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psychology 2 - Coggle Diagram

- - - - A03
        
        strengths
        
        Feng (2007) bred mice with a specific gene missing which is expressed in the parts of brain associated with planning and initiation of action. They displayed excessive grooming and anxious behaviour.
        
        LOW gen extrapolrisation of animals to humans. HOWEVER share 70% the same amount of brain matter
        
        now we have MRI and PET scans we can now see into a person's brain with OCD and understand that a person's brain with OCD has an overactive thalamus – we can see the activity of a persons brain when they are doing tasks – scientific status
        
        As OCD runs in families it could be due to genes that the brain functions differently. Therefore, this is proof that the biological explanation is reliable due to it is inheritable.
        
        Determinism: reduces the blame from the individuals -> sense of relief & early intervention
        
        The use of anti-depressants to raise serotonin levels have been successful in treatment of OCD therefore if biology can remove the symptoms, it can be deduced that biology caused the symptoms – OCD can therefore be seen as being caused by biology due to it being treated by serotonin
        
        Somoro et al (2007) found that anti-depressants were more effective for suffers of OCD than placebo
        
        weaknesses
        
        Kireev et al (2012): found other areas of the brain took over the functions of the anterior cingulate cortex
        
        The cognitive explanation says OCD is caused by self-doubt, the need for perfection and feelings of responsibility. Therefore, they are more than one reason for actions like the need to clean obsessively.
        
        only considers the nature argument – believe that the cause of OCD is brain structure not considering that it may be learnt through from family members
        
        however it's been proven that SLT is not a likely cause of OCD by children suffers having different symptoms to their parents therefore the nurture argument could not be relevant
        
        Determinism: the fact that behaviour is caused by something innate which removed free will. -> if you have this brain structure, you're going to get OCD and act a certain way -> removes blame and acts in a way your meant to
        
        It takes up to 12 weeks for the ant-depressants to work, when they raise serotonin levels immediately suggesting its not just biological causes of OCD because it would have improved immediately meaning its more behavioural -> 12 weeks to change behaviour
      - A01 (8 marks)
        
        Thalamus:
        
        over active - triggers complusions ->engage behaviour
        
        normal -> contains primitive checking and cleaning behaviours
        
        controls artless and consciousness, how we act and respond
        
        Caudate Nucleus
        
        over active: does not inhibit action
        
        Normal: inhibit the action of the globus palidus fibres
        
        Orbitofrontal cortex (OFC)
        
        Alerts the brain to potential worries in enviroment. Decoding and representing some primary reinforcements e.g. taste and touch
        
        Putmen
        
        crucial for regulating movement learning and rewarding processing
        
        Very complex feedback loop - prepares and aids in movement
        
        Caudate Nucleus Tail:
        
        role in both motor control and learning and reward processing as well as decision making
        
        has a termination (stops thoughts) issue in the angle & it doesnt finish -> link back in
        
        Cingulate cortex
        
        Crucical for linking emotional response to behaviour, plays a role in decision making, error in dection & reward & punihsment and how we adjust afterwards
        
        Globus pallidus fibres
        
        Act as braking mechanims, controlling activity in thalamus, to do with the planning & execution of movement
        
        Allows us to forget the way it was before but remeber the passive reinforcement
        
        Neuroanatomical ex: there is a abnormality in the central nervous system of people who have OCD
        
        suffers have a fault neuro-circuity that links orbitofrontal cortex to the thalamus
        
        over active & doesnt have an ending
        
        Caudate nucleus inhibit sthe action of neurones that depen the activity if the thalamus - brake for thalamic activity
        
        in OCD the caudate is overactive -> over active thalamus -> reaction in OFC -> increase stimuluation & cause a loop hyperactivity ( reapative thought)
        
        Over activitie Hypothalamus - jard wired to produce primitive cleaning amd checking behaviours
        
        Over activite OFC -> artness, anxiety and checking behaviour
    - - Intrustive thought
        
        obession
        
        relief
        
        complusion
        
        negative reinforcement
        
        anixtey lowered
        
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      - Features
        
        2 most common types germs and hording
        
        high % of OCD in china and Saudi Arabia
        
        1.2% of the Uk population suffer
        
        76-80% have anxiety
        
        13.5-27% attempt sucide
      - symptoms
        
        behavioural
        
        containmination: fear that things are contaminated and may cause illness to an individual or family member
        
        Hoarding: finds it impossible to throw things away, feel as if they need the object due to emotional attachment or because it prevents harm
        
        emotional
        
        anxiety:a feeling of unease and worry usualy characteristed by a peek in adreanaline and increased heart rate
        
        Ruminations: thinking for a long time unproductively (dwelling) going over intrustive thoughts
        
        cognitive
        
        self doubt: Salkovksi & forresler (2002) self doubt leads to repetitive actions -> exaplaining actions
        
        need for perfection: have a rigid defifition of sucess that they are constantly striving for
      - OCD: an anxiety disorder where people experience unwanted repative thoughts or images or urges that causes signifcant distress leading to repetive behaviours or mental acts to relieve anxiety
        
        Obession: recurring, instrustive and unwanted thoughts or images or urges that causes significant anxitey
        
        Complusions: a repetitive intentional behaviour or mental act preformed to neutralise anxiety or distress caused by a obession or prevent a dreaded end
    - - A01
        
        Faulty information processing
        
        perceptions or thoughts we have about our experiences will trigger an emotional response -> trigger behaviour to deal with behaviour
        
        bias attention where an individuals are overly focused on threat and irrelevant information and difficulty inhibiting responses
        
        early childhood experiences
        
        could cause general negative belief systems about how the world works -> intrustive thoughts (obessions) which are misinterpreted and made important causing anxiety to deal with anxiety person adopts counter productive behaviours (complusions) that give them temporary relid -> reinforcing the faulty thought pattern unless broken it becomes self prepetuating
        
