Schizophrenia Flashcards
(91 cards)
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Schizophrenia definition
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Schizophrenia is a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions, perceives reality, and relates to others.
•Schizophrenia is most often diagnosed between the ages of 15-35
•Schizophrenia affects about 1% of the population at some point in their lives.
•It is more commonly diagnosed in men, in cities and in the working-class population
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Classification
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A classification is a list of the symptoms of a disorder. Psychiatrists then use this list of symptoms to diagnose the disorder.
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Diagnosis
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Diagnosis is the process of identifying a specific type of mental health disorder.
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The two major systems for the classification of mental disorder are
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- ICD-11
- DSM-5
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Why is schizophrenia problematic to diagnose
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- does not have one defining characteristic but rather a cluster of seemingly unrelated symptoms.
- In addition, the ICD-11 and DSM-5 differ in their diagnosis
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How does ICD-11 diagnose
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Two or more negative symptoms for at least a one month
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How does DSM-5 diagnose
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At least one positive symptom for at least six months
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Positive symptoms
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refer to atypical symptoms experienced in addition to normal experiences
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Examples of positive symptoms
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- Hallucinations
- delusions
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Hallucinations
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Unusual sensory experiences
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Delusion
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Irrational beliefs
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Negative symptoms
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atypical symptoms that represent a loss to normal experiences
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Examples of negative symptoms
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- avolition
- speech poverty
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Avolition
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(apathy) is finding it difficult to begin or keep up with goal-directed activity.
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Speech poverty
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(alogia) is the lessening of speech fluency and productivity reflecting slow or blocked thoughts.
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reliability in the diagnosis of schizophrenia
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Reliability refers to the consistency.
There are two ways to assess reliability:
- Inter-rater reliability
-Test-retest reliability
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validity in the diagnosis of schizophrenia
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Validity refers to the extent that a diagnosis represents something that is real and distinct from other disorders and the extent that a classification system such as ICD-10 or DSM-5 measures what it claims to measure.
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Inter-rater reliability when diagnosing schizophrenia
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the extent to which psychiatrists can agree on the same diagnosis of schizophrenia when independently assessing patients
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Test-retest reliability was diagnosising schizophrenia
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the extent to which the same diagnostic tool e.g. DSM or ICD provides the same outcome over a period of time
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5 Issues with the validity of classification and diagnosis for schizophrenia
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- comorbity
- symptom overlap
- gender bias
- culture bias
- criterion validity
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Comorbidity
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When a person has a diagnosis of two different conditions
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Symptom overlap
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When a disorder shares its symptoms with other disorders
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Gender bias
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When the diagnostic system favours or misrepresents one gender.
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Culture bias
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When the diagnosis system favours or misrepresentations a culture
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Criterion validity
Whether the DSM and ICD reach the same outcome
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Family studies (genetic explantiom)
- schizophrenia runs in families through the inheritance of genes passed down through DNA.
- People do not inherit schizophrenia, but they inherit a genetic predisposition to the disorder.
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Concordance rates
- Concordance rates describes the presence of the same trait in both members of a pair of twins
- Evidence shows there is a strong relationship between the genetic similarity of family members and likelihood of both developing schizophrenia (concordance rate).
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Gottesman 1991
Gottesman (1991) carried out a family study and found the following concordance rates for schizophrenia:
- MZ = 48%
- DZ = 17%
- siblings = 9%
The results show that the closer the degree of genetic relatedness, the greater the risk of developing schizophrenia.
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why can schizophrenia be classed as polygenic
•no single gene is thought to be responsible.
•polygenic meaning many genes are involved. Each individual gene presents a small increased risk of schizophrenia.
- Ripke et al studied patients with schizophrenia and compared them to control group.108 separate genetic variations associated with increased of schizophrenia.
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why can schizophrenia be classed as aetiologically heterogenous
Different combinations of these genes in different people can lead to schizophrenia. It is therefore aetiologically (caused) heterogeneous (by different things).
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how can schizophrenia be caused by genetic mutations?
When people develop schizophrenia without any genetic link in their family it has been suggested it is caused a genetic mutation in sperm cells.
Eg. through radiation, poison or viral infections.
this risk is more likely if the father is older:
under 25 = 0.7%
over 50 = 2%
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Neural correlates
Neural correlates are when the structure or functioning of the brain is correlated (associated) with positive and negative symptoms of schizophrenia.
