Schizophrenia Flashcards
(153 cards)
1
Q
4 symptons of schizophrenia
A
Hallucinations, delusions, avolition, speech poverty
2
Q
What is avolition
A
Persisntent lack of motivation to complete normal, everyday tasks
3
Q
What is speech poverty
A
Minimal speech, lack of spontaneous, unprompted speech
4
Q
2 positive symptons of schizophrenia
A
Hallucinations and delusions
5
Q
2 negative symptons of schizophrenia
A
Avolition and speech poverty
6
Q
What book is used to diagnose mental disorders
A
DSM
7
Q
What do patients need to do to be diagnosed with schizophrenia
A
At least 2 main symptons for at least 6 months
8
Q
What must the results of a study be to be reliable
A
Consistent every time the study is repeated
9
Q
How can a schizophrenia diagnosis be reliable
A
If all doctors seperately find a schizophrenia diagnosis
10
Q
What makes a study valid
A
when it measures what it claims to measure
11
Q
What makes a diagnosis valid
A
Correctly diagnosing people with it but not diagnosing those without it
12
Q
What is inter-rater reliability
A
Multiple people measure something to see how similar their measurements were
13
Q
Inter-rater reliability is used to…
A
Assess reliability of a diagnosis of schizophrenia
14
Q
How has the reliability of schizophrenia diagnosises changed over time
A
More reliable over time
15
Q
Beck (1963) study premise
A
Reviewed 153 patients who had been diagnosed by multiple doctors - measured inter-rater reliability
16
Q
Beck (1963) study results
A
Found 54% concordance rate between doctors
17
Q
Beck (1963) study conclusion
A
Low inter-rater reliability in diagnoses of schizophrenia
18
Q
What is comorbidity
A
Schizophrenia is often diagnosed with other disorders, could lead to inaccurate diagnosises of schizophrenias when it could be a sever case of depression, may not be separate disorders
19
Q
Buckly (2009) study results
A
Found high comorbidity rates with schizophrenia for depression, drug abuse and OCD
20
Q
What is comorbidity, Buckly and sympton overlap looking at
A
Validity
21
Q
What is Rosenhan’s study methodology
A
Asked 8 volunteers to pretend they were hearing voices, once admitted to a psychiatric hospital, they were to start acting normally again
22
Q
What did Rosenhan’s study find
A
Once admitted to hospital, volunteers behaviour was still percieved as symptons of schizophrenia rather than normal behaviour - interpreted behaviour to fit with diagnosis
23
Q
How long did it take for doctors to realise their diagnosis was wrong and release Rosenhan’s volunteers
A
7-52 days
24
Q
What did Rosenhan’s study conclude
A
Schizophrenia diagnosises can lack validity
25
What did Dr Webber test
Inter-rater reliability
26
Dr Webber study methodology
100 doctors, divided into pairs, each pair got diff. description of patient displaying symptons of schizophrenia, asked each doctor to diagnose patient and compared diagnosises of doctors in the pair
27
Statistics for how reliability of schizophrenia diagnosises have changed
1962 - diagnosis for Sc were 52% similar, 2005 - 81% similar - reliability increasing
28
What is cultural bias
Researchers misinterpreting the differences between cultures
29
How does culture bias affect a diagnosis
Reduces the reliability and validity
30
In Cochrane's study why were Afro-Caribbean people living in Britain being overdiagnosed with schizophrenia
Doctors in Britian were judging the patients using the social norms from british culture
31
What is gender bias
When the differences between men and women are misrepresented
32
What is alpha bias
Over-exaggerating differences in men and women's behaviour
33
What is beta bias
Ignoring real differences between men and women
34
Loring and Powell's study premise
Gave doctors idential descriptions of a patients symptons but varied the patients gender and race
35
Loring and Powell study results
Overdiagnoses for black people and underdiagnosis for women, most accurate when gender and race of psychatrist and patient were the same
36
Loring and Powell study conclusion
Gender and culture bias are both present in the diagnosis of schizophrenia
37
What is the genetic explanation for schizophrenia
Polygenetic
38
How to study the genetic explanation for schizophrenia
Via twin studies
39
Strengths of the genetic explanation for schizophrenia
Ripke (2014), Gottesman (1991), Tienari (2004)
40
Ripke (2014) study
Conducted genetic analysis of over 36,000 schizophrenia cases, located 108 genes associated with development of schiophrenia, supports polygenetic theory
41
Gottesman (1991) study results
