Schizophrenia and related psychotic disorders

Question 1

Define Schizophrenia

Answer 1

Schizophrenia is a type of psychotic disorder where a person’s emotions, thinking and actions are affected

Question 2

Give two examples of types of schizophrenic spectrum and psychotic disorders

Answer 2

Schizotypal disorder- a personality disorder that makes people aloof
Delusional disorder- people with this disorder are afflicted with delusions

Question 3

An example of schizophrenic case study

Answer 3

Conrad (male aged 23)
-Had his first psychotic episode while on a vacation when he was 22 and was later diagnosed with schizoaffective disorder
-Was reluctant to seek treatment at the beginning because he was unsure if he would ever recover so he spent the first 8 months of his diagnosis in a psychiatric hospital
-Through trial and error he has found a drug that works for him and is doing better but he struggles maintain a healthy weight

Question 4

Positive Symptoms of Schizophrenia

Answer 4

-Hallucinations
-Delusions
-Disorganized thoughts
-Catatonic behavior

Question 5

Negative Symptoms

Answer 5

-Loss of normal functioning
-Loss of speech
-Lack of facial expressions (flat affect)
-anhedonia: inability to feel pleasure in normal pleasurable activities
-alogia: poverty of speech
-avolition: lack of motivation

Question 6

Types of delusional disorders

Answer 6

Erotomaniac- Belief that somebody is in love with them
Grandiose- Convinced they have some great unrecognized skill or status
Jealous/Infidelity- Belief that partner is being unfaithful
Persecutory- Belief that the person is being conspired against or pursued by others who intend to harm them

Question 7

Who proposed an alternative to traditional ways of diagnosing schizophrenia and in what year

Answer 7

Freeman, 2008

Question 8

Why is it difficult to diagnose schizophrenia using normal methods

Answer 8

-relies on patient answering truthfully
-cannot rule out that the beliefs of persecution are unfounded

Question 9

Strengths of using virtual reality for diagnosis

Answer 9

-allows social environments to be controlled so it can be neutral and standardized while assessing actual behaviour
-Ensures that paranoid thoughts and behaviour are genuine, as the social situation is totally artificial

Question 10

Briefly describe the procedure of Freeman’s research

Answer 10

-trialed in a non-clinical population of around 200 students
-used validated measurement tools to assess each individual’s paranoid thinking prior to virtual reality test
-measures of persecutory thinking were also taken after being immersed in the virtual environment along with visual analogue rating scales and an assessment of their degree of immersion in the virtual environment

Question 11

Briefly describe the results of Freeman’s research

Answer 11

-those who scored high in the questionnaire also experienced high levels of persecutory ideation in the VR trial
-auditory hallucinations were also experienced in VR

Question 12

List out 7 applications for VR in schizophrenia

Answer 12

-symptom assessment
-identification of physiological arousal that correlates to symptoms
-developing treatment:
-how to cope with symptoms as they occur
-exposure to persecutory fears
-teach individuals about factors that make symptoms better or worse
-establishing causal factors
-identification of environmental predictors (by altering environmental elements that increase the likelihood of delusional ideas, hallucinations or social difficulties)
-to test the already established causal factors
-identification of predictive variables (for example participants who scored high in the paranoid questionnaire showed more persecutory ideation)

Question 13

Evaluate the study by Freeman (2008)

Answer 13

-large sample; not representative of clinical population
-VR programme is standardized increasing validity
-low ecological validity since it involves a stimulated environment
-continues to rely on self-report leads to response bias
-VR program needs to be modified to avoid cultural bias

Question 14

Practical issues of using VR

Answer 14

-a wide variability in the content of people with psychosis needing differing triggering environments
-still need to ask participants about their experience since positive symptoms such as delusional thoughts and hallucinations requires verbal report to establish
-individuals might suffer from simulator sickness (dizziness, nausea, headache, and eyestrain)

Question 15

List out the three explanations of Schizophrenia

Answer 15

Genetic (Gottesman and Shields, 1972)
Biochemical (dopamine hypothesis)(Lindström et al., 1999)
Cognitive (Frith, 1992)

Question 16

Briefly explain the procedure conducted by Gottesman and Shields (1972)

