Schizophrenia

What is schizophrenia?

a type of psychosis characterised by a profound disruption of cognition and emotion

what are the types of delusions? (2)

delusions of grandeur, paranoid delusions

what is a delusion of grandeur?

believing that you are someone important or of persecution

what are features of schizophrenia? (9)

disorganised thoughts, delusions, affective flattening, alogia, social/occupational dysfunction, avolition, hallucinations, catatonic behaviour, anhedonia

what are paranoid delusions?

false beliefs about their safety being compromised

what is the percentage prevalence of schizophrenia?

1% in the UK (lower globally)

what are the classification systems for mental illness? (2)

DSM and ICD

what is different about the results of the classification systems?

the diagnosis rates differ significantly when using the two different systems is problematic

what is the DSM?

American diagnosis tool

what is a positive symptom?

Appear to reflect an excess or distortion of normal functioning

how do positive symptoms generally occur?

in short, acute periods and respond well to drug treatment

what is a negative symptom?

involve displaying of behaviours concerning diminution or loss of normal emotions and actions

how do negative symptoms generally occur?

in chronic, longer-lasting episodes that are resistant to drug treatment

what is a difficulty of diagnosing schizophrenia? (2)

it is co-morbid with depression therefore there is a lot of symptom overlap

what is avolition?

the reduction of, or inability and persistence in goal-directed behaviour

what did copeland 1971 find?

the DSM 69% clinicians diagnosed SZ based patient description whereas 2% of ICD clinicians diagnosed SZ based on the same patient description.

what is an example of avolition?

sitting in the house for hours every day doing nothing

what is affective flattening?

a reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact, and body language

what is alogia?

characterised by the lessening of speech fluency and productivity; this is though to reflect slowing or blocked thoughts

what is social/occupational dysfunction?

for a significant portion of time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset

what is catatonic behaviour?

the feeling that thoughts have been inserted or withdrawn from the mind. in some cases the person may believe their thoughts are being broadcast so that others can hear them.

what is anhedonia?

a loss of interest or pleasure in almost all activities, or lack of reactivity to normally pleasurable stimuli

what are the two issues to do with diagnosing schizophrenia?

reliability and validity

which factors affect the reliability of schizophrenia diagnosis? (1)

cultural differences

how do cultural differences affect the reliability of schizophrenia diagnosis?

culture has an influence on the diagnostic process because either the ICD and DSM have different classifications or the British and American psychologists themselves had different perceptions/experiences of schizophrenia

what are the cultural differences in experiences of schizophrenia?

cultural environment affects how someone ‘hears voices.’ in a study, 0 Americans reported hearing positive voices, whereas many of the African and Indian subjects did. they described then are playful or offering advice.

which factors affect the validity of schizophrenia diagnosis?

gender bias, symptom overlap, co-morbidity

how does gender bias affect the validity of schizophrenia diagnosis?

many of the classifications could be affected by bias of psychologists, including potentially pathologising healthy female behaviour because they (such as the DSM) define healthy adult behaviour as healthy *male* behaviour.

how does symptom overlap affect the validity of schizophrenia diagnosis?

many of the symptoms found in schizophrenia are also found in other disorders such as depression and bipolar disorder, which would mean that schizophrenic patients usually have enough symptoms of other disorders to receive at least one other diagnosis.

how does co-morbidity affect the validity of schizophrenia diagnosis?

schizophrenia is often present with other disorders, such as substance abuse, anxiety, depression, and OCD meaning that the wrong diagnosis or only one diagnosis may be made when they need treatment for multiple.

what are psychologist estimations for co-morbidity of schizophrenia?

* 50% with depression
* 47% with substance abuse

who conducted the study on degree of genetic relatedness on risk of schizophrenia?

Gottesman

what did Gottesman find?

Children with schizophrenic patients - 46% risk

Children with one schizophrenic parent - 13% risk

Children with one or more schizophrenic siblings - 9% risk

general population - 1% risk

what are the types of dopamine imbalances? (2)

hypodopaminergia, hyperdopaminergia

what is the dopamine hypothesis?