48% concordance rate in families for MZ twins and 17% for DZ twins, general popular is 1%
42
Gottesman (1991) study conclusion
DZ and MZ twins would both share the same environment so the only difference between in genes, suggesting a genetic factor in the devlopment of SZ
43
Tienari (2004) study premise
Studied bio children of SZ mothers who had been adopted
44
Tienari (2004) study results
5.8% adopted into psychologically healthy families developed schizophrenia, compared to 36.8% raised in dysfunctional famillies
45
Tienari (2004) study conclusion - biological
Well above 1% so suggests a genetic predisposition but difference between groupds also suggests environmental factors
46
Examples of neuro correlates
Dopamine hypothesis, ventricles
47
What is the dopamine hypothesis
Suggests that symptons of SZ are associated with too much/imbalance of dopamine neuro-transmitter across the brain
48
Effect of dopamine imbalance in brain
Too much in speech centres may lead to auditory hallucinations, lower levels in frontal corex could lead to negative symptons like avolition or speech poverty
49
Strength of the biological explanation - dopamine hypothesis
Leueht
50
Leueht study premise
Meta-analysis of 212 studies, assessed effectiveness of biological anti-psychotic drug treatments that worked by normalised levels of dopamine
51
Leueht study results
More effective than a placebo
52
Leueht study results
Underlying dopamine theory must have validity due to success of corresponding treatment
53
Ventricle explanation for SZ
Ventricles are voids filled with cerebrospinal fluid deep within brain, thought to provide protective cushioing effect for brain, enlarged ventricles are assossicated with SZ
54
Evaluation of the biological explanation - ventricles
Johnstone (1976) but correlational so can't establish causation relationship
55
Johnstone (1976) study
Used CT scans to identify people with SZ and larger than averge ventricles, suggested they may be linked
56
Limitation of the biological explanation for SZ
Biologically deterministic - assumes that SZ is inevitable if you have the genes
57
Strength of the biological explanation for SZ
Lots of empirical evidence due to clinical studies
58
Examples of family dysfunction as a cause of schizophrenia
Schizophrenogenic mother, double bind theory, expressed emotion
59
Schizophrenogenic mother as a cause of schizophrenia
Psychodynamic approach, people get paranoid delusions as a result of influence of cold, rejecting and controlling mother and a passive father, creates stress, tension and secrecy in family, atmosphere triggers psychotic thinking
60
Double bind theory as a cause of schizophrenia
Child gets mixed messages and feels unable to do correct thing, being told to be more independent but being overprotected and receiving criticism when they attempt to be more independent. Bateson (1972) suggests it results in disorganised thinking and paranoia
61
Expressed emotion as a cause of schizophrenia
Exaggerated involvement, indicates person is a burden, criticism and control of persons behaviour, hostility towards person
62
Research support for the family dysfunction explanation of schizophrenia
Butzlaff and Hooley (1998), Tienari (2004)
63
Butzlaff and Hooley (1998) study
Meta-analysis, 27 studies, relapse into schizophrenia is significantly more likely in families with issues with expressed emotion
64
Tienari (2004) study conclusion - psychological
Interpersonal family environment has significant impact on development of schizophrenia in genetically vulnerable people
65
Examples of cognitive explanation for schizophrenia
66
Attention deficit theory for schizophrenia
Firth's (1979), suggests schizophrenia is due to a faulty attention system unable to filter pre conscious thoughts and gives too much significance to the information that would normally be able to be filtered out so overloads mind - accounts for positive symptons like hallucinations and delusions
67
Central control explanation for schizophrenia
Firth, suggests ability to suppress and override automatic beliefs (the central control) is faulty in schizophrenic patients, difficulty resistant urges and explaining the reason results in delusions, speech derailment can be explained by inability to resist expressing automatic thoughts
68
Meta-representation explanation for schizophrenia
It's the ability to identify your own thoughts and actions as your own by paying attention to them - faults in this system results in delusions of control (feeling that your own actions are being created by an outside force)
69
Research support for the cognitive explanation of schizophrenia
