Schizophrenia

Question 1

What is schizophrenia?

Answer 1

A severe mental illness that impairs an individual’s perception of reality.

Question 2

Name some positive symptoms of Schizophrenia

Answer 2

Hallucinations - auditory or visual perceptions of reality that aren’t actually real - unusual sensory experiences

Delusions - beliefs that have no basis - e.g grandeur delusions (believing they’re more important that they are) + delusions of persecution (believing you’re being “hunted”)

(According to the DSM) - speech disorganisation too - speech becomes incoherent

Question 3

Name some negative symptoms of Schizophrenia

Answer 3

Avolition - loss of motivation

Speech poverty - loss of quality of speech

Question 4

How does the DSM and ICD differ in diagnosis?

Answer 4

DSM (UK and USA) requires at least one positive symptom as well as a negative symptom

ICD( Europe) only needs at least 2 negative symptoms

ICD also recognises subtypes of Schizophrenia whereas DSM doesn’t

Question 5

Name the issues surrounding diagnosis and classification of schizophrenia

Answer 5

Reliability

Validity

Culture bias

Gender bias

Symptom overlap

Co-morbidity

Question 6

What is reliability in terms of diagnosing schizophrenia?

Answer 6

The extent To which 2 medical professionals agree on a diagnosis

Question 7

Why is reliability an issue?

Answer 7

CHENIAUX ET AL conducted a study with psychiatrists and 100 patients

They individually diagnosed the 100 using both DSM and ICD

One psychiatrist diagnosed 26 with DSM and 44 with ICD

The other diagnosed 13 with DSM and 24 with ICD

Question 8

Why is validity an issue?

Answer 8

As seen in Cheniaux’s study, schizophrenia was diagnosed more with the ICD than the DSM

This means that either the ICD over diagnoses schizophrenia or the DSM under diagnoses it

Question 9

Why is co-morbidity an issue?

Answer 9

If two conditions occur together a lot of the time the validity of their classification and diagnosis is questioned as they might actually be the same condition

BUCKLEY ET AL concluded that around half of patients with schizophrenia also have depression and 47% also suffer with substance abuse

Other common ones are PTSD (29%)+ OCD (23%)

Question 10

Why is gender bias an issue?

Answer 10

LONGNECKER ET AL reviewed the prevalence of diagnosis and found that men are diagnosed more often than women with schizophrenia

It could be due to genetic vulnerability….

Or due to the fact that female patients are actually better at interpersonal functioning and so it’s not as obvious as the symptoms are almost masked

This can lead to diagnoses being missed for females.

Question 11

Why is culture bias an issue?

Answer 11

African - Americans and British ppl of Afro-Caribbean origin are several times more likely to be diagnosed with schizophrenia than white ppl

In African cultures hearing voices is acceptable and seen as a blessing and not actually a symptom of schizophrenia but to a foreign psychiatrist it would be bizarre

Question 12

Why is symptom overlap an issue?

Answer 12

When disorders share symptoms it causes problems with the validity of diagnosis and classification of those disorders

Avolition is a symptom of both depression and schizophrenia

Question 13

Name the three biological explanations of schizophrenia

Answer 13

Neural correlates

Genetics

The dopamine hypothesis

Question 14

Describe neural correlates (negative symptoms)

Answer 14

avolition is associated with loss of motivation -> anticipation of reward + THE VENTRAL STRIATUM is believed to be involved with anticipation

JUCKEL ET AL compared brain activity of schizophrenia patients and normal patients and found a strong negative correlation between activity level and severity of negative symptoms

Question 15

Define Neural correlates

Answer 15

Measurements of the structure or function of parts of the brain that correlate with an experience or symptom

Question 16

Describe neural correlate (positive symptoms)

Answer 16

Hallucinations are thought to be associated with the SUPERIOR TEMPORAL GRYUS AND THE ANTERIOR CINGULATE GYRUS

Allen et al compared a group of schizophrenic patients with a control group on a task of identifying audio as their own voice and found that there was lower activity in these areas in the patient group who also made more errors

Question 17

Evaluation of neural correlates

Answer 17

(+) as parts of the brain have been identified by research now, they can be used to help with the diagnosis of schizophrenia; if they’re unsure they can measure brain activity in these areas

(-) there’s still an issue with correlation not causation
We have found a correlation with activity and severity of symptoms but how do we know if the low activity is causing the symptoms or the symptom is causing the low activity so actually it tells us little about the causes of schizophrenia

Question 18

Describe how genetic basis in families causes schizophrenia

Answer 18

It’s been noted for many years that schizophrenia runs in families but this is quite weak evidence in itself

So there have been systematic investigations done to show the extent to which genetic similarity equates to likelihood of developing schizophrenia

Gottesman investigated this + found that with MZ twins the likelihood is 48%, with DZ twins it’s 17% and with siblings it’s 9%

Question 19

Describe how candidate genes are involved in the causes of schizophrenia

Answer 19

It has been identified that schizophrenia is POLYGENIC meaning there are many individual genes that each carry a small risk of inheriting schizophrenia and requires a collection

its also been identified that it is AETIOLOGICALLY HETEROGENOUS meaning there are many diff combinations that cause the condition

