Schizophrenia Flashcards
(199 cards)
1
Q
Name the four types of family dysfunction that can cause schizophrenia
A
- Schizophrenogenic mother - Double-bind theory - High expressed emotion - Marital schism
2
Q
Who came up with the schizophrenogenic mother?
A
Reichman
3
Q
How does a schizophrenogenic mother act?
A
- Cold - Rejecting - Emotionally disturbed - Perfectionist - Domineering - Lacking in sensitivity But at the same time… - Overprotective - Encouraging dependence - Rigidly moral and seductive
4
Q
What can a schizophrenogenic mother often engage in?
A
Double bind communication
5
Q
What can a schizophrenogenic mother lead to in the child?
A
- Distrust - This can manifest itself as paranoid delusions
6
Q
Who came up with double bind theory?
A
Bateson
7
Q
What is the double bind theory?
A
- A contradictory communication style - Children find themselves in a situation where they fear they are doing the wrong thing but they receive mixed messages about what this is - The child is unable to express unfairness or ask for clarification
8
Q
How is a child punished in double bind theory?
A
Withdrawal of love
9
Q
What can double bind theory lead to?
A
Developing the idea that the world is confusing (disorganised thinking) and dangerous (paranoid delusions)
10
Q
Who came up with the theory of expressed emotion?
A
Brown et al
11
Q
What is expressed emotion?
A
The amount of (usually negative) emotion expressed towards a patient by their carer. This involves: - Verbal criticism of their patient, sometimes accompanied by violence - Hostility towards the patient including anger and rejection - Emotional over-involvement in the life of the patient including needless self sacrifice
12
Q
When is expressed emotion bad for a patient?
A
When there are high levels of it
13
Q
Give some examples of criticism
A
- Can’t you do anything right? - You are the worst daughter in the world - I wish you had never been born
14
Q
Give some examples of hostility
A
- If you do that again I will shout at you - Don’t make me do something that I regret - This is going to end in tears
15
Q
Give some examples of emotional over-involvement
A
- What did your father say about me when he was upset the other night? - A parent going through their child’s mobile phone - A parent logging into their child’s email account
16
Q
What can high levels of expressed emotion result in?
A
It can sometimes trigger onset, but is more likely to be a cause for relapse
17
Q
Who came up with the theory of marital schism?
A
Lidz et al
18
Q
What is involved in marital schism?
A
- Conflict between the mother and father but neither party yields to the other - Each partner constantly strives to satisfy their own needs while ignoring the other partner’s needs - This perpetual battle for dominance between parents inevitably involves the children as the parents compete for their affections and enrol them as supporters
19
Q
What can marital schism lead to?
A
A split in the mind manifesting in psychotic symptoms
20
Q
What is a healthy output for the thought “people are laughing on the bus”?
A
“Someone told a funny joke”
21
Q
What is an unhealthy output for the thought “people are laughing on the bus”?
A
“They are laughing at me, what’s wrong with me?”
22
Q
What is a healthy output for the thought “my passport is not where I left it”?
A
“Perhaps I didn’t leave it where I thought I had”
23
Q
What is an unhealthy output for the thought “my passport is not where I left it”?
A
“Someone has taken it and is trying to steal my identity”
24
Q
What is a healthy output for the thought “I can’t hear what people are saying”?
A
“They are quite far away from me”
25
What is an unhealthy output for the thought "I can't hear what people are saying"?
"They are whispering as they are talking about me"
26
Name the 4 elements of cognitive dysfunction that Frith talked about
- Metarepresentation - Attention - Memory - Central control
27
What is metarepresentation?
Our ability to reflect upon our own thoughts and behaviours to gain an insight into our motivations and goals. We can use this skill when observing others to interpret what their motivations and goals might be
28
What might problems with metarepresentation cause?
Disruption to our ability to recognise one's own actions and thoughts as being carried out be 'me' rather than someone else.
29
What schizophrenia symptom might problems with metarepresentation cause?
- Hallucinations of voices - Delusions such as thought insertion (the experience of having thoughts projected into the mind by others)
30
What problems do schizophrenia sufferers often have with attention?
- They are bombarded with external stimuli which they cannot separate or interpret - They cannot recognise when communication is meant for them or someone else
31
What symptom of schizophrenia might problems with attention give rise to?
