Schizophrenia Flashcards

Question

whats NICE

Answer 1

The National Institute of Health and Care Excellence

Answer 2

Research has shown that CBT is only effective when made available at certain stages of the treatment Addington and Addington (2005) – claim that self-reflection isn’t appropriate during the initial phase of schizophrenia - after theyv'e been stabalised Only once symptoms are stabilized with antipsychotic medication can patients benefit from normalising their experience with CBT Furthermore, research has consistently shown that CBT is more effective on patients that have had longer experience with their symptoms weakess?

Answer 3

Despite being recommended by NICE, only around 1 in 10 patients in the UK get access to CBT for schizophrenia – the average is found to be even lower in some parts of the country Haddock et al. (2013) found that out of 187 randomly selected patients form North West England, only 6.9% had been offered CBT for schizophrenia Colling et al. (2017) found that 34.6% of patients received at least one session and 26.4% at least two sessions of CBT Issue? However, Freeman et al. (2013) found that from those who are offered CBT, a significant number refuse or fail to turn up

Answer 4

psychological therapy carried out on some/all family members to improve communication and reduce stress in the family environment

Answer 5

Prioritised when there are persistent symptoms or a high risk of relapse Offered for between 3-12 months with at least 10 sessions Sessions aim to reduce EE, educate family members about schizophrenia and provide ways to support the patient Family members are to listen to one another and discuss solutions together Burbach’s model of practice: Phase 1: sharing info, 2: identifying resources, 3: create a safe space for expression, 4: identify unhealthy communication, 5: stress management skills, 6: relapse prevention planning, 7: future maintenance

Answer 6

McFarlane (2016) carried out a review on family therapy and concluded that it is one of the most consistent treatments for schizophrenia For example, relapse rates typically reduce by 50-60% He also concluded that family therapy is highly effective when mental health is initially declining (early stages) Furthermore, NICE also recommends family therapy – they advise that all patients should be offered it once diagnosed with schizophrenia

Answer 7

The NICE review of family therapy studies found that there is significant reduction in costs for standard care of patients This is because of lower relapse rates 🡪 less hospitalisation The cost of taking additional care of relapsed patients is much more expensive than family therapy Additionally, family therapy reduces relapse rates even after the intervention is completed – meaning even more money is being saved

Answer 8

Family therapy is seen to have a positive impact on family members, as well as the patients themselves It can reduce negative impact schizophrenia has on family members and strengthens ability to support the patient Lobban et al. (2013) meta analysis on 50 family therapy studies that included intervention to support relatives 60% of studies reported a significant positive impact on relatives for at least one outcome category (problem-solving skills, relationship quality) Long term, keep using the resourses and not relasping However, methodological quality of those studies was generally poor, making it difficult to distinguish between effective/ineffective interventions

Answer 9

A form of behaviour modification where desirable behaviours are encouraged via reinforcement

Answer 10

A management technique based on operant conditioning Patients are given tokens whenever they engage in a target behaviour 🡪 tokens exchanged 🡪 rewards and privileges Ayllon and Azrin (1968) – female hospitalised patients 1. Neutral tokens given after functional tasks are completed (making bed, finishing meals) 2. tokens are then exchanged for a variety of rewards (e.g. TV, visits from family, etc.) 3. frequent exchange = frequent desirable behaviours No longer used as ‘treatment’ for ethical reasons

Answer 11

To correct bad habits developed due to prolonged hospitalisation Helps modify personal care (hygiene), condition-related behaviours (e.g. avolition) and social behaviour (interaction) Such modifications: Improve quality of life in hospital settings Normalise behaviours that will help patients adapt to demands in the outside world

Answer 12

- Based on operant conditioning – tokens are secondary reinforcers that allow for access to primary reinforcers (TV, snacks, visits, etc.) - Tokens that can be exchanged for a range of rewards are also known as generalised reinforcers (like money) - Tokens are awarded for target behaviours decided on a case by case basis - They work best when the reward is given directly after the token is received – immediate reward is more effective than delayed reward

