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Psychology - Paper 3 > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Define schizophrenia

A

A psychotic disorder where contact with reality and insight are impaired. Characteristic of impaired thinking, emotions and behaviours with patients unable to filter sensory stimuli and experiencing enhanced perception

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2
Q

Define classification of mental disorder

A

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

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3
Q

Define positive symptoms of schizophrenia

A

Atypical symptoms experienced in addition to normal experiences. These include hallucinations and delusions

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4
Q

Define negative symptoms of schizophrenia

A

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

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5
Q

Define hallucination

A

A positive symptom in which sufferers have a distorted view/perception of real stimuli or perception of stimuli which have no basis in reality

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6
Q

Define delusion

A

A positive symptom in which sufferers have beliefs which have no basis in reality

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7
Q

Define speech poverty

A

A negative symptom which occurs when the frequency and quality of speech becomes abnormally low

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8
Q

Define avolition

A

A negative symptom where the sufferer loses the motivation to carry out tasks and experiences reduction in interests, desires and goals

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9
Q

Define co-morbidity

A

The occurrence of two illnesses or conditions together, for example a person who has schizophrenia and a personality disorder. When two conditions are frequently diagnosed together the validity of classifying the two separately is called into question

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10
Q

Define symptom overlap

A

Occurs when two or more conditions share symptoms which causes problems in the validity of classifying disorders

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11
Q

What did Andreason (1982) identify?

A

Three signs of avolition:

  • Poor hygiene
  • lack of persistence in work or education
  • lack of energy
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12
Q

AO3: What is the problem with reliability in the diagnosis of schizophrenia

A
  • Reliability means consistency of diagnosis
  • Inter-rater reliability measures the extent to which the assessor agrees with others
  • Cheniaux (2009) found one psychiatrist diagnosed 26 with DSM and 44 with ICD and another diagnosed 13 DSM and 24 with ICD
  • Poor inter rater reliability as classification systems do not give same diagnosis
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13
Q

AO3: What is the problem with validity in the diagnosis of schizophrenia

A
  • The extent to what we are measuring is what we intend
  • Criterion validity: do different assessments arrive at same diagnosis
  • ICD more likely according to Cheniaux (2009)
  • Schizophrenia oveardiagnosed with ICD or DSM does not diagnose enough
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14
Q

AO3: What is the problem with co-morbidity in the diagnosis of schizophrenia

A
  • High frequency of schizophrenia and other disorders such as OCD and PTSD
  • Buckley (2009) found 29% suffered with PTSD and 50% depression
  • Issues with validity in diagnosing SZ and differentiating symptoms from other disorders
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15
Q

AO3: What is the problem with gender bias and culture bias in the diagnosis of schizophrenia?

A
  • Longenecker (2010) found more men diagnosed than women after 1980
  • Cotton suggested women better to cope and work so cover up symptoms
  • Reduces validity of the diagnosis
  • Escobar (2012) found African Americans more likely to be diagnosed due to more openness in cultures
  • Increase in false diagnoses
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16
Q

Define genes

A

Portions of DNA that code for a protein for physical features of an organisms and certain features such as neurotransmitters. These may impact psychological features

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17
Q

Define dopamine

A

A neurotransmitter that generally has an excitatory effect and is associated with pleasure. High levels are associated with schizophrenia and unusually low levels are associated with Parkinsons

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18
Q

Define neural correlates

A

Patterns or structures in the brain that occur in conjunction with an experience and hence may be involved in the origin of the experience

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19
Q

What is the evidence that schizophrenia runs in families?

A
  • Gottesman (1991) found positive correlation between increasing genetic similarity of family and increased risk of developing SZ (MZ 48% and 17% DZ) with siblings 9% and parents 6%
  • Suggests genetic basis
  • Not 100% concordance so must be environmental
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20
Q

What is the evidence for candidate genes in schizophrenia?

A
  • Ripke (2013) conducted a genome wide research
  • 22 loci associated at genome wide significance alongside 8300 separate candidate genes
  • Shows it is polygenic
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21
Q

What is the dopamine hypothesis for schizophrenia?

A
  • Neurotransmitters work differently in SZ patients
  • Hyperdpaminergia in the sub cortex suggests high dopamine levels or excess of dopamine receptors in Broca’s area hence explaining speech poverty and auditory halluncations
  • Hypodopaminergia in the cortex focuses of abnormal dopamine systems
  • Goldman Rakic (2004) identified low dopamine in prefrontal cortex leading to avolition
  • Could be both operating together
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22
Q

What is the evidence of neural correlates in schizophrenia?

