PSYCHOLOGY(SCHIZOPHRENIA)

Question 1

what is schizophrenia?

Answer 1

schiz is a psychotic disorder, which is a severe mental illness where contact with reality and insight are impaired. schizophrenia can be understood as a split between cognition and emotion.

Question 2

what is the prevalence of schiz and the prognosis?

Answer 2

PREVALENCE = affects out 1% of the population (1/100 people will have it)

PROGNOSIS = according to bleulers longitudinal study of 2000 schizophrenic patients, symptoms are most sever within early adulthood during the first 5 years after onset. bleuler found 40% of people recover from positive symptoms, 20% fully recover and 40% continue to suffer from symptoms for the rest of their lives.

Question 3

what are the 2 categories of schizophrenic symptoms?

Answer 3

> POSITIVE (presence of abnormal symptoms)
NEGATIVE (absence of normal functioning)

Question 4

what are 3 positive symptoms?

Answer 4

> HALLUCINATIONS
DELUSIONS
DISORGANISED THINKING AND SPEECH

Question 5

what are hallucinations?

Answer 5

faulty sensory inputs that create false experiences. most common ones are auditory inputs (hearing voices) and visual inputs (seeing people that aren’t there)

Question 6

what are delusions?

Answer 6

false beliefs based on facts that are hard to disprove. the three types of delusions are:
>PROSECUTION = belief you are being victimised
>GRANDEUR = belief you have great power
>CONTROL = belief your thoughts and actions are controlled by other people

Question 7

what is disorganised thinking and speech?

Answer 7

makes it hard to concentrate on anything. thoughts often jump from one thing to another with no connection between them, people describe their thoughts as “hazy”. words may also be jumbled.

Question 8

what are 4 negative symptoms?

Answer 8

> LACK OF EMOTION/FLAT AFFECT
SPEECH POVERTY
AVOLITION
APATHY

Question 9

what is lack of emotion/flat affect?

Answer 9

intensity of tone of voice, body expressions and reactions are reduced. difficulty interpreting body language.

Question 10

what is speech poverty?

Answer 10

reduction in communication, difficulty starting conversations and talking to people. short, empty replies given to questions.

Question 11

what is avolition?

Answer 11

LACK OF MOTIVATION. could neglect chores and responsibilities such as house chores and personal hygiene. low sex drive.

Question 12

what is apathy?

Answer 12

DIFFICULTY IN PLANING AND SETTING GOALS. no interest in socialising and does not want to do anything, eg may sit in house all day.

Question 13

what is symptom overlap?

Answer 13

shared symptoms between disorders. eg delusions are present in both schizophrenia and bipolar.
abolition is present in schiz and depression.

Question 14

what is comorbidity?

Answer 14

occurrence of two or more illnesses/conditions together in one person. eg 50% of people have schizophrenia and depression. 30% have schizophrenia and PTSD.

> questions validity of diagnosis as it can be tricky to classify the disorders separately.

Question 15

what are the 6 bullet points of the diagnostic criteria?

Answer 15

A-CHARACTERISTIC SYMPTOMS = must have two or more of the following for at least 1 month: hallucinations, delusions and negative symptoms

B-SOCIAL/OCCUPATIONAL DYSFUNCTION = failure to function for a significant period of time since onset, eg work, relationships or self-care

C-DURATION = some signs of the disorder must be continuous for at least 6 months. must include one symptom from category A = (ACTIVE PHASE SYMPTOMS) and may include periods of residual symptoms, where negative symptoms may be present

D-SHIZOAFFECTIVE AND MOOD DISORDER EXCLUSION = ruled out as patient has not experienced any depressive episodes at the same time as category A symptoms

E-EXCLUSION OF KNOWN ORGANIC CAUSES = disturbance is not caused by substance abuse or another medical condition

F-RELATIONSHIP TO AUTISTIC SPECTRUM DISORDER = if there is a history of autism disorders, then diagnosis is only made if prominent delusions/hallucinations are present for at least 1 month.

