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A Level Psychology AQA > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Schizophrenia

A

Term first used by Bleuler to categorise patients whose thought processes and emotional responses seemed disconnected (spectrum disorder)

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2
Q

How many people does schizophrenia affect?

A

1 in 100

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3
Q

International Classification of Diseases (ICD-10)

A

Produced by WHO (World Heath Organisation) , used as a diagnostic tool and to analyse and monitor the general health of the population

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4
Q

Diagnostic and Statistical Manual (DSM-5)

A

Produced by American Psychiatric Association, diagnose mental illness

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5
Q

Catatonic

A

classified by disturbance to movement leaving sufferer immobile

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6
Q

Paranoid

A

classified by powerful delusions and hallucinations

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7
Q

Hebephrenic

A

classified by native symptoms

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8
Q

How many symptoms must be present in order to diagnose a patient?

A

two for six months or more, active for at lease one month

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9
Q

Positive symptoms

A

represent change in behaviour or thoughts which affects or distorts their sense of reality, very distressing

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10
Q

Negative symptoms

A

can be present for several years before diagnosis - prodromal stage, appear gradually and slowly get worse. Reflect a diminution or loss of normal functioning

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11
Q

Positive symptoms- hallucinations

A

involve all the senses, common is hearing voices; abusive, assertive or annoying

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12
Q

Positive symptoms- delusions

A

held with extreme conviction despite being obviously untrue and unlikely, come as a result of hallucinations

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13
Q

Delusions of grandeur

A

individual believes they have some power or authority over the next

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14
Q

Positive symptoms- disorganised thinking

A

thoughts will drift from one thing to another, no connection between, words become jumbled (word salad)

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15
Q

Negative symptoms- speech poverty

A

social withdrawal, difficulty speaking to people

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16
Q

Negative symptoms- avolition

A

difficulty in planning and setting goals, no motivation, no interest in socialising

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17
Q

Negative symptoms- anhedonia

A

loss of interest or pleasure in all or almost all activities

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18
Q

Negative symptoms- affective flattening

A

reduced range of facial expressions and tone of voice

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19
Q

Problem with Negative symptoms

A

hard to distinguish from laziness

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20
Q

Co-morbidity

A

refers to the extent that two or more conditions or diseases occur simultaneous in a patient

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21
Q

Buckley (2009)

A

found that those diagnosed with schizophrenia were also diagnosed with other disorders

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22
Q

Buckley found that what % of those diagnosed with schizophrenia were also diagnosed with depression?

A

50%

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23
Q

Buckley found that what % of those diagnosed with schizophrenia also were diagnosed with OCD?

A

23%

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24
Q

Reliability

A

consistency of measurements and repeatability

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25
Q

Cultural differences in diagnosis - Copeland (1971)

A

gave 134 US and 194 British psychiatrists a description of a patient - 69% of US diagnosed schizophrenia but only 2% of British

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26
Q

Validity

A

whether an observed effect is a genuine one

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27
Q

Gender bias

A

when accuracy of diagnosis is dependent on the gender of an individual

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28
Q

Gender bias - Broverman (1970)

A

found that clinicians in the US equated mentally healthy ‘adult’ behaviour with mentally healthy ‘male’ behaviour = tendency for women to be perceived as less mentally ill

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29
Q

Symptom overlap

A

refers to the fact that symptoms of a disorder may not be unique to that disorder but are found in others

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30
Q

Evaluation of validity: research support for gender bias

A

Loring and Powell (1988) - randomly selected 290 male and female psychiatrists to read two case vignettes of patients’ behaviour, asked judgement. Described as males or no info on gender - 56% diagnosed schizophrenia, when female - only 20% given diagnosis

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31
Q

Evaluation of reliability: lack of inter-rater reliability

A

Whaley (2001) found inter-rater reliability correlations as low as 0.11

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32
Q

Both DSM-5 and ICD 10 are emic constructs. What is this?

