Schizophrenia Flashcards
What is Schizophrenia?
- A type of psychosis, a severe mental disorder characterised by a profound disruption of cognition and emotion so that contact with external reality and insight are impaired.
- This affects a persons language, thought, perception, emotions and even their sense of self.
- The most common psychotic disorder, affecting 1% of population.
What is Classification and talk about classification of schizophrenia?
Organizing symptoms into categories based on which symptoms cluster together in sufferers
Schizophrenia doesn’t have a single defining characteristic, it is a cluster of symptoms. There are two major systems of classification: the World Health Organization Internal Classification of Disease ICD-10 and the Diagnosis and Statistical Manual- DSM-5
What are the differences in the ICD-10 and DSM-5?
differ slightly for example the DSM says one of the positive symptoms must be present where the ICD sat two or more negative symptoms are needed.
What is Diagnosis?
deciding whether someone has a particular mental illness using the classifications
What are positive symptoms? Give examples.
Atypical symptoms experienced in addition to normal experiences (excess or distortion of normal functioning)
- Hallucinations
- Delusions
What are hallucinations?
Unusual sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are there. The most common are auditory hallucinations- hearing voices with many reported hearing voices telling them to do something like harm themselves or comment on their behaviour
What are delusions?
They involve beliefs that have no basis of reality. They can take a range of forms like a sufferer may believe that they are someone else or a victim of a conspiricy. They believe that a part of them is under external control which could make them behave in a way that makes sense to them but odd to others.
What are negative symptoms? Give examples.
atypical symptoms that represent the loss of a usual experience (loss of normal functioning)
- avolition
- speech poverty
What is Avolition?
Avolition- This is a loss of motivation to carry out tasks and keep up with goal directed activity. Andreadon identified 3 signs- poor hygiene, lack of persistence in work or education and a lack of energy.
What is Speech Poverty (alogia)?
This is a reduced frequency and quality of speech with a delay in the verbal responses. Nowadays, the DSM places emphasis on speech disorganisation where speech becomes incoherent or changes topic mid sentence- however this is a positive symptom.
What are the 4 issues with reliability and validity of Schizophrenia Diagnosis?
- Symptom overlap
- Co-morbidity
- Cultural bias
- Gender bias
What is symptom overlap?
This occurs when two or more conditions share symptoms. Where conditions share many symptoms, this falls into question the validity of classifying the two disorders separately.
Talk about evidence to undermine the issue of symptom overlap. (psychological harm)
Ketter (2005)
- Ketter points out that misdiagnosis*due to symptom overlap can lead to years of delay in receiving relevant treatment, during which time suffering and further degeneration can occur., as well as high levels of suicide.
- So, symptom overlap can have serious consequences. Focusing on fixing this issue could save money and lives.
Talk about research to support the presence of symptom overlap. (study)
Serper et al
- They assessed patients with co-morbid Sz and cocaine abuse, cocaine intoxication on its own and Schizophrenia on its own.
- They found that despite there being considerable symptom overlap in patients with Sz and cocaine abuse, it was actually possible to make accurate diagnoses
What is Comorbidity?
This is the extent that two or more conditions occur together. It is common among patients with schizophrenia where two conditions are diagnosed together
- Where two conditions are frequently diagnosed together, it calls into question the validity of the classification and diagnosis of both conditions.
Talk about research to support the presence of comorbidity.
Buckley et al (2009)
- Around half of patients with a diagnosis of Schizophrenia also gave a diagnosis of depression (50%) or substance abuse (47%).
- PTSD also occurred in 29% of cases and OCD in 23%.
What is Gender Bias?
- Gender bias in the diagnosis of Schizophrenia is said to occur when the accuracy of diagnosis is dependant on the gender of the individual.
- This may be due to gender-biased diagnostic criteria or clinicians basing their judgments on stereotypical beliefs held about gender.
Talk about a strength showing the presence of gender bias in the diagnosis of Sz (female functioning)
- Since the 1980s, men have been diagnosed with Sz more often than women. Prior to this, there had been no difference. This may be due to a gender bias in the diagnosis of Schizophrenia.
- It appears that female patients typically function better than men (more likely to work and have good family relationships).
