Schzophrenia Flashcards
Hallucinations
Hallucinations are visual/auditory unrealistic perceptions of the world.
Delusions
Are unrealistic, and bizarre beliefs which seem real to a person
Delusions of Garnier
When a person believes they are most powerful and important
Disorganized Speech
When a person’s thought processes are abnormal, has problem organizing their thoughts and this becomes evident in their speech
Grossly Disorganized and Catatonic behavior
A person is unmotivated to finish tasks they have started. They may have a decreased interest in personal hygiene. Catatonic behavior is the lack of response to the external environment, may be motor skills
Avolition
Inability to initiate or persist in any goal driven tasks
Speech poverty
The blocking of thoughts and the inability to speak spontaneously
Reliability of Sz
That the diagnosis of Sz must be repeatable, and two clinicians must reach the same conclusions and two different points in time, or when observing (inter-rater reliability)
Cultural differences in Sz (reliability)
-Copeland gave 234 US and 294 UK psychiatrists a description of a patient, in the US 69% diagnosed with Sz whereas only 2% in UK.
-Interviews with 60 patients with diagnosed Sz. 20 from each Ghana, India and the US. US patients and a negative experience but those from India and Ghana reported more of positive hallucinations
Validity in diagnosis
Validity is the extent to which we are measuring what we intend to measure. Using DSM-V and ICD-10, cheniaux found that Sz was more likely to be diagnosed using the iCD10 manual 44- to 26
Co-Morbidity
Refers to how common it is that two or more conditions are diagnosed at the same time. Buckley concluded that 50% of Sz also have depression
Symptom overlap
When one or more symptoms occur in other condition. For example, both bipolar and Sz have positive symptoms such as delusions and negative symptoms like avolition
Gender bias in diagnosis
-Broverman points out that the DVSM manual is gender bias itself. For example, the norm is more healthy male behavior.
Research support for gender bias
Loring and Powell- 290 male and female psychiatrists, when the description was male or gender was not specified, 56% gave a diagnosis of Sz, whereas when female, only 20%, less gender bias was among female psychiatrists
Lack of Inter-rater reliability
Whaley found mental IRR, as low as 0.11
Rosenhan- Sane in insane places study
-Gained admission to mental hospital, told their doctor that they had been hearing voices- “dull, empty, thud”.
-Once in the hospital, the patients behaved normally.
-All patients but one were diagnosed with Sz.
-Eventually all discharged but with the label, Sz in remission
-Follow up study, said more fake patients, detection rate of 21% although none were sent
Twin Concordance Rate for sZ
-The concordance rate for mZ twins is 40% whereby for dZ twins, 7%
-Blind diagnosis have found that when the psychiatrist did not know the mZ, the concordance rate infact dropped
Adoption studies sZ
Studied 164 adoptive families, when the biological mother had sZ. Found that 11 of these developed sZ compared to only 4 out of the control group (197)
Twin studies A03
mZ twins are arguably brought up in a similar environment, which means that nature is not distinct from nature and that cannot say biology is the definite influencing factor in this case.
Adoption Studies A03
Assumes that adoption is not selected, in counties such as Denmark and the US, families know the biological background of the children they adopt. The question is rather who would want to adopt such children
Neural Correlates
Neural correlates refers to the change in neural structures in which contribute to a mental health disorder
The dopamine hypothesis
The dopamine hypothesis is the idea that increased dopamine levels are cause to sZ. This came about because of the increase in dopamine caused by amphetamine, (correlation found)
The dopamine revised hypothesis- Higher amount of dopamine receptors are the cause of sZ
Dopamine Hypothesis A03
-A meta analysis of 212 studies found that antipsychotic in which reduce dopamine levels, were significantly more effective in reducing symptoms, both positive and negative than placebo groups ( Leucht)
-Noll argues that in 1/3 of people with DSz, antipsychotic drugs do not alleviate symptoms, meaning that dopamine hypothesis is limited because D2 receptors were blocked despite this finding
Family Disfunction
A possible cause for sZ is family disfunction, this is abnormal processes within a family such as cold parenting styles and limited communication between family members and high levels of expressed emotion
Double Bind theory
Bateson suggested the double binding theory, this is when a child receives contradictory messages from their parents. This can lead to the child being confused of the world itself (delusions) or the child being unable to respond (flattened affect or withdrawal)
Expressed Emotion
EE is high negative emotion within a family. This may be being over-involved or hostile or verbally critical. Research suggests that family’s with high levels of EE are more likely to have a relapse rate for patients. EE can lead to more stress and inability to cope with their symptoms more so than just with their symptoms alone
Cognitive explanation to sZ
The role of dysfunctional thought processes, particularly in those who display positive symptoms such as delusions and hallucinations
Cognitive explanations to Delusions
Delusions are cognitive distortions in which lead to patient to believe that unrelated external factors are directly related to themselves and thereby leading to false conclusions.
