schizophrenia

    Cards (89)

    • Describe the rationale for the use of token economies
      Institutionalization develops under circumstances of prolonged hospitalization and people often develop bad maladaptive habits
      Matson et al 2016 identified categories of institutional behavior's tackled by token economies
      - Personal care
      - Condition - related behavior's ( e.g. apathy)
      - Social behavior's
      Benefits of modifying these behavior's
      - Improves quality of life in hospital
      - Normalizes behavior's and helps adapt back into community life
    • What are the clinical characteristics of schizophrenia
      - disintegration of the personality
      - split between thinking and emotion
      - range of psychotic symptoms where there is a break from reality
      - lack insight into their condition
    • What are positive symptoms?
      Behaviours that are added to normal behaviour
    • What are negative symptoms?
      Absence or insufficiency of normal behavior
    • Who does schizophrenia affect?
      - late adolescence and early adulthood
      - Men ( 18-25)
      - Women ( 25-35)
      - Afrocarribbeans are 3-5x more likely to develop
      - incidence is 7.5-163 cases per 100,000
      - Men are more likely to suffer than females
    • What are the positive symptoms of schizophrenia?
      - delusions
      -hallucinations
      - catatonic ( random muscle movements) or disorganised behaviour
      -disorganised speech
    • What are the negative symptoms of schizophrenia?
      - A loss of normal functions
      - A lack or "flattening" of emotions
      -An inability to enjoy things
      - Social withdrawal
      - Avolition / Apathy (lack of motivation to follow through any plans )
      - Speech Poverty (lessened speech)
    • What is a strength of diagnosis and classification in schizophrenia ?
      Reliability
      A psychiatric diagnosis is said to be reliable if it has inter-rater reliability as well as test- retest reliability (same diagnosis , same individual multiple occasions)

      Flavia Osario et al (2019) report good reliability for schizophrenia diagnosis in 180 individuals using the DSM-5
      Pairs of interviewers achieved inter-rate reliability of +97 and test-retest of +92
    • Why is validity a limitation in the diagnosis of shizophrenia ?
      One way to assess validity of a psychiatric diagnosis is criterion validity
      Elie Cheniaux et al(2009) had two psychiatrists independently assess the same 100 clients using ICD-10 and DSM-IV criteria found that 68 were diagnosed with schizophrenia under the ICD system but only 39 under DSM
      Poor agreement between clinicians
    • Why is gender bias a limitation in the diagnosis of schizophrenia ?
      Since the 1980s men have been diagnosed with schizophrenia more commonly than women
      Fischer and Buchanan 2017 ( ratio of 1 : 4 .1 )
      One explanation for this is women are less vulnerable than men , perhaps due to genetic factors.
      Or women are underdiagnosed because they have closer relationships and hence get support ( Cotton et al 2009) which leads to women with schizophrenia often functioning better than men

