schizophrenia P3

Question 1

definition of schizophrenia

Answer 1

severe mental disorder where contact with reality and insight are impaired

Question 2

definitions of positive symptoms

Answer 2

atypical symptoms experienced in addition to normal experiences
e.g. Hallucinations

Question 3

definition of negative symptoms

Answer 3

atypical experiences that represent a loss of usual experience
e.g. loss of clear thinking

Question 4

prevalence of schizophrenia

Answer 4

serious mental disorder affecting 1% of population

more common in males, city-dwellers and lower socio-economic groups

Question 5

diagnosis

Answer 5

diagnosis & classification = interlinked
to diagnose we must be able to distinguish one disorder from another
classification = identify symptoms that go together to form a disorder
diagnosis == identify symptoms and use classification systems to identify the disorder

Question 6

DSM-5 & ICD-10 differences

Answer 6

• DMS-5 = one positive symptom must be present

- ICD-10 = two or more negative symptoms are sufficient for diagnosis

Question 7

Hallucinations - positive symptoms

Answer 7

unusual sensory experiences that have no basis in reality or distorted perceptions of real things
experienced in relation to any sense
e.g. hearing voices

Question 8

Delusions - positive symptoms

Answer 8

beliefs that have no basis in reality
make person behave in ways which make sense to them but unusual to others
e.g. believing that they are napoleon

Question 9

Speech poverty - negative symptoms

Answer 9

a reduction in the amount & quality of speech
can be a delay in verbal responses during conversation
but speech disorganisation = positive symptom

Question 10

Avolition - negative symptoms

Answer 10

a severe loss of motivation to carry out everyday tasks e.g. personal care
Resulting in lowered activity levels & unwillingness to carry out goal-directed behaviours

Question 11

S of diagnosis of schizophrenia is good reliability

Answer 11

a reliable diagnosis between clinicians and between occasions.
-> Osorio 2019, reported excellent reliability for schizophrenia diagnosis as the inter-rater agreement was +0.97 and test retest reliability of +0.92

This means that diagnosis of schizophrenia is consistently applied

Question 12

A limit of diagnosis is low validity

Answer 12

criterion validity involves seeing whether different procedures used to assess the same individuals arrive at the same diagnosis

->Cheniaux 2009, 2 psychiatrists independently assess the same 100 clients, 68 were diagnosed with ICD & 39 with DSM

This means that schizophrenia is either over or under diagnosed, suggesting that criterion validity is low.

Question 13

Another Limit of diagnosis is co-morbidity with other conditions

Answer 13

if conditions co-occur then they might be a single condition -> Sz diagnosed w other conditions.

Buckley 2009 concluded that Sz is co-morbid with depression (50%), substance abuse (47%) & OCD (23%)

This suggests that Sz may not exist as a distinct condition

Question 14

a limit of diagnosis is culture bias

Answer 14

some symptoms e.g. hearing voices are accepted in some cultures like Afro-Caribbean societies ‘ hear voices from ancestors’ -> Afro-Caribbean British men are 10X more likely to receive a diagnosis as white men -> due to overinterpretation of symptoms by UK psychiatrists.

This means that Afro-Caribbean men living in the UK appear to be discriminated against by a culturally-biased diagnostic system .

Question 15

Family studies -genetic basis of Sz

Answer 15

a strong relationship between the degree of genetic similarity and shared risk of schizophrenia.
Gottesman 1991

Question 16

Gottesman 1991

Answer 16

large scale study
for fraternal twins there is a 17% likelihood that if one is diagnosed, the other may develop it
but, identical twins it is 48% & for siblings it is 9%
-can share environment but indicates support for genetic view

Question 17

Candidate genes - genetic b

Answer 17

Schizophrenia is polygenic - requires several genes to develop
aetiologically heterogeneous - the risk of developing Sz is affected by a combination of genes

Question 18

Ripke 2014

Answer 18

combined previous data from genome-wide studies

found 108 separate genes associated with slightly ^ risk of schizophrenia

Question 19

Mutation - genetic basis

Answer 19

Sz can have a genetic origin in absence of family history due to mutation in parental DNA
-evidence comes from correlation between paternal age & risk of schizophrenia

Question 20

Brown 2002

Answer 20

evidence for sperm mutation being correlated with the risk of sz
increasing from 0.7% under 25 fathers to over 2% fathers over 50

