Schizophrenia Flashcards
What are positive symptoms of schizophrenia?
They add to the patients reality
What are examples of positive symptoms?
Hallucinations
Delusions
Disorganised speech
What are negative symptoms of schizophrenia?
Where patients suffers a reduction or a loss of normal functions
What are examples of negative symptoms?
Speech poverty (alogia)
Avolition
Catatonic behaviour
Grossly disorganised behaviour
What is the DSM?
Published by American psychiatric association
What is the ICD?
Published by the World Health Organisation
What is reliability in the context of schizophrenia?
Asses how consistent the diagnosis of schizophrenia is
What is validity in the context of schizophrenia?
Does the DSM or ICD really measure schizophrenia
What is co-morbidity?
Where the patient has two conditions at the same time
What is symptom overlap?
When two conditions have some effects in common
What studies are associated with reliability?
Copeland
Luhrman
Whaley
What was Copeland’s study?
134 US Psychiatrists - 69% diagnosis
194 British Psychiatrists - 2% diagnosis
Low inter-reliability reliability
What was Luhrman’s study?
Interview with 60 adults with schizo
20 in each Ghana, India and US
Africa and India, reported positive experiences with hearing voices compared to the US
Suggests schizo has a lack of consistent characteristics
What was Whaley’s study?
Found that inter-rater reliability correlations in the diagnosis of schizo was as low as 0.11
What are the studies associated with validity?
Broverman
Ellason
Buckley
What was Broverman’s study?
Mentally healthy behaviour = healthy male behaviour
Therefore women are perceived as less mentally healthy
What was Ellason’s study?
Symptom Overlap - Patients with DID have more schizo symptoms more than schizo patients
What was Buckley’s study?
Co-morbidity - Co-morbid depression occurs in 50% of patients and 47% of patients also have a lifetime diagnosis of substance abuse
What is the biological explanation of schizophrenia?
Genetics
Neural Correlates - Dopamine Hypothesis
What is the genetic explanation?
Schizophrenia is hereditary
No one gene responsible (108 genes)
What studies support the genetic explanation?
Shield
Gottesman
Teinari
What was Shield’s study?
2 Schizo parents - 46%
1 Schizo parent - 13%
Schizo parent - 9%
What was Gottesman’s study?
Summarised 40 twin studies
MZ twins - 48%
DZ twins - 17%
What was Tienari’s study?
164 adoptees who bio mothers have schizo
11 adoptees also diagnosed
Just 4 in the 194 control adoptees
What are some weaknesses of the genetic explanation?
Family rearing patterns may explain schizo link
Joseph - MZ twins are usually treated more similarly than DZ
What are neural correlates?
Patterns of structure or brain that occurs with a schizophrenic experience
What study supports negative symptoms neural correlates?
Juckel - Lower activity in the ventral striatum, is crucial in the anticipation of reward
What study supports positive symptoms neural correlates?
Allen - Lower activity in the superior temporal gyrus and anterior cingulate gyrus
What study supports neural correlates?
Suddan - MRI scans on twins, 1 has schizo
Easily identifiable enlarged ventricles in 12/15 pairs
What is the dopamine hypothesis?
Positive symptoms = Excess dopamine, hyperdopamingeria
Negative symptoms = Deficit dopamine, hypodomingeria
Who supports the dopamine hypothesis?
Falkai
L-dopa
How does Falkai support the dopamine hypothesis?
Found increased dopamine levels in the left amygdala in post-mortems of schizophrenic patients
How does the L-dopa drug support the dopamine hypothesis?
It’s a dopamine hypothesis medication
Increases dopamine levels in the brain
Resembles acute schizophrenia in non-psychotic patients
Who argues against the dopamine hypothesis?
Javitt
Davis
How does Javitt go against the dopamine hypothesis?
Found evidence of another neurotransmitter called Glutamate
Schizo’s also have a deficiency in glutamate function
How does Davis go against the dopamine hypothesis?
Takes many weeks for antipsychotics to reduce positive symptoms even though they block dopamine receptors immediately
What are the psychological explanations of schizophrenia?
Family dysfunction
Cognitive explanation
What is family dysfunction?
1- Double Bind
2 - Expressed emotion
What is the double bind?
Bateson - Child receives mixed messages and cannot do the right thing
What is expressed emotion?
Family of a psychiatric patient talk about the patient in a critical or hostile way
Can cause patients to relapse
Who supports expressed emotion?
Kuipers - Found patients returning to a high EE family is about 4 times more likely to relapse than a patient who has a low EE family
What are some supporting studies of family dysfunction?
Berger - Schizo’s reported a higher recall of double bind statements by their mothers
Tienari - Children who had schizo bio parents were more likely to become ill themselves, only occurred in adoptive families as disturbed
What is the cognitive explanation of schizophrenia?
Schizo’s had dysfunctional thought processes
Firth - Metarepresentation
Central Control
What is metarepresentation?
Disrupt our ability to recognise our actions and thoughts as our own
Carried out by someone else
What is central control?
The ability to suppress automatic responses
Disorganised speech and thought disorder
What is supporting evidence of the cognitive model?
Sarin & Wallin - Delusional patients were found to show various biases in their information processing
NICE - CBT is more effective in reducing symptom severity
What are weaknesses of psychological explanations of schizophrenia?
Deals with one aspect of the disorder but ignores other aspects such as neurochemical changes
Who addresses the issue of the rigid psychological explanation?
Howes & Murray - Argue that early vulnerability factors together with exposure to significant social stressors increase the release of dopamine - dopamine hypothesis
What are antipsychotics?
Work by reducing dopaminergic transmission
What are typical antipsychotics?
Used against positive symptoms
reducing dopamine activity
e.g. chlorpromazine
What are atypical antipsychotics?
Combat positive and negative symptoms
Block dopamine receptors
e.g. clozapine
What are the side effects of typical antipsychotics?
Tardive dyskinesia
Muscle tightening
Decrease in motivation
What study supports effectiveness of typical antipsychotics?
Barlow & Durand
Chlorpromazine effective in 60% of cases, patients still suffer from negative symptoms
What are the side effects of atypical antipsychotics?
Side effects greatly reduced but similar to typical
Loss of motivation
Dry mouth
What study supports the effectiveness of atypical antipsychotics?
Pickar-Clozapine most effective in reducing symptoms in patients that had been treatment resistant
Meltzer-Effective in 30-50% of cases where typical treatments failed
Who supports antipsychotics?
Leucht - Meta analysis of 65 studies
Placebo - 64% of patients relapsed within 12 months
Real - 27% of patients relapsed within 12 months
Who goes against the difference between side effects of atypical and typical anti-psychotics?
Crossley - Meta analysis of 15 studies
Found no significant differences between atypical and typical drugs in terms of side effects