      - WOMEN may not be recieving treatment and services that might benefit them
    • Why is Culture bias a problem in the diagnosis of schizophrenia
      Some symptoms of schizophrenia , particularly hearing voices have different meanings in different cultures
      eg in Haiti some people believe that hearing voices are communications from the ancestors
      British people of Afro-Carribbean decent are 9x more likely to recieve a diagnosis than their white counterparts
    • Why is symptom overlap a problem when diagnosing people with schizophrenia
      There is considerable overlap between the symptoms of schizophrenia and the symptoms of other conditions.
      Eg both schizophrenia and bipolar disorder involve positive symptoms (such as delusions) and negative symptoms (such as avolition).
      this suggests that schizonhrenia and binolar disorder mav not be two different conditions but variations of a single condition
      schizophrenia is hard to distinguish from bipolar disorder.
      Schizophrenia is difficult to diagnose classification and diagnosis are flawed.
    • Why is co - morbidity a problem when diagnosing schizophrenia
      If conditions occur together a lot of the time then this calls into question the validity of their diagnosis and classification because they might actually be a single condition.
      Eg one review found that about half of those diagnosed with schizophrenia
      also had a diagnosis of depression or substance abuse
      schizophrenia may not exist as a distinct condition, and at least some people diagnosed with schizophrenia may have unusual cases of conditions ike depression
    • Describe research into family studies and the genetic basis of schizophrenia
      Irving Gottesman (1991) suggests schizophrenia is inherited through genes
      Conducted a large - scale family study ( 40 people)
      eg someone with an aunt with schizophrenia has a 2% chance of developing it , increasing to 9% if its a siblings and 48% if an identical twins
      This shows risk increases with genetic similarity
      This is also backed up by other studies
      ( Kendler 1983 found 30.9 concordance MZ 6.5 concordance DZ twins)
    • What does "concordance rate" mean?
      The probability that one member of a given group (a sibling, a cousin, a MZ twin, a DZ twin, etc.) will develop a disorder given that the other member already has it
    • Outline the dopamine hypothesis
      - Originally , the dopamine hypothesis was based on the discovery that anti psychotics caused symptoms similar to those with Parksinsons disease(low DA) ( Seeman 1987)
      - Because of this, it was thought that schizophrenia was due to too high levels of dopamine in subcortical areas of the brain
      - Davis et al (1991) proposed the additiion of too low DA in the cortex which can also explain symptoms
      - Its been suggested that cortical HYPOdopamingeria can lead to HYPERdopaminergia so they both play a part
      - both genetic variations and early experiences of stress make people more sensitive to fluctuating DA levels
    • Describe the role of candidate genes in the genetic basis of schizophrenia
      -Schizophrenia is polygenic
      -Most likely genes would be those coding for neurotrasmitters ( eg dopamine)
      - Stephen Ripke et al ( 2014) combined data from genome - wide studies
      -Compared the genetic makeup of 37,000 schizophrenics compared to 113,000 controls
      - Found 108 seperate genetic variations associated with a increased risk of schizophrenia
      - Schizophrenia is aetiologically heterogeneous (combination of genes may cause it in one person but not another)
    • Describe the role of mutation in the genetic basis of schizophrenia
      - Can also have a genetic origin in the absence of a family history of the disorder
      -mutation in parental DNA which can be caused by radiation , poison or viral infection
      -Evidence for mutation comes from positive correlations between paternal age ( increased risk of sperm mutation ) and risk of schizophrenia increasing from 0.7% with fathers under 25 to over 2% in fathers over 50
      -( Brown et Al 2002)
    • Describe the role of neural correlates of schizophrenia
      - Dopamine is important in functioning of several brain systems related to the symptoms of schizophrenia
      - Originally , the dopamine hypothesis was based on the discovery that anti psychotics caused symptoms similar to those with Parksinsons disease(low DA) ( Seeman 1987)
      - Because of this, it was thought that schizophrenia was due to too high levels of dopamine in subcortical areas of the brain
      - Davis et al (1991) proposed the additiion of too low DA in the cortex ( hypodopaminergia) which can also explain symptoms
      - Its been suggested that cortical HYPOdopamingeria can lead to HYPERdopaminergia so they both play a part
      - both genetic variations and early experiences of stress make people more sensitive to fluctuating DA levels
    • Outline a strength in the genetic explanation for schizophrenia
      + Family studies such as Gottesman show that risk increases with genetic similarity to a family member with schizophrenia
      Adoption studies such as Tienari et Al 2004 show that biological children of parents with schizophrenia are at a heightened risk even if they grow up in an adoptive family
      Hilker et Al 2018 showed a concordance rate of 33% for identical twins and 7% for non identical twins
      People are more vulnerable to schizophrenia as a result of their genetic makeup
    • Outline a weakness in the genetic explanation for schizophrenia
      Environmental factors
      Environmental factors (biological and psychological) increase the risk of developing schizophrenia
      Morgab et Al 2017 said Biological risk factors include birth complications and smoking THC rich cannabis in teenage years ( Di forti et Al 2015)
      Psychological risk factors include childhood trauma which leave people more prone to adult mental health problems
      Nina Morkved et Al 2017 found 67% of schizophrenics had at least one childhood trauma compared to 38% matched geoup with non psychotic mental health issues
    • What are the two types of antipsychotics used to treat schizophrenia
      - Typical Antipsychotics
      + symptoms
      Affects just dopamine
      -Atypical antipsychp
      + and - symptomds
      affects dopamine and serotonin
    • Describe the role of Typical Antipsychotics in treating schizophrenia + an example
      - Chlorpromazine
      - Dopamine antagonists work by blocking dopamine receptors in brain synapses
      - Initially when an individual begins taking chlorpromazine dopamine levels build up then it's production is reduced
      - Effect normalises neurotransmission in key areas of the brain reducing positive symptoms ( eg hallucinations)
    • Describe the role of chlorpromazine in treating schizophrenia
      - Typical antipsychotic
      Dopamine antagonists work by blocking dopamine receptors in brain synapses
      - Permanent
      - Initially when an individual begins taking chlorpromazine dopamine levels build up then it's production is reduced
      - Effect normalises neurotransmission in key areas of the brain reducing positive symptoms ( eg hallucinations)
      - An effective sedative which may be used to calm individuals
    • Describe the role of Atypical Antipsychotics in treating schizophrenia + an example
      - Suppress the symptoms of pyschosis and minimise
      side effects
      - Clozapine binds to/ blocks dopamine receptors and acts on serotonin and glutamate receptors
      - Helps to improve mood and cognitive function and reduce depression and anxiety
      -May be prescribed when individual is at high risk of suicide (30-50% of schizophrenics)
      - Risperidone binds to dopamine and serotonin receptors but binds more strongly to dopamine receptors than clozapine
    • Describe the role of Clozapine in treating schizophrenia
      - Clozapine first developed in 1960s then withdrawn following deaths
      due to agranulocytosis
      - Binds to/ blocks dopamine receptors and acts on serotonin and glutamate receptors
      - Helps to improve mood and cognitive function and reduce depression and anxiety
      -May be prescribed when individual is at high risk of suicide (30-50% of schizophrenics)
    • Describe the role of Risperidone in treating schizophrenia
      - Risperidone binds to dopamine and serotonin receptors but binds more strongly to dopamine receptors than clozapine
    • Describe a strength of using antipsychotics to treat schizophrenia
      + Evidence for effectiveness
      Thornley et al(2003) reviewed studies comparing the effects of chlorpromazine to control conditions
      Data from 13 trials - 1211 participants showed drug associated with better functioning and reduced symptom severity as compared to placebo
      Meltzer (2012) concluded clozapine is more effective than typical antipsychotics and has been effective 30-50% of treatment resistant cases where typical antipsychotics have failed

