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Schizophrenia Flashcards

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1
Q

What is schizophrenia?

A

A serious psychotic mental disorder including problems with reality.
Psychotic disorders cause abnormal thinking and perceptions.

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2
Q

What are positive symptoms?

A

Symptoms that most healthy people do not experience but those with schizophrenia do.

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3
Q

What are negative symptoms?

A

Lack of some emotional or physical responses that are present in healthy people.

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4
Q

What are the positive symptoms of schizophrenia?

A
  • Hallucinations
  • Delusions
  • Disorganised speech
  • Disorganised or catatonic behaviour
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5
Q

What are the negative symptoms of schizophrenia?

A
  • Avolition “lack of will”
  • Speech poverty
  • Flattened affect
  • Anhedonia “not seeking pleasure”
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6
Q

What are hallucinations?

A
  • Unusual sensory experiences
  • Can be picked up from any sense and bear no relation to actual sensory input
  • Examples are hearing voices, feeling insects on the skin
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7
Q

What are delusions?

A
  • These are irrational beliefs

- May come with paranoia

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8
Q

What is disorganised speech?

A
  • Speech may be hard to understand because it does not follow a logical pattern; topics may be changed mid sentence
  • This is due to disorganised thoughts
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9
Q

What is disorganised or catatonic behaviour?

A
  • The person may act in bizarre ways, wearing winter clothes in July or full evening dress to go to the shops
  • Catatonic behaviour may involve lack of response to the environment
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10
Q

What is avolition?

A
  • “Lack of will”

- May include poor hygiene and lack of energy

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11
Q

What is speech poverty?

A
  • The quantity and quality of speech is reduced

- Speech may also be delayed or have long pauses

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12
Q

What is flattened affect?

A
  • Range and intensity of emotional expression is limited

- May include facial expression, tone of voice, hand gestures

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13
Q

What is anhedonia?

A
  • Lack of pleasure and pleasure seeking
  • Social: may be lack of enjoyment in social activities
  • Physical: Lack of pleasure from physical sensations eg. food
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14
Q

What is dopamine?

A

A neurotransmitter and there are many dopamine pathways in the brain which together are responsible for:

  • Pleasurable reward and motivation
  • Behaviour and cognition
  • Attention
  • Movement
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15
Q

What is the dopamine hypothesis?

A
  • The idea that dopamine activity is responsible for symptoms of schizophrenia.
  • As dopamine neurons are instrumental in regulating attention, it is theorised that if this process is disturbed it may lead to problems with attention, perception and thought.
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16
Q

How does the dopamine hypothesis explain positive symptoms?

A

High levels of dopamine in some areas of the brain may explain positive symptoms such as hallucinations and delusions.

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17
Q

How does the dopamine hypothesis explain negative symptoms?

A

Low levels of dopamine in other areas of the brain explain the negative symptoms such as avolition.

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18
Q

What are the two psychological explanations to schizophrenia?

A
  • Family dysfunction

- Cognitive explanations

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19
Q

What is family dysfunction?

A

Patterns of relationships and communication in families of people with schizophrenia.

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20
Q

What are the 3 types of family dysfunction?

A
  • Schizophrenogenic mother
  • Double bind
  • Expressed emotion
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21
Q

What is a schizophrenogenic mother?

A

Mother is:

  • critical
  • hostile
  • overprotective/controlling
  • rigid
  • moralistic about sex

Father is passive
- Family ‘schism’ (split)

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22
Q

How does the schizophrenogenic mother explanation explain schizophrenia?

A

Due to faulty communication and contradictory behaviour which causes confusion and distrust in the child which leads of paranoid delusions of schizophrenia.

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23
Q

What is the double bind explanation?

A
  • Child finds themselves in situations where they fear doing the wrong thing
  • Receive mixed messages
  • Feel unable to seek clarification
  • Punished by withdrawal of love
  • World seems dangerous and confusing

E.g. Child falls over and goes to mother. Mother rejects child and tells them to grow up. Child falls over again and goes to friend’s mother. Child’s mother sees and says ‘Why didn’t you come to me? Don’t you love me?

This leads to disorganised thinking and paranoid delusions of schizophrenia.