Answer 13

- Glowacki et al. (2016) identified and reviewed 7 high quality studies published between 1999 and 2013 that tested the effectiveness of token economies on patients hospitalised with chronic mental disorders - All studies showed a reduction in negative symptoms and a reduction in unwanted behaviours - Counter - is this research as strong as it looks? - Reviews containing fairly small numbers of studies indicate that there is a file drawer problem This means that studies that show insignificant or mixed (unreliable) results are ‘filed away’ This reduces the number of studies available for review, leaving a bias selection of ‘high quality’ studies to draw conclusions from Although there is research that demonstrates the effectiveness of token economies, it may not be as credible as it seems

Answer 14

- Despite token economies no longer being in use as a ‘treatment’ for schizophrenia, ‘behaviour management’ in this way still raises ethical concerns (ristricts individual free will, failire to protect psychological harm) Token economies give the professionals with authority the power to control their patients’ behaviour This can become problematic when target behaviours are not decided sensibly – e.g. staff can modify behaviours to fit their norms instead of their patients’ norms Problem? It can become easy to restrict patients of their rights to choose their norms and behaviours, as well as restricting pleasure altogether E.g. a patient may enjoy to appear scruffy or sleep in late but staff can ‘modify’ those behaviours with reward Patients may lose out on basic pleasures like watching tv or speaking to family if they do not comply to the chosen system The benefits of token economies may be outweighed by the ethical concerns

Answer 15

A way of explaining behaviour using a range of factors, such as biological and psychological factors

Answer 16

Most importantly, an interactionist approach focuses on how different factors combine to explain behaviour, rather than simply adding/including various factors together (the ways in which factors combine cannot be predicted by each factor separately) The interactionist approach to explaining schizophrenia acknowledges the role of biological, psychological and social factors to explain its development (e.g. genetic vulnerability, stress and poor familial communication respectively)

Answer 17

An interactionist approach to explain behaviour that suggests that a vulnerability and a stress-trigger are needed to develop a condition

Answer 18

For schizophrenia, diathesis can include one or more factors that make someone vulnerable to developing it (historically this just included genetics, but now we understand trauma to be a diathesis) But the onset of symptoms of schizophrenia is triggered by stress The diathesis-stress model explanation can be split into two – the original model (Meehl’s model) and the modern model

Answer 19

The original diathesis-stress model suggested that the diathesis for schizophrenia is purely genetic (schizogene) This led to the development of a biologically based ‘schizotypic’ personality – characterised by sensitivity to stress Furthermore, an individual without the schizogene would never develop schizophrenia, regardless of any stressful events But an individual that possesses the schizogene could develop schizophrenia if they experience chronic stress during childhood – in particular, if they have a schizophrenogenic mother

Answer 20

Diathesis – we now know there is no one ‘schizogene’ Different variations of candidate genes only increase vulnerability to schizophrenia by a fraction Early psychological trauma is also considered a diathesis now (rather than an environmental stressor) Read et al.’s neurodevelopmental model (2001) suggests that severe early trauma (e.g. child abuse) can alter many aspects of brain development For example, it can cause overactivity in the hypothalamic-pituitary-adrenal (HPA) (too much adrenaline) system, making the individual more vulnerable to later stress

Answer 21

In Meehl’s original model, stress was mainly psychological and related to parenting Although still important, ‘stress’ in this model is now considered to include anything that risks triggering schizophrenia Example: Cannabis Cannabis has been found to increase risk of developing schizophrenia by up to 7 times (particularly THC-rich doses) Research indicates that cannabis interferes with the dopamine system Many people that smoke cannabis do not develop schizophrenia, suggesting that most do not have the vulnerability for triggering it in the first place

