Schizophrenia Evaluation Flashcards
(12 cards)
Reliability and validity in diagnosis (reliability)
+Beck et al 1962, 54% concordance rate assessing 153 patients. 2005 concordance of 81% (using DSM) more reliable
-Read et al 2004, test-retest reliability of sz was only 37%. 1970 study also showed 194 British, 134 Us psychiatrists. 69% diagnosed sz. 2% of the British did.
+Jakobsen et al (2005) tested ICD-10 for reliability. 100 danish oatients assessed. Used operational criteria. 98% concordance.
+although not perfect, classification systems provide a common language for practitioners. Better understanding.
+Osorio eat al 2019, 180 individuals, DSM-5, pairs of interviewers achieved inter rated realiability of +92. Consistent.
Reliability and validity in diagnosis (validity)
+Kendal and Jablensky (2007) diagnostic categories are justifiable, provide framework for clinicians, greater understanding around clinical experiences (mental health)
-Cheniaux et al 2009, two psychiatrists, assess same 100 patients using ICD-10 and DSM-5. 68 under ICD. 39 under DSM. Criterion validity low, under or over diagnosed.
-no evidence to suggest patients experience the same recovery outcome. Prognosis varies, 20% recovering previous level of functioning, 30% showing improvement with intermittent relapses. Some people never recover, little predictive validity.
-Rosenhan, Stanford University, 1969-1972, 8 pseudo patients to 12 psychiatric hospitals without telling staff, all 12 instances they were diagnosed with mental disorders. Evidence against validity.
Reliability and validity in diagnosis (Co-morbidity)
-Buckley et al 2009 50% of sz patients had depression, 29% post-traumatic stress, 23% OCD. Clinicians bad at finding the difference between the two. Might also be a new single condition. Reduced validity.
-Sim et al 2006 30% of 140 hospitalised sz had an additional disorder. Reduce reliability/validity.
-Goldman 1999 50% of sz had co morbid medical condition like substance abuse. Reduce validity/reliability.
-Jeste et al 1996 states studies exclude sz with co morbid conditions from research. Not representative of most patients. Not generalisable
-hard to differentiate from bipolar disorders. Sz also includes mania and depression.
Reliability and validity in diagnosis (symptom overlap)
-Ophoff et al 2011assessed genetic material from 50,000 participants. 3 out of the 7 gene locations found for sz were also associated with bi polar. Could be one separate disorder. May not get appropriate treatment.
+ Serper et al (1999) found patient with co morbid sz and cocaine abuse had lots of overlapping symptoms but was still possible to make an accurate diagnosis
-Ketter 2005 reports misdiagnosis from symptom overlap leads to delayed treatment. Can increase suicide rates.
+grey matter in brain decreased with sz, bi polar do not. Improve validity of diagnosis.
+Konstantareas and Hewitt 2001 compared 14 autism and 14 sz. None of sz had autism symptoms but 7 of autistic has sz.
Reliability and Validity (Gender bias)
-Longnecker et al (2010) found since 1980 more men have been diagnosed with sz. Fisher and Buchanan 2017 found a ratio of 4:1. Women could be less vulnerable due to genetics or better support systems. Women may not receive the best treatment
+Lewin et al 1948 if clearer diagnostic criteria was applied the number of female individuals with sz became lower. Castle et al 1993 used restrictive diagnostic criteria and there was double the amount of men than women with sz.
+Kulkarin et al 2001 female sex hormone (estradiol) effective in treating sz in women when added to antipsychotic therapy. Different protective factors in males and females.
-females develop sz 4 to 10 years later than males and also can develop post menopausal schizophrenia. Suggests there’s different types. Questions validity.
Reliability and Validity in Diagnosis (Culture Bias)
Supports: Cochran (1997) found West Indiee and Britains to have similar rates at 1% but Afro Caribean were 7 times more likely when living in Britain. May have more stressors or invalid diagnosis being made.
McGovern and Cope 1977 found 2/3 of patients in Birmingham hospital were first or second generation Afro Caribbeans. The other third white or Asian. Over diagnosis of black population.
Whaley 2004 believes the reason for higher rates in black Americans (2.1%) than white (1.4%) is cultural bias. Ethnic differences are overlooked . Lack of validity in diagnosis cross-culturally.
