Schizophrenia Flashcards
diagnosis of schizophrenia
What are the positive symptoms of schizophrenia
Hallucinations
Delusions
diagnosis of schizophrenia
What are the negative symptoms of schizophrenia
Speech poverty
Avolition
diagnosis of schizophrenia
What are the two manuals used to diagnose schizophrenia and where are they used
DSM-5: America, Britain
ICD-10: Australia, Europe
diagnosis of schizophrenia
What does the DSM set as the criteria to diagnose someone with schizophrenia
2 out of 5 symptoms
At least 1 positive symptom
diagnosis of schizophrenia
What does the ICD set as the criteria to diagnose someone with schizophrenia
Any two symptoms
diagnosis of schizophrenia
What are the 5 symptoms of schizophrenia in the DSM and ICD
Delusions
Hallucinations
Disorganised speech
Grossly disorganised or catonic behaviour
Decreased motivation/ diminished expressiveness
issues in diagnosis of schizophrenia
Is the reliability of the classification of schizophrenia hood or bad
Good
issues in diagnosis of schizophrenia
What is test retest reliability
When the same clinician reaches the same diagnosis for the same patient on multiple occasions
issues in diagnosis of schizophrenia
What was osorio’s experiment on test retest realisability of the classification of schizophrenia
Tested 180 patients in an assessment for schizophrenia
Found test retest reliability of +0.92 for the DSM
issues in diagnosis of schizophrenia
What is inter-rater reliability
When different clinicians come to the same diagnosis on the same patient
issues in diagnosis of schizophrenia
What was osorio’s experiment on inter-rater realiability of the classification of schizophrenia
Assessed 180 individuals
Found inter-rater reliability of 0.97 using DSM
issues in diagnosis of schizophrenia
Is the validity for the classification of schizophrenia hood or bad
Bad
issues in diagnosis of schizophrenia
What type of validity are we concerned with with the classification of schizophrenia and what is it
Criterion validity- how accurately the ‘test’ used to measure schizophrenia actually measures schizophrenia
issues in diagnosis of schizophrenia
What Cheniaux find about the validity of the classification of schizophrenia
100 patients assessed by one doctor using DSM and another using ICD
DSM- 39 diagnosed
ICD- 68 diagnosed
issues in diagnosis of schizophrenia
What was rosenhan’s study on validity of classification of schizophrenia
Three woman and five men Including himself were ‘pseudopatients’
They said that they heard a ‘thud’ repeatedly to try and gain admission into 12 psychiatric facilities in 5 states
All were admitted and diagnosed with psychiatric disorders
All were forced to admit to having a mental illness and take antipsychotic drugs as a condition of their release after saying they felt fine
The average amount of time spent in institutions was 19 days
issues in diagnosis of schizophrenia
What is co-morbidity and why is this a limitation
When two conditions often occur together
Questions weather two illnesses should be diagnosed separately instead of together and if schizophrenia is a distinct condition, or if it’s symptoms are just part of other conditions
issues in diagnosis of schizophrenia
What did Buckley find about co-morbidity
50% of schizophrenia sufferers suffer from depression
47% of schizophrenia sufferers suffer from substance abuse
23% of schizophrenia sufferers suffer from OCD
issues in diagnosis of schizophrenia
Why is symptom overlap a limitation of the classification of schizophrenia
Bipolar includes symptoms such as hallucinations delusions and avolition
biological explanations- genetic
What did gottesman find about biological explanations of schizophrenia
biological explanations- genetic
What was Ripke’s experiment
Compared the genetic makeup of 37,000 schizophrenia patients with 113,000 controls through combining research on genome-wide studies
biological explanations- genetic
What did Ripke find about genetic explanations for Sz
There are 108 candidate genes associated with a slightly increased risk of schizophrenia
biological explanations- genetic
What are the strengths of biological explanations for schizophrenia
Supporting evidence- Tienari found that orphans who’s biological parents had Sz were more likely to develop it than a control group even if adoptee parents didn’t have it
Supporting evidence- Hilke found 33% concordance rate in MZ twins and 7% in DZ twins
Real world application- genetic counselling can be used for parents likely to have a child with Sz
biological explanations- genetic
What are the limitations of biological explanations for Sz
Birth complications cause heightened chance of Sz development (Morgan)
Smoking cannabis in teenage years heightens risk (Di Forti)
Morkved found that 67% of people with Sz reported at least one childhood trauma compared to 38% in a control group
biological explanations- neural correlates
What is Seeman’s dopamine hypothesis
Unusually high levels of dopamine are associated with with schizophrenia as neurons that transmit dopamine fire too easily or too often or there is an abnormal amount of D2 receptors.
