1
Q
Outline briefly what schizophrenia is and who it affects
A
- A serious mental illness that affects 1% of the population
- Distorts contact with reality and impairs a persons insight
- It is more commonly diagnosed in men than women and is seen to affect working class the most
2
Q
What is meant by the DSM-5 and ICD-10 and how do they differ in their classification?
A
- The DSM-5 is the American psychiatric association’s Diagnostic and Statistical manual which uses positive symptoms
- One or more present
- The ICD-10 is the WHO international classification of disease
- Requires 2 or more neg. symptoms
- Also recognises the different types (paranoic, catatonic etc)
3
Q
Define what is meant by negative symptoms of schizophrenia
A
The loss of an experience
4
Q
Identify and describe some negative symptoms of schizophrenia
A
- Avolition or ‘apathy’ where sufferers struggle to begin or keep up with goal directed behaviour
- Andreason identified three signs of avolition; poor hygine, lack or persistence in work and education and lack of energy. Another negative symptom is speech poverty which is reduction in the amount or quality or speech
- Speech poverty - characterised by changes in patterns of speech , emphasis is on reduction in the amount and quality of speech
5
Q
Define what is meant by positive symptoms of schizophrenia
A
An addition of an experience
6
Q
Identify and describe positive symptoms of schizophrenia
A
- Hallucinations refer to unusual sensory experiences that can be picked up from any sense - sometimes they are related to the environment and sometimes they are not
- Delusions refer to irrational beliefs and come in a variety of forms
-> Paranoid, grandeur, external control - Speech disorganisation in which speech becomes incoherent or the speaker changes topic mid sentence
7
Q
What is meant by reliability and validity in relation to the diagnosis of schizophrenia
A
- A good diagnosis tool needs to be reliable (consistency/ repeatable) and valid (legitimacy)
- Things that get in the way of validity:
Co-morbidity, symptom overlap, gender bias, culture bias
8
Q
Name all things that could affect the reliability and validity of the diagnosis of schizophrenia
A
Cultural differences, gender bias, symptom overlap, co-morbidity
9
Q
Cultural differences
A
The different values, beliefs and practices that exist between cultures
10
Q
Gender bias
A
The tendency to describe the behaviour of men and women in psychological theory and research in such a way that may not accurately represent the characteristics of either gender.
This could lead to the over or under-diagnosis of schizophrenia for either gender
11
Q
Symptom overlap
A
Occurs when two or more conditions share symptom. Where conditions share many symptoms. This calls into question the validity of classifying the two disorders separately
12
Q
Co-morbidity
A
When you get diagnosed with multiple mental disorders at the same time
13
Q
David Rosenhan “On being sane in insane places”
A
- TYPE 2 error
- 8 pseudo patients screened as ‘normal’ - relationships, history, attitudes
- Admitted themselves under fake aliases into 12 psychiatric hospitals claiming to hear voices
- Once gained admission, to stay normal and keep a journal of their experience
- Wanted to see if professionals would identify them as ‘insane’
- 30% other patients able to immediately detect they were not insane -> thought they were journalists or professors
- The staff did not pick up on it so fast, with hospitalisation ranging 7-52 days
- Normal behaviours labelled as abnormal e.g. excessive note taking
14
Q
Discuss the reliability of classification
A
Rosenhan
Classification cats lack clear boundaries causing inconsistent application
15
Q
Discuss the validity of classification
A
- Comorbidity
Overlapping conditions blur clear boundaries of schizophrenia - System overlap
Shared symptoms with other disorders challenge distinct classification - Rosenhan
Classification criteria too vague allowing mislabelling
16
Q
Discuss the reliability of diagnosis
A
- Issues with reliability (Cheniaux)
Inconsistent diagnosis between clinicians using manuals - Reliability improving
Improved consistency when diagnostic criteria are applied carefully - Rosenhan
Clinicians inconstantly identify patients
17
Q
Discuss the validity of diagnosis
A
- Gender bias
Diagnostic bias causes under/over diagnosis across genders - Culture bias
Cultural misunderstandings lead to biased diagnoses - Rosenhan
Labels bias clinical judgement leading to frequent misdiagnosis
18
Q
What are family studies and what have they shown about the role of genes in schizophrenia?
A
- Family studies find individuals with schizophrenia and determine whether their biological relatives are similarly affected more often than non-relatives
- Family studies have established that schizophrenia is more common among biological relatives of the person with schizophrenia - the closer the degree of genetic relatedness, the greater the risk
- Gottesman found that someone with an aunt with schizophrenia has a 2% chance of developing it, increasing to 9% if the individual is a sibling, and 48% if they are an identical twin
19
Q
What has research shown about candidate genes implicated in schizophrenia?