Fernando(1988) more racism/poverty could trigger sz. Cochrane 1983 points out Afro Caribbean aren’t the only minority in the UK. Instead he says Afro Caribbean could have little immunity to flu. Flu while pregnant increases chances to 88%.
Hearing voices changes meanings in different cultures. Haiti, voices from ancestors. British Afro Caribbean aren’t the only 9 times more likely to receive a diagnosis (pinto and jones 2008). Over representation iof symptoms in black British. Discriminated by culturally bias diagnostic system.
Genetic explanations
Evidence base supports
Gottesman 1991 identical twin 48% risk, non is 17%
Hilker et al 2018 33% concordance identical and 7% non identical
Joseph 2004 polled data for sz twin studies prior 2001. MZ 40% and DZ 7%
-Could be because identical twins have a higher chance at sharing a similar environment unlike cousins.
-Joseph 2004 argues MZ are treated more similarly than DZ even if they’re both types of twins. Thinks this reflects how environment effects concordance.
-MZ concordance isn’t 100% so cannot be wholly explained by genes.
-Biologically reductionist. However this is good for treatments.
-Found 67% with sz etc reported at least one childhood trauma. 38% of Control group with no disorders suffered trauma.cant just go off genetics alone.
+Genetic explanations helped create genetic counselling which helps couples make informed decisions about having children if they both have the gene. - However it doesn’t take into account the environmental factors the child could experience.
-Joseph 2004 claims adoptive parents who adopt children vulnerable to sz won’t be the same as any other adoptive parents. They will be aware of the vulnerability and therefore only some parents will be willing. Questions validity of adoptive studies.
Neural correlate explanations
+Curran et al 2004, dopamine agonists (increasing medication) make sz worse. Produce symptoms in non sufferers.
-No causation. Dopamine could cause or be caused by. Lower activity in Striatum=negative symptoms or negative symptoms=less info passing through VS. Questions validity.
-Noll 2009 says strong evidence against both dopamine hypothesis. 1/3 of people find antipsychotics don’t relive positive symptoms. People have sz with normal dopamine levels. Argues other neurotransmitters may be associated.
+Leucht et al 2013 meta analysis of 212 studies and found all drugs tested were more effective than the placebos.
-McCutcheon found high levels of glutamate in sz post mortems. Also have several sz candidate genes involved in glutamate production.
+Tenn et al 2003 induced symptoms on rats using amphetamines then relieved them using drugs that reduce dopamine.
-some sz patients have enlarged ventricles. patients with enlarged ventricles don’t respond well to medication. Suggests sz for a long time causes brain damage not that brain damage causes sz.
-must consider environmental factors such as substance abuse or stress.
Family Dysfunction Explanations
+Read et al 2005 reviewed 46 studies of child abuse and sz, 69% of women with sz had history of abuse, men was 59%.
+Tienari et al 2004 adopted children with biological sz mothers was 5.8%. Was 36% when going into dysfunctional families.
-do not consider role of biology
-socially sensitive, leads to parent blaming
-someone having schizophrenia could cause the dysfunction in the family.
-not all children in these family’s get sz. Need genetic vulnerability.
Cognitive explanations
-faulty thinking leaves patients feeling to blame
-no established cause and effect. Don’t know cause of the faulty thinking, don’t know if faulty cognition causes or symptoms or symptoms cause faulty thinking.
+Stirling et al 2006, 30 patients, 18 control, cognitive tasks (stroop task) patients took twice as long.
+Sarin and Wallin 2014, positive symptoms originate in faulty cognition. Delusions-biased, jump to conclusion. Hallucinations- impaired self monitoring, thought their internal voice was voices speaking to them.
Drug therapy
+Support for atypical antipsychotics. Meltzer 2012, found effective on 30-50% of treatment resitant where typical failed.
+Davis et al 1989 meta analysis more than 100 studies. Compared to placebos, 70% of patients treated improved in 6 weeks. 25%=placebos
+Leucht et al 2012 meta analysis involved 6000 patients. 64% given placebo relapsed. 27% who stayed on drug relapsed.
-Lieberman et al 2005, 1,400 took typical/atypical, 74% discontinued treatment within 18 months due to side effects.
+less than 3% of sz patients living permanently in hospital.
-some believe drug companies advertise them so much to make profit.
Cognitive behaviour therapy
