Schizophrenia Flashcards
What is Schizophrenia
A thought process disorder, it’s characterised by disruption to a person’s perceptions, emotions and beliefs. Can be acute (sudden onset, behaviour changes within days) or chronic (gradual deterioration in mental health over time). There are various sub types.
Psychosis
A term used to describe a severe mental health problem where the individual loses contact with reality, unlike neurosis where individual is aware they have problems
5 Sub-types of schizophrenia
Disorganised, Catatonic, Paranoid, Undifferentiated, Residual
Disorganised schizophrenia
Person’s behaviour is generally disorganised and not goal directed. Symptoms include thought disturbances like hallucinations, absence of expressed emotions, incoherent speech, social withdrawal, usually in young adulthood
Catatonic schizophrenia
Diagnosed if the patient has severe motor abnormalities such as unusual gestures or use of body language.
Echolalia: involuntary parrot-like repetition of a word or phrase spoken by another
Echopraxia: involuntary imitation or repetition of body movements of another
Paranoid schizophrenia
Involves delusions of various kinds (like persecution), patient remains emotionally responsive, more alert than patients with other types, tend to be argumentative.
Residual schizophrenia
People who, although have had an episode in past 6months and still exhibit some symptoms, do not have strong enough symptoms to merit putting them in other categories, mild symptoms
Undifferentiated schizophrenia
Category for patients who do not fit or clearly belong to any other category. Show symptoms but do not fit other types.
Positive symptoms
Where people experiencing something, feel that something is happening to them, or display certain behaviours: extra experiences not usually there, involves hallucinations, delusions, jumbled speech, disorganised behaviour
Negative symptoms
Where people don’t display ‘normal’ behaviours: lack of experiences which are normal, involves speech poverty, lack of emotion, avolition- become disinterested
Secondary symptoms
Result from the difficulties of living with the disorder, such as depression
How does DSM V classify schizophrenia
A person must have at least two of: hallucinations, delusions, disorganised speech, catatonic or disorganised behaviour, any negative symptoms. One must be from the first three, symptoms must be present for at least 6months with 1month of active symptoms. Believes schizophrenia does not have subtypes
Comorbidity
Occurrence of two illnesses or conditions occurring simultaneously. Creates a problem with reliability and validity, may be the case that some symptoms belong to one known disorder while others belong to and untreated disorder which is yet to be identified
Symptom overlap
Both schizophrenia and bipolar disorder involve positive symptoms like delusions and negatives like avolition. Questions the validity of the classification and diagnosis of schizophrenia
Rosenhan (1973)- validity of diagnosis
Conducted a study where people with no mental health problems got admitted into a psychiatric unit by saying they heard voices, became pseudo patients, behaved normally once admitted, behaviour was still seen as a symptom of disorder, lack of validity because once you are labelled as having a disorder, all behaviour can be interpreted as caused by the disorder
Positive for reliability of diagnosis of schizophrenia
Even if reliability of diagnosis based on classification systems is not perfect, they do provide forms of communication of research ideas and findings which may ultimately lead to a better understanding of the disorder and the development of better treatments
Biological explanations for schizophrenia
Genetic vulnerability, Dopamine hypothesis, Neural correlates
Genetic vulnerability (schiz)
It has been proposed that there is a genetic component to schizophrenia which predisposes the illness. Development is partly to do with genes. Sz is thought to be polygenic.
Family studies for schizophrenia
Shields (1962) found concordance rates for MZ twins was 48%, DZ was 17%. Theory can be seen as deterministic, predisposition from genes cannot mean we get the disorder, many researchers accept concordance in families may be due to environmental factors. Adoption studies had adopted children with biological mother with sz and a control group. None in control group diagnosed, 16% offspring diagnosed, suggest genes is more influential than environment
The dopamine hypothesis
Schizophrenia is linked to excess activity of the dopamine in sub cortex (hyperdopaminergia) or to low activity of dopamine in the prefrontal cortex (hypodopaminergia). Post-mortems and PET scans have shown this. High levels of dopamine in the subcortex (broca’s area) can cause poverty of speech. Low levels of dopamine in pre frontal cortex can also cause negative symptoms as it effects thought processes
Evidence for dopamine hypothesis
Antipsychotic drugs reduce the positive symptoms of schizophrenia by blocking dopamine receptors. Dopamine agonists stimulates nerve cells containing dopamine and large doses can cause hallucinations, delusions, positive symptoms
Evidence against dopamine hypothesis
The link doesn’t explain a cause and effect and therefore it may be that increased dopamine is a symptom of schizophrenia
Neural correlates of schizophrenia
The idea that schizophrenia is down to structural abnormalities in the brain. Activity in the ventral striatum has been linked to the development of avolition and negative symptom. Reduced activity in the superior temporal gyrus has been linked to development of auditory hallucinations, positive symptom. Some people with schizophrenia have abnormally large ventricles in brain meaning they have lighter brains than normal
Evaluation of neural correlates
MRIs make it possible to investigate living brains- more accurate, findings are generally inconsistent, cause and effect cannot be established with brain abnormalities
Two types of antipsychotics (Drug Therapy)
Typical- first gen, work as dopamine antagonists (reduces), example is Chlorpromazine, reduces positive symptoms, acts as a sedative
Atypical- sec gen, target a range of neurotransmitters like dopamine and serotonin, example Clozapine (used when other treatments fail, helps mood) and Risperidone (acts like clozapine with less side effects, effective at low dosage)
Evaluation of Drug Therapy
Thornley (2003)- 13 trials with a total of 1211 pptts showed chlorpromazine resulted in better overall functioning and reduced symptom severity.
