Paper 3 Schizophrenia Flashcards
Discuss issues of reliability and validity associated with the classification and/ or diagnosis of Schizophrenia
A diagnostic system for schizophrenia would be highly reliable if the results are consistently reproduced
strength
- Osorio et al (2019) report excellent reliability for the diagnosis of schizophrenia in 180 individuals using the
DSM-5. Pairs of interviewers achieved inter-rater reliability of +.97 and test retest reliability of +.92.
= diagnosis of schizophrenia is consistently applied.
A diagnostic system for schizophrenia would be valid if: we assess what we are trying to assess.
limitation
- criterion validity: two psychiatrists independently assessed the same 100 clients using the ICD-10 and the DSM-5
criteria that 68 were diagnosed with schizophrenia under the ICD system and 39 under DSM.
= schizophrenia is either over-or under diagnosed according to the diagnostic system. Either
way this suggests that criterion validity is low.
BUT:
agreement between clinicians when they used two
measures to diagnose schizophrenia both derived from the DSM system. This means that the criterion validity for diagnosing schizophrenia is actually good provided it takes place within a single diagnostic system.
co morbidity = conditions co occurring
limitation
- estimate that co-morbid depression occurs in 50% of schizophrenic patients, and 47% of schizophrenic patients also have a lifetime diagnosis of co-morbid substance abuse.
= schizophrenia may not exist as a distinct condition
symptom overlap = symptoms also found in other disorders
- schizophrenia and bipolar disorder involve positive symptoms (such as delusions) and negative symptoms (such as avolition). In terms of classification this suggests that these 2 disorders may not be two different conditions but variations of a single condition. In terms of diagnosis it means that schizophrenia is
hard to distinguish from bipolar disorder
Discuss the biological explanations of Schizophrenia
Discuss psychological explanations of Schizophrenia
family disfunction = abnormal
patterns of communication within the family.
- The explanations suggest schizophrenia is due to family experiences of conflict,
communication problems, criticism and control
the schizophrenogenic mother = cold, rejecting and
controlling, and tends to create a family climate characterised by tension and secrecy.
- leads to distrust that later
develops into paranoid delusions
double bind theory = emotionally distressing dilemma in communication in which an individual (or group) receives two or more conflicting messages
- child receives mixed messages and cannot do the right thing – results in disorganised thinking and paranoia.
expressed emotion = negative emotions, expressed towards a person with schizophrenia by their carers who are often family members.
- family shows exaggerated
involvement, control, criticism which increases likelihood of relapse in patients with schizophrenia.
- source of stress that can trigger the onset of schizophrenia in a person who is already vulnerable, due to their genetic make-up (the diathesis-stress model)
AO3:
strength - linking family dysfunction to schizophrenia.
= Indicators of family dysfunction include insecure attachment and exposure to childhood trauma, especially
abuse.
- adults with schizophrenia are disproportionately likely to
have insecure attachment.
= family dysfunction makes people more vulnerable to schizophrenia.
limitation - much data not
being collected under proper scientific conditions.
- schizophrenogenic mother and double bind.
- clinical observations of people with schizophrenia but also informal assessment of their mother’s personalities, but not systematic evidence.
FUTHER
- linking family dysfunction to schizophrenia is highly socially sensitive because it can lead
to parent-blaming.
Outline and evaluate drug therapies in the treatment of Schizophrenia
Typical antipsychotics
- dopamine antagonist: reduces actions of neurotransmitters
= reducing hallucinations
- sedation affect: effects histamine receptors = calming affect
Atypical antipsychotics
- clozapine more affective than typical antipsychotics = used when all other treatments fail (have to have regular blood tests)
- affects serotonin = improves cognitive functioning
- mood enhancing prescribed patient who is high risk suicide
risperidone
- alternative to clozapine without side affects
AO3:
strength - effectiveness
- comparison of placebo and chlorpromazine
- drug associated with better functioning and reduced symptom severity
BUT: we can’t account for antipsychotics as reducing severity of psychosis as its only a calming affective drug
Limitation - likelihood of side affects
- dizziness, agitation, sleepiness, stiff jaw etc.
- dopamine super sensitivity = involuntary facial movements
= do harm as well as good - experiencing this could lead to avoidance of drug and relapse
Outline and evaluate cognitive behavioural therapy as used in the treatment of schizophrenia
- Delivery of techniques to identify and manage intrusive or delusional thoughts = reduce stress and improves ability to function adequately
- patient is encouraged to develop rational interpretations or alternative perceptions, e.g.
viewing voices as interesting rather than threatening - promotes increase in social activity and use of relaxation strategies.
- Tarkington case study for challenging paranoid delusions
AO3:
strength - effective
- research and clinical experience support benefits for schizophrenia
Limitation - does not provide a cure
- improve quality of life but not cure
BUT evidence shows reduction in severity of positive and negative symptoms = does more than coping
Discuss token economies as used in the management of schizophrenia
improves = personal care, condition related behaviours and social behaviours
benefits
- improves quality of life within hospital setting
- normalises behaviour sp its easier to adapt to normal life in community
AO3:
strength - effectiveness
- studies showed a reduction in negative symptoms and
a decline in the frequency of unwanted behaviours.
= supports value of token economies
BUT: small amount of studies
Limitation - ethical issues raised
- considerable power to professionals to control patients
= benefits of token economies outweighed by their impact of personal freedom and short term reduction in quality of life
Outline and evaluate family therapy as used in the treatment of schizophrenia
reduces anger. frustration and expressed emotion = improve quality of communication and interaction between family members
- therapist meets family members and patient for open, productive discussion
- educates family members about the disorder and what to expect
- encourages the family to develop problem-solving and communication skills to
support the patient.
= Reducing stress is important to reduce the likelihood of
relapse.
= Reduces negative emotions
= Improves the family’s ability to help
AO3:
strength - effectiveness
- concluded that family therapy was one of the most consistently effective treatments available for schizophrenia.
- relapse rates were found to be reduced
- family therapy is likely to be of benefit to people with both early and ‘full-blown’ schizophrenia
strength - economic benefit all family members
- strengthening the functioning of a whole family, family therapy
lessens the negative impact of schizophrenia on other family members and strengthens the ability of the family to support the person with schizophrenia.
limitation - don’t cure schizophrenia
- Family therapy helps by reducing the stress of living with schizophrenia in a family, both for the patient themselves and other family members. These things are all worth doing, but should not be confused with curing schizophrenia.
= failure to cure is a weakness of treatment
Outline and evaluate the diathesis-stress model of schizophrenia
- vulnerability to developing schizophrenia
- onset of the condition is triggered by stress
modern = diathesis
- generic venerability
- childhood trauma
modern = stress
- canabis
- parenting
treatment
- combination antipsychotic medication and psychological therapy (CBT)
AO3: evidence supporting
- large scale study
- impact of genetic venerability and psychological trigger
= lead to greatly increased risk of schizophrenia
Limitation - original diathesis stress model is over simplicity
- schizophrenogenic parent is simplistic
= biological and psychological affects diathesis and stress = modern diathesis stress
Strength - combination of biological and psychological
- drug treatment and psychological therapies
= practical advantage to adopting interactionist approach to schizophrenia in terms of superior treatment outcomes
BUT:
successful treatment for mental disorders justifies a particular explanation
- treatment causation fallacy
= cannot automatically assume success of combined therapies means interactionist explanations are correct
