Schizophrenia Flashcards
1
Q
Two types of classifiers for schizophrenia?
A
DSM-5
ICD-10 (ICD-11)
2
Q
What are positive symptoms
A
Additional experiences beyond those of ordinary existence
3
Q
What are negative symptoms
A
A loss of usual of usual abilities and experiences
4
Q
Positive characteristics of Schizophrenia
A
Delusions and hallucinations
5
Q
2 types of sensory hallucinations
A
Visual and auditory
6
Q
Negative characteristics of Schizophrenia
A
Avolution and Speech poverty
7
Q
What does avolution mean (NC)
A
Low motivation to carry out tasks which leads to lower activity levels
8
Q
What does speech poverty refer to?
A
Changed speech patterns, reduced quality and speech frequency
9
Q
What is disorganised speech?
A
Incoherent speech, when the speaker changes topic mid-sentence
10
Q
What is a strength of diagnosis and classification methods
A
Good reliability
Inter-rater anf test-retest
11
Q
What are 4 limitations of diagnosis and classification methods
A
- Co-morbity
- Gender bias
- Culture bias
- Symptom overlap
12
Q
What is the symptom overlap in diagnosis and classification methods limitations
A
Schizophrenia and Bipolar disorder both have P+N symptoms
13
Q
Define co-morbity
A
2 conditions co-exist in the same person at the same time
For example, about 50% of people with schizophrenia are also diagnosed with depression.
14
Q
What gender is more likely to be diagnosed
A
Men since the 1980s
(Gender bias)
15
Q
What is culture bias and diagnosis of schizophrenia?
A
Symptoms like hearing voices have different meanings in different cultures (Haiti people ancestrial)
African caribbeans 9x more likely than white unlike in home country
16
Q
What does the original dopamine hypothesis suggest?
A
High levels of DA in the brains subcortical areas causes schizophrenia
Hyperdopaminergia
17
Q
Example of the original dopamine hypothesis
A
High DA in Brocas area has led to symptoms like speech poverty
18
Q
Who created the updated dopamine hypothesis?
A
Davis et al
19
Q
What does the updated dopamine hypothesis?
A
Inlcuding low DA in brain cortex
Including hypodopaminergia
Low DA in prefrontal cortex produces cognitive disfunctions
20
Q
What did Gottesman find in the genetic basis of schizophrenia?
A
Family studies - Large dutch
2% S aunt
9% S sibling
48% S identical twin
21
Q
Define aetiologically heterogenous
A
Different combinations of genetics
22
Q
What is the role of mutation in the genetic S basis?
A
Positive correlation between paternal age and schizophrenic risk children
- Increased risk of sperm mutation
Brown et al - Fathers >25 0.7% compared to fathers <50 2%
23
Q
Difference between typical and atypical antipsychotics (3)
A
T are traditional and AT are second generation
AT has less fatal side effects compared to T
AT also improves mood (Works on N+P symptoms through serotonin and glutamate)
Important because it reduces risk of suicide (30-50% attempt)
24
Q
Typical antipsychotic drug
A
Chlorpromazine
25
Side effects of chlorpromazine (T)
Tiredness
26
Atypical antipsychotic drugs
Clozapine
Risperidone
27
Why was risperidone developed?
Same effect as clozapine but with less side effects
(binds dopamine receptors stronger than clozapine does)
Means that less of it can be taken, so reduced side effects
28
Max dosage of risperidone?
12mg
29
How does clozapine (AT) work?
binds to dopamine receptors
acts on serotonin and glutamate receptors
30
Clozapine facts (AT) x2
Banned for a while as as many patient died due to developing agranulocytosis
Due to fatal side effects it isn't taken as an injection
31
Average dosage of clozapine?
300/450mg a day
32
Substantial benefit of clozapine?
acts on serotonin and glutamate receptors
This improves mood, reduces depression/anxiety and can improve cognitive functioning
30-50% of S people attempt suicide so this is good to reduce that
33
What is an antagonist?
Chlorpromazine - dopamine antagonist
Chemicals that reduce the action of a neurotransmitter
34
How do dopamine antagonists work?
Block dopamine receptors in the synapses of the brain, therefore reducing dopamine action
35
How does chlorpromazine (T) work?
Initially increases D level, then it reduces
(reduced symptoms like hallucinations)
36
max daily dosage of chlorpromazine (T)?
400-800mg
37
What is the sedation effect that chlorpromazine has?
Effects histamine receptors, that calms individuals with psychotic conditions
38
4 evaluations for drug therapy for schizophrenia
Side effects
Mechanism unclear
Evidence of effective - Thornley et al
HOWEVER, sedation effect
39
Serious side effect of clozapine?
Fatality
too much led to patients dying due to developing agranulocytosis
40
list 3 side effects of clozapine
agranulocytosis, myocarditis, and metabolic complications
41
List 4 side effects of chlorpromazine
sedation, acute movement disorders, parkinsonism, dizziness due to lowered blood pressure,
42
What was Thornley et als support for antipsychotics for schizophrenia?
