Schizophrenia Flashcards
Positive and negative symptoms of SZ
Positive symptoms are symptoms you gain through the disorder.
Delusions- false beliefs that are held yet illogical and no evidence
Hallucinations- disturbances in perception (hearing voices/seeing things)
Negative symptoms are things you lose and cause a decline in function.
Speech poverty- inability to speak properly.
Avolition- inability to continue with goal- like behaviour. Lose interest in usual things. Sitting in house.
Classification of SZ and the Reliability and validity of SZ diagnosis.
DSM most commonly used to diagnose. Sometimes ICD. Symptoms have to be persistent for a month and at least one has to be positive to diagnose.
Things affecting validity/ reliability:
Co morbidity - more than one disorder existing together. E.g somebody with SZ may also have anxiety. Makes it hard to classify as it may be anxiousness is confused w SZ.
+Buckley found that 50% of SZ also have depression.
Symptom overlap- similarity in symptoms between SZ and other conditions. E.g SZ and bipolar both share pos symptoms such as hallucinations. +Ellason found people with dissociation had more SZ symptoms than those diagnosed with SZ. Therefore people may mis label.
Culture bias- variation between different background in diagnosing SZ.
+(Harrison) West Indian origin we’re over diagnosed for SZ by UK doctors because of their background. Questions reliability of diagnosis as patients can show same symptoms but diagnose differently because of their culture. Also different norms in cultures
+(Africans believe hearing voices is good and from ancestors and therefore won’t diagnose)
Gender bias- bias in diagnosing one gender more than another. Women are taken less serious because they can deal better
+(Boverman) clinicians equated healthy adult with healthy male. Women less mentally healthy when don’t show male behaviour. (Clinicians don’t account for predisposing risk factors between men and women) (men have more negative symptoms and more substance abuse not taken into account)
Biological explanations for SZ a01
Genetic- SZ is driven by inherited by activity of certain genes affecting brain development and neurotransmitter levels.
Theres not one specific gene that causes SZ it’s a mixture of a few (polygenetic)
If SZ is genetic we would expect to see that the closer in DNA the more likely to share the disorder. This is proven through family studies >
Neural correlates (dopamine hypothesis and ventricles) - variations in neural structure associated with SZ. Main NC is the dopamine hypothesis (imbalance of it causes SZ) hyperdopaminergia (too much) may lead to positive symptoms such as hallucinations. Hypodopaminergia (too little) thought to lead to negative symptoms such as speech poverty.
Hypothesis came about from drug research. L-dopa (which increased dopamine) created positive symptoms in healthy patients. Antipsychotics reduce SZ symptoms and the dopamine.
Ventricles are deep in brain filled with fluid. Thought to cushion and protect brain. Enlarged ventricles are associated with SZ
Dopamine hypothesis
Biological explanations to SZ a03
Genetic:
+ Supported by twin studies. Gottsman found that MZ twins had highest concordance (48%). Lower the further related. Suggest there is a genetic basis
- however as 48% not 100% suggest there are other factors such as environment not accounted for.
Neural- (dopamine) leueht. Meta analysis. Found that dopamine involved drugs had better influence on symptoms than placebo. Therefore dopamine must be cause.
+(Ventricles) Johnstone. Used CT scans and found larger ventricles in SZ patients.
- however correlational. We don’t know if large ventricles cause SZ or visa versa.
- deterministic. Suggests it’s innate and inevitable. Makes sufferers feel less empowered.
Drug therapy (biological treatment) a01 + a03
Anti psychotics - mediation used to control psychosis. 2 types:
Typical- (first generation) calms dopamine which reduces positive symptoms. Doesn’t address negative symptoms. Has sever side effects (confusion/ constipation) one e.g- chlorpromazine
Atypical- (second generation) started to be used to avoid side effects. Also addresses negative symptoms + positive. One example is clozapine. Has less severe side effects (weight gain)
+drug therapy is cheaper than CBT and family therapy.
- suppresses symptoms but doesn’t look at underlying issue. Also no evidence for its effectiveness long term.
- both types have side effects. This leads to 2/3 stop taking them and symptoms to return.
+ supporting research. Leucht. Metanalysis of effectiveness of drug treatment. Found that the drugs were more effective than placebo at treating patients.
Psychological treatment (CBT/ FAMILY THERAPY/ TOKEN ECONOMY) a01
A) CBT- speech therapy to challenge irrational beliefs and faulty thinking. Based on Ellis ABCDE.
Activating- drugs cause side effects.
Belief- hospital trying to kill them.
Consequence- refuse treatment
Disputing belief - staff have no reason to kill you
Effect- drugs are necessary- continue taking.
