Schizophrenia flashcards

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What is schizophrenia?
A severe mental illness where contact with reality and insight are impaired
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Is scizophrenia more common between which of each pair: 1. men or women 2. working class or middle class 3. countryside residents or city residents
Men, working class and city residents
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How do we classify schizophrenia?
ICD-10 and the DSM-5
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How does the ICD-10 and the DSM-5 differ in classification of schizophrenia?
In the DSM-5 positive symptoms must be present for diagnosis whereas in the ICD-10 two or more negative symptoms are sufficient enough for diagnosis . The ICD-10 also recognises a lot of subtypes of schizophrenia
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What are the subtypes of schizophrenia?
Paranoid schizophrenia. Disorganized (hebephrenic) schizophrenia. Catatonic schizophrenia. Undifferentiated schizophrenia. Residual schizophrenia
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What is paranoid schizophrenia?
Type of schizophrenia characterized by grandiosity, suspiciousness, and delusions of persecution, often with hallucinations.
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What is disorganized (hebephrenic) schizophrenia?
Frequent incoherence, disorganized behavior associated features xtreme social withdrawal, grimacing, mannerisms, mirror gazing, inappropriate giggling
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What is catatonic schizophrenia?
involve motoric immobility, excessive motor activity
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What is undifferentiated schizophrenia?
he individual exhibits the characteristic symptoms of schizophrenia but the overall picture is not one of catatonic type, paranoid type, or disorganized type schizophrenia.
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What is residual schizophrenia?
individual has suffered an episode of schizophrenia but there are no longer any delusions, hallucinations, disorganized speech or behavior. Residual symptoms are seen in the form of negative symptoms
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What are positive symptoms of schizophrenia?
Hallucinations - unusual sensory experiences. Delusions - irrational beliefs
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What are negative symptoms of schizophrenia?
Avolition - finding it difficult to keep up with goal-orientated behaviour. Speech poverty - reduction in amount or quality of speech
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Using the ICD and DM was inter-rater reliability found to be poor or substantial?
Poor - 2 psychiatrists independently diagnosed 100 patients one diagnosed 26 with the DSM and 44 with the ICD whereas the other diagnosed 13 with the DSM and 24 according to the ICD
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Are there validity issues in the diagnosis of schizophrenia?
Yes - the study discussed on the previous card that using both diagnosis systems produced different results and so there is no criterion validity (do different assessment systems reach the same diagnosis
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What is co-morbidity and how is it a problem for the diagnosis of schizophrenia?
Co-morbidity is where two conditions occur together. If conditions have high co-morbidity rates then this questions its validity of being two separate conditions. In a study depression, OCD and PTSD were commonly diagnosed alongside schizophrenia
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How does symptom overlap cause a problem for the diagnosis of schizophrenia?
If there is an overlap between symptoms in schizophrenia and symptoms in bipolar disorder it questions the validity of the diagnosis and classification of the disorders
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There are 3 theories within the biological explanation of schizophrenia. What are they?
1. Dopamine hypothesis 2. Neural correlates 3. Geneticc basis
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What are the two main assumptions in the genetic basis of schizophrenia?
1. Schizophrenia runs in families 2. Candidate genes are associated with the risk of inheritance
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Why is the idea that schizophrenia runs in families a weak concept?
It is hard to remove nature and nurture.
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What is some evidence for the idea that schizophrenia runs in families?
Twin studies show that in MZ twins the concordance rates are much higher than in DZ twins. Adoption studies also shows that children from a biological parent with schizophrenia are at a heightened risk even if adopted into a family with no history.
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The candidate genes concept states that schizophrenia is polygenic. What does polygenic mean?
It requires a number of different candidate genes
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The candidate genes concept also states that schizophrenia is aetiologically heterogeneous? What does this mean?
Different combinations of genes can lead to the condition in one person whereas a different combination causes the condition in another person.
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What did they find in the study of candidate genes?
Genes associated with the risk of schizophrenia included those which coded for the functioning of neurotransmitters including dopamine
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What is the dopamine hypothesis?
1. Neurotransmitters appear to work differently in patients with sz in particular dopamine which is involved in brain systems that are implicated in the symptoms of sz.
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What are the 2 areas of the brain that the dopamine hypothesis highlights?
Subrotex and prefrontal cortex
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What happens in the subcortex of a schizophrenic individual?