A
- Polygenic
- A number of different genes is shown
- Most likely are those coding for neurotransmitters like dopamine
- Ripke et al identified 108 genetic variations many of which code for dopamine production or reception, each slightly increasing the risk of schizophrenia
20
Q
Describe the role of gene mutation in the development of schizophrenia
A
- Mutation in parental DNA
- Radiation, poison, and viral infection
- Brown et al. found a positive correlation between paternal age and risk
-> Increase from 0.7% (fathers under 25) to 2% (fathers over 50) - higher rate of noro mutations
21
Q
What is meant by neural correlates
A
Patterns of structure or activity in the brain that occur in conjunction to an experience and may be implicated in the origins of that experience
22
Q
Outline the dopamine hypothesis
A
- Claims that an excess of dopamine in certain regions of the brain is associated with the positive symptoms of schizophrenia
- For example, excess DA receptors in pathways from the subcortex to Brocas area may explain specific symptoms of schizophrenia such as auditory hallucinations
- Schizophrenics are thought to have abnormally high numbers of DA receptors on receiving neurons, resulting in more dopamine binding and therefore more neurons firing
23
Q
What are the two types of anti-psychotics
A
Typical and atypical
24
Q
What is meant by typical antipsychotics?
A
- First generation antipsychotics
- Work by blocking the DA receptors in mesolimbic dopamine pathways
-> Bind to receptors without stimulating them, thereby reducing their action - Initially dopamine levels builds up, but then its production reduces
- According to the dopamine hypothesis, the dopamine antagonist effect normalises neurotransmitters in key areas of the brain, reducing symptoms like hallucination
- Sedation effect - thought to be due to the effect of histamine receptors
- Chloropromazine is often used to calm individuals with a variety of conditions, often when patients are first admitted to hospitals and are very anxious
-> side effects; tardive dyskinsia
25
What is meant by atypical antipsychotics?
- Second generation antispychotic e.g. clozapine, designed to maintain effectiveness, whilst reducing side effects with a lower dosage
- Only temporarily occupy DA receptors before rapidly dissociating and allowing normal dopamine transmission -> less extra pyramidal side effects
- Don't just act on dopamine receptors, but also on serotonin and glutamate receptors
-> This means that they can effect both positive and negative symptoms
Improving mood and cognitive functioning
- Given if risk of suicide
26
Biological therapies intro
Drugs are effective in treating the most disturbing forms of psychotic illnesses called anti psychotics. They aim to increase the function of life and are recommended as initial treatments of schizophrenia.
27
What is meant by family dysfunction in relation to explaining schizophrenia
The abnormal process within a family which are the risk factor for the onset / maintenance for schizophrenia
28
Name three explanations for schizophrenia that focus on family dysfunction
The schizophrenogenic mother, the double bind hypothesis, expressed emotion
29
What is meant by the schizophrenogenic mother
- Fromm-Reichmann proposed this because a particular parenting style was identified
- Cold and rejecting yet controlling
- Creates a family climate categorised by tension and secrecy
- Father emotionally absent
- Deep distrust develops into paranoid delusions and schizophrenia
30
What is meant by double bind hypothesis?
- Bateson et al agreed that family climate was important but emphasised the role of communication
- Double-bind suggests that children who frequently receive contradictory messages from the parents are more likely to develop it
- The child often feels trapped in situations where they feel like they are doing the wrong thing
- The mixed messages often finds themself not knowing how to act and so when they get it wrong they are punished by the withdrawal of love
- The world is seen as a confusing and dangerous place
- Disorganised thinking / paranoid delusions
31
What is meant by expressed emotion in relation to explaining schizophrenia?
- The level of emotion (particularly negative) expressed towards a person with schizophrenia by a carer
- Verbal criticism and possibly violence
- Hostility, anger and rejection
- Emotional overinvolvement in life of the patient including reminding the person needlessly of the carers self sacrifice
- Serious cause of stress for the patient
- Can cause relapse or onset of symptoms in vulnerable individuals
32
Describe dysfunction thinking in schizophrenia
Information processing that does not represent reality accurateltly and produces undesirable consequences
33
Who identified 2 types of dysfunctional thought processing and what are they?
Frith et al metarepresentation and central control
34
Meta - representation
- The ability to reflect on thoughts and behaviour and allows us insight into our own intensions and goals (w/o schizophrenia)
- Dysfunction means failure to recognise actions and thoughts as being our own ones so leads to auditory hallucinations and thought insertion
35
Central control
- The ability to suppress automatic responses whilst we deliberate
- Disorganised speech - inability to suppress automatic thoughts and speech triggered by other thoughts
- Schizophrenic patients experience derailment of thoughts because each word triggers associations, which can't be suppressed
36
Name 2 or more psychological therapies for schizophrenia
CBT and family studies
37
Outline the use of CBT for schizophrenia
- Takes place over 5-20 sessions - Aim is to deal with both thoughts (cognitions) as well as behaviours
38
How does CBT work pt1?
