Schizophrenia Flashcards
What are positive symptoms to schizophrenia
Experiences that are in addition to normal experiences
What are examples of positive symptoms
Hallucinations - additional sensory experiences, seeing distortions in objects that look like faces/ hearing critical voices
Delusions - irrational beliefs about themselves or the world. E.g. government are out to get me
What are negative symptoms of schizophrenia?
Loss of normal experiences and abilities
What are some examples of negative symptoms?
Avolition - lack of purposeful, willed behaviour.
Speech poverty - brief verbal communication style. Loss of quality and quantity of verbal responses.
Reliability in the diagnosis of schizophrenia
Inter rater reliability if two observers agree
Test-retest reliability - related reliability if the same doctor is giving the same diagnosis over time with the same symptoms
Validity in the classification of schizophrenia
Validity question if a person has the disorder when diagnosed or if it’s a real disorder with clear unique symptoms
What did beck (1963) find?
153 patients, diagnosed by multiple doctors
54% concordance rate between doctors
Suggests low inter rater reliability and many diagnosed incorrectly (low validity)
What is co morbidity?
Often diagnosed with other disorders
Lead to inaccurate diagnosis of schizophrenia
What is symptom overlap?
Bipolar disorder also has hallucinations and delusions as a symptom
May not be distinct should be redefined
What did Buckley (2009) find
Co morbidity rates with schizophrenia
Depression 50%, drug abuse 47%, PTSD 29%, OCD 23%
Gender bias in diagnosis?
Cotton argues womens experiences are taken less seriously and underdiagnosed
Due to womens coping strategies leading to being less likely to seek treatment
Culture bias in schizophrenia diagnosis
People with Afro-Caribbean heritage 9x more likely to be diagnosed
Fernando argues this is due to category failure:
Western definitions are applied to non western cultures
What did Loring and Powell find?
Sent 290 psychiatrists two identical case studies (altering ethnicity and gender)
Found overdiagnosis in black client and under diagnosis of female client
Most accurate diagnosis when gender and race of the psychiatrists were the same
Suggests existence of gender/culture bias in diagnosis
What is the genetic explanation of schizophrenia?
Genes code for biological processes, including variation in brain structure and biochemistry
Polygenic disorder - multiple gene locations associated with schizophrenia
Concordance rates and schizophrenia?
Higher in families than in general population (1%)
Closer related the family member, higher the concordance for schizophrenia
Due to increased genetic similarity
What are neural correlates?
Variation in neural and biochemistry
Correlated with an increased risk of developing schizophrenia
What is the dopamine hypothesis
Symptoms are due to imbalance of the dopamine neurotransmitter across the brain
Excessive amounts of dopamine (hyperdopaminergia) in speech centres may lead to auditory hallucinations.
Lower levels (hypodopaminergia) in areas like the frontal cortex are linked to negative symptoms
What is glutamate?
Excitatory neurotransmitter involved in learning, attention and memory found in low quantities for people with schizophrenia
What are enlarged vesicles?
Voids in the brain filled with cerebrospinal fluid have been correlated with schizophrenia
What was gottesman (1991)
Concordance rate 48% for identical twins
17% for non identical twins
Suggests genetic factor however not 100% for MZ so must be a role for environmental factors
Tienari (2004)
Studied biological children of schizophrenic mothers who had been adopted
5.8% of children adopted got schizophrenia compared to 36.8% raised in dysfunctional families.
Higher figure in dysfunctional families suggest psychological trigger is a factor
What did leucht find?
Meta analysis 212 studies
Drug treatment normalising dopamine levels more effective than placebo
Supports dopamine hypothesis
How might biological approach make victims feel sad?
Claiming schizophrenia is biologicall determined may make sufferers feel disempowered when diagnosed.
Soft determinist perspective suggests clients can reconstruct the irrational mental processes, empowering sufferers
How does parsimony affect schizophrenia?
Explains schizophrenic at a basic cellular and chemical level. Led to highly effective drug therapies.
Fails to consider the evidence for psychological causes of schizophrenia
How is the diathesis stress model better?
More valid, suggests the root cause is genetic weakness (diathesis). However, an environmental stressor must be present to trigger the disorder
What is family dysfunction?
Schizophrenia symptoms are due to interpersonal relationships within the family
What is schizophrenpgenic mother theory?
Paranoid delusions result from the influence of a cold, rejecting and controlling mother and a passive father.
Atmosphere of stress and secrecy triggers psychotic thinking
What is double bind theory?
Due to mixed messages, feels unable to do the correct thing. Disorganised thinking and paranoia.
What is expressed emotion?
Verbal interactions exaggerated involvement, indicating the sufferer is a burden via self sacrifice
What does criticism, control and hostility lead to?
Rejection
Cognitive explanations?
