schizophrenia Flashcards
(32 cards)
Reliability and Validity in Diagnosis and Classification of Schizophrenia AO1
Reliability concerns the consistency of something. In relation to schizophrenia, this is the consistency of the application of the chosen classification system, and this impacts diagnosis Different clinicians must make the same, independent diagnoses of the same patient (inter-rater reliability). The same clinicians must make the same diagnoses on separate occasions from the same information (test-retest reliability).
Validity concerns the extent to which individuals are measuring what they are intending to measure. In relation to schizophrenia, validity concerns how accurate a diagnosis is
This refers to the occurrence of two or more medical conditions together. For example, schizophrenia and bipolar disorder.
Symptom overlap occurs when two or more conditions share symptoms. This makes it difficult for clinicians to decide which disorder someone is suffering from.
Gender bias is the tendency for diagnostic criteria to be applied differently to males and females. The gender of the patient may impact the diagnosis given. The psychiatrist’s gender might also impact their ability to diagnose
Reliability and Validity in Diagnosis and Classification of Schizophrenia strenght
Even if reliability of diagnosis based on classification systems is not perfect, they do provide practitioners with a common language and permit communication of research ideas and findings. This may lead to a better understanding of the disorder and the development of effective treatments.
Reliability and Validity in Diagnosis and Classification of Schizophrenia limitations
Being labelled as ‘schizophrenic’ has long-lasting, negative effects on social relationships, work prospects, self-esteem, etc., which seems unfair when diagnoses of schizophrenia are made with little evidence of validity.
- Goldman (1999) reported that 50% of people with schizophrenia had a co-morbid medical condition, such as substance abuse or polydipsia (excessive thirst). This makes reliable and valid diagnosis of schizophrenia problematic.
- Ketter (2005) reports that misdiagnosis due to symptom overlap can lead to years of delay in receiving treatment. During this time, suffering and further degeneration can occur, as well as high levels of suicide.
Genetic Explanations AO1
A biological theory that sees genes inherited from one’s ancestors as forming the basis for schizophrenia
Gottesman (1991) conducted a large-scale family study and found that MZ twins have a 48% risk of getting schizophrenia, whereas DZ twins have a 17% risk rate. Furthermore, 9% if the individual was a sibling. This is evidence that the higher the degree of genetic relatedness, the higher the risk of getting schizophrenia.
It is not believed that there is a single ‘schizophrenic’ gene, but that several individual genes are involved with a risk of inheriting schizophrenia – it is polygenic
Ripke et al., (2014) found 108 different genetic variations are associated with an increased risk of schizophrenia
Schizophrenia can also have a genetic origin in the absence of a family history of the disorder. One explanation for this is mutation in parental DNA which can be caused by radiation, poison, and viral infection.
Genetic Explanations strenghts
Tienari et al., (2004) found that adopted children of biological mothers with schizophrenia were more likely to develop the disorder themselves than adopted children of mothers without schizophrenia.
- Hilker et al., (2018) showed a concordance rate of 33% for identical twins and 7% for non-identical twins.
Genetic Explanations limitations
It may be that the increased concordance rates in family studies are due to the increased chance of sharing the same environment as the person with schizophrenia. For example, identical twins share the same environment (and may be treated similarly), whereas first cousins would not.
- The fact that the concordance rates are not 100% for MZ twins means that schizophrenia cannot wholly be explained by genes. It could be the similarity of environments that causes schizophrenia, as there is an increased concordance rate for DZ twins compared to siblings.
Neural Correlate Explanation AO1
Neural correlates- Structural and functional changes in the brain that result in the characteristic symptoms of a behaviour or mental disorder, in this case schizophrenia.
Dopamine Hypothesis- dopamine hypothesis (Davis et al., 1991) suggest patients with schizophrenia may additionally experience hypodopaminergia (too little) dopamine in the cortex (outer brain).
Ventral Striatum- Abnormalities in the ventral striatum may be involved in the development of avolition. Juckel et al., (2006) found a negative correlation between activity levels in the ventral striatum and the severity of overall negative symptoms.
