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schizophrenia Flashcards

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1
Q

what two criteria’s are used to diagnose sz?

A

DSM
ICD

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2
Q

what does DSM focus on?

A

positive symptoms, used in US and sometimes Britain

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3
Q

what does ICD focus on?

A

negative symptoms, used in Europe and majority of world

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4
Q

name some positive symptoms of sz?

A

hallucinations, delusions, speech disorganisation, catatonic behaviour

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5
Q

name some negative symptoms for sz?

A

speech poverty, avolition, affective flattening

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6
Q

what is reliability in the context of sz?

A

how consistent are the results,
inter-rater reliability - the extent to which different assessors agrees with the their assessment
two or more professionals arrive at the same diagnosis, e.g., sz

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7
Q

what is a study that shows the weakness of reliability in diagnosing sz?

A

Chenaiux - two psychiatrists independently diagnosis 100 people using DSM and ICD
inter-rater reliability was poor, 1st psychiatrist diagnosed 26 with DSM and 44 with ICD
2nd psychiatrist diagnosed 13 with DSM and 24 with ICD, poor reliability

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8
Q

what is validity in the context of sz?

A

the extent to which we are measuring what we are intending to measure, is it truly measuring

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9
Q

what studies show the weakness of validity in diagnosing sz?

A

Cheniaux - more likely to be diagnosed using ICD therefore under diagnosing in DSM showing poor validity
Rosenhan - pseudo patient study

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10
Q

what is co-morbidity?

A

two or more conditions occur together, if condition occur together then the validity is questioned
Buckley those diagnosed with sz also diagnosed with depression 50%, harder to classify and diagnose as it may be severe depression

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11
Q

what is symptom overlap?

A

when two or more conditions share symptoms
sz and bipolar disorder involve positive and negative symptoms, validity is questioned again.
ICD may diagnose them as sz whereas DSM diagnose them as bipolar

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12
Q

what is the biological explanation for sz?

A

genetics and neural factors play a role in sz

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13
Q

what is the genetic explanation for sz? evidence

A

twin studies showed the genetic link with family members.
100% DNA shared with MZ twins 50% DNA with DZ twins
candidate genes, individual genes associated with the risk of inheritance as sz is polygenic
studies have identified different candidate genes, sz is aetiologically heterogeneous, as different factors can lead to sz development

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14
Q

what did Ripke do and what were the results? biological

A

carried out a study combining previous data from genome-wide studies of sz
37,000 people DNA with sz compared to 113,000 controls.
108 genetic variations associated with the increased risk of sz

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15
Q

what is the dopamine hypothesis?

A

chemical messenger appear to work differently in the brain of a person with sz
dopamine is seen to be involved as it is important in several brain functions
hyperdopaminergia - high levels of dopamine leads to high activity in the subcortex
therefore excess dopamine in the brain associated with delusions and hallucinations

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16
Q

what is the revised dopamine hypothesis?

A

where there are high and low levels of dopamine in the brain more so low levels
hypodopaminergia - abnormal dopamine systems, low level of dopamine in prefrontal cortex

17
Q

what is the neural explanation for sz?

A

neural correlates are measurements of the structure or function of the brain that correlate with an experience
positive and negative symptoms have neural correlates
negative - avolition, abnormality of areas in the ventral striatum
positive - Allen scanned brains of people experiencing hallucinates and compared to a control
had to identify pre-recorded speech of theirs or others
lower activation in the superior temporal gyrun and anterior cingulate gyrus were found in the hallucinate group, more errors made

18
Q

what are typical antipsychotics?

A

old 1950s
aim to reduce symptoms of sz
targets dopamine neurotransmitters
e.g. chlorpromazine
there is a strong association between typical antipsychotics and the dopamine hypothesis
works by binding and blocking the dopamine receptors
reducing hallucinates
tends to block all types of dopamine activity, up to 60%

19
Q

what are the side effects of typical antipsychotics?

A

extrapyramidal symptoms problem with movements
side effects tend to be long term

20
Q

what are atypical antipsychotics?

A

1970s new
aims to reduce sz symptoms more effectively and with less side effects
targets dopamine and serotonin
e.g. clozapine and risperdone
reduces positive and negative symptoms
generally fewer side effects
still risk of agranulocytosis can be fatal

21
Q

what does CBT do for sz?

A

sessions either group or individual
the aim is to identify irrational thoughts, dicuss of how likely these are to be true and consider a less threatening possibility
not rid of the symptoms but able to make people with sz be able to cope better
people are able to then make sense of hallucinations and delusions
able to understand where the symptoms come from

22
Q

what does family therapy do for sz?

