CLINICAL PSYCHOLOGY
Diagnosis of mental disorders (4Ds)
AO1: Deviance: defiant behaviours are unusual, undesirable and bizarre. Statistical norms= are 2
standard deviations away from scale. Used 2 measure unuaualness of any behaviour. Social norms=
desirability of behaviour varies on historical context, culture, age and/or gender. FAILURE to conform to
norms= -ve attention from others and social exclusion.
Dysfunction: symptoms that distract, confuse or interfere with an individual’s day-to-day roles and
responsibilities. Is measured using a scale (eg. WHODAS II) assesses understanding on what's going
around them, communication etc. and involves trouble getting up this morning, failure in completing tasks
etc (eg. socialising).
Danger: careless, harmful or hostile behaviour that jeprodises the safety of themselves or others.
Predicting violent behaviour=hard BUT could use past history of aggression to predict that another
incident is more likely. If 3 or more professionals agree that a person is a danger to them/others, they can
be detained without consent from the individual.
Distress: symptoms carrying emotional pain or anxiety, could also be physically (ie. aches). These can
be normal depending on situations (eg. job loss or bereavement) Clinics can consider intensity.duration
of distress when diagnosing, like using quantitative data (eg. Kessler Psychological Distress Scale).
AO3: Strength: helps in diagnosis (BUT no rules on how to combine the 4Ds)
However, weakness: low objectivity and creates psychodynamic ‘sticky labels’ which can be distorted in
media
HCPC Guidelines for Clinical Practitioners
AO1: Respect confidentiality → protect confidential info and only share if ILLEGAL and a matter of
public safety (eg. plans to kidnap a kid and thinking obsessively of it = turn into police)
Communicate appropriately → listen to their needs and provide info in an understandable
manner, also don’t post on what patients disclose during meetings (eg. confessing to them loving their
cat can’t be spread).
Be open when things go wrong → don’t be dishonest and take responsibility, eg. if a notebook
with personal info gets lost on a bus, tell the patient the truth and apologise.
Concurrent Validity: comparing two types of guidelines/classification systems. Broad agreement on a
diagnosis= concurrent validity increases. Predictive validity: if you can accurately predict the future
course of events based on diagnosis, then diagnosis has a high predictive val. Aetoloigal Validity:
cross-reference patients' history with what is already known. If broadly agreed = high aetiological validity.
Lavarenne et al (2013) → Chosen Case Study
AO1: AIM: to investigate how therapy grps can provide a firm boundary within which individs
can expose their own fragile egos. PROCEDURE: therapy grop met regularly, with 10
members (4 membs were absent, 3 had difficulties attending regularly). All vulnerable to
psychosis and receiving drug treatments. Session shad coding systems that recorded
emotions expressed (eg, joy sadness), thoughts/behaviours (psychotic, shame, depressed
etc.) and verbal content (eg humor, engagement within grp). FINDINGS: Earl → rejected a
member’s Xmas card. Dan → silent for 1st 6mnths of attending and now can’t stop talking.
CONCLUSION: shows that all members' words hard to hold themselves together, sessions
reports that impressive tolerance, acceptance and constraminants from members= enabled
them to wrestle fragile egos and possibly foster psychological growth.
, AO3:Strength: indepth data, ethical issues decrease, high ecological vakidity bc real data from real schiz
in real therapy.
However, weakness: is low PV bc 6 members were mostly present most of the time= low genralisiability,
subjective as oil idea analogy being interpreted in schiz is blurry as to self or non-self
Vallentine et al (2010) → Chosen Interview
AO1:AIM: To investigate the usefulness of psychoeducational material as a part of group work for
patients in a high-security psychiatric hospital.
PROCEDURE: 42 male patients in a high-security psychiatric hospital, most diagnosed with
schizophrenia or related disorders. They took part in one of four 20-session Understanding Mental Illness
(UMI) groups over three years. Patients completed pre- and post-group assessments using CORE-OM
(wellbeing, symptoms, risks) and the Self-Concept Questionnaire. Semi-structured interviews explored
patients’ experiences, which were thematically analysed, with a second rater confirming the coding (60%
agreement).
FINDINGS: 31 completed UMI and some didnt → no signif diff between inferential stats tests
on both groups (THIS IS BAD NEWS!!! – showed UMI doesn’t work) CORE-OM: only 1 P
showed reliable change across all 4 scales of self esteem. SCQ: more cases of reliable
change and over 50% reported increase in self esteem (some showed signif negative shift).
