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Schizophrenia Flashcards

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1
Q

What are the diagnostic tools used to diagnose Schizophrenia?

A

ICD-11 and DSM-V

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2
Q

What are positive and negative symptoms?

A

Positive symptoms are additions to normal behaviour and negative symptoms are absences of normal behaviour

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3
Q

What are hallucinations?

A

Unreal perceptions of the environment

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4
Q

What are the types of hallucinations? Give an example for each.

A

Auditory- e.g. hearing voices
Visual- e.g. lights, objects or faces
Olfactory- e.g. smelling things
Tactile- e.g. feeling of bugs crawling on or under the skin

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5
Q

What are delusions?

A

Bizarre beliefs that seem real to the person with Schizophrenia, but they are not real. Sometimes these beliefs can be paranoid, such as delusions of persecution and sometimes they involve themselves such as delusions of grandeur

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6
Q

What is disorganised thinking?

A

The feeling that thoughts have been inserted or withdrawn from the mind. In some cases, the person may believe their thoughts are being broadcast so others can hear them.

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7
Q

What is catatonic behaviour? Is it a positive or negative symptom?

A

Catatonic behaviour refers to bizarre and abnormal motor movements. For example, holding the body in a rigid stance, moving in a frenzied way, peculiar facial movements or copying movements of others. It can be either a negative or positive symptom- sometimes individuals might slow down and sometimes they may speed up

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8
Q

What is affective flattening?

A

A reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language

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9
Q

What is alogia (poverty of speech)?

A

This is characterised by the lessening of speech fluency and productivity; thought to reflect slowing or blocked thoughts

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10
Q

What is social/ occupational dysfunction?

A

Occurs when one or more major areas of functioning such as work, interpersonal relations or self-care is markedly below the level achieved prior to the onset for a significant portion of time since the onset

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11
Q

What is avolition?

A

The reduction of or inability and persistance in goal-directed behaviour, for example sitting in the house for hours every day, doing nothing

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12
Q

What is anhedonia?

A

A loss of interest or pleasure in almost all activities, or lack of reactivity to normally pleasurable stimuli

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13
Q

In the current edition of DSM-V, what needs to be present for a Schizophrenia diagnosis?

A

Criterion A- 2 or more symptoms present
Criterion B- Social/ occupational dysfunction
Criterion C- positive symptoms consistently for a month prior to diagnosis

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14
Q

What is the one symptom that can diagnose Schizophrenia on its own?

A

If hallucinations/ delusions are very bizarre or voices are conversing or holding a running conversation then Schizphrenia can be diagnoses with just this 1 symptom

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15
Q

What is the reliability of diagnosis?

A

If a diagnosis is reliable it means that clinicians must reach the same conclusions at two different points in time (test-retest) or different clinicians must reach the same conclusion (inter-rater reliability)

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16
Q

How is inter-rater reliability measured?

A

By a statistic called a Kappa score. A score of 1 indicates perfect inter-rater agreement and a score of 0 indicates zero agreement. A Kappa score of 0.7 is generally considered good

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17
Q

Outline a study that shows cultural differences in diagnosis (reliability problems)

A
  • Copeland
  • 134 US and 194 British psychiatrists given description of a patient
  • 69% of the US psychiatrists diagnosed schizophrenia but only 2% of the British ones gave the same diagnosis
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18
Q

What is validity in terms of diagnosing Schizophrenia?

A

Refers to the extent that a diagnosis represents something that is real and distinct from other disorders.
The extent to which a system such as DSM-V is measuring what it intends to measure

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19
Q

Explain how gender bias affects the validity of a Schizophrenia diagnosis

A
  • Critics of DSM diagnostic criteria argue that some disagnostic categories are biased towards one gender
  • Broverman et al found that clinicians in the US equated mentally healthy ‘adult’ behaviour with mentally healthy ‘male’ behaviour
  • As a result there was a tendency for women to be perceived as less mentally healthy
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20
Q

What is symptom overlap?

