schizophrenia

Question 1

what two criteria’s are used to diagnose sz?

Answer 1

DSM
ICD

Question 2

what does DSM focus on?

Answer 2

positive symptoms, used in US and sometimes Britain

Question 3

what does ICD focus on?

Answer 3

negative symptoms, used in Europe and majority of world

Question 4

name some positive symptoms of sz?

Answer 4

hallucinations, delusions, speech disorganisation, catatonic behaviour

Question 5

name some negative symptoms for sz?

Answer 5

speech poverty, avolition, affective flattening

Question 6

what is reliability in the context of sz?

Answer 6

how consistent are the results,
inter-rater reliability - the extent to which different assessors agrees with the their assessment
two or more professionals arrive at the same diagnosis, e.g., sz

Question 7

what is a study that shows the weakness of reliability in diagnosing sz?

Answer 7

Chenaiux - two psychiatrists independently diagnosis 100 people using DSM and ICD
inter-rater reliability was poor, 1st psychiatrist diagnosed 26 with DSM and 44 with ICD
2nd psychiatrist diagnosed 13 with DSM and 24 with ICD, poor reliability

Question 8

what is validity in the context of sz?

Answer 8

the extent to which we are measuring what we are intending to measure, is it truly measuring

Question 9

what studies show the weakness of validity in diagnosing sz?

Answer 9

Cheniaux - more likely to be diagnosed using ICD therefore under diagnosing in DSM showing poor validity
Rosenhan - pseudo patient study

Question 10

what is co-morbidity?

Answer 10

two or more conditions occur together, if condition occur together then the validity is questioned
Buckley those diagnosed with sz also diagnosed with depression 50%, harder to classify and diagnose as it may be severe depression

Question 11

what is symptom overlap?

Answer 11

when two or more conditions share symptoms
sz and bipolar disorder involve positive and negative symptoms, validity is questioned again.
ICD may diagnose them as sz whereas DSM diagnose them as bipolar

Question 12

what is the biological explanation for sz?

Answer 12

genetics and neural factors play a role in sz

Question 13

what is the genetic explanation for sz? evidence

Answer 13

twin studies showed the genetic link with family members.
100% DNA shared with MZ twins 50% DNA with DZ twins
candidate genes, individual genes associated with the risk of inheritance as sz is polygenic
studies have identified different candidate genes, sz is aetiologically heterogeneous, as different factors can lead to sz development

Question 14

what did Ripke do and what were the results? biological

Answer 14

carried out a study combining previous data from genome-wide studies of sz
37,000 people DNA with sz compared to 113,000 controls.
108 genetic variations associated with the increased risk of sz

Question 15

what is the dopamine hypothesis?

Answer 15

chemical messenger appear to work differently in the brain of a person with sz
dopamine is seen to be involved as it is important in several brain functions
hyperdopaminergia - high levels of dopamine leads to high activity in the subcortex
therefore excess dopamine in the brain associated with delusions and hallucinations

Question 16

what is the revised dopamine hypothesis?

Answer 16

where there are high and low levels of dopamine in the brain more so low levels
hypodopaminergia - abnormal dopamine systems, low level of dopamine in prefrontal cortex

Question 17

what is the neural explanation for sz?

Answer 17

neural correlates are measurements of the structure or function of the brain that correlate with an experience
positive and negative symptoms have neural correlates
negative - avolition, abnormality of areas in the ventral striatum
positive - Allen scanned brains of people experiencing hallucinates and compared to a control
had to identify pre-recorded speech of theirs or others
lower activation in the superior temporal gyrun and anterior cingulate gyrus were found in the hallucinate group, more errors made

Question 18

what are typical antipsychotics?

Answer 18

old 1950s
aim to reduce symptoms of sz
targets dopamine neurotransmitters
e.g. chlorpromazine
there is a strong association between typical antipsychotics and the dopamine hypothesis
works by binding and blocking the dopamine receptors
reducing hallucinates
tends to block all types of dopamine activity, up to 60%

Question 19

what are the side effects of typical antipsychotics?

Answer 19

extrapyramidal symptoms problem with movements
side effects tend to be long term

Question 20

what are atypical antipsychotics?

Answer 20

1970s new
aims to reduce sz symptoms more effectively and with less side effects
targets dopamine and serotonin
e.g. clozapine and risperdone
reduces positive and negative symptoms
generally fewer side effects
still risk of agranulocytosis can be fatal

Question 21

what does CBT do for sz?

Answer 21

sessions either group or individual
the aim is to identify irrational thoughts, dicuss of how likely these are to be true and consider a less threatening possibility
not rid of the symptoms but able to make people with sz be able to cope better
people are able to then make sense of hallucinations and delusions
able to understand where the symptoms come from

Question 22

what does family therapy do for sz?

