schizophrenia Flashcards
introduction to schizophrenia - diagnosis/classification
diagnosis made by identifying/deciding what disord pers has
2 maj sympt for classification of ment disord : DSM-5 (world health organis)/ICD-10
differ slightly for classific of ment disord, ex. DSM-5 req +ve sympt for diag b ICD 2/+re -ve sympt sufficient
both have dropped subty bec e inconsistent
intro to schizophrenia - +ve symptoms
additional experi beyond those of ordinary existence
hallucinations ; unusual sensory experi, some relat to environmental events, may hear/smell things
delusions; irrational beliefs, makes pers beh in ways that make sense to them b not oths
intro to schizophrenia - negative symptoms
loss of unusual abilities/experiences
speech poverty; reduction in amou/quality of speech accomp w delay in verbal resp in convo
avolition; difficulty to begin/keep up w goal directed act
poor hygiene, lack persistence in work/education and lack energy
evaluation - good reliability (osario et al) ; intro to schizophrenia
osario et al; excellent reliability in 180 indiv using dsm-5 on 2 occas, test retest/inter rater reliability
interviewed pairs achieved IRR of +0.97 and TRR of +0.92
TF: reasonably sure diag of schz consistently applied
evaluation - low validity (cheniaux et al); diag/classif
limit
cheniaux et al; criterion validity used to assess validity of schz
2 psychiat indep assess 100 clients using dsm/icd
fou 68 diag in icd / 39 w dsm
TF: sugg schz over diag/under diag in each one wh sugg criterion validity low
evaluation - co morbidity (buckley); intro to schz
limit
if cond occur tg a lot of time this calls into q the validity of their diag/classif bec might be single cond
where 2 cond freq diag tg
TF: qs validity of classifying 2 disorders sep
evaluation - gender bias in diag; intro to schz
limit
men diag +re than wom bec wom less vulner than men due to genetic factors
how +re likely wom underdiag bec they closer relationships w peop and supp so wom funct bett w schz than men
TF: underdiag is gender bias /wom x get treatment that will benefit them
evaluation - culture bias in diag; intro to schz
limit
some sympt ie hearing voices have diff meanings in diff cult
ex. haiti, hearing voices r communic fr ancestors
also british caribbean peop 9x +re like to receive diag than british peop
there’s cult bias of clients by psychiat fr diff cult backgr
TF: means brit A-C may be discrim against in cult biased diag sys
biological explanations of schz - family studies
risk of schz increases w genetic similarity to relative w disorder
gottesmans family study; some1 w sibling has 9% chance developing schz and 48% if identical twin
general populat is 1%
family memb share aspects for their environ/genes
biological explanations of schz - candidate genes
schz is polygenic , most likely genes coding 4 neurotransmitters ie. dopamine
ripke et al; combin all prev data fr genome wide study of schz
genetic make up of 37000 peop w diag of schz compar to 113000 controls, fou 108 sep genetic variations assoc w slightly increased schz
diff stud identif diff candidate genes so appears schz is aetiologically heterogeneous
biological explanations of schz - role of mutation
schz can have genetic origin even in absence of family history of disorder
mutation in parents dna wh caused by radiation/poison/viral infection
evid for mutation fr +ve correlation b/w parental age and schz risk
increasing fr 0.7% w fath under 25 to over 2% in fath 50+
biological explanations of schz - og dopamine hypoth
bas on discov that drugs used to treat schz caused symp simi to those in peop w parkinson’s disease
schz may be res of high lev DA in subcortical brain areas (hyperdopaminergia)
ex. excess DA receptors in pathways fr subcortex to broca’s area may expl specific schz symp ie. speech poverty
biological explanations of schz - updated versions of dopamine hypoth
davis et al; proposed cortical hypodopaminergia wh is low lev DA in brains cortex
low DA in prefrontal cortex cou expl cog prob
sugg that cortical hypodopaminergia leads to subcortical hyperdopaminergia, both high/low lev DA in diff regions of brain part of updated version
also both genetic variations/early experi of stress make some peop +re sensitive to cortical hypodopaminergia hence subcortical hyperdopaminergia
evaluation - research support (teinari/hilker); bio expla 4 schz
strength
fami stud show risk increases w genetic simi w schz fami memb
tienari et al: adoption stud, fou biolog child of parents w schz at heightened risk even if grow up w adopted fami
hilker et al; twin stud, show concordance rates of 33% identical twins and 7% non identical
TF: shows some peop +re vulnerable to schz as res of genetic make up
evaluation - environmental factors; bio expla 4 schz
limit
clear evid environment fact increase risk for schz
trauma leads to adult ment health prob b evid now partic for schz
