Schizophrenia AO1-3 Flashcards
Outline the Classification and Symptoms of Sz
DSM-5:
Two (or more) if the following symptoms must be present during a 1 month period:
- Delusions
- Hallucinations
- disorganised speech
Type 1: Positive Symptoms
- Hallucinations
- Dellusions - of Grandeur / Of Persecution
Type 2: Negative Symptoms
- Speech Poverty
- Avolition
Assess the Reliability and Validity in Diagnosis of Sz
Reliability is the consistency in diagnosis
Can be assessed by Inter-Rater Reliability
AO3:
Cheniaux asked Two Psychiatrists to diagnose 100 patients using DSM and ICD, they found inter-rater was poor
Co-morbidity - issue for reliability, the presence of one or more additional disorders simultaneously occurring with SZ e.g: sufferers experience depression as well — suggests SZ may not be a separate disorder
AO3
- Buckley found 50% of patients w/ SZ had depression and substance abuse
Culture Bias - reduces validity / Both ICD and DSM are Western developments. So SZ being viewed as undesirable can be seen the opposite in other cultures (can effect reliability as well)
AO3:
In Haiti some believe voices in heads is communication from ancestors
Validity - if the methods are accurately measuring SZ. To assess validity we use Predictive Validity
AO3:
Symptom Overlap - where symptoms of SZ are seen in other disorders (BI-POLAR) makes it difficult to determine which is which
AO3:
Found a genetic overlap between Bipolar and Sz. Three gene locations were associated with both disorders and they both have similar symptoms
Biological Explanations of Sz
(DOPAMINE + VENTRICLE)
A bio explanation involves Neural Correlates.
- These are measurements of the structure or function of the brain that correlate with an experience
Dopamine Hypothesis:
- Overactive Transmission of Dopamine
- Abnormally high numbers of D2 receptors
- Dopamine guides attention so overactivity is said to cause symptoms of SZ
Both high(pos sympts) and low(neg sympts) levels cause SZ
AO3:
+ - PET SCANS
Found an increase in the number of DOPA RECEPTORS in patients with SZ
+ - Drug use
Coke increases dopamine levels, causing Sz like symptoms, suggests Sz is as a result of DOPAMINE
+ - PAs - revolutionised treatment
Creation of Anti-Psychotic drugs (Chlorpromazine)
Enlarged Ventricles:
fMRI have been used to show enlarged ventricles (fluid filled gaps in brain) are linked to SZ , this is caused by damage to central brain areas (causes Avolition + SP
Neural Correlates of negative symptoms
Avolition is a loss of motivation.
The Ventral Striatum is involved in anticipation (of a reward = motivation)
So an abnormality in this area can result in Avolition
Neural Cs of positive symptoms
Allen scanned brains of Ps having hallucinations, he found there were lower activation levels in the “superior temporal gyrus”
AO3:
x - data is problematic
Can’t establish causation as it is possible SZ causes changes in the brain
+ not all Ps w/ SZ have enlarged ventricles
Biological explanation of SZ
(The Genetic explanation)
SZ is believed to be Polygenic
- Family studies and Twin studies support the genetic explanation
- Established by a concordance rate
Gottesman found children with two SZ parents had a concordance rate of 46%
One parent had a concord rate of 13%
Specific genes identified
Genes associated with an increased risk included the functioning of dopamine,
NRG3 interacts w/ both NRG1 and ERBB4
This can cause SZ
AO3:
+ - support for genes causing SZ
Twin studies found 40% for MZ and only 7% DZ, (Joseph)
HOWEVER - if SZ caused by genes alone it should be 100% for MZ?
+ - adoption studies (can establish Nature Vs Nurture)
Tienari compared adopt children who bio mothers had SZ, he found a much higher rate of SZ among Bio Mother
Biological TREATMENTS for SZ
Drug Therapy includes:
- Typical - chlorpromazine
Binding to D2 receptors, block their action, positive symptoms are reduced
- Atypical - Clozapine
Blocks D2 receptors (temporarily), reduces pos symptoms , they also effect serotonin receptors, reducing negative symptoms
AO3:
+ - Thornley reviewed studies of Typical
Ps were given a drug or placebo, Chlorpromazine was associated with better overall functioning.
