Question 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
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 OCD Reduce ?
Phobia The 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 . 132 words (100 words for 4 marks) Detailed and accurate = 4 out of 4 marks
January 2012, examiner’s report: Describe the issue and then consider consequences and/or research evidence to support this. Issues
Paragraphs and lead in phrases • Each AO2 point in one paragraph – so you can see the elaboration. • Organisation counts • Line of argument counts Tired examiner
2. Issues surrounding classification &diagnosis RELIABILITY Inter-rater reliability • The 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.
2. Issues surrounding classification &diagnosis RELIABILITY Test-retest • The 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.
2. Issues surrounding classification and diagnosis VALIDITY • Research support … • Kendler found high levels of comorbidity between social phobias, animal phobias, generalised anxiety • disorder and depression • Eysenck 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). Comorbidity • If 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.
2. Issues surrounding classification and diagnosis VALIDITY • 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 … Construct validity • Demonstrating the extent to which performance on a test of anxiety measures the underlying construct (phobia). CONTEXT
January 2012, examiner’s report: Describe the issue and then consider consequences and/or research evidence to support this. Issues
Quality of written communication also assessed AO2/AO3 mark scheme
‘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.
It 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.
A 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
Question type no. 3Explanations and therapies • Evaluate one explanation/therapy of XXXX. (16 marks) • Evaluate two or more explanations/therapies of XXXX. (16 marks) • 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) Could specify psychological or biological. Mix & match
The 1 ½ theory rule Wherever the specification says ‘theories’ or explanations this means you have to cover two, BUT … Student has Theory 1 8 marks description 16 marks evaluation Student produces cut down Theory 1 5 marks description 10 marks evaluation Theory 2 3 marks description 6 marks evaluation Describe and evaluate one explanation of … (24 marks) Describe and evaluate two explanations of … (24 marks)
2 Range of relevant material • 8 marks AO1 • About 10 minutes of writing (20 minutes for AO2). • About 200-240 words of writing. • 8 points of 20-30 words for each possible essay. • For each point remember one KEYWORD.
Genetic explanations propose that an individual inherited a gene or possibly a cluster of genes. These genes are shared with their closest relatives. 23 words 23x 8 = 184 For example Schizophrenia 8 marks AO1 • Genetic explanation • Family 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 DZ • Joseph – MZ concordance 40%, DZ 7%. • Adoption studies disentangle genetic and environmental influences. • Tienariet al. – 6.7% adopted schizophrenics had biological schizophrenic mothers vs 2% adoptees born to non-schizophrenic mothers.
For example Schizophrenia 8 marks AO1 • Genetic • Family – Gottesman • Genetic relatedness • 46% vs 13% risk. • Twin studies • 40% vs 7% - Joseph • Adoption studies • Tienariet al. – 6.7% vs 2%.
For example Depression 8 marks AO1 • Neurotransmitter explanation • Serotonin low. • SRRIs work and they increase serotonin levels. • Delgado et al. gave low tryptophan diets and symptoms returned. • Amret al. organophosphateinsecticide exposure to serotonin disturbances in the brain. • Noradrenaline low. • Bunneyet 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’).
For example Depression 8 marks AO1 • Neurotransmitter explanation • Serotonin low. • SRRIs. • Delgado et al. tryptophan. • Amret al. organophosphate. • Noradrenaline low. • Bunneyet al. waste products. • Post-mortem densities of receptors, up-regulation.
For example Phobia 8 marks AO1 • Genetic explanation • Family studies (e.g. Fryer et al.) 3x as many relatives a normal controls. • Solyomet al. 45% phobics have one phobic relative. • Relatives have same phobia e.g. 64% blood phobics (Ost). • Twin studies MZ vs DZ • Torgersen – 5x more in MZ than DZ. • What is inherited? Oversensitive fear response (adrenogenic theory). • Some people more readily conditioned (higher dopamine levels).
For example Phobia 8 marks AO1 • Genetic explanation • Family (e.g. Fryer et al.) 3x • Solyomet al. 45% • 64% blood phobics (Ost) • Twin studies MZ vs DZ • Torgersen – 5x • Adrenogenic theory • Conditioning and dopamine
A prècis is a summary where one cuts out less important material leaving the key bits. goldennuggets. Why it works • Produces a précis of text. • Gives you the coat pegs. • Ensures you learn just the right amount (not too much or too little).
Why 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).
Your turn 8 marks AO1 One psychological explanation of XXXX.
Approach 1 Six ELABORATED critical points would get you a Grade A. 8 x 25 words = 200 words 8 x 50 words = 400 words
50 words x 12 = 600 words Approach 2 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 words In 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 words A2 Exam Companion
AO2/AO3 skills Evaluation
Range of relevant material • 16 marks AO2 • About 20 minutes of writing. • About 400-480 words of writing. • About 8 ELABORATED critical points (50-60 words). 8 marks AO1 • About 10 minutes of writing. • About 200-240 words of writing. • 8 points of 25-30 words. • OR 4 paragraphs of about 50 words. • For each point/paragraph remember one KEYWORD.
Psychological explanations FOUR POINT RULE • POINT • There is physiological evidence to support the cognitive explanation of schizophrenia. Top and bottom your paragraphs. • EVIDENCE • Meyer-Linderberg et al. found a link between excess dopamine in the prefrontal cortex and working memory. • EXAMPLE / EXPLAIN • Working memory dysfunction is associated with the cognitive disorganisation typically found in schizophrenics. • LINK • This shows that the cognitive explanation makes sense even at a physiological level. 51 words
Quality of written communication also assessed AO2/AO3 mark scheme
Outline 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.
Further 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.
A 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
A* AO2 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. • 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.
A* AO2 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. • 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.
A* AO2 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. • 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.