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54 Cards in this Set
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define schizophrenia |
A severe mental illness where contact with reality and insight are impaired e.g psychosis |
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what is the classification of mental disorders? |
- process of organising symptoms into categories based on which symptoms cluster in sufferers |
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How does the classification of schizophrenia differ between ICD-10 and DSM-5? |
ICD-10- The World Health Organisation's International Classification of Disease edition 10 DSM-5-American Psychiatric Association's Diagnostic and Statistical Manual edition 5 DSM-5: one positive symptom (delusions/hallucinations) must be present ICD-10: 2+ negative symptoms (flattened affect) must be present - ICD-10: recognises subtypes of schizophrenia |
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What are the three subtypes of schizophrenia classified by ICD-10? |
Paranoid schizophrenia: characterised by powerful delusions and hallucinations Hebephrenic schizophrenia: characterised primarily by negative symptoms Catatonic schizophrenia: disturbance to movement;suffer immobile/overractive |
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What are positive symptoms? |
- atypical symptoms experienced in addition to normal experiences.- include hallucinations and delusions |
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What are hallucinations ? |
- type of positive symptom of schizophrenia - sensory experiences of stimuli that have no basis in reality/distorted perceptions of things - e.g hearing voices/seeing things that are not there |
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what are delusions? |
- type of positive symptom of schizophrenia - beliefs that have no basis in reality e.g. sufferer is someone else or is a victim of a conspiracy (being Jesus) |
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What are negative symptoms? |
- atypical experiences that represent loss of a usual experience e.g. clear thinking or 'normal' levels of motivation. - e.g. avolition/speech poverty |
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What is avolition? |
- type of negative symptom of schizophrenia - loss of motivation to carry out tasks and results in lowered activity levels Andreason: three identifying signs=poor hygiene/lack of persistence in work/lack of energy |
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What is speech poverty? |
- type of negative symptom of schizophrenia - reduced frequency and quality of speech DSM-5: emphasises speech disorganisation= positive symptom |
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What is co-morbidity |
The occurrence of two illnesses or conditions together, for example, a person has both schizophrenia and personality disorder. Where two conditions are frequently diagnosed together, it calls into question the validity of classifying the two disorders separately |
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What is system overlap? |
Occurs when two or more conditions share symptoms. Where conditions share many symptoms this calls into question the validity of classifying the two disorders separately. |
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Evaluate classification and diagnosis of schizophrenia ? |
Weaknesses Research unreliable -Inter-rater reliability is poor. Cheniaux et al. -Two mental heath professionals independently diagnose 100 patients using the DSM and ICD - one psychiatrist diagnosed 26 using the DSM and 44 using the ICD. Another psychiatrist diagnosed 13 with schizophrenia using the DSM and 24 using the ICD Co-morbidity is an issue when diagnosing -Schizophrenia is commonly diagnosed with other conditions, putting into question whether they are just one condition. - Buckley et al. (2009)- Around half of patients diagnosed with schizophrenia are diagnosed with depression or substance abuse. PTSD also occurred in 29% of cases and OCD in 23%. Gender bias - gender bias- female patients more likely to get diagnose then males because they typically function better than males - more likely to have better family relationships (Cotton et al) - thus there better interpersonal relationships may bias practitioners to under-diagnose females as symptoms are masked Cultural bias - African Americans and English people of Afro-Caribbean origin are several times more likely than white people to be diagnosed with schizophrenia. -It may be underdiagnosed in African cultures as hearing voices is seen as normal and thus the positive symptoms are acceptable. - Javier Escobar-Overwhelmingly white psychiatrists may tends to over-interpret sym |
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What is the genetic basis of schizophrenia? |
- runs in family;weak evidence - twin studies: up genetic similar identical = 100% whereas non-identical 50% =up risk as genes shared - Gottesman's study- Individuals suffering schizophrenia often have relatives with the disorder, especially as MZ twins have higher concordance rates (48%) than DZ twins (17%) and schizophrenia in the general population is 1%. |
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Explain candidate genes in the genetic hypothesis of schizophrenia |
-individual genes believed to be associated w risk of inheritance as a no.of genes each appear to confer a small increased risk of schiz - Polygenic disease thus it requires a lot of factors to work in combination - aetiologically heterogeneous- different combinations of factors can lead to it - RIPKE - study combining data from genome studies - 37,000 patients vs 113,000 controls - 108 genetic variations identified were associated w high risk of schiz - genes associated w high risk included those coding for the functioning of a no.of neurotransmitters inc. dopamine |
