive value (PPV). The PPV of a disorder shows the reliability, taking the example of depression, of the DSM with that disorder; so if depression had a PPV value of 80, this means that 80% of diagnosed depression patients will have the same subsequent diagnosis when re-assessed.
However, there may also be a cultural element to reliability, for example with Cooper et al. (1972) who showed the same patient interview tapes to various American and British psychiatrists, and American clinicians diagnosed schizophrenia twice as often as the British, and the British clinicians diagnosed depression twice as often as the Americans.
Studies into reliability of the DSM
GOLDSTEIN (1988) - Goldstein tested the DSM for reliability using the at-the-time current version, DSM-III. One of the aims of her study was to test the DSM-III, comparing the results of the re-diagnoses of 199 patients who had been originally diagnosed with schizophrenia using DSM-II. Experts carried out a re-diagnosis of a random sample of eight patients using a single-blind technique (not allowing the experts to know the hypothesis, so their answers are not biased, whereas Goldstein herself was aware of the hypothesis). She found that 169 of the 199 patients diagnosed according to DSM-II as having some form of schizophrenia met the DSM-III criteria too, so reliability was seen as good with the DSM. Of the patients assessed by the clinical experts as well, she found high levels of inter-rater reliability. BROWN ET AL (2001) - In 2001, Brown et al. studied anxiety and mood disorders in 362 outpatients in Boston, to test reliability of the DSM-IV and patients underwent two independent interviews using anxiety disorder interview schedules for DSM-IV, known as the life-time version. Brown found good-to-excellent reliability for most of the DSM-IV categories (most of the disagreements tended not be on what the symptoms were, but simply if there were enough of them). However, they found some boundary problems with certain disorders, which made it hard to diagnose patients with disorders if they were at boundary level. Overall, the study highlights some problems with the DSM but generally proves it to be a reliable tool. EVALUATION OF KIRK AND KUTCHINS - In a review paper, Kirk and Kutchins argued that methodological problems with studies conducted to test the reliability of the DSM up until 1992 had limited the generalizability of their findings. For example, they argued that there had been insufficient training and supervision of interviewers, and studies tended to take place in specialised research settings, and so could lack validity as well as reliability
Cultural issues with the DSM
Scientific view o o o o o o o o o o o Culture does not affect diagnosis. The DSM is widely used and it is valid if mental disorders are clearly defined with specific features and symptoms. Mental disorders are scientifically defined- illnesses that are explained in a scientific way. Cultural issues do affect diagnosis. There are studies that show culture can affect diagnoses. Depending on cultural interpretations of what is being measured, the DSM is not always valid. A clinician from one culture must be aware that a patient from another culture is guided by their own frame of reference. Mental health problems with a set of symptoms found and recognised as an illness only in one culture. Many psychiatrists reject the idea of culture bound syndromes. The most commonly recognised syndromes are listed on the DSM-IV. E.g. Fan fear (Korea)
Spiritual view
Culture bound syndromes
Schizophrenia- symptoms Positive (type 1) symptoms
Hallucinations: seeing/ hearing things which are not there. They are often harsh and critical or controlling. They can be auditory or visual and often provide a commentary on what the person is doing and tells them what to do. Delusions: False beliefs, for example thinking that your movements are controlled by someone else, paranoid delusions where you think someone is trying to mislead or even kill you. Delusions of grandeur= thinking that you have special powers or a king or God. You may also think that things are about you which are actually unrelated to you e.g. thinking a newspaper has a secret message for you.
Thought disorders: Cause your speech to be hard to follow. You may lose concentration or complain of muddled thinking. Further, you may believe in thought insertion or thought broadcasting.
Negative (type 2) symptoms
Lack of energy and apathy- no motivation to do daily choirs. Social withdrawal- staying inside and avoiding family and friends. Flatness of emotions- the face becomes emotionless and the voice dull with no changes in pitch. Not looking after appearance and self, not adhering to expectations with regard to preserving a sense of self.
