schizophrenia

Question 1

what is meant by classification of mental disorder

Answer 1

process of organising symptoms based on which symptoms frequently cluster together

Question 2

what is schizophrenia

Answer 2

severe mental disorder where contact with reality and insight are impaired

Question 3

what are two major systems of classification of schizophrenia

Answer 3

-ICD-10
-DSM-5 (American)

Question 4

how many symptoms need to present for classification of SZ with DSM-5

Answer 4

one positive symptom

Question 5

how many symptoms need to be present for classification of SZ with ICD-10

Answer 5

two or more negative symptoms

Question 6

what are positive symptoms of SZ

Answer 6

atypical symptoms experienced in addition to normal experiences e.g. hallucinations and delusions

Question 7

what are hallucinations

Answer 7

sensory experiences that have either no basis in reality or a distorted perceptions of things that are there

Question 8

what are delusions

Answer 8

involve beliefs that have no basis in reality, e.g. a person believes they are a victim of a conspiracy

Question 9

what are negative symptoms of SZ

Answer 9

atypical experiences that represent the loss of usual experience such as speech poverty or avolition

Question 10

what is avolition

Answer 10

involves loss of motivation to carry out tasks and results in lowered activity levels

Question 11

what is speech poverty

Answer 11

involves reduced frequency and quality of speech

Question 12

evaluation 1- good reliability ( diagnosis and classification of SZ)

Answer 12

-strength
-its reliable
-A psychiatric diagnosis is said to be reliable when different diagnosing clinicians reach the same diagnosis for the same individual (inter-rater reliability) and when the same clinician reaches the same diagnosis for the same individual on two occasions (test-retest reliability).
-Osório reported excellent reliability for the diagnosis of SZ in 180 individuals using the DSM-5.
-Pairs of interviewers achieved inter-rater reliability of +. 97 and test-retest reliability of +.92.
-means that we can be reasonably sure that the diagnosis of SZ is consistently applied

Question 13

evaluation 2- low validity ( classification and diagnosis of SZ)

Answer 13

-limitation
-low validity
-Cheniaux had two psychiatrists independently assess the same 100 clients using ICD-10 and DSM-IV criteria and found that 68 were diagnosed with schizophrenia under the ICD system and 39 under DSM.
-suggests that SZ is either over- or underdiagnosed
-this suggests that criterion validity is low

Question 14

evaluation 3- counterpoint of low validity ( classification and diagnosis of SZ)

Answer 14

-Osório study reported above there was excellent agreement between clinicians when they used two measures to diagnose SZ from the DSM system.
-means that the criterion validity for diagnosing SZ is actually good when using the same diagnostic system

Question 15

evaluation 4- co morbidity (classification and diagnosis of SZ)

Answer 15

-limitation
-comorbidity with other conditions.
-SZ is commonly diagnosed with other conditions.
-e.g one review found that about half of those diagnosed with SZ also had a diagnosis of depression or substance abuse
-This is a problem for classification because it means SZ may not exist as a distinct condition, -also a problem for diagnosis as at least some people diagnosed with SZ may have unusual cases of conditions like depression.
-therefore ,if conditions occur together a lot of the time then this calls into question the validity

Question 16

evaluation 5- gender bias ( classification and diagnosis of SZ)

Answer 16

-limitation
-existence of gender bias.
-Since the 80s men have been diagnosed with SZ more commonly than women
-One possible explanation for this is that women are less vulnerable than men, perhaps because of genetic factors.
-seems more likely that women are underdiagnosed because they have closer relationships and hence get support
-This leads to women with SZ often functioning better than men.
-This underdiagnosis is a gender bias and means women may not therefore be receiving treatment and services that might benefit them

Question 17

evaluation 6- culture bias (classification and diagnosis of SZ)

Answer 17

-limitation
-existence of culture bias.
-Some symptoms of schizophrenia, particularly hearing voices, have different meanings in different cultures E.G. in Haiti some people believe that voices actually are communications from ancestors.
-British people of African-Caribbean origin are up to nine times as likely to receive a diagnosis as white British people although people living in African -Caribbean countries are not
-most likely explanation for this is culture bias in diagnosis of clients by psychiatrists from a different cultural background.
-This appears to lead to an overinterpretation of symptoms in black British people
-means that British African-Caribbean people may be discriminated against by a culturally-biased diagnostic system

