Schizophrenia (P3) Flashcards
(18 cards)
Classification and diagnosis - symptoms
Positive (an addition to usual functioning):
- hallucinations - unusual sensory experiences that have no basis in reality (distorted perceptions)
- delusions - beliefs with no basis in reality
- catatonic behaviour - abnormal motor activity - rocking back and fourth
Negative (a loss to usual functioning):
- speech poverty - reduction in amount/quality - word salad
- avolition - loss of motivation to perform goal directed behaviours
- anhedonia - loss of pleasure in everyday activities
- affective flattening - reduction in range of emotional expressions
Classification and diagnosis - diagnosis
DSM5 - 1 positive symptom must be present
ICD10 - 2 or more negative symptoms must be present
Inter-rater reliability - the extent to which different assessors arrive at the same conclusion when diagnosing the same patient
Criterion validity - whether different assessment systems arrive at the same diagnosis in the same patient
Evaluation:
P: research support
E: Cheniaux 2 psychiatrists independently diagnose 100 patients using both systems. - didnt match
T: poor inter-rater reliability and SZ is more likely to be diagnosed in ICD
P: comorbidity
E: when 2 conditions coexist in the same patient at the same time - Buckley found 50% of SZ patients also had depression
T: which do we treat first? will treating one exacerbate the other?
P: symptom overlap
E: when the symptoms of 2 conditions are shared - SZ and bipolar both share positive and negative symptoms
T: leads to mistreatment
P: gender bias
E: men are diagnosed with SZ more than women - women are better at ‘masking’ illness (better coping mechanisms)
T: poor validity of diagnosis - women are underdiagnosed
F: cannot access treatment
P: culture bias
E: Afro-Caribbean background and African Americans are more likely to be diagnosed - 7 times more likely
T: cannot be used to diagnose everyone
Explanations of schizophrenia - genetic and neural (AO1)
genetic:
- inherited - passed down families
Research: - gottesman - identical twins 48%/ cousins 2%
- the more genes shared with sufferer the more likely you are to develop SZ
- candidate genes - PCM1
-polygenic - ripke found 108
- aetiologically heterogenous - schizo-effective disorder and schizo-typical disorder
neural:
- neural correlates - structure/ function of the brain is associated with positive and negative symptoms
- enlarged ventricles - 15% bigger
- dopamine hypothesis - hyperdopaminergia (increased DA in subcortex) - positive symptoms
- hypodopaminergia (decreased DA in the cortex) - negative symptoms
Explanations of schizophrenia - genetic and neural (AO3)
P: real world application
E: drug therapy - balance dopamine
T: increased QOL
P: ignored the role of glutamate
E: raised levels in people with SZ
T: other neurotransmitters that the dopamine hypothesis doesnt account for - incomplete
P: research support
E: amphetamines mimic the affect of DA - SZ type symptoms (hallucinations)
T: provides strong evidence for role of DA, increasing credibility
P: cause and effect
E: it may be that abnormal DA levels are a consequence
T: cannot establish causation
P: reductionist
E: reduces complex phenomena of SZ down to DA
T: too simplistic
F: interactionist approach
Explanations of schizophrenia - psychological (AO1)
Schizophregenic mother - cold, uncaring, rejecting mother creates an atmosphere of distrust leading to paranoid thoughts and delusions
Double bind theory - children who constantly receive contradictory messages from their parents are likely to develop SZ as it prevents them from developing an internally coherent construction of reality
Expressed emotion - critisism, hostility, emotional over-involvement - leads to stress
Explanations of schizophrenia - psychological (AO3)
P: research support
E: berger found schizophrenics reported a higher recall of double binds from their mothers than non-schizophrenics
T: increases credibility of theory
C: findings collecting after a diagnosis mean patients delusions may affect the answers they give
P: socially sensitive
E: parent blaming - parents already have the burden of a mentally ill child and this makes the burden worse
T: unethical model
P: cause and effect
E: what causes what
T: cannot establish causation
P: alternative explanation
E: biological explanation - DA - antipsychotics