A
  • Juckel (2006) suggested abnormally low levels of activation in the ventral striatum (associated with reward and anticipation) may be associated with avolition
  • Allen (2007) Scanned brains of auditory hallucination patients and compared to a control group. Lower activation found in the superior temporal gyrus and anterior cingulate gyrus
  • Thus reduced activity of these areas is a neural correlate
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23
Q

AO3: What is the supporting evidence for the genetic basis of SZ?

A
  • Brown (2002) found the risk of having children with SZ was increased by 1.3% if the father was over 50 and hence likely to mutate sperm
  • This could affect candidate genes and hence shows a genetic basis and heritability hence supporting the use of family studies
24
Q

Why is the evidence for the dopamine hypothesis of schizophrenia mixed and why is this negative?

A
  • Support from Tauscher (2014) who found antipsychotics acting as dopamine antagonists (reduce dopamine activity) alleviated SZ symptoms suggesting dopamine has a role
  • Moghaddam and Javitt (2012) criticised the hypothesis as emphasising the role of dopamine. Serotonin and glutamate may also play a key role as evidenced by Clozapine that works on both of these substances and is more effective than other atypical (Meltzer 2012)
25
Q

AO3: What is a problem with schizophrenia neural correlate research being correlational?

A
  • No third variable taken into account which could affect both outcomes
  • For example, the link between low activation in the superior temporal gyrus and anterior cingulate gyrus could be explained by another causes, or that the hallucinations cause the neural correlate
  • Hard to determine cause and effect so should be considered greatly
26
Q

What are antipsychotics?

A

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

27
Q

What are typical antipsychotics?

A

The first generation of antipsychotic drugs, having been used first in the 1950s working as dopamine antagonists that bind to dopamine receptors and lower rates of action potentials

28
Q

What are atypical antipsychotics?

A

Second generation medication that target a wide range of receptors on the post synaptic membrane such as serotonin and glutamate

29
Q

What occurs on dosages of chlorpromazine

A
  • Drug binds to receptors
  • Inhibitory effect caused
  • Dopamine builds up
  • Production of dopamine then slows
  • Reduces hallucinations
30
Q

What occurs on dosages of clozapine

A
  • Binds to receptors of dopamine, glutamate and serotonin

- Reduces depression and anxiety

31
Q

What occurs on dosages of risperidone?

A
  • Alternative to reduce side effects

- Binds to serotonin and dopamine (dopamine more strongly) so less dose needed and hence less side effects

32
Q

AO3: Why is it negative that the use of antipsychotics is based upon the dopamine hypothesis?

A
  • Drugs alleviate symptoms by reducing hyperdopaminergia in the sub cortex
  • However, the revised dopamine hypothesis states low dopamine may also cause SZ in the cortex
  • By further reducing dopamine could worsen symptoms
  • Questions the validity and safety of antipsychotics
33
Q

AO3: What is negative about the side effects of antipsychotics?

A
  • Mild to serious and possibly fatal
  • Short term weight gain and agitation can occur
  • Long term tardive dyskinesia and neuroleptic malignant syndrome and can cause comas
  • Atypical have mostly reduce side effects (Meltzer 2012) but side effects still occur
  • Cause revolving door effect and hence negative
34
Q

AO3: What is the evidence for supporting antipsychotics but why could this be flawed?

A
  • Thornley (2003) reviewed studies comparing chlorpromazine with placebo
  • Overall positive effect from 1121 patients
  • However, data from these studies may have been published multiple times (Healy 2012) questioning validity
  • Drugs are also powerful sedatives and hence may be measuring how calm a patient appears rather than psychosis reduction
35
Q

Define CBT

A

A method for treating mental disorders based on the cognitive and behaviourist approaches. The therapy includes ways to deal with thinking

36
Q

Define family therapy

A

A psychological therapy carried out with some or all of a family with the aim of improving communication and reducing stress for the family

37
Q

Define token economies

A

A form of behavioural therapy where desirable behaviours are encouraged by the use of selective reinforcement. In schizophrenia, patients are given rewards as secondary reinforcers when engaging in desirable behaviours. These are then exchanged for primary reinforcers such as food and privileges

38
Q

Summarise how CBT is used in the treatment of SZ

A
  • Patients identify irrational thoughts by dispute and being pragmatic
  • Helps patients see how hallucinations and delusions impact on their feelings and behaviour
  • Does not cure
39
Q

Summarise research into the use of CBT treating schizophrenia

A
  • Turkington (2004) described an example where patient was scared of the Mafia targeting them
40
Q

