Psychology- schizophrenia

what percentage of the population does schizophrenia affect

1%

Which gender is most commonly diagnosed with schizophrenia

Male

What does the DSM-5 use to diagnose schizophrenia

The presence of one positive symptom

What does the ICD use to diagnose schizophrenia

The presence of two or more negative symptoms

What are positive symptoms

Symptoms that reflect an excess or distortion of normal functions

What are the two key categories of positive symptoms

Hallucinations and delusions

What are hallucinations

Unusual sensory experiences e.g. hearing voices or seeing objects

What are delusions

Irrational belief that seem real to the person suffering from them

What are the 4 main types of hallucination

Auditory, visual, olfactory or tactile

What are delusions of granduer

Delusions involving inflated beliefs about the sufferers power and importance e.g. believing their famous

What’s disorganised speech

Where an individual has problems organising their own thoughts leading to derailment (slipping from one topic to another)

What are negative symptoms

symptoms that reflect a reduction or loss of normal functions

What are the two main negative symptoms of schizophrenia

Avolition and speech poverty

What’s avolition

A reduction of interests and desires as well as an inability to initiate and persist in goal-directed behaviour

What’s speech poverty

The Lessening of speech fluency and productivity e.g. producing fewer words in a given time

What are some secondary symptoms of schizophrenia

Loss of employment, depression and the breakdown of relationships

What are the three phases of schizophrenia

The prodromal phase, the active phase and the residual phase

What occurs during the active phase

More obvious symptoms appear

What occurs during the residual phase

Obvious symptoms begin to subside

What was Cheneaux’s study

They had two psychiatrists independently diagnosed 100 patients with schizophrenia using the DSM and ICD

Evaluate the validity of the diagnosis of schizophrenia

Cheneaux’s study found schizophrenia is much more likely to be diagnosed using the ICD than the DSM suggesting that schizophrenia is either under-diagnosed with the DSM or over-diganosed with the ICD. Therefore the diagnosis of schizophrenia has poor validity as different assessment systems do not arrive at the same diagnosis

Evaluate the reliability of the diagnosis of schizophrenia

Cheneux’s study demonstrated the poor inter-rater reliability of diagnosing schizophrenia using either the DSM or ICD, demonstrating that even when diagnoses are made using a classification system the reliability isn’t perfect. However the reliability of diagnosis has improved as the classification systems have been updated. For example a story reported high reliability diagnosing 180 patients using the DSM (+0.97 inter-rater reliability) (+0.92 test-retest reliability) therefore we can be reasonably sure that the diagnosis of schizophrenia is consistently applied.

What’s co-morbidity

The occupancy of two illnesses or conditions together

How does co-morbidity weaken the validity of a patients diagnosis

Schizophrenia may not exist as a distinct condition and therefore may be a symptom of another condition, this becomes a problem for diagnosis of schizophrenia because many people with schizophrenia also have depression.

Evaluate gender bias in schizophrenia

Men are nearly 1.5x more likely to be diagnosed with schizophrenia than women, this could be because women are less vulnerable than men due to genetics however it’s more likely that women are underdiagnosed because they develop closer relationships and so seek support if suffering from schizophrenia helping them manage their symptoms, this demonstrates how schizophrenia diagnosis suffers from gender bias and as a result women may not be receiving treatment and services that benefit them

Evaluate cultural bias in the diagnosis of schizophrenia

There is a tendency to over-diagnose members of other cultures with schizophrenia, specifically African American and people of Afro-Caribbean descent are 7x more likely to than white people to be diagnosed with schizophrenia. This suggests that the diagnosis of schizophrenia has poor validity and is confounded by cultural beliefs or racist distrust of black patients

What did Rosenham’s study involve

He sent his friends and students into 15 hospitals in America claiming to hear a voice during the consultation and then acting normal if admitted to gain data on patient experiences in a psychiatric ward and to investigate psychiatric labels

What’s does the genetic biological explanation for schizophrenia suggest

That schizophrenia may be hereditary

What was the probability of fraternal twins both developing schizophrenia according to Gottsman and Shield

17%

What was the probability of identical twins both developing schizophrenia according to Gottsman and Shield

48%

What was Tienari’s adoption study investigating the genetic basis of schizophrenia

