Schizophrenia

Question 1

Symptoms of Schizophrenia: How do you diagnose schizophrenia

Answer 1

• In order to diagnose someone they would use a diagnostic manual such as the DSM-V which is the most recent update used in the US or the ICD -11 in Europe
• Divided in to positive symptoms and negative symptoms

Question 2

Symptoms of Schizophrenia: Name the positive symptoms

Answer 2

• Hallucinations
• delusions
• disorganized speech
• grossly disorganized or catatonic behavior

Question 3

Symptoms of Schizophrenia: Name the negative symptoms

Answer 3

• Speech poverty
• Avolition - a reduction in interests and desires as well as reducing goal directed behavior
• affective flattening - reduction in the range and intensity of emotional expression including facial expression, voice tone and eye contact
• Anhedonia - loss of interest or pleasure in almost all activities or a lack of reactivity to normal pleasurable stimuli

Question 4

Symptoms of Schizophrenia: Define Positive symptoms

Answer 4

• These are those that appear to reflect an excess or distortion of normal functions

Question 5

Symptoms of Schizophrenia: Define negative symptoms

Answer 5

• These are those that appear to reflect a reduction or loss of normal functions which often persist even during periods of low positive symptoms

Question 6

Symptoms of Schizophrenia: Describe hallucinations

Answer 6

• These are unreal perceptions of the environment that are usually auditory – hearing voices – but may be visual – seeing things that other people see – olfactory – smelling things that other people cannot smell – or tactile.
• Many report hearing voices or several voices telling them to do something like harm themselves or someone or commenting on their behaviour

Question 7

Symptoms of Schizophrenia: Describe delusions

Answer 7

• Bizarre beliefs that seem real to the person, they are often not real
• They can be paranoid in nature, this involves the belief that they are being followed or spied upon
• Or they can be inflated beliefs about the persons power and importance
• Delusions of reference when events in the environment appear to be directly related to them for example special personal messages are being communicated through the TV or radio

Question 8

Symptoms of Schizophrenia: Describe disorganized speech

Answer 8

• This is the result of abnormal thought processes where the individual has problems organising his or her throughs and this shows up in their speech
• Can slip from one topic to the next
• Or sound like gibberish

Question 9

Symptoms of Schizophrenia: Describe grossly disorganized or catatonic behavior

Answer 9

• Inability or motivation to initiate a task once it has finished this leads to difficulties in daily living
• Decreased interest in personal hygiene or dressing and acting in ways that can appear bizarre
• They have a reduced reaction to the immediate environment

Question 10

Symptoms of Schizophrenia: Describe speech poverty

Answer 10

• This is lessening of speech fluency and productivity, this reflects a slowing or blocking of thoughts
• They may produce fewer words in a given time on a task of verbal fluency such as name as many fruit in a minute, not the fact that they do not know them but more the idea that they cannot produce them
• Reflected in less complex syntax such as fewer clauses and shorter utterances

Question 11

Symptoms of Schizophrenia: Describe avolition

Answer 11

• A reduction in interests and desires as well as reducing goal directed behaviour
• Poor social function or disinterest this can be result of other circumstances for example having no social contact with family or friends

Question 12

Symptoms of Schizophrenia: Describe affective flattening

Answer 12

• Reduction in the range and intensity of emotional expression including facial expression, voice tone, eye contact, and body language
• Compared to this control without this symptom individuals show fewer body and facial movements and smiles and less co-verbal behaviour

Question 13

Symptoms of Schizophrenia: Describe Anhedonia

Answer 13

• Loss of interest or pleasure in almost all activities or a lack of reactivity to normal pleasurable stimuli
• Physical anhedonia is the inability to experience physical pleasures such as the pleasure from food and bodily contact and so on
• Social anhedonia is the inability to experience pleasure from interpersonal situations such as interacting with other people
  Social anhedonia overlaps with other disorders such as depression therefore physical anhedonia does not so is more of a reliable symptoms of schizophrenia

Question 14

Reliability and validity in diagnosis and classification: Describe reliability in the diagnosis of schizophrenia

Answer 14

• Diagnostic reliability means that a diagnosis of schizophrenia must be repeatable, clinicians must be able to reach the same conclusion at two different points in time or same clinicians must reach the same conclusion.
• Inter-reliability is measured by a statistic called Kappa score, score of 1 is the perfect inter-rater agreement, 0 is zero agreement, 0.7 is considered good.

