paper 3 Flashcards
(43 cards)
diagnosis and classification of schizophrenia
serious mental disorder affecting 1% population, more common in males, city-dwellers and lower socioeconomic groups
classification: identify symptoms that go together = a disorder
e.g. DSM-5 one positive symptom must be present, ICD-10 two or more negative symptoms are sufficient for a diagnosis
ICD-10 recognises a range of subtypes of schizophrenia, paranoid/catatonic, whereas current DSM doesn’t, ICD - globally by world health organisation, DSM - primarily used by american psychiatric association
diagnosis: identify symptoms and use classification system to identify the disorder
symptoms of schizophrenia
positive symptoms: anything that’s been added to normal behaviour that wasn’t previously there
hallucinations, when you perceive something that isn’t actually there, most common types are auditory but also relate to all senses, unusual sensory experiences e.g. hearing voices
delusions, bizarre irrational beliefs that are clearly untrue e.g. believing to be being a victim of conspiracy
negative symptoms: the absence of normal behaviour
speech poverty, issues with normal communication, dsm recognises as positive, icd neg
avolition, absence of goal directed behaviour, poor motivation to do everyday tasks
catatonia, strange bizarre movements or holds the same position for hours on end
affective flattening, an absence of emotion
not done genetic explanation for schizophrenia (biological)
family studies: strong relationship between degree of genetic similarity and shared risk of schizophrenia, gottesman found almost 50% chance of developing schizophrenia when identical twin with schizophrenia, almost 10% with siblings
candidate genes: schizophrenia is polygenetic, requires several genes, 108 separate genes associated with slightly increased risk of schizophrenia
mutation:
*neural correlates of schizophrenia (biological)
dopamine hypothesis: originally linked to high levels of dopamine or too many d2 receptors on receiving neurons, d2 receptors effect attention and perception, so firing more likely increases risk of distorted perception like hallucinations, now linked to low levels too
neural correlates: links characteristics or experiences of schizophrenia to specific functions or activities in brain areas
amygdela is smaller in schizophrenics, responsible for basic feelings of fear, lust and anger, smaller means it links to flattening
visual and auditory cortex, same activity in these areas during hallucinations as genuine visual and auditory experiences
- biologically reductionist
not done family disfunction in explaining schizophrenia (psychological explanations for schizophrenia)
schizophrenic mothers:
double-bind theory:
expressed emotion:
- socially sensitive research, parent blaming
*cognitive explanations for schizophrenia (psychological explanations for schizophrenia)
dysfunctional thought processing: lower levels of information processing in some areas of the brain suggest cognition is impaired, e.g. reduced processing in ventricle striatum is associated with negative symptoms
metarepresentation: the cognitive ability to reflect on thoughts and behaviour, dysfunction disrupts our ability to recognise our thoughts as our own, leading to hallucinations or delusions
central control: cognitive ability to suppress automatic responses while performing deliberate actions, dysfunction leads to speak poverty as words trigger automatic associations that cannot be suppressed
- could be a symptom rather than a cause, schizophrenia may have caused disturbed thinking, issues with causality
+ support from stirling et al, compared performance in cognitive tasks, those with schizophrenia found it harder to name the front colours due to cognitive impairment
typical antipsychotics (biological therapy for schizophrenia)
e.g. chlorpromazine
work by acting as antagonists in the dopamine system and aim to reduce dopamine action, strongly associated with dopamine hypotheses
they block the dopamine d2 receptors in the synapses in the brains that are linked to perception, which reduces dopamine action, initially increases levels but then production is reduced, normalises neurotransmission, reducing symptoms like hallucinations
also has a sedative effect, effects histamine receptors, can be used to calm anxious patients when first admitted to hospital
can be administered through tablets, injections or syrups
+ support for effectiveness, thornley, 13 trials over 1100 patients, drug was better than placebo in reducing symptoms and their severity
- side effects, sleepiness, agitation, weight gain, most serious is neuroleptic malignant syndrome (NMS) when dopamine is blocked in the hypothalamus and can lead to comas or death, can do harm as well as good, patients might avoid taking them
atypical antipsychotics (biological therapy for schizophrenia)
e.g. clozapine
aim of developing newer drugs was to maintain/improve effectiveness of drugs in suppressing psychosis symptoms and minimise side effects of the drug used
binds to dopamine, serotonin and glutamate receptors
reduces depression and anxiety as well as improving cognitive functioning, improves mood, reducing schizophrenic suicide rates
e.g. risperidone
developed due to deaths related to clozapine
binds more strongly to dopamine receptors, therefore more effective in smaller doses than most antipsychotics and has fewer side effects, safer
+ have a lower rate of tardive dyskinesia, involuntary movements of the hands, lips, face and feet making patients more likely to take them
+ more effective in treating negative symptoms than typical antipsychotics
*cbt (psychological therapy for schizophrenia)
