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Schizophrenia (Sz) Flashcards

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1
Q

Schizophrenia

A

A mental illness that usually occurs in late adolescence or early adulthood, but it can occur at any time in life. It is classified as a psychosis, as the sufferer has no concept of reality. Essentially the illness is due to a breakdown of the patient’s personality

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2
Q

Psychosis

A

A term used to describe a severe mental health problem where the individual loses contact with reality (unlike neurosis where the individual is aware that they have problems)

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3
Q

Symptoms of Schizophrenia

A
  • Multiple personalities
  • Lack of facial expression
  • Repetitive behaviours
  • Sudden weight loss
  • Loss of interest
  • Bizarre postures
  • Muddling of words
  • Neglect of hygiene
  • Hallucinations
  • Delusions of grandeur
  • Thought insertion
  • Compulsions
  • Avolition
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4
Q

Hallucinations

A
  • Involve disturbances in perception (rather than disturbances in thought) They are false perceptions that have no basis in reality
  • The most common hallucinations are auditory ones (hearing voices) but can include smell, touch and sight
  • Visual hallucinations
  • Seeing distorted facial expressions
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5
Q

Delusions

A

False beliefs that are firmly held despite being completely illogical, or for which there is no evidence

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6
Q

Delusions of persecution

A

The belief that others want to harm, threaten or manipulate you. Schizophrenics may believe that they are being spied on, that nasty rumours are being spread about them or that people are plotting to kill them

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7
Q

Delusions of grandeur

A

This is the idea that you are an important individual, even god-like and have extraordinary powers. One of the most frequent of this type of delusion is the belief that they are Jesus Christ

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8
Q

Delusions of control

A

Individuals may believe that they are under control of an alien force that has invaded their mind and/or body. This may be interpreted, for example as the presence of spirits or implanted radio transmitters

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9
Q

Negative symptoms

A

Cause a decline in functioning. They appear to reflect a loss of normal function.

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10
Q

Speech poverty

A

The inability to speak properly, characterised by a lack of ability to produce fluent words; this is thought to reflect slowing or blocked thoughts. It can manifest itself as short and empty replies to questions.

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11
Q

Avolition

A

The reduction, difficulty or inability to start and continue with goal-directed behaviour. It is often mistaken for apparent disinterest. E.g. no longer being interested in going out and meeting with friends. Sometimes called apathy

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12
Q

Compulsions

A

Behaviours that have to be done. These may be instructions from somebody else.

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13
Q

Mood disturbances

A

Affective flattening - lack of emotion in responses
Inappropriate affect - the wrong emotion for the topic/situation e.g. laughing at a funeral

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14
Q

Positive (adding) symptoms of Schizophrenia

A
  • Hallucinations
  • Delusions
  • Thought disorders
  • Disorganised speech
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15
Q

Negative (taking away) symptoms of Schizophrenia

A
  • Reduction in range and intensity of emotional expression
  • Avolition
  • Asocial behaviour
  • Speech poverty
  • Neglect of hygiene
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16
Q

Positive symptoms

A

Symptoms that are not usually present in a normal person. They reflect an excess or distortion of normal functioning.

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17
Q

DSM

A
  • Diagnostic and Statistical Manual of Mental Disorders (DSM)
  • Used in America
  • Used to recognise the subtypes but the most recent version (DSM-5) have dropped these
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18
Q

Clinical characteristics of Schizophrenia from DSM

A

Criterion A - Two or more of the following symptoms
- Delusions
- Hallucinations
- Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms
- Only one of these symptoms is needed if delusions are bizarre and hallucinations include a voice that constantly commentates

Criterion B - Social/occupational dysfunction

Criterion C - Duration
- Continuous signs of the disturbance persist for at least 6 months

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19
Q

ICD

A
  • International Statistical Classification of Diseases and Related Health Problems (ICD)
  • World Health Organisation
  • UK
  • ICD-10 featured subtypes but the current version (ICD-11) does not contain the subtypes
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20
Q

ICD-10 - Five main subtypes of Sz

A
  • Disorganised
  • Catatonic
  • Paranoid
  • Undifferentiated
  • Residual
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21
Q

Disorganised Schizophrenia

A
  • Generally disorganised behaviour
  • Thought disturbances
  • Absence of expressed emotion, incoherent speech, mood swings, loss of interest
22
Q

Catatonic Schizophrenia

A
  • Severe motor abnormalities
  • Unusual gestures or use of body language
  • Repetitive movements
  • Total immobility for hours at a time, with the patient simply staring blankly
23
Q

Paranoid Schizophrenia

A
  • Delusions (persecution or grandeur)
  • Patient remains emotionally responsive and are more alert
  • Argumentative
  • Least serious but most well known
24
Q

Undifferentiated Schizophrenia

A

Includes patients who do not clearly belong in any other category

25
Q

Residual Schizophrenia

A

Describes people who, although they have had an episode of Schizophrenia during the past 6 months and still exhibit some symptoms but these are not strong enough to put the patient in another category. Symptoms are mild.

