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Psychology > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What is schizophrenia?

A
  • A serious mental disorder that is characterised by severe disruptions in psychological functioning : cognition, emotion and sense of self
  • People with schizophrenia suffer from psychosis (haven’t got a grip of reality)
  • It affects each individual in a unique way
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2
Q

What are the positive symptoms of schizophrenia?

A

1) Hallucinations - additional sensory experiences, can be auditory such as hearing voices or visual such as seeing distorted images

2) Delusions - paranoia and irrational beliefs

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3
Q

What are the negative symptoms of schizophrenia?

A

1) Speech poverty - inability to speak properly

2) Avolition - person has little energy and motivation to act/respond to situations

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4
Q

Is the criteria for diagnosis objective or subjective?

A

Subjective

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5
Q

What is the difference between positive and negative symptoms

A
  • Positive is an ‘add on’ to normal behaviour
  • Negative is ‘taking away from normal behaviour
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6
Q

What is the biological explanation for schizophrenia?

A
  • The risk of developing SZ among individuals who have genetic family members with disorder, is higher than those who do not
  • There is no specific gene that is thought to be responsible so makes individuals more vulnerable (its more likely a combination of genes)
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7
Q

What are the family studies into the biological explanations for SZ?

A
  • Gottesman and Sheilds in 1991 found that children with 2 schizophrenic parents had a concordance rate of 46%
  • Children with 1 schizophrenic parent had a rate of 13%
  • children with a brother or sister with schizophrenia had a rate of 9%
  • These numbers were compared to 1% diagnosis rate)
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8
Q

What are the twin studies of the biological explanations of SZ?

A
  • Joseph (2004) calculated that the pooled data for all SZ twin studies carried out prior to 2001 showed a concordance rate for MZ twins of 40.4% and 7.4% for DZ twins
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9
Q

Evaluate twin studies within the biological explanation for SZ

A
  • The fact that the concordance rates for twins is not 100% means that SZ cant be explained by genetics alone
  • As we already know, the higher concordance between MZ twins could be explained by greater environmental similarity
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10
Q

What are the adoption studies of the biological explanations of SZ?

A
  • Tienari te al in 2000 studied 164 finish adoptees whose biological mothers had been diagnosed with SZ
  • Of the 164, 11 received a diagnosis of SZ, compared to 4/197 adopttes
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11
Q

Evaluate genetics within biological explanations for SZ

A
  • Genes are unlikely to be a direct cause of SZ, but it rather creates a predisposition for the disorder
  • For example, in Tienari’s study the difference only emerged in situations where the adopted family was rated as disturbed
  • Genetic vulnerability alone isn’t sufficient
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12
Q

What is neural correlates?

A
  • Measurements of the structure and function of the brain that correlate with an experience (schizophrenia)
  • Positive and negative symptoms have different neural correlates
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13
Q

What is the dopamine hypothesis? Give evidence for this

A
  • The theory claims that excess amounts of dopamine or an oversensitivity of the brain to dopamine is the cause of SZ
  • Schizophrenics are also thought to have abnormally high numbers of D2 receptors on receiving neurones = more dopamine binding so more neurones fire
  • ‘Normal’ individuals who are exposed to large doses of dopamine releasing drugs can develop characteristic hallucinations and delusions of a SZ episode
  • L-Dopa is a drug for Parkinson’s disease which increases dopamine = produces symptoms of SZ
  • Antipsychotic drugs block activity of dopamine in brain = eliminates hallucinations and decisions because activity is reduced in neural pathways
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14
Q

What is the revised dopamine hypothesis? Give evidence

A
  • David and Kahn said that the positive symptoms of SZ are caused by an excess of dopamine in sub cortical areas of brain (Mesolimbic pathway)
  • Negative symptoms of SZ arise from a deficit of dopamine in areas of prefrontal cortex
  • To support, Patel used PET scans to assess dopamine levels in schizophrenic and normal people and found low levels of dopamine in prefrontal cortex of SZ patients
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15
Q

Evaluate neural correlates

A
  • Monerieff claims stimulant drugs like cocaine have shown to induce schizophrenic episodes
  • The evidence for dopamine concentrations in post-mortem brain tissue has been negative or inconclusive
  • Antipsychotic drugs DO NOT lessen hallucinations or delusions in about 1/3 of people experiencing them
  • Hallucinations and delusions happen for those whose dopamine levels are normal so cause and effect os uncertain and lowers validity of explanation
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16
Q

What are typical anti-psychotic drugs?

A
  • Combat positive symptoms
  • Dopamine antagonists
  • Bind to and block dopamine receptors
  • Positive symptoms will disappear within a few days
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17
Q

What are atypical anti-psychotic drugs?

A
  • Combat positive symptoms
  • Beneficial effects on negative symptoms
  • Binds to dopamine receptors blocking D2 receptors temporally until normal transmission of dopamine returns
  • Also blocks serotonin receptors so it’s beneficial to negative symptoms
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18
Q

What is the problem with anti-psychotics?

