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Psych Paper 3 > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Schizophrenia

A

A psychosis - losing touch with/having a distortion of reality

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2
Q

What’s the incidence rate of sz across the world?

A

1:100 or 1%, and Fischer & Buchanan (2017) found that the ratio of men diagnosed with sz to women diagnosed with sz is 1.4:1

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3
Q

Positive Symptoms

A

Behavioural excesses that are rare in normal everyday life (e.g. hallucinations, delusions, disorganised behaviours/speech), generally respond well to drug treatment

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4
Q

Negative Symptoms

A

Behavioural deficits (the loss of behaviours that non-sz exhibit), can cause long-term consequences and are harder to treat as they’re less responsive to drug treatment

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5
Q

Hallucinations

A

A sense of perception not caused by an external stimulus: auditory, visual, olfactory, tactile, gustatory

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6
Q

Delusions

A

A false belief that is experienced without any evidence to support it - is usually very absurd & can’t be overcome by reason (e.g. persecution, grandeur)

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7
Q

Delusions of persecution

A

False belief that others are plotting against/trying to harm them

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8
Q

Delusions of grandeur

A

False belief that one has a power or is a famous person

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9
Q

Disorganised speech and/or thoughts

A

Problems with the organisation of speech and ideas, linked to ‘thought disturbances’ where an individual may appear incoherent

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10
Q

Disorganised behaviour

A

Unpredictable behaviour, either overly excited (catatonic excitement) or immobility (catatonic stuport)

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11
Q

Avolition

A

General loss of energy resulting in: lack of goal-motivated behaviour, inability to make decisions, reduced motivation, poor hygiene, social withdrawl

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12
Q

Speech poverty

A

Excessively brief replies with minimal elaboration, often with delayed responses

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13
Q

Flat affect

A

Absense of emotion and appearing lifeless, including staring vacantly and not making eye contact & speak in a flat tone

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14
Q

Whats are the 2 main classification systems used to diagnose mental illness?

A

DSM-5 & ICD-11

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15
Q

DSM-5 classification of sz

A
  • Have to have at least 2 of: delusions, hallucinations, disorganised speech, disorganised behaviour & negative symptoms - one of which must be delusions, hallucinations or disorganised speech
  • The level of functioning in everyday life has decreased significantly
  • Continuous signs of disturbance for at least 6 months, which must include 1 month of symptoms
  • Other disorders and substance abuse must be rules out
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16
Q

Test-Retest Reliability

A

Where the same clinician makes the same diagnosis on separate occasions based on the same info

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17
Q

Inter-Rater Reliability

A

Where different clinicians make the same diagnosis on the same patient

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18
Q

Reliability - Osario et al. (2019)

A

Used the DSM-5 to assess the reliability of the diagnosis of sz in 180 pps, pairs of interviewers achieved inter-rater reliability of +0.97, and test-retest reliability of +0.92, suggesting reliability of the diagnosis is very high.

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19
Q

Validity

A

The accuracy of the diagnosis

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20
Q

Reliability (according to validity)

A

A valid diagnosis must be first reliable to be valid, but this doesn’t always guarrantee validity.

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21
Q

Descriptive Validity

A

To be valid, symptoms of sz patients should be different than the symptoms of those with other disorders

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22
Q

Criterion Validity

A

To be valid, different assessment systems (e.g. DSM-5 & ICD-10) must reach the same diagnosis for the same patient

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23
Q

Validity - Cheniaux et al. (2009)

A

Had 2 psychologists assess the same 100 patients using the ICD-10 & DSM-IV. Using the ICD-10, 68 pp were diagnosed, while with the DSM-IV, only 39 were diagnosed

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24
Q

Co-morbidity

A

Refers to the presence of one or more additional disorders occurring simultaneously with schizophrenia

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25
Q

Co-morbidity - Reliability

A

The more co-morbid disorders an individual is diagnosed with, the less valid/reliable those diagnoses are

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26
Q

Co-morbidity - Validity

A

Patients may be diagnosed with the wrong disorder and receive incorrect treatment where degeneration can occur.

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27
Q

Co-morbidity - Buckley et al. (2009)

A

Reported that:
50% of sz had co-morbid depression,
47% had co-morbid substance abuse,
29% had co-morbid PTSD,
23% had co-morbid OCD,
15% had co-morbid panic disorder

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28
Q

Culture Bias

A

Tendency to over/under diagnose schizophrenia in certain cultural/ethnic groups

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29
Q

Culture Bias - Reliability

A

The same practitioner may diagnose 2 individuals with the same symptoms differently based on their cultural background

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30
Q

Culture Bias - Validity

A

Some individuals may be diagnosed incorrectly based on their cultural background rather than their symptoms

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31
Q

Culture Bias - Cochrane (1977)

A

Found that the incidence of sz in the West Indies and Britain is similar (~1%) but that people of Afro-Caribbean origin were 7x more likely to be diagnosed with sz when living in Britain. INVALID diagnoses of sz were made due to cultural bias due to ethnic stereotypes

