Flashcards in Schizophrenia Deck (96):
Severe mental disorder characterised by the disruption of cognitive and emotional functioning. Effects language, thoughts, perceptions, emotions and sense of self. Person hears voices and sees visions.
What are some causes of schizophrenia?
2. Psychotropic drugs
3. Lack of O2 at birth
4. Too high dopamine levels
5. Stressful onset
Describe type 1 (Acute) schizophrenia
Obvious positive symptoms appear suddenly.
Describe type 2 (Chronic) schizophrenia
Takes many years to develop - increased disturbance and withdrawal, negative symptoms
How many types of schizophrenia are there?
Describe the criteria for schizophrenia in the DSM-V
A - At least two symptoms must be present (or one if delusions/hallucinations): Delusions, Hallucinations, Disorganised Speech, Disorganised/Catatonic behaviour, negative symptoms
B - At least one area of functioning disrupted e.g. work
C - Continuous disturbance for 6 months, symptoms from A for 1 month
Define positive symptoms
Symptoms added to the patient's personality
State examples of positive symptoms
3. Disorganised speech
4. Grossly disorganised
5. Catatonic behaviour
Define negative symptoms
Reduction/Loss of normal functioning.
State examples of negative symptoms
2. Speech poverty/Alogia
3. Affective flattening
Describe auditory hallucinations (positive)
Patient hears voices - their own or unrecognisable. Usually negative comments
Describe visual hallucinations (positive)
Patient may see things that don't exist - may be disturbing
Describe olfactory hallucinations (positive)
Patient may smell odours that don't exist
Describe tactile hallucinations (positive)
Patient may feel things that don't exist
Describe delusions of grandeur (positive)
Patient may believe they're important/powerful (e.g. God). May think they have superpowers - can cause harm
Describe delusions of persecution (positive)
Patient believes everyone's conspiring against them - negative attitude
Describe delusions of reference (positive)
Patient believes objects, events and songs have a personal significance that refers directly to them - may become emotionally attached
State the subdivisions of disorganised speech. (positive)
3. Word salads
Describe derailment (positive)
Patient has issues organising thoughts - changes from topic to topic
Describe neologisms (positive)
Patient makes up words that don't exist
Describe word salads (positive)
Patient strings random words together to make a sentence - disorganised speech pattern
Describe catatonia (positive)
Patient has reduced reaction to environmental stimuli - might adopt rigid postures or conduct aimless motor activity e.g. rocking movements
Describe grossly disorganised behaviour (positive)
Patient has inability/lack of motivation to initiate or complete a task. Might dress/act in bizarre ways
Describe deficit syndrome (negative)
Patient has experienced 2 negative symptoms for 12months +
Describe speech poverty/alogia (negative)
Speech lessened in terms of fluency and productivity - thinking is slow. Reply briefly to questions, can't produce long list of words
Describe avolition (negative)
Patient has reduced interest to initiate/persist in goal directed behaviour around them. Occurs when patients also have bad hygiene and lack of work/school persistence
Describe affective flattening (negative)
Patient has restricted ability to respond to emotional stimuli - reduced range and intensity of expressions. May behave inappropriately in social situations
Describe anhedonia (negative)
General lack of interest in most activities and pleasurable stimuli
Physical: inability to experience physical pleasure
Social: inability to experience pleasure from social interactions - withdraws from these situations
What did Ripke theorise about the genetic cause of schizophrenia?
Schizophrenia might be polygenic - multiple candidate genes
Describe Ripke et al's 2014 study
Meta-analysis of candidate genes. 37,000 schizophrenics and 11,000 controls were investigated. He found 108 separate genetic variations associated with increased risk of schizophrenia, which coded for the function of dopamine.
State three disadvantages of Ripke's study.
1. Other approaches need to be considered e.g. behavioural, cognitive
2. Genetics isn't a full explanation - diathesis stress model would say an environmental factor would trigger the illness as well as the gene
3. Schizophrenia can occur in the absence on genetics/family history. Could be a mutation. Positive correlation between father's age and child with schizophrenia - 0.7% when <25, 2% when >50
State two advantages of Ripke's study.
