schizophrenia- 3

Question 1

outline the classification of schizophrenia

Answer 1

the process of describing its symptoms, 2 systems of classification- ICD-10, DSM-5, used as diagnostic tools

Question 2

outline positive symptoms

Answer 2

symptoms that reflect an excess or distortion of normal psychological functioning- hallucinations and delusions

Question 3

outline hallucinations

Answer 3

sensory experiences of stimuli that either have no basis in reality or are distorted perceptions of reality
-can be experiences in relation to any sensory modality, mainly auditory

Question 4

outline delusions

Answer 4

bizarre beliefs that seem real to an individual but are at odds with reality
-must be idiosyncratic, incorrigible, at odds with reality and be believed with certainty

Question 5

outline negative symptoms

Answer 5

deficits of normal emotional responses or other thoughts processes

Question 6

outline avolition

Answer 6

reduction in interests or desires as well as an inability to initiate or persist in any goal-directed behaviour
-neglecting routine activities such as work, hobbies and social activities

Question 7

outline speech poverty

Answer 7

a reduction in the amount of and/or quality of speech
-may reply sparsely, answers will lack spontaneous content or may fail to answer at all

Question 8

compare the systems of classification

Answer 8

both consider the positive symptoms as more important- cannot be diagnosed with schizophrenia if only negative are present
-DSM requires a 6 month period of active symptoms for diagnosis while ICD only requires one

Question 9

how to measure the validity of diagnosis and classification of schizophrenia

Answer 9

descriptive validity- assess whether the set of symptoms is distinct from other conditions, if symptom overlap occurs, perhaps schizophrenia is not an entirely separate condition

Question 10

how to measure the reliability of the diagnosis and classification of schizophrenia

Answer 10

inter-rater reliability- two separate clinicians diagnose the same group of patients, if there is a strong correlation between each diagnosis then diagnosis is reliable, suggesting the systems of classification are also reliable

Question 11

limitation- reliability and validity of diagnosis of schizophrenia- research challenge

Answer 11

Rosenhan- psychiatric hospitals could not distinguish patients with genuine schizophrenia from pseudopatients (confederates pretending to hear voices but otherwise acting normally)
-hospitals were inconsistent in their diagnosis (83 patients initially diagnosed with schizophrenia were later reclassified as pseudopatients) this suggests their diagnoses lacked reliability
- given that reliability is a necessary precondition for validity, the failure to reliably diagnose these patients also suggests that the process of diagnosing patients with schizophrenia is also invalid
-since 1973, the systems of classification and process of diagnosing schizophrenia has changed substantially
-Rosenhan’s research may lack temporal validity, meaning it may not tell us much about the reliability and validity of the classification and diagnosis of schizophrenia today

Question 12

limitation- reliability and validity of classification and diagnosis of schizophrenia- socially sensitive

Answer 12

Sieber and Stanley- socially sensitive research is research that has social consequences either for the research’s participants or for social groups connected to the research
- clear social consequences to researching the validity and/or reliability of schizophrenia as a diagnostic construct- possible consequence might be that people lose confidence in the profession of psychiatry, and are less willing to accept help- this might lead to mentally ill people being left untreated
-research into the validity of schizophrenia may be socially beneficial, If such research furthers our understanding of mental illness, this information could inform the treatment of mentally ill people

Question 13

what is symptom overlap

Answer 13

when disorders share common symptoms, many positive and negative symptoms of schizo are also found in depression and bipolar

Question 14

limitation- diagnosis and classification of schizo- symptom overlap

Answer 14

Konstantareas and Hewitt-compared symptoms of 14 autistic patients and 14 patients with schizo, none of the schizophrenics had autism symptoms, but 7 of the autistic participants had symptoms of schizo
- overlap between the symptoms of schizophrenia and autism, demonstrating the issue of symptom overlap for the classification of schizophrenia
- undermines the validity of the classification of schizophrenia, if the symptoms of schizophrenia overlap with other disorders, then perhaps schizophrenia is not a condition that is real and distinct from the other conditions
-could lead to invalid and unreliable diagnoses

