SZ Flashcards
(95 cards)
1
Q
diagnosis
A
- DSM-5
- ICD-11
2
Q
DSM-5
A
- american
- 1 positive symptom
3
Q
ICD-11
A
- universal
- 2 negative symptoms
4
Q
positive symptom
A
- adds on to daily life
- hallucination
- delusion
5
Q
hallucination
A
- false sense of reality
6
Q
delusion
A
- irrational beliefs
- paranoid
- delusions of grandeur - i am god
7
Q
negative symptom
A
- takes away from everyday life
- avolition
- speech poverty
8
Q
avolition
A
- loss of motivation
9
Q
issues in diagnosis and reliability
A
- good reliability
- low validity
- co-morbidity
- gender bias
- cultural bias
10
Q
good reliability
A
- findings consistent
- flavia - 180 individuals with SZ using DSM-5
- interviewed
- inter-rater reliability +.97
- test-retest reliability +.92
- sure that diagnosis is consistently applied
11
Q
low validity
A
- set out to measure what its supposed to
- cheniaux - 2 psychoatrists independently assess same 100 ps using ICD-11 and DSM-5
- 68 diagnosed under ICD-11
- 39 under DSM-5
- suggest either under/over diagnosed
12
Q
co-morbidity
A
- If conditions occur together a lot it questions the validity of their diagnose and classification
- might actually be a single condition
- SZ commonly diagnosed with other conditions
- ½ diagnoses had also been diagnosed with depression or substance abuse
- means SZ may not exist as a distinct condition
13
Q
gender bias
A
- men more commonly diagnosed
- genetic explanation - men more vulnerable
- more likely - women have closer relationships and receive more support
- leads to women functioning better than men
- under-diagnosis of women - dont receive the support
14
Q
cultural bias
A
- hearing voicing have different meanings in different cultures
- Haiti - voices from ancestors
15
Q
biological explanation
A
- genetic basis
- neural correlates
16
Q
genetic basis
A
- family studies - risk of SZ increases in line with genetic similarity to relative with SZ
17
Q
gottesman
A
- Large scale mercantile family studies
- Concordance rates of SZ MZ twins 48%
- Parents 6%
- Shows biological structures hold an influence
- Concordance rates not 100% for MZ shows there are environmental factors
18
Q
candidate genes
A
- Number of different genes involved
- SZ is polygenic
- The most likely genes would be those coding for neurotransmitters including dopamine
- Ripke – conducted meta-analysis and found 108 separate genetic variations were associated with increase risk
- Different studies have different candidate genes it also appears that SZ is aetiologically heterogenous
19
Q
role of mutation
A
- Positive correlation between parental age and increased SZ risk
-Brown – SZ risk 0.7% with fathers under 25, 2% in fathers over 50
20
Q
genetic basis evaluation
A
- research support
- environmental factors
- genetic counselling
21
Q
research support
A
- Family studies – Gottesman show that risk increases with genetic similarity to a family member with SZ
- Adoption studies show that biological children with SZ are at heightened risk even if they grow up with adoptive parents
- Shows that some people more vulnerable to SZ as a result of their genetic makeup
22
Q
environmental factors
A
- evidence to show that environmental factors also increase the risk of developing SZ
- Biological risk factors- birth complications and smoking cannabis in teenage years
- Psychological risk factors include – childhood trauma – vulnerable to mental health problems when older
- Morkved – 67% of people with SZ and related psychotic disorders reported at least one childhood trauma, 38% in control group
- Means genetic factors alone cant provide a complete explanation for SZ
23
Q
genetic counselling
A
- If 1+ of our parents have a relative with SZ they risk having a child who would go on to develop the condition
- risk estimate provided by genetic counselling is just an average figure
- wont really reflect the probability of a particular child going on to develop SZ because they will experience a particular environment which also has risk factors
24
Q
neural correlates of SZ
A
- dopamine hypothesis
25
original dopamine hypothesis
- Based on discovery that drugs used to treat SZ (antipsychotics) caused symptoms similar to those in people with Parkinson’s disease
- SZ may be the result of high levels of hyperdopaminergia in subcortical areas of the brain
- Brocas area responsible for speech production links to speech poverty
26
updated version
- Davis proposed the addition of cortical hypodopaminergia can explain symptoms of SZ
- Low DA in prefrontal cortex could explain cognitive problems
- Cortical hypodopaminergia leads to subcortical hyperdopaminergia
- Explains links between abnormal DA levels and symptoms current versions of dopamine hypothesis try to explain the origins of abnormal DA function
- Seems that both genetic variations and early experiences of stress, psychological and physical make some people more sensitive to cortical hypodopaminergia and hence subcortical hyperdopaminergia
27
neural correlates evaluation
- evidence for dopamine
- glutamate
- amphetamine psychosis
28
evidence for dopamine
- Amphetamines increase DA and worsen symptoms in people with SZ and induce symptoms in people without
- Antipsychotic drugs reduce DA activity and reduce the intensity of symptoms
- Some candidate genes act on the production of DA or DA receptors
- Strongly suggests that dopamine is involved in the symptoms of SZ
29
glutamate
- oversimplified
- Evidence for a central role of glutamate
