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schizophrenia Flashcards

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1
Q

what is schizophrenia?

A
  • a severe mental illness where contact with reality and insight are impaired
  • it is a psychotic disorder that affects thought process and ability to determine reality
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2
Q

how does schizophrenia differ between people?

A
  • the severity of the disorder changes and symptoms can differ
  • it is diagnosed more in men, who are more likely to be diagnosed earlier (late teens compared to women in 20s and 30s)
  • it rarely starts before the age of 15, there are different ages of onset
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3
Q

what are positive symptoms?

A
  • they add to the sufferer’s living experience and heighten normal function
  • they focus on displaying behaviours that show a concerning loss of touch with clarity
  • generally occur in acute, short episodes with more “normal periods”
  • these are the symptoms that tend to be more responsive to medication
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4
Q

what are negative symptoms?

A
  • they subtract from a person’s life and lessen normal functioning
  • focus on displaying behaviours that show disruption to normal emotions
  • generally occur in longer lasting episodes and are resistant to medication
  • stop people from functioning in society
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5
Q

what are the 3 main positive symptoms?

A

delusions- false beliefs that are firmly held despite being completely illogical or for which there is no evidence
hallucinations - involve disturbances in perception, resulting in false perceptions that have no basis in reality
disordered thoughts - thoughts that are often irrational and are inserted into the mind

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6
Q

what are the main 3 negative symptoms?

A

affective flattening - reduction in range and intensity of emotional expression
alogia - poor speech fluency thought to reflect slowing or blocked thoughts
avolition - the inability or reduction of goal-directed behaviour e.g sitting around

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7
Q

what is reliability when diagnosing schizophrenia?

A

the level of agreement of the diagnosis by different psychiatrists across time and culture ; stability of diagnosis over time given no change in symptoms

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8
Q

what is validity when diagnosing schizophrenia?

A

the extent to which schizophrenia is a unique syndrome with characteristics, signs and symptoms

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9
Q

what is the difference between the way that the DSM- V and ICD - 10 diagnose?

A
  • ICD is for Europe and DSM is for USA
  • DSM-V look for one positive symptom eg hallucination, delusions or speech disorganization to be present
  • ICD looks for two or more negative symptoms to be present
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10
Q

what is the first stage of the onset of schizophrenia?

A

the prodomal stage : The individual becomes withdrawn and
lose interest in work, school and leisure activities

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11
Q

what is the second stage of the onset of schizophrenia?

A

the active phase: More obvious symptoms begin to occur: the duration of this phase can vary; for some people it will last a few
months, whereas others remain in the active phase

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12
Q

what is the third and final stage of the onset of the schizophrenia?

A

The residual phase: the obvious symptoms begin to
subside, e.g. when treatment is given

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13
Q

what are the statistics for individuals who are developing schizophrenia?

A

One third of schizophrenics regain the ability to function normally, a third are permanently in the active phase, while a third move between the active and the residual phase

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14
Q

strength of diagnosing schizophrenia - good reliability

A
  • having a psychiatrist reach the same diagnosis for multiple people ( test retest reliability) and multiple psychiatrists reach the same diagnosis for a person (inter reliability ) highlights its reliability
  • before the DSM - 5 was around , there was low relaibilty
  • Osorio et al (2019) found high reliability (inter relaibility of +.97 and test - retest reliability of +.92)
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15
Q

limitation of diagnosing schizophrenia - low validity

A
  • one way to assess the validity of a diagnosis is criterion validity
  • Chineaux et al (2009) had 2 psychiatrists independently assess the same 100 clients using the IDC and DSM - 68 diagnosed under ICD and 39 under DSM
  • this shows that it is easy to lose the validity of diagnosing schizophrenia and could lead to under or over diagnosis
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16
Q

limitation of diagnosing schizophrenia - co morbidity

A
  • if schizophrenia occurs with another condition, this can question the validity of the diagnosis
  • one study found that schizophrenia often co exists with depression or substance abuse and has similar symptoms to bipolar disorder
  • this is a problem for classification because it means that it may not exist as a distinct condition as some may have 2 conditions intertwined making us question the validity of diagnosis
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17
Q

