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
1
Q
What is validity?
A
Are you measuring what you set out to measure?
2
Q
What is reliability?
A
Consistency
3
Q
What are the core four symptoms of SZ?
A
Hallucinations
Delusions
Avolition
Speech poverty
4
Q
What does a positive symptom mean?
A
Additional experiences
5
Q
What does a negative symptom?
A
Removal/lessening of experiences
6
Q
Is hallucinations a positive or negative symptom?
A
Positive
Additional sensory experiences
7
Q
Is delusions a positive or negative symptom?
A
Positive
Additional thoughts/beliefs
8
Q
Is avolition a positive or negative symptom?
A
Negative
Lack of motivation to carry out tasks
9
Q
Is speech poverty a positive or negative symptom?
A
Negative
Lack of speech fluency/emotion (monotone, forced speech)
10
Q
What are the two diagnostic tools?
A
DSM-5
ICD-10
11
Q
What symptoms must a person have to be diagnosed by the DSM-5?
A
One positive symptom
12
Q
What symptoms must a person have to be diagnosed by the ICD-10?
A
Two or more negative symptoms
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)
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?
15
Q
What are the factors affecting diagnosis and classification of SZ?
A
Gender bias
Cultural bias
Co-morbidity
Symptom overlap
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
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
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
19
Q
Which gender is more likely to be diagnosed with SZ?
A
Males
1.4:1
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
21
Q
What is symptom overlap?
A
One symptom appears in two or more conditions
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
23
Q
Limitation of reliability and validity - symptom overlap
A
Delusions
Can be bipolar disorder or dementia
Can be in multiple disorders
24
Q
What is co-morbidity?
A
Two conditions at one time
25
What is co-morbidity in relation to SZ?
Buckley 2009
Percentage of cases where SZ is co-morbid with the conditions
OCD = 23%
Depression = 50%
Substance abuse = 47%
PTSD = 29%
26
What is the psychological psychodynamic explanation for SZ called?
Family dysfunction
27
What are the three separate theories within family dysfunction?
Schizophregenic mother
Double-bind theory
Expressed emotion
28
What is the schizophregenic mother?
SZ-CAUSING mother
29
What are the characteristics of a schizophregenic mother?
Cold
Critical
Harsh
30
How does the schizophregenic mother lead to SZ?
Child turns inwards to find love and warmth to create their own reality
31
What specific symptom does the schizophregenic mother connect to?
Hallucinations
32
What is the double-bind theory?
Risk factor of SZ is receiving contradictory messages from their parent
33
How does the double-bind theory lead to SZ?
Interactions lead to the child creating their own concept of reality
34
What symptom does the double-bind theory link to?
Paranoia
Always second guessing
35
Is it high or low expressed emotion that leads to developing SZ?
High
36
What is high expressed emotion?
Members of the family talk about the patient in a critical manner and are emotionally overly involved
Tend to talk but not listen
37
What does high expressed emotion affect?
The chances of relapse for the patient
38
What is the structure of family dysfunction AO3?
+ research support
- problems with research method - self-report
+ practical application - family therapy
- alternative explanations/socially sensitive (pressure on family)
39
Strength of FD - Berger
Schizophrenics reported a higher recall of double-bind statements from mothers than non-schizophrenic controls
40
Limitation of FD - Altorfer
High EE families are interpreted differently by SZ patients
1/4 showed no psychological response to EE comments
41
Strength of FD - practical application
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
42
Limitation of FD - social sensitivity
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
43
Limitation of FD - validity
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
44
What is the name for the cognitive explanation of SZ (also a psychological explanation)?
Dysfunctional thought processing
45
What are the two theories within dysfunctional thought processing?
LACK of meta representation
LACK of central control
46
What is meta representation?
Cognitive ability to reflect on thoughts and behaviours
47
How does a lack of meta representation affect someone?
Disrupts ability to recognise our thoughts as our own, leading to sensation of hearing voices
Experience of having thoughts placed in mind of others
48
What symptoms does lack of meta representation link to?
Auditory hallucinations
Thought insertion
49
What is central control?
Cognitive ability to carry out a deliberate action whilst suppressing an automatic response
50
How does a lack of central control affect someone?
Derailment of thoughts
Each word triggers automatic association that they cannot suppress
51
What symptom does lack of central control link to?
Speech poverty
52
What is the structure of AO3 for DTP?
