Schizophrenia Flashcards

Question

Diagnosis and Classification of SZ AO3: Point Three: Gender Bias

Answer 1

The classifications systems are based on typical male behaviour and the male idea of health - **Leo and Cartagena:** women excluded from studied due to the confounding variable of hormones fluctuations → studies are therefore androcentric **Goldstien (1993)**: women as more likely to be voluntary SZ patients - could be be due to women being more likely to go and see doctors due to more stigma being placed on men’s mental health - or bc of the stress placed upon women in daily life that they are more likely to develop SZ - highlight the gendered biases within the classification and diagnosis of SZ and how it effects real life people

Answer 2

when someone has two or more of the same medical conditions, co-existing with one another → therefore a person with SZ and another personality condition like depression can cause ambiguity in diagnosis

Answer 3

when considerable symptoms overlaps due to co-morbidity → eg SZ and types of depression or drug abuse → can lead to unreliable diagnosis due to exhibiting symptoms of SZ whilst having another symptoms

Answer 4

Highlights how, with more shared genes, the higher the risk of SZ developing → this implicated Genes as an origin of SZ - MZ twins = 48%

Answer 5

- twins share either 100% or 50% of DNA and environment - they are ideal for investigating the implications of genes on the developmental risk of SZ - Twin studied have identified strong concordance rates in comparison with the general population: - G + S: - MZ: 0.48 - DZ: 0.17

Answer 6

- As children share 50% of genes with parents, if a child shows higher concordance rate of SZ with BIOLOGICAL parents over ADOPTED parents genes would be indicated as it has a stronger effect than environment.

Answer 7

- important in the functioning on several brain systems that may cause SZ symptoms, especially in the cortex and sub-cortext. - dopamine is an agonist

Answer 8

that the brain of SZ patients may produce more more dopamine than that of a neurotypical brain

Answer 9

SZ patients may have abnormally high D2 dopamine receptors

Answer 10

- Positive symptoms caused by excess of dopamine in the subcortical areas of brain (Hyperdopaminergia) - negative and cognitive symptoms arise from a deficit in the pre-frontal cortex (Hypodopaminergia)

Answer 11

* Theory comes from the knowledge that antipsychotic antagonist drugs reduce dopamine activity → theses drugs can cause Parkinson like side effects caused by low levels of dopamine in the brain

Answer 12

- Genetic: twins and family family - the Dopamine Theory

Answer 13

* Ripke: a huge sample of 4,000 → found 108 genetic variations associated with SZ → strong valid evidence for genetic component of SZ Gottesman and Shields: * Highlights a correlation between genes and risk of developing SZ → higher the % of shared genes the higher the risk → supports the notion that genes are implicated in SZ * HOWEVER: It shows correlation NOT causation → therefore it cannot be said that genes cause SZ, only that they are present in someone with SZ → significantly reduces the validity of the study and its support for the genetic explanation * There may be a 3rd factor like environment, the more genes shares, the closer the environment → highlighted by how MZ twins should be 100% if fully genetic, yet they are only 48%

Answer 14

**Support for the DH** - Falkai et al: supports the DH with post mortem examinations - Lindstroem: radioactive labelling study, found dopamine taken up faster then controls - Drugs: The L-Dopa drug (dopamine medication) can induce SZ symptoms in those with Parkinson’s → implicating dopamine as having a role **However:** - It takes the anti-psychotic several weeks to start relieving symptoms, even though it blocks dopamine receptors straight away → highlights a reduced role of D, or the implication of other NTs alongside D - Moghaddam and Javitt: found evidence for glutamate to be implicated in patients with SZ - This suggests that actually D is not the main cause for SZ, and that other factors, like other NTs or the environment as seen in G+S

Answer 15

* The bio explanation is highly deterministic AND reductionist * This can be positive, as allows patients with SZ to understand that the illness they are suffering from is not their fault → which can offer solace to patients → strengthens the theory in its application to patients * HOWEVER, it can be negative as it can highlight that there is way to fully treat the illness, as it is encoded in ones DNA → this highlights a application issue in relating to patients * Some may argue that a Free Will approach is a much better way to approach mental illness (like the cognitive approach with CBT). - However, this can lead to patient blaming as well as the notion that people with SZ are not aware they are unwell (psychotic illness) and therefore would not be able to change it themselves anyway - this view may therefore be detrimental to recovery and point to a reductionist biological approach being the best explanation in terms of patient care.