26
Q

Rosenhan (1973) Aim

A

To investigate how situational factors affect a diagnosis of schizophrenia. Sane confederates went into psychiatric hospitals and told medical health professionals they had a hallucination, and observed whether staff would realise that they were sane. If staff did not detect their sanity, it would have implications for methods of diagnosing mental illness and show that situational factors affect diagnosis.

27
Q

Rosenhan (1973) Method

A
  • 8 confederates acted as pseudo patients, going to 12 different hospitals. The real participants were the hospital staff who did not know about the experiment.
  • The pseudo patient called the hospital for an appointment.
    -When they arrived they complained of hearing voices saying “empty”, “hollow” and “thud”. They said that the voices were unclear, unfamiliar and of the same sex as the pseudo patient. Pseudo patients gave false names, occupations and symptoms, but gave real life histories.
    -Once on the ward, the pseudo patients stopped pretending symptoms, behaved normally and wrote observations. Pseudo patients were discharged only when they convinced staff that they were sane.
28
Q

Rosenhan (1973) Results

A

On admission, staff diagnosed 11 pseudo patients with schizophrenia, and one with manic-depression. Staff never detected their sanity. Nurses reported their behaviour as showing “no abnormal indications”, but did interpret their behaviour in the context of their diagnosis. The average hospital stay was 19 days. All pseudo patients were discharged with diagnosis of schizophrenia ‘inremission’. 35 real patients detected sanity (e.g., saying “You’re not crazy”).

29
Q

Rosenhan (1973) Conclusion

A

Rosenhan’s research showed that psychiatrists cannot reliably tell the difference between an insane and sane person, calling into question the reliability of a schizophrenia diagnosis. ‘Normal’ behaviour was misinterpreted as ‘abnormal’ to support their idea that the pseudo patients had a mental illness. This suggests the validity of psychiatric diagnoses was low and the DSM was flawed.

30
Q

Follow up study - Rosenhan

A
  • Staff in on hospital were asked to rate patients, seeking admission on a 10 point scale from ‘highly likely to be a pseudo patient’ (1 or 2) to ‘least likely to be a pseudo patient’
  • At this point, they were aware of the previous study and were told that one or more pseudo patients would be sent their way unannounced
  • 41 out of 193 patients received a 1 or 2 score
  • No pseudo patients were actually sent
31
Q

Is Rosenhan’s study reliable?

A

Yes, as all the psychiatrists agreed that the pseudo patients had Schizophrenia

32
Q

Is Rosenhan’s study valid?

A

No, as the pseudo patients were not actually ill.

33
Q

Loring and Powell (Gender bias in the diagnosis of SZ)

A

Loring and Powell (1988) randomly selected 290 male and female psychiatrists to read two case articles of patients’ behaviour and then asked them to offer their judgment on these individuals using standard diagnostic criteria. When the patients were described as ‘male’ or no information was given about their gender, 56% were given a diagnosis of schizophrenia. However, when the patients were described as ‘female’, only 20% were given a diagnosis of
schizophrenia. This gender bias did not appear to be evident amongst the female psychiatrists. This suggests that diagnosis is influenced not only by the gender of the patient but also the gender of the clinician.

34
Q

Criterion validity

A

Do different assessment systems arrive at the same diagnosis for the same patient?