+ research support
- problems with research method - inferences
+ practical application - CBT
- alternative explanations/socially sensitive (blame on SZ individual)
53
Strength of DTP - practical application
Creation of CBT
NICE 2014
CBT is effective at reducing relapse rates, increasing social functioning and reducing symptom severity
54
Strength of DTP - Stirling
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
55
What does CBT stand for?
Cognitive Behavioural Therapy
56
What is CBT?
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
57
What is the patient encouraged to do in CBT?
Develop rational interpretations or alternative perceptions (e.g. viewing voices as interesting rather than threatening)
58
What does CBT promote?
Increase in social activity
Use of relaxation strategies
59
What are some of the techniques of CBT?
Patient-as-scientist
Journal writing
Homework
60
What is family therapy?
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
What does family therapy have to be?
Respectful
Honest
Confidential
Open and productive discussion
62
What does the therapist give the family in family therapy?
Homework
63
What is the structure of psychological treatment AO3s?
+ research support
- key problems
- alternative treatment - biological
Research into cause/other psychological treatments
64
Strength of CBT - NICE study
Reducing relapse rates
Increasing social functioning
Reduces symptoms
65
Counterargument to NICE study - CBT
Patients on anti-psychotics as well
66
Limitation of CBT - Haddock et al
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
Strength of family therapy - Pharoah et al
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
Counterargument to Pharoah et al - family therapy
Publication bias
69
Limitation of family therapy - all family members
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
How can SZ be managed?
Token economy
71
Who is token economy normally used for?
Patients who have been hospitalised for a long time
72
What is token economy?
Helps encourage typical behaviour rather an schizophrenic symptoms
Operant conditioning
73
How quickly does the token need to be given after behaviour?
As quickly as possible
74
When is a token given?
When a desirable behaviour occurs
75
What type of reinforcer is a token?
Secondary
76
What are the rewards in token economy?
Tokens swapped for rewards that the patients chooses
77
What type of reinforcer is a reward?
Primary
78
What are some examples of desirable behaviours in token economy?
Self-hygiene (personal)
Care for environment
Social engagement
79
Strength of token economy - Dickerson et al
11/13 studies reported beneficial effects due to the treatment of increasing adaptive behaviours in a psychiatric setting
80
Limitation of token economy - ethical concerns
Is it bad for the doctors to restrict certain food, privacy and enjoyable activities until patients show desirable behaviours?
81
Why is there believed to have some genetic element in the likelihood of getting SZ?
SZ runs in families
82
How many different gene variations have been associated with a risk of SZ?
108
83
What hormone are some of the genes connected to?
Dopamine functioning
84
What have the three genes COMT, DRD4 and AKT1 been associated with?
Excess dopamine in dopamine receptors
85
AO3 genetic explanation - with a parent, what is the shared DNA and the probability of sharing SZ?
Shared DNA = 50%
Probability of sharing SZ = 6%
86
AO3 genetic explanation - with a sibling, what is the shared DNA and the probability of sharing SZ?
Shared DNA = 50%
Probability of sharing SZ = 9%
87
AO3 genetic explanation - with a MZ twin, what is the shared DNA and the probability of sharing SZ?
Shared DNA = 100%
Probability of sharing SZ = 48%
88
AO3 genetic explanation - with a DZ twin, what is the shared DNA and the probability of sharing SZ?
Shared DNA = 50%
Probability of sharing SZ = 17%
89
AO3 genetic explanation - with a grandparent, what is the shared DNA and the probability of sharing SZ?
Shared DNA = 25%
Probability of sharing SZ = 5%
90
AO3 genetic explanation - with a cousin, what is the shared DNA and the probability of sharing SZ?
Shared DNA = 12.5%
Probability of sharing SZ = 2%
91
Strength of genetic explanation - research support
Gottesman 1991
Two SZ parents = 46%
One SZ parent = 15%
92
Counter to Gottesman - genetic explanation
Not perfect theory, should be 100% and 50%
Nurture is the same
93
Counter to nurture is the same - genetic explanation
Tiernari adoption study
94
Strength of genetic explanation - adoption study
Tiernari et al 2000
164 adoptees with SZ mothers = 6.7%
197 adoptees without SZ mothers = 2%
95
Counterpoint to adoption study
Confounding variable of adoption process
96
AO3 genetic explanation - socially sensitive research
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
What does neural correlates mean?
Brain area's structure/functioning correlates with SZ symptoms
98
Where is the ventral striatum?
In frontal lobe
99
What is the ventral striatum in charge of?
