Schizophrenia Flashcards
Outline the DSM-5 in diagnosis of schizophrenia
DSM-5 says two or more of the following symptoms must be apparent for a 6-month period and at least one must be a positive symptom
-Hallucinations
-Delusions
-Disorganised speech
-Negative symptoms
Outline the ICD in diagnosis of schizophrenia
-ICD requires symptoms to be present for 1 month
+ This means there is less time in which they my be at risk to themselves and others. Immediate treatment can be provided
What is a hallucination?
What is a delusion?
Explain disorganised speech
Hallucination - Hearing, seeing or smelling things which don’t exist
Delusions - Irrational beliefs about yourself or the world
Disorganised speech - Result of abnormal thought processes and the patients struggles to organise and filter their thoughts
What is a negative symptom?
The loss of normal experiences and abilities
What is a positive symptom?
Experiences which are added in addition to normal experiences
Outline 3 negative symptoms
Anhedonia - Loss of interest/pleasure in activities
Avolition - Being unmotivated/lack enthusiasm
Speech poverty - Characterised by lessened speech poverty, due to slowed thoughts
Outline 3 positive symptoms
Hallucinations
Delusions
Disorganised speech
Research into inter-rater reliability for diagnosis of schizophrenia
(Beck et al)
Beck et al
-Agreement on diagnosis for 153 patients was only 54%, often due to vague criteria for diagnosis and inconsistencies in techniques to gather data, suggesting many people are diagnosed incorrectly
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Reliability of diagnosis
(Cheriaux et al)
Had 2 psychiatrists independently diagnose 100 patients using both DSM and ICD criteria
FOUND INTER-RATER RELIABILTY WAS POOR:
-1st psychiatrist diagnosed 26 with Sz according to DSM and 44 according to ICD
-2nd psychiatrist diagnosed 13 according to DSM and 24 according to ICD
Explain the subtypes of Schizophrenia
DSM has 5 subtypes
ICD has 7 subtypes
Reliability here is questioned as the sufferer could be diagnosed as one type of schizophrenia according to DSM and a different according to ICD
Define Comorbidity
When there could be a presence of 2 different disorders at the same time
Maybe the 2 disorders are actually just one disorder
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Outline one weakness of the classification and diagnosis of schizophrenia
(Comorbidity)
One weakness of classification and diagnosis of schizophrenia is the concept of comorbidity.
Buckley found that up to 50% of patients diagnosed with schiz also fit into the diagnosis for depression, 29% for PTSD and 23% for OCD.
This poses a challenge for the validity of schiz as a disorder itself because if we are unable to distinguish it from other disorders, the reliability of diagnosis will be inconsistent. Therefore, this weakens our acceptance of the classification and diagnosis of schizophrenia as it may not be reliable.
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Outline one weakness of the classification and diagnosis of schizophrenia
(Gender bias)
-Males first onset is between the ages of 18-25. In females, the first onset is between the ages of 25-35 and this under-diagnosis and difference between genders highlights a lack of validity in diagnosis
-Women’s symptoms of Sz is taken less seriously and underdiagnosed compared to men, as they mask these symptoms of Sz
-Cotton suggests this is due to men’s better social coping strategies leading to being less likely to seek treatment
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Outline one weakness of the classification of diagnosis of schizophrenia
(Culture bias)
One weakness of the classification and diagnosis of Sz is that it may be culturally bias.
For example, people with Afro-Caribbean heritage in the UK and African Americans are more likely to be diagnosed with Sz compared to the 1% of the general population.
Wester definitions of mental illness are applied to non-western cultures e.g. Hearing voice such as hallucinations is a symptom in the UK but a religious experience in West Indies.
