Component 3- Schizophrenia Flashcards
1
Q
Characteristics: What is schizophrenia?
A
- lifelong. psychotic illness that affects around 1% pop
- symptoms cause individual to lose touch w/ reality
- lifelong, can be treated but no cure. patients will typically suffer episodes of severe symptoms and periods being symptom free
- schizophrenics typically not dangerous. Increased risk of violence but risk schizophrenics pose to public is minimal and media exaggerates this
- no known single cause and is likely to ne caused by multiple interacting factors
- most schizophrenics have difficulty accepting diagnosis as they believe delusions and/or hallucinations real or do not have adequate language skills to fully express beliefs.
- experience of illness differs between different people
2
Q
How did Kurt Schneider (1959) suggest categorising the symptoms of schizophrenia?
A
Individuals with schizophrenia will vary substantially on most features of the disorder.
Schneider suggested categorising the symptoms into positive and negative symptoms:
Positive: symptoms/behaviours individual shows in addition to typical behaviours, so if they did not have SCh, they would not have symptom. Hallucinations, delusions and disordered thinking
Negative: symptoms/behaviours that inhibit those with Sch from showing typical behaviours such as being able to hold a conversation. Alogia, avolition, andhedonia, flatness or affect and catatonic behaviour
3
Q
Delusions
A
- fixed beliefs that are not true
- content may include a variety of themes including religion, somatic, persecution (most common), grandiose etc.
- persecution (belief one will be harmed, harrassed by person, group/organisation)
- grandiose (individual believes they have exceptional abilities, wealth or fame
- delusions are implausible and not understandable to same cultured peers and do not derive from ordinary life experiences
- example: someone has removed someone else’s organs and replaced them with another person’s without leaving any scars or wounds.(bizarre delusion
- example: one is under surveillance by the police, despite lack of evidence (non bizarre belief)
4
Q
Hallucinations
A
- perception-like experiences that occur without an external stimulus
- vivid, clear, with full force and impact as normal perceptions and not under voluntary control.
- auditory hallucinations most common, but may occur in any senses
- auditory usually experienced in voices whether familiar or unfamiliar, distinct from individual’s own thoughts
5
Q
Disorganised thinking (speech)
A
- typically inferred from speech
- switching from one topic to another (derailment or loose associations)
- answers to questions may be only loosely related or completely unrelated
- rarely speech may be so severely disorganised that it’s nearly incomprehensible
- may be severe enough to substantially impair effective communication
- less severe disorganised thinking/speech may occur in the prodromal periods of Sch
6
Q
Grossly disorganised or Abnormal Behaviour (including Catatonia)
A
- symptoms lead to difficulties performing everyday tasks
- catatonic behaviour is a decrease in reactivity to the environment. Resistance to instructions (negativism) to maintaining a rigid, inappropriate or bizarre posture, to a complete lack of verbal and motor responses (mutism and stupor). May also include purposeless and excessive motor activity for no reason (catatonic excitement).
- staring, grimacing, mutism, echoing speech
- catatonia is associated with Sch but may occur in other mental disorders
7
Q
Negative symptoms
A
- diminished emotional expression and avolition
- diminished emotional expression includes reductions in expressions of emotions in face, eye contact, intonation of speech and movements of the hand, head and face that normally emphasise emotions in speech
- avolition is a decrease in motivated self initiated purposeful activities.
- alogia, anhedonia, asociality
- alogia manifested by diminished speech
- anhedonia is the decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced
- asociality is the lack of interest in social interactions
8
Q
prodromal symptoms
A
- appears before the typical schizophrenic symptoms, particularly in young people. A prodrome of nonspecific symptoms appear, which is and early symptom indicating the onset of disease or illness. For those about to experience first episode of Sch, they may show prodromal symptoms in weeks and months before.
- loss of interest in usual activities
- avoiding others company
- staying away from school or work
- being irritable and oversensitive
- lack of interest in personal appearance and hygiene
- generalised anxiety
mild degrees of depression
these symptoms alone not enough to diagnose Sch as they are characteristics of other mental disorders such as depression or bipolar disorder. Only in retrospect once Sch has been diagnosed that these symptoms may be seen as the onset of the disorder.
9
Q
Diagnosis criteria
A
- a patient is assessed against set criteria to receive a diagnosis.
- In the UK and Europe, the criteria are laid out in the ICD-10. Medical classification list by the World Health Organisation (WHO)
- In the USA, the DSM-5 is used. Diagnostic and Statistical Manual of Mental Disorders and is published by the American Psychiatric Association (APA)
- both systems aim to clarify symptoms of illnesses to enable medical professionals to diagnose patients
- a lot of overlap between the two systems
- some differences, so an individual may receive a diagnosis for an illness with one criteria but not the other
- While DSM focusses exclusively on mental illness, ICD has a wider scope and includes physical illness
- both systems could be argued to be culturally biased. Created in west and are based on western ideals of mental health. The research that the systems are based on are predominantly conducted in western countries.