- Initially CBT helps patients make sense of irrational cognitions impact their feelings and behaviours such as delusions or hallucinations
- Just helping the patient to understand where symptoms come from can help
e.g. Voices -> Demons (faulty belief that is real) -> fear responce
Voices -> Point out its a brain malfunction -> reduced fear response
- May not remove symptoms but targets the distress so the patients can cope
39
How does CBT work pt2?
- Patients hearing voices can also be helped by teaching them that voice hearing is an extension of the ordinary experience of thinking in words
- Normalisation = what is being experienced is rooted in normal behaviour
- Delusions can then be challenged through normal CBT methods (identifying and challenging irrational thoughts)
e.g. reality testing
- Patient and therapist examine the likelihood that beliefs are true and anxietys tackled
40
What is family therapy for schizophrenia?
Takes place with the families as well as the identified patient (member who expresses family dysfunction)
41
How does family therapy help schizophrenic patients?
- Pharoah et al -> aim is to improve family function and quality of communication
- Ways include
Reducing neg. emotions = reducing expressed emotion, reduce stress and relapse, achieving balance between care and maintaining own wellbeing
- Improves families ability to help = family joins therapist (alliance) and all agree to aims of the therapy = improves families belief
42
What strategies are used in family therapy?
1. Therapeutic alliance - Therapist builds trust and rapport with the family and the identified patient
-> Establishes a non blaming, collaborative environment with respect
2. Psychoeducation - providing the family with clear info about schizophrenia
-> reduces misunderstandings and blame by helping relatives see symptoms to improve support and family anxiety
43
Briefly describe the research and development of Token economies for the management of schizophrenia
- Reward systems are used to manage maladaptive behaviour patterns due to extended periods of time in hospital
- Used a lot in the 60s where long-term hospitalization was the norm
44
What is the rationale behind the use of token economies?
- Used to manage maladaptive behaviours developed through spending long periods in psychiatric hospitals - institutionalisation
- Develop bad habits e.g. bad hygine or ceasing to socialise
- Matson identified three main cats = personal care, conditioned related behaviour, and social behaviour
- Doesn't cure but improves quality of life within setting and normalises behaviour (makes it easier to integrate back)
45
Describe the process of a token economy system
- Tokens are given to patients immediately after they have carried out a desirable behaviour
- Delays reduce the effectiveness
- Target behaviours are individual
46
Tokens have no value in themselves, but they can be swapped for tangible rewards, give examples
Sweets, magazines, films, walks
47
Describe the theoretical backbone of a token economy system
- Behaviour modification -> operant conditioning
- Tokens are secondary reinforcers because they gain power through being paired with a primary reinforcer
- This generally happens at the start of the programme
48
Research into the token economy system
- Ayllon and Nazrin
- Ward of women with schizophrenia
- Carrying out a task e.g. making bed
- Swap for gift
- Resulted in the no. of tasks increasing
- Use had decreased more recently due to a change of care routines but also due to ethics
49
Briefly outline the interactionist approach
- An approach that achnolodges that there are biological, psychological, and societal factors in the development of schizophrenia
- Genetic vulnerability/ neurochemical
- Stress e.g. events or daily life hassles
- Societal factors e.g. poor quality of interactions in family
50
Outline the diathesis stress model as an interactionist approach to explaining
- Originally Meehl suggested that diathesis was entirely genetic and due to a schizogene -> without no amount of stress will cause the disorder
- However, carriers of the gene could develop the condition as a result of chronic stress and trauma throughout childhood
e.g. Schizogene -> sensitivity to stress -> schizophrenogenic mother -> schizophrenia
51
Describe the modern view on diathesis
- Schizophrenia is polygenetic (Ripke)
- Vulnerability can also be caused by pathological trauma
e.g. early trauma like child abuse could even alter the developing brain (Read et al) due to HPA system becoming overactive and more vulnerable
52
Describe the modern view on stress
- Originally stress was seen as pathological in nature particularly in relation to parenting
- Now considered anything that risks triggering schizophrenia
e.g. cannabis use 7x likelihood
53
Outline the interactionist approach to treating schizophrenia
- Acknowledges both biological and psychological explanations and treatments
- Most common combination is anti-psychotics and CBT -> CBT is usually used to alleviate syumptoms whilst drugs tackle the underlying chemical imbalence
- Turkingson et al. points out that is it perfectly possible to believe that biologically caused disorders can still effectively be treated through CBT as long as we accept an interactionist approach
- Must believe in the relevance of all symptoms
- UK commonly used not USA
Psych
flashcards
Decks in class (14)
# Cards