Answer 22

Hospital records were reviewed from 19,000 Finnish adoptees with biological mothers that had a diagnosis of schizophrenia (high genetic risk) They were compared with a control group of adoptees with no family history of schizophrenia (low genetic risk) They also assessed the parenting style of the adoptive parents They found that a parenting style involving high levels of criticism and hostility and low levels of empathy were strongly associated with the development of schizophrenia in the children But this relationship was only found to be the case for children in the high genetic risk group – so? This suggests that a combination of genetic vulnerability and family stress may cause schizophrenia – validating the interactionist approach

Answer 23

The original model has been criticised for being too simplistic – there is no one schizogene or stressor that causes schizophrenia There are multiple genes found to increase vulnerability to schizophrenia (they have very little effect on their own) Stress can also come in many forms – stress can be biological as well as psychological Houston et al. (2008) – found that childhood sexual trauma was a major vulnerability factor, whereas cannabis use was a major trigger for developing schizophrenia Shows that diathesis is not strictly biological and stressors are not strictly psychological Problem? This invalidates the original model and supports newer versions But still suggests more research and understanding is needed to effectively apply the diathesis-stress model to schizophrenia

Answer 24

There has been support for the effectiveness of combined treatment Biological and psychological treatments combined are more effective than biological treatment alone Tarrier et al. (2004) – randomly allocated 315 patients to either medication+CBT, medication+counselling or medication only (control) They found that both combined groups showed lower symptom levels than the control group Strength? However, they found no differences in hospital readmissions

Answer 25

Researchers have critiqued the popular assumption that ‘effective treatment = valid explanation’ This is known as the ‘treatment-causation fallacy’ Successful treatment does not justify it’s matching explanation E.g. drinking alcohol reduces shyness – does this make lack of alcohol the cause of shyness? No. But the same logic is applied explanations and treatments for disorders like schizophrenia Just because combined treatment is the most effective doesn’t necessarily mean combined (interactionist) explanation is the most valid

Answer 26

Just because clinicians are consistent in diagnosis (while using the same system) doesn’t mean they are accurately diagnosing schizophrenia As the ICD-10 and DSM-5 use different criteria to diagnose, the same patient may not get a consistent diagnosis across clinicians Cheniaux et al. (2009) had two psychiatrists diagnose 100 patients independently using DSM-5 and ICD-10 criteria They found that one psychiatrist diagnosed 70/100 patients (26 using DSM and 44 using ICD) and the other diagnosed only 37/100 patients (13 using DSM and 24 using ICD) This also means 68 were diagnosed using the ICD and only 39 were diagnosed using the DSM in total There is low criterion validity – at least one of the systems is wrong when diagnosing schizophrenia – this means patients may be misdiagnosed depending on the system their clinician uses.

Answer 27

‘morbidity’ refers to how common a medical condition is Co-morbidity refers to the idea that two or more conditions occur together - Schizophrenia is often diagnosed with other conditions A review by Buckley et al. (2009) found that half of patients diagnosed with schizophrenia are also diagnosed with depression (50%) or substance abuse (47%) PTSD also occurred in 29% and OCD in 23% - Validity issues with diagnosis – there may be issues telling the difference between different conditions – misdiagnosis Validity issues with classification – if the symptoms overlap with other conditions, schizophrenia may not be a distinct condition People may receive treatment for the wrong thing, unnecessary labels, waste of research, waste of money

Answer 28

Even if an individual does not have two conditions (co-morbidity), the symptoms of schizophrenia still overlap with symptoms of other disorders For example, symptoms of bipolar disorder also include delusions (a positive symptom) and avolition (a negative symptom) This again means we may be classifying and diagnosing schizophrenia incorrectly for patients – validity issue Not only may we misdiagnose patients, it also implies that schizophrenia may not be a distinct disorder e.g. an individual may just have a rare variation of bipolar disorder People may receive treatment for the wrong thing, unnecessary labels, waste of research, waste of money

