Schizophrenia Flashcards
What are positive symptoms?
- Symptoms experienced in addition to normal experiences, they include hallucinations and delusions
What are negative symptoms?
- Symptoms that represent the loss pf a usual experience such as clear thinking or ‘normal’ levels of motivation
What are hallucinations?
- Distortion of stimuli that have either no basis reality or are distorted perceptions of things that are there
What are delusions?
- Beliefs that have no basis in reality, for example, that the sufferer is someone else or that they are the victim of a conspiracy
What are experiences of control?
- A type of delusion where people believe their thoughts and behaviour is being controlled by external forces
What is speech Poverty (Alogia)?
- A negative symptom of schizophrenia which involves reduced frequency and quality of speech
What is Avolition?
- A negative symptom which involves loss of motivation to carry out tasks and results in lowered activity levels
What is Affective Flattering?
- Loss of a range of emotional expression
What is the Genetic Theory of schizophrenia?
- Schizophrenia is down to specific candidate genes which impact dopamine.
- SZ is aetiologically heterogenous = different combinations of genes are implicated in the disorder
- Ripke = Should see higher rate of SZ in family members of those with disorder
- Gottsman = More genetic material shared, more likely to develop disorder
- Joseph = Meta analysis of twin studies -> 40% concordance for MZ but 17% for DZ
- Tienari = Compared rates of SZ in adoptees with SZ mothers with control group as well. -> 6-7% of adoptees also had SZ compared to 2% of control group -> Compare to raised in Psychologically dysfunctional adoptive families, rose to 36.8%
Evaluate genetic theory
+ Lots of supporting evidence
- Concordance is not 100% in MZ suggesting other factors may be involved in development of SZ
- MZ have same upbringing so SZ could be on environment meaning we’re not sure of genetic link
What are Neural Correlates?
- Prefrontal Cortex: Reduced activity in prefrontal cortex - Responsible for logical thinking, organising thoughts + Emotional regulation -> Relate to delusions, flattened affects, abolition
- Amygdala: Smaller in people with SZ - Leads to irritability, flattened affects, avolition
- Dopamine Hypothesis
Evaluate Neural Correlates:
+ Significant evidence to support specific brain areas as a result for SZ
- Data is correlational = May be that neural correlates cause SZ or SZ caused brain changes. OR drug treatments led to brain changes = Matters because Neural correlates doesn’t really tell us about true cause of SZ
What is the Dopamine Hypothesis?
- Excess of dopamine neurotransmitter in certain brain regions is responsible for positive symptoms of SZ.
- SZ’s have abnormally high numbers of D2 receptors = More dopamine binding = More firing -> Hyperdopaminergia
- Revised DH = High levels of dopamine in Mesolimbic Pathway + Deficit of dopamine in prefrontal cortex
Evaluate the Dopamine Hypothesis?
+ Research = Drugs that increase dopamine levels produce psychotic SZ Symptoms = Supports domaines role in SZ
- Clozapine acts on serotonin as well = Serotonin clearly involved but DH fails to consider this
- High levels of dopamine could be symptom of SZ = Can’t be sure that abnormal levels of dopamine cause SZ
+ Excess number of dopamine receptors found in Broca’s area = Speech production + Auditory hallucinations = Supports Hyperdopaminergia theory
+ Low levels of Dopamine linked to negative symptoms of SZ = Evidence for Hyperdopaminergia theory
What are Typical antipsychotics?
- Give example
- First drugs developed to treat schizophrenia
- Chlorpromazine
What are atypical antipsychotics?
- Second more recent round of drug treatments
- Clozapine
Evaluate drug treatments:
+ Lots of research evidence = review over 200 studies and found antipsychotics far more effective than placebos
+ Evidence to support use of atypical over typical = review over 200 studies and found atypical far more effective than typical + Had fewer side effects
+ Patients given combined of CBT + Antipsychotics had best improvement in symptoms + Fewer hospital stays
- May only be surprising symptoms of SZ, may not be tackling underlying cause = Limits effectiveness + Utility of treatments = Cannot be sure cause is biological in origin.
What are the characteristics of a Schizophrenic mother and why might this lead to development of SZ?
- Cold, Rejecting, Controlling mother
- Passive Father
- Create stress + tension in family =could lead to paranoid thinking + Feeling of persecution
What is double bind theory?
- Family climate key in SZ development
- Communication in families affects wellbeing
- Child receives conflicting communication of right + wrong
- Child doesn’t know what response to take
- Become trapped with fear of getting it wrong
- Feel unable to communicate
- Form of manipulation + punished with withdrawal of love
What its high expressed emotion?
- Expressed emotion relates to a negative emotional climate characterised by family communication style of criticism, hostility and emotional over-involvement.
