Schizophrenia Flashcards
(149 cards)
1
Q
SCHIZOPHRENIA
What is schizophrenia?
A
A psychotic disorder marked by severely impaired thinking, emotions, and behaviour
2
Q
CLASSIFYING MENTAL DISORDERS
Which manuals are used to classify mental disorders?
A
The DSM V or the ICD 10
3
Q
CLASSIFYING MENTAL DISORDERS
What do both manuals require?
A
Symptoms to be present for a month
4
Q
CLASSIFYING MENTAL DISORDERS
What does the DSM V require?
A
A more specific criteria; 2 or more symptoms
5
Q
CLASSIFYING MENTAL DISORDERS
What does the ICD 10 require?
A
A broader approach to diagnosis
6
Q
CLASSIFYING MENTAL DISORDERS
Which culture uses the DSM V?
A
America
7
Q
CLASSIFYING MENTAL DISORDERS
Which countries use the ICD 10?
A
Anywhere that isn’t America
8
Q
CLASSIFYING MENTAL DISORDERS
What type of functioning does schizophrenia include?
A
Excessive normal functioning
9
Q
CLASSIFYING MENTAL DISORDERS
Describe diagnosis discrepancies between men and women
A
Women diagnosed 10 years later on average than men, who are most commonly diagnosed between 18 and 21
10
Q
POSITIVE SYMPTOMS
What is a positive symptom of Schizophrenia?
A
Ones that enhance the typical experience of sufferers, and occurs in addition to their normal experiences
11
Q
POSITIVE SYMPTOMS
Define a hallucination
A
A distorted view/perception of a real stimulus or stimulus that has no basis in reality
12
Q
POSITIVE SYMPTOMS
What are the four types of hallucination?
A
- Auditory
- Visual
- Tactile
- Olfactory
13
Q
POSITIVE SYMPTOMS
Define a delusion
A
A set of beliefs with no basis in reality, for example believing members of the royal family are trying to kidnap you
14
Q
NEGATIVE SYMPTOMS
Define a negative symptom
A
Loss of normal functions due to increased serotonin and low levels of dopamine
15
Q
NEGATIVE SYMPTOMS
Define alogia
A
Speech poverty, a frequent inability to find the right words
16
Q
NEGATIVE SYMPTOMS
Define avolition
A
A reduction in interest
17
Q
NEGATIVE SYMPTOMS
Define affective flattening
A
Flat emotions, such as no excitement at christmas or grief over a deceased pet
18
Q
NEGATIVE SYMPTOMS
Define anhedonia
A
Physical or social loss of pleasure
19
Q
CULTURAL BIAS AND RELIABILITY
What is the biggest sign of cultural bias?
A
The presence of two different diagnostic manuals
20
Q
CULTURAL BIAS AND RELIABILITY
What did Copeland investigate?
A
Cultural differences in the diagnostic process
21
Q
CULTURAL BIAS AND RELIABILITY
How did Copeland investigate cultural differences?
A
134 US psychiatrists V 194 GB psychiatrists given a definition of a patient
22
Q
CULTURAL BIAS AND RELIABILITY
What were the results of Copeland’s study?
A
US 69% diagnosed schizophrenia
GB 2% diagnosed schizophrenia
23
Q
CULTURAL BIAS AND RELIABILITY
What do Copeland’s findings suggest?
A
The diagnostic process is not reliable bc there are two different diagnostic manuals. People may not be given suitable treatment due to a wrong diagnosis.
24
Q
RELIABILITY IN DIAGNOSIS
What must diagnosis be?
A
Repeatable - clinicians must be able to reach the same conclusions at two points in time (aka inter rater reliabilty)
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RELIABILITY IN DIAGNOSIS
How is inter rater reliability measured?
The kappi score
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RELIABILITY IN DIAGNOSIS
What is a score of 1?
Perfect inter rater reliability
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RELIABILITY IN DIAGNOSIS
What is a score of 0?
