Schizophrenia Flashcards
1
Q
State 4 positive symptoms of schizophrenia
A
- Hallucinations - cognitive - seeing, hearing or tactile feelings
- Delusions - paranoia/grandeur - emotional, cognitive - false cognitions
- Disordered speech - behavioural - word salad
- Disorganised/catatonic behaviour - behavioural - muscular movements
2
Q
Define - Delusional grandeur
A
Feeling overconfident
eg. faster/stronger or above the law
Cognitive
3
Q
Define - Delusional paranoid
A
Believing people are out to get you
emotional
4
Q
Define - disordered speech
A
Believe saying something reasonable but in reality something very different
Can offend/appear drunk or high.
“word salad”
Behavioural
5
Q
Define - positive symptoms
A
Additional behaviours that ‘normal’ people do not have.
6
Q
Define - negative symptoms
A
deficit behaviour that should be able to happen in ‘normal’ people
7
Q
State 4 negative symptoms of schizophrenia
A
- Avolition - no motivation - cognitive - know what wants to do but can’t
- Speech poverty - Alogia - not being able to speak - behavioural
- Affective flattening - emotional - have no expressed emotions including body language
- Anhedonia - emotional - loss of interest/pleasure they normally enjoy
8
Q
What did Serker et al find?
A
The majority of people misdiagnosed with SZ had to depression.
The only reliable symptom is physical anhedonia
9
Q
What does the DSM-V say a person must have in order to diagnose a patient with SZ?
A
- 2 or more symptoms
- Symptoms should persist constantly over a month or for a months person over 6 months.
- There must be no other extraneous symptoms
10
Q
What is a list of criticisms of the DSM-V?
A
- Symptom overlap - anhedonia also in BP, SZ, MDD
- Gender bias - men used (determinist + reductionist)
- cultural differences - some cultures believe in spirits (for example psychosis epidemic after WW2)
- comorbidity - multiple disorders to discover causes of illness.
11
Q
Explain Rosenham’s first case study
A
Being sane in an insane place
- covert participant study of 4 states
- the sample reported ‘dull thuds’ which isn’t actually a symptom on DSM
- All of the samples were diagnoses with SZ and hospitalised
- They were given meds and treatment and were unable to leave
- The inter-rater reliability was very low
- This shouldn’t happen as symptoms must persist and their should be worse symptoms that impact lives
12
Q
Explain Rosenham’s second case study
A
Being sane in an insane place
- Rosenheim said they would send some people into the hospital however sent no one
- 21% of patients were labelled as pseudopatients and were released
- Even though they should have been admitted
This enforced the idea that the inter-rater reliability was really low.
13
Q
What two gene have been shown to cause SZ?
A
- Dopamine receptor gene (D2, DRD2)
- Glutamate receptor gene (AMPA)
14
Q
Explain how the dopamine receptor gene causes SZ
A
- affects no. of dopamine receptor sites
- This transports proteins for dopamine
- excitatory neurotransmitters
15
Q
Explain how the glutamate receptor gene can cause SZ
A
- Affects no. of glutamate receptor sites this is especially important in the basal ganglia
- excitatory neurotransmitter
16
Q
State the three variations of studies that show the genetic causes of SZ
A
- Families (Gottesman)
- Twins (Joesph)
- Adoption (Tienarl et al)
17
Q
Explain Gottesman case study
A
- Doesn’t separate genes and the environment
- they study the concordance rate in children with SZ parents or siblings
- 2x SZ parents - 46%
- 1x SZ parents - 13%
- 1x SZ sibling - 9%
Not 100% genetic - diathesis-stress model
18
Q
Explain Joseph’s case study
A
- Meta-analysis - between MZ and DZ twins
- They have the same environment only difference is the genetics
- Concordance rates:
- MZ (identical) - 40.4%
- DZ (non-identical) - 7.4%
- More recently use ‘blind’ researchers - lower rates but still a large difference
19
Q
Explain Tienarl et al.’s case study
A
- Removed environment (Adoption)
- Large sample
- Compare siblings raised together vs. apart
- 6.7% develop SZ if adoptees have an SZ mother
- 2% adoptees control group develop SZ
- Conclude - Genetic feasibility is decisively confirmed.
