Schizophrenia Flashcards
Definition of positive symptoms for schizophrenia?
Symptoms and behaviours that happen in addition to normal behaviour
What are the positive symptoms of schizophrenia?
Hallucinations: unreal perceptions that can be auditory or visual
Delusions: beliefs are unreal
- beliefs that someone is out to get them
- belief that they are superior to everyone
What is disordered thinking?
The thoughts jump from one topic to another with no logical flow.
May have muddled speech.
May not always be their own thoughts
Definition of negative symptoms for schizophrenia?
Things that inhibit normal behaviour
e.g. holding a conversation
Name and describe 3 negative symptoms of schizophrenia
Alogia: the reduction of speech and loss of meaning in their speech
Anhedonia: inappropriate reaction to certain occasions. e.g. pleasure for a win
Catatonic Behaviour: fast movements to no movement at all. e.g. Move for no purpose and wandering in circles
Name the biological explanations of schizophrenia
Genetics and Structural Abnormalities
Structural Abnormalities: What are the 2 sections to describe?
Enlarged ventricles and Cortical Atrophy
Describe enlarged ventricles
Ventricles are areas that produce fluid which provides protection and stability
There are 4 ventricles which in schizophrenics are larger than people without. CAT scans showed that ventricles size was larger.
- 58 schizophrenics / 56 normal - 40% outside control
Describe Cortical Atrophy
Cortical Atrophy - loss of neurons in cerebral cortex
loss of neurons affects cognitive functions
Found to be related to sex - male
What 3 sections are used to evaluate structural abnormalities?
- Are the finding replicable
- Cause or effect?
- neurodegenerative or neurodevelopment?
Explain replicable findings of schizophrenia for structural abnormalities?
The presence of enlarged ventricles in people with schizophrenia is a reliable finding.
Abnormalities are not always found - only evident in some individuals
Need to know subtle differences between subtle differences
Explain the cause and effect theory of schizophrenia
Unclear if abnormalities are a cause or effect of schizophrenia or an effect o having schizophrenia
Environment has an effect on brain tissue
Medication treatment (antipsychotics) actually causes structural abnormalities
Explain the neurodegenerative vs neurodevelopmental theory of schizophrenia
Neurodevelopmental - hinder healthy brain development
Neurodegenerative - changes in the brain - loss of tissue
Schizophrenia result of combination between neurodegenerative vs neurodevelopmental
What sections are used to describe genetics in relation to schizophrenia?
- Twin studies
- Family Studies
- Adoption studies
What are ‘Family Studies’?
Individuals with schizophrenia and find out if relatives are affected more often than non-biological relatives
Schizophrenia is more common in relatives compared to non-biological relatives
- Closer genetic relatedness = greater risk
- 2 schizophrenic parents = 45%
- 1 schizophrenic parents = 15%
- Sibling = 10%
What are ‘Twin Studies’?
Contributions between genetic and environmental factors
- monozygotic twins - 100% genetics
- Dizygotic twins - 50% genetics
Monozygotic more likely to show traits
Joseph - 40% in MZ / 7% DZ
- Blind Studies - researchers don’t know if twins are MZ or DZ - support previous evidence
What are ‘Adoption Studies’?
Removes any environmental influence
Genetically similar - raised separately
- 160 Adoptees - mothers with schizophrenia
- 7% had schizophrenia compared to 2% of normal adoptees
- genetics have influence
Evaluate ‘Family Studies’
Appears to run in families
May be due to common upbringing
- stressful experiences beyond coping mechanisms may trigger schizophrenic episodes
Evaluate ‘Twin Studies’
- Assumption that twins grow up in same environment
- Assumed that genetics is the factor that create difference
- MZ twins may experience more similarity e.g. mistaken identity
- differences then reflet more about environment between MZ and DZ twins
Evaluate ‘Adoption Studies’
Assumption of parents that adopt potential schizophrenic child is the same as another other adopting parent
- Joseph - Denmark and US
- adopting parents informed of genetic background
- who would want a potential schizophrenic?
What are the individual differences explanations of schizophrenia?
