schizophrenia Flashcards
(97 cards)
1
Q
what is schizophrenia?
A
a psychotic thought disorder, where sufferers have have impaired insight of reality
a split between mind and emotion
2
Q
what is prevalence in reference to schizophrenia?
A
refers to how common schizophrenia is amongst the general population
3
Q
what is the prevalence of schizophrenia?
A
- affects around 0.3-0.7% of the population
- equally common in men and women
4
Q
what is the most common age of diagnosis of schizophrenia for men and women?
A
- men = mid 20s
- women = early 30s
5
Q
what does prognosis mean in reference to schizophrenia?
A
refers to the expected outcome of schizophrenia, in terms of recovery
6
Q
what are the prognoses’ of schizophrenia?
A
- 40% make a full recovery from positive symptoms
- 20% make a full recovery
- 40% suffer for the rest of their lives
- have a 5-10% chance of dying by suicide (2.5% higher then gen pop)
7
Q
what does the term positive symptoms mean?
A
the presence of abnormal functions in an individual with schizophrenia
8
Q
what are the positive symptoms of schizophrenia?
A
- hallucinations
- delusions
- disorganised thinking and/or speech
9
Q
define the hallucination symptom of schizophrenia
A
- positive symptom
- false sensations with no identifiable source
- auditory and visual are the most common
- tactile (touch) and olfactory (smell) are less common
10
Q
define the delusions symptom of schizophrenia
A
- positive symptom
- false beliefs based on no facts or evidence
- persecution (spied on)
- grandeur
- control (thoughts and actions are being controlled
11
Q
define the disorganised speech and thinking symptom of schizophrenia
A
- positive symptom
- poor concentration ability
- thoughts drift with no connections between them
- hazy and misty thoughts
- trouble focusing on an activity e.g. reading or watching tv
- jumbled and confusing speech (word salad)
12
Q
what is meant by the term negative symptom?
A
the loss and/or absence of normal functioning
13
Q
what are the negative symptoms of schizophrenia?
A
- speech poverty (alogia)
- lack of emotion (flat affect)
- social withdrawal (avolition)
- apathy
- inappropriate affect)
14
Q
define the speech poverty symptom of schizophrenia
A
- negative symptom
- reduced communication
- short and empty replies
- difficulty starting conversations
15
Q
define the flat affect symptom of schizophrenia
A
- negative symptom
- reduction in range and intensity of emotions
- reduction in range of facial expressions, tones of voice and eye contact
- body language that is hard to read
16
Q
define the avolition symptom of schizophrenia
A
- negative symptom
- lack of motivation
- reduced hygiene and cleaning of home
- low sex drive
17
Q
define the apathy symptom of schizophrenia
A
- difficulty in planning and goal setting
- disinterest in socialising and hobbies
- doesnt want to do anything
18
Q
define the inappropriate affect symptom of schizophrenia
A
- displaying unsuitable emotions for the situations they are in
- inability to express emotions in an expected way
19
Q
what is the criteria for a schizophrenia diagnosis?
A
- characteristic symptoms
- social/occupational dysfunction
- duration
- schizoaffective and mood disorder exclusion
- exclusion of known organic causes
- relationship to autistic spectrum
20
Q
what is the description of the “characteristic symptoms” criteria for diagnosing schizophrenia?
A
two or more for at least a month;
- delusions
- hallucinations
- disorganised speech
- grossly disorganised or catatonic
- any negative symptoms
21
Q
what is the description of the “social or occupational dysfunction” criteria for diagnosing schizophrenia?
A
- functioning in work or social life is below level achieved prior to disturbance
- must be for a significant portion of time
22
Q
what is the description of the “duration” criteria for diagnosing schizophrenia?
A
- prolonged and continued signs of disturbance
- continue for over 6 months
- combined with at least 1 month of symptoms from the characteristic catagory
23
Q
what is the description of the “schizoaffective and mood disorder exclusion” criteria for diagnosing schizophrenia?
A
- only diagnosed with schizophrenia if schizophrenia affective and mood disorders ruled out
- patient not experienced any depressive manic episodes at same time as characteristic symptoms
24
Q
what is the description of the “exclusion of known organic causes” criteria for diagnosing schizophrenia?
A
- affects not due to physiological or psychological effects of a substance or other medical condition
25
what is classification and why is it helpful?
