Schizophrenia Flashcards
How much of the population have sz when is the onset and what gender is more likely to develop it?
1%, 15-45 years, males
What is used to classify sz?
DSM-diagnostic and statistical manual
ICD- international classification of disease
What are positive symptoms of sz?
Experiences that are in addition to normal experiences:
-hallucinations
-delusions
What are the negative symptoms of sz?
Loss of normal experiences and abilities:
-avolition (no energy, no motivation)
-speech poverty (loss of quality and quantity of verbal responses)
What is reliability ?
How consistent the results are using the same measuring tool
What is validity?
It’s about truth are the measurements made correctly referring to something real in the world
What is inter rater reliability?
Measure of how two observers agree
What is test retest reliability?
Same doctor giving the same diagnosis overtime with the same symptoms
What did Beck 1963 research and find in his study ?
Reviewed 153 patients who had been diagnosed by multiple doctor found only a 54% concordance rate between the doctors assessments this suggests there’s a low inter rater reliability in the diagnosis of sz and suggests many ppl have been diagnosed incorrectly or have had wrong treatment
What is co morbidity ?
Sz is often diagnosed with other disorders
What did Buckly 2009 in his comorbidity study?
Found the following co morbidity rates
-50% depression
-47% drug abuse
-29% ptsd
-23% OCD
What is symptom overlap?
Bipolar disorder also has hallucinations and delusions as a symptom if the disorders are so similar it may be they aren’t actually distinct and they should be redefined.
What are the problems with gender and sz?
Mens average age of diagnosis is 25.5 years sooner than women. Men are more likely to have drug abuse as a cormobidity have worse social functioning and suffer negative symptoms women are more likely to display positive symptoms.
What is the gender bias is experiences of sz?
Women experience of sz is taken less seriously and underdiagnosed compared to men cotton suggests this is due to women’s better social coping strategies leading to being less likely to seek treatment.
How more likely are Afro caribbeans to be diagnosed with sz than British ?
9x more likely
What is the cultural bias with sz and who suggests this?
Fernando 1998 suggests category failure western definitions of mental illness are applied to non western cultures a specific example is how hearing the voices of angles would be defined as an auditory hallucination in the uk but a religious experience in the West Indies
What did loring and Powell 1988 find in their racial study ?
Sent 290 psychiatrists two identical case studies the psychiatrists however the gender and race of the case studies where changed to either a while male, black male, white female, black female or no gender or race disclosed the researchers found over diagnosis of the black case studies and under diagnosis of the female case studies the most accurate diagnosis was when the gender and race of the psychiatrists was the same as the case study suggesting the existence of both gender and culture bias in psychiatrists diagnosis of sz.
What are the biological explanations for sz?
Genetics and neural correlates including dopamine hypothesis
Why is sz a polygenetic disorder?
There isn’t one specific gene for sz however a collection of gene locations have been located that are associated with a higher risk of developing sz
What did ripke et al 2014 in his gene study find?
Conducted genetic analysis of over 36 thousand sz cases this identified 108 genetic loci associated with the development of sz this suggests a range of genes are responsible for sz but also suggests the disorder is aetiologically heterogeneous as different combinations of genes are correlated with having the disorder
What did gottesman 1991 discover in family study?
Found a concordance rate of 48% for identical twins MZ and 17% for dz this compares to the general population rate of 1% suggesting sz has a genetic aspect as there is such a large difference between two sets of twins both dz and mz should share similar environments however concordance rate isn’t 100% in mz so not fully genetic
What were tienari 2004 study findings?
Studied the biological children of sz mothers who had been adopted. It was found that a 5.8% of children adopted into psychologically healthy families developed sz compared to 36.8% of children raised in dysfunctional families as the risk for both groups is far above the 1% risk level of the general population this suggests sz has a genetic basis however difference between groups also suggests a role to play for psychological factors
What are neural correlates?
Variations in neural structure and bio chemistry that are correlated with an increased risk of developing sz
What is the dopamine hypothesis?
