Schizophrenia descriptions

Question 1

Positive symptoms-
Negative symptoms-

Answer 1

-in excess of normal functions
-reduction or loss of normal function

Question 2

Positive symptoms examples

Answer 2

-Hallucinations- unreal perception of environment, can be visual/auditory, olfactory(smell)/tactile
-Delusions- unreal beliefs eg thinking people will harm you, paranoia, delusions of grandeur (false impression of own importance eg. thinking you’re jesus)
-Disorganised speech- going on tangents, difficult to follow, word salads
-Grossly disorganised catatonic behaviour- increase in abnormal behaviour, decreased reaction to immediate environment

Question 3

Negative symptoms examples

Answer 3

-Speech poverty (alogia) - lessening of fluency, less words produced in given time
- Avolition- reduction in goal directed behaviour eg. staying in bed all day
-Affective flattening- don’t express emotions, no body language, monotone
-Anhedonia- no pleasure from things they used to enjoy

Question 4

Diagnostic reliability

Answer 4

-diagnostic reliability- diagnosis must be repeatable eg. clinicians reach same conclusion at 2 different times( test retest) or different clinicians reach same conclusion (inter rater reliability)

Question 5

Cultural differences in diagnosis

Answer 5

Copeland
-gave US and british psychiatrists a description of patient. 69% US diagnosed with Sz, 2% british diagnosed with Sz.

Luhrman
-interviewed 60 adults with Sz from india, ghana and US. Africans and Indians described their voices as positive, playful, offering advice. Us described voices as violent, hateful

-Sz has lack of consistent characteristics

Question 5

Problems with DSM-V

Answer 5

-hoped it would be a standardised method however behaviour is open to interpretation
-subjective
eg Rosenhan tested reliability and validity of DSM
-Rosenhan + 7 others entered hospitals saying their hearing voices
-once admitted, they acted as normal patients
-all were admitted to hospitals and later released with a diagnosis of Sz in remission
-found 71% of the time, Drs ignored when pseudo patients asked questions
-shows reliability of DSM but lack of validity as didn’t actually have Sz

Question 6

Gender bias in diagnosis

Answer 6

Gender bias in diagnosis
-occurs when the accuracy of diagnosis is dependent on gender
-can be caused due to gender biased criteria, or clinicians having stereotypical beliefs
-Broverman found US clinicians equated mentally healthy adult behaviour with mentally healthy male behaviour, therefore women perceived less mentally healthy
-Longenecker found men diagnosed more often then women as female typically function better due to better interpersonal functioning that masks symptoms, making case seem too mild to diagnose

Question 7

Symptom overlap- validity

Answer 7

Symptom overlap
-many symptoms found in depression, bipolar
-Ellason + Ross found people with dissociative identity disorder (DID) have more Sz symptoms then people diagnosed
-people with Sz often diagnosed with one other disorder

Question 8

Co-morbidity - validity

Answer 8

-extent that 2 or more conditions occur at same time
-such as substance abuse, anxiety, depression
-Buckley found co-morbid depression occurs in 50% of patients
-OCD and Sz are both rare, but appear together very often
-eg. Swets- meta analysis found 12% of Sz fulfilled criteria for OCD
-when conditions appear together, it questions validity of diagnosis as might be one condition not 2

Question 9

Validity in diagnosis

Answer 9

-gender bias
-symptom overlap
-co-morbidity

Question 10

Genetic description

Answer 10

Family- tendency for Sz to run in families, as genes passed to generation. Chance of Sz in pop is 1% but more relatives with Sz more likely to have Sz eg. 2 parents with Sz child 46% likely to have Sz
Twin-Gottesman, 40 twin studies found 48% concordance MZ and 17% DZ. Concordance rate of MZ was also higher even when brought up apart
Adoption studies- Tienari, finland, 164 adopted children with mother with Sz 7% had Sz, 197 control without Sz mother 2% developed Sz

Question 11

Biological explanations

Answer 11

-genetic
-dopamine hypothesis
-neural correlates

Question 12

Dopamine hypothesis

Answer 12

-Sz have high number of D2 receptors resulting in more dopamine binding
-people with parkinson’s take drug L-Dopa top to increase dopamine and have found to develop Sz like symptoms
2 sources of evidence for role dopamine
Drugs increase dopaminergic activity eg. amphetamine- dopamine agonist- stimulates nerves containing dopamine increasing levels of This causes hallucinations and delusions
Drugs decrease dopaminergic activity eg. antipsychotic drugs act as dopamine antagonists- block dopamine’s action therefore eliminating symptoms eg hallucinations or delusions

Question 13

Revised dopamine hypothesis

Answer 13

David and Kahn
-positive symptoms due to excess dopamine in subcortical areas of brain
-negative symptoms due to deficit of dopamine in prefrontal cortex
evidence: Patel, PET scans found lower levels dopamine in prefrontal cortex of people with Sz

Question 14

Neural correlates

Answer 14

-asses which area of the brain is active
-both positive and negative symptoms have neural correlates
-identified using fMRI
-eg. group all have auditory hallucinations compare to group that don’t, if an area in brain is different can conclude that part of the brain is causing the auditory hallucinations
-ventral striatum is neural correlate for negative symptoms
-superior temporal gyrus + anterior cingulate gyrus are neural correlates for auditory hallucinations

Question 15

Psychological explanations

Answer 15

-family dysfunction- schizophrenogenic mother, double
bind theory, family dysfunction
-cognitive explanations