        Traumatic event leads to those with OCD to find their obessions and latch onto these events
        
        Over protective parents, parents controlling the interfering rearing attudies is linked to the development of OCD
        
        Lack of confidence
        
        Inflated responsibility: cognitive bias where you belive you are personally reponsible for you causing or failing to prevent harm
        
        Lack of confidence in memeory can explain checking behaviours, they do not trust in their recall and feel compelled to check
        
        Woods et al (2002) did a meta analysis of studies aimed to test how memory related to checking and found that thoses suffering from OCD had a slightly worse memory for recall and felt theyre memory was inadequate compared to control
        
        hypervigilance
        
        people with OCD may be hypervigilance (williams et al 1997) meaning they are constantly stanning for threats in the enviroment and have a attentional bias towards potential threats forming the basis for obessesion
        
        Detection of treats then triggers high anxitey -> complusive behaviour -> reduce anxiety
        
        rahan (2004) case study of somesone with OCD centered on blood could recall all their past experinces with blood - hypervigilance
        
        hypervigilance - physical illness,difficulty sleeping,eating too much/not enough, being contanst fight or flight
      - A03
        
        strengths
        
        practical application (CBT) - high face validy
        
        Salkovski & Kirk (1997) diary of people with OCD told deliberately supress the obessive thoughts but others were allowed to rain free frequently of instrusive thoughts -> higher on days they tried to supress them
        
        self report data
        
        Van Balkom et al (1996) just as effective as drug treatment
        
        Peaditrics OCD treatment study (POTS) CBT is a better treatment for OCD than drug therapy
        
        weaknesses
        
        Puts blame on individual and parents - lack determisn
        
        other ex: biological
        
        does consider the role of individual differences in why young people overcome child hood experinces
        
        no evidence that faulty congtivite actually leads to symptoms
        
        Hypervigliance towards threat (should be)
    - - drugs: anti depressants & anti anxiety
        
        A01
        
        SSRI’s: Fluoxetine (Prozac), Paroxetine (Paxil) & Zoloft (Sertraline)
        
        treats both the primary symptoms of OCD and the secondary co-morbid depression
        
        Blocks the transporters increasing the stimulation of the postsynaptic neuron
        
        Reduces reuptake of serotonin into the presynaptic neuron, increasing the amount of serotonin in the synapse
        
        Tricyclics (TCAs): Works the same as above for serotonin but also increases the amount of noradrenaline in the synapse
        
        Benzodiazepines: Valium & Librium
        
        Increase the activity of GABA, quietening many neurons in the brain
        
        GABA reacts with GABA receptors on postsynaptic neurons, inhibiting the neuron to be stimulated by other neurons
        
        This enables the individual to feel more relaxed
        
        D-cycloserine
        
        Originally used to treat tuberculosis, used now as a sedative for OCD suffers
        
        Can lead to new patterns of learning due to the control and lack of stimulation it enables
        
        A03
        
        Effective
        
        Soomro et al 2007 Comparing SSRI anti depressant drug with placebo,drugs were more effective than the placebo reducing the symptoms of OCD.
        
        slow
        
        SSRIS: takes up to 12 weeks for the ant-depressants to work
        
        Koran et al 2002 found that antidepressant medication had long term effects compared to the placebo and was better at preventing relapse over an 80 week trial.
        
        side effects
        
        nausea and headaches, anxiety, leading to self-harm and increased risk of suicide -> monitoring of the person is required
        
        Ethical
        
        publican bias where the results of drug trials are more likely to be published if they are positive
        
        Goldacre (2013) found that drug companies selectively publish positive outcomes for drugs their sponsors are selling which is deceiving.
        
        Types of people
        
        co-morbid disorders are much more likely to be offered the drug
        
        Directive
        
        psychiatrist decides the type of medication (e.g. SSRIs), dosage and any changes. The patient has little control and mainly follows medical instructions
        
        relapse rates
        
        Koran et al (2002) and Romano et al (2001) showed 17.5% and 21% relapse rates respectively when a drug was continued and 38% and 59% respectively in their placebo groups.
        
        stopping the drugs later on carries a very high risk of relapse
      - CBT: exposure and response
        
        A03
        
        effective
        
        therapy has been promoted as the first choice by NICE as it has been effective at reducing symptoms and can be applied flexibly. Improvement in 50% of cases but the effectiveness is increased when combined with drugs.
        
        ERPT would not be effective for those without compulsions.
        
        POTS 2004 found CBT is more effective CBT compared to the other, however it was proposed that this was due to the therapist effect.
        
        slow
        
        13-20 sessions and follow up
        
        Some people cannot cope with the effort and distress involved
        
        Success depends on the client (individual differences)
        
        May beyond the clients will power -> CBT being unable to help without drugs like SSRIs
        
        ethical
        
        high ethics as it allows the person to take control of their own treatment
        
        However it could lead to discomfort due to having to face and be exposed to their anxieties and consciously try to resist their obsessions
        
        types of people
        
        Not effective for people that do not have compulsions, which actually equates to 44% of OCD
        
        only work for individuals who are motivated to change. It requires a lot of personal input, time and attention.
        
        relpase rates
        
        50% - 60% of patients who complete ERP treatment show clinically significant improvement in OCD symptoms and treatment gains have shown to be maintained long term
        
        Direct
        
        directive because the therapist leads the process, setting structured tasks such as exposure and response prevention (ERP). They challenge the patient’s thoughts and behaviours, guiding them step by step while the patient actively follows instructions
        