A theory that claims than an excess of the neurotransmitter dopamine in certain regions of the brain is associated with the positive symptoms of schizophrenia.

when does dopamine affect schizophrenia? (2)

when they have more dopamine receptors which leads to more firing and an overproduction of messages or more dopamine actually being there

what is hyperdopaminergia?

whehn someone has excessive levels of dopamine in the subcortex and broca’s area

what is hypodopaminergia?

low levels of dopamine in the prefrontal cortex

what are the biological explanations for schizophrenia? (4)

genetics, the dopamine hypothesis, neural correlates

what is the revised dopamine hypothesis?

the positive symptoms of schizophrenia are caused by excess dopamine in subcortical areas of the brain, particularly the mesolimbic pathway. He proposed that the negative symptoms were caused by a deficit of dopamine in the prefrontal cortex. 

brain differences that may cause schizophrenia (4)

prefrontal cortex, hippocampus, grey matter, white matter

which differences do people with schizophrenia have in the prefrontal cortex?

usually impaired in schizophrenia patients - responsible for executive control, such as in planning, reasoning, and judgement.

which differences do people with schizophrenia have in the hippocampus?

Deficits in nerve endings between the hippocampus and the prefrontal cortex usually found to affect working memory impairment, which is central cognitive impairment in schizophrenia

which differences do people with schizophrenia have with grey matter?

Schizophrenia patients usually found to have lower levels of grey matter in the brain, especially in temporal and frontal lobes

which differences do people with schizophrenia have with white matter

Reduced myelin sheath is found in patients with schizophrenia which means that information is processed less quickly through the central nervous system (myelin sheath is part of white matter)

what do schizophrenic patients lose faster than patients without schizophrenia?

grey and white matter in the brain

what are the psychological explanations for schizophrenia? (2)

family dysfunction, cognitive explanations

What are the types of family dysfunction? (2)

expressed emotion, double bind

what is the double bind theory?

theory that children who get conflicting messages from their parents verbally and and non-verbal level are likely to develop schizophrenia because it stops the development of coherent perception of reality

what is expressed emotion?

this is when a patient’s family talk in a way where it indicates a sense of over-involvement or over-concern in the patient’s behaviour. usually in a hostile or critical way.

how can expressed emotion lead to the development (or relapse) of schizophrenia?

people with schizophrenia have a lower tolerance for environmental stimuli

stats supporting that expressed emotion caused the development of schizophrenia

when family have EE the patient is 4 times more likely to relapse

which are the cognitive explanations for schizophrenia?

cognitive explanations of delusions, cognitive explanations of hallucinations

what is the cognitive explanation of delusions

during the formation of delusions, the patient’s interpretations of their experiences are controlled by dysfunctional information processing, in this case being an egocentric bias

what is the egocentric bias?

the patient believing that they are a central component to an event and so jump to conclusions about external events

how does an egocentric bias manifest?

relating irrelevant events to themselves and constantly arriving at false conclusions.

examples of egocentric bias? (2)

muffled voices are interpreted as people criticising them and flashes of light are a signal from God

what is the cognitive explanation for hallucinations?

These individuals are hypervigilant on auditory stimuli and so have a higher expectancy for the occurrence of a voice than normal individuals. they also find it difficult to distinguish between an inner representation of an idea and an actual sensory stimulus to produce an auditory image.

what is dysfunctional thought processing in delusions?

when a person relates irrelevant information to themselves and consequently draws false conclusions

what is dysfunctional thought processing in hallucinations?

the person attributes a self-generated auditory experience to an external force

what is a KEY part of cognitive explanation for schizophrenia (that you must mention in EVERY essay)?

dysfunctional thought processing

what do cognitive explanations believe dysfunctional thought processing especially explains?

positive symptoms rather than negative symptoms.

what is dysfunctional thought processing?

cognitive habits or beliefs that lead to processing information inappropriately and differently to individuals without schizophrenia.

what is the cognitive explanation for negative symptoms?

cognitive strategies used to control high levels of mental stimulation. not expressing emotion is a strategy to try to control the internal experience

what are the types of treatments of schizophrenia? (4)

drug therapy, cognitive behaviour therapy (for psychosis - CBTp), family therapy, token economy,

wht are the types of drug therapies for schizophrenia?

typical antipsychotics, atypical antipsychotics

what are typical antipsychotics? (2)

first generation of antipsychotics, no longer used

what are atypical antipsychotics? (2)

second generation of antipsychotics, still used

what do antipsychotics do?

block dopamine receptors to reduce the symptoms of psychosis

what are the differences between typical and atypical antipsychotics in how they behave? (4)

* typical bind to all dopamine receptors (particularly D2) whereas the atypical also bind to dopamine receptors but have a stronger affinity for serotonin receptors and lower affinity for dopamine ones.
* atypical carry a lower risk of extrapyramidal side effects
* have a beneficial effect on negative symptoms
* are suitable for treatment-resistant patients

What is an example of a typical antipsychotic?

