Schizophrenia Flashcards
What are the classifications of SZ
ICD-11 (UK) - two or more negative symptoms for 1 months or longer are sufficient for diagnosis
DSM-5 (USA) - one positive symptom must be present for at-least 1 month for diagnosis
Examples of positive symptoms of SZ
Hallucinations- unusual sensory experiences which have no basis in reality
(Auditory- voices/ Visual- seeing objects)
Delusions- irrational/false beliefs with no basis in reality
(Delusions of persecution- false harassment belief/ delusions of control- false belief of being controlled)
Examples of negative symptoms
Avolition- severe loss of motivation to carry out everyday tasks and difficulty to begin or keep up with goal directed activity
Speech poverty- reduction in amount and quality of speech, significant delay in verbal responses or lack of fluency
Define diagnosis
Identification of nature of an illness or other problem by examination of symptoms
Eg someone reporting hearing voices
Define classification
The action or process if classifying something according to symptoms
Eg a symptom of SZ is hallucinations
Reliability in diagnosis
Reliability= consistency
Whether we can gain consistent results when classifying and diagnosing SZ
Validity in diagnosis
Validity= accuracy
Extent to which we we are measuring what we intend
Are classification systems accurately outlining the signs and symptoms of sz?
Research into reliability and validity in diagnosis
Cheniaux- asked two psychiatrists to diagnosis same 100 patients using DSM and ICD. One diagnosed 26 to DSM, 44 to ICD, the other 13 to DSM, 24 to ICD
Poor inter rater reliability
Poor reliability
Questions validity
Define symptom overlap
Where two or more conditions share similiar symptoms
Both SZ and depression involve negative symptoms such as avolition
Biological explanation- genetic theory
SZ is hereditary and passed on from one generation to next through genes.
A person is born with genetic predisposition to SZ
Believed that several maladaptive genes such as PCM1 which increase an individuals vulnerability to developing sz
Concordance rate research
Gottesman
Studied 40 twins
Concordance rate for monozygotic twins was 48%
17% for dizygotic twins
Closer the genetic link the more chance of developing sz
Biological explanations- neural correlates
Enlarged ventricles
Meta analysis by Raz and Raz- over half of individuals tested with sz had increased ventricle size compared to a control group
Enlarged ventricles are associated with damage to central brain areas and pre frontal cortex
Associated with negative SZ symptoms
Biological explanation- neural correlates- dopamine hypothesis
Hyperdopaminergia in the subcortex- high dopamine activity in central areas of the brain such as Brocas area, may be associated with auditory hallucinations
Hypodopaminergia in the cortex - low dopamine activity in pre frontal cortex associated with negative symptoms of SZ eg avoltion
Psychological explanations - family dysfunctions
Individual develops SZ because they have been raised in a dysfunctional family
High levels of tension and arguments
Results in creating risk factors for development and maintenance of SZ
Schizophrenogenic mother
Schizophrenia is caused by patients earkt experience of a schizophrenogenic mother
- cold, controlling, rejecting, emotionally unresponsive and builds a family climate characterised by tension and secrecy
Leads to distrust and develops into paranoid delusions
Father is often passive
Double bind communication
Faulty communication patterns that exits within families
Parent communicates a verbal message which doesnt match non verbal message
=mixed messages
Verbally loving but emotionally rejecting
Can contribute or cause SZ
leads to avolition and disorganised thinking and paranoid delusions
Expressed emotion
High levels of emotion expressed towards a patient by family members eg verbal criticism, hostility, emotional over involvement
Can cause stress in patiebt and can trigger onset SZ
Can cause relapse
Cognitive explanation
Focus on role of internal mental processes
Metarepresentation
Cognitive ability to reflect on thoughts and behaviour
Allows us to understand ours and others actions
Dysfunction in metarepresentation disrupts ability to recognise own actions
Explain auditory hallucinations
Central control
Cognitive ability to suppress automatic responses whilst performing a deliberate action instead
Dysfunction could explain speech poverty and thought disorder, individual not able to suppress automatic thoughts and speech triggered by other thoughts/words
Treatments for schizophrenia
Drug therapy (antipsychotics)
Psychological therapies (CBT, family therapy)
Typical antipsychotics
Eg chlorpromazine
Dopamine antagonists
Reduce levels of dopamine in brain
Binds D2 receptors on post synaptic neurons in braun and reduces action of dopamine
Reduces positive symptoms
Eg hallucinations
Atypical antipsychotics
Clozapine
Binds D2 dopamine receptor sites on post synaptic neuron reducing positive symptoms such as hallucinations.
Act as agonists upon serotonin receptor sites
Reduces negative symptoms such as lack of emotions as it helps improve mood and reduce depression and anxiety
Cognitive behavioural therapy (CBT)
Usually takes place for between 5 and 20 sessions
Conducted in groups or individually
Based around the assumption that schizophrenics have irrational and unrealistic thought processes
Aim of CBT is to help patients identify irrational thoughts and change then into rational ones vis disputing
