Schizophrenia Flashcards
(55 cards)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
What is schizophrenia (Sz)?
Sz: a disorder in which a person has difficulty distinguishing what is real from what is in their imagination.
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Finish these sentences:
Sz is experienced by about [ ]% of the world’s population.
It is more commonly diagnosed in [ ], [ ]-[ ] and [ ] socio-eonomic groups.
The symptoms of Sz can interfere severly with everyday tasks, so that many people with Sz end up [ ] or [ ].
0/7 = 1
2/7 = 2
4/7 = 3
6/7 = 4
7/7 = 5
Sz is experienced by about 1% of the world’s population.
It is more commonly diagnosed in men, city-dwellers and lower socio-eonomic groups.
The symptoms of Sz can interfere severly with everyday tasks, so that many people with Sz end up homeless or hospialised.
0/7 = 1
2/7 = 2
4/7 = 3
6/7 = 4
7/7 = 5
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
What’s the difference between a classification and a diagnosis?
classification: identifying clusters of symptoms that occur together and classifying it as one disorder (e.g. hallucinations, delusions)
diagnosis: identifying symptoms a person has and deciding what disorder it is (e.g. schizophrenia)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Match up the following key terms to their definitions:
Co-morbidity
Gender bias
Culture bias
Symptom overlap
_______________________________________________________________________
A psychiatrist from one culture may misdiagnose people from a different cultural background.
When two disorders frequently occur together (e.g. Sz and bipolar disorder).
When disorders share the same symptoms which makes it difficult to distinguish between them.
When one gender is under diagnosed and/or one is over diagnosed (e.g. women may be underdiagnosed for Sz in the UK).
- Co-morbidity: When two disorders frequently occur together (e.g. Sz and bipolar disorder).
- Gender bias: When one gender is under diagnosed and/or one is over diagnosed (e.g. women may be underdiagnosed for Sz in the UK).
- Culture bias: A psychiatrist from one culture may misdiagnose people from a different cultural background.
- Symptom overlap: When disorders share the same symptoms which makes it difficult to distinguish between them.
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Define ‘positive’ and ‘negative’ symptoms.
positive symptoms: additional experiences beyond those of ordinary existence (add-ons) (e.g. hallucinations, delusions)
negative symptoms: loss of usual abilities and experiences (losses) (e.g. speech poverty, avolition)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline hallucinations as a positive symptom of Sz.
HALLUCINATIONS:
- unusual sensory experiences
- could be random, could be related to the individual’s environment
- commonly hearing voices (auditory) (often critic)
- can be any sense: tactile (feeling things crawling on you), visions (distorted facial expressions)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline delusions as a positive symptom of Sz.
DELUSIONS (also known as paranoia/irrational beliefs):
- make a person behave bizarrely
- e.g.) the individual believes they are in important historical figure like Napoléon or Jesus
e.g.) the individual believes they’re being persecuted by the government or aliens
- e.g.) the individual believes they have superpowers
- e.g.) the individual believes they are under external control
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline speech poverty as a negative symptom of Sz.
SPEECH POVERTY:
- a reduction in the quality and amount of speech
- changing topics mid-sentence, incoherent speech
- sometimes accompanied by a delay in a person’s responses in conversations
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline avolition as a negative symptom of Sz.
AVOLITION:
- a lack/struggle to keep up/begin goal-directed activity
- sharp reduction in motivation
- poor hygiene + grooming, lack of persistence in work/education, lack of energy (the 3 signs of avolition identified by Andreasen)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding low reliability.
P: diagnoses have low reliability
E: Cheniaux et al (2009): when two psychiatrists independently assessed 100 clients using the ICD10 and DSM4, 68 were diagnosed according to the ICD10 system vs only 39 under the DSM4 system.
E: suggests the ICD10 and DSM4 were not reliable in the diagnosis of Sz; inconsistency between two classification systems; also suggests one is more valid than the other (produced a dramatically different number of diagnoses for the same disorder)
E: BUT: Osorio et al (2019) reported high inter-rater reliability (+0.97) and test-retest (+0.92) reliability using the DSM5 => latest version of DSM (DSM5) has high reliability due to empirical evidence and therefore we can trust this classification system for reliable diagnoses for Sz.
L: increased cred of DSM5 as a classification system for diagnosing Sz due to its reliability, but needs to be some more work done to ensure consistency across all classification systems to ensure the appropriate people are correctly diagnosed with Sz.
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding low validity.
P: diagnoses sometimes have low validity
E: Buckley et al found Sz is commonly diagnosed alongside other conditions (e.g. substance abuse) because it is a co-morbid disorder.
