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Flashcards in Schizophrenia Deck (71)
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1
Q

What are the two classification systems and how do they differentiate ?

(Classification and Diagnosis)

A

International classification of disease 10 - Two or more negative symptoms needed, recognises there are different types of schizophrenia

American Psychiatric Association’s Diagnostic and Statistical Manual 5 - One postive symptom needed, does not account for different types

2
Q

What is a positive symptom and what are the types ?

(Classification and Diagnosis)

A

Positive symptoms reflect an excess or distortion in normal functioning
Dellusions are irrational beliefs. Common types are:
Delusions of persecution - The belief that others want to harm, threaten or manipulate you
Delusions of grandeur - This is the idea that you are an important individual

Hallucinations involve disturbances in perception. They are false perceptions that have no basis in reality.
Most common hallucinations are auditory ones (hearing voices) but can include smell, touch and sight

3
Q

What are negative symptoms and what are the types ?

(Classification and Diagnosis)

A

Negative symptoms reflect a loss of normal functioning

Speech poverty - the inability to speak properly, characterised by lack of ability to produce fluent words; this is thought to reflect slowing or blocked thoughts. It can manifest itself as short and empty replies to questions.

Avolition - the reduction, difficulty, or inability to start and continue with goal-directed behaviour

4
Q

How is reliability effected by gender bias ?

(Reliability in Diagnosis)

A

Critics of the DSM argue that it is biased towards men, and fails to consider the ways in which women behave differently to men

Longenecker Et Al (2010) – men are diagnosed with Schizophrenia more than women. This could be a result of gender bias

female patients function better than men, despite having other symptoms, because women have are still able to function well – they are not given a diagnosis

This means diagnosis is INCONSISTENT

5
Q

How is reliability affected by culture bias ?

(Reliability in Diagnosis)

A

African Americans and English people of Black-Caribbean origin are several times more likely than white people to be diagnosed with schizophrenia.
But rates in Africa and West Indies not particularly high - suggesting its not linked to genetics

Psychologists suggest patients can display same symptoms but receive different diagnoses because of ethnic background

6
Q

Evaluation - Research support for lack of reliability ?

(Reliability in Diagnosis)

A

Point - Cheniaux et al – had 2 psychiatrists independently diagnosed 100 patients using both DSM and ICD criteria – inter-rater reliability was poor.
1 psychiatrist diagnosed 26 according to DSM and 44 according to ICD.
The other diagnosed 13 according to DSM and 24 according to ICD

Further - Whaley – found inter-rater reliability correlations in the diagnosis of schizophrenia as low as 0.11

7
Q

Evaluation - Research support for culture bias in diagnosis ?

(Reliability in Diagnosis)

A

Point - Escobar found white psychiatrists may over-interpret symptoms of black patients during diagnosis – may be due to cultural differences in language and mannerisms, difficulties in relating between black patients and white therapists

I&D - suffers from ethnocentrism because deviation from what is normal in Western culture is misinterpreted and mislabelled as a symptom of schizophrenia - e.g. hearing voices may be more acceptable in African cultures because of cultural beliefs in communication with ancestors

8
Q

Evaluation - Research support for gender bias ?

(Reliability in Diagnosis)

A

Point - Loring and Powell – male and female psychiatrists read case articles of patients’ behaviour and asked to diagnose. Male psychiatrists – when patients described as male or no information about gender – 56% diagnosed with schizophrenia. When patients described as female – 20% diagnosed. Gender bias not evident with female psychiatrist

I&D – suffers from beta bias because differences between how males and females deal with symptoms are ignored leading to lower diagnosis for women – women typically function better than men and have a better ability to maintain relationships and jobs

9
Q

How does co-morbidity effect the validity of diagnosis ?

(Validity in Diagnosis)

A

Co-morbidity – when more than one disorder exists alongside a primary diagnosis

If conditions occur alongside each other, this means our understanding of schizophrenia may be invalid – perhaps the psychiatrist diagnosing schizophrenia is not able to tell the difference between the two conditions – meaning they may give an incorrect diagnosis

10
Q

How does symptom overlap effect the validity of diagnosis ?