Answer 22

takes place with families rather than individuals
aims to improve the quality of communication and interaction in families
some therapists see family as the root cause of sz
therapists more concerned with reducing stress within the family that might contribute to someone relapsing

Question 23

what strategies did Pharoah say were successuful in helping those with sz?

Answer 23

forming a therapeutic alliance with family
reducing the stress of caring for a relative with sz
improving the ability of the family to anticipate and solve problems
reduction of anger and guilt in family
help family achieve a balance between caring for the individual with sz and maintaining their own lives
improving families’ beliefs about and behaviour toward sz

strategies help to reduce levels of stress and expressed emotion, increasing the chance for those to comply with medication
reduce the likelihood of relapse and readmission rates

Question 24

how do token economies help sz?

Answer 24

reward systems to manage behaviour
tokens are given to patients immediately when they have carried out a desirable behaviour that has been targeted to be reinforced
most with sz will have bad hygiene and bad habits, maladaptive behaviours
immediacy of rewards is important because it prevents delay discounting the reduce effect of delayed reward
based on operant conditioning - tokens are secondary reinforcers

Question 25

what is the interactionist approach?

Answer 25

Acknowledges that there are biological, psychological and social factors. Biological – genetic vulnerability and neurochemical and neurological abnormality. Psychological factors – stress, poor quality interactions in the family Diathesis – vulnerability stress – negative psychological experience. Diathesis stress model that a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the condition.

Question 26

how has the interactionist approach helped with treatment?

Answer 26

Compatible with biological and psychological treatments. Associated with combining antipsychotic medication and CBT. Turkington – possible to believe in biological cause of sz and still practice CBT to relieve psychological symptoms. However, requires adopting an interactionist model. In Britain it is standard to treat people with a combination of medication and CBT It is usually common for medication to help those complete therapies as it may be another reason to reduce the aggressive that may appear in some schizophrenics.

Question 27

what was the Tienari study? aim/procedure

Answer 27

investigate combination of genetic vulnerability and parenting style children adopted from Finnish mothers with sz adoptive parents were assessed for child-rearing style rates if sz were compared to control whose mother did not have sz

Question 28

what were the findings from the Tienari study?

Answer 28

child rearing style characterised by high levels of criticism and conflict, the implicated the development of sz but only in those who had a genetic vulnerability genetic vulnerability and family related stress are important in the development of sz. shows the importance of an interactionist approach including poor parenting as a source of stress

Question 29

what is the schizophrenic mother theory?

Answer 29

mother is cold, rejecting and controlling creates a family climate characterised by tension and secrecy leads to distrust that develops into paranoia

Question 30

who came up with the double bind theory?

Answer 30

Bateson

Question 31

what is the double bind theory?

Answer 31

received mixed messages about something, feel unable to comment on the unfairness or seek clarification when they get something wrong, the child is punished by withdrawal of love leaves them with an understanding of the world as confusing and dangerous.

Question 32

what is expressed emotion?

Answer 32

verbal criticism accompanied by violence hostility including anger and rejection over-involvement in the life of the person

Question 33

how does EE link to sz?

Answer 33

high levels of EE is a source of stress to the patient is an explanation for relapse but also this source of stress can trigger the onset of sz if person is vulnerable diathesis-stress model

Question 34

what two types of dysfunctional thought processing are there in the cognitive explanations for sz?

Answer 34

mete-representation central control

Question 35

what is meta-representation?

Answer 35

cognitive ability to reflect on thoughts and behaviour allows insight into our own intentions and goals interpret the actions of others. dysfunction disrupts the ability to recognise our own actions, as being carried out by ourselves rather than by someone else, explain hallucinations

Question 36

what is central control?

Answer 36

cognitive ability to suppress automatic responses while he perform deliberate actions instead disorganised speech could result from suppress automatic thoughts

Question 37

what supporting evidence is there for family dysfunction?

Answer 37

Read - reviewed 46 studies of child abuse and sz 69% of adults with sz had a history of physical, sexual abuse or both in childhood. 59% for men Berry - adults with insecure attachments more likely to have sz

Question 38

why is there weak evidence for family dysfunction in sz?

Answer 38

sz may have distorted patients' recall of childhood experiences, problem for validity little evidence to support the schizophrenic mother or double bind theory. explanations have led to parent-blaming, who had to observe their child develop sz, bear the responsibility of their care, underwent further trauma by receiving the blame for the condition.

Question 39

what was Stirling's study for dysfunctional information processing?

Answer 39

stroop test 30 sz, 18 control ppt people with sz took twice as long as the control group however, with the mass amount of evidence collected, cognitive theories can explain proximal causes, what may cause symptoms but not the distal causes, the origin of the condition