Schizophreina

Question 1

What are positive symptoms?

Answer 1

Positive symptoms are an excess or distortion of normal functions, for example hallucinations, delusions and thought disturbances such as thought insertion.

Question 2

What are the 3 positive symptoms and what are they?

Answer 2

Hallucinations are usually auditory or visual perceptions of things that are not present. Imagined stimuli could involve any of the senses. Voices are usually heard coming from outside the person’s head giving instructions on how to behave.

• Delusions are false beliefs. Usually the person has convinced him/herself that he/she is someone powerful or important, such as Jesus Christ, the Queen (e.g. Delusions of Grandeur). There are also delusions of being paranoid, worrying that people are out to get them.
• Psycho motor Disturbances: Stereotypical - Rocking backwards and forwards, twitches, & repetitive behaviours. Catatonia- staying in position for hours/days on end, cut off from the world.

Question 3

What are the two types of negative symptoms and what are they?

Answer 3

Thought disorder in which there are breaks in the train of thought and the person appears to make illogical jumps from one topic to another (loose association). Words may become confused and sentences incoherent (so called ‘word salad). Broadcasting is a thought disorder whereby a person believes their thoughts are being broadcast to others, for example over the radio or through TV. Alogia - aka speech poverty – is a thought disorder were correct words are used but with little meaning.

• Avolition: Lack of volition (i.e. desire): in which a person becomes totally apathetic and sits around waiting for things to happen. They engage in no self motivated behavior. Their get up and go has got up and gone!

Question 4

What are negative symptoms?

Answer 4

Negative symptoms are a diminution or loss of normal functions such as psycho motor disturbances, lack of volition, disturbances of mood and thought disorders.

Question 5

How are hallucinations a limitation of the classification of schizophrenia?

Answer 5

Slater & Roth (1969) say that hallucinations are the least important of all the symptoms, as they are not exclusive to schizophrenic people.

Question 6

How does the positive and negative symptom classification have good real life applicability?

Answer 6

Classification and diagnosis does have advantages as it allows doctors to communicate more effectively about a patient and use similar terminology when discussing them. In addition, they can then predict the outcome of the disorder and suggest related treatment to help the patient.

Question 7

How can the positive and negative symptom diagnosis be harmful to sufferers or patients?

Answer 7

Scheff (1966) points out that diagnosis classification labels the individual, and this can have many adverse effects, such as a self-fulfilling prophecy (patients may begin to act how they are expected to act), and lower self-esteem.

Question 8

How are the ethics of classification both advantages and weaknesses?

Answer 8

Ethics – do the benefits of classification (care, treatment, safety) outweigh the costs (possible misdiagnosis, mistreatment, loss of rights and responsibility, prejudice due to labelling).

Question 9

What is reliability in classification?

Answer 9

For the classification system to be reliable, differfent clinicians using the same system (e.g. DSM) should arrive at the same diagnosis for the same individual.

Question 10

How is self report a weakness of diagnosis?

Answer 10

Diagnosis of schizophrenia is difficult as the practitioner has no physical signs but only symptoms (what the patient reports) to make a decision on.

Question 11

Who’s study demonstrated the high reliability of classifications of diagnosis in schizophrenia?

Answer 11

Jakobsen et al. (2005) tested the reliability of the ICD-10 classification system in diagnosing schizophrenia. A hundred Danish patients with a history of psychosis were assessed using operational criteria, and a concordance rate of 98% was obtained. This demonstrates the high reliability of the clinical diagnosis of schizophrenia using up-to-date classification.

Question 12

How does co-morbidity make diagnosis and classification unreliable?

Answer 12

Co-morbidity describes people who suffer from two or more mental disorders. For example, schizophrenia and depression are often found together. This makes it more difficult to confidently diagnose schizophrenia. Co-morbidity occurs because the symptoms of different disorders overlap. For example, major depression and schizophrenia both involve very low levels of motivation. This creates problems of reliability. Does the low motivation reflect depression or schizophrenia, or both?

Question 13

How is there a gender bias in classification and diagnosis?

Answer 13

Gender bias: Loring and Powell (1988) found that some behaviour which was regarded as psychotic in males was not regarded as psychotic in females.

Question 14

What is validity in relation to classification and diagnosis?

Answer 14

For the classification system to be valid it should be meaningful and classify a real pattern of symptoms, which result from a real underlying cause.

