Y2 Chapter 8 Schizophrenia Flashcards
1
Q
Outline what schizophrenia is and who it affects
A
- Schizophrenia is a serious mental illness and affects about 1% of the population
- It distorts contact with reality and impairs the persons insight
- It is more common in men than women and is more commonly seen in working class than middle class
2
Q
Define what’s meant by a negative symptom of schizophrenia
A
- A negative symptom of schizophrenia is where there is a loss in ability or control
- For example, avolition or apathy where the sufferers struggle to keep up with goal oriented behaviour
- Andreason (1982) identified three signs of avolition; poor hygiene, lack of persistence in work or education and lack of energy
- Another negative symptom is speech poverty which is the reduction in the quantity and quality of speech
3
Q
Define what’s meant by a positive symptom of schizophrenia
A
- A positive symptom refers to the addition of an experience
- For example, hallucination or delusions
- Hallucinations refer to unusual sensory experiences that can be pick up by any senses
- Sometimes they relate to the environment sometimes they don’t
- Delusions refer to irrational beliefs and come in a variety of forms
- Paranoia, grandeur, external control
4
Q
What is meant by the DSM-V and the IDC-10 and how do they differ in their classification of schizophrenia
A
- The DSM-V in the American psychiatric association’s diagnostic and statistical manual edition 5 which uses positive symptoms
- One or more positive symptoms must be present to give a diagnosis- The IDC-10 is the World Health Organization’s international classification of disease edition 10
- This requires two or more negative symptoms to be diagnosed
- Also recognises different types of schizophrenia
5
Q
Outline the weakness and limitations of diagnosis of schizophrenia
A
-Issues of reliability in the diagnosis
-Cheniaux et al. Had two psychiatrists independently diagnose 100 patients using both the DSM and ICD criteria
- inter-rater reliability was poor
-One diagnosed 26 using the DSM and 44 with the ICD; the other 13 and 24
- inconsistency is a limitation
-Issues with the validity of diagnosis
-Cheniaux et al showed that schizophrenia is more likely to be diagnosed with the ICD. This means the either the ICD over-diagnoses or the DSM under-diagnoses
-Comorbility
-Two or more conditions can occur together. Calls into question whether they are a single condition
-Bickley et al. 50% of people with schizophrenia had depression and 47% suffer from substance abuse
-If severe depression looks like schizophrenia they could be confused and maybe they should be seen as one condition
-Symptom overlap
-There is considerable overlap of symptoms of schizophrenia and other conditions such as bi-polar
-Calls into question the validity of diagnosis
-Patients would be classed as bi-polar under DSM
and schizophrenic under ICD
6
Q
Is diagnosis of schizophrenia culture bias, if so explain why
A
- African-american and british people of African origin are more likely to be diagnosed with schizophrenia in the uk
- Rates in the west indies and west africa are not so high. Some symptoms are classed as normal behaviour in west africa
- This is culture bias as people from certain backgrounds are more likely to be diagnosed with schizophrenia
7
Q
Outline one biological explanation for schizophrenia
A
- Dopamine appears to be involved in many of the systems implicated in the symptoms of schizophrenia
- The original theory focuses on excess dopamine in the sub cortex e.g. Broca’s area
- More recent theory focus on abnormal dopamine levels as it has been found that low levels of dopamine as the cause for many of the negative symptoms
- Possibly both hyper and hypodopaminergia are involved in schizophrenia
8
Q
Describe what is meant by neural correlates - use examples to illustrate your answer
A
- Patterns of structure or activity found in the brain that occur in conjunction with symptoms
- Juckel et al - found that reduced activity in the ventral striatum was associated with avolition
- This area is responsible for the anticipation of reward, which create motivation
- Without motivation people won’t engage in goal directed behaviour
9
Q
Outline a piece of supporting evidence for biological explanations of schizophrenia
A
- Gottesmean family study showed the close relationship between genetic similarity and shared risk of schizophrenia
- Adoption, family and genetic linkage studies all point towards a role of genetics in vulnerability to schizophrenia
- Tienari et al - schizophrenia may not be entirely genetic but there is lots of evidence to suggest that genetic factors contribute to vulnerability
10
Q
Outline some weaknesses of biological explanations for schizophrenia
A
- Mixed support for the dopamine hypothesis
- Support - Dopamine antagonists can make symptoms of schizophrenia worse, antipsychotics are dopamine antagonists
- Some of the genes associated with schizophrenia code for entirely different chemical e.g. glutamate
- This means the dopamine cannot provide a complete explanation for schizophrenia- Correlation vs causation
- Neural correlates are just correlates
- e.g. negative symptoms may be cause by reduced activity in the ventral striatum or the low activity is the result of low information processing due to an unknown third factor
- Correlates tell us little about the cause of schizophrenia