Superior Temporal Gyrus and Anterior Cingulate Gyrus- The left STG has been reported to be smaller in patients with schizophrenia. The volume of the STG has been found to correlate negatively with the severity of hallucinations and thought disorder.
Neural Correlate Explanation limitations
Some of the genes identified by Ripke et al., (2014) code for the production of other neurotransmitters, not just dopamine. It appears that although dopamine is likely to be one important factor in schizophrenia, other neurotransmitters are also involved.
- Neural correlate explanations could be criticised for being biologically deterministic. Just because an individual has excessive amounts of dopamine, or lower activity levels in their ventral striatum, does not mean that they will develop schizophrenia
- Post-mortem and living scan studies have consistently found raised levels of the neurotransmitter glutamate in several brain regions of people with schizophrenia (McCutcheon et al., 2020). In addition, several candidate genes for schizophrenia are believed to be involved in glutamate production or processing. This means an equally strong case can be made for the role of other neurotransmitters in the development of schizophrenia, limiting the dopamine hypothesis.
Family Dysfunction Explanation AO1
Family dysfunction- Family dysfunction refers to the processes within a family that are dysfunctional i.e., impaired. These may be risk factors for both the development and the maintenance of schizophrenia.
Family dysfunction explanations suggest that unhealthy or abnormal relationships and patterns of communication, cold parenting, and high levels of expressed emotion within families causes stress.
The Schizophrenogenic Mother- Such mothers were supposedly cold, rejecting and controlling. This tends to create a family climate characterised by tension and secrecy and leads to distrust. This later develops into paranoid delusions and ultimately schizophrenia.
Double-bind Theory- Bateson et al., (1972) agreed that family climate is important in the development of schizophrenia but emphasised the role of communication style within a family. When they ‘get it wrong’, which is often, the child is punished by the withdrawal of love. This leaves them with an understanding of the world as confusing and dangerous, and this is reflected in symptoms like disorganised thinking and paranoid delusions.
Expressed Emotion- Expressed emotion is the level of emotion (usually negative) that is expressed towards a person with schizophrenia by their family or carers.
Family Dysfunction Explanation strengths
Having a family member with schizophrenia can be problematic and stressful on family relationships. Therefore, rather than dysfunctions within families causing schizophrenia, it could be that having someone with schizophrenia within a family leads to dysfunction.
The family dysfunction theory is supported by the fact that therapies which successfully focus on reducing expressed emotions within families have lower relapse rates compared with other therapies.
Tienari et al., (2004) found that the level of schizophrenia in adopted individuals who were the biological children of schizophrenic mothers was 5.8% in those adopted by healthy families, compared to 36.8% for children raised in dysfunctional families. This supports not only the family dysfunction theory, but also the idea that individuals with high genetic vulnerability to schizophrenia are more impacted by environmental stressors
Family Dysfunction Explanation limitation
A problem with the family dysfunction theory is that it fails to explain why all children in such families do not go on to develop schizophrenia
Cognitive Explanations AO1
Cognitive explanations- Explanations that focus on mental processes (such as thinking, language and attention) as underpinning behaviour, in this case schizophrenia.
Dysfunctional thought processing- Information processing that does not represent reality accurately and produces undesirable consequences
Positive symptoms of schizophrenia are thought to be explained through two processes:
↳ Cognitive biases: these are systematic patterns of deviation from ‘normal’ thinking where inferences are drawn illogically. This can lead to delusions
↳ Information processing biases: are where information is ‘changed’ in different ways to ‘normal’ people. This can explain hallucination
Negative symptoms are thought to be explained through impaired cognitive strategies eg. Lack of emotion is thought to be because those with schizophrenia are experiencing high levels of emotions internally such as confusion, anger, fear. To keep this ‘under control’ they have to remove themselves for their ‘external’ emotional world
Dysfunctional Thought Processing- Frith et al., (1992) identified two kinds of dysfunctional thought processing that could underlie some of the symptoms of schizophrenia
↳ Meta-Representation- The cognitive monitoring of one’s own thought processes.- The cognitive monitoring of one’s own thought processes.