Question 15

How is the diagnosis and classification invalid due to the fact it is one disorder?

Answer 15

The validity of schizophrenia as a single disorder is questioned by many. This is a useful point to emphasise in any essay on the disorder. There is no such thing as a ‘normal’ schizophrenic exhibiting the usual symptoms.

Question 16

How is the problem of the validity of classification lead to another limitation?

Answer 16

Since their are problems with the validity of diagnosis classification, unsuitable treatment may be administered, sometimes on an involuntary basis. This raises practical and ethical issues when selecting different types of treatment.

Question 17

How are there problems in validity of diagnosis and classification due to a misrepresentation in what we are actually testing?

Answer 17

Problems of validity: Are we really testing what we think we are testing? In the USA only 20% of psychiatric patients were classed as having schizophrenia in the 1930s but this rose to 80% in the 1950’s . In London the rate remained at 20%, suggesting neither group had a valid definition of schizophrenia.

Question 18

How is the idea of schizophrenia as an umbrella term a limitation?

Answer 18

Neuropsychologist Michael Foster Green suggests that neurocognitive deficits in basic functions such as memory, attention, central executive and problem solving skills may combine to have an outcome which we are labelling “Schizophrenia” as if it was the cause when in fact it is simply an umbrella term for a set of effects.

Question 19

How is diagnosis invalid due to the assigning of treatments?

Answer 19

Predictive validity. If diagnosis leads to successful treatment, the diagnosis can be seen as valid. But in fact some Schizophrenics are successfully treated whereas others are not. Heather (1976) there is only a 50% chance of predicting what treatment a patient will receive based on diagnosis, suggesting that diagnosis is not valid.

Question 20

How is validity of diagnosis ruined through cause?

Answer 20

Aetiological validity – for a diagnosis to be valid, all patients diagnosed as schizophrenic should have the same cause for their disorder. This is not the case with schizophrenia: The causes may be one of biological or psychological or both.

Question 21

Who conducted research into diagnosis of schizophrenia and what did they show as an limitation?

Answer 21

David Rosenhan (1972) famous experiment involving Pseudo patients led to 8 normal people being kept in hospital despite behaving normally. This suggests the doctors had no valid method for detecting schizophrenia. They assumed the bogus patients were schizophrenic with no real evidence. In a follow up study they rejected genuine patients whom they assumed were part of the deception.

Question 22

How does schizophrenia have a culture bias and therefore lacks validity?

Answer 22

Culture - One of the biggest controversies in relation to classification and diagnosis is to do with cultural relativism and variations in diagnosis. For example in some Asian countries people are not expected to show emotional expression, whereas in certain Arabic cultures public emotion is encouraged and understood. Without this knowledge a person displaying overt emotional behaviour in a Western culture might be regarded as abnormal.

Question 23

What is the genetic basis of schizophrenia?

Answer 23

Benzel et al. (2007) three genes: COMT , DRD4 , AKT1 - have all been associated with excess dopamine in specific D2 receptors, leading to acute episodes, positive symptoms which include delusions, hallucinations, strange attitudes.

Question 24

Who’s (2 studies) research into DNA has provided a basis for the genetic basis of schizophrenia?

Answer 24

Research by Miyakawa et al. (2003) studied DNA from human families affected by schizophrenia and found that those with the disease were more likely to have a defective version of a gene, called PPP3CC which is associated with the production of calcineurin which regulates the immune system. Also, research by

Sherrington et al. (1988) has found a gene located on chromosome 5 which has been linked in a small number of extended families where they have the disorder.

Question 25

Who's study ( 2 studies) showed how closeness of biological relationship can affect schizophrenia?

Answer 25

Evidence suggests that the closer the biological relationship, the greater the risk of developing schizophrenia. Kendler (1985) has shown that first-degree relatives of those with schizophrenia are 18 times more at risk than the general population. Gottesman (1991) has found that schizophrenia is more common in the biological relatives of a schizophrenic, and that the closer the degree of genetic relatedness, the greater the risk.

Question 26

How do mono zygotic twins act as limitation of biological diagnosis of schizophrenia?

Answer 26

Very important to note genetics are only partly responsible, otherwise identical twins would have 100% concordance rates.

Question 27

How are there methodological problems with the biological diagnosis of schizophrenia?

