History Of Abnormality

● The concept of abnormality has persisted throughout centuries. It has been measured
and been attempted to be cured a plethora of times throughout human existence
● Trepanning involves cutting holes in the skull, dating back to 6500 BCE
● Ancient people believed this would allow evil spirits to escape the skull
● This line of thinking has ceased to exist in the last few hundred years

Early Alternatives to Supernatural Explanations of Abnormal Behaviour

● Ancient Mesopotamians believed a "wandering womb" caused hysteria.
● The term hysteria was specific to females, used till the early 20th century

● Hippocrates linked mental health problems to brain abnormalities, one of the first to do
so.
● He believed that four bodily fluids called "humours" dictated psychological states - and
that an imbalance of them caused abnormal behaviour

Treatment of Abnormal Individuals

● Asylums (Arkham) date back to 16th century Europe.
● They aimed to protect the public from the mentally ill by confining them.
● These confinements were not of the greatest quality, subjecting patients to horrific living
conditions and solitude. But, it was a step forward from murdering people on the basis
that they were "possessed" or "witches"

Advancement of treatment of Abnormality

● In the late 19th and early 20th centuries, some medical doctors, including Freud,
developed psychological therapies and psychogenic theories that explained syptoms
without reference to physical causes
● Following freud's development of psychoanalysis, other schools of thought began to
develop i.e CBT, Behavioural, etc.
● Electroconvulsion therapy and lobotomies were used well into the 20th century
● Antipsychotic medication and drug therapy replaced the above therapies, however.

Development of the DSM

● The DSM was created for classifying mental disorders and symptoms, leading to the first
edition being published in 1952
● The DSM has gone through several revisions, such as homosexuality being removed in
the 1970s.
● Current DSM is DSM 5
Contemporary understanding of abnormality
● Today psychiatrists and psychologists alike agree that biological, psychological and
social factors dictate our mental health
● This brings more nuance into the development of mental health, we have discovered the
role of genetics, brain organs, etc. in dictating mental health and abnormality

Statistical Infrequency Definition

● This occurs when an individual has a less common characteristic compared to the
population. It is seen as an infrequent behaviour and can be statistically shown to be so.
e.g a low score on an IQ test

Strengths
● Real life application in diagnosing intellectual disability
● Objective criteria for abnormality, increases reliability.
Weakness
● Is culture relativistic. Defining IQ is embedded in western norms and values of what is
determined to be intelligence, this decreases construct validity
●
● Unusual characteristics can be positive and desirable for example scoring high on an IQ
test. Fails to recognise desirable behaviour, which can decrease its construct validity
failure to function adequately including Rosenhan and Seligman, 1989.
● States individuals are abnormal when they are unable to cope with everyday life and this
is evident in their behaviour
● Abnormal behaviours include; distress leading to not being able to function, behaviour
that interrupts the individual's ability to work or go to school
● Rosenhan and Seligman (1989) suggest that personal dysfunction has seven features
and the more features an individual has, the more they are classed as abnormal

4 Ds of inadequate function
● Deviance: If the behaviour is considered rare enough, and deviant from the form, then
this could suggest that a clinical disorder is present
● Dysfunction: If the behaviour is significantly interfering with the person's life, then a
mental illness may be present.
● Distress: Behaviour that upsets the individual.
● Danger: Patient behaviour is assessed under two key elements: Danger to themselves
and danger to others. Interventions and isolation may be required to prevent self-harm
and harm to others

Rosenhan and Seligman (1989) failure to function adequately criteria

Strengths and weaknesses of failure to function adequately

Strengths:
 ● More holistic view of abnormality as it is not specific to a set numerical value and instead
factors in the effect it has on a person. Makes the diagnosis more valid as it more
accurately establishes cause and effect

● This definition acknowledges the subjective experience of the individual. EG: whether
they are feeling distressed because the behaviour is a problem for them. It allows for
harmless eccentricity, however unusual, to be considered normal.

Weaknesses
● It is subjective to patient experience so considers their distress even though it is difficult
to measure distress. Decreased internal validity
● Is likely culture relativistic, decreases generalisability. This is because certain behaviours
may be considered abnormal in different cultures satisfying the "Deviant" in the 4 Ds,
despite it not being inherently bad.
● Some abnormal individuals have generally high levels of functioning. EG: murderers
such as Harold Shipman, or some addicts, may manage to hold down a job and normal
family life despite their abnormality, so appear to themselves and others to be
functioning very well. While their underlying problem is clearly harmful, they would be
difficult to spot if we were using this definition of abnormality alone

Classification systems
● Used to diagnose mental illnesses

International Classification of Diseases (ICD)

● A manual used to diagnose all diseases, including mental health disorders.
● Section F of the ICD is specific to MHDs (Mental Health Disorders)
● e.g F32 is depression
● Extra digits tell you the specific sub-type of disorder
● e.g F32.0 is mild depression, and F32.0.00 is mild depression without somatic symptoms
● Within the section, each mental illness is grouped as being part of a family
● e.g mood affective disorders would include bipolar disorder
● ICD-10 was used up until 2018. A revision was made, known as the ICD-11

