1) What are the clinical characteristics of schizophrenia?
-Loss of touch with reality
-Difficulty in expressing selves in a way that is appropriate to the real world
-Fail to realise they have a problem
2) What are the possitive symptoms of schizophrenia?
-Experiences of being controlled
3) What are the negative symptoms of schizophrenia?
-Affective flattering (suppression of facial expressions)
-Alogia (lessening of speech)
-Avolition (lack of will)
4) What are the subtypes of schizophrenia?
5) What does paranoid schizophrenia consist of?
Characterised by the presence of delusions and auditory hallucinations.
6) What does disorganised schizophrenia consist of?
Stereotypical symptoms, which are: difficulty responding appropriately to the real world, disorganised thinking and unpredictable behaviour and speech, the 'flat effect' (a person showing inappropriate emotion).
7) What does canatonic schizophrenia consist of?
Sufferers experience severe disturbances of motor functioning. This might manifest itself in complete immobility or even excessive motor ability.
8) What does undifferentiated schizophrenia consist of?
Covers sufferers who don't fit into any of the other subtypes. They may not have enough symptoms to be classified accurately.
9) What does residual schizophrenia consist of?
Used to describe the condition of a person who has suffered at least one attack of schizophrenic symptoms, but in whom there is a lack of positive symptoms within the past 12 months. There may be evidence, however, of negative symptoms. This subtype of schizophrenia is often regarded as the transitional stage between full schizophrenia and the diagnosis of schizophrenia in remission.
10) Who do came up with the criteria for a diagnosis of schizophrenia?
-DSM IV (Diagnostic Statistical Manual 4).
11) What are the 5 DSM criterias?
-A: Characteristic symptoms
-B: Social/occupation dysfunction
-D: Exclusion of mood disorders
-E: Exclusion of known organic causes
12) What does the characteristic symptoms consist of?
-Two or more of the characteristics must be present for a significant amount of time during a one month period.
-Only one of the symptoms is required for diagnosis IF delusions a bixarre, or hallucinations consist of a voice giving a running commentary of the person's behaviour or thoughts, or two or more voices conversing with each other.
13) What does social/occupational dysfunction consist of?
For the majority of time since the onset of disturbance, one or more major areas of functioning, such as work, interpersonal relations, or self-care are markedly below the level of achieved prior to the onset.
14) What does the duration consist of?
Continuous signs of the disturbance persist for at least 6 months. This 6 month period must include atleast 1 month of symptoms that meet criteria A.
15) What does exclusion of mood disorders consist of?
No major episodes of depression or elation have occured concurrently with the psychotic symptoms.
16) What does the exclusion of known organic causes?
The disturbances is not due to the direct effects of drugs (a result of drug abuse or side-effect of medication) or a known brain disorder (e.g. a brain tumour).
17) What did Deifenbach do?
In a content analaysis of US television, Deifenbach found that the mentally ill were 10 times more likely to be represented as violent compared to the general population of TV characters.
18) What research is there to support Defienbach?
In any one year, 8% of schizophrenics will commit a serious act of violence, more than the population who don't have a mental disorder, but less than those with other mental disorders such as depression and personality disorders.
19) What are the issues surrounding the diagnosis and classification of schizophrenia?
-Self-diagnosis and acting accordingly
-Cultural differences between classification (cultural relativism)
-Labelling (on your medical record, might hinder future e.g. job searching)
-Standardised methods (consistency of diagnosis)
20) How is reliability in search of schizophrenia an issue surrounding to diagnosis and classification?
-Reliability is the extent to which independently assessing patients.
-The publication of DSM-111 in 1980 was specifically designed to provide a much more reliable system for classifying psychiatric disorders.
21) What did Carson do?
-Claimed from their review of the success of DSM-111 that it had fixed the problem of reliability once and for all.
-Psychiatrists now had a relatively reliable classification system, so this should have led to much greater agreement over who did, or did not have schizophrenia.
22) What is there despite the claims for increased reliability in DSM-111 (and later versions)?
-30 years later there is still little evidence that DSM is routinely used with high reliability by mental health clinicians.
23) What have recent studies shown and give an example?
Recent studies (e.g. Whaley) have found inter-rater reliability correlations in the diagnosis of schizophrenia as low as 0.11.
24) How is reliability in terms of unreliable symptoms in search of schizophrenia an issue surrounding to diagnosis and classification?
-Klosterkotter assess 489 admissions to a psychiatric unit in Aachen, Germany, to determine whether positive or negative symptoms were more suited for the determination of a diagnosis of schizophrenia.
-They found that positive symptoms were more useful for diagnosis than were negative symptoms.
25) What do some critics argue despite Klosterkotters findings?
-A diagnosis of schizophrenia is too diffuse to be useful as a diagnostic category.
-For example, it is possible to give individuals with totally different behaviours (i.e. different combinations of the characteristic symptoms) the same diagnosis of schizophrenia.
26) What did Mojtabi and Nicholson do?
-Only one of the characteristic symptoms is required 'if delusions are bizarre', yet even this creates problems for diagnosis.
-When 50 senior psychiatrists in the US were asked to differentiate between 'bizarre' and 'non-bizarre' delusions, they produced inter-rater reliability correlations of only around 0.40, forcing the researchers to conclude that even this central diagnostic requirement lacks sufficient reliability for it to be a reliable method of distinguishing between schizophrenic and non-schizophrenic patients.
27) What is needed for the DSM and ICD (International Classification system for Diseases) to be reliable?
Those using it must be able to agree when a person should or should not be given a particular diagnosis.
28) What did Beck do?
-Looked at the inter-rater reliability of between two psyhiatrists when considering the cases of 154 patients.
-It was foune that inter-rater reliability was as low as 54%, meaning their diagnosis only agreed with each other for 54% of the individual?
29) What are some reasons for Beck's findings?
-It seems that in many of the 154 cases, the patients gave different information to the two diagnosticians. This illustrates how difficult it is to gain information from patients much of the time.
-It is true that diagnosticians will have the medical records of patients available to them: however, a true diagnosis can never really be made until the patient is clinically interviewed. This means that the health professional will be relying on retrospective data, given by a person whose ability to recall much relevant information is unpredictable.
