Schizophrenia

Question 1

psych- family dys- SM

Answer 1

fromm reichman- psychodynamic
mother is cold, rejecting and controlling
creates a family dynamic characterised by tension and secrecy
leads to distrust in person which develops into paranoid delusions
-not used now as it very outdate

Question 2

family dys- DB

Answer 2

double bind- Bateson (risk factor not the main communication type)
when child does something wrong they are punished by withdrawal of love
they fear they are doing something wrong but receive mixed messages about what this is
leaves them with understanding of world as confusing and dangerous
reflected in symptoms such as paranoid delusions and disorganised thinking

Question 3

family dys- EE

Answer 3

level of emotion expressed by family towards person with sz
involves:
verbal criticism
hostility- anger and rejection
over involvement- needless self sacrifice
serious source of stress for person
primarily an explanation for relapse but can be a trigger of onset of sz to a person who is already genetically vulnerable

Question 4

family dys ao3- s

Answer 4

read et al- found that people with Sz were more likely to have insecure attachments to parents
-also found that 69% of men and 59% of women with sz had experienced some type of child physical or sexual abuse
shows link between effect of family/ childhood on sz
Tienari- children with parents with sz (adopted now) are more likely to develop sz than those without, however the genetic link is only shown when the adopted family was rated as disturbed- shows the effect of family dys

practical applications in family therapy and there is evidence for the effectiveness of this so it shows that family dys must be part of the issue

Question 5

family dys ao3- w

Answer 5

cause and effect- the disruption in family climate may be due to the sz patient in the family rather than the other way round
DB and SM are based on clinical observations of people with sz and interviews with family members, relies on retrospective info which may not be accurate (no systematic evidence)
-lack of evidence to support specific theories (most is general to effect of family)
theory is socially sensitive as it blames the sz on the mother which makes them feel guilty

Question 6

cog exp DT

Answer 6

involves info processing that doesn’t represent reality
sz associated with a number of different DT
reduced processing in temporal lobe associated with hallucinations
dys though processing in ventral striatum linked with negative symptoms

Question 7

cog exp MR

Answer 7

frith et al- cog ability to reflect on thoughts and behav
allows us to insight our intentions and intentions of others
eg ability to realise that our own thoughts are being carried out by ourselves rather than anyone else
can explain hallucinations and hearing voices

Question 8

cog exp CCD

Answer 8

central control dysfunction
inability to suppress automatic thoughts while we perform deliberate actions
disorganised speech and thoughts reflect inability to suppress automatic responses
sz often experience derailment of thoughts, speech triggered by asso with other thoughts

Question 9

cog exp ao3- s

Answer 9

stirling et al- compared performance on cog tasks in 30 people with sz to controls
stroop task- people have to suppress automatic response to say the colour that is written, and say the colour that it is in
sz patients took twice as long as controls which supports CCD

RWA in CBT- based on faulty cognitive processes
Firth studied 30 sz using PET scans and they showed a reduction in blood flow to frontal cortex (in patients with neg symptoms) associated with making decisions based on info coming in from dif parts of the brain
empirical evidence for cognitive dysfunctions

Question 10

cog exp ao3- w

Answer 10

doesn’t explain why sz developed in the first place- the origins, only explains what is happening now so is only partial exp
dys thought processing may a result of the Sz rather than a cause
reductionist

Question 11

bio treatments

Answer 11

based on dopamine hypothesis which says that high dopamine leads to increased severity of Sz
typical- alleviate positive symptoms by blocking DA receptors
side effects incl diabetes and tardive dyskinesia
eg chlorpromazine

atypical- alleviate positive and neg symptoms by blocking DA receptors and regulating serotonin
improve mood so used for patients at risk of suicide
side effects incl weight gain
clozapine

Question 12

bio treatment ao3- s

Answer 12

barlow and durand- found typical AP were effective in reducing positive symptoms in 60% of cases
Thornley- found that in 1121 ps, chlorpromazine was associated with better overall functioning and reduced symptoms compared to placebos

ch

Bagnall analysed evidence from 232 studies comparing clozapine to placebos and other drugs + found that they were the most effective, even in people who were previously treatment resistant, showed least side effects and fewer people left the treatment early

Question 13

bio treatment ao3- w

Answer 13

chemical cosh- ethical argument that suggests sz patients are given drugs in hospitals just to calm them down and make them easier to deal with - Monchief

Healey- suggested there are lots of flaws with evidence for effectiveness as they only show short term effectiveness and APs have calming effect on brain so it is easy to say symptoms have been alleviated but it is unclear if the actual psychosis is reduced
side effects of drugs- doesn’t show long term effects of drugs and people’s symptoms often come back after they finish drug treatment

Beng Choo Ho- using APs leads to a reduction in the brain tissue of sz patients

unclear how APs work as low dopamine is linked with increased severity of sz in some parts of the brain and levels of dopamine are reduced very quickly but it takes a long time for sz symptoms to decrease