A
  • Kapur estimates between 60-75% of D2 receptors in mesolimbic pathway must be blocked for drugs to work
  • To do this, similar numbers of D2 receptors in other areas of the brain must also be blocked causing severe side effects
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19
Q

What is the problem with typical anti-psychotics?

A
  • Causes extra pyramidal effects (more than half experience Parkinson type problems)
  • Taking for long periods of time = 2nd type of extrapyrmidal effects occurs
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20
Q

Evaluate drug therapy (supporting)

A
  • Support comes from studies comparing relapse rates
  • Leutch did a meta-analysis of 65 studies with 6000 patients on either typical or atypical drugs
  • Some were taken off medication and given a placebo
  • Within 12 months , 64% who had a placebo has relapsed compared to 27% of those who stayed on drugs
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21
Q

Evaluate drug therapy (not supporting)

A
  • Crossely did a meta-analysis of 15 studies to study effectiveness and side effects of atypical vs typical drugs
  • He found no sign in at difference between drugs but noticed side effects such as weight gain
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22
Q

What is a psychological explanation of schizophrenia?

A
  • Family dysfunction
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23
Q

What are the 2 explanations of family dysfunction?

A
  • Double bind theory
  • Expressed emotion
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24
Q

What is the double bind theory?

A
  • The role of communication style within a family
  • When a child is developing, they find themselves trapped in situations where they fear doing the wrong thing
  • They receive mixed messages from parents
  • They are unable to seek clarification
  • They feel the world is confusing
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25
Q

What is expressed emotion?

A
  • Negative emotion expressed towards the schizophrenic patient by their carer
26
Q

What 3 factors results in high expressed emotion?

A
  • Verbal criticism
  • Emotional over-involvment
  • Hostility
27
Q

What does expressed emotion cause for a SZ patient?

A
  • Causes stress
  • Causes relapse in SZ
28
Q

Evaluate family dysfunction (ethical issues)

A
  • Leads to parent-blaming
  • Parents who have already suffered seeing schizophrenic child underwent further trauma by receiving the blame for the condition.
29
Q

Outline a difference between the biological and family dysfunction explanations for SZ (passive and active)

A

P - One difference between these approaches is in the role that the family takes
E- In the bio explanation, the family takes a passive role, the only involvement is that the parent passes on a gene to the child. This is the genetic explanation which is nature
E - In contrast, in the family dysfunction explanation, the family takes an active role as it is the communication style adopted by the parents which influences SZ (nurture

30
Q

Outline a similarity between the biological and family dysfunction explanations for SZ (determinism)

A

P- A similarity is that they are both deterministic
E - The bio explanation assumes that if you have faulty genes or high dopamine you will develop SZ
E - Similarly, the family dysfunction explanation assumes if you experience double bind statements you are at risk of developing SZ

31
Q

What is psychological therapy to family dysfunction? Explain it

A
  • Family therapy
  • Aim is to reduce expressed emotion and improve communicate between family
32
Q

How does family therapy work?

A
  • Trained therapist visits clients home and guides them through several stages such as psycho education, setting reasonable expectations, reducing emotional climate and helping client to solve issues
33
Q

What evidence from Garety supports family therapy?

A
  • He estimated that relapse rates for individuals who receive family therapy as 25% compared to 50% for those who receive standard care alone
34
Q

What did pharaoh do?

A
  • Reviewed 53 studies to investigate the effectiveness of family intervention.
  • Studies chosen were conducted in Europe, Asia, N America
  • Studies compared the outcomes from family therapy to standard care alone
35
Q

What did Pharoah find out about mental state, compliance with medication and reduction in relapse and re admission

A
  • Mental state = overall impression was mixed, some studies reported an improvement in overall mental state because of family therapy, others didnt
  • Compliance with medication = the use of family intervention increased patients compliance with medication
  • Reduction in relapse and re admission = there was a reduction in the risk of relapse and a reduction in hospital admission during treatment
36
Q

How is family therapy similar to CBT?

A
  • Family therapy only provides a safety net against relapse and its not a cure for SZ (like CBT)
  • But this is not a reason not to use it as we dont know what the cause it, so any help and support that SZ’s are offered is highly valuable
37
Q

What approach can explain the psychological explanation of SZ?

A
  • Cognitve
38
Q

What is the assumption of the cognitive approach to explain SZ?

A
  • SZ must be a consequence of a faulty mental process
39
Q

What are the 2 dysfunctional thought processes found in people with positive symptoms of SZ?

A
  • Meta representation
  • Central control
40
Q

Explain meta representation in normal people

A
  • Reflecting on your own thoughts, behaviours and experiences
  • We are aware of our own intentions and what other peoples intentions are
41
Q

How does meta representation work for schizophrenics?

