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Schizophrenia Flashcards

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1
Q

Positive Symptoms

A

Excess or distortion of normal functions

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2
Q

Negative Symptoms

A

Normal functions are limited, including speech poverty and avolition

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3
Q

Examples of Positive symptoms of SZ

A

Psychomotor disturbances

Catationia

Hallucination, Delusions, Though disturbances

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4
Q

Psychomotor Disturbances

A

Stereotypical, rocking, twitches, repetitive behaviours

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5
Q

Catatonia

A

Staying in position for hours/days on end

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6
Q

Negative Symptoms examples

A

Speech Poverty
Avolition
Thought Disorder
Broadcasting

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7
Q

Thought disorder

A

Breaks in the train of thought and one person appears to make illogical jumps from one topic to another
Words and sentences may become incoherent

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8
Q

Broadcasting

A

A thought disorder whereby a person believes their thoughts are being broadcasted to others

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9
Q

What did Slater and Roth suggest about hallucinations as a symptom of SZ?

A

They are the least important of symptoms as they are not exclusive to SZ

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10
Q

What did Scheff Suggest about the effects of the diagnosis classification of SZ?

A

It labels the individual, causing many adverse effects, such as a self-fulfilling prophecy and lower self-esteem

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11
Q

What is the advantage of diagnosis and classification of SZ?

A

Allows doctors to communicate effectively about a patient and use similar terminology when discussing them

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12
Q

Reliability of SZ Classification

A

For the classification system to be reliable, different clinicians should arrive at the same diagnosis for one individual

Stability of diagnosis over time given no change in symptoms

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13
Q

Why is diagnosis of SZ difficult?

A

The practitioner has no physical signs and only symptoms, reported by the patient, to make a decision on

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14
Q

Comorbidity

A

A person who suffers from multiple mental disorders, which occurs due to symptoms of different disorders overlapping

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15
Q

Jacobson - Reliability of ICD-10 in diagnosing SZ

A

100 Danish patients with a history of psychosis were assessed using the opertaional criteria

98% Concordance rate - demonstrating the high reliability of the clinical diagnosis of SZ using up-to-date classification

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16
Q

SZ Gender bias - Loring + Powell

A

Some behaviour regarded as psychotic in males was not regarded as psychotic in females

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17
Q

Validity of SZ

A

The extent to which SZ is a unique syndrome, with characteristics, signs and symptoms.

For the classification system to be valid, it should be meaningful and classify a real pattern of symptoms which result from an underlying cause

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18
Q

SZ - Predictive Validity

A

If a diagnosis leads to successful treatment, the diagnosis can be seen as valid.

However, some schizophrenics are treated successfully, whereas others are not

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19
Q

SZ - Aetiological Validity

A

In order for the diagnosis to be valid, all patients diagnosed as schizophrenic should have the same cause for their disorder

This is often not the case, as the causes of SZ may be one of biological, psychological, or both

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20
Q

What are the issues of the validity of SZ as a diagnosis?

A

There is no such thing as a ‘normal’ schizophrenic demonstrating typical symptoms

Unsuitable treatments may be administered, even on an involuntary basis, raising ethical and practical issues

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21
Q

Validity of SZ - Cultural Bias - US vs london

A

USA - 20% diagnosed in 1930s vs 80% in the 1950s

London - rate remained at 20%

This suggests that neither group had a valid definition of schizophrenia

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22
Q

Validity of SZ - David Rosenham ‘pseudopatients’

A

Experiment involving pseudo patients led to 8 ‘normal’ people being kept in hospital, despite behaving normally

This suggests that doctors have no valid method for detecting SZ

In a follow up study, they rejected genuine patients whom they assumed were a part of the deception

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23
Q

Validity of SZ - Issue of Culture (Asian vs Arabic)

A

Some Asian countries are not encouraged to show emotional expression
Some Arabic cultures, public emotion is encouraged and understood

Without this knowledge, a person displaying overt emotional behaviour in a western culture may be regarded as abnormal