Answer 29

found that people with dissociative identity disorder (DID) have more symptoms of schizophrenia that people diagnosed with schizophrenia

Answer 30

most people diagnosed with schizophrenia have enough sufficient symptoms to be diagnosed with at least one other disorder

Answer 31

Men are diagnosed with schizophrenia more often than women This could be due to genetic factors, but it is more likely due to social factors Women are more likely to have close relationships and social support – leading to better functioning in society Cotton et al. (2009) – women generally function better and at a higher level than men (better interpersonal skills, etc.) Higher functioning may be why women’s symptoms are easily overlooked, leading to under-diagnosis Schizophrenia is not properly understood in women – samples are more likely to be men – treatments will therefore be tailored for men – leading to more bias in the medical field

Answer 32

Genetics Neural correlates

Answer 33

genes consisting of DNA that contain instructions for physical features of an organism, which can also influence psychological features (e.g. disorders)

Answer 34

- He found that someone with an aunt with schizophrenia had a 2% chance of developing it - A 9% chance if their sibling had it - And a 48% chance if they had a MZ twin that had it - This clearly shows a relationship between genes and schizophrenia

Answer 35

- Schizophrenia is suggested to be polygenic – no one specific gene has been found to explain schizophrenia - The genes involved are most likely to be related to dopamine - Ripke et al. (2014) did a review of genome-wide studies on schizophrenia (studies that look at one’s full genetic makeup) - After comparing 37,000 people with schizophrenia to 113,000 controls, he found 108 different genetic variations that are associated with increased risk of schizophrenia - This suggests that schizophrenia is aetiologically heterogeneous – Different combinations of genes (and other factors) can lead to schizophrenia

Answer 36

Twin studies – Hilker et al. (2018) found a concordance rate of 33% for MZ twins that shared schizophrenia compared to 7% of DZ twins that shared it The difference is best explained by the amount of genes shared (100% vs 50%) Adoption studies – Tienari et al. (2004) studied adopted children from Finland and found that of those that had schizophrenia, many of them had a biological mother that also had schizophrenia This shows that even without being raised by a schizophrenic parent, you can still develop the disorder (best explained by genes)

Answer 37

- Although research shows that genetics have a role in the development of schizophrenia, there is also a lot of evidence for environmental factors being involved - Examples include birth complications, childhood trauma and smoking cannabis during adolescence - Morkved et al. (2017) found that 67% of people with schizophrenia and other related psychotic disorders reported at least one experience of childhood trauma compared to 38% of a control group with non-psychotic disorders - incomplete explanation, as ignores enviromental factors,

Answer 38

Patterns of structure or activity in the brain that occurs in conjunction with (correlates with) an experience

Answer 39

a neurotransmitter found to be important in several brain systems related to schizophrenia It is excitatory and linked to pleasure Very low levels are associated with Parkinson’s disease Because there is no hard evidence to pinpoint exactly what the role of dopamine is in the development of the disorder, hypotheses have been generated to explain the link

Answer 40

Research showed that drugs used to treat schizophrenia (antipsychotics which reduce dopamine levels) also cause symptoms similar to those that people with Parkinson’s disease experience – PD is also associated with low dopamine levels… Therefore, from this it was hypothesised that schizophrenia may be caused by high levels of dopamine in subcortical areas of the brain (hyperdopaminergia – hyper=high) For example, speech poverty and auditory hallucinations may be caused by an excess of dopamine receptors between the subcortex and Broca’s area

Answer 41

Davis et al. (1991) hypothesised that low levels of dopamine in the cortex may cause schizophrenia (cortical hypodopaminergia – hypo=low) Low levels of dopamine in the pre-frontal cortex can explain negative symptoms associated with cognitive functioning (However, this does not oppose the original hypothesis) It is suggested the low levels of dopamine in the cortex may cause high levels in the subcortex Howes et al. (2017) suggests that this caused by genetic variations and early experiences of stress These factors may make people more sensitive to cortical hypodopaminergia and eventually 🡪 subcortical hyperdopaminergia

