Schizophrenia studies

The international classification for disease (ICD)

Produced by the world health organisation. Next edition released 2015. Mental orders were not included until 6th edition in 1952.

1 of 101

The diagnostic and statistical manual of mental disorders (DSM)

More common than ICD. Produced by American Psychiatric Association. Dominent manual in the US and is used elsewhere. Research in the US has to use DSM classifications and a DSM diagnosis for health insurance.

2 of 101

Why is DSM always revised?

New disorders discovered, advanced science and understanding.

3 of 101

Primary use of DSM by professionals?

To diagnose and compare symptoms and patients with reliability and consistency.

4 of 101

What does schizophrenia mean?

Severe disruption in psychological functioning.

5 of 101

Onset and prevalence of schizophrenia

Risk of diagnosis - 0.3-0.7% chance. Onset is usually between the ages of 15045. Equally common on males and females. Usually occurs earlier in males.

6 of 101

Delusions

False beliefs resistant to change in the light of contrary evidence.

7 of 101

Hallucinations

Perception-like experiences with no external stimulus. Usually auditory or visual.

8 of 101

Disorganised thinking

Disorganised thought inferred from speech. 'Word salad'

9 of 101

Grossly disorganised or catatonic behaviour

Disorganised - unpredictable agitation or silliness. Catatonic - decreased reactivity to the environment, rigid posture, lack of verbal/motor response.

10 of 101

Negative symptoms

Reducation in eye contact, facial expression, hand movements. Level of functioning in major areas such as self care decreases.

11 of 101

Crow (1980) - Type 1

Positive symptoms - Something is in some way added to the sufferer's personality.

12 of 101

Crow (1980) - Type 2

Negative symptoms - Something is in some way taken away from the sufferer's personality.

13 of 101

Changes in DSM 5

Dropped sub-types of schizophrenia, dropped GAF (Global Assessment of Functioning) Scale.

14 of 101

Reliability/Validity

If disgnoses are inconsistent, they cannot all be correct (valid).

15 of 101

Factors affecting reliability of diagnosis - Kleitman's 3 factors

1) differences in procedures eg: use of classification systems 2) differences between clinicians- subjective interpreation 3) Differences between patients and the presentation of their symptoms.

16 of 101

Beck (1967)

Only found 54% inter-rater reliability between 2 psychiatrists' diagnosis of 154 patients. Example of problems with earlier DSMs.

17 of 101

Improvments with DSM over time

removal of vague descriptions, blurred boundaries between disorders and clarifying how many symptoms/types of symptoms were needed.

18 of 101

Kappa statistic (k)

A way of converting agreement between raters on nominal data. k=1 means perfect agreement. k=0 means no agreement.

19 of 101

What is needed for a diagnosis to be correct/valid?

The illness must be reliably defined/classified and diagnosed. The illness has to be validly defined or classified.

20 of 101

Relaibility vs. Validity of diagnosis

Poor reliability means poor validity. The more reliable the diagnosis the more likely the correct diagnosis is being made.

21 of 101

Rosenhan (1973)

Patients reported that they were hearing a voice to doctors at psychiatric hospitals. All but one recieved a diagnosis of schizophrenia. The doctors were very reliable but were invalid as none of the patients had schizophrenia.

22 of 101

Descriptive validity

Are the symptoms rights? It is usually possible to define medical illnesses by their symptoms

23 of 101

Aetiological validity

Can we identify causes or mechanisms? It is possible to use evidence from causes or mechanisms to argue that an illness has been well-defined.

24 of 101

Predictive validity

What is the prognosis/reaction to treatment? In a well-defined illness we are able to describe how the illness progresses over time and predict a reaction to treatments.

25 of 101

What do you need to make a correct diagnosis?

Make sure: Psychiatrists are using a valid classification system, the same classification system and that the diagnosis are reliable.

26 of 101

Consequences of lack of validity

Research into schizphrenia will be false/incorrect and there may be false postive/negative disnosing.

27 of 101

Consequence of false positive - Perlman (2000)

Patients had been diagnosed with schizphrenia yet did not fit the criteria. Patients were administered with antipsychotic drugs that they did not need.

28 of 101

Consequence of false postive - self-fulfilling prophecy

If a person is told they are a 'schizophrenic' then they are likely to adopt this identity. They may self-induce some symptoms. Doctors will simply interpret these symptoms as schizphrenic as that is what they presume the patient to be.

29 of 101

Consequence of false negative

Untreated illness. The symptoms may worsen and the patients life will become increasingly harder.

30 of 101

Two aspects of biological approach that I need to know

Genetic explanation and biochemical explanation

31 of 101

Kendler et al (1985)

First degree relatives of those with schizophrenia are 18x more at risk of developing schizphrenia than the general population.