Question 16

what is syndrome/symptom pool?

Answer 16

group of symptoms occur together

Question 17

why is it important to classify/diagnose?

Answer 17

> put treatments into place
identify cause of disorder
predict future course

Question 18

AO3 for reliability of diagnosis

Answer 18

+COPELAND gave patient description to 134 us psychiatrists and 194 British psychiatrists. 69% of Americans diagnosed patient with schizophrenia compared to just 2% of brits. shows American clinics are more likely to diagnose

+FARMER = found standardised interview increased reliability because it focuses on severity and frequency of symptoms. all patients experience this

-READ = found test-retest to be as low as 37% for schizophrenia, can lead to false positives or false negatives. can give people AP’s when they don’t need them, or let suffering go untreated

Question 19

AO3 for validity of diagnosis

Answer 19

KONSTANTAREAS AND HEWITT = compared 14 male autistic patients with 14 male sz patients and found 50% of autistic males to have schiz symptoms.

BUCKLEY = found evidence for comorbid conditions = 50% with schiz and depression, 15% with panic disorder and 47% with substance abuse. substance abuse could cause schiz symptoms.

ROSENHAN = sent 8 mentally sound patients to a hospital to claim they were hearing voices. all of them were diagnosed and no one realised the misdiagnosis.

Question 20

AO3 for culture bias in diagnosis

Answer 20

MALGADY = interpretation of symptoms are unique to each culture. Costa Rican cultures interpret healing voices as spirits talking and praise it.

HARRISON = individuals in West Indian cultures were over diagnosed due to the over proportion of white doctors.

COCHRANE = afro-caribbean men were 7x more likely to be diagnosed with schiz than white cultures.

ESCOBAR = white doctors often over-interpret symptoms of black people, eg cultural differences in mannerisms and language

Question 21

AO3 for gender bias in diagnosis

Answer 21

NASSER = found most early research on schiz was done on men

LORING AND POWELL = gave a patient description to men and women doctors, 56% diagnosed patient with schiz when they were described as male, and only 20% diagnosed with schiz when they said the patient was female.

UNDERDIAGNOSIS = women go without treatment, social dysfunction so they don’t go to work and pay tax, decrease economy.

Question 22

AO1 for culture bias in diagnosis

Answer 22

the American DSM and other manuals are culturally biased as they do not take into account diverse cultural values.

1)CULTURAL INTERPRETATIONS = religious and cultural groups may mark some symptoms as desirable rather than insane
2)NEGATIVE CULTURAL ATTITUDES TOWARDS SCHIZ = psychological distress and mental health issues have different stigma in different cultures. undiagnosed stay suffering
3)CULTURE OF CLINICIAN = future bias, doctor may hold patient to standard of their own.
4)RACE DISCRIMINATION = research implies some countries have more or less cases of schiz. professionals perceive cultural groups differently, should be careful when diagnosing, mindful of subtle prejudices.

Question 23

AO1 for gender bias

Answer 23

the gender of the patient and clinicians seem to wrongfully impact whether they receive a diagnosis or not

1)UNREPORTED FACTS = men suffer more with negative symptoms than women, men also suffer from more substance related disorders.
2)BIASSED RESEARCH = research into schiz has failed to use female pts.
3)UNDERDIAGNOSING OF FEMALES = females are more under diagnosed than men

Question 24

what are the 3 theories of the biological explanation of schizophrenia?

Answer 24

both suggest mental disorders have physical causes
>GENETIC INHERITANCE
>DOPAMINE HYPOTHESIS
>NEURAL CORRELATES

Question 25

AO1 for genetic inheritance (bio exp)

Answer 25

there is a strong correlation between a family member having schiz and a close relative developing: EG gottesman and shields = 47% chance of child developing sz if both parents had it

people have a genetic predisposition to developing
disorder is polygenic :RIPKE found 108 genetic variants that could mediate vulnerability to sz
EG chromosomes 8 and 11 and C4 GENE

C4 GENE is involved in synaptic pruning. individuals with an active c4 gene have a higher chance of developing schizophrenia. pruning can help get rid of underused synapses but overturning can lead to schizophrenic symptoms.

