Schizophrenia [U9]

Question 1

Cheniaux et al. on diagnosis

Answer 1

• Two Psychiatrists
• Diagnosed 100 patients independently using DSM and ICD
• Psych A : 26 (DSM) and 44 (ICD)
• Psych B : 13 (DSM) and 24 (ICD)
• Poor Criterion Validity between manuals

Question 2

Osorio et al. on diagnosis

Answer 2

• Post-diagnosis interviews with consultants
• 180 diagnoses
• Inter-rater reliability of +0.97
• Test-retest reliability of +0.92 on 2nd diagnosis
• Manuals are consistent

Question 3

Buckley et al. on diagnosis

Answer 3

• Schizophrenia is often comorbid
• Half of patients have other diagnosis
• Depression (50%)
• Substance Abuse Disorder (47%)
• PTSD (29%)
• OCD (23%)
• Not a distinct condition, but an unusual instance of another disorder

Question 4

Symptom Overlap in diagnosis

Answer 4

• Shares symptoms with other disorders
• Positive delusion and negative avolition found in Bipolar disorder
• Hard to diagnose
• Not a distinct condition

Question 5

Cotton et al. in diagnosis

Answer 5

• Gender Bias
• Female : male diagnoses = 1 : 1.4
• Closer social/filial relationships for women is more support (Cotton)
• Better functioning in women
• Better interpersonal skills for symptom masking

Question 6

Culture Bias in diagnosis

Answer 6

• Afro-Caribbean 9x as likely to be diagnosed (Vs. White British in UK)
• Not the case in A-C countries
• Culture bias and meaning of symptoms is cause
• Voices from ancestors/angels in Haiti

Question 7

Morgan et al. & Morkved et al.

Answer 7

• Biological Reductionism
• Cannabis use in teenage years is highest risk factor (Morgan)
• 67% of schizophrenics report one or more childhood traumas. 38% of non-psychotic mentally-ill patients do so too (Morkved)

Question 8

Curran et al. & Tauscher et al.

Answer 8

• Study Support
• Amphetamines (DA agonists) worsen symptoms and cause them in neurotypical patients (Curran)
• Antipsychotics (DA antagonists) improve symptoms and reduce DA activity (Tauscher)

Question 9

McCutcheon et al. on the DA Hypothesis

Answer 9

• Glutamate’s role
• GM found in specific regions of affected’s brain, post-mortem and in live scanning (McCutcheon)
• Candidate genes involved in GM production/processing

Question 10

Thornley et al. & Meltzer

Answer 10

• Efficacy Studies
• Chlorpromazine improved overall functioning and reduced symptom severity against control (Thornley)
• Clozapine more effective that typical. (Meltzer)
• 30-50% effective in treatment resistant cases (Meltzer)

Question 11

Side effects of Antipsychotics

Answer 11

• Tardive Dyskinesia after long-term use
• Neuroleptic Malignant Syndrome (Lack of DA in key areas, like Hypothalamus)
• NMS includes fever, delirium, coma and death
• Fear breeds refusal, especially in the paranoid

Question 12

Ethics of antipsychotics

Answer 12

• Typical is recommended by NICE
• Used as first line treatment in hospitals
• Sedative effect
• Exploitation by staff and inability to consent
• Only see use in extreme cases and to engage with treatment

Question 13

Read & Read et al.

Answer 13

• Trauma predicts schizophrenia
• 69% of women/59% of men with schizophrenia have a physical/sexual abuse history (read et al.)
• Attachment predicts schizophrenia
• Disproportionate quantity of Type C (Resistant) and Type D (Disorganised) in patients

Question 14

Flaws of psychodynamic explanations

Answer 14

• Poor methodology
• Schizophrenogenic mother & Double-Bind are based off of clinical observations and informal assessment
• Subjective and Biassed

Question 15

Social sensitivity of family dysfunction

Answer 15

• Early explanations cause parent-blaming
• Insults parents and families, who are managing schizophrenic children
• But is it worth it to understand the condition and see improvements?

Question 16

Stirling et al. on dysfunctional thought

Answer 16

• Cog. performance between 30 schizophrenics and 30 control
• Stroop test - Say word’s colour instead of reading it
• Schizophrenics took twice as long
• Suggests poor central control

Question 17

Distality of cognitive explanations

Answer 17

• Proximal explanations
• What, but not why
• Distal could look at variation and childhood’s effects on metarepresentation and central control
• More useful than proximal, which are partial explanations

Question 18

Loban & Barrowclough on FT

Answer 18

• Benefits the whole family
• Strengthens family functioning
• Lessens the impact on individual family members
• Improves the family’s ability to support the identified patient

Question 19

McFarlane on FT

Answer 19

• Meta-analysis
• Most consistently effective treatment
• Reduced relapse by 50-60%
• Most effective at start of mental health decline
• Recommended for EVERYONE by NICE

Question 20

Flaws of psychological treatments

Answer 20

• Treatment is expensive
• It’s time-consuming and disruptive to normal life, increasing costs
• Requires motivation and a willingness to engage
• Not accessible to all patients (Orphans/Restarted)

Question 21

Jauhar et al. & Pontillo et al.

Answer 21

• Efficacy studies
• CBT is supported by NICE
• Small, but significant, improvement to positive and negative symptoms across 34 studies (Jauhar)
• Frequency and severity of auditory hallucinations reduced (Pontillo)

Question 22

Thomas on CBT

Answer 22

• CBT isn’t a cohesive treatment
• Different techniques on different patients with different symptom profiles in studies reduces comparability (Thomas)
• Conclusion of modest benefits is erratic
• Cannot predict efficacy for an individual patient

Question 23

Glowacki et al. on TES

Answer 23

• Meta-Analysis
• 7 High-quality studies lasting 4 years
• All demonstrated a reduction in negative symptoms and in the frequency of unwanted behaviours
• But, small sample size

Question 24

Power imbalance in TES

Answer 24

• Professionals control patient behaviour
• Used to impose norms or values as well as to restrict freedoms
• Severest patients suffer heavily when small pleasures are removed
• Short-term decline may outweigh long-term improvement

Question 25

Chiang et al. on TES

Answer 25

• Alternative, more ethical options exist
• Art therapy has low risk and high gain, so is therefore better (Chiang)
• Art therapy is less confrontational, less unethical and more pleasant for patients

Question 26

Tienari et al.

Answer 26

• Studied 19,000 Finnish adoptees with schizophrenic biological mothers
• Assessed adoptive parents for parenting style
• High criticism / conflict AND low empathy associated with condition development in high-risk adoptees

Question 27

Ripke et al. & Houston et al.

Answer 27

• Criticism of the schizogene
• 108 candidate genetic variations (Ripke)
• Stress comes in non-filial forms
• Sexual abuse in childhood is a major vulnerability and cannabis is a major trigger (Houston)

Question 28

Tarrier et al. on treatment

Answer 28

• Combining treatments enhances efficacy
• 315 participants
• Had medicine alone OR medicine and counselling OR medicine and CBT
• Combos had greater symptom severity reduction