Schizophrenia and psychotic disorders Flashcards
What is Schizophrenia and psychotic disorder?
Schizophrenia: a particularly severe type of psychotic disorder that affects all aspects of a person’s thinking, emotions and actions.
Psychotic disorder- involve a major break from reality which the individual perceives their world in a way that is very different from how others perceive it.
Symptoms can be categorised into positive (e.g delusions, hallucinations, disorganised thoughts, and catatonic behaviour) or negative symptoms (e.g loss of speech)
What is delusional disorder
Delusional disorder- is a disorder characterized by persistent delusions, but people suffering from it otherwise have quite normal behaviour unlike those with classic schizophrenia
There are 4 types of delusional disorder
Erotomanic (Belief that another person is in love with them)
Grandiose (Convinced they have a great unrecognised skill or status)
Jealous (Belief that their partner is being unfaithful)
Persecutory (Belief that the person is being conspired against or pursued by others who intend to harm them
In order to receive a diagnosis of delusional disorder, the individual must have been experiencing symptoms for one month or longer.
Describe Freeman 2008, symptom assessment using VR, findings
They created a fake environment which was a specifically designed library or underground train scene
Measures of persecutory thinking were also taken after being in the virtual environment, along with visual analogue rating scales, and an assessment of their degree of immersion in the virtual environment
Findings
The researchers found that those who scored highly on questionnaire assessment of paranoia experienced high levels of persecutory ideation
Persecutory Ideation: the process of forming an idea that one is at risk of being ill-treated or harmed by others
What are the 4 types of delusional disorder?
Erotomanic (Belief that another person is in love with them)
Grandiose (Convinced they have a great unrecognised skill or status)
Jealous (Belief that their partner is being unfaithful)
Persecutory (Belief that the person is being conspired against or pursued by others who intend to harm them
How long must the individual experience the symptom for diagnosis?
experiencing symptoms for one month or longer
Describe what psychologists have discovered about characteristics of schizophrenia spectrum and psychotic disorders
P1 - define schizophrenia + psychotic disorder
P2 - Delusional disorder, 4 types
P3- Describe + findings from freeman
(those who scored HIGHLY on questionnaire assessment of paranoia experienced high levels of PRESECUTORY IDEATION)
What is persecutory ideation?
the process of forming an idea that one is at risk of being ill-treated or harmed by others
Describe what psychologists have discovered about EXPLANATIONS of schizophrenia spectrum and psychotic disorders
P1 - genetic (Gottesman and Shields)
P2 - biochemical (dopamine hypothesis)
P3 - cognitive (Frith)
Describe what psychologists have discovered about TREATMENTS of schizophrenia
P1 - biochemical
- typical antipsychotic medication
- atypical
P2 - ECT
P3 - behavioural
- CBT
- token economy
What is Chlorpromazine (antagonist)?
(inhibitory effect) a drug that blocks symptoms of schizophrenia, occupies the dopamine site on the receptor, preventing receptor activation by dopamine
Describe the synaptic transmission
- vesicles release neorotransmitter into the synaptic cleft
- neurotransmitter binds to receptors & activates them
- excess neurotransmitter is taken up, through reuptake by the presynaptic neuron
- vesicles are replenished with new & reused neurotransmitter
What is the typical antipsychotic medication?
- first generation
- chlopromazine is one type of antipsychotic drug
- works by binding to dopamine receptors without activating them in cortex + limbic system
- 1 week to take effect
- feel less hostile
- 2-3 weeks diminished positive symptoms
What is atypical antipsychotic medication?
- second generation
- clozapine
- binds to specific types of dopamine receptors
- without activating them
— less likely to produce side effects
— particularly effective, suicidal behaviour
—> rare side effects, blood disorders, can be fatal
How is ECT used?