RIPKE et al investigated the genome of 37,000 patients + compared it w/111,300 control patients + found 108 genetic variations that were associated w/ risk of schizophrenia

Question 20

Describe the original dopamine hypothesis

Answer 20

known as hypERdomanergia

high levels of dopamine in the subcortex are present in brains of patients

e.g excessive amounts of dopamine receptors in Broca’s area may be associated with speech poverty and/or auditory hallucinations

Question 21

Describe the newer dopamine hypothesis

Answer 21

known as hypOderminergia

low levels of dopamine in the PREFRONTAL cortex (responsible for thinking and decision making) can be associated with negative symptoms

Question 22

Strengths of “genetic basis” explanation

Answer 22

(+)mutations in genetic code provide evidence for a genetic basis in schizophrenia
Even without a family history mutations in sperm cells can increase risk of inheriting schizophrenia
it was found that fathers under 25 have a 0.07% chance of passing on the risk where fathers over 25 had a chance of 2%
Mutations occur more often as you age

Question 23

Weakness of genetic basis

Answer 23

(-)it’s evident also that environment plays a role in influencing the risk of schizophrenia
Bc with even MZ twins if one has it the chance you getting it is less than 50%
Studies have shown that environmental situations like family dysfunction also add to the likelihood of developing schizophrenia
Therefore there must be an interactionist explanation as both biological and psychological explanations occurring

Question 24

Strengths of the dopamine hypothesis

Answer 24

(+) evidence
CURRAN ET AL conducted a study increasing levels of dopamine in non suffered and found that it induced schizophrenia symptoms in them
Also evidence from antipsychotics which act as dopamine antagonists
Evidence that showed they work TAUSCHER ET AL

Question 25

Weaknesses of the dopamine hypothesis

Answer 25

(-) the evidence all enforces the original dopamine hypothesis but not the newer one They all show that high levels of dopamine affects schizophrenia so what about the new hypothesis? (-) not a complete explanation using just dopamine as in RIPKE found genetic variations coding for other neurotransmitters other than dopamine including one called glutamine which could have an effect on schizophrenia

Question 26

What is drug therapy

Answer 26

The most common treatment for schizophrenia is drug therapy specially the use of antipsychotics They can be taken as tablets, injections or syrup There are two types of antipsychotics; typical and atypical

Question 27

Describe typical antipsychotics

Answer 27

One example is CHLORPROMAZINE Usual daily does of 400-800mg Acts as an agnostic (lowers levels of dopamine) Can be taken in all forms

Question 28

Describe atypical antipsychotics

Answer 28

One example is CLOZAPINE Initially was stopped due to a few deaths of patients from agranulocytosis but then bought back bc it was more effective than CHLORPROMAZINE but now patients have to have regular blood tests and not allowed to take it by injection Daily doses around 300-450 Another example is RISPERIDONE : developed in an attempt to be as effective as clozapine without the side effects Binds more strongly to dopamine receptors so only small doses required (4-8mg)

Question 29

Strengths of drug therapy

Answer 29

(+)large body of supporting evidence THORNLEY et al compared effect of chlorpromazine and a placebo found 13 trials (1121) showed chlorpromazine was associated with better functioning In 3 trials (512) chlorpromazine showed a lower relapse rate (+) also for atypical antipsychotics it was found by MELTZER who reviewed treatments with clozapine used and found that 30%-50% of cases where chlorpromazine had failed clozapine was found to be effective

Question 30

Weaknesses of drug therapy

Answer 30

(-)existence of side effects Such as dizziness, agitation, sleepiness, stiff jaw + a long term one tardive dyskinesia +NMS (-) the theory of antipsychotics align with the original dopamine hypothesis but not the newer one acc the newer one suggests that antipsychotics shouldn’t work (-) some rigorous challenges e.g from David Healy who claimed that only successful studies showing the effectiveness of antipsychotics have been published exaggerating their success and effectiveness (-)widely believed that antipsychotics used to calm patient for staff to handle easier rather than for the patients benefit raising ethical issues As sedation reduces the patient to a zombie like state effectively with no personal responsibility and control

Question 31

Define family dysfunction

Answer 31

abnormal processes within a family such as poor communication, high expressed emotion and cold parenting these are risk factors for developing and maintaining schizophrenia

Question 32

Describe the Schizophrenogenic mother

Answer 32

Frieda-Fromm Reichmann proposed this after discovering that many of her patients described of a parent who was cold, rejecting and controlling who she called the schizophrenogenic mother this creates a tense family climate that leads to distrust and eventually paranoia

Question 33

Describe the Double-bind theory

Answer 33

BATESON ET AL emphasised the role of communication style within family the developing child can find themselves in trapped situations where they fear doing smtg wrong but receive mixed messages about what is and feel unable to seek clarification they get punished by withdrawal of love which can leave them feeling confused leading to symptoms like delusions and disorganised thinking

Question 34

Describe Expressed emotion

Answer 34

EE is the level of emotion, particularly negative ones, expressed by a carer to the patient EE contains verbal criticism, hostility and emotional over--involvement high levels of EE is a source of great stuff + primarily explains relapse

Question 35

What is a cognitive explanation?