32 of 101

A01 Genetics

Schizophrenia appears to run in families, gene coding for schizophrenia may be passed down

33 of 101

A02 Genetics

Twin studies and seperated twin studies and adoption studies can allow further insight into the genetics approach

34 of 101

Family study - Gottesman (1991)

Review of 40 major European family and twin studies. MZ twin 48% of developing schizo. Child w/ 2 schizo parents 46% chance. Spouse of schizo 2% chance

35 of 101

Despite the fact that evidence shows the close the bio relationship the greater risk of developing schizo, why may this be inconclusive?

Gottesman ('91) showed high concordance rates in spouses than the general public. This suggest environmental factors.

36 of 101

Twin study - Gottesman Review (1991)

MZ twins reared togehter 48% chance, DZ twins reared together 17% chance, MZ twins reared apart 58% chance

37 of 101

Twin study - Gottesman & Shields (1972)

MZ twins reared togehter 42% concordance and DZ twins reared together 9% concordance

38 of 101

Twin study - Cardno et al (1999)

MZ twins reared together 40% concordance, DZ twins reared together 5.3% concordance

39 of 101

3 methodological flaws with twin studies

Generalised with specific cases not always acccounted for, age of seperation is important and not always accounted for, in early days of adoption and twin research there was no way of being certain if twins were MZ/DZ

40 of 101

Adoption study - Tienari's Finnish adoption study

Children adopted-away from schizo mothers(index) compared with children adopted-away from 'healthy' mothers (control). 7% of index got schizo, 1.5% controls got schizo. Supports genetics.

41 of 101

Adoption study - Kety et al (1994)

Studied Denmark's national sample and found that there were high rates of schizophrenia in adoptees whose biological parents shared the same diagnosis, even though they were adopted-away to healthy parents. Shows genetics>environment

42 of 101

Critisicm of Tienari - Wahlberg

Strong interaction between genetic and environmental factors. Only children who were adopted into families with poor communication were at increased risk. Also, longitudinal study is bad as diagnositic criteria constantly changes.

43 of 101

General criticism of adoption studies

Keiman (1977) Twins reared apart may share very similar environments as adoption agencies adopt out to families with very similar backgrounds and lives.

44 of 101

Biochem Explanation - Dopamine Hypothesis A01

Focuses on neurotransmitters. Dopamine is a neurotransmitter found in the limbic system. This is involved in regulating emotion. Is also found in basal ganglia - regulates movement and emotion. All of these are linked with schizo.

45 of 101

Biochem Explanation - Dopamine Hypothesis A01

Some symptoms of schizphrenia are the result of excess dopamine, super-sensitiivity of dopamine receptors, excess dopamine receptors

46 of 101

Biochem Explanation - Dopamine Hypothesis A02

Supporting: antipsychotics work and dopamine receptor density in the causate nuclei is greater in schizos. However -they do not work for everybody

47 of 101

Biochem Explanation - Dopamine Hypothesis A02

L-dopa produces symptoms of schizo (parkinsonian patients). However - does not always worsen symptoms of all people diagnosed with schizo.

48 of 101

Biochem Explanation - Dopamine Hypothesis A02

Seeman - post mortem evidence Increased dopamine receptor density between 60-110% in schizos. However - most have been treated for years

49 of 101

Type 1 and Type 2 A02 commentary of biochemical explanation

This distinction explains why not all patients respond to antipsychotics in the same way. Type 1 schizo is mostly causes by genetics linked with dopamine dysfunction and type 2 is usuallt caused by brain structural abnormalities.

50 of 101

Diathesis stress model

Links biological vulnerability to environmental stressors. Some people may have a genetic/injury-caused vulnerability to the disorder but will only develop it if exposed to stressful situations.

51 of 101

Support for diathesis stress model - Tienari's Finnish adoption study

Assessed quality of parenting through interviews and tests. All cases of schizo came from 'disturbed' families. The 'healthy families' of the high risk sample had lower schizo rates than general population. Shows importance of environment.

52 of 101

Evaluation of Finnish adoption study

Low-risk children from 'disturbed' families did not develop the disorder. Shows genetics are still important.

53 of 101

Practical applications of biological approach

Powerful drugs have been created to help with mental illness. Awareness of risk within families eg: twins or adopting.

54 of 101

Cognitive Explanation

Disturbed thinking processes are the cause not the consequence of schizophrenia. People with schizo cannot filter information.

55 of 101

Frith's Cognitive deficit model (explains positive symptoms)

Deficit in central monitoring system. This labels thoughts and actions as ones own thoughts or actions. Hallucinations are caused when inner speech is not recognised as self-generated. Patients think inner sppech is an external source.

