schizophrenia Flashcards
1
Q
Describe Type I and Type II schizophrenia
A
Type I : acute from characterised by positive symptoms and responsive to medication
Type II: chronic type characterised by negative symptoms and poorer prospects for recovery.
2
Q
What are positive symptoms?
A
- experiences or behaviors that are added to a person’s life
- loss of touch with reality , such as hallucinations and delusions.
- These generally occur in actute, short episodes
3
Q
What are negative symptoms?
A
- behaviors or emotions that are deficient or lacking
- these occur in chronic longer-lasting episodes , and are resistant to medication.
4
Q
How is schizophrenia usually identified and when?
- the requirements for S to be diagnosed
A
- 2 or more symptoms must be apparent for more than one of month, as well as reduced social functioning.
- commonly occurs between 15 and 45 years of age, with an equal incidence rate between males and females, though males show onset an an earlier age.
5
Q
Describe positive symptoms of schizophrenia
most are positive symptoms
A
1.Thought disorders: thoughts and actions are percieved as under external control. Sufferers believe that thoguhts are being inserted, withdrwn or broadcast to others.
2.Hallucinations : sufferers experience additional sensory experienes such as voices, often insulting and obscene or distortions of vision.
3. Primary delusions: sufferes usually have irrational beliefs about themselves e.g. delusions of grandeur belieiving they are someone important.
6
Q
Describe 3 negative symptoms of schizophrenia
Slater and Roth’s list
A
- Speech poverty: abnormally low level of the frequency and quality of speech. e.g. ‘derailment’, which is thought to be caused by dysfunctions in central control (Frith et al, 1992)
- Psychomotor disturbances: sufferers adopt frozen , statue like poses ,( catatonia) exhibit tics and twitches and repetitive behaviours. (positive)
- Avolition: sufferers display an inability to make decisions , have no enthusiasm or energy , lose interest in personal hygeine and lack sociability and affection.
7
Q
How is schizophrenia diagnosed?
A
- DSM-V and ICD-10 (WHO)
- Diagnostics and Statistics Manual and International Classification of Disease
- Both require symptoms to last at least one month for a diagnosis of schizophrenia.
- DSM-V is more specific, requiring at least two core symptoms - ICD-10 is broader , needing a general pattern
8
Q
H
Define reliability
A
- concerns the consistency of results / symtoms
9
Q
Describe the two different types of reliability
A
- Test-retest reliability: occurs when a clinician makes the same diagnosis on separate occasions from the same information
- Inter-rater reliability: occurs when different clinicians make identical , independent diagnoses of the same patient
10
Q
Outline research on the relaibility of diagnosis for those with schizophrenia
A
- Beck et al. (1962) Found a 54% concordance rate between experienced practitioners’ diagnoses when assessing patients. This suggests issues with inter-rater reliability in the diagnosis process.
- Söderberg et al. (2005) Reported an 81% concordance rate using the DSM classification system, indicating that reliability has improved over time with updated systems.
- Nilsson et al. (2000) Found a 60% concordance rate using the ICD classification system. This implies that the DSM system may be more reliable.
- Read et al. (2004) Reported a test-retest reliability rate of 37% for schizophrenia diagnoses, showing poor consistency over time.
11
Q
Evaluate research on the reliability of schizophrenia
A
- The DSM classification system is regarded as more reliable than the ICD because the symptoms outlined for each catergory are more specific
- even if reliability is not perfect , it allows practitioners to have a common viewpoint , permitting communication of research ideas and findings , which may ultimately lead to a better understanding of the disorder and the development of effective treatments.
12
Q
define validity
A
- the accuracy of a diagnosis
13
Q
Define the 4 ways validity can be assessed in the diagnosis of schizophrenia
A
- Reliability
- Predictive validity ( if diagnosis leads to successful treatment then it is valid)
- Descriptive validity: paritents with schizophrenia should differ in symptoms from patients with other disorders.
- Aetelogical validity: all should have the same cause for the disorder
14
Q
Summarise Rosenhan’s research on the validity of diagnosis using the DSM-II classification system
A
- 8 volunteers without mental illness pretended to hear voices and presented themselves at different mental hospitals. All were admitted, after which they acted normally.
- The time it took to be released and how staff interpreted their behaviors were recorded.
- In a 2nd part of the study, hospitals were informed that pseudo-patients would attempt entry within three months. Staff recorded suspected impostors, though no pseudo-patients were actually sent.
15
Q
Evaluate and give the finding’s of Rosenhan’s research
A
- The pseudo-patients were diagnosed with schizophrenia and remained hospitalized for 7 to 52 days.
