My schizophrenia

• schizophrenia


  a psychotic disorder
• positive symptoms of schizophrenia


  hallucinations

  -auditory (hearing)

  -visual (seeing)

  -olfactory (smelling things)

  -tactile (feeling)

  
  

  delusions

  -of grandeur (thinking they are special and different from everyone else, the idea that they are napoleon or Jesus Christ)

  -persecution (thinking they are being tracked or followed by secret agencies)

  
  

  disordered thinking (thoughts are being interfered with

  -broadcast

  -insertion

  -withdrawals
• negative symptoms


  Anhedonia- when tasks that usually excite you no longer do

  
  

  Avolition- when a person cannot strive towards goal orienated behaviour

  
  

  Alogia (speech poverty) - when a person is unable to speak fluently and is very disjointed, usually having no coherent point

  
  

  Flattening of affect- when a person no longer cares or shows emotions, such as using eye contact, body language, smiling.
• how do we classify schizophrenia


  using the diagnostics and statistical manual of mental disorder(DSM)

  
  

  DSM-5 says that you must have at least one positive symptom and must last at least a month

  ICD-10 says 2 or more -ve symptoms are sufficient for diagnosis (avolition and speech poverty)
• problems with using the DSM

  Reliability

  inter-rater reliability- when two different people get the same result using the same test, this is measured using the kappa score

  a score of 1 means there is a lot of agreement

  0 means no agreement

  
  

  Regier- schizophrenia only had a 0.46 score on the kappa score
• Rosenhan and reliability


  wanted to test the reliability of the diagnosis of schizophrenia

  
  

  He tested if "normal" mentally stable people would be diagnosed as schizophrenic

  
  

  8 people were asked to act as "schizophrenics" by saying they could hear and see things.

  
  

  8 people were called pseudo patients

  
  

  The pseudo patients tried to get admission to various hospitals in the US.

  
  

  All were admitted and 7/8 were diagnosed as schizophrenic

  
  

  When in the hospital they all behaved normally and attempted to be released

  
  

  It took them 7-50 days to be released

  
  

  The medical staff had no clue that they weren't mentally ill but the schizophrenics thought they were there to check up on the hospital.
• Rosenhan study critique


  Observational field experiment so it had high ecological validity

  
  

  But they used an old version of the DSM (DSM-II)
• Cultural differences in reliability of diagnosing

  schizophrenia

  
  

  Copeland


  Copeland gave psychiatrists in the U.K. and US a description of a patient.

  
  

  69% of US diagnosed them as a schizo

  2% of UK diagnosed them as a schizo
• Luhrmann et al and HEARING VOICES


  Compared the types of voices that were heard from Ghana India and US

  
  

  The African and Indian people heard positive voices while the Americans heard negative voices.

  
  

  So hearing voices may not be an inevitable feature of schizo
• Is the diagnosis of schizophrenia valid?


  Gender bias

  Co morbidity

  Symptom overlap
• Co morbidity

  Swets

  This is when two disorders are present at the same time

  
  

  Depression

  Anxiety

  Substance abuse

  Ptsd

  OCD

  
  

  Swets found that 12% of schizophrenics also had OCD.
• Gender differences ( gender bias)

  Goldstein


  Men are more likely to be prematurely diagnosed with schizophrenia than women

  
  

  Women are seen to be more functioning when having schizophrenia than men

  
  

  Goldstein found that men are more likely to be involuntarily hospitalised due to risks of socially deviant behaviour.

  
  

  Women are more likely to voluntarily go to the hospital.
• Gender bias

  Loring and Powell

  290 psychiatrists were asked to diagnose a man or a woman

  
  

  When male 56% diagnosed

  When female only 20% diagnosed

  
  

  Also depending on the gender of the psychiatrist, the diagnosis varied
• Symptom overlap

  Ellason and Ross

  Read

  Some of the symptoms of schizophrenia are also present in other disorders such as depression and bipolar disorder

  
  

  Ellason and Ross found that people with Dissosiative identity disorder showed more signs of schizophrenia than actual schizophrenics.

  
  

  Read argues that most schizophrenics have enough symptoms to be diagnosed with another disorder such as depression
• Evaluation of validity

  Weber (co-morbidity)

  Weber did a large study on 6 million hospital records to look at co morbidity rates.

  
  

  Psychiatric diagnoses accounted for 45% of co morbidity.

  
  

  There were also co morbid non psychiatric disorders.

  
  

  Schizo and asthma, type 2 diabetes, and hypothyroidism have been linked
• Evaluating reliability Mojtabi and Nicholson


  Psychiatrists were asked to differentiate between bizzare and non bizzare as this was on of the main symptoms for Shizo

  
  

  Inter rater reliability was only 0.40

  
  

  Therefore has a low reliability
• Psychological explanations for schizo

  Cognitive explanations

  Family Dysfunction
• Double bind theory

  Bateson


  Double bind theory is the view that parents that exert conflicting messages such as saying I love you to their child then turning away in disgust will lead to schizophrenia.

  
  

  May lead to future "flattening of affect" and "social withdrawal"
• Expressed emotion

  Brown et al

  Kuiper et al

  Lidz and Lidz


  Expressed emotion is the idea that a hostile environment may lead to relapse, for example parents always shouting and the individual and being disappointed and never showing love.