35
Q

Research evidence for criterion validity as an issue surrounding the diagnosis and classification of schizophrenia

A
  • There is a debate as to what causes sz. Research evidence suggests that sz may be the result of a range of differing factors.
  • Sz seems to develop differently in different patients. Some don’t recover whereas some respond well to treatment
  • Evidence indicates that 10% of patients with sz make a significant recovery and have lasting improvement, 20% recover to previous levels and 30% have some improvement but with relapses
  • Ellison and Ross (1995) found that patients with Dissociative Identity Disorder had more symptoms of sz than people diagnosed with sz. Symptom overlap.
36
Q

Morbidity

A

How common an illness is

37
Q

Co-morbidity

A

If conditions occur together a lot of the time, then this calls into question the validity of their diagnosis and classification because they might actually be one a single (combined) condition

38
Q

Research evidence for co-morbidity as an issue surrounding the diagnosis and classification of schizophrenia

A
  • People with sz often disorders as well as sz. This creates difficulty in making a valid diagnosis and in making decisions about treatment.
  • Buckley (2009) found that 50% of people with sz also have depression. 47% of people with sz also have substance abuse
39
Q

Harrison (1997) Culture bias in the diagnosis of sz

A

Found that the incidence rate of sz in African-Caribbean groups in the UK and USA is up to eight times higher than white groups. This may be down to more stressors and worse social conditions, but might be a result of cultural misunderstanding and misdiagnosis by clinicians. For example, some Caribbean cultures believe people should talk to dead friends and relatives; a clinician from another culture may misinterpret this as a symptom of sz

40
Q

Gottesman (1991)

A

Found that genetic similarity and shared risk of schizophrenia are closely related.
Concordance rates

41
Q

What are the concordance rates found in Gottesman’s study

A

General population -1%
MZ twins - 48%
Parents - 6%
Siblings - 9%
DZ twins - 17%

42
Q

Evaluation of twin studies (genetic explanations of twin studies)

A
  • 48% concordance rate is not 100% - must be other factors involved
  • Twins are very rare in the general population and so is schizophrenia. Therefore it is unusual to find twins with schizophrenia. Small samples limit the finding
43
Q

Tienari (2004) adoption study - Finland

A
  • 19,000 Finnish children whose biological mothers had been diagnosed with Schizophrenia
  • Compared to a control group adoptees without a family history of Schizophrenia (low genetic risk)
    Adoptive parents had been assessed for child-rearing were strongly associated with the development of schizophrenia but only in the high genetic risk group
  • Highlights a combination of genetic vulnerability and family stress in the risk factors for schizophrenia
  • This study is only partial evidence because Sz tended to only develop amongst adopted children who were experiencing a particular parenting style
44
Q

Ripke et al (2014)

A
  • The biological location of a specific gene for the cause of schizophrenia has not yet been identified, although several have been implicated in the development of the disorder
  • 37,00 patients vs 113,000 controls
  • 108 separate genetic variations were associated with increased risk of schizophrenia
  • Genes associated with increased risk for sz include those genes which are responsible for coding the functioning of a number of neurotransmitters including dopamine.
45
Q

Evaluation of candidate genes

A

Strength: This is strong evidence for genetic factors being
involved in the cause of Sz. The idea that genetic
factors increasing vulnerability for Sz “has
overwhelming evidence”.

Limitations: However – as ever, it’s not completely clear
cut.
Different studies have identified different
genes that are responsible.
Aetilology means “cause”.
It seems that Sz is “aetiologically
heterogeneous”, ie:

The idea that Sz is aetiologically heterogenous
is supported by the findings of 108 different
combinations of genes being found in those 37,000 cases

46
Q

Genetic causes of schizophrenia without history of the disorder in the family

A

Schizophrenia can also have a genetic origin in the absence of a family history of the disorder. One explanation for this is mutation in parental DNA can be caused by radiation, poison or viral infection

47
Q

Environmental causes against genetic explanations

A

Birth complications
Smoking THC-rich cannabis as a teenager
Childhood trauma

48
Q

Dopamine (DA) Hypothesis

A

The brain’s chemical messengers appear to work differently in the
brain of a patient with Sz. In particular, dopamine is widely believed to be involved.

49
Q

Hyperdopaminergia

A
  • Excess of dopamine
  • In the subcortex (central areas of the brain)
50
Q

Excess of dopamine in Broca’s area

A

May be associated with poverty of speech and/or the experience of auditory hallucinations

51
Q

Hypodopaminergia

A
  • Lack of dopamine
  • In the cortex/prefrontal cortex
  • These areas are responsible for thinking and decision making
52
Q

Strengths of the dopamine hypothesis (Hyperdopaminergia)

A

Post-mortems:

Amphetamines (enhance the actions of
dopamine) – these support the idea of DA being
involved in Sz
If a healthy individual takes lots of these drugs:

This supports the idea that Sz…

Psychology (17 decks)

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