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Schizophrenia Flashcards

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1
Q

What is the diagnosis and classification of schizophrenia

A

-ICD 10: two or more negative symptoms must be present
-DSM 5: one positive symptom must be present
-Both editions have dropped subtypes as they tended to be inconsistent

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2
Q

Name the positive symptoms of schizophrenia

A

-Hallucinations
-Delusions

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3
Q

Name the negative symptoms of schizophrenia

A

-Speech poverty
-Avolition

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4
Q

What are hallucinations

A

-A positive symptom of schizophrenia
-They are sensory experiences that have either no basis in reality or are distorted perceptions of things that are there

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5
Q

What are delusions

A

-Positive symptom
-They involve beliefs that have no basis in reality for example a person believes that they are someone else or are a victim of a conspiracy

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6
Q

What is speech poverty

A

-Negative symptom
-Involves reduced freyquency and quality of speech

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7
Q

What is avolition

A

-Negative symptom
-Involves loss of motivation to carry out tasks and results in lowered activity levels

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8
Q

What is co-morbidity

A

-The occurrence of two disorders or conditions together eg person has both schizophrenia and a personality disorder
-Where two conditions meet frequently in diagnosis the validity of categorising the disorders separately is questioned

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9
Q

What is co-morbidity

A

-The occurrence of two disorders or conditions together eg person has both schizophrenia and a personality disorder
-Where two conditions meet frequently in diagnosis the validity of categorising the disorders separately is questioned

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10
Q

What is symptom overlap

A

-Two or more conditions share symptoms
-When conditions share many symptoms the validity of categorising the disorders separately is questioned

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11
Q

Evaluate the issues in diagnosis and classification of schizophrenia

A

-Good reliability: Osorio et al found a inter rarer reliability with 180 individuals of .97 and a test retest of .92
-Low validity: diagnosis of ICD 68 whilst only 39 under DSM suggests a limited criterion validity
-Co morbidity low as half those diagnosed with schizophrenia also had depression or substance abuses questioning that if schizophrenia is a distinct condition
-Men diagnosed more with schizophrenia on a ratio of 1.4:1 meaning women may not be receiving much needed treatment
-Cultural bias: afro caribbean people 9 times more likely to receive a diagnosis then white british people
-Symptom overlap with bipolar disorder

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12
Q

Name the different theories on schizophrenia caused by family dysfunction

A

-Schizophrenic mother
-Double bind theory
-Expressed emotion

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13
Q

What is the schizophrenogenic mother

A

-Propsed by Fromm Reichmann 1948
-Psychodynamic explanation
-A cold rejecting controlling mother creates a family environment of tension and secrecy
-This leads to mistrust causing paranoid delusions and schizophrenia

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14
Q

What is the double bind theory

A

-Bateson et al
-Developing child finds themselves trapped no wanting to do the wrong thing but does not know what this is through mixed messages as they cannot seek clarification
-Child is often punished by withdrawal of love
-Leads them confused and viewing the world as dangerous causing schizophrenia

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15
Q

What is expressed emotion

A

-Verbal criticism of the person accompanied occasionally by violence
-Hostility towards the person anger and aggression
-Emotional over involvement mainly needless self sacrifice
-These factors cause stress which causes people to relapse with schizophrenia

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16
Q

Name the two cognitive explanations of schizophrenia

A

-Metarepresentation dysfunction
-Central control dysfunction

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17
Q

What is metarepresentation dysfunction

A

-metrepresentation is the ability to reflect our own thoughts and behaviour
-When it becomes dysfunction we fail recognise these thoughts as our own and think they are someone else’s
-This explains hallucinations and delusions

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18
Q

What is central control dysfunction

A

-Central control is the ability to suppress automatic thoughts
-Dysfunction means that a patient cannot suppress all of the thoughts that trigger when hearing a word
-This leads to disorganised thoughts and speech

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19
Q

Evaluate family dysfunction as an explanation for schizophrenia

A

-Research support: read et al found that adults with schizophrenia are more likely to have an insecure attachment type and more likely to have a history of physical and sexual abuse
-Explanations lack support for schizophrogenic mother and double bind as they are based off clinical observations of people with schizophrenia and informal assessments with no lab based systematic evidence
-Parent blaming is damaging as it causes damage to mothers being shunned for their child’s schizophrenia causing damaging real world application COUNTERPOINT: useful in the development of family therapy as a treatment