Question 21

A strength for the genetic basis is the strong evidence base

Answer 21

family studies e.g. Gottesman show risk increases with genetic similarity. Hilker 2018 Twin study found 33% in MZ twins & 7% for DZ twins.
Tienari 2014, adoption studies show that biological children of parents w SZ are at greater risk even if they in adoptive family.
-> This shows that some people are more vulnerable to sz because of their genes

Question 22

A limitation for the genetic basis is evidence for environmental risk factors

Answer 22

Biological risk factors include both complications and smoking THC rich cannabis in teenage years ->Psychological risk factors include childhood trauma e.g. 67% w Sz reported at least one childhood trauma.
->this means genes alone can’t provide a complete explanation for schizophrenia

Question 23

Neural correlates

Answer 23

measurements of the structure or function of the brain that occur in conjunction with an experience

Question 24

Dopamine- neural correlates

Answer 24

believed to be involved

it’s featured in the functioning of brain systems related to symptoms of schizophrenia

Question 25

Original Dopamine hypothesis

Answer 25

high dopamine activity in subcortex -> hallucinations & speech poverty can explain positive symptoms 'Hyperdopaminergic'

Question 26

Hyperdopaminergia

Answer 26

excessive levels of dopamine in the subcortex and broca's area

Question 27

Hypodopaminergia

Answer 27

low levels of dopamine in prefrontal cortex

Question 28

Updated dopamine hypothesis

Answer 28

low levels of Dopamine in the prefrontal cortex can explain negative symptoms explains origin of abnormal dopamine - genetic variations & experiences of stress can ppl more sensitive to cortical hyperdopaminergia -> subcortical hypodopaminergia

Question 29

Strength for neural correlates is the support for dopamine in the symptoms of schizophrenia

Answer 29

Amphetamines mimic symptoms (Curran 2004) Antipsychotic drugs reduce intensity of symptoms (Tauscher 2014) Candidate genes act on the production of Dopamine or dopamine receptors -> this strongly suggests that dopamine is involved in the symptoms of schizophrenia

Question 30

A limitation for neural correlates is evidence for a central role for glutamate

Answer 30

Post-mortem and scanning studies found raised glutamate in people with schizophrenia (McCutcheon 2020) several candidate genes for Sz are believed to be involved in glutamate production or processing -> this means that a strong case can be made for a role for other neurotransmitters in schizophrenia.

Question 31

What is family dysfunction?

Answer 31

``` A psychological explanation for Sz composed of: Schizophrenogenic Double bind theory Expressed emotion ```

Question 32

Schizophrenogenic mothers

Answer 32

-Fromm- Reichmann 1948 -psychodynamic approach 'Schizophrenia causing' mothers are cold, rejecting and controlling -> family climate of tension & secrecy -> child is distrusting -> develop paranoid delusions -> Schizophrenia

Question 33

Double bind theory

Answer 33

conflicting family communication Bateson 1972 a child who feels trapped in situations where they fear doing the wrong thing -> receive conflicting messages about what counts as wrong -> can't express their feelings of unfairness -> if get it wrong parents withdraw love -> learn world is confusing & dangerous ->disorganised thinking & delusions

Question 34

Expressed emotion

Answer 34

criticism and hostility -> relapse the high level of emotion expressed including; Verbal criticism, Hostility, Emotional over-involvement in their life -> stress in Sz sufferer -> relapse

Question 35

A strength for family dysfunction is the evidence links to schizophrenia

Answer 35

Read 2005, reported that adults with schizophrenia are disproportionately likely to have insecure-attachment. Also 69% of women and 59% of men with Sz have experienced physical or sexual abuse. -> This strongly suggests that family dysfunction does make people more vulnerable to Sz.

Question 36

A limit for family dysfunction is the poor evidence base for any explanation.

Answer 36

there is almost no evidence to support the importance of traditional family-based theories e.g. Double bind, Schizophrenogenic mother. Both theories are based on clinical observation of patients and informal assessment of the personality of the mothers. -> This means that family explanation have not been able to explain the link between childhood trauma and Sz

Question 37

Cognitive explanations

Answer 37

dysfunctional thought processing Metarepresentation Dysfunction in the central control

Question 38

What is dysfunctional thought processing?

Answer 38

lower levels of information processing in some areas suggest that cognition is impaired. E.g. Reduced processing in the ventral stratum is associated with negative symptoms

Question 39

what is Metarepresentation?

Answer 39

the cognitive ability to reflect on thoughts and behaviour (Frith 1992) disruption can lead to auditory hallucinations and though insertion delusions

Question 40

What does central control dysfunction cause?

Answer 40

-speech poverty | ppl w Sz experience derailment of thoughts as each word triggers automatic associations that they can't suppress

Question 41

What is the role of central control?

Answer 41

to suppress automatic responses while performing deliberate actions

Question 42

A strength to cognitive explanations - evidence for dysfunctional thought processing

Answer 42

Stirling 2006, compared performance on a range of cognitive tasks in ppl w & w/o Sz - > found that ppl with Sz took over twice as long to name the font-colours - > this supports the view that the cognitive processes of ppl w Sz are impaired

Question 43

A Limitation to cog is only proximal origins of symptoms are explained

Answer 43

proximal explanations explain what is happening now to produce symptoms -> cog exp are weaker as distal explanations (what causes cognitive problems), possible distal exp are genetic and family dysfunction. ->> this means that cognitive theories alone only provide partial explanations

Question 44

Evaluation extra for cog exp - is it psychological or biological?

Answer 44

The cog approach provides excellent explanation for symptoms of Sz suggesting that Sz is a psychological condition - > abnormal cognition is partly genetic in origin & the result of abnormal brain development - >> this means that although it has psychological symptoms, Sz is best seen as a biological condition.

Question 45

Biological therapy for Sz includes:

Answer 45

- Typical antipsychotics | - Atypical antipsychotics

Question 46

What are typical antipsychotics?

Answer 46