Haloperidol

what is a disadvantage of typical antipsychotics? (3)

many side effects, such as decreased muscle control (Parkinson’s type symptoms)

what is an example of an atypical antipsychotic?

only attach and block D2 dopamine receptors

what is an example of an atypical antipsychotic?

clozapine

what are disadvantages of atypical antipsychotics?

30% of people who take them will have tardive dyskinesia, and there is rapid dissociation meaning they block and then unblock quickly

what is tardive dyskinesia?

involuntary movement of lips and tongue

how long does it take for symptoms to begin to improve after taking typical antipsychotics?

within a few days to a few weeks of beginning medication

what is drug therapy particularly useful for?

positive symptoms

how long does it take for symptoms to begin to improve after taking atypical antipsychotics?

within a few

how does CBTp work?

it involves the ABC model, normalisation, critical collaborative analysis, and developing alternative explanations

what is the ABC model within CBTp?

the patient gives their activating event, irrational beliefs, and consequences.

what is normalisation within CBTp?

the therapist places psychotic experiences on the spectrum of normal experiences to make the patient feel less alienated and stigmatised and make recovery more likely.

what is critical collaborative analysis within CBTp?

the therapist uses gentle questioning to help the patient understand illogical deductions and conclusions, without causing distress, provided there is an atmosphere of trust between the patient and the therapist.

what is CBTp?

used to help patients identify and correct distorted beliefs that are causing maladaptive feelings and behaviours. it can be delivered in groups but it is mostly one-on-one. it is recommended that at least 16 sessions are carried out to see improvement.

what is family therapy?

a range of interventions aimed at the family of someone with schizophrenia, offered for a period of between 3 and 12 months and at least 10 sessions.

what are some methods that family therapy uses? (4)

* helping a person and their carers to understand the illness
* enhancing relatives’ ability to anticipate and solve problems
* reducing expressions of anger and guilt by family members
* maintaining reasonable expectations among family members for patient performance

what is the aim of family therapy?

reduce the level of expressed emotion

what is the study for family therapy?

Pharaoh et al

how did Pharaoh conduct his study?

reviewed 53 studies investigating the effectiveness of family intervention by comparing the outcomes from family therapy to standard (drug) care. these were conducted in Europe, Asia, and North America.

what were the findings of Pharaoh’s study? (4)

* mixed results in mental state
* increased compliance with medication
* improved social functioning
* reduction in relapse and readmission

what is a token economy?

a form of therapy where desirable behaviours are encouraged by the use of selective reinforcements. rewards are given as secondary reinforcers when individuals engage in correct/socially desirable behaviours. the tokens can then be exchanged for primary reinforcers - food or privileges.

what are the types of positive reinforcer?

Primary and secondary

what are examples of target behaviours clinicians might set for schizophrenic patients?

could be something as simple as brushing their teeth and could be helping another patient.

how can token economies be used to manage schizophrenia?

* assigning value to the tokens
* reinforcing target behaviours

how can you give more value to the tokens in a token economy? (3)

* it needs to be presented alongside other (primary) reinforcers.
* it can be made stronger by increasing the number of items the token can be exchanged for.


* making sure that the presentation of the token and the exchange for backup reinforcers can happen immediately.

which behaviourist concept do token economies undergo?

classical conditioning - the tokens are intially a neutral stimulus and then become a conditioned stimulus for the reinforcing properties of primary reinforcers.

mark scheme says operant conditioning - vicarious reinforcement. they are positive reinforcement

why should tokens be presented immediately after a person performs the desired behaviour?

because the patient may perform another, undesirable behaviour in the intervening period, and then that action would be reinforced rather than the target behaviour

what is the diathesis-stress model?

explains mental disorders as the result of an interaction between biological (diathesis) and the environmental (stress) influences.

what is the diathesis stress model an example of?

the interactionist approach to explaining schizophrenia.

what was the interactionist study?

Tienari et al