Schizophrenia Flashcards
(36 cards)
Gottesman
genetic basis of SZ
large scale family study - someone with an aunt with SZ has a 2% chance of developing it, increasing to 9% if the individual is a sibling and 48% if they’re an identical twin
Ripke
candidates genes- genetic basis
combined all previous data from genome wide studies of SZ- genetic makeup of 37,000 people with a diagnosis of SZ was compared to that of 113,000 controls, 108 separate genetic variations were associated with slightly increased risk of SZ
suggests SZ is aetiologically heterogenous
brown
the role of mutation- genetic basis
positive correlations between paternal age (associated with increased risk of sperm mutation) and risk of SZ increasing from around 0.7% with fathers under 25 and over 2% in fathers over 50
Tienari
+research support for fam studies
show that biological children of parents with SZ are at a heightened risk even if they grow up in an adoptive family
Hilker
+research support for fam studies
Showed a concordance rate of 33% for identical twins and 7% for not identical
-NOT 100%!
Environmental factors - limitation of genetic basis
Birth complications - Morgan
smoking THC rich cannabis in teenage years - Di Forte
Psychological risks include childhood trauma which leaves people more vulnerable to adult mental health problems in general, but now evidence for a particular link with SZ - Morkved found that 67% of people with SZ and related psychotic disorders, reported at least one childhood trauma
Fromm reichman
psychodynamic explanation for SZ based on accounts she heard from her patients about their childhood - schizophregenic mother
-cold, rejecting and controlling - created a family climate characterised by tension and secrecy - leading to distrust that develops into paranoid delusions and ultimately, SZ
Bateson
double blind theory- child finds themselves trapped in situations where they deae they are doing the wrong thing, but receive mixed messages on 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 - leaving them with a confused and dangerous view of the world - reflected in paranoid delusions
Simon
dysfunctional thinking - cognitive explanation
-sz is characterised by disruption to normal thought processing - reduced thought processing in the ventral striatum, is associated with negative symptoms, whilst reduced processing of info in the temporal and cingulate gyri is associated with hallucinations
Frith
identified two kinds of dysfunctional thought processes - metarepresentation -the cognitive ability to reflect on thoughts and behaviours- allowing insight into our own intentions and goals and the actions of others
dysfunction in metarepresentation would disrupt out ability yo recognise our own actions and thoughts as being carried out by ourselves rather than someone else (explaining hallucinations and delusions)
-central control dysfunction - 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 - derailment of thoughts
Read
+research support of family dysfunction - as shown by insecure attachment and exposure to childhood trauma, especially abuse
-according to a review by Read, adults with SZ are disproportionately likely to have an insecure attachment, particularly type C or D. Also reported 69% of women and 59% of men with SZ have a history of physical and/ or sexual abuse
-also use Morkved
Stirling
+research support of cognitive explanations
compared performance on a range of cognitive tasks in 30 people with SZ and a control group of 30 without
Tass included the stroop task, where participants have to name the font-colours of colour-words, and suppress the tendency to read words aloud
people with SZ took over twice as long on average
Thornley
+evidence of effectiveness in biological treatments
reviewed studies comparing the effects of chlorpromazine to control conditions
data from 13 trials showed that chlorpromazine was associated with better overall functioning and reduced symptom severity as compared to placebo
Meltzer
+research supporting benefits of atypical antipsychotics
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 where typical antipsychotics have failed
Healy
-counters effectiveness of antipsychotics (Thornley and Meltzer)
-as most studies are of short-term effects and some successful trials have had their data published multiple times, exaggerating the size of the evidence base for positive effects
Also, the drugs usually have calming effects, meaning it is easy to demonstrate that they have some positive effects, but not that they reduce the severity of psychosis
Pharoah
Family therapy -
reduces negative emotions - reduce levels of emotion generally but especially negative emotions such as anger and guilt which create stress - reducing stress is important to reduce the likelihood of relapse
improves family ability to help - therapist encourages family members to form a therapeutic alliance whereby they all agree on the aims of the study and the therapist tries to improve families beliefs about and behaviour towards SZ- additionally, an aim is to ensure that the family members achieve a balance between caring for the individual with SZ and maintaining their own lives
Burbach
Family therapy
proposed a model for working with families dealing with SZ - begins with sharing basic information and providing emotional and practical support
then it develops through progressively deeper levels
phase 2 involved 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 interactions
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
Jauhar
+evidence of effectiveness in CBT
reviewed 34 studies using CBT with SZ, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms
Pontillo
(used with Juahar)
-found reductions in frequency and severity of hallucinations from CBT
along with clinical advice from NICE - recommends CBT for SZ
Thomas
-limitation of CBT for SZ
-wide range of techniques and symptoms included in the studies
-points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms
-hard to say how effective CBT will be for a particular person with SZ
McFarlane
+evidence of effectiveness on family therapy
concluded that family therapy was one of the most consistently effective treatments available for SZ
-in particular relapse rates were found to be reduced by 50-60%
NICE clinical advice- also recommends family therapy for everyone with diagnosis of SZ
Barrowclough
+support of fam therapy
Benefits whole family
-concluded that these effects are important because families provide the bulk of care for people with SZ- by strengthening the functioning of a whole family, family therapy lessens the negative impact of SZ on other family members and the families ability support the person w SZ
-family therapy has wider ebendits beyond the obvious positive impact on the identified patient
Ayllon abd Azrin
Trialled a token economy system in a ward of women with SZ - every time the ppts carried out a task such as making their bed or cleaning up, they were given a plastic token embossed with the words ‘one gift’
-these tokens could then be swapped for ward privileges, such as being able to watch a film
the number of tasks carried out increased signifactiantly
-token economies used extensively in 60s and 70s when the norm for treating SZ was long term hospitalisation - use has now declined in UK partly because of the growth of community-based care and closure of many psychiatric hospitals - and ethical issues
Matson
identified 3 categories of institutional behaviour commonly tackled by means of token economy - personal care, condition-related behaviours (eg apathy) and social behaviour
-these bring 2 major benefits
1. improves persons quality if life within hospital setting
2.’normalises’ behaviour and makes it easier for people who have spent a long time in a hospital to adapt back into life in the community