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Dopamine hypothesis
Research suggests that schizophrenia is caused by abnormal levels of the neurotransmitter dopamine.
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Original dopamine hypothesis (hyperdopaminergic)
- The original dopamine hypothesis stated that schizophrenia was caused by excessive activity of dopamine (hyperdopaminergia) in the subcortex.
- An excess of DA receptors in pathways from the sub cortex to Broca’s area may explain specific symptoms of schizophrenia, such as speech poverty and auditory hallucinations.
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Updated dopamine hypothesis (hypodopaminergic)
- Davis et al (1991) proposed that schizophrenia may also be caused by low activity of dopamine (hypodopaminergia) in the prefrontal cortex.
- This can explain more of the negative symptoms of schizophrenia such as avolition as the prefrontal cortex is responsible for thinking and decision making.
- It is suggested that hypodopaminergia leads to subcortical hyperdopaminergia. The updated dopamine hypothesis suggests that both high and low levels of dopamine in different brain regions is the most likely explanation for schizophrenia.
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Enlarged ventricles
One theory is that schizophrenia is caused by enlarged ventricles (fluid-filled gaps between brain areas). Enlarged ventricles are especially associated with damage to central brain areas and the prefrontal cortex. Such damage is often associated with negative symptoms.
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Johnstone et al - enlarged ventricles
found that schizophrenics had enlarged ventricles while non-sufferers did not, which suggests schizophrenia is related to a loss of brain tissue.
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Family dysfunction
- claim that schizophrenia is caused by abnormal patterns of communication within the family and conflict within the family.
- People who advocate this view would suggest that family therapy is the most effective treatment.
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Family dysfunction points
- schizophrenogenic mother
- double bind theory
- Expressed emotion
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Schizophrenogenic mother
- suggests that mothers of individuals who develop schizophrenia have induced the illness.
- cause schizophrenia by being cold, rejecting and controlling. She is known as the ‘refrigerator mother’.
- The mothers create a family climate of tension and secrecy. This leads to distrust that later develops into paranoid delusions and develops into schizophrenia.
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Double bind theory
emotionally distressing dilemma in communication in which an individual receives two or more conflicting messages, and one message goes against the other. For example, the mother says ‘I love you’ but turns her head away in disgust.
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Bateson et al - double bind theory
- emphasised the role of communication style within a family, as a risk of developing schizophrenia. He described how a child may be regularly trapped in situations where they fear doing the wrong thing but receive conflicting messages about what counts as wrong then cannot express their feelings about the unfairness of the situation.
- When they get it wrong the child is punished with a withdrawal of love. Children learn the world is confusing and dangerous, leading to disorganised thinking and delusions.
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Expressed emotion
- relevant to explaining the maintenance of schizophrenia rather than its origins.
- where families persistently exhibit criticism, hostility and a general negative influence upon recovering schizophrenics, who when returning to their families react to the expressed emotion by relapsing and experiencing positive symptoms, such as delusions.
- High EE causes stress in the patient and is a primary explanation for relapse.
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Psychological explanations of schizophrenia
- family dysfunction
- cognitive explanation
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Biological explanations of schizophrenia
- genetic explanation
- neural correlates
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Elements of EE
- Verbal criticism of the patient – occasionally with violence
- Hostility towards the patient – including anger and rejection
- Emotional over-involvement – including needless self-sacrifice
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Cognitive explanations (psychological)
Schizophrenia is associated with several abnormal cognitive processes
• dysfunctional thought recesses
• meta representation
• central control dysfunction
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Dysfunctional thought process
- Patients with schizophrenia are thought to have reduced thought processing in the ventral striatum which leads to negative symptoms.
- It is also thought but patients have reduced processing of information in the temporal and cingulate gyri which leads to hallucinations.
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Two types of dysfunctional thought processes
- metarepresentation
- central control dysfunction
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Meta representation
This is the cognitive ability to reflect on thoughts and behaviour. This dysfunction disrupts our ability to recognise our thoughts as our own – could lead to hearing voices (hallucinations).
This could also lead to egocentricity bias – the patient wrongly believes that they are central to any event or situation (delusions).
