Schizophrenia

Question 1

How much of the population have sz when is the onset and what gender is more likely to develop it?

Answer 1

1%, 15-45 years, males

Question 2

What is used to classify sz?

Answer 2

DSM-diagnostic and statistical manual
ICD- international classification of disease

Question 3

What are positive symptoms of sz?

Answer 3

Experiences that are in addition to normal experiences:
-hallucinations
-delusions

Question 4

What are the negative symptoms of sz?

Answer 4

Loss of normal experiences and abilities:
-avolition (no energy, no motivation)
-speech poverty (loss of quality and quantity of verbal responses)

Question 5

What is reliability ?

Answer 5

How consistent the results are using the same measuring tool

Question 6

What is validity?

Answer 6

It’s about truth are the measurements made correctly referring to something real in the world

Question 7

What is inter rater reliability?

Answer 7

Measure of how two observers agree

Question 8

What is test retest reliability?

Answer 8

Same doctor giving the same diagnosis overtime with the same symptoms

Question 9

What did Beck 1963 research and find in his study ?

Answer 9

Reviewed 153 patients who had been diagnosed by multiple doctor found only a 54% concordance rate between the doctors assessments this suggests there’s a low inter rater reliability in the diagnosis of sz and suggests many ppl have been diagnosed incorrectly or have had wrong treatment

Question 10

What is co morbidity ?

Answer 10

Sz is often diagnosed with other disorders

Question 11

What did Buckly 2009 in his comorbidity study?

Answer 11

Found the following co morbidity rates
-50% depression
-47% drug abuse
-29% ptsd
-23% OCD

Question 12

What is symptom overlap?

Answer 12

Bipolar disorder also has hallucinations and delusions as a symptom if the disorders are so similar it may be they aren’t actually distinct and they should be redefined.

Question 13

What are the problems with gender and sz?

Answer 13

Mens average age of diagnosis is 25.5 years sooner than women. Men are more likely to have drug abuse as a cormobidity have worse social functioning and suffer negative symptoms women are more likely to display positive symptoms.

Question 14

What is the gender bias is experiences of sz?

Answer 14

Women experience of sz is taken less seriously and underdiagnosed compared to men cotton suggests this is due to women’s better social coping strategies leading to being less likely to seek treatment.

Question 15

How more likely are Afro caribbeans to be diagnosed with sz than British ?

Answer 15

9x more likely

Question 16

What is the cultural bias with sz and who suggests this?

Answer 16

Fernando 1998 suggests category failure western definitions of mental illness are applied to non western cultures a specific example is how hearing the voices of angles would be defined as an auditory hallucination in the uk but a religious experience in the West Indies

Question 17

What did loring and Powell 1988 find in their racial study ?

Answer 17

Sent 290 psychiatrists two identical case studies the psychiatrists however the gender and race of the case studies where changed to either a while male, black male, white female, black female or no gender or race disclosed the researchers found over diagnosis of the black case studies and under diagnosis of the female case studies the most accurate diagnosis was when the gender and race of the psychiatrists was the same as the case study suggesting the existence of both gender and culture bias in psychiatrists diagnosis of sz.

Question 18

What are the biological explanations for sz?

Answer 18

Genetics and neural correlates including dopamine hypothesis

Question 19

Why is sz a polygenetic disorder?

Answer 19

There isn’t one specific gene for sz however a collection of gene locations have been located that are associated with a higher risk of developing sz

Question 20

What did ripke et al 2014 in his gene study find?

Answer 20

Conducted genetic analysis of over 36 thousand sz cases this identified 108 genetic loci associated with the development of sz this suggests a range of genes are responsible for sz but also suggests the disorder is aetiologically heterogeneous as different combinations of genes are correlated with having the disorder

Question 21

What did gottesman 1991 discover in family study?

Answer 21

Found a concordance rate of 48% for identical twins MZ and 17% for dz this compares to the general population rate of 1% suggesting sz has a genetic aspect as there is such a large difference between two sets of twins both dz and mz should share similar environments however concordance rate isn’t 100% in mz so not fully genetic

Question 22

What were tienari 2004 study findings?

Answer 22

Studied the biological children of sz mothers who had been adopted. It was found that a 5.8% of children adopted into psychologically healthy families developed sz compared to 36.8% of children raised in dysfunctional families as the risk for both groups is far above the 1% risk level of the general population this suggests sz has a genetic basis however difference between groups also suggests a role to play for psychological factors

Question 23

What are neural correlates?