30) Validity - What happens if scientists cannot agree who has schizophrenia?
-If scientists cannot agree who has schizophrenia (low reliability), then questions of what it actually is (questions of validity) becom essentially meaningless.
-This is concerned with the appropriateness of the classification categories-whether or not the system puts together the same casual factors and who respond to similar treatments.
31) What is predictive validity?
If a person is given, for example, a diagnosis of schizophrenia it is expected that the person will respond to a particular kind of drug. If the person does not respone, it casts doubt on the validity of the original diagnosis.
32) How does prognosis fit in with reliability?
-In the same way that people diagnosed a schizophrenic rarely share the same symptoms, likewise there is no evidence that they share the same outcomes.
-The prognosis for patients diagnosed with schizophrenia varies, with about 20% recovering their previous level of functioning 10% achieving significant and lasting improvement, and about 30% showing some improvement with intermittent relapses.
-A diagnosis of schizophrenia, therefore, has little predictive validity-some people never appear to recover from the disorder, though many do.
33) What does Malmberg suggest?
What does appear to influence the outcome of having schizophrenia is more to do with gender.
34) What does Harrison suggest?
What does appear to influence the outcome of heaving schizophrenia is more to do with psychosocial factors such as social skills, academic achievement and family to lerance of schizophrenic behaviour.
35) What does standardised methods and subjectivity involve?
-It was originally hoped that the use of diagnostice tools could provide mental health proffesional with a standardised method of recognising mental disorders, so that the individual biases and personalities of practitioners would not have an effect on the diagnosis.
-It seems that, however clearly the symptoms of schizophrenia are set out, the behaviour of an individual is always open to some interpretation.
-One person could interpret a certain action in one way while another person could view it in an entirely different manner.
36) How does labelling fit in with the classification and diagnosis of schizophrenia?
-Clinicians have a tendency to put those suffering a mental illness into a category and fail to recognise that there are varying degrees to which that person may be experiencing that disorder.
37) How does labelling fit in with schizophrenia?
-It is tempting for us to label a person as a 'sufferer of schizophrenia' while not really knowing the extent to which they are suffering that condition and how much it is affecting their life.
-This is another example of the problem of subjectivity.
38) Who is the diagnosis usually left to?
-It is usually left to the skill of the individual health professional to decide which behaviours consitute a symptom and which do not.
-Thus the beliefs and biases of some might mean the unnecessary labelling of millions of people as sufferers of a mental disorder.
-For instance it is hard to know where to draw the line between what constitutes a mild schizophrenic symptom and what is a mood swing. This can be seen in the fact that most cases of schizophrenia are diagnosed at a relatively late stage, the disorder having grown progressively worse over a period of time.
-Sometimes the disorder must reach a particular level of severity before it can be recognised with confidence as a mental health issue.
39) How does cultural relativism fit in with classification and diagnosis of schizophrenia?
-Sections of newer versions of the DSM and ICD attempt to highlight and deal with the issue of cultural differences between sub-cultures within our societies, and between different cultures around the world.
40) What did Davison and Neale explain?
-In Asian cultures, a person experiencing some emotional turmoil is praised and rewarded if they show no expression of their emotions.
-In certain Arabic cultures however, the out pouring of public emotion is understood and often encouraged.
-Without this knowledge, an individual displaying overt emotional behaviour in a Western culture might be regarded as abnormal in that context.
41) What takes place to diagnose a mental disorder?
-To diagnose a mental disorder, some interaction between a health professional and the potential patient must take place.
42) What problem does this cause?
-This raises another problem in terms of culture.
-The clinician might not speak the same language as the person they are attempting to diagnose and therefore any interaction between clinician and patient should be done using a translator: otherwise the patient and diagnostician risk eperiencing a serious lack of understanding because of these language difficulties.
43) How does distinguishing schizophrenia from other mental disorders fit within the classification and diagnosis of schizophrenia?
-Although the criteria for the classification and diagnosis of mental disorders have been set out quite comprehensively, it may well be that certain criteria used to classify some disorders are incorrect.
44) How do the DSM and ICD fit in with distinguishing schizophrenia from other mental disorders?
-The DSM and ICD have very similar approaches to the classification and diagnosis of schizophrenia, agreeing on the symptoms and characteristics.
45) What did Schneider propose?
-A different approach to the diagnosis of schizophrenia. Schizophrenia shares many symptoms with other psychotic disorders. In order to distinguish schizophrenia from those other conditions, he argued that the fact a person has a particular symptom should not be regarded as being as important as the content of that symptom. It was the nature of the symptom that would determine whether a person was schizophrenic.
-For example, he studies the types of hallucinations that sufferers of schizophrenia would be afflicted with, arriving at a number of what he called "first-rank symptoms" which he could use to distinguish schizophrenia from other types of psychosis.
46) What did Schneider's "first-rank symptoms" include?
-Thought insertion and thought broadcast
47) How has Schneider's approach been critocised?
-Too stringent, on the grounds that any one of these symptoms could indicate that a person is suffering from schizophrenia.
48) What is a further complication with schizophrenia?
-An individual cannot be diagnosed with the condition, if an existing mood disorder of a pervasive developmental disorder has been diagnosed in the past or present.
-It may also be the case that such symptoms are brought about as a result of another medical condition or the abuse of illegal drugs or other medication.
-Organic problems such as brain tumours can also produce schizophrenic-like symptoms, so this possibility has to be ruled out during diagnosis since the prognosis and treatment in this case is different.
49) What are the 4 biological explanations?
-Biochemical factors/dopamine hypothesis
-Neuro-anatomical - elarged ventricles
50) How do twin studies fit with genetic factors?
-Research has consistently shown identical twins have around a 48% risk of developing schizophrenia if the other twin has it because they share 100% of genes.
51) What did Janicak show?
-Found DZ twins only have a 17% chance of developing schizophrenia if the other twin has it because they only share 50% of genes.
52) What is an evaluating point of genetic factors?
-How identical are identical twins? Twin studies do not always use the same diagnostic tools to compare twins.
