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Psychology Paper 3 > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Diagnosis and classification:

A strength of diagnosis of schizophrenia is good reliability…

A
  • a reliable diagnosis is consistent between clinicians (inter-rater) and between occasions (test-retest)
  • Osorio et all report excellent reliability for schizophrenia diagnosis (DSM-5): inter-rater agreement of +.97 and test-retest reliability of +.92
  • means diagnosis of schizophrenia is consistently applied
  • also supporting evidence from Rosenhans study were 7 out of 8 pseudo patients who acted the same were diagnosed with schizophrenia. Suggests presenting the same symptoms will end in the same diagnosis, so reliability is high
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2
Q

Diagnosis and classification:
A weakness of diagnosis of schizophrenia is low validity…

Counterpoint…

A
  • Criterion validity involves seeing whether different procedures used to asses the same individuals arrive at the same diagnosis.
  • Cheniaux et al had 2 psychiatrists independently asses the same 100 clients. 68 were diagnosed with schizophrenia with ICD and 39 with DSM
  • means schizophrenia is either over or under diagnosed, suggesting the criterion validity is low
  • *However**, in Osorio study there was excellent agreement between clinicians using different procedures both derived from the DSM
  • means criterion validity for schizophrenia is good provided it takes place within a single diagnostic system
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3
Q

Diagnosis and classification:
A weakness is co-morbidity with other conditions…

A
  • If conditions co-occur then they might be a single condition.
  • schizophrenia is commonly diagnosed with other conditions
  • e.g. Buckley et al concluded schizophrenia is co-morbid with depression (50% of cases), substance abuse (47% of cases) or OCD
  • suggests schizophrenia may not exist as a distinct condition
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4
Q

Diagnosis and classification:
A weakness is gender bias…

A
  • men are diagnosed with schizophrenia more often than women in a ratio of 1.4:1
  • could be because men are more genetically vulnerable or women have better social support, masking symptoms
  • means some women with schizophrenia aren’t diagnosed so miss out on helpful treatment
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5
Q

Diagnosis and classification:
A weakness is culture bias…

A
  • Some symptoms E.g. hearing voices are accepted in some cultures such as Afro-Caribbean societies ‘hear voices’ from ancestors
  • Afro-Caribbean British men are up to 9x more likely to receive a diagnosis as white British men, probably due to over interpretation of symptoms by Uk psychiatrists
  • means Afro-Caribbean men living in the Uk appear to be discriminated against by a culturally biased diagnostic system
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6
Q

Diagnosis and classification:
A weakness is symptom overlap

A
  • there is an overlap between the symptoms of schizophrenia and other conditions
  • E.g. both schizophrenia and bipolar disorder involve delusions and avolition. Schizophrenia and bipolar disorder may be the same condition (a classification issue)
  • schizophrenia is hard to distinguish from bipolar (a diagnosis issue)
  • this means schizophrenia may not exist as one condition and if it does, it’s hard to diagnose
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7
Q

Biological explanations for schizophrenia, genetic basis:
Gottesman’s large-scale study found…

A
  • someone with an aunt with schizophrenia has a 2% chance of developing it
  • 9% for a sibling
  • 17% DZ twin
  • 48% for an MZ twin
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8
Q

Biological explanations for schizophrenia, genetic basis:
Ripke et al combined all previous data from genome-wide studies and found…

A

108 seperate genes associated with a slightly increased risk of schizophrenia

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9
Q

Biological explanations for schizophrenia, genetic basis:
Evidence of genetic origin in absence of family history due to mutation in parental DNA comes from

A

The correlation between paternal age (associated with increased risk of sperm mutation) and risk of schizophrenia (Brown et al 2003)

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10
Q

Biological explanations for schizophrenia, genetic basis:
A strength is strong evidence base…

A
  • Family studies show risk increases with genetic similarities.
  • Twin study found 33% concordance rate for MZ and 7% for DZ twins(Hiker et al)
  • adoption studies (E.g. Tienari et al 2004) show that biological children of people with schizophrenia are at greater risk even if they grow up in an adoptive family
  • shows that some people are more vulnerable to schizophrenia because of their genes
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11
Q

Biological explanations for schizophrenia, genetic basis:
A weakness is evidence of environmental factors

A
  • biological risk factors include birth complications and smoking THC-rich cannabis in teenage years.
  • psychological risk factors include childhood trauma E.g. 67% with schizophrenia (38% matched controls) reported at least one childhood trauma
  • this means genes alone cannot provide a complete explanation for schizophrenia
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12
Q