(Validity in Diagnosis)

A

There is a considerable overlap between the symptoms of schizophrenia and other conditions

Under ICD patient may be diagnosed as schizophrenic, however many of the same patients would be diagnosed with bi-polar using DSM
Some argue it suggests that schizophrenia and bi-polar may not be two different conditions but one

11
Q

Evaluation - Research Support for Lack of Validity in Diagnosis and Classification ?

(Validity in Diagnosis)

A

Point - Cheniaux et al – had two psychiatrists diagnose 100 patients using both DSM and ICD criteria. One psychiatrist diagnosed 26 using the DSM and 44 using the ICD, the other diagnosed 13 with the DSM and 24 with the ICD. This demonstrates that schizophrenia is either under or over-diagnosed as the researchers are not close in their diagnoses

Further – Rosenhan – “normal” people presented themselves to psychiatric hospitals in the US claiming they heard an unfamiliar voice in their head. They were all diagnosed with schizophrenia and admitted. None of the staff recognised that they were normal

12
Q

Evaluation - Research Support for Co-Morbidity ?

(Validity in Diagnosis)

A

Point - Buckley et al – around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%). PTSD in 29% of cases, OCD in 23% - schizophrenia commonly occurs alongside other mental illnesses

Counter - Co-morbidity may not indicate an issue with validity – it may simply mean that disorders such as depression are a consequence of suffering from schizophrenia over a period of time

13
Q

Evaluation - Research support for system overlap ?

(Validity in Diagnosis)

A

Point - Ketter – misdiagnosis due to symptom overlap can lead to years of delay in receiving relevant treatment, during which time suffering and further degeneration can occur as well as high levels of suicide

I&D – Missing out on treatment is a significant issue, and this is a bigger issue for women and therefore subject to gender bias. Longenecker Et Al (2010) found that despite having other symptoms, because women have are still able to function well – they are not given a diagnosis and are likely to not be treated compared to men

14
Q

What does the genetic explanation claim ?

(Genetic Explanation)

A

Argues that a predisposition to Schizophrenia could be inherited from parents
There are specific genes implicated in the cause of Schizophrenia

15
Q

How can people can be predisposed to schizophrenia due to inheritence ?

(Genetic Explanation)

A

Family Studies – indicate that the closer the genetic relationship to someone with schizophrenia the greater the chance of developing the disorder
Gottesman – When a first degree relative has Schizophrenia, the chance of the child inheriting is 12%.
If both parents have schizophrenia – 40% likelihood child will develop disorder

Twin Studies – research shows much higher concordance rate in MZ twins than DZ
Gottesman and Shields – concordance rate of 47% in MZ and 9% in DZ

16
Q

What specific genes cause schizophrenia ?

(Genetic Explanation)

A

Ripke Et Al (2014) – studied the genetic makeup of 37,000 Schizophrenics against 113,000 controls. They found 108 genetic variations that were associated in the risk of schizophrenia. A lot of those genes were found to be involved in dopamine. Evidence of it being polygenic

Miyakawa et al – studied DNA from families affected by schizophrenia – those affected with the disease more likely to have a defective version of PPP3CC gene – evidence of a candidate gene

17
Q

Evaluation - Limitation – Inheritance – Could be Due to Shared Environment Not Genes ?

(Genetic Explanation)

A

Point - Problem of comparison of people in same family – share same environment. Even with twin studies, MZ twins may be treated more similarly than DZ twins Better to look at concordance in adopted children and compare to adoptive and biological parents

Counter - Heston compared 47 children of schizophrenic mothers fostered or adopted in first month of life with control group of 50 children raised in the same home as these children – none of control group developed schizophrenia but 17% of children with biological schizophrenic mothers did

18
Q

Evaluation - Limitation – Genetics Can’t be Sole Explanation ?

(Genetic Explanation)

A

Point - Concordance Rates for MZ twins are between 40-60% - if genetics was the sole explanation it would be 100% - could be that genetics give someone a pre-disposition to schizophrenia but are not the sole factor in development

I&D – Biological Reductionism – focusing on one factor, i.e. genes, does not consider any other factors like family dynamics

19
Q

Evaluation - Limitation – Does Not Explain Schizophrenia For Patients Without A Relative with Schizophrenia ?

