Schizophrenia

What is schizophrenia?

-affects around 1% of the population, interfere severly with everyday life meaning often end up hospitalised or homeless, men>women, city>country, working-class>middle-class

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What are the two different classification systems?

The ICD-10 and the DSM-5. Schizophrenia doesn't have a single defining factor, more of a cluster of symptoms that appear unrelated

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What is the ICD-10?

Two or more NEGATIVE symptoms for diagnosis, recognises different sub-types such as paranoid schizophrenia which is characterised by powerful delusions and hallucinations

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What is the DSM-5?

One POSITIVE symptom needed for diagnosis, speech poverty as a positive, sees it as just one disorder

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What are the positive symptoms? (Additional experience beyond normal)

Delusions = irrational beliefs, religious figures such as Jesus, thinking you are going to be persecuted. Hallucinations = unusual sensory experiences, can be any sense, some are related to the environment but some have no relation to the environment

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What are the negative symptoms? (loss of a usual ability and experiences)

Avolition = lack of motivation, find it difficult to keep up with goal related activities. Speech poverty = thoughts loosely connected, no coherence, gaps in speech.

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How does the diagnosis of schizophrenia lack reliability?

Inter-rater reliability - if two assessors agree, should come to the same diagnosis. Cheniaux: two psychiatrists independantly diagnose. DSM= 26 and 13, ICD= 44 and 24. poor inter-rater reliability.

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How can co-morbidity be used as an evaluation?

Two or more conditions occuring at once. Could just be a single condition. 50% = depression and 47% substance abuse. Shows better as one condition? Shows bad at diagnosing?

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How can gender bias be used as a evaluation?

Men are more genetically vulnerable to develop schizophrenia. Females function better than men so might not be diagnosed. Better inter-personal functioning may bias practioner to under diagnose as it is masked, or symptoms seem too mild to diagnose

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(Biological)Genetic Basis - What are individual genes associated with? What is polygenic? How is this visible?

A small increased risk of inheritance however it appears polygenic - requires a number of different factors to work in combination. Visible when studying concordance rates between twins, siblings and parents

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(Biological)Genetic Basis - What did Gottesman find a similarity between?How do Adoption Studies support the Genetic Basis?

Genetic similarity and the risk of schizophrenia. Children of schizophrenia sufferers are still at risk even if adopted into a family of non sufferers.

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(Biological)Genetic Basis - What was the large study done by Ripke?

Considered genome-wide data of 37,000 patients and 113,000 controls, found genes associated with increased risk included those coding for the function of neurotransmitters such as dopamine.

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(Biological)Dopamine Hypothesis - What is Dopamine a type of?

Neurotransmitter, seems to work differently in the brain of a patient with schizophrenia

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(Biological)Dopamine Hypothesis - What was the original version of the Dopamine Hypothesis?

Hyperdopamineria in the subcortex - focused on high levels or activity of dopamine in the subcortex, like the excess of dopamine receptors in Brocas area responsible for speech production

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(Biological)Dopamine Hypothesis - What is the recent version of the Dopamine Hypothesis?

Hypodopamineria in the cortex - focused on abnormal dopamine systems in the cortex, like low dopamine levels in the prefrontal cortex responsible for thinking and decision-making

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(Biological)Dopamine Hypothesis - What dopamine agonists?How do antipsychotic drugs support the Dopamine Hypothesis?

A chemical that increases dopamine levels such as amphetamines. Antipsychotics reduce dopamine activity and reduce schizophrenic symptoms.

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(Biological)Neural Correlates - What are neural correlates?

Measurements of the structure or function of the brain that correlates with an experience.

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(Biological)Neural Correlates - What are the neural correlates for negative symptoms?

Abnormal activity in the ventral striatum, involved in the anticipation, have been found in people suffering from Avolition

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(Biological)Neural Correlates - What are the neural correlates for positive symptoms?

Reduced levels of activity in the superior temporal gyrus and the anterior cingulate gyrus (involved identifying if a pre-recorded voice is theirs or not) have been found in people suffering auditory hallucinations

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(Biological)Neural Correlates - What is the problem with Causation?

It could be the low levels of activity in the ventral striatrum is causing the negative symptoms, or the negative symptoms are causing the low activity? It could even be another factor that is causing both

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(Biological)Neural Correlates - What is a strength of the Methodology used in neural correlates?

The research used was conducted in a lab and used scientific methods such as brains scans that are reliable as they are real results and measurements that cant be faked, scientific studies also have high control and can control extraneous variables

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(Psychological)Family Dysfunction - What is Family Dysfunction?

