Schizophrenia Flashcards
Diagnosis Reliability (Schizophrenia)
Osorio et al.
Post-diagnosis interviews with consultants over 180 diagnoses found an inter-rater reliability of +0.97
When asked to do a second diagnosis, test-retest reliability was +0.92
Consistent when same manual is applied
Comorbidity & Diagnosis
Buckley et al.
⚬ Depression [50%]
⚬ Substance Abuse [47%]
⚬ PTSD [29%]
⚬ OCD [23%]
Unusual cases of other conditions, not necessarily schizophrenia
Symptom Overlap & Diagnosis
⚬ Schizophrenia & Bipolar both have positive symptoms like delusions and negative symptoms like avolition
⚬ Makes it difficult to diagnose and suggests that it may not exist as a standalone condition - Classification and Diagnosis is flawed
Diagnosis Validity (Schizophrenia)
Cheniaux et al.
Two psychiatrists diagnose the same 100 patients, once with ICD criteria and once with DSM criteria.
Psychiatrist A : Diagnosed 26 using DSM and 44 using ICD
Psychiatrist B : Diagnosed 13 with DSM and 24 with ICD
Low Criterion Validity between manuals
Biases in Schizophrenia Diagnosis
[Gender]
⚬ Fischer & Buchanan : Ratio of men to women with schizophrenia is 4 : 1
⚬ Cotton et al. : This is because women get more support through closer familial and social relationships
⚬ Female schizophrenics are higher functioning and mask symptoms more easily
[Culture]
⚬ Afro-Caribbeans are 9x more likely to be diagnosed with schizophrenia in British society
⚬ In Afro-Caribbean societies, this is not the case. Therefore, it isn’t genetic.
⚬ Psychiatrists with a different cultural background to a patient will interpret normal cultural behaviours as bizarre and irrational, suggesting bias and misdiagnosis
Biological Explanations for Schizophrenia
[-] Biologically reductionist - Environmental factors clearly have an effect
⚬ Morgan et al. : THC-rich cannabis consumption in teenage years is highest risk factor
⚬ Morkved et al. : 67% of schizophrenics report at least one childhood trauma, compared to 38% of those with non-psychotic mental illness
[+] Drug Study Support
⚬ Curran et al. : Dopamine Agonists (Amphetamines) worsen schizophrenic symptoms and produce them in non-sufferers
⚬ Tauscher et al. : Antipsychotics reduce schizophrenic symptoms and reduce dopamine activity
[-] Role of Glutamate
⚬ McCutcheon et al. : Post-mortems and live scans consistently find elevated glutamate levels in specific regions of schizophrenics’ brains.
⚬ Many candidate genes of schizophrenia are involved in glutamate production/processing
Biological Treatments for Schizophrenia
[+] Efficacy Studies
⚬ Thornley et al. : Chlorpromazine had better overall functioning and symptom severity reduction that control groups with placebo
⚬ Meltzer : Clozapine is more effective than typical antipsychotics. Also effective in 30-50% of treatment-resistant cases.
[-] Serious side effects can occur
⚬ Long term use leads to Tardive Dyskinesia (Unwanted facial movements due to dopamine sensitivity)
⚬ Neuroleptic Malignant syndrome (Lack of dopamine in critical areas, like the hypothalamus) can involve fever, delirium, coma and death
⚬ Treatment is ineffective if patients fear these side effects and refuse to take them. This can especially be the case with paranoid patients
[-] Typical antipsychotics recommended by NICE and used as first line treatment in hospitals during psychotic episode.
⚬ Induce sedative state, which can be exploited by staff and may lead to them not being able to give full consent.
⚬ Only use in extreme cases and to engage with other treatments.
Family Explanations for Schizophrenia
[+] Trauma and attachment type predict schizophrenia
⚬ Read : Schizophrenics disproportionately likely to have Type C or D insecure attachment
⚬ Read et al. : 69% of women and 59% of men with schizophrenia have a history of physical/sexual abuse
[-] Little evidence for traditional theories, like schizophrenogenic mother and double bind
⚬ Both are based on clinical observations and informal assessment
[-] Early explanations identify correlations, but they are also very socially sensitive
⚬ Leads to parent blaming and insults those already managing their schizophrenic children
⚬ Should we conduct socially sensitive research?
Cognitive Explanations for Schizophrenia
[+] Stirling et al.
Compared cognitive task performance between 30 schizophrenics and 30 control participants.
⚬ Stroop test - Have to say the colour of colour-words instead of reading it out. Schizophrenics took over twice as long as control group, suggesting poor central control
[-] Explanations are only proximal
⚬ Explain what is happening, but not why
⚬ Distal explanations look at how genetic variation and childhood experiences impact metarepresentation and CC
⚬ More useful than proximal origins, which are only partial explanations
Family Therapy for Schizophrenia
[+] McFarlane’s Meta-analysis
⚬ Most consistently-effective treatment, reducing relapse by 50-60%. Most effective at the start of mental health decline
⚬ Recommended by NICE for everyone with a diagnosis
[+] Benefits Whole Family
⚬ Lobban and Barrowclough : Strengthening family a sa whole lessens impact on individual members and supports the identified patient
[-] General : Time consuming & Expensive
[-] General : Less accessible and requires willingness to engage
Cognitive Behavioral Therapy for Schizophrenia
[+] Efficacy studies
⚬ NICE supports use of CBT
⚬ Jauhar et al. : Reviewed 34 studies and identified small but significant effect on both positive and negative symptoms
⚬ Pontillo et al. : Reduction in frequency and severity of audio hallucinations
[-] “CBT” isn’t one thing
⚬ Thomas : Studies look at different CBT techniques on different patients with different combinations of positive and negative symptoms
⚬ “Modest benefits” conceal a wide variety of effects - Hard to say how effective it is for an individual patient
[-] General : Time consuming & Expensive
[-] General : Less accessible and requires willingness to engage
Token Economies
[+] Glowacki et al.’s meta-analysis
⚬ Reviewed 7 High-quality studies over a 4 year span that examined TES’ effects on those with chronic mental health problems
⚬ All demonstrated a reduction in negative symptoms and in the frequency of unwanted behaviours
[-] Professionals have power over patient behaviour
⚬ Imposing of norms and restrictions of freedoms
⚬ Removal of small pleasures can worsen experience for patients with severest symptoms
⚬ Short-term restrictions may not be worth long term improvement
[-] Alternative approaches with fewer issues exist
⚬ Chiang et al. : Art therapy may be a better alternative (Low risk and high gain)
⚬ Art therapies are less confrontational and ethically dubious, as well as a better patient experience - More appropriate
Interactionist Approach to Schizophrenia
[+] Tienari et al.
