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8/19/2019 schizophrenianicky-130317120250-phpapp02

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Schizophrenia – Treby

‘Schizophrenia is characterisedby Psychosis – a loss of contact

with reality’


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Clinical Characteristics of

Schizophrenia:

• Prevalence = 1% of the poplation

!prevalence = The percenta"e of apoplation that is a#ected with aparticlar disease at a "iven ti$e&

'ro(en down into Positive Sy$pto$s!Type )& and *e"ative Sy$pto$s !Type))&


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.irst 2an( Sy$pto$s – Schneider

1343

Schneider believed that 5rst ran(sy$pto$s !Type )& sch as:

,elsions- feelin" controlled by so$eoneelse- and hallcinations

+ere only associated with schizophrenia

!/owever- these sy$pto$s have also

been lin(ed with depression and bipolar&S6*7PT)C)T68 2andy 9ardener !13;& also e


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,i#erent types ofschizophrenia:

1.Paranoid – ,e

lsions hallcinations

2.Catatonic – nsal $otoractivity- e 2are

3.Hebephrenic !)C,& or

Disorganised !,S?& early a"e-disor"anised speech- at a#ect-so$e hallcinations delsions

4. Undiferentiated –Schizophrenic sy$pto$s thatdon’t neatly 5t a dia"nosis

5.Residual – 0t least one episodeof schizophrenia e


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Classifyin" ?ental /ealth ,isorders:,ia"nostic and Statistical ?anal !,S?&:

•

Pblished in 0$erica• n"lish only

• Predo$inantly sed in the DE

• Classi5es 4 sb@types of schizophrenia

• Foo(s after $onths of sy$pto$s

• Dsed by professionals

e" psychiatrists- psycholo"ists- socialwor(ers

• Contains $ental health statistics

• ?lti@a


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valatin"classi5cation syste$s:

'ec( !13I& – 2F)0')F)T6

.or psychiatrists sed the ,S? to dia"nose 14Hpatients

ach patient was interviewed separately with Bpsycholo"ists

There was 4;% a"ree$ent on dia"noses ofschizophrenia- even less a"ree$ent on sb@types

• S$all sa$ple- not necessarily representative

!tho"h- $ental health is not that prevalent&• People $st be trained to nderstand ,S?

• SbJective

• Fac(s inter@rater reliability


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valatin" classi5cationsyste$s:

Cooper et al !13IB& – CDFTD20F 2F0T)>)S?

+hen patients !with identical sy$pto$s&presented the$selves Schizophrenia was T+)C

as li(ely to be dia"nosed by #e$ %or&erpsychiatrists sin" the ,S? than 'ondoner psychiatrists sin" the )C,

The opposite was tre of depression

• Dnreliable

• Cltral relativis$ – *6 F dia"nose di#erently

• SbJective


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valatin"classi5cation syste$s:

Te$perline !13IA& – >0F),)T6

)nterview with an actor was recorded I "ropswere as(ed to assess his $ental health

9rops consisted of professionals: e"psychiatrists- psycholo"ists and law stdents

4KI "rops heard that the $an bein"interviewed was interestin" as he loo(s

nerotic- bt is actally psychotic The th "rop heard nothin"- and the Ith "rop heardhe was healthy


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Te$perline – contined8

+ith those that heard he was nerotic- a $aJorityof the$ said that he was nerotic

0nd there was frther disa"ree$ent a$on"stprofessionals

9rop that heard he was $entally healthy: 1AA%said healthy

This shows that the ,S? and )C, $ay lac( validityas so$e dia"noses $ay already be for$ed fro$e


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Te$perline – evalation:

• People loo( at the labels rather theirown opinion

• 9rops are all fro$ di#erentbac("ronds !e


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valatin" classi5cationsyste$s:

2osenhan !13IH& – F0'FF)*9

i"ht people with no history of $ental illness roc(ed p at a psychiatrichospitalL clai$in" to be hearin" voices in their head

7ther than this- they answered frther Mestions as $entally healthyindividals

They were all ad$itted- once in- they acted co$pletely nor$allySta# reported nor$al behavior as if it were abnor$al

7ne patient (ept notes in a diary This was described as ‘e


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'iolo"ical:

*atre: "enetics- brain da$a"e- bioche$istry-infection

They di#er fro$ yor nrtre ie peers-pbrin"in"- cltre- friends- environ$ent


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'iolo"ical – 9enetics:


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,e5nitions8

(ord De)nition

Schizophrenia PsychosisG Foss of contact withreality

?onozy"otic twin !?N& )dentical twin !sa$e "enetics&

,izy"otic twin !,N& *on@identical !di#erent "enetics&Concordance rate Fi(elihood of one twin "ettin"

sa$e illness as the other twin

Twin stdies Stdies involvin" twins- if they’re?N then they have sa$e "enes-so we can see if they were

inenced by natre !"enes& ornrtre !pbrin"in"&

0doption stdies Stdies involvin" adoptedchildren to see whether or notthey have sa$e "enetic disorders

as their real parents to see ifillnesses are inherited


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Twin stdy @ Cardno et al!BAAB&:

• ,ia"nosed schizophrenia in twins

• Dsed ‘?adsley Twin 2e"ister’ to "etstrict dia"nosis

• Showed B4% concordance rates in?N twins

• A% concordance rates in ,N twins

This shows that it is yor "enetics!natre& that a#ects schizophreniarather than yor environ$ent!nrtre&

2**2


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0doption stdy – Eety!133;&:

• /i"h rates of schizophrenia inindividals who’s parents hadschizophrenia- bt had been

adopted by psycholo"icallyhealthy parents

Shows that "enetics are$ore i$portant than yorenviron$ent

Spports Cardno et al

1++4


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Stren"ths wea(nesses!0AB&:

!trengths (ea&nesses Twin Stdies: ?N have sa$e

"enetic $a(ep- soyo can test *atrevs *rtre

7bJective !Mantdata&

Twins are rare

,i#erent criteria fordi#erent twin stdies!so- Cardno sed

?adsley- bt otherpeople se others&

Concordance rates$easred di#erently= sbJective

0doption Stdies: *atre vs nrtre

7bJective !Mantdata&

'i""er sa$ple sizespossible than twin =

)ndividal di#erences!life events&


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'iolo"ical – 'ioche$istry:


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Spports hypothesis –9rilly !BAAB&:

Par(inson’s disease:

- ,e"enerative nerolo"ical condition

-

Fow levels of dopa$ine- Prescribed ‘F@,opa’ to raise

dopa$ine in brain

-

So$e individals went on to developschizophrenic@type sy$pto$s

thical isses – protection fro$ har$


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Spports hypothesis and contradictshypothesis – PT Scans:

• +on" et al !13O& sed PT Scansand fond dopa$ine activity was"reater in schizophrenics co$pared

to a control

• /owever- Copolov and Croo( !BAAA&have not fond evidence of altereddopa$ine activity in schizophrenic’s

brains


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,opa$ine hypothesis –evalation:

• 7bJective –antitative data-scienti5c

•PT Scans !+on"et al 13O&

• /or$onal

• 2eliable

• ,eter$inistic – nobla$e

• 2edctionist – noconsideration forsocial events- $ayi"nore actal case

• *atre vs *rtre –*0TD2- "ood as

no bla$e 'DT-cold lead topassive patients


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Psychodyna$ic approach:


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.red !13B;&:

.red believed that schizophrenia ca$e fro$:

- Parents bein" coldKncarin"

- Casin" child to regress bac( into in/antile

state- +here the e"o is not yet properly for$ed

- Sy$pto$s inclde: ,elsions of "rander!believin" yo can y etc&

- 't also- aditory hallcinations cold beseen as an individal’s atte$pt to re@establish e"o control


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Spportin" .red – .ro$$@

2eich$ann !13;O&:

• 7verprotective- reJectin"- do$inant-and $oralistic $others cancontribte to children developin"

schizophrenia• Spports .red in that the condition

ste$s fro$ childhood


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Spports .red – 'ateson et al!134&:

• Children who "et $i


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0r"es .red – 7lt$anns et al

!1331&:

• Parents act di#erently once theirchild has been labelled asschizophrenic

• *ot prior to

• Therefore it is not parentalinence and it ar"es .red

• !S6*7PT)C: (inda li(e in

2osenhan’s 13IH psedo@patientsstdy as the nrses reacted tothe$ di#erently once they hadbeen labelled&


