Schizophrenia Flashcards
(173 cards)
1
Q
Définition of scz
A
‘severe mental disorder where contact with reality and insight is impaired. This is a type psychosis
2
Q
Define psychosis
A
losing contact with reality ( schizophrenia, BPD…)
3
Q
Three most common factors of people with schizophrenia
A
- most commonly experienced by men
- Most common by people who live in cities and lower socioeconomic groups
- Usually homeless/hospitalised
4
Q
What are positive symptoms of scz
2 eg
A
experiences that are addition to atypical experiences.
Delusions
Hallucinations
5
Q
Delusions
A
positive symptom of schizophrenia
cognitive process/thoughts : that have no basis in reality. This can be believing you’re someone else, part of a conspiracy or delusions of ‘GRANDEUR’
6
Q
Three types of delusions
A
- Delusions of grandeur: thinking you are more important/able than you are.
- Delusions of persecution : that you think is someone out to get you/watching you
- Delusions of paranoia: negative things are going to happen, not necessarily from another person.
7
Q
Hallucinations
A
- Hallucinations: positive symptom of schizophrenia
these are sensory experiences (any sense) that have either no basis in reality or are distorted perceptions of things that there are.
8
Q
What is a negative symptoms
A
loss of a typical experience. So the rest of the population experience something and schizophrenia dont experience it: a ‘loss’
9
Q
Speech poverty
A
A negative symptom of schizophrenia.
This involves reduced frequency of speaking and a reduced quality of speech (fluency)
10
Q
Avolition
A
A negative symptom of schizophrenia
Aka: lack of motivation, to carry out tasks. Lowered energy/activity
11
Q
What does Cheniaux et al (2009) show
A
The differences shows
1. There is a lack of agreement about what schizophrenia is
2. Over diagnosing: people are wrongly labelled and medicated
3. Under Diagnosing: lack of treatement they need
12
Q
Cheniaux (2009)
A
2 psychologists diagnosed 100 patients independently with both DSM and ICD.
They found the inter rater reliability was really low.
First psychologist:
Diagnosed 26 people with DSM
Diagnosed 44 people with ICD.
Second psychologist:
Diagnosed 13 with DSM
Diagnosed 24 with ICD.
The differences shows
There is a lack of agreement about what schizophrenia is
Over diagnosing: people are wrongly labelled and medicated
Under Diagnosing: lack of treatement they need
13
Q
Osorio (contradicting to Cheniaux)
A
Once DSM was updated inter rater reliability was very high.
180 individuals.
Pairs of interviewers had inter rater reliability of 97% reliable
And also test - retest reliability (double checking) of 92% reliable
This means that now schizophrenia may be more understood. There may be a higher temporal validity (2009 vs 2019)
Pros/cons
1. Concurrent validity - the extent to which a psychological measure relates to a pre-existing measure.
The ICD and DSM have low concurrent validity because they are different in achieving same measure.
14
Q
4 Issues in classification of scz
A
- Co morbidity
- Symptom overlap
- Gender bias
- Cultural bias/ racial bias
15
Q
What is concurrent validity
A
the extent to which a psychological measure relates to a pre-existing measure.
The ICD and DSM have low concurrent validity because they are different in achieving same measure.
16
Q
What is symptom overlap
A
When two or more conditions share symptoms,
lowering the validity of diagnoses in the DSM
as they can be mistakenly diagnosed
17
Q
Co morbidity
A
The occurrence of two or more disorders/conditions.
Aka schizophrenia and personality disorders.
Two disorders are frequently diagnosed together, which lowers the validity of classifying the disorders separately. This may either be that they have the same causes
18
Q
What is required to diagnose with the
1. DSM
2. ICD
A
DSM 5 : only requires one positive symptom to be present for diagnosis
ICD 11: requires two negative symptoms to be present for diagnosis.
19
Q
Study for symptoms overlap
A
Ketter (2005) : misdiagnosis due to symptom overlap can lead to years of delay in correct treatement. Degeneration (the issue getting worse) can occur as well as high levels of suicide.
20
Q
Ketter
A
Ketter (2005): misdiagnosis due to symptom overlap can lead to years of delay in correct treatement. Degeneration (the issue getting worse) can occur as well as high levels of suicide.
21
Q
Study for co morbidity
A
Buckley (2009) - found that around half patients with schizophrenia also have a diagnosis of:
Depression 50%
Substance abuse 47%
PTSD 29%
This shows that scz occurs commonly alongside other illnesses and the validity of the classification is questioned.
22
Q
Buckley (2009)
A
Is a study for co morbidity
Buckley (2009) - found that around half patients with schizophrenia also have a diagnosis of:
Depression 50%
Substance abuse 47%
PTSD 29%
This shows that scz occurs commonly alongside other illnesses and the validity of the classification is questioned.
23
Q
Two problems with diagnosing scz in terms of reliability
A
Co morbidity
Symptom overlap
24
Q
Two problems with diagnosing scz in terms of validity
A
Gender bias
Culture bias
25
Study for validity of gender bias (4)
Broverman (1970) :
Found that clinicians in the US equated mentally healthy adult behaviour with mentally healthy male behaviour.
This is a form of androcentrism, and shows there is a tendency for women to be perceived as mentally less healthy when they dont show male behaviour. This is called pathologizing women.
Loring and Powell (1988)
research indicated that a psychiatrists gender may influence their ability to diagnose/amount of diagnoses they give.
Random participants 290 male and female psychiatrists to read two case articles of patients behaviour then to diagnose.
When the patients were described as ‘male’ or ‘no info’ was given about gender, 56% were given a diagnosis of scz.
When described as female only 20% were given a diagnosis of scz.
This gender bias was not evident among the female psychiatrists but only the male.
This suggests :
Psychiatrists own gender is influential in diagnosis
Patient own gender is influential
Might also occur due to clinicians not considering that there are gender DIFFERENCES, makes have higher typical levels of substance abuse and females have higher recovery rates and lower relapse rates. These differences influence the validity of diagnoses.
Fischer and Buchanan
Men have been diagnosed with scz much more: 140 : 100, male : female
One explanation for this is that maybe because of sociocultural influences, it is typically believed that women behave with the positive symptoms anyway. Only women used to be able to be diagnosed with ‘hysteria’- female extreme emotion and behaviour, so maybe it is still a natural characteristic assumed of women to be crazed and hysterical.