Question 15

what is co-morbidity

Answer 15

when two or more conditions co-occur, e.g. depression and substance abuse

Question 16

limitation- diagnosis and classification of schizophrenia- co-morbidity

Answer 16

Sim et al- 32% of patients hospitalised with schizophrenia had an additional mental health disorder
-co-morbidity is common with people with schizophrenia
- this threatens the validity of the diagnosis of schizophrenia, as if conditions frequently co-occur, then they may actually represent a single condition
-systems of classification may be incorrect in distinguishing schizophrenia from other disorders (making them invalid)

Question 17

what is gender bias (in diagnosis of schizo)

Answer 17

when validity of diagnosis is dependent on gender of the patient

Question 18

limitation- diagnosis of schizo- gender bias

Answer 18

Longenecker - reviews studies of the prevalence of schizophrenia, found that since the 1980s, men have been diagnosed more with schizophrenia than women
-could be an issue of gender bias within the diagnosis of people with schizophrenia, as there is a clear gender difference in these findings
-systems of classification are biased, so more effective at describing the presentation of schizophrenia in men than women, leading clinicians to more effectively diagnose men than women
- might be more likely if female patients typically function better than men, leading them to mask the negative symptoms of schizophrenia more effectively
- also possible that schizophrenia is simply a condition that occurs more in men, meaning the systems of classification do validly describe schizophrenia and there is no issue with the validity or reliability of the diagnosis- If true, gender bias is not an issue for the diagnosis and classification of schizophrenia

Question 19

what is cultural bias (in the diagnosis of schizo)

Answer 19

tendency to over diagnose poeple from certain cultures and perhaps under diagnose poeple from other cultural backgrounds

Question 20

limitation- diagnosis of schizophrenia - cultural bias

Answer 20

Cochrane- rate of schizophrenia in the West Indies and in Britain is very similar, but people of Afro- Caribbean backgrounds in the UK were seven times more likely to be diagnosed with schizophrenia than White British people in the UK
-similar rates in the two countries suggest there is nothing innate to people of an Afro-Caribbean background that makes them more likely to develop schizophrenia
- high diagnostic rates in the UK may be the result of a tendency for British clinicians to over-diagnose the condition in the population, indicating a culturally biased approach to diagnosis
-this might result from culturally biased attitudes of British clinicians, who may distrust the honesty of self-reported symptoms by Black British patients
- also possible the context of being black and British may result in a stressful environment, which perhaps results in more people from an Afro-Caribbean background developing schizophrenia in Britian- If true, this would mean the diagnosis of schizophrenia is not affected by cultural bias, making it valid and reliable

Question 21

outline the genetic exp for schizo

Answer 21

early research (meehl) suggested a single gene was responsible for schizo- schziogene
-schizo has a genetic basis- many candidate genes, polygenetic
-one candidate gene is the COMT gene- involved in regulation of dopamine, provides genetic basis for dopamine hypothesis

Question 22

outline the dopamine hypothesis

Answer 22

positive symptoms of schizo are caused by hyperactivity or dopaminergic neurones in the reward pathway
-due to high levels of dopamine released and high levels of D2 receptors

Question 23

outline the revised dopamine hypothesis

Answer 23

negative symptoms caused by hypoactivity of dopaminergic neurones in prefrontal cortex

Question 24

outline neural correlates

Answer 24

aim to identify abnormalities in structure and function of regions of the brain that correlate with positive and negative symptoms
-auditory hallucinations- reduced activity in superior temporal gyrus (responsible for recognition of inner speech)
-avolition- reduced activation of ventral stratum (responsible for anticipation of reward)

