Flashcards in Schizophrenia Deck (43):
1
Define schizophrenia
A severe mental illness where contact with reality and insight are impaired, an example of psychosis
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What are the 2 major systems for classifying mental disorders
ICD-10
DSM-5
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What are the 3 sub-types of schizophrenia recognised by ICD-10?
Paranoid - delusions & hallucinations
Hebephrenic - primarily negative symptoms
Catatonic - disturbance to movement - overactive/immobile
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State a difference of classification between DSM-5 and ICD-10
In DSM-5 one positive symptom must be present where as for ICD-10 two or more negative symptoms must be present
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What are positive symptoms of schizophrenia
Hallucinations and delusions
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What are hallucinations
Unusual sensory experiences, for example voices to or commenting on the sufferer
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What are delusions
Aka paranoia, = irrational beliefs. Takes a range of forms
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Give examples of negative symptoms
Loss of usual abilities and experiences - avolition & speech poverty
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What is avolition
'Apathy' - difficult to begin or keep a goal = reduced motivation
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What are the 3 identified signs of avolition by Andreason (1982)
Poor hygiene and grooming, lack of persistence in work/education and lack of energy
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What is speech poverty
Changes in patterns of speech. Negative in ICD-10
Speech disorganisation = positive in DSM-5
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Evaluation - why is inter-rated reliability poor?
Inter-rater reliability = the extent to which 2 or more mental health professionals arrive at the same diagnosis. Cheniaux et al (2009) had 2 psychiatrists independently diagnose 100 patients using DSM or ICD criteria. One psychiatrist diagnosed 26 with schizophrenia according to DSM and 44 according to ICM, the other diagnosed 13 according to DSM and 24 according to ICD
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Why does diagnosis of validity have poor validity?
Cheniaux et al - patients are more likely to be diagnosed with schizophrenia using ICD than DSM. Suggests schizophrenia may be over diagnosed in ICD or under diagnosed in DCM.
14
Explain why co-Morbidity is a weakness is diagnosing schizophrenia
Buckley et al (2009) concluded that 50% of patients diagnosed with schizophrenia have also been diagnosed with depression or 47% substance abuse. Post-traumatic stress disorder occurred in 29% and OCD in 23%. May be bad a telling the different between schizophrenia and depression or they may be same condition.
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Explain how symptom overlap is a negative of diagnosing schizophrenia
Schizophrenia and bipolar disorder involve positive symptoms like delusions and negative symptoms like avolition. Questions the validity. Under ICD may be diagnosed with schizophrenia where as others may be diagnosed with bipolar disorder under DSM. Suggests they may not be 2 different conditions but 1.
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Describe gender bias in schizophrenia diagnosis
Longenecker et al (2010) reviewed studies of prevalence of schizophrenia and concluded that since 1980s men have been diagnosed with schizophrenia more than women. May be because men are more genetically vulnerable. Or may be gender bias - females function better than men and are more likely to work and have good family relationships (Cotton et al). High functioning may explain some women are not diagnosed with schizophrenia when men with similar symptoms might have been.
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Describe cultural bias in diagnosis
African Americans and English people of Afro Caribbean origin are several times more likely than white people to be diagnosed with schizophrenia. May be because hearing voices is more acceptable in African cultures due to cultural beliefs in communication with ancestors and are therefore more likely to acknowledge such experiences. Escobar (2012) - white psychiatrists may tend to over interpret symptoms and distrust the honesty of black people during diagnosis.
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What are the 3 psychological therapies for schizophrenia?
Cognitive Behaviour Therapy (CBT)
Family therapy
Token economies
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What is CBT?
5-20 sessions - aim = helping patients identify irrational thoughts and try change them. May involve argument/discussion of how likely patients beliefs are to be true
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How does CBT help schizophrenia?
Patients can be helped to make sense of how their delusions and hallucinations impact on their feelings and behaviour. Understanding where symptoms come from can be hugely helpful for some patients. Delusions can be challenged so the patient can learn their beliefs are not based on reality
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What is family therapy?
Aims to improve the quality of communication and interaction between family members. Some therea islets see family as root cause of condition. Most therapists concerned with reducing stress within family that might contribute to patients risk of relapse. Aims to reduce levels of expressed emotion.
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How does family therapy help according to Pharoah et al (2010)?
Strategies:
Forming therapeutic alliance between family members
Reduce stress of caring for someone with schizophrenia
Improving ability of family to anticipate and solve problems
Reduction of anger and guilt in family members
Helping family members achieve balance between caring for individual with sz and maintaining own life
Improving families beliefs and behaviour towards sz.
Pharoah suggested these strategies work by reducing levels of stress and expressed emotion whilst increasing patients chance of complying with medication.
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What are token economies?
Reward systems used to mange the behaviour of patients with sz, in those who have adapted patterns of maladaptive behaviour through spending long time in psychiatric hospitals. Does not sure sz but improves quality of life,
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Explain how tokens are used in a token economy system
Tokens given to patients who perform desirable behaviour that has been targeted for reinforcement e.g getting dressed in the morning or making their bed. Immediacy of reward is important as it prevents 'delay discounting'
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Explain the concept of rewards in the token economy system
Tokens swapped for rewards. Based on operant conditioning. Tokens = secondary reinforcers because they only have value once he patients have learned that thy can obtain rewards. E.g sweets or walk outside.
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What are the evaluation points for psychological therapies?
