Schizophrenia Flashcards
Define schizophrenia
The thought process disorder
Characterised by disruption to a persons perceptions, emotions and beliefs
Define acute
A sudden onset where behaviour changes within a few ,days
Define chronic
A gradual deterioration in mental health that develops slowly over time
Are males and females equally affected
Yes
Males: develops in late teens or early 20’s
Females: develop 4/5 years later
How much of the population is affected
0.5%
What are perceptual symptoms
Auditory hallucinations: hearing things that aren’t there
- usually saying abusive things
- most common type of hallucination
Social symptoms
Social withdraw
- not taking part in or enjoying social situations
- people might be aloof or avid eye contact
Cognitive symptoms
Delusions
- believing things that aren’t true
- can also experience delusions of control
Language impairments
- speech poverty- very brief replies and invent words
- irrelevant and incoherent speech
- can’t maintain a thought
What is and what are the positive symptoms
- positive= extra thing
- experience something, feel that something is happening to them
- hallucinations, delusions
What are and what is negative symptoms
- people don’t display normal behaviour
- negative= lacking
- speech poverty, lack of emotion, abolition (becoming disinterested)
What is the DSM
- the American Psychiatric Association Diagnostic and Statistical manual of mental disorders
- contains a list of mental health disorders
- aims to diagnose of mental disorders reliability and validity
What is reliability
- how far the classification system produces the same diagnosis for a particular set of symptoms
- for it to be reliable the same diagnosis should be made each time
- different clinicians should reach the same diagnosis
What is validity
Whether the classification system is actually measuring what it aims to measure
Different types
What is descriptive validity
How similar individuals diagnosed with the disorder are
What is aetiological validity
How similar the cause of the disorder is for each sufferer
What is predictive validity
How useful the diagnostic categories are for predicting the right treatment
How many symptoms should the patient show
- at least two (delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour, and negative symptoms)
- at least one has to be one of the first three
- their symptoms have to have been present for at least six months with one month of active symptoms
Problems with reliability
- may be affected by culture bias
- Harrison et al- over- diagnosis in West Indian patients in Bristol
- / patients can show the same symptoms but be diagnosed differently
- gender bias
- loring and Powel- 290 psychiatrists asked to diagnose the same two patients
- male, 56% diagnosed with Sz
- female, 20% diagnosed Sz
- despite the symptoms being identical
Problems with validity
- symptom over lap, lost of the most common symptoms in Sz are also found in other disorders
- abolition is a symptom of depression
- rosenhan p: people with no mental health problem got themselves admitted to a psychiatric unit by saying they heard voices
- the became pseudo patients
- once admitted they acted ‘normal’ again
- this behaviour was seen as a symptom of their disorder
- once people are labelled as having a disorder all their behaviour can be interpreted as a symptom
What is comorbidity
- issue in making a reliable and valid diagnosis
- having two or more conditions at the same time
- patients with Sz and depression
- having two or more conditions can make it really difficult for professionals to diagnose Sz as a distinct mental illness
Explanations- genetics
- being genetically related to someone with Sz can significantly increase a persons chance of developing it
Explanations- genetics
Gottesman
- 40 twin studies
- found MZ twins 48% concordance rate (48% chance one of the twins will have Sz)
- Dz twins 17% concordance rate
- both twins share the same environment influences which means the increase is for the genetic difference
What percentage of genes do MZ and ads twins share
100% MZ
50% Dz
Explanations- genetics
Evidence for twin studies
- shields found MZ twins raised in different families still showed around 50% concordance
- adoption studies- children adopted, one biological parent has Sz the chance of them developing it stays the same
- genetics more significant than the environment
Explanations-genetics
Evidence against twin studies
- no study has found 100% concordance rate so Sz can’t just be genes
- other factors need to be considered
Explanations- dopamine hypothesis
First explanation
- where there is an excess of the neurotransmitter dopamine in a certain region of the brain
- messages from numerous that transmit dopamine fire too easily/ often