10
Q
Introduce the dysfunctional families social explanation for schizophrenia
A
psychoanalysts such as Frieda Fromm-Reichmann suspected family relationships could be the catalyst for the development of schizophrenia. Although the major concepts of the psychodynamic approach to scizophrenia were declining in popularity by the 1950s, the idea that family relationships could be a causal factor remained a popular idea. The double bimd theory and expressed emotion were two of the most influential explanations for this.
11
Q
What is Metacommunication, as a concept in the Double Bind theory?
A
- sch may develop when child repeatedly exposed to social intercations with 2 conflicting messages and child does not have opportunity to adequately respond to or ignore them
- double bind theory states it is the way parets/family members interacts with child that causes sch
- if child repeatedly exposed to double bind statements/communication they become incapable to responding logically to others, as the verbal and non verbal contradictions counteract with each other
- Due to child also being so reliant on parent, they are unable to metacommunicate (cannot comment on the fact that contradictory messages have been used)
- Bateson (1956) was clear this was not the main type of communication in family or only sch factor, just a risk factor
- e.g. mother tells child she loves them but in a tone of voice that does not suggest love
12
Q
What is Paralanguage, as a concept in the Double Bind Theory?
A
- Paralanguage is the non verbale cues that betray true feelings such as body language, tone of voice and facial expressions.
- the words a child hears may not match with the paralanguage shown by parent e.g. if a prent asks child if they want to be read a bedtime story, the words imply the mother wants to, but paralanguage may show mother’s true feelings that she doesn’t want to read a story.
- child receives conflicting messages. Whatever the child’s actions, they cannot win, as they are in a double bind. If child says yes to bedtime story, mother will be unhappy when doing so which will be unpleasant for child. If child says no, they are rejecting mother which may be punished by mother for not showing how loving they are
13
Q
How do double bind statements impact future relationship formation for an individual?
A
- children who grow up with double bid statements regulalry learn they have no idea how to respond in a reasonable way in conversations
- double bind interactions with a role model, usually parent, so grow up belieivng all relationships work in this way
- in future struggle establishing normal relationships
14
Q
How does the double bind theory link to the symptoms of schizophrenia?
A
- Bateson (1956) claimed long term exposure double bind contradicting messages means child learns to perceive the world in terms of contradictory environmental input and cannot discriminate between contradictory messages, as they have internalised the double bind situation
- argued double bind statements may eventually lead to hallucinations and delusions of sch. Arise to escape conflict caused by contradictory double bind statements. They can also cause child to respond with maladaptive thinking patterns to help them navigate social situations, such as ‘all statements are to be taken literally’
- Berger (1965) interviewed schizophrenics and found they had a higher recall of double bind statements from mother than non schi controls
15
Q
Outline Expressed Emotion, as part of the dysfunctional families social explanation for schizophrenia
A
- Evidence that interactions within family can be a key factor in maintaining schizophrenic symptoms of those with schizophrenia.
- expressed emotion refers to the harmful family environment thatinvolves quality of ineraction patterns and nature of family relationships among the caregivers and patient with schizophrenia.
- families who engage in expressed emotion (EE) show high levels of criticism, hostility and emotional overprotectiveness
- Kavanagh (1992) found schizophrenics in families with high expressed emotion four times more likely to relapse compared with those who live in families with low expressed emotion
16
Q
Outline the study by Brown (1959), in relation to expressed emotion
dysfunctional families social explanation
A
- 1950s, specific antipsychotic drug used to treat sch but many patients soon readmitted to hospital after being released due to symptom relapse
- Brown (1956) investigated 156 men with sch after discharge and found relapse strongly connected ti type of home men discharged to. Men discharged to stay with parents/wives more likely to relapse than men who lived in lodgings/siblings
- Brown conducted interviews with wives and parents of individuals with schizophrenia
- found relationship between amount of expressed emotion and likelihood of relapse
17
Q
State the components of expressed emotion suggestes by Brown (1959)
A
- critical comments
- hostility
- emotional over involvement
- warmth
- positive regard
18
Q
What are critical comments, as a component of expressed emotion suggested by Brown (1959)
dysfunctional families social explanation
A
comments made by caregiver regarding behaviours of schizophrenic.
