Schizophrenia Flashcards
When does sz develop
in early adult life
How many people does sz affect
1% of the population
Which gender is more affected
men
How much later is does womens sz show
5-10 years
Where is sz more common
in the cities and america
Which classification system recognises different subtypes
ICD, not DSM
How many symptoms do you need to be diagnosed in the DSM
1 positive symptom
How long must symptoms last for`
at least a month
Name 3 symptoms
hallucinatory voices
neologisms (fast speaking/nonsense)
catatonic behaviour (energy levels)
What does co morbid mean
having two or more disorders at one time
Does sz have a high co morbidity rate
yes
What must a patient not have done when being diagnosed
drugs or alcohol
What type categories are symptoms split into
positive and negative
What is a positive symptom
appear in excess eg too much energy
What is a negative symptom
loss of normal functions eg very low energy
Name 3 positive symptoms
delusions which are not possible
hallucinations
disordered thinking
Name 3 negative symptoms
affective flattening - loss of emotion in face
alogia - lessening of speech fluidity
avolution - loss of goal orientated behaviour
Name a study which looks co morbidity
Buckley et al (2009)
50% also have depression
47% have a drug abuse problem
Name a study which proves the reliability of sz is bad
Cheniaux (2009) asked 2 patients to diagnose 100 patients and their inter-rater reliability was poor
Why is sz validity poor
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
Why is symptom overlap an issue is sz
as bipolar and sz have many of the same symptoms and in the DSM sz patients are more likely to be diagnosed with bipolar
Name the study that looks at gender bias in sz
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
Explain cultural bias in diagnosis
Afro-caribbeans and african americans communicate with ancestors more in their culture and accept these voices
can be misinterpreted by white clinicians (Escobar 2012)
Name a culture bias study between UK and US
Copeland (1971) gave description of a patient to psychiatrists
69% of US diagnosed
2% of UK
What is the course of sz like
episodic, psychotic episodes then normal functioning
How long does this active phase last
1-6 months but has been see to last a year
What % of sz patients commit suicide
10-15%
Name the five sub types of sz
paranoid, catatonic, disorganised, undifferentiated, residual
What is paranoid sz
most common, sees hallucinations
What is catatonic sz
very rare, complete immobility or weird motor behaviour
What is disorganised sz
often in early life, disorganised speech
What is undifferentiated sz
symptoms but not sure which group
What is residual sz
had at least one episode but no longer exibiting symptoms
What is a positive of getting diagnosed
relief in knowing there is a reason for the symptoms
can get help and treatment
What is a negative of getting diagnosed
sticky labels
banned from certain jobs
How much more likely is a sz diagnosis in black people in the UK compared to white
7x
Are black people more likely to be diagnosed in their own country
no
What are the three biological factors affecting sz
genetic, biochemical, neuroanatomical
Explain how studies show sz runs in families
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
Name the study looking at sz in twins
Kendler (1983)
30.9% concordance for identical twins
9% concordance for non identical twins
Why can’t genetics account for all sz
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
Sz is polygenic - what does this mean
many genes work in combination to increase risk
Which study looks at candidate genes
Ripke et al (2014) found 108 different gene combinations that increase risk of sz
Which neurotransmitter can cause sz
dopamine
issues with the receptors and or presynaptic neurons can cause sz
What does dopamine control
attention and perception
What is the original version of the dopamine hypothesis
dopamines role in the high levels of activity in the subcortex
What is an example of dopamine issues in the subcortex
excess of receptors in Broca’s area which is responsible for speech production may lead to poor speech or auditory hallucinations
What is the more recent version of the dopamine hypothesis
abnormal dopamine systems in the cortex
What is a study into cortex dopamine
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
What is the difference between hyperdopaminergia and hypodopaminergia
hyper - too much in the sub cortex
hypo - too little in the cortext
Name the post mortem study into sz
Seeman (1987) increase in dopamine in parts of the brain in sz patients
What are the two psychological socio-cultural factors affecting sz
family dysfunction
life events
What are the 4 parts of family dysfunction
Schizophrenogenic mother
double bind theory
expressed emotion
diathesis stress model
Who proposed the psychodynamic explanation of the sz mother
Reichmann (1948)
What traits come with a sz mother
cold
unloving
rejecting
controlling
What does a sz mother lead to later in life
distrust which develops into paranoid delusions and then sz
Who introduced the double bind theory of sz
Bateson et al (1972)
What did Bateson suggest
family climate plays a large role in sz, communication needed and contradictory messages from parents can develop sz
Why does the double bind theory lead to sz
