Schizophrenia

Question 1

Diagnosis and classification of schizophrenia

1) what is schizophrenia?

Answer 1

1) a severe mental illness where contact with reality and insight are impaired - an example of psychosis

Question 2

2) how is schizophrenia diagnosed?

Answer 2

2) doesn’t have a single defining characteristic, cluster of symptoms that appear to be unrelated

Question 3

3) what are the 2 major systems for the classification of mental disorder?

Answer 3

3) WHO ICD 10 - international classification of disease and DSM-5 - both classify schizophrenia differently - ICD 10 2 or more negative symptoms and DSM 5 one or more positive symptom

Question 4

4) what is the definition of classification of mental disorder?

Answer 4

4) the process of organising symptoms into catagories based on which symptoms cluster together in sufferers

Question 5

5) what are the different subtypes of schizophrenia by ICD 10

Answer 5

5) paranoid schizophrenia - characterised by powerful delusions and hallucinations but few other symptoms
hebephrenic schizophrenia - primarily negative symptoms
catatonic schizophrenia - disturbance to movement - leaving sufferer immobile or alternatively overactive
simple schizophrenia - uncommon - progressive development of -ve symptoms no psychotic history
undifferentiated schizophrenia - previously called atypical - come criteria of a mix of the other groups

Question 6

6) what are primary delusions?

Answer 6

false beliefs which continue despite evidence to the contrary

Question 7

7) what are the 4 different types of delusions?

Answer 7

a) delusions of grandeur - believe you are more important than you are - e.g king
b) delusions of persecution - belief people are plotting against you or being interfered with certain people or organised group
c) delusions of reference - belief objects/ events have personal significance - usually negative
d) delusions of nihilism - belief nothing really exists and all things are simply shadows - common person thinks they are dead and watching world from before

Question 8

8) what are positive symptoms of schizophrenia?

Answer 8

8) aytpical symptoms experienced in addition to normal experiences - hallucinations and delusions

Question 9

9) what are hallucinations?

Answer 9

9) a positive symptom of schizophrenia - sensory experiences of stimuli that either have no basis in reality or are distorted perceptions of things that are there.

Question 10

10) what are delusions?

Answer 10

10) positive symptom of schizophrenia - involve beliefs that have no basis in reality - sufferer is someone else or that they are victim of conspiracy - paranoia - irrational beliefs

Question 11

11) what are negative symptoms of schizophrenia?

Answer 11

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

Question 12

12) what is avolition?

Answer 12

loss of motivations - lowered activity levels

Question 13

13) what is speech poverty?

Answer 13

reduced frequency and quality of speech

Question 14

biological explanations for schizophrenia

14) what is the genetic basis of schizophrenia?

Answer 14

schizophrenia runs in families - although weak evidence because family members generally share same environment - strong relationship found between degree of genetic similarity and shared risk of schizophrenia - Gottesman (1991) large-scale family study

Question 15

15) what are candidate genes?

Answer 15

individual genes believed to be associated with risk of inheritance. schizophrenia = polygenic. different studies identified different candidate genes - schizophrenia = aetiologically heterogenous, - different combinations leading to condition - ripke et al (2014) genome wide study 37000 patients compared to that of 113000 controls - 108 separate genetic variations found - inclusing neurotransmitters

Question 16

16) evaluate the genetic basis of schizophrenia

Answer 16

strong evidence for genetic vulnerability to schizophrenia - gottesman 1991 shows genetic similarity and shared risk of schizophrenia is closely related
adoption studies pekka tienari et al 2004 - children of schizophrenia sufferers still at heightened risk if adopted into families with no history of schizophrenia
genetic factors therefore do make people much more susceptible to schizophrenia however cannot say entirely genetic or ignore environmental factors - evidence to suggest genetic vulnerability = very important

Question 17

17) explain the dopamine hypothesis

Answer 17

neurotransmitters - brains chemical messengers work differently in schizophrenic patient - dopamine DA – important in functioning of several brains systems may be implicated into symptoms of schiophrenia

hyperdopaminergia in subcortex - original version - high levels of activity of DA in subcortex - central brain areas e.g brocas area - speech poverty or auditory hallucinations

hypodopaminergia in cortex - abnormal DA in cortex - goldman-rakic et al 2004 identified roles for low DA levels in prefrontal cortex - thinking and decision making in -ve symptoms of schizophrenia
possible that both high and low levels od DA = responsible for schizophrenia

Question 18

18) evaluate the dopamine hypothesis

Answer 18

support for abnormal dopamine functionally in schizophrenia - DA agonists - amphetamine that increase levels of DA make schizophrenia worse and can produce schizophrenia-like symptoms in non-sufferers - curran et al (2004)
anti psychotic drugs reduce DA activity - both type of drugs suggest important role in schizophrenia
radioactive labelling studies found chemicals needed to produce DA are taken up faster in that of schizophrenic patients therefore possibly more is produced
also evidence to suggest dopamine doesn’t provide complete explanation for schizophrenia - there are other neurotransmitters - glutamate evidence for DA hypothesis = mixed

Question 19

explain neural correlates of schizophrenia

Answer 19

measurements of structure or function of the brain that correlate with an experience - +ve and -ve symptoms have neural correlates
neural correlates of -ve symptoms - avolition loss of motivation - anticipation of reward - ventral striatum therefore abnormalities in ventral striatum may be involved in avolition development
juckel et al 2006 - measured activity levels in VS in schizophrenia and found lower levels of activity than controls - -ve correlation between activity in VS and severity of -ve symptom - VS = neural correlate of -ve symptoms of schizophrenia
neural correlates of +ve symptoms - allen et al 2007 scanned brains of patients experiencing auditory hallucinations and compared to control - lower activity levels in superior temporal gyrus and anterior cingulate gyrus found in hallucination group - made more errors than controls - reduced activity in these areas is a neural correlate of auditory hallucinations.

