Schizophrenia Flashcards

Question

What did Gottesman find regarding genetic risk for schizophrenia?

Answer 1

Found - children with 2 SZ parents= 46% concordance rate -children with 1 SZ parent= 13% Therefore the greater the genetic compilation, the higher the risk of SZ

Answer 2

Found MZ twins = 40.4% concordance DZ twins = 7.4% concordance More recent studies have been more strict lowering concordance rates yet still show higher MZ concordance than DZ twins

Answer 3

164 adoptees with SZ mothers -> 6.7% ended up with SZ 197 adoptees with non-SZ mothers -> 2% ended up with SZ Therefore suggests a strong genetic bias

Answer 4

X Nature Nurture - children in family/ twin studies grow up in the same environment with SZ parents and therefore does not separate nature and nurture Therefore results are invalid X Selective Adoption - adoptive parents are made aware that their adoptive child has a SZ mother - they may treat the child in a different way (i.e treating them as a SZ) that leads to them becoming SZ X Higher rates than normal in adoption studies -the rates of adoptees with non-SZ mothers and having SZ is 20% higher than what would occur normally Therefore may suggest that becoming adopted may increase chances of becoming SZ

Answer 5

There is a relationship between schizophrenia symptoms and neural functioning.

Answer 6

Too much dopamine in certain areas of the brain causes positive symptoms of schizophrenia. SZs may have abnormally high Dz receptors resulting in more dopamine binding and therefore more neurons firing

Answer 7

e.g Amphetamine -stimulates nerve cells containing dopamine, causing synapse to be flooded with this neurotransmitter -non schizophrenic individuals exposed to a dopamine agonist can develop hallucinations and delusions like of a SZ episode

Answer 8

found that ppl with Parkinson (low dopamine) who took dopamine agonists have been found to develop SZ symptoms

Answer 9

-antipsychotic drugs that block the activity of dopamine in the brain -reduces activity in the neural pathways of the brain that use dopamine -these drugs eliminate symptoms such as hallucinations and dopamine The fact that these drugs alleviated many of the SZ symptoms strengthens the importance of the role of dopamine

Answer 10

-Revised Dopamine Hypothesis -positive symptoms = excess of dopamine in subcortical areas of brain -negative symptoms= deficit of dopamine in pre-frontal cortex

Answer 11

-evidence of revised dopamine hypothesis -used PET scans and found lower levels of dopamine in prefrontal cortex of SZs compared to control

Answer 12

✔Seeman -conducted post mortems on SZ patients -found double the density of D2 receptor sites X2 Patients are dead -also would have been taking anti-psychotics throughout their life which can increase the number of D2 receptor sites Therefore we may be viewing the effect of SZ not the cause x3 Seeman is supported by Wong -PET scans on live SZs with no history of taking anti-psychotics -60% to 110% denser D2 receptor sites Therefore supports D.Hypothesis whilst removing concerns of previous research X4 Wong's research has not been successfully replicated ✔Leucht's Meta-analysis -212 studies -all studies showed anti-psychotics were more effective at reducing positive symptoms than a placebo ✘Biological Reductionism -assumes dopamine is the sole cause of SZ Noll found numerous SZ with normal dopamine level -also found numerous non-SZs with elevated dopamine

Answer 13

-Animal study -depleted dopamine in prefrontal cortex of rats, leading to cognitive impairment (i.e negative symptoms) which could then be reversed using atypical antipsychotics Therefore suggests that dopamine in varying levels causes different levels of SZ

Answer 14

-help manage the most disturbing forms of psychotic illness -can help reduce symptoms, improve day to day functoning and increase subjective wellbeing -reduce action of dopamine in the brain

Answer 15

-antagonists; bind to but do not stimulate dopamine receptors Therefore blocking dopamine’s actions Therefore reduce positive symptoms such as delusions and hallucinations -these usually decreased within a few days of first taking the drugs; other symptoms may take several weeks to subside

Answer 16

-60% to 75% of D2 receptors in mesolimbic pathway must be blocked in order for it to be effective -blocks dopamine receptors in all areas of brain indiscriminately, leading to side effects

Answer 17

-lower risk of side effects, suitable for treatment-resistant patients and can help negative symptoms and cognitive impairment as well -also act on D2 receptors, but they ‘rapidly dissociate’ which helps to reduce side effects as they are messing with dopamine transmission less -less focused on blocking D2 receptors -have an affinity with serotonin receptors