ICD-10 to ICD-11
● The ICD-11 has no paradigm shift relative to the ICD-10.
● New diagnostic categories such as Prolonged Grief Disorder were added
● New categories such as prolonged grief disorder were created
● computer gaming and compulsive sexual behaviour were pathologised, which was a
source of controversy
● Clinicians can use a system to guide a patient through diagnosis via clinical interview
DSM
● Diagnostic and Statistical Manual of Mental Disorders
● was created to help psychiatrists to communicate using a common system of diagnosis.
Its forerunner was published in 1917, containing statistics gathered across mental
hospitals
● The DSMV also groups disorders into families, with linked disorders grouped together.
● The DSM is an American diagnostic manual
What the DSM5 has changed relative to the DSMIVR
● Abolished the 5 axes (Used to diagnose mental health disorders)
● Merged all autism diagnoses into ASD (Autism Spectrum Disorder)
● Covers more PTSD Symptoms
● Separates dementia into major and mild dementia for quicker diagnosis
● Removes terms such as "mental retardation" in favour of "intellectual disability"
● Removes culture bound syndromes
DSM IV-R
● Revised edition of DSM4
● Included "culture-bound syndromes" and recognised that mental health is understood
differently across cultures
● The DSM5 may have an effect on the mental health section of the ICD-11, as the
classification systems are becoming more and more similar

Strengths and Weaknesses of DSM and ICD

Strengths of DSM
● Stinchfield (2003) conducted diagnostic evaluations of pathological gambling (sever
enough to interfere with daily functioning)
○ The sample included 803 participants from Minnesota and 259 from a gambling
treatment programme
○ 19 Items from the DSM IV were used in the questionnaire for pathological
gambling
○ The questionnaire results were able to help researchers to correctly sort the
gamblers from the non gamblers, so the DSM has construct validity

● Goldstein (1988) re-diagnosed 199 patients using the DSM3, who were originally
diagnosed using the DSM2.
○ She found that the diagnoses were 85% consistent, indicative of test-retest
reliability
 ● Rosenhan (1973)'s study adds reliability because the pseudopatients were all diagnosed
with schizophrenia presumably using the current DSM.

Weakness of the DSM

● Rosenhan (1973)'s study indicates that the DSM misdiagnosed healthy patients as
schizophrenics, decreases construct validity
● Cooper (2014) discovered that only 15% of the disorders evaluated in the DSM5 field
trials achieved a Kappa value of more than 0.6, compared with the original 0.7 kappa
value identified by Spitzer in his DSM3 review. This suggests that the DSM5 may be
distinctly less reliable than previous versions

Strengths of the ICD

● Galeazzi et al (2004) arranged 2 psychologists to conduct a joint interview to assess 100
clients for psychosomatic symptoms using the ICD-10, their inter-rater agrement was
excellent, with a kappa value of 0.69-0.97 (very high). This means the ICD is reliable

● Mason et al (1997) compared different ways of making a diagnosis. ICD9 and ICD 10
were reasonably good at predictive validity as it was able to diagnose people with
schizophrenia 13 years after the initial diagnosis.
Weaknesses
● Nicholls et al (2000) looked at eating disorders in children. 81% of patients were
assessed using the DSM4 .
○ The kappa values for the ICD were 0.36, which indicates weak agreement, so the
ICD may be considered unreliable

● The ICD 10 fails to recognise frequently diagnosed conditions such as Seasonal

Affective Disorder. This decreases the validity of the classification system as it fails to
recognise a condition

Types of validity
● Concurrent validity: a way of establishing validity that compares evidence from several
studies testing the same thing to see if they agree.
● Aetiological validity: the extent to which a disorder has the same cause or causes.
Aetiological validity exists when the diagnosis reflects known causes, such as a family
history, in a disorder that is known to have a genetic cause.
● Predictive validity: The extent to which results from a test such as DSM, or a study can
predict future behaviour
● Construct Validity: The extent to which your test or measure accurately assesses what
it's supposed to
Reliability issues in diagnosis
● This refers to the extent to which clinicians agree on the same diagnosis for the same
patient.
● Ward et al (1962) studied two psychiatrists diagnosing the same patient. The main
source of disagreement was discovered to be the classification system, indicating that
the diagnostic tool at hand was the source of the reliability issue.
● For a system to be reliable, it needs to pass an inter-rater reliability test
● Brown et al (2001) tested the reliability of DSM4 diagnoses for anxiety and found them to
be good to excellent.
● Chenieux et al (2009), however, found that there is a lack of reliability between both the
ICD-10 and DSM, with 26 of a 100 patients diagnosed with schizophrenia when using
DSM and 44/100 when using ICD.

Patient Factors
● Unreliable diagnoses may occur because of patient factors, such as the patient being
unwilling to share information because of memory issues, or shame.
○ The divulgence of information may ultimately affect the diagnosis given by each
clinician

Clinician Factors
● Unreliable diagnoses may also occur due to clinician factors.
● This includes things such as subjective judgment on how they interpret the symptoms a
patient presents, the clinician's background, etc.
● The line of questioning may also affect the diagnosis as different information may be
gathered depending on the questions asked
● The unstructured nature of the clinical interview can also lead to a focus on certain
symptoms

● Spitzer & Fleiss 1974 found that communication between clinicians increases reliability.
○ In a meta analysis of 6 studies (1974), they also found that there were many
differences in diagnosis, which indicates weak reliability.
● However, this study was conducted pre-DSM3 which was created to address the
reliability and validity problem.
● With every DSM released, an effort to obtain increased validity and reliability is made,
indicating that with every edition, reliability increases.

