Schizophrenia Flashcards
Define schizophrenia
A severe mental illness in which contact with reality and insight are impaired.
What is the DSM?
Diagnostic and Statistical Manual
5th version
Mainly used in the US
What is the ICD?
International Classification of Diseases
11th version
Mainly used in UK and Europe
What are Positive symptoms?
Additional symptoms that interfere with reality. They are in addition to their normal experiences.
What are Negative symptoms?
The loss of abilities
Who is most common to get schizophrenia?
Men who live in a city with a low socio-economic status
What are the positive symptoms in the classification for schizophrenia?
Delusions: unshakable belief in something that is very unlikely, bizarre or obviously untrue.
Disorganised Speech: often known as a ‘word salad’ where an individual speaks in ways that are completely incomprehensible.
Hallucinations: bizarre and unreal perceptions of the environment. These can be auditory, visual, olfactory, or tactile.
What are the negative symptoms in the classification of schizophrenia?
Speech Poverty: alogia, where speech becomes lessened. It may be difficult to produce words or coherent sentences.
Affective Flattening: a lack of emotions where the persons voice becomes dull and monotonous and their face takes a constant blank appearance.
Catatonic or Disorganised Behaviour: individual behaves in ways that seem inappropriate or strange to the norms of society e.g. lack of motivation.
Avolition: apathy, where they have a lack of motivation to follow through plans and neglect household chores.
Anhedonia: inability to enjoy things that they used to enjoy, food (physical anhedonia) or social withdrawal (social anhedonia).
What is diagnostic reliability?
Means that a diagnosis of schizophrenia must be repeatable.
Clinicians must be able to reach the same conclusions at 2 different points in time.
What is IRR?
Inter-rater reliability
Measured by a statistic called a Kappa score
1- indicates perfect inter-rater agreement
0- indicates zero agreement
0.7 or above is considered good.
What is gender bias?
Said to occur when accuracy of diagnosis is dependent on the gender of an individual, effects accuracy.
Is there any symptom overlap with schizophrenia?
Bipolar disorder also involves positive symptoms like delusions and negative symptoms like avolition.
What is comorbidity, and outline the research?
When 2 or more conditions are happening at the same time.
Buckley et al. found that comorbid depression occurred in 50% of his patients
Kessler argues that comorbid depression is a common cause for suicidal behaviour in SZ individuals.
Evaluate the classification of SZ
+ Buckley found co-morbidity rates with SZ, depression 50%, drug abuse 47%
- 153 patients diagnosed by multiple doctors had only a 54% concordance rate between Drs assessments, Low IRR
What 4 things make up the biological explanation of schizophrenia?
Family studies
Adoption studies
Twin studies
Candidate genes
Describe family studies as a biological explanation
Schizophrenia is more common among biological relatives, and the closer the degree of relative the higher the risk.
Gottesman and Shields: children with 2 SZ parents has a concordance rate of 46%. Children with 1 SZ parent had a concordance rate of 13%.
Siblings were 9%
Cousin, uncle, aunt were 2%
Nephew, niece were 4%
Grandchild 5%
Ferternal twins 17%
Identical twins 48%
Describe adoption studies as a biological explanation
Tienari et al. (Finland) found 164 adoptees whose bio mothers had been diagnosed with schizophrenia, 11 also were diagnosed with SZ.
Compared to just 4/197 control adoptees.
Clearly a genetic component
Describe twin studies as a biological explanation
Gottesman and Shields found concordance rate monozygotic=48%
dizygotic=17%
Therefore SZ is inherited through genes
Describe candidate genes as a biological explanation
SZ is polygenic
Ripke looked at date of genome wide studies:
37,000 with SZ compared to 133,000 controls
The are 108 different genetic variations to have an increased risk of SZ
SZ is aetiologically hetrogenous.
Evaluate the genetic factors
- Concordance rates from both family studies can be explained by factors other than genetics: could be down to external factors, childhood, diet?
- Twin studies for SZ have very small sample sizes, so we cannot generalise to the whole population.
- Many of these studies are dated, there has since been changes in the diagnostic criteria so therefore may not be relevant to now.
What is the role of dopamine neurons?
Instrumental in regulating attention, active in the limbic system (an area of the brain governing emotion) .
If disturbed may lead to problems with attention, perception and thought.
Outline the original dopamine hypothesis
-Messages from neurons that transmit dopamine fire is too easily or too often leading to symptoms of SZ.
-Schizophrenics are thought to have abnormally high numbers of D2 receptors on recieving neurons resulting in more dopamine binding therefore more neurons firing.
What are Amphetamines in the original dopamine hypothesis?
a dopamine agonist, stimulates nerve cells to be flooded - large doses can cause hallucinations and delusions.
What are antipsychotic drugs in the original dopamine hypothesis?
Are antagonists, reduce stimulation of dopamine system, hallucinations are eliminated.
Outline the updated Dopamine Hypothesis
Attempts to explain the cause of abnormal dopamine levels.
Current thinking (Howes et al) is a combination of genetic variations and early experiences of stress can make an individual more sensitive to hypodopaminergia and therefore sub-cortical hyperdopaminergia.
Davis et al. suggested the edition of cortical hypodopaminergia which is the low levels of dopamine in the cortex , which can explain the cognitive symptoms of SZ.
Evaluate the dopamine hypothesis
+ Meta analysis of 212 studies, found drug treatments work via normalising dopamine levels were more effective than a placebo.
What is the psychological explanation for schizophrenia and its sub sections?
Family dysfunction
The schizophrenogenic mother
Double blind theory
Expressed Emotion
Describe the schizophrenogenic mother explanation
By Fromm-Reichmann
-cold, dominant and creates conflict
-This was thought to cause SZ to emerge in a child.
