Schizophrenia Flashcards

Question

Dysfunctional thought processing

Answer 1

-metarepresentation: ability to reflect on our thoughts and behaviours -helps us identify goals, intentions, and interpret others' actions -dysfunction in this area can cause us to confuse our own actions with someone else’s -may explain hallucinations, as the inner voice is mistakenly experienced as coming from an external source -central control: ability to suppress automatic responses in favor of deliberate actions -disorganised speech in schizophrenia may result from an inability to suppress automatic thoughts and speech triggered by other thoughts -many schizophrenics experience derailment in their thoughts and speech because each word triggers associations -they struggle to suppress automatic responses to these associations

Answer 2

Strength - research to support that information processing differs in schizophrenics -Stirling et al. (2006) compared 30 schizophrenia patients with 18 controls on cognitive tasks, including the Stroop Test -participants named ink colors of color words, suppressing the impulse to read the word itself -schizophrenic patients took twice as long as controls to complete this task -implies difficulties with central control and suppressing automatic associations Strength - further research support -Sarin and Wallin (2014) found evidence that faulty cognition causes positive symptoms of schizophrenia -delusional patients showed biases in information processing, e.g. jumping to conclusions and lack of reality testing -patients with hallucinations displayed impaired self-monitoring, often perceiving their own thoughts as external voices -demonstrates that cognitive biases are present in schizophrenia but not in typical controls Limitation - cannot establish cause and effect -cognitive approaches do not clarify the origin of cognitive deficits -unclear whether these deficits cause schizophrenic behavior or whether schizophrenia causes cognitive deficits -lowers internal validity of explanation -however, links between symptoms and faulty cognition are evident

Answer 3

-primary psychological treatment for schizophrenia -NICE (2014) recommends it for all patients with this condition -operates on the belief that individuals with schizophrenia can be aided by identifying and altering faulty cognitions -based on the assumption that individuals with schizophrenia hold distorted beliefs that influence their behaviour -delusions are thought to stem from faulty interpretations of events -CBT helps patients recognise and correct these irrational beliefs -hence, CBT aims to improve symptoms by addressing maladaptive thinking and distorted perceptions underlying the disorder -specific type of CBT used for schizophrenia is Cognitive Behavioral Therapy for Psychosis (CBTp) -originally developed to address persistent symptoms that remain despite antipsychotic medication

Answer 4

Note: Antipsychotic drugs are usually given first to reduce psychotic thoughts, making the CBT more effective 1. CBTp usually takes place once every ten days for 12-16 sessions (NICE recommends 16) 2. It can be delivered in groups, but is typically delivered on a one-to-one basis. 3. The aim of CBTp is to establish links between the sufferer's thoughts, feelings, actions and their symptoms and general level of functioning. By monitoring their thoughts, feelings and actions in relation to their symptoms, patients can consider alternative ways of explaining why they feel and behave the way they do. Patients are also taught to recognise the signs of relapse. 4. Drawings are often used to display links between the sufferer's thoughts, actions and emotions. 5. Cognitive techniques are developed between patient and therapist such as distractions from intrusive thoughts, challenging intrusive thoughts, increasing/decreasing social activity to distract them from the thoughts, or using relaxation techniques 6. This therapy relies on the patient taking an active part, and they are given ‘homework' between sessions, like keeping a diary of the contents of their delusions, or trying out coping mechanisms 7. During the therapy the therapist lets the patient develop alternatives to any previous maladaptive explanations, ideally looking for alternative explanations and coping strategies that are already present in the patient's mind