Answer 23

Variations in neural structure and bio chemistry that are correlated with an increased risk of developing sz

Question 24

What is the dopamine hypothesis?

Answer 24

Suggests that symptoms of sz are associated with too much or an imbalance of the dopamine neurotransmitter across the brain
Excessive amounts of dopamine (hyperdopaminergia) in speech centres like Broca’s area may lead to auditory hallucination
Lower levels hypodopaminergia in areas like the frontal cortex are thought to lead to negative symptoms like avolition and speech poverty

Question 25

How did the dopamine hypothesis come about?

Answer 25

From observations that dopamine releasing drugs such as l-dopa can produce sz like symptoms in healthy patients

Question 26

What did leueht et al find in his meta analysis ?

Answer 26

Meta analysis review of 212 studies these studies assessed the effectiveness of biological anti psychotic drug treatments that work via normalising levels of dopamine results demonstrated theses drugs were more effective than the placebo the effectiveness of treatments that influence the dopamine system suggest that the underlying biological theory of sz cause has validity otherwise drug wouldn’t be effective

Question 27

What are ventricles?

Answer 27

Voids filled with cerebrospinal fluid deep within the brain enlarged ventricles are associated with ppl with sz

Question 28

What did Johnstone 1976 research using ct scans discover?

Answer 28

First identified ppl with sz had larger than average ventricles suggesting this structural difference may be linked to the cause of sz

Question 29

How is the biological explanation of sz biologically deterministic?

Answer 29

Genetic basis assumes that sz is inevitable or biologically determined potentially making sufferers feel disempowered when diagnosed the cognitive approach has a soft determinist perspective suggesting that mental processes can be altered or managed via free will to control the disorder

Question 30

What does the biological reductionist approach fail to consider ?

Answer 30

Evidence for the range of psychological aspects of sz such as expressed emotion that seem to have a large influence on the development and relapse of the disorder.

Question 31

What would a holistic approach of sz consider?

Answer 31

The diathesis stress approach in which the root cause of the disorder is a biological/gentic weakness however a environmental stressor such as family stress triggers the disorder

Question 32

What is the psychological explanations for sz?

Answer 32

Family dysfunction, cognitive explanations

Question 33

What is family dysfunction?

Answer 33

Suggests its the interpersonal relationships within the family that result in symptoms

Question 34

What’s a schizophrenogenic mother?

Answer 34

Psychodynamic theory that suggests people with sz get their paranoid delusions as a results of influence of a cold rejecting and controlling mother and a passive father she creates an atmosphere of stress,tension and secrecy in the family the atmospheres triggers psychotic thinking

Question 35

What is the double bind theory?

Answer 35

Child gets mixed messages and feels unable to do the correct thing Bateson 1972 suggests this results in disorganised thinking and paranoia.

Question 36

What is expressed emotion?

Answer 36

Verbal interactions the caregiver has with person with sz Exaggerated involvement: indicating the sufferer is a burden via self sacrifice Criticism and control of the sufferers behaviour Hostility towards the sufferer

Question 37

AO3 of family dysfunction what did Butzlaff and Hooley 1998?

Answer 37

Showed using a meta analysis of 27 studies that relapse into sz is significantly more likely in families that have issues with expressed emotion

Question 38

What was supporting evidence on family dysfunction from tienari 2004 AO3?

Answer 38

Studied the biological children of schizophrenic mothers who had been adopted it was found that 5.8% of those adopted into psychologically healthy families developed sz compared to 36.8% of children raised in dysfunctional families. This suggests that the interpersonal family environment has a significant impact on the development of sz in genetically vulnerable people.

Question 39

What are cognitive explanations for sz and what are the assumptions of it?

Answer 39

Cognitive explanations for sz are based on the assumption that the ability to process thoughts is dysfunctional Firths 1979 attention deficit theory suggests sz is due to a faulty attention system unable to filter pre conscious thought and gives too much significance to the info that would usually be filtered therefore overloading the mind this accounts for positive symptoms like hallucinations/delusions

Question 40

What is firth theory about the ability to suppress and override automatic actions?

Answer 40

Suggests the ability to suppress and override automatic actions and speech and make deliberate actions to achieve goals (central control) is sometimes faulty in sz patients.

Question 41

Firth 1992 what studied did he support this with ?A03

Answer 41

Firth 1992 supported these ideas with biological/cognitive neuroscience studies. 30 sz patients with various symptoms had PET scans these scans indicated a reduction in blood flow in the frontal cortex with patients with negative symptoms like avolition and the inability to suppress automatic throughs this suggests there are biological differences in sz brain regions associated with the theorised cognitive process.

