Schizophrenia Flashcards
What is schizophrenia
A type of psychosis, a server ,mental disorder characterised by profound disruption of cognition and emotion so that contact with external reality and insight are impaired.
What is classification
Organising symptoms into categories based on which symptoms cluster together
What is diagnosis
Deciding on whether someone has a particular mental illness using the classifications.
What are positive symptoms
Atypical symptoms experienced in addition to normal experiences- including hallucinations and distortions.
What are negative symptoms
Atypical experiences that are the loss of a usual experience- loss of a normal function
What are the two positive symptoms of schizophrenia
Hallucinations and delusions
What are hallucinations
Disturbances of perception in ant sense. False perceptions of reality (hearing voices). Many schizophrenics hear many voices or see people telling them to do something e.g. harming themselves or commenting on their behaviour
What are the 4 types of delusion
Delusion of persecution
Delusions of grandeur
Delusions of control
Delusions of reference
What are delusions of persecution
The belief that others want to harm, threaten or manipulate you e.g. The government
What is reliability in schizophrenic classification
Reliability is the level of agreement/ consistency on the diagnosis of schizophrenia by different psychiatrists
What is validity in schizophrenia
The extent to which schizophrenia is a unique syndrome with characteristics, signs and symptoms
What are the four issues with the reliability and validity in the diagnosis and classification of schizophrenia
Co- morbidity
Symptom overlap
Cultural differences/ bias
Gender bias
What are the two negative symptoms of schizophrenia
Avolition
Speech poverty
What are the two negative symptoms of schizophrenia
Avolition
Speech poverty
What is avolition
A lack of purposeful, willed behaviour. It is the reduction, difficulty or inability to start and continue with goal-directed behaviour i.e. actions performed to achieve a result. People with schizophrenia often have a sharply reduced motivation to carry out a range of activities and results in lowered activity levels.
E.g. no longer being interested in going out and meeting friends, poor hygiene and grooming, lack of persistence in work or education, sitting in the house every day doing nothing.
What is avolition
A lack of purposeful, willed behaviour. It is the reduction, difficulty or inability to start and continue with goal-directed behaviour i.e. actions performed to achieve a result. People with schizophrenia often have a sharply reduced motivation to carry out a range of activities and results in lowered activity levels.
E.g. no longer being interested in going out and meeting friends, poor hygiene and grooming, lack of persistence in work or education, sitting in the house every day doing nothing.
What is speech poverty
limited speech output with limited, often repetitive content. It involves reduced frequency (amount) and quality of speech. This is sometimes accompanied by a delay in the sufferer’s verbal responses during conversation. It’s not that they don’t know the words, but that they have a difficulty in spontaneously producing the speech.
What is the definition of symptom overlap
There is considerable overlap between the symptoms of schizophrenia and other conditions, despite the claim that the classification of positive and negative symptoms would make for more valid diagnoses (symptom overlap).
How can symptom overlap the validity of classification
lack of distinction calls into question the validity of the classification and diagnosis of schizophrenia as a unique syndrome with its own characteristics, signs, and symptoms.
How can symptom overlap the validity of classification
lack of distinction calls into question the validity of the classification and diagnosis of schizophrenia as a unique syndrome with its own characteristics, signs, and symptoms.
what is co- morbidity
refers to the extent that two or more conditions occur together. Co-morbidities are common among patients with schizophrenia
What was Serper et al. (1999) study into co- morbidity in schizophrenia
They assessed patients with co-morbid schizophrenia and cocaine abuse, cocaine intoxication on its own and schizophrenia on its own. They found that despite there being considerable symptom overlap in patients with schizophrenia and cocaine abuse, it was actually possible to make accurate diagnoses.
What was the process of Ketter’s (2005) research into symptom overlap and what did it tally us about receiving treatment
Ketter 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, as well as high levels of suicide- so symptom overlap can have serious consequences. Focusing on fixing this issue could save money and lives.
What did Buckley et al. Tell us about the diagnosis of schizophrenia
They concluded that around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%). PTSD also occurred in 29% of cases and OCD in 23%.
How can you evaluate the classification of schizophrenia with cultural bias
Research suggests that there is a significant variation between cultures when it comes to diagnosing schizophrenia.