``` dopamine antagonists reduce positive symptoms Chlorpromazine 1950s aim to reduce the action of dopamine Associate with the dopamine hypothesis ```

Question 47

How do typical antipsychotics work?

Answer 47

block dopamine receptors in synapses reduce action of dopamine initially dopamine levels rise then fall as production is decreased normalises neurotransmission in key areas of the brain -> reduces the symptoms of hallucinations

Question 48

what are the side effects of chlorpromazine?

Answer 48

-affects histamine receptors -> sedation effect | used to calm anxious patients when they are first admitted to hospital

Question 49

What are Atypical antipsychotics?

Answer 49

1970s suited for treatment-resistant patients based on revised dopamine hypothesis aim of AA was to be more effective in supressing the symptoms of psychosis & to minimise the side effects of the drugs used

Question 50

Name two Atypical antipsychotics:

Answer 50

clozapine | Risperidone

Question 51

how do atypical antipsychotics work?

Answer 51

bind to dopamine (D2), serotonin receptors but also dissociates to reduce action of dopamine reduce positive symptoms and some negative symptoms

Question 52

How does Clozapine work?

Answer 52

binds of dopamine & serotonin receptors reduces depression & anxiety, improves cognitive functioning -improves mood, up to 50% of ppl w Sz attempt suicide

Question 53

How does risperidone work?

Answer 53

developed due to fatalities of clozapine 1990s binds to dopamine & serotonin receptors binds strongly to dopamine receptors but also dissociates -> fewer side effects & effective in smaller doses

Question 54

What is a negative side effect of clozapine?

Answer 54

it can cause a blood condition -> '' Agranulocytosis''

Question 55

A strength of biological therapy - evidence for the effectiveness

Answer 55

Thornley 2003 -> reviewed data from 13 trials and found that chlorpromazine was associated with better functioning and reduced symptoms severity compared with a placebo - > support for benefits of atypical antipsychotics -> Meltzer 2012, concluded that clozapine is more effective than typical antipsychotics, it is effective in 30-50% of treatment-resistant cases. - > this means that as far as we can tell, antipsychotics work

Question 56

A counterpoint to strength of biological therapy

Answer 56

most studies are of short-term effects only and some data sets have been published several times, exaggerating the size of the evidence base. Benefits may be due to calming effects of drugs rather than real effects on symptoms. -> the evidence of effectiveness is less impressive than it seems

Question 57

A limit to biological therapy is the likelihood of side effects

Answer 57

Typical Ap's are associated with dizziness, agitation, sleepiness and weight gain. Long term use -> lip-smacking & grimacing due to dopamine super sensitivity. - > most serious is neuroleptic malignant syndrome -> caused by blocking dopamine action in the hypothalamus which disrupts body systems - >> this means that antipsychotics can do harm as well as good & individuals may avoid them therefore reducing the effectiveness

Question 58

EVAL extra for biological therapy, the chemical cosh.

Answer 58

believed that Antipsychotics are used in hospitals to calm people w Sz & make it easier for staff to deal with - > However, calming ppl distressed by hallucinations & delusions probably makes them feel better and allows them to engage with other treatments like CBT - >> on balance then there are clear benefits to using antipsychotics to calm ppl w Sz and in the absence of a better alternative they should be prescribed.