This suggests the classifications are culturally bias as there are different norms in different societies meaning we cant generalise western definitions of schiz to other cultures with different norms. This is not accounted for by the classifications, thus weakening acceptance of the classifications
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Outline the biological (genetic) explanations of schizophrenia
Gottesman:
Mz twins had concordance rates of 48%
Dz twins had concordance rates of 17%
-Ripke et al found 108 genetic variants associated with schizophrenia
-Genes that were associated with an increased risk in Sz included genes that code for the functioning for neurotransmitters
-Sz is aetiologically heterogeneous - One group of genes may cause Sz in one person but a different set of genes in another
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Explain one limitation of adoption studies, with reference to the environmental influence on a child
Adoption studies assume that the biological parent has no environmental influence on the child. However, children are often paired with adoptive parents who come from a similar background and live in a similar area. Therefore, while there is no direct influence, the adopted child may still grow up in an environment similar to how they would have grown up with their biological parent. This is a limitation because adoption studies may be over-exaggerating the genetic influence on the child, because they are ignoring the potentially shared environment between the adopted child and biological parent
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Outline the Neural correlates of Sz (Dopamine hypothesis)
-Pattern of structure or activity of the brain can be correlated with an increased risk of developing Sz
-Hyperdopaminergia —> Higher levels of dopamine than usual. linked to positive symptoms e.g. hallucinations. Excess dopamine in Broca’s area may be linked to poverty of speech or auditory hallucinations
-Hypodopaminergia —> Lower levels of dopamine than usual. Less dopamine being transmitted across synapse. Linked with negative symptoms
Outline the role of agonist drugs
-Chemicals in the brain which mimic other neurotransmitters
-Activates a receptor to produce a biological responses
-Drugs which increase activity
-Can relieve some patients positive symptoms
Outline the role of antagonist drugs
-Antipsychotic drugs such as chlorpromazine reduce dopamine activity and help reduce symptoms like hallucinations
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Brain structure in Schiz (Neural correlates)
Enlarged ventricles - Produce cerebrospinal fluid, patients with Sz tend to have larger ventricles in comparison to healthy individuals.
AO3 - Data is correlational. Cannot infer whether enlarged ventricles is the cause of Sz. Could be a side effect of medication or a phenotype of schiz
Smaller frontal cortex
Ventral striatum - abnormality in this brain region is associated with avolition
Juckel et al found people with Sz have lower levels of activity in the ventral striatum. There was a negative correlation between activity levels in the ventral striatum and severity of overall symptoms
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Research into brain structure on schizophrenia
Torrey conducted MRI scans on people with schiz and compared them to healthy individuals without schiz
He found that on average, people with Sz had ventricles which were 15% larger than those in the control group
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Outline one weakness of the biological explanations of Schizophrenia
(Twin studies)
One weakness of the biological explanations of schizophrenia is that concordance rates are not 100%.
For example, Gottesman found a concordance rates of 48% between Mz twins for schizophrenia.
This suggests that there is still 52% is down to other factors such as the environment, which the theory doesn’t account for, suggesting it is biologically reductionist.
Therefore it may be better to adopt an interactionist approach which encompasses both biology and environmental factors. This can be seen in the diathesis stress model, suggesting biology alone cant be responsible for schizophrenia, as the explanation suggests it is.
Therefore this weakens our acceptance of he biological explanations of schiz because it there are other factors which the theory doesn’t account for
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Outline one weakness of the biological explanations of schizophrenia
(Cause and effect)
One weakness of the biological explanations of schizophrenia is that there are problems with establishing cause and effect.
For example, Many drugs which patients with Sz take have side physical side effects, one of these side effects could be enlarged ventricles, meaning we cant be sure enlarged ventricles cause Sz, rather they may just be a side effect of the medication. Hence we cant establish a causal relationship between the two variables in question. This is a weakness as it questions the credibility of the explanations, there may be confounding variables which may influence the neural correlates and Sz. Therefore, this weakens acceptance of the biological explanations of Sz.
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Outline one strength of the biological explanations of schizophrenia
(Drugs)
One strength of the biological explanations of schizophrenia is that it has lead to drug development.
For example, through assuming an imbalance of dopamine is responsible for Sz, we can develop agonist and antagonistic drugs to balance out these neurotransmitters.
This suggests, we can develop drugs which reduce symptoms of Sz in a patient and improve their quality of life through these biological explanations, thus strengthening acceptance of the theory as it has positive real world effects.
However, 1/3 of patients are resistant to drug treatment, suggesting other factors are responsible for the onset of schizophrenia, which contradicts the theory, weakening acceptance after all.