A

a test that is created and tested in one country, meaning that its construct may only reflect the norms and values of that culture

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33
Q

Imposed etic

A

imposing the judgements and values of one culture onto another

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34
Q

Ethnocentric

A

assumption that there is no difference between cultures (culturally biased)

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35
Q

Genetic factors - Kendler et al (1985)

A

found that the first-degree relatives of those with schizophrenia were 18 times more likely to develop the disorder

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36
Q

Family Studies: Gottesman (1991)

A

children with two schizophrenic parents had a concordance rate of 46%, children with one schizophrenic parent a rate of 13% and siblings a concordance rate of 9%

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37
Q

Twin Studies: Joseph (2004)

A

if monozygotic twins are more similar than dizygotic, then this suggests that the greater similarity is due to genetic factors. Concordance rate for monozygotic twins of 40.4% and 7.4% for dizygotic twins

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38
Q

Adoption Studies: Tienari (1991)

A

164 adoptees’ biological mothers had been diagnosed with schizophrenia, 11 also received a diagnosis of schizophrenia, compared to just 4 of the 197 control adoptees

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39
Q

Evaluation of genetic factors: twin studies

A

Joseph argued the difference in concordance rates between monozygotic and dizygotic twins reflects the environmental differences that distinguish twin types due to identical twins being treated more similarly - hereditary factors not valid

40
Q

Evaluation of genetic factors

A

Biological approach as a whole is reductionist

41
Q

The Dopamine Hypothesis

A

excess of the neurotransmitter dopamine in certain regions of the brain is associated with the positive symptoms of schizophrenia

42
Q

What do schizophrenics have abnormally high numbers of on receiving neurons?

A

D2 receptors, resulting in more dopamine binding and therefore more neurons firing, leading to hallucinations and delusions

43
Q

Drug that increases dopaminergic activity

A

Amphetamine - stimulates nerve cells containing dopamine, causing synapse to be flooded with neurotransmitter

44
Q

Drug that decreases dopaminergic activity

A

Antipsychotics, such as olanzapine - block the activity of dopamine in the brain, eliminating symptoms

45
Q

The Revised Dopamine Hypothesis - Davis and Kahn (1991)

A

Positiive symptoms are caused by an excess of dopamine in subcortical areas of the brain and -ive arise from a deficit of dopamine in areas of the prefrontal cortex

46
Q

Animal Studies - Wang and Deutch (2008)

A

induced dopamine depletion in the prefrontal cortex in rats - resulted in cognitive impairment that researchers were able to reverse using antipsychotics

47
Q

Evaluation of dopamine hypothesis: weakness

A

neuroleptic drugs do not work for all patients diagnosed suggesting it is not just dopamine that causes symptoms

48
Q

Evaluation of dopamine hypothesis: weakness of brain scans

A

in 1990s, did not find that people suffering have more dopamine receptors

49
Q

Evaluation of dopamine hypothesis - strength

A

successful drug treatments - Leucht’s meta analysis of 212 studies analysing the effectiveness of antipsychotic drugs

50
Q

Evaluation of dopamine hypothesis - weakness of D2 receptors

A

blocking the D2 receptors of individuals has little to no effect on their symptoms suggesting other neurotransmitter symptoms may also produce positive symptoms associated with schizophrenia

51
Q

Family Dysfunction

A

schizophrenia develops as a result of poor communication or faulty relationships within the family

52
Q

Double bind theory

A

Bateson et al (1956) - suggest that children who frequently receive contradictory messages from their parents are likely to develop schizophrenia

53
Q

Expressed emotion

A

family communication style likely to influence relapse rates

54
Q

Cognitive explanations of delusions

A

egocentric bias leads person to relate irrelevant events to themselves

55
Q

Cognitive explanations of hallucinations

A

hypervigilance (auditory stimuli) leads to higher expectancy for the occurrence of a voice than normal individuals

56
Q

Evaluation of family dysfunction - importance of family relationships

A

Tiernari et al found disturbed adoptive families more likely to trigger schizophrenia in children with genetic vulnerability

57
Q

Evaluation of double bind theory

A

Berger (1956) - schizophrenics reported higher recall of double bind statements than non-schizophrenics

58
Q

Evaluation: individual differences vulnerability to EE

A

not all schizophrenics respond negatively to high EE and not all patients who live in low EE homes avoid relapse

59
Q

Evaluation of cognitive explanations - supporting evidence

A

Sarin and Wallin (2014) - found evidence that +ive symptoms arise from faulty processes such as impaired self-monitoring

60
Q

Evaluation - support for cognitive therapies

A

CBT more effective at reducing symptom severity than antipsychotics

61
Q

Typical drug therapy

A

typical antipsychotics are dopamine antagonists, used to combat +ive symptoms, block action of dopamine

62
Q

Atypical drug therapy

A

atypical antipsychotics combat +ive and -ive symptoms, show rapid dissociation from D2 receptor and a stronger affinity for serotonin receptors

63
Q

What % of D2 receptors must be blocked for antipsychotics to be effective?