Question 16

Schizophrenogenic

Answer 16

Fromm-Reichmann
-schizophrenic causing mother
-cold, dominant, moralistic
-in addition to psychodynamic explanation- result of internal conflict
-leads to a family climate of secrecy and tension
-causes distrust and paranoid delusions

Question 17

Double bind theory

Answer 17

Bateson
-children who receive contradictory messages are more likely to develop sz eg. mother tells child she loves him but then turns her head in disgust
-conflicting messages on different communication levels, verbal and non- verbal
- child develops fear of doing wrong thing as when they do they get punished by withdrawal of love
-causes disorganised thinking and paranoid delusions

Question 18

Expressed emotion

Answer 18

-explanation for relapse
-family communication style where the family talk of the patient in a critical hostile manner or that indicates emotional over involvement
-Kuipers found high EE relatives talk more and listen less
-Linszen found patients returning to high EE family 4x more likely to relapse
-3 elements- verbal criticism of patient, hostility towards patient, emotional over-involvement

Question 19

Cognitive explanations
(psychological explanations)

Answer 19

Frith
-identified 2 types of dysfunctional thought processing
1. metarepresentation- cognitive ability to reflect on thoughts and behaviour. Dysfunction disrupts our ability to recognise our own actions and thoughts as being carried out by ourselves. Explains hallucinations and delusions like thought insertion
2. central control- cognitive ability to suppress automatic responses while we perform deliberate actions, this can cause disorganised speech and thought disorder. People with sz have derailment of thoughts as each word triggers associations and the patient can’t suppress the automatic response to these

Question 20

Biological treatments

Answer 20

-antipsychotics either oral or intravenous
-typical or atypical
-typical- dopamine antagonist as reduces action of dopamine by blocking receptors therefore according to dopamine hypothesis this will reduce positive symptoms eg. hallucinations
-atypical- newer drugs with less side effects, blocks dopamine and serotonin receptors so also enhance mood. Bind stronger to dopamine receptors meaning can be prescribed at lower dose, which reduces side effects

Question 21

Chlorpromazine
Typical/ atypical
How it works
Side effects
research

Answer 21

-typical
-blocks dopamine receptors so reduces its activity
-muscle tightening, fidgeting, weight gain
-Barlow + Durand - effect in reducing symptoms in 60% of patients

Question 22

Haloperidol
Typical/ atypical
How it works
Side effects
research

Answer 22

-typical
-blocks dopamine receptors so reduces its activity
-muscle tightening, fidgeting, weight gain, (Schooler -55% relapse rate)
-Schooler - 75% showed reduction in symptoms

Question 23

Clozapine
Typical/ atypical
How it works
Side effects
research

Answer 23

-atypical
-blocks serotonin and dopamine receptors
-similar to typical, but fewer
-Pickar et al - compared with a placebo found clozapine most effective at reducing symptoms

Question 24

Risperidone
Typical/ atypical
How it works
Side effects
research

Answer 24

-atypical
-blocks serotonin and dopamine receptors
-similar to typical, but fewer (45% relapse rate)
-Emsley- 84% showed a reduction in +ve and -ve symptoms

Question 25

Psychological therapies

Answer 25

-CBT
-token economy
-family therapy

Question 26

CBT

Answer 26

-takes 5-20 sessions
-allows patient to adjust thinking so they can cope- doesn’t get rid of symptoms
-assumes thoughts, feelings and behaviour are all linked
-challenges maladaptive thoughts as often unaware of their cognitive errors
-therapists tried to make these thoughts conscious by challenging them and considering evidence
-behavioural assignments to challenge thoughts so they can acknowledge faulty thinking

Question 27

Token economies

Answer 27

-used in psychiatric hospitals
-don’t cure positive symptoms but help with negative symptoms eg. avolition
-aim to modify institutionalised behaviour so patient can live outside of hospital
-operant conditioning via positive reinforcement
-token is secondary reinforcer which can be traded in to gain primary reinforcer

Question 28

Family therapy

Answer 28

-families believed to play a role in onset of sz
-aims to improve interaction within families by reducing expressed emotion
-Pharoah identified strategies to reduce levels of expressed emotion
1. less stress with regards to caring for patient
2. reduces anger and guilt in family
3. family members still have time for themselves
4. challenges and changes negative beliefs about sz

Question 29

Interactionist approach

Answer 29

-holistic as acknowledges lots of things lead to the development of sz
-diathesis stress model proposed by Meehl, diathesis= schizogene, stress= schizophrenogenic mother
-Read- childhood trauma alters the developing brain leaving a person vulnerable which can then be triggered by an environmental factor
-stress element may not be psychological factors eg. cannabis use can lead to sz as acts as enviro trigger
-treatment using the diathesis stress model us mainly used in UK, antipsychotics and CBT
-Tienari study

Question 30

Tienari study (interactionist approach)

Answer 30

-reviewed 20,000 hospital records of women admitted to psychiatric hospitals with sz
-145 adopted away from mother (vulnerable group) compared to 158 adoptees without genetic risk
-adoptees individually assessed after 12 years and 21 years
-also assessed family functioning using oulu family rating scale
-psychiatrists kept blind as to which kids were vulnerable
-found 14 of the adoptees developed sz, 11 from vulnerable group
-reared in a healthy adoptive family, high risk group may not develop sz
-adoptive-family stress was a predictor in development of sz in low risk group