1. Schizophrenia

Question 1

positive symptoms

Answer 1

hallucinations, experiences of influence, passivity or control (though withdrawal, insertion broadcasting), Delusions (grandeur, persecution)

Question 2

weaker verions of the core symptoms

Answer 2

prodromal symptoms

Question 3

negative

do not experience typical emotional highs and lows

Answer 3

flat effect

Question 4

negative

not able to carry out a goal directed behaviour

Answer 4

avolition

Question 5

negative

lack of spoken language

Answer 5

alogia

Question 6

negative

inability to experience pleasure

Answer 6

anhedonia

Question 7

age of onset

Answer 7

earlier for males: early to mid 20s
females: late 20s
late onset (more common in females): 40s

Question 8

persecutory ideation – freeman

Answer 8

The belief (without any evidence) that other people are being hostile towards you, or that they have negative feelings towards you.

It can lead to complete social withdrawal and an inability to maintain usual activities due to the fear of hostility from others.

Question 9

Interpersonal Sensitivity - freeman

Answer 9

A tendency to focus on feelings of personal inadequacy or inferiority and a feeling of marked discomfort during interpersonal interactions

Question 10

freeman aim

Answer 10

Whether neutral, non-threatening avatars could provoke persecutory thoughts in people with no previous clinical diagnosis

Whether this was more common in people with higher levels of paranoia and emotional distress

Question 11

methodology — freeman

Answer 11

Correlational study

Based on quantitative data gathered via questionnaires

Qualitative data was collected in semi-structured interviews, and scored later to provide further quantitative data

Question 12

sample – freeman

Answer 12

12 male and 12 female
Paid volunteers
Mean age=26
Recruited from University College, London, UK
All mentally well
21 students and 3 administrative staff

Question 13

freeman questionaires

Answer 13

Brief Symptom Inventory (BSI)
a 53-item questionnaire to assess mood, anxiety and psychotic symptoms in the last 7 days

two 20-item self-reports which measures ideas of persecution and reference:

The Spielberger State Anxiety Questionnaire (scale on 1 not at all to 4 very much so)

The Paranoia Scale

15-item VR-Paranoia Questionnaire, which measured persecutory thoughts, ideas of reference and positive beliefs about the avatars.

Question 14

conclusions – freeman

Answer 14

Emotional processes linked to anxiety and interpersonal sensitivity contribute directly to the development of persecutory ideation

VR holds ‘great promise’ as a way of helping individuals evaluate and reduce persecutory ideation and delusions

Question 15

data gathered for ICD-11

Answer 15

The ICD-11 encourages both idiographic and nomothetic approaches; data about symptoms is gathered through:

A clinical interview regarding the individual’s experiences (idiographic)

The clinician also rates each of the six-dimensional descriptors on a four-point scale (nomothetic)

Question 16

Concordance Rate (MZ and DZ) - Genetic Explanation - Classic Research

Answer 16

the probability of two people with the same genes getting the same disease:

monozygotic (MZ) twins - 42%
dizygotic (DZ) twins - 9%

Question 17

genes that come in different forms

also. GWAS

Answer 17

polymorphic
schizo is a polygenic disorder

Genome-Wide Association Studies

Question 18

COMT gene

Answer 18

During cell division a whole strands of DNA can become duplicated/even deleted

e.g. in DiGeorge syndrome, a strand of DNA is deleted from a chromosome

This has been linked to the deletion of a specific gene called COMT

COMT codes for an enzyme which breaks down neurotransmitters (such as dopamine)

the absence of COMT could be partially responsible for the complex neurochemical imbalances that seem to underpin the symptoms of schizophrenia

Question 19

DISC1 gene and evidence

Answer 19

the ‘disrupted in schizophrenia’ increases the risk of schizophrenia due to its association with the neurotransmitter GABA

GABA is an inhibitory neurotransmitter which helps to regulate activity in neural circuits that communicate via dopamine and glutamate

An abnormality of this gene could increase vulnerability to excess dopaminergic activity and subsequent symptoms of schizophrenia

Eg: In a large Scottish family with an unusually high rate of schizophrenia, 34 family members carried the DISC1 gene