aims to identify and challenge irrational thoughts e.g. delusions and hallucinations
coping strategy enhancement, specific cbt for psychotic symptoms of schizophrenia, based on tarrier research where triggers could be identified ad coping strategies were given e.g. distraction, positive self talk, behavioural strategies, relaxation training
5-20 sessions that can be done individually or in a group
helps patients to understand how their delusions and hallucinations impact their feelings and behaviours, e.g. hearing voices - demons - afraid
normalisation involves explaining to the patient that hearing voices is an ordinary experience
example: turkington et al treated a paranoid client who believed the mafia was trying to kill him, acknowledged the anxiety, explained other, less frightening possibilities and gently challenged his beliefs
- not accessible for everyone, learning disabilities or unable to communicate
+ supporting research, tarrier found reduction in positive symptoms with cbt in comparison to control group
*family therapy (psychological therapy for schizophrenia)
aims to reduce levels of expressed emotions, especially negative emotions like anger and guilt that create stress, reducing these reduces the chance of relapse
therapist encourages family members to for a therapeutic alliance, all agree on aims of the therapy, also tries to improve their beliefs and behaviours towards schizophrenia, achieve a balance between caring for the individual with schizophrenia and maintaining their own lives
burbachs model: phase 1 and 2, share information, identify resources family can offer, phase 3 and 4, learn mutual understanding, look at unhelpful patterns of interaction, phase 5, 6 and 7, skill training (e.g. stress management techniques), relapse prevention and maintenance
+ benefits not just the individual, helps the family know how to give support, wider benefits to society and to the individual
+ supporting evidence, mcfarlane found relapse rates reduced by around 50-60%
- doesn’t address underlying cause just prevents relapse
*token economies (management of schizophrenia)
ayllon and azrin used a token economy in a schizophrenia ward, a gift token was given for every tidying act, which could then be exchanged for privileges e.g. films
institutionalisation occurs in long term hospital treatments, matson et al identified three categories of institutional behaviour that can be tackled using token economics: personal care, condition related behaviours and social behaviour, modification to this behaviour doesn’t cure schizophrenia but has two benefits
1. quality of life, improve quality of life in the hospital setting
2. ‘normalises’ behaviours, encourages return to ‘normal’ behaviour, making it easier to adapt once out of the hospital
process: tokens given immediately after desired behaviour, target behaviour decided individually, then sapped for rewards, must be given tokens immediately or its less effective
based on operant conditioning, tokens are secondary reinforcers exchanged for primary reinforcers (rewards), generalised reinforcers, tokens that can be exchanged for a range of different primary reinforcers are more effective
- ethical issues, professionals have the power to control people’s behaviour, may make them more distressed by not having pleasures
- not long term, behaviours are likely to return once out of hospital
+ easy to implement, doesn’t require specialists, cheap
*interactionist approach to schizophrenia
considers combined effects of biological, psychological and social factors on the development and treatment of schizophrenia
(original) diathesis stress model: diathesis, genetic vulnerability (schizogene), if a person didn’t have this gene they wouldn’t develop schizophrenia, stress, environmental trigger (schizophrenic mother), triggers gene to develop schizophrenia
(new) diathesis stress model: original too simplistic, diathesis, any vulnerability, stress, any kind of trigger
+ tienari et al: investigated combination of genetic vulnerability and parenting style in children adopted from finnish mothers with schizophrenia, adoptive parents assessed on child-rearing style, compared with control of no genetic risk, high levels of criticism and conflict and low levels of empathy lead to development of schizophrenia in children with the genetic risk
+ holistic, integrates multiple factors, more reflective of the complexity
treatment involves combining antipsychotics with a psychological therapy (usually cbt), antipsychotic reduces dopamine activity and cbt helps identify negative thoughts
+ tarrier et al: randomly allocated patients to medication + cbt, medication + supportive counselling group or control group, just medication, patients in experimental groups showed less symptoms than control, approach is beneficial and reduces suffering
- challenging in practice, may find it hard to adhere to both treatments simultaneously, requires collaboration between healthcare professionals from different disciplines
*reliability and validity in classification and diagnosis of schizophrenia
reliability: how consistent findings are, in context of schizophrenia, extent to which psychiatrists can agree on the same diagnosis when independently assessing patients (inter-rater reliability), should reach the same diagnosis each time
(ao3): rosenham ‘being sane in insane places’, pseudo patients did not all receive the same diagnosis when in psychiatric hospitals showing the same symptoms, hearing voices and feeling ‘empty’, poor consistency in diagnosis and classification, poor inter-rater reliability
validity: how accurate the results are, consider validity of diagnosis tools, do dsm and icd measure what they are supposed to?