Reviewed studies comparing chlorpromazine to control conditions
(13 trials 1121 participants)
Showed better overall functioning, reduced symptoms and reduced relapse rates over 6m to 2yrs.
43
Counter of research into antipsychotics?
Publication bias
Healy - some successful trials had data published multiple times, therefore exaggerating the size of evidence for a positive effect
ALSO - calming sedative effects reduces symptoms due to dosage rather than as an effective treatment
44
2 types of psychological effects on schizophrenia
Family dysfunction explanation
Cognitive explanation
45
3 factors in the Family dysfunction explanation
the schizophrenic mother
double blind theory
Expressed emotion (EE)
46
Who created the idea of the czhizophrenic mother
Reichmann 1948
47
How did reichmann get the idea of the schizophrenic mother in the Family dysfunction explanation
Conducted interviews on S patients and gathered an idea f a parent type
48
What are characteristic of the schizophrenic mother
Cold, controlling, rejecting and creates family tensions/secrecy
49
How do the characteristic of the schizophrogenic mother cause S?
Leads to later life distrust that forms paranoid delusions and then S
50
Who created the idea of the double-blind theory?
Bateson et al
51
What is the double blind theory in Family dysfunction explanation?
A communication dilemma between two or more messages
52
# iccor
What does the double blind theory lead to?
Conflicted relationship msgs prevent development of an 'internally coherent construction of reality'
53
What is an issue with prevented development of an 'internally coherent construction of reality'?
Gives us an idea that the world is confusing and dangerous
Leads to disorganised thinking and paranoid delusions
54
How does the double blind theory effect schizophrenia?
It acts as a "RSIK FACTOR" for developing S
55
What is expressed emotion in the family dysfunction explanation?
Refers to the level of emotion (negative) towards and S individual by their carers
(Usually family members)
56
What are the 3 types of 'Expressed emotion'?
Verbal criticism
Hostility towards the person (anger and rejection/threats)
Emotional over-involvement in the persons life,
57
What did Linszen et al find in EE
High EE family patients were 4x more likely to relapse compared to those with a low EE families
58
Who found that High EE family patients were 4x more likely to relapse compared to those with a low EE families?
Linszen et al
59
How does EE link to S?
Caused individuals stress which then can act as a trigger
60
What is the cognitive explanation for S?
Focuses on the role of mental processes
61
What 2 dysfunctions did Frith did in cognitive explanation for S?
Metarepresentation dysfunction
Central control dysfunction
62
Explain what metarepresentation is?
Our cognitive ability to reflect on our thoughts and behaviours
Allows us insight to our own goals/intentions and lets us interpret the actions of others
63
What happens when the metarepresentation is dysfunctioned?
Effects how we recognise our own thoughts/actions/behaviours
Explains hearing voices and delusions through insertion
64
2 evaluations of the cognitive explanation of S in psych explt of S
Research support - Stirling et al 'stroop task'
- Similar to CCT, S individuals were 2x more likely than average to take longer to name the font colours
A proximal explanation
Only explains what happening now to form symptoms, not based on the initial cause (Distal) like genetic
- therefore only a partial explanation
65
What are two psychological therapies?
CBT
Family therapy
66
Who created the phases for family therapy?
Burbach
67
What are the 2 ways that family therapy can help?
Reduces negative emotion
Improves families ability to help
68
How does family therapy improve the families ability to help (3)
Encourage families members to make a therapeutic alliance ( agree on therapy aims)
Attempts to improve families beliefs/behaviours towards S
Ensure family members can achieve a balance between caring for the S individual and maintaining their own lives
69
What is the aim of family therapy?
Improve the communications within the family and reduce the stress of living as a family
70
How many phases were proposed in Burbach's model of practice for family therapy?
7
71
What is phase 6 of Burbach's model of practice for family therapy?
Relapse prevention planning
72
What is phase 7 of Burbach's model of practice for family therapy?
Maintenance for the future
73
What is phase 1 of Burbach's model of practice for family therapy?
Sharing basic info and providing emotional and practical support
74
What is phase 2 of Burbach's model of practice for family therapy?
Identifying resources, including what different family members can (and cannot) offer
75
How does CBT work as a psychological therapy?
It helps clients make sense of how their irrationial incognitions can impact their feeling and behaviours
(helps them understand their symptoms)
76
How does CBT make it easier for S ppl to cope?
When they understand where their symptoms come from it can reduce their distress improve their ability to function adequately
77
How can delusions be challenged in CBT?
Reality testing
78
What does reality testing challenge in CBT?
Delusions
79
How can 'hearing-voices' be helped to in CBT?
Teaching normalisation, voice hearing as an extension of the ordinary experiences of thinking in this world
80
What is symptom overlap? (3 points)
System overlap refers to the way that disorders have shared symptoms.
For example hallucinations are a symptom of both schizophrenia and bipolar disorder.