No agreement
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RELIABILITY IN DIAGNOSIS
What is generally considered a good score?
0.7
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RELIABILITY IN DIAGNOSIS
What was the DSM V's kappi score?
Only 0.4
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RELIABILITY IN DIAGNOSIS
What does the DSM V's kappi score show?
There is significant variation between countries when diagnosing schizophrenia
31
VALIDITY: SYSTEM OVERLAP
What did Ellason and Ross point out?
People w schizophrenia have less schizophrenic symptoms than those diagnosed with D.I.D
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VALIDITY: SYSTEM OVERLAP
What did Read find?
People w schizophrenia have sufficient symptoms of other disorders
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VALIDITY: COMORBIDITY
What does Buckeley et al estimate?
50% of patients w schizophrenia have depressive symptoms
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VALIDITY: COMORBIDITY
What did Swets et al find?
12% of patients w schizophrenia have OCD symptoms
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VALIDITY: COMORBIDITY
What do the studies suggest?
It's very common amongst all patients w schizophrenia to be misdiagnosed. Reduced the validity of diagnosis
36
GENDER BIAS
How did Coring and Powell investigate gender bias?
Randomly selected 290 male and female psychiatrists to read two case vignettes of patients behaviour and were asked to give a judgement using standard diagnostic criteria
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GENDER BIAS
What were Coring and Powell's findings
- Male or unlabelled patient: 56%
- Female patient: 20%
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GENDER BIAS
What does Coring and Powell's results suggest?
The diagnosis of Schizophrenia is influenced by the gender of the patient
39
BIO EXP FOR SZ: GENETICS NUMBER ONE
What is the key assumption?
Looking at sz from a biological basis. This can be explained by genetics. A degree of inheritability.
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BIO EXP FOR SZ: GENETICS NUMBER ONE
Describe family studies
Gottesman investigated the genetic prevalence amongst the family. General pop: 1%, parents 6%, siblings 9%
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BIO EXP FOR SZ: GENETICS NUMBER ONE
What do family studies suggest?
More genes you share more likely to inherit sz
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BIO EXP FOR SZ: GENETICS NUMBER ONE
Describe adoption studies
Tienari found 6.7% of children adopted w sz biological mother had been diagnosed w schizophrenia themselves. Opposed to 2% of children diagnosed w no sz mother
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BIO EXP FOR SZ: GENETICS NUMBER ONE
What do adoption studies suggest?
Genetic predisposition overrides environmental factors
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BIO EXP FOR SZ: GENETICS NUMBER ONE
What percentage of DNA do twins share?
DZ (50% of same DNA) MZ (100% of same DNA)
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BIO EXP FOR SZ: GENETICS NUMBER ONE
Describe twin studies
Gottesmas carried out meta-analysis and reviewed 40 studies that had investigated family history of sz. DZ twins 17% MZ twins 48%
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BIO EXP FOR SZ: GENETICS NUMBER ONE
What do twin studies suggest?
Genetic predisposition - more genes more likely
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BIO EXP FOR SZ: GENETICS NUMBER ONE
AO3 scientific credibility
- Research evidence providing empirical facts
- Joseph found 40% for MZ and 7.4% for DZ
- Scientific credibility due to research
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BIO EXP FOR SZ: GENETICS NUMBER ONE
AO3 deterministic
- Overly stating role of nature
- Highest concordance rate 48% MZ, strongest genetical link one can have
- Leaves room for other explanations
- OCD 87% which further belittles this figure
- Biology not only explanation
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BIO EXP FOR SZ: GENETICS NUMBER ONE
AO3 methodology issues
Twins are small sample size already, then a set of twins one w schizophrenia (at least) reduces even more. Can you therefore generalise?
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BIO EXP FOR SZ: GENETICS NUMBER ONE
AO3 methodology issues
Twins are small sample size already, then a set of twins one w schizophrenia (at least) reduces even more. Can you therefore generalise?