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24
Q

Validity of SZ - Cochrane - Culture

A

Those of Afro-Carribean heritage are 7x as likely to be diagnosed as having SZ when living in the UK

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25
Q

Gottesman Concordance Rates MZ & DZ twins + Siblings for SZ

A

MZ - 48%
DZ - 17%
Siblings - 9%

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26
Q

Tienari - SZ adoption study

A

Adopted children of biological mothers with schizophrenia were more likely to develop the disorder themselves than adopted children of mothers without schizophrenia, supporting the genetic link

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27
Q

Hyperdopaminergia

A

Abnormally high levels of dopamine in the subcortex

Linked with positive Symptoms, such as hallucinations

There may be a higher number of dopamine receptors, causing over-activity of dopamine, causing sensory hallucinations

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28
Q

Hypodopaminergia

A

Low levels of dopamine in the subcortex

Less dopamine transmitted across the subcortex

Linked with negative symptoms

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29
Q

Curran - Hypodopaminergia

A

Dopamine agonist produce SZ-type symptoms in patients, supporting the hypodopaminergia aspect of the dopamine hypothesis

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30
Q

Tauscher - hyperdopaminergia

A

Antipsychotics, which lower dopamine levels, reduced the occurrence of positive symptoms, supporting the hyperdopaminergia aspect of the dopamine hypothesis

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31
Q

What did Noll find about antipsychotics?

Opposing evidence of the dopamine hypothesis

A

They do not work in 1/3 of patients

Some patients still experience hallucinations despite dopamine levels being normal

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32
Q

Role of Vental Striatum in SZ

A

Vental Striatum involved in reward anticipation

SZ patients have less activity in this region

The lower the activity, the more severe the negative symptoms, which could explain avolition

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33
Q

Allen - What parts of the brain had lower activity levels of those experiencing hallucination?

A

Superior temporal gyrus

Anterior Cingulate Gyrus

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34
Q

Typical Antipsychotic

A

Chlorpromazine

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35
Q

Chlorpromazine - How does it work?

A

Antagonist in the dopamine system
Blocks dopamine receptors to reduce action
Binds to receptors in the mesolimbic dopamine pathway
Normalizes neurotransmission
Reduces positive symptoms

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36
Q

Chlorpromazine side effects

A

Extrapyramidal effect
Shuffling of feet, moving slowly
Restlessness and limb discomfort
Tardive Dyskinesia

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37
Q

Tardive Dyskinesia

A

Jerky movements of the face, tongue and whole body, sucking and smacking of lips

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38
Q

What % of patients receiving chlorpromazine develop tardive dyskinesia?

A

Up to 30%

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39
Q

After 25 years on chlorpromazine, what % of patients develop tardive dyskinesia?

A

up to 68%

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40
Q

Atypical antipsychotics

A

Clozapine

Risperidone

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41
Q

When were atypical antipsychotics developed?

A

1970s

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42
Q

What is different about atypical antipsychotics compared to typical?

A

Suppress symptoms and minimize effects

Suitable for treatment resistant patients

Block dopamine AND serotonin receptors

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43
Q

What dosage of clozapine are patients given?

A

300-450mg daily

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44
Q

How does Clozapine work?

A

Temporarily binds to D2 receptors and acts on serotonin and glutamate receptors

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45
Q

What patients is Clozapine suitable for?

A

Suicidal patients - improves mood

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46
Q

A strength of Clozapine compared to other antipsychotics?

A

Does not cause motor problems

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47
Q

Risperidone Dosage

A

4-12mg daily through tablet, syrup or injection

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48
Q

How does Risperidone work?

