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schizophrenia Flashcards

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1
Q

what is schizophrenia?

A

schizophrenia - severe mental illness where contact with reality and insights are impaired.
around 1% of the population are sufferers

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2
Q

what are the 2 major class systems for diagnosing schizophrenia?

A

World Health Organisation’s International Classification of Disease edition 10 (ICD - 10)
American Psychiatric Association’s Diagnostic and Statistical Manual edition 5 (DSM - 5)

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3
Q

How do the DSM and ICD differ in their classifications of schizophrenia?

A

DSM - one of the positive symptoms must be present for diagnosis
ICD - two or more negative symptoms must be present for diagnosis
also recognises a range of subtypes of Sz e.g paranoid SZ (delusions and hallucinations)

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4
Q

what are the 2 positive symptoms of Sz?

A

hallucinations
delusions

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5
Q

hallucinations (3)

A

hallucinations are unusual sensory experiences
some may relate to environment or be completely random
sufferers may see distorted faces, hear voices, or see things which aren’t there

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6
Q

delusions

A

delusions are irrational beliefs - commonly related to historical figures or believing they are under the control of external forces
induce bizarre behaviour or aggression

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7
Q

what are the 2 negative symptoms of Sz?

A

avolition
speech poverty

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8
Q

avolition (2)

A

avolition (apathy) - finding it difficult to keep up with goal-orientated activity or lacking motivation
andreason - 3 key signs of avolition are poor hygiene, lack of persistence an a lack of energy

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9
Q

speech poverty (2)

A

speech poverty characterised by changes in speech patterns
reduction in amount and quality of speech - language may be abrupt, incoherent or lack consistency

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10
Q

what are the 3 biological explanations of Sz?

A

genetic basis - family and canditate genes
dopamine hypothesis - hyper/hypodopaminergia
neural correlations - of positive/negative symptoms

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11
Q

AO1 BIOLOGICAL EXPLANATIONS: runs in families (1)

A
  • genetic similarities - Gottesman found the risk of developing Sz in Mz twins 48%, siblings 9%
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12
Q

AO1 BIOLOGICAL EXPLANATIONS - RUNS IN FAMILIES: candidate genes (3)

A
  • polygenic - requires a number of factors in combination to induce symptoms
  • found to be 108 associated variations to Sz
  • key gene - disruption of the dopamine gene - controls about of the NT
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13
Q

what is dopamine?

A

dopamine - NT thought to be closely involved with development of Sz

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14
Q

THE DOPAMINE HYPOTHESIS: hyperdopaminergia

A

hyperdopaminergia - high levels of dopamine (due to an excess of dopamine receptors) in the subcortex - an excess of dopamine in Broca’s area associated with speech poverty

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15
Q

THE DOPAMINE HYPOTHESIS: hypodopaminergia

A

hypodopaminergia - goldman identified role of low levels of dopamine in the prefrontal cortex (associated with decision-making) in negative symptoms

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16
Q

what are neural correlates?

A

neural correlates - measurements of the structure/function of the brain that correlates with an experience.

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17
Q

what are the neural correlates of negative symptoms?

A
  • activity in the ventral striatum is a neural correlate of negative symptoms
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18
Q

how does the ventral striatum act as a neural correlate for negative symptoms of Sz?

A
  • avolition involves loss of motivation - motivation involves loss of anticipation of a reward
  • found lower activity levels in ventral striatum in Sz patients correlates to the overall severity of negative symptoms
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19
Q

what are the neural correlates of positive symptoms?

A

reduced activity in the superior temporal gyrus and anterior cingulate cyrus is a neural correlate of positive symptoms e.g hallucinations

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20
Q

RESEARCH: how do the temporal gyrus and anterior cingulate gyrus act as a neural correlate of positive symptoms?

A
  • Allen- demonstrated lower activation levels in the temporal gyrus and anterior cingulate gyrus in a hallucination Sz group compared to a control group
  • the patients also made more errors in attempting to identify if pre-recorded speech was themselves or someone else
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21
Q

AO1 PSYCHOLOGICAL EXPLANATIONS: what are the 2 psychological explanations for schizophrenia?

A

family dysfunction - schizophrenogenic mother, double-bind theory, expressed emotion

cognitive explanations - Frith and abnormal information processing

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22
Q

FAMILY DYSFUNCTION: what is the schizophrenogenic mother?