Meltzer (2012)- concluded clozapine to be more effective than any drug, effective in 30-50% of treatment resistant cases
Some side effects involve dizziness, agitation, sleepiness.
Usage of drug therapy is dependent on the dopamine hypothesis, only show short-term benefits with no comments on longer term results.
Psychological explanations for schizophrenia
Stress resulting from life events and daily hassles
Family Dysfunction (schizophrenogenic mother, double bind theory, EE)
Cognitive explanations ( dysfunctional thought processes)
Socio-cultural Theory (social status)
Family Dysfunction
Abnormal processes within a family, such as poor communication or cold parenting, these can be risk factors in developing and maintaining schizophrenia
Schizophrenogenic mother
Theorists, believed a mother who was cold, dominant, and created conflict caused schiz to emerge in a child. Mothers were rejecting, overprotective, self-sacrificing. The distrust, resent and instability caused by this parent creates a family climate characterised by tension and secrecy developing into paranoid delusions and schiz
Double Bind Theory
Bateson(1972)- emphasised the role of the communication style within the family. Suggests children who constantly receive contradictory messages (double binds) from parents are more likely to develop schiz. These interactions prevent the development of an internally coherent construction of reality
Expressed Emotion (EE)
A family communication style in which members of a family of a psychiatric patient talk about the patient in a hostile manner which indicates emotional over-involvement. If high levels of hostility (anger) or emotional over-involvement (self-sacrifice) then risk of relapse is high. Suggests that stress can trigger the onset of schiz for those who are already vulnerable
Cognitive explanation for schizophrenia
Schiz is a result of dysfunctional thought processing as its characterised by disturbances in language, attention, thought etc.
Cognitive Dysfunction- Study
Frith(1992)- people with schiz fail to monitor their own thoughts correctly, attributing them to the outside world. Auditory hallucinations are their own inner speech being misinterpreted, they believe something external is communicating.
Dysfunction in central control
Disorganisation of speech and thought disorder could result from the inability to suppress automatic responses, can also result in derailment of thoughts.
Auditory selective attention impairment
Negative symptoms of schiz may be the result of cognitive strategies used by the individual to keep mental stimulation to a manageable level, when they experience potentially overwhelming levels of info from external and internal worlds
Socio-cultural Theory
People with low social status are more likely to develop schiz than those of higher, poverty and discrimination exhibit high stress levels. Harrison (2001) found those born in deprived areas were more likely to develop schiz. Correlational results so no show of cause and effect, social drift hypothesis suggest more likely to be in deprived areas because having sz gives them lower social status.
Evaluation of Family Dysfunction
Berry (2008) found adults with insecure attachments are more likely to develop schiz. People with schiz were found to have mothers who did not fit the schizophrenogenic criteria. Berger (1965) found people with schiz had higher recall of double bind statements by mothers than control group but unreliable patient recall can be affected by shiz. Families with high EE resulted in 58% patients returning to hospital but 10% for low EE, so it can affect recovery rate, most evidence is Western, EE measurement is also unreliable with single interviews. Conflicts biological and almost blames parents
Evaluation of cognitive
It does describe how info processing is affected in schiz. Cognitive disturbances may be symptoms of the disorder rather than an explanation. It doesn’t provide a distal cause explanation. Explains positive symtpoms better than negative, some inconsistentcy, reduces reliability. Can be seen as reductionist
Diathesis-Stress Model (schizophrenia)
An interactionist approach. Proposes that people who are biologically vulnerable to developing a mental disorder may be more likely to develop if they are subject to certain social or environmental stressors. A combination of biological and psychological factors
Meehl’s Model (1962) and a more Modern understanding of Diathesis
Believed diathesis was entirely genetic, its the result of a single ‘schizogene’. If a person doesn’t have the schizogene then no amount of stress would lead to schizophrenia. In carriers of the gene, chronic stress through childhood and adolescence could result in schizophrenia. Modern views show that there is no single ‘schizogene’ but many genes that increase genetic vulnerability and accounts impacts of trauma.
Tienari Studies
Adoption study,
Cognitive Behavioural Therapy
Helps patients identify irrational thoughts and tries to challenge them. Helps make sense of how delusions and hallucinations impact behaviour and helping to understand their existence can help reduce anxiety. CBT allows patients make sense of symptoms but does not fully treat symptoms, can be unethical by interfering with freedom of thought. CBT can be very time-intensive causing drop outs, difficult to measure effectiveness as it relies on self-reports.
Family Therapy
Seeks to treat members of the family as well as the patient. Hopes to reduce the high level of EE in a household. Therapists work with the family and the patient to develop strategies to cope better with the mental disorder and its symptoms. Family informed of symptoms and trained to recognise early signs of relapse so they can respond rapidly to reduce the severity of it. Helps reduce stress, anger (EE). Doesn’t fully treat, families need to be engaged and open to changing behaviour- not all are
Token Economies
Reward systems to manage behaviour, modifying behaviour is there to improve quality of life and improves likelihood of life outside the hospital. Based on operant conditioning tokens are secondary reinforcers. Can improve self care and desirable behaviour. Don’t have high ecological validity as cannot be generalised to real world, behavioural effects may not be longlasting
Interactionist Approach to Treatment
Uses a combination of antipsychotics with psychological therapies such as CBT, standard practice in GB is to combine the two rather than one alone. Helps manage symptoms and reduce causes of schizophrenia. Difficult to know which treatment is working, can be very complicated and time consuming