Cotton (2009)
Says that women are under diagnosed with scz because they have more close relationships so they can get support faster. So women either deal with it better, sooner or just recover faster.
This under diagnosis is still gender biased and means lots of women may be lacking treatement they need.
26
Broverman
Broverman (1970) :
Found that clinicians in the US equated mentally healthy adult behaviour with mentally healthy male behaviour.
This is a form of androcentrism, and shows there is a tendency for women to be perceived as mentally less healthy when they dont show male behaviour. This is called pathologizing women.
27
Loring and powell
Loring and Powell (1988)
research indicated that a psychiatrists gender may influence their ability to diagnose/amount of diagnoses they give.
Random participants 290 male and female psychiatrists to read two case articles of patients behaviour then to diagnose.
When the patients were described as ‘male’ or ‘no info’ was given about gender, 56% were given a diagnosis of scz.
When described as female only 20% were given a diagnosis of scz.
This gender bias was not evident among the female psychiatrists but only the male.
This suggests :
Psychiatrists own gender is influential in diagnosis
Patient own gender is influential
Might also occur due to clinicians not considering that there are gender DIFFERENCES, makes have higher typical levels of substance abuse and females have higher recovery rates and lower relapse rates. These differences influence the validity of diagnoses.
28
Fisher and buchanan
Fischer and Buchanan
Men have been diagnosed with scz much more: 140 : 100, male : female
One explanation for this is that maybe because of sociocultural influences, it is typically believed that women behave with the positive symptoms anyway. Only women used to be able to be diagnosed with ‘hysteria’- female extreme emotion and behaviour, so maybe it is still a natural characteristic assumed of women to be crazed and hysterical.
29
Cotton
Cotton (2009)
Says that women are under diagnosed with scz because they have more close relationships so they can get support faster. So women either deal with it better, sooner or just recover faster.
This under diagnosis is still gender biased and means lots of women may be lacking treatement they need.
30
Studies that q the culture bias in diagnosing scz
Copeland - bias in where psychiatrists r from that affects amount of diagnosis.
Pinto and jones - british with African Caribbean descent 9x more likely to receive diagnosis than white british
Escobar - overinterpretation of symptoms in black british ppl
Whaley - incidents of scz in black Americans are 2% : 1.4% in white Americans
31
Copeland
Copeland (1971) - 134 US and 194 UK psychiatrists received a description of a patient,
Uk - 2% diagnosed
Us - 69% diagnosed.
This suggests a significant difference between countries when it comes to diagnosing scz.
32
Whaley (2004)
Found that incidents of schizophrenia black Americans in comparison to white Americans is greater: 2% : 1.4% , as a result of cultural bias
33
Pinto and jones - 2008
(2008) - They found that British people of African Caribbean descent are 9x more likely to receive a diagnosis than white British people, even though people living in African Caribbean countries are not. This rules out a genetic basis of schizophrenia And is therefore a result of racial bias.
34
Escobar
Escobar (2012) - overinterpretation of symptoms in black british people. This means British African Caribbean people may be discriminated against by a culturally biased agnostic system.
35
What are neural correlates
Neural correlates - patterns or activity in the brain that occur simultaneously with another experience. It is then possibly implicated in the origins of that experience.
36
Dopamine - what is its relevance in scz
Dopamine - neurotransmitter generally causing an excitatory effect, aka reward. High levels of dopamine is associated with schizophrenia. Low levels associated with Parkinson’s.
37
Candidate genes -
Candidate genes - individual genes that may be associated with schizophrenia. Might code for some neurotransmitters associated with dopamine.
38
Concordance rate :
Concordance rate : extent to which first degrees relatives are similar, and liekly to develop a disorder.
39
Studies in support of nurture debate
Loehlin and Nichols (1976) - higher concordance rate seen in MZ twins, may be due to the fact that MZ twins being identical tend to be treated more similarly than dz twins. Therefore nurture may explain high concordance rates not nature.
40
Studies in support of nature debate - genetic base
Kendler - first degree relatives of those with Scz were 18x more likely to develop it. This shows a high concordance rate of scz in families.
Shields (62) - found that concordance rates of scz for MZ twins brought up apart are similar to those brought up together. This suggests it is not due to the environment, but a high genetic influence in scz.
Gottesman (1991) - as genetic similarity increases so does the probability of scz.
MZ twins - 48% risk of developing scz (100% dna)
Dz twins - 17% risk (50%)
41
Kendler - 1985
first degree relatives of those with Scz were 18x more likely to develop it. This shows a high concordance rate of scz in families.
42
Shields (‘62)
Shields (62) - found that concordance rates of scz for MZ twins brought up apart are similar to those brought up together. This suggests it is not due to the environment, but a high genetic influence in scz.
43
Gottesman (91)
Gottesman (1991) - as genetic similarity increases so does the probability of scz.
MZ twins - 48% risk of developing scz (100% dna)
Dz twins - 17% risk (50%)
44
Loehlin and Nichols (1976) -
Loehlin and Nichols (1976) - higher concordance rate seen in MZ twins, may be due to the fact that MZ twins being identical tend to be treated more similarly than dz twins. Therefore nurture may explain high concordance rates not nature.
45
3 possible environmental causes
Some environmental causes:
1. Morgan et al (2017) - birth complications
2. Di Forti et al (2015) - THC strong cannabis in teenage years, even without genetic disposition
3. Morkved et al (2017) - childhood trauma, 67% with scz related to psychotic disorders, reporting at least one trauma. This is in comparison to a matched group with no psychotic disorders.
if trauma did lead to scz then why did 38% who did report a trauma not have a psychotic disorder? This shows it is not guaranteed or deterministic, this means it lacks predictive value because there isnt a secure guarantee in causing of scz and therefore any treatments/Interventions of scz.
what about epigenetics? Can a trauma be passed on? Is that free will?
Also because it is only 67% not 100% concordance rate, then it is a limited explanation as it evidently Is more complex and is influenced by many/other factors.
46
Morgan et al (2017)
Birth complications
Environmental influence
47
Di forti et al (2015)
Di Forti et al (2015) - THC strong cannabis in teenage years, even without genetic disposition
Environmental influence
48
Morkved et al (2017) -
3. Morkved et al (2017) - childhood trauma, 67% with scz related to psychotic disorders, reporting at least one trauma. This is in comparison to a matched group with no psychotic disorders.
