Option 2: Schizophrenia

Question 1

what is schizophrenia?

Answer 1

a mental disorder characterised by disruption of cognition and emotion.
it manifests through a person’s sense of self, actions, thoughts, perceptions and language.

Question 2

what diagnostic tools are used to diagnose schizophrenia (Sz)?

Answer 2

usually the DSM-V

Question 3

what clinical symptoms are sought out to diagnose Sz?

Answer 3

delusion
hallucinations
disorganised speech (e.g frequent derailment, incoherence)
grossly disorganised (catatonic behaviour)
negative symptoms (e.g alogia, avolition, affective flattering)

Question 4

how many symptoms of Sz are needed to diagnose Sz?

Answer 4

two or more

Question 5

what is the exception in the amount of symptoms needed to diagnose Sz?

Answer 5

only one symptom needed if delusions are bizarre or hallucinations consist of running commentary or conversations.

Question 6

what are positive symptoms?

Answer 6

these ‘add’ or distort normal functions

Question 7

what are negative symptoms?

Answer 7

these ‘take away’ or indicate a loss of normal functioning.

Question 8

explain hallucinations as a positive symptom.

Answer 8

• it is a sensory malfunction, meaning you perceive the environment incorrectly.
• usually hearing voices, but can also be seeing things, smelling or even feeling things that aren’t there.
• hearing voices takes on several forms; running commentary, discussion of patient, voices from another part of the body.

Question 9

explain delusions as a positive symptom.

Answer 9

• these are bizarre beliefs, rather than perceptions. for example, paranoid delusions (fear of being watched, persecution, etc.)
• there are also delusions of reference; believing secret messages meant just for them.
• as well as delusions of grandeur; inflated self importance.

Question 10

explain disorganised speech as a negative symptom.

Answer 10

• this is where abnormal thought processes lead to disorganised thoughts, which in turn affect speech.
• on the topic of derailment this is slipping from one topic to another, often in mid sentence.
• basically a ‘word salad’- gibberish.

Question 11

explain grossly disorganised as a negative symptom.

Answer 11

• where you can’t start or complete a task due to a lack of focus or motivation.
• it can lead to poor functioning e.g hygiene, clothing etc.
• in regards to catatonic behaviour there is reduced response to immediate environment, rigid posture or aimless repeated motor activity.

Question 12

explain speech poverty (alogia) as a negative symptom.

Answer 12

• these are slowed/blocked thoughts which lead to lessened speech fluency and productivity.
• most likely to be poorer at speech tasks, e.g ‘name as many…in a minute’
• there is often simplified speech as well.

Question 13

explain avolition as a negative symptom.

Answer 13

• less interest in or desire for things
• the inability to begin any meaningful behaviour — sit around doing nothing.

Question 14

explain affective flattening as a negative symptom.

Answer 14

• emotions are dulled — poorer emotive language use, body language, tone, etc.

Question 15

explain anhedonia as a negative symptom.

Answer 15

• loss of interest/pleasure in most/all activities. e.g physical = food, intimacy + social= interacting with others

Question 16

what is diagnostic reliability?

Answer 16

diagnostic reliability means that a diagnosis of schizophrenia (Sz) must be repeatable, i.e clinicians must be able to reach the same conclusions at two different points in time (test-retest reliability), or different clinicians must reach the same conclusions (inter-rater reliability).

Question 17

what is inter-rater reliability, in terms of Sz?

Answer 17

There are concerns over the lack of reliability in symptoms: only one symptom is needed if delusions are ‘bizzare’.
when Mojtabi & Nicholson asked 50 senior psychiatrists to differentiate between bizzare and non-bizzare delusions, they found a concordance rate of +0.40 (they still disagreed more than they agreed).
this indicates that even the basic classification criteria are too vague to allow for reliable diagnosis, thus emphasising another issue with diagnosing Sz.

Question 18

explain culture bias, in relation to Sz

Answer 18

it is assumed that Sz manifests equally across all cultures. the diagnostic criteria for Sz is based on western concepts, therefore harder to apply to non-western cultures.
it was found that 69% of US psychiatrists would diagnose a patient with Sz, only 2% of UK psychiatrists would diagnose the same person.
this is an issue because it can lead to false diagnoses depending on the culture.

