Schizophrenia Flashcards
Classification
Organising symptoms into categories based on which symptoms cluster together in sufferers i.e. what are the symptoms of schizophrenia?
Positive Symptoms
Atypical symptoms experienced in addition to normal experiences.
Negative Symptoms
Atypical experiences that represent the loss of usual experiences or abilities.
Hallucinations
Things a person sees, hears, smells or feels that no one else can see, hear, smell or feel. Have no basis in reality or are distorted perceptions of things that are there.
Delusions
Bizarre beliefs that seem real to the schizophrenic. Person believes delusions even after beliefs (which can be paranoid) are proved to be not true or logical.
Poverty of speech
Speech becomes less fluent. Sometimes there is a delay in responses during conversation.
Avolition
Lack of ability or motivation to begin and sustain planned activities. Might lead a person to fail to take care of themselves e.g lack of hygiene, poor diet.
Diagnosis
Deciding whether someone has a particular mental illness using the classifications.
Schizophrenia
A severe mental illness where contact with reality and insight are impaired, an example of psychosis.
DSM
Diagnostic and statistical manual of mental disorder. 2 positive symptoms must be present for diagnosis but only one if delusions or hallucinations consist of a voice keeping up a running commentary. There must be continuous signs of disturbance for at least 6 months.
ICD
International statistical classification of diseases. 2 or more negative symptoms are sufficient for diagnosis or one positive symptom. Recognises a range of subtypes of schizophrenia.
Reliability (in relation to diagnosis and classification of schizophrenia)
The level of agreement (consistency) on the diagnosis of schizophrenia by different psychiatrists (inter-rater reliability), across time (test- retest reliability) and across cultures. It is also the stability of diagnosis over time given no change in symptoms.
Validity (in relation to diagnosis and classification of schizophrenia)
The extent to which schizophrenia is a unique syndrome with unique characteristics, signs and symptoms.
4 issues with the validity of diagnosing schizophrenia
symptom overlap, co-morbidity, cultural bias, gender bias.
Symptom Overlap
Occurs when 2 or more conditions share symptoms. Where conditions share may symptoms this calls into question the validity of classifying the two disorders separately.
Co-morbidity
The occurrence of two illnesses or conditions together, for example a person has both schizophrenia and a personality disorder. Where two conditions are frequently diagnosed together, it calls into question the validity of classifying the two disorders separately.
Gender Bias
Diagnosis of schizophrenia is said to occur when the accuracy of diagnosis is dependent on the gender of the individual due to gender-bias diagnostic criteria or stereotypes. Loring and Powell is research evidence of this.
Loring and Powell
Research evidence for gender bias. Randomly selected 290 psychiatrists (male and female) to read of patient behaviour and offer judgement. When told the patient was male or the gender was not specified, 56% were given diagnosis of schizophrenia. But when told the patient was female, only 20% diagnosed.
Cultural Bias
Research shows that there’s a significant variation between cultures when it comes to diagnosing schizophrenia.
Escobar
Research evidence for cultural bias. Pointed out that white psychiatrists may tend to over-interpret the symptoms of black people. Such factors may be causing the problems such as: cultural differences in language and mannerisms, difficulty in relating, myth that black people rarely suffer from affective disorders. Clinicians must pay more attention to effects of cultural differences on diagnosis.
Biological Explanations of Schizophrenia
Candidate genes (Ripke et al). Dopamine Hypothesis (Goldman-Rakic et al). Neural correlates (Juckel et al. and Allen et al).
Rosenhan
Tested reliability of mental health diagnosis. Being sane in insane places study.
Biological Therapies for Schizophrenia
Drug treatments for schz include first gen typical antipsychotics (e.g. Chlorpromazine) and second gen atypical antipsychotics (e.g. Clozapine, Risperidone).
Ripke et al.
Meta-analysis of genome studies in schz. Genetic makeup of patients compared to control groups. 108 separate genetic variations were associated with increased risk of schz.
