Schizophrenia Flashcards
Describe the diagnosis and classification of schizophrenia
Diagnosis and classification
- ICD 11
- DSM 5
- there are different requirements for symptoms to be identified as a part of SZ
Positive symptoms
- hallucinations, unusual sensory experiences, such as hearing voices
- delusions, irrational beliefs such as being an important historical figure or that they are under external control
Negative symptoms
- speech poverty, a reduction in the amount and quality of speech
- avolition, difficulty completing goal orientated tasks, for example, unable to take a shower
Describe the issue in diagnosis and classification
Good reliability
- Osorio reported excellent reliability for the diagnosis of SZ in 180 individuals using the DSM 5, achieving an inter-rater reliability of +.92
Low validity
- Cheniaux found that out of 100 clients, 68 were diagnosed with SZ under the ICD and 39 under the DSM-5, and is a result either over or underdiagnosed
Co-morbidity
- SZ is commonly diagnosed alongside depression, which is an issue as it means SZ may not exist as a distinct condition and is a problem for diagnosis for people who have unusual cases of the condition such as depression
Gender bias in diagnosis
- men are more commonly diagnosed than women and this is due to the closer relationships women have that allow them to get support and often functioning better than men
- women may not therefore be receiving treatment and services that might benefit them
Culture bias is diagnosis
- symptoms in different cultures have different meanings, such as hearing voices is considered normal in african-carribean countries, but not in british culture
- this leads to an overinterpretation of symptoms and as a result, african carribean people may be discriminated against by a culturally biased diagnostic system
symptom overlap
- SZ and bipolar disorder share the symptoms of avolition and delusions, suggesting that they may not be two different conditions, but instead variations of one disorder
- SZ is therefore hard to distinguish from bipolar and means that SZ may not exist as a distinct condition that is easy to diagnose
Describe the biological explanations for schizophrenia
the genetic basis of schizophrenia
family studies
- risk of SZ increases in line with genetic similarity to a relative with the disorder
- 2% if an aunt has it, 9% if a sibling has it, 48% is your identical twin has it
candidate genes
- polygenic, ie, more than one gene codes for neurotransmitters including dopamine
- Ripke combined data from all genome studies on people with SZ compared to a control group and found that there were 108 separate genetic variations that were associated with a slightly increased risk of SZ
- aetiologically heterogenous
the role of mutation
- fathers under 25 have a risk of sperm mutation of 0.7%, which increases to over 2% at the age of 50
- explains how a family with no history of SZ develops a child with SZ
neural correlates of schizophrenia
- low levels of dopamine in the prefrontal cortex could explain cognitive problems
Evaluation of the biological explanation for schizophrenia
the genetic basis
Strength
research support
- Tienari show that biological children of parents with SZ are at a heightened risk even if they grow up with an adoptive family
- Hiker showed a concordance rate of 33% for identical twins and 7% for non-identical twins
- therefore some people are more vulnerable to SZ as a result of their genetic makeup
limitation
environmental factors
- birth complications and smoking cannabis in teenage years can increase risk
- Morkved found that 67% of people with SZ and related psychotic disorders reported at least one childhood trauma, compared to 38% of a matched group with non-psychotic mental health issues
- therefore genetic factors cannot provide a complete explanation
neural correlates
strength
evidence for dopamine
- amphetamines increase DA and worsen symptoms of people with SZ and induce symptoms in those without
- antipsychotic drugs reduce DA and reduce the intensity of symptoms
- some candidate genes act on the production of DA or DA receptors
limitation
glutamate
- post mortem and live scanning have found raised levels of the neurotransmitter glutamate in people with SZ, as well as several candidate genes
- this suggests there are other neurotransmitters that effect SZ and not just dopamine
Describe the psychological explanation for schizophrenia
family dysfunction
the schizophrenogenic mother
- the mother is cold, rejecting, and controlling, tending to create a family dynamic that is characterized by tension and secrecy
- this leads to distrust that then develops into paranoid delusions and ultimately SZ
high expressed emotion
- verbal criticism with violence, hostility including anger and rejection, emotional overinvolvement including needless self-sacrifice
- this causes a very stressful environment and is the main explanation for relapse
- this stress could also trigger the the onset of SZ due to a genetic vulnerability
cognitive explanation
central control dysfunction
- we are unable to suppress automatic responses while performing deliberate tasks
- explains speech poverty
- derailment of thoughts occurs because each word triggers associations that aren’t able to be repressed
Evaluation of the psychological explanations for schizophrenia
family dysfunction
strength
research support
- Read found that adults with SZ are likely to have insecure attachment
- Read found that 69% of women and 59% of men with SZ have a history of physical or sexual abuse
limitation
explanations lack support
- the schizophrenogenic mother is based on clinical observation and an informal assessment of the mothers personalities, but not systematic evidence
- therefore family explanations have not been able to account for the link between childhood trauma and SZ
cognitive explanation
strength
research support
- Stirling compared performance on a range of cognitive tasks between 30 people with SZ and 30 without, including the stroop test
- he found that people with SZ took over twice as long than average to name the font colors
- this means the cognitive processes of people with SZ are impaired
limitation
a proximal explanation
- they explain what is happening now to produce symptoms, but not the distal explanation, which is what initially caused the problem
- how does genetic variation or childhood trauma lead to problems with central control
- the cognitive theory therefore only provides a partial explanation for SZ
Describe the biological therapy for schizophrenia
drug therapy
typical
