schizophrenia Flashcards
define what positive symptoms of schizophrenia are
symptoms that are in excess or distorted of normal functions
what are the positive symptoms of schizophrenia
hallucinations, delusions, disorganised speech, catatonic behaviour,
what is a negative symptom
a symptom that reduces or loses the normal functions that persist
what are the negative symptoms of schizophrenia
alogia, avolition, affective flattening, anhedonia
what is alogia
When speech is poor and can’t communicate well anymore and is thought to reflect slowing or blocked thoughts
what is avolition
Inability to initiate in goal orientated behavior
Reduction in self-initiated involvement in activities that are available to patients
what is affective flattening
Reduction in range and intensity of emotional expression, voice tone, eye contact and body language
what is anhedonia
A loss of interest in pleasure in all or almost all activities to normal pleasurable stimuli
what are hallucinations
Auditory- hearing voices or a voice that isn’t yours telling them to do something, usually starts well and ends badly. The voice is normally not violent but often very cruel.
Taste, seeing, smelling can also be hallucinated
what are delusions and the types of them
Beliefs that seem real to the person but aren’t real
Delusions are often paranoid and believed they are being watched, indoctrinated and your thoughts are being heard
You can also have a grandeur delusion which is when you think you are more important than you really are e.g. life saver, world save
what is disorganised speech and the different types
Derailment is when they start talking about one thing and then start talking about something else straight away
Word salad when you say a sentence and they are in the wrong order
Echolalia is when you must rhyme your words and can be very repetitive, they may also repeat the words back to you
Neologism is when you make up words
what is catatonic behaviour
Catatonic behaviors are characterised by a reduction reaction to immediate environment, rigid postures or aimless motor activity
what does reliability in terms of diagnosis of schizophrenia mean
the consistency of classification systems such as the DSM-V to assess symptoms of schizophrenia
what does validity in terms of diagnosis of schizophrenia mean
refers to the extent that a diagnosis represents something that is real and distinct from other disorders
what does criteria a include
two or more of the following: delusions, hallucinations, disorganised speech, grossly disorganised or cationic behaviour, negative symptoms
what does criteria b include
social/occupational dysfunction: significant portion of the time since onset one or more areas of functioning such as work, interpersonal relations or self-care are below before onset
what does criteria c include
duration: continuous signs of disturbance persist for 6 months which must include at least one month of symptoms.
outline Rosenhans study
aim: investigate psychiatric diagnosis and what it is like for a patient on a psychiatric ward
sample: range of hospitals, new or old, short staffed/well staffed
procedure:
field experiment- 8 sane people presented one symptom of having a voice that was unfamiliar and the same sex as themselves and tried to get admitted to 12 different hospitals and once admitted they started acting sane again. the pateints kept records of the ward as a whole as well as how they were treated
findings:
all of them were dignosed with schi.
they had to convince the staff they were sane to leave
evaluate rosenhans study
+ validity was high as it was a covert observation and no demand characteristics were present
+ high ecological validity due to the field experiment
+ generalisable as it was a wide range of different types of hospitals
what is wrong with the reliability of schizophrenia
- There are cultural differences in diagnosis of schizophrenia
- There is not one universally agreed definition of schizophrenia
- There are differences between the characteristics of the disorder in the DSM-V and the ICD-11
- There are a lack of consistent characteristics in schizophrenia from one patient to the next
what are the issues with validity of schizophrenia diagnosis
Comorbidity is common in schizophrenic patients which causes confusion with symptoms
Other factors such as epilepsy and recreational drug use can induce symptoms similar to schizophrenia
Antipsychotic drugs do not always reduce the symptoms of schizophrenia
Symptom overlap
Gender bias in diagnosis as men are diagnosed more with schiz. then women
what is the supporting research for the reliability being bad
Beck et al- interrater reliability between 2 psychiatrists when considering the cases of 154 patients and the reliability was only 54%
Scored a KAPPA score of 0.46 which is a poor interrater reliability showing how subjective the criteria is
Copeland gave 134 US and 194 British psychiatrists a description of the same patient and 69% of the US psychiatrists diagnosed them with schiz. Whereas 2% of British did.
outline the supporting research into the validity of schizophrenia to be bad
Longeneck et al reviewed studies of the prevalence of schizophrenia and found that since 1980s men have been diagnosed with schizophrenia more often then women. Female patients typically function better than men be more likely to work and have good family relationships.
Ellason and Ross point out that people with DID actually have more symptoms of schiz. then people being diagnosed with schizophrenia.