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BIO EXP NEUROTRANSMITTERS
What is the key assumption?
Biological basis for sz due to biochemical imbalances
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BIO EXP NEUROTRANSMITTERS
What does the dopamine hypothesis claim?
Having an excess of dopamine in central regions of the brain is associated w positive symptoms of sz. It is thought this is due to abnormally high levels of D2 receptors on the receiving neuron
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BIO EXP NEUROTRANSMITTERS
What does the dopamine hypothesis result in?
More dopamine binding so more neurons firing
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BIO EXP NEUROTRANSMITTERS
What does amphetamine do?
Increase dopamine activity, leading to an increase in sz symptoms
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BIO EXP NEUROTRANSMITTERS
How does amphetamine lead to an increase in sz symptoms?
Stimulating nerve cells containing dopamine, causing the synapse to be flooded w the neurotransmitter
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BIO EXP NEUROTRANSMITTERS
What did Grilly 2002 say?
When parkinson sufferers take drug called 'l-dopa' which raises d levels, it causes them to develop sz like symptoms. This suggests there is a relationship bt dopamine and sz
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BIO EXP NEUROTRANSMITTERS
Describe antipsychotic drugs
Block activity of dopamine in brain. By reducing the activity in neural pathways which use dopamine, you eliminate the symptoms
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BIO EXP NEUROTRANSMITTERS
Who did the revised dopamine hypothesis
Davis and Kahn
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BIO EXP NEUROTRANSMITTERS
What did Davis and Kahn propose?
Proposed positive symptoms due to an excess dopamine in the subcortical areas of the brain. The negative symptoms arise from a deficit of dopamine in pre-frontal cortex
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BIO EXP NEUROTRANSMITTERS
Scientific credibility
- Empirical evidence
- Neural imaging: CAT and PET scans which can show physical differences bt sz and non sz patients
- Patel et al found sz patients had higher levels of dopamine in prefrontal cortex compared to control group
- This suggests that the concept of diff neural activity in sz to non sz is a plausible explanantion
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BIO EXP NEUROTRANSMITTERS
RWA
- Cause, handle, reduce
- Leucht meta analysis of 212 studies. All drugs tested were sig more effective than a placebo
- Suggests can rule out psychosematic of drugs
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BIO EXP NEUROTRANSMITTERS
Determinism
- Assumes all pp w sz have high dopamine levels
- Not all patients been found to have this
- Individual differences, environmental factors, unhealthy family dynamic
- Bateson double blind exp
- Suggest must be other explanations
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BIO EXP NEUROTRANSMITTERS
Determinism
- Assumes all pp w sz have high dopamine levels
- Not all patients been found to have this
- Individual differences, environmental factors, unhealthy family dynamic
- Bateson double blind exp
- Suggest must be other explanations
62
BIO EXP NEUROTRANSMITTERS
Determinism
- Assumes all pp w sz have high dopamine levels
- Not all patients been found to have this
- Individual differences, environmental factors, unhealthy family dynamic
- Bateson double blind exp
- Suggest must be other explanations
63
FAMILY DYSFUNCTION
Describe the double blind theory
Bateson 1956, sz is a consequence of abnormal patterns in family communication. The patient is a symptom of a family wide problem. They become ill to protect the stability of the family system.
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FAMILY DYSFUNCTION
In a double blind situation, what is a person given?
Mutually contradictory signals by another person, placing them in an impossible situation causing internal conflict. Sz symptoms represent an attempt to escape from the double blind.
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FAMILY DYSFUNCTION
Describe Read
Reviewed 42 studies. Concluded 69%of female inpatients and 59% of male had a history of childhood physical/sexual abuse
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FAMILY DYSFUNCTION
Positive of double blind
Berger found evidence of double blind communication by parents of sz patients compared to controls
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FAMILY DYSFUNCTION
Give the two negatives of double blind
- LIEM et al compared communication patterns in families w and wout a sz member. Abnormality in parental communication response rather than cause
- Validity issues: conclusions tend to be based on clinical obvs of patients, researcher bias.
