Schizophrenia Flashcards
1
Q
What is meant by schizophrenia?
A
Schizophrenia is a mental disorder characterised by a profound impairment to cognition and emotion
2
Q
Why is it a type of psychosis?
A
Because thoughts and emotions are so impaired that there is a loss of contact with reality.
3
Q
What is the DSM-V
A
Diagnostic & statistical manual of mental disorders
4
Q
What are the type types of symptoms?
A
Positive (excess of normal function) and negative (loss of normal functions)
5
Q
What are the three types of positive symptoms
A
Delusions, Hallucinations, disorganised thinking and speech.
6
Q
What are delusions?
A
Delusions are bizarre beliefs that seem real to the sufferer but are untrue.
7
Q
What are two types of delusions?
A
Delusions of grandeur- you are more important/ powerful or have special abilities.
Delusions of persecution- being followed or spied upon.
8
Q
What are Hallucinations, and the senses?
A
Hallucinations are unreal perceptions of reality or the environment that are sensory.
(Auditory, visual, tactile, olfactory)
9
Q
What is disorganised thinking and speech?
A
Problems organising his or her thoughts which lead to incoherence.
10
Q
What are the three types of disorganised speech?
A
Neologisms: newly created words with no meaning
Word salads: random mixture of words or phrases that have no meaning.
Clang: compulsive rhyming.
11
Q
What are the two types of negative symptoms?
A
Avolition and Poverty of speech (Alogia)
12
Q
What is Alogia?
A
Alogia is characterised by a reduction in the amount and quality of speech ( they have difficulty producing words and also produce fewer words)
13
Q
What is Avolition?
A
Avolition is the reduction of interests and desires - inability to persist in goal driven behaviours.
14
Q
Why is Avolition different to poor social functioning?
A
For Avolition there must be a reduction in self initiated involvement in activities that are available to the patient.
15
Q
What is the requirement for diagnosis statement?
A
Under DSM-V criteria the diagnosis of schizophrenia requires two or more positive or negative symptoms to persist for at least two months.
HOWEVER: only one symptom is required if it is considered particularly problematic.
16
Q
What is the classification?
A
Definition in the manuals
17
Q
What is the diagnosis?
A
Application to the patient
18
Q
ISSUES SURROUNDING THE CLASSIFICATION AND DIAGNOSIS OF SZ. - How is this essay split?
A
D: Issues with the validity of classification and diagnosis of SZ.
D: issues with the reliability of classification and diagnosis (of SZ).
19
Q
What is meant by the validity in SZ?
A
Validity refers to EXTENT TO WHICH A DIAGNOSIS OF SZ REPRESENTS AN ACCURATE AND REAL DIAGNOSIS DISTINCT FROM OTHERS
and
the EXTENT TO WHICH A CLASSIFICATION SYSTEM (DSM-V) MEASURES WHAT IT INTENDS TO MEASURE.
20
Q
What are the three problems making it difficult for the classification and diagnosis of SZ to be valid?
A
Gender bias
Symptom overlap
Comorbidity
21
Q
What is meant by gender bias in classification and diagnosis of sz?
A
The accuracy of the diagnosis is dependant on the gender of the individual, diagnostic criteria may be more biased to one gender (or due to stereotypical beliefs of the clinician)
22
Q
What is meant by symptom overlap in SZ?
A
Some symptoms of SZ are also found in other disorders such as bipolar disorder (both involve positive symptoms like delusions) - difficult to accurately distinguish SZ from other disorders
23
Q
Comorbidity
A
The extent to which two or more conditions co-occur (people diagnosed with SZ may also suffer from symptoms of depression) - this makes it hard to separate out the different conditions during diagnosis and what treatments to provide
24
Q
E: support from Loring and Powell - Gender bias
A
Group of randomly selected male and female participants given a case described as male 56% gave diagnosis of SZ but female only 20% diagnosed with SZ.
25
Evidence for force comorbidity issues from Buckley et al.