Answer 16

-carried out twin study research into the genetic inheritance of schizophrenia
-sample was taken from 467 twins who were registered at the Maudsley Hospital in London between 1948 and 1964 (longitudinal study)
-a series of tests were conducted on 57 pairs of twins: 24 MZ twins and 33 DZ twins.
-blood group and finger prints were used to classify twins as MZ or DZ
-Patients and twins were interviewed along with undertaking cognitive tests such as object sorting
-external of judges were used to evaluate case summaries of each independent participant to ensure validity of diagnosis

Question 17

Briefly explain the results by Gottesman and Shields (1972)

Answer 17

-approximately 50% of MZ twins had a shared schizophrenic status while it was only 9% for DZ twins (showing that schizophrenia is caused significantly by genetics but relies on some environmental factors)
-the co-twin was more likely to have schizophrenia if the first twins illness was severe
-conclusion: found a higher concordance rate for schizophrenia in monozygotic (MZ) than dizygotic (DZ) twins

Question 18

Evaluate the study by Gottesman and Shields (1972)

Answer 18

-large sample
-results are not generalizable to non-twin individuals
-results are less generalizable because sample was from one hospital
-researchers confirmed diagnosis of schizophrenia using an external panel of judges reducing researcher bias
-used quantitative measures to confirm if twins were MZ or DZ (raised validity of study)
-qualitative data was also collected (interview) gaining in-depth data about participants; subjective data is prone to interpretation and biased by the researcher’s opinions or feelings
-quantitative element of the study allows the results to be easily compared and analyzed

Question 19

Nature Vs Nurture Debate in Gottesman and Shields (1972)

Answer 19

while this study does try to establish a casual link between genetics (nature) and mental disorder; we can’t rule out that maybe what actually caused the concordance of schizophrenia in MZ twins was because they were treated more similarly by the environment they grew up in (nurture) compared to DZ twins. Therefore all differences between MZ and DZ twins can be attributed to genetics.

Question 20

What does the dopamine hypothesis state

Answer 20

-the brains of those with schizophrenia produce more dopamine than those without the disorder
-there is a link between excessive amounts of dopamine or dopamine receptors and positive symptoms of schizophrenia and related disorders

Question 21

State the evidence that supports the dopamine hypothesis

Answer 21

-drugs that increase levels of dopamine in brain (cocaine) lead to more reported hallucinations and delusions
-when patients with Parkinson’s disease are treated with high doses of synthetic form of dopamine (L-dopa), it creates schizophrenic symptoms
-Wise et al found that brain fluid in post-mortem studies lack the enzyme used to break down dopamine suggesting it was present in large amounts
-PET scans by Nestler et al. suggests that decreased levels of dopamine activity in prefrontal cortex correlate with negative symptoms such as flattened affect in schizophrenia

Question 22

What does the cognitive theory by Frith (1992) state

Answer 22

schizophrenia involves faulty mental processes rather than relying solely on physiological explanations

Question 23

How does Frith (1992) explain schizophrenia

Answer 23

-describes schizophrenia as an abnormality of self monitoring
-patients fail to recognize hallucinations as just inner speech
- patients with incoherent speech as symptom performed worst at identifying source of speech which may be linked to memory and attention difficulties crucial to self-monitoring
-delusions arise from self-generated thoughts that appear to be from external source than become incorporated in the individuals sets of beliefs
-negative symptoms such as lack action have difficulty generating spontaneous actions

Question 24

What are the 4 treatments to schizophrenia

Answer 24

-biochemical (antipsychotics and atypical antipsychotics)
-electro-convulsive therapy
-token economy (Paul and Lentz, 1977)
-cognitive behavioral therapy (Sensky et al., 2000)

Question 25

Biochemical treatments

Answer 25

-typical antipsychotics(1950s) and atypical antipsychotics(1990s)
-both reduce the severity of psychotic symptoms
-they work by blocking dopamine and serotonin receptors along with effecting serotonin and norepinephrine neurotransmitters

Question 26

State an example of an antipsychotic drug and an example of an atypical antipsychotic drug