Ability to process thoughts is dysfunctional. Firths (1979) attention deficit theory.
Faulty attention system, cannot filter preconscious thought, gives too much significance to normally filtered information, overloads mind.
Accounts for positive symptoms
Delusions of control
A fault in meta representation, ability to recognise thoughts and actions as your own
Butzlaff and hooley (1988)
Meta analysis, 27 studies
Relapse into schizophrenia is more likely in families with issues in expressed emotion
Tienari (2004)?
5.8% of biological children of schizophrenic mothers adopted into psychologically healthy families
36.8% in dysfunctional families
How are psychological explanations Socially sensitive?
Induces stress and anxiety into families
Research evidence that genetics and neutrotransmitters cause schizophrenia
Stirling (2006)
Patients with schizophrenia took twice as long to name the colour in the stroop test
Suggests dysfunctional thought processing with faulty central control.
How is psychological evidence correlational?
Could be that having a schizophrenic child causes family dysfunction
What are antipsychotics?
Medication used to control the symptoms of psychosis e.g. delusions and hallucinations
What are typical antipsychotics?
Drug therapy that treats positive symptoms and has many side effects.
E.g. chlorpromazine, dopamine antagonists, reduce dopamine activity by blocking receptors. Side effects include dry mouth, constipation, lethargy, confusion, tardive dyskinesia
What are atypical antipsychotics?
Clozapine. Avoids more severe side effects. Blocks dopamine receptors but also acts on acetylcholine, glutamine, serotonin. Also treats negative symptoms like avolition. Side effects include weight gain and cardiovascular problems.
Bagnall (2003)
Reviewed 232 studies comparing atypical and typical antipsychotics.
Atypical more effective than typical in treating overall symptoms
Fewer movement disorder symptoms. Clozapine most effective drug.
Positive of drug therapies
Cheap, compared to hospital treatment and therapy
Tarrier (1988)
Placed patients randomly in routine care, CBT, or combined treatment
Patients in combined improved severity and number of positive symptoms as fewer days in hospital receiving care.
Suggests drug therapies are effective but better when combined
Negative of drug therapies
May only suppress symptoms and not treat underlying problems, may be cognitive
Cognitive behaviour therapy and schizophrenia?
Assumes schizophrenia results from dysfunctional thought processes
ABC (DE) model by Ellis?
Change irrational beliefs by disputing (D) delusions them restructuring those beliefs into alternatives (E).
What is reality testing?
Patient can demonstrate that their irrational thoughts are not real.
What is family therapy?
Improve the home situation of a schizophrenic person
Family dysfunction can increase the risk of relapse into schizophrenia
Intended to change the families behaviour.
Family is educated on symptoms
Develops techniques to reduce conflict, stress and self sacrifice, improved communication and problem solving
What are token economies?
Designed to make behaviour more manageable within a hospital or prepare long-stay patients for transfer into the community
Based on operant conditioning, tokens are used as positive reinforcements.
Patients rewarded when showing a pre defined target behaviour (such as washing). Tokens are exchanged for something else they want. Behaviour is progressively changed.
Sensky (2000)
Patients who resisted drug treatment had reduction in symptoms when treated with 19 sessions of CBT. Continued to improve after CBT ended.
Positive of CBT?
No side effects
Negatives of CBT?
Drug therapy is cheaper
Dropping out is common, symptoms may become severe. Negative symptoms can lead to unwillingness to participate, positive can lead to distrust.
Leff (1985)
Reviewed aftercare of patients with schizophrenia
50% relapsed within 9 months
8% with family therapy
After two years it was 50% with family therapy and 75% with standard care
Negatives of family therapy
Not a cure to the disorder as symptoms remain however it does improve them
Problematic practical issues such as the length. Patients may drop out if they have family incidents or severe symptoms
Dickerson (2006)
Reviewed 13 studies
Token economies can effectively improve adaptive behaviour of people with schizophrenia
Negative of token economies
Do not directly treat symptoms
Only manage negative symptoms
Degrading to patients, manipulating them (ethics)
What is the interactionist approach?
Suggests development is due to combine effects of biological and psychological
What is the diathesis stress model?
Diathesis - genetic vulnerability resulting in dopamine imbalance
Stress - negative environmental experiences such as family dysfunction, emotional stress/anxiety or a major adverse life event.
Emotional event triggers the disorder
Importance of an interactionist approach?
Both biological and psychological aspects to schizophrenia development
Combine treatments such as CBT and drug therapy
Biological treatments reduce symptoms allowing them to engage in CBT.
Negative of interactionist approach
Uncertain as how an adverse event triggers a biological response. Reduces confidence in the approach as a full explanation
Interactionist approach for treatment negative
Same limitation as both treatment options
Expensive for CBT and side effects for drug treatment