African Americans and English people of Afro-Caribbean origin are several times more likely to be diagnosed with schizophrenia. Given that rates in Africa and the West Indies aren’t high, the diagnosis seems to be the result of cultural bias. Positive symptoms of hearing voices may be more acceptable in African cultures because of cultural beliefs in communication with ancestors. Therefore, people are readier to acknowledge such experiences. When reported to a psychiatrist from a diverse cultural tradition, these experiences are likely to be seen as bizarre and irrational.
This calls into question the validity of diagnoses of schizophrenia- psychiatrists may impose their own cultural standards for schizophrenia onto those from other cultures (imposed) and so are biased towards what is ‘normal’ in their culture (ethnocentric).
What did Longnecker et al.’s study in 2010 tell us about the influence of gender bias on the classification of schizophrenia
They reviewed studies of the prevalence of schizophrenia and concluded that since the 1980s, men have been diagnosed with schizophrenia more often than women. Prior to this, there had been no difference.
This may be due to a gender bias in the diagnosis of schizophrenia. It appears that female patients typically function better than men, being more likely to work and have good family relationships. This high functioning may explain why some women have not been diagnosed with schizophrenia where men with similar symptoms might have been.
Therefore, women’s better functioning may bias practitioners to under-diagnose schizophrenia either because their symptoms are masked altogether by good interpersonal functioning, or because the quality of interpersonal functioning makes the case seem too mild to warrant a diagnosis.
Consequently, clinicians failing to consider these issues could affect the validity of diagnosis of schizophrenia.
What are biological explanations of schizophrenia
Biological explanations emphasise the role of inherited factors and dysfunction of brain activity in the development of schizophrenia.
—> Most modern psychologists believe that schizophrenia is at least partly biological.
What are biological explanations of schizophrenia
Biological explanations emphasise the role of inherited factors and dysfunction of brain activity in the development of schizophrenia.
—> Most modern psychologists believe that schizophrenia is at least partly biological.
We main biological explanations
- Genetics
- The dopamine hypothesis (the role of neurotransmitters)
- Neural correlates
Describe Gottesmans 1991 study into the genetic explanation for schizophrenia
conducted a large-scale family and found much higher concordance rates in MZ identical twins (48%) in comparison to DZ fraternal twins (17%). The data showed that the greater amount of genetics shared between people correlates to a greater risk of developing schizophrenia. Other data included general population 1%, half siblings 6%, siblings 9% and children 13%.
Keynote: you must explain how this supports the genetic explanation (using the % of genes they have in common and the concordance rates) to get high marks.
How can we describe the theory that schizophrenia is polygenic
Schizophrenia is thought to be polygenic (it requires several different factors to work in combination) and so different combinations of genes can lead to the condition. Research suggests that there are 108 genetic variations associated with increased risk of schizophrenia.
Explain the original dopamine hypothesis explanation
Dopamine is a neurotransmitter that generally has an excitatory effect and is associated with the sensation of pleasure. Unusually high levels are associated with schizophrenia, particularly the positive symptoms. Messages from neurons that transmit dopamine fire to easily or too often in those with schizophrenia.
Schizophrenics are thought to have abnormally high levels of D2 receptors on post-synaptic neurons, resulting in more dopamine binding and therefore more neurons firing. This is thought to lead to hallucinations and delusions.
(This only accounts for the positive symptoms of schizophrenia)
What was the original dopamine hypothesis criticised
Because it only focused on the positive symptoms of schizophrenia
Who created the revised dopamine hypothesis
Davis and Khan in 1991
What did Davi’s and Khan suggest in the revised dopamine hypothesis
positive symptoms= caused by higher levels or activity of dopamine in the subcortex (central areas of the brain).
E.g. An excess of dopamine receptors in Broca’s area may be associated with speech poverty and/or auditory hallucinations.
The negative symptoms= lower levels of dopamine in the pre- frontal cortex. It may be that both high and low levels of dopamine in different brain regions are involved in schizophrenia.
What is the explanation of Neural correlates in the biological explanations of schizophrenia
Neural correlates are measurements of the structure or function of the brain that occur in conjunction with (correlates with) the characteristic symptoms of schizophrenia, and so may be implicated in the origins of schizophrenia.
- Lower activation levels in the superior temporal gyrus and anterior cingulate gyrus have been found in those experiencing auditory hallucinations.
