Schizophrena Flashcards
A01
What is schizophrenia
- a severe mental illness where contact with reality and insight is impaired
- 1% of population have it
- onset is typically in late adolescent and early childhood
- uses the DSM-5 or ICD-11
A01
What are the two classification systems for metal disorders
DSM-5 and ICD-11
A01
How does the DSM-5 classify schizophrenia
- requires two or more of the following symptoms to be apparent for a six month period, at least one must be a positive symptom (hallucinations, delusions, disorganised speech) and negative symptoms
A01
What are positive symptoms
- experiences that are added in addition to normal experiences
A01
What are hallucinations
- hearing voices, seeing things or even smelling things all of which don’t exist
A01
What are delusions
- irrational beliefs about themselves or the world
A01
What is disorganised speech
- result of abnormal thought processes and see’s the sufferer struggle to organise and filter their thoughts which show up in their speech
A01
What are negative symptoms, give examples
- loss of normal experiences and abilities e.g:
1) avolition- inability to make decisions, lack of energy, enthusiasm and loss of interest in personal hygiene, sociability and affection
2) anhedonia: loss of interest or pleasure in activities or the lack of reactivity to normally pleasurable stimuli
3) speech poverty: lessened speech fluency and productivity which is believed to reflect slowed or blocked thoughts
A01
What are the differences between DSM-5 and ICD-10
- DSM: all people diagnosed as suffering from schizophrenia must have the symptoms present for at least 6 months
- ICD requires the signs to be apparent for one month
- ICD only need to show at least 2 negative symptoms
A01
How does the ICD compare to the DSM-5
- firstly with the symptoms only needing to be present for one month as opposed to six with the DSM, suffers do not have so much time in which they may be at risk to themselves and others
- they also only have to live without help for 1 month before receiving diagnosis and therefore appropriate treatment
- don’t state you need to have one positive symptom
A01
What is meant by reliability in diagnosis
- measures consistency, how consistent the results are using the same measuring tools
- inter rater reliability
A01
What is meant by validity in diagnosis
- measure what you intend to measure (i.e how accurate the diagnosis for schizophrenia) this means each time the classification system is used to diagnose a behaviour/set of symptoms is SHOULD produce the same outcome
- e.g anhedonia is also present in depression, symptoms overlap
- can we say these are actually symptoms of sz
A01
What are the weaknesses of the classification for schizophrenia diagnosis
1) inter rated reliability- Beck et al- agreement on diagnosis for 153 patients was only 54%, often due to vague criteria for diagnosis and inconsistencies in techniques to gather data
- many ppl may have been diagnosed incorrectly
2) reliability- Cheniaux et al had 2 psychiatrists independently diagnose 100 patients using both DSM and ICD criteria
- inter rater reliability was poor, 1st psychiatrist diagnosed 26 with schitz according to DSM and 44 according to ICD
- 2nd psychiatrist diagnosis end 13 according to DSM and 24 according to ICD
- this is a weakness of diagnosis, reliability is poor and down to human judgement
A01
What is meant by co-morbidity
- presence of 2 different disorders at the same time. It may be that the disorders are actually one disorder, and perhaps should be seen as one condition
A01
What is meant by symptom overlap
- when two or more disorders share the some of the symptoms needed for classification. Schizophrenia and bipolar disorder share many symptoms (delusions and avolition) meaning that the same patient could receive two different diagnosis
- therefore problem of validity, are we really measuring what we intended to measure because of overlapping of symptoms
- are we actually measuring schitz or another condition
A01
What is research support for co-morbidity
1) Research support- Buckley found up to 50% of patients diagnosed with schizophrenia also fit into the diagnosis for depression and 29% for PTSD and 23% for OCD
- poses a challenge for the validity of schizophrenia as a disorder itself because if we are unable to distinguish it from, other disorders, the reliability of diagnosis by clinicians will also be inconsistent
A01
Explain gender bias in schizophrenia diagnosis
- suggested that women’s experience of schizophrenia is taken less seriously and undiagnosed compared to men