Psychodynamic Approach and Cognitive Approach
3 sections to describe on the psychodynamic approach of schizophrenia
- Fixation/Regression
- Lose of touch with reality
Describe Fixation + regression
During psychosexual stages libido receives satisfaction of lips and mouth - oral stage
Too much satisfaction causes fixation during oral stage
As adult - If excessive stress experienced
Regression is an ego defence - retreat back to earlier stage - oral stage
Describe the loss of touch with reality
Ego is not developed during oral stage
Ego’s role is to control id’s impulses and try to balance the demands.
Regress back to where the ego doesn’t exist
Individual loses touch with reality
Unable to distinguish between reality and desires
Normal adults have well-developed egos
What are the 2 sections used to evaluate the psychodynamic approach of schizophrenia?
- Freudian Concepts are out of date
- Failure to provide an effective treatment
Explain the out of date Freudian concepts (psychodynamic evaluation)
- circular thinking due to lack of science
- Never been able to test theories of psychodynamic
e.g. Id, ego, superego never tested - How can it be trusted?
- Biological evidence explain some reasons behind schizophrenia - psychodynamic ignores these theories - can’t ignore genetics
- Adoption studies = 10% of adoptees with schizophrenic mother diagnosed with schizophrenia
Explain the failure to produce and effective treatment (psychodynamic evaluation)
- Individuals with schizophrenia not suitable to undergo psychoanalysis
- Schizophrenics lacked ability to reflect and use insight - necessary for treatment
- Psychoanalysis can lead to more stress - harmful if patients can’t access memories - distressing
- Freud said that there was no effective treatment
- Theory but no treatment
What are the 3 sections of cognitive explanation approach?
- Explaining Hallucinations
- Explaining negative symptoms
- Lack of preconscious filters
Describe the explanation of hallucinations
- Hallucinations seen by many people – not just schizophrenics – most people not diagnosed with psychiatric problem.
- Sleep deprivation can be a trigger
Some people relate these voices to the devil - This create social withdrawal behaviours or self-harm – producing sadness/ shame
- Reinforce message of the ‘voices’
Describe the explanation of negative symptoms (cognitive)
- Beck - cognitive triad - explains depression
- Dysfunctional Beliefs due to negative view of future - only allow negative messages
Lead to:
Flatness of effect
Anhedonia (inappropriate reactions)
Describe the lack of preconscious filters (cognitive)
- Frith - information that reaches the awareness = preconscious
- Attentional filters inhibit most sensory information going out of consciousness are defective
- Schizophrenics aware of many different interpretations of events
- Unable to select correct interpretation
- Frith - symptoms are a result of faulty attentional filters
What are the 2 sections used to evaluate the cognitive approach for schizophrenia?
- A reductionist account
- Not a comprehensive theory
What is the explanation of the reductionist account?
- Frith - explanation that the faulty cognitive mechanisms and disconnection between the mechanisms in the frontal cortex (decision making) and mechanisms in posterior (perception) areas
- Frith evidence when detecting changes in blood flow in the brain of people with schizophrenia when completing cognitive tasks
- Summary is reductionist - a highly complex life experience is purely down to the dysfunction of brain circuits.
Describe the non-comprehensive theory of the cognitive approach (Evaluation)
- Criticised - only able to explain cognitive symptoms of schizophrenia
- Issues with movement are not able to be explained
- Only able to explain the symptoms – but not the origin
e.g. can only explain what causes current symptoms, but not the origin of the condition.
People should be cautious to only take the cognitive explanation on schizophrenia
What are the social psychological explanations of schizophrenia?
- Dysfunctional Families + Expressed Emotion
- Sociocultural families
What is the double bind theory?
- Symptoms a result of mixed communication signals
- Conflicting messages
- Child isn’t able to appropriately respond to signals
e.g. mother shows verbal interest, conflicting with no interest non-verbally - Child reliant on mother - not able to explain feelings about mixed message
- Long-term exposure causes child to be unable to understand the difference between normal and conflicting messages - lead to hallucinations + delusions
Name and describe 3 components of expressed emotion
- Critical Comments – ‘they are so lazy, they don’t help’ – high EE carers, low EE understand behaviours due to illness
- Hostility – present with high EE carers – may be as a result of unmanageable anger and irritation
- Emotional Over-involvement – manifest with happiness, sadness, self-sacrifice and over-protection – especially evident with parental carers
Describe the study on Expressed Emotion
Brown - the use of the drug chlorpromazine
many patients that used the drug relapsed and readmitted into hospital.