Environmental causes
49
What three theories does frith have for cognitive cause of schizophrenia
- filter theory
- dysfunction in cognitive metarepresentation
- central control dysfunction
50
What is friths filter theory
The idea that non-SCZ individuals are able to filter out irrelevant stimuli (images sounds etc) and focus on one thing, filtering out everything else.
SCZ Individuals are unable to filter out other irrelevant auditory stimulus, becoming overwhelmed with sensory information, unable to process and interpret.
51
What symptoms does friths filter theory account for
This might account for symptoms such as speech poverty
Might also account for auditory hallucinations?
52
Explain friths idea about conscious processing
Link to scz
Conscious processing = the highest Level of cognitive functioning takes place, and we are aware of this. However this has a limited capacity so we can only carry out one task at a time.
- only important information goes into the conscious awareness
- for scz people the attentional filter breaks down, meaning the unimportant information enters the conscious for scz.
-Therefore the mind of scz think everything has to be attended to.
53
Explain friths idea about preconscious processing
Link to scz
Preconscious processing = we are unaware of this as it is an automatic process, and we carry out many tasks at one time.
- only important information goes into the conscious awareness
- for scz people the attentional filter breaks down, meaning the unimportant information enters the conscious for scz.
-Therefore the mind of scz think everything has to be attended to.
54
How does friths theory of conscious and preconscious process explain auditory hallucinations in scz
For AUDITORY HALLUCINATIONS: FRITH
when SCZ are bombarded with sounds, and our our preconscious filter is defective, meaning all sounds are recognised as significant and reach the conscious level of processing.
They would misinterpret non speech sounds as speech and might mistake them for voices.
55
What are two types of dysfunctional thought processing that frith identifies in scz
Metarepresentation
Central control dysfunction
56
What is metarepresentation
(Who thought of it aswell)
2: METAREPRESENTATION
= the cognitive ability to differentiate between our own actions/thoughts and actions of others.
Frith
57
How does metarepresentation link to scz according to frith
Schizophrenics may experience a dysfunction in this area, meaning they may be unable to differentiate their own thoughts and accidentally believe they are somebody else’s. >
This might lead to hallucinations or delusions, specifically thought insertion delusions ( thinking we are hearing voices but it is our own though )
58
One study supporting filters theory of metarepresentation in scz
Bental et al (91) found that SCZ struggled to identify words belonging to a certain category, such as birds that they had seen before, drawn themselves or had not seen before.
They are unable to recognise their own output - Dysfunction in metarepresentation, support of frith
59
Bental (1991)
Bental et al (91) found that SCZ struggled to identify words belonging to a certain category, such as birds that they had seen before, drawn themselves or had not seen before.
They are unable to recognise their own output - Dysfunction in metarepresentation, support of frith
60
What is central control
Who thought of it
Frith
CENTRAL CONTROL DYSFUNCTION
Your central control is linked to cognitive functions that suppress automatic responses, whilst we perform deliberate actions.
61
What is central control dysfunction
How does it explain scz
Having a dysfunction in your central control is linked to SCZ because it means an inability to to suppress these automatic thoughts and speech triggered by stimuli, derailing their thoughts and sentences.
Frith links this to speech poverty, when scz show word salads and lack of fluent sentences.
62
What does the biological explanation for scz think causes it
(2)
Neural correlates
Candidate genes
63
What is a neural correlate
Link to explaining scz
Neural correlates - patterns or activity in the brain that occur simultaneously with another experience. It is then possibly implicated in the origins of that experience.
Disbalance of dopamine levels in the brain (could be high or low amounts) have been correlated to scz, implicated in causing it.
64
Two weaknesses of neural correlates
X : not causational but correlational
X : Problem of chicken and the egg - not necessarily that the brain activity causes SCZ, but SCZ might cause brain activity.
65
What is dopamine
Why is dopamine associated with schizophrenia
neurotransmitter generally causing an excitatory effect,
aka reward. High levels of dopamine is associated with schizophrenia. Low levels associated with Parkinson’s.
66
What is a candidate gene
Why is it associated with scz
Candidate genes -
A gene associated with a trait/condition
individual genes that may be associated with schizophrenia. Might code for some neurotransmitters associated with dopamine.
67
What is concordance rate
Link to scz
Concordance rate : extent to which first degrees relatives are similar genetically, and liekly to develop a disorder.
Usually measured in twins that either have 50/100% shared genetic material.
If someone is similar genetically or a close relative to someone with scz they might have a higher chance of also having that disorder.
68
Kendler (1985)
Kendler (1985) - first degree relatives of those with Scz were 18x more likely to develop it. This shows a high concordance rate of scz in families.
69
Shields (1962)
Shields (62) - found that concordance rates of scz for MZ twins brought up apart are similar to those brought up together. This suggests it is not due to the environment, but a high genetic influence in scz.
70
Gottesman (1991)
Gottesman (1991) - as genetic similarity increases so does the probability of scz.
MZ twins - 48% risk of developing scz
Dz twins - 17% risk
71
Loehlin and Nichols (1976)
Loehlin and Nichols (1976) - higher concordance rate seen in MZ twins, may be due to the fact that MZ twins being identical tend to be treated more similarly than dz twins. Therefore nurture may explain high concordance rates not nature.
Not necessarily biology basically
72
Three studies that support a genetic cause of scz
Kendler (1985) - first degree relatives of those with Scz were 18x more likely to develop it. This shows a high concordance rate of scz in families.
Shields (62) - found that concordance rates of scz for MZ twins brought up apart are similar to those brought up together. This suggests it is not due to the environment, but a high genetic influence in scz.
Gottesman (1991) - as genetic similarity increases so does the probability of scz.
MZ twins - 48% risk of developing scz (100% dna)
Dz twins - 17% risk (50%)
73
Study that supports environmental cause over biological cause of scz
Loehlin and Nichols (1976) - higher concordance rate seen in MZ twins, may be due to the fact that MZ twins being identical tend to be treated more similarly than dz twins. Therefore nurture may explain high concordance rates not nature.
74
Tienari et al (2004)
Tienari et al (2004) - Biological parents of kids with scz are at heightened risk, shows a lack of environmental risk. This shows a predisposition to scz, that the environment didnt buffer the probability.