- Delusions of grandeur where the sufferer believes that all communication is intended for them - Delusions of paranoia where the sufferer believes that all communication is about them
32
Why do schizophrenia patients often have memory problems?
They often fail to activate schemas leading to inability to distinguish between current information stored (memories) and new incoming sensory information
33
What symptom of schizophrenia does memory problems lead to?
Hallucinations. The sufferer believes they are seeing or hearing things which are actually just memories.
34
What is healthy central control?
Being able to carry out a conversation and stay focused as they suppress automatic connections and associations their mind makes with every word
35
What is an unhealthy central control?
Being unable to carry out a conversation and stay focused as they suppress automatic connections and associations their mind makes with every word
36
What schizophrenia symptom does unhealthy central control lead to?
Thought disorder and disorganised speech (tangential speech). Each word will trigger an association or connection to something else and the sufferer cannot suppress these leading to derailment of thought and spoken sentences.
37
What can be used to assess problem solving?
The key search test
38
Explain the key search test
Imagine you are in a field and you have spent the day picnicking and playing ball games all over the field. At some point you dropped your keys, Draw a plan of the path you would take to make absolutely sure you would find your keys. A healthy person would take an organised route
39
What is the most common treatment used for sz?
Drugs
40
What factors affect the type of drug diagnosed?
- Frequency - Format - Type - Length
41
What are the three drug formats?
- Pills - Syrups - Injections
42
What are the two types of antipsychotic drug?
- Typical - Atypical
43
Why are drugs superior to early psychiatric treatments?
- The effects aren't necessarily permanent (unlike lobotomies) - There is no surgery involved - It is more ethical as it is less dehumanising - Easier to administer/take - Patients have more motivation to engage in drug therapy
44
Name three antipsychotic drugs
- Chlorpromazine - Clozapine - Risperidone
45
What type of drug is chlorpromazine?
Typical antipsychotic
46
What decade was chlorpromazine first used in?
1950s
47
How often should chlorpromazine be taken?
Daily
48
What is the typical dosage of chlorpromazine?
400-1000mg
49
What format is chlorpromazine taken in?
- Tablet - Syrup - Injection
50
What is the mode of action for chlorpromazine?
- It acts as a dopamine antagonist, binding to the dopamine receptor and blocking the reuptake of dopamine - Initially this causes a build up of dopamine but eventually this diffuses and dopamine production reduces
51
What are chlorpromazine's other important properties?
It also works as a sedative due to its action on histamine receptors and can have a secondary effect of calming patients. When needed in this role, syrup is used rather than tablets
52
What type of drug is clozapine?
Atypical antipsychotic
53
What illness is a possible side effect of clozapine?
Agranulocytosis
54
What decade was clozapine first used?
1970s (although it was withdrawn for a few years in the 70s due to deaths from agranulocytosis)
55
How frequently should clozapine be taken?
Daily
56
In what format is clozapine taken?
- Tablets - Syrup
57
What is the typical dosage of clozapine?
300-450mg
58
What is clozapine's mode of action?
- Binds to dopamine receptors in a similar way to chlorpromazine - Also acts on serotonin and glutamate receptors, which improves mood and reduces anxiety - It is more likely to be prescribed if the patient is a suicide risk
59
What type of drug is risperidone?
Atypical antipsychotic
60
When was the decade of first use for risperidone?
1990s
61
How frequently should risperidone be taken?
Daily
62
In what format should risperidone be taken?
- Tablet - Syrup - 2 week injection available
63
What is the dosage of risperidone?
4-8mg (max 12mg)
64
What is the mode of action for risperidone?
- It binds to dopamine and serotonin receptors - It binds more strongly to the dopamine receptor than clozapine, making it effective in much smaller doses and possibly reducing side effects
65
Name the strengths of drugs
- Empirical evidence to show the effectiveness of chlorpromazine - Empirical evidence to show the effectiveness of clozapine
66
Name the weaknesses of drugs
- Side effects - Ethical issues - Issues with research
67
What empirical evidence shows the effectiveness of chlorpromazine?
Thornley et al (2003)
68
Outline Thornley et al's study
Reviewed 1121 cases from 13 drug trials and found that Chlorpromazine was associated with greater functioning when compared with a placebo. It also reduced the risk of relapse compared with no treatment
69
What study is empirical evidence for the effectiveness of Clozapine?
