Schizophrenia Flashcards
1
Q
What is schizophrenia?
A
mental health disorder that falls into the category of ‘psychosis’ - contact with reality is impaired
2
Q
What are positive symptoms?
A
additional symptoms beyond those of ordinary existence
3
Q
What are negative symptoms?
A
involve the loss of usual abilities
4
Q
What are positive symptoms of schizophrenia?
A
Hallucinations - when you experience a sense that isn’t actually there
Delusions - a belief you hold with complete conviction
Speech disorganisation - speech becomes incoherent
5
Q
What are negative symptoms of schizophrenia?
A
Speech poverty - limited speech output
Avolition - lack of purposeful, willed behaviour
Emotional blunting
Anhedonia - the inability to enjoy experiences or activities that normally would be pleasurable
6
Q
How do we diagnose schizophrenia?
A
-identify clusters of symptoms that occur together and classify these as a disorder
-no objective biological test
7
Q
What are the two classification systems for schizophrenia?
A
World Health Organisation’s International Classification of Disease - used in majority of the world
American Psychiatric Association’s Diagnostic and Statistical Manual - used in North America
8
Q
What are the two similarities between the classification systems?
A
- symptoms present for a month
- ignore substance use
9
Q
What are the two differences between the classification systems?
A
- ICD needs 1 symptom but DSM needs at least 2
- ICD has subtypes
10
Q
What are the three subtypes of schiziphrenia?
A
Paranoid Schizophrenia = Powerful delusions and hallucinations but relatively few other symptoms.
Residual schizophrenia =
This consists of people who are experiencing mild symptoms (20% of people are diagnosed with this type).
Catatonic Schizophrenia =
Disturbance to movement; immobile or overactive
11
Q
What was the aim of Rosenhan’s study?
A
Rosenhan wanted to test the reliability of mental health diagnosis, to see if medical professionals could tell the sane from the insane in a clinical setting. He also wanted to investigate the effect of labelling on medical diagnosis.
12
Q
What was the procedure of Rosenhan’s study?
A
- The participants were the staff and patients in 12 psychiatric hospitals (mental asylums) in the United States.
- The 8 pseudopatients went to clinical interviews and reported their ‘symptoms’. They reported hearing a voice saying the words ‘empty, hollow, thud’. When they were admitted to a hospital, they started behaving normally and stopped reporting hearing voices. As soon as they were admitted, the pseudopatients requested to be discharged.
13
Q
What was the findings of Rosenhan’s study?
A
- All 12 hospitals diagnosed the pseudopatients as mentally ill. 11 hospitals diagnosed schizophrenia, 1 hospital (the private hospital) diagnosed manic-depression (bipolar disorder). The pseudopatients went to hospitals that had diagnosed them with schizophrenia.
- None of the staff recognised that the pseudopatients were healthy. It took between 7 and 52 days for the pseudopatients to be discharged; the mean length of stay was 19 days. The pseudopatients were discharged with a diagnoses of “schizophrenia - in remission” (meaning the person has schizophrenia but the symptoms appear to have stopped) in 7 cases; 1 pseudopatient was discharged with a diagnosis of “schizophrenia” on their medical record.
14
Q
What was the conclusion of Rosenhan’s study?
A
We do not reliably distinguish the sane from the insane in psychiatric hospitals
15
Q
Is validity a strength or weakness + evidence for this?
A
Weakness
Cheniaux had two psychologists independently assess the same 100 clients using ISD-10 and DSM-IV criteria and found that 68 were diagnosed with schizophrenia under the ICD system and 39 under DSM.
16
Q
Is reliability a strength or weakness + evidence for this?
A
Strength
Osorio found that pairs of interviewers achieved inter-rater reliability of 0.97 and test-retest reliability of +0.92 when looking at the diagnosis of 180 individuals using the DSM-5
17
Q
Is symptom overlap a strength or weakness + evidence for this?
A
both schizophrenia and bipolar disorder involve positive symptoms (such as delusions) and negative symptoms (such as avolition).
18
Q
Is gender bias a strength or weakness + evidence for this?