Therapist might also use reality testing. (If they think they can see into future they may get a deck of cards and ask them to predict)
B) family therapy - dysfunction can lead to relapse and so this therapy improves home life of SZ patient.
Aims to change the behaviour of whole family not just SZ.
Psycho education is used to so family can understand disorder and be more sensitive.
Also deals with reducing stress/ improving communication/ reduce conflict.
C) token economy- behavioural treatment based on reinforcement.
The tokens are a form of positive reinforcement. An immediate reward for good behaviour. They can be exchanged for pleasures (chocolate)
This leads to behaviour progressively changing.
Treatment is used in hospitals to produce easier to manage behaviour or to reintegrate back in to society.
However it is best used with midly I’ll patients.
Psychological treatment (CBT/ FAMILY THERAPY/ TOKEN ECONOMY) a03
A) CBT
+ supporting research. Sensky. Patients who resisted drug therapy showed reduction in pos + neg symptoms after 19 CBT sessions.
- leaving treatment early. It is very long process and symptoms might develop in this time. Negative symptoms can lead to unwillingness to take part also.
- severe ill patients may not be able to face confrontation of CBT.
B) family therapy-
- time consuming. Takes up to a year. Patients may drop out.
- it focuses on improving home life to avoid hospital admission. but not the actual issue. Symptoms remain.
+ supporting evidence. Leff. Found 50% patients relapsed after leaving hospital with standard care. Only 8% with family therapy after.
C) token economies-
- doesn’t tackle symptoms. Only attempts to manage negative symptoms such as low motivation.
- not effective for patients who are severely ill.
- may be degrading for patients. Devised from skinners box. Treats them like lab rats.
Interactionist approach explaining SZ a01 + a03 (diathesis stress)
Interactionist approach- development of SZ is due to combined effects of biological and psychological factors.
Diathesis stress model- concept that disorder is due to interaction with a vulnerability (diathesis) and an environmental trigger (stress)
Diathesis in SZ- often genetic vulnerability. However other reasons such as flu during pregnancy and child trauma.
Stressors in SZ- later negative environmental experiences. E.g major life event. This triggers the disorder.
+supporting. Gottesman twin study. Found 48% concordance in MZ twins. Suggests other factor as well as biological supporting interactionist.
+tienari supporting. Studied adoptees of SZ mother. Adopted into healthy family 5.8% SZ rates. Adopted into dysfunctional family 36.8% rate. Support biological by high rate even in healthy family. But psychological for rate increasing in dysfunction.
Psychological explanations to SZ (Family dysfunctions) a01 + a03
Family dysfunctions:
It is the interpersonal relationship within family that causes SZ
A) Schizophregenic mother. Get their symptoms from a controlling, rejecting and cold mother. She creates atmosphere of stress and secrecy. This triggers psychotic thinking.
B) double bind theory. Child gets mixed messages. E.g told to be independent but is over protected. Leads to paranoia and disorganised thinking
C) expressed emotion. Verbal interaction caregiver has to person with SZ which increases.
Exaggerated involvement. Indicates sufferer is a burden “this is so hard to deal with”
Criticism of sufferers behaviour “you don’t know how to do anything.
And hostility towards sufferer.
+ (expressed emotions) butzlaff and hooley. Meta analysis and found relapse into SZ is more likely in families that have expressed emotion issues
+ supporting research for influence of family dynamic. (Tienari). Studied biological children who were adopted from SZ mother. 5.8% developed SZ when adopted by healthy family. 36.8% when adopted by dysfunctional family.
- however they were already at genetic risk.
- socially sensitive to blame family
- hard to establish which way round dysfunction occurred.
Psychological explanations to SZ (cognitive) a01 a03
Cognitive - Ability to process thoughts is dysfunctional.
Firth attention deficit theory- SZ is due to faulty attention system. Can’t filter thoughts therefore overloading mind. Leads to positive symptoms.
2 components of cognitive:
A) central control- faulty, inability to suppress thoughts and actions. E.g can’t resist urge to open a door. Leads to delusions.
B) meta- representation- the ability to identify your thoughts and actions as your own. Faults In this system leads to delusions as u feel your actions are controlled by outside force.
+ Stirling. Tested central control. 30 SZ 18 control ppts. Wrote words of colours in different in ink. Had to name the ink colour not the word.SZ patients took twice as long.
Interactionist approach treating SZ a01 + a03
As approach suggests it’s a combination of factors it suggests the effective treatment would be a combination of CBT and drug therapy.
Drug therapy can reduce symptoms so they can tackle CBT. CBT can then give cognitive skills to challenge faulty thinking.
+ supporting research. Tarrier. Ppts were placed in routine care (drug therapy) or routine care and CBT. Those combining treatments showed better symptoms and spent fewer days in hospital. Suggests interactionist approach to treating is more effective than usual approaches
