Flashcards in Schizophrenia Deck (39):
What are the positive symptoms of SZ?
Hallucinations - unusual sensory events
Delusions - irrational beliefs and paranoia
What are the negative symptoms of SZ?
Avolition - finding it hard to begin or keep up with goal directed activity
Speech poverty - changes in speech, lack fluency, quality and quantity of speech reduced
What affects the validity of classification?
What affects the reliability of classification?
What is symptom overlap
People with dissociative identity disorder actually have more SZ symptoms than those diagnosed with SZ
What is co- morbidity?
Another disorder is accompanied with SZ
What is the original dopamine hypothesis ?
An excess of dopamine in certain regions of the brain is associated with the positive symptoms of SZ.
Messages from neutrons that transmit dopamine fire too easily or too often, which leads to hallucinations and delusions
What is the revised dopamine hypothesis?
The symptoms of dopamine are caused by excess of dopamine in the subcortical areas of brain, particularly in the Mesolimbic pathway.
The negative symptoms of SZ are thought to arise deficit of dopamine in areas of the prefrontal cortex .
Evaluate the biological approach of SZ?
Reductionist - explained SZ in terms of just one gene or the action of one neurotransmitter
Socially sensitive - people with SZ family members may get upset
Practical implications - dopamine hypothesis
Dopamine abnormalities are not present in all people with SZ
What are typical antipsychotics used for?
Used primarily to combat the positive symptoms of SZ
How do typical antipsychotics work?
Typical antipsychotics bind to dopamine receptors and block its action.
In order for the pathways to be blocked a similar number of D2 receptors in the other areas of the brain must also be blocked causing undesirable side effects
What are atypical antipsychotics used for?
Combat positive symptoms but they are are also claimed to have beneficial effects on negative symptoms
How do atypical antipsychotics work?
Temporarily occupy the D2 receptors and rapidly dissociate to allow normal dopamine transmission
Evaluate biological treatment for SZ
Effectiveness - less relapse rate than placebo
Ethics - in extreme cases they are forced to take the drug, even if it is against their will
Appropriateness - requires little motivation and is relatively fast acting. Means it is good for patients who need urgent attention
Side effects - typical antipsychotics can cause movement problems
What are the 3 aspects of family dysfunction?
- high levels of arguments
- difficulty communicating with each other
- parents being excessively critical and controlling of their children
What is the double bind theory?
Children who frequently receive contradictory messages from their parents are more likely to develop SZ.
It causes the child to feel confused about the world which is reflected in their symptoms like disorganised thinking and paranoid delusions
What is expressed emotion?
Explanation for relapse
A family communication in which members of a family of a psychiatric patient talk about them in a critical manner
Hostility towards patient
Emotional over involvement
Evaluate family dysfunction explanations
- predictive validity
- environmentally deterministic
- cannot account for when one child in family gets SZ but others do not
What are the two types of dysfunctional thought processing outlined by Frith?
Metarepresentation - ability to reflect on thoughts and behaviour
Central control - ability to suppress automatic responses while we perform deliberate actions instead
Evaluate the cognitive explanations
Does not explain why people have the cognitive dysfunction and why some do not
What is the basic assumption of CBT?
Everyone has distorted beliefs which influence their thoughts and feelings
What are CBT patients encouraged to do?
Encouraged to trace back the origins of their symptoms in order to get a better idea or how they might have developed. Also to evaluate the content of delusions and ways to test the validity of faulty beliefs.
What are the 3 phases of CBT?
1- keep diary of faulty thinking
2- identity faulty thinking
3- challenge faulty thinking
How do patients of CBT identify their faulty thinking
Assessment - patient expresses his or her thoughts about their experience to the therapist
ABC model - explain the activating events
How do patients of CBT challenge the faulty thinking ?
Normalisation. - inform them that lots of people experience positive symptoms
Critical collaborative analysis - question
Developing alternative explanations - the patient does this
Effectiveness - people with drug therapy and CBT recover better than just drugs
Appropriate- can be adjusted for what stage of SZ the patient is in
What is the aim of family therapy?
To reduce EE and increase the capacity of relatives to solve related problems
What are the strategies of family therapy ?
- forming an alliance
- reducing emotional climate
- reduce expressions of anger from family
Evaluate family therapy
Effectiveness - pharaoh et al
It treats symptoms as well as the cause
Appropriateness - significantly cheaper than standard care
What are the 2 types of reinforcer in token economies?
Primary- anything that gives pleasure
Secondary - no value initially but acquire reinforcing properties by being paired with primary reinforcer
What does token economies do?
Reinforces target behaviours
When the patient performs target behaviours, the clinician Awards them a token
Trade - the patient trade tokens for back up rewards which are chosen by the clinician
Evaluate token economies
Effectiveness - Dickerson et al, 11 studies reported beneficial effects
Ethics - dehumanising
Appropriateness - not appropriate for living in community as need a high control environment
Describe the diathesis stress model
Diathesis - identical twins of a person with SZ have a greater risk of developing SZ than a sibling or a DZ twin
Stress - stressful life events that can trigger SZ
Evaluate the diathesis stress model
Holism- combines biological and psychological aspects so it's a holistic approach
Practical applications - those with genetic vulnerability can be identified and avoid any environmental facts that could trigger
Diathesis - vulnerability is only in terms of genetic influences but brain damage can cause an increase risk of SZ
What is the neural correlates explanation?
- measurements of the structure or function of the brain that correlate with the positive or negative symptoms of SZ
- Ventral striatum - involved in anticipation of reward/ loss of motivation (avolition) in SZ may be explained by low activity levels here
What are weaknesses of the neural correlate explanation
- cannot be sure that unusual activity in the brain causes the symptoms or whether there are other explanations for the correlation
- probability of developing SZ in identical twins is less than 50% suggesting environment must play a part
- biologically deterministic
What are the 2 manuals of diagnosing schizophrenia?
DSM-5 and ICD-10
Where are the two manuals for diagnosis used?
DSM is mostly used in US whereas Europe ICD is used