Schizophrenia Flashcards
What are the two classification systems and how do they differentiate ?
(Classification and Diagnosis)
International classification of disease 10 - Two or more negative symptoms needed, recognises there are different types of schizophrenia
American Psychiatric Association’s Diagnostic and Statistical Manual 5 - One postive symptom needed, does not account for different types
What is a positive symptom and what are the types ?
(Classification and Diagnosis)
Positive symptoms reflect an excess or distortion in normal functioning
Dellusions are irrational beliefs. Common types are:
Delusions of persecution - The belief that others want to harm, threaten or manipulate you
Delusions of grandeur - This is the idea that you are an important individual
Hallucinations involve disturbances in perception. They are false perceptions that have no basis in reality.
Most common hallucinations are auditory ones (hearing voices) but can include smell, touch and sight
What are negative symptoms and what are the types ?
(Classification and Diagnosis)
Negative symptoms reflect a loss of normal functioning
Speech poverty - the inability to speak properly, characterised by lack of ability to produce fluent words; this is thought to reflect slowing or blocked thoughts. It can manifest itself as short and empty replies to questions.
Avolition - the reduction, difficulty, or inability to start and continue with goal-directed behaviour
How is reliability effected by gender bias ?
(Reliability in Diagnosis)
Critics of the DSM argue that it is biased towards men, and fails to consider the ways in which women behave differently to men
Longenecker Et Al (2010) – men are diagnosed with Schizophrenia more than women. This could be a result of gender bias
female patients function better than men, despite having other symptoms, because women have are still able to function well – they are not given a diagnosis
This means diagnosis is INCONSISTENT
How is reliability affected by culture bias ?
(Reliability in Diagnosis)
African Americans and English people of Black-Caribbean origin are several times more likely than white people to be diagnosed with schizophrenia.
But rates in Africa and West Indies not particularly high - suggesting its not linked to genetics
Psychologists suggest patients can display same symptoms but receive different diagnoses because of ethnic background
Evaluation - Research support for lack of reliability ?
(Reliability in Diagnosis)
Point - Cheniaux et al – had 2 psychiatrists independently diagnosed 100 patients using both DSM and ICD criteria – inter-rater reliability was poor.
1 psychiatrist diagnosed 26 according to DSM and 44 according to ICD.
The other diagnosed 13 according to DSM and 24 according to ICD
Further - Whaley – found inter-rater reliability correlations in the diagnosis of schizophrenia as low as 0.11
Evaluation - Research support for culture bias in diagnosis ?
(Reliability in Diagnosis)
Point - Escobar found white psychiatrists may over-interpret symptoms of black patients during diagnosis – may be due to cultural differences in language and mannerisms, difficulties in relating between black patients and white therapists
I&D - suffers from ethnocentrism because deviation from what is normal in Western culture is misinterpreted and mislabelled as a symptom of schizophrenia - e.g. hearing voices may be more acceptable in African cultures because of cultural beliefs in communication with ancestors
Evaluation - Research support for gender bias ?
(Reliability in Diagnosis)
Point - Loring and Powell – male and female psychiatrists read case articles of patients’ behaviour and asked to diagnose. Male psychiatrists – when patients described as male or no information about gender – 56% diagnosed with schizophrenia. When patients described as female – 20% diagnosed. Gender bias not evident with female psychiatrist
I&D – suffers from beta bias because differences between how males and females deal with symptoms are ignored leading to lower diagnosis for women – women typically function better than men and have a better ability to maintain relationships and jobs
How does co-morbidity effect the validity of diagnosis ?
(Validity in Diagnosis)
Co-morbidity – when more than one disorder exists alongside a primary diagnosis
If conditions occur alongside each other, this means our understanding of schizophrenia may be invalid – perhaps the psychiatrist diagnosing schizophrenia is not able to tell the difference between the two conditions – meaning they may give an incorrect diagnosis
How does symptom overlap effect the validity of diagnosis ?
