Schizophrenia Flashcards
(82 cards)
1
Q
What is schizophrenia
A
a disorder in the psychosis spectrum disorders it affects the way a person thinks, acts, expresses emotions, perceives reality, and relates to others
2
Q
what are the other types of spectrum disorders other than schizophrenia
A
-Delusional disorder
-Schizoaffective
-Schizotypal disorders
3
Q
Describe the ICD-11 diagnostic criteria for schizo
A
-Schizophrenia should be diagnosed if a person shows at least two symptoms, at least one of which must be from the core symptoms/positive symptoms (hallucinations, delusions,experiences of influence,passivity or control and disorganised thinking). The other may include a negative symptom or disorganised movement. For at least a month.
- The symptoms are not a manifestation of substance misuse or drugs.
-
-
4
Q
What are the symptoms of schizophrenia
A
Delusions ;
1)delusions of grandeur - a false belief that a person has special abilities or special power
2)Delusions of social reference ;
a false belief that a neutral event e.g a tv show is fashioned (directed) towards you.
3)Delusions of persecution ;
a false belief that there is a conspiracy to harm you.
4) hallucinations ;
auditory , visual , tactile , gustatory
5)Disorganised thinking (thought disorder);
e.g loose association of words
a) neologisms - creating new words
b)word salads - strings of words that make no meanings
c)irrelevant speech - speech that isn’t in sync with context
12) Experience of influence , passivity or control
- subjective experience that our thoughts, feelings or actions are being controlled by external forces;
thought withdrawal -> the feeling that thoughts are being removed
thought insertion-> the feeling that thoughts are being implanted
Thought broadcasting - the feeling that thoughts are being transmitted to others.
NEGATIVE SYMPTOMS ;
7)Affective (mood) flattening/blunting
8)Alogia
9)Avolition
10)Anhedonia
11)Asociality
5
Q
Describe what is meant by positive symptoms
A
These are experiences or behaviours that are an addition to normal functioning
6
Q
Describe what is meant by negative symptoms
A
This is when normal behaviours thoughts or feelings are distorted or fall short of normal standards
7
Q
What is delusions of social reference
A
a false belief that a neutral event e.g a tv show is fashioned towards you
8
Q
What is delusions of grandeur as a symptom of schizophrenia
A
A false belief that a person has special abilities or powers
9
Q
what is delusions of persecution
A
a false belief that there is a conspiracy to harm you
10
Q
what is avolition
A
completely devoid motivation
11
Q
what is alogia
A
poverty of speech e.g providing one word answers for everything
12
Q
What is anhedonia
A
lack of interest in activities you enjoyed before the episode
13
Q
What are word salads (under disoraginsed thinking)
A
string of words that make no meaning
14
Q
what is irrelevant speech (under disoraginsed thinking)
A
speech that isn’t in sync with context
15
Q
what is neologism (under disoraginsed thinking)
A
creating new words
16
Q
what is asociality (negative symptom)
A
One is non-sociable , socially withdrawn
17
Q
what is echolalia (under disoraginsed thinking)
A
repeating other peoples words
18
Q
what is echopraxia (under disoraginsed thinking)
A
repeating other peoples movements
19
Q
what is broadcasting (under experiences of influence , passivisity and control)
A
Broadcasting is a thought disorder whereby a person believes their thoughts are being broadcast to others, for example over the radio or through TV. Alogia – aka speech poverty – is a thought disorder were correct words are used but with little meaning.
20
Q
what is thought disorder
A
Thought disorder in which there are breaks in the train of thought and the person appears to make illogical jumps from one topic to another (loose association). Words may become confused and sentences incoherent (‘word salad).
Broadcasting is a thought disorder .
21
Q
List positive symptoms of schizophrenia
A
Hallucinations
Delusions of persecution
Delusions of social reference
Delusions of grandeur
Experiences of influence , passivity or control
22
Q
List negative symptoms of schizophrenia
A
-Alogia
-Anhedonia
-Avolition
-Asociality
23
Q
Aneja et al (case study of schizophrenia)
A
The boy came from a troubled home with an aggressive father. When he was ten, his parents divorced and he began
living with his grandparents. His schoolwork suffered and by 12 he was not attending school at all. He was irritable, sad
and often got into trouble for fighting.