(Genetic Explanation)

A

Point - Two thirds of people with schizophrenia have no relative with a similar diagnosis – no one to inherit it from

Further - The focus on only biological factors ignores the role of psychological and environmental factors

20
Q

What are the two types of dopamine hypothesis ?

(Dopamine Hypothesis)

A

Hyperdopaminergia - Subcortex – HIGH levels of Dopamine - Focuses on role of high levels of activity of dopamine in the subcortex - associated with positive symptoms

Hypodopaminergia - Cortex – LOW levels of Dopamine - Focuses on low levels of dopamine in pre-frontal cortex - associated with negative symptoms

21
Q

Evaluation - Strength – Research Support ?

(Dopamine Hypothesis)

A

Point - Owen et al – autopsies found schizophrenic sufferers have more dopamine receptors which may lead to more neural firing – evidence of dopamine abnormalities in brains of schizophrenic sufferers

Counter – Dopamine abnormalities are not present in all schizophrenic sufferers especially those with negative symptoms

22
Q

Evaluation - Limitation – Implication of Other Neurotransmitters ?

(Dopamine Hypothesis)

A

Point - Davis et al – the diverse types of schizophrenia and symptoms implies there are several neurotransmitters involved not just dopamine

Further – newer drugs e.g. clozapine, which are more effective than traditional drugs, affect other neurotransmitters as well as dopamine e.g. serotonin

I&D – biological reductionism – by focusing on one sole neurotransmitter

23
Q

Evaluation - Limitation – Problem of Cause and Effect ?

(Dopamine Hypothesis)

A

Point - Impossible to state whether the raised dopamine levels cause schizophrenia or are the result of schizophrenia

Further – Lloyd et al – even if dopamine is a cause, it may be an indirect one influenced by environmental factors – abnormal family circumstances can lead to high levels of dopamine which in turn triggers schizophrenic symptoms

I&D – Nature v Nurture – even with a seemingly biological cause such as dopamine, it may be impossible to separate biological and environmental factors in the cause of schizophrenia

24
Q

What does neural correlates mean ?

(Neural Correlates)

A

Neural correlates – are measurements of the structure or function of the brain that correlate with an experience

The Neural Correlates theory argues that – Schizophrenia develops due to structural and functional abnormalities in the brain of schizophrenic patients

25
Q

What is the neural correlate of negative symptoms ?

(Neural Correlates)

A

One negative symptom is avolition – involving the loss of motivation

believed that this anticipation is linked to the ‘ventral striatum’, a part in the brain

abnormal functioning in ventral striatum could be the cause of the negative symptom and therefore causes schizophrenia

26
Q

What is the evidence for neural correlates of negative symptoms ?

(Neural Correlates)

A

Juckel et Al (2006) – compared the activity levels in the ventral striatum in schizophrenic patients and found lower levels of activity than the control group

found a negative correlation between activity levels in the ventral striatum and the severity of the overall symptoms

27
Q

What is the neural correlate of positive symptoms ?

(Neural Correlates)

A

Allen Et Al (2007) – scanned brains of patients experiencing auditory hallucinations and compared them to a control group

They found lower activation levels in the superior temporal gyrus and anterior cingulate gyrus for the schizophrenic patients
Therefore, reduced activity in these two areas could be the cause of auditory hallucinations

28
Q

Evaluation - Strength – use of fMRI as a method ?

(Neural Correlates)

A

Point - Research carried out into neural correlates often uses fMRI which has high spatial resolution - meaning it shows highly detailed images and shows how brain function is localised. This increases the validity of the study

Counter – over-emphasis on Biological causes, Bateson’s Double Bind Theory highlights that ‘contradictory communication’ from a parent over a prolonged period prevents the ability to construct a coherent (logical) construction of reality and causes schizophrenia

29
Q

Evaluation - Limitation – cause vs correlation ?

(Neural Correlates)

A

Point - It is not clear whether structural abnormalities in the brain are the cause of schizophrenia or an effect of suffering from schizophrenia over a period of time

Further – All these studies have revealed is that there is a neural difference between schizophrenic patients and neurotypical people. The information does not provide much practical application beyond a potential association

30
Q

Evaluation - Limitation – biologically determinist ?