Answer 27

One weakness of the genetic explanation of schizophrenia is that there are methodological problems. Family, twin and adoption studies must be considered cautiously because they are retrospective, and diagnosis may be biased by knowledge that other family members who may have been diagnosed. This suggests that there may be problems of demand characteristics.

Question 28

How is the issue of nature nurture a limitation of the biological diagnosis of schizophrenia?

Answer 28

It is very difficult to separate out the influence of nature-v-nurture. The fact that the concordance rates are not 100% means that schizophrenia cannot wholly be explained by genes and it could be that the individual has a pre-disposition to schizophrenia and simply makes the individual more at risk of developing the disorder. This suggests that the biological account cannot give a full explanation of the disorder.

Question 29

How is the reductionist approach of biological diagnosis a limitation?

Answer 29

A final weakness of the genetic explanation of schizophrenia is that it is biologically reductionist. The Genome Project has increased understanding of the complexity of the gene. Given that a much lower number of genes exist than anticipated, it is now recognised that genes have multiple functions and that many genes behaviour. Schizophrenia is a multi-factorial trait as it is the result of multiple genes and environmental factors. This suggests that the research into gene mapping is over simplistic as schizophrenia is not due to a single gene.

Question 30

What is the dopamine hypothesis and what does high dopamine levels relate to?

Answer 30

Dopamine is a neurotransmitter. It is one of the chemicals in the brain which causes neurons to fire. The original dopamine hypothesis stated that schizophrenia suffered from an excessive amount of dopamine. This causes the neurons that use dopamine to fire too often and transmit too many messages. • High dopamine activity leads to acute episodes, and positive symptoms which include: delusions, hallucinations, confused thinking.

Question 31

Where does evidence for the dopamine hypothesis come from?

Answer 31

Evidence for this comes from that fact that amphetamines increase the amounts of dopamine. Large doses of amphetamine given to people with no history of psychological disorders produce behaviour which is very similar to paranoid schizophrenia. Small doses given to people already suffering from schizophrenia tend to worsen their symptoms.

Question 32

What is the second dopamine hypothesis refering to the receptors?

Answer 32

A second explanation developed, which suggests that it is not excessive dopamine but that fact that there are more dopamine receptors. More receptors lead to more firing and an over production of messages. Autopsies have found that there are generally a large number of dopamine receptors (Owen et al., 1987) and there was an increase in the amount of dopamine in the left amygdala (falkai et al. 1988) and increased dopamine in the caudate nucleus and putamen (Owen et al, 1978).

Question 33

How is the cause and effect argument a limitation of the dopamine hypothesis?

Answer 33

One criticism of the dopamine hypothesis is there is a problem with the cause and effect. Is the raised dopamine levels the cause of the schizophrenia, or is it the raised dopamine level the result of schizophrenia? It is not clear which comes first. This suggests that one needs to be careful when establishing cause and effect relationships in schizophrenic patients.

Question 34

How is a study done on normal non schizophrenic individuals, a limitation of the biological diagnosis?

Answer 34

One of the biggest criticisms of the dopamine hypothesis came when Farde et al found no difference between schizophrenics’ levels of dopamine compared with ‘healthy’ individuals in 1990.

Question 35

How is evidence for no association between anti psychotics and schizophrenia a limitation?

Answer 35

Noll (2009) also argues around one third of patients do not respond to drugs which block dopamine so other neurotransmitters may be involved.

Question 36

How is the biological diagnosis of schizophrenia a weakness?

Answer 36

A final weakness of the dopamine hypothesis is that it is biologically deterministic. The reason for this is because if the individual does have excessive amounts of dopamine then does it really mean that thy ey will develop schizophrenia? This suggests that the dopamine hypothesis does not account for freewill.

Question 37

What are neural correlates?

Answer 37

• People with schizophrenia have abnormally large ventricles in the brain. Ventricles are fluid filled cavities (i.e. holes) in the brain that supply nutrients and remove waste. This means that the brains of schizophrenics are lighter than normal. The ventricles of a person with schizophrenia are on average about 15% bigger than normal (Torrey, 2002).

Question 38

What is a strength of neural research into neural correlates in diagnosis?

Answer 38

A strength is that the research into enlarged ventricles and neurotransmitter levels have high reliability. The reason for this is because the research is carried out in highly controlled environments, which specialist, high tech equipment such as MRI and PET scans. These machines take accurate readings of brain regions such as the frontal and pre-frontal cortex, the basil ganglia, the hippo campus and the amygdale. This suggests that if this research was tested and re-tested the same results would be achieved.