75
Three studies that depict three different environmental causes of scz
1. Morgan et al (2017) - birth complications
2. Di Forti et al (2015) - THC rich cannabis in teenage years, even without genetic disposition
3. Morkved et al (2017) - childhood trauma, 67% with scz related to psychotic disorders, reporting at least one trauma. This is in comparison to 38% of a matched group with no psychotic disorders. Matched them with the severity of SCZ.
76
Morgan et al (2017)
Birth complications increase likelihood of scz in the offspring
77
Di forti et al (2015)
THC rich cannabis in teenage years, even without genetic disposition increases likelihood of scz
78
Morkved et al (2017)
Morkved et al (2017) - childhood trauma,
67% with scz related to psychotic disorders, reporting at least one trauma.
in comparison to 38% reporting a trauma of a matched group with no psychotic disorders. Matched them with the severity of SCZ.
79
3 limitations of Morkved et al
if trauma did lead to scz then why did 38% who did report a trauma not have a psychotic disorder?
1. Predictive value is low
This shows it is not guaranteed or deterministic, this means it lacks predictive value because there isnt a secure guarantee in causing of scz and therefore any treatments/Interventions of scz.
2. Limited explanation
only 67% not 100% concordance rate, then it is a limited explanation as it evidently Is more complex and is influenced by many/other factors.
3. what about epigenetics? Can a trauma be passed on? Is that free will?
80
Polygenic meaning
Link to scz
That there isnt one type of candidate gene for a disorder/condition
There are multiple different genes
Therefore there are multiple genes that can code for schizophrenia
81
Study for schizophrenia being polygenic and aetiologically heterogeneous
Ripke et al (2014) - meta analysis
Looked at pre existent genome studies of scz. This was 37,000 people with scz in comparison to a control group of 113,000.
They found 108 separate genetic variations that were associated with increased risk of scz.
This shows that scz is aetiologically heterogeneous - there isnt one combination of polygenic genes, it is differnt combinations for different people.
82
Aetiologically heterogeneous meaning
Link to scz
= not one combination of polygenic genes in scz but lots of possible combinations for different people
Supported by Ripke who found that there are up to 108 genetic variations in increasing likelihood of having scz
83
Ripke (2014)
What does it show
Ripke et al (2014) - meta analysis
Looked at pre existent genome studies of scz.
This was 37,000 people with scz VS control group of 113,000.
They found 108 separate genetic variations that were associated with increased risk of scz.
This shows that scz is aetiologically heterogeneous - there isnt one combination of polygenic genes, it is differnt combinations for different people.
84
Two limitations of Ripke et al
1. Predictive value
This means scz has low predictive value/validity because there are so many different genes as well as combinations that could code for scz.
2. Not a rounded explanation
Why is it 0.7% > the missing .3 might be accounted for by environmental factors like THC consumption or childhood trauma.
85
What is the role of mutation in causing scz idea
Supporting studies?
That idea that if your genetic material is mutated, by radiation poisoning or infection, it is correlated with increased right of scz
Brown et al
Under 25 men : 0.7% chance of scz
Over 50 men : 2% chance of scz
86
Brown et al (2002)
One limitation of this
Brown et al (2002)
increased risk of sperm mutation (which increases naturally with age) correlates with an increased risk of scz.
Fathers under 25 had a 0.7% of scz.
Fathers over 50 had a 2% chance of scz.
1. Limited explanation
Why is it 0.7% > the missing .3 might be accounted for by environmental factors like THC consumption or childhood trauma.
87
One useful application of biological explanation of scz
Genetic counselling
One application of understanding the likely role of genes in scz is genetic counselling.
- genetic counselling is basically when you can see an infants genes to see what potential conditions they might be born with.
88
What is hyperdopaminergia
Hyperdopaminergia - ‘hyper’ = lots of
This is when an excess of dopamine or dopamine receptors in pathway from the sub (sub meaning below) cortex to Broca’s area, the frontal lobe, which might be responsible for speech poverty or auditory hallucinations in scz
89
What is hypodopaminergia
- ‘hypo’ = lower
This is when there is lower amounts of dopamine or dopamine receptors in the prefrontal cortex, which is associated with decision making and impulsivity, can lead to cognitive problems.
90
Problem with hyperdopaminergia and hypodopaminergia
chicken/egg? we do not know if it scz causes the dopamine changes or the changes causing scz. Unclear.
91
Three medicines for scz
L-Dopa - increases dopamine
Amphetamines - really strong stimulant drugs that are excitatory
Antipsychotics - inhibit dopamine
92
Three medicines for scz
1.L-Dopa - increases dopamine
2. Amphetamines - really strong stimulant drugs that are excitatory
3. Antipsychotics - inhibit dopamine
93
What is L-Dopa
What does it do
given to sufferers of Parkinson’s, which is caused by low levels of dopamine
L-Dopa therefore increases levels of dopamine
94
What are amphetamines
What do they do
stimulant drugs that are excitatory and speed up messages between your brain and body
This increases dopamine, worsening symptoms.
Curran et al - amphetamines are so strong that it can induce scz in people without it
Tenn et al - amphetamines induced scz like symptoms in rats, and then relieved those symptoms using drugs that reduce dopamine
95
What are antipsychotics and what do they do
Tauscher et al (2014) antipsychotics decrease dopamine and reduce symptoms
96
Curran et al (2004)
Curran et al (2004) : amphetamines are so strong it can induce scz in people without it
Ampetamines increases dopamine - so it shows that increased dopamine does correlate to schizophrenia
97
Tenn et al (2003)
Tenn at al (2003): induced scz like symptoms in rats using amphetamines, and then relieved those symptoms using drugs that reduce dopamine actions, supporting dopamine hypothesis.
98
Tausher et al (2014)
3. Tauscher et al (2014) antipsychotics decrease dopamine and reduce symptoms
4. Some candidate genes act on the production of dopamine like D receptors.
99
Seeman (1987)
scz people have increased dopamine receptor density rather than increased levels of dopamine in their body.
Dopamine receptor density means they have an increased sensitivity to dopamine.
This is more than 2x normal amount (60% - 110%)
100
Alternative to dopamine hypothesis
McCutcheon et al (2020) - using post mortem and live Brian scans, found raised levels in several brain regions of scz patients of glutamate.