Answer 42

Curran et al. (2004) found that when amphetamines are given to patients with schizophrenia, they increase dopamine levels and worsen symptoms of the disorder Amphetamines also induce similar symptoms in people without schizophrenia! Tauscher et al. (2014) also found that antipsychotics decrease dopamine levels and symptoms of schizophrenia Both studies suggest that dopamine levels (in particular high levels) are associated with schizophrenia Furthermore, some candidate genes identified also affect dopamine production and dopamine receptors Amphetamines are stimulant drugs. They make the messages between your brain and body move faster. As a result, you are more alert and physically active. Some people use amphetamines to help them stay awake on the job or to study for a test. Others use them to boost their performance in sports

Answer 43

Research has also found glutamate (another excitatory neurotransmitter) to be associated with schizophrenia McCutcheon et al. (2020) found increased levels of glutamate in several brain regions of schizophrenic patients across brain-imaging and post-mortem studies Furthermore, some of the candidate genes identified affect the production of glutamate as well - neural explanation, brain activity can be investigated to find schitzophernia, practical value as can make it easier to diagnose

Answer 44

Family dysfunction Cognitive explanations

Answer 45

Abnormal patterns of communication within the family, such as cold parenting, poor communication and high expressed emotion Such aspects of the family dynamic are suggested to be risk factors for both the development and maintenance of schizophrenia

Answer 46

- Schizophrenogenic mother (cold parenting) - Double-bind theory (poor communication) - Expressed emotion

Answer 47

Fromm-Reichmann (1948) Noted that many of her patients spoke about a particular type of parent – she named the ‘schizophenogenic’ mother This means ‘schizophrenia-causing’ This is a mother that is cold, rejecting and controlling She creates a family dynamic characterised by tension and secrecy This is suggested to cause distrust which later develops into paranoid delusions, and eventually, schizophrenia This is a psychodynamic explanation – how childhood experiences can affect you psychologically

Answer 48

Bateson et al. (1972) Children receive contradictory messages from parents E.g. verbal and non-verbal contrasts Children then fear doing the wrong thing, even when they don’t understand what the wrong thing is (due to mixed messages) They feel unable to protest about the unfairness of a situation, nor do they feel able to seek clarity on it They learn that doing the wrong thing leads to a withdrawal of love, causing them to understand the world to be confusing and dangerous Bateson argues that this is what leads to paranoid delusions and disorganised thinking patterns Bateson et al. clarified that this was not a generalisable sole cause for schizophrenia, just a risk factor EE includes elements of verbal criticism, sometimes accompanied by violence, hostility including anger and rejection and over-involvement

Answer 49

EE refers to the level of emotion expressed towards the schizophrenic patient by family members/carers A high level of negative expressed emotion is suggested to be a significant source of stress and can trigger the onset of the disorder (in those already vulnerable), as well as relapse

Answer 50

- Verbal criticism and sometimes violence towards the patient - Hostility, anger and rejection - Emotional over-involvement in the patient’s life

Answer 51

There is a range of research to suggest that issues within the family dynamic play a role in schizophrenia Insecure attachment – Read et al. (2005) found that adults with schizophrenia are disproportionately likely to have had insecure resistant or disorganised attachment as a child Abuse – Read also found that 69% of women and 59% of men have a history of physical and/or sexual abuse Trauma – Morkved et al. (2017) found that 67% of patients with a psychotic disorder reported at least one childhood trauma All of the research suggests that family dysfunction can make you more vulnerable to developing schizophrenia