limitation of diagnosing schizophrenia - gender bias

A
  • one explanation for the reasons that men may be diagnosed more is that they may be more genetic vulnerable
  • it is thought that women are underdiagnosed as they have closer support and therefore function better than men ( cotton et al 2009)
  • this may mean that women may not receive the right treatment
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18
Q

limitation of diagnosing schizophrenia - cultural bias

A
  • some symptoms fo schizophrenia like hearing voices means different things in different cultures e.g in haiti it is communication from ancestors
  • british people of african - carribean origin are 9 times as likely to recieve diagnosis than white british people, genetics do not play a factor
  • this is most likely caused by bias from psychiatrists of those from a different background
  • this causes discrimination by a culturally biased diagnostic system
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19
Q

what is the family studies explanation for schizophrenia?

A
  • individuals who have schizophrenia may used in family studies to determine the likelihood of it being caused by biological relatives
  • the closer the degree of relatedness
  • children with 2 schizophrenic parents have a concordance rate of 46 %, children of schizophrenic parents have a concordance rate rate fo 13%, those who have a sibling is 9% (Gottesman 1991)
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20
Q

what is the evaluation for family studies?

A
  • many researchers now accept that it may be due to common rearing patterns, or factors that have nothing to do with hereditary
  • research on expressed emotion has shown that the negative climate in some families may lead to stress that causes schizophrenia
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21
Q

what is the twin studies explanation for schizophrenia?

A
  • twin studies offer a unique opportunity to researchers as they give them the chance to study the influence of nature and nurture
  • it is thought that the concordance rate for monozygotic twins is 40.4 % and for dizygotic twins is 7.4 % ( Joseph 2004)
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22
Q

what is the evaluation for twin studies?

A
  • it is though that the environments of MZ and DZ twins is similar, but Joseph 2004 states that MZ twins are treated more similarly and are likely to experience similar environments
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23
Q

how many people diagnosed with schizophrenia have no known relative with a diagnosis?

A

89%

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24
Q

what evidence is there against the biological approach in general for schizophrenia?

A

there is no evidence in cells or animals

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25
Q

what changes are there in a schizophrenic brain

A

thinner cerebral cortex and fewer synapses

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26
Q

what did Tienari (1987) research?

A

Tienari (1987) found that in adoptee children aged 5-7 that were separated from their mothers before the age of 4, 7% of them developed schizophrenia while only 1.5% of the control group did. This goes against the biological approach and suggests that the separation from the mother is therefore the trigger for higher rates of schizophrenia.

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27
Q

what is dopamine’s role?

A

dopamine is important in the functioning of several brain systems that may be implicated in schizophrenia

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28
Q

what does the original dopamine hypothesis say?

A
  • there are excess levels of dopamine in the subcortex and Broca’s area (hyperdopaminergia)
  • high levels of dopamine in Broca’s area is thought to lead to things like speech poverty and auditory hallucination
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29
Q

what does the updated dopamine hypothesis say?

A
  • there are abnormally low levels of dopamine in the pre frontal cortex (hypodopaminergia)
  • this can lead to the negative symptoms associated with schizophrenia (Goldman - Rakic 2004)
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30
Q

strength of the dopamine hypothesis- amphetamines and antipsychotics

A

amphetamines increase the levels of dopamine and worsens the symptoms of schizophrenia while antipsychotics decrease the levels of dopamine and alleviates the symptoms of schizophrenia

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31
Q

limitation of the dopamine hypothesis - post mortem studies

A
  • drugs used to treat schizophrenia by blocking dopamine activity can actually increase it ass neurons try to compensate for the deficiency
  • Haracz (1982) found that most schizophrenics who had an increase in dopamine had taken anti psychotics before their deaths
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32
Q

limitation of the dopamine hypothesis - neuroimaging

A

the development of neuroimaging e.g PET has allowed researchers to look at dopamine levels more precisely
- however, there is little evidence to show the altered dopamine activity in those with schizophrenia (coplov and Crooke 2000)

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33
Q

what percent of people experience reduced symptoms on anti psychotics ?