- Cotton suggests this is due to women’s better social coping strategies leading to being less likely to seek treatment
A01
Explain culture bias in schizophrenia
- people with Afro-Caribbean heritage in the uk and African Americans more likely to be diagnosed with SZ compared to the 1% of the general population
- westerns definitions of mental illness are applied to non western cultures, a specific example is how hearing voices would be seen as auditory hallucination in the UK but as a religious experience in the West Indies
A01
What is the biological explanation for schizophrenia
- there is evidence that schizophrenia runs in families and so appears to have a genetic basis
- twin studies are used to assess this
A01
What research was conducted on twin studies and how schizophrenic characteristics are inherited
1) Gottesman- reviewed cases of schizophrenia in families and found evidence that a schizophrenia runs in families. MZ twins had concordance rate of 48% and DZ twins had concordance rate of 17% suggesting schizophrenia has a genetic component
2) Ripke conducted a genetic analysis of over 36 thousand patients with schizophrenia and found 108 genetic variants associated with development of schizophrenia (polygenic, many genes involved)
- genes associated with the functioning of neurotransmitters such as dopamine (supporting dopamine hypothesis)
A01
What is meant by ‘aetiologically heterogeneous’
- one group of genes may cause SZ in one person but a different group of genes may cause sz in another
- different combinations
A01
What is meant by neural correlates of schizophrenia
- patterns of structure or activity in the brain that are correlated with an increased risk of developing a condition
- dopamine is a neurotransmitter; the levels if which seen to be associated with schizophrenia symptoms
- e.g avolition (loss of motivation) involves the reward region of brain (ventral striatum), abnormality in areas such as the ventral striatum may be involved in the development of avolition
- research found low levels of this activity was more common in SZ patients
A01
Explain the term hyperdopmainergia
- higher than usual levels of dopamine, linked with positive symptoms such as hallucinations
- excess dopamine in Broca’s area, responsible for speech, may be linked with poverty of speech or auditory hallucinations
A01
What is meant by hypodopaminergia
- refers to lower than usual levels of dopamine, where less dopamine is being transmitted, linked with negative symptoms such
- e.g lower levels in the prefrontal cortex can lead avolition where the ability to make decisions and function in day to day living is reduced
A01
What is the dopamine hypothesis
- symptoms of schizophrenia are due to too much or an imbalance of dopamine across the brain
- excess (hyperdopaminergia) in speech centres like mesolimbic system (involved in processing reward) = positive symptoms (hallucinations)
- lower levels (hypodopaminergia) in areas like frontal cortex= negative symptoms (avolition or speech poverty)
- enlarged ventricles: produce cerebrospinal fluid, schizophrenia patients tend to have larger ventricles
A01
What is an agonist and how does it link to the dopamine hypothesis
- a drug (chemical that mimics dopamine) that increases dopamine activity help reduce negative symptoms
- links to hypodopaminergia as there is too little dopamine which needs to be increased
A01
What is an antagonist and how does it link to the dopamine hypothesis
- drugs such as chlorpromazine which reduce dopamine activity (antipsychotics) to help reduce positive symptoms such as hallucinations
- links to hyperdopaminergia as there’s too much dopamine which needs to be decreased
A01
What are biological treatments for schizophrenia
- typical antipsychotics (1st wave) e.g chlorpromazine
- atypical antipsychotics e.g clozapine
A01
What is the role of typical antipsychotics and give an example of one
- antagonists which reduce the action of the neurotransmitter, block the receptors and reduce firing of neuron’s, less positively charged particles in synaptic cleft, fewer nerve impulses generated, less EPSP
- chlorpromazine- can be taken as tablets, syrup or injection, acts as a sedative often used to calm down patients
- don’t cure schizophrenia, instead dampen the effects of the disorder to a level where they can function
- side effects include dry mouth, urinary problems, constipation and visual disturbance
- long term use also leads to tardive dyskinesia in 15% of sufferers which involves uncontrollable muscle movements usually around the mouth
- can never fully cure, as patients can relapse
A01
Explain the role of atypical antipsychotics (2nd wave) and give an example of one
