Topic 8 - Schizophrenia Flashcards
What is schizophrenia?
A psychotic disorder marked by secretly impaired thinking, emotions and behaviours.
Schizophrenia parents and typically unable to what?
Filter sensory stimuli and may have enhanced perceptions of sounds, colours and other features of the environment.
What are positive symptoms and give examples?
They enhance typical experience of sufferers and occur in addition to their normal experiences. Eg. Hallucinations and delusions.
What are negative symptoms and give examples.
Take away from the typical experience of sufferers, and so represents a ‘loss’ of experience. Eg. Speech poverty and avolition.
What are hallucinations?
A distorted view/ perception of real stimuli or perception of stimuli which have no basis in reality.
What are auditory hallucinations and what causes them?
Hallucinating the voices of loved ones or the deceased and are thought to be caused by an excess of dopamine receptors in Broca’s area.
What are delusions and give an example?
A set of beliefs with no basis in reality at all. Eg. the sufferer believes they are being stalked by the royal family.
What are the different types of delusions?
Persecutory, grandeur, jealousy, erotonomania and somatic delusion disorders.
What is speech poverty?
When there is an abnormally low level of the frequency and quality of speech. A common type is derailment which is thought to be caused by dysfunctions in the central control (Firth et al 1992).
What is avolition?
A subjective reduction in interests, desires or goals. The inability to cope with the normal pressures and motivations associated with everyday tasks.
What are the two types of classification systems for mental disorders?
The diagnostic and the statistical manual (DSM) and the international classification of disease.(ICD)
What does the DSM-V require?
- 1 positive symptom must be present for a significant period of time during a 1 month period, + 1 other positive or negative symptom, for diagnosis,
- Disorganised speech (positive)
- Used to have subtypes but not in this version.
What does the ICD require?
- 2 or more negative symptoms are sufficient for diagnosis.
- Speech poverty (negative)
- A range of subtypes are recognised e.g.
Paranoid schizophrenia – powerful hallucinations/delusions but few other symptoms.
Hebephrenic schizophrenia – primarily negative symptoms.
Catatonic schizophrenia – disturbance to movement.
What is Co-morbidity?
Two or more conditions occurring together. Co-morbidity calls into question the validity of diagnosis because they could actually be a single condition.
What is Symptom overlap?
Symptoms of schizophrenia also being symptoms of other conditions.
What is gender bias?
A particular gender being diagnosed more prevalently than others.
What is cultural bias?
A particular races/cultures being diagnosed more prevalently than others.
What did Cheniaux et al. (2009) do and explain findings?
Had 2 psychiatrists diagnose 100 patients using both DSM and ICD criteria.
One diagnosed 26 with schizophrenia using DSM and 44 with ICD.
The other diagnosed 13 with DSM and 24 using ICD.
This shows poor inter-rater reliability.
What did Rosenhan (1973) do and what did he find?
sent 8 people into a psychiatric hospital and report that a voice said words like ‘thud’, ‘empty’, or ‘hollow’. Then when admitted they acted ‘normally’. All except 1 were diagnosed with schizophrenia and stayed for between 7 to 52 days.
Rosenhan then told institutions to expect other individuals to try and get admitted. 41 were suspected of being fakes and 19 of those had been diagnosed by 2 members of staff. In fact, none had been sent at all. Rosenhan then told institutions to expect other individuals to try and get admitted. 41 were suspected of being fakes and 19 of those had been diagnosed by 2 members of staff. In fact, none had been sent at all.
What did Buckley et al. (2009) find?
He concluded that around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%). PTSD occurred in 29% of cases and OCD in 23%.
This challenges both classification and diagnosis of schizophrenia.
What did Longenecker et al. (2010) conclude?
He concluded that since the 80s, men have been diagnosed with schizophrenia more often than women (prior to this there appears to have been no difference).
This could be due to men being more genetically vulnerable, or a gender bias in diagnosis.
What did Cotton et al (2009) find?
He found that female patients typically function better than men when suffering with schizophrenia. They are more likely to work and have good family relationships.
This could explain why women could be underdiagnosed.
What did Escobar (2012) suggest?
Suggested that (overwhelmingly white) psychiatrists may tend to over-interpret symptoms and distrust the honesty of black people during diagnosis.
What was the Anti-psychiatry movement?
Some believed in this as they disagreed with the use of asylums, or the idea at the time that homosexuality was a mental illness, or the use of electric shock treatments.
What are the main 3 biological explanations?
- Genetics.
- Dopamine hypothesis.
- Neural correlates.
Explain the genetic theory?
This theory suggests that schizophrenia may run in families. Gottesman (1991) suggests that there is a strong relationship between the degree of genetic similarity and shared risk of schizophrenia. Schizophrenia is likely to be polygenic – it requires a number of genes to work in combination.
What does aetiologically heterogeneous mean?
Different combinations of genes can lead to the condition.
What did Ripke et al (2014) do?
- Combined all previous data from genome – wide studies of schizophrenia.