SYMPTOMS
Hearing voices that teased him
Suspicious of his mother
· Muttered, laughed and shouted at unseen others
· Spoke very little
· Poor sleep and self-care
.Preferred to be alone, away from other people
Lack of insight into his condition
TREATMENT
He was given sodium valporate, a drug often used to treat bipolar disorder (see page 260). His mood and behaviour improved for a while but soon got worse again. Eventually, he was diagnosed with very- early-onset schizophrenia (VEOS). His aggressive and violent outbursts increased, and he was often
admitted to hospital, for his own safety.
24
Q
what are the explanations of schizophrenia
A
1)Biological explanations
2)Psychological explanations
25
What are the two biological explanations of schizophrenia
Genetic
Biochemical explanation
26
Explain Genetics as an explanation for schizo
This is the idea that individuals inherit genetic markers from their parents.
These markers/traits increase their vulnerability to psychosis
27
What are the three ways of investigating the involvement of genes in psychosis
1)Family studies
2)Twin studies
3)Adoption studies
28
Explain family studies as a way of investigating the involvement of genes in psychosis
-First degree relatives (50% DNA similarity) are most at risk of schizo if a family member has it followed by second degree.
29
Explain twin studies as a way of investigating the involvement of genes in psychosis
-DZ (fraternal) twins share 50% of their DNA -MZ(identical) twins share 100% of their DN
-If schizo is inheritable then the concordance for the trait should be higher in MZ compared to DZ because MZ have 100% genetic resemblance.
-Gottesman (1991) found that the concordance for schizo trait is 48% an average for MZ compared to 17% on average for DZ. This is evidence that the higher the degree of genetic relativeness, the higher the risk of getting schizophrenia
30
What are DZ twins and how much DNA do they share
Fraternal = 50% DNA
31
What are MZ twins and how much DNA do they share
identical = 100% DNA
32
Explain Adoption studies as a way of investigating the involvement of genes in psychosis
-These are designs that are used to separate the difference of nature and nurture factors on the development of a trait
-If a trait is inheritable then a set of twins will both inherit the trait regardless of the difference in their upbringing.
-Adoption studies have shown that shared schizophrenic status is evident in adoptees and it increases with degree of relativity notwithstanding the difference context of upbringing
33
Explain biochemical explanation as a way of explaining the involvement of genes in psychosis
-Biochemicals are neurotransmitters .
Neurotransmitters help with the transmission of impulses or signals between neurons in the brain
-in schizo a neurotransmitter called dopamine is implicated (involved)
-Research has shown that brains of people with schizo have more dopamine receptors than brains of people who don't have schizo.
34
How does high regions of dopamine in the brain affect functions
High regions of dopamine in regions of the brain that process executive functions have been found to impair such functions.
For example high dopamine activity in the brocas area (a region of the brain that processes language has been shown to impair logical speech.
35
What is the evidence of the involvement of dopamine in schizo
-Patients with parkinson's disease are treated with synthetic dopamine called levo-dopa an overdose of this gives patients symptoms similar to psychosis e.g hallucinations
36
Evaluation of the biological explanation
-It is objective ;
The genetic explanation uses scientific methods e.g DNA testing to isolate the degree of similarities in genetic make-up between individuals.
Also the biochemical explanation uses scientific methods such as PET scans and Parkinson's disease as evidence. Scientific methods are objective.
-Data from dopamine hypothesis is correlational ;
this means that cause and effect statements cannot be made .Therefore whether high brain dopamine receptors cause psychosis or vice-versa is debatable. This lowers the validity of the dopamine hypothesis.
-There is more to schizophrenia than genetics;
The fact that the concordance for schizophrenia for MZ twins who share 100% DNA is not 100% means that there is more to schizophrenia than genes.
Therefore a third variable may be implicated. Thus lowers the validity of the genetic explanation.
-Genetic explanation is low in validity ;
Biological psychologists cannot isolate one gene responsible for the experience of psychosis. They claim it is polygenic this lowers the validity of the genetic explanation.
