Schizophrenia Flashcards
Define schizophrenia
Severe mental disorder where contact with reality and insight become impaired.
What is a positive symptom
A symptom experienced in addition to normal experiences.
Give two examples of positive symptoms of schizophrenia
Hallucinations - sensory illusion that has either no basis in reality or is a warped perception of reality.
Delusions - involve beliefs with no basis in reality. For example, believing they are Napoleon, or the victim of a conspiracy
What are negative symptoms of schizophrenia
Atypical experiences that describe the loss of normal functioning.
Give two examples of negative symptoms of schizophrenia
Speech poverty - Reduced frequency and quality of speech
Avolition - Loss of motivation to carry out tasks, results in much lower activity levels.
What is a strength of diagnosis of schizophrenia
Good reliability
Osorio et al (2019) had pairs of interviewers study schizophrenic patients according to DSM-V and achieved inter-rater reliability of +.97 and test-retest reliability of +.92.
What are three limitations to diagnosis of schizophrenia (no explanation)
Validity issues
Co-morbidity
Gender bias
Explain validity issues in schizophrenia diagnosis
Chenieaux et al (2009) had two psychiatrists independently assess the same 100 clients using ICD-10 and DSM-V.
Found 68 were diagnosed with schizophrenia using ICD-10 and 39 under DSM-V.
This means schizophrenia can be over or under diagnosed according to the diagnostic system used.
What is co-morbidity
The occurrence of two disorders together, e.g schizophrenia and a personality disorder, or anxiety and depression.
How does co-morbidity weaken classificiation of schizophrenia
If conditions occur together a lot of the time, then it calls into question that they might be a single condition.
For example, Buckley et al found 50% of schizophrenia patients also had depression.
This means schizophrenia may not exist as a single condition, but rather as an abnormal form of depression.
How does gender bias affect diagnosis of schizophrenia
Men are diagnosed more than women with schizophrenia (Fisher and Buchanan).
This may be due to women having more support from closer relationships with friends/family so can function better.
This means that some women may not be getting treatment that they need for their disorder.
What are the two biological explanations for schizophrenia
Genetic
Neural
Who carried out family studies to identify inheritability of schizophrenia
Gottesman (1991)
What did Gottesman find
MZ twins had concordance of 48%, DZ twins had 17%, children of schizophrenic parents had 13%.
General population is 1%.
This suggests that there is a genetic factor to schizophrenia development.
What is the original dopamine hypothesis
Based on discovery that that antipsychotics caused side effects similar to Parkinson’s symptoms, a condition associated with low dopamine.
Therefore, schizophrenia may be the result of excessively high levels of dopamine.
Who created the revised dopamine hypothesis
Davis et al (1991)
What Davis propose in the revised dopamine hypothesis
Theorised that as well as excessive dopamine in subcortical areas of the brain, there is abnormally low levels on the prefrontal cortex.
This can explain negative symptoms of schizophrenia, as it would explain cognitive problems
What is a strength of the genetic explanation
Strong supporting evidence
Gottesman’s family studies showing the concordance rates increasing along with number of shared genes (MZ twins with 48%), and adoption studies by Tienari that show even if children of schizophrenic parents grow up away from that environment they still have heightened risk.
This shows genetic makeup can influence schizophrenia onset
What is a limitation of genetic explanation
Discounts environmental factors
There is evidence to show environment can influence schizophrenia, like THC-rich cannabis in formative years, or childhood trauma.
This means genetic factors alone do not explain schizophrenia.
Johnstone et al
CT scans
Found enlarged ventricles in schizophrenic people. Suggests this structural difference can cause schizophrenia.
What are ventricles
Voids filled with cerebrospinal fluid deep in the brain, thought to provide protective cushioning.
What is a disadvantage of ventricles being used to explain schizophrenia
Correlational research
Ventricles may be enlarged as a result of medication, or having schizophrenia, rather than the cause
What is a disadvantages to the biological approach
Biologically deterministic - may make patient feel hopeless.
Reductionist - doesn’t consider triggers or environmental factors. Should use diathesis stress model.
What is the family dysfunction explanation
A psychological explanation suggesting it is interpersonal familial relationships that result in symptoms.
What are the three family dysfunction explanations
Schizophrenogenic mother
Double-bind theory
Expressed emotion
Explain the schizophrenogenic mother
Suggests those with schizophrenia get paranoid delusions from cold rejecting and controlling mother and passive father. `
Explain double bind theory
Suggests child gets mixed messages and feels unable to do the correct thing, like being told to be independent but overprotected and receiving criticism when they try do this.
Explain expressed emotion
Negative verbal interactions between schizophrenic and caregiver.
What are the three parts to expressed emotion
Exaggerated involvement - suggest sufferer is a burden; “I do so much for you it’s hard for me”
Criticism and control - “you don’t know how to do anything, you need to listen to me more and do as you’re told”
Hostility - towards sufferer, physical verbal or emotional abuse.
