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A Level Psychology > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

When does sz develop

A

in early adult life

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2
Q

How many people does sz affect

A

1% of the population

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3
Q

Which gender is more affected

A

men

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4
Q

How much later is does womens sz show

A

5-10 years

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5
Q

Where is sz more common

A

in the cities and america

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6
Q

Which classification system recognises different subtypes

A

ICD, not DSM

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7
Q

How many symptoms do you need to be diagnosed in the DSM

A

1 positive symptom

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8
Q

How long must symptoms last for`

A

at least a month

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9
Q

Name 3 symptoms

A

hallucinatory voices
neologisms (fast speaking/nonsense)
catatonic behaviour (energy levels)

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10
Q

What does co morbid mean

A

having two or more disorders at one time

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11
Q

Does sz have a high co morbidity rate

A

yes

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12
Q

What must a patient not have done when being diagnosed

A

drugs or alcohol

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13
Q

What type categories are symptoms split into

A

positive and negative

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14
Q

What is a positive symptom

A

appear in excess eg too much energy

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15
Q

What is a negative symptom

A

loss of normal functions eg very low energy

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16
Q

Name 3 positive symptoms

A

delusions which are not possible
hallucinations
disordered thinking

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17
Q

Name 3 negative symptoms

A

affective flattening - loss of emotion in face
alogia - lessening of speech fluidity
avolution - loss of goal orientated behaviour

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18
Q

Name a study which looks co morbidity

A

Buckley et al (2009)
50% also have depression
47% have a drug abuse problem

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19
Q

Name a study which proves the reliability of sz is bad

A

Cheniaux (2009) asked 2 patients to diagnose 100 patients and their inter-rater reliability was poor

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20
Q

Why is sz validity poor

A

as it lacks criterion validity as people in Cheniaux study are much more likely to be diagnosed using ICD than DSM so ICD is either over-diagnosed or under-diagnosed in DSM

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21
Q

Why is symptom overlap an issue is sz

A

as bipolar and sz have many of the same symptoms and in the DSM sz patients are more likely to be diagnosed with bipolar

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22
Q

Name the study that looks at gender bias in sz

A

Longenecker et al (2010) looked at studies from 1980
men are much more likely to be diagnosed as they are more genetically vulnerbale
also women are more capable of functioning, so can mask symptoms

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23
Q

Explain cultural bias in diagnosis

A

Afro-caribbeans and african americans communicate with ancestors more in their culture and accept these voices
can be misinterpreted by white clinicians (Escobar 2012)

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24
Q

Name a culture bias study between UK and US

A

Copeland (1971) gave description of a patient to psychiatrists
69% of US diagnosed
2% of UK

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25
Q

What is the course of sz like

A

episodic, psychotic episodes then normal functioning

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26
Q

How long does this active phase last

A

1-6 months but has been see to last a year

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27
Q

What % of sz patients commit suicide

A

10-15%

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28
Q

Name the five sub types of sz

A

paranoid, catatonic, disorganised, undifferentiated, residual

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29
Q

What is paranoid sz

A

most common, sees hallucinations

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30
Q

What is catatonic sz

A

very rare, complete immobility or weird motor behaviour

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31
Q

What is disorganised sz

A

often in early life, disorganised speech

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32
Q

What is undifferentiated sz

A

symptoms but not sure which group

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33
Q

What is residual sz

A

had at least one episode but no longer exibiting symptoms

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34
Q

What is a positive of getting diagnosed

A

relief in knowing there is a reason for the symptoms

can get help and treatment

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35
Q

What is a negative of getting diagnosed

A

sticky labels

banned from certain jobs

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36
Q

How much more likely is a sz diagnosis in black people in the UK compared to white

A

7x

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37
Q

Are black people more likely to be diagnosed in their own country

A

no

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38
Q

What are the three biological factors affecting sz

A

genetic, biochemical, neuroanatomical

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39
Q

Explain how studies show sz runs in families

A

twin studies and family studies show those with a greater degree of genetic similarity have a shared risk of sz
Grottesman (1991) found as genetic similarity increases so does the probability of sharing sz

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40
Q

Name the study looking at sz in twins

A

Kendler (1983)
30.9% concordance for identical twins
9% concordance for non identical twins

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41
Q

Why can’t genetics account for all sz

A

as the concordance rate for mz twins is not 100%
sample size is small
mz twins elicit more similar treatment so have a greater shared environment

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42
Q

Sz is polygenic - what does this mean

A

many genes work in combination to increase risk

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43
Q

Which study looks at candidate genes

A

Ripke et al (2014) found 108 different gene combinations that increase risk of sz

