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
What is validity?
Are you measuring what you set out to measure?
What is reliability?
Consistency
What are the core four symptoms of SZ?
Hallucinations
Delusions
Avolition
Speech poverty
What does a positive symptom mean?
Additional experiences
What does a negative symptom?
Removal/lessening of experiences
Is hallucinations a positive or negative symptom?
Positive
Additional sensory experiences
Is delusions a positive or negative symptom?
Positive
Additional thoughts/beliefs
Is avolition a positive or negative symptom?
Negative
Lack of motivation to carry out tasks
Is speech poverty a positive or negative symptom?
Negative
Lack of speech fluency/emotion (monotone, forced speech)
What are the two diagnostic tools?
DSM-5
ICD-10
What symptoms must a person have to be diagnosed by the DSM-5?
One positive symptom
What symptoms must a person have to be diagnosed by the ICD-10?
Two or more negative symptoms
How do you define reliability in terms of SZ?
Consistency across diagnosis (same symptoms should have same diagnosis)
Consistency across classification (same diagnosis when saying same symptoms for DSM-5 and ICD-10)
How do you define validity in terms of SZ?
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?
What are the factors affecting diagnosis and classification of SZ?
Gender bias
Cultural bias
Co-morbidity
Symptom overlap
What is cultural bias (in relation to SZ)?
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
AO3 reliability and validity - cultural bias
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
What is gender bias (in relation to SZ)?
How the sex of the person with SZ and the sex of the medical professional affects the diagnosis and classification of SZ
Which gender is more likely to be diagnosed with SZ?
Males
1.4:1
AO3 reliability and validity - gender bias
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
What is symptom overlap?
One symptom appears in two or more conditions
What is symptom overlap in relation to SZ?
How the symptoms of SZ are seen in other disorders, making it difficult to diagnose and classify SZ
Limitation of reliability and validity - symptom overlap
Delusions
Can be bipolar disorder or dementia
Can be in multiple disorders
What is co-morbidity?
Two conditions at one time
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%
What is the psychological psychodynamic explanation for SZ called?
Family dysfunction
What are the three separate theories within family dysfunction?
Schizophregenic mother
Double-bind theory
Expressed emotion
What is the schizophregenic mother?
SZ-CAUSING mother
What are the characteristics of a schizophregenic mother?
Cold
Critical
Harsh
How does the schizophregenic mother lead to SZ?
Child turns inwards to find love and warmth to create their own reality
What specific symptom does the schizophregenic mother connect to?
Hallucinations
What is the double-bind theory?
Risk factor of SZ is receiving contradictory messages from their parent
How does the double-bind theory lead to SZ?
Interactions lead to the child creating their own concept of reality
What symptom does the double-bind theory link to?
Paranoia
Always second guessing
Is it high or low expressed emotion that leads to developing SZ?
High
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
What does high expressed emotion affect?
The chances of relapse for the patient
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)
Strength of FD - Berger
Schizophrenics reported a higher recall of double-bind statements from mothers than non-schizophrenic controls
Limitation of FD - Altorfer
High EE families are interpreted differently by SZ patients
1/4 showed no psychological response to EE comments
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
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
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
What is the name for the cognitive explanation of SZ (also a psychological explanation)?
Dysfunctional thought processing
What are the two theories within dysfunctional thought processing?
LACK of meta representation
LACK of central control
What is meta representation?
Cognitive ability to reflect on thoughts and behaviours
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
What symptoms does lack of meta representation link to?
Auditory hallucinations
Thought insertion
What is central control?
Cognitive ability to carry out a deliberate action whilst suppressing an automatic response
How does a lack of central control affect someone?
Derailment of thoughts
Each word triggers automatic association that they cannot suppress
What symptom does lack of central control link to?
Speech poverty
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)
Strength of DTP - practical application
Creation of CBT
NICE 2014
CBT is effective at reducing relapse rates, increasing social functioning and reducing symptom severity
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
What does CBT stand for?
Cognitive Behavioural Therapy
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
What is the patient encouraged to do in CBT?
Develop rational interpretations or alternative perceptions (e.g. viewing voices as interesting rather than threatening)
What does CBT promote?
Increase in social activity
Use of relaxation strategies
What are some of the techniques of CBT?
Patient-as-scientist
Journal writing
Homework
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
What does family therapy have to be?
Respectful
Honest
Confidential
Open and productive discussion
What does the therapist give the family in family therapy?
Homework
What is the structure of psychological treatment AO3s?
+ research support
- key problems
- alternative treatment - biological
Research into cause/other psychological treatments
Strength of CBT - NICE study
Reducing relapse rates
Increasing social functioning
Reduces symptoms
Counterargument to NICE study - CBT
Patients on anti-psychotics as well
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
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
Counterargument to Pharoah et al - family therapy
Publication bias
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
How can SZ be managed?
Token economy
Who is token economy normally used for?
Patients who have been hospitalised for a long time
What is token economy?
Helps encourage typical behaviour rather an schizophrenic symptoms
Operant conditioning
How quickly does the token need to be given after behaviour?