Several candidate genes (Ripke - 108 candidate genes for SCZ) also code for glutamate.
101
McCutcheon et al (2020)
McCutcheon et al (2020) - using post mortem and live Brian scans, found raised levels in several brain regions of scz patients of glutamate.
Several candidate genes (Ripke - 108 candidate genes for SCZ) also code for glutamate.
M
102
Name Friths dysfunctional thought processing theories
1. Friths faulty filter theory
2. Metarepresentation
3. Central control dysfunction
103
Outline Friths filter theory as an explanation for scz
Seven key words
1. Friths faulty theory
We have ‘attentional filters’
- non-SCZ individuals are able to filter out irrelevant stimuli (images sounds etc) and focus on one thing, filtering out everything else.
- SCZ Individuals are unable to filter out other irrelevant auditory stimulus, becoming overwhelmed with sensory information, unable to process and interpret.
He then distinguishes between conscious and preconscious processing
Conscious processing = the highest Level of cognitive functioning takes place, and we are aware of this. However this has a limited capacity so we can only carry out one task at a time.
Preconscious processing = we are unaware of this as it is an automatic process, and we carry out many tasks at one time.
He states that usually only important information goes into the conscious awareness but for scz people the attentional filter breaks down, meaning the unimportant information enters the conscious for scz. Therefore the mind of scz think everything has to be attended to.
- Frith argues this is how delusions occur, specifically thought insertion, and might account for auditory hallucinations.
104
Outline Friths theory of metarepresentation as an explanation for scz
Four kw
2: METAREPRESENTATION
= the cognitive ability to differentiate between our own actions/thoughts, output and actions of others.
Schizophrenics may experience a dysfunction in this area, meaning they may be unable to differentiate their own thoughts and accidentally believe they are somebody else’s. >
This might lead to hallucinations or delusions, specifically thought insertion delusions ( thinking we are hearing voices but it is our own thoughts )
105
Supporting evidence for metarepresentation
Bental et al (91) found that SCZ struggled to identify words belonging to a certain category, such as birds that they had seen before, drawn themselves or had not seen before.
They are unable to recognise their own output - Dysfunction in meta-representation, as they don’t recognise their own drawings (output) which is support of frith
106
Bental (1991)
Bental et al (91) found that SCZ struggled to identify words belonging to a certain category, such as birds that they had seen before, drawn themselves or had not seen before.
They are unable to recognise their own output - Dysfunction in meta-representation, as they don’t recognise their own drawings (output) which is support of frith
107
108
Outline friths theory of central control dysfunction
Seven kw
Your central control is linked to cognitive functions that suppress automatic responses, whilst we perform deliberate actions.
Having a dysfunction in your central control is linked to SCZ because it means an inability to to suppress these automatic thoughts and speech triggered by stimuli, derailing their thoughts and sentences.
Frith links this to speech poverty, when scz show word salads and lack of fluent sentences.
109
Supporting evidence for central control dysfunction
Stirling et al :
tested stroop test on scz and non scz, and it took over 2x longer for scz to complete it. This is good evidence for central control dysfunction because it shows their ability to suppress automatic response when doing deliberate actions is much slower.
110
What is the stroop test
This is found using the Stroop test, when you have to, under timing, read out the colours of words but they are typed in different colours than what they are. EG:
Red. Blue. Purple. Green
111
Stirling et al
tested stroop test on scz and non scz, and it took over 2x longer for scz to complete it. This is good evidence for central control dysfunction because it shows their ability to suppress automatic response when doing deliberate actions is much slower.
112
4 strengths of the cognitive psychological explanation for scz
Strengths
1. It explains different symptoms clearly - face validity
2. Strong supporting evidence - central control dysfunction (stroop test Stirling et al)
3. Cognitive treatement works better than biological treatment - means the cognitive explaiantion is stronger.
4. NICE (National institute for care) et al (2014) did a meta analysis of CBTp (CBT for psychosis patients), and found it was more effective than antipsychotic meds.
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Outline four limitations of the cognitive psychological explanation
1. There isnt one theory of dysfunctional thought processing explains all of them
2. It doesnt explain why the delusions (voices they hear) are negative abusive or suggest reprehensible acts.
3. Cognitive study support is reliant on inferences, unproved and correlational and
4. Cognitive factors are unable to provide a distal explanation for scz like biological.
Distal explanation - root/cause explanation
Proximal - what directly causes something
Cognitive provides a proximal explanation:
Eg: faulty filter > hallucinations
However a distal explanation is better because it provides the first cause: this is better cause knowing jsut that there is a faulty filter isnt enough, we need to know what causes this.
Eg: dopamine levels in brain, neural correlates > faulty filter > hallucinations
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What is the difference between distal and proximal explanations
Distal explanation - root/cause explanation
Proximal - what directly causes something
Cognitive provides a proximal explanation:
Eg: faulty filter > hallucinations
However a distal explanation is better because it provides the first cause: this is better cause knowing jsut that there is a faulty filter isnt enough, we need to know what causes this.
Eg: dopamine levels in brain, neural correlates > faulty filter > hallucinations
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DRUG THERAPHY FOR SCZ: Atypical antipsychotics, Typical antipsychotics or BOTH?
1. Only addresses positive symptoms of scz
2. Addresses both negative and positive symptoms
3. Can influences serotonin receptors
4. Can improve cognitive functioning and mood due to influencing serotonin and glutamate receptors
5. Must work on 60-70% of dopamine to be effective (leading to extra pyramidal side effects
1. T
2. A
3. B
4. A
5. T
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DRUG THERAPHY FOR SCZ: Atypical antipsychotics, Typical antipsychotics or BOTH?
6. Less extra pyramidal side dede tá
7. Can lead to tardive dyskinesia
8. Only antagonises dopamine receptors temporarily
9. Has a sedative effect
10. Chloropromazine is an EG
11. Clozapine is an EG
12. Could be fatal (agranulocytosis)
6. A
7. T
8. A
9. B
10. T
11. A
12. A
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What are the three topics within the family dysfunction theory as the cause of scz
1. Schizophrenogenic mother
2. Double bind theory
3. EE (Expressed emotion)
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What is the schizophrenogenic mother theory
the theory that mothers cause (ogenic) scz.
Fromm-Reichmann:
This was based on interviews, and the inference that the mothers ‘seemed like this’.
