Schizophrenia Flashcards
(367 cards)
1
Q
Schizophrenia
How many people suffer from it
A
1% of world ppopulation
2
Q
Schizophrenia
Who is it most commonly diagnosed in
A
Men rather than women
3
Q
Schizophrenia
Where is it. OST commonly diagnosed
A
In cities rather than the countryside
4
Q
Schizophrenia
What class is it most commonly diagnosed in
A
Working class rather then middle Class
5
Q
Schizophrenia
What symptoms interfere with
A
Everyday tasks, many sufferers end up homeless or hospitalised
6
Q
Schizophrenia
What does it affect
A
Thought processes and Ability to determine reality
7
Q
Schizophrenia
How does degree of severity vary
A
Some sufferers encounter only one episode some have persistency episodes but live relatively normal lives through taking medication
8
Q
Schizophrenia
Where does a split occur in schizophrenia for sufferers
A
Between a persons though processes and reality
9
Q
Symptoms
What is a psychosis
A
Term used to describe a severe mental health problem where the individual loses contact with reality
10
Q
Symptoms
How were people with schizophrenia dealt with before the 1950a
A
Spent most of lives in psychiatric hospitals
11
Q
Symptoms
How has it changed from institutionalisation
A
New treatment methods have changed this
12
Q
Symptoms
What are the symptoms split into
A
Positive and negative symptoms
13
Q
Symptoms
What are positive symptoms
A
Additional experiences beyond those of ordinary existence and involve displaying behaviours concerning ;loss of touch to reality
14
Q
Symptoms
How do positive symptoms generally occur
A
In short episodes with normal periods in between
15
Q
Symptoms
How do positive symptoms respond to mediation
A
Squire well
16
Q
Symptoms
What are negative symptoms
A
Involve loss of usual ability and experiences involving displaying of behaviours concerning disruptions of normal emotions and actions
17
Q
Symptoms
How do negative symptoms occur
A
In longer lasting episodes
18
Q
Symptoms
How do negative symptoms respond to medication
A
Resistant to it
19
Q
Symptoms
What else may a person also be affected w=by
A
Secondary symptoms or impairments such as depression
20
Q
Symptoms
What are the two positive symptoms need to know *
A
Delusions
Hallucinations
21
Q
Symptoms
What are delusions
A
Irrational beliefs which can tale a rampage of forms
22
Q
Symptoms
What are some common delusions
A
Delusions of grandeur which involve being an important historical political or religious figure such as Jesus
Delusions of being persecuted such as by governments or aliens
23
Q
Symptoms
How can decisions make a sufferer behave
A
In ways that make sense to them but seem bizarre to others
24
Q
Symptoms
What do some delusions led to
A
Aggression
25
Symptoms
What are hallucinations
Unusual sensory experiences
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Symptoms
What are some hallucinations related to
Events in the environment whereas other bear np relationships to what the senses are picking up such as vices heard either taking or commenting on the sufferer
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Symptoms
What two negative symptoms do need to know *
Speech poverty
Avolition
28
Symptoms
What is speech poverty
Patient uses as few words as possible and individual cannot express themselves effectively
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Symptoms
What is avolition
Loss of motivation to carry out tasks
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Symptoms
What does avoliton result in
Lowered activity levels, inability to make decisions,have no enthusiasm may lose interest ion personal hygiene
31
Classification and diagnosis
What do classification systems do
Classify abnormal patterns of thinking behaviour and emotion into mental disorders and give guidance on how to diagnose them
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Classification and diagnosis
What are the two widely used systems
ICD and DSM
33
Classification and diagnosis
What is used to classify or diagnosis schizophrenia
Doesn’t have single defining characteristic as is a cluster of symptoms some of which appear to be unrelated to
34
Classification and diagnosis
What are the five main subtypes of schizophrenia
Disorganised
Catatonic
Paranoid
Undifferentiated
Residual
35
Classification and diagnosis
What is disorganised schizophrenia
Behaviour is disorganised and not goal directed symptoms include disturbance,absence of emotions,mood swings and social withdrawal often in young adulthood
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Classification and diagnosis
What is catatonic schizophrenia
If patient has severe motor abnormalities such as unusual gestures or use of body languages
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Classification and diagnosis
What is paranoid schizophrenia
Involves delusions of various kinds however patient remains emotionally responsive and are more alert, tend to be argumentative
Later onset then other
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Classification and diagnosis
What is undifferentiated schizophrenia
Show symptoms of schizophrenia but don’t fit into the other types
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Classification and diagnosis
What is residual schizophrenia
Describes people who have had episode within last 6 months but symptoms not strong enough to be put in other symptoms
40
Classification and diagnosis
Why is it important to receive a reliable and valid diagnosis
Will go on to affects and individuals treatment and quality of life
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Classification and diagnosis
What does reliability mean
Consistency
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Classification and diagnosis
What are the two important types of reliability
Test retest reliability
Inter rater reliability
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Classification and diagnosis
What is test retest reliability
Occurs when a clinician males the same diagnosis on separate occasions from same information
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Classification and diagnosis
What is interrater reliability
Occurs when different clinicians make identical independent diagnoses of the same patient
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Classification and diagnosis
Research for reliability
Cheniaux et al
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Classification and diagnosis
What did cheniaux et al do
Had two psychiatrists diagnose 100patients using both the DSM and ICD criteria
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Classification and diagnosis
What did cheniaux et al find
Inter rater reliability was poor
One psychiatrist diagnosing 26 patient with schizophrenia according to DSM and 44 to ICD
Other diagnosed 13 according to DSM and 24 to ICD
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Classification and diagnosis
Which classification system is regarded as more reliable and why
DSM as symptoms outlined for each category is more specific
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Classification and diagnosis
What may come from diagnosis based on classification systems
Provides practitioners with a common language which may facilitate research and ultimately better understanding and treatment
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Classification and diagnosis
What does evidence suggest for reliability
Poor reliability but is improving as classification systems have been updated
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Classification and diagnosis
What is validity
Extent to which we are measuring what we intend to measure
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Classification and diagnosis
What are the 4 validity issues to consider
Criterion
Reliability
Predictive
Decriptive
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Classification and diagnosis
What is criterion validity
Where’d ifferent assessment systems arrive at the same diagnosis for the same patient
54
Classification and diagnosis
How is reliability linked to validity
A valid diagnosis must first be reliable although reliability doesnt guarantee validity
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Classification and diagnosis
What is predictive validity
If diagnosis leads to successful treatment diagnosis is seeen as valid
56
Classification and diagnosis
What is descriptive validity
To be valid patient with schizophrenia should differ in symptoms,protons from patients with other disorders
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Classification and diagnosis