- In the second part, 193 patients were admitted, of whom 83 were suspected to be impostors by staff, though none were fake.
- Highlighted flaws in diagnostic systems and raised awareness about the stigma of mental health diagnoses.
- The study’s results might be influenced by clinicians’ expectations and the unusual nature of faking mental illness to gain hospital entry.
16
Q
Give research on validity of diagnosis
A
- Bailie et al surveyed 154 British psychiatrics to find that other than an agreement as to the influence of genetics, neural abnormalities and substance abuse , they had differing views on the cause of S. Suggests that aetiological validity of S is low.
- Jager et al found that it was possible to use ICD-10 TO distinguish 951 cases of S from cases of acute and transient psychotic disorders. Suggests that diagnosis has high descriptive validity.
17
Q
Evaluate the validity of diagnosis in schizophrenia
A
- the predictive validity of S diagnosis can be argeud to be low because different sufferers experience such a wide range of symptoms
- Being labelled S has a long lasting negative effect on social relationships , work prospects , self esteem etc which is unfair if diagnoses is invalid
18
Q
Define comorbidity
A
- the presence of one or more additional disorders or diseases simultaneously occuring with schizophrenia
- schizophrenics often suffer from forms of depression, and bipolar disorder.
- also raises issues of descriptive validity as having simul. disorders suggests that S may not actually be a seperate disorders
19
Q
Give research on comorbidity
A
-Sim et al reported that 32% of 142 hospitilised S had an additional mental disorder.
- Bucekly reported that an estimated 50% S had comorbid depression , 15% panic disorder, 23% with OCD, 47% with substance abuse.
20
Q
How does culture bias affect the diagnosis of schizophrenia?
A
- concerns the tendency to over-diagnose members of other cultures as suffering from S.
- In Britain, Fearon found people with Afro-Caribbean hertiage in the UK and African Americans are up to 9 times more likely to be diagnosed with S
- despite 1% of the general population having S.
21
Q
none
A
whoop
22
Q
Evaluate the effect of culture bias on diagnosis of S
A
- Cochrane argue that the racism and social deprivation immigrants suffer are bound to negatively affect mental health but that clinicians wrongly attribute their behaviour to their ethnicity.
- Rack points out that in many cultures hearing recently deceased loved ones to be normal and part of the grieving process but in Western Cultures , this would lead to a diagnosis of S.
23
Q
Describe how gender bias affects the diagnosis of Schizophrenia
A
- males tend to suffer more negative symptoms and have higher levels of substance abuse then females
- females tend to have better recovery rates and lower relapse rates.
- Men’s average age of diagnosis is 25 whereas women are 18-20. Cotton suggest that women’s underdiagnosis is due to women’s better social coping strategies leading to being less likely to seek treatment.
24
Q
Give research on gender bias in diagnosis
A
- Haifner reported that males have more severe negative symptoms and higher levels of substance abuse.
- Powell sent 290 psychiatrics 2 identical case studies where the gender and race of the patients where changed to either WF, WM, BF,BM , or NN. The researchers found overdiagnosis for black patients and underdiagnosis for females.
- the most accurate diagnosiss was when the gender and race of the psychiatrist was the same
25
Define symptom overlap and give some examples.
- the perception that symptoms of S are also symptoms of other disorders.
- Ophoff assessed genetic material from 50,000 particiapnts to find that of 7 gene locations on the genome assoicated with S , 3 of them were also associated with bipolar disorder, which suggests a genetic overlap.
26
Evaluate the impacts of symptom overlap
- the fact that there is genetic overlap between mental disorders suggests that gene therapies might be developed which simulataneously treat different disorders.
- Ketter report that misdiagnosis due to SO can lead to years of delay in recieving relevent treatemnt , during time suffering and further degeneration can occur , aswell as high suicide levels.
27
Give the genetic explanation of schizophrenia
- sees S as transmitted through hereditary means.
- Believes it to be a polygenic disorder, which increases an indidivuals overal vulnerability to developing schizophrenia
28
Give research on the genetic explanations for schizophrenia
- Gottesman & Shields (1976) reviewed 5 twin studies and reported a concordance rate of between 75% and 91% for MZ twins with severe forms of S , suggresting that genetics plays a role.
- Torrey et al (1994) reviewing evidence from twin studies, found that if one MZ twin develops S , there is a 28% chance that the other twin will do to.
- Kety & Ingraham: found that prevalence rates of S were 10 times higher among genetic than adoptive relatives of S suggesting that genetics > environmental factors.