* Brown found high EE caregivers tended to make negative comments about behaviour of patient and may express frustration with them in emphasises tone
* low EE caregivers tended to acknowledge behaviours due to illness
19
Q
What is hostility as a component of expressed emotion, suggested by Brown (1959)?
dysfunctional families social explanation
A
hostility is either absent or present in interviews
* hostility present in interviews with high EE caregivers
* hostility thought to be consequence of unmanageable anger and irritation directed at individual, which followed by critical comments leads to rejection of patient
20
Q
What is emotional overinvolvement, as a component of expressed emotion suggested by Brown (1959)?
dysfunctional families social explanation
A
- manifests itself in high levels of both happiness and sadness, excessive self sacrifice and extreme over protective behaviour of caregiver towards patient
- especially evident in parent caregivers as repeatedly report feelings of guilt for illness, as excessively trying to repair damage
- this may discourage individual’s skills and self reliance so over protection hinders recovery of patient
21
Q
What is warmth, as a component of expressed emotion, suggested by Brown (1959)?
dysfunctional families social explanation
A
- assessed based on amount of kindness, concern and empathy expressed by caregiver during interview
- largely dependent on vocal qualities and behaviours that convey empathetic tone, such as smiling
- considered one of primary characteristics of low EE families
22
Q
what is positive regard, as a component of expressed emotion, suggested by Brown (1959)?
A
- refers to the number of reinforcing statements made by the caregiver which express both support and admiration of patient
- positive regard lacked in high EE caregivers
23
Q
What is an overall limitation of the dysfunctional families social explanation for schizophrenia?
A
- arguable theories out of date
- developed decades ago and much of research also conducted many years ago
- society undergone huge social changes and alterations have occurred with how communication takes place, such as the introduction and evolvement of social media.
24
Q
What are the strengths of the dysfunctional families social explanation of schizophrenia?
A
- research support for expressed emotion: Vaughn and Leff (1976) show clear support for role of EE in relapse rates. Found 53% schizophrenics with high EE realtive relapsed within 9 months, but only 12% of those with low EE relatives relapsed. BUT not all research supports. McCreadie and Phillips (1998) failed to find higher subsequent 6 and 12 month relapse rates among schizophrenics. Not only factor that determines relapse
- practical applications: exploring roles that family dynamics play in the exprience of schixophrenia can lead to advances in therapy. Schizophrenic therapy relies on a holistic approach rather than just finding the right combo of medication and clear family can play huge role in recovery. Family assessments can be used to plan treatment such as relapse prevention. e.g. family intervention to help families of schizophrenics work toegther to reduce stress and help person cope. NICE guidelines reccomend this therapy for schizophrenics in close contact with family.
25
Q
What are the weaknesses of the dysfunctional families social explanation for stress?
A
- where do double bind communications come from?: key part of double bind explanation is to offer an account for origins of the dysfunctional communication. Koopmans (1997) notes incidental variations in family interactions that normally would not have big impact, may at times of family disruption, lead to double bind communications. This offers a reasonable explanatiom for how double bind communications could be established in family, but there is little empirical evidence to support, which is needed for greater elaboration of origins of dysfunctional communications
- cause and effect: double bind theory argues that contradictory messages from parent to child that leads to sch in children. BUT not necessarily the case as may not be that double binding communication is the CAUSE of sch. Liem (1974) found no difference in communication styles during a structured task, involving 11 sons with schizophrenia and their parents, compared to 11 sons without sch and their parents. Suggested the studies that did find difference may actually just be detecting parents who have had to adapt to their communication styles when dealing with schizophrenic child, suggesting communication difficulties suggested by double bimd theory are just an EFFECT, rather than the CAUSE of schizophrenia
26
Q
What are the methodological issues with the dysfunctional families social explanation for schizophrenia?
A
- many of studies investigating family communication (double bind and expressed emotion) use self report, where schizophrenics and/or families asked about their relationships and communication. Open to social desirability bias where participants give the ‘correct’ answers they believe the researchers are looking for or deliberately the opposite.
- Controlled Observations : some studies avoid issues raised by self report with controlled observations. Schziphrenics observed communicating with family members in home or in controlled environment and communication recorded and analysed. Open to demand characteristics where participants behave differently when they are aware they are being observed
27
Q
What are the social issues with the dysfunctional families social explanation of schizophrenia?
A
- Theory does not make specific reference to mother as main generator of double bind statements, theory criticised as being sexist. Traditionally mothers children spent most time with and more of child’s communication will be with mothers so mother likely to be held accountable.
- both theories ignore role of gender and little attempt been made to investigate effect of gender
28
Q
What are the cultural issues with the dusfunctional families social issue of schizophrenia?
A
- both theories ignore role of culture.
- most research into effect of dysfunctional families on schizophrenia comes from western, industrialised cultures.