(Neural Correlates)

A

Point - Neural correlates as an explanation forschizophreniais abiologically deterministictheory, i.e., it supports the notion that our thoughts and behaviours aredictatedpurely bybiologicalfactorsrather than our own free will

Further - biologically determinist theories have negativeimplicationsfor our justice system. It will become increasingly difficult to justify punishment for severe crimes because the offender might cite biologically deterministic ideas as an excuse for their behaviour

31
Q

What is a scizoprenic mother and how do they cause schizophrenia ?

(Family Disfunction Theory)

A

Freida Fromm Reichmann - schizophregenic mother is cold, rejecting and controlling. Creates family environment of secrecy and tension.
Lead to distrust that causes paranoid dellusions, and ultimately schizophrenia

32
Q

What is the double-bind theory ?

(Family Disfunction Theory)

A

Developed by Bateson Et al (1972) – argues the style of communication plays a significant role in the development of schizophrenia

suggests that mixed messages from parents that express care but also appear to be critical lead to schizophrenia
suggest that your verbal behaviour and non-verbal behaviour can be very different

leads the child to see the world as confusing and dangerous – which then leads to symptoms of disorganised thinking and paranoid delusions

33
Q

What is expressed emotion ?

(Family Disfunction Theory)

A

Main focus is on why somebody may relapse

concerned with the level of emotion (typically negative) expressed towards a person with Schizophrenia by their carers
Contains the following elements:
Verbal criticism of the person, sometimes accompanied by violence
Hostility towards the person, including anger and rejection
Emotional over-involvement in the life of the person

High levels of expressed emotion in carers directed towards patients are a serious source of stress for the patient

34
Q

Evaluation - Strength – Research Support for Double-Bind ?

(Family Disfunction Theory)

A

Point - Berger – schizophrenics reported a higher recall of double-bind statements by their mothers than non-schizophrenics

Counter – may not be reliable as patients’ recall may be affected by their illness
Counter - Liem – measured patterns of parental communication in families with a schizophrenic child and found no difference compared with normal families

35
Q

Evaluation - Strength – Research Support for Expressed Emotion ?

(Family Disfunction Theory)

A

Point - Hooley et al – meta-analysis of 26 studies – found schizophrenics returning to a family environment of high EE experiences had double the average relapse rate

Further – Kavanagh’s meta-analysis found relapse rate for schizophrenics returning to live with high EE families was 48% compared with 21% for those who lived with low EE families

36
Q

Evaluation - Limitation – Family Dysfunction Explanation Not a Complete Explanation ?

(Family Disfunction Theory)

A

Point - Explanations fail to explain why some children in dysfunctional families often do not go on to develop schizophrenia – if family dynamics were the sole cause of schizophrenia all children raised in similar environments would develop the disorder

I&D – nature v nurture – it is highly likely that one element of nurture (family dynamics) is not enough to cause schizophrenia without a biological predisposition

37
Q

What does the cognitive explanation suggest ?

(Cognitive Explanations)

A

Schizophrenia involves disruption to normal thought processing. This is seen in many symptoms

Frith et al identified two kinds of dysfunctional thought processing which could lead to the behaviour seen in those with schizophrenia
Metarepresentation
Central control

38
Q

What is metarepresentation ?

(Cognitive Explanations)

A

our ability to reflect on thoughts and behaviour. It allows us to identify our goals and intentions, as well as allowing us to interpret the actions of others.

Dysfunction in this area would disturb out ability to recognise our own actions and thoughts as being ours and carried out by ourselves, rather than being carried out by someone else

therefore can explain hallucinations as the inner voice is experienced as coming from an external source when really it comes from the person’s own thoughts

39
Q

What is central control ?

(Cognitive Explanations)

A

Central control is our ability to suppress automatic responses while we perform deliberate actions instead

Having disorganised speech could be due to an inability to suppress automatic thoughts and speech triggered by other thoughts

Many schizophrenics experienced derailment of thoughts and spoken words/sentences because each word triggers an association and the schizophrenic cannot stop the automatic responses to these associations - meaning its hard for them to focus

40
Q

Evaluation - Strength – Research Support for Dysfunctional Thought Processing ?