- The SWGPGC analysed the DNA of 36,989 S and 113,000 non-schizophrenics to identify 128 independent genetic variations at 108 locations on the human chromosomes that contribute to developing S. Of these 83 , had not been identified before.
29
Evaluate the genetic explanations for schizophrenia
- Twin studies suggest a genetic factor but do not consider socio-psychologcal factors between twins. Twin and family studies also fail to consider shared environmental influences.
- if genes caused S on their own, concordance rates between MZ twins would be 100%, which they are not. Twin studies also produce confusing evidence , with heritability estimates ranging from 58% for MZ down to as low as 11%.
- Leo (2006) argues that Kety's adoption study evidence is not convincing as sample sizes were small makiing generalisations difficult , and many of the biological relatives with S were distant relatives , such as half siblings , with low biological similarity.
- diathesis stress response: individuals inherit different levels of genetic predisposition to developing S , but it is environmental triggers that determine whether individuals go on to develop S.
30
Describe the dopamine hypothesis
- The DH believes that the onset of S is related to abnormal levels of the hormone and neurotransmitter dopamine.
- dopamine increases the rate of firing of neurons during synapse which enhances communication between neurons. Snyder argued that if too much dopamine is released during synapse, it can lead to S.
- DH was developed when phenothiazines and antipsychotic drugs lessened the symptoms of S, which decreased dopamine activity.
- excessive amounts of dopamine in speech centres like Broca's area may lead to auditory hallucinations and lower levels in areas like the frontal cortex are thought to contribute to negative symptoms like avolition
31
Give research on the dopamine hypothesis
- Randruo & Munkvad created S-like behaviour in rats by giving them amphetamines , which activate dopamine production , and then reversed the effects by giving them neuroleptic drugs, which inhibit the release of dopmine, supporting the DH.
- Iversen (1979) reported that post mortems on people who had S found excess dopamine in the limbic system.
- Javitt (2000) reported that the drugs phencylcidine and ketamine induce schizophrenic symptoms in non-sufferers by blocking neurotransmissions for glutamate receptors which leads to abnormal dopamine system functioning suggesting that there is a connection between D and S.
- Leuhet et al conducted a meta analysis of 212 studie which tested the effectiveness of anti-psychotic drug treatments on dopamine balance vs a placebo. drugs were seen as more effective then placebo
32
Evaluate the dopamine hypothesis as an explanation for schizophrenia
- evidence is inconclusive as there is no consistent difference in dopamine levels between drug-free S and non-sufferers.
- several neurotransmitters may be involved in the development of S , some drugs implicate serotonin's involvement.
- Healy (2000) beleives that pharmaceutical companies were keen to see the dopamine theory promoted to make huge profits.
- LLoyd et al beleive that even if dopamine is a causative actor , it may be an indirect factor mediated through environemtal factors as abnormal family can lead to high levels of D which n turn trigger S symptoms
33
Describe neural correlates as a biological explanation for schizophrenia
- believes the development of S is related to structural and functional brain abnormalities
- also believed that enlarged ventricles ( which is associated with damage to central brain areas ) is assoiared w negative symptoms of S.
34
Outline research on neural correlates
- Johnstone using CT scans first identified people with S had larger than average ventircles suggesting this structural difference may be linked to the cause of S.
- Weyandt reported that enlarged ventricles are associaed with negative symptoms only , which implies EV cannot explain all symptoms of S.
35
Evaluate neural correlates as a biological explanation for schizophrenia
- ventricle studies are based on correlational research it is difficult to determine if there is a causal relationship, or a 3rd factor linked to both the EV and S such as a potenial side effect of medication.
- must be a consideration to environmental factors such as substance abuse and stress levels, which mau have a damaging effect on brain tissue.
- Ho et al performed MRI scans on recent schizophrenics and re-scanned them 3 years later. They found evidence of brain damage in the recent which worsened over time even with medication, especially in the frontal lobes. - supports NC
-
36
Evaluate the biological explanation for schizophrenia
- supported by biological treatments
- assumes that S is biologically determined making sufferers feel disempoweered when diagnosed. Cogntive approaches have a soft determinist perspective
- bioloigcally reductionist as fails to consider evidence for the range of psychological aspects of S such as EE.
- a holistic explanation would consider the diathesis-stress approach in which the root cause of the disorder is a biological/genetic weakness however an env factor triggers the disorder.
