Schizophrenia Flashcards
DSM
= US & Australia - only mental disorders latest version = X subtypes
must have 1 positive & 1 other
ICD
WHO - Eur = all med disorders
only need at least 2 negative symptoms
Positive Symptoms
additional experiences beyond ordinary existence = hallucinations & delusions
Hallucinations
aud/ visual hear voices = crit & unfriendly some also see, smell, taste & feel things not their = sensory expers that = not real / distorted
Delusions
unshakeable belief in something unlikely / bizarre
paranoid d’s - believe = misled / manip / hurt
d’s of grandeur believe have imaginary power / auth e.g., spy / on mission from god
Negative Symptoms
loss of normal function = speech poverty & abolition
Speech Poverty
also = alogia = dec in verbal output / express may = monosyllabic yes / no to ?s or delay in words
Avolition
lack of motivation for plans / negl household chores X hygiene - lack of persist in edu. / work
Reliability: Cheniaux et al (2009)
2 psychs independently assessed 100 ppl using DSM & ICD interrater reliability = poor ICD = 44 ppl DSM = 26 ppl other = 24 + 13
Reliability: Rosenhan
sent friends/ students to be diagnosed - heard voice hollow, empty, thud did match Sz but sent to mental hospital - acted normal & staff didn’t notice
Validity
Extent to which diagnosis = real & distinct & measures what says - criterion val - do dif systems arrive at same diag for same patient - Cheniaux ICD m likely than DSM so either over / under diagnose
Comorbidity
when 2 conditions occur together if 2 a lot = ? val might = 1 condition = prob for Sz 1/2 also diag w/ dep - may = bad at seeing difs if severe dep looks like Sz might be better as 1 = weakness
Comorbidity: Buckley (2009)
around 1/2 also have depression, 47% substance abuse, 29% PTSD & 23% OCD
Symptom Overlap
consid overlap between Sz symps & other conditions e.g., Bipolar also delusions & abolition ?s val of D&C under ICD someone might = Sz but = bipolar under DSM - could = same
Gender Bias: Longnecker (2010)
reviewed studies of prevalence of Sz conc since 1980s men = diag m often than women b4 = no dif men may have gen val
Gender Bias: Cotton (2009)
women fund better m likely to work & have pos fam rela inc func may explain why some aren’t diag where men might be - interpersonal fun might bias psychs so symps = masked
Culture Bias: DSM
created by US for US behav in 1 cup might not = viewed as symps but DSM says is - voices - leads to incorrect treatment & diag - drug side effects
Culture Bias: Escobar (2012)
white psychs over interp symps & distrust patient honesty - Afro-Caribbeans m likely to = diag but not in Africa & West Indies so not gen vol = cup bias - pos symps voices = commun w/ ancestors
Genetics
specific genes = assoc w/ risk of inheritance = polygenic num of studies have identified it as aetiologically heterogenous dif combo can cause
Gottesman
greater gen sim inc risk MZ = 48% DZ 17% comp 9% siblings 6% 1/2 siblings suggests other factors
Ripke et al (2014)
carried out large scale study combo data from genome wide studies not particular genes = 108 sep genetic variations assoc w/ inc risk
Tienari (2000)
looked at 164 adopted children who’s mothers had Sz concor = 67% comp to 2% in adopted children w/ Sz parents
Deterministic
ignores environment nature Vs nurture why is concor not 100% in MZ
Reductionist
Bio Explanation
ignores impact of environ & neurochem
Neural Correlates
patterns of structure / activity in brain that occur in conjunc w/ an exper include DA levels
Dopamine Hypothesis
chem sub manu in brain transmits messages between neurones causes them to fire works dif in Sz = NB for cortex & sub cortex
Hyperdopaminergia
in sub cortex & B’s A = excess of DA activity / receptors = assoc w/ speech pov & auditory hallus
Hypodopaminergia
in cortex abnormal low levels of DA Rakil et al (2004) iden low levels in PFC = responsible for decision making & assoc w/ neg symptoms
Wise & Stein (1973)
abnor low DBH in post mortem studies of Sz suggests abnor high DA activity as DBH breaks down Sz - can’t rule out cause of death
Tausher et al (2014)
anti psych drugs dec DA activity symps can be treated w/ DA untags = effective in 60% of cases w/ m impact on + symps - what about 40%
Lindstroem et al (1999)
chems needed to produce DA = taken up faster in Sz brain than control - prod m DA
Moghaddam & Javitt (2012)
evidence for role of neurochem glutamate Sz have deficit in G activity
Amphetamine
overdose can produce Sz like symps = Da antagonist & Sz have abnor large responses to amphet doses - issue = oversen not excessive levels
Ventral Striatum
involv in motivation & reward anticipation if activity levels are low then no anticipation no reason to engage in behavs to get reward - neural correlate to neg symps links to abolition - Juckel et al (2006) Sz have low levels of activity comp to control
Superior Temporal Gyrus
recon sounds contains primary and cortex
Allen et al (2007) scanned patients w/ aud hallus comp to control lower activations levels in STG lower activity = NC for aud halls less STG activity may = dif in detecting origins of a voice & inability to recog internal monologue
