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Schizophrenia Flashcards

Reliability and Validity in the Diagnosis and Classification; Family Dysfunction; Dysfunctional Thought Processing; Psychological Treatments; Token Economy; Genetic Explanation; Neural Correlates and Dopamine Hypothesis; Biological Treatments; Interactionist Approach

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1
Q

What is validity?

A

Are you measuring what you set out to measure?

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2
Q

What is reliability?

A

Consistency

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3
Q

What are the core four symptoms of SZ?

A

Hallucinations

Delusions

Avolition

Speech poverty

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4
Q

What does a positive symptom mean?

A

Additional experiences

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5
Q

What does a negative symptom?

A

Removal/lessening of experiences

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6
Q

Is hallucinations a positive or negative symptom?

A

Positive

Additional sensory experiences

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7
Q

Is delusions a positive or negative symptom?

A

Positive

Additional thoughts/beliefs

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8
Q

Is avolition a positive or negative symptom?

A

Negative

Lack of motivation to carry out tasks

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9
Q

Is speech poverty a positive or negative symptom?

A

Negative

Lack of speech fluency/emotion (monotone, forced speech)

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10
Q

What are the two diagnostic tools?

A

DSM-5

ICD-10

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11
Q

What symptoms must a person have to be diagnosed by the DSM-5?

A

One positive symptom

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12
Q

What symptoms must a person have to be diagnosed by the ICD-10?

A

Two or more negative symptoms

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13
Q

How do you define reliability in terms of SZ?

A

Consistency across diagnosis (same symptoms should have same diagnosis)

Consistency across classification (same diagnosis when saying same symptoms for DSM-5 and ICD-10)

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14
Q

How do you define validity in terms of SZ?

A

Diagnosis of SZ is accurate for your symptoms or misdiagnosis

Which of the classifications is the correct diagnostic tool for SZ, or are both incorrect?

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15
Q

What are the factors affecting diagnosis and classification of SZ?

A

Gender bias

Cultural bias

Co-morbidity

Symptom overlap

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16
Q

What is cultural bias (in relation to SZ)?

A

How the culture of the person with SZ, the culture of the doctor and the country the person is in affects the diagnosis and classification of SZ

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17
Q

AO3 reliability and validity - cultural bias

A

African-Americans and Latinos have higher chance of being diagnosed with SZ by a white doctor than any other ethnicity

Afro-Caribbean British men are up to 10x more likely to receive a diagnosis

Validity: a patient may get an accurate diagnosis of SZ by one doctor/classification/country but receive a misdiagnosis of SZ in another

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18
Q

What is gender bias (in relation to SZ)?

A

How the sex of the person with SZ and the sex of the medical professional affects the diagnosis and classification of SZ

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19
Q

Which gender is more likely to be diagnosed with SZ?

A

Males

1.4:1

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20
Q

AO3 reliability and validity - gender bias

A

Doctors more likely to believe men talking about their symptoms than females

Longbecker et al: when men reported their failure to function adequately was seen as worse than females

More males used in research

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21
Q

What is symptom overlap?

A

One symptom appears in two or more conditions

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22
Q

What is symptom overlap in relation to SZ?

A

How the symptoms of SZ are seen in other disorders, making it difficult to diagnose and classify SZ

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23
Q

Limitation of reliability and validity - symptom overlap

A

Delusions

Can be bipolar disorder or dementia

Can be in multiple disorders

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24
Q

What is co-morbidity?

A

Two conditions at one time

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25
Q

What is co-morbidity in relation to SZ?

A

Buckley 2009

Percentage of cases where SZ is co-morbid with the conditions

OCD = 23%
Depression = 50%
Substance abuse = 47%
PTSD = 29%

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26
Q

What is the psychological psychodynamic explanation for SZ called?

A

Family dysfunction

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27
Q

What are the three separate theories within family dysfunction?

A

Schizophregenic mother

Double-bind theory

Expressed emotion

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28
Q

What is the schizophregenic mother?

