Schizophrenia Flashcards
what is schizophrenia?
can’t distinguish between what is and isn’t real
what are the two types of symptoms of schizophrenia?
positive and negative
what are positive symptoms?
experienced in addition to reality (hallucinations, dellusions)
name 3 types of hallucinations and 3 types of delusions (positive symptoms)?
Auditory hallucinations- voices that are often abusive or critical of their behaviour
Visual hallucinations- seeing things that others can’t
Tactile hallucinations- touch based e.g., feeling like someone is touching you
Paranoid delusions- people are out to get you or trying to hurt you
Delusions of grandeur- believing you are important or famous
Delusions linked to the body- they are being controlled by someone else
what are negative symptoms?
affect your ability to function
what is avolition and speech poverty (negative symptoms)
Avolition- severe lack of motivation to do any purposeful activity, thus they cant get anything done, thus they sit doing nothing for hours. Symptoms of this:
-poor hygeine
-lack of energy
Speech poverty- lack of speech fluency and productivity. E.g., delay in response during conversation, not because they know less, they struggle to produce speech, thus they may engage in less conversations or give short responses
what is DSM-5 and where in the world is it used to diagnose schizophrenia? (include criteria of symptoms and requirements)
DSM-5 (used in USA)
symptoms:
-delusions
-hallucinations
-disorganized speech
-avolition
2 or more of above symptoms present for significant proportion of time (1 month)
Disturbance cant be attributed to drug abuse or other
what is ICD-11 and where in the world is it used to diagnose schizophrenia? (include criteria of symptoms and requirements)
ICD-11 (used in Europe)
Symptoms:
-persistant delusions
-persistant hallucinations
-thought disorder
-psychomotor disturbances
Not manifestation of other medical condition or drug abuse
what is reliability and how did cheniaux find low reliability of diagnosis of schizophrenia?
-consistency of diagnosis
-e.g., test-retest, inter-rater reliability
Cheniaux- study on inter-rater reliability
-found patients more likely to be diagnosed using ICD than DSM
-low reliability
what is symptom overlap and how does this criticise validity of diagnosis?
Symptom overlap- symptoms of schizophrenia similar to symptoms of depresssion, bipolar etc.
-what condition do they actually have?
-can cause misdiagnosis, leading to treatment delay and symptoms worsening
what is comorbidity and how does this criticise validity of diagnosis?
Comorbidity- more than one medical condition
-can cause issues with validity of diagnosis
-50% of those diagnosed with schizophrenia also diagnosed with depression
what is gender bias and how does this criticise validity of diagnosis?
Gender bias- males diagnosed with schizophrenia more than females
-females may deal better with symptoms
-when psychiatrists presented with same transcript from males and females
-56% of males diagnosed
-20% of females diagnosed
what is cultural bias and how does this criticise validity of diagnosis?
Cultural bias- criteria differences cross-culturally
-some symptoms may be ignored as they are considered normal in some cultures
what is the APFC of rosenhan’s study of how situational factors affect diagnosis?
A: how situational factors affect diagnosis
P: 8 p’s pretended to hear voices at appointment at ental hospital
-all were admitted
-stopped pretending
-noted interactions with patients and other staff
F: staff never detected sanity
-stayed in there for up to 2 months before released
what is the double-bind hypothesis? (family dysfunction)
-when an individual receives 2 or more pieces of conflicting info.
