Schizpohrenia Flashcards
Classification and diagnosis A01- DSM and ICD
SZ is a type of psychosis is a severe mental disorder in which thoughts and emotions are impaired so that contact is lost with external reality.
-SZ is characterised by positive symptoms which reflect an excess or restoration of normal functioning E.G hallucinations and delusions
-SZ also characterised by negative symptoms which affect a loss of normal functioning E.G speech poverty and avolition
-there are two main classification systems for the diagnosis one the ICD-10 and the DSM-5
-these two main classification systems classify schizophrenia slightly differently as the DSM-5 needs only one positive symptom to be present while the ICD 10 needs two or more negative symptoms.
Classification and diagnosis of SZ - reliability a01 key study rosenhan
-relability in the context of diagnosing in classifying SZ is ensuring there is consistency in the diagnosis and classification of SZ by different psychiatrists across time and cultures
-The two factors which bring to question the reliability of SZ are cultural differences and inter-rater reliability
-cultural differences: refers to how there are symptoms which would seem acceptable in some cultures and would not receive a diagnosis of SZ
-inter rater reliability: refers to the extent to which two or more mental health professionals arrive at the same diagnosis for the same patients
Co morbidity: refers to the presence of one or more additional disorders or diseases simultaneously occurring with schizophrenia.
-Rosenhan
- wanted to test the validity of diagnosis for mental disorders
- for the study eight ps including himself were recruited as ‘pseudopatients’ which had no past or present symptoms of psychiatric disorders
-all 8 were admitted to 12 different mental hospitals
-the hospital staff did not know about the experiment
- the p patient called the hospital for an ppotiment
- when arrived they complained of hearing voices saying ‘empty’ ‘hollow’ and ‘thud’
-they said the voices were unclear
-once’s admitted to the wards they stopped pretending symptoms behaved normally and wrote observations
-on admission staff diagnosed 11 wth SZ and one with manic depression
- normal behaviour was interpreted in the context of illness
-e.g nursing records suggest writing is pathological
- the study shows psychiatric cannot reliably te;; the difference between sane and insane patients
-and normal behaviour was mis interpreted as normal
- suggests the validity of psycoatric diagnosis was low and DSM was flawed
Classification and diagnosis- validity A01
-refers to ensuring the patient is receiving the correct diagnosis and SZ has been classified correctly
-two factors bring into questioning the validity are symptom overlap, and gender bias.
Symptom overlap: occur when symptoms of SZ are also found in other disorders E.G delusions and evolution occurring both schizophrenia and bipolar disorder
Gender bias: refers to the differential treatment of males and females in the diagnosis of schizophrenia. The diagnostic criteria may be gender biased or clinicians may base their judgements on stereotypical beliefs about gender.
Classification and diagnosis- AO3 culture bias- RELIABILITY rosenhann
research suggests there is a significant variation between cultures when it comes to diagnosing SZ
-Copeland give both US and British psychiatrist a description of patients
-It was found that 69% of the US psychiatrist diagnosed the patient with schizophrenia but only 2% of the British ones administered the same diagnosis
This demonstrates the discrepancies between the two countries in terms of diagnosed and schizophrenia
-Hearing voices is more acceptable in African cultures because of cultural beliefs in communication with ancestors
-However when reported to a psychiatrist from a different culture such as a more western culture these experiences are likely to be seen as irrational which would lead to a diagnosis.
-therefore questioning the reliability of the diagnosis systems put in place
-Rosenhann
- is reliable as he followed a standardised procedure
- his 8 patients were trained in the same way
-reported same symptoms (hearing same voices) and concealed that they had any background in psychology or psychiatry
- in hospital all stopped claiming they heard voices
-ad took secret notes on observations
- therefore increasing the study’s internal reliability as its easy to replicate
Classification and diagnosis- A03 validity gender bias/
- research suggests gender bias is a problem when diagnosing in which clinicians may over diagnose or under diagnosed based on a patients gender.
-males are more likely to be diagnosed with Sz than females
-Women appear to typically function better than men be more likely to work and have a good family relations
-This explains why some women have not been diagnosed with SZ when men with similar symptoms might have
-Lauren and Powell got 290 male and female psychiatrist who were selected to read it to case studies of patient’s behaviour and asked to offer their judgement
When the ps were described as males 56% of the psychiatrist gave a diagnosis of SZ whereas one described as female only 20% gave a diagnosis.