Features of Schizophrenia
schizophrenia appears to be a universal disorder (the condition can affect anyone in any place, males and females) the profile of sufferers seems to be as follows: ¼ of patients will have one episode of schizophrenia and then fully recover ¼ of patients will suffer chronic schizophrenia, having continuous schizophrenic episodes ½ of patients will have occasional schizophrenic episodes but do not have a chronic disorder positive symptoms (those added to the sufferer’s being) can be overcome (e.g. hallucinations, delusions), whereas the negativ e symptoms (those lacking in sufferers) tend to remain male sufferers tend to experience a more severe course of the disorder than females (Goldstein, 1988) there are five categories which psychiatrists and diagnosticians use to describe different types of schizophrenia
Biological explanation of Schizophrenia
Genetic factors: o o o o Schizophrenia does seem to run in families suggesting that there is a genetic link. The common view is that schizophrenia is caused by a number of genes rather than one specific gene. Family & twin studies have been used to study the genetic influence on Schizophrenia e.g. Gottsman and Shields. Puts forward the idea that schizophrenia is related to neurotransmitter functioning. Schizophrenics are found to have high levels of dopamine in their brains during a schizophrenic episode. The dopamine hypothesis:
o o o o
It is believed that high levels of dopamine in the mesolimbic pathway contribute to the positive symptoms of schizophrenia and dopamine in the mesocortical pathway contributes to the negative symptoms. Neurotransmitters like dopamine are chemical substances released through an electrical impulse into neurones where they carry messages which control the behaviour of the brain and the body. The electrical impulses are converted into chemical processes and pass through a synaptic gap between the pre synaptic and post synaptic neurones. The post synaptic neurone contains receptor sites where the levels of dopamine are observed and this is thought to be the cause of positive symptoms of schizophrenia, alternatively the excess dopamine which is usually reabsorbed into the pre synaptic neurone may be going into receptors once they become empty, giving double the amount of dopamine to the body.
About statistical infrequency. Behaviour that is statistically rare is said to be abnormal. IQ is often used as an example of the definition because it is normally distributed throughout the population and people outside the normal limits is said to be abnormal. Abnormality is anything that is statistically infrequent. This links to normal distribution. With a characteristic, it is ‘normally distributed’ if the mean average, median and mode fall in the same place- in the middle of the scores. There are roughly the same numbers of scores each side of the average. Scores are normally distributed around the average. A set of normally distributed scores will have a set percentage at each standard deviation from the mean. A person's trait, thinking or behaviour is classified as abnormal if it is rare or statistically unusual. Necessary to be clear about how rare a trait or behaviour needs to be before we class it as abnormal. Any human characteristic is spread in a normal way across the general population. When plotted on a graph, it will form a normal distribution curve. The majority of people will fall in the middle of the graph with the minority being at either extreme end of the graph. The same is true of normal and abnormal behaviour. If someone's behaviour falls in the top or bottom 2.5% then it is considered to be abnormal.
Evaluation STRENGTH - It is an objective definition, therefore one that all clinicians can use to ensure consistency in diagnosis. WEAKNESS - Does not give a clear-cut definition and takes away the subjectivity of clinicians diagnosis. WEAKNESS - Doesn't take account of cultural variations.
-
WEAKNESS - If a person's score is only one or two above what is classed as abnormal, they may not get the help that they need. WEAKNESS - Some behaviours that people show every day such as anxiety may be considered normal but abnormal in a clinical sense.
Deviation from Social Norms
Another definition of abnormality. Every society has accepted standards of behaviour, these are sometimes written as part of the law. Others are implicit: they are generally accepted but not legally binding. Social norms allow for the regulation of normal behaviour. One approach to defining abnomality is to consider deviations from social norms as an indicator of abnormal behaviour. A person's thinking or behaviour is classed as abnormal if it violates the rules about what is expected or acceptable behaviour in a particular social group. Their behaviour may be incomprehensible to others or make others feel threatened or uncomfortable. To define people's mental health in terms of deviation from social norms suggests that those who behave in a socially deviant or incomprehensible way should be regarded as abnormal because they break with conventions and so not do what is normally expected. Some roles in society also come with what is considered to be normal behaviour, such as doctors are expected to be caring towards their patients.
Evaluation
-
WEAKNESS - Can lead to an abuse of a person's rights based on what society sees as normal. WEAKNESS - It is culturally biased. What is unacceptable in one culture may be seen as acceptable in another culture.