A
Men are more likely to be diagnosed with schizophrenia than women at a ratio of 1.4:1 (Fischer and Buchanan)
19
Q
Is comorbility a strength or weakness + evidence for this?
A
Buckley found that 50% of individuals with a diagnosis of schizophrenia also have depression and 47% have a comorbidity with substance abuse.
20
Q
Is culture bias a strength or weakness + evidence for this?
A
British people of African-Caribbean origin are up to nine times as likely to receive a diagnosis as white British people (Pinto and Jones) although people living in African-Caribbean countries are not.
21
Q
What are the three biological explanations for schizophrenia?
A
- Genetics (inherited from parents)
- Biochemical (neurotransmitters sending messages)
- Neuroanatomy (differences in structures in the brain)
22
Q
What does neural correlates mean?
A
variations in neural structure and biochemistry that are correlated with an increased risk of schizophrenia
23
Q
Explain 2 issues with biological explanations of schizophrenia?
A
Cause and effect = altered biology may have an effect rather than a cause
Treatments = biological explanations suggest drug treatment whereas other explanations would favour other treatments
24
Q
What is the genetic explanation of schizophrenia?
A
This explanation suggests that schizophrenia is inherited and a result of biological processes driven by the activity of certain genes. For example, genes that influence brain structure or certain neurotransmitter levels.
25
Why are families and twins are often used when researching genetics?
Families share genes, so we can look to see if there are any traits that occur in more than one family member. Monozygotic twins share 100% of their genes meaning that a shared trait is likely to be genetic.
26
What would we expect from the concordance rate between identical twins if schizophrenia had a genetic basis?
If schizophrenia was caused by genes alone, we would expect a concordance rate of 100% in monozygotic twins. If one twin had schizophrenia the other also would.
27
What was the aim of Gottesman's study?
investigated the concordance rate of schizophrenia
28
What was the procedure of Gottesman's study?
Gottesman carried out a large scale family study looking into concordance rates for schizophrenia in families.
29
What was the findings of Gottesman's study?
One finding was that there was a 48% concordance rate in MZ twins and a 17% concordance rate in DZ twins.
30
What was the conclusion of Gottesman's study?
As genetic similarity increases so does the probability of sharing schizophrenia (concordance rate). As MZ twins share 100% genes, this would suggest that Schizophrenia has a large genetic component. However, the concordance rate is 48%, not 100%, so other factors must also play a part.
31
What was the strengths of Gottesman's study?
This was a large scale study, so results are reliable and consistent across a large sample.
32
What was the weaknesses of Gottesman's study?
It is impossible to control for all extraneous variables, this limits internal validity. Twins share the same environment and MZ twins are more likely to be treated the same meaning we cant be sure that the increased concordance rate is due to shared genetics, or shared environment.
33
What about schizophrenia when there is no family history?
Mutation - Parental DNA may mutate because of radiation, virus, etc
Evidence for mutation comes from positive correlations between paternal age (associated with increased risk of sperm mutation) and risk of schizophrenia increasing from around 0.7% with fathers under 25 to over 2% in fathers over 50 (Brown et al., 2002).
34
What is genetic counselling?
information about the probabilities of inheriting schizophrenia, so that they can make informed choices
35
What is a strength of genetic counselling?
Understanding genetic risk can help people understand their options and make informed choices
36
What is a weakness of genetic counselling?
The environment also impacts whether someone develops schizophrenia so understanding genetics is only part of the picture. E.g. smoking cannabis is a risk factor for schizophrenia.
37
What was research into candidate genes?
Early research into candidate genes looked for a single genetic variation in the belief that one faulty gene could explain schizophrenia.
Genes linked to schizophrenia include the COMT gene which codes for the functioning of a number of neurotransmitters such as dopamine.
38
What does polygenic mean?
influenced by a number of different genes
39
What are genome wide studes?
Research now suggests that there are a number of different genes are involved. We now usually use genome wide studies to look at the whole human genome rather than just specific candidate genes.
40
What is research evidence to support schizophrenia being polygenic?
Ripke et al (2014) looked at the genetic makeup of 37,000 people with a diagnosis of schizophrenia compared to that of 113,000 controls.