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32
Q

Cultural Bias - Copeland et al. (1971)

A

Gave a description of the patient to 134 US & 194 British psychiatrists.
69% of US were diagnosed
BUT only 2% of British were diagnosed

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33
Q

Cultural Bias - Occurence

A

Escobar (2012) suggests that (overwhelmingly white) psychiatrists may tend to over-interpret symptoms and distrust the honesty of black people during diagnosis

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34
Q

Cultural Bias - other reasons

A
  • Cochrane & Sashidharan (1995) argued racism and social deprivation immigrants tend to suffer more stress & therefore may influence the development of sz.
  • Cochrane (1983) suggests the reason Afro-Caribbean people are the only immigrants to be more likely to be diagnosed with sz due to their little immunity to the flu
35
Q

Gender Bias

A

The tendency to over/under diagnose sz in one gender/sex (men are more likely to be diagnosed

36
Q

Gender Bias - Reliability

A

The same practitioner may diagnose 2 individuals with the same symptoms differently based on gender

37
Q

Gender Bias - Validity

A

Some people may be diagnosed incorrectly based on their gender rather than symptoms

38
Q

Gender Bias - Cotton et al. (2009)

A

Suggests that female patients tend to function/cope better than men, causing psychiatrists to make more diagnoses in men as their symptoms are more visual.

39
Q

Gender Bias - other reason?

A

Men may be more genetically vulnerable to developing sz

40
Q

Symptom Overlap

A

Where symptoms of sz are the same as the symptoms of other disorders/mental illnesses

41
Q

Symptom Overlap - Reliability

A

Where different practitioners may diagnose the same individual with different disorders OR where the same practitioner diagnoses differently on different occasions

42
Q

Symptom Overlap - Validity

A

Some individuals may be diagnosed incorrectly with the wrong disorder

43
Q

Symptom Overlap - Ophoff et al. (2011)

A

Assessed genetic material from 50,000 pps and found 7 gene locations on the genome associated with sz. 3 were also associated with bipolar disorder, suggesting a genetic overlap.

44
Q

Genetics

A

Sz may be (at least) partially inherited - contemporary views suggesting genetics explain at least 50% of the cause of sz.
-Unlikely there’s only one gene, polygenic!

45
Q

Genetics - Twin Studies

A

As MZ twins share 100% of their genes & DZ twins share 50%, if sz was genetic, the concordance rate for MZ twins would be greater than for DZ twins

46
Q

Genetics - Family Studies

A

Found that sz is more common among biological relatives of an individual with sz

47
Q

Genetics - Family Studies: GOTTESMAN (1991)

A

Found CC rates of:
- Child w/ 2 sz parents was 46%
- Child w/ 1 sz parent was 13%
- Child w/ 1 sz sibling was 9%
- MZ twins 48%
- DZ twins 17%

48
Q

Genetics - Adoption Studies

A

Similar to family studies but separates the effects of genes and environmental factors

49
Q

Genetics - Candidate Genes

A

Gene-mapping has identified several candidate genes which may be associated with sz

50
Q

Neural Correlates

A

The development of sz is related to structural/function brain abnormalities

51
Q

Neural Correlates (-ve)

A

Avolition involves loss of motivation & the ventral stratum is linked with the anticipation of reward in motivation

52
Q

Neural Correlates (+ve)

A

Lower activation levels in the superior temporal gyrus & anterior cingulate gyrus were found in individuals that have auditory hallucinations

53
Q

Dopamine Hypothesis (original)

A

High levels/activity of dopamine in the subcortex was associated with the development of sz symptoms

54
Q

Dopamine Hypothesis (evidence)

A

Post Mortems - sz showed hihg levels of dopamine
Amphetamine - increased dopamine activity results in symptoms similar to sz
Parkinson’s Disease - low dopamine levels are treated with amphetamines
Antipsychotic Drugs - drugs (like Chlorpromazine) block dopamine activity in the brain

55
Q

Dopamine Hypothesis (new)

A
  • Goldman-Rakic et al. (2004) -found a role of low dopamine levels in prefrotal cortex in -ve symptoms
  • Davis et al. (1991) suggested that high levels of dopamine in mesolimbic dopamine system are linked with +ve symptoms & high levels in mesocortical dopamine system linked with -ve symptoms
56
Q

Family Dysfunction

A

Where an individual develops sz because they were raised in a dysfunctional family environment

57
Q

Family Dysfunction Characteristics

A
  • High levels of interpersonal conflict
  • Difficulties communicating with eachother
  • Highly critical & controlling of children
58
Q

Double Bind

A

Bateson (1956) - believed that faulty communication in families was a key risk factor in developing sz.
Parents place children in a no-win situation by giving them contradictory messages.