Conducted interviews and found these characteristics to be common :
cold, rejected, controlled, creating atmosphere of tension and secrecy. This leads to distrust nad paranoid delusions
Also paired with passive father who isnt really involved
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1. What is the double bind theory
- What does it consist of
- Supporting study
2. What does the double bind theory say the behaviour can lead to?
1. This theory (family dysfunction theory for scz)
States that it is not specific family members but the ‘family climate’ and the role of communication style that onsets scz
- Double bind theory consists of two things:
1. Receiving mixed messages (verbal v physical) creating uncertainty in child.
2. Withdrawal of love, unclear boundaries.
- Bateson (1972)
Scz is caused by mixed messages from parents that express care but at the same time appear critical and hence incoherent. (Mother asking for hug (initiating care) and then being physically tense (critical)).
Double bind behaviour can also relate to contradiction between persons verbal and non verbal behaviour
2. This can lead to incoherent ideals of reality, influencing scz symptoms such as emotional flattening (no emotion or inappropriate/wrong emotion) and social withdrawal, as well as inducing delusions of paranoia
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Bateson (1972)
Argues that the family dysfunction creates scz: DOUBLE BIND THEORY
Argues that it is not based on the mother but more the ‘family climate’ and the role of communication style which is important.
receiving missed messages about behaviour ( contrasting verbal and physical communication) means that they are trapped feeling like they are doing the wrong thing
Thus means they are unable to comment on unfairness of situation and when they get it wrong , child is punished by withdrawal of love.
This can leave them with an understanding of the world as confusing and dangerous
Scz is caused by mixed messages from parents that express care but at the same time appear critical and hence incoherent. (Mother asking for hug (initiating care) and then being physically tense (critical)).
Double bind behaviour can also relate to contradiction between persons verbal and non verbal behaviour
This can lead to incoherent ideals of reality, influencing scz symptoms such as emotional flattening (no emotion or inappropriate/wrong emotion) and social withdrawal, as well as inducing delusions of paranoia
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WHAT IS expressed emotion
1. Examples
2. Supporting study
EE is the level of emotion which is shown to a person before and when they have scz
1. THREE TYPES OF EE
- verbal criticism, accompanied by violence
- Hostility towards the person, including anger and rejection
- Emotional overinvolvment in the life of the person including needless self sacrifice (like guilt inducement: sure ill take you to the shops but i guess i wont eat)
These levels of expressed emotion are sources of stress for the person and mean that relapse into worse scz episodes/symptoms are induced. It is also suggested that ot may be a source of stress that triggers an onset of scz in a person who is already vulnerable (diathesis stress model)
2. Linzen et al (97) found that patrients who return home to families high in hostility, emotional over involvement and criticism are 4x more likely to relapse, rather than those who have families with low amount of these characteristics.
This shows that people recovering form scz are more likelihood to experience. Return from their symptoms - doesnt necessarily show causation, just worsening of symptoms.
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Linzen et al (1997)
SUPPORTING EVIDENCE FOR EE
Found that patrients who return home to families high in hostility, emotional over involvement and criticism are
4x more likely to relapse
, rather than those who have families with low amount of these characteristics.
This shows that people recovering form scz are more likelihood to experience. Return from their symptoms - doesnt necessarily show causation, just worsening of symptoms.
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Read et al (2005)
What does this show/support
Read et al (2005) : 69% of women and 59% of men with scz have a history of physical and sexual abuse.
Supports morkved that found most adults with scz report at least one childhood traumas of abuse
Implies that people recovering from scz are strongly influenced by family dysfunction or more likely to come from dysfunctional families.
Not necessarily causational but a correlation might indicate we should improve family functioning
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Evaluate family dysfunction as a theory for scz
3c
0P
X: Theories and evidence are hard to falsify - chicken or egg? Which came first the expressed emotion or the scz? More correlational than causational.
X - limited evidence: strong evidence for EE (not 100% concordance rate though) and almost no evidence to support scz mother and double bind theory. They are based on observations and assessments but not systematic evidence.
This implies a limited link with childhood trauma and scz - lack of FALSIFIABILITY
X : socially insensitive as this can lead to a lot of parent blaming, which ads Ethical implications : parent blaming?
D: Linking family dysfunction to scz is socially insensitive, even if it is true we could intervene, but it can lead to parent blaming. It might mean they cant support their scz child if they feel that guilty.
Not true / justified
Reduce ability to support scz child
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General strengths /weaknesses of antipsychotics as a treatment for scz
- Less than 3% of people with scz now live permanently in hospitals. This is a strength as the majority of scz live in communities rather than institutions.
Why is this a strength:
- better quality of life: not isolated from the rest of society which means they can live a more fulfilling life, even if they cannot work.
- Also even if they cant work to benefit the economy they can still spend money so they would still profit the goverment.
- economic implications: more people paying tax, paying for housing,
- Less people institutionalised means funding for hospitals for those scz is allocated to other treatments or other people who need it.
- However: this might mean that families become providers and caregivers which might be limiting on the economy.
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Typical antipsychotics
One example
First generation of antipsychotics that work as dopamine antagonists
EG: chloropromazine
Antipsychotics work by antagonising dopamine, reducing the effect of dopamine at the receptors by blocking them and making a reuptake inhibition effect where the concentration in the synaptic cleft is increased.
Side effects:
Tardive dyskinesia - this is when there is an involuntary movement of the tongue face and jaw. This is an extrapyramidal side effect (meaning a motor/movement side effect) as it targets muscles.
It can also lead to permanent disfiguration of the tongue/face/jaw.
Dyskinesia = involuntary movement
Tardive = late/tarde. As in the dyskinesia is onset when there is a long term use of the medicine, even after they’re not taken.
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One problem with typical antipsychotics way they function
One problem with typical antipsychotics is that its not specific to neurotransmitter systems so it cannot target specific lobes or functions: leading to the more extreme side effects and the extra pyramidal side effects.
Side effects:
Tardive dyskinesia - this is when there is an involuntary movement of the tongue face and jaw. This is an extrapyramidal side effect (meaning a motor/movement side effect) as it targets muscles.
It can also lead to permanent disfiguration of the tongue/face/jaw.
