Schizophrenia Flashcards
Flaum
Found enlarged ventricles, superior temporal lobes and abnormalities in the hippocampus and thalamus in the brains of SZ patients
Brown
Found enlarged ventricles and decreased brain weight in schizophrenic patients
Buschbaum
Found abnormalities in the hippocampus, pre-frontal cortex, frontal lobe, basal ganglia and amygdala (in the temporal lobe) in brains of SZ patients
Castner
Monkeys
- Foetal, exposed to brain damaging x-rays
- SZ symptoms developed during puberty
L-Dopa
Given to those with Parkinson’s disease
Increases dopamine levels as those with Parkinson’s have lower levels
Too large a dose can cause SZ symptoms
Anti-psychotics
Decreases dopamine levels in schizophrenics
Effectively removes symptoms
Amphetamines
Increase dopamine levels in Brain
Causes SZ like symptoms
Haracz
Post-mortems
Those who were given anti-psychotics had increased levels of dopamine whilst those who hadn’t had normal levels of dopamine
Over-compensating neurones as don’t know how to cope with sudden deficiency
Copolov and Crook
Neuroimaging e.g. PET scans more accurate than post mortems
No evidence for altered dopamine levels in SZ patients
Torrey and Peterson
Proposed viral hypothesis
More likely to be SZ if born in early spring
Mother has flu in second trimester causing an infection leading to drain damage in baby
Mednick
Increase of SZ patients born in the Helsinki flu epidemic
Takei
More SZ patients born in flu epidemics
Comer
Fingerprints develop during second trimester
More fingerprint abnormalities in SZ patients than control group
Gottesman
Conducted a study producing concordance rates for the likelihood of developing SZ depending upon genetic links to SZ
1% general population
17% DZ twins
48% MZ twins
Joseph
Twin studies
MZ twins - 40% concordance rate
DZ twins - 7.4% concordance rate
Tienari
164 adoptees with SZ mothers - 6.7% developed SZ
197 adoptees with non-SZ mothers - 2% developed SZ
Hallucinations
Distorted perceptions arising from any one of the senses
Auditory or visual
Delusions
Bizarre beliefs that seem real to the SZ patient, but are not real
Paranoid delusions
Bizarre belief that you are being followed e.g. Stalked that increase anxiety levels
Delusions of grandeur
Belief you are better than those around you e.g. Jesus
Affective flattening
Lack of interest in the self, blunt emotions
Alogia
Poverty of speech
Avolition
Lack of motivation
Disordered thinking
Confused or muddled thoughts, lack of concentration
Alien control
Belief that the mind is being controlled by an alien force or outside force
Crow
Type | - acute positive
Type || - chronic negative
Schizophrenia definition
Schizophrenia can be diagnosed as profound disruption of cognition and emotions that affects language, thought and perception of self
Fromm-Reichman
Schizophrenogenic family (lots of secrets, conspiracies, close alliances and high emotional tension)
Schizophrenogenic mother (contradictory messages prevent effective communication with child, overprotective but rejecting, insensitive and domineering
Lidz
Marital skew - one parent dominant, the other submissive
Marital schism - emotional distance between parents
Linszen
High EE leads to schizophrenic relapse for discharged partients
EE - expressed emotion is a system that involves hostility, criticism, over-involvement and over concern
Bateson
Double binds
suggests that a lack of communication can less to SZ. A mother for example will communicate to a child on two different levels and if these two levels contradict each other this will causes confusion within the child. So, the mother will communicate affection verbally and animosity non-verbally creating a conflicting message through saying something such as “I love you” whilst turning her head away in disgust. This creates a conflicting message and confusion, which stops the child from developing a coherent construction of reality leading to symptoms such as affective flattening
Hammersley and Read
Reviewed 13 studies into abuse and SZ
Some as high as 97% abuse rates
Brown and Birley
50% reported a negative life event 3 weeks prior to episode
12% reported a negative life event in the nine weeks prior to that
Control group - unchanging stress levels and low life events over the Same period
Hirsch
71 patients over a 48 week period
Cumulative effect of life events over a twelve month period not concentrated life events in a three week period as suggested by Birley and brown
Zimbardo
People turn to friends and relatives —> friends and relatives deny the reality of the sensations —> sufferers conclude that their friends are trying to hide the truth —> reject all feedback and develop beliefs that they are being persecuted
Hemsley
Suggests there is a breakdown between information that has already been stored in memory (internal) and new incoming sensory information (external). This may produce hallucinations.
