Schizophrenia Flashcards
(84 cards)
1
Q
What is schizophrenia?
A
A type of psychosis, a severe mental disorder in which thoughts and emotions are so impaired that contact is lost with external reality.
2
Q
What are positive symptoms?
A
Symptoms which reflect an excess or distortion of normal functioning.
3
Q
What are negative symptoms?
A
Symptoms which reflect a loss of normal functioning.
4
Q
What are 2 positive symptoms of schizophrenia?
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Hallucinations and delusions.
5
Q
What are 2 negative symptoms of schizophrenia?
A
Speech poverty and avolition.
6
Q
What are hallucinations?
A
Sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are there but seem true to the individual
7
Q
What are delusions?
A
Erroneous beliefs that hold no basis in reality.
8
Q
What is speech poverty?
A
The lessening of speech fluency and productivity, which reflects slowing or blocked thoughts.
9
Q
What is avolition?
A
Loss of motivation to carry out goal directed behaviour and tasks, resulting in lowered activity levels.
10
Q
What did Andreason (1982) identity as signs of avolition?
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Poor hygiene and grooming, lack of persistence in work or education, lack of energy.
11
Q
What are delusions of grandeur?
A
A false impression of one’s own importance.
12
Q
What is reliability in terms of schitzophrenia?
A
Ensuring there is consistency in the diagnosis and classification of schizophrenia by different psychiatrists across times and cultures
13
Q
What is validity in terms of schizophrenia?
A
Ensuring the patient is recieving a correct diagnosis and that schizophrenia has been correctly classified.
14
Q
What are two factors which brings into question the reliability of diagnosing schizophrenia?
A
- Cultural differences 2. Inter-rater reliability.
15
Q
What are 3 factors which bring into question the validity of diagnosing schizophrenia?
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- Symptom overlap 2. Co-morbidity 3. Gender bias.
16
Q
What is co-morbidity, why does it reduce validity of diagnosis and example study?
A
The extent that two (or more) conditions or diseases occur simultaneously in a patient.
If found commonly alongside another disorder, it may not be a separate condition.
Buckley et al. (2009) found 50% people diagnosed with schizophrenia also have depression
E.g. a patient having both schizophrenia and depression.
17
Q
What is symptom overlap, why does it reduce validity of diagnosis and example study?
A
Symptoms of a disorder may not be unique to that disorder but may also be found in other disorders,.
Makes accurate diagnosis difficult.
Ellason et al (1995) Claimed DID has more schizophrenic symptoms than people with schizophrenia
18
Q
How do cultural differences affect reliability of diagnosing schizophrenia?
A
Some positive symptoms such as hearing voices is seen as acceptable in African cultures. Within these cultures the person would not receive a diagnosis whereas in the UK which in a Western culture this is seen as bizzare and they are more likely to be diagnosed. Colchrane et al (1977) found people of Afro-Caribbean origin are 7 times more likely to be diagnosed with Schizophrenia when they are in the UK
19
Q
What is inter-rater reliability in relation to the diagnosis of mental health disorders, example?
A
The extent to which different clinicians arrive at the same diagnosis for the same patients.
Cheniaux et Al. 2009 - 2 psychiatrists independently diagnosed 100 patients using both DSM and ICD manuals.
20
Q
What is gender bias in terms of schizophrenia, why and study
A
Accuracy of diagnosis is dependent on the gender of the individual
Males are more likely to be diagnosed than females as females appear to function better- means schizophrenia could be unrecognised in females.
Loring and Powell (1988) selected 290 psychiatrists to read 2 case studies of patients behavior. When patients were described as male 56% of psychiatrists diagnosed them with schizophrenia versus 20% when described as a female.
21
Q
What are 2 biological explanations for schizophrenia? One broken into 3 more explanations
A
Genetic factors
Neural correlates - dopamine hypothesis, reduced activity in ventral striatum and enlarged ventricles
22
Q
What are genetic factors?
A
Inherited factors make certain individuals more likely to develop a behaviour or mental disorder.
23
Q
What evidence shows supports for genetic influences?
A
Gottesman (1991)- Carried out a large scale family study to investigate the genetic influence of schizophrenia.
