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Summary Edexcel A Level Psychology Notes - Clinical Psychology
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A* notes for the Clinical Psychology Module at A Level - the ONLY notes you need for this course!
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1Clinical Psychology
- Concerned with abnormal behaviour
- Defines what makes behaviour abnormal and works to diagnose the problem so it
can be treated
- Symptoms, duration, general health, other social/psychological problems all
considered when diagnosing disorder and choosing a treatment
5.1 Content
5.1.1 Diagnosis of Mental Disorders
- Psychiatrists gather information on:
o Symptoms, e.g. hallucinations
o Duration, e.g. one month
o General health, e.g. other illnesses
o Social or psychological problems, e.g. other mental health disorders
- Must be aware that the same disorders can present themselves completely
differently amongst two people
- Different psychologists may give different diagnoses due subjective interpretation of
the information given
The Four ‘Ds’ of Diagnosis
- Deviance - The extent of the abnormality of the behaviour
- If it is seen as deviant from the norm within society a clinical disorder may be
present
- May change across time/place as social norms change
- Dysfunction - The degree to which the behaviour significantly interferes with the
patient’s life
- May not be obvious so all aspects of everyday life would be discussed with a clinician
- The larger the interference the more likely a clinical disorder is present
- Distress - The level of upset caused to the individual and others by the behaviour
- Treated separately from the other Ds
- It is likely that each patient will have completely different experiences while suffering
from the same condition
- The subjectivity of experiences must be kept in mind
- Someone suffering with a large difficulty may experience minimal distress
- Danger - Intervention is needed if a patient puts either their own life or other’s lives
in danger
- A diagnosis is often necessary for those partaking in these risky behaviours
- *Duration - It is only when deviance, dysfunction, distress and danger persist into the
long term that psychiatric attention is required
Evaluation:
- Possible subjectivity in the interpretation of an individual patient’s experience
- It is difficult to know what behaviours are considered as ‘normal’ or ‘abnormal’
, 2
- The way in which the individual is coping with the behaviour needs to be extensively
discussed, as this differs from person to person
- Issues of reliability as obtaining a diagnosis lies on the discussion between the
patient and clinician
- Level of deviance must be based on standardised measures not personal judgment
- Clinicians must consider the 4 Ds evenly and in-depth when considering if a patient
needs further psychiatric care to ensure standardisation
5.1.2 Classification Systems for Mental Health
- 1948 - WHO accumulated a list of mental disorders in the International Classification
of Diseases – ICD
- 1952 - American Psychiatric Association published the Diagnostic and Statistical
Manual of Mental Disorders (DSM) as another way to identify mental disorders
- They are both continually revised, with DSM V being released in 2013 and the 10th
version of the ICD in 2017
- No obvious measurable physiological signs so reliant on interpretation of
behavioural symptoms
- This is not exact so issues of reliability and validity
- DSM and ICD describe clusters of symptoms that define disorders that have come
from clinical practice, field trials and pooled expertise so should have better
diagnoses
- However, not universally accepted
International Classification of Diseases (ICD)
- The ICD-10 focuses on all diseases, with a specific section focusing on mental health
disorders
- Disorders are grouped in families
- E.g. The category ‘mood affective disorders’ would include mental illnesses such as
depression or bipolar disorder
- They are coded according to the section (F), with a digit to represent the
corresponding family and another to signify the specific disorder - depression = F32
- This is taken further through specifying the type of disorder by another digit after a
decimal space - mild depression = F32.0
- This can then be additionally classified according to specific symptoms - mild
depression with physical symptoms = F32.0.01
- This ICD provides a foundation to make an accurate diagnosis, detailing likely
symptoms for each disorder, severity and duration
- Confident diagnoses are made with the patient’s symptoms clearly fitting the ICD
manual descriptions
Diagnostic and Statistical Manual of Mental Disorders (DSM V)
- Only focuses on mental health disorders
