paper 2-schziophrenia Flashcards
what is the prevalence of SZ
characterised by split between schizophrenics mind and reality
1% of population likely to get it
what age are people typically diagnosed
late teens, early 20s
which gender is diagnosed more often
men more commonly diagnosed
general critieria for diagnosing SZ
- report 2 symptoms must be present over 1 month period
2.reduced social functioning
how do DSM-V and ICD-10 differ in their diagnostic criteria for SZ
DSM-V states you need at least one postive symptom present
ICD-10 states need at least two negative symptoms are sufficient
what are the SZ symptoms
Speech poverty -
Avolition -
Delusions +
Hallucinations +
hallucinations
auditory or visual
delusions
irrational beliefs/paranoia
avolition
finding it difficult to keep up with goal directed activity
lack of energy, lack of persistence, poor hygiene
speech poverty
reduction in amount and quality of speech
type 1 SZ
-characterized by positive symptoms
-symptoms which are an addition to the person
type 11 sz
-characterised by negative symptoms
-normal emotions and actions effected
-things are taken away from person
what is diagnosis
identifying a disease on basis of the identification of the symptoms and signs
validity
-the extent to which something is true
extent to which a diagnosis accurately represents disorder they are suffering from
inter-rater reliability in relation to SZ
the extent to which psychists can agree on the same diagnosis when independently assessing patients
test-re-test reliability in relation to SZ
whether tests used to deliver these diagnoses are consistent over time
A03
Cheniaux et al
-had two psychriatists diagnose 100 patients using both DSM-V and ICD-10 criteria
-1 psychiatrist diagnosed 26 with schziophrenia with DSM
-44 according to ICD
-other psychosts diagnosed 13 accoriding to DSM and 24 according to ICD-10
-conclusion-inner-rater reliability is low
1 26 44
2 13 24
what were the results of both psychiatrists
DSM-V ICD-10
26 44
13 24
A03 Rosenhan
-aim-how reliable is diagnosis of SZ
-sent 7 volunteers, and he took part himself
-they had to fake being SZ without having symptoms
-said they had symptoms, ‘heard voices’ e.g ‘its empty’
-every single one was diagnosed as SZ or bipolar
-when in hospital, acted normally
-took 19 days till discharged
-he was in hospital for 2 months as coudent figure out why he shouldn’t be there
-conclusion-issues with diagnosis system in hospitals were identified
-concludes there not very good at their job
-hard to generalise
-good ecological validity as done in real life hospital
What are the 3 biological explanations of SZ (GOOD NIGHT DICK)
-Genetic explanantion
-Dopamine Hypothesis
-Neural correlates
what are candidate genes
what increase risk of sz
candidate genes for sz include
aetilogically heterogenous
polygenic
aetiologically heterogenous
different studies show different candidate genes for SZ
suggests its aetologically hetergenous meaning different combinations
polygenic
needs several factors to work together
ripke et al
what is dopamine
neurontransmitter
hyperdopaminergia in sub-cortex
-too much dopamine
-high levels of activity of dopamine in sub cortex (central area of brain)
-e.g. excess of dopamine receptors in Broca’s area may result in speech poverty
dopamine hypothesis
sz results in in excess levels of neurotransmitter, dopamine
different view is that neurons in sz patients are oversensitive to dopamine
therfore rpoduced overexaggerated respinse and realy unncessary messages to brain
hypodopaminergia in the cortex
cortex=outer layers of brain
-too little dopamine
-Goldman
-identified role for low levels of dopamine in pre-frontal cortex (decision making and thinking) in negative symptoms of SZ
-
neural correlates
measure of the structure and function of brain that correlate with experinece
-positive symptoms
-negative symptoms
neural correlates-positive symptoms
allen at al
typical antipsychotics
example-chlorpromazine
-can be taken as pill/syrup or injection
-not taken often
-most start between 400-800mg of dosage
-max dosage is 1000mg
-does declined over past 50 years
how do typical antipsychotics work
-bind to D2 receptors on neuron without stimulating reduction of dopamine
-block dopamine receptors in brain
-according to dopamine hypothesis, dopamine neurotransmitters can stop hallucinations
