schiz Flashcards
classification of schiz & symptoms AO1
AO1=
- positive symptoms= exp in addition 2 normal exp examples= halluications e.g distortions verbal/auditory delusions= irrational beliefs ab self/ world
- wt r negative symptoms= loss of normal exp/ abilities examples = avolition= lack purposeful willed behaviour no energy, speech poverty= brief verbal communication style loss of quality & quantity of verbal responses. can b classified as + sympt if disorganised speech
- issues w reliabiliyt extends 2 which findings r consistent. for schiz could include inter-rater reliability where same patient w same symptoms given same diagnosis by multiple psychiatrists
- test retest too when same patient presents w same symptoms over time & receives same diagnosis
AO3 points for classification of schiz
evidence for low inter-rater reliability in sz diagnosis= beck asked psychiatrists 2 review the diagnosis of 153 sz patients. only found 54% concordance rate between psychiatrists diagnosis. casting doubt on reliability of classification system used 2 diagnose sz as low inter-rater reliability suggests there is diff in using it to accurately diagnose patients
gender & culture bias e.g african ppl more likely 2 be diagnosed
rosenhan & confed went to mental institution reporting hearing words such as empty, hollow&thud which were not in any classification system of sz. psychiatrsist gave them diagnosis of sz & taken 2 menatl hospital. once in they dropped symptoms & found that even after acting normal some had 2 wait months to be released. after exp rosehan told instituiins hes sendinf pseudo pateints over & mental institutions identified potential pseudo pateints even tho rosenhan sent none. shows evidnece for lack of validity in diagnosis of sz as drs r uncertain of characteristics of sz aswell as how 2 identify suffererd from regular ppl. implications on society suggesting many ppl inaccuratelt diagnosed & not given adequate treatment
Reliability & validity in diagnosis & classification of schiz mention culture, gender, comorbid, symp overlap
AO1=
reliability= how consistent results r using same measuring tool so if measured again get sme results e.g biological assement / questionnaire. inter rater helps w relibailty e.g measure of how 2 observers agree e.g 2 dr giving same diagnosis. test retest relibaility = same dr giving same diagnosis overtime w same symptoms
validity= accuracy of measurements made 2 see if schiz is actually a real disorder w unique set of symptoms
gender bias= most rsrch done is typically on MEN so women r not represented as much in rsrch due 2 standardisation issues e.g women exp much greater hormonal fluctuations. leads 2 difficulty diagnosing women coz rsrch leans towards male norm. ALSO AVG AGE DIAGNOSES IN MEN =25 , 5 YRS EARLER THAN WOMEN
ALSO most psychiatrists r typically white elderly & male thus diff 2 relate to woman w sz so cannot diff between how sz occurs diff between men & women.
comorbidity= coz schůzi often diagnosed w other disorder cld lead 2 inaccurate diagnosis of schizophrenia when cld jus b severs case anx depr.
symptom overlap= bipolar disorder also has hallucinations so if 2 disorder r so similar maybe theyre not 2 distinct disorder & shld be looked into again
culture= ppl w afro-carribean heritage 9x more likely 2 b diagnosed w schizz comp to 1% general pop. specific example is how hearing voices angels= defined as audiotry hallucination in UK but religious exp in West Indies
AO3 Reliability & validity in diagnosis & classification of schiz mention culture, gender, comorbid, symp overlap
- BECK REVIEWD 153 PTS DIAGNOSED BY MULTIPLE DR & FOUND ONLY 54% CONCORD RATE BETWEEN DR ASSES… LOW INTER-RATER RELIABILITY THUS WRONG PPL DIAGNOS & INAPP TREATMENT
COORMORB= BUCKLY FOUND FOLLOWING COMORBID RATES W SCHIZ. 50% depression, 47% drug abuse, 29% PTSD, 23% OCD. shows original diagnosis of schiz may b error if disorders share symptoms & schiz complicated.
