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Schizophrenia Flashcards

1
Q

For the clinical characteristics of schizophrenia, how long does a person have to show at least one symptom for in list 1, to be diagnosed with schizophrenia?

A

1 symptom for 1 month

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2
Q

For the clinical characteristics of schizophrenia, how many symptoms does a person have to show in list 2, to be diagnosed with schizophrenia?

A

2 symptoms

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3
Q

What are the 3 characteristics in list 1?

A

Thought control
Delusions of control
Hallucinatory voices

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4
Q

What 3 characteristics are included in Thought control?

A 
Thought withdrawal( belief that thoughts are being actively being removed from the mind)
Thought insertion( the belief that thoughts are being actively put into the person's mind)
Thought broadcast (The idea that a person's thoughts are accessible to others around them. they are being broadcast)
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5
Q

What is the definition of delusions of control?

A

The individual does not feel in control of their own thoughts, feelings and will

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6
Q

What is hallucinatory voices?

A

Hearing voices that do not exist. These voices are often negative in tone and may take form of running commentary on an individuals behaviour

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7
Q

What are the 3 characteristics from list 2?

A

Incoherent/ irrelevant speech
Catatonic behaviour
Negative symptoms

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8
Q

What is Incoherent/ irrelevant speech?

A

Arises when individuals’ train of thought is disrupted to the point where their speech may become jumbled and meaningless. May include neologisms( made up words)

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9
Q

What is Catatonic behaviour ?

A

Unusual body movements, May include odd postures, uncontrollable limb movements and frozen immobility

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10
Q

What are Negative symptoms?

A

The absence of behaviours that a normal person may show. (lack of motivation , drive and lack of emotion

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11
Q

There are different specific types of schizophrenia which are characterised by specific symptoms identified (list one and two) being dominant. For example ?

A

Catatonic Schizophrenia and residual type

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12
Q

What is catatonic behaviour?

A

Motor Abnormalities - main symptom. Need is paired with another condition

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13
Q

What is residual behaviour?

A

No symptoms but symptoms have occurred in the last 12 months

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14
Q

What issues of classification and diagnosis of schizophrenia are there?

A 
No sole contributing factor.
No objective test
Different diagnostic tools are used (DSM and ICD)
Cultural variations
Over lapping symptoms
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15
Q

What are the differences are there between the 2 diagnosis tools (ICD and DSM) for schizophrenia?

A

DSM requires symptoms be shown for 6 months ICD for 1 month
Differ in how they define sub-types( 5 DSM 7 ICD)
DSM requires comparison to ‘normal’ person

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16
Q

Name the research studies into the classification and diagnosis?

A

Rosenhan
Beck et al
Jansson and Parnass
Cochrane

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17
Q

Describe the research of Rosenhan

A

8ppts 5m3f attempted to gain access to 12 mental hospitals accross the US. reported hearing the empty words ‘empty hollow thud’ otherwise acting normally. kept note whilst in hospital about behaviour of other staff.
7 diagnosed with schizophrenia 1 with bi polar. administered 2100 drugs
kept in hospital for period ranging from 7 to 52 days
note taking was taken as abnormal behaviour

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18
Q

Describe the research of Beck et al

A

Reported a 54% concordance rate between experienced practitioners diagnoses when assessing 153 patients. Soderberg et al reported a concordance rate of 81% using the DSM-IV-TR the most up to date form of DSM classification

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19
Q

Describe the research of Jansson and Parnass

A

Reviewed 92 polydiagnositic studies. these studies apply different definitions of disorder to same patient to assess reliability. Although reliability of the DSM and ICD were moderate , both were weaker in terms of their validity

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20
Q

Describe the research of Cochrane

A

Found that more African- Caribbean origin were 7 times more likely to be diagnosed with S than whites in the UK

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21
Q

What are the 2 biological explanations of schizophrenia and what are they?

A

Genetic explanation- S is inherited through genes
Dopamine hypothesis- suggests what S is the result of excessive Dopamine or excess Dopamine receptors. over activity of Dopamine

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22
Q

What are the twin studies research studies for the genetic explanation?