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44
Q

Which neurotransmitter can cause sz

A

dopamine

issues with the receptors and or presynaptic neurons can cause sz

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45
Q

What does dopamine control

A

attention and perception

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46
Q

What is the original version of the dopamine hypothesis

A

dopamines role in the high levels of activity in the subcortex

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47
Q

What is an example of dopamine issues in the subcortex

A

excess of receptors in Broca’s area which is responsible for speech production may lead to poor speech or auditory hallucinations

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48
Q

What is the more recent version of the dopamine hypothesis

A

abnormal dopamine systems in the cortex

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49
Q

What is a study into cortex dopamine

A

Goldman-Rakic et al (2004) have identified a role for low levels of dopamine in the prefrontal cortex in negative symptoms
also found other neurotransmitters involved

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50
Q

What is the difference between hyperdopaminergia and hypodopaminergia

A

hyper - too much in the sub cortex

hypo - too little in the cortext

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51
Q

Name the post mortem study into sz

A

Seeman (1987) increase in dopamine in parts of the brain in sz patients

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52
Q

What are the two psychological socio-cultural factors affecting sz

A

family dysfunction

life events

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53
Q

What are the 4 parts of family dysfunction

A

Schizophrenogenic mother
double bind theory
expressed emotion
diathesis stress model

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54
Q

Who proposed the psychodynamic explanation of the sz mother

A

Reichmann (1948)

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55
Q

What traits come with a sz mother

A

cold
unloving
rejecting
controlling

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56
Q

What does a sz mother lead to later in life

A

distrust which develops into paranoid delusions and then sz

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57
Q

Who introduced the double bind theory of sz

A

Bateson et al (1972)

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58
Q

What did Bateson suggest

A

family climate plays a large role in sz, communication needed and contradictory messages from parents can develop sz

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59
Q

Why does the double bind theory lead to sz

A

interactions prevent understanding of world as its confusing

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60
Q

What is Bateson clear on with his theory

A

that this is only one risk factor

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61
Q

What is expressed emotion

A

level of emotion expressed towards someone by their carer

family communication style that involves verbal criticism and emotional over involvement

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62
Q

Why does EE lead to sz

A

result in high levels of stress and can lead to a relapse and stress overtakes coping mechanisms

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63
Q

Name a study involving EE

A

Kalafi and Torabi (1996) found that high EE in Iranian families (overprotective mother and rejecting father) was one of the main causes of sz

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64
Q

What are the three dimensions of EE

A

hostility, emotional over-involvement, critical comments

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65
Q

Explain each dimension

A

hostility - negative attitude directed towards patient because family feel disorder is uncontrollable and patient is choosing to not get better
emotional over-involvement - family members blame themselves for the mental illness and show a lot of concern
critical comments - combination of other two dimensions, parents think there is some control over the disorder that the patient is choosing to ignore

66
Q

When does EE tend to develop

A

after someone has been diagnosed

67
Q

What does the diathesis stress model suggest needs to be present for an episode

A

vulnerability and stress

68
Q

Name a study where life events have affected sz

A

Brown and Birley (1968) found that prior to a sz episode, patients who had an episode had twice as many stressful life events

69
Q

Freud believed sz was the result of what two processes

A

regression at pre-ego stage

attempts to re establish ego control

70
Q

Explain a cognitive model of sz

A

when sz’s start hearing voices, they turn to others to confirm the voices. they deny, so the sz believes they are trying to trick them and hide the truth, leading them to think that everyone is out to get them

71
Q

What does Frith’s cognitive model distinguish

A

the difference between conscious and preconscious processing

72
Q

What does Frith believe delusions are a result of

A

faulty attention system

73
Q

How does a faulty attention system lead to sz

A

preconscious thoughts are given conscious attention, this unimportant info is misinterpreted and seen as something that needs to acted upon leading to delusions

74
Q

What is metarepresentation

A

our ability to reflect on and gain insight into thoughts and behaviours of ourselves and others

75
Q

What is central control

A

the control that allows us to suppress automatic responses and perform deliberate actions instead

76
Q

What does Helmsley’s cognitive model believe

A

that some psychotic symptoms of sz arise from a disconnection between stored knowledge and current sensory input

77
Q

How does Helmsley’s model explain hallucinations

A

schemas are not corresponded to the correct stimuli being received, so internal events can be mistaken for external events

78
Q

What are the two types of dysfunctional thought processing (Frith 1992)

A

metarepresentation

central controls

79
Q

What is the supporting data for dysfunctional families

A

Read et al (2005) 69% of women and 59% of men sz in patients had child abuse experiences

