Very detailed mind maps of Edexcel A level Clinical Psychology notes - these helped me get an A* at AS and predicted an A* for my A level
It includes the AO1 details of the studies and theories you need to know and also the AO3 evaluation
This is the whole package of clinical psychology notes! Yo...
• They are a valuable construct for clinicians to identify the
points on a continuum at which human cognition, emotion •
and behaviour change from normal into abnormal and • The extent to which the behaviour causes emotional upset to
therefore can be classified as a psychiatric disorder.
the individual (rather than an objective measure of the severity
of the dysfunction)
For example:
Distress can be explored using the diagnosis of Hypochondriasis, a
preoccupation with the fear of having a serious disease. This fear is
based on the misinterpretation of bodily symptoms. The more medical
• Any behaviour which goes against the norms shown or
reassurance is sought, the more distress increases.
expected by society
For example:
Paedophilia, characterized by recurrent urges, fantasies or
behaviours existing over at least 6 months and directed at
children 13 years of age or younger. Symptoms must
present significant distress or impairment. The individual
must be over 5 years older than the subject of desire. This • The extent to which a person’s behaviour
illustrates both the statistical and societal nature of poses a threat to themselves or others
deviance.
For example:
Almost all psychiatric diagnoses show elevated
• The extent to which the behaviour is significant enough to interfere mortality compared to the general population. Of
in the individual’s life (e.g. social, occupational) in some major way. all types of unnatural deaths, suicide was the
For example: most prevalent. This shows the necessity of
A severe Major Depressive Disorder diagnosis indicates that this episode
assessing danger when conceptualizing a mental
has elevated to the point where it markedly interferes with the individual’s
occupational or social life. For example, the person will experience a diagnosis.
depressed mood for most of the day which will interfere with relationships
with others, as easily perceived by outside observers.
, • The DSM is produced by the American Psychiatric Association • The ICD is concerned with all diseases and section F covers mental health disorders.
(APA) and adopts a similar system of grouping symptoms into
‘families’ to enable the clinician to go from a general to a specific • It groups disorders as part of a family, for example ‘mood disorders’ is a family that
diagnosis includes all forms of depression including bipolar disorder.
• Section 1 offers guidance on using the system. Section 2 details • This coding allows the clinician to go from general to specific and convey the diagnosis to
disorders and is categorised according to our current understanding others in a systematic way.
of underlying causes and similarities between symptoms. • The system can be used to guide the diagnosis through a clinical interview with the
• Some disorders have been simplified patient although this requires expertise on the part of the clinician as mental disorders
• The DSM 5 has been criticised for its’ huge increase in size and the are often not clear in their presentation.
medicalisation of more minor issues • It considers: Axis 1 – clinical syndromes including personality disorders. Axis 2
• Section 3 includes suggestions for new disorders which currently disabilities. Axis 3 environmental and personal factors.
require further investigation. • The ICD is produced by the World Health Organisation and is used in over 100 countries,
some of which prefer it to the DSM.
• ICD is produced by the World Health Organisation and the DSM
is produced by the American Psychiatric Association
• ICD is a free and open resource whereas the DSM provides
a revenue source for the American Psychiatric Association
• ICD is multilingual and multidisciplinary but the DSM is USA
dominated and English language
• ICD covers all health conditions while the DSM is
specifically for mental disorders
• Allows common diagnosis to be reached by clinicians.
• Through revisions it has stood the test of time and is probably the best attempt at
diagnosis given the limited understanding of mental disorders as when two or more
doctors use it they should come close to the same diagnosis
• The DSM-5 underwent field trials before publication which included test-retest reliability
where different clinicians independently evaluated the same patient using its criteria
• The British Psychological society (BPS) has expressed concern about the DSM-5 because it requires
clinicians to make judgements about social norms.
• Deviance and dysfunction relate to culture and social norms as they might be different across cultures
• The DSM confirms the medical state of mental disorder by labelling sufferers as ‘patients’ who need to be
cured.
• It could be said that some mental disorders are ways of living rather than illnesses
, • Reliability refers to consistency of measurement, so a system is •
reliable if those using it consistently make the same diagnosis.
• If something is done more than once, one would expect the For:
same results. If the same results are found then they are • Regier et al (2003): reported 3 disorders (including PTSD which has a specific set of
reliable. This applies to the diagnosis of mental health criteria) had kappa values from 0.6 to 0.79 which is very good using the DSM-5
issues, as if one person goes to two different clinicians and
gets a different diagnosis then there is no reliability. • As a result of the DSM-4 not being reliable for eating disorders in children, Great
• Similarly, if a clinician gives diagnosis ‘A’ to a person presenting Ormond Street Hospital have created their own system (due to their expertise in
with a set of symptoms and features, and then diagnosis ‘B’ to this certain area) which showed 0.88 reliability (88% agreement)
another person presenting with the same issues, this shows
unreliability and lack of validity in the diagnosis too.
• Pedersen et al: gave 10 Danish GPs one day’s training in the use of ICD-10 criteria
• for diagnosing depression. Over the next 8 weeks they diagnosed a 116 patients
with a depressive episode.
• There was a rate of 0.71 agreement between the GP’s
Against:
• The degree of agreement between two or more clinicians
on the diagnosis of a patient. • Regier et al (2003): 7 more disorders (including schizophrenia
which is more complex than PTSD and more difficult to
understand) had kappa values of 0.4 to 0.59 which isn’t as
good
• Nicholls et al (2000): found that neither the ICD-10 and the DSM-4 demonstrate good inter-rater
• Whether the same doctor would give the same reliability for eating disorders in children
diagnosis of the same patient at a different time. 81 patients aged 7-16 years with eating problems were classified using the ICD-10 and DSM-4
Over 50% of the children could not be diagnosed according to DSM criteria.
DSM inter-rater reliability was 0.64 (64% agreement between raters) but this figure was inflated by the fact
that most raters agreed they could not make a diagnosis.
ICD-10 showed 0.36 reliability (36% agreement)
• Spitzer (chaired the DSM-III committee) introduced the use of Cohen’s• •
kappa to improve reliability.
• The statistic is written as a decimal and can be used for inter-rater or test- Rosenhan (1973) suggested possible reasons for unreliability of diagnosis:
retest reliability. • Patients may give different psychiatrists different information for some reason,
highlighting the element of subjectivity in diagnosis
• Spitzer and his colleagues felt that 0.7 would indicate ‘good agreement’
• The information gathered may be insufficient:
(i.e. same diagnosis given 70% of the time). o Unstructured interviews are not reliable and are often used*
o The patient may withhold information (social stigma, cultural pressure)
o The psychiatrist may not have sufficient time to get all the relevant information
• Cultural factors may affect diagnosis, both on the part of the psychiatrist and the patient
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