Comorbid depression occurs in 50% of patients and 47% have a diagnosis of comorbid substance abuse - this makes diagnosis difficult
26
what Is meant by the reliability and how can it be measured
May be issues with the reliability (consistency) of SZ diagnosis. Inter-observer reliability: whether two independent assessors using the same classification give the same diagnosis. Test-retest reliability: diagnostic tests are consistent on different occasions.
27
What is meant by Culture bias in SZ?
Culture bias can lead to issues with the validity and the reliability of diagnosis - The accuracy of the diagnosis is dependant on the cultural background of the individual - This can lead to inconsistent diagnosis.
28
Evidence for cultural bias in diagnosis comes from Copeland.
Copeland found that when british and American psychiatrists were given a description of a patient and asked for a diagnosis 69% Americans gave diagnosis whereas 2% of british did. Diagnosis has low inter-observer reliability between cultures
29
Patients from certain cultures are more likely to be diagnosis.
Harrison et al found that African Caribbean groups were 8 times more likely to be diagnosed with SZ than white groups in the UK, This could be from misinterpreting cultural differences - ethnocentric bias reduces the validity
30
The genetic explanation for SZ suggests what?
SZ is passed on from one generation to another through inheritance- The more closely related a family member is to the schizophrenic the more likely the chance of developing the disorder.SZ is thought to be polygenic.
31
Where does the evidence for biological explanation come from?
Twin studies, family studies and adoption studies: All used to establish concordance rates.
32
What is meant by concordance rate in SZ?
The degree to which relatives share the same disorder, using MZ and DZ twins where one of each twin pair has SZ can be compared to see how often the other twin shows the same illness. (if it is genetic MZ twins should have higher concordance rates than DZ)
33
What support has come from Family studies (Varma)
Varma found that 16% of the first degree relatives of schizophrenics developed SZ whereas only 7% of the controls did. - inheriting genes from a relative with SZ inc chance of developing disorder.
34
Evidence come from twin research (Joseph)
He found a concordance rate of 40% in MZ twins and just over a 7% in DZ twins this suggests the more genes that you share with someone the more likely you are to develop.
HOWEVER other factors this is because concordance rate was not 100% for MZ twins.
35
What is meant by the Dopamine hypothesis?
This biochemical explanation suggests that positive symptoms of SZ is the result of the overactive transmission of the neurotransmitter dopamine, Schizophrenics are thought to have abnormally high numbers of D2 receptors on receiving neurons
36
what does having abnormally high numbers of D2 receptors mean?
more dopamine binding and therefore more neurons firing, since dopamine plays a role in guiding attention, this may lead to problems relating to attention and perception and thought to be found with people with SZ
37
Evaluation - practical application
The dopamine hypothesis has lead to practical applications in developing treatments for SZ - Typical antipsychotic drugs blocking D2 receptors so reduce positive symptoms like hallucinations and delusions this has benefitted lives in the real world.
38
Evidence to support the dopamine hypothesis comes from drug research.
Amphetamine drugs are dopamine agonists which means that they stimulate neurons containing dopamine causing the synapse to be flooded with this neurotransmitter. This seems to show excess of dopamine in the brain helps explain onset of positive symptoms of SZ.
39
why are newer atypical antipsychotics better than typical.
They only temporarily block dopamine but they also act on serotonin and are more effective than typical antipsychotics, this suggests that not just dopamine plays a role in SZ other factors like serotonin do too
40
What is meant by a neural correlate?
Measurements of the structure and function of the brain that correlate with an experience - abnormalities within specific brain areas associated with the development of SZ
41
What is the abnormality for SZ (Neural correlates)
By using fmris it is found that schizophrenics had enlarged ventricles these enlarged ventricles are associated with damage to central brain errors and prefrontal cortex.
42
What is one problem of Neural correlates?
Cause and effect is unclear as it could be the schizophrenia itself causing the changes in brain structure - therefore we do not fully understand the roles of neural correlates in the development of schizophrenia.
43
What are problems with biological explanations (Dopamine hypothesis, neural correlates and genetic explanation) of SZ?
