P3 Section C (Schizophrenia) Flashcards
What are the positive symptoms of schizophrenia
The positive symptoms of schizophrenia are hallucinations, delusions, disorganised speech and catatonic behaviour
What are the negative symptoms of schizophrenia
The negative symptoms of schizophrenia are speech poverty, avolition, affective flattening and anhedonia
What are hallucinations
Hallucinations are bizarre perceptions of the environment and can be olfactory, auditory, visual or tactile
What are delusions
Delusions are irrational and bizarre beliefs and can be of persecution (feeling like being watched) and of grandeur (like having superpowers or being a historical figure)
What is disorganised speech
Disorganised speech is difficulty organising thoughts so have poor speech
What is catatonic behaviour
Catatonic behaviour is inability or unmotivated to complete tasks
What is speech poverty
Speech poverty is lower speech fluency/productivity due to slow thoughts
What is avolition
Avolition is reduction of interests or desires and inability to initiate or persist goal-directed behaviour
What is affective flattening (lack of)
Affective flattening is lack of co-verbal behaviours (gestures when speaking) and reduction in intensity of emotional expression
What is anhedonia
Anhedonia is the loss of interests in most activities that would normally be pleasurable and can personal or bodily
What is diagnostic reliability
Diagnostic reliability is when a diagnosis is repeatedly given by clinicians
What is test-retest reliability
Test-retest reliability is when clinicians reach the same conclusions at two different points in time
What is inter-rater reliability
Inter-rater reliability is when two separate clinicians reach the same conclusions
What is Kappa Score
Kappa Score is a measure of inter-rater reliability and a score of 1 indicates perfect agreement and a score above 0.7 is considered good
What is Schizophrenia’s kappa score
Schizophrenia’s kappa score is 0.46 in DSM-V field trials
What did Copeland find in cultural differences of SZ diagnosis
Copeland found in cultural differences of SZ patients that when one description of a patient was given: 69% US psychiatrists gave diagnosis and only 2% UK psychiatrists gave diagnosis
What is symptom overlap
Symptom overlap is where symptoms exist in more than one condition which can pose issues of misdiagnosing
What did Ellason and Ross find SZ has symptom overlap with
Ellason and Ross found SZ has symptom overlap with dissociative identity disorder and found that DID patients had more symptoms of SZ than those that had been diagnosed with SZ
What is co-morbidity
Co-morbidity is the extent to which two or more conditions can co-occur
What did Buckley found in co-morbidity with SZ
Buckley found 50% SZ patients have co-morbid depression and 47% have co-morbid substance abuse
How did Ripke support genetic explanation for SZ
Ripke supports genetic explanation for SZ as he found in a meta-analysis of 150,000 people, there was 108 candidate genes involved in SZ - showing it is polygenic
How did Gottesman and Shields support genetic explanation for SZ
Gottesman and Shields support genetic explanation for SZ as he found there was a 75% concordance rate for severe SZ in MZ twins, compared to 24% for DZ twins - suggesting correlation between degree of genetic sharing and SZ symptoms
How did Tienari support genetic explanation of SZ
Tienari supports genetic explanation of SZ as she found in study of 164 Finnish adoptees, 6.7% with a biological mother with SZ also were diagnosed with SZ and only 2% of a control group without a biological mother with SZ were diagnosed with SZ
How does Joseph criticise Gottesman’s findings
Joseph criticises Gottesman’s findings by saying that it is the similar environment in which MZ twins share during upbringing which causes the high concordance rate
What is the hormonal explanation for SZ
hormonal explanation for SZ is the dopamine hypothesis that excess dopamine neurotransmitters in the brain result in the positive symptoms of SZ
How did Davis and Kahn support hormonal explanation of SZ
Davis and Kahn supported hormonal explanation of SZ by theorising the revised dopamine hypothesis which is that positive symptoms are due to excess dopamine in subcortical areas like mesolimbic pathway and added that negative symptoms are due to deficient dopamine in prefrontal cortex
How did Patel support hormonal explanation of SZ
Patel supported hormonal explanation of SZ by finding low level of dopamine in dorsolateral cortex in SZ patients compared to a normal control group in PET scans
