Option 2: Schizophrenia Flashcards
what is schizophrenia?
a mental disorder characterised by disruption of cognition and emotion.
it manifests through a person’s sense of self, actions, thoughts, perceptions and language.
what diagnostic tools are used to diagnose schizophrenia (Sz)?
usually the DSM-V
what clinical symptoms are sought out to diagnose Sz?
delusion
hallucinations
disorganised speech (e.g frequent derailment, incoherence)
grossly disorganised (catatonic behaviour)
negative symptoms (e.g alogia, avolition, affective flattering)
how many symptoms of Sz are needed to diagnose Sz?
two or more
what is the exception in the amount of symptoms needed to diagnose Sz?
only one symptom needed if delusions are bizarre or hallucinations consist of running commentary or conversations.
what are positive symptoms?
these ‘add’ or distort normal functions
what are negative symptoms?
these ‘take away’ or indicate a loss of normal functioning.
explain hallucinations as a positive symptom.
- it is a sensory malfunction, meaning you perceive the environment incorrectly.
- usually hearing voices, but can also be seeing things, smelling or even feeling things that aren’t there.
- hearing voices takes on several forms; running commentary, discussion of patient, voices from another part of the body.
explain delusions as a positive symptom.
- these are bizarre beliefs, rather than perceptions. for example, paranoid delusions (fear of being watched, persecution, etc.)
- there are also delusions of reference; believing secret messages meant just for them.
- as well as delusions of grandeur; inflated self importance.
explain disorganised speech as a negative symptom.
- this is where abnormal thought processes lead to disorganised thoughts, which in turn affect speech.
- on the topic of derailment this is slipping from one topic to another, often in mid sentence.
- basically a ‘word salad’- gibberish.
explain grossly disorganised as a negative symptom.
- where you can’t start or complete a task due to a lack of focus or motivation.
- it can lead to poor functioning e.g hygiene, clothing etc.
- in regards to catatonic behaviour there is reduced response to immediate environment, rigid posture or aimless repeated motor activity.
explain speech poverty (alogia) as a negative symptom.
- these are slowed/blocked thoughts which lead to lessened speech fluency and productivity.
- most likely to be poorer at speech tasks, e.g ‘name as many…in a minute’
- there is often simplified speech as well.
explain avolition as a negative symptom.
- less interest in or desire for things
- the inability to begin any meaningful behaviour — sit around doing nothing.
explain affective flattening as a negative symptom.
- emotions are dulled — poorer emotive language use, body language, tone, etc.
explain anhedonia as a negative symptom.
- loss of interest/pleasure in most/all activities. e.g physical = food, intimacy + social= interacting with others
what is diagnostic reliability?
diagnostic reliability means that a diagnosis of schizophrenia (Sz) must be repeatable, i.e clinicians must be able to reach the same conclusions at two different points in time (test-retest reliability), or different clinicians must reach the same conclusions (inter-rater reliability).
what is inter-rater reliability, in terms of Sz?
There are concerns over the lack of reliability in symptoms: only one symptom is needed if delusions are ‘bizzare’.
when Mojtabi & Nicholson asked 50 senior psychiatrists to differentiate between bizzare and non-bizzare delusions, they found a concordance rate of +0.40 (they still disagreed more than they agreed).
this indicates that even the basic classification criteria are too vague to allow for reliable diagnosis, thus emphasising another issue with diagnosing Sz.
explain culture bias, in relation to Sz
it is assumed that Sz manifests equally across all cultures. the diagnostic criteria for Sz is based on western concepts, therefore harder to apply to non-western cultures.
it was found that 69% of US psychiatrists would diagnose a patient with Sz, only 2% of UK psychiatrists would diagnose the same person.
this is an issue because it can lead to false diagnoses depending on the culture.
define validity, in relation to schizophrenia
whether or not the classification or diagnosis is accurate and correct
define co-morbidity
two or more conditions/disorders can occur simultaneously within a patient.
explain why co-morbidity is an issue within diagnosis/classification of Sz
buckley has suggested that depression occurs in around 50% of Sz patients, while substance abuse does in around 47%.
this is an issue because it makes diagnosis and treatment harder some symptoms of Sz may be depression and so separate from Sz, while both disorders may require contrasting treatments, causing great difficulty in advising patients.
define symptom overlap
when two disorders have a common symptom.
explain why symptom overlap is an issue within diagnosis/classification of Sz
a valid diagnosis must show an illness to be distinct from other disorders and be based on a system which measures what it claims to.
research has suggested that the validity of diagnostic systems can be called into question — many symptoms of Sz are also symptoms of other disorders such as depression and bipolar.
define gender bias, in relation to schizophrenia
gender bias in the diagnosis of Sz is said to occur when accuracy of diagnosis is dependent on the gender of the individual.
the accuracy of diagnostic criteria is based on a clinician’s judgement with their stereotypical beliefs held about gender.
