FEB 23

Question 1

Define Schizophrenia

Answer 1

A severe metal disorder characterised by a profound disruption of cognition and emotion.

Question 2

Define classification

Answer 2

The process of organising symptoms into categories based on which symptoms cluster together in sufferers.

Question 3

What are positive symptoms?

Answer 3

Atypical symptoms experienced in addition to normal experiences.

Question 4

What are negative symptoms?

Answer 4

Appear to reflect a loss or reduction in normal functions.

Question 5

Name 2/4 positive SZ symptoms

Answer 5

Hallucinations
Delusions
Catatonic or disorganised behaviour
Disorganised speech

Question 6

Define Hallucinations

Answer 6

Sensory experiences of stimuli that have no basis in reality
or are distorted perceptions of things that aren’t there.

Question 7

Define Delusions

Answer 7

Bizarre or irrational beliefs that seem real to the sufferer but aren’t.
Paranoid -> eg. being spied on
Grandiose -> eg. believes they are important/ famous/ powerful

Question 8

Name 2/4 negative SZ symptoms

Answer 8

Speech poverty (alogia)
Avoliton
Affective flattening
Anhedonia

Question 9

Define speech poverty/ alogia

Answer 9

Lessening of speech fluency and productivity.

Question 10

Define Avolition

Answer 10

Reduction of interests and desires available to them.
Inability to initiate and persist in goal-directed behaviour.

Question 11

Reliability refers to…

Answer 11

… the consistency of a classification system, in this case SZ.

Question 12

What is test-retest relaibility?

Answer 12

Occurs when a clinician makes the same diagnosis on 2 separate occasions from the same information.

Question 13

Read et al (2004)

Answer 13

Reported test-retest reliability to be 37%…. LOW PERCENTAGE SUGGESTS QUESTIONABLE SZ CLASIFICATION AND DIAGNOSIS.

Question 14

What did a 2005 study on Inter-rater reliability report?

Answer 14

81% agreement using DSM… although figures vary widely.

Question 15

Validity refers to…

Answer 15

… the extent to which a classification system accurately measures what its supposed to.

SZ context) diagnosis represents something real and distinct from other disorders

Question 16

Explain Cheniaux et al (2009)

Answer 16

Gave 2 psychiatrists 100 cases, asked them to diagnose patients using ICD and DSM.
Psychiatrist 1 -> diagnosed 26 with DSM, 44 ICD.
Psychiatrist 2 -> 13 DSM, 24 ICD.

This indicates poor inter-rater reliability AND a lack of validity - 2 systems yielded different results. Means over or under diagnosis.

Question 17

Name the 4 factors that affect reliability and validity of SZ diagnosis and classification.

Answer 17

Co-morbidity
Culture
Gender bias
Symptom overlap

Question 18

Explain co-morbidity

Answer 18

Extent two or more conditions co-occur.
If conditions occur together, validity of diagnosis and classification is questionable as they may be a single other condition.

Question 19

Buckley et al (2009)

Answer 19

Estimated co-morbid depression occurs in 50% of patients, and 47% of patients have co-morbid substance abuse.

Question 20

Explain culture

Answer 20

African Americans and British people of Afro-Caribbean origin are several times more likely tha white people to be diagnosed with SZ.
As rates in Africa and West Indies aren’t very high, this may not be due to genetic vulnerability.

So culture bias in SZ diagnosis.

One factor involved is that in African cultures symptoms such as hearing voices are more acceptable because of cultural beliefs in communication with ancestors.

Question 21

Longenecker et al (2010)

Answer 21

Reviewed studies of the prevalence of SZ.
Found before 1980 equal numbers of diagnosis between genders, but increasingly more male diagnosis since then.
Females with SZ more likely to function better than men, work, and have better family relationships.

Question 22

Loring and Powell (1988)

Answer 22

Suggests gender bias.
Randomly selected 290 male and female psychiatrists to read two case vignettes of patients’ behaviour.
When patients describe male/ not assigned gender -> 56% psychiatrists diagnosed SZ.
When female -> 20%
This gender bias was less pronounced in females, suggesting both the gender of the patient and psychiatrist affect diagnosis.

Question 23

Explain symptom overlap

Answer 23

Overalap between SZ symptoms and other conditions.
Eg. hallucinations and abolition are SZ and bipolar symptoms.
Questions validity of classification and diagnosis of SZ.
ICD and DSM may classify different conditions depending on the symptoms they use to classify too.

Question 24

What are the biological explanations for schizophrenia?

Answer 24

Genetics
Neural correlates, including dopamine hypothesis.

Question 25

Biological explanation 1 - Genetics: SZ is thought to be __________ (a product of the combined effect of a number of candidate genes).

Answer 25

polygenic

Question 26

Ripke et al (2014)

Answer 26

Found that 108 separate genetic variations were associated with the increased risk of schizophrenia.

Question 27

Explain family studies

Answer 27

Established the closer degree of genetic relatedness, the greater the SZ risk. Established SZ more commonly among biological relatives of a schizophrenic person.

Question 28

Gottesman and Shield’s 1991 study findings?

Answer 28

Children with two SZ parents… 46% concordance. Children with one SZ parent… 13% Siblings to a SZ person… 9%

Question 29

What might explain family similarities?

Answer 29

Common rearing patterns. Eg. Negative emotional climate in some families may lead to stress beyond an individual’s coping mechanisms, triggering SZ episodes.

Question 30

Explain Joseph (2004)

Answer 30

Pooled data for SZ twin studies. Identical twins 40.4% concordance. Non-identical 7.4% concordance. Supports genetic factors for SZ, as the greater the genetic similarity the greater the risk. u

Question 31

What did Joseph 2004 point out about twin studies criticism?