Question 25

limitation- bio exp for schizo- reductionism

Answer 25

biologically reductionist -seek to explain complex phenomena in terms of the contribution of features of our biology, such as our genes
- simplifies and ignores the interaction with other relevant levels of explanation, such as the role of stressor in our environment (diathesis-stress model)
- at odds with holistic explanations, which consider the role of all relevant factors and avoids the oversimplification resulting from reductionist explanations
- entirely biological explanation can only offer a partial explanation of the disorder

Question 26

strength- genetic exp (bio exp) for schizo - research support

Answer 26

• Joseph- meta-analysis of schizophrenia twins
  -MZ twins was 40.4% and 7.4% for DZ twins
  -higher concordance rates for MZ twins indicate that genetics do play a role in causing schizophrenia
• However the concordance rates for MZ twins were not 100% -although schizophrenia clearly has a genetic basis, it is not entirely a genetic condition
  -suggests environmental factors also play a role in explaining schizophrenia, meaning the genetic explanation can only offer a limited explanation for schizophrenia
• support is limited by its reliance on twin studies- cannot ensure equal environmental treatment of DZ twins
  -meta-analysis- large representitive samples, generalisable to wide population

Question 27

strength- dopamine hypothesis (bio exp) for schizo- research support

Answer 27

antipsychotics which block the action of dopamine (dopamine antagonists) have been used to effectively treat the positive symptoms of schizophrenia
- users of dopamine agonists, such as cocaine and amphetamine, experience symptoms like hallucinations and delusions that mirror the positive symptoms of schizophrenia
-only provides support for the dopamine hypothesis, no support or challenge to the revised dopamine hypothesis

Question 28

strength- neural correlate (bio exp) for schizo- research support

Answer 28

Allen, using fMRI - compared to controls, schizophrenic patients had abnormally low activity in the superior temporal gyrus-associated with identification of inner speech
- provides clear evidence that abnormalities in the superior temporal gyrus are linked to the auditory hallucinations of schizophrenia
-only provides evidence of a correlation, we cannot necessarily assume the direction of causation
-fMRI-produces images of a very high spatial resolution, can be confident of specific area

Question 29

what are antipsychotics

Answer 29

class of medication used to treat many symptoms of schizophrenia
-two groups- typical and atypical
-dopamine antagonists, block D2 receptors without activating them

Question 30

what are the side effects of antipsychotics

Answer 30

extrapyramidal symptoms, weight gain, sex drive loss, possibly agranulocytosis (ineffective production of white blood cells)

Question 31

what are extrapyramidal symptoms and why do they occur

Answer 31

undesirable movement problems e.g. spasms and motor restlessness
-occur since dopamine antagonists block D2 receptors in areas of the brain controlling movement
-atypicals causes fewer since they only temporarily occupy the receptors so dont disrupt functioning as much

Question 32

outline how atypicals can have beneficial effects on affective symptoms and cognitive deficits

Answer 32

clozapine- serotonin agonist for 5-ht1a receptor, produces beneficial effects on mood and anxiety

Question 33

strength/limitation- drug therapies for schizo- research

Answer 33

Crossley-meta-analysis to compare the effectiveness of typical and atypicals -equally effective in reducing positive symptoms but atypicals lead to more weight gain and produce more extrapyramidal symptoms
-both typical and atypical antipsychotics can be equally useful in treating some of the symptoms of schizophrenia
- both cause side effects, resulting in a reduction of compliance with taking the medication, making the drug therapies less useful for helping people with schizophrenia
- different profile of side effects means that psychiatrists need to carefully consider the relative advantages and disadvantages when deciding what to prescribe patients
-meta-analysis- large sample size, more externally valid

Question 34

limitation- drug therapies for schizo- limited treatment

Answer 34

2015 meta-analysis of studies examining the effectiveness of typical and atypical antipsychotics - none of these medications provided clinically significant benefits for negative symptoms
-drug therapies only offer a limited treatment for schizophrenia
- meta-analysis- large sample size, more externally valid
- causes of the negative symptoms are more complex than the positive ones or that they are rooted as much in psychological factors as in chemical changes within the brain cells
-demonstrates the importance of avoiding a reductionist approach to the treatment of schizophrenia, which focuses only on one level of explanation

