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Schizophrenia, Interactionist Explanations & Treatments, Psychological…

- - - - Clang Associations
        
        "Playing football makes me tall but if I run into a wall I might fall"
      - Thought Blocking
        
        Stop speaking abruptly mid sentence
      - Alogia
        
        Speech that is dramatically reduced in content
      - Word Salad
        
        Uttering a combination of words that make no sense to anybody apart from the user.
      - Mutism
        
        Patient's refusal to engage others with language or emotional recognition
    - - Errors in thought processing & memory function
        
        Difficulty with memory: Struggle with working memory & processing new information
        
        Attention Deficit: Inability to pay attention to appropriate stimuli in a given situation
        
        Patients can find it hard to filter out irrelevant sensory information and choose the correct stimuli to focus on
    - - These include psychomotor disturbances
        
        Stereotypy
        
        Patient repeats movements & gestures
        
        e.g: imaginary drawing
        
        Echopraxia
        
        Patient repeats gestures made by others
        
        Excessive Motor Activity
        
        Engaging in constant physical activity
        
        e.g: Pacing up & down
        
        Catatonic Supor
        
        Lack of activity (mobility). Patient adopts a fixed/rigid position (i.e: stupor)
        
        Short to long periods of time
        
        Prominent Mannerisms
        
        e.g: Grimacing
  - - - Passivity Experiences: Individual believes thoughts & behaviours are being controlled by something/someone external e.g: an alien
        
        Examples
        
        Thought insertions 💉: Belief that thoughts are being put into the mind by outside agencies e.g: God or the Government
        
        Thought withdrawal 📤: If you think about something, those thoughts will be taken from the mind by external forces e.g: God or the Government
        
        Thought broadcasting 🔊: Belief that thoughts are being broadcasted & made known to others
    - - False belief that persists EVEN if individual is shown evidence that contradicts their belief
        
        Delusions of...:
        
        Persecution
        
        Belief they are God or well known-figure e.g: believing they are the 2nd coming of Jesus
        
        Reference
        
        Believing objects/events (usually negative) have hidden meanings & are specifically referring to them e.g: "The lyrics of this song are talking about me."
        
        Grandeur
        
        Believing someone is plotting or conspiring against them e.g: "The government is out to get me!"
    - - Hallucination: Sensory perceptions of stimuli that are not actually present
        
        Can occur in any sense modality (hearing, seeing, tasting, touching & smelling). Most common is auditory hallucinations
  - - - Avolition: Lack of volition. e.g: LACK of self-care, social interaction and/or everyday functioning
        
        Patient loses motivation to engage in everyday life
    - - Patient is uncaring of others
        
        Displays inappropriate emotional responses in a given situation --> lack of emotional sensitivity
        
        e.g: Laughing during a sad story
    - - No emotions displayed during a situation when others would normally react e.g: happiness or sadness
- - - - DSM V & ICD 10 are the 2 classification systems used for diagnosing schiz
        
        Having 2 separate means of classifying schiz creates problems with reliability of diagnosis e.g: DSM V & ICD 10 differ in number of sub-types of schiz (5 vs 9 types)
        
        Inconsistency in classification can affect what type of treatment patient gets depending on where they live in the world
    - - Comorbidity
        
        Describes the existence of other medical condition/s alongside schizophrenia
        
        Leads to misdiagnosis of schizophrenia
        
        Slim et al (2006) found that 32% of hospitalised schizophrenics had an additional mental disorder.
        
        Co-morbid conditions can include depression, OCD, substance abuse, bipolar depression or panic disorder
      - Symptom Overlap
        
        Similar symptoms can occur in a bipolar disorder
        
        e.g: Depression is a common symptom alongside hallucinations
        
        Hard for clinicians to make a reliable & valid diagnosis of schiz
        
        Creates problems when trying to decide what treatments co-morbid patient's should recieve
    - - M & F should be equally vulnerable to developing schizophrenia
        
        Studies show up to 50% more males are diagnosed as schizophrenic than females
        
        Explanation
        
        One reason for the difference could be that the vast majority of clinicians are male
        
        Male clinicians could have misapplied the diagnostic criteria when assessing female patients e.g: passing symptoms off as menopause
        
        Leads to under-representation in diagnostic statistics
    - - Studies show there's a tendency to over-diagnose members of Afro-Caribbean descent as schizophrenic
        
        Cochrane found that people of Afro-Caribbean origin were 7x more likely to be diagnosed with schizophrenia when living in Britain
        
        Indicates a cultural bias in diagnosing process. Afro-Caribbean schizophrenics are much more likely to be perceived as dangerous and confined in secure hospitals than white people
    - - Inter-rater reliability: 2 psychiatrists should come up with the same diagnosis if they observed the same patient
        
        However, reliability is undermined by the vagueness of DSM V diagnostic criteria
        
        e.g: No clarification on what is a "significant amount of time" or what "very bizarre" means
    - - Rosenhan investigated the validity of diagnosis of schiz
        
        Procedure
        
        8 volunteer participants were asked to go to different mental hospitals and claim that they were hearing voices
        
