Schizophrenia and Psychotic Disorders

Question 1

What are psychotic disorders?

Answer 1

Involve a major break from reality in which the individual perceives the world in a way that is vastly different to how others perceive it e.g Schizophrenia is a very severe type of psychotic disorder

Question 2

What is Schizophrenia

Answer 2

According to the ICD-11 ,this is characterized by disturbances across many aspects of a persons thoughts, feelings, experience and behaviour along with a major break from reality.

Question 3

Core symptoms(positive)

Answer 3

1. Persistent Delusions: belief that a person holds which are not based in reality e.g falsely believing that someone is trying to harm you
2. Persistent Hallucinations: Sensory experiences(visual, olfactory, gustatory, tactile) most commonly auditory(hearing things that aren’t there)
3. Disorganized speech and behaviour

Question 4

Negative symptoms

Answer 4

• Avolition- Lack of motivation
• Flattened Affect-blunted emotional expression
• Impaired cognitive function-reduced memory/ attention
• Catatonia-Lack of movement/speech

Question 5

What is a positive symptom?

Answer 5

an experience that ‘is an addition to’ or ‘a distortion of’ normal experience.

Question 6

What is a negative symptom?

Answer 6

where the level of functioning or experience falls below normal level.

Question 7

Diagnostic criteria of Schizophrenia

Answer 7

A.) Has at least one of the positive symptoms-delusions, hallucinations or disorganized speech/thinking.
B.) Symptoms affect one or more major areas such as work, interpersonal relations, self-care(reduction in functioning)
C.) Continous signs if disturbance persists for at least 6 months. This period must include at least 1 month of active symptoms
D.) The disturbance isn’t attributable to the physiological effects of a substance, health condition or medication

Question 8

What is the criteria for delusional disorder

Answer 8

1. One has to have delusions for 1 month or longer
2. Criteria of schizophrenia has never been met meaning that the person doesn’t have hallucinations, disorganized speech or negative symptoms (hallucinations if present are not prominent and are related to the delusional theme)
3. Functioning isn’t impaired and behaviour is not odd/bizzare
4. the disturbance is not attributable to the physical effects of a substance/another medical condition.

Question 9

Types of delusion

Answer 9

1. Persecutory delusion- a strong belief that you are in danger, that you are being conspired against and that others are pursuing you to try to do you harm.
2. Grandiose delusion- a strongly held belief that you are someone with special abililities/special powers.
3. Delusions of reference- a strongly held belief that events in the environment are related to you e.g T.V programmes is talking about you.

Question 10

KEY STUDY: FREEMAN ET AL.
Context

Answer 10

VR has been shown to be useful to treat several psychological disorders such as phobias (shown in Rothbaum et al.) and anxiety disorders. It has been used in exposure therapy, exposing patients gradually to more and more fear inducing stimulus until they no longer fear the stimulus e.g public speaking

Question 11

KEY STUDY: FREEMAN ET AL.
Main theories and explanations

Answer 11

Persecutory ideation is the belief that other people are being hostile/have negative feelings towards you.
It can lead to social withdrawal and inability to maintain usual activities.
If VR can develop a greater understanding of this in people without schizophrenia then it would help them understand it in those with schizophrenia.

Question 12

KEY STUDY: FREEMAN ET AL.
Aims

Answer 12

1. To investigate whether participants without a history of mental illness have thoughts of persecutory nature in a virtual reality.
2. To discover whether there are cognitive factors that predict the likelihood of persecutory ideation being shown in VR.

Question 13

KEY STUDY: FREEMAN ET AL.
Hypothesis

Answer 13

Researchers hypothesized that a small no. of participants would have have thoughts of a persecutory nature in VR, and that these would be ppl with higher levels of emotional distress and paranoia

Question 14

KEY STUDY FREEMAN ET AL.
Sample & Design

Answer 14

• Sample: 12 male, 12 female ppts. all students/administrative staff from University College London, avrg age-26yrs, no history of mental illness, volunteer sample recruited through adverts in UCL
• Design: Lab experiment

Question 15

KEY STUDY FREEMAN ET AL.
Procedure

Answer 15

• Ppts were trained how to use the VR equipment and then asked to enter a virtual environment (a library scene) for 5 minutes.
• Ppts. were not told the research was exploring persecutory ideation but were asked to explore the environment and try to form an impression of the ppl in the room and what they might think of the ppt. 5 avatars-3 sat at 1 desk and 2 sat at another. They showed ambiguous behaviour e.g smiling, looking.
• After leaving the VR environment, ppts were given a range of questionnaires. BSI(Brief Symptom Inventory) 53-item self report measure designed to assess 9 symptom dimensions over the last week. e.g interpersonal sensitivity, depression, anxiety, hostility