Answer 26

chlorpromazine and risperidone

Question 27

Research on antipsychotics

Answer 27

-researched using RCT and double-blind placebo controlled procedure -50% of those taking the medication have a significant improvement in their condition four to six weeks
-30-40% show partial improvement
-some show no improvement , known as “treatment resistant schizophrenia”

Question 28

Side effects and negatives of antipsychotics

Answer 28

-have high relapse rates
-antipsychotics more likely to cause extrapyramidal symptoms (EPS) and tardive dyskinesia (TD) while atypical antipsychotics more likely to cause weight gain and elevated glucose levels
-when their is a reduction of symptoms along with negative side effects likely to cause non-adherence to medication

Question 29

How does Electro-Convulsive work

Answer 29

-passes electricity through the brain so that the induced seizure can treat schizophrenia
-electricity applied unilaterally across the brain to reduce memory loss
-it affects the post-synaptic responses to central nervous system
-most effective for individuals experiencing catatonic symptoms and acute episodes of psychosis

Question 30

Risks of using Electro-Convulsive Therapy

Answer 30

-affects the central nervous system and cardiovascular system which can dangerous for those with pre-existing conditions
-usually temporary memory loss
-neurological damage
-death

Question 31

What is the behavioral approach to schizophrenia

Answer 31

-Token economy by Paul and Lentz (1977)
-consider symptoms of the disorder occurring as learned response
-is concerned with making individual’s unlearn individual symptoms in order to get better

Question 32

How does the token economy (Paul and Lentz, 1977) work

Answer 32

-uses operant conditioning strategy to reinforce appropriate behavior
-tokens were given as a reward for appropriate behaviors of self-care, attending therapy and engaging in social behavior
-they could than exchange these tokens for luxury items such as cigarettes, sweets, clothing and TV use

Question 33

Briefly describe the procedure conducted by Paul and Lentz, 1977

Answer 33

-sample was 84 individuals with chronic admissions to psychiatric institutions
-used independent measures design: milieu therapy, token economy and normal hospital treatments
-longitudinal study (4 1/2 years)
-behavior monitored through time-sampled observations, standardized questionnaire scales and individual interviews

Question 34

Briefly describe the results of Paul and Lentz study (1977)

Answer 34

-token economy was most effective at reducing catatonic behavior and social withdrawal; much less effective at reducing hallucinations and delusions
-individuals were able to live independently for 1.5 years to 5 years:
-97% from token economy
-71% from milieu therapy
-45% from hospital group
-conclusion: operant conditioning can be effective in managing symptoms of schizophrenia and ensuring long-term discharge of patients

Question 35

Evaluate the study be Paul and Lentz (1977)

Answer 35

-intensive staff training to ensure token were issued reliably
-staff were monitored and issued a manual to ensure standardization
-harder to reinforce such procedures outside the hospital; low ecological validity.
-token economy is less effective for non-inpatients
-ethical issues: denying privileges to patients may make them demotivated and stressed by therapy

Question 36

Briefly explain the procedure performed by Sensky et al. (2000)

Answer 36

-RCTs was used to compare cognitive behavioral therapy to befriending sessions
-90 patients with treatment resistant schizophrenia received a mean of 19 individual treatment sessions over 9 months
-both interventions were administrated by 2 experienced nurses who were regularly monitored
-Patients were assessed by blind raters at baseline, after treatment , and at a 9-month follow-up evaluation
-validated standardized assessments such as Comprehensive Psychiatric Rating Scale (CPRS) and Scale Assessments for the Negative Symptoms (SANS) were used

Question 37

What is CBT

Answer 37

a form of talking therapy designed to help people change through recognizing thoughts that underlie their behaviors

Question 38

Briefly describe the results of study by Sensky (2000)

Answer 38

-both interventions resulted in significant reductions in positive and negative symptoms
-at the 9-month follow-up evaluation, patients who had received cognitive therapy continued to improve, while those in the befriending group did not
-conclusion: CBT is fairly effective as a treatment and may offer hope to individuals that don’t respond well to antipsychotic treatments

Question 39

Evaluate the study by Sensky et al. (2000)

Answer 39

-RCT design increased validity
-blind assessors used removed bias
-fairly representative sample since they were from across different clinics in the UK; low generalizability to patients outside the UK
-trained nurses ensured standardization