- rosenhan study him & confed gone 2 mental insitut reporting hearing words thud & hollow WHICH WERENT ON ANY CLASSIFICATION LIST 4 SHCIZ. psychiatrists gave them schiz diagnoses & took 2 mental hospital. once in dropped sumpoyms & found even after acting normal took 2 months to b released. after he said he’d send pseudo patients but didnt & hospitals identified potential sent patienys. shows evidnece for lack of validity in diagnosis of sz as drs r uncertain of characteristics of sz aswell as how 2 identify suffererd from regular ppl. implications on society suggesting many ppl inaccuratelt diagnosed & not given adequate treatment
- study 290 psychiatrists w 2 near identical case studies only diff being race & gender patient. found black ppl typica over diagnosed w schiz & women underdiagnosed. MOST ACCURATE CA,E WHEN RACE X GENDER OF PSYCHIATRIST MATCHED CASE STUDY SO SHOWS EVIDENCE FOR CULTURE & GENDER BIAS IN DIAGNOSIS OF SZ
AO1 bio expl schiz genetics and neural correlates, including the dopamine hypothesis.
AO1
dopamine hypothesis= symptoms of schiz r assosciated w too much/ imbalace of dopamine near-transm across brain. exact mechanism unsure but but excessive amounts dopamine in speech areas e.g broca= auditory hallucinations & lower levels in areas= frontal cortex lead 2 negative symptoms e.g avolition/ speech therpary
- suggests schiz is inherited & results frim biological process driven by activity of certain genes such as for brain structure & neurotransmitter levels
no specific schiz gene but collection of gene locations have been located that r associated w higher risk of developing schiz. means schiz thought 2 be polygenic disorder
Neural correlates= r variations in neural structures & biochem that r correlated w increased risk developing schiz. ppl w enlarged ventricles of brain associated w schiz
dopamine hypo came from obs that dopamine releasing drugs e.g L-dopa could prroduce schziophrenic like symptoms in healthy individuals. also how anti-psychotic drugs devrease symptoms & reduce dopamine
AO3 bio expl schiz genetics and neural correlates, including the dopamine hypothesis.
CT scan research= first identified ppl w schiz had larger than average ventricles thus may be linked 2 schiz. CS=… CANT ESTABLISH CAUSE X EFFECT
+ meta analysis review 212 studies studies assesed effectiveness of biologucal antipsychotic drug treatments that work via normalising levels dopamine. results showed they were more effective than placebo suggesting underlying biological expl schiz has valdiity coz successful.. CA= CBTp cld b better
- biological explanation sugegsts schiz is inevitable/ biologically determined. potentially making sufferers feel disempowered when diagnosed. other more psych approaches e.g cog approach has soft determinist perspective suggesting that mental processes can be altered / managed via free will e.g CBT 2 control disorder
- ASLO biologically reductiosnit better exp = diathesis approach e.g environmemntal factors
psychological & cog expl schiz
AO1 psych
- family dysnfunction= explanation that schiz suggesting its interperosmal rsp wthin family results in symtpoms
- schizophrogenic mum= psychodynaic theory tht suggests ppl w schiz get paranoid delusions coz of cold controlling mother & passive father. she creates atmosphere stress/tension/fear & secrecy which triggers psychotic thinking
- double bind theory= child gets mixed messages & feels unable to do correct thing. e.g being told they need 2 be independent but being criticsed & shouted at when independent. bateson suggests this leads 2 disorganised thinking & paranoia
- expressed emotion= verbal interactions caregiver has w persom w schiz e.g i do sm for you its hard for me……………….