-children who receive contradicting messages from parents are more likely to develop schizophrenia
-e.g., saying ‘i love you’ then turning head away in disgust
-causes child to be trapped in situation where they fear doing the wrong thing
-getting it wrong results in withdrawal of love
-creates the understanding that the world is confusing and dangerous
-results in paranoid delusions and disorganised thinking
2 AO3 points of double-bind (recall of double-bind statements and self-report)
+: Berger- schizophrenics recalled more double-bind statements by their mothers than non-schizophrenics
This is self-report, so they may have hallucinated these double-binds, thus low validity. Liem- recall affected by mental illness
what is expressed emotion? (family dysfunction)
-negative expressed motion towards patient from carer
-e.g., verbal criticism, hostility, emotional over-involvement
-can trigger schizophrenic episode in someone who is vulnerable due to genetic makeup or can lead to relapse
2 AO3 points of expressed emotion? (meta-analysis and indiv. differences)
+: meta-analysis into EE found that relapse rate for those that returned to high EE families was 48% compared with 21% for those that went to low EE families
-: could be due to individual differences, not all that live with high EE family’s relapse
2 general AO3 points of family dysfunctions? (reduction and socially sensitive)
Reductionism- reduces onset of S to family environment, ignoring that not all patients relapse when returning to high EE homes. Diathesis stress- model instead
Socially sensitive- being blamed for child’s illness is insulting, may add more stress to caring for them
what is meta-representation? (dysfunctional thinking)
-meta representation- ability to reflect on thoughts and behaviour, gives insight into intentions and goals
Impaired meta-representation- failure to recognise thoughts as being our own, explaining auditory hallucinations and thought insertion
what is central control? (dysfunctional thinking)
-central control- ability to suppress automatic responses while we perform deliberate actions. Speech poverty thought disorder could result from this inability.
Schizophrenic patients experience derailment of thoughts because each word triggers associations which can’t be suppressed.
4 AO3 points of central control and meta-representation? (strrop, cog. biases, exp. of initiation, machine with voices)
+: Stroop test- S patients took twice as long as control group, thus struggling to have central control
+: supports deficits in info processing. Delusional patients showed biases in their info processing, such as jumping to conclusions, also found to experience their thoughts as voices
-: explains that S is due to cog. Deficits but doesn’t explain what caused it to develop
+: machine developed to produce voices, designed to show that voices aren’t real to S patients. Help design effective treatments to improve quality of life
what is token economy, how does it work?
-Behavioural therapy based on operant conditioning
-tokens used as secondary reinforcer given as reward when patient displays desired behaviour. E.g., washing
-tokens can be exchanged for something patient wants e.g., chocolate
Behaviour shaping- behaviours progressively change. Tokens given for small changes contributing to ideal.
Psych. Institutions- design to produce easier to manage behaviour to prepare patients for transfer into community
Mild negative symptoms- can be used for patients with mild symptoms but more ill patients are less able/willing to engage
4 evaluation points of token economy?
-: ethical concerns over treatment. Clinicians exercise control over food/ privacy. All human beings have basic human rights.
+: alternatives such as art therapy, with less ethical concerns, though evidence is small
+: looked at 7 high quality studies looking at effectiveness of TE for people with S in a hospital setting. All these showed reduction in negative symptoms/ behaviours. Suggesting TE is effective in behaviour management. However, there may be issues with file drawer effect- tendency to publish only positive findings.
-: once S patients are released they only get care for a few hours a day, thus TE cant be used regularly, thus patients may not target behaviours for rearward, thus less effective in real world.
what is family therapy and how does it work?
-attempt to improve relationships to prevent relapse due to family dysfunctions
-change behaviour of whole family not just S patient
Psychoeducation- family educated on symptoms of S, thus they can understand their family members behaviours
Priorities:
Reduce conflict- caused by caring responsibilities
Reduce stress- caused by caring responsibilities
Reduce self-sacrifice- by getting carers to consider their own needs
Improve communication- by considering how to limit EE
Improve prob. solving- predicting problems and preparing solutions
4 evaluation points of family therapy?
+: meta-analysis compared recieving family therapy to drug treatment. Family therapy invcreased compliance to taking medication and reduced relapse rates. Though some reported improvement from drug treatment alone.
+: family therapy- 60% reported positive imoat in at least one outcome category. E.g., ability to cope or relationship quality
+: family therapy= decreased relapse rates= decreased hospitalisation= less money spent on hospitalisation= cost effective
-: methodological isssues- lack of blind trial used or included in study reports in studys from chine = findings lack validity
what is CBT and how does it work?
-Identify and change faulty cognitions
-uses logical disputions to restructure delusions
A-Side effects of treatment
B-Hospital staff trying to kill them
C-Refuse treatment
D-Staff have no reason to kill them
E-Treatment is necessary
Reality testing- patient can demostrate themselves that their irrational thoughts (delusions) aren’t real
AO1 for genetic basis of S (bio exp.)
