Schizophrenia Flashcards
Schizophrenia definition and what is it characterised by
- Schizophrenia is a severe mental illness where contact with reality and insight are impaired- an example of psychosis
- It is characterised by incoherent or illogical thoughts, bizarre behaviour and speech, delusions or hallucinations
What is psychosis
Psychosis is a term used to describe a severe mental health problem where the individual loses contact with reality (unlike neurosis where the individual is aware that they have problems)
What are the clinical characteristics of Scjizophrenia
- Schizophrenia can be described as a disintegration of personality
- A main feature is a split between thinking and emotion
- Involves a range of psychotic symptoms (a break from reality)
- Schizophrenic patients lack insight into their condition, i.e they do not realise they are ill
What is the prevalence of schizophrenia
- affects 1% of the population
- men are more likely to suffer than women
- the onset is typically in late adolescence and early adulthood
- commonly diagnosed in cities and the working class
Def of positive vs negative symptoms of schizophrenia
Positive Symptoms= symptoms that appear to reflect an excess or distortion of normal functions
Negative Symptoms= symptoms that appear to reflect a loss of normal functions
What are the positive symptoms of Schizophrenia
Delusions and Hallucinations
What are delusions (positive symptom) associated with schizophrenia
DELUSIONS
- delusions are irrational beliefs
- delusions of grandeur involve being important historical/political/religious figures such as Jesus
- Delusions can also involve being persecuted by government/aliens/superpowers
- can concern the body - they may believe a part of them is under external control
- some delusions can lead to violence
What are hallucinations (positive symptom) associated with schizophrenia
What are the negative symptoms of Schizophrenia
Avolition and Speech poverty
What is avolition (negative symptom) associated with schizophrenia
What is speech poverty (negative symptom) associated with schizophrenia
How is Schizophrenia diagnosed
- there are a number of systems by which we can classify abnormal patterns of thinking, behaviour and emotion into mental disorders. These systems not only classify abnormality, but give guidance on how to diagnose them
ICD - uses subtypes
(2 or more negative symptoms needed for diagnosis)
DSM 5 - this system does not use subtypes
(At least one positive symptom needed for diagnosis)
Evaluation for diagnosing schizophrenia
Describe the reliability in the diagnosis of schizophrenia
- diagnosis is difficult because the practitioner has no physical signs, but only symptoms (what the patient reports) to make a decision on.
- Jacobsen et al tested the reliability of the ICD-10 classification system in diagnosing schizophrenia:
100 Danish Patients with a history of psychosis were assessed using operational criteria, and a concordance rate of 98% was obtained.
This demonstrates the high reliability of the clinical diagnosis of schizophrenia using up-to-date classification
Describe the validity in diagnosing schizophrenia
- the validity of a single schizophrenic disorder is critiqued as there is no such thing as a ‘normal’ schizophrenic.
- Problems with the validity of diagnosis result in unsuitable treatment, sometimes on an involuntary basis. This raises practical and ethical issues.
-CHENIAUX ET AL:
Two psychologists assessed the same 100 Dutch patients as Jakobson et al.
68 were diagnosed using the ICD-10 and 39 were diagnosed using the DSM-5
This demonstrates that schizophrenia is either under diagnosed or over diagnoses as there is low criterion validity.
What should schizophrenic diagnosis be like is it is fully reliable?
Different clinicians using the same system (e.g DSM) should arrive at the same diagnosis for the same individual (inter observer reliability)
What should schizophrenic diagnosis be like is it is fully valid?
It should be meaningful and classify a real pattern of symptoms, which results from a real underlying cause
What is co-morbidity and it’s relation to schizophrenia
Co-morbidity describes people who suffer from two or more mental disorders.
For example, schizophrenia and depression are often found together as symptoms overlap (e.g both involve very low levels of motivation)
- this makes it more difficult to confidently and reliably diagnose schizophrenia
- it also calls into question the validity of schizophrenia as an actual condition
What is the evidence for co-morbidity
- A US study looked at nearly 6million hospital discharge records to calculate co-morbidity rates
- They found co-morbidity of other psychiatric disorders with schizophrenia (45%)
- Schizophrenia is co-morbid with depression in 50% of cases and OCD in 23% of cases
- They found co-morbid, non-psychiatric disorders such as asthma, hypertension and type 2 diabetes
Describe the gender bias in schizophrenia diagnosis
Describe the culture bias in schizophrenia diagnosis
Describe David Rosenhan’s famous experiment on schizophrenia
Describe the reason why schizophrenia as a condition is criticised
Describe the biological explanation of schizophrenia (GENETICS)
- Genes consist of DNA that are involved in producing instruction - this may impact psychological features such as intelligence or mental disorders and, hence, schizophrenia may be affected.
- Genes are inherited
- Research into this area focuses on looking into pin-pointing a single genetic variation responsible for SZ. In reality, SZ is polygenic. Genes coding for neurotransmitters, including dopamine, are involved.
FAMILY STUDIES:
- Gottesman 1991 suggests schizophrenia is inherited through genes.
- He conducted a large-scale family study showing that the risk of schizophrenia increases in line with genetic similarity to a relative.
- For example, a 2% change of developing schizophrenia if you have a first cousin who is diagnosed, 9% chance if you have a sibling with SZ and a 48% chance is you have an identical twin who has SZ
CANDIDATE GENE EVIDENCE:
- A genetic makeup of 37,000 individuals with SZ were compared to 113,000 controls. 108 genetic variations were associated with a slightly increased risk of schizophrenia
- Different studies have found different candidate genes, leading to the conclusion that schizophrenia is aetiologically heterogeneous (meaning that a different combination of factors, including genetic variations, can lead to the condition)
- This suggests that there is weak evidence for a specific candidate gene and genetics being the only explanation for schizophrenia
MUTATION:
- Schizophrenia can also have a genetic origin in the absence of family history.
- This may be as a result of inheriting mutated DNA from parents, caused by radiation, poison or viral infections
- Brown et al (2002) - Evidence for mutation comes from positive correlations between paternal age (with an increased risk of sperm mutation) and schizophrenia: 0.7% risk for fathers under the age of 25, increasing to a 2% risk for fathers aged over 50.