Schizophrenia

Question 1

What percentage of the world population experiences schizophrenia?

Answer 1

About 1%

Schizophrenia is more commonly diagnosed in men, city-dwellers, and lower socioeconomic groups.

Question 2

What are the two major systems for the classification of mental disorders?

Answer 2

• World Health Organisation’s International Classification of Disease (ICD-10)
• American Psychiatric Association’s Diagnostic and Statistical Manual edition 5 (DSM-5)

ICD-11 has been published but won’t be used for diagnosis until 2022.

Question 3

What is the difference in diagnostic criteria for schizophrenia between DSM-5 and ICD-10?

Answer 3

DSM-5 requires at least one positive symptom, while ICD-10 requires two or more negative symptoms

Previous editions of ICD and DSM recognized subtypes of schizophrenia, which have since been dropped.

Question 4

Define positive symptoms of schizophrenia.

Answer 4

Additional experiences beyond ordinary existence, including hallucinations and delusions.

Question 5

What are hallucinations?

Answer 5

Unusual sensory experiences that can occur in any sense

Examples include hearing voices or seeing distorted images.

Question 6

What are delusions?

Answer 6

Irrational beliefs, often involving persecution or having special powers.

Question 7

Define negative symptoms of schizophrenia.

Answer 7

The loss of usual abilities and experiences, such as speech poverty and avolition.

Question 8

What is speech poverty?

Answer 8

Reduction in the amount and quality of speech, characterized by delays in responses.

Question 9

What is avolition?

Answer 9

Difficulty in beginning or sustaining goal-directed activities

Identified signs include poor hygiene, lack of persistence, and lack of energy.

Question 10

What does reliability mean in the context of psychiatric diagnosis?

Answer 10

Consistency in diagnosis, both inter-rater and test-retest reliability.

Question 11

What did Flávia Osório et al. (2019) report about the reliability of schizophrenia diagnosis using DSM-5?

Answer 11

Excellent reliability with inter-rater reliability of +.97 and test-retest reliability of +.92.

Question 12

What is a limitation of the diagnosis of schizophrenia related to validity?

Answer 12

Criterion validity is low, suggesting schizophrenia might be over- or underdiagnosed.

Question 13

What is co-morbidity in the context of schizophrenia?

Answer 13

The occurrence of schizophrenia alongside other conditions, such as depression or substance abuse.

Question 14

What gender bias exists in the diagnosis of schizophrenia?

Answer 14

Men are diagnosed more commonly than women, possibly due to underdiagnosis of women.

Question 15

What is culture bias in the diagnosis of schizophrenia?

Answer 15

Differences in symptom interpretation across cultures, leading to potential misdiagnosis.

Question 16

What is symptom overlap in schizophrenia?

Answer 16

The presence of similar symptoms between schizophrenia and other conditions, such as bipolar disorder.

Question 17

What is the relationship between genetic similarity and the risk of developing schizophrenia?

Answer 17

Risk of schizophrenia increases with genetic similarity:
* 2% for a relative like an aunt
* 9% for a sibling
* 48% for an identical twin

Based on findings from Gottesman’s family study (1991)

Question 18

What are candidate genes in the context of schizophrenia?

Answer 18

Candidate genes refer to genes that are believed to be involved in the risk of developing schizophrenia, indicating that the disorder is polygenic.

Early research focused on identifying a single genetic variation, but later findings showed multiple genes contribute.

Question 19

What significant finding did Ripke et al. (2014) discover regarding genetic variations and schizophrenia?

Answer 19

108 separate genetic variations were associated with slightly increased risk of schizophrenia in a study comparing 37,000 diagnosed individuals to 113,000 controls.

This highlights the complexity and heterogeneity of the genetic factors involved.

Question 20

How can mutations in parental DNA contribute to schizophrenia?

Answer 20

Mutations can occur due to factors like radiation, poison, or viral infection, leading to schizophrenia even in individuals without a family history of the disorder.

Paternal age has been linked to increased risk of sperm mutation and schizophrenia.

Question 21

What is the original dopamine hypothesis of schizophrenia?

Answer 21

The original hypothesis posits that high levels of dopamine (hyperdopaminergia) in subcortical areas of the brain contribute to schizophrenia symptoms.

This was based on the effects of antipsychotics reducing dopamine levels.

Question 22

What did Kenneth Davis et al. (1992) propose regarding dopamine levels in schizophrenia?

