schizophrenia Flashcards
discuss issues associated with classification & diagnosis of schizophrenia AO1
validity - accuracy of diagnosis & classification
assess: criterion validity
- do diff assessment systems (ICD-10 & DMV-5) & arrive at same diagnosis
- symptom overlap: symptoms in schiz can overlap w/other MHDs, making diagnosis inaccurate e.g., auditory hallucinations
- gender bias: accuracy of diagnosis depends on gender of person being examined (psychiatrist may be biased towards diagnosing one gender over other so diagnosis not accurate
reliability - consistency in diagnosis & classification
- must be able to diagnose schiz at two diff points in time (test-retest) or diff clinicians reach same conclusions (inter-rater reliability)
- cultural bias: tendency for people to judge world through narrow view based on own culture - affects reliability as will get diff diagnosis depending on whether psychiatrist understands cultural beliefs
discuss issues associated with classification & diagnosis of schizophrenia AO3
V - symptom overlap > invalid diagnosis of schiz - found when comparing 14 autistic to 14 schiz, 7 autistic showed symptoms of schiz > diagnosis of schiz may not always be valid as person may exhibit symptoms typical of schiz but could have another condition w/same symptom
v - gender bias in diagnosis of schiz - loring and powell (56% of psychiatrists gave diagnosis when description of male patient, 20% when female) > diagnosis not always valid as it is dependent on gender
r - cultural bias can lead to inconsistencies in diagnosis of schiz - Copeland (134US 194brit psychiatrists description of patient, 69% US gave diagnosis, 2% brit) > diagnosis dependent on psychiatrist having accurate understanding of cultural background
diagnosis of schiz leads to labelling Rosenhan - label of schiz can be difficult to remove & affects attitudes towards you (even when invalid diagnosis given, all behaviour interpreted as symptom) >diagnosis of schiz has long, lasting effects on social relationships, work prospects & self-esteem
outline and evaluate biological explanations of schizophrenia AO1
genetic explanations - schiz is hereditary + gene mapping not single schiz gene but polygenic
- gottesman MZ twins 48 v DZ 17
- more similar = more likely
dopamine hypothesis
- hyperdopaminergia = excess levels in subcortical > pos symptoms e.g., excess of dopamine in Broca’s area > auditory hallucinations
- hypodopaminergia = low levels in cerebral cortex > neg symptoms
lower activity in ventral striatum (involved in anticipation of reward)
- jucket found lower levels v healthy control
- loss of motivation = lower activity here
pos symptoms have neural correlates
- temporal gyrus responsible for processing sounds
- patients w/auditory hallucinations = lower activity here v healthy control
outline and evaluate biological explanations of schizophrenia AO3
- MZ twins encounter similar env + crucial assumption underlying twin studies is env of MZ & DZ are same - Joseph (MZ twins encounter more similar envs so experience identity confusion) > differences in concordance reflects env differences
+ dopamine hypothesis - Curren (when non-schiz take amphetamines, experience psychotic symptoms) > increased levels of dopamine don’t correlate w/symptoms
+ neural correlates - vita meta-analysis (patients w/schiz higher reduction in cortical grey matter volume over time) > decreased levels of grey matter contributes to schiz
+ neural - implications for treatment - treatment as prevention used in longitudinal studies (neuroimaging to predict who will develop MHD) - lower levels of activity in VS &/or TG flagged as at risk > biological explanations could benefit society as future researchers may be able to treat at risk patients before psychosis begins
outline and evaluate psychological explanations of schizophrenia AO1
dysfunctional thought processes
- leading to hallucinations: metarepresentation: cog ability to reflect on thoughts & behaviours
- dysfunction >disrupt ability to recognise actions & thoughts being carried out by ourselves (auditory hallucinations)
- leading to delusions: lack of reality testing: schiz fail to test reality of experiences
- e.g., hearing buzzing - tinnitus but coded messages (delusions of grandeur)
family dysfunction: schizophrenogenic mothers - psychodynamic explan for schiz based on patient accounts from childhood
- cold, rejecting, controlling & create family climate characterised by tension & secrecy > persecutory delusions
double bind: contradictory messages from parents e.g., give me a hug + you are too old for a hug > contradicting messages & one invalidates other
- prevents development of internally coherent construction of reality & in long-term manifest as symptoms
outline and evaluate psychological explanations of schizophrenia AO3
+ Stirling - 30 schiz w/control of 18 healthy patients on range of cog tasks (2x as long to name colours) > consistent with friths theory of central control dysfunction, strengthening cog explanations of schiz
- reductionist (cog explan ignore role of genetic & neural factors despite evidence low neurotransmitters caused by cog deficits) > bio & cog factors together produce symptoms of schiz, undermining credibility of psych explans as they are over simplistic in explan
+ read et al (46 studies & concluded 69% of schiz females suffered history of physical and/or sexual abuse in childhood, 59% in men) > traumatic childhood associated w/increased risk of schiz of adulthood, strengthening FD as explan for schiz
- harmful ethical implications (schizophrenogenic mother places blame of schizo parents + adds trauma to parents likely to bear lifelong responsibility for childs care) >FD as explan could prove harmful to society + explain why since 1980s, concept of schizophrenogenic mother declined
outline and evaluate drug therapies for schizophrenia AO1
typical antipsychotics (chlorpromazine) - original dopamine hypothesis > dopamine antagonist
- bind to D2 receptors to prevent too much dopamine absorbed by D2 receptors > normalises neurotransmission in key brain > reducing pos symptoms (hallucinations)
atypical antipsychotic (clozapine) - when other treatments failed as more effective than typical
- binds to dopamine receptors + acts on serotonin & glutamate receptors
