Schiz Flashcards
(20 cards)
Classification and Diagnosis
- Knowledge
- schiz is a serious mental disorder, affects 1% of world population and isn’t more common in men who are from lower socioeconomic backgrounds living in cities
- we need to distinguish between disorders before diagnosis
- classification : when we take a range of different symptoms and group them together to form a classification system for a particular disorder
- diagnosis - when we see if an individuals symptoms match with those symptoms assigned to the classification system for the disorder
- dms-5 - need one positive symptom for schizophrenia for diagnosis
- icd-10 - need two or more negative symptoms for diagnosis
positive symptoms
- hallucinations : unusual sensory experiences , they may have no basis in reality or they may have some basis but are distorted perception / exaggerated - hearing voices, seeing things etc
- delusions - irrational beliefs which have no basis in reality such as thinking you are Jesus or an important political figure
negative symptoms
- speech poverty - reduction in the quality and quantity of speech - delayed response from individual during conversation
- speech disorganisation - muddled up or unclear conversation and words - person may often shift topics randomly and have disorganised speech
- avolition - finding it hard to complete goal directed activity or tasks due to a lack of motivation
- 3 signs - andreasen - poor hygiene or grooming , lack of persistence in school or work, lack of energy
Classification and Diagnosis
- Evaluation
- GOOD RELIABILITY
- a diagnosis is considered reliable when different diagnosing clinicians can reach the same diagnosis for the same person ( inter-rather reliability ) or when the same diagnoising clincian can reach the same diagnosis for an individual but on 2 different occasions ( test - retest reliability )
- these 2 reliability’s of diagnosis for schizophrenia using the dsm-5 has been reported as excellent
- inter rater - +0.97 test-retest - +0.92 - CO MORBIDITY
- a person suffering shhizophernia may also experience co morbidity of other conditions such as depression
- when conditions co occur it may actually be only one single condition
- this questions the validity of the schiz classification system as schiz may not exist as just a single condition - GENDER BIAS
- men are more commonly diagnosed with schiz than women
- this may be due to them having more genetic vulnerability and women are more social so receive more social support so they can hide their symptoms
- women with schiz have better functioning than men
- the underdiagnosis of women having schiz means that they may not receive the same treatments and services when required
Biological Explanations for Schizophrenia
- Knowledge - GENETIC
- family studies suggest that schiz has a biological basis
- risk of developing schiz increases in line with genetic similarity to a relative with the disorder
- gottseman family study found that an individual with an aunty who has schiz has a 2 % chance of developing it, 9% for sibling and 48% for twin
- suggests that increased genetic similarities increases both individuals risk of having schiz which shows it has a biological basis
- candidate genes
- genes which are involved in a persons genetic vulnerability or developing schiz
- schiz has been found to include many different genes which makes it polygenic
- rike et al also studied genetic makeup in 37000 pl w schiz and compared it to a control group of 113,000 people w out schiz
- found 108 genetic variations associated with the increased risk of schiz
- suggests that schiz is aetilogically heteronegous which is the different combination between genes and other factors which lead to developing schiz
role of mutation
- mutation in parental dna can cause schiz
- mutation can be caused by exposure to radiation or infection
- positive correlation between the risk if schiz and parental age increases from 0.7% which fathers under 25 and over 2% with fathers over 50
Biological Explanations for Schizophrenia
- Evaluation - GENETIC
- RESEARCH SUPPORT
- family studies like gottsemans found that schiz risk increases in line with genetic similarities of a relative with the disorder
- adoption studies also find the children who’s biological parents have schiz have heightened risk of also developing it regardless of being adopted
- twin studies have found concordance rate for it to be 33% in mz twins and 7% in dz twins
- suggests that vulnerability increases as a result of genetic makeup - ENVIRONMENTAL FACTORS
- include biological and psychological factors
- biological - birth complications or smoking thc rich cannabis
- psychological - childhood trauma can make a person more vulnerable to developing adult mental health problems
- morkved found that 67% of people with schiz reported at least 1 childhood trauma compared to only 38% of control group without schiz
- suggests that biological explanations alone cannot explain schiz and it is not complete - reductionist
- interactionist approach may be more comprehensive
Biological Explanations for Schizophrenia