They are determinist - SZ is caused by factors outside of our control, this is a problem as it ignores our free will.
They are reductionist this is because it focuses wholly on internal factors and may ignore the role that the environment plays
44
Evidence for enlarged ventricles comes from …? who found...?
Johnstone et al found that schizophrenics had enlarged ventricles compared to a control group
45
What is the main psychological explanation for Schizophrenia?
This is the family dysfunction explanation, claims that the risk of SZ is increased by abnormal patterns of communication within the family
46
Family dysfunction is split into two explanations, describe double bind theory.
Double bind theory: Bateson suggested that children who receive contradictory messages from parents are more likely to develop SZ. (then give example) (these contradictions means the child regularly finds themselves trapped in situations where they fear doing the wrong thing but receive mixed messages about how to think or behave). Contradictory messages leave the child with an understanding of the world as confusing and dangerous, later reflected in symptoms such as paranoid delusions
47
What is meant by expressed emotion regarding the psychological explanations of SZ.
This refers to the level of emotion expressed towards the SZ sufferer by their family.
- Verbal criticism of the patient: hostility towards them.
- Emotional over-involvement in the patients life: needless sacrifice.
EE has been linked to the course rather than the cause, EE can lead to an increased likelihood of relapse.
48
Why can family dysfunction explanations for SZ be criticised for ethical issues?
Both double bind theory and EE suggest that parents are responsible for their child's illness which may cause even greater stress and anxiety, this suggests that these theories may be more harmful than helpful.
49
Support for the double bind theory comes …? who found ….?
Berger found that Schizophrenics reported higher recall of double bind statements from their mothers than non-schizophrenics. This suggests that contradictory messages during upbringing may increase the risk of SZ later in life.
50
One positive of family dysfunction theories is that...? and what did NICE find?
They have lead to practical applications such as family therapy to decrease chance of relapse, NICE found relapse rate in family therapy condition was 26% compared to control group 50% relapse rate.
51
What is the cognitive explanation for SZ?
Focuses on the role of thinking, This explanation argues that symptoms are the result dysfunctional thought processing, Specific symptoms can be linked to disruption to specific cognitive processes.
52
What is meant by egocentric bias in terms of the cog explanations for SZ?
Delusions (of grandeur) are a result of egocentric bias - sufferers interpret external events as having personal significance to them. Central component of unrelated events leads to false conclusions e.g. flashes of light may be god signalling something to them,
53
What is meant by central control in terms of the cog explanations for SZ?
This is the second cognitive ability which may be dysfunctional in some sufferers- this is the ability to supress automatic responses whilst performing deliberate actions e.g. sentences may become derailed (helps explained disorganised thinking and speech).
54
What is one problem with all psychological explanations for SZ?
Cause and affect is not clear as irrational thinking (and abnormal patterns of communication) could be an effect rather than the cause of SZ - we do not fully understand the role of psychological factors in SZ.
55
What is one strength for the cognitive explanations for SZ? And what did NICE find?
It has practical applications this is because it has lead to the development of Cognitive Behavioural Therapy for psychosis which has been extremely effective in treating SZ. NICE found that CBTp far more effective than antipsychotic drug therapy at treating symptom severity,
56
What do psychological explanations of SZ fail to take into account?
They fail to take into account the role of biological factors e.g neurotransmitters like dopamine or brain abnormalities which are associated with the development of SZ. Therefore a more wholistic approach must be considered, this suggests that the interactionalist approach which combines both biological and psychological explanations may be more appropriate
57
Biological therapies for SZ: drug therapies. Typical antipsychotics
ANTIPSYCHOTIC DRUGS
Typical-antipsychotic drugs (e.g. Chlorpromazine) - Positive symptoms such as hallucinations and delusions are thought to be result of overactive dopamine system. Chlorpromazine is a dopamine antagonist (works to reduce effects of dopamine), by binding to the D2 receptors this blocks their action this in turn reduces the positive symptoms within days of being medicated.
