Schizophrenia Flashcards

Question

Describe the neural correlates; positive symptoms

Answer 1

-Allen 2007- scanned the brains of SZ patients who experience auditory hallucinations while they identified voice clips as either their own or someone else’s voice. Compared to controls, the SZ patients had lower activation in the superior temporal gyrus (processes sound) and anterior cingulate gyrus (processes emotion). The hallucination group also made more errors than the control group. Therefore we can conclude that reduced activity in these 2 areas of the brain is a neural correlate of auditory hallucination .

Answer 2

+ lots of evidence for genetic explanations . Very strong evidence for genetic vulnerability to SZ from multiple sources . Gottesman- genetic similarity is closely related to shared risk - Tienari- biological children of SZ sufferers are still at heightened risk even when adopted into families with no history of SZ - Ripke- particular genetic variations significantly increase the risk of SZ - therefore, genetics do seem to play a role in the onset of SZ

Answer 3

- Support for the role of dopamine . Antipsychotics (reduce dopamine) also relate to symptoms- Tauscher 2014 - However Ripke found that some of the genes they identified were implicated in the production of neurotransmitters other than dopamine (such as glutamate) - So the dopamine hypothesis is not a complete explanation of SZ - so the dopamine hypothesis is not a complete explanation of SZ

Answer 4

- neural correlates are useful in flagging up particular brain systems that may not be working properly, but do not prove that unusual activity in a certain region of the brain causes a symptom. Other untested factors may be involved. - so the existence of neural correlates in SZ tells us relatively little

Answer 5

- SZ can take place in the absence of a family history of the disorder - This may be explained by a mutation in parental DNA, which may be caused by radiation, poison, viral infection, etc - Brown 2002 found a positive correlation between age of a persons father (associated with increased risk of sperm mutation) and risk of SZ . 0.7% in under 25s . 2% in over 50s - so even within biologically explanations, we are not sure where the true cause lies

Answer 6

- Biological factors have a lot of evidence, but if the concordance rate of MZ twins is less than 50%, something else must be playing a part - So psychological explanations, such as the role of the family, must be important too - Therefore, there is too much emphasis on nature, making the explanation biologically reductionist

Answer 7

Family Dysfunction - The Schizophrenogenic Mother - Double-Bind Theory - Expressed Emotion

Answer 8

Metarepresentation Central control

Answer 9

- Fromm-Reichmann(1948) noted that many of her patients spoke of a particular type of parent, which she called the Schizophrenogenic mother - Characteristics of the schizophrenogenic mother: cold, rejecting, controlling, creates a family climate characterised by tension and secrecy - Leads to distrust that later develops into paranoid delusions

Answer 10

- Bateson (1972) emphasised the role of communication within a family as a risk factor of SZ - The child regularly finds themselves trapped in situations where they fear doing the wrong thing, but receive mixed messaged about what this is - When the child ‘gets it wrong’ (which is often) they are punished by withdrawal of love, which leaves the child thinking the world is confusing and dangerous, and is reflected in symptoms like disorganised thinking and paranoid delusions

Answer 11

- The level of (usually negative) emotion expressed towards a patient by their carers - Contains several elements . Verbal criticism (and occasionally violence) . Hostility, including anger and rejection . Emotional over-involvement in the life of the patient - These high levels of EE are a serious source of stress for the patient and often cause relapse in SZ patients - Could also be the stress that triggers the onset of SZ in already vulnerable people (e.g those with a genetic link to SZ (Diathesis-stress model)

Answer 12

- Cognitive explanations focus on the role of mental processes - SZ is characterised by disruption to normal though processing, suggesting that cognition is likely to be impaired - Frith (1992) identified 2 kinds of dysfunctional thought processing that could underlie some symptoms . Metarepresentation . Central control

Answer 13

- The cognitive ability to reflect on thoughts and behaviour - Allows us to have insight into our intentions and goals, and to interpret actions of others - Dysfunction in Metarepresentation would disrupt out ability to recognise our behaviour and thoughts and thoughts as our own and not someone else’s - Explains auditory hallucinations and delusions such as thought insertion (someone projecting thoughts into ones own mind)