- Women’s better functioning may bias practitioners to under- diagnose Sz either because their symptoms are masked by good interpersonal functioning, or because high quality of functioning makes the case seem too mild to warrant a diagnosis.
Talk about supporting evidence showing the presence of gender bias (psychiatrist diagnosis)
Loring and Powell:
- 290 male and female psychiatrists had to read 2 case articles and were asked to give judgement on individuals using standard diagnostic criteria
- Male/ no info = 56% diagnosed Female= 20% diagnosed
- Gender bias did not appear amongst female psychiatrists. Lack of inter-rater reliability. Also suggest gender bias may lie with those giving diagnoses rather than patients.
Talk about culture bias in schizophrenia diagnosis
-Research suggests that there is a significant variation between cultures when it comes to diagnosing Schizophrenia e.g African- Americans and English people of Afro-Caribbean origin are several times more likely to be diagnosed with Schizophrenia.
- Given that the rates in Africa and the West Indies aren’t high, the diagnosis seems to be the result of culture bias.
Talk about support for culture bias in schizophrenic diagnosis (African positive symptoms)
In some African cultures, positive symptoms like hearing voices may be more accepted due to beliefs in ancestral communication. As a result, individuals are more likely to acknowledge such experiences. However, when assessed by psychiatrists from different cultural backgrounds, these symptoms may be misinterpreted as bizarre or irrational.
This questions the validity of schizophrenia diagnosis, as psychiatrists may impose their own cultural standards (imposed etic), leading to ethnocentric bias. Consequently, diagnoses may not be valid across cultures.
What are the three biological explanations for Schizophrenia?
1.Genetics
2.Biochemicals (neurotransmitters)
3.Neural correlates
Define genetics and heritability
Genetics - Genes consist of DNA strands that produce instructions for the general physical features of an organism, as well as specific physical features that can impact psychological traits. Genes are inherited.
Heritability- This refers to the extent to which a condition or trait has been passed on generationally through families via genes.
Talk about candidate genes and schizophrenia
a single gene that so far has been identified as causing schizophrenia, it is thought to be polygenetic meaning it involves the combined effect of several genes. Genes assosiated with the increased risk include those who code for the functioning of a number of neurotransmitters like dopamine.
Talk about twin studies and the genetic basis of schizophrenia
Gottesman et al MZ= 48% DZ= 17%
Joseph MZ= 40.4% DZ= 7.4%
- Suggests that Schizophrenia is inherited through genes as the concordance rate is much higher than 1% (rate seen in general population)
- Higher rate for MZ grab DZ suggests role of nature as MZ twins share 100% genes while DZ only share 50%. Implies importance of genetics in explaining Sz.
(-) however.. Concordance rates not 100%, greater environmental similarity, small sample size of such twin studies e.g 54 in Gottesman
Talk about Family studies and schizophrenia
- Gottesman studied families- he concluded that if both parents suffer from Sz, there is a 46% chance of the child also developing the disorder.
- Findings have shown that the greater the degree of genetic relatedness, the greater the risk of developing Sz.
- Tienari found that of the 164 adoptees whose biological mothers had been diagnosed with Sz, 6.7% were diagnosed compared to just 2% of the control adoptees.
- Although only a small %, it still suggests that the genes must play a role in Schizophrenia.
Talk about the scientific nature of the genetic basis
Scientific- Methods used to measure a genetic explanation for schizophrenia are clinical, objective and not affected by sources of bias such as individual differences meaning they have good reliability and Validity.
What are some negatives to the genetic basis of schizophrenia?
- Genetics could be a factor in explaining schizophrenia but may not be the explanation. If schizophrenia was purely biological, the concordance rates would be 100% which no research ever found.
- The small sample sizes of schizophrenia twin studies being only 54 pairs. This means that generalizability may be limited.
Talk about the biochemical explanation of schizophrenia
THE DOPAMINE HYPOTHESIS
- Neurotransmitters: the brain’s chemical messengers, they appear to work differently in the brain of a patient with Schizophrenia. In particular, dopamine is widely believed to be involved.
- Dopamine: important in the function of a number of brain systems that may be implicated in symptoms of Schizophrenia. The D2 pathway is associated with Schizophrenia.