68
FAMILY DYSFUNCTION
What are expressed emotions categorized by?
Criticism, hostility, emotional overinvolvement (helicopter parenting)
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FAMILY DYSFUNCTION
What are communication patterns w high EE relatives usually categorised by?
Intense and negative verbal exchanges
70
FAMILY DYSFUNCTION
What did Brown find?
70% of neg comments aimed at sz were aimed at negative symptoms. They tend to be oppositional or conflictual in nature, and tone of voice is very important
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FAMILY DYSFUNCTION
Give the two positives of expressed emotions
Evidence: Kwipers found relapse more likely when family is high in expressed emotions. Linzen put this at 4x
RWA: family therapy
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FAMILY DYSFUNCTION
Give a negative of expressed emotions
Individual differences. Deterministic, not every family w a sz patient would be dysfunctional. Differing resilience levels
73
COGNITIVE EXPLANATIONS FOR SZ
What is the key assumption?
Dysfunctional thought processing which effects behaviour
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COGNITIVE EXPLANATIONS FOR SZ
What can explain delusions and hallucinations?
A maladaptive blackbox: beck
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COGNITIVE EXPLANATIONS FOR SZ
Non sz people laughing and whispering on a bus
Nothing unusual happening - puts headphones in, minds own business
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COGNITIVE EXPLANATIONS FOR SZ
Sz person people laughing and whispering on a bus
Dysfunctional backbox - there is something wrong with me. Delusion = they are all laughing at me, then causes a scene
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COGNITIVE EXPLANATIONS FOR SZ
Non sz person changing a lightbulb
Flickering lights - realisation the bulb is dying - changes the bulb
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COGNITIVE EXPLANATIONS FOR SZ
Sz person changing a lightbulb
Flickering lights - someone is trying to send me a message - delusions of grandeur
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COGNITIVE EXPLANATIONS FOR SZ
What did Beck and Rector say?
Sz are unlikely to consider their blackbox as wrong
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COGNITIVE EXPLANATIONS FOR SZ
Self talk 'I am a bad person'
Non sz, this is an internal event. For a sz this is external, someone else is telling them this. Results in people talking to themselves
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COGNITIVE EXPLANATIONS FOR SZ
What did Baker and Morrison say?
Sz misattribute self talk as an external voice
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COGNITIVE EXPLANATIONS FOR SZ
A03 research support
O'Carrol found 75% of sz patients report cognitive impairment in memory, attention, and motor skills. Dual task performance, limited cognitive capacity
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COGNITIVE EXPLANATIONS FOR SZ
A03 RWA
CBTp, ecological validity
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COGNITIVE EXPLANATIONS FOR SZ
A03 chicken and egg
- Cause effect cannot be established
- Descriptive explanation
- Cause of repercussion
- Not predictive
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BIOLOGICAL TREATMENTS FOR SZ
What is the key assumption?
Sz comes from a physical origin
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BIOLOGICAL TREATMENTS FOR SZ
How do all antipsychotics work?
Reducing dopamine transmission
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BIOLOGICAL TREATMENTS FOR SZ
What is the first main type of antipsychotic?
Typical (first generation) 1950
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BIOLOGICAL TREATMENTS FOR SZ
What is an example of a typical antipsychotic?
Chlorprozamine
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BIOLOGICAL TREATMENTS FOR SZ
What do all antipsychotics' act as?
Dopamine antagonists
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BIOLOGICAL TREATMENTS FOR SZ
What do typical antipsychotics do?
Bind but don't stimulate dopamine D2 receptors. By reducing stimulation of dopamine system, hallucination's and delusions are eliminated
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BIOLOGICAL TREATMENTS FOR SZ
What do typical antipsychotics do?
