Schizophrenia 🧏‍♀️

Question 1

Diagnosing schizophrenia

Answer 1

DSM-V criteria -
two or more characteristic symptoms
Social dysfunction
At least six months
Bipolar and depression ruled out
Substance abuse ruled out

Question 2

Positive symptoms

Answer 2

An additional experience,

hallucinations (visual, auditory and olfactory )

Delusions ( paranoia, delusions of grandeur and delusions of reference)

Question 3

Negative symptoms

Answer 3

Reduction or loss of usual abilities,

Speech poverty

Avolition ( lack of interest, motivation or concern)

Question 4

Reliability

Answer 4

• Whaley, inter rater correlations for DSM-3 as low as 0.11
• Osorio et al, inter rater reliability of DSM-5 of 0.97 and test re test reliability of 0.92

Question 5

Validity

Answer 5

• Cheniaux et al, two psychiatrists, same 100 patients, ICD = 68, DSM = 39 diagnosed
• Osorio et al, excellent agreement between clinicians within DSM system

Question 6

Factors that impact reliability and validity of diagnosing schizophrenia

Answer 6

Co-morbidity
Gender bias
Culture bias
Symptom over lap

Question 7

Co morbidity

Answer 7

• Extent at which multiple conditions co occur
• Buckley et al 50% of patients have depression, 47% substance abuse and 23% OCD

Question 8

Symptom overlap

Answer 8

• symptoms may not be unique to the illness
• Ellason and Ross said people with DID have the most schizophrenic symptoms

Question 9

Gender bias

Answer 9

• Loring and Powell said 56% of doctors gave male diagnoses compared to 20% female
• Longnecker et al since 1980’s men have been more commonly diagnosed

Question 10

Culture bias

Answer 10

• Copeland 69% US psychiatrists diagnosed same patients compared to 2% British
• Luhrmann et al interviewed patients from Ghana India and US about hearing voices, patients from the US we’re more likely to report violent voices

Question 11

Genetic explanations for schizophrenia

Answer 11

• Gottesman, concordance rates of risk of developing schizophrenia, 48% MZ, 17% DZ and 9% siblings

Question 12

Adoption studies

Answer 12

• Tienari et al, 164 adoptees with biological schizophrenic mothers, 11(6.7%) also received a diagnosis compared to just. 2% of the 197 controls

Question 13

Candidate genes

Answer 13

Early research suggested on one schizogene but now it appears to be polygenic as Ripke et al found 108 separate genes

Question 14

The role of mutation

Answer 14

Mutation of genes can be caused by poison, radiation and viral infection. Brown et al found parental age increased risk of schizophrenia

Question 15

The original dopamine hypothesis

Answer 15

High levels of dopamine in the sub cortical areas (hyperdopaminergia)

Question 16

The updated dopamine hypothesis

Answer 16

Davis et al - low levels of dopamine in the cortex ( hypodopaminergia)

Question 17

Evaluations of biological explanations

Answer 17

Strength - research support
- gottesman
- tienari

Strength - dopamine research support
- leucht et al, meta analysis of 212 studies, antipsychotic drugs were more effective than placebos

Weakness - biological reductionism
- gottesman findings should be 100%

Question 18

Family dysfunction

Answer 18

• schizophrogenic mother
• double bind theory
• express emotion

Question 19

The schizophrogenic mother

Answer 19

• From-Reichmann, psychodynamic explanation, many patients spoke about a particular type of parent
• cold, rejecting, controlling, creates tension and secrecy which leads to distrust and paranoid delusions

Question 20

Double bind theory

Answer 20

• Bateson et al, role of communication in a family, child worries about doing the right thing, confusion due to contradictory messages, getting it wrong results in absence of love, child views the world as dangerous and confusing leading to disorganised thinking and paranoid delusions

Question 21

Expressed emotion

Answer 21

• level of negative emotion expressed from carer to patient
• verbal criticism, violence, hostility, anger, rejection and emotional over involvement
• serious source of stress and main cause of relapse
• can cause schizophrenia in already vulnerable people (diathesis stress model)

Question 22

Cognitive explanations

Answer 22

Dysfunctional thought processing
- reduced processing In Ventral striatum causes negative symptoms

• reduced processing in temporal and cingulate gyri causes positive symptoms

Question 23

Dysfunctional thought processes

Answer 23

Frith identified two types of

Meta representation

Central control

Question 24

Meta representation

Answer 24

Cognitive ability to reflect on thoughts and behaviour, if dysfunctional, disrupts our ability to recognise our own actions and behaviours as our own, explains auditory hallucinations and delusions