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20
Q

Evaluate the cognitive explanations of schizophrenia

A

-Genetic factors of schizophrenia are not explored and undervalued
-Only a proximal explanation as it does not focus on what caused the symptoms in the first place
-Research support as stirling et al found participants with schizophrenia took twice as long completing a colour stroop test

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21
Q

What did gottesman find relating to the genetic risk of developing schizophrenia

A

-Identical twins 48% chance of developing
-Sibling 9% of developing SZ
-Aunt 2%
-General populations 1%

22
Q

What are the candidate genes relating to schizophrenia

A

-SZ is polygenic
-most likely genes involved is coding for neutransmitters including dopamine
-Ripke found that 108 genetic variations were associated with risk of schizophrenia
-schizophrenia is aetiologically heterogeneous (different combinations of genes)

23
Q

What is the role of mutations in schizophrenia

A

-schizophrenia can have a genetic origin in the absence of family history through gene mutation
-Brown found that risk of schizophrenia increased from 0.7% in fathers under 25 to 2% in fathers over 50

24
Q

What are neural correlates

A

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

25
Q

What is the role of ventricles in schizophrenia

A

People with schizophrenia have abnormally large ventricles which are fluid filled cavities. This means the brains of schizophrenics are lighter than usual

26
Q

What is dopamine

A

-Neurotransmitter that generally has an excitatory effect and is linked to the sensation of pleasure
-Unusally high levels are associated with schizophrenia and low levels are associated with parkinson’s disease

27
Q

What do neurotransmitters do

A

act on receptor sites at synapses causing next neutron to either fire (excitatory) or not fire (inhibitory)

28
Q

What is the dopamine hypothesis

A

-Positive symptoms of schizophrenia may be result of high levels of dopamine receptors in subcortical areas of the brain
-Excess of dopamine receptors in broca’s area may explain auditory hallucinations and disorganised speech
-Updated dopamine hypothesis states that negative symptoms of schizophrenia can be explained through too little dopamine
-Too little dopamine in the prefrontal cortex could lead to disorganised thinking and avolition

29
Q

Evaluate the genetic basis of schizophrenia

A

-Identical twins not showing a 100% concordance rate in gottesmanns study shows that enviromental factors must play a factor in developing schizophrenia
-Useful in development of genetic counselling as counsellors can priotise those with a genetic vulnerability to schizophrenia to get the help they need

30
Q

Evaluate the dopamine hypothesis

A

-One limitation is that dopamine hypothesis is biologically reductionist meaning that it ignores the role of outside factors which is an issue as Gottesmann did not find a 100% concordance rate in MZ twins
-Useful on the development of drug related therapy
-Post mortems and live scanning studies have found the neurotransmitter glutamate to be raised in people with schizophrenia suggesting a strong case for other neurotransmitters (McCutcheon)

31
Q

What are antipsychotics

A

-Drugs to reduce the intensity of symptoms in particular the positive symptoms of psychotic disorders like schizophrenia
-Can be typical or atypical

32
Q

What are typical antipsychotics

A

-first generation of antipsychotics made in the 1950s
-Chlorpromazine: taken orally up to 1000mg daily with amount prescribed decreasing over last 50 years
-Works as a dopamine antagonist: blocks dopamine receptors in the brain reducing positive symptoms
-Has a sedative effect

33
Q

name the two atypical antipsychotics

A

-Clozapine
-Risperidone

34
Q

What is clozapine

A

-Created 1960s
-Taken orally up to 450mg daily
-Patients have to be monitored for agranulocytosis which is a potentially fatal blood condition
-Works as a dopamine antagonist
-Effects seratonin and glutamate receptors leading to better treatment of negative symptoms

35
Q

What is risperidone

A

-Developed 1990s
-Clozapine without fatal side effects
-dosage 8mg to 12mg daily
-Works as a dopamine antagonist with fewer side effects

36
Q

Evaluate drug therapy as a biological treatment to schizophrenia

A

-Research support as thornley et al in a trial of 1121 participants chlorpromazine was associated with better functioning and reduced symptom severity compared to placebo COUNTERPOINT: study only studied the short term effects and because of the sedative effect this may have not reduced schizophrenia merely sedated them
-Serious side effects including dizziness agitation sleepiness and weight gain with the potential of causing neuroleptic malignant syndrome which is caused by the blocking of dopamine functioning in the hypothalamus potentially causing a fatal coma
-Limited understanding of why they work as dopamine hypothesis is not a complete explanation as dopamine levels in the brain are too low in some areas so in theory antipsychotics should not work therefore they may not be the best treatment

