A03 Psychologists for Schizophrenia Flashcards
(36 cards)
Cultural bias: Tendency to over diagnose members of other cultures.
Do you know any research support for this statement?
A03: Classification and/or diagnosis of schizophrenia
✩Research shows that there is a tendency to over diagnose members of other cultures.
✩For example, Cochrane found that the incidence of schizophrenia in the West Indies is similar to the UK at 1% but found that people of Afro-Caribbean origin are x7 times more likely to be diagnosed with schizophrenia when living in the UK
Can you explain to me why this constitutes an mis-diagnosis of schizophrenia?
A03: Classification and/or diagnosis of schizophrenia
✩ In other cultures, hearing voices is normal, whereas in the UK hearing voices is a positive symptom of schizophrenia. e.g. rituals of recieving messages from God may be percieved as schizophrenic by Westerm practitioners.
✩ Perhaps there may be a misdiagnosis of schizophrenia because the system of diagnosing schizophrenia has been made based on Western symptoms of schizophrenics; and thus suffers from imposed etic.
Can you explain to me why this constitutes an over-diagnosis of schizophrenia?
A03: Classification and/or diagnosis of schizophrenia
✩ However, there may be an over-diagnosis of schizophrenia because when people move to the UK, they may undergo environmental stressors that actually made it even more likely for Afro-Carribeans to develop schizophrenia such as suffering from poverty.
✩ Therefore, this leads to an increase in the amount of schizophrenia diagnosed as a result.
High inter-rater reliability…
A03: Classification and/or diagnosis of schizophrenia
✩ Beck found 54% concordance between clinicians who used the DSM manual to diagnose schizophrenia.
High test-retest reliability
A03: Classification and/or diagnosis of schizophrenia
✩ In 2005, Soderberg found +0.81 correlation in reliability using the DSM 1V, suggesting that there has been an improvement in reliability.
What has research found about co-morbidity rates in those with schizophrenia?
A03: Classification and/or diagnosis of schizophrenia
✩Buckley found that 50% of patients diagnosed with schizophrenia were also diagnosed with depression.
✩This is a limitation because it undermines the usefulness of diagnosis and classification systems of schizophrenia.
✩This is because if half as many patients with schizophrenia also have severe depression it suggests that schizophrenia could be one single condition, affecting the validity of diagnosing schizophrenia.
Research support from Loring and Powell for existence of gender and cultural bias
A03: Classification and/or diagnosis of schizophrenia
✩Loring and Powell sent 290 psychiatrists two identical case studies, the psychiatrists changed the gender and race of the case studies to different genders and races and a control situation in which no gender or race is disclosed.
✩The researchers found an over diagnosis of black case studies and under-diagnosis of female case studies.
✩When the race and gender of the psychiatrist was the same, an accurate diagnosis was achieved.
✩This suggests the existence of both gender and cultural bias in psychiatrists diagnosis of schizophrenia.
Contradictory research support for inter-rater reliability
A03: Classification and/or diagnosis of schizophrenia
✩Cheniaux found low inter-rater reliability when 2 clinicians diagnosed 100 patients.
✩This shows that the reliability of diagnosis is not consistent.
Gender bias in diagnosing schizophrenia
A03: Classification and/or diagnosis of schizophrenia
✩ Cotton et al who found female patients with negative symptoms of schizophrenia can typically function better than men- and therefore escape diagnosis of schizophrenia.
✩ The reliability of the diagnosis of schizophrenia is low because men and women with the same symptoms may get different diagnoses, meaning that diagnosis is not consistent.
However, how can the idea of diagnosis being gender bias be criticised?
A03: Classification and/or diagnosis of schizophrenia
✩ Different diagnosing problems may not be due to the inconsistency of diagnosing but due to actual physiological differences between males and females e.g. in terms of hormones.
Rosenhan’s study of ‘Sane in Insane Places’
A03: Classification and/or diagnosis of schizophrenia
✩ Students inffiltrated the hospital and pretended to be schizophrenic; but had no actual symptoms.
✩ Average stay before being discharged from the mental hospital war was 19 days.
✩ It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behaviour can easily be misunderstood
✩ Therefore, this casts doubt on the validity and reliability of schizophrenia as it cannot be easily identified.
Research support for implications of dopamine in causing schizophrenia through effectiveness of drugs…
A03: Biological Explanations of Schizophrenia
✩ Barlow & Durand (1995) report that chlorpromazine is effective in reducing schizophrenic symptoms in about 60% of cases.
✩ Clearly shows that dopaminergic activity is implicated in schizophrenia because the study demonstrates that using a dopaminergic activity blocking drug like chlorpromazine is effective in treating schizophrenia in many cases.
Genetic mutations support the genetic explanation of schizophrenia
A03: Biological Explanations of Schizophrenia
✩ It is possible for people to develop schizophrenia even in the absence of a family history of the disorder. This could be through mutation in the paternal DNA in the sperm because of mutagenic agents.
✩ Brown et al found a relationship between paternal age (which is linked with an increased risk of mutation) and the risk of developing schizophrenia. He found that in men under 25 the risk was 0.7% and men over 50 was 2%.
✩ Therefore, the older the father, the higher the risk that the child develops schizophrenia, supporting the theory of the genetic explanation
Research support from twin studies
A03: Biological Explanations of Schizophrenia
✩ Gottesman reviewed cases of schizophrenia and found a concordance rate of 48% for MZ twins and 17% for DZ twins.
✩ This suggests that schizophrenia has a genetic aspect because MZ twins had a significantly higher concordance rate than DZ twins.
Research support for the effectiveness of antipsychotic drugs through meta-analysis.
A03: Biological Explanations of Schizophrenia
✩ Leucht et al carried out a meta-analysis of 212 studies which analysed the effectiveness of different antipsychotic drugs compared with a placebo.
✩ They found all drugs tested were significantly more effective than the placebo in the treatment of positive and negative symptoms.
✩ The effectiveness suggests that dopamine does play an important role in the development of schizophrenia.
Research support from Cognitive Neuroscience
A03: Biological Explanations of Schizophrenia
✩ Kesler et al (2000) used MRI and PET scans to compare schizophrenic and non-schizophrenic participants. They found differences in dopamine levels suggesting that dopamine is an important factor in the onset of schizophrenia.
✩ This study supports the dopamine strand as the finding shows that dopamine levels are different in non-schizophrenics and schizophrenics.
Research support for enlarged ventricles
A03: Neural correlates explanation of schizophrenia
✩ Suddath et al. (1990) used MRI (magnetic resonance imaging) to obtain pictures of the brain structure of MZ twins in which one twin was schizophrenic.
✩ The schizophrenic twin generally had more enlarged ventricles and a reduced anterior hypothalamus.
✩ This suggests that there is wider academic credibility for enlarged ventricles determining the likelihood of schizophrenia developing.
Supporting research of the influence of family dysfunction from family studies.
A03: Psychological explanations of schizophrenia
✩ Tienari who studied the biological children of schizophrenic mothers who had been adopted.
✩ It was found that 5.8% of those adopted into psychologically healthy families developed schizophrenia, compared to 36.8% of children raised in dysfunctional families.
✩ This suggests that the interpersonal family environment has a significant impact on the development of schizophrenia is genetically vulnerable people.
Meta analysis supporting family dysfunction in causing schizophrenia…
A03: Psychological explanations of schizophrenia
✩ Butzlaff and Hooley showed using a meta-analysis of 27 studies that relapse into schizophrenia is significantly more likely in families that have issues with expressed emotion.
Research support for relapse rate and its relation to expressed emotion
A03: Psychological explanations of schizophrenia
✩ Hooley found that there is a 70% relaps rate in high EE families except for 30% in low EE families.
There is research support contradicting the importance of double bind (mixed messages)…
A03: Psychological explanations of schizophrenia
✩ Research from Ringuette and Kennedy contradicts the importance of double bind.
✩ A content analysis of letters sent to psychiatric patients from mothers had found no difference in the number of double bind communications in patients with schizophrenia compared to patients with other psychiatric conditions.
✩ Therefore, it was concluded that double bind led to poor mental health not schizophrenia
Research support for deficits in central control - stroop test…
A03: Cognitive Explanations of Schizophrenia
✩ Stirling et al (2006) conducted the Stroop test on 30 patients with schizophrenia and 18 control patients. The task involved naming the ink colours without saying the word.
✩ This is difficult as there is desire to say the words that needs to be controlled. Stirling found that patients with schizophrenia took twice as long to name the colours as controls.
✩ This shows that patients with schizophrenia do have dysfunctional thought processing such as deficits in Central control tasks, supporting Firth’s ideas
Firth supported his ideas with cognitive neuroscience studies.
A03: Cognitive Explanations of Schizophrenia
✩ Firth (1992) supported these ideas with biological/cognitive neuroscience studies. 30 schizophrenic patients with various symptoms had PET scans.
✩ The scans indicated a reduction in the blood flow in the frontal cortex of patients with negative symptoms like Avolition and inability to suppress automatic thoughts.
✩ Scans also showed increased activity in an area of the temporal lobe with patients with reality distortion
✩ This suggests that there are biological differences in schizophrenics brain regions associated with theorised cognitive processes.
Practical applications of cognitive explanation…
A03: Cognitive Explanations of Schizophrenia
✩ Yellowless et al. (2002) developed a machine that produced virtual hallucinations, such as hearing the television telling you to kill yourself or one person’s face morphing into another’s.
✩ The intention is to show schizophrenics that their hallucinations are not real. This suggests that understanding the effects of cognitive deficits allows psychologists to create new initiatives for schizophrenics and improve the quality of their lives.