Schizophrenia Flashcards
What is the definition of schizophrenia?
A severe mental disorder where contact with reality and insight is impaired, this is an example of psychosis.
What is the DSM-5’s criteria for diagnosing Sz?
A (2+ symptoms) = disorganised speech,grossly disorganised/ catatonic bhvr, hallucinations and negative symptoms.
B = social occupation dysfunction
C (duration) = 6 months of disturbances with at least 1 month of symptoms from Criteria A
What is ICD’s criteria for diagnosing Sz?
2+ negative symptoms, this doesn’t need to have positive symptoms additionally.
What are the two classification systems used to diagnose Sz?
ICD (Europe) and DSM-V (USA)
What is positive symptoms?
A symptom that adds to the Norma experience of a person.
Excess/ distorts normal functions.
What are some examples of positive symptoms ?
Hearing voices
Disorganised speech
Hallucinations
Delusions
What are negative symptoms?
Symptoms that take away from a person’s everyday experience. This can be present without positive symptoms.
State some examples of negative symptoms
Speech poverty
Avolition
What are hallucinations?
Sensory experiences of stimuli that are not real/ distorted
What are delusions?
Firm but false beliefs
What is Speech poverty?
A negative symptom that causes the quality of speech to lower e.g grammar
What is a strength for the the classification of SZ?
Inter-rate reliability is high IF USING A STANDARDISED METHOD = APPLICATION
Jakobsen et al (2004) = concordance rate of 98% between clinicians
What is the weaknesses of the classification of SZ?
ETHICS = Scheff (1966)
Self-fulfilling prophecy = pygamalion effect (unconsciously acting the way they believe). This is unethically wrong bc could make a person worse.
Co-morbidity = Qs validity, what if better to see it as one condition
Buckey et al = 50% depression and 47% substance abuse.
Symptoms overlap = Qs validity bc unclear what causes symptoms e.g BPD and Sz. The ICD = Sz but the DSM = BPD this is limited application
What are the differences between the DSM and ICD?
DSM = doesn’t acknowledge subtype e.g catatonic whilst ICD does = makes it easier to be diagnosed Sz under ICD
DSM = disorganised speech is positive whilst speech poverty = negative
Criteria = 2+ positive and negative symptoms with a duration over 6mths. 1 mth at least from criteria A. Whilst ICD just negative symptoms.
What are the purpose of classification systems?
To help professionals diagnose Sz and suggest treatment to alleviate symptoms.
To do this the system must be reliable AND valid. It can’t be one or the other.
How does test re-test reliability relate to the classification and diagnosis of Sz?
This means that with the same symspoms a person will get the same diagnosis.
How does inter-rater reliability relate to the classification and of Sz?
This is the agreement between clinicians over the same set of symptoms on diagnosis.
What is disorganised speech?
A positive symptom that causes incoherent speech.
Derailment is when the person keeps changing topic and this is a form of disorganised speech.
What is avolition?
The loss of motivation and ability to act. This will cause a person with Sz not care about their personal hygiene.
How does cultural differences affect reliability?
COPELAND (1971)
194 British psychiatrists diagnose Sz = 2%
134 US psychiatrists diagnose Sz = 69%
Shows that it can’t be used outside its culture and is limited.
How does individual differences affect the reliability of the classification and diagnosis of Sz?
Clinicians could have unconscious bias to men (bc they have a higher rate to Sz) or if a person is dressed badly. They could also have little time so they will not in-depth check their symptoms.
A patient’s clothes/ gender bias / culture bias.
How have there been improvements made to the reliability?
Standardised assessments (interview) cut the external factors that effect the diagnosis and classification of Sz.
Jakobson et al (2005) = ICD 10 and 100 Danish patients. Had a concordance rate of 98% in diagnosis.
Soderberg et al (2005) = concordance 81% using the DSM 4
How does validity relate to the diagnosis and classification of Sz?
This refers to the way Sz is measured and defined distinctly so psychiatrists can accurately diagnose Sz.