A

Binds to dopamine and serotonin receptors but more strongly to dopamine

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49
Q

Side effect of Risperidone

A

No side effects at a normal dosage, other than occasionally akathasia

50
Q

Akathasia

A

Restlessness and agitation

51
Q

Davis - meta analysis on the effectiveness of antipsychotics compared with placebos

A

Antipsychotics more effective than placebos in 70% of patients, seeing improvements after 6 weeks

Less than 25% reported improvements with placebos

52
Q

Vaughn & Leff - Review of Davis meta analysis of antipsychotics

A

Antipsychotics only made a difference for those living with hostility and criticism in their home environment

53
Q

Vaughn & Leff - relapse rate for those on antipsychotics vs placebos

A

Antipsychotics - 53%

Placebo - 92%

54
Q

Antipsychotics vs placebos for those with a supportive home environment

A

12% - placebo
15% - antipsychotic

55
Q

What did Marder suggest about atypical antipsychotics vs typical?

A

Atypical antipsychotics are just as effective as typical

56
Q

What % of patients who resisted typical antipsychotics responded to atypical antipsychotics?

A

30-61%

57
Q

Benefit of atypical antipsychotics

A

Fewer side effects, meaning patients are more likely to continue treatment, resulting in improved symptoms

58
Q

Atypical antipsychotics side effects

A

Reduction in WBC count - regular blood tests required

Health risks: weight loss, stroke, cardiac arrest, diabetes

59
Q

Tardive Dyskinesia sufferer in US

A

Won a large out-of-court settlement due to drug breaching the human rights act 1988

60
Q

Appropriateness of antipsychotics

A

Cheap and easy to administer - advantageous from an economical viewpoint

Help those who struggle to talk about their mental health problems

Positive effect on many sufferers, allowing them to live a relatively normal life

61
Q

Criticisms of antipsychotics

A

Not effective in treating the underlying cause - only provide relief of symptoms

High relapse rate

Not an effective long-term solution

62
Q

Relapse rate of those on antipsychotics within first year and in later years

A

First year - 40%

Later years - 15%

63
Q

Ross + Read - criticism of antipsychotics

A

Prescribing medication reinforces the idea that there is ‘something wrong with you’

Prevents the individual to think about possible stressors triggering their condition

64
Q

Haslam - surveyed people on the causes of schizophrenia - results

A

People less inclined to confront environmental factors such as poverty or childhood trauma if they were simply given drugs to manage their condition

Drug therapies may be inappropriate as a first point of call

65
Q

3 types of family dysfunction

A

Schizophrenogenic mother

Double-bind theory

Expressed emotion

66
Q

Schizophrenogenic mother

A

Cold, rejecting, controlling

Leads to Distrust and paranoid delusions

67
Q

Double-bind theory

A

Conflicting messages

68
Q

Expressed emotion

A

Verbal criticism of the patient, violence

Hostility towards patient, anger and rejection

Emotional over-involvement in the life of a patient

69
Q

How does expressed emotion link to schizophrenia?

A

Levels of EE by carers can be a serious source of stress, causing high relapse rates in schizophrenia patients

However, the source of stress may trigger the inset of symptoms in a person who is already vulnerable

70
Q

What did Bateson suggest about double-bind theory as a caise of schizophrenia

A

Communication style within a family leads to development of schizophrenia

Children are ‘trapped’ in situations where they fear what they are doing wrong

Punished by ‘withdrawal of love’ Receive mixed messages and see the world as dangerous and confusing which is reflected in symptoms such as disorganised thinking and paranoid delusions

71
Q

What was emphasised about double-bind theory contributing to schizophrenia?

A

Neither the main type of communication or only factor in the development of schizophrenia

72
Q

Read - what type of attachment do those with schizophrenia typically have?

A

Insecure

73
Q

What % of men and women with SZ have a history of physical and/or sexual abuse?

A

Women - 69%

Men - 59%

74
Q

how do family dysfunction explanations of schizophrenia lack support?

A

poor evidence based for any of the explanations

Although there is plenty of evidence supporting the idea that family-based stress is associated with adult SZ, there is almost none to support the schizophrenogenic mother and double-bind

75
Q

What is research around double-bind and schizophrenogenic mother based on?

A

Clinical observation and informal assessment

76
Q

Cognitive explanation of Schiozophrenia

A

SZ is caused by abnormal information processing and disruption to normal thought processes

Lower level of information processing suggests that cognition is likely impaired

77
Q

What 2 kinds of dysfunctional thought processing did Frith identify which may underlie some symptoms of Schiozophrenia?