He studied 164 adoptees whose biological mothers had been diagnosed with schizophrenia and found that 11 were diagnosed as schizophrenic compared to 4 of the 197 control adoptees which suggests a genetic vulnerability to schizophrenia

What’s a candidate gene

Genes associated with specific illnesses

Outline Ripke’s study into the genetic basis of schizophrenia

He mapped the genome of schizophrenia and found 108 separate variations associated with an increased risk of schizophrenia showing that its aetiologically heterogeneous

What’s aeteologically heterogenous

When different combinations of factors including genetic variation can lead to a condition

What are examples of things that can cause genetic mutations

Radiation, poison or viral infections

What’s the study into sperm mutations causing schizophrenia

A study showed that there was a positive correlation of schizophrenia diagnosis with paternal age (0.7% with fathers over 25 and 2% with fathers over 50) this increase is associated with a positive correlation of sperm mutation with age

How does the neural correlated explanation explain schizophrenia

It suggests that schizophrenia has developed due to structural and functional brain abnormalities

What areas of the brain does the neural correlated explanation suggest is linked to schizophrenia

It suggests that enlarged ventricles can cause schizophrenia

What does the original dopamine hypothesis suggest causes schizophrenia

Schizophrenia is caused by hyperdopaminergia in the subcortex (high dopamine levels)

What does the updates dopamine hypothesis suggest causes schizophrenia

Hypodopaminergia in the cortex (low dopamine levels)

What’s the relationship between hyperdopaminergia and hpodopaminergia according to the updated dopamine hypothesis

Hypodopaminergia in the cortex leads to hyperdopaminergia in subcortical areas

What’s a schizophrenogenic mother as an explanation for sz

A cold and dominant mother who is both overprotective and rejecting leading to the child becoming confused and paranoid

What’s double bind as an explanation for sz

Schizophrenia develops due to mixed messages from parents who express care but also appear very critical leading to the child receiving conflicting messages

What’s expressed emotion as an explanation for sz

It’s a family communication style in which the family of a psychiatric patient are emotionally over involved with their lives

What are the 3 main elements of EE

Verbal criticism, hostility and emotional over-involvement

What does EE lead to

Relapse in recovered schizophrenics

Reed (2005)

Reviewed 46 studies of child abuse and sz in adulthood, 69% of females and 59% of males experienced child abuse suggesting that family dysfunction increases vulnerability to sz

What’s Meta representation

The ability to recognise thoughts/actions as your own

What does a lack of meta representation lead to

Hallucinations

What’s central control

The ability to suppress automatic responses when performing deliberate actions

What does a lack of central control lead to

Disorganised speech and derailment

How does the cognitive explanation explain sz

Through dysfunctional thought processes

What are the two main kinds of dysfunctional thinking

Meta representation and central control

Stirling

Compared sz and non-sz patients using the stroop test, those with sz took twice as long to complete the tasks providing evidence for the idea that information processing is different in the mind of a schizophrenic

What was the standard treatment for sz prior to the 1950’s

A long term stay in a psychiatric hospital

What are typical antipsychotics used for

To combat the positive symptoms of sz (hallucinations)

What are atypical antipsychotics used for

To combat positive symptoms and have a beneficial effect on negative symptoms

What are antipsychotics

Drugs used to treat the most disturbing forms of psychotic illness

Which antipsychotic is a dopamine antagonist

Typical antipsychotics

What’s an example of a typical antipsychotic

Chlorpromazine

What does chlorpromazine do

Permanently binds to dopamine and histamine receptors causing dopamine levels to increase which eventually reduces production

What are two examples of atypical antipsychotics

Clozapine and risperidone

How do clozapine and risperidone differ

respiradone binds more strongly to dopamine receptors than clozapine meaning it can be given in smaller doses

What is the difference in the action of typical and atypical antipsychotics

Atypical antipsychotics only bind to dopamine receptors temporarily and then dissociate returning dopamine transmission to normal whereas typical antipsychotics bind permanently

What are the benefits of using atypical antipsychotics over typical antipsychotics

Atypical antipsychotics have a lower risk of side effects and also have a beneficial effect on negative symptoms of sz so are suitable for treatment-resistant patients

Thornley

Found that clozapine was associated with better functioning and fewer symptoms than a placebo supporting the use of drug therapy for sz

