Schizophrenia Flashcards
1
Q
Diagnosis and classification of schizophrenia
- How do we diagnose a specific disorder?
- What are the two major systems of classification?
- How are they different to each other?
A
- Diagnosis and classification interlinked
- In order to diagnose a specific disorder, need to distinguish disorders from each other
- Done by identifying cluster of symptoms that occur together, classifying this as one disorder
- Two major systems for the classification of mental disorder
- World Health Organisation’s International Classification of Disease (ICD-10)
- American Psychiatric Association’s Diagnostic and Statistical Manual edition 5 (DSM-5)
- Differ slightly, DSM-5 positive symptoms must be present for diagnosis
- ICD-10, 2+ negative symptoms are sufficient for diagnosis of schizophrenia
2
Q
Positive Symptoms
- What are positive symptoms?
- Give two examples of positive symptoms
- What is example (1), give an example
- What is example (2), give an example
- What are the three types of (2), describe each briefly with an example
A
- Experiences beyond ordinary existence, this includes hallucinations and delusions
- Hallucinations are a disturbance in perception, false perceptions that have no basis in reality
- This includes hearing voices, seeing distorted facial expressions or seeing people/things that are not there
- Delusions are false/irrational beliefs that are firmly held despite being illogical as well as having no evidence
- Delusions of Persecution, belief others want to harm, threaten or manipulate you (People want to kill you)
- Delusions of Grandeur, belief they are an important individual (They are God, have powers)
- Delusions of Control, belief they are under the control of an alien force that has invaded their mind/body (possessed by spirits, implanted radio transmitters)
3
Q
Negative Symptoms
- What are negative symptoms?
- Give two examples of negative symptoms
- What is example (1), give an example
- What is example (2), give an example
- What are the signs of (2)?
A
- Loss of normal functioning, this includes speech poverty and avolition
- Speech poverty, changes in speech patterns, reduction in amount and quality of speech
- Sometimes accompanied by delay in verbal responses
- In the present more emphasis placed on speech disorganisation
- This is when speech is incoherent and the speaker changes topic mid-sentence
- Classified as positive symptom in DSM-5, speech poverty negative symptom
- Avolition (Apathy), reduction difficulty or inability to start or continue goal-directed behaviour
- Sharply reduced motivation, poor hygiene and grooming, lack of persistence in work, lack of energy
- Anderson (1982) identified three signs of avolition as shown above (everything except motivation)
4
Q
Issues in diagnosis and classification
A
- Good reliability
- Low Validity
- Counterpoint (Good validity, Osorio et al)
- Co-morbidity
- Gender bias
- Culture bias in diagnosis
- Symptom overlap
5
Q
Good reliability (Osorio et al 2019)
A
- Osorio et al (2019) reported excellent reliability for diagnosis in 180 individuals using DSM-5
- Pairs of interviewers achieved inter-rater reliability of +0.97 and test-retest reliability of 0.92
- Can be reasonably sure that diagnosis of schizophrenia is consistently applied
6
Q
Low Validity (Cheniaux et al 2009)
A
- Cheniaux et al (2009), two psychiatrists independently asses 100 clients using ICD-10 and DSM-4 criteria
- 68 diagnosed with Schizophrenia under ICD-10. 39 under DSM-4
- Suggests schizophrenia is under or over diagnosed, criterion validity therefore low
7
Q
Counterpoint (Good validity, Osorio et al)
A
- Osorio et al, excellent agreement between clinicians, used two measures derived from DSM system
- Suggests criterion validity good provided it takes place within a single diagnostic system
8
Q
Co-morbidity (Buckley et al)
A
- When two or more condition occur together (for example schizophrenia and depression)
- Questions validity, might be single condition
- Buckley et al, 50% individuals diagnosed with schizophrenia also have depression, 47% have co-morbidity with substance abuse, 23% with OCD
- Suggests schizophrenia may not be a distinct disorder, some individuals may have been wrongly diagnosed when they just have unusual cases of depression for example
9
Q
Gender bias (Cotton et al 2009)
A
- Men more commonly diagnosed with schizophrenia
- Could mean women less vulnerable
- Cotton et al (2009), women underdiagnosed due to closer relationships hence getting support
- Leads to women functioning better than men
- Underdiagnosis is gender bias, women may not be receiving treatment and services that might benefit them
10
Q
Culture bias in diagnosis (Pinto and Jones 2008)
A
- Hearing voices for example, different cultures different meanings
- Pinto and Jones (2008), British people of African-Caribbean origin 9x more likely to get diagnosed with schizophrenia than White British people
- Caused when psychiatrists are of a different culture to the client they are diagnosing
- Suggests people could be discriminated against by a culturally biased diagnostic system
11
Q
Symptom overlap
A
- Considerable overlap between symptoms of schizophrenia and symptoms of bipolar disorder
- Share positive symptom (delusions) and negative symptom (avolition)
- Suggests they may not be two different disorders, variation of single condition
- Schizophrenia is hard to distinguish from bipolar disorder
- Classification and diagnosis are flawed
12
Q
Biological explanations for schizophrenia
- What are the two biological explanations for schizophrenia?