Question 18

evaluation 7- symptom overlap (classification and diagnosis of SZ)

Answer 18

-limitation
-symptom overlap with other conditions.
- E.G. both SZ and bipolar disorder involve positive symptoms (such as delusions) and negative symptoms (such as avolition)
-SZ and bipolar disorder may not be two different conditions but variations of a single condition.
-In terms of diagnosis it means that schizophrenia is hard to distinguish from bipolar disorder
- therefore, both its classification and diagnosis are flawed

Question 19

what are the two biological explanations for schizophrenia

Answer 19

-genetic basis
- neural correlates

Question 20

family studies- genetic basis of SZ ( biological explanation of SZ)

Answer 20

-Family studies have confirmed that risk of schizophrenia increases in line with genetic similarity to a relative with the disorder.
-shown in Gottesman’s large-scale family study.
-e.g.someone with an aunt with schizophrenia has a 2% chance of developing it, increasing to 9% if the individual is a sibling and 48% if they are an identical twin.
-family members tend to share aspects of their environment as well as many of their genes, so the correlation represents both
-but family studies still give good support for the importance of genes in schizophrenia.

Question 21

candidate genes- genetic basis of SZ (biological explanation of SZ)

Answer 21

-Early research in this area looked for a single genetic variation in the belief that one faulty gene could explain schizophrenia.
-it appears that a number of different genes are involved, i.e. schizophrenia is polygenic.
-The most likely genes would be those coding for neurotransmitters including dopamine
-large study by Ripke et al combined all previous data from genome-wide studies of schizophrenia.
-The genetic make-up of 37,000 people with a diagnosis of schizophrenia was compared to that of 113,000 controls,
-108 separate genetic variations were associated with slightly increased risk of schizophrenia.
-schizophrenia is aetiologically heterogeneous, i.e. different combinations of factors can lead to the condition.

Question 22

the role of mutation - genetic basis of SZ (biological explanation of SZ)

Answer 22

-Schizophrenia can also have a genetic origin in the absence of a family history of the disorder.
-One explanation for this is mutation in parental DNA which can be caused by radiation, poison or viral infection.
-Evidence for mutation comes from positive correlations between paternal age ( increased risk of sperm mutation) and risk of schizophrenia, increasing from around 0.7% with fathers under 25 to over 2% in fathers over 50 (Brown et al).

Question 23

evaluation 1- research support ( genetic basis of SZ: biological explanation of SZ)

Answer 23

-strength
-strong evidence base.
-Family studies such as Gottesman show that risk increases with genetic similarity to a family member with schizophrenia.
-Adoption studies such as Tienari et al show that biological children of parents with schizophrenia are at heightened risk even if they grow up in an adoptive family.
-A recent twin study by Hilker et al showed a concordance rate of 33% for identical twins and 7% for non-identical twins.
-This shows that some people are more vulnerable to schizophrenia as a result of their genetic make-up.

Question 24

evaluation 2- environmental factors ( genetic basis of SZ: biological explanation of SZ)

Answer 24

-limitation
-there is clear evidence to show that environmental factors also increase the risk of developing schizophrenia.
-These environmental factors include both biological and psychological influences.
-Morgan et al-Biological risk factors include birth complications
and
-smoking THC-rich cannabis in teenage years (Di Forti et al ). -Psychological risk factors include childhood trauma which leaves people more vulnerable to adult mental health problems
-Mørkved found 67% of people with schizophrenia and related psychotic disorders reported at least one childhood trauma
-This means that genetic factors alone cannot provide a complete explanation for schizophrenia.

Question 25

what is meant by neural correlates

Answer 25

patterns of structure or activity in the brain that occur in conjunction with an experience and may be implicated in the origins of experience

Question 26

the original dopamine hypothesis- neural correlates (biological explanation of SZ)

Answer 26

-original hypothesis was based on the discovery that drugs used to treat schizophrenia caused symptoms similar to those in people with Parkinson’s disease, a condition associated with low DA levels (Seeman ).
-Therefore schizophrenia might be the result of high levels of DA (hyperdopaminergia) in subcortical areas of the brain.
-e.g. excess of DA receptors in pathways from the subcortex to Broca’s area (responsible for speech production) may explain specific symptoms such as poverty of speech and auditory hallucinations.