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Psychodyna$ic approach07B:

• Spportin" research– .ro$$@2eich$ann!13;O& !se othertwo in 071&

• Considers socialinences sch aspbrin"in"

• )ndividal di#erences

• SbJective

• Si$plistic – biolo"ynot considered


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Co"nitive for

schizophrenia:


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Co"nitive:

• Co"nitive approach loo(s atbiolo"ical factors for schizophrenia-says Type )Kpositive sy$pto$s co$e

fro$ biolo"y• 't frther sy$pto$s ste$ fro$

people tryin" to $a(e sense of their

sy$pto$s• They reJect feedbac( fro$ others and

believe that their beliefs are

$aniplated by others


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Co"nitive – .rith !13I3&:

• 0r"es schizophreniaco$es fro$ faltyattention syste$s

• with an inability to 5lter

ot nnecessary info thatthey have "atheredthro"h their senses

• This leads to illsion of

distorted tho"hts

,oes not consider individaldi#erences


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Co"nitive – 'entall !133;&:

• Schizophrenics have troble with processin"infor$ation

• Shown in Stroop tests: Color words !red and"reen& are sbstitted for e$otional words

!death and la"hter&-

• Schizophrenics ta(e lon"er than non@schizophrenics to na$e the words

• 0to$atic sbconscios processin" – $ay

accont for positive sy$pto$s

Stroop tests $ay be nreliable

)ndividal di#erences

h h l h


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+hat have we learnt thsfarGQ

• Co"nitive psycholo"y is concerned withtho"ht processes sch as $e$ory andattention

• The co"nitive approach to psycholo"yreco"nises that biolo"ical factorscontribte to the positive sy$pto$s ofschizophrenia 7ther sy$pto$s- sch as

ne"ative sy$pto$s develop fro$ theindividal atte$ptin" to $a(e sense of ane


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?ore st# we’ve learntG

• People provide infor$ation they need to$aintain a "rasp on reality and if this doesnot happen- psychosis $ay occr !loss ofcontact with reality& and people $ay beco$eparanoid they are bein" controlled byso$eone else

• 0 falty attention syste$ is bla$e as the

reason for schizophrenia !.rith- 13I3& as theycan not 5lter ot nnecessary infor$ationwhich leads to proble$s with attention


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Spports co"nitive – ?eyer@

Findenber" et al !BAAB&:

•


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Spports co"nitive – %ello$leeseet al !BAAB&:

• ,eveloped a virtal hallcination$achine

• " hearin" a T> tellin" yo to (ill

yorself

• These were shown to schizophrenicsto show their own hallcinations

were nreal irrational

thical isses – protection fro$ har$


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0r"es Co"nitive – ?cEenna !133;&:

• Schizophrenics aren’t $ore easilydistracted than non@schizophrenics inco"nitive tas(s

/istorical validity

Fab stdy $ay a#ect reslts ,istraction = sbJective


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Co"nitive 07B:

• 6ellowleese et al !BAAB&

• .ree will

• 0pplication to real life:treat$ents

• ?ore holistic – approach

believes that positivesy$pto$s have abiolo"ical inence

•

?cEenna !133;&

• )ndividaldi#erences


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Treat$ent of

schizophrenia:


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0ntipsychotic dr"s:

• Che$otherapy !che$ical treat$ents&sed to treat sy$pto$s of psychoticdisorders sch as schizophrenia and

$anic depression• Two types of antipsychotic dr"s:

Conventional and atypicalG


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0ntipsychotic dr"s:

Conentional• " ChlorP27$azine

!pro – treats positivesy$pto$s&

• Sch as hallcinationsand delsions

• 2edces the e#ects ofdopa$ine by bloc(in"

receptors• ,opa$ine

antagonists

• Side e#ects

tpical antipschoticdrugs

• " Clozapine

• +or(s on both positiveand ne"ative sy$pto$s!depression apathy&

• 0cts on dopa$ine serotonin receptors

• Side e#ects inclde

tardive dys(inesia!involntary $ove$entof $oth and ton"e&

• Fess side e#ects


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#ectiveness and appropriateness ofconventional and atypical dr"s:

Conentional• 'u/t ,2** .ond that

conventional dr"s areassociated with sdden deathwhereas atypicals are not

• Hill ,1+6 fond that HA% ofpeople ta(in" conventionaldevelop Tardive ,ys(inesia

•

Ross and Read ,2**4 –?otivational de5cits- sch aslabellin"- reinforcin"‘so$ethin"’s wron" with yo’which is nethical

tpical

• 'eucht et al ,1+++ @ ?eta@analysis showed that atypicalare only a little better

• 7este et al ,1+++ @ Sidee#ects Fess chance of Tardive,ys(inesia !4% of people&

• Dais et al ,1+6* – 2elapsePlacebo = 44% relapsed0typicals = B@BB% relapsed

)ndividal di#erences etc etc


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0ntipsychotic dr"s 07B

• 'iolo"ical

• 7bJective

• 2eal life application

• ,eter$inistic

• 2edctionist –individal

di#erences


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Psycholo"ical therapies for

schizophrenia:


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Psychoanalysis:

• 9ettin" to yor sbconscios to see if yor childhooda#ected yo – sally associated with .red’spsychodyna$ic approach

• .red believed that this approach wold not wor( as

schizophrenics are nable to for$ a trans/erence withthe analyst

• This is when the e$otions of a patient are nconscioslyshifted onto the analyst

SbJectiveCheapic(Can co$bine with $edicine

i f h l i


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0ppropriateness of psychoanalysis –9ottdiener !BAAA&:

• ?eta@analysis of HIstdies

• Coverin" B;B patients• % of the$ i$proved

after treat$ent sin"

psychotherapyKpsyschoanalysis

# i f h l i


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#ectiveness of psychoanalysis:?al$ber" and .enton !BAA1&

• )t is i$possible to draw ade5nite conclsion for ora"ainst the efectienessof psychoanalysis

• )n fact the schizophreniapatient otco$e researchtea$ ,P8R9 has even

ar"ed thatpsychoanalysis $ay behar$fl to schizophrenics

#ectiveness of


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#ectiveness ofpsychoanalysis:

• Therapists aree


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Co"nitive behavioraltherapy:

• Cased by falty thin(in" Tryin" to5nd root of the proble$ to proveirrational tho"hts are irrational

• Foo( at alternative e


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0ppropriateness of C'T @ Ein"donand Eirschen !BAA&:

• 1;B patients weretested- and fond that$any patients were not

sitable for C'T as theywold not flly en"a"ewith it

• )n "eneral- it was lesse#ective on older fol(than yon"er ones

# ti f C'T 9 ld t l


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#ectiveness of C'T: 9old et al

!BAA1&:

• ?eta@analysis of Istdies

• 2eported that therewas a statisticallysi"ni5cant decrease

in the posities"pto"s ofschizophrenia aftertreat$ent

Istdiespositive

s $ to

l ti f h l i l


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valation for psycholo"icaltherapies of schizophrenia – 07B:

• Co$$ent one#ectiveness andappropriateness for

each

• Can be sed alon"side dr" therapies

• Co$$ent on e#ectiveness andappropriateness for each

• Si$plistic – only treatin"tho"hts even tho"h co"nitive

theory s""ests that positivesy$pto$s derive fro$biolo"ical inences

• People have to be trained to doC'T and psychoanalysis which

is e


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Eey words:

(ord De)nition

Psychosis Foss of contact with reality

Positive sy$pto$s 0dded to personality e"delsions and hallcinations

*e"ative sy$pto$s So$ethin" re$oved fro$ yor

personality- sch as alo"ia = lossof speech

'ioche$istry /or$ones and nerotrans$itters

Che$otherapy Treat$ents based on che$icals

Serotonin 0 nerotrans$itter- low levels of

this have been lin(ed todepression

,opa$ine 0 nerotrans$itter- hi"h levelshave been lin(ed to schizophreniain the dopa$ine hypothesis


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?700022 de5nitions8

(ord De)nition

,opa$ine anta"onist Che$ical which inhibits e#ect ofdopa$ine

Placebo ‘fa(e’ version of a dr" whichtests whether the dr" has

biolo"ical i$pacts2elapse +hen yo lose yor sy$pto$s of

abnor$ality- bt then they co$ebac(

*erotrans$itter Che$icals that trans$it i$plses

across a synapse casin" achan"e in behavior

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