20
Q
What is the Dopamine hypothesis?
A
- Dopamine made in VTA - the mesolimbic pathway and ACG
- SZ is caused by an imbalance of dopamine
- Too many D2 receptors
- This means the person is very sensitive as impulse fires too often producing too much dopamine
- People live in constant hyperdopaminergic
21
Q
What is the effect of hyperdopaminergic?
A
- Sub cortex
- positive symptoms
- ACG does not stop and too much dopamine is taken up and used in this area.
- Eg. Brocas area means too much speech.
22
Q
What is the effect of hypodopaminergic?
A
- (Pre-frontal) Cortex
- negative symptoms
- Failed PFC, DLPFC and DFC
- under motivated so avolition and catatonia.
23
Q
Explain research into drug therapy that explains the dopamine hypothesis
A
- Amphetomine and L-Dopa increase dopaminergic activity
- Parkinson patients given L-Dopa experience hallucinations as too much dopamine - found positive symptoms caused by high dopamine levels.
- Chlorpromazine - reduce dopamine levels
- Clozapine - decrease dopamine and increase serotonin.
24
Q
Explain Davis and Khon’s research
A
- First to link dopamine to SZ
- Too much dopamine in the mesolimbic pathway - positive symptoms
- Too little dopamine in prefrontal cortex - negative symptoms
- First to use dissection
- explains all symptoms.
25
Where does the mesolimbic pathway go?
Travels through areas responsible for **negative emotions.**
26
Explain the stages of the genetic explanation for SZ
* **Stimulus**/ info from environment
* **Overactive emotion and memory** areas **receive the dopamine**
* There is **no dopamine left so ACG (filter) is under active**
* **Results in underactive perception and action.**
27
Give an example of a typical antipsychotic drug
**Chlorpromazine**
* For positive symptoms eg. hallucinations and delusions.
28
Give an example of an **atypical** antipsychotic drug
Clozapine
* Stopping positive and negative symptoms
29
Why can't atypical drug therapies be used for all SZ sufferers?
* Cause **agranulocytosis** - lowering white blood cell count and thinning the blood
* Meaning can't be used on young, old and anyone undergoing chemotherapy.
30
What do typical drugs do?
* **dopamine antagonists**
* **bind to D2 receptor** so it isn't stimulated
* Making receptor busy
* However - **Kapur et al** showed 60-75% of mesolimbic receptors much be blocked in order to actually have desired effect.
31
What are some side effects of typical drugs?
* Lethergy
* Insomnia
* Anhedonia
* Loss of sex drive
* Avolition
* weight gain
* Anxiety
* Tardive dyskinesia - muscle spasms
32
What do atypical drugs do?
* **Bind to D2 receptors** for positive symptoms
* **Rapidly dissociation** controlling episodes but don't have to be taken in the long term
* **Act on serotonin** - reduce negative symptoms
* **Also reduces depression and anxiety** - 30-50% SZ patients attempt suicide
33
What are some symptoms of atypical drugs?
* Less side effects as only used during episodes
* Agranulocytosis
* Allergic reactions
* Bleeding
* Constipation
34
What are two psychological explanations for dysfunctional families?
* Double Bind
* Expressed emotion
35
Explain the double bind dysfunctional family
* **Batesan et al.** - Study the effect of **contradictory messages** for children increasing chance of SZ.
* Confusing pain for nice people
* Parenting type = **Schizophrenogenic mother (**Fromm-Reichmann)
* Role models form **dysfunctional internal working models** which **reinforce** SZ actions.
* Leads to flattening affect, withdrawal and auditory hallucinations.