      HOWEVER
      Healy (2012) suggested serious flaws
      Most studies are of short term effects and some successful trials have had their data published multiple times , exaggerating the size of evidence
      Also because antipsychotics have a calming effect , which may have a positive effect but not actually reduce severity of psychosis
    • Describe the similarities and differences between using Typical and Atypical drugs to treat schizophrenia
      Similarities
      - Lowers the amount of dopamine.
      - Bad side effects such as agranulocytosis.
      - Based on assumptions from Biological approach.


      Differences

      - Typical only affect one neurotransmitter (dopamine) whereas atypical also affects serotonin and glutamate
      - Typical has little effect on negative symptoms whereas atypical works to alleviate positive and negative symptoms,.
    • Describe debates and research into the appropriateness of drug therapy when treating schizophrenia
      - Some sufferers who undertake drug therapy are liable to relapse after the drugs have been discontinued
      - Sufferers can also get used to drug therapy and dependency can become an issue which means higher and higher doses are needed
      - Schooler et al 2005 found 55% of typical drug users suffered from relapse and 42% of atypical drug users( this was later )
    • Describe debates and research into the effectiveness of drug therapy when treating schizophrenia
      - For most sufferers , antipsychotics calm effects
      - Silverman 1987 stated that antipsychotics have beneficial side effects for some people in increasing levels of attention and information processing
      - Chlorpromazine is most widely used and was first used in 1952 by Delay and Deniker
      - Has been seen to be more effective than phenothiazines helping 80% of schizophrenics ( Kane , 1992)
    • Describe debates and research into the appropriateness of drug therapy when treating schizophrenia ( side effects)
      - 20 to 25% of sufferers experience serious side effects and will suffer from some form of disordered motor movements like tremors and involuntary tics ( eg Tardive Dyskenisia)
      - Causes 50% of sufferers to stop taking within the first year
    • Describe a limitation of using antipsychotics to treat schizophrenia
      - Side effects
      Typical antipsychotics - dizziness , agitation , sleepiness , stiff jaw , weight gain , itchy skin
      Long term use can cause tardive dyskinesia or neuroleptic malignant syndrome

      - Mechanism unclear
      We do not know why they work
      - Understanding is tied up with the dopamine hypthesis but is not a complete explanation for schizophrenia
      - Antipsychotics may not be the best treatment to opt for
    • Describe tardive dyskinesia
      - Caused by dopamine sensitivity
      - Causes involuntary facial movements , such as grimacing , blinking and lip-smacking
    • Describe neuroleptic malignant syndrome
      - Caused mainly by typical antipsychotics
      - Drug blocks dopamine action in the hypothalamus
      - Causes high temperature , delirium and coma and can be fatal
    • What are the psychological explanations for schizophrenia
      Family dysfunction
      - Schizophenogenic Mother
      - Double bind theory
      - Expressed emotion
    • Describe how the schizophrenogenic mother is used as a psychological explanation for schizphrenia
      - Frieda Fromm Reichman (1948)
      Psychodynamic explanation
      Noted that many of her patients spoke of a specifc type of parent
      Schizophrenogenic mother is cold , rejecting and controlling and tends to create a family climate characterised by tension and secrecy
      Leads to distrust that later develops into paranoid delusions and ultimately schizophrenia
    • Describe how the double bind theory used as a psychological explanation for schizophrenia
      Gregory Bateson (1972)
      Family climate is important in the development of schizophrenia but emphasised the role of communication style within a family
      Child finds themselves trapped in situations where they fear doing the wrong thing but receive mixed messages about this
      Feel unable to comment on unfairness or seek clarification
      When they get it wrong , child is punished by withdrawal of love
      Child left with confused dangerous understanding of the world ( leads to disorganised thinking , paranoid delusions)
    • Describe how expressed emotion is used as a psychological explanation for schizophrenia
      Expressed emotion is the level of emotion (negative) towards a person with schizophrenia by their carers / family members . This includes:
      - Verbal criticism of the person , often accompanied by violence
      - Hostility towards the person , including anger and rejection
      - Emotional over involvement in the life of the person , including needless self sacrifice
      High levels of expressed emotion directed towards individuals become source of stress
      -Also explanation for relapse or trigger an onset of schizophrenia in someone who is already vulnerable
    • What aspects of family dysfunction are used as a psychological explanation for schizophrenia
      Family dysfunction
      - Schizophenogenic Mother
      - Double bind theory
      - Expressed emotion
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