Summarise how family therapy is used in the treatment of SZ

A
  • Improves quality of communication and interaction between family
  • Some family therapists see the family as the cause whilst others try to reduce stress
  • Main aim now is to reduce chance of Expressed emotion which can cause relapse
41
Q

Summarise the researcher who described how family therapy helps and the factors she identified

A

Pharaoh (2010):
- Therapist forms alliance with family
- Stress of caring reduced
- Improves ability of family to anticipate and solve problems
- Reduce anger and guilt in family members
- Help family achieve balance between care and free time
- Improve attitudes towards schizophrenia
Pharaoh suggested this works by reducing stress for both parties, reducing EE and increasing compliance with medication

42
Q

Summarise how token economies are used in the treatment of SZ

A
  • Reinforces behaviour
  • Immediately given to reduce delay discounting (the reduced effect of a delayed reward)
  • Form of operant conditioning
43
Q

AO3: What is negative about the psychological therapies for SZ?

A
  • None actually treat and cure but just improve quality of life
  • Token economies increase compliance as does family therapy with reduction of stress
  • CBT improves understanding
  • Possible that an interactionist approach is best adopted
  • Failure to cure a weakness
44
Q

AO3: What are the ethical issues with psychological treatments of schizophrenia?

A
  • Whilst they do not have side effects, token economy has proven controversial as mild symptom patients have more access to privileges than severe patients
  • Additionally, preventing calls home and exercise may aggravate and make someone worse
  • CBT may also intrude on freedom of thought e.g if applied in a highly controlled government
45
Q

AO3: What are the other psychological treatments for SZ and why is this positive?

A
  • Art therapy but the NICE provides patients with creative outlet
  • Does not require change of belief unlike CBT
  • Positive as less ethical issues and can be selected accordingly by providing more options
46
Q

AO3: What is the evidence for effectiveness psychological therapies for SZ?

A
  • Jauhar (2014) reviewed 34 cases of CBT
  • A small, but significant effect seen on both types of symptoms
  • Pharaoh reviewed family therapy and saw reduced hospital admission. Evidence was inconsistent so family therapy evidence may be weak
  • McMonagle and Sultana (2009) found only one in three randomly allocated treatments showed information about behaviour change
47
Q

Define family dysfunction

A

Abnormal processes within a family including poor communication, cold parenting and high levels of EE. These may be risk factors for both the development and maintenance of schizophrenia

48
Q

Define cognitive explanations

A

Explanations that focus on mental processes such as thinking, language and attention

49
Q

Define dysfunctional thought processing

A

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

50
Q

Summarise the schizophrenogenic mother

A
  • Fromm- Reichmann (1948) suggested a psychodynamic explanation based on what she heard from parents
  • The mother is cold, rejecting and controlling and creates a climate of tension and secrecy causing paranoia and anxiety
  • These manifest themselves as delusions
51
Q

Summarise the double bind theory

A
  • Bateson (1972) agreed family climate is a cause and that SZ is caused by mixed messages from both parents and the child is unable to clarify these messages or voice their opinions due to fear
  • Punishment includes withdrawal of love
52
Q

What is expressed emotion?

A

Negative emotion displayed by the carer causing stress and resulting in disobedience with therapy and medication and hence causing relapse. Elements of this contain verbal criticism of the patient, hostility and emotional over involvement

53
Q

What did Frith (1992) suggest about the role of cognitive processes in SZ?

A
  • Metarepresentation is the ability to differentiate between our own actions and the actions of others. Dysfunctions are associated with auditory hallucinations and paranoid delusions
  • Central control is the ability to carry out a deliberate action whilst suppressing an automatic response. People with Sam have dysfunctional central control abilities and so suffer from derailment
54
Q

AO3: What is the supporting evidence for dysfunctional though processes

A
  • Stirling (2006) found SZ sufferers made significantly more mistakes and took twice as long to complete a task compared to a control
  • Likely due to faulty central control skills
  • However, dysfunctional thinking is a proximal cause and not distal so limits the psychological explanation
55
Q

AO3: What is the lack of support for family based psychological explanations for schizophrenia?

A
  • Idea of schizophrenogenic mother based on historical observations
  • Observers would have been looking for crazy characteristics (Harrington 2012) which is not an objective nor a reliable indicator
  • Emphasis also placed on family and experience rather than genetic/biological predisposition which can cause harm to family
56
Q

AO3: Why may psychological explanations of SZ only be suited to proximal causes

A
  • No accommodation for biological explanations. Biological can explain distal origins of SZ and hence psychological explanations can only explain proximal causes
  • Also the question of what causes what

Psychology - Paper 3 (3 decks)

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