A

SZ-CAUSING mother

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29
Q

What are the characteristics of a schizophregenic mother?

A

Cold

Critical

Harsh

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30
Q

How does the schizophregenic mother lead to SZ?

A

Child turns inwards to find love and warmth to create their own reality

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31
Q

What specific symptom does the schizophregenic mother connect to?

A

Hallucinations

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32
Q

What is the double-bind theory?

A

Risk factor of SZ is receiving contradictory messages from their parent

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33
Q

How does the double-bind theory lead to SZ?

A

Interactions lead to the child creating their own concept of reality

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34
Q

What symptom does the double-bind theory link to?

A

Paranoia

Always second guessing

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35
Q

Is it high or low expressed emotion that leads to developing SZ?

A

High

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36
Q

What is high expressed emotion?

A

Members of the family talk about the patient in a critical manner and are emotionally overly involved

Tend to talk but not listen

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37
Q

What does high expressed emotion affect?

A

The chances of relapse for the patient

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38
Q

What is the structure of family dysfunction AO3?

A

+ research support

  • problems with research method - self-report

+ practical application - family therapy

  • alternative explanations/socially sensitive (pressure on family)
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39
Q

Strength of FD - Berger

A

Schizophrenics reported a higher recall of double-bind statements from mothers than non-schizophrenic controls

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40
Q

Limitation of FD - Altorfer

A

High EE families are interpreted differently by SZ patients

1/4 showed no psychological response to EE comments

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41
Q

Strength of FD - practical application

A

Creation of family therapy

Pharoah et al 2010

Reviewed 53 studies (2002-2010) that compared family therapy against standard care (medication) in Europe, Asia and Northern American

Increase with compliance to medication and reduction in relapses during treatment and 24 months after

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42
Q

Limitation of FD - social sensitivity

A

Blames family members for causing their child to become schizophrenic

Could cause more stigma towards those family members

Could increase stress levels in the house

Could cause family to not seek support/take part in research

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43
Q

Limitation of FD - validity

A

Majority of research evidence for psychological explanation is self-report techniques

Interview the person who has SZ about their childhood experiences and relationships with their families

People with SZ suffer from delusions so may not have most accurate recall

When family interviewed, may have social desirability bias and not want to accurately report any negative interactions with SZ person

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44
Q

What is the name for the cognitive explanation of SZ (also a psychological explanation)?

A

Dysfunctional thought processing

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45
Q

What are the two theories within dysfunctional thought processing?

A

LACK of meta representation

LACK of central control

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46
Q

What is meta representation?

A

Cognitive ability to reflect on thoughts and behaviours

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47
Q

How does a lack of meta representation affect someone?

A

Disrupts ability to recognise our thoughts as our own, leading to sensation of hearing voices

Experience of having thoughts placed in mind of others

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48
Q

What symptoms does lack of meta representation link to?

A

Auditory hallucinations

Thought insertion

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49
Q

What is central control?

A

Cognitive ability to carry out a deliberate action whilst suppressing an automatic response

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50
Q

How does a lack of central control affect someone?

A

Derailment of thoughts

Each word triggers automatic association that they cannot suppress

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51
Q

What symptom does lack of central control link to?

A

Speech poverty

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52
Q

What is the structure of AO3 for DTP?

A

+ research support

  • problems with research method - inferences

+ practical application - CBT

  • alternative explanations/socially sensitive (blame on SZ individual)
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53
Q

Strength of DTP - practical application

A

Creation of CBT

NICE 2014

CBT is effective at reducing relapse rates, increasing social functioning and reducing symptom severity

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54
Q

Strength of DTP - Stirling

A

Compared 30 SZ patients with 18 controls using Stroop test

SZ patients took twice as long to complete the test

Problem with self-control caused them to be slower processing the information

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55
Q

What does CBT stand for?

A

Cognitive Behavioural Therapy

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56
Q

What is CBT?

