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A Level Psychology > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

What is schizophrenia?

A
  • A severe mental illness where contact with reality and insight are so impaired that contact is lost with external reality
  • An example of psychosis
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2
Q

When is schizophrenia most often diagnosed?

A

Between the ages of 15 and 35, with men and women affected equally.

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3
Q

What is the classification of mental disorders?

A

The process of organising symptoms into categories based on which symptoms cluster together in sufferers.

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4
Q

What are positive symptoms of schizophrenia?

A

Atypical symptoms experienced in addition to normal experiences

  • Hallucinations
  • Delusions
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5
Q

What are hallucinations?

A
  • A positive symptom of schizophrenia
  • They are sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are there.
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6
Q

What are delusions?

A
  • A positive symptom of schizophrenia
  • They involve beliefs that have no basis in reality, for example, that the sufferer is someone else or that they are a victim of a conspiracy.
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7
Q

What are negative symptoms of schizophrenia?

A

Atypical experiences that represent the loss of a usual experience such as clear thinking or ‘normal’ levels of motivation.

  • Speech poverty
  • Avolition
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8
Q

What is speech poverty?

A
  • A negative symptom of schizophrenia

- It involves reduced frequency and quality of speech.

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9
Q

What is avolition?

A
  • A negative symptom of schizophrenia

- It involves loss of motivation to carry out tasks and results in lowered activity levels.

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10
Q

What is comorbidity?

A
  • The occurrence of two illnesses or conditions together, for example a person who has both schizophrenia and a personality disorder
  • Where two conditions are frequently diagnosed together it calls into question the validity of classifying the 2 disorders separately.
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11
Q

What is symptom overlap

A
  • Occurs when 2 or more conditions share symptoms

- Where conditions share many symptoms this calls into question the validity of classifying the 2 disorders separately.

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12
Q

What are the 2 systems of classification and diagnosis?

A
  • ICD

- DSM

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13
Q

What is the ICD?

A

International Classification of the Causes of Disease and Death (World Health Organisation)
- Recognises a range of subtypes

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14
Q

What is the DSM?

A

Diagnostic and Statistical Manual of Mental Disorder (American Psychiatric Association)
- Also used to recognise the subtypes but the most recent DSM-5 have dropped these.

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15
Q

Does schizophrenia have a single defining characteristic?

A

No

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16
Q

According to the ICD 10, how many subtypes of schizophrenia are there?

A

5

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17
Q

What are the 5 subtypes of schizophrenia?

A
  • Disorganised Schizophrenia
  • Catatonic Schizophrenia
  • Paranoid schizophrenia
  • Undifferentiated schizophrenia
  • Residual schizophrenia
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18
Q

What is disorganised schizophrenia?

A
  • Must have all; disorganised speech and behaviour, flat or inappropriate affect
  • Must not meet the criteria for Catatonic Type
  • Symptoms include thought disturbances (including delusions and hallucinations), an absence of expressed emotion, incoherent speech, large mood swings and a loss of interest in life – social withdrawal
  • Usually diagnosed in adolescence/young adulthood
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19
Q

What is catatonic schizophrenia?

A
  • Immobility or stupor excessive motor activity that is apparently purposeless, extreme negativity, strange voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms or prominent grimacing.
  • Echolalia: The involuntary parrot-like repetition (echoing) of a word or phrase just spoken by another person
  • Echopraxia: The involuntary imitation or repetition of the body movements of another person, sometimes practiced by catatonic schizophrenic patients.
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20
Q

What is paranoid schizophrenia?

A
  • Preoccupation with one or more delusions or frequent auditory hallucinations
  • No disorganised speech, disorganised or catatonic behaviour, or flat or inappropriate affect.
  • These patients tend to be argumentative and are more alert than patients with other types of schizophrenia.
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21
Q

What is undifferentiated schizophrenia?

A

Variation between symptoms, not fitting into a particular type

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22
Q

What is residual schizophrenia?

A
  • Absence of prominent delusions, hallucinations, disorganised speech, and grossly disorganised or catatonic behaviour
  • A presence of negative symptoms
  • This is the category that describes people who, although they have had an episode of schizophrenia during the past 6 months and still exhibit some symptoms, these are not strong enough to merit putting them in the other categories.
  • Consists of patients who are experiencing mild symptoms.
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23
Q

What are secondary impairments?

A

Impairments as a result of the difficulties of living with schizophrenia:

  • Depression
  • Loss of employment
  • Breakdown of relationships
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24
Q

What are the 3 phases of schizophrenia?

A
  • The Prodromal (first) Phase
  • The Active Phase
  • The Residual Phase
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25
Q

What is the prodromal phase of schizophrenia?

A

The individual becomes withdrawn and loses interest in work, school and leisure activities

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26
Q

What is the active phase of schizophrenia?

A

More obvious symptoms begin to occur: the duration of this phase can vary; for some people it will last a few months, whereas others remain in the active phase

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27
Q

What is the residual phase of schizophrenia?