Interviews showed what Ps valued and what was difficult/unhelpful.
CONCLUSIONS: further consider absence of reliable changes and negative changes in some patients;
analysis of interviews showed that patients did value a sense of hope and environment provided.
AO3:Strength: is easy to replicate, various research methods used obtains more data.
However, weakness: Researcher (interviewer) effect= lowers validity of responses; Ps may be more
reluctant to give out personal info; unreliable results and shows in many cases that psychoeducational
materials aren’t helpful.
Classification Systems (ICD-10)
AO1: ICD is a multilingual, freely available response used globally and provides a common language, so
data collected in diff countries can be compared. Was developed since 1983 + current ver. Published in
1992. Chapter 5= ‘Mental and Behavioural Disorders’, has 11 sections (starts with F), and each section
has ‘leftover codes’ so new disorders can be added without having to re-code others.
Eg: F 32.0
(F= mental health disorder; 3= family of disorder (eg. affective); 2= type of disorder (eg.
depression); 0= intensity (eg. mild)); so this code is ‘mild affective depression’.
To diagnose someone: 1) Select key words from client interview on symptoms (eg. hallucinate) 2) look up
symptoms on ICD-10; 3) use other symptoms to locate a subcategory (Eg. F20, then F20.1 based on
symptoms)
AO3:Strength: is that there is a high reliability between ICD-9 and ICD-10: Ponizovsky et al (2006)
compared them using the Positive Predictive Value (PPV) and found a proportion of people who gets
same diagnosis when reassesed and scores for schizophrenia increased from 68% to 94.2%
However, weakness: is reliability is meaningless without high validity (so just because reliability is high, it
does not mean that the system is valid).
Another weakness is that: cultural bias can affect diagnosis given: client could be given diff diagnosis,
especially if the clinician and client comes from different cultures COUNTER: so, research was made to
review different diagnostic practice in different langs and cultures, as well as removed any
inconsistencies, ambiguities and overlaps. This means that the ICD-10 is now made to be available in
different languages and forms to make the diagnostic system more readily available for all.
Diagnosis of mental disorders (4Ds)
AO1: Deviance: defiant behaviours are unusual, undesirable and bizarre. Statistical norms= are 2
standard deviations away from scale. Used 2 measure unuaualness of any behaviour. Social norms=
desirability of behaviour varies on historical context, culture, age and/or gender. FAILURE to conform to
norms= -ve attention from others and social exclusion.
Dysfunction: symptoms that distract, confuse or interfere with an individual’s day-to-day roles and
responsibilities. Is measured using a scale (eg. WHODAS II) assesses understanding on what's going
around them, communication etc. and involves trouble getting up this morning, failure in completing tasks
etc (eg. socialising).
Danger: careless, harmful or hostile behaviour that jeprodises the safety of themselves or others.
Predicting violent behaviour=hard BUT could use past history of aggression to predict that another
incident is more likely. If 3 or more professionals agree that a person is a danger to them/others, they can
be detained without consent from the individual.
Distress: symptoms carrying emotional pain or anxiety, could also be physically (ie. aches). These can
be normal depending on situations (eg. job loss or bereavement) Clinics can consider intensity.duration
of distress when diagnosing, like using quantitative data (eg. Kessler Psychological Distress Scale).
AO3: Strength: helps in diagnosis (BUT no rules on how to combine the 4Ds)
However, weakness: low objectivity and creates psychodynamic ‘sticky labels’ which can be distorted in
media
HCPC Guidelines for Clinical Practitioners
AO1: Respect confidentiality → protect confidential info and only share if ILLEGAL and a matter of
public safety (eg. plans to kidnap a kid and thinking obsessively of it = turn into police)
Communicate appropriately → listen to their needs and provide info in an understandable
manner, also don’t post on what patients disclose during meetings (eg. confessing to them loving their
cat can’t be spread).
Be open when things go wrong → don’t be dishonest and take responsibility, eg. if a notebook
with personal info gets lost on a bus, tell the patient the truth and apologise.
Concurrent Validity: comparing two types of guidelines/classification systems. Broad agreement on a
diagnosis= concurrent validity increases. Predictive validity: if you can accurately predict the future
course of events based on diagnosis, then diagnosis has a high predictive val. Aetoloigal Validity:
cross-reference patients' history with what is already known. If broadly agreed = high aetiological validity.