58
Biological therapies for SZ: drug therapies. Atypical anti-psychotics
ANTIPSYCHOTIC DRUGS
Atypical-antipsychotic drugs (e.g. Clozapine) help deal with the positive and negative symptoms, (e.g. hallucinations and avolition) these work by temporarily blocking dopamine receptors before dissociating to allow normal transmission, they also impact on serotonin. These second gen drugs have lower risk of extreme side effects and work on the negative symptoms as well as positive.
59
Evidence to support the effectiveness of Chlorpromazine comes from placebo research by Th...
Thorny who reviewed studies comparing effects of Chlorpromazine to control groups in which patients received placebo, it was found that Chlorpromazine was associated with reduced symptom severity and reduced relapse rates, this is positive as typical antipsychotic drugs are medically effective at preventing relapse rates.
60
One major criticism of Typical anti-psychotic drugs is that they are less appropriate. However...
This is because they have worrying side effects, for example 30% of people taking this medication develop a condition called TARDIVE DYSKINESIA which leads to patients to suffer uncontrollable repetitive movements (e.g. excessive eye blinking) negative as the costs of taking the drug may outweigh the benefits. However the rates of TARDIVE DYSKINESIA have found to be only 5% for atypical antipsychotics.
61
What is one problem with all drug therapies is that...
The side effects can lead to a huge problem with patient compliance, it was found that 50% of SZ patients stop taking their medication after a year, this causes revolving door syndrome (reluctant to taking medication and regularly relapses) this means that drugs may not be appropriate if they rarely lead to a long term and stable recovery.
62
Psychological therapies for SZ.
Cognitive behavioural therapy (For psychosis) (CBTp) works by challenging irrational thoughts and replacing them with rational ones (cognitive restructuring)
- Focuses the patient on the present experience and aims to identify irrational thoughts (Thought catching) keeping it in a thought record.
-Patient as scientist as they are generating hypotheses which can be tested (active participation), may be set homework test the validity of these thoughts (give the delusions of persecution going to shops example)
-Ellis building on ABC model with D,E: patients are asked to write down suggestions to DISPUTE their irrational beliefs (There are three types of disputing) by regularly asking these questions when irrational thoughts occur they will eventually do it spontaneously. The EFFECT of thinking differently will reduce anxiety and have a positive effect on their behaviour.
63
What are the three types of disputing? + Explain
Logical Disputing - whether or not the beliefs make sense
Empirical Disputing - seeking evidence for beliefs
Pragmatic- questioning the usefulness of belief
64
Evidence to support the effectiveness of CBT(p) comes from ....
NICE, who found that CBTp was far more effective that anti-psychotic drug therapies at treating symptom severity and also improved social functioning, This shows that CBTp is a very effective treatment of SZ.
65
The effectiveness of CBTp may depend on...
The stage of the disorder, Addington and Addington claim that in the initial phase of SZ Self reflection on symptoms may not be appropriate but following stabilisation of symptoms individuals can benefit from group based CBT, this is negative as CBT is limited and may only be useful for specific stages of treatment,
66
What is the other type of psychological therapy for SZ?
Family Therapy is based off the idea that may patients returning home from institutional care are more likely to relapse if they return to a families that show high 'expressed emotion', therefore the aim of family therapy is to make family life less stressful to reduce the risk of relapse.
- Educating families about the risk of high expressed emotion and enabling them to understand SZ better.
- This should enable families to reduce expressions of anger and guilt whilst also having more reasonable expectations for patient behaviour as well as warning signs to look out for to help prevent relapse.
67
Evidence to support the effectiveness of family therapy comes from...
Nice who found that relapse rate in the family therapy condition was 26% whereas the control group who had standard care had a relapse rate of 50%, this shows that family therapy is effective at preventing relapse.
68
One problem with all psychological therapies is that...
They may only address the symptoms and not the causes of SZ, for example it has been argued that SZ has biological causes such as dopamine, this suggests that psychological therapies may only be appropriate when used alongside other therapies e.g. biological treatments (Chlorpromazine and Clozapine)
69
Psychological therapies are more appropriate than Biological because..
