Schizophrenia

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  • Created by: Sona
  • Created on: 25-04-15 13:25

Issues with Diagnosing Schizophrenia

RELIABILITY - consistency, DSM

INTER-RATER - 2 clinicians = similar results, positive correlation = high reliability

- little evidence that DSM improves reliability

WHALEY - IRR in 1 diagnosis was low was .11 = IRR is not effective

MOJTABI - IRR correlation was 40% between senior clinicians = cannot agree 60% - not effective

TEST-RETEST - several cognitive tests, consistency of results

PRESCOTT - TRT in 14sz = stable 6 months = more reliable than IRR - only 14sz - not generalised

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Issues with Diagnosing Schizophrenia

VALIDITY - real & distinct - measures what it says it measures

COMORBIDITY - 2+ disorders co-occur

BUCKLEY - comorbidity depression in 50% of patients - 47% = lifetime disorder = complications

WEBER - psychiatric & behaviour = 45% com - com in non-psych - sz diag with other problems - com = weakens validity = causes problems

+ & - SYMPTOMS

KLOSKUTTER - + symptoms more useful than - symptoms

CULTURE - UK whites less likely to diagnosed with sz than UK blacks

HARRISON - rate of African Americans 8x more likely than American whites - due to poverty - possibility of misdiagnosis

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Biological Explanation for Schizophrenia

GENETIC EXPLANATION - inherited sz

FAMILY STUDIES - genetic link

GOTTESMAN - 2 parents - 46% concordance rate (CR), 1 parent 13% CR, 1 sibling 9% CR = biological relatives can inherit sz HOWEVER environment plays a role (common rearing patterns& negative emotional climate) 

TWIN STUDIES - identical twins = 100%, non-identical = 50%

JOSEPH - Mz = 40.4% CR, Dz = 7.4% CR - HOWEVER Mz = similar - no individuality - identity confusion = Mz & Dz CR  due to environmental factors

ADOPTION - genetics/environment

TIRANI - Finland, biological mother = sz, 164 adoptees = 6.7% diagnosis = genetic link (not conclusive) HOWEVER Finland - cannot be generalised to rest of world. 

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Biological Explanation for Schizophrenia

DOPAMINE HYPOTHESIS - messages fire dopamine too easy/often = characteristics of sz (delusions)

AMPHETAMINES - stimulates nerve cells containing dopamine = synapse flooding = high dopamine in brain = sz symptons 

HIETALA - post-mortem & PET scans = dopamine receptors in people with sz = high dopamine = high levels of sz symptoms

ANTI-PSYCHOTIC - block dopamine activity, low simulation, eliminate sz symptoms = low dopamine = low sz symptoms HOWEVER anti-psychotics = high sz symptoms

HARACZ - post-mortem - high dopamine in anti-psychotics before death = high dopamine levels = sz symptoms = high A-P drugs (CRITICISES DH)

PARKINSON'S DISEASE - low dopamine = parkinsons - people who took L.Dopa = high dopamine levels = sz symptoms = high dopamine levels = sz symptoms (SUPPORTS DH)

[DH better explanation than Genetic]

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Biological Therapy for Schizophrenia

ECT process

- patinet - anaesthetic & muscle relaxant, electric current applied to brain temples = seizsure, works on decrease levels of dopamine & positive symptoms

EFFECTIVENESS

CHAMPATTANA - drug resistant ps given ECT, decrease positive symptoms & drug treatment = effective for positve symptoms

THARYAN - meta-analysis, ECT = short term, less effect on negative symptoms = cannot treat long-term symptoms

APPROPRIATENESS

SIDE EFFECTS - memory loss, neurological damage HOWEVER side effects = short term

ETHICAL ISSUES - most ps hate ECT - high pressure on them 

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Psychological Therapy for Schizophrenia

FAMILY INTERVENTION - sz in families that express high criticism, hostility & over involvement - had high frequence relapse rates than peopl with the same problem

BROWN - family intervention makes less stress in the family life (strategies = forming alliance, anticipate & solve problems) - used with drug treatments = low relapse rates

EFFECTIVENESS 

META-ANALYSIS - relapse rates in family intervention = 26% whereas in control group = 50% = family intervention = effective therapy

PHAROAH - meta-analysis = family intervention improves clinical outcomes (mental state & social functioning) interacting with people 

AUTHORS - main reason for effectiveness = high medical compliance = medical & family intervention = effective

APPROPRIATENESS

NICE REVIEW - family intervention with significant low savings when offered to ps with sz & standard care = low cost of hospitalisation = low relapse rates

CULTURE LIMITATIONS = hospitalisation differs across countries, non UK countries not appicable to UK = hospitalisation for treated sz cannot be generalised - lacks validity

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Psychological Explanation for Schizophrenia

SOCIO-CULTURAL FACTORS

LIFE EVENTS - associated with the onset of sz e.g. death of a loved one

BROWN & BIRLEY - sz = x2 many stressful life events compared to control group = link between stress & onset of sz

VANOS - no link, major life events decreases relapse rates = different perspective on life events

BATESON - children recieve contradictory messages from parents - likely to develop sz (e.g. mum tells them she loves them, does not provide for them) - DOUBLE-BLIND THEORY

BERGER - sz recalled high no. of double blind statements than non sz HOWEVER ps recall may be affected by sz, thought process messed up

LIEM - no difference when compared sz child patters with normal families = no link between family relationship & onset of sz

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Psychological Explanation for Schizophrenia (2)

EXPRESSED EMOTION (EE) - family communication (hostile, criticism = negtaive emotional climate) - high levels of sz & relapse rates

LINZEN - ps returning to home with EE = 4x more likely to replase than low expressed emotion  = high EE = high sz

KALAFI - high prevalence of EE in Iranian culture = high relapse rates = emotional climate = stress on sz - therapy decreases expressed emotion

HOGART - low sz relapse rates - not clear where EE intervention = other factors

LABELLING THEORY (LT)

SCHEFF - social groups = rules to follow, sz = deviant

SCHEFF (2) - meta-analysis on 18 studies = 13 consistent with LT & 5 inconsistent = link between LT & sz

ROSENHAAN - 'label' of sz - diagnosed continued to influence behaviour of staff towards patient when this was no longer warranted.

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