A

Gottesman and Shields (1972)

Gottesman and Shields (1976)

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23
Q

Describe the research of Gottesman and Shields (1972)

A

Medical records of 57 Schizophrenic twins between 1948 and 1964. 23 MZ and 34 DZ twins
if their twin did not have S they were followed for 13 yrs. 42% likelihood of MZ twins developing S compared to 9% for DZ twins

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24
Q

Describe the research of Gottesman and Sheilds (1976)

A

Meta-analysis of 5 studies. Reported concordance rates of between 75% and 91% for twins with severe form of S

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25
What are the adoption research studies for the genetic explanation of S?
Tiernari (Finnish adoption study)
26
Describe the research of Tiernari( Finnish adoption study )
Followed 155 adoptees that born to S mothers In adulthood, over 10% of adoptees with biological S mothers had developed the disorder. this compared to just over 1% of adoptees who developed the disorder who did not have a S mother
27
What are the family research studies for the genetic explanation of S?
Kendler et al | Dormas et al
28
Describe the research of Kendler et al
First degree relatives of S individuals were x 18 more likely to develop the disorder
29
Describe the research of Dormas et al
Followed 207 children who had S mothers. at a 27 year follow up, 16% had been diagnosed with S compared to 2% in a low risk group
30
What are the evaluation points for the genetic explanation of Schizophrenia?
Too simplistic Methodological issues with adoption studies Could be explained by both genes and the environment( diathesis stress) Research suggests that genes cannot be the only factor involved in S Methodological issues
31
What is the Dopamine Hypothesis ?
Dopamine is a neurotransmitter. Found in the Limbic system in the brain, the Limbic system is thought to be related to our emotional life. An increase number of dopamine receptors in the brain. Research has suggested abnormally high numbers of D2 receptors in the brain of S's
32
What was found in the Post mortems of S?
Abnormally high levels of dopamine in the limbic system
33
What are Phenothiazines and what do they do?
It is an anti-psychotic drug found to reduce the symptoms of S. it reduces Dopamine activity by blocking the dopamine receptors.
34
What do Amphetamines and LSD do to a healthy individuals brain?
They have an effect on dopamine levels inducing states similar to S
35
What does L-DOPA do?
It stands for dopamine releasing drug. can induce symptoms resembling Paranoia symptoms in Parkinsons patients ( who have low levels of dopamine)
36
Which dopamine system are associate with positive symptom and which is associated with negative symptoms when high levels of Dopamine occur ?
Mesolimbic - Positive Symptoms | Mesocortical - Negative symptoms
37
What are the evaluation points for the Dopamine hypothesis?
``` Too simplistic (x2) Practical applications Cause and effect Other neurotransmitters may be involved Drug companies may have inappropriately promoted the dopamine hypothesis ```
38
What are the 4 research studies for research into the dopamine hypothesis?
Randrup and Munkvad Iversen Kessler et al Wong et al
39
Describe the research of Randrup and Munkvad
Gave amphetamines to rats and observed similar behaviour to Schizophrenics
40
Describe the research of Iversen
Reported post mortems on people who had , had schizophrenia. Found excess Dopamine in the Limbic system, suggesting the involvement of the neurotransmitter
41
Describe the research of Kessler et al
Using PET and MRI found that people with S had elevated Dopamine levels in the basal forebrain
42
Describe the research of Wong et al
Found a two thirds increase in the density of dopamine receptor sites in people with S who had never been treated with drugs
43
Freud developed the Psychodynamic approach, which consists of the psychosexual stages and the Psyche. What 3 componants made up the Psyche?
``` The ID (Pleasure) The EGO(Reality) The SUPEREGO(Morality) ```
44
According to the Freudian in some abnormal upbringings, the ego attempts to protect the individual from this trauma. How does it protect the individual?
It regresses them to an early psycho-sexual stage, leaving them in a childlike state.
45
What is the reality principle?
It's the ego's job to keep control of the ID's impulses and strike a compromise between the demand of the ID and the moral restriction of the Superego. Early trauma is thought to lead to a weak ego.
46
What is ego disintegration?
