Schizophrenia Flashcards
(116 cards)
1
Q
What are the main symptoms that schizophrenia characterised by?
A
Schizophrenia is characterised by delusions and hallucinations (other less well known symptoms include disorganised speech and catatonic behavior)
2
Q
What are hallucinations?
A
When people experience things that are not truly there. They can be auditory, tactile, olfactory or visual.
3
Q
What are delusions?
A
When people believe things that can’t be real, but seem real to the person.
4
Q
What is grossly disorganised behavior?
A
The inability to initiate everyday tasks, for instance carrying out personal hygiene.
5
Q
What is catatonic behavior?
A
They are characterised by a reduced reaction to the immediate environment, rigid postures, or aimless motor activity.
6
Q
What are negative symptoms?
A
They reflect a loss of normal functioning. This occurs in 1/3 schizophrenics.
7
Q
What is speech poverty?
A
It is characterised by the lessening of speech fluency and productivity, reflecting slowing or blocked thoughts.
8
Q
What is avolition?
A
A reduction of interest and desires, as well as an inability to perform goal-oriented tasks.
9
Q
What is active flattening?
A
A reduction in emotional expression, including facial expressions, voice tone, eye contact and body language.
10
Q
What is anhedonia?
A
A loss of interest in almost all activity, or a lack of reactivity to normal, pleasurable stimuli. This can be physical (i.e. you can not experience pleasure from food, bodily contact etc.) or social (lack of pleasure form interactions). Social anhedonia overlaps with other disorders, such as depression.
11
Q
Name four positive symptoms
A
Hallucinations, delusions, disorganised speech and grossly disorganised/catatonic behavior.
12
Q
Name four negative symptoms
A
Avolition, active flattening, speech poverty and anhedonia.
13
Q
Are mood swings a symptom of schizophrenia?
A
No
14
Q
What could drugs relate to a schizophrenia diagnosis?
A
It could be diagnosed as drug-induced psychosis if the symptoms only occur after taking drugs.
15
Q
What are the drug therapies for psychosis called?
A
antipsychotics
16
Q
What are the two types of antipsychotics?
A
typical and atypical
17
Q
What is one example of typical antipsychotics?
A
chlorpromazine
18
Q
What is one example of atypical antipsychotics?
A
dozapine
19
Q
What symptoms do typical antipsychotics treat?
A
positive symptoms
20
Q
What symptoms do atypical antipsychotics treat?
A
Positive symptoms, negative symptoms and they are claimed to help relieve cognitive impairment
21
Q
How do typical antipsychotics work?
A
They bind to D2 receptors, therefore stopping dopamine from creating a response as it can not meet receptors. They are therefore dopamine antagonists.
22
Q
What did Raper et. al suggest about typical antipsychotics?
A
That they must block 75-80% of D2 receptors in order to work.
23
Q
What is one issue with typical antipsychotics that relates to receptors?
A
they block 75-80% of D2 receptors, but they also block 75-80% of other receptors as well.
24
Q
What are 6 side effects of typical antipsychotics?
A
Lethargy Muscle spasms Flat Affect- reduced emotional response Reduced physical and sexual stimulation weight Gain Reduced Cognitive ability
Basically gives the patient depression.
25
What is one cost of typical antipsychotics?
They put takers at high risk of suicide, so those taking them need therapeutic support workers
26
How do atypical antipsychotics differ from typical antipsychotics?
They also block D2 receptors but have rapid dissociation, so the effects very quickly wear off, resulting in less severe side effects. They are also claimed to stimulate serotonin receptors, therefore helping with depressive symptoms.
27
How is dopamine related to serotonin?
They are both monoamines, which could explain why dopamine blockers also affect serotonin.
28
what statistic relates suicide to schizophrenia?
30-50% of schizophrenic patients attempt suicide at some point.
29
What are 7 side effects of atypical antipsychotics?
Tardive Dyskinesia- losing control of muscles, causing spasms
Agranulocytosis- lots of white blood cells die, so your immune system becomes compromised (therefore immunocompromised people can't take A.A.)
Constipation
loss of vision
Can destroy your stomach lining
Can cause an allergic reaction
You can't drive or look after kids while on them
30
What is one positive of atypical antipsychotics?
They are much faster acting than typical antipsychotics
31
what are three common comorbidities of schizophrenia?
Bipolar disorder, depression and schizoaffective disorder
32
Who was the double blind theory formulated by?
Bateson et al (1956)
33
What does the double blind theory of causation of schizophrenia suggest?
