Y2 Module 8 - Schizophrenia Flashcards
What is schizophrenia and who does it affect?
Schizophrenia is a serious mental illness that affects 1% of the population. It distorts contact with reality and impairs a person’s insight. It is more commonly diagnosed in men than women and is seen to affect working class more than middle class.
What is meant by negative symptoms of schizophrenia?
Negative symptoms of schizophrenia is where there is a loss in ability or control. For example, avolition or ‘apathy’ where sufferers struggle to begin or keep up with goal directed behaviour. Andreason (1982) identified three signs of avolition; poor hygiene, lack of persistence in work and education and lack of energy. Another negative symptom is speech poverty which is reduction in the amount or quality of speech.
What is meant by positive symptoms of schizophrenia?
Positive symtoms refer to the addition of an experience. E.g. Hallucinations or delusions. Hallucinations refer to unusual sensory experiences that can be picked up from any sense - sometimes they are related to the environment and sometimes they are not. Delusions refer to irrational beliefs and come in a variety of forms. Paranoid, grandeur, external control.
What is meant by the DSM-V and the ICD-10 and how do they differ in their classification of schizophrenia?
The DSM-V is the American psychiatric association’s Diagnostic and Statistical manual edition 5 which uses positive symptoms. One or more must be present to give a diagnoses.
The ICD-10 is the World Health Organisation’s International Classification of disease edition 10. This requires two or more negative symptoms to be diagnosed. Also recognises different types of schizophrenia, eg. paranoid, hebephrenic and catatonic.
Evaluate the theory/diagnosis of schizophrenia.
Issue of reliability with diagnosis. Cheniaux et al. Had 2 psychiatrists independently diagnose 100 patients using both the DSM and ICD criteria - inter-rater reliability was poor. One diagnosed 26 with the DSM and 44 with the ICD; the other 13 and 24 respectively. Inconsistency is a limitation.
Issue of validity in the diagnosis. Cheniaux et al. showed that schizophrenia is more likely to be diagnosed using the ICD - assessment criteria doesn’t arrive at the same conclusion. Schizophrenia is either over-diagnosed in ICD or under-diagnosed in DSM. Poor validity is a weakness.
Comorbidity. When 2 or more conditions occur together - could be the same condition. Buckley et al. found that 50% of patients with schizophrenia have depression and 47% suffer from substance abuse. If very severe depression looks like schizophrenia, it can be confusing for classification. This is a limitation.
Culture bias in diagnosis. African-Americans/people of African descent are more likely to get diagnosed with schizophrenia in the UK. Some behaviours we see as positive symptoms are normal in African culture, e.g. hearing voices. Therefore it has low external validity as individuals from different cultural backgrounds are more likely to be diagnosed with schizophrenia due to bias.
Symptom overlap. There is significant overlap between symptoms of schizophrenia and other conditions. Bi-polar can involve delusions and avolition. The validity of diagnosis and classification is questioned. Patients would be diagnosed with Bi-polar disorder under the DSM and with schizophrenia under the ICD.
Outline one biological explanation for schizophrenia.
Dopamine (DA) appears to be involved in many of the systems implicated in the symptoms of schizophrenia. The original hypothesis focussed on the role of excess levels of dopamine in the sub cortex eg. Broca’s area. More recently the hypothesis has focussed on abnormal dopamine systems. A role of Low levels of dopamine have been identified in the cause of negative symptoms. Possibly both hyper- and hypodopaminergia are involved in schizophrenia.
What is meant by neural correlates?
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 involved in the anticipation of reward, which creates motivation. Without motivation, people won’t engage in goal directed behaviour.
Explain how family dysfunction might be involved in schizophrenia. Refer to two or more types of family dysfunction in your answer.
Schizophrenogenic Mother. Cold, rejecting and controlling. Makes an environment of secrecy and tension. Can lead to distrust & paranoid delusions.
Double-Bind. Role of communication. Child receives mixed messages about what to do & trapped in situation 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 & negative towards the patient from their carers. Verbal criticism, hostility, anger, rejection & over-involvement in life of patient. Serious source of stress → primary source of relapse.
Outline at least two ways in which a cognitive psychologist might explain schizophrenia.
Poor Metarepresentation. The ability to reflect on thoughts and behaviour. Insight into intentions and goals & allows us to interpret the actions of others. Inability to recognise our actions as being our own → hallucinations.
Poor central control. Inability to suppress automatic responses while we perform deliberate actions. Disorganised speech. Inability to suppress automatic thoughts associated with other thoughts.
What is meant by typical antipsychotics?
E.g. Chlorpromazine. Work by acting as antagonists in the dopamine system → aim to reduce the action of dopamine. Work by blocking the dopamine receptors in the synapses. Initially dopamine levels build up to make up for the deficit, but then production is reduced → normalises neurotransmission in the brain, which reduces positive symptoms. Also has a sedation effect - also useful for anxious patients.
What is meant by atypical antipsychotics?
More modern form of drug therapy. Target dopamine and serotonin. Designed to reduce side effects, whilst maintaining effectiveness.
Name and describe 2 types of atypical antipsychotics.
Clozapine - acts on serotonin and dopamine and glutamate receptors → reduces depression and anxiety while improve cognitive functioning → also improves mood.
Risperidone - developed due to the side-effects of clozapine (blood clotting). Binds more strongly to dopamine receptors - more effective in smaller doses and has less side-effects.
Name two or more psychological therapies for schizophrenia.
CBT; Family Studies; Token Economies.
Outline the use of 2 psychological therapies for schizophrenia.
Identifies and changes irrational thoughts. Could involve discussion regarding how likely the beliefs are to be true and consideration of less threatening options. CBT helps patients to make sense of their symptoms and how they impact on behaviour and feelings. This could reduce anxiety and help patients realise beliefs are not based in reality.
Family Therapy aims to reduce EE in the family - improvement of communication and interaction. Reduction of stress that could contribute to relapse. Improvement of family function. Strategies to reduce likelihood of relapse include (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 behaviour towards schizophrenia.
Tokens are used to reinforce desirable behaviour for patients in long-term care. This reward reinforces the desirable behaviour and because it is given immediately it prevents ‘delay discounting’. The tokens are secondary reinforcers - the value is not the tokens themselves, but from their association with the reward.
Outline the interactionist approach to explaining and/or treating schizophrenia.
The diathesis stress model - genetic vulnerability paired with a trigger causes schizophrenia. Meehl - Vulnerability is due to a schizogene → without the gene no amount of stress will cause the disorder. Modern version view diathesis as anything than can increase vulnerability e.g. trauma or genes. Modern views of stress includes anything that is likely to trigger an episode of schizophrenia e.g. cannabis use. Treatments include using both drugs and CBT (usually). CBT is usually used to alleviate symptoms whilst drugs tackle to underlying chemical imbalance. You must take an interactionist approach if you want to use both explanations effectively. Combination treatments are common in the UK, however historically the two schools clash in the US and so the interactionist approach is not as widespread.