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24
Q

What is expressed emotion?

A
  • Level of negative emotion expressed towards or about schizophrenic patient by carers.
  • E.g. verbal criticism, hostility and rejection
  • Causes stress for patient
  • High levels of EE are associated with relapse
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25
Q

How does expressed emotion explain schizophrenia?

A

Higher levels of relapse in households with higher EE.

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26
Q

What are the strengths of family dysfunction as an explanation for schizophrenia?

A

Support for EE
- 26 studies for EE were reviewed patients with high EE families had a 48% relapse rate whereas those in low EE families had a 21% relapse rate

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27
Q

What is the limitation of schizophrenogenic mother and double bind theories?

A
  • Specific evidence for schizophrenogenic mother and the double bind causing schizophrenia is weak
  • Based on outdated ideas of blaming parents
  • Therefore these explanations lack validity and cannot give us a casual explanation of schizophrenia
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28
Q

What are the two types of dysfunctional cognitions that could cause schizophrenia symptoms?

A
  • (Lack of) central control

- (Lack of) metarepresentation

29
Q

What is central control?

A
  • Ability to suppress automatic responses so we can perform deliberate actions instead
  • Lack = disorganised speech - can’t suppress automatic thoughts from becoming speech
30
Q

What is metarepresentation?

A
  • Being able to reflect on thoughts and behaviour (gives insight)
  • Allows us to work out we are responsible for our thoughts and actions, not someone else
  • Also allows us to work out the motivations of other people
  • A lack would explain being experienced as auditory hallucinations and actions being seen as due to some outside influence (delusions)
31
Q

What is the strength of central control?

A
  • Research support
  • Patients with schizophrenia and non-patient controls compared on cognitive tasks (Stroop test)
  • Patients took twice as long to name the ink colour as the control group
  • This is because they have problems with central control and find it harder to override automatic reponses with deliberate actions
32
Q

What is the strength of metarepresentation?

A
  • Research support
  • Found faulty cognitions in those with schizophrenia
  • Eg. delusional patients showed cognitive biases such as jumping to conclusions and lack of reality testing
  • This can explain why a person crossing the road as you approach can be seen as a rejection by a paranoid schizophrenic person
33
Q

How do antipsychotic drugs work?

A

They block the receptor sites on the post-synaptic neuron so the dopamine can’t bind with the receptor sites and so can’t transmit its message.

34
Q

How are typical antipsychotic drugs such as Clorpromazine (Thorazine) effective?

A
  • They block D2 receptors in the dopamine pathway, reducing action of dopamine so reduces positive symptoms
  • Also an effective sedative, reduces anxiety
  • Little effect on negative symptoms
35
Q

What are the side effects of typical antipsychotic drugs?

A
  • Agitation
  • Weight gain
  • Itching
  • Tardive dyskinesia (involuntary facial movements)
  • Neuroleptic malignant syndrome (high temperature, delirium and coma)
36
Q

What are the two examples of atypical antipsychotics?

A
  • Clozapine

- Risperidone

37
Q

How is clozapine (atypical antipsychotic) effective?

A
  • Significantly better than all other anti-psychotics
  • Binds to D2 receptors but also serotonin and glutamate receptors; reduces positive symptoms and reduces anxiety
  • Useful for patients with anxiety
  • May help reduce negative symptoms
38
Q

What are the side effects of clozapine (atypical antipsychotic)?

A
  • Reduced risk of side effects
  • Drowsiness is a common side effect
  • Potentially fatal from rare blood condition
39
Q

How is risperidone (atypical antipsychotic) effective?

A
  • Acts on dopamine and serotonin receptors
  • Binds more strongly to D2 receptors than clozapine does, more effective in lower doses
  • Reduces positive symptoms and may help reduce negative symptoms
40
Q

What are the side effects of risperidone (atypical antipsychotic)?

A
  • Fewer side effects than others due to lower doses
  • Less likely to produce tardive dyskinesia
  • Less risk of fatality than clozapine
  • Metabolic changes, weight gain and sluggishness
41
Q

What is the strength of drug therapy for schizophrenia?

