schizophrenia Flashcards
A negative symptom is…
symptom that takes away from the ability to function normally
A positive symptom is…
symptom that adds to normal mental functioning
The two negative symptoms are…
speech poverty and avolition
Avolition is the…
lack of motivation and will to perform tasks/do stuff
The two positive symptoms are…
hallucinations and delusions
co morbidity is…
When a person has two or more disorders at the same time
symptom overlap is…
when two different disorders have a symptom in common/share a symptom.
may lead to incorrect diagnosis
difference between reliability and validity
reliability=consistency of measure
validity-accuracy of measure
State evidence for genetic explanations of schizophrenia
(Gottesman) risk of developing schizophrenia is
48% in twins
9% with a sibling
2% with a relative e.g.uncle
what is the genetic explanation of schizophrenia
If some family members have schizophrenia, then it is more likely they develop schizophrenia due to inheriting the gene alleles for schizophrenia
Schizophrenia is caused by multiple….
gene alleles
e.g .Ripke did a meta analysis of genome wide studies on sch. and found that there are 108 alleles which may increase risk of sch.
Schizophrenia is most likely caused by the gene that codes for….
dopamine
twin study evidence for genetic explanations of schizophrenia
Gottesman
concordance rates for schizophrenia
MZ- 48%
DZ- 17%
adoption study evidence for genetic influence of schizophrenia
Tienari et al.
experimental group-adopted kids whose biological mothers had sch
control group-adopted kids whose biological mothers did not have sch
significantly more kids with sch in experimental group than control group
limitation of adoption studies
Assume that the biological parent has no influence on the child. This is not true because children are paired with adoptive parents with a similar background, living in similar area with biological parent. Ignores potential shared environment between bioparent and child.
what is the dopamine hypothesis?
Sch caused by excess and imbalance of dopamine in areas of the brain
A neural correlate is…
a biological process in the nervous system associated with schizophrenia e.g. dopamine hypothesis
outline 2 features of dopamine hypothesis
1)high levels of D2 receptors on their receiving neurons resulting in more dopamine binding and thus more neurons firing.
4)Low DA in prefrontal cortex leads to high DA in subcortex
original dopamine hypothesis
Hyperdopaminergia- subcortex
HIGH dopamine activity in subcortex e.g. excess dopamine receptors in broca’s area(responsible for speech production) associated with hallucinations and speech poverty
updated dopamine hypothesis
Hypodopaminergia- prefrontal cortex
LOW dopamine affects thinking and decision making(avolition//negative symptoms)
The dopamine hypothesis originates from…
Dopamine releasing drugs produce Schizophrenic symptoms
anti-psychotic drugs like clozapine reduce schizophrenic symptoms
evaluation of the dopamine hypothesis
Correlational research. therefore it is different to determine a causal relationship between dopamine and schizophrenic symptoms. Other factors like other neurotransmitters may influence symptoms of SCH.
(limit) Schizophrenia research is hard deterministic because….
Sch is biologically determined therefore the biological approach to sch states that it has a genetic basis. This makes patients feel discouraged when diagnosed, which may have further detrimental effects on their MH which may worsen their sch symptoms. Cognitive approach(soft deterministic) suggests that mental processes can be altered and manage d via freewill which gives hope to sch patients that they can live a normal life.
what are the two psychological explanations for schizophrenia
-family dysfunction exp. (schizophregenic mother)
-cognitive explanations(dysfunctional thinking)
cognitive explanation of sch.
symptoms of schizophrenia are caused by dysfunctional mental processes such as dysfunctional attention, and dysfunctional reasoning(e.g. in games)
Dysfunctional attention causes patients to overfocus on small irrelevant details of real events and coincidences. This causes positive symptoms such as hallucinations(can’t distinguish thought from reality) and delusions.
What are the two kinds of dysfunctional thinking ?(Firth et al.)
how do they explain negative symptoms?
/1/ Meta representation-cognitive inability to identify thoughts as your own, a persecution bias that some demonic force is putting specific thoughts into your head, these are often caused by paying attention to irrelevant, irrational thoughts which means that you can’t identify your behaviour as your own
/2/ central control dysfunction- inability to suppress hallucinatory and delusional thoughts(or at least they are trying to, but it is very hard for them…like me) hard to speak and suppress thoughts= speech poverty
AVoliTioN = trying to not go outside/ do anything cos you don’t want people to see you as crazy, or if you do go outside/ be active aliens will attack and kill you….
cognitive explanation for positive symptoms
due to dysfunctional attention, people with Sch overfocus on things the imagine,,,Over focussing on imagined events causes the imagined events to begin to feel real.People with schizophrenia struggle to tell the difference between things that they imagine and things that have actually happened. = hallucinations
persecution and jumping to conclusions bias= delusions
research support for cognitive explanation(AO3)
Stroop test experiment—>required to name out loud the font-colours of colour-words(red, blue , green). people with schizophrenia took twice as long as the control group without schizophrenia
limitation of cognitive explanation(AO3)
cannot eplain origins of sch. ignores effect of biology on sch. therefore cognitive explanation is a partial explanation. dysfunctional thinking could be a consequence of schizophrenia rather than a cause
3 explanations in family dysfucntion exp.
- The schizophrenogenic mother
- double bind
- expressed emotion
double bind
A double bind is when someone experiences contradictory messages, confusing them on how they should behave.