Therefore, reduced activity in these two areas is a neural correlate of auditory hallucinations (positive symptoms).
How can we use gottesman and tienari et al.s research into biological explanations of schizophrenia to explain the relationship between schizophrenia and genetic
P= There is supporting research to prove biology can be used to explain schizophrenia
E= There is now strong evidence for genetic vulnerability to schizophrenia from a variety of sources. E.g. Gottesman’s (1991) study.
Additionally, Tienari et al.’s (2004) adoption study found that children of schizophrenia sufferers are still at heightened risk of schizophrenia if adopted into families with no history of schizophrenia.
L= This supports the idea that genetic factors make some people much more vulnerable to developing schizophrenia than others (remember that you need to explain how exactly). This does not mean that schizophrenia is entirely genetic—> there are a number of environmental factors associated with risk of schizophrenia, but the available evidence suggests that genetic susceptibility is very important!
How can we use Leucht et al.s research into anti-psychotic drugs to explain the impacts of genetics on the development of schizophrenia
supporting evidence for the genetic explanation’s being the cause for schizophrenia.
E= Much of the evidence supporting the dopamine hypothesis comes from the success of drug treatments that attempt to change levels of dopamine activity in the brain. The basic method mechanism of anti-psychotic drugs is to reduce dopamine activity and so reduce the effect of schizophrenia.
Leucht et al. (2013) found that anti-psychotic drugs were significantly more effective than placebo in the treatment of positive and negative symptoms. Dopamine agonists that increase the levels of dopamine make schizophrenia worse and can produce schizophrenia-like symptoms in non- sufferers (Curran et al., 2004).
L= This suggests that normalisation of dopamine activity levels treats schizophrenia and therefore that dopamine activity levels may cause schizophrenia, supporting the biological explanation.
What are drug therapies as a treatment for schizophrenia
Drug therapies involve the treatment of schizophrenia through the use of antipsychotic medication to reduce the symptoms of the disorder.
How do antipsychotics work
All antipsychotics work by reducing dopaminergic transmission i.e. reducing the actions of the neurotransmitter dopamine in areas of the brain associated with the symptoms of schizophrenia
What are the two types of antipsychotics
- Typical
- Atypical
What do typical anti-psychotics do as drug treatments
chlorpromazine are dopamine antagonists they bind to (and so block) dopamine receptors but don’t stimulate them, reducing the action of dopamine. Initially dopamine levels build up, but the production is reduced.
This normalises neurotransmission in key areas of the brain, by reducing stimulation of the dopamine system reducing positive symptoms such as hallucinations- permanent
What do atypical anti-psychotics do as drug treatments
clozapine and risperidone also block dopamine receptors like typical antipsychotics. However, they only temporarily occupy the receptors and then rapidly dissociate to allow normal dopamine transmission.
This is thought to be responsible for fewer side effects. They also act on other neurotransmitters, particularly serotonin and they address negative symptoms e.g. avolition as well as positive symptoms.
What are dysfunctional families in the psychological explanations of schizophrenia
A dysfunctional family is when there exist certain unfavourable behaviours between family members, such as a lack of empathy, and unhealthy interactions between parents and their children. These may create a confusing situation for the child, which may, in turn, produce erratic behaviours.
What research did Fried Fromm-Reichmann do and what theory did he propose
Fried Fromm-Reichmann proposed a psychodynamic explanation based on account she had heard from her patients about their childhood. – the schizophrenogenic mother AKA the = schizophrenia Causing mother
Whilst being overprotective she’s also cold, rejective and controlling. Creates a family dynamic of secrecy and tension which leads to distrust and later paranoid delusions.
What are some problems of the schizophrenic mother theory
- pressurises mothers
-economic impacts and social stigmas
What research and hypothesis did Bateson et al. Of 1972 develop
Bateson et al. (1972) when individuals received two or more conflicting messages.
Double blind hypothesis= Children who frequently receive these messages from their parents are more likely to develop schizophrenia. Results in the child feeling trapped in situations where they seek doing the wrong things. Can’t seek clarification- getting it wrong results in a withdrawal of love which fosters an understanding of the world as a dangerous and confusing place. Leads to period delusions and disorganised thinking.
