Schizophrenia Flashcards
Define schizophrenia
A severe mental disorder where contact with reality and insight are impaired
Schizophrenia is prevalent in about __% of the world’s population
1%
Which 3 groups are the most likely to be diagnosed with schizophrenia?
City dwellers
Men
Poorer groups
What are the conditions for diagnosing schizophrenia in the ICD11?
Two or more negative symptoms in order to be sufficient for diagnosis
What are the conditions for diagnosing schizophrenia in the DSM5?
At least one positive symptom in order to be sufficient for diagnosis
Define the phrase positive symptom?
Symptoms which add to our experience of reality
Define the phrase negative symptom?
Symptoms which take away our experiences and abilities
Name three positive symptoms
- hallucinations (distorted sensory experience)
- delusions (extreme paranoia - cant be convinced otherwise - lack insight)
- speech disorganisation (incoherent)
Name two negative symptoms
- avolition (the complete loss of motivation)
- speech poverty (a lack of quantity & quality of speech)
Define avolition
A complete loss of motivation
Define speech poverty
A lack of quantity & quality of speech
What two manuals can we use for schizophrenia diagnosis
DSM5
ICD11
What is a strength of schizophrenia diagnosis?
- reliability of diagnosis: Osario, 2 psychiatrists using the DSM5 assessed 180 people and found inter rater reliability of +.97 and test retest reliability of +.92 heightening the reliability of SZ diagnosis
Expand on the limitation co-morbidity of schizophrenia diagnosis
The occurrence of two disorders at once - schizophrenia is often diagnosed alongside depression & substance abuse - questioning whether schizophrenia is its own condition or not - reducing the validity of diagnosis
Expand on the limitation symptom overlap of schizophrenia diagnosis
Schizophrenia shares symptoms with other disorders e.g. bipolar disorder - this overlap makes it hard to know whether they are seperate disorders - reducing the validity of diagnosis
Expand on the limitation validity of diagnosis of schizophrenia
Chenioux : 2 psychiatrists using both manuals (ICD10 & DSM5) assessed 100 clients
ICD = 68 diagnoses
DSM = 39 diagnoses
Results are not concurrent and suggest ICD over diagnoses and DSM under diagnoses
Expand on the limitation gender bias of schizophrenia diagnosis
Men are diagnosed 1:4:1 against women - likely not genetic but women have stronger support systems and can therefore manage symptoms better leaving them undiagnosed and men more frequently diagnosed
Expand on the limitation gender bias of schizophrenia diagnosis
Men are diagnosed 1:4:1 against women - likely not genetic but women have stronger support systems and can therefore manage symptoms better leaving them undiagnosed and men more frequently diagnosed
Expand on the limitation culture bias of schizophrenia diagnosis
Symptoms i.e. hearing voices have different meanings in other cultures e.g. Haiti (seen as a blessing/communication with God) in addition to this Black British = 9x more likely to be diagnosed yet this decreases in African countries
What are the two types of biological explanations for schizophrenia?
Genetic
Neural
What type of study did Gottesman use? (Genetic explanation)
family study
What did Gottesman find? (Genetic explanation)
Identical twins (MZ) shared the highest concordance rate - 48% and so have a higher risk of SZ diagnosis compared to 1% of the general population
Fraternal twins (DZ) shared the second highest - 17%
What do Gottesman’s findings suggest? (Genetic explanation)
The more genetic material you share with someone that has SZ the greater the probability you also develop SZ
What is the significance of MZ twins having a less than 50% concordance rate in Gottesman’s study?
as the highest genetic compatibility monozygotic twins (100%) have a less than 50% concordance rate it is likely there are other factors that cause SZ
What is a limitation of Gottesman’s study? (Genetic explanation)
Nature v nurture - family studies are unable to distinguish between nature & nature as family members are likely to share environment/ experiences - results cant claim SZ is solely genetic - diminished validity
What are candidate genes?
genes associated with particular traits or disorders
Define polygenic?
multiple genes associated with the same disorder
Define aetiologically heterogeneous?
different combinations of different genes are associated with the same disorder
Schizophrenia is polygenic
True or false?
true
Schizophrenia isn’t aetiologically heterogeneous
True or false?
false
Early research believed there to be a single _____________ (genetic explanation)
schizogene
What did Ripke do? (Genetic explanation)
Ripke conducted a meta analysis looking into the genetic makeup of thousands of SZ sufferers to thousands as a control
What did Ripke find?
