Schizophrenia Flashcards
(10 cards)
Diagnosis and Classification of schizophrenia
Diagnosis and Classification of schizophrenia:
Diagnosis and Classification:
() Diagnostic and Statistical Manual edition 5: One positive symptom must be present
() International Classification of Disease: 2 negative symptoms
Positive symptoms:
() Hallucinations: Unusual sensory experiencces
() Delusions: Irrational beliefs
Negative Symptoms:
() Speech poverty: Speaker sometimes delayed, more emphasis on speech disorganization these days
() Avolition: “apathy”, Andreasen: poor hygiene and grooming, lack of persistence in work, lack of energy
Biological Explaination (Genetic Basis)
Family Studies:
() Gottesman
(^) Large-scale family study
() Aunt: 2%
() Sibling: 9%
() Twin: 48%
(^) CORRELATION: Represents both environmental and genes
Candidate Genes:
() Polygenic
() Genes coding for NEUROTRANSMITTER: DOPAMINE
() Stephen Ripke
(^) Combined data from genome-wide studies
(^) 37000 schiz, 113000 controls
(^) 108 genetic variations
() AETIOLOGICALLY HETEROGENEOUS
Role of mutation:
() Schizophrenia can be present with no family history
() Parental mutation causes: radiation, poison, viral infection
() Brown: Increase in paternal age (increased risk of sperm mutation): 0.7% fathers under 25, 2% fathers over 50
Biological Explaination (Neural correlates)
Orginial dopamine hypothesis:
() Drugss used to DECREASE dopamine in schiz lead to parkinson symptoms
() HYPERDOPAMINERGIA in subcortial areas of the brain (too much dopamine)
() Hyperdopaminergia in Brocas area may explain speech poverty
Updated versions:
() Davis: Cortical HYPOdopaminergia, abnormally low DA in brains CORTEX
() Example: Low DA in prefrontal cortex could explain cognitive problems
() Cortial hypodopaminergia leads to low subcortial hyperdopaminergia
() Suggests orgins: stress leads to cortial hypo which leads to subcortial hyper
Psychological Explainations: Family disfunction
Schizophrenogenic mother:
() Fromm-Reichmann: Patients talk about mother
() Schizophrenogenic: Schizophrenia causing
() Cold, rejecting, controlling
() Secrecy and tension leads to distrust leading to schiz
Double-bind:
() Batson: Role of communication in family
() Child fears doing wrong thing, but recieve mixed messages about what it is
() Unable to comment or seek clarity
() “Get it wrong”: Punishment by withdrawal of love
() World is confusing and dangerous: Disorganised thinking, paranoid delusions
() Baton “Not the main factor, just a risk”
Expressed Emotion:
() Negative emotion expressed by family members
() Verbal critisism
() Hostility: Anger and rejection
() Emotional overinolvement in their life: Needless self-sacrifice
() Primarily explaination for relapse
Psychological Explainations: Cognitive explainations
Dysfunctional thinking:
() Reduced thought processing in the VENTRAL STRIATUM: associated with negative symptoms
() Reduced processing in TEMPORAL and CINGULATE GYRI: assoicated with hallucinations (Simon)
Metarepresentation dysfunction:
() Frith
() Cognitive ability to reflect on thoughts and behaviour
() Disrupts ability to recognise actions as our own
() Explains hallucinations and hearing voices
Central Control Dysfunction:
() Frith
() Lack of ability to suppress automatic responses
() Explains speech poverty and thought disorder
Drug therapy
Drug therapy:
() TYPICAL: Traditional
() ATYPICAL: Second-generation
Typical:
() Chlorapromazine: 1950s, tablets, syrup, injection, dosage increased to max of 400mg-800mg
() DOPAMINE ANTAGONISTS
(^) Block dopamine receptors in the brain
() Initially dopamine levels build up, then production is reduced
() SEDATION EFFECT
(^) Used to calm individuals with schiz and other
() Believed to be related to its effect on histamine receptors (unclear exactly why)
() Syrup given as it works faster than tables
Atypical:
CLOZAPINE:
() Developed 1960s, trialed 1970s and withdrawn due to deaths of patients with blood condition AGRANULOCYTOSIS, 1980s discovered to be more effective and administrered when chlorapromazine failed
