schizophrenia Flashcards
(104 cards)
1
Q
what are the two models called
A
icd-11
dsm-5
2
Q
the difference?
A
icd-11:
2/+ negative symptoms
dsm-5:
1 positive symptom
3
Q
Positive symptoms
A
- Hallucinations: unusual sensory experiences
e.g. voices heard either talking to or commenting on a person, often criticising them. - Delusions: Irrational beliefs
e.g. Being an important historical/political/religious figure - jesus - being persecuted by government or aliens
4
Q
Negative symptoms
A
- Speech Poverty +
delayed responses when talking to someone
e.g speech disorganisation: change topic midway conversation
DSM-5 (POSITIVE)
- Avolition - apathy
-finding it difficult to keep up with a goal or even achieve it in the first place. - decreased motivation to carry out any tasks
5
Q
Avolition
A
Poor hygiene
Poor grooming
Lack of persistence in work or education + lack of energy
6
Q
STRENGHT OF SCHIZOPRENIA
A
Reliability - consistency
Inter-rater reliability
test retest reliability
7
Q
study
A
180
interviews
inter-rater reliability
.97
test retest
.92
8
Q
Limitations
A
Low validity- assessing what we are meant to assess?
co morbidity
culture bias
gender bias - men more than women
symptom laps
9
Q
what type of validity + study
A
Criterion validity
100
icd-10 dsm-IV
68 under icd
39 under dsm IV
Over/underdiagosis of schizophrenia
10
Q
counter
A
two measure from the same system dsm5 = excellent agreement between clinicians
good provided it takes place from the same diagnostic system
11
Q
co morbidity
A
reduces the validity of schizophrenia as a separate diagnosis
OCD/ substance abuse or depression
maybe its a different type of depression and not a whole new diagnosis
12
Q
gender bias
A
men more than women
women are less vulnerable than man
genetic factors.
underdiagnosis of women?
- closer relationships- get more support = functioning better than men
13
Q
culture bias
A
Haiti- hearing voices are normal - ancestors trying to communicate
British people of African-Caribbean origin are 9 times more likely to receive a diagnosis of schizophrenia than White people.
don’t rule out a genetic vulnerability
black british people are discriminated
14
Q
symptom overlap with what condition and what negative and positive points does it show
A
Bipolar
positive - delusions
negative avolition
schizophrenia and bipolar different?
15
Q
Genetic basis of schizophrenia
A
Family studies
candidate genes
the role of mutation
16
Q
family studies
A
- gottesman’s
aunt 2%
sibling 9%
identical twin 48%
+ family members usually share the same environment + genes = good correlation as it represents both
17
Q
candidat genes
A
polygenic
those coding for neurotransmitters - dopamine
ripke
37000vs 113000 = 108 separate genetic variations
aetiologicaly heterogenouses
18
Q
different combinations of factors, including genetic variation can lead to the condition
A
aetiologically heterogeneous
19
Q
mutation
A
mutation in parental DNA which can be caused through:
- Poison
- radiation
- viral infection
Paternal age - sperm mutation
0.7 under 25 2% 50+
20
Q
neural correlation of schizophrenia
A
the original dopamine hypothesis
updated versions
21
Q
original dopamine hypothesis
A
increased rates of dopamine in certain subcortical areas of the brain
22
Q
example
A
Broca’s area:
- responsible for speech production = explains the specific symptoms of speech poverty
23
Q
other hypothesis
A
Lowered da levels in the pre frontal cortex leads to the negative symptoms
one leads to the other
24
Q
concordance rates
A
33 7
25
biological risk factors
birth complications and smoking thc tich cannabis in teenage years
26
psychological factors
childhood trauma
67% schizophrenia and psychosis had a childhood trauma vs 38 matched pairs
27
genetic basis evaluation
research support
environmental factors
genetic counselling
28
increase dopamine =
amphetamines
worsen symptoms + induce symptoms with no symptoms
29
reduce
antipsychotic
reduce intensity of symptoms
30
dopamine - no ....... yes
glutamate - post partem brain scanning
candidate genes are involved for the production of these.
31
neural correlations of schizophrenia
dopamine support
glutamate
32
Psychological explanations for schizophrenia
family dysfunction
cognitive explanations
33
family dysfunction
the schizophrenogenic mother
Double blind theory
expressed emotion
34
FRIEDA
fromm richmann
35
Characteritics of a schizophrenogenic mothier
Cold
rejecting
controlling
tends to create a family climate full of tension and secrecy
36
this leads to
distrust which later becomes paranoia and then delusions
37
double blind theory
bateson
38
explain the double blind theory
developing children fear from doing the wrong thing
but they are not told what this wrong thing is so the are left confused
they feel unable to comment on the unfairness of the situation
when the child gets something wrong they are punished by withdrawal of love.
world is confusing and dangerous = disorganised thoughts + paranoid delusions
39
EE?
