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Schizophrenia Flashcards

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1
Q

What are the 2 types of schizophrenia symptoms?

A

Positive and negative

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2
Q

What is a positive symptom?

A

Anything which is an addition to a normal experience

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3
Q

What is a negative symptom?

A

Anything which is a reduction or loss of normal behaviour

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4
Q

Name 3 positive symptoms and what they mean

A

Hallucinations - Unreal perceptions of the environment

Delusions - Strange beliefs that seem real to the person with schizophrenia but aren’t real

Catatonic behaviour - Abnormal and bizarre motor movements

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5
Q

Name 3 negative symptoms and what they mean

A

Alogia - speech poverty

Avolition - Can’t work towards goals (lack of motivation)

Disorganised thinking - Can’t follow a train of thought

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6
Q

ICD vs DSM

A

ICD = Europe
DSM = USA
ICD needs 1 positive and 2 negative symptoms
DSM needs 2 general symptoms

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7
Q

What is symptom overlap? How does it relate to schizophrenia?

A

Schizophrenia has lots of symptoms shared with other disorders

Depression - avolition
Bi-polar - delusions

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8
Q

How do culture and schizophrenia interact?

A

Blacks and Hispanics are most likely to be diagnosed with it
This is because certain cultural practices may be misunderstood

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9
Q

How does comorbidity relate to schizophrenia

A

Schizophrenia is often co-morbid with other conditions
This make it more difficult to diagnose

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10
Q

Osorio

A

Gave 180 people the dsm5
In pairs, they had to diagnose individuals
Achieved an inter-rater of 0.97 and a test-retest of 0.92

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11
Q

Cheniaux

A

2 psychiatrists diagnosed 100 people with the ICD and DSM
Very low agreement
ICD = 68
DSM = 39

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12
Q

Buckley

A

Co-morbid:
50% - depression
47% - substance abuse
23% - OCD

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13
Q

Diagnosis of schizophrenia evaluation

A

Very reliable - Osorio

Its co-morbid with other conditions so we don’t fully understand it (Buckley)

Shows symptom overlap making it hard to diagnose

Culturally biased but diagnosis should be unbiased

Lacks validity (Cheniaux)

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14
Q

What are the biological explanations of schizophrenia?

A

Genetics
Dopamine hypothesis
Neural correlates

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15
Q

Gottesman

A

Large scale study on schizophrenia running in families
General population - 1%
Parents - 6%
MZ twins - 48%

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16
Q

Hilker

A

Shown the genetic explanation through twin studies
33 concordance in MZ twins
7 in DZ twins
MZ share more genes so more likely to have schizophrenia

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17
Q

What is a candidate gene?

A

A specific gene which causes something

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18
Q

How is schizophrenia found in DNA?

A

Its polygenetic so more than 1 gene

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19
Q

Ripke

A

37000 suffered
113000 controls
108 genetic variations that could cause schizophrenia

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20
Q

Genetic explanations of schizophrenia evaluation

A

Doesn’t take into account how people without a family history of schizophrenia develop the disease - however this could be explained via mutation

Very deterministic - the illness is written into DNA. C.A. As identical twins share 100% of their genes, it would be expected that the concordance rate for schizophrenia would be 100% if it was purely genetic. As it is only around 50%, this suggests other influences are playing a part.

Provides real world application (embryo screening) - however this is unethical selecting desirable traits in babies

It may be that the increased concordance rates in the Gottesman study were due to the increased chance of sharing the same environment as the person with schizophrenia. For example, identical twins share the same environment (and may be treated similarly), whereas first cousins would not. This means that it can’t be concluded that genetics has caused schizophrenia

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21
Q

What does the dopamine hypothesis of schizophrenia suggest

A

Over or under production of dopamine can affect different brain regions and their functions

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22
Q

What is hyperdopaminergia and what are it effects?

A

Too much dopamine is produced which affects Brocas area and then leads to alogia. Also linked to auditory hallucination

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23
Q

What is Hypodopaminergia and what are its effects

A

The under production of dopamine. This affects the prefrontal cortex which is involved in decision making and problem solving - these processes often decline in sufferers

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24
Q

Goldman-Rakic

A

Identified a role for low levels of dopamine in the prefrontal cortex - links to negative symptoms of schizophrenia e.g. alogia and affective flattening

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25
Q

How do drugs that block dopamine receptors effect schizophrenia

A

They reduce symptoms (not cure)