- ^^ criticism & control of sufferers of bhvr= u dnt know how 2 do anything listen 2 me & do as ur told
- ^^ hostiltiy towards sufferer e.g physical verbal emotion towards such as ur a watse pf space
AO1 cog
- based on assumption of dysfunctional tht process. “attention deficit theory” suggests schiz is due 2 faulty attention system unable 2 filter preconscious thought & gives too much signig 2 info thatd normally be filtered thus overfilling mind. accounts for + symptoms e.g hallucinations/delusions
- also suggests ability 2 suppress & override automatic actions & speech & make deliberate actions 2 achieve goals ( CENTRAL CONTROL) is sometimes faulty in schiz patients. explain this e.g urges to open random doors or delusions. also speech derailment (saying random thoughts out loud) can b explained by inability 2 resist expressing automtic thoughts
- ability to identify own thoughts & actions as own by paying attention to them= meta representation & faults in this system resukts in delusions of control feeling that ur own actions r controlled by outside force
AO3 PSYCH & COG EXPL
AO3 PSYCH
+ meta analysis of 27 studies relapse in2 schiz is signif more likely in families w issues w expressed emotions… CA= impossible 2 demons cause `& effect rsp, cld b that schiz sufferer cant express feelings/ communic effectively causing porblems w fam rsps not other way round
+ family therapy real life application. can support family dysfc & shown 2 be effective
- famoly dysf theory= socially sensitive coz parents/fam alr dealing w schiz indiv & additional rsrch can cause more stress/ anxiety making family think theyre responsible
+ study of biological children of schiz mothers who’ve been adopted. found 5.8% of those adopted 2 healthy families developed schiz & 36.8% riased in dysfunctional developed schiz. SUGGESTS INTERPERSONAL FAMILY ENV HAS SIGINIF IMPACT ON DEVELOPMENT OF SCHIZ IS GENETICALLY VULNERBALE 2 PPL CA….= CA= psych factros dont explain whole pic coz these individuls were gentically vulnerable & 5.8% of them in healthy fam developed schiz WHICH IS FAR HIGHER THAN 1% expected public. so incompl theory on its own
AO3 COG=
+ supported ideas w cog neurosc studies. 30 schiz patients w various symptoms had PET scans. scans inidcated reduction in blood flow in frontal cortex w patients w -tive symptoms e.g avolition & inability 2 suppress automatic thoughts. also scans showed increaswed activity in area of temporal lobe resposnilne for retrieval memories w patients w reality distortions.. suggests that theres biological diff in schiz brain regions assosc w theorised cog processes CA= REDUCTIONIST
typical & atypical schiz
AO1=
DOPAMINE HYPOTHESIS explain
- antipsych= meds used 2 control psychosis e.g delusions & hallucinations.
- Typical= first gen drug therapy w severe side eggects ONLY TREATING POSITIVE SYMPTOMS.
- psoitibe sym,ptoms= excess dopamine
- example= chloropromazine. drug works by reducing dopamine activity by blocking dopamine receptors in synapse. calms dopamine systm in brain reducing halluincatiosn also has sedative effect.
- side effects= dry mouth, constipation, lethargy, unctrollable muscle movements usually affecting face
- A-typical= second gen to avoid severe side effects
- e.g clozapine
- block dopamine receptors BUT ALSO ACT ON OTHER NEUROTRANS E.G ACETYLCHOLINE
- also reduces negative e.g avolition
- side efeftcs= weight gain, heart problems less likley to cause involuntary movemenmt side effects
AO3=
+ supporting rsrch. 212 studies in meta analysis on effectiveness of biolog anitpsych drug treatments tht work by normalising levels of dopamine. treatment of symptoms w drugs were found 2 be more effective than placebo SUGGESTS TREATMENS TARGETTING dopamine system r effective in reducing symptoms …. CA= can b seen as reductionuist coz other psych aspects not con sidered
+ - PSYCH AND ECONOMY CHEAPER THAN CBT ON NHS CA= ppl dont feel in control ALSO IMPROVES LIVES OF PPL SO CAM GO BACK 2 WORK & ALLOWED FOR INDEPENDECE OF PPL SO NO LONGER SPENT IN MENTAL HOSPITALS
LIMITATION rsrch. placed patients randomly in conditions w anti-psychotics routine care or routine care AND CBT. patienys in combined treatment had signif imporement in severity & n. positive symp as well as fewer days in hospital care. SUGGESTS DRUG THERAPRY ALONE NOT MOST EFFECTIVE TREATMENT PLAN & INTERACTIONLIT APPROCH VIA CBT BETTER
MASKS SYMPTOMS SO CBT BETTER
CBTp & family therapy treatments schiz
AO1 CBT=
- CBT assumes schiz is result of dysfunctional thought processes e.g faulty cognitioms such as delusions r identified w CBT & ultimately changed
- therapists role= 2 challenge irrational beliefs by logically disputing reality of delusions & helping 2 develop alternatives
- ellis ABCD used 2 understand source of faulty cognition & provide process 2 cognitive restructure irrational beliefs (delusions)
- activating event beliefs consequences disputing irrational beliefs resutructure beliefs