Question 39

Who's study supports neural correlates as a diagnosis for schizophrenia?

Answer 39

Supporting evidence for the brain structure explanation comes from further empirical support from Suddath et al. (1990). He used MRI (magnetic resonance imaging) to obtain pictures of the brain structure of MZ twins in which one twin was schizophrenic. The schizophrenic twin generally had more enlarged ventricles and a reduced anterior hypothalamus. The differences were so large the schizophrenic twins could be easily identified from the brain images in 12 out of 15 pairs. This suggests that there is wider academic credibility for enlarged ventricles determining the likelihood of schizophrenia developing.

Question 40

How are neural correlates deterministic and how is this a weakness?

Answer 40

A second weakness of the neuroanatomical explanations is that it is biologically deterministic. The reason for this is because if the individual does have large ventricles then does it really mean that they will develop schizophrenia? This suggests that the dopamine hypothesis does not account for freewill.

Question 41

Who proposed family dysfunction and what did they say?

Answer 41

Laing and others rejected the medical / biological explanation of mental disorders. They did not believe that schizophrenia was a disease. They believed that schizophrenia was a result of social pressures from life. Laing believed that schizophrenia was a result of the interactions between people, especially in families.

Question 42

What is the double blind theory and who proposed it? | And how does this cause schizophrenia?

Answer 42

Bateson et al. (1956) suggested the double bind theory, which suggests that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia. For example parents who say they care whilst appearing critical or who express love whilst appearing angry. They did not believe that schizophrenia was a disease. They believed that schizophrenia was a result of social pressures from life. Prolonged exposure to such interactions prevents the development of an internally coherent construction of reality; in the long run, this manifests itself as typically schizophrenic symptoms such as flattening affect, delusions and hallucinations, incoherent thinking and speaking, and in some cases paranoia.

Question 43

What is another hypothesis of family association in the getting of schizophrenia?

Answer 43

Another family variable associated with schizophrenia is a negative emotional climate, or more generally a high degree of expressed emotion (EE). EE is a family communication style that involves criticism, hostility and emotional over-involvement. The researchers concluded that this is more important in maintaining schizophrenia than in causing it in the first place, (Brown et al 1958). Schizophrenics returning to such a family were more likely to relapse into the disorder than those returning to a family low in EE. The rate of relapse was particularly high if returning to a high EE family was coupled with no medication.

Question 44

Who's study supports the double blind theory?

Answer 44

One strength of the double bind explanation comes from further empirical support provided by Berger (1965). They found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics. However, evidence may not be reliable as patient’s recall may be affected by their schizophrenia. This suggests that there is wider academic credibility for the idea of contradictory messages causing schizophrenia.

Question 45

How do EE's have good practical application?

Answer 45

A second strength of the research into expressed emotion (EE) is that it has practical applications. For example Hogarty (1991) produced a type of therapy session, which reduced social conflicts between parents and their children which reduced EE and thus relapse rates. This suggests that gaining an insight into family relationships allows psychiatric professionals to help improve the quality of patient’s lives.

Question 46

How is a weakness for family explanations in cause and effect?

Answer 46

A weakness of the family relationships approach is that there is a problem of cause and effect. Mischler & Waxler (1968) found significant differences in the way mothers spoke to their schizophrenic daughters compared to their normal daughters, which suggests that dysfunctional communication may be a result of living with the schizophrenic rather than the cause of the disorder. This suggests that there is a problem of the chicken and egg scenario in relation to expressed emotion causing schizophrenia.

Question 47

How are their ethical issues with the double blind theory?

Answer 47

A second weakness of the double bind theory is that there are ethical issues. There are serious ethical concerns in blaming the family, particularly as there is little evidence upon which to base this. Gender bias is also an issue as the mother tends to be blamed the most, which means such research is highly socially sensitive. This suggests that the research therefore does not protect individuals from harm.

Question 48

What is the cognitive approach to schizophrenia?

Answer 48

Cognitive approaches examine how people think, how they process information. Researchers have focused on two factors which appear to be related to some of the experiences and behaviours of people diagnosed with schizophrenia. First, cognitive deficits which are impairments in thought processes such as perception, memory and attention. Second, cognitive biases are present when people notice, pay attention to, or remember certain types of information better than other.

