Schizophrenia Flashcards
1
Q
Kraeplin
A
First identified schizophrenia calling it ‘dementia praecox’
2
Q
Bleuler
A
Called the ‘dementia praecox’ schizophrenia as it means split mind
3
Q
Prevalence of schizophrenia
A
Affects 1% of the population
Males= mid 20s
Females= early 30s
4
Q
When are symptoms most severe
A
According to Bleulers 2000 schizophrenics the most severe is early adulthood in first 5 years of onset
5
Q
% that recover from positive symptoms
A
40%
6
Q
% that can make a full recovery if diagnosed early
A
20%
7
Q
% of patients that suffer for rest of lives
A
40%
8
Q
Positive symptoms of schizophrenia
A
Hallucinations
Delusions
Disorganised thinking and speech
9
Q
Negative symptoms of schizophrenia
A
Speech poverty (alogia)
Flat effect
Avolition
Apathy
Innapropriate effect
10
Q
Hallucinations
A
False sensory experiences (auditory and visual)
11
Q
Delusions
A
False beliefs that aren’t based on facts that are hard to disprove. Persecution, grandeur and control
12
Q
Disorganised thinking and speech
A
Thoughts drift from one thing to another (misty or hazy). Have trouble reading an article or watching TV. Words may become confused or jumbled.
13
Q
Speech poverty (alogia)
A
Reduction in communication where it would be considered normal To communicate. Thought to result from other slowing of thoughts.
14
Q
Flat affect
A
A reduction or flattening of emotions. The range and intensity of facial expressions, tone of voice and eye contact reduce. Body language becomes difficult too
15
Q
Avolition
A
Lack of motivation and severe lack of initiative to accomplish tasks. Could neglect household chores and personal hygiene
16
Q
Apathy
A
Difficulty in planning and setting goals. No interest in socialising or hobbies. A person doesn’t want to do anything and will sit in their house for hours or days
17
Q
Innapropriate affect
A
Emotional expressions are unsuitable for the situation. When individuals appear to have lost the ability for emotions occur in a normal way. Affect is a reaction to their hallucinations
18
Q
Diagnostic criteria
A
A. Characteristic symptoms
B. Social/occupational dysfunction
C. Duration
D. Schizoactive and mood disorder exclusion
E. Exclusion of knows organic cause
F. Relationship to Austism
19
Q
Characteristic symptoms
A
2 or more of symptoms are present for 1 month
20
Q
Social/occupational dysfunction
A
Impairment in one of the main areas of functionin for a significant period of time since the onset of the disturbance
21
Q
Duration
A
Some signs of the disorder must last for a continuous period of time of at least 6 months. Which just include 1 month of symptoms that meat criteria A
22
Q
Schizoaffective and mood disorder exclusion
A
Schizophrenia if Schizoaffective and mood disorder have been ruled out
23
Q
Exclusion of known organic cause
A
The disturbance isn’t due to substance abuse
24
Q
Relationship to autism
A
Need to rule out autism or history of autism
25
Co-morbidity
Simultaneous presence of 2 or more disorders at same time
Lowers the validity of classification
26
Buckley co-morbidity percentages
50% of schiz are depressed
29% of schiz have PTSD
23% of schiz have OCD
47% of schiz suffer from substance abuse
27
What does comorbidity do to classification
Comorbity lowers the validity of classification
28
Symptom pool
Collection of symptoms a culture associates with an illness
29
Copeland (1970)
Gave a description of a patient to 134 US and 194 British psychiatrists and found 69% of us diagnosed them with schizophrenia but only 2% of British did.
