Schizophrenia Flashcards
What is schizophrenia?
A severe mental disorder where contact with reality & insight are impaired & characterised by hallucinations, delusions, avolition & speech poverty
What are the 2 classification systems and how is schizophrenia classified?
- ICD-10 & DSM-5
- DSM-5 only needs 1 positive symptom for a diagnosis
- ICD-10 needs 2 or more negative symptoms
- ICD-10 recognises subtypes of schizophrenia: paranoid schizophrenia (powerful delusions), hebephrenic (negative symptoms) schizophrenia & catatonic
What is the reliability of a diagnosis?
- Reliability refers to the consistency of diagnosis, including inter-rater reliability where the same diagnosis is made by two or more assessors
What is the validity of a diagnosis?
- Validity is the extent to which the methods used to diagnose mental illness are accurate e.g. that the methods are able distinguish schizophrenia from other, similar disorders
What is the difference between co-morbidity & symptom overlap?
- Symptom overlap: the extent to which the symptoms of one disorder are also present in a different disorder
Co-morbidity: the extent to which two or more conditions occur together, calling into question the validity of diagnosis
What are the strengths of diagnosing schizophrenia?
- Good reliability: a diagnosis = reliable when the same clinician reaches the same diagnosis for the same individual (inter-rater) & on two occasions (test-retest) - post DSM-5, reliability for schizo diagnosis had risen -> Osario et al reported excellent reliability in diagnosis of 180 individuals using DSM-5 (inter-rate of +.97 & test-retest of +.92)
What are the issues with diagnosis & classification of schizophrenia?
- Comorbidity = extent to which two or more conditions occur together, calling into question the validity of diagnosis - Buckley et al. found that around half of all patients diagnosed with schizophrenia also had a diagnosis of depression - called into question the ability to tell the difference between the two & diagnose accurately -> could be that very severe depression can present as schizophrenia because it looks a lot like it (problems for classification)
- Gender bias: Since 1980s, men have been diagnosed with schizo more commonly than men (1.4:1 - Fischer & Buchanan) - could that be women are less genetically vulnerable but more likely that women are underdiagnosed as they have closer relationships -> more support (Cotton et al) -> schizophrenic women function better than men -> women don’t recieve right treatment
- Culture bias: some schizophrenic symptoms have different meanings in different cultures e.g. Haitians believe voices are communications from ancestors -> British Afro-Caribbeans are 9x mor likely to be diagnosed than white Brits (Pinto & Jones) yet people in African-Caribbean countries aren’t (rules out genetics) - due to culture bias in diagnosis by psychiatrists -> overinterpretation of symptoms in Black Brits (Esocbar)
- Symptom overlap: schizophrenia & bipolar disorder involve positive & negative symptoms - in terms of classification this implies schizo & bipolar disorder may not be 2 different conditions but variations of a single condition + in terms of diagnosis, it’s hard to distinguish the 2 + co-morbidity means schizo may not exist as a distinct condition -> flawed
What are hallucinations?
When we perceive things around us that aren’t actually real e.g. hearing, feeling, or seeing things that aren’t there (can involve any of our 5 senses)
What are delusions?
Firmly holding onto irrational beliefs about the world even when the evidence contradicts your beliefs
What is avolition?
What are the 3 signs of avolition (Andreasen)
- When individuals feel a persistent lack of motivation or energy to complete their normal everyday tasks
- 3 signs: poor hygeine & grooming, lack of persistence in work or education, lack of energy
What is speech poverty?
When people rarely speak & show a lack of spontaneous unprompted speech
What is speech disorganisation?
- Speech becomes incoherent or the speaker changes topic mid sentence
- Classified in DSM-5 as a positive symptom
What are the positive symptoms of schizophrenia? (define positive symptoms)
- Symptoms that involve abnormal, additional experiences that people don’t normally have
- E.g. hallucinations, delusions, speech disorganisation
What are the negative symptoms of schizophrenia? (define negative symptoms)
- Symptoms that involve absence of usual experiences that people normally have
- E.g. avolition, speech poverty
What are the 2 psychological explanations for schizophrenia?
- Family dysfunction
- Cognitive
What is the family dysfunction explanation (psychological)?
- Abnormal processes within a family such as poor communication, cold parenting & high levels of expressed emotion which can be risk factors for the onset/maintenance of schizophrenia
What is the schizophrengenic mother element of family dysfunction?
- Psychodynamic explanation proposed by Fromm-Reichmann based on patient’s childhood accounts
- Mother = cold, controlling, rejecting
- Family climate marked by tension & secrecy
- Leads to distrust & later paranoid delusions
What is the double-bind hypothesis element of family dysfunction?
- Bateson et al (1972)
- Communicative style marked by contradictory or unclear messages from parents
- Children who frequently receive contradictory messages from parents -> schizophrenia
- Child fears trapped in situations where they fear doing the wrong thing + can’t seek clarification
- Getting it wrong results in withdrawal of love -> creates an understanding of the world as confusing
What is the expressed emotion explanation element of family dysfunction?
- Negative EE is the level of negative emotion towards the patient by the carer e.g. hostility, anger, emotional over-involvement, verbal criticism
- Serious source of stress: can trigger a schizophrenic episode in someone genetically vulnerable or a relapse
What are the 2 cognitive explanations as part of the psychological explanations for schizophrenia?
- Metarepresentation dysfunction
- Central control dysfunction
What is dysfunctional thinking as a cognitive explanation for schizophrenia?
- Schizophrenia is characterised by disruption to normal thought processing
- Reduced thought processing in the ventral straitum is associated with negative symptoms
- Reduced processing of information in the temporal & cingulate gyri is associated with hallucinations
What is the ‘metarepresentation dysfunction’ as a cognitive explanation?
- The ability to reflect on thoughts & behaviours - allows us insight into our own intentions & goals + allows us to interpret the actions of others
- Dysfunction in metarepresenation disrupts our ability to recognise our own actions & thoughts as being carried out by ourselves rather than someone else
- Would explain hallucinations of hearing voices & delusions like thought insertion
What is the ‘central control dysfuntion’ as a cognitive explanation?
- Frith et al also identified issues with the cognitive ability to suppress automatic responses while we perform deliberate actions
- Speech poverty & thought disorder could result from inability to suppress automatic thoughts & speech triggered by other thoughts
- E.g. schizophrenics tend to experience a derailment of thoughts
What are the strengths of family dysfunction? (A03)
- Research support: a review by Read et al found schizophrenic adults are likely to have insecure attachment, particularly type D or C & found that 69% of women & 59% of male schizophrenics have a history with physical and/or sexual abuse
- Accounts for environmental influences: psychological explanations (e.g., family dysfunction) consider the impact of childhood experiences, stress, & faulty thinking - provides a more holistic approach than purely biological models, making it more comprehensive