Schizophrenia Flashcards
1
Q
What is schizophrenia?
A
It is a type of psychosis characterized by a profound disruption of cognition and emotion. There is contact lost with external reality.
2
Q
Schizophrenia is the most common psychiatric disorder affecting what percent of the population at at least one stage in their life?
A
1%
3
Q
How would a clinician make a diagnosis of schizophrenia? and where are these manuals used.
A
Using a diagnostic manual such as DSM-Version 5 - US manual.
ICD used in Europe.
4
Q
How are the symptoms of schizophrenia divided?
A
Divided into positive and negative symptoms - positive reflecting an excess or distortion. Negative, reflecting a reduction or loss of normal functions.
5
Q
What are the 4 positive symptoms for diagnosing schizophrenia?
A
- Hallucinations
- Delusions
- Disorganised speech
- Grossly disorganised / catatonic behaviour.
6
Q
What is a hallucination?
A
BIZZARE Visual/auditorial unreal perceptions of the environment.
7
Q
What are delusions?
A
BIZZARE beliefs that seem real to person with schizophrenia but they are not real.
8
Q
What is disorganised speech?
A
Problems in his/her thoughts shows up in their speech as they speech gibberish, incoherent.
9
Q
What is grossly disorganised or catatonic behaviour?
A
Inability to motivate oneself to initiate task.
Catatonic behaviours characterised by reduced reaction to immediate environment - rigid postures.
Extra/less movement when unnecessary.
10
Q
What are the 4 negative symptoms for diagnosing schizophrenia?
A
- Speech poverty (alogia)
- Avolition
- Affective flattening
- Anhedonia
11
Q
What is speech poverty?
A
There is a reduction of speech production - speech fluency and productivity.
12
Q
What is avolition?
A
Difficulty in engaging or being motivated towards goal oriented behaviour.
13
Q
What is affective flattening?
A
Flat tone of voice, reduction in the range of emotional expression.
14
Q
What is anhedonia?
A
Opposite to a hedonist. Anhedonists receive no pleasure from any physical or mental activity.
15
Q
How many symptoms have to be present and for how long until you would receive a diagnosis of schizophrenia?
A
2 or more symptoms present for a month (on and off or constant).
16
Q
What is reliability in diagnosing and classifying schizophrenia?
A
Refers to consistency of classifactory system such as DSM.
17
Q
What is needed for diagnostic reliability as it must be REPEATABLE
Only 1 needed but 2 points.
A
- Clinicians must be able to reach the same conclusions at 2 different points (test-retest)
- Two different clinicians must reach same conclusions (inter-rater reliability 0-1) 1=perfect, a kappa score of 0.7 generally considered good.
18
Q
Describe 1 research study into cultural differences in diagnosis. (Copleand’s)
A
- Copeland (1971)
- 134 US + 194 British psychiatrists a description of patient.
- 69% of US psychiatrists diagnosed schizophrenia whereas only 2% of British psychiatrists diagnosed schizophrenia
19
Q
Describe 1 research study into cultural differences in diagnosis. (Luhrmann’s)
A
Luhrmann (2015)
-‘hearing voices’ is a main characteristic of schizophrenia.
-20 African, 20 Indian, 20 US each asked about what voices they heard. Many African and Indian subjects reported voices were positive, offered playful advice.
-Not one US described the voices as positive.
Tf, suggests harsh violent voices are common in Western countries as a symptom but may not be an inevitable symptom of schizophrenia.
20
Q
1
A
1
21
Q
What is validity in diagnosis and classification for schizophrenia.
A
Refers to the extent that a diagnosis represents correct effect.
22
Q
What is gender bias in diagnosis for schizophrenia?
A
Occurs when accuracy of diagnosis is dependent on the gender of the individual.
Clinicians may have biased judgement based on stereotypical beliefs held about gender.
23
Q
Who did a study into gender bias in diagnosis?
A
Broverman (1970) - clinicians in US equated mentally healthy adult behaviour with ‘male’ behaviour. Tf, females perceived as less mentally healthy.
24
Q
What is symptom overlap?
A
Despite claim that classification of positive and negative symptoms would make for more valid diagnoses of schizophrenia. Many of these symptoms are also found in many other disorders, eg: depression.
25
Who did a study into symptom overlap?
Ellason and Ross (1995) found people with dissociative identity disorder actually have more schizophrenic symptoms than schizophrenics.
