schizophrenia

Question 1

introduction to schizophrenia - diagnosis/classification

Answer 1

diagnosis made by identifying/deciding what disord pers has
2 maj sympt for classification of ment disord : DSM-5 (world health organis)/ICD-10
differ slightly for classific of ment disord, ex. DSM-5 req +ve sympt for diag b ICD 2/+re -ve sympt sufficient
both have dropped subty bec e inconsistent

Question 2

intro to schizophrenia - +ve symptoms

Answer 2

additional experi beyond those of ordinary existence
hallucinations ; unusual sensory experi, some relat to environmental events, may hear/smell things
delusions; irrational beliefs, makes pers beh in ways that make sense to them b not oths

Question 3

intro to schizophrenia - negative symptoms

Answer 3

loss of unusual abilities/experiences
speech poverty; reduction in amou/quality of speech accomp w delay in verbal resp in convo
avolition; difficulty to begin/keep up w goal directed act
poor hygiene, lack persistence in work/education and lack energy

Question 4

evaluation - good reliability (osario et al) ; intro to schizophrenia

Answer 4

osario et al; excellent reliability in 180 indiv using dsm-5 on 2 occas, test retest/inter rater reliability
interviewed pairs achieved IRR of +0.97 and TRR of +0.92
TF: reasonably sure diag of schz consistently applied

Question 5

evaluation - low validity (cheniaux et al); diag/classif

Answer 5

limit
cheniaux et al; criterion validity used to assess validity of schz
2 psychiat indep assess 100 clients using dsm/icd
fou 68 diag in icd / 39 w dsm
TF: sugg schz over diag/under diag in each one wh sugg criterion validity low

Question 6

evaluation - co morbidity (buckley); intro to schz

Answer 6

limit
if cond occur tg a lot of time this calls into q the validity of their diag/classif bec might be single cond
where 2 cond freq diag tg
TF: qs validity of classifying 2 disorders sep

Question 7

evaluation - gender bias in diag; intro to schz

Answer 7

limit
men diag +re than wom bec wom less vulner than men due to genetic factors
how +re likely wom underdiag bec they closer relationships w peop and supp so wom funct bett w schz than men
TF: underdiag is gender bias /wom x get treatment that will benefit them

Question 8

evaluation - culture bias in diag; intro to schz

Answer 8

limit
some sympt ie hearing voices have diff meanings in diff cult
ex. haiti, hearing voices r communic fr ancestors
also british caribbean peop 9x +re like to receive diag than british peop
there’s cult bias of clients by psychiat fr diff cult backgr
TF: means brit A-C may be discrim against in cult biased diag sys

Question 9

biological explanations of schz - family studies

Answer 9

risk of schz increases w genetic similarity to relative w disorder
gottesmans family study; some1 w sibling has 9% chance developing schz and 48% if identical twin
general populat is 1%
family memb share aspects for their environ/genes

Question 10

biological explanations of schz - candidate genes

Answer 10

schz is polygenic , most likely genes coding 4 neurotransmitters ie. dopamine
ripke et al; combin all prev data fr genome wide study of schz
genetic make up of 37000 peop w diag of schz compar to 113000 controls, fou 108 sep genetic variations assoc w slightly increased schz
diff stud identif diff candidate genes so appears schz is aetiologically heterogeneous

Question 11

biological explanations of schz - role of mutation

Answer 11

schz can have genetic origin even in absence of family history of disorder
mutation in parents dna wh caused by radiation/poison/viral infection
evid for mutation fr +ve correlation b/w parental age and schz risk
increasing fr 0.7% w fath under 25 to over 2% in fath 50+

Question 12

biological explanations of schz - og dopamine hypoth

Answer 12

bas on discov that drugs used to treat schz caused symp simi to those in peop w parkinson’s disease
schz may be res of high lev DA in subcortical brain areas (hyperdopaminergia)
ex. excess DA receptors in pathways fr subcortex to broca’s area may expl specific schz symp ie. speech poverty

