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Schizophrenia Flashcards

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1
Q

DSM

A

= US & Australia - only mental disorders latest version = X subtypes
must have 1 positive & 1 other

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2
Q

ICD

A

WHO - Eur = all med disorders
only need at least 2 negative symptoms

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3
Q

Positive Symptoms

A

additional experiences beyond ordinary existence = hallucinations & delusions

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4
Q

Hallucinations

A

aud/ visual hear voices = crit & unfriendly some also see, smell, taste & feel things not their = sensory expers that = not real / distorted

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5
Q

Delusions

A

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

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6
Q

Negative Symptoms

A

loss of normal function = speech poverty & abolition

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7
Q

Speech Poverty

A

also = alogia = dec in verbal output / express may = monosyllabic yes / no to ?s or delay in words

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8
Q

Avolition

A

lack of motivation for plans / negl household chores X hygiene - lack of persist in edu. / work

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9
Q

Reliability: Cheniaux et al (2009)

A

2 psychs independently assessed 100 ppl using DSM & ICD interrater reliability = poor ICD = 44 ppl DSM = 26 ppl other = 24 + 13

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10
Q

Reliability: Rosenhan

A

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

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11
Q

Validity

A

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

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12
Q

Comorbidity

A

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

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13
Q

Comorbidity: Buckley (2009)

A

around 1/2 also have depression, 47% substance abuse, 29% PTSD & 23% OCD

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14
Q

Symptom Overlap

A

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

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15
Q

Gender Bias: Longnecker (2010)

A

reviewed studies of prevalence of Sz conc since 1980s men = diag m often than women b4 = no dif men may have gen val

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16
Q

Gender Bias: Cotton (2009)

A

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

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17
Q

Culture Bias: DSM

A

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

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18
Q

Culture Bias: Escobar (2012)

A

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

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19
Q

Genetics

A

specific genes = assoc w/ risk of inheritance = polygenic num of studies have identified it as aetiologically heterogenous dif combo can cause

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20
Q

Gottesman

A

greater gen sim inc risk MZ = 48% DZ 17% comp 9% siblings 6% 1/2 siblings suggests other factors

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21
Q

Ripke et al (2014)

A

carried out large scale study combo data from genome wide studies not particular genes = 108 sep genetic variations assoc w/ inc risk

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22
Q

Tienari (2000)

A

looked at 164 adopted children who’s mothers had Sz concor = 67% comp to 2% in adopted children w/ Sz parents

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23
Q

Deterministic

A

ignores environment nature Vs nurture why is concor not 100% in MZ

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24
Q

Reductionist

Bio Explanation

A

ignores impact of environ & neurochem

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25
Q

Neural Correlates

A

patterns of structure / activity in brain that occur in conjunc w/ an exper include DA levels

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26
Q

Dopamine Hypothesis

A

chem sub manu in brain transmits messages between neurones causes them to fire works dif in Sz = NB for cortex & sub cortex

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27
Q

Hyperdopaminergia

A

in sub cortex & B’s A = excess of DA activity / receptors = assoc w/ speech pov & auditory hallus

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28
Q

Hypodopaminergia

A

in cortex abnormal low levels of DA Rakil et al (2004) iden low levels in PFC = responsible for decision making & assoc w/ neg symptoms

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29
Q

Wise & Stein (1973)

A

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

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30
Q

Tausher et al (2014)

A

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%

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31
Q

Lindstroem et al (1999)

A

chems needed to produce DA = taken up faster in Sz brain than control - prod m DA

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32
Q

Moghaddam & Javitt (2012)

A

evidence for role of neurochem glutamate Sz have deficit in G activity

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33
Q

Amphetamine

A

overdose can produce Sz like symps = Da antagonist & Sz have abnor large responses to amphet doses - issue = oversen not excessive levels

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34
Q

Ventral Striatum

A

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

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35
Q

Superior Temporal Gyrus

A

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

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36
Q

Family Dysfunction

A

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

37
Q

Schizophrenogenic Mother

A

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

38
Q

Double Bind Theory

A

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)

39
Q

Expressed Emotion

A

= 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

40
Q

Dysfunction of Thought Processes

A

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

41
Q

Metarepresentation

A

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

42
Q

Central Control

A

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

43
Q

A03 Family Dysfunction

A

Sz mum research showed mums personality = X reli predictor of mental illness - seen as embass & sexist