-Karmin: adoption agencies will often adopt out to families who are similar to the adoptees and even to members of the same family, so twins reared apart still share similar environments.
-Family studies are usually inconculsive because they are conducted retrospectively that is, they are comparing a cross section of people who have already been diagnosed. A prospective (longitudinal) study can provide more reliable data because it follows the same group of people over a period of time and can make comparisons before and after signs of the illness.
53) What do biochemical factors suggest?
The dopamine hypothesis
-Dopamine=transmitter in the brain
-Schizophrenics are thought to have more D2 receptors, therefore more dopamine binds to the receptors and causes more neurons to fire.
54) How does correlation and concordance fit in with twin studies?
-With continuous characteristics (e.g. IQ test scores) resemblance is defined in terms of correlation.
-Schizophrenia is discontinuous (you have it or you don't) and resemblance is therefore defined in terms of concordance.
-If two twins have schizophrenia, they are concordant, if one has it and the other does not, they are discordant.
55) What did Gottesman and Shields do?
-Looked at medical records between 1948-1974 (N=45,000).
-From these records they identified 57 schizophrenics with a twin, who agreed to participate in the study.
-They used diagnosis plus hospitalisation as the criteria for schizophrenia and found concordance rates of 42% for MZ and 9% for DZ twins.
-Gottesman summarised about 40 published twin studies: Concordance rates= MZ 48%, DZ 17%.
56) What did Shields do?
-Found that separated MZ twins have similar concordance, again suggesting genetics may be more influential, but the separated twins in the study were not all permanently separated and some were cared for by relatives and went to same schools.
57) What did Heston do?
Found that if an MZ twin had a schizophrenic disorder, there was a 90% chance that the other twin had some sort of mental disorder.
58) What did Gottesman do towards the family studies?
-Looked at family concordance rates
-Both parents have schizophreni, child has 46% chance
-One parent, 16%
-(rate is 1% in general population)
if parent had schizophrenia and was an identical twin, concordance was 17% (could be due to heredity or environment). However, if parent did not have schizophrenia but had an identical twin who did not have schizophrenia, rate remained at 17%. i.e. what is of most importance is the genes that are passed on by the parents.
59) What is an evaluating points to Gottesman?
-Gottesman's work clearly indicates that schizophrenia runs in families.
-Concordance rates are higher amongst family members with high genetic similarity.
-However, those with high genetic similarity are also likely to have most contact, so environmental factors cannot be excluded.
60) What have adoption studies shown?
-Adoption studies argubaly provide the most equivical test of genetic influences, because they allow the clearest separation of genetic and environmental factors.
61) What did Heston show?
-Studied 47 adults born to schizophrenic mothers and separated from them within 3 days of birth.
-As children, they'd been reared in a variety of circumstances, though not by the mother's family.
-They were compared (average age 36) with controls matched for circumstances of upbringing, but where mothers hadn't been schizophrenic.
-Five of the experimental group, but none of the controls were diagnosed as schizophrenic.
62) What did Rosenthal show?
-Began a series of studies in 1965 in Denmark, which has national registers of psychiatric cases and adoptions. They confirmed Heston's findings, using children separated from schizophrenic mothers, on average at 6 months.
63) What did Tienari find?
-155 schizophrenic mothers who had given up children for adoption, and they were compared against children who did not have a schizophrenic parent.
-As adults: Schizophrenic mother, 10.3% children developed schizophrenia.
Non-schizophrenic mother, 1.1% children developed schizophrenia.
64) What are the 3 broad models for considering gene-environment factors?
-Gene-environment interaction - genetic effects can be expressed only when certain environmental conditions exist.
-Gene-environment correlation - genetic differences among individuals lead to differences in the environments to which they are exposed, either because people react to them differently or because the specific levels of their inherited abilities lead them to seek out certain environments.
-Genetic-environmental influences change in magnitude through the lifespan - as we develop, we widen our environment from nuclear family to school, peers, media, work etc.
65) What did Comer suggest about the role of biochemical factors?
-Dopamine is linked to control and attention. A degeneration of dopamine leads to problems with attention which is thought to be found in people with schizophrenia and Parkinson's disease.
66) What are the three views of brain biochemistry explanations of schizophrenia?
-Genetic factors may lead to differences in brain biochemistry.
-Biochemical abnormalities may be important in the development and maintenance of schizophrenia (e.g. excess levels of neurotransmitter dopamine).
-Different view is that neurones in the brains of people with schizophrenia are oversensitive to dopamine.
67) What is the dopamine hypothesis?
-Hallucinogenic drugs such as LSD, cocaine and amphetamines (can all cause delusions of persecution and hallucinations) are chemically similar to noradrenaline and dopamine (a neurotransmitter), which occur naturally in the brain.
68) What is the earliest theory implicating dopamine?
-That schizophrenia was caused by excess production of dopamine and indeed post-mortems of people with schizophrenia showed that they had higher levels than normal of dopamine in their brains.
69) How has the theory of dopamine altered?
-The theory has now altered to consider that rather than producing more dopamine, it is in fact used as a result of over-sensitive post-synaptic receptors for it, or because of an excess of receptor sites. For example, the density of one site (D4 receptor) is six times greater in schizophrenic than non-schizophrenic brain tissue.
70) What did Kety do?
-Identified 207 offspring of mothers diagnosed with schizophrenis along with a matched control group of 104 children with 'healthy' mothers.
-The children were aged between 10 and 18 years at the start of the study and were matched on age, gender, parental socio-economic status and urban/rural residence.
71) What were Kety's findings?
-Schizophrenia was diagnosed in 16.2% of the high-risk group compared with 1.9% in the low risk group.
-Schizotypal personality disorder was diagnosed in 18.8% of the high-risk group compared with 5% in the low risk group.
72) What is some research support for Ketty?
-Another prospective studt with offspring of patients with schizophrenia - the New York High-Risk Project - has reported similar findings at a 25-year follow-up by Erlenmeyer-Kimling et al.
73) What are some evaluating points to Ketty's study?
