Schizophrenia Flashcards
What do psychologists use to diagnose?
DSM
What are the 2 types of symptoms of schizophrenia?
positive and negative symptoms
What are positive symptoms?
an excess or distortion of normal functions
What are the examples of positive symptoms?
hallucinations
delusions
disorganised speech
paranoia
What are hallucinations?
are usually auditory or visual perceptions of things that are not present
What are delusions?
are false beliefs
What are negative symptoms?
where normal functions are limited
What are the examples of negative symptoms?
- avolition
- anhedonia
- alogia
- affective flattening
What is avolition?
loss of motivation
What is anhedonia?
loss of pleasure
What is alogia?
speech poverty
What is affective flattening?
loss of emotion
What is diagnostic reliability?
means that a diagnosis of schizophrenia must be repeatable
What is one difference which can affect the reliability?
cultural differences
How does cultural differences affect reliability?
there is a variance between countries in diagnosing schizophrenia
What is the study to support cultural differences in schizophrenia?
Copeland
- gave 134 US and 194 British psychiatrists a description of patients
- 69% of US diagnosed the patient with schizophrenia
- only 2% British did
What are 3 the factors which affects validity?
gender bias in diagnosis
symptom overlap
co-morbidity
What is gender bias in diagnosis?
when accuracy of diagnosis is dependent on gender of the individual
What is symptom overlap?
positive and negative symptoms are found in other mental disorders for example depression.
What is comorbidity?
refers to the extent that two (or more) conditions or diseases occur at the same time for a patient
Why does gender bias in diagnosis happen?
because of diagnostic judgements like gender-biased diagnostic criteria or the doctor bases their judgements on stereotypical beliefs of that gender.
What are examples of comorbidity with SZ?
substance abuse, anxiety and depression
What are the 2 biological explanations for SZ?
genetic factors and the dopamine hypothesis
What does the genetic factor explanation suggest?
that SZ occurs due to heredity
What are the types of studies which support that genes cause SZ?
family, twin and adoption
What is the family study for SZ?
Gottesman
- find individuals with SZ and see whether their relatives are similarly affected more often than non-related relatives
- studied children with two SZ parents
- studies children with one SZ parent
- studied siblings with SZ
What is the twin study for SZ?
Joseph
studied MZ twins and DZ twins
MZ = genetically identical
DZ = share 50% of the same genes
What is the adoption study for SZ?
Tiernai
- studies how genes and environment affected risk of getting SZ
- studied 164 children who had a SZ mother but was reared apart from her
- control group of 190 children
What were the results of the family study?
concordance rate:
2 SZ parent = 46%
1 SZ parent = 13%
sibling with SZ = 9%
What were the results of the twin study?
concordance rate:
MZ twins = 40%
DZ twins = 7 %
What were the results of the adoption study?
- 11 out of 164 (6.7%) were also diagnosed with SZ
- 4 (2%) of the 190 from the control group were diagnosed with SZ
What are the psychological explanations of SZ?
Family dysfunction - double blind theory and expressed emotion (EE)
cognitive explanations to delusions and hallucinations
What is the double bind theory?
- suggests that children who frequently receive contradictory messages from their mother are more likely to develop SZ. The mother is cold/ rejecting and hostile
- which prevents interactions and child knowing what reality is
- and can cause SZ symptoms like affective flattening
What is the expressed emotion theory?
is a family communication style - lot of emotion intensity leads to relapse, and causes stress. Which kicks off you episodes
What are the 2 types of drugs?
atypical antipsychotics and typical antipsychotics
What are typical antipsychotics drugs?
used just to treat positive symptoms
What are atypical antipsychotics drugs?
used just to treat negative and positive symptoms
How do typical antipsychotics treat positive symptoms?
they bind to D2 receptors but do not stimulate them, this causes the receptors to bit blocked
How do atypical antipsychotics treat positive and negative symptoms?
they block D2 receptors, but they only temporarily block them and then rapidly
Where are D2 receptors found?
in the mesolimbic pathway and the brain
What is the key study for typical antipsychotics?