- 37,000 patients compared to 113,000 controls.
108 separate genetic variations were associated with an increased risk of schizophrenia. - Genes associated with increased risk included those coding for the functioning of a neurotransmitters including dopamine.
There are three areas of research for biological explanations, what are they and explain.
- Family studies – the more closely related someone is, the more vulnerable they are. E.g. Gottesman 1991
- Twin studies – Joseph (2004) MZ 40.4% vs. DZ 7.4% concordance.
- Adoption studies – disentangle environment and genes. Looks at genetically related children but they have grown up apart - Tieranari et al (2000) 6.7% of adopted children with schizophrenic mother were diagnosed themselves. Only 2% of controls (non-schizophrenic mother) were diagnosed
What is the dopamine hypothesis?
Focusses on high levels or activity of dopamine (hyperdopaminergic) in the subcortex which leads to symptoms of schizophrenia.
● At the synapse, too much dopamine is released.
● There are abnormally high numbers of D2 receptors on receiving neurones.
● E.g. this occurring in Broca’s area (responsible for speech production) may be associated with poverty of speech and/or auditory hallucinations.
Explain more recent versions of dopamine hypothesis.
Focusses on abnormal dopamine systems.
● Could be high levels in certain areas relating to positive symptoms.
● However, Goldman-Rakic et al. (2004) identified a role in low levels of dopamine (hypodopaminergic) in the prefrontal cortex (responsible for thinking and decision making) in the negative symptoms of schizophrenia.
There are two psychological explanations. What are they?
1 Family dysfunction:
* Schizophrenogenic mother.
* Double-bind theory
* Expressed emotion.
2 Cognitive explanations
* Dysfunctional thought processing.
Describe Fromm-Reichman (1948) findings about the schizophrenogenic mother.
- This proposed a psychodynamic explanation for schizophrenia.
- She noted that many of her patients had a particular type of parent.
- Schizophrenogenic mother means ‘schizophrenic-causing’.
- This means the mother is cold, rejecting and controlling and creates a family climate characterised by tension and secrecy. This leads to distrust which develops into paranoid delusions and ultimately schizophrenia.
What is the double-bind theory and who proposed this?
(Bateson 1972)
Due to confusion in thinking within the family, the individual makes this their normal thinking.
The situation cannot be resolved by the individual so becomes a double bind (they cannot act in one way or the other without going against their parents’ apparent wishes).
Bateson said that children who frequently receive mixed messages from their parents are more likely to develop schizophrenia. The child struggles to respond because one message invalidates the other. This prevents the development of a coherent construction of reality and develops over time as a schizophrenia symptom. He claimed this is a risk factor.
What is expressed emotion ?
This is the level of negative emotion expressed towards a patient by their carers.
Contains several elements:
* Verbal criticism of the patient, occasionally accompanied by violence
* Hostility including anger and rejection
* Emotion over – involvement in the life of the patient, including needless self-sacrifice.
* May be trigger for the onset of schizophrenia for those who are vulnerable.
Give supporting evidence for expressed emotion.
- Kuipers et al 1983
- High EE relatives talk more and listen less.
- High EE influences relapse in patients with schizophrenia.
- Linszen et al 1997
- A patient returning to a high EE family is approx. 4 times more likely to relapse than if the family is low EE.
Could be due to a low tolerance for intense environmental stimuli.
Causes stress beyond the patients coping strategies and triggers a schizophrenia episode.
What are cognitive explanations?
Based around the idea of faulty information processing and faulty thinking.
What did Frith et al 1992 find? Hint: 2 types of dysfunctional thought processing.
Meta representation – the cognitive ability to reflect on our own thoughts, gives us insight into our own intentions, helps us interpret the actions of others.
* Disrupts the ability to recognise our own actions as our own and not someone else.
* Helps explain hallucinations and delusions.
Central control – the ability to suppress automatic responses while we perform deliberate actions instead.
Schizophrenic patients tend to experience derailment of thoughts. Would struggle with the Stroop task.
What is drug therapy?
Antipsychotic drugs are the most common treatment for schizophrenia.
● Can be taken as tablets or syrup form.
● Injections available – useful for those at risk of not taking medication.
● Can be taken short or long term.
● 2 categories; typical (traditional) and atypical (newer) or second-generation drugs.
The first generation of antipsychotics, developed in the ….
1950s.
What did Liu and de Haan (2009) do?
Found that prescribed doses have declined over the last 50 years.
What is the dopamine hypothesis?
● Chlorpromazine acts as an antagonist.
● Antagonists are chemicals that reduce the action of a neurotransmitter.
● Chlorpromazine is a dopamine antagonist – blocks dopamine receptors in synapse.
● To start, dopamine builds up. It then is produced less.
● Normalises neurotransmission in key areas of the brain, reducing symptoms such as hallucinations.
● Chlorpromazine is also an effective sedative.
● Thought to be related to effect on histamine receptors but not fully understood.
● Often used to calm down patients with schizophrenia and other conditions.