A
  • Research support for effectiveness
  • Meltzer conducted a review and found clozapine is the most effective antipsychotic drug working for 30%-50% of patients where typical drugs have failed to help
  • The treatment therefore does what it is claimed to do
  • Therefore the drugs are very useful and can improve people’s wellbeing
42
Q

Why is the fact that drug treatment relies on the dopamine hypothesis being true a limitation?

A
  • Drugs target the dopamine system
  • Just because dopamine is associated with schizophrenia does not mean it is the cause of symptoms
  • Also the explanation may be over simplified, there are lots of neurotransmitters involved and research is still ongoing
  • Therefore although we know the drugs work, we can’t assume that dopamine causes schizophrenia
43
Q

Why is the fact that drug treatment often makes patients experience serious side effects a limitation?

A
  • Some particularly concerning side effects are tardive dyskinesia because they can be permanent
  • This means costs can outweigh the benefits for some patients, meaning they won’t take the drugs
44
Q

Why is the fact that drug treatment can be criticised using the chemical cosh argument a limitation?

A
  • It has been suggested that it is unethical to use powerful drugs just to make patients easier to manage.
  • They may be medicated for other people’s benefit rather than their own benefit
  • This suggests that they may be being used unethically
45
Q

What is family therapy?

A

Based on the theory that there are poor relationships and communication between an individual with schizophrenia and their carers
E.g. hostile mother and passive father

10 sessions over 3-12 months

46
Q

What is the aim of family therapy?

A

To provide support for carers to make family life less stressful hence reducing schizophrenia.

47
Q

How does family therapy work?

A
  • Aimed at reducing levels of EE and stress in the family
  • Therapist forms alliance with both patient and carer
  • Together they work out ways for the family to solve problems
  • Psychoeducation: Helping person and carers to understand and better able to deal with the illness
  • Reducing anger and guilt in family members
  • Helping families achieve balance between own needs and the schizophrenic’s needs

Also used along side drug therapy (drugs can help calm down symptoms so they engage in therapy)

48
Q

What are the strengths of family therapy?

A

Support from evidence

  • Reviewed evidence of effectiveness from 53 studies
  • Found moderate evidence that therapy helped reduce hospital admissions and improved quality of life
  • Compliance increased
  • No difference in ability to live independently

High economic benefit

  • Improvements in clinical, social and family functioning reduce the need for intensive medical and social care and so produce economic benefits
  • Cost savings can be substantial
  • The additional cost to the family is usually minimal, particularly as treatment sessions can be arranged flexibly to minimise loss of earnings or transport cost
49
Q

What is a limitation of family therapy?

A
  • Study found no difference in relapse rate between families that had family therapy and those who didn’t
  • Maybe modern families have greater understanding and empathy
  • Tend to have low EE
50
Q

What is CBTp?

A
  • Cognitive behaviour therapy for psychosis
  • It is based on the idea that it is distorted beliefs which influence feelings and behaviour
  • Based on the ABCDE model
  • Challenges people’s beliefs and change them
  • Around 16 sessions on a one-one basis
  • Behavioural assignment (homework)
51
Q

What is the ABCDE model?

A 
Activating event
Beliefs about A
Consequences of B
Dispute by therapist
Effect of dispute on B and C
52
Q

How does CBTp work?

A

Assessment: Therapist discusses individual’s current symptoms and origins. Once they’re known, realistic therapeutic goals are set
Engagement: The therapist empathises with the person’s distress
Normalisation: Placing the person’s psychotic experiences with normal experiences. If the client is told their experiences are common, they will feel less alienated and stigatised
Critical collaborative analysis: Gentle empathetic and non-judgmental questioning helps the person understand their false beliefs.
Developing alterative explanations: Enables healthier explanations for beliefs and experiences. This is supported with help from the therapist if the personal has difficulty.

53
Q

What is a limitation of CBTp?

A

Not everyone benefits from it

  • It is not widely available and not routinely offered to patients
  • Less than 1/10 patients who could benefit from CBTp receive it
  • Some refuse or fail to attend therapy (lack insight)
54
Q

What research support is there for CBTp?

A

NICE review of research
Those treated with both drugs and CBTp had:
- Reduced readmission rates for up to 18 months following treatment
- Reduced symptom severity
- Improved social functioning

Reviewed 34 studies
- Found that CBTp has a highly significantly effect on both positive and negative symptoms of schizophrenia

55
Q

What are token economies based on?