A
The two biological explanations for schizophrenia are genetics and neural correlates.
13
Q
Genetic Basis-Family studies
- What was Gottesman’s study, what did it demonstrate?
- How does this link to issues and debates?
A
- People with schizophrenia often have relatives with disorder
- Gottesman’s (1991) large scale family study
- MZ twins higher concordance rate (48%) than DZ twins (17%)
- Family members share aspects of their environment
- Correlation represents both nature and nurture
14
Q
Genetic Basis-Candidate genes
- What was the original belief with genes and Sz?
- What do we now know?
A
- Originally believed that one gene could explain schizophrenia
- We now know that several different genes are involved (polygenic)
- For example, genes that code for functioning of neurotransmitters including dopamine
15
Q
Genetic Basis-Mutation
- What mutation causes schizophrenia?
- What did Brown et al demonstrate?
A
- Schizophrenia can have a genetic origin even if previous family members did not have the disorder
- One explanation is mutated parental DNA caused by radiation, poison or viral infection
- Brown et al (2002) positive correlations between paternal age (age of father when child conceived) and risk of schizophrenia
- 0.7% father under 25, 2+% father over 50
16
Q
Neural correlates of schizophrenia
- What does neural corelate mean?
- What is the best-known neural correlate for Sz?
- How does it link to schizophrenia?
A
Neural correlate means the brain structure or function. The best known neural corelate for schizophrenia is dopamine, due to its importance in the functioning of several brain systems related to symptoms of schizophrenia
17
Q
Neural correlates-Original dopamine hypothesis
- What discovery did Seeman 1987 make?
- What is schizophrenia the result of according to this hypothesis?
- Give an example of this, what could this example explain?
- What is Hyperdopaminergia?
- What is Hypodopaminergia?
A
- Based on discovery that drugs (antipsychotics, reduce dopamine) used to treat schizophrenia caused symptoms similar to people with Parkinson’s (associated with low dopamine levels)- Seeman 1987
- Schizophrenia result of high levels of dopamine in subcortical areas of the brain
- Example- excess dopamine receptors in pathways from subcortex to Broca’s area
- May explain poverty of speech, auditory hallucinations
- Hyperdopaminergia means high levels of dopamine
- Hypodopaminergia means low levels of dopamine
18
Q
Neural correlates-Updated versions of dopamine hypothesis
- What did Davis et al propose?
- What could explain cognitive problems?
- What two things does the updated hypothesis attempt to explain?
A
- Davis et al (1991) proposed abnormally low levels of dopamine in the brains cortex to be an explanation
- Low dopamine in prefrontal cortex (responsible for thinking) could explain cognitive problems
- Both high and low levels of dopamine are in the updated version
- Attempts to explain link between abnormal dopamine levels and symptoms
- Also attempts to explain the origins of the abnormal dopamine function
19
Q
Evaluation for Genetic and Neural correlates of Schizophrenia
A
- Research support (Gottesman, Tienari)
- Environmental factors (Not just genetic)
- Evaluation for dopamine hypothesis
- Glutamate
20
Q
Research support for Genetic (Gottesman, Tienari)
A
- Genetic explanation of schizophrenia has strong evidence
- Gottesman showed risk increases with genetic similarity to a family member with schizophrenia
- Tienari et al (2004) showed bio children of schizophrenic still at risk even when growing up in an adoptive family
- Suggests some people more vulnerable to schizophrenia due to their genetic make up
21
Q
Environmental factors (Morgan et al 2017, Morkved et al 2017)
A
- Environmental factors also increase the risk of schizophrenia
- Include both biological and psychological influences
- Birth complications (Morgan et al 2017), Smoking cannabis in teen years (Di Forti et al 2015)
- Childhood trauma, more vulnerable to mental problems in adulthood
- Nina Morkved et al (2017), 67% people with schizophrenia or related psychotic disorders at least one childhood trauma
- 38% matched group with non-psychotic mental health issues
- Suggests genetic factors alone cannot provide a complete explanation for schizophrenia
22
Q
Evaluation for dopamine hypothesis (Curran et al 2004, Tauscher et al 2014)
A
- Evidence for dopamine being involved
- Curran et al (2004), amphetamines increase dopamine, worsen symptoms in people with schizophrenia
- Induces (Brings about) symptoms in people without the disorder
- Tauscher et al (2014) antipsychotic drugs reduce dopamine, reduce intensity of symptoms
- Some candidate genes act on production of dopamine and dopamine receptors
- Suggests dopamine is involved in symptoms of schizophrenia
23
Q
Limitation of Dopamine Hypothesis-Glutamate
A
- Post-mortem and live scanning studies found raised levels glutamate in several brain regions of schizophrenics
- Several candidate genes believed to be involved in glutamate production or processing
- Suggests equally strong case for other neurotransmitters
24
Q
Psychological explanations for schizophrenia
- What are the two psychological explanations for schizophrenia?
