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Psychology unit 4 > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

What does DSM V stand for?

A

Diagnostic and Statistic Manual of Mental disorders version 5

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2
Q

What are positive symptoms of Schizophrenia?

A

Symptoms the person didn’t have before the illness such as delusions and hallucinations

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3
Q

What are negative symptoms of Schizophrenia?

A

Symptoms that have caused loss for the patient such as loss of emotion, speech and motivation.

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4
Q

How many stages does it take to diagnose Schizophrenia?

A

5

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5
Q

What is the first step in diagnosing someone with Schizophrenia?

A

Looking at symptoms: A person must show at least one of the following- delusions, hallucinations and disorganised speech.

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6
Q

What is a delusion and what are the three types?

A

A delusion is an incorrect belief

  • Delusions of persecution (believing people are out to get you)
  • Delusions of grandeur (believing you are someone great)
  • Delusions of reference (believing everyday things such as a song playing on the radio has some significance)
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7
Q

What is a hallucination and what are the three types?

A

Sensing something that isn’t there

  • Auditory hallucinations (hearing something that isn’t there)
  • Visual hallucinations (seeing something that isn’t there)
  • Somatosensory hallucinations (feeling something that isn’t there)
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8
Q

What are the two features of disorganised speech?

A
  • Loose associations (jumping from topic to topic in conversation)
  • Word salad (severe form of loose associations but make no sense at all)
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9
Q

What are the features of grossly disorganised and catatonic behaviour?

A
  • Catatonia (maintaining a rigid posture for a long period of time)
  • Stereotypy (engaging in repetitive and pointless movements
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10
Q

What are the two types of negative symptoms according to the DSM V?

A
  • Lack of volition (withdrawal from social life)

- Flattened affect (no emotional expression)

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11
Q

What is the second stage of diagnosis of Schizophrenia?

A

Areas affected

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12
Q

Regarding areas affected what must the patient be underachieving in as a result of their illness?

A
  • Work
  • Relationships
  • Self care
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13
Q

What is the third stage of diagnosis of Schizophrenia?

A

Duration - the patient must have shown continuous signs of disturbance for at least 6 months and a month of symptoms.

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14
Q

What is the fourth stage of diagnosis of Schizophrenia?

A

Rule out other disorders first as there are similar psychotic disorders such as schizoaffective disorder and mood disorder with psychotic features.

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15
Q

What is the fifth stage of diagnosis of Schizophrenia?

A

Rule out known causes

A person won’t be diagnosed if there has been known drug use or previous medical condition to explain symptoms

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16
Q

After a psychiatrist has diagnosed a person with Schizophrenia how many types can they be placed into according to their most dominant symptom?

A

5

Paranoid, Disorganised, Catatonic, Undifferentiated and Residual

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17
Q

What describes a person with PARANOID schizophrenia?

A

-Delusions and auditory hallucinations

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18
Q

What describes a person with DISORGANISED schizophrenia?

A
  • Disorganised speech and behaviour

- Flattened affect

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19
Q

What describes a person with CATATONIC schizophrenia?

A

-Motor disturbances (jerking movements or rigid posture)

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20
Q

What describes a person with UNDIFFERENTIATED schizophrenia?

A

Where the symptoms don’t fit into paranoid, disorganised and catatonic types

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21
Q

What describes a person with RESIDUAL schizophrenia?

A

Continuing evidence of the disorder but none of the active symptoms fit into the other types

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22
Q

What is reliability when linked to schizophrenia?

A

How consistent the diagnosis over time and between doctors

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23
Q

What are two issues surrounding the classification and diagnosis of schizophrenia?

A

Reliability and validity

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24
Q

What 3 factors did Kleitman (1961) identify which could make the diagnosis of schizophrenia unreliable?

A
  1. Differences between clinicians - symptoms could be interpreted differently by different psychiatrists, difference in culture and behaviour. Cause a disagreement in diagnosis
  2. Differences between patients - No two cases are the same, a psychiatrist may misinterpret behaviour of a patient who is of a different culture. Also patients display different symptoms on different days so could lead to different diagnoses
  3. Difference in classification systems to diagnose a patient - Using different systems means low reliability as they may end up giving different diagnoses as systems describe different clinical characteristics.
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25
Q

What was Jones and Gray’s (1986) research that supports there is low reliability in the diagnosis of schizophrenia?