↳ Central Control- The cognitive ability to suppress automatic responses while performing deliberate actions- Those with schizophrenia tend to experience derailment of thoughts and spoken sentences because each word triggers associations, and the responses to the associations cannot be suppressed. The inability to stop automatic thoughts and speech could explain the disorganised speech, speech poverty and disorganised thought that is seen in people with schizophrenia.
Cognitive Explanations strengths
strength
Supporting evidence
Stirling at al., (2006) compared 30 patients with a diagnosis of schizophrenia with 18 non-patient controls on a range of cognitive tasks, including the Stroop task. Patients took over twice as long to name the ink colour as the control group
This supports central control impairment with those with schizophrenia, as it suggests difficultly in suppressing automatic processing (i.e., saying the word
Strength
The claim that the symptoms of schizophrenia have their origin in faulty cognition is reinforced by the success of cognitive-based therapies for schizophrenia
In CBT for psychosis, patients are encouraged to evaluate the content of their delusions or of any voices, and to consider ways in which they might test the validity of their faulty beliefs
The effectiveness of this approach was demonstrated in the NICE review of treatments for schizophrenia (NICE, 2014). It found consistent evidence that, when compared with treatment by antipsychotic mediation, CBT was more effective in reducing symptom severity and improving levels of social functioning
Cognitive Explanations limitations
Limitation
Cognitive explanations of schizophrenia do not explain how the faulty cognition occurred
The cognitive explanations are purely descriptive; they explain the links between the symptoms of schizophrenia and the faulty thinking that occurs, but they do not explain what causes the faulty thinking
Limitation
The cognitive explanations suggest that faulty thinking is responsible for the symptoms of schizophrenia and therefore one way to treat the illness would be to change an individual’s cognitions.
This could lead to individuals feeling like they are to blame for the development of schizophrenia.
Drug Therapy AO1
Drug therapy- Treatment of mental disorders, such as schizophrenia, using medication to reduce the symptoms of the disorder.
Typical antipsychotics- These are dopamine antagonists; they bind to but do not stimulate dopamine receptors. They work to reduce the symptoms of schizophrenia.
primarily to combat the positive symptoms of schizophrenia such as hallucinations, delusions and disordered thinking which are thought to be the product of overactive dopamine systems
They work by binding to dopamine receptors and blocking their action
Due to the calming effect of typical antipsychotic drugs, there tends to be a general sedative effect.
Atypical antipsychotics- These typically target a range of neurotransmitters such as dopamine and serotonin. They work to reduce the symptoms of schizophrenia.
Combat positive and negative symptoms
They tend to target a range of neurotransmitters such as dopamine and serotonin
An example of an atypical antipsychotic is clozapine. Clozapine binds to dopamine, serotonin, and glutamate receptors in the brain. By impacting all three neurotransmitters, clozapine reduces both positive and negative symptoms such as avolition, whilst also improving mood and cognitive functions, and reducing depression and anxiety.
Drug Therapy strentghs
Strength
Antipsychotics are relatively cheap to produce, easy to administer and have positive effects on many patients, allowing them to live relatively normal lives outside of mental institutions.
This has resulted in less than 3% of people with schizophrenia in the UK living permanently in hospital. This means that antipsychotics are cost effective.
Strength
It is widely believed that antipsychotics had been used in hospital situations to calm people with schizophrenia and make them easier for staff to work with, rather than for the benefits to the people themselves (Moncreiff, 2013
On the other hand, calming people distressed by hallucinations and delusions almost certainly makes them feel better and allows them to engage with other treatments such as cognitive behaviour therapy and services such as meeting with a social worker to organise accommodation.
Drug Therapy limitations
Limitation
Lieberman et al., (2005) examined the effectiveness of typical and atypical antipsychotics in treating 1,432 individuals with chronic schizophrenia, finding that 74% of patients discontinued their treatment within 18 months due to intolerable side effects and reduced quality of life.
this can lead to high relapse rates. Evidence suggests around 40% in the first year after treatment and 15% in later years. This is generally due to patients stopping treatment because of the side effects
Limitation
The use of antipsychotics as a therapy for schizophrenia is based on the premise that too much dopamine is responsible for the symptoms of schizophrenia
Psychologists now know that too little dopamine in some areas of the brain may be responsible for schizophrenia symptoms. Antipsychotics therefore should not work
Cognitive Behaviour Therapy AO1
Cognitive Behavioural therapy (CBT)- A method for treating mental disorders based on both cognitive and behavioural techniques. It aims to deal with thinking, such as challenging negative thoughts and beliefs, and changing behaviour as a response.