Study for validity
Rosenhan
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Classification and diagnosis
What did rosenhan do
8 volunteers who didn’t suffer with mental illness presented themselves to different mental hospitals claiming to jhear voices
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Classification and diagnosis
What did rosenhamn find
Volunteers took between 7 and 52 days to be released , diagnosed as schizophrenic in remission
Normal behaviour interpreted as signs of schizophrenia
Concluded that the diagnosis of schizophrenia lacks validity as psychiatrists cannot distinguish between real and pseudo patients
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Classification and diagnosis
What is the effects of being labelled as schizophrenia
Long lasting negative effect on social relationships work prospects self esteem etc which seems unfair when diagnosis seem to have little evidence of validity
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Classification and diagnosis
What is co morbidity
Phenomenon when two or more conditions occur together
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Classification and diagnosis
What does comorbidity create problems with
Reliability of diagnosis as may be confusion over which actual disorder is being diagnosed
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Classification and diagnosis
What has been reported for schizophrenics with co morbid conditions what what does it suggest
Excluded from research and yet form the majority of patients suggests research findings into the cased of schizophrenia can’t be generalised to most sufferers
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Classification and diagnosis
What will this have an effect on
What treatments patients should receive
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Classification and diagnosis
What does conditions occurring together a lot of the time call into question
Validity of their diagnosis and classification as may actually be a single condition
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Classification and diagnosis
What is symptom overlap
When two or more condions share symptoms
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Classification and diagnosis
What does symptom overlap call into question
Validity of classification two disorders separately
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Classification and diagnosis
Wjhayt does schizophrenia have symptom overlap with
Other conditions such as bipolar as both involve positive symptoms like delusions and negative symptoms like avolition
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Classification and diagnosis
What could misdiagnosis due to symptom over 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
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Classification and diagnosis
What is gender bias in diagnosis
Some disagreement but some argue clinicians misapplied diagnostic criteria to women
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Classification and diagnosis
Research for geneder bias
Longnecker et al
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Classification and diagnosis
What did longenecker et al find
Reviewed studied of the prevalence of schizophrenia and concluded that since the 1980s men have been diagnosed with schizophrenia more often them women
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Classification and diagnosis
What two reasons may this be
Men are genetically vulnerable to develop schizophrenia
Or gender bias
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Classification and diagnosis
Why may females be less likely diagnose
Female patients typically funtion better then men eg have good family relationships
Better interpersonal functioning may bias practitioners to under diagnose schizophrenia
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Classification and diagnosis
What is also true for females
Tend to develop schizophrenia on average between 4 and 10 years later than males and females can develop a much later form of post menopausal schizophrenia suggesting there are different types
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Classification and diagnosis
What does this question
Validity of diagnosis
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Classification and diagnosis
What is culture bias in diagnosis
Concerns tendency to over diagnose member of other cultures as suffering from schizophrenia
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Classification and diagnosis
What os true in Britain for cultura bias
Those who are of African American decent are several times more likely to be diagnosed then white peoples
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Classification and diagnosis
Why is it not due to genetic vulnerability
As rater in Africa and West Indies are not particularly high
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Classification and diagnosis
Why may positive symptoms be more acceptable in African cultures
Because of cultural beliefs in communication with ancestors as people more ready to acknowledge such experiences
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Classification and diagnosis
What does this over diagnosis cast doubt on
Validity of diagnosis
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Explanations
What threee do need to know
Genetic explanation
Dopamine hypothesis
Neural correlates
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Genetic explanation
What does this explanation see schizophrenia as
Transmitted through hereditary means (DNA or genes passed through family )
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Genetic explanation
How is the evidence for a genetic link and why
Quite weak evidence because family members also share aspects of their environment as well as genes
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Genetic explanation
What are the three key terms
Candidate genes
Polygenic
Aetiologically heterogeneous
86
Genetic explanation
What does candidate genes mean
Several genes involved which increase overall vulnerability to developing schizophrenia
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Genetic explanation
Example of candidate gene
PCM1
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Genetic explanation
What does polygenic mean
Number of genes each appear to confer a small increased risk of schizophrenia increased risk of schizophrenia with number of genes working in combination
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Genetic explanation
What does aetiologically heterogeneous mean
Different combinations of factors can lead to the condition
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Genetic explanation
How is genetic explaniton researched
Twin family and adoption study to assess concordance rates of developing schizophrenia
Gene mapping more recently used looms for genetic material common found among sufferers
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Genetic explanation
What have genes associated with increased risk oincluded
Genes linking with the functioning of a number of neurotransmitters including dopamine
92
Genetic explanation AO3
Strength
Researcher evidence
93
Genetic explanation AO3
What is the research evidence
Torres et al
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Genetic explanation AO3
What did Torrey et al review
Evidence from twin studies
95
Genetic explanation AO3
What did torrey et al find
If one MZ twin develops schizophrenia there a 28% chance the other twin will also
96
Genetic explanation AO3
What does this support
Idea that schizophrenia is inherited
97
Genetic explanation AO3
3 weaknesses
Problems with studies
Biological reductionism
Consequences of assuming a genetic cause
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Genetic explanation AO3
What is bad for twin studies
Whilst suggest a genetic factor in onset of schizophrenia they don’t consider the influence of social class and shared environmental influences
99
Genetic explanation AO3
Why must other factors be considered
No study has found 100% concordance rate between MZ twins so schizophrenia can’t just be cause by genetic
100
Genetic explanation AO3
What is not consistent for twin studies
Heritability estimates
101
Genetic explanation AO3
What may oversimplifying a complex disorder lead to
Loss of validity
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Genetic explanation AO3
What does explaining schizophrenia from a genetic basis not include