Question 27

updated version of dopamine hypothesis- neural correlates (biological explanation of SZ)

Answer 27

-Davis et al. proposed the addition of cortical hypodopaminergia
-This too can explain symptoms of schizophrenia.
-e.g. low DA in the prefrontal cortex (responsible for thinking) could explain cognitive problems i.e. negative symptoms of schizophrenia.
-It is suggested that cortical hypodopaminergia leads to subcortical hyperdopaminergia - so both high and low levels of DA in different brain regions are part of the updated version.
-it seems that both genetic variations and early experiences of stress, both psychological and physical, make some people more sensitive to cortical hypodopaminergia and hence subcortical hyperdopaminergia (Howes et al).

Question 28

evaluation 1- evidence for dopamine ( neural correlates : biological explanation of SZ)

Answer 28

-strength
-support for the idea that dopamine (DA) is involved in SZ
-amphetamines increase DA and worsen symptoms in people with schizophrenia and induce symptoms in people without (Curran). -antipsychotic drugs reduce DA activity and also reduce the intensity of symptoms (Tauscher).
-some candidate genes act on the production of DA or DA receptors.
-This strongly suggests that dopamine is involved in the symptoms of schizophrenia.

Question 29

evaluation 2- glutamate ( neural correlates : biological explanation of SZ)

Answer 29

-limitation
-there’s evidence for a central role of glutamate.
-Post-mortem and live scanning studies have consistently found raised levels of the neurotransmitter glutamate in several brain regions of people with SZ (McCutcheon).
-also, several candidate genes for SZ are believed to be involved in glutamate production or processing.
-This means that an equally strong case can be made for a role for other neurotransmitters.

Question 30

what are the 2 psychological explanations for SZ

Answer 30

-family dysfunction
-cognitive explanations

Question 31

what is meant by family dysfunction

Answer 31

-refers to processes within a family such as poor family communication, cold parenting and high levels of expressed emotion
-might be the risk factors for both development of schizophrenia and maintenance of it

Question 32

the schizophrenogenic mother- family dysfunction

Answer 32

-Fromm-Reichmann proposed a psychodynamic explanation for schizophrenia based on the accounts she heard from her patients about their childhoods.
-she noted that many of her patients spoke of a schizophrenogenic mother.
-‘Schizophrenogenic’ literally means ‘schizophrenia-causing’
-schizophrenogenic mother is cold, rejecting and controlling, and tends to create a family climate characterised by tension and secrecy.
-This leads to distrust that later develops into paranoid delusions and ultimately schizophrenia

Question 33

double bind theory- family dysfunction

Answer 33

-Bateson et al agreed emphasised the role of communication style within a family.
-The developing child regularly finds themselves trapped in situations where they fear doing the wrong thing, but receive mixed messages about what this is, and feel unable to comment on the unfairness of this situation or seek clarification.
-When they ‘get it wrong’ the child is punished by withdrawal of love.
-This leaves them with an understanding of the world as confusing and dangerous, and this is reflected in symptoms like disorganised thinking and paranoid delusions.

Question 34

expressed emotion- family dysfunction

Answer 34

-Expressed emotion (EE) is the level of negative emotion, expressed towards a person with schizophrenia by their carers who are often family members.
-EE contains several elements:
* Verbal criticism of the person, occasionally accompanied by violence.
* Hostility towards the person, including anger and rejection.
* Emotional overinvolvement in the life of the person, including needless self-sacrifice.
-These high levels of expressed emotion are a serious source of stress for them.
-This is primarily an explanation for relapse in people with schizophrenia.
-it has been suggested that it may be a source of stress that can trigger the onset of schizophrenia in a person who is already vulnerable due to their genetic make-up

Question 35

evaluation 1- research support ( family dysfunction: psychological explanations for SZ)

Answer 35

-strength
-evidence linking family dysfunction to schizophrenia.
-Indicators of family dysfunction include insecure attachment and exposure to childhood trauma, especially abuse.
-Read et al = adults with schizophrenia are disproportionately likely to have insecure attachment
-Read et al. also reported that 69% of women and 59% of men with schizophrenia have a history of physical and/or sexual abuse.
-In the Morkved et al study most adults with schizophrenia reported at least one childhood trauma, mostly abuse.
-This strongly suggests that family dysfunction makes people more vulnerable to schizophrenia.