HYPERDOPAMINERGIA - high levels of dopamine in the subcortex may be associated with speech poverty or auditory hallucinations
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What happens in the prefrontal cortex of a schizophrenic individual?
HYPODOPAMINERGIA - low levels of dopamine in the prefrontal cortex are involved in the negative symptoms of schizophrenia
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What is some evidence for the dopamine hypothesis?
Dopamine agonists such as amphetamines that increases the levels of dopamine make symptoms of schizophrenia worse and produce schizophrenic-like symptoms in non sufferers
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What is some evidence that disproves the dopamine hypothesis?
Some of the genes identified in the candidate genes study shows that there are other neurotransmitters involved such as glutamate
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What are neural correlates?
Patterns of structure or activity in the brain that occur in conjunction with an experience and may b implicated in the origins of that experience
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What are the neural correlates of positive symptoms of schizophrenia?
Patients experiencing auditory hallucinations had lower activation levels in the superior temporal gyrus and anterior cingulate gyrus
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What are the neural correlates of negative symptoms of schizophrenia?
Avolition is caused by low levels of activity in the ventral striatum
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What is a problem with the neural correlates concept of schizophrenia?
Correlation is not causation. It could be a symptom of the condition
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How does mutation affect the genetic factors argument for schizohprenia?
If it is proven that a mutation causes schizophrenia could support the genetic factors concept as if there is an absence of history of sz and a mutation occurs to cause sz then this does not discredit the genetic factors concept.
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One psychological expanation of schizoprenia is family dysfunction. What is the schizophrenogenic mother concept?
In 1948 a doctor noted that many of her patients spoke of a particular type of parent, the schizophrenogenic mother which has the characteristics of: cold, rejecting, controlling and tends to creat a faily climate characterised by tension and secrecy
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How does the schizophrenogeneic mother create the child to become schizophrenic?
The child has distrust which leads to paranoid delusions and eventually leads to schizophrenia
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One psychological expanation of schizoprenia is family dysfunction. What is the double-bind theory of schizophrenia?
The devlopmentof schizophrenia is emphasised on the communication style of the family. The child is fearful of doing the wrong thing as when they do the wrong thing that are withdrawn from love and so their understanding of the world is confusing
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What is expressed emotion?
The level of emotion exprssed towards a patient by their carers such as verbal criticism, emotional over-involvemen and hostilitiy
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What would cognitive psyxhologust say the cause of schizophrenia is?
Abnormal information processing
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What is some proof of the cognitive explanation of schizophrenia?
Reduced processing in the ventral striatum is associated with negative symptoms and reduced processing in the temporal and cingulate gyri are associated with hallucinations
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Frith identified 2 kinds of dysfuntional thought processing, what are the two kinds?
1. Metarepresentation: ability to reflect on thoughts and behaviour. Dysfunction of this explain hallucinations and delusions 2. Central control: ability to suppress automatic responses and perform delibrate actions instead. e.g disorganised speech
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What is some supporting evidence for family dysfunction?
Read reviewed 46 studies of child abuse and schizophrenia and concluded that 69% of adult women in-patients with schizophrenia had a history of physical abuse of sexual abuse in childhood. For men the figure was 59%.
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What is the weakness of the supporting evidence discussed on the previous card?
Info about childhood expereince was gathered after the development of symptoms and the schizophrenia may have distorted patients recall of experiences - problem of validity
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What is a problem of family based explanations?
Almost no evidence to support the schizpophrenogenic mother or double bind theory.It also put a lot of pressure on parents as it shifts the blame to the mother
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What is some strong supprting evidence for dysfunctional information preocessing?
Stirling compared 30 patients with schizophrenia with 18 non-patient controls on a range of cognitive tasks such as participnats naming ink colours of colour words with an opposing colour, patients with schizohprenia took twice as long to name them.
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What is a problem with the supporting evidence discussed above?
Although it shows strong links between dysfunctional info processing and schizophrenia this doesnt show causation. It shows the cause of symptoms not the cause of schizophrenia
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What is the mpst common treatment for schizophrenia?
Antipsychotic drugs
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What are typical antipsychotics? Give an example od a drug.
The first generation of antipsychotic drugs, work as dopamine antagonists (reducing the action of dopamine by blocking dopamine receptor sites) e.g chlopromazine