T: decreases validity of family dysfunction as a sole explanation
Explanations of schizophrenia - cognitive (AO1)
Cognitive deficits - gaps in thinking
Cognitive bias - inclinations to certain thoughts
Dysfunction with metarepresentation - ability to reflect on and have insight into our own intentions/ actions of others is impaired - individual does not recognise their own thoughts are theirs - hallucinations and delusions
Central control - ability to supress automatic responses or triggers in response to stimuli - disorganised speech/ disordered thinking
Explanations of schizophrenia - cognitive (AO3)
P: machine reductionist
E: reduces complex phenomena of SZ down to faulty thought processes
T: too simplistic
F: interactionist approach
P: cause and effect
E: what causes what
T: cannot establish causation as it may be a symptom
P: real world application
E: CBT - identify and challenge delusional thoughts and substitute with non-delusional ones
T: increases QOL
F: boosts economy
P: research support
E: stroop test - SZ patients took twice as long to name ink colours - suggests SZ have cognitive deficits
T: increases credibility
P: alternative explanation
E: dopamine hypothesis/ family dysfunction
T: not a sole explanation
Treatments of SZ - Drug therapy (AO1)
Aim: To correct the imbalance of neurotransmitters (DA) in the brain
Practicalities: medication taken as pills, syrups, injections
How:
Typical - reduce dopamine activity by blocking DA receptors on post-synaptic neuron so less is transmitted across, reducing positive symptoms such as hallucinations. E.g - chlorpromazine - sedative effect
Atypical - reduce dopamine, glutamate and serotonin by blocking these receptors, reducing positive symptoms as well as depression and anxiety (prescribed when at risk of suicide). E.g - clozapine
Treatments of SZ - Drug therapy (AO3)
P: Does not solve the root of the problem
E: Only relieves patients symptoms instead of treating the cause of SZ
T: Once medication stops, symptoms may return, reducing its effectiveness
P: There are severe side effects
E: Weight gain, muscle tremors, fatal side effects such as neuroleptic malignant syndrome
T: Patients become reluctant to take them, reducing its effectiveness
P: It cannot be used for every patient
E: Those with a history of addiction cannot access it as SZ is comorbid with substance abuse.
T: Reduces its effectiveness as it excludes a group of people
P: Alternative therapy
E: CBT/ Family therapy
T: It is not a sole most effective treatment
P Research support
E: Meta-analysis found chlorpromazine was associated with reduced symptom severity and better functioning, supporting its positive effect of treating SZ
T: Increases its credibility
Treatments of SZ - CBT (AO1)
Aim: Identify and challenge delusional thoughts, substituting them with non-delusional ones
Practicalities: 5-20 sessions for 1hour, between patient and therapist
How:
1- Identify delusional belief - patient and therapist identify what the delusional beliefs are
2 - Test the reality of the beliefs - therapist asks the patient logical, empirical and pragmatic questions
3 - Develop alternative explanations - therapist and patient try to come up with less threatening alternative accounts
4 - Develop coping strategies - therapist teaches patient coping strategies such as positive self take, negative thought stopping, imagery
5 - Education on SZ - therapist educates patient on SZ to explain why they are experiencing their symptoms
Treatments of SZ - CBT (AO3)
P: Not suitable for everyone
E: Those with speech poverty and avolition cant access it
T: Makes it limited as it cannot be used by every patient and they have to rely on other methods
P: There are alternative treatments
E: Drug therapy is based on the idea that SZ is a biological condition - antipsychotics have proven to be a successful treatment
T: not a sole most effective treatment and others may be more effective
F: a combination of drug therapy and CBT may be a better approach
P: It is very lengthy
E: it takes months compared to drug therapy which takes weeks, leading to disengagement as they don’t see immediate effects
T: leads to high attrition rates as they lack motivation to continue, reducing its effectiveness
P: Research support
E: found CBT led to a reduction in auditory hallucinations
T: increases its credibility