Question 36

evaluation 2-explanations lack support ( family dysfunction: psychological explanations for SZ)

Answer 36

-limitation
-poor evidence base for any of the explanations.
-there is almost none to support the importance of traditional family-based theories such as the schizophrenogenic mother and double bind.
-Both these theories are based on clinical observation of people with schizophrenia and not systematic evidence.
-This means that family explanations have not been able to account for the link between childhood trauma and schizophrenia.

Question 37

what is meant by cognitive explanations

Answer 37

explanations that focus on mental processes such as thinking,language and attention

Question 38

dysfunctional thinking- cognitive explanations

Answer 38

-Schizophrenia is associated with several types of dysfunctional thought processing, and these can provide possible explanations for schizophrenia as a whole.
-Schizophrenia is characterised by disruption to normal thought processing.
-Reduced thought processing in the ventral striatum is associated with negative symptoms, whilst reduced processing of information in the temporal and cingulate gyri is associated with hallucinations
-This suggests that cognition is likely to be impaired

Question 39

meta-representation dysfunction - cognitive explanations

Answer 39

-frith identified two kinds of dysfunctional thought processes.
-The first is metarepresentation, the cognitive ability to reflect on thoughts and behaviour.
-allows us insight into our own intentions,goals and interpret the actions of others.
-Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves
-This would explain hallucinations of hearing voices and delusions

Question 40

central control dysfunction- cognitive explanations (psychological explanations for SZ)

Answer 40

-Frith et al identified issues with the cognitive ability to suppress automatic responses while we perform deliberate actions.
-Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts.

Question 41

evaluation 1- research support ( cognitive explanations: psychological explanations for SZ)

Answer 41

-strength
-evidence for dysfunctional thought processing
-Stirling et al compared performance on a range of cognitive tasks in 30 people with schizophrenia and a control group of 30 people without schizophrenia.
-Tasks included the Stroop task in which participants have to name the font-colours of colour-words so have to suppress the tendency to read the words aloud.
-people with schizophrenia took longer - over twice as long on average - to name the font-colours.
-This means that the cognitive processes of people with schizophrenia are impaired.

Question 42

evaluation 2- a proximal explanation ( cognitive explanations: psychological explanations for SZ)

Answer 42

-limitation
-they only explain the proximal origins of symptoms.
-Cognitive explanations for schizophrenia are proximal explanations because they explain what is happening now to produce symptoms but dont take in account factors within the past
-What is currently unclear is how genetic variation or childhood trauma might lead to problems with metarepresentation or central control.
-This means that cognitive theories on their own only provide partial explanations for schizophrenia.

Question 43

what are the therapies for schizophrenia

Answer 43

-biological therapy= drug therapy
-psychological therapy= CBT and family therapy

Question 44

what are antipsychotics ( drug therapy)

Answer 44

drugs used to reduce the intensity of symptoms, in particular the positive symptoms, of psychotic disorders like SZ

Question 45

what are the two types of antipsychotic drugs

Answer 45

-typical
-atypical

Question 46

what are typical antipsychotics

Answer 46

-around since 1950’s
-e.g. chlorpromazine
-act as a dopamine antagonist
-reduce symptoms such as hallucinations
-acts as a sedative

Question 47

how does chlorpromazine work

Answer 47

-acts as a dopamine antagonist.
-It acts against dopamine in this case blocking dopamine receptors at the postsynaptic receptor sites.
-This reduces the action of dopamine.
-Initially levels of dopamine build up in the synapse, but then production is reduced.

Question 48

side effects of typical antipsychotics

Answer 48

-dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin.
-More serious side effects = tardive dyskinesia and neuroleptic malignant syndrome, which can lead to death.

Question 49

Sedative effects of drug therapy (chlorpromazine)

Answer 49

-Chlorpromazine is also a sedative.
-This is linked to its effects on histamine receptors.
-The drug is used to calm SZ patients and others.

Question 50

1.what symptoms does chlorpromazine reduce
2. when is chlorpromazine usually administered
3.what form can chlorpromazine be taken in
4. what is the average dosage of chlorpromazine daily

Answer 50

1.reducing positive symptoms like hallucinations.
2.Used on initial admittance to hospital if very anxious.
3. tablets,syrup or injections
4. 400 to 800 mg

Question 51

what are atypical antipsychotics

Answer 51

-around since 1960s-80s
-made to improve the effectiveness of drugs in supressing the symptoms of psychosis and minimising side effects
-e.g. clozapine and risperidone

Question 52

what are the examples of atypical antipsychotics and what receptors they bind to

Answer 52

-clozapine= taken if typical drugs fail, thought to work on dopamine, serotonin and glutamine receptors, improves mood so can reduce suicide risk.
-Risperidone= less side effects than Clozapine, binds to dopamine and serotonin sites.