A

Noted that a large proportion of afro-Caribbean descents in western culture were being diagnosed with schizophrenia as there ‘symptoms’ are being misinterpreted by psychiatrists. Misinterpret the way they speak with disorganised speech and it is normal for them to be visited by the deceased - this could be seen as a hallucination. Supports the idea that cultural background of the psychiatrist can lower the reliability of diagnosis.

26
Q

What was Stephens et al’s (1982) study that supports there is low reliability in the diagnosis of schizophrenia?

A

Investigated the inter-rater reliability of nine different classification systems - doctors given the files of 283 patients and asked to use the different classification systems to diagnose them. Found that the agreement between psychiatrists was poor and the same diagnosis was not given.

27
Q

What was Motjabi and Nicholson’s (1995) research that supports there is low reliability in the diagnosis of schizophrenia?

A

Investigated how the subjectiveness of psychiatrists might lead to differences in diagnosis.
Gave 50 psychiatrists examples of delusions and had to sort them into bizarre and non bizarre. They agreed only on average 40% of the time. Supports idea that subjectiveness can cause low reliablility

28
Q

What was Copeland et al’s study (1971) that supports there is low reliability in the diagnosis of schizophrenia?

A

Investigated how culture of the psychiatrist might lead to a difference in diagnosis. 134 US and 194 UK psychiatrists were given a description of a patient and asked to diagnose them using the same classification system. 69% of the the US psychs diagnosed schizophrenia compared to 2% of UK psychs.

29
Q

What was Harvey et al’s study (2012) that supports there is reliability in the diagnosis of schizophrenia?

A

Carried out a meta analysis on the reliability to diagnose schizophrenia. Found that the older classification systems led to unreliable diagnoses however since the publication of the DSM IV reliability in diagnosis has increased. Shows that the mental health community is improving in reliability of diagnosis.

30
Q

What was Pagsberg’s study (2012) that supports there is reliability in the diagnosis of schizophrenia?

A

Argues that DSM IV will lead to much a more reliable diagnosis as its clinical characteristics have been tightened up to be clearer.

31
Q

What is validity in the context of schizophrenia?

A
  1. Does schizophrenia actually exist? As in is it one unitary disorder or a combination of other mental illnesses
  2. Is diagnosis accurate? Are psychiatrists accurate in their diagnoses?
32
Q

What are the two factors that cast the doubt on the validity of diagnosis?

A
  1. The wide range of experiences- There are many symptoms of schizophrenia and a person only needs to display two symptoms to have it, most cases are completely opposite so is it fair to say that they have the same illness?
  2. The similarities of other mental illnesses- Schizophrenia doesn’t have any pathognomic symptoms (symptoms exclusive to one disorder) lowers validity as someone could be diagnosed with schizophrenia when they have a different mental illness
33
Q

Why is validity of diagnosis such a big issue?

A
  1. Must make an accurate diagnosis so that the patient receives appropriate treatment
  2. Should avoid labelling someone schizophrenic as has a big stigma attached to it.
    - Thornicroft et al (2009) looked at 732 patients with schizophrenia and found that since diagnosis 47% found it hard to keep or maintain friends, 29% found it hard to keep a job and 43% suffered discrimination by their own family members
34
Q

What research by Rosenhan (1973) supported that there is low validity in the diagnosis of schizophrenia?

A

Rosenhan and eight others (all mentally healthy) each went to a separate psychiatric institution complaining that they could hear the word ‘thud’ All but one of the ‘patients’ were admitted to the ward as suffering from schizophrenia and the remaining person suffered from ‘manic depressive psychosis’. Lowers validity as all diagnosed with a disorder that they don’t have.

However the doctors were being tested on their ability to detect a lie rather than their ability to diagnose schizophrenia

35
Q

What was Kim and Berrios (2001) study that supports there is low validity in diagnosis?