A

Identifying irrational thoughts (delusions) and changing them

Focusing on helping them with delusions and hallucinations and reflecting on how they make them feel to reduce anxiety

Delivery of techniques to identify and manage intrusive or delusional thoughts

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57
Q

What is the patient encouraged to do in CBT?

A

Develop rational interpretations or alternative perceptions (e.g. viewing voices as interesting rather than threatening)

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58
Q

What does CBT promote?

A

Increase in social activity

Use of relaxation strategies

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59
Q

What are some of the techniques of CBT?

A

Patient-as-scientist

Journal writing

Homework

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60
Q

What is family therapy?

A

Improve communication

Resolve conflict

Learn about diagnosis

Reduce negative emotions (anger, frustration, expressed emotion)

Improve family’s ability to help

Encourage development of problem-solving and communication skills to support patient

61
Q

What does family therapy have to be?

A

Respectful

Honest

Confidential

Open and productive discussion

62
Q

What does the therapist give the family in family therapy?

A

Homework

63
Q

What is the structure of psychological treatment AO3s?

A

+ research support

  • key problems
  • alternative treatment - biological

Research into cause/other psychological treatments

64
Q

Strength of CBT - NICE study

A

Reducing relapse rates

Increasing social functioning

Reduces symptoms

65
Q

Counterargument to NICE study - CBT

A

Patients on anti-psychotics as well

66
Q

Limitation of CBT - Haddock et al

A

Even though it is the recommended treatment - 6.9% of 187 patients

Those advised didn’t attend all sessions or refused to go (avolition)

Economic cost of CBT

67
Q

Strength of family therapy - Pharoah et al

A

Reviewed 53 studies that compared family therapy against standard case (medication) in Europe, Asia and Northern America

Mental state - mixed results

Compliance with medication - increase

Social functioning - no effect

Relapse - reduction during treatment and 24 months after

68
Q

Counterargument to Pharoah et al - family therapy

A

Publication bias

69
Q

Limitation of family therapy - all family members

A

All family members need to be involved

Sometimes family members may be reluctant to take part in therapy or feel that therapy is adding to the blame/guilt that they already feel

Only effective when all family members are actively engaged with the therapy

70
Q

How can SZ be managed?

A

Token economy

71
Q

Who is token economy normally used for?

A

Patients who have been hospitalised for a long time

72
Q

What is token economy?

A

Helps encourage typical behaviour rather an schizophrenic symptoms

Operant conditioning

73
Q

How quickly does the token need to be given after behaviour?

A

As quickly as possible

74
Q

When is a token given?

A

When a desirable behaviour occurs

75
Q

What type of reinforcer is a token?

A

Secondary

76
Q

What are the rewards in token economy?

A

Tokens swapped for rewards that the patients chooses

77
Q

What type of reinforcer is a reward?

A

Primary

78
Q

What are some examples of desirable behaviours in token economy?

A

Self-hygiene (personal)

Care for environment

Social engagement

79
Q

Strength of token economy - Dickerson et al

A

11/13 studies reported beneficial effects due to the treatment of increasing adaptive behaviours in a psychiatric setting

80
Q

Limitation of token economy - ethical concerns

A

Is it bad for the doctors to restrict certain food, privacy and enjoyable activities until patients show desirable behaviours?

81
Q

Why is there believed to have some genetic element in the likelihood of getting SZ?

A

SZ runs in families

82
Q

How many different gene variations have been associated with a risk of SZ?

A

108

83
Q

What hormone are some of the genes connected to?

A

Dopamine functioning

84
Q

What have the three genes COMT, DRD4 and AKT1 been associated with?

A

Excess dopamine in dopamine receptors

85
Q

AO3 genetic explanation - with a parent, what is the shared DNA and the probability of sharing SZ?

A

Shared DNA = 50%

Probability of sharing SZ = 6%

86
Q

AO3 genetic explanation - with a sibling, what is the shared DNA and the probability of sharing SZ?

A

Shared DNA = 50%

Probability of sharing SZ = 9%

87
Q

AO3 genetic explanation - with a MZ twin, what is the shared DNA and the probability of sharing SZ?