Question 53

1.side effects of clozapine
2.ways to administer clozapine
3. dosage of clozapine

Answer 53

1.agranulocytosis-blood condition
2.tablet or syrup
3.300-450mg

Question 54

1.side effects of risperidone
2.ways to administer risperidone
3. dosage of clozapine

Answer 54

1.no serious side effects
2.tablet, syrup or injection (last up to 2 weeks)
3.small dose is initially given and build up to a typical dose of 4-8mg (maximum is 12mg)

Question 55

evaluation 1- evidence for effectiveness ( drug therapy: biological therapy for SZ)

Answer 55

-strength
-evidence to support their effectiveness.
-There is evidence to support the idea that both typical and atypical antipsychotics are at least moderately effective in tackling the symptoms of schizophrenia.
-Thornley et al reviewed data from 13 trials with a total of 1121 participants showing that chlorpromazine was associated with better overall functioning and reduced symptom severity as compared to placebo.
-There is also evidence for the benefits of atypical antipsychotics.
-Meltzer concluded that clozapine is more effective than typical antipsychotics and other atypical antipsychotics, and that it is effective in 30-50% of treatment-resistant cases
-This means that, as far as we can tell, antipsychotics work.

Question 56

evaluation 2- counterpoint of evidence for effectiveness ( drug therapy: biological therapy for SZ)

Answer 56

-Healy has suggested serious flaws with evidence for effectiveness.
- e.g. most studies are of short-term effects only and some successful trials have had their data published multiple times, exaggerating the size of the evidence base for positive effects.
-Also, because antipsychotics have powerful calming effects, it is easy to demonstrate that they have some positive effect on people experiencing the symptoms of schizophrenia.
-This is not the same as saying they really reduce the severity of psychosis.
-This means that the evidence base for antipsychotic effectiveness is less impressive than it first appears.

Question 57

evaluation 3- serious side effects( drug therapy: biological therapy for SZ)

Answer 57

-limitation
-likelihood of side effects.
-Typical antipsychotics are associated with a range of side effects including dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin.
-Long-term use can result in tardive dyskinesia, which causes involuntary facial movements such as grimacing, blinking and lip-smacking.
-The most serious side effect of antipsychotics is neuroleptic malignant syndrome (NMS) which results in high temperature, delirium and coma, and can be fatal.
-This means that antipsychotics can do harm as well as good and individuals who experience these may avoid such treatments

Question 58

evaluation 4- mechanism unclear ( drug therapy: biological therapy for SZ)

Answer 58

-limitation
-we do not know why they work.
-Our understanding of the mechanism by which antipsychotic drugs work is tied up with the original dopamine hypothesis - symptoms of schizophrenia are linked to high levels of dopamine activity in the subcortex of the brain.
-we now know that this original dopamine hypothesis is not a complete explanation for schizophrenia
-Given that there are questions over the effectiveness of antipsychotics, this adds to the argument that in fact they are ineffective.
-This means that at least some of the antipsychotics may not be the best treatment to opt for - perhaps some other factor is involved in their apparent success.

Question 59

what are the 2 psychological therapies for SZ

Answer 59

-cognitive behaviour therapy
-family therapy

Question 60

what is CBT

Answer 60

-aims to deal with thinking, such as challenging negative thoughts
-deals with both thoughts (cognitions) and behaviour

Question 61

how many CBT sessions do individuals usually take

Answer 61

It usually takes place over a period of 5-20 sessions (this is longer than for other conditions),

Question 62

How cognitive behaviour therapy helps

Answer 62

-Help a client make sense of how their irrational cognitions (such as delusions and hallucinations) impact on their feelings and behaviour.
-Just understanding where symptoms come from can be hugely helpful for those with symptoms like auditory hallucinations.
-This will not eliminate the symptoms of schizophrenia but it can make people better able to cope with them. This in turn reduces their distress and improves their ability to function adequately.
-normalisation=People hearing voices can also be helped by teaching them that voice-hearing is an extension of the ordinary experience of thinking in words

Question 63

Example of how CBT helps

Answer 63

-For example, a client hears voices and believes the voices represent demonic forces, they will naturally be very afraid.
-If a therapist can convince them that the voice actually comes from the malfunctioning speech centre in their own brain and that it cannot hurt them if they ignore it, this is much less frightening and hence less debilitating.