What is co- morbidity?
This is where 2 illnesses are diagnosed together. E.gE,depression and Sz.
Qs the validity bc it could be better to see it as 1 condition?
ETHICAL IMPLICATIONS = the treatment given depends on the diagnosis therefore they could get the wrong one.
BUCKEY ET AL (2009) = 50% depression, 47% substance abuse and 29% PTSD
What is symptom overlap?
2+ conditions have the same symptoms e.g Sz and BPD
Qs the validity bc we can’t differentiate what causes the symptoms. Under the ICD = Sz but under the DSM = BPD
APPLICATION = a person could get the wrong treatment
How does gender bias affect the validity of the diagnosis and classification of Sz?
This suggest that diagnosis is unobjectionable to women.
Reduces Validity bc view of normal bhvr is not reflective of both genders and distorted. This is an example of Beta bias (trying to suggest both men and women are the same)
BROVERMAN ET AL = DSM is androcentric and women may be seen as unwell because they don’t follow men.
LONGNECKER ET AL = Since the 1980s men have higher rates of diagnosis of Sz bc psychiatrists have a bias that women have good interpersonal function. This masks Sz and stops the correct diagnosis.
How does cultural bias affect the validity of the diagnosis and classification of Sz?
Reduces Validity = LIMITED APPLICATION bc can’t be used outside of cultural context.
African American + English people of Afro-Caribbean descent = more likely to be diagnosed Sz than whites people. Even though the rate of SZ is not high in Africa and the West Indies.
How does Cheniaux et al (2009) show a problem with the reliability and validity of the diagnosis and classification of Sz?
2 psychiatrists independently diagnosed schizophrenia. They both used ICD and DSM to diagnose.
Psych 1 = 26% (DSM) and 44% (ICD)
Psych 2 = 13% (DSM) and 24% (ICD)
VALIDITY PROB. = differences between criteria show there is a lack of agreement between what Sz.
RELIABILITY = lack of inter-rate reliability
What happened in the Rosenhan (1973): Sane in Insane Places study?
Investigated the diagnosis and treatment I; a mental hospital
8 pseudo patients = friends and students —> prepped for appointment by discarding their personal hygiene
Appointment = said they hear 3 words: “hollow, empty and thud.” (This is not a symptom of Sz).
Facility = acted sane but none of the staff knew. 2 months later = diagnosed and released with “Sz in remission.”
Follow up study = told the hospital they would be sending more fake patients —> hospital ‘found’ fakes.
How does Rosenhan’s study show there was a problem with reliability in the diagnosis and classification of Sz?
Shows there wasn’t a high inter-rate reliability between the clinicians. Which also Qs the validity because this suggests that clinicians don’t know what Sz is yet.
WEAKNESS = low temporal validity
POSITIVE = led to to the revision of the DSM bc more info was known
How did the BPS react to the classification and diagnosis of Sz in 2011?
To get higher valdity = FMS should look at the symptoms AND other factors e,g poverty/unemployment/ trauma —> to increase validity.
Paradigm shifts needs = ‘disease’ model becomes less dominant and other alternative diagnosis methods will develop.
Classification systems = should look @ individual’s experiences and problems = more idiographic.
How does Rosenhan (1973) study show a problem with validity of the diagnosis and classification of Sz?
Low inter-rather reliability = shows validity problems bc practitioners can’t agree what Sz is.
A valid concept is needed to defined and understood for it to be valid.
What neurotransmitter is associated with Sz?
Dopamine = please chemical messenger
What happened in Gottesman‘s (1991) study?
general pop. = 1%
My twins 48%
Wha5 happened in Tienari et al (200) Finland
164 adoptees = biological mum = Sz diagnosed.
@97 = control groups= mothers not diagnosed with Sz.
Experimental = 11 adoptees (6.7%) = Sz
Control = 4 adoptees (2%)
What happened in Ripke e5 al (2014)?