A

Shared DNA = 100%

Probability of sharing SZ = 48%

88
Q

AO3 genetic explanation - with a DZ twin, what is the shared DNA and the probability of sharing SZ?

A

Shared DNA = 50%

Probability of sharing SZ = 17%

89
Q

AO3 genetic explanation - with a grandparent, what is the shared DNA and the probability of sharing SZ?

A

Shared DNA = 25%

Probability of sharing SZ = 5%

90
Q

AO3 genetic explanation - with a cousin, what is the shared DNA and the probability of sharing SZ?

A

Shared DNA = 12.5%

Probability of sharing SZ = 2%

91
Q

Strength of genetic explanation - research support

A

Gottesman 1991

Two SZ parents = 46%

One SZ parent = 15%

92
Q

Counter to Gottesman - genetic explanation

A

Not perfect theory, should be 100% and 50%

Nurture is the same

93
Q

Counter to nurture is the same - genetic explanation

A

Tiernari adoption study

94
Q

Strength of genetic explanation - adoption study

A

Tiernari et al 2000

164 adoptees with SZ mothers = 6.7%

197 adoptees without SZ mothers = 2%

95
Q

Counterpoint to adoption study

A

Confounding variable of adoption process

96
Q

AO3 genetic explanation - socially sensitive research

A

Cost
- individuals with SZ (decide not to have kids)
- family members/parents (blame, could cause furthering of symptoms)

Benefit
- gene screening to diagnose
- drug treatment (dopamine)

97
Q

What does neural correlates mean?

A

Brain area’s structure/functioning correlates with SZ symptoms

98
Q

Where is the ventral striatum?

A

In frontal lobe

99
Q

What is the ventral striatum in charge of?

A

Anticipating reward

100
Q

How does knowledge of the ventral striatum affect token economy?

A

The reason patients need immediate rewards

101
Q

What symptom does the dysfunction in the ventral striatum link to?

A

Avolition

102
Q

Where is the superior temporal gyrus?

A

Temporal lobe

Auditory cortex

103
Q

What is the superior temporal gyrus involved in?

A

Processing sound

104
Q

What symptom does the dysfunction in the superior temporal gyrus link to?

A

Auditory hallucinations

105
Q

Strength of neural correlates - practical application

A

Diagnosis

Brain scan

fMRIs

106
Q

What is the word for high levels/activity of dopamine?

A

Hyperdopaminergia

107
Q

Where in the brain does hyperdopaminergia affect?

A

Subcortex

Broca’s area

108
Q

What symptom does hyperdopaminergia link to?

A

Broca’s area links to speech poverty

109
Q

What is the word for low levels of dopamine systems?

A

Hypodopaminergia

110
Q

Where in the brain does hypodopaminergia affect?

A

Frontal lobe

Pre-frontal cortex

111
Q

What symptoms does hypodopaminergia link to?

A

Negative symptoms like avolition

112
Q

Strength of dopamine hypothesis - practical application

A

Treatment

Anti-psychotics

113
Q

Limitation of dopamine hypothesis and neural correlates - problems with research method

A

Cannot establish cause and effect

Need more research

114
Q

What symptoms do typical antipsychotics work on?

A

Positive symptoms only

115
Q

What symptoms do atypical antipsychotics work on?

A

Positive and negative symptoms

116
Q

Is chlorpromazine typical or atypical?

A

Typical

117
Q

What receptors does chlorpromazine bind to?

A

Dopamine

118
Q

What are the side effects of chlorpromazine?

A

Tardive dyskinea (permanent movement disorder)

119
Q

Is clozapine typical or atypical?

A

Atypical

120
Q

What receptors does clozapine bind to?

A

Dopamine

Serotonin

Glutamate

121
Q

What is the effect of taking clozapine?

A

Reduce depression and anxiety

Improve cognitive functioning and mood

122
Q

What are the side effects of clozapine?

