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Schizophrenia Flashcards

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1
Q

What is schizophrenia?

A

A severe mental illness that impairs an individual’s perception of reality.

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2
Q

Name some positive symptoms of Schizophrenia

A

Hallucinations - auditory or visual perceptions of reality that aren’t actually real - unusual sensory experiences

Delusions - beliefs that have no basis - e.g grandeur delusions (believing they’re more important that they are) + delusions of persecution (believing you’re being “hunted”)

(According to the DSM) - speech disorganisation too - speech becomes incoherent

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3
Q

Name some negative symptoms of Schizophrenia

A

Avolition - loss of motivation

Speech poverty - loss of quality of speech

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4
Q

How does the DSM and ICD differ in diagnosis?

A

DSM (UK and USA) requires at least one positive symptom as well as a negative symptom

ICD( Europe) only needs at least 2 negative symptoms

ICD also recognises subtypes of Schizophrenia whereas DSM doesn’t

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5
Q

Name the issues surrounding diagnosis and classification of schizophrenia

A

Reliability

Validity

Culture bias

Gender bias

Symptom overlap

Co-morbidity

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6
Q

What is reliability in terms of diagnosing schizophrenia?

A

The extent To which 2 medical professionals agree on a diagnosis

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7
Q

Why is reliability an issue?

A

CHENIAUX ET AL conducted a study with psychiatrists and 100 patients

They individually diagnosed the 100 using both DSM and ICD

One psychiatrist diagnosed 26 with DSM and 44 with ICD

The other diagnosed 13 with DSM and 24 with ICD

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8
Q

Why is validity an issue?

A

As seen in Cheniaux’s study, schizophrenia was diagnosed more with the ICD than the DSM

This means that either the ICD over diagnoses schizophrenia or the DSM under diagnoses it

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9
Q

Why is co-morbidity an issue?

A

If two conditions occur together a lot of the time the validity of their classification and diagnosis is questioned as they might actually be the same condition

BUCKLEY ET AL concluded that around half of patients with schizophrenia also have depression and 47% also suffer with substance abuse

Other common ones are PTSD (29%)+ OCD (23%)

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10
Q

Why is gender bias an issue?

A

LONGNECKER ET AL reviewed the prevalence of diagnosis and found that men are diagnosed more often than women with schizophrenia

It could be due to genetic vulnerability….

Or due to the fact that female patients are actually better at interpersonal functioning and so it’s not as obvious as the symptoms are almost masked

This can lead to diagnoses being missed for females.

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11
Q

Why is culture bias an issue?

A

African - Americans and British ppl of Afro-Caribbean origin are several times more likely to be diagnosed with schizophrenia than white ppl

In African cultures hearing voices is acceptable and seen as a blessing and not actually a symptom of schizophrenia but to a foreign psychiatrist it would be bizarre

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12
Q

Why is symptom overlap an issue?

A

When disorders share symptoms it causes problems with the validity of diagnosis and classification of those disorders

Avolition is a symptom of both depression and schizophrenia

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13
Q

Name the three biological explanations of schizophrenia

A

Neural correlates

Genetics

The dopamine hypothesis

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14
Q

Describe neural correlates (negative symptoms)

A

avolition is associated with loss of motivation -> anticipation of reward + THE VENTRAL STRIATUM is believed to be involved with anticipation

JUCKEL ET AL compared brain activity of schizophrenia patients and normal patients and found a strong negative correlation between activity level and severity of negative symptoms

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15
Q

Define Neural correlates

A

Measurements of the structure or function of parts of the brain that correlate with an experience or symptom

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16
Q

Describe neural correlate (positive symptoms)

A

Hallucinations are thought to be associated with the SUPERIOR TEMPORAL GRYUS AND THE ANTERIOR CINGULATE GYRUS

Allen et al compared a group of schizophrenic patients with a control group on a task of identifying audio as their own voice and found that there was lower activity in these areas in the patient group who also made more errors

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17
Q

Evaluation of neural correlates

A

(+) as parts of the brain have been identified by research now, they can be used to help with the diagnosis of schizophrenia; if they’re unsure they can measure brain activity in these areas

(-) there’s still an issue with correlation not causation
We have found a correlation with activity and severity of symptoms but how do we know if the low activity is causing the symptoms or the symptom is causing the low activity so actually it tells us little about the causes of schizophrenia

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18
Q

Describe how genetic basis in families causes schizophrenia

A

It’s been noted for many years that schizophrenia runs in families but this is quite weak evidence in itself

So there have been systematic investigations done to show the extent to which genetic similarity equates to likelihood of developing schizophrenia

Gottesman investigated this + found that with MZ twins the likelihood is 48%, with DZ twins it’s 17% and with siblings it’s 9%

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19
Q

Describe how candidate genes are involved in the causes of schizophrenia

A

It has been identified that schizophrenia is POLYGENIC meaning there are many individual genes that each carry a small risk of inheriting schizophrenia and requires a collection

its also been identified that it is AETIOLOGICALLY HETEROGENOUS meaning there are many diff combinations that cause the condition