Talk about hyperdominergia as part of the dopamine hypothesis,
Hyperdominergia in the sub cortex- the origional hypothesis focuses on the positive role of high levels of activity of the dopamine sub cortex- an excess of dopamine receptors in the Brocas area may be associated with speech poverty or hallucinations.
Talk about hypodominergia as part of the dopamine hypothesis
Hypodominergia in the sub cortex- more recent versions of the hypothesis focuses on the abnormal dopamine sypotoms in the brains cortex. Researchers habe identified a role for low levels of dopamine and negative syptoms.
Evaluate the dopamine hypothesis- drugs
- Antipsychotic drugs affect dopamine levels in different regions of the brain and are known to treat symptoms.
- Amphetamines like cocaine- increase dopamine release often leading to psychosis like experiences in normal people. This shows hightened levels of dopamine leads to psychotic systems.
Talk about research to support the dopamine hypothesis. -brain scanning
Research suggests that dopamine may play a key role in schizophrenic symptomatology e.g. et al. (1999), Desbonnet (2016) with brain-imaging studies demonstrating high activity in dopamine-rich areas of the brains of schizophrenics.
Talk about research undermining the dopamine hypothesis- other neurotransmitters
Grunder & Cumming (2016) point out that the dopamine hypothesis should be modified to include the role of glutamate as a key contributory factor in promoting schizophrenic symptoms.
Talk about other negatives to the dopamine hypothesis- correlation
There is also the issue of cause/correlation to consider as it is still unclear as to whether abnormal brain activity in specific regions such as the ventral striatum actually causes schizophrenia or is the relationship between the two the result of other factors as yet unknown?
What are neural correlates?
These refer to the specific brain regions/ structures/ functions that are implicated in the symptoms and behaviors associated with the disorder.
Talk about negative symptoms and neural correlates
The ventral striatum (VS), which is the largest structure in the basal ganglia has been associated with negative symptoms like avolition. The VS is part of the limbic system associated with the anticipation reward. Schizophrenic patients show less activity in the VS.
Talk about research supporting negative symptoms and neural correlates
Juckel et al. Measured the activity levels in the VS in those with schizophrenia found in lower levels of activity than those observed in controls. They observed a negative correlation between activity levels in the VS and severity of negative symptoms.
Talk about positive symptoms and neural correlates
The superior temporal gyrus (STG) is thought to control the processing of speech, has been assosiated with the positive symptoms of schizophrenia for example hallucinations. Sz patients show reduced volume of grey matter in the STG which is associated with hallucinatois and thought disorder.
Talk about research supporting positive symptoms and neural correlates
Allen et al. scanned the brain of patients experiencing auditory hallucinations and compared to a control. Lower activation levels in the STG found in hallucination group.
Talk about positives of neural correlates
The use of brain- imaging techniques such as PET, MRI and fMRI provide objective evidence as they pinpoint specific brain structures implicated in the symptoms. They are conducted under controlled clinical conditions meaning they are likely to show consistent results overtime so are reliable
Talk about negatives of neural correlates
- The research evidence for neural correlated takes a correlational approach to mapping brain regions meaning it lacks cause- effect explanation.
- Deterministic- no acknowledgement of the role of the environment to a neural correlates based explanation of schizophrenia meaing it lacks external validity.
What are the family dysfunction theories of schizophrenia?
- The schizophrenogenic mother
- The double blind theory
- Expressed emotion
Talk about the schizophrenogenic mother theory
This explanation is the idea that a toxic, negative, dysfunctional mother is a major factor in her childs development of Schizophrenia. This is a psychodynamic explanation as its based on a patients current internal conflict having its roots in adverse childhood experience. The toxic behaviour is theorised to lead to distrust, paranoia delusions and unltimately the development of Sz.
Talk about what hartwell said about the schizophrenogenic mother theory?
argues that schizophrenogenic mother concept was developed during a time of tension over women’s changing position and roles in American society as a way of reclaiming psychotherapy as purely male dominant
Talk about the double blind theory
This was proposed by Bateson et al and describes a situation where no matter what a child does, they can’t win as they recieve mixed messages and unpredictable/ inconsistant standards are imposed on them.
