Schizo Flashcards
1
Q
Classification of schizophrenia
A
- mostly men get schizo around 15-45yo
- DSM (Diagnostic statistical manual of mental disorders) and ICD (International classification of disease) used
- DSM-5(USA) and ICD-10 (UK) separate criteria for diagnosis
- DSM requires min 1month of 2 pos symptoms
Positive symptoms:
- Hallucinations- additional sensory experiences
eg seeing faces/hearing voices
- Delusions- irrational beliefs about world/self
eg feelings of persecution or grandeur
Neg symptoms:
- Avolition- lack of purposeful goals/behaviours.
no energy to socialise/maintain hygiene/appear disinterested
- Alogia- speech poverty
eg no fluency/slow speech which reflects slow thought processes: disorganised/no quality or quantity
Reliability in diagnosis/classification of schizo:
-
extent to which a finding’s consistent ie extent to which psychiatrists agree on same diagnosis when independently assessing p(s) (Inter-rater reliability).
For classification to be reliable, same diagnosis should be made everytime so basically diff psychiatrists should reach same conclusion when assessing p(s) -
Test-retest reliability:
if test gives same results each time tested eg Dr giving same diagnosis over time for same symptoms - Inter-rater reliability of schizo often low. Beck 1936 found only 54% concordance r8 bw Doctors’ assessments of 153 p(s)
- Counter, Jakobsen et al 2005 tested reliability of ICD-10 on 100 Danish p(s) n found 98% concordance which demonstrates high reliability of clinical diagnosis of schizo using up-to-date classification
- Gender n culture bias reduce reliability c next flashcards
Validity in diagnosis/classification of schizo:
-
Extent to which we are measuring what we actually wish to measure
eg Does diagnosis methods used give valid conclusion? Do a different methods agree with diagnosis of the same patient? - Validity of schizophrenia is also in question as to whether it’s unique or not
eg has own characteristics or j a combo of other mental illnesses? - Predictive validity issue here bcz if diagnosis leads to successful treatment, then diagnosis was valid but some p(s) recover some don’t. Low % recover which means predictive validity low
- Co-morbidity n Rosenhan’s study reduces validity c next flashcards
2
Q
Gender/ culture bias affecting reliability
A
Gender bias:
-
more men diagnosed with schizophrenia
eg due to genes?or women issues not taken serious? -
Loring n Powell 1988 290 M&F psychiatrist read case histories of p(s) behaviours n diagnose em according to standard criteria.
Found when p described as male, then 56% of M psychiatric diagnosed em schizo
When described as female, only 20% diagnosed em w it.
But F psychiatrists didn’t show this bias suggesting gender of psychiatrist important not j p(s) gender
Culture bias
-
Cochrane 1997 found rate of diagnosis in the UK, for Afro-Caribbean ppl 7% compared to 1% for general UK pop n 1% for Afro-Caribbeans in Caribbean
suggests they’re over-diagnosed in UK - additionally, Copeland et al 1977 gave description of p to 134 USA n 194 UK psychiatrists. 69% USA diagnosed em w schizo n 2% UK did.
No research found the cause for this suggesting symptoms of ethnic minorities misinterpreted. This question the reliability of diagnosis of schizo bcz it suggests p(s) can display same symptoms but be diagnosed diff bcz of ethnicity
3
Q
Comorbidity/Rosenhan’s study affecting validity
A
Comorbidity (person has more than 1 mental illness)
- This affects validity of schizophrenia as a condition
-
Buckley 2009 found 50% of schizo have depression, 47% drug abuse, 29% PTSD, 23% OCD
so possible other conditions could be misdiagnosed with schizophrenia or perhaps they’re not even separate disorders at all -
Symptom overlap another issue affecting validity. Other disorders (eg bipolar) have hallucinations/delusions as pos symptoms too
Read 2004 argues symptoms of schizos overlap w other conditions so much so that they could easily receive at least 1 other diagnosis
Rosenhan’s study
AIM:
•to assess if situational factors affect diagnosis of schizo
METHOD:
•8 confs entered diff psychiatric hospitals n told med professionals they’ve hallucinations n observed if staff noticed they’re sane. They became pseudo p(s) n when in the wards they behaved normal n were only discharged when they convinced staff they’re sane
FINDINGS
• staff diagnosed all w schizophrenia n 1 w manic-depression n didn’t detect their sanity
• real schizo p(s) detected their sanity
**CONCLUSIONS*
• Type I error made (shouldn’t have diagnosed em w schizo cos only had 1 mild pos symptom)
• psych staff can’t always distinguish bw sanity/insanity suggesting such diagnostic methods are not valid/reliable
•but can argue it’s easier to class someone as ill than healthy so shows situs factors does affect diagnosis of schizo
4
Q
Biological explanation to schizophrenia
A
- genetics
- neurotransmitter
- Neural correlates
5
Q
genetics explaining schizo
A
- If schizophrenia is a genetic and a person has it, the more closely related they are to a person, the more likely the other person will have it too
- This measure of probability is concordance rate
- Genetic concordance is shown by family studies
eg Siblings are more likely to both have it than cuzs - Schizophrenia is polygenic (more than 1 gene’s responsible/linked). - Different combinations of candidates genes can lead to schizophrenia
6
Q
Evaluate genetic explanation to schizo
A
- Ripke 2014 found 108 diff genetic combos associated w schizo so strongly supports genetic basis for it.