Risk of developing schizophrenia among individuals who have family members with the disorder is higher than it is for those that don’t.
Tsuang found that the risk of developing schizophrenia if a first degree relative has it is 5-20 times higher than if they don’t have a relative with it
Twin studies:
MZ twins had higher concordance rates than DZ twins, thus there is a degree of heritability. Found that if MZ twin has S, their twin had 48% risk of also developing S. the risk was only 17% for DZ twins. Identical genetic make-up= increased chance of developing S.
Suggested S is polygenic- Several different genes implicated.
It is also aetiologically heterogeneous- Different combination of genes can lead to the disorder.
Ripke found that 108 different genetic variations were associated with the risk of schizophrenia.
one example of a candidate gene is COMT, which regulates dopamine production
2 AO3 points for genetic basis of S?
+: found concordance rates of 40% for MZ twins and 7% for DZ twins. MZ share 100% of env, DZ share 50%, thus genes must have some influence on development of S. though concordance rates not 100%, thus other factors may be involved.
-: difficult to seperate from nature and nurtere, sharing of environment may icrease concordance rates regardless of genes. Higher concordance rates of MZ twins could be due to them being treated more similar compared to DZ twins.
AO! for the dopamne hypothesis?
Argues that schizophrenia has developed due to structural and functional brain abnormalities
Hyperdopaminergia in sub-cortex- s was caused by high levels of dopamine activity in the subcortex. There may be a high number of dopamine receptors, which have a high level of dopamine sensitvity.
Hypodopaminergia in cortex- low levels of dopamine in the pre-frontal cortex are responsible for S. the PFC is responsible for thinking/ decision making, which could explain negative symptoms of S
2 AO3 points for dopamine hypothesis?
+: meta-analysis that analysed effectiveness of anti-psychotic drugs compared to placebo. Found drugs more effective than placebo in treating +/- symptoms. Thus dopamine has a role in S
-: clozapine is more effective than traditional drugs, it effects other neurotransmitters like serotonin compared to dopamine, thus several neurotransmitters may cause S, dopamine hyp.= too simplistic
AO1 for enlarged ventricles?
Enlarged ventricles- Fluid filled gaps between brain areas that help keep the brain cushioned. They are associated with damage to certain brain areas and the PFC. This damage is associated with negative symptoms.
Found that S patients had enlarged ventricles, non-patients didn’t, suggesting S is related to loss of grey matter and associated with damage to central brain and PFC, which is associated with negative symptoms
1 AO3 point for enlarged ventricles?
-: research is inconclusive, some non S patients have enlarged ventricles, while not all S patients do. Research shows enlarged ventricles are associated with – symptoms. Thus explanation cant explain all symptoms.
diathesis using twin study?
We know that there is no one gene associated with schizophrenia, Also, it is likely that genetic factors are linked to faulty dopaminergic systems and possible abnormal functioning in other neurotransmitters. One explanation for the concordance rate twin study is that the environment has an influence in determining whether genetic vulnerability is triggered, and the disorder is developed.
stress origanally and now?
The original diathesis-stress model argues that stress is focused on dysfunctional family dynamics. Whilst the family is still considered an important factor,
nowadays a broader definition has been adopted for the ‘stress’ component and refers to anything. Recent research for example has focused on cannabis use as it
can interfere with the dopamine system. Research suggests it can increase the risk of schizophrenia by up to 7 times depending on dose.
interactionist approach in s treatment?
each patient’s circumstances and needs may dictate which combination of treatment is best. For example, there is little point in combining drugs with family therapy if the patient has little contact with their relatives. Turkington et al. (2006) argue that it is possible to think that schizophrenia is caused by biology and still offer a
psychological treatment to treat the psychological symptoms associated with schizophrenia as well as the biological cause. However, it doesn’t make sense to tell people that their disorder is purely biological and then offer them a
psychological treatment such as CBT. An interactionist approach should be adopted. In Britain, antipsychotic drugs are usually given first to reduce the patient’s symptoms so that any psychological treatment
provided, most commonly CBT, has a better chance of being engaged with.