A

Refers to the fact that symptoms of a disorder may not be unique to that disorder but may also be found in other disorders, making accurate diagnosis difficult

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21
Q

Outline a study which shows the effects of symptom overlap

A
  • Ellason and Ross
  • Found that patients with dissociative identity disorder (DID) had more Schizphrenia symptoms than patients diagnosed with Schizophrenia
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22
Q

What is co-morbidity?

A

Refers to the extent that two (or more) conditions or diseases occur simultaneously in a patient, for example schizophrenia and depression

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23
Q

Outline a study of co-morbidity

A
  • Buckley et al
  • Found that co-morbid depression occurs in 50% of patients
  • 47% patients also have a lifetime diagnosis of co-morbid substance abuse
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24
Q

Give two evaluation points for validity in diagnosis and classification of Schizophrenia

A

Research support for gender bias- Loring and Powell presented 290 psychiatrists with a patient description. They found that when the patient was described as male or no information given about gender, 56% of the psychiatrists gave the schizophrenia diagnosis but when the patient was described as female only 20% were diagnosed with Schizophrenia

Consequences of co-morbidity- studies found many patients with a primary diagnosis of schizophrenia were also diagnosed with medical problems such as asthma, hypertension and type 2 diabetes. They found that the very nature of a diagnosis of a psychiatric disorder means patients receive a lower standard of care which will affect their Schizophrenia diagnosis

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25
Q

Give two evaluation points for reliability in diagnosis and classification of Schizphrenia

A

Lack of inter-rater reliability- Whaley found inter-rater reliability correlations in diagnosis of Schizophrenia as low as 0.11

Unreliable symptoms- one of the characteristic symptoms for diagnosing Schizophrenia is “bizarre delusions” but when 50 senior psychiatrists were asked to differentiate between bizarre and non-bizarre delusions, their inter-rater reliability correlations were only 0.40 which shows that even this central diagnostic requirement lacks sufficient reliability.

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26
Q

Describe a family study of Schizophrenia

A
  • Gottesman
  • Found individuals with Schizophrenia and aimed to determine whether their biological relatives are similarly affected
  • Found that Schizophrenia is more common among biological relatives and that the risk increases with genetic closeness
  • Children with two Schizophrenic parents had a concordance rate of 46% and children with one schizophrenic parent had a concordance rate of 13%
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27
Q

Describe a twin study of Schizophrenia

A
  • Joseph
  • Found a concordance rate of 40.4% for M/Z twins and 7.4% for DZ twins
  • This supports a genetic position
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28
Q

Describe an adoption study of Schizophrenia

A
  • Tienari et al
  • Studied 164 adoptees whose biological mothers were diagnosed with Schizophrenia
  • 11 (6.7%) also received a diagnosis of Schizophrenia compared to just 4 (2%) of 197 control adoptees
  • This supports the fact that people have a genetic liability to Schizophrenia
29
Q

How does the dopamine hypothesis explain Schizophrenia?

A

The dopamine hypothesis claims that an excess of dopamine in certain regions of the brain is associated with positive symptoms of schizophrenia. Schizophrenics are thought to have abnormally high numbers of D2 receptors on receiving neurones, resulting in more dopamine binding and more neurons firing.

30
Q

What are the two pieces of evidence for the role of dopamine in Schizophrenia?

A

Drugs that increase dopaminergic activity:
Amphetamine stimulates nerve cells containing dopamine, increasing its concentration in the synapse. ‘Normal’ individuals exposed to large doses of drugs like amphetamines can develop hallucinations and delusions. People with Parkinson’s who take the drug L-Dopa which increases dopamine levels have been found to exhibit Schizophrenia-like symptoms

Drugs that decrease dopaminergic activity:
Antipsychotic drugs that reduce the activity of dopamine in the brain eliminate symptoms such as hallucinations and delusions

31
Q

What is the revised dopamine hypothesis?

