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A level Psychology > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

what is schizophrenia (3)

A

split mind -
disorganised though processes
split between intellect and emotions
split between intellect and external reality

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2
Q

what are the main symptoms of schizophrenia (5)

A

hallucinations - visual/auditory
delusions - false beliefs (grandeur, persecution)
disordered thinking - thoughts are not their own (inserted, taken)
control - lack of self control (under control by alien power)
emotional and volitional changes - flattened emotions, little energy and initiative

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3
Q

what are the primary impairments of schizophrenia? (5)

A 
hallucinations
disordered thinking
delusions
apathy
emotional blunting
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4
Q

what are the secondary impairments of schizophrenia? (2)

A

social - unemployment, social drift, institutionalisation, rejection and prejudice

psychological - dependent, poor coping, loss of confidence and no motiation

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5
Q

how are primary and secondary impairments linked of schizophrenia?

A

secondary are caused by primary

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6
Q

what are positive symptoms/type one of schizophrenia? (4)

A

response to drug treatment
additional to normal behaviour displayed
hallucinations
limbic system changes

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7
Q

waht are negative symptoms/type two of schizophrenia? (6)

A 
less response to drugs
deficit in normal behaviour displayed
enlarged ventricles in brain
lack of facial expressions/emotions - flattening effect, monotonous tone
avolation - loss of energy
poor social skills
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8
Q

how are symptoms of schizophrenia perceived?

A

on a continuum

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9
Q

what are the five subtypes of schizophrenia?

A 
paranoid
catatonic
disorganised
residual
undifferentiated
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10
Q

what are the problems with classifying subtypes of schizophrenia? (5)

A
  • hard to fit into one category as individual may ehibit many symptoms
  • labels could alter behaviour
  • overuse of undifferentiated category
  • catatonic could be a result of meds
  • many similar disorders like schizoaffective disorder
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11
Q

define a paranoid schizophrenic (2)

A

hallucinations and delusions

none of: disorganised speech or thoughts or catatonia, or flat effect

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12
Q

define a catatonic schizophrenic (4)

A

immobility or excessive motor activity
echolalia/echopraxia
prominent mannerisms
extreme negativism or mutism, posturing, stereotyped movements

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13
Q

define a disorganised schizophrenic (3)

A

disorganised speech, behaviour and flat effect

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14
Q

define a undifferentiated schizophrenic

A

criteria is no met for paranoid, catatonic or disorganised but shows primary impairments

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15
Q

define a residual schizophrenic

A

negative symptoms or a couple of primary impairments

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16
Q

what are the basic ideas for the biological explanation of schizophrenia (3)

A

genetics
neurochemical
neuroanatomical

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17
Q

what is the meta analysis results from the gottesman study?

A

children with two parents with schiz - 46.3

children with one parents with schiz - 12.9

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18
Q

why are twin studies used in schiz and what does it show (3)

A

shows genetic link to schiz, MZ twins have 100% same genes unlike DZ twins so they would have a higher concordance than DZ twins

of developing schiz 46% vs 14%

shows there is a major genetic factor

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19
Q

what are the problems with using twin studies to find genetic links to schiz? (2)

A

it’s hard to separate the environment and genetics.
MZ twins tend to share the same environment so they could be measuring the environmental effect rather than the genetic

small samples of twins with schiz so it’s hard to generlise to the public

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20
Q

why are adoption studies used in studying genetic links in schiz? what study had results? (3)

A

so we can see the genetic factors rather than the environment.
children are adopted by a neuro typical mother.
Heston found a 16% chance of them developing schiz (well above the 1%)

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21
Q

what is the reason for the high discordance rate in twins for schiz? (2)

A

half of the discordant group will go on to develop a schizoid or similar disorder which the stats do not include.
If a broader term for schizophrenia is used the MZ rate is higher

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22
Q

what is the neurochemical explanation of schizophrenia

A

Dopamine hypothesis

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23
Q

What is the dopamine hypothesis?

A

first thought that excessive dopaminergic activity in the brain was the cause of schizophrenia:

  • neurotypical individuals who take drugs that increase dopaminergic activity in the brain display psychotic symptoms like hallucinations
  • these drugs can also make a schizophrenic’s symptoms worse
  • neuroleptic drugs that block the dopaminergic neurons reduce psychotic symptoms
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24
Q

why is the dopamine hypothesis outdated?

A

post mortem studies did not show consistent evidence for an increased dopamine level.
rather the receptors for dopamine are more sensitive

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25
Q

what do post mortem (and) studies show in terms of D2 receptors?