  
  

  Brown et al found that many schizophrenics experienced a lot of expressed emotions at home

  
  

  Kuiper et al- high EE relatives talk more and listen less. High levels of expressed emotion may lead relapse - a patient returning to a high EE home is 4 times more likely to relapse than a low EE.

  
  

  Lidz and Lidz- a mother who micromanages her child and doesn't acknowledge their independence
• Support for family dysfunction

  Tienari


  Those adopted children who had schizo biological parents were more likely to become ill themselves than those with non schizo biological parents.

  
  

  This difference only emerged when the adopted parents were rated as disturbed (only under the right environmental conditions the schizo arose)
• Support for double bind theory

  Berger

  Schizophrenics reported higher levels of double bind comments from their mothers than non schizo.

  
  

  However this could be unreliable as the schizo could be affecting their memory
• Negative criticism for double bind

  Liem


  Liem measured patterns of parental communication in families with schizophrenic child and non schizo and found no difference.
• Negative for EE

  Altorfer

  Lebell


  Not all patients with high EE relapse and not all with low EE avoid relapse.

  
  

  Altorfer sound that 1/4 of patients he studied showed no response to stressful comments from their parents.

  
  

  ( so may just depend on their individual vulnerability to EE) -Lebell
• Psychological explanations


  Cognitive explanations
• Cognitive explanations


  Perceptual deficits

  Memory issues
• Perceptual issues

  Shin et al

  Ekman and Friesen

  Schizophrenics have trouble reading facial expressions and emotions

  
  

  This leads to a social dysfunction and may lead to delusions. Shin et al

  
  

  Ekman and Friesen

  - schizo found it difficult to distinguish between two peoples facial expressions.
• Memory deficits (the working memory)

  Lee and young


  The perceptual issues may be due to issues in encoding into the working memory.

  
  

  Issues in spatial working memory and the central executive.
• Cognitive explanation of delusions


  Schizo people usually assume they are at the centre of events (egocentric bias) and therefore jump to conclusions about events.

  
  

  Muffled voices are people taking to them or about them and lights are flashes of god.
• Cognitive explanations for hallucinations


  Hearing voices.

  
  

  Schizo people have a thing called hypervigilance (focus too much on what they hear)

  
  

  ^ link it with the "where" system in our brains
• Reasoning deficits> delusional thinking

  Jumping to conclusions hypothesis

  Garety et al


  2 issues

  Having the negative thoughts and thinking they are real.

  
  

  Mate is trying to poison you and you believing they really are.

  
  

  Garety- 2 jars of coloured beads 2 colours

  
  

  The researcher took out two from one jar and the participants had to judge wether it was from two jars or one. The schizo people hesitated and were suspicious about which jar. Non schizophrenics knew they were from the same jar.
• Evaluation of cognitive explanations

  Cause or effect?
• positive feedback of cognitive view

  NICE review

  
  

  Sarin and Wallin

  When using CBTp with antipsychotics the level of social functioning increased.

  
  

  S and W found that positive symptoms were due to things such as a propensity to jumping to conclusions.
• Drug therapy- typical and atypical drugs


  Dopamine antagonist (bind but do not stimulate D2 receptors)
• Typical Antipsychotics


  Bind to but don't stimulate D2 receptors in the mesolimbic pathway.

  
  

  They help reduce the positive symptoms of schizo like hallucinations and delusions

  
  

  Example is chlorpromazine or Haloperidol

  (Chlor = low potency)

  (Halo= high potency)
• Side effects of haloperidol


  Again motor malfunctioning (extrapyramidal side effects)

  Sleep affected both ways (too much or prevents it)
• Evaluation of typical Antipsychotics

  The side effects reduce drug adherence

  
  

  May cause death soooo it iss unethical

  
  

  Extrapyramidal
• Side effects of chlorpromazine


  Blocks serotonin so depression

  Affects acetylcholine so dry mouth

  Affect motor functioning

  Cause Parkinsonism (high dopamine)
• atypical antipsychotics


  The key feature here is "rapid dissociation" the dopamine binds to the D2 receptors but do not stimulate them, however in atypical antipsychotics the dopamine dissociates after a while. This leads to a lower chance of extrapyramidal side effects and reduces some negative symptoms as well as positive ones

  
  

  Examples are clozapine and olanzapine
• Drugs side effects (atypical)


  Clozapine affects blood cells

  Olanzapines can make you gain weight (better at treating those who are at a high risk of developing schizophrenia) (prodomal)

  
  

  Olanzapines have fewer side effects than typical so people are more likely to adhere to the drug
• Critique for antipsychotics

  Crossley

  Ross and Read

  Reductionist

  INTERACTIONIST approach

  Atypical may be better than typical as they result in less extrapyramidal side effects.

  
  

  Atypical antipsychotics also reduce some negative symptoms.

  
  

  Crossley- meta analysis of 15 studies to examine the efficacy of the drugs (how well they reduce symptoms)

  
  

  Crossley found no differences between typical and atypical

  
  

  The only differences were the side effects.

  
  

  Ross and read argue that when people are prescribed medication it reinforces the view that there is "something wrong with them".

  This may prevent them from thinking about the reasons why the have the condition.

  
  

  This in turn may reduce their motivation to look for other causes such as environmental stressors.

  
  

  Reductionist as they ignore other factors such as environmental and stress related causes, also EE and double bind could have helped aid the initiation of schizophrenia.

  
  

  INTERACTIONIST approach helps solve the reductionist issue.