Clinical Psychology

Theorists
Key question
Studies
1. Classical: Rosenhan (1973)
  1. Procedure: Rosenhan aimed to see if the sane can be distinguished from the insane. Sent 8 pseudo-patients to 12 different hospitals of different backgrounds. The pseudo-patients were of different ages and occupations and had to pretend they heard voices saying "hollow", "empty" and "thud". Hospitals were located on East and South coast of America. All other details were accurate. They stopped pretending to have symptoms as soon as they were admitted. They kept notes of observations on the ward, which were done in secret to begin, but soon did it publicly as no one cared. They said they were fine if asked how they were and in 4 hospitals, they asked when they were likely to be discharged. All but 1 of the pseudo-patients were admitted with a diagnosis of schizophrenia in remission, the remaining one was diagnosed with manic (bipolar) depression. The average stay was 19 days but ranged from 7-52 days. All Pseudo-patients were discharged with schizophrenia in remission.
  2. Results: 35 of 118 patients recognised the pseudo-patients weren't real but normal behaviour was viewed pathologically by staff (e.g. note taking was seen as obsessive writing behaviour). Pseudo-patients referred to Nurse's closed off quarters as the cage and recorded the number of times Nurses emerged from it. Nurses emerged approx. 9.4 times a shift (range 4-39) and doctors was even less at 6.7 times (range 1-17). In a follow up at a hospital who thought they couldn't be tricked, they were told that atleast 1 pseudo would appear in the next 3 months. Staff had to rate patients on how likely they were to be pseudo patients. 193 patients had judgements obtained from. 41 were thought to be a pseudo by atleast 1 staff member, 23 by a psychiatrist and 19 by a psychiatrist and 1 other staff member. No pseudo-patients actually appeared. Rosenhan concluded staff were unable to distinguish between the sane and insane and that the "stickiness of labels" had important implications for society.
Research Methods
Diagnosis (The 4 D's and manuals)
1. Deviation: rare, unique, different or extreme behaviour can be either from statistical (top/bottom 2.2% of curve of normal distribution) or social norm (Abnormal behaviour within society that may change between people and cultures).
2. Dysfunction: The behaviour significantly interferes with a persons ability to carry out everyday tasks. This can be through distractions, confusions or interferences and is rated using the GAF scale.
3. Distress: The extent to which the behaviour cause anxiety and stress to the individual and is assessed using the Kessler Psychological Distress Scale (K10).
4. Danger: Careless, hostile or hazardous behaviour both to themselves or others around them. It is rated on a Scale of Severity.
5. ICD
  1. Desc: Published by WHO in 1948 and used to monitor incidence and prevalence. 11 is the current version since Jan 2022. 10 was used from 1992-2021. Reed et al (2011) asked 4887 psychiatrists whether they used it and 70% said in day-to-day clinical work compared to 23% DSM. It's multilingual, covering a variety of illnesses, diseases and disorders both physical and mental. Mental health disorders are found under section F plus number based off type of disorder. e.g. F20 = Schizophrenia.
  2. Reliability: Hiller et al (1992)-Compared ICD 10 to DSM-III-R and found that 10 had a higher reliability for all disorders accept bipolar. However, Nicholls et al (2000) found reliability was only 0.36 against eating disorders when paired with DSM at Great Ormond Street Hospital.
  3. Validity: Mason et al (1997) found ICD 10 was "reasonably good" predicting disability in 99 people with schz 13 years after diagnosis, as measured using GAF scale, suggesting that ICD 10 was useful and meaningful in ability to predict future outcomes. However, Valle (2022) found ICD 11 was adequately reliable but the validity was uncertain.
6. DSM
  1. DSM-IV-TR (1994): revised version of DSM-IV and described disorders using axes for the first time. 1: Mental Health and substance use disorders, 2: Personality problems, 3: General medical conditions, 4: psychological and environmental problems, 5: Global assessment of functioning (GAF) scale. More holistic (takes whole person into account) and first version to deal with culture-bound syndromes. However, it wasn't very easy to use.
  2. DSM-5 (2013): March 2022 DSM-5-TR published. Aimed to harmonise with ICD. 3 Sections instead of multi-axial system; 1-Explains organisation and introduces changes, 2-gives diagnostic criteria and codes, 3-emerging measures and models/future diagnosis. Each criteria has a set of criteria and symptoms and unnecessary and over-used categories were removed.
  3. Reliability: Stinchfield et al (2015) found DSM-5 led to fewer negatives than DSM-IV when diagnosing gambling disorder suggesting the classification systems were valid. However, the BPS are concerned that it has considered social norms. This is concerning as the BPS that doing so requires clinicians to make judgements about this and their own social norms and cultural difference may affect judgement. Therefore, Subjectivity of Clinician may affect diagnosis.
  4. Validity: Sanchez (2008) administered the standard interview from DSM-IV-TR to ppys with current depression diagnosis and found 74% correctly identified correctly. However, the fact that this is not 100% highlight potential issues with the validity of the DSM
7. Issues and debates of ICD and DSM
  1. Psychology over time: both have changed in order to account for developments in understanding over time.
  2. Culture: Both take into account how different cultures view mental illness. However, DSM is mainly for American and Western countries, whereas ICD is more applicable to multiple cultures as it is published by WHO and so used more globally.
  3. Gender: Don't tend to include differences in symptomology of males and females. Therefore, there is potential for genders to be misdiagnosed simply because they don't fit the "classic" symptoms.
8. Reliability and validity issues of Diagnosis
  1. Validity: Internal - Symptoms of patient should match those considered present for disorder to be valid and 2 patients with the same symptoms should be given the same diagnosis. Construct - for Mental disorders to be defined, they should be operationalised to make the disorder measurable. Predictive - diagnosis valid if can accurately predict the course of the disorder and if treatment put in place is effective. Aetiological- a group diagnosed with the same disorder should have the same factors causing it.
    1. Eval: Both manuals have been revised multiple times to increase validity by adding and removing some disorders.

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