Expressed emotion
40
negative emotions
- verbal criticism of the person x violence
- hostility towards the person x anger + rejection
- Emotional overinvolvement in the life of the person x needless self-sacrifice
41
how can ee lead to schizophrenia
1. diathesis stress model - such behaviour acts as a stressor for vulnerable people
2. Primary an explanation for relapsing
42
cognitive explanations
dysfunctional thinking
metarepresentation dysfunction
central control dysfunction
43
dysfunctional thinking processing
information processing that does not represent reality accurately and produces undesirable consequences
44
negative symptoms
ventral striatum
45
positive symptoms
hallucinations - temporal + cingulate gyri
46
whta is metarepresnetation
the cognitve ability to reflect on thoughts and behaviour
47
schiophrenia
the metarepresnetation is dysfunctionl hence cannot understand that our actions are driven by ourselves and not others hence they experience hallucinations + delusions
48
central control
dysfunction in the automatic thought supresssion and speech triggered by other thoughts
49
research support
insecure attachment + exposure to childhood trauma / abuse
schizophrenia - type c or d attachments (disorganised)
69% women / 59% history of sexual or physical abuse
50
explanations lack support
all through informal assesment dk how importnt such a thing really is
51
parent blaming
52
reasearch support
stroop task 30vs 30
schizophrenia ppl took longer
53
proximal explantions
don't tell us what actually causes the disorder just explains what it does unlike biological or family disfunction
54
what are the drugs used called
antipsychotics deal with positive symptoms
55
They can be divided into
typical or non typical
56
Typical antipsychotics
- choloropromazine
-tablets
-injection
-syrup
typical drugs have declined over the years
57
Dosage
1000mg unusual
usual 400-800 mg
58
Dopamine
antaggonist - reduces levels of neurotransmitter
chlorozopamine - 1st dopamine levels increase but then they reduce
thisnormalises dopamine levels in key areas of the brain reducing symptoms like hallucinations
59
what effect
sedation - histamine receptors
60
what is absorbed quicker
syrup hospital for anxious ppl
61
atypical why
develop antipsychotics
reduce symptoms
62
example
clozapine
blood condition
remarketed as it was discovered to be better
regular blood test
not available as injection
300-450mg
63
blood condition
agranulocytosis
64
what receptors does it work on
serotonin
glutamate
improve mood and reduce depression and anxiety in patients = improve cognitive processes
perscribed when indivudual at high risk
65
2nd
risperidone
tablet
injection
syrup
lats for2 weeks
4-8 12maximum
66
binds to
dopamine and serotonin receptors
better at binding to dopamine receptros hence beter than clozapine
67
research support
1121 13 trails - chlorpramazine worked better than placebo
better overall functioning + reduced symptoms severity vs placebo
atypical clozapine better than typical 30-50% of the time where typical have failed
68
Counter
- most studies are short term effect
- successful trials have had their data published multiple times
- calming effect does not mean severity of symptom has been reduced just reduced the amount of symptoms experienced
69
serious side effects
Typical
- dizziness
- agitation
- sleepiness
- stiff jaw
- weight gain
- itchy skin
long term - tardive dyskinesia
- dopmanine supersensitivity - involuntery facial movements - lip smacking
- grimacing
- blinking
Atypical:
- NMS - blocked dopmane in hippothalamus
- high temprature
-coma
frequenci 0.1-2+ %
70
mechanism unlear
dk why these drugs work
dopamine hypothesis - not a complete hypothesis
dopmanine levels in other parts of the brain are in fact too low rather than high = most antisychotics should not work
effectiveness?