Question 42

What was Stirling et al 2006 stroop test study?A03

Answer 42

Conducted a stroop test was conducted on 30 patients with sz and 18 control patients this involved naming the ink colours on words without saying the word this is difficult as there is a desire to say the words that needs to be controlled Stirling found that patients with sz took twice as long to name the colour as the controls. This suggests that patients with sz do have dysfunctional thought processing

Question 43

Does ft reduce ee in families?A03

Answer 43

Yes it does

Question 44

What indicated that cognitive factors are involved in the disorder?

Answer 44

As cognitive behavioural therapy for psychosis can be affective treatment this indicated that cognitive factors are involved in the disorder

Question 45

What is it socially sensitive to suggest sz is caused by the family ?a03

Answer 45

Socially sensitive as parents are already dealing with the difficulty of their relatives behaviour theorists may be adding additional stress by making the family think they are responsible

Question 46

Is it possible to demonstrate cause and effect of sz? A03

Answer 46

Impossible to demonstrate cause and effect it could be that sz of the child and associate behaviour is the cause of the family dysfunction

Question 47

Why can it be argues that the basic cause is biological and why is this a negative of ft?

Answer 47

There’s research that sz is a biological cause such as genetics (gottensman) ad neurotransmitters (leucht) family dysfunction might act as a trigger but it can be argues the basic cause is biological

Question 48

Define antipsychotics

Answer 48

Medications that are used to control psychosis such as delusions and hallucinations they are taken in pill or injected

Question 49

Define typical antipsychotics and example

Answer 49

A drug therapy used since 1950s that are less popular now cause of the side effects and only treating positive symptoms an example is chlorpromazine

Question 50

How do typical drugs work and what are the side effects?

Answer 50

Drugs work as dopamine antagonists they reduced domapine activity by blocking domapine receptors at the synapse Calms the dopamine system in the brain reducing positive symptoms also has a general sedative effect Side effects include dry mouth, constipation, confusion uncontrollable muscle movements usually affecting the face.

Question 51

Define a typical anti psychotics and example?

Answer 51

Drug therapy started to be used in 1970s to avoid the more severe side effects of typical drugs example clozapine

Question 52

How do atypical drugs work and side effects?

Answer 52

Block dopamine receptors but also act on other neurotransmitters e.g glutamate and serotonin they also address the negative symptoms such as avolition side effects: weight gain, cardiovascular problems

Question 53

What was some supporting evidence by leucht et al on drug therapy?

Answer 53

Leucht et al 2013 reviewed 212 studies in a meta analysis on the effectiveness of biological antipsychotic drug treatments that work via normalising levels of dopamine treatment of symptoms with the drugs were found to be much more effective than a placebo this suggests the treatments that target the domapine system are effective in reducing symptoms.

Question 54

How does Bangnall 2003 study support drug therapy?

Answer 54

Used 232 studied to compare the effectiveness of a range of a typical and typical anti psychotics it was found that a typical drugs were more effective than typical in treating overall symptoms resulting in fewer movement disorder side effects and fewer people left the drug early overall clozapine was found to be the most effective in reducing negative symptoms and treating people who were resistant to other drugs this research suggests anti psychotics are an effective treatment plan

Question 55

How does research by tarrier 1998 not support drug therapy ?

Answer 55

Placed patients randomly into routine care or routine care (drugs) and CBT patients in the combined treatment had a significant improvement in the severity and number of positive symptoms as well as fewer days in hospital recieveing care this suggests drug therapy alone isn’t the most effective treatment plan and an interactionalist approach to treating sz along with CBT is the better option

Question 56

Are drugs a cheap or expensive option ?

Answer 56

Cheaper than CBT or family therapy

Question 57

Can drugs treat the root cause?

Answer 57

Drug therapy may only be suppressing symptoms and not treating the underlining problem

Question 58

How do drugs enhance the quality of life ?

Answer 58

The use of drugs has resulted in the end of long term institutionalisation in mental health hospitals

Question 59

What are the ethical issues surrounding drugs?

Answer 59

Often prescribed forcibly during peak disorder so ethical issues with consent and side effects

Question 60

Why are side effects a negative thing?

Answer 60

Due to the severity of side effects 2/3 of people stop taking them and results in the revolving door theory

Question 61

Define cognitive behavioural therapy and what si the therapist role ?