-Advantage op prospective study: It has the advantage of any prospective study in that it looks at children before they show any symptoms of schizophrenia and does not rely on retrospective data. Retrospective data depend on people's memory and/or recorded data from schools, hospitals, etc., which is not always reliable. Kety and his team were able to select participants appropriately and follow them accurately because of the detailed life-long records that are kept on Danish citizens. The study was conducted over many years - this is important as schizophrenia can develop in individuals over the age of 40, even though it usually has a much earlier onset than this.
-Matching of relevant variables: The children were carefully matched on relevant variables as detailed above. It is very important to take into account factors such as socio-economic status and whether the children live in urban or rural environments. This is because low socio-economic status and urban environments are known to be risk factors for schizophrenia.
-Genes versus environment: In spite of the fact that this was a large, well-controlled study carried out over a number of years, there are some problems of interpretation. The main difficulty with family studies such as this is that they cannot differentiate between genetic and environmental influences because the children share the same environment as their mothers.
-Reliability of diagnosis: The diagnosis of schizophrenia is not always reliable. The mothers of these children had all been diagnosed with schizophrenia before the modern diagnostic systems were available, so it is possible that they varied widely in their symptoms. It might even be the case that they would not have been given this diagnosis at all if later criteria had been used. People diagnosed with schizotypical personality disorder were also included in the overall figures, whereas this is different from schizophrenia and may have different causes. In fact, in DSM-IV-TR, it is regarded as a distinct personality disorder rather that a schizophrenic spectrum disorder.
74) What evidence is there supporting and challenging the dopamine hypothesis?
-Grilly: Parkinson is treated with L-dopa which increases dopamine levels. This increase in L-dopa caused schizophrenic like symptoms.
-Antipsychotic drugs - they block the activity of dopamine and eliminate symptoms such as hallucinations and delusions (schizophrenia) - working on possitive symptoms.
-In non-schizophrenics, cocaine and amphetamines produce delusions of presecution and hallucinations, similar to those experienced in schizophrenia, and both substances also stimulate dopamine receptors. This suggests that dopamine plays a part in these symptoms.
-Neuroleptic drugs that block dopamine seem to reduce the symptoms of schizophrenia. The phenothiazines block dopamine at the synapse and typically reduce many of the symptoms, but they have more effect on the positive than the negative symptoms. It is possible that the positive symptoms of schizophrenia have one cause and the negative symptoms have a separate cause.
-The role of dopamine is challenged by Barlow and Durrand who claim that neuroleptic drugs block dopamine quickly but the symptoms take days or weeks to reduce. Surely if dopamine were so important in the development of symptoms, relief from symptoms would be far more immediate if dopamine levels are reduced.
75) What is some AO2 to support and challenge the dopamine hypothesis?
-We do not know if dopamine changes are the cause or effect of schizophrenia. If dopamine changes occur after the onset of the disorder, dopamine plays no part in causing schizophrenic symptoms.
76) What are some evaluating points of the genetic factors?
-Post-mortem studies: most of these studies to test dopamine levels is inclusive and is carried out on the dead. Also, we can't say if the increase in dopamine is a cause or effect of schizophrenia.
-Drugs: that affect levels of dopamine do not benefit all sufferers, e.g. drugs used to reduce dopamine may effectively reduce type 1 (positive) symptoms but not type 2 (negative) symptoms.
-Reductionism in biochemical explanation: they reduce a complex behavior such as schizophrenia down to relatively simple levels of explanations, i.e. an imbalance in brain chemicals. The influence of brain chemicals such as dopamine is indisputable but to argue that they cause schizophrenia is to neglect all other potential influences (stress, irrational thought processes).
-Strong evidence of genetic factors from twin studies, but concordance is not 100% and therefore environmental influence cannot be executed.
-Higher rate in MZ twins could be that MZ twins are treated more similarly than DZ twins, so the greater environmental similarity may be responsible for higher concordance. But MZ twins elicit more similar treatment than DZ twins so this suggests that the greater genetic similarity of identical twins may be a cause rather than an effect of their more similar parental treatment.
77) What are the neuro-anatomical explanations?
-Torrey: Brain imaging techniques have identified schizophrenics have enlarged ventricles (about 15% larger than normal), cavities in the brain that supply nutrient and remove waste.
-Bornstein: Such individuals tend to display negative rather than positive symptoms and have greater cognitive disturbances and porer response to traditional antipsychotic drugs. Because they've got larger cavities in the brain, smaller mass so they were missing things.
-Enlarged ventricles may be a result of poor brain development or tissue damage. These problems lead to the development of schizophrenia.
78) What is some research evidence for the neuro-anatomical explanations?
-Sigmundssen et al found less grey matter and smaller frontal and temporal lobes in schizophrenics.
-Lambert and Kinsey found that the reason for enlarged ventricles in the brains of sufferers may be due to smaller frontal and temporal lobes.
-Ho et al found that schizophrenia sufferers were more likely to have enlarged ventricles and more cerebrospinal fluid.
79) What is some evaluation points for the neuro-anatomical explanations?
-It is difficult to say whether the differences in neuroanatomical structures of sufferers causes schizophrenia or schizophrenia causes the brain changes.
-Is it possible to measure ventricle enlargement accurately?
-There are individual differences: men are larger, and they enlarge with age.
-Lyon: found that in the process of trying to treat schizophrenia with antipsychotic drugs, as the dose of the drug increases, brain tissue decreases leading to enlarged ventricles.
80) What are some biological treatments for schizophrenia?
*Conventional antipsychotic drugs
*Atypical antipsychotic drugs
81) What does antipsychotic medication do?
-Discovered in the 1950's
-Helps the person with the disorder function as well as possible in their life, as well as increasing their feelings of subjective wellbeing.
82) What are the three categories of drugs and an example?
*Chlorpromazine, which is a Phenothiazine, the oldest type of antipsychotic.
-Less typical/conventional antipsychotics
*Risperidone, which is the newest form of antipsychotics and seem to be the most effective over a broader range of psychotic symptoms.
83) How do conventional antipsychotics work?
-People with the symptoms of schizophrenia have problems with seeing things, hearing voices etc. The main theory is the "Dopamine Hypothesis".