- Post-mortem and live scanning studies have consistently found raised levels of neurotransmitter glutamate in several brain regions of people with SZ
- Several candidate genes for SZ are believed to be involved in glutamate production or processing
30
amphetamine psychosis
- Induced SZ like symptoms in rats using amphetamines and then relived symptoms using frugs that reduce DA action
- Supports dopamine hypothesis
- However other drugs that increase DA levels don’t cause SZ like symptoms
- Garson challenged idea that amphetamine psychosis closely mimics SZ
31
psychological explanations
- family dysfunction
- cognitive explanation
32
family dysfunction
- SZ causing mothers
- SZ due to issues in childhood
- mothers - cold, rejecting
- creates tense environment
- double blind
- expressed emotion
33
double blind
- caused by poor communication
- child recieves mixed messages about right choice
- child sees world as confusing
- diorganised thinking + delusions
34
expressed emotions
- high hostile EE creates stressful environment
- exaggerated involvement
- negative emotions expressed by caregiver to patient
35
family dysfunction evaluation
- research support
- explanations lack support
- parent blaming
36
research support
- Indicators of family dysfunction include insecure attachment and exposure to childhood trauma especially abuse
- read - 69% of women 59% of men with SZ have a history of physical/ sexual abuse
- Morkved study – most adults with SZ reported at least 1 childhood trauma, mostly abuse
- Strongly suggests that family dysfunction makes people more vulnerable to SZ
37
explanations lack support
- Almost no evidence to support the importance of traditional family-based theories such as SZ mother and double blind
- Both theories based on clinical observation of people with SZ and also informal assessment of their mothers personalities but not systematic evidence
- Means that family explanations have not been able to account for the link between childhood trauma and SZ
38
parent blaming
- Unethical
- Undermine the ability of mother to help the patient get better/ through recovery
- Mothers feel high level of guilt
- Reductionist – only looks at psychological level
- Outdated
- Highly socially sensitive because it can lead to parent blaming
39
cognitive explanations
- dysfunctional thinking
- metarepresenational dysfunction
- central control dysfunction
40
dysfunctional thinking
- Focuses on role of mental processes
- Provide possible explanation of SZ as a whole
- Reduced thought process in ventral stradtum – negative symptom
41
metarepresentational dysfunction
- Frith
- 2 kinds of dysfunctional thought process
- Cognitive ability to reflect on thought and behaviour
- Allows us insight into own intentions and goals
- Allows us to interpret actions of others
- Disrupt ability to recognise own actions
- Explain hallucinations
42
central control dysfunction
- Issues with cognitive ability to supress automatic responses while we perform deliberate actions
- Speech poverty and thought disorder could result from inability to supress automatic thoughts
- People with SZ tend to experience derailment of thoughts because each word triggers associations and person cant supress automatic responses
43
cognitive explanations evaluation
- research support
- proximal explanation
- psychological or biological
44
research support
- Evidence for dysfunctional thought processing
- Stirling – compared performance on cognitive task in 30 people with SZ and control of 30 without
- Included stroop task – participants have to name the font colours of colour words so have to suppress the tendency to read the words aloud
- As predicted by firth central control theory – people with SZ 2x as long to name colour
- Means cognitive processes of people with SZ are impaired
45
proximal explanation
- Cognitive explanations for SZ are proximal explanations because they explain what is happening now to produce symptoms
- Possible distal explanations are genetic and family dysfunction explanations
- unclear and not well-addressed how genetic variation or childhood trauma might lead to problems with metarepresentation or central control
- Means that cognitive theories on their own provide partial explanations for SZ
46
psychological or biological
- Cognitive approach provides an excellent explanation for the symptoms of SZ
- Argument for seeing SZ primarily as a psychological condition
- But also appears that the abnormal cognition association with SZ is partly genetic in origin and result of abnormal brain development
- Would suggest SZ is biological condition
47
biological therapy - drug therapy
- antispsychotics
- typical
- atypical
48
antipsychotics
- Main type of drug to treat SZ
- Reduce the intensity of symptoms particularly positive ones
- Don’t cure – make it manageable
- 2 types – typical and atypical
- Administered through tablets, syrup, injections every 2-4 weeks – patient can pick preference
- more likely to be compliant with their treatment- increase effectiveness, symptoms may prevent them taking some ways
49
typical antipsychotics
chlorpromazine
- Works as an antagonist
- Blocks dopamine receptors sites in the synapse by binding to them on the post synaptic neuron
- Initially dopamine is increased before production is reduced
- Reduces positive symptoms of SZ
50
side effects of chlorpromazine
- Mild – dizziness, weight gain
- Continued use – tardier dyskinesia