Question 49

What are cognitive deficits and what are some examples of them?

Answer 49

* There is evidence that people diagnosed as schizophrenic have difficulties in processing various types of information, for example visual and auditory information. Research indicates their attention skills may be deficient – they often appear easily distracted. * A number of researchers have suggested that difficulties in understanding other people’s behaviour might explain some of the experiences of those diagnosed as schizophrenic. Social behaviour depends, in part, on using other people’s actions as clues for understanding what they might be thinking. Some people who have been diagnosed as schizophrenic appear to have difficulties with this skill. * Cognitive deficits have been suggested as possible explanations for a range of behaviours associated with schizophrenia. These include reduced levels of emotional expression, disorganised speech and delusions.

Question 50

What is a cognitive bias and what are examples?

Answer 50

* Cognitive biases refer to selective attention. The idea of cognitive biases has been used to explain some of the behaviors which have been traditionally regarded as ‘symptoms’ of ‘schizophrenia’. * - Delusions: The most common delusion that people diagnosed with schizophrenia report is that others are trying to harm or kill them – delusions of persecution. Research suggests that these delusions are associated with specific biases in reasoning about and explaining social situations. Many people who experience feelings of persecution have a general tendency to assume that other people cause the things that go wrong with their lives.

Question 51

How does the cognitive approach have good practical application?

Answer 51

A strength of the cognitive explanation is that it has practical applications. Yellowless et al. (2002) developed a machine that produced virtual hallucinations, such as hearing the television telling you to kill yourself or one person’s face morphing into another’s. The intention is to show schizophrenics that their hallucinations are not real. This suggests that understanding the effects of cognitive deficits allows psychologists to create new initiatives for schizophrenics and improve the quality of their lives.

Question 52

How is the cognitive approach strengthened by its use of nurture?

Answer 52

A final strength is that it takes on board the nurture approach to the development of schizophrenia. For example, it suggests that schizophrenic behavior is the cause of environmental factors such as cognitive factors.

Question 53

How is cause and effect a limitation of the cognitive approach?

Answer 53

One weakness of the cognitive explanation is that there are problems with cause and effect. Cognitive approaches do not explain the causes of cognitive deficits – where they come from in the first place. Is it the cognitive deficits which causes the schizophrenic behaviour or is the schizophrenia that causes the cognitive deficits? This suggests that there are problems with the chicken and egg problem.

Question 54

How is the reductionist approach of the cognitive approach a limitation?

Answer 54

A second weakness of the cognitive model is that it is reductionist. The reason for this is because the approach does not consider other factors such as genes. It could be that the problems caused by low neurotransmitters creates the cognitive deficits. This suggests that the cognitive approach is over simplistic when consider the explanation of schizophrenia.

Question 55

What are Typical Anti psychotics? What do they do? and how can they have side effects?

Answer 55

* First generation Antipsychotics are called “Typical Antipsychotics” Eg. Chlorpromazine and Haloperidol. * They arrest dopamine production by blocking the D2 receptors in synapses that absorb dopamine, in the mesolimbic pathway thus reducing positive symptoms, such as auditory hallucinations. * But they tended to block ALL types of dopamine activity, (in other parts of the brain as well) and this caused side effects and may have been harmful.

Question 56

What are Atypical Anti psychotics? | And how do they differ from Typical in terms of side effects?

Answer 56

Newer drugs, called “atypical antipsychotics” attempt to target D2 dopamine activity in the limbic system but not D3 receptors in other parts of the brain. • They also have some effect on other neurotransmitters such as serotonin. They generally have fewer side effects eg. less effect on movement Eg. Clozapine, Olazapine and Risperidone.

Question 57

How have modern advancements improved the reliability of anti psychotics?

Answer 57

Since the mid-1950s anti psychotic medications have greatly improved treatment. Medications reduce positive symptoms particularly hallucinations and delusions; and usually allow the patient to function more effectively and appropriately.

Question 58

How are anti psychotics great economical value? | However how are they not a "treatment"

Answer 58

Anti psychotic drugs are highly effective as they are relatively cheap to produce, easy to administer and have a positive effect on many sufferers. However they do not "cure" schizophrenia, rather they dampen symptoms down so that patients can live fairly normal lives in the community.

Question 59

Who found that anti-psychotics were effective for one year and what else did they find?