Question 25

Central control

Answer 25

Cognitive ability to suppress automatic responses while we perform deliberate actions If dysfunctional, cannot suppress automatic thoughts and speech (speech poverty) and people with schizophrenia tend to experience derailment of thoughts

Question 26

Evaluations of psychological explanations

Answer 26

STRENGTH- research support for family dysfunction - read et al, reviewed 46 studies of child abuse, 69% female, 59% male patients had a history of abuse - Tienari et al, adoption studies, children were more likely to develop schizophrenia if their adopted families were disturbed STRENGTH-research support for cognitive - Stirling et al, compared 30 patients with 18 non patients with strip test, patients took over twice as long - Jauhar et al, reviewed 34 studies of CBT, had a significant effect on both positive and negative symptoms WEAKNESS- weak evidence for family dysfunction and blamed parents WEAKNESS- direction of causality with cognitive explanations is unclear

Question 27

Typical antipsychotics

Answer 27

Chlorpromazine, 1950s, blocks dopamine receptors, causes movement problems it by skin weight gain and dizziness

Question 28

Atypical antipsychotics

Answer 28

Clozapine, 1960s, involves serotonin dopamine and glutamate, causes blood clotting Risperidone, 1990s, involves dopamine and serotonin and causes movement problems and dizziness

Question 29

Evaluations of drug therapies

Answer 29

Strength - research support, Leucht et al analysed them and placebos, they were more effected and caused less relapse Weakness - serious side effects Weakness - biological reductionism, Ross and Reid argues that it stops people from looking into environmental stressors

Question 30

Psychological treatments (CBT)

Answer 30

5-20 sessions Argument or discussion Find problem and how to get over it together

Question 31

Psychological treatments (family therapy)

Answer 31

Improve communication between family members Reduction of anger and guilt Striking a balance between caring and having a life Burbachs model - sharing basic information, identifying what members can offer, encourage mutual understanding, identify unhelpful patterns, skills training, relapse prevention planning, maintenance

Question 32

Evaluations of psychological therapies

Answer 32

Strength of CBT - Jauhuar et al reviewed 34 studies, clear evidence for small but significant effectiveness on positive and negative symptoms Weakness of CBT - techniques vary widely Thomas points out different studies involve different uses. Hard to say how effective it is on individual cases Strength of family therapy- effectiveness, McFarlane concluded it was one of the most effective treatments relapse rates reduced 50-60% Weakness - treatments don’t cure, they help with sense and aim but not curing the biological disease

Question 33

Token economies (management of schizophrenia)

Answer 33

Reward systems that manage behaviour of people who have gained maladaptive behaviours Tokens - eg coloured disks, immediate reward Reward - tokens exchanges for tangible rewards

Question 34

Evaluations of management (token economies)

Answer 34

Strength - effectiveness, Glowacki et al identified seven studies that examined the efdectiveness of Roman economies, reduction in negative symptoms and poor behaviour Weakness. - ethical issues, gives people power to control others behaviours, imposing norms Weakness - alternative approaches - Chiang et al said art therapy can be effective less side effects or ethical abuse

Question 35

Interactionist approach

Answer 35

Distress stress model Schizophrenia is caused by biology interacting with the stress from the environment vulnerability and stress trigger are needed

Question 36

Examples of diathesis stress model

Answer 36

Diathesis - Gottesman 48% mz twin concordance rates and 17% dz Stress - read et al child abuse and schizophrenia , 69% female and 59% male had history of abuse

Question 37

Meehl’s model

Answer 37

Original distress stress model, one schizogene diathesis was completely genetic, led to development of schiotypic personality, if one lacks biology no amount of stress can cause schizophrenia

Question 38

Modern understanding of diathesis

Answer 38

Ripke et al - 108 genes not one Psychological trauma can be a diathesis Read ET al early trauma changes the brain making someone more vulnerable to stress

Question 39

The modern understanding of stress

Answer 39

Houston et al - stress includes anything that may be a trigger not just focusing on parenting Cannabis is a stressor as it makes you seven times more vulnerable

Question 40

Treatment according to the interactionist model

Answer 40

Combination of antipsychotics and CBT

Question 41

Evaluations of the interactionist approach

Answer 41

Strength - evidence, Tienari, genetic venerability and parenting style of adoptees with schizo bio mums, the children with bio mothers with the child rearing style ( criticism and conflict) had increased vulnerability to schizo Weakness - original model is overly simplistic, multiple genes (Ripke), stress can come from anything Houston. Support for combination treatment, Tarrier, antipsychotics and CBT, drugs and counselling or just drugs. Patients in combination groups showed less symptoms.

Question 42

Pharoah et al family therapy

Answer 42

Alliance Help with care Reduce anger and guilt Balance life with care Educate and beliefs