56 of 101

Frith's Cognitive deficit model (explains positive symptoms)

Unable to filter out irrelevant information gained form the world around them which leads to a cognitive overload which makes it hard to focus as random thoughts may be interpretted as more important than they actually are.

57 of 101

Support for Frith - Bentall et al (1991)

Ppts asked to either generate items themselves eg: food beginning with B or to read out a list. A week later, asked if they had thought of or read the words. Schizophrenics - no recall if had thought of or read the words.Espesh. hallucinaters.

58 of 101

Shallice (1988) (explains negative symptoms)

2 types of actions; self willed and environmentally driven. Patients with negative symptoms have a deficit in the supervisory attention system'. This cog. process generates self-initiated actions. Deficit can lead to lack of volition etc.

59 of 101

Support for Shallice - Frith & Done (1986)

Experimental fluency task. Patients asked to generate self-initiated actions and responses were measured. eg: name as many fruits as you can. In comparrison, schizos named very few fruits. Either said nothing, repeated words or spoke irrelevently.

60 of 101

Criticism of frith and done and bentall

Patients have usually taken medication therefore it is hard to find a comparable control group. This makes it almost impossible to distinguish between whether results are due to cognition or medication. Reduces validity.

61 of 101

Park and Faraone

Cognitive impairment has some causal role because there are cognitive deficits in non-schizphrenic relatives. (the disorder cannot cause the cognitive impairment) but the cognitive deficit cannot cause schizo by itself or all relatives would have it

62 of 101

Cognitive approach - link to other approaches

Need to combine cog. approach with bio. approach for a more complete explanation. Genes cause cog. deficit, deficit brings vulnerability to certain symptoms.

63 of 101

Family Models

Key concepts: schizophrenogenic families (including double-bind and marital schism) and expressed emotion.

64 of 101

Schizophrenogenic families (Fromm-Reichmann 1948)

disturbed patterns of communication within families, families with high emotional tension, families with secrets or close alliances.

65 of 101

Bateson (1956) Double blind hypothesis

Constant exposure to conflicting injunctions. Where one message invalidates the other. ie: saying i love you to your son with a disgusted face. Child looses ability to discriminate between difference communcation levels.

66 of 101

Lidz - Marital Skew

One parent dominates the other

67 of 101

Lidz - Marital Schism

Parents have contrary views

68 of 101

Expressed Emotion

Hostility, critical comments and emotional over involvement. Can be assessed through camberwll family interview.

69 of 101

Brown (1972) Evaluation of Expressed Emotion

Patients more likely to relapse if they returned to their homes if they were characterised by high levels of espressed emotions than low levels.

70 of 101

Evaluation of Schizophrenogenic Families

Mainly based on case studies - discuss methodological issues with these

71 of 101

Diathesis stress model eval of family model

The Israli High Risk Study (1987) Envronmental factors assessed through assessing parents. All cases of schizo had poor parenting. However, all cases showed neuropsychological abnormalities. Their influence is questionable but supports dia.stress mod

72 of 101

Practical applications of family model

Treatment of schizo now usually includes education and training for family members in controll EE levels. Supported by less relapse rates in countries where schiz has less stigma.

73 of 101

Drug treatment - conventional/typical antipsychotics

eg: chlorpromazine. Aim to reduce positive symptoms. Based on idea that schizo is excess of dopamine activity. Reduces dopamine activity at certain receptor sites. Blocks D2 receptors, lessening their response.

74 of 101

Drug treatment - atypical antipsychotics

eg: clozpine. Much newer drugs. Shown to be as effective as typical drugs but with less side effect. Reduces both neg & pos symptoms. Based on dopamine & seretonin problems. Works by blocking receptors.

75 of 101

Antipsychotic drugs - general

Usually taken orally, absorbed from the digestive tract, pass the blood/brain barrier ad then go to the synapses and bind to post-synaptic recepts. Drugs can also be injected, especially for those who forget to take them orally.

76 of 101

A02 Drugs - positive of traditional drugs

Drugs are much more human than previous methods of controlling patients such as straitjackets, drugs have rapidly reduced the average length of time in hospital, those who respond positively to drugs are kept on maintenance doses

77 of 101

A02 Drugs - limitations of traditional drugs

Traditional drugs cause severe side effects such as dizziness, parkinsonian symptoms, dry mouth, constipations, muscular rigidity etc. Traditional drugs delay rather than prevent symptoms. Many relapse within a year.