26
What is co-morbidity?
Extent that 2 conditions or diseases occur simultaneously in a patient
27
What 2 studies were there into co-morbidity?
Buckley (2009) estimated co-morbid depression occurs in 50% of patients.
Rosenhan
28
What are 2 results Gottesman found of family studies showing genetic factors contribute to schizophrenia.
If a parents has schizophrenia, child is more likely to have schizophrenia.
Gottesman found:
2 parents with it = 46% chance of child developing schizo
1 parent with it = 13% chance.
29
What did Joeseph (2004) find in twin studies (genetic factors)
- Monozygotic (genetically identical) more similar than dizygotic (sharing 50% of genes)
- concordance rate showed MZ twins with schizo = 40% compared to 7%.
- Tf, MZ much more likely to both have it if one has it.
30
What is a limitation of working on twin studies with schizophrenia.
Twins are extremely hard to find both with schizophrenia, so there is a very limited sample size. Also, it is very time consuming, because you have to search far and wide.
31
What did Tienari (2000) find in adoption studies.
Of 160 adoptees whose biological mother had been diagnosed with schizo - 11 adoptees also received diagnosis for schizo.
Compared to 4/197 control adoptees those born with non schizo mothers.
Tf, investigators could confirm the genetic liability.
32
What is a limitation of Tienari's (2000) adoption study?
Dependent on how long they were with their biological mother could affect results. The older, the less likely they are to be influenced by their environment.
33
What does neural correlates(correlations) mean in the biological explanations for schizo.
Focuses on the important role of the neurotransmitter dopamine AND on areas of the brain influential in the onset and development of this disorder.
Changes in neuronal events and mechanisms that result in the characteristic symptoms of a behaviour or mental disorder
34
Does more dopamine in the brain trigger negative or positive symptoms of schizo?
POSITIVE.
35
What is the dopamine hypothesis?
Claims an excess of dopamine in certain regions of the brain often associated with positive symptoms of schizo.
People with schizo are believed to have abnormally high numbers of D2 receptors on receiving neurons - resulting in more dopamine binding and Tf firing.
36
Give an example of 1 drug that increases dopamine activity in the brain - how does this happen.
Amphetamine = dopamine agonist
| Stimulates nerve cells containing dopamine, causing synapse to be flooded with this neurotransmitter - more is uptaken
37
What is a limitation (AO3) of increasing dopamine activity.
Dopamine enters the whole brain, not just the area where it is needed.
38
What is Davis + Kahn's (1991) revised version of the dopamine hypothesis?
Positive symptoms of schizo are caused by an excess of dopamine in subcortial areas of the brain - particularly mesolimbic pathway.
Negative thoughts arise from deficit of dopamine in areas of the prefrontal cortex.
39
Name 2 areas of the brain involved in schizo.
- Prefrontal cortex.
| - Hippocampus
40
How is the prefrontal cortex involved in schizo?
Main area involved in executive control.
| Research shows that this area is impaired in schizophrenics.
41
How is the hippocampus involved in schizo?
Deficits nerve connection between hippocampus and prefrontal cortex.
Central cognitive impairment in schizo.
42
Give 2 eval point for genetic factors for schizo.
-May be a limitation of research into MZ twins because they are more likely to encounter similar environments.
Joseph (2004) highlights potential identity confusion as they are treated more as 'twins' than 2 distinct individuals.
-Adoptees may be selectively placed
Central assumption of adoption studies is that adoptees do not have schizophrenic tendencies is the child does.
But not always the case.
43
Give 2 eval points for the dopamine hypothesis.
-Evidence from success of treatment.
Antipsychotic drugs are used to reduce effects of dopamine in the brain - reduce schizo.
Leucht (2013) all antipsychotics, more effective than placebo.
-Noll (2009) Challenges hypothesis, argues antipsychotics do not alleviate hallucinations + hallucinations still occur despite dopamine levels being normal.
44
Why are psychological explanation for schizo important.
No doubt biological processes are important but should not take away importance of psychological.
45
What are the 2 psychological explanations for schizophrenia?
- Family dysfunction
| - Cognitive explanations.
46
What 2 things to family dysfunction include?
- Double bind theory
| - Expressed emotion
47
What is family dysfunction in psychological explanations for schizophrenia?
Linking schizophrenia with childhood and adult experiences living in a dysfunctional family. Claims schizophrenia is caused by abnormal patterns of communication within family.