atypical antipsychotics
-newer then typical psychotics
-have LESS side effects
-quite effective
-lower dosage 300-400mg a DAY
-has side efefct called agranulocytosis-blood condition where white blood cells are reduced
test-re-test
whether tests are consistent over time
weakness-symptom overlap
overlap between symptoms of schizophrenia and other conditions
Ophoff et al
assessed genetic material from 50,000 participants
found seven locations of genome of SZ , 3 of them also associated with bipolar
suggests genetic overlap between the two
what are the biological explanations of SZ
GND
genetic explanation
neural correlates
dopamine hypothesis
Genetic explanation
greater genetic similarity in families, associated with how likely both will develop SZ
Gottesmans study shows:
many candidate genes for SZ
Aetiologically heterogenous-different studies found different candidate genes
suggests it has different combinations
polygenic-needs several factors to work together
dopamine hypothesis
may result in excess levels of neurotransmitter dopamine
different view is neurons in brain are oversensitive to dopamine making an overexaggerated response and relay unnecessary messages to brain
hyperdopaminergia in sub-cortex
too much dopamine
high levels of activity of dopamine in sub cortex(central areas of brain)
genetic explanation
research shows greater genetic similarity amongst family, association with how likely both will develop SZ
e.g results of Gottesmans study shows:
there are many candidate genes for SZ
atelogically heterogenous-studies show it has different combinations
polygenic-needs several factors to work together
dopamine hypothesis
SZ may result in excell levels of neurotransmitter dopamine
different view is that neurons in brain of SZ are oversensitive
neurons then produce overexagerated response and relay uncessary messages to brain
hyperdopaminergia in sub cortex
too much dopamine
high levels of activity of sopamine in sub-cortex (centreal areas of brain)
hypodopaminergia in cortex
too little dopamine
neural correlates
measurements of the structure and function of brain that correlate with experience
what are the 2 biological therapies for SZ
typical antipsychotics
atypical antipsychotics
typical antipsychotics
example-chlorpromazine
-can be taken as pill or injection that dont have to do often
-start with 400-800mg of dosage
max dosage is 1000mg
how do typical antipsychotics work
block dopamine recpetors in brain
can stop hallucinations
atypical antipsychotics
newer then typical antipsychotics
example-clozapine
lower dosage 300-400mg a DAY
side effect-agranulocytosis-blood condition where white blood cells are reduced
how do atypical antipsychotic’s work
same as typical antipsychoists so bind with D2 recpetors
however, also act as sereotonin and gluatmate receptors
help reduce depression and anxiety in patients
may improve cognitive functioning
another example of atypical antipsychotic
risperidone
typical dosage of 4-8mg
max dosage is 12 mg
how does risperidone work (atypical antipsychotic)
binds with both dopamine and serotonin receptors
but binds more strongly with dopamine receptors than clozapine
so effective in small doses
fewer side effects
A03 points for biological therapies
diagnosis
identifying disease on basis of identificatioon of symptoms and signs
inter rater reliability
extent to which psychiarists get the same diagnonis when indepndetly assessing patients
test-re-test reliabialty
whether tests are consistent
A03 point for genetic explanation
Ripke et al
-huge study
-combined aall previous data from genome studies
-foudn genetic make up of 37,000 compared to 113,000 contols
-found 108 variations associating with the increased risk of SZ
what are a03 points for biological therapies
Practical applications
Strong side effects
first strength a03 of biological therapies
practical applications
-nurses relied on antipsychotics in mental institutions to calm patients and make them easier to work with
-Davis et al performed meta analysis of 100 studies
-compared antipsychotics with placebos
found patients improved condition within 6 weeks with antipsychotics showing more useful then placebos
-strength as shows antipsychotics do help patients
-weakness-has ethical implants due to lack in consent
weakness of biological therapies
