SCHIZOPHRENIA Flashcards
What is schizophrenia?
- A type of psychosis characterised by a profound disruption of cognition and emotion
- A severe mental disorder in which thoughts + emotions are so impaired that contact is lost with external reality
Most common psychotic disorder
Explain the causes of schizophrenia
- Often diagnosed between ages of 15 and 35 - men + women affected equally
- Affects about 1% of population at some point in their lifetime
Explain how schizophrenia is diagnosed
- A clinician would sue a diagnostic manual (e.g. DSM-V/Diagnostic and Statistical Manual of Psychiatric Disorders)
^— is a classification + description of over 200 mental disorders (mainly used in US) - In Europe, ICD (International Classification of Diseases) is used (currently at ICD-11 in 2018)
Explain what is meant by the positive symptoms of schizophrenia
- Those that appear to reflect an excess or distortion of normal functions
- This adds something to an affected individual’s lived experiences
List some of the positive symptoms of schizophrenia
- Hallucinations
- Delusions
- Disorganised speech
- Grossly disorganised or catatonic behaviour
Outline the nature of hallucinations as a positive symptom of schizophrenia
- Bizarre, unreal perceptions of the environment that are usually auditory (hearing) - but may be visual, olfactory (smelling) or tactile (feeling)
- Many schizophrenics report hearing a voice or several voices telling them to do something (e.g. harm themselves or another person) or commenting on their behaviour
Outline the nature of delusions as a positive symptom of schizophrenia
- Bizarre beliefs that seem real to the sufferer, but aren’t real
^— can be paranoid in nature (involves a belief that they are being followed or spied on - maybe believe their phone is tapped or there are hidden cameras in their home) - May also believe they are famous or have special powers/abilities
- Delusions of reference: events in the environment appear to be directly related to them (e.g. special personal messages being communicated through the TV or radio)
Outline the nature of disorganised speech as a positive symptom of schizophrenia
- The result of thought processes, where the individual has problems organising their thoughts + is present in their speech
- May slip from one topic to another (derailment) - even mid sentence
^— may even be complete gibberish (word salad)
Outline the nature of grossly disorganised/catatonic behaviour as a positive symptom of schizophrenia
- Includes the inability or motivation to initiate a task/complete it once it’s started
^— leads to difficulties in daily living + can result in decreased interest in personal hygiene - May dress/act in a bizarre way (e.g. heavy clothes on a hot summer’s day
- Catatonic behaviour - characterised by a reduced reaction to the immediate environment, rigid postures or aimless motor activity
Explain what is meant by the negative symptoms of schizophrenia
- Appear to reflect a diminution or loss of normal functioning
- Involve loss of usual abilities + experiences
List some of the negative symptoms of schizophrenia
- Speech poverty
- Avolition
- Affective flattening
- Anhedonia
Outline the nature of speech poverty as a negative symptom of schizophrenia
- Alogia
- Lessening of speech fluency + productivity
- Changes in speech patterns, recognised by ICD-10
^— though to reflect slowing or blocked thoughts
Outline the nature of avolition as a negative symptom of schizophrenia
- Sometimes called apathy - reduction of interests + desires as well as inability to initiate + persistence in goal-oriented behaviour (e.g. sitting in the house for hours every day doing nothing)
- Finds it difficult to begin or keep up with a foal-directed activity (RESULTS IN REDUCED MOTIVATION)
Outline the nature of affective flattening as a negative symptom of schizophrenia
- Reduction in range + intensity of emotional expression, including facial expression, voice tone, eye contact + body language
- When speaking, patients may also show deficit in prosody (i.e. paralinguistic features such as intonation, tempo, loudness + pausing)
Outline the nature of anhedonia as a negative symptom of schizophrenia
- Loss of interest or pleasure in all/almost all activities, or lack of reactivity to normal pleasurable stimuli
- May be pervasive (i.e. all embracing) or confined to a certain aspect of experience
- Physical anhedonia: inability to experience physical pleasures such as pleasure from food, bodily contact, etc
- Social anhedonia: inability to experience pleasure from interpersonal situations such as interacting with other people
SOCIAL ANHEDONIA OVERLAPS WITH OTHER DISORDERS WHILE PHYSICAL IS MORE RELIABLE TO SCHIZOPHRENIA
Define co-morbidity