Meltzer (2012)
70
Outline Meltzer's findings
- Clozapine was more effective than other atypical antipsychotics - Clozapine was particularly effective in treatment-resistant cases. In 30-50% of such cases patients were able to improve functioning despite having little to no success with typical drugs
71
List some side effects of typical antipsychotics
- Dizziness - Agitation - Sleepiness - Stiff jaw - Weight gain - Itchy skin - Headaches - Tardive dyskinesia - Neuroleptic malignant syndrome
72
What is tardive dyskinesia?
A disorder which causes involuntary facial movements such as grimacing, lip smacking and blinking
73
What is neuroleptic malignant syndrome?
Blocking dopamine in the hypothalamus can lead to coma or even death
74
Which have less side effects: atypical or typical antipsychotics?
Atypical because they were developed specifically to address this issue
75
What is major side effect of atypical antipsychotics?
Agranulocytosis
76
What is agranulocytosis?
A dangerous blood disorder which affects immune system functioning
77
What does agranulocytosis mean for the way atypical antipsychotics are delivered?
It cannot be given in injection from and users must have regular blood checks. This may make patients more reluctant to use it.
78
What are the ethical issues surrounding drugs (especially atypical)?
- They have a calming effect on patients that is beneficial to hospital staff but that acts as a chemical straightjacket for the patient - Moncrief (2013). suggested that the use of drugs was an abuse of human rights
79
Why might the ethical issues of drugs be outweighed?
The calming effects may be considered necessary to keep the patient from harming themselves or other people or to allow other therapies to have an opportunity to work.
80
Why is there an issue with drug studies that use a placebo condition?
- Ross and Read point out that the patient is usually in a withdrawal state as they've had their antipsychotic replaced with an inert substance - This means their dopamine receptors are suddenly flooded with dopamine at much greater levels than they would usually experience
81
What other issue is there with drug studies?
- Healy (2012) claimed that some of the successful trials showing the effectiveness of drug therapy have been published multiple times, inflating their success - Studies also ignore the success of placebos - while the antipsychotic may have a greater effectiveness, the placebos often show some degree of effectiveness too
82
What does the partial effectiveness of placebos show?
The importance of the patient's psychology on their recovery
83
Who profits from the inflated success of drug trials?
Drug companies
84
Name the 3 types of psychological therapy
- CBT - Family therapy - Token economy
85
How many sessions does CBT usually take?
Between 5 and 20
86
Briefly outline how CBT works
- It helps patients identify irrational thoughts and tries to change them - The patient is encouraged to consider the extent to which their beliefs are true - The patient is encouraged to think about alternative explanations for what is happening to them
87
What particular form of CBT was developed to help sz patients?
Coping strategy enhancement
88
Who devised coping strategy enhancement?
Tarrier (1990)
89
Summarise what happens in coping strategy enhancement
- Therapists establish rapport with the patient - Therapists help the patient identify potential triggers for their psychotic symptoms - They target specific symptoms and find way of dealing with them
90
What is the result of coping strategy enhancement?
Patients learn to recognise the triggers for schizophrenic episodes and apply a technique to reduce the impact of that trigger and avoid an episode
91
Name the two coping strategies used in coping strategy enhancement
- Cognitive strategies - Behavioural strategies
92
What do cognitive strategies involve?
- Distraction - Concentrating on a specific task - Positive self talk
93
What do behavioural strategies involve?
- Relaxation techniques - behavioural experiments
94
Give some examples of relaxation techniques
- Breathing exercises - Social withdrawal - Increasing social contact - Loud music to drown out voices and behavioural experiments
95
Give some coping strategies someone who is triggered by their parent could use
- Distraction - Social withdrawal - Positive self talk
96
Give some coping strategies someone who is triggered by being on their own could use
- Distraction (radio or TV) - Keeping your mind focused on something
97
Give some coping strategies someone who is triggered by being put under stress could use
- Relaxation - Positive self talk - Deep breathing
98
What is the aim of family therapy?
To reduce some of the characteristics that lead to a dysfunctional family by improving the communication and interactions that occur within the family. Dysfunctional families are now associated more with relapse of sz rather than cause, so much of the focus is also on reducing the amount of expressed emotion.
99
Who came up with the important strategies in family therapy?
Pharoah (2010)
100
Name all the main focuses of family therapy
- Forming a therapeutic alliance with all family members - Reducing the stress of caring for a relative with sz - Improving the ability of the family to anticipate and solve problems - Reduction of anger and guilt in family members (recognition) - Helping family members balance caring for relatives with maintaining their own lives - Improving family beliefs about and behaviour towards sz
101
Why is forming a therapeutic alliance with all family members important?