lead to serious side effects
ranging from mild to fatal
typical antipsychtoics associtd with range of side effects
-seide effects include dizziness
most serious side effect is NMS
drug blocks dopamine action in hypothalaumum
NMS results in high temp, even coma
undermine how appropriate they are
psychological explanations of SZ
schziophrenic mother
bouble bind theory
high expressed emotion
schizophrenic mother
schziophrenic=schziophrenia causing
mother is cold, rejecting and controlling
creates tension and secrecy family
leads to distrust then to paranoid delusions, leading to SZ
double bind theory
empahsises role of communication within family
child regualry trapped in situations where they worry about doing wrong thing
recieve mixed messages
feel unable to comment and how unfair this is or seek clarification
when get it wrong punised with withdrawl of love
e.g parrents complain no affection, when they give attention, they complain
makes them feel world is confusing and dangerous
results in paranoid delusions and sisorganised thinking
a03 point symptom overlap for issues with reliability and validity
considerbale overlap between symptoms a=of sz and other conidtions
ophoff et al
assessed genetic material from 50,000 paricpants
foudn that of 7 genes loactions of genome asssociated with sz, 3 of which were associated with biopolar
shows genetic overlap
what are the psychological explanations of SZ
schizophrenogical mother
double bind theory
high expressed emotion
cogntive
schziophrenigoenic mother
fromm reichman proposed psychodynamic explanation based on accounts of parents childhood
many mentioned specific type of parent-schziophrengenic mother
schziophreniogenic=schziophrenia causing
where mother is cold, rejecting and controlling causing tension and secrecy within the family
later devlops distruct which leads to paranoid delusions leading to sz
double bind theory
bateson et al emphasised communication within a family
child regulary trapped in situations where they worry about doing wrong thing
and recive mixed messages
they feel unable to comment on unfaireness or seek clarrification
when punished for doing wrong this, causes withdrawl of love
e.g parent complains no affection give affection and get complained at
mkes them feel world is dangerous and confusing
therefore leads to paranoid delusions and distorted thinking
high expressed emotion
ee is the level of emotion, mostly neagtively expressed towards sz patinets by carers
may include verbal criticsm even violence
histiity including anger and rejection
over involvement of patients life
high ee increase stress of patient and big factor of relapse
alternatively, could interact with egnetic vulnerability to cause SZ
A03 points for reliability and validity of sz
CHENIEUX ET AL
ROSENHAN
SYMPTOM OVERLAP-ophoff et al
biological explainations of SZ
Gene explantion-gottesmans
N
D
Gene explanation
much research into running of SZ in families
greater genetic simialrity amongbgt family, associated with how likely to develop SZ
e.g shown in Gottesmans study
there are many cnancdate genes for sz
aetiologically heterogenous-diffreent studies found different candidate genes suggesting sz has different combinations
polygenetic-needs several factors to work together
A03 point for genetic explanation
strong evidence for genetic vulnerability to sz
e.g gottesman showed genetic similaity and shared risk of SZ are cloeely related
also evidence from adoption studies e.g tierina et al showed children of SZ parents were still at risk of getting SZ even when adopted with no history of the condition
shows genetic plays key role in development of disorder
dopamine hypothesis
sz may result from excess levels of the neurontransmitter (dopamine)
different view is that neurons in the brain of sz are oversentive to dopamine causing an overexaggerated response and relay unnecessary messages
hypodermainergia in the sub cortex
too much dopamine
e.g excess amount in Brocas area may be repsonible for speech poverty
hypodopaminergia in cortex
too little dopamine
neural correlates
postive symptoms
allen
scanned brains of pateints with auditory hallucinations and compared them with control gorup. Found lower acitvity in the superieror temporal gyrus for halluciantions gorups who also made more errors then control group
negaitv symptoms