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26
Q

Phenothiazine

A

Block dopamine receptors and reduce schizophrenia symptoms

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27
Q

L-dopa

A

Parkinsons treatment
Increases dopamine in the brain and can bring out schizophrenia symptoms

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28
Q

Amphetamines

A

Increase dopamine levels and cause the development of schizophrenia symptoms in users

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29
Q

Dopamine hypothesis evaluation

A

Led to drug development such as Phenothiazine

Tauscher found antipsychotics that reduce the role of dopamine will alleviate schizophrenia symptoms and reduce the occurrence of positive symptoms

Very reductionist - evidence that other biological factors play a role e.g. genetics and also psychological factors such as family. A more holistic approach may be more favourable

Drugs don’t work for all users - this is an issue as if schizophrenia is caused by dopamine levels, drugs should work for everyone

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30
Q

What does neural correlates mean?

A

Relating brain structure or function to schizo

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31
Q

What brain area is associated with reward

A

The ventral striatum

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32
Q

Juckel

A

Measured activity levels in the ventral striatum in schizophrenic people

Lower level of activity than the controls
The less activity, the worse the negative symptoms

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33
Q

Allen

A

Scanned brains of those with auditory hallucinations

Compared to controls

Played pre-recorded speech to participants

They had to identify speech as their own or others

Sufferers experienced lower level of activation in their superior temporal gyrus and anterior cingulate gyrus

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34
Q

Neural correlates evaluation

A

The research is all correlational - there is a relationship between brain region and certain symptoms of schizo however we are still lacking cause and effect

Application - way to diagnose sufferers as if there is a change in brain structure, this could be used to identify the disorder

Buchsbaum used PET scans to find reduced cerebral blood flow in schizophrenic patients compared to controls. This can explain the arise of catatonic symptoms.

Current research only explains a few schizophrenia symptoms such as alogia and auditory hallucinations. Doesn’t explain other symptoms suggesting another approach may be better. Opposing argument …

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35
Q

What are the 3 explanations of family dysfunction

A

Schizophrenogenic mother
High EE (expressed emotion)
Double bind

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36
Q

What does having a schizophrenogenic mother mean?

A

A psychodynamic explanation
Cold and rejecting mothers
Atmosphere of tension and secrecy
Child is therefore distrusting and paranoid
Develops delusions and eventually schizophrenia

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37
Q

What does double bind mean (schizophrenia)

A

No matter what a child does, they can’t win as parents give mixed messages and inconsistent standards are imposed on them

The child wants to do the right thing but fears being wrong.

A child caught in a double-bind may develop schizophrenic symptoms such as paranoia and disorganised thoughts e.g. Am I doing the right thing?

When they make an error, they are punished through withdrawal of love

The world is confusing, unpredictable and dangerous

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38
Q

What is High EE (schizophrenia)

A

How a family member communicates their thoughts and feelings towards a person in the family

Negative emotions directed towards child - “can’t you do anything right?”

Hostility, anger and rejection of child

Parents too emotionally involved in kids social lives

39
Q

What is likely to trigger a schizophrenia relapse

A

High EE because high stress triggers a schizophrenic episode. These families have secret alliances between them which encourages paranoid symptoms

40
Q

Family dysfunction evaluation

A

The schizophrenogenic mother creates a dangerous stereotype and produces a blame culture which has no scientific basis

The schizophrenogenic mother theory clearly shows acute gender bias as it suggests that women play a key, destructive role in the onset of schizophrenia in a child (alpha bias as it assumes key differences based on gender).

Biology cannot fully explain the development of schizophrenia. Family dysfunction helps to fill in gaps. C.A - Research in this area is often retrospective, meaning that patients with the disorder are asked to think back to their childhood and explain what it was like. Such recollections are unlikely to be completely trustworthy, therefore reducing the validity of the evidence and therefore the explanation.

Led to family intervention therapies

41
Q

What are the psychological explanations for schizophrenia

A

Cognitive
Family dysfunction

42
Q

How does the cognitive approach explain schizophrenia

A

Disfunctional thought processes
Negative schemas

43
Q

Who proposed the cognitive theory of schizophrenia

A

Frith

44
Q

What did Frith suggest about cognitive functioning?

A

It happens in 2 forms
Conscious - we deal with info in full awareness
Pre-conscious - We do this without thinking

45
Q

What did Frith believe caused schizophrenia?

A

Having a faulty filter between conscious and pre-conscious processing

Our preconscious thoughts arrive in the conscious mind giving it more importance than necessary

This would bombard stimuli leading to hallucinations

46
Q

What is central control? How does it link to schizophrenia?