Compared 37,000 patients to 113,000 controls
Saw that Sz = aetiologically heterogenous = 108 different genetic variations caused Sz
Sz is polygenic
Genes linked with neurotransmitters e,g dopamine
What are the strengths of Genetic explanations?
Shows support for other factors = Tienari et al (2000 = control developed Sz (2%)
Something other than genes must have triggered this.
Research support: Ripke et al = genetic susceptibility and used a large sample.
What are the weaknesses of genetic explanations for Sz?
BIOLOGICAL REDUCTIONISM = Qs validity = Nature vs nurture debate.
Gottesman (1991) = family study doesn’t show a concordance of 100% in MZ twins therefore interactionist approach more suitable
What is the original dopamine hypothesis arguing?
HYPERdomainergia = high levels of dopamine
Areas in the brain = subcortex e.g Broca’s area
Function of that area = speech production
Symptoms = speech poverty/ auditions hallucinations.
What did the recent versions of the dopamine hypothesis now argue?
HYPOdopaminergia = low levels of dopamine
Goldman-Rakic et al (2004) = prefrontal cortex
Function = thinking and decision making
Symp = negative symp
What does the effect of having two version mean to the dopamine hypothesis?
Both could be correct because they are different areas in the brain
Reflects the complexity + variation between people.
What are the strengths of the dopamine hypothesis?
Curran et al = dopamine agonists e.g amphetamines worse Sz/ cause Sz-like symp
This shows drug research = important in Sz
Clozapine = effective at reducing Sz is bc it acts against dopamine = APPLICATION. = increases the quality of life.
What are the weaknesses of the dopamine hypothesis?
Biological reductionism = incomplete explanation
Moghaddam and Javitt (2012) = glutamate neurotransmitter has a large influence. Therefore a higher level of understanding if we look at other factors.
Link to Clozapine = also binds to serotonin receptors. Therefore bc it alters serotonin the dopamine hypothesis should explain how it works with serotonin but it doesn’t.
What are neural correlates?
Measure,emits of the structureor pfunction fit he Brian that correlates with a positive or negative symptoms
the neural correlates of negative symposium
Low activity in the Ventral Straitjm = avolition and loss of motivation
Juckel et al (2006) = people with Sz have lower levels of activity in this area. There is a neg. correlation between severity of symp and activity.
Lower levels of activity = stronger severity.
Explain the neural correlates for positive symptoms
Low actively = Superior temporal Gyrus and anterior cingulate Cyprus causes auditory hallucinations
Allen et al (2007)
Participants had to identify whether speech was there’s.
Low levels of activity in this area = experimental group made more mistakes.
What are the other areas linked with Sz?
Enlarged ventricle size = Paul, Swayze and Andreason (1999) = revised nearly 50 studies and saw enlarged ventricle size in Sz patients.
This affected the central brain + pre-frontal cortex = negative symptoms
What are the strengths of nerual correaltes?
Rest each support jacket et all (2006)
Methodology = Allen et al (2007 = used scanning of the brain
What are the weaknesses of neural correlate?
Correlation-causation = various research = Sz is caused in many ways = therefore hard to find a cause. Correlation problem = problem with VS cause neg. symp/ negative symp cause low activity in VS/ 3rd external party.
What are antipsychotics?
Drugs that reduce the severity of Sz symptoms by affecting D2 receptors in the brain.
What are typical antipsychotics?
Used since the 1950 = dopamine agonists. Some have effects on histamine receptors.
What are atypical antipsychotics?
Developed after typical antipsychotics and targets more than one neurotransmitter because it binds to more than one neurotransmitter.
State facts about chlorpromazine
Since 1950s used
Forms = tablets, syrup and injection
Taken daily up to 1000mg = gradually increase
Facts about clozapine
Atypical
Mixed history bc severe side effects
1980 = remarketed bc typical failed.
Only use with regular blood tests.
