what are positive symptoms of schizophrenia? examples?
additional experiences that those without schizophrenia dont have, i.e delusions, hallucinations and disorganised speech
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what are hallucinations?
unusual sensory experiences which can be in relation to any sense i.e visual or auditory
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what are delusions?
irrational beliefs, makes schizos behave in a way that makes sense to them but seems bizarre to others.
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what is disorganised speech?
incoherent and/or the speaker changes topic mid sentence
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what are negative symptoms? examples?
the loss of usual abilities and experiences, e.g abolition and speech poverty
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what is avolition? what are the signs of this?
finding it difficult to begin or maintain goal related activity i.e schizos often have reduced motivation. Signs of abolition are poor hygiene, lack of persistence in work and lack of energy
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what is speech poverty?
reduction in the amount and quality of speech, may be accompanied by a delay in verbal responses in conversation
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what is inter rater reliability?
the extent to which 2 different assessor agree on their assessment
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what is test-retest reliability?
whether the tests for diagnosis are consistent over time
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what is validity?
the extent to which we are measuring what we intend to measure
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how can the validity of a diagnosis be measured? what is this called?
criterion validity - whether different assessment systems arrive at the same diagnosis for the patient
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who researched the criterion validity of schizophrenia? what did they find?
Cheniaux et al - 2 psychiatrists and 100 patients, one diagnosed 26 according to DSM and one diagnosed 44 according to ICD
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What is co morbidity?
where 2 or more conditions occur together which calls into question the validity of the diagnosis as they may be a single condition
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Who researched co morbidity in the diagnosis of schizophrenia?
Buckley et al - half of the patients with schiz also diagnosed with depression (50%) or with substance abuse (47%), may be that severe depression looks like schiz & may be 1 condition.Reduces valid of diagnosis.
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what has been found in terms of the schizophrenia diagnosis of different genders? explanations for this?
men diagnosed more often than women, may be because men are more genetically vulnerable to developing schiz but could be gender bias in diagnosis of schiz
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who investigated gender bias in diagnosis of schizophrenia?
Cotton et al - female patients typically function better than men. are more likely to work & have good family relationships.If women are under diagnosed this suggests valid of diagnosis of schiz is poor.
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What has been found in the diagnosis of schizophrenia in terms of culture? what does this imply
African americans and english people of afro-caribbean origin are several times more likely to be diagnosed w/schiz than white people. implies culture bias as unlikely due to genetic vuln. as rates of schiz low in africa.
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how is the validity of diagnosis confounded by culture beliefs and behaviours for schizophrenia?
positive symptoms such as hearing voices more acceptable in culture i.e africa as seen as spiritual experience and not mental health issue but in england seen to be bizarre and irrational. validity of diagnosis poor as varies across cultures.
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who investigated the effect of racism on the diagnosis of schizophrenia?
Escobar - white psychiatrists tend to over interpret symptoms and distrust the honestly of black people during diagnosis , poor validity confounded by races,
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What are the 3 biological explanations of schizophrenia?
genetic, dopamine and neural.
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what is the genetic explanation for schizophrenia?
schiz runs in families so individuals suffering from schiz have relatives w/disorder as genes for genetic vulnerability of developing it is inherited
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who investigated the genetic cause of schizophrenia using a large family study?
Gottesman - found a positive correlation between genetic similarity and increased risk of developing schiz. MZ twins had higher concord rates (48%) than DZ (17%)
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explain the type of genes involved in schizophrenia?
a number of candidate genes are associated with a small increased risk of developing schiz, suggesting schiz is polygenic (number of genes involved). Schiz also etiologically heterogeneous (different combos of genes lead to condition)
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who investigated the genetic variations involved in schizophrenia and what was found?
Ripke et al - found 108 separate genetic variations associated with increased risk of schizophrenia
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what is an advantage of the genetic explanation for schiz? (supporting evidence)
Gottesman - family study and found pos correlation between genetic similarity and increased risk of developing schiz. Also found MZ twins have higher concord rates (48%) than DZ (17%) for schiz. suggests schiz has genetic cause.
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what is a disadvantage of supporting research for genetic explanation?
methodological issues w/twin studies. may lack validity as whilst twins share genes they also share environment so similarities in twins could be due to enviro not genes.
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what is another disadvantage of twin studies as supporting research for genetic explanation?
identical twins share 100% of genes but none of concordance rates are 100% so suggests that genes are only partly responsible for schiz & other influences such as enviro. raises issue of nature-nurture debate and suggests genes only partial explan.