A

schizophrenogenic mother - cold, distant mother who is controlling and tends to create a hostile family environment - leads to distrust and develops into paranoia associated with Sz

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23
Q

FAMILY DYSFUNCTION: what is double-bind theory? (2)

A
  • double-bind theory argues that strained communication is a key factor which can contribute to children being confused and having mixed signals about what is right and wrong -
  • when the child does wrong - withdrawal of love may be a punishment leaving them confused which reflects itself in the symptoms of disorganised thinking, and delusions
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24
Q

FAMILY DYSFUNCTION: what is the expressed emotion (EE) theory? (3)

A
  • negative emotions from carer to patient - criticism, hostility or over emotional involvement in a patient’s life
  • may cause serious stress in patient and induce relapse
  • could also trigger onset of Sz symptoms for someone who is already genetically vulnerable
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25
Q

COGNITIVE EXPLANATIONS: how do cognitive explanations explain Sz? (2)

A
  • cognitive explanations point to abnormal information processing
  • reduced processing in ventral striatum or cingulate gyri causing symptoms - lower level of info processing suggests cognitive is likely to be impaired
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26
Q

COGNITIVE EXPLANATIONS: who was Frith?

A

Frith - identified 2 kinds of dysfunctional thought processing which could induce symptoms

These are metarepresentation and central control

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27
Q

COGNITIVE EXPLANATIONS: what is metarepresentation? how does it link to Sz symptoms? (2)

A

metarepresentation - the cognitive ability to reflect on thoughts and behaviours

Frith - dysfunction here disrupts ability to recognise our own thoughts/actions as our own - explains voice hallucinations and delusions

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28
Q

COGNITIVE EXPLANATIONS: what is central control? how does it link to Sz symptoms? (2)

A

central control - is the cognitive ability to suppress automatic responses whilst we carry out deliberate actions

Frith - dysfunction here - disorganised speech and inability to suppress automatic derailment of thoughts - triggered by stimuli

29
Q

what are antipsychotics?

A

antipsychotics - most common treatment for Sz - can be taken in drug, syrup or injection form

they may be required as a short term or long term solution for symptoms

30
Q

what are typical antipsychotics? can you name an example?

A

typical antipsychotics - first generation of antipsychotics

Chlorpromazine

31
Q

what is chlorpromazine? (3)

A
  • a typical antipsychotic and dopamine antagonist which works against the dopamine system by binding to dopamine receptors
  • normalising neurotransmission in key areas of the brain reduces symptoms like hallucinations
  • can be also be taken as a sedative
32
Q

what are atypical antipsychotics? can you name 2 examples?

A

atypical antipsychotics - new generation of antipsychotics which aim to be effective and have less side effects

clozapine and risperidone

33
Q

what is clozapine? (3)

A
  • clozapine is a dopamine antagonist and atypical psychotic
  • it binds to dopamine receptors as well as serotonin and glutamine receptors to improve mood and reduce the risk of depression and suicidal thoughts
    • taken in a small dose, not as an injection and blood tests must be taken regularly as it has been associated with some blood diseases
34
Q

what is risperidone? (3)

A
  • risperidone is an atypical antipsychotic and dopamine antagonist
  • developed to be as effective as clozapine but was less side effects - taken as tablet, syrup or injection
  • binds to serotonin and dopamine receptors - as it binds more strongly than clozapine to receptors it is more effective in smaller doses and less side effects
35
Q

CLASSIFICATION OF SCHIZOPHRENIA: AO3 POINTS (2 strengths, 1 weakness)

A

+ practical application

+ Jakobsen reliability test of ICD-10

-co-morbidity limits

36
Q

AO3 CLASSIFICATION OF SCHIZOPHRENIA: state two strengths

A

P: classification and diagnosis has key practical applications it advantages doctors’ ability to treat Sz patients as it allows them to communicate more effectively with patients about their symptoms as well as predict the outcome of their disorders and suggest an appropriate treatment

P: Jakobsen et al tested the reliability of the ICD-10 - 100 Danish patients with a history of psychosis assessed using operational criteria and a concordance rate rate of 98% obtained - demonstrate reliability of clinical diagnoses -→ opposing research suggests that subjectivity and differences between ICD an DSM lead to contradictions in diagnoses

37
Q

AO3 CLASSIFICATION OF SCHIZOPHRENIA: state one weakness

A

P: weakness of classification is the issue of co-morbity - the phenomenon that 2 or more conditions occur together, blurring the lines between diagnoses and can lead to wrongful diagnosis