The extent that 2+ conditions or disease occur simultaneously in a patient
^— e.g. schizophrenia _ depression
Define symptom overlap
Refers to the fact that symptoms of a disorder may not be unique to that disorder but may also be found in other disorders
Outline cultural difference in diagnosis of schizophrenia
- Research suggests significant variation between countries when diagnosing
- Copeland (1971) gave 134 US + 194 British psychiatrists a description of a patient
^— 69% of US psychiatrists diagnosed schizophrenia, BUT 2% of British psychiatrists gave teh same diagnosis - ‘Hearing voices’ also influenced by cultural environment
- Luhrmann et al. (2015) interviews 60 adults diagnosed with schizophrenia (20 each in Ghana, India, US)
^— each was ask about heard voices
^— African + Indian subjects reported positive experiences (voices being playful or offering advice) | US subjects reported negative experiences (voices being harsh or violent) + indicative of being ‘sick’
Outline gender bias in diagnosis of schizophrenia
- Occurs when accuracy of diagnosis is dependent on gender of an individual
- Accuracy of diagnostic judgements can vary for a number of reasons, including gender-based diagnostic criteria or clinicians basing judgements on stereotypical beliefs held about gender
^— e.g. critics of DSM criteria argue that some diagnostic categories are biased towards pathologising one gender rather than the other - Boverman et al. (1970) found that clinicians in the US equated mentally healthy ‘adult’ behaviours either mentally healthy ‘male’ behaviours
^— resulted in tendency for women to be perceived as less mentally healthy
Describe the use of family studies in determining the role of genetics in schizophrenia
- Family studies have established that schizophrenia is more common among bio. Relatives of a person with schizophrenia
- Gottesman: children w/ 2 schizophrenic parents had concordance rate of 46% | children w/ 1 schizophrenic parent had concordance rate of 13% | siblings (where brother/sister had schizophrenia) had concordance rate of 9%
Describe the use of twin studies in determining the role of genetics in schizophrenia
- If MZ twins are more concordant that DZ, then this suggests that the greater similarity is due to genetic factors
- Joseph (2004): calculated that the pooled date for all schizophrenic twin studies carried out before 2001 showed concordance rate for MZ as 40.4% + 7.4% for DZ
Describe the use of adoption studies in determining the role of genetics in schizophrenia
- Used due to difficulties of disentangling genetic + environmental influences for individuals who share genes + environment (so genetically related individuals who are reared apart are used)
- Tienari et al. (2000): of 164 adoptees whose bio mums had schizophrenia, 11 (6.7%) also had schizophrenia compared to just 4 (2%) of 197 control adoptees (non-schizophrenic mothers)
^— showed genetic liability to schizophrenia had been ‘decisively confirmed’
Outline the genetics of schizophrenia
- Schizophrenia is polygenic (multiple genes contributing to the risk of schizophrenia)
Define candidate genes in terms of schizophrenia
- Specific genes increasing the likelihood of developing schizophrenia
^— includes genes related to dopamine regulation + neural communication (e.g. COMT + DRDR)
What are neural correlates?
Changes in neuronal events + mechanisms that result in the characteristic symptoms of a behaviour or mental disorder
What is the original dopamine hypothesis?
Claims that an excess of dopamine in certain regions of the brain is associated with the positive symptoms of schizophrenia
^— schizophrenics thought to have abnormally high numbers of D₂ (dopamine) receptors on receiving neurons - results in more dopamine binding + more neurons firing
Describe evidence associating hyperdopaminergia with schizophrenia
- Amphetamine is a dopamine agonist
- Normal individuals exposed to large doses of dopamine-releasing drugs such as amphetamines can develop the characteristic symptoms of a schizophrenic episode, which generally disappear with abstinence from the drug
Describe evidence associating hypodopaminergia with schizophrenia
- All antipsychotic drugs block the activity of dopamine in the brain
^— by reducing activity in neural pathways of the brain that use dopamine as the neurotransmitter, these drugs eliminate hallucinations + delusions - The fact these drugs alleviated many schizophrenic symptoms, strengthened the case for the important role of dopamine in this disorder
What is a dopamine agonist?
Stimulate the nerve cells containing dopamine, causing the synapse to be flooded with this neurotransmitter
What is a dopamine antagonist?
They block dopamine’s action
What is the revised dopamine hypothesis?