-We know that dopamine is involved with positive symptoms.
-If you give a person a drug that increases the activity of dopamine, it can produce the symptoms of psychosis.
*For example, Amphetamines and L-Dopa (also to treat parkinsons) can both produce schizoform symptoms.
-If you reduce the activity of dopamine, it reduces the symptoms of psychosis.
*E.g. using Haloperidol
-Research suggests people with schizophrenia have been shown to have more dopamine activity in their brains.
-Thus, if a person has too much dopamine activity in one part of the brain, this will produce too much "perception".
*For example, seeing and hearing things that aren't there (and thus thinking they come from somewhere e.g. television, radio etc).
-They block dopamine receptors (by fitting into the receptor space usually reserved for dopamine).
84) What are some negatives to blocking dopamine receptors?
-It can upset muscle control (Parkinson's type symptoms).
-If you block acetylcholine receptors, it reduces your learning, produces mild sedation and confusion etc.
-If you block noradrenalin it sometimes upsets your blood pressure e.g. feeling dizzy when you stand up.
-If you block some serotonin receptors, it may have an effect on your appetite and hence weight gain can occur.
85) What is the appropriateness of conventional antipsychotics?
-Tardive dyskinesia: They have many worrying side effects, including tardive dyskinesia. Hill found that about 30% of people taking antipsychotic medication develop tardive dyskinesia, and it is irreversible in 75% of cases.
-Motivational deficits: Ross and Read argue that being prescribed medication reinforces the view that there is 'something wrong with you'. This prevents the individual from thinking about possible stressors that might be a trigger for their condition. In turn this reduces their motivation to look for possible solutions that might alleviate these stressors and reduce their suffering.
86) What is the effectiveness of conventional antipsychotics?
-The effectiveness of the dopamine antagonists in reducing these symptoms led to the development of the dopamine hypothesis of schizophrenia.
-Relapse rates: Many studies that have evaluated the effectiveness of antipsychotic medication have done so by comparing the relapse rates of those on medication with those on a placebo. For example, a review by Davis found a significant difference in terms of relapse rates between treatment and placebo groups in every study reviewed, thus demonstrating the therapeutic effectiveness of these drugs.
-Other factors are important - One of the studies in the Davis review (Vaughn and Leff) found that antipsychotic medication did make a significant difference, but only for those living with hostility and criticism in their home environment. In such conditions, the relapse rate for those on medication was 53%, but for those in the placebo condition the relapse rate was 92%. For individuals living in more supportive home environments, however, there was no significant difference between those on medication (12% relapse rate) and those in a placebo condition (15% relapse rate)
87) How do conventional antipsychotics work?
-They are dopamine receptors (partc. D2) but do not stimulate them, allowing them to reduce hallucinations and delusions.
88) What are atypical antipsychotic used for?
-Used to combat the positive symptoms of schizophrenia, but there are some claims that they are beneficial effects on negative symptoms as well.
-They are a group of unrelated antipsychotic drugs used to treat psychiatric conditions.
-Act on dopamine and block serotonin receptors in the brain too.
89) What did Kapur and Remington suggest?
-Suggested that atypical antipsychotic drugs do not involve serotonin or other neurotransmitters, but only dopamine system, and the D2 receptors in particular.
90) What are some evauating points of atypical antipsychotics?
-By only temporarily occupying the D2 receptors and then rapidly dissociating to allow normal dopamine transmission. It is this characteristic of this drug that is thought to be responsible for the lower levels of side effect, such as tardive dyskinesia.
-Leucht: Good for 'positive' symptoms, however comparative affects on 'negative' schizophrenia are marginal.
-Leucht: good for 'positive' symptoms, however comparative affects on 'negative' schizophrenia are marginal.
91) What are the symptoms of tardive dyskinesia?
-Involuntary movements of the mouth and tongue.
92) What is the effectiveness of atypical antipsychotics?
-Atypical versus conventional antipsychotics: Although the introduction of the new 'atypical' antipsychotics raised expectations for the outcomes possible with medication, a meta-analysis of studies published in 1999 revealed that the superiority of these drugs compared to conventional antipsychotics was only moderate (Leucht). This analysis found that two of the new drugs tested were only 'slightly' more effective than conventional antipsychotics, while the other two were no more effective.
-Effectiveness with negative symptoms: The claim that atypical antipsychotics are particularly effective with the negative symptoms of schizophrenia also has very marginal support. In the Leucht study, two of the atypical drugs were 'slightly' more effective than conventional antipsychotics, one was 'as effective' and one 'slightly worse'.
93) What is the appropriateness of atypical antipsychotics?
-Lower likelyhood of tardive dyskinesia: One of the main claims of the atypical antipsychotics is the lower likelihood of tardive dyskinesia. The claim was supported in a study by Jeste, which found tardive dyskinesia rates in 30% of people after nine months of treatment with conventional antipsychotics, but just 5% for those treated with atypical antipsychotics.
-Fewer side effects: Atypical antipsychotics may ultimately be more appropriate in the treatment of schizophrenia because there are fewer side effects, which in turn means that patients are more likely to continue their medications and therefore see more benefits.
94) What is the appropriateness of drug therapy as a whole?
-Drugs treat the symptoms of the disorder, but not the cause.
-Cannot seek out and kill/change the cause of schizophrenia.
-We don't know what the cause of schizophrenia is. So all drugs do is help reduce the effect of the illness.
-Some sifferers who undertake drug therapy are liable to relapse after the drugs have been discontinued.
-Sufferers can also get used to drug therapy, their bodies begin to compensate and change, therefore dependency becomes an issue. As a consequence, higher and higher doses are needed.
-Side effects is a reason why about 50% of sufferers stop taking drugs within the 1st year. However, the newer forms of antipsychotic drugs have been found to be more effective.
-Not all sufferers will respond in the same way to them. Around 30% of sufferers who take them will not respond favourably.
-Only seem to help with positive symptoms of schizophrenia. Negs have to be addressed with other drugs or with psychological treatment.
95) What is the effectiveness of drug therapy?
-For most sufferers, antipsychotic drugs successfully calm the effects of schizophrenia.