Question 15

Reliability and validity in diagnosis and classification:

Reliability: Describe cultural differences in diagnosis

Answer 15

• Significant variation between countries when it comes to diagnosing schizophrenia
• Copeland 1971 – gave 134 US and 194 British psychologists a description of a patient 69% of the US psychiatrists diagnosed schizophrenia but only 2% of the British psychiatrists diagnosed them as schizophrenic
• Luhrman et al 2015 interviewed 60 adults diagnosed with schizophrenia, 20 each in Ghana, India and the US each were asked about the voices they heard. While many of the African and Indian subjects reported positive experiences with the voices who often offered them help the US subjects were more likely to describe the voices as violent and hateful

Question 16

Reliability and validity in diagnosis and classification:

Describe factors that make up validity

Answer 16

• Gender bias in diagnosis
• symptom overlap
• Co-morbidity

Question 17

Reliability and validity in diagnosis and classification: Describe gender bias in diagnosis

Answer 17

• Gender bias occurs when the accuracy of diagnosis is dependent on the gender of an individual
• Clinicians could have gender based and stereotypical beliefs held about gender
• DSM criteria argues that some diagnostic cater goes are biased towards pathologising one gender rather than the other
• Broverman et al – found that clinicians in the US equated mentally healthy adult behaviour with mentally healthy male behaviour therefore there is a tendency to show that women are less mentally healthy

Question 18

Reliability and validity in diagnosis and classification: Describe symptom overlap

Answer 18

• Many of symptoms are also found in other disorders such as depression and bipolar, this is referred to as symptom overlap
• Elllason and Ross 1995 pointed out that people with dissociative identity disorder have more schizophrenic symptoms that people diagnosed with schizophrenia
• They usually have sufficient symptoms of other disorders that they have at least one other diagnosis

Question 19

Reliability and validity in diagnosis and classification: Describe co-morbidity

Answer 19

• Refers to the extent that two or more issues can occur
• Buckley et al estimated that co-morbid depression occurs in 50% of patients and 47% of patients also have a lifetime diagnosis of co-morbid substance abuse
• OCD and Schizophrenia appear together more often than chance would suggest, meta-analysis by Swets et al found that at least 12% of patients with schizophrenia also fulfilled the diagnostic criteria for OCD and about 25% displayed OCD symptoms

Question 20

Evaluation of validity: Research for gender bias in diagnosis

Answer 20

Research support for gender bias in diagnosis

• Loring and Powell – randomly selected 290 male and female psychiatrists to read two case vignettes for patients behaviour, they were then asked to offer their judgement on these individuals using standard diagnostic criteria, when they were described as males or no information was given about their gender 56% gave diagnosis of schizophrenia however when they were female only 20% were diagnosed
• Not as evident among female psychiatrists – affected by gender of clinicians as well

Question 21

Evaluation of validity: The consequences of co-morbidity

Answer 21

• A number of studies have examined single co-moralities with schizophrenia but these involved small sample sizes
• US study Weber et al looked at 6y million hospital discharge records to calculate co-morbidity rates, psychiatric and behaviour related diagnosis accounted for 45% of co-morbidity, also found evidence of many co-morbid non psychiatric diagnoses
• Many patients with primary diagnosis of schizophrenia were diagnosed with medical problems such as asthma, hypertension and type two diabetes

Question 22

Evaluation of validity: Differences in prognosis

Answer 22

• No evidence that they share the same outcomes when they are diagnosed with the same symptoms
• The prognosis for patients diagnosed with schizophrenia varies with about 20% recovering to their previous level of functioning and 10% showing a long lasting improvement and 30% showing some improvement with relapses
• It has little predictive validity and some people never recover
• What does influence outcome is more to do with gender, and psycho-social factors such as social skills academic achievement and family tolerance