A

patients with schiz have more D2 receptors than others
Study: pearlson - showed same evidence
Study: Seeman - 6x more D4 receptors

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26
Q

evaluation of neurochemical explanation for schiz

A
  • it is not clear what the cause and effect is - d2 is cause or effect?
  • study by pearlson: carried out on patients that had not been exposed to neuroleptic drugs and ruled out cause and effect problem found with post mortem studies
  • dopamine hyperactivity is oversimplifying schiz. neurotransmitters interact and not much is known about it.
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27
Q

what is the neuroanatomical explanation of schizophrenia?

A

structure of the brain:
limbic system
corpus callosum
abnormal brain development

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28
Q

limbic system and schiz?

A

cell loss in the limbic system of schiz patients shown in post mortem studies
unusual cell connections in the hippocampus

29
Q

corpus callosum and schiz?

A

gender difference in the thickening of these fibres are reversed in schiz individuals

30
Q

abnormal brain development and schiz?

A

development of cerebral cortex
-development of neuronal dendrites and organisation of synapses in the cortex
hemispheres are LESS asymmetrical especially in the tempero parietal region of the cortex

31
Q

brain imaging studies and schiz?

A

STudy: RAZ and RAZ - ventricular volume of schiz and controls = increase of ventricles in brain for schiz

32
Q

brain image study: suddath

A

monozygotic discordant twins

twin with schiz: smaller bilateral hippocampus and larger ventricles

33
Q

what do functional studies of the schiz brain show?

A

cerebral blood flow (CBF) show underactivity in the tempero frontal areas
known has hypofrontality - particularly evident in chronic patients

34
Q

evaluation

A

hard to link structural symptoms to symptoms
Lewis: found no significant link between enlarged ventricules and negative symptoms
-cause and effect!
-likely that a number of environmental factors are part of schiz = biological factors probably contribute to schiz

35
Q

cognitive explanations of schizophrenia?

A

mediating processes, the way we think, interpret and perceive ourselves and our environment can be faulty or biased - can explain positive symptoms like hallucinations and delusions really well

36
Q

cog explanation of hallucinations? (2)

A
  • Bentall: mistakening their own internal thoughts for external public events
  • five factor model
37
Q

what is the five factor model?

A

Slade and Bentall:

1) stress induced arousal
2) predisposition (more likely to hallucinate)
3) environment (quiet or noisy)
4) reinforcement (anxiety)
5) expectancy(see or hear what they believe exists)

38
Q

evaluation of the five factor model/

A
  • sensory deprivation or noise stimulation are condition associated: old people tend to hallucinate more
  • Close and Garrety: hallucinations cause more anxiety
  • cross cultural studies show we see what we believe: western culture assumes those who receive them are mentally ill
39
Q

cog explanation of delusions?

A

on a continuum

result of abnormal cognitions and perceptions

40
Q

delusions are a result of abnormal cognitions?

A

bentall: psychological defence against depression and low self esteem
maintained by both attention and memory biases

41
Q

delusions are a result of abnormal perceptions?

A

delusions are adaptive and rational response to abnormal internal events such as hallucinations
maher’s model

42
Q

what is Maher’s model for delusions?

A

delusions are mini theories
used when events are not predictable
it explains why events are not predictable
beliefs are judged by others

43
Q

evaluation of cognitive theories for schiz

A
  • studies show delusions occur in wide range of disorders with not history of cognitive impairment (manschrek)
  • when normal individuals undergo abnormal experiences delusions can occur (zimbardo) supporting the continuum
  • cannot explain why schiz occurs but can explain how it is maintained
44
Q

what is the sociocultural explanation of schix

A

seen as aresult of societal or family interactions

  • labelling
  • family dysfunction
45
Q

what is labelling (schiz)

A

Szasz claimed labelling individual with mental illness is a way of excluding individuals who don’t conform to our social and cultural norms
Scheff: learned role and theorised that someone who breaks one or more residual rules is assigned a mentally ill label
people accept their new role as others treat them as such - self fulfilling prophecy

46
Q

What is rosenhan’s study? (schiz)

A

investigated reliability of diagnosis

  • 8 pseudo patients
  • claimed to have hallucinations but then proceeded to act normal once inside
  • could not convince staff they were neurotypical as their behaviour was interpreted as mentally ill
  • showed diagnosis is unreliable
47
Q

evaluation of labelling theory

A

rosenhan’s study improved the reliability of diagnosis - showed we interpret behaviour in a way that fits in with our assumptions
cannot explain the cause of schiz but can explain the maintainence
ignores genetic evidence
trivialises disorders

48
Q

what has family dysfunction got to do with schiz?

