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SZ Flashcards

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1
Q

diagnosis

A
  • DSM-5
  • ICD-11
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2
Q

DSM-5

A
  • american
  • 1 positive symptom
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3
Q

ICD-11

A
  • universal
  • 2 negative symptoms
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4
Q

positive symptom

A
  • adds on to daily life
  • hallucination
  • delusion
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5
Q

hallucination

A
  • false sense of reality
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6
Q

delusion

A
  • irrational beliefs
  • paranoid
  • delusions of grandeur - i am god
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7
Q

negative symptom

A
  • takes away from everyday life
  • avolition
  • speech poverty
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8
Q

avolition

A
  • loss of motivation
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9
Q

issues in diagnosis and reliability

A
  • good reliability
  • low validity
  • co-morbidity
  • gender bias
  • cultural bias
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10
Q

good reliability

A
  • findings consistent
  • flavia - 180 individuals with SZ using DSM-5
  • interviewed
  • inter-rater reliability +.97
  • test-retest reliability +.92
  • sure that diagnosis is consistently applied
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11
Q

low validity

A
  • set out to measure what its supposed to
  • cheniaux - 2 psychoatrists independently assess same 100 ps using ICD-11 and DSM-5
  • 68 diagnosed under ICD-11
  • 39 under DSM-5
  • suggest either under/over diagnosed
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12
Q

co-morbidity

A
  • If conditions occur together a lot it questions the validity of their diagnose and classification
  • might actually be a single condition
  • SZ commonly diagnosed with other conditions
  • ½ diagnoses had also been diagnosed with depression or substance abuse
  • means SZ may not exist as a distinct condition
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13
Q

gender bias

A
  • men more commonly diagnosed
  • genetic explanation - men more vulnerable
  • more likely - women have closer relationships and receive more support
  • leads to women functioning better than men
  • under-diagnosis of women - dont receive the support
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14
Q

cultural bias

A
  • hearing voicing have different meanings in different cultures
  • Haiti - voices from ancestors
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15
Q

biological explanation

A
  • genetic basis
  • neural correlates
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16
Q

genetic basis

A
  • family studies - risk of SZ increases in line with genetic similarity to relative with SZ
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17
Q

gottesman

A
  • Large scale mercantile family studies
  • Concordance rates of SZ MZ twins 48%
  • Parents 6%
  • Shows biological structures hold an influence
  • Concordance rates not 100% for MZ shows there are environmental factors
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18
Q

candidate genes

A
  • Number of different genes involved
  • SZ is polygenic
  • The most likely genes would be those coding for neurotransmitters including dopamine
  • Ripke – conducted meta-analysis and found 108 separate genetic variations were associated with increase risk
  • Different studies have different candidate genes it also appears that SZ is aetiologically heterogenous
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19
Q

role of mutation

A
  • Positive correlation between parental age and increased SZ risk
    -Brown – SZ risk 0.7% with fathers under 25, 2% in fathers over 50
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20
Q

genetic basis evaluation

A
  • research support
  • environmental factors
  • genetic counselling
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21
Q

research support

A
  • Family studies – Gottesman show that risk increases with genetic similarity to a family member with SZ
  • Adoption studies show that biological children with SZ are at heightened risk even if they grow up with adoptive parents
  • Shows that some people more vulnerable to SZ as a result of their genetic makeup
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22
Q

environmental factors

A
  • evidence to show that environmental factors also increase the risk of developing SZ
  • Biological risk factors- birth complications and smoking cannabis in teenage years
  • Psychological risk factors include – childhood trauma – vulnerable to mental health problems when older
  • Morkved – 67% of people with SZ and related psychotic disorders reported at least one childhood trauma, 38% in control group
  • Means genetic factors alone cant provide a complete explanation for SZ
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23
Q

genetic counselling

A
  • If 1+ of our parents have a relative with SZ they risk having a child who would go on to develop the condition
  • risk estimate provided by genetic counselling is just an average figure
  • wont really reflect the probability of a particular child going on to develop SZ because they will experience a particular environment which also has risk factors
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24
Q

neural correlates of SZ

A
  • dopamine hypothesis
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25
Q

