Schizophrenia

Question 1

Define schizophrenia

Answer 1

A type of psychosis characterized by severely impaired emotions, cognition and behaviour.

Question 2

Define the classification of mental disorders

Answer 2

The process of organising symptoms into categories based on which symptoms frequently cluster together.

Question 3

State the two major systems for the classification of mental disorders

Answer 3

ICD-10 AND DSM-5

Question 4

State the criteria for DSM-5

Answer 4

For a diagnosis, symptoms must be present for 6 months, with one positive symptom.

Question 5

State the criteria for ICD-10

Answer 5

For a diagnosis, symptoms must be present for 1 month, with 2 or more negative symptoms.

Question 6

Define positive symptoms

Answer 6

Symptoms that enhance the typical experience of sufferers, and occur in addition to their usual behaviour.

This includes hallucinations (auditory & visual) and delusions

Question 7

Define negative symptoms

Answer 7

Symptoms that take away from the typical experience of sufferers, and so represent a loss of usual abilities and behaviour.

This includes speech poverty and avolition.

Question 8

Define delusions

Answer 8

Also known as paranoia, delusions are distorted and irrational beliefs, with no basis in reality at all.
The most prevalent forms in Sz are delusions of grandeur, persecutory and physicality,

Question 9

Define delusion of grandeur

Answer 9

Involves the Sz person believing that they have a higher power, importance or significance. (For example, the belief that they are Jesus or Einstein).

Question 10

Explain persecutory delusions

Answer 10

Involve the Sz person having an all-consuming belief that they’re under threat (maybe by the government), being stalked for example or that someone is out to harm them.

This is likely to install a great sense of fear within them, hence the paranoia.

Question 11

Define physical delusions

Answer 11

Delusions that manifest themselves within the body in which the person may believe that their body is under the control of someone or something else.

This causes them to act in a way that may seem bizarre to others, but makes sense to them.

Question 12

Explain hallucinations

Answer 12

These are unusual sensory experiences, meaning that a Sz person could hear (auditory) or see (visual) things that aren’t there, but they can be experienced in relation to any sense.

Sometimes hallucinations are directly related to what the Sz person picks up from the environment around them, such as overhearing someone critising another person. But sometimes this isn’t the case, such as when a Sz hears voices inside their head when they’re alone.

Hallucinations may also take the form of distortions, such as seeing a distorted face in the mirror.

Question 13

Explain speech poverty

Answer 13

Also known as alogia and represents a reduction in the quality and amount of speech. This means that they’ll speak infrequently, not fluently and incoherently.

Some features also include giving one-word answers and a delay in verbal responses.

Question 14

Define avolition

Answer 14

The complete lack of motivation to engage with goal-oriented behaviour. Andreason categorised it into 3 areas: poor hygiene & grooming, lack of persistence in work and education and lack of energy.

Question 15

Define disorganised speech

Answer 15

Mixed-up thought processes affect a patient’s speech resulting in muddled sentences where they often mix up topics in a sentence, so it doesn’t make sense.

Question 16

Define inter-rater reliability

Answer 16

Whether different clinicians uses different classification systems with the same patient and it gives the same diagnosis.

Question 17

Define test-retest reliability

Answer 17

Whether the same clinician uses the same classification system with the same patient, at 2 different time periods, and it gives the same diagnosis.

Question 18

Define reliability in terms of the classification and diagnosis of schizophrenia

Answer 18

Refers to how consistently schizophrenia is diagnosed.

Question 19

Explain why co-morbidity may be an issue in the validity of the diagnosis and classification of Sz (AO3)

(Refer to Buckley)

Answer 19

POINT - Co-morbidity refers to when 2 or more conditions occur together. If conditions are occurring together, it’s possible that they’re actually a single condition. Schizophrenia is commonly diagnosed with other mental health disorders.

EVIDENCE - For example, in one review, Buckley et al found that 50% of Sz patients also have depression, 47% have a co-morbidity with substance abuse and for OCD, 23%.

ELABORATE - This poses a challenge for diagnosis bc it could be that psychiatrists are bad at differentiating between conditions. As for classification, it may be that if severe depression looks a lot like Sz and vice versa, they may be better seen as a single condition.

LINK - Therefore, this confusing picture affects descriptive validity as it makes it harder to diagnose accurately.

Question 20

Define validity in terms of the classification and diagnosis of schizophrenia.

Answer 20

Refers to how accurately schizophrenia is diagnosed.

Question 21

Define predictive validity

Answer 21

To be valid, diagnosis should lead to effective treatment and we should be able to predict the prognosis (likely cause) of the disorder.

Question 22

Define descriptive validity

Answer 22

To be valid, patients with schizophrenia should differ in symptoms from patients with other disorders.

