Schizophrenia Flashcards

Question

research into symptom overlap

Answer 1

Ellason and Ross (1995)- people with DID have more schizophrenic symptoms than people schizophrenics Read (2004)- most people diagnosed with schizophrenia have sufficient symptoms of other disorders that they could also receive at least one other diagnosis

Answer 2

the extent that 2 or more conditions occur at the same time If 2 occur together lots, then validity questioned- might be a single condition (very severe depression and sz look very similar so may be 1 condition)

Answer 3

Buckley et al (2009)- co-morbid depression occurs in 50% of patients, and 47% of patients also have a lifetime diagnosis of co-morbid substance abuse Swets et al (2014)- meta analysis found that at least 12% of patients with schizophrenia also fulfilled the diagnostic criteria for OCD and about 25% displayed significant obsessive-compulsive symptoms but as both uncommon, would think only a few people with schizophrenia would develop OCD and vice versa as roughly 1% of the population develop schizophrenia, and roughly 2-3% develop OCD

Answer 4

research support for gender bias- Loring and Powell (1988)- 290 male and female psychiatrists used DSM. 56% diagnosed schizophrenia when patient was male/ no info about gender. 20% when female. gender bias not as evident from the female clinicians comorbidity research- 50% depression, 47%(?) substance abuse, 12% OCD 25% severe OC symptoms symptom overlap research- DID patients have more sz symptoms than sz patients schizophrenics rarely share same symptoms or outcomes. 20% completely recover, 30% some improvement, 10% significant improvement. if each person has such diff outcomes, how can we be sure they have schizophrenia

Answer 5

whaley 2001 found interrater reliability correlations for diagnosing sz as little as 0.11. also illustrated in Rosenhan study. beck et al- interrater reliability only 54% unreliable symptoms- only one characteristic symptom is required for a diagnosis if delusions are bizarre but 50 senior psychiatrists asked to differentiate bizarre and not and only had 0.4 interrater reliability barnes 2004- cultural and racial differences- ethnic minority experienced less distress associated w mental disorders due to protective characteristics and social cultures. brekke and barrio 1997- 184 sz people- white americans more symptomatic than the 2 non-white minority groups

Answer 6

genetic (biological predisposition, polygenic)- family studies, twin studies, adoption studies neural correlates- dopamine hypothesis, neural imaging, animal studies

Answer 7

family study- genetic element- passed on more closely related= greater risk twin study- gottesman and shields- 2 sz parents= 46% conc rate one sz parent= 13% conc rate sibling= 9% conc rate Joseph (2004)- MZ= 40.4%, DZ= 7.4% polygenic- multiple genes that contribute together 108 candidate genes

Answer 8

more recent studies where the researcher is blind to whether twins are mz or dz shows lower concordance rate for mz but still higher than dz. also similarities between mz could still be environment because joseph (2004)- mz treated more similarly than dz, more similar environment, more identity confusion scientific- post mortems and genomes studied adoption study (disentangles genes and environment) - Tiennari-164 adoptees whose biological mothers had schizophrenia, 11 also received a diagnosis compared to 4 of 197 control adoptees (non-schizophrenic mothers)- but control 2% not 1% Tienari also suggests environment plays a role- all those that developed sz had dysfunctional family

Answer 9

- even twins reared apart shared womb so same environment for some time - mz may be treated more similarly than dz and experience identity confusion - common rearing patterns in family

Answer 10

Davis and Khan (1991)- excess of dopamine in mesolimbic pathway causes positive symptoms and deficit of dopamine in mesocortical pathway causes negative and cognitive symptoms schizophrenics have more D2 receptors on receiving neurones so more dopamine binds so more neurones fire so more positive symptoms

Answer 11

dopamine agonists- stimulate nerve cells containing dopamine, causes synapses to be flooded with it normal individuals- delusions and hallucinations parkinsons- have low levels of dopamine. take these drugs and end up developing schizophrenia type symptoms (Grilly 2002) eg L-dopa and amphetamine

Answer 12

antipsychotics block activity of dopamine in the brain so eliminate delusions and hallucinations dopamine antagonists these work- evidence for dopamine being a cause

Answer 13

patel et al 2010- used PET scans to assess dopamine levels in schizophrenics and controls found lower levels of dopamine in dorsolateral prefrontal cortex of schizophrenics compared to controls

Answer 14

Wang and Deutch (2008)- induced dopamine depletion in prefrontal cortex in rats. resulted in cognitive impairment that the researchers were able to reverse using olanzapine (atypical antipsychotic thought to have beneficial effects on negative symptoms in humans)