37
What are the issues/debates in psychology
1)Reductionism vs holism
2)Determinism vs free will
3)Idiographic vs nomothetic
38
Reductionism vs Holism as an issue regarding the Biological explanation of schizophrenia
Reductionism is when a complex behaviour/trait is investigated as individual components in isolation.
Reductionism allows for in depth investigation to be done on a specific component of the complex behaviour.
Holism seeks to identify interconnectedness of different aspects/theoretical perspectives to human behaviour and experience.
The biological explanation of schizophrenia is REDUCTIONIST as it reduces a trait as complex as schizo to only neurotransmitter imbalances and genetic factors.
It disregards other possible explanations e.g difficulties with self monitoring and other cognitive explanations
39
Determinism VS free will as an issue regarding the Biological explanation of schizophrenia
-Determinism
is the idea that we are products of functions beyond our control
e.g 1) biological determinism.
-} we are products of genes inherited from our parents
-}We are products of brain neurotransmitters
2)Behavioural determinism
-}We are products of conditioning
3)Psychic determinism
-} We are products of early childhood experiences
-Free will
is the idea that we have freedom of choice.
We are free to choose our behaviours.
-The biological explanation of schizophrenia supports the determinism side of the debate. In the biological debate
genetic markers and an increase in dopamine receptors are implicated in schizophrenia.
40
Idiographic vs nomothetic as an issue regarding the Biological explanation of schizophrenia
-Nomothetic ;
this is the idea that general principles or laws can be determined by studying a sample of people and extending the findings to the general population.
it uses QUANTITATIVE methods and statistical analysis to investigate and make conclusions about behaviour and experiences. Methods like ; experiments
-Idiographic ;
it focuses on understanding individuals in their unique context. It seeks to uncover individual factors and experiences that contribute to a person's behaviour.
it uses QUALITATIVE METHODS or in depth analysis to gain rich insight into behaviour. Uses methods like ; case studies , self reports , autobiographies.
The biological explanation supports the nomothetic side of the debate. For example it uses quantitative methods e.g PET scans to measure dopamine receptors in patients with schizophrenia.
From such investigations conclusions are made about human behaviour/the causes of schizo from the sample investigated which is then generalised about the biological causes of schizo.
41
Applications to everyday life (biological explanation)
-The biological explanation has useful application to everyday life for example the dopamine hypothesis has lead to the discovery of antipsychotics which have been used as dopamine antagonists they work by polarizing dopamine receptors therefore lowering the disability caused by positive symptoms of schizophrenia.
42
Cognitive explanations of Schizophrenia
-This explanation argues that schizophrenia is a product of difficulties with cognitions which consequently impair functions.
The conditions implicated include;
1) Difficulties with source monitoring
2)Difficulties with Theory of mind
43
Explain difficulties with source monitoring as cognitive explanation for schizophrenia
-Source monitoring is the processes involved in making attributions about the origins of memory and voices.
i.e victims of psychosis cannot differentiate between memories that are internally generated or externally derived.
-Also people with schizo cannot recognise that their perceived hallucinations are in fact just inner speech (the kind of self talk that people experience) this leads them to attribute what they are hearing to someone else. (auditory hallucinations)
-The idea of reality monitoring may be particularly relevant to psychosis. Patients with psychosis are unable to monitor the generation of their own thoughts and actions hence they think that these thoughts come from external sources.
-Studies of action monitoring performance have used tasks that require subjects to keep track of the actions they just performed in the absence of visual feedback.
The results have shown that patients with the experiences of external control have difficulties monitoring their actions internally.
44
Explain difficulties with Theory of mind as a cognitive explanation of schizophrenia
-Theory of mind is the ability to imagine other people's mental states e.g thoughts , goals , feelings and respond appropriately (Preemack and woodruff 1978)
-Frith has applied the concept of theory of mind to specific symptoms of schizophrenia e.g delusions of influence , persecution and 3rd person hallucinations.
According to him these experiences are characterised by misinterpretation of another person's behaviour/intentions.
-For example in delusions of persecution people with psychosis often misinterpret other people's intentions (They believe that other people want to harm them) this is due to a lack of TOM they are unable to imagine other people's thoughts and feelings appropriately.
