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psychology paper 3 > schizophrenia > Flashcards

schizophrenia Flashcards

1
Q

who does schizophrenia affect?

A

about 1% of the population, its more common in males, city dwellers and those of lower socio-economic groups
schizophrenia can often lead to homelessness and hospitalisation due to its symptoms severe interference in life

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2
Q

what two diagnosis systems do we use for schizophrenia?

A
  • DSM-5, this requires at least one positive symptom
  • ICD-10, this requires at least two negitive symptoms
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3
Q

what are the two positive symptoms and why are they called ‘positive’?

A

positive refers to having an additional experiences that people dont ordinarily experience
they are hallucinations and delusions

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4
Q

what are hallucinations and delusions?

A

hallucinations are an unusual sensory experience. they cn be related to any sense, eg visual (seeing people etc) and auditory (hearing voices etc) the person may see distorted faces or things that just arent there

delusions is aka paranoia, theyre irrational beliefs, commonly believing youre a famous historical figure (eg jesus), being followed by the government or aliens or believing that someone else is controlling them

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5
Q

what are the two negative symptoms and why are they called ‘negative’?

A

negitive refers to having a loss of ordinary abilities
they are speech poverty and avolition

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6
Q

what is speech poverty and avolition?

A

speech poverty is having changes in patterns of speech, this could be a reduction of the amount and the quality of your speech such as delayes replying. however nowadays disorganisation is emphisised although this is classed as a positive symptom, it refers to being incoherent, changing topic mid sentence etc

avolition or apathy is difficulty completing goal-directed activities. lots of schizophrenics experience reduced motivation for eg hygene, work, etc

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7
Q

why is co-morbidity an issue for diagnosing SZ?

A

conditions that commonly align cause issues for the validity of diagnosis because they might just be one condition.
half of people diagnosed schizophrenic also have a depression or substance abuse diagnosis

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8
Q

diagnosis of SZ is impacted by biases, explain these issues

A

gender bias: men are diagnosed more than women, this may be because women are less vulnerable or because they have more social support and so dont seek diagnosis because they can function better however this ultimatetly means women arent recieving the treatment they need

culture bias: hearing voices of loved ones who have died in African-Caribbean cultures is considered normal, as a result people from the culture are 9x more likely to be diagnosed, but only in other countries, this means they could be being discriminated against

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9
Q

what are the two biological origins of schizophrenia

A

genes
neural correlates (brain structure or function)
if SZ is genetic it could lead to having different brain structures

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10
Q

what have family studies told us about SZ?

A

its hereditable, with the likelyhood of you getting schizophrenia increasing with the more related you are to someone with SZ, eg a MZ twin youd have a 48% chance compared to 17% in DZ, 6% in parents etc

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11
Q

in the biological explanation, much like OCD, schizophrenia has/is:

A

candidate genes - genes involved in SZ, early research looked for a spesific schizogene but theres a number of genes involved
polygenic - ^ this means its polygenic, with multiple genes involved
ateologically hererogeneous - different variations of genetic combinations can lead to SZ in different people

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12
Q

what is the role of mutation in schizophrenia?

A

mutation in DNA can be because of poison, radiation, infection etc
sperm mutation increases with age, studies have shown a correlation between paternal (dads) age and SZ

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13
Q

what is the original dopamine hypothesis?

A

schizophrenia is a result of high dopamine levels in the subcortical areas of the brain, we know this because drugs used to treat SZ caused symptoms simular to parkinsons symptoms and that condition is linked to low dopamine levels

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14
Q

whats the updated dopamine hypothisis?

A

low dopamine levels - hypodopiminersia in the prefrontal cortex causes the hyperdopiminersia (high levels) in the subcortical area. the low dopamine could explain the negitive symptoms

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15
Q

what are the 6 psychological explanations for SZ (3 family, 3 cognitive)?

A

family dysfuntion: the schizophrenogenic mother, double bind theory, expressed emotion
cognitive explanations: dysfunctional thinking, meterepresentation dysfunction, cenderal control dysfunction

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16
Q

what is the schizophrenogenic mother?

A

based on patients desciptions of their childhoods, lots of people described whats now called the schizophrenogenic (SZ - causing) mother, ie. a cold, rejecting, controlling mother creating a family dynamic of tension and secrecy which develops into paranoia and ultimately SZ

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17
Q

what is the double bind theory?

A

this refers to the families communication style
the child fears doing the wrong thing, recieving mixed messages about what the right/wrong thing even is and feeling unable to ask for clarification. the child often gets it wrong and are punished through withdrawal of love
the child is confused, paranoia and disorganised thinking develops

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18
Q

what is expressed emotion?

