Schizophrenia Flashcards
How is schizophrenia classified?
ICD-10 = 2+ negatives.
DSM-5 = 1 positive.
What are the positive symptoms of schizophrenia?
1) . Hallucinations –> sensory with no basis of reality.
2) . Delusions –> beliefs not based on reality.
What are the negative symptoms of schizophrenia?
1) . Avolition –> loss of motivation.
2) . Speech poverty –> frequency and quality affected.
Evaluate the classification and diagnosis of schizophrenia?
1). Reliability = Cheniaux =
- 1 psychiatrist = 26 patients (DSM), 44 (ICD)
- 1 psychiatrist = 13 (DSM), 24 (ICD).
2) . Validity =
- more likely to be diagnosed with ICD than DSM.
3) . Co-morbidity =
- Buckley et al. = 50% (depression), 47% (drug abuse).
4) . Gender bias =
- Longenecker = 1980s –> more men than women = women have better interpersonal skills.
5) . Cultural bias =
- black people more likely = normal to hear voices in African culture.
What are the 3 biological explanations of schizophrenia?
1) . Genetic basis of schizophrenia.
2) Dopamine hypothesis.
3) . Neural correlates.
What did Gottesman find in his twins study?
MZ = 48%.
DZ = 17%.
How is schizophrenia polygenetic and aetiologically heterogenous?
- Polygenetic = individual genes increase risk.
- Aetiologically heterogenous = different combinations.
How many genetic variations did Ripke et al. find?
108 (candidate genes).
Where/what is hyperdopaminergia?
Subcortex –> high dopamine activity =
- hallucinations + speech poverty.
Where/what is hypodopaminergia?
Prefrontal –> low dopamine activity =
- affects thinking and decision making.
What did Juckel et al. find about the ventral striatum and avolition?
Low activity = loss of motivation (avolition).
What did Allen et al. find about the superior temporal gyrus and hallucinations?
Low activity = hallucinations.
What are the evaluations of the biological explanations of schizophrenia?
1) . Could be environment =
- not 100% MZ, 50% DZ.
2) . Evidence for genetic vulnerability = Tienari et al. =
- adopted children from a schizophrenic mother are still at risk.
3. Correlation-causation =
- cant tell whether the structure causes the symptoms, or vice versa.
4) . Support from drug studies =
- increased dopamine in Parkinson’s = normality (opposite of schizophrenia).
What are the 2 psychological explanations of schizophrenia?
1) . Family dysfunction.
2) . Cognitive explanation.
How does Fromm-Reichmann explain schizophrenia?
Schizophrenic mother.
- cold, rejecting and controlling mothers cause schizophrenia.
How does Bateson et al. explain schizophrenia?
Double-bind theory.
- confusing communications = receive conflicting messages from parents –> disorganised thinking and delusions.
What is meant by expressed emotion as a psychological explanation?
Hostility and verbal criticism causes a relapse in schizophrenic patients.
What are the cognitive explanations of schizophrenia?
1) . Dysfunctional thought processing =
- lower levels of info processing.
2) . Metarepresentations =
- lack reflection on thoughts and behaviour –> hallucinations/delusions.
3) . Poor central control =
- unable to suppress automatic responses –> speech poverty.
Evaluate the psychological explanation of schizophrenia?
1) . Support for family dysfunction =
- Read et al. –> many patients report child sexual abuse.
2) . Weak evidence for family-based explanations =
- little evidence to support schizophrenic mother/double-bind - may encourage blaming parents.
3) . Evidence for dysfunctional thought processing =
- Stirling et al. –> patients took longer in Stroop task, showing impairment.
4) . Biological factors are sometimes overlooked =
- the diathesis-stress model is more valid than psychological/biological alone.
What are the biological therapies for schizophrenia?
1) . Typical antipsychotics –> old.
2) . Atypical antipsychotics –> new.
How do typical anti… work?
Dopamine antagonists =
- blocks dopamine, reducing activity.
What is an example of typical anti…?
Chlorpromazine =
- also a sedative.
What are the evaluations of typical anti…?
1) . Evidence for effectiveness =
- Thornley at al. –> associated with better functioning when compared to placebo.
2) . Serious side effects =
- e.g. dizziness, lip-smacking, NMS (can be fatal).
How do atypical anti… work?
Target dopamine and serotonin receptors.
What is an example of atypical anti…?
1) . Clozapine =
- reduces depression and anxiety, improves mood.
2) . Risperidone =
- fewer side effects, developed to tackle deaths from clozapine (agranulocytosis).
What are the evaluations of atypical anti…?
1) . Evidence for clozapine’s effectiveness =
- Meltzer –> more effective than typical.
2) . Depends on dopamine hypothesis =
- have to accept dopamine hypothesis for drug use to be rational (acts on dopamine).
What are the 3 psychological therapies for schizophrenia?
1) . CBT.
2) . Family therapy.
3) . Token economies.
What is CBT?
Helps patients identify and change irrational thoughts/beliefs.
- helps them understand their symptoms –> reduces anxiety.
What is family therapy?
- Reduces EE = aim to improve communication in the family, reducing stress, preventing relapse.
What strategies did Pharaoh et al. identify family therapists use to prevent relapse?
1) . Reduce stress of care.
2) . Improve family’s ability to anticipate and solve problems.
3) . Reduce guilt and anger in family members.
How do token economies reduce symptoms of schizophrenia?
- tokens given to patients for desirable behaviours (operant conditioning).
- reward given immediately to reduce ‘delay discounting’.
- associated with primary reinforcers (classical conditioning - they know what they can get with them).
What are the evaluations of the psychological therapies for schizophrenia?
1) . Evidence for effectiveness =
- Jauhar et al. (CBT), Pharoah et al. (family therapy) and McMonagle and Sultana (token economy) –> shown modest benefits to schizophrenic patients.
2) . Improve quality of life but not care =
- don’t cure schizophrenia, just help to cope and avoid relapse.
3) . Ethical issues =
- token economy –> severely ill less able to comply, so no rewards.
- CBT –> challenges beliefs part of their identity.
What is the interactionist explanation of schizophrenia?
Diathesis-stress model =
- vulnerability + stress trigger = schizophrenia.
What is Meehl’s model?
schizophrenia = schizogene + schizophrenic mother (without gene, they wouldn’t develop schizo).
What is the modern understanding of diathesis and stress?
Vulnerability not due to 1 ‘schizogene’ =
- many vulnerability factors including multiple genes, trauma and stress.
- stress = cannabis can increase stress trigger = schizophrenia.
Evaluate the interactionist approach to schizophrenia?
1) . Evidence for role of vulnerability + triggers =
- Tienari et al. –> schizophrenia = children with genetic vulnerability and parents with high criticism/low empathy.
2) . Original diathesis-stress model over-simplified =
- trauma causes vulnerability (not genes), cannabis is the stressor.
3) . Support for combining therapies =
- CBT + drugs = more effective than alone.