What are atypical antipsychotics?
● Second-generation of antipsychotics, used since the 1970’s.
● Rationale was to increase effectiveness but decrease side effects.
● Range of different atypical antipsychotics – not all understood.
● Clozapine – developed in the 60s and trialled in the 70s.
● Works in same way as chlorpromazine by binding to receptors for dopamine.
● Also acts on serotonin and glutamate receptors.
● Improves mood and reduces depression and anxiety.
● Often prescribed when patient is high suicide risk (30-50% of people with schizophrenia attempt suicide).
● May improve cognitive functioning.
Give information about Risperidone .
● Developed in the 90s.
● Attempt to produce a drug as effective as clozapine but without serious side effects.
● Much smaller daily dosage (4-12mg).
● Binds more strongly to dopamine and serotonin receptors.
● Early research ’suggests’ less side effects.
A03 Points for Biological treatments.
- ✅Plenty of support to suggest antipsychotics are at least moderately effective in tackling schizophrenia symptoms.
- ✅Thornley et al (2003) reviewed studies comparing effects of chlorpromazine with control group (placebo). Data from 13 trials (1121 ptps) showed chlorpromazine was associated with better overall functioning and reduced symptom severity.
- ✅Data from 3 trials (512 ptps) showed relapse rates were lower.
- ✅This suggests that drug treatments are successful at reducing symptoms, therefore allowing patients to live relatively normal lives outside of hospitals/institutions.
- ✅Evidence for the effectiveness of clozapine.
- ✅Meltzer (2012) concluded that it was effective in 30-50% of treatment resistant cases, i.e. other drugs had failed.
- ❌Side effects range from mild, to serious, to fatal.
- ❌Typical side effects include dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin.
- ❌Long-term use can result in tardive dyskinesia (involuntary movement of lips and tongue, grimacing, lip smacking).
- ❌Hill (1986) cause this effect in 30% of cases, and irreversible in 75% of those.
- ❌Most serious side effect of typical drugs is neuroleptic malignant syndrome (NMS).
- ❌Thought to be caused because drug blocks dopamine action of hypothalamus (responsible for regulation of a number of body systems).
What is CBT?
Cognitive behavioural therapy,
- 5 to 20 sessions, either individual or in groups.
- Based on the idea that most unwanted thinking patterns, and emotial and behavioural reactions ae learnt over a long period of time.
- Not a cure, just a coping mechanism.
- People schizophrenia can suffer with delusions and maladaptive beliefs.
- CBT encourages patients to develop alternatives to these maladaptive beliefs and delusions.
- Not based on reality.
What did Turkington (2004) do?
CBT is used to gently challenge where a patients paranoid delusions come from.
What is family therapy?
● Linked to schizophrenogenic mother, double bind theory and expressed emotion.
● Takes place within the family, rather than focussing just on individual.
● Some therapists see the family as the root cause of the condition.
● More often, family therapists are focussed on reducing stress within the family that might contribute to relapse – reduce levels of EE.
What did Pharoah et al. (2010) do?
He identified a range of strategies:
● Teaching the whole family to be constructive, undemanding and empathetic.
● Forming an alliance with relatives who care for the person with schizophrenia.
● Reducing the emotional climate and the burden of care for family members.
● Enhancing relatives’ ability to anticipate and solve problems.
● Maintaining reasonable expectations amongst family members for patient behaviour.
● Encouraging relatives to set appropriate limits whilst maintaining some degree of separation when needed.
What is token economy?
● Mainly used on patients who are/have been institutionalised (spent long periods of time in psychiatric hospitals.
● This method can help them with any bad habits/behaviours they may have developed, e.g. poor hygiene, pyjamas all day etc.
● Uses reward systems to manage behaviour.
● Does not cure behaviour but can improve quality of life.
● Awarding of tokens when patients show desirable behaviour – brushing hair, dressing etc.
● Immediate reward = important so it is associated with desirable behaviour.
● Tokens themselves have no value.
● But can be swapped for rewards e.g. watch a movie, sweets, magazine, walk outside of the hospital.
● Tokens are secondary reinforcers – they only attain value when the patient has learned they can be ‘used’ to obtain rewards.
● Positive reinforcement.
● Effectiveness decreases if more time passes between presentation of token and exchange of reward – patient might have become involved in other poor behaviour.
Describe and explain the diathesis-stress model.
Having a vulnerability / a predisposition to develop schizophrenia and having any environmental factor that could trigger the disorder leads to the chances of developing schizophrenia being much higher. Diathesis (vulnerability) is entirely genetic – the result of a single schizogene, which led to a biologically based schizotypic personality – extremely sensitive to stress.
No amount of stress will lead to schizophrenia if the gene is not present.
Who proposed the original diathesis-stress model?
Meehl (1962)
What did Ripke suggest (2014)?
Ripke et al. (2014) there is no single ‘schizogene’ but rather many genes that appear to increase genetic vulnerability.
What did Read et al. (2001) suggest?
Suggested early trauma alters the developing brain.