- Davis + Kahn (1991)
- Proposed that the positive symptoms of schizophrenia are caused by an excess of dopamine in subcortical areas of the brain (particularly in the mesolimbic pathway)
- negative + cognitive symptoms of schizophrenia are thought to arise from the deficit of dopamine in areas of the prefrontal cortex) mesocortical pathway)
Outline support for the revised dopamine hypothesis
- Patel et al. (2010)
- Used PET scans to assess dopamine levels in schizophrenic + ‘normal’ individuals
^— found lower levels of dopamine in the dorsolateral prefrontal cortex of schizophrenic patients compared to the controls
List FOUR specific brain areas involved in schizophrenia
- The prefrontal cortex
- The hippocampus
- Grey Matter
- White matter
Outline the association of the prefrontal cortex with schizophrenia
- PFC is the main area of the brain involved with executive control (i.e. planning, reasoning + judgement)
- Weinberger + Gallhofer (1997): shown this is impaired in schizophrenia patients
- Hypothesised that the cognitive symptoms of schizophrenia result from deficits within the PFC + it’s connections with other areas of the brain, particularly the hippocampus
Outline the association of the hippocampus with schizophrenia
- An area of the brain involved the temporal lobe
- Conrad et al (1991): reported anatomical changes in the hippocampus is schizophrenia patients
- Deficits in the nerve connections between the hippocampus + the prefrontal cortex have been found to correlate with the degree of working memory impairments - a central cognitive impairment in schizophrenia
Outline the association of grey matter with schizophrenia
- Schizophrenics have reduced volume of grey matter (cell bodies + unmyelinated axons) in the brain - temporal + frontal lobes
- Many schizophrenics (mostly with negative symptoms) have enlarged ventricles (brain cavities filled with cerebrospinal fluid)
- Enlarged ventricles thought to be a consequence of nearby brain parts not developing properly or being damages
Outline the association of white matter with schizophrenia
- Found in brain + spinal cord & made up of nerve fibres covered in myelin
- Myelin creates an insulating sheath around nerve fibres, helping conduct info quickly through the CNS, enabling efficient info processing
What is family dysfunction?
The presence of problems within a family the contribute to relapse rates in recovering schizophrenics, including lack of warmth between parents + child, dysfunctional communication patterns + parental overprotection
What are the three main types of family dysfunction?
- The schizophrenogenic mother
- Double-bind theory
- Expressed emotion
Outline the schizophrenogenic mother explanation of schizophrenia
- Fried Fromm-Reichmann (1948) - originates from what she calls her idea of a particular type of parent
- Schizophrenogenic = ‘schizophrenia-causing’
- Mothers described as COLD, REJECTING, CONTROLLING + tend to create a family climate characterised by tension + secrecy + leads to distrust leading to paranoid delusions
Outline the double-bind theory explanation of schizophrenia
- Bateson et al. (1956) - emphasised communication style
- Developing child finds themselves trapped in situation where they fear doing the wrong thing, but receive mixed messages about what this is
- e.g. mother tells her son she loves him, but simultaneously turns her head away in disgust
^— affection on the verbal level, yet animosity on the non-verbal level
^— Child’s ability to respond to mother is incapacitated by contradictions because one message invalidates the other, preventing developing of internally coherent construction or reality
Outline the expressed emotion explanation of schizophrenia
- Level of emotion (particularly negative emotion) expressed towards a patient by parent
- Verbal criticism of patients sometimes accompanied by violence
- Hostility to patient (anger + rejection)
- Emotional over-involvement is patient life
Family communication style where family members talk about the patient critically/hostilely - High EE = x4 more likely to relapse than patient with low EE family
What are cognitive explanations?
- Propose that abnormalities in cognitive function are a key component of schizophrenia
What is dysfunctional thought processing?
Cognitive habitats or beliefs that cause the individual to evaluate information inappropriately
What are the two types of dysfunctional thought processing?
- Metarepresentation
- Central control
Outline metarepresentation as a type of dysfunction thought processing
- The cognitive ability to reflect on own behaviour
^— allows insight into out own intentions + goals + interpret actions of others - Dysfunction in metrepresnetation = disrupted ability to recognise our own actions + thoughts as being carried out by another
^— explains hallucinations of voices + delusions like thought insertion - faulty cognitive ability results in delusions of control (feeling our own actions are being created by an outside force)
Outline central control as a type of dysfunction thought processing
- The cognitive ability to suppress automatic responses while we perform deliberate actions instead
^— inability to suppress automatic thoughts + speech triggered by other thoughtsresults in disorganised speech + thought disorder - Schizophrenics tend to experience derailment of thought + spoken sentences because each word triggers associations + patient cannot suppress automatic repsponses
What is drug therapy?