No injection and 300-450mg a day
Facts about Risperidone
Atypical
Since 1990s
Alert native to clozapine bc no severe side effects.
Form = syrup, tablet, injection = lasts only two weeks
Small dose = 12mg maximum very effective
What are the side effects of chlorpromazine
STE =Dizziness
LTE = tardive dyskinesia = supersensitivity to blinking e,g grimacing
Neural malignant syndrome = high temp, delirium and coma = fatal. Depends on dosage.
What are the side effects of clozapine?
Agranulocytosis =fatal blood condition
Side effects of Risperidone
Extrapyramidal side effects = movement such as tremors or slurred speech.
How does chlorpromazine treat Sz?
Reduces overactive dopamine systems = positive symptoms
Sedative effects = can calm patient
How does clozapine treat S?
Offered to treatment resistant patient only after trying other drugs (could weakness)
Helps regulate mood and symptoms affecting movement. Reduces depression and anxiety = cognitive function improves.
How does Risperidone treat Sz?
Effective in smaller doses. As effective as clozapine but without the serious side effects
What happened in thorny et al (2003)?
Review of era how
Comparison = controls had none = placebo effect
We trials = 1121 participants = drug reduced severity of symptoms and had better overall functioning.
Drug = relapse rate went down.
What happened in Meltzer (2012)?
Review of reasreach = concluded clozapine was:
More effective than other typical and atypical antipsychotics
Effective in 30-50% of treatment-resistant cases where typical was ineffective.
What are the strengths of drug therapy?
Meltzer (2012)
What are the weaknesses of drug therapy
Side effects
Methodological problems = HEALY (2012) data of successful trials are exaggerated and published multiple times. Sedative effects = positive effects
Controlling a person’s life = inappropriate
MORITZ ET AL (2013) = patients self-reported = drugs is emotionally dampening and doesn’t treat symp m
Chemical cosh = make life better for the staff
MONCRIEFF ET AL (2013) = human rights abuse.
What us schizophrenogenic mothers?
FROMM-REICHMAN (1948)
historical theory
Characteristic of mother ➡️ scary family climate ➡️ leads to distrust and symptoms e.g paranoid delusions ➡️ Sz causing.
What is double binds
Mixed messages can cause Sz.
rather doing the wrong thing and feel unable to comment about the situation or ask for clarification.
Child is punished by withdrawal of love.
Feel the world is confusing and dangerous = disorganised thinking and paranoid delusions.
What did Lidz (1978) say about double binds?
Double bind commutation between parents = Sz
Marital Schism = both parents are unyielding and want the attention of the child.
Marital Skew = one parent is dominant and the other is submissive.
Abnormal environment without parental cooperation = anxieties in children and Sz
What is expressed emotion?
Verbal criticism
Hostility to patient
Emotional over involvement
Three aspects = trigger genetic predisposition = most recent addition to theory.
What are the strengths of family dysfunction?
TIENARI ET AL (1994)= prospective study. Show adoptive family v rated disturbed = genetic vulnerability is triggered in children.
HOGARTY (1991) = therapy developed. Social conflicts decreased between parent and child. Relapse rates decreased.
What are the weaknesses of family dysfunction?
Socially sensitive
Supporting evidence = retrospective
What does NICE stand for?
National institute for health and care excellence
What does therapists do in family therapy?
Rapport with family
Reduce stress with caring for relative with Sz
Increase ability to prep/ solve problems
Reduce anger and guilt in family
Fam = balance with caring and living
Educating beliefs about Sz
What happened in Pharoah et al meta-analysis of 53 studies (2010)
2002-2010
Asia, Europe and north America
Mental state = mixed
Compliance with meds = increased
Social functioning = mixed ➡️ no concrete evidence e.g employment
Low relapse and readmission = during treatment and after 24 months
What happened in Gareth et all (2008)
A = patients with FT B = patients with no FT C = patients with no carers
AB = relapse rate was lower. A = 25% and B = 50%. Good care more important bc low expressed emotions found between AB = education