They found 108 genetic variations that are associated with a slightly increased risk of schizophrenia.
41
What is aetiologically heterogeneous?
Because different studies have different candidate genes it appears that schizophrenia is aetiologically heterogeneous - different combinations of factors, including genetic variation, can lead to the condition.
42
What is the dopamine hypothesis?
- a neurotransmitter is a chemical messenger that sends messages between neurons in the brain
- dopamine is a neurotransmitter related to feelings of reward and has been linked to symptoms of schizophrenia
43
What is the original dopamine hypothesis?
- Hyperdopaminergia (high dopamine levels) in the subcortical brain areas such as Brocas area.
- Broca’s area is responsible for speech production
- Therefore this could explain symptoms of speech poverty or be linked to the positive symptom of auditory hallucinations
44
What is the updated dopamine hypothesis?
- Hypodopaminergia (low dopamine levels) in brain areas such as the pre-frontal cortex.
- The prefrontal cortex is linked to decision making and impulse control
- Therefore this could explain negative symptoms and cognitive problems associated with schizophrenia.
45
Key terms associated with the original dopamine hypothesis
- Hyperdopaminergia
- Broca's area
- Poverty of speech
- Auditory hallucinations
- Subcortical areas
46
Key terms associated with the updated dopamine hypothesis
- Hypodopaminergia
- Prefrontal cortex
- Negative symptoms
- Cognitive deficits
- Thinking
47
How do the original and updated dopamine hypotheses work together?
- It has been suggested that low dopamine levels in the brain’s cortex can lead to high dopamine levels in subcortical brain areas.
- Low dopamine in the cortex → high dopamine levels in the subcortex
48
What is glutamate?
an excitatory neurotransmitter involved in learning, attention and memory is found in low quantities in people with schizophrenia
49
What is serotonin?
a drug, clozapine, is an effective treatment and acts on the serotonin system.
50
What is evidence to support the role of dopamine in schizophrenia?
- Catharine Tenn et al. (2003) induced schizophrenia-like symptoms in rats using amphetamines and then relieved symptoms using drugs that reduce dopamine action.
- Amphetamines increase dopamine and worsen symptoms of schizophrenia. They can also induce symptoms in people without schizophrenia (Curran et al., 2004)
51
What is evidence to contradict the role of dopamine in schizophrenia?
- Post mortem studies and live scanning studies have consistently found raised levels of the neurotransmitter glutamate in several brain regions of people with schizophrenia (McCutcheon et al., 2020).
- Although amphetamines increase symptoms of schizophrenia, not all drugs that increase dopamine levels cause schizophrenia like symptoms (Depatie and Lal, 2001)
52
What is a neuroanatomical explanation for schizophrenia?
suggests that variations in the structure and function of the brain are correlated with an increases risk of schizophrenia
53
What differences are there when we compare the brain of patients with schizophrenia to a healthy brain?
ventricles, ventral stiatrum, superior temporal gyrus
54
How do ventricles differ?
patients with schizophrenia have larger sized ventricles compared to people without schizophrenia
55
How does the ventral striatum differ?
involved in motivation! patients with schizophrenia have lower activity in ventral striatum. could explain why avolition is a negative symptom
56
How does superior temporal gyrus differ?
allen found fMRI scans of patients with auditory hallucinations showed reduced activity in the superior temporal gyrus compared to a control group. the superior temporal gyrus (STG) is involved in the auditory inputs for language and music processing!
57
What experiments are ones into mental illnesses?
- Research into mental illnesses like schizophrenia often takes the form of a correlation or quasi experiment.
- This is because we cannot manipulate the IV (schizophrenia is naturally occurring and would never be manipulated by the researcher!)
58
What are the three Psychological Explanations of Schizophrenia: Family Dysfunction?
- The Schizophrenogenic Mother
- Expressed Emotion (EE)
- Double Bind Theory
59
What is the The Schizophrenogenic Mother?
A psychodynamic explanation; if a mother is cold, rejecting and controlling and tends to create a family climate that is characterised by tension and secrecy - this leads to distrust that later develops into paranoia in the child.