Answer 22

Davis proposed the addition of cortical hypodopaminergia, which suggests low dopamine in the cortex contributes to negative symptoms of schizophrenia.

This updated hypothesis integrates both high and low dopamine levels in different brain regions.

Question 23

What evidence supports the genetic explanation for schizophrenia?

Answer 23

Strong evidence from:
* Family studies showing increased risk with genetic similarity
* Adoption studies indicating biological children at risk despite adoptive environments
* Twin studies showing concordance rates of 33% for identical twins

This demonstrates a genetic vulnerability to the disorder.

Question 24

What environmental factors are associated with an increased risk of schizophrenia?

Answer 24

Environmental factors include:
* Birth complications
* Smoking THC-rich cannabis during teenage years
* Childhood trauma

These factors interact with genetic predispositions, complicating the understanding of schizophrenia.

Question 25

What is genetic counseling in the context of schizophrenia?

Answer 25

Genetic counseling provides risk estimates for couples with a family history of schizophrenia, informing them of the average likelihood of having a child who may develop the condition. ## Footnote The estimates do not account for specific environmental influences on the child.

Question 26

What evidence supports the role of dopamine in schizophrenia symptoms?

Answer 26

Evidence includes: * Amphetamines increasing dopamine and worsening symptoms * Antipsychotics reducing dopamine and alleviating symptoms * Candidate genes affecting dopamine production or receptors ## Footnote This suggests a strong link between dopamine and schizophrenia.

Question 27

What limitation exists regarding the dopamine hypothesis?

Answer 27

Evidence for a central role of glutamate has emerged, showing raised levels in individuals with schizophrenia, indicating other neurotransmitters may also be involved. ## Footnote Post-mortem studies and candidate genes linked to glutamate processing support this view.

Question 28

What experiment did Catherine Tenn et al. (2003) conduct related to amphetamines?

Answer 28

Tenn induced schizophrenia-like symptoms in rats using amphetamines and relieved symptoms with drugs that reduce dopamine action. ## Footnote This supports the dopamine hypothesis but also highlights the complexity of drug effects.

Question 29

True or False: Amphetamine psychosis closely mimics schizophrenia according to Justin Garson (2017).

Answer 29

False ## Footnote Garson challenged the idea that the symptoms induced by amphetamines accurately represent schizophrenia.

Question 30

What is family dysfunction in the context of schizophrenia?

Answer 30

Family dysfunction refers to dysfunctional family dynamics that may contribute to the development of schizophrenia. ## Footnote This includes issues like cold, rejecting, and controlling parenting.

Question 31

Who proposed the concept of the schizophrenogenic mother?

Answer 31

Frieda Fromm-Reichmann proposed the concept of the schizophrenogenic mother in 1948. ## Footnote She based this on accounts from her patients about their childhood experiences.

Question 32

What characteristics define a schizophrenogenic mother?

Answer 32

A schizophrenogenic mother is characterized by: * Coldness * Rejection * Controlling behavior ## Footnote This parenting style creates a family climate of tension and secrecy.

Question 33

What is the double-bind theory in relation to schizophrenia?

Answer 33

The double-bind theory posits that children in dysfunctional families receive mixed messages and feel trapped, leading to confusion and potential schizophrenia. ## Footnote This theory emphasizes the role of communication style within the family.

Question 34

What does expressed emotion (EE) refer to?

Answer 34

Expressed emotion (EE) is the level of negative emotion expressed towards a person with schizophrenia by their family members. ## Footnote High levels of EE are linked to increased stress and relapse in schizophrenia.

Question 35

List the components of expressed emotion.

Answer 35

The components of expressed emotion include: * Verbal criticism * Hostility * Emotional overinvolvement ## Footnote These elements contribute to stress for individuals with schizophrenia.

Question 36

What is dysfunctional thinking in the context of schizophrenia?

Answer 36

Dysfunctional thinking refers to impaired cognitive processes associated with schizophrenia, affecting thought processing and contributing to symptoms. ## Footnote This includes disruptions in normal thought processing.

Question 37

What is metarepresentation dysfunction?

Answer 37

Meta-representation dysfunction is the inability to reflect on one's own thoughts and behavior, leading to issues like hallucinations and delusions. ## Footnote This cognitive ability allows insight into intentions and interpreting others' actions.

Question 38

What is central control dysfunction?