Question 19

define validity, in relation to schizophrenia

Answer 19

whether or not the classification or diagnosis is accurate and correct

Question 20

define co-morbidity

Answer 20

two or more conditions/disorders can occur simultaneously within a patient.

Question 21

explain why co-morbidity is an issue within diagnosis/classification of Sz

Answer 21

buckley has suggested that depression occurs in around 50% of Sz patients, while substance abuse does in around 47%.
this is an issue because it makes diagnosis and treatment harder some symptoms of Sz may be depression and so separate from Sz, while both disorders may require contrasting treatments, causing great difficulty in advising patients.

Question 22

define symptom overlap

Answer 22

when two disorders have a common symptom.

Question 23

explain why symptom overlap is an issue within diagnosis/classification of Sz

Answer 23

a valid diagnosis must show an illness to be distinct from other disorders and be based on a system which measures what it claims to.
research has suggested that the validity of diagnostic systems can be called into question — many symptoms of Sz are also symptoms of other disorders such as depression and bipolar.

Question 24

define gender bias, in relation to schizophrenia

Answer 24

gender bias in the diagnosis of Sz is said to occur when accuracy of diagnosis is dependent on the gender of the individual.
the accuracy of diagnostic criteria is based on a clinician’s judgement with their stereotypical beliefs held about gender.
Boverman et al. (1970) found that clinicians in the US, equated mentally healthy ‘adult’ behaviour with mentally healthy ‘male’ behaviour. as a result there was a tendency for women to be perceived as less mentally healthy.

Question 25

what are the three genetic explanations of Sz?

Answer 25

family studies twin studies adoption studies

Question 26

explain family studies within Sz

Answer 26

this is where researchers located people with Sz and aimed to determine whether biological relatives are more likely to also suffer from Sz than non-biological relatives.

Question 27

explain a family study conducted for Sz

Answer 27

Gottesman: - children with 2 Sz parents had a 46% concordance rate - children with 1 Sz parent had a 13% concordance rate - children with a Sz sibling had a 9% concordance rate. therefore, the greater the genetic similarity, the higher the risk of Sz.

Question 28

explain twin studies within Sz

Answer 28

Mz twins share 100% of genes; Dz twins share only 50%. therefore the concordance rate of Sz should be much higher in Mz twins. if genes are the sole cause of Sz, there should be a 100% concordance.

Question 29

explain a twin study conducted for Sz

Answer 29

Joseph: Mz twins had a 40.4% concordance rate whilst Dz twins had a 7.4% concordance rate. therefore the greater the genetic similarity, the greater risk of Sz.

Question 30

explain adoption studies within Sz

Answer 30

this studies separated parents and children — therefore disentangling nature and nurture.

Question 31

explain an adoption study conducted for Sz

Answer 31

Tiernari: Finnish Adoption Study - 164 adoptees with Sz mothers; 6.7% ended up with Sz - 197 adoptees with non-Sz mothers; 2% ended up with Sz. this suggests a strong genetic basis.

Question 32

define neural correlates

Answer 32

there is a relationship between Sz symptoms and neural functioning. e.g dopamine hypothesis

Question 33

define the dopamine hypothesis

Answer 33

too much dopamine in certain areas of the brain causes positive symptoms of Sz.

Question 34

explain the dopamine hypothesis

Answer 34

it is where messages from the neurons that transmit dopamine fire too easily or too often, leading to hallucinations and delusions that are the characteristics positive symptoms of Sz. schizophrenics are thought to have abnormally high numbers of dopamine receptorson receiving neurons, resulting in more dopamine binding and therefore more neurons firing.

Question 35

explain the drugs that increase dopaminergic activity

Answer 35

- amphetamine is a dopamine agonist, i.e. it stimulates nerve cells containing dopamine , causing the synapse to be flooded with this neurotransmitter. - 'normal' individuals who are exposed to large doses of dopamine releasing drugs such as amphetamines can develop the characteristic hallucinations and delusions of a schizophrenic episode. this generally appears with abstinence from the drug. - people who suffer from Parkinson's disease who take the drug, L-dopa, to raise their dopamine levels have been found to develop schizophrenic-type symptoms.