- Men with schizophrenia who had strong links with the type of home they went after discharge – stayed with parents, wives or siblings
- Interviews with carers show links between amount of expressed emotion and likelihood of relapse
What are the 2 sections that evaluate dysfunctional families?
- Double bind: cause or effect
- Shared environment or shared genes
Explain the cause or effect evaluation of double bind theory
Studies show communication difficulties with individuals with schizophrenia
- Not many show difficulty in communication between families` who have an individual with schizophrenia
- parents of 11 sons with schizophrenia had no disordered communication than the family with parents of 11 sons without schizophrenia
- Studies that show mixed communication may be parents adapting to their child who had schizophrenia
- The double bind communication may be an effect was schizophrenia not cause
Describe the shared genes or environment evaluation
- Challenge of explaining schizophrenia by using families is that schizophrenia may be due to Expressed Emotion, could also be the result of shared genes within the family.
- Diathesis-stress, mixed communication and the different levels of EE and other family relationships may be a trigger that causes the genetically vulnerable people to develop schizophrenia.
What sections explain the sociocultural factors or schizophrenia?
- Social Isolation
- Ethnicity and Discrimination
Describe the social isolation explanation of schizophrenia.
- Individuals tend to have a solitary background, with no friends and no social network than people without schizophrenia
- Schizophrenics tend to find social interactions with other people stressful so therefore withdraw – urbanicity can lead to social isolation
- Self-imposed isolation blocks the individual from the understanding what behaviours are appropriate, then may behave in a strange manner
- Jones - Suggest that individuals diagnosed with schizophrenia were more likely to show solitary behaviours from an early age and rate themselves as less socially confident
Describe the ethnicity and discrimination factor of schizophrenia.
- Statistic show that Caribbean individuals have higher diagnosed individuals with schizophrenia
- This group is more likely to find themselves being compulsory admitted to hospital
- This is not genetic as this rate of diagnosis is not shown in studies taken place in the Caribbean
- Stress caused by migration may be a reason
- Caribbean children who were born in the UK kept these numbers of diagnosis
- Discrimination in society and psychiatry is a better explanation
What is the sociocultural evaluation for schizophrenia?
Social isolation: Cause or effect
Evaluate Social Isolation (cause or effect)
- Research suggests a causal role of social isolation
- Suggests that single people who lived in areas with few single people had an increased risk to develop schizophrenia –then increased their isolation even further
- Social isolation is a valid cause of schizophrenia
- Social isolation may not be a cause it, may be an early indication of psychosis
- Not able to pursue this idea forward until we have a prevention strategy
e.g. a friend group in a controlled setting which will remove the role of social isolation
What are the methods of modifying behaviour for schizophrenia?
- Antipsychotic drugs
- CBT
How do Antipsychotic drugs work?
- blocks the dopamine receptors
- The presynaptic neuron releases dopamine and the drug causes more dopamine to be released into the synapse – creating an overall rise in the level of dopamine in the body
- Chlorpromazine blocks the dopamine receptors
- Effect of this is that the level of dopamine eventually drops as the stores are depleted and so are the levels of dopamine in the synapse
- This is due to the continued blockade of chlorpromazine which leads to a decrease in neural activity
- A decrease in activity in the brain is thought to be responsible for the reduction of the positive symptoms of schizophrenia – hallucination and delusions
What is the difference between Typical and Atypical drugs?
- Atypical are newer
- work the same as conventional
- Way of working is unknown
What are the 2 sections that evaluate antipsychotic drugs?
