schiz

Question 1

family dysfunction

Answer 1

psychologist has attempted to link schizophrenia to childhood and adult experiences of living in a dysfunctional family

Question 2

schizophrenogenic mother

Answer 2

psychodynamic explanation
accounts of childhood
particular parent type- schizophrenogenic mother
schizophrenogenic-> schizophrenia causing
is cold rejecting and controlling
creates family climate characterised by tension and secrecy
leads to distrust-> develops into paranoid delusions and ultimately schizophrenia

Question 3

double bind theory

Answer 3

family climate is important in the development of schizophrenia
emphasis the role of communication style within a family
developing children are trapped in situations where they fear doing the wrong thing but receive mixed messages about what this is
and feel unable to comment on the unfairness of this situation or seek clarifications
child is punished by withdrawal of love
leaves them understanding the world as confusing and dangerous
reflected in symptoms like disorganised thinking and paranoid delusions
just a risk factor

Question 4

expressed emotion

Answer 4

level of emotion expressed towards a person with schizo by their carers who are often family members

• verbal criticism + violence
• hostility-> anger and rejection
• emotional overinvolvement -> needless self sacrifice

expressed emotions are a serious source of stress for them
primary explanation for relapse
suggested that source of stress can trigger schizo in a vulnerable person eg genetics

Question 5

research support

strength- evidence linking family dysfunction to schizo

Answer 5

indicators of FD include insecure attachment + exposure to trauma eg abuse
adults with schizo likely have insecure attachment
69% women, 59% men with schizo have a history of physical/ sexual abuse
most adults with schizo had at least one childhood trauma mostly abuse

FD makes people more vulnerable to schizo

Question 6

explanations lack support

limitation- poor evidence base for any of the explanations

Answer 6

plenty of evidence supporting the idea that childhood family based stress is associated with adulthood schizo
no support of the important traditional family based theories eg schizo mother and double bind
based on clinical observation
+ informal assessment of their mother’s personality but not systematic evidence
family explanations have not been able to account for the link between childhood trauma and schizo

Question 7

parent blaming

limitation- very controversial

Answer 7

family schizo link no research support
research may be useful in showing insecure attachment and experience of childhood trauma affects individuals’ vulnerability to schizo
investigate links between FD and schizo
double bind and schizo mother- help us not ignore earlier theories

research linking FD and schizo is highly socially sensitive- leads to parent blaming
parents watch child experience the symptoms of schizo and take responsibility for their care, blame adds insult to injury

psycho theories shouldn’t cause harm, theories like schizo mother and double bind have done harm

research into DF and schizo will always be very controversial

Question 8

cognitive explanations

Answer 8

dysfunctional thinking
metarepresentation dysfunction
central control dysfunction

Question 9

dysfunctional thinking

Answer 9

cog explanations- role of mental processes
associated with types of dysfunctional thought processing could provide an explanation

characterised by disruption to normal thought processing.
reduced thought processing in ventral striatum- negative symptoms
reducing processing of info in temporal and cingulate gyri- hallucinations
lower than usual level of info processing suggest that cog is likely impaired

Question 10

metarepresentation dysfunction

Answer 10

identified two kinds of dysfunctional thought processes
metarepresentation- cog ability to reflect on thoughts and behaviour
allows insight into our own intentions and goals, interpret actions of others
dysfunction- disrupt our ability to recognize our own actions and thoughts as being carried out by ourselves rather than someone else
explain hallucinations of hearing voices and delusions like thought insertion

Question 11

central control dysfunction

Answer 11

cog ability to suppress automatic responses while we perform deliberate actions
speech poverty and though disorder could result from the inability to suppress automatic thoughts and speech triggered by others thoughts
eg people tend to experience derailment of thoughts because each ord triggers associations and person cant suppress automatic responses to these

Question 12

research support

strength- evidence for dysfunctional thought processing

Answer 12

compared performance on a range of cog task
30 people with and without schizo
stroop task - name font colour of colour words
suppress the tendency to read the words aloud
people with schizo took longer

cog processes of people with schizo are impaired

Question 13

proximal explanation

limitation- only explain the proximal origins of symptoms

Answer 13

cog explain what is happening now to produce symptoms- distinct from distal explanations which focus on what initially caused the condition

possible distal explanation- DF and genetic
unclear and not well addressed is how genetic variation or childhood trauma might lead to problems with metarepresentation or central control

cog theories on their own only provide partial explanations for schizo

Question 14

psycho or bio?

limitation- might be best seen as a bio condition than psycho symptoms

Answer 14

cog approach provides explanation for symptoms
seeing schizo primarily as a psycho condition
experiences are psycho- positive symptoms eg hallucinations and negative symptoms eg disruption to thinking and speech
psycho in nature

abnormal condition partial genetic in origin and result of abnormal brain development
suggest that it is a bio condition
environmental influences on development of schizo appear to operate on a bio level affect brain development

Question 15

drug therapy

Answer 15

treatment involves antipsychotic drugs
a person with psychosis experiences some loss of contact with reality eg hallucinations or delusion

Reduce the intensity of schizophrenia symptoms, especially positive ones (e.g. hallucinations).

