Schizophrenia Flashcards
What is Schizophrenia (Sz)?
Serious mental disorder experienced by around 1% of the world population. More commonly diagnoses in men, city-dwellers and lowers socioeconomical backgrounds. It can interfere with everyday tasks
Describe the diagnosis and classification of Sz
We idenfiy a cluster of symptoms and identify this as one disorder. We then look at someones symptoms and diagnose. We use either the ICD-10 or the DSM-5. In the DSM-5 one positive symptom must be present whereas in the ICD-10 two negative symptoms must be present. Both do not have subtypes
What is a positive symptom?
They are additional experiences added on to the normal experience. For example hallucinations or delusions
Describe hallucinations
Unusual sensory experiences some which are related to an environment, others which are not. This can include hearing things that are critiquing you or seeing things
Describe delusions
Also known as paranoia, irrational beliefs that are person may have. People may have reference delusions (conspiracies) or grandeur delusions (believing they are a figure such as Naoplean etc)
What are negative symptoms
Involve the loss of usual abilities and experience for example speech poverty or avolition
Describe speech poverty
Reduction in the amount or quality of speech. May also mean delay in conversation
Describe avolition
Finding it difficult to begin or keep up with a goal directed activity. Sharply reduced motivation. Three main signs: lack of hygeine, lack of persistance, lack of energy
Evaluate classification of Sz
One strength is it’s reliability. Said to be reliable when different clincians diagnose the same disorder (inter rater) or when the same diagnosis is reached on two occasions (test-retest). In a study pairs of clinicians recieved a .97 reliability for interater. This means we can reasonably be sure that the diagnosis is applied
Evaluate classification of Sz
One limitation is its validity. One way to assess is criterion validity. Two psychiatrists were given patients. 68 were diagnosed under ICD-10 and 39 under DSM-5. This suggests it is either under or over diagnosed
Counterpoint: Excellent agreement when they both used measures within the DSM system. This means criterion validity is good provided it is done under the same classification
Evaluate classification of Sz
Another limitation is co-morbidity. Conditions occurring at the same time, may just be one condition. SZ is commonly diagnosed with others. Found in half of those diagnosed with SZ, they had a diagnosis of depressions. This means SZ may not exist as a seperate condition or it may be unusual cases of things such as depression
Evaluate classification of Sz
A further limitation is that there is gender bias. Since the 80s, men have been diagnosed more than women. This may be because of genetic factors however it also may be because women have more support leading to better functioning. This therefore means they may not be receiving the best treatment
Evaluate classification of Sz
A further limitation is culture bias. Some symptoms such as hearing voices may have different meanings in other cultures. British afro-caribbean people are 9x more likely to recieve a diagnosis although people in those countries are not. Occurs due to having psychologists from different backgrounds leading to misinterpretation. This may lead to discrimination
Evaluate classification of Sz
A final limitation is symptom overlap. There is significant overlap between SZ and other disorders for example bipolar and sz both have positive and negative symptoms. Suggests they may not be two seperate conditions but one disorder. This makes it hard to diagnose. Means that Sz may not exist as a single disorder therefore making the classification of it flawed
Describe how family studies have shown the genetic explanation of Sz
Risk of SZ increases in line with the genetic similarity to a relative with the disorder. Gottesman found that those with a sibling with Sz have a 9% chance and MZ twins have a 48% chance. The correlation represents both genetic and environment as it is likely that family members are going to live with the same environment
Describe candidate genes
Sz is polygenic as there is multiple genes involved. Ripke looked at 37,000 people with a diagnosis and foudn 108 different genes that could cause it. Different genes therefore cause it in different people making is aetologically heterogenous
Describe the role of mutation in Sz
Mutation in parental DNA which can be caused by a combination of radiation or poison
What is dopamine (DA)?