A

Found that 80% of people are undiagnosed with schizophrenia when they actually have it. This isnt due to the doctor not being able to diagnose but due to the large stigma attached as doctors don’t want to burden their patients with the stigma so changed the name to ‘mind-split disease’ as they hold less negative connotations

36
Q

What was Ellason and Ross (1995) research that supports low validity in diagnosis?

A

Investigated the idea that the lack of pathognomic symptoms in schizophrenia reduces the validity of the concept. Compared patients who had been diagnosed with schizophrenia and dissociative identity disorder and found that the overlap was so great that people with DID had more schizophrenic symptoms than the people with schizophrenia. Shows easiness to misdiagnose a person.

37
Q

What was Bleuer (1978) research that supports low validity in diagnosis?

A

Looked at the predictive validity of the disease (persons improvement of symptoms from being given the most appropriate treatment) Looked at 2000 patients who had been diagnosed with schiz. Found that 20% made a full recovery, 40% recovered from positive symptoms and 40% continued to have psychotic episodes. Shows that schiz isn’t a valid concept as wouldn’t be such disparity in recovery if they all had the same disorder.

38
Q

What is Marius Rommes view on validity of diagnosis?

A

One of Schizophrenias biggest critics, claims it has no scientific validity because when diagnosing no attention is paid to how the person developed the symptoms- cant treat illness if don’t know how it came about.

39
Q

What are the two biological explanations of schizophrenia?

A
  • Dopamine hypothesis

- Genetics

40
Q

What are the two psychological explanations of schizophrenia?

A
  • Family Factors

- Socio-cultural factors

41
Q

What was the original dopamine hypothesis proposed by Snyder (1976)?

A

Too much dopamine=Schizophrenia
Based on medication reducing positive symptoms. Snyder noticed that the anti-psychotics had an effect at blocking dopamine receptor sites in the brain- dopamine doesn’t get absorbed if sites are blocked so has no effect on the body.

42
Q

Why was the dopamine hypothesis changed?

A

Seen as too simplistic and only explains how positive symptoms are reduced

43
Q

What is the revised dopamine hypothesis?

A

Abnormal levels of dopamine cause schizophrenia but shows that the effect of dopamine has effects on two separate parts of the brain
Excess dopamine production in the mesolimbic pathway of the brain causes positive symptoms
Low dopamine production in the mesocortical pathway causes the negative symptoms

44
Q

What is a strength of the dopamine hypothesis by Iverson (1979)?

A

Iversons research (1979) carried out post mortem studies on those who had suffered with schizophrenia - found that these people had higher concentrations of dopamine in their brains, supports the link between high levels of dopamine and schizophrenia.

However, a problem with Iverson’s study is that all of his participants had been taking anti-psychotic medication to control their symptoms. Anti-psychotic medication has the effect of blocking dopamine receptor sites, as a result of this it’s possible that the body adapts to these drugs by creating more dopamine receptor sites leading to higher concentrations.

45
Q

What is a strength of the dopamine hypothesis by Wong et al (1986)?

A

Carried out PET scans on living sufferers of schizophrenia, the PET scans measured the density of the dopamine receptor sites in 3 groups of participants:
1. Schizophrenics who were taking anti-psychotics
2. Schizophrenics who had never taken anti-psychotics
3. A control group of non-schizophrenics
It was found that both groups of schizophrenics had dopamine receptor sites that were significantly more dense than the other groups - Provides support for the dopamine hypothesis as its not the anti-psychotics which cause dopamine levels to rise as the group with medication had an increase in dopamine.

However there is an issue with cause and effect when looking at Wongs research don’t know if the high levels of dopamine came first or the schizophrenia developed first.

46
Q

What is a strength of the dopamine hypothesis by Timmons and Hamilton? (1990)

A

Schizophrenia is extremely rare in people with Parkinson’s disease, the reason this is significant is that this disease is caused by a lack of dopamine as opposed to schizophrenics which have high levels of dopamine. Drugs like Mirapex which are given to Parkinson’s can cause schizophrenic symptoms if the dosage is too high. - they increase dopamine levels beyond the optimum. Some schizophrenic sufferers will show P type symptoms after taking their anti-psychotic medication as their dopamine levels have decreased below the optimum levels

47
Q

What is a limitation/debate of the dopamine hypothesis?