E: suggests our current diagnosis strategy provides an incomplete criteria for the symptoms of Sz to provide an accurate diagnosis (since Sz symptoms cannot be fully explained by just a diagnosis of Sz)
E: PLUS: some symptom overlap between Sz and other conditions (symptoms appear in both Sz and Bipolar disorder such as delusions and avolition); diagnosis of Sz is therefore not always accurate, could easily be confused/misdiagnosed for other disorders with very similar/the same symptoms
L: low validity for diagnosis of Sz suffers due to the incomplete explanation and criteria for what symptoms Sz encompasses
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding biased diagnoses (gender and cultural).
P: diagnoses are affected by gender and cultural biases
E: cultural bias: some symptoms have different meanings in different cultures, e.g. hearing voices in Haiti may be interpreted as communication from ancestors; plus British people of African-Caribbean heritage are 9x more likely to receive a diagnosis than White British people
E: PLUS: gender bias: men diagnosed more often than women (1.4(men):1(women)).
E: Sz inconsistently diagnosed between cultures and genders; those with a lower chance of being diagnosed (e.g. women) less likely to receive treatment they need to improve their QOL
L: reduced cred of diagnosis of Sz due to inconsistent diagnoses across cultures and genders
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Briefly outline and evaluate one study of validity in relation to the diagnosis of schizophrenia. [4 marks]
ROSENHAN (1973)
AO1:
- 7 students visited 12 different asylums in USA
- all faked hearing voices “hollow, empty, thud”
- all were admitted to a ward as ‘insane’
- once inside they behaved normally, saying the symptom had gone away and they were fine
- none were detected as being pseudo-patients
AO3:
- strength: brought about a revision of the classification system to incorporate a more in-depth overview of mental disorders
OR
- limitation: brought about widespread distrust of psychiatrists to accurately diagnose mental disorders
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the original dopamine hypothesis as a neural correlate (explanation) of Sz.
- high levels of dopamine in subcortical regions in the brain
- subcortical hypERdopaminergia
- e.g.) excess of dopamine receptors in Boca’s area explains speech poverty as a symptom of Sz
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the updated dopamine hypothesisas a neural correlate (explanation) of Sz.
(- in addition to hypERdopaminergia)
- low levels of dopamine in cortex
- cortical hypOdopaminergia
- e.g.) defecit of dopamine in prefrontal cortex (thinking) could explain cognitive problems (-ve symptoms)
- cortical hypOdopaminergia leads to subcortical hypERdopaminergia
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
What acronym can we use to remember the original and updated dopamine hypotheses?
Only
Happy
Squirels
Bury
Seeds
Under
Large
Coarse
Pine
Cones
Original
High (=hyper)
Subcortical
Broca
Speech
Updated
Low (=hypo)
Cortex
Prefrontal
Cognitive
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Briefly outline one strength and one weakness of the dopamine hypotheses as a neural correlate (explanation) of Sz.
strength:
- research has shown that drugs that increase the levels of dopamine produce schizophrenic symptoms => shows higher levels of dopamine are linked to Sz symptoms which supports dopamine hypothesis
weakness:
- clozapine is the most effective drug at reducing Sz symptoms + acts on dopamine and serotonin => dopamine hypothesis isn’t a complete explanation if serotonin is also being acted on because this suggests that serotonin also has a role to play in Sz, which isn’t included in the dopamine hypothesis
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline family studies as a genetic explanation of Sz.
family studies:
- Gottesman (1991) large-scale family study: risk of Sz increases with genetic similarity to a relative with the disorder
- e.g.) aunt with Sz => 2% chance of developing Sz
- e.g.) sibling with Sz => 9% chance of developing Sz
- e.g.) identical twin with Sz => 48% chance of developing Sz
- family members tend to share aspects of their environment as well as may of their genes so the correlation represents them both, but family studies still give good support for the importance of genes in Sz
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline candidate genes as genetic explanation of Sz.
candidate genes:
- Sz is polygenetic (lots of genes involved)
- the most likely genes are the ones coding for neurotransmitters (dopamine)
- Ripke et al (2014) combined all data from genome-wide studies of Sz, 108 separate genetic variations were associated with slightly increased risk of Sz
- Sz is aetiologically heterogeneous (different combinations of factors, including genetic variation, can lead to the condition)
- Benzel et al (2007): there are 3 genes that have been associated with excess dopamine in specific receptors, leading to positive symptoms such as delusions and hallucinations: COMT, DRD4, AKT1
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the role of mutation as genetic explanation of Sz.
mutation:
- Sz can have genetic origin despite the absence of a family history of it
- mutation in parental DNA caused by radiation, poison or viral infection
- positive correlations between paternal age (associated with increased risk of sperm mutation) and risk of Sz (0.7% risk with fathers under 25 and 2% with fathers over 50)
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one weakness of biological explanations of Sz, regarding biological reductionism.
P: One limitation of biological explanations of Sz is that they are considered biologically reductionist.
E: For example, the complex behaviour of Sz is being broken down into its constituent components and explained through genetic and neural processes.
E: This is a weakness because there is evidence that suggests that environmental factors also increase the risk of developing Sz including birth complications (Morgan et al, 2017) and smoking THC-rich cannabis in teenage years (Di Forti et al, 2015). Furthermore, Morkved et al (2017) found that 67% of people with Sz reported at least one childhood trauma as opposed to 38% of a matched control group with non-psychotic mental health issues. This suggests that, on their own, biological explanations do not provide a holistic and complete explanation for Sz.
E: Furthermore, the dopamine hypothesis takes the most reductionist level of explanation at the neurochemical level. Research from post-mortem and brain scanning studies demonstrate that other neurochemicals such as glutamate also seem to be abnormally higher in people with Sz (McCutcheon et al, 2020).
L: As a result, the credibility of biological explanations is reduced as they are not sufficient as stand-alone explanations.
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one strength of biological explanations of Sz, regarding real-world application.
P: One strength of biological explanations for Sz is that they have real-world application.
E: For example, one application of our understanding of the likely role of genes in schizophrenia is genetic counselling. If one or more potential parents have a relative with Sz, they risk having a child who would go on to develop Sz. For instance, based on Gottesman’s study, the child would have a 6% probability if the patient has a half-sibling with Sz. Genetic counselling involves informing potential parents of these probabilities so they can make informed choices about whether to have children who risk having a poor quality of life if they develop Sz.
E: However, the risk estimate provided by genetic counselling is just an average figure based on the whole population. It won’t really reflect the probability of that particular child going on to develop Sz because any given child will be exposed to a particular environment which also exposes the child to risk factors. For example a child’s risk of developing Sz would be higher than its genetic probability if they experience childhood trauma and go on to smoke cannabis in their teens. Therefore genetic counselling only provides an estimate of risk of the unborn child going on to develop Sz.
E: Furthermore, by examining the role of neurochemicals such as dopamine (DA), antipsychotics have been produced to attempt to regulate levels of dopamine for individuals with Sz. According to Taylor et al (2014), these drugs reduce DA activity and the intensity of the symptoms of those with Sz. This is a strength because it allows individuals suffering with Sz to have an improved quality of life and could potentially allow them to return to work and therefore contribute positively to the economy.
L: As a result, the credibility of biological explanations of Sz is increased as they provide practical applications to individuals.
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one weakness of biological explanations of Sz, regarding inconsistent evidence.
P: One limitation of biological explanations of Sz is that there is inconsistent evidence on the dopamine hypothesis from amphetamine psychosis.
E: For example, amphetamines (speed) can reproduce symptoms of Sz, which Tenn et al (2003) did in rats to then relieve the symptoms with drugs that reduce DA activity. In other research, amphetamines have been found to raise DA levels (Curran et al 2004) and amphetamines in high doses can produce auditory hallucinations that resemble those often seen in Sz. This evidence of a link between amphetamines and Sz symptoms supports the dopamine hypothesis.
E: However, other drugs that also increase DA levels (apomorphine) do not cause Sz-like symptoms (Dépatie and Lal, 2001). Also, Garson (2017) has challenged the idea that the symptoms of amphetamine psychosis closely mimic Sz. This is an issue because it suggests the relationship between dopamine and Sz is not well understood as evidence is contradictory.
E: Furthermore, psychologists should be mindful about the conclusions made from amphetamine psychosis about dopamine levels as a lot of the research comes from animal studies which may not be generalisable to humans, since we have different psychological and cognitive systems and structures. Therefore the link between amphetamine psychosis and Sz may not be as close as some have suggested.
L: As a result, the credibility of the biological explanations of Sz is reduced since amphetamine psychosis is not particularly strong evidence to support the dopamine hypothesis.
DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Fill in the blanks:
The most common treatment for Sz involves the use of [ ] drugs. These drugs may be required on a [ ]-[ ] or [ ]-[ ] basis. They can typically be divided into two types and administered in [ ], [ ] or [ ] form:
- [ ] antipsychotics: these are [ ] drugs that have typically been used since the 1950s
- [ ] antipsychotics: these drugs have been used since the 1970s. They aim to improve the effectiveness of drugs in [ ] symptoms of psychosis AND minimise the [ ] [ ].
0/14 = 1
4/14 = 2
7/14 = 3
10/14 = 4
14/14 = 5
The most common treatment for Sz involves the use of antipsychotic drugs. These drugs may be required on a short-term or long-term basis. They can typically be divided into two types and administered in tablet, injection or syrup form:
- Typical antipsychotics: these are older drugs that have typically been used since the 1950s
- Atypical antipsychotics: these drugs have been used since the 1970s. They aim to improve the effectiveness of drugs in suppressing symptoms of psychosis AND minimise the side effects.
0/14 = 1
4/14 = 2
7/14 = 3
10/14 = 4
14/14 = 5