Answer 52

Although research shows a link between childhood family-based stress and schizophrenia (generally) there is little evidence to support specific explanations such as schizophrenogenic mother and double-bind theory Research on these explanations come from clinical observation of individual patients and informal assessments of the mother’s personalities Furthermore, research that does exist contradicts the explanations Liem (1974) found no differences in parental communications between schizophrenic and non-schizophrenic patients Hall and Levin’s (1980) meta analysis found no differences in contradictory statements made in families with and without a schizophrenic patient Low explanatory power – FD may not be good enough to explain the link between childhood experiences and schizophrenia Low validity – contradictory suggests FD is an incorrect explanation

Answer 53

Explanations that focus on mental processes (thinking, language, attention) to explain behaviour

Answer 54

Stirling et al. (2006) gave the stroop test to 30 schizophrenic patients and 30 controls (the task was to say the colour of the font of the word rather than reading the word) The schizophrenic patients took twice as long as the control group to complete the task correctly – so? This suggests that those with schizophrenia struggled to supress the tendency to read the words instead of the colours, showing dysfunctional central control This validates the role of central control dysfunction in schizophrenia

Answer 55

A proximal explanation only goes as far to explain present circumstances as opposed to explaining how the circumstances developed in the first place (distal explanations) Biological and family dysfunction explanations can explain how symptoms of schizophrenia develop initially But cognitive explanations offer no insight on how dysfunctional thought processing develop initially Furthermore, cognitive explanations are difficult to link with the others – genetic variations nor childhood trauma can explain how dysfunctional thought processing develops Low explanatory power- only a partial explanation

Answer 56

Drug therapy – antipsychotics Typical antipsychotics Atypical antipsychotics

Answer 57

Drugs used to reduce the intensity of symptoms of a psychotic disorder (usually positive ones)

Answer 58

Introduced in the 1950s – no treatment before this

Answer 59

- ecommended for initial treatment - then used in combination with psychological therapies later on -some use them in the short term without symptoms returning - but most need to take them for life

Answer 60

typical antipsychotics aytpical antipsychotics

Answer 61

used primarily for positive symptoms

Answer 62

also combat positive symptoms, but has some beneficial effects on negative symptoms as well

Answer 63

The first generation of antipsychotic drugs, having been used since the 1950s. They work as dopamine antagonists. E.g. Chlorpromazine

Answer 64

Antagonists are blockers – they block the activity of neurotransmitters Typical antipsychotics are dopamine antagonists which bind to D2 receptors on neurons, blocking their action (blocking transmission of dopamine) At first dopamine levels build up (because transmission is blocked) but over time, less and less dopamine is produced elimination of hallucinations and delusions happens after a few days Other positive symptoms may take longer (several weeks) The effectiveness eventually led to the original dopamine hypothesis Can be taken via tablet , syrup or injection – up to 1000mg a day (avg 400-800mg for most patients)

Answer 65

Typical antipsychotics like chlorpromazine also work as a sedative (although not properly understood why) They can be given to patients with other conditions to calm them E.g. patients that are very anxious may be given them when they are first admitted to hospital They are most likely given as syrup for these purposes as they are absorbed faster than tablets Kapur et al. (2000) – estimated 60-75% of D2 receptors must be blocked in the mesolimbic pathway But this means D2 receptors in other areas are blocked too This can lead to undesirable/possibly harmful side effects

Answer 66

Kapur et al. (2000) – estimated 60-75% of D2 receptors must be blocked in the mesolimbic pathway But this means D2 receptors in other areas are blocked too This can lead to undesirable/possibly harmful side effects

Answer 67

First trialled in the 1970s – despite some patients later dying from a blood condition after taking them (agranulocytosis), they were remarketed in the 80s as the treatment to use if other treatments failed – and were found to be more effective than typical antipsychotics (today regular blood tests are taken and dosages are kept low) - Clozapine binds to D2 receptors, as well as serotonin and glutamate receptors - This consequently improves mood and reduces anxiety and depression - As well as suicidal thoughts (which can occur in 30-50% of patients) No injections as side effects can be fatal