Contradictory messages during childhood can increase risk of schizophrenia. For instance, if your mother said she loved you and then hit you, this would create a muddled and contradictory perception of reality. Your inner working model would be formed with these contradictions, so your schema for the world would suggest that when people say one thing, they mean another, hence forming delusions.
34
What is a schizophrenogenic mother?
a mother who presents as cold, rejecting and secretive, so therefore leads the child to have a constant belief that they are being persecuted.
35
How is Bateson similar to Bowlby?
They both focus on the importance of the mother in development.
36
How can flattening effect be explained by the double blind theory?
Flattened affect can occur as the child was taught that expressing their emotions and feelings would have negative consequences, due to their oppressive parents.
37
Who suggested emotional expression theory?
Kuipers et al 1983
38
What does emotional expression theory suggest?
That families with large amounts of emotional expression can trigger schizophrenic episodes.
39
What did K__p_r find family to say about their schizophrenic family members?
Kuiper
| family members describe schizophrenic individuals in critical and hostile terms
40
How does emotional expression relate to relapse?
Emotionally expression in family and friends strongly correlates with relapse rates
41
How has the theory of emotional expression helped in the treatment of mental disorders?
It has allowed us to create family therapy to treat schizophrenia
42
What did N__l 2009 suggest?
Noll
He used family therapy to show how negative emotions can trigger schizophrenia in vulnerable people while supportive environments help decrease relapse rates
43
What did Fr__h et al 1992 suggest?
Frith
| That schizophrenic individuals have issues with meta-representation and central control
44
In what way do schizophrenics have issues with meta-representation?
They are unable to reflect accurately on your own thoughts and actions as well as the thoughts and actions of others. Therefore, they can often make up them and other people saying things
45
In what way do schizophrenics have issues with central control?
Schizophrenic patients have a lack of filter, so they can not suppress automatic behaviors if they are also focused on other tasks.
46
What is one issue of drug therapy relating to long-term solutions?
The relief provided with drugs is only temporary
47
What is one positive of drugs relating to the economy?
They are cheap and easy to administer and some could argue that the economic benefits outweigh the ethical costs. Therapy is also too expensive to be administered to everyone
48
What is one positive of drugs relating to the self blame?
medicalizing sz helps reduce self blame, as the patient would feel validated that their struggles are real, and negative self view may have been a symptom of schizophrenia
49
What is one positive of drugs relating to time?
It gives instantaneous and controllable affects, and takers can be surveyed in hospital
50
What is one negaitive of drugs relating to schedules?
Sz patients may have issues with daily tasks and goal oriented tasks, so may not stick to medications schedules, making them uneffective.
51
What did Bateson et al suggest?
The double bind theory
52
What does the double blind theory suggest?
That contradictory messages during childhood could increase the risk of schizophrenia. This is because the contradiction makes the person confused about what reality is. For instance, if your mother tells you she and then hits you, this confuses reality for the child, as we learn what reality is when we are young and our working memory model/schema for life is created while we are young, so a confused reality during childhood will make your perception of reality in adulthood also muddled.
53
What is a schizophrenogenic mother?
A mother who is cold, rejecting and secretive, who confuses the child by sending mixed messages or says something and then does the opposite. This can give the child a constant sense of fear and belief that they are being persecuted.
54
How can double blind theory explain flattened affect?
Someone with a confusing and muddled childhood, and therefore a confusing and muddled perception of childhood, they can develop a negative outlook on the world, causing a lack of responsiveness. The child may also have been punished for their emotions so therefore have learnt to suppress their emotions.
55
How can the double blind theory explain auditory hallucinations?
Individuals could experience auditory hallucinations as they believe they are always doing something wrong or feels blamed so is therefore reprimanded by their auditory hallucinations. The loss of grasp on reality would be because of your parents giving them a skewed/contradictory view of reality.
56
What did K__p_s et al 1983 suggest?
kuipers
Families with high amounts of emotional families can trigger schizophrenic episodes. Family members describe them in critical and hostile terms. Emotional expression in family and friends is strongly correlated with relapse rates. Because of this, family therapy can be used for schizophrenia, which reduced the relate of relapse.
57
What did Noll 2009 suggest?
He used family therapy to show how negative emotions can trigger schizophrenia in vulnerable people, while supportive environments help decrease relapse rates. This was suggested to work best in diathesis-stress with drug therapies.
58
What did Frith et al 1992 suggest about meta-representation in individuals with schizophrenia?