Involves treatment if mental disorders (e.g. schizophrenia) through use of antipsychotics to reduce symptoms of the disorder
What are typical antipsychotics?
- 1st generation of antipsychotic drugs
- Acts as dopamine antagonist
- Normalises neurotransmission in key brain areas, reduced hallications
- Treats positive symptoms
e.g. Chlorpromazine
What are atypical antipsychotics
- 2nd generation of antipsychotic drugs
- Aimed to improve effectiveness of drugs in suppressing psychoses (e.g. schizophrenia) + minimise side effects
- Carry lower risk of extrapyramidal side effects
- Treat negative symptoms, positive symptoms, cognitive impairment
- Suitable for treatment-resistant patients
e.g. Clozapine + Risperidone
What is CBT?
- Cognitive Behavioural Therapy
- Combination of cognitive therapy (way of changing maladaptive thoughts + beliefs) and behaviour therapy (way of changing behaviour in response to these thoughts + beliefs)
Outline how CBT is used in the treatment of schizophrenia
- Cognitive behavioural therapy for psychosis (CBTp) - people have distorted beliefs that influence feelings + behaviours in maladaptive ways
- Patients encouraged to trace back origins of their symptoms in order to get an idea of how they developed
- Helped to make sense of how delusions + hallucinations impact on feelings + behaviours
^— patients has voices + believes it’s demons so very afraid - Therapist challenges their delusions and hallucinations + encourages patient to test their validity
- May be set behavioural assignments to improve their general level of functioning
- Therapist lets the patient develop their own alternatives to their maladaptive beliefs, looking for alternative explanations + coping strategies that are already present in the patient’s mind
What is family therapy?
- A psychological therapy carried out with all or some members of a family with the aim of improving their communication + reducing the stress of living as a family
- A range of interventions aimed at the family (e.g. parents, siblings, partners) of someone with a mental disorder
Describe the nature of family therapy
- Offered for a period between 3-12 months + at least 10 sessions
- Aimed at reducing level of expressed emotion in the family (which can increase the likelihood of relapse)
- Involves providing family members with information about schizophrenia , finding ways of supporting an individual with schizophrenia + resolving any practical problems
- Should aso involve the schizophrenic
^— schizophrenics are usually suspicious about their treatment, and involving the individual overcomes this problem - Improves relationships within the household because the therapist encourages family members to listen to each other and openly discuss problems + negotiate solutions together
Outline the procedure of one study supporting family therapy
- Pharoah et al. (2010)
- Meta-analysis 53 studies published 2002-2010 to investigate effectiveness of family intervention
^— studies conducted in Europe, Asia + North America - Compared outcomes from family therapy to ‘standard’ care (antipsychotics) alone
Outline the findings of one study supporting family therapy
- Pharoah et al. (2010)
- Mental state: Mixed. Some studies reported improvement in overall mental state compared to standard care, while not others
- Compliance with medication: INCREASED patients; compliance with meds
- Social functioning: SOME improvement on general functioning, but family therapy not much effect on more concrete outcomes (e.g. independent living)
- Reduction in relapse/readmission: REDUCTION in relapse risk + hospital admission during + in 24 months after treatment
What is a token economy?
- A way to manage schizophrenia rather than treat
- Aims to make behaviour socially acceptable rather than reduce symptoms
What are primary reinforcers?
Anything that gives pleasure (food, shelter, comfort, privilege) or removes unpleasant states (alleviation of boredom)
What are secondary reinforcers?
Initially have no value, but acquire reinforcement properties when paired with/ primary reinforcers
^— e.g. token given out when patient engages in target behaviour
How do token economies work?
- Tokens paired with rewarding stimuli + become secondary reinforcers
- Patient engages in target behaviours or reduces inappropriate ones
- Patient is given tokens for engaging in these behaviours
- Patient trades these tokens for access to desirable items or other privileges
Max effectiveness = reinforcement needs top occur immediately after target behaviours performed
^— if not, another behaviour may occur in intervening period + could be reinforced instead
What is the diathesis stress model?
Explains mental disorders as the result of an interaction between biological (diathesis) and environmental (stress) influences
Explain Meehl’s diathesis stress model
- ORIGINAL
- Diathesis is entirely genetic - result of single ‘schizogene’
^— lead to development of a biologically based schizotypic personality (characteristic sensitivity to stress) - If no schizogene, no stress leading to schizophrenia