(Cognitive Explanations)

A

Point - Stirling et al – Stroop Test – naming ink colours of colour words – suppressing the impulse to read the word - schizophrenic patients took twice as long as controls to name the ink colours indicating they were struggling to have central control and suppress the automatic associations

Counter – task lacks mundane realism – does not reflect the real life situations people face so ineffective in explaining cognitive processes in everyday life for someone with schizophrenia

41
Q

Evaluation - Strength – Real Life Application for Treatment ?

(Cognitive Explanations)

A

Point - Cognitive Behaviour Therapy – NICE – meta-analysis – consistent evidence that CBT more effective when compared to antipsychotic medication in reducing symptoms and improving levels of social functioning

Further – CBT has fewer side effects compared to drug therapy and may be seen as preferable

42
Q

Evaluation - Limitation – Issue of cause and effect ?

(Cognitive Explanations)

A

Point - Cognitive approaches do not explain the causes of dysfunctional thinking – where does the dysfunction comes in the first place – are they the cause of schizophrenic symptoms or is the schizophrenia a cause of the dysfunctional thinking

Further - neural correlates may be the cause of schizophrenia and also explain cognitive deficits – reduced activity in ventral striatum and superior temporal gyrus and anterior cingulate gyrus may lead to dysfunctional thought processing

43
Q

How does drug therapy treat schizophrenia ?

(Drug Therapy)

A

Most common treatment for Schizophrenia is antipsychotic drugs

Some people can take them for a short course and then stop using them without returning to symptoms
Others may require antipsychotics for life or they face the likelihood of recurring schizophrenic episodes

44
Q

What are typical antipsychotics and how do they treat schizophrenia ?

(Drug Therapy)

A

Traditional Antipsychotics - eg chlorpromazine
Used primarily for positive symptoms
Called Dopamine Antagonists

Basic function – to reduce or block the effects/actions of dopamine and reduce the symptoms

Bind to dopamine receptors and block them so they cannot absorb the dopamine

Normalise neurotransmission by ensuring post-synaptic neurons receive less dopamine

45
Q

What is tyhe atypical antipsychotic Clozapine and how does it treat schizophrenia ?

(Drug Therapy)

A

2nd generation antipsychotics that aim to treat positive symptoms but also minimise the side effects

Clozapine
Works on dopamine system
Also blocks serotonin and glutamate receptors – helps improve mood and reduce depression and anxiety which may improve cognitive functioning
prescribed when a patient is at high risk of suicide

Risperidone – more recently developed
Developed to be as effective as Clozapine but without the serious side effects
Binds to dopamine and serotonin receptors
Binds more strongly to dopamine receptors than Clozapine so effective in much smaller doses

46
Q

What is tyhe atypical antipsychotic Risperidone and how does it treat schizophrenia ?

(Drug Therapy)

A

Risperidone – more recently developed
Developed to be as effective as Clozapine but without the serious side effects
Binds to dopamine and serotonin receptors
Binds more strongly to dopamine receptors than Clozapine so effective in much smaller doses

47
Q

Evaluation - Strength – Research Support ?

(Drug Therapy)

A

Point - Lecht et al – patients that remained on their antipsychotic medication were only 27% likely to relapse compared to 64% for those given a placebo

Further - Meltzer – found clozapine is effective in up to 50% of cases where patients have not responded well to typical antipsychotics

I&D – research conducted by Lecht Et Al is highly unethical - participants are deceived when given a placebo. This research is socially sensitive as it caused a relapse among patients and this would have significant consequences on their lives

48
Q

Evaluation - Limitation – Serious side effects ?

(Drug Therapy)

A

Point - Typical antipsychotics associated with a range of side effects. Long term use can cause tardive dyskinesia - condition where your face, body or both make sudden, irregular movements which you cannot control

Further – Atypical Antipsychotics – while there is less chance of developing Tardive Dyskinesia they are associated with diabetes and cardiac arrest

49
Q

How is CBT used to treat schizophrenia ?

