Schizophrenia Flashcards
(78 cards)
1
Q
What are positive symptoms of schizophrenia?
A
They add to the patients reality
2
Q
What are examples of positive symptoms?
A
Hallucinations
Delusions
Disorganised speech
3
Q
What are negative symptoms of schizophrenia?
A
Where patients suffers a reduction or a loss of normal functions
4
Q
What are examples of negative symptoms?
A
Speech poverty (alogia)
Avolition
Catatonic behaviour
Grossly disorganised behaviour
5
Q
What is the DSM?
A
Published by American psychiatric association
6
Q
What is the ICD?
A
Published by the World Health Organisation
7
Q
What is reliability in the context of schizophrenia?
A
Asses how consistent the diagnosis of schizophrenia is
8
Q
What is validity in the context of schizophrenia?
A
Does the DSM or ICD really measure schizophrenia
9
Q
What is co-morbidity?
A
Where the patient has two conditions at the same time
10
Q
What is symptom overlap?
A
When two conditions have some effects in common
11
Q
What studies are associated with reliability?
A
Copeland
Luhrman
Whaley
12
Q
What was Copeland’s study?
A
134 US Psychiatrists - 69% diagnosis
194 British Psychiatrists - 2% diagnosis
Low inter-reliability reliability
13
Q
What was Luhrman’s study?
A
Interview with 60 adults with schizo
20 in each Ghana, India and US
Africa and India, reported positive experiences with hearing voices compared to the US
Suggests schizo has a lack of consistent characteristics
14
Q
What was Whaley’s study?
A
Found that inter-rater reliability correlations in the diagnosis of schizo was as low as 0.11
15
Q
What are the studies associated with validity?
A
Broverman
Ellason
Buckley
16
Q
What was Broverman’s study?
A
Mentally healthy behaviour = healthy male behaviour
Therefore women are perceived as less mentally healthy
17
Q
What was Ellason’s study?
A
Symptom Overlap - Patients with DID have more schizo symptoms more than schizo patients
18
Q
What was Buckley’s study?
A
Co-morbidity - Co-morbid depression occurs in 50% of patients and 47% of patients also have a lifetime diagnosis of substance abuse
19
Q
What is the biological explanation of schizophrenia?
A
Genetics
Neural Correlates - Dopamine Hypothesis
20
Q
What is the genetic explanation?
A
Schizophrenia is hereditary
No one gene responsible (108 genes)
21
Q
What studies support the genetic explanation?
A
Shield
Gottesman
Teinari
22
Q
What was Shield’s study?
A
2 Schizo parents - 46%
1 Schizo parent - 13%
Schizo parent - 9%
23
Q
What was Gottesman’s study?
A
Summarised 40 twin studies
MZ twins - 48%
DZ twins - 17%
24
Q
What was Tienari’s study?
A
164 adoptees who bio mothers have schizo
11 adoptees also diagnosed
Just 4 in the 194 control adoptees
25
What are some weaknesses of the genetic explanation?
Family rearing patterns may explain schizo link
Joseph - MZ twins are usually treated more similarly than DZ
26
What are neural correlates?
Patterns of structure or brain that occurs with a schizophrenic experience
27
What study supports negative symptoms neural correlates?
Juckel - Lower activity in the ventral striatum, is crucial in the anticipation of reward
28
What study supports positive symptoms neural correlates?
Allen - Lower activity in the superior temporal gyrus and anterior cingulate gyrus
29
What study supports neural correlates?
Suddan - MRI scans on twins, 1 has schizo
Easily identifiable enlarged ventricles in 12/15 pairs
30
What is the dopamine hypothesis?
Positive symptoms = Excess dopamine, hyperdopamingeria
Negative symptoms = Deficit dopamine, hypodomingeria
31
Who supports the dopamine hypothesis?
Falkai
L-dopa
32
How does Falkai support the dopamine hypothesis?
Found increased dopamine levels in the left amygdala in post-mortems of schizophrenic patients
33
How does the L-dopa drug support the dopamine hypothesis?
It's a dopamine hypothesis medication
Increases dopamine levels in the brain
Resembles acute schizophrenia in non-psychotic patients
34
Who argues against the dopamine hypothesis?
Javitt
Davis
35
How does Javitt go against the dopamine hypothesis?
Found evidence of another neurotransmitter called Glutamate
Schizo's also have a deficiency in glutamate function
36
How does Davis go against the dopamine hypothesis?
Takes many weeks for antipsychotics to reduce positive symptoms even though they block dopamine receptors immediately
37
What are antipsychotics?
Work by reducing dopaminergic transmission
38
What are typical antipsychotics?
Used against positive symptoms
reducing dopamine activity
e.g. chlorpromazine
39
What are atypical antipsychotics?
Combat positive and negative symptoms
Block dopamine receptors
e.g. clozapine
40
What are the side effects of typical antipsychotics?
Tardive dyskinesia
Muscle tightening
Decrease in motivation
41
What study supports effectiveness of typical antipsychotics?
Barlow & Durand
Chlorpromazine effective in 60% of cases, patients still suffer from negative symptoms
42
What are the side effects of atypical antipsychotics?
Side effects greatly reduced but similar to typical
Loss of motivation
Dry mouth
43
What study supports the effectiveness of atypical antipsychotics?
Pickar-Clozapine most effective in reducing symptoms in patients that had been treatment resistant
Meltzer-Effective in 30-50% of cases where typical treatments failed
44
Who supports antipsychotics?
Leucht - Meta analysis of 65 studies
Placebo - 64% of patients relapsed within 12 months
Real - 27% of patients relapsed within 12 months
45
Who goes against the difference between side effects of atypical and typical anti-psychotics?