Boverman et al. (1970) found that clinicians in the US, equated mentally healthy ‘adult’ behaviour with mentally healthy ‘male’ behaviour. as a result there was a tendency for women to be perceived as less mentally healthy.
what are the three genetic explanations of Sz?
family studies
twin studies
adoption studies
explain family studies within Sz
this is where researchers located people with Sz and aimed to determine whether biological relatives are more likely to also suffer from Sz than non-biological relatives.
explain a family study conducted for Sz
Gottesman:
- children with 2 Sz parents had a 46% concordance rate
- children with 1 Sz parent had a 13% concordance rate
- children with a Sz sibling had a 9% concordance rate.
therefore, the greater the genetic similarity, the higher the risk of Sz.
explain twin studies within Sz
Mz twins share 100% of genes; Dz twins share only 50%.
therefore the concordance rate of Sz should be much higher in Mz twins.
if genes are the sole cause of Sz, there should be a 100% concordance.
explain a twin study conducted for Sz
Joseph:
Mz twins had a 40.4% concordance rate whilst Dz twins had a 7.4% concordance rate.
therefore the greater the genetic similarity, the greater risk of Sz.
explain adoption studies within Sz
this studies separated parents and children — therefore disentangling nature and nurture.
explain an adoption study conducted for Sz
Tiernari: Finnish Adoption Study
- 164 adoptees with Sz mothers; 6.7% ended up with Sz
- 197 adoptees with non-Sz mothers; 2% ended up with Sz.
this suggests a strong genetic basis.
define neural correlates
there is a relationship between Sz symptoms and neural functioning. e.g dopamine hypothesis
define the dopamine hypothesis
too much dopamine in certain areas of the brain causes positive symptoms of Sz.
explain the dopamine hypothesis
it is where messages from the neurons that transmit dopamine fire too easily or too often, leading to hallucinations and delusions that are the characteristics positive symptoms of Sz.
schizophrenics are thought to have abnormally high numbers of dopamine receptorson receiving neurons, resulting in more dopamine binding and therefore more neurons firing.
explain the drugs that increase dopaminergic activity
- amphetamine is a dopamine agonist, i.e. it stimulates nerve cells containing dopamine , causing the synapse to be flooded with this neurotransmitter.
- ‘normal’ individuals who are exposed to large doses of dopamine releasing drugs such as amphetamines can develop the characteristic hallucinations and delusions of a schizophrenic episode. this generally appears with abstinence from the drug.
- people who suffer from Parkinson’s disease who take the drug, L-dopa, to raise their dopamine levels have been found to develop schizophrenic-type symptoms.
explain the drugs that decrease dopaminergic activity
- antipsychotic drugs block the activity of dopamine in the brain. by reducing activity in the neural pathways of the brain that uses dopamine as the neurotransmitter, these drugs eliminate symptoms such as hallucinations and delusions.
- the drugs known as dopamine antagonists, because they block its action, alleviated many of the symptoms of Sz and so strengthened the case for the important role of dopamine in this disorder.
explain the revised dopamine hypothesis: Davis & Kahn
positive symptoms are a result of excess of dopamine in subcortial areas of the brain.
negative symptoms are a result of a deficit of dopamine in the prefrontal cortex.
what evidence is there behind the revised dopamine hypothesis: Davis & Kahn?
– neural imaging — Patel et al. used PET scans, found lower levels of dopamine in the prefrontal cortex of the Sz’s compared to the control group.
– animal studies — Wang & Dutch — depleted dopamine in the prefrontal cortex of rats, leading to cognitive impairment (i.e. a negative symptom) which could then be reversed using atypical antipsychotics.
what does the evidence from the revised dopamine hypothesis: Davis & Kahn, suggest?
it suggests that dopamine in varying levels causes different symptoms of Sz.
what are antipsychotics?
they are drugs which help manage the most disturbing forms of psychotic illness.
they can help reduce symptoms, improve day to day functioning, and increase subjective well-being.
they reduce the action of dopamine in the brain.
what are typical antipsychotics?
they were developed in the 1950s.
they are antagonists — so they bind to but do not stimulate dopamine receptors, therefore blocking dopamine’s action.
they therefore reduce positive symptoms such as delusions and hallucinations.
the symptoms usually decrease within a few days of first taking the drugs — other symptoms may take several weeks to subside.
what is an example of a typical antipsychotic drug?
chlorpromazine
what is a flaw in typical antipsychotics?