Treatments of SZ - Family therapy (AO1)
Aim: reduce levels of high expressed emotion, family dysfunction and make the home environment more pleasant for the patient
Practicalities: Educational talking therapy between patient therapist and family in 1hour sessions weekly for 12 weeks
How:
Burbach’s model
1- sharing basic info about SZ
4- identify unhelpful patterns of interaction
7- planning for the future
Treatments of SZ - Family therapy (AO3)
P: It cannot work for every patient
E: It relies on a family who is willing to attend therapy and acknowledge they may be part of the problem. Practical issues as certain family members may have other commitments and cannot attend weekly sessions
T: limits its use as it only works for those with a supportive family, decreasing its usefulness
P: It benefit the whole family
E: benefits and educates the whole family
T: multiple individuals are benefitting, increasing its usefulness
P: Research support
E: reduced relapse rates by 50-60%
T: increases its credibility
P: Families are better capable at providing the bulk of care
E: less patients in in hospital settings taking up resources
T: benefits the economy as less resources are required, cost effective
P: alternative therapy
E: CBT, drug therapy
T: not a sole treatment
Treatments of SZ - Token economies (AO1)
Aim: behaviour shaping, increase socially desirable behaviours, reduce negative symptoms
Practicalities: in patient setting - psychiatric ward
How:
Based on operant conditioning
patients are given tokens for socially desirable behaviours (secondary reinforces) such as taking a shower and these can be exchanged for meaningful rewards such as sweets or cigarettes (primary reinforces)
Treatments of SZ - Token economies (AO3)
P: ethical issues
E: tokens cannot be accessed by those with most severe symptoms as they cannot perform socially desirable behaviours (discriminated against for being severely ill)
T: decreases its usefulness as not everyone can access it
P: hard to continue outside of hospital setting
E: the system needs to be monitered closely so it only works in a clinical setting
T: limits its usefulness
P: alternative treatment
E: art therapy is used by many and has no ethical issues/ more pleasant
T: means art therapy is preferred by many therapists and patients, reducing how often token economies are used
P: historical baggage
E: nurses rewarded patients with cigarettes, leading to heavy smoking culture and nicotine addiction in psychiatric hospitals
T:
P: research support
E: found token economies led to better overall patient functioning and less behavioural disturbances
T: increases its credibility
Interactionist approach (AO1)
Diathesis - predisposition or vulnerability to a disorder
Stress - a persons life event or something in a persons environment that trigger or worsen the disorder
Meehl’s model:
- both a genetic vulnerability and a stress trigger are necessary
- Diathesis is genetic (schizogene)
- Psychological stress (schizophregenic mother)
Neurodevelopmental model:
- both a genetic vulnerability and a stress trigger are necessary
- Diathesis is due to many genes increasing vulnerability, or could be due to a childhood trauma which affects the developing brain
- stress can be psychological or biological (smoking cannabis)
Interactionist approach (AO3)
P: the original model is too simplistic
E: diathesis only involves one schizogene and stress only involves the schizophregenic mother. it has since been proven to involve many genes and stress can also be biological (cannabis)
T: Meehl’s model is too simplistic and it cannot fully explain the development of SZ
P: real world application
E: a combination of all treatments as it understands both our biology and psychology are involved
T:
C: NHS do not have the resources for this, too expensive for the economy
P: research support
E: found those with drug therapy and CBT showed lower symptoms levels than those only taking drugs
T: supports the interactionist approach, increases its credibility
P: Holistic
E: combines a range of factors (psychological, biological and social)
T: captures the complexity of mental illness and it is a realistic explanation
P: favours neither nature nor nurture
E: combines diathesis (nature) and stress (nurture)
T: captures the complexity of mental illness and it is a realistic explanation