-Silverman stated that antispychotics have beneficial side effects for some people in increasing levels of attention and information processing.
-Chlorpromazine is probably the most widely used antpsychotic and was 1st used on schizophrenia patients in 1952 by Delay and Deniker.
-Kane found Chlorpromazine to be more effective than the phenothiazines, helping approximately 80-85% of schizophrenics.
96) What does psychosurgery involve?
-Damaging the brain in order to bring about behavioural changes.
-Involved an instrunment very similar to an ice pick being inserted under the upper eye-lid and hammered up into the brain through the orbital socket followed by a rotation to sever connections.
97) When was psychosurgery first used to treat schizophrenia?
-In the 1930's with attempts to sever the connections between the frontal lobes and the rest of the brain.
98) What was the outcome of this psychosurgery?
-Patients treated were calmer and displayed none of the symptoms of the disorder of schizophrenia: however, they were sluggish and apathetic and had no real quality of life.
99) What are some AO2 points to psychosurgery?
-Some psychiatrists boasted that they could treat a dozen patients in a single morning.
100) How popular were was psychosurgery?
-The exact figure is not known, but it is estimated that some 18,000 lobotomies were performed in the USA alone between 1939 and 1951.
-By the 1970s, the use of frontal lobe lobotomies had all but died out due to the introduction of drug therapies.
-Between 1980 and 1986, 32 lobotomies were performed in France, and around 15 each year in the UK.
-Some are still carried out in this country, although usually only in very exceptional circumstances.
101) Is psychosurgery apprpopriate?
-Studies using MRI have shown that there is abnormal functioning in the frontal lobes of schizophrenics. A surgery that reduces the functioning of the frontal lobe may actually help to control the symptoms of some sufferers.
-Such a drastic step as deliberately damaging the brain can ever be justified is a matter of debate.
-A very serious problem is that it is totally irreversible meaning the side effects are permanent.
-Major loss of memory, emotional disturbance, loss of creativity, personality change, lack of social inhibitation and other serious problems have been noted as side effects.
102) Is psychosurgery effective?
-Tooth and Newton: Between 1942 and 1954, 41% of patients 'recovered' or 'greatly improved', 28% were 'minimally improved', 25% showed 'no change', 4% had died, and 2% were made worse.
-Issues with the term 'recovered' as wholly inappropriate when discussing the effects of psychosurgery on sufferers of schizophrenia.
-Reduces the symptoms in the same way that drinking alcohol 'cures' anxiety and stress.
103) What are the three psychological explanations of schizophrenia?
-Cognitive: irrational thoughts, cognitive bias
-Behavioural: classical/operant/social learning
-Psychodynamic: personality (id, ego, super ego), traumatic childhood experience (repressed memories)
104) What is the cognitive explanation of schizophrenia?
-Schizophrenia is caused by disorganised and disordered thinking.
105) What is Friths cognitive theories?
Attention deficit theory
-It is the result of faulty attention system, such as pre-concious thoughts which contains huge quantities of information that would normally be filtered, leaving only a small amount to enter into conscious thought.
-Because there is a problem with attention, schizophrenics have difficulty focussing on anyhting for any period of time, giving the impression of disrodered thought and producing the possitive side effects.
106) What does Bentall's attention bias theory involve?
-It is where schizophrenics have deficits and biases in how they process information.
-They have attention bias towards stimuli of a threatening and emotional nature.
107) What does the stroop test prove?
-If colour words like 'red' and 'green' are substituted for emotional words such as 'death' and 'laugh', it generally takes a schizophrenic longer to name the colour of the ink in which the emotional word is printed than is needed. This is because the meaning of the word recieves automatic subconcious processing, and because the word meaning receives a disproportionate amount of attention the naming of the ink colour is interfered with.
-This can explain why some people get the positive effects.
108) What is an evaluating point of the attention deficit theory from the cognitive explanation?
-Frith: Cognitive deficits equals abnormalities in the areas of the brain that uses dopamine, e.g. the hippocampus. This shows that schizophrenics have reduced cerebral blood flow to these areas during certain cognitive tasks.
109) What is an evaluating point of the cognitive processing bias theory from the cognitive explanation?
-Research support: Research has shown that schizophrenics are more sensitive than normal control participants in judging whether a photograph showing painful electric shock being administered to someone is genuine or involves an actor. It has been suggested that this sensitivity is due to the stimuli receiving greater processing.
110) What are some evaluation points of the cognitive explanation as a whole?
-How do we define irrational thoughts?
-Can't determine/prove whether the disordered thoughts are a cause or effect of schizophrenia.
-Whilst cognitive theories appear to explain many of the positive symptoms of schizophrenia satisfactorily, they don't adequately explain negative symptoms.
-Holistic; takes biological influences into account.
111) What is the behavioural explanation for schizophrenia?
-Schizophrenia is a learned response to ceratin environmental events.
-Liberman: learned responses from role models.
*Believed that role models don't reinforce their appropriate behaviour towards social stimuli, and so they disregard these stimuli. Instead, they begin to notice less socially relevant stimuli, and so they disregard these stimuli. (They influence maladaptive behaviour in future schizophrenics.) Their responses are seen as bizarre by other people, rather than being told the behaviour is inappropriate the behaviour is then carried on and reinforced.
112) What is some supporting evidence for the learned response theory?
-Roder: children who recieve little reinforcement for normal behaviour develops schizophrenia.
113) What is some evaluating point of the behavioural explanation?
-There has been inconsistent support for this theory.
-If it's that simple to be learnt, than should be able to be unlearned.
-There have been many attempts to use the behaviourist approach to ease the symptoms of schizophrenia, but few reports of any significant positive effects.
-Belcher has shown that ignoring the bizarre responses of schizophrenic sufferers and reinforcing their socially acceptable behaviours by the use of food, attention, etc., does increase the number of appropriate social interactions and responses of schizophrenics. It does not however cure the problem.
-Reductionist: only says schizophrenia can be learnt.
114) What is the psychodynamic explanation for schizophrenia?
-Schizophrenia is caused by a problem with an ego defence mechanism called regression.