36
Explain the expressed emotion dysfunctional family
* **Kulpers et al. - overly emotional triggers SZ** - strong correlation to relapse rates
* **Noll -** interpreted findings - **negative emotions trigger SZ** episodes where **protective environments may be protective** - **diathesis-stress model** can be used instead of drugs.
37
What experiment did Frith et al. conduct?
* **Congnitive deficits underlying causes of symptoms**
* Meta-representation
* Not reflect own thoughts and behaviours
* **central control** - **inability to suppress automatic** behaviours when focused on other tasks
* Seen between Stage 2+3 of Becks triad when testing reality
* mesolimbic pathway.
38
What three stages did Beck and Rector apply to the symptoms of SZ?
* **Stage 1 - Cognitive processing biases** - hyperdopaminergic in and around MLP (low activity as study show larger vesicles as surrounding cells are dead)
* **Stage 2 - Misattribution of consequences to causes** - hyperdopaminergic in ACG and PFC
* SZ symptoms generated between 2 and 3.
* **Stage 3 - Failure to test reality with memory/logic.** - DLPFC - hippocampus links atrophy or dysfunction
39
What reason did Beck and Rector give for delusions?
* Inadequate info processing
* egocentric bias
* **failure to contextualise events**
* leads to reality testing
40
What reason did Beck and Rector give for hallucinations?
* **hypervigilance**
* the higher expectancy of voices
* **patients can't distinguish between sensory information and internal images.**
41
Give two studies that helped enforce Beck and Rectors idea for the causes of hallucinations
* **Aleman** - Misattribute source of internal images to external sources
* **Baker and Morrison** - Don't see disconfirming evidence as don't reality check.
42
What do Beck and Rector mean by reality testing?
* **Idea SZ can't test pain**
* Eg. tripped and hurt food a normal person would check the floor was uneven however a SZ patient may see that someone tripped them over became they want them to die.
* **Fail to contextualise.**
43
What is the aim of CBTp?
* To identify thoughts and challenge them
* Reality testing to reduce distress
44
How many sessions of CBTp do NICE suggest?
16
Normally need 5-20 sessions.
45
Using the ABCDE model explain the psychological treatment of CBT
**A** - Activiting events
**B** - resulting beliefs
**C** - emotional and behaviour consequences
**D** - rationalised can be disputed
**E** - Change through critical collaborative analysis - effect
46
What is critical collaborative analysis?
During CBTp
* Questions to help understand and challenge the illogical deductions and conclusions.
47
How does CBTp use the normalisation to help treat SZ?
* Show that other people share SZ beliefs and ideas
* This reduces anxiety and the sense of isolation
* Making patients feel less alienated and stigmatised
48
How does CBTp use behavioural assignments to treat SZ?
* Help **improve the general level of functioning**
* May be to show everyday.
* Small tasks.
49
What is an alternative treatment from CBTp?
* **Coping strategies.**
* using **mindfulness exercises**
* Eg. meditation and body scanning to identify where the physical sensations originate.
* This links feeling to symptoms
50
Give a case study example of the application of CBTp
* **william Bradshaw**
* Long-term outpatient
* Showed major improvements after treatment
* results in less time in hospital in the future.
51
Give two studies supporting the effectiveness of CBTp
* **Rolsman** - researched stress, coping and individual response to disorder influences the severity of the disability.
* **Chadwick and Lowe -** CBT reduced delusions in 10/12 patients - other 30% normally get worse.
52
What two studies lead to the psychological treatment of Family Therapy?
* Studies on dysfunctional families:
* **Baterson et al.** - Double bind
* **Kulper et al.** - Expressed Emotion
53
What did Garety et al. suggest about family therapy?
* **Reduce relapse rate by 50%**
* NICE recommends for all SZ families
* For at least 10 sessions over 3-12 months.