-this supports the idea that gender differences in diagnosis exist
-And appears that because we’re in a better functioning it may bias clinicians to underdiagnose SZ in women
-Therefore threatening the validity of the diagnostic system because many people make it incorrect on no diagnosis based on their gender rather than symptoms.
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Classification and diagnosis A03 - idc and DSM
- criticism that the DSM and icd have poor reliability
-chinziaux at all had two psychiatrists diagnosed 100 patients using the DSM and the ICD
-He found there was poor inter- rater reliability and the findings suggested that the ICD overdiagnosed and the DSM underdiagnosed
-This inconsistency shows is a weakness
Moreover, this study also highlights the issues of validity in the diagnosis
SZ is more likely to be diagnosed in the ICD than the DSM
-A standard way to asses validity is to see if the classification systems arrive at the same diagnosis and this is not true for this study which can have an impact on treatment.
Bio explanations of SZ AO1- genetics
-caused by biological factors like genetics
-It tends to read families with the risk of developing it higher when you have a family member with SZ
-a genetic argument means that the closer relationship to a person with SZ the more likely they are to have it
- not one gene responsible
- polygenic- requires number of genes to work in combo and a number of factors
- studies show that certain genes are responsible for the cause of SZ e.g the NRG3 gene variants interact with both NRG1 and ERBB4
Bio explanations of SZ AO1- dopamine
-suggests excess of this NS can lead to hallucinations and delusions which are common symptoms of SZ
-hypodopaminergia is an excess of dopamine in the and Broca’s area- responsible for speech production so excess may cause auditory hallucinations
-Central areas which are associated with +ve symptoms of SZ
-hyperdomapineriga is low levels of dopamine in the pre-frontal cortex ( responsible for thinking and decision making)
-Idea, more recently as prefrontal cortex is associated with negative symptoms E.G evolution
-Drugs like amphetamine can act as antagonists which increased dopamine and cause symptoms like hallucinations and delusions
-suffered with SZ are thought to have higher no of D2 receptors resulting in more dopamine binding so more neurones firing
Bio explanations of SZ AO1- neural correlates
- brain structure differences correlate with certain psychological disorders like SZ
- originally evidence was limited to post-mortems who had suffered with SZ
Research now uses non-invasive scanning techniques like FMRI which give pictures of brain in action through magnetic fields
-early research was focused on people with SZ having enlarged ventricles. This is associated with the damage to central brain areas and prefrontal cortex which recent scanning studies have linked the disorder.-research focus on suffers of FZ having enlarged ventricles and these were associated with negative symptoms of SZ such as avolition and speech poverty
-negative symptoms EG avolition one areafthe brain though to be involved is the ventral straitum involved in anticipation, emotion processing and reward-based learning
-So logically and abnormality in this area being involved in the development of avolition
+ve symptoms also have neuro correlates
-Alan scanned brained of ps experiencing auditory hallucinations and in compared to control group
-Lower activities in superior Temporal gyrus and anterior syngulate gyrus or found in the hallucination group
Logical to assume reduce activity in these areas the brain is a neural correlate of auditory hallucinations
Bio explanations of SZ AO3- -ve neural, correlation
-evidence in neural is correlational so impossible to establish causation
-It’s possible the SZ symptoms called changes in the brain rather than the other way round
-Also not all patients with SZ have evidence of enlarged brain ventricles and some having enlarged vegetables but do not suffer with schizophrenia
-Weakness makes it difficult to draw further conclusions about role of correlates in cause of SZ so reducing validity of theory and using enlarge vent theory alone to explain SZ is not possible
Bio explanations of SZ AO3- +ve evidence genetic
-Evidence suggesting genetics plays role in development
- grottesman- analysis of twin studies revealed 48% concordance for MZ
- DZ= 17%
-risk of developing SZ is greater for those more closely relate to the SZ
-both parents = 46% chance
-one parent= 16% chance
-sibling= 8%
-Could be argued it’s due to environment as twins tend to have similar upbringing
-However research showed this to be unlikely
-teinari looks adoptees whose mothers had schizophrenia compared to control group
- 10.3% of adopted children who had SZ mother developed SZ in adulthood
-compared to only 1.1% of adopted children who did not have a SZ mother
-Researchers claim this gave a decisive answer that genetics played role and development of SZ