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Evaluate the genetic explanation of schiz |
Strength Research support -Gottesman (1991). - large-scale family study of schizophrenia found the risk of developing schizophrenia is relative to the proportion of genes shared with other family members. -E.g. children of a person with schizophrenia had a 13% risk, whereas grandchildren of a person with schizophrenia had a lower risk at 5%. - suggests schizophrenia has a genetic basis because the more genetically similar a person is to a schizophrenic sufferer, the greater the risk of them developing the disorder. Weakness Methodological criticism - using MZ twins they are often treated more similarly than DZ twins because they often look identical - higher concordance rates for schizophrenia for MZ twins could therefore be due to exposure to similar environmental factors, such as stressful family surroundings and not due to identical genes. - This therefore reduces the validity of research as environmental factors confound the results. |
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What is the dopamine hypothesis? |
Dopamine is a neurotransmitter which has many functions in the brain. The dopamine hypothesis of schizophrenia suggests that abnormalities in the dopamine systems involved in movement and attention are responsible and linked to schiz |
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What does an increase in dopamine do? |
- An increase in dopamine (hyperdopaminergia) in the subcortex- linked to positive symptoms of schizophrenia. -One cause is the presence of abnormally high levels of D2 receptors on receiving neurons results in more dopamine binding and therefore more neurons firing - If this increased activity occurs in Broca’s area this is said to lead to hallucinations and speech difficulties |
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What does a decrease in dopamine do? |
-A decrease in dopamine activity (hypodopaminergia) in the cortex - linked to negative symptoms of schizophrenia - Decreased activity in the prefrontal cortex which is responsible for thinking and decision making - linked to negative symptoms of schiz BOTH CAUSE HYPER AND HYPO CAUSE SCHIZ |
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Evaluate the dopamine hypothesis |
Strength Support evidence - Curran et al -Dopamine agonists like amphetamines that increase the levels of dopamine make schiz worse and can produce schizophrenia-like symptoms in non-sufferers - thus increase in dopamine causes schiz Weakness Direction of causality -It could be that the disorder led to the dopamine system becoming dysfunctional rather than a dysfunctional dopamine system leading to schiz -It would be difficult and unethical to test the direction of causality as don't know if it is making them better or worse - further research needs to be done to establish direction of causality ALSO BIOLOGICAL REDUCTIONIST |
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What is meant by the neural correlates of schizophrenia? |
- Neural correlates of schizophrenia refers to abnormalities in structural or functional features of the brain which link to particular schizophrenic experiences. Both positive and negative symptoms have neural correlates |
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What are the neural correlates of negative symptoms? |
- Lower activity in the ventral striatum has been linked to the negative symptom of avolition(loss of motivation). - ventral striatum involved in anticipation and this is needed for motivation -Abnormally low functioning in this area may therefore lead to apathetic behaviour in a schizophrenic. - thus activity in ventral striatum is a neural correlate of negative symptoms of schiz |
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What are the neural correlates of positive symptoms? |
- Allen et al- scanned brains of patients experiencing auditory hallucinations vs control group - lower activation levels in the superior temporal gyrus and anterior cingulate gyrus were found in hallucination group - thus low activation of these 2 areas is a neural correlate for positive symptoms |
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Evaluate neural correlates |
Strength Research support for functional abnormalities - Juckel et al. (2006). -They found lower levels of activity in the ventral striatum of schizophrenic sufferers compared to a control group. -They also observed a more general negative correlation – the lower the level of activity in the ventral striatum, the higher the severity of overall negative symptoms. -this suggests that activity of the frontal lobe of the brain is linked to negative symptoms Weakness Correlation- causation problem - Many studies have found structural or functional abnormalities this is hardly correlational evidence; it does not show whether such abnormalities are a cause or consequence of having the disorder -For example, reduced activity in the ventral striatum could link to negative symptoms of schizophrenia; however, also possible that another factor influences both the activity in the ventral striatum and the negative symptoms |
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What is family dysfunction? |
-Abnormal processed within a family such as poor family communication, cold parenting and high levels of expressed emotion. |
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What are the 2 examples of family dysfunction? |
Double-bind theory -A child is confused by mixed messages in communications and punished by withdrawal of love. -the developing child often finds themselves trapped in situations where they fear there doing the wrong thing but receive mixed messages on what this is and are unable to ask - when wrong they are punished with withdrawal of love - leaves them w understanding the world is confusing and dangerous - results in symptoms such as delusions Expressed emotion -EE is the level of negative emotion expressed towards a patient by their carers -EE contains several elements: - verbal criticism 2 patient - accompanied by violence - Hostility 2 patient inc anger and rejection - emotional over-involvement by the patient- self sacrifice - causes serious stress for patient which can cause schiz - also can be due to diathesis stress model |