A
  • Davis and Kahn
  • Proposed that the positive symptoms of Schizophrenia are caused by an excess of dopamine in subcortical areas
  • The negative and cognitive symptoms of Schizophrenia arise from a deficit of dopamine on areas of the prefrontal cortex
32
Q

What is the evidence for the revised hypothesis?

A

Neural imaging: Patel et al found lower levels of dopamine in the dorsolateral prefrontal cortex of schizophrenic patients compared to their normal controls
Animal studies: Wang and Deutch induced dopamine depletion in the prefrontal cortex in rats which resulted in cognitive impairment that was able to be reversed with an antipsychotic drug.

33
Q

Evaluate the biological explanations of Schizophrenia.

A

WEAKNESS: MZ twins encounter more similar environments- MZ twins tend to be treated more similarly, encounter more similar environments and experience identity confusion. Therefore the differences in concordance rates between MZ and DZ twins may not be entirely due to genetic factors.

WEAKNESS: Adoptees may be selectively placed- Joseph found that in countries such as Denmark and the US potential adoptive parents would have been informed of the children’s genetic background which could have influenced how they raised the children

STRENGTH: Evidence for the dopamine hypothesis from treatment- Leucht et al carried out a meta-analysis of 212 studies and found that all the drugs tested were significantly more effective in the treatment of positive and negative symptoms than a placebo

WEAKNESS: Challenges to the dopamine hypothesis- Noll argued that antipsychotic drugs do not alleviate hallucinations and delusions in about one-third of people experiencing these symptoms and in some people hallucinations and delusions are present despite levels of dopamine being normal which suggests dopamine is not the most important cause of positive symptoms

34
Q

What does family dysfunction suggest about the cause of Schizophrenia?

A

That Schizophrenia is caused by abnormal patterns of communication within the family

35
Q

What do cognitive explanations suggest about the cause of Schizophrenia?

A

Cognitive explanations emphasise the role of dysfunctional thought processing i.e. people with Schizophrenia process information differently to people without the disorder

36
Q

Outline double bind theory

A
  • Bateson et al
  • Suggested that children who frequently receive contradictory messages from their parents are more likely to develop Schizophrenia
  • For example if a mother tells her son that she loves him but at the same time turns her head away in disgust
  • There is a message of affection on the verbal level but one of animosity on the non-verbal level
  • These interactions prevent the development of an internally coherent construction of reality which in the long run manifests itself as symptoms of Schizophrenia
37
Q

Outline how expressed emotion can cause Schizophrenia

A
  • Expressed emotion (EE) is a family communication style in which members of the family of a psychiatric patient talk about them in a critical or hostile manner in a way that indicates emotional over-involvement or over-concern
  • Kuipers et al found that high EE relatives talk more and listen less
  • High EE increases relapse rates- a patient returning to a family with high EE is about four times more likely to relapse
  • This suggests that people with Schizophrenia have a lower tolerance for intense environmental stimuli such as intense emotional comments and interactions with family members
38
Q

How can cognitive deficits explain symptoms of Schizophrenia?

A
  • Research has shown that people with Schizophrenia often get distracted
  • They may have difficulties processing auditory or visual information
  • Difficulties in understanding other people’s social behaviour and what they might be thinking can explain some experiences of Schizophrenics
  • Cognitive deficits have been linked to a range of Schizophrenia symptoms such as disorganised speech and delusions
39
Q

How can cognitive biases explain symptoms of Schizophrenia?

A
  • Cognitive biases are to do with paying selective attention to certain stimuli
  • For example they may place too much attention on an auditory stimulus (hyper vigilance) so have a higher chance of an auditory hallucination
  • Many people who experience feelings of persecution have a general tendency to assume that other people cause the things that go wrong with their lives
  • This leads to delusions of persecution
40
Q

Evaluate psychological explanations for Schizophrenia

A

WEAKNESS: Cause and effect- It is difficult to establish whether it is the family dysfunction that is causing the Schizophrenia or if the presence of a Schizophrenic child is causing the family dysfunction.