Buckley et al estimate that comorbid depression occurs in 50% of patients and 47% of patients also have a lifetime diagnosis of comorbid substance abuse.
what are the biological explanations of schizophrenai
genetics and the dopamine hypothesis
outline the genetic explanation for schizophrenia
Schizophrenia tends to run in families among relatives and not in-laws. The risk of developing the disorder among individuals who have family members with schizophrenia is higher than those who don’t. Schizophrenia is also polygenic and therefore its more likely that different combinations
what is the supporting research for the genetic explanation of schizophrenia
Family studies- Gottesman and shields children with 2 schizo parents had a concordance rate of 46%, children with 1 schizo parent had a concordance rate of 13% and siblings who had a schizo sibling had a concordance rate of 9%
Twin studies- joseph calculated that the pooled data for all schizophrenic twins studies carried out showed a concordance rate for MZ twins of 40.4% and 7.4% of DZ twins
outline the dopamine hypothesis as an explanation of schizophrenia
- excess of dopamine in the subcortical area particuluary the mesolimbic pathway of the brain is associated with the postitve symptoms
beacuse an excess of dopamine causes neurons to fire too easily too often leading to hallicinations and delusions. Schizophrenics are thought to have abnormally high numbers of D2 receptors recieiving neurons resulting in more dopamine binding and therefore more neurons firing.
It is also beleived that the negative symptoms of schizophrenics are caused by a deficit of dopamine in the prefrontal cortex
evaluate the dopamine hypothesis
Supporting research: research has shown that drugs increase levels dopamine produce psychotic symptoms. Leucht et al meta analysis of 212 studies that had analysed the effectiveness of antipsychotics compared to placebo and found all drugs were more effective in treatment of positive and negative symptoms of schizophrenia achieved by normalising dopamine levels
Criticisms: research has shown the clozapine is the most effective drug at reducing schizophrenia symptoms but it acts as serotonin and dopamine showing reduction. Noll said antipsychotic drugs don’t work for 1/3 of people so lacks validity
Opposing: high levels of dopamine could be a symptom of schizophrenia not a cause
Usefulness: we can develop drugs to treat the symptoms schizophrenia as we know the dopamine is the cause of the symptoms
Testability: scientific and reliable
evaluate the genetic explanation for schizophrenia
Supporting research: Mz twins have 40.4% concordance rate of schizophrenia whereas Mz twins have 7.4%, twin studies, adoption studies, family studies
Criticisms: environment can’t be controlled in all of the studies for genes and Mz twins don’t have 100% concordance rate.
Opposing: psychological explanations e.g. upbringing/cognitive
Usefulness: gene therapy and stop schizophrenia gene from expressing, preventative measures
Testability; scientific and reliable
what are the psychological explanations for schizophrenia
cognitive and family disfunction
outline the family disfunction as an explanation for schizophrenia
Double bind theory:
- when children receive 2 contradictory messages from their family makes them more likely to develop schizophrenia
- They start to fear doing the wrong thing and feel unable to comment on the unfairness of the situation.
- Leaves them with a confused understanding of the world and this is reflected in their symptoms like disorganised thinking and paranoid delusions
Expressed emotion:
Means there is a negative emotional climate where the families communication style is speaking more than listening
EE can be verbal criticism, hostility and emotional over involvement in the family environment
outline the cognitive explanation for schizophrenia
Dysfunctional Central control:
- Not being able to suppress autonomic responses while we perform deliberate actions and this can explain derailment and disorganised speech
Meta representation:
- The inability to reflect and understand thoughts and behaviour of yourself which explains the hallucinations of voices and delusions like thought insertion
evaluate family disfunction as an explanation for schizophrenia
Supporting research-
-Support from Tierni et al showed that the illness only manifested in appropriate environmental conditions like an EE family
-Berger- found schizophrenics could recall double bind statements from mothers more than non schizophrenics
-Read et al reviewed 46 studies of child abuse and schizophrenia and found that 69% of adult women in patients and 59% of men with a diagnosis of schizophrenia had a history of physical abuse/ sexual abuse in childhood
Criticisms-
-Parent blaming
-Deterministic/ individual differences
-Reductionist environmentally
-Liem found no differences in communication styles in families between SZ and non
Opposing -
-Biological explanations Mz twins and dopamine hypothesis
Usefulness-
-Help family not be too stressful for schizophrenics and provide an environment that will help the schizophrenic patient not relapse
evaluate cognitive disfunction as an explanation of schizophrenia
Limitations:
-Doesn’t explain where the dysfunctional thought processes came from in the first place
-Biological approach is stronger and more scientific like Mz twins having a 40.4% concordance rate
-Howes and Murray address the problem of reductionism with an integrated model of schizophrenia and argue that the early vulnerability factors like genes paired with the exposure of social stressors is what causes schizophrenia.
