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  • Created by: Kerry
  • Created on: 10-04-15 12:20
What are clinical characteristics according to?
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What are positive symptoms?
Reflect an excess or distortion of normal functions
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What are the 4 positive symptoms?
Delusions, Experiences of control, Hallucinations and Disordered thinking
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What are delusions?
Bizarre beliefs, seem real to the person but arent real. Could be inflated beliefs about power
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What are experiences of control?
Person believes they are under the control of an alien force that has invaded their mind and body
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What are hallucinations?
Bizarre, unreal perceptions of environment, usually auditory - hearing voices. Can also be visual, olfactory or tactile
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What is disordered thinking?
Feeling that thoughts have been inserted or removed from the brain. Characterised by incoherent and loosely associated speech
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What are negative symptoms?
Reflect a loss of normal functions, often appear during periods of low positive symptoms
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What are the 3 negative symptoms?
Affective flattening, Alogia and Avolition
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What is affective flattening?
Reduction in range and intensity of emotional expression, includes face expression, voice tone and eye contact
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What is alogia?
Poverty of speech, characterised by less speech fluency and productivity. Thought to reflect slowed or blocked thoughts
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What is avolition?
Reduction or inability to initiate or persist in goal directed behaviour, the individual may sit around for hours doing nothing
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What are the 5 types of schizophrenia?
Catatonic, paranoid, residual, disorganized and undifferentiated
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What is reliability in terms of schizophrenia diagnosis?
The consistency of a measuring instrument to assess the severity of schizophrenic symptoms
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What is reliability divided into?
Inter-rater - whether 2 independent assessors give same diagnosis and test-retest reliability - whether tests that deliver diagnosis are consistent over time
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What was produced to try and improve inter-rater reliability?
The DSM-III in 1980, Carson reviewed it and claimed it had fixed the problems of inter-rater reliability once and for all. Should lead to greater agreement over diagnosis
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What did Whaley et al claim?
Claims of good inter-rater reliability may be exaggerated, found inter-rater reliability using DSM-III had a correlation in diagnosis of 0.11
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What did Copeland find?
There are cultural variations in inter-rater reliability. 69% of US and 2% of UK psychiatrists diagnosed an individual with schizophrenia after being presented with their description
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What is validity?
The extent that a diagnosis presents something real and distinct from other disorders and measures what it claims to measure
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What are the 3 issues affect validity?
Comorbidity, positive or negative symptoms and prognosis
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What is comorbidity?
Refers to the extent that 2 or more conditions co-occur, psychiatric comorbidities are common in schizophrenic sufferers. Can include substance abuse, anxiety and depression. This creates difficulties in diagnosis of a disorder and advising treatment
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What did Weber et al find?
Comorbidity may cause poor level functioning found in many schizophrenics. Found patients with schizophrenia had lower standard or medical care because of comorbid medical conditions, this affected prognosis
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What else is the problem with comorbidity?
Schizophrenia shares some symptoms with other disorders, e.g. bipolar disorder sufferers also experience hallucinations and delusions. For diagnosis to be valid, would expect to see schizophrenia as only disorder with these symptoms in the DSM
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What is the issue around positive and negative symptoms?
Klosterkotter et al assessed 489 admissions to psychiatric unit to determine if positive or negative symptoms were more valid for diagnosis. Found positive symptoms more useful for diagnosis than negative
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What did Cochrane find relating to cultural bias?
Found people of afro-caribbean origin are 7x more likely to be diagnosed with schizophrenia than white or asian. Could be due to psychiatrists being mainly white and middle class. Misunderstand cultural/social situations
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How does prognosis affect validity?
People diagnosed with schizophrenia rarely share the same symptoms or the same outcomes
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What did Bentall et al find about predictive validity?
20% of patients recover to normal functioning, 40% never recover. Diagnosis of schizophrenia therefore has low predictive validity and doesnt help deal with the causes of schizophrenia
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What 3 types of studies are used to investigate the genetic basis of schizophrenia?
Twin studies, adoption studies and family studies
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What was Grottesman's family study?
Found schizophrenia is more common among biological relatives with schizophrenia than the general population. The greater the degree of genetic relatedness, the greater the chance of developing schizophrenia. CR as high as 46% for 2 parents with it
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What is negatives of this study?
Could be due to factors other than genetics, fact schizophrenia runs in families could be due to rearing patterns. Negative emotional climates have been shown to lead to stress beyond coping mechanisms - triggers schizophrenic episode
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What was Joseph's twin study?
MZ (share 100% of genes) DZ (share 50% of genes). Meta analysis and found concordance rates for schizophrenia in MZ twins was 40.4% and in DZ it was 7.4%. Suggests schizophrenia due to genes