Biological explanations for schizophrenia, neural correlates:
A strength is support for the role of dopamine in symptoms of schizophrenia…

A
  • Amphetamines (increase DA) mimic symptoms (Curran et al 2004).
  • Antipsychotic drugs (reduce DA) reduce intensity of symptoms (Tauscher et al 2014).
  • candidate genes act on the production of DA or DA receptors
  • this strongly suggests that dopamine is involved in the symptoms of schizophrenia
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13
Q

Biological explanations for schizophrenia, neural correlates:
A weakness is evidence for central role of glutamate…

A
  • post-mortem studies and scanning studies found raised glutamate in people with schizophrenia (McCutcheon et al 2020).
  • also, several candidate genes for schizophrenia are believed to be involved in glutamate production or processing
  • this means that a strong case can be made for other neurotransmitters in schizophrenia
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14
Q

Biological explanations for schizophrenia:
A biological approach to explaining schizophrenia, such as a genetic basis assumes that schizophrenia is inevitable, or biologically determined…

A
  • Potentially making sufferers feel disempowered when diagnosed.
    -Other more psychological approaches such as the cognitive approach has a soft determinist perspective suggesting that mental processes can be altered or managed via free will to control the disorder.
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15
Q

Biological explanations for schizophrenia:

Explaining schizophrenia at the basic cellular and chemical level has the advantage of the scientific principle of parsimony (preferring the theory with fewer assumptions)

A

this biologically reductionist approach fails to consider evidence for the range of psychological aspects of schizophrenia such as expressed emotion that seem to have a large influence on the development and relapse of the disorder

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16
Q

Biological treatment of schizophrenia:
A strength is antipsychotics are cost effective

A
  • in relation to other treatments such as therapy E.g. can be £60+ per session whereas 28 100mg chlorpromazine tablets could cost around £15
  • more accessible for everyone
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17
Q

Biological treatment of schizophrenia:
A strength is positive impact on economic state

A

Fewer hospitalised psychiatric stays (lower cost) and patients able to return to work

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18
Q

Biological treatment of schizophrenia:
A strength is evidence of effectiveness…

A
  • Thornley et al reviewed data from 13 trials (1121 participants) and found that chlorpromazine was associated with better functioning and reduced symptom severity compared with placebo
  • there is also support for benefits of atypical antipsychotics. Meltzer concluded that clozapine is more effective than typical antipsychotics and that it is effective in 30-50% of treatment-resistant cases
  • means as far as we can tell antipsychotics work
19
Q

Biological treatment of schizophrenia:
A weakness is most studies are of short-term effects only and…
However..

A
  • some data sets have been published several times, exaggerating the size of evidence base (Healy 2012).
  • also benefits may be due to calming effects of drugs rather than real effects on symptoms
  • means evidence of effectiveness is less impressive than it seems
  • also may only be suppressing symptoms and not treating underlying problem
  • however,they help calm patients and reduce symptoms so can engage more in treatments such as therapy E.g. CBT
20
Q

Biological treatment of schizophrenia:
A weakness is likelihood of side effects

A
  • typical antipsychotics are associated with dizziness, agitation, sleepiness, weight gain, etc.
  • long-term use can lead to lip-smacking and grimacing due to dopamine super-sensitivity (=tardive dyskinesia)
  • the most serious side effect is neuroleptic malignant syndrome (NMS) caused by blocking dopamine action in the hypothalamus (can be fatal due to disrupted regulation of several body systems). This means that antipsychotics can do harm as well as good and individuals may avoid them (reducing effectiveness)
  • due to severity of side effects 2/3 of people stop taking them which results in symptoms returning and a “revolving door” of people returning to treatment
21
Q

Biological treatment of schizophrenia:
A weakness is don’t know how they work

A
  • The use of most of these drugs is strongly tied up with the dopamine hypothesis and the idea that there are higher-than-usual levels of dopamine in the subcortex of people with schizophrenia.
  • but there is evidence that this may not be correct and that dopamine levels in other parts of the brain are too low rather then too high
  • if so, most antipsychotics shouldn’t work
  • this means that antipsychotics may not be the best treatment to opt for (perhaps some other factor is involved in their apparent success)
22
Q