- Effectiveness of Antipsychotics
- Difficulty assessing antipsychotics
Describe the study that shows the effectiveness of antipsychotics
- Cole – suggests that psychiatry could affect and treat the mental disorders in the same way as physical disorders could be treated – by using drugs
- 75% of the people given the antipsychotic improved compared to the group given the placebo (25% improved)
- None of the patients give the drug had become worse in comparison the roughly 50% given the placebo
- Schizophrenia used to be considered untreatable
Evaluate the difficulty of assessing the effectiveness of antipsychotics
- One problem with antipsychotic drugs is that the medication is of non-compliance
- An issue with individuals with chronic schizophrenics lack insight – believing that they have no problem and don’t need medication
- The was only full compliance from 54% of the individuals with schizophrenia who took these drugs
- So therefore the drugs may not be as effective as they seem
What are the evaluation points of social and ethical implications?
Ethical: Side effects, Chemical Straightjackets
Social: Risk of Violence
Describe the evaluation of side effects of antipsychotic drugs
- Problem with drugs is that they have side effects (some more than others)
- Serious side effects of these antipsychotics is the risk of Parkinsonism (shaking and tremors) and seizures
- Need to weigh up the risk of these side effects with the benefits
- Patients with an acute episode of schizophrenia they may be given with a dose of antipsychotics – this lacks valid and informed consent
Describe the evaluation of chemical straightjackets
- Antipsychotics are no more than chemical straightjackets and are used as a means to keep people under control
- Raises the question of: Are antipsychotics used to alleviate suffering or used to increase the compliance of an individual to society?
- If offer the ‘right to refuse’ then people must be aware of the potential consequences that may result
e.g. self-harm or harm to others
Explain the risk of violence for social implications
- Individuals who don’t use antipsychotics pose as a threat to themselves or others. Increase in homicide rate caused by people who have refused to undergo drug therapy
- May not be purely the case of the increase homicide rate, it may be a risk factor
What is CBT?
Cognitive Behavioural Therapy
- helps to organise and rationalise irrational thoughts
Components of CBT
- Engagement strategies – very similar to REBT:
First sessions to talk about symptoms and worries
Therapist develop an understanding with the client – discuss coping strategies that can be used - Psycho-education: normalises the experiences and increases client and therapist understanding of the context and symptoms
- Cognitive strategies: e.g. thought diaries
- Behavioural skills training:
the teaching of the effect strategies – e.g. relaxation techniques – can help manage symptoms not managed by medication
Problem-solving – identify solutions, decide which solution, evaluate outcome. - Relapse Prevention:
Therapist and client identify early warning signs – identify thoughts and feelings before becoming unwell
Evaluate the effectiveness of CBT as a treatment (study)
- Schizophrenics with positive symptoms and ‘medication resistant’
- Placed into groups: CBT + standard care, CBT only, Standard care only
- People placed in CBT + Standard care symptoms had changed – 50% improved
- Standard care only – 30% improved
- CBT + standard care had significantly improved compared to only standard care
Describe the short-term effectiveness of CBT for schizophrenia
- CBT for schizophrenia works for a limited period of time
- Showed by individuals who received CBT shortly after diagnosis
- CBT group had the same relapse rate as the people who just had standard care
- The effects of CBT were only lasting for a short period of time
- Another study people who had the CBT were less effected than those who hadn’t had CBT – may be the way you measure the ‘benefits’
What are the social and ethical evaluations for CBT for schizophrenia?
- Ethical: Limited Access to CBT
- Social: CBT is cost effective
Evaluate the Ethical implications for CBT for schizophrenia
- Psychiatrists don’t see CBT as an option for suffering from schizophrenia
- Based on the fact that the client doesn’t accept that their illness is real
- Therapist doesn’t believe that the client will engage with CBT
- May be coping with the medication
- Only 50% of schizophrenics get the opportunity to experience CBT
- Therapist limits an individual from CBT who may benefit
Evaluate the social implication of CBT for schizophrenia
- Use of CBT + drugs impacting the economy?
- CBT initially more costly, in the long term it reduces the cost of the individuals needing psychiatric services
- Means that the money is saved for other health departments and for treatments
- Budgets given to healthcare services are for the immediate response and care not for the long-term - short-term and long-term costs do not balance out