Lavarenne et al (2013) → Chosen Case Study
AO1: AIM: to investigate how therapy grps can provide a firm boundary within which individs
can expose their own fragile egos. PROCEDURE: therapy grop met regularly, with 10
members (4 membs were absent, 3 had difficulties attending regularly). All vulnerable to
psychosis and receiving drug treatments. Session shad coding systems that recorded
emotions expressed (eg, joy sadness), thoughts/behaviours (psychotic, shame, depressed
etc.) and verbal content (eg humor, engagement within grp). FINDINGS: Earl → rejected a
member’s Xmas card. Dan → silent for 1st 6mnths of attending and now can’t stop talking.
CONCLUSION: shows that all members' words hard to hold themselves together, sessions
reports that impressive tolerance, acceptance and constraminants from members= enabled
them to wrestle fragile egos and possibly foster psychological growth.
, AO3:Strength: indepth data, ethical issues decrease, high ecological vakidity bc real data from real schiz
in real therapy.
However, weakness: is low PV bc 6 members were mostly present most of the time= low genralisiability,
subjective as oil idea analogy being interpreted in schiz is blurry as to self or non-self
Vallentine et al (2010) → Chosen Interview
AO1:AIM: To investigate the usefulness of psychoeducational material as a part of group work for
patients in a high-security psychiatric hospital.
PROCEDURE: 42 male patients in a high-security psychiatric hospital, most diagnosed with
schizophrenia or related disorders. They took part in one of four 20-session Understanding Mental Illness
(UMI) groups over three years. Patients completed pre- and post-group assessments using CORE-OM
(wellbeing, symptoms, risks) and the Self-Concept Questionnaire. Semi-structured interviews explored
patients’ experiences, which were thematically analysed, with a second rater confirming the coding (60%
agreement).
FINDINGS: 31 completed UMI and some didnt → no signif diff between inferential stats tests
on both groups (THIS IS BAD NEWS!!! – showed UMI doesn’t work) CORE-OM: only 1 P
showed reliable change across all 4 scales of self esteem. SCQ: more cases of reliable
change and over 50% reported increase in self esteem (some showed signif negative shift).
Interviews showed what Ps valued and what was difficult/unhelpful.
CONCLUSIONS: further consider absence of reliable changes and negative changes in some patients;
analysis of interviews showed that patients did value a sense of hope and environment provided.
AO3:Strength: is easy to replicate, various research methods used obtains more data.
However, weakness: Researcher (interviewer) effect= lowers validity of responses; Ps may be more
reluctant to give out personal info; unreliable results and shows in many cases that psychoeducational
materials aren’t helpful.
Classification Systems (ICD-10)
AO1: ICD is a multilingual, freely available response used globally and provides a common language, so
data collected in diff countries can be compared. Was developed since 1983 + current ver. Published in
1992. Chapter 5= ‘Mental and Behavioural Disorders’, has 11 sections (starts with F), and each section
has ‘leftover codes’ so new disorders can be added without having to re-code others.
Eg: F 32.0
(F= mental health disorder; 3= family of disorder (eg. affective); 2= type of disorder (eg.
depression); 0= intensity (eg. mild)); so this code is ‘mild affective depression’.
To diagnose someone: 1) Select key words from client interview on symptoms (eg. hallucinate) 2) look up
symptoms on ICD-10; 3) use other symptoms to locate a subcategory (Eg. F20, then F20.1 based on
symptoms)
AO3:Strength: is that there is a high reliability between ICD-9 and ICD-10: Ponizovsky et al (2006)
compared them using the Positive Predictive Value (PPV) and found a proportion of people who gets
same diagnosis when reassesed and scores for schizophrenia increased from 68% to 94.2%
However, weakness: is reliability is meaningless without high validity (so just because reliability is high, it
does not mean that the system is valid).
Another weakness is that: cultural bias can affect diagnosis given: client could be given diff diagnosis,
especially if the clinician and client comes from different cultures COUNTER: so, research was made to
review different diagnostic practice in different langs and cultures, as well as removed any
inconsistencies, ambiguities and overlaps. This means that the ICD-10 is now made to be available in
different languages and forms to make the diagnostic system more readily available for all.
