Schizophrenia

Question 1

What I need to know (SPEC)

Answer 1

Classification of schizophrenia. Positive symptoms of schizophrenia, including hallucinations and delusions. Negative symptoms of schizophrenia, including speech poverty and avolition. Reliability and validity in diagnosis and classification of schizophrenia, including reference to co-morbidity, culture and gender bias and symptom overlap.

Biological explanations for schizophrenia: genetics and neural correlates, including the dopamine hypothesis.

Psychological explanations for schizophrenia: family dysfunction and cognitive explanations, including dysfunctional thought processing.

Drug therapy: typical and atypical antipsychotics.

Cognitive behaviour therapy and family therapy as used in the treatment of schizophrenia. Token economies as used in the management of schizophrenia.

The importance of an interactionist approach in explaining and treating schizophrenia; the diathesis-stress model.

Question 2

What is used to diagnose SZ?

Answer 2

DSM-5 - Diagnostic and Statistical Manuel
ICD-10 - International Classification of Diseases

Question 3

What is the ICD?

Answer 3

International Classification of Diseases which is used worldwide to diagnose SZ and only negative symptoms need to be present

Question 4

What is DSM?

Answer 4

Diagnostics and Statistical Manuel which is mainly used in America where only positive symptoms need to be present

Question 5

What is meant by positive symptoms?

Answer 5

Positive symptoms are an excess or distortion of normal functions, for example hallucinations, delusions and thought disturbances such as thought insertion.

Question 6

What is meant by hallucinations?

Answer 6

Hallucinations are usually auditory or visual perceptions of things that are not present. Imagined stimuli could involve any of the senses. Voices are usually heard coming from outside the person’s head giving instructions on how to behave.

Question 7

What is meant by Delusions?

Answer 7

Delusions are false beliefs. Usually the person has convinced him/herself that he/she is someone powerful or important, such as Jesus Christ, the Queen (e.g. Delusions of Grandeur). There are also delusions of being paranoid, worrying that people are out to get them.

Question 8

What is meant by negative symptoms?

Answer 8

Negative symptoms are a diminution or loss of normal functions such as psychomotor disturbances, avolition (the reduction of goal-directed behavior), disturbances of mood and thought disorders

Question 9

What is meant by avolition?

Answer 9

Avolition: Lack of volition (i.e. desire): in which a person becomes totally apathetic and sits around waiting for things to happen. They engage in no self motivated behavior. Their get up and go has got up and gone!

Question 10

What did Slater & Roth (1969) say (A03 - )

Answer 10

Hallucinations are the least important of all the symptoms, as they are not exclusive to schizophrenic people.

Question 11

What did Scheff (1966) say ( A03 -)

Answer 11

Diagnosis classification labels the individual, and this can have many adverse effects, such as a self-fulfilling prophecy (patients may begin to act how they are expected to act), and lower self-esteem.

Question 12

What is meant by reliability?

Answer 12

Reliability is the level of agreement on the diagnosis by different psychiatrists across time and cultures; stability of diagnosis over time given no change in symptoms.

For the classification system to be reliable, differfent clinicians using the same system (e.g. DSM) should arrive at the same diagnosis for the same individual.

Question 13

What did Jakobsen et al (2005) find out? (AO3 +)

Answer 13

Tested the reliability of the ICD-10 classification system in diagnosing schizophrenia. A hundred Danish patients with a history of psychosis were assessed using operational criteria, and a concordance rate of 98% was obtained. This demonstrates the high reliability of the clinical diagnosis of schizophrenia using up-to-date classification

Question 14

What does comorbidity mean? (AO3 -)

Answer 14

Comorbidity describes people who suffer from two or more mental disorders. For example, schizophrenia and depression are often found together. This makes it more difficult to confidently diagnose schizophrenia. Comorbidity occurs because the symptoms of different disorders overlap. For example, major depression and schizophrenia both involve very low levels of motivation. This creates problems of reliability.

Question 15

What did Loring and Powell? (1988) find out (AO3 -)

Answer 15

Some behavior which was regarded as psychotic in males was not regarded as psychotic in females.

Question 16

What is meant by validity?

Answer 16

The extent to which schizophrenia is a unique syndrome with characteristics, signs and symptoms

Question 17

What is meant by aetiological validity?