A

Operant conditioning - behaviourism

56
Q

What sort of symptoms do token economies aim to treat?

A

Negative symptoms such as avolition

57
Q

How do token economies work?

A
  • Clinicians set target behaviour that they believe will improve patient’s engagement in daily activities eg. dressing themselves
  • The tokens are paired with a reward the patient wants
  • Tokens are awarded when patient engages in target behaviour
  • Tokens have no intrinsic value (they are secondary reinforcers)
  • Tokens are later exchanged for various rewards and privileges.
58
Q

Why does research show that token economies are more effective when tokens can be exchanged for a variety of items?

A 
It makes it more motivating and personalised to the person to do the target behaviour.
Prevents satiation (full up)
59
Q

Why does research show that token economies are more effective when tokens are awarded immediately without delay following the desired behaviour?

A 
Makes it clear and easy for them to know which behaviour was rewarded.
Temporal contiguity (time close by)
60
Q

Why does research show token economies are less effective when patients live in the community?

A
  • Doctors have less control over patient’s lives, particularly access to rewards and unable to observe behaviour on a constant basis
  • Therefore token economies are of limited effectiveness, useful only in inpatient settings
61
Q

Why may a token economy do little to treat schizophrenia symptoms in patients?

A

Because it produces only surface behavioural changes and won’t change the underlying symptoms or cause of schizophrenia.

62
Q

How might use of token economies with patients with schizophrenia be unethical?

A

Those with positive symptoms may be unable to access rewards which is unfair.
Those with severe illness will get fewer rewards so this is unfair as the disorder is out of their control.

63
Q

What is the interactionist approach in explaining schizophrenia?

A

Acknowledges that there are biological, psychological and societal factors in the development of schizophrenia.
Biological: Genetic vulnerability
Psychological and societal: Stress resulting from life events and daily hassles, including poor quality interactions in the family

64
Q

How does the diathesis-stress model explain the cause of schizophrenia?

A

A biological vulnerability to schizophrenia and a stress trigger are necessary to develop the disorder.
One or more underlying factors make a person vulnerable but the onset of the condition is triggered by stress.

65
Q

What was the original diathesis-stress model like?

A
  • Said diathesis was entirely genetic, the result of a single ‘schizogene’.
  • If a person doesn’t have the schizogene then no amount of stress will lead to schizophrenia
  • The gene interacting with stress through childhood and adolescence results in schizophrenia
66
Q

What is the modern understanding of diathesis?

A
  • Many genes increase genetic vulnerability
  • There is no ‘schizogene’
  • Modern views of diathesis also include a range of factors beyond the genetic, including early psychological trauma - trauma becomes the diathesis rather than the stressor
  • Found that early trauma meant that brain architecture did not develop as it should
  • This gives the individual a biological vulnerability to schizophrenia as they are more sensitive to stress later in life
67
Q

What is the modern understanding of stress?

A
  • Originally stress was seen as psychological in nature, in particular related to parenting
  • Psychological stress is still seen as important but a modern definition of stress includes anything that risks triggering schizophrenia including biological factors such as a virus or cannabis
  • Cannabis users 2.5x more likely, heavy users 6x more likely to develop schizophrenia
  • 7x the risk if mother had influenza virus during pregnancy
68
Q

What is the limitation of the original diathesis-stress model?

A
  • It is over-simplified
  • Original model said diathesis came only from having a schizogene but now we know if it many genes
  • Also, early trauma can alter architecture of the brain and give biological vulnerability
    Original model says stress came from a family causing psychological stress, but now we know biological stress from environment such as viruses or cannabis use
69
Q

What is a strength of the diathesis-stress model as an explanation for schizophrenia?

A
  • Research support
  • Large prospective study of adopted children
  • Compared biological children of schizophrenic mothers with the biological children of non-schizophrenics
  • First group was much more likely to be schizophrenic
  • But only if the adoptive family they were brought up in was rated as disturbed - high conflict and criticism and low empathy
  • It shows both biological vulnerability and environmental stress are needed

Psychology (17 decks)

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