Schizophrenic patients have issues with meta-representation, so are unable to reflect accurately on your own thoughts and actions. therefore, they often can't tell where they were specifically or what they were doing specifically.
59
What did Frith et al 1992 suggest about central control in individuals with schizophrenia?
Schizophrenic patients have a lack of filter, so they can not suppress automatic behaviors if they are also focused on other tasks.
60
What is the cognitive process/pathway of delusions?
Inadequate Information Processing (failure to focus attention effectively) ----------- Egocentric bias ---------- Failure to contextualize events
61
What is one daily factor of life that schizophrenic patients would have issues with?
Reality testing
62
What is the cognitive process/pathway of hallucinations?
Hypervigilance----- Higher expectancy of voices------ patients can't distinguish between sensory information and internal images (Aleman 2001)----- They misattribute the source of the internal images to external sources (Baker and Morrison 1998)
63
What was the cognitive process that Beck and Rector suggested for schizophrenic individuals in stages?
Stage 1- Cognitive Processing Bias (attention is focused on the wrong thing)
Stage 2- Misattribution of consequences to causes (i.e. they feel bad and focus on something unrelated to explain it)
Stage 3- Failure to test reality with memory or logic
64
What three stages of biological processes can we relate to the cognitive processes in B__k and R_____'s theories?
Beck and Rector
Stage 1- Hyperdopaminergia in and around the mesolimbic pathway
Stage 2- Hypodopaminergia in the anterior cingulate cortex and prefrontal cortex
Stage 3- The link between the hippocampus and the dorsolateral prefrontal cortex is disrupted or atrophical- hence why you can't use memory or logic to rationalise
65
How does the DSM V treat subtypes of schizophrenia?
It no longer uses subtypes of schizophrenia, but instead uses subtypes to specify between other psychotic conditions.
66
What is attenuated psychosis syndrome?
It is when someone someone does not have a full psychotic disorder but do exhibit minor versions of some symptoms. This helps with identifying risk of developing a psychotic disorder, so can help with early intervention.
67
What does it mean if a diagnosis of schizophrenia is reliable?
If multiple clinicians consistently come to the same conclusion using the criteria in the DSM V.
68
what does the dopamine hypothesis of schizophrenia suggest?
Sz is caused by an imbalance of dopamine. This could be because of the sufferer having too many D2 receptors, the D2 receptors are too sensitive/fire too often or too much dopamine is produced. This is related to positive symptoms.
69
How can excess dopamine result in disorganised speech?
Broca's area is responsible for producing speech. If there is too much dopamine in this area, this can result in this symptom.
70
How can levels of dopamine relate to avolition?
Hypodopaminergia can under-stimulate the prefrontal cortex, which result in this symptom.
71
What is one study that helped create the link between dopamine levels and positive symptoms?
Grilly 2002- they used a drug called levadopa. This only released dopamine. It was given to people with Parkinson's as an attempt to treat their low dopamine levels. It caused positive SZ symptoms.
72
what genes have been related to SZ and what do they do?
Dopamine receptor genes (D2 DRD2)- affects the number of receptors and the transport proteins for dopamine
Glutamate receptor genes (AMPA)- affects the number of glutamate receptors and are especially important for the basal ganglia
73
What did Gutt____n 1991 suggest?
| clue- genes
Guttesman
He tested the concordance in children with schizophrenia with parents or siblings. 2 schizophrenic parents resulted in 46% concordance, 1 schizophrenic patient had 13% concordance and 1 schizophrenic sibling resulted in 9% concordance.
74
What did J____h 2004 suggest?
| clue- twins
Joseph
He did a meta-analysis on monozygotic and dizygotic twins and their concordance for schizophrenia ( all these studies were before 2001) Monozygotic twins had 40.4% concordance while dizygotic twins had 7.4% concordance.
75
What did D__s and K__n suggest?
Dans and Kahn
Too much dopamine in the mesolimbic pathway results in positive symptoms while too little dopamine in the prefrontal cortex resulted in negative symptoms.
76
Social causation hypothesis- H______n et al
```
Harrison
The idea that people are more subject to mental illness if they experience economic hardship. This can inhibit socioeconomic attainment and lead people to drift into the lower social class or never escape poverty.
```
77
what are some neural correlates of schizophrenia?
People with schizophrenia tend to have larger ventricles and abnormalities in the orbitofrontal cortex
78
What are some elements of the diathesis explanation of schizophrenia?
biology, the D2 gene, hyperdopaminergia in the mesolimbic pathway, hypodopaminergia in the prefrontal cortex, epigenetics and having an older father (increased risk of mutation and risk epigenetics)
79
What are some elements of the "stress" explanation of schizophrenia?
triggering events (a negative psychological experience e.g. dysfunctional parents and stressful life events). Chronic stress can also be produced by the genetic vulnerability in schizophrenia.