- Severe – 0.1-2%, neuroleptic malignant syndrome – coma – death
51
atypical drugs
- modern drugs
- aim to minimise side effects
- clozapine
- riperidone
52
clozapine
- Binds to dopamine receptors as well as serotonin and glutamate receptors in the synapse – mood changing effect – for patients with suicide risk
- Helps to reduce the comorbidity of depression and anxiety as well as improving cognitive function
- Blood tests to monitor blood disorder – agranulocytosis
53
risperidone
- Binds to dopamine and serotonin receptors in the synapse
- Binds more strongly to receptors sites and so smaller doses can be administered
- Evidence suggests that there are fewer side effects than other antipsychotics
- Tablets, syrup or injection
54
drug therapy evaluation
- effectiveness
- serious side effects
- ethics
- mechanisms unclear
55
effectiveness
- Thornley – reviewed studies comparing the effects of chlorpromazine to control conditions
- 13 trials with 1121 participants showed that chlorpromazine was associated with better overall functioning and reduced symptom severity as compared to placebo
- Meltzer – clozapine more effective than typical antipsychotic, is effective in 30-50% of treatment-resistant cases where typical antipsychotics have failed
56
counterpoint
- Most studies are of ST effects only and successful trials have had their data published multiple times – exaggerating size of evidence base for positive effect
- Antipsychotic have powerful calming effects, easy to demonstrate that they have some effect on people experiencing symptoms of SZ
- Not the same as saying they really reduce severity of psychosis
- The evidence base is less impressive than it first appears
57
serious side effects
- Typical – dizziness, agitation, weight gain
- LT use can cause tardive dyskinesia – caused by dopamine super sensitivity causes involuntary facial movements
- Neuroleptic malignant syndrome – caused when drug blocks dopamine action in the hypothalamus – result in high temp, coma, can be fatal
- Antipsychotics can do harm, as well as good
58
mechanisms unclear
- We don’t know why they work
- Understanding is tied up with original dopamine hypothesis – idea that symptoms of SZ are linked with high levels of dopamine activity
- Now we know it is low levels not high– therefore antipsychotics shouldn’t work
- means antipsychotics may not be best treatment
59
ethics
- Chemical cosh
- Patients with severe SZ may not be able to give consent
- Moncrieff – makes it easier for staff with patent not for benefit of the patient themselves
60
61
psychological therapy
- CBT
- family therapy
62
CBT
- aims to deal with thoughts and behaviour
- identifies faulty cognition and deals w them
- normalisation used to decrease anxiety and treat reality of thoughts
- 5-20 sessions
- understanding where symptoms come from help hallucinations
63
63
CBT evaluation
- evidence of effectiveness
- quality of evidence
- doesnt cure
- ethical issues
64
evidence of effectiveness
- juhar reviewed 34 studies of using CBT with SZ
- clear evidence for small but significant effects on both positive and negative symptoms compared to control group
- Clinical evidence from NICE recommends CBT for SZ
- Means that both research and clinical experience support the benefit of CBT for SZ
65
quality of evidence
- CBT techniques and SZ symptoms vary widely from one case to another
- Thomas – points out different studies have involved the use of different CBT techniques and people with different combinations of positive and negative techniques
- Overall modest benefits of CBT for SZ probably conceal a wide variety of effects of different CBT techniques on different symptoms
- Makes it harder to say how effective CBT will be for a particular person with SZ
66
doesnt cure
- May improve quality of life but doesn’t cure them
- SZ appears to be largely biological condition, expect psychological therapy just benefits people by improving ability to live with SZ
- However, studies report significant reduction in severity of both positive and negative symptoms
- Suggest CBT does more than enhance coping
67
ethical issues
- Therapist essentially has control over patients’ views
- By challenging the idea of mafia as a controlling government instead
- Therapy infiltrating into patients’ personal beliefs
- Changes can be anything – not always beneficial
68
family therapy
- Aims to improve quality of communication and interaction between family members
- alliance - work to support each other
- psychoeducation- understand illness
- reduces negative emotions - reduce stress and improve family ability to help
- pharaoh identified strategies to help improve functioning of family
69
family therapy evaluation
- evidence for effectiveness
- benefits to whole family
- ethical issues
70
evidence for effectiveness
- McFarlane 2016
- Concluded that family therapy was one of the most consistently effective treatment available for SZ
- Relapse rates were reduced by 50-60%
- Clinical advice from NICE recommends family therapy to everyone diagnosed with SZ
- Means family therapy is likely to benefit to people with early and ‘full blown’ SZ
71
benefits to whole family
- Not just for the benefit of identified patient but for families that provide care
- Lobban and Barrowclough concluded that these effects are important because families provide bulk of care for people with SZ