Answer 5

Strength - research support -patients who receive CBTp experience fewer hallucinations and delusions -recover more effectively than those on antipsychotic drugs alone -furthermore, Drury et al. (1996) found a 25-50% reduction in recovery time when CBT was combined with antipsychotic medication -shows that patients make faster progress with both treatments together Strength - beneficial when CBTp combined with drug therapy -Tarrier et al. (2000) found patients receiving 20 one-to-one CBT sessions with drug therapy, followed by four booster sessions over a year, improved more significantly than those receiving drug therapy or supportive counseling alone -Kuipers et al. (1997) also found that combining CBTp with medication resulted in lower dropout rates and higher patient satisfaction -however, as CBTp was administered alongside drugs, it is difficult to conclude whether the effectiveness was due to CBT alone or the combination of treatments Strength - effective for patients unresponsive to other treatments -Sensky et al. (2000) found that CBT was beneficial for schizophrenics who hadn’t responded to drug therapy -improvements continuing nine months after treatment ended -suggests that CBT has long-lasting positive effects for drug-resistant patients Strength - fewer side effects than drug therapy -avoids physical issues like tardive dyskinesia or diabetes -however, limited availability, due to budget constraints in healthcare -only 1 in 10 patients in the UK are offered CBT -Haddock et al. (2013) found that 6.9% of their sample of 187 sufferers received CBT Limitation - CBT is more costly than medications -may mean it is not accessible for many people -however, although initially more expensive, CBT could save healthcare systems money long-term -as it reduces the need for additional interventions associated with antipsychotic side effects Limitation - not suitable for all schizophrenia patients -Kingdon et al. (2006) studied 142 patients in Hampshire -found many were not suitable for CBT, often due to an inability to fully engage with the therapy -older patients were found to be less suitable than younger ones -CBT may be inappropriate for those too disoriented, agitated, or paranoid to build trusting relationships with therapists -however, it may benefit those refusing drug treatments Limitation - questionable effectiveness -Jauhar et al. (2014) conducted meta-analysis of 50 studies -found only a small therapeutic effect on symptoms, including positive symptoms like delusions and hallucinations, which CBT aims to target -small effect disappeared in studies using blind testing, where researchers were unaware of which patients received CBT -however blind-testing is much less common than meta-analyses when studying treatments for schizophrenia -Wykes et al. (2008) found that the more rigorous the study, the weaker the observed effect of CBT on schizophrenia

Answer 6

-form of psychotherapy -alters relationship and communication patterns within families -commonly used alongside medication and outpatient clinical care -NICE (2014) recommends that family therapy be offered to all schizophrenics who are in contact with family members -cases with persistent symptoms or a high risk of relapse should be prioritised Main aims: -improve positive and decrease negative forms of communication -increase tolerance levels and reduce criticism among family members -decrease feelings of guilt and responsibility for causing the illness within the family -reduce the burden and stress of care for family members -enhance relatives' ability to anticipate and solve problems How it works: -therapist meets regularly with the patient and close family members -talk openly about the patient's symptoms, behaviour and progress. -taught to support each other and be caregivers -each person given a specific role in the rehabilitation process -emphasis on openness, with no details remaining confidential, with boundaries set in advance -usually between 3 months to a year, and at least ten sessions -aimed at reducing the level of expressed emotion (EE) within the family, to reduce the likelihood of relapse -providing family members with information about schizophrenia -finding ways to support the individual -easier to resolve any practical problems, like ensuring the sufferer takes their medication

Answer 7

Strength - research support -Pharoah et al. (2010) conducted meta-analysis of 53 studies from Europe, Asia, and the USA -found that family therapy increased a patient's compliance with medication -reduced risk of relapse and hospital admission during and up to 24 months after treatment -hence family therapy effective in the long term -however, patients benefit more from drugs when they stick to their treatment routine -these findings may be due more to improved medication compliance, -hence, the results may not be solely due to family therapy Strength - further research support -McFarlane et al. (2003) conducted meta-analysis -confirmed that family therapy reduces relapse rates, lessens symptom -also improves family relationships and enhances patient well-being -reinforces effectiveness Limitation - the focus on ‘openness’ may make family members hesitant to share information -could cause or reopen tensions -some may avoid confronting issues -reduces effectiveness, as honest engagement is necessary to address faulty family communication Strength - helpful for patients who lack insight into their illness or have difficulty speaking coherently -family members can assist by providing information to the therapist -they often have valuable insight into a patient's behaviour and moods, which the patient may not always be aware of Strength - cost-effective -reduces relapse rates and decreases the need for hospitalisation -educates family members to help manage a patient’s medication regimen -hence reduces the need for additional medical intervention -furthermore, combining drugs with family therapy is ideal -but budget constraints often prevent this approach -the Schizophrenia Commission (2012) estimates that family therapy costs £1,004 less per patient than standard care (drugs alone) over three years -suggests it can save money