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What are Atypical antipsychotics
How do they function
Give example if one
Second type of antipsychotics
-less severe side effects, affect wider group of people, target more neurotransmitters
EG: CLOZAPINE
Atypical antipsychotics
These also act on the dopamine system by block the dopamine receptors: they only temporarily occupy the dopamine receptors = rapid disassociation. This is similar to reuptake inhibition: which means dopamine isn’t dissolved in the synaptic cleft but the concentration is increased in the cleft, meaning the dopamine effect lasts a bit longer. In atypical antipsychotics this is rapid disassociation, so the dopamine receptors are only temporarily blocked.
This is associated with lower levels of extra-pyramidal side effects (motor) which is seen in typical antipsychotics: tardive dyskinesia as the temporary occupation of the dopamine receptors mean they can’t reach permanent/serious side effects
Atypical also act on serotonin and glutamate which is correlated with atypical antipsychotics being able to target mood and cognitive functioning.
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Pros /cons of atypical antipsychotics
Clozapine
Argranulocytosis - fatal blood condition
(LIMITATION. - might not be able to be used by those with heart or blood conditions - not idiographic approach as it fails to consider the individual context)
LIMITATION: means that those on this medication would need regular medical visitations for blood health which may not be economically attainable for the NHS/ attainable for the scz as it might trigger them to be in certain environments?
STRENGTH: works on both positive and negative symptoms of scz unlike typical meds
STRENGTH: targets the suicidal rates as it can improve mood and cognitive function and suicide in scz is 30-50% common.
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Evaluate drug therapy medication (biological theory for treating scz)
Evaluate drug therapy
X: serious and long term side effects increase the attrition rate (dropout rate)
X : drugs are only palliative, meaning they only treat the symptoms and not the distal cause. This is limiting because it means there cannot be a cure/more secure decrease of symptoms.
if a patient stops taking their meds, the symptoms will return.
X: drugs treat the symptoms but not the cause
P: faster acting than therapy, can be used before engaging with therapy if scz are unwilling to go to therapy.
X: medicine requires continuous use otherwise there is a high chance of relapse.
X: can patients with SEVERE scz really consent to the dangerous side effects of meds? Do they have informed consent and understanding.
Thornley et al (2003) - chloropromazine is associated with better overall fiunctioning than a placebo given to scz participants
Meltzer (2012) clozapine is more effective than typical antipsychotics and atypical ones, and seen in 30-50% of treatement resistant cases (where scz gave tried loads of treatments and nothing has worked).
This means clozapine> typical and atypical antipsychotics
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Thornley et al
Chloropromazine is associated with better overall fiunctioning than a placebo given to scz participants
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Meltzer (2012)
clozapine is more effective than typical antipsychotics and atypical ones, and seen in 30-50% of treatement resistant cases (where scz gave tried loads of treatments and nothing has worked).
This means clozapine> typical and atypical antipsychotics
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Healy
Most studies that show successful trials have had their data published multiple times.
A: the powerful calming/sedative effect makes it easy to demonstrate a positive effect but it doesnt really mean that the psychosis is reduced it may just be that the symptoms are suppressed. This is a limitation of the research because it means the evidence base for antipsychotic effectiveness is less effective than i
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Crossley
(2010) : meta analysis of efficacy and side effects of atypical v typical. Found that there isnt a significant difference in effect on symptom but only differences in types of side effects
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Leucht et al (2012)
found in a meta analysis (of 65 studies, over 6k scz) all patients either were given typical/atypical and then maybe given a placebo.
Within a year : 64% of the placebo had relapsed, and 27% on drug had relapsed.
A: This shows that antipsychotics are therefore somewhat effective in targeting the likelihood of relapse rates in scz.
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Why CBTp is good as a treatment for SCZ
(3)
around 5-20 sessions in groups/individually.
Helps patients identify the irrational thoughts and try to change them or approach from a new perspective
Also helps scz by normalising their reactions and for them not to feel crazy: “many struggle with this”
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Give three ways that CBT helps with scz
1. It identifies triggers.
If the hallucination/delusions are difficult to reduce, then avoid the trigger (a certain place/image). People hearing voices can also be helpful by teaching them that voice hearing is an extension of the ordinary experience of thinking in words. This would be ‘normalisation’.
2. Helps to make sense of how delusions and hallucinations impact their behaviour and feelings
3. If delusions are resistant to Reality testing, you can still help with anxiety with the experience.
For eg: if a person hears voices (that they believe is a demon) they may have anxiety. If a therapist can convince them the voice is not real/ comes from a cognitive malfunction then they will have reduced anxiety and can function better. This wouldn’t mean that scz is gone but its easier to cope with and reduce distress.
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What are the two types of coping strategies in therapy
- Two types of coping strategies in therapy:
1. Cognitive strategies
positive self talk (delusions tend to be negative and scz tend to have negative thoughts)
Distraction
Concentrating on a. Specific task
2. Behavioural strategies.
relaxation techniques (breathing, massage, reciprocal inhibiton (when in systematic desensitisaiton they pair a poisitive thing with a negative thing and you cant feel both at same time, its counter conditioning)
Social withdrawal - increasing social contract
Loud music to drown out voices
Example of application of behavioural and cognitive strategies in CBT:
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Cognitive strategies for scz (3) in CBTp
positive self talk (delusions tend to be negative and scz tend to have negative thoughts)
Distraction
Concentrating on a. Specific task
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Behavioural strategies (3) for scz in CBTp
relaxation techniques (breathing, massage, reciprocal inhibiton (when in systematic desensitisaiton they pair a poisitive thing with a negative thing and you cant feel both at same time, its counter conditioning)
Social withdrawal - increasing social contract
Loud music to drown out voices
Example of application of behavioural and cognitive strategies in CBT:
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Turkington
Turkington et al (2004) - describe a CBT EG to challenge paranoid delusions
Patient: the mafia are observing me to decide how to kill me
Therapist: you are obviously very frightened…there must be good reason for this. EG OF NORMALISATION
Patient: do you think its the mafia
Therapist: its a possibility but there could be other explanations.
How do you know its the mafia? - EG OF LOGICAL DISPUTE
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Evaluate CBTp as a treatment for scz
3 studies
Jauhar (2014) : reviewed results of 34 studies of CBT and found that it has a significant but fairly small effect on positive negative symptoms.
This suggests that CBT doesn’t just enhance coping but actually reduces frequency of symptoms
Bateman (2007) looked at effects of CBT in reducing suicidal thoughts and behaviour.