Goldman-Rakic et al.
Identified role for low levels of dopamine in the pre-frontal cortex (responsible for thinking and decision making) in the negative symptoms of schz.
Juckel et al.
Observed negative correlation between activity levels in the ventral striatum ant the severity of negative symptoms. Therefore, activity in ventral striatum is a neural correlate of negative symptoms of schz.
Allen et al.
Patients suffering from auditory hallucinations scanned while they did an audial test and compared to control group. Low action levels in some areas of the brain found in the hallucination group who made more errors than the control group. Can therefore say that reduced action in these two areas are neural correlates of auditory hallucinations.
Meltzer
Found that clozapine is more effective in 30 - 50% of cases who were resistant to typical antipsychotics. Brain scanning research has shown that patients who are resistant to treatments may not have abnormal dopamine levels or activity.
Psychological explanations of schizophrenia
Dysfunctional families. Schizophrenogenic mothers, Double bind theory. Expressed emotion.
Dysfunctional Families
Abnormal family processes may be risk factors in development and maintenance of schizophrenia. Such as poor family communication, cold parenting and high expressed emotion.
Schizophrenogenic Mother
Frieda Fromm-Reichmann
Noted that many of her patients spoke of a particular type of parent. Schizophrenogenic means schizophrenia causing. Schzphnognc mother is cold, rejecting, controlling etc. Leads to distrust, which leads to paranoid delusions, and schizophrenia.
Double Bind Theory (Bateson)
Dilemma in communication where individual (the child) receives conflicting messages (from parents) and so cannot resolve the situation. Can cause the child to become paranoid and anxious and could lead to schz.
Expressed Emotion (EE)
The level of emotion (particularly negative) expressed towards a patient by their carer. Three key elements: verbal criticism of patient, hostility towards the patient, emotional over-involvement in the life of the patient. High levels of EE in carers is a source of stress for the patients. Explanation for relapse of patients but also could be a stress trigger for those with vulnerabilities to schz.
Brown (1972)
Found that patients who are discharged from psych hospitals to a family with high EE are more likely to relapse than those released to a family with low EE.
Read et al.
Reviewed studies of child abuse and schz and concluded that 69% of adult women and 59% of adult men in-patients with a diagnosis of schizophrenia had a history of physical abuse, sexual abuse or both childhood.
Psychological Therapies for Schz
Cognitive Behaviour Therapy, Family Therapy.
Cognitive Behaviour Therapy for psychosis (CBTp)
Goal is to correct faulty interpretation of events by helping make links between their symptoms and thoughts. If they understand where these symptoms are coming from it is hoped to reduce distress and improve their ability to function. Process: 1)Assessment, 2) Engagement, 3) The ABC Model, 4) Normalisation, 5) Critical Collaborative Analysis, 6) Developing alternative explanations.
Family Therapy
Involves a range of interventions targeted at the family of those with schz. Aim is to reduce level of expressed emotion (EE) with the family. Process: 1) Psycho-education, 2) Forming an alliance with relatives, 3) Reducing emotional climate, 4) Enhancing relatives ability to anticipate and solve problems, 5) Reducing expressions of anger and guilt from family, 6) Maintaining reasonable expectations for patient performance, 7) Encouraging relatives to set limits.
Management of Schizophrenia: Token Economy
Based on operant conditioning and aims to increase desirable behaviour and decrease undesirable behaviour by using positive reinforcement, negative reinforcement or punishment. Tokens are the secondary reinforcements that are awarded for good behaviour and can be traded in for primary reinforcements such as treats etc. Undesirable behaviour is punished but not by taking away basic commodities.
Interactionist Approach
A broader approach where both physiological and social elements can be drawn upon to explain and treat schizophrenia. Behaviour can be explained using the diathesis-stress model.
Meehl’s Model
Believed that if a person does not have the ‘schizogene’, then no amount of stress would lead to schizophrenia. But carriers of the gene, chronic stress through childhood could result in the development of the condition.