81
Why is symptom overlap a problem?
This can lead to problems with reliability of diagnosis as one doctor might diagnose the person as having schizophrenia while another might diagnose bipolar disorder.
82
An example of symptom overlap?
For example hallucinations are a symptom of both schizophrenia and bipolar disorder.
83
How many sessions should family therapy have?
Atleast 10
84
What is the duration that family therapy should be?
3 - 12 months
85
What was the relapse rates findings found by Garrety et al on family therapy?
Reduced from 50% to 55% when family therapy is used
86
Who found that relapse rates fell from 50% to 25% under family therapy?
Garrety et al
87
What is psychoeducation in family therapy?
Informing family members about schizophrenia
(including symptoms etc)
88
What does CBT encourage?
Clients to find the origins of their symptoms
89
Evidence of effectiveness for antipsychotics
Leucht et al - Meta analysis of 56 studies
Who created the degrees of constancy
90
What is an example of behaviour modification?
Token economies
91
What is behaviour modification in T.E?
A behavioural therapy based on operant conditioning
where token are seen as secondary reinforcers and the meaningful rewards are primary reinforcers
92
What are token economies used for in schizophrenia?
Managing the behaviour of schizophrenic individuals
93
What was the study by Azrin and Ayllon in 1968?
Introduced a token economy system in a ward of women with schizophrenia
Given for tasks like tidying and doing their beds.
Later traded in for privileges like movie watching
Found that the number of tasks done by the women increased
94
What years were token economies mainly used in?
1960s and 1970s
95
Why has token economies seen a decline (2)
Ethical concerns
closure of psychiatric hospitals and the growth of community based care
96
What 3 areas did Malson et al find that was tackled by token economies?
Personal care
Condition related behaviours
Social behaviours
97
How do modifying behaviours through a token economy system benefit s individuals?
Improve their quality of life within the hospital setting
Normalises behaviour to make it easier when they adapt into life within a community
98
When are tokens given to a schizophrenic patient?
When they carry out a desirable behaviour
99
What did Cooper et al say in token economies for schizophrenic patients?
Target behaviours are decided on an individual basis and its important to know the person in order to identify the most appropriate target behaviours for them
100
When should tokens be administrated?
As soon as possible after a target behaviour
101
Why should tokens be given as soon as the target behaviour happens?
Giving some form of immediate award is important because delayed awards are less effective
102
What type of reinforcers are tokens and why?
Tokens are secondary reinforcers
BECAUSE they only have value once the person receiving them has learnt that they can be used to obtain meaningful rewards
103
What are the primary reinforcers?
The meaningful rewards
104
What are secondary reinforcers called?
Generalised reinforcers
105
How can tokens become secondary reinforcers?
They must be paired with primary reinforcers
Which is why at the start of the token economy programme tokens and primary reinforcers are administered together
106
What are 2 limitations of using token economies?
Ethical issues
File drawer problem
(Only the published findings are shown and the ones with undesirable results had been 'filed away')
107
What is the evidence of effectiveness for token economies for schizophrenia?
Glowacki et al
Found 7 high quality studied from 1999 to 2013 that examined the effectiveness of TE for patients
Found that there was a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
108
What was the findings of Glowacki et als evidence of effectiveness for token economies?
Found that there was a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
109
Explain the ethical issue with token economies
Gives professionals consideravle power to control the behaviour of people in the role of patients
110
What are token economies?
A reward system used to manage the behaviour of people with schizophrenia?
111
# AA
Whi did the study of women using token economies?
Ayllon and Azrin
112
when are typical antipsychotics first used?
1950s
113
What did Thornley et al find as effectiveness for drug therapy?
Chlorpromazine was more effective than a placebo
| 1000 participants
114
What 2 things does clozapine act on?
Glutamate and serotonin
115
Why is risperidone better than chlorpromazine
It binds more strongly to serotonin receptors so can be used in much smaller doses
Leading to fewer side effects
116
What is a better form of managing schizophrenia rather than token economies?
Art therapy
117
What is an issue with the evidence of effectiveness for token economies?
File drawer problem
## Footnote
Where undesirable results are hidden away
118
What is the primary reason for relapse rates for schiophrenia patients?
Expressed emotion
## Footnote
It acts as a source of stress than can trigger schizophrenia
119
Who introduced the cognitive explanations of schiz?
Frith et al
120
3 evaluations of the interactionist approach for schizophrenia?
RWA - Tarrier et al (Meds v Meds + therapy)
HOWEVER, treatment causation fallacy
Oversimplified the diathesis -stress
no 'Schizogene', biology suggests schizophrenia is polygenic
121
who and what is an alternative approach to managing schizophrenia that isnt token economies?
Chiang et al - art therapy as its a high gain low risk approach and is a pleasant experience without TE side/ethical issues
122
What did Glowacki et al find in token economies as support?
Analysed several studies to TE in institutions for mental patients
Found a reduction in negative symptoms
## Footnote
However, file drawer problem