Question 59

What are the two psychological therapies?

Answer 59

Cognitive behaviour therapy | Family therapy

Question 60

What are the aims of CBT?

Answer 60

to help clients identify irrational thoughts (hallucinations & delusions) and try to change them -occurs in 5-20 sessions, individually or in a group

Question 61

How does CBT help patients w Sz?

Answer 61

make sense of how their delusions and hallucinations impact on their feelings and behaviour

Question 62

what is 'normalisation'?

Answer 62

where people who hear voices can be taught that voice-hearing is an extension of an experience of thinking in words

Question 63

what is reality testing?

Answer 63

delusions testing, in which the person w schizophrenia and their jointly examine the likelihood that beliefs are true

Question 64

what happens in a CBT session?

Answer 64

therapist teaches client to identify distorted cognitions through evaluation - set homework -'reality testing' - idea is for client to identify their irrational beliefs and go against it to prove wrong

Question 65

Turkington 2004, case study for CBT

Answer 65

treated a paranoid client who believed the Mafia were plotting against to kill him (Delusions of persecution) therapist acknowledged the client's anxiety & explained that there were other less frightening possibilities -> explained the clients evidence for his beleif in the mafia explanation

Question 66

A strength for CBT is evidence for it's effectiveness?

Answer 66

Jauhar 2014 -> reviewed 34 studies of CBT for Sz & concluded that there is evidence for significant effects on symptoms - > Pontillo 2016, found reductions in auditory hallucinations, clinical advice from NICE recommends CBT for schizophrenia. - >> this means that both research & clinical experience support CBT for schizophrenia

Question 67

A limit for CBT is the quality of evidence

Answer 67

Thomas 2015, points out that different studies have focused on CBT techniques and people with different symptoms - > overall modest benefits of CBT for Sz may conceal a range of effects of different symptoms. - >> this means that it is hard to say how effective CBT will be treating a particular person with Sz

Question 68

what is the aim of family therapy?

Answer 68

reduce levels of expressed emotion, especially negative like guilt & anger -> stress reducing stress to reduce the likelihood of response improve communication within family

Question 69

How does family therapy help?

Answer 69

Fiona pharaoh, identified a range of strategies that family therapies improve the functioning of family members w Sz - form a therapeutic alliance whereby all family members agree on aims - improve families beliefs about and behaviour towards Sz - achieve a balance between caring for person w Sz & maintaining their own lives

Question 70

Family therapy, model of practice 2018

Answer 70

Burbach 2018 - Phase 1 &2: share info, identify resources family can offer - Phases 3&4: learn mutual understanding and look at unhelpful patterns of interaction - Phase 5,6&7: skills training, relapse prevention and maintenance

Question 71

A strength of family therapy is the evidence of it's effectiveness

Answer 71

McFarlane 2016, concluded that family therapy is effective for Sz, relapse rates were reduced by 50-60%. -> particularly promising during time when mental health initially starts to decline, NICE recommends ->> this means that family therapy is good for people with both early and 'full-blown' schizophrenia.

Question 72

Another strength is the benefits for the whole family

Answer 72

therapy is not just for benefit of identified patient but also for the families that provide bulk of care for people w SZ - > Family therapy lessens the negative impact of schizophrenia on the family and strengthens the ability of the family to give support - >> this means that family therapy has wider benefits beyond the obvious positive impact on the identified patient

Question 73

Who developed token economies?

Answer 73

Ayllon & Azrin 1968 used a token economy in a SZ ward extensively used in 1960s & 70s but declined due to shift of care in community rather than hospitals & of ethical concerns

Question 74

What is a token economy?

Answer 74

A gift token is given for a desirable behaviour target behaviours decided individually based on knowledge of person tokens are swapped for rewards like a walk outside or watch a film given immediately following target behaviour

Question 75

The rationale for token economies

Answer 75

institutionalism occurs in long-term hospital treatment Matson 2016 identified 3 categories of institutional behaviour that can be tackled using token economies: personal care, condition-related behaviours and social behaviours

Question 76

What do token economies benefit?

Answer 76

Quality of life - improve within hospital settings e.g. more sociable with other residents Normalises behaviour - encourages the return back to more normal behaviour, easier to adapt into the community e.g. Making your bed.

Question 77

What is the theory based behind token economies?