Answer 61

Assumes that sz is the result of dysfunctional thought process the therapist role is to challenge irrational beliefs this could be logically disputing the reality of the delusions

Question 62

How can u use Ellis abc model in sz?

Answer 62

A-activating event B-beliefs C-consequences D-disputing irrational belief E-restructured belief

Question 63

How does Sensky et al 2000 support CBT?

Answer 63

Showed that patients who had resisted drug treatments had a reduction in postitve and negative symptoms when treated by 19 sessions of CBT also they continued to improve even 9 months after the treatment had ended this suggests that CBT can be effective when drugs aren’t but also are an improvement on drug therapy as drugs are short term

Question 64

How can the length of CBT be a weakness?

Answer 64

Treatments end early due to length and it requires engagement, negative symptoms can lead to an unwillingness to take part in.

Question 65

How does CBT compare to drug therapy?

Answer 65

CBT doesn’t produce side effects but it a more costly plan

Question 66

Define psycho education?

Answer 66

The family is educated on the symptoms of sz in order for them to be more understanding of their family member

Question 67

How does family therapy help when dealing with sz?

Answer 67

It reduces conflict, reduces stress, reduces self sacrifice, improve communication, improve problem solving skills

Question 68

How does leff 1985 study support family therapy?

Answer 68

Looked at aftercare of patients with sz of those that were provided with standard outpatient care 50% had relapsed within 9 months compared to only 8% who received family therapy however after two years this had risen to 50% with family therapy and 75% with standard care this suggest that the use of family therapy is helpful in reducing re admission in the short term however families may not maintain postitve patterns of behaviour over the long term

Question 69

What are the practical issues with ft?

Answer 69

Length of therapy as patients may drop out and you need to get everyone at the same time

Question 70

Does ft cure the root cause?

Answer 70

Doesn’t cure the disorder but helps manage sz but symptoms still remain

Question 71

What is token economy ?

Answer 71

Behavioural therapy technique based on skinners operant conditioning this is learned through re enforcement of desired behaviour Tokens are used a type of positive reinforcement they are an immediate reward for when the patient shows pre defined target behaviour tokens are then exchanged for something else they want

Question 72

Evidence from Dickerson 2005 to support token economy?

Answer 72

Found when reviewing the findings of 13 studies token economies can be effective in improving the adaptive behaviour of people with sz

Question 73

Does token economy treat the root cause?

Answer 73

Doesn’t directly treat symptoms of sz they only attempt to manage negative symptoms

Question 74

Is token economy effective with everyone?

Answer 74

Not effective with unresponsive patients such as those with strong negative symptoms

Question 75

How is token economy ethically problematic?

Answer 75

Degrading to patients manipulating them like lab rats

Question 76

What is the internationalist approach?

Answer 76

Suggests that the development of sz is due to the combined effects and interaction of biological and social/psycholgical factors

Question 77

What is the diathesis stress model?

Answer 77

A psychological concept that a disorder is due to the interaction between a predisposed vulnerability and an environmental trigger later in life

Question 78

What are stressors in sz?

Answer 78

Later negative environmental experiences such as family dysfunction, emotional stress or a major negative life event drug abuse is also seen as a stressor

Question 79

How does gottensman 1991 research support the diathesis stress model?

Answer 79

Found a concordance rate of 48% for identical twins and 17% for non identical compared to the general population of 1% this suggests a role for both biological genetic factors as the concordance rate is much higher for identical twins who share 100% their dna but as the concordance rate is less than 100////5 for MZ twins this suggest there must be some psychological experience triggering in one twin but not the other

Question 80

How does tienari 2004 study support diathesis stress model?

Answer 80

Found that 5.8% of children adopted into psychologically healthy families developed sz compared to 36.8% of children raised in dysfunctional families this research supports the influence of biological factors due to high rate even in psychologically healthy families but the even higher figure for dysfunctional families suggests a psychological trigger is needed

Question 81

How does tarrier 1998 reaserch suport an interactionalist approach?

Answer 81

Patients were randomly allocated treatment with drugs only or drugs and CBT patients with combined treatment did better this suggests an interactionalist approach to treating sz is more effective than the usual treatment plan

Question 82

How is the interactionalist approach better than others?

Answer 82

It’s holistic and considers a range of factors unlike biological or psychological

Question 83

Is there enough evidence for diathesis stress model?

Answer 83

The fundamental mechanism by which a negative psychological event actually triggers a complex biological response resulting in symptoms is still uncertain reducing confidence in the interactionalist approach as a full explanation for sz