Analysis of social context or cognitive factors which might be implicated in the disorder
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Genetic explanation AO3
What does this mean
Genetic explanation can only ever form part of an explantion
104
Genetic explanation AO3
What might this explantion lead to
Feeling of family responsibility for the onset of schizophrenia which is unhelpful
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Genetic explanation AO3
What could this lead to
Very pessimistic outlook on life
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Dopamine hypothesis
What is the central idea
Neurotransmitter dopamine is liked to onset of the disorder
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Dopamine hypothesis
What effect for dopamine generally have
Excitatory effect and is associated to sensation of pleasure
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Dopamine hypothesis
Why has this theory developed
Antipsychotic drugs work by decreasing dopamine activity and these lessening symptoms of schizophrenia
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Dopamine hypothesis
What did the original version focus on
Hyperdopaminergia
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Dopamine hypothesis
Where has hyperdopaminergia been linked to
Subcortex
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Dopamine hypothesis
What might Hyperdopaminergia be associated with
Poverty of speech or auditory hallucination as around Broca’s area
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Dopamine hypothesis
What is the most recent version focused on
Hypodopaminergia
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Dopamine hypothesis
Where has hypodopaminergia been linked to
Cortex
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Dopamine hypothesis
What may hypodopaminergia in the cortex be responsible for
Thinking and decision making so negative symptoms
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Dopamine hypothesis
What is the difference between Hyperdopaminergia and hypodopaminergia
Hyper is high levels of
Hypo is high levels
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Dopamine hypothesis AO3
Strength
Research support
117
Dopamine hypothesis AO3
What is the research support
Randrup and munkvad
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Dopamine hypothesis AO3
What did randrup and munkvad do
Created schizophrenic like behaviour in rats by giving them amphetamines which activate dopamine production
They then reversed the effects by giving them neuroleptic drugs which inhibit the release of serotonin
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Dopamine hypothesis AO3
What dos this support
Dopamine hypothesis
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Dopamine hypothesis AO3
3 limitations
Evidence is inconclusive
Oversimplistic
Biological redcutiomism
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Dopamine hypothesis AO3
Where is there no consistent difference
Between drug free schizophrenics and non sufferers
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Dopamine hypothesis AO3
What other neurotransmitters may be implicated
Glutamate and serotonin
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Dopamine hypothesis AO3
What does dopamine seem to be more associated with and what does this mean
Positive symptoms so may only contribute to certain aspects of the disorder or only certain types of schizophrenia
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Dopamine hypothesis AO3
What does this mean for the dopamine hypothesis
May be accused of being oversimplistic as many other neurotransmitters may also be involved in development of the disorder
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Dopamine hypothesis AO3
What may oversimplifying a complex disorder lead to
Loss of validity
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Dopamine hypothesis AO3
What does explains schizophrenia to a biological basis not include
Analysis of social context or cognitive factors which may be implicated in the disorder
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Dopamine hypothesis AO3
What’s does this mean
Can only ever form part of an explanation
128
Neural correlates
How does this explain schizophrenia
Abnormalities within specific brain ares may be associated with the development of schizophrenia
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Neural correlates
Where is evidence for this explantion from
Originally only post mortem so but now fMRI scans are used to get a picture of the brain in action through the use of magnetic fields and radio waves
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Neural correlates
How can links between functioning of brain be made
Comparing functioning of brains of schizophrenics to non sufferers to identify brain areas
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Neural correlates
What is an important consideration
Whether brain abnormalities found in schizophrenics are caused by genetic factors or are a result of the disorder itself
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Neural correlates
What two things have neural correlates
Positve and negative symptoms
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Neural correlates
What is a neural correlate of negative symptoms
Activity in the ventral straitum
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Neural correlates
How does activity in ventral straitum relate to avolition
Motivation involves anticipation to a reward and the ventral straitum is believed to be involved in this so abnormalities in this are may be involved
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Neural correlates
What evidence for negative symptom nearly correlate and what found
Juckel et al found lower levels of activity in the ventral straitum in schizophrenic than controls
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Neural correlates
What is a neural correlate of Positve symptoms
Reduced activity in the superior temporal gyrus and the anterior cingulate gyruas as a neural correlates of auditory hallucination
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Neural correlates
What did a reach do for Positve neural correlate
Allen et al scanned the brains of patients experiencing auditory hallucinations and compared them to a control group whilst they indentured prerecorded speech as theirs or others
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Neural correlates
What Did Allen et al find
Low activation levels in the superior temporal gyrus and anterior cingulate gyrus were found in the hallucination group and hallucinogenic group also made more errors then the control group
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Neural correlates AO3
1 strength
Research evidence
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Neural correlates AO3
What eveidne is there
Large amount of research linking structure and activity in the brain with having schizophrenia
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Neural correlates AO3
What si example for research
Juckelet al and Allen et al
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Neural correlates AO3
What does a this back up
Idea that there is some abnormality in the specific brain areas in schizophrenics
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Neural correlates AO3
3 limitations
Inconsistency in research findings
Causal correlation problems
Unclear picture
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Neural correlates AO3
Example for inconsistency in research findings
Some non schizophrenics have enlarged ventricles whilst not all do
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Neural correlates AO3
What does consideration need to be given too
Environmental factors such as substance abuse and stress levels a which may have a damaging influence upon brain tissue
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Neural correlates AO3
Why may studies not be useful in flagging up particular brain systems that arent working normally
Evidence leaves some important questions unanswered
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Neural correlates AO3]
What is important question about usual activity
Does the unusual activity in a region of the brain actually cause the symptom
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Neural correlates AO3
What is the issue with cause and correlation