Question 13

biological explanations of schz - updated versions of dopamine hypoth

Answer 13

davis et al; proposed cortical hypodopaminergia wh is low lev DA in brains cortex
low DA in prefrontal cortex cou expl cog prob
sugg that cortical hypodopaminergia leads to subcortical hyperdopaminergia, both high/low lev DA in diff regions of brain part of updated version
also both genetic variations/early experi of stress make some peop +re sensitive to cortical hypodopaminergia hence subcortical hyperdopaminergia

Question 14

evaluation - research support (teinari/hilker); bio expla 4 schz

Answer 14

strength
fami stud show risk increases w genetic simi w schz fami memb
tienari et al: adoption stud, fou biolog child of parents w schz at heightened risk even if grow up w adopted fami
hilker et al; twin stud, show concordance rates of 33% identical twins and 7% non identical
TF: shows some peop +re vulnerable to schz as res of genetic make up

Question 15

evaluation - environmental factors; bio expla 4 schz

Answer 15

limit
clear evid environment fact increase risk for schz
trauma leads to adult ment health prob b evid now partic for schz
morkved et al; 67% peop w schz /related psychotic disorders report at least 1 childh trauma compar to 38% of matched grp w non psychotic ment health issues
TF: means genetic fact alone x prov complete expla 4 schz

Question 16

evaluation - evid 4 dopamine ; bio expla 4 schz

Answer 16

strength
amphetamines incr da /worsen symp in peop w schz and induces symp in peop w/o
antipsychotics decr da activity /reduce symp intensity
some candidate genes act on production of da/da receptors
TF: strongly sugg da involv in symp schz

Question 17

evaluation - glutamate; bio expla 4 schz

Answer 17

limit
post mortem/live scanning stud consist fou raised lev og glutamate in sev schz brain regions
sev candidate genes for schz believed involv in glutamate production/processing
TF: means usually strong case can be made for oth neurotransmitters

Question 18

psychological expla for schz - schizophrenogenic mother

Answer 18

reichmann; noted many of her patients w schz describ partic ty of parent
characterised by cold, uncaring, controlling, rejecting
creates tension/secrecy wh leads to atmosphere of distrust and developm of paro thoughts wh beco delusions

Question 19

psychological expl 4 schz - double bind theory

Answer 19

bateson et al; emphasis role of communication style w/n fami
developing child regularly finds themselves trapped in situs where they fear doing wrong thing b receive mix messages abo what is wrong thing
when ‘get it wrong’ child punished by withdrawal of love so think world is confusing/dangerous
reflected in symp like disorganised thinking/paro delusions
he makes clear that it’s just a risk factor

Question 20

psychological expla 4 schz - expressed emotion

Answer 20

lev emot express. towards pers w schz by their carers
contain; verb criticism of pers, hostility towards pers, emot over involvement in pers life inclu needless self sacrifice
high lev EE directed towards indiv r serious source of stress for them
primarily expla 4 relapse in peop w schz how. also sugg that it may be source of stress that can trigg onset of schz in pers already vulnerable

Question 21

psychological expla 4 schz (cog expla) - dysfunctional thinking

Answer 21

schz characterised by disruption to normal thought processing
reduc thought process in ventral striatum assoc w -ve symp
reduc process info in temporal/cingulate gyro assoc w halluc
this lower than usual lev of info proc sugg cog like 2 be impaired

Question 22

psychological expla 4 schz - metarepresentation dysfuntion (cog expla)

Answer 22

frith et al; metarep, cog abil to reflect on thoughts/beh wh allows insight in2 own intentions/goals and allows us to interpret actions of oths
dysfunct in metarep wou disrupt abil to recog own act/thoughts as being carried out by ourselves than some1 else
expla halluc of hearing voices /delusions like thought insertion