Suggests that symptoms of sz are associated with too much or an imbalance of the dopamine neurotransmitter across the brain
Excessive amounts of dopamine (hyperdopaminergia) in speech centres like Broca’s area may lead to auditory hallucination
Lower levels hypodopaminergia in areas like the frontal cortex are thought to lead to negative symptoms like avolition and speech poverty
How did the dopamine hypothesis come about?
From observations that dopamine releasing drugs such as l-dopa can produce sz like symptoms in healthy patients
What did leueht et al find in his meta analysis ?
Meta analysis review of 212 studies these studies assessed the effectiveness of biological anti psychotic drug treatments that work via normalising levels of dopamine results demonstrated theses drugs were more effective than the placebo the effectiveness of treatments that influence the dopamine system suggest that the underlying biological theory of sz cause has validity otherwise drug wouldn’t be effective
What are ventricles?
Voids filled with cerebrospinal fluid deep within the brain enlarged ventricles are associated with ppl with sz
What did Johnstone 1976 research using ct scans discover?
First identified ppl with sz had larger than average ventricles suggesting this structural difference may be linked to the cause of sz
How is the biological explanation of sz biologically deterministic?
Genetic basis assumes that sz is inevitable or biologically determined potentially making sufferers feel disempowered when diagnosed the cognitive approach has a soft determinist perspective suggesting that mental processes can be altered or managed via free will to control the disorder
What does the biological reductionist approach fail to consider ?
Evidence for the range of psychological aspects of sz such as expressed emotion that seem to have a large influence on the development and relapse of the disorder.
What would a holistic approach of sz consider?
The diathesis stress approach in which the root cause of the disorder is a biological/gentic weakness however a environmental stressor such as family stress triggers the disorder
What is the psychological explanations for sz?
Family dysfunction, cognitive explanations
What is family dysfunction?
Suggests its the interpersonal relationships within the family that result in symptoms
What’s a schizophrenogenic mother?
Psychodynamic theory that suggests people with sz get their paranoid delusions as a results of influence of a cold rejecting and controlling mother and a passive father she creates an atmosphere of stress,tension and secrecy in the family the atmospheres triggers psychotic thinking
What is the double bind theory?
Child gets mixed messages and feels unable to do the correct thing Bateson 1972 suggests this results in disorganised thinking and paranoia.
What is expressed emotion?
Verbal interactions the caregiver has with person with sz
Exaggerated involvement: indicating the sufferer is a burden via self sacrifice
Criticism and control of the sufferers behaviour
Hostility towards the sufferer
AO3 of family dysfunction what did Butzlaff and Hooley 1998?
Showed using a meta analysis of 27 studies that relapse into sz is significantly more likely in families that have issues with expressed emotion
What was supporting evidence on family dysfunction from tienari 2004 AO3?
Studied the biological children of schizophrenic mothers who had been adopted it was found that 5.8% of those adopted into psychologically healthy families developed sz compared to 36.8% of children raised in dysfunctional families. This suggests that the interpersonal family environment has a significant impact on the development of sz in genetically vulnerable people.
What are cognitive explanations for sz and what are the assumptions of it?
Cognitive explanations for sz are based on the assumption that the ability to process thoughts is dysfunctional
Firths 1979 attention deficit theory suggests sz is due to a faulty attention system unable to filter pre conscious thought and gives too much significance to the info that would usually be filtered therefore overloading the mind this accounts for positive symptoms like hallucinations/delusions
What is firth theory about the ability to suppress and override automatic actions?
Suggests the ability to suppress and override automatic actions and speech and make deliberate actions to achieve goals (central control) is sometimes faulty in sz patients.
Firth 1992 what studied did he support this with ?A03
Firth 1992 supported these ideas with biological/cognitive neuroscience studies. 30 sz patients with various symptoms had PET scans these scans indicated a reduction in blood flow in the frontal cortex with patients with negative symptoms like avolition and the inability to suppress automatic throughs this suggests there are biological differences in sz brain regions associated with the theorised cognitive process.