Question 23

Evaluation of reliability: Lack of inter-rater reliability

Answer 23

• Despite the claims for increased reliability in the DSM, there is still little evidence that the DSM is used with high reliability by mental health clinicians
• Whaley – found inter-rater reliability correlations in the diagnosis of schizophrenia are illustrated in the Rosenhan study

Question 24

Evaluation of reliability: Unreliable symptoms

Answer 24

• Only one of the characteristics are required, this creates problems for reliability
• When 50 senior psychiatrists in in the US were asked to differentiate between bizarre and non-bizarre delusions they produced inter-rater reliability correlations of only 0.4 forcing the researchers to conclude that even this central diagnostic requirement lacks sufficient reliability for it to be a reliable method of distinguishing between schizophrenic and non-schizophrenic patients

Question 25

Evaluation of reliability: A comment on cultural differences in the diagnosis of schizophrenia

Answer 25

- There are Racial and cultural differences in the diagnosis, - The prognosis for members of ethnic minority groups may actually be more positive than for majority group members - Ethnic minority groups experience less distress associated with mental disorders because of the protective characteristics and social structures - Brekke and Barrio found evidence to support this hypothesis in a study in 184 individuals diagnosed with schizophrenia or a schizophrenia spectrum disorder this sample was drawn front wo non-white minority groups and a majority group - They found that non-minority groups were consistently more symptomatic than members of the two ethnic minority groups findings which supported the ethnic culture hypothesis

Question 26

Biological explanations for schizophrenia: Are genetic factors responsible for schizophrenia

Answer 26

- May be hereditary as tends to run in the family - Higher chance of getting it if you have family members who have it - No single gene is responsible for it but a mixture or different combinations of genes make individuals more vulnerable

Question 27

Biological explanations for schizophrenia: Family studies

Answer 27

- Gottesman 1991 – found that individuals who have schizophrenia and determine whether their biological relatives are similarly affected more often than non-biological relatives - The c loser the degree of relatives of a person with schizophrenia the greater the risk for example children with two schizophrenic parents had a concordance rate of 46% whereas those with one schizophrenic parent had a concordant rate of 13% and those with a brother or sister had a rating of 9%

Question 28

Biological explanations for schizophrenia: Twin studies

Answer 28

- Joseph 2004 calculated that the pooled data for all schizophrenic twin studies carried out prior to 2001 showed a concordance rate for MZ twins of 40.4% and 7.4% for DZ twins - More recent studies where it is blind and the researcher does not know if the twin is MZ or DZ has shown a lower concordance rate for MZ twins, but they still support a genetic position as they are still much higher than non-twins

Question 29

Biological explanations for schizophrenia: Adoption studies

Answer 29

- Studies of genetically related individuals who have been reared apart are used to show how the environment can affect the illness - Tienari et al 2000 in Finland, of the 164 adoptees whose biological mothers had been diagnosed with schizophrenia 11 of them received a diagnosis compared to just 4 of the 197 control adoptees therefore this shows the genetic link

Question 30

Biological explanations for schizophrenia: Neural correlates, the dopamine hypothesis

Answer 30

- The dopamine hypothesis claims that an excess of the neurotransmitter dopamine in certain regions of the brain is associated with the positive symptoms, messages fire to easily and often this leads to delusions and hallucinations - They have abnormally higher numbers of D2 receptors on receiving neurons this results in more dopamine binding and more neurons firing

Question 31

Biological explanations for schizophrenia: Drugs that increase dopaminergic activity

Answer 31

- Amphetamine is a dopamine agonist this means it stimulates nerve cells containing dopamine which causes the synapses to be flooded with this neurotransmitter - Normal individuals who are exposed to large doses of dopamine relating drugs can develop hallucinations and delusions like a schizophrenic episode, this disappears when the drugs wear off - People who suffer from Parkinson’s disease which is caused by low levels of dopamine and take the drug L-dopa in order to raise dopamine levels develop schizophrenic like symptoms

Question 32

Biological explanations for schizophrenia: Drugs that decrease dopaminergic activity