It is thought this causes paranoia and disorganised thoughts which are sympotoms of schizophrenia. Parents may withdraw their love and approval as a punishment for percieved wrongs which could result in the child being fearful and confused.
This is a risk factor of Sz
Talk about research supporting the double blind theory
Sojit- an observation of the parents of schizophrenics interacting with their children compared with other groups i.e. parents of young offenders supported as the parents of Sz patients were more likely to send messages to their children than other parents
Talk about expressed emotion
This refers to how a family member communicates their thoughts and feelings towards the schizophrenic person in the family. There are several elements:
- Hostility- showing anger and resentment
- Criticism of the Sz person, i.e. being only judgemental
- Over-Involvment
High EE is assosiated with relapse in the recovering of Sz while low EE is more likely to produce warmth and support helping recovery
Talk about positives to the family dysfunction approach
- purely biological explanations cant fully account for the array of factors contributing to the onset of Sz, so family dysfunction explains this gap
- Research- Kavanagh, did a meta analysis which shows that there is a high relapse rate (48%) for schizophrenic patients who live with high EE familys compared to low (21%) in low EE families
Talk about negatives to the family dysfunction theory
- The concept of SM is dangerous stereotype as a product of blame culture having no basis in scientific fact and may cause harm to mothers and families.
- It is almost impossible todifferentiatedouble-bind from more ordinary, everyday forms of family communication within a specificfamily dynamicwhich means that the theory lacks reliabilityas it cannot beoperationalisedandvalidityas it cannot offer acomplete explanationfor the onset of schizophrenia
Relate the dysfunctional family theory to issues and debayes (bias and SSR)
The schizophrenogenic mother theory clearly shows acutegender biasas it suggests that women/mothers play a key,destructive rolein the onset of schizophrenia in a child (alpha biasas it assumes key differences based on gender).
This topic issocially sensitivewhich means that there areethical implicationsas to how the findings of research in this field should be presented so as to avoid furtherbias, prejudice and discrimination
What is dysfunctional thought processing?
Frith says that this refers to the ways in which a person with Sz understands, percieves and interprets the world and people around them
They may be unable to distinguish between the natural inner voice and what they percieve to be a voice or voices speaking to them.
Talk about metarepresentation as dysfunctional thought processing
This is the ability to reflecr on ones own thoughts and behaviours and to know what one’s intentions, goals and motivations are. This allows us insight into our own intentions and goals and to interpret the actions of others. Dysfunction in this disrupts the ability to recognise ones self talk and actions explaining hallucinations and delusions
Talk about central control as dysfunctional thought processing
This is the cognitive ability to supress automatic responses while we perform deliberate actions instead. Disorganised speech and thought disorder could result from the inability to supress automatic thoughts and speech triggered by other thoughts. For example, sufferers of Sz experience derailment of thoughts and spoken sentences as each word triggers associations and patients cant supress automatic responses
Talk about positives to the cognitive explanation of schizophrenia
Schizophrenia is a condition which is marked by amisperceptionof reality which means that cognitive explanations have goodvalidityin theirassumptionsi.e.hallucinationsare the product of adistorted senseof what isrealand what isfantasy
Talk about issues with the cognitive explanation of schizophrenia
- Cognitive explanations lackcause-effect conclusions: does schizophrenia cause dysfunctional thought processing or is that dysfunctional thought processing leads to schizophrenia symptoms?
- There may be issues with thevalidityof cognitive explanations, for example a person’s thought processing is likely to be highlysubjective, regardless of whether they have schizophrenia or not, so it is difficult to know how tojudge and asseswhat is ‘dysfunctional’ or ‘biased’ when it comes toidiosyncraticcognitions
Talk about the cognitive approach related to issues and debates
This topic takes thedeterminismside of thedeterminism/freewill debateas it assumes that anyone with schizophrenia will think in adisorderedway using attentional biases to interpret the world. In short, it does not account forindividual differenceswithin the array of experience of people with schizophrenia.
Talk about typical antipsychotics
These are the first generation of antipsychotic drugs been used since the 1950’s. They are dopamine antagonists meaning they inhibit dopamine activity by blocking dopamine receptors in the synapse. Examples include Chlorpromazine. They are effective in treating the positive symptoms of schizophrenia like delusions.