Strengths:
-Sarin and Wallin research support- reviewed research relating to the cognitive model of schizophrenia and found supporting evidence for the claim that the positive symptoms have their origins in faulty cognition. For example, delusional patients were found to show various biases in their informational processing such as jumping to conclusions that lack reality
-CBT can help limit the symptoms of schizophrenia by encouraging patients to evaluate the content of their delusions or of any voices and to consider the ways they might test the validity of their faulty beliefs. It was also shown in the NICE review that CBT was more effective in reducing symptom severity and improving levels of social functioning compared to drug treatments. So, we can say there are cognitive reasons for symptoms
what are the four treatments of schizophrenia
Drug therapies
CBT
Family therapy
Token economy
outline the use of drugs as a treatment for schizophrenia
antipsychotics help a person with a disorder function as well as possible in life and are usually recommended for initial treatment for the symptoms of schizophrenia and there are two types typical and atypical
outline what atypical antipsychotics
Atypical antipsychotics: used to combat the positive symptoms but they are also claimed to have some beneficial effects on negative symptoms as well
Have beneficial effects on negative symptoms like cognitive impairments and are suitable for treatment resistant patients
Only temporarily occupy the D2 receptors and then rapidly dissociate to allow normal dopamine transmission that is thought to be responsible for the lower levels of extrapyramidal side effects
Atypical antipsychotics have a stronger affinity for serotonin receptors and a lower affinity for D2 receptors and this explains the different effects of the atypical drugs on the negative symptoms
outline what typical antipsychotics are
Typical antipsychotics: are primarily used to combat the positive symptoms such as hallucinations and thought disturbances- products of an overactive dopamine system
Reduce the effects of dopamine by binding to the D2 receptors in the mesolimbic pathway to eliminate the hallucinations and delusions
Leads to extrapyramidal side effects as it blocks dopamine receptors in other pathways in the brain and this can cause tardive dyskinesia, blurred vision, immobility, tremors and high BP
evaluate drugs as a treatment of schizophrenia
+ supporting research as Leucht et metanalysis of 65 studies published involving 6000 patients and all of them were either given an atypical or typical antipsychotic and some of them were then taken off of them ad given a placebo instead and 64% of those who had been given the placebo had relapsed compared to 27% of those who stayed on the antipsychotic.
- Extrapyramidal side effects like movement problems for the patient and appear to impact the extrapyramidal area of the brain which helps control the motor centre and the most common are Parkinsons related symptoms and more than half of the patients taking typical antipsychotics experience these problems.
Typical antipsychotics also cause low white blood cell which causes septicaemia counts which causes them to have to take regular blood tests must be taken - The prescription of antipsychotics reinforces the view that there is something wrong with them and this prevents the individual from thinking about possible stressors that might be possible for their condition and therefore reduces their motivation to look for possible solutions that might alleviate these stressors.
+ cheaper, easier and can be the first step required for other treatments like CBT
outline cognitive behavioural therapy as a treatment of schizophrenia
This form of therapy is called CBTp when used ot treat schizophrenia which was originally developed to provide treatment for residual symptoms that persist despite drug treatments. The CBT corrects faulty thoughts and provide coping strategies.
Method of CBTp
1. Assessment where the patient expresses his or her thoughts about their experiences to the therapist and realistic goals are discussed
- Engagement where the therapists empathises with the patients perspective and their feelings of distress
- The ABC model where the patient gives their explanation of the activating events and irrational beliefs that appear to cause their emotional and behavioural consequences
- Normalisation telling the patient that many people have unusual experiences such as hallucinations and delusions under maybe different circumstances reducing anxiety and sense the isolation and this makes the patient feel less alienated and stigmatised making recovery seem more possible
- Critical collaborative analysis where the therapist uses gentle questioning to help the patient understand illogical deductions and conclusions
- Developing alternative explanations where the patient develops thier own alternative explanations for their previously unhealthy assumptions and these healthier explanations might have been temporarily weakened by their dysfunctional thinking patterns
evaluate CBT as a treatment for schizophrenia
+ the NICE review of treatments for schizophrenia found consistent evidence that when compared to standard care CBTp was effective in reducing rehospitalisation rates up to 18 months treatment and was shown to be effective in reducing symptom severity
- CBTp seems to be more effective in specific stages of the disorder Addington and Addington claim that in the initial acute phase schizophrenia, self-reflection is not appropriate, and CBT is more appropriate after initial drug treatment
- Lack of availability of CBTp as there are not enough clinical psychologists are out there are the treatment requires 1 on 1 long term treatment
- There are schizophrenic specific barriers to CBT like: negative symptoms making it hard to be motivated for change, hallucinations/delusions may make it difficult to remember to engage with the therapist, poor memory recall may make it difficult to remember to engage in homework tasks, patient must want to get rid of the voice and some build relations with the voice
outline family therapy as a treatment for schizophrenia
Family intervention has developed as a result of srudies of the family environment and its possible role in affecting schizophrenia. Research has consistently shown that schizophrenia has much to do with the relationship between the individual anf those who care for them.