60
What is expressed emotion?
- Another family variable associated with SZ is a negative emotional climate, or a high degree of expressed emotions.
- Expressed emotion is a communication style where family members will talk about/to the SZ sufferer in ways that might be critical, hostile manner or that indicate emotional over-involvement or over-concern (High EE).
- This suggests that schizophrenics have a lower tolerance for environmental stimuli, leading to stress beyond a manageable level.
61
What is double blind theory?
Double Bind Theory states that schizophrenia is caused by mixed messages from parents that express care but at the same time appear critical. Double bind behaviour can also relate to a contradiction between a person’s verbal behaviour and nor verbal behaviour. This causes them to develop an incoherent version of reality, which influences schizophrenic symptoms such as social withdrawal and flattening of affect.
- Bateson et al’s. (1956) double bind theory says that parents predispose their children to SZ through contradictory communications.
E.g. A mother tells her son she loves him but then turns away when he approaches her for affection.
62
What are the strengths of the Psychological Explanations of Schizophrenia: Family Dysfunction?
- Adoption studies provide research support that family relationships are important.
Tienari ‘High genetic risk’ adopted children (with Sz mothers) were more likely to develop Sz than those ‘low genetic risk’ children
However, the highest risk was when high risk children were adopted into families high in ‘criticism and conflict’.
This suggests that the illness only manifests itself under appropriate environmental circumstances and not simply due to genetic vulnerability.
- Research support that expressed emotion may play a role in relapse. Vaughn found that relapse rates for Sz sufferers was twice as high for high EE families as for low EE familes. This suggests that, although there may be limited evidence for family dysfunction in the initial development of Sz, it may play a role in recovery (or relapse)
63
What are the weaknesses of the Psychological Explanations of Schizophrenia: Family Dysfunction?
- Lack of research support for family dysfunction explanations of schizophrenia - Harrington
very little evidence that parental characteristics influence SZ development.
This is ESPECIALLY TRUE for double-bind theory
Also, there are ethical implications of these theories, as they have historically led to parent-blaming (especially mother-blaming), causing further trauma to parents already dealing with SZ in a child. Ignores biological explanantion
64
What are the two Psychological Explanations of Schizophrenia: cognitive approach?
- meta-representation
- central control
65
What is meta representation?
- ability to reflect on our own thoughts and behaviours and those of others
- schizophrenic people cannot do this
- can lead to hallucinations and delusions
66
What is central control?
- suppression of automatic responses while performing deliberate actions instead
- link to disorganised speech due to the lack of ability to ignore word associations as they speak
67
What is meta-representation and delusions?
- Patients' interpretations of their experiences result from faulty information processing.
- The patient may have Egocentric Bias.
- The individual perceives themselves as the central component of events and so they jump to conclusions.
- The patient tends to relate irrelevant events to themselves and arrive at false conclusions.
68
What is meta-representation and hallucinations?
- Hallucinating patients with SZ are significantly more likely to misattribute the source of a self-generated auditory experience to an external source.
- These errors are not corrected because a person with SZ does not go through the same process of reality testing that non-SZ people would do.
- This example helps us to see how cognitive explanations can be easily combined with other models (such as biological models), to provide more complete explanations for conditions.
69
What are the strengths to the Psychological Explanations of Schizophrenia: cognitive approach?
- evidence - stirling stroop test
- development of treatments - cbt
70
What are the weaknesses to the Psychological Explanations of Schizophrenia: cognitive approach?
- proximal - explains what is happening now to produce symptoms compared to distal which focuses on what initially caused condition
71
What is the biological treatment for schizophrenia?
drug therapies
72
What are the two types of drugs?
typical and atypical
73
What are typical antipsychotics?
- Reduce positive symptoms, e.g. hallucinations.
- Strong links between typical antipsychotics and the dopamine hypothesis…this is because they reduce the action of dopamine (they are dopamine antagonists).
- Chlorpromazine, taken as tablets, syrup or injection.
- Have been around since the 1950s
74
What are side effects of typical antipsychotics?