- Hostility = aggressive behaviour
- Emotional over-involvement = over-protective parenting and family members can become overly moralistic
Evaluate Family Dysfunction?
+ Patients who return from hospital to a family high in hostility, criticism + Emotional over-involvement = 4x more likely to relapse - Shows FD is a valid explanation
+ Berger = non-schizophrenics reported higher recall of double bind statements by their mothers than non-schizophrenics = Shows FD is valid explanation for development of SZ not just relapse
+ Kalafi + Tobari = Negative emotional climate in Iranian culture led to higher relapse = Evidence for NEC as a cause + also shows it is culturally relative = Not culturally bias
- High expressed emotion among families could be symptom rather than cause = Shows might not be a separate factor leading to SZ but rather a result of SZ
What is the Cognitive Explanation of SZ?
- SZ is a result of abnormal thought processing
- Supported by Neural Correlates = reduced processing in prefrontal cortex -> Observations suggest cognitions likely to be impaired in SZ
What is metarepresentation in Abnormal Thought Processing?
- Cognitive ability to accurately reflect on our own thoughts and behaviours
- Aware of our intentions + goals
- Can Interpret behaviour of others accurately
What is Central Control in Abnormal Thought Processing?
- Suppresses automatic responses, allowing us time to reflect on our behaviour + make deliberate choices
- In SZ, disorganised speech + thought disorder come from inability to suppress automatic thoughts + Respond with speech
- SZ’s often experience derailment of thoughts. Each word spoken triggers another thought/ association, and they lack ability not to respond to these.
Evaluate the cognitive explanation of SZ:
+ Myer-Lindenberg found reduced activity in prefrontal cortex of Schizophrenics when did a task involving working memory = Shows reduced neural correlates affects cognitive function -> Leads to impaired cognitions
+ Stirling conducted troop task with SZ people -> Took twice as long as non-SZ people to identify font colours correctly = Shows SZ patients have difficulty with central control = Validity
- Dysfunctional thinking could be a consequence rather than a cause = SZ means some patients have inability to suppress thoughts = Goes against what the theory says -> Reduces validity
What is CBTp?
- Assumes SZ is the result of dysfunctional thought processes
- Aims to identify and challenge faulty cognitions
- Every 10 days -> 16 sessions
- Deals with long term symptoms
Evaluate CBTp:
+ Drury - Faster recovery for patients given CBT + Drugs = CBT Valid -> Drugs make CBT work
+ Fewer side effects = More likely to stick to CBT -> Expensive
What is Family Therapy?
- Family dysfunction is key
- Improves positive and reduces negative communication + Reduces expressed emotion
- Reduce criticism + Increases praise
- More openness
- Develop more understanding + compassion for patients by educating family about illness
- Months to a year
Evaluate Family Therapy:
+ Cost effective - reduces relapse = Reduces revolving door phenomenon = cheaper for NHS
- Should be used alongside drugs = not affordable for individual families = Inequaity
+ ‘Pharaoh’ reduces relapse as increases drug compliance = effective treatment = drugs could be thing that is having a real effect
What is Token Economy?
- Behaviourist approach
- Rewards given for ‘good’ behaviour
- Operant conditioning = Reward -> Positive reinforcement
- Desirable behaviours = Brushing teeth, social engagement
- Rewards = TV time, cigarettes
- Token has to be given straight away to have an effect
Evaluate Token Economy:
- Comer -> Poor controls in research -> no control groups = Poor quality research = DOn’t know why it works
- Token economy doesn’t work well outside of hospital = Not useful in real world
- Humiliating/ patronising -> Treating people as children -> Rewards could be argued to be basic human rights
+ Hospital environment became better for staff = Safer for staff - Reductionist
What is the interactionist approach to understanding Schizophrenia?
- Considers both biological and psychological factors in development of SZ
- Encompasses Diathesis-stress model -> Biological and Environmental factors
- Several genes identified to increase vulnerability to SZ. -> Genetic factors also linked to faulty dopaminergic systems
- Original Diathesis stress model argues stress is psychological in nature + context of SZ it was caused by dysfunctional family dynamics.
- Nowadays, broader definition has been adopted and refers to anything that risks triggering schizophrenia -> E.G Cannabis use is a stressor so can disrupt body’s cycle
Evaluate the interactionist approach to SZ:
+ Barlow and Durand found that a family history of SZ pointed to a genetic link. -> When combined with dysfunctional the risk of developing SZ increased -> Supports Interactionist approach
- Not precisely known how risk factors contribute to Diathesis-Stress interaction = Hard to identify cause and effect = over simplistic explanation
- Idea of vulnerability being biological and stress being environmental is dated and over simplistic = We know more about stressors and so know what stress is far more complex than just being about environmental factors
