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Schizophrenia - Coggle Diagram
Schizophrenia
Classification of Schizophrenia
1% of the population have the disorder - onset of first symptoms is around 14-15 years old - men are more likely to develop the disorder and have earlier onset of symptoms
The diagnostic and statistical manual (DSM) is most often used for classification - however, the International classification for disease (ICD) may also be used too
Positive symptoms: Experiences that are in addition to normal experiences
Hallucinations
- Additional sensory experiences such as seeing distortions in objects that look like faces or hearing voices
Delusions
- Irrational beliefs about themselves or the world e.g. feelings of persecution
Negative symptoms: Loss of normal experiences or abilities
Avolition - A lack of purposeful or willed behaviour - no energy, sociability, affection or attempt at personal hygiene
Speech poverty - Brief verbal communication style - Los of quality and quantity of verbal responses
Reliability - how consistent the results are using the same measuring tool so if we measure again we get the same results
Beck - in a review of 153 patients who had been diagnosed by multiple doctors found only a 54% concordance rate between the doctors assessments this suggests a low. inter-rater reliability in the diagnosis of schizophrenia - also suggests many people have been misdiagnosed
Buckly - found these co-morbidity rates
Depression = 50%
drug abuse = 47%
PTSD = 29%
OCD = 23%
Symptom overlap - Bipolar disorder also has hallucinations and delusions as symtoms
Gender - men and women equally likely to be diagnosed however mens average age of diagnosis is 5 years earlier than women - men m ore likely to display negative symptoms and women positive symptoms
Gender bias - suggested that women experience of schizophrenia is taken less seriously and under diagnosed compared to men - Cotton suggests this is due too women better social coping strategies leading to less likely to seek treatment
Culture - people with Afro-Caribbean heritage in the UK are up to 9x more likely to be diagnosed with schizophrenia compared to 1% of general pop
Culture bias - Rise in diagnosis rates is due to culture bias - western definitions of mental illness are applied to non-western cultures
Loring and Powell - sent 290 psychiatrists twi identical case studies - white male, black male, white female, black female, no gender or race disclosed - researchers found, over-diagnosis of the black case studies and under-diagnosis of the female case studies - most accurate was when gender and race matched the psychiatrist -0 suggests gender and culture bias in diagnosis of schizophrenia
Interactionalist approach to Schizophrenia
Suggests that the development of schizophrenia is due to the combined effects and interaction of biological and social/psychological factors
Diathesis -stress model - psychological concept that an individual can be predisposed to inheriting a disorder (diathesis) but the environment in which they live is what triggers the disorder (Stress)
Diathesis In Schizophrenia - genetic vulnerability possibly resulting in dopamine imbalance - some scientists now argue diathesis may not be genetic such as flu in pregnant mothers
Stress in Schizophrenia - later negative environmental experiences - family dysfunction, emotional distress 0r major negative life event - can also include drug abuse such as canabis
Eval: :check: Gottesman and Tiernari - genetics and environment causing schziophrenia
Treating Schiz - interactionalist approach both psychological treatment (CBT) and biological treatment (drug therapies) would be most successful
In patients severe Symptoms - biological treatments can allow the patient to reduce their symptoms so they can engage in psychological therapies
:check: Tarrier suggested that there are improvements that can be made with standard drug therapy - placed patients randomly into routine care (anti-psychotics) or routine care and CBT - Patients with combined treatment had significant improvement in the severity of positive symptoms as well as fewer days in hospital - suggest interactionalist approach to treating symptoms isn more effective that just drug therapy alone
Eval: :check: Diathesis has developed - no longer one schizophrenia gene now polygenetic or other factors are now included such as pregnant mother having flu
:check: Holistic explanation of human development
Biological explanation for Schizophrenia
Genetic explanation for Schizophrenia
Schiz is inherited and results from a biological process driven by the activity of certain genes such as for brain structure and neurotransmitter levels
There is no one schizophrenia gene however a collection of gene locations have been located that are associated with a higher risk of developing schizophrenia - polygenetic disorder
Ripke et al - conducted genetic analysis of over 36,000 schizophrenia cases - identified 108 genetic loci associated with the development of schizophrenia - suggests a range of genes responsible for schizophrenia
If genetic we expect to see a concordance rate between two people who are closely related - Twin and Family studies will show this (MZ twins share 100% of DNA)
Gottesman and Shields reviewed cases of schizophrenia in families:
General pop = 1%
Siblings = 9%
DZ twins = 17%
MZ twins = 48%
Suggest genetic element however also suggest that other factors must be involved because MZ twins share 100% of their DNA and only 48% concordance rate