30
Overlapping symptoms
No schizophrenic specific symptoms means that a valid diagnosis is hard to achieve. As we can’t be sure that symptoms someone is experiencing is because that have schizophrenia. They could have Bipolar
Lowers validity of diagnosis
31
When was DSM classification system first published
1952
32
When was DSM V published
2013
33
Buckley- how many schiz are depressed
50%
34
Buckley- how many schiz have ptsd
29%
35
Buckley- how many schiz have OCD
23%
36
Buckley- how many schiz hade substance abuse
47%
37
Beck et al research (reliability)
A group of 153 patients with schizophrenia were each assessed by 2 different psychiatrists. Only agreed 54% of time - implying low interrater
38
A group of 153 patients with schizophrenia were each assessed by 2 different psychiatrists. Only agreed 54% of time - implying low interrater
Beck et al
39
2 ways of testing reliability
Test retest
Inter rater
40
Strengths of reliability for schiz
+ Farmer (standardised interview)
+improvements to DSM (stripped bizzare and nonbizzare)
41
A weakness weaknesses of reliability of schizophrenia diagnoses
-Copeland
-read
42
Read et al (overlapping symptoms)
13% of population hear voices but 1% are diagnosed w schizophrenia
43
Weaknesses of validity of schiz
-Buckley
-Konstantareas and hewitt
-Rosenhand
44
Cultural interpretations of schizophrenia symptoms affect classification
Research shows that religious and cultural groups can have a marked effect on perceptions of schizophrenia. What can be seen as insane in one culture may be seen as desired in another. Therefore this can complicate a valid classification of schizophrenia
45
Negative cultural attitudes to schizophrenia
Psychological distress and mental health issues attract different levels of stigma in different cultures that will clearly affect the diagnosis of schizophrenia. This implies that without being diagnosed people with schizophrenia will continue to suffer needlessly and unable to access treatment
46
Culture of the clinician effects the diagnosis of schizophrenia
The actual nationality/ culture of the clinician can create reliability and validity issues when diagnosing schizophrenia. For many reasons different cultures diagnose in different ways (Copeland)
47
Race discrimination is evident in diagnosing schiz
Research has implied that some nationalities or countries have considerably more cases of schizophrenia than others. It’s suggested that mental health professionals perceive diverse ethnic and cultural groups very differently. Implies that to avoid misdiagnosis, clinicians should be mindful of subtle prejudices
48
Weaknesses of cultural bias affecting classification of schizophrenia
-Malgady research (voices in head in Costa Rica)
-Copeland research
49
Strengths of cultural bias in diagnosis of schizophrenia
+ being aware can lead to training of psychologists in cultural differences
+ allows for different symptoms pools to be created (takes cultural norms into account)
50
Unreported facts between men and women when diagnosing schizophrenia
Men suffer more severe negative symptoms than women as well as suffering more from substance related disorders. Men are more likely to be involuntarily committed psychiatric wards than women (Goldstein)
51
Biased research (gender bias schizophrenia)
Some psychologists claim research into schizophrenia has neglected to use many female patients, questioning it’s usefulness and representativeness
52
Under diagnosing of female patients suffering from schizophrenia
Some research has suggested that women actually go under diagnosed in comparison to men. This could have far reaching consequences as it implies many women could be denied access to treatment and continue to suffer from the symptoms
53
Strengths of gender bias in schizophrenia
+prac app
54
3 biological explanations of schizophrenia
Genetic inheritance
Dopamine hypothesis
Neural correlates
55
Explain Genetic Inheritance of schizophrenia
No one gene is responsible for schizophrenia but several genes are involved
Ripke et al reported 108 genetic variants that could mediate a vulnerability to the disorder
Including variations to chromosomes 8 and 11 and the C4 gene
Havin some of these faulty genes can increase someone’s vulnerability to developing schizophrenia by inheriting biochemical imbalances or brain structure abnormalities
56
Ripke et al
reported 108 genetic variants that could mediate a vulnerability to the disorder
Including variations to chromosomes 8 and 11 and the C4 gene
57
Who reported 108 genetic variants that could mediate a vulnerability to the disorder
Including variations to chromosomes 8 and 11 and the C4 gene
Ripke et al
58
Tienari (biological schiz)
Adoption study in Finland with over 164 adopted kids whose biological mothers had been diagnosed with schizophrenia.
The study found 11 of the sample whose biological mums had schizophrenia also had schizophrenia compared to 4 from a control group
59
Adoption study in Finland with over 164 adopted kids whose biological mothers had been diagnosed with schizophrenia. The study found 11 of the sample whose biological mums had schizophrenia also had schizophrenia compared to 4 from a control group
Tienari
60
Strengths of genetic explanations of schizophrenia
+ evidence from Joseph et al
+ Tienari
61
Weaknesses of genetic explanations of schizophrenia
-twin studies would be 100%
- family studies might validate environmental explanations better (imitation)
-biological reductionism and determinism
62
Full Dopamine hypothesis explained
Elevated levels of dopamine at key synaptic sites within the subcortical regions of the brain
Eg. The Mesolimbic pathway (pos) and mesocortical pathway (neg)
Excess of dopamine is a system overload where too many impulses are transmitted. Triggering positive symptoms
63
Randrup and munkvad
Have a sample of rats schizophrenic like behaviours by giving them dopamine agonists. The rats were given it to raise dopamine levels 3 times a day for 6 days - led to long lasting abnormalities like inability to filter out irrelevant sounds. This was reversed by antipsychotics
64
Have a sample of rats schizophrenic like behaviours by giving them dopamine agonists.