Question 35

outline the family dysfunction exp for schizophrenia- psychological exps

Answer 35

explains schizo in terms of problematic patterns of behaviour within the family

Question 36

outline high levels of expressed emotion

Answer 36

type of dysfunctional family process, intensity of negative emotion expressed by family member
-hostility, emotional over-involvement, critical comments
- known predictor of relapse- leads to decline in mental health
-stress caused by EE may lead to development of schizo (diathesis-stress)

Question 37

what is hostility (high levels of EE)

Answer 37

generally negative attitude directed at patient- results from familys belief that disorder is controllable and patient chooses not to get better

Question 38

what is emotional over-involvement (high levels of EE)

Answer 38

over-protective style of engagement towards patient, intrusive and controlling
-needless self-sacrifice by family

Question 39

what are critical comments (high levels of EE)

Answer 39

complaints directed at patient, accusations of laziness and selfishness

Question 40

outline dysfunctional thought processing- decision making- as a cog exp for schizo

Answer 40

dysfunctional form of decision making- jumping to conclusions- reaching rapid decisions on uncertain evidence
-can explain delusions- more easy to hold beliefs that are at odds with reality

Question 41

outline dysfunctional thought processes- metarepresentation- as a cog exp of schizo

Answer 41

disruption of a persons ability to identify inner speech from outer speech
-explains hallucinations- a person may mistakenly believe their own thoughts have an external origin- hearing voices

Question 42

similarities between family dysfunction exp and cognitive exps-psychological exps

Answer 42

both middle level exps
-both reductionist
-both nomothetic

Question 43

differences between family dysfunction exps and cognitive exps- psychological exps

Answer 43

social-psychological level (externals impact on internal) of exp vs cognitive level of exp (internal only)
-EE explains onset of symptoms and severity of illness, cog only explains specific symptoms

Question 44

strength- psychological exps for schizo- real-life applications

Answer 44

both family dysfunction and cog exps have led to the development of successful therapies (family and cbt)
-success of treatments provides support for validity of exps

Question 45

limitation- psychological exps for schizo (family dysfunction)- socially sensitive

Answer 45

socially sensitive research has potentially harmful social consequences either for participants or people connected to the research
-may lead family members to feel blamed for relatives condition, could lead to caretakers stopping engaging with medical professionals- impacting patients recovery
-doesnt discredit family dysfunction exps- but vital that researchers challenge the blame on family members - careful consideration on communication of findings

Question 46

limitation- psychological exps for schizo (cog exps) - limited exps

Answer 46

clear links between dysfunctional thought processes and symptoms, but no explanation of what led to development of dysfunctional thought processes
-partial exp for symptoms, other theories needed to explain development of symptoms
-issue with reductionist levels of exp, holistic account needed

Question 47

what is the aim of token economies

Answer 47

to manage the symptoms of patients being cared for in institutions

Question 48

how are token economies used in hospitals

Answer 48

patients are given tokens when they complete desirable behaviours, such as washing or exercising, they can then exchange these for rewards, such as food or cigarettes

Question 49

why are token economies effective

Answer 49

positive reinforcement, the tokens act as a secondary reinforcer meaning the ability to reinforce behaviours is only obtained when they become associated with the primary reinforcer of the reward
-tokens must be given immediately after the behaviour is completed to avoid delay discounting

Question 50

strength- token economies- research support

Answer 50

schizo patients in Iranian hospital who were randomly allocated to token economy programme had fewer negative symptoms than those in control condition
-use of random allocation allows control for individual differences
-shows token economies can be effective as treatment of negative symptoms

Question 51

limitation- token economies- ethical issues

Answer 51

use of token economies results in patients less able to manage their symptoms receiving less privileges than those who can
-discrimination- discriminate against those with more severe symptoms as they will find it harder to complete target behaviours
-token economies are therefore not used in modern hospitals