1. Lots of research support
2. Supported by the dopamine hypothesis - Ripke's work intertwines biological mechanisms (genetics and high dopamine). Valuable support for biological approach
Describe Gottesman and Shields' study
Investigated 224 sets of twins (106 MZ, 118 DZ) from 1948-1993. Average pps age was 46, ranging in ethnicities. Longitudinal study over 25 years in London. In depth interviews, doctors case notes and the DSM were used to diagnose schizophrenia. One twin already had schizophrenia. Results found 48% MZ were both concordant by the end, and 17% DZ were concordant by the end
State three advantages of the Gottesman and Shield's study
2. Supports the biological approach (genetics) - 48% concordance
3. Reliable (inter-rater reliability) and valid - three different methods of diagnosis used - more credibility
State two disadvantages of the Gottesman and Shield's study
1. Ignores the behavioural approach - twins may imitate each other and obtain schizophrenic symptoms this way
2. Relied on interviews - schizophrenics often have issues communicating correctly, could've caused misdiagnosis. Can be improved through using multiple interviewers
Describe Kety et al's 1994 study (The Copenhagen High Risk Study)
Initial study in Denmark started in 1972, follow up study occurred in 1974 and 1989.
207 adopted children (bio mothers had schizophrenia) matched pairs with control group of 104 (healthy bio mothers) - all aged 10-18.
Results found 16.2% of first group were diagnosed with schizophrenia, and 1.9% from control group. Schizotypal personality disorder was diagnosed in 18.8% of first group and 5% in control group
State three advantages of Kety's study
1. Supporting study was carried out by Erienmeyer-Kimling in 1997 - 'New York High Risk Study'. Lasted 25yrs, found similar results
2. Study was a prospective longitudinal study - looks at children before they show symptoms, doesn't rely on retrospective data. Kety followed the children accurately - life-long records were held about citizens in Denmark and they identified when the illness began
3. All children were matched carefully on relevant variables. Very fair and controlled study - eliminates extraneous variables
State two disadvantages of Kety's study
1. Cannot separate genes from environment - could've influenced them obtaining schizophrenia
2. Mothers had been diagnosed with schizophrenia before the DSM and ICD were around - could've been misdiagnosed (schizotypal personality disorder instead)
What is schizotypal personality disorder?
Similar illness to schizophrenia. Person experiences discomfort in close relationships, cognitive distortions, eccentric behaviour, digressive speech etc. Not as extreme as schizophrenia - patient doesn't lose contact with reality.
What is dopamine?
A neurotransmitter - increases motivation, excitation and pleasure in high amounts
What are some assumptions of the Dopamine Hypothesis by Davis and Neale?
1. Schizophrenia sufferers usually have more dopamine receptors (over-sensitive) - causes high dopamine levels
2. Winterer (2004) investigated receptors, D1 and D2, found schizophrenics with abnormal ratios of dopamine
3. Anti-psychotics (e.g. phenothiazines) block activity in dopamine receptors - minimise positive symptoms
4. The drug, L-dopa, increases dopamine levels in those with Parkinson's - side effect is schizophrenic symptoms
What is the effect of drugs, such as LSD and amphetamines, on dopamine levels?
Increases dopamine levels, can induce schizophrenic symptoms
On which three facts did Davis and Neale base the Dopamine Hypothesis on?
1. Post mortem studies found increased amount of dopamine receptors in the left amygdala of schizophrenics
2. Dopamine metabolism in schizophrenics is abnormal - monitored by PET (Position Emission Tomography) scans
3. Hypothesis might be linked to faulty genes that causes dopamine level increase
What is the effect of the anti-psychotic drug, Clozapine?
Doesn't block dopamine activity, but reduces schizophrenic symptoms
What three things did Davis find in the revised dopamine hypothesis in 1991?