- leads to hallucinations/ positive symptoms
- SZ high numbers of dopamine receptors
- more dopamine firing- more binding
- too much dopamine causes SZ
- too much in the subcortex
Explanations- dopamine
Second explanation
- low levels of dopamine in outside of the cortex causes SZ
- negative/ cognitive symptoms
- thought to arise from a deficit of dopamine in areas of the prefrontal cortex
What is a neural correlate
Measurements of the structure or function of the brain that correlate with an experience
Growing evidence for SZ,brain scanning
Neural correlates Ao3
:) juckel et al compared activity levels in SZ brains compared to control
- SZ had significantly lower activity
:( correlation doesn’t always mean causation
- could be a third factor affecting the activity in the brain
AO3- dopamine
What are agnostics
- chemicals that bind to a receptor cell
- cocaine- can cause positive symptoms of SZ and exaggerate them in people who already have the disorder
AO3- dopamine
What is antagonist
- blocks/ reduces the effects of neurotransmitters
- antipsychotic drugs reduce dopamine activity and can eliminate delusions
AO3- dopamine
:) both show importance of dopamine
:( not a complete explanation
Ripke huge study into combining all previous data. 108 different genes implicated
- not all were connected to dopamine
Explanations- psychological
Family dysfunction
- to do with how you have been brought up/ what is happening in your life
- cold and dominant ‘schizophrenic’ mother could create conflict causing SZ
- if you have a bad relationship with your mother then you could develop SZ in your later life
Explanations- psychological
Double-blind theory
- Bateson
- agrees family climate is important- emphasis role of communication
- faulty communication in families could lead to contradictory messages for children
- ’ I love you’ then gets ignored
- when badly behaved punished by withdrawal of love
- learns the word is confusing and dangerous
- this could lead to paranoid delusions/ disorganised thinking
Explanations- psychological
Expressed emotion and SZ
- the level of emotion often negative expressed to the patient
- environments contain high levels of hostility and criticism towards the person with SZ
- EE has been found in dysfunctional families and correlates with relapse in people with SZ
- contributes to the onset of SZ in those already vulnerable due to genes
Evaluation of family dysfunctions
:) evidence link between difficult childhood relationships/SZ
- read et al: 46 cases of child abuse found 69% of adult women in patients with SZ had a history of physic,a/ sexual abuse in childhood
- contributing factor
:( the theory ignores the biological evidence for SZ and puts the blame on the family and the parent.
- studies on the families were retrospective (done after disorder was found)
Explanations- cognitive
What are the two types of dysfunctional thought processing and main points of cognitive explanation
- associated with several types of abnormal information processing
- SZ is caused by dysfunctional thought processing
- leads to thought interference, delusions and language impairment
- two kinds of dysfunctional thought processing
- central control and meta representation
Explanations- cognitive
What is meta representation
- ability to reflect on thoughts/ behaviour
- allowing insight on own intentions/ goals
- SZ can’t recognise own thoughts/ actions carried out by themselves
‘FBI has planted a chip in my brain’
Explanations- cognitive
Central control
- people can suppress automatic responses while we perform drivers the actions instead
- disorganised speech- each word they say triggers a word
- people can suppress and continue with conversation
- patients with SZ can’t- speech becomes distorted
Explanations- cognitive
Evaluation
:) neufeld compared the cognitive processes of people with SZ with a control group. Participants with SZ took longer to encode stimuli and showed short term memory problems. This suggests their ability to process information was impaired.
:( cognitive explanations don’t exclusively explain the cause of SZ they might need to be linked to biological explanations
Explanations- socio-cultural factors
What are they
- people with a Lower social status are more likely to suffer from SZ than people with a higher social status
- factors like poverty and discrimination chase high stress levels
- which can then cause SZ
Explanations- social-cultural factors
Evaluation
:) Harrison et al found that people who were born in deprived areas were more likely to develop SZ
- suggests the factors like unemployment, poverty and crowding have an impact on SZ
:( these results are correlational, so they don’t show chase and effect.