Eradicates any individual alliances that exist and allows an open and honest environment, free from secrets
102
Why is reducing the stress of caring for a relative with sz important?
Increases patience of carer, leading to less bitterness directed at sufferer. This reduces the guilt they feel.
103
Why is improving the ability of the family to anticipate and solve problems important?
If problems are recognised early family can use taught strategies to cope with them, ultimately reducing stress.
104
Why is reduction of anger and guilt in family members (acknowledgement) important?
Reduces the defensive response they may have if they feel less to blame therefore become more supportive
105
Why is helping family members balance caring for relatives with maintaining their own lives important?
Increases overall wellbeing of carer which will have a knock on effect on the sufferer. Also reduces the guilt they feel if they put their own lives first
106
Why is improving family beliefs about and behaviour towards sz important?
Allows more empathy from family members who perhaps don't understand the causes of the illness and the severity of the symptoms
107
What is a token economy?
A reward system used to manage the behaviour of patients with sz.
108
What are token economies particularly useful for?
Patients who have been institutionalised, leading to the development of maladaptive behaviours such as staying in pyjamas all day or not maintaining a good level of self care
109
What do token economies address?
The likelihood of a recovery outside of institutional care
110
When should tokens be given and why?
Straight after the desirable behaviour This positive reinforcement should occur immediately or it reduces the impact as it leads to 'delay discounting'.
111
Give some examples of desirable behaviour
- Brushing your teeth - Making a phone call home - Playing a game of chess - Changing routine - Engaging in a therapy session - Saying something nice about yourself
112
Give some examples of some rewards
- Watching a movie - An outing - Chocolate - Cigarettes - Off cleaning duty for a day - New item of clothing
113
What type of conditioning is a token economy?
Operant conditioning
114
Explain token economies in terms of operant conditioning
- Operant conditioning occurs when tokens can be exchanged for rewards - The token becomes the secondary reinforcer and the reward becomes the primary reinforcer
115
What 3 categories can psychological therapies for sz be evaluated against?
- Effectiveness (does it reduce symptoms?) - Effectiveness (does it improve life quality?) - Ethical issues
116
Name 3 studies into whether psychological therapies reduce symptoms of sz
- Juahar et al (2014) - Pharoah (2010) - McMonagle and Sultana (2009)
117
Outline Juahar's study
- Reviewed the results of 34 studies of CBT in treating sz - They concluded that it has a significant, but fairly small, effect on positive and negative symptoms
118
Outline Pharoah's study
- Reviewed evidence on the effectiveness of family therapy on sz sufferers - They concluded that although there was moderate evidence to show that it reduces hospital admissions and improves quality of life for both patients and families, there was inconsistencies in findings
119
Outline McMonagle and Sultana's study
- Reviewed evidence for token economy and found only 3 studies which used random allocation to assign patients to a condition. - Of these, only one found an improvement in symptoms and none found evidence of behaviour change
120
Make a conclusion about whether psychological therapies reduce sz symptoms
There is only modest support for the effectiveness of psychological treatments and sz remains one of the harder mental health problems to treat, making this a limitation of psychological treatments
121
How does CBT affect life quality?
Allows patients to make sense of, and in some cases challenge, some of their symptoms
122
How does family therapy affect life quality?
It helps to reduce the stress of living with a family member who has sz, both for the patient and other family members
123
How do token economies affect life quality?
They help by making the patient's behaviour more socially acceptable so they can better reintegrate into society
124
Make a conclusion about how psychological therapies affect quality of life
All of these therapies will in some way improve the life quality of the patient as they will help patients understand their symptoms. Additionally they will allow the patient to return to a more supportive family environment and reintegrate successfully back into society
125
Make a conclusion about the overall effectiveness of sz treatments
- Although these are all useful outcomes, they do not cure sz - Even though biological treatments do not cure symptoms, they do reduce the severity of symptoms quite quickly - The inability to cure the illness is a limitation of psychological treatments
126
What are the ethical issues with CBT?
- Generally considered to be ethically sound - When challenging patient's paranoia, CB therapists may be accused of interfering with their freedom of thought
127
What are the ethical issues with family therapy?