Answer 32

- Although there are many different types of antipsychotic drugs they all have one thing in common this is the blocking of the activity of dopamine in the brain - By reducing the neural pathways of the brain they eliminate symptoms such as hallucinations - This increased the case for dopamine as a factor that causes schizophrenia

Question 33

Biological explanations for schizophrenia: Revised dopamine hypothesis

Answer 33

- Davis and Kahn 1991 proposed that the positive symptoms of schizophrenia are caused by an excess of dopamine in subcortical areas of the brain, particularly the mesolimbic pathway - The negative and cognitive symptoms of schizophrenia are thought to arise from a deficit of dopamine in areas of the prefrontal cortex - Neural imaging – Patel et al – used PET scans to assess dopamine levels in schizophrenic and normal individuals, found lower levels of dopamine in the dorsolateral prefrontal cortex of schizophrenic patients compared to normal controls - Animal studies – Wang and Deutch 2008, induced dopamine depletion in the prefrontal cortex in rats, this resulted in cognitive impairment and the researcher were able to reverse this using olanzapine as an atypical antipsychotic drug which has beneficial effects of negative symptoms in humans

Question 34

Evaluation of genetic factors: Common rearing patterns may explain family similarities

Answer 34

- Research has shown that schizophrenia appears to run in families, supporting the argument for genetic basis - Researcher have now accepted it may be due to common rearing patterns for example research on expressed emotion has shown that the negative emotional climate in some families may lead to stress beyond a individuals coping mechanisms leading to a schizophrenic episode

Question 35

Evaluation of genetic factors: MZ twins encounter more similar environments

Answer 35

- Crucial assumption which underlies all twin studies is that the environment that they grow up in is the same therefore the concordance rate is due to genetic similarity and not environmental similarity - Joseph 2004 points out that the environments could be different that they grow up in therefore concordance rates highlight the different environmental differences and not the genetic differences or similarities

Question 36

Evaluation of genetic factors: | Adoptees may be selectively placed

Answer 36

- Central assumption of adoption studies is that adoptees are not selectively placed, adoptive parents who adopt children with schizophrenic biological parent are not different from those that adopt a normal parented child - Joseph claimed that this is unlikely to be the case as US and Denmark adoptive parents are informed of the genetic background prior to adoption, therefore they are less likely to be adopted

Question 37

Evaluation of the Dopamine hypothesis: Evidence from treatment

Answer 37

- Much evidence comes from the success of drug trials, for example treatments that attempt to change levels of dopamine activity in the brain, basic mechanism of antipsychotic drugs reduce the effects of dopamine and therefore reduce the symptoms of schzioprhenia - Leucht et al – carried out a meta-anaylsis of 212 studies that had analysed the effectiveness of different antipsychotic drugs compared with a placebo, they found that all the drugs tested were significantly more effective than placebo in the treatment of positive and negative symptoms

Question 38

Evaluation of the Dopamine hypothesis: Inconclusive supporting evidence

Answer 38

- Moncrieff 2009 claims that evidence for dopamine levels are not conclusive - Stimulate drugs can cause schizophrenia episodes and they are known to affect neurotransmitters other than dopamine - Evidence for dopamine concentrations in the post-mortem brain tissue has either been negative or inconclusive - Factors that lead to dopamine release such as stress and smoking have never been considered

Question 39

Evaluation of the Dopamine hypothesis: Challenges to the dopamine hypothesis

Answer 39

- Noll 2009 – claims there is strong evidence against the original dopamine hypothesis and the revised dopamine hypothesis - Argues that antipsychotic drugs do not alleviate hallucination sand delusions in 1/3 of those experiencing them - Points out that hallucination and delusions are present despite dopamine levels being normal - Blocking D2 has little effect on symptoms therefore other neurotransmitter systems are responsible for the positive symptoms

Question 40

Psychological explanations for schizophrenia: Double blind theory

Answer 40

- Gregory Bateson et al suggested that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia - For example a mother who tells her son that she loves him yet turns her head in disgust at the same time, therefore the child receives two different conflicting views on their relationship - Child can no longer respond to the mother due to these contradictions and these prevent the development of internally coherent construction of reality and can cause schizophrenic symptoms

