Schizophrenia

Question 1

what is schizophrenia

Answer 1

a severe mental disorder where contact with reality and insight are impaired, example of psychosis.

Question 2

what is the classification of a mental disorder?

Answer 2

process of organising symptoms into catagories based on which symptoms frequently cluster together

Question 3

what are the two major systems for classification?

Answer 3

ICD-10 (11 since 2022) and DSM-5. DSM-5= positive symptoms must be present for diagnosis and ICD-10= two or more negative symptoms are sufficient.
Old sub-types were dropped because they tended to be inconsistent e.g. someone with diagnosis of paranoid schizophrenia would not show these same symptoms a year later

Question 4

positive symptoms of schizophrenia:

Answer 4

additional experiences beyond those of ordinary existence, including hallucinations and delusions

Question 5

what are hallucinations?

Answer 5

a positive symptom that are sensory experiences that have either no basis in reality or are distorted perceptions

Question 6

what are delusions

Answer 6

positive symptom- involve beliefs that have no basis in reality e.g. person believes they are someone else

Question 7

what are negative symptoms of schizophrenia?

Answer 7

atypical experiences that represent the loss of a usual experience such as a loss of clear thinking. Speech poverty and Avolition

Question 8

what is speech poverty

Answer 8

negative symptom: reduced frequency and quality of speech.

Question 9

what is Avolition

Answer 9

involves loss of motivation to carry out tasks and results in lowered activity levels

Question 10

what are the strengths of diagnosis and classification?

Answer 10

good reliability, counter point to validity limit

Question 11

what are the limits of diagnosis and classification?

Answer 11

low validity, co- mobidity, gender bias in diagnosis, cultural bias in diagnosis

Question 12

three main genetic basis for schizophrenia?

Answer 12

family studies, candidate genes and role of mutation

Question 13

family studies- biological explanation for schizophrenia

Answer 13

family studies have confirmed risk of schizophrenia increases in line with genetic similarity to a relative disorder. E.g. someone with an aunt with schizo= 2% chance, 9% if they are a sibling and 48% if they are an identical twin. They do tent to share aspects of the environment as well however family studies show good support for genes importance

Question 14

candidate genes- biological explanation for schizophrenia

Answer 14

It appears schizo is poly genetic- number of different genes are involved. Most likely genes would be those coding for neurotransmitters such as dopamine. Study- combines all previous data from genome wide studies of schizo. Genetic makeup of 37000 people with a diagnosis compared to 113000 controls, 108 separate genetic variation were associated with slight increased risk of it. Because studies have identified different candidate genes it appears it is aetiologically heterogeneous (diff combos of factors including genetic variation can lead to condition

Question 15

role of mutation- biological explanation for schizophrenia

Answer 15

can also have a genetic origin in absence of family history: mutation in parental DNA caused by radiation, poison or viral infection. Positive correlations between paternal age (associated with increased risk of sperm mutation) and schizo. increasing with 0.7 for fathers under 25 and 2% over 50

Question 16

what is neural correlates (schizophrenia)

Answer 16

patterns of structure or activity in the brain that occur in conjunction with and experience and may be implicated in the origins of that experience

Question 17

what is the original dopamine hypothesis? (neural correlates of schizo)

Answer 17

based on discovery that drugs used to treat schizo (anti psychotics that reduce DA) caused symptoms similar to those with Parkinsons- condition associated to those with low DA levels. Therefore schizo may be a result of high dopamine in sub cortical areas of the brain. E.g.excess of DA receptors in pathways from subcortex to Brocas may explain reasons for speech poverty

Question 18

updated versions of dopamine hypothesis? (neural correlates of schizo)

Answer 18

proposed addition of cortical hypodopaminergia (low DA in brains cortex. This could explain some symptoms such as: low DA in prefrontal cortex could explain cognitive problems (negative symptoms) It has also been suggested that cortical hypodoperminergia leads to subcortal hyperdopaminergia. It also tries to explain the origins of abnormal DA function. It seems both genetic variations, early stress, psychological and physical make people sensitive to both low and high DA.

Question 19

two psychological explanations for schizophrenia

Answer 19

family dysfunction and cognitive explanation

Question 20

family dysfunction- three theories

Answer 20

-schizophrenogenic mother
-double bind theory
-expressed emotion

Question 21

family dysfunction- schizophrenogenic mother:

Answer 21

researcher based this on accounts from patients about childhood. Noted they spoke about a type of parent that was schizophrenia causing. Characteristics of this parent are: cold rejecting and controlling. Family climate of tension and secrecy. This leads to distrust, later develops into paranoid delusions and then schizophrenia.

Question 22

family dysfunction- double bind theory:

Answer 22

emphasized role of communication style in family. Developing child often find themselves in situations where they fear doing the wrong thing, receive mixed messages, feel unable to comment on the unfairness of the situation or seek clarification. When they get it wrong the child is usually punished with withdrawal from love. This leaves them thinking world is dangerous reflecting symptoms of delusions and disorganized thinking.

Question 23

family dysfunction- expressed emotion

Answer 23

-this is the level of emotion, in particular negative emotion, expressed towards a person with schizophrenia by their carers who are often family members. This includes these elements:
-verbal criticism, occasionally accompanied by violence
-hostility, including anger and rejection
-emotional involvement in the life of a person, including needles self sacrifice.
These are a serious source of stress for directed individual. Primarily explanation for relapse of it. It has also been suggested this can trigger the onset of schizo for somnolent who is already vulnerable (e.g. due to genetic makeup

Question 24

three cognitive explanations for schizophrenia

Answer 24

dysfunctional thinking, metarepresentation dysfunction and central control dysfunction.