- Environment is clearly involved
- The probability of developing schizophrenia is only about 50% even for identical twins
- Evidence shows that family factors could also play a role in the development of schizophrenia
- Schizophrenia may be a result of a combination of biological and environmental factors
- Correlation vs causation
11
Q
Explain how family dysfunction might be involved in schizophrenia. Refer to two or more types of family dysfunction in your answer
A
- Schizophrenogenic mother
- Cold, rejecting and controlling
- Environment of secrecy and tension
- Can lead to distrust and paranoid delusions- Double blinds
- Role of communication
- Child receives mixed messages about what to do and trapped in situations where they fear doing the wrong thing
- Can’t ask for clarification
- Punished through withdrawal of love
- Leads to a view of the world as a confusing and dangerous place
- Expressed emotion
- Communication and negative towards the patient from their carers
- verbal criticism, hostility, anger, rejection and over-involvement in life of patients
- Serious source of stress - primary source of relapse
- Double blinds
12
Q
Outline at least two ways in which a cognitive psychologist might explain schizophrenia
A
- Poor metarepresentation
- Metarepresentation is the ability to reflect on thought and behaviour
- insight into interactions and goals allows us to interpret actions of others
- People with schizophrenia have an inability to recognise their actions as being their own- Poor central control
- People with schizophrenia have an inability to suppress automatic reactions while they perform deliberate ones
- Disorganised speach
- They also have an inability to suppress automatic thoughts associated with other thoughts
- Poor central control
13
Q
Outline a supporting study for dysfunctional thought processing
A
- Stirling et al
- Compared 30 patients with schizophrenia to a control group on cognitive tasks
- Patients with schizophrenia took longer to complete the stoop test
- Shows cognitive impairment
- Supports the theory of central control dysfunction
- However, a downside of cognitive explanations is that they tell us nothing about the origin of symptoms
14
Q
Evaluate psychological explanations for schizophrenia
A
- Research into the role of the family
- A large proportion of patients report childhood sexual abuse (Read et al) or insecure attachment (Berry et al)
- Supports the link between upbringing and schizophrenia
- However, the evidence is retrospective
- Symptoms could distort recall
- therefor the research lack validity- Evidence for family based explanations is weak
- Little to no evidence for schizophrenogenic mother or double-bind hypothesis
- In addition, family based explanations may encourage the blaming of the parents whose children develop schizophrenia
- Undermines the appropriateness and credibility of the explanation
- Direction of causality
- It remains unclear whether cognitive aspects are a cause or a result of neural correlates and abnormal neurotransmitter levels
- Evidence for family based explanations is weak
15
Q
What is meant by typical antipsychotics?
A
- E.g. chlorpromazine
- Work by acting as antagonists in the dopamine system –>aims to reduce the action of dopamine
- Works by blocking the dopamine receptors in the synapses
- Initially the dopamine levels build up to make up for the deficit, but then production is reduced
- This normalises neurotransmission in the brain, which reduces positive symptoms
- Also has a sedation effect , useful in anxious patients
16
Q
What is meant by atypical antipsychotics?
A
- More modern form of drug therapy
- Targets dopamine and serotonin
- Designed to reduce side effect while maintaining effectiveness
17
Q
Name and describe two types of atypical antipsychotics
A
- Clozapine
- Acts on dopamine, serotonin and glutamate receptors
- Reduces depression and anxiety while improving cognitive functions, also improves mood- Risperidone
- Developed due to the side effects of clozapine e.g. blood clotting
- Binds more slowly to dopamine receptor
- More effective in smaller doses than clozapine
- Risperidone
18
Q
Evaluate the effectiveness of antipsychotic drugs
A
- They help to reduce symptoms
- Thornly et al
- Chlorpromazine, better functioning and reduced symptom severity than a placebo
- Meltzer et al
- Clozapine is more effective than typical antipsychotics and 30-50% more effective in treatment resistant cases- Exaggerated effect
- Healy et al
- Data from successful trails had been published more than once
- Antipsychotics also have a calming effect
- Easy to demonstrate positive effects without actually reducing psychosis
- Exaggerated effect
19
Q
Outline two limitations of biological treatments for schizophrenia
A
- Side effects
- Antipsychotics are associated with dizziness, agitation, sleepiness, weight gain ect
- Long term use can lead to lip smacking and grimacing due to dopamine sensitivity
- Neuroleptic malignant syndrome
- Caused by blocking dopamine in the hypothalamus
- Can be fatal- Ethical issues
- Drugs are used in hospitals to make the patients calm and manageable instead of their intended use
- This practice is seen as unethical, know as ‘chemical straightjackets’
- No therapeutic value or curing symptoms
- This is unethical as it is controlling their behviour
- Can sometimes be necessary if the patient is causing harm to themselves or others