A

bateson: double binds (actions and words oppose each other) causing the child to not trust their own feelings and mistrust communications (onset of paranoid??)
- families fail to provide stability: appropriate role models (schismatic and skewed families) causes anxiety and schiz may be a way of handling it

49
Q

what is a skewed family?

A

one partner is abnormally dominant in relationship - impairing cognitive and social development

50
Q

what is a schismatic family?

A

parents fight for affection of other family members and take control

51
Q

evaluation of family patterns

A

difficult to prove a casual relationship as it isn’t possible to untangle cause and effect

52
Q

what is expressed emotion?

A

Brown: people with high EE families tended to relapse quicker.
high face to face contact - over involvement, emotion (posi or neg), hostility and critical comments

53
Q

what is bebbington and kuipers study?

A

EE was measured
families with low EE tended not to relapse as fast
high EE caused a higher rate of relapse

54
Q

evaluation of EE explanation of schiz

A

ability to predict relapse rates shows EE is a good indicator
EE - cause and effect?
high EE can affect other disorders too
EE is measured with one interview? not enough?

55
Q

treatments for schiz?

A 
antipsychotics
behavioural treatments
-social skills training
Psychothrapy
-CBT
Community care
56
Q

what are the antipsychotics for schiz?

A

neuroleptics (older) is highly effective on positive symptoms
-small numbers that fail to respond (loebel) within 12 months

atypical (recent) eg risperidone
-can cause akathisia

chlozapine

  • removes ALL symptoms
  • Meltzer: 66% respond when neuroleptics fail
57
Q

evaluation of antipsychotics for schiz?

A
  • side effects of neuroleptics: muscular spasms, parkinsonism, tardive dyskinesia
  • neuroleptics only extend interval between relapses - cannot prevent them
  • bimonthly injections - controlling not curing
  • neuroleptics do not effect negative symptoms
  • clozapine lowers white cell blood count, weight gain
  • atypical drugs are expensive
58
Q

behavioural treatments for schiz?

A
  • based on operant conditioning: token economies
  • useful when medication has reduced psychotic episodes
  • can reverse the effect of hospitalisation
  • Paul and Lentz: interpersonal and self care skills significantly improved in token economy groups
59
Q

What is social skills training?

A

modifies social behavour of schizophrenics
modelling, reinforcement and role playing: teaches patients to acquire non/verbal skills.
can include: conflict management, medication self management and employment skills

60
Q

evaluation of behavioural therapy?

A

SST: effective in increasing patients ability, comfort and assertiveness in social situations (birchwood and Spencer)

  • cannot generalise to everyday life
  • behaviour therapy can’t help with distress associated with psychotic symptoms, doesn’t look at the cognitive things
61
Q

what is psychotherapy? why is it not always effective?

A

generic term covering psychodynamic and cognitive therapies

not always effective because it relies on talking and listening

62
Q

what is cognitive behavioural therapy?

A

focusing on individual symptoms like hallucinations and delusion - engage in coping strategies

63
Q

study for cognitive behavioural therapy and evaluation

A

Tarrier - patients with hallucinations or delusions were interviewed and talked about their episodes
talked about their coping strategies = coping strategies helped them

evaluation: relies on client being able to recall and communicate with therapist (catatonic?)

64
Q

what is Coping Strategy Enhancement

A

teach patients how to cope with symptoms with their existing coping strategies

1) what is the psychotic episode e.g. voices?
2) how do they make patient feel
3) assess person’s thoughts
4) assess coping strategies

then moves onto

  • education and rapport training: creates shared understanding to work together
  • symptom targeting: enhance coping strategy
65
Q

evaluation of CSE

A
  • high dropout rate because it is hard to face episodes and work on strategies etc
  • patients receiving CSE had a significant improvement in coping skills (tarrier)
66
Q

What is community care?

A

move away from hospitalisation
support in the community instead
client is allocated a community psychiatric nurse and receives help from various organisations to cope (multi axial approach)

67
Q

Study supporting community care?

A

Stein and Test: patients who did not receive community care were readmitted back into hospital within 12 months than patients who did receive it.
when program ended, patients were then readmitted…

Community care if effective but they were not cured, requires financial and personnel investment

68
Q

evaluation of community care

A

reduces stigmatisation
doesn’t encourage withdrawal and negative symptoms

failings can lead to bad consequences eg jonathan zito
burden on family
services are often patchy
lack of 24/7 surveillance
expensive
69
Q

evaluation of hospitalisation

A

24/7 surveillance
cheaper
more stigmatisation - alienated from society
encourages negative and withdrawal symptoms

A level Psychology (4 decks)

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