-Distruct and instability was thought to induce a schizophrenic reaction in their offspring.
What are some problems with the schizophrenogenic mother explanation?
-Only a small % women fit the criteria
-Hard to establish cause + effect
-No such thing
Describe the Double Blind Theory
Bateson et al.
Family climate is important but so is communication. It is a risk factor, not the only factor.
Mixed messages, feels unable to do the correct thing.
Evaluate the double blind theory
+ Research support: Berger reported higher recall of double blind statements in schizophrenics than non-SZ
- Hall and Levin found no difference in patterns of parental research.
Describe the Expressed emotion
Level of negative emotion towards a patient by their carers.
-Verbal criticism
-Hostility and rejection
-Emotional ever-involvement from patient
High levels of expressed emotion is a source of stress.
Evaluate expressed emotion
+ Research support: Brown- families with high expressed emotions= 58% schizophrenia returning to hospital for further treatment.
- Methodological issues: levels of EE are often measured by one interview.
Evaluate psychological explanations, family dysfunction
-Lack of research support: Read et al. 69% women and 59% men with SZ had a history of physical/sexual abuse as a child.
-Socially sensitive: Parents who have suffered seeing their child with SZ received blame for the condition.
+Research support: the schizophrenic mother and double blind theories are based on clinical observations and early evidence involved assessing patients mothers for ‘crazy-making characteristics’
What is CBTp and its key points?
Cognitive behavioural therapy for psychosis
- 5-20 sessions (at least 16)
-Aims to identify and change irrational thoughts
-Cope with symptoms
-Involves arguement + discussion
What is the procedure of CBTp?
-Assessment
-Engagement
-ABC model
-Normalisation
-Critical collaborative analysis
-Developing alternative explanations
Offer psychological explanations can reduce anxieties
Challenge delusions to learn beliefs are not realities
apple eclairs are not cool desserts
Evaluate CBTp
+ Drury et al. found a reduction in positive symptoms in those taking CBTp.
+ Kuipers: lower drop out rates and greater patient satisfaction were present when CBTp was used alongside drugs.
- Not all are offered: found 187 patients randomly selected from NW England, 6.9% had been offered CBTp.
What is a token economy?
A technique which reinforces appropriate behaviour by giving or witholding tokens.
What is institutionalisation?
Patients who spend a long time in psychiatric hospitals become institutionalised and would not cope in every day life.
Explain how Ayllon + Azrin used a token economy
Used a token economy in a womens ward in a mental institution in the US.
-Rewarded tokens for self-care
-Exchanged for privileges
-Desirable behaviours increased significantly
-Decreased significantly once system was withdrawn.
Evaluate Token economies
+ Evidence of effectiveness- studies showed a reduction in negative symptoms.
- Ethical issues: gives professionals considerable power to control patient behaviour.
- Alternative approaches: these may not raise the same ethical issues
MORE DETAIL
What are the 3 parts of the interactionist approach?
Biological: genetics, neurochemicals, abnormality
Psychological: stress
Societal: poor quality interactions
What is the Diathesis stress model in the interactionist approach?
-Vulnerability to SZ and stress trigger
-One or more underlying factors make a person vulnerable.
What is Meehl’s Model?
Original DSM vulnerability was genetic (single schizogene) which leads to a schizotypal personality.
Carriers= chronic stress in childhood and presence of a schizophrenogenic mother.
No single schizogene= no amount of stress would lead to SZ.
What is the modern understanding of diathesis?
There is no single gene: many genes may appear to increase genetic vulnerability.
Range of factors beyond genetics: psychological trauma as a diathesis.
Neurodevelopment model: early trauma alters the developing brain.
What is the modern understanding of stress?
Originally stress was seen as psychological in nature and related to parenting.
Modern- anything that risks triggering SZ e.g cannabis use as a stressor.
Outline family therapy
-Focus on helping family members support someone who has schizophrenia in the best way.
-Help family members deal with some problems of living with people with SZ
What is the aim of family therapy
Reduce high level of expressed emotion within household which can cause relapse.
How does family therapy work?
- In their home
-3 to 12 months with sessions every 2-4 weeks
-Minimum 10 sessions
-Make sure family members have all info about diagnosis
-Encouraged to ask questions
-All views listened to
-Practical skills to cope
Outline research evidence for family research
Hogarty- at a 2 year follow up 25% of those who recieved family intervention relapsed compared to 62% only getting medication.
Pharoah- found family therapy improved patients mental health and social functioning. Reduced hospital admissions and relapse rates.
to do
research drugs
evaluations
double blind
What are antipsychotics?
Medications used to control symptoms of psychosis, e.g. delusions and hallucinations.
Taken in pill form or injected
What are typical antipsychotics?
1st generation drug therapy used since the 1950s that are less popular due to severe side effects and only treat positive symptoms.
e.g. Chlorpromazine
How do typical antipsychotics work?
Dopamine antagonists (reduce dopamine activity) by blocking dopamine receptors at the synapse
Side effects of typical antipsychotics?
Dry mouth, constipation, lethargy, confusion, tardive dyskinesia.
What are atypical antipsychotics?
2nd generation drug therapy that avoid the more severe side effects
eg. Clozapine
How do atypical antipsychotics work?
Block dopamine receptors but also act on other neurotransmitters eg. acetylcholine
Address the negative symptoms
What are the side effects of atypical antipsychotics?
Weight gain, cardiovascular problems.
Evaluate biological treatments for SZ (drugs)
+ Meta analysis including 212 studies, found drug treatment for symptoms was more effective than placebo.
+ Cheap compared to hospital treatment such as therapy.
- May only suppress symptoms and not treat the underlying problem.