Question 41

Psychological explanations for schizophrenia: Expressed emotion

Answer 41

- Negative emotional climate or a high degree of expressed emotions can cause schizophrenic symptoms - Expressed emotion is a family communication style in which members of the family talk about that patient in a critical or hostile manner or in a way that indicates emotional over involvement or over concern for the patient - Kuipers et al found that high EE relative talk more and listen less and they are most likely to influence relapse rates, 4 times more likely to relapse - People with schizophrenia have a low tolerance for intense environmental stimuli and intense emotional comments and interactions with family members - Leads to stress beyond there coping mechanisms causing an episode - Supportive and undemanding may help reduce dependence of antipsychotic medication and reduce chance of relapse

Question 42

Psychological explanations for schizophrenia: Cognitive explanations

Answer 42

- Levels of dysfunctional thought processing in people with schizophrenia this is shown in positive symptoms which are displayed

Question 43

Psychological explanations for schizophrenia: Cognitive explanations of delusions

Answer 43

- During formation of delusions the patients interpretations of their experiences are controlled by inadequate information processing - Characteristic of delusional thinking is the degree to which the individual sees him or herself as the central component in events so jumps to conclusions about external events - Patients tendency to relate irrelevant events to themselves and arrive at false conclusions - Muffled voices are interpreted as people criticising them and flashes of light are a signal from God - Unwilling to recognise that they are wrong

Question 44

Psychological explanations for schizophrenia: Cognitive explanations of hallucinations

Answer 44

- Aleman 2001 suggest that hallucination prone individuals find it difficult to distinguish between imagery and sensory based perception - The inner representation of an idea can override the actual sensory stimulus and produce an auditory image - They do not go through the same process of reality testing.

Question 45

Evaluation of family dysfunction: Family relationships

Answer 45

- Tinari et al – adopted children who had schizophrenic biological parents were more likely to become ill themselves than those with non-biological schizophrenic parents, differences only emerged in situations where the adopted family was rated as disturbed

Question 46

Evaluation of family dysfunction: Double blind theory

Answer 46

- Berger 1965 found that schizophrenics reported a higher recall of double blind statements by their mothers than non-schizophrenics - May not be reliable as recall is affected by their schizophrenia

Question 47

Evaluation of family dysfunction: Individual difference in vulnerability to EE

Answer 47

- Not all patients who live in high EE families relapse, and not all patients who live in low EE homes avoid relapse - Altorfer et al have found individual differences in response high EE like behaviours, found ¼ of the patients they studies showed no physiological responses to stressful comments from their relatives, vulnerability to the influences of high EE may also be psychologically based - Lebell et al suggests how patients appraise the behaviour of their relatives is important, in cases where high EE behaviours are not perceived as being negative or stressful they can do well regardless of the family environment

Question 48

Evaluation of cognitive explanations: Supporting evidence for the cognitive model of schizophrenia

Answer 48

- Sarin and wallin reviewed recent research evidence relating to the cognitive model of schizophrenia - They found supporting evidence that positive symptoms of schizophrenia have their origins in faulty cognition - For example delusional patients were found to show various biases in their information processing such as jumping to conclusions and lack of reality testing - Schizophrenic individuals with hallucinations were found to have impaired self-monitoring and also tended to experience their own thoughts as voices

Question 49

Evaluation of cognitive explanations: Support from the success of cognitive therapies

Answer 49

- Claim that symptoms of schizophrenia have their origin in faulty cognition is reinforced by the success of cognitive based therapies for schizophrenia - Patients encouraged to evaluate the content of their delusions or of any voices and to consider ways in which they may test the validity of their faulty beliefs - Effectiveness was demonstrated in the NICE review of treatments – found consistent evidence that when compared with the treatment by antipsychotic medication CBT was more effective in reducing symptom and increasing social functioning

Question 50

Evaluation of cognitive explanations: An integrated model of schizophrenia

Answer 50

- Howes and Murray – addressed the problem of the integrated model dealing in adequately with multiple aspects of the disorder, they created an integrated model and argue that early vulnerability factors such as genes, birth complications together with exposure to social stressor and the dopamine system can cause schizophrenia - Results in hallucinations and psychosis