Answer 68

Developed in the 90s – develop to reduce side effects that come with Clozapine It binds to more dopamine receptors than Clozapine so smaller doses are needed – and it can be taken in any form Some evidence suggests it has fewer side effects than the other antipsychotics

Answer 69

typical proved effect on positive sysmptoms atypiclal claimed effect on cognitive imparmnet and negative symptoms

Answer 70

Drugs that developed after typical antipsychotics (1970s). They typically target both dopamine and serotonin. E.g. Clozapine and Risperidone | AKA second-generation antipsychotics

Answer 71

atypical : less extrapyramidal side effects, more beneficial for negative symptoms, better for treatment-resistant patients

Answer 72

Clozapine and Risperidone

Answer 73

Lots of research compares relapse rates for antipsychotics and placebos Leucht et al. (2012) did a meta-analysis of 65 studies from 1959-2011, involving ~6000 stabilised patients They were stabilised with either typical/atypical drugs Some were taken off their medication and given a placebo instead Within 12 months, 64% given the placebo relapsed, compared to 27% who stayed on the antipsychotic drug - suggests the drug is effective, high practical use

Answer 74

Typical antipsychotics are more likely to produce side effects than atypical ones - Including dizziness, sleeplessness, weight gain, stiff jaw and itchy skin More long-term effects include tardive dyskinesia which Involves involuntary facial movements (blinking, grimacing) This is caused by dopamine supersensitivity The most serious side effect is neuroleptic malignant syndrome (NMS) which causes delirium, coma and sometimes death (up to 2% risk), suggested to be caused by the blocking of dopamine to the hypothalamus - may not be worth the risk, Typical antipsychotics have been criticised for its overall cost-benefit analysis This is because the drugs have led to many harmful side-effects, deaths and psychosocial consequences E.g. Chari et al. 2002 – covered a large out-of-court settlement for a patient suffering from tardive dyskinesia in the US Based on the Human Rights Act 1988, the patient was compensated for the side effects experienced – as it states ‘no one shall be subjected to inhuman or degrading treatment or punishment’ Further suggesting that drug therapy may do more harm than good in real life (for patients, professionals and economy)

Answer 75

- It is not fully understood why antipsychotic drugs work to reduce symptoms - The use of drugs is heavily tied with the original dopamine hypothesis (that schizophrenia is caused by subcortical hyperdopamineria) but we now know that the original dopamine hypothesis is not the full explanation – the updated hypothesis suggests that low levels of dopamine in the cortex may also cause the condition - - Therefore, drugs that ultimately decrease dopamine levels overall should not work – so why do they? - low explanatroy power

Answer 76

it is now considered a method of management as opposed to treatment

Answer 77

AO1 – identify the issues Introduce the classification systems (ICD-10 and DSM-5) Explain how diagnosis differs depending on the system used Start introducing the issues (it makes sense to start with reliability and validity issues if none are specifically named in the question) AO3 – discuss the issues (what implications do they have for patients, the economy and the medical field?) Discuss why having low reliability/validity is a problem when diagnosing/classifying schizophrenia Discuss the issues of co-morbidity, symptom overlap, gender bias and culture bias

Answer 78

Reliability Validity Symptom overlap Co-morbidity Gender bias Culture bias

Answer 79

Just because clinicians are consistent in diagnosis (while using the same system) doesn’t mean they are accurately diagnosing schizophrenia As the ICD-10 and DSM-5 use different criteria to diagnose, the same patient may not get a consistent diagnosis across clinicians Cheniaux et al. (2009) had two psychiatrists diagnose 100 patients independently using DSM-5 and ICD-10 criteria They found that one psychiatrist diagnosed 70/100 patients (26 using DSM and 44 using ICD) and the other diagnosed only 37/100 patients (13 using DSM and 24 using ICD) This also means 68 were diagnosed using the ICD and only 39 were diagnosed using the DSM in total There is low criterion validity – at least one of the systems is wrong when diagnosing schizophrenia – this means patients may be misdiagnosed depending on the system their clinician uses.

