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73 Cards in this Set
- Front
- Back
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Schizophrenia |
A severe mental disorder in which people interpret reality abnormally |
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Positive symptoms |
Additional symptoms beyond normal experience |
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Positive symptoms: hallucinations |
Sensory experience with no basis of reality. There are visual and auditory hallucinations. |
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Positive symptoms: delusions |
Belief not based in reality. |
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Positive symptoms: catatonic behaviour |
Reduced reaction to the immediate environment, rigid posture and immobility. |
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Positive symptoms: disorganised speech |
A collection of speech abnormalities, unrelated answers , jump topics, talking to oneself or imagined people This can lead to word salad if random words are muddled together. |
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Negative symptoms |
Deficits in normal experience |
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Negative symptoms: avolition |
Loss of motivation |
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Negative symptoms: speech poverty |
Reduced frequency and quality of speech |
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Negative symptoms: affective flattening |
Reduction in range and intensity of emotion expressed and including facial expressions, tone of voice, eye and body contact. |
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Negative symptoms: anhedonia |
Loss of interest or pleasure in usually pleasurable stimulus or activities |
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DSM |
Hi |
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ICD |
Classification systems of diagnosing schizophrenia |
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Issues surrounding the diagnosis of schizophrenia |
Reliability Validity Criterion validity Co morbidity Symptom overlap Gender Culture bias |
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Reliability |
This is an issue when demonstrating the diagnosis of schizophrenia because poor or inconsistent diagnosis can lead to people being wrongly diagnosed so therefore given incorrect treatment. This is supported by chineaux et al because when psychiatrists were asked to diagnose 100 paitents they found low interest rater reliability using both the DSM and ICD which leads to wrong diagnosis and treatment. |
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Criterion validity |
This is a problem when diagnosing schizophrenia because different diagnostic systems don't agree This is supported by chineaux et al who found paitents are more likely to be diagnosed using the ICD than the DSM. This suggests schizophrenia is either under (dsm) or under (ICD) diagnosed. This is further supported by rosenhan study who demonstrates that psychiatrists were poor at diagnosing schizophrenia and were uniformed of the disorder |
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Biological explanation for schizophrenia |
Runs in families Candidate genes Neural correlates |
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Runs in families..... |
The more closely related the family member to the schizophrenic the greater chance of developing the disorder. This enables us to be able to predict the likelihood of the disorder occuring Supported by Gotesman who found strong concordance rates as 48% of identical twins share the risk of developing schizophrenia However other factors may be involved because twins share the same environment |
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Candidate genes |
Individual genes believed to be associated with the risk of inheritence Polygenic requires a number of factors and genes to work in combination Aetiologically heterogeneous is when a different combination of factors can lead to the condition Ripke et al found a relationship between candidate genes and developing schizophrenia Compared the genetic make up of 37,000 paitents to 113,000 controls Found 108 seperate candidate genes and over 9.5 million combinations associated with increased risk of schizophrenia |
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Evaluation of the biological approach |
Trienari et al did an adoption study and found 155 adoptees whose mother had been diagnosed with schizophrenia 10% recieves a diagnosis of schizophrenia compared to just 1% of controls There may be culture bias |
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Counter evidence of the biological approach |
Heston did an adoption study and found none of the control group were diagnosed but 16% of the offspring of the schizophregenic mothers were diagnosed This shows that environmental factors play a role as well as genetic factors |
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Dopamine hypothesis |
Old hypothesis: the brain of schizophrenic paitents produces more dopamine than the brain of a normal person New hypothesis: schizophrenics have an abnormally high number of D2 receptors This shows an issue with cause and effect as we are unsure whether it's more dopamine or D2 receptors that are the cause of schizophrenia |
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Dopamine hypothesis 2 |
Hyperdopaminergia = excessive levels of dopamine in the subcortex and Broca's area which is associated with speech production so !ay be associated with symptoms such as speech poverty, disorganised speech, word salad and auditory hallucinations. Hypodopaminergia= low levels of dopamine in the prefrontal cortex in the negative symptoms of schizophrenia patients which is responsible for thinking and decision making Reduced activity in these 2 areas leads to hallucinations and therefore a neural correlates of schizophrenia. |
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Evaluation of dopamine hypothesis |
It doesn't show cause and effect so it could be that something being wrong in the ventral striatum leads to negative symptoms or it could be that due to negative symptoms less information passes to the striatum causing reduced activity or it could be other factors |
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Support for the dopamine hypothesis |