Question 51

Drug therapy: Antipsychotics

Answer 51

- Treat the most disturbing forms of psychotic illnesses, - Helps person function with there life - Tend to use a combination of medicine to treat it, they all work by reducing the dopaminergic transmission - Typical antipsychotic – are used primarily to combat the positive symptoms of schizophrenia such as hallucinations and thought disturbances - Atypical antipsychotic – combat positive symptoms but in addition there are claims that they have some beneficial effects on negative symptoms as well

Question 52

Drug therapy: Typical antipsychotics

Answer 52

- Developed in 1950s - They reduce the effects od dopamine and reduce the symptoms of schizophrenia, typical antipsychotics are dopamine antagonists in that they bind to but do not stimulate dopamine receptors and block their action - Therefore drugs such as chlorpromazine eliminates the hallucinations and delusions experienced by people with schizophrenia - Hallucinations and delusions diminish within a few days of the medication - Kapur et al 2000, estimate that between 60% and 75% of D2 receptors in the mesolimbic dopamine pathway must be blocked for these drugs to be effective, in order to do this a similar number of D2 receptors in other areas of the brain must also be blocked leading to side effects - High cost

Question 53

Drug therapy: Atypical antipsychotics

Answer 53

- They have three main differences to the first generation typical antipsychotics, they have a low risk of extrapyramidal side effects and have a beneficial effect on negative symptoms and cognitive impairment therefore they are suitable for treatment resistant patients - Drugs also act on dopamine systems and block D2 receptors and rapidly dissociate to allow normal dopamine transmission - Drugs such as clozapine have little effect on the dopamine systems that control movement and do cause the movement problems. - Rapid dissociation is one feature of atypical antipsychotics that distinguish them from typical antipsychotics, - Typical only block D2 receptors, however atypical have a stronger affinity for serotonin receptors and a lower affinity for D2 receptors

Question 54

Evaluation of Drug therapy: Antipsychotic versus placebo

Answer 54

- Leucht et al – carried out a meta-analysis of 65 studies between 1959 and 2011 involving nearly 6000 patients, all patients had been stabilised or either on typical or atypical antipsychotics, some were taken of the antipsychotic and given a placebo instead, the remaining patients remained in the antipsychotic, within 12 months 64% on the placebo relapsed and only 27% relapsed on the antipsychotic

Question 55

Evaluation of Drug therapy: Extrapyramidal side effects

Answer 55

- Typical antipsychotic drugs can sometimes produce movement problems for the patients - Drugs impact extrapyramidal side of the brain, they can experience symptoms like the Parkinson’s disease - Or they could get tardive dyskinesia this is involuntary movement of the tongue face and jaw, these are distressing for the patients so other drugs have to be given to control them

Question 56

Evaluation of Drug therapy: Ethical problems with typical antipsychotics

Answer 56

- If side effects, deaths and psychosocial consequences were taken into account a cost-benefit analysis of its advantages would be negative - In the US a large out of court settlement was given to a tardive dyskinesia sufferer on the basis of article 3 of the human rights act as its is inhuman and degrading treatment

Question 57

Evaluation of Drug therapy:Advantages of atypical over typical antipsychotics

Answer 57

- Fewer side affects - Less likely to produce extrapyramidal side effects - More likely to continue with there medication which means they are more likely to see a reduction in their symptoms

Question 58

Evaluation of Drug therapy:Are atypical antipsychotics better

Answer 58

- Crossley et al – meta-analysis of 15 studies to examine the efficiency and side effects of atypical versus typical antipsychotics in the early phase treatment of schizophrenia, they found no differences between atypical and typical in terms of their affect on treatment but did not there side effects experienced - Atypical – gained more weight than those on typical - Typical – experienced extrapyramidal side effects

Question 59

Evaluation of Drug therapy:Motivational deficits

Answer 59

- Ross and Read 2004 – argued that when some people are prescribed antipsychotic medication it reinforces the view that there is something wrong with them, prevents the individual from thinking about possible stressors - Reduces their motivation to look for possible solutions that might alleviate these stressors and reduce suffering