A

The obvious symptoms begin to subside, e.g. when treatment is given

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28
Q

What is the Mental Health Act?

A

People with schizophrenia can be admitted to hospital against their will and given treatment without their consent under the Mental health Act if they do not realise they are ill and refuse treatment when they need it

29
Q

What are the strengths of the diagnosis of schizophrenia?

A
  • Provide practitioners with a common language, permitting communication of research ideas and findings, which may ultimately lead to a better understanding of the disorder and the development of better treatments
  • Evidence does generally suggest that reliability of diagnoses has improved as classifications systems have been updated
30
Q

What are the weaknesses of the diagnosis of schizophrenia?

A
  • Gender bias, women tend to be under-diagnosed
  • Cultural bias, African Americans and English people of Afro-Caribbean origin are several times more likely to be diagnosed with schizophrenia than white people
  • Comorbidity
  • Symptom overlap
31
Q

What is dopamine?

A
  • A neurotransmitter that generally has an excitatory effect and is associated with the sensation of pleasure
  • Unusually high levels are associated with schizophrenia and unusually low levels are associated with Parkinson’s disease.
32
Q

What are neural correlates?

A

Measurements of the structure or function of the brain that correlate with an experience, in this case schizophrenia

33
Q

What does the biological explanation for schiziphrenia suggest is it’s cause?

A

It runs in families

34
Q

What is the dopamine hypothesis?

A
  • The brain’s chemical messengers appear to work differently in the brain of a patient with schizophrenia
  • In particular, dopamine (DA) is widely believed to be involved
  • Dopamine is important in the functioning of several brain systems that may be implicated in the symptoms of schizophrenia
35
Q

What is hyperdopaminergia in the subcortex?

A
  • The original version of the dopamine hypothesis

- High levels or activity of dopamine (hyperdopaminergia) in the subcortex

36
Q

Give an example of hyperdopaminergia in the subcortex.

A

An excess of dopamine receptors in Broca’s Area (responsible for speech production) may be associated with poverty of speech and/or the experience of auditory hallucinations.

37
Q

What is hypodopaminergia in the cortex?

A
  • A more recent version of the dopamine hypothesis
  • Abnormal dopamine systems in the brain’s cortex (low levels)
  • Goldman-Rakic et al (2004) have identified a role for low levels of dopamine (hypodopaminergia) in the prefrontal cortex (responsible for thinking and decision making) in the negative symptoms of schizophrenia.
38
Q

Which is correct in explaining schizophrenia through the dopamine hypothesis; hyperdopaminergia or hypodopaminergia?

A

It may be that both hyper- and hypodopaminergia are correct explanations - both high and low levels of dopamine in different brain regions are involved in schizophrenia.

39
Q

What is the neural correlate of the negative symptoms of schizophrenia?

A
  • Avolition = loss of motivation
  • Motivation involves the anticipation of a reward, and certain regions of the brain, for example, the ventral striatum, are believed to be particularly involved in this anticipation
  • It therefore follows that abnormality of areas like the ventral striatum may be involved in the development of avolition
40
Q

What did Juckel et al do?

A
  • Measured activity levels in the ventral striatum in schizophrenia
  • Found lower levels of activity than those observed in controls
  • A negative correlation between activity levels in the ventral striatum and the severity of overall negative symptoms
  • Activity in the ventral striatum is a neural correlate of negative symptoms of schizophrenia.
41
Q

What did Allen et al do?

A
  • Scanned the brains of patients experiencing auditory hallucinations and compared them to a control group whilst they identified pre-recorded speech as theirs or others.
  • Lower activation levels in the superior temporal gyrus and anterior cingulate gyrus were found in the hallucination group, who also made more errors than the control group.
  • Reduced activity in these 2 areas of the brain is a neural correlate of auditory hallucination (a positive symptom)
42
Q

What is family dysfunction?

A
  • Abnormal processes within a family such as poor family communication, cold parenting and high levels of expressed emotion
  • May be a risk factor for both the development and maintenance of schizophrenia.
43
Q

What is dysfunctional thought processing?

A

A general term meaning information processing that is not functioning normally and produces undesirable consequences

44
Q

What is the schizophrenogenic mother?

A
  • Cold, dominant and created conflict
  • Caused schizophrenia to emerge in a child
  • Rejecting, overprotective, self-sacrificing, moralistic about sex and fearful of intimacy
45
Q

What does modern research conclude about the schizophrenogenic mother?

A
  • No such thing as a ‘schizophrenogenic mother’
  • Only a small percentage of women who might arguably fit the criteria of schizophrenogenic mother had actually produced schizophrenic children
  • Many schizophrenics were found to have mothers who did not fit the criteria
  • Hindered progress in psychiatry and understanding the disorder
46
Q

What is the double bind theory?

A
  • Children are ‘punished’ for doing what was asked
  • Children will become confused and lose their grip on reality
  • Negative symptoms of social withdrawal may be an appropriate and logical response to double bind situations
  • Can’t trust anyone else and as a result they do not trust their own feelings and perceptions
47
Q

What is expressed emotion in a family with a patient of schizophrenia?

