Schizophrenia Ao1 Only Flashcards
Outline diagnosis and classification of schizophrenia.
Serious mental disorder. Affects 1% of the population. More common in males, city-dwellers and lower socio-economic groups.
Classification - Identify symptoms that go together for disorder. Then identify disorder based on symptoms. Classify, then diagnose.
DSM-5 = One positive symptom
ICD-10 = Two or more negative symptoms
Outline positive and negative symptoms of schizophrenia.
Positive:
Additional experiences beyond ordinary
1. Hallucinations: Hearing/ seeing weird shit
2. Delusions: Paranoid af
Negative:
Loss of usual abilities/ experiences
1. Speech poverty: Reduced amount and quality
2. Avolition: Severe loss of motivation
Outline the first biological explanation for schizophrenia, genetic basis.
Family studies: Gottesman
- Risk increases with genetic similarity e.g 2% for aunt, 17% for DZ twins and 48% for MZ identical twins.
Candidate genes: Ripke et al.
- Polygenic (multiple genes required) and aetiologically heterogenous. Meta-analysis, 108 genetic variations associated with risk.
Mutation: Brown et al.
- Genetic vulnerability in people with no family history. If fathers were over 50 then 2% risk.
Outline the second biological explanation for schizophrenia, neural correlations.
DA = Dopamine which is linked as it features in brains systems associated with Schizophrenia. Levels linked with stress when young and genetic vulnerability.
Original DA hypothesis:
- High DA in subcortex (hyperdopaminergia) explains speech poverty, disruption to Broca’s.
Updated DA hypothesis:
- High DA in subcortex (hypodopaminergia plus low in cortex explains negative symptoms.
Outline the first psychological explanation for schizophrenia, family dysfunction.
Schizophrenogenic mothers:
Fromm-Reichmann (psychodynamic)
- Cold and rejecting, leads to distrust and then paranoid delusions and hallucinations.
Double-bind theory:
Bateson et al.
- Contradictory family communication about what is “right” or “wrong”. Child often punished as they “can’t win” so learn world is confusing and dangerous. Leads to disorganised thinking and delusions.
Expressed emotion:
- High negative emotion expressed to people causes stress. May trigger onset or relapse.
Outline the second psychological explanation for schizophrenia, cognitive explanations.
Dysfunctional thought processing:
- Reduced activity in ventral striatum linked to negative symptoms.
Metarepresentation:
- M is the cognitive ability to reflect on thoughts and behaviour. Lack of it, can’t recognise thoughts as one’s own, leads to hallucinations/ delusions.
Central control:
- CC is the cognitive ability suppress automatic responses. People with schizophrenia don’t have it which causes derailment of thought.
Explain Typical antipsychotics as the first biological treatment for schizophrenia.
Dopamine antagonists - reduce DA levels
Block dopamine receptors in the synapse, normalises neurotransmission in key areas of the brain which are linked to symptoms such as hallucinations.
Chlorpromazine:
- Affects histamine receptors which causes sedation.
Explain A-typical antipsychotics as the second biological treatment for schizophrenia.
Newer drugs, aimed at improving effectiveness and reducing side effects.
Clozapine:
- Binds to dopamine, glutamate and serotonin receptors. Enhances mood and improves cognitive functioning. But causes blood condition called agranulocytosis which has caused deaths.
Risperidone:
- Safer, binds more strongly to dopamine receptors than clozapine so smaller doses.
Outline CBT as a psychological treatment for schizophrenia.
Identify rational thoughts and develop the behaviour to change them. Individual or 5-20 group sessions.
CBT helps clients to understand symptoms, normalisation.
Turkington et al.
- Paranoid patient who believed Mafia trying to kill him. Acknowledged and gently challenged irrational belief. Irrational thought identified.
Outline family therapy as a psychological treatment for schizophrenia.
Reduce negative emotions. EE creates stress, dealing with EE prevents clients relapse.
Improve family’s ability to help, therapeutic alliance formed and improved families’ attitudes toward schizophrenia. Care for each other.
Burbach’s model of practice
Phases 1 and 2:
- Share info, identify resources family can offer.
Phases 3 and 4:
- Mutual understanding, identify unhelpful interaction patterns.
Phases 5,6 and 7:
- Skills training, relapse prevention and maintenance.
Outline token economies as management for schizophrenia.
Early practice:
Ayllon and Azrin
- Gave gift tokens for every tidying act, tokens could be exchanged for rewards.
Rational:
Being in hospital leads to institutionalisation, but these behaviours can be tackled with token economies. This has two major benefits…
1. Quality of life is improved
2. Normalises behaviour needed outside
Tokens given immediately for desirable behaviour, swapped later for rewards.
Operant conditioning, tokens are secondary reinforcers.
Outline the diathesis stress model as part of the interactionist approach to schizophrenia.
Diathesis stress model:
Vulnerability + Stress trigger = Schizophrenia
- Individually they may be ok
Meehl’s model:
- Diathesis is genetic and the result of a single “schizogene”. Someone without this gene can never develop schizophrenia (out of date theory).
Modern understanding demonstrates that many genes cause vulnerability. Also, it may not even be genetic - there is evidence of child abuse creating vulnerability to stress.
Modern understanding of stress (in relation to diathesis model) is anything that risks triggering schizophrenia, biological or psychological.
What is the interactionist approach to treatment.
Antipsychotic drugs and CBT makes sense if you support an interactionist model.
UK more accepting of interactionist than the US.