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what is a disadvantage and advantage of the genetic explanation overall? (SSR)
genetic explan has lead to gene mapping i.e developing tests to identify high risk individuals, this is SSR as may lead to prejudice against these groups. However, may lead to early treatment of schiz before it develops
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what is the dopamine hypothesis for schizophrenia?
theory that dopamine levels involved in the development of schiz, the dopamine levels of schizos are abnormal compared to non schizos and as dopamine is important in the operation of many brain systems this causes them to function improperly
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what are neurotransmitters and how do they play a part in the dopamine hypothesis?
neurotransmitters are the brain's chemical messages and they work differently in the brain of schizophrenics i.e abnormal levels of dopamine
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what is hyperdopaminergia in the sub cortex? what version of the dopamine hypothesis is this?
this is the original version, focuses on high levels of dopamine in the sub cortex contribute to schiz. Excess of dopamine receptors in Broca's area (responsible for speech production) is associated w/poverty of speech and auditory hallucinations
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what is hypodopaminergia in the cortex? what version of the dopamine hypothesis is this?
modern version, focuses on abnormal systems in the brain's cortex. Found low levels in the prefrontal cortex (decision making) responsible neg. symptoms of schiz.
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what is a disadvantage of the dopamine hypothesis? (drugs)
antipsychotic drugs such as Clozapine is most effective at reducing schiz symptoms but works on serotonin as well as dopamine. implies serotonin also involved so dopamine hypothesis over simplistic as other neurotransmitters also involved.
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what is an advantage of the dopamine hypothesis? (supporting research)
Iverson - post mortems on schizos and found excess dopamine in limbic system. suggests increased levels of dopamine may lead to schiz.
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what is a disadvantage of supporting research for the dopamine hypothesis?
most research finding a relationship with dopamine and schiz is correlational. Assumed high levels of dopamine cause schiz but could be a symptom. Means something else may cause schiz.
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what is the neural correlates explanation for schiz?
neural correlates are measurements of the structure or function of the brain that correlate with schizophrenia. Originally evidence limited to post mortems but research now uses brain scans such as FMRI which gives picture of the brain in action
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what is a negative symptom of schizophrenia which has been explained by the abnormal functioning of the brain in schizophrenics?
avolition - involves the loss of motivation. motivation involves anticipation of a reward and certain regions of brain (ventral striatum) believed to be involved in this anticipation
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who studied the levels of activity in the ventral striatum of schizophrenics? What did they find?
Jackel et al - found lower levels of activity in VS than controls and negative correlation between activity levels in VS and severity of negative symptoms. SO activity levels in VS neural correlate of schiz.
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what is a negative symptom of schizophrenia which has been explained by the abnormal functioning of the brain in schizophrenics? (explain w/research)
Allen et al - scanned brain of patients w/aud. hallucs. & ask identify speech as own or others. Low activation levels in superior temporal gyrus & interior cingulate gyrus found in schizo who made more errors. these areas = neural corr. of schiz.
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what is a disadvantage of the neural correlates explanation? (disadv of supporting research)
it's correlational so cant establish cause and effect. although they identify brain systems that may be functioning abnormally leading to symptoms. BUT symptoms could lead to abnormal functioning. limited explan.
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advantage of neural correlates explanation? but disadv? (app to real life)
early intervention and identification of abnormal brain functioning may prevent development of schiz. and can produce targeted medication. however early detection of ab. functioning is SSR and = discrimination.
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what is a general evaluation for all biological explans of schiz?
biologically deterministic i.e has no control over whether they get schiz. But adv = takes the blame away from sufferers & makes it easier to accept. Also, drug treatment can lead to dependency & other side effects, so biological determinism not good
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what are biological treatments of schizophrenia? what do they do and what types are there?
anti-psychotic drugs, reduce intensity of symptoms and include both typical and atypical drugs
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what are typical drugs? when? such as? side effects? how are they taken?
introduced 1950s e.g chlorpromazine. dopamine antagonists (block dopamine receptors in brain & normalises transmission of dopamine & reduces symptoms like hallucinations). severe side effects e.g tardive dyskinesia. tablets, syrup or injection.
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why were atypical drugs designed?
developed to maintain or improve the effectiveness of drugs in surprising symptoms and minimise side effects.
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what are the 2 types of atypical drugs?
clozapine and risperidone
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what is clozapine? when? side effects? taken as?
1960s, binds to dopamine receptors but works on serotonin and glutamate too. Improves mood, reduces dep/anx. (prescribe to suicidal) & improve cog. func. fewer side effects but can be fatal. tablets, syrups cant be injected.
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what is risperidone? when? side effects? taken as?