-
WEAKNESS- At times, breaking with the dominant culture is something to be applauded (freedom fighters) STRENGTH - Allows us to consider different behaviour which may not on their own be classified as abnormal.
Primary Data- Description:
Primary data is data which has been collected by those who witnessed an event first hand or who collected the data themselves through a study etc. Presents new thinking or information and can be collected in a variety of ways e.g. questionnaires and experiments which are either quantitative or qualitative. The data may be sets of statistics which are input into a computer programme to construct frequency distributions or other descriptive statistics.
Strengths:
Reliable source as the researcher can replicate the procedures to check the results because they know the procedures and how the data was collected and analysed. The data will be more up-to-date. Using data which was gathered years previously is less likely to provide reliable answers to the question which the data needs to address. Taken directly from the population so it is best to collect for methods like surveys.
Weaknesses:
Researchers may be subjective in the data that they look for e.g. looking for data which matches their hypotheses. Because the data us gathered from scratch it involves finding a large enough sample to make the results credible and generalizable and gain a large volume of data meaning it is more costly and time consuming than collecting secondary data.
Secondary data- description:
Second hand analysis of pre-existing data. It may be analysed in a different way or be used to answer a different question from that which is addressed in the original research. Secondary analysis uses data which was collected by someone else in order to further a study which they are interested in completing. Usually interprets analyses, evaluates, explains or comments on a primary source or event. After statistical operations have been performed on primary data, it becomes secondary data. In some cases, secondary data is gathered before primary data in order to find out what is already known about a subject before embarking on a new investigation.
Strengths:
Saves time and expense which would otherwise be spent collecting data. It can provide a larger database than an individual researcher would hope to collect. Often the only resource and therefore the only way to examine large scale trends of the past e.g. historical documents.
Weaknesses:
The researcher cannot personally check the data so its reliability may be questioned. The researcher may have no knowledge of how the data was collected; therefore they do not know anything about the accuracy or bounds of error. May be out of date and therefore not suitable for current research.
The DSM Diagnostic and statistical manual of mental disorders used by psychiatrists to aid in the diagnosis of mental disorders. It is regularly updated and multi-axial i.e. it considers a number of factors (e.g. health and social factors) in making a diagnosis.
AXIS I- Disorders, clinical and mental e.g. schizophrenia Diagnostic category with appropriate sub-classification e.g. schizophrenia; paranoid type. Include substance related disorders e.g. drug and alcohol abuse, schizophrenia and other psychotic disorders, mood disorders, anxiety, sexual and gender identity disorders and sleep disorders. AXIS II- Personality (underlying including mental retardation) Personality and developmental disorders are listed here if presen.t These include: paranoid, schizoid, anti-social, dependent, obsessive-compulsive.
AXIS III- Medical and physical conditions A list of any current physical disorders that may be relevant to understanding and treating the person. Any relevant general medical condition from which the person is currently suffering.
AXIS IV- Environmental factors Documentation of preceding stressful events. These include: emotional problems, occupational, housing, finance, access to healthcare, legal/criminal problems, other psychosocial problems e.g. death of a loved one or divorce. AXIS V- Global functioning An evaluation of how well the individual had functioned socially and occupationally prior to onset of illness. Here, social, psychological and occupational functioning is considered on a scale from 0-100, 1-10 severe danger of self-harm or harm to others or a persistent lack of personal hygiene or serious suicidal acts with clear expectation of death.
Validity of the DSM
Construct validity If the DSM is to define mental disorders, then mental disorders have to be operationalised. Lists of symptoms and behaviour are the result of making a mental disorder measurable. Some people argue that by operationalising mental disorders such as depression, something is lost from the understanding of the experience of depression meaning that the DSM is not a valid tool. There is a lack of construct validity in that the constructs drawn up to represent depression etc. may not be representative enough. Etiological validity If it has etiological validity, a group of people who have been diagnosed with the same disorder will have the same symptoms or factors causing it. E.g. schizophrenia is sometimes caused by too much of the neurotransmitter dopamine, to have etiological validity; everyone diagnosed with schizophrenia should have excess levels of dopamine in their brain. Concurrent validity To have concurrent validity, symptoms that form part of the diagnosis but are not part of the actual disorder should also be the same in those that are diagnosed with the disorder. E.g. schizophrenics often have problems with personal relationships but this isn’t a diagnostic criteria according to the DSM’s classification.
