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Schizophrenia Flashcards

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1
Q

State 4 positive symptoms of schizophrenia

A
  1. Hallucinations - cognitive - seeing, hearing or tactile feelings
  2. Delusions - paranoia/grandeur - emotional, cognitive - false cognitions
  3. Disordered speech - behavioural - word salad
  4. Disorganised/catatonic behaviour - behavioural - muscular movements
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2
Q

Define - Delusional grandeur

A

Feeling overconfident

eg. faster/stronger or above the law

Cognitive

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3
Q

Define - Delusional paranoid

A

Believing people are out to get you

emotional

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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

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5
Q

Define - positive symptoms

A

Additional behaviours that ‘normal’ people do not have.

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6
Q

Define - negative symptoms

A

deficit behaviour that should be able to happen in ‘normal’ people

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7
Q

State 4 negative symptoms of schizophrenia

A
  1. Avolition - no motivation - cognitive - know what wants to do but can’t
  2. Speech poverty - Alogia - not being able to speak - behavioural
  3. Affective flattening - emotional - have no expressed emotions including body language
  4. Anhedonia - emotional - loss of interest/pleasure they normally enjoy
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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

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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
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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.
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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
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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.

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13
Q

What two gene have been shown to cause SZ?

A
  1. Dopamine receptor gene (D2, DRD2)
  2. Glutamate receptor gene (AMPA)
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14
Q

Explain how the dopamine receptor gene causes SZ

A
  • affects no. of dopamine receptor sites
  • This transports proteins for dopamine
  • excitatory neurotransmitters
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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
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16
Q

State the three variations of studies that show the genetic causes of SZ

A
  1. Families (Gottesman)
  2. Twins (Joesph)
  3. Adoption (Tienarl et al)
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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

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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
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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.
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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
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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.
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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.
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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.
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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.
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25
Q

Where does the mesolimbic pathway go?

A

Travels through areas responsible for negative emotions.

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26
Q

Explain the stages of the genetic explanation for SZ

A
  • 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.
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27
Q

Give an example of a typical antipsychotic drug

A

Chlorpromazine

  • For positive symptoms eg. hallucinations and delusions.
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28
Q

Give an example of an atypical antipsychotic drug

A

Clozapine

  • Stopping positive and negative symptoms
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29
Q

Why can’t atypical drug therapies be used for all SZ sufferers?

A
  • Cause agranulocytosis - lowering white blood cell count and thinning the blood
  • Meaning can’t be used on young, old and anyone undergoing chemotherapy.
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30
Q

What do typical drugs do?

A
  • 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.
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31
Q

What are some side effects of typical drugs?

A
  • Lethergy
  • Insomnia
  • Anhedonia
  • Loss of sex drive
  • Avolition
  • weight gain
  • Anxiety
  • Tardive dyskinesia - muscle spasms
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32
Q

What do atypical drugs do?

A
  • 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
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33
Q

What are some symptoms of atypical drugs?

A
  • Less side effects as only used during episodes
  • Agranulocytosis
  • Allergic reactions
  • Bleeding
  • Constipation
34
Q

What are two psychological explanations for dysfunctional families?

A
  • Double Bind
  • Expressed emotion
35
Q

Explain the double bind dysfunctional family

A
  • 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
Q

Explain the expressed emotion dysfunctional family

A
  • 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
Q

What experiment did Frith et al. conduct?

A
  • 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
Q

What three stages did Beck and Rector apply to the symptoms of SZ?

A
  • 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
Q

What reason did Beck and Rector give for delusions?

A
  • Inadequate info processing
  • egocentric bias
  • failure to contextualise events
  • leads to reality testing
40
Q

What reason did Beck and Rector give for hallucinations?

A
  • hypervigilance
  • the higher expectancy of voices
  • patients can’t distinguish between sensory information and internal images.
41
Q

Give two studies that helped enforce Beck and Rectors idea for the causes of hallucinations

A
  • Aleman - Misattribute source of internal images to external sources
  • Baker and Morrison - Don’t see disconfirming evidence as don’t reality check.
42
Q

What do Beck and Rector mean by reality testing?

A
  • 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
Q

What is the aim of CBTp?

A
  • To identify thoughts and challenge them
  • Reality testing to reduce distress
44
Q

How many sessions of CBTp do NICE suggest?

A

16

Normally need 5-20 sessions.