- identifying groups and patterns of behavioural, emotional, physical and motivational symptoms that occur together to form a mental disorder
- can help with treatment, identification of cause and prognosis
26
what is reliability in terms of schizophrenia?
the consistency of the diagnosis
27
what is validity in terms of schizophrenia?
the accuracy of the diagnosis including cultural and gender bias
28
what are some negative implications of a schizophrenia diagnosis?
- stigma
- discrimination
- biased or wrong diagnoses
29
what are the two variables that affect a reliable schizophrenia diagnosis?
- inter rater reliability
- test retest reliability
30
what is inter-rater reliability in terms of schizophrenia diagnosis?
- occurs when clinicians make identical, independent diagnosis of the same patient
- want 80% agreement
31
what did Beck et al find about the inter-rater reliability for schizophrenia?
- when a group of 153 patients were assesses by 2 different psychiatrists the IRR was only 54%
- low IRR for schizophrenia
32
what could influence the Inter-rater reliability of a diagnosis?
- the culture of the clinicians
- causes biases
33
what is Copelands study and what does it say about inter-rater reliability for schizophrenia diagnosis?
- described a patient to 134 us and 194 british psychiatrists
- 69% US diagnosed schizophrenia
- 2% British diagnosed schizophrenia
- calls into question the reliability
34
what is test-retest reliability in relation to schizophrenia?
when the same clinician makes the same diagnosis of the same patient on separate occasions with the same information
35
what is wrong with test-retest reliability?
it doesnt take into account natural progression of the patient
36
what is some research that refutes the reliability of diagnosing for schizophrenia?
- Read;
test retest analysis is as low as 37%, especially when considering false positives
incorrect diagnoses may be made
- Copeland;
- 69% vs 2% IRR between US and British psychiatrists
37
what is comorbidity and how does it affect the validity of schizophrenia diagnoses?
- refers to when more than one disorder exists at the same time as a primary disorder
- when two things are commonly diagnosed together it questions the validity of the classification of both disorders
- lowers validity of SZ diagnosis
38
what are some disorders that have high comorbidity rates with schizophrenia?
Buckley (2009);
- SZ and depression: 50%
- SZ and PTSD: 29%
- SZ and OCD: 23%
- SZ and substance abuse: 47%
39
what is overlapping symptoms in reference to schizophrenia and how does it affect the validity of the schizophrenia diagnosis?
- no symptoms of SZ are exclusive to SZ
- lowers validity massively
40
what are some disorders that have overlapping symptoms with schizophrenia?
Read et al (2011)
- delusions: SZ and bipolar
- hallucinations: SZ and PTSD
- attention difficulties: SZ and ADHD
- avolition: SZ and depression
41
what is symptom heterogeneity?
- where symptoms of a disorder vary greatly across different patients
- schizophrenia has symptom heterogeneity
42
what is aetiological heterogeneity?
- where cases of the same disorder are caused by different things
- SZ has this
43
what is some research that supports the fact that comorbidity lowers validity of SZ diagnosis?
Buckley et al;
50% of SZ also had depression, 47% suffered from substance abuse and 23% had OCD
hard to judge which part of the disorder is SZ or what is a separate disorder entirely
some clinicians may judge different symptoms differently so diagnose differently
44
what is some research that supports overlapping symptoms reduces validity of schizophrenia diagnoses?
Konstantareas and Hewitt:
- compared symptoms of 52 SZ patients with autistic patients
- not all SZ patients had autistic symptoms but 50% of autistic patients had SZ symptoms
- could lead to misdiagnosis or mistreatment of symptoms
- treatments that dont really target SZ
45
what is some research that shows culture bias in diagnosis of schizophrenia?
- copeland:
2% vs 69%
- cochrane:
the incidence of SZ in the west indies and britain is similiae
afro caribbean men in britain are more likely to be diagnosed with SZ then in the west indies
- Malgadys:
in traditional Costa Rican cultures hearing voices is seen as spiritual, whereas in UK and US its a main symptom of SZ
46
what are the three parts of gender bias in Schizophrenia?
- unreported facts when diagnosing in men and women ( men have more -)
- biassed research
- under diagnosing of females
47
what are the four main parts of culture bias in schizophrenia?
- cultural interpretations affect diagnosis
- negative cultural attitudes towards schizophrenia
- culture/ nationality of clinician effecting diagnosis
- race discrimination
48
what is some research that shows gender bias in schizophrenia diagnosis?
- cotton:
implies women recover more and suffer less relapses than men do, if this ignored women may not be treated in the optimum way or treatment being continued when not necessary
- Nasser:
early research on SZ was only conducted on men, treatment plans may not be suitable fir women
- Loring and Powell:
290 male and female psychiatrists asked to read a case study, when no gender was given 56% of psychiatrists diagnosed SZ, when described as female only 20% diagnosed
49
what are the three biological explanations of schizophrenia?
