schizophrenia Flashcards
DSM-V
used in the USA and contains only psychological diagnostic criteria and may be influenced by pharmaceutical companies
ICD-10
was created by WHO and used in Europe and covers medial and psychological criteria
construct reliability
how well something tests or measures the phenomenon it intends to measure
comorbidity
2 or more disorders occur together
criterion validity
how well does a new test or measure correlate with existing ones
this is subdivided into predictive, concurrent and retrospective validity (past,present,future)
schizophrenia
- 24-55 million people worldwide
- has positive and negative symptoms
- 2 or more symptoms must be present for more than 1 month
- it must reduce social functioning
positive symptoms definition
things that are absent in neurotypical people and are only considered by the DSM-V
negative symptoms definition
things that people experience that are absent in schizophrenia and are only considered by the ICD-10
positive symptoms
- hallucinations
- delusions
- psychomotor disturbances
hallucinations
auditory or visual perceptions that aren’t real, typically characterised by hearing voices that give instructions
delusions
false beliefs that are generally either paranoia or delusions of being an important or god-like figure
psychomotor disturbances
twitches, rocking motions, repetitive behaviours as well as catatonia - staying in the same position for ages
negative symptoms
- thought disorders
- broadcasting
- alogia
- avolition
thought disorders
a person makes illogical jumps in reasoning or a topic that doesn’t have a clear line or thinking
broadcasting
a person believes their thoughts are audible to others through radio or over tv
alogia
speech poverty, where correct words are used, but with little meaning
avolition
a lack of desire and total apathy
Scheff (1966)
even suggest that the diagnosis may lead to a self-fulling prophecy due to labelling
Slater and Roth (1969)
suggest that hallucinations are the least important symptom as they are present in many other disorders
Luhrmann and Marrow (2016)
have demonstrated that experience of hallucinations is culturally relative, with those in India and Africa much more likely to hear familiar voices than those in the USA
Gottesman (1991)
MZ twins have a concordance rate of 48% vs 27% of DZ twins
Benzel et al (2007)
candidate genes DRD4, ATK1 and COMT have been linked to a dopamine excess in specific D2 receptors, which lead to positive symptoms
Kendler (1985)
direct relatives are 18 times more likely to develop schizophrenia
polygenic
a disorder caused by lots of genes
Ellman (2010)
immune responses to flu during pregnancy makes the foetus 1.5 to 7 times more likely to develop schizophrenia
evaluation of biological approach
- hard to separate nature and nurture
- twins aren’t representative
- family upbringings are different
- criterion validity
dopamine
is en excitatory neuron that encourages neurons to fire and transmit messages and high release of this leads to hallucinations
Falkai (1988)
higher dopamine is in the left amygdalae (the break peddle)
Owens (1978)
higher dopamine in the caudate nucleus and putamen
the first dopamine hypothesis
existing dopamine receptors are simply doing too much
the second dopamine hypothesis
there are too many receptors that fire at a regular rate
Noll (2009)
about 1/3 of patients didn’t respond to dopamine-blocking medication
neural correlates
patterns of activity or structural trends that occur in conjuction with schizophrenia
Torrey (2002)
found that the ventricles, which are fluid filled cavities that supply nutrients and remove waste, were 15% larger in someone with schizophrenia
Suddath et al (1990)
MRI research of MZ twins found that 12/15 twins could be identified as schizophrenic based on enlarged ventricles
Laing
rejects the idea that schizophrenia is medical and is a response to social pressures, interactions and family dynamics
Bateson (1956)
children who receive contradictory messages from their parents more frequently are more likely to develop schizophrenia
e.g. parents who are critical but appear friendly
family affects
- prolonged exposure to contradictory environments prevents children from being able to create an accurate reality
- over time this manifests as a flattening effect, delusions, hallucinations and incoherent speech
Brown (1958)
patients returning to families with high negative emotional climate have higher rates of relapse
narcissist
consider themselves a victim/hero and the attention must be them, expects for normal parental duties
enabler
considered the good parent and very co-dependent so remains loyal and will downplay their partners behaviour
scapegoat
acts out and verbalises problems that the family tries to cover up, so the narcissist projects their rage onto this child
golden child
narcissist projects their best qualities onto this child and they receive whatever they want
Mischeler and Waxler (1968)
found significant differences in the way mothers spoken to their schizophrenic daughters compared to their other daughters, which suggests dysfunctional communication may be a result of it, not a cause
cognitive models
focus on information processing deficits and biases in perception, attention and memory
information processing deficits
- difficulty processing visual and auditory information
- difficulty in understanding others’ behaviours
- emotional expression, language and perception of reality
Yellowless (2002)
developed a machine that produces hallucinations to demonstrate to patients that they are not real
history of treatments
1930’s - insulin shock therapies forced convulsions and put people into comas
after 1930’s - lobotomys were used for every mental illnesss
thorazine
- the most famous and typical antipsychotic
- came around in the 1950’s
- dampen positive symptoms by blocking all dopamine receptors
side effects of thorazine
- 5 times more likely to gain weight
- 2 times more likely to get Parkinsons
- 3 times more likely to have decreased blood pressure
atypical antipsychotics
- developed in the 1990’s
- risperidone is an example
- these bind to dopamine, serotonin and glutamate receptors
- help with negative symptoms
Crossley (2010)
atypical antipsychotics aren’t more effective but do have less side effects
Le Blanc (2005)
effective in treating aggression and conduct disorders in young boys
aims of family therapy
- improves communication and reduces negative expressed emotions
- educate the family
- share effective management strategies
steps of family therapy
- preliminary analysis - family are observed and weaknesses are found
- information transfer - education about the disorder and risk factors
- communication skills training - teaching parents to listen and communicate properly
Anderson et al
- 40% relapse rate with just drugs
- 20% with just family therapy
- less than 5% with both
Pharoah et al
meta-analysis found that family interventions helped the patient understand and deal with their illness better, which reduced relapse rates
token economy
is a form of managing, rather than treating, which uses operant conditioning and secondary reinforcers
Paul and Lentz
token economy led to better overall patient functioning and less behavioural disturbance
steps of CBT
- assessment
- engagement
- ABC model
- normalisation
- critical collaborative analysis
Turkington et al
suggests CBT is very effective and should be the mainstream treatment
Zubin and Spring
a vulnerability can be present from birth and triggered by everyday stress, but coping mechanisms, support networks and resources can be protective factors
Brown and Birley
50% people who had an acute schizophrenia episode had experienced a major life event in the 3 weeks prior
Bentall
meta-analysed research into childhood abuse and found it increases the risk of developing schizophrenia
Fox
found that poverty or deprivation in lifestyle can cause the disorder