A

Wholly takes the nature side of the nature/nurture debate it sees that schizophrenia is a biological disorder that doesn’t explain environmental factors/ It’s also a reductionist theory as only blames neural factors and ignores bigger terms in biology

48
Q

What does the genetic explanation of schizophrenia explain?

A

Argues that faulty genes can lead to the disorder

49
Q

What is the prevalence rate when there is no family history of schizophrenia?

A

Genes shared with affected family member: 0%

Chance of developing schizophrenia:1%

50
Q

What is the prevalence rate when there a cousin with schizophrenia?

A

Genes shared with affected family member: 12.5%

Chance of developing schizophrenia: 2%

51
Q

What is the prevalence rate when there is a half brother/sister with schizophrenia?

A

Genes shared with affected family member: 25%

Chance of developing schizophrenia: 6%

52
Q

What is the prevalence rate when there is a sibling or DZ twin with schizophrenia?

A

Genes shared with affected family member: 50%

53
Q

What proof is there that schizophrenia may be due to a mutated gene?

A

Karayiorgou et al (2012) looked at 225 people some had schizophrenia and some didn’t- Studied the genetic code and found mutations in 40 different genes were linked to schizophrenia
Also pre-natal factors could be linked such as the mother having the flu virus whilst pregnant which causes abnormalities and mutations in there genes.

54
Q

What is a strength of the genetic explanation by Rosenthal (1963)?

A

Case study on Genain (dreadful gene) quadruplets. They’re identical so share 100% of the genes and all developed schizophrenia by the time they were in their early 20s. Believed that their father and paternal grandmother suffered from schizophrenia - shows a gene has been inherited into the family.

55
Q

What is a strength of the genetic explanation by Kety et al (1994)?

A

They used a longitudinal study following two groups of participants. ‘High Risk’ group were 207 children of mothers diagnosed with schizophrenia. ‘Low risk’ group were 104 children with non-schizophrenic mothers. Children were matched on relevant variables such as age, gender, socio economic status. After 27 years it was found that 16.2% of the high risk group had developed schizophrenia compared to 1.9% of the low risk group. Strongly suggests that schizophrenia holds a genetic cause.

56
Q

What is a limitation of the genetic explanation in terms of debates?

A

Wholly takes the nature side of the nature/nurture debate because it sees schizophrenia being determined by biological factors alone and ignores environmental factors that could contribute to the disorder. For instance the Genain quadruplets grew up with a schizophrenic father and the environment this caused (extreme stress) could have led to the quadruplets developing the disorder alone

57
Q

What is a strength of the genetic explanation by Gottesman and Shields (1972)?

A

Used a sample of 57 participants who had been diagnosed with schizophrenia and all had a twin who had not been diagnosed with the disorder. Researchers looked into whether the undiagnosed twin did in fact have the disorder and found that there was a concordance rate of 42% for identical twins and 9% for non identical twins. The difference in concordance rates strongly suggests that schizophrenia has a genetic basis.

58
Q

What is the problem with drawing conclusions from twin studies?

A

Concordance rates are never 100% which you’d think they would be if they are identical and share the same genes. This means that the gene must make a person vulnerable to schizophrenia but something must trigger another factor e.g. stressful life experience.
Heston (1970) found that if one twin had schizophrenia then there was a 90% chance that the other twin had some type of mental illness - shows inheritance of mental disorders rather than specific ones.

59
Q

What is another strength of the genetic explanation by Jonsson et al (1997)?

A

Looked at a set of male triplets with schizophrenia and found that they all had an extra band in chromosome 15p. Shows that there is something wrong with schizophrenics genetics. However when looking at the Genain quadruplets they didn’t all have the same gene problem.

60
Q

What are the psychological explanations of schizophrenia?

A

Family factors and Socio-cultural factors

61
Q

What does the role of family factors explain’?

A

That an unhealthy family environment leads to schizophrenia based on 3 theories:

  1. The Double Bind Theory
  2. Expressed Emotion
  3. The Schizophrenogenic mother

Psychology unit 4 (2 decks)

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