Evidence for effectiveness
Treatments improve quality of life but do not cure
Ethical issues
Quality of the evidence for effectiveness
Alternative psychological treatments
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Describe evidence for effectiveness of psychological therapies?
Jauhar et al (2014) reviewed 34 studies of CBT for sz. Concluded that sz has significant but small effect on positive and negative symptoms.
Pharoah et al reviewed evidence for effectiveness of family therapy, they concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission and improves quality of life for patients and families.
Also noted that results of different studies were inconsistent and there were problems of quality for some evidence. Overall weak evidence.
McMonagle and Sultana (2009) reviewed evidence for token economies and found only 3 studies where patients had been randomly allocated to conditions with treatment and control groups. Only 1/3 studies showed improvement in symptoms. Only modest support for effectiveness of psychological treatments, one of the hardest mental illnesses to treat = limitation.
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Describe the evaluation point 'treatments improve quality of life but do not cure'
All the treatments aim to make sz more manageable and improve patients quality of life. CBT helps challenge symptoms, family therapy reduces stress of living with sz and token economy help make sz patients behaviour more socially acceptable. These are worth doing but do not cure sz. = weakness.
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Outline ethical issues of psychological therapies of sz
Token economies - privileges, services etc become more available to patients with mild symptoms and less so for those with severe symptoms. Means most severely ill patients suffer discrimination is addition to other symptoms.
CBT may involve challenging persons paranoia but to extent may interfere with individuals freedom of thought.
= weakness
30
Outline alternative psychological treatments
NICE recommends art therapy provided a qualified art therapist wit working with sz sufferers is available.
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Outline quality of the evidence for effectiveness of psychological treatments
Small scale studies by mental health professionals have compared patients before and after psychological treatments and found more positive results. However these studies often lack a control group or patients are not randomly allocated to treatment and control conditions. Conclusions are generally more optimistic than those that strictly control which studies are included.
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What are the 3 biological explanations for schizophrenia?
Genetic basis
Dopamine hypothesis
Neural correlates
33
Outline the dopamine hypothesis
Neurotransmitters work differently in the brain of someone with schizophrenia.
Original version - hyperdopaminergia in subcortex - e.g. Excess of dopamine receptors in Broca's area relates to speech poverty
Recent version - hypodopaminergia in cortex - Goldman-Rakic et al (2004) identified a role for low levels of dopamine in prefrontal cortex (responsible for thinking and decision making) in negative symptoms of sz.
Likely both to be correct
34
Define neural correlates
Measurements of the structure and function of the brain which correlate with an experience (schizophrenia)
35
Outline neural correlates of negative symptoms
Avolition involves loss of motivation. Motivation involves anticipation of a reward and the ventral striatum is involved with this.
Juckel et al (2006) measured levels of activity of ventral striatum in sz and found lower levels of activity than controls. Observed a negative correlation between activity levels in ventral striatum and severity of overall symptoms.
So activity in ventral striatum is a neural correlates of negative symptoms of sz.
36
Outline neural correlates of positive symptoms
Allen et al (2007) scanned brain of patients experiencing auditory hallucinations and compared them to control group whilst they identified pre-recorded speech as theirs or others.
Lowe activation levels in the superior temporal gyrus and anterior cingulate gyrus were found in hallucinations group who also made more errors. Reduced activity in these 2 areas is a neural correlates of auditory hallucinations
37
Outline research on candidate genes
Ripken et al (2014) carried out study combining previous data from genome wide studies of sz. Genetic make up of 37,000 patients was compared to 113,000 controls. 108 separate genetic variations were associated with increased risk of sz. Genes associated with increased risk included those for the functioning for a number of neurotransmitters including dopamine.
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What are the evaluation points for biological explanations of schizophrenia?
Multiple sources of evidence for genetic susceptibility
Mixed evidence for dopamine hypothesis
Correlation-causation problem
Role of mutation
Role of psychological environment in important but unclear
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What is the evidence for genetic susceptibility?
Gottesman (1991) study shows how genetic similarity and and shared risk of schizophrenia are closely related
Tienari (2004) - adoption study showed children of sz sufferers are at heightened risk of sz if adopted into families with no history of sz.
Ripke et al (2014) evidence at molecular level showing genetic variations increasing risk of sz.
Evidence that genetic factors make some people more vulnerable to developing sz.
40
Outline the mixed evidence for the dopamine hypothesis
Support for abnormal dopamine functioning - Curran et al (2004) found dopamine agonists that increase levels of dopamine make sz worse and produce sz like symptoms in non-sufferers
Lindstroem et al (1999) found in radioactive labelling studies that chemicals needed to produce dopamine are taken up faster in the brains of sz sufferers than controls = sz sufferers produce more dopamine.
Some genes identified in Ripke et al study, code for the production of other transmitters so although dopamine is important, so are other transmitters e.g glutamate.
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Describe the correlation-causation problem in biological explanations
Neural correlates are useful in flagging up brain systems which are not working normally but doesn't say if this unusual activity causes the symptom. Another factor could produce both of these or the symptom could cause the unusual activity.
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Explain the role of mutation is biological explanations
Sz can take place in absence of family history of disorder due to mutation in parental DNA. Can be caused by radiation, poison or viral infection. Brown et al - positive correlation between paternal age and risk of sz, 0.7% with fathers under 25 and over 2% in fathers over 50. Shows not entirely genetic.
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