Perhaps an interactionist approach which accounts for both biological and psychological explanations should be used when trying to explain complex mental disorders such as schizophrenia
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Dopamine hypothesis
-People with schizophrenia have high levels of dopamine in the mesolimbic pathway
-Overactivity in the mesolimbic system causes the positive symptoms of schizophrenia
-People with schizophrenia have lower levels of dopamine in the frontal cortex than usual
-Underactivity in frontal cortex causes negative symptoms
Which drugs can be used to treat Hyperdopaminergia?
Antagonistic —-> Reduce dopamine activity
(Chlorpromazine)
Which drugs can be used to treat Hypodopaminergia?
Agonistic drugs —-> Increase dopamine activity
(Risperidone)
AO3 Research Dopamine hypothesis
Noll et al
Noll looked at studies in which Sz patients were given drugs which reduce levels of dopamine
A review by Noll found that in 1/3 of patients, dopamine-reducing drugs did not prevent positive symptoms of schizophrenia. This is a limitation of the dopamine hypothesis.
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Outline one weakness of the dopamine hypothesis
(Noll et al)
One limitation of the dopamine hypothesis as an explanation for Sz is that there is contrary evidence from Noll et al.
For example, Noll conducted a meta analysis of studies in which patients were given drugs which reduce dopamine levels. For 1/3 of patients, drugs which decreased levels of dopamine didn’t stop positive symptoms such as hallucinations and delusions from being experienced by the patients. These findings indicate that high levels of dopamine are not the only cause of positive symptoms. This is a weakness because Noll’s research indicates that there may be other factors influencing the development of Sz e.g. abnormal brain structure or family dysfunction, which aren’t taken into account by the dopamine hypothesis. Therefore this weakens acceptance of the dopamine hypothesis as an explanation for Sz.
Explain atypical antipsychotics
-Work by acting upon serotonin receptors as well as dopamine production systems and affect negative symptoms e.g. avolition
-Side effects include weight gain and CVD
-E.g. Clozapine - It acts on multiple receptors
Explain why atypical antipsychotics have fewer side effects than typical antipsychotics.
Atypical antipsychotics bind to dopamine receptors for a shorter period of time than typical antipsychotics. By allowing dopamine to still bind to the receptors from time-to-time, people who take atypical antipsychotics typically experience less side effects, because there is less disruption to dopamine activity in all areas of the brain
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Evidence for antipsychotic drugs
+ Patients prescribed with antipsychotics show improvements in comparison with patients who took a placebo. This shows that antipsychotics are effective in treating schizophrenia and that they are targeting the dopamine system
-Patients prescribed antipsychotic drugs or antipsychotics + CBT. Those who took drugs showed better improvements in their symptoms in comparison to those who took drugs only. Suggests and interactionist approach may better treat schizophrenia
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Outline one weakness of antipsychotic drugs as a treatment for Sz
(Side effects)
One weakness of antipsychotics as a treatment for Sz is that they produce unwanted side effects
For example, these side effects can include extrapyramidal symptoms where patients lose control over movement (i.e. stiff, jerky movements) and cause excess problems like obesity and diabetes as antipsychotic drugs don’t just influence the brain and spinal cord, but rather the whole body. This means antipsychotic drugs may reduce levels of dopamine where there isn’t an imbalance, this causes unwanted side effects like low levels of dopamine in the motor cortex leads to stiff jerky movements
Therefore these unwanted side effects from the antipsychotics reduce use of them as a treatment for Sz
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Outline one weakness of antipsychotic drugs as a treatment for Sz
(Negative symptoms)
One weakness of this treatment is that it fails to treat negative symptoms.
For example, antipsychotics work by preventing dopamine from binding to receptors on the post synaptic neuron to prevent overactivity in the mesolimbic system. However, according to the dopamine hypothesis, negative symptoms such as avolition and speech poverty are not caused by overactivity in the mesolimbic system, rather they are caused by low levels of dopamine in the frontal cortex. Antipsychotic drugs dont increase the levels of dopamine in the frontal cortex, but decrease dopamine across the whole brain, meaning they dont treat the negative symptoms of Sz. This suggests that someone with negative symptoms wont be cured if they take antipsychotic medication, therefore indicating this treatment is not as effective as once thought, thus decreasing the use of antipsychotic drugs to treat Sz
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Outline one weakness of drug therapy for treatment of Sz
(Relapse)
One weakness of using drugs to treat Sz is that they don’t actually cure the root cause of Sz.