-
counter w
if this case, then irl app useless cos can’t narrow down specific genes n can’t treat it then -
Gottesman 1991 reviewed cases of schizo n found 48% concordance r8 for MZ twins n 17% for DZ which compares to 1% for general pop.
He also found 46% concordance if both parents have, 16% if one parent has, and 8% if sibling has. This shows there’s strong genetic basis for schizophrenia -
counter w
not 100% concordance rate for the MZ or DZ twins meaning other factors (eg env) affect it. Can argue that bio makes more vulnerable but other factors (eg stress) trigger it (Diathesis stress model) cos likely twins, tho experiencing same env, won’t experience exact same things cos still separate ppl -
Adoption study support
Tienari et al found 6.7% out of 164 adopted kids, whose bio mums had schizo, got it compared to 2% of controlled adoptees. Shows strong genetic link -
counter w:
can still argue that it’s down to env cos most likely ppl that adopt the kids only did cos they know how difficult it is to deal w schizo family members. means they placed in similar env to what they tried escape so env involved which weakens genetic explanation n shows it’s reductionist
7
Q
Neurotransmitter explanation to schizophrenia
A
- Dopamine hypothesis State symptoms of schizophrenia, is because of an imbalance in dopamine in the brain
- Seidman 1983 Believes too much dopamine may lead to positive symptoms(eg hallucinations) because messages from neurons, releasing dopamine, fire too often/easily
- Low dopamine in the front of the cortex could lead to negative symptoms (Avolition/Alogia)
- The theory is based on dopamine-releasing drugs, producing schizophrenic-like symptoms in normal patients
- Antipsychotic drugs, reduce symptoms by decreasing dopamine levels, suggesting there is a correlation between dopamine and schizophrenia
8
Q
Evaluate neurotransmitters explaining schizophrenia
A
Pros:
-
Research support
Leucht et al 2013 Review 212 studies in a meta analysis of the effectiveness of Bio treatments that normalise dopamine levels n found it more effective than placebo drugs
Suggest dopamine is involved in mechanisms/cause of schizophrenia
Cons:
-
Other neurotransmitters maybe involved
Glutamite Has been found to link to schizophrenia, which suggests dopamine doesn’t give a full explanation and is merely just one of the many factors involved.
This weakens validity of the dopamine hypothesis as cause of schizo -
Bio reductionist
Ignores other factors involved. Research showed there is a vile link to schizo, but not everyone gets schizophrenia suggesting other factors may trigger it eg env stress (Diathesis stress model).
holistic approach, considering environmental and bio factors, would be more credit worthy in explaining the cause of schizophrenia instead of a reductionist approach by saying it’s due to biology
9
Q
Neural correlates in explaining schizophrenia
A
- Refers to correlation between brain structures and positive or negative symptoms in schizophrenia
- A neural correlate is ventricle size
- Ventricles are internal brain cavities that contain and produce cerebrospinal fluid (CSF). This gives a cushioning affect that protects the brain from damage when getting a knock to the head
10
Q
Evaluate neural correlates
A
Pro:
-
High reliable
Research into enlarged ventricles and neurotransmitter levels have high reliability as they’re done in controlled environment with specialised technology. This suggests a free tests are done the same results would be found -
Research support
Suddath et al 1990. Used MRI to get brain scans of MZ twins where one of them had schizophrenia.
found the schizophrenic twin had enlarged ventricles and differences so large, that they were able to distinguish which one schizophrenia from the pics.