115) What is the Id, ego and super ego?
Id - pleasure principle
Ego - understanding of rules of society
Super ego - sense of right or wrong.
116) What are the three psychodynamic theories?
-Family systems theory
117) What did Freud believe?
-If a child is raised by cold or uncaring parents, their Ego will attempt to protect them from the trauma this causes. To do this it employs the defence mechanism of regression (oral stage).
-A person brought up in a cold and uncaring environment will have a weak Ego, and so, in dealing with the huge demands placed on it by employing its defence mechanisms, the Ego shatters, leaving the Id in charge of the sufferer's personality.
-They develop primary narcissism as a person becomes totally focussed on themselves, to such an extent that they lose all touch with reality.
118) What is the family systems theory?
-Fromm-Reichman's "shcizophrenogenic families" - Usually the mother conveying conflicting messages to the child. They are cold and distant but dominating and severe. They were often rejecting of the child but still demanded that the child show emotional expression and were dependent on the mother at all times.
119) What is the double-bind theory?
-Bateson suggests that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia. The child's ability to respond to the mother is incapaciated by such contradictions because one message invalidates the other. These interactions prevent the development of an internally coherent construction of reality, and in the long run, this manifests itself as schizophrenic symptoms.
120) What is some research support to the double-bind theory?
-Psychiatrist R.D. Laing argued that what we call schizophrenia is actually a reasonable response to an insane world.
121) What is expressed emotion?
- Linszen: A family communication style that involves criticism, hostility, and emotional over-involvement. High levels of EE are most likely to influence relapse rates. A patient returning to a family with high EE is about 4x more likely to relapse than a patient returning to a family with low EE.
122) What is some research support to expressed emotion?
-In a study of the relapse rates among schizophrenics in Iran, Kalafi and Torabi found that the high prevalence of EE in Iranian culture (over-protective mothers and rejective fathers) was one of the main causes of schizophrenic relapses. It appears that the negative emotional climate in these families arouses the patient and leads to stress beyond his or her already impaired coping mechanisms, thus triggering a schizophrenic episode.
123) What are some evaluating points to psychotherapeutic explanations? (psychological theories)
-There is no research evidence to support Freud's specific ideas concerning schizophrenia, except that psychoanalysts agree that disordered family patterns are the cause of schizophrenia.
-Fromm-Reichmann described 'schizophrenogenic mothers' or families as important contributory influences in the development of schizophrenia.
-Studies have been shown that parents of patients do behave differently, but this is as likely to be a consequence of their children's problems as a cause.
124) What are some evaluating points to cognitive explanations? (psychological theories)
-Meyer-Linedberg found a link between excess dopamine in the prefrontal cortex, and working memory.
-Yellowlees has developed a machine that produces virtual hallucinations. The intention is to show schizophrenics that their hallucinations are not real; no evidence its successful.
125) What are some evaluating points on life events and schizophrenia? (socio-cultural factors)
-Van Os reported no link between life events and the onset of schizophrenia, infact those who had experienced a major life event went on to have a lower likelihood of relapse.
-Evidence that suggests a link between life events and the onset of schizophrenia is only correlational - life events after the onset of the disorder may be a consequence rather than a cause of mental illness.
126) What is an evaluating point to family relations?
-Tienari: found adopted children who had schizophrenic biological parents were more likely to become ill than those without. However, difference only emerged when adopted families were rated as disturbed. -Genetic vulnerability alone was not sufficient.
127) What are some evaluating points of the double-bind theory?
-Berger found schizophrenics reported a higher recall of double-bind statements by their mothers. However recall may be affected by schizophrenia.
-Liem measured patterns of parental communication in families with a schizophrenic child and found no difference when compared to normal families.
-Hall and Levin analysed data from various previous studies and found no difference between families with and without a schizophrenic member in the degree to which verbal and non-verbal communication were in agreement.
128) What is an evaluating point to expressed emotion?
-Hogarty found EE can significantly reduce relapse rates. However, it is not clear whether the EE intervention was the key element of the therapy or whether other aspects of family intervention may have helped.
129) What are the psychological treatments for schizophrenia?
-Behavioural Therapy (token economy)
-Cognitive Behavioural Therapy (SIT, Rational-Emotive therapy, errors of logic)
-Psychodynamic Therapy ('talking cure'/sullivan's therapy)
130) What is the behavioural therapy and how does it work?
-The token economy works in co-ordance with operant conditioning (reward). They would be rewarded for not displaying any unusual behaviour. Through progress they start to be rewarded for normal behaviour. The tokens are used as a possitive reinforcement which would allow them to do a treat.
131) What is some supporting research to token economy?
-Allyon and Azrin studied 45 female patients who were in mental institutions to assess they're behaviour on the token economy. They observered the treatment.
132) What is the appropriateness of behaviour therapy in the treatment of schizophrenia?
-Using token economy has allowed patients in schizophrenia institutions more freedom and independence, which has helped the therapeutic process considerably.
-It does not deal with the causes of schizophrenia.
-Paul and Lentz point out that this type of therapy does not have an effect on the behaviour of schizophrenics (doesn't cure them, manages the behaviour instead.)
-As it is a form of manipulation, the ethics of treating patients in this way have been questioned/seems like bribary.)
133) What did Paul and Lentz show towards the effectiveness of behaviour therapy in the treatment of schizophrenia?
-Paul and Lentz looked at the effectiveness of token economy compared to other therapies.
-Patients were suffering from chronic schizophrenia and put into 3 groups:
1) the learning group (token economy group)
2) Milieu therapy (patients treated morally, showed oppinions)
3) general group (treated normally from institutions)
-90% of all patients were recieving drug treatments at the start of the study.
-4 years later, the number of patients who were taking drugs in the general group rose to 100%, the milieu therapy group fell to 18%, and the learning group fell to 11%.
-turning to communities, the learning group did significantly better.
-Can't generalise: all females, all chrinic sufferers, indiviual differences.
134) What other psychologists show towards the effectiveness of behaviour therapy in treatment of schizophrenia?