Answer 15

evidence from treatment- Leucht et al (2013)- meta-analysis of 212 studies that had analysed effectiveness of diff antipsychotics compared with placebo. all drugs tested were significantly more effective than placebo in treatment of positive and negative symptoms, achieved through the normalisation of dopamine prac aps- drug treatments animal studies- dopamine in brain of rats Noll (2009)- evidence against original and revised dopamine hypothesis. antipsychotics dont alleviate hallucinations/ delusions in 1/3 of people. some have hallucinations/ delusions despite normal dopamine (blocking D2 receptors has little effect on symptoms). other neurotransmitters may play a role

Answer 16

family disfunction (abnormal patterns of communication)- double bind, expressed emotion cognitive (schemas that see world in more threatening way

Answer 17

Gregory Bateson et al (1956) suggest children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia eg 'I love you' whilst turning head in disgust- conflicting messages child fears doing wrong thing but dk what that is believe world is confusing and dangerous- reflected by disorganised thinking and paranoid delusions just a risk factor

Answer 18

primarily an explanation for relapse negative emotional environment, family communication style where family members talk about patient in critical/ hostile way that indicates over concern or over involvement Kuipers et al (1983) found that high EE relatives talk more and listen less patient returning to a family with high EE is 4x more likely to relapse that a patient whose family is low in EE (Linszen et al 1997) (Noll, 2009)- family environment that is relatively supportive and emotionally undemanding may help the person with schizophrenia to reduce their dependence on antipsychotic drugs and help reduce the likelihood of relapse

Answer 19

verbal criticisms often accompanied by violence hostility including anger and rejection emotional over-involvement leads to stress in patient

Answer 20

interpretations of experiences controlled by inadequate information processing critical characteristic is degree to which individual perceives themself as central component in events (egocentric bias) so jumps to conclusions- relate irrelevant events to themselves and arrive at false conclusions (whispering is about them, flash of light is from God) unwilling/ unable to consider that they are wrong (Beck and Rector, 2005) impaired insight, an inability to recognise cognitive distortions and substitute more realistic explanations for events

Answer 21

Individuals focus excessive attention on auditory stimuli- have a higher expectancy for occurrence of voice than normal individuals Aleman (2001)- hallucination-prone individuals struggle to distinguish between imagery and sensory-based perception inner representation of an idea can override actual sensory stimulus and produce an auditory image that is as real as the transmission of actual sound hallucinating patients significantly more likely to misattribute source of self-generated auditory experience to an external source than are non-hallucinating patients (Baker and Morrison, 1998) dont go through the same processes of reality testing (such as checking external sources) than others would do

Answer 22

meta representation- cognitive ability to reflect on thoughts/ behaviour gives us insight into goals/ intentions, allows us to interpret actions of others. dysfunction in meta representation means cant recognise own actions/ thoughts as being carried out by self- explains thought insertion central control- cognitive ability to supress automatic responses whilst performing deliberate actions instead. inability to leads to disorganised speech and thought disorder. derailment of thought

Answer 23

Tienari et al (1994)- adopted children w sz bio parents were more likely to become ill than those with non bio parents. but, diff only occurred in situations where adopted family was rated as disturbed. ie illness only manifested under appropriate conditions- genetic vulnerability not enough Berger (1965)- szs reported higher recall of double bind from mother. but, their recall may be affected by sz. Liem (1974)- measured patterns of parental communication in families w sz child and found no diff Read et al (2005)- reviewed 46 studies of child abuse and sz and concluded 69% adult women in patients with sz had history of physical/ sexual abuse. men- 59% evidence for double bind is weak- based on clinical obs and (in the past) assessing mother for 'crazy-making characteristics'. also leads to parent blaming- parents have already seen child suffer and is now being blamed- ethics

Answer 24

Sarin and Wallin (2014)- found evidence to support positive symptoms having origin in faulty cognition, eg delusional patients found to show various biases (jump to conclusions). szs with hallucinations were found to have impaired self monitoring. patients w negative symptoms also displayed dysfunctional thought processes eg low expectations regarding success cognitive based therapies work so must be cognitive. eg CBTp was found to be more effective in reducing symptoms severity and improving levels of social functioning than antipsychotics reductionist- doesnt take into account neurochemical changes. But, Howes and Murray- early vulnerability factors combined w social stressors sensitises dopamine system so increased release - leads to paranoia, hallucinations which cause stress and cycle repeats not so good at explaining negative symptoms

Answer 25

drug therapy- antipsychotics CBT family therapy token economy

Answer 26

initial and most effective treatment reduce dopaminergic transmission typical- combat + symptoms atypical- combat + and - symptoms