Question 14

family therapy

Answer 14

aims to improve communication and interactions in families
usually occurs when a sz patient is returning from psych ward
involves educating the family on the symptoms of sz, reducing conflict and stress
gives the family solutions to problems that may arise
-reduces negative emotions by reducing levels of EE, stress is reduced, less likely to relapse
-finds balance between patient’s needs and the family’s life

Question 15

family therapy ao3

Answer 15

mcFarlane- concluded that family therapy was one of the most consistently effective treatments for Sz and it reduced relapse rates by 50-60%
benefits the whole family as they all have to deal with the patient, lessens the neg impact the sz patient has on the family + strengthens their ability to help the sz patient

some families may not want to deal with the sz patient as they have already caused enough issues in the family
puts a lot of pressure on the family to deal with sz patient

Question 16

cbt

Answer 16

involves helping the patient identify irrational thoughts so they can challenge + change them
deals with symptoms but doesn’t eliminate them
involves
-critical collaborative analysis- use of general questioning to help patient understand and challenge illogical delusions
-reality testing to reduce distress
-normalisation to reduce stress and feelings of abnormality
use of ABCDE mode

Question 17

cbt ao3

Answer 17

jahur- eviewed studies of CBT for SZ patients and found small but significant effects on pos + neg symptoms incl. reduction in severity of hallucinations
patient is actively involved, treats root rather than just symptoms

not all patients can face CBT as their symptoms are too severe or they are convinced that their symptoms are real- requires self-awareness and ability to engage with the process.
some patients with symptoms such as avolition may not be able to do therapy
CBT is a very long process and people may drop out before they complete it

Question 18

interactionist approach

Answer 18

diathesis- vulnerability to Sz
stress- trigger
biological and psychological factors

Meehl’s early model- suggested that there was a schizogene (diathesis entirely genetic) and no amount of stress could cause Sz if SZG wasn’t present

modern- views of diathesis include a range of factors include psychological trauma - trauma can become diathesis
Ripke- found that there are 108 genetic variations associated with Sz (not one schizogene but lots of genes)
Read- proposed neurodevelopment model where early trauma alters the developing brain, HPA system becomes overactive and person is more vulnerable to later stress
-cannabis is stressor as it increases risk of sz by 7x as it interferes with dopamine system

Question 19

IA ao3- s

Answer 19

less reductionist
less determinist
practical applications in treatment
Tienari- investigated effect of genetic vulnerability and psychological trigger (dysfunctional parenting)
followed 19000 children whose bio mothers had sz
high genetic risk group were compared to control group of adoptees (low genetic risk)
-assessed adopted parents child rearing style
-found that high levels of hostility and criticism were strongly associated with sz but only in high genetic risk group
-shows its the genetic vulnerability and the family stress that leads to Sz
one of them on their own isn’t enough to lead to Sz
-real world application in treatment

Question 20

IA to treating

Answer 20

acknowledges biological and psychological elements

combines drug treatments (APs) and psych treatments eg CBT

Question 21

IA treating ao3

Answer 21

Tarrier- 315 patients were randomly allocated to
control group
medication and CBT
medication and supportive counselling
-patients in two combination groups showed lower symptom levels than controls
-no differences in hospital readmissions

Question 22

token economy

Answer 22

reward system used to help people manage Sz where desirable behaviours are encouraged and rewarded using selective reinforcement, based on operant conditioning
tokens are secondary reinforcers (positive reinforcement) which can be exchanged for primary reinforcers which involve things that the sz patient wants eg tv time or to see family

Matson et al (2016) identified 3 categories of institutional behaviour that can be tackled using TE- personal care, condition related behaviour, social behaviour
TE doesn’t cure SZ but it improves quality of life in hospital and normalises behaviours that will be used outside of the hospital

institutionalisation can lead to development of bad habits incl not socialising

Question 23

TE ao3- s

Answer 23

doesn’t cure the person of their Sz but it helps them to manage their symptoms which can make their day to day life easier for themselves and others around them- helps to normalise behaviour which will be used when they leave institutions

Allyon + Azrin (1968)- trialled TE in a ward of women with Sz and ps would be rewarded tokens for good behaviour which could be swapped for privileges and found that the number of tasks completed increased significantly

Evidence for effectiveness from Glowacki et al (2016) who identified 7 high quality studies which examined the use of TE and all showed a reduction in negative symptoms in ps with chronic mental health issues

Question 24

TE w

Answer 24

doesn’t cure sz
not used as much now, was mainly used when long term institutionalisation was more common, in order to control behaviours

ethical issues- gives professionals the power to control the behaviour of patients and may not be accurate for all Sz patients as their norms are different and shouldn’t be normalised between people

doesn’t really work outside of the hospital as behaviours cannot be monitored closely

Question 25

IA ao3- w

Answer 25

Diathesis and stress are very complex and we do not know exactly how Ds model works as there are multiple factors that can affect both diathesis and stress