For example, antipsychotics have high relapse rates with up to 40% in the first year and then 15% in later years due to patients stopping their course of drugs because of the side effects and the impacts it has on quality of life.
Family dysfunction
Psychological explanations of Sz : The Schizophrogenic mother
A psychodynamic theory that suggests people with Sz get their paranoid delusions as a result of influence of a cold, rejecting and controlling mother
The mother creates an atmosphere of stress, tension and secrecy in the family. This atmosphere triggers psychotic thinking
Family dysfunction
Psychological explanations : Double bind theory
Children receive mixed and contradictory messages from their parents and this influences the onset of Sz
Family dysfunction
Psychological explanations : Expressed emotions
-A family communication style that involves criticism, hostility and emotional over involvement
-Exaggerated involvement : Indicating the sufferer is a burden via self sacrifice ‘I do so much for you it is hard for me’
-Criticism and control of the individuals behaviour ‘You dont know how to do anything, you need to listen to me’
-Hostility towards parent, show anger and resentment
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Cognitive explanations of Sz
-Sz is associated with dysfunctional thought processing
-Firth et al identified two types of dysfunctional processing: Meta representation and central control
Central control:
-Healthy individuals have the ability to supress automatic function. Patients have difficulty resisting automatic triggers
-Disorganised speech —> Inability to suppress automatic thoughts and speech triggered by their thoughts
Meta representation:
-In healthy individuals, they are able to reflect on thoughts and behaviour
-Allows us insight into our own intentions and goals
-In patients, failure to recognise actions and thoughts as being our own, Auditory hallucinations and thought insertions
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Outline one strength of Family dysfunction as an explanation of Sz
(Tienari adoption study)
One strength of this explanation is that their is research from Tienari et al who studied biological children of schizophrenic mothers who had been adopted.
5.8% of those adopted into psychologically healthy families developed Sz compared to 36.8% of children raised in dysfunctional families.
This suggests that those raised in dysfunctional families are more likely to develop Sz than those raised in functional families, with the same genetic predisposition, which is what coincides with the theory thus strengthening our acceptance of it
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Outline one strength of Family dysfunction as an explanation of Sz
(Read et al) + COUNTER
Read et al reviewed 46 studies of child abuse and schizophrenia and found that 69% of adult women in-patients with Sz have a history of physical or sexual abuse in childhood. For men this was 59%
This suggests that early child hood traumatic experiences in a dysfunctional family led these patients to develop Sz, which is what coincides with the theory of family dysfunction.
Counter
However, for most studies where information about childhood experiences was gathered after the development of symptoms . The patients may be relying on inaccurate memories or they could have distorted the recall due to social desirability purposes
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Outline one strength of the family dysfunction explanation of Sz
(Research support for double bind)
+COUNTER
One strength of Double bind theory is that there is supporting research from Berger et al. For example, he found that Sz patients were able to recall significantly more double binds compared to non-Sz individuals. This is a strength as it suggests that double bind theory can be seen in real life to impact the development of Sz. Therefore this supporting research strengthens acceptance of the double bind theory, and family dysfunction as a whole, as an explanation for Sz
HOWEVER, this research maybe invalid as Berger used a self report method by using interviews. This is a problem as self report methods often lack objectivity and can be inaccurate due to reconstructive memory and social desirability bias. Furthermore, If the interviewer asks a leading question, a participant would be responding to demand characteristics in the study, caused by investigator effects. Therefore this weakens acceptance of Berger’s supporting research as it used non-scientific and unreliable methods to collect data
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Outline one strength of the family dysfunction explanation for Sz
(Research support for high expressed emotion)
One strength of this explanation is that there is supporting research for high expressed emotions from Vaughn et al. For example, using the observational technique, he found that after leaving the hospital and being treated for Sz, Schizophrenics with families displaying high expressed emotion, were more likely to relapse into severe symptoms of Sz. This is a strength as it indicates that families in which there is high expressed emotion, schizophrenics are more likely to relapse into Sz, which is what coincides with the theory, thus strengthening acceptance of expressed emotion, and family dysfunction as a whole
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Outline one weakness of Family dysfunction as an explanation of Sz
(Socially sensitive)
Research linking family dysfunction and Sz can pose a moral dilemma. It can lead to parent blaming and adds insults to injury for the parents who are having to watch their child experience symptoms of Sz
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Outline one strength of the cognitive explanations of Sz
(Supporting research - Stroop test)
One strength of the cognitive explanations of Sz is that they are supported by research from Stirling
He compared 30 Sz patients with 18 controls on a range of cognitive tasks one of which included the Stroop test. This tests their ability to suppress words as patients name the colours of the words rather than the word itself. Patients with Sz took over twice as long as the control group to name the colours of the words. In psychologically healthy patients, they should be able to suppress the automatic function and recall the colour of the word.