        A01
        
        Obsessions are negatively reinforced by avoidance
        
        Compulsive rituals are associated with anxiety
        
        EXPOSURE
        
        Individual is presented with the fear until anxiety reduces
        
        The fear is presented in a hierarchy from least to most threatening
        
        Relaxation techniques are taught to use outside of therapy
        
        RESPONSE PREVENTION (RP)
        
        The client is taught that the obsessions that previously created anxiety no longer produce this response
        
        They are prevented from engaging in the compulsive responses
        
        Lists/rules are often given i.e. only vacuum for half an hour each day
        
        New routines are provided to restrict the compulsive behaviours
        
        client usually engages in 13-20 sessions with monthly follow ups
  - - - symptoms
        
        For the diagnosis of Sz an individual must have 2 or more key symptoms for a high propotion of last month
        
        Negative symptoms
        
        Symptoms that subtract from normal behaviours
        
        catatonia stupor: standing motionless
        
        social withdrawal
        
        avolition - lack of motivation
        
        Flat emotions: no emotional response can be elicated from any stimulus
        
        Inappropriate affect: silliness and laughter which are out of context
        
        Apathy: loss of interest in normal goals
        
        loss of drive: feeling drained of energy and unable to initiate or complete a course of action
        
        grossly disorganised behaviour: difficulty in goal organised behaviours
        
        possitive symptoms
        
        Symptoms that add to the experience
        
        disorganised thinking: finds it hard to think in a ordered and logical way
        
        delusions (false belief)
        
        persecution: believe people are plotting against them, spied on, they are being talked about or victimised
        
        grandeur: belief they are someone grand or famous
        
        disorganised behaviour: severe distrupton in the ability to perform daily living tasks
        
        Hallucinations (things that are not present)
        
        auditory hallucinations: a person hearing something that isn’t actually there
        
        visual hallucination: when a person sees something that isn’t actually there.
        
        disorganised speech: inappropriate speech e.g. 'dog, pizza, red'
        
        Echolalia: repetitive echoing of word spoken by other or the accentuated imitation of the mannerisms of people
        
        thought insertion: someone thinks their thoughts are put there by someone else
        
        Excessive motor activity: moving in odd and distrubing ways that are 'purposeless' and not influenced by an external stimuli
        
        e.g. speech issues
      - features
        
        Prevalence and onset
        
        likelihood of an individual developing schizophrenia 0.3-0.7%
        
        Males have a higher proportion of negative symptoms and longer duration of the disorder than females – showing gender differences
        
        onset of the disorder is between late adolescence and mid thirties
        
        peak being mid-twenties for males and late twenties for females.
        
        affects 1% of population more common in lower econmic groups
        
        A 15% remain chronically ill, requiring regular treatment and intervention.
        
        Cognitive functioning deficits can take place impacting the working memory, language functioning and speed of information processing.
        
        Mood abnormalities are common e.g. inappropriate mood displays
        
        25% completely recover
        
        10% die most likley suicide
      - neurotransmitter explantaion
        
        genetic explaination
        
        A01
        
        ev of genetic compentant
        
        1% risk in general population
        
        2-6% risk if you have a second degree relative with sz
        
        6-17% risk if you have a first-degree relative
        
        48% concordance rate in identical (mz) twins
        
        Sz runs in families - more closely related you are -> higher risk.
        
        genetic make up from both parents 50%, if one parent suffers -> 50% chance of being passed on
        
        both are carriers 25%
        
        specific genes involved
        
        COMT gene
        
        affects domapine regulation in the brain
        
        DISC1 gene
        
        invloved in brain development and synaptic functioning and mutations are associated with increased risk
        
        NRG1 gene
        
        affects brain cell communication; variants are links to sz
        
        stress diathesis model
        
        genetic risk may be triggered by enviromental factors e.g. stress
        
        genes create vulnerability enviroment can activate it
        
        not everyone with 'risk genes' develops sz
        
        Human genome
        
        23,000 sets of genes each have a specifc set of instrcutions that bulid up our unique being
        
        twin studies
        
        compare the variance between mz (100%) and dz (50%) twins. aruged that if one mz twin has a disorder than the other will suffer.
        
        show that concordance for sz is 4* as high in Mz compared to DZ
        
        adoption studies
        
        compare biological and adoptive parents to their childern
        
        disorder is down to genetics, it can be expected that biological parent will share disorder with their childern they have not raised
        
        risk is 1% to 10%
        
        weaknesses
        
        research has failed to isolate a single gene (recssive or dominant) Tamminga Schulz (1991)
        
        concordance isnt 100% - carsten pedersen & peneben mortensens (2006) city -> sz rural areas -> no sz
        
        other ex: social causation, dopamine hypothesis
        
        Ezra susser and collegues (1992): early prenatal nutriton can increase risk of sz
        
        twin/ adpotion studies often have small samples
        
        determinstic
        
        reduces the likelihood that behavioural treatment can assist suffer
        
        strengths
        
        Harrison & Owen (2003) found risk is about 10* higher if a close family member has sz
        
        Gottesmen (1991) concordance rate show risk increases with genetic relatedness
        
        Mz - 48% Dz - 17%
        
        not 100% concordate rate -> must be both nature and nurture and mz are more likely to be treated similarly
        
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        Tienari et al (2000) childern adopted away from sz biological mothers still had a much higher rate of sz
        
        7% adoptee with sz biological mother compared to 2% who go to mother without sz
        
        Twin/adoption studies -> no maniuplation of variables & natural experiment -> high mundane realism
        
        genetic couselling if diagnosed with sz - recurrence risk can be calculated and counsellor in place to aid family
        
        micheal and egan et al link between decrease in dopamine activity in perfrontal cortex and 1 form of COMT gene and 2 copies -> sz
        
        Tarik Danhoun et al (2017) DISC1 is associated with the presynaptic dopmaine dysregulation -> sz
        
        Harrison and owen (2003) 6 different types of genes invloved in the development of sz
        
        reduces blame
        
        social causation hypothesis
        
        treatment
        
        Drug therapy
        
        weaknesses
        
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        Cognitive Behavioural Therapy (CBT)
        
        CBT is based on both cognitive elements as well as learning theories
        
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        adresses thinking and behaviour involved in sz
        
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        can be done one to one weekly over a number of weeks. or group therapy, self help books, online, family therapy, structured activities
        
        Paitent therapist relationship is important and focus on therapist being non theratening and supporting.
        