A

this refers to the level of negitive emotion expressed in the family, this usually contains:
- verbal criticism, sometimes accompanied by violence
- hostility including anger and rejection
- emotional overinvolvement
this explanation states the stress in the environment causes SZ in an already vulnerable person, it also explains relapse

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19
Q

what is dysfunctional thinking

A

disruption to normal thought processing. reduced thought processing in the ventral striatum = negitive symptoms, reduced processing in the temboral and cingulate gyri = hallucinations

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20
Q

what is metarepresentation dysfunction

A

metarepresentation is the ability to reflext on thoughts and behaviours disruption would mean they ant recognise that their halucinations are from themselves and not out there by someone else

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21
Q

what is central control dysfunction

A

issues supressing automatic respoonses when performing deliberate actions, resulting in speach poverty and thought disorder because of things like derailment, when the person cant suppress their distractions and go off on tangents

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22
Q

what is good and bad about the family disfunction explanations?

A

in a study they found people with schizophrenia have a disproportionate likelyhood to have insecure attachment (poor relationship and communication with mum) the majority also had a history of abuse (childhood trauma (EE), psysical, sexual)

23
Q

what research supports the cognitive explanations?

A

in one study they found people with SZ took twice as long to conplete the stroop test because they couldnt supress the automatic thought
(red, blue, green, say the colour but the words are in the wong colour)

24
Q

what is the most common treatment for schizophrenia?

A

drug therapy - antipsychotics
they can be used short term and long term
antipsychotics split into typical (older, 1950s) and atypical (newer, 1970s)

25
Q

what is one typical antipsychotic and how does it work?

A

chlorpromazine (claw prom azine) is a dopamine antagonist, this means that it blocks the dopamine receptors in the brain (to reduce dopamine), this can help to reduce the hallucinations. its usually prescribed at 400-800mg

26
Q

whats a side effect of chlorpromazine?

A

it also works as a seditive and so is often used to calm individuals when theyre very anxious when being admitted to hospital, in this case its administered as a syrup because its absorbed faster

side note eval, this is ethically questionable, medicating people to make them easier to manage, however they are distressed so maybe its fine

27
Q

what are two atypical antipsychotics and when did we begin to use them?

A

clozapine and risperidone
- atypicals have been around since the 1970s
- clozapine was developed in the 60s and trialed in the 70s but was withdrawn after causing a blood condition resulting in death, it was remarketed in the 80s and deemed safe as long as you get regular blood tests
- risperidone has been around since the 90s

28
Q

how does clozapine work?

A

clozapine binds to dopamine, serotonin and glutamate receptors, it has mood-enhancing (reduced depression+anxiety) effects so is used for pations who are a suicide risk, this is important because 30-50% of people with SZ attempt suicide at some point
its typically prescribed at 300-450mg

29
Q

how does risperiodone work?

A

risperidone binds to serotonin receptors and more strongly to dopamine receptors, this means its dosage is much lower at 4-8mg typically, increasing to a max of 12mg, this means it has much fewer side effects

30
Q

whats 3 evaluations for use of drug treatments?

A
  • theyre a very effective form of treatment, better functioning seen accross the board for the drug in placebo having studies
  • drugs can have serious side effects, clozapine can cause a severe blood disorder resulting in death, drugs can also cause stiff jaw, weight gain, sleep disruption and more
  • we dont know how they all work, our undarstanding is based strongly on the origional dopamine hypothesis
31
Q

what are the two psychological therapy treatments for schizophrenia?

A

family therapy and cognitive behavioural therapy

32
Q

what is family therapy?

A

therapy that takes place with the family aswell as the SZ patient (the identified patient). the aim is to improve communication and interactions between members

33
Q

how does family therapy help?

A
  • reduces negitive emotions: reduces the expressed emotions, the negitive emotions eg guilt, which can help to reduce stress
  • improves the families ability to help: the therapist helps to improve the beliefs and behaviours to the identified patient and ensures theres a balance in caring for the patient and having their own lives
34
Q

how would a family therapy session go? (7 phases)

A
  1. sharing basic information and providing practical emotional support
  2. identifying the resources the members can and cannot offer
  3. encouraging a mutual understanding and creating a safe space for all members to express themselves
  4. identifying the unhelpful patterns of interactions
  5. skills training of eg stress management techniques
  6. relapse prevention and setting a plan
  7. maintenence for the future
35
Q

what is good about using family therapy?

A

condidered one of the most effective treatments with reduced relapse rates than in other treatments, NICE reccomends everyone with SZ to do family therapy and is seen as good for both mild/early and severe SZ

its strengthens the functioning of the whole family not just the patient, it also means they can provide the bulk of the care

36
Q

what is cognitive behavioural therapy (CBT)?