45
Q

Using the ABCDE model explain the psychological treatment of CBT

A

A - Activiting events

B - resulting beliefs

C - emotional and behaviour consequences

D - rationalised can be disputed

E - Change through critical collaborative analysis - effect

46
Q

What is critical collaborative analysis?

A

During CBTp

  • Questions to help understand and challenge the illogical deductions and conclusions.
47
Q

How does CBTp use the normalisation to help treat SZ?

A
  • 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
Q

How does CBTp use behavioural assignments to treat SZ?

A
  • Help improve the general level of functioning
  • May be to show everyday.
  • Small tasks.
49
Q

What is an alternative treatment from CBTp?

A
  • Coping strategies.
  • using mindfulness exercises
  • Eg. meditation and body scanning to identify where the physical sensations originate.
  • This links feeling to symptoms
50
Q

Give a case study example of the application of CBTp

A
  • william Bradshaw
  • Long-term outpatient
  • Showed major improvements after treatment
  • results in less time in hospital in the future.
51
Q

Give two studies supporting the effectiveness of CBTp

A
  • 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
Q

What two studies lead to the psychological treatment of Family Therapy?

A
  • Studies on dysfunctional families:
  • Baterson et al. - Double bind
  • Kulper et al. - Expressed Emotion
53
Q

What did Garety et al. suggest about family therapy?

A
  • Reduce relapse rate by 50%
  • NICE recommends for all SZ families
  • For at least 10 sessions over 3-12 months.
54
Q

Explain family therapy for SZ

A
  • 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
Q

What strategies did Pharoah et al. suggest to improve the effectiveness of family therapy?

A
  • 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
Q

What did Pharoah et al investigate?

A
  • Reducing stress and expressed emotion to reduce relapse rate and hospital readmissions.
57
Q

What procedure did Phoroah et al. use ?

A
  • 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
Q

What did Pharoah et al.’s key study find?

A
  • Quality of life not improved
    • Mental state
    • social functioning
  • Operational outcomes improved
    • Compliance with medication
    • reduction of relapse and readmissions.
59
Q

What was the key study by Ayllon and Azrin?

A
  • 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
Q

Define - Token Economy

A
  • 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
Q

When are token economies used most effectively?

A
  • 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
Q

What is the process of a token economy?

A
  1. Agree on value of token
  2. Neutral stimulus paired with reinforcing stimulus
  3. Conditioned stimuli - token is given for a target behaviours
63
Q

What were some research support for the use of a token economy for treating SZ?

A
  • Sran and Borrero - More variety of rewards available = better reinforcement
  • Kazdin - quicker exchange of tokens = more effective treatment
64
Q

What is the interactional approach to SZ?

A
  • Diathesis stress model
  • chronic stress + genetics = SZ
  • Additive effect of both.
  • One can’t happen without the other.
65
Q

What was the aim of the key study by Tienari et al for the diathesis-stress model?

A
  • See if genetic factors moderate susceptibility to environmental risks associated with adoptive family functioning.
66
Q

What was the procedure of the key study by Tienari et al for the diathesis-stress model?

A
  • Check hospital records for mother who gave kids to adoption and had a psychotic episode
  • 145 high risk adoptees + 158 control adoptees - remove 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
Q

What were the results of the key study by Tienari et al for the diathesis-stress model?

A
  • 14 developed SZ
  • 11/14 from the high-risk group
  • Conclude = healthy adoptive family environment reduces change of SZ
68
Q

What evidence can be used for the diathesis section of the diathesis-stress model?

A
  • Tienari et al. - Genetics increase chance of SZ - not all with genes have symptoms
69
Q

What evidence can be used for the stress section of the diathesis-stress model?

A
  • 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
Q

Evaluate the classification of SZ

A
  • 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
Q

Evaluate the reliability and validity of diagnosis

A
  • 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
Q

Evaluate the biological explanations for SZ

A
  • 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
Q

Evaluate the psychological explanations of dysfunctional families

A
  • 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
Q

Evaluate the psychological explanations of the cognitive approach

A
  • 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
Q

Evaluate antipsychotic drug therapy

A
  • 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
Q

Evaluate CBTp

A
  • 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
Q

Evaluate family therapy

A
  • 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
Q

Evaluate a Token Economy

A
  • 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
Q

Evaluate the diathesis-stress model for SZ

A
  • 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
Q

What are the key terms associated with CBTp?

A
  • 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

A level Psychology (5 decks)

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