SCHIZOPHRENIA Flashcards
define schizophrenia
a mental disorder which affects thoughts and emotions to the point they loose touch of reality
- affects 1% of population between 15-35
- most common psychotic disorder
positive symptom of schizophrenia
addition to normal life
1. hallucinations
2. delusions
negative symptoms
atypical experiences that represent loss of function
1. avolition- lack of activity levels
2. speech poverty
ICD-10
created by world health organisation
used across world
recognises subtypes
2+ negatives
DSM-10
american psychiatric association
USA only
previous subtypes removed since DSM 1
1+ positive symptom
validity in schizophrenia
the extent to which schizophrenia is accurately classified as a unique syndrome with symptoms
whats criterion validity
evaluates accuracy a test measures
whats symptom
overlap
symptom overlap considers overlap in symptom of disorders
lowers validity of diagnosis of a unique syndrome
whats co morbidity
the extent to which 2 or more conditions occur together and common in patients eg: depression
rosenhan aim
how well can psychiatrists distinguish real schizophrenia from 8 pseudo patients who gained admission in 12 hospitals by 1 fake symptom
procedure 1
8 pseudo patients ( 2W, 5M )
they arrived at 12 hospitals around 5 states in USA
symptom: hearing voices ( empty hollow and thud )
after admission, patients acted normal and acted as if they wanted to leave
- no medication swallowed
- recorded doctors answers
- no further symptoms
results from procedure 1
all were admitted, average stay was 19 days
range between 7-52
released with diagnosis of schizophrenia
30% of cases- real patients made comments that fake patients was fine
procedure 2 of Rosenhan
nurses and doctors made aware that these pseudo patients would come back in 3 months
doctors had to rate likability that patients were fake
results from procedure 2
41/193 were rated fake
all were real
3 strengths of rosenhan study
hospitals vary- generalised findings
design was simple, patients were asked to be themselves
replicated and reliable
weakness of rosenhan
symptom was valid, therefore results may be less suprisijg
how does rosenhans findings link to a lack in validity of diagnosis
lacks validity as sz was applied inappropriately.
the studies findings emphasise how professionals could not tell the difference between sane and insane individuals, questioning reliability and validity of psychiatric labels
cultural bias within validity of classification and diagnosis of sz
African Americans and english people of afro carribean origin are several times likelier to be diagnosed with sz
HOWEVER
rates of sz arent high in the west indied, thereofre diagnosis is a result of culturasl bias
extra note of cultural bias example within diagnosis of SZ
positive symptoms may be accepted in African cultures due to cultural beliefs ( eg communication with ancestors ) and not be viewed as SZ
Escobar 2012 study
white psychiatrist may over interpret symptoms of black people during diagnosis due to cultural differences and mannerisms
Thereofore, this suggests psychiatrists must pay more attention to cultural differences
gender bias within diagnosis of SZ study
290 psychiatrists were shown cases of patient behaviours
males 56% diagnosed
females 20%
issues with low validity
misdiagnosis- mistreatment- worsen symptoms- QOL- economy worsens
Serper et al 1999 study
assessed patients with co- morbid SZ and cocaine abuse, j ca and j sz
they found despite symptom overlap it was possible to make accurate diagnosis
INC VALIDITY AND QOL
Ketter 2005 study
points out that misdiagnosis due to symptom overlap can lead to years of delay in receiving relevant treatment, during which time suffering and further degeneration can occur
QOL DEC people endure years of suffering
symptom overlap percentages
around half of patients with diagnosis of sz also have diagnosis of depression (50%) as well as substance abuse ( 47% ).