48
What is the double bind theory in psychological explanations for schizophrenia?
Bateson et al (1956) says when a child is developing and regularly finding themselves in situations where they fear doing the wrong thing - but receive contradictory messages about what to do. They feel unable to seek clarification, they are more likely to develop schizophrenia.
49
What is an example of double bind theory?
Mother tells son that she loves him but at the same time turns her head away in disgust - child receives 2 conflicting feelings.
50
What is expressed emotion?
Members of family of a psychiatric patient talk about the patient in a critical/hostile manner.
51
What are the three types to express negative emotion
- Verbal criticism of patient
- Hostility towards patient, anger
- Emotional over-involvement, including self-sacrifice.
52
How much more likely are patients liable to relapse returning to a family in a high EE environment.
4 times.
53
What did Kuipers et al (1983) find about expressed emotion?
Found high EE relatives talk more and less listen less. High levels of EE most likely to affect relapse rates.
54
What does cognitive explanations involve in psychological explanations for schizophrenia?
Dysfunctional thought processing - process info differently concerned with internal mental processes.
55
What are cognitive explanations of delusions in psychological explanations of schizo?
- Patients interpretations of experiences are controlled by inadequate information processing.
- Perceives themselves as central component in events (egocentric)
56
What are cognitive explanations of hallucinations in psychological explanations of schizo?
- Auditory hallucinations common for people diagnosed with schiz. 73% reporting experiences the,.
- Aleman (2001) suggests hallucination - prone to find it difficult to distinguish between imagery and sensory perception.
57
Eval for family dysfunction.
| Family relationships?
Tienari (1994) found that adopted children who had schizophrenic biological parents were more likely to develop schizophrenic symptoms than those whose parents were not schizophrenic. However, this
difference emerged only in situations where the adopted families were rated as disturbed.
Suggests that the illness only manifests itself under
appropriate environmental conditions, and therefore genetic vulnerability on its own is not a sufficient trigger.
58
Eval for family dysfunction.
| Double bind theory?
Berger (1965) found schizophrenics reported a higher recall of double bind statements than non-schizophrenics.
59
Eval for family dysfunction.
| Individual differences in vulnerability to expressed emotion.
Not all individuals who live in high EE environments relapse + not all those living in low EE home avoid relapse.
Altofer (1998) found 25% of patients studied showed no psychological responses.
60
Eval for family dysfunction.
| Cognitive explanations
Sarin + Wallkin (2014) found supporting evidence for the claim that positive symptoms of schizo.
Delusional patients showed various biases in info processing, eg: jumping to conclusion + lack of reality.
Tf, therapist can use info to design techniques for treatment of patients.
61
What are the two types of antipsychotic?
- Typical - conventional / first-generation
| - Atypical - 2nd generation / generally fewer side effects.
62
What do typical antipsychotics do?
- Combat positive symptoms (hallucinations)
- Work in reducing amount of dopamine.
- Dopamine antagonists bind but do not stimulate dopamine receptors (mainly D2 receptors) thus blocking their action - not stimulating them.
63
What is an example of a typical antipsychotic.
Chlorpromazine.
64
What do atypical antipsychotics do?
- Used to treat positive symptoms + claimed effect on negative symptoms.
- Work on dopamine system + block serotonin receptors.
- Also bind to D2 receptors but rather than permanently blocking D action, temporarily bind to receptors then rapidly dissociate to allow normal transmission.
- Thought to carry lower levels of extrapyramidal side effects.
65
What is an example of an atypical antipsychotic.
Clozapine.
66
Kapur (2000) did research into typical antipsychotics, what did Kapur find?
Approx. 60-75% pf D2 receptors need to be blocked in mesolimbic pathway for drugs to be effective
But as a result, D2 receptors are also blocked from the rest of the brain.
67
Give 2 strengths of drug therapy.
-Allows patient to live in society rather than hospitalisation which is cheaper and allows the patient to still live their live relatively normally.
-Leucht (2012) meta anaysis. 65 studies nearly 6000 patients between 1959 - 2011
Large sample size + temporal validity.
Found 64% of placebo group relapsed compared to 27% who stayed on antipsychotic drug.
-Emsley (2008) injecting drug risperidone. Those injected early in course of disorder = high remission rates + low relapse rates.
68
Give 2 limitations of drug therapy.
