Schizophrenia
- 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
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
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.
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]
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
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
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
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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