Predictive validity Present if a diagnosis can lead to a prediction of future behaviours caused by the disorder. If a diagnosis has predictive validity we should be able to say whether the person is likely to recover or whether symptoms will continue, it should also be possible to predict how someone with a specific disorder will respond to particular treatments. E.g. the drug lithium carbonate is effective for bipolar disorder, but not for other mental disorders. If a classification system has good predictive validity and diagnoses someone with bipolar disorder, they should respond to lithium carbonate.
Convergent validity When tests results converge or get close to another test result that measures the same thing. A correlational test would be carried out. If two scales measure the same construct, for example, then a person’s score on one should converge with (correlate with) their score on the other. The difference between convergent validity and predictive/concurrent validity is that in convergent validity the two measures should be measuring exactly the same thing, whereas in the other two types of validity there can be a different way of measuring each case.
Studies into validity of the DSM
KIM COHEN (2005) - longitudinal study looking at conduct disorder in over two thousand five year olds. Supports predictive validity of the DSM IV as children who received a diagnosis of conduct disorder based on a questionnaire were more likely to display behavioural and educational difficulties at age 7. However this could be a result of self-fulfilling prophecy rather than the DSM’s predictive validity. LEE (2006) – Aimed to see whether the DSM criteria for ADHD would be useful for Korean children. 1663 large sample of children. Match between the features of ADHD outlined in the DSM and the responses to questionnaires, an ADHD test and teacher assessments. Supports the concurrent validity of the DSM however the match was not as good for girls so there could be a validity issue. HOFFMAN (2002) - Hoffmann studied prison inmates to look at diagnoses of alcohol abuse, alcohol dependency and cocaine dependency, to see if differences would occur in a computer-prompted structured interview, compared to the DSM-IV-TR criteria. It was found that the DSM-IV-TR diagnosis was valid and that the interview data supported the idea that dependence was more a severe syndrome than abuse. The symptoms from the automated interview matched those of the DSM criteria. Supports validity of the DSM.
The reliability of the DSM
To be reliable as a diagnostic classification system, there would have to be consistency with the DSM. This means that the DSM is reliable if the clinicians using it consistently arrive at the same diagnoses as each other. The term inter-rater reliability is used to describe the extent to which different clinicians agree on the same diagnosis for the same patient.
Traditionally, reliability is calculated mathematically, often using a measure known as positive predictive value (PPV). The PPV of a disorder shows the reliability, taking the example of depression, of the DSM with that disorder; so if depression had a PPV value of 80, this means that 80% of diagnosed depression patients will have the same subsequent diagnosis when re-assessed.
However, there may also be a cultural element to reliability, for example with Cooper et al. (1972) who showed the same patient interview tapes to various American and British psychiatrists, and American clinicians diagnosed schizophrenia twice as often as the British, and the British clinicians diagnosed depression twice as often as the Americans.