Cultural issues in diagnosis

● Psychology is a very western discipline, and psychiatry is very western in outlook.
 ● The DSM is an American diagnostic manual and it has a far-reaching and widespread
influence.
● Mental disorders are not specific to the west, they occur worldwide.
● African-Caribbeans are said to talk to dead relatives when grieving, this leads to them
being diagnosed with a much more severe disorder than they really have (such as
schizophrenia rather than mild depression) - a false positive diagnosis

● Disorders recognised by western psychiatry become "official" mental disorders and

attract research which develops treatments
● This leads to "unofficial" mental disorders considered to be folk illnesses and not taken
seriously. A psychiatrist may miss this, leading to a false negative diagnosis.
● The DSM has however tried to combat this. The DSM-5 gets rid of "culture-bound
syndromes" and instead replaces it with advice on "Cultural Concepts of Distress"
○ The DSM is trying to portray a holistic understanding of mental disorders

● The DSM includes culture bound syndromes such as Genital Retraction (Penis Panic)

● The ICD, however, fails to recognise the importance of culture on mental disorders
● It does not contain any information on cultural variables affecting diagnostics.

Validity in Diagnosis
● Rosenhan (1973) is a perfect example of reliability - all pseudo patients were diagnosed
with schizophrenia
● But even if a diagnosis is reliable, it must also be valid. It must genuinely reflect the
underlying disorder
● Incorrect diagnosis may lead to wrong treatment, which can delay recovery or
exacerbate a person's underlying condition.
● Lee (2006) used the DSM-IV to look at the diagnosis of Korean children with ADHD and
found that there was a match between features of ADHD outlined in the DSM and the
response to an ADHD questionnaire containing 18 ADHD items from the DSM-IV. This
indicates good validity.

● Concurrent validity can be checked by comparing the DSM with the ICD, seeing if there
is a broad agreement about which symptoms constitute which disorder.
○ Andrews et al (1999) found a 68% agreement between the ICD-10 and DSM-IV

● Aetiological validity can be established by examining what is known about the causes of
the disorder and matching them to the person's history
 ● Predictive validity should also be examined. This is where the future course of the
disorder is known and can be used to treat the person e.g if a patient has depression,
and an improvement might be expected within eight weeks if they are prescribed
anti-depressants

● Clinicians may also be affected by implicit biases such as diagnosing females with
depression more readily due to depression being more prevalent in females.

Schizophrenia
● Refers to a spectrum of psychological disorders characterised by distortions of thought,
perception, emotion and social withdrawal

Symptoms of Schizophrenia
● Symptoms are categorised into two types: Positive and Negative
○ Positive symptoms add to the experience of the patient. These include delusions,
hallucinations, disorgansied thinking, etc.

● Negative symptoms are symptoms that schizophrenia TAKES AWAY from your
experience of the world.
○ These include speech impediments, loss of emotions, lack of motivation, etc.

Examples of Positive Symptoms

Delusions
● Beliefs held by an individual that, despite not being true, cannot be changed even if
evidence to the contrary is shown.
○ Examples of delusion can include grandiose delusions, where they believe
themselves to have a remarkable quality such as being famous
● Thought insertion is the belief that your thoughts are not your own and have been put
into your mind by someone else. This is a sub-category of Delusion.

Hallucinations
● When you see or hear things that aren't real. A common type of auditory hallucination is
voices.

Disorganised thinking
 ● (example of disordered thinking manifesting in speech:
https://youtu.be/u2vMnyTiwp4?t=20)
● This is best diagnosed from speech.
● It's essentially where ideas are loosely connected to each other, or completely
unconnected. A person simply jumps from one topic to another, it becomes a word salad,
essentially

Examples of Negative Symptoms

● Speech problems, causing impediments or the inability to speak
● Loss of emotions - feeling numb and loss of facial expression
● Lack of motivation to do things
● Social Withdrawal - breaking friendships, not making eye contact, etc.

Features of Schizophrenia
● Likelihood of a person development schizophrenia is between 0.3-0.7%
● 20% of schizophrenics will respond to treatment
● NIH reports that the ratio of schizophrenia of men to women is 1.4:1, males report higher
incidences of schizophrenia. So 1.4x more frequency in males.
● NIH reports that African Americans are 4x more likely to be diagnosed with
schizophrenia than Euro-Americans
● 544 out of 100,000 people in Japan are diagnosed with schizophrenia.