A

20%

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34
Q

what is treatment aetiology fallacy?

A

just because drugs work, does not means that the brain’s chemistry was the cause in the first place

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35
Q

what are the structural abnormalities for schizophrenia?

A
  • unusually large corpus collosum
  • high density of white matter
  • small amount of grey matter in the temporal lobe
  • a change in blood flow in the central cortex
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36
Q

Allen et al (2007) neural correlations of positive symptoms

A
  • scanned the brains of patients experiencing auditory hallucinations and compared them to a control group
  • they found lower activity in the superior temporal gyrus in those experiencing hallucinations
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37
Q

strength of neural correlations - ho et al (2003)

A
  • has shown by re-scanning patients, that brain differences increase over time as symptoms worsen - despite being on medication
38
Q

negative of neural correlations - is it a cause of schizophrenia, or an effect?

A
  • research does not usually mention that it is potentially the medication that is causing these brain changes, the same with co morbidity
39
Q

what 2 things are crucial for biological treatments?

A
  • effectiveness
  • appropriateness
40
Q

what is the difference between typical and a typical treatments?

A

typical treatments are older treatments, originating from the 1950s and a typical are the newer forms of anti psychotics

41
Q

what is the effectiveness of typical treatments?

A
  • reduced positive symptoms in about 75% of patients
  • did not reduce negative symptoms
  • offered an alternative to ECT and psychosurgery
42
Q

what are some side effects of typical treatments?

A
  • apathy
  • risk of depression
  • dry mouth
  • if the drug is stopped, the symptoms come back, creating “revolving door syndrome”
  • tremors in 30% of patients
43
Q

what is the effectiveness of a typical , second generation medications?

A
  • work by blocking dopamine and serotonin receptors
  • more effective for 25% of patients who were not helped by first generation
  • alleviates most motor problems
44
Q

what are the side effects of a-typical, second generation?

A
  • clozapine can lead to angranulocytosis - white blood cells are reduced - this can be fatal but monitored by regualr blood tests
  • weight gain
  • sexual dysfunction
45
Q

what happens in ECT?

A
  • an electric current is passed between two scalp electrodes to create a seizure
  • the patient is unconcious
  • they are then given a nerve blocking agent, paralysing the muscless of the body to prevent cotnraction
  • a seizure is then produced and the schizophrenia is treated
46
Q

a strength of the effectiveness of conventional antipsychotics - relapse rates

A
  • a review done by Davis et al (1980) found a significant difference in terms of relapse rates between treatment and placebo groups in every study reviewed, thus demonstrating the therapeutic effectiveness of the drug
47
Q

limitation of the effectiveness of conventional antipsychotics - other factors are important

A
  • one studies by Davis et al found that antipsychotic medication did make a significant difference but only in those in a hostile living environment - 53% for the medication - 92% for placebo
  • there was no difference between those on medication and those not of those who were in good home environments
48
Q

limitation of the effectiveness of a typical antipsychotics - effectiveness with negative symptoms

A
  • in the Leut et al study, two of the a typical drugs were “slightly” more effective than the conventional antipsychotics, one was “as effective” and the other was “slightly worse”
49
Q

appropriateness for conventional antipsychotics - tardive dyskinesia

A
  • conventional antipsychotics have many worrying side effects
  • about 30% of people taking conventional antipsychotics experience this and with 75% of cases, it is irreversible (Hill, 1986)
50
Q

appropriateness for atypical antipsychotics - fewer side effects

A
  • atypical antipsychotics may ultimately be more appropriate in the treatment as there are fewer side effects, which means people are more likely to continue their medication
51
Q

what is the meaning behind Fromm- Reichman’s “the schizophrenogenic mother”

