Schizophrenia - Paper 3 Flashcards
What is Schizophrenia?
Severe mental disorder affecting 1% of the population
More common in males, city dwellers and low social economic groups
What is classification?
Identifying symptoms that go together
What are the two classification systems?
DSM - 5 = requires 1 or more positive symptom
ICD - 10 = requires 2 or more negative symptoms
What are positive symptoms?
Additional experiences beyond ordinary
Hallucinations
Delusions
What are negative symptoms?
Loss of usual ability and experiences
Speech poverty
Avolition -loss motivation
Evaluation of diagnosis (reliability and validity)
+ good diagnosis reliability - consistent. Inter rater reliability
- low validity - 2 independently assess 100 participants - 68 ICD and 39 DSM
- gender bias - men diagnosed more than women - women mask symptoms
What is diagnosis reliability?
A diagnosis must be repeatable
What is test-retest reliability?
Clinicians reaching the same conclusion at 2 different points in time
What is inter - rater reliability?
Different clinicians researching the same conclusion
How is inter-rater reliability measured?
Kappa score
Perfect 1
Describe Copeland’s research into cultural differences
134 US
194 UK
Description patient given
69% US diagnosed
2% UK diagnosed
What is symptom overlap?
Symptoms of sz found in other disorders
Depression bipolar
What is co-morbidity?
The extent 2 or more conditions can occur at the same time
What is the genetic basis of schizophrenia study?
Family studies
Gotterman - large scale
Aunt 2%
Sibling 9%
Identical twin 48%
Evaluation of Gotterman
Family share the same environment
Nature v nurture
What is the candidate gene schizo
Polygenic - require several genes
Ripke et al - 108
What is mutation in schizophrenia
In parent DNA
Correlation between parental age and risk
Evaluation of the genetic basis of schizophrenia
+ streng evidence - family studies, twin studies
- environmental risk - birth complications, childhood trauma
What are neural correlates: the role of dopamine
Features in functioning of brain system related to symptoms
What is the original DA hypothesis
Hyperdopaminergia associated with subcortex
Hallucinations and poverty of speech e.g. Broca’s area
What is the updated DA hypothesis
Hypodopaminergia linked prefrontal cortex - explain negative, early stress
Evaluate the role of dopamine
+ support - antipsychotic reduce symptoms, candidate genes produce DA, dopamine involved
- role of glutamate - post mortem and scanning, raised glutamate, role of other neurotransmitters
Psychological explanations - Family dysfunction - schizophregenic mothers
Rejecting and controlling create tension and secrecy.
Lead to distrust, paranoid delusions and schizophrenia
What is the double bind
Bateson et al - child trapped, fear wrong thing, get wrong, punished by withdrawal of love
Lead disorganised thinking
What is expressed emotion
Verbal criticism, hostility, over-involvement and stress
Evaluate family dysfunction
+ evidence - schizophrenic disproportionately likely to have insecure attachment, around 60% history of abuse
- poor evidence - no evidence support traditional family based theories, based on clinical observations, cannot explain link
What are the cognitive explanations - dysfunction thought
Low level informational processing suggest cognitive impairment
Metarepresentation leads to hallucinations
Dysfunction recognise own thoughts. And lead to hearing voices
Central control to speech poverty
Derailment of thought, each trigger automatic associations they cannot suppress
Evaluate cognitive explanations
+ evidence - compare performance on cognitive tasks. SZ took 2x as long
- proximal origins explained - what happening now, possible genetic / family, only partial explanation - reductionism
Biological therapy - typical antipsychotics
Dopamine antagonists - aim reduce actions of dopamine
Block dopamine receptors in synapse
Chlorpromazine sedation - clam anxious patients when first admitted
Biological therapy - atypical antipsychotics
Newer drug - maintain and improve effectiveness
Clozapine on dopamine, Glutamate on serotonin - reduce depression and anxiety
Risperdone as effective but safer - clozapine involves deaths
Evaluate biological therapy of schizophrenia
+ evidence for effectiveness - associated better functioning and reduced severity
- counter - short term effects, some published multiple times, benefit due to calming effect
- side effects - dizziness, agitation, weight gain, can be fatal
Psychological therapy - CBTp
Identify and change irrational thought
Understand - normalisation explains client that hearing voices is ordinary
Evaluation of CBT
+ evidence - reduction in auditory hallucinations
+ quality - different techniques for different symptoms, treating particular person
+ nomothetic
Psychological therapy - family therapy
Reduce negative emotions - anger and guilt which create stress
Improve family ability to help - family belief, balance between care and maintaining life
Psychological therapy - family therapy
Reduce negative emotions - anger and guilt which create stress
Improve family ability to help - family belief, balance between care and maintaining life
Evaluation of family therapy
+ evidence - relapse rate reduced by 50%
+ benefit whole family - negative impact on family
Management of schizophrenia
Token economies - gift for every good act then exchanged for privileges, used for personal care.
Related behaviour and social behaviour
1. Quality of life
2. Normalises behaviour
Operant conditioning - reinforces
Evaluation of management of schizophrenia
+ effectiveness - reduction negative symptoms, decline in frequency of unwanted behaviour
- ethical issues - control peoples behaviour, restrict pleasure of already ill people
- more pleasant alternatives - art therapy, pleasant experience, no side effects
The interactionalist approach - diathesis stress
Vulnerability and trigger
Meehl’s model - diathesis genetic, someone without schizo gene wont develop
Modern understanding - many genes increase - trauma affecting brain development e.g. cannabis up 7x as effect dopamine
Evaluation of interactionalist approach
+ dual role vulnerability and stress - high criticism implemented cause SZ but only with genetic
- oversimplistic - no schizo gene, stress can include bio
+ real world application - benefit, can help treating
Key study validity and reliability - Rosenhan
8 confederates - 12 different hospitals - said hearing voices - acted normal when on ward - average stay 19 days
Key study validity and reliability - Rosenhan - validity
Normal behaviour misinterpreted as abnormal to support idea that pseudopatients had mental illness. Validity low and DSM flawed
Key study validity and reliability - Rosenhan - reliability
Cannot tell difference between schizo and bipolar depression - Same symptoms different illnesses were diagnosed
Neural correlates example
Brain scanning techniques
Positive correlation the superior temporal gyrus and auditory hallucinations
Evidence that brains are different - neural correlates
Torres - ventricles in schizo are 15% larger than those without