Neurotransmitters as an explanation for Schizophrenia

● An increase in Dopamine has been cited as a cause for schizophrenia.
● Studies done on rats wherein dopamine was injected into them has shown us that rats
begin to exhibit more stereotyped, aggressive behaviour. Almost psychotic.
● Enzymes such as beta hydroxylase, which break down dopamine are not present in high
levels, causing an excess build up of dopamine
● D2 receptors, which are dopamine receptors, are overactivated/hyperactive, contributing
to positive symptoms of schizophrenia.
● Increases in dopamine have also been linked to increased aggression.
Strengths
● First generation drugs such as Haloperidol (dopamine antagonist) and chlorpromazine
(d2 receptor antagonist. Blocks D2 receptors) which prevent dopamine from binding to
the receptors all have an anti-psychotic effect and reduce symptoms. Increases internal
validity

● Parkinsons disease often involves the precscription of a medication known as L-Dopa.

which is a dopamine agonist (activates dopamine receptors). If medication dose is too
high, individuals will experience hallucinations and delusions, similar to schizophrenia
symptoms. This indicates that dopamine is involved in positive symptoms, increasing
internal validity.

● Randrup and Munkvad (1966) injected amphetamine into rats, increasing dopamine
levels in their brain, and found that this caused them to become more aggressive,
isolated, resulted in psychotic behaviour consistent with those shown in schizophrenic
patients. Increases internal validity.

Weakness
● Alpert and Friedhoff (1980) found that patients showed no improvement whatsoever after
taking dopamine antagonists, implying there may be more to the cause than just
dopamine. Decreases internal validity.

● Reductionist as it posits that dopamine is the sole cause of schizophrenia even though
Social and envionrmental factors such as those shown by Fox (1990) show that poor
conditions may trigger onset of schizo

● Drugs such as clozapine have been shown to increase dopamine levels in some parts
of the brain YET it is still reported to have anti-psychotic, anti-schizophrenic effects on
patients

Genetics as an Explanation for Schizophrenia

● Posits that there is evidence of a strong heritable factor in the development of the
disorder
● If you have a relative such as an aunt or uncle with the illness, that risk increases to a
maximum of 6%
● first degree relatives e.g siblings with the condition increases your risk up to 17%
 ● Gottesman (1991) found that monozygotic twins had a 48% chance of developing schizo
if their siblings had it too, implying a strong genetic element.

● Deletion of the COMT gene (which produces an enzyme which breaks down dopamine)
has been found in schizophrenic patients (likely due to dopamine regulation being more
difficult)

● Oxidative DNA Damage has also been linked to schizophrenia

● DISC1 gene which codes for GABA which regulates dopamine in the limbic system.
People born with abnormalities to this gene are 1.4x more likely to suffer from
schizophrenia

Strengths and Weaknesses of Genes for schizophrenia

● Gottesman (1991) found that monozygotic twins had a 48% chance of developing
schizophrenia if one of their siblings. This shows that there is a very strong genetic
component as MZ twins share 100% of genes. Increase internal validity

● Tienari et al (2000) found that 7% of adoptees with schizophrenia had a biological

mother with the same disorder. Increased internal validity

Weaknesses
● Research has failed to isolate a single gene that seems to cause the illness. This
decreases internal validity.
● Reductionist as it fails to account for environmental factors. Pederson and Mortenson
(2001) found that there is a greater risk of developing SZ by living in city life.

Unipolar Depression
● A type of mood disorder causing periods of feeling sad, depressive episodes, typically
characterised by persistently low mood among other symptoms

Main symptoms of unipolar depression

● Lowering of mood
● Lack of energy despite resting for a long time
● Lack of motivation to do things
 ● Suicidal tendencies

● The symptoms must also cause significant distress or impairment to the person's life
and must be present for more than 2 weeks

Features of Unipolar Depression

● 1 in 15 people worldwide suffer from an episode of serious depression every year
● Unipolar depression is 2x more likely to develop in females than males
● Seligman (1988) reports that people in the 1980s were 10x more likely to be diagnosed
with depression than in the 1940s
● Successful suicide is higher in male sufferers of unipolar depression
● 50-54 year olds are at the highest risk of unipolar depression

Neurotransmitter Explanation for Depression

● The monoamine hypothesis states that depression results from a chemical imbalance in
the monoamine neurotransmitters in the brain, specifically serotonin and noradrenaline.
● Serotonin is a mood regulator and noradrenalin has many roles including maintaining
concentration
● In the 1950s, it was noticed that drugs which decreases these neurotransmitters brought
about symptoms of depression, and so, drugs like SSRI's were developed which would
increase these missing neurotransmitters and alleviate symptoms

● However, despite noradrenalin and serotonin increasing following ingestion of these

drugs, the symptoms often do not improve for a period of up to 6 weeks in some cases.
○ This challenges the monoamine hypothesis so a more complex alternate
explanation was made

● This new alternate explanation was that low levels of serotonin and noradrenalin
changed the neuro-circuitry of the brain, causing an up-regulation in the sensitivity of the
receptor sites on the post-synaptic neuron, so more receptors are produced.
○ When more neurotransmitters become available via anti-depressant drugs,
down-regulation occurs where receptors are desensitised and reduced in
number, causing a delayed response to the drug as it takes more time for binding
to occur as receptor sites aren't as readily available.
 ● 5-HTT gene has been linked to regulating serotonin levels. People with variations of the
5-HTT gene that are underactive are more likely to suffer from depression following
stressful life events.

● MAOA-H which is a gene that codes for increased numbers of monoamine oxidase, an
enzyme that breaks down monoamines, can also be responsible for depression as it
starves you of serotonin and noradrenaline.

