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
AO3
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
AO3
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.
AO3
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
AO3
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
Outline the biological 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
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
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
Brain structure in Schiz
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
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
AO3
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
AO3
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.
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
()
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
AO3
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
AO3
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
AO3
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
AO3
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
AO1
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
AO3
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
AO3
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
AO3
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
AO3
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
AO3
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
AO3
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