morkved et al; 67% peop w schz /related psychotic disorders report at least 1 childh trauma compar to 38% of matched grp w non psychotic ment health issues
TF: means genetic fact alone x prov complete expla 4 schz
evaluation - evid 4 dopamine ; bio expla 4 schz
strength
amphetamines incr da /worsen symp in peop w schz and induces symp in peop w/o
antipsychotics decr da activity /reduce symp intensity
some candidate genes act on production of da/da receptors
TF: strongly sugg da involv in symp schz
evaluation - glutamate; bio expla 4 schz
limit
post mortem/live scanning stud consist fou raised lev og glutamate in sev schz brain regions
sev candidate genes for schz believed involv in glutamate production/processing
TF: means usually strong case can be made for oth neurotransmitters
psychological expla for schz - schizophrenogenic mother
reichmann; noted many of her patients w schz describ partic ty of parent
characterised by cold, uncaring, controlling, rejecting
creates tension/secrecy wh leads to atmosphere of distrust and developm of paro thoughts wh beco delusions
psychological expl 4 schz - double bind theory
bateson et al; emphasis role of communication style w/n fami
developing child regularly finds themselves trapped in situs where they fear doing wrong thing b receive mix messages abo what is wrong thing
when ‘get it wrong’ child punished by withdrawal of love so think world is confusing/dangerous
reflected in symp like disorganised thinking/paro delusions
he makes clear that it’s just a risk factor
psychological expla 4 schz - expressed emotion
lev emot express. towards pers w schz by their carers
contain; verb criticism of pers, hostility towards pers, emot over involvement in pers life inclu needless self sacrifice
high lev EE directed towards indiv r serious source of stress for them
primarily expla 4 relapse in peop w schz how. also sugg that it may be source of stress that can trigg onset of schz in pers already vulnerable
psychological expla 4 schz (cog expla) - dysfunctional thinking
schz characterised by disruption to normal thought processing
reduc thought process in ventral striatum assoc w -ve symp
reduc process info in temporal/cingulate gyro assoc w halluc
this lower than usual lev of info proc sugg cog like 2 be impaired
psychological expla 4 schz - metarepresentation dysfuntion (cog expla)
frith et al; metarep, cog abil to reflect on thoughts/beh wh allows insight in2 own intentions/goals and allows us to interpret actions of oths
dysfunct in metarep wou disrupt abil to recog own act/thoughts as being carried out by ourselves than some1 else
expla halluc of hearing voices /delusions like thought insertion
psychological expla 4 schz - central control dysfunction (cog expla)
frith et al; identif issues w cog abil 2 suppress automatic resp while we perform delib actions
speech poverty/thought disord cou res fr inabil 2 suppress autom thoughts /speech trigg by oth thoughts
ex. peop w schz experi derailment of thoughts bec each word trigg assoc/pers cx suppress autom resp
evaluation - empirical supp (berger) ; psychological expla 4 schz
strength
fou schz reported higher recall of double bind statements by their moths than non schz
this shows how double bind statements and actions like needless self sacrifice is freq fou in household w a schz memb and towards them
this real life evid increases the validity of the theory
evaluation - empirical supp counterpoint ; psychological expla of schz
evid may x be reliable as patients recall may be affected by their schz
sugg there is wider academic credibility for idea of contradictory messages causing schz x double bind theory
evaluation - real world applic of EE; psychological expla r schz
strength
hogarty; produced ty therapy session wh reduced social conflicts b/w parents and their childr wh reduced EE and relapse rates
TF: sugg gaining insight into fami relationships allows psychiat prof to help improve quality of patients lives
evaluation - research supp (cog expla); psychological expl 4 schz
strength
evid 4 dysfunctional thought processing
stirling et al; compar performance on range of cog task (stroop task) in 30 peop w and 30 peop w/o
as predicted, peop w schz took 2x longer to name font colours
TF: means cog processing of peop w schz impaired
evaluation - proximal expla (cog expla); psychological expl 4 schz
limit
only expla proximal origins of sympt
distal explan focus on what initially caused condit ex. genetic/family dysfunction expla
unclear how genetic variation/childh trauma might lead to metrep/cent contr prob
TF: means cog theories on their own only provide partial expla 4 schz
biological therapy 4 schz - typical antipsychotics
conventional drug treatments , chlorpromazine
oral administration (1000 mg)
reduce dopamine uptake /production
binds to D2 receptors
taken as tablets , syrups, injection depending on pers condit
acts as antagonist as blocks receptors so effectors impulse x happen