Answer 16

- Family Dysfunction - Cognitive Explantion

Answer 17

- Double bind - Expressed Emotion

Answer 18

- SZ as a consequence of miscommunication and abnormal patterns of communication in the family - when paralanguage (eg tone of voice) does match what is being communicated - It can cause children to become unable to respond logically to others and have maladaptive thinking patterns

Answer 19

Bateson: suggested families of SZ communicate in an destructively ambiguous fashion

Answer 20

Families that engage in high levels of criticism, hostility and overprotectiveness - Eg verbal criticism, anger, rejection, needless self-sacrifice Communication that is LOW in EE is UPR Highly linked to relapse → when entering the EE environment SZ can occur again

Answer 21

- Cognitive Dysfunction (inclusing ToM) - Central Control Dysfunctional

Answer 22

Proposes that behaviour is caused by internal mental process → the brain is like a computer SZ is an issue with cognition and impairment of processing emotion, social cues and ToM

Answer 23

- comprimised TOM can cause SZ - **ToM**: the ability to understand that we and other have our own minds and that our minds are distinct - Helps us to understand our own desires and that they may not be the same as others - Not born with it → develops around 2-3

Answer 24

- Some cog impairments in SZ is due to faulty ToM - Do not have a clear grasp of their own mind and misunderstand their own thought processes - Unable to distinguish actions done by external forces or free will - This is called metarepresentation

Answer 25

these deficits: - Inability to generate willed action - Inability to monitor willed action - Inability to monitor the beliefs and intentions of others

Answer 26

- a lack of preconscious filters (filters out the un-important info taken in by the sensory registers) - includes Firth's Attention Deficiet Theory

Answer 27

SZ is a result of the breakdown of through filtering processes → issues with attention and not being able to filter out non important info An inability to properly focus can cause disordered thoughts → could account for hallucination, delusions, and disorganised speech This deficite MAY be caused by abnormalities in the prefrontal cortex → interactionist approach → Frith found reduced blood flow to these areas

Answer 28

Found SZ have attention bias towards threatening and emotional stimuli More likely to perceive stimuli as threatening → can explain paranoia

Answer 29

Reductionist: takes into account the enviroment of pateints, unlike other theories like SZ ------------------------------------------------------------------ Reseach Evidence: stregthens reliability - Double Blind: Mishcler and Waxler - found the mothers to SZ daughters were rather aloof and unresponsive → implicates communication as playing a role - Berger: interview SZ and found higher recall of DB by mothers than non SZ → implicates DB as a cause - Expressed Emotion: Kavanagh - found SZ in families with high EE were four times more likely to relapse that those in families with low EE → highlighting EEs role in relapse ------------------------------------------------------------------ Parent Blaming + Cause and Effect - Is the family dynamic what caused SZ to develop, or has the dysfunctional dynamic occurred due to the stresses of dealing with a child who is developing SZ → CANNOT SHOW CAUSATION, SIGNIFICANTLY REDUCES THE VALIDITY OF THE ARGUMENT

Answer 30

* Stirling: found SZ were a lot slower on cog tasks (The Stroop Test) that link to the central control theory → highlights a link between cognitive impairment and atypical functioning ------------------------------------------------------------------ * Cause and Effect - Central Control: It cannot be said if SZ is caused by the cognitive dysfunction, or if it simply an effect of SZ → this is a correlation and not a causation, and therefor the theory lacks considerable validity in its claims, weakening the theory - ToM: Regardless of research support, ToM has a validity issue -> ToM is heavily implicated in people with diagnosed autism -> why manifest as autism in some and SZ in another? ------------------------------------------------------------------ This highlights that the theory may be incomplete through not stating where ToM or CC actually stems from -> implicates something other than cog dysfunction as causing SZ, eg biological

Answer 31

The theory does provide a good explanation for some of the theories of SZ HOWEVER, there are huge methodological issues in studies those with SZ - All patients with SZ are highly medicated in order to allow them to deal with the difficult disorder - It would be highly unethical to force patients to come off these drugs for the purpose of a study - Therefore, all research into SZ lacks validity as it cannot be said if the drugs patients are on exacerbate or reduce certain aspects of the illness and skew results.