Biological treatment of schizophrenia:
A weakness is don’t know how they work

A
  • The use of most of these drugs is strongly tied up with the dopamine hypothesis and the idea that there are higher-than-usual levels of dopamine in the subcortex of people with schizophrenia.
  • but there is evidence that this may not be correct and that dopamine levels in other parts of the brain are too low rather then too high
  • if so, most antipsychotics shouldn’t work
  • this means that antipsychotics may not be the best treatment to opt for (perhaps some other factor is involved in their apparent success)
23
Q

Psychological explanation for schizophrenia, family dysfunction:
A strength is evidence linking family dysfunction to schizophrenia…

A
  • a review by Read et al reported that adults with schizophrenia are disproportionally likely to have insecure attachment (Type C or D).
  • Also 69% of women and 59% of men with schizophrenia have a history of physical and/or sexual abuse
  • strongly suggests that family dysfunction does make people more vulnerable to schizophrenia
24
Q

Psychological explanation for schizophrenia, family dysfunction:
A weakness is poor evidence base for any of the explanations

A
  • Almost no evidence to support the importance of traditional family based theories
  • E.g. schizophrenogenic mother and double bind. Both theories are based on clinical observation of patients and informal assessment of personality of mothers of patients
  • means that family explanations haven’t been able to explain the link between childhood trauma and schizophrenia
25
Q

Psychological explanation for schizophrenia, family dysfunction:
A weakness is the theory is socially sensetive…

A
  • as it it can lead to parent blaming.
  • this creates additional stress for parents who are already seeing their child experience schizophrenia and taking responsibility for their care
  • therefore research into family dysfunction and schizophrenia is controversial
26
Q

Psychological explanation for schizophrenia, cognitive explanations:
A strength is there is evidence for dysfunctional thought processing

A
  • Stirling et al compared performance on a range of cognitive tasks (E.g. stroop task) in people with and without schizophrenia.
  • as predicted by central control theory, people with schizophrenia took over twice as long on average to name the font-colours
  • this supports the view that the cognitive processes of people with schizophrenia are impaired
27
Q

Psychological explanation for schizophrenia, cognitive explanations:
A weakness is it may be best seen as a biological condition

A
  • abnormal cognition is probably partly genetic in origin and the result of abnormal brain development
  • in a study by Frith schizophrenia patients with various symptoms had PET scans. These scans indicated a reduction in blood flow in the frontal cortex with patients with negative symptoms like avolition and the inability to suppress automatic thoughts. Also the scans showed increased activity in an area of the temporal lobe responsible for the retrieval of memories with patients with reality distortion.
  • underlying cause may be biological
28
Q

Psychological therapy for schizophrenia, family therapy:
A strength is evidence of effectiveness…

A
  • McFarlane concluded that family therapy is effective for schizophrenia.
  • Relapse rates were reduced by 50-60%.Particularly promising during time when mental health initially starts to decline
  • NICE recommends family therapy
  • this means that family therapy is good for people with both early and “full blown” schizophrenia.
29
Q

Psychological therapy for schizophrenia, family therapy:
A strength is benefits for the whole family…

A
  • therapy isn’t just for the benefit of the identified patient but also for the families that provide bulk of care for people with schizophrenia
  • family therapy lessens the negative impact of schizophrenia on the family and strengthens ability of the family to give support
  • means family therapy has wider benefits beyond the obvious positive impact on the identified patient
30
Q

Psychological therapy for schizophrenia, family therapy:
A weakness is it can be time consuming as it is a lengthy process

A
  • family therapy can last up to a year
  • symptoms or incidents (such as disputes or conflict in the family) may cause patients and family to drop out of therapy (requires active involvement that not everyone can commit to)
  • also means therapy is of great expense
  • not always accessible and suitable for everyone
31
Q

Psychological therapy for schizophrenia, CBT:
A strength is evidence of effectiveness

A
  • Jauhar et al reviewed 34 studies of CBT for schizophrenia and concluded there is evidence for significant effects on symptoms.
  • Pontillo et al found reductions in auditory hallucinations
  • clinical advice from NICE recommends CBT for people with schizophrenia
  • this means both research and clinical experience support CBT for schizophrenia
32
Q

Psychological therapy for schizophrenia, CBT:
A weakness is it’s not suitable for everyone…

A
  • requires self awareness and willingness to engage which isn’t always possible as some positive symptoms can lead to lack of awareness and some negative reluctance to engage
  • additionally, there is the vigorous confrontation element which some may not want to engage with
  • not always effective treatment
33
Q