Answer 14

- The cognitive ability to suppress automatic responses while we perform deliberate actions instead - Inability to do this may lead to disorganised speech and thought disorder - SZ sufferers tend to experience derailment of thoughts and spoken sentences because each word triggers association, and the patient cannot suppress automatic responses to these

Answer 15

+ Support for family dysfunction as a risk factor .Berry-(2005)adults with insecure attachments to their primary carer are more likely to have SZ .Read-(2008)- 69% of female and 59% of male SZ inpatients had a history of physical abuse, sexual abuse, or both during childhood -so family dysfunction does appear to play a role in the development of SZ -however, information about childhood experiences was gathered after SZ symptoms had developed, memories may have been distorted, weakening validity + Strong evidence for cognitive explanations .stirling (2006) compared 30 SZ sufferes to 18 controls on the stroop test. Patients took twice as long to name the ink colours - this supports the central control theory, providing validity for the explanation

Answer 16

- Lack of evidence for schizophrenogenic mother and double-bind theory . Both theories are based on clinical observations of patients and assessing the patients mothers for ‘crazy-making’ characteristics - These theories also blame parents of SZ suffers, when parens are already dealign with having a child with SZ and likely the caring responsibilities too, adding unnecessary added trauma - so these 2 theories are not appropriate nowadays - Can’t infer causes of SZ from cognitive explanations -Links between symptoms and faulty cognition are clear, but we do not know the origins of these cognitions -So while cognitive theories can explain proximal causes of SZ (what causes current symptoms)< they don’t explain the distal causes (orgins of the condition) - Psychological explanations don’t consider biological factors . Could be that both biological and psychological factors can separately produce the same symptoms . Could be diathesis-stress model- SZ more likely due to genetic vulnerability and triggered by stress? - so psychological explanations are reductionist

Answer 17

Drug therapies

Answer 18

Typical antipsychotics- traditional Atypical antipsychotics- second-generation

Answer 19

- Have been taken since the 1950s - Strong link with the original dopamine hypothesis - Typical antipsychotics act as antagonist for dopamine - Antagonists= reduce the action of a neurotransmitter - Dopamine antagonist work by blocking dopamine receptors in the synapses of the brain, reducing the action of dopamine - Reduce positive symptoms - Example: Chlorpromazine

Answer 20

- Have been used since the 1970s - The aim of developing newer antipsychotics was to improve upon the effectiveness of drugs in suppressing the symptoms of psychosis (such as SZ). And also minimise the side effects - Typically target a range of NTs, including dopamine and serotonin - Claim to have an effect on negative symptoms as well as positive - Examples: Clozapine and Risperidone

Answer 21

- Initially, when a patient begins taking Chlorpromazine, dopamine levels build up and then its production is reduced - According to the dopamine hypothesis, this normalises neurotransmission in key areas of the brain, and reduced symptoms like hallucinations - Also has a sedation effect, so is also used to calm anxious patients

Answer 22

- Clozapine binds to dopamine receptors in the same way that Chlorpromazine does, but in addition it acts on serotonin and glutamate receptors - More effective than typical antipsychotics- reduces depression and anxiety in patients and improves cognitive functioning - Also improves mood- important as 30-50% of SZ sufferers attempt suicide at some point

Answer 23

- Is as effective as Clozapine but safer (fewer side effects) - Developed because Clozapine caused some deaths due to a blood condition called agranulocytosis - Like Clozapine, Risperidone binds to dopamine and serotonin receptors - Risperidone binds more strongly to dopamine receptors than Clozapine and is therefore effective in much smaller doses than most antipsychotics and has fewer side effects

Answer 24

+ Evidence for effectiveness - lots of evidence to support that typical and atypical antipsychotics are at least moderately effective in tackling the symptoms of SZ . Thornley found that Chlorpromazine was associated with better overall functioning and reduced symptom severity compared to a placebo. Relapse rate was lower in group taking the antipsychotic - so antipsychotics appear to be reasonably effective