Kapur
What did Kapur show?
that 60 to 75% of the D2 receptors in the mesolimbic pathway have to be blocked in order for these drugs to be be effective. But also this means that D2 receptors in the brain have to be blocked as well which causes side effects for example weight gain
What is the assumption of CBTq?
is that people often have distorted beliefs
What is the dopamine hypothesis?
states that schizophrenia is caused by imbalances of dopamine - too much in the mesolimbic pathway and not enough in the ACG and PFC
What are the 3 things to do with dopamine which could cause a person to get schizophrenia?
- they have too many D2 receptors
- their D2 receptors are too sensitive / fire too often
- they produce too much dopamine
What are the actions of dopamine known as?
dopaminergia
What is the word used when someone has too much dopamine?
hyperdopaminergia
What is the word used when someone has too little dopamine?
hypodopaminergia
What are the effects of having hyperdopaminergia?
- hyperdopaminergia in the subcortex (MLP) is associated with positive symptoms
- Broca’s area produces speech. Too much dopamine here causes speech and hearing problems
What are the effects of having hypodopaminergia?
- hypodopaminergia in the cortex is associated with negative symptoms
- prefrontal cortex is the central executive. Too little causes avolution
How do we know schizophrenia might have something to do with dopamine?
- amphetamines are used for depression and sleeping problems
What are the 2 drugs which decrease dopaminergic activity?
- chlorpromazine - which acts on dopamine
- clozapine - acts on dopamine and serotonin
What is the evidence for the dopamine hypothesis?
- dopamine explains positive and negative symptoms - David & Kahn
- PET scans
What did Davis & Kahn do?
put all these findings together and suggested :
- too much dopamine in the mesolimbic pathway =
positive symptoms
- too little dopamine in the prefrontal cortex = negative
symptoms
What did PET scans show?
lower dopamine levels in PFC of schizophrenic patients compared to controls - Wang & Deutch
What did Wang & Deutch do?
- lowered rats’ the dopamine levels in PFC
- this impaired their cognition
- then gave the rats atypical antipsychotics (improve negative symptoms) and this was reversed
What does the diathesis stress model suggest?
that schizophrenia can be explained by biology and the environment - which is shown by adoption studies
What are the 2 types of drugs which are used to treat schizophrenia?
typical (chlorpromazine)
atypical (clozapine)
What do typical drugs stop?
stops hallucinations
What do atypical drugs treat?
positive and negative symptoms
How do typical antipsychotics work?
they bind to D2 receptors but do not stimulate them, so they block the action of dopamine
What are typical antipsychotics also known as?
dopamine antagonsists
What are the limitations of using typical antipsychotics?
- in order for them to work 60-70% of the D2 receptors in the mesolimbic pathway have to be blocked. Also, they don’t only block the receptors in the MLP but everywhere and this can cause side effects like seizures
How do atypical antipsychotics work?
act on D2 receptors, they remove dopamine quickly in the synapse, which treats positive symptoms. They also act on serotonin which mean it doesn’t just reduce SZ symptoms but also symptoms of depression, which good as SZ patients 30%-60% attempt suicide
What are the advantages of antipsychotics?
- good short term fix
What are the disadvantages of antipsychotics?
- ethics - if cost/benefit analysis was done it would be negative due to the side effects. Large payments made to SZ patient with tardive dyskinesia (involuntary face movements) which was caused by dopamine super-sensitivity by government
- side effects - typical drugs cause NMS which is caused by dopamine killing of receptors. NMS leads to fever which is related to death of dopamine receptors in the hypothalamus. Rate of getting NMS is 0.1 - 2%
- atypical drugs require frequent blood checks as it can cause agranulocytosis ( reduction of white blood cells) which caused increased risk of infection. Effects people quality of life as they need checks weekly so cant do normal things e.g holidays
What is disorganised speech?
the individual has trouble organising their thoughts
What is speech poverty?
lessening of speech fluency
What is the study which shows the reliability and validity in diagnosis?
hospital study - where students went in and said that they could hear a ‘dull thud’. They were all diagnosed with SZ and not released
he then repeated - and does it reverse calls the hospital and says he is going to send in student to test their diagnosis and 20% less were diagnosed. When all had SZ.
