Schizophrenia

Question 1

Symptoms

Answer 1

Positive:
      Delusions
      Hallucinations
      Disordered thought 
Negative:
      Affective flattening
      Alogia
      Avolition

Question 2

Classification

Answer 2

DCM 5
      Used in America
      2 symptoms for 1+ months
      at least 1 criterion A symptom (positive)
ICD 10
      2 positive symptoms 
      or 1 if symptoms are 'bizarre'

Question 3

Psychosis

Answer 3

mental disorder, can’t tell difference between thoughts and reality, disrupts cognition and emotion

Question 4

Phases

Answer 4

Prodromal phase
      withdraw socially, lose interest in work and leisure 
      (avolition) 
Active phase
      Obvious symptoms 
      length of phase varies a lot, months to permanent
Residual phase
      obvious symptoms subside
      often occurs when treatment given

Question 5

Onset

Answer 5

After age 15
Men notice symptoms in late teens
Women notice symptoms in 20’s and 30’s

Question 6

Rosenhan - classification

Answer 6

people try to get committed
say they hear voices saying “hollow, dull, thud”
act normally after being committed
labelled as insane, normal behaviour seen as crazy
shows we don’t understand Sz

BUT was done during DSM-3,
different results with DSM-5

Question 7

Gottesman - biological explanation

Answer 7

concordance rates in both parents and child is 46%

general population has 1% chance

Question 8

Joseph - biological explanation

Answer 8

Mz twins concordance rate: 40%
Dz twins concordance rate: 7%
Joseph admits Mz twins treated more similarly
could be environmental cause

Question 9

dopamine hypothesis

Answer 9

too much dopamine causes Sz
abnormal numbers of D2 receptors
more dopamine binds, more neurons fire
too reactive to stimuli
Chlorpromazine block D2 receptors
reduces Sz symptoms
amphetamines cause more dopamine in synapse
people on amphetamines have Sz like symptoms
Aetiology fallacy
dopamine causes Sz symptoms, not Sz
is excess dopamine a cause or effect of Sz?

Question 10

Davis and Kahn - revised dopamine hypothesis

Answer 10

too much dopamine in subcortial areas: positive symptoms

too little dopamine in prefrontal cortex: negative symptoms

Question 11

Patel et al. - dopamine hypothesis

Answer 11

PET scans found less dopamine in prefrontal cortex of Sz patients

Question 12

Typical anti-psychotics

Answer 12

used from 50’s
chlorpromazine - antagonistic to dopamine system
blocks dopamine receptors
reduces positive symptoms
strong sedative
75% of dopamine receptors must be blocked
Strong side effects - extrapyramidal - involuntary movements like parkinsons
blocking dopamine in hypothalamus - comas fatal

Question 13

Atypical anti-psychotics

Answer 13

used from 70’s
temporarily block dopamine receptors
clozapine
more effective than typical
binds to dopamine, serotonin, glutamate receptors
improves mood as well - used on suicidal patients
can lead to blood disorders
risperidone
binds to dopamine and serotonin receptors
binds stronger than clozapine
stronger means smaller dosage needed, so less side effects

Question 14

Ross and Read anti-psychotics

Answer 14

drugs reinforces view that there’s somethings wrong with them
causes motivational deficit to look for other causes in both patients and doctors

Question 15

Crosslet et al. anti-psychotics

Answer 15

meta-analysis of 15 studies

found no difference in effectiveness of typical and atypical antipsychotics for treating Sz

Question 16

Coping Strategy enhancement therapy

Answer 16

build rapport with patient
identify triggers for psychotic symptoms
develop behavioural coping strategies to target each individual symptom/trigger
give hw to patients to try outs strategies in real life

Question 17

Tarrier - Coping Strategy Enhancement

Answer 17

interviewed Sz’s
found they could identify triggers for psychotic symptoms and had created their own coping strategies
led to development of coping strategy enhancement therapy

Question 18

Chadwick - coping strategy enhancement

Answer 18

had a Sz patient who thought they could see the future
they watched 50 video clips, couldn’t predict how any would end correctly
this showed them that the delusion was fake
allowed him to cope with the delusion

Question 19

Juckel et al - neural correlates

Answer 19

less ventral striatal activity in Sz patient
ventral striata linked to reward anticipation
this could cause the avolition symptom
MRI scans found ventricular enlargement in Sz patients
but also in some non-Sz controls

Question 20

Beng-Choon Ho - neural correlates

Answer 20

longitudinal study of 211 Sz’s
antipsychotic drugs cause 11% loss of brain tissue
after 30 years 35% classed as much improved
brain tissue never grows back

Question 21

Fromm-Reichmann - schizophrenogenic mother

Answer 21

psychodynamic theory
cold, rejecting mothers creates distrust in child
leads to paranoid delusions
mother makes the child become Sz

Question 22

Bateson et al. - Double bind theory

Answer 22

psychodynamic theory
family communication style is important
giving child mixed messages when punishing them
i.e. say one thing, do another
makes them think world is confusing/dangerous
leads to disorganised symptoms and paranoid delusions

Question 23

Frith et al. - cognitive explanations

Answer 23

2 kinds of dysfunctional thought processing
Metarepresentation
ability to recognise thoughts as ours
if dysfunctional could lead to hallucinations/delusions
Central Control
ability to stop automatic responses whilst doing deliberate actions
if dysfunctional could lead to disorganised speech/thought disorder
can’t suppress thoughts that are triggered by other thoughts

Question 24

Read et al. - family dysfunction

Answer 24

46 child abuse and Sz studies

69% of the Sz women and 59% of the Sz men had been abused as a child

Question 25

Harrington - schizophrenogenic mother

Answer 25

no evidence to suggest it exists | no grounding to label certain mothers' personality type as causing Sz in child

Question 26

Stirling et al. cognitive explanations

Answer 26

Sz patients took twice as long to do Stroop test name colour of ink, not word written shows Frith's theory of dysfunctional central control

Question 27

Drury et al. - CBT

Answer 27

25-50% reduction in recovery time for patients of CBT and antipsychotics drugs reduce symptoms so they can work on identifying the causes/triggers

Question 28

Houston et al. Diathesis stress

Answer 28

Traditional model (1 schizogene, and environmental trigger) is too basic Childhood sexual trauma can be a vulnerability - the diathesis Cannabis is the trigger - the stress Shows diathesis doesn't have to be a genetic origin

Question 29

Tienari et al. Diathesis stress

Answer 29

19,000 adoptees from Sz Finnish mothers Adoptive parents child rearing style assessed Compared to adoptees with no family history of Sz Child rearing with high criticism, conflict and little empathy leads to Sz in those with family history