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What is a negative of this study?
Difference in CR's could be due to environmental differences, Joseph stated that MZ twins tend to be treated similarly and have a similar environment compared to DZ twins
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What was Tienari et al's adoption study?
164 adoptees - biological mothers had schizophrenia, 197 - adoptees - didnt have schizophrenia. 11 of schizo group also diagnosed with schizophrenia and 4 of control group diagnosed. Suggested that link between genes and schizophrenia was confirmed
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What is a problem with adoption studies?
Selective placements - adoptive parents likely to know genetic background of child, therefore children with schizophrenic mother may be raised in different environment to child without schizophrenic mother
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What are methodological issues with genetic studies?
Definition of schizophrenia - definition has to be broadened to include non-psychotic schizophrenia to show a link with genes
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What is the dopamine hypothesis?
Neurones in the brain that transmit dopamine fire too easily or too often, leads to excess dopamine in the brain and symptoms of schizophrenia
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What was found in schizophrenics?
Have abnormally high levels of D2 dopamine receptors, causes more dopamine neurones to fire.
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What does dopamine do? What problems may this cause according to Comer?
Important role in guiding attention, disturbances in dopamine levels may lead to problems in perception and thought associated with schizophrenia
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How are amphetamines related to the dopamine hypothesis?
Amphetamines are dopamine antogonists - stimulate dopamine. Causes synapse to be flooded with dopamine leading to hallucinations and delusions - symptoms of schizophrenia
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How is Parkinson's disease related to dopamine hypothesis? (Grilly)
Low dopamine levels found in sufferers, Grilly found that patients give drug L-dopa to increase dopamine levels started to develop schizophrenic type symptoms
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How does Davis et al support the dopamine hypothesis?
Changing dopamine levels can reduce schizophrenic symptoms. Meta analysis - effectiveness of antipsychotic compared to placebo. Relapse of 55% in patients that took placebo, only 19% that took antipsychotics relapsed
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What did Haracz suggest?
High levels of dopamine a CONSEQUENCE not a cause. Reviewed post mortems and found patients with high dopamine had recieved anti-psychotics before death. Suggests high levels of dopamine could be consequence of treatment.
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Why cant dopamine be the sole cause of schizophrenia?
25% of patients dont respond well to anti-psychotic medication. Suggests excess dopamine not the single cause, something else in the brain causes schizophrenia
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What are the two types of biological therapies?
Conventional/ typical antipsychotics and unconventional/atypical antipsychotics
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What is the role of biological therapies?
Based on dopamine hypothesis - want to reduce dopamine levels in the brain so therefore reduce the symptoms of schizophrenia
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What symptoms do conventional antipsychotics focus on?
Positive symptoms like hallucinations and delusions
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What is an example of a conventional antipsychotic?
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How do conventional antipsychotics work?
Bind to D2 dopamine receptors in the brain on post synaptic neurone, dont stimulate receptors - they block their action. Therefore the dopamine levels are reduced and symptoms are reduced
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What type of drug are conventional antipsychotics?
Dopamine antagonists as they prevent dopamine action
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How did Hill suggest conventional antipsychotics lack appropriateness?
Have serious side effects - like tardive dyskinesia. 30% of people taking typical antipsychotics develop TD and in 75% of these people it is irreversible
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What did Davis et al's study suggest about the effectiveness of conventional antipsychotics?
Reviewed 29 studies, found relapse rate occurred in 55% of people on a placebo drug but only in 19% of people on the antipsychotic drug
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However, what did Vaughan and Leff suggest about the effect of other factors?
Antipsychotic medication only effective for those living in a hostile and critical environment - lower relapse rate compared to placebo. In supportive environment - no difference between drug and placebo
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What symptoms do atypical antipsychotics focus on?
Negative symptoms e.g. alogia or avolition
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How do they work?
Bind to dopamine receptors (D2) but only TEMPORARILY. They then dissociate to allow normal dopamine transmission.
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What is an example of an atypical antipsychotic?
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What other neurotransmitter do they work on as well?
The serotonin in the brain
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What did Leucht et al find about the effectiveness of atypical antipsychotics?
Meta analysis, found they only had moderate superiority over conventional antipsychotics - although they still came out as more effective
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What did Jeste et al find about the appropriateness of atpyical antipsychotics?
Found 30% of people had TD after 9 months of conventional antipsychotics, but only 5% had TD after 9 months of atypical antipsychotics.
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However, what makes them less appropriate?
Individual differences. The drugs arent appropriate for all patients, about 15% of people dont respond to atypical antipsychotics
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What does the cognitive explanation suggest is the cause of schizophrenia?
Schizophrenia is caused by faulty thinking - schizophrenics have defective processing systems for incoming stimuli. Therefore overwhelmed with sensory information and cannot process/interpret it