Family Dysfunction
fam systems theory looks at relas & how influence behaviour psych approach due to maternal behav ab upbringing creating fragile ego easily broken by id can’t distinguish fantasy & reality
Schizophrenogenic Mother
Fromm-Reichman (1948) Sz mum creates Sz children = domineering, cold, rejecting & guilt producing w/ passive ineffectual father = driven to Sz - fam chara = secretive & tense creates distrust and develops into paranoid delusions & Sz
Double Bind Theory
Sz = conseq of abnormal patterns in fam commun (Bateson 1956) - patient = symp of fam become ill to protect fam system stability
given mutually contradicting signals = impos situ causes internal conflict Sz symps = attempt to escape double bind
e.g., father says daughter doesn’t love him (primary commun) but won’t take a hug (meta commun)
Expressed Emotion
= maintenance some fam mems = freq hostile - anger & rejection = crit & over involv = high EE others don’t show = low EE
Vaughan & Leff (1976) extent of EE w/in fam = predictor of relapse rates if H EE 51% relapse 13% in L EE stress of EE = blame
Dysfunction of Thought Processes
McKenna (1996) may = due to defect n selective attention so symps depend on poor ability to concentrate = lack of self monitoring thoughts & ideas = attributed to external sources e.g., hallus & delus don’t realise = self gen explains disorganised speech - already seen dec processing in VS & STG = cog impair
Metarepresentation
Cog ability to reflect on thoughts and behav allows insight into intentions goals and interp others actions
Dysfunc means inability to recognise own actions and thoughts as own - thought insertion
Central Control
Cog abil to suppress auto responses while we perform deliberate actions instead
Disorg speech & thought disorder = inabil to suppress auto thoughts & spoken sentences trigger other thoughts by assoc & can’t stop the response
A03 Family Dysfunction
Sz mum research showed mums personality = X reli predictor of mental illness - seen as embass & sexist
Bateson (1956)
Reports clinical evidence illus use of double bind commun by parents of Sz but = retrospective researcher bias & causality problems
Berger (1965)
Found Sz reported inc recall of double bind statements by mum than non Sz recall may = affected by Sz
Read et al (2005)
69% of women & 59% of men w/ Sz = physical / sexual abuse early trauma = risk factor
Hagarty (1991)
Produced therapy session dec social conflicts between parents & kids and dec EE & relapse rates but not all low EE X relapse
Mischler & Waxler (1968)
Sig dies in how mums spoke to Sz c’s than non Sz = result X cause
Socially Sensitive
= serious ethical concerns in blaming fam = little evidence parents already struggling w/ care - gender bias bc mothers = blamed
Stirling
Strop test given name of colour written in dif colour ink had to say ink colour Sz took 2x longer than control - processing issue CC but others found Sz = faster so may be testing v specific cog CC not complete exp
McGuire et al (1996)
Sz have dec activity in brain areas that monitor inner speech
Cognitive A03
Research lacks mundane reality & gen to Sz symptoms accounts for positive but not negative symptoms
Has scientific validity research self monitoring = experimental methods
Other factors w/ little relevance to cognitive deficits have = found to influ Sz development not clear how/if genetic factors stress & social factors interlink w/ cognitive
Direction of causality - cog defs
Not clear whether cog dysfunc = C/E prospective longitudinal research w/ children at risk assessed overtime / w/ self monitoring = nec to estab direct effect
Chlorpromazine
Typical
1950s daily dose = up to 1000mg a day
DA antag blocks receptors in brain synapses to DA actions & symps initially causes DA build up then diffuses & prod less
extrapyramidal side effects & = sedative dec hallus
Clozapine
Atypical
1970s w/ drawn deaths
daily dose = 300-450mg binds to receptors - acts on serotonin & glutamate inc mood dec anxiety inc cog func
agranulocytosis - blood tests
also used if inc suicide risk
Risperidone
Atypical
1990s injection every few weeks / daily 4-8 mg tablets up to 12mg binds to DA & S receptors = stronger than Cloz & m effective in smaller doses & dec side effects
Thornley et al (2003)
m-a looking at Chlor effectiveness comp to placebo from over 1000 ptps showed assoc w/ better overall func & dec symps severity and relapse rates
Meltzer (2012)
Cloz = effective 30-50% treatment resistant cases where typical failed
A03 Effectiveness - drugs
but drug comps fund research Healy (2012) some studies have data pub multi times = inflated effectiveness
Side Effects
dizziness, agitation, sleepiness, stiff jaw, weight gain, itchy skin LT can = dyskinesia DA super-sen & invol facial movements e.g., grimacing - m serious = neuroleptic malignant syndrome - drug blocks DA action in hypothalamus = inc temp coma can = fatal = rarer now 0.1-2%
Appropriateness
some ppl may not = able to manage regular meds & will have to take for rest of life = LT & a while to work
Family Therapy
improv commun & dec stress, EE & relapse rates to edu fam on Sz & m effective stress management
Pharaoh (2010)
