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A2 Abnormality Psychology > Schizophrenic and psychotic disorders > Flashcards

Schizophrenic and psychotic disorders Flashcards

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1
Q

Define psychotic disorders

A

It is when a person loses their sense of reality through hallucinations and delusions, so they become increasingly withdrawn. Schizophrenia is one of the psychotic disorders.

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2
Q

Diagnosis of schizophrenia

A

One of the following:
Delusions, hallucinations, disorganised speech, catatonic behaviour, negative symptom.
Symptoms present for at least 6 months, cannot be attributed to illegal substances and medication.

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3
Q

List the schizophrenia spectrum and other psychotic disorders

A

Personality disorder (schizotypal), delusional disorder, brief psychotic disorder, schizophrenia, schizoaffective disorder, substance-induced psychotic disorder, psychotic disorder due to another medication, catatonia associated with another mental disorder, unspecified schizophrenia spectrum.

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4
Q

Define hallucinations

A

Sensory experiences that may involve seeing and hearing things that do not exist.

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5
Q

Define delusions

A

Beliefs individuals hold which are not based on reality.

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6
Q

Define affect

A

A person’s feelings or emotions. A ‘flat’ affect can refer to a lack of visible response.

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7
Q

Define delusional disorder

A

A disorder characterised by persistent delusions. Apart from delusions, patients have normal behaviour.

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8
Q

Types of delusional disorder

A

Erotomanic (belief that another person is in love with them), Grandiose (great unrecognised skill or status), jealous (partner is unfaithful), persecutory (person is being conspired against or is in harm,)

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9
Q

Diagnosis of delusional disorder

A

Experiencing symptoms for one month or longer, symptoms unrelated to physiological effects of substance abuse, are not better explained by another disorder.

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10
Q

Case study of schizophrenic and psychotic disorders

A

Conrad age 23 had his first psychotic episode when he was 22. He was diagnosed with schizoaffective disorder.

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11
Q

Define persecutory ideation

A

The process of forming an idea that one is at risk of being harmed by others

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12
Q

Aim of Freeman’s study

A

Usually symptom assessment relied on an interview, but this causes social desirability. To explore the potential use of VR to eliminate such challenges when checking symptoms and developing a treatment for schizophrenia.

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13
Q

Procedure of Freeman’s study

A

VR scene of library or underground train for 5 minutes .
200 non-clinical students
Prior: they measured paranoid thinking, emotional distress by using the 16 items of GPTS.
User takes a ride or walk in the presence of neutral avatars.
Post: measured persecutory thinking through visual analogue rating scales

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14
Q

Results of Freeman’s study

A

High score of questionnaire assessment of paranoia leads to high levels of persecutory ideation and more likely to make negative comments.
People who experienced auditory hallucinations also experienced them in the VR.

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15
Q

Strengths of Freeman’s study

A

High ecological validity
Applicable
High reliability

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16
Q

Weaknesses of Freeman’s study

A

Low ecological validity > aware that it’s virtual
Low generalisability > not target population
Applicability > cannot replicate every setting

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17
Q

Issues and debates of Freeman’s study

A

Good relevance to everyday life but yet to be determined whether it can replace traditional diagnosis .
Cultural bias - some cultures are more tolerant than others in what is considered normal with regard to hearing voices. Social norms, eye contact and personal space vary amongst cultures.

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18
Q

Aim of Gottesman and Shields

A

To investigate to what extent schizophrenia is genetic and to investigate the relative importance of genetic and environmental influences on schizophrenia by comparing MZ and DZ twins.

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19
Q

Procedure of Gottesman and Shields

A

24 MZ twins, 33 DZ twins from one hospital in London.
Age 19-64 years old
Identified as MZ or DZ using blood group and fingerprint
Interviewed parents and twins
Used cognitive tests such as object sorting
Summaries were evaluated by external judges

20
Q

Results of Gottesman and Shields

A

48% of MZ shared schizophrenia status
9% in DZ twins
More likely to be schizophrenic if illness of twin is severe

21
Q

Conclusion of Gottesman and Shields

A

Genes play an important role in schizophrenia because concordance rate is higher in MZ twins than DZ twins.
Environmental factors must be important as concordance rate is not 100%.
Concordance rate for both MZ and DZ twins are higher than general population, proving strong genetic evidence.