        Ptts then acted normally once they were admitted to hospital
        
        Rosenhan recorded time taken to be released from the hospital & interactions between ptts & clinical staff
        
        Results
        
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  - - - Catatonic Schizophrenia
        
        Disorganised Schizophrenia
        
        Residual Schizophrenia
        
        Undifferentiated Schizophrenia
        
        Patient has characteristics of both positive & negative symptoms
        
        BUT they don't meet the specific criteria for either 'Paranoid,' 'Disorganised,' or 'Catatonic' subtypes
        
        Type II Negative Syndrome Schizophrenia
        
        Symptoms
        
        Social withdrawal - Avoidance of social interaction
        
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        Type I Positive Syndrome Schizophrenia
        
        Patient WILL respond to medication
        
        Symptoms
        
        Disorganised thought - passivity experiences (thought controlled by external forces)
        
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        unclassified sub-type (not Type I or Type II symptoms)
        
        Rare: Result of untreated Schiz
        
        Symptoms
        
        Disorganised behavioural symptoms. Patient must have at least 2 of the following:
        
        Immobility such as stupor (fixed rigid position) OR slightly more flexible immobility i.e not rigid
        
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      - Type 1 Positive Syndrome Schizophrenia
        
        Symptoms
        
        Frequent auditory hallucinations (hearing voices)
        
        Delusions (false beliefs) of persecution, grandeur, reference or jealousy
        
        NO negative symptoms e.g: no blunting, flat emotion, disorganised speech or catatonic behaviour
        
        Conclusion
        
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  - - - Practicing clinicians then make the diagnosis of which sub-type
        
        Classification systems
        
        DSM V
        
        Diagnostic and Statistical Manual of Mental Disorders vol.V
        
        Produced by the American Psychiatric Association
        
        Used in the USA & some parts of Europe
        
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        ICD 10
        
        International Classification of Diseases vol.10
        
        Produced by the World Health Organisation (WHO)
        
        Used worldwide, including UK & Europe
- - - - More responsive to treatment (medication) --> Better prospects of recovery
        
        Positive symptoms: Symptoms that show the sufferer has lost touch with reality (psychotic episode)
        
        Disorganised thoughts
        
        Delusions
        
        Hallucinations
- - - - More difficult to treat (chronic symptoms) --> low prospects of recovery
        
        Negative symptoms: Disruption of normal emotions & everyday functioning
        
        Avolition: Lack of motivation for self-care
        
        Flat or Blunt emotions
        
        Social withdrawal
- - - - e.g: Hearing voices may be very real to the sufferer, but another observer may think the person is acting weird
        
        Leads to impairments in everyday functioning e.g: Social, work, relationships, personality & intellectual functioning
        
        Degree of severity depends on type of Schiz & effective use of treatment
        
        Some sufferers are "treatment resistant" (unresponsive to medication)
        
        Usually need to be institutionalised and end up remaining severely disturbed
        
        Some may experience 1 episode of schizophrenia while others experience recurring episodes
        
        Both can still live a relatively normal life if medication is taken properly
        
        There is NO cure for Schiz but it's mostly a pretty treatable disease
        
        Main treatment is medication but research shows that an eclectic mix of different types of therapies (including medication) is the most effective
- - - - Stress:
        
        Genes on their own do not cause schiz, but increase a person's vulnerability (diathesis) to developing disorder
        
        An environmental trigger e.g: a Stressor is needed to be experienced in order to develop the disorder
        
        Examples of Stressors
        
        Family Dysfunction
        
        Substance abuse
        
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      - Diathesis:
        
        Biological factors can contribute to onset of schizophrenia e.g: genetic vulnerability
        
        Studies show identical twin (MZ) of a schizophrenic is at greater risk of developing schizophrenia than a sibling or fraternal twin (DZ)
        
        However 50% of identical twins (where 1 of them is schizophrenic) never meet the diagnostic criteria for schizophrenia
        
        Discordance among identical twins indicates environmental factors also play a role in determining whether biological vulnerability plays a role in development of schiz
- - - - Better to view Schizophrenia as a disorder that's developing as different factors interact more (biology & environment)
        
        Therefore, testing different combinations of therapies is the best form of treatment
- - - - Genetic influences are assumed to cause neurological abnormalities --> Increases risk of developing schiz
        
        HOWEVER, brain damage can also be caused by environmental factors --> Also increases risk
        
        Verdoux et al. (1998) found that individuals who experienced complications during birth were at 4x greater risk of developing schizophrenia
        
        e.g: prolonged labour --> oxygen deprivation
  - - - HOWEVER we do not fully understand the mechanisms behind why & how vulnerability + stress produce these symptoms
  - - - HOWEVER, just because a mix of biological & psychological treatments are more effective than on their own, DOES NOT mean that the interactionist approach to schizophrenia is correct
        
        e.g: Just because drugs help symptoms, it DOESN'T mean the disease is biological in origin
- - - - Correlation between levels of cortisol & severity of symptoms
        
        Stress levels interact with genetic abnormalities in dopamine transmission --> increases a person's vulnerability
        