Question 36

explain the drugs that decrease dopaminergic activity

Answer 36

- antipsychotic drugs block the activity of dopamine in the brain. by reducing activity in the neural pathways of the brain that uses dopamine as the neurotransmitter, these drugs eliminate symptoms such as hallucinations and delusions. - the drugs known as dopamine antagonists, because they block its action, alleviated many of the symptoms of Sz and so strengthened the case for the important role of dopamine in this disorder.

Question 37

explain the revised dopamine hypothesis: Davis & Kahn

Answer 37

positive symptoms are a result of excess of dopamine in subcortial areas of the brain. negative symptoms are a result of a deficit of dopamine in the prefrontal cortex.

Question 38

what evidence is there behind the revised dopamine hypothesis: Davis & Kahn?

Answer 38

– neural imaging — Patel et al. used PET scans, found lower levels of dopamine in the prefrontal cortex of the Sz's compared to the control group. – animal studies — Wang & Dutch — depleted dopamine in the prefrontal cortex of rats, leading to cognitive impairment (i.e. a negative symptom) which could then be reversed using atypical antipsychotics.

Question 39

what does the evidence from the revised dopamine hypothesis: Davis & Kahn, suggest?

Answer 39

it suggests that dopamine in varying levels causes different symptoms of Sz.

Question 40

what are antipsychotics?

Answer 40

they are drugs which help manage the most disturbing forms of psychotic illness. they can help reduce symptoms, improve day to day functioning, and increase subjective well-being. they reduce the action of dopamine in the brain.

Question 41

what are typical antipsychotics?

Answer 41

they were developed in the 1950s. they are antagonists — so they bind to but do not stimulate dopamine receptors, therefore blocking dopamine's action. they therefore reduce positive symptoms such as delusions and hallucinations. the symptoms usually decrease within a few days of first taking the drugs — other symptoms may take several weeks to subside.

Question 42

what is an example of a typical antipsychotic drug?

Answer 42

chlorpromazine

Question 43

what is a flaw in typical antipsychotics?

Answer 43

Kapur — 60-75% of dopamine receptors in the mesolimbic pathway must be blocked in order for the drug to be effective. the drug blocks dopamine receptors in all areas of the brain indiscriminately leading to side effects.

Question 44

what are atypical antipsychotics?

Answer 44

these are '2nd generation antipsychotics' they also act on dopamine receptors but they rapidly dissociate and so they do bind to the receptors temporarily, then break off to allow normal dopamine transmission which helps to reduce side effects as they are messing with dopamine transmission less.

Question 45

what are the 3 main differences between atypical and typical antipsychotics?

Answer 45

atypical has a lower risk of side effects atypical is more suitable for treatment-resistant patients (those whom chlorpromazine didn't work for) atypical can help negative symptoms and cogntive impairment as well.

Question 46

what are the further differences of atypical antipsychotics compared to typical antipsychotics?

Answer 46

they are less focused on blocking dopamine receptors. they also have an affinity with serotonin receptors, potentially explaining the different effects compared to typical antipsychotics.

Question 47

what is dysfunctional thought processing?

Answer 47

where lower levels of the information processing in some areas of the brain suggest cognition is impaired.

Question 48

what is metarepresentation?

Answer 48

it is the cognitive ability to reflect on thoughts and behaviour (Frith et al. 1992).

Question 49

how does metarepresentation lead to hallucinations?

Answer 49

this dysfunction disrupts our ability to recognise our thoughts as our own. this could lead to the sensation of hearing voices (hallucination) and having thoughts placed in the mind by others (delusions).

Question 50

how does dysfunction of central control lead to speech poverty?

Answer 50

Frith et al. (1992) also identified of dysfunction of central control as a way to explain speech poverty – central control being the cognitive ability to suppress automatic responses while performing deliberate actions. people with Sz experience derailment of thoughts and spoken sentences because each word triggers automatic associations that they cannot suppress.

Question 51

what are the 3 types of family dysfunction as a psychological explanation for Sz?