How did Seeman and Kapur support hormonal explanation for SZ
Seeman and Kapur supported hormonal explanation for SZ by finding more dopamine receptors in post-mortem examinations of SZ patients compared to a control group - suggesting more dopamine is binding which sends more neural impulses leading to positive symptoms
What is a negative of biological explanations of SZ
A negative of biological explanations of SZ is that they are biologically deterministic as it blames biochemistry for behaviour which is immoral as it removes any responsibility for a person’s actions
How do antispsychotics reduce positive symptoms of SZ
antispsychotics reduce positive symptoms of SZ by blocking neural pathways of the brain that use dopamine
Why does L-dopa increase positive symptoms of SZ in Parkinson’s disease sufferers
L-dopa increases positive symptoms of SZ in Parkinson’s disease sufferers as they take it to increase dopamine
How does Leucht support dopamine hypothesis (hormonal explanation) of SZ
Leucht supports dopamine hypothesis (hormonal explanation) of SZ as he found in meta analysis of 212 studies, antipsychotic drugs were more effective than a placebo in treating symptoms of SZ by normalising dopamine levels
How does Noll criticise dopamine hypothesis (hormonal explanation) of SZ
Noll criticises dopamine hypothesis (hormonal explanation) of SZ by finding antipsychotics do not alleviate hallucinations and delusions in 1/3rd people so dopamine therefore can’t be the sole cause of positive symptoms
What are the psychological explanations of SZ
the psychological explanations of SZ are family dysfunction and cognitive
What is family dysfunction explanation of SZ
family dysfunction explanation of SZ is that maladaptive relationships and poor communication between family are sources of stress which can cause schizophrenia
What is Bateson’s double bind theory
Bateson’s double bind theory is the idea that children who are involved in contradictory situations with parents (where a verbal message is given but the opposite behaviour is exhibited) will often display negative symptoms like social withdrawal and the flattening effect in order to escape these double bind situations
What is another feature of Bateson’s double bind theory
another feature of Bateson’s double bind theory is that SZ patients of high expressed emotion families will often relapse and experience hallucinations and delusions when they return to their families
How does Noll support double bind theory
Noll supports double bind theory as he argues families with low expressed emotion are generally more supportive and can reduce likelihood of relapse and reduce the use of anti-psychotic medication
What is the cognitive explanation of Schizophrenia
cognitive explanation of Schizophrenia is that dysfunctional thought processing is particularly evident in those who display positive symptoms
How is cognitive explanation for SZ flawed
cognitive explanation for SZ flawed as it is impervious to reality testing since patients are unwilling/unable to consider that they might’ve been wrong since they have impaired insight
How does Baker and Morrison support cognitive explanation for SZ
Baker and Morrison support cognitive explanation for SZ as they suggest those with SZ find it difficult to separate the inner voices within their head and actual external sources
What is metarepresentation
Metarepresentation is the ability to reflect on our own thoughts and behaviours which allow us to distinguish the actions of others from our own
How does dysfunction of metarepresentation lead to SZ
dysfunction of metarepresentation leads to SZ as it disrupts our ability to recognise own actions being carried out by ourselves rather than others leading to hallucinations and delusions
Con of family dysfunction explanation of SZ
Con of family dysfunction explanation is that it leads to blaming the family
How does Sarin and Wallin support idea that faulty cognition creates positive symptoms of SZ
Sarin and Wallin supports idea that faulty cognition creates positive symptoms of SZ as they found delusional SZ patients would display faulty information processing by jumping to conclusions and failing reality testing
how does cognitive therapy support cognitive explanation of SZ
cognitive therapy supports cognitive explanation of SZ as evaluating content of delusions and assessing validity of faulty cognitions was found in NICE reviews to be more effective than antipsychotics in reducing symptoms and improving social functioning
how do antipsychotics of SZ work