attempts to restore normal funct ex. halluc reduced and has sedative properties
b serious side eff
biological therapy 4 schz - atypical antipsychotics
1 clozapine
early withdrawal due to agranulocytosis
+re eff
oft used when oth treatments fail
users have regular bl test x administered by injections
acts on serotonin /gluatamate receptors and dopamine recept
2 risperidone
been around seen 1990s
drug as eff as clozapine b w/o side eff
low dose of max 12mg
binds to same receptors as clozapine b +re strongly to dopamine recept
evid of reduced side eff
evaluation - evid 4 effectiveness (thornley); biological therapy 4 schz
strength
reviewed stud comparing eff of chloropromazine to contr
data fr 13 trials w 1121 ppts
fou chloroprom assoc w better overall funct/reduc symp severity compar to placebos
meltzer; conclu clozapine +re eff than typical antipsychotics/some atypical
effective in 30-50% treatment resist cases where typical drugs have failed
TF: means antipsychotics work
evaluation - serious side effects ; biological therapy 4 schz
limit
typical assoc w range side eff inclu dizziness/weight gain
long term symp of tardiness dyskinesia wh caused by dopamine super sensitivity wh causes involuntary facial expressions ie. blinking
most serious side eff of neuroleptic malignant syndrome caus when drug blocks dopamine action in hypothalamus
NMS res in high temp, delirium and coma
freq ranges fr less than 0.1% to over 2%
TF means antipsychotics can do harm and indiv who experi may avoid treatment wh makes treatment ineff
evaluation - mechanism unclear ; biological therapy 4 schz
limit
x know y drug works
og da hypoth; idea that high lev dopamine in brain subcortex causes symp
how. og hypoth x complete expla 4 schz as acc dopamine lev too low in oth parts
if true then most antipsych shou x work wh means they’re ineff
TF: means at least some antipsych may x be best treatment to opt 4
evaluation - social/economic implications; biological therapy 4 schz
strength
drugs allow people to go back to work and their normal lives
so they can be active in the economy and don’t need to rely on the welfare state wh benefits the economy
psychological therapy 4 schz - CBT
challenges irrational beliefs /thoughts
use techniques like homework,diaries ,discussion
challenges delusions /hallucinations
turkington; case ex. of cbt w mafia delusion
he acknowledged the patients thoughts b. challenged their beliefs
why they happen/that they might be delusions/hallucinations
psychological therapy 4 schz - family therapy
reducing stress and EE in family context and focuses on entire family
aimed at reducing relapse
therapist observes/researched family interaction
educates fami on how to communicate/facts of illness
pharaoh et al; recommends nu strategies (unites)
unity in caring for indiv w schz, negative emot/stress reduction, irritation/guilt reduction, teaching boundaries, educating relatives about schz, solve/anticipate problems
evaluation - evidence of effectiveness (jauhar et al) ; psychological therapy 4 schz
strength
jauhar et al; reviewed 34 studies of using cbt w schz
fou clear evid for small b signif eff of both +ve/-ve symp
pontillo et al; fou reduction in freq/severity of auditory halluc
clinical advice fr NICE recommends cbt 4 schz
TF: means both res/clinical experi supports benefits of cbt 4 schz
evaluation - quality of evid; psychological therapy 4 schz
limit
wide range techniques/sympt inclu in studies
thomas; diff stud involv use of diff cbt techniques /peop w diff combo of +ve/-ve sympt
overall modest benefits of cbt 4 schz probably covers wide variety eff of diff cbt techniques on diff symp
TF: makes hard to say how effective cbt will be 4 partic pers
evaluation - evidence for effectiveness (mcfarlane) ; psychological therapy 4 schz
strength
mcfarlane; conclu family therapy one of the most consistently eff treatm available 4 schz
relapse rates reduced by 50-60%, promising even when ment health initially declines
clinical advice fr NICE recommends family T 4 everyone w schz
TF: means family therapy likely benefit peop w both early/late schz
evaluation - benefits to whole family (lobban/barrowclough); psychological therapy 4 schz
strength
lobban/barrowclough; conclu these eff import bec fami prov care for pers w schz
family therapy lessens -ve impact of schz on oth family memb/strengthens abil of fami to supp pers w schz
TF: means family therapy has wider benefits beyond the obvious +ve impact on the identif patient
management of schz - token economies
token economies are reward sys used to manage beh of peop w schz
in partic those who develop maladaptive beh thru spending long periods in psychiatric hospital
management of schz - developing token economies w schz
azrin; trialled token economy sys in ward of wom w schz
every time ppts did task (eg cleaning) they were given a plastic token that cou be swapped w privelleges