It has been found that an excess of dopamine in subcortical brain areas such as Broca’s area may explain positive symptoms
biological explanations- neural correlates
What is Davis’ updated dopamine hypothesis
Updated because found that not all schizophrenics have high levels of dopamine and clozapine was effective for treating Sz even though it does nothing to block dopamine
New theory is of hypodopaminergia- too little dopamine. This means that a lack of dopamine in areas such as the PFC can be seen to cause negative symptoms
Overall, can be seen that both hyperdopaminergia and hypodomaminergia in different brain areas are associated with different symptoms of schizophrenia
biological explanations- neural correlates
What are the strengths of neural correlates as an explanation for Sz
Currant- amphetamines increase dopamine and also worsen and induce symptoms of Sz
Tauscher- antipsychotic drugs reduce dopamine levels and intensity of symptoms
Ripke- some of the candidate genes proposed by Ripke act on production of dopamine
biological explanations- neural correlates
What are the limitations of neural correlates as an explanation for Sz
Role of glutamate ignored- McCutcheon found using brain scans and post-mortems of schizophrenics that they had increased levels of glutamate. Shows the dopamine theory is over-simplified
psychological explanations
what are the two psychological explanations for schizophrenia
Family dysfunction
Cognitive explanations
psychological explanations- family dysfunction
what is the definition of family dysfunction
the abnormal processes within a family, such as poor communication, cold parenting and high levels of expressed emotion
psychological explanations- family dysfunction
who proposed the theory of the schizophrenogenic mother
Reichmann-1948
psychological explanations- family dysfunction
what is the theory of the schizophrenogenic mother
when a mother is cold and distant yet dominating and controlling this can explain why a person is schizophrenic
psychological explanations- family dysfunction
who devised the double-bind theory
Bteson-1972
psychological explanations- family dysfunction
what is the double-bind theory
when a child is faced with a situation where they don’t want to do the wrong thing but don’t know what it is due to receiving mixed messages, then when the child makes the wrong decision (which happens frequently) they are punished
this is a problem because is that this miscommunication can lead. to a child thinking the world is a dangerous and confusing place
psychological explanations- family dysfunction
what symptoms of schizophrenia is the double-bind theory thought to cause
disorganised thinking
paranoid delusions
psychological explanations- family dysfunction
what is the expressed emotion theory
the theory that a schizophrenia sufferer is more likely to relapse due to the poor quality of interaction with their family- it refers to high amounts of emotion (mainly negative) being directed at the sufferer
psychological explanations- family dysfunction
what are the three types of expressed emotion
hostility- being angry with the sufferer and rejecting them
emotional over-involvement- being too controlling and sacrificing things for the sufferer
verbal criticism- insulting or putting down the individual
psychological explanations- family dysfunction
what is a strength of family dysfunction as an explanation for schizophrenia
good supporting evidence- Read found that adults with Sz were more likely to have insecure attachment types (C or D) and that 69% of women and 59% of men with Sz were physically or sexually assaulted as a child. this shows a link between childhood and developing sz
psychological explanations- family dysfunction
what are the limitations of family dysfunction as an explanation for schizophrenia
report techniques- evidence based off retrospective, subjective report techniques that can distort recollections (under-report good memories, over-report bad memories)- this means poor internal validity
socially sensitive- places blame on family and specifically mother- can induce guilt and increase likelihood of neuroticism leading to schizophrenogenic behaviour
psychological explanations- cognitive
What are the cognitive explanations of schizophrenia
Sz is associated with several types of dysfunctional though processing- as seen through the hallucinations and delusions that can be seen in sufferers
psychological explanations- cognitive
what are the two types of dysfunctional thought processing Frith identified as causing Sz
Meta-representation dysfunction
lack of central control
psychological explanations- cognitive
what is the definition of dysfunctional though processing
when a person struggles to reflect on their own thoughts and behaviour as well as struggling to interpret the thoughts and beliefs of others. This leads to a person not being able to recognise that their thoughts and and actions are caused by themselves, not others
psychological explanations- cognitive
what symptoms does dysfunctional thought processing cause
auditory hallucinations
delusions
psychological explanations- cognitive
why does dysfunctional thought processing cause auditory hallucinations and delusions
a person would not be able to tell their own thoughts from others
psychological explanations- cognitive
what is the definition of a lack of central control
when a person is unable to think before they speak or act- causing unusual behaviours.