original dopamine hypothesis

A
  • Based on discovery that drugs used to treat SZ (antipsychotics) caused symptoms similar to those in people with Parkinson’s disease
  • SZ may be the result of high levels of hyperdopaminergia in subcortical areas of the brain
  • Brocas area responsible for speech production links to speech poverty
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26
Q

updated version

A
  • Davis proposed the addition of cortical hypodopaminergia can explain symptoms of SZ
  • Low DA in prefrontal cortex could explain cognitive problems
  • Cortical hypodopaminergia leads to subcortical hyperdopaminergia
  • Explains links between abnormal DA levels and symptoms current versions of dopamine hypothesis try to explain the origins of abnormal DA function
  • Seems that both genetic variations and early experiences of stress, psychological and physical make some people more sensitive to cortical hypodopaminergia and hence subcortical hyperdopaminergia
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27
Q

neural correlates evaluation

A
  • evidence for dopamine
  • glutamate
  • amphetamine psychosis
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28
Q

evidence for dopamine

A
  • Amphetamines increase DA and worsen symptoms in people with SZ and induce symptoms in people without
  • Antipsychotic drugs reduce DA activity and reduce the intensity of symptoms
  • Some candidate genes act on the production of DA or DA receptors
  • Strongly suggests that dopamine is involved in the symptoms of SZ
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29
Q

glutamate

A
  • oversimplified
  • Evidence for a central role of glutamate
  • Post-mortem and live scanning studies have consistently found raised levels of neurotransmitter glutamate in several brain regions of people with SZ
  • Several candidate genes for SZ are believed to be involved in glutamate production or processing
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30
Q

amphetamine psychosis

A
  • Induced SZ like symptoms in rats using amphetamines and then relived symptoms using frugs that reduce DA action
  • Supports dopamine hypothesis
  • However other drugs that increase DA levels don’t cause SZ like symptoms
  • Garson challenged idea that amphetamine psychosis closely mimics SZ
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31
Q

psychological explanations

A
  • family dysfunction
  • cognitive explanation
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32
Q

family dysfunction

A
  • SZ causing mothers
  • SZ due to issues in childhood
  • mothers - cold, rejecting
  • creates tense environment
  • double blind
  • expressed emotion
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33
Q

double blind

A
  • caused by poor communication
  • child recieves mixed messages about right choice
  • child sees world as confusing
  • diorganised thinking + delusions
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34
Q

expressed emotions

A
  • high hostile EE creates stressful environment
  • exaggerated involvement
  • negative emotions expressed by caregiver to patient
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35
Q

family dysfunction evaluation

A
  • research support
  • explanations lack support
  • parent blaming
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36
Q

research support

A
  • Indicators of family dysfunction include insecure attachment and exposure to childhood trauma especially abuse
  • read - 69% of women 59% of men with SZ have a history of physical/ sexual abuse
  • Morkved study – most adults with SZ reported at least 1 childhood trauma, mostly abuse
  • Strongly suggests that family dysfunction makes people more vulnerable to SZ
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37
Q

explanations lack support

A
  • Almost no evidence to support the importance of traditional family-based theories such as SZ mother and double blind
  • Both theories based on clinical observation of people with SZ and also informal assessment of their mothers personalities but not systematic evidence
  • Means that family explanations have not been able to account for the link between childhood trauma and SZ
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38
Q

parent blaming

A
  • Unethical
  • Undermine the ability of mother to help the patient get better/ through recovery
  • Mothers feel high level of guilt
  • Reductionist – only looks at psychological level
  • Outdated
  • Highly socially sensitive because it can lead to parent blaming
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39
Q

cognitive explanations

A
  • dysfunctional thinking
  • metarepresenational dysfunction
  • central control dysfunction
40
Q

dysfunctional thinking

A
  • Focuses on role of mental processes
  • Provide possible explanation of SZ as a whole
  • Reduced thought process in ventral stradtum – negative symptom
41
Q

metarepresentational dysfunction

A
  • Frith
  • 2 kinds of dysfunctional thought process
  • Cognitive ability to reflect on thought and behaviour
  • Allows us insight into own intentions and goals
  • Allows us to interpret actions of others
  • Disrupt ability to recognise own actions
  • Explain hallucinations
42
Q