abnormaility may be associated with avolution
what are the 2 biological therapies for SZ
TYPICAL ANTIPSYCHCOTICS
ATYPICAL ANTIPSYCHOTICS
typical antispcyhotics
e.g chlorpromaxine
taken as pill, injection or syrup not very often
start with 400-800mg dosage
1000 max dosage
work-block dopamine receptors in the brain
atypical antipsychotics
taken as pill every day
newer then typical
fewer side effects
e.g clozapine
dosage is 300-450mg a day
side effect called argarlycostis-redcution in amount of white blood cells
binds with D2 recpetos same as chlopromaxine but also acts as glutamate receptotd and serotonin
belived helps reduce deprssion
increases congitive function
risperidone
can be taken as syrup, pill or injection
typical dosage 4-8mg
max dosage is 12mg
binds with both serotonin and dopamine receptors
binds more with dopamine receptors means it is more effective in small doses. has fewer side effects
A03 for biological therapies for SZ
Practical applications
Serious side effects
strength-practical applications
nurses has relied on in mental health institutions
been able to calm patinets so easier to work with
davis et al perfomed metal analysis
100 studies comparing antipsychotics and placebos
results found drugs were useful
improved condition within 6 weeks
fewer then 25% imporved with placebos
strength as showed postively used to help patients
critizedd as lack of conformed consent
they dont ask for it, jst given it to calm them down
weakness-serious side effects
lots of negtive side effects
atypical antipshticots have side affects ranging from mild to fatal
typical psychotics have side effects inculding dizziness and agitiation etc
belived to be beacse drugs block dopamine in the action of the hypothalmus
undermines how appropriate they are
psychological explanations of SZ
Schziphrenogenic mother
Double bind theory
High expressed emotion
schziophrenogic mother
fromm-reichmann proposed explantion based on accounts from patients childhoods
all may specific type of mother:sz mother
schziophrenogic means schziophreia causing
where mother is cold and rejecting and creates family of tension and secrey
leads to distust and later devlops paranoid delucsions leading to SZ
double bind theory
Bateson et al emphasised role of communciation within a family
child is trapped in situations where they worry about doing wrong thing
receive mixed messages. feel unable to comment abotu how unfair this is
when get it wrong punished with withdrawl of love
feel world is confsung and dangerous
results in paranoid delusions and disorgainsed thinking
high expressed emotion
high level of emotion mostly negative expressed at pateinst from cariers
may icnlude verbal criticsm even violence, hostility towards pateint, eotional over-involvemnt in life of patient
can intercat with gentic vulnerabiity developing SZ
psychological therapies for SZ
-therpies for treatment of SZ
CBT
family therapy
therapies for managment of SZ
token economies
CBT (cognitive behaviour therapy)
5-20 sessions
done by either groups or individuals
aim is to help patient identify irrational thoughts and try change them using ABC model
crtical collabaroative analysis techique inolving questioning to help patrient undertand conclusions
doesnt get rid of symptoms just helps patients cope
helps patient make sense of how hallucationation impact their feelins and behaviur
family therapy
done with families rather then SZ individuals
tries to improve communication within family
goes on for 10-12 sessions
pharaoh et al identifies a range of startegies used in family therapy to imporve functioning
-reduces anger and gulit
improves famiy ability to anticipate and sole probekms
token economies
reward systems used to manger behaviours of SZ
especially used for those hwo have spent large amoutn of time in hopsital and devloped maladaptive behaviour e.g poor hygiene
does not cure SZ but imprives quclty of life
steps for token economies
assign value to tokens
decide target behaviour e,g making bed
if do behaviour, reinforced so given token
reinforces taget behaviours
e.g coloured disks
gievn immediately to patient when do desired behaviour, reinforcement
must be immediate to delay discounting-where something less rewardi g fter a delay
tokesn switched later for rewards
these may be sweets, trips etc a walk outside of the hospital