PTSD also occured in 29% of cases and OCD 23%
cause of SZ: family dysfunction define
one cause of SZ is family dysfunction, suggested by frith. this is where psychologusts have tried to link SZ and living in a dysfunctional family
who came up with three theories of family dysfunction
frith
theory one: schizophrenogenic mother
FROMM REICHMAN
mothers: cold, rejecting, controlling
impact of schizophrenogenic mothers
creates family of tension, secrecy and leads to distrust
what symptoms do schizophrenogenic mothers lead to
paranoid delusions and SZ
theory 2 cause of SZ: family dysfunction
double bind
BATES 72’
child gets mixed signals and “cant do anything right”
theory 2: double bind
IMPACT AND SYMPTOM
confusion
eg: more independant but overbearing
PARANOID DELUSIONS AND SZ
theory 3 cause of SZ: family dysfunction
expressed emotion
high levels of emotion towards child eg: critisism
impact of expressed emotion
explains relapse of SZ patient
eg: from psychiatric ward back home
strength of family dysfunction theory
read et al 05’ reviewed 46 studies of child abuse and SZ
69% women 59% men w SZ experienced abuse
RESEARCH SUPPORT FAMILY DYSFUNCTION ASSOCIATED WITH HIGH SZ LEVELS
weakness of family dysfunction theory
even with evidence, none that supports traditional views
CANT ACCOUNT FOR LINK BETWEEN TRAUMA AND SZ
weakness of family dysfunction theory 2
research linking FD to SZ is socially sensitive and leads to parent blaming ( specifically mothers )
PRODUCES HARM AND HIGHLIGHTS WHETHER WE SHOULD KEEP RESEARCHING
weakness of family dysfunction theory 3
doesnt account for nature factors ( biological )
cultural and social influences eg: poverty
ignores individual differences between patients
explanation SZ two: cognitive dysfunction
define
the study of how people think and process information, explaining SZ through dysfunction in cognitive processing.
theory one within cognitive dysfunction
Dysfunctional thought processing
cognitive beliefs that cause someone to evaluate info inappropriately and produce neg consequences
eg: reduced thought processing in ventral striatum- negative symptoms
theory two cognitive dysfunction
metarepresentation
cognitive ability to reflect on own thoughts and behaviours
dysfunction affects ability to recognise thoughts as our own
leads to hallucinations and delusions
theory three cognitive dysfunction
central control dysfunction
ability to suppress automatic responses whilst performing deliberate actions
dysfunction leads to inability to suppress these thoughts
LEADS TO SPEECH POV AND DERAILMENT OF THOUGHTS
strength of cognitive dysfunction
stirling 06’ investigated performance of people with SZ and control group using stroop
SZ took 2x longer to read ink colour
RESEARCH SUPPORT THAT CC IN SZ ARE IMPAIRED
weakness of cognitive dysfunction
do cognitive dysfunctions cause SZ or vice versa
cant establish cause and effect, we can only make inferences which means our understanding of SZ decreases
weakness 2 of cognitive dysfunction
reductionist
- no cognitive factors/ biological
- oversimplistic
- validity decrease
whats the biological explanation
emphasises the role of inherited factors and dysfunction of brain activity in development of SZ
genetic explanation within biological
focusses on family studies, SZ increases in line with genetic similarity to someone with SZ
gottesman study and results
1991- conducted a large family study and found high concordance rates in MZ ( 48% ) in comparison to DZ (17%)
what does gottesmans study suggest
as genes have a role, we should identify candidate genes
around 108 genes involved, making SZ polygenic
what does gottesmans study suggest
as genes have a role, we should identify candidate genes
around 108 genes involved, making SZ polygenic
whats the neural explanation of SZ
brain structure/ function related to cause of SZ
eg: the abnormality of ventral stratum is linked to avolition
what is the original hypotheses theory
SZ caused by high levels of dopamine in sub cortex areas of brain eg: excess of dopamine from sc and broca which may cause speech poverty
whats the revised hypotheses
SZ caused by too low of dopamine im cortex area eg: low in prefrontal explains cognitive issues
strength of genetic explanation
research support, gottesman and tienari adoption found children w SZ parents are still at high risk if adopted in family w no history
LINK OF GENES TO SZ
strength of neural explanation
drugs developed based on original hypotheses. dopamine agonists inc dopamine and made SZ worse; antipsychotic dec levels of DA and levels dec of symptoms
LINK TO NEURAL AND SZ
weakness of neural
arguments contradicting
noll (2009) argues antispychotic drugs dont alleviate hallucinations in ab 1/3 of people. Also, in some people, hallucinations are present despite levels of dopamine being normal.