37
Name the psychological explanations for schizophrenia
- family dysfunction
- cogntive explanations ( inc. dysfunctional thought processing)
38
Describe family dysfunction as an explanation for schizophrenia
- sees maladaptive relationships and patterns of communications within families as sources of stress, which can cause the development of schizophrenia.
- Parents of schizophrenics often display high levels of interpersonal conflict (arguments). Difficulty communicating with each other. Being excessively critical and controlling of their children.
39
Describe the double bind theory and its role in family s=dysfunction
- Bateson used the Db to explain the contradictoy situations children could be placed in by parents . where a verbal message is given but oppposite behaviour is exhibited.
- This leads to a negative reaction of social withdrawal & a flat effect (a lack of emotional expression) in order to escape double bind situations.
40
Describe the role expressed emotion plays in family dysfunction
- verbal interactions that the caregiver has with person with S, where families persistently exhibit criticism and hostility exert a negative influence on the S.
- involves exaggerated involvement , critiism and control and hostility
- This can lead to relapsing to an ative phase of the disorder and experience severe positive symptoms.
41
Give research into psychological explanations for schizophrenia
- **Tienari et al. (2004)** found that adopted children of schizophrenic mothers were more likely to develop schizophrenia if they were raised in dysfunctional families (36.8%) compared to those raised in healthy families (5.8%). ( supports genetic + environment)
-**Kavanagh (1992)** found that schizophrenia relapse rates were higher in high expressed emotion (EE) families (48%) compared to low EE families (21%). This suggests that high EE increases relapse risk.** Butzlaff and Hooley (1998)** supported this with a meta-analysis showing that schizophrenics in high EE environments had more than double the average rate of symptom return.
42
Evaluate psychological explanations for schizophrenia
- family therapy reduces expressed emotion in families, this has been demonstrated to be an effective intervention and supports this family dysfunction argument.
- A problem with the family dysfunction theory is that it fails to explain why all children in such families ofoten do not go on to develop S.
- It is impossible to demonstrate cause and effect. It could be that S of the child and associated behaviour is the cause of the family dysfunction.
- it is socially sensitive to suggest that S is caused by the family - may increase additional stress and anxiety.
43
Describe the cognitive explanation of schizophrenia
- based on the assumption that the ability to process thoughts is dysfunctional.
- Frith (1992) suggested this is due to impaired metarepresentation, the ability to reflect on one's own and others' thoughts and intentions
- Firts suggests this is due to a faulty attention system unable to filter preconcious thought and gives too much signifcance to the info that would usually be filtered, therefore overloading the mind.
- Attentional bias is another feature, where individuals focus on perceived threats while ignoring harmless stimuli.
- People with schizophrenia often struggle with self-monitoring, making it difficult to dismiss irrational thoughts, contributing to delusions.
44
Give research on the congitive explanations of schizophrenia.
- Stirling et al. (2006) had schizophrenia patients complete the Stroop test and found they took twice as long as control participants. This suggests impaired central control and supports the view of dysfunctional thought processing in schizophrenia.
- Takahashi et al. (2013) found that schizophrenics had difficulty detecting changes in auditory tones, which may explain problems with attention, information encoding, and the presence of auditory hallucinations.
- O'Carroll (2000) found that 75% of people with schizophrenia show cognitive impairments (e.g. in memory, attention, and executive function)
45
Evaluate the cognitive explanation for schizophrenia
- cogntive theories do not explain what led to cogntive dysfunctions thus can't explain to the same extent that biological explanations can an explicit cause.
- can account for both positive and negative symptoms.
- It can be combined with other explanations , such a s biological onees, to give a fuller understanding of the causes of S.
- Research suggests that DTF in S occurs before the onset of S + so is not an effect of being S. DFT is not a causative factor, BUT may instead itself be an effect of abnormal brain functioning
46
define antipsychotics
- also known as neurleptics
- medications that are used to control psychosis, such as delusions od hallunciations
- they are taken in pill form or injected.
47
What are *typical* antipsychotics in schizophrenia?
| - first gen
## Footnote
give example
- a drug therapy used in 1950s that treat positive symptoms but lead to severe side effects
- dry mouth, constipation, confusion and tardive dyskinesia
48
Name and Describe the mechanism of action of typical anti-psychotics
- chlorpromazine
- work as dopamine antagonists , reducing its activity by blocking dopamine receptors at the synapse
- reduces positive symptoms with a general sedative effect, also.
49
What are atypical anti-psychotics?