-People who experience negative symptoms e.g flattening effect , avolition , alogia etc. Have difficulties generating spontaneous actions , they get confused by social setups and find it difficult to make decisions on how to behave or what to do without a type of prompt from someone else.
45
What are the treatments for schizophrenia
1)Biochemical treatments ===
2)Psychological treatments
46
What are the class of medications used to treat schizophrenia called
Antipsychotics
47
What are the two types of antipsychotics
-Typical antipsychotics
-Atypical antipsychotics
48
Describe Typical antipsychotics
-They are also called first generation antipsychotics
-They are specific to the dopamine pathways especially the dopamine D2
-They are dopamine antagonists they work by polarising dopamine receptors causing a massive down regulation (reduction) in the dopamine D2 receptors.
49
Give an example of typical antipsychotics
-Chlorpromazine
-Haloperidol
50
What are the side effects of Typical antipsychotics
They have severe and fatal side effects ;
1)Agranulocytosis - low white blood cell
count ,
compromised immunity
2)Neuroleptic malignant syndrome ;
Caused by low dopamine levels in the brain and is characterised by fever , rigid muscles , confusion , uncontrollable changes in heart rate , blood pressure and breathing
3) Extrapyramidal symptoms ;
Impaired motor actions
->Tardive dyskinesia (T.D) irregular jerky movements e.g protruding tongue , lip smacking , facial grimacing , uncontrollable blinking.
-> Dystonia - continuous spasms and muscle contractions e.g
drooling uncontrollably , rapid blinking
51
Describe Atypical antipsychotics
-Also called second generation antipsychotics
-They were discovered in the 1990's as a response to the negative side effects of typical antipsychotics.
-They work as dopamine antagonists but they rapidly disintegrate allowing normal dopamine activity to resume hence less severe side effects.
-They target both serotonergic and dopaminergic pathways.
52
Examples of Atypical antipsychotics
1)Clozapine
2)Olanzapine
53
What are the side effects of Atypical antipsychotics
1)Nausea
2)Weight gain
3)Blurred vision
4)Dry mouth
54
Describe the evidence for the effectiveness of antipsychotics in managing schizophrenia
-Clinical trials using randomised double blind placebo control trials have shown that 50% of those taking anti-psychotic medication show significant improvement in their cognition after 4-6 weeks.
-Around 30-40% show partial improvement
-While a substantial minority show little to no improvement.
55
Evaluate the biochemical treatments
-The use of antipsychotics to treat schizophrenia is reductionist
-They breach ethical guidelines
-Support the nomothetic side of the debate
56
Explain how the use of antipsychotics to treat schizophrenia is reductionist
(evaluation of biochemical treatment of schizo)
--The use of antipsychotics to treat schizophrenia is reductionist as medication only helps to minimise symptoms but does not treat the cause.
For example antipsychotics are very helpful in minimizing positive symptoms of schizophrenia however they cannot treat the cause.
However a combination of psychotherapy and medication has been shown to have high effectiveness in the treatment and management of schizophrenia
57
Explain ethics as an evaluation for the biochemical treatments of schizophrenia
-Antipsychotics especially typical have severe and unpleasant side effects for example extrapyramidal symptoms which impair motor actions for example Tardive dyskinesia which causes irregular jerky movements like lip smacking and protruding tongue.
These unpleasant side effects could lead to non-adherence of medication lowering the validity of the treatment.
Also the unpleasant side effects breach the guideline of protection from harm.
58
How do the biochemical treatments of schizophrenia support the nomothetic side of the idiographic vs nomothetic debate
-Randomised control trials are clinical trials that use experimental methodology to test the effectiveness of a newly discovered medication on a sample of patients.
-Trends of response to the medication can be discovered from the sample. Generalisations are then made about the effectiveness of the medication according to how the sample responded.
This supports the nomothetic side of the debate as it demonstrates how findings can be applied to larger populations.
59
What is electroconvulsive therapy
ECT
-This involves shocking the brain more specifically the less dominant hemisphere
in order to treat schizophrenia.
-The electricity causes seizures(convulsions) which act as a treatment.