DOPAMINE DOESNT AFFECT SZ AND DRUG ARE INEFFECTIVE IN SOME
weakness two of neural explanation
weakness of evidence
studies are useful in determining parts of brain that may not be working, however this kind of evidence doesn’t prove that the activity in the brain causes symptom
CANT ESTABLISH CAUSE AND EFFECT
whats token economy
a form of behavioural modification where desirable behaviours are encouraged using selective reinforcement
how does token economy work
patients are given tokens for every desirable behaviour immediately to condition the behaviour
they can later swap this for rewards ( operant conditioning )
how are token and rewards named
rewards- primary
tokens- secondary
strength of token economy
research and support showing effectiveness.
researchers identified 7 high qual studies that showed token economy reduced symptoms and inc desirables
suggests TE is effective and improves QOL
allows us to focus on real symptoms instead of developed ones
weakness 1 of token economy ( ES )
ethical issues raised.
gives professionals power to control behaviour, also takes away freedom. legal action from families have been taken which contributes to the decline
suggests TE dehumanises and the negative outweigh the pos, raises the question?
weakness 2 of token economy
alternatives that are more beneficial
for example, art therapy suggested by NICE may be good alternative
doesnt carry ethical issues
other approaches better chance of treating, te will decline
weakness 3 of token economy
lack of ability to further on outside
difficult to maintain because behaviours cant be monitored as close and arent given to patients immediately
MAY RESULT IN RELAPSE and may only be effective in hospital
what are the two psychological treatments to SZ
CBT and family therapy
whats CBT
recognises examples of dysfunctional thinking and advices on how to avoid acting on these
what thoughts does CBT alter
general beliefs
self image
methods of coping
what does CBT aim to do
rationalise thoughts
normalise thoughts
reduce confusion, stress and shame
strength of CBT within SZ
Jahuar reviewed 34 studies of CBT and SZ
found cbt had small but significant effect on reducing pos and neg symptoms
research report, QOL inc, go back to work, economy
weakness of CBT
requires motivation
can be lengthy, has high drop out rates as pps need to be willing to engage eg: homework
may not be effective if symptom of avolition
family therapy strength
review of studies found it was one of the most consistent effective treatments
reduced symptoms by 50-60%
effective and dec relapse rates
strength of family therapy
benefits whole family
strengthens ability to support and therefore improves QOL
weakness of both family therapy and CBT
doesnt cure, however the do improve
treatment may need to be LT which is hard to do
what are the two biological treatments of SZ
typical and atypical antipsychotics
what hypotheses does the typical relate to
original as it follows hyperdominergia
what does the typical antipsychotic do
reduces and blocks dopamine
reduces positive symptoms and has calming effect
side effect of typical antipsychotics
involuntary movement eg: tardive dyskinesia
what theory does the atypical antipsychotic follow
revised dopamine hypotheses as it follows hypodominergia ( too little dopamin )
why was atypical made and what does it do
to improve effectiveness and sympt
temporarily blocks receptors in only brain ( to red symp)
acts on both dopamine and seratonin
side effects with atypical
still neuroleptic malignant affected, may result in coma or death
what do drugs reduce
the reuptake of neurotransmitters by blocking receptors binding to them
strength of biological treatment
thornley meta analysed 1000 patients and found chlorpromazine was associated with better functioning and reduced symptoms
compared to placebo
SHOWS THEY ARE EFFECTIVE
weakness 1 of biological treatments
side effects eg: NMC
may lead to a decreased quality of life which means more time off work etc
should be prescribed w caution
weakness 2 of biological treatments
ethical issues raised
pps w severe conditions may not give consent to having the drug prescribed
therefore raises the question of whether we should prescribe at all
weakness 3 of biological treatments
therapies more efficient
no side effecrs and take more of an interactionist approach
ALTERNATIVES
whats the interactionist approach also known as ?
biosocial model
define diathesis
caused by underlying vulnerability ( diathesis ) and a stress trigger
whats the diathesis stress model
diathesis - genetic, result of schizogene
stress- childhood and adolescence
whats the modern understanding
diathesis- many genes increase genetic vulnerability and SZ can be a result of psychological trauma
strength of interactionist approach within schizophrenia
tarrier allocated 315 pps to medication and cbt or only meds
found cbt and meds showed less symptoms
clear practical advantage to adopting IA
strength 2 of IA
tienari studied 19000 finish adoptees whose bio mothers had SZ
they found adoptive parents with high level of critisism along w bio mothers had SZ
shows combination of genetic vulnerability and stress can lead to inc in risk of Sz, supports IA
strength 3 of IA
clear evidence to show that env factors also inc SZ
eg: the fact that concordance rates in MZ twins was not 100% suggests other factors
genetic factors alone cant explain, IA is worth adopting
weakness of IA
original diathesis model portrayed diathesis and single gene and stress being schizophrenogenic parenting
studies show multiple causes for both
original model too simplistic and didnt take evidence to support modern