Answer 18

✔Leucht et al - Effective -meta-analysis of 65 studies -patients stabilised with antipsychotics, then some were switched to a placebo -within a year, 64% of placebo group relapsed; only 27% of those who stayed on drugs Therefore significantly more effective than placebo ✘ Side effects -can include minor issues such as drowsiness or changes in weight -or more serious issues i.e depression -can also have Extrapyramidal side effects; impact on extrapyramidal area of brain responsible for motor activity. -over 50% of patients on drugs develop Parkinson's -prolonged use can lead to tardive dyskinesia; uncontrollable movements of tongue, face and jaw -around 30% of patients taking conventional antipsychotics for 7 years develop this; irreversible in 75% of cases but only 5% of atypical experience this -can lead to revolving door phenomenon Therefore have to weigh up costs and benefits of taking drugs ✘Ethics - can a person with a mental disorder give fully informed consent? -recently cases have been brought against doctors and pharmaceutical companies due to side effects; negative consequences are deemed to outweigh the benefits -a recent case saw a tardive dyskinesia sufferer given a large settlement Therefore there are issues over the wellbeing and rights of SZ patients to consider before applying drugs ✔Crossley - Atypical vs Typical -meta-analysis of 15 studies -found no significant difference between effectiveness on symptoms but noted different side-effects -typical led to more pyramidal side effects; atypical led to weight gain -fewer side effects in atypical drugs therefore patients are more likely to continue with treatment increasing effectiveness

Answer 19

SZs have dysfunctional thought processes which can lead to positive symptoms

Answer 20

-key characteristic in forming delusions= how far a person sees themselves as the central component of events (ego bias) -SZs have delusions because they jump to conclusions about external events irrelevant to them, relating them to themselves and coming to false conclusions -delusions are resistant to reality testing (attempting to show patients the truth and getting them to admit they are wrong) -this is because SZs have impaired insight inability

Answer 21

inability to recognise cognitive distortions and subsequently come to more logical conclusions of events

Answer 22

-SZs hear voices more because they pay excessive attention to auditory stimuli (hypervigilance) Therefore they expect to hear voices SZs that hallucinate=more likely to incorrectly attribute the source of an internal auditory experience to an external source as SZ's don't reality test as much as other ppl do, these errors are not corrected

Answer 23

SZs find it hard to distinguish between an inner representation of an idea and the actual sensory stimuli -what a person imagines they perceive overrides what is actually there e.g the expect ppl to speak negatively about them and this overrides what they actually say

Answer 24

confirming with others as the where an experience came from

Answer 25

claim that SZ is caused by abnormal patterns of communication within the family

Answer 26

Bateson et al -children who frequently receive contradictory messages from parents are likely to develop SZ -the child becomes confused by the contradiction in words and meaning so they cannot respond appropriately -this prevents them developing a coherent version of reality developing into SZ

Answer 27

✔Support from Berger -SZ patients reported higher levels of double bind statements at home -however this self-report may not be reliable as they are SZs ✘Lots of opposition -Liem found no difference in parental communication in SZ and non SZ families -however results may have been subject to demand characteristics ✘Hall and Lerin -studied data from various studies, finding no differences between families with and without as SZ member and the amount of double bind present

Answer 28

suggests that families where emotions - especially negative ones- are often expressed at a high level are more likely to lead to SZ -e.g criticisms, hostility, emotional over-involvement The emotions are beyond what the patient's coping mechanisms can cope with, causing stress to occur. Overloads already impaired coping mechanisms, triggering an episode

Answer 29

found that high EE relatives talk more and listen less

Answer 30

an SZ returning to a family with high SZ is 4X more likely to relapse than a patient whose family is low in EE

Answer 31

✘ Causality is an issue -can't explain all SZs; many patients in high EE families don't relapse; many patients in low EE families do relapse Altofer et al -1/4 of patients studied showed no physiological responses to high EE comments from relatives ✘Lebell et al -key factor is how patients interpret high EE comments, not whether they are present or not -if a patient does not interpret a high EE comment as negative or stressful, it won't affect them Has led to effective therapy; teaching family members to reduce the EE they show in order to support SZ patient better and reduce relapse rates (Hogarty et al)