- By strengthening the functioning of a whole family therapy lessens the negative impact of SZ on other family members and strengthens the ability of the family to support the person with SZ
- Means family therapy has wider benefits beyond positive impact on individual
72
ethical issues
- not suitable for all families
- eg abusive family
73
management of SZ
token economies
74
token economies
- Reward systems
- Form of behavioural modification where desirable behaviours are encouraged by use of selective reinforcement
- People given reward (token) for desirable behaviours
- Tokens are secondary reinforcers and can be exchanged for primary reinforcers
75
avollon and azrin
- ward of women with SZ
- Every time participants carried out task – making bed, cleaning – where given plastic token
- swapped for privileges – able to watch film
- Number of tasks carried out significantly increased
76
institutionalisation behaviours
- tackled with TE
- improves quality of life in a hospital setting
- normalises behaviour for when they go back to outside world
77
behaviour modification
- behaviours progressively changed
- tokens exchanged for primary reinforcers
78
management of SZ evaluation
- evidence for effectiveness
- ethical issues
- ART therapy
79
evidence for effectiveness
- Glowacki – identified 7 high quality studies published between 1999-2013 that examined effectiveness of token economies for people with SZ living in hospital settings
- All studies showed reduction in negative symptoms and decline for unwanted behaviours
- Supports value
80
counterpoint
- 7 studies are small evidence to base the support of effectiveness on
- Issue on number of small studies is file drawer problem
- Leads to bias towards positive published findings because undesirable results have been filed away
- Problem in reviews that only include small numbers of studies
- Means that there is serious question over the evidence for the effectiveness
81
ethical issues
- Gives professionals considerable power to control behaviour of patient
- Involves imposing one person’s norms on to others
-Eg who likes to look scruffy may have these personal freedoms curtailed
- Restricting the availability of pleasures to people who don’t behave in desirable way, means seriously ill people have even worse time
- Benefits for token economies may be outweighed by their impact on personal freedom and ST reduction in quality of life
82
ART therapy
- Existence of more pleasant and ethical alternatives
- Even if TE can be helpful in management there are other approaches that doesn’t raise same ethical issues
- art therapy may be good alternative
- is a high-gain low risk approach to managing SZ
- Art therapy is pleasant experience without risk of side effects or ethical abuse
- NICE guidelines recommend art therapy for patients
83
interactionist approach
- acknowledges there are biological, psychological and social factors in development of SZ
- Biological factors include – genetic vulnerability, neurochemical and neurological abnormalities
- Psychological factors include – stress, from life events, daily hassles
- Social factors include - poor quality interactions with family
84
stress model
- Interaction between something that makes you vulnerable and stress
- Way to present interactionist approach
- Diathesis means vulnerability
- Stress means negative experience
- Stress could include family dysfunction, brain trauma
- Vulnerability could include family dysfunction, levels of dopamine, brain abnormality
- Patients’ needs a vulnerability and a stress-trigger to develop SZ
85
meehl model
- single schizogene creates vulnerability
- if didnt have gene no amount of stress could cause SZ
86
modern understanding of diathesis
- polygenic
- trauma can also create vulnerability
- no single schizogene
87
modern understanding of stress
- any potential trigger
- psychological (parenting) or biological (cannabis)
88
cannabis
- smoking weed
- 7x likely to develop SZ
- interferes with dopamine system
89
parenting
- read
- insecure attachment from birth makes you more vulnerable to SZ
- childhood trauma affects brain development and increases SZ risk
90
interactionist treatment
- antipsychotics and CBT
- more effective for severe cases
- offered combination of therapy
- need to consider both biological and psychological treatments
91
interactionist evaluation
- support
- diathesis and stress are complex
- real world application
92
support
- gottesman
- 48% concordance rates for MZ twins
- shows genes and other factors contribute
93
diathesis and stress are complex
- Oversimplified
- original model portrayed diathesis as single schizogene and portrayed stress as SZ parenting is simplistic
- Multiple genes in multiple combinations influence diathesis
- Stress also comes in many forms
- Diathesis can be influenced by psychological factors and stress can be biological as well as psychological
- Houston study – childhood sexual abuse emerged as major influence of underlying vulnerability to SZ and cannabis use as the major trigger
- Multiple factors, both biological and psychological affecting both diathesis and stress supporting modern understanding
94
real world app
- Combination of biological and psychological treatments
- Drug treatment and therapy
- Tarrier – randomly allocated 315 participants to medication and CBT or medication and counselling or control group (medication only)
- Participants in combination groups showed lower symptoms following trial
- Clear practical advantage to adopting interactionist approach