- Similar system to the ICD in that disorders are grouped into families
- Linked disorders grouped together enabling movement from general to specific
diagnosis
- Used in combination with information gained through clinical interview and medical
records
, 3
DSM IV-TR
- The DSM IV was published in 1994 and updated to DSM IV-TR in 2000
- It was split into 5 chapters:
o Major clinical syndromes, e.g. schizophrenia and anxiety disorders
o Symptoms related to personality disorders
o Medical conditions, e.g. brain damage or HIV, that could have led to the
clinical issues
o Psychological and environmental problems, e.g. bereavement or
unemployment
o Scale to assess global functioning of an individual
- Scale shows how well a patient goes about normal activities so helped with diagnosis
and finding a suitable treatment
Evaluation:
ICD 10 DSM V
Less specific detail than DSM because it is a Latest version takes various stages of life
diagnosis for both mental and physical into account where certain disorders are
health, making it a less accurate diagnosis more likely to occur, e.g. depression in
for mental illness adolescence
Constantly updated, current revision 10 - More detailed than ICD 10 because the
increased reliability focus is purely on mental health - more
reliable
Clusters of symptoms, if the classification is
reliable can lead to a more reliable Constantly updated, current revision 5 –
diagnosis increased reliability
Clusters of symptoms, if the classification is
reliable can lead to a more reliable
diagnosis
Reliability of Diagnosis
- The extent to which clinicians agree on the same diagnosis for the same patient
- Many symptoms are constant across a range of mental illnesses
- Two clinicians may assign different causes to the exact same symptom, suggesting
the unreliability of diagnosis
- Ward et al 1962 studied the diagnosis of one patient from two psychiatrists
- His findings suggested issues of reliability of the diagnostic tools being used
- He found disagreement in diagnosis being the cause of:
o Inconsistent information given by the patient (5%)
o Inconsistent interpretations of symptoms (32.5%)
o Inadequacy of symptom classification (62.5%)
- Diagnosis systems are required to pass an inter-rater reliability test
- At least two clinicians must be shown details of a patient’s case history and assess
the level of agreement
, 4
- If all agree on the on the diagnosis, the method of diagnosis is said to have high
inter-rater reliability
- Generally, early diagnostic systems had low inter-rater reliability
- Beck 1954 - The exact same group of symptoms were only diagnosed as the same
disorder in approximately 50% of cases, indicating low reliability
Patient Factors
- Information provided by patients may be influenced by:
o Memory
o Denial
o Shame
- Specific issues (below) can lead to difficult diagnosis and are likely to differ between
clinicians
o Disorganised thoughts
o Psychopathy
o Manipulative tendencies
Clinician Factors
- Due to clinical interviews being unstructured, some clinicians may focus on one
specific symptom where as another may focus on a completely different symptom
- As a result, different information is gathered about a patient and can result in a
different diagnosis
- Clinicians’ subjective judgment is also largely influential to the diagnosis
- This is subject to the background, training and experience of the clinician
- E.g. Psychodynamic training may mistake hallucinations for past trauma but a
medically trained psychiatrist may explain hallucinations as a consequence of excess
of dopamine in the brain
- A reliable diagnosis with agreement from many clinicians still may not be valid
- Rosenhan found high inter-rater reliability while diagnosing schizophrenia from the
same set of symptoms but this was not valid because the people receiving the
diagnosis were not actually mentally ill
Validity of Diagnosis
- A diagnosis is required to genuinely reflect the underlying disorder due to the
serious effects of misdiagnosis
- Wrong treatment may lead to delay of recovery and thus development in the
seriousness of a patient’s condition
- Concurrent Validity - A way of establishing validity that compares evidence from
several studies testing the same thing to see if they agree
- Could be checking by comparison to another diagnostic tool
- Broad agreement about what symptoms constitutes a disorder means there is broad
concurrent validity
- The DSM V constantly refers to the coding in the ICD, showing strong agreement
between the two tools
- Aetiological Validity - The extent to which a disorder has the same cause or causes
- It exists when the diagnosis reflects knows causes in a disorder that is known to have
a genetic cause
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