What was Stirling et al 2006 stroop test study?A03
Conducted a stroop test was conducted on 30 patients with sz and 18 control patients this involved naming the ink colours on words without saying the word this is difficult as there is a desire to say the words that needs to be controlled Stirling found that patients with sz took twice as long to name the colour as the controls. This suggests that patients with sz do have dysfunctional thought processing
Does ft reduce ee in families?A03
Yes it does
What indicated that cognitive factors are involved in the disorder?
As cognitive behavioural therapy for psychosis can be affective treatment this indicated that cognitive factors are involved in the disorder
What is it socially sensitive to suggest sz is caused by the family ?a03
Socially sensitive as parents are already dealing with the difficulty of their relatives behaviour theorists may be adding additional stress by making the family think they are responsible
Is it possible to demonstrate cause and effect of sz? A03
Impossible to demonstrate cause and effect it could be that sz of the child and associate behaviour is the cause of the family dysfunction
Why can it be argues that the basic cause is biological and why is this a negative of ft?
There’s research that sz is a biological cause such as genetics (gottensman) ad neurotransmitters (leucht) family dysfunction might act as a trigger but it can be argues the basic cause is biological
Define antipsychotics
Medications that are used to control psychosis such as delusions and hallucinations they are taken in pill or injected
Define typical antipsychotics and example
A drug therapy used since 1950s that are less popular now cause of the side effects and only treating positive symptoms an example is chlorpromazine
How do typical drugs work and what are the side effects?
Drugs work as dopamine antagonists they reduced domapine activity by blocking domapine receptors at the synapse
Calms the dopamine system in the brain reducing positive symptoms also has a general sedative effect
Side effects include dry mouth, constipation, confusion uncontrollable muscle movements usually affecting the face.
Define a typical anti psychotics and example?
Drug therapy started to be used in 1970s to avoid the more severe side effects of typical drugs example clozapine
How do atypical drugs work and side effects?
Block dopamine receptors but also act on other neurotransmitters e.g glutamate and serotonin they also address the negative symptoms such as avolition side effects: weight gain, cardiovascular problems
What was some supporting evidence by leucht et al on drug therapy?
Leucht et al 2013 reviewed 212 studies in a meta analysis on the effectiveness of biological antipsychotic drug treatments that work via normalising levels of dopamine treatment of symptoms with the drugs were found to be much more effective than a placebo this suggests the treatments that target the domapine system are effective in reducing symptoms.
How does Bangnall 2003 study support drug therapy?
Used 232 studied to compare the effectiveness of a range of a typical and typical anti psychotics it was found that a typical drugs were more effective than typical in treating overall symptoms resulting in fewer movement disorder side effects and fewer people left the drug early overall clozapine was found to be the most effective in reducing negative symptoms and treating people who were resistant to other drugs this research suggests anti psychotics are an effective treatment plan
How does research by tarrier 1998 not support drug therapy ?
Placed patients randomly into routine care or routine care (drugs) and CBT patients in the combined treatment had a significant improvement in the severity and number of positive symptoms as well as fewer days in hospital recieveing care this suggests drug therapy alone isn’t the most effective treatment plan and an interactionalist approach to treating sz along with CBT is the better option
Are drugs a cheap or expensive option ?
Cheaper than CBT or family therapy
Can drugs treat the root cause?
Drug therapy may only be suppressing symptoms and not treating the underlining problem
How do drugs enhance the quality of life ?
The use of drugs has resulted in the end of long term institutionalisation in mental health hospitals
What are the ethical issues surrounding drugs?
Often prescribed forcibly during peak disorder so ethical issues with consent and side effects
Why are side effects a negative thing?
Due to the severity of side effects 2/3 of people stop taking them and results in the revolving door theory
Define cognitive behavioural therapy and what si the therapist role ?