A

between 60% and 70%

64
Q

Evaluation of antipsychotics - weakness

A

typical impact on areas of the brain that control motor activity - extrapyramidal side effects

65
Q

Evaluation of antipsychotics - ethical weakness

A

cost-benefit analysis may be negative, human rights abuse because of side effects

66
Q

Evaluation of antipsychotics - no difference?

A

Crossley et al conclude no difference in efficacy of typical and atypical but more severe side effect for atypical

67
Q

Cognitive Behavioural Therapy for psychosis (CBTp)

A

form of psychotherapy that aims to identify and challenge the faulty and irrational thought processes so they are replaced with rational thoughts

68
Q

How can the ABCDE model be used to challenge irrational thoughts?

A

Identify the events that prevent the person achieving their life goals (activating agent). Acknowledge their belief system and the consequences. Irrational thoughts are then disputed. Rational thoughts are then created (effects)

69
Q

Evaluation of CBTp - effectiveness

A

Startup et al (2004) - found that after one year those who had received CBT were better able to manage their +ive and -ive symptoms

70
Q

Evaluation of CBTp - lack of availability

A

Haddock et al suggests only small proportion of people are offered CBTp

71
Q

Family Therapy

A

takes part at home, coping strategies are developed so whole family can deal with symptoms, discussion is encouraged about day-to-day problems, experiences are shared.

72
Q

KEY STUDY: Pharaoh et al (2010) procedure

A

meta-analysis - reviewed 53 studies in Europe, Asia and North America, compared outcomes from family therapy to standard care. Research concentrated on studies that were randomised controlled trials

73
Q

KEY STUDY: Pharoah et al (2010) findings

A

use of family intervention increased patients’ compliance with medication, family intervention did not appear to have much affect on employment and independence. Moderate evidence that it significantly reduces hospital readmission and improved quality of life.

74
Q

Evaluation of family therapy - strength

A

Tarrier et al (1989) - may improve a patient’s overall social functioning

75
Q

Evaluation of family therapy - weakness of Pharoah

A

possibility of observer bias where raters were not ‘blinded’ to the condition to which people were allocated

76
Q

Token economies

A

involve analysing the patient’s faulty behaviour patterns with the aim of changing the behaviour through reinforcement, rewards and even punishment

77
Q

Name the type of conditioning used in token economies

A

operant conditioning

78
Q

How do token economies work?

A

1) Tokens are paired with rewarding stimuli and so become secondary reinforcers. 2) Patient engages in ‘target’ behaviours or reduces inappropriate ones. 3) Patient is given tokens for engaging in these target behaviours (e.g. dressing themselves). 4) Patient trades these tokens for access to desirable items or other privileges.

79
Q

Evaluation of token economies - strength

A

provide patients with the incentive to behave in appropriate ways

80
Q

Evaluation of token economies - weakness

A

method lacks external validity - therapy is only effective in controlled environments where behaviour can be carefully monitored

81
Q

Evaluation of token economies - ethical concerns

A

clinicians may exercise control over important primary reinforcers such as food, privacy or access to activities that alleviate boredom

82
Q

Diathesis-Stress Model

A

schizophrenia occurs as a result of a genetic predisposition or vulnerability to the disorder and an environmental factor that triggers the disorder

83
Q

Evaluation of the diathesis-stress model - strengths

A

integrates different explanations - not a reductionist and do not ignore complex nature of human behaviour

84
Q

Evaluation of the diathesis-stress model - weaknesses

A

difficult to investigate how the two factors interact, more hypothetical and does not have predictive power of scientific explanations - lacks reliability and validity

85
Q

KEY STUDY: Ripke et al (2014) - Candidate Gene Procedure

A

Completed a study combining all data from a genome wide study of schizophrenia.