Perhaps something wrong in the ventral straitum is causing the negative symptoms or it the negative symptoms themselves are resulting in less information passing through the straitum and therefore reduced activity
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Neural correlates AO3
What could other factors be doing
Causing the negative symptoms and the reduce activity
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Neural correlates AO3
What does this mean
The existence of neural correlates tells us relatively little in itself
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Neural correlates AO3
Who don’t respond to medication who mainly exhibits enlarged ventricles
Schizophrenics
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Neural correlates AO3
What could this mean
That it is the effect of suffering from schizophrenia over a long period that leads to physical brain damage rather than brain damage leading to schizophrenia
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Neural correlates AO3
Why may it be that schizophrenic patients don’t respond to mediation
Because structural brain damage doesn’t allow antipsychotic medications to have a therapeutic effect on reducing symptom levels
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Family dysfunction explanation
What does is think causes or influences the development of schizophrenia
Maladaptive relationships and patterns of communications within families as sources pf stress
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Family dysfunction explanation
What are the three parts
Schizophrenogenic mother
Double bind
Expressed emotion
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Family dysfunction explanation
What approach does the schizophrenogenic use
Psychodynamic
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Family dysfunction explanation
What is the schizophrenogenic mother
Cold rejecting and controlling
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Family dysfunction explanation
What is the dad in the schizophrenogenic mother explanation
Often passive
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Family dysfunction explanation
What is the family climate characterised by in the schizophrenogenic mother
Tension and secrecy
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Family dysfunction explanation
What does tensions and secrec in family lead to
Distrust which develops into paranoid delusions and then schizophrenia
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Family dysfunction explanation
What does the double bind theory emphasis
Family climate and role of communication style within a family
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Family dysfunction explanation
What happens to children in the double bind theory
Often places in contradictory situations by parents so fears doing wrong this and unable to seek clarification
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Family dysfunction explanation
What happens when children get it wrong
Punishment is withdrawal of love
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Family dysfunction explanation
What may his lead to
See world as confusing uncertain and dangerous often reflected in symptoms like disorganised thinking and paranoid delusions (negative symptoms symptoms )
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Family dysfunction explanation
What is expressed emotion
Level of emotion in particular negative emotion expressed towards a patient by their carers
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Family dysfunction explanation
What three elements does expressed emotions contain
Verbal criticism of the patient occasionally accompanied by violence
Hostility towards the patient including anger and rejection
Emotional over involvement in the life of the patient including needless self sacrifice
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Family dysfunction explanation
What are the high levels of expressed emotion towards the patient a source of
Serious stress
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Family dysfunction explanation
What is the double bind theory primarily and explantion for
Relapse
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Family dysfunction explanation
What else may it be a source of stress for
Trigger on set of schizophrenia in a vulnerable person
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Family dysfunction explanation AO3
1 strength
Research support
171
Family dysfunction explanation AO3
What is the research support
Read et al
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Family dysfunction explanation AO3
What did read et al do and find
Reviewed 46 studies of child abuse and schizophrenia and concluded that 69% of adult women in patients with a diagnosis of schizophrenia had a history of abuse
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Family dysfunction explanation AO3
What does this support
Idea that family dysfunction is linked to the onset of schizophrenia
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Family dysfunction explanation AO3
3 limitations
Lack of evidence and parent blaming isn’t helpful
Problems with cause and 3ffect
Incomplete explanation
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Family dysfunction explanation AO3
What is there no evidence for
Supporting the importance of the schizophrenogenic mother or double bind
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Family dysfunction explanation AO3
What is the schizophrenogenic mother and double bind theory based on
Clinical observations of patients and assessing the personality of the mothers of parents for crazy making characteristics which is not reliable
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Family dysfunction explanation AO3
What can dysfunctional family explantions lead to
Parent blaming
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Family dysfunction explanation AO3
Why is parent blaming unhelpful
Parents have already suffered seeming their child’s decent into schizophrenia and are also likely to bear lifelong responsibility for their care then undergo furhter trauma by receiving blames
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Family dysfunction explanation AO3
What has this led to
Decline of the schizophrenogenic mother and double bind theories
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Family dysfunction explanation AO3
What are the problems with cause and effect
Unsure that the dysfunctional family has caused schizophrenia and it is not the stress on have a schizophrenic in the family which has caused the dysfunction
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Family dysfunction explanation AO3
What is a key problem with the family dysfunction theory
Fails to explain why all children in such families often don’t go on to develop schizophrenia
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Family dysfunction explanation AO3
What does thus mean
Other factors must be involved and family dysfunction is therefore an incomplete explanation
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Cognitive explanation
What type of explanation is it
Psychological
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Cognitive explanation
What dies this explantion focus on
Role of maladaptive thought processes
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Cognitive explanation
When do cognitive deficits occur
Where sufferers experience problems with attention communication and information overload
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Cognitive explanation
Why may Positve symptoms occur
Because of cognitive biases (thinking in irrational ways ) or because of biased information processeing
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Cognitive explanation
Why may negative symptoms occur
Because of cognitive strategies to control the high level of mental stimulation not expressing themselves levels and withdrawing may be a strategy to control the levels of emotion being experienced
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Cognitive explanation
What two kinds of dysfunctional though processing have been identified whoich could underlie some symptoms
Meta representation problems
Central control problems
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Cognitive explanation
What is meta representation
Cognitive ability to reflect on thoughts behaviour and experience
Allows us self awareness and insight into our own intentions, goals and interpretation of others
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Cognitive explanation