no tasks carried out increased significantly
use has declined in uk due to growth of community bas care and ethical issues raised by restricting rewards to peop w ment disorders
management of schz - rationale for token economies
institutionalisation develops under circumstances of prolonged hospitalisation
peop develop bad habits (eg stop maintaining pers hygiene)
token economies tackle personal care, condit related beh & social beh
modifying these beh doesn’t cure schz b improves quality of life w/n hospital setting
and normalises beh to make it easy to adapt back into life in community
management of schz - theoretical understanding
token economies bas on operant conditioning
tokens r secondary reinforcers as only have value when they can be used to gain meaningful rewards
meaningful rewards r primary reinforcers
tokens r paired w primary reinforced to become secondary reinforces
evaluation - evidence of effectiveness (glowacki) ; management of schz
glowacki; identif 7 stud that examined eff of token economies for ppl w chronic ment health issues
involv patients living in hospitals
all stud showed reduction in -ve symp
evaluation - evid of eff counterpoint ; management of schz
limit
7 stud is small evid base to supp eff
prob w small nu of stud is file drawer prob where there’s bias towards +ve published findings
bc undesirable results have been filed away
evaluation - ethical issues ; management of schz
gives prof power to contr beh of patients & involves imposing one pers norms onto oths
eg some1 who likes to look scruffy may have personal freedom restricted
restricting availability of pleasures to seriously ill peop may be distressing
caused legal action by fami wh have contrib to declined in use
evaluation - alternative appr; management of schz
limit
there’s oth appr that x raise ethical issues
art therapy; high gain low risk appr to managing schz w/o side eff or ethical abuses
NICE guidelines recommend art therapy 4 schz
TF: may be good alternative to token economies
interactionist appr to schz - diathesis stress model
vulnerability + stress trigg neccess to develop schz
1/+re underlying fact makes pers vuln b condit trigg by stress
meehls mod; in og ds mod diathesis was entirely genetic, res of schizogene
if pers x have gene then no amount stress can lead to schz
for carries of gene , chronic stress thru childh cou res in disorder
modern understanding of diathesis
many genes incr genetic vulnerability slightly b no singl schz gene
read et al; neurodevelopmental mod, early trauma alters developing br
severe trauma like child abuse can eff many aspects of br developm
ex. hypothalamic pituitary adrenal sys can beco over active making pers +re vuln to stress later
modern understanding of stress
houston; inclu anything that risks trigg schz
recent res shows cannabis use fact of trigg schz
cannabis interferes w dopamine
treatment according to the interaction model
turkington
biological expla (however partial) compatible w cbt
ds = drug therapy + cbt is most approp appr
cbt helps management + understanding of disorder
evaluation - support for vuln and trigg ; interactionist appr
strength
tienari et al; investigated impact of both genetic vuln + psycholog trigg
study follow 19000 finnish childr w schz biolog moth
in adulthood high risk grp compar to cg of adoptees w/o family history of schz
adoptive parents assessed for child rearing /fou high lev of hostility , criticism and low lev empathy strongly assoc w schz development b only in high genetic risk grp
TF: shows combo of genetic vuln/family stress can lead to greatly incr risk of schz
evaluation - diathesis and stress are complex ; interactionist appr
limit
og ds mod over simple
og mod of diathesis as single schizogene /schizophrenogenic parenting too simplistic
multiple genes in multiple combo influe diathesis
diathesis can be influe by psychological fact
houston et al; stud fou childhood sexual abuse emerged as maj influe on underlying vuln to schz / cannabis use as maj trigg
TF: means multiple fact both biol/psychol wh affects both diathesis/stress supp modern understanding of D + S
evaluation - real world applic; interactionist appr
strength
stud show combo of treatm enhances their eff
tarrier et al; randomly allocat 315 ppts to 1) medicat + cbt, 2) medicat + counselling, 3) cg of medicat only
fou ppts in 2 combo grp show lower symp that cg b no difference in hosp readmission
TF: means clear practical advantage to adopting interactionist appr to schz in terms of superior treatm outcomes
evaluation - urbanisation; interactionist appr
limit
schz +re commonly diag in urban areas than rural
this stat sometimes used to justify interactionist posit as assumes urban living +re stressful and tf city living acts as trigg
how may simply be that schz +re like to be diag in cities or that peop w diathesis 4 schz tend to migrate to cities
TF: interactionist may be overgeneralised