Question 26

AO3 for genetic inheritance

Answer 26

+JOSEPH ET AL = twin studies = 40% concordance rate of schizophrenia between MZ twins, and 7% between DZ twins
+PRACTICAL APPLICATIONS = sz patients can be made aware of passing on a vulnerability to their disorder to their children, help them make a decision.
+TIENARI = adoption studies, if biological mother had sz then the child had 10% chance of developing(higher than other children)

-THEORETICAL FLAW = JOSEPH = MZ twins did not have 100% concordance, environmental may trigger it. interactionist approach should be considered
-BIOLOGICAL DETERMINISM = should consider psychological explanations

Question 27

AO1 for dopamine hypothesis

Answer 27

orignial dopamine hypothesis stated that the individual with sz produced too much dopamine, but was revised to include excess of dopamine receptors.

> HYPERDOPAMINERGIA = elevated dopamine activity = “system overload” can lead to positive symptoms
HYPODOPAMINERGIA = no D2 receptors in the prefrontal cortex leads to a deficiency in dopamine activity and creates negative symptoms

research for hyperdopaminergia comes from the idea that amphetamines increase dopamine. large doses of amphetamine was given to people with no history of psychological disorders and they produced similar behaviour to a paranoid schizophrenic.

Question 28

AO3 for dopamine hypothesis

Answer 28

+RANDRUP AND MUNKVAD = created sz behaviour in rats by giving them dopamine agonists. the rats were unable to filter out irrelevant sounds and had attentional issues, this was reversed with APs
+PRACTICAL APPLICATIONS = led to development of APS, typical APs reduce positive symptoms by blocking dopamine receptors in mesolimbic pathway. 85% effective

-ALTERNATIVE = family dysfunction and double bind
-THEORETICAL FLAWS = APs are not successful for 15% of people
-BIOLOGICAL DETERMINISM

Question 29

what are the three brain structures linked to schizophrenia as explained by neural correlates?

Answer 29

> enlarged ventricles
hypofrontality
hippocampus - amygdala areas

Question 30

how do these 3 neural correlates link to sz?

Answer 30

> ENLARGED VENTRICLES = increased size of ventricles in the brain can lead to negative symptoms.

> HYPOFRONTALITY = is the state of decreased blood flow in the prefrontal cortex. PFC is responsible for the motor cortex, which is to do with thinking and actions. reduced activity here can lead to disorganised thinking and speech

> HIPPOCAMPUS AND AMYGDALA REGION = both are smaller in size and volume. responsible for flat affect

Question 31

AO3 for neural correlates

Answer 31

+PROMOTES PSYCHOLOGY AS A SCIENCE

-McEWAN = nurturing influences can instigate these structural changes in the brain. children and adolescent brains are more sensitive to chronic stress (eg physical abuse) which can reshape structure of cortical regions
-THEORETICAL FLAW = enlarged ventricles are not exclusive to schiz, eg they are in parksinsons disease as well. not all sz patients have enlarged ventricles.
-ALTERNATIVE
-CORRELATIONAL

Question 32

what are 2 psychological explanations?

Answer 32

family dysfunction

cognitive explanation

Question 33

what is family dysfunction?

Answer 33

emphasises family orientated theories and the importance of childhood upbringing, especially trauma, in the development of sz in adulthood. stresses the importance of how maladaptive family relationships and poor communication contributes.

eg= child experiences trauma, which is repressed or denied unconsciously through defence mechanisms. this unconscious issue can manifest in adulthood as a sz symptom.

Question 34

what are the 3 parts to family dysfunction?

Answer 34

> SCHIZOPHRENOGENIC MOTHER
DOUBLE BIND HYPOTHESIS
HIGH EXPRESSED EMOTION

Question 35

what is the schizoprhenogenic mother?

