Schizophrenia Evaluation Flashcards
Strengths of Sz diagnosis
Reliability- clinicians each same diagnosis inter rater reliability +0.97 and on two occasions test retest reliability 0.92
Limitations of sz diagnosis
Validity - chenaux icd10 68 and DSM Iv = 39 either over or under diagnosed suggests criterion validity is low
Comorbidity - might be due to one single condition 50% depression or sub abuse -sz may not exist maybe unusual case of depression
Gender bias- 80s women less vulnerable than men - women closer relationship and support
Culture bias- Afro Caribbean voices = gift ancestors 10x more likely lead to over interpretation discriminated
Evaluation of genetic basis
Strength- strong evidence base = gottesman family studies show risk incr w genetic similarities / tienari bio children w Sz heightened risk / hilker concordance 33% compared to 7%
Limitation - environment factors = biological eg birth complications/thc cannabis childhood trauma 67% sz and trauma compared with 38% other
Evaluation of neural correlates
Strength- support dopamine amphetamines increase dop worsening symptoms/ antipsychotic reduce dop reducing symptoms
Limitation- glutamate post mortem and scanning found raised levels of glut with sz and several genes linked to this
Evaluation of family dysfunction
Strength- fam dys= insecure attachment and childhood trauma Sz= type c or d 69% women 59% men w sz have abuse history
Limitations- no evidence to support sz mother and double bind based only on observations no systematic evidence
Evaluation of cognitive explanations
Strength- evidence support dysfunction thought = Stirling 30/30 with sz without colours of font of words - suppress reading words sz 2x longer
Limitation- only explain proximal origins (now) unclear on childhood trauma leads to cognitive expression of sz - partial explanation
Evaluation of drug therapy
Strength - effectiveness chloropromazine was associated with better overall function and reduced symptoms than placebo and atypical anti psych are effective in30-50% when typical don’t work
Limitation- serious side effects NMS can be fatal and tardive dyskinesia long term effect - may avoid
- do not know why they work - know now that dopamine isn’t a complete explanation and shouldn’t work - perhaps some other factor is involved in their success
Evaluation of cognitive therapy
Strength - evidence of its effectiveness CBT had clear effect on reducing positive and negative symptoms especially hallucinations
Limitation- wide range of techniques and symptoms vary from case to case may be effective for some only
Evaluation of family therapy
Strength - evidence of effectiveness relapse rates reduced by 50-60% NICE recommends it. Can be used for early and full blown Sz
Strength- benefits all family members by strengthening functioning of whole family lessens negative impact and strengthens support
Evaluation of token economy system
Strength- evidence for effectiveness all showed a reduction of negative symptoms and a decline in frequency of unwanted behaviours
Limitation- ethical issues gives professionals power over patients restricting availability of pleasures who are seriously ill doesn’t improve symptoms
Existence of more pleasant and ethical alternatives - art therapy manages sz calming environment pleasant without side effects or ethical issues
Evaluation of interactionist approach
Strength- evidence supporting the role of vulnerability and trigger - tienari 19000 children w sz mothers genetic vulnerability and dysfunctional parenting more likely develop Sz
Limitation- over simplicity multiple genes influence diathesis stress also comes in many forms eg childhood trauma - abuse and cannabis can be a trigger
Strength- RWA combining treatments medication and cognitive therapies study combination groups showed lower symptoms - superior treatment outcomes