Answer 31

MZ (identical) twins encounter more similar environments (more likely to to do things together, treated more equally) so this may explain the higher concordance rates.

Question 32

Explain Tienari et al (2000) adoption study

Answer 32

Finland study. Of adoptees whose biological mothers had SZ, 7% also had SZ. Of those with normal mothers, it was just 2%. HOWEVER… adoptees were only found to have this increased risk if there was dysfunction in the adoptive families. Suggests an **interaction** between genetic vulnerability and environmental influences.

Question 33

What are neural correlates?

Answer 33

Measurements of the structure or function of the brain that correlate with experience (eg. SZ). Many parts of the brain are linked with SZ.

Question 34

What did the dopamine hypothesis initially suggest?

Answer 34

An excess of dopamine in certain brain regions is associated with the positive SZ symptoms. SZs have higher numbers of D2 receptors on receiving neurons, causing more dopamine binding and neurons firing.

Question 35

Explain the Evidence: drugs that increase dopamine

Answer 35

- **Parkinson’s disease patients who take the drug L-Dopa to raise dopamine have been found to develop SZ-type symptoms.** - “Normal” individuals exposed to large doses of dopamine-releasing drugs can develop characteristic hallucinations and delusions of SZ.

Question 36

Explain the Evidence: drugs that decrease dopamine

Answer 36

Drugs that reduce dopamine activity eliminate SZ symptoms. Supports initial dopamine hypothesis, as it suggests that dopamine is involved in SZ.

Question 37

The revised dopamine hypothesis - Davis and Kahn (1991) proposed that:

Answer 37

- Positive SZ symptoms are caused by too much dopamine in subcortical brain areas (mesolimbic pathway). - Negative and cognitive SZ symptoms arise from too little dopamine in prefrontal cortex areas (mesocortical pathway).

Question 38

The revised dopamine hypothesis: Evidence from neural imaging: Explain Patel et al 2010

Answer 38

Using PET scans, found lower dopamine levels in the prefrontal cortex of SZ patients compared to normal controls.

Question 39

The revised dopamine hypothesis: Evidence from animal studies: Explain Wang and Deutsch 2008

Answer 39

Induced dopamine depletion in the prefrontal cortex in rats. Resulted in cognitive impairment, which researchers reversed using antipsychotic drugs thought to have benefitial effects on negative symptoms in humans.

Question 40

The revised dopamine hypothesis: Evidence from treatment: Explain Leucht et al 2013

Answer 40

Meta-analysis 212 studies that analysed effectiveness of different antipsychotic drugs compared to placebo. Found that all drugs tested were significantly more effective than placebo in treatment of SZ + and - symptoms, achieved via dopamine normalisation.

Question 41

What is inconclusive supporting evidence for the revised dopamine hypothesis?

Answer 41

Moncrieff 2009) stimulant drugs that affect SZ episodes also affect neurotransmitters other than dopamine. Dopamine concentrations form post-mortem brain tissue have been inconclusive. Other confounding sources of dopamine release haven’t really been considered.

Question 42

How did Noll 2009 challenge the dopamine hypothesis?

Answer 42

Noll (2009) claims strong evidence against the old and new dopamine hypothesis. Antipsychotic drugs don’t alleviate hallucinations and delusions in about a third of people. In some people, hallucinations and delusions are present with normal dopamine levels, and blocking their D2 receptors has little or no effect on their symptoms. This suggests other neurotransmitter systems may produce positive SZ symptoms, eg. glutamate.

Question 43

What are other neural correlates of SZ?

Answer 43

Many people with SZ, particularly negative symptoms, have enlarged ventricles. May be due to near parts of the brain not developing properly or being damaged.

Question 44

Explain Cannon et al (2014)

Answer 44

Found that **individuals at high clinical risk who converted to SZ** showed a **steeper rate of grey matter loss** and a **greater rate of brain ventricles expansion** compared to those who didn’t convert to SZ.

Question 45

Explain Allen et al (2007)

Answer 45

Scanned brains of **patients with auditory hallucinations**. Compared to a control as **they identified pre-recorded speech as theirs or others.** **Lower activation levels in the superior temporal gyrus (processes sounds) in hallucination group,** and they **made more errors.**

Question 46

Evaluate neural correlates (long sentence worth)

Answer 46

✅ These studies (Cannon and Allen) are **useful in flagging up particular brain systems** that may not be working normally in those with SZ. ❌ But **doesn’t tell us about cause and effect.**

Question 47

Conclusion for neural correlates? Couple sentences

Answer 47

**Overwhelming evidence** for the role of biological factors in aggression. **However,** there’s also evidence to suggest environmental factors, like psychological ones in family functioning, play a role too.

Question 48

Psychological explanations: cognitive explanations.. explain cog, explain. of delusions

Answer 48

Cognitive explanations of delusions… perceives self as central component in events (egocentric bias) and jumps to confusion about external events.

Question 49

Psychological explanations: cognitive explanations.. explain cog, explain. of hallucinations

Answer 49

hyper vigilance

Question 50

Psychological explanations: cognitive explanations.. explain meta representation

Answer 50

Ability to reflect on thoughts and behaviour. Dysfunction of this in SZ explains hallucinations and delusions

Question 51

Psychological explanations: cognitive explanations.. explain central control..

Answer 51

Ability to suppress automatic responses as we perform deliberate actions instead.

Question 52

Psychological explanations: cognitive explanations.. WEAKNESS?

Answer 52

Can’t establish cause and effect between faulty thinking and SZ

Question 53

Psychological explanations: cognitive explanations.. STRENGTH?

Answer 53

Success of CBT eg. NICE found it effective in reducing rehospitalisation rates up to 18 months after treatment ends.