54
Explain family therapy for SZ
* Range of interventions with patient and fam
* to **improve the quality of communication and interaction** between fam members
* **reducing stress to improving the environment**
* reduce **rehospitalisation rates and improving quality of life**
* In conjunction with drug therapy and outpatient clinical care
* **Educate family and teach coping mechanisms** to spot and support symptoms.
55
What strategies did Pharoah et al. suggest to improve the effectiveness of family therapy?
* **Understanding and learning** to better deal with
* Form **therapeutic alliance** - family members can act as a therapist
* **Reducing stress and emotional climate**
* family can anticipate and solve problems and triggers.
56
What did Pharoah et al investigate?
* Reducing stress and expressed emotion to reduce relapse rate and hospital readmissions.
57
What procedure did Phoroah et al. use ?
* Review **53 studies** investigating the effectiveness if family therapy
* Studies **different cultures**
* **compare outcomes of fam therapy and standard therapy**
* **Randomise controlled trials** - very internally valid
58
What did Pharoah et al.'s key study find?
* **Quality of life not improved**
* Mental state
* social functioning
* **Operational outcomes improved**
* Compliance with medication
* reduction of relapse and readmissions.
59
What was the key study by Ayllon and Azrin?
* Based on behaviourist and learning theory for many psychological conditions
* **Patients learn through associated positive behaviours with +tive outcomes**
* This leads to behaviourist changes
60
Define - Token Economy
* System where **tokens are earned** for **appropriate behaviours** and **exchanged later** for reinforcers
* **Primary reinforcer** = what exchanged for eg. food, TV time
* **Secondary reinforcer** = token
61
When are token economies used most effectively?
* **long stay hospitals** as they are easier to manage
* **Selective reinforcement** used to encourage desired behaviours
* Tokens are given **immediately** as a secondary reinforcer.
62
What is the process of a token economy?
1. Agree on value of token
2. **Neutral stimulus** paired with reinforcing stimulus
3. **Conditioned stimuli** - token is given for a target behaviours
63
What were some research support for the use of a token economy for treating SZ?
* **Sran and Borrero** - More variety of rewards available = better reinforcement
* **Kazdin** - quicker exchange of tokens = more effective treatment
64
What is the interactional approach to SZ?
* **Diathesis stress model**
* chronic stress + genetics = SZ
* Additive effect of both.
* One can't happen without the other.
65
What was the aim of the key study by Tienari et al for the diathesis-stress model?
* See if genetic factors moderate susceptibility to environmental risks associated with adoptive family functioning.
66
What was the procedure of the key study by Tienari et al for the diathesis-stress model?
* Check **hospital records** for mother who gave kids to adoption and had a **psychotic episode**
* 145 high risk adoptees + 158 control adoptees - r**emove environment**
* Assessed over 12 years and follow up at 21 years - a **longitudinal study**
* **Family functioning was assessed**
* **Researchers blind** about the status of biological mother.
67
What were the results of the key study by Tienari et al for the diathesis-stress model?
* 14 developed SZ
* **11/14 from the high-risk group**
* Conclude = healthy adoptive family environment reduces change of SZ
68
What evidence can be used for the diathesis section of the diathesis-stress model?
* **Tienari et al.** - Genetics increase chance of SZ - not all with genes have symptoms
69
What evidence can be used for the stress section of the diathesis-stress model?
* **Varese et al.** - Severe trauma under the age of 16 = 4 times more likely to develop SZ
* **Noll** - environment can be harmful or protective
70
Evaluate the classification of SZ
* **P - Misdiagnosis**
* E - Co-morbidity - 30-50% of patients also have depression with suicidal thoughts.
* E - symptoms overlap - eg. bipolar disorder/depression. - anhedonia BD
* L - Lacks external validity - unethical - give incorrect treatment. - protection from harm
* **P - Gender Bias**
* E - men used in studies for DSM.
* E - women are often seen as hysterical so not treated for SZ.