- Knowledge - NEURAL
- neural correlates - brain structures or activity which occur alongside an experience and may include the cause of that experience
- da is main neural correlate in schiz
- has an excitory effect
- dopamine hypothesis
- suggest that drugs which are used to treat schiz cause symptoms similar to those with parkinson’s which is associated with low da levels
- suggests that schiz may be caused by high da levels in subcortical regions of the brain
- for example excess da receptors in pathways from the subcortex to broca’s area may explain symptoms like speech poverty
updated dopamine hypothesis
- davi’s et al suggested that some parts of the brain like the prefrontal cortex have too little da and this is hypodopamingeria - cause negative symptoms like cognitive distortions
- also suggests that cortical hypoD can lead to subcritical hyperD - too little or too little high da levels in different brain regions
- early life experiences and genetic variations can make a person more sensitive to hypoD and as a result hyperD
Biological Explanations for Schizophrenia
- Evaluation - NEURAL
- EVIDENCE FOR DOPAMINE
- amphetamines increase da levels and can worse the symptoms of people w schiz and induce it in people without schiz
- antipsychotics reduce da levels and can reduce intensity of schiz symptoms
- candidate genes associated w schiz also act upon production of da
- suggests that dopamine is involved with symptoms of schiz - GLUTAMATE
- brain scanning studies and post mortems have found increased levels of glutamate in different brain regions of those with schiz cause symptoms
- candidate genes associated w schiz also are involved in production of glutamate
- the neural explanation does not consider the role of glutamate in schizophrenia and so is insufficient explanation
- brain scanning studies are objective and scientifically credible
Psychological Explanations for Schizophrenia
- Knowledge - FAMILY DYSFUNCTION
- schizohpregneic mother - psychodynamic explanation proposed by reichmann
- based it on her schiz patients reports of a particular type of mother who was cold, rejecting and controlling
- this created a family climate of tension and secrecy
- this therefore led to paranoia, distrust and delusions in the child and ultimately schizophrenia
- double blind theory - psychodynamic explanation proposed by bateson
- emphasises the role of communicating styles in families - risk factor not a main cause of schiz
- mixed messages / signals from parents to children leave them trapped and confused
- they are punished for doing the wrong thing without actually being told what that is
- they are punished by a withdrawal of love and they feel like its unfair and cannot express their emotions
- this makes the view the world as confusing and dangerous
- therefore leads to paranoia and disorganised thinking and then schiz
expressed emotions ( EE ) - high levels of negative emotions from a family member expressed to a person with schiz
- this includes verbal criticism, hostility and emotional over - involvement - trigger people who are already vulnerable due to their genetic makeup
- high levels of EE cause stress to increase which can trigger or worsen schiz and explains relapse in recovery
Psychological Explanations for Schizophrenia
- Evaluation - FAMILY DYSFUNCTION
- RESEARCH SUPPORT
- studies link childhood trauma ( abuse , insecure attachment ) to schiz
- read et al found that disproportionate amount of people with schiz will have insecure attachment - particularly type c or d
- read also found that 69% of women and 59% of men with schiz had a history of abuse
- morkved also found that childhood trauma is a strong risk factor
- more adults w schiz were likely to report at least one childhood trauma
- supports the idea that dysfunctional family environments can lead to developing schiz - LACK OF EVIDENCE
- there is not evidence to support theories like schizophregenic mother and double blind
- this is because they are based on clinical evidence and informal assessments rather then systematic evidence
- therefore they are unable to prove a link between childhood trauma and schiz
Psychological Explanations for Schizophrenia
- Knowledge - COGNITIVE EXPLANATIONS
- focus on role mental processes in explaining schiz
- dysfunctional thinking - schiz can be caused y dysfunctional thought processes
- ventral striatum dysfunction can cause negative symptoms of schiz
- temporal or cingulate gyri dysfunction can cause hallucinations
- reduced information processing can cause cognitive impairements
- frith et al suggested 2 types of dysfunctional thought processes
- metarrepresnetation dysfunction - metarepresentation allows for self reflection and understanding of our own actions, insight into our own goals and intentions
- dysfunction of this disrupts out ability to recognise our actions as being carried out by ourselves rather than others
- this can lead to hallucinations ( hear in voices ) or delusions ( thought insertion ) - central control dysfunction - allows us to surprise automatic responses