Question 16

Interpersonal sensitivity

Answer 16

tendency to focus on feelings of personal inadequacy/inferiority and feeling of marked discomfort during interpersonal relations

Question 17

FREEMAN ET AL
Results

Answer 17

1. Most ppts had positive opinions about the avatars but some had ideas of persecution.
2. No significant differences in the persecution scores between males and females
3. Higher levels of interpersonal sensitivity and anxiety were significantly correlated with higher level of persecutory thoughts in VR
4. Freeman concluded that ppl do attribute mental states to VR characters and although usually postive, they can be persecutory in nature.
5. He also concluded that People are more likely to show persecutory ideation if they show high levels of interpersonal sensitivity or anxiety

Question 18

Genetic explanations

Answer 18

One biological explanation for schizophrenia is that genes or a particular combination of genes are passed on to offspring which may cause the disorder to devolop. 3 ways of investigating are through:
1. Family studies
2. Twin studies
3. Adoption studies

Question 19

Family Studies

Answer 19

Show a general trend in the development of a disorder for individuals who have close family members(with whom they share a higher proportion of their genes) with that disorder. This research shows that if you have close family members with schizophrenia you are more likely to develop schizophrenia (shows that schizo is at least partly caused by genetics)

Gottesman found that the likelihood of developing schizophrenia went fro

1% in gen pop. up to 48% if you have an identical twin with SCZ

Question 20

Twin Studies

Answer 20

Monozygotic(MZ) twins share 100% of their DNA while Dizygotic(DZ) twins share 50% of their DNA.
Research shows that that the concordance of schizophrenia is higher in MZ twins than in DZ twins, again, suggesting there is a genetic contribution.

Hilker et al. carried out a twin study with over 3000 twin pairs in denmark using two national registers. Hilker concluded that the heritability of schizophrenia was 79%

Question 21

Adoption studies

Answer 21

Unlike Family and Twin studies, it helps us separate the influence of genetics and the influence of the environment.
It compares a child raised by an adoptive family with their biological parents.
Tienari et al. found schizophrenia in 6.7% of adoptees with a biological mother with schizophrenia compared to just 4% of a control group, suggesting that there is a genetic influence in the development of schizophrenia.

Question 22

Biochemical (Dopamine Hypothesis)

Answer 22

• States that the brains of people with schizophrenia produce more dopamine than the brains of people without schizophrenia
• The dopamine hypothesis identifies a link between excessive amounts of dopamine/dopamine receptors and positive symptoms of schizophrenia and related disorders.
• Research suggests that neurons that use the transmitter dopamine either fire too often, or send too much information. Excess dopamine in particular brain regions can be related to certain symptoms.
• Dopamine is released by the brain, picked by the dendrites, then the dendrites pass info through the axon, myelin sheathes are used to insulate the neuron

Question 23

Evidence supporting The Dopamine Hypothesis (Drug Trials)

Answer 23

• Drug trials- Involving people with and without schizophrenia. Drugs that increase the level of dopamine in the brain include amphetamines and cocaine. Large increases in dopamine production are correlated with an increase in reporting of hallucinations and delusiosn
• Parkinson’s disease is often treated with a synthetic form of dopamine, L-dopa, in which if the dosage is too high, it also creates symptoms identical to those in ppl with schizophrenia such as hallucinations (Lindstrom).

Question 24

Evidence supporting the Dopamine Hypothesis (Post-mortem studies)

Answer 24

Post-mortem studies have found that the brains of decesased individuals with schizophrenia have a larger number of dopamine receptors than those without the disorder.
Wise et al found that the brain fluid from deceased individuals had abnormally low levels of the enzyme that breaks down dopamine, suggesting that dopamine may have been present in excessive quantities

Question 25

Evidence supporting the Dopamine Hypothesis (Position emission tomography)

Answer 25

PET scan analysis indicates a greater number of receptors in the striatum, limbic system and cortex of the brain. Excessive dopamine activity in these areas may be linked to positive symptoms.
Nestler et al. suggests that decreased dopamine activity in the prefrontal cortex of schizophrenia patients may correlate with negative symptoms such as flattened affect

Question 26

Cognitive Explanation

Answer 26

1. Frith describes schizophrenia as an “abnormality of self-monitoring” which occurs when patients fail to recognize that their perceived hallucinations are in fact just inner speech. It leads them to attribute what their hearing to someone else e.g a voice speaking to them from an external source.
   He tested this idea with patients with schizophrenia by asking them to decide whether items that had been read out loud were done so by themselves, an experimenter or a computer. Patients with SCZ who had incoherent speech as a symptom performed the worst at this task which may be linked to memory and attention difficulties crucial for self-monitoring.
2. Frith also suggested that a major positive symptom- delusional thinking may also arise from an misinterpretation of perception in which those experiencing delusions may be applying logical reasoning to their hallucinations making them believe that they’re coming from an external source. e.g. auditory hallucinations.
3. He explained that those experiencing negative symptoms such as avolition have diffuculty generating spontaneous actions without some prompt from someone or something else.