A
  • This quite literally means ‘schizophrenia-causing.’
  • Fromm-Reichmann proposed this type of mother from accounts that patients had given her about their childhoods.
52
Q

what behaviours may “the schizophrenogenic mother” display

A
  • cold
  • rejecting
  • controlling
  • tends to cause tension and secrecy in the household
  • this then leads to distrust and causes later paranoid delusions
53
Q

what is double bind theory (Bateson, 1956)

A
  • a psychological explanation which can be classes as a socio-cultural explanation
  • Bateson suggested that schizophrenia is best understood as a wider problem occuring within the family
  • it is not an inborn mental disorder but instead is a learned confusion in thinking
  • Sz is due to the exposure to, and participation in dysfunctional communication patterns in the family.
  • An example of this dysfunctional communication pattern is double bind communication.
  • Double-bind communication is where a pair of messages are mutually contradictory
54
Q

how does double bond lead to the development of schizophrenia?

A

the result is that children lose their grip on reality and if double bind messages are presented continually and habitually within the family context from infancy on by the time the child is old enough to have identified the double bind situation, it has already been internalised and the child is unable to confront it.

55
Q

what is expressed emotion (EE)?

A
  • a qualitative measure of the amount of emotion displayed within the family setting, usually by family members
  • it can be measured by using the camberwell family interview or the 5-minute speech sample
  • the theory proposes that a high level of EE within the home of the schizophrenia can:
  • worsen the prognosis in patients with schizophrenia
  • increase the likelihood of relapse and readmission into hospital for the patient
56
Q

what are the 3 dimensions of an EE household ?

A
  1. Hostility:
    Hostility is a negative attitude directed at the patient because the family feels that the disorder is controllable and that the patient is choosing not to get better. Problems in the family are often blamed on the patient. The family believes that the cause of many of the family’s problems is the patient’s mental illness.
  2. Emotional over-involvement:
    It is termed emotional over-involvement when the family members blame themselves for the mental illness. This is commonly found in females. The family member shows a lot of concern for the patient and the disorder. This is the opposite of a hostile attitude, but still has the same negative effect on the patient as it makes the patient feel guilty. The pity from the relative causes too much stress and the patient relapses to cope with the pity.
  3. Critical Comments:
    Critical attitudes are combinations of hostile and emotional over-involvement. It shows an openness that the disorder is not entirely in the patients control but there is still negative criticism. Critical parents often influence the patient’s siblings to be the same way.
57
Q

how does this result in relapse?

A
  • this high level of EE becomes too much for the patient to handle as they have to deal with criticism from those they would need support from in their time of recovery
  • this stress may cause the patient to relapse and make them fall into a cycle of rehabilitation and relapse
  • the only way to escape this cycle us for the family to go through family intervention therapy together
  • this will greatly lower family conflicts and reduce the amount of EE within the household.
58
Q

strength of family dysfunction - research support

A
  • indicators like insecure attachment and sexual abuse are linked to schizophrenia
  • Read et al found that 69% of women and 59% of men have had previous sexual trauma
59
Q

limitation of family dysfunction - explanations lack support

A
  • there is support for family stress theories but little for traditional theories like the schizophrenic mother and double bind theory
  • both theories are based on clinical observation and assessments of their mothers personalities, but not systematic evidence
  • this weakens the link between family studies and schizophrenia
60
Q

limitation of family dysfunction - socially sensitive

A

A limitation of the family dysfunction explanation is that it implies that parents are responsible for the problems of their children - mothers are particularly blamed and the whole topic is socially sensitive as it can lead to parent blaming - could cause psychological harm to the parents

61
Q

Support for the family dysfunction explanation comes from Berger (1965) - DOUBLE BIND

A
  • found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics
    -This seems to support the theory, but patients recall may be affected by their schizophrenia
  • Retrospective data is unreliable, as participants usually have very poor recall of past events
  • The data is correlational, so it cannot be implied that one actually caused the other
62
Q

Support for the family dysfunction explanation comes from Kalafi and Torabi - iranian mothers

A
  • found that the negative emotional climate in Iranian culture (over-protective mothers and rejecting fathers) led to a higher relapse rate in schizophrenia…
  • This support the theory, suggesting that EE is highly implicated in relapse rates of schizophrenia.
  • However, it doesn’t tell us that it actually cased the schizophrenia in the first place.
63
Q

what are the main assumptions of the cognitive approach?