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Evaluate family dysfunction |
Strengths Evidence -Read et al - 46 studies of child abuse and schiz concluded that 69% of women in-pateints had a history of physical abuse or sexual abuse in childhood - for men was 59% Evidence for EE - Kavanagh (1992). -26 studies found the mean relapse rate for schizophrenics returning to families with high EE was 48% compared with 21% for those who returned to families with low EE. -increases support to the idea that dysfunctional communication styles in the family increases the chances of schizophrenia occurring Weaknesses Problem with validity - childhood info was gathered after diagnosed thus may be faulty info as their memories have been distorted -however Tienari et al followed this up to see if any childhood experiences predicted any adult characteristics and found results to be inconsistent Overlooks biological factors -diathesis-stress model suggests such situations may merely act as a trigger for an underlying biological predisposition to be expressed. -It may be the combination of a genetic abnormality causing a reduction in brain matter in areas of the prefrontalcortex in combination with a oppressive family environment where an individual cannot think for themselves that leads to symptoms of schizophrenia arising. |
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What are cognitive explanations of schiz? |
Explanations that focus on mental processes such as thinking, language and attention |
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What is dysfunctional thought processing? |
information processing that is not functioning normally and produces undesirable consequences |
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What are the 2 types of dysfunctional thought processing? |
1) Metarepresentation - Dysfunction in ability to reflect on own thoughts and behaviour leads to thinking that own actions and thoughts are being carried out by someone else. 2) Central control -Schizophrenics tend to suffer derailment of thoughts because a word triggers associations and the patient cannot suppress automatic central responses to these. |
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Evaluate cognitive explanations? |
Strengths Evidence- lack of central control -Stirling et al - Used the Stroop Test which involves participants identifying the colour of ink that words are written in whilst getting them to say the word itself. - found 30 patients with symptoms of schizophrenia took on average twice as long to read out the colours than 18 non-patient controls. - findings suggest schizophrenia is linked to a lack of cognitive ability CBT effective therapy - In CBT for psychosis patients encouraged to evaluate their delusions to consider ways in which they might test the validity of their faulty beliefsNational Institute for Healthcare Excellence found evidence when compared to antipsychotic medication CBT was more effective in reducing symptoms -CBT supports the explanation that the symptoms of schiz originate in faulty cognitions Weaknesses Describe but not explain--causality -remains unclear what cause what, including whether cognitive factors are a cause or are a result of the neural correlates and abnormal neurotransmitter levels seen in schiz - hard to establish cause of schizophrenia as cognitive because sufferers are only investigated after they have been diagnosed Cant explain the distal causes - doesn't tell us anything about the origins of those cognitions or of schiz -cog theories can explain the proximal causes of schiz i.e what causes current symptoms but not distal causes i.e origins of condition |
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What are antipsychotics? |
Drugs used to reduce the intensity of symptoms, in particular the positive symptoms of psychotic conditions e.g schiz - divided into typical and atypical drugs |
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what are Typical antipsychotics ? |
- The first generation of anti-psychotics have been in use since 1950s. They work as dopamine antagonists and include chlorpromazine |
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What are antagonists ? |
Antagonists are chemicals which reduce the action of a neurotransmitter by blocking receptors out |
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How do dopamine antagonists work? |
- works by the drug blocking dopamine receptors in the synapses of the brain, reducing action of dopamine - when chlorpromazine is first taken dopamine levels build up, but then production is reduced - dopamine-antagonist effect normalises neurotransmission in key areas of the brain - Symptoms like hallucinations usually diminish |
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What are the side effects associated with typical anti-psyhcotics? how do they happen |
- they happen as because chlorpromazine blocks D2 receptors in the mesolimbic pathway it also blocks other receptors in the brain leading to side effects - Dry mouth -blurred vision - dizziness -weight gain - Chlorpromazine is also sedative so good to calm patients |
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What are atypical antipsychotics ? |
Drugs for schizophrenia developed after typical antipsychotics. Typically target a range of neurotransmitters such as serotonin and dopamine. Examples include clozapine |
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What is clozapine? |
- Clozapine was developed in the 1960s and trialled in the early1970s. This is used in patients who are unresponsive to or intolerant of other antipsychotics. Also reduces rate of suicidal behaviour as 30-50% with schiz contemplate it - reduces positive symptoms of schiz |