central control dysfunction

A
  • Issues with cognitive ability to supress automatic responses while we perform deliberate actions
  • Speech poverty and thought disorder could result from inability to supress automatic thoughts
  • People with SZ tend to experience derailment of thoughts because each word triggers associations and person cant supress automatic responses
43
Q

cognitive explanations evaluation

A
  • research support
  • proximal explanation
  • psychological or biological
44
Q

research support

A
  • Evidence for dysfunctional thought processing
  • Stirling – compared performance on cognitive task in 30 people with SZ and control of 30 without
  • Included stroop task – participants have to name the font colours of colour words so have to suppress the tendency to read the words aloud
  • As predicted by firth central control theory – people with SZ 2x as long to name colour
  • Means cognitive processes of people with SZ are impaired
45
Q

proximal explanation

A
  • Cognitive explanations for SZ are proximal explanations because they explain what is happening now to produce symptoms
  • Possible distal explanations are genetic and family dysfunction explanations
  • unclear and not well-addressed how genetic variation or childhood trauma might lead to problems with metarepresentation or central control
  • Means that cognitive theories on their own provide partial explanations for SZ
46
Q

psychological or biological

A
  • Cognitive approach provides an excellent explanation for the symptoms of SZ
  • Argument for seeing SZ primarily as a psychological condition
  • But also appears that the abnormal cognition association with SZ is partly genetic in origin and result of abnormal brain development
  • Would suggest SZ is biological condition
47
Q

biological therapy - drug therapy

A
  • antispsychotics
  • typical
  • atypical
48
Q

antipsychotics

A
  • Main type of drug to treat SZ
  • Reduce the intensity of symptoms particularly positive ones
  • Don’t cure – make it manageable
  • 2 types – typical and atypical
  • Administered through tablets, syrup, injections every 2-4 weeks – patient can pick preference
  • more likely to be compliant with their treatment- increase effectiveness, symptoms may prevent them taking some ways
49
Q

typical antipsychotics

A

chlorpromazine
- Works as an antagonist
- Blocks dopamine receptors sites in the synapse by binding to them on the post synaptic neuron
- Initially dopamine is increased before production is reduced
- Reduces positive symptoms of SZ

50
Q

side effects of chlorpromazine

A
  • Mild – dizziness, weight gain
  • Continued use – tardier dyskinesia
  • Severe – 0.1-2%, neuroleptic malignant syndrome – coma – death
51
Q

atypical drugs

A
  • modern drugs
  • aim to minimise side effects
  • clozapine
  • riperidone
52
Q

clozapine

A
  • Binds to dopamine receptors as well as serotonin and glutamate receptors in the synapse – mood changing effect – for patients with suicide risk
  • Helps to reduce the comorbidity of depression and anxiety as well as improving cognitive function
  • Blood tests to monitor blood disorder – agranulocytosis
53
Q

risperidone

A
  • Binds to dopamine and serotonin receptors in the synapse
  • Binds more strongly to receptors sites and so smaller doses can be administered
  • Evidence suggests that there are fewer side effects than other antipsychotics
  • Tablets, syrup or injection
54
Q

drug therapy evaluation

A
  • effectiveness
  • serious side effects
  • ethics
  • mechanisms unclear
55
Q

effectiveness

A
  • Thornley – reviewed studies comparing the effects of chlorpromazine to control conditions
  • 13 trials with 1121 participants showed that chlorpromazine was associated with better overall functioning and reduced symptom severity as compared to placebo
  • Meltzer – clozapine more effective than typical antipsychotic, is effective in 30-50% of treatment-resistant cases where typical antipsychotics have failed
56
Q

counterpoint

A
  • Most studies are of ST effects only and successful trials have had their data published multiple times – exaggerating size of evidence base for positive effect
  • Antipsychotic have powerful calming effects, easy to demonstrate that they have some effect on people experiencing symptoms of SZ
  • Not the same as saying they really reduce severity of psychosis
  • The evidence base is less impressive than it first appears
57
Q

serious side effects

A
  • Typical – dizziness, agitation, weight gain
  • LT use can cause tardive dyskinesia – caused by dopamine super sensitivity causes involuntary facial movements
  • Neuroleptic malignant syndrome – caused when drug blocks dopamine action in the hypothalamus – result in high temp, coma, can be fatal
  • Antipsychotics can do harm, as well as good
58
Q

