Schizophrenia Flashcards

Question

What are the positive symptoms neural correlates?

Answer 1

Allen et al 2007 - scanned brains of patients experiencing auditory hallucinations compared to control group as they tried to identify whether pre-recorded speech was theirs or others. S group made more errors and lower activation levels found in superior temporal gyrus and anterior cingulate gyrus - reduced activity in these areas is a neural correlate

Answer 2

Multiple sources of evidence - Gottesman 1991 shows genetic similarity and risk of S are very closely linked Tienari 2004 - children of suffers of S are still at high risk even when adopted by non-s sufferers Ripke 2014 - shows certain variations of molecular levels significantly increase risk of S

Answer 3

Support for number of sources for abnormal dopamine functioning in S - amphetamines that increase level of dopamine make S worse and can produce symptoms in non-sufferers - Curran et al 2004 HOWEVER Does not provide a complete explanation for S. Some of the genes in Ripke's study code for different neurotransmitters such as Glutamate which seems to be another important factor (Moghaddam and Javitt 2012)

Answer 4

Correlation-causation problem of neural correlates Does the unusual activity in a region of the brain CAUSE the symptom? Could it be that the negative symptoms mean less info is passed through the VS resulting in reduced activity?

Answer 5

Family dysfunction - attempt to link S to childhood experiences in living in a dysfunctional family. 3 factors that increase risk of S - schizophrenogenic mother, double bind theory and expressed emotion Cognitive explanation - focuses on role of mental processing saying cognitive processes are faulty

Answer 6

SCHIZOPHRENIA CAUSING Frieda Fromm-Reichmann proposed psychodynamic explanation, formed by talking to patients about their childhoods Mothers were cold, rejecting and controlling, which created an atmosphere of tension and secrecy, which developed into paranoid delusions and then S

Answer 7

Gregory Bateson et al believed communication is key Children may find themselves trapped where they are afraid of doing wrong, but the wrong thing is not clearly communicated, punished with withdrawal of love, feeling the world is confusing and dangerous so patients are confused between what's reality and whats not. Disorganised thinking and paranoid delusions are the result

Answer 8

Level of negative emotion directed towards an individual, including; verbal criticism, sometimes violence, hostility, anger and rejection and emotional over-involvement and needless self-sacrifice They are very stressful and may lead to relapse or trigger S in high risk individuals

Answer 9

Metarepresentation | Central control

Answer 10

Our ability to reflect and understand upon our own thoughts and behaviour - if this fails we do not recognise our thoughts and behaviours as our own - e.g. thinking a tune in their head comes from an external radio, such as speech in a hallucination

Answer 11

Important cognitive ability to suppress responses, this seems to be malfunctioning in brains of people with S. End up with disorganised speech because they can no longer suppress every little thought as each word triggers new associations

Answer 12

Evidence to suggest that difficult relationships in childhood are associated with increased risk of S - Read et al 2005 reviewed 46 kids with child abuse and S and concluded 69% of women patients with S had a history of physical and sexual abuse as kids, 59% for men ADULTS WITH INSECURE ATTACHMENTS WERE MORE LIKELY TO HAVE S - Berry 2008 PATIENTS COULD HAVE DISTORTED IDEAS ABOUT THEIR CHILDHOODS NOW WHICH COULD MEAN THEY HAVE POOR VALIDITY

Answer 13

Almost no support for schizophrenic mother and double bind their. Earlier evidence involved assessing mothers personality for 'crazy-making characteristics' which is not modern - Harrington 2012 Another weakness is that it leads to parent-blaming which is highly socially sensitive - very subjective

Answer 14

Support for the idea that info is processed differently in patients with S - Stirling et al 2006 compared 30 S patients to 18 controls including troop test, patients with S took over twice as long as control group, in line with Frith's ideas

Answer 15

Links between symptoms and faulty cognition are clear however this does not tell us anything about the origins of the condition. May be that faulty processing is a symptom rather than a cause - cause and effect problem

Answer 16

Drug therapy - antipsychotics

Answer 17

Most common treatment for S, involving use of anti-psychotic drugs in the form of tablets, syrup and injections (every 2-4 weeks). Treatment may be required long-term or short-term, the 2 categories are typical and atypical

Answer 18

Chlorpromazine Around since 1950's, tablet, injection or syrup, max dosage of 1000mg, dosage declined over last 50 years Strong association with use of typical antipsychotics and dopamine hypotheis