- small current passed through brain for about 0.5s
- causes seizure which lasts for 1min
- one electrode on non-dominant brain hemisphere + one electrode middle of forehead
- 3 times per week, for up to 5 weeks
- muscle relaxant drug, anaesthetic
Strengths for using ECT \
- effective when used together with other treatment, e.g. clopazine
- effective for depressed people who do not respond to drug treatment or are at high risk of suicide
Weaknesses for using ECT
- not ethical, lack of informed consent, sometimes without anaesthetic
- reductionist - doesn’t take into account the influence of any other causal factors, e.g. social,
Strengths and weaknesses for typical antipsychotic medication
strength: short term beneficial 75%, long term 60%
weaknesses: side effects, weight gain, drowsiness
reduce +ve symptoms but little effect on -ve symptoms
Strengths and weaknesses for atypical antipsychotic medication
strength: less side effect
weaknesses: rare side effect, fatal blood disorder
Describe the token economy
- behavioural modification therapy, based on operant conditioning
- reinforcement to promote behaviours (token)
- punishment to extinguish unwanted behaviours (token taken away)
- different numbers of tokens are exchanged for primary reinforcer (sweet, freedom)
Evaluate token economy (effectiveness)
Paul and Lentz study: reduction of both positive and negative especially catatonic behaviours and social withdrawal, less successful in reducing hallucinations and delusional thinking
Describe CBT on key assumptions of cognitive and behaviourist approaches
- Cognitive assumption that this disorder result from irrational thinking
- Learned and unlearned
- talking therapy, recognise thoughts underlie behaviour
Evaluate CBT (effectiveness)
Sensky et al. (2002):
Randomised control trial to compare effectiveness of CBT and befriending (= informal, one-to-one discussions about hobbies, sports or current affairs)
Findings: both groups showed significant reduction of both positive and negative symptoms
CBT group continued to improve in reduction of pos. Symptoms but befriending grp did not.
Describe Frith’s theory, cognitive explanation (brief)
- patients have positive symptoms and negative symptoms
- cognitively impaired
1. inability to generate willed action (intention to action)
2. inability to monitor willed action (origin)
3. lack of ToM
What is positive symptom in Frith’s theory?
Auditory hallucinations are misattributed inner speech as result of impaired ability to monitor willed action.
- thoughts are self generated instead appear to be coming from an external source, and incorporated in the individual’s set of beliefs
What is negative symptoms in Frith’s theory?
e. g. lack of action
- impaired ToM
- problems in recognising the intention of others
- flattening of affect, social withdrawal
—> might also due to FUNCTIONAL DISCONNECTION between frontal areas of the brain concerned action and area control perception
Descrive Gottesman and Shields, biological explanation
- twin study, research into genetic inheritance of schizophrenia
- genes / particular combinations of genes —> passed onto offspring, cause the disorder to develop
- symptoms: abnormalities like sensory dysfunction, memory impairment
- 50% MZ twins had a shared schizophrenic status, concordance lower in DZ
- In MZ, co-twin was more likely to be schizophrenic if the illness of their twin was severe
Describe the dopamine hypothesis, biochemical explanation
- brains produce more dopamine than normal
- link between excessive amounts of dopamine/receptors = positive symptoms
- neurons use transmitter dopamine, fire too often, send too much info
Evidence to support this theory comes from drug trials involving those with schizophrenia and those without the disorder
Describe belief modification in CBT
- patient can be persuaded into substituting more rational interpretations for irrational ones
- what triggers symptoms
- analysing, rationalising
- hallucinations, explain where the voice comes from
- keep diaries, develop understanding of symptoms
- coping strategies, pay attention to voices at specific times
Evaluate CBT ( appropriateness)
Strengths:
- help improve patient’s response to drug treatments, increase adherence, improve self esteem
- reduce likelihood of rehospitalisation, give strategies that will enable them to function more adaptively everyday life
- no side effects
Weaknesses:
- delay effect - lengthy course of treatment, may not be achievable
- does not cure on its own