A

The ability to suppress information like what’s in our peripheral vision whilst we are performing a deliberate action instead.
This could lead to disorganised speech alogia

47
Q

What is metarepresentation? How does it link to schizophrenia?

A

The ability to reflect on thoughts or behaviour
It would disrupt our ability to recognise our actions - could lead to hallucinations or delusions

48
Q

Cognitive explanation of schizophrenia evaluation

A

Issues with the validity of cognitive explanations, for example a person’s thought processing is highly subjective, regardless of whether they have schizophrenia or not, so it is difficult to know how to judge and asses what is ‘dysfunctional’ or ‘biased’

Doesn’t explain why people experience these faulty thought processes - Abnormal cognitions may be one of the effects/consequences of schizophrenia, rather that actually causing the development of it in the first place.

Research support for the idea that people with schizophrenia process information differently. Stirling et al. (2006) compared 30 people with schizophrenia to controls on a range of cognitive tasks such as the Stroop test. They found that schizophrenics took over twice as long as controls to complete these tasks.

Stroop test can be used to diagnose schizophrenia - if peoples cognitive functioning is very different to a healthy adult, may indicate schizophrenia

49
Q

What are the biological treatments for schizophrenia?

A

Anti-psychotics

50
Q

What is the difference between typical and atypical anti-psychotics

A

Typical = older
Atypical = 2nd gen drugs

51
Q

Off what principle to typical anti-psychotics work

A

The dopamine hypothesis

52
Q

How do typical anti-psychotics work?

A

Patient begins treatment

Drug builds up in nervous system over a few weeks

Drug blocks dopamine receptors on synapses (acts as a dopamine antagonist)

Initial increase in dopamine as dopamine is stuck in the synapse

Overtime, dopamine production reduces

Symptoms reduce

53
Q

Thornley

A

Compared treatment of chlorpromazine to controls
13 trials
1121 people
Increased function and reduced symptom severity

54
Q

What do typical drugs also act as and why is this an issue?

A

Sedative - schizophrenics can benefit from calming effects
It is not fully understood why this is the case
Chemical straight jacket

55
Q

Why are atypical drugs better

A

They maintain the effectiveness of typical drugs but reduce side effects

56
Q

Meltzer

A

Tested clozapine, an atypical drug
Also works on serotonin receptors
Effective in 30-50% of cases where previous treatment hadn’t worked

57
Q

Clozapine

A

Clozapine works in the same way as chlorpromazine but also works on serotonin and glutamate receptors

Clozapine users need regular blood tests to insure they don’t develop a fatal blood condition

58
Q

What are some side effects of anti-psychotics?

A

Diziness
Tardive dyskinesia
NMS

59
Q

What is tardive dyskinesia

A

The result of dopamine super sensitivity - leads to grimacing and lip smacking

60
Q

What is NMS

A

Neuroleptic malignant syndrome - hypothalamus isn’t getting enough dopamine which can cause comas and can be fatal

61
Q

Antipsychotics evaluation

A

Positive effect on treating people helping schizophrenics to lead happy lives
Still don’t fully understand the drugs
Socially sensitive (chemical straight jacket)
They are effective - counter side effects

62
Q

What are the psychological treatments for schizophrenia?

A

CBT
Family intervention therapy

63
Q

What is the aim of CBT?

A

To help patients identify irrational thoughts and try to challenge them

64
Q

What symptoms does CBT focus on

A

Mainly positive symptoms

65
Q

What does CBT do to schizophrenia?
(How long is it done for)

A

Short term solution (12-16 weeks)
It doesn’t cure it but helps develop coping mechanisms

66
Q

What are 3 features of CBT

A

Normalisation
Reality testing
Coping mechanisms

67
Q

What’s normalisation

A

A therapist convinces the schizophrenic that the voices they hear are an extension of their own thoughts

68
Q

What’s reality testing?

A

The therapist and patient question how likely the persons delusions are to be true

69
Q

What are coping mechanisms?

A

The patients can be given methods to help with their depression and anxiety

70
Q

CBT evlauation

A

Opposed by drugs which are easy and effective

R.S. from Jahuar

Just challenging the dysfunctional thoughts through disputing may not be enough to change them if the thoughts have a biological basis. CBT is rarely used without drug therapy, suggesting it is not enough on its own to treat schizophrenia.