() Used today after testing patient does not have AGRANULOCYTOSIS
() 300-450mg a day
() Binds to dopamine receptors, acts on SEROTONIN and GLUTAMATE receptors
() Reduce DEPRESSION, may improve cognitive function
() Mood enhancing: 30-50% of schiz attempt suicide
RISPERIDONE:
() Around since 1990s
() Taken in form of tablets, syrup, injection
() 4-8mg dose typical, 12mg dose maximum
() Binds more strongly than clozapine
() Some evidence suggests less side effects
Psychological therapy (CBT)
CBT:
() Help make sense of irrational cognitions: Delusions, hallucinations
() Example: Auditory hallucinations, therapist try to convince its from malfunctioning speech center
() Not eliminate schiz, but help manage
() NORMALIZATION: Extention of experience of thinking in words
() Delusions tested: Patient lead to examine likelihood that beliefs are true
Psychological therapy (Family Therapy)
Family therapy:
() IDENTIFIED PATIENT: Member of family who expresses family conflicts
() Improves quality of interactions between family members
() Based on psychological theories like double-bind, schiz mother
() Reduces negative emotion: Reduces expressed emotion, decreases chance of relapse
() Improves family ability to help: Encourages a THERAPEUTIC ALIANCE to form, ensure families have a balance between caring and their own life
Burbach model of practice
() Phase 1: Share basic information
() Phase 2: Identify resources family can offer
() Phase 3: Mutual understanding
() Phase 4: Identify unhelpful patterns of interaction
() Phase 5: learning stress management techniques
() Phase 6: Preventing relapse
() Phase 7: Maintainance for the future
Token economies
What is involved:
() Tokens often given on individual basis
() Immediate reward: More effective
() Rewards: sweets, magazines, films, walk outside
Theroetical understanding:
() BEHAVIOUR MODIFICATION
() Based on OPERANT CONDITIONING
() Tokens are SECONDARY REINFORCERS
() Can be used to obtain a RANGE of PRIMARY REINFORCERS (secondary reinforcers are generalized reinforcers
() At the start secondary and primary are paired
Developing:
() Ayllon and Azrin: Trialled token economy in schiz ward of women
() Every time patients did a task they would get a token, “one gift”, which could be swapped for WARD PRIVILIGIES
() Number of tasks carried out increased SIGNIFICANTLY
() Used extensively in 1960s and 70s
() Declined in UK due to: Increase in comm-based care, ethical issues raised
() Still used in other parts of the world
Rationale:
() Institutionalization: Prolonged hospitalization leads to bad habits
() Johnny Matson: 3 categories of institutional behaviour tackled by token economies: personal-care, condition-related behaviours, social behaviours
() Does not cure schiz but has benefits:
() Improves persons quality of life within hospital
() Makes life easier to adapt to when released
Interactionalist approach
Diathesis-stress model:
() DIATHESIS: Vunerability
() STRESS: Negative experience
Meehls Model:
() Orginal diathesis stress model
() Diathesis is entirely genetic: a single SCHIZOGENE
() Lead to idea of SCHIZOTYPIC PERSONALITY: Includes sensitivity to stress
() Stress: Childhood stress such as schizophrenogenic mother
Modern understanding of diathesis:
() No schizogene: Many genes increase vunerability slightly (Ripke)
() Diathesis could include psychological trauma
() John Read: NEURODEVELOPMENTAL MODEL
(^) Severe enough trauma (child abuse) can affect aspects of brain development, for example the HYPOTHALAMIC-PITUITARY-ADRENAL system can become overactive, leading to stress
Modern understanding of stress:
() Psychological stress considered important but triggers for schizophrenia include modern defintion
() Example: Cannabis
() Can increase risk up to 7x, interferes with DOPAMINE system
Treatment:
() Compatible wth both biological and psychological factors
() Combination of CBT and ANTIPSYCHOTIC medication
() Standard practice in Britain
() US: Less common due to history of conflict between psychological and biological models of schiz