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Central control dysfunction
Central control is the cognitive ability to supress automatic responses while performing deliberate actions. Dysfunction of this process has been identified to explain speech poverty.
People with schizophrenia experience derailment of thoughts and spoken sentences because each word triggers automatic associations that they cannot supress.
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What are the different ways antipsychotics can be taken
- The most common treatment for schizophrenia is antipsychotic drugs taken as syrup or tablets. If a patient is unlikely to take their medication, they will get injections instead.
- Antipsychotics can be used to stop or prevent psychosis which is a loss of contact with reality
They can be divided into two types:
Typical antipsychotics
Newer atypical antipsychotics
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A brand name of typical antipsychotics
Chlorpromazine
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How do typical antipsychotics theoretically work
They work according to the assumption of the dopamine hypothesis. Typical antipsychotics act as dopamine antagonists. Antagonists work by blocking dopamine receptors in the synapses in the brain, reducing the action of dopamine. They are tightly bound in receptors and target all dopamine receptors.
Dopamine initially builds up but they lower levels are produced in the brain. This normalises levels of dopamine in key areas of the brain, which in turn reduces hallucinations.
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chlorpromazine - sedative effect
- Chlorpromazine also has sedative effect as they are thought to work on histamine receptors
-As a result of this it is often used to calm patients with sz and other conditions
- It is often used when patients are first admitted to hospital and are anxious, using syrup as it is absorbed quicker
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Side effects of chlorpromazine
Tardive dyskinesia sometimes resembling Parkinson’s disease
Confusion
Lethargy
Dizziness
Agitation
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What was the need for atypical antipsychotics
Atypical antipsychotics were developed in the 1970s to improve the effectiveness of treating negative symptoms and reduce the side effects of typical antipsychotic drugs.
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Brand name of an Atypical antipsychotic
Clozapine
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How to atypical antipsychotics work
Unlike typical antipsychotics atypical ones such as clozapine target a range of neurotransmitters. It binds to and blocks dopamine receptors in the same way as typical antipsychotics but also acts on serotonin (to reduce depression and anxiety) and glutamate receptors (to improve cognitive functioning e.g. delusions)
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Side effects of clozapine
- Agranulocytosis (a blood disorder which can be fatal)
- Weight gain
- Cardiovascular problems
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Why was risperidone developed
Risperidone is a newer atypical antipsychotic which was developed in 1990s due to clozapine causing agranulocytosis.
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How does risperidone work
Like clozapine, risperidone binds to dopamine and serotonin receptors.
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Why is risperidone better than clozapine
It binds more strongly than clozapine, to dopamine receptors and is therefore more effective in smaller doses than most antipsychotics and has fewer side effects.
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Aim of CBT for schizophrenia
• The aim of CBT in the treatment, is for patients to identify irrational thoughts, identify alternative explanations and try to change them using the ABCDE model (Ellis).
• Typically, 5-20 sessions are offered but NICE recommend at least 16 sessions.
•Patients are also often encouraged to trace back to the origins of their symptoms.
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What is the aim of CBTp
CBTp helps patients to make sense of how their delusions and hallucinations impact on their feelings and behaviour e.g. a client may hear voices and think they are from the demons and therefore feel very afraid.
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How can CBTp help with delusions and hallucinations
Offering explanations for symptoms aims to reduce anxiety as patients can realise their beliefs are not based on reality.
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What is normalisation
Normalisation involves explaining to the client that hearing voices is an extension of an ordinary experience.
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Does CBTp cure schizophrenia
CBTp will not cure symptoms but help patients to cope with them through disputing and restructuring beliefs.
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What did Turkington find
who describes a case study patient being treated with CBTp to challenge paranoid delusions.
Patient: The mafia observing me to decide how to kill me.
Therapist: You are obviously very frightened... there must be a good reason for this.
Patient: Do you think it's the mafia?
Therapist: It’s a possibility but there could be other explanations. How do you know that it's the mafia?
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Family therapys aim
Therapy takes place with families rather than just the individual with schizophrenia (the identified patient). It aims to improve communication and interaction in the family.
In keeping with psychological explanations such as the double bind and schizophrenogenic mother, some therapists see the family as the root cause of the condition.