RIPKE et al investigated the genome of 37,000 patients + compared it w/111,300 control patients + found 108 genetic variations that were associated w/ risk of schizophrenia

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20
Q

Describe the original dopamine hypothesis

A

known as hypERdomanergia

high levels of dopamine in the subcortex are present in brains of patients

e.g excessive amounts of dopamine receptors in Broca’s area may be associated with speech poverty and/or auditory hallucinations

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21
Q

Describe the newer dopamine hypothesis

A

known as hypOderminergia

low levels of dopamine in the PREFRONTAL cortex (responsible for thinking and decision making) can be associated with negative symptoms

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22
Q

Strengths of “genetic basis” explanation

A

(+)mutations in genetic code provide evidence for a genetic basis in schizophrenia
Even without a family history mutations in sperm cells can increase risk of inheriting schizophrenia
it was found that fathers under 25 have a 0.07% chance of passing on the risk where fathers over 25 had a chance of 2%
Mutations occur more often as you age

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23
Q

Weakness of genetic basis

A

(-)it’s evident also that environment plays a role in influencing the risk of schizophrenia
Bc with even MZ twins if one has it the chance you getting it is less than 50%
Studies have shown that environmental situations like family dysfunction also add to the likelihood of developing schizophrenia
Therefore there must be an interactionist explanation as both biological and psychological explanations occurring

24
Q

Strengths of the dopamine hypothesis

A

(+) evidence
CURRAN ET AL conducted a study increasing levels of dopamine in non suffered and found that it induced schizophrenia symptoms in them
Also evidence from antipsychotics which act as dopamine antagonists
Evidence that showed they work TAUSCHER ET AL

25
Q

Weaknesses of the dopamine hypothesis

A

(-) the evidence all enforces the original dopamine hypothesis but not the newer one
They all show that high levels of dopamine affects schizophrenia so what about the new hypothesis?

(-) not a complete explanation using just dopamine as in RIPKE found genetic variations coding for other neurotransmitters other than dopamine including one called glutamine which could have an effect on schizophrenia

26
Q

What is drug therapy

A

The most common treatment for schizophrenia is drug therapy specially the use of antipsychotics

They can be taken as tablets, injections or syrup

There are two types of antipsychotics; typical and atypical

27
Q

Describe typical antipsychotics

A

One example is CHLORPROMAZINE

Usual daily does of 400-800mg

Acts as an agnostic (lowers levels of dopamine)

Can be taken in all forms

28
Q

Describe atypical antipsychotics

A

One example is CLOZAPINE

Initially was stopped due to a few deaths of patients from agranulocytosis but then bought back bc it was more effective than CHLORPROMAZINE but now patients have to have regular blood tests and not allowed to take it by injection

Daily doses around 300-450

Another example is RISPERIDONE : developed in an attempt to be as effective as clozapine without the side effects

Binds more strongly to dopamine receptors so only small doses required (4-8mg)

29
Q

Strengths of drug therapy

A

(+)large body of supporting evidence
THORNLEY et al compared effect of chlorpromazine and a placebo
found 13 trials (1121) showed chlorpromazine was associated with better functioning
In 3 trials (512) chlorpromazine showed a lower relapse rate

(+) also for atypical antipsychotics it was found by MELTZER who reviewed treatments with clozapine used and found that 30%-50% of cases where chlorpromazine had failed clozapine was found to be effective

30
Q

Weaknesses of drug therapy

A

(-)existence of side effects
Such as dizziness, agitation, sleepiness, stiff jaw + a long term one tardive dyskinesia +NMS

(-) the theory of antipsychotics align with the original dopamine hypothesis but not the newer one acc the newer one suggests that antipsychotics shouldn’t work

(-) some rigorous challenges e.g from David Healy who claimed that only successful studies showing the effectiveness of antipsychotics have been published exaggerating their success and effectiveness

(-)widely believed that antipsychotics used to calm patient for staff to handle easier rather than for the patients benefit raising ethical issues
As sedation reduces the patient to a zombie like state effectively with no personal responsibility and control

31
Q

Define family dysfunction

A

abnormal processes within a family such as poor communication, high expressed emotion and cold parenting

these are risk factors for developing and maintaining schizophrenia

32
Q

Describe the Schizophrenogenic mother

A

Frieda-Fromm Reichmann proposed this after discovering that many of her patients described of a parent who was cold, rejecting and controlling who she called the schizophrenogenic mother

this creates a tense family climate that leads to distrust and eventually paranoia

33
Q

Describe the Double-bind theory

A

BATESON ET AL emphasised the role of communication style within family

the developing child can find themselves in trapped situations where they fear doing smtg wrong

but receive mixed messages about what is and feel unable to seek clarification

they get punished by withdrawal of love which can leave them feeling confused leading to symptoms like delusions and disorganised thinking

34
Q

Describe Expressed emotion

A

EE is the level of emotion, particularly negative ones, expressed by a carer to the patient

EE contains verbal criticism, hostility and emotional over–involvement

high levels of EE is a source of great stuff + primarily explains relapse

35
Q

What is a cognitive explanation?