Question 52

what is the aim of CBTp

Answer 52

to challenge the dysfunctional thinking and behaviour associated with schizo, and reduce the stress caused by the symptoms

Question 53

outline psycho-education (CBTp technique)

Answer 53

educating patient about their condition using the stress- vulnerability model
- outlines link between thoughts, feelings and behaviours
-can make the illness seem more manageable, reducing stress and helping the patient engage with the therapy

Question 54

outline cognitive therapy for delusions and or hallucinations (CBTp technique)

Answer 54

explores rationality of patients delusional belief, aiming to changing the beliefs that cause distress
-reality testing experiments- look for evidence to challenge their delusions

Question 55

outline behavioural skills training (CBTp technique)

Answer 55

agree on behavioural actions for patient to take to reduce stress caused by symptoms
-behaviours are individualised to situation but could include things like controlled breathing

Question 56

outline the stress vulnerability model

Answer 56

an event is created by a combination of how someone interprets it, feels about it and reacts to it (their interpretations, emotions and behaviours)

Question 57

strength- CBT for schizo- research support

Answer 57

meta-analysis of 14 studies of CBT involving 1484 patients showed that CBT reduced positive symptoms
-meta-analysis- large samples size, representative and generalisable
-no evidence for help with negative symptoms

Question 58

limitation- CBT for schizo- methodological issues

Answer 58

supporting studies fail to blind researchers when assessing effectiveness of treatments
- researchers then know what treatment patients are receiving and this could lead to investigator effects
-some studies fail to use control group, meaning improvements could result from individual differences instead of CBTp

Question 59

what are the aims of family therapy

Answer 59

to improve communication, reduce levels of negative emotion including EE, and help members of the family balance their needs with the need to care for the patient

Question 60

why is family therapy helpful

Answer 60

families can provide an important source of support, which can be harmful in situations of family dysfunction

Question 61

what is psychoeducation in family therapy

Answer 61

teaching the patient and family the facts about the illness, its causes, the influence of drug abuse and the effect of stress and guilt

Question 62

what is communication skills training in family therapy

Answer 62

teaching family to listen, to express emotions in a constructive way and to discuss things
- additional communication skills are taught, such as compromise and negotiation and requesting a time out

Question 63

strength- family therapy for schzio- research support

Answer 63

randomly allocated 63 poeple with schizo to either have standard drug care or with family therapy, after a year 61% of patients in drug care had relapsed, compared to 33% with family therapy
-effective as additional treatment
-shows long term benefits
-random allocation- difference in relapse can be attributed to use of family therapy instead of individual differences

Question 64

limitation- family therapy for schzio- research challenge

Answer 64

garety- high levels of relapse in schizo patients without carers and low levels of patients with carers, regardless of whether they were in family therapy
-shows that family plays an important role in care and support of patients but shows family therapy wasn’t helpful in preventing relapse

Question 65

outline the diathesis stress model in explaining schzio

Answer 65

diathesis makes a person vulnerable to developing schizo but this must interact with a stressor to cause the illness to develop

Question 66

outline the interactionist approach to treating schizo

Answer 66

CBT and drug therapies- antipsychotics administered to reduce positive symptoms which then allows patients to better engage with CBT
-family therapies and drug therapies - drug therapies administered allowing patient to be well enough to return to care of family, family therapy then helps family better care for patient

Question 67

strength- interactionist exp for schizo - research support

Answer 67

research on adopted children of 19000 finnish mothers - being raised in family environment with high levels of criticism and low levels of empathy is a risk factor for developing schizo but only when bio mother had schizo
-supports diathesis- stress model
-large sample size, representative and generalisable- only on adopted children

Question 68

limitation- interactionist exps for schizo- falsifiability

Answer 68

an exp which focuses on only one level of exp are easier to falsify
-more complex interactions and variables making it harder to test empirically- not falsifiable, lacking scientific credibility