This provides real world evidence that , which coincides with what the theory of central control says, therefore strengthening our acceptance of it
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Outline one weakness of the cognitive explanations of Sz
(Causes of underlying symptoms)
One major issue with cog explanations of Sz such as dysfunctional thought processing is that it does not tell us anything about the origins of abnormal cognitions or the condition itself. E.g. The biological explanations of Sz state imbalance of neurotransmitters are responsible for hallucinations and disorganised speech.
It could be that dysfunctional thought processes are merely a symptom of Sz rather than the cause itself which further undermines this explanation as it suggests we cant establish cause and effect between Sz and the symptoms
This weakness our acceptance of these explanations as they are lacking in detail
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Outline one strength of the cognitive explanations of Sz
(Real world application)
If dysfunctional cognition can better characterise Sz this presents to us real world applications as we can look to construct a specific cognition deficit profile to help with the diagnosis of the disorder.
Kane et al argued that including cognitive impairment within the diagnosis criteria for Sz would help improve the currently poor reliability in diagnosis for Sz.
This could then help in creating more targeted treatment with cognitive enhancements being the goal.
This strengthens acceptance as it indicates these explanations can be used to positively impact patients with Sz, reducing their symptoms, improving the quality of their life
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CBT as a treatment for Sz
-Patients are asked to trace back the origins of their symptoms and understand how they started
-Helps patient understand where their symptoms come from
-The sufferer is thought to recognise their own examples of delusional thinking
-CBT challenges the patients interpretation of events, and helps them to change their habit of thinking about things in a pathological way
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Family therapy as a treatment for Sz
-Aims to improve the quality of communication and interaction between family members
-Links to double bind theory and schizophregernic mother, some therapists see family as root cause
-Thus therapists reduce stress that may contribute to risk of patients relapse
-Pharoah et al identified a range of strategies by which family therapists aim to improve the functioning of a family with a member suffering from Sz
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Token economies as a treatment for Sz
-Manage behaviour, especially institutionalised patients which developed maladaptive behaviour
-Coloured discs are given to patients when they carry out a desirable behaviour that has been targeted for reinforcement
-Tokens can then be swapped for more tangible things e.g. sweets, magazines
-Based off the concepts from operant conditioning, as patients are learning through behaviours and their consequences
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Outline one weakness of CBT as a treatment for Sz
(Access to CBT)
One weakness is that only 1 in 10 actually get access to this form of therapy.
For example, Haddock et al found that of 187 randomly selected schizophrenics, only 13 had been offered CBT and of those who were offered, many failed to attend or refused thus limiting the effectiveness of CBT as it requires a trained professional to deliver the sessions over a number of months making it costly + time consuming. Therefore this reduces use of CBT as a treatment for Sz as it may be the case that this form of therapy is not widely accessible for al schizophrenic patients
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Outline one weakness of CBT as a treatment for Sz
(Skill level)
Moreover, the effectiveness of CBT depends on the skill level of the therapists themselves, meaning if the therapists has a low skill level, the CBT would be ineffective at reducing symptoms of Sz in a patient, thus weakening acceptance of the use of CBT to treat Sz. Perhaps drugs such as antipsychotics would be more effective as they dont depend on the skill level of a therapist, furthermore, they are cheaper and only need to be taken once, unlike CBT which requires multiple expensive sessions, suggesting drug treatments are a more attractive option than CBT.