- Reduces whole brain activity
- Extrapyramidal side effects, typical antipsychotics can sometimes produce movement problems for patient as the drugs interfere with extrapyramidal parts of the brain which helps to control motor activity.
- Antipsychotics purely deal with the symptoms, cannot kill/change the cause of schizophrenia.
- Motivational deficits, Ross and Read (2004) argue people prescribed antipsychotic medication reinforces the view 'something is wrong with them'. Could contribute to condition.
69
What is the basic assumption of CBT for psychosis?
People often have distorted beliefs, which influence their feelings and behaviours in maladaptive ways
70
How are sessions of CBT for psychosis delivered. How many sessions are recommended?
Delivered in groups, 1-1 most usual.
| NICE recommends 16 sessions.
71
How does the nature of CBT for psychosis work. What are patients encouraged to do.
- Encouraged to trace back to the origins of symptoms.
| - Encouraged to evaluate content of their delusions and to consider how they can test validity of their faulty beliefs.
72
What are the 3 points of the cognitive triad Beck proposed - to do with CBT.
- Negative views about the WORLD
- Negative views about the FUTURE
- Negative views about ONESELF
73
During the CBT for psychosis the therapist may use the ABC model (proposed by Ellis (1962). What is this?
ACTIVATING events cause
their emotional and BEHAVIOURAL CONSEQUENCES.
Patient's own beliefs cause the consequences and the therapy attempts to rationalise these irrational beliefs.
74
Behaviour activation is often used in CBT for psychosis. What is this?
Set homework tasks to improve general life functioning.
75
Give a strength of CBT for psychosis.
-NICE (2014) - temporal validity - When compared with standard care it was effective in reducing rehospitalisation rates up to 18 months following end of treatment.
Also effective in reducing symptom severity when compared with patients receiving standard care.
76
Evaluation point of the effectiveness of CBTp being dependent on the stage of the disorder.
Addington and Addington (2005) claim initial phase of schizo is not appropriate, but following stabilisation of psychotic symptoms with antipsychotic medication - it is effective.
77
Give 2 limitations of CBT for psychosis.
-Lack of availability - Haddock (2013) - temporal validity - in North of England random 200 patients selected and only 7% had been offered CBT for psychosis.
weakness of study - only in the north of England..
- Time consuming to get to therapy and takes time to talk through problems. Results may take a lot more time compared to the response of drug therapies which are quick but on the other hand do not cure problem - dampen symptoms.
- Costs more money than drug therapies where drugs are widely available.
78
What brings together the biological and psychological approaches to schizophrenia?
The interactionist approach
79
What does family therapy attempt to do?
Seeks to treat members of family as well as patients with schizo. In the hope to reduce high levels of expressed emotion within the household.
80
Give 2 aims of family therapy.
- Improve positive and decrease negative forms of communication.
- Increase tolerance levels and decrease criticism levels between family members.
- Decrease feelings of guilt or responsibility for causing illness amongst family members.
81
What was Pharoah's et al (2010) key study into family therapy about?
- Meta analysis - 53 studies
- Studies from Europe, Asia and North America
- Compared the outcome of family therapy to 'standard care' eg: antipsychotics.
82
What did Pharoah et al (2010) find into family therapy? (4)
- Mental state; mixed impression.
- Compliance with medication; increased compliance
- Social functioning; no effect
- Reduction in relapse + readmission; reduction in the risk of relapse + hospital admission reduction during treatment and 24 months after.
83
Give 2 strengths of Pharoah's study into family therapy.
- Economic benefits: despite initial cost, cheaper than hospitalisation.
- Impact on family members: may have additional positive affect on family members.
- Large study, across continents so a wide range of cultures - enables some generalisation.
84
Give 2 limitations of Pharoah's study into family therapy.
Methodological issues:
-Problems with random allocation - no structure to the groups of their severity of schizophrenia.
-Lack of blinding - over 20 of the studies either did not report blinding or did not blind - raters were aware of the type of treatment received (family therapy)
85
Give 2 ways family therapy can work.
- Psychoeducation, helping whole family understand and help deal with illness better.
- Forming alliance with relatives who care for person with schizo.
86
1 strength of family therapy.
-Main reason for F.T's effectiveness may be due to the fact it increases medication compliance.
suggesting main benefit of the therapy is it makes people more likely to comply with their medication.
87
1 limitations of family therapy.
Family therapy may not be worth while - Garety et al (2008) failed to show better outcome for patients who had family therapy rather than a carer.