A
The two psychological explanations for schizophrenia are family dysfunction and cognitive explanations
25
Q
Family dysfunction
- What is family dysfunction?
A
This is childhood and adult experiences of living in a dysfunctional family
26
Q
Family dysfunction-Schizophrenogenic mother
- What did Reichmann (1948) propose?
- What is a Schizophrenogenic mother?
- Describe the characteristics of a SM
- What does an SM create?
- What does this lead to?
A
- Reichmann (1948) proposed a psychodynamic explanation for schizophrenia based on patients accounts about their childhood
- Patients spoke of type of parent (labelled schizophrenogenic mother)
- Schizophrenogenic mother means “schizophrenia causing mother”
- Mother is cold, rejecting and controlling
- Creates family climate characterised by tension and secrecy
- Leads to distrust which later develops into paranoid delusions and ultimately schizophrenia
27
Q
Family dysfunction-Double bind theory
- What did Bateson et al (1972) emphasis?
- What is double bind theory?
- What does the child receive when they “get it wrong”?
- How does this leave their understanding of the world?
- How does this relate to symptoms of schizophrenia?
- What does Batson make clear?
- Give an example of a situation using double bind theory
A
- Bateson et al (1972) emphasised role of communication style within a family
- Developing child trapped in situations where they fear doing the wrong thing
- Receive mixed messages about what this is
- Feel unable to comment on unfairness of situation, cannot seek clarification
- When they “get it wrong” (which is often), punished with withdrawal of love
- Leaves their understanding of the world as confusing and dangerous
- Reflected in symptoms such as disorganised thinking, paranoid delusions
- Bateson makes it clear this is just a risk factor, nothing more than that
- Example, mother saying “I love you” to child, same time turning away in disgust
28
Q
Family dysfunction-Expressed emotion (EE)
- What is expressed emotion?
- What elements are in EE?
- How does EE affect a schizophrenic?
- What is EE primarily an explanation for?
- What can it trigger?
A
- This is the level of emotion (in particular negative emotion) expressed towards schizophrenic by their carers (usually family members)
- EE contains several elements as shown in the following
- Verbal criticism (occasionally accompanied by violence)
- Hostility towards person (includes anger and rejection)
- Emotional overinvolvement in the life of the person (needless self-sacrifice)
- High levels of EE, serious source of stress for individual
- Primarily explanation for relapse
- Can trigger onset of schizophrenia in vulnerable people due to their genetic make up for example
29
Q
Cognitive Explanations
- What do these explanations focus on?
- Give examples
A
Explanations that focus on mental processes such as thinking, language and attention.
30
Q
Cognitive Explanations-Dysfunctional thinking
- What is schizophrenia associated with?
- How is schizophrenia characterised?
- Give examples of this, how does this link to symptoms?
- What does a lower level suggest?
- What are the two types of dysfunctional thought processing?
A
- Schizophrenia associated with several types of dysfunctional thought processing (info processing that does not represent reality accurately, produces undesirable consequences)
- Schizophrenia is characterised by disruption to normal thought processing
- Reduced thought processing in ventral striatum associated with negative symptoms
- Reduced processing of information in temporal and cingulate gyri associated with hallucinations
- Lower level of info processing suggests cognition likely to be impaired (damaged)
- Two types of dysfunctional thought processing, Meta representation dysfunction and Central control dysfunction
31
Q
Cognitive Explanations-Meta representation dysfunction
- What did Frith et al 1992 identify?
- What is meta representation, what does this allow?
- What would dysfunction to this do?
- What could this explain?
A
- Frith et al (1992) identified two kinds of dysfunctional thought processing
- Meta representation is the ability to reflect on thoughts and behaviour
- Allows insight to our own intentions and goals, interpret action of others
- Dysfunction would disrupt our ability to recognise our own actions, thoughts as our own
- Explains hallucinations of hearing voices and delusions of control
32
Q
Cognitive Explanations-Central control dysfunction
- What us central control?
- How does this relate to schizophrenia?
- How could derailment of thoughts be explained with this?
A
- Frith et al also identified issues with ability to supress automatic responses while performing deliberate actions
- Speech poverty, thought disorder could result from inability to supress automatic thoughts and speech triggered by other thoughts
- People with schizophrenia tend to experience derailment of thoughts
- Could be because each word triggers associations, person cannot suppress automatic responses to these
33
Q
Evaluation for psychological explanations
A
- Research support (Read et al, Morkved et al)
- Explanations lack support
- Socially sensitive research
34
Q
Research support (Read et al, Morkved et al)
A
- Evidence linking family dysfunction to schizophrenia
- Read et al (2005), adults with schizophrenia disproportionally likely to have insecure attachment (Type C and D particularly)
- Also reported 69% women, 59% men with schizophrenia have history of abuse
- Morkved et al (2017) showed adults with schizophrenia reported at least one childhood trauma
- Suggest family dysfunction makes people more vulnerable to schizophrenia