Question 64

How can delusions be challenged using CBT

Answer 64

-process of reality testing in which the person with schizophrenia and their therapist jointly examine the likelihood that beliefs are true.
-In some cases where delusions are resistant to reality testing CBT can still be used to tackle the anxiety and depression that result from living with schizophrenia.

Question 65

evaluation 1- evidence of effectiveness( CBT: psychological therapy for SZ)

Answer 65

-strength
-there is evidence for its effectiveness.
-Jauhar et al. reviewed 34 studies of using CBT with schizophrenia, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms.
-also Pontillo et al found reductions in frequency and severity of auditory hallucinations.
-Clinical advice from NICE( National Institute for Health and Care Excellence) recommends CBT for schizophrenia.
-This means that both research and clinical experience support the benefits of CBT for schizophrenia.

Question 66

evaluation 2- quality of evidence ( CBT: psychological therapy for SZ)

Answer 66

-limitation
-there is wide range of techniques and symptoms included in studies.
-CBT techniques and schizophrenia symptoms vary widely from one case to another.
-Thomas points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms.
-The overall modest benefits of CBT probably conceal a wide variety of effects of different CBT techniques on different symptoms.
-This makes it hard to say how effective CBT will be for a particular person with schizophrenia.

Question 67

what is family therapy

Answer 67

-Takes place with families as well as the identified patient.
-The therapy aims to improve the quality of communication and interaction between family members.
-There is a range of approaches to family therapy for schizophrenia.

Question 68

How family therapy helps

Answer 68

Pharoah et al identified a range of strategies that family therapists use to try to improve the functioning of a family that has a member with schizophrenia.

Question 69

What are the strategies that family therapists use to improve family functioning

Answer 69

-Reduces negative emotions: Family therapy aims to reduce levels of expressed emotion (EE),Reducing stress is important to reduce the likelihood of relapse.

-Improves the family’s ability to help: The therapist encourages family members to form a therapeutic alliance whereby they all agree on the aims of therapy. A further aim is to ensure that family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.

Question 70

A model of practice for families dealing with SZ- Burbach ( family therapy: psychological therapy for SZ)

Answer 70

Phase 1-sharing basic information and providing emotional and practical support.
Phase 2 -involves identifying resources including what different family members can (and cannot) offer.
Phase 3- aims to encourage mutual understanding, creating a safe space for all family members to express their feelings.
Phase 4 -involves identifying unhelpful patterns of interaction.
Phase 5- is about skills training such as learning stress management techniques.
Phase 6- looks at relapse prevention planning.
Phase 7- is maintenance for the future.

Question 71

evaluation 1- evidence of effectiveness ( family therapy: psychological therapy for SZ)

Answer 71

-strength
-there is evidence of its effectiveness.
-McFarlane concluded that family therapy was one of the most consistently effective treatments available for schizophrenia.
-relapse rates were found to be reduced, typically by 50-60%.
-Clinical advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia.
-This means that family therapy is likely to be of benefit to people with both early and full-blown’ schizophrenia.

Question 72

evaluation 2- benefits to whole family ( family therapy: psychological therapy for SZ)

Answer 72

-strength
-benefits all family members.
-Lobban and Barrowclough concluded that families provide the bulk of care for people with schizophrenia.
-By strengthening the functioning of a whole family, family therapy lessens the negative impact of schizophrenia on other family members and strengthens the ability of the family to support the person with schizophrenia.
-This means that family therapy has wider benefits beyond the obvious positive impact on the identified patient.

Question 73

what is the management strategy for SZ

Answer 73

token economy

Question 74

what are token economies

Answer 74

-reward systems used to manage the behaviour of people with schizophrenia
-in particular those with maladaptive behaviour through spending long periods in psychiatric hospitals.

Question 75

What are token economies based on

Answer 75

operant conditioning

Question 76

What type of reinforcers are tokens

Answer 76

-secondary reinforcers
-as they only have value once the person receiving them has learned that they can be used to obtain meaningful rewards, such as sweets or a walk outside

Question 77

What type of reinforcers are rewards

Answer 77

-primary reinforcers.

