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Schizophrenia - Coggle Diagram

- - - - emotionally disturbed, cold, rejecting, dominating, perfectionistic, and insensitive
        
        Can lead to paranoid delusions/hallucinations
    - - Conflicting messages from family
    - - Too much negative emotion in a household. Expressed by carers. Verbal criticism of the patient occasionally accompanied by violence, Hostility towards the patient including anger and rejection and Emotional over involvement.
        
        Sources of stress for the patient. Can be explanation for relapse or trigger onset of schizophrenia (diathesis-stress model).
    - - Support
        
        Read et al. 46 studies of child abuse and schizophrenia and concluded that 69% of adult women diagnosed have history of physical/emotional/sexual abuse. For men the figure was 59%.
      - Weakness
        
        No evidence to support double bind or refrigerator mother. Both theories based on clinical observations of patients. May also be inaccurate due to temporal validity patients may not be able to recall over long period of time or schizophrenic hallucinations may have altered reality.
  - - - Helps patient identify irrational thoughts
      - May involve argument or discussion on patients beliefs
      - How their delusions or hallucinations may impact their behaviour or feelings
      - Delusions can also be challenged so that the patient can come to learn that their beliefs are not based on reality.
    - - Takes place with families and not individual patients
      - Challenging double bind and the refrigerator mother
      - Therapists sometimes see the family as the root cause of the condition.
      - Therapist might:
        
        Form an alliance with all family members
        
        Reducing stress of caring for a relative with schizophrenia
        
        Improving the ability of the family to anticipate and solve problems
        
        Reduction in anger and guilt of family members
        
        Helping family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives
        
        Improving families beliefs about and behaviour towards schizophrenia
      - EVALUATION
        
        Family may not consent, this may be a double bind as it seems like they don't want to help the patient. However they may not consent for privacy/confidentiality reasons.
    - - Reward system to manage behaviour of patients with schizophrenia, in particular those who have developed maladaptive behaviour through spending long periods of time in psychiatric hospitals.
      - Common maladaptive behaviours include
        
        Bad hygiene
        
        Remain in pyjamas all day
        
        Modification of these habits can include
        
        Getting dressed in morning
        
        Making bed
      - Positive reinforcer=food privelages
      - Secondary reinforcer=Token due to the fact that it only has value once the patients knows what it can be traded for
      - EVALUATION
        
        Treatment improves quality of life but does not help with causes this can still lead to a relapse
        
        Patients may not be able to consent to this if their schizophrenia is so severe because they may not understand what they have consented to or may not know about their right to withdraw or not know how to for example if one of their characteristics are social/occupational dysfunction
  - - - attentional filter
    - - frith claimed it can leads to symptoms such as disorganised thinking
    - - Emotional Stroop test even lower than regular Stroop test results
      - Weakness because it is not a complete theory there is no cause in the theory it may be neural correlates/dopamine hypothesis that induces this phenomenon
- - - - 1 Schizogene
  - - - Vulnerability
        
        108 polygenic aetiologically heterogenous TIENARI
      - Trigger
        
        THC rich cannabis
    - - Vulnerability
        
        Abuse as a child physical/psychological/sexual HOUSTON
      - Trigger
        
        Stress trigger eg. work, bereavement
- - - - Newer developed in 1960s but more commonly in use in 1970s
      - Less side effects due to it being temporary
      - Side effects can include Agranulocytosis due to it effecting glutamate receptors which effect white blood cells.
      - Clozapine + Risperidone
      - Binds to serotonin/dopamine/glutamate receptors
      - When patient is considered at high risk of suicide they can be prescribed Atypical antipsychotics due to its mood enhancing effects because it also acts on serotonin receptors.(REDUCES DEPRESSION)
    - - Older developed in 1950s
      - Chlorpromazine
      - Only acts on dopamine receptors
      - Also an effective sedative
      - Reduces symptoms like hallucinations because its a dopamine antagonist.
      - Can lead to Parkinson's like called tardive dyskinesia.
    - - Works better then placebo in research
      - Clozapine more typical than other antipsychotics
      - Serious side effects
      - May not understand drugs side effects if their schizophrenia is so severe
      - Depends on dopamine hypothesis
      - Serious side effects may be permanent and life threatening. Agranulocytosis and tardive dyskinesia.
      - Chemical cosh Human rights abuses/Straight jacket for mind
  - - - Functions and areas in brain associated with developing schizophrenia
        
        neurotransmitters
        
        hypodopaminergia
        
        More recent versions of hypothesis too little dopamine in cortex such as prefrontal cortex=disorganised thinking
        
        hyperdopaminergia
        
        Original version of dopamine hypothesis.
        
        Too much dopamine in sub cortex such as Broca's area
      - Other areas of brain linked to schizophrenia
        
        Basal ganglia
        
        Associated with movement
        
        Catatonic behaviour
        
        Auditory cortex
        
        Associated with hearing
        
        Auditory hallucinations
        
        Visual cortex
        
        Associated with seeing
        
        Visual hallucinations
        
        Amygdala
        
        Affective flattening
    - - Candidate genes
      - polygenic
      - aetiologically heterogenous
      - 108 associated genes
      - 10% risk from immediate family
      - 15% for non identical
      - 50% for identical twins
- - - - More males diagnosed females are better at masking symptoms
    - - Afro-Caribbean culture normal for hearing voices
  - - - Different criteria from DSMV and ICD 11