Schizophrenia Flashcards
Define Schizophrenia
a sever mental disorder where contact with reality and insight are impaired. symptoms can affect everyday tasks
1%
classification of mental disorders
DSM - now of the positive symptoms must be present for diagnosis
BUT
ICD- 2 positive symptoms must be present
positive symptoms
additional experiences beyond those of ordinary existence
hallucinations- sensory experiences
delusions- /paranoia, irrational beliefs, makes a person behave in ways that make sense to them but seem bizarre to others
negative symptoms
loss of usual abilities and experiences
speech poverty- changes in speech patterns, reduce ion on the amount and the quality of speech/ disorganisation - speech is incoherent.
Avolition- difficulty to begin or keep up with goal directed activity (poor hygiene, lack of persistence and lack of energy)
Reliability in diagnosis and classification
A03
same diagnosis for same individual - inter rater reliability
reach the same conclusion for an individual more than one time- test resets reliability
low validity in diagnosis and classification
A03
validity coiners whether we awsses what we are trying to assess
criterion validity
(study in which 2 psychiatrists idependelty assessed same 100 clients using ICD and DSM. found that there were different number of patients diagnosis with different classification.
= criterion validity is low
co morbidity
A03
if condition occur together a lot of the time - question the validity of diagnosis and classification because thy might be a single condition.
= schizophrenia may not exist as a distinct condition and problem with diagnosis
gender bias in diagnosis
A03
men have been diagnosed more than women
possibly due ti women being less vulnerable than men BUT more likely that women are undiagnosed because they have closer relationships and get more support = cope better than men
= do not receive treatment or aid
Genetic basis of schizophrenia
candidate genes
candidate genes - genes believed to be associated with the risk of inheritance
disorder is polygenetic
Ripke- combined all previous data from genome wide studies of schizophrenia - 37,000 people compared to 113,000 control
108 genetic variations were associated with increased risk
- included those coding for number of neurotransmitters - dopamine
Biological explanation
dopamine hypothesis
neurotransmitters appear to work differently i the brain of a person with schizophrenia - Dopamine (important in the functioning of several brain systems that may be implicated with symptoms)
Hyperdopaminergia in subcortex:
focused on possible role of high levels or activity of dopamine in central areas of the brain
- Brocas areas = speech poverty / auditory hallucinations
Hypodopaminergia in cortex:
focuses on abnormal dopmaine systems in the brain cortex
Rakic - identified a role of low levels of dopamine in prefrontal cortex - thinking and decision making - negative symptoms
Biological explanation
neural correlates
measurements of the structure or function of the brain - both positive and negative symptoms have neural correlates
negative symptoms:
avolition involves loss of motivation - involves the anticipation of reward - ventral striatum
= abnormality linked to areas may be involved in development
Juckle- measured activity levels in the Ventral striatum and found lower levels of activity - found negative correlation of levels and severity of symptoms
positive symptoms:
Allen- scanned the brains of people experiencing auditory hallucinations and compared to a control group. lower activation level in superior temporal gyrus and anterior cingulate grus were found in hallucination group.
= reduced activity in areas of brain is a neural correlate of auditory hallucinations
Genetic basis of schizophrenia
candidate genes
A03- Support
Adoption Studies - Tienari
children from shcizophrenics are still heightended risk of developing shcizophrenia even if adopted with no history
particular genetic variations that siginficantly increase risk of shciozophrenia
BUT not entirely genetic and other factors may influence
Biological explanation
dopamine hypothesis
A03 - mixed evidence
Tauscher- antipsychotics, which act as dopamine antagonists and so reduce dopamine activity, alleviated the symptoms of SZ=dopamine has a key role in its development,
Javitt -critcising the emphasis role of dopamine. For example, the neurotransmitters glutamate and serotonin may also play a key role, as evidenced by the antipsychotic Clozapine acting upon both of these substances and being more effective than other atypical antipsychotics in reducing SZ symptoms, as suggested by Meltzer (2012).
