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Schizophrenia Flashcards

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1
Q

What is schizophrenia?

A

A severe mental illness where contact with reality and insight are impaired, an example of psychosis

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2
Q

Describe the prevalence of schizophrenia (4)

A
  • It affects 1% of the population
  • Men are more likely to suffer than women
  • The onset is typically in late adolescence and early adulthood
  • Commonly diagnosed in cities and the working class - pressures
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3
Q

Describe the diagnosis and classification of schizophrenia

A
  • Diagnosis and classification are interlinked. To diagnose a specific disorder, we need to be able to distinguish one disorder from another
  • Classification - identify symptoms that go together = a disorder
  • Diagnosis - identify symptoms and use classification system to identify the disorder
    There are two main classification systems in use:
  • DSM-5 - one positive symptom must be present
  • ICD-10 - two or more negative symptoms
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4
Q

What is the difference between positive and negative symptoms?

A
  • Positive - those that appear to reflect an excess or distortion of normal functions
  • Negative - those that appear to reflect a loss of normal functions
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5
Q

What are the positive symptoms of schizophrenia? (2)

A
  • Hallucinations - unusual sensory experiences that have no basis in reality or distorted perceptions of real things. Experienced in relation to any sense. E.g. hearing voices
  • Delusions - beliefs that have no basis in reality. Make a person with schizophrenia behave in ways that make sense to them but are bizarre to others. E.g. beliefs about being a very important person
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6
Q

What are the negative symptoms of schizophrenia? (2)

A
  • Speech poverty - a reduction in the amount and quality of speech. May include a delay in verbal responses during conversation (ICD - negative symptom). DSM emphasises speech disorganisation and incoherence as a positive symptom
  • Avolition - severe loss of motivation to carry out everyday tasks e.g. work, hobbies, personal care. Results in lowered activity levels and unwillingness to carry out goal-directed behaviours
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7
Q

Biological explanations for schizophrenia (genetic basis) - family studies (2)

A
  • Family studies show that there is a strong relationship between the degree of genetic similarity and shared risk of schizophrenia
  • Family members also share environment but still indicates support for genetic view
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8
Q

Biological explanations for schizophrenia (genetic basis) - candidate genes (3)

A
  • Early research looked unsuccessfully for a single genetic variation to explain S
  • S is polygenic - a number of different genes are involved
  • It is also aetiologically heterogenous - different combinations of factors can lead to the condition
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9
Q

Biological explanations for schizophrenia (genetic basis) - mutation

A

S can have a genetic origin in the absence of a family history because of mutation in the parental DNA which can be caused by radiation, poison and viral infection

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10
Q

Biological explanations for schizophrenia (neural correlates) - why is dopamine widely believed to be involved in schizophrenia?

A

It is featured in the functioning of brain systems related to the symptoms of schizophrenia

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11
Q

Biological explanations for schizophrenia (neural correlates) - the original dopamine hypothesis

A

High dopamine activity in subcortex is associated with hallucinations and speech poverty

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12
Q

Biological explanations for schizophrenia (neural correlates) - the revised dopamine hypothesis (2)

A
  • Positive - an excess of dopamine in subcortical areas of the brain, particularly in the mesolimbic pathway
  • Negative and cognitive - deficit of dopamine in areas of the prefrontal cortex (the mesocortical pathway)
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13
Q

Psychological explanations for schizophrenia (family dysfunction) - give an overview of family dysfunction as an explanation for schizophrenia

A

The development of s is due to abnormal family communication styles created by the schizophrenogenic mother, mixed messages according to double-bind theory, and the stress caused by high levels of expressed emotion

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14
Q

Psychological explanations for schizophrenia (family dysfunction) - schizophrenogenic mothers (2)

A
  • Term used to describe a mother who is said to cause S in her child
  • Some characteristics of a schizophrenogenic mother Fromm-Reichmann (1948) identified: cold and domineering, overprotective, rigid and insensitive, rejecting
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15
Q

Psychological explanations for schizophrenia (family dysfunction) - double-bind theory (2)

A
  • A child may be regularly trapped in situations where they fear doing the wrong thing, but receive conflicting messages about what counts as wrong. They cannot express their feelings about the unfairness of the situation
  • When they ‘get it wrong’ the child is punished by withdrawal of love - they learn the world is confusing and dangerous, leading to disorganised thinking and delusions
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16
Q

Psychological explanations for schizophrenia (family dysfunction) - expressed emotion (2)

A
  • Expressed emotion (EE) is the level of emotion (mainly negative) expressed including: verbal criticism of the person with S, hostility towards them, emotional over-involvement in their life
  • High levels of EE cause stress in the person, may trigger onset of schizophrenia or relapse
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17
Q

Psychological explanations for schizophrenia (cognitive explanations) - dysfunctional thinking (2)

A
  • Compared to normal controls, research has found evidence of dysfunctional thought processing in people with s
  • Particularly evident in those who display the characteristic positive symptoms of s such as delusions and hallucinations
18
Q

Psychological explanations for schizophrenia (cognitive explanations) - what are the two kinds of dysfunctional thought processes?