Answer 8

-behaviourist approach, introduced in the 1970s, to manage schizophrenia -tokens are awarded for desired behavioural change -mainly used with long-term hospitalised patients -enables them to leave the hospital and live relatively independently in the community -aimed at changing negative symptoms of schizophrenia, e.g. low motivation, poor attention and social withdrawal -clinicians set target behaviours that they believe will improve the patient's engagement in their daily activities -e.g. brushing hair or persevering with a task -patient receives token for it -can be exchanged for various rewards at a later date -encourages patient to engage with desirable behaviours more often -the behaviours become associated with these rewards and privileges -tokens in themselves are neutral but is given value through classical conditioning -it’s repeatedly presented alongside or immediately before the reward -these neutral tokens become secondary reinforcers -hence can be used to modify the behaviour in people with schizophrenia. -in the early stages of the treatment, frequent exchange periods mean that the patients can be quickly reinforced -target behaviours can then increase in frequency -effectiveness of the token economy may decrease if more time passes between the presentation of the token and exchange for the reward

Answer 9

Strength - research found it is effective -Ayllon and Azrin (1968) applied a token economy on a ward of female patients with schizophrenia -many had been hospitalised for years -patients received plastic tokens for behaviors like making their beds -could later exchange them for rewards such as watching a film -this approach led to a dramatic increase in the number of desirable behaviors the patients displayed each day -furthermore, Dickerson et al. (2015) reviewed 13 studies -found the technique effective in increasing adaptive behavior in people with schizophrenia, particularly when used in combination with drugs -however, the specific benefits of combining the two were not identified -suggests that token economies should not be seen as standalone treatments for schizophrenia Limitation - issues with the research methodology used to study token economy in schizophrenia -Comer (2013) highlights that studies on token economies tend to be uncontrolled -typically all patients participate -no control group -consequently, improvements in patients’ behaviours can only be compared with their own past behaviours -can’t compare to control group -this comparison may be misleading, as factors like increased staff attention could contribute to patient improvement rather than the token economy itself Strength - encourages patients to become more independent and active -often leads to nurses respect patients more -this motivates patients to develop positive self-esteem -hence token economies effectively address the effects of institutionalisation in long-term hospital patients -furthermore, when token economies help create a healthier, safer, and more stable environment -reduces staff and patient injuries -decreases staff absences and emergency incidents Limitation - treatment does not seem to work long-term -patients’ desirable behavior becomes dependent on reinforcement -once patients are released into the community, the reinforcement ends -often results in high readmission rates -without professionals to provide constant reinforcement, people with schizophrenia may struggle to maintain target behaviors outside the hospital setting -suggests that token economies are ineffective outside of the hospital environment Limitation - ethical concerns regarding token economies -people with schizophrenia may feel humiliated -to make reinforcement effective, clinicians may control access to primary reinforcers -e.g. food or privacy -patients can earn by displaying target behaviours -however, it is generally accepted that all human beings have certain basic rights that should not be violated, regardless of the positive outcomes that may result from manipulating these needs

Answer 10

-considers both biological and psychological factors in the development of schizophrenia -acknowledges that multiple factors contribute to the illness -diathesis-stress model proposes that schizophrenia is triggered when environmental stress interacts with an existing biological vulnerability. -suggests that both a vulnerability to schizophrenia (such as genetics) and a stress trigger (like dysfunctional family dynamics) are necessary for the illness to develop -factors like genetics or biochemistry may increase a person’s vulnerability -but schizophrenia will not manifest without an environmental stressor -studies show that schizophrenia has a biological component, potentially linked to genetics or biochemistry -certain genes are associated with increased vulnerability, and having a relative with schizophrenia raises an individual’s risk -genetic factors are thought to be linked to abnormalities in dopaminergic systems and potentially other neurotransmitters -however, the diathesis-stress model argues that biology alone does not cause schizophrenia; -instead, biological vulnerability increases the likelihood that environmental stressors will trigger the illness -Read et al. (2001) suggest that diathesis encompasses various factors, including child abuse -early psychological trauma may alter an infant’s brain development -makes them more vulnerable to stress by causing the hypothalamic-pituitary-adrenal (HPA) system to become overactive -stress can include any factor that could potentially trigger schizophrenia -e.g. Houston et al (2008): cannabis use is considered a stressor because it disrupts the body’s dopamine system