Answer 19

Acts as an antagonist in the dopamine system - blocks dopamine receptors in the synapses of the brain reducing the action of dopamine. It normalises neurotransmitters in key areas of the brain which reduces symptoms like hallucinations. It is also an effective sedative - don't know why, often used to calm patients with S and other conditions SYRUP IS ABSORBED FASTER - WHEN THEY FIRST ENTER HOSPITAL NORMALLY GIVEN TO CALM

Answer 20

Clozapine and Risperidone

Answer 21

Developed on 1960's, 1st trialled in 1970's, was withdrawn for a while due to a few patients dying from blood condition ARANGULOCYTOSIS (deficiency of granulocytes in the blood) People taking it need to go for regular blood tests - not available as an injection due to side effects

Answer 22

Binds to dopamine receptors but also serotonin and glutamate receptors, helps to improve mood and reduce depression/anxiety. As it is a mood enhancer it is often prescribed when a patient has a high risk of suicide

Answer 23

Around since 1990's, developed to be as effective as Clozapine but without such serious side effects, tablet, injection or syrup. Small doses build up to a daily dosage of 4-8mg, 12mg is max dosage

Answer 24

Binds to dopamine and serotonin receptors but dopamine stronger so this is why you need a smaller dose, as you give a lower amount there are fewer side effects

Answer 25

Evidence of effectiveness - Typical - Thornley et al 2003 compared C to a placebo and found in 13 trials, 1121 participants showed C was associated with better overall functioning and reduced symptoms & relapse rate was lower Atypical - Meltser 2012 found C is more effective than typical antipsychotics as 30-50% of cases where typicals failed, atypicals worked STUDIES COMPARING THE TYPES OF ATYPICAL HAVE BEEN INCONCLUSIVE, AS IT MAY BE THAT ONE PATIENT RESPONDS BETTER TO ONE THAN ANOTHER

Answer 26

Side effects, such as TARDIVE DYSKINESIA - involuntary facial movements and NEUROLEPTIC MALIGNANT SYNDROME (NMS) which can be fatal Also with atypical drugs you still have to have regular blood tests

Answer 27

Our understanding of mechanism of antipsychotics comes from the dopamine hypothesis (too much dopamine in subcortex of brain) however evidence suggests there is too LITTLE and therefore how do antipsychotics help S if this is the case?

Answer 28

Evidence that challenges usefulness of antipsychotics - Healy 2012 suggested some successful trials have data published more than once and therefore exaggerates positive effects. Also suggested that antipsychotics have a powerful calming effect but this is not the same as reducing severity of psychosis

Answer 29

It is widely believed that antipsychotics have been used in hospitals to calm patients so they work well with staff rather than for patients benefits - this practise, approved by NICE, is seen by some as human rights abuse

Answer 30

CBT - cognitive behaviour therapy. tends to be between 5-20 sessions individually or in small groups. Aims to help patients identify irrational thoughts and challenge them Family therapy - involves family unit in therapeutic setting, designed to improve nature of interaction and communication within the unit. Reduce levels of expressed emotion too Token economies - based on operant conditioning, involves use of positive reinforcement

Answer 31

TARRIER - coping strategy enhancement Builds on patients existing coping strategies for S. the 2 types are; Positive self-talk and behavioural relaxation techniques The 2 parts to the therapy are; Develop rapport with client and identify psychotic symptoms and existing strategies Target specific symptoms and find strategies to deal with them. e.g. loud music to block out voices DELUSIONS ARE CHALLENGED TO SEE BELIEFS ARE NOT BASED ON REALITY

Answer 32

Turkington 2004 - challenges a patients paranoid delusions about the mafia wanting to kill him

Answer 33

Evidence for effectiveness - Jauhar et al 2014 reviewed results of 34 studies of CBT for S and found CBT had a significant but fairly small effect on positive and negative symptoms Overall there is modest support for CBT but S remains one of the harder mental health disorders to treat

Answer 34

Improves quality of life but does not cure. Allows patients to make sense of and challenge their symptoms but failure to cure is a weakness

Answer 35

Range of strategies to aim to improve functioning of a family with a member with S; 1) Forming a therapeutic alliance 2) reducing stress of caring with a relative with S 3)improves ability of family to anticipate and solve problems 4) reduction in anger and guilt of family members 5) helping balance caring for patient and maintaining own lives 6) improving families beliefs and feelings towards S THIS REDUCES STRESS LEVELS AND EE LEVELS WHILST INCREASING PATIENTS CHANCES OF COMPLYING WITH MEDICINES AND REDUCES RELAPSE AND READMISSION TO HOSPITAL