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How does clozapine work? |
-Clozapine binds to dopamine receptors in a similar way to chlorpromazine, but the drug only temporarily occupies the D2 dopamine receptors and then rapidly dissociates to allow some transmission of dopamine, this avoids serious side effects, - Also acts on serotonin and glutamate receptors which improve mood and reduce depression and anxiety in patients |
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Evaluate antipsychotics as a treatment to schizophrenia |
Strengths Evidence -Thornley et al - reviewed studies comparing the effects of chlorpromazine to control conditions in which patients took a placebo so their experience was identical apart from the chlorpromazine in their medication - date from 13 trials n 1121 ppts showed chlorpromazine made better functioning and reduced symptoms -data from 3 trials 512 ppts showed relapse rates were was lower aswell Weaknesses Serious side effects - typical antipsychotics are associated w dizziness, agitation, sleepiness etc. Long term use can result in tardive dyskinesia caused by dopamine super-sensitivity and cause involuntary movements e.g blinking - this can cause people to stop taking them - side effects thus still a weakness and if people stop taking they are also ineffective Problems w evidence -Healy (2012) - suggested that some successful trials have had their data published multiple times often exaggerating the evidence for the improvement of schizophrenic symptoms. -This generates bias and is misleading to healthcare professionals. Chemical cosh - antipsychotics only used to calm patients and make them easier for staff to work with, rather than benefitting the patient - although recommended use by NICE still seen as human rights abuse |
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What is cognitive behavioural therapy (CBT) and what is its aims? |
- A method for treating mental disorders based on both cognitive and behavioural techniques - Aims to identify and challenge irrational thinking and beliefs, including the delusions and hallucinations of schizophrenia. |
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How does CBT help schizophrenic patients? |
- patients can be helped to make sense of their delusions and hallucinations impact on their
feelings and behaviour - understanding where symptoms come from help massively - offering psychological explanations for existence of hallucinations and delusions helps reduce anxiety (scared from demon voices for example) |
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Evaluate CBT as a therapy to schizophrenia |
Strength Suport evidence - Jauhar et al - reviewed results of 34 studies of CBT for schiz - concluded that CBT has a significant but fairly small effect on both positive and negative symptoms - reliable therapy strategy Weakness Stage of schiz - effectiveness and appropriateness of CBT depends on stage patient is at -Addington & Addington - CBT inappropriate in initial stage - however appropriate following stabilisation of symptoms - thus CBT should be used in conjunction w patient rather than first choice Improve quality of life but don't cure - Family therapy helps by reducing stress of living w schiz in a family both for patient and family - This is worth doing but should not be confused w curing schiz whereas biological treatments reduce symptoms and psychological ones don't Is it an appropriate therapy? - CBT requires self awareness - + symptoms lack awareness and - symptoms inability to engage -Thus therapy only appropriate for those who are capable of gaining insight into their problems |
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What is family therapy and what is the aim of it? |
- series of 10 sessions from 3-12 months - Takes place w families rather than individual patients - Aims to improve family communication and reduce stress of living as a family. |
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How family therapy helps schizophrenia? |
-Pharoah et al- identified range of strategies by which family therapies aim to improve functioning of family: - forming a therapeutic alliance w all fam members - Reducing the stress for relative w schiz - improving ability of the family to anticipate and solve problems - helping families balance between caring for individual w schiz and maintaining their own life -improving families beliefs and behaviours towards schiz -education elements helps the person understand and more able to deal w the illness including medication compliance - work by reducing stress and EE whilst increasing chance of patients complying w medication - leads to reduced likelihood of relapse and improves quality of life for patients and families |
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Evaluate family therapy |
Strength Support evidence - Pharoah et al - meta-analysis 53 randomised control studies - compared family therapy to standard care, showed: - mental state improved sometimes - compliance w medication increase w FT - improvement of general functioning - reduction in relapse for up to 24 months Evidence for effectiveness - NCCMH*- meta-analysis of 32 studies 2500 ppts found FI to be effective compared to standard care -found reduction of hospital admission up to 24 months after treatment - 26% relapse rate vs 50% in standard care Weakness Improve quality of life but don't cure - Family therapy helps by reducing stress of living w schiz in a family both for patient and family - This is worth doing but should not be confused w curing schiz whereas biological treatments reduce symptoms and psychological ones don't Methodological issues of Pharaoh - problem of randomisation - all 53 studies claimed to have randomly allocated patients to the conditions - Chinese studies didn't do this thus not valid explanation |