(CBT)

A

The goal of CBT is to provide an alternative to the often bizarre psychotic thoughts and feelings that the person with schizophrenia experiences

CBT then aims to modify the hallucinations and delusional beliefs by challenging them

This will not get rid of Schizophrenia but it can make it easier for people to cope with it

50
Q

What is coping strategy enhancement ?

(CBT)

A

This is a form of CBT devised by Tarrier (1987)

One of the ideas of this approach is that the majority of people who experience delusions/hallucinations report using coping strategies

The therapist and client work together to improve the effectiveness of the coping strategies, as well as identifying other strategies

51
Q

Evaluation - Strength – Fewer Side Effects ?

(CBT)

A

Point - CBT has fewer side effects compared to drug therapy. E.g. patients not at risk of problems such as tardive dyskensia, diabetes or cardiac arrest

Counter – CBT is more expensive than drug therapy so not always readily available and accessible to all

52
Q

Evaluation - Strength – Research Support ?

(CBT)

A

Point - Tarrier (2005) reviewed trials of CBT, finding evidence of reduced symptoms, especially positive ones, and lower relapse rates. Turkington et al. (2006) CBT is highly effective and should be used as a mainstream treatment for schizophrenia wherever possible

Counter - 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

53
Q

Evaluation - Limitation – Treatment is very time consuming and lengthy ?

(CBT)

A

Point - It takes months compared to drug therapy that takes weeks. This leads to patients becoming disengaged as they don’t see immediate effects - A patient who is very distressed and perhaps suicidal may benefit better in the short term from antipsychotics

Further - 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

54
Q

What is family therapy ?

(Family Therapy)

A

Based on explanation that family dysfunction plays a role in the development of schizophrenia and that altering relationship and communication in families should help recovery

Treatment involves the whole family – not just the sufferer

Family therapy aims to reduce levels of ‘expressed emotion’

55
Q

What are the aims of family therapy ?

(Family Therapy)

A
56
Q

How does family therapy work ?

(Family Therapy)

A

Therapist meets regularly with the patient and close family members who are encouraged to talk openly about patient’s symptoms, behaviour and progress

They are taught how to support each other with each person given a specific role in the rehabilitation process

Emphasis on openness – no details remain confidential

57
Q

What are 3 types of family therapy ?

(Family Therapy)

A

Psycho education:This focuses on teaching a family about an illness to change any negative (and possibly false) ideas that family members may have about the illness.

Systemic models:These consider that dysfunctional family relationships often worsen an illness and therefore improving family relationships will improve symptoms.

Solution focused therapy:Thisfocuses on identifying each family member’s strengths and then using these strengths to help solve problems.

58
Q

Evaluation - Strength - Research support ?

(Family Therapy)

A

Point - Pharoah et al – meta-analysis – compared those who had family therapy to those that only took antipsychotic drugs – family therapy increased patients’ willingness to take medication, reduced risk of relapse and hospital admission during treatment and for 24 months afterwards

Further – McFarlane et al – meta-analysis – family therapy reduced relapse rates, reduces symptoms and improves relationships among family members

59
Q

Evaluation - Strength – Cost Effective ?

(Family Therapy)

A

Point - It is a cost-effective therapy as it decreases relapse rates and lowers the need for hospitalisation. Also educates family members on patients’ medication regime decreasing the need for medical help

Counter – unlikely to be effective without drug therapy – costs and side effects of drug therapy will not be eliminated

60
Q

Evaluation - Limitation – Not Suitable for All Patients ?

(Family Therapy)

A

Point - Not all patients would engage with or benefit from family therapy – if relations within a family have broken down to the point that it could be detrimental to the patient.

I&D – idiographic approach should be adopted and each individual case of schizophrenia should be reviewed, to find a treatment that is suitable to that specific patient

61
Q

Explain what token economies are and how they work ?

(Token Economy Systems)

A

Behaviourist Approach
Only manages schizophrenia – does not attempt to treat
Tokens are awarded for desired behavioural change
Mainly used with long-term hospitalised patients who have picked up maladaptive behaviours – institutionalised
To enable them to leave the hospital and live relatively independently in the community

62
Q

How do token economy systems work ?