80
Q

Why is dysfunctional family data not entirely accurate

A

patents may have distorted view of experiences which lowers validity

81
Q

Why is there problems with sz mother and double bind studies

A

had to look at ‘crazy making characteristics’ (Harrington 2012) which modern day psychologists would never engage in

82
Q

Why was the parent-blaming approach unhelpful

A

as the patients needed care and not to split the family or cause a scapegoat, and families had already been through a lot of trauma

83
Q

Is there string or weak evidence for the idea that sz patients process information differently

A

strong

84
Q

What study showing this difference in info processing

A

Stirling et al (2006) Stroop test done where colour of word has to be said not what the word says
30 sz with 18 control p’s
to complete they must suppress their automatic response
sz patients took twice as long

85
Q

What is a problem with a lot of sz psychological explanations

A

they explain the proximal causes (causes of current symptoms) but not the distal causes (origins of condition)

86
Q

Which factors are not adequately considered

A

biological

87
Q

How would we treat sz looking at bio factors

A

through drug therapies

88
Q

When were anti psychotic drugs founded

A

1950’s

89
Q

What do these drugs do

A

affect neurotransmitter activity to reduce symptoms but does not reduce amount of NT

90
Q

What are drugs often used alongside

A

psychological therapies

91
Q

Lowering the transmission of which NT reduces symptoms

A

dopamine

92
Q

What is the name of the typical 1950’s anti psychotic drug that was used to combat positive symptoms

A

Chlorpromazine

93
Q

What is the name of the two atypical 1950’s anti psychotic drug that was used to negative and positive symptoms

A

Clozapine and Risperidone

94
Q

What did the typical drugs do

A

block D2 receptors of dopamine which reduces hallucinations

95
Q

What are drugs that block receptor sites also known as

A

antagonists

96
Q

How was Chlorpromazine taken

A

injected, syrup or tablets

97
Q

What did the atypical drugs do

A

block the D2 receptors but also block serotonin receptors

98
Q

What is an issue with typical drugs

A

they are sedatives and have very significant side effects

99
Q

What is the dosage of chlorpromazine

A

1000mg a day

100
Q

What is the dosage of clozapine

A

300-450mg a day

101
Q

What is the dosage of risperidone

A

12mg a day

102
Q

What does Clozapine help with

A

reduces anxiety and depression and also suicidal ideation

103
Q

Name a study where Chlorpromazine was found to work

A

Thornley et al (2003) compared effectiveness with a placebo group
1121 p’s
drug showed to be associated with better functioning and reduction in relapse rates

104
Q

Name a study where clozapine was found to be effective

A

Meltzer (2012) found to work on 30-50% of treatment resistant cases

105
Q

Which drug is the most recently developed

A

risperidone

106
Q

How did typical drugs help in real life

A

they got people of out psych wards and into real life as they could manage their symptoms better

107
Q

What are some negatives with typical drugs

A

they don’t reduce negative symptoms
increased risk of depression
feeling apathetic
if drugs stopped symptoms come back so not a cure

108
Q

What are the serious side effects that come with typical sz drugs

A

tremors
parkinsons like symptoms
affects up to 30% of takers
risk is at 68% after 25 years (Glenmullen 2000)
Neuroleptic malignant syndrome where body overheats as it blocks hypothalamus functions and can cause coma’s or fatality

109
Q

What is a positive of clozapine

A

more effective for reducing negative symptoms

helped the 25% of first generation resistant people

110
Q

Name an issue with clozapine

A

clozapine can lead to agranulocytosis where white blood cells are reduced

111
Q

Name 3 issues with drug therapies

A

medication depends on the dopamine hypothesis which is not a complete explanation
evidence has been published many times (Healy 2012)
suggests that the drugs are used to make patients easier to handle for the staff’s benefit and not the patients

112
Q

Name a non mainstream therapy that is only rarely used in USA

A

ECT, stimulation of the brain whilst on anesthesia

113
Q

What type of sz patient is ECT used on in the UK

A

catatonic

114
Q

What factors does the interactionalist approach look at in sz

A

biological, psychological, societal

115
Q

What does diathesis mean

A

vulnerability

116
Q

Who came up with the original diathesis-stress model

A

Meehl (1962)

117
Q

What did the diathesis in the original stress model

A

it was genetic, a ‘schizogene’

118
Q

Name 2 things wrong with Meehl’s model and idea that a genetic vulnerability lead to sz

A 
it is over-simplistic as there is more than one schizogene that increase vulnerability (Ripke)
Modern research (Ingram and Luxton 2005) suggests that psychological abuse can lead to a sz vulnerability as it affects the way the brain develops
119
Q

What was the original stress in the model

A

poor parenting

120
Q

What is the stress in model research of the model

A

anything that may act as a trigger (Houston et al 2008)