Psychological therapies have a ideographic approach as family therapies and CBTp can be easily adapted to the needs of patients unlike biological therapies that treat every sufferer in a similar way (a nomothetic approach)
70
Token economy and the management of SZ (A type of behavioural therapy)
A token economy is a form of behavioural therapy where clinicians (or psychiatrists) set target behaviours that they believe will improve the patient's engagement in daily activities. in particular it is used to manage those who have developed maladaptive behaviours. This is based off the assumption that all behaviour is learnt through the principles of conditioning and can therefore be unlearned (Counter conditioning).
- Token economy uses operant conditioning and aims to use selective positive reinforcement to encourage appropriate behaviour e.g. tokens may be given for making their bed. These tokens can then be used to obtain various privileges such as cigarettes.
-Over time to encourage further improvements, more may be expected of patients to achieve token rewards, this means that their behaviour can be shaped over time.
71
Support for the effectiveness of token economies comes from Dickerson et al...
.. who found from a meta-analysis that 11 out of 13 studies had reported beneficial effects, therefore it can be said that token economies increase the adaptive behaviour of SZ patients in institutional care.
72
However it is argued that the token economy may not be as effective as..
Token economies are only effective in treating the negative symptom which involve social withdrawal and are not effective at treating the positive symptoms such as hallucinations and delusions.
73
Added section on classical conditioning to Token economy:
Tokens initially have no value but their value has to be learned by associating them with the rewards they receive in exchange, the rewards are primary enforces as they give pleasure without the need for learning whereas the tokens themselves are secondary reinforces as they have to acquire their value through association with the primary reinforcers (Classical conditioning)
74
Name two other problems with token economies.
-May only be effective in institutions as their good behaviour can be consistently rewarded.
-There are also ethical issues surrounding this approach as it is viewed as taking the power away from an individual.
75
The interactionalist approach to SZ
The diathesis stress model sees SZ as a result of an interaction between the biological (diathesis) and the environmental (stress) influences, whether or not a person develops SZ is partly determined by an individuals genetic vulnerability but also by the amount and level of stresses they experience over their lifetime.
-DIATHESIS-
-genes play a key role in the development of SZ, this is supported by MZ twins who share 100% of the same genes have a greater risk of developing SZ than a DZ twin, in 50% of identical twins where one has the disorder the other does not this suggests that environmental factors must also play a role in determining whether the vulnerability develops into the disorder.
-STRESS-
-Stressful life events can trigger SZ in lots of forms such as childhood trauma. VARSE found that children who had experienced severe trauma before the age of 16 were three times likely to develop SZ in later life. It has also been suggested that living in an urban environment can also increase the risk as a result of stressful living conditions and densely populated areas.
76
What is the treatment according to the interactionalist approach?
Interactionalist approach acknowledges both biological and psychological factors in SZ and it is then compatible with both biological and psychological treatments this model would therefore combine anti-psychotic medication with psychological therapies such as CBTp.
77
Why might the 'stress' not be exclusively environmental?
More modern versions of the diathesis stress model suggest that anything may trigger SZ including biological factors like drug use, for example cannabis is seen as a key stressor as it increases the risk of SZ by up to 7 times according to the dose, therefore the original diathesis model may be too simple.
78
Support for the effectiveness of combinations of treatment comes from T..
Tarrier et al who found that after patients were randomly allocated to a medication + CBTp group, medication + supportive counselling group or control group, patients in the two combined treatments group showed lower levels of symptoms than those in the control group, this is positive as it shows a clear advantage to adopting an interactionalist approach, THEREFORE THE APPROACH CAN BE PRAISED FOR TAKING A HOLISTIC VIEW TO EXPLAINING AND TREATING SZ
79
We are still unsure on how exactly diathesis and stress work..
we do not yet fully understand the mechanisms by which the symptoms of SZ appear and how both the vulnerability and the stress interact to produce them, this would therefore suggest that the interactionalist explanation of SZ is incomplete as it is limited in its explanation of how SZ develops
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