Falkirk et all found increased dopamine levels in the left amygdala in post mortem of schizophrenic paitents L-dopa is a dopamine synthesis medication this means it increases dopamine levels in the brain and can include symptoms resembling a cute schizophrenia in non psychotic paitents Drugs like LSD and amphetamine can activate the dopamine system in the brain increasing symptoms in schizophrenic individuals and including schizophrenic like states in non sufferers of schizophrenia. |
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Evaluation of dopamine hypothesis |
Antipsychotic drugs such as chlorpromazine which reduce the symptoms of schizophrenia work by inhibiting dopamine transmission. However, antipsychotic drugs only reduce all symptoms in 20% of paitents |
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Critique of the dopamine hypothesis |
There's some evidence to suggest that dopamine isn't the only neurotransmitter involved Research found evidence for the role of a different type of neurotransmitter called glutamate in which it appeared that schizophrenics have a deficiency in glutamate function |
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Neural correlates |
Are measures of the structure or function of the brain that occur in conjunction with experience There's growing evidence that schizophrenia is down to structural abnormalities in the brain Brain scanning techniques Both positive and negative symptoms have correlates |
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Neural correlates of negative symptoms |
Ventral striatum is the ventral (lower side ) part of the striatum which is part of the forebrain and a critical component of the reward system Juckel et al Measured activity levels in the ventral striatum Found low levels of acitivity Negative correlation between activity levels in ventral striatum and severity of overall negative symptoms |
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Neural correlates of positive symptoms |
Allen et all scanned the brains of paitents experiencing auditory hallucinations compared to a control group whilst they identified pre recorded speech as theirs or others Hallucinations group= lower activation levels in the superior temporal gyrus and antererior Cingular gyrus and made more errors than the control group |
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Psychological theories of schizophrenia |
Family dysfunction is the idea that dysfunctional family relationships and patterns of communication are related to the development of schizophrenia. Schizophrenogenic mother Double bind theory Expressed emotion |
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Schizophrenogenic mother |
Fromm Reichmann suggested the mother is cold, rejecting and controlling which creates a family climate characterised by tension and secrecy which causes distrust which develops into delusions and schizophrenia |
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Double bind theory (risk factor) |
It causes mixed messages from parents that express care but also appear critical Relate to a contradiction between a person's verbal and non verbal behaviour This causes those to develop an incoherent version of reality which influences schizophrenic symptoms such as social withdrawal and the flattening effect |
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Expressed emotion |
A negative emotional climate characterised by a family communication style of criticism, hostility and emotional over involvement High levels of expressed emotion are likely to influence relapse rates It's high stress levels that triggers a schizophrenic episode These families feature secret alliances between members which encourages paranoid symptoms such as delusions of persecution |
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Support for family dysfunction |
Kalfi and torabi found that negative emotional climate in Iranian culture led to high relapse rates. This suggests schizophrenia can be linked to aspects of family environment such as over protectiveness is a characteristic of a schizophrenic mother whilst a negative emotional climate would link to high expressed emotion |
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Limitation of Family dysfunction |
A limitation of the family dysfunction explanation is thathigh expressed emotion amongst families could be a symptom rather than a cause.This is a problem with cause and effect as this implies that certain familysetting are a consequence of living with a schizophrengenic rather than theschizophrengenic helped schizophrenia develops. A further problem is that information about childhoodexperience was gathered after the development of symptoms and a diagnosis ofschizophrenia. This suggests that patients disturbed cognition my distort thevalidity of the information patients provide when recalling how their parentstreated them as children.
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Cognitive explanation |
refers tothe idea that the development of schizophrenia is related to maladaptivethought processes. It suggests schizophrenia is associated with several types ofabnormal information processing.
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support for cognitive explanation |
Strength of the explanation is it can account for both thepositive and negative symptoms of the disorder. For example, the reducedprocessing in the ventral striatum is associated with negative symptoms whilstreduced processing of information in the temporal and cingulated gyri areassociated with hallucinations. This lower than usual level of informationprocessing suggests that cognition is likely to be impaired. Support for the cognitive explanation comes from Takahasi(2013) who compared electrical brain activity when exposed to auditory tonesand found that the ability to detect changes in tone was severely limited inthe schizophrenics. This therefore may explain the experience of auditoryhallucinations and delusions in schizophrenics. This supports the cognitiveexplanation.
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Limitation for cognitive explanation |
However, the cognitive explanation isn’t a completeexplanation of schizophrenia this is because it doesn’t explain what led to thecognitive dysfunctions seen in schizophrenics so cannot be seen as explain the causesof schizophrenia.