Answer 35

the mother is domineering, controlling and overprotective. she may refuse to acknowledge her childs’ independence which can lead to faulty communication lines between them. this can lead to excessive stress and manifest as psychotic thinking.

Question 36

what is the double bind hypothesis?

Answer 36

the child receives conflicting messages. for example, a family member may say they love them, but then turn their head away in disgust. this can cause confusion and suspicion as the child cannot create a coherent construction of reality. can develop into disorganised thinking in adulthood.

Question 37

what is a high expressed emotion househould?

Answer 37

refers to family interactions and focuses more on the development of sz rather than the onset. they express considerable emotion, such as increased hostility/concern over the patient. KUIPERS found that HIGH EE households talk more and listen less.

Question 38

AO3 for family dysfunction

Answer 38

+LINSZEN = schiz patients returning to a high ee household were 4x more likely to relapse

+PRACTICAL APPLICATIONS = led to useful treatment. eg HOGARTY developed treatment that reduced social conflicts between parents and children and therefore relapse rates. family therapy….

+BERGER = found that schizophrenics reported a higher recall of double bind statements their mothers had said compared to non-sz.

-AETOLOGICAL FALLACY

-ETHICS = puts blame on family, especially mothers. can create feelings of guilt and social stigma.

Question 39

what is the cognitive theory of schizophrenia?

Answer 39

suggests that faulty behaviour comes from faulty information processing. BECK AND RECKER proposed the holistic theory that took into account structural problems in the brain, that can lead to a vulnerability to a stressful life events and therefore cognitive impairments

> cognitive biases = present when people notice or pay attention to them
cognitive deficits = impairments in thought processes such as perception and attention.

Question 40

what are the 3 dysfunctions that link to cognition

Answer 40

> DYSFUNCTION WITHIN THE SAS = supervisory attention system generates self initiated actions by allowing general strategies to be employed for novel situations. dysfunction within this can lead to not appropriately responding to environmental stimuli and therefore leads to flat affect.

> DYSFUNCTION WITHIN THE CMS = responsible for labelling and recognising thoughts/actions as “being done by me”. a malfunction within this system can lead to positive symptoms due to misattribution errors. FRITH suggested that schizophrenic patients fail to monitor their own thoughts correctly, so when they hear a voice, it is actually their own inner speech being misinterpreted. this can be referred to as “alien control system” as sufferers feel external forces are influencing their thoughts and actions

> DYSFUNCTION WITH INSIGHT/EGOCENTRIC BIAS = typically we see that we aren’t the central component to all events int he world. with sz, they tend to believe that anything and everything relates to them and jump to faulty conclusions, which leads to delusions. for example, they hear muffled voices and believe it is criticism toward them. this is known as delusions of grandeur as they see themselves as the most important person in the world

Question 41

AO3 for cognitive theory

Answer 41

+BENTALL
+STIRLING = sz patients took twice as long to complete a stroop test than others. shows inability to have central control/SAS.
+CBT CREATION = cut is successful, suggests proposed cognitive theories are correct

-AETOLOGICAL FALLACY
-REDUCTIONIST = only explained in cognitive terms, ignores other explanations with credible research.
-LESS SCIENTIFIC than dopamine. cognitions based on inference.

Question 42

what is the biological treatment for schizophrenia?

Answer 42

DRUG THERAPY (ANTIPSYCHOTICS)
APs are responsible for regulating, monitoring or blocking dopamine, serotonin and glutamate receptors. all APs can reduce dopaminergic receptors.

MODE OF ACTION :
-block receptors in mesolimbic pathway which is made up of projections from the VTA
-this system plays a key role in motivation, emotions and positive symptoms.

Question 43

what are the two types of antipsychotics?

