A2 schizophrenia

Question 1

what is schizophrenia

Answer 1

a profound disruption of cognition and emotion which affects language thought and perception of self.

Question 2

where is dms 5 used

Answer 2

USA

Question 3

where is the ICD 10 used

Answer 3

europe

Question 4

what is the DSM 5 criteria for schizophrenia

Answer 4

one positive symptom so delusions and hallucinations

Question 5

what is the ICD 10 criteria for schizophrenia

Answer 5

two or more negative or positive symptoms

Question 6

what are positive symptoms of schizophrenia?

Answer 6

something an individual experiences in addition to what we would consider an ordinary existence e.g hallucinations and delusions

Question 7

what is a negative symptom of schizophrenia

Answer 7

symptoms when an individual has lost an aspect of what we consider a normal reality e.g avolition and speech poverty

Question 8

what is meant by diagnosis?

Answer 8

deciding what disorder a person has, labelling

Question 9

what is meant by classification

Answer 9

how the disorder is defined, characterisation

Question 10

what is meant by ensuring diagnosis is reliable?

Answer 10

when the criteria is used by another psychiatric they come to the same conclusion and diagnosis

this is inter-rater reliabilty

Question 11

what is meant by ensuring classification of sz is valid?

Answer 11

the criteria is accurately measuring schizophrenia and not another disorder

Question 12

what is meant by ensuring diagnosis of sz is valid?

Answer 12

accurately labelling the patient as having schizophrenia when they do

Question 13

what is the issue with classifying schizophrenia?

Answer 13

DSM 5 and ICD 10 both define schizophrenia differently

issue because we dont know if we are accurately measuring schizophrenia. If they were defining schizophrenia accurately we should have one universal definition

Question 14

what is the validity issue with diagnosing schizophrenia?

Answer 14

patients may be misdiagnosed. Given a sz diagnosis when they dont actually have sz

Question 15

what is the issue with the reliability of diagnosing schizophrenia?

Answer 15

ICD10 and DSM5 dont produce the same results.
inter rater reliability would be low because different manuals may produce different diagnosis for the same patient depending on what being used

this means some countries over diagnose schizophrenia and some under diagnose

Question 16

A03 for diagnosis and classification of schizophrenia

Answer 16

1. D&c of Sz is invalid Rosenhan: staff were quick to judge someone was SZ. This show the classification isnt measuring Sz and the diagnosis is subjective so its invalid
2. diagnosis of SZ is culturally bias as manuals say hallucinations = SZ but it ignores cultural difference. e.g talking to ancestors. afro Caribbean are several times more likely to be diagnosed w SZ.

3.symptom overlap w sz and other conditions. e.g SZ and BPD both involve avolition and delusions. classification is invalid because these may not be 2 different disorders but a variation of one disorder.

Question 17

what is co morbity

Answer 17

when a person has 2 or more disorders at the same time that may hide behind or reinforce one another

Question 18

what is symptom overlap

Answer 18

when 2 different disorders have a symptom in common

Question 19

explain schizophrenogenic mother and how it causes schizophrenia

Answer 19

she is cold controlling and rejecting and creates a family climate of tension and secrecy.

this leads to distrust then paranoid delusions then schizophrenia

Question 20

explain double bind theory

Answer 20

based on communication style within family
children who receive contradictory messages from parents are more likely to develop sz
e.g parents say they love you whilst being angry

Question 21

what was the aim of rosenhans study

Answer 21

to know to what extent a psychiatrist would abe able to tell the difference between someone with or without schizophrenia

Question 22

explain rosenhans method and results

Answer 22

12 people, 12 different psychiatric wards in america pretended to hear voices that said “thud empty hollow”

11 were admitted medicated and isolated and after acted normal again displaying no sz symptoms. they were released and diagnosed with sz in remission.

they were misdiagnosed so the diagnosis lacks validity

Question 23

how can double bind

Answer 23

the child fears doing the wrong thing because when they do they’re punished with the withdrawal of love. they understand the world as confusing and this causes disorganised thinking and paranoid delusions

Question 24

what is expressed emotion

Answer 24

the level of negative emotion expressed by a carer toward the patient

Question 25

name 3 elements of expressed emotion

Answer 25

hostility- anger and rejection verbal criticism - with violence sometimes emotional over involvement in the patients life including needless self sacrifice