A
  • Metarepresentation
  • Central control
19
Q

Psychological explanations for schizophrenia (cognitive explanations) - describe metarepresenation (2)

A
  • The cognitive ability to reflect on thoughts and behaviour
  • Dysfunction in this area disrupts our ability to recognise our thoughts as our own - could lead to the sensation of hearing voices (hallucinations) and experience of having thoughts placed in the mind by others (thought insertion, a delusion)
20
Q

Psychological explanations for schizophrenia (cognitive explanations) - central control (2)

A
  • Dysfunction of central control is a way to explain speech poverty. Central control is the cognitive ability to suppress automatic responses while performing deliberate actions
  • People with s experience derailment of thoughts because each word triggers automatic associations that they cannot suppress
21
Q

Biological therapy for schizophrenia - what are antipsychotics?

A

Drugs used to reduce the intensity of symptoms, in particular the positive symptoms, of psychotic disorders like schizophrenia

22
Q

Biological therapy for schizophrenia - describe what typical antipsychotics are (4)

A
  • The first generation of drugs for S and other psychotic disorders
  • They have been used since the 1950s
  • They work by acting as antagonists in the dopamine system and aim to reduce the action of dopamine
  • Examples include chlorpromazine
23
Q

Biological therapy for schizophrenia - describe how typical antipsychotics work (3)
Block
Chlorpromazine
Neurotransmission

A
  • They block dopamine receptors in the synapses in the brain, reducing the action of dopamine
  • Initially, dopamine levels build up after taking chlorpromazine, but then production is reduced
  • This normalises neurotransmission in key areas of the brain, which in turn reduces symptoms like hallucinations
24
Q

Biological therapy for schizophrenia - why does chlorpromazine also have a sedation effect? (2)

A
  • Chlorpromazine also has an effect on histamine receptors which appears to lead to a sedation effect
  • It is also used generally to calm anxious patients when they are first admitted to hospital
25
Q

Biological therapy for schizophrenia - describe atypical antipsychotics (3)
After
Aim
Examples

A
  • Drugs for schizophrenia developed after typical antipsychotics
  • The aim of developing newer antipsychotics was to maintain or improve upon the effectiveness of drugs in suppressing the symptoms of psychosis and also to minimise the side effects of the drugs used
  • Examples include clozapine and risperidone
26
Q

Biological therapy for schizophrenia - describe how clozapine works (3)
Binds
Effective
Mood

A
  • Binds to dopamine receptors and also acts on serotonin and glutamate receptors
  • More effective than typical antipsychotics - clozapine reduces depression and anxiety as well as improving cognitive functioning
  • It also improves mood which means that it is sometimes prescribed when an individual is considered at high risk of suicide
27
Q

Biological therapy for schizophrenia - describe how risperidone works (3)
Developed
Binds
Strongly

A
  • Developed in the 1990s because clozapine was involved in the death of some people from a blood condition called agranulocytosis
  • Binds to dopamine and serotonin receptors
  • But risperidone binds more strongly to dopamine receptors and is therefore more effective in smaller doses than most antipsychotics and has fewer side effects
28
Q

Psychological therapy for schizophrenia (CBT) - what are the aims of CBT?
It usually takes place over a period of how many sessions?