A

takes place with families rather than individuals
aims to improve the quality of communication and interaction in families
some therapists see family as the root cause of sz
therapists more concerned with reducing stress within the family that might contribute to someone relapsing

23
Q

what strategies did Pharoah say were successuful in helping those with sz?

A

forming a therapeutic alliance with family
reducing the stress of caring for a relative with sz
improving the ability of the family to anticipate and solve problems
reduction of anger and guilt in family
help family achieve a balance between caring for the individual with sz and maintaining their own lives
improving families’ beliefs about and behaviour toward sz

strategies help to reduce levels of stress and expressed emotion, increasing the chance for those to comply with medication
reduce the likelihood of relapse and readmission rates

24
Q

how do token economies help sz?

A

reward systems to manage behaviour
tokens are given to patients immediately when they have carried out a desirable behaviour that has been targeted to be reinforced
most with sz will have bad hygiene and bad habits, maladaptive behaviours
immediacy of rewards is important because it prevents delay discounting the reduce effect of delayed reward
based on operant conditioning - tokens are secondary reinforcers

25
Q

what is the interactionist approach?

A

Acknowledges that there are biological, psychological and social factors. Biological – genetic vulnerability and neurochemical and neurological abnormality. Psychological factors – stress, poor quality interactions in the family
Diathesis – vulnerability stress – negative psychological experience. Diathesis stress model that a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the condition.

26
Q

how has the interactionist approach helped with treatment?

A

Compatible with biological and psychological treatments. Associated with combining antipsychotic medication and CBT.
Turkington – possible to believe in biological cause of sz and still practice CBT to relieve psychological symptoms. However, requires adopting an interactionist model.
In Britain it is standard to treat people with a combination of medication and CBT
It is usually common for medication to help those complete therapies as it may be another reason to reduce the aggressive that may appear in some schizophrenics.

27
Q

what was the Tienari study? aim/procedure

A

investigate combination of genetic vulnerability and parenting style
children adopted from Finnish mothers with sz
adoptive parents were assessed for child-rearing style
rates if sz were compared to control whose mother did not have sz

28
Q

what were the findings from the Tienari study?

A

child rearing style characterised by high levels of criticism and conflict, the implicated the development of sz but only in those who had a genetic vulnerability
genetic vulnerability and family related stress are important in the development of sz. shows the importance of an interactionist approach including poor parenting as a source of stress

29
Q

what is the schizophrenic mother theory?

A

mother is cold, rejecting and controlling
creates a family climate characterised by tension and secrecy
leads to distrust that develops into paranoia

30
Q

who came up with the double bind theory?

A

Bateson

31
Q

what is the double bind theory?

A

received mixed messages about something, feel unable to comment on the unfairness or seek clarification
when they get something wrong, the child is punished by withdrawal of love
leaves them with an understanding of the world as confusing and dangerous.

32
Q

what is expressed emotion?

A

verbal criticism accompanied by violence
hostility including anger and rejection
over-involvement in the life of the person

33
Q

how does EE link to sz?

A

high levels of EE is a source of stress to the patient
is an explanation for relapse
but also this source of stress can trigger the onset of sz if person is vulnerable
diathesis-stress model

34
Q

what two types of dysfunctional thought processing are there in the cognitive explanations for sz?

A

mete-representation
central control

35
Q

what is meta-representation?

A

cognitive ability to reflect on thoughts and behaviour
allows insight into our own intentions and goals
interpret the actions of others.
dysfunction disrupts the ability to recognise our own actions, as being carried out by ourselves rather than by someone else, explain hallucinations

36
Q

what is central control?

A

cognitive ability to suppress automatic responses while he perform deliberate actions instead
disorganised speech could result from suppress automatic thoughts

37
Q

what supporting evidence is there for family dysfunction?

A

Read - reviewed 46 studies of child abuse and sz
69% of adults with sz had a history of physical, sexual abuse or both in childhood. 59% for men
Berry - adults with insecure attachments more likely to have sz

38
Q

why is there weak evidence for family dysfunction in sz?

A

sz may have distorted patients’ recall of childhood experiences, problem for validity
little evidence to support the schizophrenic mother or double bind theory.
explanations have led to parent-blaming, who had to observe their child develop sz, bear the responsibility of their care, underwent further trauma by receiving the blame for the condition.

39
Q

what was Stirling’s study for dysfunctional information processing?

A

stroop test
30 sz, 18 control ppt
people with sz took twice as long as the control group
however, with the mass amount of evidence collected, cognitive theories can explain proximal causes, what may cause symptoms but not the distal causes, the origin of the condition

psychology (11 decks)

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