Assumes that sz is the result of dysfunctional thought process the therapist role is to challenge irrational beliefs this could be logically disputing the reality of the delusions
How can u use Ellis abc model in sz?
A-activating event
B-beliefs
C-consequences
D-disputing irrational belief
E-restructured belief
How does Sensky et al 2000 support CBT?
Showed that patients who had resisted drug treatments had a reduction in postitve and negative symptoms when treated by 19 sessions of CBT also they continued to improve even 9 months after the treatment had ended this suggests that CBT can be effective when drugs aren’t but also are an improvement on drug therapy as drugs are short term
How can the length of CBT be a weakness?
Treatments end early due to length and it requires engagement, negative symptoms can lead to an unwillingness to take part in.
How does CBT compare to drug therapy?
CBT doesn’t produce side effects but it a more costly plan
Define psycho education?
The family is educated on the symptoms of sz in order for them to be more understanding of their family member
How does family therapy help when dealing with sz?
It reduces conflict, reduces stress, reduces self sacrifice, improve communication, improve problem solving skills
How does leff 1985 study support family therapy?
Looked at aftercare of patients with sz of those that were provided with standard outpatient care 50% had relapsed within 9 months compared to only 8% who received family therapy however after two years this had risen to 50% with family therapy and 75% with standard care this suggest that the use of family therapy is helpful in reducing re admission in the short term however families may not maintain postitve patterns of behaviour over the long term
What are the practical issues with ft?
Length of therapy as patients may drop out and you need to get everyone at the same time
Does ft cure the root cause?
Doesn’t cure the disorder but helps manage sz but symptoms still remain
What is token economy ?
Behavioural therapy technique based on skinners operant conditioning this is learned through re enforcement of desired behaviour
Tokens are used a type of positive reinforcement they are an immediate reward for when the patient shows pre defined target behaviour tokens are then exchanged for something else they want
Evidence from Dickerson 2005 to support token economy?
Found when reviewing the findings of 13 studies token economies can be effective in improving the adaptive behaviour of people with sz
Does token economy treat the root cause?
Doesn’t directly treat symptoms of sz they only attempt to manage negative symptoms
Is token economy effective with everyone?
Not effective with unresponsive patients such as those with strong negative symptoms
How is token economy ethically problematic?
Degrading to patients manipulating them like lab rats
What is the internationalist approach?
Suggests that the development of sz is due to the combined effects and interaction of biological and social/psycholgical factors
What is the diathesis stress model?
A psychological concept that a disorder is due to the interaction between a predisposed vulnerability and an environmental trigger later in life
What are stressors in sz?
Later negative environmental experiences such as family dysfunction, emotional stress or a major negative life event drug abuse is also seen as a stressor
How does gottensman 1991 research support the diathesis stress model?
Found a concordance rate of 48% for identical twins and 17% for non identical compared to the general population of 1% this suggests a role for both biological genetic factors as the concordance rate is much higher for identical twins who share 100% their dna but as the concordance rate is less than 100////5 for MZ twins this suggest there must be some psychological experience triggering in one twin but not the other
How does tienari 2004 study support diathesis stress model?
Found that 5.8% of children adopted into psychologically healthy families developed sz compared to 36.8% of children raised in dysfunctional families this research supports the influence of biological factors due to high rate even in psychologically healthy families but the even higher figure for dysfunctional families suggests a psychological trigger is needed
How does tarrier 1998 reaserch suport an interactionalist approach?
Patients were randomly allocated treatment with drugs only or drugs and CBT patients with combined treatment did better this suggests an interactionalist approach to treating sz is more effective than the usual treatment plan
How is the interactionalist approach better than others?
It’s holistic and considers a range of factors unlike biological or psychological
Is there enough evidence for diathesis stress model?
The fundamental mechanism by which a negative psychological event actually triggers a complex biological response resulting in symptoms is still uncertain reducing confidence in the interactionalist approach as a full explanation for sz