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How does family therapy improve the families ability to help
Pharoah (2010) identified a range of strategies that family therapists use to try and improve the functioning of a family:
- Reduce levels of expressed emotion. By doing so it reduces the risk of relapse and increases the chance of the patient complying with medication.
- Improves the families ability to help by forming a therapeutic alliance. They aim to improve beliefs about schizophrenia and help families support each other whilst maintaining their own lives.
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The process of family therapy
Phase 1: Sharing of basic information and providing emotional and practical support
Phase 2: Identifying resource is including what different family members can and cannot offer
Phase 3: Encourage mutual understanding they save space for all family members to express their feelings
Phase 4: Identify unhelpful patterns of interaction
Phase 5: Skills training such as learning stress management techniques
Phase 6: Relapse prevention
Phase 7: Maintenance for the future
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What are token economies
Token economies are reward systems used to manage the behaviour of people with schizophrenia. The aim is to manage behaviour of patients with schizophrenia who spend long periods in psychiatric hospitals.
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What did Ayllon & Azrin find in the first trial of token economies
- trialled a token economy system on a ward of women with schizophrenia.
- Every time a woman carried out a desirable task such as making their bed, they were given a plastic token with the words ‘one gift’ embossed on it. These tokens could then be swapped for privileges, for example being able to watch a film.
- They found that the number of desirable tasks carried out increased significantly.
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In which context/types of behaviours would token economies be used for ?
- Institutionalisation can develop under circumstances of prolonged hospitalisation.
- An outcome is that people can develop bad habits for example not maintaining good hygiene.
- Matson et al (2016) identified three categories of institutional behaviour which can be tackled by token economies.
These include:
- Personal care
- Condition related behaviours e.g. apathy
- Social behaviour
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What are the benefits of token economies in the management of schiz
1. It improves the person's quality of life within the hospital setting
2. It normalises behaviour but will make it easier for people to transition back into the community
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How are the tokens used ?
- Tokens are coloured discs which are given to patients who carry out desirable behaviours.
- This token reinforces the desirable behaviour. The system is based on skinner's operant conditioning.
- Target behaviours are decided individually based on knowledge of the person.
- The immediacy of the reward is important as it prevents delay discounting which is the reduced effort of a delayed reward.
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Which theory is token economies based on
Operant conditioning
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Why are tokens secondary reinforcers
The tokens are secondary reinforcers as they have no value themselves
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Primary reinforces
Secondary reinforcers (tokens) can be swapped for other rewards which are the primary reinforcers e.g. sweets, a walk outside etc.
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What are generalised reinforcers
Tokens which can exchange for a range of primary reinforcers known as generalised reinforcers.
For the token to become a secondary reinforcer it needs to be paired with the primary enforcer so at the start of a token economy programme tokens and reinforces are administered together.
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Interationist approach to a schiz
The interactionist approach acknowledges that there are a range of factors including genetics and the environment which interact and are involved in the development of schizophrenia.
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Diathesis meaning
Comes from the Greek word for disposition. It refers to a pre-disposition or vulnerability (internal factor).
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Stress meaning
A physical, emotional or psychological strain. A stressor is an environmental trigger (external factor).
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How does the diathesis stress model explain schizn
Both a vulnerability and a trigger are needed. Schizophrenia is unlikely to develop with the absence of one of these factors.
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What does Meehls original model suggest
- The original model suggested there was a single schizogene and without this gene a person would never develop schizophrenia.
- However, a person with the gene and with chronic stress may develop schizophrenia.
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What does the updated model suggest about “diathesis”
- It is now believed that schizophrenia is polygenic. Many genes are thought to increase vulnerability. According to Ripke (2014) 108 genetic variations
- Diathesis also does not need to be genetic it could be childhood trauma.
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What does the updated model a suggest about “stress”
A modern definition of stress (in relation to this model) includes anything that risks triggering schizophrenia. These can include any external risks that are psychological e.g. parenting or biological e.g. drug use.
Cannabis use can increase the risk of developing schizophrenia by up to 7 times.
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How would a clinician treat a person with schiz using interactionist approach
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How does the uk typically treat people with schiz
In the UK it is increasingly standard practice to treat patients with a combination of drugs and CBT.
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How does the us typically treat people with schiz
In the US there is more of a conflict between psychological and biological model of schizophrenia, and this may have led to slower adoption of the interactionist approach.