Answer 27

reduces effects of dopamine so reduces (positive) symptoms dopamine antagonists- bind to receptors but dont stimulate effectiveness lead to dopamine hypothesis Kapur et al (2000) estimate that between 60% and 75% of D2 receptors in the mesolimbic pathway must be blocked for these drugs to be effective- to do this D2 receptors in other pathways are blocked so results in side effects - symptoms similar to parkinsons- stiff, tremors) - in 30% this leads to tardive dyskinesia- facial ticks - low bp, blurred vision, constipation

Answer 28

- lower risk of extrapyramidal side effects - beneficial for negative and cognitive symptoms - suitable for treatment resistant patients only temp blocking of D2 receptors so less extrapyramidal side effects littel effects on dopamine systems that control movement stronger affinity for serotonin receptors and less for D2 - only used if typical doesnt work as can cause blood condition (agranulocytosis) so need reg blood tests. can be fatal

Answer 29

leucht et al- meta analysis of 65 studies where patients stabilised on typical/atypical antipsychotics, some placebo- in 12m, 64% with placebo relapsed compared to 27% on medication typical- extrapyramidal side effects (movement problems) as drugs affect extrapyramidal area of brain which controls motor skills. parkinsons related symptoms. experienced by over 50%. may also have tardive dyskinesia- involuntary movements of tongue, face, jaw, atypical- blood condition- ethical problems ross and reid- when prescribed antipsychotics, reinforces belief something is wrong. prevents patient from thinking about poss stressors so reduces motivation to look for poss solutions. reid and haslam- when asked what causes sz, public say social factors, poverty, trauma more than biological factors masks symptoms not remove- relapse however- economy

Answer 30

all patients should have CBT to treat residual symptoms that persist despite medication - correct faulty thoughts - provide coping strategies NICE recommend at least 16 sessions patient encouraged to trace origins of symptoms and evaluate content of delusions etc

Answer 31

assessment- express thoughts about experiences, discuss realistic goals engagement- therapist empathises w patients perspective and distress and explanations of distress developed together ABC- activating event, beliefs, consequences- change beliefs normalisation- say that many experience hallucinations and delusions in diff circumstances- reduces anxiety and isolation- recovery seems more possible critical collaborative analysis- gentle questioning to help understand illogical deductions and conclusions eg if voices real, why cant others hear? remain non judgemental and empathetic developing alternative explanations- healthier explanations can be thought of by patient/ together

Answer 32

cognitive - distraction - focus on specific task - positive self talk behavioural - relaxation techniques - loud music - behavioural experiments (test faulty thoughts) - ignore hallucinations - hw - social withdrawal/ opposite

Answer 33

NICE- compared to just drugs, CBTp effective in reducing rehospitalisation rates up to 18m following end of treatment. also effective in reducing symptom severity and improves social functioning. however, tests of CBTp have been done when patient is taking drugs too so dk effect of CBTp alone more effective when available at diff stages. addington and addington- in initial acute phase, self reflection not really appropriate. benefit more when have group CBTp after drugs have stabilised symptoms. group means their experiences are normalised Juni et al (2001)- evidence that the problems associated w methodologically weak trials (eg not blind, not randomly allocated) translated into biased findings. Wykes et al- more rigorous study= CBTp seems weaker Jauhar et al 2014- only small effect on key symptoms of sz but even these disappeared when tested blind. uncertainty over if it works or not has led to conflicting guidance on drugs vs therapies between countries in the UK

Answer 34

- negative symptoms make it difficult to be open to change - hallucinations/delusions may make it difficult to trust that the therapist isnt working against them - poor memory recall- forget hw tasks - must be stabilised on drugs first - got to want it to work but some have relationship w voices - voices may distract them from therapists guidance - not effective in initial stages but more effective as you get more experienced w sz

Answer 35

provides support for carers in attempt to make family life less stressful and reduce hospitalisation and relapse. given with drug treatment & outpatient clinical care - psychoeducation- help person and carers understand and deal w illness - form alliance w relatives who care for patient - reduce emotional climate in family and burden of care for family members - enhance relatives ability to anticipate and solve problems - reduce expressions of anger/ guilt from family - maintain reasonable expectations - encourage relatives to set appropriate limits - patient talk to family and say what support is helpful Garety et al 2008- relapse rate for individuals w family therapy- 25%, w/o- 50%

Answer 36

reviewed 53 studies on effectiveness of family intervention in europe, asia, N.america. compared outcomes from family therapy to standard care - some studies reported improved mental state, some didnt - increased compliance w medication - didnt have much effect on social functioning eg living independently/ employment - reduced risk of relapse and hospitalisation during and 24m after family therapy