A
  • People with SZ have a dysfunction in meta representation
  • They have the inability work out where speech is coming from because they have lost the control of their own thoughts
  • Delusions is the inability to make judgments about others intentions
42
Q

Explain central control for normal people

A
  • The ability to suppress automatic responses to stimuli whilst performing actions opposite to our intentions
43
Q

How does central control work for schizophrenics?

A
  • People with SZ don’t have the ability to suppress automatic thoughts resulting in disorganised thought, speech and behaviour
44
Q

What is the supporting A03 evidence for cognitive explanations of SZ?

A
  • The stroop test
  • 30 SZ patients were compared 19 non-schizophrenics on a stroop test
  • Required p’s to suppress impulses to read a word rather than a colour (central control task)
  • SZ patients took TWICE as long showing they find suppressing automatic thoughts challenging
45
Q

Evaluate cause and effect of the cognitive explanation to explain SZ

A
  • It is uncertain whether cognitive factors area cause or an effect of SZ.
  • Biological changes could cause SZ and the effect is suffering from irrational thought processes
  • Therefore the validity of cognitive explanation is uncertain because the variable causing the disorder is unknown
46
Q

Evaluate real world application of the cognitive explanation to explain SZ

A
  • CBT is used for psychosis
  • Patients evaluate the content of their delusions or voices and consider ways they might test the validity of their faulty beliefs
  • A NICE review found consistent evidence that CBT was more effective than drugs to reduce symptoms and improving levels of social functioning.
47
Q

Evaluate the comparison of cognitive and biological approach to explain SZ

A
  • A weakness is that the biological approach can be compared with the cognitive approach
  • It might provide a better explanation
48
Q

What is another psychological therapy of SZ?

A
  • CBT
49
Q

What is the aim of CBT?

A
  • Wants patient to realise thoughts are irrational and want to change the mindset of the patient over the process
  • Produces a coping mechanism
  • Uses cognitive restructuring via ABCDE frame work
  • Activating event, exploring Beliefs, recognising Consequence, Dispute, Restructuring
50
Q

What are the characteristics of CBT?

A
  • Collaboratives
  • Evidence based
  • Behavioural methods
  • Active
  • Focus on problem
  • Summary and feedback
51
Q

Why might it be difficult to treat a patient with CTBp WITHOUT also treating them with medication?

A
  • CBTp appears to be more effective when it is made available at specific stages of the disorder and when the delivery of treatment is adjusted to the stage that the individual is at
  • E.g: Addington and Addington claim that in the initial acute phase of SZ, self-reflection is not particularly appropriate and CBTp is not accessible to those patients
  • Psychotic symptoms are stabilised with antipsychotic medication, however some can benefit more from group based CBTp, normalising their experiencing by meeting people with similar issues
52
Q

What are token economies?

A
  • Form of behavioural therapy using operant conditioning
  • Used to target negative symptoms
53
Q

How is token economises different from drugs and therapies?

A
  • It is not a treatment or cure
  • It is used in the management of SZ
54
Q

How does a token economy work?

A
  • Clinicians set target behaviour that they will believe will improve patients engagements in daily activities
  • Tokens are awarded when a patient engages in target behaviour
  • Tokens are later exchanged for rewards
55
Q

How can token economies work most effectively

A
  • A token needs to be given out immediately after the performance of the target behaviour
56
Q

What is the supporting evidence for token economies?

A
  • Researchers used token economies on a ward of female SZ patients
  • They were given tokens for behaviours such as making their bed or doing chores
  • They could then exchange them for privileges like watching a film
  • The number of desirable behaviours patients performed each day increased dramatically
57
Q

What is the problem with the use of token economies?

A
  • They are used in hospital settings so less useful for those living at home/in community
  • Patients in hospital receive 24hr care so tokens can be given immediately, those in community will have to wait several days
  • Ethical concerns, should we be controlling behaviour with basic rewards?
58
Q

How are token economies researched?

A
  • It’s difficult to asses because there are no control groups
  • We can only compare to past behaviour and other factors that could be affecting the change (patients wanting more attention)
  • Not often used anymore, SZ’s are supported with life training so its more holistic
59
Q

Explain how symptom overlap might lead to problems with diagnosis or classification of SZ

A
  • Shared symptoms could lead to an unreliable/incorrect diagnosis
  • Person may exhibit a symptom typical of SZ (delusions), but may have another condition with the same symptom (bipolar disorder)
60
Q

In the context of SZ, outline what is meant by co-morbidity

A
  • Co-morbidity is where 2 conditions co-exist in the same individual at the same time
  • A person with SZ might also be suffering another condition at the same time (depression)
61
Q

In the context of SZ, outline what is meant by co-morbidity

A
  • Co-morbidity is where 2 conditions co-exist in the same individual at the same time
  • A person with SZ might also be suffering another condition at the same time (depression)

Psychology (10 decks)

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