Question 23

State the 3 biological explanations for schizophrenia

Answer 23

• genetics
• neural abnormalities
• abnormalities in dopamine

Question 24

Outline family studies as a genetic explanation of schizophrenia
(Refer to Gottesman)

Answer 24

In Grottesman’s study he found that childrden with two Sz parents had a concordance rate of 46%, children with one Sz parent a rate 13%, and siblings (where a brother or sister had Sz) a concordance rate of 9%.

This established that Sz is more common among biological relatives of a person with Sz, and that the closer the degree of genetic relatedness, the greater the risk.

Question 25

Outline twin studies as a genetic explanation of schizophrenia
(Refer to Grottesman)

Answer 25

In Grottesman’s study he found that Mz twins have a 48% risk of getting Sz whereas DZ twins have a 27% risk rate.

This research shows that individuals with identical genetic makeup have an increased risk of developing Sz. Further highlighting the significance of genetics.

Question 26

Explain what is meant by neural correlates

Answer 26

A biological explanation of schizophrenia that seeks to find regions in the brain that are active during cognitive and behavioural experiences of a Sz person.

Correlations are then looked at among the brain structures of people with schizophrenia.

The best-known neural correlate of Sz is the neurotransmitter dopamine.

Question 27

Outline research into the original dopamine hypothesis

Answer 27

This was based on the discovery that antipsychotics ,which reduce the amount of dopamine (DA) in the brain, causes similar symptoms to those with Parkinson’s disease, a conditioned associated with low DA levels.

Therefore, it was assumed that Sz might be the result of high levels of DA (hyperdopaminergia) in the subcortical areas of the brain. For example, an excess of DA receptors from the subcortex to Broca’s area may explain positive symptoms of Sz, such as speech poverty and/or hallucinations.

Question 28

Outline research into the updated dopamine hypothesis

Answer 28

Psychologists have identified a new role for levels of dopamine in associated with the symptoms of Sz. They proposed the addition of abnormally low level of DA, in the prefrontal cortex, could explain the negative symptoms of Sz. It’s also been suggested that cortical hypodopaminergia leads to subcortical hyperdopaminergia.

Question 29

Explain how there is evidence to suggest low inter-rater reliability in the diagnosis of Sz

Answer 29

POINT - Reliability can be measured by inter-rater reliability. This defines as whether different clinicians uses different classification systems with the same patient and it gives the same diagnosis.

EVIDENCE - Two psychiatrists independently diagnosed 100 patients using both DSM AND ICD criteria. Inter-rater reliability was poor, with one psychiatrist diagnosis 26 with Sz according to DSM and 44 according to IDC, and the other diagnosing 13 according to DSM and 24 according to ICD.

ELABORATE - This clearly shows that the criteria isn’t “one size fits all”, if it’s producing different results for the same person. Perhaps there needs to be a revaluation as to which classification system is better suited.

LINK - Therefore, this poor reliability weakens the diagnosis of Sz.

Question 30

Define CBT

Answer 30

A psychological treatment aiming to help individuals manage their thoughts, feelings and physical sensations. It helps patients to identify irrational thoughts and try to change them.

Question 31

Define token economy

Answer 31

A form of behavioural therapy where desirable behaviours are encouraged by the use of selective reinforcement and is based on operant conditioning, as proposed by the behaviourist Skinner.

Question 32

Describe how token economies is used to manage Sz

Answer 32

• When desired behaviour is displayed e.g. self-care and taking meds, tokens (in the form of coloured discs) are given as secondary reinforcers which can be exchanged for primary reinforces. For example, rewards such as sweets and cigarettes.
• Therefore, patients are motivated by the primary reinforcer to carry out the desirable behaviours, and their frequency of doing so increases as they are positively reinforced.
• The token must be given immediately and repeatedly to be associated with the reinforcing stimulus.

Question 33

State the aim of token economies

Answer 33

It aims to manage and resolve maladaptive behaviours, developed in patients who have been institutionalised for long periods, rather than treat Sz.

Question 34

State the three categories of institutional behaviour commonly tackled by means of token economies

Answer 34

• Personal care
• Conditioned-related behaviours (e.g. apathy)
• Social behaviour

Question 35

State the two major benefits of modifying institutional behaviour

Answer 35

1) Improves the persons quality of life within the hospital setting

2) ‘Normalises’ behaviour to make it easier for them to adapt back into life in the community

Question 36

Explain a strength of the dopamine hypothesis

Answer 36

POINT - There is support from a number of sources for abnormal dopamine functioning in Sz.

EVIDENCE - Firstly, a systemic review (Curran et al) found that amphetamines, that increase DA levels, worsen symptoms in people with Sz and induce them in people without. Secondly (Tauscher et al) found that antipsychotic drugs reduce DA activity and the intensity of symptoms.

EXPLAIN -

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