Answer 80

‘morbidity’ refers to how common a medical condition is Co-morbidity refers to the idea that two or more conditions occur together - Schizophrenia is often diagnosed with other conditions A review by Buckley et al. (2009) found that half of patients diagnosed with schizophrenia are also diagnosed with depression (50%) or substance abuse (47%) PTSD also occurred in 29% and OCD in 23% Why is this a problem? Validity issues with diagnosis – there may be issues telling the difference between different conditions – misdiagnosis Validity issues with classification – if the symptoms overlap with other conditions, schizophrenia may not be a distinct condition People may receive treatment for the wrong thing, unnecessary labels, waste of research, waste of money

Answer 81

Even if an individual does not have two conditions (co-morbidity), the symptoms of schizophrenia still overlap with symptoms of other disorders For example, symptoms of bipolar disorder also include delusions (a positive symptom) and avolition (a negative symptom) This again means we may be classifying and diagnosing schizophrenia incorrectly for patients – validity issue Not only may we misdiagnose patients, it also implies that schizophrenia may not be a distinct disorder e.g. an individual may just have a rare variation of bipolar disorder People may receive treatment for the wrong thing, unnecessary labels, waste of research, waste of money Ellason and Ross (1995) found that people with dissociative identity disorder (DID) have more symptoms of schizophrenia that people diagnosed with schizophrenia Read (2004) – most people diagnosed with schizophrenia have enough sufficient symptoms to be diagnosed with at least one other disorder

Answer 82

hearing voices is a symptom that may be interpreted differently in different countries Black British people are up to 10 times more likely to be diagnosed with Schizophrenia than white British people, even though rates of schizophrenia in African and Caribbean countries are not particularly high Escobar (2012) suggested that (overwhelmingly white) psychiatrists may tend to over-interpret symptoms and distrust the honesty of ethnic minorities during diagnosis Copeland (1971) gave 134 US and 194 British psychiatrists a description of a patient 69% of the US psychiatrists diagnosed the patient, but only 2% of the British ones did! This suggests that there are huge cultural differences in how doctors diagnose patients

Answer 83

Men are diagnosed with schizophrenia more often than women This could be due to genetic factors, but it is more likely due to social factors Women are more likely to have close relationships and social support – leading to better functioning in society Cotton et al. (2009) – women generally function better and at a higher level than men (better interpersonal skills, etc.) Higher functioning may be why women’s symptoms are easily overlooked, leading to under-diagnosis Schizophrenia is not properly understood in women – samples are more likely to be men – treatments will therefore be tailored for men – leading to more bias in the medical field

Answer 84

Different combinations of genes (and other factors) can lead to schizophrenia

Answer 85

A form of behaviour modification where desirable behaviours are encouraged via reinforcement A management technique based on operant conditioning Patients are given tokens whenever they engage in a target behaviour 🡪 tokens exchanged 🡪 rewards and privileges

Answer 86

1. Neutral tokens given after functional tasks are completed (making bed, finishing meals) 2. tokens are then exchanged for a variety of rewards (e.g. TV, visits from family, etc.) 3. frequent exchange = frequent desirable behaviours No longer used as ‘treatment’ for ethical reasons

Answer 87

To correct bad habits developed due to prolonged hospitalisation Helps modify personal care (hygiene), condition-related behaviours (e.g. avolition) and social behaviour (interaction)

Answer 88

- Improve quality of life in hospital settings -Normalise behaviours that will help patients adapt to demands in the outside world

Answer 89

- Based on operant conditioning – tokens are secondary reinforcers that allow for access to primary reinforcers (TV, snacks, visits, etc.) - Tokens that can be exchanged for a range of rewards are also known as generalised reinforcers (like money) - Tokens are awarded for target behaviours decided on a case by case basis - They work best when the reward is given directly after the token is received – immediate reward is more effective than delayed reward