Answer 35

Explanations that focus on mental processes such as though processing

Question 36

What is schizophrenia characterised by in terms of cognitive processes?

Answer 36

By disruption to normal thoiugh processing e.g reduced processing in ventral striatum is associated with negative symptoms

Question 37

What did Frith et al identify?

Answer 37

They found two kinds of dysfunctional thought processing; meta representation and central control

Question 38

Describe meta representation and how its different for schizophrenic patients?

Answer 38

Meta representation allows us to reflect on thoughts + behaviours + our own intentions, also allows us to interpret other's actions Disruption in this can disrupt our ability to recognise our own actions + thoughts as our own explaining hallucinations and delusions

Question 39

Describe central control and how its different to schizophrenic patients?

Answer 39

Central control allows us to think about what we are saying and filter out things we know we don't need to day out loud - it suppresses automatic responses dysfunctional central control leads to disorganised speech because we say everything on our mind

Question 40

Strengths of Psychological explanations of schizophrenia

Answer 40

(+)research support - Berger - found schizophrenics reported a higher recall of double-bind statements by mothers than non-schizophrenics (+)research support - sterling et al - compared 30 patients within 18 non-patients on a rage of cognitive tasks like the stroop test - patients took over twice as long - central control support

Question 41

Limitations of Psychological explanations of schizophrenia

Answer 41

(-) info about childhood experiences gathered after development of symptoms - srs problem for validity - (-)an issue with this explanation is that dysfunctional thinking could be a consequence of schizophrenia rather than a cause - incomplete explanation (-) it can imply that the parents are responsible - psychological harm - blame and guilt on top of the existing suffering of seeing their children suffering

Question 42

Define CBT

Answer 42

- a method for treating mental disorders based on cognitive + behavioural techniques - CBT commonly used to treat patients now and occurs across between 5 + 20 sessions - does not get rid of schizophrenia but can help patients cope with it

Question 43

How does CBT help?

Answer 43

- it aims to help identify irrational thoughts + try to change them, may involve argument or discussion - patients can be helped to make sense of how their delusions + hallucinations impact them

Question 44

What is Family therapy?

Answer 44

Psychological therapy carried out with all/some members of family aiming to improve communication + reduce stress

Question 45

How family therapy helps?

Answer 45

PHAROAH AT EL identified range of strategies aiming to improve family functioning including, reducing stress of caring for patient, reduction of anger + guilt these strategies work by reducing levels of stress so a reduced likelihood of relapse

Question 46

What is Token economies?

Answer 46

- a form of behavioural therapy where desirable behaviours are selectively reinforced - a reward system used to manage behaviour particularly in psychiatric hospitals

Question 47

How does Token Economies work?

Answer 47

Tokens are given to patienst when they perform a desirable behaviour for example a patient who struggles with avolition could be rewarded every time they get out of bed and make their bed - these tokens(secondary reinforcers) are then exchanged for rewards (primary reinforcers)

Question 48

Strengths of psychological therapies

Answer 48

(+)

Question 49

Research support for psychological therapies (jahuar)

Answer 49

(+) JAHUAR et al reviewed 34 studies about CBT - they concluded that CBT makes a fairly small but significant impact on both positive and negative symptoms

Question 50

Research evidence limitations for psychological therapies (McMonagie and sultana + Pharaoh et al)

Answer 50

(-) McMonagie and Sultana reviewed studies into token economies + found that only three studies (110pps) had pps randomly allocated + then only 1 out of 3 showed improvement in behaviour (-) Pharaoh reviewed studies into family therapy + found that results did show a significant decrease ion hospital re-admission but also diff studies had inconsistent results

Question 51

Limitations of psychological therapies

Answer 51

(-) these therapies don't cure schizophrenia, they just help patients cope with the symptoms (-) token economies can't work for the patients with ,more severe symptoms and this is unfair and therefore raises ethical concerns

Question 52

Define the Interactionist approach in terms of explaining schizophrenia

Answer 52

- a broad approach which acknowledges biological, societal and psychological factors in the development of schizophrenia

Question 53

Describe the Diathesis-stress model

Answer 53

Schizophrenia can be explained by an underlying vulnerability (diathesis) being triggered (stress) to onset schizophrenia

Question 54

Describe Meehl's model

Answer 54

- diathesis was entirely genetic - "the schizogene" - according to Meehl if someone didn't have the schizogene, no amount of stress can lead them to develop schizophrenia

Question 55

Describe the modern understanding of diathesis

Answer 55

- nowadays we recognise that there is not one single schizogene but actually a number of genes appear to slightly increase vulnerability (Ripke et al) -and that also it's not entirely genetic, it can also be trauma such as childhood abuse

Question 56

Describe the modern understanding of stress

Answer 56

- a modern definition of stress includes anything that risks triggering schizophrenia - much recent research has concerned cannabis use - cannabis use increases risk of schizophrenia by up to 7x

Question 57

Describe treatment using the interactionist model

Answer 57

- most commonly associates combining antipsychotics and psychological therapies