59
Q

Expressed Emotion

A

Where the factors are high in a family, there’s a high level of stress for the patient and there are significantly more likely to replase

60
Q

Expressed Emotion Factors

A
  • Verbal Criticism fo the patient (which may occasionally include violence)
  • Hostility towards the patient (including anger & rejection)
  • Emotional Over-Involvement (including needless self-sacrifice)
61
Q

Brown et al. (1966)

A
  • Investigated the impact of family relationships on the recovery of sz patients, interviewing family members
  • Found that the families with high levels of EE resulted in 58% of relapse compared to low EE families with only 10%
62
Q

Cognitive Explanations

A

Sz is a result of cognitive deficits and/or dysfuncitonal processing

63
Q

Beck & Rector (2005)

A

Proposed a model which combines many models:
- Neurobiological anomalies occur due to brain damage or genetic defect
- These abnormalities lead to an increased vulnerabilities to stress
- Leads to dysfunctional beliefs and behaviour
- Cognitive deficits occur in attention, communication & information processing

64
Q

Frith et al. (1992)

A

Identified two kinds of dysfunctional thought processing that could underlie some symptoms:
- METAREPRESENTATION
- CENTRAL CONTROL

65
Q

Metarepresentation

A

Ability to reflect on thoughts & behaviour, so dysfunction would disrupt ability to recognise own actions/thoughts, explaining auditory hallucinations

66
Q

Central Control

A

Ability to suppress automatic responses, so disorganised speech/thoughts may be a result of an inability of this

67
Q

Antipsychotic Drugs

A

Developed in 1950s to reduce the positive symptoms of psychosis
- either typical or atypical

68
Q

Typical Antipsychotic Drugs

A

CHLORPROMAZINE (T/S/I)
- drugs that bind to dopamine receptors but don’t stimulate them, blocking receptors so dopamine cannot bind to them.
- initially causes a build up of dopamine levels in the synapse but overall production is decreased
- reduces frequency and strength of hallucinations etc.

69
Q

Atypical Antipsychotic Drugs

A

CLOZOPINE (T/S)
- binds to dopamine receptors but don’t stimulate them, blocking receptors so dopamine cannot bind to them. (LIKE TYPICAL)
- but also blocks serotonin & glutamate receptors and is believed to improve mood & reduce depression and anxiety
RISPERIDONE (T/S/1)
- binds strongly to dopamine & serotonin receptors, but stronger than clozapine

70
Q

Cognitive Behaviour Therapy (SZ)

A

Designed to help the sz patient change disorted & irrational thoughts into more accurate/rational ones.
- takes place over 5-20 sessions, usually individually for sz patients

71
Q

Personal Therapy

A

A specific type of CBT that involves a detailed evaluation of problems and experiences.
TECHNIQUES:
- distractions
- challenging meanings from intruisive thoughts
- inc/dec social activity
-relaxation

71
Q

CBT for Delusions

A
  • Patients think about where delusions first started to gain a better understanding of its origin
  • ARGUMENT with patient to encourage an evaluation of the content of their delusion
  • Patient’s allowed to devleop alternatives like coping strategies
72
Q

Family Therapy

A

Aims to increase tolerance, reduce critisism & guilt, and impreove communication in families of sz patients
- takes place over 9-12 months
LOWERING EE

73
Q

Pharoah et al. (2010)

A

Identified a range of stratgies which family therapists aim to improve the functioniung of a family with a sz member:
- forming an alliance with all family members
- reducing stres of caring for a sz relative
- improve ability to solve problems with family
- reduction of anger & guilt

74
Q

Token Economies

A

Uses principles of operant conditioning to help the MANAGEMENT of sz in institutions - POSITIVE REINFORCEMENT

75
Q

Tokens

A

(coloured disks) - given out immediately to patients who have carried out desirable behaviours, individualised
- tokens can be exchanged for rewards, and are secondary reinforcers

76
Q

Secondary Reinforcers

A

Indirectly reinforce behaviour by providing an access to a primary reinforcer (only have value once the patient has learm that they can be used to obtain rewards)

77
Q

Primary Reinforcers

A

Directly reinforce behaviour & are biological (have direct value to the patient)

78
Q

Rewards

A

Can be in the form of: materials, services, or privileges

79
Q

Interactionism Explanation

A

Suggests sz develops through several interacting factors/explanations - DIATHESIS STRESS MODEL

80
Q

Diathesis (DSM)

A

Vulnerability - a variety of different factors could cause vulnerability to sz
- genetics (Candidate Genes)
- psychological trauma (Read at al. (2001) early childhood trauma could significantly affect many aspects of brain development)

81
Q

Stress (DSM)

A

Psychological triggers for sz can be high EE, substance abuse, critical life events etc. Those most at risk of developing the disorder will be most vulnerable to such triggers

82
Q

Interactionist Treatments

A

The best form of treatment is to provide sz with a combination of different therapies, as research indicates that pairing multiple treatment leads to more effective results

Psych Paper 3 (4 decks)

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