A

Fatal blood condition

123
Q

Is risperidone typical or atypical?

A

Atypical

124
Q

What receptors does risperidone bind to?

A

Dopamine

Serotonin

125
Q

What are the benefits of risperidone?

A

More effective in smaller doses

Fewer side effects

126
Q

What is the effect of taking risperidone?

A

Works on cognitive impairments

127
Q

What are the side effects of risperidone?

A

Normal ones

Nausea

Drowsiness

Headaches

Weight gain/loss

128
Q

How does taking antipsychotics affect synaptic transmission?

A

On the post-synaptic neuron to stop absorption and decrease the amount of dopamine

129
Q

AO3 antipsychotics - evaluation points

A

Short term vs long-term effects (relapse, revolving door effect)

Comparison with alternatives (family therapy, CBT)

Implications for patient and family and economy (reasoned discussion of cost/time)

130
Q

Limitation of antipsychotics - deterministic

A

SZ individuals may choose not to take them

Drugs don’t fix all symptoms and cause of SZ

131
Q

Limitation of typical - side effects

A

Dizziness, agitation, sleepiness, weight gain

Problems associated with movement have been seen such as tremors similar to those experienced by patients suffering from Parkinson’s disease

Permanent side-effect of movement disorder (face and neck)

May lead to patients stopping taking their medication

132
Q

Strength of typical - Thornley et al

A

Reviewed data from 13 trials

Chlorpromazine associated with better functioning and reduced symptom severity compared with placebo

133
Q

Strength of typical - relative effectiveness

A

Typical drugs more effective for positive symptoms

134
Q

Strength of atypical - Meltzer

A

Clozapine is more effective than antipsychotics

Worked for patients who had tried all other treatments 30-50% of the time

135
Q

What is the interactionist explanation?

A

Diathesis-stress model

136
Q

What is the diathesis-stress model?

A

Combines effects of internal vulnerability and external stress trigger

137
Q

What is the diathesis?

A

Vulnerability originally thought to be genetic, now includes vulnerabilities due to childhood trauma which might have affected brain development

138
Q

What is the stress trigger?

A

Any negative psychological experience (breakdown of relationship, academic pressure)

139
Q

What was Meehl’s model?

A

Person with a schizophrenic gene is vulnerable to effects of chronic stress in childhood or adolescence which could lead to SZ

140
Q

In Meehl’s model, can you get SZ without the schizogene?

A

No

141
Q

In Meehl’s model, can you get SZ without the chronic stress?

A

No

142
Q

What is the modern interactionist theory?

A

Genes are not the only type of vulnerability

143
Q

What are examples of other vulnerabilities which could lead to SZ?

A

Early psychological trauma affecting brain development

Cannabis use (specifically THC in plant) can increase risk of SZ up to 7x depending on dose (interferes with dopamine system)

144
Q

Strength of interactionist explanation - stressors importance

A

Tiernari et al 2004

Compared 145 genetic risk adoptee’s with 158 low genetic risk adoptees

Family functioning of adoptive parents was significant predictor in likelihood of being diagnosed with SZ

Low OPA score had protective effect for high risk children

145
Q

What are interactionist treatments?

A

Combining anti-psychotic medication with psychological therapy (CBT)

146
Q

Strength of interactionist treatments - Tarrier et al

A

315 patients

Drugs and CBT, drugs and supportive counselling, control group (medication only)

Combination was best for lowering symptoms

147
Q

Counter to Tarrier et al - interactionist treatments

A

No difference in relapse

However family therapy helps with relapse

148
Q

Limitation of interactionist treatments - cost

A

CBT and supportive counselling is expensive

Sometimes people don’t go

Having both is “double” the cost

Relapses will cost more

149
Q

AO3 interactionist approach

A

Understanding of diathesis (polygenic) and stress trigger (any risk trigger)

Single treatments vs multidisciplinary approach

Links to broader theories (behaviour, biological approach, psychodynamic theory) and broader debates (reductionism vs holism)

Psychology (11 decks)

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