Strengths and Weaknesses of Neurotransmitters as an explanation for Unipolar Depression

● Caspi et al (2003) found that those with a short version of the 5-HTT gene who
experienced stressful life situations were more likely to be diagnosed with depression,
indicating genes had a role in depression. Increased internal validity.

● Many anti-depressant drugs block the re-uptake of serotonin and noradrenaline, and
these have been shown to improve symptoms of depression, there's a reason they're
used to treat it. This indicates that neurotransmitters like serotonin and noradrenaline
play a role in depression. Internal validity increased.

Weaknesses
● Correlation is not causation. Just because serotonin and noradrenaline are correlates of
depression does not mean that they are the cause of depression. Just because drugs
can treat a disorder does not mean they reveal the root cause. Aetiological fallacy.
Decreases internal validity

● Angoa-Perez (2014) found that in mice lacking the gene tryptophan (precursor enzyme
to serotonin production), the mice did not show any depressive traits, nor did they
respond to antidepressant medication. Even under stress, they did not behave any
differently to normal mice. This suggests that low level of serotonin may not be the sole
cause of depression, maybe other factors are involved too.
Cognitive explanation for depression
Beck's cognitive triad
● Beck believed depression could be explained by three negative thought patterns that
people may develop about themselves
○ Their belief about the future
○ Their belief about the world
○ Their belief about themself

● These cognitive biases can cause a negative world view

● This causes magnification, which is essentially them seeing their problems as worse
than they actually are
Albert Ellis's ABC Model
● Albert Ellis believed there are three stages to depression which can then cause
someone to become depressed

Strengths and Weaknesses of cognitive theory explanation of depression

Strengths
● D'Allesandro (2002) found that student with negative views about their future saw an
increase in their depressed mood. Supports beck's cognitive triad
● Another strength of the cognitive theory explanation is that it has been applied to
therapy. Cognitive behavioural therapy (CBT) is one of the leading treatments for
depression.

Weaknesses
● A weakness is that it is difficult to tell whether irrational thoughts are a cause of
depression or a symptom of being depressed.
● It only account for reactive depression, where the individual has had an activating event
but does not account for endogenous depression, when the depression is not traceable
to life events.
Drug Therapy for Schizophrenia
● Anti-psychotic drugs include drugs such as chlorpromazine and haloperidol.
● These drugs typically work by reducing the level of dopamine in areas of the brain
associated with symptoms.
○ Their primary mechanism of action is by blocking the dopamine receptors, which
prevents the binding of the dopamine to their receptors
○ They mostly blockade D2 receptors

Strengths
● McEvoy et al (2006) found that clozapine was the most effective anti-psychotic drug as it
showed the most improvement 3 motnhs after taking the drug in schizophrenia patients

● Furakawa et al (2015) found that severe schizophrenia symptoms were most effectively
treated using anti-psychotics.

Weakness
● Severe side-effects such as drowsiness, rapid heart rate, etc.
● Many people argue that while drugs do improve the symptoms, the do not treat the root
cause.

Family therapy
● Used to support the individual diagnosed with a mental illness
● Develops a support network within the family

How it works
● Family talks openly about symptoms experienced by patient
○ Patient is encouraged to explain what they expereince as a schizophrenic
● The family will be educated on the causes of the illnesses to break down the concerns
and to shift the blame from the patient to the illness
● Family learns stuff like how symptoms cannot be controlled during psychosis
● Drug therapy may also be offered as part of the treatment
● Family members are also encouraged to talk about other concerns they have e.g
unhygienic schizophrenic, leading to family getting angry at the schizophrenic.
● This helps the patient feel supported, and helps their treatment become more successful
Strengths
● Goldstein and Miklowitz (1995) found that family interventions + drug therapy was highly
effective in reducing relapse of symptoms in schizophrenics
● Pilling et al (2002) found that Family therapy was extremely effective at reducing relapse
rates for psychosis as well as improving the compliance with medication prescribed.
● Avoids side effects of drug therapy

Weakness
● Family therapy requires that the family be motivated. A lack of this motivation will
invalidate the therapy
● Does not address the root cause at all, at best it alleviates symptoms.

Drug Therapy for Unipolar Depression

Strengths
● Royal College of Psychiatrists report that 65% of patients with depression had improved
symptoms compared to the 30% that took a placebo
● Allow a patient to access other forms of therapy such as CBT which can help them get
better

Weakness
● Side effects. Dizzziness, Erectile dysfunction, MAOIs cause dangerous reactions with
certain foods
● Improve symptoms, but don't treat disorder. Kirsch (2005) reports that patients
depression symptoms relapse post-treatment.
Cognitive Behavioural Therapy as a treatment for Depression

● the first stage involves discussing their symptoms with the therapist and explaining how
they feel, what makes them feel this way, etc.
● The second stage involves challenging these irrational beliefs.
○ When a patient can recognise thoughts as irrational or negative, they should try
to replace them with more rational and positive ways of thinking

● The patient will have a series of sessions and be prescribed "homework"

○ This homework can entail writing about their feelings in a diary, and trying to
replace negative thought patterns with more positive ones.