However, they come with many undesirable side effects like drowsiness, agitation, dizziness. An over use of them may lead to tardive dyskinesia- sensitivity to dopamine which can be life threatening
Talk about atypical antipsychotics
These are second genderation antipsychotics developed in the 1980’s as a solution to the side effecrs of typical treatments. They are also dopamine antagonists however, they only block receptors temporatily. They can also act as seretonin agonists- inhibit the reuptake of seretonin. They treat both negative and positive symptoms of schizophrenia. Examples include risperidone which has side effects like autoimmune disease for RBC’s.
Talk about positives of biological therapies
- Supporting evidence- Marder & Meibach (1994) -Schizophrenic patients who took risperidone compared to haloperidol or aplacebo showed significant improvement in both positive and negative symptoms
- Most effective for treating patients with the most severe sympotoms who may not be treatable any other ways
Talk about negatives of biological therapies
Patients withmilder, less extreme forms of schizophreniabenefit lessfrom taking antipsychotics and may additionally experienceadverseside-effects
It is not clear as to how effective antipsychotics are inpreventing relapsesin patients who are inremission
- Ethics?- critics argue that considering side effects and psychological side effects that costs may outweigh the benefits and also severe cases may not be able to five informed concent
Talk about CBT
This is a method for treating mental disorders based on both cognitive and behavioural techniques. In CBT, they aim to enable the client to challenge negative/ dysfunctional thoughts and help them to modify their reactions to the thoughts. In relation to schizophrenia, the therapist aims to help the client understand what is real and what is fantasy by putting routines and strategies in place to live life productivly.
It is generally a short- term solution to treating schizophrenia but it can help clients develop social skills and problem-solving skills.
Talk about family therapy
This is carried out with all or some members of the family with the aim of improving their communication and reducing the stress of living as a family. The psychological explanations focus on the possible toxic home environment as key contributing factors to the development of Sz
The outcome should be the person with schizophrenia is supported in their illness so the aversive symptoms reduce significantly
Talk about pharaoh et al
identified the most important goals for family therapies:
- Eliminate or reduce destructive emotions like guilt and shame which can affect all family members
- Enable the family to work as a team and to understand commaraderie
- Educate family members as to the nature of schizophrenia as an illness and dispel any myths
Talk about positives to psychological therapies
- CBT has been tried and tested as a suitable therapy for Sz meaning as a trearment it has good validity. It also has been working for comorbid disorders patients may suffer from i.e. depression.
- Family therapy should result un Sz feeling less alone and isolated ultimately benefit the economy as it means less reliance on external mental health providers plus able to work and get life back to normal
- Less side effects/ fatal side effects
Talk about negatives to psychological therapies
- Not everyone is suited to CBT and as schizophrenia exists on a spectrum it may only bee good for people with mild or easily managed symptoms
- Family therapy may actually worsen symptoms if they feel they are being forced to interact with or depend on people who are are emotionally detructive
What are token economies
This is a form of behavioural therapy where desirable behaviours are encouraed by the use of selective reinforcement. For example, patients are given rewards as secondary reinforcers when they engage in correct desirable behaviours. These tokens can be exchanged for primary reinforcers like foods or privalages
This aims to incentivise schizophrenia patients to behave in a socially acceptable way and help them to manage their illness
Talk about positives of token economies
- Token economies may be useful for patients whose symptoms aremildand who need somemotivationto enable them to cope witheveryday challengessuch associal interactionandpersonal hygiene
- A programme of token economy behaviour management is less potentiallyharmfulthandrug therapyso it may be moreethically validto some extent
- Monagle & Sultana (2000) -Areview articlewhich concluded that token economies are effective in treating thenegative symptomsofschizophreniae.g.avolition
Talk about negatives of token economies
- Monagle & Sultana (2000) also concluded that research on token economies is unclear as to the extent to which token economies have along-term effecti.e. are theymaintainedbeyond thetreatment programme?
- A token economy could be viewed as beingpatronising(i.e. treating patients like children; deciding when/how/if to give rewards) which means that there areethical concernsabout theprotectionof patients who are enrolled in such a system
What is the interactionist approach?