STRENGTH/ WEAKNESS: RE for double bind- Berger found that Schizophrenics reported higher recall of double bind statements by their mothers than non-schizophrenics. HOWEVER, this may not be reliable as patients’ recall may be affected by their Schizophrenia

STRENGTH- Support from the success of cognitive therapies: the NICE review in 2014 found consistent evidence that when compared to treatment by antipsychotic medication, cognitive behavioural therapy was more effective which suggests a cognitive basis for Schizophrenia

WEAKNESS: Integrated model might be better: The psychological model fails to acknowledge other factors such as neurochemical changes. Howes and Murray created an integrated model which argues that early vulnerability together with exposure to social stressors causes more dopamine to be released, leading to symptoms such as paranoia and hallucinations.

41
Q

What is drug therapy?

A

Drug therapy involves treatment of mental disorders such as schizophrenia through the use of antipsychotics to reduce the symptoms of the disorder

42
Q

What are typical antipsychotics?

A

Typical antipsychotics like chlorpromazine are used primarily to combat the positive symptoms of schizophrenia such as hallucinations and thought disturbances

43
Q

What are atypical antipsychotics?

A

Atypical antipsychotics such as clozapine combat positive symptoms but also seem to have beneficial effects on negative symptoms too

44
Q

How do typical antipsychotics work?

A
  • They are dopamine antagonists
  • They bind to dopamine receptors (specifically D2 receptors) and prevent the passage of dopamine across the synapse
  • By reducing the stimulation of the dopamine system in the mesolimbic pathway, hallucinations and delusions are reduced
45
Q

Name two examples of typical antipsychotics

A
  • Chlorpromazine

- Haroperidol

46
Q

What are the side effects of typical antipsychotics?

A
  • The blocking of receptors can upset motor control and muscle movement
  • One example is tardive dyskinesia, which is present in 30% of schizophrenia patients and irreversible in 75% of cases
  • This involves involuntary spasms of the face, hands and feet
  • Other side effects include diabetes, a lack of motivation to see alternative treatment and being confined in a chemical straight-jacket
47
Q

Outline the mechanism of atypical antipsychotics

A
  • Act as temporary dopamine occupiers
  • Work by temporary blocking D2 receptors
  • They occupy the receptors and rapidly dissociate, allowing normal transmission of dopamine
  • They are less likely to cause muscular side-effects and there is only a 5% incidence of tardive dyskinesia
  • Effective at reducing some of the negative symptoms as well as the positive
48
Q

What does ECT stand for?

A

Electroconvulsive therapy

49
Q

How is ECT used to treat schizophrenia?

A
  • Based on the observation that dementia praecox (early name for schizophrenia) was relatively rare in epileptics
  • Scientists hypothesised that inducing a seizure may alleviate symptoms of schizophrenia
  • Tharyan and Adams carried out a meta-analysis of 26 studies involving 798 patients with schizophrenia and found use of ECT led to significant improvements in patients compared to a placebo
50
Q

What are the side effects of ECT?

A

Memory loss, confusion, headaches, paranoia, nausea and muscle aches

51
Q

Evaluate drug therapy as a treatment for schizophrenia

A

STRENGTH: Research support for typical antipsychotics- Leucht carried out a meta-analysis of 65 studies with 6,000 patients who were either on typical or atypical antipsychotics. Some patients were taken off their medication and given a placebo instead. Within 12 months, 64% patients of the patients who were given the placebo had relapsed as opposed to 27% of those who stayed on the antipsychotic drug

WEAKNESS: Ethical problems with typical antipsychotics- If side effects, deaths and psychosocial consequences were taken into account, the cost-benefit analysis would probably be negative.

STRENGTH: Drug therapies are easier, quicker and require less motivation than other treatments such as CBT

WEAKNESS: Motivational deficits- Ross and Read suggest that prescribing people antipsychotics reinforces the idea that something is wrong with them which prevents the individual from considering possible stressors and reduces their motivation to look for possible solutions that might alleviate these stressors

52
Q

What does CBTp stand for?

A

Cognitive behavioural therapy for psychosis

53
Q

What does CBTp assume about Schizophrenia patients?