- Risk of social coercion: family members may not wish to participate in the therapy but feel obliged to - The therapist will have to work hard to remain neutral and avoid taking sides
128
What are the ethical issues with token economy?
- Rewards become more available to those with milder symptoms as they are more able to engage in positive behaviours - This leads to discrimination of those who are severely affected
129
Make a conclusion about the ethical issues of psychological therapies
Overall, there are a number of ethical issues associated with treatments for sz, in comparison with drug treatment, they are considered less concerning and therefore looked upon more favourably. However, issues such as victimisation and social control are potentially possible meaning that all psychological treatments must be conducted with the utmost care and diligence.
130
What is the problem with studies into the effectiveness of psychological therapies that compare patients before and after the therapies are administered?
There are a number of methodological issues
131
What are the methodological issues with studies into the effectiveness of psychological therapies that compare patients before and after the therapies are administered?
- There is no inclusion of a control group for comparison, therefore any changes that occur could be due to individual differences such as patient variables and 'spontaneous recovery' - Where control groups are included, random allocation is rarely used to assign patients to groups. The researcher could potentially place patients with less severe symptoms in the treatment group and their improvement is likely to be more pronounced than those with more severe symptoms
132
Name the strengths of the psychological explanations of sz
- A wealth of evidence supports the role of the family in the development of sz - A large body of research that supports the cognitive dysfunction explanation of sz - The cognitive explanation explains both positive and negative symptoms
133
Name the weaknesses of the psychological explanations of sz
- The family dysfunction explanation blames parents for their children's problems - High expressed emotion could be a symptom rather than a cause - Cognitive dysfunction could be a symptom rather than a cause of sz - Cognitive dysfunction fits better with the biological explanation than the family dysfunction explanation does
134
Name 3 studies that provide evidence for the role of family in the development of sz
- Read (2005) - Berry (2008) - Berger
135
What did Read find?
69% of women and 59% of men with sz had a history of physical abuse, sexual abuse or both - indicating early trauma in childhood was a risk factor
136
What did Berry find?
Adults with an insecure attachment were more likely to develop sz - indicating relationships with the primary caregiver could contribute to the development of sz
137
What did Berger find?
Sz sufferers reported a greater recall of both double bind statements by their mothers than non-sz - indicating this communication style is implicated in sz.
138
What is a problem with research that supports the role of the family in the development of sz?
Data was collected retrospectively, suggesting caution should be exercised as the recall of sz may be highly unreliable
139
Why is it a limitation of the family dysfunction explanation that parents are blamed for their children's problems?
- It adds insult to injury to mothers who have already suffered seeing their child's descent into schizophrenia and will likely be responsible for the lifelong care of that child - The evidence for double bind and schizophrenogenic mothers is minimal and much of it comes from early techniques which involved assessing the personality of the mother for "crazy-making characteristics"
140
Why might high expressed emotion be a symptom rather than a cause of sz?
- Having a sz member in the family would affect the communication and interactions of the rest of an otherwise healthy family - Kalafai and Torabi found that negative emotional climate in Iranian culture led to a higher relapse in schizophrenia. This suggests that this isn't the family that causes sz, otherwise there would be a higher onset rate in Iran.
141
Name the 2 studies that support the cognitive dysfunction explanation
- Stirling (2006) - Meyer-Linderberg (2002)
142
Outline what Stirling found
- Participants with sz took over twice as long to complete the stroop task than controls - They were unable to suppress the impulse to read the word rather than ink the colour
143
What is the stroop task?
The Stroop test requires individuals to view a list of words that are printed in a different colour than the meaning of the word. Participants are tasked with naming the colour of the word, not the word itself, as fast as they can.
144
What did Meyer-Linderberg find?
- Found reduced activity in the prefrontal cortex of schizophrenics when they did a task involving the Wisconsin Card Sorting Test (testing working memory) - This is consistent with the cognitive dysfunction explanation that schizophrenics have poor reasoning and memory skills
145
Why is there debate over whether cognitive dysfunction is a cause of symptom of sz?
For example: Having hallucinations could trigger malfunction in the working memory as it tries to rationalise what is happening. Therefore, the symptom causes the dysfunction rather than vice versa.
146
Why might cognitive dysfunction be considered a more complementary explanation alongside the biological explanation than family dysfunction?