● Patients are also taught techniques to processing events that have happened and
mapping the emotional response that follows.

strengths
● Beltman et al (2010) found that depressed patients with CBT improved more than those
who were still waiting for/not receiving treatment
● No side effects in this therapy
 ● May be longer lasting treatment as patients learn to control their symptoms by
challenging their own thoughts, as opposed to drugs where it may just mitigate the
symptoms temporarily

Weaknesses
● Requires motivation on the patient to change, otherwise it's all useless
● Ethical concerns as patient is essentially blamed for their thoughts and is told that it is an
"incorrect" manner of thought
○ This can discourage patients from attending therapy and may contribute to a
distrust between patient and therapist

Rosenhan (1973)
Aim
● Investigate whether the sane can be distinguished from the insane
● To observe whether normal people can get admitted to psychiatric hospitals, and if they
can detected as "sane" once admitted
● Investigating how patients are treated in psychiatric hospitals
● To determine the validity of psychiatric diagnosis

Procedure
● The study is a field experiment
● Indepenent groups design used (each hospital takes part once, they are not visited
again)
● IV was schizophrenic symptoms offered by the pseudo-patient, and DV was the
admission and diagnostic label given to the pseudopatients

Sampling
● 8 volunteers were selected.
○ These volunteers included 3 women, and 5 men. (Not including Rosenhan
himself, who participated in this experiment himself)
● Hospital sampling was done by selecting 12 different hospitals across 5 different USA
states.
○ Old and new hospitals were included
○ Research orientated and vice versa were included
○ Understaffed and not understaffed were included
○ Private and state funded were included
 ● The pseudo patients offered false names and jobs, but just about everything else about
their life e.g work, school life, relationships, etc., was true.
● They had no prior psychiatric problems
● The hospital had no clue about who the pseudo-patients were, except when Rosenhan
admitted himself (because he informed the Chief Psychologist of the hospital)

● Initially, the pseudopatients telephoned the hospital for an appointment, and when at the
admissions office, they complained that they had been hearing voice.
● The pseudopatients were instructed to describe the voice as "empty" or "hollow" - that
the voice was unclear to them, but it was the same sex as them

● They were then admitted to the psychiatric ward with a schizophrenia diagnosis in all but
one case
● Immediately after being admitted, all pseudopatients stopped simulating any symptoms
of abnormality
● Their objective was to get discharged with a diagnosis of "sane"

● The pseudopatients took part in ward activities, spoke to staff, write their observations
○ The note taking was initially done secretly, but given that no one gave a shit
about them note taking, it was done more openly

● The pseudopatients were also given medication for their illness which was not taken

● When asked by the ward staff how they were feeling, they said they were fine and no
longer experienced symptoms

● The pseudo patient's "normal" behaviour was often seen as part of their illness.
● Nursing records stated that "patient engages in writing behaviour"
● Nursing records also showed that their behaviour was seen as "fully cooperative" and
had no "abnormal indications"

Results
● No pseudopatients were detected
● They were discharged with a diagnosis of "schizophrenia in remission" without ANY
clear evidence of the disorder following the initial admitance
● The pseudopatients stayed in the hospital for an mean number of 19 days

● 35/118 patients expressed suspicion about the pseudopatients' sanity

● pseudopatients were given 2100 tablets. Only two were swallowed, the rest was flushed
down the toilet
 ● Nurses stayed in the ward offices for 90% of the time

● Time spent with pseudopatients by hospital staff was on average, under 7 minutes a day

Conclusion
● This study can be indicative of the DSM failing to account for sanity, with healthy patients
being diagnosed schizophrenic
● Medical professionals tend to err on the side of caution, potentially leading to
overdiagnosis and serious consequences for individuals.
● The diagnosis "schizophrenia in remission" is not indicative of the pseudo-patient
behaviour, and that if the person is to be discharged, that person is never believed to
have been "sane" and are stuck with the label of schizophrenia
● Evidence of abusive behaviour towards patient in full view of other patients

Study 2
Aim
● Investigate whether teh tendency to diagnose the sane as insane could be reversed
●
● Procedure
● Staff at a teaching hospital were informed that over the next 3 months, one or more
pseudopatients would make an attempt to gain admission to the hospital
●
● Each staff member had to rate each patient for diagnosis, or who had been admitted on
the likelihood that they were the pseudo patient
● Rosenhan did not send any pseudo patients to the hospital

Results
● 193 patients received judgments from staff who had sustained contact with them
○ 41 were judged with high confidence by one staff member
○ 23 were suspected by at least one psychiatrist
○ 19 were judged to be possible pseudopatients by at least 1 Psychiatrist and 1
member of staff

Conclusions
● Tendency to diagnose insane over sane could be reversed if there is something at stake,
such as reputation or status of the staff.
Strengths and weaknesses of Rosenhan (1973)
Strengths
● Detailed notes taken by the pseudo-patients gives strong validity to the data about
inpatient experiences, as they documented how they were treated, and felt how others
were treated
● Findings about the hospital have practical application as they would use it to improve the
care of patients in institutions
● Study has high ecological validity as the hospitals were in real life settings, so
represented how psychiatric care took place and experiences of real patients

Weakness
● Lacks generalisability as only USA hospitals were used so may not represent a hospital
in Kyrgyzstan
● UNETHICAL BECAUSE DOCTORS DID NOT KNOW THEY WERE TAKING PART IN
THE STUDY AND THEREFORE DID NOT HAVE A RIGHT TO WITHDRAW

Seymour Kety’s interesting take on the deception presented by the pseudopatients

Suzuki et al (2014)
Aim:
● To investigate the prevalence of underweight and obesity in Japanese inpatients with
schizophrenia
● To assess the nutritional status of Japanese inpatients with schizophrenia

Procedure
● Height and bodyweight were measured to calculate BMI
● Nutritional status was operationalised as total protein level, total cholestrol, triglyceride
level, and fasting plasma glucose levels
 ● These were measured using a blood sample taken after a >=9 hour fast

Several standards were given to assess nutritional status.

