Mini studies clinical

Davis

claims that those suffering mental illness have a 25% increased chance of dying from unnatural disorders eg. Suicide- supports danger as an important dimension of diagnosis

Chehil

Some disorders have clear evidence of danger eg. Half of all people who die by suicide may have major depressive disorder, having this or one other of the mood disorders such as bipolar disorder- increases risk of suicide by 20 times

beck et al

37% of prisoners in the study said that they had been diagnosed with a mental illness and 36% of them said that they had received mental health therapy. Supporting danger, dysfunction and deviance

Seymour kitty

Criticised rosenhan saying that because the pseudo patients were faking an unreal mental condition, it doesn’t tell us anything about how people with genuine mental health issues are diagnosed

Ward et al

disagreement in diagnosis was due to inconsistency of information provided by patients. This is because their actual disorder can ha e negative effects on their memory and perceptions of their illness. They can also be manipulative. This means that there are serious concerns with diagnosis which relies heavily on patient self-reports, regardless of how rigorous the classification systems are

Ca-however, ward also found that there were also more problems with psychiatrists interpretation of symptoms and inadequacy of the classification system itself which suggests that the main reliability issue at the time was the diagnostic tool being used

Spitzer and fleiss (early evidence)

Study compared 18 investigations into the reliability of the dsm 2 and showed psychiatrists coming up with different diagnosis for the same symptoms. This implies that to be reliable, there needs to be good inter-rater reliability between clinicians, they need to be consistent in their diagnosis and wherever a patient may be that diagnosis needs to be the same

Nicholls

Found the inter-rater reliability for both dsm-5 and icd-10 to be different in the diagnosis of eating disorders in children. 0.64 for dsm (substantial agreement)

Yet, 0.36 (fair) for icd-10. The great or one street system emerged as far superior. This suggests that classification systems are not in agreement for this disorder

Regier

reliability of major depressive disorder using the dsm to be only 0.28, whereas schizophrenia had a kappa value of 0.46 for the icd implying that the icd may be more reliable for some disorders.

However, ptsd had kappa values ranging from 0.60-0.79 (very good) for dsm which is a reflection of clinicians adapting well to the changes made to the criteria for this disorder. This showed that some disorders have higher reliability in diagnosis compared to others

Reed

inter-rater reliability for icd 11 for mental disorders was superior to the icd-10. Icd-11-0.87 for schizophrenia, 0.49 for ptsd

Hoffman et a;

compared the dsm-5 and icd-10 in a study of alcoholism among over 7000 prisoners. The two systems agreed in diagnosing healthy Individuals and those with severe alcoholism. However, the diagnosis differed when it came to mild-to-moderate alcohol disorders. About a third of those with mild alcoholism diorder according to dsm 5 received no diagnosis from icd-10

Cooper et al

the aim of the study was to investiagate reliability of diagnosis of depression and schizophrenia. The researchers asked American and British psychiatrists to diagnose patients by watching videotaped clinical interviews. The British psychiatrists diagnosed the patients in the interview to be clinically depressed twice as often. The results indicated that the same cases did not result int the same diagnosis in the two countries. This pointed towards problems of reliability in diagnosis caused by cultural differences in the interpretation of symptoms

Kim cohen et al

demonstrated concurrent, atielogical and predictive validity was high for dsm in the diagnosis of conduct disorder. Concurrent-interviewed children and mothers and used questionnaires completed by teachers as well as observing the children’s anti-social behaviour. This shows agreement among measuring the children. Atielogical-specific risk factors eg. Male, low income, parents with psychological disorders were common in many cases. This shows that known causes of conduct disorder were present. Predictive-5 year olds with conduct disorder were significantly more likely to display behavioural and educational problems at age 7. This shows that the diagnosis of conduct disorder matched the children’s future outcomes.

Ca-interviewers and questionnaires are subjective so may not actually have the disorder

Ca-labelling them at age 5 may make them act like they ahve conduct disorder at age 7

Robert Schwartz and David Blankenship

a literature review showed that Afro-Americans are three to four times more likely to be diagnosed with a psychotic disorder than euro-Americans. This means that a persons ethnicity may affect the practitioners diagnosis as they will be more likely to diagnose a disorder which fits stereotypical, schema knowledge

Zutt

in some cases people with the same diagnosis present very different symptoms and this suggests that the disorder in question does not have good descriptive validity. He coined the term pathoplasticity to describe the fact that culture differences can shape the way in which a disorder manifests itself. One example of this is schizophrenia which has many and varied symptoms

Suhail and Cochrane

have shown that people diagnosed with schizophrenia from Pakistan were more likely to experience visual hallucinations (including ghosts and spirits) than Pakistani and white people living in Britain with a diagnosis of schizophrenia. The latter groups were both more likely to experience auditory hallucinations than the people with schizophrenia living in Pakistan

Falkai et al

Autopsies have found that there are a large number of dopamine receptors in the brain and an increase in teh amount of dopamine in the left amygdale In people with schizophrenia

Putman

increased dopamine in caudate nucleus of people with schizophrenia

Randrup and munkvard

injected rats with amphetamines which increased dopamine activity. Rats showed many of the behavioural indicators of schizophrenia including stereotypical movement (involuntary movements) findings were replicated with chickens, pigeons, cats, dogs and squirrels which provides the theory with reliable evidence

Ca-our brains are much more complex, can’t represent human brains. So not representable and generalisable. Animals can’t talk to us about how their feelings whereas humans can

leucht et al And noll et al

Evidence supporting the dopamine hypothesis comes from the success of drug treatments. This is because drugs work on reducing the effects of dopamine in the brain. Eg. Laucht et al carried out a meta-analysis and found that such anti-psychotics were more affective than a placebo in reducing symptoms of schizophrenia. Meta-analysis involving nearly 6000 patients on typical or atypical anti-psychotics and found that after taking some people off the drugs and putting a placebo 64% had relapsed compared to only 27% who stayed on the anti-psychotic.

