Schizophrenia last minute revision

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  • Created on: 03-06-12 18:19
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Schizophrenia (SZ)
Clinical characteristics and diagnosis:
Negative symptoms (social withdrawal, alogia, affective flattening)
Positive symptoms (hallucinations, delusions)
DSM and ICD (2+ characteristic symptoms, duration of least 6 months, social and occupational dysfunction)
Catatonic (refusal to follow instructions, echo back speech of others, swollen/stiff limbs)
Paranoid (delusions/hallucinations, emotionally responsive, angry, agitated and violent)
Disorganised (difficult to follow speech, constant shifts of emotion, neglects appearance)
Reliability issues of classifying SZ
Reliability (Extent to which psychiatrists agree on same definition)
Making reliable diagnosis of SZ is problematic because there are no physical signs only symptoms
Beck et al. Reported 54% concordance rate between practitioners diagnosing 153 patients (1962)
Soderberg et al. Reported 81% concordance rate using up to date DSM IV TR
This suggests classification systems have become more reliable over time
Rosenhan Pseudo patients at psychiatric hospitals, non identified as fakes, 41 real identified as fakes
Rosenhan's study has ethical issues pseudo patients may receive label of SZ may affect lives
Validity issues of classifying SZ
Validity (Is it measuring what it claims to measure?)
Schneider 1st rank symptoms of SZ (delusions) are also 1st rank symptoms of bipolar disorder and depression
Ellason and Ross people with DID disorder have more SZ type symptoms than people diagnosed with SZ
Other issues of classifying SZ (Labelling and culture differences)
Once labelled as SZ, label sticks and determines how people view your case which affects jobs, relationships
Copeland et al. Description of a patient to US and UK psychiatrists-69% US and 2% UK gave same diagnosis
Biological explanations of SZ
Genetic explanations: SZ is a genetic disorder with genetic predisposition
Gottesman and Shield MZ twins (48% concordance rate) DZ twins (17% concordance rate) genes play a part
No study has found 100% concordance rate, common rearing patters play a role, large sample size, outdated
Tienari et al. 11 kids SZ (adopted) 164 biological mothers had SZ, control group 4 had SZ 197 non SZ mothers
Dopamine hypothesis: SZ's have abnormally high numbers of D2 receptors resulting in more neurons firing
Grilly People taking L-Dopa drugs that raises levels of dopamine developed SZ type symptoms
Over simplified explanation on its own
Psychological explanations of SZ
Psychodynamic: world of SZ has been harsh in childhood leads to under-development of ego
Hammersley et al. (2003) Hallucinations experienced in SZ linked to abuse in childhood
Correlation study doesn't establish cause and effect, high in temporal validity
Psychodynamic approach hard to falsify thus it is useful, deterministic not all suffers undergo abuse
Double bind theory: when children receive contradictory messages from parents they can develop SZ
Berger found that SZ reported higher recall of double bind statements by their mothers than non-SZ
Evidence may not be reliable because patients recall may be affected by their SZ
Serious ethical issues in double bind theory as it blames the family (esp. Mother) for the development of SZ
Labelling theory: symptoms of SZ are deviant from normal thus they get labelled leading to self fulfilling prophecy
Scheff evaluated studies relating to labelling theory and found they are consistent with the theory supported by
Labelling theory is deterministic as it assumes the label will stick and will always have an affect

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Biological therapies of SZ
Antipsychotic medication: do not cure a patient but dampen symptoms down to a level where they can function
1st generation (chlorpromazine) reduce the effects of dopamine so reduce positive symptoms of SZ (e.g. delusions)
2nd generation (clozapine) reduces both positive and negative symptoms because it targets serotonin and dopamine
Davis et al. Meta analysis of 100 studies compared antipsychotics to placebos and found drugs to be more effective
Schooler et al.…read more

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Biological models of addiction
Genetics: initiation caused by genetic predisposition and triggered by environmental stressors
Kendler et al found that common genetic factors contributed to the total variance in drug abuse and alcohol
Culturally biased (carried out only in US) temporal validity (2003) ignores environmental factors
Disease model: addictive drugs stimulate reward circuits in the brain, trigger the release of dopamine feels rewarding
Volkow et al Ritalin (lifts dopamine levels) given to adults ­ those who loved it had fewer D2 receptors
Biological…read more


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