Need To Know Schizophrenia Flashcards
1
Q
Schizophrenia definition
A
- severe mental disorder characterised by profound disruption of cognition & emotion
- affects persons language,thought, perception, emotions & even sense of self
- schizophrenic believes things that aren’t true (delusions) or hears voices or sees visions when there are no sensory stimuli to create them (hallucinations)
- Schizophrenia ranks among top 10 cases of disability worldwide
- affects about 4 in 1000 people at some time in their lives
2
Q
Prevalence
A
- affects 1% of population
- men are more likely to suffer than women
- onset is typically in late adolescence and early adulthood (15-35)
- commonly diagnosed in cities and working class
- many symptoms of disorder although not every patient displays all symptoms
3
Q
DSM 5 criteria for schizophrenia
A
1a) 3 top systems must be had duration of 6 months
1. delusions
2. Hallucinations
3. Disorganised speech
4. Catatonic behaviour
5. Negative symptoms
4
Q
List negative symptoms
A
- avolition
- alogia
- affective flattening
- anhedonia
4
Q
Describe negative symptoms
A
- alogia -reduction in range and intensity of emotional expression voice tone,eye contact and body language
- anhedonia-reduction of interests and desires as well as inability to initiate and persist in goal directed behaviour
- eg sitting in house for hours everyday doing nothing.
- distinct from poor social function or disinterest which can be result of other circumstances
- affective flattening-Lessening of speech fluency and productivity
- thought to reflect slowing or blocked characteristic signs
- may produce fewer words in given time on a task or verbal fluency
- avolition-loss of interest in pleasure in all or almost all activities
- may be persuasive ie all embracing or it may be confined to a certain aspect of experience
- physical type is inability to experience physical pleasures like pleasure from food, bodily contact and so on
5
Q
List positive symptoms
A
- delusions
- hallucinations
- catatonic or disorganised behaviour
- disorganised speech
6
Q
Describe positive symptoms
A
- hallucinations-sensory experiences
- Some hallucinations are related to events in environment whereas others bear no relationship to what senses are picking up from environment
- delusions-irrational beliefs delusions of grandeur involve being important historical, political or religious figures like Jesus delusions of paranoia
- grossly disorganised of catatonic behaviour- includes inability or motivation to initiate task or to complete it once it’s started leads to difficulties in daily living & can result in decreased interest in personal hygiene.
- Catatonic behaviours characterised by reduced reaction to immediate environment,rigid posture or aimless motor activity
- disorganised speech -result of abnormal thought processes where individual has problems organising his/her own thoughts & shows up in their speech
- may slip from one topic to another derailment even in mid sentence & in extreme cases speech may be so incoherent it sounds like complete gibberish
7
Q
Family dysfunction A01
A
- refers to any forms of abnormal processes within a family
- such as:
- conflict
- communication problems
- cold parenting
- criticism
- control
- high levels of expressed emotions
- may be risk factors for development and maintenance of schizophrenia.
8
Q
Family dysfunction studies, effects of EE and schizophrenogenic
A
- double bind communication
- Bateson 72
- child receives mixed messages and can’t do right thing
- results in disorganised thinking and paranoia
- high EE where family shows exaggerated involvement, control, criticism which increase likelihood of relapse (kavanagh 1992) relapse rate is doubled (butzlaff and Hooley)
- psychodynamic theorists recognised a schizophrenogenic mother
- typically cold, controlling and rejecting which leads to excessive stress which triggers psychotic thinking; father in such families is often passive
9
Q
Biological explanations for schizophrenia
-3 explanations
A
- Genetic vulnerability
- role of the neurotransmitter dopamine
- Neural correlates
11
Q
Difference between Agonist & antagonist
A
- Agonists= chemical that binds to receptor of a cell & triggers a response by that cell.
- An antagonist blocks or reduces effect of a neurotransmitter
12
Q
The dopamine hypothesis explanation for schizophrenia
- amphetamine
- cocaine
- antipsychotic drugs (dopamine antagonists)
A
- amphetamine=dopamine agonist
- stimulates nerve cells containing dopamine
- causing synapse to be flooded
- large doses of drug can cause hallucinations & delusions of a schizophrenic episode
- Cocaine increase levels of dopamine in brain
- cause positive symptoms of schizophrenia
- exaggerate them in people who already have disorder
- Antipsychotic drugs (dopamine antagonists) block activity of dopamine in brain
- by reducing stimulation of dopamine system eliminates hallucinations & delusions
- By alleviating many symptoms of schizophrenia antipsychotic drugs strengthen case for dopamine being significant contributory factor
13
Q
The Subtypes of schizophrenia
A
- disorganised - thought disorder
- paranoid- delusions/hallucinations
- Residual- -/+ symptoms, low intensity
- Undifferentiated- Symptoms don’t meet diagnostic criteria
- Catatonic - Marked absences
14
Q
Genetic explanations for schizophrenia
A
- schizophrenia thought to be polygenic
- means it’s development isnt determined by single gene but few maybe as many as 108 genes
- there is little predictive power from this explanation
15
Q
Classification
A
- number of symptoms by which we can classify abnormal patterns of thinking,behaviour and emotion into mental disorders
- systems not only classify abnormality but give guidance on how to diagnose them
- two most widely used systems of classification and diagnosis are DSM and ICD
- ICD- international classification of causes of disease and death (world health organisation) recognises range of subtypes
- DSM - diagnostic and statistical manual of mental disorder (American psychiatric association) used to also recognise subtypes but most recent DSM 5 have dropped these
16
Q
What are positive and negative symptoms
A
- positive symptoms are those that appear to reflect an excess or distortion of normal functions
- negative symptoms are those that appear to reflect a diminution or loss of normal functions
17
Q
Negative symptoms speech poverty avolition
-andreason 3 signs
3 signs of avolition
A
- poor hygiene and grooming
- lack of persistence in work/education
- lack of energy
18
Q
Crow argues that individuals with + symptoms and acute onset should be diagnosed as type 1 schizophrenia. Individuals with chronic onset with symptoms should be diagnosed as type two schizophrenia
What’s acute and chronic
A
- acute- when person who was previously healthy develops symptoms of schizophrenia over short period of time
- chronic- long term state of schizophrenia
19
Q
Classification
-schizophrenia doesn’t have a single defining characteristic. It’s a cluster of symptoms some of which appear to be unrelated
According to ICD 10, subtypes of schizophrenia disorder are what
A
- disorganised/hebephrenic schizophrenia
- primarily negative symptoms
- catatonic schizophrenia
- person is withdrawn mute,negative and often assumes very unusual body positions
- paranoid schizophrenia
- feels extremely suspicious or grandiose
- undifferentiated schizophrenia
- residual schizophrenia
20
Q
The interactionist approach
-biological, societal and psychological factors
A
- acknowledges there are biological,psychological and societal factors in development of schizophrenia
- biological- genetic vulnerability and neurochemical and neurological abnormality
- psychological - Stress resulting from life events and daily hassles including poor quality interactions in family
21
Q
Thé diathesis stress model
A
- vulnerability to sz and a stress trigger are necessary to develop sz
- one or more underlying factors make a person vulnerable but onset of condition is triggered by stress
22
Q
Meehls model of diathesis
A
- believed diathesis was entirely genetic result of single schizogene
- led to development of a biologically based schizotypic personality one characteristic is sensitivity to stress
- according to Meehl if person doesn’t have schizogene then no amount of stress would lead to sz
- However in carriers of gene,chronic stress through childhood and adolescence particularly schizophrenic mother could result in sz
23
Q
Modern understanding of sz
A
- now clear that many genes increase genetic vulnerability.
- no single schizogene
- modern views of diathesis also include range of factors beyond genetic including psychological trauma
- trauma becomes diathesis rather than stressor
- read proposed neurodevelopmental model in which early development in early trauma alters developing brain
- Eg hypothalamic pituitary adrenal system HPA becomes over active and person is more vulnerable to later stress
- psychological stress is still seen as important
- modern definition of stress includes anything that risks triggering sz eg cannabis
- cannabis is a stressor because it increases risk of sz x7 as it interferes with dopamine system
- however most don’t develop sz after smoking cannabis so there must be other vulnerability factors
24
Q
Treatment interactionist approach
A
- approach acknowledges both biological and psychological factors and is compatible with both types of treatment
- model combines antipsychotics with psychological therapies such as CBT
- standard practice in GB to combine two and is unusual to treat using psychological therapies alone
25
Q
A03 evidence for the role of vulnerability and triggers
R
A
- tienari investigated combination of genetic vulnerability and parenting style (the trigger)
- Children adopted from 19000 Finnish mothers with sz between 1960-1979 followed up
- adoptive parents assessed for child rearing style & rates of sz were compared to those in control group of adoptees without any genetic risk
- child rearing style of high levels of criticism and conflict and low levels of empathy was implicated in development of sz but only for children with high genetic risk but not in control group
- suggests both genetic vulnerability and family stress are important in development of sz
- genetically vulnerable children are more sensitive to parenting behaviour
26
Q
A03 thé original diathesis stress model is over simplistic
A
- idea of single schizogene and schizophrenic parenting style as major source of stress is over simple
- multiple genes increase vulnerability theres no single gene
- stress can also come in many forms not just dysfunctional parenting
- now believed vulnerability can be caused by early trauma as well as genetic make up & stress can come in many forms including biological
- Houston: childhood sexual trauma emerged as vulnerability factor while cannabis was trigger.
- shows old idea of diathesis as biological and stress as psychological is over simple this is problem for old idea of diathesis stress but not for newer models
27
Q
A03 support for combination of treatments tarrier
A
- tarrier 315 patients were randomly allocated to medication +CBT group, medication + supportive counselling or control group
- patients in two combination groups showed lower symptom levels than control although there were no difference in rates of hospital réadmission
- this and other studies show theres clear advantage to adopting an interactionist approach
28
Q
A03 we don’t know exactly how diathesis and stress work
A
- strong evidence to suggest some sort of underlying vulnerability coupled with stress can lead to sz
- also have well informed suggestions for how vulnerabilities and stress might lead to symptoms
- however we don’t yet fully understand mechanisms by which symptoms of sz appear and how both vulnerability and stress produce them
29
Q
Dopamine affects
A
-dopamine is a neurotransmitter that generally has an excitatory effect and is associated with sensation of pleasure