A
  • based around the idea of faulty information processing and faulty thinking
  • in non schizophrenic brain, we are able to filter in incoming stimuli and process them to extract meaning
  • it is thought that this filtering mechanism is not present in those with schizophrenia
64
Q

what are the 3 main aspects of the cognitive assumption?

A
  • dysfunctional thinking
  • metarepresentation dysfunction
  • central control dysfunction
65
Q

what is dysfunctional thinking?

A
  • reduced thought processes can be seen in many of its symptoms
  • reduced thought process in the ventral stratium is associated with negative symptoms
  • reduced information processing in the temporal and cingulate gyri is associated with hallucinations
  • this lower than usual level of information processing suggests cognition is impaired
66
Q

what is metarepresentation dysfunction?

A
  • Frith et al (1992) identified 2 kinds of dysfunctional thinking
  • the first is metarepresentation - the inability to reflect on one’s own thoughts and feelings
  • this stops us having the ability to recognise our own actions and thoughts
  • this explains hallucinations of hearing voices and delusions like thought insertion
67
Q

what is central control dysfunction?

A
  • Frith et al also identified issues with the cognitive ability to suppress automatic responses while we commit deliberate actions
  • speech poverty and thought disorders could result to supress automatic thoughts and speech triggered by other thoughts
  • for example, people with schizophrenia tend ot experience derailment of thoughts because each word triggers association and they cannot suppress automatic responses to these
68
Q

what are the 3 main psychological treatments

A

CBT
token economies
family therapies

69
Q

what do family therapies involve?

A
  • takes place with the family rather than with the individual
    the therapy aims to increase the quality of communication and interaction between family members
  • some therapies seem the family as the root cause of the disorder, keeping in lime with the double bind and schizophrenogenic mother explanations
  • these days most therapies are concerned with reducing the amount of stress a patient is likely to endure, which can lead to relapse - expressed emotion
70
Q

according to pharoah et al (2010) what are the strategies that can help the functioning of the family?

A
  • forming a therapeutic alliance with all the family
  • reducing the stress, a relative with schizophrenia deals with
    improving the ability of the family to anticipate and solve problems
  • reduction in anger and guilt in the family
  • improving families’ beliefs about and behaviour towards schizophrenia
71
Q

what are the key things to think about when talking about treatments?

A

Is it effective?
Is it ethical?
Does it improve quality of life?

72
Q

what is CBT?

A

Cognitive Behavioural Therapy (CBT) works by identifying a patient’s irrational thoughts and trying to change them. CBT can’t actually remove the symptoms completely, but will ensure that the patient is better equipped to cope with them. It helps the patient to make sense of how their hallucinations and delusions impact on their behaviour.

73
Q

what are the stages of CBT?

A
  • assessment
  • the ABC model
  • Critical collaborative analysis
74
Q

what is token economy?

A
  • reward systems used to manage behaviour of patients with schizophrenia, in particular those who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals.
  • under these conditions patients begin to show bad habits including unacceptable hygiene. Modifying these bad habits will not cure schizophrenia, but it will help patients improve their quality of life and makes it more likely they can live outside a hospital setting
  • the token is given immediately to prevent delay discounting
  • they have been targeted for reinforcement
  • they are secondary reinforcers because they only have the values once the patient has learned to obtain rewards
75
Q

what is Coping strategy enhancement:

A

tarrier devised a specific form of CBT for schizophrenia known as coping strategy enhancement which focused on building on schizophrenic’s existing coping strategies - especially for hallucinations and delusions

76
Q

what are outcome studies?

