Schizophrenia

Question 1

Diagnosis - Reliability - Beck et al

Answer 1

Agreement on 153 patients who were assessed by two psychiatrists was 54%

Question 2

Diagnosis - Reliability - Rosenham

Answer 2

8 pseudo-patients were able to be admitted to a mental hospital just by claiming to hear voices saying the words ‘Hollow’ and ‘Thud’

In a follow up, the hospital were told to expect pseudo-patients, when none were sent. They turned away 21% real patients as such.

Question 3

Diagnosis - Reliability - Carson

Answer 3

Believed the DSM-III fixed the problem of reliability

Question 4

Diagnosis - Reliability - Whaley

Answer 4

Found that the DSM-III produced inter rater reliability correlations as low as 0.11

Question 5

Diagnosis - Reliability - Bizarre/Non-Bizarre

Answer 5

When 50 senior psychiatrists were asked to differentiate between ‘bizarre’ and ‘non-bizzare’ delusions, inter rate reliability correlation was 0.40

Question 6

Diagnosis - Reliability - Copeland

Answer 6

When psychiatrists in the USA and the UK were given the same description of a patient, 69% of the US psychiatrists classified them as schizophrenic, compared to 4% of the UK psychiatrists.

Question 7

Diagnosis - Validity - Weber

Answer 7

Found evidence for many comorbid diagnoses among schizophrenic patients

Question 8

Diagnosis - Validity - Japan

Answer 8

Only 20% of Japanese schizophrenics are aware of their condition

Question 9

Diagnosis - Validity - Harrison et al

Answer 9

Rates of SZ are higher among Afro-Caribbean populations, possibly due to a racial bias or lack of cultural understanding in the diagnostic process

Question 10

Diagnosis - Validity - Bleur

Answer 10

Out of 2000 patients, 20% fully recovered, 20% recovered from positive symptoms and 40% continued to have schizophrenic episodes

Question 11

Dopamine Hypothesis - Haracz

Answer 11

Meta-analysis of post-mortem studies found that those who showed higher levels of dopamine/receptors had taken anti-psychotics shortly before death

Question 12

Dopamine Hypothesis - Wong

Answer 12

PET scan. Found a 2 fold increase in dopamine receptor sites

Question 13

Genetic Hypothesis - Family

Answer 13

Children with 2 SZ parents have a concordance rate of 46%
Children of 1 SZ parent have a concordance rate of 13%
Children with a SZ sibling had concordance rates of 9%

Question 14

Genetic Hypothesis - Twin study

Answer 14

DZ twins have a 7.4% concordance rate, while MZ twins have a 40.4% concordance rate

Question 15

Genetic Hypothesis - Gottesman and Shields

Answer 15

Used MZ twins which had been reared apart. Found a 58% concordance rate

Question 16

Genetic Hypothesis - Tienari

Answer 16

Out of 164 adoptees whose biological mothers had been diagnosed with SZ, 6.7% also had SZ, compared to 2% of the controls

Question 17

Genetic Hypothesis - Joseph (adoption studies AO2)

Answer 17

Potential adoptive parents would have been informed of the genetic background of the children - it would take a certain type of person to adopt such a child

Question 18

Socio-Cultural - Bateson

Answer 18

A cause of SZ is receiving contradictory messages (double binds) from parents, as this prevents the child from developing a coherent construction of reality

Question 19

Socio-Cultural - Berger (AO2)

Answer 19

Schizophrenics recalled a higher number of double binds from their mothers than non-schizophrenics

Question 20

Socio-Cultural - Liem (AO2)

Answer 20

Found no difference in patterns of communication in families with and without a schizophrenic child

Question 21

Socio-Cultural - Fox (AO2)

Answer 21

Found no evidence supporting the social drift hypothesis

Question 22

Socio-Cultural - Vaughan and Leff

Answer 22

The extent of expressed emotion in families was a strong predictor of relapse rates among discharged patients

Question 23

Socio-Cultural - Kalifi and Torabi

Answer 23

High EE leads to stress beyond their coping mechanisms, thus triggering a SZ episode

Question 24

Socio-Cultural - Brown (AO2)

Answer 24

Patients returning to homes characterised by high EE homes were more likely to relapse than those in low EE homes

Question 25

Socio-Cultural - Vaughan and Leff (AO2)

Answer 25

Relapse rates were 51% for high EE homes, compared to 13% for low EE homes.

Question 26

Biological Therapies - Anti-Psychotic Medication - Davis et al

Answer 26

Conventional-
Found a significant difference in terms of relapse rates in all studies reviewed when comparing medication with a placebo.
Placebo- 55%
Medication- 19%

Question 27

Biological Therapies - Anti-Psychotic Medication - One of the studies in Davis et al’s review

Answer 27

Conventional-
One study found a significant difference in relapse rates but only for those living with EE. In these conditions, relapse rates were:
Placebo- 92%
Medication - 53%

Question 28

Biological Therapies - Anti-Psychotic Medication - Leucht et al (superiority of atypical)

Answer 28

Atypical-
2 of the new drugs ‘slightly more effective’
Other 2 ‘no more effective’

Question 29

Biological Therapies - Anti-Psychotic Medication - Leucht et al (atypical drugs better with negative symptoms)

Answer 29

Atypical-
2 ‘slightly more effective’ at treating negative symptoms
1 ‘as effective’
1 ‘slightly worse’

Question 30

Biological Therapies - Anti-Psychotic Medication - Ross and Read

Answer 30

Davis et al’s study suggests 45% benefitted from placebos alone.

Are placebos a fair test?
Those taking the placebo were in a drug withdrawal state, meaning the dopamine system which was once blocked becomes flooded and overwhelmed with dopamine. This is likely to have caused the relapses.

Question 31

Biological Therapies - ECT - Tharyan and Adams

Answer 31

Meta-analysis of 26 studies
Compared to ‘sham’ (placebo) ECT, more improved - but no indication for if this was maintained
Compared to medication, results favoured medication
Some limited evidence to suggest the 2 combined (ECT and medicine) resulted in greater improvement

Question 32

Psychological Therapies - CBT - Chadwick

Answer 32

Studied a patient who thought he could make things happen by thinking of them. Patient was shown videos, they were paused and patient was asked what would happen. In 50 trials, he was incorrect and was able to see this

Question 33

Psychological Therapies - CBT - Drury

Answer 33

Found benefits in the reduction of positive symptoms and also a 25-50% reduction in recovery time for those taking anti-psychotics in conjunction with CBT

Question 34

Psychological Therapies - CBT - Kuipers

Answer 34

CBT is effective in reducing delusional symptoms. Also, more likely to maintain having treatment if they have CBT than those just on drugs

Question 35

Psychological Therapies - CBT - Could et al

Answer 35

All 7 studies in their meta-analysis reported a statistically significant decrease in the positive symptoms

Question 36

Psychological Therapies - Milieu Therapy (Socio-Cultural) - Birchwood and Spencer

Answer 36

‘Social skills training’ is beneficial in increasing the individual’s competence in social situations. But, active intervention needs to be maintained otherwise social skills will deteriorate

Question 37

Psychological Therapies- Family Intervention (Socio-Cultural) - Meta-analysis

Answer 37

Meta-analysis of 32 studies comparing family intervention with patients receiving standard care alone. After the intervention, there was a reduction in hospital admissions and in the severity of symptoms (followed up up to 24 months after)