- a drug therapy used in 1970's to avoid the more severe side effects of typical antipsychotics
- less side effects
50
Give and describe the mechanism of action of an atypical anti-psychotics
- blocks dopamine receptors but also act on other neurotransmitters e.g. acetylcholine , glutamate and serotonin to ease positive symtoms
- also addresses the negative symptoms i.e avolition
- side effects: weight gain , cardiovascular problems
51
Give research on the effectiveness of antipsychotic drugs in treating schizophrenia.
- ✓ Bagnall et al (2003): conducted a systematic review of randomised controlled trials (RCTs).Reviewed 295 studies,found atypical antipsychotics (e.g. risperidone, olanzapine) are generally more effective at treating both positive and negative symptoms than typical ones and have fewer side effects, leading to better treatment adherence. Patients were more likely to continue treatment, suggesting better tolerability.
- ✓ Davis et al. (1989) Performed a meta-analysis of over 100 studies comparing antipsychotics to placebos. Found that over 70% of patients treated with antipsychotics improved in condition after six weeks,
Compared to fewer than 25% who improved with a placebo.
- X Lieberman et al. (2005): 74% of 1432 individuals discontinued treatment within 18 months due to intolerable side effects;
52
Give the strengths of the use/effectiveness of drug treatments
- Drug therapies are often cheaper to presribe then providing hospital treatment od therpaies such as CBT and family therapy
- The use of drug treatments has resulted in the end of long term instituionalistion in mental health hospitals and perhaps enhanced quality of life with people living with their families and additional independence.
- Antipsychotics are effective in reducing symptoms of schizophrenia - Davis etc
53
Outline the limitations of the use of drug treatments
- both types of drugs have side effects , due to the severtity of the side effects 2/3 of people stop taking them.
- drugs are ofte prescribed forcefully. There are ethical issues regarding informed consent.
- the widespread use of antipsychotics may be driven more by the profits of pharmaceutical companies than by patient welfare.
- Some patients develop serious neurological side effects, such as neuroleptic malignant syndrome (NMS),
- 40% of patients relapse in the first year after starting antipsychotic treatment.
54
Name the psychological treatments used in managing schizophrenia
- CBT
- Family Therapy
- Token Economics
55
Describe how CBT is used in managing Schizophrenia
- assumes that S is the result of dysfunctional thought processes
- focusing on altering maladaptive thinking and distorted perceptions to help modify hallucinations and delusional belief - Ellis ABC model
- typically combined with antipsychotic drugs to reduce psychotic symptoms, making CBT more effective.
- involves around 12 sessions, held every 10 days
56
Give research on the effectivness of CBT on managing schizophrenia
- Zimmerman et al. (2005): A meta-analysis of 14 studies supported the effectiveness of CBT in reducing positive symptoms, especially in those experiencing short-term acute episodes of schizophrenia.
- Tarrier et al. (2000): Their study indicates that a combination of drug therapy and psychotherapy (PT), along with booster sessions, resulted in better outcomes compared to drug therapy alone or supportive counseling.
57
Evaluate CBT's effectiveness in reducing schizophrenia
- CBT does not produce the side effects of drug therapies making it a preferred treatment plan for many patients , however it is more expensive.
- ending treatment early is common due to the length of treatment . CB requires engagement , negative symptoms can lead to an unwillingness to take part due to severity of symptoms. This usually leads to drug therapy used first.
- The success of CBT relies heavily on the quality of the therapeutic relationship between the patient and the practitioner. Rathod et al. (2005) highlight how cultural differences—such as ethnic background—can impact the effectiveness of CBT.
- research success supports its effectiveness (F.56)
58
Describe family therapy as a psychological treatment in treating schizophrenia
- as family dysfunction can increase risk of relapse , family therapies attempt to change and improve familial relationships and behaviour.
- involves psychoeducation: family is educated on the symptoms of schizophrenia in order for them to be more understanding, and supportive
- usually given for between nine months and a year
59
Give the aims of family therapy
- improve positive and decrease negative forms of communication
- increase tolerance levels and decrease criticism levels between family members
- decrease feelings of guilt and responsibility for casuing the menal disroder among family members.
60
Give research into the effectiveness of family therapy in treating schizophrenia
- Leff (1985) found that family therapy was more effective than standard outpatient care in reducing relapse rates for schizophrenia patients in the short term, with only 8% relapsing within 9 months compared to 50% for standard care.
- However, after two years, relapse rates increased to 50% for family therapy and 75% for standard care, suggesting that family therapy is effective short-term but less so long-term.
61
Evaluate family therapy into the effectiveness of family therapy in treating schizophrenia
- there are problematic practical issues such as the length of therapy. During
