Schizophrenia Flashcards
classification/diagnosis of schizophrenia
-no single defining characteristic (collection of seemingly unrelated symptoms)
-DSM-5, one positive symptom present
-ICD-10, two or more negative symptoms
issues in diagnosis:
1- reliability (consistent)
2- validity (measure what they are designed to measure)
3- co-morbidity (two illnesses which confuse diagnosis)
4- symptom overlap (sharing symptoms)
AO3
:( low reliability of diagnosis, Cheniaux 2 psychiatrists vs 100 patents diagnosed with DSM5 and ICD, poor interrater reliability
1st 25D 44I
2nd 13D 24I
:( comorbidity, half patients also have depression
:( gender bias, female patients function better than males so escape diagnosis
:( culture bias, African-americans more likely to be diagnosed in uk as positive symptoms are considered normal for them (hearing voices from ancestors) 9x more likely diagnosed
symptoms of schizophrenia
positive=
delusions ( e.g beliefs about being a very important person)
hallucinations (hearing or seeing things)
negative=
avolition (severe loss of motivation)
speech poverty (reduced amount and quality of speech)
:( culture bias, African-americans more likely to be diagnosed in uk as positive symptoms are considered normal for them (hearing voices from ancestors)
biological explanations
(genetic)
genetic-
-running in families
-Gottesmans MZ- 48% vs DZ- 17%
-polygenetic, each individual gene increased chance
- different combinations, aetiologically heterogeneous
-Ripke, 37,000 found 108 separate genetic variations
AO3
:) Tienari, adoption studies (still heightened risk so must be genetics)
:( biological determinism, not 100% concordance so can’t be complete explanantion
biological explanations
(dopamine hypothesis)
-role of dopamine, dopamine widely believed to be involved in schizophrenia as in brain related to symptoms
-HYPERdopaminergia high dopamine in subcortex associated with hallucinations and speech poverty (excess of dopamine receptors in brocas)
-HYPOdopaminergia
low levels of dopamine in prefrontal cortex (responsible for thinking and decision making)
AO3
:( mixed support
:( what came first chicken or egg
biological explanations
(neural correlates)
-neural correlates = measurement of the structure or function of the brain that correlates with positive or negative symptoms
-ventral striatum and avolition
ventral striatum, is involved with anticipation of reward (related to motivation), loss of motivation can be explained through lower levels of activity here
-superior temporal gyrus and hallucinations
Allen, patients experiencing auditory hallucinations recorded lower activation levels in superior temporal gyrus
psychological explanations
(family dysfunction)
family dysfunction
-schizophrenogenic mothers, cold rejecting and controlling mothers that create tension .. leads to paranoid delusions
-double bind theory, bateson et al, children fear doing the wring thing due to inconsistent boundaries , when they get stuff wrong they’re punished through withdrawal of love learn the world is confusing leading to disorganised thinking and delusions
-expressed emotion,
criticism and hostility lead to relapse of patients
-verbal criticism
-hostility
-emotional over-involvement in life
AO3
:) Read et al, 42 studies, 69% patients experienced childhood physical/sexual abuses HOWEVER info gathered after diagnosis so could be distorted
:( weak, blame parents for child’s suffering, little evidence
psychological explanations
(cognitive explanations)
-dysfunctional thought processing, lower levels of info passing through brain suggest impaired cognition e.g reduced processing in ventral striatum = negative symptoms
-frith meta representation leads to hallucinations,
=cognitive ability to reflect on thoughts and behaviour, disrupts ability to recognise out own thoughts leading to sense of hallucinations and delusions
-frith
dysfunction of central control explains speech poverty, central control= cognitive ability to suppress automatic responses whilst performing deliberate actions
-derailment of thoughts as each word triggers automatic associations they can’t suppress
AO3
:(unlear whether they are as a result of or a cause of neural correlates
:) Stirling stroop test, 30 schiz, 30 without, wiht took twice as long (speech poverty)
typical antipsychotics
1st gen
Chlorpromazine,
reduces positive symptoms and blocks dopamine receptors
side effects
tardive dyskinesia
AO3
:) metaanalysis, 212, more effective than a placebo
:( could only be suppressing symptoms
:) end of long term institutionalisation
:) effect on economy (go back to work and drug therapies = cheaper)
:( side effects
atypical antipsychotics
2nd gen
Clozapine
bind to dopamine, serotonin and glutamate receptors
reduces positive and negative symptoms
side effects = more manageable e.g weight gain
AO3
:) metaanalysis, 212, more effective than a placebo
:( could only be suppressing symptoms
:) end of long term institutionalisation
:) effect on economy (go back to work and drug therapies = cheaper)
psychological treatments
CBT
-challenge irrational beliefs
-helps gain understanding of symptoms
family therapy
-reduces expressed emotion
-Pharoah, improves family function through:
1 lowering stress of caring for patient
2 improving ability of family to anticipate and problem solve
3 reduces guilt or anger of family
4 improves beliefs about behaviours towards schizophrenia
token economies
-token given to patients who display desirable behaviour
-vicarious reinforcement
-operant conditioning
-tokens secondary reinforcers
AO3
:(not a cure but a way to cope
:( ethics, token economies, punishes severely ill also CBT could interfere with freedom of thought
:( alternative therapies have not been researched e.g art therapy
:( cost of cbt
:( drop out rates for cbt and family therapy as length processes
interactionist approach
diathesis stress model
-Meehl, ‘schizogene’ and stressor caused schizophrenia
- modern understanding, schiz is polygenetic, so genetic vulnerability plus stressor (dysfunctional family) leads to schizophrenia
- due to noticing importance of biological and psychological, treatments follow combination of cbt and drug therapies
AO3
:) support for dual role of vulnerability, Tienari et al, child adopted away from schizophrenic mothers 5.8% vs adopted into dysfunctional families 36.8%
:) studies show more effective treatment
:( treatment has both side effects so cost and side effects