This is because they are unable to suppress automatic responses when doing deliberate actions
psychological explanations- cognitive
what symptoms does a lack of central control cause in schizophrenics
disorganised thoughts, speech and behaviour
psychological explanations- cognitive
why does a lack of central control cause disorganised thoughts, speech and behaviours
because a person cannot suppress automatic responses
psychological explanations- cognitive
what is a strength of the cognitive explanations of schizophrenia
Stirling compared 30 schizophrenics to 30 controls and found that people with schizophrenia took twice as long to complete the Stroop test (word colours)- this shows a link between a lack of central control and schizophrenia as schizophrenics couldn’t suppress automatic responses
psychological explanations- cognitive
what is a limitation of the cognitive explanations of schizophrenia
cognitive are ‘proximal explanations’ not ‘distal explanations’ as they only show what is happening now that causes symptoms not explaining how it occurred initially- this shows that cognitive explanations to not explain the root of the problem, therefore they do not help with trying to treat the condition
psychological therapy- CBT
what is the assumption of cognitive behavioural therapy
schizophrenia is the result of dysfunctional thinking
psychological therapy- CBT
how many sessions of CBT does a schizophrenic usually have
5-20
NICE recommend 16
psychological therapy- CBT
how does CBT tackle schizophrenia
Recognising- patient recognises dysfunctional thought
Educating- explaining where patients symptoms actually come from (dopamine etc)
Normalising- make patient realise what they experience is normal (voices just an expression of thought)
(reality) Testing- testing if patients beliefs are actually true
psychological therapy- CBT
what are the strengths of CBT as a therapy for schizophrenia
supporting evidence- Jauhar conducted a meta analysis of 34 studies where CBT was used and found evidence for significant effects on positive and negative symptoms- better than drugs which only effect positive symptoms
supporting evidence- Pontillo found CBT reduced the severity of auditory hallucinations and the national institute for health and care excellence (NICE) recommended CBT for schizophrenia, showing both research and clinical experience suggest CBT
psychological therapy- CBT
what are the limitations of CBT as a therapy for schizophrenia
not standardised- Thomas pointed out that different studies use different CBT techniques on people with different symptoms- CBT may be more effective for some than it is for others
doesn’t cure issue- CBT is palliative not curative as Sz is biological and the treatment is psychological so it doesn’t tackle the root of the problem
biological therapy
how can drug therapy be used to treat sz
antipsychotic medication is prescribed to reduce symptoms
biological therapy
how do all anti-psychotics work
by reducing dopaminergic transmission
biological therapy
what are the two types of antipsychotics
typical
atypical
biological therapy
what is a type of typical antipsychotic
chlorpromazine
biological therapy
how does chlorpromazine work
block dopamine receptors in the brain which initially causes an increase of dopamine levels but overtime the production of dopamine is reduced
biological therapy
what is the average daily does of chlorpromazine
400-800 mg
maximum of 1,000 mg
biological therapy
what effects does chlorpromazine have on symptoms and why
reduces positive symptoms as these are caused by hyperdopaminergia
biological therapy
what are the two types of atypical antipsychotic
clozapine
risperidone
biological therapy
when was clozapine invented
1970’s
biological therapy
when was chlorpromazine invented
1950’s
biological therapy
why was clozapine invented
to treat sz with fewer side effects for the patient
biological therapy
how is clozapine taken
tablet only
biological therapy
how is chlorpromazine taken
tablets, syrup or injection
biological therapy
whats the dosage per day of clozapine
450 mg
biological therapy
how does clozapine differ from typical antipsychotics
not only binds to dopamine receptors but also serotonin and glutamate receptors
biological therapy
why is clozapine binding to dopamine, glutamate and serotonin receptors a good thing
all are associated with sz
increase of serotonin makes it good for suicidal or depressed patients as can lift mood and relax the patient
biological therapy
when was risperidone invented
1990’s
biological therapy
why was risperidone invented
to overcome serious side effects of clozapine
biological therapy
how is risperidone taken
tablet, liquid or injection
biological therapy
what receptors does risperidone bind to
dopamine and serotonin
biological therapy
how does risperidone differ from clozapine and what does this mean
binds to dopamine receptors more strongly
makes it more effective in smaller doses
biological therapy
whats the daily dosage of risperidone
4-8 mg
maximum of 12 mg
biological therapy
what are the severe side effects of chlorpromazine