Buckley found that around 50% of patients with Sz also have a diagnosis of depression - wrongful diagnosis limits the classification of Sz, and its external validity as it may lead to incorrect treatment

-→ multiple types in ICD-10 solves this

38
Q

AO3 BIOLOGICAL EXPLANATION OF SCHIZOPHRENIA: AO3 points (2 strengths, 1 weakness)

A

+ support for dopamine function

+ Gottesman’s research supporting genetic vulnerability

-biologically reductionist

39
Q

AO3 BIOLOGICAL EXPLANATION OF SCHIZOPHRENIA: state one weakness

A

P: Biologically reductionist - Genome Project had increased understanding of the complexity of the gene - a much lower number of genes exist than anticipated, it is now recognises that genes have multiple functions and impacts on behaviour - Sz is a polygenetic phenomena and is highly complex - suggests attempts to map genes are oversimplistic and impossible to completely understand

-→ movement of research and generation of new hypothesis

40
Q

AO3 BIOLOGICAL EXPLANATION OF SCHIZOPHRENIA: state two strengths

A

P: strong evidence to support that there is a genetic vulnerability - Gottesman’s study demonstrated how genetic similarity and shared risk of Sz are closely related - adoption studies demonstrated that children still were at risk of Sz symptoms - highlights role of genetic predisposition playing a role

-→ there still could be environmental factors involved

P: support for the role of abnormal dopamine function - radioactive labelling studies have found that chemicals needed to produce dopamine are taken up faster in Sz patients than control - suggesting they produce more dopamine -→ success of antipsychotics also supports it

-→ dopamine hypothesis doesn’t give a full explanation, certainly plays a role but other NT like glutamate may also play significant role

41
Q

AO3 PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: A03 points (1 strength, 2 weaknesses)

A

+ research into expressed emotion has key PA

-ethical issues

-cognitive model labelled reductionist

42
Q

AO3 PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: state one strength

A

P: research into EE has key practical applications - Hogarty produced a type of therapy which reduced social conflicts between parents and their children which reduced EE and thus relapse rates - gaining an insight into family relationships allows psychiatric professionals to help improve quality of patient’s lives

43
Q

AO3 PSYCHOLOGICAL EXPLANATIONSOF SCHIZOPHRENIA: state two weaknesses

A

P: ethical issues of double bind theory and schizophrenic mother - serious ethical concerns in blaming the family, particularly as there is little evidence upon which to base this. Gender bias is also an issue as the mother tends to be blamed the most, which means such research is highly socially sensitive. This suggests that the research therefore does not protect individuals from harm

P: cognitive approach is reductionist and over-simplified. fails to explain how these cognitive deficits are caused (could be that the problems caused by low neurotransmitters levels) and this approach also completely overlooks the role of genes. This suggests that the cognitive approach is oversimplistic when consider the explanation of schizophrenia

-→ cognitive explanation may be reductionist, but in taking a more scientific approach, research may induce further hypothesis and used in conjunction with biological approach

44
Q
A
45
Q

What are the 3 psychological therapies used to treat Sz?

A

CBT

FAMILY THERAPY

TOKEN ECONOMIES

46
Q

What is CBT? How does it help? (3)

A
  • individual, aims to identify and challenge irrational thoughts through discussion and cognitive behavioural techniques
  • aims to teach patients to challenge irrational thoughts and how to cope with symptoms
    • helps - make sense of delusions (i.e they’re not based on reality) and their impacts - this understanding reduces anxiety
47
Q

What is family therapy? (2)

A
  • focuses on root cause of symptoms in environment i.e schizophrenogenic mother, double-blind and EE
    • focus on family rather than individual to improve communication and interactions in order to reduce stress/risk of relapse
48
Q

What did Pharoh identify about family therapy?

A

Pharoh: a range of techniques to improve family function: forming therapeutic alliances between members, reducing anger and guilt, improving family’s ability to solve problems, improving balance between caring for patient/own personal lives

49
Q

How does CBT/family therapy help someone who is already taking medication? (2)

A

strategies work in reducing stress and EE, and increase the chance of patients’ complying with medication. The combination reduces relapse/hospital readmission risk

50
Q

Outline how token economies are used to treat Sz

A

Token economies are a form of behaviour modification based on the principle of operant conditioning. Patients are given tokens for demonstrating good behaviours such as personal hygiene. These tokens act as secondary reinforcers because they can be exchanged for primary reinforcers such as privileges like smoking. These systems can help to treat avolition, which is a common negative symptom of schizophrenia.