mechanisms unclear

A
  • We don’t know why they work
  • Understanding is tied up with original dopamine hypothesis – idea that symptoms of SZ are linked with high levels of dopamine activity
  • Now we know it is low levels not high– therefore antipsychotics shouldn’t work
  • means antipsychotics may not be best treatment
59
Q

ethics

A
  • Chemical cosh
  • Patients with severe SZ may not be able to give consent
  • Moncrieff – makes it easier for staff with patent not for benefit of the patient themselves
60
Q
A
61
Q

psychological therapy

A
  • CBT
  • family therapy
62
Q

CBT

A
  • aims to deal with thoughts and behaviour
  • identifies faulty cognition and deals w them
  • normalisation used to decrease anxiety and treat reality of thoughts
  • 5-20 sessions
  • understanding where symptoms come from help hallucinations
63
Q
A
63
Q

CBT evaluation

A
  • evidence of effectiveness
  • quality of evidence
  • doesnt cure
  • ethical issues
64
Q

evidence of effectiveness

A
  • juhar reviewed 34 studies of using CBT with SZ
  • clear evidence for small but significant effects on both positive and negative symptoms compared to control group
  • Clinical evidence from NICE recommends CBT for SZ
  • Means that both research and clinical experience support the benefit of CBT for SZ
65
Q

quality of evidence

A
  • CBT techniques and SZ symptoms vary widely from one case to another
  • Thomas – points out different studies have involved the use of different CBT techniques and people with different combinations of positive and negative techniques
  • Overall modest benefits of CBT for SZ probably conceal a wide variety of effects of different CBT techniques on different symptoms
  • Makes it harder to say how effective CBT will be for a particular person with SZ
66
Q

doesnt cure

A
  • May improve quality of life but doesn’t cure them
  • SZ appears to be largely biological condition, expect psychological therapy just benefits people by improving ability to live with SZ
  • However, studies report significant reduction in severity of both positive and negative symptoms
  • Suggest CBT does more than enhance coping
67
Q

ethical issues

A
  • Therapist essentially has control over patients’ views
  • By challenging the idea of mafia as a controlling government instead
  • Therapy infiltrating into patients’ personal beliefs
  • Changes can be anything – not always beneficial
68
Q

family therapy

A
  • Aims to improve quality of communication and interaction between family members
  • alliance - work to support each other
  • psychoeducation- understand illness
  • reduces negative emotions - reduce stress and improve family ability to help
  • pharaoh identified strategies to help improve functioning of family
69
Q

family therapy evaluation

A
  • evidence for effectiveness
  • benefits to whole family
  • ethical issues
70
Q

evidence for effectiveness

A
  • McFarlane 2016
  • Concluded that family therapy was one of the most consistently effective treatment available for SZ
  • Relapse rates were reduced by 50-60%
  • Clinical advice from NICE recommends family therapy to everyone diagnosed with SZ
  • Means family therapy is likely to benefit to people with early and ‘full blown’ SZ
71
Q

benefits to whole family

A
  • Not just for the benefit of identified patient but for families that provide care
  • Lobban and Barrowclough concluded that these effects are important because families provide bulk of care for people with SZ
  • By strengthening the functioning of a whole family therapy lessens the negative impact of SZ on other family members and strengthens the ability of the family to support the person with SZ
  • Means family therapy has wider benefits beyond positive impact on individual
72
Q

ethical issues

A
  • not suitable for all families
  • eg abusive family
73
Q

management of SZ

A

token economies

74
Q

token economies

A
  • Reward systems
  • Form of behavioural modification where desirable behaviours are encouraged by use of selective reinforcement
  • People given reward (token) for desirable behaviours
  • Tokens are secondary reinforcers and can be exchanged for primary reinforcers
75
Q

avollon and azrin

A
  • ward of women with SZ
  • Every time participants carried out task – making bed, cleaning – where given plastic token
  • swapped for privileges – able to watch film
  • Number of tasks carried out significantly increased
76
Q

institutionalisation behaviours

A
  • tackled with TE
  • improves quality of life in a hospital setting
  • normalises behaviour for when they go back to outside world
77
Q