Answer 17

For a diagnosis to be valid, all patients diagnosed as schizophrenic should have the same cause for their disorder. This is not the case with schizophrenia: The causes may be one of biological or psychological or both

Question 18

What did David Rosenhan (1973) find (AO3 -)

Answer 18

Pseudopatients (patients who pretend to act sick) led to 8 normal people being kept in hospital despite behaving normally. This suggests the doctors had no valid method for detecting schizophrenia. They assumed the bogus patients were schizophrenic with no real evidence. In a follow up study they rejected genuine patients whom they assumed were part of the deception.

Question 19

Cultural bias (AO3 Validity -)

Answer 19

African Americans and those of Afro-carribean descent are more likely to be diagnosed than their white counterparts but diagnostic rates in Africa and the West Indies is low - Western over diagnosis is a result of cultural norms and the diagnosis lacks validity.

Question 20

What are the three biological explanations fo SZ?

Answer 20

Genetics
The Dopamine Hypothesis
Neural Correlates

Question 21

What did Gottesman (1991) find out (AO1)

Answer 21

Gottesman (1991) found that MZ twins have a 48% risk of getting schizophrenia whereas DZ twins have a 17% risk rate. This is evidence that the higher the degree of genetic relativeness, the higher the risk of getting schizophrenia

Question 22

What did Benzel et al (2007) find out (AO1)

Answer 22

three genes: COMT , DRD4 , AKT1 - have all been associated with excess dopamine in specific D2 receptors, leading to acute episodes, positive symptoms which include delusions, hallucinations, strange attitudes

Question 23

Evaluation of twin studies (concordance rates A03 -)

Answer 23

Shows how genetics is not only responsible as if it was the concordance rate would be 100%

Question 24

What is dopamine?

Answer 24

Dopamine is a neurotransmitter. It is one of the chemicals in the brain which causes neurons to fire that regulates mood and attention

Question 25

What does the dopamine hypothesis state?

Answer 25

The original dopamine hypothesis stated that schizophrenia suffered from an excessive amount of dopamine. This causes the neurons that use dopamine to fire too often and transmit too many messages

Question 26

What is meant by Hyperdopaminergia?

Answer 26

Excess amount of dopamine

Question 27

What does hyperdopaminergia in subcortex lead to?

Answer 27

May be associated with auditory hallucinations or povety of speech aka positive symptoms

Question 28

What does hypodopaminergia in prefrontal cortex cause?

Answer 28

Negative symptoms (e.g. decision making)

Question 29

What is anhedonia?

Answer 29

A loss of interest or pleasure in all or almost all activities

Question 30

What are the 2 types of anhedonia?

Answer 30

Physical- the inability to experience physical pleasure such as from food or bodily contact
Social- the inability to experience pleasure from interpersonal situations such as interacting with others

Question 31

What is one limitation of social anhedonia?

Answer 31

It overlaps with other disorders like depression according to Sakar et al

Question 32

What is used to measure inter-reliability

Answer 32

Kappa score

Question 33

What is kappa score?

Answer 33

Used to measure inter-reliability in classification. A score of 1 means perfect inter-reliability but anything above 0.7 is considered good

Question 34

What is the kappa score of schizophrenia?

Answer 34

0.46 (reigner et al)

Question 35

What did Whaley find out?

Answer 35

Inter-realisability correlations as low as 0.11 in the DSM

Question 36

What did Ellie Cheniaux et al investigate (2009)

Answer 36

The inter-rather reliability of the classification of schizophrenia

Question 37

What was the method of Elle Cheniaux et al research

Answer 37

Had two psychiatrists independently diagnose 100 patients using both the DSM and ICD criteria

Question 38

What were the results of Elle Cheniaux el al research?

Answer 38

-One psychiatrists diagnoses 20 patients with SZ using DSM and 44 using ICD
-Another psychiatrists diagnosed 13 using the DSM and 24 using ICD
-The classification of SZ has poor reliability as the classification depends on how the doctor interprets the classification system meaning you can get an inaccurate diagnosis
-This can lead to people getting incorrectly diagnosed and not getting the help/treatment they require

Question 39

What did Rosenhan investigate?

Answer 39

The validity of the classification of SZ

Question 40

What was the procedure of Rosenhan’s research?

Answer 40

People with no mental health conditions presented themselves to psychiatrist hospitals and got themselves admitted by saying they hear voices thus making them pseudo patients. Throughout their stay none of the staff noticed they were acc normal and some staff even claimed a patron was displaying “writing behaviour” when they were just writing in a diary

Question 41

What is the result of Rosenhan’s research

Answer 41

-There is poor validity of the classification of SZ
-Once a person is labelled of having a mental disorder all of their behaviour can be interpreted as a cause of that disorder