+ - Meltzer concluded that Atypical was more successful in treating resistant cases than Typical (30-50% more effective)
x - side effects
Typical can cause Tar-dive Dyskinesia (TD) which is involuntary movements and is irreversible (75% of cases)
Psychological explanations for SZ
(Family Dysfunction)
1) Family Dysfunction - SZ is increased when there are abnormal patterns of communication
- arguments
- Difficulty communicating
- being controlling of children
2) The Double-Bind Hypothesis
Bateson - children can find themselves trapped in situations — they fear doing wrong but don’t know what’s right
If they do the wrong thing, affection is withdrawn
- Contradictory Messages - Parents say they love them but opposite is shown
3) Expressed Emotion
EE - the amount of negative emotion shown towards a patient by their career
- Verbal critism
- Hostility towards patient
- Emotional over involvement in life
These EEs cause stress and can cause an onset of SZ in a person who is already GENETICALLY VULNERABLE
AO3:
+ Berger found Ps w/ SZ recalled higher levels of Double-Bind statements in the family
x - HOWEVER - most professionals now agree the Double-Bind has poor evidence and is based on unobjective theory
+ - PAs - Lead to Family Therapy
Relapse Rate for FT was 26% compared to 50% control group
X - FAMILY DYSFUNCTION may be a symptom of HAVING someone with SZ rather than causing SZ
- this is the idea that the patient already has SZ and this causes a family dysfunction
Psychological explanations of SZ
(Cognitive)
Based on mental processes and is the idea that SZ is a result of a disruption of normal thought processing
Meta representation - this is the cognitive ability to reflect on thoughts
- a dysfunction contributes to an onset of hallucinations
E.G: P believes inner voices are thoughts of others
Central Control - the cognitive ability to suppress automatic responses while we perform deliberate actions
- A dysfunction of this can cause disorganised speech and thoughts.
(Derailment)
AO3:
+ - O’Carrol found cognitive impairments existed in 75% of cases. They effected attention, memory and verbal learning
++ - Stirling found SZ patients took twice as long on a cognitive task
+ - PAs - Lead to CBTp which is effective in treating SZ
Psychological TREATMENT of SZ
(Cognitive Behavioural Therapy + FT)
CBTp takes place for five and twenty sessions
- A therapist begins by developing a trusting relationship with patient
- NORMALISATION is used to shown paranoid thoughts are more common than They think
- The Beliefs they have about the Event leads to Consequence — so the therapist works to correct faulty beliefs
- ABCDE MODEL PRETTY MUCH
AO3:
+ - Tarrier found evidence of a reduction in positive symptoms, and lower relapse rates in the short term
+ - No side effects (unlike drugs)
x - high drop out rates, Tarrier found 45% of the sample refused to cooperate, patients must be highly motivated
Family Therapy
Based on the idea that communication in the family is dysfunctional. Aims to improve the quality of interaction to reduce levels of EE.
* Pharoah (family therapist)
- for alliance with all family members
- Problem solving
- reduce stress in caring w/ person w/ SZ whilst maintaining their own lives
- reduction of anger + guilt
NICE recommends FT to all ppl w/ SZ
AO3:
+ - proven to be effective
Pharaoh found a reduction in risk of relapse and hospital admission due to family therapy
+ - helps improve the lives of relatives
An insight into SZ can help family members assist the patient when they can’t do so themselves
Psychological MANAGEMENT of SZ
(Token Economy)
Based on the principles of operant conditioning, the aim of this is to change maladaptive behaviours
- a token is given after good behaviour is shown, this reinforces desirable behaviour — can be swapped for treats
AO3:
+ - Glowacki showed 7 studies found TEs led to a reduction in neg symptoms
x - can’t treat pos symptoms
Outline the importance of an Interactionist approach to explain and treat SZ ( Diathesis-Stress )
The Diathesis-Stress model suggests that an individual must have a genetic vulnerability and a stress trigger to develop SZ
A Diathesis can be biological or psychological (genes / trauma) as genes can cause SZ , and early trauma can effect brain development
AO3:
+ - Tienari found adopted children who were subject to low levels of empathy and a genetic vulnerability can lead to a development of SZ compared to a control group
+ - MZ twin concordance rates for SZ rarely rise above 50% suggesting environmental factors also play a role.
Interactionist approach can also treat SZ,
- it would recommend to combine antipsychotic medication and psychological therapy’s
So CBT + FT + Antipsychotic meds
AO3:
+ - Tarrier studied 315 patients, they were randomly allocated to either
1) Meds + CBT
2) Meds + Counselling
3) Control group ( Meds only )
He found symptom levels were low in both combination groups compared to control group
x - can’t assess which is more successful
