Schizophrenia

Question 1

Harrison et al (1984)

Answer 1

Showed that there was an over diagnosis of Sz in West Indian psychiatric patients in Bristol - suggests that the symptoms of the ethnic minority patients have been misinterpreted
Suggests patients can display the sam symptoms but receive different diagnosis due to ethnicity

Question 2

Copeland et al (1971)

Answer 2

Found that 69% of American psychiatrists in the study diagnosed a particular patient as have Sz compared with only 21% of GB psychiatrists - Issue of having 2 diagnostic tools

Question 3

Wilks et al (2003)

Answer 3

Gave 2 forms of the RBANS test to patients over a period of 1-134 days and found that test-retest reliability was very high at 0.84

Question 4

Prescott et al (1986)

Answer 4

Looked into test-retest reliability of several tests that measure attention and information processing. A sample of 14 chronic Sz patients were used to test reliability. It was found that performance on these tests was stable over a 6 month period

Question 5

Cheniaux et al (2009)

Answer 5

Tested the inter-rater reliability of the DSM and the ICD and found that the inter-rater reliability was over 0,50 for both measures

Question 6

Buckley et al (2009)

Answer 6

Found that 50% of Sz patients have comorbid depression and 47% have a comorbid diagnosis of lifetime substance abuse

Question 7

Weber et al (2009)

Answer 7

Examined nearly 6 million hospital discharge records to calculate comorbidity. 45% of comorbidities were psychiatricc related
Found patients with a diagnosis of Sz were also diagnosed with problems including asthma, hypertension and type 2 diabetes
Concluded that being diagnosed with Sz means patients received a lower standard of care which in turn negatively affected their prognosis

Question 8

The Copenhagen high-risk study, Kety et al (1994)

Answer 8

Longitudinal study that began in 1992 in Denmark. 207 offspring of mothers with Sz compared to a control group of 104 offspring of ‘healthy’ mothers with follow-ups in 1974 and 1989
Sz diagnosed in 16.2% of high-risk group and 1.9% of the control group

Question 9

Gottesman and Shields (1982)

Answer 9

Found 58% of MZ twins raised apart were concordant for Sz

Question 10

Cardno et al (1999)

Answer 10

Found a 40% concordance rate in MZ twins, compared with 5.3% in DZ twins

Question 11

Joseph (2004)

Answer 11

Higher concordance rates in MZ twins is because they are treated similarly

Question 12

The Danish Adoption Study, Kety et al (1994)

Answer 12

Found high rates of diagnosis for chronic Sz in adopts whose biological parents had the same diagnosis even though they had been adopted by ‘healthy’ parents

Question 13

Wahlberg et al

Answer 13

Strong interaction between genetic and environment factors. Seemed that only children adopted into families with poor communication were at increased risk of developing Sz

Question 14

Haracz (1999)

Answer 14

In a review a post mortem studies it was found that most of those studied who showed elevated dopamine levels and received antipsychotic drugs shortly before death

Question 15

Suddath

Answer 15

Found that the same enlarged cavities when using MRI scans on SZ patients

Question 16

Brown (2003)

Answer 16

Women who contracted flu in pregnancy were more likely to give birth to children who developed Sz

Question 17

Mojtabi and Nicholson (1995)

Answer 17

For a diagnosis of Sz only one of the characteristic symptoms is required if delusions are bizzare
50 US senior psychiatrists were asked to differentiate between bizzare and non-bizzare delusions and there was a inter-reliability of +0,4
Shows that even the central diagnostic requirement lacks sufficient reliability

Question 18

Meyer-Lindenberg et al (2002)

Answer 18

Found a link between excess dopamine in the prefrontal cortex and working memory - not just excess dopamine but the effect it has on parts of the brain

Question 19

Yellowlees et al (2002)

Answer 19

Developed a machine that produces virtual hallucinations, such as hearing the the TV to kill yourself. The intention is to show sz’s that their hallucination are not real
–> Research can lead to new treatments

Question 20

Falloon et al (1996)

Answer 20

Suggests that high levels of physiological arousal is associated with neurotransmitter changes

Question 21

Brown and Birley (1968)

Answer 21

Found that about 50% of people experience a stressful life event in the 3 weeks prior to a schizophrenic episode

Question 22

Van Os et al (1994)

Answer 22

Reported no link between life events and the onset of Sz

Question 23

Berger (1965)

Answer 23

Found that sz’s reported a higher recall of double-bind statements by their mothers that non-sz’s

Question 24

Liem (1974)

Answer 24

Measured patterns of parental communication in families with a schizophrenic child and found no difference when compared with normal families

Question 25

Davis et al (1980)

Answer 25

There is a significant difference in the relapse rates between patients receiving conventional drugs and those receiving a placebo in every study reviewed suggesting that the drugs are effective
–> when receiving the release rates of 29 studies it was found that there was a higher relapse rate using the placebo (55%) compared to the drugs (19%)

Question 26

Vaughan and Leff (1976)

Answer 26

When comparing 2 environments, they found that antipsychotic medication did make a significant difference but only for those living with hostility and criticism in their home environment
–> in hostile conditions, the relapse rate for those on medication was 53% but for those in the placebo group the relapse rate was92% whereas in the supportive home environment there wasn’t significant difference between those on medication and those in a placebo condition

Question 27

Ross and Read (2004)

Answer 27

Argue that Davis et al’s study fails to compare drugs and placebo’s properly as the placebo group were actually experiencing drug withdrawal - their previously blocked dopamine system becomes flooded and have heightened sensitivity, resulting in relapse

Question 28

Hill (1986)

Answer 28

About 30% of people taking antipsychotic medication develop tar dive dyskinesia, and it is irreversible in 75% of cases

Question 29

Leucht et al (1999)

Answer 29

Only 2 of the new drugs tested were only slightly more effective than conventional antipsychotics while the other 2 were no more effective
In terms of alleviating negative symptoms, 2 of the atypical drugs were slightly more effective, one was as effective and one was slightly worse

Question 30

Jeste et al (1999)

Answer 30

Found tardive dyskinesia in 30% of people after 9 months of treatment with conventional antipsychotics, but just 5% for those treated with atypical antipsychotics

Question 31

American psychiatric association review (2001)

Answer 31

Looked at 19 studies that compared ECT with stimulated ECT
Concluded that ECT was no more effective than antipsychotic medication and only slightly more effective than stimulated ECT

Question 32

Read (2004)

Answer 32

Side effects and risks of ECT include memory dysfunction, brain damage and even death

Question 33

Gould et al (2001)

Answer 33

Found that all 7 studies in their meta-analysis reported a statistically significant decrease in the positive symptoms of Sz after treatment

Question 34

Kingdon and Kirschen (2006)

Answer 34

Found that many patients were deemed unsuitable as they were unable to fully engage, especially older patients

Question 35

NICE (2009)

Answer 35

A meta-analysis involving 32 studies and nearly 2500pp’s found significant evidence for the effectiveness of family intervention
The relapse rate in the family intervention condition was 26% compared to 50% in the control group

Question 36

Pharaoh et al (2012)

Answer 36

Meta-analysis of 53 studies which compared outcomes from family intervention to standard care, the results were:

• mental state - overall the results were mixed as well as some suggested an improvement whilst others did not
• compliance with medication - the use of family intervention increased patients’ compliance with medication
• social functioning - family intervention did not appear to have much of an effect

Question 37

NICE review (2009)

Answer 37

Found that family intervention is associated with significant cost savings when offered to people with Sz in addition to standard care - less relapse=less hospitalisation=less cost