- Tardive Diskinesia (Involuntary facial movements e.g. grimacing, blinking, movements of mouth and tongue).
- Dizziness
- Agitation
- Sleepiness
- Stiff jaw
- Weight gain
- Itchy skin
75
How do typical antipsychotics work?
a typical antipsychotic temporarily blocks dopamine receptors at the synapse. this reduces the action of dopamine because dopamine can no longer bind to the receptors to send messages between neurons.
76
What are atypical antipsychotics?
- Aim: Improve effectiveness of drugs and minimise side effects
- They started to be developed in the 1970s
- eg clozapine and risperidone
block dopamine receptors and also act on other neurotransmitters eg serotonin.
- They also address negative symptoms such as avolition
- There are a range of atypical antipsychotics and they do not all work in the same way. We do not actually know how some of them work.
77
What is clozapine?
- Acts upon serotonin and glutamate receptors as well as dopamine – improves mood whilst reducing depression and anxiety.
- Used for patients who are also experiencing depression or who might be at risk of suicide
- First developed in the 1960s and first trialled in the 1970s. It’s use was stopped in the 1970s due to deaths from the blood condition agranulocytosis.
- Reused again from the 1980s alongside regular blood tests to ensure patients are not developing agranulocytosis. This is because it is more effective than other antipsychotics and used as an option when other treatments have not worked.
78
What is risperidone?
- Has been around since the 1990s
- Can be taken in the form of injections, syrups or tablets
- Binds more closely to dopamine receptors than clozapine.
- Is effective in much smaller doses with fewer side effects
79
Side effects of atypical antipsychotics?
- weight gain
- cardiovascular problems
- agranulocytosis (autoimmune disorder affecting white blood cells) - this is specifically associated with Clozapine
80
What are the strengths of drug therapies?
- Evidence -thornley found chlopromazine had better functioning and reduced symptom severity compared to placebo
81
What are the weaknesses of drug therapies?
- side effects
-don't know how they work
82
What are the basic assumptions of CBT?
- CBT works on the assumption that there is a link between someone’s thoughts and beliefs with their emotions and behaviours.
- The assumption is that people with schizophrenia have irrational thoughts and beliefs about their symptoms.
- The basic aim of CBTp is to help people to understand the irrational beliefs they hold about their symptoms, and challenge these so that this has positive impacts on their emotions and behaviours.
- When treating schizophrenia, NICE recommends at least 16 sessions in order for treatment to be fully effective.
83
What is the nature of CBT?
- Patients are encouraged to trace back to the origins of their symptoms.
- They are also encouraged to evaluate the content of their hallucinations/delusions as well as think of ways to test the validity of their faulty beliefs.
- Behavioural assignments are set so that the patient can try to improve their general level of functioning.
- The therapist encourages the patient to come up with their own alternatives to previous maladaptive beliefs.
84
What are the phases of CBT?
Assessment – the patient expresses his/her thoughts about their experiences to the therapist. Realistic goals for the therapy are discussed, using the patient’s current distress as a motivation for change.
Engagement – the therapist empathises with the patient’s perspective and their feelings of distress, and stresses that explanations for their distress can be developed together.
The ABC model – Identifying activating event (A),
exploring beliefs (B), recognising consequences (C), disputing irrational beliefs (D),
restructured belief (E).
Normalisation – information that many people have unusual experiences such as hallucinations and delusions under many different circumstances (e.g. in situations of extreme stress).
Critical collaborative analysis – the therapist uses gentle questioning to help the patient understand illogical deductions and conclusions, or works with the patient to ‘reality test’ them.
Developing alternative explanations – the patient develops their own alternative explanations for their previously unhealthy assumptions.
85
What is an example of distorted beliefs influencing someone in a maladaptive way in schizophrenia?
Someone with schizophrenia may hear voices, and may have an irrational belief that the voices they are hearing represent demonic forces. The consequence of this belief could be that the person feels fearful, and their behaviour may be that they do not interact with others due to this fear. This is maladaptive as not interacting with others and feeling fear would negatively impact their quality of life and could lead to isolation.