Answer 59

Kahn et al. (2008) found that anti psychotics are generally effective for at least one year, but second- generation drugs were no more effective than first-generation ones.

Question 60

How do anti psychotics have ethical issues due to the side effects leading to more drug treatments?

Answer 60

Some sufferers only take a course of anti psychotics once, while others have to take a regular dose in order to prevent symptoms reappearing. There is a sizeable minority who do not respond to drug treatment. Pills are not as helpful with other symptoms, especially emotional problems. Older anti psychotics like haloperidol or chlorpromazine may produce side effects Sometimes when people with schizophrenia become depressed, so it is common to prescribe anti-depressants at the same time as the anti-psychotics.

Question 61

How do relapses show effectiveness of anti psychotics?

Answer 61

All patients are in danger of relapsing but without medication the relapses are more common and more severe which suggests the drugs are effective.

Question 62

How is clozapine extremely effective? However what is its drawback? and do alternatives work as good?

Answer 62

Clozapine targets multiple neurotransmitters, not just dopamine, and has been shown to be more effective than other anti psychotics, although the possibility of severe side effects – in particular, loss of the white blood cells that fight infection Even newer anti psychotic drugs, such as risperidone and olanzapine are safer, and they also may be better tolerated. They may or may not treat the illness as well as clozapine.

Question 63

Whos study acts as an limitation to A typical anti psychotics?

Answer 63

Meta – Analysis by Crossley Et Al (2010) suggested that Atypical anti psychotics are no more effective, but do have less side effects.

Question 64

What are the four aims of family therapy?

Answer 64

* To educate relatives about schizophrenia. * To stabilize the social authority of the doctor and the family. * To improve how the family communicated and handled the situation. * To teach patients and carers more effective stress management techniques.

Question 65

What are the 4 methods used in family therapy and outline them.

Answer 65

* Families taught to have weekly family meetings solving problems on family and individual goals, resolve conflict between members, and pinpoint stressors. * Preliminary analysis: Through interviews and observation the therapist identifies strengths and weaknesses of family members and identifies problem behaviors. * Information transfer – teaching the patient and the family the actual facts about the illness, it’s causes, the influence of drug abuse, and the effect of stress and guilt. • Communication skills training – teach family to listen, to express emotions and to discuss things. Additional communication skills are taught, such as “compromise and negotiation,” and “requesting a time out” . This is mainly aimed at lowering expressed emotion.

Question 66

Who's study shows the validity of using family therapy with drug treatments?

Answer 66

A study by Anderson et al. (1991) found a relapse rate of almost 40% when patients had drugs only, compared to only 20 % when Family Therapy or Social Skills training were used and the relapse rate was less than 5% when both were used together with the medication.

Question 67

Who performed a meta analysis on patients undergoing family therapy and found it valid?

Answer 67

Pharaoh et al. (2003) meta - analysis found family interventions help the patient to understand their illness and to live with it, developing emotional strength and coping skills, thus reducing rates of relapse

Question 68

How are there economic benefits associated with family therapy?

Answer 68

Economic Benefits: Family therapy is highly cost effective because it reduces relapse rates, so the patients are less likely to take up hospital beds and resources.

Question 69

How is it effective for other family members also, but how can it fail with more sever cases?

Answer 69

Lobban (2013) reports that other family members felt they were able to cope better thanks to family therapy. In more extreme cases the patient might be unable to cope with the pressures of having to discuss their ideas and feelings and could become stressed by the therapy, or over-fixated with the details of their illness.

Question 70

What is token economy? How does it work? what symptoms does it reduce?

Answer 70

The main idea is that behavioural change can be achieved by awarding tokens for desired actions. These reinforces are exchanged for benefits such as a film or a coffee. * The focus of a token economy is on shaping and positively reinforcing desired behaviours and NOT on punishing undesirable behaviours. The technique alleviates negative symptoms such as poor motivation, and nurses subsequently view patients more positively, which raises staff morale and has beneficial outcomes for patients. * It can also reduce positive symptoms by not rewarding them, but rewarding desirable behaviour instead. Desirable behaviour includes self-care, taking medication, work skills, and treatment participation.

Question 71

Who's study showed the overall defectiveness of token economy?

Answer 71

Paul and Lentz (1977) Token economy led to better overall patient functioning and less behavioural disturbance, More cost effective (lower hospital costs)

Question 72

Who found that token economies addressed the issue of weight with anti psychotics?