What is expressed emotions and what can they develop into.
Negative expressed emotions is the level of negative emotion expressed towards the patients by the carer=
- Verbal criticism including violence
- Hostility, anger, or rejection
- Emotional over involvement
Serious source of stress and can trigger a schizophrenic episode in someone who is vulnerable, or someone who is susceptible to schizophrenia because of their genotypes.
What are the two cognitive theories of dysfunctional thinking
Metarepresentation
Central control
What is metarepresentation
Refers to the ability to reflect on thoughts and behaviour.
insight into our own intentions and goals. Allows us to be conscious of what we intend to achieve with our actions. Also allows us to interpret the actions of others and interpret what their intentions are.
Therefore, schizophrenic patients with impaired metarepresentation have disrupted thoughts and actions, as they being their own thoughts are being carried out by ourselves rather than someone else- explains auditory disillusions and delusions.
What is central control
Ability to suppress automatic responses whilst we perform deliberate actions.
Speech poverty and disorganised speech could result from this inability., as one thought triggers another thought and another speech. Derailment of thoughts- each word triggers associations, because we can’t suppress automatic responses
What are the three main types of therapies for schizophrenia
- Cognitive behavioural therapy (CBT)
- family therapy
- token economy system
How does CBT work to treat schizophrenia
Addressing irrational beliefs, working through them logically which works for positive symptoms such as hallucinations and delusions.
What type of testing is used as a core part of CBT
Reality testing which helps cases of positive schizophrenic symptoms
What are the type steps of the CBT process
Assessment and engagement
What is assessment in the CBT process
Patients explain their situation to their therapist, identifying problematic thoughts and the potential causes for these thoughts.
Reflection is a core aspect of the assessment stage, requiring the patient to truly think back on themselves and understand where their symptoms are coming from and what makes them better/worse. Rating scales are used to monitor progress.
What is engagement process in the CBT process
Once the above issues have been identified, the therapist can set out a cognitive framework to address these issues and logically work through them.
Socratic questioning is employed, alongside a vulnerability-stress model. Empathy is heavily emphasized between patient and therapist.
What are family therapies for schizophrenia
Family therapy focuses on the people around the patient, involving them in the treatment process. Research has shown that many relapses in schizophrenia tend to occur after a patient has returned to their family environment.
What are the main purposes of family therapies (Caqueo-Urizar et al. 2015)
• Psychoeducational.
• Opportunities for stress reduction.
• Avenues for emotional processing.
• Cognitive reappraisal.
What is the token economy system for schizophrenic treatments
In schizophrenic patients, token economies focus on maladaptive behaviours that prevent a patient from adapting to new situations, treating both positive and negative symptoms of schizophrenia.
What does the behavioural based reward system in token economies do
behavioural-based reward system= encourages ‘good behaviours’ and discourages ‘bad behaviours’. It is based on the concept of operant conditioning.
What is the process of TES/ token economy treatments
• TES is introduced as soon as a patient enters the setting: rewards and good behaviours are established.
• They use physical tokens or tally systems: they can be earned and easily understood/quantified by introducing physical tokens or tally systems. These are the secondary reinforcers.
• They then trade these tokens in: Rewards can be given based on how many tokens a person has earned with good behaviour —> These are the primary reinforcers.
What did the interactionalist explanation for schizophrenia suggest
Suggests schizophrenia is caused by a combined effect of biological and social/psychological factors
What is Diathesis in schizophrenia? And what is the Diathesis stress model?
Diathesis stress model is a psychological concept that a disorder is due to the interaction between a predisposed vulnerability (Diathesis) and an environmental trigger later in life.
Diathesis in schizophrenia is often considered to be a genetic vulnerability, potentially resulting in a dopamine imbalance.
What are stressors in schizophrenia
Stressors in schizophrenia are later negative environmental experiences such as family dysfunction, emotional stress, or a major negative life event. This emotional event then triggers the disorder.
What does the interactionalist approach suggest about treatments for schizophrenia
the effective treatment of schizophrenia would combine psychological aspects such as CBT and biological drug therapies to address both psychological and biological causes.
What study that we have previously learnt about can we link to the interactionalist explanation for schizophrenia
Gottesmans 1991 study into the correlation of MZ and DZ twins and the development of schizophrenic symptoms
