Schizophrenia Flashcards
Kraeplin
First identified schizophrenia calling it ‘dementia praecox’
Bleuler
Called the ‘dementia praecox’ schizophrenia as it means split mind
Prevalence of schizophrenia
Affects 1% of the population
Males= mid 20s
Females= early 30s
When are symptoms most severe
According to Bleulers 2000 schizophrenics the most severe is early adulthood in first 5 years of onset
% that recover from positive symptoms
40%
% that can make a full recovery if diagnosed early
20%
% of patients that suffer for rest of lives
40%
Positive symptoms of schizophrenia
Hallucinations
Delusions
Disorganised thinking and speech
Negative symptoms of schizophrenia
Speech poverty (alogia)
Flat effect
Avolition
Apathy
Innapropriate effect
Hallucinations
False sensory experiences (auditory and visual)
Delusions
False beliefs that aren’t based on facts that are hard to disprove. Persecution, grandeur and control
Disorganised thinking and speech
Thoughts drift from one thing to another (misty or hazy). Have trouble reading an article or watching TV. Words may become confused or jumbled.
Speech poverty (alogia)
Reduction in communication where it would be considered normal To communicate. Thought to result from other slowing of thoughts.
Flat affect
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
Avolition
Lack of motivation and severe lack of initiative to accomplish tasks. Could neglect household chores and personal hygiene
Apathy
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
Innapropriate affect
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
Diagnostic criteria
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
Characteristic symptoms
2 or more of symptoms are present for 1 month
Social/occupational dysfunction
Impairment in one of the main areas of functionin for a significant period of time since the onset of the disturbance
Duration
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
Schizoaffective and mood disorder exclusion
Schizophrenia if Schizoaffective and mood disorder have been ruled out
Exclusion of known organic cause
The disturbance isn’t due to substance abuse
Relationship to autism
Need to rule out autism or history of autism
Co-morbidity
Simultaneous presence of 2 or more disorders at same time
Lowers the validity of classification
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
What does comorbidity do to classification
Comorbity lowers the validity of classification
Symptom pool
Collection of symptoms a culture associates with an illness
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.
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
When was DSM classification system first published
1952
When was DSM V published
2013
Buckley- how many schiz are depressed
50%
Buckley- how many schiz have ptsd
29%
Buckley- how many schiz have OCD
23%
Buckley- how many schiz hade substance abuse
47%
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
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
2 ways of testing reliability
Test retest
Inter rater
Strengths of reliability for schiz
+ Farmer (standardised interview)
+improvements to DSM (stripped bizzare and nonbizzare)
A weakness weaknesses of reliability of schizophrenia diagnoses
-Copeland
-read
Read et al (overlapping symptoms)
13% of population hear voices but 1% are diagnosed w schizophrenia
Weaknesses of validity of schiz
-Buckley
-Konstantareas and hewitt
-Rosenhand
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
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
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)
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
Weaknesses of cultural bias affecting classification of schizophrenia
-Malgady research (voices in head in Costa Rica)
-Copeland research
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)
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)
Biased research (gender bias schizophrenia)
Some psychologists claim research into schizophrenia has neglected to use many female patients, questioning it’s usefulness and representativeness
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
Strengths of gender bias in schizophrenia
+prac app
3 biological explanations of schizophrenia
Genetic inheritance
Dopamine hypothesis
Neural correlates
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
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
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
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
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
Strengths of genetic explanations of schizophrenia
+ evidence from Joseph et al
+ Tienari
Weaknesses of genetic explanations of schizophrenia
-twin studies would be 100%
- family studies might validate environmental explanations better (imitation)
-biological reductionism and determinism
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