CBT does not get rid of the symptoms of schizophrenia, but it can make patients more able to cope with them by knowing their origin. This in turn reduces their distress, and improves their ability to function adequately
From the cognitive viewpoint, the therapy aims to identify irrational thoughts, including delusional beliefs and hallucinations, and try to modify them. CBT assumes it is these delusional beliefs which cause schizophrenia
Delusional beliefs may occur due to incorrect interpretations the sufferer has of the world around them, themselves, or other people; maladaptive thinking; distorted perceptions of how to approach problems and goals
CBT can help patients to make sense of how their delusions and hallucinations impact on their feelings and behaviour
Cognitive Behaviour Therapy strengths
Strentgh
McGorry et al., (2002) found CBT was effective when comparing two samples of patients at high risk of having a first-onset schizophrenic episode receiving different treatments.
. After six months, 36% of patients receiving psychotherapy developed schizophrenia, while only 10% of those receiving CBT and drug therapy developed the disorder
This suggests CBT is more effective than psychotherapy in preventing first-onset schizophrenia
Strength
Jauhar et al., (2014) reviewed the results of 34 studies using CBT for schizophrenia. They concluded that CBT has a significant, but small effect on both positive and negative symptoms. This means that research supports the benefits of CBT for schizophrenia
Cognitive Behaviour Therapy limitations
Limitation
CBT requires a trained professional to deliver the sessions over several months making it incredibly costly and time consuming. Patients may also struggle to open up or build rapport with a therapist and the effectiveness of the therapy is largely influenced by the skill of the practitioner.
Limitation
CBT is not suitable for all patients, especially those too disorientated, agitated or paranoid to form trusting alliances with practitioners. It may be more suitable for those refusing drug treatments. However, for some of these patients it may be difficult to effectively undertake CBT if they are not taking the medication to help them access the therapy
Family Therapy
Family Therapy- A psychological therapy carried out with all or some members of a family with the aim of improving the communications within the family.
a form of psychotherapy that is carried out with all, or some members of the schizophrenic individual’s family. It is based on the psychological explanations for schizophrenia including the double-bind theory, expressed emotion and the schizophrenogenic mother, which see the family as the ‘root’ cause of schizophrenia.
The main aims of family therapy are:
· To improve positive communication and decrease negative forms of communication within the family.
· Reduce the stress of living as a family.
· Increase tolerance levels and decrease criticism levels between family members.
· Decrease feelings of anger, guilt, and responsibility for causing illness among family members
Numerous strategies can be used to improve the functioning of a family where there is an individual who is suffering from schizophrenia. For example Helping family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives
Family Therapy strenghts
Strength
Pharoah et al., (2010) reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family intervention
They found there was a reduction in the risk of relapse and a reduction in hospital admission during treatment and in the 24 months after
Strength
Family therapy can be useful for patients who lack insight into their illness or cannot speak coherently about it, as family members may be able to assist. Family members have lots of useful information and insight into a patient’s behaviour and moods and are often able to speak for them. This can make it more appropriate than CBT
family therapy limitation
Limitation
With the emphasis on ‘openness’, there can be an issue with family members being reluctant to share sensitive information as it may cause or reopen family tensions.
Some family members may also be reluctant to talk about, or even admit, their problems, lowering the effectiveness of the treatment.
Token Economy Programmes AO1
Token economy programmes- A form of behavioural modification where desirable behaviours are encouraged by the use of selective reinforcement.
Token economy programmes are based on operant conditioning principles. Patients receive reinforcements in the form of tokens immediately after producing a desired behaviour.
Tokens act as secondary reinforcers because they only have value once the patient has learned that they can be used to obtain rewards; the token itself does not hold any value. Rewards may include sweets, watching films
At the start of a token economy programme, tokens and primary reinforces (rewards) are administered together. However, when the programme is established, the tokens are swapped at a later date for a reward that the patient desire