- dysfunction can lead to speech derailment - unable to suppress automatic thoughts and speech is triggered by other thoughts
- people with schiz find it difficult to filter thoughts and can lead to disorganised speech
Psychological Explanations for Schizophrenia
- Evaluation - COGNITIVE EXPLANATIONS
- RESEARCH SUPPORT
- support for dysfunction thought processing in people with schiz
- stirling et al conducted a study which compared cognitive task performance in 30 people with schiz and 30 people without it
- he did a strop task - ppts had to name the font colours of colour words while suppressing the urge to read them
- people wirth schiz took twice as long to name the font colours
- supports frith’s central control theory that cognitive processes are impaired in people with schiz - PROXIMAL EXPLANATION
- cognitive explations can only address proximal causes ( what is happening now to cause symptoms )
- it does not consider distal causes ( genetics or family dysfunction origins )
- it is unclear how genetics or childhood trauma actually lead to metarepresenation or central control dysfunction
- it is a limited and incomplete explanation
Biological Therapy for Schizophrenia
- Knowledge
- drug therapy is the main form of treatment for schiz and involves antipsychotics
- help to reduce symptoms like hallucinations or delusions
- it can be used short or long term depending on severity
- has 2 types - typical antipsychotics or atypical antipsychotics
typical antipsychotics - developed in the 1950s and an example is chlorpromazine
- acts as a dompaine antagonist - blocks dopamine receptors and reduces neurotransmitter action
- initially dopamine levels will build up but production is decreased overtime
- links to the dopamine hypothesis - reduced dopamine levels normalises key areas of the brain which reduces symptoms like hallucinations
sedative effect
- chlorpromazine has a calming effect so often used in hospitals to treat agitated patients
- it has is believed to affect histamine receptors - cause sedation
- it is used alongside other treatments and not just schiz
atypical antipsychotics - developed in 1960’s - aimed to be as effective as typical A but with fewer side effects
- many of these drugs exist but their exact mechanisms are unknown
- clozapine - developed in the 1960’s and reintroduced in the 1970’s due to its effectiveness
- withdrawal in 1970’s due to its fatal blood condition risk however reintroduced after because it was found to be more effective than other antipsychotics
- targets domapine, serotonin and glutamate receptors - helps to reduce anxiety and depression levels in people with schiz
- lowers suicide risk which is important as 30-50 % of schizophrenia patients attempt suicide
- can be given through injection or through careful monitoring due to its side effects
- risperidone - developed as an alternative to clozapine - aim to be as effective but with reduced side effects
- binds dopamine and serotonin receptors - binds more strongly than clozapine and so smaller doses are needed
- it has fewer serious side effects compared to clozapine
Biological Therapy for Schizophrenia
- Evaluation
- RESEARCH SUPPORT
- research support for the effectiveness of both typical and atypical
- ben thornless - reviewed 13 trials which showed that chloropromzine had improved overall functioning and reduced symptom severity in those with schiz compared to a placebo
- herbert meltzer - found atypical a ( clozapine ) were effective in 30 - 50 % of treatment resistant cases where other drugs had failed
- shows they work, but effectiveness varies
COUNTERPOINT : david healy suggests that researchers overestimate their effectiveness
- this is because of research issues such as short term effects , selective data publishing and exaggerated positive outcomes
- antipsychotics also had a strong sedative effect so it may make patients appear better without truly reducing their symptoms
- so evidence for effectiveness is weaker than firstly seen - SERIOUS SIDE EFFECTS
- antipsychotics can have side effects such as weight gain, agitation , sleep issues and dizziness
- long term risks can include : - tardive dyskinesia - involuntary facial movements due to dopamine sensitivity
- neuroleptic malignant syndrome ( NMS ) - rare but fatal condition which can cause delirium , high fever and coma , more common in typical antipsychotics
- clozapine can also affect the immune system which makes infections more likely
- these side effects stop patients from wanting to take treatment so reduces its effectiveness - MECHANISMS UNCLEAR
- how antipsychotics work are unclear
- this is because the dopamine hypothesis suggests that overactive dopamine causes schiz but new research challenges this
- therefore, if dopamine is not the only cause, then blocking dopamine may not be the best treatment
- so uncertainty over their mechanisms raises doubts about why and who they work for
Psychological Therapy for Schizophrenia
- Knowledge - CBT
aims of cbt is to :
- help patients cope and understand their symptoms better
- encourage patients to challenge their irrational beliefs