1990s, developed to be as effective as clozapine w/out serious side effects. binds more strongly to dopamine & serotonin receptors so effective in smaller doses. few side effects. taken tablets, syrup, injections.
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what is an advantage of atypical drugs? (supporting research)
Meltzer - clozapine more effective than typical antipsychotics. effective in 30-50% cases where typical drugs failed.
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what is a disadvantage of typical drugs? (effects)
serious side effects. long term use results in tar dive dyskinesia i.e involuntary facial movements. also can be fatal.
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what is a disadvantage of antipsychotic drugs in general? (effective long term?)
high relapse rate, 40% in 1st yr of treatment and 15% in later years. generally due to stopping treatment due to side effects and lack quality of life. reduces effectiveness as requires patients compliance
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what is another disadvantage of antipsychotic drugs in general? (ethical)
used for benefit of hospital staff not patient, 'chemical straightjackets' patients reduced to calm state so easier to work with. unethical as control their behave.
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what are the psychological explanations for schizophrenia?
family dysfunction and dysfunctional thought processing (cognitive explanation)
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what are the 3 parts of the family dysfunction theory?
schizophrenogenic mother, double bind theory and expressed emotion
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what does the schizophrenogenic mother briefly mean?
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what is the theory about the schizophrenogenic mother?
mother is cold & rejecting, leads to family enviro characterised by tension/ secrecy. leads to distrust which develops into paranoid delusions and eventually schizophrenia
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what is the double bind theory and who is it by?
Bateson - schiz due to communic. style of fam. Kids fear doing wrong but mixed messages about what it is, unable to comment unfairness of situ. when wrong punished w/lack of love; think world confusing & dangerous = disorg. thinking & para. delusions
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what is the expressed emotion theory?
neg emot. climate = schiz. i.e communic. style = hostile, criticism & emot. over involve. High levels EE = influence relapse after schizo return after treatment. High stress trigger schizo episode. Secret alliances in fam = delusions of persecution
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what does criticism relate to in terms of the expressed emotions theory?
negative comments between family members
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what does hostility relate to in terms of the expressed emotion theory?
aggressive behaviour in the family
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what does emotional involvement relate to in terms of the expressed emotions theory?
over protective parenting where parents spend too much time interfering in the affairs of other family members
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what is a disadvantage of the family dysfunction theory? (patients giving info)
information about childhood experiences was gathered after the development of symptoms and a diagnosis of schiz. Suggests patients disturbed cognitions may distort validity of info they provide when asked how parents treated them as children.
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what is another disadvantage of the family dysfunction theory?(SSR)
implies that parents are responsible for their children's schiz, could cause psychological harm to parents = unethical as undermines parents ability to help them.
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what is an advantage of the family dysfunction theory? (supporting evidence)
Berger - schizos had higher recall of double bind statements by their mothers than non schizos. Implies exposure to mixed messages causes schiz to develop
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what is the cognitive explanation for schizophrenia?
suggests faulty thought processing is the cause of schiz, i.e problems w/attention, communication and info overload. Problems w/metarepresentation disrupts ability to recognise actions/thoughts as being carried out by themselves.
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what is metarepresentation? why is the absence of this in schizophrenics a problem?
cognitive ability to reflect on thoughts and behaviour and allows us to interpret actions of others. Schizos cannot identify others actions as not being theirs and vice versa due to probs with metarepresentation.
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what is egocentric bias in the cognitive explanation?
egocentric bias = individual sees self as central component in all events (delusional thinking) & comes to false conclusions, i.e muffled voice = someone criticising them. Schizos unaffected by reality testing (they have impaired insight)
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what is an advantage of the cognitive explanation? (supporting evidence - working memory)
Myer Linderberg - found reduced activity in the prefrontal cortex of schizos when did a task on working memory. Shows theres a link between dysfunctional info processing and schiz.
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what is a disadvantage of the cognitive explanation? (cause and effect)
dysfunctional thinking could be a consequence of schiz rather than a cause. Suggests something else causes schiz in the first place and this leads to distortions in cognitions.
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what is an advantage of the cognitive explanation? (supporting research - colours)
Stirling - compared 30 schizos with 18 non schizos on a range of cognitive tasks. Schizo patients took 2x as long to name colours compared to controls. Suggests info processing different in schizos.
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what are the 3 types of psychological therapies in schizophrenia?
cognitive behaviour therapy, family therapy and token economies.
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what is the aim of cognitive behaviour therapy?
help patients identify irrational thoughts and change them. makes patient make sense of how their delusions and hallucinations impact on their feelings and behaviour. Offering psychological explans for delusions reduces anxiety and fear
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what is the process of cognitive behaviour therapy?
patient + therapist discuss how likely beliefs are to be true & consider less threatening possibilities. Develop cognitive coping strategies (breathing ex). Hw set to learn this between sessions.