- genetic inheritance
- dopamine hypothesis
- neural correlates
50
briefly explain the genetic inheritance explanation of schizophrenia
- some people may have a genetic predisposition
- runs through faulty genes
- up to 108 genetic variants involved (Ripke)
- chromosome 8 , 11 and the C4 gene
- faulty genes increase a persons vulnerability to developing SZ by inheriting biochemical imbalances or brain structure abnormalities
51
how is the faulty C4 gene implicated in the presence of schizophrenia?
- C4 gene involved in immune function and synaptic pruning
- if there is too much C4 activity there is an increased chance of SZ
- too much synaptic pruning so needed synapses are lost
- research by Sekar
52
what did Gottesman and Shields find and what explanation does it support?
- supports biological explanations for SZ
- twin studies
- DZ(fraternal) twins have a 17% risk of developing schizophrenia if their other twin has developed it
- MZ (identical) twins have 48%
- genetics must play at least some role
53
what is the advantage of adoption studies over twin or family studies?
shows impact of genetics without household environment
54
what did Tienari et al find in their adoption studies?
- 164 finish kids who had mothers with a history of SZ
- all kids adopted by healthy functional families
- found children with SZ parents still had a 10x greater chance of developing schizophrenia than the children of the parents without the disorder
55
what is did the first dopamine hypothesis propose?
- schizophrenics have too many D2 receptors in their brain
- too much dopamine taken up
- causes delusions and hallucinations
56
what is some research that supports dopamine playing a role in schizophrenia?
- Randrup:
amphetamines to rats to increase dopamine
rats exhibited schizophrenic behaviours
57
why did the dopamine hypothesis get revised?
- davis et al pointed out that the PFC has no D2 receptors and there appears to be a deficiency in dopamine in these areas
58
what is the revised dopamine hypothesis?
- schizophrenics experience hypo-dopamingeria and hyper-dopaminergia
- hypo;
low levels of dopamine in the mesocortical pathway and causes negative symptoms
- hyper;
along reward pathways, ventral tegmental area to nucleus accumbens, causes positive symptoms
59
where does hypo-dopaminergia occur?
mesocortical pathway
60
where does hyper-dopaminergia occur?
-ventral tegmental area to nucleus accumbens
-reward pathway
61
what did Farde et al find about levels of dopamine to schizophrenia?
- no real difference between dopamine levels in SZ and in healthy individuals in 1990
62
briefly explain the neural correlates explanation for schizophrenia, and what are the three neural correlates?
- neuroanatomical issues influence schizophrenia
- enlarged ventricles
- hypofrontality
- hippocampul-amygdala region
63
explain the enlarged ventricles explanation for schizophrenia
- ventricles are cerebrospinal fluid filled sacs
- people with SZ have 15% larger ventricles
- SZ brains are lighter and have a lower vol of grey matter
- cognitive decline and negative symptoms
64
what is the issue of the enlarged ventricles explanation for schizophrenia?
- unsure if it is a cause or effect
- isnt looked at before SZ is developed so hard to tell if SZ causes decreased brain matter or decreased brain matter causes SZ
65
describe the hypofrontality explanation for schizophrenia
- state of decreased cerebral blood flow to PFC
- underactivation of dorsolateral PFC
- decreased cognitive activation
- negative symptoms and memory function decreased
66
describe the hippocampul-amygdala region explanation for schizophrenia
- hippocampus and amygdala decrease in size
- flat effect and negative symptoms
67
what are the two psychological explanations of schizophrenia?
- family dysfunction
- cognitive explanation: dysfunctional thought processing
68
what a dysfunctional family?
a family that doesnt have beneficial relationships with eachother
69
what are the three sections of the family dysfunction explanation for schizophrenia?
- schizophrenogenic mother
- double bind hypothesis
- High expressed emotions
70
what are traits of the schizophrenogenic mother and how was it theorised to cause schizophrenia?
- mother lacks necessary emotional warmth
- over protective, insensitive, rigid, rejecting, scared of intimacy
- faulty communication between M and C
- builds stress, paranoid delusions ect
71
explain the double bind hypothesis
- when a child is in a contradictory situation
- causes disorganised thinking, paranoid delusions, learned hopelessness
72
explain high expressed emotions in relation to schizophrenia
- families reactions to patients become hostile, critical and intolerant
- think they are helping with this attitude but they are not
- criticise all behaviours
- 4x more likely to cause relapse
- 13% normally, 51 with HEE from vaughn
73
what is family schism?