Answer 32

Modification of mental illness (treatment not cure)

Answer 33

alter levels of neurotransmitters in the brain

Answer 34

- first dopamine hypothesis - work on the notion that SZ is caused by too much dopamine in the sub cortex of the brain

Answer 35

NEUROLEPTIC

Answer 36

Chlorpromazine - Dopamine antagonist: inhibits dopamine by binding to dopamine receptors to reduce their action and not stimulating them - block the NTs in the synapses in the limbic systems - Stop positive symtoms like hallucinations

Answer 37

- attempting to reduce dopamine in the sub cortex regions of the brain -> the cerebral cortex’s dopamine levels are also effected → this is where the motor area is, and can therefore impair movements - Prolonged used to neuroleptic drugs can lead to Tardive Dyskinesia (involuntary movements of the tongue, face, jaw, etc) - also dizziness, weight gain, and itchy skin

Answer 38

second dopamine hypothesis, developed in the 1970s → works to counter hypo and hyperdopaminergia Reduces some positive symtoms, but most notably negative ones Acts on dopamine as well as other NTs like glutamate and serotonin

Answer 39

Clozapine: - Dopamine partial agonist → aims to balance dopamine across the brain - occupies receptors is areas of the brain where it is to high - temporally occupy D2 receptors and then rapidly dissociating it to allow normal dopamine distribution → still receive dopamine just in smaller levels - boost the levels of dopamine activity where it is to low

Answer 40

Agranulocytosis: a deficiency of white blood cells, causing people to be more susceptible to illnesses by weakening the immune system

Answer 41

- Lobos: Found clozapine worked better (very effective) at reducing positive symptoms of SZ, however the serious side effects increased attrition rates -> this reduces the effectiveness if A rates are high as it defeats the purpose of a drug treatment ------------------------------------------------------------------ - Maintenance Schedule: issue with adherence to maintenance schedule from patients -> treatment lacks ecological validity -> ‘revolving door psychiatry’ ------------------------------------------------------------------ - Valenstein et al: Study on 63,000 SZ on antipsychotics and 40% had poor adherence to medications. However: Clozapine was the only drug with a 4.6% level of poor adherence (opposing Lobos) - Highlighted how adherence can vary for different groups -> young people (rebellious nature) and African-Americans (lack of trust due to institutional racism) were less likely to adhere ------------------------------------------------------------------ LTQ: Highlights the nature of individual differences in drug effectiveness, which reduces the validity of the treatment by making it reliant on external factors (maintenance schedules) to work

Answer 42

Side Effects: - Antipsychotic medication has extreme side effects, like TD, NMS etc. weight gain which can lead to many health complications → diabetes, heart disease - Inappropriate Drug Use : Lack informed consent → psychosis, not understand that the drugs are there to help them - Can take years to find the right combo of drugs for a person, which can worsen symptoms → some arguments that we should understand them better before we use them -> links back to idea of reduced validity due to individual differences ------------------------------------------------------------------ - Moncrieff: Chemical Straight Jacket -> does not believe that medication is the best way to treat SZ -> found that withdrawal can cause psychosis, even in a patient that has no history of it ------------------------------------------------------------------ - Szasz: anti-psychiatry -> argues that mediation just makes patients more compliment and to fit in with societies ideas of normal ------------------------------------------------------------------ Begs the question, is mental illness a myth or purely labelling ------------------------------------------------------------------ · LTQ: If treatment is unethical and cannot be appropriately applied, therefore lacks RWA and weakens the external validity

Answer 43

- Social Implications: Pre-drug treatments people were treated inhumanly - Societal Gains: Drugs allow more people to be in the workplace → positive economic implications and Less money spent on institutionalisation, drugs are cheaper ------------------------------------------------------------------ - HOWEVER: issues with releasing people with SZ into society who could become violent - however: is there a greater benefit to more people to live independently with SZ than there is for a select few cases of violent crime ------------------------------------------------------------------ - Cost Benefit Analysis: Long term medication can be costly, but a lot less then life in an institution. - The cheapest drug if chlorpromazine -> less used now due to its side effects → however, it is still used in developing countries. - NHS limited budget, and drugs cheapest ------------------------------------------------------------------ LTQ: if treatment cannot be properly applied to society, external validity is worded. However, the financial benefits of drugs cheapness strengthen external val.