- It can be traced back to neurological abnormalities in the brain which are highly likely to be an inherited trait or caused by too much dopamine - It is highly probable that sz has some basis in biology, so the cognitive explanation works well within the biological model as it explains the symptom whilst biology explains the cause
147
How can positive and negative symptoms both be explained in terms of dysfunctional thought processes?
- Eg: metarepresentation and memory deficits can account for positive symptoms such as hallucinations and delusions - Eg: central control can explain negative symptoms such as poverty of speech and thought disorder
148
What is the interactionist approach?
It acknowledges that there are biological, psychological and social factors in the development of sz.
149
What is the diathesis stress model?
The theory that both a vulnerability to sz and a stress-trigger are necessary in order to develop the disorder
150
Who investigated diathesis stress in 1962?
Meehl
151
What was vulnerability (diathesis) a result of, according to Meehl?
- Genetics - The result of a single schizogene leading to a schizotype personality who was, by nature, more sensitive to stress
152
Who, according to Meehls, could develop sz?
- Only those who have the schizogene (no amount of stress could otherwise produce it) - For those with the gene, chronic stress in childhood (particularly the presence of a schizophrenogenic mother) could lead to the development of sz
153
What is the modern day understanding of vulnerability (diathesis)?
- The idea of a single schizogene is outdated - It is thought a number of genes increase diathesis, or even early trauma
154
Who conducted a study into early trauma and its effect on stress?
Read (2011)
155
What did Read find?
Severe trauma can alter a developing brain and the hypothalamic-pituitary system becomes overactive, making a person more susceptible to stress later in life
156
What is the 21st century view of stress that can cause sz?
- Parents are no longer considered to be the sole cause of stress, but just one of many potential environmental triggers - Houston said that a stressor in terms of sz is anything which risks triggering the illness - Cannabis is thought to be one of the biggest stressors as the risk increases up to 7 times with use
157
What is the problem with solely using drug therapy?
If there are environmental triggers that are likely to bring on an episode (which is common for sz sufferers) then as soon as the patient stops taking drugs those triggers will continue to cause symptoms
158
What is the problem with solely using CBT?
There is clear evidence to show the role of excess dopamine in sz symptoms and it is hard to see how CBT could reduce those levels. So although a patient may understand the symptoms... they will still have them
159
Why is interactionism so important?
If there are a combination of reasons for why someone develops sz then it will be necessary to have a combination of therapies to treat it - biological to treat the genetic component and psychological to treat the environmental
160
Name the strengths of the interactionist approach
- Tienari (2014) - Tarrier (2004) - Avoids the treatment-causation fallacy - Twin studies - It does not adopt extreme viewpoints (eg: wholly biological or wholly psychological)
161
What was Tienari's sample?
19,000 children who were born to mothers of sz in Finland from 1960 - 1979 and adopted into non-sz families
162
What did Tiennari investigate?
She assessed the adoptive parents on child-rearing styles and compared the children with a control group with no genetic risk
163
What did Tienari find?
Child rearing styles associated with high levels of criticism and conflict and low levels of empathy were implicated in the development of sz, but only in the experimental group where there was a genetic risk
164
What were Tarrier's findings?
In his study of 315 patients who were randomly allocated either: - medication and CBT condition - medication and supportive counselling condition - Control group of medication only those patients who engaged in a combination therapy had a greater reduction in severity of symptoms than those treated only with drugs
165
What is the treatment-causation fallacy?
The assumption that because the treatment works that the cause must be whatever the treatment treats. Eg: Assuming that if drugs work that sz is caused by excess dopamine or because CBT works that sz is result of faulty cognitions
166
Why is the treatment-causation fallacy dangerous?
Often therapies treat the symptoms, not the underlying cause. This means the real cause of sz may just be suppressed by drug treatment or family therapy. A soon as the therapy stops the symptoms will return.
167
Why do twin studies show the importance of the interactionist approach?
Whilst both twins have inherited the same genes, they may experience different interactions within the family, different stressful life events, or a different pre-natal environment in terms of placenta size and nutrition. Therefore, diathesis may be triggered in one twin but not the other.
168
What is schizophrenia?
- A serious mental disorder experienced by about 1% of the world population.
- It is more commonly diagnosed in men, city-dwellers and lower scio-economic groups
- The symptoms of schizophrenia can interfere severely with everyday tasks, so that many people with it can end up homeless or hospitalised.
169
What is the link between diagnosis and classification?