- target dopamine receptors, block dopamine from binding to receptors, also act upon serotonin receptors
- don’t block the receptors a for as long as typical antipsychotics, so therefore have fewer side effects
- more effective at treating negative symptoms such as avolition and speech poverty
- e.g Clozapine binds to dopamine receptors as chlorpromazine does but additionally acts on serotonin and glutamate receptors
- is mood enhancing and also reduces depression in patients
A03
What are weaknesses of typical antipsychotic drugs
1) cause side effects- reduce activity of dopamine in other parts of the brain where there isn’t an imbalance of dopamine, causing unwanted behaviours (side effects), e.g blocking receptors in motor cortex, loss of control and movement/ muscle spasms (extra pyramidal symptoms), increased risk of health problems e.g heart problems, obesity and diabetes
2) low levels of dopamine in frontal cortex cause negative symptoms such as avolition and speech poverty, therefore antipsychotics don’t treat the negative symptoms as they reduced dopamine in the brain, so may even make them worse
A03
What is a strength of atypical antipsychotic drugs
1) research support, Lecht conducted a meta analysis, 65 studies looking at typical and atypical antipsychotics
- found that across these, atypical and typical antipsychotics were more effective at treating symptoms than placebo pills
- those who took the drugs experienced less positive symptoms than the control group, less likely to relapse
2) Fewer side effects, bind to dopamine receptors for a shorter amount of time compared to typical antipsychotics, Crossley found they were only associated with weight gain, found that typical and atypical antipsychotics didn’t have a significant difference in how effective they were at preventing symptoms
A03
What are weaknesses of atypical (and typical) antipsychotics
1) Only mask symptoms, don’t treat underlying cause
-don’t always prevent relapse, as soon as medication is stopped likelihood of relapsing and starting to show symptoms of schizophrenia increases quickly, meaning to stop SZ medication will have to be taken everyday despise side effects
- relapse, up to 40% in first year, 15% in later years
A01
What are the two psychological explanations of schizophrenia
1) family dysfunction
2) cognitive explanations
A01
What are the 3 family dysfunctions as a psychological explanation for sz
1) the schziophrenogenic mother
2) double blind theory
3) expressed emotions
A01
Explain the SZ mother as a psychological explanation of schizophrenia
- a psychodynamic theory that suggests ppl with SZ get their paranoid delusions as a result of the influence of a cold, rejecting and controlling mother
- creates atmosphere of stress, tension and secrecy in the family, triggers psychotic thinking
A01
Explain the double blind theory as a psychological explanation for schizophrenia
- children receive mixed and contradictory messages from parents about what is right and wrong, means child is unable to clarify messages or voice their opinions about unfairness of conflicting messages
- child sees world as unfair and confusing due to this confliction, reflected in symptoms of disorganised thinking and paranoid delusions
A01
Explain expressed emotions as a psychological explanation for schizophrenia
- family communication style that involves criticism, hostility and emotional over-involvement, also indicating sufferer is a burden e.g ‘I do so much for you, it’s hard for me’
- showing anger and resentment
- prolongs and worsens symptoms
A01
What are the 2 cognitive explanations for schizophrenia
1) Meta- representation
2) central control
- Frith suggested that dysfunctional thought processes contribute to the development of schizophrenia
A01
Explain central control as an cognitive explanation for schizophrenia
- patients are unable to to suppress automatic responses
- e.g disorganised speech: inability to suppress automatic thoughts and speech triggers
- measured in the Stroop Test- involves identifying colour of each word where there is a discrepancy e.g the word ‘brown’ written in yellow, automatic response of reading the word must be suppressed to allow for identification of font colour
A01
Explain meta representation as a cognitive explanation for schizophrenia
- healthy individuals have the ability to reflect on thoughts and behaviours and allow insight into intentions and goals
- in patients- failure to recognise actions and thoughts- auditory hallucination and thought inerstion due to inability to differentiate between own thoughts and those of others