Answer 25

- Typical antipsychotics associated with- dizziness, agitation, weight gain - Atypical antipsychotics were developed to reduce side effects but they still exist - therefore antipsychotics are not a problem-free treatment

Answer 26

- Use of antipsychotics strongly linked with the original dopamine hypothesis (too much dopamine), but a lot of evidence says that this is not a complete explanation- new hypothesis not enough dopamine - So it is not clear how antipsychotics (dopamine antagonists) can help with SZ when they reduce dopamine activity - Modern dopamine hypothesis suggests that antipsychotics shouldn’t work - so this has undermined the faith of some people that antipsychotics do really work

Answer 27

- Chemical cosh= drugs used to subdue patients in an institution - Antipsychotics are used in hospital siutations to calm patients and make them easier to work with, rather than for the benefit of the patients - While short-term use to calm patient is recommended by the National Institute for Health and Clinical Excellence, this can be seen as human rights abuse - so there are some serious ethical issues within the use of antipsychotics in a medical setting

Answer 28

CBT Family Therapy Token Economies

Answer 29

- 5 - 20 sessions - Can occur in groups or individually - Helps patients to identify irrational thoughts and change them - Considers less-threatening possibilities of the patients beliefs - Will not remove symptoms of SZ but can help them to cope with them by allowing them to make sense of how their feelings are impacted - Just knowing where their symptoms come from can reduce patient’s anxiety - Delusions may be challenged so the patient can learn that they’re not reality

Answer 30

- Takes place within the family environment - Aims to improve communication between family members - Originally based on the idea that the family as the root of the problem (double bind theory, Schizophrenogenic mother) - Nowadays: more focused on reducing the stress in the family (expressed emotion) - Strategies: . Form a therapeutic alliance with all family members . Reducing the stress of caring for a relative with SZ . Improving the family ability to anticipate and solve problems . Helping family members achieve a balance between caring and maintaining their own lives . Improving the family’s beliefs about and behaviour towards SZ - These strategies reduce levels of stress and EE, while increasing the chances of patients complying with medication - Reduces likelihood of relapse and re-admission to hospital

Answer 31

- Reward systems used to manage patients’ maladaptive behaviours that have developed as a result of spending long periods of time in psychiatric hospitals (e.g. spending all day in their pajamas, bad hygiene) - Does not cure SZ but improves quality of life, meaning patients will find it easier to live outside of a hospital setting - Tokens (e.g. coloured discs) are given immediately to patients when they have carried out a desirable behaviour as a form of operant conditioning- immediacy is important to avoid a reduced effect due to a delayed reward (delay discounting) - Tokens have no value in themselves, but they can be swapped later for rewards - Could be sweets, magazines, cigarettes or services (room cleaned, going on walk outside hospital) - Tokens are secondary reinforcers- only have value once the patient has learnt that they can be exchanged for rewards

Answer 32

+ There is supporting evidence for the effectiveness of psychological treatments - eg Jauhar 2014 found that CBT has a small but significant effect on both positive and negative symptoms of SZ - Pharoah found that family therapy significantly reduces hospital readmission and improves the quality of life for patients and their families. - therefore, CBT and family therapy are valid ways of treating schizophrenia

Answer 33

- Results are inconsistent across different studies. Many small-scale studies comparing patients before and after psychological treatments have found positive results, but these studies often lack a control group,or patients are not randomly allocated to their treatment condition. - so, the supporting evidence for psychological therapies is problematic

Answer 34

- Psychological treatments improve quality of life in a number of ways. CBT allows patients to make sense of, and in some cases, challenge their symptoms - Family therapy helps by reducing the stress of living with schizophrenia, both for the patient and the other family members. Token economies make patients’ behaviour more socially acceptable so that they can reintegrate into society - but no treatments cure SZ so psychological treatments are weak overall