80
What did T_____i et al 2004 aim to investigate?
Tienari
Whether genetic factors will moderate susceptibility to environmental risks associated with the stressors in an adoptive family.
81
What was the method of T_____i et al 2004?
Tienari
Checked hospital records to identify women who'd had a psychotic episodes and noted who, out of these women, had given up children for adoption. They then tested 145 high-risk of schizophrenia adoptees of the schizophrenic mothers to a control of 158 "control" adoptees. Both groups were assessed for schizophrenia after 12 years and were followed up after 21 years. Family functioning was also assessed. Interviewers were not told whether the child had a schizophrenic mother or not.
82
What is one positive of Tienari et al 2004 relating to investigator effect?
They used a double blind method- keeping the investigator unaware of if the child had a schizophrenic mother or not.
83
What was one positive of Tienari et al 2004 relating to the experimental design?
It was a longitudinal study, meaning it would have had good temporal validity.
84
What were the findings of Tienari et al 2004?
11 of the kids with schizophrenic mothers and 3 in the control group (4% and 1%) developed sz. A healthy adoptive family seemed to significantly reduce risk of schizophrenia, but this was most prevalent in children with a schizophrenic mother.
85
What is one proof that SZ is not just due to nature?
Even in monozygotic twins, there is never a concordance rate of 100%. This shows that other factors must influence this.
86
What did Varese et al 2012 suggest?
he suggested that severe trauma before the age of 16 makes you 4 times more likely to develop schizophrenia.
87
How do types of environment relate to schizophrenia?
Urban environments have more than twice the rate of schizophrenia.
88
What is the basis of family therapy?
- So successful at reducing relapse that NICE recommends it for all families involved with someone with schizophrenia.
- It reduces the chance of relapse by up to 50% (Garety et al 2008)
- Lasts from 3-12 months (usually about 10 sessions)
89
What are some strategies of family therapy?
Aiding understanding and dealing with illness
Educating the family on the causes of schizophrenia
Forms therapeutic alliance with family members
Reducing stress and high emotional climate within the family
Improving ability to anticipate and share problems
Reduction of anger and guilt in family members
Helps family members maintain a balance between care for the patient and their own lives
Maintains responsible expectations for the patient
90
What were the details of P_____h et al?
Pharoah
Meta-analysis study- considered 53 studies in Europe, Asia and Northern America to see the effectiveness of family intervention. They compared antipsychotics alone and used in conjunction with family therapy. They found no significant improvement in mental state but aided compliance to medication, basic social functioning and reduced relapse and rehospitalization.
91
What is one issue with family therapy relating to ethics?
It is questionable whether there would be ethical benefits to family therapy.
Pharoah et al suggested that, though Family therapy did improve compliance with meds and some social functions, there was no conclusive evidence of an improvement in mental state.
This suggests that, though there are economic benefits to family therapy, whether it is entirely effective is debatable
92
What is one evaluation of Pharoah's study relating to validity?
It was a meta-analysis study using 53 studies from England, Asia and North America.
This would suggest good population validity and good reliability due to using a lot of secondary data.
93
How many sessions of CBTp are recommended by NICE?
16 (it usually takes 5-20)
94
What model does CBTp use?
CBTp uses the ABCDE model. It involves identifying activating events (A), resulting beliefs(B), behavioral consequences(C), these beliefs are then rationalised/disputed (D) and changed through critical collaborative analysis, leading to the effect(E).
Critical collaborative analysis- gentle questioning to help the patient understand and challenge illogical deductions and conclusions- still using unconditional positive regard.
95
How does CBTp use normalization?
The therapist shares with the patient that many people have unusual experiences such as hallucinations and delusions in different circumstances. This reduces anxiety and feelings of isolation, helping to remove stigma- which makes recovery more likely.
96
How does CBTp use behavioral homework?
Patients may be set behavioral homework to improve their general level of functioning.
97
What were the findings of Ch___ick and L__e (1993)?
Chadwick and Lowe
| CBTp reduced delusions in 10/12 patients. However, whilst 70% benefited, 30% regressed after therapy.
98
How can CBTp be related to a psychological placebo?
the patient is actually only getting benefit from talking to someone who is friendly and supportive. This could suggest that a more effective treatment may be support groups or talking groups, as these are less expensive, and CBTp is so hard to come by that it is only offered to 1 in 10 szc patients
99
What is one support of diathesis-stress relating to ecological validity?