1. High dopamine found in mesolimbic dopamine system - associated with positive symptoms
2. High dopamine found in mesocortical dopamine system - associated with negative symptoms
3. Dopamine restricts release of Glutamate (neurotransmitter involved in learning and memory) - schizophrenics usually have reduced functioning of NMDA glutamate receptors
State two advantages of The Dopamine Hypothesis
1. Lots of research support - Davidson found when given L-Dopa, schizophrenic symptoms intensified
2. Lots of scientific evidence - use of PET and fMRI scans - highly valid and reliable objective data.
State three disadvantages of The Dopamine Hypothesis
1. Cause and effect isn't clear
2. Dopamine has a complex role in the brain - associated with bipolar depression, which is treated differently. Several other neurotransmitters (serotonin, glutamate) must be involved - more research needs to be done
3. Reductionist - must be other factors
What are the neural correlates in relation to schizophrenia?
Schizophrenia may be due to structural and functional brain abnormalities. Schizophrenics are given cognitive and memory tasks to do whilst doing an fMRI
How are enlarged brain ventricles related to schizophrenia?
Enlarged brain ventricles arise due to damage to the central brain and pre-frontal cortex - contributes to negative symptoms
State and describe the brain structure associated with controlling avolition.
Juckel (2006) found abnormalities and low functioning in ventral striatum caused avolition and increased negative symptoms
Describe the study carried out by Allen (2007)
Used brain scans to compare control group and schizophrenics with auditory hallucinations - had to identify pre-recorded speech as theirs or others. Lower activation levels in anterior cingulate gyrus (involved in executive function) found in schizophrenics, also made more errors.
Describe the study carried out by Swayze
Reviewed 50 studies of schizophrenics and examined brain with MRI. Found structural abnormalities:
1. Decrease in brain weight
2. Enlarged ventricles (filled with water)
3. Smaller hypothalamus
4. Less grey matter (where intelligence is held)
5. Abnormalities in pre-frontal cortex
State two advantages of the neural correlates explanation
1. Strong amount of supporting evidence - Swayze, Juckel, Allen
2. Uses scientific methods of measurement - MRI and fMRI scans
State four disadvantages of the neural correlates explanation
1. Andreason (1982) found the extent of ventricle enlargement in schizophrenics isn't significant - very little difference, may not be a large factor
2. Cause and effect needs to be established
3. Studies don't explain why schizophrenia doesn't occur from infancy - Weinberger (1987) found pre-frontal cortex develops in adolescence so symptoms wouldn't be noticed till then
4. Davison and Neale (2001) found evidence of enlarged ventricles not only found in schizophrenic patients (in bipolar depression also). Can't cause schizophrenia on its own - needs trigger factor
Why is it important that the DSM-V and ICD-10 are reliable?
There should be a consistency in diagnosis over a period of time with different psychologists.
For inter-rater reliability, there needs to be a kappa score of +0.7 or more.
DSM-V is more reliable than ICD-10 - more specific categories. Reliability for schizophrenia diagnosis is more superior than other mood disorders.
Why is it important that the DSM-V and ICD-10 are valid?
The use of the DSM-V and ICD-10 are only as good as the psychologist using it
Why is co-morbidity an issue for validity?
Refers to the extent that 2 or more illnesses occur simultaneously in a patient. 12% of schizophrenics suffer from OCD too - issue with classifying schizophrenia. Also, depression is co-morbid - causes issues for psychologist
State four evaluation points for co-morbidity.
1. DSM and ICD lack validity - There's too much overlap between schizophrenia and mood disorders. A second opinion may be needed
2. Sim (2006) found diagnosis can be invalid and unreliable. 32% of 142 hospitalised schizophrenics were co-morbid
3. Schizophrenics have been found with a history of substance abuse - difficult to give a reliable diagnosis as some symptoms of schizophrenia are the same as those with substance abuse
4. Jeste (1996) found co-morbid patients were often excluded from research but majority of schizophrenics are co-morbid - diagnosis can't be generalised to all patients
Why is cultural bias an issue for reliability & validity?
Culture influences diagnosis and classification e.g. auditory hallucinations
Describe two studies on cultural bias
1. Davison and Neale (1994) found that in the Asian culture they're praised for suppressing emotion/mental illness - won't seek help. Whereas in the Arabic culture, it's the opposite.