A very stressful experience=more likely to develop Sch.
expressed emotion
-The expression of negative emotions
-Members of a family speak to each other in negative ways, constant over protection/over involvement in their lives. Hostility and harsh criticism towards patient. high levels of stress results in Sch.
research—LinsZen et al—patients returning to a family with high EE are more likely to relapse than those with low EE
schizophregenic mother explanation
early rejection from mother
cold, rejecting and secretive mother leads to distrust==causes delusions
increases levels of stress=schizophrenia
evaluate family dysfunction exp. of Sch (AO3)
W-High expressed emotion may be a result of the person having Sch, consequence of living with someone with sch because sch is a nasty disorder…icl. sch patient may have delusions about their family which may result in high EE
W- For research support, info about childhood experiences was gathered from adults with sch. Unreliable source because their memory may have been distorted. They also have sch, so they may have delusions.
S- Research support-Berger found that ppl with Sch reported higher recall of double-bind statements by their mothers than control group without Sch. Shows a positive correlation between these co-variables. shows how exposure to conflicting messages amy cause Sc.
outline family therapy
-involves patient with Sch and their family
works by:
-reduced expressed emotion (reduce negative emotions by family). Aims to educate the family members and hange the family’s communication style. also teaches coping strategies to cope with sch. patient.
improve family’s ability to help
outline CBT as a treatment for schizophrenia
-Cognitive behavioural tehrapy challenges the client’s irrational beliefs(delusions and hallucinations, basc. negative symptoms)
-reduces symptoms that cause stress and anxiety but does not treat them
- also uses coping strategies that help to not trigger schizophrenic episodes:
-cognitive strategies- positive self talk, distraction
-behavioural strategies- loud music, breathing exercises
strength and weakness of CBT
S- evidence for effectiveness. Pontillo found reductions in severity and frequency of auditory hallucinations. Nationial institute for health care and excellence and NHS have recommended CBT for sch, which shows that CBT is used in medical/clinical field.
W- CBT is variable- different techniques and symptoms are included in studies. we don’t know which typa CBT is the most effective, effectiveness varies for type of symptoms dealt with=reduced quality of evidence.
strengths of family therapy
S-evidence for effectiveness. replase rates reduced by 50-60%. NICE recommends it.
S-benefits all family members. family provides the most care so effects of family therapy are important. strengthens functioning of whole family, lessens the negative impacts of Sch. on family members
What are Token economies ?
Systems of secondary reinforcement used to improve the behaviour of individuals by systematically rewarding desired behaviour.
- used in psychiatric hospitals/institutions to adjust patients who have developed bad habits back to normal life/community.
-based upon operant conditioning(positively reinforces behaviour)
-
3 categories of target behaviours in token economies
-personal care
-condition related behaviour
- social behaviour
research support(AO1)
benefits of token economies
Ayllon and Aznin-used on a ward of female psychiatric patients and the number of tasks carried out by patients increased significantly
-improves quality of life and normalises behaviour that is usually difficult e.g. Showering
Secondary reinforcers vs primary reinforcers
Secondary reinforcers - tokens(plastic circle)
primary reinforcers- reward e.g. chocolate
tokens are exchanged for rewards
strengths of Token economies
S- Research support. researcher identified 7 high quality studies that examined effectiveness of TE and found a decline in frequency of unwanted behaviour and negative symptoms
weaknesses of Token economies
W- ethical issues-gives professionals power to control the behaviour of people, Target behaviours may not be identified sensitively. Some people are seriously ill and restricting the availability of pleasures may make their condition worse. Has resulted in legal action by families in some cases.
W- Research used as evidence uses seven studies, which may have been chosen because of their desirable results, may have been bias towards positive published findings,and may have chosen what was available(not random). Results lack validity, so can the findings on TE be generalised?
W- difficult to continue outside a hospital setting e,g in community care because target behaviours are not monitored closely, and tokens aren’t given immediately so TEs loses its effectiveness
What is the interactionist approach?
a range of factors, including biological and psychological and social are involved in the development of schizophrenia.
traditional diathesis-stress model
(Meehl)
Diathesis- schizogene which causes a schizotype personality. Amount of stress is irrelevant, without schizogene
Stress- chronic stress through childhood leads to Sch.
modern diathesis stress model
Diathesis- no schizogene- 108 gene alleles instead-ripke et al
diathesis does not have to be genetic may be psychological,g, trauma
neurodevelopment-early trauna affects brain develiopment, HPA becomes overactive so person is vulnerable to later stress.
Stress- e.g. cannabis use/substance abuse may interfere with dopamine system
treatment according to interactionist model
antipsychotics combined with CBT
evaluate interactionist model
S- Research support(Tienari et al)
DSM-5 needs….
one positive symptom to diagnose SCh
ICD-10 needs…
2 or more negative symptoms to diagnose SCh.
difference between agonist and antagonist
agonist-increases action of a neurotransmitter
antagonist-decreases action of a neurotransmitter
name the 3 antipsychotics
-clozapine
-risperidone
-chlorpromazine
Typical vs Atypical antipsychotics
typical = older
atypical=newer
Function of chlorpomazine(Typical)
Dopamine antagonist(blocks dopamine)
reduces positive symptoms-hallucinations
normalises neuro transmission in areas of the brain. sedation effect, calming effect and reduces anxiety
Function of clozapine and risperidone(atypical)
clozapine- Acts on dopamine, glutamate, serotonin. Also binds to and blocks dopamine. improves mood, reduces depression and anxiety. usually for ppl at high risk of suicide. weaker immune system tho.
Risperidone: most recent, binds to dopamine receptors more strongly than clozapine does, so smaller dose and fewer side effects.
weakness of typical antipsychotics
- dangerous side effets. Patients may experience involuntary movement of the tongue, jaw and face. Side effects are so distressing that patients need to take drugs to suppress these side effects or stop medicine.
- may also get symptoms that resemble Parkinson’s disease
strength of atypical antipsychotics
less severe side effects.