A

Meta-representation

Central Control

78
Q

Meta-representation

A

Cognitive ability to reflect on thoughts and behaviours

allow us insight into our own intentions and goals

interpretations of the intentions of others

79
Q

Meta-representation linked to Schiozophrenia

A

inability to recognize our own actions and thoughts are carried out by ourselves rather than by anyone else

Hallucination of vouces and delusions such as thought insertion

80
Q

Central Control

A

Cognitive ability to suppress automatic responses while we perform deliberate actions

81
Q

Central Control linked to Schiozophrenia

A

Disorganised speech and thought disorder could result from the inability of Central Control and speech triggered by other thoughts

82
Q

Cognitive explanation of Schiozophrenia - Stirling - Ink colours

A

30 SZ vs 18 non-SZ
Patients took 2x as long to name the ink colours compared to the control group

83
Q

CBT on Schiozophrenia patients effectiveness

A

CBT is effective, suggesting there is a cognitive aspect

84
Q

Normalisation of Schiozophrenia symptoms

A

Placing psychotic experiences on a continuum of normal experiences means the patient feels less alienated and stigmatised

85
Q

Critical Collaborative Analysis

A

Critical questioning to understand illogical deductions and conclusions

86
Q

Developing Alternative Explanations

A

Patient develops their own alternative explanations for their previously unhealthy assumptions

87
Q

Basic assumption of CBT

A

People have distorted beliefs which influence their behaviour in maladaptive ways

88
Q

What are Schiozophrenia patients encouraged to do in CBT?

A

Trace back the origin of their symptoms in order to get a better idea of how the symptoms may have developed.

They are also encouraged to evaluate the content of their delusions and auditory hallucinations and consider ways in which they might test the validity of their faulty belief

89
Q

Jauhar et Al - evaluation of CBT on Schiozophrenia patients

A

Meta-analysis - found that CBT had an effect on positive and negative symptoms

This effect was significant but quite small, suggesting moderate support for the effectiveness of CBT in treating schizophrenia

90
Q

How does CBT have potential ethical issues when treating Schiozophrenia patients?

A

Challenging the validity of beliefs may interfere with the freeddom of thought

91
Q

Why is CBT not effective by itself as a treatment for Schiozophrenia?

A

If the dysfunctional thoughts have a biological basis, disputing may not be enough to change them

CBT is rarely used without drug therapy

92
Q

CBTp techniques

A

Critical Collaborative Analysis

Normalisation

ABC

93
Q

The nature of family therapy

A

3-12 months
10+ sessions
Reducing levels of expressed emotion

94
Q

Schiozophrenia relapse with rate with and without family therapy

A

With - 25%

Without - 50%

95
Q

Family Therapy Study - Pharoah

A

Moderate evidence to show that family therapy reduces relapse rates and hospital readmissions in Schiozophrenia patients

There were variances in the quality of research studies used. therefore, there is weak research support family therapy

96
Q

Why does family therapy not actually treat SZ?

A

It is not aimed at the patient

97
Q

Token Economy Systems

A

A form of psychological therapy based on operant conditioning, which uses a reward system to manage maladaptive behaviours

98
Q

Primary and Secondary reinforcers in Token Economy

A

Primary - reward

Secondary - token

99
Q

Wolfe - Chimpanzees TE

A

Investigated the effectiveness of token rewards for chimpanzees, where chimpanzees could discriminate tokens and their associations with prizes such as food

Other systems then adopted TES, as the focus on behavioural alteration and maintenance gained traction

100
Q

TE - 1960s

A

TE was a widely used therapy in the 1960s because many patients were institutionalized in hospital settings

101
Q

Who were some of the first people to explore TES as a form of motivational therapy and rehabilitation?