86
Q

KEY STUDY: Ripke et al (2014) - Candidate Gene Findings

A

37,000 paitents were compared to 113,000 controls. 108 separate genetic variations were associated with an incresed risk of schizophrenia

87
Q

KEY STUDY: Goldman-Rakic et al (2004) - Dopamine Hypothesis (Hypodopaminergia old)

A

Abnormal dopamine systems in the brain cortex. Identified a role for the low levels of dompamine in the prefrontal cortex. Affects negative symptoms of schizophrenia as it effects thinking and decision making.

88
Q

KEY STUDY: Juckel et al (2006) - Neural correlates with Negative symptoms

A

Lower activity levels of compared to controls.Activity in the ventral striatum has been linked to the development of avolition (loss of motivation)(Negative symptom of schiz). The ventral striatum are believed to be particularly involved in the anticipation of a reward for certain actions. Negative correlation between activity levels in the ventral striatum and the severity of overall negative systems

89
Q

KEY STUDY: Allen et al (2007) - Neural correlates with Positive symptoms

A

Reduced activity in the superior temporal gyrus and anterior cingulate gyrus have been linked to the development of auditory hallucinations. Patients experiencing auditory hallucinations showed lower activation levels in these areas than controls. Therefore, reduced activity in these areas of the brain is a neural correlate of auditory hallucinations

90
Q

KEY STUDY: Fromm-Reichmann (1948) - Schizophrenogentic Mother

A

Early theorists influenced by Freudian ideas, thought that a ‘schizophrenogenic mother’, who was cold, dominant and created conflict, caused schizophrenia to emerge in the child. These mothers were said to be rejecting, overprotective, selfsacrificing, moralistic about sex and fearful of intimacy. The distrust, resentfulness and instability caused by such a parent creates a family climate characterised by tension and secrecy. This leads to distrust that later develops into paranoid delusions (i.e. the belief that one is being persecuted by another person), and ultimately schizophrenia.

91
Q

KEY STUDY: Read et al (2005) - Support for Family Dysfunction as a risk factor

A

Reviewed 46 studies of child abuse and schizophrenia and concluded that 69% of adult women in-patients with a diagnosis of schizophrenia had a history of physical abuse, sexual abuse or both, in childhood. • Men- 59% • Berry et al. (2008) adults with insecure attachments are more likely to have schizophrenia.

92
Q

KEY STUDY: Turking et al (2004) - Evidence for CBT

A

CBT was used to challenge paranoid delusions: E.G. Patient: The mafia are observing me to decide how to kill me Therapist: You are obviously very frightened…there must be good reason for this Patient: Do you think it’s the mafia? Therapist: It’s a possibility, but there could be other explanations. How do you know it’s the mafia?

93
Q

KEY STUDY: Read et al (2001) - Neural Development Model

A

Proposed a neurodevelopmental model in which early development in which early trauma alters the developing brain. E.g. The hypothalamic-pituatry-adrenal system (HPA) becomes over-active and the person is more vulnerable to later stress

94
Q

KEY STUDY: Meehl’s Model

A

Believed diathesis was entirely genetic, the result of a single ‘schizogene’. This led to the development of a biologically based schizotypic personality, one characteristic is sensitivity to stress. According to Meehl, if a person doesn’t have the schizogene then no amount of stress would lead to schizophrenia. However, in carriers of the gene, chronic stress through childhood and adolescence, particularly a schizophrenic mother could result in schizophrenia.

95
Q

KEY STUDY: Turkington et al (2006) - Both neural and Biological causes

A

it is perfectly possible to believe in biological causes and still practice CBT to relive psychological symptoms. Treatment would need to be adapted

96
Q

KEY STUDY: Frith (1992) - Dysfunctional in meta representation

A

Frith suggested that people with schizophrenia fail to monitor their own thoughts correctly, misattributing them to the outside world. When a person hears voices, it is actually their own inner speech being misinterpreted, however, sufferers may believe that someone or something in the external world is communicating with them. Such processing problems in people with schizophrenia are sometimes referred to as alien control symptoms because the sufferer feels as if external forces are influencing their thoughts and actions and they have no personal control.

A Level Psychology AQA (11 decks)

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