Firth (1992), Stirling et al (2006)
70
Firth (1992) study premise
30 schizophrenic patients with various symptons had PET scans
71
Firth (1992) study results
Reduction in blood flow in frontal cortex with patients with negative symptons like avolition and inability to suppress automatic thoughts, also showed increased activity in an area of temporal lobe responsible for retrieval of memories with patentients with reality distortions
72
Firth (1992) study conclusion
Biological differences in schizophrenic brain regions associated with theorised cognitive processes
73
Stirling et al (2006) study premise
Conducted strop test , 30 patients with schizophrenia and 18 control patients, involved naming ink colours on words without saying the word - difficult as desire to say the word has to be controlled
74
Stirling et al (2006) study results
Schizophrenic patients took twice as long to name the colours as the control group
75
Stirling et al (2006) study conclusion
Patients with schizophrenia have dysfunctional thought processing with faulty central control
76
2 strengths of the psychological explanations for schizophrenia
Family therapy, CBT
77
Family therapy as a strength for eh psychological explanations for schizophrenia
Reduces expressed emotion in families, shown to be an effective intervention and supports family dysfunction argument
78
CBT as a strength for eh psychological explanations for schizophrenia
Can be an effective treatment which indicated that cognitive factors are involved in the disorder
79
3 limitations of the psychological explanations for schizophrenia
Socially sensitive, cause and effect, biological
80
Socially sensitive as a limitation of the psychological explanation for schizophrenia
Suggests that schizophrenia is caused by family
81
Cause and effect as a limitation of the psychological explanation for schizophrenia
Can't demonstrate it, could be that schizophrenia is cause of family dysfunction
82
Biological as a limitation of the psychological explanation for schizophrenia
Significant amount of research that schizophrenia is caused by genetics (Gottesman) and neurotransmitters (Leucht), family dysfunction may act as a trigger but can be argued that basic cause is biological
83
Psychological explanations for schizophrenia
Family dysfunction, cognitive explanation
84
What are antipsychotics
Medications used to control psychosis such as delusions and hallucinations
85
Types of antipsychotics
Typical and Atypical anti-psychotics
86
Typical antipsychotics notes
First generation, used since 1950's, less popular now, severe side effects and only treat positive symptons - example is chlorpromazine
87
How typical antipsychotics work
Dopamine antagonists (reduce it) by blocking receptors at synpase, calms dopamine system in brain so reduces positive sympons, has a general sedative effect
88
Side effects of typical antipsychotics
Dry mouth, constipation, lethargy, confusion, tardive dyskinesia (uncontrollable muscle movement usually affecting the face)
89
Atypical antipsychotics notes
Second generation, used since 1970s to avoid more severe side effects of typical anti-psychotics - example is clozapine
90
How atypical antipsychotics work
Block dopamine transmitters but also act on other neurotransmitters (acetylcholine, glutmate and serotonin), address negative symptons such as avolition
91
Side effects of atypical antipsychotics
Weight gain, cardiovascular problems, less likely to cause involuntary muscle side effects
92
Research support for drug therapy as a treatment for schizophrenia
Leucht (2013), Bagnall (2003)
93
Leucht (2013) study premise
212 studies, meta-analysis on effectiveness of biological antipsychotic drug treatments that work via normalising levels of dopamine
94
Leucht (2013) study results
Treatment of symptons with drugs were found to be much more effective than a plavebo
95
Leucht (2013) study conclusion
Suggests the treatements that target the dopamine system are effective in reducing symptons
96
Bagnall (2003) study premise
232 studies to compare effectiveness of a range of Atypical and typical anti-psychotics
97
Bagnall (2003) study results
A-typical more effective than typical in treating overall symptons, resulted in fewer movement disorder side effects and fewer people left drug trial early, clozapine found to be most effective in reducing negative symptons and treating people that were resistant to other drugs
98
Bagnall (2003) study conclusion
Suggests antipsychotics are an effective treatment plan, especially on those that focus more on neurotransmitters than dopamine, also development of atypical has improved the treatment