A
  • Critical comments, occasional accompaniment of violence, hostility, anger, rejection
  • If these factors are high, then the risk of a relapse is high
  • Family relationships can affect the degree of recovery rates
  • 58%of people with schizophrenia returning to hospital for further treatment
48
Q

What is the cognitive explanation of schizophrenia:

A
  • Characterised by disturbance in language, attention, thought and perception.
49
Q

What dis Frith do?

A
  • Suggested that schizophrenics fail to monitor their own thoughts correctly, misattributing them to the outside world.
  • When a person hears voices, it is actually their own inner speech being misinterpreted
  • Dysfunction in metarepresentation (the cognitive ability to reflect on thoughts and behaviour) would disrupt our ability to recognise our own thoughts and actions as being carried out by ourselves rather then someone else - this would explain hallucinations of voices and delusions like thought insertion
50
Q

What is auditory selective attention?

A

The process by which the brain selects which sounds to respond to.

51
Q

What is auditory selective attention impairment and how can it cause schizophrenia?

A
  • Negative symptoms of schizophrenia may be the result of cognitive strategies used to control potentially overwhelming levels of information from the external world and their inner world
52
Q

What did Pickering do?

A

Proposed that catatonic schizophrenia may be caused by a breakdown in auditory selective attention; this would make social interaction increasingly difficult - they have no choice but to withdraw from the world as this way they can keep sensory stimulation at a manageable level

53
Q

What is the interactionist approach?

A
  • A broad approach to explaining schizophrenia

- A range of factors, including biological and psychological factors, are involved in the development of schizophrenia

54
Q

What is Meehl’s diathesis-stress model?

A
  • Diathesis (vulnerability) is entirely genetic
  • A single schizogene, which led to a biologically based schizotypal personality and is extremely sensitive to stress.
  • No amount of stress will lead to schizophrenia if the gene is not present
  • However, in carriers of the gene, chronic stress as a child in the presence of the schizophrenogenic mother could get schizophrenia
55
Q

What is the modern understanding of the diathesis-stress model?

A
  • Many genes each appear to increase genetic vulnerability
  • No single schizogene
  • Psychological trauma- trauma becomes the diathesis rather than the stressor
  • Neurodevelopmental approach- early trauma alters the developing brain
56
Q

How can we treat schizophrenia according to the interactionist approach?

A

Combine antipsychotic medication and psychological therapies such as CBT.

57
Q

What are the biological therapies for schizophrenia?

A

Typical or atypical antipsychotics

58
Q

What are antipsychotics?

A

Drugs used to reduce the intensity of symptoms, in particular the positive symptoms

59
Q

Who are more likely to respond to antipsychotic drugs?

A

Those having their first episodes of psychosis meaning that they can be given a lower dosage

60
Q

What are typical antipsychotics?

A
  • The first generations of antipsychotic drugs

- They work as dopamine antagonists

61
Q

What are atypical antipsychotics?

A
  • Drugs for schizophrenia developed after typical antipsychotics
  • Target a range of neurotransmitters such as dopamine and serotonin
62
Q

What is chlorpromazine?

A
  • Typical antipsychotic drug
  • Work by acting as antagonists (chemicals which reduce the action of a neurotransmitter) in the dopamine system
  • Blocks dopamine receptors in the synapses of the brain, reducing the action of dopamine
  • It is also an effective sedative
63
Q

What is clozapine?

A
  • Developed in the 1960s
  • Trialled in the early 1970s and withdrawn for a while following the deaths of some patients from a blood condition called agranulocytosis.
  • It is to be used when other treatments fail (last resort)
  • Binds to dopamine receptors in the same way that chlorpromazine does, but in addition, it acts on serotonin and glutamate receptors
64
Q

What is risperidone?

A
  • Developed as an attempt to produce a drug as effective as clozapine but without the side effects
  • It is believed to bind to dopamine and serotonin receptors more strongly than clozapine does and is therefore effective in much smaller doses than most antipsychotics.
65
Q

How many patients that are given antipsychotic drugs

are non-compliant?

A

50%

66
Q

What is cognitive behaviour therapy (CBT)?

A
  • A method for treating mental disorders based on both cognitive and behavioural techniques
  • Aim of CBT is to help patients identify irrational thoughts and try to change them
  • Will not cure schizophrenia but it cam help make their delusions and hallucinations
    easier to cope with and understand what and why they occur
67
Q

What is family therapy?

A

A psychological therapy carried out with all or some members of a family with the aim of improving their communication and reducing the stress of living as a family.

68
Q

What are token economies?

A
  • A form of behavioural therapy
  • Desirable behaviours are encouraged by selective reinforcement
  • Patients are given tokens as secondary reinforcers when they engage in correct socially desirable behaviours
  • Tokens can be exchanged for primary reinforcers - favourite foods or privileges

A Level Psychology (11 decks)

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