Question 23

psychological expla 4 schz - central control dysfunction (cog expla)

Answer 23

frith et al; identif issues w cog abil 2 suppress automatic resp while we perform delib actions
speech poverty/thought disord cou res fr inabil 2 suppress autom thoughts /speech trigg by oth thoughts
ex. peop w schz experi derailment of thoughts bec each word trigg assoc/pers cx suppress autom resp

Question 24

evaluation - empirical supp (berger) ; psychological expla 4 schz

Answer 24

strength
fou schz reported higher recall of double bind statements by their moths than non schz
this shows how double bind statements and actions like needless self sacrifice is freq fou in household w a schz memb and towards them
this real life evid increases the validity of the theory

Question 25

evaluation - empirical supp counterpoint ; psychological expla of schz

Answer 25

evid may x be reliable as patients recall may be affected by their schz sugg there is wider academic credibility for idea of contradictory messages causing schz x double bind theory

Question 26

evaluation - real world applic of EE; psychological expla r schz

Answer 26

strength hogarty; produced ty therapy session wh reduced social conflicts b/w parents and their childr wh reduced EE and relapse rates TF: sugg gaining insight into fami relationships allows psychiat prof to help improve quality of patients lives

Question 27

evaluation - research supp (cog expla); psychological expl 4 schz

Answer 27

strength evid 4 dysfunctional thought processing stirling et al; compar performance on range of cog task (stroop task) in 30 peop w and 30 peop w/o as predicted, peop w schz took 2x longer to name font colours TF: means cog processing of peop w schz impaired

Question 28

evaluation - proximal expla (cog expla); psychological expl 4 schz

Answer 28

limit only expla proximal origins of sympt distal explan focus on what initially caused condit ex. genetic/family dysfunction expla unclear how genetic variation/childh trauma might lead to metrep/cent contr prob TF: means cog theories on their own only provide partial expla 4 schz

Question 29

biological therapy 4 schz - typical antipsychotics

Answer 29

conventional drug treatments , chlorpromazine oral administration (1000 mg) reduce dopamine uptake /production binds to D2 receptors taken as tablets , syrups, injection depending on pers condit acts as antagonist as blocks receptors so effectors impulse x happen attempts to restore normal funct ex. halluc reduced and has sedative properties b serious side eff

Question 30

biological therapy 4 schz - atypical antipsychotics

Answer 30

1 clozapine early withdrawal due to agranulocytosis +re eff oft used when oth treatments fail users have regular bl test x administered by injections acts on serotonin /gluatamate receptors and dopamine recept 2 risperidone been around seen 1990s drug as eff as clozapine b w/o side eff low dose of max 12mg binds to same receptors as clozapine b +re strongly to dopamine recept evid of reduced side eff

Question 31

evaluation - evid 4 effectiveness (thornley); biological therapy 4 schz

Answer 31

strength reviewed stud comparing eff of chloropromazine to contr data fr 13 trials w 1121 ppts fou chloroprom assoc w better overall funct/reduc symp severity compar to placebos meltzer; conclu clozapine +re eff than typical antipsychotics/some atypical effective in 30-50% treatment resist cases where typical drugs have failed TF: means antipsychotics work

Question 32

evaluation - serious side effects ; biological therapy 4 schz

Answer 32

limit typical assoc w range side eff inclu dizziness/weight gain long term symp of tardiness dyskinesia wh caused by dopamine super sensitivity wh causes involuntary facial expressions ie. blinking most serious side eff of neuroleptic malignant syndrome caus when drug blocks dopamine action in hypothalamus NMS res in high temp, delirium and coma freq ranges fr less than 0.1% to over 2% TF means antipsychotics can do harm and indiv who experi may avoid treatment wh makes treatment ineff

Question 33

evaluation - mechanism unclear ; biological therapy 4 schz

Answer 33

limit x know y drug works og da hypoth; idea that high lev dopamine in brain subcortex causes symp how. og hypoth x complete expla 4 schz as acc dopamine lev too low in oth parts if true then most antipsych shou x work wh means they’re ineff TF: means at least some antipsych may x be best treatment to opt 4