interactions prevent understanding of world as its confusing
What is Bateson clear on with his theory
that this is only one risk factor
What is expressed emotion
level of emotion expressed towards someone by their carer
family communication style that involves verbal criticism and emotional over involvement
Why does EE lead to sz
result in high levels of stress and can lead to a relapse and stress overtakes coping mechanisms
Name a study involving EE
Kalafi and Torabi (1996) found that high EE in Iranian families (overprotective mother and rejecting father) was one of the main causes of sz
What are the three dimensions of EE
hostility, emotional over-involvement, critical comments
Explain each dimension
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
When does EE tend to develop
after someone has been diagnosed
What does the diathesis stress model suggest needs to be present for an episode
vulnerability and stress
Name a study where life events have affected sz
Brown and Birley (1968) found that prior to a sz episode, patients who had an episode had twice as many stressful life events
Freud believed sz was the result of what two processes
regression at pre-ego stage
attempts to re establish ego control
Explain a cognitive model of sz
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
What does Frith’s cognitive model distinguish
the difference between conscious and preconscious processing
What does Frith believe delusions are a result of
faulty attention system
How does a faulty attention system lead to sz
preconscious thoughts are given conscious attention, this unimportant info is misinterpreted and seen as something that needs to acted upon leading to delusions
What is metarepresentation
our ability to reflect on and gain insight into thoughts and behaviours of ourselves and others
What is central control
the control that allows us to suppress automatic responses and perform deliberate actions instead
What does Helmsley’s cognitive model believe
that some psychotic symptoms of sz arise from a disconnection between stored knowledge and current sensory input
How does Helmsley’s model explain hallucinations
schemas are not corresponded to the correct stimuli being received, so internal events can be mistaken for external events
What are the two types of dysfunctional thought processing (Frith 1992)
metarepresentation
central controls
What is the supporting data for dysfunctional families
Read et al (2005) 69% of women and 59% of men sz in patients had child abuse experiences
Why is dysfunctional family data not entirely accurate
patents may have distorted view of experiences which lowers validity
Why is there problems with sz mother and double bind studies
had to look at ‘crazy making characteristics’ (Harrington 2012) which modern day psychologists would never engage in
Why was the parent-blaming approach unhelpful
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
Is there string or weak evidence for the idea that sz patients process information differently
strong
What study showing this difference in info processing
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
What is a problem with a lot of sz psychological explanations
they explain the proximal causes (causes of current symptoms) but not the distal causes (origins of condition)
Which factors are not adequately considered
biological
How would we treat sz looking at bio factors
through drug therapies
When were anti psychotic drugs founded
1950’s
What do these drugs do
affect neurotransmitter activity to reduce symptoms but does not reduce amount of NT
What are drugs often used alongside
psychological therapies
Lowering the transmission of which NT reduces symptoms
dopamine
What is the name of the typical 1950’s anti psychotic drug that was used to combat positive symptoms
Chlorpromazine
What is the name of the two atypical 1950’s anti psychotic drug that was used to negative and positive symptoms
Clozapine and Risperidone
What did the typical drugs do
block D2 receptors of dopamine which reduces hallucinations
What are drugs that block receptor sites also known as
antagonists
How was Chlorpromazine taken
injected, syrup or tablets
What did the atypical drugs do
block the D2 receptors but also block serotonin receptors
What is an issue with typical drugs
they are sedatives and have very significant side effects
What is the dosage of chlorpromazine
1000mg a day
What is the dosage of clozapine
300-450mg a day
What is the dosage of risperidone
12mg a day
What does Clozapine help with
reduces anxiety and depression and also suicidal ideation
Name a study where Chlorpromazine was found to work
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
Name a study where clozapine was found to be effective
Meltzer (2012) found to work on 30-50% of treatment resistant cases
Which drug is the most recently developed
risperidone
How did typical drugs help in real life
they got people of out psych wards and into real life as they could manage their symptoms better
What are some negatives with typical drugs
they don’t reduce negative symptoms
increased risk of depression
feeling apathetic
if drugs stopped symptoms come back so not a cure
What are the serious side effects that come with typical sz drugs
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
What is a positive of clozapine