22
Q

Strengths of Gottesman and Shields

A
  • High generalisability
  • High reliability > scientific method
  • High application > useful for identifying specific genes
  • Longitudinal
23
Q

Weaknesses of Gottesman and Shields

A
  • Low generalisability > one hospital, cultural bias > culture affects causes and diagnosis
  • Low reliability > self-report data might lead to response bias.
24
Q

Why was the study by Gottesman and Shields conducted?

A

Psychosis has known genetic origins which we call endophenotypes. Thus, schizophrenic symptoms are believed to have genetic markers which may be inherited.

25
Q

Define twin study

A

A study which compares sets of twins to analyse similarities and differences. Both MZ and DZ twins are studied. as well as twins who have been raised together or separately. Results may be compared with other family members to isolate effects of nature and nurture,.

26
Q

State the dopamine hypothesis by Lindstrom et al.

A

Messages from neurons that transmit dopamine fire too easily and too often. Schizophrenic people produce more dopamine than those without disorder and have more D2 receptors on postsynaptic neurons. It identifies a link between excessive dopamine and positive symptoms.

27
Q

What is the role of dopamine?

A

Dopamine plays a key role in guiding attention, so disturbances may lead to attention, perception and thought problems.

28
Q

Evidence to support dopamine hypothesis

A
  • Drugs that increase level of dopamine in the brain correlate with increasing hallucinations and delusions. This worsen positive symptoms. Patients with Parkinson’s disease are treated with a synthetic form of dopamine which is L-dopa. If dosage is too high, it can cause hallucinations.
  • Post-Morten studies help us understand the neurochemistry involved. Brains of deceased schizophrenic patients have large number of dopamine receptors. Their brain fluid had abnormally low levels of enzyme which breaks down dopamine.
  • PET scans found a greater number of receptors in the striatum, limbic system, and cortex of brain in people with schizophrenia. Decreased dopamine correlate with negative symptoms such as flattened effect.
29
Q

Describe how dopamine is transported

A

In this process electrical signal is transferred to chemical energy and is transferred back into electrical signal. Neurotransmitters are stored in vesicles. Dopamine is a neurotransmitter. Once the vehicle binds to the presynaptic neuron, it is released into the synaptic cleft. The neurotransmitters bind to the receptor sites on postsynaptic membrane. Some neurotransmitters go through a process called reuptake.

30
Q

Explain the cognitive approach to abnormality

A

It explains the cause of schizophrenia using more complex psychological factors of faulty thought processes such as attention and perception. These factors are based on specific brain mechanisms and schizophrenia develops in individuals where connections between these mechanisms are faulty.

31
Q

Explain Frith’s model

A

People with schizophrenia are cognitively impaired. They are unable to distinguish between actions that are brought by external forces and those that are generated internally. This is abnormality of self-monitoring.

  1. inability to generate willed action: cannot translate intention to action.
  2. Inability to monitor willed action: cannot understand origin of their cognitions and actions.
  3. Inability to monitor the beliefs and intentions of others: lack theory of mind. .

This is due to a functional disconnection between areas of the brain that control action and perception.

32
Q

How did Frith prove his theory?

A

He detected changes in blood flow in the brains of people with schizophrenia when engaged in specific cognitive tasks. This demonstrates an overlap between cognitive and biological explanations.

33
Q

How did Frith explain positive symptoms?

A

Auditory hallucinations are caused from inability to monitor willed action when they misattribute inner speeches. This can lead to delusions.

34
Q

How did Frith explain negative symptoms?

A

They are due to failure to initiate willed action such as avolition (cannot complete self generated tasks.)