Ca-yet, noll et al suggests that antipsychotic drugs do not alleviate hallucinations and delusions in about one third of people diagnosed with schizophrenia and that some people diagnosed with schizophrenia experience these symptoms despite dopamine levels being normal. Blocking the da receptors in some people have little or no effect in reducing their symptoms. This means that the evidence for the dopamine hypothesis is not conclusive and does not take into account individual differences

wim veling

the role of neurotransmitters doesn’t explain why certain groups in society are more likely to be diagnosed with schizophrenia eg. Wim veling found Moroccan immigrants in the Netherlands were more likely than Turkish immigrants to be diagnosed with schizophrenia. This correlated with the amount of discrimination faced by each group which suggests that environmenta factors such as social stress might be a better explanation for schizophrenia

Lurhman

different experiences of hallucinations in the us- auditory hallucinations compared to the uk- spiritual hallucinations. This implies that research fails to capture the holistic experience of people suffering form schizophrenia

Kendler

first degree relatives of those with schizophrenia are 18 times more at risk of developing schizophrenia than the general population

Tienari et al and Joseph et al

Children of schizophrenia sufferers are still at heightened risk of schizophrenia despite being adopted into families with no history of the condition. This suggests a strong genetic link over environmental factors

Ca-suggets that because prospective parents would be aware of the child’s background, there may be an element of selective placing involved meaning that the environment that they’re placed in may have similarities to their biological families. Therefore this implies that environmental influences may still be a factor in determining whether an individual developes schizophrenia and suggests that an explanation which considers genetic influence alone can also be nurture.

Bateson et al

Double bind theory

Brown

individuals from families with high expressed emotion are 3.7 times more likely to likely to relapse than families with low expressed emotion.

Vaughn and leff

51% of schizophrenics relapsed in highly expressed emotion homes, compared to only 13% in low expressed emotion homes

Pharaoh et al

meta-analysis found that family interventions help the patient to understand their illness and live with it, developing emotional strength and coping skills, reducing the rates of relapse, the success of family therapy therefore provides the family explanation fo schizphrenia with credibility (because family therapy works)

Mischeler and Waxler

found significant differences in the way mothers spoke to their normal daughter, which suggests that dysfunctional communication may be a result of living with the schizophrenic rather than the cause of the disorder. This suggests that there is a problem with establishing whether schizophrenia is caused by dysfunctional communication within a family or wherever the condition itself leads to these problems

Meltzer et al

carried out studies to look at the use of drug therapy on schizophrenic patients. 48 patients were put into groups based on different drugs. Four new drugs were given compared to one well established drug called haloperidol: haloperidol showed significant improvement with two new drugs showing improvements for both positive and negative symptoms of schizophrenia. This demonstrates the development chemotherapy through time in treating people with schizophrenia.

Emsley

Studied the effectiveness of anti-psychotic drug risperidone. He found that those who had the injection early in the course of the illness had high remission rates and low relapse rates. In 84% of the patients there was at least a 50% reduction in positive and negative symptoms and over two years 64% went into remission. This gives further credibility to the use of anti-psychotics to treat schizophrenia.

Davidson and neale

50% stop taking anti-psychotics one year after initial treatment and 75% stop taking anti-psychotics after 2 years. This leads to the revolving door problem (in and out of treatment) which means they may be better suited to different treatment models

Anderson et al

Found a relapse rate of almost 40& when patients had drugs only, compared to only 20J% when family therapy or social skills training was used. The relapse rate was less than 5% when they were both used together with the medication.

Pharaoh et al

Pharaoh et al reviewed 53 studies in his meta-analysis and found that family therapy is effective in reducing hospital readmissions over the course of a year and improved clinical outcomes such as mental and social functioning.

Lobban

reports that the other family members felt that they ere able to cope better thanks to family therapy

Max et al

When the basal ganglia is disconnected from the frontal cortex during surge ocd like symptoms are reduced, providing further support for the role of the basal ganglia in ocd

Salkovoskis and Kirk

conducted a diary study of people with ocd where on some days they were told to try and suppress their obsessive thoughts, whereas on other days they could allow free rein. They found that the recorded frequency of intrusive thoughts was higher on the days they tried to suppress them.

Ca-self-report unreliable

Rahman

supports hyper vigilance-reports a case study where someone who centred on blood could, due to hyper vigilance recall oall past events when she had come into contact with blood

Van ballon

found cbt to be an effective drug treatment supporting the view that ocd may be the result of faulty cognition. Cognitions play a role.

Brody

brain differences (in metabolism in left compared to right ofc) predicts whether someone will respond better to drugs or therapy. Doctors will not have access to this information (only gained by scanning) which suggests that prescribing drugs might be a bit of a ‘hit or miss’

Soomoro et al

reviewed studies which compared the effectiveness of ssris with placebos, finding significant better results for the ssris.symtpoms typically declined by 70%

Moselles et al

found that about 44% of ocd sufferers only suffer from obsessions. They also found that 75% suffer from comobid depression whcih lessens the effectiveness of erp. In fact having persistent depressive symptoms after therapy was a strong predictor of relapse

Fisher and wells

used a standardised procedure to measure the effectiveness of different types of therapy and concluded that the erp is the most effective therapy, showing a 50-60% reduction in all symptoms.

Foa et al

found that a combination of an antidepressant and erp was more effective than either alone. Although erp has been shown to be effective in treating ocd, it is even more effective if paired with drugs, especially in the first instance