A
  • To help clients identify irrational thoughts (e.g. delusions and hallucinations) and try to change them
  • 5-20 sessions, individually or in a group
29
Q

Psychological therapy for schizophrenia (CBT) - describe how CBT works (3)
Make sense
Normalisation
Delusions

A
  • Clients are helped to make sense of how their delusions and hallucinations impact on their feelings and behaviour. E.g. a client may hear voices = demons, very afraid. If a therapist can convince them that the voice comes from the malfunctioning speech centre in their own brain and that it cannot hurt them if they ignore it, much less frightening and less debilitating
  • Normalisation involves explaining to the client that hearing voices is an ordinary experience
  • Delusions can also be challenged, e.g. by a process of reality testing in which both jointly examine the likelihood that beliefs are true
30
Q

Psychological therapy for schizophrenia (family therapy) - what does the therapist encourage family members to form? (2)

A

A therapeutic alliance whereby they all agree on the aims of the therapy

31
Q

Psychological therapy for schizophrenia (family therapy) - what are the aims of family therapy? (3)

A
  • Reduce levels of EE, especially negative emotions such as anger and guilt which create stress. Reducing stress is important to reduce the likelihood of relapse
  • Improve families’ beliefs about and behaviour towards S
  • Ensure that family members achieve a balance between caring for the individual with S and maintaining their own lives
32
Q

Psychological therapy for schizophrenia (family therapy) - Burbach’s (2018) model for working with families dealing with schizophrenia (3)

A
  • Phases 1 and 2 - share information and identify resources family can offer
  • Phases 3 and 4 - learn mutual understanding, and look at unhelpful patterns of interaction
  • Phases 5,6 and 7 - skills training (e.g. stress management techniques), relapse prevention and maintenance
33
Q

Management of schizophrenia - development of token economies (2)

A
  • Extensively used in the 1960s and 70s. Decline in the UK due to a shift towards care in the community rather than hospitals and because of ethical concerns
  • Still remain a standard approach to managing schizophrenia in many parts of the world
34
Q

Management of schizophrenia - describe the token economy (4)

A
  • A form of behaviour therapy based on behaviourist principles (operant conditioning) and used in psychiatric institutions
  • Target, desirable behaviours identified by the staff e.g. dressing themselves. Behaviour rewarded with a token (secondary reinforcer), then exchanged for a reward or privilege (primary reinforcer)
  • Motivated by the primary reinforcer to carry out the desirable behaviours, and their frequency of doing so increases as they are positively reinforced
  • Rewards - extra TV time, exercise taken outside of the grounds of the hospitals
35
Q

Management of schizophrenia - describe the rationale for token economies (4)

A
  • Institutionalisation occurs in long-term hospital treatment
  • Matson et al. (2016) identified three categories of institutional behaviour that can be tackled using token economies: personal care, condition-related behaviours (e.g. apathy) and social behaviour
    Modifying these behaviours does not cure S but has two major benefits:
  • Improves the quality of life within the institution
  • Normalises behaviour and helps them integrate back into the community setting
36
Q

The interactionist approach to schizophrenia - describe the diathesis-stress model in terms of schizophrenia (2)

A
  • Both a vulnerability and a trigger are needed to develop S
  • Individually may not cause S, both have to be present for S to occur
37
Q

The interactionist approach to schizophrenia - describe the original diathesis-stress model (Meehl’s model) (3)

A
  • Vulnerability is entirely genetic - caused by a single schizogene which leads to a biologically based schizotypic personality where people are extremely sensitive to stress
  • No amount of stress will lead to S if the gene is not present
  • Chronic stress in someone with the gene could lead to the development of the disorder - nature and nurture interact. Stress - environmental trigger, usually parenting e.g. schizophrenogenic mother
38
Q

The interactionist approach to scizophrenia - modern understanding of diathesis (3)

A
  • It is now believed that diathesis is not due to a single schizogene. Instead it is thought that many genes increase vulnerability
  • Diathesis does not have to be genetic. It could be early psychological trauma affecting brain development
  • E.g. child abuse affects the HPA system, making a child vulnerable to stress
39
Q

The interactionist approach to schizophrenia - modern understanding of stress (3)

A
  • A modern definition of stress includes anything that risks triggering S
  • Can be psychological e.g. parenting or biological e.g. cannabis use
  • Cannabis use can increase the risk of S up to 7 times depending on dose - probably because it interferes with the dopamine system
40
Q

The interactionist approach to schizophrenia - differences between Meehl’s model and the modern diathesis-stress model (3)

A
  • Many genes, not one
  • Not just genetic vulnerability
  • Not just parenting as a stressor
41
Q

The interactionist approach to schizophrenia - treatment according to the interactionist model (3)

A
  • Antipsychotic drugs should be taken in combination with CBT
  • In Britain it is increasingly standard practice to treat patients with a combination of drugs and CBT
  • In the US there is more of a conflict between psychological and biological models of S and this may have led to a slower adoption of the interactionist approach

Psychology (12 decks)

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