Answer 32

Drug treatment often still leaves SZs with many residual symptoms- both positive and negative CBTp is designed to help SZs (once stable) learn how to manage these symptoms in order to cope everyday

Answer 33

-assumes SZs have distorted beliefs which can lead to maladaptive emotions and actions -aims to help SZs identify and correct these faulty thoughts -at least 16 sessions recommended (NICE) -teaches SZs to monitor their thoughts, feelings and behaviours with consideration to their symptoms -hope to allow patients to consider alternative ways of explaining why they feel and behave the way they do Therefore should reduce stress and improve functioning

Answer 34

Assessment Engagement ABC model Normalisation Critical Collaborative Analysis Developing Alternative Explanations

Answer 35

-patient expresses their thoughts about their experiences to the therapist -set realistic goals and use the patients current distress as reason to change

Answer 36

therapist emphasises with the patient's perspective and their feelings of distress and stresses that explanations for their distress can be developed together

Answer 37

patient explains their activating events, negative beliefs and consequences the patient's beliefs can then be rationalised and changed

Answer 38

being told that many ppl have unusual experiences e.g hallucinations and delusions patients feel less alienated and stigmatised

Answer 39

therapist uses gentle questioning to help patients understand delusions

Answer 40

patients develop their own alternative explanations for their previously unhealthy assumptions

Answer 41

✔Advantages of CBTp over standard care -NICE review of treatment for SZ found consistent evidence that compared to standard care CBTp was more effective in reducing rehospitalisation rates -CBTp also shown to be effective in reducing symptom severity and some evidence for improving social functioning However most studies have been conducted with patients also taking anti-psychotic medication Therefore difficult to assess effectiveness of CBTp independent of antipsychotic medication ✘Benefits may be overstated -Jauhar et al -revealed only a 'small' therapeutic effect on the key symptoms of SZ such as hallucinations and delusions However, even these small effects disappeared when symptoms were assessed blind -many studies into CBTp effectiveness appear to have similar design problems leading to conflicting recommendations of treatments even within the UK

Answer 42

a series of treatments aimed at reducing environmental stresses such as EE in order to prevent relapse, and to allow SZs to live a more normal life

Answer 43

-interventions aimed at the family of SZs -NICE recommends it be offered to all SZs who live with/have close contact with their family -important for those with high instances of relapse -focuses on reducing levels of EE -creates reasonable expectations -uses psychoeducation and improves family's problem solving abilities -SZ patient should be involved if possible; in case of suspicions and to form alliances -encourages listening and discussion -usually used in conjunction with drugs

Answer 44

-meta-analysis of 53 studies published between 2002 and 2010 -studies conducted in Europe, Asia and North America -compared outcomes from family therapies to 'standard' care alone Results; Mental state; overall mixed Compliance with medication; use of family therapy increased patient's compliance with medication Social Functioning; FT showed some improvement of general functioning but had little impact on concrete outcomes i.e living independently ir emloyment Reduction in relapse; FT led to a reduction in the risk of relapse and a reduction in hospital admission during treatment and in the 24 months after

Answer 45

✘Only effective due to increasing medication compliance -the reasons for improvements in mental state social functioning and relapse are more to do with the fact that increases medication compliance Therefore, patients are more likely to reap the benefits of medication because they’re more likely to comply with their medication regime ✘Studies have issues over effectiveness -Observer bias; those judging improvement weren’t blinded to conditions in 10 of Pharaoh’s studies; 60 more didn’t mention either way -large proportion of studies were from China, which has a habit of not using random allocation even when it says it has ✘May not be worthwhile Garety et al -Relapse levels in SZs in FT no higher than those SZZ who simply have a trained carer -these carers often low EE, suggesting FT may not be worth the time and money over simply having high quality standard care ✔Lobban- positive impact on family members + patients -60% of 50 students analysed reported positive impacts on families and their functioning Therefore a benefits the family, even if it doesn’t do much for the patient ✔Economic benefits -cost of FT is quickly offset by the long-term savings on hospital stays, as SZs tend to have fewer, less serious relapses after FT -This means they don’t need as much treatment in institutions, thus saving families and health services money in the long run

Schizophrenia Flashcards

(69 cards)