60
How long is ECT done for
-The standard practice is 2-3 sessions a week for between 6 and 12 weeks
61
What type of patients receive ECT
-Patients who are medication resistant
-Patients with acute psychosis
62
How is ECT done? explain the procedure
-An IV line ic created that is used to deliver an analgesic (pain killer) and an anaesthetic
-Electrodes are attached to the scalp to deliver 800 milliamps of electricity.The electricity induces seizures which happen to help the patient.
-After the sessions the patient is taken to the recovery room as they gain consciousness.
63
What are the side effects of ECT
-Short term confusion or disorientation
-Pain in the joints , stiffness of the muscles
-Short term memory loss
64
Evaluation of ECT
-Strengths / weaknesses
-Useful applications to everyday life
-Which debate is relevant?
65
What are the strengths of ECT
-When it is combined with antipsychotics the effectiveness of the treatment increases.
This implies that combining treatments is effective in the management of disabling symptoms of schizophrenia and restoring the patients functions
66
What are the weaknesses of ECT
-ECT is unethical and controversial because of the unpleasant side effects following the procedure e.g memory impairment , nausea , muscle aches etc
67
What are the useful applications to everyday life of ECT
-ECT has been used as a last resort treatment for medication resistant schizophrenia and acute psychosis.
This means that patients who don't benefit from medication may have hope in ECT.
68
What debate is relevant to ECT and why
Reductionism vs holism debate
-The use of ECT to treat schizophrenia is reductionist as it only reduces the traits/symptoms of psychosis but does not full treat schizophrenia.
69
What is the psychological treatment for schizophrenia
CBT
70
Explain CBT as a treatment for schizophrenia
-Cognitive psychologists believe that most of our problems come from impaired cognitions e.g impaired beliefs , impaired perception , impaired memory loss
Talking therapy that involves cognitive restructuring. Therapist and patient discuss the goals of the therapy which are problem-focused (often 5-20 weeks). For schizophrenia this could involve reducing delusions, ignoring hallucinations and/or coping strategies. Will discuss issues (e.g. delusional thoughts) with therapist and set homework to challenge thoughts during the week. For example, if the patient has a delusion that they are being followed by spies the therapist could acknowledge that is possible but question why spies would be interested in the patient and suggest who else it might be (e.g. friends out for a walk). As therapy progresses the patient learns how to challenge their thoughts and becomes aware of improvements in symptoms.
example study sensky et al (2000)
-Sensky carried out a randomised control trial to compare the effectiveness of CBT with befriending.
-It was a randomized trial because ss were put into either the CBT or Befriending at random
-Two treatment centres were used one in London and one in Newcastle
-Random allocation was done by members of the research team who were not involved with either assessment or treatment .
- Four outcome measures were used to asses the gains of therapy ; SANS (scale for assessment of negative symptoms)
CPRS ( comprehensive psychiatric rating scale)
- Two experienced nurses MO and RS delievered either therapy based at each study centre
-The sessions were audiotaped for supervision and quality control
71
Describe the study by Sensky (CBT and befriending for treating schizo)
Aim -
- to compare the effectiveness of CBT with befriending for people with schizophrenia
Sample -
- 90 patients aged 16-60 years , with a diagnosis of treatment resistant schizophrenia.
- Two treatment centers were used one in London and one in Newcastle
Procedure;
-There were two groups ; the befriending grp and the CBT group
-Befreinding sessions included informal one-to-one discussions about hobbies , sports or current affairs. This was done to test whether CBT itself is effective rather than the experience of talking to others.
-Particiopants were randomly allocated to either group. Random allocation was done by memebers of the research team who were not involved with either assesment or treatment
-Patients recived an average of 19 sessions of CBT or befreinding over the treatment period.
-Each intervention was delivered by two experinced nurses.
-The CBT treatment followed distinct stages, including ; engaging with tha patient and discussing the emrgence of their disorder before tackiling specific symptoms. E.g patients with auditory hallucinations engaged in a joint critical analysis with the nurse to challenge beliefs about the nature and orgins of their voice
-Patients were assesed using blind raters nefore the strat of their treatment and at treatment completion , and at a 9 month follow up.
