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A2- Schizophrenia, A severe mental disorder where contact with reality and…
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Classified by WHO,Needs 2 of -ve symptoms for diagnosis,Has sub-types of schizophrenia:
- Paranoid S = Due to powerful delusions&hallucinstions
- Hebephrenic S = Negative symptoms
- Catatonic S = Affected movement either immobile/overactive
Classified by American psychiatrists, Needs 1 of +ve symptoms for diagnosis & no longer has subsystems
Additional symptoms to normal experiences
- Hallucinations = Sensory experiences that don't link to reality/ are distorted perceptions of things that aren't there. E.g. Hearing voices or distorted facial expressions (Visual or Auditory)
- Delusions = Irrational Beliefs that don't link to reality (paranoia) E.g. Thinking they are a Historical or religious figure. Sufferers even behave in ways that's normal for them but bizarre to others.
Experiences representing the loss of a usual experience
- Avolition = Lack of motivation to carry out tasks & low energy levels. Andreason found poor hygiene, lack of energy & persistence in work/skl are signs
- Speech poverty = Reduced amount & quality of speech, can affect conversations
These differences can confuse patients & even clinicians. As one may be diagnosed with S through ICD, but not through DSM that affect a patient from receiving the correct/necessary treatment.
+ve Standardisation = Patients receive the necessary treatment regardless of location or ability to pay
-ve Can create stigma (feel like a disgrace for having sz)that can be distressing for patients so diagnosis must be done carefully
-ve One symptom isn't enough to diagnose schizophrenia as there could be other behavioural explanations
- Investigations have shown that the greater the genetic similarity between family members, the more likely they are to get schizophrenia
- Evidence is weak as family members share environmental aspects as well as genes
Gottesman 1991 has shown the degree of genetic similarity affects the chance of getting Schizophrenia
- Identical twins = 48%
- Fraternal twins = 17%
- Siblings = 9%
- Parents = 6%
- General population = 1%
Genetics = Genes which are sections of DNA that provide instructions for our physical features (eye colour or neurotransmitter levels) and affects our psychological features like intelligence. Are inherited from our parents.
His study looked at the whole human genome than genes causing schizophrenia
- He looked at the genes of 37,000 patients finding 108 separate genetic variations to do with the risk of schizophrenia
- Supports biological explanations as evidence shows it's aetiologically heterogeneous
- The genes with a risk coded for neurotransmitter dopamine
Dopamine = Neurotransmitter with an exitory effect that causes pleasure, which works differently in the brain of those with Schizophrenia
- High dopamine levels = Schizophrenia
- Low dopamine levels = Parkinson's disease
- High levels of dopamine
- E.g. Excess dopamine in Broca's area usually for speech production can be affected by Schizophrenia by speech poverty & auditory hallucinations
- Goldman-Rakic found low levels of dopamine in prefrontal cortex (usually for thinking and decision making)
- Caused -ve symptoms of Schizophrenia
Glutamate hypothesis is no longer accepted but is still a popular theory for the cause of schizophrenia Its a neurotransmitter for normal brain function for cognition, memory & learning.
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- Hypothalamus = above the pituitary gland & below thalamus, regulating body temp, releasing hormones and behaviours like hunger (reward systems) important in connecting the endocrine and nervous system - Anterior cingulate gyrus = near front of the corpus callosum frontal lobe which processes & shows emotions
- Superior temporal gyrus = Wernicke's area left hemisphere for auditory processing of language
- Ventral striatum = An input to the basal ganglia for reward systems and motor movements
Antipsychotic drugs = Reduce symptoms of schizophrenia, mainly +ve symptoms
Are older drugs since the 1950s
- Chlorpromazine can be taken as a tablet, syrup & injection
- This associates with Dopamine hypothesis acting as an antagonist
- Antagonists reduce dopamine receptors (blocks them) = reducing dopamine = reducing symptoms like Hallucinations (returning neurotransmission back to normal)
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- Taken as tablet
- Binds to dopamine receptors as well as serotonin & glutamate receptors
- Improves mood, depression, cognitive functioning & risk of suicide from schizophrenia
- Yet, due to its side effects when taking this blood tests must be taken to reduce agranulocytosis (when bone marrow doesn't produce granulates which are white blood cells fighting against infection)
- Taken as a tablet, syrup & injection
- Binds to the dopamine & serotonin receptors more strongly than clozapine
- Has fewer side effects being more effective than clozapine & typical chlorpromazine
Childhood & adult experiences in a family e.g. poor communication/parenting that develops schizophrenia
- Schizophrenogenic mother = Fromm-Reichman heard from many patients of a parent who's cold, rejecting & controlling --> causing tension and secrecy in a family --> distrust forms delusions --> schizophrenia
- Double-bind theory = Bateson found communication in a family can be a risk factor of schizophrenia, as a child receives mixed messages from parents e.g. A mother who said they loved their child but when they did something wrong they'd look away in disgust --> creates confusion --> causing delusions & disorganised thinking
- Expressed emotion = -ve emotions through: Verbal criticism of a patient, Hostility (rejection "you're a waste of space") & emotional over involvement in the life of the patient
Occurs with families to improve communication & interaction between family members, to help the patient
Pharaoh's strategies:
1) Form therapeutic alliance with family
2) Reduce stress of family for caring for patient
3) Improve the ability of families to solve problems & reduce anger/guilt
4) Help family to balance care & their own life
5)Improving their behaviours towards schizophrenia
Therapy that manages a patients behaviours through reinforcement (operant conditioning) to improve their quality of life.
- Tokens are given to patients for their desirable behaviours (secondary reinforcers)as a reward which reduces delayed discounting(prevents their rewards being delayed)
- Tokens are then swapped for rewards (primary reinforcers) e.g. sweets or magazines or go out for a trip
To do with the mental thought processing that occurs
- In SZ its not normal e.g. reduced thought processing in ventral striatum = avolition or in temporal & cingulate gyrus = hallucinations
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- Helps patients identify their irrational thoughts & challenge them
- They'd discuss/ argue about how likely their beliefs are, to help cope with SZ
- Understanding their delusions & hallucinations --> reduce their anxiety --> helps with their behaviours
- Delusions can be challenged to help learn they aren't based on reality
Includes Biological (genetics), Psychological (stress) & societal factors
- Diathesis = Vulnerability, Stress (trigger) = -ve psychological experience, that both develop SZ
- Meehl's OG D-SM = Said vulnerability was fully genetic due to a schizogene, by stress
- But if one didn't have this gene then no stress could cause SZ
- And the stress was due to schizophrenogenic mother, both causing SZ
- Modern Diathesis = No schizogene, as many genes cause SZ (Ripke)
- Diathesis here due to genes & trauma(shifts from stressor--> diathesis), Ingram & Luxton
- Read found early trauma like childhood abuse affected brain development e.g. flight or flight response being continuously active
- Modern stress = Stress links to anything that risks triggering SZ, Houston (psychological from parenting remains stress)
- Cannabis is an e.g. of triggering stress as it increases SZ by x7 & affects the dopamine system, yet vulnerability can cause smoking it too
- Biological & psychological treatments are used of antipsychotics and CBT, as both factors are involved
- Turkington found an interactionist model must be adopted as you can believe biological symptoms cause SZ & it can be treated psychologically by CBT. But patients must be aware both factors are involved not one.
- UK uses the combo of treatments, but USA has conflict of both so they've adopted this approach slower