Evidence leans towards genetic role so bio factor do you have a major part to play in SZ
-Specifically research shows genetics increase the likelihood of development with high concordance rates between those who share more genes
-however it’s unlikely that SZ is entirely genetic as the concordance rate for MZ twins was not 100%
-which suggests that genetic factors may predispose but not cause SZ so it cannot be a wholly genetic disorder
Bio explanations of SZ AO3- +ve drugs and dopamine evidence
-supporting evidence shows that drugs increase dopamine activity can increase SZ symptoms
-Amphetamine is one
-Those are exposed to large doses of one of these drugs can develop hallucinations and delusions which are similar to those experience in an SZ episode
-Characteristics tend to disappear with withdrawal
-Simile evidence from drugs which decrease a level of dopamine
-When individuals take the drugs they have reduction in hallucinations and delusion
-Strengthen the argument for domino hypothesis and provides further support for biological factor
-However it’s biologically deterministic and ignores other factors
-Evidence suggests CBT have higher level of effectiveness in treating schizophrenia as a combat disorder. CBT has been proven to have high success rates suggesting there must be a cognitive course behind SZ and it can’t be solely biological.
Bio explanations of SZ AO3- -ve dompaine
Moncrieff suggests evidence is not conclusive
-Despite drugs increasing dopamine they also affect other NTs
-Thus evidence for the job Me now but this is me like in face validity
-No claims is a strong evidence against the hypothesis argues the antipsychotic drugs do not reduce hallucinations and delusions in one third of people
-In addition, those who have normal dome levels still experienced the symptoms
-Thus blocking the receptors of these people have no little effect
-Suggesting that dopamine cannot be the sole cause+ve symptoms suggested by the hypothesis but maybe by other NTs
Psychological explanations of SZ A01- double blind
Many of the psychological explanations of SZ focus on the role of the family
-Family dysfunction explanations claim that the risk of SZ is increased when there are abnormal patterns of communication within the family
- was developed by baetson it suggests that within a family the child receives mixed messages from both parents on right and wrong
-The style means the child is unable to clarify these messages or voice their opinions about unfairness or conflicting messages
-When the child makes a mistake, they are punished through a withdrawal of love/ affection
-Bateson argued this was reflected in the symptoms such as disorganised thinking and paranoid delusion
-It can also lead to a negative reaction from the child of social withdrawal and a flat effect
-He was clear that he viewed these double blind as a risk factor rather than the sole cause of SZ
Psychological explanations of SZ A01- higher expressed emotion
-refers to the level of negative emotion expressed towards a patient by their carers
-Contains several elements;
-Verbal criticism of the patient
-Hostility towards the patient
-and emotional over involvement in the life of the patient
-these high levels of EE are serious source of stress for the patient
-It’s argued that this stress can trigger the onset of SZ in a person who’s already genetically vulnerable to the disorder
-It’s been primarily linked to the course of the disorder rather than being seen as the cause
- High levels in EE carers have been found to lead to poor outcomes and an increased likelihood of relapse as this stress and anxiety may lead them to not take medication or comply to Cognitive therapies and return to such psychotic experiences for the patient.
Psychological explanations of SZ A01- mother
According to Fromm- reichman
- A schizophrenic mother (schizophrenic causing) it’s called rejecting and controlling and tends to cause a family environment characterised by tension and secrecy
-At least it distrust which may manifest itself into para delusions in the child
-often a family skew with a dominant mother and a passive father
Psychological explanations of SZ A01- cognitive
-frith hiloghted how cognitive issues are linked to SZ
-It’s based on mental processes and explains symptoms of SZ being result of disruption of normal thought processes
-evidence has shown dysfunctional thought processing in people with SZ
Meta representation : cognitive ability to reflect on our own thoughts and behaviour
-Believe that dysfunction in this contribute to the onset of hallucinations
-E.G person believes their actions are carried out by others
-May also cause the patient to believe their own inner voices are actually the thought of others being projected in their heads
-Central control:the abilities to suppress or override automatic thoughts actioned in speech in response to stimuli. self control can be faulty impatience with SZ.
-Disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thought
-EG suffered with SZ tend to experiment derailment of thoughts and spoken sentences because each word triggers an association and the patient has difficulty suppressing an automatic response to these.
-patient with SZ will have difficulty resisting urges for example they cannot resistant urge to press a button but they are unable to explain why they chose to do it fully
-Can result in delusions an individual cannot explain why they did something or identify where the thought came from Aunty to create feelings of paranoia
-Line of thought maybe jumbled or sections are missing completely
-Then they question reality in themselves and can’t find internal rational sources for their decision-making
-speech can also be affected
-Conversation topics will frequently shift and change
-May be hard to resist speaking out loud when such thoughts would usually be filtered out or dismissed
-topics can trigger thoughts that are hard as a press and can result in disorganised speech
Psychological explanations of SZ A03- family dysfunction evidence support EE
-tenari assessed adopted children whose biological mothers had SZ compared to control group of adoptee without any genetic risk
-They found when the parenting style of the adoptive family was characterised as highly critical with low levels of empathy. This increased the risk of SZ but being in a healthy adoptive family had a protective effect in those with high genetic risk
-This suggests that EE in families can increase the risk of SZ but also that being low in EE in families can help prevent SZ
Psychological explanations of SZ A03 real world applications - family dysfunction
-means the focus on the role of the family in SZ has led to researchers to develop family therapy CBT for psychosis CBTp to increase the patient’s chance of recovery and decrease the chance of rel
-Evidence comes from NICE who found that the relapse rate in a family therapy condition was 26% compared to 50% relapse in a control group receiving standard care
-Strength as it suggests family dysfunction theories have led to psychological therapies that have benefited peoples live
= by supporting the family it also allows sufferers of SZ a reduced chance of relapse
Psychological explanations of SZ A03- weakness cognitive -lacks explanation
-cognitive theories have been criticised for only identifying the reason for current symptoms
-Theories identify faulty cognition as the cause of some of the symptoms such as disorganised thinking and deficits in the processing but does not explain what led to the cognitive impairments in the first place
-Therefore fault cognition explain symptoms but not cause causes
-Weakness as it suggests we can’t fully explain the cause of SZ using a talkative theory alone
-We have much more evidence for the biological aspect of the causes of SZ
-For example tierne at all compared to adopted children whose biological mother has had SZ compared to a control group of adoptee without any genetic risk
-He found a much higher rate of SZ amongst those whose biological mothers had SZ
-So it may be more logical to conduct that a genetic risk has a higher explanation for why schizophrenia is caused
Psychological explanations of SZ A03 - weakness medication contrite
It’s been suggested that cognitive impairment found in SZ maybe due to antipsychotic medication
-For example medication has serious side-effects that may account for some of the deficits found in patients with SZ
-It’s also been found that cognitive differences are a result of neural correlates and abnormal neurotransmitter levels rather than the cause of schizophrenia
-Therefore it suggests that genetic factors may play a larger role than just cognitive and the biological factors are the cause of the cognitive
-therefore it has a doubt on the belief that cognitions are to blame for schizophrenia
A01 drugs - typical psychotics
-these drugs have been used since the 1950s
-Less popular now due to severe side effects
-And only treating positive symptoms
-e.g chlorpromazine this drug works as a dopamine antagonist
-It binds to the D2 receptors and block them from absorbing dopamine at the synapses
-They improve the positive symptoms and have a sedative effect
-Patients take 400 to 800 mg daily
A01 drugs - typical psychotics
-these drugs have been used since the 1950s
-Less popular now due to severe side effects
-And only treating positive symptoms
-e.g chlorpromazine this drug works as a dopamine antagonist
-It binds to the D2 receptors and block them from absorbing dopamine at the synapses
-They improve the positive symptoms and have a sedative effect
-Patients take 400 to 800 mg daily
A01 drugs - a typical
Drug therapies that started to be used in the nineteen seventies to avoid the most severe side effects of typical antipsychotics
-e.g clozapine this works by blocking dopamine and other neurotransmitters e.g acetylcholine
-They do this by temporarily binding to the D2 receptors and then rapidly dissociate
-These drugs address the negative symptoms of schizophrenia such as avolition
-Patients take 200 to 450 mg daily