108 genetic variations associated with an increased risk of SZ
There can be a genetic component to SZ without a family history due to _________ ___________
genetic mutation
Research found an increased risk of genetic mutation associated with SZ when __________ are older
Fathers
What is the risk of genetic mutation associated with SZ for fathers under 25?
0.7% chance of passing on a genetic mutation associated with SZ
What is the risk of genetic mutation associated with SZ for fathers over 50?
Over 2% chance of passing on a genetic mutation associated with SZ
What are two strengths of the genetic explanation for SZ?
research support: adoption studies successfully separate nature from nurture - children whose biological parents have SZ have been found to bear a greater risk of developing the disease despite being raised by parents without SZ - more accurate than family studies - increased validity
Practical application: genetic counselling - sitting down with a geneticist that calculates your potential risk of conceiving a child with SZ or other disorders - helps people make informed decisions - exemplifies effectiveness & usefulness
What is a limitation of the genetic explanation for SZ?
environmental factors: the concordance rate in Gottesman’s study is not 100% suggesting their are environmental factors present e.g. family dysfunction has been found to have an effect on SZ - high levels of expressed emotions in families may increase the risk of SZ diagnosis - incomplete approach - an interactionist approach may be more appropriate
What does the neural explanation of SZ consider?
brain structures and chemistry
What type of neurotransmitter is dopamine?
excitatory
What was the original dopamine hypothesis called?
hyperdopaminergia in the sub cortex
Hyper = too much dopamine
What is an example of Hyperdopaminergia in the sub cortex?
High levels of dopamine in Broca’s area (speech production) has been linked to speech related symptoms of SZ e.g. speech poverty & auditory hallucinations
What is the name of the dopamine hypothesis that was developed later on?
hypodopaminergia in the pre frontal cortex
Hypo = too little
What is the pre frontal cortex responsible for?
thinking and decision making
What have low levels of dopamine in the pre frontal cortex been associated with?
negative symptoms of SZ e.g. avolition
What are two strengths of the neural explanation for SZ?
Dopamine evidence: anti psychotics block dopamine production and have been associated with improved SZ symptoms - it has also been found that amphetamines (increase dopamine) which are clinically used to treat ADHD produces SZ like symptoms when given to those without SZ - when given to those with SZ symptoms worsen - increased validity and exemplifies effectiveness
Practical application: drug therapy - has led to the development of anti psychotics (dopamine antagonists) which have helped numerous SZ sufferers - useful - increased validity
What are two limitations of the neural explanation for SZ?
Glutamate: an excitatory neurotransmitter used more widely across our brains than dopamine - brain scans & post mortems have consistently found increased levels of glutamate in SZ sufferers - dopamine hypothesis doesn’t consider this - incomplete - diminished validity & so limited applicability
Causal explanation: we don’t know with 100% certainty that neurotransmitters are a cause of SZ or a symptom of it - no way of knowing which is correct as SZ sufferers are only studied after diagnosis - limits the explanation
What is a strength of the biological approach (genetic & neural) of explaining SZ?
scientific: this approach uses scientific methods to investigate SZ e.g. FMRI scans are used to measure brain activity when examining possible neural explanations - increases the scientific credibility of the BA to explaining SZ
How should SZ be treated according to the biological approach?
via drug therapy
What are the two types of anti psychotics?
typical
Atypical
When were typical antipsychotics developed?
first generation of treatment developed in the 1950’s
Give an example of a typical antipsychotic?
chlorpromazine
Antipsychotics are otherwise known as….
dopamine antagonists (inhibit dopamine reuptake)
What is the max dosage for antipsychotics
1000mg (but doses will start much lower IOT increase dosage when resistance develops)
How does chlorpromazine work? (Typical antipsychotic)
binds to the receptor sight on the post synaptic neuron blocking an action potential transmission
What forms can antipsychotics be taken in?
tablets
Syrups
Injections
What are some side effects of chlorpromazine?
weight gain
Low blood pressure
Lowered sex drive
Nausea
Constipation/diarrhoea
When were atypical antipsychotics developed?
second generation of treatment starting in the 1970’s
Why were atypical antipsychotics developed?
with the aim of being more effective than typical AP & having less side effects
How does clozapine work?
dopamine antagonist - also works on serotonin & glutamate receptors (block glutamate & prevents serotonin reuptake) - improves mood & negative symptoms
Why is it good that clozapine & risperidone improve mood & negative symptoms?
important as 30 - 50% of sufferers attempt suicide
Why was clozapine initially removed from the market?
can cause agranulocytosis (damages white blood cells and so infection can’t be fought off)
Why was clozapine eventually put back on the market?