- does not eliminate symptoms but can help them cope better with them
- reality testing : therapist and client jointly examine the likelihood of their irrational beliefs being true - does it even have a basis in reality
- reduces anxiety and depression caused by schiz
- also helps the therapist to distinguish between what’s real and fantasy - helps them understand where their symptoms come from
- for example a patient who believes demons are talking to them because they hear voices will be told that this is due to a speech malfunction in the brain - helps them feel less scared, can function adequately
- they will also be told that hearing voices is normal as it is thinking in words - normalisation
Psychological Therapy for Schizophrenia
- Evaluation - CBT
- EVIDENCE FOR EFFECTIVENESS
- sameer jahuar reviewed 34 studies of cbt on schiz and found that there was small but significant effects on both positive and negative symptoms
- pontillo also found that it reduces the frequency and severity of auditory hallucinations
- NICE recommends cbt for those w schiz based on research and clinical findings - QUALITY OF EVIDENCE
- cbt methods and schiz symptoms vary widely between cases
- neil thomas found that diff studies use different cbt methods for diff symptom combinations
- hard to determine how effective cbt will be for individual patients
Psychological Therapy for Schizophrenia
- Knowledge - FAMILY THERAPY
- aim is to use the family members and the identified patients
- aims to reduce stress and improve family communication styles to prevent relapse risk
- links to theories like schiz mother and double blind
pharaoh et al identified 3 key benefits
+ reduces stress and negative emotions like anger and guilt which play a huge part in relapse
+ improves the families ability to help - encourages a balanced problem solving and support dynamic , therapist improves the families beliefs and behaviours towards schiz by correcting any incorrect info and myths - the family have balance of their own lives and supporting their schiz family member
+ enhances communication - reduces EE to lower relapse risk
model of practice proposed - frank burbach
1. basic support - sharing info and providing practical and emotional support
2. identify resources - define what family members can and cannot offer
3. mutual understanding - create a safe space for open communication between everyone
4. addresss issues - identify unhelpful patterns of interaction
5. skills training - provide family skills like anger management or stress management techniques
6. relapse prevention - put a plan in place to reduce relapse risk
7. long term maintenance - ensure ongoing support and stability
Psychological Therapy for Schizophrenia
- Evaluation - FAMILY THERAPY
- EVIDENCE FOR EFFECTIVENESS
- McFarlane found family therapy to be the most effective form of treatment for schiz
- in one study it was found that relapse rates were reduced by 50-60% using cbt
- family therapy is also beneficial when mental health starts to decline
- NICE also recommends CBT for anyone diagnosed with schiz
- is effective in early stage and severe schiz - BENEFITS WHOLE FAMILY
- not just for identified patients but rather all family members
- labbon and barrowclough found that family support is crucial as they provide the most care
- improves overall functioning and reduces schiz negative impact on other members
- strengths the families ability to help - techniques such as stress management etc
- therefore it has wider benefits beyond just the patient
Management of Schizophrenia
- Knowledge
- token economies are used which is a reward system which encourages positive behaviours
- ayllon and azrin tested this in women with schiz in hospitals
- tokens ( plastic chips ) were given for completeting tasks ( cleaning up )
- these tokens could then be exchanged for tangible rewards like sweets or watching a film
- task completion had increased significantly
use declined due to
1.closure of many psychiatric hospitals
2. ethical concerns over restricting freedoms of those with mental illness
rationale :
- institutionalisation can lead to poor hygiene and social withdrawal due to prolonged hospital stays
- mateson identified 3 key institutional behaviours
+ condition related behaviours + personal care + social behaviour
- moditifying these does not cure schiz but can help improve it - key benefits are
1. improves quality of life with ppl w schiz in hospitals
2. normalises key behaviours to help them retinergate back into society
how they work
- tokens are given immediately after desired behaviours
- target behaviours may be specfic to the individual
- they have no literal value but can be exchanged for tangible rewards
- they need to be given immediately after desired behaviours for system to be effective
- based on operant conditioning
- tokens become secondary reinforces by being paired with primary reinforcers - this is done by giving them both together at the start of the programme
Management of Schizophrenia
- Evaluation
- EVIDENCE FOR EFFECTIVENESS
- glowacki reviewed 7 high quality studies of token economies used on people with schiz in hospitals