- dopamine antagonists work by reducing the action of dopamine by blocking dopamine receptors in the synapses of the brain
- this normalizes neurotransmission and as a result reduces symptoms like hallucinations
- chloroprozamine also has sedative properties
atypical
- clozapine binds to dopamine, glutamate, and serotonin receptors, helping to improve mood and reduce depression and anxiety and improves cognitive functioning
- risperidone, binds more strongly to dopamine receptors
as well as serotonin receptors than clozapine and is therefore more effective in smaller doses, leading to less side effects
Evaluation of biological therapy for schizophrenia
Strength
evidence for effectiveness
-thornley reviewed studies that compared chlorprozamine to a control and found that chlorprozamine was associated with better overall functioning and reduced symptom severity compared to the placebo
- Meltzer found that clozapine is more effective than other antipsychotics and is effective in 30-50% of cases where other treatments failed
- however, most studies are only short term effects, so don’t tell us much about the long term
- because the antipsychotics have a calming effect, we don’t know if the symptoms are actually being reduced or just masked by the calm
limitations
serious side effects
- dizziness, agitation, sleeplessness
- can be fatal due to neuroleptic malignant syndrome
- antipsychotics can as a result do as much harm as good
mechanism unclear
- if some of the cause of SZ is too low of dopamine, then the antipsychotics shouldn’t work, as they further reduce the levels of dopamine
- therefore, some might not be the best treatment and some other factor of them is involved in their success
what are the two psychological therapies for schizophrenia
cognitive behavior therapy
family therapy
Explain cognitive behavior therapy as psychological therapy for schizophrenia
- helps a client make sense of how their irrational cognitions impact on their feelings and behavior
- convincing someone that the demonic voice in their head is not demonic and is actually a malfunction in the speech center of their brain
- helps them better able to cope with the symptoms
example of CBT
paranoid client: the mafia is observing me to decide how to kill me
therapist: you are obviously frightened, there must be a good reason for this
client: do you think its the mafia
therapist: possible, but how do you know its the mafia?
Explain family therapy as a psychological therapy for schizophrenia
how does it help?
- reduces negative emotions by reducing anger which in turn then reduces stress for the individual with SZ and therefore the risk of relapse
- improves the families ability to help by improving the beliefs and behaviors around SZ and ensuring the family is maintaining a balance between personal lives and caring for the family member
a model of practice
1. share basic information and provide emotional and practical support
2. identify resources that the family can or cannot provide
3. aim to encourage a mutual understanding where the family can say what they think
4. identifying unhelpful patterns of behavior
5. learning skills, such as stress management
6. relapse prevention
7. maintenance for the future
Evaluation of cognitive behavior therapy as a psychological therapy for schizophrenia
Strength
evidence of effectiveness
- Juahar reviewed 34 studies using CBT for SZ and found that there is a small yet significant effect on both positive and negative symptoms, including reducing frequency and severity of auditory hallucinations
limitation
quality of evidence
- different studies use different CBT techniques and people with different combinations of symptoms, and as a result, the overall modest benefits conceal a wide variety of effects on different symptoms of SZ
Evaluation of family therapy as a psychological therapy for schizophrenia
Strengths
evidence of effectiveness
- McFarlane concluded that family therapy was one of the most consistently effective treatments and reduced relapse rates by 50-60%, especially when used as mental health initially begins to decline
- therefore useful for benefiting all stages of SZ
benefits to whole family
- the effects on the whole family are important, as families provide the bulk of care for people with SZ. this lessens the negative impact of SZ on other family members and strengthens the families ability to support
- therefore, wider benefits other than the impact on the identified patient
Describe the management of schizophrenia
token economies
- Ayllon and Azrin trialed this in a womens ward, where they were given a token for carrying out tasks such as making their bed, which could be swapped for privledges
- they found that the number of tasks carried out increased significantly
- use has declined in the UK now due to ethical issues
rationale for token economies
- helps maintain behaviors that are sometimes lost within institutions, including personal care, condition related behaviors, and social behavior
- this improves the persons quality of life, and normalizes behavior and makes the transition back to normal living easier
what is involved in a token economy
- delayed rewards a less effective, so receiving the token right away is important
theoretical understanding of token economies
- based on operant conditioning, with the tokens as secondary reinforcers and the rewards as primary reinforcers
Evaluation of token economies as a management technique of SZ
Strength
evidence of effectiveness
- Glowacki identified 7 studies that examined the effectiveness of token economies for people with chronic mental health issues and found a reduction in negative symptoms and a decline in the frequency of unwanted behaviors
- however, 7 studies is a small evidence base, and undesirable evidence may have been hidden away, and as a result the findings may not tell us much
limitations
ethical issues
- imposes one persons norms on another, for example, someone may enjoy waking up later and looking scruffy, however, don’t get the same rewards that others do for waking up early
- restricting the availability of pleasure to those behaving correctly is unfair to the severely ill and gives them a worse time in the institution
- the benefits are outweighed by the impacts on personal freedom and short term reduction in quality of life
alternative approaches
- Chiang concluded that art therapy could be a good alternative, as it is a high gain, low risk way to manage SZ, and is a pleasant experience without major risks of side effects or ethical abuses
- therefore art therapy is a good alternative to token economies
