Schizophrenia

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Kraeplin
SZ is premature mental deterioration
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Bleuler
SZ symptoms don't get progressively worse, so it can't be like early onset deprivation
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What percentage of the population does SZ affect?
1%
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When do SZ symptoms appear in men?
Late teens/early 20s
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How long must symptoms last before diagnosis?
6 months
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Course of the disease
1/3 have one episode and make a full recovery, 1/3 have frequent episode and 1/3 seriously deteriorate
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First rank symptoms
Thought disturbances, hallucinations and delusions. Must be present for diagnosis to be made
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Thought disturbances
Thought insertion, thought withdrawal, thought broadcasting
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Thought insertion
Believing that thoughts are being inserted into your head by an outside force
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Thought withdrawal
Believing that thoughts are being removed by an external force
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Thought broadcasting
Believing that everyone can hear your thoughts
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Hallucinations
The perception of stimuli that isn't actually present. Visual and auditory.
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Delusions
False beliefs that have no rational belief for existing
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Delusions of grandeur
Believing that you are more important than you are
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Delusions of persecution
Believing that someone/something is out to get you
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Delusions of reference
Belief that something is made specifically for you and has a personal message for you
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Disorganised thought and speech
Inability to keep to the point, can't filter out unnecessary info, loose associations and neologisms
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Disturbances of affect
Emotional disturbances and inappropriate affect
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Emotional disturbances
Fluctuating sensitivity, too much/not enough emotion
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Inappropriate affect
Inappropriate displays of emotion
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Psychomotor disturbances
Catatonia, stereotyping (purposeless, repetitive movements) and sudden movements
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Lack of volition
Loss of interest in environment, loss of will power, withdrawal from social situations
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Positive symptoms
Symptoms that have been brought on my SZ
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Negative symptoms
Behaviours that have been lost because of SZ
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DSM-5
American handbook for diagnosing mental illness. Only one first rank symptom has to be present for SZ diagnosis.
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ICD-10
British handbook for diagnosing mental illness. SZ diagnosis if 2+ negative symptoms are present.
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Cooper (1970s)
US psychs are 2x more likely to diagnose SZ than British psychs
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Genetic cause of SZ
SZ can be inherited
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Gottesman parent study
46% risk of developing SZ if both parents have SZ
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Kendler et al
18x higher risk of developing SZ if close family member has it
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Gottesman twin study
48% risk of SZ if MZ twin has it, 17% if DZ twin has it
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Rosenthal quadruplet study
All developed SZ but were all abused
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Tienari adoption
10.3% of adopted children with SZ parents developed SZ even in a healthy household
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Ripke
SZ is polygenic. 108 genetic variations may cause SZ.
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Dopamine hypothesis
Too much dopamine=too many brain messages.
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Dopamine inhibitors....
reduce SZ symptoms, suggesting that SZ is caused by an excess of dopamine
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L-Dopa
Used in Parkinson's patients to increase dopamine. Can also cause SZ symptoms.
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Brown et al: neural correlates
SZ brains have larger ventricles=less rational thinking
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Buchsbaum: smaller frontal lobes
SZ brains have smaller frontal lobes=less higher thinking, less of a grip on reality
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Young et al: brain abormality
The more severe the brain abnormality, the more severe the SZ symptoms
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Juckel et al: less motivation
Less activity in the area of the brain where motivation is controlled
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Castner at al: fetal monkeys
Fetal monkeys exposed to damaging x-rays, developed SZ symptoms in their later life
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Bateson's double bind theory: psychological explanation of SZ
Parents giving a child mixed messages eg. asking for affection but rejecting it when it is offered
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Wynne: Deviant communication
Replacing a child's own emotions with something else eg. 'you're not sad, you're just tired'
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Lidz: Marital schizm and skew
Divorced parents communicating negatively about each other to the child, but scolding the child for communicating in similar ways
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The Schizophrenogenic mother
Dominant, cold mother+ passive, weak father= SZ child
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Expressed emotion
,The range of feelings and emotions found in families that may reduce/increase the chance of relapse. How they talk about the patient and treat them.
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Negative elements that may increase risk of relapse
Hostility, over-emotional involvement and criticism
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Positive elements that may reduce risk of relapse
Helpfulness, warmth and healthy emotional involvement
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92% of patients relapse if....
Not on medication and are exposed to over 35 hours of negative expressed emotion a week
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Chlorpromazine
Blocks dopamine receptors in the brain, reduced responsivity to external stimuli, alleviates some positive symptoms
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Clozapine
Blocks dopamine and serotonin, improves mood and cognitive functioning, reduces some negative symptoms
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Risperidone
Reduces serotonin and dopamine. Fewer negative side effects.
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Pre-frontal lobotomy (1935s-50s)
Cut connections between frontal lobes and the rest of the brain. Believed to cut out 'fixed thoughts'
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Token economies
Used to reward patients for good behaviour. Used in psychiatric hospitals
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Criticisms of token economies
Desirable behaviour dictated by other people. May just be used to make patients more manageable. Can make patients dependent.
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Aylton and Azyrin: token economies
SZ women did do more work when in a token economy system, but this doesn't mean they got better.
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Family therapy
Aims to improve communication between SZ patients and their family. Drastically reduces chance of relapse.
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Pharaoh et al: why family therapy works
Forms an alliance between family and SZ patient, reduces stress of caring for SZ patient, improves ability to solve problems, reduces anger/guilt and improves balance and improves attitudes towards SZ
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CBT and SZ
Aims to challenge negative thoughts, change unhealthy thinking and challenge distorted illusions
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CBT: how it works
May help reduce hallucinations if root cause can be found, helps identify irrational thinking, draws links between behaviours and thoughts
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Personal therapy
Provides range of coping techniques, learn relaxation techniques and distracts from intrusive thoughts
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Turkington et al: personal therapy
Personal therapy aims to get to the root of why SZ patients think the way they do
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Rosenhan: the issue of diagnosing SZ
8 people went to a psychiatric institutions and said they were having auditory hallucinations. All were admitted to the institutions, even though they did not really have SZ
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Rosenhan: time at the institution
When participants tried to tell nurses that they were there because it was a study, they were told they were delusions of grandeur. Nurses ignored patients 88% of the time.
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Rosenhan: after the institution
Said he would send an institution fake patients, and the institution said they had identified all of them, when Rosenhan hadn't sent any patients at all
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Cultural bias in SZ
African Americans/Caribbeans are 3-5x more likely to be diagnosed with SZ and institutionalised
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Deviation from social norms and cultural bias (SZ)
It is normal in some cultures to see dead people for 2 weeks after they have died. In Western culture, this would be seen as abnormal hallucination.
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Gender bias and SZ
More men are likely to be diagnosed with SZ than women. Mentally healthy behaviour is seen as healthy male behaviour. Women can mask their symptoms more, and men are more likely to have negative symptoms.
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Loring and Powell: SZ and gender bias
Psychologists are more likely to diagnose SZ if they know the patient is male
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Symptom overlap
SZ and bipolar disorder are very similar and their symptoms often overlap. Some psychiatrists think they are the same disorder as they share 3 out of 7 of the same genes. Some people with DID have more SZ symptoms than people with SZ.
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Card 2

Front

SZ symptoms don't get progressively worse, so it can't be like early onset deprivation

Back

Bleuler

Card 3

Front

1%

Back

Preview of the back of card 3

Card 4

Front

Late teens/early 20s

Back

Preview of the back of card 4

Card 5

Front

6 months

Back

Preview of the back of card 5
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