Schizophrenia Flashcards
1
Q
Diagnosis and Classification of Schizophrenia- AO1
A
- SZ=severe mental disorder contact with reality and insight are impaired
- Diagnosis and classification:
Diagnosis=distinguish one disorder from other by identifying symptoms
Classification=organising symptoms into categories
ICD-10=two negative symptoms
DSM-5=one positive symptom - Positive symptoms=in addition to normal experiences
=Hallucinations=sensory experiences no basis in reality/distorted perceptions things that are there
=Delusions=beliefs that have no basis in reality - Negative symptoms=loss of usual experiences
=Speech poverty=reduced frequency and quality of speech
=Avolition=loss motivation carry out tasks=lowered activity levels- poor hygiene/lack of persistence in work/lack of energy
2
Q
Diagnosis and Classification of Schizophrenia- AO3
A
- Good reliability +
Inter-rater reliability=different clinicians same diagnosis
Test-retest reliability=same diagnosis same person different occasions
Osorio=excellent reliability SZ in 180 DSM-5- inter-rater=0.97 test-retest=0.92 - Low validity -
Criterion validity
Cheniaux=two psychiatrists 100 clients using ICD-10 and DSM-4
68 SZ ICD and 39 SZ DSM - Co-morbidity -
Two conditions occurring together=question validity
1/2 SZ=depression or substance abuse - Gender bias in diagnosis -
Men diagnosed more than women
Women less vulnerable due to genetic factors
Women closer relationships and get more support
Women with SZ function better than men - Culture bias -
Symptoms different meanings in different cultures
Hearing voices=communication from ancestors
British afro-caribbean origin=9x likely diagnosis as white british
Culture bias by psychiatrists from different cultural background
Overinterpretation symptoms black british - Symptom overlap -
Between symptoms of SZ and other conditions
Both SZ and bipolar=positive and negative symptoms
May not be two different conditions but variations of same one
SZ hard to distinguish from bipolar
3
Q
Biological Explanations for Schizophrenia- Genetic Basis- AO1
A
- Family studies=risk SZ in line genetic similarity relative with disorder
Gottesman:
General population=1% risk
Parents=6% risk
Children=13% risk
MZ twins=48% risk - Candidate genes
SZ=polygenic=multiple genes involved=coding for dopamine
Ripke=37,000 SZ 113,000 controls
108 genes=increased risk SZ
Aetiologically heterogenous=different combination of factors can lead to SZ - Role of mutation
Parental DNA caused by radiation, poison or viral infection
Positive correlations=paternal age and risk of SZ
0.7% risk under 25 2% risk over 50
4
Q
Biological Explanations for Schizophrenia- Genetic Basis- AO3
A
- Research support +
Family studies=risk increases with genetic similarity to family with SZ
Tienari=bio. children of parents SZ=heightened risk if grow up in adoptive family
Hilker=concordance rate 33% MZ and 7% DZ twins - Environmental factors -
Biological and psychological influences
Birth complications / smoking THC-rich cannabis when teenager / childhood trauma=more vulnerable mental health problems respectively
Morkved=67% SZ and related psychotic disorders=childhood trauma as opposed to 38% control
5
Q
Biological Explanations for Schizophrenia- Neural Correlates- AO1
A
- Neural correlate=patterns of structure/activity in brain that occur in conjunction with an experience- SZ=dopamine (DA)
- Original dopamine hypothesis:
Drugs used to treat SZ (antipsychotics reducing DA) cause symptoms similar to those in Parkinson’s (low DA levels)
SZ due to hyperdopaminergia=high DA in subcortical areas of brain
Excess of DA receptors from subcortex to Broca’s area explains speech poverty - Updated dopamine hypothesis- Davis:
SZ also due to hypodopaminergia=low DA in brain’s cortex
Low DA in prefrontal cortex explains cognitive problems
Cortical hypodopaminergia leads to hyperdopaminergia
=both genetic variations and early stress=more sensitive to cortical hypo and thus subcortical hyper
6
Q
Biological Explanations for Schizophrenia- Neural Correlates- AO3
A
- Evidence for dopamine +
Amphetamines increase DA, worsen symptoms in SZ and induce symptoms in people without
Antipsychotic drugs reduce DA and intensity of symptoms
Some candidate genes act on production of DA or DA receptors - Glutamate -
Post-mortem and live scanning studies=raised levels glutamate in brain regions of people with SZ
Several candidate genes for SZ involved in glutamate production/processing
7
Q
Psychological Explanations for Schizophrenia- Family Dysfunction- AO1
A
- Family dysfunction=abnormal processes within family may be risk factors for development and maintenance of SZ
- Schizophrenogenic mother:
Fromm-Reichmann=psychodynamic expansion patients and childhoods
=cold, rejecting, controlling, family environment of tension and secrecy
Leads to distrust=paranoid delusions=SZ - Double-bind theory:
Bateson=role of communication style within family important development SZ
Child fears doing wrong thing but mixed messages what is actually wrong- unable comment on unfairness or seek clarification
When get it wrong=punished by withdrawal of love- world is confusing and dangerous
=risk factor in developing SZ - Expressed emotion:
Level of emotion expressed towards patient by carers who are often family members
=verbal criticism- accompanied by violence
=hostility- anger and rejection
=emotional over-involvement- needless self-sacrifice
High levels expressed emotion=serious source stress- explanation relapse SZ patients
Source of stress triggers onset SZ in already vulnerable person (due to genetic makeup eg)
8
Q
Psychological Explanations for Schizophrenia- Family Dysfunction- AO3
A
- Research support +
Indicators family dysfunction=insecure attachment and exposure to childhood trauma