A
  • these measure how well a patient does after particular treatment compared with the accepted form of treatment for that condition
  • outcome studies of CBT suggest that the therapy shows more effective results for sufferers that those who simply take medication
  • patients who receive cognitive therapy experience few hallucinations and delusions and recover their functioning to a greater extent than those who receive antipsychotic medication alone
77
Q

strength of CBT - evidence for its effectiveness

A
  • Jauher et al (2004) reviewed 34 studied of using CBT with schizophrenia and concluded that there is small but significant effects on both positive and negative symptoms of schizophrenia
78
Q

limitation of CBT - quality of evidence

A
  • CBT techniques and schizophrenia symptoms vary from one case to another
  • Thomas (2015) points out the fact that different studies have used different CBT techniques and a mix of people with positive and negative symptoms
  • the benefits probably conceal a huge range of techniques and effects that CBT can have
  • this makes it hard to say how effective CBT will be for a particular person with schizophrenia
79
Q

other evaluation points of CBT?

A
  • CBT requires a lot of commitment from the patient. They have to buy into it and be prepared to attend sessions as well as conduct homework
  • CBT is a lengthy process and could lead to a high dropout rates for the most severe cases
80
Q

strength of family therapies - evidence of tis effectiveness

A
  • McFarlane (2016) concluded that relapse rates were reduced by up to 50-60%
  • family therapies is tohguht to help everyone no matter the stage of their disorder
81
Q

strength of family therapies - benefits the whole family

A
  • Lobban and Marclough (2016) concluded that these effects are important becasue families provide the bulk of care for those with schizophrenia
  • by strengthening the family as a whole, family therapy lessens the negative effect of schizophrenia
82
Q

what is the original diathesis stress model? Meehl’s (1962)

A
  • Diathesis (vulnerability) is entirely genetic - the result of a single schizogene, which led to a biologically based schizotypic personality - extremely sensitive to stress
  • no amount of stress will lead to schizophrenia is the gene is not present
  • however, chronic stress in someone with the gene could lead to the development of the disorder - nature and nurture interact
83
Q

In what way is the original model oversimplified?

A

it does not properly explain how vulnerabilities and stress work. it is fine to stay that vulnerability may lead to stress being a higher trigger, however, it doesn’t explain how both vulnerability and stress are produced and how they then produce schizophrenia

84
Q

what does the modern diathesis stress model say?

A
  • many genes increase vulnerability, not just the schizogene
  • goes beyond genetics - psychological trauma e.g sexual abuse can affect brain development
  • stress is not always caused by parenting
  • cannabis can also be trigger but schizophrenia cannot develop without the original vulnerability
85
Q

what does turkington et al point out about interactionist treatment?

A
  • it is not possible to have a purely biological and psychological approach with CBT and they are best used together
86
Q

strength of the interactionist approach - evidence supporting the role of vulnerability and triggers

A

Tienari et al (2004) found that in 19,000 finnish adoptees, they had an increased chance of developing schizophrenia with a schizophrneic mother and a tenser adoptive environment compared to the control group with low genetic risk and a better environment

87
Q

limitation of the diathesis stress model - over simplified

A
  • houston et al (2008) studied the impacts of cannabis and secual abuse prove that the reasoning behind schisophrenia is so much bigger than a gene and parenting
88
Q

How many times more likely are users of cannabis likely to develop schizophrenia?

A

2.3 times more likely

89
Q

strength of the interactionist approach - real world application

A
  • becasue the use of combination treatment is so beneficial - it proves it application
  • 55% medication
  • 52% CBT
  • 86% together
    Tarrier et al (2004) - randomly allocated 315 pariticpants to groups and the combination group has the lowest symptoms
90
Q

counterpoint to real life application

A

-Jarvis and Okami (2019) point out that treatment- causation fallacy massively affects schizophrenia
- the assumption, that when using one treatment such as drugs, if symptoms are reduced, it is assumed that the cause is biological
-therefore we cannot automatically assume that the success of combination therapies means that the interactionist thoery is correct

psychology (11 decks)

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