Question 20

The Dopamine Hypothesis: two mechanisms in which we could have excessive amounts of dopamine

Answer 20

excess L-Dopa (the substance that dopamine is made from)

synapses that use dopamine may also be overactive due to differences in the number of receptors on the postsynaptic cell

Question 21

cognitive explanations

Answer 21

Errors in self-monitoring Patients fail to recognise that their perceived hallucinations are in fact just inner speech. They attribute what they are hearing to someone else (a voice speaking to them from an external source)

Difficulties with mentalising (believe that others have the same opinion of them as they have of themselves, neutral behaviour may be misinterpreted as hostility)

Thinking errors and biases (tend to draw conclusions based on insufficient evidence and show a bias against counter-evidence)

Question 22

Typical antipsychotics - what and side effects

Biochemical treatments

Answer 22

The first of these drugs was called chlorpromazine - blocks dopamine receptors on the postsynaptic cell, without activating them → less dopamine activity

dopamine antagonists - effective in reducing positive symptoms of schizophrenia

side effects:

can be unpleasant, debilitating and even fatal, Dizziness, drowsiness and restlessness are common, as well as nausea, constipation and excessive weight gain

uncontrollable blinking, jerking and twitching of the face and body)

Question 23

Atypical Antipsychotics what and side effects

Biochemical treatments

Answer 23

These drugs block both dopamine and serotonin (an inhibitory neurotransmitter ) receptors.

Ex: clozapine and risperidone

Effective in reducing both negative and positive symptoms of schizophrenia

The rapid dissociation allows for normal dopamine transmission to take place → fewer side effects

side effects:

Clozapine can cause agranulocytosis (a potentially fatal blood condition, although the risk is minimised through regular blood counts)

Question 24

The Texas Medication Algorithm Project (TMAP)

Answer 24

Designed to assist doctors in the prescription of antipsychotics.

1. using an atypical drug, such as risperidone
2. if this does not work to move onto a typical drug, such as haloperidol, or olanzapine
3. if the person still does not find any relief, clozapine may be trailed.
4. final stages of the TMAP include combining antipsychotics with other types of medication, such as mood stabilisers like lithium.
5. Once doctors have exhausted their options with medications, they may move onto the use of electroconvulsive therapy

Question 25

Randomised control trials (RCTs)

Answer 25

a study where the participants are randomly assigned to either the treatment or the control condition

Used to research the use of antipsychotic drugs

These trials are often double-blind placebo controlled

Question 26

ECT - What it does, anasthesic

Answer 26

Involves delivering electrical pulses (70-150 volts, up to 1 second) to one or both sides of the brain via electrodes placed on the scalp, with the intention to induce a controlled seizure of up to one minute. It is used in addition to medication, for people who are treatment-resistant.

it is believed the shocks trigger the release of neurotransmitters like dopamine and serotonin

administered under general anaesthetic using muscle relaxants (the person cannot be injured during the seizure and has no recollection of the procedure)

Applied unilaterally to the non-dominant hemisphere only, to reduce memory loss

Question 27

Cognitive-Behavioural Therapy

Psychological Treatment

Answer 27

a therapeutic alliance.

Thoughts - Physical Sensations- Emotions - behaviours

aims to develop coping skills, including stress management, and helps identify early warning signs (prodromal symptoms)

Psychoeducation

Focusing very much on present issues, as opposed to past life events, the therapist helps the person to explore how thoughts are interlinked

Question 28

decompensation

remission

Answer 28

decompensation - breakdown in an individual’s defence mechanisms resulting in progressive loss of functioning or worsening of psychiatric symptoms

Remission: a reduction in symptoms to the point where the person no longer meets the threshold for diagnosis

Question 29

sensky conclusion

Answer 29

CBT was more effective than befriending

Patients continued to improve post-treatment to follow-up, unlike befriending, where initial improvements were no longer at follow-up

Question 30

The dopamine deficiency hypothesis

Answer 30

The brain compensates for low levels of dopamine by increasing the number of receptors on the postsynaptic cell (upregulation)