Question 78

demonstration of a token economy carried out by Ayllon and Azrin (developing token economies with SZ)

Answer 78

-They trialled a token economy system in a ward of women with a diagnosis of schizophrenia.
-Every time the participants carried out a task such as making their bed or cleaning up they were given a plastic token which said ‘one gift’.
-These tokens could then be swapped for ward privileges, e.g.being able to watch a film.
-The number of tasks carried out increased significantly.

Question 79

Why are token economies not commonly used now in the UK

Answer 79

-declined because of the growth of community-based care and the closure of many psychiatric hospitals
-also because of the complex ethical issues raised by restricting rewards to people with mental disorders.
-However token economies still remain a standard approach to managing schizophrenia in many parts of the world.

Question 80

when does institutionalisation develop

Answer 80

develops under circumstances of prolonged hospitalisation.

Question 81

what are the outcomes of institutionalisation

Answer 81

One outcome is that people often develop bad habits,e.g. they might cease to maintain good hygiene or perhaps stop socialising with others. This is an understandable response to living without the kind of routine and small pleasures we experience in everyday life.

Question 82

What categories of behaviour did Matson identify were commonly tackled in Token economies

Answer 82

personal care, condition-related behaviours (e.g. apathy) and social behaviour.

Question 83

how are Matsons behaviours modified to benefit individuals with SZ

Answer 83

-Improves the person’s quality of life within the hospital setting,e.g social interaction for a usually sociable person.
-‘Normalises’ behaviour and this makes it easier for people who have spent a time in hospital to adapt back into life in the community,e.g. getting dressed in the morning or making their bed.

Question 84

What is involved in a token economy?

Answer 84

-given immediately to individuals when they have carried out a desirable behaviour.
-Target behaviours are decided on an individual basis
-it is important to know the person in order to identify the most appropriate target behaviours for them -Cooper et al
-tokens are swapped later for more tangible rewards.
-immediate reward for target behaviour is important because delayed rewards are less effective.
-Rewards in a hospital setting might include objects like sweets or magazines, or access to activities like a film or a walk outside, or perhaps an appointment with a social worker to plan for life after hospitalisation.

Question 85

token economies are an example of behaviour…………..- a behavioural therapy based on operant conditioning

Answer 85

modification

Question 86

evaluation 1- evidence of effectiveness ( token economy: management of SZ)

Answer 86

-strength
-evidence for their effectiveness.
-Glowacki et al identified seven high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues such as schizophrenia and involved patients living in a hospital setting.
-All the studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours.
-This supports the value of token economies.

Question 87

evaluation 2- counterpoint of evidence of effectiveness ( token economy: management of SZ)

Answer 87

-seven studies is quite a small evidence base to support the effectiveness of a technique.
-One issue with a small number of studies is the file drawer problem.
-This leads to a bias towards positive published findings because undesirable results have been ‘filed away”.
-This is a particular problem in reviews that only include a small numbers of studies.
-This means that there is a serious question over the evidence for the effectiveness of token economies.

Question 88

evaluation 3-ethical issues ( token economy: management of SZ)

Answer 88

-limitation
-ethical issues raised.
-because it gives professionals considerable power to control the behaviour of people in the role of patient.
-This involves imposing one person’s norms on to others, which is problematic
-e.g. someone who likes to look scruffy and get up late might have these personal freedoms curtailed.
-Perhaps more seriously, restricting the availability of pleasures (e.g. having sweets or seeing films) to people who don’t behave as desired means that seriously ill people, who are already experiencing distressing symptoms, have an even worse time.
-This means that the benefits of token economies may be outweighed by their impact on personal freedom and short-term reduction in quality of life.

Question 89

evaluation 4- alternative approaches ( token economy: management of SZ)

Answer 89

-limitation
-existence of more pleasant and ethical alternatives.
-other approaches with a comparable evidence base that do not raise the same ethical issues.
-e.g. Chiang et al concluded that art therapy might be a good alternative.
-there is evidence to show that art therapy is a high-gain low-risk approach to managing schizophrenia.
-art therapy is a pleasant experience without major risks of side effects or ethical abuses.
-NICE guidelines recommend art therapy for schizophrenia.
-This means that art therapy might be a good alternative to token economies.

Question 90

what is the interactionist approach

Answer 90

an approach that acknowledges that there are biological, psychological and social factors in the development of schizophrenia.