A

Explanations that focus on mental processes such as though processing

36
Q

What is schizophrenia characterised by in terms of cognitive processes?

A

By disruption to normal thoiugh processing

e.g reduced processing in ventral striatum is associated with negative symptoms

37
Q

What did Frith et al identify?

A

They found two kinds of dysfunctional thought processing; meta representation and central control

38
Q

Describe meta representation and how its different for schizophrenic patients?

A

Meta representation allows us to reflect on thoughts + behaviours + our own intentions, also allows us to interpret other’s actions

Disruption in this can disrupt our ability to recognise our own actions + thoughts as our own explaining hallucinations and delusions

39
Q

Describe central control and how its different to schizophrenic patients?

A

Central control allows us to think about what we are saying and filter out things we know we don’t need to day out loud - it suppresses automatic responses

dysfunctional central control leads to disorganised speech because we say everything on our mind

40
Q

Strengths of Psychological explanations of schizophrenia

A

(+)research support - Berger - found schizophrenics reported a higher recall of double-bind statements by mothers than non-schizophrenics

(+)research support - sterling et al - compared 30 patients within 18 non-patients on a rage of cognitive tasks like the stroop test - patients took over twice as long - central control support

41
Q

Limitations of Psychological explanations of schizophrenia

A

(-) info about childhood experiences gathered after development of symptoms - srs problem for validity -

(-)an issue with this explanation is that dysfunctional thinking could be a consequence of schizophrenia rather than a cause - incomplete explanation

(-) it can imply that the parents are responsible - psychological harm - blame and guilt on top of the existing suffering of seeing their children suffering

42
Q

Define CBT

A
  • a method for treating mental disorders based on cognitive + behavioural techniques
  • CBT commonly used to treat patients now and occurs across between 5 + 20 sessions
  • does not get rid of schizophrenia but can help patients cope with it
43
Q

How does CBT help?

A
  • it aims to help identify irrational thoughts + try to change them, may involve argument or discussion
  • patients can be helped to make sense of how their delusions + hallucinations impact them
44
Q

What is Family therapy?

A

Psychological therapy carried out with all/some members of family aiming to improve communication + reduce stress

45
Q

How family therapy helps?

A

PHAROAH AT EL identified range of strategies aiming to improve family functioning including, reducing stress of caring for patient, reduction of anger + guilt

these strategies work by reducing levels of stress so a reduced likelihood of relapse

46
Q

What is Token economies?

A
  • a form of behavioural therapy where desirable behaviours are selectively reinforced
  • a reward system used to manage behaviour particularly in psychiatric hospitals
47
Q

How does Token Economies work?

A

Tokens are given to patienst when they perform a desirable behaviour for example a patient who struggles with avolition could be rewarded every time they get out of bed and make their bed

  • these tokens(secondary reinforcers) are then exchanged for rewards (primary reinforcers)
48
Q

Strengths of psychological therapies

A

(+)

49
Q

Research support for psychological therapies (jahuar)

A

(+) JAHUAR et al reviewed 34 studies about CBT - they concluded that CBT makes a fairly small but significant impact on both positive and negative symptoms

50
Q

Research evidence limitations for psychological therapies (McMonagie and sultana + Pharaoh et al)

A

(-) McMonagie and Sultana reviewed studies into token economies + found that only three studies (110pps) had pps randomly allocated + then only 1 out of 3 showed improvement in behaviour

(-) Pharaoh reviewed studies into family therapy + found that results did show a significant decrease ion hospital re-admission but also diff studies had inconsistent results

51
Q

Limitations of psychological therapies

A

(-) these therapies don’t cure schizophrenia, they just help patients cope with the symptoms

(-) token economies can’t work for the patients with ,more severe symptoms and this is unfair and therefore raises ethical concerns

52
Q

Define the Interactionist approach in terms of explaining schizophrenia

A
  • a broad approach which acknowledges biological, societal and psychological factors in the development of schizophrenia
53
Q

Describe the Diathesis-stress model

A

Schizophrenia can be explained by an underlying vulnerability (diathesis) being triggered (stress) to onset schizophrenia

54
Q

Describe Meehl’s model

A
  • diathesis was entirely genetic
  • “the schizogene”
  • according to Meehl if someone didn’t have the schizogene, no amount of stress can lead them to develop schizophrenia
55
Q

Describe the modern understanding of diathesis

A
  • nowadays we recognise that there is not one single schizogene but actually a number of genes appear to slightly increase vulnerability
    (Ripke et al)

-and that also it’s not entirely genetic, it can also be trauma such as childhood abuse

56
Q

Describe the modern understanding of stress

A
  • a modern definition of stress includes anything that risks triggering schizophrenia
  • much recent research has concerned cannabis use
  • cannabis use increases risk of schizophrenia by up to 7x
57
Q

Describe treatment using the interactionist model

A
  • most commonly associates combining antipsychotics and psychological therapies

Psychology (10 decks)

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