Read=adults SZ disproportionately likely insecure attachment, type C/D
Read=69% women 59% men SZ history of physical/sexual abuse
Morkved=most adults SZ at least one childhood trauma - Explanations lack support -
No evidence to support importance traditional family-based theories like schizophrenogenic mother and double bind
Theories based on clinical observations and informal assessment of personality of mothers of patients but no systematic evidence
9
Q
Psychological Explanations for Schizophrenia- Cognitive Explanations- AO1
A
- Cognitive explanations=focusing on mental processes such as thinking, language and attention
- Dysfunctional thinking:
Dysfunctional thought processing=information processing does not represent reality accurately and produces undesirable consequences
Reduced thought processing ventral striatum=negative symptoms
Reduced processing info in temporal and cingulate gyri=hallucinations - Metarepresentation dysfunction:
Frith=cognitive ability to reflect on thoughts and behaviour- insight into intentions and goals and allows us to interpret actions of others
Disrupt ability to recognise own actions and thoughts as carried out by ourselves- explaining hallucinations and delusions like thought insertion - Central control dysfunction:
Frith=issues with cognitive ability suppress automatic responses while perform deliberate actions
Speech poverty result from inability suppress automatic thoughts and speech triggered by other thoughts
10
Q
Psychological Explanations for Schizophrenia- Cognitive Explanations- AO3
A
- Research support +
Stirling=performance cognitive task 30 SZ and 30 control
Stroop task
Frith=people with SZ took longer, over twice as long, to name font colours
Cognitive processes of SZ=impaired - Proximal explanation -
Proximal=explain what happening now to produce symptoms- distinct from distal explanations which focus on initial cause of condition
Distal explanations=genetic and family dysfunction
Unclear and not well addressed=genetic variation/childhood trauma lead to metarepresentation/central control
11
Q
Biological Therapy for Schizophrenia- AO1
A
- Drug therapy:
Antipsychotic drugs as psychosis=characteristic of SZ - Typical antipsychotics=first generation- tablets, syrup, injection- max 1000mg- gradually increased
=Dopamine antagonists:
Chlorpromazine and dopamine hypothesis
Blocking dopamine receptors in synapses- normalising it in key areas of brain to reduce symptoms
=Sedation effect:
Effective sedative maybe due to effect on histamine receptors- calm individuals- syrup absorbed faster than tablets - Atypical antipsychotics=developed after typical second generation- improve effectiveness and minimise side effects
=Clozapine:
Regular blood tests to ensure no condition resulting in deaths in past
Not available as injection
Daily dosage=300-450mg
Binds to dopamine receptors and acts on serotonin/glutamate receptors- improve mood reduce depression
=Risperidone:
Tablets, syrup, injection lasting two weeks
Small dose initially but built up to 4-8mg and max 12mg a day
Binds to dopamine and serotonin receptors- binds stronger to dopamine=more effective
12
Q
Biological Therapy for Schizophrenia- AO3
A
- Evidence for effectiveness +
Typical/atypical moderately effective tackling SZ symptoms
Thornley=chlorpromazine to controls- associated with better functioning and reduced symptom severity than placebo
Meltzer=clozapine more effective than typical and other atypical - Serious side effects -
Typical=dizziness, sleepiness, weight gain
Long term=tardive dyskinesia=involuntary facial movements
Most serious=neuroleptic malignant syndrome- blocked dopamine action in hypothalamus (regulation body systems)=high temp, delirium, coma, fatal - Mechanism unclear -
By which antipsychotics work tied up with original dopamine hypothesis- symptoms SZ hyperdopaminergia in subcortex brain
Dopamine levels other parts brain too low rather than too high=most antipsychotics should not work
Adds to argument they are ineffective
13
Q
Psychological Therapy for Schizophrenia- CBT- AO1
A
- 5-20 sessions of challenging irrational beliefs
- How CBT helps:
=make sense of how irrational thoughts impact behaviour
=doesn’t eliminate symptoms but better able cope with them- reducing stress and improving functioning
=normalisation=voice hearing an extension of of ordinary experience of thinking
=examine likelihood delusions are true
=tackle anxiety and depression
14
Q
Psychological Therapy for Schizophrenia- CBT- AO3
A
- Evidence of effectiveness +
Jauhar=34 studies CBT and SZ=small but significant effects positive and negative symptoms
Pontillo=reduction frequency and severity hallucinations
NICE recommends CBT for SZ - Quality of evidence -
Thomas=different studies use different CBT techniques and different combos of positive and negative symptoms
Modest benefits CBT conceal these
Hard to comment on effectiveness
15
Q
Psychological Therapy for Schizophrenia- Family Therapy- AO1
A
- All or some family members with aim of improving communications and reducing stress of living as family
- How family therapy helps:
Pharoah=range of strategies use to improving functioning of family
=reduces negative emotions- reducing stress reduces likelihood of relapse
=improves family’s ability help- therapeutic alliance all agree on aims of therapy, improve family’s belief and behaviour about SZ, balance between caring and maintaining own lives - Model of practice- Burbach:
=sharing basic info and providing support
=identifying resources of what can(not) offer
=encourage mutual understanding
=identifying unhelpful patterns of interaction
=skills training- stress management
=relapse prevention planning
=maintenance for future