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Dysfunctional though processing |
is the ideathat the development of schizophrenia is related to abnormal ways of thinking. Meta-representation is the cognitive ability to reflect onthought and behaviour which would disrupt our ability to recognise our ownactions and thoughts as being carried out by ourselves rather than someoneelse. This would explain hallucinations of voices and delusions like insertion.Central control is the cognitive ability to suppressautomatic response while we perform deliberate actions. Disorganised speech andthough disorder could result from the inability to suppress automatic thoughtsand speech triggered by other thoughts.
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support for dysfunctional thought processing |
Supported by Betall who found that schizophrenics struggledto identify words belonging to a certain category that they had read earlier,created themselves or had not seen before supporting the idea thatschizophrenics have meta-representation problems. This is further supported by Brune who reviewed 20 years ofevidence to report that many symptoms of schizophrenia and the consequentimpairments in social functioning result from poor meta cognition especiallythe ability to self reflect and empathise with other. Listlsw8`
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Overall ..... |
Garety believe that schizophrenia is best understood by linking different explanations both biological and psychological with cognitive explanations.
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Biological therapies for the treatment of schizophrenia |
the use of anti psychotic drugs which are divided into typical and atypical |
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typical anti psychotics |
were created in the 1950s to treat schizophrenia by combating positive symptoms its job is to reduce or block the action of dopamine by blocking dopamine receptors in synapses eventually normalize neurotransmision in key area of the brain reducing symptoms like hallucinations |
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Atypical antipsychotics |
were produced later and are seen as more effective with fewer side effects by combating both positive and negative symptoms they work by blocking the dopamine but also blocking serotonin and glutamate receptors which work by temporarily occupying D2 receptors and the rapid dissociating it to allow normal dopamine distribution. |
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Evaluation of biological treatments |
Atypical drugs are seen as more effective as they treat a wide range of symptoms. Schooler et al found 75% of patients using atypical drugs experienced at least a 20% reduction in symptoms. This suggests that atypical drugs are effective at reducing some of the symptoms. |
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Evaluation of biological treatments
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Where as Kapur et al found for typical antipsychotics to be effective 60-70% of receptors must be blocked but also a similar number of D2 receptors must be blocked leading to increased side effects so patients stop using their medication. This suggests that typical drugs aren't cost effective as they may cause relapses. |
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Evaluation of biological treatments
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Leucht et al found patients who remained on their antipsychoticmedication were only 27% likely to relapse compared to 64% for a placebo. This suggests drugs are more effective than placebos whichshow that antipsychotics are an appropriate and effective type of treatment. However, even though atypical antipsychotics are moreeffective they aren’t 100% effective so can’t be considered a superior treatment.r
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Evaluation of biological treatments
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Atypical drugs are only palliative so they can only treatsymptoms and not offer a cure .
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Psychological therapies: cognitive behavior therapy (CBT) |
aims to help patients identify irrational thoughts and try to change them. involves an argument or discussion of how likely the patients beliefs are to be true and a consideration of other less threatening possibilities. It doesn't get rid of symptoms but it can make patients better able to cope with them. |
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How CBT helps |
Patients can be helped to make sense of how their delusions and hallucinations impact on their feelings and behavior. e.g. if the patient hears voices and believes they are demons they will be afraid psychological explanations for the existence of hallucinations and delusions can help reduce this anxiety. delusions can be challenged so the patient can come to learn their beliefs aren't based in reality. |
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Family therapy |
takes place with families aiming to improve the quality of communication and interaction between family members which would lead to double bind and schizophrengenic mother. Most therapists are concerned with reducing stress within the family that might contribute to relapses of patients Aims to reduce levels of Expressed Emotion. |
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How family therapy helps ... |
Pharoah et al identified a range of strategies by which family therapists aim to improve the functioning of a family with a member suffering from schizophrenia: forming a therapeutic alliance with family members reduce stress improve ability to anticipate and solve problems helping family members achieve a balance between caring for the schizophrenic and maintaining their own lives. |
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Family therapy |
suggests these strategies work by reducing levels of expressed emotion and stress whilst increasing the chances of patients complying with medication. his combination of beliefs tends to result in a reduced likelihood of relapse and readmission to hospital. |
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Token economies |
reward systems used to manage the behavior of patients with schizophrenia in particular those who have developed patterns of maladaptive behavior through spending long periods of time in institutions. Common for patients to develop bad hygiene or remain in PJs all day. Modifying these bad habit doesn't cure schizophrenia but does improve the quality of life and make it more likely they can live out of hospital. |
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TOKENS |
E.g. in the form of colored disks are given to patients when they have carried out a desirable behavior that has been targeted for reinforcement. Its based according to the patients individual behavior issues. This immediacy of reward is important because it prevents delay discounting, the reduced effect of a delayed reward. |
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Rewards |
Tokens have no value but an be swapped for rewards. Token economies are a kind of behavioral therapy based on ope rant conditioning . Tokens are secondary reinforces because they only have value once the patient has learned they can obtain rewards. |
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Evidence based on Family Therapy and CBT is weak |
Jauhar reviewed results of 34 studies of CBT for schizophrenia and concluded CBT had a significant but fairly small effect on both positive and negative symptoms. Pharaoh et al reviewed evidence for effectiveness of family therapy for families of schizophrenics concluding there's moderate evidence to show that family therapy significantly reduces hospital readmission over a year and improves quality of life for patients and their families. However, they noted that results of different studies were inconsistent and there were problems with quality of some evidence. |
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Weak evidence |
a review of evidence for token economies found only 3 studies where patients had been randomly allocated to conditions with only 110 patients. only 1 of 3 studies showed improvement in symptoms and none yielded useful information about behavior change. overall, there's only modest support for effectiveness of psychological therapies.