- Different cultures have different family dynalmics and communication styles
- different cultures have different acceptable pareenting styles e.g. in terms of corporal punishment, this is illegal in many european countries but in UK, smacking children for bad behaviour is still legal.
29
Q
What are the ethical issues with the dysfunctional families social explanation for schizophrenia?
A
topic is socially sensitive which means there are ethical implications as to how the findings of research in this field should be presented to avoid further bias, prejudice and discrimination.
30
Q
Introduce antipsychotic drugs as a method of modifying schizophrenia
A
- most common treatment
- unsuccessfully treated by psychiatrists before first antipsychotic meds first used, in many ways, for example asylums and whirling (patient placed in chair and spun until lost consciousness)
- all these methods are barbaric and unsuccessful, so is therefore not surprising that within one year of Delay and Deniker (1952) publishing a paper highlighting the virtues of the drug chlorpromazine it was being used extensively to treat numerous psychiatric conditions including Schzophrenia
- no cure for schizophrenia and drugs only control the symptoms
- different drugs have different effectiveness on different people, not one size fits all.
31
Q
What is the dopamine hypothesis?
methods of modifying-antipsychotics
A
- antipsychotics alter effect of dopamine in brain
- proposed that excess levels of neurotransmitter dopamine may cause schizophrenia. First notices in 1950s that a drug used for parkinson’s disease that increases dopamine levels can produce many schizophrenia symptoms
- in experiments, participants can show positive symptoms of schizophrenia (e.g. paranoid delusions) when injected with drugs that increase dopamine
- dopamine attaches to dopamine receptors on dendrites of receiving neurones, which causes the electrochemical impulse to activate receiving neurone.
- there are D1-D5 receptors (different receptors in different parts of brain)
- D2 receptors found mostly in limbic system (system of subcortical structures engaged in many functions, e.g. memory and emotions)
- too much dopamine activating D2 receptors actvating mesolimbic pathway in limbic system may cause overstimulation and may explain some positive symptoms such as delusions and hallucinations
32
Q
What are Conventional Antipsychotics?
A
- ‘typical’ antipsychotics
- first developed in 1950s
- block action of dopamine
- chlorpromazine acts primarily as an antagonist (blocking agent) of D2 receptors
- also blocks D1, D3, D4 and D5 receptor sites
33
Q
How do Conventional Antipsychotics work?
A
- after presynaptic neurone releases dopamine into synapse, receptor sites on postsynaptic neurone are blocked by chlorpromazine, so reducing activity in postsynaptic neurone
- initially this causes presynaptic neurone to increase dopamine release
- BUT in due course, dopamine production stops because it is depleted and amount of dopamine in synapse decreases
- lower levels in synapse and blockage of receptors sites leads to substantial decrease in neural activity
34
Q
What are the side effects of antipsychotics?
A
- movement effects such as uncontrolled facial movements
- sedation: sleepiness and low energy
- weight gain, which can lead to diabetes
- dizziness(side effect of typical antipsychotics)
- hallucinations
- serious side effects including decreased white blood cell count- weaknened immune system
35
Q
What are Atypical Antipsychotics?
A
- aka ‘newer’ or ‘second generation’
- developed in 1980s and 1990s due to potentially damaging side effects of typical
- tend to have less severe side effects than conventional antipsychotics
- tend to work faster, which is important in long term management
- clozapine is very effective but has some serious side effects so tends to only be used if patient has not responded to any other treatments
- antipsychotics can work as antagonists or partial agonists
- antagonists reduce dopamine all over brain, whereas partial agonists occupies receptors of areas where dopamine too high, but only gives a partial response so it reduces dopamine activity in that area. In areas where dopamine too low, it boosts dopamine levels, so less likely to lead to side effects that antagonists cause by reducing dopamine all over brain, such as weight gain.
36
Q
What are the differences between conventional and atypical antipsychotics?
A
- atypical are received at fewer dopamine D2 receptor sites and at more D1 and D4 receptor sites, in comparison with conventional
- most atypical also antagonise the serotonin receptor 5-HT2A to the same degree as they antagonise dopamine D2 receptor
- ‘Fast off theory’ (Seeman 2002) argues atypical antipsychotics bind more loosely to the D2 receptor sites than conventional antipsychotics, meaning although the blockade has a therapeutic effect, it does not last long enough to also produce the side effects that conventional antipsychotics cause
- the ‘half life’ of atypical antipsychotic medication thought to be less than conventional antipsychotic medication. with Atypical antipsychotics, the occupancy of D2 receptors falls off within 24 hours, however with conventional antipsychotics, the fall off is longer than 24 hours.