-Allyon and Azrin found that this method of token economy significantly reduced the bizarre behaviour displayed by many of the patients while also significantly increasing their helping behaviour and 'normal' behaviour.
-Gripp and Margo found that the symptoms of patients with schizophrenia treated using the token economy method improved significantly more than patients who were treated using other methods.
-Gershon found that people on the token economy therapy spent more time doing activities, less time in bed and made fewer disturbing comments to other patients on the ward.
135) What is the effectiveness of behaviour therapy in treatment for schizophrenia?
-Behavioural therapy has been used in conjunction with other types of treatments, like drug therapy, to help sufferers with their behaviour and facilitate their return to society.
-Token economy can seem to have little effect on schizophrenia because the treatment over looks the influence of a persons cognition and thought process have in the development of schizophrenia.
136) What is the cognitive behavioural therapy?
-CBT addressed and changes sufferer's dysfunctional emotions, thought processes and the subsequent behaviours that result.
137) What did Meichenbaum do towards the cognitive behavioural therapy?
-SIT (stress innoculation therapy)
-Claims that mental disorders are the product of abnormal thoughts and feelings so by changing ones thoughts it will start to change their behaviour.
138) What is an example of CBT?
-Albert Ellis states that dysfunctional behaviour is the result of irrational thoughts. Also irrational thoughts lead to irrational behaviour. Hence, should be replaced by rational thoughts and cognitions.
139) What did Beck propose?
-The errorsof logic as one of the reasons for disorders, such as schizophrenia.
-These forms of CBT work by challenging their illogical thinking and unusual explanations for their feelings.
-The goal is to strengthen a sufferer's logical reasoning skill, this providing an alternative to the often bizarre psychotic thoughts and feeling.
140) What does CSE aim to do?
-Help schizophrenics cope better with their psychotic symptoms. The therapist works with the schizophrenic to develop ways of managing symptoms, targeting specific symptoms such as auditory hallucinations.
141) What is the appropriateness of CBT in the treatment of schizophrenia?
-It can be difficult to use CBT in the treatment of individuals with schizophrenia as it means they have a lack of coherant thinking and inshight into their condition.
-Needs to work in condunction with other therapies to be most effective.
-The growth in support for a biological bias has led clinicians to suggest that an excess in the production of dopamine is responsible for many of the symptoms experienced by schizophrenia sufferers.
-Morrison believes that CBT can effectively be adapted to challenge the dysfunctional beliefs that sufferers experience and that is could therefore reduce their symptoms and distress, possibly leading to a lasting decrease in the symptoms associated with schizophrenia.
-Garrett described successfully using CBT to change a patient's mind about taking the antipsychotic drugs she was prescribed and therefore reducing her symptoms in that way.
142) What is the effectiveness of CBT in the treatment of schizophrenia?
-Zimmermann found that CBT was effective in that it was better at treating the positive symptoms of schizophrenia than having no treatment at all. They also proposed that the effect of this treatment was relatively long-lasting and could help sufferers for up to 12 months.
-Can be useful in recognising, and therefore counteracting, a possible relapse caused by stressors in sufferers of schizophrenia.
-Helps a person recognise the stressors recognise the stressors, recognise that their reaction to it is inappropriate, therefore preventing realapse of schizophrenic symptoms.
-Turkington found that CBT was effective in treating short-term and some long term symptoms of schizophrenia.
-Sensky found it was still effective in reducing symptoms, even after 9 months.
-Tarrier found no real benefits a year after treatment was stopped, and even less after 2.
-Zimmermann found that CBT is most effective when helping with the auditory and visual hallucinations that sufferers experience; particularly in reducing the distress and negative emotions experienced by the individuals.
-Kopelowicz and Liberman found, in are view of overall benefits of CBT in treating schizophrenia, that it moderately improved symptoms of schizophrenia in 50%-60% of sufferers, but only when used in conjunction with drug therapy. The relapse rate was moderate and the treatment was deemed to be moderately expensive.
143) What is Freud's talking cure/psychoanalysis?
-He never intended it to be used to treat schizophrenia as he thought that the essence of their condition made a personal relationship, essential for development in psychoanalysis impossible.
-However, subsequent psychoanalysts have adapted the treatment so that it might be used when dealing with those suffering from schizophrenia and some therapists have even claimed to have had some success.
144) What did Sullivan and Pratt believe?
-That schizophrenia was a way of returning, or regressing, to an early childhood in terms of cognition and communication due to a stressful event that led to a weak ego.
145) What did Sullivan's therapy seek to achieve?
-An insight into the influence that their post experiences have had on their current condition. They are also encouraged to learn the adult form of communication essential for normal living so that they are able to clearly express the effect of their past. A very gradual relationship is developed, one which is safe and doesn't threaten the suffering any way.
146) What is the appropriateness of psychogynamic therapies in the treatment of schizophrenia?
-Psychodynamic therapies suggest that a patient can only be 'cured' when they have gained sufficient 'insight' into their condition. However, schizophrenics have a lack of personal insight, suggesting that they cannot be 'cured'.
-Many of the people who were treated by Sullivan and Pratt would not have been diagnosed with schizophrenia if they had been assessed using today's criteria.
147) What is an evaluating point into the effectiveness of psychodynamic therapies in the treatment of schizophrenia?
-There is very little research to suggest that this type of therapy works with schizophrenia.
148) What did Drake and Sederer show towards the effectiveness of psychodynamic therapies in the treatment of schizophrenia?
-Looked at the effectiveness of a range of different therapies and found that therapies which involved a close client-therapist relationship, age regression and high levels of emotionally actually worsened a sufferer's symptoms, often leading them to become hospitalised for significantly longer periods.
149) What other support to this is there that links to this?
-Stanton also reported therapy to have very little effect.
150) What did Stone show towards the effectiveness of psychodynamic therapies in the treatment of schizophrenia?
-Looked at a number of patients who had been diagnosed with schizophrenia, discharged from a mental institution in New York between 1963 and 1976.
-Reported a significant lack of improvement in any of the schizophrenics who had under gone this form of therapy.
-The suggestion was that intruducing in to the mind of a sufferer of a serious and chronic psychotic disorder could do more haarm than good.