People are also subjected to sensory overload and do not know what aspects of a situation to deal with. This may produce delusions as you may start to panic and think that people are laughing at you, talking about you etc.
Frith
Attempted to explain the onset of positive symptoms of schizophrenia. His idea is that people with schizophrenia are unable to distinguish between actions that are brought about by external forces and those that are generated internally.
Freud
Regression to the oral stage if abused or had bad childhood. The oral stage is before the ego develops, and without this there is no concept of reality just like in schizophrenia. Schizophrenia was therefore seen by Freud as an infantile state. E.g. delusions of grandeur would be explained because babies believe they are the centre of the world and have no concept of other people
Social learning theory
Behaviourists explain the fact that schizophrenia runs in families as a function of social learning. Bizarre behaviour from parents is copied by kids. Parents then reinforce this behaviour and the behaviour becomes progressively more unusual until eventually the child acquires the label of being ‘schizophrenic’.
Operant conditioning
Behaviourists argue that learning plays a key role. One suggestion is that an early experience of punishment may lead to the child retreating into a rewarding inner world. Others then label them as ‘odd’ or ‘strange’.
Scheff
Labelling theory - individuals labelled in this way may continue to act in ways that conform to the label. Bizarre behaviour is rewarded with attention and becomes more and more exaggerated in a continuous cycle before being labelled as ‘schizophrenic’. Attention is received from strange behaviour and so is reinforced - others may be rewarded by people leaving them alone if they are anti-social and so act crazy in order to be rewarded with alone time
Ullman and Krasner
Observed mental health nurses in their interactions with patients and concluded that staff actually reinforce schizophrenic behaviour by giving more attention to those patients.
Allyon and Azrin
- showed that schizophrenics have learned to make their own beds etc. when given rewards for doing so
Roder et al.
Roder et al. - social skills training techniques have been used to help SZ’s acquire social skill - the success of these suggests these skills schizophrenics failed to learn in the first place
May
May: Found that the therapy used by the psychodynamic approach did not work on schizophrenics - if the therapy doesn’t work then there are flaws in the explanation - low validity
Conventional Anti-Psychotics
An example is chlorpromazine
They work by blocking the dopamine receptors
They are dopamine antagonists - they bind to dopamine receptors but do not stimulate them, blocking their action
Reduces levels of dopamine in the brain, eliminating positive symptoms
Davis et al.
Meta-analysis of 29 studies (3519 people) looking at relapse rates in patients taking conventional anti-psychotics. Relapse rates were 55% with placebo and only 19% for those taking conventional anti-psychotics
Vaugn and Leff
Conventional anti-psychotics only reduce relapse rates when the patient is living in a hostile and critical environment (negative expressed emotion) - 53% relapse with drugs, 92% relapse with placebo. If the patient is living in a happy hope environment (positive expressed emotion) the drugs make no real difference - 12% relapse with drugs, 15% with placebo. This suggests the environment is almost as important as your brain chemistry in reducing likelihood of relapse.
Side effects of Conventional Anti-Psychotics
Conventional anti-psychotics have worrying side-effects, including tardive dyskenesia (uncontrollable movements of lips, mouth, tongue, hands or feet). About 30% of people get this after taking conventional anti-psychotics and in 75% of cases it is irreversible.
Ross and Read
Being prescribed medication takes too much attention away from other possible causes such as life history or current circumstances (environmental factors
Atypical Anti-Psychotics
An example is Clozapine
These work by blocking dopamine receptors but they also block serotonin receptors too
Developed to reduce the nasty side-effects of conventional antipsychotics
Kapur and Remington
Suggested that atypical anti-psychotics do not involve serotonin or other neurotransmitters but they help by temporarily occupying D2 receptors and rapidly dissociating to allow normal dopamine transmission
Leucht et al
Meta-analysis comparing conventional and atypical antipsychotics. Only 2 of the 4 new drugs came out as ‘slightly’ more effective than conventional. He also compared their effectiveness for negative symptoms and 2 were ‘slightly more effective’, one was ‘as effective’ and one was ‘slightly worse’.