What does dysfunction in meta representation disrupt
Ability to recognise our own actions and thoughts as carried out by ourselves rather than someone else
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Cognitive explanation
What three symptoms can be explained meta representation problems
Hearing voices
Delusion of thought insertion
Delusion of being persecuted
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Cognitive explanation
How can hearing voices be explained by meta representation problems
Failure of meta representation means the patient is unable to distinguish speech heard externally from a thought generated in their own mind
Think something and cannot tell accurately whether they or someone else said it
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Cognitive explanation
How can the delusion of though insertion be explained by meta representation problems
Patient believes they thought come from sole one else can be explained in the same way
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Cognitive explanation
How can the delusion of being persecuted be explained by meta representation problems
Could be explained by meta representation failure as we require it to make judgements about others intentions
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Cognitive explanation
What is the central control
Cognitive ability to suppress automatic responses to stimuli while we perform deliberate actions that reflect our wishes or intentions
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Cognitive explanation
What do we do whenever we want to achieve something
Suppress the brain systems responsible for stimulus driven behaviour and activate those responsible for willed behaviour
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Cognitive explanation
What symptoms can be explained by central control problems
Disorganised thinking
Disorganised speech
Derailment
Clanging
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Cognitive explanation
How can disorganised behaviour be explained by central control problems
Result from a failure to regulate willed and stimulus driven behaviour
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Cognitive explanation
How can disorganised speech be explained by central control problems
Could result from the inability to suppress automatic thoughts and speech triggered from other thoughts
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Cognitive explanation
How can derailment be explained by central control problems
Each word triggers associations dn the patient cannot suppress automatic responses to these
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Cognitive explanation
What is clanging
Patient takes one word in a sentence and drifts from the sentence into words associated eg rhyming
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Cognitive explanation AO3
1 strength
Reseach evidence
203
Cognitive explanation AO3
What is there strong support for
Idea that information is processed differently in the mind of schizophrenia sufferers
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Cognitive explanation AO3
What is the research support
Stirling et al
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Cognitive explanation AO3
What did Stirling et al do
Compared 30 schizophrenics with 18 controls on a range of cognitive tasks eg stroop test (name ink colour to suppress impulse to read the words
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Cognitive explanation AO3
What did Stirling et al find
Patients took twice as long to name the ink colour as the control group
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Cognitive explanation AO3
What does this support
Theory of central control dysfunction
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Cognitive explanation AO3
3 limitations
Directions of causality
Real life application
Individual blaming
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Cognitive explanation AO3
What remains unclear
What causes what from abnormal cognitions in schizophrenia but remains unclear what causes what
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Cognitive explanation AO3
What is difficult
Conlusion as to whether cognitive factors are a cause or result of the neural correlates seen on schizophrenia
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Cognitive explanation AO3
What do some studies show for CBT
Can be effective in schizophrenia supporting an involvement of cognitive factors in the disorder
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Cognitive explanation AO3
What does highlighting meta cognition as important indicate therapies will need to concentrate on
Improving meta cognitive abilities to be effective
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Cognitive explanation AO3
What does this mean for the therapy
Could be targeted as specific areas of meta cognitive impairment to best suit needs of patient
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Cognitive explanation AO3
Why is this a strength
May increase effectiveness of treatment and allow sufferers to access a more normal life
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Cognitive explanation AO3
What do cognitive explanations sometimes lead to
Blaming the individual and making them actively responsible for their symptoms
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Cognitive explanation AO3
What does this contrast to
Biological explantions which people may feel there less control over
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Cognitive explanation AO3
Why is this unhelpful
Can put even more stress on the sufferer
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Cognitive behaviour therapy
What is it
Main psychological treatment used with schizophrenia
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Cognitive behaviour therapy
How long does it normally take
Between 12 to 20 sessions
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Cognitive behaviour therapy
What is the main aim
To help patients identify irrational thoughts, maladaptive thinking and distorted perceptions and try to change them
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Cognitive behaviour therapy
What do beliefs expectations and cognitive ideas affect
How individuals perceive themselves
How problmeas are approached
How successful people are ion coping and reacting goals
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Cognitive behaviour therapy
How does it aim to help schizophrenics
Help by changing maladaptive thinking and distorted perceptions seen as underpinning the disorder in order to modify hallucinations and delusional Beliefs
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Cognitive behaviour therapy
How might these be disputed
By argument or discussions of how likely the beliefs are to be true
Considerations of less threatening alternate explanations
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Cognitive behaviour therapy
What are coping strategies used for
Dealing with symptoms eg Positve self talk
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Cognitive behaviour therapy
What is the ABCDE framework for cognitive restructuring
A activating event
B beliefs
C consequences
D disputing irrational beliefs
E effect
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Cognitive behaviour therapy
What are used alongside
Antipsychotic drugs
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Cognitive behaviour therapy AO3
2 strengths
Effective treatment
Less side effects
228
Cognitive behaviour therapy AO3
What supports cas3 for double treatment
Evidence suggesting that CBT plus antipsychotics is effective in treating schizophrenia then drugs or CBT alone
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Cognitive behaviour therapy AO3
What does CBT mean for patients
Helps to make schizophrenia more manageable and improve quality of life
Can make sense of and challenge some symptoms
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Cognitive behaviour therapy AO3
What side effects can antipsychotics have
Weight gain and blurred visions
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Cognitive behaviour therapy AO3
Why is no side effects as strength
Less impact on constsnt day to day live
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Cognitive behaviour therapy AO3
2 limitations
Expensive
Not sutiable for all patients
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Cognitive behaviour therapy AO3