- They are interlinked
- In the medical approach, to diagnose a specific disorder, you need to distinguish one from another
- This is done by identifying clusters of symptoms that occur together and classifying this as one disorder
- Diagnosis is then possible by identifying symptoms and deciding what disorder the person has
170
What are the two major systems for the classification of mental disorder?
- World Health Organisaton's ICD-10
- American Psychiatric Association's Diagnostic and Statistical Manual DSM-5
171
How do the ICD-10 and DSM-5 differ in classifying schizophrenia?
They differ slightly in their classification of schizophrenia e.g. in the DSM system 1 positive symptom must be present whereas 2 or more negative symptoms are sufficient under ICD
172
How did previous editions of the ICD and DSM recognise subtypes of schizophrenia?
- They mainly involved powerful hallucinations and delusions
- Both systems dropped subtypes because they tended to be inconsistent
173
What are positive symptoms?
- Any additional experiences beyond those of ordinary existence such as hallucinations and delusions
174
What are hallucinations?
- Unusual sensory experiences
- Some are related to events in the environment and some aren't
- Hallucinations can be experienced in relation to any sense e.g. seeing distorted facial expressions
175
What are delusions?
- Also known as paranoia, they are irrational beliefs
- Common delusiosn include being an important historical, political or religious figure
- They commonly involve bbeing persecuted or having superpowers
- They can also concern the body and a person may believe they are under external control --> behave in ways that others would deem bizarre
176
What are negative symptoms?
- They involve the loss of usual abilities and experiences such as speech poverty and avolition
177
What is speech poverty?
- Characterised by changes in pattern of speech
- Deemed negative because there's emphasis on the reduction in the amount and quality of speech produced --> can be accompanied by a delay in the person's verbal responses during a conversation
- Speech disorganisation is when speech becomes incoherent or the speaker changes topic mid-sentence BUT this is seen as a POSITIVE symptom
178
What is avolition?
- Sometimes called apathy
- Can be described as finding it difficult to begin or keep up with goal-directed activity
- People with schizophrenia often have sharply reduced motivation to carry out a range of activities
- 3 signs include: poor hygiene/grooming + lack of persistence in work/education + lack of energy
179
In what ways does the diagnosis of schizophrenia have good reliability?
- Prior to DSM-5, reliability was low but has now improved
- Osorio et al report excellent repeatability for diagnosis in 180 indiviulas using the DSM-5
- Pairs of interviewers reached inter-rater reliability of +9.7 and test-retest reliability of +9.2
180
In what ways does the diagnosis of schizophrenia have low validity?
- Cheniaux (2009) had 2 psychiatrists independently assess the same 100 clients using ISD and DSM criteria and found that 68 were diagnosed under the ICD system and 39 under DSM
- This suggests that schizophrenia is either over/under diagnosed, meaning criterion validity is low
181
In what ways does the diagnosis of schizophrenia have good validity?
- In the Osorio (2019) study, there was an excellent agreement between clinicians when they used 2 measures to diagnose schizophrenia both derived from the DSM system
- This suggests that the criterion validity for diagnosis is actually good, provided it takes place within a single diagnostic system
182
In what ways is the diagnosis of schizophrenia affected by co-morbidity?
- Schizophrenia is commonly diagnosed with other conditions
- Buckley et al's review found that about half of those diagnosed with schizophrenia also had a diagnosis of depression or substance abuse
- This is a problem for classification because it means that schizophrenia may not exist as a distinct condition
183
In what ways is the diagnosis of schizophrenia affectd by gender bias?
- Since the 1980s, men have been diagnosed more commonly that women --> ratio of 1.4:1 (Fischer and Buchanan 2017)
- One possible explanation is that women are less vulnerable than men, perhaps due to genetic factors
- HOWEVER it seems more likely that women are underdiagnosed because they have closer relationships and hence get more support (Cotton et al. 2009)
184
In what ways is the diagnosis of schizophrenia affected by culture bias?
- Some symptoms of schizophrenia e.g. hearing voices have different meanings in different cultures
- Black British people are up to 9x more likely to receive a diagnosis than white British people
- There seems to be an overinterpretation of symptoms in black British people --> suggesting discrimination from a culturally biased diagnostic system
185
In what ways does the diagnosis of schizophrenia suffers from symptom overlap?