Randrup and munkvad
The rats were given it to raise dopamine levels 3 times a day for 6 days - led to long lasting abnormalities like inability to filter out irrelevant sounds. This was reversed by antipsychotics
65
Cochrane
Schizophrenia is 1% in both Britain and windies but Afro Caribbean men are several times more likely to be diagnosed in Britain
66
Schizophrenia is 1% in both Britain and windies but Afro Caribbean men are several times more likely to be diagnosed in Britain
Cochrane
67
Benzel et al
Identified Three genes COMT DRD4 AKT1 all associated with excess dopamine in specific D2 receptors leading to positive symptoms
68
3 candidate genes for schizophrenia
COMT DRD4 AKT1
69
Strengths of dopamine hypothesis
+ practical applications (can give dopamine agonists or antagonists) antagonists will block receptor site and increased reuptake
+scientifically adaptable (been thru several versions showing it’s more valid than stubborn theories such as family dysfunction)
70
Weaknesses of dopamine hypothesis
-correlational
-Farde et al found no difference between schiz and normals people levels of dopamine which harms the credibility of the theory
71
Chlorpromazine
Typical antipsychotic that blocks D2 receptor
72
Typical antipsychotic that blocks D2 receptor
Chlorpromazine
73
Original dopamine hypothesis
More dopamine was produced in the brain
74
New dopamine hypothesis
Further research shows that schizophrenics had abnormally high number of D2 receptors
75
Owen et al
Found a large number of dopamine receptors in brains of schizophrenics
76
Found a large number of dopamine receptors in brains of schizophrenics
Owen et al
77
How are positive symptoms of schizophrenia caused in dopamine hypothesis
Overactivity in mesolimbic pathway
78
How are negative symptoms of schizophrenia caused in dopamine hypothesis
Lower dopamine activity in Mesocortical pathway
79
Enlarged ventricles
Correlation between schizophrenia and enlarged ventricles with them having up to 15% larger ventricles
80
Family dysfunction
Families do not have beneficial relationships and are constant sources of stress are thought to influence the onset of schizophrenia
81
3 factors of a dysfunctional family
1. High levels of interpersonal conflict
2. Poor communication or difficulty in communication
3. Being overly critical and controlling of children
82
Double bind theory
Putting children into a confusing and contradictory situation
Eg one parent saying one thing but other parent saying opposite
83
Putting children into a confusing and contradictory situation
Double bind theory
84
Learned helplessness
Created by double bind and is created when people feel like they’re in a lose lose situation and feel powerless to do anything about it
Leads to Flatt affect in adulthood
85
Family dysfunction mainly causes…
Flatt affect in adulthood
86
Strengths of family dysfunction
+research support (Lidz)
+ family therapies
+Linssen
87
Weaknesses of family dysfunction
- Aetiological Fallacy
-cause and affect
-Liem
88
Aetiological Fallacy
Mistaken way of thinking (mistake giving theory credit because practical application that came from it is good)
89
Schizophrenogenic mother
Historical theory from 1950s that Blamed mother for lacking the necessary emotional support for their children.
90
Characteristics of schizophrenogenic mother
Domineering, insensitive, controlling, overprotective as well as rejecting, refuses to acknowledge child’s independence
91
Expressed emotion
HEE families express considerable emotions ( higher concern or higher hostility)
Focus on a families reaction to someone’s deteriorating mental state which can have a huge effect on the client
92
Linszen
Found patients that return to a HEE household are 4x more likely to relapse
93
Found patients that return to a HEE household are 4x more likely to relapse
Linszen
94
Kuipes
Found HEE relatives talk more and listen less
95
Found HEE relatives talk more and listen less
Kuipes
96
Liem
Measured patterns of parental communication in families with schizophrenic child and found no difference compared with normal families (refutes double bind)
97
Measured patterns of parental communication in families with schizophrenic child and found no difference compared with normal families (refutes double bind)
Liem
98
Cognitive theory of schizophrenia
Faulty thought processes are responsible for the onset and maintenance of schizophrenia
Delusions are seen as occurring due to processing information irrationally
99
Cognitive deficits
Impairments in thought processes such as perception, memory and attention
Difficulty understanding other people’s behaviours might explain some of the problems schiz ppl have.
100
Cognitive bias
Present when people notice, pay attention to or remember certain types of information better than others (selective)
Can explain delusions (like persecution) and auditory hallucinations
101
Strengths of cognitive approach to schizophrenia
+ lead to prac app (STARTUP)
+ research support (Stirling)
102
Weaknesses of cognitive approach to schizophrenia
-cause and effect
-alternative explanations (biological is more valid - less inferences)
103
Meta representation
How people monitor their thoughts
People with schizophrenia are thought to have dysfunction with thought processes. Leading to problems with attention memory.
