Schiz Eval

Question 1

Issues in diagnosis and classification

Answer 1

Good Reliability:
() Osorio: excellent reliability of schiz in 180 people using DSM-5. Inter-rater: +.97, test-retest: +.92

Co-mordidity:
() If conditions occur together often they could be a single condition
() Buckley: Half diagnosed with schiz also had depression or substance abuse, 23% for OCD
() May not exist as single condition

Gender-bias:
() Fischer and Buchanan: men:women 1.4:1.
() Women could be less vunerable than men
() Cotton: Women not diagnosed because they get more support

Culture-bias:
() Haiti: Voices from ancestors
() African-Caribean brits are 9x as likely to be diagnosed, but people living there are not

Symptom overlap:
() Schiz and bipolar disorder involve postive symtpoms like delusions and negative symptoms like avolition
() Schiz is hard to distinguish from bipolar
() May not exist as a single condition

Question 2

Genetic basis

Answer 2

+ Tienari: Biological children of schiz are more likely even when adopted. Hilker: CONCORDANCE RATE of 33% for MZ, 7% for DZ

• Environmental factors
  () Biological: birth complications, cannabis
  () Psychological: Childhood trauma
  () Morkved: 67% schiz reported at least one childhood trauma compared to MATCHED GROUP of 38%

Question 3

Neural correlates

Answer 3

+ Evidence for dopamine:
() Curran: Amphetamines increase DA and worsen symtpoms in people with schiz
() Tausher: Antipsychotic drugs reduce DA activity and reduce the intensity of symptoms

• Glutamate:
  () Post mortem and live scanning studies found increased glutamate
  () McCutcheon: Several candidate genes are involved in glutamate production

Question 4

Family dysfunction

Answer 4

+ Research support:
() John read: Adults with schiz have disprortionate type C or D insecure attachment

• Almost no evidence to support double-bind or schizophrenogenic mother
  () Just based on clinical observation

Question 5

Cognitive explainations

Answer 5

+ Stirling
() Compared cognitives tasks of schiz on cognitive tasks like stroop test
() Support for central control theory: Schiz took twice as long

• PROXIMIAL EXPLAINATION:
  () Don’t explain causation

Question 6

Drug therapy

Answer 6

• Side effects
  () Typical antipsychotics: Dizziness, agitation, sleepiness
  () Long-term: TARDIVE DYSKINESIA: Involuntary facial movements
  () NEUROLEPTIC MALIGANT SYNDROME: Drug blocks dopamine action in hypothalamus: High temp, deliurium, coma, 0.1%-2%
• Mechanism unclear:
  () Tied up in dopamine hypothesis
  () Some parts of the brain are too low, in which cases it shouldnt work

+ Evidence for effectiveness:
() Ben Thornley: Chlorpromazine to CONTROL CONDITIONS
() 13 with 1121 participants showed chlorpromazine was associated with better overal functioning than PLACEBO
() Meltzer: Clozapine effective in 30-50% of cases where typical failed
CC: Healy: Most studies are short term effects only (Sedation cheese)

Question 7

CBT

Answer 7

+ Evidence for effectiveness:
() Jauhar: 34 studies: Small but significant effects on postive and negative symptoms
() NICE reccomends CBT

• Quality of evidence
  () People have varied abounts of symtoms
  () Generalization of studies conceal specific effects
  () Hard to say for specific person

Question 8

Family therapy

Answer 8

+Evidence for effectiveness:
() McFarlane: Family therapy reduce relapse by 50-60%
() NICE: Reccomends family therapy for everyone

+ Benefits all family members
() Strength function of all family members which leads to better care

Question 9

Management of schizophrenia

Answer 9

• Ethical issues:
  () Gives power to control
  () Imposes norms onto others
  () “Likes to be scruffy and get up late”
  () Legal action has had major effect on the decline
• Alternative approaches:
  () Chiang: Art therapy good alternative
  () Evidence base is small but low-risk, high-gain
  () NICE: Reccomends art therapy

+ Evidence for efffectiveness
() Glowacki: 7 high quality studies analysed, reduction in negative symptoms
CC: Small evidence base, FILE DRAWER PROBLEM

Question 10

Interact

Answer 10

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