Answer 44

Overall: antipsychotic use is not simple and requires nuance. Can depend upon many factors and therefor individual differences can play a major role

Answer 45

- CBTp - family therapies

Answer 46

- To help patients challenged and modify their delusions, especially through the use of evidence and reality testing - Aims to alter the way that SZs think to organise their disordered thinking by making conscious the patients irrational thoughts / delusions. - Does no seek to prevent delusions but help cope with symtoms

Answer 47

- hallucination investigation - Relapse Prevention Stratagies - Socratic Questioning

Answer 48

- Help to understand that the voices in their mind are from theirselves, and not an external source. - Normalisation: understand the voices are their own by focusing on the tone of voice and whether to not is is male or female etc

Answer 49

- learn to recognise signs and symtoms of a relapse - therapist and patient create a checklist of warning signs and triggers that make relapse likely - Help to develop a plan with the patient and social network of people with SZ

Answer 50

- curiosity driven questions asked by the therapist asked in sessions to highlight errors in their thinking - the lack of evidence should start to undermine a patients belief in the delusion

Answer 51

- Take place in the person’s home → context dependent forgetting link - Develop strategies with the patient’s family to help the patient cope with SZ → leads to a more supportive atmosphere in the home to reduce relapse - Family taught about SZ and the particulars of the patient’s diagnosis

Answer 52

- ask questions and properly learn about the disorder - learn more constructive ways of communication (counter EE) - learn to recognise early signs of relapse so they can repsond and lower its severity

Answer 53

* Research support: Turkington and Pontillo * However: SZ is rarely used on own but with drugs * Issues with causation -> is it purely the drugs or the introduction of CBTp that is helping the symptoms -> lowers validity * Issues with Research: - studies are biased towards those who have less sever symptoms and have an increased willingness with CBTp - therefore the research not accurately portray all types of SZ and -> cause and effect * is that CBTp works well? or are there individual differences that effect it - Also: studies lack a control group → cannot use the idea of a control with placebo which makes it scientific → lacks validity

Answer 54

‘Post code lottery’: - There is a issue with the access to CBTp, espec in the north of England * Haddock: 187 random selected people with SZ in the North West, 6.9% had been offered CBTp - Despite NICE recommendations, approx 1 in 10 of those who need it are able to access CBTp - Therefore, however effective it is, if it cannot be accessed it cannot help people → it therefore lacks external validity as it has low applicability due how expensive it is

Answer 55

Research Evidence: National Collaborating Centre for Mental Health * Meta Analysis of 32 studies and compared those who had FT with those just having drugs - Found the relapse rate of family therapies was 26% in the control if was 50% ------------------------------------------------------------------ * Garety: relapse = 25% in family therapy and 50% in drug use alone → this highlight the effectiveness of FT but also highlights the replicability of the NCCMH research which increases its validity ------------------------------------------------------------------ Issues with Research Support: * Small scale before and after studies tend to show high effectiveness, whereas larger ones show lower effectiveness * This highlights a flaw in the scientific basis of the research into FT * Could there be an observer bias in smaller scale research? or are the researcher more attuned to the idiosyncrasies of convalescence ------------------------------------------------------------------ * Issues with research support affect the internal validity of the theory by highlighting scientific flaws in the research

Answer 56

Token Economies

Answer 57

A technique which reinforces appropriate behaviour by giving or withholding tokens which can be exchanged fro privileges.