- targets other neurotransmitters & treats pos/neg symptoms of schiz > reduces depression & anxiety in patients which 50% schiz do
atypical (risperidone) - binds to both dopamine & serotonin
- binds more strongly to dopamine > more effective in smaller doses + fewer side effects compared
outline and evaluate drug therapies for schizophrenia AO3
+ thornley (13 trials, chlorpromazine better functioning & reduced symptom severity v placebo) > strengthens bio treatments as typical anti-psych help schiz patients minimise symptoms & enhance equality of life
+ atypical anti-psychotics effective - meltzer (clozapine more effective in 30-50% treatment resistant cases where typical anti-psych failed) > atypical anti-psych more effective than typical
- other treatments more clinically successful - anti-psych only reduce symptoms not underlying cause (stop taking med > schiz symptoms reappear > reliant on drug to function normally) > psychological treatments which tackle underlying causes more successful than drug therapies
+ some argue drug treat more effective than psych as more cost-effective (no trained psych) > patients return to work quicker + minimise burden on NHS
outline and evaluate psychological treatments for schizophrenia AO1
CBT - anti-psychotics first to reduce psychotic thoughts so CBT more effective
- structured + time-limited
- early sess: identify beliefs
- persuade distorted thinking/maladaptive thinking cause withdraw from norm activities (> neg symptoms)
- ABCDEF chart (link ABC)
- disputing techniques + behavioural techniques
family therapy: assumes FD contributes to development of schiz
- aim: alter relationships + communication patterns within fams (9-12months, min 10 + 2 family therapists)
involves: getting consent (talk openly + no details)
- learning about disorder (members given relevant info about diagnosis)
- discussing day problems & strategies of how to solve as family)
- strategies for better communication (strategies to support in tolerant way) + effective caregivers
aim: communication, tolerance levels between members, feelings of guilt & responsibility for causing, involve family in rehab
outline and evaluate psychological treatments for schizophrenia AO3
+ (CBT) nice review (patients w/CBTp average 8.26 in hospital v several weeks - better attitudes, motivation & commitment towards recovery) > CBTp effective therapy in treating schiz as reduces hospitalisation, increasing credibility of psych treatments
+ (CBT) Tarrier (schiz 10 weeks of CBT + drug therapy better improvement in pos symptom reduction v just drug therapy) > CBTp reduced pos symptoms & reinforces importance of interactionist
- (CBT) effectiveness depends of stage of schiz - Addington & Addington (initial acute phase of schiz, self-reflection of symptoms not app) - following stabilisation, more likely to benefit > individuals in deeper stages & greater realisation of problems benefit more from CBTp
+ (FT) McFarlane - FT greatly improved relations among members (led to increased well-being for patients & fewer psychotic episodes) > FT helps reduce symptoms & reinforces importance of good comm within family as provide support network during recovery
outline and evaluate token economies for schizophrenia AO1
reward systems (OC) used to manage behaviour who spend long periods in hospitals
- tokens given for desirable behaviours
- immediately after
- no value but swapped (secondary reinforcers as only value once patient has learnt they can be used to obtain rewards)
- token paired w/rewarding stimuli > secondary reinforcer
- patient engages in target behaviour/reduces inappropriate
- given tokens for engaging in target
- trades tokens for access to desirable/privileges
outline and evaluate token economies for schizophrenia AO3
+ Paul & Lentz - token economies led to improvements in self-care & pro-social behaviour (after 4 yrs, 98% released from institution v 71%) > token economies effective in reducing neg symptoms & more successful than alternative programmes in reintegrating patients
+ Allyon & Azrin - sample of female schiz patients hospitalised avg 16 years (rewarded w/tokens for behaviours, avg no daily chores from 5 to 42) > TE effective in improving motivation & sense of responsibility
- ethical issues in use in psychiatric settings - violate basic human rights (severely ill patients less able to comply w/behaviours so experience discrimination towards basic rights) > ethical issues make psychological therapies controversial & cause us to question appropriateness of such treatment
discuss the interactionist approach to explaining & treating schizophrenia AO1
interactionist: acknowledges biological, psychological & societal factors involved in development
diathesis-stress model: underlying (genetic) vulnerability (diathesis) & env trigger (stress) > necessary for onset of schiz
Meehl: diathesis (vulnerability) due to singular ‘schizogene’
- no genetic vulnerability = no amount of stress leads to schiz
- stress (trigger) = neg psychological experience
- chronic stress w/genetic vulnerability > schiz
modern understanding: now believed diathesis not due to single schizogene (many genes)
- diathesis doesn’t have to be genetic (early psychological trauma affecting BD) e.g., child abuse affects HPA system > more vulnerable to stress
discuss the interactionist approach to explaining & treating schizophrenia AO3
+ Tiernari 145 children (1 bio parent w/schiz) adopted & compared w/158 adoptees w/out genetic risk (adopted parents assessed for child-rearing style - high criticism + conflict + low empathy implicated in develop of schiz but only in high genetic risk) > convincing evidence for dual role of diathesis (genes) and stress (hostile child rearing practices) in develop of schiz
- original D-S model too simplistic as suggests diathesis purely biological & stress only psychological (Houston found CSA diathesis & cannabis use a trigger) > old idea of diathesis as biological & stress as psychological turned out overly simple
- Tarrier randomly allocated 315 to medication + CBT or medication + supportive counselling or control (2 combination groups lower symptom levels than control) > interactionist approach best at treating schiz in terms of symptom reduction