Answer 35

- Token economies have ethical issues . Token economies are controversial as the rewards are more available to patients with mild symptoms, as those with severe symptoms may be unable to comply with desirable behaviours. Therefore severely ill patients are discriminated against - CBT have ethical issues . Challenging a persons paranoia can interfere with freedom of thought. - If a patient believed that the government was highly controlling, challenging this belief could easily stray into modifying their politics. - so therapists should be careful when challenging patients thoughts

Answer 36

Acknowledges that there are biological, psychological and societal factors in the development of schizophrenia - Biological factors . Genetic vulnerability . Neurochemical and neurological abnormality - Psychological factors . Stress- life events and daily hassles

Answer 37

Diathesis= vulnerability Stress= a negative psychological experience - The diathesis stress model says that both vulnerability to SZ and a stress-trigger are necessary to develop SZ - One or more underlying factors make a person particularly vulnerable to developing SZ but the onset of the condition is triggered by stress

Answer 38

- In the original diathesis-stress model, Meehl, 1962, the diathesis was the result of a single gene ‘schizogene’ - This led to the development of a ‘Schizoptypic personality’a characteristic of which was sensitivity to stress - According to Meehl, if a person doesn’t have the schizogene, then no amount of stress could lead to SZ - Carriers of the gene, however, who experience chronic stress through childhood and adolescence, particularly those with a Schizophrenogenic mother, could get SZ

Answer 39

- We now know now there is no single ‘schizogene’ but rather many genes appear to increase genetic vulnerability slightly- Ripke - Also, diathesis may not just be genetic but rather it could include psychological trauma - Read- proposed a neurodevelopment model in which early trauma alters the developing brain- Early and severe enough trauma (e.g child abuse) can seriously affect brain development e.g. the hypothalamic-pituitary-adrenal (HPA) system can become over-active, making the individual more vulnerable to later stress

Answer 40

Originally, stress was seen as psychological, and generally related to parenting A modern definition includes anything that risk triggering SZ A lot of recent research has considered cannabis use as a trigger for SZ - cannabis is a stressor because it increases SZ risk by up to 7x (likely because cannabis interferes with the dopamine system) - however, most people who smoke cannabis do not develop SZ, there must be one or more vulnerability factors

Answer 41

Compatible with both biological and psychological treatments Most common combination: antipsychotics + CBT

Answer 42

- there is evidence to support the dual role of vulnerability and stress in the development of schizophrenia Teinari 2004- investigated the combination of genetic vulnerability and parenting style (the trigger). Children adopted from 19,000 Finnish mothers with schizophrenia between 1960 and 1979 were followed up. Their adoptive parents were assessed for child-rearing style, and the rates of schizophrenia were compared to those in a control group of adoptees without any genetic risk. A child-rearing style characterised by high levels of criticism and conflict and low levels of empathy were implicated in the development of SZ, but only for children with high genetic risk (not in the control group). This suggests that both genetic vulnerability and family-related stress are important in developing SZ- genetically vulnerable children are more sensitive to parenting behaviour - this is very strong direct support for the importance of adopting an interactionist approach to schizo, including handing on to the idea that poor parenting is a possible source of stress

Answer 43

- there is support for the usefulness of adopting an interactionist approach from studies comparing the effectiveness of combinations of biological and psychological treatments for schizophrenia versus biological treatments alone - as Turkington (2006) points out it is not really possible to use combinations of treatments without adopting an interactionist approach - studies show an advantage to using combinations of treatments for SZ. For example, in one study by Tarrier 2004, 315 patients were randomly allocated to a medication + CBT group, medication + supportive counselling, or a control group. Patients in the 2 combination groups showed lower symptom levels than those in the control group (medication only) although there was no different in rates of hospital readmission - studies like this show that there is a clear practical advantage to adopting an interactionist approach in the form of superior treatment outcomes, and therefore highlight the importance of taking an interactionist approach