Sufferers disrupt their own ability to recognise whether a behaviour is carried out by ourselves or others. (Hallucination is interpreted as someone speaking to us but is actually our own thoughts)
104
How people monitor their thoughts
Meta representation
105
Central control
Cognitive ability to suppress automatic thoughts
Could result in disorganised speech and thinking
Each work triggers associations which the patient cannot suppress automatic responses to
106
Side effects to typical antipsychotics (chlorpromozine)
Dry mouth, urinary problems, constipation and visual disturbance
Low
Blood pressure
107
Atypical antipsychotics
1990s
Modulates levels of dopamine in key pathway in brain.
Also work on seratonin and glutamine and relived negative symptoms aswell as positive
108
Side effects of atypical antipsychotics
(Riseridone)
NMS
Weight gain
109
Lidz
Looked at cases of 50 schizophrenic patients and investigated family backgrounds. 90% had seriously disturbed families. 60% of patients had 1 or both parents with a personality disorder
Skewed families
110
Looked at cases of 50 schizophrenic patients and investigated family backgrounds
Lidz
Found 90% of patients had seriously disturbed families
60% had one or both parents with mood disorder
Typically came from skewed families
111
Farmer
Found that a standardised interview technique such as the PSE increases the reliability of diagnosing schizophrenia because it focuses on the frequency and severity of symptoms.
112
Who Found that a standardised interview technique such as the PSE increases the reliability of diagnosing schizophrenia because it focuses on the frequency and severity of symptoms.
Farmer
113
Konstantarea and Hewitt
Compared 14 male autistic patients with 14 male schizophrenia patients.
Found none of the schizophrenic patients had symptoms of autism but 50% of autistic patients had symptoms of schizophrenia. Showing support for symptom overlap
114
Malgady
Different cultures interpret symptoms of mental disorders differently. In traditional Costa Rican culture hearing voices is interpreted as spirits talking to them but in the USA the phenomenon is a symptom of schizophrenia
115
Who said Different cultures interpret symptoms of mental disorders differently. In traditional Costa Rican culture hearing voices is interpreted as spirits talking to them but in the USA the phenomenon is a symptom of schizophrenia
Malgady
116
Loring and Powell
Randomly selected 290 male and female psychiatrists to read two cases. When the patient was described as male or no info given, they would be diagnosed 56% of the time. Whereas if they were described as female only 20% were diagnosed.
117
Who Randomly selected 290 male and female psychiatrists to read two cases. When the patient was described as male or no info given, they would be diagnosed 56% of the time. Whereas if they were described as female only 20% were diagnosed. h
Loring and Powell
118
Joseph
Found a 40% concordance rate in schizophrenia for MZ twins and 7% for DZ twins. The higher concordance rate for MZ twins indicates a genes have an influence over the development of schizophrenia
119
Who Found a 40% concordance rate in schizophrenia for MZ twins and 7% for DZ twins. The higher concordance rate for MZ twins indicates a genes have an influence over the development of schizophrenia
Joseph
120
Tienari
Finish 164 adopted kids whose biological mum had schizophrenia. Matched with kids whose mum didn’t have schizophrenia. The study found 11 of the sample also had schizophrenia compared to just 4 of the control group.
121
Who studied 164 adopted finish kids whose biological mum had schizophrenia. Matched with kids whose mum didn’t have schizophrenia. The study found 11 of the sample also had schizophrenia compared to just 4 of the control group.
Tiernari
122
Mcewen
Argues that nurturing influences can actually instigate the structural changes in the brain, making the explanation incomplete.
Children and adolescents brains are more sensitive to stressors and which can reshape the organisation of cortical regions, leading to schizophrenia
123
Who Argues that nurturing influences can actually instigate the structural changes in the brain, making the explanation incomplete.
McEwen
124
Butzlaff and hooley
completed a meta analysis of 26 studies and found that when patients suffering from schizophrenia returned to families with high EE they experienced more than twice the rate of relapse of schizophrenia
125
Who completed a meta analysis of 26 studies and found that when patients suffering from schizophrenia returned to families with high EE they experienced more than twice the rate of relapse of schizophrenia
Butzlaff and hooley
126
Stirling
Found that participants with schizophrenia took longer to complete a stroop test. Supporting the idea that schizophrenia sufferers have problems with their CMS (ability to suppress automatic thoughts)
127
Davis
Analysed the results of 29 studies and found that relapse occurred in 55% of patients on a placebo drug competed too just 19% of those on antipsychotic medication.