Crossley - Meta analysis of 15 studies
Found no significant differences between atypical and typical drugs in terms of side effects
46
What are the psychological explanations of schizophrenia?
Family dysfunction
Cognitive explanation
47
What is the family dysfunction explanation?
Double bind (Bateson)-Children who receive contradictory messages results in disorganised thinking and paranoia
Expressed emotion-Members of schizo's family talk over patient in a hostile manner, source of stress for patient
48
Who backed double bind theory?
Berger-Schizo's reported a higher recall of double bind statements by mothers than non-schizo's
49
Who backed expressed emotion?
Linszen-A patient returning to a high EE family are 4 times more likely to relapse compared to a low EE patient
50
Who supports family dysfunction?
Tienari-Adopted children who had schizo bio parents were more likely to become ill themselves however, the difference only emerged in situations where the adopted family were 'disturbed'
51
Who goes against family dysfunction?
Liem-Measured patterns of parental communication in families with/without a schizo child and found no difference
Ethical considerations, families start to blame themselves and shifts the blame. Causes personal distress to family
52
What is the cognitive explanation?
Schizophrenics have dysfunctional thought processes
Firth - Metarepresentation and Central control
53
What is Metarepresentation?
Ability to reflect on thoughts and behaviour, dysfunction would disrupt our ability to recognise our own actions
This explains hallucination of voices and deulsions
54
What is central control?
Ability to suppress automatic responses, dysfunction could result in disorganised speech and derailment of thoughts/spoken sentences
55
Who support evidence of cognitive explanation?
Sarin and Wallin - Positive symptoms have their origins in faulty cognition, show biases in there information processing, also had impaired self monitoring so heard their own thoughts as voices
Success from CBT for psychosis suggests cognitive explanation holds validity - NICE found CBT compared to anti-psychotic drugs was more effective in reducing symptom severity
56
What are the disadvantages of the cognitive explanation?
Cognitive ignores other explanations of schizo such as biological
Murray - Integrated model of schizo, early vulnerability factors (genes/birth complications) paired with significant exposure to social stressors increases the release of dopamine and therefore psychosis
57
What is CBT for schizophrenia?
Assessment - Patient expresses their thoughts about their experiences and realistic goals are discussed
Engagement - Therapist empathises with patients perspective
Normalisation - makes the patient feel less alienated
Develop alternative explanations
58
What is Ellis' ABC model?
Activating event (hearing voices)
Belief (everyone will hate me if I tell them I have voices)
Consequence (Isolation)
59
Who supports the effectiveness of CBT?
Chadwick - worked with patient that thought he could predict the future, he failed to predict what would happen in 50 video clips. Helped show his delusions were false
Tarrier found that medication and CBT are better than just medication alone
60
What is a disadvantage of CBT?
Need a trained psychologist to conduct the session and motivation, recommended 16 sessions
Not very accessible or cost friendly
61
What is family therapy?
Provide support for carers in an attempt to make family life less stressful and reduce rehospitalisation of the patient
62
What studies are associated with family therapy?
Garety
Pharoah
Lobban
63
What does family therapy include?
Psychoeducation
Reduce expressions of anger
Maintain reasonable expectations
64
What does Garety argue?
Relapse rate for those with is 25%
Relapse rate for without is 50%
65
What was Pharoah's study?
Reviewed 53 studies that investigated the effectiveness of family intervention
Family intervention outcomes were compared to 'standard care' alone
Main results were that increased patients compliance with medication and reduction in relapse an re-admission
66
What was Lobban's study?
Analysed the results of 50 family therapy studies
60% of these studies reported a significant positive impact of the intervention on at least one outcome for relatives
e.g. coping and problem solving skills
67
How does Token Economy help treat schizophrenia?
Uses operant conditioning to reinforce positive target behaviour
Tokens given for target behaviours
Tokens then exchanged for treats
68
What studies are used in token economies?
Ayllon and Azrin
Dickerson
Comer
69
What was Ayllon and Azrin's study?
Used token economy on a female ward
Embossed each token with 'one gift'
These tokens were exchanged for privileges such as watching a movie
The amount of desirable behaviours dramatically increased
70
What was Dickerson's study?
Reviewed 13 studies using token economies
11 reported beneficial effects directly related to token economies
Concluded these studies provide evidence of the effectiveness of token economies
71
What was Comer's study?
Major problem in assessing the effectiveness was the use was uncontrolled, all patients are brought into the token economy rather than having a control group
Their improvements can only be compared to past behaviours
Suggested increased staff attention led to better behaviour rather than the token economy
72
What are the concerns of using a token economy?
In the community patients will not get rewarded for everything so target behaviours may stop
Patients are at increased risk of being controlled or even abused
Argued it is simply just manipulating vulnerable individuals
73
What is the interactionist approach to schizophrenia?
A perspective that believes a range of factors including biological and psychological factors are involved in the development of schizophrenia
74
What is the stress diathesis model?
Schizophrenia is explained as the result of both an underlying vulnerability (genetics/brain structure/trauma) and trigger in the environment (exams/getting fired)
75
What studied are associated with the stress diathesis model?
Tienari
Verdoux
Tarrier
76
How is Tienari used to support the interactionist/stress diatheses model?
It shows that a biological basis mixed with a high stress adoptive family can result in the development of schizophrenia
77
What was Verdoux's study?
The risk of developing schizophrenia later in life for those who experienced complications at birth was four times greater than those who experience no complications
78
What was Tarrier's study?
315 patients randomly allocated to 3 different conditions
Medication + CBT
Medication + Supportive counselling
Control group
Found patients in the 2 combination groups showed lower symptom levels that those is the control group