Bind but don't stimulate dopamine D2 receptors. By reducing stimulation of dopamine system, hallucination's and delusions are eliminated
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BIOLOGICAL TREATMENTS FOR SZ
What do typical antipsychotics do?
Bind but don't stimulate dopamine D2 receptors. By reducing stimulation of dopamine system, hallucination's and delusions are eliminated
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BIOLOGICAL TREATMENTS FOR SZ
What is the main advantage of typical antipsychotics?
They work!
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BIOLOGICAL TREATMENTS FOR SZ
What did Leucht do?
Meta analysis of 65 studies 1959 - 2011, 6000 patients
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BIOLOGICAL TREATMENTS FOR SZ
What happened to the 6000 patients?
Some were taken off medication, replaced with a harmless placebo. Viewed for a whole year
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BIOLOGICAL TREATMENTS FOR SZ
How many of the placebo group relapsed?
64% compared to 27% for non placebo
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BIOLOGICAL TREATMENTS FOR SZ
What does Leucht's study suggest?
Drugs do work for positive symptoms
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BIOLOGICAL TREATMENTS FOR SZ
What is an extrapyramidal side effect?
Muscular
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BIOLOGICAL TREATMENTS FOR SZ
Describe parkinsonism
Tremors, rigidity, slowness of movement, temporary paralysis
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BIOLOGICAL TREATMENTS FOR SZ
Describe dystonia
Involuntary muscle contractions
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BIOLOGICAL TREATMENTS FOR SZ
What is the issue with extrapyramidal side effects?
They are very visible
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BIOLOGICAL TREATMENTS FOR SZ
What do critics argue about typical drugs?
If side effects, death and psychological consequences are taken into account, cost benefit analysis would be mostly negative. Patients most likely stop taking them.
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BIOLOGICAL TREATMENTS FOR SZ
Give an example of an atypical drug
Clozapine
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BIOLOGICAL TREATMENTS FOR SZ
What do atypicals do?
Block dopamine and serotonin receptors
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BIOLOGICAL TREATMENTS FOR SZ
Give a positive of atypicals
Fewer side effects, particularly extra pyramidal symptoms
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BIOLOGICAL TREATMENTS FOR SZ
What are the side effects of atypicals?
Weight gain, diabetes, blood clots, stroke
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BIOLOGICAL TREATMENTS FOR SZ
What did crossley do?
Meta analysis of 15 studies
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BIOLOGICAL TREATMENTS FOR SZ
What did crossley examine?
Efficacy and side effects in early stages of treatment
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BIOLOGICAL TREATMENTS FOR SZ
What did crossley find?
No diff in efficiacy between the two
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BIOLOGICAL TREATMENTS FOR SZ
A03 MAT
- Don't require motivation or effort
- Quicker than therapy
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BIOLOGICAL TREATMENTS FOR SZ
Give two negatives
- Side effects
- Treatment not cause
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FAMILY THERAPY
What is family therapy?
A range of interventions aimed at the family
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FAMILY THERAPY
What does NICE recommend?
All SZ patients should be offered it
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FAMILY THERAPY
What is the nature of family therapy?
- 10 sessions
- Aim to reduce levels of expressed emotions
- Family given psychoeducation
- Encouraged to be open about problems and listen
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FAMILY THERAPY
Research support
Leff compared family therapy w routine outpatient care. Relapse rates after 9 months:
- 50% routine care
- 8% family therapy
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FAMILY THERAPY
Give two negatives
- Availability
- Effort
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COGNITIVE TREATMENTS FOR SZ
What is the key assumption?
Info is processed, how thinking impacts behaviour
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COGNITIVE TREATMENTS FOR SZ
What does CBTp stand for?
Cognitive behaviour therapy psychosis
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COGNITIVE TREATMENTS FOR SZ
What is CBT p
Therapy which aims to help patient to identify and correct disordered/delusional thinking
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COGNITIVE TREATMENTS FOR SZ
What does NICE recommend?