(Token Economy Systems)

A
  1. Clinician sets target behaviours that will improve patient’s engagement in daily activities
  2. Tokens are awarded whenever the patient engages in one of the target behaviours
  3. Tokens can be exchanged for rewards at a later date
63
Q

What are the behaviourist principles of token economy systems ?

(Token Economy Systems)

A

Operant conditioning – positive reinforcement - patient will completed the desired behaviour because the behaviour leads to rewards

Classical Conditioning - Tokens are neutral but by pairing the tokens with the reward, the neutral token becomes associated with the reward

64
Q

Evaluation - Strength – Research Support ?

(Token Economy Systems)

A

Point - Ayllon and Arzin – used token economy on ward of female schizophrenia patients, many of whom hospitalised for years – found use of token economy dramatically increased the number of desirable behaviours

Further – Dickerson et al – meta-analysis – found technique is useful in increasing the adaptive behaviour of people with schizophrenia

65
Q

Evaluation - Limitation – Methodological Issues with Research ?

(Token Economy Systems)

A

Point - Comer – the research used in token economy systems usually includes no control groups – when used on a ward, typically all patients are brought into the programme with no control group - so we are unaware of size of improvment compared to control

Further – McMonagle and Sultana – meta-analysis – of the 3 studies found where patients were randomly allocated to control and experimental groups, only one study showed improvement in symptoms

66
Q

Evaluation - Strengths – Benefits to Patients ?

(Token Economy Systems)

A

Point - Patients are able to become more independent and active – can help with institutionalisation. Wards may become more healthy and safe – a benefit to both staff and patients, and patients may be able to leave institutions and live in the community

Counter – any positive effect of the treatment are short-lived – the treatment does not appear to work long-term as the desirable behaviour is dependent on token – once in the community, reinforcement ends leading to high re-admittance rates

67
Q

How does the diathesis-stress model explain how a paitents attains schizophrenia ?

(Interactionist Approach)

A

Schizophrenia caused by a combination of biological and environmental factors

Both diathesis and stress necessary for schizophrenia to develop - biological vulnerability increases the risk that environmental stressors can trigger schizophrenia

Biological factors – can include genetic vulnerability, neurochemical factors, neurological abnormality
Psychological factors – stress, life events, family dysfunction/poor interactions

68
Q

Explain Meehl’s early diathesis stress model ?

(Interactionist Approach)

A

Diathesis – entirely genetic – result of a single “schizogene”
Stress – psychological e.g. schizophrenogenic mother or family dysfunction

69
Q

Explain modern diathesis stress model ?

(Interactionist Approach)

A

Diathesis
Ripke et al – no single schizogene – schizophrenia is polygenic
Read et al – early psychological trauma can alter child’s developing brain and cause vulnerability as hypothalamic-pituitary-adrenal (HPA) system becomes overactive

Stress
Broader definition – other psychological or social factors or anything else that risks triggering schizophrenia

70
Q

How do you treat schizophrenia with the interactionist approach ?

(Interactionist Approach)

A

Combining biological and psychological treatments
Specific combination will depend on patient’s circumstances and needs

Britain – antipsychotic drugs usually given first to reduce the patient’s symptoms so that any psychological treatments have a better chance of being engaged with

America – mostly offers medication without psychological therapies
Unusual to treat schizophrenia using psychological therapies alone

71
Q

Evaluation - Strength - Research Support for Interactionist Explanation of Schizophrenia ?

(Interactionist Approach)

A

Point - Tienari et al – adoption study – children were adopted from 19,000 schizophrenic mothers over 19 years. Adoptive parents were assessed for child-rearing styles. Rates of schizophrenia were compared in the to those in a control group where the adoptees had no genetic risk. Child rearing that involved high levels of criticism and conflict implicated the risk of developing schizophrenia, but only for those with the genetic risk

Counter – research gives a too simplistic picture of ‘stress’ by presenting the idea that ‘stress’ is only caused by certain parenting styles. Many other factors can cause stress such - Vasos (2012) Found the risk of schizophrenia was 2.37 times greater in cities than it was in the countryside