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Outline one strength of CBT as a treatment of Sz
(Research from Sensky)
One strength of CBT as a treatment of Sz is that there is supporting research from Sensky et al.
For example, he found that patients who resisted drug treatments had a reduction in positive and negative symptoms after 19 sessions of CBT. Moreover, they continued to improve even 9 months after the treatment had ended. This indicates that CBT can be effective when drugs are not used, and they are also an improvement on drug therapies as drugs only reduce symptoms in the short run as they dont actually cure the root cause of the disorder, rather they mask the symptoms. Therefore this strengthens acceptance of the use of CBT to treat Sz.
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Outline one weakness of CBT as a treatment for Sz
(Age)
One weakness of the use of CBT as a treatment for Sz is that the research indicates that age may well be a factor which determines the effectiveness of the treatment. For example, CBT may be less effective for older patients compared to younger patients as they may not engage well with this form of therapy. Perhaps it would be easier to treat these patients with drugs as that only requires them to take the drugs, not talk to and engage with a therapist. Therefore this indicates that CBT may not be an effective form of treatment for patients of all ages, unlike drug treatment, thus weakening acceptance of CBT as a treatment for Sz.
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Outline one weakness of Family therapy as a treatment for Sz
(Burden on family)
One weakness of this treatment is that it puts significant burden on the family members who are ill equipped to cope with the needs of Sz sufferer.
Specialist care and intervention may be better suited by staff that better understand the symptoms and problems that are posed by Sz, hence the use of family members as a form of intervention may not be appropriate as this could cause an impact on their lives leading to greater stress as they try to manage another person’s problems as well as their own. This indicates there is a methodological problem with this treatment as it may place a greater burden on the family members of the patient who dont have the mental capacity of facilities to deal with such problems which are posed by Sz, thus weakening acceptance of the theory
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Outline one strength of family therapy as a treatment for Sz
(Relapse)
+ Counter
One strength is that there is support from Leff (1985) who looked at the aftercare of patients with schizophrenia. Of those that were provided with standard outpatient care, 50% had relapsed within 9 months, compared to only 8% who received family therapy. This provides support for the notion that family therapy is effective at reducing symptoms of Sz, thus strengthening acceptance of the use of this treatment for Sz.
HOWEVER, after two years this had risen to 50% with family therapy and 75% with standard outpatient care. This suggests that the use of family therapy is helpful in reducing re-admission in the short term, but families may not be able to maintain positive patterns of behaviour over the long term, thus weaking acceptance in the long run.
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Outline one weakness of Token economies as a treatment for Sz
(Dont treat symptoms)
One weakness is that Token economies dont directly treat symptoms of Sz, rather they only attempt to manage negative symptoms such as poor motivation, poor attention and social withdrawal. This suggests that this therapy may not be effective at treating positive symptoms such as hallucinations and delusions meaning other treatments would be required e.g. Drugs or CBT. Therefore this incomplete nature of token economies reduces use of them to treat Sz.
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Outline one weakness of Token economies as a treatment for Sz
(Patients with negative symptoms)
A second weakness of token economies is that they are not effective with severely unresponsive patients. For example, for those with very strong negative symptoms, this could be seen as a punishment for illness. This is a weakness as it means token economies alone can not be used to effectively treat symptoms of Sz, rather they could worsen the condition of the patient by making them think they are being punished for their problems, decreasing the chances the patient makes a healthy recovery. Therefore this weakens acceptance and use of token economies to treat individuals with Sz.
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Outline one weakness of Token economies as a treatment for Sz
(Ethical issues)
Lastly, the use of token economies can be considered unethical. For example, the use of Skinnerian principles is argued to be degrading to patients, effectively manipulating them as lab rats. This poses questions over the ethical legitimacy of the methods used by token economies. Hence, this ethical issue reduces acceptance of token economies to help treat Sz as they may use unethical methods to help treat patients.