This is a broad approach to explaining schizophrenia which acknowledges that a rage of factors including biological and psychological factors are involved in the development of schizophrenia
What is the diathesis stress model?
This is the interactionist approach to explaining behaviour and disorders like depression and schizophrenia. It assumes that schizophrenia doesn’t stem from one main source but is a combination of genetic vulnerability and an activating event which triggers the development of schizophrenia
The more vulnerable a person is, then the less stress needed to pull the trigger.
Talk about the modification of the diathesis stress model
The model has undergone some revision and modification:
- Diathesis may come in many forms: biological, specific genes or psycho-social i.e early abuse.
- Stress also comes in many forms and may form the basis of the diathesis rather than the trigger- living with a parent with a mentla illness
- Research has suggested a neural diathesis- stress model which proposes that stress heightens cortisol levels triggering the sympotoms of Sz.
What are protective factors?
Protective Factors- guard against the harm of various risk factors which could trigger schizophrenia
- Toxic parenting could be offset by having caring gradparents who offer love and nurture a child needs
- Personal traits like resilience, optimism can help protect.
Talk about research supporting the diathesis stress model
Silverton (1988)found that a sample of participants who had schizophrenic parents were more likely to develop schizophrenia and to engage incriminal behaviourif they had shown shortattention spansasinfantswhich supports the original diathesis-stress model (i.e. some people may have a genetic vulnerability to schizophrenia which is marked bydistinct behavioursin early childhood)
Talk about positives to the diathesis stress model
The model could be applied to formintervention strategiessuch asresilience-building, mentoring/buddy programmes, social skills trainingso to this extent it has someexternal validity
Talk about negatives to the diathesis stress model
- The model has been criticised for not acknowledging the role of other biological factors such as the role ofneurotransmitters(see thedopamine hypothesisfor example) in the development of schizophrenia which means that it may offer only apartial explanation
- There is somevaguenessover exactly how biological, psychological and social factors interact according to the model which means that it lacksobjectivityi.e. it is notscientificorreliable
Evaluate the diathesis stress model in relation to issues and debates
The diathesis-stress model strives to be holistic rather thanreductionistin itsall-encompassing explanationof how a disorder such as schizophrenia develops. It achieves this holistic aim to some extent but it still cannot fully account forindividual differenceswhich means that it is not fully holistic and may lack someexplanatory power.
Talk about the interactionist approach and treatments
The interactionis approach to treating schizophrenia is to combine both drug therapy woth CBT. Schizophrenia may not have one true cause and may in fact develop due to a range of factors so it makes sense to treat both biological and psychological sympotoms.
The interactionist element usually starts with the patient taking antipsychotic medication followed by CBT. This is designed to enable the schizophrenic person to be able to participate in CBT more successfully as the drug therapy should have reduced some of their symptoms priot to CBT sessions
Talk about research to support the interactionist approach symptoms
Morrison et al. (2018)conducted asingle-blindpilot studywith 75 schizophrenic patients in Manchester: patients wereallocatedto drugs-only, CBT-only or a combination of CBT plus drugs and the findings showed that the combination condition was the most promising for the successful treatment offirst-episodeschizophrenia
Talk about positives to the interactionist approaches treatment
Using the interactionist approach may prove to becost-effective(i.e. good for theeconomy) if it is more successful than other treatments as the patient will improve more quickly and is less likely to relapse, saving money onhealth servicesand getting the patient back into theworkplacemore quickly
Talk about negatives to the interactionist treatments
- The interactionist approach may not suit all patients. Some may have difficulty understanding or interpreting theside-effectsof their drugs which CBT could actually worsen with its emphasis on challenging dysfunctional thoughts. In other words, the effects of the drug may be exacerbated by the process of CBT
- Thetreatment-causation fallacysuggests that the interactionist approach may bemistakenin treating the (supposed) biological causes of the illness first as there is nohard evidencethat schizophrenia has its roots in biological factors
Talk about interactionist treatments in relation to issues and debates
There is a lack ofcultural relativismin the interactionist approach so it could be accused ofculture biasi.e. some cultures may respond to neither drug therapy nor CBT as both of these treatments may misalign with somecultural normsandculture bound syndromes.