tardive dyskinesia- involuntary face movements
neuroleptic malignant syndrome (NMS)- high temperature, delirium and coma which could be fatal
biological therapy
what percentage of chlorpromazine takers suffer from NMS
1%
biological therapy
what are the less severe side effects of chlorpromazine
sedation, dizziness, stiff jaw, weight gain, itchy skin
biological therapy
what is the severe side effect of clozapine
agranulocytosis- lowered amounts of white blood cells, making patient more susceptible to bacteria and infections which could be fatal
biological therapy
what are the less severe side effects of clozapine
dizziness, headaches, nausea, blurred vision
biological therapy
what are the severe side effects of risperidone
nothing
biological therapy
what are the less severe side effects of risperidone
agitation, anxiety, blurred vision, muscle spasms
biological therapy
What was Gilbert’s meta analysis show (AO3)
Oversaw 66 studies and found that 53% of patients relapse after 10 months not on medication compared to 16% who did take it
Straight as it shows antipsychotics are effective in treating symptoms
Can be a limitation as shows people have to take a medication that has severe side effects for their whole life
biological therapy
What was Meltzers study? (AO3)
Compared clozapine to other drugs. Found that it worked for 30-50% of treatment-resistant people
Strength as it shows it works when other treatments fail as fits to three receptors- D,S and G
biological therapy
What is the problem of side effects of antipsychotics
Can decrease quality of life and people may chose to not take medication as is worse for them than schizophrenia itself
biological therapy
What is the problem with the second dopamine hypothesis and medication (AO3)
Hypodopaminergia is the theory when there is too little dopamine in cortical areas so if antipsychotics limits the uptake of dopamine can make people depressed
pyschological therapy- family therapy
What is the aim of family therapy
Aims to improve the quality of communication and interaction between family members
pyschological therapy- family therapy
What did Pharoah identify as strategies in family therapy
Reduce negative emotions- reduce expressed emotion which should reduce a sufferers stress and relapse rates
Improves family ability to help- makes family all agree on how they will help to maintain a normal life while helping the sufferer
pyschological therapy- family therapy
What are Burbachs proposed model for family therapy
Basic information
Resources
Safe space
C
Stress management
Relapse prevention
Maintenance
pyschological therapy- family therapy
What supporting evidence is there that frailty therapy is successful (AO3)
McFarlane found that relapse rates were reduced by 50-60% due to family therapy
NICE recommends family therapy
This shows that it can help patients lead normal lives without suffering side effects and the risk of relapse
pyschological therapy- family therapy
What did Barrowclough say about family therapy (AO3)
Does not just benefit the schizophrenic but also their family as it lessens the impact on them so they can help the sufferer more
This is a strength because it shows how the family learn to understand and tackle the problem which benefits all parties and limits the effects of schizophrenia on their everyday lives
pyschological therapy- family therapy
What are the economic benefits of family therapy
Reduces the amount of time patients need to be in hospital so costs less for NHS
management of schizophrenia
describe the first use of a TES
Allyon and Azrin used one in a women psychiatric ward in 1968
management of schizophrenia
what did Allyon and Azrin find about TES and what did this lead to
found out the number of positive behaviours displayed increased significantly
led to increased use of TES in 70’s
management of schizophrenia
what did Matson find TES helped with
personal care, condition-related behaviours and social behaviour
management of schizophrenia
what two things do TES do positively
improves quality of life
normalises behaviour
management of schizophrenia
what is selective reinforcement in regards to TES
a type of reinforcement which aims to increase positive behaviours by rewarding them while extinguishing negative behaviours through not responding to them
management of schizophrenia
what kind of reinforcer are tokens
secondary reinforcer
management of schizophrenia
what is the primary reinforcement er in TES
rewards such as being able to watch a film
management of schizophrenia
What did Glowacki find about TES (AO3)
Examined 7 studies from 1999-2013
all studies showed a reduction of negative symptoms and decline in frequency of unwanted behaviours
strength as makes patients more ready for real world and makes institutions better places
management of schizophrenia
what is a problem with Glowacki’s research (AO3)
seven studies isn’t many- ‘file drawer problem Amy be an issue’
problem as makes TES seem more effective than they actually are
management of schizophrenia
what are the ethical issues of TES (AO3)