iden NB Strats to dec stress/ EE & inc chance of med compliance
weekly fam meetings to solve problems resolve conflict & pinpoint stressors
interviews to iden & observe +&- of fam mems & prob behavs - specific goals
taught to listen express emos & compromise & time out dec EE
help bal care & own lives less guilt if do something for self
CBT
taught to recon examples of dysfunc thinking & how to avoid acting on it - m able to cope 5-20 sessions
iden irrational thoughts & challenge them / distract
inc/dec soc activity / breathing / relax - loud music to drown out voices
Tarrier (1999)
stab rapour, iden triggers , find coping Strats = distraction - concentrate on task, pos self talk, behav Strats e.g., relax, loud music, soc inc/dec
Pharaoh et al
reviewed evidence for FT effectiveness = mod evi to show sig dec in hospital readmin over 1 yr & inc qual of life for fam but = inconsistent & = probs w/ evi quality so = weak
Anderson et al (1991)
relapse rate = 40% on drugs = 20% w/ FT & 5% when combo
Lobban (2013)
other fam mems felt able to cope better in m extreme cases some = unable to cope w/ pressures of discussing ideas & feelings = overfixhted w/ details of their illness
Family Therapy A03
highly cost effective p’s less likely to take up beds - dec relapse rates NICE review demoed = assoc w/ sig cost savings when offered w/ standard care savings can = higher
Sameer Jauhar et al (2014)
reviewed results of 34 studies & conc CBT = small but sig effect on + & - symps
Sensky et al (2000)
comp CBT w/ non-specific befriending interventions both dec symps at 9 month follow up CBT showed inc improvements = effective & sustained for at least 9 months
CBT A03
allows m normal func & prevents learned symps developing can be used w/ other therapies X side effects not v rational to teach to see everything through + lens X work for everyone & = expensive
McMonagle & Sultana (2009)
reviewed evidence for TEs & found only 3 studies where Sz p’s = randomly allocated = 110 ptps only 1 showed improvement & none = useful info about behav change
Paul & Lentz (1977)
TEs
led to better overall function & dec behav disturbance = m cost effective
Upper & Newton (1971)
weight gain assoc w/ antipyschs = addressed w/ TEs & chronic Szs achieved 3lbs of weight loss a week
Not a Cure
= m dif to keep going once home
Kazdin et al found changes in behav achieved via TEs don’t remain when tokens = w/drawn suggesting treatments address effects of Sz X causes
TEs Appropriateness
severely ill p’s can’t get privileges = less able to comply w/ desirable behavs than mod ill = subjected to regime which takes away choices less prob than drugs but issues w/ victimisation & soc control = m expen & time consuming
Diathesis Stress Model
although research shows NBance of bio also shows sig environ factors links bio vul & environ stressors
explains will develop Sz if have biopredis & exposed to stressful situ
Meehl’s Diathesis Stress Model (1962)
= trad model thought = schizogene & w/o wouldn’t develop no matter how much stress - diathesis (vol) = soley genetic
Modern Diathesis Stress Model
many genes inc gen vul & stressful life events can trigger - childhood trauma- Read et al - history of abuse altered brain development, living conditions e.g., highly urbanised
stress seen as pysch in nature related to parenting
Houston et al (2008)
mod day stressors include anything that triggers Sz - cannabis inc risk by x7
Implications of Diathesis Stress Model
acknows interaction of bio & psych factors
Turkington et al - can still believe bio basis & use CBT to relieve psych symps
UK uses combo USA = drugs
Tienari et al (2004)
investigated combo of genetic vul & parenting (trigger) 19000 adopted kids w/ Sz mums p’s assessed for p style & Sz rates comp to control w/o gen vul
if highly crit & = conflict low empathy = implicated inSz development but only in the exper group w/ gen risk
Vassos (2012)
m-a Sz risk inc 2.37% in cities comp to country - unsure why
OG model = oversimplified
= multi genes stress can = many forms not limited to dysfunc parenting - no single source = could = early trauma & genes Houston shows = oversimple
Effective Treatment
sup for usefulness of interactionist approach & combo bio & psych treatments Vs bio alone - Turkington
Tarrier et al (2004) 315 p’s randomly allocated to med & CBT / med & sup counselling / control - combo dec symps comp to med control but no dif in hospital readmim shows clear practice advantage for better outcomes
Treatment Causation Fallacy
Turkington et al argues = logical fit IA & combo but fact combo = m effective than on own doesn’t mean IA = correct sim bc drugs work doesn’t mean = bio - error of logic
Token Economies
Token economies aim to manage schizophrenia rather than treat it.
They are a form of behavioural therapy where desirable behaviours are encouraged by the use of selective reinforcement and is based on operant conditioning
Tokens - given immediately after desirable behaviour: Brushing your teeth, Making a phone call home
Rewards - the token becomes the secondary reinforcer while the reward is the primary reinforcer
1. Watching a movie
2. An outing
3. Chocolate