Due to effectiveness yet regular blood tests are required to check for agranulocytosis
How does risperidone work?
dopamine antagonist - also works on serotonin and glutamate receptors - improves mood and negative symptoms
Binds more strongly to receptors than clozapine
Why does risperidone require a lower dosage than clozapine
binds more strongly to receptors than clozapine = lower dosage = less side effects
Risperidone doesn’t cause ___________
agranulocytosis
What are three strengths of antipsychotics as a way to treat SZ?
effective - research into antipsychotics have proven that they are effective in treating SZ symptoms - Thornley et al discovered that chlorpromazine reduced symptoms & improved functioning when compared to a placebo - improves SZ sufferers quality of life - high validity
Effective x2 - Meltzer concluded clozapine is more effective than typical & other atypical drugs with an effectiveness of 30-50% in treatment resistant cases - proven usefulness - scientific credibility of drug therapy - increased validity
Time & cost effective - antipsychotics can be mass produced quickly & cheaply & so are able to treat large amounts of people with relatively little cost - the drug’s sedative effective works within 1-3 days quicker than psychological treatments like CBT which can take months to be effective - more applicable, available & preferable for a wider population
What are two limitations of antipsychotics as a way to treat SZ?
Ethical violations - it has been documented that facilities used these treatments for their sedative qualities typically upon the patients first admission to a hospital to make them easier to work with rather than for the benefit of the patient
Side effects - all antipsychotics have side effects which worse the longer you are on the drug e.g. clozapine may cause agranulocytosis but typical antipsychotics have been associated with NMS in the long term which can be fatal - both types of antipsychotics have been associated with permanent tardive dyskinesia - drug therapy has the potential to severely impair the quality of life for those with SZ
What are the two types of psychological explanation for SZ?
family dysfunction
Cognitive explanation
What are the three types of family dysfunction explanations?
Schizophrenogenic mother
Expressed emotion
Double bind theory
Who define schizophrenogenic mother?
Fromm-Reichmann
What did Fromm-Reichmann find from discussions with SZ patients?
Many of her patients often described a mother with similar qualities e.g overprotective & rejecting - controlling & creates dependence
What was the effect of the schizophrenogenic mother on the family environment?
Creates a climate of tension, secrecy & mistrust and in some cases this leads to paranoid delusions & SZ in the child
Who define double bind communication?
Bateson
What id double bind communication?
communication with mixed messages
What does double bind communication do to the family environment?
The child fears wrongdoing but is unsure of what that is when they do wrong it is punished with withdrawal of love & hostility - may lead to mistrust & tension can cause disorganised thinking/paranoid delusions
What are the different forms of double bind communication?
one singular parent and their inconsistent parenting style OR inconsistent parenting style between parents i.e. what one parent defines as a ‘wrong doing’ the other might not leads to confusion for the child
What is expressed emotion?
Negative emotions expressed towards a SZ sufferer typically by a family member or carers
What does expressed emotion include?
criticism, hostility & involvement/needless sacrifice
An environment with expressed emotion by family may cause…..
high stress, tension & guilt - and so is commonly associated with high relapse rates
How can expressed emotion act as a cause for SZ?
can act as a trigger to those genetically vulnerable
What are two strengths of the family dysfunction explanation of SZ? (Psychological)
Research support: research has supported the idea that difficult family relationships in childhood are associated with increased risk of SZ in adulthood - Read et al reviewed 46 studies of child abuse & SZ - concluded 69% of adult women with SZ had a history of physical/sexual abuse in childhood - increases validity of the explanation
Adoption studies - successfully separate nature from nurture - Tiener studied Finnish children who had biological parents with SZ but were raised by parents without SZ - he found the children were more likely to have SZ if raised in a ‘disturbed environment’ (high anxiety, conflict & instability) - increases validity showing a connection between childhood trauma & SZ diagnosis
What are two limitations of the family dysfunction explanation?
lack of evidence: double bind theory & schizophrenogenic mother are not based on standardised or scientific evidence rather clinical observations & informal assessments - diminished internal validity
Socially sensitive: SZ mother specifically blames mothers for their children’s SZ diagnosis - creates guilt for the parent who already has to watch their child suffer - can negatively effect the parents
What are the three types of cognitive explanations for SZ? (Psychological)
dysfunctional thinking
Metarepresentation
Central control
What is Metarepresentation?