A03
What is a strength of family dysfunctions as a psychological explanation for schizophrenia
1) Research support- Read et al reviewed 46 studies of child abuse and SZ, found 69% of adult women in patients with SZ had a history of physical and sexual abuse in childhood, for men this was 59%
COUNTERPOINT: for most studies, info about childhood experiences was gathered after the development of symptoms, patient could have distorted recall
- also is socially sensitive research, can lead to parent blaming and add insults to parents watching their child experience symptoms of SZ
A03
What is a strength of cognitive explanations as a psychological explanation for SZ
1) Supporting evidence: Stirling compared 30 patients with SZ with controls on a range of cognitive tasks, one included the stroop test, testing ability to suppress words
-patients with the disorder took over twice as long as the control group to name the ink, supporting cognitive explanations of disorder
A03
What is a weakness of cognitive explanations as a psychological explanation for SZ
1) problem with underlying cause: e.g dysfunctional thought processing does not tell us anything about the origins of abnormal cognitions of the condition itself could be argued that dysfunctional thought processes are merely a symptom of SZ rather than the cause itself
2) Ignores biological factors, Gottesman found concordance rate 48% for MZ twins showing a genetic link, and antipsychotics can reduce the symptoms of SZ, as they decrease dopamine activity
- cognitive explanation doesn’t account for role of biological factors in SZ
A01
What are the 3 psychological treatments for SZ
1) CBT
2) Family therapy
3) token economics
A01
Explain CBT as a psychological treatment of SZ
- intervention for changing both thoughts and behaviours
- patients asked to trace back origins of their symptoms and understand how they started
- suffer is taught to recognise their own examples of delusional thinking (increasing self awareness), by challenging their interpretations and change their thinking
A01
Explain family therapy as a psychological treatment for SZ
- aim to improve quality of communication + interaction between family members
- relating to double blind + schizophrenic mother, some therapies see the family as the root cause
- aims to reduce stress that may contribute to risk of relapse
- Pharoah identified a range of strategies:
1) form therapeutic alliance with family members
2) reducing stress of care
3) improve ability to solve problems
4) reduce anger + guilt
5) improving beliefs of SZ
6) help members care for individuals with SZ whilst maintaining their own lives
A01
Explain token economics as a psychological treatment for SZ
- reward system- manages behaviour, especially patients who have developed maladaptive behaviour
- form of coloured discs given to patients when they carry out desirable behaviour that’s been targeted for reinforcement
- patients are motivated to carry out desirable behaviours
- tokens can get swapped for something more tangible e.g sweets/magazines
A03
What are strengths of CBT as a psychological treatment of SZ
1) research support: the National Institute for Health and Clinical Excellence (NICE) conducted a review of studies which compared the use of CBT combined with medical drugs to medical drugs alone. Treatments with CBT were found to reduce the likelihood of a patient relapsing, and more effective at reducing symptoms
COUNTERPOINT: ppts weren’t assigned using random allocation, so can’t control participant variables that influence the ppts behavior e.g some may have had less sever symptoms than the control group
- therefore findings may have been overexaggerated
What’s an implication for the difference in DSM and ICD classification
- those diagnosed by the DSM have to wait at least 6 months to get treated, therefore symptoms may get worse and the doctors don’t provide immediate support
- for the ICD sufferers diagnosed 1 month in, run the risk they may be misdiagnosed
What’s an issue with schizophrenia subtypes (reliability)
- ICD and DSM do not entirely agree on the number of subtypes of schizophrenia, with the ICD suggest seven different subtypes and the DSM five
- the reliability here is questioned as a sufferer could be diagnosed as one type of schizophrenia according to the DSM and a different type according to the ICD
- implications is incorrect treatment
What’s a limitation of the diagnosis of sz (validity)
- symptom overlap and co morbidity validity issue
- symptoms also belong to other conditions, hope can we be accurate that these symptoms are a true reflection of sz