* L - Lack of pop validity - deterministic and reductionist - lack ecological as less relevant for females.
* **P - Cultural differences**
* E - some collectivist cultures believe in spirits. So normalising psychosis.
* E - real-world application - psychosis epidemic after WW2 as many came to Britain for jobs and diagnoses for SZ.
* L - Cultural bias - lack pop validity
71
Evaluate the reliability and validity of diagnosis
* **P - Lack of inter-rater reliability**
* E - Rosenham’s 2nd condition - 21% patients labelled pseudopatients and released
* E - whalley - later research - 0.11 inter rater reliability
* L - not internally valid - research supports this lack of reliability - not repeatable.
* **P - Scientific method**
* E - Development of program - DSM-11 - now the DSM - 5
* E - could no longer happen as symptoms must persist and impact life.
* L - improve reliability - improve internal validity - keep contextually valid as you adapt to new discoveries. - reviewed
* **P - Lack of population validity**
* E - based on a case study - Rosenhan
* E - Improve using meta-analysis to reinforce findings. - so idiographic data - also improve culture reductionism
* L - Reduced reliability - lack external validity.
72
Evaluate the biological explanations for SZ
* **P - Economic applications**
* E - antipsychotic drugs - L-dopa - for parkinsons - contain dopamine and cause hallucinations - +tive symptoms.
* E - chlorpromazine - reduces dopamine levels.
* L - eco validity - NHS - drug therapy
* **P - Research support**
* E - Davis and Khin - link to dopamine - +tive symptoms too much in mesolimbic pathway.
* E - -tive symptoms - too little in the prefrontal cortex. - explains all symptoms
* L - generalise - reliable - dissections - pop validity.
* **P - Biologically reductionist**
* E - research suggests diathesis stress model - partly bio but impacted by environment.
* E - control group still 2% and only half people will both SZ parents have
* L - lack pop validity - lack generalisability
73
Evaluate the psychological explanations of dysfunctional families
* **P - correlation not causation**
* E - correlation between orphans/abused children and amount of SZ
* E - Batesan et al. - contradictory messages for children becoming SZ
* L - env reductionist - also bio - orphan study - increase chance if parents. - lack reliability
* **P - Treatment applications**
* E - family interventions reduce relapse rates - family therapy - identify issue areas
* E - don’t have all side effects of drug therapies - long term solution.
* L - cost-benefit analysis - long term improve - if not success then more problems
* **P - concurrent validity**
* E - built on theories of Bowlby and Skinner
* E - also freudian theory - often having beta bias - men only tested on
* L - not always internally valid - face validity but not accurate
74
Evaluate the psychological explanations of the cognitive approach
* **P - Biologically reinforced**
* E - meso-cortical pathway linked with frith et al.
* E - combination of enviro and bio factors
* L - reductionsist to look at one. - diathesis stress model
* **P - Related to symptoms - applications**
* E - delusions and hallucination symptoms
* E - pop validity - reliable
* L - does not treat SZ - no eco validity
* **P - Research support - link to bio explanation**
* E - stages align between cognitive + biological - hyperdopaminergia - stage 1 - hyperdopaminergia - stage 2
* E - over time periods stayed consistent. - low activity in the mesolimbic pathway - larger vesicles - surrounding cells dead - so can’t reality test.
* L - temporal and concurrent validity - also internally valid
75
Evaluate antipsychotic drug therapy
* **P - Side Effects**
* E - Typical - dizziness, agitation, sleepiness and weight gain. Atypical - agranulocytosis
* E - Long term use results in tardive dyskinesia - also neuroleptic malignant syndrome - can be fatal
* L - Can not be used by all patients - not effective - lack ecological validity - lack pop validity.
* **P - Research support**
* E - Leucht et al. - meta-analysis - some placebo - ⅓ more with antipsychotics.
* E - However, much cheaper than CBT. - short term impact.
* L - lack external validity - placebo effect very good - do improve - ecological validity.