Anticipating reward
100
How does knowledge of the ventral striatum affect token economy?
The reason patients need immediate rewards
101
What symptom does the dysfunction in the ventral striatum link to?
Avolition
102
Where is the superior temporal gyrus?
Temporal lobe
Auditory cortex
103
What is the superior temporal gyrus involved in?
Processing sound
104
What symptom does the dysfunction in the superior temporal gyrus link to?
Auditory hallucinations
105
Strength of neural correlates - practical application
Diagnosis
Brain scan
fMRIs
106
What is the word for high levels/activity of dopamine?
Hyperdopaminergia
107
Where in the brain does hyperdopaminergia affect?
Subcortex
Broca's area
108
What symptom does hyperdopaminergia link to?
Broca's area links to speech poverty
109
What is the word for low levels of dopamine systems?
Hypodopaminergia
110
Where in the brain does hypodopaminergia affect?
Frontal lobe
Pre-frontal cortex
111
What symptoms does hypodopaminergia link to?
Negative symptoms like avolition
112
Strength of dopamine hypothesis - practical application
Treatment
Anti-psychotics
113
Limitation of dopamine hypothesis and neural correlates - problems with research method
Cannot establish cause and effect
Need more research
114
What symptoms do typical antipsychotics work on?
Positive symptoms only
115
What symptoms do atypical antipsychotics work on?
Positive and negative symptoms
116
Is chlorpromazine typical or atypical?
Typical
117
What receptors does chlorpromazine bind to?
Dopamine
118
What are the side effects of chlorpromazine?
Tardive dyskinea (permanent movement disorder)
119
Is clozapine typical or atypical?
Atypical
120
What receptors does clozapine bind to?
Dopamine
Serotonin
Glutamate
121
What is the effect of taking clozapine?
Reduce depression and anxiety
Improve cognitive functioning and mood
122
What are the side effects of clozapine?
Fatal blood condition
123
Is risperidone typical or atypical?
Atypical
124
What receptors does risperidone bind to?
Dopamine
Serotonin
125
What are the benefits of risperidone?
More effective in smaller doses
Fewer side effects
126
What is the effect of taking risperidone?
Works on cognitive impairments
127
What are the side effects of risperidone?
Normal ones
Nausea
Drowsiness
Headaches
Weight gain/loss
128
How does taking antipsychotics affect synaptic transmission?
On the post-synaptic neuron to stop absorption and decrease the amount of dopamine
129
AO3 antipsychotics - evaluation points
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
Limitation of antipsychotics - deterministic
SZ individuals may choose not to take them
Drugs don't fix all symptoms and cause of SZ
131
Limitation of typical - side effects
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
Strength of typical - Thornley et al
Reviewed data from 13 trials
Chlorpromazine associated with better functioning and reduced symptom severity compared with placebo
133
Strength of typical - relative effectiveness
Typical drugs more effective for positive symptoms
134
Strength of atypical - Meltzer
Clozapine is more effective than antipsychotics
Worked for patients who had tried all other treatments 30-50% of the time
135
What is the interactionist explanation?
Diathesis-stress model
136
What is the diathesis-stress model?
Combines effects of internal vulnerability and external stress trigger
137
What is the diathesis?
Vulnerability originally thought to be genetic, now includes vulnerabilities due to childhood trauma which might have affected brain development
138
What is the stress trigger?
Any negative psychological experience (breakdown of relationship, academic pressure)
139
What was Meehl's model?
Person with a schizophrenic gene is vulnerable to effects of chronic stress in childhood or adolescence which could lead to SZ
140
In Meehl's model, can you get SZ without the schizogene?
No
141
In Meehl's model, can you get SZ without the chronic stress?
No
142
What is the modern interactionist theory?
Genes are not the only type of vulnerability
143
What are examples of other vulnerabilities which could lead to SZ?
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
Strength of interactionist explanation - stressors importance
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
What are interactionist treatments?
Combining anti-psychotic medication with psychological therapy (CBT)
146
Strength of interactionist treatments - Tarrier et al
315 patients
Drugs and CBT, drugs and supportive counselling, control group (medication only)
Combination was best for lowering symptoms
147
Counter to Tarrier et al - interactionist treatments
No difference in relapse
However family therapy helps with relapse
148
Limitation of interactionist treatments - cost
CBT and supportive counselling is expensive
Sometimes people don't go
Having both is "double" the cost
Relapses will cost more
149
AO3 interactionist approach
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)