        Maladaptive thinking (thinking that is not helpful or suitable) comes from schemas and general beliefs about the world oneself and the future
        
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        weaknesses
        
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        negative symptoms: difficulty concentrating, avolition, problems with working memory, difficulty in executive function
        
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        motivational interviewing: identifes persons goals or values and seeks to help them to change, finds out how they can change
        
        Psychoeduction: learn about your illness, recognise triggers & relapse & what relapse looks like -reduces blame
        
        skills training: learn to self mange and how to find support, social skills and life skills
        
        therapist challenge delusions by asking for evdience against the devlusion
        
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        try to get paitent to relaise when they are halluncinating - by filtering through and paying attention 'its just a voice'
        
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        Dickerson (2000) - treatment that allivates symptoms is useful as 60% of sz are unable to live normally due to their symptoms
        
        belief modification: challenging the delusional thinking directly and testing against reality
        
        normalising: de-stimatising the psychotic experience - using relaxation techniques and activity planning
        
        focusing and reattribution: reduces the distress of hallunictions -focuses on the characteristics of voices, patient records what they say
        
        strengths
        
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        enviromental factors affect your chance of having sz
        
        growing up in urban enviroment
        
        cannabis usage
        
        stress
        
        malnutrition
        
        since the 1950s higher rate of sz has been seen in lower classes
        
        social class
        
        lower social groups have higher incidences of sz -> social class may cause sz
        
        4 in 1000 has been found in
        
        white lower class
        
        black immigrant in lower class
        
        sz has been found more in lower classes amoung the unemployed and deprived areas.
        
        people tend to experince a different course for illness and different medical care
        
        social class can impact stress levels instead of causing sz
        
        lower social class paitents tend to be brought into medical care by police or social service to become complusorily admitted and to become longer term cases
        
        misdiagnosis (positive screw) - for individuals regularly come into contact with authority -> long term cases
        
        social adversity: exposure to hardship as a result of social circumstances
        
        Eaton (2000): living in cities rather than rural areas increases chance of sz
        
        cities -> drug use, crowded no medical care
        
        Hjem et al 2004: social adveristy in child hood relates to development of sz later in life. pressures in childhood and adolence link to being in a lower social class and sz
        
        cooper(2005) single men in unskilled manual labour jobs (lower class) were 4.1* more likely to develop sz than men in managerial roles (upper class)
        
        social class -> risk factor but outdated
        
        white people in lower social groups do not show increased risk of having mental disorders like black immgrants (more than social standings)
        
        tendency for sz come from whata happened to somsone in their childhood and early child hood - to do with childern living in conditions rather than social adversity
        
        factors that affect development of sz
        
        adversity in adult life
        
        unemployment and poverty
        
        drugs -> dopamine hypothesis
        
        social isolation
        
        could all lead to change in brain during child hood
        
        delusions hearing voices
        
        inner city housing and over crowding
        
        seperation from parents as child
        
        social care
        
        Immigrants
        
        high incidence of sz in afro caribbean and black immigrant population 4* more likely
        
        afro caribbean people sz more likely to experience unemployment,living in poor inner city areas and in worse situations than other same ethnic back grounds
        
        social drift theory people with severe mental health problems tend to ‘drift’ down the social hierarchy into lower social classes over time
        
        cooper 2005 - rate for sz in second-gen african caribbean people is higher than first gen (suggests enviromental effect)
        
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        immigrant population are more likely to be at a disadvantage in educational attiment social class, standard of housing, discrimination,over crowding
        
        Brown (2010): Veiling et al (2008) carried out a study where if immigrant resided in areas where their ethnic groups did not predominate there was a higher rate if psychotic disorders compared to areas where it did
        
        social factors can affect devlopment of sz discrimination can -> increase risk
        
        strengths
        
        explains using the nature & nurture approach (considering the adversirty people face) - suggests triggers for sz
        
        studies show that they are many social factors (reliable even cross cultrally)
        
        mortensen - living in urban areas and birth -> increase risk
        
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        can be seen as a holstic perspective
        
        Eaton found through meta-analysis of 17 studies that the rate of Sz is much higher in lower class areas than upper class areas, supporting social causation.
        
        weaknesses
        
        may be an issue with the diagnosis with sz rather than the enviroment
        
        ICD & DSM - different ways of diagnosing,paitent may forget, different disorder, cormorbidy (unreliable)
        
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        social drift may be better ex
        
        social drift = mental illness -> low social econmic background
        
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        Other ex: genetic, neurotransmitter - doesnt account for all factors
        
        doesnt account for individual differences
        
        cause and effect: wheather social adversity leads to sz or if sz leads to social adversity
        
        neurotransmitters
        
        neurotransmitters
        
        synaptic cleft
        
        Post synaptic cleft
        
        terminal button
        
        axon
        
        vessicles
        
        presynaptic cleft
        
        presynaptic neurone
        
        post synaptic neurone
        
        synaptic transmission
        
        action potential get sent through axon hillock towards the terminal button where the vesicles are located which are filled with neurotransmitters
        
        message reaches the axon - calcium channels open and release calcium ions
        
        calcium ions trigger the release of vesicles
        
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        Dopamine hypothesis
        
        hyperdopaminergic: sz symptoms linked to high levels of dopamine
        
        what causes the increase is unclear
        
        low levels of hydroxtylase (breaks down dopamine) -> build up
        
        Prolideral of D2 dopamine receptors on post synaptic cells
        
        paitents who abuse amphetamine (create dopamine) -> possitive symptoms
        
        Randrupand Manukvad (1966): injected rats with ampetamines -> agression and isolation, dopamine impact psychotic symptoms
        
        hypodopaminergic
        
        Kenneth Davis et al (1991) suggested that possitive symptoms of sz (delusions and halluctions) are due to excess of dopminergic acticity in the mesolimic pathway where as negative symtoms (low mood) result from hypodopaniengia -> lack of dopamine in mesocortial pathway
        