Why si the expense an issue for nhs
At time of reduced healthcare budgets
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Cognitive behaviour therapy AO3
Why is expense a limitation for patient
May not able able to afford to consistently go
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Cognitive behaviour therapy AO3
Who may CBT not be suitable for
Patients who are too disoriented agitated or paranoid to form trusting alliances with practitioners
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Cognitive behaviour therapy AO3
What does CBT require
Self awareness and willingness to engage with process as positive symptoms lead to lack of awareness and negative symptoms lead to reluctance or inability to engage
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Cognitive behaviour therapy AO3
Why si this a limitation
Not all clients are suited to vigorous confrontations
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Family therapy
What is it a form of
Psychotherapy
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Family therapy
What is it based on
Assumption that family dysfunction can play a role in development of schizophrenia and involves who,e family not just the patient
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Family therapy
What does it focus on
Altering relationships and communication within dysfunctional families to try to lower levels of expressed emotions
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Family therapy
What does it do to try to lower levels of emotion
Improve Positve and negative forms of communication
Increase tolerance levels and decrease criticism levels between family members
Decrease feelings of guilt and responsibility for causing the illness among family members
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Family therapy
What did pharaoh et al do
Identified a range of strategies used by family therapists to improve family functioning where there is a schizophrenic family member
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Family therapy
What strategies did pharaoh et al identify
Forming therapeutic alliance with all family members
Improving ability of family to anticipate and solve problems
Help family members and achieve balance between caring and mainting lives
Reduce stress of caring
Reductions of anger and guilt
Improve families beliefs about behaviour towards schizophrenia
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Family therapy AO3
2 strengths
Family assistance
More cost effective
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Family therapy AO3
Which patients can it be useful for
Patients who lack insight into illness or cannot speak coherently about i
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Family therapy AO3
How can family members assist here
Family members Have lots of useful information and insight into a patients behaviour and moods and can often speak for them
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Family therapy AO3
Why is this a strength
As well as decreasing replace rates and lowering the need for hospitalisation family therapy can educate family members t help mange a patients medication regime
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Family therapy AO3
Why is this more cost effective
Family members help manage a patients medication regime and decreasing need for clinicians to do this
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Family therapy AO3
What is it cheaper then
Other treatments such as CBT
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Family therapy AO3
Why is cost effectiveness a strength
Mean more accessible to more patients and improve for of their quality of life
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Family therapy AO3
2 limitations
Family tension
Not a cure
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Family therapy AO3
What can be an issue
Emphasis on openness can be an issue if members reluctant to share sensitive information
Also may open family tension
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Family therapy AO3
Why is this a limitation
Lowers the effectiveness’s of the treatment s
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Family therapy AO3
Why can it not be considered a cure
Whilst family therapy helps by reducing the stress of living with schizophrenia in a family doesnt cure schizophrenia
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Family therapy AO3
Why may it not be considered a cure
Although coibantion of drug and family therapy is desirable often not possible due to const restraints so other treatment such as drugs may be better if possible
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Token economies
What are they a form of
Behavioural therapy
Behaviour modification
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Token economies
What is it based on
Principles of operant conditioning g
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Token economies
What is the aim
To use reinforcement to encourage desirable behaviour and change behaviour cor the better to improve patients quality of life
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Token economies
Who si it particularly aimed at
Those with negative symptoms who have developed patterns of maladaptive behaviour thought institutionalisation eg bad hygiene
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Token economies
How is the idea of generalisation in learning theory apoplied
Idea that desired behaviour once reinforced in an institution would be generalised to the outside world , intention of treatment that more natural reinforcers will eventually replace the tokens
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Token economies
What is it more likely for patients
To live outside of a hospital setting
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Token economies
How does it work (long )
List of target behaviours to be reinforced drawn up
Patient receives a token immediately after carrying out desired behaviour
Tokens have no value in themselves but can be saved up and swapped for more desirable and tangible rewards
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Token economies
Why is immediacy of giving the token important
To prevent delay discounting, effect of reward is reduced if reward delayed
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Token economies
What are secondary reinforcers
The tokens
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Token economies
What are primary reinforcers
Reward
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Token economies
What does the rewards have to be for the technique to work
Desirable to the patient
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Token economies AO3
2 strengths
Effective treatment
Staff-patient environment
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Token economies AO3
What has the use of tokens shown
Considerable success in psychiatric institutions
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Token economies AO3
What behaviour have shown improvement
Self care and prosocial behaviour
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Token economies AO3
What does this mean for the patients
Makes schizophrenia more manageable and can improve patients quality of life
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Token economies AO3
Why is this a strength
Helps make their behaviour more socially acceptable so they can better reintegrate into society
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Token economies AO3
What does it mean for staff and patient interaction
Becomes more Positve
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Token economies AO3
What do token economies facilitate
A safer more stable therapeutic environment
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Token economies AO3
Why is this a strength
Staff and patient injuries reduce, less staff absenteeism and emergency incidents
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Token economies AO3
2 limitations
Dependency
Ethical issues
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Token economies AO3
What may token lead to
Dependency whereby patients only produce desired behaviour to receive tokens
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Token economies AO3
What can there be problems with
Transferring behaviour to outside world as everyday reinforcement is much more subtle and often delayed
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Token economies AO3
What may this lead to