99
Research limitation for drug therapy as a treatment for schizophrenia
Tarrier (1998)
100
Tarrier (1998) study premise
Placed patients randomly into routine care (antipsychotics) or routing care and CBT
101
Tarrier (1998) study results
Patients in combined treatment had significant improvement in severity and number of positive symptons, also had fewer days in hospital receiving care
102
Tarrier (1998) study conclusion
Suggests that drug therapy alone is not the most effective treatment plan and an interactionalist approach to treating schizophrenia alongside CBT is a better option
103
2 strengths of drug therapy as a treatment for schizophrenias
Economy, quality of life
104
Economy as a strength of drug therapy as a treatment for schizophrenia
Cheaper than hospital treatment or therapies like CBT or family therapy
105
Quality of life as a strength of drug therapy as a treatment for schizophrenia
Drug therapy resulted in end of long term institutionalistation in mental health hospitals
106
3 limitations of the drug therapy as a treatment for schizophrenia
Symptons not cause, ethics, side effects
107
Symptons not cause as a limitation of drug therapy as a treatment for schizophrenia
Supresses symptons, doesn't treat underlying problem, lack of evidence showing long term benefits of medication, most studies are short term
108
Ethic as a limitation of drug therapy as a treatment for schizophrenia
Drugs often prescribed/forcibly given when disorder is severe, issues regarding informed consent especially considering severe side effects
109
Side effects as a limitation of drug therapy as a treatment for schizophrenia
Both types of drugs have side effects, due to this 2/3 stop taking them, when symptons return they start again creating a loop
110
Types of psychological treatments
CBT, family therapy, token economy
111
Example of therapies to treat schizophrenia
CBT, ABC model, reality testing
112
Basis for CBT as a treatment for schizophrenia
Sz as a result of dysfunctional thought processes such as faulty cognitions like delusions being identified and challenged with CBT
113
Therapist role in CBT
Challenge irrational beliefs
114
ABC model by Elllis as a treatment for SZ + example
Understand source of faulty cognition and cognitively restructure - A - drug treatments are causing side effects, B - hospital staff trying to kill them, C - refuse treatment, D (dispute) - staff have no reason to, E (effect - restructured belief) - drugs are necessary
115
Reality testing as a treatment for Sz
Process where the patient can demonstrate for themselves that irrational thoughts (delusions and hallucinations) are not real
116
Research support for therapy as a treatment of schizophrenia
Sensky et al (2000)
117
Sensky et al (2000) study results
Patients who has resisted drug treatments had a reduction in positive and negative symptons when treated by 19 sessions of CBT, continued to improve 9 months after treatment ended
118
Sensky et al (2000) study conclusion
CBT can be effective when drugs are not, better than drug treatments as are long term
119
Limitations of therapy as a treatment of schizophrenia
Ending treatment early, patients struggling to cope
120
Ending treatment early as a limitation of therapy as a treatment for schizophrenia
Common due to length of treatments, negative symptons lead to unwillingness to participate, positive symptons lead to distrust of process
121
Patients struggling to cope as a limitation of therapy as a treatment for schizophrenia
Severity of symptons can lead to people not being able to cope with the vigorous confronttion of beliefs that CBT requires - antipsychotic medication can be used to initially reduce severity of sypmtons
122
Cost benefit analysis of the therapy vs drug therapy as a treatment for schizophrenia
CBT doesn't cause side effects but are much more expensive and time-consuming than drug therapy
123
Premise of family therapy as a treatment of schizophrenia
Family dysfunction increases risk of relapse so they aim to improve home situation, family centred - changes behaviour of whole family, psychoeducation - family educated on symptons of Sz to help them be more understanding
124
Key aims of family therapy as a treatment of schizophrenia
Reduce conflict (address anger), Reduce stress (caused by caring), Reduce self-sacrifice (have carer consider own needs), improve communication (limit expressed emotions), improve problem solving skills (predict problems and have solutions prepared)
125
