Schizophrenia

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What are the five key symptoms of schizophrenia according to the DSM?
Delusions, Hallucinations, disorganised speech, catatonic behaviour, negative symptoms
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What is a positive symptom?
Positive symptoms reflect an excess or distortion of normal functioning
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What is a negative symptom?
Positive symptoms reflect a reduction or loss of normal functioning
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What are two examples of positive symptoms?
Hallucinations, Delusions
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Define a hallucination
Snesory experiences that have no basis in reality, experienced in relation to any sense
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Define a delusion
Bizarre beliefs that seem real but are not, may be paranoid in nature, may involve inflated beliefs of importance.
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What are two negative symptoms?
Avoltion, speech poverty
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What is avolition?
Severe loss of motivation to carry out everyday tasks, inability to persist in goal-directed behaviour
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What is Speech poverty
Lesssening of speech fluency and productivity, less complex syntax, relfects slow or blocked thoughts
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What is Diagnostic reliability in schizophrenia?
This means that a diagnosis of schizophrenia must be repeatable, clinicians must reach the same conclusion at 2 points in time, or different clinicians reach the same conclusion.
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How is inter-rater reliability measured?
By the Kappa scale, 1 is perfect.
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What is a potential reliability problem with a schizophrenia diagnosis? Develop your answer.
A potential for cultural bias, Evidenced by Copeland, who gave US and Uk psychologists a patient description, 69% of US psychologyists diagnosed schizophrenia, compared to only 2% of UK psychologists.
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What is a characteristic of schizophrenia that changes across cultures?
Auditory hallucinations appear to be influenced by cultural environment, In certain cultures (e.g africa) research has shown the majority of schizophrenics report the voices as playful or positive, yet this is very rare in westernised culture.
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What is validty in diagnosis?
Validity in diagnosis is the extent to which a diagnosis is accurate and meaningful Must be real and distinct from other disorders.
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What is a potential validity problem within schizophrenia?
The potential for gender bias. Critics argue the DSM criterias are biased towards pathologising one gender over another. Mentally healthy adult behaviour can be equated with mentally healthy male behaviour. Women can be seen as less mentally healthy.
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What is symptom overlap in schizophrenia? Why is this an issue?
Many people diagnosed with schizophrenia have sufficient symptoms of other disorders that they could recieve another diagnosis (e.g. bipolar). This reduces the accuracy of a schizophrenia diagnosis as it is not distinct from other disorders.
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What is Comorbidity and why is this an issue?
Comorbidity refers to the extent that 2 or more condition can occur at the same time. Buckley et al estimates co-morbid depresssion occurs in 50% of schizophrenics. Reduces validity as indistinct and possibly only one condition.
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What are the three biological explanations for schizophrenia?
Genetics, dopamine, neural correlates
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Why is it theorised schizophrenia is due to genetics?
There is a strong relationship between genetic similarity of family members and the likelihood of both developing schizophrenia.
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How can the genetic explanation be studied?
Through family studies and adoption studies
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Describe family studies.
Investigates whether biological relatives are more likely to be affected with schizophrenia than non biological relatives.
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What is the overall lifetime risk of schizophrenia compared to MZ twins?
Overall lifetime risk is 1%, if identical twins it is 48%
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Describe adoption studies
Separates influence of genetics and environment by investigating individuals who are genetically related but reared apart.
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What is the role of dopamine in the brain?
Dopmaine has influence in the visual pathway of the brain as well as the movement system
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Explain the original dopamine hypothesis
This explanation states the neurotransmitter dopamine is connected to the onset of schizophrenia. The original model focuses on an excessive amount of dopamine in the subcortex, causing neurons to overfire and transmit too many messages.
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What is the more updated dopamine hypothesis?
More recent version sof the hypothesis have focused on too many D2 dopamine receptors which lead to more firing and overproduction of messages. (can lead to many symptoms e.g. visual disturbances)
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What are neural correlates?
Neural correlates are patterns of structure or activity in the brain that occur with a (schizophrenic) experience.
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What suggests neural correlated are implicated in schizophrenia?
Neural correlates occur simultaneously with schizophrenic experiences, this suggests the patterns observed may cause schizophrenia.
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What is a common neural correlate found in schizophrenic patients?
Many schizophrenic brains have abnormally large lateral ventricles. Enlarged ventricles can occur as brain areas around them have decreased in volume.
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Describe the neural correlate associated with avolition.
Avolition is associated with the Ventral Striatum, one of the main reward centres in the brain crucial in anticipation of a reward. Research has found a negative correlation between activity levels and avolition severity.