35
Q

Describe the biochemical treatment of schizophrenia

A

Typical antipsychotics work by block dopamine and serotonin receptors in 2 areas of the brain. After 2-3 weeks, patients often report diminished positive symptoms. Atypical antipsychotics work by binding to specific types of dopamine receptors without activating them. This is less likely to produce side effects such as EPS (extrapyramidal) and TD (tardine dyskinesia), but as effective. It still has rare side effects such as blood disorders.

36
Q

Describe ECT treatment for schizophrenia

A

A current of 0.6 A is passed through the brain for 45 seconds, which causes a seizure for a minute. It is usually given 3 times per week for 5 weeks. Muscle relaxant and anesthetic are used for safety reasons. Instead of applying ECT bilaterally, it is now usually applied unilaterally to prevent memory loss. This is done by placing one electrode on the temple and the other on the forehead. It affects central nervous system and cardiovascular system which can lead to memory loss and neurological damage. One theory is that it affects post-synaptic responses to central nervous system transmitters. ECT can be effective for catatonic symptoms.

37
Q

Describe the token economy (Paul and Lentz) treatment for schizophrenia

A
  • Investigates operant conditioning strategy to reinforce appropriate behaviours.
  • Type of behaviour modification therapy
  • Used independent groups to compare milieu therapy, traditional hospital management and token economy with chronic admissions.
  • Given token as a reward for appropriate behaviours such as self-care.
  • Can be exchanged for primary reinforcers such as sweets. Tokens act as secondary reinforcers.
  • Token may be taken away to punish.
  • Monitored through time sample observations, questionnaire scale, and interviews.
  • Conducted for 4 and a half years.
  • 97% of the token economy group were able to live independently for many years, higher than other groups.
  • It is effective for managing symptoms and ensure good potential for discharged patients.
38
Q

Strengths of the token economy treatment

A
  • Reliable > intensive staff training (issued with manual) , standardized
  • Applicable
  • Longitudinal
39
Q

Weaknesses of the token economy treatment

A
  • Low ecological validity > requires rigorous reinforcement

- Ethical issues > denying privileges to punish patients.

40
Q

Describe cognitive behavioral therapy (Sensky)

A
  • Psychological disorders result from irrational thinking
  • Behavioural assumption that what is learned can be unlearned
  • Behavioural therapy which aims to help patients recognize the thoughts that underlie their behaviour.
  • Effective for reducing distress for those who did not respond to medication.
41
Q

Why is it called CBT?

A

It treats mental health disorders by incorporating both cognitive Ned behaviour it’s approaches to psychology.

42
Q

Describe the process of belief modification in CBT

A

-Patients can be persuaded j to substituting more rational interpretations for their irrational ones.
-Therapist engages patient and gets to know their symptoms.
-They explore what triggers the symptoms and work on rationalizing their irrational beliefs.
-Patient keeps diaries and will be given homework to develop understanding of symptoms.
-Patients are taught coping strategies to manage symptoms.
-

43
Q

Evaluate appropriateness of CBT

A
  • Does not cure schizophrenia on its own
  • Improve patient’s response to drug treatments, increase adherence and improve self esteem.
  • Reduce likelihood of rehospitalisation
  • No side effects but may have delayed effects. Patients need to commit to lengthy course.
  • Not appropriate for people with rigid thinking and demotivated people.
44
Q

Evaluate effectiveness of CBT using case study of Sensky

A
  • Randomised control trial by comparing with control group ‘befriending’
  • 90patients, 16-60 years old from 5 clinical services. Received 19 sessions.
  • Experienced nurses.
  • After the sessions, patients kept voice diaries to generate coping strategies.
  • Assessed by blind eaters before treatment, after treatment and 9month follow up.
  • Used standardized scales such as CPRS and SANS.
  • Both group showed significant reduction in all symptoms.
  • Follow up: CBT improved only.
45
Q

Strengths of CBT

A
  • High validity > Blind raters
  • Representative
  • Reliable

A2 Abnormality Psychology (2 decks)

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