Question 26

how does expressed emotion explain relapse

Answer 26

the features act as a source of stress that trigger the onset of SZ symptoms in someone who is already vulnerable

Question 27

name 2 psychological causes of schizophrenia

Answer 27

cognitive explanation family dysfunction

Question 28

explain dysfunctional meta representation

Answer 28

Dm would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather that someone else explains auditory hallucinations

Question 29

explain dysfunctional central control

Answer 29

people with SZ cant suppress automatic responses while they perform deliberate actions this explains speech poverty - inability to supress automatic thoughts and speech triggered by other sports

Question 30

A03 EVALUATION FOR psychological explanation

Answer 30

1.socially sensitive. theory says cold others cause schizophrenia - schizophrenogenic mother. this is parent blaming, mother is already suffering with their childs state to have further trauma from being blamed for it. 2.read et al. 69% of adult women and 59% of men w sz had P or S abuse during childhood. berry et al found adults w insecure attachment are more at risk of sz. suggesting FD increases risk. 3. evidence for dysfunctional thought processing. stirling et al compared results on stroop task w 30 people with and 30 w/out SZ . ptps have to name the font colour of colour words and must supress the tendency to read th word and people with sz took twice as long as they cant supress automatic responses

Question 31

what does CBT do

Answer 31

helps identify and challenge delusional thought through reality testing. the patient and therapist will examine the likelehood that beliefs are true. cbt can then be used to tackle the anxiety and depression from SZ. The therapist offers alternative/ logical explantions to the delusions.

Question 32

what is normalisation

Answer 32

another cbt strategy that involves teaching patients that voice hearing is an extension of the ordinary experience of thinking in words. understanding where symptoms come from e.g voices arent due to demons can help reduce anxiety

Question 33

2 A03 EVAL for CBT

Answer 33

1. Evidence to support effectiveness. Pontillo found CBT can reduce frequency and severity of auditory hallucinations and Jauhar reviewed 34 studies and found it improves negative symptoms. Hwvr, doesn't cure patients only improves quality of life. 2. weakness. of investigating is Cbt involes a range of techniques and symptoms. different studies involve different cbt techniques and people with a different combination of negative and positive symptoms. cant conclude how effective CBT will be for a particular person

Question 34

What is the aim of family therapy?

Answer 34

to improve the families communication and interaction as well as reducing the stress of living as a family

Question 35

Name 2 things family therapy does?

Answer 35

1. reduce negative emotions by reducing levels of expressed emotion 2. improve the families ability to help by forming a thereapeutic alliance, improve their attitudes towards sz and help family members achieve a balance

Question 36

A03 two evaluations of family therapy

Answer 36

1. evidence of it effectiveness. MCfarlane found it reduced relapse rates by 50-60%, especially when menta health initially starts declining 2. FT benefits the whole family. it reduces the stress of being a carer of a Sz and teaches carers how to have a balance in life. this lessens the negative impact of sz on the family.

Question 37

what are token economies?

Answer 37

a form of behaviour therapy when desirable behaviours are encouraged by the use of selective reinforcement

Question 38

How are token economies used for schizophrenia

Answer 38

they are used to manage the behvaiour of SZ ppl who have developed maladaptive behaviour from being in psych wards to improve their quality of life

Question 39

what is the difference betweeen primary and secondary reinforcement

Answer 39

primary is a reward that fulfils a biological need secondary reinforcers are learned and work via association with the primary reinforcer

Question 40

explain the process of token economy?

Answer 40

tokens are given out immediately to patients when they demonstrate a desirable behaviour that they want repeated tokens are later swapped for tangible rewards like sweets

Question 41

why must the token be given out immediately?

Answer 41

so they know the reward is for that specific behaviour and they should repeat it

Question 42

A03 give 3 evaluation points for the token economy being used to manage schizophrenia

Answer 42

1.evidence for effectiveness. Glowacki et al examined studies where token economy was used for SZ patients. there was a reduction in negative symptoms and the frequency of unwanted behaviours 2. unethical. imposes the institutions norms onto others. limits peoples personal freedom to look scruffy. restricting availability of pleasures may may their stay even worse. 3. not long term solution. cant continue outside the hospital as behaviours cant be monitored closely and tokens cant be delivered immediately.

Question 43

how does the diathesis stress model explain schizophrenia

Answer 43

a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the condition.

Question 44

what is the modern understanding of a stressor

Answer 44

the OG DSM model states stress is psychological and related to parenting but the modern model suggests stress is anything that risks triggering schizophrenia.