Question 16

typical antipsychotic

Answer 16

been around since 1950s
tablets, syrup or injection
max daily- 1000mg

Dopamine antagonists: chlorpromazine blocks dopamine receptors, reducing neurotransmitter activity and symptoms eg hallucinations.

Sedation effect: also acts as a sedative, calming effect (reduces anxiety).

Question 17

atypical antipsychotics

Answer 17

been around since 1970s
maintain or improve the effectiveness of drugs in suppressing the symptoms and minimise side effects

Clozapine: binds to dopamine receptors but also works on serotonin and glutamate. May improve mood and cognitive functioning (but potentially fatal agranulocytosis).

Risperidone: most recent, binds to dopamine receptors more strongly than clozapine does, so smaller dose and fewer side effects. as effective as clozapine without side effects.

Question 18

evidence for effectiveness

strength- evidence to support their effectiveness

Answer 18

evidence that both drugs are moderately effective in tackling the symptoms of schizo

13 trials
1121 ppt
showed that chlorpromazine was associated with better overall functioning and reduced symptom severity compared to placebo

clozapine is more effective than typical antipsychotics and other atypical antipsychotics and it is effective in 30-50% of treatment-resistant cases where typical antipsychotics have failed.

Question 19

counterpoint

Answer 19

serious fails with evidence for effectiveness
most studies are short-term effects only and some successful trials have had their data published multiple times exaggerating the size of the evidence base for positive effects

antipsychotics have powerful calming effects it is easy to demonstrate that they have some positive effects on people experiencing the symptoms of schizo
not the same as saying they really reduce the severity of psychosis

evidence-base for antipsychotic effectiveness is less impressive than it first appears

Question 20

serious side effects

limitation- likelihood of side effects

Answer 20

typical drugs side effects- dizziness agitation sleepiness stiff jaw weight gain and itchy skin
long term use can lead to tardive dyskinesia- dopamine hypersensitivity and cause involuntary facial movements
most serious- neuroleptic malignant syndrome
result in high-temperature delirium and coma fatal
freq 0.1%-2%
Antipsychotics can do harm as well as good and individuals who experience these may avoid such treatment making it ineffective

Question 21

mechanism unclear

limitation- we don’t know why they work

Answer 21

our understanding of the mechanism by which the drugs work is strongly tied up with the dopamine activity in the subcortex
we now know that this dopamine hypothesis is not a complete explanation for schizo
dopamine levels are too low rather than high

if this is true then most drugs shouldn’t work.
given that there are questions over the effectiveness of the drugs this adds to the idea that they are ineffective

some drugs may not be the best treatment to opt for

Question 22

chemical cosh

strength- clear benefits and lack of a better alt

Answer 22

used in hospitals to calm people and make them easier for staff to work with rather than for the benefit of the people themselves.

powerful sedative effects + antipsychotic properties
the temptation to use to make patients more docile

but calming people distressed by hallucinations and delusions make them feel better and allows them to engage with other treatments eg cog behaviour therapy and services of social workers
new people can benefit from feeling calmer and being able to mix with others

clear benefits to using to clam people and bc of an absence of a better alt should be used

Question 23

cognitive behaviour therapy

Answer 23

5-20 sessions
individual or group
aims to deal with thoughts and behaviour

Question 24

how does it help?

CBT

Answer 24

Shows clients how delusions and hallucinations affect their feelings and behaviour, reality testing.

Question 25

evidence of effectiveness

strength- evidence of effectiveness

Answer 25

34 studies using CBT with schizo
clear evidence for small but significant effects on both pos and neg symptoms

other studies focused on symptoms
eg reduction in freq and severity of auditory hallucinations
clinical advice from national institute for health and care excellence recommends CBT for schizo

both research and clinical experience support benefits for CBT

Question 26

quality of evidence

limitation- wide range of techniques and symptoms included in studies

Answer 26

CBT and schizo vary widely from case to case
different studies involve different CBT techniques and people with a different combo of pos and neg symptoms
overall modest benefits of CBT conceal a wide variety of effects of different CBT on different symptoms

Question 27

does CBT cure?

strength- evidence for partial cure

Answer 27

CBT may improve quality of life
but not cure them
schizo appears to be largely a bio condition
psycho therapy like CBT just benefit people

but studies reported a significant reduction in the severity of both pos and neg symptoms. suggest that CBT does more than enhance coping.