Answer 11

Strength - research support -Barlow and Durand (2009) found that a family history of schizophrenia indicated a genetic link -when combined with a dysfunctional family environment, the risk of developing schizophrenia increased -supports the diathesis-stress model, as the heightened risk was due to the interaction between genetics and family-induced stress -furthermore, Cannon et al. (2002) identified positive correlation between birth complications and a later risk of schizophrenia -this was attributed to damage to the hormone and neurotransmitter systems -reinforces idea of an interaction between biological vulnerabilities and later environmental stressors Limitation - not entirely understood how various risk factors contribute to the diathesis-stress interaction -e.g. biological, environmental, psychological, and social -these causes may vary among individuals with schizophrenia -lack of a full understanding of the mechanisms through which vulnerability and stress interact to produce the illness -weakens internal validity of model Limitation - original diathesis-stress model is criticised for being overly simplistic -e.g. notion that a single gene, combined with a specific parenting style, leads to schizophrenia -several genes have been linked to an increased risk of developing the disorder -suggests that no single "schizogene" exists -furthermore, stress is not limited to parenting styles or family dynamics -Houston et al. (2008) found that vulnerability is not purely biological -e.g. childhood sexual trauma heightened the risk of developing schizophrenia when paired with later cannabis use -hence, the original model's assumption that vulnerability is purely biological and stress is solely environmental is outdated

Answer 12

-extensive research has examined the effectiveness of different treatments for schizophrenia -Guo et al. (2010) found that combining both biological and psychological treatments is more effective -however, determining the best combination of treatments can be challenging -as it often depends on individual patient needs and circumstances -e.g. combining drugs with family therapy may be less beneficial for patients who have limited family contact -In Britain, antipsychotic drugs are typically prescribed first to reduce symptoms -makes it easier for patients to engage with psychological treatments like CBT -uncommon for patients with schizophrenia to receive psychological therapy without medication -in the USA, treatment often focuses on medication alone, with psychological treatments being less frequently offered -rare in both countries to offer a psychological treatment, such as CBT, without any accompanying medication -Turkington et al. (2006) argue that it is possible to view schizophrenia as having a biological basis while still providing psychological treatment -hence adopts an interactionist approach by addressing both biological and psychological symptoms -however, it would be inconsistent to claim that schizophrenia is solely biological in nature, devoid of psychological aspects, while simultaneously offering psychological therapy -using an interactionist approach to treat schizophrenia implies recognising the role of both diathesis (vulnerability) and stress in the development of the disorder

Answer 13

Strength - combining antipsychotic medication and psychological therapies for schizophrenia can be cost-effective -schizophrenia has both biological and psychological components -so a combined treatment approach is more beneficial as it simultaneously targets both elements -furthermore, although it initially appears costly, patients are achieving better and longer-lasting outcomes -suggests increased effectiveness in the long term Strength - research support -e.g. Guo et al. (2010) found that patients in the early stages of schizophrenia who received both antipsychotics and psychological therapy showed improvements in insight and social functioning -also had lower relapse rates compared to those on antipsychotics alone -highlights the effectiveness of combining biological and psychological treatments -however, combining treatments does not always yield positive results -some patients undergoing CBT have misinterpreted the side effects of antipsychotics in a delusional way -led to mistrust and resistance toward further treatment -suggests that, in certain cases, combining treatments could introduce additional complications Limitation - interactionist approach's logic in treating schizophrenia is criticised -Turkington et al. (2006) argue that while studies show that combined treatments are more effective than standalone approaches, this does not inherently validate the interactionist perspective -referred to as the treatment-causation fallacy -means that we cannot definitively conclude that it is the interaction of the treatments that enhances effectiveness

Schizophrenia Flashcards

(37 cards)