discriminates against those who are extremely ill. Eg those who are too mentally unwell to make bed etc will receive less rewards so their time in hospital will be made worse-this has lead to peoples family members taking legal action in the past
management of schizophrenia
what did Chiang say about TES
art therapy is a ‘high-gain, low-risk’ alternative as doesn’t have ethical issues so may be better to use
the interactionist approach to schizophrenia
what is the interactionist approach
combines biological and psychological explanations and they say they interact with each other to cause Sz
the interactionist approach to schizophrenia
what is diathesis
vulnerability
the interactionist approach to schizophrenia
what does stress mean
a negative psychological experience
the interactionist approach to schizophrenia
what is the diathesis stress model
when a person with vulnerability to a mental disorder goes through trauma which causes the development of a disorder
the interactionist approach to schizophrenia
what was Meehl’s original model
that there was one ‘schizogene’ a person could have which when combined with stress could make them schizophrenic. someone without this gene could undergo any amount of stress and not get schizophrenic
the interactionist approach to schizophrenia
what disproves Meehl’s model
Ripke discovering there is 108 genes that can cause Sz
the interactionist approach to schizophrenia
how does the hypothalamic-pituitary- adrenal system (HPA) support the neurodevelopmental model
this model proposes early trauma alters development of the brain
The HPA can be more overactive due to child abuse leading to a person being more vulnerable to stress later in life
the interactionist approach to schizophrenia
how has the understanding of ‘stress’ changed over time
used to be seen as psychological in nature and particularly treated to parenting. Now refers to anything that can trigger schizophrenia- for example cannabis use (Houston)
the interactionist approach to schizophrenia
how does cannabis use act as a stressor
makes Sz up to 7 times more likely as it increases dopamine levels
the interactionist approach to schizophrenia
what did Tienari find which support=s the interactionist approach (AO3)
studied 19000 Finnish children. 145 hwere adoptees with one parent with Sz. these were compared to a control of adoptees without this genetic risk. found that those with adoptee parents who were critical and had conflict were more likely to develop sz, but this was only in those who had the sz genes
the interactionist approach to schizophrenia
what is the problem with Meehl’s original model (AO3)
OVERSIMPLIFIED- Ripke found 108 genes that cause Sz
the interactionist approach to schizophrenia
what did Houston find which supports the interactionist approach
studied surveys with schizophrenics and found 543 reported childhood sexual abuse and 643 reported cannabis use before the age of 16
the interactionist approach to schizophrenia
what is the interactionist approach to treatment
using a combination of CBT and drug therapy
the interactionist approach to schizophrenia
what did Turkington say about the interactionist approach to treatment
it is possible to believe in biological causes of Sz but use CBT to reduce symptoms
the interactionist approach to schizophrenia
what is the most common way to treat schizophrenics in Britain
combination of CBT and drugs
the interactionist approach to schizophrenia
what is the most common way to treat schizophrenics in the USA
drugs
this is due to conflict between biological and psychological models for sz
the interactionist approach to schizophrenia
what was Tarriers research into interactionist treatment of Sz (AO3)
three groups
medication and CBT group, medication and counselling, control
found that in both interactionist groups there were lower symptom levels but there were no differences in hospital readmission rates
the interactionist approach to schizophrenia
what is Jarvis and Okamis view on interactionist treatment
treatment-causation fallacy present, the belief that because a treatment is effective then it validates the cause of the disorder (there are biological and psychological causes of the disorder)
the interactionist approach to schizophrenia
what is urbanisation (AO3)
schizophrenia likely to occur when someone moves from a rural area to a busy city (trigger)
however this could be because young people more likely to do this or they are more likely to be diagnosed
diagnosis of schizophrenia
what does ICD stand for
international classification of disease
diagnosis of schizophrenia
what does DSM stand for
diagnostic and statistical manual
diagnosis of schizophrenia
what are hallucinations
unusual sensory experiences- can be auditory or visual
diagnosis of schizophrenia
what are delusions
irrational beliefs (also known as paranoia). can involve a person believing they are someone they are not or that they are being followed etc. can lead to violence
diagnosis of schizophrenia
what is speech poverty
a reduction in the quality of speech of a person, can be seen in a delay of verbal response etc.
