Schizophrenia AO1 Flashcards
Outline the classification of schizophrenia (Sz)
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Positive and Negative symptoms of Sz
The DSM-5 criteria:
Two or more of the following symptoms must be present:
- Delusions
- Hallucinations
- Disorganised speech
- Catatonic Behaviour
- Avolition
Type 1 (positive)
- Delusions of Persecution- beliefs they are being spied on
- Delusions of Grandeur - belief that they are a powerful historical figure such as the queen
Type 2 (negative)
- Speech Poverty - decrease in speech fluency
- Avolition - a reduction of interests and desires
Outline the Biological Explanation of Sz
(Neural Correlates including the Dopamine Hypothesis)
The Dopamine Hypothesis suggests that Sz is as a result of an overactive transmitted of neurotransmitter dopamine.
- Sufferers also have abnormally high levels of D2 receptors on receiving neurons, resulting in more dopamine binding, and more neurons firing
- This can then lead to the problem of diverting attention, perception and thoughts in those with Sz
It is then thought that both high and low levels of dopamine in the different areas of the brain can cause symptoms… such as low levels in the Broca’s area causes speech poverty
AO1 - Enlarged Ventricals
Scanning techniques such as fMRI can highlight that those suffering with Sz have enlarged ventricles (fluid filled areas in the brain)
Neural Correlates of Negative symptoms
Abnormalities in the Ventral Striatum can cause Avolition
Outline the biological explanation of Sz (The Genetic Explanation)
The Genetic explanation argues that Sz is passed on from one generation to the next. (Sz is polygenic)
- Talk about Concordance rates and Family studies
- Gottesman found that children with two Sz parents had a concordance rate of 46%, children with one Sz parent had a rate of 13%
Specific Genes have been identified
- It has been found that the NRG3 gene variant interact with both NEG1 and ERBB4 gene to correlate with Sz
Outline Biological TREATMENTS for Sz
Typical Antipsychotics:
Chlorpromazine - introduced 1950s
- reduces effects of dopamine by binding to dopamine receptors and blocks the action
- this reduces positive symptoms
Atypical Antipsychotics:
Clozapine - introduced 1970s
- blocks D2 receptors temporarily before disassociating and allowing for normal dopamine transmission
ATYPICAL ALSO EFFECTS SERTONIN which stops negative symptoms unlike typical antipsychotics
Outline psychological explanations of Sz
(FAMILY DYSFUNCTION + cognitive explanations)
Family Dysfunction
This means the risk of Sz is increased when there are abnormal patterns of communication within the family
1. Arguments 2. Difficulties communicating 3. Being controlling of children
The Double-Bind Hypothesis
Bateson suggests children can find themselves “trapped” in situations where they fear doing the wrong thing, but or not given guidance of what the wrong thing is
The child receives contradictory messages like showing love one second and shying away the next
This is a risk factor and not the cause of Sz
Expressed Emotion (EE)
The level of negative emotion towards a patient by their caregiver
- verbal criticism
- hostility towards patient Anger/Rejection
- over involvement in patients life
EE can cause an onset of Sz to those who are already vulnerable (diathesis-stress disorder)
Schizophrenogenic Mother
A mother that is cold, rejecting and controlling, this leads to distrust which can lead to paranoid delusions in the child (Fromm-Reichman)
LINK WITH COGNITIVE EXPLANATIONS
Outline the Psychological explanations for Sz (COGNITIVE EXPLANATIONS + Family Dysfunction)
Based on mental processes and explains symptoms of Sz as being a result of a disruption of normal thought processing
Meta-representation - the cognitive ability to reflect on our own thoughts and behaviour — it is believed that a dysfunction in meta-representation contributes to an onset of Hallucinations
E.G: They think their inner voices are the voices of other people being projected into their heads
Central Control
The cognitive ability to suppress automatic responses while we perform deliberate actions instead.
- Disorganised Speech and thought disorder could result from the inability to suppress these thoughts.
E.G: Sufferers experience Derailment of Thoughts
LINK WITH FAMILY DYSFUNCTION
Outline Cognitive Behavioural Therapy used to treat Sz
(CBTp)
CBTp Procedure:
- 5-20 Sessions
- develop a trusting relationship to patient
- create normalisation to reduce anxiety
CBTp assumes it is not the activating event (A) that causes Sz but the Beliefs (B) they have about the events.
- Distorted beliefs will have a negative effect on their feelings (Consequence (C))
The Therapist will discuss how likely these irrational beliefs are to be true, and in turn consider more rational beliefs instead (Dispute (D)).
By the patient challenging these thoughts with the Dispute, the patient should feel the Effect (E) and become less anxious (The ABCDE Model)
Outline Family Therapy used in the treatment of Sz
Family Therapy is used if the communication and interactions in the family are dysfunctional, Pharoah states we can achieve this by:
- Forming an alliance with all family members
- Reducing the stress of caring for a relative with Sz
- Problem solving
- Reduction of Anger and Guilt
- Help achieve a balance between care and maintaining their own lives
- improving beliefs and behaviour towards Sz
NICE recommends family therapy should be offered to all diagnosed with Sz, interventions should be seen as a priority where there are persistent symptoms or risk of relapse
Outline Token Economies used in the management of Sz
- Token Economies is a form of behavioural therapy used in hospitals. - Based on the principles of operant Conditioning
The Aim is to change maladaptive behaviours that Sufferers may have (social withdrawal, poor motivation) - A Token is given upon the action of desirable behaviour which can be swapped for treats, such as sweets
(to promote desirable behaviour)
THESE BEHAVIOURS DO NOT CURE BUT IMPROVE
behaviours are shaped over time to make them more able to function on their own
Outline the interactionist approach to explain and treat Sz
Explanation:
The Diathesis-Stress Model
Diathesis - underlying vulnerability
Stress - negative psychological experience
This model suggests an individual must have the genetic vulnerability and a stress-trigger present in order to develop the condition
Diathesis can be biological (genes) or psychological (trauma)
(State the Bio Approach and how it can link with psychological approach)
Stress can be psychological or biological
TREATMENT
The model would recommend to combine antipsychotic medication and psychological therapies.