Answer 72

Upper and Newton (1971) found that the weight gain associated with taking anti psychotics was addressed with token economy regimes. Chronic schizophrenics achieved 3lbs of weight loss a week.

Question 73

Who's longitudinal study proves that token economies are effective?

Answer 73

McMonagle and Sultana (2000) reviewed token economy regimes over a 15-year period, finding that they did reduce negative symptoms, though it was unclear if behavioural changes were maintained beyond the treatment programme.

Question 74

How is token economy flawed in that it does not treat schizophrenia and fails at homes?

Answer 74

It is difficult to keep this treatment going once the patients are back at home in the community. Kazdin et al. Found that changes in behaviour achieved through token economies do not remain when tokens are withdrawn, suggesting that such treatments address effects of schizophrenia rather than causes. It is not a cure.

Question 75

How are their ethical issues with token economy?

Answer 75

There have also been ethical concerns as such a process is seen to be dehumanising, subjecting the patient to a regime which takes away their right to make choices. In the 1950s and 60s nurses often “rewarded” patients with cigarettes. Due to the pivotal role of dopamine in schizophrenia this led to a culture of heavy smoking an nicotine addiction in psychiatric hospitals of the era.

Question 76

What is Cognitive Behavioural Therapy and what areas does it aim to improve?

Answer 76

Central idea: Patients problems are based on incorrect beliefs and expectations. CBT aims to identify and alter irrational thinking including regarding: ``` General beliefs. Self image. Beliefs about what others think. Expectations of how others will act. Methods of coping with problems. In theory, when the misunderstandings have been swept away, emotional attitudes will also improve. ```

Question 77

What is the assessment part of CBT?

Answer 77

Assessment: The therapist encourages the patient to explain their concerns. * describing delusions * reflecting on relationships * laying out what they hope to achieve through the therapy.

Question 78

What is the engagement part of CBT?

Answer 78

Engagement: The therapist wins the trust of the patient, so they can work together. This requires honesty, patience and unconditional acceptance. The therapist needs to accept that the illusions may seem real to the patient at the time and should be dealt with accordingly.

Question 79

What is the ABC part of CBT?

Answer 79

ABC: Get the patients to understand what is really happening in their life: A: Antecedent - what is triggering your problem ? B: behavior – how do you react in these situations ? C: Consequences – what impact does that have on your relationships with others?

Question 80

What is the normalisation part of CBT?

Answer 80

Normalisation: Help the patient realise it is normal to have negative thoughts in certain situations. Therefore there is no need to feel stressed or ashamed about them.

Question 81

What is the critical collaborative analysis in CBT?

Answer 81

Critical Collaborative Analysis: Carrying on a logical discussion till the patient begins to see where their ideas are going wrong and why they developed. Work out ways to recognise negative thoughts and test faulty beliefs when they arise, and then challenge and re-think them

Question 82

What is the developing alternative explanations part of CBT?

Answer 82

Developing Alternative Explanations: Helping the patient to find logical reasons for the things which trouble them Let the patient develop their own alternatives to their previous maladaptive behaviour by looking at coping strategies and alternative explanations.

Question 83

What is the second form of CBT? And who used it?

Answer 83

Another form of CBT: Coping Strategy Enhancement (CSE) • Tarrier (1987) used detailed interview techniques, and found that people with schizophrenia can often identify triggers to the onset of their psychotic symptoms, and then develop their own methods of coping with the distress caused. These might include things as simple as turning up the TV to drown out the voices they were hearing! At least 73% of his sample reported that these strategies were successful in managing their symptoms.

Question 84

How does CSE work?

Answer 84

• CSE aims to teach individuals to develop and apply effective coping strategies which will reduce the frequency, intensity and duration of psychotic symptoms and alleviate the accompanying distress. There are two components: 1. Education and rapport training: therapist and client work together to improve the effectiveness of the client’s own coping strategies and develop new ones. 2. Symptom targeting: a specific symptom is selected for which a particular coping strategy can be devised Strategies are practised within a session and the client is helped through any problems in applying it. They are then given homework tasks to practice, and keep a record of how it worked.

Question 85

How does evidence for CBT prove invalid due to other treatments operating?