Cognitive explanations to hallucinations
Sz with hallucinations have a high excessive attention to stimuli (hypervigilant) and this causes the expectancy for the event to occur to be higher too. Aleman suggests that hallucinatory prone individuals cannot distinguish between sensory and imaginary based perception. This imaginary van over-ride the sensory and cause the individual to base inner representations outward
Family studies A03
In Tienari adoption study it was found that children with a biological mother with sZ were more likely to develop the condition than those who did not. However, the difference only emerged when the adoptive family was rated as “disturbed”, meaning genetic vulnerability was not the only factor alone, had to be psychological factors too
Double bind theory A03
Berger found that Sz had displayed a higher rate of double bind theory statements from their mothers than non sZ. However this could be reliable as sZ may affect recall. Other studies are less supportive, there has been study where o correlation at all has been found
CBT evidence
NICE recommended CBT as an effective way to treat sZ. They found consistent evidence that CBTp was more effective in improving social functioning than in antipsychotics alone
Integrated model for sZ
The cognitive explanation does not account for neural mechanisms, the integrated model suggests that genetic vulnerability and stressors lead to the dopamine release, thus then causes cognitive bias resulting in hallucinations and paranoier
(Typical) First generation drugs
First gen drugs, treat positive symptoms of sZ by inhibiting D2 receptors. This means that less dopamine is released. However, by doing this, also blocks other dopamine pathways in the brain (mesolimbic pathways). Control motor movements. Causes extrapyramidal movements.
(Atypical) Second generation drugs
-Treat both positive and negative symptoms
-Temporarily block dopamine receptors
-High affinity for serotonin receptors
-Does not cause extrapyramidal movements
Drug therapy A03
-65 studies, 6000 patients, some given a placebo, it is found that within 12 months, 54% in placebo group relapsed compared to 27% of those taking antipsychotics
- Typical drugs- side effects, motor neuron disease in half the patients taking the drug
-Are Atypical drugs better?- Crossley- meta analysis, 15 studies found same improvements, other than patients who took typical drugs put on weight and those who took typical- extrapyramidal drugs
-Ross and Read- Reinforces that there is something wrong with them, far more traumatic experiences than biology
Cognitive behavioral Therapy
- Initial assessment- when patient and therapist form a relationship and discuss goals.
-Incorporation of Ellis’ ABC model
-Normalization- Trying to normalize symptoms
-Critical Collaboration analysis- Challenging a patients irrational thoughts and faulty beliefs, ask questions without causing distress
-Alternative explanations- Giving the patient an alternative to their unhealthy assumptions, new ideas can be constructed with the therapist
CBT A03
-NICE recommend CBT, up to 16 sessions, it is found that more effective than antipsychotic drugs in improving social functioning, and symptom severity.
-A sampling issue with CBT, a study found that only 1/10 who need access to CBT, eventually obtain access, smaller sample size, harder to generalize
-Independent differences- Speech poverty and those with more severe symptoms
-methodological issue, most patients have also been treated with same antipsychotic medication, whether need a combination
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Family Therapy
Family therapy is when the full family engage with the therapist in order to fully understand how to communicate
-pyschoeducation
-reduce emotional climax
-Set boundaries to reduce confusion
Family Therapy A03
-Confusion over if should be combined with drug therapy. Not good alone should be complimented with drug therapy. Therapy, improves social functioning and mental state, but is this because it increases medication compliance
-Relapse rate, 50% compared to 9% after 12 months but after 2 years increased to 75% and 50%
-Practicality- Have to be committed
-Because of lower relapse rates, lower cost, lower hospitalization, and for a sig. period of time
-Family therapy is not a cure
-Pharaoh- Meta analyisis of 53 studies, reduced hospitalization rates for a year and improves quality of life. HOWEVER he also noted inconsistently- tests validity