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Describe the neural correlate associated with hallucinations.
HAllucinations have been found to have neural correlate with the superior temporal gyrus. Patients experiencing auditory hallucinations recorded lower activation levels of this area.
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What are the two psychological explanations for schizophrenia?
Family dysfunction and cognitive explanations
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How could family dysfunction cause schizophrenia?
Explanations based on family dysfunction claim that schizophrenia is caused by abnormal patterns of communication within the family.
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What are two examples of family dysfunction linked to schizophrenia?
Two examples of family dysfunction which have been linked to schizophrenia are Expressed Emotion and Double bind theory.
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Describe Double Bind Theory.
Proposed by Bateson et al. Suggests children who recieve contradictory messages from their parents are more likely to develop schizophrenia. Prolonged exposure prevents the development of a internally coherent construction of relality.
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What is an example of a conflicting message in the Double Bind theory?
Different communication levels, affection on a verbal level, animosity on a non verbal level. these messages invalidate each other so the child is no longer able to respond.
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Describe Expresssed emotion.
In EE the family members of the schizophrenic patient talk about the patient in a critical or hostile manner, or are emotionally overinvolved or overconcerned.
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What do high levels of EE cause?
High levels of EE have been shown to influence relapse rates. Research has indicated a patient returning to a family with high EE are more than 4 times more likely to relapse than a patient with a family low in EE.
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Why might high levels of EE effect schizophrenia?
People with schizophrenia may well have a lower tolerance for intense interactions with family members, the negative emotional climate in these families arouse the patient and lead to stress beyond their innate coping mechanisms.
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Describe the cognitive explanation for schizophrenia
Cognitive explanations emphasise the role of dysfunctional thought processing, particularly evident in those who display positive characteristics.
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How can the cognitive explanations explain delusions?
When delusions are formed the patients interpretations of their experiences are controlled by inadequate information preocessing. E.g. an egocentric bias leads to the individual jumping to false conclusions about external events.
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How can the cognitive explanations explain halluciations?
People with hallucinations experience hypervigilance so have a higher expectancy to hear a voice. They may also misattribute the source of a self generated auditory experience to an extenral source.
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Describe typical antipsychotics
Developed in the 1950s. Work by acting as antagonists in the dopamine system and aim to reduce the effects of dopamine. They bind to but do not stimulate D2 receptors.
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Why can typical antipsychotics cause side effects?
In order to be effective, research indicates 60-75% of D2 receptors in the mesolimbic pathway must be blocked. This means however that a similar number of D2 receptors in other areas of the brain are blocked, leading to undesirable effects.
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Describe atypical antipsychotics
Atypical psychotics have a stronger affinity for serotonin receptors and a lower affinity for D2 receptors.Atypical antipsychotics work by blocking D2 receptors, but they rapidly dissociate to allow normal dopamine transmission
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What are three benefits of atypical antipsychotics
They have a lower risk of side effects, have a beneficial effect on negative symptoms and are sutiable for treatment resistant patients.
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What is a benefit of typical antipsychotics?
Less withdrawal effects
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Describe CBTp
CBTp is used to help the patient identify and correct faulty interpretations of events and to help to establish links between their thoughts , feelings or actions and their symptoms, to consider alternative explanations for their behaviours.
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What model does CBTp follow?
The ABC model; the patient discusses the Activating event, the Belief, and the Consequence. The patients beliefs can be rationalised and changed into healthier explanations.
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What is the main aim of family therapy for schizophrenia?
The main aim is to provide support for carers in an attempt to make family life less stressful and so reduce rehospitalisation. Also aims to reduce EE
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What were the 4 key family therapy strategies outlined by Pharoah et al?
Forming a theraputic alliance with all of the family, Reduce guilt and anger in family members, improve ability of family to anticipate and solve problems, reduce stress of carers.
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What is a token economy?
A token economy is used to manage the symptoms of schizophrenia. It is based on the principle of secondary reinforcement. Tokens are given for socially desirable behaviours which can be exchanged for certain primary reinforcers (e.g. food/TV).
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What is a positive symptom?

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Positive symptoms reflect an excess or distortion of normal functioning

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What is a negative symptom?

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Card 4

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What are two examples of positive symptoms?

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Define a hallucination

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