Psychologists attempted to link schizophrenia and adult experiences of living in a dysfunctional family

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(Psychological)Family Dysfunction - What is the Schizophrenic Mother?

Suggested by Fromm-Reichmann who said her patients spoke of a particular type of parent in childhood. Cold,rejecting, tends to create a family climate characterised by tension and secrecy,leading to distrust that later develops into paranoid delusion

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(Psychological)Family Dysfunction - What is the Double-Bind theory?

Suggested by Bateson, agreed family climate and communication style is important in the development. Feels trapped where they fear doing wrong but recieve mixed messages, unable to comment on unfairness of situation.Punished with withdrawal of love

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(Psychological)Family Dysfunction - What is the Double-Bind theory?

Leaves them with a view of the world as confusing and dangerous this is reflected in symptoms like disorganised thinking.

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(Psychological)Family Dysfunction - What is Expressed Emotion?

The level of emotion, in particular negative, expressed towards a patient by their carers. This is a serious source of stress.. Verbal Critiscm, Hostility, Emotional-Overinvolvement.

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(Psychological)Cognitive - What is the Cognitive Explanation?

Schizophrenia is characterised by disruption to normal thought processing. As we have seen, reduced processing in parts of the brain occurs within the schizophrenia. This suggests that cognition is likely to be impaired

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(Psychological)Cognitive - What are the two kinds of Dysfunctional thought processing?

Metarepresentation -the cognitive ability to reflect on thoughts and behaviour. Central-Control - The cognitive ability to suppress automatic responses while we perform deliberate actions instead.

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(Psychological)Evaluation - What did Harrington say about the Schizophrenic Mother theory?

'crazymaking characteristics' is not helpful and there is almost no evidence to support this Parents who have already suffered at seeing their childs descent and who are likely to bear lifelong responsibility for their care, underwent further trauma

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(Psychological)Evaluation - How did Reads study support Family Dysfunction?

Reviewed 46 studies. 69% women inpatients with diagnosis had history of physical or sexual abuse. For men the figure was 59%. Adults with insecure attachments > schizophrenia. Caution as experiences are gathered reterospectively.

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(Psychological)Evaluation - How did Stirlings research provide strong evidence for dyssfunction information processing?

Compared 30 schizophrenia patients and 18 non patient controls on a range of cognitive tasks including the stoop test, and found patients took twice as long as non patients however cognitive can explain the causes of current symptoms not the origin.

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(Biological Therapy)What are drug therapies?

Most common treatment, tablets, syrup, injections, short term with no return of symptoms or long term for life.

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(Biological Therapy)What are Typical Antipsychotics?

Chlorpromazine. Doses gradually build to 800mg. Associated to the Dopamine Hypothesis, act as antagonists in dopamine system by blocking dopamine receptors. Syrup often used as it is absorbed more quickly

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(Biological Therapy)What are the side effects of Chlorpromazine?

Short term = dizziness, sleepiness. Long term = Involuntary facial movements and can often be fatal.

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(Biological Therapy)What is the evidence for effectiveness for Typical drugs?

Thornley reviewed studies comparing Chlorpromazine to a placebo drug. 13 trials with 1121 patients showed it was associated with better functioning, reduced symptom severity and relapse rate.

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(Biological Therapy)What are Atypical Drugs?

Aim to maintain or improve the effectiveness of supressing symptoms, minimise side effects

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(Biological Therapy)What is Clozapine?

Used when other drugs fail - has risks linked to serious blood disorders. Only available in small syrup or tablet doses due to fatal side effects.

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(Biological Therapy)How does Clozapine work?

Binds to receptors in the same way that chlorpromazine does. Acts on serotonin and glutamate receptors. Believed to improve mood, reduce anxiety and improve cognitive functioning. Prescribed when risk of suicide is high.

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(Biological Therapy)What is Risperidone?

Aimed to reduce side effects of clozapine. Binds more strongly to Dopamine receptors so is more effective in smaller doses, still includes involuntary movements blood clots and diabetes.

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(Biological Therapy)What is the evidence for effectiveness for Atypical drugs?

Meltzer found clozapine is more effective than typical and other atypical drugs. Effective in 30-50% of cases where other antipsychotics have failed. Studies show different medication works for different patients but generally reasonably effective.

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(Biological Therapy)How does the use of antipsychotics depend on the dopamine hypothesis?

Original dopamine hypothesis is not a complete explanation. Dopamine levels in parts of the brain other than the subcortex are too low rather than high. Not clear how antipsychotics which are dopamine antagonists can help when they reduce activity.