speech disorganisation more of a focus- this is whej people change conversation mid sentence or speech becomes incoherent. this is a positive symptom in the DSM
diagnosis of schizophrenia
what is avolition
when a person finds it difficult to begin or keep up with goal-directed activity
anderson suggested three signs of avolition- poor hygiene, lack of persistance, lack of energy
issues with diagnosis of schizophrenia
what are the types of issues with diagnosis of sz
good reliability
poor validity
co-morbidity
gender bias
culture bias
symptom overlap
issues with diagnosis of schizophrenia
what did osorio find about reliability of diagnosis of sz
in a sample of 180- inter-rater reliability was 0.97 and test-retest reliability was 0.92
issues with diagnosis of schizophrenia
why is gender bias an issue in sz diagnosis
men diagnosed more often than women (1.4:1)
cotton suggests that this is because women are better at seeking help than men so deal with sz better.
suggests women may not be receiving treatment that might benefit them
issues with diagnosis of schizophrenia
why is culture bias an issue in sz diagnosis
some symptoms have different meanings in different cultures- hearing voices seen as commun ication with ancestors in afro-carribean culture
afro-carribeans 10x more likely to be diagnosed than white people in englans. not the case in africa. escobar says this is due to overinterpretation of symptoms in black british people.
shows discrimination and culture bias in diagnosis
biological explanations- genetic
what is the role of genetic mutation in sz
mutation can occur through radsiation, poison or viral infection
biological explanations- genetic
what was browns research into genetic mutation
positive correlationb between parental age and sz
0.7% chance when father under 25
2% chance when father is over 50
psychological explanations- cognitive
what part does dysfunctional thinking play in sz
sz associated with multiple types of faulty information processing
this is seen in many of its symptoms
psychological explanations- cognitive
what evidence is there for dysfunctional thinking causing sz
reduced thought processing in ventral striatum- negative symptoms
reduced processing in temporal gyrus and cingulate gyrus- hallucinations
psychological explanations- cognitive
what is metarepresentation dysfunction
metarepresentation is our ability to reflect on thoughts and behaviour
a dysfunction in this disrupts ability to to recognise our own actions and thoughts as being carried out by ourselves. this explains delusions and hallucinations
psychological explanations- cognitive
what is central control dysfunction
this results in speech poverty and thought disorder as a person is believed to not be able to supress automatic thoughts and speech triggered by thoughts.
psychological explanations- cognitive
what is the stroop test (AO3)
stirling tested on 30 sz and 30 controls their ability to read a name of a colour in a diffrent colour. found on average a much better performance in the control group. proving a central control dysfunction is a valid explanation
biological treatments
what can typical antipsychotics be described as
dopamine antagonists
biological treatments
why are typical antipsychotics dopamine antagonists
typical AP such as chlorpromazine rblock dopamine receptors in the brain which reduces action of dopamine
biological treatments
what other effect do typical antipsychotics such as chlorpromazine have
sedation effect- used to calm those with sz and other disorders in situations such as in hospital to seate them. usually a syrup not a tablet for this as syrup dissolves faster