Question 25

dysfunctional thinking as a cognitive explanation for schizophrenia

Answer 25

Schizo is associated with several types of dysfunctional though processing- and these can provide explanations.
Schizo is characterized as disruption to normal thought processing. E.g. reduced thought processing in the ventral striatum is associated with negative symptoms, while reduced in temporal and cingulate gyri is associated with hallucinations. This is lower than usual level of info processing suggests cognition is likely to be impaired.

Question 26

metarepresentation dysfunction as a cognitive explanation

Answer 26

researchers identified two types of dysfunctional thought processes: metarepresentation, and ability to reflect on thoughts and behavior. Dysfunction in metarepresentation would disrupt our ability to recognize our own actions and thoughts as being carries out by ourselves. This would explain hallucinations of hearing voices and delusions like thought intersertion.

Question 27

central control dysfunction as a cognitive explanation

Answer 27

researcher identified issues with cognitive ability to suppress automatic responses when we perform deliberate actions. Speech poverty and thought disorder could be due to this (automatic thought and speech triggered by other thoughts) E.g. with schizo people experience derailment of thought as each word triggers associations and they cannot suppress the automatic responses to it

Question 28

what are antipsychotics?

Answer 28

most common drug treatment for schizophrenia- reduce intensity of symptoms, in particular the positive symptoms. they can be divided into typical and newer atypical drugs.

Question 29

what are typical antipsychotics?

Answer 29

around since 1950s, served as first drugs for schizo and other psychotic disorders. They work as dopamine antagonists (reduce the action of neurotransmitter) and include chlorpromazine. This is also an effective sedative. Often used to calm people with schizo and other conditions.

Question 30

what are atypical antipsychotics?

Answer 30

used since 1970s, developed after typical. They typically target a range of neurotransmitters such as dopamine and serotonin. Purpose was to maintain or improve effectiveness while also minimizing side effects. Examples include Clozapine and Risperidone.

Question 31

What is clozapine?

Answer 31

Marked to be used when other treatments failed as it was observably more effective from typical antipsychotics but had some serious side effects (blood problems) daily dosage is lower than clozapine- 300-450mg a day (1000mg or 400-800) and is not taken by injection due to risks like chlorpromazine can be. Acts on serotonin and glutamate receptors as well as dopamine. Mood enhancing means it is prescribed when patient becomes suicidal.

Question 32

what is risperidone?

Answer 32

developed to be as effective as clozapine but less side effects. smaller does of 4-8-12mg as it binds to dopamine receptors more effectively, while also binding to serotonin. Syrup, tablet or injection like chlorpromazine.

Question 33

what are the two types of psychological therapy for schizophrenia?

Answer 33

Cognitive behavior therapy and family therapy

Question 34

what is CBT for schizophrenia?

Answer 34

takes place over 5-20 sessions, deals with cognitions and behavior.

Question 35

how does CBT help for schizophrenia?

Answer 35

-makes client aware how irrational thought impacts thier behavior. If the client is aware of the reason for things such as auditory hallucinations from a malfunctioning speech center and it cannot hurt them if they ignore it, it is much less debilitating. Helps people better cope with it. Delusions can also be challenged through reality testing with client and therapist.

Question 36

what is family therapy for schizophrenia?

Answer 36

therapy carried out with some or all members of the family with the aim of improving communications within the family and reducing stress of living as a family

Question 37

how does family therapy help schizophrenia?

Answer 37

reduces negative emotions: reduce levels of expressed emotion, reducing stress which can usually cause relapses

improves families ability to help: encourages family members to form a therapeutic alliance where they all agree on the aims of the therapy. Tries to improve beliefs about schizo behavior and ensure family maintain a balance between caring for individual and balancing thier own lives.

Question 38

what’s the model of practice for family therapy?

Answer 38

1) sharing basic info and providing support, develops into deeper levels. 2) identifying resources family can and cannot provide 3) aims to encourage mutual understanding, safe space. 4) identifying unhelpful patterns of interaction 5) skills training such as management techniques. 6) relapse prevention 7) maintenance for future

Question 39

what are token economies?

Answer 39

form of behavior modification where disiarable behaviors are encouraged by the use of selective reinforcement. E.g. they are given tokens. Delayed rewards are worse, so they have immediate rewards for exchanging the tokens

Question 40

token economies and schizophrenia

Answer 40

Study trialed a token economy system in a ward of women with schizophrenia. Every time they carries out tasks such as making their bed they were given a token that could be swapped for ward privileges such as a film. Number of tasks carried out increased significantly. They used to be the norm for treating schizo in long term hospitalization. Use has now declined in the UK due to growth of community based care.

Question 41

reason for token economies:

Answer 41

institutionalization develops over long term hospitalization and leads to bad habits such as no good hygiene
three categories token economies helped are personal care, condition related behaviors and social behavior. modifying them does not cure it but has two major benefits:
-improves persons quality of life for setting of hospital
-normalizes the behavior, making it easier for people who have spent time in the hospital to adapt back to their community life

Question 42

what is the theoretical understanding of token economies?

Answer 42

example of behavior modification - behavioral therapy based on operant conditioning.
Tokens are secondary reinforcers as they only have value once people learn they can bring reward. The meaningful rewards are a primary reinforcer.