behaviour modification

A
  • behaviours progressively changed
  • tokens exchanged for primary reinforcers
78
Q

management of SZ evaluation

A
  • evidence for effectiveness
  • ethical issues
  • ART therapy
79
Q

evidence for effectiveness

A
  • Glowacki – identified 7 high quality studies published between 1999-2013 that examined effectiveness of token economies for people with SZ living in hospital settings
  • All studies showed reduction in negative symptoms and decline for unwanted behaviours
  • Supports value
80
Q

counterpoint

A
  • 7 studies are small evidence to base the support of effectiveness on
  • Issue on number of small studies is file drawer problem
  • Leads to bias towards positive published findings because undesirable results have been filed away
  • Problem in reviews that only include small numbers of studies
  • Means that there is serious question over the evidence for the effectiveness
81
Q

ethical issues

A
  • Gives professionals considerable power to control behaviour of patient
  • Involves imposing one person’s norms on to others
    -Eg who likes to look scruffy may have these personal freedoms curtailed
  • Restricting the availability of pleasures to people who don’t behave in desirable way, means seriously ill people have even worse time
  • Benefits for token economies may be outweighed by their impact on personal freedom and ST reduction in quality of life
82
Q

ART therapy

A
  • Existence of more pleasant and ethical alternatives
  • Even if TE can be helpful in management there are other approaches that doesn’t raise same ethical issues
  • art therapy may be good alternative
  • is a high-gain low risk approach to managing SZ
  • Art therapy is pleasant experience without risk of side effects or ethical abuse
  • NICE guidelines recommend art therapy for patients
83
Q

interactionist approach

A
  • acknowledges there are biological, psychological and social factors in development of SZ
  • Biological factors include – genetic vulnerability, neurochemical and neurological abnormalities
  • Psychological factors include – stress, from life events, daily hassles
  • Social factors include - poor quality interactions with family
84
Q

stress model

A
  • Interaction between something that makes you vulnerable and stress
  • Way to present interactionist approach
  • Diathesis means vulnerability
  • Stress means negative experience
  • Stress could include family dysfunction, brain trauma
  • Vulnerability could include family dysfunction, levels of dopamine, brain abnormality
  • Patients’ needs a vulnerability and a stress-trigger to develop SZ
85
Q

meehl model

A
  • single schizogene creates vulnerability
  • if didnt have gene no amount of stress could cause SZ
86
Q

modern understanding of diathesis

A
  • polygenic
  • trauma can also create vulnerability
  • no single schizogene
87
Q

modern understanding of stress

A
  • any potential trigger
  • psychological (parenting) or biological (cannabis)
88
Q

cannabis

A
  • smoking weed
  • 7x likely to develop SZ
  • interferes with dopamine system
89
Q

parenting

A
  • read
  • insecure attachment from birth makes you more vulnerable to SZ
  • childhood trauma affects brain development and increases SZ risk
90
Q

interactionist treatment

A
  • antipsychotics and CBT
  • more effective for severe cases
  • offered combination of therapy
  • need to consider both biological and psychological treatments
91
Q

interactionist evaluation

A
  • support
  • diathesis and stress are complex
  • real world application
92
Q

support

A
  • gottesman
  • 48% concordance rates for MZ twins
  • shows genes and other factors contribute
93
Q

diathesis and stress are complex

A
  • Oversimplified
  • original model portrayed diathesis as single schizogene and portrayed stress as SZ parenting is simplistic
  • Multiple genes in multiple combinations influence diathesis
  • Stress also comes in many forms
  • Diathesis can be influenced by psychological factors and stress can be biological as well as psychological
  • Houston study – childhood sexual abuse emerged as major influence of underlying vulnerability to SZ and cannabis use as the major trigger
  • Multiple factors, both biological and psychological affecting both diathesis and stress supporting modern understanding
94
Q

real world app

A
  • Combination of biological and psychological treatments
  • Drug treatment and therapy
  • Tarrier – randomly allocated 315 participants to medication and CBT or medication and counselling or control group (medication only)
  • Participants in combination groups showed lower symptoms following trial
  • Clear practical advantage to adopting interactionist approach

psychology paper 3 (2 decks)

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