Answer 51

schizophrenogenic mothers double-bind theory expressed emotion

Question 52

what are schizophrenogenic mothers?

Answer 52

Fromm-Reichmann's (1948) psychodynamic explanation is based on patients' early experiences of 'schizophrenogenic mothers'; mothers who cause Sz. these mothers are cold, rejecting and controlling, and create a family climate of tension and secrecy. this leads to distrust and paranoid delusions and Sz.

Question 53

what is the double-bind theory?

Answer 53

bateson et al. (1972) described how a child may be regularly trapped in situations where they fear doing the wrong thing, but receive conflicting messages about what counts as wrong. they cannot express their feelings about the unfairness of the situation. when they 'get it wrong' (often) the child is punished by withdrawal of love – they learn the world is confusing and dangerous, leading to disorganised thinking and delusions.

Question 54

what is expressed emotion (EE)?

Answer 54

expressed emotion is the level of emotion (mainly negative) expressed towards the schizophrenic patient and includes: – verbal criticism of the patient – hostility towards them – emotional over-involvement in their life. high levels of EE cause stress in the patient, a primary explanation for relapse in patients with Sz.

Question 55

what are the 3 psychological therapies for Sz?

Answer 55

cognitive behaviour therapy (CBT) family therapy token economies

Question 56

what is the aim of CBT?

Answer 56

the aims of CBT in general are to help patients identify irration thoughts and try to change them.

Question 57

what does CBT involve?

Answer 57

it may involve discussion of how likely a patient's beliefs are to be true, and consideration of less threatening possibilities.

Question 58

how does CBT help patients?

Answer 58

patients are helped to make sense of how their delusions and hallucinations impact on their feelings and behaviour. offering explanations for these symptoms reduces anxiety and helps the patient realise their beliefs are not based on reality.

Question 59

what is family therapy?

Answer 59

family therapy is with families rather than the individual patients, aiming to improve communication and interaction in the family.

Question 60

what do family therapists try to reduce?

Answer 60

they try to reduce stress within the family that may contribute to patient's risk of relapse (reduce levels of EE).

Question 61

what are the range of strategies, identified by Pharaoh et al. (2010), family therapists use to reduce the likelihood of relapse and readmission to hospital?

Answer 61

1. reduce the stress of caring for a relative with Sz. 2. improve the ability of family to anticipate and solve problems. 3. reduce guilt and anger in family members 4. improve beliefs about and behaviour toward Sz.

Question 62

what are token economies?

Answer 62

token economies are reward systems (operant conditioning) used to manage the behaviour of patients with Sz who spend long periods in psychiatric hospitals.

Question 63

how do token economies wprk?

Answer 63

tokens are given to patients who carry out desirable behaviours (e.g. getting dressed, making a bed, etc.). this reward reinforces the desirable behaviour and because it is given immediately prevents 'delay discounting' (reduced effect of a delayed reward).

Question 64

how are the token 'secondary reinforcers'?

Answer 64

tokens have no value in themselves but can be swapped later for tangible reward (e.g. sweets, a walk outside, etc.). they are secondary reinforcers because they only have value due to the learned association (classical conditioning) with innate primary reinforcers.

Question 65

what is the diathesis-stress model?

Answer 65

it says both a genetic vulnerability and a stress trigger are needed to develop Sz.

Question 66

what is the modern understanding of 'diathesis'?

Answer 66

diathesis means genetic vulnerability it is now believed that diathesis is not due to a single 'schizogene'. instead it is thought that many genes increase vulnerability. also, diathesis doesn't have to be genetic. it could be early psychological trauma affecting brain development.

Question 67

what is the modern understanding of 'stress'?

Answer 67

a modern definition of stress (in relation to diathesis-stress) includes anything that risks triggering schizophrenia (including psychological stress). Varese found that children who experienced trauma before the age of 16 were 3 times as likely to develop Sz in later life compared to those who didn't experience childhood trauma.

Question 68

how would diathesis-stress work?

Answer 68

both diathesis and stress add up to total to Sz. so a person with a large genetic vulnerability may only need a small stress trigger to push them over.