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What are are 2 examples of atypical antipsychotics and how do they work?
Clozapine: binds to dopamine, serotonin and glutamate receptors. It is believed that this helps improve mood and reduce depression. 2. Risperidone: bind to dopamine and serotonin receptors more strongly that other drugs and leads to fewer side effect
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What is a problem with the atypical antipscyotic drug clozapine?
Causes a blood condition which is fatal so patients must get blood checks
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What is some evidence for effectiveness of antipsychotics?
Thornley reviewed studies that compared the effectiveness of chlorpromazine in which patients recieved a placebo. Data from 13 trials with 1121 patients showed that chlorpromazine caused better overall functioning and reduced symtom severity.
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What is some evidence that atypical antipsychotics are better than typical?
Meltzer concluded that clozapine is more effective as it is effective in 30-50% of treatment resistant cases
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What are some side effects associated with typical antipsychotics?
Dizziness, sleepiness, weight gain and itchy skin. Long term use = involunatry facial movements, NMS which can lead to high temp, delrium and coma and can be fatal
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What is a theoretical issue with the use of antipsychotics?
It relies on the dopamine hypothesis (too much dopmine in schiophrenic patients) and so all weakness on the dopamine hypothesis reflect back to the use of antipsychotic drugs
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What has been suggessted that means the drugs dont actually effect the symptoms of schizophrenia?
They have a calming effect on the patient this dosent mean that they reduce any of the symptoms.
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What is CBT?
Cognitive behaviour therapy: therapy that aims to deal with irrational thoughts.
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How does CBT help in sczhizophrenia?
Helps patients to understand their delusions & hallucinations
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Why is family therapy used in families with a schiophrenic member?
It aims to improve the quality of communication and interaction between family members as the family may be the root of the condition or just for reducing stress as this may increase the patients chance of relapse. It aims to reduce expressed emotion
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What are token economies?
reward systems used to manage the behaviour of patients, modifying bad habits and improving the patients quality of life
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How do token economies work?
Patient is given a token (fake money) for good behaviour used for reinforcement. These tokens can be used for rewards, based on operant conditioning. Tokens are seconday reinforcers.
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What is the effectiveness of these psychological therapies?
CBT: out of 34 studies the therapy had a significant effect on both positive and negative symptoms. Family: weak evidene for effectiveness. Token econmonies: 1 of 3 studies showed improvments of symptoms
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What is a negative of these psychological therapy?
Treatments involve quality of life but do not cure it.
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How do psychological treatments raise ethical issues?
Token economy: privileges become available to patients with mild symptoms and not patients with severe symptoms. CBT also challenges the patients freedom of thought
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What is the interactionist approach?
Acknowledging that a range of factors are involved
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What is a model that explains the interactionist approach?
Diathesis-stress model
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What is the diathesis stress model?
Diathesis means vulnerability and stress is a negative psychological experience
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What treatment does the diathesis-stress model suggest?
Combining antipsychotics and CBT
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What is some evidence for vulnerability and trigger?
Children adopted from 19,000 finnish mothers w/ schizophrenia were followed up. Adoptive parents were judged on the child-rearing style high criticism & low empathy were implicated in development of schiz but only if the child had high genetic risk
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What is some support for the effectiveness of the combined treatment of drugs and CBT?
315 patients were randomly allocated to a medication + CBT group, medication + supportive conselling or a group control. Patients in the two combination groups showed lower symptoms but there was no difference in hospital readmission rastes
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Why might the effectiveness of combined therapy be a weakness for the interactionist approach?
Just because they work better together does not be the interactionist approach is correct. This is called treatment-causation fallacy
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Card 2

Front

Is scizophrenia more common between which of each pair: 1. men or women 2. working class or middle class 3. countryside residents or city residents

Back

Men, working class and city residents

Card 3

Front

How do we classify schizophrenia?

Back

Preview of the front of card 3

Card 4

Front

How does the ICD-10 and the DSM-5 differ in classification of schizophrenia?

Back

Preview of the front of card 4

Card 5

Front

What are the subtypes of schizophrenia?

Back

Preview of the front of card 5
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