A neurotransmitte that has an excitory effect and iss linked to the sensation of pleasure. High levels of this are associated with Sz
Describe the original dopamine hypothesis
Sz may be a result of high levels of DA in the subcortial areas for example excess DA pathways near the Broca’s area may result in things such as poverty of speech etc
Describe the updated dopamine hypothesis
Low levels of DA in areas such as the prefrontal cortex can cause negative symptoms of Sz. Both high and low levels of DA can cause Sz. They also try to explain the origins behind the lack of DA
Evaluate genetic explanations for Sz
One limitation is that there are environmental factors. Biological factors such as birth complications and psychological factors such as childhood trauma have been shown to have an effect on causing Sz. In a study it was found that 67% of people with a psychotic disorder had childhood trauma in comparison to 38% of a matched control group. This means genetic explanations alone cannot be enough to explain Sz
Describe family dysfunction
Poor family communication, cold parenting and high levels of expressed emotion are risk factors for the development and maintenance of Sz
Describe the schizophrenogenic mother
Fromm Reichmann - Psychodybamic Approach
Reports of mothers that are cold, rejecting and controlling and creates a family climate of secrecy. Leads to distrust that ultimately caused paranoid delusions
Describe double bind theory
Emphasies the role of communication
Receiving mixed messages, feeling unable to comment on unfairness and seeking clarification. When they get things wrong they are met with withdrawal of love which can cause disorganised thinking
Describe expressed emotion EE
Level of negative emotion expressed to someone with Sz by their carers. Contains several elements:
Verbal criticism
Hostility
Emotional overinvolvement
High levels fo EE directed towards the individual are a serious source of stress for them. Source of stress that can trigger the onset of Sz in a person with Sz
Evaluate family dysfunction
One strength is there is evidence leading to dysfunction. Include insecure attachment and exposure to childhood trauma. They are more likely to have a Type C or Type D attachment. Reported that 69% of women and 59% of men have a history of physical or sexual abuse. Strongly suggests family dysfunction is linked to Sz
Evaluate family dysfunction
One limitation is the poor evidence base for any of the explanations. No evidence to support family-based theories. Both these theories are based on clinical evidence and informal assessment of their mother’s personalities. May not be the reason for the link between the two
Describe dysfunctional thinking in relation to Sz
Focuses on the role of mental processes and there are several types of these. An example is reduced thought processing in the ventral striatum is associated with negative symptoms
Describe metarepresentation dysfunction
Our cognitive ability is to reflect on thoughts and behaviour. Allows into an insight of our own intentions and goals. Dysfunction would disrupt our ability to recognise our own thoughts as being carried out by ourselves which explains hallucinations and delusions
Describe a faulty attention filter
Normally our brain filters out unnecessary information so we can focus on what it important. Everything seems equally important leading to confusion or disorganised thinking
Evaluate cognitive explanations for Sz
One strength is that there is research support. Compared 30 Sz people and 30 non-Sz people in a range of tasks and found that people with Sz took over twice as long to name the colours. This means there coginitive processes are impaired
Evaluate dysfunctional thinking
One limitation is it only explains proximal origins. They focus on what it happening now rather than distal explanations which focus on what initially caused the condition. What is currently unclear with distal explanations may be a result of proximal explanations. This means it only provides a partial explanation rather than a full one
What are antipsychotics (Ap)?
Drugs that are used to reduce the intensity of symptoms, in particular positive symptoms, of psychotic disorders like Sz. Some may require it for a short period of time , other for life. They can be broadly divided into typical and atypical
Describe typical APs
Been around since the 1950s. Examples include chlorpormazine (CH). It can be taken as a syrup, injection or tablet. Diagnoses of this has decreased
Describe CH as a dopamine antagonist and sedative
Dopamine Antagonist: They would by blocking the dopamine synapses in the brain. This normalises neurotransmission in the brain, reducing symptoms such as hallucinations
Sedative: Has an effect on histamine receptors. It is used to calm individuals and therefore is able to help those going into hospital for the first time. Given as a syrup in this case
Describe atypical Ap’s
Used since the 1970’s. Target a range of neurotransmitters such as dopamine and serotonin. They were developed in the hopes of minimising side effects
Describe clozapine
Was pulled out of treatment in the 1970s after people were dying from blood conditions. Brought back in to be used when all other treatments fail. It is a lower daily dose, people also need blood tests when on it.