Answer 77

Operant conditioning - behaviour modification -secondary reinforces which are exchanged for rewards Tokens that can be exchanged for a range of different primary reinforces are 'generalised reinforcers' - more powerful

Question 78

A strength for token economies is the evidence of effectiveness

Answer 78

Glowacki 2016 identified 7 high quality studies published between 1999 - 2013 on the effectiveness of token economies in a hospital setting -> all studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours ->> This supports the value of token economies

Question 79

Counterpoint for strength of token economies - file drawer problem

Answer 79

seven studies is quite a small evidence base. a issue with such a small number of studies is the file drawer problem - a bias towards publishing positive findings. This means that there is a serious question over the effectiveness of token economies

Question 80

A limit for token economies is the ethical issues raised

Answer 80

professionals have the power to control people's behaviour and this means imposing one persons norms on to others e.g. a patient may like to look scruffy - > also restricting the availibility of pleasures to people who don't behave as desired means that very ill people experiencing distressing symptoms, have an even worse time - >> this means that benefits of token economies may be outweighed by the impact on freedom and short-term reduction in quality of life

Question 81

A limit for token economies is the existence of more pleasant and ethical alternatives

Answer 81

Other approaches do not raise ethical issues e.g. Art-therapy is a high gain low risk approach to managing Sz (Chaing 2019) - > even if the benefits of art therapy are modest, this is true for all approaches to treatment and management of schizophrenia and art therapy is a pleasant experience - >>this means that art therapy might be a good alternative to token economies as there are no side effects or ethical abuses

Question 82

The interactionist approach consists of:

Answer 82

the diathesis-stress model | treatment according to the interactionist model

Question 83

What does the diathesis-stress model suggests about schizophrenia?

Answer 83

A Vulnerability +trigger = Sz Trigger is a negative experience which stresses both vulnerability and trigger are needed to develop Sz -The interaction of both is which causes Sz

Question 84

What is Meehl's model for the interactionist approach?

Answer 84

in the original, the diathesis was entirely the result of one 'schizogene' -Meehl argued that someone w/o this gene should never develop Sz no matter how much stress they were exposed too A person who does have the gene is vulnerable to the effects of chronic stress -schizogene is neccesary but not sufficient for development of Sz

Question 85

What is the modern understanding of the diathesis model?

Answer 85

the diathesis is not down to a single 'schizogene', many genes cause the diathesis -> also, doesn't have to be genetic -> early psychological trauma affecting brain development-> e.g. child abuse affects the HPA axis -> more vulnerable to stress

Question 86

What is the modern understanding of stress?

Answer 86

a modern definition includes anything that risks triggering schizophrenia Psychological e.g. parenting or Biological e.g. Cannabis use

Question 87

What is the risk of cannabis use?

Answer 87

7x more likely to develop schizophrenia | as it interferes the dopamine system (increases)

Question 88

Antipsychotics and CBT according to the interactionist model

Answer 88

Antipsychotic drugs taken in combination with CBT -interactionist model Turkington 2006 not possible to adopt biological approach, telling the patients their condition is purely biological and then treat them with CBT

Question 89

what is the difference between the UK and USA when adopting the interactionist approach?

Answer 89

UK- treat with drug therapy & CBT USA - conflict between biological and psychological models led to slower adoption of interactionist approach, more likely to be treated with just drug therapy

Question 90

What is a strength of the interactionist approach, referring to the support for the dual role of vulnerability and stress?

Answer 90

Tienari 2004 studied children adopted away from mothers diagnosed with SZ. the adoptive parents parenting style was assessed and compared with a control group of adoptees with no genetic risk -> a child rearing style with high levels of criticism & conflict and low levels of empathy was implicated in the development of Sz but only in the adoptees with a high genetic risk. ->> this shows that a combination of genetic vulnerability & family stress leads to increase risk of Sz

Question 91

What is a strength of the interactionist approach referring to the real world application of interaction?

Answer 91

Tarrier 2004 randomly allocated 315 ppts to medication & CBT group, Medication &supportive counselling group and control group of only medication -> ppts in the two combination groups showed lower symptom levels than those in the control group, but no difference in hospital readmission ->> this means that there is a clear practical advantage to adopting an interactionist approach in the form of superior treatment outcomes.

Question 92

What is a limitation to the interactionist approach, referring to the original diathesis stress model it is too over simplistic?

Answer 92

multiple genes increase vulnerability each with a small effect on it's own - no schizogene Stress comes in many form, including dysfunctional parenting -> researchers now believe stress can also include biological factors, Houston 2008 found that childhood sexual trauma was a diathesis & cannabis use a trigger ->> this means that there are multiple factors, biological and psychological affecting both diathesis and stress.