2. Cochrane (1977) found schizophrenia prevalence was 1% in West Indies and Britain. Afro-carribean people were 7x more likely to be diagnosed
State an advantage of cultural bias
Barnes (2004) found supporting evidence for cultural differences. Ethnic culture hypothesis predicts ethnic minorities experience less distress if they have schizophrenia due to protective features in their culture - social support
State two disadvantages of cultural bias
1. Cultural relativism - psychologist may not fully understand the patient's cultural background. e.g. in the African culture, auditory hallucinations may be seen as a gift from God, but in the Western culture it's a symptom of schizophrenia.
2. Cochrane (1995) found research evidence suggests diagnosing schizophrenia can be invalid for immigrants. Clinicians may relate schizophrenia prospects to ethinicity rather than the stressors they occurred in life - could be wrongly diagnosed
Why is gender bias an issue for validity?
Males tend to show more negative symptoms than females, and are more likely to suffer from substance abuse.
Males have earlier onset (18-25) than females (25-35), and different peak onset ages.
Accuracy could vary due to clinician stereotypes about gender
State two disadvantages of gender bias as an issue.
1. Loring (1985) gave 290 male and female psychologists case studies (one male, one female) - they had to judge the diagnosis of the patients. With male patient or no gender stated - 56% of psychologists gave a positive diagnosis for schizophrenia. With female patient - 20% gave a positive diagnosis for schizophrenia
2. Validity of diagnosis is questioned - females develop 4-10 years later than males, and males and females are more vulnerable to different types of schizophrenia
State an advantage of gender bias as an issue.
Kulkarni(2001) conducted research to suggest females are less susceptible to schizophrenia. Female sex hormone (estradiol) can help treat schizophrenia in females, when added to anti-psychotic drugs. This is a protective factor in females - must be taken into account for a valid diagnosis
Why is symptom overlap an issue for validity?
Some symptoms of schizophrenia can be found in other disorders, such as depression or bipolar disorder. The symptoms must be carefully investigated to ensure the correct illness is addressed
Which disorders have symptom overlap with schizophrenia?
Bipolar depression, Depression, Cocaine intoxication, Schizotypal personality disorder Dissociative Identity Disorder
State an advantage of symptom overlap as an issue.
Clinicians could conduct a brain scan or EEG to examine the brain in sufficient detail and check the grey matter in the brain - schizophrenics usually have a deterioration of grey matter, bipolar depression sufferers don't
State two disadvantages of symptom overlap as an issue
1. Can cause misdiagnosis - leads to years of delays as they receive incorrect treatment. Can increase rates of suicide and mental deterioration
2. Inter-rater reliability is quite low - Beck (1961) studied 154 patients with two other psychiatrists and inter-rater reliability was 54%. Misdiagnosis due to symptom overlap
What does the double bind theory by Bateson suggest?
Disturbed patterns of communication and family dysfunction might be a risk factor for schizophrenia. The hypothesis refers to conflicting messages from parents to children - can cause confusion and self-doubt, and an inability to form an internal sense of reality. The child may feel scared to do the wrong thing.
What is a marital schism?
When parents argue in front of the children and involve the children in the argument - causes distress and confusion, might develop symptoms
State two advantages of the Double Bind Theory.
1. Berger (1965) found schizophrenics had higher recall of double bind statements by their mothers than those without schizophrenia
2. Read (2005) found people with a difficult childhood had an increased risk of schizophrenia. 46 studies of child abuse and schizophrenia found 69% of female and 59% of male schizophrenics had a history of physical or sexual abuse in childhood
State three advantages of the Double Bind Theory
1. Cause and effect isn't clear
2. Research is based off of retrospective data - inaccurate, should've conducted a longitudinal study instead
3. Ethical issues - can cause psychological harm to blame family on onset of schizophrenia in a family member. Also, results should be kept confidential.
What is expressed emotion? How is it related to schizophrenia?
Theorized by Kavanagh (1992)
A set of traits whereby family members talk about/to the patient in a critical/hostile manner.
It may aid a relapse, or aid in causing and maintaining the illness.
What traits are included in expressed emotion?
Criticism, hostility and emotional over-involvement
Describe research conducted on expressed emotion.
Kujipers (2007) found families with high EE talk more than they listen - patient has low tolerance for emotional commentary, causes stress and can lead to an episode.