They used the Comprehensive Psychiatric Rating Scale (CPRS) and Scale for the Assesment of Negative Symptoms (SANS).
Results ;
-Immediately following the treatment period both groups showed a significant overall reduction in both positive and negative symptoms of scizophrenia.
-At the follow up stage 9 months later the improvement in the symptoms remained in those in the CBT condition but was no longer evident in the befrienidng condition.
Conclusion;
-CBT is an effective treatment for for reducing positive and negative symptoms of scizophrenia and that the benefits continue for at least another 9 months after the end of treatment.
72
who did the random allocation in the study by Sensky
Random allocation was done by members of the research team who were not involved with either assessment or treatment
73
What made patients "fail" in the treatment
(sensky)
Patients in either group who attended fewer than 6 sessions were considered to have failed in the treatment
74
How were the gains of the treatment assessed (Sensky)
-Outcome measures were used at terminational treatment and at 9 month follow up to asses the gains of therapy.
75
Describe the sample from the study by Sensky
-There were 90 patients
-Aged 16-60 years
-They received an average of 19 sessions of CBT or befriending
76
How was CBT done in the study by Sensky
-Patients recived an average of 19 sessions of CBT
-Each intervention was delivered by two experinced nurses.
-The CBT treatment followed distinct stages, including ; engaging with tha patient and discussing the emrgence of their disorder before tackiling specific symptoms. E.g patients with auditory hallucinations engaged in a joint critical analysis with the nurse to challenge beliefs about the nature and orgins of their voice
-Patients were assesed using blind raters nefore the start of their treatment and at treatment completion , and at a 9 month follow up.
They used the Comprehensive Psychiatric Rating Scale (CPRS) and Scale for the Assesment of Negative Symptoms (SANS).
77
How was befriending done in the study by Sensky
The sessions focused on neutral topics, such as hobbies, sports, or current affairs
The therapist aimed to be as non-directives
empathetic as possible
Psychotic and affective symptoms were not correlated talked in effective ways
Patients in befriending had approximately the same amount of therapist hours as patients with cognitive behavioral therapy
78
What are the results from the study by Sensky
Both CBT and BF resulted in significant symptom improvements at the end of the treatment as captured by SANS and CPRS
However at 9 month follow ups, CBT resulted in significantly greater improvements than BF for all the four outcome measures
Between the outcome and follow up evaluations those in the CBT group continued to show improvement while those in the BF group lost some of their gains
79
What is the conclusion from the study by Sensky
CBT is an effective treatment for reducing positive and negative symptoms of schizophrenia and the benefits are enduring for at least another nine months at the end of the treatment
80
What are the strengths of the study by Sensky
1. Useful full application to every day life;
Patients leave therapy with skills that enable them to survive in the absence of therapist [lower dependence.]
They are quickly integrated back into the communities with minimal relapse cases
Some of the skills obtained from CBT include
1. Reattribution
2. Diary, keeping [voice diary]
3. Socratic questioning
2. it can be used on drug resistant patients; CBT can be used as a last resort for patients who are drug resistant and it targets both positive and negative symptoms unlike medication the targets negative symptoms only.
3. No side effects;
CBT lax, unpleasant, side effects, that are persistent in medication and ECT. Therefore, it is a more ethical form of therapy.
81
What are the limitations of the study by sensky
1. Reductionist
CBT is reductionist as it disregards the biological components of schizophrenia, such as biomarkers [genetic markers] and upregulation of dopamine receptors. It’s only focuses on, reducing the impaired cognition by elucidating, the origin and nature of psychosis.
82
Explain the procedure in the study by Sensky
CBT treatment included experienced nurses engaging with the patient, discussing the emergence of the disorder before tackling symptoms, e.g. patients experiencing auditory hallucination engaged in joint critical analysis with nurses to challenge beliefs about the nature and origin of voices.
Patients kept voice diaries to record what they were hearing to generate coping strategies.
Participants were assessed via blind raters before treatment at treatment completion and a 9-month follow-up.
Blind raters: those rating the treatment group were blind to the treatment.
Comprehensive Psychiatric Rating Scale (CPRS) and Scale for Assessment of Negative Symptoms (SANS) were used to assess the positive and negative symptoms.