Question 27

Biological Treatments 1

Answer 27

• Typical antipsychotics (first gen)- antipsychotics developed in the 1950s that reduce the effects of dopamine therefore reducing the positive symptoms of schizophrenia(mainly hallucinations and delusions). They are dopamine agonists, meaning that they block dopamine receptors so there is less dopamine activity. There are many undesirable side effects. Examples: chlorpromazine, tegretol
• Atypical antipsychotics (second gen)- antipsychotics developed in the 1990s that work by blocking dopamine but unlike typical antipsychotics they rapidly dissociate( only block dopamine activity for a short period of time). The rapid dissociation allows for normal dopamine transmission to take place which leads to lower risk of side effects. They have a beneficial effect on both negative and postive symptoms.

Question 28

RCT(randomised control trials)

Answer 28

double-blind placebo controlled( neither patient nor psychologists know who have been given the real drug and who has been given the placebo) and consistently show that 50% of those taking antipsychotic medication show significant improvement in their condition after 4-6 weeks. 30%-40% show partial improvement.

Question 29

Antipsychotic relapse rates

Answer 29

• Relapse rates using antipsychotics can be quite high as patients are directed to keep taking meds after acute psychotic episodes even in periods of remission(periods of time where they aren’t experiencing symptoms), albeit at lower doses.
• However, the meds can cause unpleasant side effects that, combined with a reduction in symptoms can result in non-adherence to medication (when patient goes against physicians instructions for drug dosage)

Question 30

Side effects of antipsychotics

Answer 30

Typical antipsychotics- common and can be severe e.g. extrapyramidal symptoms and tardive dyskenesia.
Atypical antipsychotics- less severe e.g weight gain, drowsiness, difficulty concentrating.

Question 31

Biological treatment 2

Answer 31

Electro-convulsive therapy
* for 100s of yrs inducing seizures by other methods had been used to treat psychiatric problems. In the 1930s it was mistakenly believed that schizophrenia was very rare in those that suffered from epilepsy.
* The modern ECT is a much more refined version of the traditional one, involving passing electricity through the brain to cause a seizure which is the treatment.
* It ranges from 6-12 sessions. typically given twice a week during the treatment period or less commonly at longer intervals to prevent relapse of symptoms.
* It is now applied unilaterally to the non-dominant hemisphere only to reduce memory loss.
* ECT is now rarely used as a treatment of SCZ due to it’s lack of evidence to suggest that it is more effective than other forms of treatment.
* Evidence suggests that ECT can be effective during acute episodes of psychosis where fast, short-term improvement of severe symptoms is needed.

Question 32

Risk of ECT

Answer 32

• affects the CNS(central nervous system) and the cardiovascular system which is dangerous for those with pre-existing medical conditions.
• Patients may also suffer temporary memory loss
• More serious but extremely rare side effects can including lasting neurological damage or even death.

Question 33

Psychological treatment- Cognitive-Behavioural Therapy

Answer 33

• CBT is a talking therapy designed to help people change through recognising and challenging the thoughts that underlie their behaviour
• It departs fromthe behaviourists’ strict focus on observable behaviour in order to recognise the invisible cognitive processes on learning.
• Almost always used as a treatment alongside antipsychotic drugs and often requires an intitial treatment with antipsychotics to stabilise the patient enough to engage in the therapy

Question 34

Sensky et al. (2000)

Answer 34

Aim- To test the effectiveness of CBT compared to befriending using a randomised control trial. Befriending sessions involved informal one-to-one sessions about hobbies, sports and current affairs
Sample: 90 patients, 16-60 yrs old. All with a diagnosis of treatment-resistant schizophrenia
Procedure: Patients recieved an average of 19 sessions of CBT/befriending. They were randomly allocated to either treatment condition, making it an independent-groups design.
Each intervention delivered by 2 experienced nurse. The CBT treatment followed distinct stages, including engaging with the patient and discussing the emergence of their disorder, before tackling specific symptoms.
Patients were assessed by blind raters( didn’t know what condition the ppt was in) before the start of their treatment, at the treatment completion (up to 9 months) and at 9-month follow up. Used validated assessment scales like the CPRS and SANS.
Results: Immediately following treatment both groups showed a significant overall reduction in both positive and negative symptoms of SCZ.
At 9-month followup, the improvemnt in symptoms remained in those in the CBT condition but was no longer evident in the befriending condition
Conclusion: CBT is an effective treatment for reducing positive and negative symptoms of SCZ and that benefits continue for at least another 9 months after the end of treatment.