A

it aims to deal with both thoughts and behaviour, it can take between 5-20 sessions, typically nearer the longer side in SZ patients than people with other disorders

37
Q

how does CBT help? (4 points)

A

it helps people to cope and manage their symptoms rather than iliminating them
- teaching patients where the symptom comes from: reduces fear, eg telling them their auditary ahllucination comes from a malfunctioning speech center means they know it wont hurt them
- normalising symptoms: explaining that hearing voices is an extention of having an inner voice
- challanging desusions through reality testing: this involves discussing the likelyhood theyre right and asking for proof
- tackling the accompanying depression

38
Q

whats one example of how a conversation in CBT would play out?

A

client: the mafia are observing me to decide how to kill me
therapist: you are obviously very frightened, you must have good reason to believe this?
client: do you think its the mafia?
therapist: its a possibility but theres also other explanations, how do you know its the mafia?

39
Q

what is one strength and one weakness of CBT?

A

theres evidence for its effectiveness, 34 studies show a small but significant improvement for both positive and negitive symptoms with reduction in frequency and severity of hallucinations

however the studies involved very different methods and techniques and symptoms, it makes it hard to say how effective CBT will be for a particular person considering the vast variation in cases

40
Q

what technique is used to manage schizophrenia in psychiatric wards?

A

token economy systems - a reward system to modify people to have more desirable bahviours when they’ve spent extended periods in hospital

41
Q

whats involved token economy systems?

A

tokens, like in poker, are given out immidiately to people when they perform the desired task, eg putting day clothes on (not pjs), these tasks are decided on an individual basis as people will struggle with different things
the tokens can then be swapped for a reward eg TV time or a magazine, sweets etc
the token is there so they get an immidiate reward, its administered immidiately to build that assosiation with task/reward so they do it more

42
Q

how did token economy systems in relation to schizophrenia come about?

A

a trial was done on schizophrenic women in a ward, when they eg made the bed, they were given a token (engraved with ‘one gift’) they could exchange for a reward. they founf that tasks done increased significantly. after this in the 60s/70s they became the norm to use for SZ in long term hospitals
they have sinse declined due to ethical issues and families complaining however are still used alot around the world

43
Q

what do token ecomonies tackle the effects of?

A

effects of institutionalisation, people often develop bad habits eg not getting out of pijamas, not maintaining good hygene etc
token economies spesifically try to improve self care, social behaviour and condition-related behaviours

44
Q

what two major benefits do token economies have?

A
  1. it improves the quality of the persons life, eg giving makeup to someone who values their appearence
  2. it normalises behaviours again and helps people adapt back to normal life when transitioning out of hospital back to their life, their community etc
45
Q

what is the theory behind why token economies work?

A

theyre a form of behaviour modification based on operant conditioning (learning through consiquence, praise, positive reinforcement) the reward is the primary reinforcer, its what they actually want, the token is a secondary reinforcer, it represents the primary

46
Q

what is the main ethical issue that token economies have?

A

it gives the professional power over the patients behaviour, and modify it to what their standards of good/bad are, ie its imposing one persons norms onto another person
it also restricts the pleasures they get to have, reducing them to reward only. its argued their quality of life is already bad, why deprive them of that further, they should be allowed to have access to the rewards in normal life

47
Q

what alternitive can be used instead of token economies?

A

art therapy, although evidence is limited its shown to be alow risk high reward therapy without any of the ethical issues of the token economies

48
Q

what is a diathesis-stress model?

A

diathesis (vulnerabllity stress (trigger)
when an environmental stressor triggers a vulnerability to a condition causing them to develop it

49
Q

what was meehl’s origonal diathesis-stress model?

A

the diathesis was genetic, they had a schizogene, this lead to a schizotpic personality meaning youre sensitive to stress, the stress then causes the SZ, or chronic stress eg in the family home can also lead to SZ
no amount of stress will lead to schizophrenia if you dont have the gene

50
Q

what is the modern understanding of diathesis?

A

although we know that genes do impact likelihood, theres no one ‘schizogene’. trauma is now oulines as a diathesis, a neurodevelopmental model was proposed where severe early trauma can affect your brain development

51
Q

what is the modern understanding of stress?

A

stress now includes anything that could risk schizophrenia, not just parenting eg cannabis use especially in teens

52
Q

what treatments are used in the interactionist approach?

A

because it akgnowledges both biological and psychological factors the treatment is a combination of antipsychotic drugs and psychological treatment, typically CBT
this combination approach is used in the UK but not as much in the US where they tend to go for just medication

53
Q

what studies have been done to prove the effectiveness of interactionist treatments?

A

315 ptps randomly selected to be in eather 1. meds+CBT, 2. meds+councilling or 3. just meds (control group)
ptps in the combination groups had much more success, showing less symptoms than the just meds group

side note, this doesnt however show causation, just because alcohol reduces shyness it doesnt mean shyness is due to a lack of alcohol

psychology paper 3 (5 decks)

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