What are 2 benefit of family dysfunction as an explanation for schizophrenia
Research support, Butzlaff and Hooley
Meta analysis of 27 studies found schizophrenic relapse is significantly more likely in families with expressed emotion
RWA - family therapy can give schizophrenics a better environment to recover in
What is the key assumption of the cognitive explanation for schizophrenia
That schizophrenia comes from a dysfunctional ability to process thoughts
What was the attention deficit model
Suggests schizophrenia is due to a faulty attention system unable to filter preconscious thought, overloading the mind, accounting for positive symptoms
What are 2 supports of Firth’s attention deficit model
Cognitive neuroscience studies - 30 schizophrenics had PET scans, which indicated a reduction in blood flow in frontal cortex in patients with negative symptoms, and increased activity in temporal lobes for patients with reality distortion.
Stirling et al - Stroop test.
30 schizophrenics, 18 controls.
Involved naming the ink colour on a word without saying the word. This is difficult as there is a desire to say the word that has to be controlled.
Stirling found schizophrenics took twice as long to say the colour, suggesting they have dysfunctional thought processing.
What are three negatives of family dysfunction as an explanation for schizophrenia
Socially sensitive to suggest family is responsible
Impossible to demonstrate cause and effect - associated behaviour could be caused by the schizophrenias strain on family
Significant evidence stating schizophrenia has biological causes, such as Gottesman
What are typical antipsychotics
Drug therapies used in the 50s.
Less popular now due to only treating pos symptoms and severe side effects
Name a typical antipsychotic, what it does, and its side effects
Chlorpromazine
Dopamine antagonist, blocking it at synapse. Reduces positive symptoms, such as hallucinations.
Side effects include dry mouth, constipation, lethargy and tardive dyskinesia (uncontrollable muscle movements affecting the face)
What are atypical antipsychotics
Second generation drug therapy introduced in the 70s to avoid severe side effects of typical antipsychotics
Describe an atypical antipsychotic, what it does and the side effects
Clozapine
Block dopamine receptors, but also act on serotonin, addressing negative symptoms as well.
Side effects include weight gain, cardiovascular problems, but less likely to include involuntary movement side effects
What are two research supports for drug therapies
Leucht et al
Meta analysis of 212 studies of antipsychotics.
Found drugs to be much more effective than placebo.
Bagnalli
232 studies to compare typical and atypical antipsychotics
Found atypical better at treating overall symptoms, with fewer side effects and people leaving.
Clozapine found to be most effective.
Suggests antipsychotics are effective
What are two limitations of antipsychotics
Tarrier
Found those with both antipsychotics and CBT had significant improvement compared to drug therapy alone.
This suggests that drug therapy alone is not the most effective, interactionist approach should be used
Side effects are still not completely removed by atypical antipsychotics, meaning it is not suitable or safe for all patients
What are two further benefits of antipsychotics
Drugs are cheaper to prescribe than psychological treatments like CBT
Less time investment, making it easier for patients to stick with their treatment
What does the psychological approach to treating schizophrenia assume, and what does the therapy aim to do
Schizophrenia is the result of dysfunctional thought processes.
Aim to challenge irrational beliefs
What was Ellis’ model for CBT
A - activating event
B - beliefs
C - Consequences
D - Dispute
E- Restructured belief (effect)
Outline an example of ABCDE model in effect for schizophrenia
A - Drug treatment causing side effect
B - Hospital staff trying to kill them
C - Refusing treatment
D - Staff have no reason to kill them
E - The drugs are necessary
What is reality testing
In CBT, a form of disputing, where patient demonstrates for themselves that their irrational thoughts are not real.
What is an example of reality testing
If a patient believes they can see into the future, then the clinician may ask them to predict cards drawn from a deck
What is a research support of CBT and one other benefit
Sensky et al
Showed patients who were not affected by drugs had reduction in pos/neg symptoms after 19 CBT sessions. Continued to improve 9 months after it ended.
No side effects
What are two limitations to CBT
Treatment often ended early due to treatment length.
Symptoms such as avolition may lead to an unwillingness to take part.
What is the purpose of family therapy
A family centred therapy aimed at educating the family on schizophrenia to improve the home situation of the patient and decrease chances of relapse
What are the 6 aims of family therapy
Reduce conflict
Reduce stress
Reduce self sacrifice
Improve communication
Improve problem solving skills
What is a support to family therapy
Leff (1985)
Looked at aftercare of schizophrenics.
Standard outpatient care - 50% relapsed in 9 months
Family therapy - 9% relapse in 9 months
What is the token economy treatment based on
Skinners behaviourist ideas of operant conditioning
What is behaviour shaping
Behaviours being progressively changed
How does token economy work
Upon completing a task, such as making your bed or participating in an activity, a token is given.
The token can be exchanged for goods.
Positive reinforcement.
What is a support to token economies
Dickerson
Reviewed 13 studies
Found token economies are effective in improving adaptive behaviour of schizophrenics
What are three negatives to token economy
Do not directly treat schizophrenia, only manage negative symptoms.
Not effective with severely unresponsive patients such as those with strong negative symptoms.
Ethical issues. Can be seen as degrading and treating the patients like ‘lab rats’
What does the interactionist approach suggest
That the onset of schizophrenia is due to combined effects of biological and environmental factors
What is the diathesis stress model
A pre existing biological vulnerability, such as dopamine imbalance, and an environmental trigger later in life
What is a support for interactionist approach
Gottesman (1991)
Found genetics significantly affect concordance rates, but it isn’t 100%. This suggests there must be environmental triggers in one twin but not the other.