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What are token economies and what is their aim? |
- desirable behaviours are encouraged by the use of selective reinforcement -reward systems used to manage the behaviour of patients w schiz in particular those who have developed patterns of maladaptive behaviours |
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How does the token economy help aid schiz? |
Tokens - coloured discs given out when patients do a desirable behaviour target for reinforcement e.g making their bed - immediacy of reward is important as it prevents the reduced effect of a delayed reward 'delay discounting' Rewards -tokens swapped for rewards - therapy based on operant conditioning - tokens are secondary reinforces as they only have value once patient learns that they can be used to get r9ewards e.g sweets, cigarettes or services |
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Evaluate the use of token economies |
Strengths Support evidence managing schiz - McMonagle & Sultana - found only 3 studies where patients were randomly allocated to conditions (N=110 total) - Only one study showed improvement in symptoms & none produced useful info about behaviour change Weakness Ethical issues - form of social control - major issue - privileges, services become more available to patients w mild symptoms and less so for those w more severe symptoms of schiz that parents them to perform desirable behaviour - thus most ill suffer discrimination and has reduced the use of token economies Improve quality of life but don't cure - Family therapy helps by reducing stress of living w schiz in a family both for patient and family - This is worth doing but should not be confused w curing schiz whereas biological treatments reduce symptoms and psychological ones don't Confounding variables - Tokens - not reason for behavioural improvements - staff attention rather than tokens cause behavioural improvements - to show it is a token you need to compare to control group who arent using tokens - hard as all the patients w schiz in an institution so improvement can only be made w past experiences - thus token economy may be effective for reasons other than those suggested ALL - Alternative psychological treatments : - more available but less-well known - NICE - recommends art therapy |
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What is the interactionist approach? |
Acknowledges that a range of factors, including biological and psychological, are involved in the development of schizophrenia. |
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What is the diathesis-stress model? |
The diathesis-stress model sees schizophrenia as the results of an interaction between biological vulnerability (the diathesis) and environmental (stress) influences. |
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What are the 3 stages of the diathesis stress model? |
Original diathesis stress model -Meehl's model- diathesis (vulnerability) was genetic, the result of a 'schizogene' - lead to a biologically based schizotypic personality, one characteristic that is sensitive to stress - if no gene then no amounts of stress will cause you schiz Modern understanding of diathesis - changed - NOW many genes each appear to increase genetic vulnerability - no single 'schizogene' (Ripke) - modern views of diathesis include a range of factors such as psychological trauma - trauma becomes diathesis rather than stress, early and severe trauma etc Modern understanding of stress - original - stress seen as psychological nature e.g parenting - although parenting still seen as important- definition of stress includes anything that risks triggering schiz - most research into factors triggering shciz has been cannabis use as it is a stressor as it increases risk of schiz up to 7 times as it interferes w dopamine system - however most people don't develop schiz after smoking thus there myst be one or more vulnerability factors |
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Explain treatment of schizophrenia according to the interactionist model |
- model associated w combining biological and psychological treatments e.g antipsychotic medication and CBT -Turkington et al - perfectly possible to believe in biological causes using CBT to relieve psychological symptoms - however this requires an interactionist model telling patients that their condition is both biological and psychological - thus it is standard practice to treat with antipsychotics and CBT and is seen as unusual not to - UK adopted quick - USA slow due to conflict between the two |
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Evaluate the interactionist approach |
Strengths Evidence for role of vulnerability and triggers - Tienari et al. (2004) - children adopted from 19,000 finish mothers w schiz. their adoptive parents were assessed for child-rearing style, rates of schiz were compared to control group of adoptees without any genetic risk - child-rearing style w high levels of criticism and conflict and low levels of empathy = schiz but only for high genetic risk - schiz is both genetic and family-related stress Support for combination of treatments -Tarrier et al -315 patients randomly allocated to a medication + CBT, medication + supportive counselling or a control group. - patients in the 2 combo groups showed lower symptoms compared to control - no diff in hospital readmissions Weakness Original model over simple - classic model of schizogene and schiz parenting style as mako source of stress v oversimple -multiple genes increase vulnerability and no sing schizogene -stress can come in many forms as well including dysfunctional parenting thus vulnerability and stress don't have 1 source We don't know exactly how diathesis and stress work - we have some evidence how vulnerability and stress lead to schiz - BUT We dont fully understand the mechanisms of schiz appear and how both vulnerability and stress produce them |