- found a reduced negative symptoms and fewer unwanted behaviours
- supports token economies as valuable in managing schiz
COUNTERPOINT : there is a limited number of studies used so a smaller sample base
- this can result in a file drawer problem which is when positive results are published and negative ones are hidden which leads to bias
- this raises serious doubts about the effectiveness and reliability claims - ETHICAL CONCERNS
- concerns over the issue of control - professionals have the power over patient behaviour
- problematic when imposing norms - target behaviours may not be identified sensitively
- for exmaple restricting rewards like sweets or watching a film can be unfair
- this can worsen or distress a person already struggling
- their usage may decline due to issues of ethical concerns
- the benefits may be outweighs by freedom restrictions and short term quality of life reduction - ALTERNATIVE APPROACHES
- there may be more pleasant and non controversial methods
- evidence is les consistent but studies like chang suggest positive effects
- for example art therapy has high gain and low risk and is a pleasant experience without risk of abuse or ethical issues etc
- it is also recommended by NICE for people with schiz
Interactionist Approach to Schizophrenia
- Knowledge
- diathesis stress model - suggests that vulnerability ( diathesis ) and stress combined can cause the development of schizophrenia
- biological presupposition alone cannot cause schiz - stress trigger the onset of it
meehls model :
- original diathesis stress model
- suggested that schiz was purely genetic and was caused by 1 gene which led to genetic vulnerability known as the ‘schizogene’
- this gene led to a schizotypic personality which is more vulnerable to stress
- therefore carrying this gene as well as having a stress trigger such as trauma increases the risk of schiz
- without this gene, not amount of stress can lead to developing schizophrenia
modern understanding of diathesis
- we know that schiz can be caused my multiple diff genes which can cause genetic vulnerability
- there are also many factors involved such as psychological trauma or early brain damage
- trauma becomes the diathesis rather than the stressor and john read suggests a neurodevelopmental model which suggests that early enough and severe trauma can have affects on the developing brain which can lead to HPA dysfunction ( more sensitive to stress )
- early developmental issues can also lead to increased vulnerability in later life
modern understanding of stress
- the original DSM suggests that stress was referred to as parenting style
- but it is know modern definition is known as anything which increases the risk of triggering schiz
- these are many different factors involved as well such in addition to parenting style such as psychological trauma, early stressors or environmental factors
- example is increased cannabis use which increases risk of schiz due to its interference w da system
- usually more common in people who already have vulnerability
interactionist approach
- favours combining both psychological and biological treatments
- most common is antipsychotics and cbt to treat it
- turkington et al suggests that biological causes of schiz can still be accepted while still using cbt to treat psychological factors - interactionist approach is needed to combine both perspectives
- uk - more common to use both medication and therapy
- us - more common to use medication only due to healthcare costs
Interactionist Approach to Schizophrenia
- Evaluation
- SUPPORT FOR VULNERBAILITY AND TRIGGERS
- tinerai studies genetic vulnerability and psychological triggers
- followed study of 19,000 finish adoptees and found that : - high genetic risk + dysfunctional parenting = higher risk of schiz
- high genetic risk + healthy family = low risk of schiz
- suggests that genetic vulnerability and family stress can influence schiz risk - DIATHESIS AND STRESS ARE COMPLEX
- original DSM is complex
- this is because there are multiple genes contributing to vulnerability
- stres also comes in many forms
1.psychological ( trauma ) - biological - cannabis use which interferes with da system
- houston found that childhood sexual trauma + cannabis use was a major trigger and major influence in schiz personality
- therefore schiz influenced by both biological and psychological factors - REAL WORLD APPLICATION
- interactionist approach prefers combining biological and psychological treatments
- this has practical advantage as we can combine antipsychotic drugs and psychological therapies - increases effectiveness
- tarrier - randomly assigned 315 patients to treatment groups - medication + cbt
- medication + counselling
- medication only ( control group )
- found combination groups has lowered symptoms compared to medication only
- suggests that interactionist approach is more effective than single treatment methods
COUNTERPOINT : treatment causation fallacy - we cannot assume that just because combined treatments are succcessfull that the interactionist explanation is completely correct