The ability to reflect on our thoughts and behaviours
When an individual is an unable to participate in metarepresentation they cant…..
separate their thoughts from external stimuli and so cant follow train of thought or justify actions - can make us doubt whether they happened at all or understand/interpret decisions
What can an inability to participate in metarepresentation lead to?
Hallucinations & paranoid delusions
What is central control?
The ability to suppress automatic responses to stimuli
What can an inability to participate in central control lead to?
Disorganised/erratic thoughts and speech which can cause speech disorganisation or poverty (SZ symptoms)
What type of SZ symptoms can central control lead to?
speech disorganisation or poverty
What is dysfunctional thinking?
reduced thought processing (synaptic transmission) in certain brain regions associated with SZ symptoms
What is the role of the cingulate gyrus?
processing emotion
What is reduced synaptic transmission in the cingulate gyrus linked to?
avolition
What is the ventral striatum known as?
the ‘reward hub’
What is reduced synaptic transmission in the ventral striatum linked to?
Lack of anticipation for rewards - avolition
What is the role of the temporal gyrus?
auditory recognition
What is reduced synaptic transmission in the temporal gyrus linked to?
Hallucinations
What is a strength of the cognitive explanations for SZ? (Psychological)
Research support - Sterling compared 30 SZ sufferers to 30 without on their ability to complete a cognitive task e.g. the stroop test - he found that those with SZ took twice as long to complete it suggesting an impaired central control (unable to suppress automatic response to stating the colour of the word rather than the word itself)
What is a limitation of the cognitive explanations for SZ?
Proximal explanation: the explanations only consider what is happening now to produce symptoms e.g. dysfunctional thinking but don’t explain how the disorder develops -cognitive theories are only partial explanations for SZ - diminished validity
What is a limitation for psychological explanations? (Family dysfunction & cognitive)
reductionist: psychological explanations oversimplify SZ into faulty cognition or dysfunctional family dynamics - fails to take into account biological factors that take part in SZ diagnosis/ symptom development e.g. genes - diminishes validity as it is an incomplete explanation
What is CBT used for? (Psychological treatment)
It is used to address dysfunctional/ irrational thought processes
How many sessions of CBT are required?
5 - 20 sessions (group or individual)
When treating a patient with SZ what might the therapist do?
identify & challenge irrational thoughts
Explain origin of symptoms e.g. auditory hallucinations are too much dopamine in Broca’s area
What is the outcome of CBT for SZ patients?
It does not eliminate the disorder but eases anxiety and helps patients cope
What is the aim of family therapy? (Psychological treatment)
The aim of family therapy is to improve the sufferer’s psychological treatment e.g. by improving communication
What two strategies did Pharaoh suggest for family therapy?
Reduce expressed emotion levels - reduce stress
Improve knowledge & abilities
What were Burbach’s 7 suggested techniques for family therapy?
1) provide information about SZ
2) dividing responsibilities
3) encourage understanding & emotional openness
4) identify unhelpful patterns
5) skills training i.e. stress management techniques
6) relapse prevention planning
7) long term maintenance
What is a strength of CBT as a way to treat SZ
improves quality of life - research has found that CBT has a significant effect on both positive and negative symptoms especially when coupled with drug therapy - also CBT directly challenges paranoid delusions which can help the individual transition back to day to day life showing the benefits of CBT for SZ
What is a limitation of CBT as a way of treating SZ?
Time & cost: 5-20 sessions are costly if not free & so poorer groups are less likely to be diagnosed (not accessible for all) - time consuming which might lead to relapse as it isn’t an immediate solution
What is a limitation of psychological treatments? (family therapy & CBT)
Not a cure - psychological treatments aim to improve the patients quality of life & reduce symptoms yet doesn’t completely eradicate them or cure SZ - limited effectiveness
What are three strengths of family therapy as a way to treat SZ?
Effective - NICE clinically recommends FT as a way to treat SZ as it has been found to reduce relapse rates by 50-60% - it targets expressed emotion which is positively correlated with relapse rates - increased validity & proven usefulness
cost effective a lower relapse rate leads to less hospitalisations which don’t cost the economy - SZ sufferer may return to work which also benefits the economy
Benefits the whole family - strengthens communication as everyone gets support - acknowledges the effect diagnosis has on the whole family - family intervention has been linked to reduced relapse rates in turn reducing stress for the whole family - exemplifies effectiveness
What are two limitations of family therapy as a way of treating SZ?