Question 20

20) evaluate neural correlates of schizophrenia

Answer 20

correlation-causation problem
number of neural correlates of schizophrenia symptoms - -ve and +ve symptoms - leaves important questions unanswered - which causes what symptom cause abnormality or abnormality causes symptoms - or possibility of third factor influencing both neural correlate and symptom - not great explanation of schizophrenia

Question 21

Psychological explanations of schizophrenia
family dysfunction
21) what is the idea of family dysfunction

Answer 21

that there is a link between schizophrenia and childhood and adult experience of living in a dysfunctional family

Question 22

22) what is a schizophrenogenic mother

Answer 22

psychodynamic explanation for schizophrenia - Fromm-reichmann 1948 - based on accounts she heard from patients about childhood - many patients spoke of particular type of parent - schizophrenogenic mother -= cold rejecting and controlling creating a family climate of tension and secrecy - leads to distrust later developing into paranoid delusions and ultimately schizophrenia

Question 23

23) what is double-bind theory

Answer 23

Gregor bateson et al 1975 agreed family climate is important in development of schizophrenia - emphasised role of communication style within family - trapped in situations fear doing the wrong thing but dont know what it is - ‘get it wrong’ = withdrawal of love - world is confusing and dangerous - disorganised thinking and paranoid delusions = risk factor

Question 24

24) what is expressed emotion

Answer 24

level of emotion - particularly -ve expressed towards a patient by their carers
- verbal criticism - sometimes violence
- hostility - anger and rejection
- emotional over-involvement - needless self-sacrifice
serious source of stress and main cause of relapse - also possibly trigger onset for someone already vulnerable

Question 25

25) what are the cognitive explanations of schizophrenia

Answer 25

- focuses on mental processes - schizophrenia associated with abnormal info processing schizophrenia characterised by disruption to normal thought processing e.g ventral striatum and -ve symptoms whilst reduced processing info in temporal and cingulate gyri = hallucinations

Question 26

26) what is dysfunctional thought processing

Answer 26

metareprensentation - cognitive ability to reflect on thoughts and behaviour - own intentions and goals - interpret actions of others - dysfunction will mean unable to recognise actions as own and thoughts - so hallucinations and voices of delusions e.g voice insertion central control - suppress automatic responses - perform deliberate actions instead- disorganised speech and thoughts

Question 27

27) evaluate family dysfunction

Answer 27

read et al - 46 studies of child abuse and schizophrenia - 69% adult women with schizophrenia had history of physical abuse, sexual abuse and both - men = 59% adults with insecure attachments are more likely to have schizophrenia lots of evidence linking schizophrenia to family dysfunction - however info about childhood carried out after development of symptoms and schizophrenia may have distorted recall = validity results from studies from childhood = inconsistent

Question 28

28) evaluate family-based explanations

Answer 28

not much evidence to support schizophrenogenic mother or double bind theory parent-blaming - suffered seeing child go through schizophrenia now being blamed

Question 29

29) dysfunctional information processing

Answer 29

stirling et al 2006 - compared 30 patients with schizophrenia to 18 controls on range of cognitive tasks - stroop test - patients took x2 longer to name ink colour than controls supporting central control links between faulty cognition and symptoms are clear but no origin is known - proximal causes but not distal causes

Question 30

30) what is the interactionist approach

Answer 30

a broad approach to explaining schizophrenia which acknowledges that a range of factors are involved in development of schizophrenia

Question 31

31) what is the diathesis-stress model

Answer 31

an interactionst approach to explaining behaviour - schizophrenia is a result of underlying issues - genetics (diathesis) and a trigger both necessary for schizophrenia to start - early version vulnerability was genetic and triggers were psychological - now both genes and trauma are diathesis and stress can be psychological and biological in nature

Question 32

32) explain the diathesis -stress model | - original stress model

Answer 32

``` meehls model (1962) diathesis = entirely genetic as a result of single schizogene - schizotypic personality - one characteristic - sensitivity to stress according to Meehl no amount of stress could leas to schizophrenia if schizogene wasn't present - however in gene carriers chronic stress e.g schizophrenogenic mother could result in development of condition ```

Question 33

33) explain the diathesis -stress model | - new stress model

Answer 33

now clear many genes increase genetic vulnerability - ripke et al range of factors become diathesis beyond genetic such as psychological trauma - becomes diathesis rather than stressor read et al 2001 neurodevelopmental model in which early trauma alters developing brain - child abuse can affect brain development such as HPA being overactive

Question 34

34) modern understanding of stress

Answer 34

in original stress was psychological - parenting in particular modern definition includes anything that risks triggering schizophrenia - much research involves cannabis use -cannabis is a stressor - interferes with DA system

Question 35

35) treatment for interactionist model

Answer 35

combining CBT and anti-psychotic medication - unusual to treat by only psychological