CBT does more than teach coping skills and may be a partial cure for schizo

Question 28

family therapy

Answer 28

Aims- improve family communication and reduce stress of living as a family.

Question 29

how does it help?

family therapy

Answer 29

Reduces expressed emotion: e.g. anger and guilt which can cause stress.
reducing stress is important to reduce the likelihood of relapse

Improves family’s ability to help: form a therapeutic alliance, improve beliefs, achieve a balance between caring for the individual and maintaining their own lives

Question 30

a model of practice

Answer 30

phase 1- sharing info on emotional and practical support
phase 2- identifying resources including what different family members can and cant offer
phase 3- encourages mutual understanding creating a safe space to express feelings
phase 4- identifying unhelpful patterns of interaction
phase 5- skill training
phase 6- relapse prevention planning
phase 7- maintenance for the future

Question 31

evidence of effectiveness

strength- evidence of its effectiveness

Answer 31

review of studies concluded that family therapy was one of the most consistently effective treatments available
relapses rates reduced 50-60%
clinical advice from the national institute of health and care recommends family therapy

likely to benefit people both early and full blown schizo

Question 32

benefits to whole family

strength- benefits all family members

Answer 32

review of evidence concluded that these effects are important because families provide the bulk of care for people with schizo
by strengthening the functioning of the whole family, lessens the neg impacts of schizo on other family members and strengthens the ability of the family to support the person with schizo

wider benefits beyond the positive impact on the identified patient

Question 33

which matters most?

strength- benefits to person and econ gain bonus

Answer 33

family therapy reduces relapse rates and makes families better able to provide the bulk of care it has huge economic benefits. State doesn’t need to pay hospital care, benefits etc.

family therapy- significant therapeutic benefits for people with schizophrenia and their families. important to remember the importance of the recovery and future quality of life for the person with schizophrenia as well as wider economic benefits.

everyone wins, therapy benefits the individual with schizophrenia and then their family, and any economic gain is a bonus.

Question 34

token economies for schizo

Answer 34

Systems of secondary reinforcement used to improve the behaviour of individuals by systematically rewarding desired behaviour.

Question 35

developing token econ with schizo

Answer 35

Ayllon and Azrin: women on ward given plastic tokens for tasks, exchanged for privileges. Popular in 1960s/1970s but use declined.

due to growth of community based care and the closure of many psychiatric hospitals

ethical issues raised by restricting rewards to people with mental disorders.

Question 36

rationale for token econ

Answer 36

Modify personal care and social behaviours to improve quality of life in institutions and normalise behaviour to adapt back into community.

institutionalisation develops under circumstances of prolonged hospitalisation
could result in bad habits eg hygiene

three categories of institutional behaviour are commonly tackled by means of token econ

• personal care
• condition-related behaviour eg apathy
• social behaviour

modifying doesn’t cure but benefits:
improves quality of life within hospital setting
normalise behaviour and makes it easier for people to transition back into community life

Question 37

whats involved in a token econ?

Answer 37

Tokens (plastic discs) given to individual immediately after performing desired behaviour, swapped for tangible rewards (sweets, activities, etc.).

Question 38

theoretical understanding of token econ

Answer 38

token econ- behaviour modification
based on operant conditioning
token are secondary reinforcers- value once the person learns that they can be used to obtain meaningful rewards
meaningful rewards- primary reinforcers

Operant conditioning – tokens are secondary reinforcers, gain value through link with primary reinforcers (meaningful rewards).

Question 39

evidence for effectiveness

strength- evidence of effectiveness

Answer 39

7 high quality studies published between 1999 and 2013 examined the effectiveness of token econ for chronic mental health patients living in hospital settings.

all studies showed a reduction in negative symptoms and a decline in freq of unwanted behaviour

Question 40

counterpoint

Answer 40

7 studies is small evidece base to support the effectiveness of a technique
file drawer problem- leads to bias towards positive published findings because undesirable results have been filed away.

serious question over the evidence for the effectiveness of token econ

Question 41

ethical issues

limitation- use of token econ to manage schizo is the ethical issue raised

Answer 41

gives professionals considerable power to control the behaviour of people in the role of patient
imposing the person’s norms onto others
problematic if target behaviour is not identified sensitively
seriously ill people who are already experiencing distressing symptoms have an even worse time
legal action by families who see their relative in this position has been a major factor in the decline in the use of token econ
benefits of token econ may be outweighed by their impact on personal freedom and short term reduction in qualify of life

Question 42

alt approaches

limitation- existence of more pleasant and ethical alternatives

Answer 42

art therapy is a good alt
the evidence base is regularly small and has some methodological limitations but it appears to show that art that is a high gain low risk approach to manage schizo

benefits are modest but this is true for all approaches to treatment and management and unlike token econ, art therapy is pleasant experience without major risk of side effects or ethical abuse.

art therapy is a good alt to token econ

Question 43

benefits

Answer 43

one problem with token econ
they are very difficult to continue once a person is outside a hospital setting.
target behaviour cant be closely monitored and tokens cant be administered
benefits will be lost and the freq of undesirable behaviour will increase

people may only get the chance to live outside a hospital if their personal care and social interaction can be improved.
risk of the token economy losing its effect outside hospital, risk worth taking for individuals who might remain institutionalised.

worth the issues around using token economies in hospital to give people a chance outside the hospital.