(Validity in Diagnosis)
There is a considerable overlap between the symptoms of schizophrenia and other conditions
Under ICD patient may be diagnosed as schizophrenic, however many of the same patients would be diagnosed with bi-polar using DSM
Some argue it suggests that schizophrenia and bi-polar may not be two different conditions but one
Evaluation - Research Support for Lack of Validity in Diagnosis and Classification ?
(Validity in Diagnosis)
Point - Cheniaux et al – had two psychiatrists diagnose 100 patients using both DSM and ICD criteria. One psychiatrist diagnosed 26 using the DSM and 44 using the ICD, the other diagnosed 13 with the DSM and 24 with the ICD. This demonstrates that schizophrenia is either under or over-diagnosed as the researchers are not close in their diagnoses
Further – Rosenhan – “normal” people presented themselves to psychiatric hospitals in the US claiming they heard an unfamiliar voice in their head. They were all diagnosed with schizophrenia and admitted. None of the staff recognised that they were normal
Evaluation - Research Support for Co-Morbidity ?
(Validity in Diagnosis)
Point - Buckley et al – around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%). PTSD in 29% of cases, OCD in 23% - schizophrenia commonly occurs alongside other mental illnesses
Counter - Co-morbidity may not indicate an issue with validity – it may simply mean that disorders such as depression are a consequence of suffering from schizophrenia over a period of time
Evaluation - Research support for system overlap ?
(Validity in Diagnosis)
Point - Ketter – misdiagnosis due to symptom overlap can lead to years of delay in receiving relevant treatment, during which time suffering and further degeneration can occur as well as high levels of suicide
I&D – Missing out on treatment is a significant issue, and this is a bigger issue for women and therefore subject to gender bias. Longenecker Et Al (2010) found that despite having other symptoms, because women have are still able to function well – they are not given a diagnosis and are likely to not be treated compared to men
What does the genetic explanation claim ?
(Genetic Explanation)
Argues that a predisposition to Schizophrenia could be inherited from parents
There are specific genes implicated in the cause of Schizophrenia
How can people can be predisposed to schizophrenia due to inheritence ?
(Genetic Explanation)
Family Studies – indicate that the closer the genetic relationship to someone with schizophrenia the greater the chance of developing the disorder
Gottesman – When a first degree relative has Schizophrenia, the chance of the child inheriting is 12%.
If both parents have schizophrenia – 40% likelihood child will develop disorder
Twin Studies – research shows much higher concordance rate in MZ twins than DZ
Gottesman and Shields – concordance rate of 47% in MZ and 9% in DZ
What specific genes cause schizophrenia ?
(Genetic Explanation)
Ripke Et Al (2014) – studied the genetic makeup of 37,000 Schizophrenics against 113,000 controls. They found 108 genetic variations that were associated in the risk of schizophrenia. A lot of those genes were found to be involved in dopamine. Evidence of it being polygenic
Miyakawa et al – studied DNA from families affected by schizophrenia – those affected with the disease more likely to have a defective version of PPP3CC gene – evidence of a candidate gene
Evaluation - Limitation – Inheritance – Could be Due to Shared Environment Not Genes ?
(Genetic Explanation)
Point - Problem of comparison of people in same family – share same environment. Even with twin studies, MZ twins may be treated more similarly than DZ twins Better to look at concordance in adopted children and compare to adoptive and biological parents
Counter - Heston compared 47 children of schizophrenic mothers fostered or adopted in first month of life with control group of 50 children raised in the same home as these children – none of control group developed schizophrenia but 17% of children with biological schizophrenic mothers did
Evaluation - Limitation – Genetics Can’t be Sole Explanation ?