- Dehumanising and they may not have consented to treatment, as they may no be in a position to give consent
- Ethical issues
20
Q
Name two or more psychological therapies for schizophrenia
A
- CBT
- Family therapies
- Token economies
21
Q
Outline the use of 2 psychological therapies for schizophrenia
A
- Identifies and challenges irrational thoughts
- Could involve discussions regarding how likely the beliefs are to be true and considering less threatening alternatives
- CBT helps patients to make sense of their symptoms and how they impact their behaviour and feelings
- This could reduce anxiety and help patients realises beliefs are not based in reality
- Family therapies help to reduce EE in the family - improvement in communication and interaction
- Reduces stress that could contribute to relapse
- Improvement in family function
- Strategies to reduce the likelihood of relapse included (Pharoah et al 2010)
- Reduction of stress for carers
- Improve the ability of carers to anticipate and resolve problems
- Reduction of guilt
- Improvement of beliefs and behaviours towards schizophrenia
- Tokens are used to reinforce desirable behaviour in patients in long-term care
- This rewards reinforces the desirable behaviour because it is given immediately to reduce ‘delay discounting’
- The tokens are secondary reinforcers as they do not have value themselves but derive value from their associate reward
22
Q
Outline the weaknesses of psychological therapies for schizophrenia
A
- Help but don’t cure
- CBT = makes sense of symptoms
- Family therapy = reduction of stress of living
- Token economies = increases socially desirable behaviour
- All of these should not be confused with cure
- Biological therapies also don’t cure, however they help with symptom severity and therefore may be more desirable- Effectiveness of psychological therapies
- Jauhar eet al. CBT has a small but significant impact on positive and negative symptoms
- McMonagle and Sultana
- Only one in three token economies actually caused improvement in patiens
- Pharoah et al. Reviewed the effectiveness of family therapies
- Moderate evidence for the reduction of hospital admissions over one year and some evidence for the improvement of quality of life, but evidence was inconsitent
- Only moderate support for the effectiveness of psychological therapies
- Ethics
- Token economy systems are contriversail
- Severely ill patients cannot get privileges,as they are less able to comply with desirable behviour
- This discriminates against them
- CBT is used to challenge paranoia
- This could be seen as interfering with freedom of thought
- Contriversail
- Token economy systems are contriversail
- Quality of evidence
- Small scale studies that compare patients before and after therapy show positive results
- These often lack control groups or random allocation
- This means that the effectiveness of psychological therapies may be overestimated
- Effectiveness of psychological therapies
23
Q
Outline the interactionist approach
A
- The diathesis stress model
- Genetic vulnerability paired with trigger causes schizophrenia- meehl
- Vulnerability is due to a schizogene
- Without the gene no amount of stress will cause the disorder
- Modern versions view diathesis as anything that can increase vulnerability e.g. trauma or
- Treatments included using both CBT and drugs
- CBT is usually used to alleviate symptoms whilst drugs tackle to underlying chemical imbalance
- meehl
24
Q
Outline why it might be preferable for a person with schizophrenia to be treated with both drugs and CBT
A
- CBT will help sufferers make sense of symptoms
- Will help patients to cope with their delusions and hallucinations
- Increases compliance with medical regimes (drug therapies)
25
Q
Outline the weaknesses of the diathesis stress model
A
- The original model is oversimplified
- Stress can come in many forms, not just family
- It has also been found that vulnerability can come from trauma as well as genetics, e.g. childhood sexual trauma (Houston 2008)- Challenges the original diathesis stress model
- We don’t actually know how the model works
- Lots of evidence for the role of underlying vulnerability and stress
- Also have lots of evidence for the role of underlying vulnerability and stress
- Also have lots of explanations for how these can lead to symptoms
- However, we do not actually fully understand the underlying mechanisms by which symptoms appear and how they are produced
26
Q
Outline a weakness of the interactionist approach to schizophrenia
A
- Treatment =/= causation
- Turkington et al
- There is a logical fit between the interactionist approach and using combination treatments
- However, just because a combination treatment works, doesn’t meant that approach is corret
- If the underlying cause is neither to do with dopamine or family dysfunction then we are simply suppering symptoms rather than treating the causes
27
Q
Outline a strength of the interactionist approach to schizophrenia
A
- Studies show an advantage to using combination treatments
- Tarrier et al. patients were randomly assigned to 1 of three groups either medication + CBT, medication with supportive counselling or the control group
- Patients in the combination group showed lower symptom levels than the control group
- However, relapse rates were no different
- Superior treatment outcomes