Kapur — 60-75% of dopamine receptors in the mesolimbic pathway must be blocked in order for the drug to be effective. the drug blocks dopamine receptors in all areas of the brain indiscriminately leading to side effects.
what are atypical antipsychotics?
these are ‘2nd generation antipsychotics’
they also act on dopamine receptors but they rapidly dissociate and so they do bind to the receptors temporarily, then break off to allow normal dopamine transmission which helps to reduce side effects as they are messing with dopamine transmission less.
what are the 3 main differences between atypical and typical antipsychotics?
atypical has a lower risk of side effects
atypical is more suitable for treatment-resistant patients (those whom chlorpromazine didn’t work for)
atypical can help negative symptoms and cogntive impairment as well.
what are the further differences of atypical antipsychotics compared to typical antipsychotics?
they are less focused on blocking dopamine receptors. they also have an affinity with serotonin receptors, potentially explaining the different effects compared to typical antipsychotics.
what is dysfunctional thought processing?
where lower levels of the information processing in some areas of the brain suggest cognition is impaired.
what is metarepresentation?
it is the cognitive ability to reflect on thoughts and behaviour (Frith et al. 1992).
how does metarepresentation lead to hallucinations?
this dysfunction disrupts our ability to recognise our thoughts as our own. this could lead to the sensation of hearing voices (hallucination) and having thoughts placed in the mind by others (delusions).
how does dysfunction of central control lead to speech poverty?
Frith et al. (1992) also identified of dysfunction of central control as a way to explain speech poverty – central control being the cognitive ability to suppress automatic responses while performing deliberate actions.
people with Sz experience derailment of thoughts and spoken sentences because each word triggers automatic associations that they cannot suppress.
what are the 3 types of family dysfunction as a psychological explanation for Sz?
schizophrenogenic mothers
double-bind theory
expressed emotion
what are schizophrenogenic mothers?
Fromm-Reichmann’s (1948) psychodynamic explanation is based on patients’ early experiences of ‘schizophrenogenic mothers’; mothers who cause Sz.
these mothers are cold, rejecting and controlling, and create a family climate of tension and secrecy. this leads to distrust and paranoid delusions and Sz.
what is the double-bind theory?
bateson et al. (1972) described how a child may be regularly trapped in situations where they fear doing the wrong thing, but receive conflicting messages about what counts as wrong. they cannot express their feelings about the unfairness of the situation.
when they ‘get it wrong’ (often) the child is punished by withdrawal of love – they learn the world is confusing and dangerous, leading to disorganised thinking and delusions.
what is expressed emotion (EE)?
expressed emotion is the level of emotion (mainly negative) expressed towards the schizophrenic patient and includes:
– verbal criticism of the patient
– hostility towards them
– emotional over-involvement in their life.
high levels of EE cause stress in the patient, a primary explanation for relapse in patients with Sz.
what are the 3 psychological therapies for Sz?
cognitive behaviour therapy (CBT)
family therapy
token economies
what is the aim of CBT?
the aims of CBT in general are to help patients identify irration thoughts and try to change them.
what does CBT involve?
it may involve discussion of how likely a patient’s beliefs are to be true, and consideration of less threatening possibilities.
how does CBT help patients?
patients are helped to make sense of how their delusions and hallucinations impact on their feelings and behaviour.
offering explanations for these symptoms reduces anxiety and helps the patient realise their beliefs are not based on reality.
what is family therapy?
family therapy is with families rather than the individual patients, aiming to improve communication and interaction in the family.
what do family therapists try to reduce?
they try to reduce stress within the family that may contribute to patient’s risk of relapse (reduce levels of EE).
what are the range of strategies, identified by Pharaoh et al. (2010), family therapists use to reduce the likelihood of relapse and readmission to hospital?
- reduce the stress of caring for a relative with Sz.
- improve the ability of family to anticipate and solve problems.
- reduce guilt and anger in family members
- improve beliefs about and behaviour toward Sz.
what are token economies?
token economies are reward systems (operant conditioning) used to manage the behaviour of patients with Sz who spend long periods in psychiatric hospitals.
how do token economies wprk?
tokens are given to patients who carry out desirable behaviours (e.g. getting dressed, making a bed, etc.).
this reward reinforces the desirable behaviour and because it is given immediately prevents ‘delay discounting’ (reduced effect of a delayed reward).
how are the token ‘secondary reinforcers’?
tokens have no value in themselves but can be swapped later for tangible reward (e.g. sweets, a walk outside, etc.).
they are secondary reinforcers because they only have value due to the learned association (classical conditioning) with innate primary reinforcers.
what is the diathesis-stress model?
it says both a genetic vulnerability and a stress trigger are needed to develop Sz.
what is the modern understanding of ‘diathesis’?
diathesis means genetic vulnerability
it is now believed that diathesis is not due to a single ‘schizogene’. instead it is thought that many genes increase vulnerability.
also, diathesis doesn’t have to be genetic. it could be early psychological trauma affecting brain development.
what is the modern understanding of ‘stress’?
a modern definition of stress (in relation to diathesis-stress) includes anything that risks triggering schizophrenia (including psychological stress).
Varese found that children who experienced trauma before the age of 16 were 3 times as likely to develop Sz in later life compared to those who didn’t experience childhood trauma.
how would diathesis-stress work?
both diathesis and stress add up to total to Sz. so a person with a large genetic vulnerability may only need a small stress trigger to push them over.