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What did Hemsley suggest?
Non-schizophrenic individuals give meaning to new sensory input by using previously stored subconscious information called schemas
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What isnt activated in schizophrenics?
The schemas - subjected to overload of sensory information and dont know what to attend to
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Therefore what do schizophrenics suffer?
Think superficial incidents are highly relevant, internal speech/thoughts are not recognised as this but thought to come from an external source- auditory hallucinations
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Why is the explanation valid?
Treatments based on cognitive explanation (CBT) improve schizophrenia outcomes, suggests that explanation is valid because the treatment is effective and appropriate
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What did Meyer-Lynderberg et al find?
Link between excess dopamine in prefrontal cortex and dysfunction of working memory. Working memory is associated with cognitive disorganisation - typical of schizophrenics. Supports biological factors involved with faulty information processing
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What is a negative of the explanation?
Doesnt explain cause of schizophrenia - only really explain symptoms and not why schizophrenia happens. Cant explain why voices are violent/abusive. Only explains positive symptoms and not negative symptoms like alogia
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What does the behavioural explanation suggest?
Schizophrenia isnt a mental illness with a physical cause - it is a behaviour learned from the environment
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How is it learned through operant conditioning?
Bizarre behaviour may be rewarded - positively reinforced as brings attention. Relating to "inner world" allows chance to escape real world pressures
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What does social learning theory suggest?
Individual observes schizophrenic behaviour being reinforced in another person, learn the behaviour through vicarious reinforcement. Individual reproduces behaviour to get the same reinforcements
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Why is the success of treatment a positive of this explanation?
Token economy (based on behavioural) is sucessful. Schizophrenics rewarded with tokens for exhibiting normal behaviour. Implies some support for the behaviourist explanation.
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What is a negative of studies into the treatments?
Studies seem to suggest improvement, although many patients in studies are also in hospital so on medication as well. Improvements could be due to medication and not token economy treatment
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What does the behavioural explanation fail to explain?
Why an individual who has never had contact with a schizophrenic displays symptoms of schizophrenia. Or why the disorder tends to occur in late adolescence or early adulthood
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What does CBT focus on?
Combines cognitive and behavioural approach. Emphasis is on the cognitive causes of the schizophrenic behaviour. Attempts to deal with faulty thinking and distorted perceptions
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What does CBT involve?
Identifying the problem the individual has e.g. hallucinations, what triggers this problem and the strategies they use to deal with the problem.
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What does CBT make connections with?
Patients feelings and thought patterns that cause the behaviour, makes them aware of their faulty thinking. Challenges interpretation of invents, change thinking from irrational to rational
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What did Lewis et al find about the effectiveness of CBT?
If CBT is used during first episode it shortens length of that episode. However 18 months later the patients suffer same relapse rate as patients that didnt have CBT. Effective short term
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Why is CBT not appropriate according to Kingdon and Kirschen?
Many patients deemeed not suitable for CBT as believed they wouldnt fully engage with the therapy, older patients deemed less suitable than younger patients
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Why may not studies claiming CBT is effective be valid?
Usually given to individuals also on antipsychotic medication and involved in other therapies. Difficult to determine if improvements are due to CBT or other treatments.
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What is token economy based on?
The behavioural approach, in particular operant conditioning.
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What is the aim?
Modify directly observable behaviours
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What are the 3 main steps involved?
Identifying maladpative behaviour, identifying reinforcers that maintain the behaviour, restructuring environment so maladaptive behaviour isnt reinforced
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What happens when patient displays "normal" behaviour?
Rewarded through positive reinforcement - given tokens that can be exchanged for larger rewards or privileges
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What did Ost et al find about the effectiveness of TE?
12 schizophrenics treated with TE for 12 months. Found positive changes in behaviour - 5 patients were able to be discharged and non readmitted in the next year.
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However what is a negative of this?
Changes behaviour positively, doesnt say if symptoms are improved e.g. hallucinations
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What is a negative of TE?
Only effective if tokens given immediately after desired behaviour. Longer interval means the less likely it is learning will occur. - Easy to miss the desired behaviour
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What did Kazdin and Bootzin find?
TE doesnt lead to permament behavioural change. Once reinforcement is removed, undesirable behaviours return to normal level. Increase in relapse rate if not maintained or if they go back to maladaptive environment
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What are positive symptoms?


Reflect an excess or distortion of normal functions

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What are the 4 positive symptoms?


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What are delusions?


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What are experiences of control?


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