Schizophrenia Flashcards
What is classification?
Organising symptoms into categories based on which symptoms cluster together in sufferers.
What is diagnosis?
deciding whether someone has a particular mental illness using the classifications.
What is schizophrenia?
a type of psychosis - a severe mental disorder characterised by disruption of cognition and emotion so that contact with external reality and insight are impaired.
What are positive symptoms of Schizophrenia?
Experienced in addition to normal reality - hallucinations and delusions.
What are negative symptoms of schizophrenia?
represent loss of usual experience - loss of clear thinking or avolition.
What is avolition?
loss of motivation to carry out tasks and lowered activity levels.
What is co-morbidity?
The occurrence of two disorders or conditions together. This calls into question the validity of classifying them separately.
What is symptom overlap?
When two or more conditions share symptoms. This calls into question classifying the two separately.
What are the two main classification systems?
ICD-10 mostly used in Europe, and DSM-5 mostly used in the USA.
What does ICD-10 require?
Two or more negative symptoms, or one positive symptom.
What does DSM-5 require?
Two positive symptoms, one if symptom is serious.
What are hallucinations?
Unusual sensory experiences.
What are delusions?
Irrational beliefs
What is the gender bias in schizophrenia diagnosis?
Women have closer relationships and hence get more support, leading to them functioning better than men.
What is the cultural bias issue in schizophrenia diagnosis?
In other cultures, hearing voices may be seen as hearing ancestors voices. Black British people are up to nine times more likely to receive a schizophrenia diagnosis.
What is reliability?
The consistency of a measure.
What is validity?
The extent to which a test measures what it set out to measure.
What is reliability for schizophrenia?
- The inter-rater reliability across time (test-retest reliability) and cultures. It is also the stability of diagnosis over time given no change in symptoms.
- Osario et al. (2019) found inter-rater reliability of +0.97 and test-retest reliability of +0.92 for the DSM5 suggesting the diagnosis of schizophrenia is consistently applied.
What is validity for schizophrenia?
The extent to which schizophrenia is a unique syndrome with unique characteristics, signs and symptoms.
What overlaps are there between schizophrenia and bipolar?
- hallucinations
- delusions
What overlaps are there between schizophrenia, bipolar and depression.
- difficulty concentrating.
- lack of interest or pleasure.
What are the two main biological explanations of Schizophrenia?
- genetics
- neural correlate (dopamine hypothesis)
What was Gottestman’s 1991 study?
A large scale family study and found higher concordance rates in MZ twins (48%) in comparison to DZ twins (17%). This suggests there must be a genetic element to this.
What does it mean that Schizophrenia is thought to be polygenic?
It requires a number of different genes to work in combination and so different combinations can lead to the condition.
How many genetic variations could cause schizophrenia?
108
What is the second potential genetic cause of schizophrenia?
Mutation of parental DNA through radiation, poison or viral infection. Brown et al. found a positive correlation between paternal age and risk of schizophrenia.
What are neural correlates?
Measurements of the structure or function of the brain that occur in conjunction with the symptoms of schizophrenia.
What was the original dopamine hypothesis?
based on the discovery that antipsychotics cause symptoms similar to those in people with Parkinson’s, which is associated with low DA levels. Therefore schizophrenia could be the result of low levels of DA.
What might an excess of DA receptors in the pathway from the subcortex to to Broca’s area explain?
Specific symptoms of schizophrenia such as speech poverty or auditory hallucinations.
What is the updated version of the dopamine hypothesis?
- an addition of cortical hypodopaminergia (i.e. abnormally low DA in the brains cortex).
Learn updated dopamine hypothesis
How can antipsychotic medicine be taken?
As tablets, syrup or injections.
How do all antipsychotics work?
By reducing dopaminergic transmission - reducing the actions of the neurotransmitter dopamine in some areas of the brain.
What are the two types of antipsychotic?
- Typical (traditional)
- Atypical (newer)
What is an example of a typical antipsychotic and when was it developed?
Chlorpromazine - 1950s
How do typical antipsychotics work?
They are dopamine antagonists, so block dopamine receptors, reducing the action of dopamine. Initially levels build up, but then production is reduced.
What symptoms do typical antipsycotics work for?
Positive symptoms such as hallucinations.
What are the side effects of typical antipsychotics?
weight gain, itchy skin and tardive dyskinesia (involuntary muscle movements of the tongue, face and jaw).
how do atypical antipsychotics work?
Also blocks dopamine receptors - however only temporarily, then they rapidly disassociate.
what examples are there of atypical antipsychotics?
Clozapine - used since 1970s.
What is the most serious side effect of atypical antipsychotics?
agranulocytosis (an autoimmune disorder affecting white blood cells).
What symptoms do atypical antipsychotics treat?
positive, but also negative such as avolition because they serotonin.
Which antipsychotic has more symptoms?
Typical because of their mechanism of action.
In what situations would typical antipsychotics be used?
- If the person only has positive symptoms.
- If the person had pre-existing autoimmune issues.
In what situations would atypical antipsychotics be used?
- If the person is a suicide risk.
- If the person has negative and positive symptoms.
What are the family dysfunction explanations of schizophrenia
- schizophrenogenic mother.
- Double-bind theory.
- expressed emotion.
What are the cognitive explanations of schizophrenia?
- Dysfunctional thought processing.
Who proposed schizophrenogenic mother theory?
Freida Fromm-Reichmann (1948)
What is schizophrenic mother theory?
When a mother is cold, rejecting and controlling, tending to create a family climate controlled by secrecy and tension. This leads to distrust which leads to paranoid delusions.