Question 44

interactionist approach

Answer 44

Acknowledges that a range of factors, eg biological psychological social, are involved in the development of schizophrenia.

bio- genetic vulnerability neurochemicals and neurological abnormality

psycho- stress eg life events and daily hassles

social- poor quality interaction in the family

Question 45

diathesis stress model

Answer 45

Suggests that both vulnerability (diathesis) and a trigger (stress) are necessary for the onset of schizophrenia.

Question 46

meehl’s model

Answer 46

the diathesis was entirely genetic. A schizogene led to a schizotypic personality which is especially sensitive to stress.
if no gene then no amount of stress would lead to schizo

carrier genes chronic stress through childhood and adolescents particular presence of schizophrenogenic mother could result in development of the disorder

Question 47

modern understanding of diathesis

Answer 47

now clear that many genes each appear to increase genetic vulnerability only slightly there is no single schizogene

A range of factors beyond genes, including psychological trauma

so trauma becomes the diathesis rather than the stressor
early and severe enough trauma eg child abuse can seriously affect many aspects of brain development

e.g. makes hypothalamic-pituitary-adrenal system overactive more vulnerable to later stress

Question 48

modern understanding of stress

Answer 48

Stress is not just parenting-related but anything that may trigger schizophrenia (e.g. cannabis use). can increase the risk of schizo by up to 7 times according to dose
cannabis interferes with the dopamine system
most people don’t develop schizo after smoking cannabis presumably because they lack the requisite vulnerability factors

Question 49

treatment according to the interactionist model

Answer 49

The model combines biological and psychological therapies , most commonly antipsychotic medication and CBT.

Question 50

support for vulnerability and triggers

strength- evidence supporting the roles of vulnerability and triggers

Answer 50

study impact of both genetic vulnerability and a psychological trigger eg dysfunctional parenting
19000 Finnish children
bio mothers have been diagnosed with schizo
adulthood this high genetic risk group were compared to a control group of adoptees without a history of schzio
adoptive parents were assessed on child-rearing styles and found high levels of criticism hostility and low levels of empathy were strongly associated with the development of schizo but only in the high genetic risk group

combo of genetic vulnerability and family stress can lead to greatly increased risk of schizo

Question 51

diathesis and stress are complex

limitation- original model is oversimplified

Answer 51

OG model portrayed diathesis as a single schizogene and stress as schizophrenic parenting is simplistic

multi gene in multi combo
stress comes in many forms eg dysfunctional parenting
diathesis can be influenced by psycho factors and stress can be bio and psycho
study- childhood sexual abuse emerged as a major influence on the underlying vulnerability and cannabis use as the major trigger

multiple factors both bio and psycho affecting both diathesis and stress supposing the modern understanding of both diathesis and stress.

Question 52

real-world application

strength- combo of bio and psycho treatment

Answer 52

the practical application acknowledges bio and psychological factors combo of drug and psycho therapies

combo treatments enhance their effectiveness 
randomly allocated 315 ppt 
1) medication + CBT 
2) medication + counselling 
3) control group (mediation only) 

ppt in two combo groups showed lower symptoms following the trial than the medication-only group- no difference in readmission

there is clear practical advantage to adopting an interactionlist approach to schizo in terms of superior treatment outcome

Question 53

counterpoint

Answer 53

successful treatment for mental disorder justifies a particular explanation is a logical equivalent of saying that because alcohol reduces shyness. shyness is caused by a lack of alcohol.

this logical error is called the treatment causation fallacy

we can’t automatically assume that the success of combo therapies means interactionist explanations are correct.

Question 54

urbanisation

limitation- greater diagnosis in cities is not strong support for the interactionist position

Answer 54

commonly diagnosed in urban than rural areas.
this statistic is used to justify the interaction position
assuming that urban living is more stressful than rural.
urban has more psycho stressful because crowd, noise or the stressors might be biological eg pollution

however this could be explained that schizo is more likely to be diagnosed in cities or that people with a diathesis for schzio ef teens abused as children tend to migrate to cities.

greater pop density in cities= more people tend to witness early symptoms and refer to doc and a significant number of young homeless people in the city have escape from abuse in the countryside

greater diagnosis in cities is not strong support for the interactionist position