As DS is the most commonly used treatment method and is recommended by NICE
100
What is one issue with diathesis stress relating to internal validity?
Most of the research that diathesis stress is based on is correlational data, so we don't know if there is a third variable, therefore reducing internal validity.
101
What other study supports the idea that family relationships are important in the development of schizophrenia?
Tienari et al, he found that children who were raised in families with a schizophrenic parent were 3% more likely to develop schizophrenia. This suggest that families with a schizophrenic parent may be more likely to show high EE or double blind theory, so supports the idea of these stipulating schizophrenia.
102
What is one study that shows cultural differences creates issues for reliability of diagnosis?
Co_el_nd
Copeland (1971)
Gave 134 US psychiatrists and 134 UK psychiatrists a description of a patient. 69% of the US psychiatrists diagnosed schizophrenia while only 2% of the British psychiatrists gave a schizophrenia diagnosis.
103
How can auditory hallucinations be influenced by culture?
In a study (Luhrmann), African individuals often reported their hallucinations to be playful or advising, while american participants were more likely to report their hallucinations as being violent or hateful.
104
What information/research shows how gender can influence the validity of diagnosis?
A study showed that, when given a description of a patient and asked to give a diagnosis, if the gender was said to be male or not specified, 56% diagnosed schizophrenia, but when the gender was specified, only 20% were given a diagnosis of schizophrenia.
105
What is the issue of system overlap in validity of diagnosis?
When the symptoms of sz overlap with other disorders, such as bipolar or depression, making it less distinct whether the disorder is actually schizophrenia or not.
106
What are the two most common comorbidities of schizophrenia and how are these represented by statistics?
Comorbid depression occurs in 50% of psychotic patients and 47% also have a lifetime diagnosis of substance abuse.
107
How can diagnosis be suggested to be too not specific (to each person) ?
There are always differences in prognosis. 20% recover to their previous function, 10% show significant improvement, 30% show some improvement with intermittent relapses. Therefore, diagnosis can only take you so far in understanding the patient.
108
What is one problem with adoptive environment studies such as Tienari et al?
Though we assume that the adoptive families would all be random, so would therefore would all be equally prepared/not prepared for their child being schizophrenic, in earlier studies, the adoptive would likely have been informed of the genetic background of the child prior to adoption, so the families with these children would be more likely than the average family to CHOOSE a child with these predispositions, either because they don't care, so wouldn't properly support this child, because they don't know what these genetic predispositions mean or they are prepared/ready to accept a sz child.
109
What two drugs that they always mentioned in bland and unoriginal rap songs and are in "The Wolf of Wall Street" a million times even though no one really notices because we're all more interested in Margot Robbie's character are said to induce psychosis? How does this relate to the dopamine hypothesis?
Cocaine and amphetamines, these affects the regulation of dopamine.
110
What did the NICE review for treatment of schizophrenia in 2014 suggest about the effectiveness of CBTp?
They found consistent evidence that, when compared with treatment by antipsychotics alone, CBT was more effective in reducing symptom severity and improving levels of social functioning.
111
what type of experiment shows the effectiveness of antipsychotics? Can you please describe one of these? If that's okay with you, and you're not busy or anything x
Placebo studies, were you give some patients the real drug and some patients a placebo and see if there is a difference. Leucht carried out a meta-analysis of these studies and found that, within 12 months, 64% of those patients who had been given the placebo had relapsed , compared to 25% of those who had taken the actual antipsychotic.
112
What are extrapyramidal side effects?
Side effects of taking antipsychotics that affect our motor activity. If antipsychotics are taken for an extended period of time, you can develop tardive dyskinesia, characterised by involuntary movement of the tongue, face and jaw. The patient may then have to take drugs to relieve this side effect.
113
What is one issue with the assumption that atypical antipsychotics are more effective?
Crossley suggested that there is no distinct in difference in efficacy between the two, but there is a distinct difference in the side effect profile, with AAs being more likely to cause more significant weight gain and TAs being more likely to cause tardive dyskinesia.
114
What is one benefit of family therapy relating to the economy?
It is said to be an economic treatment, as the extra cost of the therapy is less than the costs of hospitalisation.
115
What is the final conclusion of whether token economy works or not?
We don't know, there is no conclusive evidence that it does or doesn't work.
116
What is one criticism of token economy relating to setting?
It is only really effective in hospital, not in the community.