78 of 101

A02 Drugs - newer atypical drugs

targets both positive and negative symptoms, patients are less likely to drop out of treatment programme, less side effects generally but motor side effects are more serious

79 of 101

A02 Drugs - cochrane- review of chlorpromazine

Meta-analysis of 302 studies. All used placebo + random allocation. Found that chlorpromazine reduces relapse, improves symptoms, leads to various side effects

80 of 101

A02 Drugs - cochraine - review of clozapine vs. typical antipsychotics

Meta-analysis of 52 controlled trials, no significant difference to typical drugs in terms of broad outcome, fewer relapses, more acceptable as long term treatment than traditional drugs.

81 of 101

ECT - electroconvulsive therapy

Originally used to treat schizophrenia but now usually used for depression. The shock of the convulsions disrupts/corrects the abnormal neurotransmitter activity.

82 of 101

ECT process

muscle relaxant & anaestetic, electric current applied via electrodes on either one or both sides of bread. Small current is passed for 0.5-5 seconds. Several sessions over a number of weeks.

83 of 101

Evaluation of ECT - Tharyan et al

Meta analysis of 26 studies. ECT can be a short term improvement for some people with schizo. ECT combined with drug treatment may be considered for a more long term solution.

84 of 101

Evaluation of ECT

Drugs are more evasive than ECT as they enter the blood stream. A combination of the 2 does not hold much improvement.

85 of 101

Evaluation of ECT

A good option for someone that has become a danger to themselve or others or is suicidal. Also for people who are pregnant or old and cannot take antipsychotics.

86 of 101

Evaluation of ECT - side effects

Memory less may occur of recent events, names and dates but is usually forgotten tememorarily. ECT has no impact on intelligence. As long as muscle relaxant is used, no bones should be injured.

87 of 101

Evaluation of ECT

The argument that ECT disturbed the memory so that all disordered thinking can be restructured is not legit as unilateral ECT causes minimal memory loss and still works.

88 of 101

Evaluation of ECT

The idea that schizo and depression can be treated in the same way is illogical as they have different symptoms. This suggests that one of the disorders that is being treated through ECT is being treated incorrectly.

89 of 101

Cognitive Behavioural Therapy

A treatment designed for those who are capable of gaining insight into their problems. The aim is so adjust people's way of thinking and alter inapproprite beliefs.

90 of 101

One type of CBT - belief modification

Cognitvely challenges beliefs ie: hallucinations/dellusions. Patients learn to challenge initial interpretations and see them as hypothesis instead of reality.

91 of 101

One type of CBT - RET/REBT

1) patient pinpoints activating event and consequence eg: voices and subsequent behaviour. They discuss the belief about the event that caused the behaviour. Therpist shows that belief is illogical by providing counter evidence.

92 of 101

Evaluation of CBT - Jones et al (2000)

meta analysis on trials of belief modification and found it reduced both the frequency and intensity of hallucinations

93 of 101

Evaluation of CBT - Drury et al (2000)

Followed a treatment programme, found that short term gains were positive but after a 5 year follow up the treatment group showed no advantage over control group.

94 of 101

Evaluation of CBT - Bradshaw (1998)

Followed the case study of an american woman who did not respond to drug treatment and who often went to hospital, after 3 years of regular CBT she showed positive improvements and maintained the benefits after a year.

95 of 101

Evaluation of CBT - appropriateness

Does not cure the patient of their symptoms but normalizes/reduces them. Is ethically sound as it is a collaborative therpay, patient does not become passive. If patients do not realise that they have a prob, they gain more insight through CBT

96 of 101

Family Intervention

To reduce the chance of relapse in a schizphrenic patient. Provide coping skills. Create a trusting environment. Family members as will as patient are educated on this disorder and ways of managing it.

97 of 101

Family Intervention

Process: 1) family gets info on the disorder, each member discusses their feelings on the patient and the disorder, contructive ways of communication are taught, taught how to express anger, training on early signs of relapse.

98 of 101

A02 Family Intervention - Research - Cochrane Review

Meta analysis of studies focusing on families of people with schizo, comparing family based intervention with standard care. Found that familie intervention may reduce relapse risk, encourage compliance with meds. Data not sound, can't be confident

99 of 101

A02 Family Intervention - Research - Leff et al (1982)

Programme created, educational sessions, group family meetings with other well coping families, social workers discussed fam's concerns. 2 year programme. 78% of control group readmitted to hosp, 14% of treatment group. Treat. gr. showed less EE.

100 of 101

Negative of Family Intervention and CBT

Both very time consuming. Particularly with CBT, can be expensive.

101 of 101

Get Revising

Schizophrenia studies

Other cards in this set

Card 2

Front

Back

Card 3

Front

Back

Card 4

Front

Back

Card 5

Front

Back

Comments

Similar Psychology resources:

Other cards in this set

Card 2

Front

Back

Card 3

Front

Back

Card 4

Front

Back

Card 5

Front

Back

Comments

Related discussions on The Student Room

Similar Psychology resources: