Schizophrenia

Question 1

What is Schizophrenia?

Answer 1

A type of psychosis/severe mental disorder categorised by a profound amount of disruption of cognition and emotion. Contact with external reality and insight are impaired. Affects a person’s language through perception, emotions and sense of self.

Question 2

How many people are affected by Schizophrenia at one point in their life?

Answer 2

1% of the population. No more than 1 in 5 completely recover.

Question 3

Definition of Positive Symptoms

Answer 3

Aren’t called positive because they are good but because they add something which ‘normal’ people don;t have.

Question 4

What are some examples of Positive symptoms?

Answer 4

1. Hallucinations
2. Delusions/paranoia/grandeur
3. Disorganised speech
4. Disorganised/catatonic behaviour

Question 5

What are hallucinations?

Answer 5

Disturbances of reality in any of the sense. False perceptions that either have no base in reality or are distorted perceptions of things that are. Most common are auditory hallucinations.

Question 6

What are delusions?

Answer 6

Firmly held irrational beliefs that have no basis in reality. Common types:

• Delusions of persecution
• Delusions of grandeur
• Delusions of control
• Delusions of reference

Question 7

Definition of negative symptoms

Answer 7

Known as ‘deficits’ if they’re present for at least a yea, and are something someone has lost.

Question 8

Examples of negative symptoms

Answer 8

1. Avolition
2. Speech Poverty (Alogia)
3. Affective Flattening
4. Anhedonia

Question 9

What is Avolition?

Answer 9

Lack of purposeful, willed behaviour. Reduction, difficulty or instability to start or continue with goal-directed behaviour. People with SZ often have a sharply reduced motivation to carry out a range of activities and results in lowered activity.

Question 10

What is Speech Poverty (Alogia)?

Answer 10

Limited speech output with limited, often repetitive, content. Involves reduced frequency and quality of speech.

Question 11

What is Anhedonia?

Answer 11

Loss of interest/pleasure, or reduced emotions to things that are pleasurable. Social aspect confused with depression - only physical anhedonia is reliable for SZ.

Question 12

Who conducted the ‘Sane in Insane Places’ study?

Answer 12

Rosenhan (1973)

Question 13

What was the ‘Sane in Insane Places study?

Answer 13

• Covert ppt observation
• Students reported a ‘dull thud’ which was not an actual symptom according to the DSM II
• All were diagnosed with SZ and hospitalised
• They were given meds/treatments and not allowed to leave until the university intervened, sometimes up to 2 months
• Rosenhan later phoned and said he was sending more fake patients. Over the next few weeks, 21% were diagnosed as ‘pseudopatients’ and sent home.
• He never actually sent any over.

Question 14

The role of Dopamine Receptor Genes in SZ

Answer 14

(D2, DR2)

• Affects a number of dopamine receptor sites and transports proteins for dopamine
• Associated with negative and positive symptoms (Davis & Khan 1991)

Question 15

The role of Glutamate Receptor Genes in SZ

Answer 15

(NMDA, AMPA)

• Affects a number of glutamate receptor sites. Especially important in the ventral striatum
• Associated with negative symptoms (Sorg et al 2013)

Question 16

The role of GRK in SZ

Answer 16

(G-Protein Coupled Receptor Kinase)
- Makes epigenetic and sensitivity changes to receptors for a number of excitatory neurotransmitters. Higher levels increase effects (Funk et al 2014)

Question 17

Gottesman’s study on SZ in families

Answer 17

(1991)
Studied concordance rates in children with SZ parents or siblings
2x SZ parents: 46% concordance
1x SZ parent: 13% concordance
1x SZ sibling: 9% concordance

Question 18

Joseph’s study on SZ in twins

Answer 18

(2004)
Meta analysis of data on MZ vs DZ twin concordance with SZ
MZ concordance: 40.4%
DZ concordance: 7.4%
Modern studies use ‘blind’ researchers. They show a lower but still big difference

Question 19

Tienari’s study on SZ in adoptive families

Answer 19

(2000)
Compared siblings raised together vs apart
164 had SZ mothers = 6.7% developed SZ
197 were in a ‘control group’ = 2% developed SZ
Conclusion = genetic liability for SZ is ‘decisively confirmed’

Question 20

What is the Dopamine Hypothesis?

Answer 20

States that SZ is caused by an imbalance of dopamine, either:

• They have too many D2 receptors
• Their D2 receptors are too sensitive/fire too often
• They produce too much dopamine

Question 21

What is Dopaminergia?

Answer 21

Dopamine’s actions in the brain. If there is too much, it’s known as hyperdopaminergia. If there is too little, it’s known as hypodopaminergia.

Question 22

What does Hyperdopaminergia cause in the subcortex?

Answer 22

It’s associated with positive symptoms. Broca’s area produces speech and too much dopamine here leads to the speech and hearing-related symptoms

Question 23

What does Hypodopaminergia cause in the subcortex?

Answer 23

Associated with negative symptoms. PFC is the central executive and too little here leads to avolition/catatonia.

Question 24

What are drugs that increase dopamine activity?

Answer 24

• Amphetamines

- L-dopa

Question 25

What are drugs that decrease dopamine activity?

Answer 25

• Chlorpromazine

- Clozapine

Question 26

What did Davis & Khan theorise about Dopamine in SZ?

Answer 26

• Too much in mesolimbic pathway > positive symptoms

- Too little in PFC > negative symptoms

Question 27

What is the Double Bind Theory?

Answer 27

Bateson et al (1956): contradictory messages are responsible for children having/developing SZ. The parenting type is known as the ‘Schizophrenogenic Mother’

Question 28

What did Kuipers et al say about Expressed Emotion?

Answer 28

• Families with high expressed emotion can trigger psychotic episodes
• These families describe SZ relatives in hostile, critical terms
• EE levels in family/friends is strongly correlated with relapse rates

Question 29

What did Noll et al say about Expressed Emotion?

Answer 29

• Negative emotions can trigger SZ episodes in vulnerable people. Supportive environments may be protective. This is a diathesis-stress model.

Question 30

What are the three stages of Beck & Rector’s Cognitive Model?

Answer 30

Stage 1: Cognitive Processing Biases
Stage 2: Misattribution of consequences to causes
Stage 3: Failure to test reality with memory or logic

Question 31

What is the cognitive process of Delusions?

Answer 31

Inadequate information processing > Egocentric Biases > Failure to contextualise events