Question 91

what is the diathesis stress model - interactionist approach

Answer 91

-is one way to present an interactionist approach.
-Diathesis means vulnerability.
-The diathesis-stress model says that both a vulnerability to schizophrenia and a stress-trigger are necessary in order to develop the disorder.
-One or more underlying factors make a person particularly vulnerable to developing schizophrenia but it is triggered by stress.

Question 92

Meehl’s model-interactionist approach

Answer 92

-diathesis (vulnerability) was entirely genetic, the result of a single schizogene.
-This led to the idea of a biologically based schizotypic personality
-According to Meehl, if a person does not have the schizogene then no amount of stress would lead to schizophrenia.
-However, in carriers of the gene, chronic stress through childhood and adolescence,e.g. schizophrenogenic mother, could result in the development of the disorder.

Question 93

modern understanding of diathesis- interactionist approach

Answer 93

-it is now clear that many genes each appear to increase genetic vulnerability only slightly, there is no single ‘schizogene’ (Ripke et al).
-also include a range of factors beyond the genetic, including psychological trauma (Ingram and Luxton) - so trauma becomes the diathesis rather than the stressor
-Read et al proposed a neurodevelopmental model in which early trauma alters the developing brain.
-Early and severe enough trauma, such as child abuse, can seriously affect many aspects of brain development.
-For example the hypothalamic-pituitary-adrenal (HPA) system can become overactive, making a person much more vulnerable to later stress.

Question 94

modern understanding of stress- interactionist approach

Answer 94

-Although psychological stress, including that resulting from parenting may still be considered important, a modern definition of stress includes anything that risks triggering schizophrenia (Houston et al.).
-Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use.
-cannabis is a stressor because it increases the risk of schizophrenia by up to seven times according to dose.
-This may be because cannabis interferes with the dopamine system.
-However, most people do not develop schizophrenia after smoking cannabis presumably because they lack the requisite vulnerability factors.

Question 95

treatment according to the interactionist model

Answer 95

-The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia
-In particular the model is associated with combining antipsychotic medication and psychological therapies, most commonly CBT.
-Turkington point out that it is perfectly possible to believe in biological causes of schizophrenia and still practise CBT to relieve psychological symptoms.
-In Britain it is increasingly standard practice to treat people diagnosed with schizophrenia with a combination of antipsychotic drugs and CBT.
-In the US there is a slower adoption of an interactionist approach, thus medication without an accompanying psychological treatment is more common in the US than in the UK.

Question 96

evaluation 1- support for vulnerability and triggers ( interactionist approach)

Answer 96

-strength
-there’s evidence supporting the role of both vulnerability and triggers.
-Tienari et al followed 19,000 Finnish children whose biological mothers had been diagnosed with SZ
-In adulthood this high genetic risk group were compared to a control group of adoptees without a family history of SZ
-Adoptive parents had been assessed for child-rearing style and it was found that high levels of criticism, hostility and low levels of empathy were strongly associated with the development of SZ but only in the high genetic risk group.
-This shows that a combination of genetic vulnerability and family stress can lead to greatly increased risk of SZ

Question 97

evaluation 2- diathesis and stress are complex (interactionist approach)

Answer 97

-limitation
-original diathesis-stress model is oversimplified
-Multiple genes in multiple combinations influence diathesis and stress also comes in many forms
-diathesis can also be influenced by psychological factors and stress can be biological as well as psychological.
-shown in a study by Houston in which childhood sexual abuse was a major influence on vulnerability to SZ and cannabis use as the major trigger.
-This supports the modern understanding of both diathesis and stress.

Question 98

evaluation 3- real world application (interactionist approach)

Answer 98

-strength
-there are combinations of biological and psychological treatments.
-e.g. drug treatment and psychological therapies.
-Studies show that combining treatments enhances their effectiveness.
-e.g. Tarrier et al randomly allocated 315 participants to medication + CBT, medication + counselling, or control group (medication only).
-Participants in the two combination groups showed lower symptoms following the trial than the medication-only group.
-this means that there is a clear practical advantage to adopting an interactionist approach to SZ treatment

Question 99

evaluation 4-counterpoint of real world application ( interactionist approach)

Answer 99

-Jarvis and Okami point out that saying that a successful treatment for mental disorder justifies a particular explanation is the logical equivalent of saying that because alcohol reduces shyness, shyness is caused by lack of alcohol.
-This logical error is called the treatment-causation fallacy.
-Therefore we cannot automatically assume that the success of combined therapies means interactionist explanations are correct.