What are the 2 genes which are involved in SZ?
D2 and D4
What are D2 and D4 linked to?
D2 - positive
D4 - negative
What are D2 and D4?
dopamine genes
What is a limitation of the dopamine hypothesis?
reductionist - only considers dopamine, which is too simple. However they should consider glutamate which is shown to be involved by recent research
What is the cognitive model done by Beck & Rector?
three boxes :
- hypervigilance - egocentric bias
- processing error - cannot process as mother taught them wrong
- reality check failure
What is hypervigilance?
too much stress
What is CBTp?
is a combination of cognitive therapy (a way of changing thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and feelings)
What are the steps involved in CBTp?
1 - assessment 2 - engagement 3 - the ABC model 4 - normalisation 5 - critical collaboration analysis 6 - developing alternative explanations
What is assessment stage in CBTp?
patient expresses their thoughts about their experience and their goals of the therapy
What is engagement stage in CBTp?
therapist empathises with the patient and their feelings
What is ABC model stage in CBTp?
patients gives their explanation of the activating event (A) which causes their emotional and behavioural (B) consequences (C)
What is normalisation in CBTp?
information that people have unusual experiences such as hallucination and delusions under different circumstances. Which reduces anxiety and the sense of isolation
What is critical collaborative analysis in CBTp?
therapist uses gentle questioning to help understand illogical deductions
What is developing alternative explanations in CBTp?
the patient develops their own explanations for their previously unhealthy assumptions.
What are the strengths of CBTp?
- ## better than drug treatments - no relapse - reduces hospitalization rates up to 18 months after treatment
What are the limitations of CBTp?
- availability of CBTp is poor - only 1 in 10 can access it
- effectiveness is dependent on the stage of disorder - treatment has to be adjusted to the stage of disorder
What is family therapy?
is family interventions aimed at the family of someone with SZ
How does family therapy work?
reduces the levels of expressed emotion and stress and reduce the incidence of relapse for the person with SZ
What are 3 strategies of family therapy?
- psychoeducation - helping the person and carer to understand and be better to deal with the illness
- reducing expressions of anger and guilt by family members
- forming an alliance to care for the person with SZ
What is the key study for family therapy?
Pharoah
What was Pharoah’s family therapy study?
- reviewed 53 studies which investigated the effectiveness of family intervention
- studies were conducted in Europe, Asia and South America
- studies compared outcomes from family therapy to standard care (drug treatment) al.one.
What were the findings of Pharoah’s family therapy study?
- mental state - some studies reported an improvement in the overall mental state of patients compared to drug treatment, but some didnt
- compliance with medication - family therapy increased patients compliance with medication
- social functioning - some improvement on general functioning, family therapy did not appear to have that much effect
- reduction in relapse and readmission - there was a reduction during treatment and 2 years after when family therapy used
What are the strengths of CBTp?
- positive impacts on family members - improves the outcomes of the person with SZ but also improves coping and problem solving skills, family functioning and relationships. Which is supported by a study of 50 case studies where 60% improved them outcomes. However, in the study there was methodology problems which made it had to distinguish effective from ineffective interventions.
- economic benefits - is cost saving compared to drug treatment even though the sessions of family therapy is more it is offset by the cost of rehospitalization because of lower relapse rates.
What are the limitations of CBTp?
- methodology problems with Pharoah’s key study - observer bias as the observer was not blinded to the condition e.g either family therapy or drugs to which people were allocated. 10 said no blinding was used and 16 didnt not say whether it was or wasnt used.
What is token economy?
a form of therapy where desirable behaviours are encouraged bu the use of reinforcements. Rewards (tokens) are given as secondary reinforcements when people do the correct behaviour. The tokens can be exchanged for primary reinforcements like food or privileges.
