schizophrenia AO1

Define positive symptoms of schizophrenia

Atypical symptoms experienced in addition to normal experiences (including hallucinations and delusions).

Define negative symptoms of schizophrenia

Atypical experiences that represent the loss of usual experience (e.g. loss of clear thinking of loss of motivation)

Hallucinations

• positive symptom

• sensory experiences that have no basis in reality or are distorted perceptions of things that are there

Delusions

• positive symptoms

• beliefs that have no basis in reality (e.g. victim of conspiracy)

Speech poverty

• negative symptom

• reduced frequency and quality of sleep

Avolition

• negative symptom

• loss of motivation to carry out tasks

• lowered activity levels

Co-morbidity

Occurrence of two disorders or conditions together (e.g. schizophrenia and bpd). Two conditions frequently diagnosed together calls into question validity of classifying the two disorders separately.

Symptom overlap

Two or more conditions sharing symptoms- two disorders having many of the same symptoms calls into question the validity of classifying the two disorders separately.

What are the two parts of the biological explanation of schizophrenia?

• the genetic basis

• neural correlates

What does the genetic basis for sz include?

• family studies

• candidate genes

• role of mutation

Genetic basis for sz- Gottesman’s family study

• large scale family study

• someone with an aunt with sz has a 2% chance of developing it

• someone with an identical twin with sz has a 48% chance of developing it

What did Gottesman’s study show?

Family members share aspects of their environment as well as genes, so the correlation represents both (still good support for importance of genes).

Sz is aetiologically heterogenous

Different combinations of factors, including genetic variation, can lead to the condition.

Genetic basis- twin studies

• concordance rate for MZ twins = 40.4%

• concordance rate for DZ twins = 7.4%

Genetic basis- candidate genes

genes that are implicated are the ones that code neurotransmitters (specifically dopamine)

Genetic basis- Ripke et al

108 genetic variations involved in schizophrenia

Dopamine hypothesis- neural correlates meaning

specific parts of the brain can be linked to certain symptoms of schizophrenia

hyperdopaminergia (original dopamine hypothesis)

excessive levels of dopamine

hypodopaminergia (updated dopamine hypothesis)

low levels of dopamine

Updated dopamine hypothesis

• Davis and Kahn

• Positive symptoms are caused by excess dopamine in subcortical areas of the brain

• Negative symptoms are from a deficit of dopamine in the prefrontal cortex

Difference between typical and atypical antipsychotics

• typical = first generation drugs that only treat positive symptoms

• atypical = second generation drugs that treat both positive and negative symptoms with fewer movement related side effects

What’s an example of a typical antipsychotic?

chlorpromazine

What are two side effects of chlorpromazine?

• diziness

• stiff jaw

How does chlorpromazine work?

• acts as an antagaonist in the dopamine system

• reduces action of dopamine

• through block dopamine receptors in the synapse

Why is chlorpromazine less commonly used today?

• severe side effects- tardive dyskinesia

• only targets positive symptoms

What are two examples of atypical antipsychotics?

• clozapine

• risperidone

How do clozapine and risperidone work?

• bind to dopamine receptors

• also act on serotonin and glutamate receptors

• this helps to improve mood and reduce depression and anxiety

Why is risperidone preferred over clozapine?

binds more strongly to dopamine receptors, meaning that a smaller dose is needed and there are less side effects

What’s the serious side effect that means clozapine requires blood monitoring?

agranulocytosis- severe and potentially fatal drop in white blood cells

Why can it be argued that antipsychotics are more beneficial when combined with psychological therapies rather than used alone?

• combines nature and nurture

• medication addresses the biological elements of the disorder

• therapies address the cognitive and environmental factor

• combined are more effective at reducing symptoms and preventing relapse

What are the three psychological explanations for schizophrenia?

• the schizophrenogenic mother

• double-bind theory

• expressed emotion

Psychological explanations- the schizophrenogenic mother

• developed by Fromm-Reichmann

• a psychodynamic explanation

Psychological explanations- the schizophrenogenic mother characteristics

• cold

• rejecting

• controlling

• leads to tension and secrecy within the household

• leads to distrust and potentially paranoid delusions

Psychological explanations- double-bind theory

• developed by Bateson et al

• all about family climate and communication style

Psychological explanations- double-bind theory (how it works)

• child fears doing wrong

• builds confusion

• child is unable to seek clarification

• world is viewed as confusing and dangerous (can lead to disorganaised thinking and paranoid delusions)

• simply a risk factor for schizophrenia

Psychological explanations- double-bind theory example

That joke was so funny, that’s so unlike you.

Psychological explanations- (high levels of) expressed emotion

• also known as EE

• level of negative emotion expressed towards patients by their carers

Psychological explanations- (high levels of) expressed emotion explanation

• verbal criticism, occasionally with violence

• hostility- anger, rejection

• emotional involvement, needless self sacrifice

What are the 2 psychological treatments for schizophrenia?

• CBT

• family therapy

CBT overview

• 5-25 sessions

• can be done in groups or individually

• focus on cognitive behaviour

CBT- dealing with irrational cognitions (hallucinations and delusions)

• trying to make sense of hallucinations and delusions

• goal isn’t to cure

• reduce stress and make patients more able to cope

• improve the patients’ ability to function adequately

CBT aim

to make symptoms less frightening and more understandable

Who developed coping strategy enhancement?

Tarrier

What is coping strategy enhancement?

getting existing coping strategies of people with schizophrenia and making them better

How do you do coping strategy enhancement?

• identify the triggers for episodes (e.g. a certain person, being alone, stress etc)

• develop and apply coping strategies for the psychotic symptoms and the stress they produce, building upon the ones that the patient already have

Why do they have homework for CBT?

to consolidate learning of strategies between sessions

Psychological treatments- who developed family therapy

Pharoah

What are some of the aims of Pharaoh’s family therapy?

• helping family members feeling less angry and guilty

• creating relationships within the family

• problem solving

• balancing care for schizophrenic relative with their own life

What is phase 3 of BURBACH’S phases of family therapy?

encouraging mutual understanding and creating a safe space for family members to express their feelings

What is phase 6 of BURBACH’S phases of family therapy?

relapse prevention planning and maintenance for the future