As a result of the demands of the Ego, to protect itself from trauma , the ego is thought to breakdown leading to ego disintegration. This would explain the loss of touch with reality.
47
Attempts to re establish ego control has lead to.... .......
Auditory Hallucinations
48
What is expressed emotion?
Schizophrenogenic families tend to be 1. High in emotional tension 2. Many secrets 3. Form close alliances 4. Conspiracy ridden
49
What symptoms did Feud see are a result of individuals attempt to regain contact with the real world?
Auditory hallucinations | Visual hallucinations
50
Freud saw as evidence of the Schizophrenics self centred personality
1. Thought disorder 2. Withdrawal from society 3. Inability to communicate
51
What are the evaluation points for the Psychodynamic explanation of schizophrenia?
Parents of schizophrenics do act differently Emotional family environments(cause and effect?) Psychoanalysis is not a useful treatment( no prac apps) No support for schizophrenic mothers Ego disintegration isn't testable
52
What are the research studies into the psychodynamic explanation of schizophrenia ?
Brown et al | Vaughn and Leff
53
Describe the research of Brown et al
Conducted a 9 month follow up of S patients who ahd returned to their families from hospital. The family environments were defined as high EE or low EE. The research found a 10% relapse rate in the low EE and 58% relapse rate in high EE.
54
Describe the research of Vaughn and Leff
Found that high EE in families was linked to high rates of relapse in recovering patients campared to low EE(51% compared to 13%)
55
Cognitive psychologicals believe that ............... is the cause of S rather than the consequence of the disorder
CAUSE
56
How does the role of attention play a role in the cognitive explanation of S?
Schizophrenics can't filter and process incoming stimuli like a 'normal' person. they are are inundated with irrelevant information and are unable to process and interpret.
57
What are Schemas?
Pockets of information. based on past experiences that help us interpret the world around us.
58
What did Hemsley argue?
schemas are not activated. S's are unable to distigush between aspects of our environment that require attention and those which do not. This leads to sensory overload. Schemas tell us what is relevant and what is not in schizophrenics it doesn't happen. Delusions may result
59
What are the research studies into the cognitive approach to S?
Liddle and Morris | Frith
60
Describe the research of Liddle and Morris
Found that S individuals performed poorly on stroop tests. this is demonstration of interference in reaction time ( brain train word red written in blue) This could be because S's find it more difficult because they have a harder time filtering out the irrelevant informantion
61
Describe the research of Frith
Suggested that cognitive deficits are the result of abnormalities in areas of the brain associated with dopamine especially the prefrontal cortex. He showed that S individuals have reduced blood flow to these areas during cognitive tasks
62
What are the evaluation points from the cognitive explanation of schizophrenia?
Cause and effect Practical applications A physical basis for disordered thoughts
63
What is the most common form of treatment for schizophrenia?
Drug therapies(chemotherapy)
64
What common type of drugs used to address Schizophrenia?
Anti-psychotics
65
What do conventional anti psychotics(Phenothiazines) work on ?
The dopamine system
66
What do Atypical anti psychotics work on?
The Dopamine and Serotonin system
67
What example of phenothiazines is thought to reduce positive symptoms ?
Chlorpromazine
68
What is the trade name for Chlorpromazine is ?
Thorazine
69
They are known as Dopamine .............. because they combat the action of dopamine
Antagonists
70
Phenothiazines reduce what disturbances caused by S?
Emotional disturbance | Thought Disturbance
71
What do Atypical anti-psychotics do the serotonin receptors?
Temporarily bind to the receptors before allowing normal transmission
72
An example of an atypical anti psychotic?
Clozapine | Olanzapine( pos and neg symptoms)
73
What are the research studies into drug therapies?
Davis et al Kahn et al Schooler et al
74
Describe the research of Davis et al
Performed a meta analysis on 100 studied. Compared drug treatments with placebos. found that anti psychotics were more effective. 70% of sufferers improved with anti psychotics after 6 weeks, compared with 25% of those taking a placebo
75
Describe the research of Kahn et al