Side effects of atypical drugs
Atypical drugs have fewer side-effects, including tardive dyskenesia. Research has shown that after nine months on atypical only 5% of patients developed tardive dyskenesia compared to 30% on conventional
How ECT works
three or four times a week maximum of 12 treatments.
intravenous line is attached and through it the patient will be given an anaesthetic and a muscle relaxant.
Then an electrical shock is applied to try patient’s head via electrodes. The shock will last only one or two seconds (high voltage/low amperage) and will make the brain have a seizure,
this seizure is controlled by the medicines to stop/reduce the body having a grand muscular spasm.
wake up within 5 to 10 minutes after the treatment.
Tharyan and Adams
ECT better than placebo in short term, but not in medium/long term
Drugs worked better than ECT
Limited evidence that combination of drugs and ECT = most effective
Sarita
No difference in symptom reduction between patients given ECT or simulated ECT
ECT side effects
Side effects may result from the anaesthesia and the ECT
Common side effects include temporary short-term memory loss, confusion, paranoia, nausea, muscle aches and headache
Some people may have longer-lasting/permanent problems with memory/paranoia
Nowadays, rare causes result in death (in the past it was often caused by poor calibration of the shock, coupled with a lack of muscle relaxants)
CBT
CBT is based on the idea that most unwanted thinking patterns, emotional reactions and behavioural reactions are learnt over a long period of time. In CBT, discorded and delusional thinking can be identified and replaced with though processes that are more constructive and more in line with reality.
Psychoanalysis
Includes free associations, hypnotic regression and dream analysis
Therapist uncovers unconscious conflicts and interprets them to create a subjective resolution of the problem
Not suitable for SZ (Freud) due to distorted touch of really to can’t focus on transference
Malmberg and Fenton
Impossible to derive definite conclusions for or against the effectiveness of psychoanalysis - may even be harmful for patients as may cause relapse as have to recover harmful events so it’s unethical
May
Antipsychotics are significantly better than psychoanalysis
Karon and VandenBos
Patients treated with the therapy improved more than those on medication alone
Appropriateness of ECT
Takes a long time - attrition
Expensive - statistics show SZ’s are likely to be out of a job as severe symptoms
American Psychiatric Association
Still recommend this with medication and so adds validity to therapy
Gould et al
Gould et al. found that all seven studies in their meta-analysis reported a statistically significant decrease in the positive symptoms of schizophrenia post-treatment.
Kingdon and Kirschen
Kingdon and Kirschen’s study of 142 schizophrenic patients, they found that many of the patients were deemed unsuitable for CBT because psychiatrists believed they would not fully engage with the therapy.
Drury et al.
Those receiving medication and CBT experience fewer hallucinations and delusions (20/25% reduction in recovery time)
Kuipers
Those using CBT and medication had lower drop out rates and greater patient satisfaction
Klosterkotter et al.
Schizophrenia is too broad a category for it to be a useful diagnosis. Two patients could have completely different symptoms. So he suggested that positive symptoms may be more suited for a diagnosis of schizophrenia.
Mojtabi and Nicholson
50 US psychiatrists asked to distinguish bizarre and non-bizarre delusions. Inter-rater reliability correlation of around 0.4
Copeland et al.
Description of the same patient given to 134 US and 194 British Psychiatrists
69% of the US psychiatrists diagnosed schizophrenia
2% of the UK psychiatrists diagnosed schizophrenia
67% more US Psychiatrists diagnosed schizophrenia
Rosenhan
Rosenhan sent 8 ‘normal’ people to different hospitals, all claiming they had been hearing voices saying ‘empty’ ‘hollow’ and ‘thud’. All admitted to the hospital - 7 with schizophrenia and 1 with bi-polar disorder
Nazroo
In the UK, African-Caribbeans are up to five times more likely to be diagnosed with Schizophrenia than the general population (Nazroo, 1997)
Bentall et al
Almost every factor known to influence human behaviour has been suggested as a cause of schizophrenia (Bentall et al.)
Rosenhan
one of the pseudo patients had been diagnosed, the facts about them were unintentionally distorted by staff to fit in with his disorder. They suggested one of them had an ‘unstable’ relationship with his wife ‘punctuated with angry outbursts’ when really his relationship was good. However, this would not have fit in with his diagnosis