CBT may involve challenging the validity of beliefs, which may interfere with freedom of thought. For example, trying to persuade an individual that the government is not watching or monitoring them in any way may interfere with their (possibly justifiable) fear of an over-controlling government. Therefore, CBT has potential ethical issues

71
Q

Jahuar

A

34 studies of CBT on schizophrenia

Jauhar et al (2014) found in a meta-analysis that CBT had an effect on positive and negative symptoms. This effect was significant, but quite small. This is therefore moderate support for the effectiveness of CBT in treating schizophrenia.

72
Q

What is family intervention therapy?

A

Whole families take part including the patient

73
Q

Pharoah

A

Forming a therapeutic alliance with family members
Reduces tree of caring for a relative with schizophrenia
Improves families ability to anticipate and solve problem
Reduction go anger/guilt in family members
Helps family members for a balance between caring for patient and maintaining their own lives
Improves families beliefs around schizophrenia

74
Q

Family intervention therapy evaluation

A

Very cost effective as it helps reduce relapse rate by 50-60% (McFarlane)

Family therapy may actually worsen someone’s symptoms if they feel that they are being forced to interact with or depend on people who are emotionally destructive

Not a cure - Family therapies may improve the quality of life for schizophrenia patients and their families, but do not provide a cure for schizophrenia, rather a management of the effects. This means it cannot be used to treat schizophrenia by itself - which questions its validity

Family therapy should result in a schizophrenia patient feeling less alone and isolated which should ultimately benefit the economy as it means less reliance on external mental health providers plus the patient may be able to work which means fewer days absence lost to sickness

75
Q

What is token economy

A

A management technique (not a cure)

76
Q

Aim of token economy

A

Positive behaviours are rewarded and negative behaviours discouraged

Incentivise schizophrenia patients to behave in a more socially acceptable way

77
Q

Who proposed token economy?

A

Skinner

78
Q

What technique does token economy use?

A

Operant conditioning

79
Q

What is the process of token economy

A

Patients given coloured disks for doing a good thing that can later be cashed in

80
Q

What are the tokens in token economy

A

Valueless secondary reinforcers

81
Q

Why are the tokens secondary reinforcers

A

They have no intrinsic value but can be exchanged for things with value

82
Q

What does token economy target

A

Negative symptoms

83
Q

What did Mateson identify as the 3 categories that are dealt with through token economy

A

Personal care
Condition related behaviour e.g. apathy
Social behaviour

84
Q

Token economy evaluation

A

Sultana - meta-analysis of 110 studies, that only 3 had used random allocation (where a true comparison was available with an experimental and control group). Of these, only 1 study showed improvement in symptoms and behavioural change in patients. Therefore, the evidence supporting token economies is very weak.

Doesn’t work outside institutional setting as they will no longer get rewarded

Token economies raise ethical issues. The patients with the most severe symptoms are unable to access the tokens, as they are unable to perform the desirable behaviours. They are effectively discriminated against (in this case, denied rewards) for being more severely ill. The legality of this has been challenged, and the use of token economies has declined as a result.

Very socially sensitive - the hospitals have the power to reward good behaviour. Who decides what behaviours need correcting?

85
Q

What is the interactionist view (schizophrenia)

A

A holistic approach that combines biology and psychology into 1 theory and realises its cause is likely a combination of both

86
Q

How does the diathesis stress model support the interactionist view

A

You must be genetically vulnerable to it but also have a stressor

87
Q

Who proposed the diathesis stress model (Schizophrenia)

A

Meehl

88
Q

What did Meehl believe about the interactionist approach for explaining schizophrenia

A

People had a “schizo” gene which created a schizotypic personality and therefore makes you vulnerable to developing the disorder
Some form of psychological stress must accompany it which activates the gene

89
Q

How does cannabis relate to schizophrenia

A

Cannabis can be a trigger of the diathesis stress. It can increase the risk of it 7X

90
Q

Read et al

A

46 studies of childhood abuse and schizophrenia
69% of women with schizophrenia experienced physical/sexual abuse
59% of men
Severe enough trauma can affect the brains development

91
Q

What is the suggested interactionist treatment

A

Anti-psychotics and CBT

92
Q

Interactionist approach evaluation

A

Treatment causation fallacy - just because schizophrenia is treated successfully via interactionist treatments, doesn’t mean that it must be caused by a combination of factors (biological theories underpin majority of theory)

We don’t know how the diathesis and the stress interact with each other - there is some vagueness

Accepts both nature and nurture - therefore drug and CBT treatment

Ignores other biological factors such as dopamine levels

93
Q

Tienari

A

19000 adopted from parents with schizophrenia
Compared to controls
High EE was linked to schizophrenia but only to people who were already genetically vulnerable
The stress was needed as a trigger

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