Schizophrenia AO3 Flashcards
(13 cards)
How can we evaluate the classification and diagnosis of schizophrenia?
❌ Cheniaux et al. (2009) – poor inter-rater reliability: DSM diagnosed 26 people, ICD diagnosed 44 (same group).
❌ Symptom overlap – e.g., hallucinations in both schizophrenia and bipolar disorder reduces diagnostic validity.
❌ Comorbidity – Buckley et al. (2009): 50% of SZ patients also have depression; questions distinctiveness.
❌ Gender bias – Longenecker et al. (2010): more men diagnosed than women; women may function better = underdiagnosis.
❌ Culture bias – African-Americans more likely diagnosed; suggests clinician bias (Escobar, 2012).
What are the AO3 points for the genetic explanation of schizophrenia?
✅ Gottesman (1991): concordance rate of 48% in MZ twins vs 17% in DZ; supports genetic link.
✅ Ripke et al. (2014): meta-analysis identified 108 genetic variations linked to SZ risk.
❌ Concordance never 100% – must be non-biological factors (e.g., environment).
❌ Polygenic and aetiologically heterogeneous – hard to create universal genetic treatments.
✅ Real-world application: may help identify at-risk individuals for early intervention.
How can we evaluate dopamine and neural explanations for schizophrenia?
✅ Support from antipsychotic drugs (e.g., Chlorpromazine) reducing positive symptoms = causal link.
❌ Noll (2009): some patients show no dopamine irregularities = not universal explanation.
✅ Evidence for revised hypothesis – hyperdopaminergia in mesolimbic pathway, hypodopaminergia in mesocortical (positive/negative symptoms).
✅ Neural correlates like enlarged ventricles supported by Johnstone et al. (1976).
❌ Correlation ≠ causation – changes in brain structure may result from illness or medication.
Evaluate the family dysfunction explanation of schizophrenia.
✅ Read et al. (2005): 69% of adult women with SZ had a history of childhood abuse.
❌ Reliance on retrospective recall – low validity and subject to memory distortion.
❌ Blame placed on families (especially mothers); leads to social sensitivity and guilt.
✅ Compatible with diathesis-stress model – can act as environmental trigger in genetically vulnerable.
❌ Reductionist if taken alone – ignores biological basis.
What are the strengths and limitations of cognitive explanations of schizophrenia?
✅ Frith et al. (1992): supports idea of metarepresentation and central control dysfunctions in SZ.
✅ Supported by Stirling et al. (2006): SZ patients performed poorly on Stroop task.
❌ Doesn’t explain origin of cognitive deficits – describes symptoms, doesn’t explain why they occur.
✅ Practical use – CBT developed from these ideas has shown some symptom reduction.
❌ May ignore emotional, environmental or social contributors (e.g., trauma, stress).
Evaluate the use of antipsychotic drugs for schizophrenia.
✅ Thornley et al. (2003): Chlorpromazine more effective than placebo in reducing symptoms.
✅ Clozapine effective for treatment-resistant cases; treats both positive and negative symptoms.
❌ Serious side effects – tardive dyskinesia, agranulocytosis, weight gain (risks > benefits?).
❌ Chemical straitjackets – focus on sedation rather than recovery or insight.
✅ Cost-effective and quick-acting – useful in managing acute episodes.
How can we evaluate psychological therapies for schizophrenia?
✅ Jauhar et al. (2014): CBT modestly effective at reducing positive symptoms.
✅ Family therapy reduces relapse rates (Pharoah et al., 2010) by improving communication.
✅ Token economies effective in managing negative symptoms in institutions.
❌ Psychological therapies don’t cure – best seen as symptom management tools.
❌ Token economies raise ethical issues – may deny rewards for basic right
What are the strengths and limitations of the interactionist approach?
✅ Tienari et al. (2004): Finnish adoptees with SZ mother only developed SZ when placed in dysfunctional families.
✅ Allows integrated treatment (antipsychotics + CBT) = more holistic approach.
❌ Diathesis hard to define – no single “SZ gene” or clear stressor identified in all cases.
✅ Practical success – Tarrier et al. (2004) found combined treatment more effective than medication alone.
❌ Still unclear how genetic vulnerability and stress interact biologically.
What are the strengths and weaknesses of typical antipsychotics?
✅ Thornley et al. (2003): Chlorpromazine led to better symptom reduction and reduced relapse than placebo.
❌ Extrapyramidal side effects (e.g., tardive dyskinesia) in up to 30% of cases (Meltzer, 2012).
❌ Works only on dopamine system – treats mainly positive symptoms, not negative ones.
✅ Cost-effective and widely available, used in acute phases.
❌ Ethical concerns: seen as chemical restraints; may reduce agency and insight.
How do atypical antipsychotics compare to typical ones?
✅ Meltzer (1999): Clozapine effective in 30–50% of cases where typicals failed; reduces both positive and negative symptoms.
✅ Fewer motor side effects than typicals, although agranulocytosis risk with Clozapine.
❌ Expensive, and blood monitoring is required for Clozapine — reduces practicality.
✅ Risperidone more recently developed, binds dopamine + serotonin = more targeted.
❌ Some studies (e.g., Lieberman et al., 2005) found no major differences in relapse rates.
What are the strengths and limitations of CBT as a treatment?
✅ Jauhar et al. (2014): CBT had a small but significant effect on reducing positive symptoms.
✅ Helps challenge delusions, normalise experiences, and develop coping strategies.
❌ Requires insight and engagement – not suitable for all, especially in acute psychosis.
✅ Non-invasive and empowers patients by involving them in their recovery.
❌ Doesn’t address biological underpinnings – best when combined with medication.
How effective is family therapy for treating schizophrenia?
✅ Pharoah et al. (2010): reduces relapse rates and improves medication compliance.
✅ Improves family communication and lowers emotional expressiveness (EE), which is a known relapse trigger.
❌ Some families may feel blamed or defensive, especially if trauma-related causes are raised.
✅ Practical benefits – reduces hospital readmissions, saving NHS resources.
❌ Works best as adjunct, not standalone; needs patient + family motivation.
What are the key evaluation points of token economies in schizophrenia?
✅ Allyon & Azrin (1968): token economy improved social and self-care behaviours in long-stay patients.
✅ Operant conditioning helps shape adaptive behaviours and manage negative symptoms.
❌ Only effective in structured institutions – limited real-world application post-discharge.
❌ Ethical concerns – basic needs may be withheld (e.g., visiting time or food access).
✅ Doesn’t treat the illness but improves quality of life and readiness for community reintegration.