128
Analysed the results of 29 studies and found that relapse occurred in 55% of patients on a placebo drug competed too just 19% of those on antipsychotic medication.
Davis
129
Analysed the results of 29 studies and found that relapse occurred in 55% of patients on a placebo drug competed too just 19% of those on antipsychotic medication.
Davis
130
Startup
Recruited 90 patients who had schiz. 43 were given AP. And the rest were given AP and CBT
They found that 60% of CBT group showed clinical improvement. Compared to 40% of the AP group.
131
Who Recruited 90 patients who had schiz. 43 were given AP. And the rest were given AP and CBT
Startup
They found that 60% of CBT group showed clinical improvement. Compared to 40% of the AP group.
132
Zimmerman
Found that CBT is useful at dealing with the stress that comes with positive symptoms. But may be less useful at treating negative symptoms of the disorder
133
Leff
Tested the effectiveness of family therapy
Found that families involved in the intervention showed a decrease in critical comments directed towards the patient. Plus 78% of patients in the control group were readmitted to hospital compared to 14% of the experimental group.
134
Who Tested the effectiveness of family therapy
Leff
Found that families involved in the intervention showed a decrease in critical comments directed towards the patient. Plus 78% of patients in the control group were readmitted to hospital compared to 14% of the experimental group.
135
Vaughn and Leff
Researched schizophrenia pays its returning to high or low EE households. The effect of no medication on low EE was insignificant. In the High EE household relapse was 92% with no medication
136
Allyon and Azrin
Set aside a ward of 45 schizophrenia patients. They screamed for long periods of time, assaultive and were mute. Following a system of TE they had dramatic improvements in selfcare. However when the system was removed these behaviours disappeared.
137
Longnecker
Reviews studies and concluded since 1980 males have been diagnosed with schizophrenia more often than women
138
Heterogeneous disorder
Symptoms can present themselves in very different ways
139
Liberman
Compared the effectiveness of typical and atypical antipsychotics in 1400 patients and found 74% discontinued cof of side effects
140
Compared the effectiveness of typical and atypical antipsychotics in 1400 patients and found 74% discontinued cof of side effects
Liberman
141
Evaluations of drug therapy
+ Davis
+ non disruptive compared to cbt
-Liberman
-doenst tackle root cause (reductionism)
142
Evaluations for CBT
+ startup
+tackles root cause with no side effects
-only good for mild to moderate
-expensive
143
IPT
Integrated psychological therapy
Improve attention- may be taught to recognise and respond appropriately to social cues
Reality testing to remove patients false beliefs
144
CSE
Coping strategy enhancement
Teaches better ways to manage the severity of their symptoms to reduce distress and impact on day to day functioning
Can include positive self talk and relaxation techniques
145
Tarrier
Found 73% of their sample reported they were successful at managing their symptoms
146
Tarrier
Found 73% of their sample reported they were successful at managing their symptoms
147
Chadwick
Showed someone who thought he could determine the future 50 vids and asked him what would happen next
He got it wrong everytime leading him to see that he could not
148
Family therapy
An attempt to fix the faulty and dysfunctional dynamic of a family
Tries to alter communication within a family and trains people to express emotion in a more beneficial way
149
Ao1 family therapy
Improve positive and decrease negative forms of communication
Increase tolerance levels and decease criticism within family
Decrease feelings of guilt or responsibility
‘4 safe walls’
9-12 months
-educate family on disorder and push for openness
150
Evaluations of family therapy
+ tackles cause of problem
+ decrease the chance of relapse aswell as educating the sufferer (leff)
-requires whole family to be 100% committed
-9 to 12 months
151
Evaluations for token economy
+ ghipour
+ doesn’t treats anything just manages it
-not appliquable outside of institution
-patronising
152
Gholipour
Found that token economy approach reduced negative symptom scores by 46%
153
Diathesis stress model schiz
Dispatches is can be a biological factor or modern theories suggest even childhood trauma that can be triggered by a major life event or amalgamation of stress to cause schizophrenia
154
Walker
Reported schizos have higher cortisol levels which is related to severity of symptoms
He found these stress increases heightened genetically influenced abnormalities in dopamine transmission triggering schizophrenia
Also found high stress was present before onset of schizophrenia
155
Evaluation of interactinalist explanation of schiz
+ walker
+ prac ap
- can’t see HOW they interact
156
Guo
Patients who received a combo of AP and CBT had improved quality of life and better insight than just AP and they were also less likely to discontinue treatment
157
Evaluations of interactionalist treatments
+GUO
+ more cost effective in long term as reduced relapse
-more expensive than single therapy
-patients can interpret side effects from drugs as CBT side effects creating mistrust and less effective therapies