Answer 44

The classic model of a single schizogene and schizophrenic parenting style as the major source of stress is now known to be very over-simple Multiple genes increase vulnerability to schizophrenia, each having a small effect on its own; there is no single schizogene. Also, stress can come in many forms, including (but not limited to) dysfunctional parenting. - therefore, vulnerability and stress do not have one singe source In fact, it is now believed that vulnerability can be the result of early trauma as well as genetic make-up, and that stress can come in many forms including biological. In one recent study by Houston childhood sexual trauma emerged as a vulnerability factor whilst cannabis use was a trigger - this shows that the old idea of diathesis as a biological factor and stress as a psychological factor has turned out to be overly-simple - this is a problem for the old idea of diathesis, but not newer models

Answer 45

- Tuckington argue that there is a good logical fit between the interactionist approach and using combination treatment - however, the fact that combined treatments are more effective than either on their own does not necessarily mean the interactionist approach is correct - similarly, the fact that drugs help does not mean schizophrenia is biological in origin. -this error of logic is called the treatment-causation fallacy

Answer 46

Two or more illnesses occur together in the same person Eg schizo and depression Miss other symptoms so only diagnoses 1 illness Decreases reliability- diff doctors diagnose diff disorders Decreases validity- criteria for diag schizo incorrect might not be two separate conditions

Answer 47

Symptoms of a disorder may not be unique to that disorder but may also be found in other disorders, making accurate diagnosis difficult - decreases reliability- doctors wont agree on a diagnosis- diagnose with diff disorders - decreases validity- if the criteria incorrectly diagnoses someone as having schizophrenia- diagnosed with wrong disorder

Answer 48

Symptoms of a disorder may not be unique to that disorder but may also be found in other disorders, making accurate diagnosis difficult

Answer 49

For one patient whose symptoms remain the same, different doctor give the same diagnosis consistently For different patients with the same symptoms, one doctor gives all patients the same diagnosis consistently

Answer 50

Extent to which a diagnosis reflects an actual disorder so the DSM measures what it says it measures The criteria used to make the diagnosis allow us to correctly identify people who have a particular illness Also avoid incorrectly diagnosing those who don’t have the illness

Answer 51

Make the same measurement to see how similar their measurements are Becke found that diagnoses of schizo in 1962 was 52% similar and in 2005 the diagnoses of schizo was 81%= suggests the diagnosis of schizo is becoming more reliable overtime

Answer 52

-1972 - 8 volunteers went to mental health hospital - all mentally healthy but pretended they were hearing voices - hallucinations - admitted into hospital and then instructed to behave normally again - see how long it takes doctors to realise patients were not schizophrenic Findings - even normal behaviours interpreted as abnormal - writing behaviour - 1st voluntter released after 7 days - final 52 days - doctors in the hospital made incorrect diagnoses- doctors diagnosis lacked validity

Answer 53

1. Cultural bias 2. Gender bias 3. Co-morbidity 4. Overlap of symptoms

Answer 54

Researchers misrepresent the differences between cultures Reduces reliability and validity of diagnosis as doctors use the social norms of their own culture to decide whether a patients behaviour match any of the symptoms of SZ- this can lead to over diagnosis of sz in patients from a different culture to the doctors own culture

Answer 55

Cochrane How commonly people diagnosed with schizophrenia across Britain and across the Caribbean. - 1% in Britain - 1% in Caribean - afro-caribean peopel 7 x more lielyl to be diagnosed with schizo due to cultural bias of dcotrs Rate of schizo similar in both places

Answer 56

When the differences between men and women are misrepresented 1. Alpha bias 2. Beta bias = misdiagnosed or ignored Diff diagnosis depending on their gender

Answer 57

1988 Loring and Powell whether gender affects the diagnosis the patient receives - gave bunch of doctors descriptions of a patient- some received description that the patient was male ad some female- always same symptoms - asked to diagnose patient Male- 56% doctors diagnosed with SZ Female- 20% Displayed gender bias- alpha bias Lacked reliability

Schizophrenia Flashcards

(83 cards)