antipsychotics of SZ work by reducing dopamine transmission
how do typical antipsychotics work
typical antipsychotics work by binding to dopamine receptors particularly in the mesolimbic pathway and blocking their action
example of typical antipsychotic
example of typical antipsychotic is chlorpromazine which eliminate hallucinations and delusions
how do atypical antipsychotics work
atypical antipsychotics work by blocking dopamine receptors but only temporarily and they rapidly dissociate to allow normal dopamine transmission afterwards
example of atypical antipsychotic
example of atypical antipsychotic is clozapine which has little affect on the dopamine system which controls movement so reduces side effects of typical antipsychotics
what is a problem with typical antipsychotics
problem with typical antipsychotics is that Kapur found 60-70% of dopamine receptors in mesolimbic pathway need to be blocked to be effective which will lead to extrapyramidal side effects like tardive dyskinesia (involuntary movement of face and jaw)
what is an issue with extrapyramidal side effects and tardive dyskinesia
Issue with extrapyramidal side effects is that it can lead to patients giving up their drug course
how does Crossley criticise antipsychotics
Crossley criticises antipsychotics by finding that there is no difference between reduction of symptoms between typical and atypical, but difference in side effects as atypical caused weight gain and typical leads to extrapyramidal side effects
how does CBTp treat SZ patients
CBTp treats SZ patients by identifying faulty cognitions and their link to symptoms and then encouraging patients to develop coping strategies and alternative explanations to their faulty beliefs
how does Addington criticise CBTp
Addington criticise CBTp by saying self-reflection is not appropriate at acute stage (most severe) and so drug therapy should be used first
how does CBTp lack availability
CBTp lacks availability as only 1 in 10 gain access to the therapy and of those who are offered the therapy, a significant number refuse or do not attend which limits effectiveness further
how is CBTp good long-term
CBTp is good long-term as it provides skills to cope with symptoms that can be used forever to maintain progress and challenge irrational thoughts
how does family therapy treat SZ
family therapy treats SZ by educating family of SZ disorder, reducing hypersensitivity to the disorder (as this can be a cause), teaching how to spot when an episode will occur and teaching families that 1/3rd patient symptoms do not dissipate
what did Pharoah find about family therapy
Pharoah find about family therapy that it would reduce risk of relapse and reduce hospital readmission during treatment and 24 months after and also some cases showed improvement whereas others did not
how does family therapy reduce suspicions associated with CBTp
family therapy reduce suspicions associated with CBTp as if family are involved in treatment then SZ patients are less likely to have irrational beliefs about treatment
how does Varese show environmental impact on SZ
Varese show environmental impact on SZ development by finding teenagers who had a traumatic life event before 16 were 3x more likely to develop SZ in later life compared to general population
what is token economy
token economy is a management of SZ whereby patients are rewarded for positive behaviour (like making the bed) with tokens which can be exchanged for tangible rewards within the institution like TV remote or sweets
how is token economy behaviourist
token economy is behaviourist as it uses operant conditioning in the form of positive reinforcement to make a person more likely to repeat a desirable behaviour or removing an undesirable behaviour by taking away any reinforcers that maintain it
how did Sultana support token economy
Sultana supported token economy by a meta-analysis finding token economy would reduce negative symptoms however it was unclear whether these behavioural changes lasted beyond the treatment programme
problem with token economy
a problem with token economy is that alone, it merely masks the symptoms of schizophrenia with desirable behaviours making it ineffective as the underlying cause is not tackled in any way
how does NICE support family therapy treatment
NICE supports family therapy treatment by reviewing and finding it provides significant cost savings when combined with standard care as the extra cost of the therapy is offset by the savings from lower re-hospitalisation rates due to lower relapse rate