Answer 58

A BEHAVIOUR MODIFICATION SYSTEM

Answer 59

three areas in hospitals that can be tackled using TE - personal hygiene - illness related issues (positive and negative issues) - social behaviour

Answer 60

Desirable behaviour is reinforced with use of tokens These tokens have no intrinsic value: are called secondary reinforcers They can be exchanged for primary reinforcers, things wanted by the person

Answer 61

the longer you wait between receiving token and getting the reward, the less the person will link them

Answer 62

Clear definitions of: - what the desire behaviour is - what a token is and how tokens are allocated - what the rewards are - rewards removed once behaviour sis achieved

Answer 63

Skinner's operant conditioning

Answer 64

* Dickerson: meta-analysis to study TW finding almost all were effective * Glowaki: semi-meta-analysis of 7 studies, found TE worked well ------------------------------------------------------------------ * HOWEVER: Issues with Research - File draw bias: researchers are more likely to pick studies that align with their hypothesis over those that do not → lower the validity of the research support ------------------------------------------------------------------ - McMonagle and Sultana: noted in TE patients weren't often randomly allocated, so hard to tell efficiency * the types of patents used in studies tend to be those who’s have less sever symptoms (lowered psychotic, and so can understand that they have an issue and comply with TE) * Lowers the interval validity significantly by not having a representative, random sample

Answer 65

Milby: found that programs were successful in psychiatric settings and aided preparing people to leave hospital. HOWEVER, also said that we do not know the effects in the long term ------------------------------------------------------------------ Corrigan: TE only works in hospital, and without other patients in the community, it wasn't good ------------------------------------------------------------------ Highlights that RE can only be an effective management for SZ in an institutional setting, this lowers its external validity

Answer 66

TE is Ethically problematic * Tokens and rewards are easier for people with less harsh / more manageable symptoms to obtain * This can cause a discrepancy between patients with different levels of severity in their symptoms, which patients can view as unfair by other patents ------------------------------------------------------------------ * This issue cannot be rectified, as if token are given for effort rather than number of behaviours completed, those who can complete more behaviours with less effort would feel unfairly compensated ------------------------------------------------------------------ This lowers external validity, as it highlights how TE cannot be ethically implemented in practice regardless of validity.

Answer 67

- Explaining and treating SZ using both biological (nature), psychological (social and environmental) factors. - these factors CANNOT be separated when explaining and treating SZ

Answer 68

Diathesis stress model

Answer 69

- Diathesis vulnerability is entirely genetic and the result of a single **schizogene** which results in a **schitzotypic** personality- extremely sensitive to stress - No amount of stress will lead to SZ if the gene is not present - Chronic stress + gene = development of SZ

Answer 70

* More nuanced use of the interactionist approach -> does not focus simply on genetic vulnerability - Read: things like childhood trauma - Ripke: many different genes responsible

Answer 71

- exemplifies the DSM through their longitudinal adoption study - highlighted children with a genetic predisposition (SZ mother) and a critical upbringings are more likely to develop SZ as an adult than a control.

Answer 72

* Acknowledges the influence of both biological and phycological factors effecting development and maintenance of SZ → treatment therefore both should influence treatment → drugs + phycological therapies like CBTp / family therapies

Answer 73

Tienari: - support for the theory with high internal validity through a scientific methodology - Large sample: 19,000 Finnish child - Control group - Longitudinal These factors highlight a strong internal validity ------------------------------------------------------------------ HOWEVER: - binary definition of good or bad rearing style (this is subjective) - Ethical issues: the study hypothesised that a group of the children would develop SZ, which they did. in not intervening, the researchers effectively let a large group of people develop a sever mental illness - this is unethical but also effect’s the study’s reliability as it cannot be replicated - These methodological issues actually lower the study's application and ecological validity by highlighting a flawed internal validity and low reliability

Answer 74

* UK drug and physiological therapies are often used in conjunction, but in the US it is a lot less likely * This reduces the access to treatment in America * If there is low access to an interactionist treatment, it doesn’t matter how effective the theory is at explaining or treating SZ if it cannot be implemented * This limited access to treatment lowers the ecological validity of the theory and highlights its lowered acceptance by the global scientific community, effecting its real world application.

Answer 75

the evidence of stress, only shows correlation and not causation * We cannot actually know if the stress triggers the vulnerability as it would be unethical to study this → we could not make an experimental group smoke weed weekly for two years to see if this triggers their vulnerability * Therefore only a correlational relationship can be seen and this potentially argued that SZ cannot be properly treated if we do not know the true cause * limits the validity of treatment and theory as a whole by highlighting the lack of internal validity of the theory (issues with causation) and a lack of validity when it comes to treating SZ

Schizophrenia Flashcards

(104 cards)