- There is considerable overlap between the symptoms of schizophrenia and bipolar disorder
- This makes it hard to distinguish one from the other, leading to issues with classification and diagnosis
186
What is the "family studies" explanation for schizophrenia?
- They have confirmed that the risk of schizophrenia increases in line with genetic similarity
- Of course, family members tend to share environments as well as their genes, so the correlation represents both BUT family studies still give good support for the importance of genes in schizophrenia
187
What is the "candidate genes" explanation for schizophrenia?
- Early research looked for a single genetic variation, in the belief that one faulty gene could explain schizophrenia
- HOWEVER, it appears that a number of different genes are involved i.e. polygenic, most likely coding for neurotransmitters
188
What did the Ripke et al. (2014) study show in relation to candidate genes?
- It combined all previous data from genome-wide studies of schizophrenia
- The genetic makeup of 37,000 people with schizophrenia was compared to 113,000 controls.
- 108 separate genetic variations were associated with slightly increased risk of schizophrenia
- It also appears that schizophrenia is aetiologically heterogeneous
189
What is the role of mutation in explaining schizophrenia?
- There could be mutations in parental DNA which can be caused by radiation, poison or viral infection
- Evidence for this comes from positive correlations between paternal age and risk of schizophrenia, increasing from around 0.7% with fathers under 25 to over 2% in fathers over 50 (Brown et al. 2002)
190
What is the original dopamine hypothesis?
- It was based on the discovery on the drugs used to treat schizophrenia (antipsychotics to increase DA) caused symptoms similar to those in people with Parkinson's disease (linked to low DA levels)
- Therefore, schizophrenia may be the result of high dopamine levels (hyperdopaminergia) in subcortical areas of the brain
- For example, an excess of DA receptors in pathways from the subcortex to Broca's area (speech production) may explain some symptoms such as speech poverty or hallucinations
191
What did Kenneth Davis et al. propose?
- The addition of cortical hypodopaminergia i.e. low dopamine levels in the brain's cortex
- For example, low DA in the prefrontal cortex (linked to thinking) could explain the negative symptoms
- It has been suggested that cortical hypodopaminergia causes subcortical hyperdopaminergia
192
Whar does Howes et al. suggest about dopamine?
- It seems that both genetic variations and early experiences of stress, both psychological and physical make some people more sensitive to cortical hypodopaminergia and hence subcortical hyperdopaminergia
193
Where is there research support for the genetic explanation?
- Family studies such as Gottesman show that risk increases with genetic similarity
- Adoption studies such as Tienari et al. (2004) show that biological children of parents with schizophrenia are at heightened risk even if they are adopted
- Hilker et al. (2018) showed a concordance rate of 33% identical twins and 7% for non-identical twins
194
In what way do environmental factors limit the genetic explanation?
- Biological risk factors include birth complications and smoking cannabis in teenage years
- Psychological risk factors include childhood trauma which leaves people more vulnerable to adult mental health problems in general, but more specifically schizophrenia
195
What did Morkved et al. (2017) show?
- 67% of people with schizophrenia and related disorders reported at lest once childhood trauma as opposed to 38% of a matched group with non psychotic mental health issues
196
What is the application of the genetic explanation?
- Genetic counselling
197
Where is there evidence for dopamine?
- First, amphetamines increase DA and worsen symptoms of those with schizophrenia and induce symptoms of those without (Curran et al. 2004)
- Secondly, antipsychotic drugs reduce DA and reduce the intensity of symptoms
- Thirdly, some candidate genes act on the production of DA or DA receptors
198
Why is the role of glutamate a weakness of the dopamine hypothesis?
- Post-mortem and live scanning studies consistently show a central role of glutamate in several brain regions of people with schizophrenia (McCrutcheon et al. 2020)
- Furthermore, several candidate genes for schizophrenia are believed to be involved in glutamate production or processing
- This means there are other neurotransmitters involved
199
Why is the amphetamine psychosis not particularly strong evidence to support the dopamine hypothesis?
- Amphetamines (speed) can reproduce symptoms of schizophrenia. Catherine Tenn et al. (2003) induced schizophrenia-like symptoms in rats using amphetamines and then relieved symptoms using drugs that reduce DA action.
- However, other drugs that also increase DA levels (e.g. apomorphine) do not cause schizophrenia-like symptoms (Dépatie and Lal 2001). Also, Justin Garson (2017) has challenged the idea that the symptoms of amphetamine psychosis closely mimic schizophrenia.