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Treatments improve quality of life but don't cure schizophrenia |
all psychological treatments aim to make schizophrenia more manageable and improve quality of life CBT- helps patients make sense and challenge their symptoms Family therapy- reduces stress of living with a schizophrenic Token economies- help by making patients behavior more socially acceptable so they can better re-integrate into society. Failure to cure schizophrenia is a weakness. |
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Ethical issues |
don't have serious side effects or medical risks like drug treatments. CBT challenges an individuals freedom of thought. token economies- issue that privileges and services become more available to patients with mild symptoms and less so for those with more severe problems which prevents them complying with desirable behaviors |
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Quality of evidence for effectiveness |
many small scale studies in which mental health professionals have compared patients before and after psychological treatments have found more positive results. But these studies often lack a control group or patients aren't randomly allocated to treatment and control conditions. where studies are included in reviews, conclusions are more optimistic than those that strictly control which studies are included. Psychological treatments may be more effective for some individuals than others because of individual differences. |
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Internationalist approach to schizophrenia |
an approach that acknowledges that there are biological, psychological and societal factors in the development of schizophrenia. |
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Diathesis stress model |
both a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the condition. |
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Meehl's model |
diatheis (vulnerability) was entirely genetic the result of a single schizo-gene development of a schizotypic personality- in carriers of gene chronic stress through childhood and adolescence in particular the presence of a schizophrengenic mother could result in development of schizophrenia. |
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Modern understanding of diathesis stress |
its now clear many genes each appear to increase genetic vulnerability. there's a range of factors beyond genetic including psychological trauma. Read et al proposed a neurodevelopmental model in which early trauma alters the developing brain. severe trauma such as child abuse can seriously affect many aspects of the brain development hypothalamic pituitary adrenal (HPA) system becomes over active making the person more vulnerable to later stress. |
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Recent research into factors triggers an episode of schizophrenia has concerned cannabis use. |
Cannabis is a stressor because it increases the risk of schizophrenia by up to X7 as it interferes with the dopamine system. BUT most people don't develop don't develop schizophrenia after smoking cannabis so there must be more than on vulnerability factor |
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Biological vulnerability |
several genes seem to increase vulnerability to developing disorder genetic factors are linked to faulty dopaminergic systems in those with schizophrenia and to abnormal functioning of other neurotransmitters in schizophrenics. research ndicates that neural correlates are an effect of being schizophrenic rather than being due to genetic influences. |
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Psychological triggers |
family dysfunction, substance abuse and critical life events those most genetically at risk of developing the disorder will be most vulnerable to triggers |
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Treatments using the interactionist model |
model is associated with combining antipsychotic medication and CBT Turkington et al point out that its perfectly possible to believe in biological causes of schizophrenia and still practice CBT to relieve psychological symptom |
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Evidence for the role of vulnerability and triggers |
ienari investigated the combination of genetic vulnerability and parenting style (trigger). Children adopted from 19000 Finnish mothers with schizophrenia were followed up. A child rearing style characterized by high levels of criticism and conflict and low levels of empathy was implicated in the development of schizophrenia but only for the child with high genetic risk but not in the control group. This suggests that both genetic vulnerability and family related stress are important in the development of schizophrenia. |
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We don't know exactly how diathesis and stress work |
We don't fully understand the mechanisms by which the symptom of schizophrenia appear and how both vulnerability and stress produce them. |
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The treatment causation fallacy |
Turkington et al argue that there's a good logical fit between the interactionist approach and using a combination of treatments. However, the fact that combined biological and psychological treatments are more effective together doesn't mean the interactionalist approach is correct. may not be treating the underlying rot cause |