(Genetic Explanation)
Point - Concordance Rates for MZ twins are between 40-60% - if genetics was the sole explanation it would be 100% - could be that genetics give someone a pre-disposition to schizophrenia but are not the sole factor in development
I&D – Biological Reductionism – focusing on one factor, i.e. genes, does not consider any other factors like family dynamics
Evaluation - Limitation – Does Not Explain Schizophrenia For Patients Without A Relative with Schizophrenia ?
(Genetic Explanation)
Point - Two thirds of people with schizophrenia have no relative with a similar diagnosis – no one to inherit it from
Further - The focus on only biological factors ignores the role of psychological and environmental factors
What are the two types of dopamine hypothesis ?
(Dopamine Hypothesis)
Hyperdopaminergia - Subcortex – HIGH levels of Dopamine - Focuses on role of high levels of activity of dopamine in the subcortex - associated with positive symptoms
Hypodopaminergia - Cortex – LOW levels of Dopamine - Focuses on low levels of dopamine in pre-frontal cortex - associated with negative symptoms
Evaluation - Strength – Research Support ?
(Dopamine Hypothesis)
Point - Owen et al – autopsies found schizophrenic sufferers have more dopamine receptors which may lead to more neural firing – evidence of dopamine abnormalities in brains of schizophrenic sufferers
Counter – Dopamine abnormalities are not present in all schizophrenic sufferers especially those with negative symptoms
Evaluation - Limitation – Implication of Other Neurotransmitters ?
(Dopamine Hypothesis)
Point - Davis et al – the diverse types of schizophrenia and symptoms implies there are several neurotransmitters involved not just dopamine
Further – newer drugs e.g. clozapine, which are more effective than traditional drugs, affect other neurotransmitters as well as dopamine e.g. serotonin
I&D – biological reductionism – by focusing on one sole neurotransmitter
Evaluation - Limitation – Problem of Cause and Effect ?
(Dopamine Hypothesis)
Point - Impossible to state whether the raised dopamine levels cause schizophrenia or are the result of schizophrenia
Further – Lloyd et al – even if dopamine is a cause, it may be an indirect one influenced by environmental factors – abnormal family circumstances can lead to high levels of dopamine which in turn triggers schizophrenic symptoms
I&D – Nature v Nurture – even with a seemingly biological cause such as dopamine, it may be impossible to separate biological and environmental factors in the cause of schizophrenia
What does neural correlates mean ?
(Neural Correlates)
Neural correlates – are measurements of the structure or function of the brain that correlate with an experience
The Neural Correlates theory argues that – Schizophrenia develops due to structural and functional abnormalities in the brain of schizophrenic patients
What is the neural correlate of negative symptoms ?
(Neural Correlates)
One negative symptom is avolition – involving the loss of motivation
believed that this anticipation is linked to the ‘ventral striatum’, a part in the brain
abnormal functioning in ventral striatum could be the cause of the negative symptom and therefore causes schizophrenia
What is the evidence for neural correlates of negative symptoms ?
(Neural Correlates)
Juckel et Al (2006) – compared the activity levels in the ventral striatum in schizophrenic patients and found lower levels of activity than the control group
found a negative correlation between activity levels in the ventral striatum and the severity of the overall symptoms
What is the neural correlate of positive symptoms ?
(Neural Correlates)
Allen Et Al (2007) – scanned brains of patients experiencing auditory hallucinations and compared them to a control group
They found lower activation levels in the superior temporal gyrus and anterior cingulate gyrus for the schizophrenic patients
Therefore, reduced activity in these two areas could be the cause of auditory hallucinations
Evaluation - Strength – use of fMRI as a method ?
(Neural Correlates)
Point - Research carried out into neural correlates often uses fMRI which has high spatial resolution - meaning it shows highly detailed images and shows how brain function is localised. This increases the validity of the study
Counter – over-emphasis on Biological causes, Bateson’s Double Bind Theory highlights that ‘contradictory communication’ from a parent over a prolonged period prevents the ability to construct a coherent (logical) construction of reality and causes schizophrenia
What are the aims of family therapy ?
(Family Therapy)
