schizophrenia

speech poverty

negative: lessoning of speech quality and fluency

emotional disturbance

negative: displaying no/innapropriate emotions

avolition

negative: lacking energy to do basic activities

disorganised speech

negative: vague/incoherent speech

delusions

positive: strongly held false beliefs

hallucinations

positive: experiencing a real perception of something false

test retest reliability

when a psychiatrist makes the same diagnosis on 2 occasions with the same information

inter-rater reliability

2 different psychiatrists agree on the same diagnosis

dsm-5

usa

requires positive symptoms

spectrum (kappa)

icd-10

international

can be based on negative symptoms

subtypes

kappa score: cohen

a score measuring inter rater reliability

cohen: sz has a ks of 0.46 :(

rosenhans pseudopatient study

sent pseudopatients undercover in a psych ward, asked psychiatrists to identify pseudopatients

luhrman: voices

in african cultures, hearing voices is not a sign of sz and is seen as a sign of ancestors interacting.

cultural bias in reliability

evaluation of reliability in diagnosis

• rosenhan used a small sample

• rosenhans study led to improved care

• sz has a low kappa score, low in reliability

co morbidity

the extent that 2 or more conditions occur simultaneously

buckley

comorbidity of sz and depression; occurs in 50% of patients

swets et al

most ppl with sz also have ocd, meta analysis on sz patients with ocd symptoms (25%)

ross et al

people with DID have more sz symptoms than people diagnosed with sz, can lead to wrong diagnosis

gender differences

women are diagnosed later due to masking

goldstein

men are more involuntary commited to psych wards due to sigma

bravermen et al

the sz diagnosis was based on healthy adult males, gender bias as it doesnt include women

evaluation of validity in diagnosis

biological explanations for sz

genetics

dopamine hypothesis

neural correlates

genetics

gottesman: the more closer related, the higher chance of sz (siblings 9%, identical twins 48%)

sz has no candidiate genes, polygenic

ripke et al: 108 variations

dopamine hypothesis

calebrasi et al:

hyperdopaminergia: excess can lead to positive

hypodopaminergia: less can lead to negative

neural correlates

patterns/brain structure

avolition linked to ventral striatum (rewards), sz patients have low brain activity

allen: brain scans on patients with hallucainations have low activity in superior temporal gyrus; to so with languagw centres

evaluation of biological explanation of sz

enviroment plays apart, biologically reductionist

dopamine cause or effect of sz

noll: 1/3 of pateints dont respond to dopamine drugs

bioloigcally deterministic, reliable and scienfitic using brain scans

biological treatment of sz

antipsychotics

typical + atypical

typical

chloropromazine; blocks receptors in synapse to reduce dopamine action to normalise to reduce symptoms

atypical

clozapine; severe side effects: binds to dopamine receptors

evaluation of biological treatment of schizophrenia

side effects

dopamine hypothesis, other neurotransmitters could affect

chemical lobotomies

placebo

expensive

psychological explanations of schizophrenia

family dysfunction

double bind theory

expressed emotion

cognitive factors

family dysfunction

reichmann: having a schizophrenogenic mother whos cold, distant and controlling

can lead to delusions and paranoia

double bind theory

bateson et al: communication style within families, child recieves inconsistent message and gets punished

leads to paranoia

expressed emotion

family communication, criticism or overly loving.

too intense leads to stress

cognitive factors

frith et al: dysfunctional thought processing

meta representation: cant reflect

central control: cant supress emotioms

evaluation of psychological explanations

reductionist, cause or effect of cognitive deficiencies

research support: stirling et al - compared sz patients, cognitive tasks took them longer

berger: sz patients had higher recall of double bind statements

hogarty: therapy with expressed emotions helps reduce symptoms

psychological treatment for sz

cbtp (cognitive behavioral therapy psychosis)

family therapy

token economy

cbtp

correct delusional thoughts and change the way you react to them.

cognitive restructuring: identifying

reality testing

coping

family therapy

aims to improve communication within families

phaeroh: identified strategies used in family therapy (form alliences, reduce anger, ability to care) reviewed 53 studies to investigate FT compared to medicine, less relapse

token economy

rewarding positive behavior through OC

azin et al: used TE on female sz patients, reinforced positive behaviour.

sran et al: variety of rewards better than 1 big reward

evaluation of psychological treatment if sz

ethics, cbtp is dependant on disprder stage, medical complaincw, no binding, economy,family helps,community sz wards,

diathesis stress model

people with more genetic vulnerability are more likely to have sz.

diathesis (genetics)

stress (nurture)

tienari et al

genetics can be moderated by the enviroment; he found 145 high risk adopted children and 158 low risk adopted children who were rehomed. 14 had sz and 11 of them high risk. diff enviroment lowered chance of sz