Schizophrenics living in high EE families are 4x more likely to relapse. Hooley (1998) found high EE affects other disorders also - more typical in developed countries.
Leff(1990) found high EE in 23% of families in India, and 47% of families in London
State two advantages of expressed emotion
1. Brown's research supports Kavanagh's on high EE causing schizophrenia/relapse
2. Large amount of evidence found to suggest high EE can cause a relapse - found in many cultures. Such a strong theory that families who show high EE are encouraged to undergo training to help reduce EE level
State three disadvantages of expressed emotion
1. Cause and effect isn't clear
2. Ignores biological factors - main causes for schizophrenia are biological. Highly unlikely that high EE can cause schizophrenia alone
3. Isn't much evidence to show schizophrenics in families with low EE are less likely to relapse. Also, patients don't have much family contact (institutionalized, family withdrawal) so EE can't be a major causal factor
What is the focus of the cognitive approach in relation to schizophrenia?
Focuses on internal mental processes and thoughts. Patients tend to have impairments: 1)Poor attention 2)dysfunctional thought processes 3) language deficits.
Faulty maladaptive thinking can be linked to positive symptoms, such as hallucinations or delusions
What is Frith's cognitive view of schizophrenia?
Stated that schizophrenics can't track their own thoughts properly - often claim their thoughts aren't their own, and are unable to recognize their cognitive distortions (cognitive bias). Delusions of control or auditory hallucinations may occur due to issues with self-monitoring and inadequate informational processing.
Define meta representation
The ability for a person to reflect on thoughts and experiences
What three factors of meta representation of schizophrenics suffer from?
1. Inability to generate voluntary action
2. Inability to monitor voluntary action
3. Inability to monitor the beliefs and intentions of others
What can be concluded from Frith's theory?
Schizophrenics can't distinguish between internal actions (their own mind) and external actions (from other people)
Describe Frith's (1970) research
Gave healthy and schizophrenic pps a two choice task - had to guess whether next card was red or black. Schizophrenics produced stereotypical choices, either all red, all black or alternating black and red. Healthy pps produced more random choices.
What can be concluded from Frith's research study?
Schizophrenics have problems generating immediate actions - lack of self-control which is caused by cognitive impairments
State two advantages of Frith's research.
1. Cognitive approach provides a reasonable account of how positive symptoms develop - cognitive impairments
2. Research is conducted as a lab experiment, so is highly controlled, scientific and objective - psychologists can accurately see the effect of the IV
State four disadvantages of Frith's research
1. Meta representation is criticized as being reductionist - simplifies schizophrenia as due to three issues.
2. Cognitive model fails to account for negative symptoms
3. Cause and effect isn't clear - research has found people with maladaptive processing are a greater risk for developing mental disorders in general - needs more research
4. Approach is clear in the symptoms of patients, but not clear on what causes schizophrenia
According to Hemsley (1993), what two factors do schizophrenics have issues with?
Perception and memory
What did Hemsley state about schizophrenics and schemas?
Schizophrenics have a breakdown in schemas - can't create and store schemas. Unable to predict what happens next and often ignore aspects of the environment (concentrate on insignificant events). May experience sensory overload
State four evaluation points of Hemsley's theory.
1. Nature vs nurture debate - are the cognitive impairments due to nature or nurture? Needs further investigation
2. Ethical issues - might not get informed consent due to state of patient, risk of psychological harm, may feel uncomfortable or upset. Patient may wish to withdraw but doesn't know how to
3. Stirling (2006) found schizophrenics process information differently. 30 patients, compared to 18 controls, were given a Stroop test - patients took twice as long to name the colours (central control dysfunction). Supports Frith's and Hemsley's ideas.
4. Cognitive approach gives a good explanation for dysfunctional thoughts leading to symptoms, but not for the cause of schizophrenia.
What three other factors did Beck and Rector state could cause schizophrenia?
Environmental, Behavioural and Neurobiological
How could you deal with the issue of fully informed consent with schizophrenic patients?
Ask the family
What symptoms do typical drugs target?
What symptoms do atypical drugs target?
Positive and negative symptoms
What are some examples of typical drugs?
Phenothiazines, Haldol, Prolixin