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Classification and Diagnosis
Reliability and Validity of schizophrenia
Biological explanations for schizophrenia
Biological treatments for schizophrenia
Psychological explanations for schizophrenia
Psychological treatments for schizophrenia
The interactionist approach to schizophrenia
Managing Schizophrenia - Token Economies
Biological Explanations for Schizophrenia
Genetic similarities
Gotteman et al large scale family study →
Aunt 2%, sibling 9%, identical twin 48%
Share environment and genes - correlation
Candidate genes - polygenic inheritance coding for dopamine
Ripke et al - SCZ genetic makeup vs control - separate variations found
Aetiologically heterogeneous
OG hypothesis → hypERdopaminergia - high dopamine in subcortical areas (positive symptoms)
REVIVED → hypOdopaminergia - low dopamine in prefrontal cortex (negative symptoms)
Cortical hypOdopaminergia leads to supcortical hypERdopaminergia
Support → Tienari et al - adoptees in Finland w/ biological SCZ mother 6.9% chance
Hilker et al → concordance rates 33% MZ and 7% DZ - regardless of environment, genes significant
Limitation → environment significant. Morgan et al → birth complications and smoking THC cannabis in teen
years. Psychological risk e.g childhood trauma leads to vulnerability in mental health. Morkved → 67% SCZ at
least 1 childhood trauma vs 38% matched group with no psychotic issues. Genetics aren’t complete.
Support → Amphetamines increase dopamine worsening SCZ symptoms (Curran et al). Antipsychotics reduce
dopamine, reducing symptoms. Noll et al → dont work ⅓ w/ positive symptoms
Limitation → McCutcheon → post mortem showed raised glutamate levels in SCZ patients
Moghaddan and Javitt → link between glutamate and SCZ symptoms
Antipsychotics should not just focus on dopamine
Classification and Diagnosis
A01 thoughts and emotions are impaired and contact is lost with external reality. affects 1% of the population,
most common psychotic disorder, mainly men. the clinician uses a diagnostic manual for criteria fitting. American
DSM-5 (5 positive symptoms - 6 months symptoms) and European ICD-11 (2 or more symptoms - symptoms 1
month). subtypes dropped as inconsistent
A01 Positive - delusions and hallucinations
Negative - Alogia and Avolition
A03 Osorio - DSM-5 reliability 180 people. Interrater reliability +.97 and test retest +.92. Removed old criteria -
positive symptoms bizarre (subjective)
A03 Ethnocentric - cultural differences
Pinto and Jones - British African Caribbean 9x likely SCZ than British people
Luhmann interviewed 60 adults - Ghana, India, USA
Africans and Infians - positive experiences
, Us - negative experiences
Different meanings, discriminated against by cultural biassed system
A03 Gender bias
Fisher and Buchanan - men more diagnosed, ration 1.4:1
Genetically vulnerable or clinician affecting diagnosis - men overdiagnosed
Cotton et al - women closer, more support
Loosing custody
Underdiagnosis - receiving less treatment
A03 Symptom overlap - SCZ and BPD (delusions and avolition)
Ellason and Ross - DID more symptoms of SCZ than SCZ patients
Reliability and Validity of Schizophrenia
A01 Reliability - Interater - two clinicians reach the same conclusions with the same manual/criteria. Kappa score
of 1 (perfect agreement) and 0 (no agreement). 0.7 above is good. DSM-5 - Whaley - 0.11 and Reiger 0.46.
Manuals not reliable causing misdiagnosis/ missed diagnosis. Not accessing the right treatment/services. Test
retest - same conclusions reached at two different times.
A03 Osorio excellent reliability in DSM-5 for 180 individuals. Inter rater +.97 and test retest +.92. Improved
reliability by removing criteria that positive symptoms have to be ‘bizarre’ enough - subjective, disagreed
meaning.
A01 Reliability - Culture Bias - Pinto and Jones - British African Caribbean 9x likely diagnosed vs white british.
Those in their own countries aren't. Ethnocentric - not reliable as different diagnosis for different cultures, not
consistent.
A03 Luhmann interviewed 20 adults from Ghana, India and US about voices. Positive - playful, offering advice,
negative - violent and hateful. Culture impacts symptom experience. Shouldn’t be used to classify in other
cultures.
A01 Validity - Gender bias - Fisher and Buchanan - men more diagnosed 1.4:1. Cotton et al - women function
better, likely to work with good family relationships.
A03 Loring and Powell - overdiagnosis of males and underdiagnosis females - not enough service/treatment.
Gender influences diagnosis, male psychiatrist overdiagnosed men. Women don't want to lose custody.
A01 Symptom overlap - SCZ and BPD (delusions) - may not be two conditions. Hard to distinguish and diagnose.
Variations of the same condition?
A03 Ellason and Ross - DID more SCZ symptoms than SCZ patients. SCZ criteria invalid, not distinct from other
disorders, misdiagnosis likely.
Biological treatments for schizophrenia
A01 Typical antipsychotics - reduce positive symptoms
Antagonists bind to D2 - blocking neurotransmission
Kapur et al - 60-70% D2 receptors blocked - tardive dyskinesia
Chlorpromazine - initially dopamine increase then reduced production
Sedative calming - not just SCZ condition
A01 Atypical antipsychotics - reduce negative symptoms
Antagonists bind to D2 - blocking neurotransmission TEMPORARILY
Rapidly dissociate allowing normal transmission
No tardive dyskinesia
Clozapine - acts on dopamine, serotonin and glutamate receptors
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