Tienari - Studied the biological children of schizophrenogenic mothers who had been adopted - 5.8% of children adopted into psychologically healthy families developed schizophrenia compared to 36.8% of children raised in dysfunctional families - both above 1% (general pop) suggest genetic element
Neural correlates
The variations in neural structure and biochemistry that are correlated with an increased risk of developing schizophrenia
The dopamine hypothesis - suggest that symptoms of schizophrenia are associated with too much or an imbalance of the dopamine neurotransmitter across the brain
Excessive amounts of dopamine in speech centres like Brocas area will lead to auditory hallucinations - lower levels of dopamine in areas like the frontal cortex will most likely to lead to negative symptoms like avolition
Came about after observations that dopamine releasing drugs like L-dopa can produce schizophrenic like symptoms in healthy patients - also antipsychotic drugs like phenothiazine decrease symptoms of schizophrenia and reduce dopamine levels
Leueht et al - conducted a meta-analysis of 212 studies which assessed the affectedness of biological anti-psychotic drug treatments that working by normalising levels of dopamine - results showed that these drugs were more effective than the placebo - suggests dopamine is underlying cause of schizophrenia otherwise drugs wouldn't be effective
Other neurotransmitters are also implicated:
Glutamate is an excitatory neurotransmitter involved in learning, attention and memory is found in low quantities in people with schizophrenia
Serotonin
Ventricles - are voids filled with cerebrospinal fluid deep within the brain, these are thought to provide a protective cushioning effect for the brain - enlarged ventricles are associated with people with schizophrenia
Based on correlational research so lacks validity - correlation does not show causation
Eval: :no_entry: Biological deterministic
:check: biological explanation has scientific valdity
Psychological explanations
Family dysfunction - suggest schizophrenia is the interpersonal relationship between family that results in symptoms
Schizophrenogenic mother - psychodynamic theory that suggests people with schizophrenia get their paranoid delusions as a result of a cold, rejecting and controlling mother and a passive father - creates an atmosphere of stress and tension which triggers psychotic thinking
Double-blind theory - suggests the child gets mixed messages and feels unable to do the correct thing - e.g. being told to be more independent but then being overprotected and receiving criticism when they are independent - results in disorganised thinking and paranoia
Expressed emotion - verbal interactions the caregiver has with person with schizophrenia
Exaggerated involvment indicating the sufferer is a burden
Criticism and control of the sufferers behaviour - "you don't know how to do anything you need to listen to me"
Hostility towards the sufferer - physical, verbal or emotional suggesting rejection
Tienari - Studied the biological children of schizophrenogenic mothers who had been adopted - 5.8% of children adopted into psychologically healthy families developed schizophrenia compared to 36.8% of children raised in dysfunctional families - both above 1% (general pop) suggest genetic element
Cognitive - based on dysfunctional thought processes
Firth's "attention deficit theory" suggests schizophrenia is due to a faulty attention system unable to filter preconscious thought and gives too much significance to information that would usually be filtered - accounts for positive symptoms such as hallucinations and delusions
Want to carry out unnessescary actions and cant explain why - seeing a door handle and wanting to open it
Meta-representation - identifying own thoughts and actions as your own by paying attention to them - faults in this system results in delusions
Firth - cognitive neuroscience - 30 schizophrenia patients with various symptoms had PET scans - indicated a reduction in blood flow in the frontal cortex in patients with negative symptoms like abolition - also showed increased activity in an area of the temporal lobe responsible for for the retrieval of memories with patients with reality distortions
Eval: :check: Family therapy reduces expressed emotion in families - this has been demonstrated to be an effective intervention and supports the family dysfunction argument
:check: CBT can be an effective therapy suggesting cognitive element
:no_entry: Socially sensitive to suggest schizophrenia is due to family environment and relationships
:no_entry: significant amount of research in the biological approach
Psychological treatments for Schizophrenia
Token economies
Behavioural therapy technique based on Skinners operant conditioning - learning through reinforcement of desires and behaviours
Tokens are used as a type off positive reinforcement - an immediate reward for when the patient shows pre-defined target behaviour - tokens are then exchanged for something they want
Behaviour shaping - Behaviours are progressively changed with tokens first given for small changes in behaviour towards the ideal
Psychiatric institutions - Treatment is designed to produce easier to manage bahveiour within the hospital or to prepare long stay patients for transfer into the community
Mild Negative symptoms - treatment can be used for patients with mild negative symptoms but more profoundly ill patients are less able or willing to engage