Question 34

evaluation - social/economic implications; biological therapy 4 schz

Answer 34

strength drugs allow people to go back to work and their normal lives so they can be active in the economy and don’t need to rely on the welfare state wh benefits the economy

Question 35

psychological therapy 4 schz - CBT

Answer 35

challenges irrational beliefs /thoughts use techniques like homework,diaries ,discussion challenges delusions /hallucinations turkington; case ex. of cbt w mafia delusion he acknowledged the patients thoughts b. challenged their beliefs why they happen/that they might be delusions/hallucinations

Question 36

psychological therapy 4 schz - family therapy

Answer 36

reducing stress and EE in family context and focuses on entire family aimed at reducing relapse therapist observes/researched family interaction educates fami on how to communicate/facts of illness pharaoh et al; recommends nu strategies (unites) unity in caring for indiv w schz, negative emot/stress reduction, irritation/guilt reduction, teaching boundaries, educating relatives about schz, solve/anticipate problems

Question 37

evaluation - evidence of effectiveness (jauhar et al) ; psychological therapy 4 schz

Answer 37

strength jauhar et al; reviewed 34 studies of using cbt w schz fou clear evid for small b signif eff of both +ve/-ve symp pontillo et al; fou reduction in freq/severity of auditory halluc clinical advice fr NICE recommends cbt 4 schz TF: means both res/clinical experi supports benefits of cbt 4 schz

Question 38

evaluation - quality of evid; psychological therapy 4 schz

Answer 38

limit wide range techniques/sympt inclu in studies thomas; diff stud involv use of diff cbt techniques /peop w diff combo of +ve/-ve sympt overall modest benefits of cbt 4 schz probably covers wide variety eff of diff cbt techniques on diff symp TF: makes hard to say how effective cbt will be 4 partic pers

Question 39

evaluation - evidence for effectiveness (mcfarlane) ; psychological therapy 4 schz

Answer 39

strength mcfarlane; conclu family therapy one of the most consistently eff treatm available 4 schz relapse rates reduced by 50-60%, promising even when ment health initially declines clinical advice fr NICE recommends family T 4 everyone w schz TF: means family therapy likely benefit peop w both early/late schz

Question 40

evaluation - benefits to whole family (lobban/barrowclough); psychological therapy 4 schz

Answer 40

strength lobban/barrowclough; conclu these eff import bec fami prov care for pers w schz family therapy lessens -ve impact of schz on oth family memb/strengthens abil of fami to supp pers w schz TF: means family therapy has wider benefits beyond the obvious +ve impact on the identif patient

Question 41

management of schz - token economies

Answer 41

token economies are reward sys used to manage beh of peop w schz in partic those who develop maladaptive beh thru spending long periods in psychiatric hospital

Question 42

management of schz - developing token economies w schz

Answer 42

azrin; trialled token economy sys in ward of wom w schz every time ppts did task (eg cleaning) they were given a plastic token that cou be swapped w privelleges no tasks carried out increased significantly use has declined in uk due to growth of community bas care and ethical issues raised by restricting rewards to peop w ment disorders

Question 43

management of schz - rationale for token economies

Answer 43

institutionalisation develops under circumstances of prolonged hospitalisation peop develop bad habits (eg stop maintaining pers hygiene) token economies tackle personal care, condit related beh & social beh modifying these beh doesn’t cure schz b improves quality of life w/n hospital setting and normalises beh to make it easy to adapt back into life in community

Question 44

management of schz - theoretical understanding

Answer 44

token economies bas on operant conditioning tokens r secondary reinforcers as only have value when they can be used to gain meaningful rewards meaningful rewards r primary reinforcers tokens r paired w primary reinforced to become secondary reinforces