88
What is token economy?
Token economy is a form of behavioural therapy where clinicians set target behaviours they believe will improve patient's engagement in daily activities.
89
When are token are awarded in the token economy?
Give an example.
and what does this allow?
- Rewards are given when desirable behaviour is demonstrated.
eg: maintaining personal hygiene.
- Rewards usually tokens/points - can then be exchanged.
90
What is the primary and secondary reinforcer in the token economy?
Tokens have no intrinsic value - secondary reinforcers.
| What can be exchanged with your tokens are the primary reinforcer.
91
What are the 4 stages to the token economy cycle?
1 - Tokens paired with rewarding stimuli, so become secondary reinforcers
2 - Patient engages in target behaviours or reduces inappropriate ones.
3 - Patient given tokens for engaging in these target behaviours, like dressing themselves.
4 - Patient trades these tokens for access to desirable items.
92
What is reinforcing the target behaviours about?
Generalisation - learning theory principles is important because once behaviours are reinforced and established in an institution, they then need to be generalised to the outside world.
93
Give 2 limitations of the token economy.
- Dependency; patients may only produce the desired behaviour in order to receive a token, not because they have learned.
- Transference; desired behaviours in real life can lead to rewards but often not, (eg: getting dressed). Tf there can be great difficulty in transferring this from an institution to real life.
-Less useful for patients living in community. Shown to reduce negative symptoms, only in hospital settings.
Corrigan (1991) argues outpatients struggle - only receive care a few hours a day. Tf, t.e. limited time, results may not be maintained beyond environment.
94
Give 2 reasons why token economy may not work. Another evaluation point for the limitation of the token economy.
- Staff not committed to programme, do not focus sufficiently.
- Inconsistent rewards given for same behaviour - could confuse patient.
- Failure to plan for transferring to environment outside the institution.
95
Give 2 strengths of token economies. (A GRAPHIC)
- Cheap methods of rehabilitating
- Anyone can reward with tokens.
-Found to be successful by many studies, approx 10-20% people do not respond well.
-Research support, Dickerson et al. (2005) reviewed 13 studies, use of token economy systems.
Overall 11/13 studies reported beneficial effects , studies provide evidence of t.e. effectiveness.
96
What is the interactionist approach about?
About the INTERACTION between biological and environmental influences.
97
What is the diathesis in the diathesis stress model?
The predisposition to develop a medical condition because of their genes.
98
What is the stress in the diathesis stress model?
Stress is any environmental factor such as childhood trauma.
99
What evidence supports the diathesis part of the diathesis stress?
Identical twin of a person is at greater risk of developing schizophrenia than a sibling / fraternal twin.
100
What evidence supports the stress part of the diathesis stress?
Varese et al. (2012) children who experienced severe trauma 3x as likely to develop schizophrenia in later life compared to general population.
101
What was Tienari's (2004) study into the diathesis stress. Procedure?
Prospective study of 150 children from Finland adopted away from biological family who had mothers diagnosed with schizophrenia.
Compared this group with group 150 children who did not have parents with schizophrenia.
102
What did Tienari (2004) find into his diathesis stress key study.
- After 21 years, 14/300 adoptees developed schizophrenia.
| - 11/14 from high risk group (mothers who had schizophrenia).
103
Give 2 strengths of Tienari's (2004) study into the diathesis stress model.
- Longitudinal study, more credible as it is work over many years.
- Large sample size helps provide accurate mean values.
104
Give 2 limitations of Tienari's (2004) study into the diathesis stress model.
- Researchers noticed when psychiatristds assessed stress levels in the adoptive family - the family function was only assessed at one point in time and did not adapt to changes.
- OPAS scale used, Oulu scale, only used in Finland, difficult to generalise to other areas of the world.
- Lack population validity; everyone from the study is from Finland. We know Finland is an individualistic culture - Tf we cannot generalise to collectivist cultures like Japan.
105
What is a strength of the diathesis stress model.
Recognises both nature and nurture have an influence on development of schizophrenia.
106
Evaluation point of the diathesis stress model.
- Difficulties in determining casual stress. Hammen (1992) argue bad methods of coping with stress in childhood and throughout development means individual fails to pick up coping skills.
- Diathesis may not be exclusively genetic, evidence for brain damaged being caused by environmental factors. Verdoux et al (1998) risk of developing schizo later in life for individuals who experienced complications at birth, 4x greater than those who experienced no complications.
