Schizophrenia

Positive symptoms (definition)

reflect an excess/distortion of normal function (added)

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Positive symptoms (examples)

delusions, experiences of control, auditory hallucinations, disordered thinking, catatonic behaviour

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Negative symptoms (definition)

reflect a diminuition/loss of normal function (taken away)

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Negative symptoms (examples)

affective flattening, alogia/speech poverty, avolition, caratonic behaviour

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Primary impairments

symptoms of schizophrenia

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Secondary impairments

results of primary impairments e.g. dependence, poor coping, unemployment, social drift

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Conditions for DSM diagnosis

2+ symptoms for at least 1 month in a 6 month period, interferes with normal functioning (e.g. work, interpersonal relations etc.)

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DSM types of schizophrenia

paranoid, catatonic, disorganised, undifferentiated, residual

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Conditions for ICD diagnosis

1+ section 1 symptoms (thought echo, delusions, hallucinatory voices) OR 2+ section 2 symptoms (persistent hallucinations, neologisms, catatonic behaviour, negative symptoms)

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Evaluation of Schizophrenia

no agreement on symptom distinctions, symptoms should be viewed on a continuum, umbrella term for many illnesses, case study (Heather)

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Reliability of diagnosis

can scientists agree on the same diagnosis (classification)?

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Inter-rater reliability (Beck et al.)

inter-rater reliability between 2 psychiatrists was 54%

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Validity of diagnosis

can scientists agree on what schizophrenia is (characteristics/symptoms)?

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Co-mornidity/symptom overlap

2 separate disorders diagnosed e.g. depression, anti-NDMA

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Cultural Relativism

Asian countries - no expression of emtional turmoil (contrast to Aeabic countries), overt emotional behaviour regarded as abnormal

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Language difficulties

clinician and patient may not speak the same language, things may be "lost in transaltion", could lead to inappropriate/no treatment

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Rosenhan study

used clinical characteristics (all bar 1 pp diagnosed), however it shows that symptoms can be faked

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Dopamine Hypothesis

more dopamine produced, high level of D2 receptors, increased activity of substantia nigra, opens up pathways (e.g. between Broca's area and auditory cortex - auditory hallucinations)

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Neural correlates

decreased activity of ventral striatum increases the severity of avolition (activity can be increased with drug treatment)

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Genetics

polygenic but main gene is the TOP 3 B gene, runs in families, identical twins are 48% likely to develop schizophrenia

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Family Study concordance rates

children with 2 schiz parents - 46%, 1 schiz parent - 13%, 1 schiz sibling - 9%

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Twin study concordance rates

MZ - 40.4% (WHO 49%), DZ - 7.4% (WHO 17%)

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Adoption Study concordance rates

schiz biological mother - 7%, non-schiz biological mother - 2%

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Schizophrenogenic mother

cold, dominant, create conflict, rejecting, overprotective, self-sacrificing, moralistic about sex, fearful about intimacy - induces positive symptoms

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Schizophrenogenic mother STRENGTH (Rosca)

high positive correlation of insecure attachment and schizophrenia, avoidant - positive and negative symptoms, resistant - only positive symptoms

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Schizophrenogenic mother WEAKNESS

concluded there was no such thing - only a small % of women fit the criteria (had produced schizophrenic children)

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Double-Bind

contradictory information (punished for doing what was asked) - child loses grip on reality leading to negative symptoms e.g. affective flattening

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Double-Bind Bateson factors

2+ people, repeated affect, negative consequences (primary injunction), positive behaviour (secondary injunction)

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Double-Bind STRENGTH

schiz patients reported a higher recall of double-bind statements, HOWEVER may not be reliable as recall is affected by schizophrenia

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Double-Bind WEAKNESS

no difference in parental commuication in families with a schiz child in comparison to 'normal' families

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Expressed Emotion (EE)

critical comments (tone, content), hostility (anger,rejection), emotional over-involvement in patients life (needless self-sacrifice)

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EE STRENGTH

58% of schiz patients relapsing had families with high EE

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EE WEAKNESS

unclear whether EE is a causal agent in relapse rate or just a reaction to parents behaviour

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Family dysfunction STRENGTH

adults with insecure attachments are more likely to develop schiz

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Family dysfunction WEAKNESS

'parent blaming' - parents already suffereing enough dealing with their schiz child undergo further trauma by recieving blame for the condition (could be displaced onto the child)

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Assumptions of cognitive approach

defective filtering mechanisms and processing, cognitive deficits due to physiological abnormalities, schizophrenics can't filter out irrelevant auditory stimuli

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Frith's model

preconscious and conscious, attention filter breaks down in schiz and unimportant information is seen as important - causes delusions and auditory hallucinations (misinterpret non-speech sounds as voices)

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Hemsley's model

schemas aren't activated in schizophrenics - meaningless information seems highly relevant, internal speech and thoughts are experienced as auditory hallucinations

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Cognitive approach STRENGTH (Meyer-Linderberg et al.)

working memory dysfunction is associated with cognitive disorganisation (caused by excess dopamine in PFC), lack of distinction between PL and VS leads to auditory hallucinations), underlying biologial factors involved

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Cognitive approach WEAKNESS

mainly explains positive symptoms (not negative), can't explain why hallucinations are negative/abusive/suggest reprehensible acts

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Typical antipsychotics

dopamine antagonists, temporary effect only work on positive symptoms, e.g. chlorpromazine

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Typical antipsychotics STRENGTH (Sampath et al.)

33% relapsed compared to 75% on placebo

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Typical antipsychotics WEAKNESS

many side effects - 30% get TD, 75% of cases are irreversible

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Atypical antipsychotics

act on dopamine/acetylcholine/serotonin, treat positive and negative symptoms, e.g. clozapine

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Atypical antipsychotics STRENGTH (Scholer et al.)

75% of patients experienced at least 20% reduction in their symptoms

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Atypical antipsychotics WEAKNESS

expensive - £1500 per year per patient

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Drug therapy STRENGTH

positive application - improves quality of life as patients can live independently outside of an institution

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Drug therapy WEAKNESS

don't cure schizophrenia, just relieve the symptoms

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CBT

used alongside medication (bring patient back to reality), 1. develop trusting relationship, 2. patient explains experiences, 3. uncover patterns in the experiences, 4. challenge beliefs

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CBT STRENGTH

2118 patients didn't show statistically different differences between CBT and standard care (related to mortality, relapse, treatment adherence)

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CBT WEAKNESS

palliative treatment not a cure - uncertain whether it is caused by cognitive remodelling or relationship between the client and tehrapist

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Perceived Barriers to Psychological Treatment (PBPT)

cost, time constraints, availability of services

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Systemic therapy

looks at relationships between individuals as part of a unit and how systems work together e.g. family therapy

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Family therapy

involves psychoeducation, providing the whole family with coping strategies and training to recognise early signs of relapse

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Family therapy STRENGTH (NCCMH)

family intervention relapse rate - 26%, standard care - 50%, also reduction in hospital admissions and severity of symptoms during and following intervention

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Family therapy STRENGTH (Garty et al.)

family intervention relapse rate - 25%, medication only - 62%

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Family therapy WEAKNESS

alongside medication - hard to distinguish the effects of family therapy from the medication (low validity)

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Token economy

based on operant conditioning, removes reinforcers of undesirable behaviour, positively reinforce desired behaviour

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Token economy STRENGTH (Ayllon and Azrin)

tokens were effective in eliminating undesired behaviours and maintaining desired behaviours

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Token economy WEAKNESS

only changes observable behaviour - can't read patients minds and they may end up hiding delusions/auditory hallucinations

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Get Revising

Schizophrenia

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