At least 16 sessions
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COGNITIVE TREATMENTS FOR SZ
What does CBTp include?
A behavioural element, develop coping strategies to improve functioning
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COGNITIVE TREATMENTS FOR SZ
Describe assessment
Patient identifies and expresses thought to therapist
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COGNITIVE TREATMENTS FOR SZ
What model is used after assessment?
The ABC model
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COGNITIVE TREATMENTS FOR SZ
Describe process of normalisation
Explain to patient we all have times of delusional thought
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COGNITIVE TREATMENTS FOR SZ
Describe critical analysis
Where is the evidence? etc if voices are real why can't others hear them, offer alternative explanations
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COGNITIVE TREATMENTS FOR SZ
How many sessions do most people require?
8-20 sessions over the space of 6-12 months, usually last for about an hour
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COGNITIVE TREATMENTS FOR SZ
Sensky A03
Compared CBT with non specific befriending intervention. 9 month follow up evaluation lower relapse rates in CBT
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COGNITIVE TREATMENTS FOR SZ
Give two positives
- No physical side effects
- Gives patients more control over treatments
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COGNITIVE TREATMENTS FOR SZ
Give two negatives
- Motivation
- Accessibility
129
TOKEN ECONOMY
When was this theory developed?
1970s
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TOKEN ECONOMY
What principle is this based upon?
Operant conditioning (if you reward a behaviour it will be repeated)
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TOKEN ECONOMY
What is this therapy mainly used on?
Institutionalised patients and is a method of helping them manage/control their impulses and behaviour
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TOKEN ECONOMY
What are patients given?
Coloured counters which can be handed in for privileges like cigarettes and watching TV
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TOKEN ECONOMY
What is the first step of the process?
Identify desirable behaviour eg getting dressed
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TOKEN ECONOMY
What is the second step of the process?
Tokens then offered immediately
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TOKEN ECONOMY
Give step three
Where tokens can be exchanged for privileges of a variety rather than one item, rates of response tend to be higher Sran and Borenno
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TOKEN ECONOMY
Give Allonby and Azron's positive
Female patients w sz had been hospitalised for an average of 16 years, and were rewarded for actions like brushing hair or making beds. Focus on negative symptoms, on average 5-40 good acts increased.
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TOKEN ECONOMY
Give two negatives
Determinism, behaviour vs reward
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THE INTERACTIONIST EXPLANATION FOR SZ
What is the diathesis stress model?
A model for an interaction between biology and psychology
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THE INTERACTIONIST EXPLANATION FOR SZ
What does the DSM assume?
Genetic predisposition but environmental trigger
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THE INTERACTIONIST EXPLANATION FOR SZ
Diathesis genetic predisposition
- Largely inherited, based on nature
- Gottesman individual 1% twin 48%
- Not 100%
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THE INTERACTIONIST EXPLANATION FOR SZ
Stress environmental factor
- Family dysfunction
- Double blind EE
- Reference Batesman or Brown
- Urban vs rural environment
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THE INTERACTIONIST EXPLANATION FOR SZ
Urban vs rural
Urban - city, lonely
Town - community feeling
More likely to develop sz in urban area therefore
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THE INTERACTIONIST EXPLANATION FOR SZ
What does the DSM explain?
Why there is no 100% concordance rate, biological but with individual differences
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THE INTERACTIONIST EXPLANATION FOR SZ
What is neither explanation?
Strong enough on it's own, would be reductionist to assume only one. Nature and nurture
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THE INTERACTIONIST EXPLANATION FOR SZ
What does combining both explanations mean?
Strengths and weaknesses cancel out
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THE INTERACTIONIST EXPLANATION FOR SZ
What is the interactionist explanation more?
Holistic, acknowledges both factors. Considers relationship both share in development of sz. ID