Compared typical and atypical anti-psychotics in first instance S. found that antipsychotics were successful for one year but that atypical were not necessarily any more effective that typical anti psychotics
76
Schooler et al
Compared typical and atypical antipsychotics and found that 75% of patients reported a significant reduction in symptoms.However relapse rates were considerably higher in those taking typical compared to atypical anti psychotics (55%/42%)
77
What are the evaluation points for chemotherapy(drugs) as a biological treatment ?
Has been usefully applied to help people Too simplistic Extreme side effects(sweating, immobility and tremors) Effectiveness vs cost Do patient take their drugs Best combined with other treatments
78
What is the second biological treatment besides drugs?
ECT( elector convulsive therapy)
79
Describe ECT
A therapy founded by Cerlutti and Bini in 1938. Given muscle relaxant and an anaesthetic before treatment. Electrodes attached to the temples and an electric current of 0.6 amps are passed through the brain. unilateral ECT involved attaching electrodes to one temple and the other the forehead. ranging from 0.5 -1 second. lead to convulsions. patients have no memory of treatment. found 6 sessions over a period of a few weeks.
80
What are the research studies for ECT?
Thayran and Adams (2005) Tang et al Thayran (2006)
81
Describe the research of Thayran and Adams (2005)
Reviewed 26 studies of ECT with S. Found that it was fairly effective in the short term,Being better than no treatments but not as effective as anti psychotic drugs
82
Describe the research of Tang et al
Found ECT to be effective in those who did not respond to anti-psychotic drugs. This suggests it can be effective for some sufferers of S
83
Describe the research of Thayran (2006)
Suggested it is an effective short term treatment but that the treatment was most effective when combined with other treatments such as anti-psychotic drugs
84
What are the evaluation points for ECT as a biological treatment for schizophrenia?
Effectiveness Ethical issues Side effects
85
What is CBT?
Cognitive behaviour therapy
86
A form of CBT is CSE what does it stand for?
Coping strategy enhancement
87
CSE aim to teach indidivuals to develop and apply effective coping strategies which will reduce........
The Frequency Intensity Duration of psychotic symptoms and the stress it brings
88
What are the 2 components of CSE?
Education and rapport training | Symptom targeting
89
Stress management is known as .......
``` Personal therapy involves the detailed evaluation of problems. They assess triggers for episodes and consequences of an episode and strategies to cope ( Questioning reality increasing social activity Breathing techniques) ```
90
What are the CBT as a therapy for S?
Tarrier (2005) Tarrier et al (2000) Trower et al
91
Describe the research of Tarrier (2005)
20 controlled trails of CBT using 739 patients. reduced symptoms lower relapse and speedier recovery rate. short term follow ups needed to assess CBT's long term benefits
92
Describe the research of Tarrier et al( 2000)
20 sessions of PT in 10 weeks, coupled with drug therapy followed by 4 booster sessions during following year did better than sufferers receiving drug therapies alone or supportive counselling. 1/3 of patients receiving PT achieved a 50 % reduction in psychotic experiences with 15% per cent free of all positive symptoms
93
Describe the research of Trowel et al
Controlled trial of CBT. didn't reduce the intensity of hallucinations but made them seem less of a threat by persuading sufferers that they outrank the voices. reduced positive and negative symptoms
94
What is the evaluation points for CBT as a treatment for S?
Supporting research on effectiveness Ethics It normalises symptoms, it doesn't get rid of them. Does CBT require insight and coherent thinking? Combine with other treatment for best results Requires considerable training
95
What is family intervention?
Aim is to reduce EE in the family environment. family given information about the disorder and ways of managing it. 1.Improving communication style 2. Lowering EE 3. Adjusting exprectations the family has on the individual 4. Expanding social networks
96
What are the research studies into family therapy?
Goldstien 1978 | Leff et al 1985
97
What are the research points for family intervention and schizophrenia
Effective treatment What if the individual is not in contact with the family Could it make things worse?

Psychology (8 decks)

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