A2 schizophrenia Flashcards
what is schizophrenia
a profound disruption of cognition and emotion which affects language thought and perception of self.
where is dms 5 used
USA
where is the ICD 10 used
europe
what is the DSM 5 criteria for schizophrenia
one positive symptom so delusions and hallucinations
what is the ICD 10 criteria for schizophrenia
two or more negative or positive symptoms
what are positive symptoms of schizophrenia?
something an individual experiences in addition to what we would consider an ordinary existence e.g hallucinations and delusions
what is a negative symptom of schizophrenia
symptoms when an individual has lost an aspect of what we consider a normal reality e.g avolition and speech poverty
what is meant by diagnosis?
deciding what disorder a person has, labelling
what is meant by classification
how the disorder is defined, characterisation
what is meant by ensuring diagnosis is reliable?
when the criteria is used by another psychiatric they come to the same conclusion and diagnosis
this is inter-rater reliabilty
what is meant by ensuring classification of sz is valid?
the criteria is accurately measuring schizophrenia and not another disorder
what is meant by ensuring diagnosis of sz is valid?
accurately labelling the patient as having schizophrenia when they do
what is the issue with classifying schizophrenia?
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
what is the validity issue with diagnosing schizophrenia?
patients may be misdiagnosed. Given a sz diagnosis when they dont actually have sz
what is the issue with the reliability of diagnosing schizophrenia?
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
A03 for diagnosis and classification of schizophrenia
- 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
- 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.
what is co morbity
when a person has 2 or more disorders at the same time that may hide behind or reinforce one another
what is symptom overlap
when 2 different disorders have a symptom in common
explain schizophrenogenic mother and how it causes schizophrenia
she is cold controlling and rejecting and creates a family climate of tension and secrecy.
this leads to distrust then paranoid delusions then schizophrenia
explain double bind theory
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
what was the aim of rosenhans study
to know to what extent a psychiatrist would abe able to tell the difference between someone with or without schizophrenia
explain rosenhans method and results
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
how can double bind
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
what is expressed emotion
the level of negative emotion expressed by a carer toward the patient
name 3 elements of expressed emotion
hostility- anger and rejection
verbal criticism - with violence sometimes
emotional over involvement in the patients life including needless self sacrifice
how does expressed emotion explain relapse
the features act as a source of stress that trigger the onset of SZ symptoms in someone who is already vulnerable
name 2 psychological causes of schizophrenia
cognitive explanation
family dysfunction
explain dysfunctional meta representation
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
explain dysfunctional central control
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
A03 EVALUATION FOR psychological explanation
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.
- 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
what does CBT do
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.
what is normalisation
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
2 A03 EVAL for CBT
- 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.
- 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
What is the aim of family therapy?
to improve the families communication and interaction as well as reducing the stress of living as a family
Name 2 things family therapy does?
- reduce negative emotions by reducing levels of expressed emotion
- improve the families ability to help by forming a thereapeutic alliance, improve their attitudes towards sz and help family members achieve a balance
A03 two evaluations of family therapy
- evidence of it effectiveness. MCfarlane found it reduced relapse rates by 50-60%, especially when menta health initially starts declining
- 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.
what are token economies?
a form of behaviour therapy when desirable behaviours are encouraged by the use of selective reinforcement
How are token economies used for schizophrenia
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
what is the difference betweeen primary and secondary reinforcement
primary is a reward that fulfils a biological need
secondary reinforcers are learned and work via association with the primary reinforcer
explain the process of token economy?
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
why must the token be given out immediately?
so they know the reward is for that specific behaviour and they should repeat it
A03 give 3 evaluation points for the token economy being used to manage schizophrenia
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
- unethical. imposes the institutions norms onto others. limits peoples personal freedom to look scruffy. restricting availability of pleasures may may their stay even worse.
- not long term solution. cant continue outside the hospital as behaviours cant be monitored closely and tokens cant be delivered immediately.
how does the diathesis stress model explain schizophrenia
a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the condition.
what is the modern understanding of a stressor
the OG DSM model states stress is psychological and related to parenting but the modern model suggests stress is anything that risks triggering schizophrenia.
explain the modern understanding of the diathesis stress model
there is no one single schizogene that causes schizophrenia
diathesis can also be psychological trauma, its not just a stressor
A03 evaluation for the interactionist approach
- 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.
- Treatment causation fallacy - interactionsist treatment is effective but doesnt mean interactionist approach is correct. SZ may be purely psychological but drug treatment still works.
- 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.
explain the genetic explanation of schizophrenia
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
What 3 genes have been associated with schizphrenia?
COMT, DRD4, AKTI are associated with excess dopamine leading to the positive symptoms.
explain the original dopamine hypothesis
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.
Explain the updated dopamine hypothesis
HypOdopaminergia in the cortex (low levels of dopamine)
this is associated with negative symptoms
What are neural correlates?
structure or activity in the brain that occur in conjunction with an experience and might be causing said experience
explain the neural correlates of positive symptoms
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.
Explain avolition using neural correlates
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.
A03 Give 3 evaluations of the biological explanation of schizophrenia
- 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
outline typical antipsychotics
The first generation antipsychotic drugs
work as dopamine antagonists
e.g chlorpromazine - has a sedation effect
outline atypical antipsychotics
target neurotransmitters like dopamine and serotonin
e.g clozapine and risperidone
how do typical anti psychotics work
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
why were atypical antipsychotics developed?
To Improve the effectiveness of drugs in supressing the symptoms of psychosis and minimise side effects
outline risperidone as an atypical antipsychotic
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
A03 Give 3 evaluation for drug therapies as a treatment for schizophrenia
- 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
- 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