Eval: :check: Supporting evidence - when reviewing the findings of 13 studies - token economies can be effective in improving the adaptive behaviour of people with schizophrenia
:no_entry: Do not directly treat symptoms of schizophrenia only attempt to manage
:no_entry: Not effective for patients with severe symptoms
Cognitive Behavioural Therapy - assumes that schizophrenia is the result of dysfunctional thought processes - faulty cognitions such as delusions
The therapists role is to challenge irrational beliefs
Ellis's ABC (DE) model - used to understand faulty cognition and provide a process to cognitively restructure irrational beliefs
Activating event - Drug treatment causes side effects
Beliefs - Hospital staff are trying to kill them
Consequences - refusing treatment
Dispute Irrational Beliefs - The staff have no reason to kill them
Effect - The drugs are necessary (restructured belief
Reality testing - Patient can demonstrate to themselves that their beliefs are irrational
:check: Supporting research by Sensky et al - showed that patients who had resisted drug treatments had a reduction in positive and negative symptoms after 19 sessions of CBT - also continued to improve 9 months after the treatment - suggests CBT can be effective when drugs are not :no_entry: Ending treatment is common due to the length of treatment - CBT requires engagment :no_entry: Some patients due to severity of symptoms or personality may not be able to cope with the confrontation of their beliefs :check: Does not have side effects that with physically affect body like drug therapies can do
Family Therapy
Family dysfunction can lead to the risk of relapse into shizophrenia - family therapies attempt to improve the home situation of the person with schizophrenia
Family centered - the therapy is intended to change the behaviour of the whole family not just the person with Schizophrenia
Psychoeducation - The family is educated on the symptoms of schizophrenia in order to be more understanding of family members behaviour
Reduce conflict - addressing anger within the family
Reduce Stress - cause by caring responsibilties
Reduce self sacrifice - By getting carers to consider their own needs
Improve communication - considering how to limit expressed emotion
Improve problem solving skills - predicting problems and having solutions in advance
Eval: :check: Leff - 50% with standard outpatient care had relapsed compared to 8% who had family therapy within 9 months -however, after 2 years this had risen to 50% - suggests the use of family therapy is successful in reducing re-admission in the short term, however, families may not maintain positive patterns of behaviour over a longer term
:no_entry: Problematic practical issues with family therapy such as the length - can take up to a year and in this time symptoms may cause patients to drop out
:no_entry: managing schizophrenia not curing
Drug treatments for Schizophrenia
Antipsychotics - also known as neuroleptics are medications that are used to control psychosis
Typical antipsychotics (first generation)
- a drug therapy used since the 1950s which are now less popular due to severe side effects - taken in pill form or injected
One example is Chlorpromazine - the drugs work as dapomaine antagonists - they reduce dopamine activity by blocking dopamine receptors at the synapse
Calms the dopamine system in the brain reducing positive symptoms such as hallucinations and delusions
Side effects - dry mouth, constipation, lethargy and confusion and tar dive dyskinesia
Atypical antipsychotics (second generation
) - started being used in 1970s to avoid more severe side effects
One example is Clozapine - block dopamine receptors but also act on other neurotransmitters e.g. serotonin and glutamate
Also address negative symptoms as well as positive
Side effects - weigh gain, cardiovascular problems - less likely to cause tar dive dyskinesia
Leueht et al - conducted a meta-analysis of 212 studies which assessed the affectedness of biological anti-psychotic drug treatments that working by normalising levels of dopamine - results showed that these drugs were more effective than the placebo - suggests dopamine is underlying cause of schizophrenia otherwise drugs wouldn't be effective :check:
Bagnall who used 232 studies to compare the effectiveness of a range of a-typical and typical antipsychotics - found atypical were more effective in reducing symptoms, resulting in fewer movement disorder side effects - fewer people discontinued on atypical than typical - overall Clozapine was found to be the most effective especially in treating people with negative symptoms and people who are resistant to other drugs - suggests antipsychotics are an effective treatment plan :check:
:no_entry: Research my Tarrier suggested that there are improvements that can be made with standard drug therapy - placed patients randomly into routine care (anti-psychotics) or routine care and CBT - Patients with combined treatment had significant improvement in the severity of positive symptoms as well as fewer days in hospital - suggest interactionalist approach to treating symptoms isn more effective that just drug therapy alone
Eval: :check: Psychology and the economy -drug therapies are often cheaper to prescribe than providing hospital treatment or psychological therapies
:no_entry: Drug therapies only suppress symptoms they dont treating the underlying problem
:no_entry: side effects can be so severe that many people dont complete their treatment leading to symptoms becoming severe again and having to restart the drug therapy