Question 45

explain the modern understanding of the diathesis stress model

Answer 45

there is no one single schizogene that causes schizophrenia diathesis can also be psychological trauma, its not just a stressor

Question 46

A03 evaluation for the interactionist approach

Answer 46

1. evidence to support. tienari et al found child rearing characterised by conflict and criticism increased risk of SZ but only if children had a genetic vulnerability. 2. Treatment causation fallacy - interactionsist treatment is effective but doesnt mean interactionist approach is correct. SZ may be purely psychological but drug treatment still works. 3. OG DSM is too simplistic. states: SZ is caused by having a schizogene that is triggered by SZ parenting style. we now know theres not just one gene and theres many forms of stressors.

Question 47

explain the genetic explanation of schizophrenia

Answer 47

SZ tends to run in families the more closely related you are to someone with SZ the more likely you are to develop it polygenic genes : COMT, DRD4, AKTI - associated with high dopamine leading to positive symptoms

Question 48

What 3 genes have been associated with schizphrenia?

Answer 48

COMT, DRD4, AKTI are associated with excess dopamine leading to the positive symptoms.

Question 49

explain the original dopamine hypothesis

Answer 49

HypERdopaminergia in the subcortex (broca's area) SZ is caused by an excess amount of dopamine in the subcortex this leads to acute episodes and symptoms like auditory hallucinations and speech poverty.

Question 50

Explain the updated dopamine hypothesis

Answer 50

HypOdopaminergia in the cortex (low levels of dopamine) this is associated with negative symptoms

Question 51

What are neural correlates?

Answer 51

structure or activity in the brain that occur in conjunction with an experience and might be causing said experience

Question 52

explain the neural correlates of positive symptoms

Answer 52

allen et al scanned brains of people experiencing auditory hallucinations whilst they identified speech as theirs or someone elses lower activation levels in the superior temporal gyrus and the anterior cingulate gyrus were found in the hallucination group who made more errors than the control group. reduced activity in these areas is a neural correlate of auditory hallucinations.

Question 53

Explain avolition using neural correlates

Answer 53

motivation is caused by the anticipation of a reward and the ventral striatum is involved in this motivation. abnormality in the ventral striatum could be involved in the development of SZ.

Question 54

A03 Give 3 evaluations of the biological explanation of schizophrenia

Answer 54

1. we dont know the direction of cause and effect for NC. it states low activity in the ventral striatum is whats causing negative symptoms but the symptoms could mean less info passing through leading to less activity. 2 evidence to suppport dopamine hypothesis. Amphetamines increase Da and worsen SZ symptoms but antipsychotics decrease DA and reduce intensity of symptoms. sz is due to abnormal dopamine 3.evidence to support genetics. Tienari found the biological children of parents w SZ are high risk even growing up in an adoptive family. Also gottesman if aunt has schizophrenia u have 2% chance of developing it, compared to 48% if an identical twin

Question 55

outline typical antipsychotics

Answer 55

The first generation antipsychotic drugs work as dopamine antagonists e.g chlorpromazine - has a sedation effect

Question 56

outline atypical antipsychotics

Answer 56

target neurotransmitters like dopamine and serotonin e.g clozapine and risperidone

Question 57

how do typical anti psychotics work

Answer 57

they are antagonists that target positive symptoms they work by blocking dopamine receptors in the synapse which reduces the action of dopamine and therefore symptoms e.g hallucinations

Question 58

why were atypical antipsychotics developed?

Answer 58

To Improve the effectiveness of drugs in supressing the symptoms of psychosis and minimise side effects

Question 59

outline risperidone as an atypical antipsychotic

Answer 59

was created to be as effective as clozapine without the side effects risperidone binds more strongly to dopamine and serotonin receptors than clozapine so its effective in much smalller doses and has fewer side effects

Question 60

A03 Give 3 evaluation for drug therapies as a treatment for schizophrenia

Answer 60

1. side effects. less serious are nausea and headaches whilst more serious are neuroleptic malignant syndome which cause coma, high temp and death. they wont take meds 2.they have unclear mechanisms. the OG DH states hyperdopaminergia causes SZ but the updated says hypodopaminergia causes sz. most drugs shouldnt work 3. Thornley et al 13 drug trials found chlorpromazine is more effective than placebo but clozapine is more effective than typical anti psychotics. treated 50% of treatment resistent patients