Answer 36

Double bind theory - states S is caused by mixed messages from parents causing them to develop an incoherent version of reality - influences symptoms of S such as social withdrawal

Answer 37

Evidence for effectiveness - Pharoah et al concluded there is moderate support to show family therapy significantly reduces hospital readmission over the course of a year and improves quality of life. However, they noted different studies were inconsistent and there were problems with some evidence, overall fairly weak evidence

Answer 38

Alternative therapy's may be more effective for people who do not like to talk in regular therapy. Art therapy allows people to access and express feelings through a different medium, it is recommended by NICE providing there is a qualified art therapist who has worked with people with S IT IS UNLIKELY 1 TYPE OF TREATMENT WILL ADDRESS ALL OF S'S SYMPTOMS

Answer 39

Reward systems are used to manage a patients behaviour, according to individual behavioural issues. Helps those who have developed maladaptive behaviour from being institutionalised for a long time, therapy does not cure but modifies bad habits so they can live outside a hospital setting Immediacy of a reward prevents 'delay discounting'.

Answer 40

Value themselves, they can be used to gain more tangible rewards. They are secondary reinforcers as they only have value once the patients learn they can be used to obtain rewards

Answer 41

Ayllon and Azrin 1968 - found the system worked to improve a wide range of prosocial behaviours in schizophrenics, but did not reduce the frequency or intensity of positive symptoms. THEY STATED THE SYSTEM WORKED SUCCESSFULLY AS GOAL WAS NOT TO CURE BUT TO IMPROVE DAILY BEHAVIOUR WITHIN A HOSPITAL

Answer 42

Ethical issues - Token economy requires patients to adhere to desired behaviours in order to gain the tokens. This proves much harder for those with more severe symptoms. This shows a clear discrimination for those with severe symptoms

Answer 43

Diathesis (vulnerability) stress (negative psychological experience) model suggests there is a genetic vulnerability to S however a stress trigger is needed for the condition to be developed - 1 or more underlying factors make someone vulnerable

Answer 44

Complex mix of 3 essential interacting factors. Biological - genes, neurochemical and neurological Psychological - stress, poor interactions with family Societal factors - drugs, alcohol, daily hassles

Answer 45

Meehl's model (original) 1962 Stated vulnerability was entirely genetic as a result of the 'schizogene', led to development of schizotypic personality, where one factor was stress If you do not have the schizogene, no amount of stress would lead to S. However, having a schizophrenogenic mother could result in development of S

Answer 46

Clear now many genes increase genetic vulnerability - there is no schizogene (Ripke 2014). View on psychological trauma becoming the diathesis rather than stress according to Ingram and Luxton 2005 Read et al 2001 proposed neurodevelopmental model where early trauma such as child abuse alters the brain so the hypothalamic-pituitary-adrenal (HPA) system becomes overactive, making you more vulnerable to later stress

Answer 47

Both biological and psychological treatments combined. Turkington et al 2006 said it is possible to believe in the biological causes of S but also believe psychological treatments will relieve symptoms - not possible with only 1 treatment In the UK it is common to treat patients with both types of therapies which may have led to the fast adoption of the model unlike the US

Answer 48

Psychological treatments, usually carried out whilst patients are taking anti-psychotics

Answer 49

The original model holds a oversimplified view of S Now seen that there is no 1 schizogene, multiple genes increase vulnerability to developing S. Now believed vulnerability can be result of early trauma - Houston et al 2008 found childhood sexual trauma emerged as a vulnerability factor whilst cannabis use was the trigger Shows old idea of diathesis as biological and stress as psychological is oversimple

Answer 50

315 patients were randomly allocated to a medication and CBT group, or to a medication and supportive counselling group or to the control group of just medication. He found patients in 2 combined groups showed lower symptom levels, although there was no difference in rates of hospital readmission. Shows a clear practical advantage to adopting interactionist approach and their idea of superior treatments

Answer 51

Tienari et al 2004 investigated combo of genetic vulnerability and parenting style with 19000 children adopted in Finland with schizophrenic mothers. Compared to a control group of adopted children with mothers with no genetic risk. Found child-rearing style was characterised by high criticism and conflict levels and low empathy levels but ONLY for those with the pre-existing genetic risk Suggests both genetic vulnerability and family related-stress are important in the development of S