Research support for family therapy as a treatment of schizophrenia
Leff (1985)
126
Leff (1985) study premise
Looked at aftercare of patients with schizophrenia
127
Leff (1985) study results
Standard outpatient care = 50% relapse after 9 months, Family therapy = 8%, after 2 years; standard = 75%, family = 50%
128
Leff (1985) study conclusion
Use of family therapy helpful in reducing re-admission in short term but not in longer term
129
Limitations of family therapy as a treatment of schizophrenia
Time, not a cure
130
Time as a limitation of family therapy as a treatment of schizophrenia
Can take up to a year, in this time lots of drop out especially if severe symptons or a family incident
131
Not a cure as a limitation of family therapy as a treatment of schizophrenia
Improves symptons and avoids admission to a mental health facility but not a cure
132
Token economy premise as a treatment for schziophrenia
Behavioural therapy, reinforcement of certain behaviours, immediate reward (tokens) for target behaviours (washing) which can be traded in for something (activities/chocolate),
133
How to use token economy as a treatment for schizophrenia
Behaviour shaping - desire behaviours start small and are progressively changed, psychiatric institutions - treatment desired to produce easier to manage behaviour within hospital or make it easier to reintegrate patients into society, mild negatice sypmtons - more ill patients are less able/willing to engage
134
Research support for token economy as a treatment of schizophrenia
Dickerson (2005)
135
Dickerson (2005) study premise
Reviewed findings of 13 studies
136
Dickerson (2005) study conclusion
Token economies can be effective in improving adaptive behaviour of people with schizophrenia
137
Limitations of token economy as a treatment of schizophrenia
Don't treat symptons, not effective with severe symptons, ethics
138
Don’t treat symptons as a limitation of token economy as a treatment of schizophrenia
Only manage negative symptons (poor motivation, poor attention, social withdrawal)
139
Not effective with severe symptons as a limitation of token economy as a treatment of schizophrenia
Not effective for severely unresponsive patients
140
Ethics as a limitation of token economy as a treatment of schizophrenia
Using Skinners principles could be seen as degrading as its manipulating them like lab rats
141
Interactionist approach to explaining schizophrenia
Diathesis stress model - disorder due to interaction between predisposed vulnerability and environmental trigger
142
Diathesis in schizophrenia
Often thought to be genetic (ie dopamine inbalance), some non genetic diathesis (flu in pregnant mother or birth complications), thought to include early psychological trauma as it can influence brain development
143
Stressors in schizophrenia
Later negative environmental experiences such as family dysfunction, emotional stress/anxiert or major negative life event, or even drug abuse (cannabis linked to schizophrenia due to interference with dopamine system)
144
Research support for the interactionist approach to explaining schizophrenia
Gottesman (1991), Tienari (2004)
145
Interactionist approach to treating schziophrenia
Combining psychological aspects like CBT and biological therapies to address both causes
146
How the interactionist approach to treating schizophrenia works
Bio treatment reudces symptons so that engagement with psychological therapies can occur, CBT then gives sufferers the cognitive skills needed to change their underlying faulty cognitions
147
Research support of the interactionsit approach to treating schizophrenia
Tarrier (1998)
148
Strengths of the interactionist approach to schizophrenia
Progression of understanding, holistic, nature/nurture debate
149
Progressons of understanging as a strength of the interactionist approach to schizophrenia
Diathesis now believed to be polygenic and include early trauma (Read 2001), Stressor developed to include other factors like drug abuse
150
Holistic as a strength of the interactionist approach to schizophrenia
Looks at a complex range of factors as a cause of schizophrenia, doesn't limit it to certain biological or psychological factors
151
Nature/nurture debate as a strength of the interactionist approach to schizophrenia
Considers both hereditary and environmental factors
152
Limitations of the interactionist approach to schizophrenia
Not fully understood
153
Not fully understood as a limitation of the interactionist approach to schizophrenia
Not fully understood how a negative stressor triggers schizophrenia