As quickly as possible
When is a token given?
When a desirable behaviour occurs
What type of reinforcer is a token?
Secondary
What are the rewards in token economy?
Tokens swapped for rewards that the patients chooses
What type of reinforcer is a reward?
Primary
What are some examples of desirable behaviours in token economy?
Self-hygiene (personal)
Care for environment
Social engagement
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
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?
Why is there believed to have some genetic element in the likelihood of getting SZ?
SZ runs in families
How many different gene variations have been associated with a risk of SZ?
108
What hormone are some of the genes connected to?
Dopamine functioning
What have the three genes COMT, DRD4 and AKT1 been associated with?
Excess dopamine in dopamine receptors
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%
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%
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%
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%
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%
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%
Strength of genetic explanation - research support
Gottesman 1991
Two SZ parents = 46%
One SZ parent = 15%
Counter to Gottesman - genetic explanation
Not perfect theory, should be 100% and 50%
Nurture is the same
Counter to nurture is the same - genetic explanation
Tiernari adoption study
Strength of genetic explanation - adoption study
Tiernari et al 2000
164 adoptees with SZ mothers = 6.7%
197 adoptees without SZ mothers = 2%
Counterpoint to adoption study
Confounding variable of adoption process
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)
What does neural correlates mean?
Brain area’s structure/functioning correlates with SZ symptoms
Where is the ventral striatum?
In frontal lobe
What is the ventral striatum in charge of?
Anticipating reward
How does knowledge of the ventral striatum affect token economy?
The reason patients need immediate rewards
What symptom does the dysfunction in the ventral striatum link to?
Avolition
Where is the superior temporal gyrus?
Temporal lobe
Auditory cortex
What is the superior temporal gyrus involved in?
Processing sound
What symptom does the dysfunction in the superior temporal gyrus link to?
Auditory hallucinations
Strength of neural correlates - practical application
Diagnosis
Brain scan
fMRIs
What is the word for high levels/activity of dopamine?
Hyperdopaminergia
Where in the brain does hyperdopaminergia affect?
Subcortex
Broca’s area
What symptom does hyperdopaminergia link to?
Broca’s area links to speech poverty
What is the word for low levels of dopamine systems?
Hypodopaminergia
Where in the brain does hypodopaminergia affect?
Frontal lobe
Pre-frontal cortex
What symptoms does hypodopaminergia link to?
Negative symptoms like avolition
Strength of dopamine hypothesis - practical application
Treatment
Anti-psychotics
Limitation of dopamine hypothesis and neural correlates - problems with research method
Cannot establish cause and effect
Need more research
What symptoms do typical antipsychotics work on?
Positive symptoms only
What symptoms do atypical antipsychotics work on?
Positive and negative symptoms
Is chlorpromazine typical or atypical?
Typical
What receptors does chlorpromazine bind to?
Dopamine
What are the side effects of chlorpromazine?
Tardive dyskinea (permanent movement disorder)
Is clozapine typical or atypical?
Atypical
What receptors does clozapine bind to?
Dopamine
Serotonin
Glutamate
What is the effect of taking clozapine?
Reduce depression and anxiety
Improve cognitive functioning and mood
What are the side effects of clozapine?
Fatal blood condition
Is risperidone typical or atypical?
Atypical
What receptors does risperidone bind to?
Dopamine
Serotonin
What are the benefits of risperidone?
More effective in smaller doses
Fewer side effects
What is the effect of taking risperidone?
Works on cognitive impairments
What are the side effects of risperidone?
Normal ones
Nausea
Drowsiness
Headaches
Weight gain/loss
How does taking antipsychotics affect synaptic transmission?
On the post-synaptic neuron to stop absorption and decrease the amount of dopamine
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)
Limitation of antipsychotics - deterministic
SZ individuals may choose not to take them
Drugs don’t fix all symptoms and cause of SZ
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
Strength of typical - Thornley et al
Reviewed data from 13 trials
Chlorpromazine associated with better functioning and reduced symptom severity compared with placebo
Strength of typical - relative effectiveness
Typical drugs more effective for positive symptoms
Strength of atypical - Meltzer
Clozapine is more effective than antipsychotics
Worked for patients who had tried all other treatments 30-50% of the time
What is the interactionist explanation?
Diathesis-stress model
What is the diathesis-stress model?
Combines effects of internal vulnerability and external stress trigger
What is the diathesis?
Vulnerability originally thought to be genetic, now includes vulnerabilities due to childhood trauma which might have affected brain development
What is the stress trigger?
Any negative psychological experience (breakdown of relationship, academic pressure)
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
In Meehl’s model, can you get SZ without the schizogene?
No
In Meehl’s model, can you get SZ without the chronic stress?
No
What is the modern interactionist theory?
Genes are not the only type of vulnerability
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)
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
What are interactionist treatments?
Combining anti-psychotic medication with psychological therapy (CBT)
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
Counter to Tarrier et al - interactionist treatments
No difference in relapse
However family therapy helps with relapse
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
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)