37
Q

What is cognitive behavioural therapy (CBT)

A

-a method for treating mental disorders based on both cognitive and behavioural techniques
-From cognitive viewpoint the therapy aims to deal with thinking such as challenging negative thoughts
-Also includes behavioural techniques
-Takes place over 5 to 20 sessions in groups or by individual

38
Q

How does cognitive therapy help schizophrenia

A

-Therapist helps client make sense of symptoms eg understand the origins of voices
-Normalisation to challenge anxiety and reality testing to challenge delusions

39
Q

Outline a case example of CBT

A

-Turkington et al describe an example of CBT used to challenge where are paranoid clients delusions come from by asking the client how they know the mafia are trying to kill the client

40
Q

Evaluate CBT

A

-CBT does not offer clients an actual cure for their condition only ways to manage the symptoms of schizophrenia by teaching coping strategies which matters because schizophrenia is very biological (grossman)
-Schizophrenia is a varied illness with different patients with different symptoms in addition CBT may not work for people with very severe schizophrenia or learning disabilities
-Supporting evidence as Jauhar et al reviewing 34 studies using CBT found a small but significant reduction of positive and negative symptoms

41
Q

What is family therapy

A

-Psychological therapy carried out with all of some members of the family with the aim of improving the communications within the family and reducing the stress of living as a family
-Lasts 3 to 12 months with a minimum of 10 sessions

42
Q

What are the strategies of family therapy

A

-Forming a therapeutic alliance with all family members
-Reducing the stress of caring for a relative with schizophrenia
-Improving the ability of the family to anticipate and solve problems
-Reduction in negative emotions (anger and guilt expressed emotion)
-Helps family achieve a balance of caring for family member and own life
-Improving family’s beliefs and behaviour towards person with schizophrenia

43
Q

Evaluate family therapy

A

-Economic benefits in reducing the relapse rates reducing strain on the NHS
-However family therapy is not effective once the client has relapsed only before

44
Q

What are token economies

A

-Useful at preventing institutionalisation where people develop bad habits and cannot reintegrate into society relating to personal care, condition related behaviour (apathy towards treatment) and social behaviour
-Tokens are secondary reinforcers, rewards are primary reinforcers
-reinforcing a behaviour means it is more likely to be repeated

45
Q

Evaluate token economies

A

-Only provide short term benefits as once the patient goes out of institutions the rewards stop
-Behaviour effective at tackling negative symptoms such as removing a lack of motivation and antisocial behaviour COUNTERPOINT: less effective at positive symptoms such as delusions and hallucinations
-Token economies give away freedoms and give them back as a reward such as free will so significant ethical concerns

46
Q

What is the interactionist approach

A

-An approach acknowledging there are biological psychological and social factors in developing schizophrenia
-Biological factors include genetic vulnerability and neurological abnormality
-Psychological factors include stress resulting from life events
-Social factors include poor quality interactions in the family

47
Q

What is the interactionist approach

A

-An approach acknowledging there are biological psychological and social factors in developing schizophrenia
-Biological factors include genetic vulnerability and neurological abnormality
-Psychological factors include stress resulting from life events
-Social factors include poor quality interactions in the family

48
Q

What is the diathesis stress model

A

-Interactionist approach to explaining behaviour
-Schizophrenia explained as a result of both an underlying vulnerability (diathesis) and a trigger (stressor) both necessary for the onset of schizophrenia
-Early versions by Meehl 1962 the diathesis stress model vulnerability was genetic eg schizotypic personality and trigger were psychological eg schizophrogenic mother
Nowadays genes and trauma seen as diathesis and stress can be psychological or biological in nature

49
Q

What are treatments according to the interactionist model

A

-Combine antipsychotic drugs and CBT
-Can believe in a biological cause of schizophrenia but use CBT in combining the role of psychological factors
-Combination of antipsychotic drugs and CBT most used in UK and US

50
Q

Evaluate the interactionist approach to schizophrenia

A

-Tienari et al studies 19000 finnish children whose bio mother had been diagnosed with schizophrenia compared to a control group finding that adoptive parents with high levels of criticism hostility associated with schizophrenia but only in genetic risk group
-Original diathesis stress model is over simplistic as the role of the schizophrogenic is hopelessly simplistic as factors can be biological and psychological
-Real world application in the combination of drug taddiction and atm nets and CBT with tarried finding medication plus CBT saw most reduction in symptoms

psychology (12 decks)

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