A
  • Assumes that people have distorted belies which influence their feelings and behaviours in maladaptive ways
  • Works to help the patient identify and correct faulty interpretations of events
54
Q

What does CBTp aim to do?

A
  • Help establish links between thoughts, feelings or actions and general functioning
  • By monitoring these thoughts and feelings, patients are able to consider alternative ways of explaining their thoughts and feelings
55
Q

How does CBTp work in practice?

A
  • Patients are encouraged to trace back the origins of their symptoms
  • They are then encouraged to test and evaluate the validity of their delusions
  • They might be set behavioural assignments to improve their general functioning
  • The therapist allows the patient to develop their own alternatives to maladaptive beliefs
56
Q

What are the phases of CBTp? (6)

A
  1. Assessment: patient expresses their thoughts and experiences to the therapist
  2. Engagement: therapist empathises with the patient’s and feelings of distress
  3. ABC model: patient explains their activating events that cause behavioural and emotional consequences
  4. Normalisation: by placing psychotic experiences on a continuum with normal experiences, the patient feels less alienated and stigmatised
  5. Critical collaborative analysis: therapist asks gentle questions to help the patient understand illogical deductions and conclusions.
  6. Developing alternative explanations: the patient develops their own alternative explanations for previously unhealthy assumptions
57
Q

Give four evaluation points for CBTp

A

STRENGTH: Advantages: NICE found consistent evidence that when compared to standard care, CBTp was effective in reducing rehospitalisation rates up to 18 months following the end of treatment and reducing symptom severity

WEAKNESS: Dependent on stage of disorder: Addington and Addington claimed that in the initial phase of Schizophrenia, self-reflection is not particularly appropriate and patients can benefit from CBTp following stabilisation of psychotic symptoms with drug therapy

WEAKNESS: Lack of availability: in the UK only 1 in 10 patients who could benefit from this therapy get access to it. Haddock et al found that out of 187 randomly selected patients with Schizophrenia, only 6.9% had been offered CBTp as treatment

WEAKNESS: Problems with meta-analysis: fail to take into account study quality. June et al found there was clear evidence that the problems associated with weak methodology translated into biased findings about CBTp

58
Q

What is family therapy?

A
  • A range of interventions aimed at the family of someone with Schizophrenia
  • Aims to reduce the level of expressed emotion within the family which has been linked with relapse
  • Typically conducted for 3-12 months
  • Involves educating the family about the illness, reducing expressions of anger and guilt and maintaining reasonable expectations
59
Q

Outline research supporting family therapy

A
  • Meta-analysis of 53 studies
  • Compared outcomes from family therapy to ‘standard’ care i.e. drug therapy
  • They found that family therapy increased patients’ compliance with medication, improved general functioning and reduced risk of relapse and hospital admissions
  • However it appeared to have mixed effects on mental state and did not appear to have much of an effect on social functioning
60
Q

Give four evaluation points for family therapy as a treatment for Schizophrenia

A

STRENGTH: Economic benefits- NICE associated family therapy with significant cost savings when offered to patients with Schizophrenia alongside standard care. This is because it reduces hospitalisation and relapse

STRENGTH: Positive impact on the family themselves- Lobban analysed 50 family therapy studies and found 60% of them reported a significant positive impact on at least one outcome category for relatives e.g. problem-solving and family functioning

WEAKNESS: Diathesis stress- suggests that a disorder may be due to a genetic predisposition that was triggered by an environmental stressor. This means that Schizophrenia should ideally be treated with a combination of treatments i.e. drugs and therapy, as there is likely a more complicated cause

WEAKNESS: Methodological limitations of Pharoah et al’s meta-analysis- Random allocation was stated to be used but was not in many studies. There was also the possibility of observer bias where rates were not ‘blinded’ to the condition to which people were allocated. 10 studies reported no blinding and a further 16 did not mention whether blinding has been used

61
Q

What is token economy?