Meltzer

Compared the efficacy of typical and atypical antipsychotics and found clozapine was more effective than typical antipsychotics

What’s CBT

A therapy that aims to help patients identify and challenge irrational thoughts

How can CBT used to help treat sz

When used alongside drug therapy it can help treat residual symptoms

Jaguar

Conducted a meta-analysis of CBT and found that it had a significant but small effect on positive and negative symptoms

What’s family therapy

A therapy designed to improve the quality of communication and interaction between family members

How does family therapy help treat sz

It reduces expressed emotion and allows families to find a balance between caring for the individual and maintaining their own lives as well as being trained to recognise signs of relapse

McFarlane

Reviewed family therapy and found that it’s as one of the most consistently effective treatments reducing sz relapse by 50-60% and it benefitted people on a broad spectrum of sz

What’s the impact of institutionalisation following long-term hospitalisation

The development of bad habits as a result of living without a routine

Azrin

Trialled a token economy system in a women’s sz ward by giving them plastic tokens after they completed tasks e.g. making their bed and found that the number of tasks carried out increased significantly

Why have token economy systems reduced in use

Long-term hospitalisation of people with sz has declined and people have been made aware of the extensive ethical issues of the token economy systems

What is a way of managing sz

Token economy systems

What are the three categories of institutional behaviour managed by token economies

Personal care, condition-related behaviours and social behaviour

What are the two major benefits of token economies

Improving someone’s quality of life within hospital settings and normalising behaviour allowing easier adaptation back to normal life

What’s a primary reinforcer

Anything that elicits pleasure or removes unpleasant states

What are secondary reinforcers

Things atht initially have no value but acquire value through association with primary reinforcers

What are ethical issues surrounding token economy systems

They reward patients with mild symptoms not severe symptoms, discriminating against those who are severely ill

What are the benefits of using token economy systems over CBT

Token economies are more pleasant and interfere less with freedom of thought than CBT

What’s the real world application of token economy systems (or not!)

They only have short-term benefits outside of a hospital settings and so have limited application in the real world but they do help people leave hospital who wouldn’t have otherwise been able to giving them a chance to go home

What’s AVATAR therapy

A therapy designed to help people suffering from hearing distresssing voices

How does AVATAR therapy work

It uses a computer program to develop a voice similar to the one being heard allowing the patient to challenge it and utilise coping mechanisms to get it under control

What’s the interactionist approach in terms of sz

An approach acknowledging that a range of factors (both biological and psychological) are involved in the development of sz

What’s the diathesis stress model

A psychological model suggesting that disorders develop through genetic vulnerability followed by a stress trigger

What was Meehl’s original diathesis-stress model

A model suggesting that diathesis was entirely genetic, the result of a single schizogene and that without the gene no amount of stress could trigger sz

What’s the modern understanding of diathesis

That many genes increase genetic vulnerability to a disorder and beyond this many other factors can create vulnerability e.g. trauma

What’s the modern understanding of stress

Stress is no longer viewed as purely psychological but instead as anything that risks triggering sz

How does cannabis act as a stressor for sz

It interferes with the dopamine systems in the body which can lead to sz

How does the interactionist model suggest sz should be treated

Through a combination of biological and psychological treatments e.g. antipsychotics and CBT

Guo (2010)

Researched the efficacy of different treatments for sz and found that combining biological and psychological treatments are the most effective form of treatment

What’s Britains approach to treating sz

The standard practise is to provide antipsychotic drugs alongside psychological therapy

What’s the USA’s approach to treating sz

It’s more common for medication (antipsychotics) to be given without CBT as they haven’t fully adopted the interactionist approach

Tienari’s adoption studies

Studies the combination of genetic vulnerability and parenting style using Finnish adoptees, he found that child-rearing styles with high levels of criticism and low levels of empathy only affected the development of sz in those with high genetic risk for sz suggesting that genetic vulnerability and family stress and important in the development of sz

What’s treatment-causation fallacy

A logical error where it’s assumed that a successful treatment of a mental disorder justifies a particular explanation

Why is sz more commonly diagnosed in urban areas

Because there’s a greater population density so people are more likely to witness early symptoms and be referred to a doctor and therefore have a greater chance of being diagnosed or it has been suggested that city life is more stressful than rural life acting as a trigger for sz