● An example of this is the fact that Hypoproteinemia was defined as having less than 6.7
grams per deciliter of protein in one's blood
● for weight, having a bmi of 18.5 to 25 kg/m^2 was defined as standard weight. Anything
above or below is either overweight or underweight

Sample
● 333 inpatients diagnosed with schizophrenia, all aged 16 to 80, were collected from 9
psychiatric hospitals in the niigata prefecture of Japan
● Matched pairs design used on age and sex, with a control group of 191 health
volunteers.
● All participants gave informed consent
● Patients with recent changes in drug therapy, treatments with drugs other than
benzodiazepines and mood stabiliers were excluded form the study
● BMI of inpatients and control group was compared

Results
● Schizophrenics had 14.1% underweight and control group had 4.2% underweight
○ More underweight in schizophrenic groups

Schizophrenics had 26.7% overweight and control group had 22.0% overweight
○ Roughly little difference between overweights in schizophrenic group and control
group

● Hypoproteinemia was 22.3% in schizophrenic group and 2.1% in control group

○ More hypoproteinemia in schizo group

Conclusion
● Nutritional status of japanese inpatients with schizo is poorer than that of the general
population
● No significant difference between schizos and control group with respect to obesity,
therefore health hazards are similar for both groups
● Underweight schizophrenic patients had the highest hospitalisation duration and were
reported to have a high correlation with risk of death
--
Strengths of Suzuki
● Study has high internal validity due to using objective measurements being done through
BMI and blood tests, so cant be influenced by researcher expectations.
 ● Operationalisation of nutritional status further objectified and made measurement more
empirically testable

● Ethical as informed consent was gained from all the patients 😊

● High generalisability as it took a large age range from 9 different mental hospitals

Weaknesses
● ETHNOCENTRIC IT ONLY INCLUDES JAPANESE PATIENTS SO MAY NOT BE
INDICATIVE OF OVERALL SCHIZOPHRENIC POPULATION WORLDWIDE
● Suzuki et al did not control the patient's eating behaviours which can affect the
participant's weight. This means confounding variables were present in the study, which
reduces the validity of the conclusions drawn

Hans and Hiller (2013)

Aim
● Investigate the effectiveness and drop out rates of individuals and group outpatient CBT
(group CBT sessions) for adults with unipolar depression

Procedure
● Meta analysis using 34 effectiveness studies from manual and electronic searches
● They only used studies of their target group of 18-65 years old and had a diagnosis of
major depressive disorder, minor depressive disorder or dysthymic disorder
● Their search criteria was operationalised using terms such as "non-randomised" to
gather their sources
● Any studies that had less than half the usual of 12 CBT sessions were excluded as they
were deemed unrepresentative of CBT
● Hans and Hiller were both trained in the coding protocol, Hans coded all studies and
Hiller coded 20% to provide inter-rater reliability which was assessed using Cohen's
kappa score

Results
● Hans and Hiller found statistically significant improvement outcomes for depressive
symptoms in those who completed CBT over those who dropped out.
● Individual dropout rate for CBT was 18.99 and 8.78 for Group. Almost 2.2x higher
dropout rate for individuals.

Conclusions
● meta-analysis suggests that routine CBT for outpatients is effective
 ○ Those who completed CBT reported a substantial reduction in depression at the
end
○ And there is evidence that this effectiveness is maintained for at least 6 months
after therapy completion

● Despite favourable outcomes, there is a high drop out rate with every fourth person who
begins CBT, dropping out
Strengths
● Inter-rater reliability on clinical representativeness of the studies was considered fair by
Hans and Hiller, as their cohen kappa value of .25 suggests. This increases the reliability
of the findings
● Data was fully operationalised as search terms like "non-randomised" were used and
any study with <12 CBT sessions was excluded. This increases validity of the findings

Weaknesses
● Some of the studies of CBT sampled in the meta-analysis may have been of poor quality
with poor methodology which reduces the credibility of their findings about the
effectiveness of CBT

● They used studies of CBT dating back to 1987 which means the data was time-locked
and not reflective of 2013. This means the effectiveness may not be a valid
representation of contemporary CBT practices

● File drawer effect. Hans and hiller did not control for this by looking at unpublished
studies so the findings may not be truly representative of the effectiveness

Im guessing this involves stuff like case studies, observations, correlations, etc. If you can find
my notes on them have at it lol

nvm it's on page 329-335 in the uk edexcel book u can go there

Randomised Control Trials (RCT)
● A sample of participants are chosen. Patients in clinical psychology.
○ They are randomly allocated to group A or group B, typically using matched pairs
design (i.e matching on age, gender, etc.)
○ RCT's contain a control group that is used for comparison. This control gorup
receives a placebo.
○ This control group helps attribute the difference to the effect of the treatment
confidently

● RCTs use allocation concealment so participants dont know if they are in the control
(placebo) group or experimental group

● Double blind methods are used (researcher and participants dont know who gets which
pill). This is done to prevent bias.