        Dopamine dysregulation
        
        oliver howes and shitij kapuf (2009) - dopamine dysfunction in the striatum -> psychosis.
        
        Attention should be to high presynaptic dopamine levels
        
        interactions between genetics, enviroment, and socio-cultrual factors
        
        D2 hypersensity: more likely to overreact in presence of dopamine
        
        Owen et al (1978) - post mortem of sz show higher D2 receptors
        
        Seeman (2013) - sz have higher number of D2 receptors - higher affinity to dopamine -more dopamine absorbed by post synaptic cleft
        
        different ways the brain receptors react to dopamine - liberman et al (1987) 78% of schizophenia paitents take ampetamines show new symptoms/ increase psychosis however only a small protion who regularly use suffer these symtoms
        
        Dopamine: feel good hormone in charge of making you feel happy, satified and motivated
        
        Glutamine: controls the amount of dopamine released by the brain and lowers levels of dopamine
        
        reduction in glutamine -> increase in the amount of dopamine released
        
        serotonin: regulates sleep, mood, apptite and digestion
        
        increase-> possitive and negative symptoms
        
        GABBA: calming neurotrasmitter, helps regulate anxiety mood control and sleep
        
        reduction-> anxiety,mood disorders, seizured
        
        strengths of dopamine hypothesis
        
        Traditional antipsychotic drugs (block dopamine receptors) work
        
        often co-occurs with depression and substance abuse with 50% of sz paitents at a risk of substance misuse - accounted for by changes in concentrations of dopamine in different areas across the brain
        
        revisied hypothesis suggests that neurotransmitter can explain negative symptoms of sz ( depression) which other ex cant - reduction in mesocortical pathway -> flattened effect
        
        Parkinsons is associated with low levels of dopamine - perscribed L dopa (dopamine agonist) however can suffer possitive symptoms due to a high dose
        
        Atypical neuroplepitic block dopamine and serotnin - effective have fewer side effect, can increase dopamine
        
        weaknesses of dopamine hypothesis
        
        brain scans can only be taken once sz is comfriemed so its difficult to prove cause and effect wheather its dopamine sensivity -> sz or sz -> brain chemistry to change
        
        reductionist: explains a complex disorder but ignores biological psychological and social factors. Birley and brown (1968) 50% of paitents suffer from traumatic event 3 weeks before relapse suggest that social conditions can impact onset of sz
        
        dopamine antagonist can cause up-regulation (brain produces more of something in response to its decrease)
        
        dopamine receptors increase which can increase the dopamine in the body, those who take antipsychotics for a long period of time have elevated levels of dopamine which are not found in those who do not take medication
        
        Alpert and Friedhoff (1980) - paitents show no improvement from taking dopamine antagonist (prevent dopamine being abosrbed)
        
        Ethics: cannot provide informed consent to treatment, may not understand implications, however may treat sz - better quality of life
  - - - amoung psychologist theres a disagreement between the causes of abnormal behaviour and the approach taken impacts the disganose given as well as how to treat it
    - - Dysfunction
        
        when behaviour significantly impacts individuals life, distrubances could be present in areas that are not immediately obvious - how it effects their every day life
        
        Examples: not attending work due to feeling lethargy, wearing the same clothes all day and all night, withdrawing from family events
        
        Dysfunction must be significant enough to intefere with the individuals life in a major way
        
        reliability - symptoms can be interperted in different ways (vidoe gaming and queen victorias mourning) -> shopping around for a psychologist who will diagnose you
        
        however major depressive disorders do interfer with your social life and occupation
        
        many life events are dysfunctional: e.g. funeral, accident, family members who are unwell -> dysfunction -> disorder
      - danger
        
        An assessment is done to see whether an individual is a danger to themsleves and/or others - if so intervention is nesscary
        
        Example: feeling exterme anger -> violence. Nitcotine dependence - you know its harming you yet you still take it
        
        Generlisable - smoking,alcholics, drug use
        
        Cause and effect - is it the disorder or behaviour
        
        For example: hallications - danger or dangerous
        
        is danger due to the actual disorder or due to associated behaviours
      - Deviance
        
        extend to which behaviour is rare in society and deviates from the norm - can change across culture and time depending on the disorder
        
        Can be primarily understood formal classication scheme e.g.DSM and clinlic interviews
        
        Pedophilia - is an example of divant behaviour
        
        3-9% male report same intrest in underage childern - relibale however social desirbaility wonr admit - can vary between cultures
        
        Co-morbidty: multiple disorders clash,due to one thing and not another
      - distress
        
        the extent to which a behaviour is causing upset to the individual. isolated feature of the disorder, may be distressed with current situation but operate well in day-day. may not be distressed when should - related to dysunction
        
        Examples: hallunications, withdrawing from family events, feeling unworthy, wearing same clothes all day and all night, no feeling regarding when dishes have pilled up
        
        Hypochondriasis - consist of a preoccupation of fear having or the idea that one has a serious disease
        