- when fathers may form rivalling factions with mothers
- use children as a way to compete with other parents
74
what is family skew?
where one parent, often the mother, dominates the household
75
what is some research support for psychological explanations of schizophrenia?
- Berger;
found that schizophrenia reported and recalled a higher number of double bind situations from their childhood than “healthy” people
- vaughn;
found schizophrenics with highly expressed emotional families were 4x more likely to relapse
76
what is the basic premise of the cognitive explanation for schizophrenia?
- schizophrenia caused by faulty thought processing
- problems with meta representation; ability to reflect upon behaviours, thoughts and feelings
77
what are three factors that contribute to family dysfunction?
- high levels of interpersonal conflict
- poor communication or difficulty communicating
- over criticising or controlling children
78
what are the three sections of the cognitive explanations for schizophrenia?
- dysfunction in the central monitoring system
- dysfunction in the supervisory attention system
- dysfunction within insight/ egocentric bias
79
what the central monitoring system usually do in healthy people?
processes thoughts and actions as being done “by me” and “mine”
80
how could dysfunction within the central monitoring system cause or contribute to schizophrenia?
- could cause positive symptoms like delusions or hallucinations
- miss-attribution errors of assigning our inner thoughts and monologues to external sources
81
how could dysfunction within the supervisory attention system cause or contribute to schizophrenia?
- can affect activeness and self initiated actions when faulty
- not responding to stimuli, or responding inappropriately
- speech poverty ect
82
how can dysfunctions within insight/ ego centric bias contribute to schizophrenia?
- typically healthy people can recognise they are not at the centre of all actions all the time
- schizophrenic people can have egocentric bias, where they believe everything relates to them all the time
- makes them resistant to believing otherwise
- causes delusions of grandeur
83
what are meta cognitions?
- how people monitor their thought process
- dysfunctional in schizophrenics
84
what are cognitive biases?
- cognitive things that are wrong
- delusions, selective attention hallucinations
85
what is a research problem with the cognitive explanation for schizophrenia?
- relies on self report
- bias
- participants may want to give socially acceptable answers
86
what is beck and rectors research that supports the cognitive explanation for schizophrenia?
- holistic theory
- structural problems in the brain which lead to vulnerability to stress and faulty cognitions
- stress causes cognitive impairments
87
what are the two biological treatments for schizophrenia?
- typical antipsychotics
- atypical antipsychotics
88
what is the aim if antipsychotics?
- to reduce and stabilise the amount of dopamine the 4 key dopamine pathways to alleviate symptoms of schizophrenia
89
what is a typical antipsychotic?
- chlorpromazine
90
what is the action and half life of chlorpromazine?
- half life is 30 hours
- antagonise dopamine systems by blocking the receptor sites on post synaptic neurone
- less dopamine taken up
- reduce positive symptoms
91
what are the side effects of chlorpromazine?
- extrapyramidal symptoms; tremors, muscle stiffness and random movement
- drowsiness
- weight gain
- sedation
- dry mouth
- constipation
- dizziness
92
what is an atypical antipsychotic?
clozapine
93
what is the half life, aim and action of clozapine?
- half life is 6-26 hours
- aim is to block dopamine sites
- action; regulate functioning of D2 receptors and serotonin receptors (5-HTZ) in several areaa
94
what are some side effects of clozapine?
- weight gain
- hyperlipidemia
- diabetes
- hyper salivation
95
describe the “hit and run” action if atypical antipsychotics
- in the mesolimbic dopamine pathway
- this sensory pathway is involved in the regulation of emotions and pleasure
- reducing dopamine activity here decreases positive symptoms
- uses a rapid dissociation technique so antipsychotics have their effect then quickly leave receptor sites so normal dopamine can be absorbed
- can reduce some side effects
96
describe the action of antipsychotics in the nigrostritial dopamine pathway
- this pathway involved in movement and includes dopamine and serotonin
- serotonin stimulates dopamine release
- APs block serotonin receptors whilst also stimulating a natural normal release of dopamine
- tackles negative symptoms
97
what is davis et als research which supports the biological treatments for schizophrenia?
- meta analysis of over 100 studies
- compared typical antipsychotics to placebos
- APs more effective
- 75% improving conditions in 6 weeks vs 25% with placebo
- shows true effectiveness