        Walker also found that cortisol levels were high before the onset of schizophrenia INSTEAD of afterwards (post-schizophrenic episode)
        
        Suggests that elevated levels of cortisol trigger the schizophrenia INSTEAD of being a consequence
- - - - Focuses on schizophrenics with positive symptoms e.g: delusions & hallucinations
        
        Frith (1992)
        
        Identified 2 kinds of dysfunctional thought processing
        
        Meta-representation: ability to reflect on our thoughts & identify our own intentions & goals
        
        Dysfunction in this area could lead to patient NOT being able to recognise their own thoughts
        
        Believe the thoughts are from someone else
        
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        Central control: Ability to suppress automatic responses & perform deliberate actions instead
        
        Dysfunction in this area explains disorganised speech (word salad, clang associations etc.)
        
        Sufferer won't be able to suppress automatic thoughts & speech triggered by these thoughts
        
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        Beck & Rector (2005)
        
        Proposed a cognitive model of Schizophrenia
        
        Combines neurobiological, environmental, behavioural & cognitive factors to explain the disorder
        
        The Cognitive Model
        
        Neurological abnormalities in brain functioning increase vulnerability to stressful life (environmental) experiences
        
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        Explaining Positive & Negative Symptoms
        
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- - - - 31 Schizophrenics
        
        Results
        
        Schizophrenics & brain-damaged patients had impaired executive functioning
        
        Shows the role of dysfunctional thought processing in Schizophrenia
      - 35 Brain injured patients
      - 26 Healthy participants
  - - - Compared electrical brain activity in 410 schizophrenics + 247 non-sufferers
        
        Procedure
        
        Ptts exposed to changing auditory tones
        
        Results
        
        Ability to detect changes in sound was limited in Schizophrenics compared to non-schiz
        
        Conclusions
        
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  - - - Cognitive psychology has shown us that metacognition is a major issue for schizophrenics
        
        Indicates that therapies need to be focused on improving abilities e.g: self reflection, feelings & goal-oriented behaviours (disorganised behaviours)
        
        This can help patient make sense of their lives
  - - - Therefore it cannot be considered a cause for schiz
        
        More likely that dysfunctional cognition is caused by neurological brain abnormalities
  - - - Suggests schiz is the result of interaction between neurological, environmental & cognitive factors
        
        Scientific theories: Established ONLY when theory cannot be falsified after testing
        
        The problem
        
        Difficult to test variables (neurological, environmental & cognitive) in isolation & under scientific conditions
        
        Beck & Rector's theory therefore cannot be considered a solid, scientific explanation for schiz
        
        Further research needs to be conducted on neurological, environmental & cognitive factors
- - - - Correlation statistics have been used to produce concordance rates
        
        These highlight the genetic risk factor associated with the disorder
        
        Studies had focused on family, twin & adoption research and show different levels of genetic relatedness
        
        Twin Studies
        
        Based on correlation statistics that compare concordance rates
        
        Monozygotic twins
        
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        Dizygotic twins
        
        1 more item...
        
        Family Studies
        
        Based on correlation statistical methodology
        
        The closer a person's genetic relationship to a family member who is schizophrenic, the higher the genetic risk factor
        
        1 more item...
        
        Gene Mapping
        
        More recent research has used gene mapping to look for common genetic material among sufferers
        
        Avramopoulos et al (2013)
        
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        Gurling et al (2006)
        
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- - - - Allows for brain action in sufferers to be examined and compared to brains of normal people
        
        Helps to identify brain areas that may be linked to schiz
        
        Procedure
        
        Tasks to do with types of functioning are given to participants (schizophrenics & non-schizophrenics (control))
        
        Types of functioning: Social cognition, thought processing & working memory
        
        Enlarged ventricles
        
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        Specific Brain Areas
        
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- - - - The excess dopamine creates higher than 'normal' levels of neurological arousal
        
        Disrupts cognitive functioning --> disorganised thinking
        
        Drugs that DECREASE dopaminergic activity
        
        All anti-psychotic drugs block activity of dopamine in the brain
        
        Reduced neural activity in pathways that use dopamine
        
        Drugs eliminate positive symptoms of hallucinations & delusions
      - LOW levels of dopamine cause negative symptoms
        
        Drugs that INCREASE dopaminergic activity
        
        Agonist: Excitatory drugs. (drug equivalent of excitatory neurotransmitters)
        
        Amphetamine is a dopamine agonist
        
        Nerve cells that contain dopamine are stimulated
        
        Synapse is flooded with dopamine
      - Revised Dopamine Hypothesis
        
        Davis & Kahn (1991) suggested that positive symptoms are caused by excess dopamine in the subcortical areas of the brain e.g: the mesolimbic pathway
        
        Negative symptoms & cognitive symptoms arise from a deficit of dopamine in the pre-frontal cortex
        
        Patel et al (2010) used PET scans to assess dopamine levels in a schizophrenic & non-schizophrenic
        
        Findings
        
        There were lower levels of dopamine in the dorsolateral prefrontal cortex in schizophrenics compared to non-schizophrenics