A
  • Form of behavioural therapy
  • Target behaviours are set to improve the patient’s engagement in daily activities
  • Tokens are awarded whenever the patient engages in one of the target behaviours
  • The tokens can later be exchanged for rewards and privileges
  • The idea is that the patient will engage more often with desirable behaviours because they become associated with rewards and privileges
62
Q

Outline a study supporting token economy as a treatment for Schizophrenia

A
  • Ayllon and Azrin
  • Used a token economy on a ward of female Schizophrenic patients
  • Given plastic tokens for behaviours such as making their bed
  • The tokens were exchanged for privileges such as watching a movie
  • Found that the use of a token economy increased the number of desirable behaviours performed each day
63
Q

Give four evaluation points for the use of token economy as a treatment for Schizophrenia

A

STRENGTH: Research support- Dickerson et al reviewed 13 studies of the use of token economy and found 11 of these studies reported beneficial effects that were directly attributed to the use of token economics

WEAKNESS: Difficulty assessing the success- When a token economy system is introduced patients are brought into the study rather than having a control group so improvements can only be compared with past behaviour

WEAKNESS: Less useful for patients living in the community- Corrigan argues that there are problems administering the token economy method with outpatients because they only receive day treatments for a few hours a day and so the method can only be used for a limited time a day

WEAKNESS: Ethical concerns- Gives clinicians control over primary reinforces such as food, privacy, activities etc. Humans have certain basic rights that cannot be violated regardless of the positive consequences of the token economy programme

64
Q

What is the diathesis-stress model?

A

Sees schizophrenia as a result of the interaction between biological and environmental influences. This model suggests that individuals will develop Schizophrenia if they have a genetic predisposition to it which is triggered by an environmental factor

65
Q

What are examples of the diathesis factors?

A
  • Genetic factors
  • Exposure to the flu virus during gestation can alter the development of the nervous system making people more predisposed to develop Schizophrenia
  • Birth complications can alter CNS functioning and development
66
Q

What are examples of stress factors?

A
  • Family dysfunction
  • Trauma: abuse and/ or neglect
  • Parenting style
  • Exposure to particular chemicals e.g. cannabis
67
Q

Outline Tienari’s study on the diathesis-stress model and its relevance to Schizophrenia

A
  • Hospital records reviewed for 20,000 Finnish women diagnosed with Schizophrenia
  • They looked at 145 offspring of these women who had been adopted away from their families (high-risk group) and compared them to a sample of 158 adoptees without this genetic risk (low-risk group)
  • Both groups were assessed after 12 years with a follow-up at 21 years
  • Family functioning was also assessed
  • Of the 303 adoptees, 14 had developed Schizophrenia over the course of the study
  • 11 out of 14 were from the high-risk group and 3 were from the low-risk group
  • However being raised in a ‘healthy’ adoptive family appeared to have a protective effect even for high-risk individuals
68
Q

Give four evaluation points for the interactionist approach as an explanation for Schizophrenia

A

WEAKNESS: Diatheses may not be exclusively genetic- Can also result from brain damage caused by the environment e.g. birth complications. Verdoux et al found that the risk of Schizophrenia in individuals who have experienced obstetric complications at birth is four times greater than those who do not experience these complications

WEAKNESS: Difficulties in determining causal stress- diathesis stress often refers to the stress caused close to the onset of the disease. However, Hammen argues that maladaptive methods of coping with stress in childhood means that an individual fails to develop coping skills which can make life generally more stressful

WEAKNESS: Limitations of Tienari’s study- The psychiatrists assessing family functioning only assessed it at one given point in time which fails to reflect developmental changes in family functioning over time. They should also have observed the interaction between the adoptee and the adopted parents to determine how much stress was caused by the child themselves

STRENGTH: Implications for treatment- The recognition that Schizophrenia can be caused by a viral infection during pregnancy (environmental) if both mother and child carry a specific gene defect (genetics) then anti-viral medication can be given in pregnancy to women who are known to carry this gene defect to prevent the onset of Schizophrenia in later life

Psychology A Level (11 decks)

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