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what is the aim of family therapy?
to improve the quality of communication and interaction between family members by sessions with the patient and their whole family
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who identified strategies to improve the the functioning of a family w/a member who has schiz? what are they?
Pharaoh - strategies include: reducing guilt, anger and stress of caring for relative, improving families beliefs about schiz & ability to anticipate and solve problems & form therapeutic alliance w/all family members.
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how do these strategies work?
help family develop a balance beywen caring for the relative & maintaining own lives. Strategies work by reducing levels of stress and expressed emotion whilst inc. patients' chances of complying w/medication. This combo reduces likelihood of relapse
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what is the aim of token economies as a psychological therapy?
manages the behaviour of patients especially those w/maladaptive behaviour by spending long periods in psychiatric hospitals.
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how do token economies work?
tokens given immediately for desire. behav, encourage reinforcement. immediacy important, prevents delay discounting (reduced affect of delayed reward). no value (2ndary reinforcers) but swap for tangible reward. doesn't cure but improve qual of life
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what is an advantage of psychological therapies in general? (quality)
make schiz more manageable & improve patients' qual of life. CBT = make sense of & challenge symptoms. Fam therapy = reduces stress of living w/schiz. Token = make patient behav socially accept. so can reintegrate into society
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what is a disadvantage of psychological therapies in general? (cure)
fail to cure schiz,only a temporary solution and manage symptoms. Could be argued more for the benefit of families and staff than the patient.
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what is another disadvantage of psychological therapies in general? (ethics)
raise ethical issues, especially token economy. issue is that privileges/ services more available to patients w/minor symptom which prevent them complying w/desirable behaviours. therefore they suffer discrimination.
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what is a disadvantage of CBT? (suitable?)
not suitable for patients who are too disorientated or paranoid to form trusting alliances w/practitioners. therefore effectiveness is limited to those with mild symptoms
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what is a disadvantage of Family therapy? (tension)
by having an emphasis on openness there can be an issue w/fam members being reluctant to share sensitive info as may open family tensions. Lowers effectiveness of treatment & can make situ worse.
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what concept does the interactionist approach of schizophrenia include?
diathesis stress model
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what does diathesis mean?
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what does stress mean?
a negative psychological experience
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what is the basic assumption of the diathesis stress model?
that both a vulnerability to schizophrenia and stress are necessary to developing the condition
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what is Meehl's model of the diathesis stress model?
vulnerability is entirely genetic as a result of a schizogene which leads to a schizotypic personality (extremely sens. to stress), no amount of stress will lead to schiz w/out gene. but stress + gene = schiz (nature and nurture interact)
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what is briefly the modern understanding of diathesis?
no single 'schizogene', many genes increase vulnerability slightly. Diathesis seen as trauma rather than stress.
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what is the neurodevelopment model in the modern understanding of diathesis?
early trauma e,g child abuse can affect many aspects of brain development. i.e hypothalamic-pituitary-adrenal (HPA) can become overactive, making person more vulnerable to later stress
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what is the modern understanding of stress?
in o.g model stress = psych in nature, now includes anything that inc. risk of schiz, i.e cannabis as interferes w/dopamine system. BUT must be other vuln. factors as most dont develop schiz after smoking cannabis. other factors = infect. during preg
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explain the treatment of the interactionist approach?
combines antipsychotic medication and psych. therapies ( mostly CBT). believe schiz has biological basis but use CBT to relieve psy symptoms. this combo common in UK but in US conflict between biological and psy treatments
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what is an advantage of the interactionist approach? (supporting evidence - adoptees)
Tienari - asses combo of vuln. & parent style (trigger). Finnish adoptees w/schiz mums. adoptive parents child rearing style assessed & rates of schiz compared control group w/out schiz mum. high genetic risk &neg parenting style = schiz. proves it.
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what is another advantage of the interactionist approach? (economy)
although the combo of drug treatment w/psy treatment increases the overall cost of treatment, it makes relapse and hospitalisation less likely
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what is another advantage of the interactionist approach? (supporting research - given combo treatment)
Tarrier - pps randomly allocated to medication & CBT group, med + supportive counselling or control group (just med). control group had highest symptom levels. shows effectiveness of interactionist treatment.
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Other cards in this set
what are hallucinations?
unusual sensory experiences which can be in relation to any sense i.e visual or auditory
what are delusions?
what is disorganised speech?
what are negative symptoms? examples?