High re admittance rates
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Token economies AO3
Why are tokens not a cure
May onl change behaviour in the short term as it doesnt address underlying causes
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Token economies AO3
What can be argued
Behaviour is on you changed superficially not the patients actual thin,ing so should not be seen as a treatment in itself
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Token economies AO3
When does it work best
When combine with other treatments such as antipsychotic drugs
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Token economies AO3
What ethical issues are associated with
Differences between patients
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Token economies AO3
What is true for patients with more old symptoms
Have more access to privileges and services (the rewards )
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Token economies AO3
What is true for those with more severe symptoms
Symptoms prevent them from complying with desirable behaviour and miss out on rewatrds
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Token economies AO3
Why is this a limitation
Lead to discrimination and may delay treatment s
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Drug therapy
When is it used
As most common treatments for schizophrenia involves use of antipsychotic drugs
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Drug therapy
How are antipsychotic taken
Can be taken as tablet or syrup or injection
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Drug therapy
Is the effects long term
Can be long or short term
For some symptoms don’t return other need to take them fr life
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Drug therapy
What are drugs divided into
Typical and atypical
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Drug therapy
What is the example of an typical antipsychotic
Chlorpromazine
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Drug therapy typical antipsychotic
What do typical do
Reduce dopamine activity by blocking dopamine receptors at the synapse
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Drug therapy typical antipsychotic
What symptoms do typical effect
Positive like hallucinations and delusion
Also have sedative effect
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Drug therapy typical antipsychotic
What are typical taken as
Tablets syrups or injection
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Drug therapy typical antipsychotic
How is dosage decided
Initial small dose and increased until max of 1000
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Drug therapy typical antipsychotic
What effect do typical have
Major effect by enabling many people with schizophrenia to live relatively normal lives outside mental institutions
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Drug therapy typical antipsychotic
What neurotransmitter do they work on
Dopamine
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Drug therapy typical antipsychotic
How do they effect the dopamine system
Reduce dopamine actives by blocking receptors at the synapse to normalise neurotransmittion in key areas
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Drug therapy typical antipsychotic
What can these drugs also act as
An effective sedative
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Drug therapy typical antipsychotic
When do patients start to see improvement
Symptoms such as hallucination and feelings of agitation tend to recur within a few days and delusion after weeks
Imprpvent after 6 weeks
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Drug therapy typical antipsychotic
What symptoms are associated
Dry mouth unrinatory problems constipation stiff jaw dizziness agitation sleepiness weight gain itchy skin visual disturbance low blood pressure problems with sexual function nasal congestion
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Drug therapy typical antipsychotic
What can be developed from long term use
15% of sufferers develop tardive dyskinesia which causes involuntary and uncontrolled muscles movements especially around the mouth and may be permanent
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Drug therapy atypical antipsychotic
What is example of an atypical
Clozapine
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Drug therapy atypical antipsychotic
How do atypical work
Bind to dopamine receptors and also serotonin and glutamate receptors
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Drug therapy atypical antipsychotic
Which symptoms do they act on
Negative and positive
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Drug therapy atypical antipsychotic
What is the aim of atypical
Suppress the symptoms of psychosis and minimise side effects
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Drug therapy atypical antipsychotic
When are they used
When other treatments failed
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Drug therapy atypical antipsychotic
What has to be done for patients who are on clozapine
Regular blood tests to ensure they’ve not developed agranulocytosis , a blood disorder with reduction of white blood cells
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Drug therapy atypical antipsychotic
How does daily dose compare to typical
Little lower
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Drug therapy atypical antipsychotic
How do they work
Bind to dopamine serotonin and glutamate receptors
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Drug therapy atypical antipsychotic
How does this reduce negative symptoms
Helps improve mood and reduce depression and anxiety
May also improve cognitive functioning
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Drug therapy atypical antipsychotic
What are dose effects of atypical
Weight gain malignant syndrome, life threatening neurological disorder, increased risk of stroke sudden cardiac death blood clots and diabetes
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Drug therapy AO3
1 strength
Effective as a way to reduce symptoms
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Drug therapy AO3
What is there evidence for
Support of idea that both typical and atypical antipsychotics are atleast moderatly effective in tackling symptoms of schizophrenia
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Drug therapy AO3
3 limitations
Side effect
Reliant on dopamine hypothesis
Drug companies
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Drug therapy AO3
What are the likelyhood of side effects
Very high ranging from mild to serious to fatal
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Drug therapy AO3
What are typical antipsychotics associated with
Range of side effects including dizziness agitation sleepiness stiff jaw and weight gain
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Drug therapy AO3
What can long term use of typical result in
Tardive dyskinesia caused by dopamine hypersensitive gives involuntary facial movement eg grimacing
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Drug therapy AO3
Why are side effects a weakness
Impact everyday life and may be worse then the original symptoms
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Drug therapy AO3
What does the use of antipsychotics depend on
Dopamine hypothesis
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Drug therapy AO3
What is a limitation of the original hypothesis
A lot of evidences to show not a complete explantion of schizophrenia
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Drug therapy AO3
Effect if dopamine in other area
Dopamine levels in other areas of the brain other than the subcortex are too low rather then too high
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Drug therapy AO3
Why is this a weakness
Unclear how antipsychotics would help ad they reduce dopamine activity
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Drug therapy AO3
What is a limitation for drug industry
Many within the psychiatric community who see the widespread use of antipsychotics as being fuelled by powerful incfluence of drug companies
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Drug therapy AO3
Why may drug companies try to push use of antipsychotics
To get profits made
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Drug therapy AO3
What may drug companies do to push use of antipsychotic
Skew drug trials to be in favour of the drug
Push ineffective drugs