The more genetically similar you are to a family member, the higher the shared risk of schizophrenia.
Identical twins - 48%, Fraternal twins -17%, Nieces and Nephews 4%
24
Q
What are neural correlates?
A
Changes in neuronal events and mechanisms that result in the characteristic symptoms of a behaviour or mental disorder.
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What is the dopamine hypothesis?
Claims that an excess of the neurotransmitter dopamine in certain regions of the brain is associated with the positive symptoms of schizophrenia and lack of dopamine with negative symptoms.
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What is hyperdopaminergia?
Excessive levels of dopamine in the subcortex and Borca’s area leading to positive symptoms
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What is hypodopaminergia?
Low levels of dopamine in the prefrontal cortex leading to negative symptoms
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Explain the two other changes in the brain linked to symptoms of schizophrenia?
1. Reduced activity in the ventral striatum (reward system)- Link found between avolition and ventral striatum. This region in the brain is crucial in the anticipation of reward.
2. Enlarged ventricles- linked to negative symptoms. Ventricles are fluid filled cavities that supply nutrients and remove waste. These have found to be 15% bigger in those with schizophrenia.
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2 Strengths of genetic explanations for schizophrenia (1 COUNTER)
Evidence for genetic susceptibility:
Gottesman 1991 - twins MZ - 48%, DZ - 17%
COUNTER - Equal environment assumption. MZ twins treated more similarly than DZ twins. Could be environmental differences.
Role of mutation:
Mutation in parental DNA can explain how schizophrenia takes place in absence of family history of the disorder. Brown et al (2002) found a positive correlation between parental age (associated with increased risk of sperm mutation) and risk of schizophrenia increasing from about 0.7% with fathers under 25, to over 2% in fathers over 50. Also highlights the genetic influence on schizophrenia
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2 Strengths of neural correlates (2 counter limitations)
Evidence from brain scanning research
Juckel et al. (2006)- measured activity levels in the ventral striatum in schizophrenics and found lower levels of activity than those observed in controls.
COUNTER - Does not show a causal relationships. It may be that the negative symptoms themselves have resulted in less info passing through the ventral striatum resulting in reduced activity, rather than the reduced activity causing the negative symptoms.
Evidence for dopamine hypothesis from drugs:
There has been successful drug treatment for schizophrenics which attempt to change levels of dopamine activity in the brain.
1. Drugs that increase dopaminergic activity: - Amphetamines are dopamine agonists and increase levels of dopamine. ‘Normal’ individuals exposed to amphetamines can develop characteristic symptoms of a schizophrenic episode, which disappear when they stop taking drug.
2. Drugs that decrease dopaminergic activity: - Antipsychotic drugs- block activity of dopamine and so eliminate symptoms such as hallucinations and delusions.
COUNTER - Noll (2009) found that psychotic drugs do not alleviate hallucinations and delusions in about one third of people. In addition, in some people, hallucinations and delusions are present despite levels of dopamine being normal.
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What are 2 psychological explanations for schizophrenia?
1. Family dysfunction 2. Cognitive explanation.
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What is family dysfunction?
People are more at risk of developing schizophrenia if they have experienced abnormal processes within their family environment such as conflict, communications and control
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What are three risk factors within the family which could trigger schizophrenia?
1. Double bind theory
2. The schizophrenogenic mother
3. Expressed emotion
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Who developed schizophrenic mother theory, why? How does this lead to schizophrenia?
Fromm-Reichman (1948) found many of her patients who had schizophrenia spoke of a particular type of parent. Cold, rejecting and controlling creates a family climate of tensions and secrecy. This can result in distrust which could then lead to paranoid delusions.
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What is the double bind theory?
Children are given conflicting messages from parents e.g. mother telling son she loves him and turning away in disgust= confusion in child.
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How can the double-bind theory lead to schizophrenia?
Mixed messages prevent development of internally coherent construction of reality and create confusion. This confusion can lead to disorganised thinking and this can manifest in psychotic symptoms and a loss of contact with reality.
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What is expressed emotion and how is it linked to schizophrenia?
Family communication style in which high levels of negative emotions are expressed including verbal criticisms and sometimes violence, leading to hostile climate. This has been found to result in higher relapse rates.
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What is the cognitive explanation for schizophrenia?
Proposes that abnormalities in a person’s thought processes (dysfunctional thought processing) are a key component of schizophrenia.
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What are two kinds of dysfunctional thought processing and which symptoms do they cause?
1. Dysfunction in meta-representation= hallucinations and delusions
2. Dysfunction in central control= disorganised speech.
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What is central control and how does dysfunction in our central control lead to schizophrenic symptoms??
The cognitive ability to suppress automatic responses whilst we perform deliberate actions.
Inability to suppress automatic thoughts and speech triggered by other thoughts and replace them with deliberate thoughts causes disorganised speech and thought disorder.
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What is meta representation and how does the dysfunction in this lead to schizophrenic symptoms?
Cognitive ability to reflect on thoughts and behaviour and allow us insight into our own intentions and interpret actions of others.
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2 Strengths of cognitive explanations for schizophrenia
Evidence for dysfunctional information processing:
Stirling et al. (2006)- compared patients with a diagnosis of schizophrenia with non-patient controls on a range of cognitive tasks, including the Stroop Test. Participants must name the ink colours of coloured words, suppressing the impulse to read the words. They found that patients took over twice as long to name the ink colours as the control group.
This supports the idea that people with schizophrenia have a dysfunction in their central control.
Support from success of cognitive therapies:
The effectiveness of cognitive behavioural therapy (CBTp) has been demonstrated in the National Institute for Health and Care Excellence (NICE) review of treatments for schizophrenia. This review found consistent evidence that, when compared with treatment by antipsychotic medication, CBT was more effective in reducing symptom severity and improving levels of social functioning.
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2 Limitations of cognitive explanations for schizophrenia
Causation-correlation issue:
Could be that cognitive dysfunctions are a result of schizophrenia, not a cause.
Environmentally reductionist:
Ignores biological factors which have been supported by research. - Ripke et al. (2014) studied the genetic makeup of 37,000 patients and found 108 seperate variations of base pairs associated with increased risk of schizophrenia. They found these coded for the functioning of dopamine.
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2 Strengths (1 COUNTER) for family dysfunction explanations for schizophrenia
Research support:
Read et al. (2005)- reviewed 46 studies of child abuse and schizophrenia. Found that 69% of adult women and 59% of male in-patients with schizophrenia had a history of physical abuse, sexual abuse or both.
COUNTER: Information about childhood experiences was gathered after the development of symptoms and the schizophrenia may have distorted patients’ recall of childhood experiences. Brings into question the validity of the results.
Practical application:
Has allowed for the creation of family therapies which have been effective in the treatment of schizophrenia. Pharoeh et al. (2010) - Carried out a metanalysis on the effectiveness of family therapies and found it significantly reduced hospital readmissions after a year, quality of life for patients and their carers versus standard care.
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2 Limitations for family dysfunction explanations for schizophrenia
Socially sensitive:
The idea that family dysfunction can be causing the development of schizophrenia can lead to parent-blaming. Mothers seem to be particularly blamed (schizophrenogenic mother). This places an unfair burden on the mother especially after having to watch their child experience schizophrenic symptoms and take responsibility for their care- to be blamed on top of this could cause significant distress.
Lacks support:
Fromm-Reichman’s theories are based on observations and informal assessments of patients’ mothers’ personalities, but not systematic evidence.
Double-bind and expressed emotion unconvincing, in fact patterns of parental communication in families with a schizophrenic child have been measure by researchers who found no difference when compared to normal families.
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What are antipsychotics?
Drugs used to reduce the intensity of positive symptoms of psychotic conditions.
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What are the two types of antipsychotics?
Typical and atypical.
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What are typical antipsychotics?
The first generation of antipsychotic drugs. They target dopamine reducing the positive symptoms of schizophrenia.
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What are atypical antipsychotics?
The second generation of antipsychotic drugs. They target dopamine and serotonin, reducing positive and negative symptoms of schizophrenia.
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How do typical antipsychotic drugs work?
They act as dopamine antagonists in that they bind to dopamine receptors at the postsynaptic neuron and block the action of dopamine.
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How do atypical antipsychotic drugs work?
Also act as dopamine antagonists, but they also block the action of serotonin.
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What is an example of a typical antipsychotic and max dose?
Chlorpromazine. Max 1000mg a day
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What are 2 examples of an atypical antipsychotic and max doses?
Clozapine and Risperidone. Max 450mg a day
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Which type of antipsychotic causes severe side effects and examples
Typical antipsychotics.
Dizziness, restlessness, sedation.
Movement problems that resemble Parkinsons. Symptoms begin gradually, sometimes with a barely noticeable tremor in the hand.
LT use can result in Tardive Dyskinesia. This is a condition where your face or body makes sudden irregular movements you cannot control.
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Why are there less side effects with atypical antipsychotics?
Typical antipsychotics bind more tightly than dopamine itself to the dopamine D2 receptor, with dissociation constants that are lower than that for dopamine. The newer atypical antipsychotics all bind more loosely than dopamine to the dopamine D2 receptor and have dissociation constants higher than that for dopamine. This means they transiently occupy D2 receptors and then rapidly dissociate to allow normal dopamine transmission.
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2 Strengths (1 COUNTER) of biological therapies for schizophrenia
Leuch et al. (2012)- carried out a meta-analysis involving nearly 6,000 patients- some taken off their antipsychotic medication and given a placebo instead. The remaining patients remained on their regular antipsychotics. Within 12 months, 64% of placebo patients had relapsed, compared to 27% of those who stayed on the antipsychotic drug.
COUNTER - It is also suggested that because antipsychotics have powerful calming effects, it is easy to demonstrate that they have some positive effect on patients. This is not the same as saying they really reduce the severity of psychosis.
Research into biological therapies allows us to improve their effectiveness.
A key advantage of atypical antipsychotics that were developed later is that patients experience fewer side effects- less likely to result in movement problems commonly found with typical antipsychotics. As a result patients are more likely to continue with their medication, which in turn means they are more likely to see a reduction in their symptoms.
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2 Limitations of biological therapies for schizophrenia
Typical antipsychotics can produce severe side effects for the patient:
These drugs reduce dopamine levels which is responsible for movement. Therefore, side effects include serious movement problems. More than HALF of the people who take these drugs experience side effects. The most common resembling the neurological disorder Parkinsons and can lead to Tardive Dyskinesia in which your face and body male sudden irregular movements that cannot be controlled.
Motivational deficits associated with taking drugs;
It is argued that when people are prescribed antipsychotic, it prevents the individual from thinking about possible stressors (such as life history or current circumstances) that might be contributing to their condition. In turn this reduces their motivation to look for possible solutions that might alleviate these stressors and reduce their suffering.
As human misery is largely inflicted by other people then the best solutions are usually human interventions, rather than chemical.
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What are 3 psychological therapies for schizophrenia?
1. Cognitive behavioural therapy for psychosis
2. Family therapy
3. Token economies.
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What is cognitive behavioural therapy?
A combination of cognitive therapy (way of changing maladaptive thoughts and beliefs) and behavioural therapy (way of changing behaviour in response to these thoughts and beliefs).
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What is the main aim of CBTp?
Helps patients to identify irrational thoughts and challenge them by reality testing. Specifically, challenging the faulty interpretations of the world that lead to delusions
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What framework does CBTp make use of?
Ellis' ABCDE model.
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How does the ABCDE model work?
Identify activating events (A) which trigger irrational beliefs (B) and cause emotional and behavioural consequences(C). The beliefs can be disputed (D) through gentle questioning and changed leading to an effect (E) which is the restructured belief.
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What is normalisation?
Therapist shares with patient that many people have unusual experiences making them feel less isolated and stigmatised.
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What behavioural assignments can be set during CBTp?
Tasks to improve general level of functioning- shower every day, go out and socialise with friends.
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2 Limitations of CBT for schizophrenia
Advantages over drug therapies:
The NICE (2014) review of treatments for schizophrenia found consistent evidence that, when compared with standard care (antipsychotic medication alone), CBTp was effective in reducing rehospitalisation rates up to 18 months. CBTp was also found to be more effective in reducing symptom severity and improving social functioning compared to standard care.
Effectiveness of CBT:
Sensky et al (2000) found that CBT was effective in treating patients with Schizophrenia who hadn’t responded to drug treatment. CBT was helpful with both positive and negative symptoms and a continued improvement was seen 9 months after treatment with CBT had ended
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3 Limitations of CBT for schizophrenia
CBTp may not be effective for all stages of the disorder:
Addington and Addington (2005)- in the initial acute phase of schizophrenia, self-reflection is not particularly appropriate- positive symptoms lead to lack of self-awareness and negative symptoms lead to reluctance to engage, both of which are vital for CBTp.
It has been found that CBTp is more effective for individuals with more experience of their schizophrenia and a greater realisation of their problems.
Effectiveness may have been overstated:
Whikes et al. (2008) revealed only a ‘small’ therapeutic effect on the key symptoms of schizophrenia. Even these small effects disappeared when symptoms were assessed ‘blind’ (assessors were unaware of whether the patient was in the therapy or control condition).
Lack of availability:
Despite being recommended by NICE as a treatment for people with schizophrenia, it is estimated that in the UK only 1 in 10 of those who could benefit get access to this form of therapy.
Haddock et al. (2013)- carried out survey in North West of England. Found that of 187 randomly selected patients diagnosed with schizophrenia, only 13 had been offered CBTp. Even those that were offered CBTp, a significant number failed to attend the therapy sessions. As they struggled to commit to large amount of sessions and further limiting its effectiveness.
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What is family therapy?
A range of interventions carried out with members of a family of someone with a mental disorder - improves their communication and reduces stress of living as a family.
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What is the main aim of family therapy?
To provide support for carers to make family life less stressful, as well reduce relapse rates and hospitalisation.
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What are the 5 strategies developed by Pharoeh used in family therapy
Psychoeducation - helping carers understand and deal with the illness
Alliance with family members
Improving ability of family to anticipate and solve problems.
Reduction of expressions of anger and guilt among family members
Helping family members get a balance between caring and maintaining own lives
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mnemonic for remembering the 5 strategies used in family therapy
Pharaohs
Always
Improve
Rubbish
Health
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3 Strengths (1 COUNTER) of family therapy for schizophrenia
Evidence for its effectiveness:
Pharoah et al. (2010)- Carried out a meta-analysis on studies investigating the effectiveness of family therapy. Found family intervention may decrease the frequency of relapse, reduce hospital admissions, encourage compliance with medication, improve general social impairment and the levels of expressed emotion within the family.
COUNTER - Methodological limitation= raters were not ‘blinded’ to the condition to which participants had been allocated. In other words, raters were aware of the type of treatment received (family therapy or standard care) by the participants they were rating, which may have influenced their conclusions.
Economic benefits:
The NICE review of family therapy studies revealed that family therapy is associated with significant cost savings when offered to people with schizophrenia. The extra cost of family therapy is offset by a reduction in costs of hospitalisation because of the lower relapse rates associated with family therapy.
Positive impact on family members:
Lobban et al. (2013)- carried out meta-analysis on family therapy studies which has included an intervention to support relatives. 60% of studies reported a significant positive impact of the intervention on at least one outcome category for relatives, e.g. coping and problem-solving skills etc.
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1 Limitation of family therapy for schizophrenia
Limits applicational use:
Family therapy might not be suitable for all schizophrenic patients as it requires having a family that is willing or able to take part, and this is not always possible.
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What are token economies?
A form of behaviour modification based on the principle of operant conditioning. Specifically, desirable behaviours are encouraged by selective reinforcement. Rewards (tokens) are given as secondary reinforcers whenever patients carry out agreed tasks, which can then be exchanged for tangible primary reinforcers- food or privileges.
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What type of symptom do token economies aim to alleviate?
Negative symptoms
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When was the first use of token economy systems?
Allyon and Arzin (1968) trialled a token economy system in a ward of women with schizophrenia. Every time they completed a task they were given a token embossed with the words "one gift". These could then be swapped for ward privileges. They found the number of tasks increased significantly.
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2 Strengths (1 COUNTER) of token economies for schizophrenia
Research support:
Dickerson et al. (2005) reviewed 13 studies and 11 reported beneficial affects that were directly attributed to the use of token economies.
COUNTER - There was no control group to compare the patients' improvements to and so they could only compare the patients with their past behaviours which could improve due to confounding variables such as an increase in staff attention.
Community reintegration benefits:
Comaty et al. (2001) looked at 51 patients in a US psychiatric hospital who underwent a token economy programme. After an average of 9 months of token economy treatment, 75% discharged patients remained living in the community after 3 years. Better than typical statistics for readmission.
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3 Limitations of token economies for schizophrenia
Applicational use:
Research has shown that token economies only really work well in a hospital setting. Within a psychiatric ward setting, inpatients receive 24-hour care and so there is better control for staff to monitor and reward patients appropriately. However, outpatients living in the community only receive treatment for a few hours a day so the token method could only be used for part of the day. As a result, even if the token economy did produce positive results within the ward setting, these results may not be maintained beyond that environment.
Alternative psychological treatments with less ethical issues:
Chiang et al. (2019) concluded art therapy is a good alternative. Evidence suggests it is a high-gain low-risk approach to managing schizophrenia. Arttherapy is a pleasant experience without major risks of side effects or ethical abuses.
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What is the interactionist approach to schizophrenia?
Explains schizophrenia as the result of an interaction between biological influences and environmental influences.
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What does Meehl’s (1962) original diathesis-stress model state?
That diathesis (vulnerability) is entirely genetic and the result of a single schizogene which leads to a biologically based schizotypic personality (sensitivity to stress). Thus, no amount of stress will lead to schizophrenia if this gene is not present. Stress is seen as psychological in nature and naturally related to dysfunctional parenting.
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What does the modern understanding of diathesis entail? Explain researcher's new proposition
Many genes each can increase genetic vulnerability, not just one gene. Also diathesis can be more than just genetics. Read (2001) proposed a neurodevelopmental model where psychological trauma is seen as the diathesis. This is bcs it has been found that early trauma alters the developing brain. For example, the HPA system can become overactive, making a person more vulnerable to later stress.
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What does the modern understanding of diathesis entail? Explain an example and study
Anything that risks triggering schizophrenia, not just parenting.
Houston et al. (2008) - cannabis had triggered schizophrenic episodes in patients. Cannabis is a stressor as it increases risk by up to 7 times, interfering with the dopamine system.
82
What combination of treatment would an interactionist model use?
Antipsychotics and CBT.
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2 Strengths of the interactionist approach (1 COUNTER)
Support for interactional approach to treating schizophrenia:
Tarrier et al. (2004)- compared patients who were receiving combined treatment with patients receiving standard care (antipsychotics only)
Of the 315 patients, those receiving combination treatments showed lower symptom levels than those in control group.
COUNTER - There was no difference in hospital readmission between the groups suggests in the long-term, these two treatments are as effective as each other. It would cost more for combination treatments so may be better to just focus on biological treatments if both are as effective as each other in the long-term.
Research support:
Tienari et al. (2004)
A nationwide study of Finish Schizophrenic parents’ offspring given up for adoption compared to adopted offspring with biological parents without schizophrenia. Found there were 7 psychotic cases. 6 we’re offspring of schizophrenics and one was a control. However no seriously disturbed offspring found in a healthy house. This suggests that both genetic vulnerability and family-related stress are important in the development of schizophrenia.
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1 Limitation of the interactionist approach
Oversimplified:
Original diathesis-stress model has been criticized for oversimplifying the complex nature of schizophrenia, in that it claims that diathesis (vulnerability) is entirely genetic and the result of a single ‘schizogene’.
Research has shown that there are multiple genes (polygenic) which increase vulnerability to schizophrenia and no single gene. - Ripke et al. (2014) studied the genetic makeup of 37,000 patients and found 108 seperate variations of base pairs associated with increased risk of schizophrenia. They found these coded for the functioning of dopamine.
Also diatheses do not have to be purely genetic. An increased risk for schizophrenia can also result from brain damage caused by environmental factors or psychological trauma, such as child abuse.