- reality testing process used where patient can demonstrate for themselves their irrational thoughts (hallucinatins & delusions) r not real. e.g therapsit bringiung stack of cards 4 patient who caan mind read 2 guess
AO1 family therapy
- Attempt to improve rsps of ppl w schizophrenia
- coz family dysfunction increases risk of relase of schiz
- family centred- therapy designed 2 change bhvr of whole family not jus individ w schiz
- Pychoeducation= family educated on symptoms of schiz in order for them 2 be more understanding of their family membrers bhvr
- also helps reduce conflict, reduce stress, redyce self sacrifice , improive communication
AO3
+ cbt study shows patients who resisted drug treatments had reduction in + and - symptoms when treated w 19 sessions of CBT suggests CBT can b effective when drugs r not used but also r an improvement on drug therapies coz drugs only reduce sumptoms in short term CA= sm ptients q
w severe schiz / diff personality not suited
+ CBT= no side effects but COSTLTY & requires dedication
+ family therapy. study looked at aftercare of patients w schiz. of those that were provided w standard outpatient care 50% relapsed within 9 months compared to only 8% who received family therapy. howevrr after 2 years this rose to 50% with family therapy + 75% w standard out patient care. SUGGESTS taht the use of family therapy is heloful for reducing readmisison in shorter. CA= however may not maintain + patterns of bhvr in long term
- lenght of treatment. so practia; issues can take up to a year and some patients mat drop out esp if severe symptom or family incident
token economies
- r a behavioural therapy technique based on skinners operant conditioning. learnt via reinfrocement of desired behaviours
- tokens r used for +ive reinforcement. they r an immediate reward for when patient shows pre defined taregt behaviour (such as washing) token r then exchanged for something they want (acitivites, chocolate)
- behaviour shaping- behaviours r progressively changed w tokens first given for small changes in bhvr towards the ideal
- psychitatric institutions- treatment designed 2 produce easier to manage behaviour within hospital or 2 prepare long stay patients to transfer into community
- mild negative symptoms- treatment can be used for patients w mild symptoms but more profoundly ill patients r less able/ willing 2 enagage
AO3
+ evidence when reviwienf findings of 13 studies found token economies can be effective in improving the adaptibve behavour of ppl w schz CA=.. but token economies dont direclty treat symptoms of schiz only attempt to manage negative sumptoms such as poor motivation poor attention & social withdrawals
- not effective w severely unresponsive patients e.g strong negative symptoms could be seen as punishment for illness
- using skinners principles can be seen as degrading to patients effectivelt manipulating them like lab rats which cld be ethically problematic
interactionist expl & treatinf schiz
AO1
- interactionist approach= suggests development of schiz is due 2 combined effects & iteractions of biolo & social/ psych factprs
- diathesis stress mode;= psych concept that disorder due 2 interaction between predisposed vulnerability (diathesis) & environmental trigger later in life (trigger)\
- diathesis in schiz= often considered 2 be genetic vulnerability potentially resulint in dopamine imbalances. e.g very earlt psych trauma such as child abuse thought 2 influene brain development causinf diathesis
- stressors in schiz= r later negative environmental experiences such as family dysfunction emotional stress/ anxiety or major negative life event which act as emotional evfents triggerng disorders
- also drugs act as stressors
treating
- suggests both bio & psych aspects 2 schiz develipment so effective treatment wld b CBT along w biological drug therpaiies to address bioth causes
- CBT gives cog skills needed 2 change underlying faulty conditions
- drug therapy helps 2 get person stable to help patient
AO3=
FOR EXPLAINING gottesman rsrch reviewed cases of schiz & found concord rate 48% MZ twin & 17% DZ compared to general population being 1%. suggests role for both biological genetic factors as concordance rate much higher for identical twins who share 100% same DNA. CA== NOT 100% SO OTHER FACTORS
+FOR TREATING patients placed in routine care (antipsychotics) or routine care & CBT. found patients w combined treatmenr had signifi improvement in severinf & number posiitve sumptoms & shorter stay at hospital so pro for interactionalist
+ FOR EXPLAINING study biological children of schizo mothers who had been adopyed found 5.8% adopted into healthy families developed schiz compaired 36.8% of children raised in dyxfucntional families supportinf influence bio factors due 2 high rate EVEN IN HEALHTY FAMILIE but EVEN HIGHER FOR DYSFUNC suggests psych trigger…
CA= fundamnetal mechanism by which - pych event actually triggers complex biol response resulting in symptoms still uncertain reducting confidnce in interactionalist approach as fullexplantiom to schiz
