1
Q
What is schizophrenia?
A
- a mental disorder characterised by disruption of cognition and emotion.
- it manifests through a persons sense of self, actions, thoughts, perceptions and language.
2
Q
Diagnostic tools for diagnosing schizophrenia
A
DSM 5 - US based
ICD II - europe based
3
Q
Characteristics of schizophrenia from the DSM 5
A
1) delusions
2) hallucinations
3) disorganised speech
4) grossly disorganised / catatonic behaviour
5) negative symptoms, e.g alogia, avolition, affective flattening
4
Q
What criteria must you meet for a diagnosis?
A
- two or more of the DSM 5 symptoms, or only one needed if that symptom is ‘bizarre’.
- has to negatively impact your life, relationships and self care must be substandard etc
- continuous signs of disturbance for longer than six months
5
Q
What are positive and negative symptoms
A
- positive adds or distorts normal functions
- negative take away or indicate a loss of function
6
Q
Hallucinations
A
- positive symptom
- sensory malfunction, perceiving info incorrectly
- hearing voices, seeing things, smelling, feeling things that aren’t there
- voices can be running commentary, discussions, voices from another part of the body etc
7
Q
Delusions
A
- positive symptoms
- bizarre beliefs rather than perceptions, eg paranoid delusions
- delusions of grandeur = inflated self importance
- delusions of reference = believing secret messages meant just for them
8
Q
Disorganised speech
A
- negative symptom
- abnormal thought processes lead to disorganised thoughts, which in turn affect speech
- derailment = slipping from one topic to another, often in mid sentence
9
Q
Grossly disorganised / catatonic behaviour
A
- positive symptom
- can’t start of complete a task due to lack of motivation or focus
- can lead to poor functioning
- reduced response to immediate environment, rigid postures or aimless repeated motor activity
10
Q
Alogia
A
- negative symptom
- speech poverty
- slowed, blocked thoughts lead to lessened speech fluency and productivity
- poorer at speech tasks, simplified speech
11
Q
Avolition
A
- negative symptom
- less interest in / desire for things
- inability to begin meaningful behaviour
12
Q
Affective flattening
A
- negative symptom
- emotions are wrong / dulled, poorer emotive language use, body language, tone, that indicate emotion
13
Q
Anhedonia
A
- negative symptom
- loss of interest / pleasure in all activities
- emotional anhedonia is not considered reliable as a diagnosis as it overlaps with other disorders
14
Q
Ways of assessing reliability of diagnosis / classification
A
- inter rater reliability: how consistent different peoples diagnoses are
- test retest reliability: how consistent one persons diagnosis is on two separate occasions
15
Q
reliability of sz diagnosis in an ideal world
A
- 100% concordance rates of inter-rater and test-retest reliability
16
Q
ao3 of reliability in diagnosis / classification
A
- whaley: found +0.11% concordance rates between psychologists
- mojtabi & nicholson: found +0.4% concordance rates between psychologists
-> condorance rates should be +0.7%
17
Q
cultural differences on validity of sz diagnosis
A
- some behaviours in non-western cultures may be deemed as symptoms of schizophrenia from a western perspective, when they are actually just normal behaviours within that culture. sz diagnosis duffers from ethnocentrism, imposed etic
18
Q
ao3 of cultural differences
A
- copeland: found US psychologists diagnosed a patient 69%, whereas UK psychologists diagnosed only 2%
- luhrmann: found that in Ghana and India, voices in head are deemed positive and encouraging, whereas this is a symptom of schizophrenia in US, and voice is usually always negative
19
Q
comorbidity on validity of sz diagnosis
A
- comorbidity is when a pateitn can suffer two illnesses simultaneously at once
- makes it difficult to treat, because different illnesses require different treatments
20
Q
ao3 on comorbidity
A
- buckley: found that 50% of sz’s suffer from depression, 47% from substance abuse, evidence of its existence
- 1% of sz patients will attempt, jumps to 40% if they also have depression, showing the issue of not being able to treat both, consequences around comorbidity
21
Q
symptom overlap on validity of sz diagnosis
A
- the same symptoms can be indicative of two different illnesses
- an issue because a valid diagnosis should be separate to another illness
22
Q
ao3 on symptom overlap
A
- ellason and ross: patients with disassociative identity disorder often show more schizophrenic symptoms than people with schizophrenia
23
Q
what is genetics
A
- the idea that schizophrenia can be passed down (inherited) from parents by their genes. schizophrenia is hereditary
24
Q
family studies
A
gottesman:
- with two sz parents, 46% of development
- with one sz parent, 13% development
- with one sz sibling, 9% development
25
twin studies:
joseph
- mz twins show 40.4% concordance rates of sz
- dz twins show 7.4% concordance rates of sz
26
adoption studies:
tienari:
- 164 adopted children with sz mothers, 6.7% chance of development
- 197 adopted children without sz mothers, 2% chance of development
27
genetic explanation ao3
❌ - twin studies have the same environment too, not just studying nature but also nurture
❌ - selective adoption in tienari study
❌ - social sensitivity, parents can be blamed for causing sz in their children
❌ - biological determinism
❌ - leans too far towards nature, ignores nurture influences.