(ao3): cheniaux et al, two psychiatrists independently diagnosed 100 patients using dsm and icd criteria, more likely to be diagnosed with icd than dsm, 68 icd and 39 dsm, lack of criterion validity
(two of) co-morbidity, symptom overlap, gender bias, cultural bias + ao3
*piagets theory of cognitive development
children don’t know less, they just think differently, changes through stages, motivation plays an important role in learning and drives how learning takes place
schemas: mental representation of our knowledge of the world, infants born with a few but construct new ones from the start
disequilibrium: when a child cannot make sense of their world due to insufficient schema knowledge, uncomfortable state
equilibrium: pleasant state of balance achieved by exploration and learning, when experiences in the world match the state of our current schema
assimilation: incorporate new experience/information into an existing schema, e.g. new breed of dog fits into dog schema
accommodation: creation of a new schema or major change to an existing schema, e.g. making a new cat schema after thinking it was the same as a dog originally
- underestimated role of other people, contrast with vygotsky, limited explanation
+ revolutionised teaching, readiness, discovery learning, children activity engage in constructing their knowledge, positive impacts
not done piagets stages of intellectual development
sensorimotor:
pre-operational:
concrete operational:
formal operational:
*vygotsky’s theory of cognitive development
develop reasoning skills through social processes
cultural differences in cognitive development as we grow up and learn about the world surrounded by our cultural values and beliefs
zone of proximal development: gap between what a child knows and can do alone, and the potential capabilities, following interaction with someone more expert, role of the teacher is to guide us through this gap
advanced reasoning ability: becoming more skilled at reasoning, most advanced reasoning can only be achieved through the help of experts, not just exploration
scaffolding: process of helping a learner across the ZPD and advance as much as possible, typically level of help decreases as the learner progresses across the ZPD, strategies include, demonstration, preparation for child, specific verbal instructions, general prompts and indication of materials
+ real world applications to things such as tutoring, children progressed further in reading than a control when they had tutors, real world value in education
- individual differences, not all children learn best in a social situation, have to consider personality of learner, not applicable to all children
*piaget vs vygotsky
piaget: schemas, motivated to learn through disequilibrium, assimilate or accommodate, stage theory
vygotsky: sociocultural context of cognitive development, learn through social interactions with more knowledgeable others, language plays essential role, zpd and scaffolding helps child move through cognitive development
similarities (ao3): children play an active role, piaget - direct interactions with environment for schema adaptation, vygotsky - social interactions, both led to practical applications, piaget - readiness and discovery learning, vygotsky - scaffolding in teaching
differences (ao3): role of culture, piaget - universal stages, similar in all cultures, vygotsky - interactions can be different dependent on the social and cultural environment, when children learn best, piaget - readiness, only understand when cognitively ready, biological maturity, vygotsky - accelerated through social interactions with others
baillargeon’s explanation of infant abilities
suggested children have a better understanding of the physical world than piaget proposed, and behaviour is better explained by poor motor skills or distractions
violation of expectation (VOE): technique to compare babies reactions to an expected and unexpected event to make inferences about an infant’s cognitive abilities
study: 24 babies, 5-6 months, shown tall or short rabbit passing behind a screen with a window, expected condition - could see the tall rabbit but not the short, unexpected - neither rabbit was seen, looked for and average of 33s in unexpected, 25s in expected, interpreted as they were surprised at the unexpected, showing object permanence before 6 months
physical reasoning system (PRS): enables us to learn about the world more easily, develops with experience, object persistence - we know objects do not disappear e.g. from birth babies can identify event categories (ways that objects interact), object persistence means they quickly learn that one object can block another (occlusion)
+ validity of VOE research, control of cofounding variable, distraction, more reasonable assumption than piaget saying the object didn’t exist to them
- credibility of physical reasoning, working with newborns makes it hard to distinguish what they are actually thinking or responding to
+ explains why physical understanding is universal, innate, know that if we drop something it will fall to the floor, no cultural differences found
*selmans levels of perspective-taking (stages)
Eat Ur Shit Idiot Son Real Men Shave Carefully
selman disagreed with piaget, social perspective taking develops separately from other aspects of cognitive development
