Schizophrenia

Question 1

Classification

Answer 1

Organising symptoms into categories based on which symptoms cluster together in sufferers i.e. what are the symptoms of schizophrenia?

Question 2

Positive Symptoms

Answer 2

Atypical symptoms experienced in addition to normal experiences.

Question 3

Negative Symptoms

Answer 3

Atypical experiences that represent the loss of usual experiences or abilities.

Question 4

Hallucinations

Answer 4

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.

Question 5

Delusions

Answer 5

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.

Question 6

Poverty of speech

Answer 6

Speech becomes less fluent. Sometimes there is a delay in responses during conversation.

Question 7

Avolition

Answer 7

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.

Question 8

Diagnosis

Answer 8

Deciding whether someone has a particular mental illness using the classifications.

Question 9

Schizophrenia

Answer 9

A severe mental illness where contact with reality and insight are impaired, an example of psychosis.

Question 10

DSM

Answer 10

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.

Question 11

ICD

Answer 11

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.

Question 12

Reliability (in relation to diagnosis and classification of schizophrenia)

Answer 12

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.

Question 13

Validity (in relation to diagnosis and classification of schizophrenia)

Answer 13

The extent to which schizophrenia is a unique syndrome with unique characteristics, signs and symptoms.

Question 14

4 issues with the validity of diagnosing schizophrenia

Answer 14

symptom overlap, co-morbidity, cultural bias, gender bias.

Question 15

Symptom Overlap

Answer 15

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.

Question 16

Co-morbidity

Answer 16

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.

Question 17

Gender Bias

Answer 17

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.

Question 18

Loring and Powell

Answer 18

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.

Question 19

Cultural Bias

Answer 19

Research shows that there’s a significant variation between cultures when it comes to diagnosing schizophrenia.

Question 20

Escobar

Answer 20

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.

Question 21

Biological Explanations of Schizophrenia

Answer 21

Candidate genes (Ripke et al). Dopamine Hypothesis (Goldman-Rakic et al). Neural correlates (Juckel et al. and Allen et al).

Question 22

Rosenhan

Answer 22

Tested reliability of mental health diagnosis. Being sane in insane places study.

Question 23

Biological Therapies for Schizophrenia

Answer 23

Drug treatments for schz include first gen typical antipsychotics (e.g. Chlorpromazine) and second gen atypical antipsychotics (e.g. Clozapine, Risperidone).

Question 24

Ripke et al.

Answer 24

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.

Question 25

Goldman-Rakic et al.

Answer 25

Identified role for low levels of dopamine in the pre-frontal cortex (responsible for thinking and decision making) in the negative symptoms of schz.

Question 26

Juckel et al.

Answer 26

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.

Question 27

Allen et al.

Answer 27

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.

Question 28

Meltzer

Answer 28

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.

Question 29

Psychological explanations of schizophrenia

Answer 29

Dysfunctional families. Schizophrenogenic mothers, Double bind theory. Expressed emotion.

Question 30

Dysfunctional Families

Answer 30

Abnormal family processes may be risk factors in development and maintenance of schizophrenia. Such as poor family communication, cold parenting and high expressed emotion.

Question 31

Schizophrenogenic Mother

Frieda Fromm-Reichmann

Answer 31

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.

Question 32

Double Bind Theory (Bateson)

Answer 32

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.

Question 33

Expressed Emotion (EE)

Answer 33

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.

Question 34

Brown (1972)

Answer 34

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.

Question 35

Read et al.

Answer 35

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.

Question 36

Psychological Therapies for Schz

Answer 36

Cognitive Behaviour Therapy, Family Therapy.

Question 37

Cognitive Behaviour Therapy for psychosis (CBTp)

Answer 37

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.

Question 38

Family Therapy

Answer 38

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.

Question 39

Management of Schizophrenia: Token Economy

Answer 39

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.

Question 40

Interactionist Approach

Answer 40

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.

Question 41

Meehl’s Model

Answer 41

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.