Psychological Explanations
Family Dysfunction - Schizophregenic Mother
- particular type of parents
- cold, rejecting and controlling
- creates family tension and secrecy
- causes distrust = develops into paranoid delusions
*
Psychological Explanations
Family Dysfunction - Schizophregenic Mother
A03- Lack Of Support
based upon historical observations of families with SZ members, where observers would be searching for ‘crazy-making characteristics’ (Harrington, 2012)
= not objective or reliable indicator of cause of Schz.
Psychological Explanations
Family Dysfunction - Double Bind Theory
- child receives mixed messages from both parents about what is right or wrong.
- The tense atmosphere or controlling parenting
- =means that the child is unable to clarify these messages or voice their opinions about the unfairness of conflicting messages.
- punished through a withdrawal of love. = sees the world as unfair and confusing due to this confliction
- (disorganised thinking and paranoid delusions.)
Psychological Explanations
Family Dysfunction - Expressed Emotions
- negative emotions expressed to those with schizophrenia
- verbal criticism
- needles “sacrifieces”
- violence
- hostility
- significant source of stress for the patient.
- This means that they are less likely to take their medication or comply to cognitive therapies provided by their hospital or institution
- leading cause for relapse.
MAY BE SOURCE OF STRESS FOR DIATHESIS STRESS MODEL
Cognitive Explanations
metarepresentation
- cognitive ability to differentiate between our own actions and the actions of others,
- allowing us insight into the intentions and emotions as others, as well as maintaining a realistic/functional view of our own goals and intentions.
- Dysfunctions in metarepresentation have been associated with auditory hallucinations, and thought insertion,
- due to the inability to differentiate between our own thoughts and that of others.
- This may lead to paranoid delusions due
to the contents of inserting others’ thoughts into the mind of the patient.
Cogntive Explanations
Central Control
- cognitive ability to carry out a deliberate action whilst suppressing an automatic response,
- measured using the Stroop Test.
- This test involves identifying the colour of each word, where there is often a discrepancy
- e.g. the word ‘brown’ written in a yellow font.
- Therefore, the automatic response of reading the word must be suppressed, to allow for identification of the font colour.
- People with SZ often have dsyfunctional central control abilities,
- suffer from derailment because they cannot suppress the automatic associations that each new word in a sentence brings, and so begin to talk off-topic.
Cogntive Explanations
Central Control
A03 Support
There is evidence supporting the idea that dysfunctional thought processes are implicated in the development of schizophrenia, and that
* faulty central control skills may be responsible for some SZ symptoms
* * Stirling et al (2006). The researchers found that SZ sufferers made significantly more mistakes and twice as long to complete the task, compared to a healthy neurotypical control group.
* However, it should be emphasised that dysfunctional thought processing can only offer explanations for the indirect, proximal causes of SZ,
* can explain the symptoms but not the origin of SZ.
* This limits the utility of psychological explanations for schizophrenia
Psychological Explanations
A03 Lack of Nature
- that they do not accommodate for biological factors.
- Since such biological factors can explain the distal origins of schizophrenia (i.e. in terms of dopamine levels in the brain, candidate genes and patterns of activity coinciding with symptoms/ neural correlates),
- psychological explanations would best be reserved for the proximal causes of SZ
- as these causes are more likely to be most affected by psychological factors.
Treatment
Typical Antipsychotics
- Chlorpromazine
- due to its calming and sedative effects- acting upon histamine receptors in addition to dopamine receptors.
- Dopamine Hypothesis - Works as an antagonist = reduce action of the neurotransmitter
- reduce symptoms like hallucinations
- pill, syrup and injection
Treatment
Atypical Antipsychotics
- add to the effectiveness of first generation medications, and also alleviate the serious side effects associated with such drugs.
- **Clozapine **- binds to dopamine receptors AND acts on serotinis and glutamate receptors
- helps improve mood and reduce depression and anxiety
- = improves cognitive functioning
- perscribed when at high risk of suicide
- not injected
- ** Risperidone **- less serious side effects due to lower dose
- because it binds more strongly to dopamine receptors
- can be injected and last 2 weeks
Treatment
Antipsychotics
A03- Side Effects
- short-term side effects of typical antipsychotics are relatively mild
- (e.g. agitation and weight gain),
- long-term risk include involuntary contraction and relaxation of the facial muscles)
- neuroleptic malignant syndrome (NMS).