        Salkousk, Warwick, Daele - found an individual can be distressed without having a disorder
        
        difficult to measure a person may be able to function but not show disrress
        
        Can measure function but not distress, low mood/ bad self esteem but doesn't effect day to day life - doesnt effect them enough to be a disorder
      - A03
        
        subjectivity: interpetation of behaviour are subjective. clinicians must consider how the paitent is coping with their behaviour -> people shopping around for psychiatrist who will support their beliefs about the disorder
        
        Reliability: Spitzer and Fleiss (1974)claimed reliability is not high - forgetting lying effects reliability
        
        Reliability: the clinicans must ensure to explore each dismension of behaviour the same way with every client. ensures every paitent is assessed in a standard way. measured using a statistical frequency (Distribution curve)
        
        Measuring deviance: a issue with the concept of deviance - some symtpoms are not rare e.g. depression due to that is important to weight up all deminsions of behaviours to make decisions
        
        behavioural changes: time in history, age, culture, situation
  - - - they have an idiographic approach they focus in detail on a topic and on the individuals around them
      - case studies use other research methods e.g. interviews to gather information about the case they are studying.
      - they often gather qualitative data
      - they use triangulation which takes multiple pieces of infromation and draws them together to make an overall conclusion
      - A01 case studies
    - - strengths
        
        case studies tend to use more than one way of collecting data, triangulation can be used to test both reliability and validy and shows the credbility of findings
        
        look at rare situations and individuals where samples of such individuals are difficult to find. data cannot be collected in a more general way - case study is a way of collecting alot data about rare individuals
        
        indepth detail about an individual or small group - rich to draw conclusions from. allows depth, and variety in detail.
      - weaknesses
        
        focuses on one individual or small group - generlising the findings is not possible. sample is not representative
        
        case studies is often carried out by researcher and their team who will get to know the small group or individual -> bias
    - - A01
        
        Aim: to investigate how people from the group form firm ego boundaries, wheather those with psychosis have weak ego boundaries
        
        ego boundarie: a sense or awareness that there is a distinction between the real and unreal
        
        Procedure: 'thursday group' with 6 paitents, all with fragile ego boundaries (sz), the study part took of 45 minute sessions, after the sessions group leader noted down key points about behaviour, expression, participation, emotion and comments
        
        Conclusion: each member showed that they suffered from weak ego boundaries, the group seemed to help strength their ego boundaries
      - A03
        
        G: 6 ppts all suffered from weak ego boundaries - not gen
        
        R: gathers qualititative data after the session, not replicable - each time the session was done data was collected differently
        
        V: Qualitive data - detailed about ppts
        
        V: Internal validy - notes taken after group and therefore are subject to the memory of group leaders (which were disorted due to sz)
        
        V: Population Validy - very unqiie individuals all with different experinces and severity of sz cannot be applied to another population
  - - - structured interview: can be in the form of questionaires, questions remain the same for all respondents each person is asked in the same format
      - Semi-structured interview: set question but there is some freedom for the interviewer to explore issues in order to extend answers
      - unstrcutured: interviewer is free to explore areas without any set questions (still has an schedule and area to cover)
      - Used to find out personal data required for the study
      - will use some standardised instrcutions at the start of the interview so respondant is aware of ethical issues, will be told purpose
      - A03: interview
        
        weaknesses
        
        Interviewer may affect finding because of they way they ask the questions or the way they are dressed -intervewer bias
        
        subjective - when anaylising data researcher may let their own personal experince or judgements affect their anaylsis
        
        strengths
        
        Unstructed: useful for obtaining qualitive data- issues and ideas can be explored - depth and detail
        
        more vaild than questionaire as interviewee can responds using their own words
    - - A03
        
        strengths
        
        Reliable: second rater repeated anayliss of interviews and had a 60% average level of agreement
        
        Reliable: two questionaires were standardised and statistical testing was used to look at differences between their pre-test scores and their post-test scores
        
        questionaires and semi-structured interviews gave qualitative data - strong conclusions both types of data support
        
        weaknesses
        
        using one group session is not enough to show change for offenders - cannot show long term effect
        
        may have been bias - medication change controlled by pharmacist not by paitent
        
        All male, all schizopheric/delousional - specific not generlisable
      - A01
        
        Aim: investiagte the usefulness of psycho educational material provided via group work for offender paitents in high security psychiatric hospitals
        
        Procedure:42 male paitents detained under the mental health act - they had sz or delusional disorders. Over 4 20 min sessions run over 3 years consisting of 9 paitents.
        
        self concept questionaire (SCQ) 30 item questionaire that measures self esteem. high reliability and validy
        
        semi structured interviews was conducted with lead researcher to evulate PP experience if the group,how it could be improved and what they had felt they had gained.
        
        CORE-OM (clinical outcomes in routine evaluation - outcome measures) assess subject well being, problems/symptoms, social life functioning and risk to others. Low score -> less issues
        
        findings: changes occured across all 4 scales of CORE-OM only 1 ppt showed reliable change. SCQ 50% showed improve in self esteem however some did have a negative impact on their selfesteem.
        
        conclusion: absence of reliable changes werrants attention as does futher consideration of negative change. Qualitive analysis showed paitents did value the sense of hope and empowerment provided
  - - - assumed that the hospital staff were competent, the individual behaved as they normally did, no suggestion they had any previous mental health problem.
    - - setting: 12 hospitals located in 5 different states in the USA and varied in character (old, new, good/bad staff to patient ratio, private or not)
      - admission: saying they have been hearing voices. Said the voices were unclear but seemed to be saying ‘empty’, ‘hallow’ or ‘thud’ - these words place an emphasis on social life. Changed their name and some of their personal history each pseudo-patient gave details of their own life.
      - sample: Eight: 3 women 5 men pseudo-patient (people with no mental disorder). One 20 year old graduate, 3 psychologists, a painter and a housewife and Rosenhan.
      - admitted: pseudo-patient stopped stimulating symptoms of abnormality. Some were nervous but they all behaved as they would ‘normally’. They were given medication –that they didn't take. Responded to instructions from staff and chatted to patients. Each pseudo-patient would have to get out by convincing the staff they were sane.
      - results: pseudo-patients were never detected. All except one admitted with the diagnosis of Sz in remission (able to be discharged). No records by hospital staff showing that they were any doubts about the authenticity of the patient. Between 7 and 52 days were spent in the hospital by the ‘patients’ average of 19 days.
      - Pseudo-paitents were not observed carefully – not observation led to label of Sz.
        
