Schizophrenia Flashcards
psychotic disorders
Psychotic disorders involve a major break from reality in
which the individual perceives their world in a way that is
very diff erent from how others perceive it
Dsm 5 defines psychotic spectrum as
Delusions
Hallucinations
Disorganised thoughts
Catatonic behaviour
Negative symptoms
affect
a person’s feelings or emotions. A ‘flat’ affect can refer
to a lack of visible response such as a frown or smile
schizotypal
great difficulty in developing emotionally meaningful relationships with
others and showing extreme ‘coldness’ and flat affect
schizophrenia
-at least one positive symptom
-and may include negative symptoms or catatonic
-must show a reduction in normal functioning
-these symptoms need to be present for at least 6 months and cannot be attributed to use of illegal substances or medication
Case study
Conrad, m, 23
Delusional disorder diagnosis
-persistent delusions, otherwise normal
-must have the symptoms for at least 1 month
-mustn’t be linked to substance, medication, or other disorders
Types of delusions
erotomanic
grandiose
jealous
persecutory
Symptom assessment using vr (Freeman)
-Normal diagnosis of schizophrenia presents problems: interpretation of individual’s experiences in the social world, misinterpretation of others’ behaviour, distrust paranoia and withdrawal, relies on truthful answers
-Using vr the assessment can be novel and standardised while assessing actual behaviour
-it can also ensure that paranoid behaviour is genuine as the social environment is artificial
Evaluation (freeman)
+fairly large sample
-did not represent a clinical population
+standardised assessment -> +reliability of measurement
-ecological validity (artificial environment)
-uses self report which can lead to response bias
Explanations of schizophrenia and delusional disorders
II
II Genetic
-Gottesman & Shields, genetic inheritance of schizophrenia
- genes or particular combinations of genes are passed on to offspring which may cause the disorder to develop
-symptoms may include psychosis
-known as endophenotypes
-schizophrenic symptoms are believed to have identifiable genetic markers which can be inherited
Psychosis
consists of a series of abnormalities of function; such as sensory dysfunction and working memory impairment
Gottesman and Shield 1972 (GENETIC)
-467 twins
-Maudsley hospital london
-1948-1964
-24 MZ
-33 DZ
-interviewed them (some had schizophrenia), also took cognitive tests
-50% of mz shared a schizophrenic status (9% in dz)
-in mz if one was severely schizo, the other was much more likely
II Biochemical (dopamine)
-The dopamine hypothesis essentially states that the
brains of those with schizophrenia produce more
dopamine than those without the disorder
-links excessive amounts of dopamine with positive symptoms of schizophrenia
-evidence comes from drug trial on those with and without schizo
-(if patients with parkinsons are given too much L-dopa they have the same positive effects as those with schizo
- autopsies have found that the brains of deceased individuals with
schizophrenia have a larger number of dopamine receptors
than those without the disorder
-Wise et al -> low levels of enzyme which breaks down dopamine
-PET scans show that excessive dopamine in striatum, limbic system, and cortex leads to positive symptoms
-Nestler argues that decreased dopamine in the prefrontal cortex may lead to negative symptoms such as flattened affect
II Cognitive
-Frith
-recognises that biological factors contribute in some way to the positive symptoms of schizophrenia
-describes schizo as ‘abnormality of self-monitoring’
-patients fail to recognize their own internal voice as theirs
-delusional thinking may arise from a misinterpretation of perception
-those experiencing negative symptoms such as lack of action have difficulty generating spontaneous actions; this may arise due to impaired theory of mind
-flattening of affect, lack of speech and social withdrawal result from difficulties in monitoring their own mental states and the states of others
Gottesman and shields evaluation
+large sample
-not generalisable to non-twins
-sample drawn from only one hospital
+independent judges reducing researcher bias
qualitative data +in depth data about participants -subjective
Treatment and management
III
III Biochemical
antipsychotics and atypical antipsychotics reduce the severity of symptoms
-chloropromazyne and others block dopamine and serotonin receptors in cortical and limbic areas
-others affect serotonin and norepinephrine
-after one week less hostile and agitated, after 3 weeks diminished positive symptoms
Research on biochemical
-randomized control trial (rct)
-double blind placebo controlled
-50% show significant improvement after 4-6 weeks
-30-40% show partial improvement
-rest show no improvement
-relapse rates are high
-side effects such as weight gain, drowsiness, extrapyramidal symptoms, tardive dyskenesia (last two affect motor control)
III Electro convulsive therapy
ECT involves passing electricity through the
brain with the intention of inducing a seizure; the
seizure is the ‘treatment’ rather than the electricity
-usually undergo a course of ECT of 6-12 sessions
-usually twice a week
-it is now applied unilaterally to the non-dominant hemisphere to reduce memory loss
-The procedure affects the central nervous system and cardiovascular system
-Memory loss is still a common side effect
-extremely rarely: death
Research on ECT
-no generally accepted explanation
-One theory is that it affects post-synaptic responses to central nervous
system transmitters
-evidence suggests it is can be effective during acute episodes where fast short term improvement is needed
-lack of evidence to suggest it is more effective than other treatments
III Token economy
-Paul & Lentz
-The behavioural approach to schizophrenia considers that
symptoms of the disorder occur as a learned response
-not focused on internal experiences (auditory hallucination) as with the effect on their behaviour (acting as they hear voices)
-therapies focus on ‘unlearning’ individual symptoms
Paul & Lentz 1977 (TOKEN ECONOMY)
- operant conditioning to reinforce appropriate behaviour in schizo patients through use of rewards (in this case)
-84 individuals with chronic admissions to psychiatric institutions
-3 different forms of treatment: millieu therapy, traditional, token economy
-once 4 and 1/2 years they used an independent measures design to compare the outcomes
-behavior such as self-care, attending therapy and engaging socially
-tokens could be exchanged for luxury items
-the behaviour was monitored through time-sampled observations, standardised
questionnaire scales and individual interviews
-some overall reduction in positive and negative symptoms was observed
-most effective at reducing catatonic behaviour and social withdrawal but less successful in reducing hallucinations and delusional thinking
-97% of the token economy were able to live independently in the community for 1.5 years, 71% millieu, 45% hospital group
III Cognitive behaviour therapy
-Sensky et al
- CBT is a talking therapy designed to help people change through recognising thoughts
which underlie their behaviours
Sensky et al 2000 (CBT)
-randomised control trial
-compare cbt with control group engaging in ‘befriending’
-befriending sessions included one-to-one sessions of talking about hobbies, sports, etc
-90 patients
-16-60 years
-diagnosed with treatment-resistant schizophrenia from 5 different clinics
-mean of 19 sessions of befriending or cbt
-randomly allocated, independent groups design
-cbt included talking with patients about emergence of disorders before tackling symptoms
-assessed by blind raters before treatment, at treatment competition and 9 month follow up
-they used CPRS and SANS scales
-both groups showed significant reduction in positive and negative symptoms
-at follow up, cbt continued to improve while the other did not
Paul and Lentz evaluation
+intensive staff training –> improved reliability
+standardised
-low ecological validity
-ethical issues with patients who are denied privileges by not behaving
Sensky et al evaluation
+RCT –> improved validity
+double blind –> reduces bias
+sample from different clinics across UK –> representative
+nurses carefully trained –> standardised