- . Therefore, a cost-benefit analysis should be carried out to consider whether the benefit of symptom reduction outweighs the cost of side effects for each specific patient.- needs to be consistenly monitored
Treatment
Antipsychotics
A03- dopamine Hypothesis
- The development of antipsychotics was mainly based upon the dopamine hypothesis, and so their use depends on this theory too.
- For example, if antipsychotics appear to alleviate symptoms by reducing the action of dopamine,
- is not in line with the revised version of the dopamine hypothesis, which suggests that abnormally low levels of dopamine in the cortex are responsible for symptoms.
- Therefore, a further reduction in dopamine levels should make symptoms worse, and not better.
- This paradox has caused some to question the validity of the use of antipsychotics, as well as the accuracy of the dopamine hypothesis as an explanation for schizophrenia.
Psychological therapies
Cognitive Behaviour Therapy
- CBT emphasises the importance of understanding
- although this treatment cannot directly ‘cure’ SZ, many patients find it comforting to understand the causes of their symptoms, especially if they are suffering from upsetting hallucinations or paranoid delusions.
- This understanding reassures patients that they are not ‘crazy’, reducing the intrusive effects of their symptoms and increasing their self-awareness
- Turkington- that CBT could be used to challenge a patient’s paranoid beliefs about being targeted by the Mafia.
- questioning the reality of the patient’s beliefs and
considering other, more reasonable alternatives
Psychological Therapies
Family Therapy
- Family therapy aims to reduce the stress of living together as a family, with a schizophrenic mother.
- In particular, the levels of expressed emotion are lowered through improving the families’ beliefs and attitudes towards schizophrenia, reducing stress,
- increasing feelings of self-efficacy and being trained to look for signs which may precede a schizophrenic episode.
- Therefore, the stress upon the SZ patient lessens, reducing the likelihood of relapse because they are more likely to be cooperative with medical advice and diligently take their medication.
Psychological Therapies
Token Economy
- Token economy systems are based upon behaviourist principles and are frequently used in psychiatric institutions.
- Target, desirable behaviours are identified by the staff.
- Every time a patient displays one of these behaviours, they are rewarded with a token
- (which acts as a secondary reinforcer)
- which can then be exchanged for a reward or privilege (which acts as a primary reinforcer).
- 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.
- Rewards may include extra TV time, exercise taken outside of the grounds of the hospitals and favourite magazines.
Psychological Therapies
A03- “cure”
- None of the three psychological therapies above actually treat the patient and ‘cure’ their schizophrenia.
- Instead, these therapies simply improve their quality of life through making the symptoms more manageable.
- For example, token economies increase the likelihood that the patients act in accordance with hospital rules and breaks disruptive patterns of behaviour,
- whilst family therapies reduce stress within a schizophrenic family and so increase the likelihood of the patient complying with their medical advice,
- whereas CBT improves the patient’s understanding of their symptoms.
- This suggests that an interactionist approach towards treatment is best adopted: biological therapies can treat the distal causes of SZ, whilst psychological therapies can treat the proximal symptoms
Psychological Therapies
A03-ethical issues
- concerning token economies.
- For example, some may argue that the ‘privileges’ that patients receive upon displaying appropriate behaviours are actually rights.
- Preventing patients from calling home or exercising outside may increase their stress and so aggravate their condition further.
- patients with the most severe SZ may find it near impossible to comply with these rules, and so will bear the most negative consequences.
- Similarly, CBT raises ethical issues because the therapist essentially has control over the patient’s views.
- This means that by challenging the idea of a Mafia as a controlling government instead, for example, the therapy is infiltrating into the patient’s personal beliefs. These changes can be anything, and not always beneficial.
Psychological Therapies
A03 -limited effectivness
- Pharoah - found that family therapy lowered rates of readmission and improves quality of life for individuals and families
- however found problems with quality of evidence
token economies
* Sultana foudn that only 3 stufies had randomly allocated people with schizophrenia with a total of only 110 people
* (important in controlling extraneous variables)
* only one of three studies showed improvements in symptoms and non yeilded useful information about behaviour changes
ONLY modest support for the effectiveness of psychological treatments and remains dififcult to treat.