Question 45

evaluation - evidence of effectiveness (glowacki) ; management of schz

Answer 45

glowacki; identif 7 stud that examined eff of token economies for ppl w chronic ment health issues involv patients living in hospitals all stud showed reduction in -ve symp

Question 46

evaluation - evid of eff counterpoint ; management of schz

Answer 46

limit 7 stud is small evid base to supp eff prob w small nu of stud is file drawer prob where there’s bias towards +ve published findings bc undesirable results have been filed away

Question 47

evaluation - ethical issues ; management of schz

Answer 47

gives prof power to contr beh of patients & involves imposing one pers norms onto oths eg some1 who likes to look scruffy may have personal freedom restricted restricting availability of pleasures to seriously ill peop may be distressing caused legal action by fami wh have contrib to declined in use

Question 48

evaluation - alternative appr; management of schz

Answer 48

limit there’s oth appr that x raise ethical issues art therapy; high gain low risk appr to managing schz w/o side eff or ethical abuses NICE guidelines recommend art therapy 4 schz TF: may be good alternative to token economies

Question 49

interactionist appr to schz - diathesis stress model

Answer 49

vulnerability + stress trigg neccess to develop schz 1/+re underlying fact makes pers vuln b condit trigg by stress meehls mod; in og ds mod diathesis was entirely genetic, res of schizogene if pers x have gene then no amount stress can lead to schz for carries of gene , chronic stress thru childh cou res in disorder

Question 50

modern understanding of diathesis

Answer 50

many genes incr genetic vulnerability slightly b no singl schz gene read et al; neurodevelopmental mod, early trauma alters developing br severe trauma like child abuse can eff many aspects of br developm ex. hypothalamic pituitary adrenal sys can beco over active making pers +re vuln to stress later

Question 51

modern understanding of stress

Answer 51

houston; inclu anything that risks trigg schz recent res shows cannabis use fact of trigg schz cannabis interferes w dopamine

Question 52

treatment according to the interaction model

Answer 52

turkington biological expla (however partial) compatible w cbt ds = drug therapy + cbt is most approp appr cbt helps management + understanding of disorder

Question 53

evaluation - support for vuln and trigg ; interactionist appr

Answer 53

strength tienari et al; investigated impact of both genetic vuln + psycholog trigg study follow 19000 finnish childr w schz biolog moth in adulthood high risk grp compar to cg of adoptees w/o family history of schz adoptive parents assessed for child rearing /fou high lev of hostility , criticism and low lev empathy strongly assoc w schz development b only in high genetic risk grp TF: shows combo of genetic vuln/family stress can lead to greatly incr risk of schz

Question 54

evaluation - diathesis and stress are complex ; interactionist appr

Answer 54

limit og ds mod over simple og mod of diathesis as single schizogene /schizophrenogenic parenting too simplistic multiple genes in multiple combo influe diathesis diathesis can be influe by psychological fact houston et al; stud fou childhood sexual abuse emerged as maj influe on underlying vuln to schz / cannabis use as maj trigg TF: means multiple fact both biol/psychol wh affects both diathesis/stress supp modern understanding of D + S

Question 55

evaluation - real world applic; interactionist appr

Answer 55

strength stud show combo of treatm enhances their eff tarrier et al; randomly allocat 315 ppts to 1) medicat + cbt, 2) medicat + counselling, 3) cg of medicat only fou ppts in 2 combo grp show lower symp that cg b no difference in hosp readmission TF: means clear practical advantage to adopting interactionist appr to schz in terms of superior treatm outcomes

Question 56

evaluation - urbanisation; interactionist appr

Answer 56

limit schz +re commonly diag in urban areas than rural this stat sometimes used to justify interactionist posit as assumes urban living +re stressful and tf city living acts as trigg how may simply be that schz +re like to be diag in cities or that peop w diathesis 4 schz tend to migrate to cities TF: interactionist may be overgeneralised