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Drug therapy AO3
Why os this a limitation
Drug may not actually work
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Drug therapy AO3
Why os this a limitation
Drug may not actually work
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Interactionist approach
How do they see schizophrenia as developing and treated
Several interacting factors including biological and psychological View
View combination of different therapies as the best treatment
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Interactionist approach
What do bioligxakl factors include
Genetic vulnerability and neurological abnormality
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Interactionist approach
What do psychological factors include
Stress from life events and daily hassles including poor quality interactions
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Interactionist approach
What model do they use to explain the interactionist approach
Diathesis stress model
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Interactionist approach
What does Diathesis mean
Vulnerability
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Interactionist approach
What does stress mean
Negative psychological experience
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Interactionist approach
What does this model say is necessary to develop the condition
Botha a vulnerability to schizophrenia and stress trigger
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Interactionist approach
Who created the original model
Meehl
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Interactionist approach
What was the problem with Meehls original model
Oversimplistic
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Interactionist approach
What did meehl view the Diathesis as
Entirely genetic and result of a single schizogene this led to sensitivity to stress
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Interactionist approach
What did meehl view the stress as
Psychological in nature in particular relating to parenting
Eg chronic stress through childhood and adolescence particularly schizophrenogenic mother
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Interactionist approach
What does the modern model view Diathesis as
Many genes identified which slightly increase the vulnerability to developing schizophrenia
Also likely genetic factors are linked with faulty dopaminergic systems and to abnormal functioning of other neurotransmitters
Also may be psychological trauma
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Interactionist approach
How may psychological trauma lead to an underlying vulnerability
Early trauma such as child abuse can later the developing brain
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Interactionist approach
What is stress according to modern models
Anything that risks triggering schizophrenia psychological triggers such as family dysfunction, substance abuse or critical life events
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Interactionist approach
What substance abuse can act as a trigger
Cannabis use as interferes with dopamine system but not everyone develops schizophrenia from it so much have underlying vulnerability
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Interactionist approach
What does it believe the best treatment is
Combining antipsychotic medication and psychological therapies usuallyCBT
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Interactionist approach
What has to ve adopted to use a combination of treatments
The interactionist model eg if adopt a purely biological approach and tell patients there’s no psychological significance to their symptoms it wouldn’t make sense to treat them with CBT
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Interactionist approach
In Britain what is the view of combining treatment
Increasingly standard practice to treat patients with a combination of antipsychotics drugs and CBT
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Interactionist approach
In USA what is the view of combining treatment
Conflict between biological and psychological models so slower adoption of Interactionist approach, drugs without psychological treatment is more common
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Interactionist approach
What is the typical combination
Unusual to treat schizophrenia using psychological therapies alone CBT family therapy and token economy’s often carried out whilst patients takes antipsychotics
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Interactionist approach
What is the effectiveness of treatments dependent on
Factors such as cost relapse rates degree of side effects symptom reduction but research suggest a combination is generally most effective
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Interactionist approach
What is the combination of treatment used determined by
Each patients individual circumstances and needs
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Interactionist approach
What is generally done for combinging them
Antipsychotics given first to reduce symptoms so psychotic al treatment ewill have greater effect
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Interactionist approach
What is generally done for combinging them
Antipsychotics given first to reduce symptoms so psychotic al treatment ewill have greater effect
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Interactionist approach AO3
2 strengths
In line with knowledge of genes
Differential susceptibility
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Interactionist approach AO3
What do we know about genes
Genes cannot determine outcomes on their own they need a particular environment in which to express themselves
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Interactionist approach AO3
Example of genes not determine own outcomes
Genotype and phenotype
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Interactionist approach AO3
Example of candidate genes
PCM1
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Interactionist approach AO3
What does this mean
Therefore Genes that predispose someone to have increased vulnerability to schizophrenia cannot on their own cause the disorder they need particular stressors to be present to trigger the potential f the genes
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Interactionist approach AO3
Why is this a strength
In line with the Diathesis stress model
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Interactionist approach AO3
What is the differential susceptibityy of the model
Includes positive as well as negative environments
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Interactionist approach AO3
How is the different environments shown
An individual may have biological vulnerabilities combined with a stressor leading to schizophrenia however the same individual if exposed to a Positve environment such as a loving family could have better outcomes that reduce the chances of them becoming schizophrenic
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Interactionist approach AO3
2 limitations
Original Diathesis tress model is oversimple
Combination os treatments can be expensive
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Interactionist approach AO3
What is now known to be oversimplistic
Classic model of schizogene and schizophrenic parenting style as the major source of stress
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Interactionist approach AO3
Why is the Diathesis wrong
Multiple genes i crease vulnerability to schizophrenia each having a small effect on its own not a single schizogene
Can be th result of each trauma and genetic make up
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Interactionist approach AO3
Why is the stress wrong
Can come in many forms including but not limited to dysfunctional parenting including biological sources
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Interactionist approach AO3
Why is this a limitation
Therefore an incomplete explanation
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Interactionist approach AO3
Counter
Although co,violation of behavioural and cognitive therapy is effective
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Interactionist approach AO3
What is the problem.
Cost can be an issue
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Interactionist approach AO3
Why is this a limitation
Not all patients will be able to access the full range of the treatment