Strengths
● Prevents Bias in allocation of conditions. Increases valdiity
● High statistical power as since both groups are balanced and matched to ensure similar
sex, gender, social class, ethnicity, etc.
● Blinding people about which group they're in can reduce demand characteristics and
prevent researcher effect

Weaknesses
● Unethical due to blinding
● Unethical because it could potentially deny a participant normal traetment.
● RCTs are longitudinal in nature meaning some of the participants may drop out.
Threatens the statistical power of the experiment and validity.
● Requires large sample size to show a concrete difference
(Neuroimaging notes omitted. They can be found in my unit 2 notes)
(Link here:
https://docs.google.com/document/d/1h3lFQ0A1vTwasqF3YqUcPyunhNLtGqtFfZ7V0mPYlyQ/e
dit?usp=sharing)

Conventions of published psychological research

Must contain:
● Abstract: Concise summary of a research paper or entire thesis
● Introduction: Explains the paper's main topic and prepares the reader for the rest of the
paper
● Aim: A broad statement indicating the general purpose of your research project
● Hypotheses: Prediction about experiment
● Methods: How experiment was performed e.g What was manipulated and what was
measured
● Results: What you obtained (typically numerically) from the experiment
Peer Review
● Research Paper is completed
 ● Paper submitted to a journal
● Peer review involves critiquing scientific errors, design, methodology
○ they review originality (i,e if it advances the field)
○ they assess the significance of the finding (if they are important)
○ they identify missing or inaccurate references
○ If all goes well it will get published
● Single blind peer review involves the reviewers knowing who the author is
● Double blind involves neither knowing who each other is
● Open peer review involves everyone knowing who they are

Health and Care Professions Council guidelines for Clinical Practitioners

● Overseeing body ensuring all clinicians are meeting the required standards of practice
● Contains 15 standards of proficiency to ensure safe and effective practice

A few examples that I recommend learning include:

● Practice with the legal and ethical boundaries of the profession
● Practicing in a non-discriminatory manner
● Practicing in an autonomous way and using professional judgment
● Ensuring confidentiality of any client that has worked with you

To register with the HCPC you have to:

● Show you have credible, good character that makes you suitable for the role.
● Ensure your health does not affect your practice. You must provide health info every 2
years to ensure you are able to continue healthily
● Are able to practice ethically

Evaluation of research in developmental psychology: Reliability, Validity, Generalisability,

Credibility, Objectivity, Subjectivity, Ethics and Practical application
(Notes omitted. Part of my developmental psych notes)
(link here:
https://docs.google.com/document/d/1lgyVbJaY4rDF2ecY8GEbq5MbZEMxF0gO5ZLNI2vZ3E4/
edit?usp=sharing)

Practical for Clinical Psych

Aim
● To investigate how different contemporary media sources report mental health issues by
performing content analysis.

Procedure
● Content analysis
● 4 different sources of primary data were collected from news articles and medical
journals online. Each article numbered to around 400 words.
● Coding categories were created to quantify the perception of mental health and tallied
based on "negativity" and "positivity"
● Words such as “danger”, “danger to others”, “self-care”, “medical condition” and
“destigmatize” were selected as words to be tallied
● Each class member would then code the articles one by one. Once successful, the
coding categories would be compared amongst each other, assessing the inter-coder
reliability.
● A kappa value of 0.41 and above (Moderate reliability) was accepted. If it was lower, the
article would be re-evaluated using two different coders.
● Once the coding and reliability checks were conducted, it was discovered that there was
an imbalance towards portrayal of mental health.

Results
● Results indicated there was a more positive attitude towards mental health in
contemporary media sources, with an average of 10 more positive words to describe
mental health relative to negative words
●
● A kappa value of 0.643 was obtained when calculating inter-rater reliability, which was
indicative of substantial agreement amongst coders.
●
● The term "destigmatise" was observed very frequently in positive tallies amongst coders

Conclusion
 ● The data suggests that mental health is painted in a positive light when viewing
contemporary media sources, likely due to the increased awareness efforts generated
around mental health.
● Frequency of terms like "destimgatise" also indicate that there is an active effort to
destigmatise any stereotype or stigma against mental health

Strengths
● Ecological Validity: Focusing directly on sources from news articles and medical journals
ensures the study is grounded in real reports about mental health, enhancing the validity
of the findings.

● Inter-coder reliability as coders would perform inter-coder reliaiblity checks which was
assessed via cohen's kappa value

Weaknesses
● Subjectivity. Each coder is inevitably going to be subjective which can decrease the
validity of our findings and decisions on which word fits into which category

● It took a lot of time to categorise the data in the sources, so a content analysis of this
nature is suitable for a small number of articles and sources