Studies into reliability of the DSM
GOLDSTEIN (1988) - Goldstein tested the DSM for reliability using the at-the-time current version, DSM-III. One of the aims of her study was to test the DSM-III, comparing the results of the re-diagnoses of 199 patients who had been originally diagnosed with schizophrenia using DSM-II. Experts carried out a re-diagnosis of a random sample of eight patients using a single-blind technique (not allowing the experts to know the hypothesis, so their answers are not biased, whereas Goldstein herself was aware of the hypothesis). She found that 169 of the 199 patients diagnosed according to DSM-II as having some form of schizophrenia met the DSM-III criteria too, so reliability was seen as good with the DSM. Of the patients assessed by the clinical experts as well, she found high levels of inter-rater reliability. BROWN ET AL (2001) - In 2001, Brown et al. studied anxiety and mood disorders in 362 outpatients in Boston, to test reliability of the DSM-IV and patients underwent two independent interviews using anxiety disorder interview schedules for DSM-IV, known as the life-time version. Brown found good-to-excellent reliability for most of the DSM-IV categories (most of the disagreements tended not be on what the symptoms were, but simply if there were enough of them). However, they found some boundary problems with certain disorders, which made it hard to diagnose patients with disorders if they were at boundary level. Overall, the study highlights some problems with the DSM but generally proves it to be a reliable tool. EVALUATION OF KIRK AND KUTCHINS - In a review paper, Kirk and Kutchins argued that methodological problems with studies conducted to test the reliability of the DSM up until 1992 had limited the generalizability of their findings. For example, they argued that there had been insufficient training and supervision of interviewers, and studies tended to take place in specialised research settings, and so could lack validity as well as reliability
Cultural issues with the DSM
Scientific view o o o o o o o o o o o Culture does not affect diagnosis. The DSM is widely used and it is valid if mental disorders are clearly defined with specific features and symptoms. Mental disorders are scientifically defined- illnesses that are explained in a scientific way. Cultural issues do affect diagnosis. There are studies that show culture can affect diagnoses. Depending on cultural interpretations of what is being measured, the DSM is not always valid. A clinician from one culture must be aware that a patient from another culture is guided by their own frame of reference. Mental health problems with a set of symptoms found and recognised as an illness only in one culture. Many psychiatrists reject the idea of culture bound syndromes. The most commonly recognised syndromes are listed on the DSM-IV. E.g. Fan fear (Korea)
Spiritual view
Culture bound syndromes
Schizophrenia- symptoms Positive (type 1) symptoms
Hallucinations: seeing/ hearing things which are not there. They are often harsh and critical or controlling. They can be auditory or visual and often provide a commentary on what the person is doing and tells them what to do. Delusions: False beliefs, for example thinking that your movements are controlled by someone else, paranoid delusions where you think someone is trying to mislead or even kill you. Delusions of grandeur= thinking that you have special powers or a king or God. You may also think that things are about you which are actually unrelated to you e.g. thinking a newspaper has a secret message for you.
Thought disorders: Cause your speech to be hard to follow. You may lose concentration or complain of muddled thinking. Further, you may believe in thought insertion or thought broadcasting.
Negative (type 2) symptoms
Lack of energy and apathy- no motivation to do daily choirs. Social withdrawal- staying inside and avoiding family and friends. Flatness of emotions- the face becomes emotionless and the voice dull with no changes in pitch. Not looking after appearance and self, not adhering to expectations with regard to preserving a sense of self.
Features of Schizophrenia
schizophrenia appears to be a universal disorder (the condition can affect anyone in any place, males and females) the profile of sufferers seems to be as follows: ¼ of patients will have one episode of schizophrenia and then fully recover ¼ of patients will suffer chronic schizophrenia, having continuous schizophrenic episodes ½ of patients will have occasional schizophrenic episodes but do not have a chronic disorder positive symptoms (those added to the sufferer’s being) can be overcome (e.g. hallucinations, delusions), whereas the negativ e symptoms (those lacking in sufferers) tend to remain male sufferers tend to experience a more severe course of the disorder than females (Goldstein, 1988) there are five categories which psychiatrists and diagnosticians use to describe different types of schizophrenia
Biological explanation of Schizophrenia
Genetic factors: o o o o Schizophrenia does seem to run in families suggesting that there is a genetic link. The common view is that schizophrenia is caused by a number of genes rather than one specific gene. Family & twin studies have been used to study the genetic influence on Schizophrenia e.g. Gottsman and Shields. Puts forward the idea that schizophrenia is related to neurotransmitter functioning. Schizophrenics are found to have high levels of dopamine in their brains during a schizophrenic episode. The dopamine hypothesis:
o o o o
It is believed that high levels of dopamine in the mesolimbic pathway contribute to the positive symptoms of schizophrenia and dopamine in the mesocortical pathway contributes to the negative symptoms. Neurotransmitters like dopamine are chemical substances released through an electrical impulse into neurones where they carry messages which control the behaviour of the brain and the body. The electrical impulses are converted into chemical processes and pass through a synaptic gap between the pre synaptic and post synaptic neurones. The post synaptic neurone contains receptor sites where the levels of dopamine are observed and this is thought to be the cause of positive symptoms of schizophrenia, alternatively the excess dopamine which is usually reabsorbed into the pre synaptic neurone may be going into receptors once they become empty, giving double the amount of dopamine to the body.