        Visitors and patients felt they were sane, during the first 3 hospitalisations 35/118 patients on the ward voiced their suspicions such ‘you're not crazy’. Doctors are more likely to make error due to caution.
      - Rosenhan found that ‘normal’ family background was interested as ‘abnormal’ in diagnosis.
    - - proecdure: Rosenhan told the staff that sometime in the three months one or more pseudo-patients would attempt to be admitted. Each staff member was asked to rate patient presenting themselves on a scale on 1-10 to reflect the likelihood of them being the pseudo-patients.
      - results: Judgements were given on 193 patients admitted for psychiatric treatment, 41 were strongly judged to be pseudo-patients, 23 were suspected by staff to be pseudo-patients and 19 were thought to be pseudo-patients. They was no pseudo-patients.
      - Conclusion: sane cannot be distinguished from the insane in the psychiatric hospitals. Rosenhan is against using labels for diagnosis, felt it would be more helpful to keep patients in a better environment.
    - - high in gen due to the variety in insituitons and area covered
      - all reported the same symptoms - standardised procedure easily replicated
      - being insuitited -> depression due to poor treatment - can affect how nurses & care falcilies treat paitents and the quality of care provided - conclusions led to remmondations and changes in diagonstic mannuals
      - high ecological validy: no demand characteristics as staff did not know the ppts were not 'sane', as they has been admitted with sz, staff were being normal
      - labelling someone wrong with a disorder and giving them meds may change their behaviour may be seen as a form of social control Rosenhans study points this out
    - - hospitals assessed were in the USA - same western culture - not representing eastern culture
      - paitents were nervous -> not beliving theyd be belived -> shaking, sped up speaking -> sz
        
        Spitzer (2005) argues that there are methodological flaws
      - temporal validy: 1973 - 47 years ago, DSM and ICD was updated in 2022 - changes since regarding standards of treatment
      - Pseudopaitents did not consent to enter the study as a part of research study
      - decption/no protection: staff/hosptial were affected by study were unware it was going on -> undesired effects -> people not going to clinlic or untrust - professionalism questioned
      - rosenhan was one of the ppts - could have been bias & scewed the results & data (self report)
      - Observation method - ppts could forget to write down information or be unable to do so - not have all the data unreliable
      - lead to clinlics being critised heavily and people not trusting the diagnostic cirteia - unknown effects - people not reaching out
  - - - Excluded participants: Severity of symptoms were measured using ‘children's yale brown obsessive-compulsive scale’ – score of 16+ -> included 15- not included.
    - - Diagnosis: via dsm IV
        
        Cooper 2015 credits the DSMs reliability saying that you’d have a 60% of getting the same diagnosis from a different clinician.
        
        Ward et al (1962) found 5% of cases were diagnosed differently by different clinicians due to patient information
    - - CBT only required
        
        14 clinical sessions over 12 week period. Each session set goals, a review pf the previous week, therapist assisted practice, homework and monitoring
      - Combination of CBT and drug therapy
        
        was time linked and provided simultaneously was not felt needed to include a CBT and placebo group.
      - Drugs only condition:
        
        children had to attend weekly for the first 6 weeks then every other week for 9 weeks. Parents would monitor the medication that was taken and they kept a medication diary.
      - Participants were assed again at 4 weeks and 8 and finally at 12 weeks by independent evaluators trained to a reliable standard. The process was strictly supervised and reviewed to establish reliability.
      - placebo only condition
    - - CBT leads to a higher improvement rate than drugs - first line of treatments should be CBT
        
        minimal gain can be added by including drugs however can lead to a less effective therapy
    - - Gen: Sample was large and representative of target population with low dropout rate of 87%.
        
        Gen: sample attrition makes the results less represenative
      - Gen: Analysis of the sample in each condition showed no difference between them so results cannot be due to individual differences.
      - Rel: Assessors were blind to the condition so they could not be bias in their evaluation and improvements. Patients in placebo were unaware that the drug was not active and neither was therapist (double blind).
      - Rel: The assessors were trained and monitored in order to ensure reliability in the measure of change and scale used to asses the change was a well recognised
      - Valid: Conducted the study over 3 centres and run by 2 unis in tandem. One centre had better results perhaps being better at CBT, however all centres used the CBT manual to maintain consistency.
      - Ethics: All participants gave full written consent as well as one parent did. Each one had an assigned psychiatrist to monitor and support them furthers ethical benefit. Those on drug therapy were regularly checked and dosages changed if necessary, thus protecting them from harm.
      - rel: Experimental design: independent group (children were randomly allocated to the 4 groups) - nonbias
      - Excluding ppts increasing internal validy by focusing on OCD as a specifc variable
      - Ethic: Placing young suffers on a placebo can cause distress and negatively impact their mental health. Placebo condition was offered therapy.
- - - - A03
        
        2010 williams et al - 60% of inmates had one or more head injury when they were younger - dont know what type of brain injury - false memories/ recall issues - false negative/positives
        