Binds to dopamine receptors but also works on serotonin and glutamate. This is used to improve mood and reduce depression. Commonly used for those who are at a high risk of suicide
Describe risperidone
It is an attempt to create a drug similar to clozapine but without the side effects. It can be taken in syrup, injection and tablet. Believed to bind more strongly to dopamine receptors meaning it is effective in much smaller doses
Evaluate drug therapy in Sz
One strength is that there is research support. Reviewes studies comparing effects of CH in relation to a control group. 1121 ppts showed it had a more improved rate in functioning when compared to a placebo. There is also research that shows that clozapine has a better effect than other drugs.
Counterpoint: Serious flaws. They only demonstrate the short term effects and many psychologists produce their study multiple times to exaggerate. Also as they have sedation effects, they may simply be more calm rather than having their psychosis reduced
Evaluate drug therapy in Sz
One limitation is the likelihood of side effects. Can cause more minor side effects such as stiff jaw or weight gain. However it can cause serious effects such as Neuroleptic Malignant Syndrome. This means the drug blocks DA in the hypothalamus which means it cannot reach body systems. It can result in comas or be fatal. This means they may avoid the treatment
Evaluate drug therapy in Sz
Another limitation is that we do not know why they work. Many of the basis for the drugs is the original dopamine hypothesis however we now know that is only a partial explanation for Sz and that DA being too low can also cause Sz. This means they may not be the best treatment to opt for
What is cognitive behaviour therapy (CBT)?
A method to treat mental disorders based on both cognitive and behavioural explanations as it aims to look at irrational thinking and behaviours that can help
How does CBT help those with Sz?
Helps to make sense of how their irrational thoughts impact their feelings and behaviour. If a client hears voices they will be afraid, however if a therapist can convince them that this is coming from a malfunctioning speech centre in their brain, they will feel less afraid and can ignore them. It helps them to cope with the symptoms meaning they function better
They can also use normalisation to show them that there symptoms are normal for the illness they have
They also use reality testing for delusions as they jointly examine the likelihood that their beliefs are real
Evaluate CBT
One strength is that there is evidence for its effectiveness. Review of 34 studies found small but significant effects on both positive and negative symptoms. NICE recommends cBT as a treatment and has shown a decrease in auditory hallucinations. This means both research and clinical experience support the benefits of CBT
Evaluate CBT
One limitation is the wide range of techniques used. Symptoms vary greatly depending on the person and in each study the techniques used and the combination of positive and negative symptoms is different. This means it is hard to say how effective it will be for one person
What is family therapy?
Therapy carried out with different family members in the hopes of producing better communication and reducing stress
How does family therapy help?
Reduces negative emotions: Reduce level of EE. Reducing stress is also important in reducing the likelihood of relapse
Improves families ability to help: Encourages an alliance where they all agree on aims. They are educated on the condition and they are also helped with balancing help and maintaining their own life
Describe Burbachs phases of family therapy (name 3 phases)
Phase 1: Sharing basic info
Phase 2: Identifying resources and what they can or cannot offer
Phase 3: Encourages mutual understanding to express their feelings
Phase 4: Identifying unhelpful patterns
Phase 5: Learning stress management techinques
Phase 6: Relapse prevention
Phase 7: Maintenance for future
Evaluate neural correlates
One strength is that there is research support. Amphetemines increase DA and increase symptoms in those with Sz and induces people without. Some candidate genes also act on the production of DA or DA receptors. Strongly suggests it is involves in the symptoms
Evaluate family therapy
One strength is that it benefits all family members. Not just for patient but families to as they provide the bulk of the care. Lessens the negative impact of Sz on family networks and strengthens ability to help the person. This means it has benefits aside from the impact on the patients
Evaluate neural correlates
One limitation is there is evidence for the central role of glutamate. Post mortems have found an increased level of glutamate of those with Sz. Several candidate genes are thought to be involved in the production of this. This means an equally strong case can be made for the role of other neurotransmitters
What are token economies (TE)?
Desirable behaviours being encouraged by selective reinforcement (OC). Tokens are secondary reinforcers that can be exchanged for primary reinforcers
How to develop TE with Sz?