44
Q

Bateson (1956)

A

Reports clinical evidence illus use of double bind commun by parents of Sz but = retrospective researcher bias & causality problems

45
Q

Berger (1965)

A

Found Sz reported inc recall of double bind statements by mum than non Sz recall may = affected by Sz

46
Q

Read et al (2005)

A

69% of women & 59% of men w/ Sz = physical / sexual abuse early trauma = risk factor

47
Q

Hagarty (1991)

A

Produced therapy session dec social conflicts between parents & kids and dec EE & relapse rates but not all low EE X relapse

48
Q

Mischler & Waxler (1968)

A

Sig dies in how mums spoke to Sz c’s than non Sz = result X cause

49
Q

Socially Sensitive

A

= serious ethical concerns in blaming fam = little evidence parents already struggling w/ care - gender bias bc mothers = blamed

50
Q

Stirling

A

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

51
Q

McGuire et al (1996)

A

Sz have dec activity in brain areas that monitor inner speech

52
Q

Cognitive A03

A

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

53
Q

Direction of causality - cog defs

A

Not clear whether cog dysfunc = C/E prospective longitudinal research w/ children at risk assessed overtime / w/ self monitoring = nec to estab direct effect

54
Q

Chlorpromazine

Typical

A

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

55
Q

Clozapine

Atypical

A

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

56
Q

Risperidone

Atypical

A

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

57
Q

Thornley et al (2003)

A

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

58
Q

Meltzer (2012)

A

Cloz = effective 30-50% treatment resistant cases where typical failed

59
Q

A03 Effectiveness - drugs

A

but drug comps fund research Healy (2012) some studies have data pub multi times = inflated effectiveness

60
Q

Side Effects

A

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%

61
Q

Appropriateness

A

some ppl may not = able to manage regular meds & will have to take for rest of life = LT & a while to work

62
Q

Family Therapy

A

improv commun & dec stress, EE & relapse rates to edu fam on Sz & m effective stress management

63
Q

Pharaoh (2010)

A

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

64
Q

CBT

A

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

65
Q

Tarrier (1999)

A

stab rapour, iden triggers , find coping Strats = distraction - concentrate on task, pos self talk, behav Strats e.g., relax, loud music, soc inc/dec

66
Q

Pharaoh et al

A

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

67
Q

Anderson et al (1991)

A

relapse rate = 40% on drugs = 20% w/ FT & 5% when combo

68
Q

Lobban (2013)

A

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

69
Q

Family Therapy A03

A

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

70
Q

Sameer Jauhar et al (2014)

A

reviewed results of 34 studies & conc CBT = small but sig effect on + & - symps

71
Q

Sensky et al (2000)

A

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

72
Q

CBT A03

A

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

73
Q

McMonagle & Sultana (2009)

A

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

74
Q

Paul & Lentz (1977)

TEs

A

led to better overall function & dec behav disturbance = m cost effective

75
Q

Upper & Newton (1971)

A

weight gain assoc w/ antipyschs = addressed w/ TEs & chronic Szs achieved 3lbs of weight loss a week

76
Q

Not a Cure

A

= 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

77
Q

TEs Appropriateness

A

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

78
Q

Diathesis Stress Model

A

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

79
Q

Meehl’s Diathesis Stress Model (1962)

A

= trad model thought = schizogene & w/o wouldn’t develop no matter how much stress - diathesis (vol) = soley genetic

80
Q

Modern Diathesis Stress Model

A

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

81
Q

Houston et al (2008)

A

mod day stressors include anything that triggers Sz - cannabis inc risk by x7

82
Q

Implications of Diathesis Stress Model

A

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

83
Q

Tienari et al (2004)

A

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

84
Q

Vassos (2012)

A

m-a Sz risk inc 2.37% in cities comp to country - unsure why

85
Q

OG model = oversimplified

A

= multi genes stress can = many forms not limited to dysfunc parenting - no single source = could = early trauma & genes Houston shows = oversimple

86
Q

Effective Treatment

A

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

87
Q

Treatment Causation Fallacy

A

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

88
Q

Token Economies

A

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

Psychology (11 decks)

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