Poor relationships tend to result in relapse and the aim of family therapy is to provide support for carers in an attempt to make family life less stressful
Family therapy is typically offered for a period of between 3 and 12 months and at least 10 sessions. Family based interventions are aimed at reducing the level of expressed emotion within the family as expressed emotion has been demonstrated to increase the likelihood of relapse
The strategies include:
1. Reducing the emotional climate within the family and the burden of care for family members
2. Enhancing relatives ability to anticipate and solve problems
3. Reducing expression of anger and guilt by family members
4. Maintaining reasonable expectations among family members for patient performance
evaluate family therapy as a treatment for schizophrenia
+ Pharoah et al meta analysis established that family therapy can be effective in improving clinical outcomes such as mental state and social functioning - but some suggest this is more to do with the fact it increases medical compliance
+ additional advantages as the family therapy has been showed by Lobban that 60% of these studies reported a significant positive impact of the intervention on at least one category
- Garrety et al failed to show any better outcomes for patients given sessions of family therapy compared to those simply having carers. Individuals in both groups were found to have low relapse rates and that family intervention may not improve outcomes further than a goof standard of treatment as usual.
- expensive and time consuming
- only appropriate if family is high EE or double bind is occuring
outline token economies as a treatment of schizophrenia
The use of the token economy system based on the principles of operant conditioning was developed as a way of dealing with these negative symptoms and encouraging more positive behaviours.
The behavioural principles employed in token economy systems are based on the theory of operant conditioning and the idea that the tokens are positive reinforcers
There are 2 types of reinforcer:
Primary reinforcers are anything that gives pleasure or remove unpleasant states and they don’t depend on learning to acquire their reinforcing value
Secondary reinforcers initially have no value to the individual but acquire their reinforcing properties as a result of being paired with primary reinforcers and the token is given out when a patient engages in a target behaviour
For the reinforcer to be effective it must be given out immediately after the target behaviour otherwise the token will encourage another behaviour
evaluate token economy as a treatment for schizophrenia
+ research support from Dickerson et al who reviewed 13 studies of the use of token economies in the treatment of schizophrenia and 11 of these studies had reported beneficial effects and found overall the studies provided evidence of token economies being effective in increasing the adaptive behaviours of people with schizophrenia.
- It could also be unethical as you are rewarding things that should be rights anyway like Tv and food treats
+ It is cost effective, easy and doesnt require training to implement
- It wouldn’t work in a real life setting as you cant keep tabs on them at all times and they may do undesirable behaviour and the rewards have to be appropriate for the patients
outline the interactionalist approach for an explanation of schizophrenia
There are a number of different theories about the onset of schizophrenia and the diathesis stress model is a an explanation that proposes that the onset of schizophrenia is caused by a combination of genetics and the environment a person is exposed to
According to the model there is a genetic component in schizophrenia that makes someone vulnerable and this is supported by the twin studies and the 40.4% concordance rates between Mz twins compared to the 7.4% with Dz twins. Then there is the stress part of the model where life experiences can trigger schizophrenia like childhood trauma and this is showed by Varese et al who found that children who experienced severe trauma before the ages of 16 were 3x more likely to develop schizophrenia
outline the key study into the diathesis stress model as an explanation of schizophrenia
Key study: tiernari et al
Procedure- hospital records reviewed for nearly 20,000 women admitted to psychiatric hospitals identifying those that had been diagnosed at least once with schizophrenia and this list was checked to find mothers who had more than one offspring adopted away. The resulting sample was 145 at high risk of schizophrenia and this was paired with a control group of 158 without genetic risk.
Both groups of adoptees were independently assessed after an interval 12 yrs with a follow up after 21 yrs and they were interviewed and rated on the OPAS scale
Findings:
Of 303 adoptees 14 developed schizophrenia over the course of the study and 11 of these were from high risk groups and 3 from the low risk group
evaluate the diathesis stress model as an explanation for the onset of schizophrenia
- Diathesis may not be exclusively genetic and there may be a link to brain damage instead of genetics like experiencing oxygen deprivation in labour making a person 4x more likely to get schizophrenia
- Difficulties that the diathesis stress model is that Hammen argues that is the challenges a person faces that builds up their ability to develop effective coping skills and those who don’t are more vulnerable to stress and mental illness
- limitations of the Tiernari study is that the researcher identified that the assessment was of the family at one singular time and that the adoption may be the stressor and not the family
+ supports the usefulness of adopting an interactionalist approach from studies comparing the effectiveness of combinations of biological and psychological treatments and the isolated treatments the interactionalist treatments are more superior
- Turkington et al argued that there is a good logical fit between the interactionalist approach and using combination treatments, but this could be causation fallacy and that it doesn’t necessarily mean that it is correct