51
Q

How does the interactionist approach explain Sz (2)

A

wide rage of factors (e.g biological and environmental) in the development of Sz

uses the diathesis-stress model - both a genetic vulnerability (diathesis) and a stress-trigger (stressor) are necessary to develop the condition

52
Q

What is Meehl’s model?

A

Meehl’s model is the original diathesis-stress model used to explain Sz

53
Q

What does Meehl’s model argue? (2)

A
  • older - entirely genetic based, Sz caused by a single schizogene which leads to the development of a schizogenic personality with a higher sensitivity to stress
    • For only carries of the gene, chronic stress (childhood etc) could lead to the development of Sz
54
Q

What is the more modern understanding of the diathesis-stress model when explaining Sz? (3)

A
  • many genes cause vulnerability - polygenetic condition
  • diathesis doesn’t have to be genetic, could be other factors like psychological trauma (trauma can hinder neurological development in key systems which makes someone more vulnerable to later stress)
    • stressor doesn’t have to be stress related necessarily e.g cannabis has been found to increase the risk of developing Sz by up to 7 times (messes with dopamine system)
55
Q

How is the interactionist approach used when treating Sz? What did Turkington say? (2)

A
  • treatments could address both biological and psychological factors e.g medication coupled with CBT
  • Turkington - should not just adopt a biological approach as telling a patient their condition is completely biological is unfounded and would make them believe that their condition was irresolvable - thus hindering their progress in recovery
56
Q

Outline how family therapy is used to treat Sz

A

The therapy aims to form an alliance with all family members, improving communication and interaction. Pharoah identified a range of strategies which improved functioning of the family, such as reducing conflict and stress, and improving communication. By reducing the level of stress and expressed emotion, whilst increasing the chances of the patient complying with medication, there may be a reduced relapse rate. Overall, the therapy is the only one which focuses on the family rather than the individual, aiming give families the ability to resolve problems, reduce anger and guilt, and help find a work/life balance.

57
Q

Outline and evaluate antipsychotics as a treatment for Sz (16m)

A

AO1: TYPICAL - how they work and an example

A03: research

A03: side effects

AO1: ATYPICAL - how they work and an example

AO3: ethical issues

58
Q

state a limitation of antipsychotics at a treatment for Sz in terms of side effects

A

P: have various side effects, some of which can be fatal

E: Typical antipsychotics are associated with side effects such as weight gain, or even a serious conditions such as tardive dyskinesia (TD). This causes sudden uncontrollable facial movements and is associated with irregularities in the dopamine system

E: Despite such antipsychotics being produced to reduce the symptoms of Sz, such side effects suggests that they are not fully effective or safe for public use

L: This reduces the credibility of antipsychotics as a treatment for Sz

→ benefits of Fluoxetine

59
Q

state a limitation of antipsychotics at a treatment for Sz in terms of ethical issues

A

P: suggested that is such antipsychotics have been abused by caring staff

E: It has been suggested that hospital staff administer antipsychotics to tranquilize patients, to make them easier to work with

E: Though this is recommended by professionals to calm patients, this is seen as a violation of a patient’s dignity and rights. It could be viewed unethical to control a patient’s behaviour, and removing their individual autonomy or ability to give consent to such treatment.

L: This may not actually benefit patients, and may lead to a loss of trust in psychiatric care, thus reducing the external validity of antipsychotic drugs as a treatment for Sz

→ is it necessary for the patient’s and carers safety?

60
Q

state a strength of antipsychotics as a treatment for Sz in terms of supporting research

A

P: There’s a large body of evidence to support the idea that both typical and atypical antipsychotics are moderately effective in reducing Sz symptoms

E: Research reviewing studies comparing the effects of chlorpromazine compared to a ‘placebo’ group showed that the antipsychotics was associated with reduced symptoms and overall better functioning.

E: This research is also reinforced by studies on the effectiveness of clozapine as well. This demonstrates that such antipsychotics can actively improve the quality of life of a patient, and thus catalyse their rates of recovery.