Answer 43

> TYPICAL APS = CHLORPROMAZINE
acts as a dopamine antagonist which blocks dopamine receptors on the post synaptic neuron to reduce dopamine activity in the mesolimbic pathway. this reduces positive symptoms such as hallucinations. however it also decreases dopamine in the mesocortical pathway so can aggregate negative symptoms

> ATYPICAL APS = CLOZAPINE
work on serotonin and glutamate receptors as well as dopamine so help relieve both positive and negative symptoms as they help to increase mood and reduce depression/anxiety. they TEMPORARILY block receptors to decrease dopamine in mesolimbic pathway but they also block serotonin receptors in nigrostriatal pathway to increase dopamine and decrease negative systems.

Question 44

what are side effects of APs in the noradrenergic NT system?

Answer 44

low blood pressure
nasal conggestion
low sex drive

Question 45

AO3 for drug therapy/biological explanations

Answer 45

+DAVIS = analysed results from studies looking into the ffectivness of APs on psychotic disorders. found 55% of sz patients relapsed when their AP was replaced with placebo, and only 19% relapsed on AP.
+EFFECTIVENESS = effectiveness can be increased when combined. meds can suspend delusionary thought processes and allow the patients to engage with CBT and adress cognitive and family issues

-ROSS AND READ = said figures from Davis may be misleading, as 45% who were on placebo were still fine.
-SIDE EFFECTS = tardive dyskinesia affects about 60% of AP users. DAVISON AND NEALE found that 50% stop taking the drug after a year and 75% after 2 years because of the side effects

Question 46

what is CBT?

Answer 46

works on the basis that our thoughts, feelings and behaviours are connected and all influence each other. AIMS to challenge maladaptive thinking of the individual.

Question 47

what are the two main techniques involved in CBT for schizophrenia treatment ?

Answer 47

IPT - INTEGRATED PSYCHOLOGICAL TREATMENT

CSE - SOPING STRATEGY ENHANCEMENT)

Question 48

how does IPT work as part of CBT?

Answer 48

> aims to improve attention and refine concept information.
identify specific cognitive deficits and remedy them in a non-confrontational matter
individuals taught to respond and react appropriately to social cues to combat avolition.
taught to understand verbal cues more accurately (combat alogia and disorganised thinking/speech)
engaging group exercises to emphasise repetitive training
reality test faulty interpretations

Question 49

how does CSE work as part of CBT?

Answer 49

> manage severity and frequency of symptoms to decrease stress.
based on thorough behavioural analysis of each symptom
trained to use two types of strategies:
-COGNITIVE STRATEGIES (eg distraction techniques)
-BEHAVIOURAL STRATEGIES (listening to music to drown out hallucinatory voices) relaxation techs

Question 50

AO3 for CBT

Answer 50

+GARRET = the treatment encourages patients to take their meds. CBT was found to change a patients mind about taking her drugs. peripheral benefits alongside biological treatments
+STARTUP = investigated the effectiveness of CBT on patients who had been admitted to hospital with a culture episode. found 60% of CBT patients improved compared to 40%

-ALTERNATIVE = drugs are easier to take
-APPROPRIATENESS = patients do not have coherent thinking and may not think that they’re ill, so believe they don’t need help. KINGDON AND KIRSCHEN found older pts were deemed as less suitable for CBT sd their cognitions had already set in
-REDUCTIONIST = based on cognitive approach which simplifies brain down to computer processor.

Question 51

what are the 5 stages in family therapy?