research: asking children to take the perspective and consider the emotions of different people in a social situation e.g. holly not climbing up trees but seeing a cat stuck up one, seeing how each person would feel if she climbed the tree
EU: egocentric or undifferentiated perspective, 3-6, unaware of any perspective other than own, cannot distinguish between own and others emotions
SI: social informational role taking, 6-8, recognise others have different perspectives because they’ve received information
SR: self reflective role taking, 8-10, know that viewpoints may conflict even when receiving the same information, cannot consider more than one at a time
M: mutual role taking, 10-12, can consider different viewpoints at the same time
SC: social and conventional role taking, 12+, understand another’s perspective by comparing it to the society in which they live
key elements: interpersonal understanding, interpersonal negotiation strategies (having to develop other skills), awareness of personal meaning of relationships (relating social behaviour to the people we’re interacting with)
- only one aspect of social development considered, empathy and external factors are also important, over simplified
+ helps to understand atypical development, children with adhd found the task more difficult, couldn’t identify feelings and consequences, key social deficit found, leading to interventions and specialised support
*theory of mind
personal understanding (theory) or belief about what other people know, are feeling or thinking, looks at the age this develops
intentional reasoning tasks: test whether children understand and can explain the motives, beliefs and thoughts which cause others to perform certain actions
false beliefs tasks: whether children understand that people can believe something that isn’t true
meltzoff: 18 month old children observed adults placing beads into a jar, the experimental condition involved adults struggling with this and dropping some outside the jar (control - did it successfully), in both conditions toddlers placed the beads in the jar, imitating what the adult intended to do, showing a theory of mind
eyes task: older children with asd can succeed on false belief tasks, so baron-cohen developed a task that involved reading complex emotions from eyes, adults with asd struggled to identify the emotions, ToM is a possible cause of asd
sally-anne experiment
- false belief tasks have low validity, involve other processes like memory, studies with visual aids had greater success for children
- eyes task lacks mundane realism, looking at pictures doesn’t reflect real life
- children who fail false belief tasks can pretend play which involves a ToM, doesn’t measure what it’s supposed to so lacks validity
*sally-anne study (theory of mind)
baron-cohen
20 children with autism, 14 with down syndrome, 27 without a diagnosis (control group) children were told a story involving two dolls, sally and anne, sally put a marble in her basket and left the room and children were asked where sally would look for the marble after anne moved it to her own box
results: 85% of children in the control group correctly said where sally would look for her marble because they had developed theory of mind as sally would not know the marble had been moved, in the asd group only 20% could identify this, which explains deficits in the theory of mind and how it could explain autism as they struggle to attribute false beliefs to others
- low validity of research tasks, may fail false belief tasks due to others cognitive abilities, such as forgetting parts of the story
- low consistency of results
not done mirror neuron system
mirror neurons respond to motor activity of others
not done *top-down approach to offender profiling
behavioural and analytical tool of scene and evidence to predict characteristics of unknown criminals, narrow down likely suspects list, used by professional profilers
usa, 1970s, fbi conducted interviews with 36 sexually motivated killers
pre-established typology, offenders have a signature ‘way of working’
organised: no evidence left, high iq, control and precision, have a ‘type’, usually married sometimes with kids, planned crime
disorganised: overkill, leave evidence or body, impulsive
the construction of an fbi profile has four stages: data assimilation, crime scene classification, crime reconstruction, profile generation
- issues with fbi research, self-report techniques, limited sample
- cannot be generalised to all crimes, burglary, assault
+ support for organised offenders, canter et al, 100 murder cases, 39 characteristics
not done*bottom-up approach to offender profiling
work up from the crime scene evidence, build hypothesis about characteristics, routines and social backgrounds
investigative psychology: uk, statistical procedures and psychology theories, identify patterns of behaviour and create a statistical database for comparison
smallest space analysis: ‘closeness’ of various traits
interpersonal coherence, forensic awareness
geographical profiling: rossmo, spatial consistency, predict offenders base or future crimes, mark on map, examine spread, build jeopardy surface, predict next strike
circle theory: canter and larkin, marauders, commuters
+ scientific and objective
+ can be applied to more crimes
+ evidence for geographical, canter et al, 66 sexual assaults