Answer 38

Central control dysfunction refers to difficulties in suppressing automatic responses while performing deliberate actions, which can lead to disorganized speech and thought patterns. ## Footnote This can result in derailment of thoughts in individuals with schizophrenia.

Question 39

What evidence supports the link between family dysfunction and schizophrenia?

Answer 39

Evidence includes: * Insecure attachment in adults with schizophrenia * High rates of childhood trauma among those diagnosed ## Footnote Studies show a disproportionate likelihood of insecure attachment and abuse histories.

Question 40

What is a limitation of family-based explanations for schizophrenia?

Answer 40

A limitation is the poor evidence base for traditional family theories like the schizophrenogenic mother and double-bind. ## Footnote These theories lack systematic evidence despite clinical observations.

Question 41

What is a potential negative consequence of research linking family dysfunction to schizophrenia?

Answer 41

Research can lead to parent-blaming, particularly of mothers, which adds stress to families already dealing with schizophrenia symptoms. ## Footnote This raises ethical concerns about the impact of such research.

Question 42

What did John Stiling et al. (2006) find in their research on cognitive tasks?

Answer 42

They found that individuals with schizophrenia took significantly longer to perform cognitive tasks, supporting the idea of impaired cognitive processes. ## Footnote The tasks included the Stroop test, which measures cognitive control.

Question 43

What is a proximal explanation in the context of cognitive theories of schizophrenia?

Answer 43

A proximal explanation focuses on immediate causes of symptoms, rather than underlying origins like genetics or childhood trauma. ## Footnote Cognitive theories primarily address current cognitive dysfunction.

Question 44

Is schizophrenia primarily a psychological or biological condition?

Answer 44

There is an ongoing debate whether schizophrenia is best viewed as a psychological or biological condition. ## Footnote Some argue it has psychological roots while others point to genetic and developmental factors.

Question 45

What are typical antipsychotics? What to dopamine antagonists do?

Answer 45

1st generation of drugs such as dopamine antagonists (Chlorpromazine) They block dopamine receptors reducing dopamine action. Initially dopamine builds up, then production is reduced. Normalises neurotransmission which reduces hallucinations. Also a sedative

Question 46

What are Atypical antipsychotics?

Answer 46

Target a range of neurotransmitters e.g Serotonin (Clozapine) More effective than typical antipsychotics BUT potentially fatal as it can cause blood condition. Binds to dopamine, serotonin and glutamate receptors which improves mood, reduces depression and anxiety, and improves cognitive functioning

Question 47

Thornley at al

Answer 47

Reviewed studies comparing effects of chlorpromazine to control conditions. 13 trials, 1121 pps showed it was associated w/ better functioning + reduced symptom severity. MELTZER concluded clozapine was most effective in 30-50% of cases

Question 48

Healy (2012)

Answer 48

Flaws of evidence for effectiveness. Most studies are short-term effects + successful trials published several times which exaggerates results. Antipsychotics have powerful calming effects, not the same as reducing psychosis

Question 49

Side effects

Answer 49

Long-term use of typical antipsychotics can result in trade dyskinesia (involuntary facial movements) Most serious effect-neuroleptic malignant syndrome (NMS): high temp, delirium, coma and can be fatal

Question 50

How does cognitive behaviour therapy (CBT) help?

Answer 50

CBT helps client understand how irrational thoughts impact feelings and behaviour. Understanding where symptoms come from helps with symptoms like auditory hallucinations as it makes them less frightening and less debilitating. Teaches them to cope

Question 51

How does family therapy help? (What strategies + who developed them?)

Answer 51

Improves communication + interaction between family members Pharoah- identified strategies to improve function of families Reduces -ve emotions - reduce levels of expressed emotion to prevent stress that could result in relapse Improves family ability to help -form therapeutic alliance (agree of therapy aims). Improve beliefs and behaviour about SZ, balance care and maintaining own lives

Question 52

Evidence for effectiveness (Jauhar, Pontillo

Answer 52

-34 studies using CBT -> clear evidence for small but significant effects (research evidence) -Reduced frequency + severity of auditory hallucinations (clinical)

Question 53

Thomas (quality of evidence)

Answer 53

Diff studies use diff CBT techniques + ppl w/ diff symptom combinations

Question 54

McFarlane

Answer 54

FT one of the most consistently effective. Relapse rates reduced by 50-60% FT promising when used in early stages

Question 55

Lobban + Barrowclough

Answer 55

Benefits family (provide bulk of care) so strengthens function of whole family