What is Double-bind theory?
Emphasises role of communication style. Developing child receives mixed messages and fears doing the wrong thing. Punished by withdrawal of love when wrong. Leads to view of world as dangerous and confusing -> more of a risk factor for schizophrenia than cause.
Who developed double bind theory?
Bateson et al. (1972)
What is expressed emotion theory?
carers express negative emotion regularly to person with schizophrenia.
Contains: verbal criticism, hostility, emotional overinvolvement.
Can cause relapse of schizophrenia, or onset for those already genetically vulnerable.
What are the two types of dysfunctional thought? Who came up with them?
- Meta-representation
- Central control
- Frith et al. (1992)
What is dysfunctional thinking?
Cognitive habits or beliefs which cause the individual to evaluate info inappropriately, causing undesirable consequences.
What is dysfunction in meta-representation?
disrupted ability to recognise our own thoughts and actions as our own as opposed to being carried out by someone else. This explains hallucinations and delusions.
What does dysfunction in central control lead to?
disorganised speech, speech poverty and thought disorder as unable to supress automatic thoughts.
What is meta representation?
the cognitive behaviour to reflect on thoughts or behaviour.
What is central control?
The cognitive ability to supress automatic responses while we perform deliberate actions instead.
What is CBTp?
Cognitive Behavioural Therapy (for) psychosis
What is the aim of CBTp?
To identify irrational thoughts and challenge them, and reality testing them to reduce stress.
How does the ABCDE model work for CBTp?
(A) - activating event
(B) - resulting belief
(C) - beliefs consequences
(D) - disputing (critical collaborative analysis)
(E) effect (restructured beliefs)
What is critical collaborative analysis?
Gently questioning illogical deductions and conclusions - develops alternative explanations for unhealthy assumptions.
What is reality testing?
The individual and the therapist jointly examine the likelihood that beliefs are true, developing alternative, more rational, explanations.
What does CBTp do instead of getting rid of schizophrenia?
It helps patients to cope better, reducing their distress.
What is normalisation?
The therapist reassures the patient that their experience is just an extension of normal reality e.g. hearing voices is just an extension of the ordinary experience of saying words in your head. This reduces the sense of isolation and distress.
What might patients be set in CBTp?
behavioural assignments to improve general level of functioning e.g. shower everyday. May also include relaxation techniques.
How many sessions of CBTp do NICE recommend?
At least 16.
What are two differences between CBTp and antipsychotics?
- CBTp does not have medical side effects, whereas antipsychotics have ones that can lead to death.
- Antipsychotics work to get rid of symptoms, CBTp helps people to try and understand and cope with the symptoms.
What is a similarity between CBTp and antipsychotics?
- Both have been found to be effective.
What is family therapy?
A range of interventions aimed at the family, which should involve the schizophrenic person if possible.
What is the aim of family therapy?
- To reduce anger, frustration and expressed emotion, to reduce the stress of living together.
- To improve communication and interaction.
What is family therapy commonly used in conjunction with?
drug therapy and outpatient clinical care.
What are three strategies used in family therapy? What is the end goal?
- Improving family knowledge of Schizophrenia.
- Maintaining reasonable expectations in the family for patient performance.
- reducing anger and guilt in the family.
—-> reduced chance of relapse and rehospitalisation.
What is the basic idea behind the token economy?
Encouraging desirable behaviours through selective reinforcement. Responding to desired behaviours with a pleasurable stimulus, and seeking to extinguish undesirable behaviours by not responding.
How does token economy work in practise?
Tokens (rewards) given immediately following behaviour as secondary reinforcers, but can be swapped later for sweets, magazines etc. (primary reinforcers) forming an association.
What is the aim of token economy?
To make patients staying for long period in hospitals easier to manage, and to make it more likely they will do well outside a hospital setting.
What is the interactionist approach?
Explaining development of behaviours in terms of a range of factors, including biological, physical and social ones. These factors combine and interact in an unpredictable way.
What is the diathesis-stress model?
There is an underlying vulnerability (diathesis) and a trigger (stressor), both of which are required for the onset of schizophrenia.
What does the term ‘diathesis’ mean for schizophrenia?
A vulnerability to schizophrenia.
What does the term ‘stress’ mean for schizophrenia?
Negative psychological experience which triggers schizophrenia.
What is the diathesis in Mehl’s 1962 model?
Entirely genetic - genes cause neurotypical abnormalities (too low dopamine levels in the pre-frontal cortex leading to too high levels in the subcortex) increasing schizophrenia risk.
What is the stressor in Mehl’s 1962 model?
Chronic stress in childhood, especially schizophrenogenic mother. This is where the mother is cold, rejecting and controlling and the father is passive. This leads to tension and secrecy within the family and is thought to lead to psychotic thinking and paranoid delusions.
What is the diathesis in the revised diathesis-stress model?
Revised to include vulnerabilities due to childhood trauma which might affect brain development, such as the hypothalamic-pituitary-adrenal (HPA) system (chronic stress response) becoming overactive, making a person much more vulnerable to later stress.
What is stress in Mehl’s revised model?
Revised to include any negative psychological experience that risks triggering schizophrenia e.g. stressful life events.
What would treatment for schizophrenia based off Mehl’s model be?
A combination of antipsychotics and psychological therapies.
What is a limitation of the original model of the interactionist approach?
It is an overly simplistic, as multiple genes in different combination can cause schizophrenia, for example childhood sexual abuse as a diathesis and cannabis use as a stress.
What evidence is there supporting an interactionist approach?
A study found that participants who had a combination of treatments showed lower symptoms levels than those in a control group.