        Application - knowledge about brain injury and crime could be used along side mental health assessments in court when sentencing to see if people need more or less time
        
        lack of evidence about ABIs on women results cannnot be generlised - more men are at risk due to playing sport or interactions
        
        Kreutzer et al (1991) - no cause and effect between traumatic brain injury and agression
        
        Vietnam head injury study - 14% of brain injured paitents got into fights compared to 4% without
        
        Reductionist
      - A01
        
        sustained during childhood -> criminal behaviour (low impluse, control, agression, poor decision making, forward planning)
        
        Injuries to head e.g. falls -> Aquired brain injuries (ABIs) -> disrupt development-> never move past risk taking behaviours
        
        incarcerated offenders fond to have brain injury -> early rate of offending & high likelyhood to reoffend
        
        caused by accident or illness. Traumatic brain injury occurs as a result of trauma e.g. car crash
        
        caused by long term alchol or drug use alchol toxins affect CNS and interferes with absorption of vitiam Bi - aid in brain nutrients
        
        Drunkness can impair blance or decision making -> increase falls/accidents
    - - A03
        
        panini et al 2014 - those with reduced amygdala volume -> more agressive and prome to psychopathic tendensy
        
        Cause and effect - hard to establish - at what point is the amydala or the engaging in agression - plascity
        
        sham rage 1925 - removed amgydala->calm. amgydala stimuluated -> anger
        
        isolating the amygdala as the only cause is not valid as they is other parts of the brain
        
        Raine 1997 -murders had differences/abnormalities in hippocampus & amgydala
        
        James falian 2006 (neuropsychologist who ideniftied brains of psychopaths) - idenified himself as a psychopath
      - A01
        
        located within the limbic system in both hemispheres of the brain
        
        involved in reward pathways and decision making
        
        responsible for helping us direct how we react to the emotions of others and potentially threating situations
        
        Abnormalties: can vary (size,shape,function, tumour) -> increased agression -> cannot tell what is and isnt a violent situation
        
        Damage due to brain injury e.g.accident or illness
        
        damage -> unemotional or overreaction
        
        small amygdala -> psychopathic qualties & higha agression levels
        
        When removed aggression can no longer be shown
        
        responsible for controlling emotions
    - - A01
        
        10 in 1000 males are born with an extra chromosomes XY this happens randomly
        
        people with XYY have behavioural & physical differences e.g.being taller, lower intellergence, implusivity
        
        learning difficulties: speech delay(makes reading and writing harder) ->harder to gain an education -> harder to gain job -> harder to intergate into society
        
        humans have 23 pairs of chromosomes - 46 all together
        
        XX= female XY=male males can only get XYY
        
        Genetic condition when a male has an extra chromosome with the 23rd pair -> 47 chromosomes
        
        Many males dont know they have it & may lack sympathy be over agressive lack empathy (super male symdrone)
      - A03
        
        adler et al (2007) - argued that agression & violent behaviour is partely determined by genetics
        
        Jacobs (1965) 15 in 10,000 males in prison had XYY for being mentally ill which is an over represntation within the prison population
        
        does explain female criminality - explains why theres more male criminals
        
        Ret Birkodd (2015) - no link XYY and criminal
        
        Klinefelter - men with XYY more likely too be convicted for SA, arson and bulery
        
        Unlikey to know the true extend - cant look at all male offends genetic
        
        Theilgards small % of XYY amoung criminal poplation -> cannot be the only explinataion of SLT
    - - A03
        
        Strengths
        
        Boduszek et al (2013) - tested PEN amoung repeat offender all high PEN validy
        
        weaknesses
        
        reductionist to say personality is fixed - excuse - no change - no free will
        
        psychoticism was added later on - cannot explain link via nerovus system-> unreliable comapred to neurtoic and extroverison
        
        EPQ - self report - demand characteristics - social desirability however reliable used by many different reasearchers
        
        Farrington et al (1982) very little ev for criminal personality
        
        does account for individual differences - Digman 1990 added openness, conscientiousness & agreeable to the theory suggesting that criminality is more complex than be propsed
        
        Personality as a social contruct - Walter Mischel (1968) - people react to enviromental cues rather than being guided by an inner self
      - A01
        
        Extrovert behaviour is out going sociable & active. wants excitement & easily bored. Introvert reserved & reflective Prefer solitary to social activites
        
        Neuroticism: emotional instability - anxiety, fear, depression, envy. Emotional stable: the extend ti which a person is calm, secure
        
        Psychoticism: emotional instability - anxiety fear, depression, envy.Self control: ability to regulate ones emotions, thoughts and behaviour
        
        Innate: behaviour that is insinctive and does not need to be learned - Hans eysenck 1964 - certian personality traits may mean an individual is more prone to criminal behaviour - personality traits cannot be changed/fixed
        
        (P) high psycoticism: lack compassion & may display antisocial behaviour, (E) high Extroversion: more sensation seeking due to having low arousal (N) high neuroticism: become quickly unerved and will react extremely
        
        1990 arsoual theory - extraversion is arsoual in the ascending reticular activating system (ARAS) which stimualtes the cerebral cortex -> higher cortical arsoual. Introverts -> higher level of activity -> requires less stimulation -> less out going. Extroverts -> underactive ARAS -> more out going
        
        Eysenck believed neurotic individuals have a greater activation level and lower threshhold within the limbic system (sympathic nervous system) - easily upset for minor stress
        
        Psycoticism: people who show a pschotic epsiode have increase testrone and low MAO levels
        
        Eysneck personality questionaire (EPQ) - likerk scale with closed questions
        
        Did acknowledge socialisation -> criminality however extroverts are natural reward seekers -> less receptive to operant conditioning -> less effective to punishment. high neurotics interfere with learning -> antisocial behaviour