L: increases the external validity

→ reliance on the incomplete dopamine hypothesis (some places are too low, some areas too high levels too high)

61
Q

Describe and evaluate psychological treatments of Sz (16m)

A

AO1: CBT - challenging of irrational thoughts and discussion

AO3: evidence for effectiveness

AO1: family therapy

AO3: flexibility of treatments

AO1: token economies

AO3: ethics

62
Q

state a strength of psychological therapies as a treatment for Sz in terms of supporting research

A

P: there is research to support the effectiveness of CBT

E: Research reviewed 34 CBT sessions for SZ and concluded that CBT as a significant, but small, effect on positive and negative symptoms. Pharoh reinforced this by reviewing the effectiveness of family therapy on Sz. He found an improvement in the quality of life and severity of symptoms for Sz patients.

E: Such evidence suggests the effectiveness of psychological treatments of Sz, and improves their internal validity as a treatment for Sz

→ CBT only associated with a marginal change when used in isolation, would be better alongside drugs meaning it’s not a completely effective treatment alone

63
Q

state a strength of psychological therapies as a treatment for Sz in terms of flexibilty

A

P: can be used in conjunction with other therapies

E: allows treatment to be catered to patient’s needs and therefore is likely to be more effective. This is arguably not achievable by drug treatments, whereas psychological therapies can come in a range of styles.

E: For example, NICE recommends art therapy, to allow patients who struggle with communication to still access the help they need, but instead with a qualified art therapists who can aid their treatments through creative medias.

L: Increases the internal and external validity of psychological treatments, as they are proven as effective but also applicable to a wide range of patients.

→ are these sort of therapies accessible to everyone or just the wealthy?

64
Q

state a limitation of psychological therapies as a treatment for Sz in terms of ethics

A

P: token economies are associated with some ethical issues

E: Privileges are more readily available to patient’s with milder symptoms, compared to severely ill patients who would struggle extensively more to maintain good behaviour

E: such ‘discriminatory’ practices reduces the usefulness of token economies, as their use in psychiatric hospitals may lead to patients not being treated equally.

L: reduces the internal validity

→ based on a process of classical conditioning, which behaviourists have proven to be an effective method of changing maladaptive behaviour

65
Q

Describe and evaluate the interactionist approach to both explaining and treating Sz (16m)

A

AO1: diathesis-stress and Meehl’s model

AO3: older model far too simple

AO1: new models of understanding diathesis-stress

AO3: evidence

AO1: treating using interactionist approach

AO3: support for effectiveness of combo treatments

66
Q

state a limitation of the interactionist approach Sz in terms of Meehl’s model

A

P: Meehl’s model oversimplifies a very complex disorder

E: focus on a single ‘schizogene’ as the root cause of a patient’s higher risk to developing symptoms when faced with stress/trauma, is incompatible with the modern understanding of the diathesis-stress model.

E: Modern understanding suggests Sz to be a polygenetic disorder, meaning there may be many candidate genes which may influence vulnerability to developing symptoms like the MAOA gene (involved with serotonin regulation), or the dopamine gene etc

L: Therefore Meehl’s emphasis of a single ‘schizogene’ being the only diathesis factor of Sz, is unfounded.

→ this model allowed future research/generation of future hypothesis for the understanding we have today

67
Q

state a strength of the interactionist approach Sz in terms of research for the modern diathesis-stress

A

P: research to support the role of trauma and genetic dysfunction in the development of Sz

E: Tienari investigated the combination of genetic vulnerability and parenting style. Found that child-rearing techniques characterised by high levels of criticism and low empathy was implicated in the development of Sz in children who already had genetic vulnerabilities.

E: This suggests that a combination of both genetic risk and family related trauma is important in the development of Sz. Whereby, genetically vulnerable children are more sensitive to parenting trauma.

L: supports the modern understanding of the interactionist approach to Sz, particularly when considering parenting as a possible risk factor. This increases the internal validity of the approach.

→ social implications in blaming parents

68
Q

state a strength of the interactionist approach Sz in terms of combining treatments

A

P: To support Turkington’s views, there’s strong evidence to suggest that combing treatments and adopting and interactionist perspective to Sz is effective

E: Studies where participants are randomly allocated to different methods of treating Sz (e.g CBT + medication, medication alone etc), have demonstrated that patients in combination groups had reduced symptoms by the end of the experiment.

E: This demonstrates that adopting an interactionist approach facilitates superior treatment outcomes and highlights the practical applications of adopting an interactionist approach when treating Sz

→ in this study there was no difference in hospital readmission rates - is it effective?

z -psychology paper three (5 decks)

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