more effective for reducing negative symptoms
helped the 25% of first generation resistant people
Name an issue with clozapine
clozapine can lead to agranulocytosis where white blood cells are reduced
Name 3 issues with drug therapies
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
Name a non mainstream therapy that is only rarely used in USA
ECT, stimulation of the brain whilst on anesthesia
What type of sz patient is ECT used on in the UK
catatonic
What factors does the interactionalist approach look at in sz
biological, psychological, societal
What does diathesis mean
vulnerability
Who came up with the original diathesis-stress model
Meehl (1962)
What did the diathesis in the original stress model
it was genetic, a ‘schizogene’
Name 2 things wrong with Meehl’s model and idea that a genetic vulnerability lead to sz
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
What was the original stress in the model
poor parenting
What is the stress in model research of the model
anything that may act as a trigger (Houston et al 2008)
What stress has been focused on recently
cannabis induced sz as it changes the neurochemistry in the brain
Give 3 model diathesises
genetics
birth complications/exposure to flu virus during gestation
psychological trauma
Give 3 model stressors
family dysfunction
exposure to drugs
daily hassles
What does treatment have to acknowledge in the interactionalist approach
that sz can be caused by biological and psychological factors so treatment must do the same
What treatment is given in the interactional approach
antipsychotic medication combined with psychological therapies such as CBT
Explain the Tienari et al (2004) study into adopted sz offspring
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
What did Turkington et al find in terms of treatment
that using the treatments together work better than on their own but doesnt mean the interactionalist is right
Name two psychological therapies used in sz treatment
CBT and family therapy
How many sessions of CBT may a patient need
5-20
How many people is CBT done in
individuals or groups
What is the aim of CBT
to identify irrational thoughts and trying to change them
How can CBT help
helps patients make sense of their delusions and hallucinations and how it impacts tehir feelings and behaviour
What model does CBT follow
ABC model
What is the ABC model
Activating event recognised
cause of Behaviour
looking at Consequences
What can CBT reduce
anxiety
What is normalisation
knowing that there are other people who experience the same things
What is ciritical collaborative analysis
needs to be trust between patient and therapist
Explain the evidence for effectiveness for CBT
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
What are some negatives of CBT
allows pateints to manage symptoms but does not cure sz
flawed studies without control groups and a lack of random allocation
What are the ethical issues with CBT
challenging pateints beliefs interfere with patients freedom of thought
What is family therapy
a psychological therapy carried out with all or some of the patients family
What is the aim of family therapy
improving their communication and reducing the stress of living as a family
reduce leves of expressed emotion
Why are doctors using family therapy
as some belive schizo mother and double bind suggests family is behind sz
but mainly because family life can stop relapses
Who identified strategies to reduce EE and reduce likelihood of relapse
Pharoah et al (2010)
Name 3 of the 6 strategies suggested for this
form a therapeutic alliance with the family
improving families beliefs and behaviours towards sz
reduce anger and guilt of family
What evidence did Pharoah et al
reviewed evidence of family therapy and found moderate evidence that it reduced hospital readmissions over the course of a year
What negatives were found with family therapy
findings in studies were inconsistent
quality of evidence was weak
reduced stress of living but not a cure of sz
Name a specific form of CBT and what its focused on
coping strategy enhancement and focused on building on previously made coping strategies
What are token economies
reward systems to manage behaviour of patients with sz
What type of sz patients are token economies usually used on
patients who have been institutionalised and have developed maladaptive behaviour
What does token economies improve
quality of life
What are tokens
secondary reinforcers given to patients when they have carried out a desirabe behaviour (reinforcement and operant conditioning)
Why is the token given straight away
to prevent delay discounting
What can these tokens be swapped for
rewards
Why are token economies controversial
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
What is a study that showed token economies to have positive effects
McMonagle and Sultana (2003)
110 patients either token or control
only one patient showed signs of improved behaviour
What is another issue with token economies
at best token economies help pateints have more socially acceptable behaviours but does not cure them
What are delusions of grandeur
where someone belives they are greater than they really are
What are delusions of persacution
thinking someone wants to attack you
What is social withdrawal
not wanting to go do social things or go outside
What is speech poverty
having disorganised speech