Psychological therapy for schizophrenia, CBT:
A weakness is therapy is lengthy and time consuming… (kind of similar to not suitable for everyone point, could word it as drug treatments may be a more appropriate treatment/ are more time efficient + cheaper)

A
  • as between 5 and 20 sessions are taken which can be more expensive than drug treatments or lead to drop outs
  • not cost or time effective
34
Q

The interactionist approach:
A strength is support for the dual role of vulnerability and stress…

A
  • Tienari et al studied children adopted away from mothers diagnosed with schizophrenia. The adoptive parents parenting styles were assessed and compared with a control group of adoptees with no genetic risk
  • a child-rearing style with high levels of criticism and conflict and low levels of empathy was implicated in the development of schizophrenia but only for children with a high genetic risk
  • shows that a combination of genetic vulnerability and family stress leads to increased risk of schizophrenia
35
Q

The interactionist approach:
A strength is support for the dual role of vulnerability and stress…

A
  • Tienari et al studied children adopted away from mothers diagnosed with schizophrenia. The adoptive parents parenting styles were assessed and compared with a control group of adoptees with no genetic risk
  • a child-rearing style with high levels of criticism and conflict and low levels of empathy was implicated in the development of schizophrenia but only for children with a high genetic risk
  • shows that a combination of genetic vulnerability and family stress leads to increased risk of schizophrenia
36
Q

The interactionist approach:
A strength is real-world application of interaction

A
  • Tarrier et al randomly allocated 315 participants to (1) medication + CBT group (2) medication + supportive counselling group, or (3) control group (medication only).
  • participants in the two combination groups showed lower symptom levels than those in the control group (but no difference in hospital re admission)
  • means there is a clear practical advantage to adopting an interactionist approach in the form of superior treatment outcomes
37
Q

The interactionist approach:
A weakness is Jarvis and Okami suggest this is a treatment-causation fallacy…

A
  • in that a successful treatment doesn’t identify the cause (this argument is the same as claiming that because alcohol reduces shyness, shyness is caused by a lack of alcohol)
  • just because there seems to be a connection (correlation) this doesn’t equate to the cause (causation)
    (Cannot automatically assume the success of combined therapies means the interactionist explanations are correct)
38
Q

The interactionist approach:
A weakness is the fundamental mechanisms about how stress can trigger biological response is still unclear

A
  • many complex factors are involved in this response (E.g. psychological trauma) which can be hard to gauge empirically (hard to test scientifically)
  • may lack validity
39
Q

The interactionist approach:
A weakness is the fundamental mechanism by which a negative psychological event actually triggers a complex biological response resulting in symptoms is still uncertain

A
  • many complex factors are involved in this response which can be hard to gauge empirically (hard to test scientifically)
    -reducing confidence in the interactionist approach as a full explanation for schizophrenia.
  • may lack validity
40
Q

Management of schizophrenia:
A strength is evidence of effectiveness…

However…

A
  • Glowacki et al identified 7 high quality studies (published between 1999 and 2013) on the effectiveness of token economies in a hospital setting
  • all the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviour
  • this supports the value of token economies
    however
  • studies have a small evidence base. The Issue with such a small number of studies is the file drawer problem, a bias towards publishing positive findings
  • serious question over effectiveness of token economies
41
Q

Management of schizophrenia:
A strength is could be administered by anyone (with training) and…

A

Tokens and rewards are relatively cheap, so the programme is not expensive and there are more benefits than costs

42
Q

Management of schizophrenia:
A weakness is ethical issues are raised…

A
  • professionals have the power to control people’s behaviour and this means imposing one persons norms on to others (E.g. a patient may like to look scruffy)
  • also restricting the availability of pleasures to people who don’t behave as desired means that very ill people, already experiencing distressing symptoms, have an even worse time
  • this means that benefits of token economies may be outweighed by the impact on freedom and short-term reduction in quality of life
43
Q

Management of schizophrenia:
A weakness is existence of more pleasant and ethical alternatives

A
  • other approaches don’t raise ethical issues E.g. art therapy is a high-gain low-risk approach to managing schizophrenia
  • even if benefits of art therapy are modest, this is true for all approaches to treatment and management of schizophrenia and art therapy is a pleasant experience
  • this means art therapy might be a good alternative to token economies as no side effects or ethical abuses
44
Q

Management of schizophrenia:
A weakness is hard to continue outside hospital setting…

A

Target behaviours cannot be monitored closely and token cannot be given immediately

Psychology Paper 3 (3 decks)

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