Schizophrenia

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  • Schizophrenia
    • Classification of Schizophrenia
      • No single defining characteristic, cluster of symptoms
      • DSM 5 requires at least 1 positive symptom for diagnosis
      • ICD 10 allows 2 or more negative symptoms for diagnosis
    • Positive Symptoms
      • Additional experiences beyond ordinary existence
      • Hallucination: Unusual sensory experiences that can come from any sense
      • Delusions: Irrational beliefs, believing one to be someone else or of persecution
    • Negative Symptoms
      • The loss of usual abilities and experiences
      • Speech Poverty: Reduction in amount and quality of speech, delay in verbal responses
      • Avolition: Difficulty beginning or continuing goal-directed activity. Poor hygeine, lack of energy, lack of persistence in work or education
    • Evaluation of classification
      • Inter-rater reliability/ 2 or more make same diagnosis/ Cheniaux found diagnosis of 26 with DSM and 44 with ICD, other found 13 DSM & 24 ICD/ Weakness of diagnosis
      • Criterion validity/ Cheniaux shows diagnosis more likely with ICD/ over diagnosed in ICD or under in DSM/ poor validity is weakness
      • Co-morbidity is it single condition/ Buckley 50% depression/ if half have depression maybe same condition/ Weakness
      • Symptom overlap with other conditions/ bipolar has similar positive and negative symptoms/ under ICD be schizophrenic, under DSM be bipolar/ might not be separate conditions
      • Since 80s men diagnosed more/ maybe men more genetically vulnerable/ maybe gender bias as women function better with work and relationships/ unclear if not schizophrenic or just good interpersonal functioning
      • African Americans & Afro Carribean more likely to be diagnosed/ Rates in Africa and West Indies not high, must be culture bias/ positive symptoms mor acceptable in african cultures/ Escobar (2012) showed white doctors more likely to diagnose and mistrust black people in diagnosis
    • Biological Explanations
      • Genetic basis: Runs in families, strong relationship with genetic similarity. Gottesman (1991) familial relationship immediately doubles risk 1% to 2%
        • Candidate genes: Believed to be polygenic. Ripke (2014) 108 genetic variations found to increase risk of schizophrenia
      • Dopamine Hypothesis: Dopamine belived to be involved
        • Hyperdopaminergia in the subcortex: high levels of dopamine in the central areas. Excess in Broca's Area associated with speech poverty or auditory hallucinations
        • Hypodopaminergia in the cortex: low levels of dopamine in the pre-frontal cortex (thinking & decision making)
      • Neural Correlates: Measuing structure/function that correlate with experience
        • Negative Correlation between activity in Ventral Striatum & severity of negative symptoms
        • Lower activation levels in Superior Temporal Gyrus & Anterior Cingulate Gyrus correlate to auditory hallucinations
    • Psychological Explanations
      • Family Dysfunction
        • Schizophrenogenic mother: cold, rejecting & controlling, create atmosphere of secrecy
          • Paranoid Delusions
        • Double-Bind Theory: Child is sent mixed messages & fear doing the wrong thing
          • Disorganised thinking, paranoid delusions
        • Expressed Emotion: Verbal criticism, hostility & emotional over-involvement, source of stress
          • Relapse or onset
      • Cognitive Explanations: disruption to normal thought processes & dysfunctional thought processiong
        • Metarepresentation: ability to reflect on thoughts and behaviour
          • Disrupt ability to recognise own thoughts as own, hallucinations and delusions
        • Central Control: ability to supress automatic responses
          • Derailment of thoughts & speech

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