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(Psychological Therapy)What is Cognitive Behvaiour Therapy?

Commonly used, 5-20 sessions, groups or individual. Aim is to help identify irrational thoughts and try change them. Argument or discussion of how likely belief is true, wont get rid of symptoms but will help patients be able to cope with them

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(Psychological Therapy)What is Cognitive Behaviour Therapy

Make sense of delusions and hallucinations impact on their feeling and behaviour.

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(Psychological Therapy)Evaluation - What was the research that provided evidence for effectiveness for CBT?

Jauhar - reviewed the results of 34 studies of CBT for schizophrenia and found a significant but small effect on both positive and negative symptoms

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(Psychological Therapy)What is Family therapy?

Families rather than individual basis. Aims to improve quality of communication and interaction between family members. Some see family as the root cause. Most now more concerned with preventing expressed emotion.

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(Psychological Therapy)Identify 3 strategies used by Therapists in family therapy?

Form a therapeutic alliance with all family. Help families achieve a balance between caring for a relative and maintaining own life. Reduce stress of caring for a relative

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(Psychological Therapy)How does these strategies work?

Reducing stress and levels of expressed emotion, helps with coplying with medication, reduce relapse rates

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(Psychological Therapy)Evaluation - What was the research that provided evidence for effectiveness for Family Therapy

In a review by Pharoah, found that family therapy reduces hospital admissions but the overqall evidence base is very weak due to inconsistency of results and quality evidence

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(Psychological Therapy)What are token economies?

Reward systems to manage behaviour, in particular those who have developed maladaptive patterns through spending long periods in psychiatric hospitals - poor hygiene. Modifying bad habits gives better quality of life. more likely they can live outsid

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(Psychological Therapy)What is the idea behind token economies?

'tokens' given immediately when they carry out desireable behaviour that has been targeted for reinforcement. Immediacy reduces 'delay discounting' reduced effect of delayed reward. No value but can be swapped. Operant condit. secondary reinforcers

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(Psychological Therapy)Evaluation - What research didnt provide evidence for effectiveness for token economies?

Only three studies where patients had been randomly allocated with a totaal of only 110 patients. Only 1/3 showed improve symptom and none showed useful info about behaviour change

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(Psychological Therapy)Evaluation - treatments improve quality of life not symptoms

CBT - allow to make sense and challenge symptoms. Family therapy - reduces stress of living with someone with disorder. Token - behaviour more socially acceptable. Do not cure schizophrenia

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(Psychological Therapy)Evaluation - What are the ethical issues associated with this

Token - privelges and services become available to those with mild issues and less for those with severe, hard to comply with desirable. CBT - challenges persons paranoia, challenge freedom of thought.

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(Interactionist approach)What is the interactionist approach?What is Diathesis-Stress Model?

Acknowledges that there are biological, psychological, societal factors. Diathesis= vulnerbility Stress = negative psych experience. Says both needed for schizophrenia

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(Interactionist approach)What did the original Diathesis-Stress model by Meehl say?

Diathesis was genetic, single 'schizogene'. If they didnt have the schizogene then no amount of stres would cause schizophrenia

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(Interactionist approach)What does newever versions say?

Diathesis is in form of multiple genes. Trauma as cause not trigger. Early trauma increases risk. Parenting as important. 19000 Finnish mothers adopted children, childrearing techniques

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(Interactionist approach)How does more recent research use Cannabis?

Cannabis, stressor, increases schizophrenia x7. Cannabis interferes with the dopamine system. Childhood sexual trauma was vulnerability. Cannabis was stressor.

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(Interactionist approach)What is INteractionist treatments?

Combines antipsychotic medication and psychological therapies, CBT. UK = standard practise to combine USA= Slower adoption. Unusual to use only psychological, most carried out with use of medication aswell

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(Interactionist approach)What is the research for importance of vulnerability and trugger?

19000 finnish mothers with schizophrenia. Adoptive parents assessed for child rearing. High levels of conflict implicated in development only for those with genetic vulnerability.

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(Interactionist approach)In what was was the original diathesis-stress model oversimplified?

Multiple genes, each have a small effect. Stress coes in many forms, not limited to dysfunctional parenting. Model has been rewritten to address these issues

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(Interactionist approach)What are the therapies that have been developed because of interactionist approach?

Cant use cobination of treatments without adoptingthis. 315 patient, med+cbt, med+support consel, control. Lower symptom incomb. no diff in readmission. Clear practical adantage.

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Schizophrenia

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