71
evaluation
research support
serious side effects
mechanism unclear
the chemical cosh - for hospitals benefit to calm patients down not for patient themselves
72
psychological theraphy for schiophrenia
cbt - turkington case example - mafia
family therapy - pharoah burbach
73
cbt
5-20 sessions
deals with thoughts and behaviours
not elemenating but make it easier for the patient to understand by telling them no one is coming after them and its just a impaired speech auditory system in their own brain
this would - reduce distress and allow the patient to work more adequately
understanding where such symptoms are coming from can be really helpful for those people
delusions can be challanged
normalisation
74
Family therapy
- reduces negative emotions
- improves the families ability to help
75
phases
7
1. identifying and defining issues
2. identifying resources and what family members can do to help
3. encourage mutual understanding
4. identifying unhelpful patterns of interaction
5. skills training learning how to reduce anger issues
6. relapse prevention
7. maintanence for the future
76
evidence for effectiveness
34 studies
evidence - small but significant for reducing negative+positive symptoms
reduction in auditory hallucinations
NICE recommends cbt for schizophrenia
77
quality of evidence
evryone experiences different combiantions of postive and negative symptoms and so the cbt techniques have been tailored to each individual case
78
evaluation
evidence
quality of evidence
cure?
79
evidence
over suggested theraphy
reduced relapse rates by 50-60%
nice recommends it
80
benefits to the whole family
not only therphy for the identified patient but for those around them aswell
also reduces chances of someone else getting diagnosed with schizophrenia
gives the ability for the family to provide such a bulk of care to the identified patient
81
evalution
effective evidence
benefits to the whole family
cost effective
82
token economy
ayllon
azrin
83
?
women ward - token economy
performed a specfific task - made their bed or cleaning up
they were rewarded with a token saying one gift
these could then be switched for a reward - watching a movie
taks carried out increased significantly
were sued for people that were hospitalized for a long time -
- declined now due to ethical issues - restricting rewards for people with mental disorders
- closure of psychiatrist awards
- other community services hence other routes
84
rationale for token economies
- institulisation - people develop bad habits
- stop socialising with others
- bad hygiene
tackled by token economy
personal care
condition related behaviour
social behaviour
85
improves quality of life
normalises
86
whats involved in the token economy
- given right after - dleayed rewards are les effective
- discs
- sweets/magazines/ access to activities such as films/walks outside
87
theoratical understanding of token economies
Behaviour modification - behaviour therapy based on operant conditioning
- tokens are secondary reinforcers - onlt have value once leasent reward has been learnt
- meaningful rewards are primary reinforcers
88
generalised reinforces
token which can be used for particular primary reinforcers are powerful secondary reinforcers
89
evidence efffectiveness
7 high quality studies
chronic disorders
hospitalized
=reduction in unwanted behaviours and negative symptoms
90
counter
- only seven?
- file drawer problem - only positive results studies have been published undesirable ones have been filed away
91
ethical issues
- imposing one persons or institutions norms on others- problematic if target behaviour has not been identifies sensitively
someone may enjoy looking scuffy ect. hence forcing them to do something they don't want to do is wrong
taking away pleasures from someone some peoples conditions are already really bad and hence they cant perform such tasks so its not fair to so something like that for someone with mental disorders hence this is why people fled cases against some institutions which led to them closing down and so their decline.
92
Alternative approaches
- art therapy - mechanical problems but high gain low risk
- NICE recommends art therapy for schinzophrencic patients
93
Evaluation
- evidence for effectiveness
- ethical issues
- alternatives
benefits?
94
The interactionist approach
biological + psychological approach
- biological: neurochemicals + neurological reasons
- psychological: stress = life events + work hassles + poor family quality
95
the diathesis stress model
vulnerability + stress = schizophrenia
96
meehl's model
- diathesis - was entirely genetic
- single 'schizogene'
meehl = no gene no chance of schizophrenia
- chronic stress though childhood trauma and adoloscence especially in the presence of a schizophrenogenic mother = could result in the disorder
97
modern understanding of diathesis
early trauma - diathesis as it can alter the development of the brain
HPA - Overactive = making the person more vulnerable to later stress
98
modern understanding of stress
original:
parenting
anything that risks tiggering schizophrenia
- cannabis x7
- as its linked to dopamine
someone wont get schizophrenia after smoking cannabis as they would lack the vulnerability factor
99
Treatment according to the interactionist model
Antipsychotic x cbt
psychological treatment is ore common in the ul then in the us
100
`support for vulnerability
finnish children
high levels of:
- criticism
- hostility
- low levels of empathy
only in the high genetic risk group
genes + stress = schizophrenia
101
original diathesis stress model is overly simplified
stress can be biological not only limited to family dysfunction
sexal abuse underlying factor led to canabis major stimulating factor
102
real world application
randomly allocated 315 participants
1. medication + cbt
2. medication + counselling
3. medication
1+2 showed lowered symptoms vs the only medication group no difference in hospital readmissions
103
counter
treatment causation fallacy
104