28
neural correlates
- based on faulty functioning in the brain
- dopamine hypothesis, too much dopamine in mesolimbic pathway leads to development of positive symptoms
- amphetamines cause a dopamine flood, can lead to positive symptoms
- all antipsychotics have one thing in common, they lower the dopamine levels in the brain
- parkinsons sufferers who take the L-dopa drug to increase dopamine levels often experience positive symptoms
29
neural correlates ao3
✅ - seeman found increased D2 receptors in post mortems of sz's
❌ -> increased D2 receptors may have just been due to antipsychotics
✅ - scientific, backed up by evidence
❌ - ignores environmental explanations, biological reductionism
❌ - real world application of antipsychotics
✅ - leucht meta analysis
❌ - meta analysis issues
30
cognitive explanation
- delusions are caused by jumping to conclusions
- form irrational beliefs that the person believes are true
- delusions of grandeur, delusions of reference
- immune to reality testing due to impaired insight
- hallucinations are caused by hypervigilance
- paying too much attention ti auditory / visual stimuli can lead to someone seeing / hearing things that aren't there.
31
cognitive explanation ao3
✅ sarin & wallin found sz's with delusions had biases in their processing, would jump to conclusions and immune to reality testing
❌ - theoretical model, cannot be empirically tested
❌ - reductionism, does not include biological or environmental impacts
✅ - led to CBTp, real world application
32
family dysfunction explanation
- puts the cause of schizophrenia in the household environment
- double bind theory: double bind statements (where a parent says one thing and means the other) can lead to the development of schizophrenia
- children are unable to respond to double binds correctly, their view of reality is warped, causing impaired perception / insight, leading to positive symptoms
- high expressed emotion refers to negative emotion within a household, such as overly involved or critical parents, or constant arguing
- high EE leads to overwhelming the child, they begin to stress and their coping mechanisms are overrun, leading to irrational coping mechanisms, leading to positive symptoms of schizophrenia.
33
family dysfunction ao3
✅ led to effective family therapy, keep people out of care for 18 months
❌ - sz's can come home to low EE households and relapse, and vid versa
✅ - berger found increased report of double bind statements in schizophrenic people
❌ - hall & levin. eta analysis, found no correlation of report of double bind statements in schizophrenic people
❌ - self report of schizophrenics is not reliable
❌ - meta analysis issues
❌ - social sensitivity, blames schizophrenia completely on the parents
34
drug therapy
- all antipsychotics (dopamine antagonists) reduce dopamine levels in the brain
- chlorpromazine (typical) block D2 receptors in the mesolimbic pathway, so dopamine cannot cause an excitatory effect, decreasing positive symptoms of sz
- clozapine (atypical) block D2 receptors in the mesolimbic pathway, but they also rapidly disassociate from the synapse so they have less negative side effects for the patient.
- clozapine also decreases negative symptoms in patients, which chlorpromazine does not do.
35
drug therapy ao3
✅ - backed up by science
✅ - all other therapies rely on how effective drug therapy is
✅ - cheaper and more accessible than other therapies, economic benefit
❌ - ethics of informed consent
❌ - negative side effects, tardive dyskinesia case study
36
cognitive behavioural therapy for psychosis
- CBTp aims to identify the problems with sz and create logical explanations for the patient
- best done 1 on 1, as in group therapy they can bounce off of eachothers delusions
1) assessment
2) engagement
3) ABC
4) normalisation
5) critical collaborative analysis
6) logical explanations
37
CBTp ao3
✅ - keep patients out of care for 18 months, economic benefit
❌ - not very accessible, very expensive and requires a trained professional, which there arent many of. only 13% are offered it, and only 1 in 10 benefit.
❌ - effectiveness is dependent on the stage of the disorder, does not work while in an episode
❌ - relies on the effectiveness of drug therapies
38
family therapy
- aimed at the family, ways to manage the sz member
- 10 sessions recommended, sz member should be present so they don't think they're being conspired against
1) psychoeducation
2) forming alliance
3) reasonable expectations
4) problem solving
5) reducing EE
39
family therapy ao3
✅ / ❌ - pharaoh meta analysis. had a positive benefit on complying with medicine, had no effect on mental state or social functioning
❌ - meta analysis issues
✅ - keeps sz's out of care for 24 months, economic benefit
❌ - effectiveness is down to drug therapy
❌ - still not accessible, expensive and hard to come by
40
token economies
- a system of rewarding good behaviour in hospitals with tokens than can be exchanged for rewards
- built off of learning theory, the idea that sz's can be conditioned to behave well if they are positively reinforced for it
- the exchange of good behaviour and the token, as well as the token for the reward must be instant to build an association in their heads
41
token economy ao3
✅ - meta analysis, 11 out of 13 studies reported a positive impact
❌ - meta analysis issues
❌ - hard to experimentally study, as it is unethical to have a control group that do not benefit from the token economy
❌ - inethical, making humans behave well for basic rewards such as family visits?
❌ - cannot be used outside of a hospital
42
interactionist approach
- interactionist means it tajes into account both biological and environmental influences on sz
- genetics / neural correlates provide a biological vulnerability for schizophrenia, not necessarily causing it
- however, when coupled with an environmental trigger, sz can develop
- this is a diathesis stress model, it is additive, meaning each influence adds up to meet a threshold of sz, it can be 90% genes and 10% environment, or vice versa
43
interactionist approach ao3
✅ - falls in the middle of nature nurture, not environmentally or biologically reductionist
❌ - hard to pinpoint the trigger, because it can be multiple things that add up over time
✅ - vassos found that people in urban environments are more likely to develop sz because their environment is more stressful than rural areas
❌ - may not be the case, urban environments are usually more poor, the socio-economic impact could lead to sz instead of the immediate environment
✅ - implications for treatment, improving genetic causes of sz, cytomegalovirus in pregnancy can lead to sz, CMV can now be treated, decreasing % development of sz.