Answer 37

Paroah et al 2010 but is it effective just due to increased drug compliance. economy- back to work as less relapse, less relapse means less hospital so less money. but expensive to train/ give family therapy helps family members as well as patients. Lobban et al (2013)- analysed results of 50 family therapy studies that included intervention to support relatives. 60% had positive impact on family members eg coping and problem solving, relationships etc. however, the studies had methodological flaws Garety et al (2008)- failed to show better outcomes for patients given ff than those who just had carers. both groups had low relapse. for many people, family intervention may not improve outcomes further than good standard treatment as usual Garety et al 2008- relapse rate for individuals w family therapy- 25%, w/o- 50%

Answer 38

using operant conditioning and positive reinforcement to reduce negative symptoms and encourage positive behaviours 2 types of reinforcer - primary- gives pleasure/ removes unpleasant states. dont depend on learning - secondary- initially no value but aquire reinforcing properties when paired w primary reinforcer. tokens are secondary reinforcer has to be given as soon as poss after target behaviour as another behaviour may have happened in between and this could be reinforced instead targets- brush hair, dress, help someone reward- food, privileges, activity token traded for reward- has to happen soon to work best

Answer 39

token economy on ward of female sz patients given plastic tokens, each saying ‘one gift’ for behaviours eg making their bed/ chores. tokens exchanged for privileges eg movie. found that the number of desirable behaviours performed each day increased dramatically

Answer 40

research support- Dickerson et al (2005)- reviewed 13 studies of use of token economy in psychiatric setting. 11 reported beneficial effects directly attributed to the token economy. however, many of the studies have methodological limitations so limit impact in overall assessment Comer (2013)- major prob in assessing effectiveness is that studies tend to be uncontrolled. when a token economy is brought in, all patients take part in programme rather than having a control group. as a result, behaviours compared to past behaviours not control group. other factors may be improving patients behaviour eg increased attention from staff alloyn and azrin ethical concerns dk if it actually works. very few randomised trials carried out to support effectiveness. so, not used much as no evidence. McMonagle and Sultana (2000) suggest it may still be important if randomised trials could be carried out.

Answer 41

diathesis-stress- combo of psychological/environmental and biological/genetic influences. symptoms of sz are triggered/ made worse when stressors combine w biological vulnerability. explains why not all w genetic predisposition go on to develop sz diathesis- genetic/ any biological factors in terms of vulnerability. supported by conc rates w twins. however, not 100% so environmental part too. stress- childhood trauma, living in highly urbanised environment. Varese et al (2012)- children who experienced trauma before 16 were 3x more likely to develop sz. relationship between level of trauma and likelihood of developing sz. Vassos et al (2012)- meta analysis found risk of sz in urban environments was estimated to be 2.37x higher than most rural environments. reason not clear but environment may be a contributory factor. many people live in deeply populated urban areas but only a small minority develop sz. relationship between urban stress and sz is conditional on some other factor eg biological vulnerability. several ways the combo of diathesis and stress can lead to onset of sz. eg relatively small stressors may lead to onset who is highly vulnerable or major stressor in someone w low vulnerability. they add together.

Answer 42

procedure- hospital records for nearly 20000 women admitted to Finish psych hospitals 1960- 1979. identified those diagnosed at least once w sz. list checked to see mothers who had one/more offspring adopted. resulting sample 145 adopted offspring (high risk group) were matched w 158 wo genetic risk (low risk group) both groups independently assessed after 12yrs then followed up after 21yrs. family functioning is adoptive families was assessed- interviewers were kept blind whether mother had sz or not findings- 14/303 adoptees developed sz. 11 from high risk and 3 from low risk. however, being in healthy adoptive family appeared to have protective effect even if high genetic risk. in families of high risk group, adoptive family stress was signif predicot of development of sz conclusion- biology plays a role but environment provides protective factors

Answer 43

Tienari study limitations of Tienari study eg when assessing family functioning, this was only at one point in time- fails to reflect developmental changes in family functioning. support for usefulness of combos of biological and psychological treatments vs bio alone. Tarrier et al (2004)- studied 315 patients randomly allocated to med + CBT, med + supportive counselling, control (med only). patients in 2 combo groups showed lower symptoms than control. superior treatment outcomes shows importance of this approach Turkington et al- good logical benefit between interactionist and using combo treatments. however, fact combo is more effective doesnt necessarily mean interactionist approach is correct just like drugs working doesnt necessarily mean sz has biological origin. this is the treatment-causation fallacy mz twins not 100%

Schizophrenia Flashcards

(67 cards)