121
Q

What stress has been focused on recently

A

cannabis induced sz as it changes the neurochemistry in the brain

122
Q

Give 3 model diathesises

A

genetics
birth complications/exposure to flu virus during gestation
psychological trauma

123
Q

Give 3 model stressors

A

family dysfunction
exposure to drugs
daily hassles

124
Q

What does treatment have to acknowledge in the interactionalist approach

A

that sz can be caused by biological and psychological factors so treatment must do the same

125
Q

What treatment is given in the interactional approach

A

antipsychotic medication combined with psychological therapies such as CBT

126
Q

Explain the Tienari et al (2004) study into adopted sz offspring

A

289 children whos mothers had sz put up for adoption
adopted to nice family - still higher risk than general population
adopted to dysfunctional family - even higher risk

127
Q

What did Turkington et al find in terms of treatment

A

that using the treatments together work better than on their own but doesnt mean the interactionalist is right

128
Q

Name two psychological therapies used in sz treatment

A

CBT and family therapy

129
Q

How many sessions of CBT may a patient need

A

5-20

130
Q

How many people is CBT done in

A

individuals or groups

131
Q

What is the aim of CBT

A

to identify irrational thoughts and trying to change them

132
Q

How can CBT help

A

helps patients make sense of their delusions and hallucinations and how it impacts tehir feelings and behaviour

133
Q

What model does CBT follow

A

ABC model

134
Q

What is the ABC model

A

Activating event recognised
cause of Behaviour
looking at Consequences

135
Q

What can CBT reduce

A

anxiety

136
Q

What is normalisation

A

knowing that there are other people who experience the same things

137
Q

What is ciritical collaborative analysis

A

needs to be trust between patient and therapist

138
Q

Explain the evidence for effectiveness for CBT

A

Jauhar et al (2014) reviewed 34 studies and found that CBT has a significant but fairly small effect on both positive and negative symptoms
Gould et al carried out a meta analysis of 7 studies and found a significant decrease in positive symptoms

139
Q

What are some negatives of CBT

A

allows pateints to manage symptoms but does not cure sz

flawed studies without control groups and a lack of random allocation

140
Q

What are the ethical issues with CBT

A

challenging pateints beliefs interfere with patients freedom of thought

141
Q

What is family therapy

A

a psychological therapy carried out with all or some of the patients family

142
Q

What is the aim of family therapy

A

improving their communication and reducing the stress of living as a family
reduce leves of expressed emotion

143
Q

Why are doctors using family therapy

A

as some belive schizo mother and double bind suggests family is behind sz
but mainly because family life can stop relapses

144
Q

Who identified strategies to reduce EE and reduce likelihood of relapse

A

Pharoah et al (2010)

145
Q

Name 3 of the 6 strategies suggested for this

A

form a therapeutic alliance with the family
improving families beliefs and behaviours towards sz
reduce anger and guilt of family

146
Q

What evidence did Pharoah et al

A

reviewed evidence of family therapy and found moderate evidence that it reduced hospital readmissions over the course of a year

147
Q

What negatives were found with family therapy

A

findings in studies were inconsistent
quality of evidence was weak
reduced stress of living but not a cure of sz

148
Q

Name a specific form of CBT and what its focused on

A

coping strategy enhancement and focused on building on previously made coping strategies

149
Q

What are token economies

A

reward systems to manage behaviour of patients with sz

150
Q

What type of sz patients are token economies usually used on

A

patients who have been institutionalised and have developed maladaptive behaviour

151
Q

What does token economies improve

A

quality of life

152
Q

What are tokens

A

secondary reinforcers given to patients when they have carried out a desirabe behaviour (reinforcement and operant conditioning)

153
Q

Why is the token given straight away

A

to prevent delay discounting

154
Q

What can these tokens be swapped for

A

rewards

155
Q

Why are token economies controversial

A

patients with milder symptoms are more likely to comply and therefore get more rewards
more severe sufferers are discriminated against as they struggle to comply more so get less rewards

156
Q

What is a study that showed token economies to have positive effects

A

McMonagle and Sultana (2003)
110 patients either token or control
only one patient showed signs of improved behaviour

157
Q

What is another issue with token economies

A

at best token economies help pateints have more socially acceptable behaviours but does not cure them

158
Q

What are delusions of grandeur

A

where someone belives they are greater than they really are

159
Q

What are delusions of persacution

A

thinking someone wants to attack you

160
Q

What is social withdrawal

A

not wanting to go do social things or go outside

161
Q

What is speech poverty

A

having disorganised speech

A Level Psychology (12 decks)

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