Answer 85

CBT does seem to reduce relapses and readmission's to hospital (NICE 2014) However the fact that these people were on medication and having regular meetings with doctors would be expected to have that effect anyway.

Question 86

Who found that CBT was highly effective and felt it needed to be used?

Answer 86

Turkington et al. (2006) CBT is highly effective and should be used as a mainstream treatment for schizophrenia wherever possible.

Question 87

Who reviewed CBT and found its effects? Supporting the use of CBT

Answer 87

Tarrier (2005) reviewed trials of CBT, finding evidence of reduced symptoms, especially positive ones, and lower relapse rates.

Question 88

Who said that treatment of schizophrenia is temporal invalid? And how does it fail on treatment?

Answer 88

Addington and Addington (2005) claim that CBT is of little use in the early stages of an acute schizophrenic episode, but perhaps more useful when the patient is more calm and beginning to worry about how life will be after they recover. In other words, it doesn’t cure schizophrenia, it just helps people get over it.

Question 89

Who's research in Hampshire showed how subjective CBT is?

Answer 89

Research in Hampshire, by Kingdon and Kirschen (2006) found that CBT is not suitable for all patients, especially those who are too thought disorientated or agitated, who refuse medication, or who are too paranoid to form trusting alliances with practitioners.

Question 90

What can CBT be used alongside to increase its effectiveness?

Answer 90

As there is strong evidence that relapse is related to stress and expressed emotion within the family, it seems likely that CBT should be employed alongside family therapy in order to reduce the pressures on the individual patient.

Question 91

Who proposed the diathesis stress model and what is it?

Answer 91

Zubin and Spring suggest that a person may be born with a predisposition towards schizophrenia which is then triggered by stress in everyday life. But if they have a supportive environment and/or good coping skills the illness may not develop.

Question 92

Who's study first showed the effects of the diathesis stress model?

Answer 92

Tienari Et. A. (2004): Adopted children from families with schizophrenia had more chance of developing the illness than children from normal families. This supports a genetic link. However, those children from families schizophrenia were less likely to develop the illness if placed in a “good” family with kind relationships, empathy, security, etc. So environment does play a part in triggering the illness.

Question 93

Who's study supports the stress and nurture side of the model?

Answer 93

Falloon et al (1996) stress – such as divorce or bereavement, causes the brain to be flooded with neurotransmitters which brings on the acute episode.

Question 94

Who's study showed how major life events cause schizophrenia?

Answer 94

Brown and Birley (1968) 50% people who had an acute schizophrenic episode had experienced a major life event in 3 weeks prior.

Question 95

How is drug use a strength of diathesis stress model?

Answer 95

Substance abuse: Amphetamine and Cannabis and other drugs have also been identified as triggers as they affect serotonin and glutamate levels.

Question 96

What 4 studies show the importance of location in the diathesis stress model and thus supporting it?

Answer 96

Vasos (2012) Found the risk of schizophrenia was 2.37 times greater in cities than it was in the countryside, probably due to stress levels. Hickling (1999) the stress of urban living made African-Carribean immigrants in Britain 8 to 10 times more likely to experience schizophrenia. Faris and Dunham (1939) found clear pattern of correlation between inner city environments and levels of psychosis. Pederson and Mortensen (Denmark 2001) found Scandanavian villages have very LOW levels of psychosis, but 15 years of living in a city increased risk.

Question 97

Who showed that poorer conditions can be a cause and thus supporting the diathesis stress model?

Answer 97

Fox (1990): It is more likely that factors associated with living in poorer conditions (e.g. stress) may trigger the onset of schizophrenia, rather than individuals with schizophrenia moving down in social status.

Question 98

Who's meta analysis showed the affects of abuse on schizophrenia and therefore supports the diathesis stress model?

Answer 98

Bentall’s meta analysis (2012) shows that stress arising from abuse in childhood increases the risk of developing schizophrenia.

Question 99

Who's study showed how modern urban living has an effect on schizophrenia and therefore supports the diathesis stress model?

Answer 99

Toyokawa, Et. Al (2011) Suggest many aspects of urban living – ranging from life stressors to the use of drugs, can have an effect on human epigenetics. So the stressors of modern living could cause increased schizophrenia in future generations.

Question 100

How is the abundance of evidence for the diathesis stress model support?

Answer 100

The abundance of evidence in support of the diathesis stress model gives it great scientific credibility, along with the combination of both biological and environmental influences.