Answer 51

> COOPERATION + TRUSTING R/SHIPS = family and patient are met in supportive environment where all members of the family are valued

> EDUCATE = made aware of symptoms, causes and prognosis. patient encouraged to open up about what makes their symptoms worse etc

> COPING STRATEGIES = coping skills to manage everyday difficulties with the disorder

> HOW TO EXPRESS EMOTION WITHOUT BEING HIGH EE = accept the family may feel anger/impatient sometimes. taught relaxation techniques to calm down before expressing concern

> RECOGNITION OF EARLY RELAPSE SYMPTOMS = so family can respond rapidly and reduce the severity. symptoms such as insomnia, paranoia and social withdrawal

Question 52

AO1 for family therapy

Answer 52

attempt to fix faulty and dysfunctional dynamic of a family that may have caused schizophrenia. aims to increase positive communication and decrease criticism/feelings of guilt about causing disorder

Question 53

AO3 for family therapy

Answer 53

+LEFT = sz patients in a programme, where there were educational sessions about symptoms, and group meetings between families on how they deal with schizophrenic members. found that families involved in the interview showed a decrease in critical comments. 78% of control group were readmitted compared to 14% in experiment.
+ANDERSON ET AL = 40% relapse on drugs, 20% with family therapy.

-METHODOLOGICAL FlAW = LEFT patients had different severity of symptoms, all took drugs differently. could not account for individual differences/participant variables
-ENVIRONMENTALLY DETERMINIST

Question 54

what is token economy?

Answer 54

behavioural therapy that manages symptoms rather than treating them. desirable behaviours are encouraged through selective reinforcement. it is based on operant conditioning, with focus on negative symptoms.

tokens are used as the reinforcement, can be exchanged for privileges. they are used for reinforcement and punishment. for example, pt receives a token when they engage in daily activities, this targets avolition. a token is taken away when a patient responds with dull emotion, this targets flat affect (negative reinforcement)

Question 55

AO3 for token economy

Answer 55

+ALLYON AND AZRIN = 45 female, chronic schizophrenics admitted to hospital. all were mute, assaultive and no longer ate with cutlery. TE reinforced behaviour such as hard work around the hospital and self care. tokens exchanged for privileges such as renting a private room. self care behaviours significantly improved
+GHOLIPOUR = reduced negative symptom scores by 46%

-METHODOLOGICAL FLAW = KAZDIN ET AL found that changes in behaviour from TE did not remain when tokens are withdrawn. hard to keep up treatment when the patient is back at home, effects are institutionally bound.
-ALTERNATIVE

Question 56

what is the interactionist explanation for schizophrenia?

Answer 56

the interactionist approach explains how a complex disorder such as schizophrenia cannot solely be explained or treated with either biological or psychological explanations/treatments.

suggests environmental stress triggers and already existing biological or psychological related vulnerability. can be explained through:
>DIATHESIS-STRESS MODEL
diathesis = how certain things make you more vulnerable to developing and can create a predisposition. this predisposition could be biological (such as genetics) or psychological (easy childhood trauma, as early trauma can affect development of the brain.)
stress = situations, experiences or events can TRIGGER this predisposition causing development of schizophrenia. MEEHLS original model suggested patients had a ‘schizogene’ that was triggered from a stressor.

RESEARCH SUPPORT = READ found people who had experienced early childhood trauma have an overactive stress response which increases vulnerability.

talk about cortisol

Question 57

AO3 for interactionist explanation

Answer 57

+WALKER found cortisol levels are higher before onset than during recovery, ensures cause and effect.
+BENTALL = meta analysis and found stress arising from abuse increased risk of SZ
+PRACTICAL APPLICATIONS = can identify stressors that may trigger a predisposition, help individuals avoid this.
+HOLISTIC

-NOT CLEAR how biological and psychological interact to cause SZ

Question 58

AO1 for interactionist treatment

Answer 58

the national institute of health and care guidelines recommends treating sz with a full range of psychological, pharmacological and social interventions.

Question 59

AO3 for interactionist treatment

Answer 59

+ANDERSON ET AL = combination of APs and family therapy had a relapse rate of less than 5%
+LONG TERM = more beneficial and effects are long lasting
+HOLISTIC = likely that sz is caused by biological and psychological explanations, so it is logical to treat it this way.

-EXPENSIVE = more expensive than a single treatment, this puts pressure on the NHS economy
-MISINTERPRETATION = participants may misinterpret side affects of their drug to be from CBT, increase the mistrust and severity of symptoms = delusions