A

Allyson and Azrin

102
Q

Allyson and Azrin - TES study

A

45 Female SZ patients in a psychiatric ward showed significant improvements in their symptoms and behaviours after the introduction of TES

103
Q

What did Allyon and Azrin demonstrate about TES?

A

TES can help control and treat symptoms and behaviours associated with SZ

104
Q

Glowacki - TE meta-analysis

A

7 hight quality studies of the effectiveness of TES in hospitals

Decreased negative symptoms
Decrease in frequency of undesirable behaviours

Concluded the use of TES in psychiatric settings should be considered. However, the study included only a small evidence based to support it

105
Q

McMonagle and Sultana - Review of TES over multiple studies

A

Found TES reduced negative symptoms by acting as a motivational tool

However, it was unclear whether the patients maintained these behaviours after the treatment programme

Results may not be reproducible, so clinical validity os questionned

106
Q

Dickerson - TES review

A

13 controlled TES studies

TES effectively increased adaptive behaviours and decreased maladaptive behaviours

However, the historical context and methodological issues limit the studies

107
Q

Ethical issues with TES

A

Gives professionals significant power of control over the behaviour of a patient

It imposes a ‘norm’ that, whilst it may be appropriate in societal settings, it is not fair to expect this perfection off of patients. this is a restriction of personal freedom, and it is unethical to deprive people of their rights

108
Q

Milby - TES studies review

A

Whilst TES is effective in hospital work, upon review, the studies were found to be both poorly designed and lacking sufficient follow-up data

109
Q

General Issue of TES

A

It may aggravate more distressing symptoms by removing pleasurable activities from the patient

It is normal to have off days. it would be unfair to deprive you of your favourite things because you were having a bad day. this has led to legal action In the past, as families are not okay with personal liberties being taken away from the patient

110
Q

Kadzin - Effect of TES after discharge

A

Changes that were developed during a patients time in the hospital using TES did not remain once they were discharged, suggesting issues with maintenance that TES suggests it excels at

111
Q

Meehl’s Model

A

Diathesis was entirely genetic and the result of a single schizogene

Development of a biologically based schizotype personality

112
Q

What did Paul Meehl say about the schizogene?

A

If a person does not have the schizogene then no amount of stress would lead to SZ

However, in carriers of the gene, chronic stress through childhood and adolescence could result in the development of SZ

113
Q

Modern Understanding of diathesis

A

Many genes increase genetic vulnerability and there is no single schizogene

Range of factors beyond genes, such as psychological trauma - where trauma acts as the diathesis rather than the stressor

114
Q

Who proposed a neurodevelopmental model?

A

Read et al

115
Q

Read et al - neurodevelopmental model

A

Early trauma affects the developing brain

Such as the HPA system becoming overactive, making the person much more vulnerable to later stress

116
Q

The Modern understanding of stress

A

In the original model, stress was seen as psychological in nature

The Modern definition includes anything that risks triggering SZ

117
Q

Effect of Cannabis on SZ

A

Cannabis can trigger an episode of SZ as it is seen as a stressor which interferes with the dopamine system

7x increased risk

Howevere, most people do not develop SZ after smoking cannabis, so there may be multiple vulnerability factors

118
Q

Treatment of SZ according to the interactionist approach

A

Antipsychotic medication combined with CBT

119
Q

Turkington - interactionsit approach to treating SZ

A

It is possible to believe in biological causes of SZ and still practice CBT to relieve psychological symptoms

However, it is not possible to adopt a purely biological approach and to simultaneously treat them with CBT

120
Q

Tarrier - support for the effectiveness of combination of treatments

A

Randomly allocated 315 patients to a medication and CBT group; medication and supportive counselling; control group (only meds)

2 Combination groups showed lower symptom levels than those in control group

No difference in rates of hospital readmission

121
Q

Tienari - role of vulnerability and triggers

A

Child-rearing style characterised by high levels of criticism and low levels of empathy was implicated in the development of SZ but only for adopted children who had a high genetic risk and were adopted by Finnish mothers with SZ but not in the adopted control group with no genetic risk

Psychology (11 decks)

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