Trialled in a women insitution. They were given a plastic token everytime they did a basic chore, which could be swapped for specific privileges. Desirable behaviour increased hugely. They are no longer used in the UK due to the ethical issues surrounding them
What are the reasons for TE?
To prevent insitiutionalisation i.e. developing bad habits or stop socialising.
Three categories tackled by TE: Personal care, condition related behaviour, social behaviour
There are two main benefits:
Improves quality of life inside hospital
Normalises behaviour and makes it easier for them to adapt back into society
How does a TE work?
Tokens are given for doing target behaviours. These behaviours and decided on an individual basis. They are then swapped for rewards which are given almost immediately as delayed rewards don’t work as well. When the tokens are paired with rewards they are conditioned to want the rewards or primary reinforcers
Evaluate TE
One strength is there is research support. 7 studies which examined the effects of TE on behaviour. All the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours. This therefore supports the value of TE
Counterpoint: However seven studies is a small evidence base to go off. The file drawer problem lead to positive bias as all the negative results have been filed away. This means it is a problem to include such a small number of studies
Evaluate TE
One limitation is the ethical issues. Gives people power in controlling the behaviour of others which means imposing someone’s norms onto another person. Also people that have severe mental disorders are less likely to get the rewards as they are experiencing severe personal distress meaning they may feel left out. This may mean legal action is taken. Means the benefits may be outweighed
Evaluate TE
Another limitation is the existence of more pleasant alternatives. Concluded that art therapy may be a better alternative as it is a high gain, low risk approach to Sz. Even if the effects are modest this is the same for most treatments but unlike other treatments there is no risk of ethical abuse. This means art therapy might be a good alternative
Describe the interractionist approach
A way to explain Sz while acknowledging biological such as genetics and social factors such as life events
Describe the diathesis stress model
Someone may have vulnerability to Sz but a stress trigger may be the reason for the development of the disorder. In Meehls updated model it has been suggested that if a person does not have the schizogene there is no chance of them developing Sz however for carriers of the gene life events can have a huge effect
Describe a modern understanding of diathesis
Many genes appear to cause Sz and there is not a singular one to identify. Factors other than genetics such as trauma and neurodevelopmental model which suggests childhood trauma alters the brain chemistry
Describe the modern understanding of stress
Although psychological stress is still important it may be that other risk factors such as cannabis can increase the likelihood of Sz as it has an effect on dopamine
Describe treatment as a result of the interractionist approach
Combining antipsychotic medicine and CBT. To do this a fully interractionist approach needs to be adopted. In the UK this approach is incredibly common
Evaluate the interractionist approach
One strength is that there is evidence supporting the role of triggers. In an adoption study, it was found that there was a correlation between nurture based factors such as the level of criticism someone faces and the genetic that they have. With more nurture it was more common for them to contract Sz. This demonstrates that a vulnerability and stress is the most likely cause for Sz
Evaluate the interractionist approach
One limitation is that it is too simplistic. Original model explains that there is only one diathesis and one stress however there are multiple different biological factors and psychological stressors that can cause Sz. In a study it was found that childhood sexual abuse can be a leading cause to Sz. This means that there are multiple factors involved
Evaluate the interractionist approach
One strength is that it has real world application. Studies show that combining the treatments based off that approach us more effective. PPts were placed in three groups based off either one treatment of multiple. They found that those who had a combination of treatments had a reduced symptom level compared to the singular group. This means there is a clear practical advantage in adopting treatment
Counterpoint: It may that they cause each other for example depression causes Sz or Sz cause depression. cannot automatically assume that they are correct
Evaluate family therapy
One strength is there is research support. Found to be one of the most effective treatments that reduces by around 50-60%. Best to use it when mental health intially starts to decline and it is recommended for everyone. Can help lots of people
Evaluate genetic explanations for Sz
One strength is that there is research support. Studies such as Gottesman show an increased risk with an increase in genetic similarity. Tienari showed that adoptees were more likely to have Sz if there biological parents had it in comparison to their adoptive parents. This suggests some people do contract it as a result of genetic makeup