Difficulty with accepting blame - family therapy requires a willingness to go by all ppts - some may be hesitant to engage fully perhaps due to a fear of being judged - by refusing to accept any blame/fault or actively participating the effects of FT are limited
Cultural restrictions - some cultures don’t associate the symptoms of SZ with a mental disorder and so may be unwilling to go to FT or buy into it’s effectiveness - limited applicability & western bias meaning there is a risk for imposed etic
Token economies are considered _____________ of SZ rather than treatment
management
Token economies are considered _____________ of SZ rather than treatment
management (used to modify behaviour rather than treat symptoms)
Where are token economies usually used?
In institutions
Token economies are based on what type of conditioning?
operant conditioning
The token is a __________ reinforcer & given when ___________ behaviour is exhibited
Secondary
Desirable behaviour e.g. getting dressed, making the bed etc
The tokens can eventually be exchanged for a ____________ reinforcer
Primary (the desirable reward)
What is the aim of token economies in the long term?
long term = removal of bad behaviours e.g. poor hygiene, social & personal behaviours
Aims to help you transition back to the outside world once out of the hospital - as positive behaviours are conditioned
What is a strength of token economies as a way to manage SZ?
effective - 7 studies in 7 different hospitals found token economies to be effective in decreasing negative symptoms & undesirable behaviours - research support increases validity of TE as a way to manage SZ
What are some limitations of token economies as a way to manage SZ?
low temporal validity - outdated - no longer commonly used in institutions/hospitals - not necessarily a go to method anymore more prevalent in the 50’s/60’s when hospitalisation was the first method of treatment
Ethics - it is slightly immoral to modify people’s behaviours to what we perceive as the social norm - normal can be subjective (typically viewed through a western lens) - TE promote cultural bias & prejudice towards those with SZ in society
Ethics x2 - can favour those who have a less severe form of SZ and are able to partake in reward based activities - ostracising those who are severely ill and can’t engage in these activities - can be discouraging and have a negative effect on the patients mental health
Difficult to maintain - long term effectiveness is diminished as families are unable to fully commit to the TE process due to other responsibilities - lacks RW application outside of the hospital -disrupts transition into real life and may lead to bad habits returning - low ecological validity cant be applied to the home setting
Who developed the original diathesis stress model
Meehl
In Meehl’s original diathesis stress model what was the diathesis?
The diathesis was genetic (single schizogene)
In Meehl’s original diathesis stress model what was the stress?
The stress was in childhood/adolescence (e.g. SZ mother)
In the modern diathesis model what is the diathesis?
diathesis = polygenic & aetiologically heterogeneous
Early stress can also act as a diathesis - changes structures of the brain - increasing vulnerability to later stressors
In the modern diathesis model what is the stress?
Stress = still psychological (i.e. parenting) - cannabis can also act as a stressor (interferes with dopamine) - can increase risk up to 7x
What is the biological element of interactionist treatment?
Anti psychotics
What does the biological element of interactionist treatment aim to do?
To relieve symptoms of SZ
What is the psychological element of interactionist treatment?
Therapy e.g. CBT
What does the psychological element of interactionist treatment aim to do?
This aims to help patients cope with the disorder and life
What are some strengths of the interactionist approach?
research support - Houston - people with SZ reported child sexual abuse & cannabis use - those who only reported child SA didn’t have SZ - those who reported only cannabis use didn’t have SZ
Urbanisation - more hectic & stressful city lifestyle compared to quiet rural areas can act as a trigger making people more likely to develop SZ
Research support x2 - Tarrier - randomly allocated patients to one of 3 conditions - 1) AP + counselling, 2) drugs only, 3) AP & CBT - found 1 & 3 were more successful in relieving symptoms than drugs alone - supports an interactionist approach to treating SZ
What are three limitations of the interactionist approach?
Meehl’s original model = too simple - considered the diathesis to be a single schizogene when SZ was later found to be polygenic & aetiologically heterogeneous - underestimated the variety of influence on SZ - therefore updated versions of the model may be more appropriate
Unclear as to how diathesis & stress works - whilst there is strong evidence the mechanics of this approach are still unknown i.e. we dont fully understand the mechanisms by which symptoms of SZ appear & how both genetic vulnerability + stress produce them - limits the approach & it’s applicability
Mixed application - an interactionist approach is standard in the UK but in the USA application is slightly lower (drugs alone are more common) - in the US there is a history of conflict between bio & psych explanations of SZ - Led to slower application of IA