Suggests wider credibility for enlarged ventricles, determining the likelihood of schizophrenia developing
Cons:
-
Bio reductionist/determinist
see previous flashcard
11
Q
Psychological explanations of schizo
A
- family dysfunction
- Cognitive explanations
12
Q
Family dysfunction
A
refers to family issues causing schizo
-
Double bind theory
Bateson et al 1956 suggests schizophrenia happens where the child gets conflicting messages from the parents
eg told to be independent then criticised when they try
Bateson suggested this upbringing results in disorganised thinking/paranoia and which then leads to development of schizo tendencies -
Expressed emotion
how carers expressed emotion and affects the sufferer
eg telling sufferer they’re burden, inconvenience, controlling them, criticising them, hostility
all of which can lead to schizo n relapses
13
Q
Evaluate family dysfunction
A
pro:
-
Research support for EE
Kalafi n Torabi 1996 found high levels of EE in Iranian culture where mum=overprotective and dads reject their children to be 1 of main cause of schizophrenia relapse. Stress from env causes suffering person to relapse -
Research support for DB
Berger 1965 recalls schizos recalling more DB comments than non-schizos which shows DB does acc affect condition -
Irl app
Only syrupy is use to combat dysfunctional families as a cause of schizophrenia. It helped to reduce expressed emotion in families, which, in turn reduces relapse rates. supports idea dysfunctional families cause/contribute to schizo
Cons:
-
Reductionist
There is ample evidence bio factors could be the cause of schizophrenia
eg Gottesman (genes)
Leucht (neurotransmitters)
Suddath (neuro correlates)
This weakens idea of family dysfunctions as cause of it.
Holistic Approach better say consider bio n env trigger is family n diathesis stress model -
Ethics
It’s hard to determine if schizophrenia was actually caused by the family. Assuming this is unethical because they already dealing with issues of sufferer n saying they caused it will add to stress.
On this note, hard to est cause n effect: did schizo cause dysfunction or vice versa? Weakens family dysfunction as cause of schizophrenia
14
Q
cognitive explanations for schizo
A
Cognitive psychologists c schizophrenia as caused by disorganised thinking/dysfunctional thought processing which lead to hallucinations/delusions
- Firth 1979 propose the Attention-deficit theory
- it stated Schizophrenia is due to faint attention system unable to filter out preconscious thoughts n gives too much significance to information that would’ve been filtered out normally (accounts for pos symptoms)
-
Firth also suggests schizos less able to suppress urges n make decisions to carry them out
eg c red button gonna push it
n Firth suggests they can’t explain y they can’t resist urge - also talks about meta-representation (refers to ability to identify one’s own thoughts as own by paying attention to it) n says schizos don’t have this cos feel their actions controlled by external force
-
Alt cog explanation:
There’s a breakdown in organisation of new info coming in from senses n info stored in memory meaning schemas aren’t activated. This produces overload of info that schizos not sure how to rep to - Schizos have egocentric bias making think they centre of everything
eg light flashing means God chatting to em
ppl whispering means they plotting against em
This would make a person overwhelmed by thinking everything is to do w them which would then overstimulate/stress them out causing schizophrenia
15
Q
Evaluate cog explanation to schizophrenia
A
Pros:
-
Cognitive neuroscience
Firth 1992 studied 30 schizophrenics w PET scanners n found lack of blood flow in frontal cortex. This is responsible for decision making n was esp apparent in p(s) w neg symptoms. Supports idea that schizos can’t control thoughts -
Irl app
CBT is used for em n is effective which indicates cog factors involved w schizo. Hella research support eg
Drury et al 1996 found pos symptoms of p(s) reduced when CBT given alongside bio meds
COUNTER:
If bio meds worked it suggests schizophrenia cos of bio factors n not cognitive. also suggests maybe uncontrollable thoughts arrived cos of schizo n not vice versa so can’t establish cause n effect