* **P - Unethical**
* E - side effects, deaths and psychosocial consequences. Real world application - USA settlement to tardive dyskinesia sufferers - human rights act
* E - make patients calmer and easier to deal with.
* L - cost-benefit. - can not give fully informed consent - protection from harm
76
Evaluate CBTp
* **P - Lack ecological validity**
* E - very time consuming and training needed. - Expensive - strain NHS
* E - case study show improvements - 70% success - not reliable
* L - cost-benefit - 30% get worse
* **P - drug treatment more effective**
* E - patients must be very compliant - some SZ patients don’t believe they are ill
* E - not a cure - drugs needed anyway - antipsychotics
* L - side effects - short term better but coping mechanisms improve
* **P - research support**
* E - eco validity using case study to show less time in hospitals
* E - some say no better than simple counciling
* L - not reliable as case study - concurrent validity - across many studies - current treatment method
77
Evaluate family therapy
* **P - Not generalised to all.**
* E - Allows applications of studies however the environment must be perfect to be beneficial.
* E - 50% improvement - only compliant families
* L - cost-benefit - not pop valid - not externally valid - assume all families are same
* **P - Ecological validity**
* E - Not a short term cure - in conjunction to drug therapy
* E - However no specific training needed so less expensive than CBT - more a long term solution
* L - cost-benefit analysis - side effects of drugs - long term eco validity - NHS less relapse and admissions
* **P - Scientific - Research support strong internal validity**
* E - meta analysis - culturally valid - randomised controlled trials - however only compared to drug therapy not CBT
* E - however jeopardizing quality of life for financial benefits - improve operational making cheaper
* L - NHS - eco validity - applications to treatment - not fully beneficially - NICE recommends so showing focus on money not life improvements.
78
Evaluate a Token Economy
* **P - Not specific for SZ**
* E - Ayllon & Azrin made generalisable to many psy conditions. - forensics, autism & drug addiction
* E - whereas CBTp specific for SZ - better for others
* L - generalised - not realistic - not specific - lack internal validity - no research support
* **P - Overly controlled environment**
* E - not realistic or application to stimulation of life - must give immediately - Kardin - speed imperative
* E - Drugs and CBT better - all research show. - used for cultures who can’t afford/access these.
* L - lack internal and external validity - problem for outpatients - no immediate - only if family can give - only specific families - may be cheaper (eco validity) - stress on fam
* **P - Research support**
* E - Dickerson et al - meta analysis - however survey on therapists - so lack internal validity - demand characteristics - sample bias
* E - Sran & Borrero - more value over time gives incentive to long term changes - however this is too complex for children
* L - strong internal in lab/controlled environment (hospital) - but not generalised to other environments.
79
Evaluate the diathesis-stress model for SZ
* **P - Research support**
* E - Tienari et al - increased genetic chance - 11/14 from high-risk - also study - 13% children of SZ + 48% identical twins
* E - varese et al - severe trauma \< 16 = 4 times more likely to develop SZ - Noll - Environment can be harmful or protective
* L - reliable - eco validity - understanding causes
* **P - Interaction nature and nurture**
* E - not bio or psy reductionist - as combine both
* E - elements show correlations no causality found - damage internal validity
* L - reliable all finding same - strong external validity
* **P - Research very strong construct validity**
* E - Naturally occuring IV - increase internal validity
* E - long-term assessment - not correlation or erroneous from one test - temporal validity
* L - longitudinal study and no researcher bias increase reliability and natural field study.
80
What are the key terms associated with CBTp?
* **Assessment** - discuss current symptoms and origins
* **Engagement** - emphasis on distress
* **ABC model** - challenge persona beliefs
* **Normalization** - Bring experiences on a continuum with normal - show not alienated experience
* **Critical Collaborative analysis** - Empathetic and non-judgemental questioning
* **Developing alternative explanations** - enabling healthier explanations