86
What are the strengths of CBT?
evidence - jauhar found evidence for effects on symptoms, pontillo found reduction in auditory hallucinations
87
What are the weaknesses of CBT?
- wide range of techniques and symptoms
- may not be effective in acute stages of Sz - addington and addington
88
What is family therapy?
- Family therapy is based on the finding that families can play an important role in affecting the course of schizophrenia.
- Through dysfunctional communication and high expressed emotion (EE).
- Therefore, the sufferer’s family can be used to help reduce the symptoms.
- ‘Family’ includes a schizophrenic patient’s parents, siblings and partner.
89
What does family therapy involve?
- Therapy lasts for 3-12 months over at least 10 sessions, in conjunction with antipsychotic medication.
- It aims to reduce levels of expressed emotion and stress.
- By reducing EE levels and increasing family members’ ability to anticipate and solve related problems, schizophrenics will hopefully be less likely to relapse.
90
How does family therapy work?
- An alliance is formed with family members using several strategies:
- Providing knowledge about schizophrenia and how to deal with it (psychoeducation).
- Reducing the emotional climate (e.g. anger and guilt) within the family, and the burden of care (e.g. expectations about the schizophrenic’s behaviour).
- Encouraging family members to set appropriate limits while maintaining some degree of separation when needed.
- During family therapy sessions, the individual with SZ is encouraged to talk to their family and explain what sort of support they find helpful, and what makes things worse for them.
91
What are the strengths of family therapy?
- evidence - mcfarlane says most effective, reduced by 50-60%
- benefits all family members - lobban and barrowclough concluded families provide bulk care
92
What are the weaknesses of family therapy?
- not an effective treatment alone
93
What is a token economy?
- It is a form of behavioural therapy based on operant conditioning.
- Clinicians set target behaviours that they believe will improve the patient’s engagement in daily activities.
- These might be simple everyday tasks or more socially oriented behaviour.
- Tokens are awarded to the patient every time they engage in that behaviour, and these tokens can later be exchanged for various rewards and privileges – in other words positive reinforcement.
94
How are value assigned to the tokens?
- To give the neutral token some ‘value’, it needs to first be repeatedly presented alongside or immediately before the reinforcing stimulus.
- The reinforcing stimulus may take the form of food, privileges or other incentives.
- By pairing neutral tokens with the reinforcing stimulus, the neutral token eventually acquires the same reinforcing properties.
- As a result of this conditioning, these neutral tokens become secondary reinforcers, and so can be used to modify behaviour.
94
What are the strengths of a token economy?
- evidence - glowacki found reduction in negative symptoms
94
What are the weaknesses of a token economy?
- ethical issues - gives professionals power to control patients
- alternatives - chiang recommends art therapy
94
What is an interactionist approach?
approach that acknowledges there are biological, psychological and social factors in development of schizophrenia
94
What is the diathesis-stress model?
both a vulnerability to Sz and a stress-trigger are necessary in order to develop the disorder
95
What was Meehl's original diathesis-stress model?
entirely genetic as a result of a single 'schizogene,' which leads to 'schizotypic personality.' according to meehl, if a person does not have schizogene then no amount of stress can cause schizophrenia.
96
What is modern understanding of diathesis?
many genes increase genetic vulnerability, there is no single schizogene (ripke.) modern views of diathesis also understand there is a range of factors beyond genetic, including psychological trauma (ingram and luxton) so trauma becomes the diathesis rather than the stressor. read proposed a neurodevelopmental model in which early trauma alters a developing brain, e.g. the hypothalamic-pituitary-adrenal system can become overactive, making a person more vulnerable to later stress
97
What is modern understanding of stress?
a modern definition of stress includes anything that risks triggering Sz (houston.) cannabis is a stressor because it increases risk up to seven times as it interferes with dopamine system.
98
What is the treatment needed according to the interactionist approach?
antipsychotic medication and cbt
99
What are the strengths to the diathesis-stress model?
- evidence - tienari found high genetic risk and high levels of hostility and criticism in household led to Sz
- development of treatment - tarrier found medication and cbt had lower symptoms than just one
100
What are the weaknesses to the diathesis-stress model?
- original model is oversimplified