- social drift hypothesis suggests that more people with SZ are in deprived areas because having SZ gives them low social status
Explanations- diathesis stress model
Why has the biological approach been criticised for being a reductionist theory
- ## attempts to explain SZ by reducing it dos into the simplest, smallest components possible such as genetics and neurotransmitters and parts of the brain
What is and interactionist approach, and how does it link to SZ
- assumes that processes interact with each other to cause a behaviour
- SZ, combination of biological and psychological factors
What is the diathesis stress model
- proposes people who are biologically vulnerable to developing a menta, disorder may be more likely to develop it if they are subjected to certain social or environmental stressors
- lots of research has been done to this- concordance rates in twin studies
Treating schizophrenia - biological
Drug therapy
Main points and two main drugs
- treatment is based on the dopamine hypothesis( SZ linked to increased dopamine activity in the brain)
- antipsychotic (blocks dopamine receptors)
- help reduce intensity of symptoms
- typical and atypical
Typical antipsychotic drugs
- used to combat positive symptoms- hallucinations
- first generation- 1950’s
- comes as a tablet, injection or syrup
- does starts low- people are different and need different doses
- normal dose- 400-800mg a day
- blocks dopamine receptors in the brain
- hallucinations and delusions usually diminish in a few days ( but for some it takes longer)
- still used today but les widely used, undesirable side effects
- sides effects- dry mouth, blurred vision, muscle spasms
Atypical antipsychotics
- also combats positive effects but have some beneficial effects on negative symptoms
- second generation
- newer and more effective
- 300-450 mg
- binds with receptors
- act both on serotonin and dopamine receptors
- can have severe side effects too
- blocks serotonin- improves mood
- lower risk of side effects
- beneficial effect on negative symptoms/ cognitive
Advantages of drug therapy
- more effective at reducing positive symptoms
- successful for a large number of people- can live in the community
- most widely used and effective form of treatment- almost all other treatments are put alongside drug therapy
Disadvantages of drug therapy
- isn’t effective for treating negative symptoms
- ethical issues- ‘chemical straitjacket’- doesn’t really help the patient, it controls their behaviour
- long-term side effects- increased risk of diabetes
- treats the symptoms but not the cause
Treating schizophrenia
Cognitive behavioural therapy
Main points
- based on the assumption that patients can be helped by identifying and changing their ‘faulty cognitions’
- one of the main techniques is based on Ellis’s ABC model
- people with SZ are encouraged to reality- test their hallucinations
- reducing levels of stress
- pushed to challenge their beliefs and question where the voices originate from
- positive self talk
- do role play and homework to test their faulty thinking
- over time they can gradually realise where the faults in their thought pattern are and begin to change them
Treating SZ- CBT
Advantages
- sensky et al- found it was effective in treating patients with SZ who hadn’t responded to drug treatment.
- helpful with positive and negative symptoms and patients could improve 9 months after treatment had ended
- puts patients in charge of their own treatment by teaching them self help techniques- fewer ethical issues
Treating SZ- CBT
Disadvantages
- only treats symptoms- doesn’t address the cause
- difficult to measure the effectiveness of CBT because it relies on self-report from the patient, and the therapists opinions. Less objective
- patients can become dependent on their therapist
- individual differences
Treating schizophrenia
Family therapy
Main points
- family intervention,- family dysfunction can lead to an increase risk of relapse
- aim: reduce conflict, and high emotion amongst family members
- can happen: by helping family form alliances, reduce the burden of care , limit outbursts of anger expressed by individual family members and encourage people to set realistic goals
- often used alongside other treatments
Treatments- family therapy
Advantages
- has experienced some success- pilling et al- found therapy reduced the rate of read mission in some patients with SZ
- ## useful in patients who lack insight into their own condition or can’t coherently explain their thoughts
Treatments- family therapy
Disadvantages
- getting informed consent from all members of the family is difficult
- issues surrounding confidentiality which needs to be addressed
- families need to be engaged and open to changing behaviour- not every family will
Treating SZ
Token economies
Main points
- behavioural treatment for SZ based on operant conditioning
- learning through reinforcement
- can help encourage people in psychiatric institutions to perform socially desirable behaviours (getting dressed)
- patients are given tokens which they can trade for something they want like sweets
- this is positive reinforcement
Treating SZ
Advantages
- can produce significant improvements in self care and desirable behaviour even with chronic institutionalised people with SZ
- ## work best with institutions- people who have lost the motivation to care for themselves
Treating SZ
Disadvantages
- don’t have high ecological validity- don’t transfer into the real world
- once people are away from the institution they often don’t continue showing desirable behaviour because theirs nothing to reinforce them
- patients behaviour might be superficial- might only provide desirable behaviour just because they are going to receive a token
- ethical issues- doesn’t really help the patient, just makes the behaviour more acceptable to other people
Treating SZ
Interactionist approach
Main points
- uses a combination of approaches to explain behaviour
- holistic approach- so treatment should be this too and in love biological, cognitive and behavioural therapies
- medication only seems to treat the symptoms, and patients don’t often take it regularly due to forgetting or because of the side effects
- other treatments should be used alongside medication
Treating SZ
Interactionist approach
Advantages
- since not one treatment works fully, makes sense to use a variety of treatments
- using psychological treatments alongside drug therapies not only allows the patient to manage their behavioural symptoms, but also provides them with the skills to tackle their condition and challenge any faulty ‘cognitions’
Treating SZ
Interactionist approach
Disadvantages
- difficult to know which treatment is working
- people with severe SZ are more likely to need a higher dose. These patients often are unwilling to try new things
- therefore treatments need to be flexible and appropriate
- can get very complicated and time consuming, patients may be required to take medication, do family therapy, and cognitive therapy and then also have forms of social support