99 patients split into two conditions: CBT or no CBT.
All had been antipsychotic resistant
CBT was found to reduce suicidal ideation both immediately after therapy and up to nine months later.
This is strong because CBT has NO side effects
Is longer lasting than medicine and has immediate effect which may not be seen in meds.
More client specific - idiographic approach rather than nomothetic application of medication
Also is more empowering to the patient as they take responsibility for their improvement and build good habits actively rather than passively taking meds.
Senskey et al (2000)
Found that patients that resisted drug treatments had a reduction in positive and negative symptoms when treated by 19 sessions of CBT.
furthermore they continued to improve even 9 months after the treatment had ended, suggesting that CBT can be effective when drugs are not and are also an improvement on drug therapies as drugs only short term reduce symptoms.
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Jahuar (2014)
Jauhar (2014) : reviewed results of 34 studies of CBT and found that it has a significant but fairly small effect on positive negative symptoms.
This suggests that CBT doesn’t just enhance coping but actually reduces frequency of symptoms
144
Bateman (2007)
Bateman (2007) looked at effects of CBT in reducing suicidal thoughts and behaviour.
99 patients split into two conditions: CBT or no CBT.
All had been antipsychotic resistant
CBT was found to reduce suicidal ideation both immediately after therapy and up to nine months later.
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Sensory et al (2000)
Senskey et al (2000)
Found that patients that resisted drug treatments had a reduction in positive and negative symptoms when treated by 19 sessions of CBT.
furthermore they continued to improve even 9 months after the treatment had ended, suggesting that CBT can be effective when drugs are not and are also an improvement on drug therapies as drugs only short term reduce symptoms.
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Strengths of CBTp as a treatment
4p
- This is strong because CBT has NO side effects
- Is longer lasting than medicine and has immediate effect which may not be seen in meds.
- More client specific - idiographic approach rather than nomothetic application of medication
- Also is more empowering to the patient as they take responsibility for their improvement and build good habits actively rather than passively taking meds.
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What are family therapy strategies
therapy strategies = when a therapeutic alliance is formed with all family members, in order to reduce the stress of caring for a scz relative and maintaining own lives.
This can reduce EE
improves the ability of the family to anticipate and solve problems
Improves the families beliefs and the behaviour towards scz.
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What do family therapy strategies target to improve
This can reduce EE
improves the ability of the family to anticipate and solve problems
Improves the families beliefs and the behaviour towards scz.
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What family factors does family therapy target. (3)
As family dysfunction can increase the risk of relapse in scz, family therapy attempts to improve the home situation of the person with scz.
Family centred: the therapy is intended to change the behaviour of the whole family not just the person with scz (DOUBLE BIND THEORY) this is a holistic approach
Psychoeducation: the family is educated on the symptoms of scz in order for them to be more understanding of the scz behaviour.
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Supporting studies of family therapy
Leff (1985)
50% of those with standard outpatient care had relapsed within 9 months
This is in comparison to 8% that relapsed within 9 months but instead received family therapy.
HOWEVER after two years, this had risen to 50% with family therapy and 75% with standard care.
This suggests that the use of fmaily therapy is helpful in reducing re admission in short term but may not be as reliable in the long term.
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Leff
Leff (1985)
50% of those with standard outpatient care had relapsed within 9 months
This is in comparison to 8% that relapsed within 9 months but instead received family therapy.
HOWEVER after two years, this had risen to 50% with family therapy and 75% with standard care.
This suggests that the use of fmaily therapy is helpful in reducing re admission in short term but may not be as reliable in the long term.
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SETAP - A01 GM FOR FAMILY THERAPY
S - SELF SACRIFICE - reducing stress of caring for scz
E - reduced EE (expressed emotion)
T - therapeutic alliance to agree on aims
A - anticipate and solve problems (triggers)
P - psychoeducation : improving Beliefs and behaviour towards SCZ
(Psychoeducation: the family is educated on the symptoms of scz in order for them to be more understanding of the scz behaviour. )
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What is a token economy
A way to manage, NOT CURE/TREAT, and promote acceptable or positive habits.
Token economies improve social functioning such as getting a job.
This is typically in institutions (orphanages, hospitals etc)
154
What ISNT a token economy
NOT a treatment for scz just improving pro social functioning.
155
How do token economies work
Through operant conditioning
The ‘tokens’ are a neutral secondary reinforcer; they are presented as tasks which are positive habits (making bed, personal hygiene, socialising). By doing these neutral secondary reinforcers, they are rewarded with primary reinforcers (the goal that the scz people actually want) such as privileges or rewards: sweets/magazines/films
156
What is required for a token economy to work
They must ensure to make an initial pairing for the scz: need to demonstrate that the secondary and primary reinforcers are linked and work together. Some scz might not be able to understand that or might have a faulty filter…
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What has been found about token economies
it was shown to increase the number of tasks they completed SIGNIFICANTLY: which has been linked to been able to reduce avolition
Mainly used in institutions or hospitals.
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Ayllon and Azrin
What did they find
What does this mean
Trialled a token economy system in a ward of women (gynocentric study)with scz. Every time participants carried out a task eg, making bed or cleaning they were given a plastic token.
This was the secondary neutral reinforcer in order to reach the primary reinforcers.
The number of tasks they carried out increased significantly.
This means that token economies are efficient systems to increase pro social behaviour
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What are the goals of token economies
(3)
To improve the bad habits developed when institutionalised
1. Bad hygiene
2. Reduced socialisation
3. Apathy
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What are some strengths of token economies (2)
Pro: improves quality of life, easier to normalise and adapt back into the community which isnt just beneficial for the scz but economically for the government if they have more workers and less in institutions.
Pro: it can target key behaviours for each scz, which is a personalised idiographic management.
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Glowacki
6 cons and 3 pros
Meta analysis of 7 studies, found that token economies reduced negative symptoms.
Cons (6)
- Doesnt reduce positive Symptoms
- Might be a submission/represison of symptoms not actually reducing scz symptoms jsut making them less obvious.
- File drawer bias
- Might give professionals too much powers over the patients which curtails their freedom
- also means that the patients might become over accustomed to the person rather than actually have independence for these socially positive habits.
- glowackis study participants probably also had fmaily therapy, meds and CBTp meaning its hard to differentiate that it is the token economies that are improving the negative symptoms.
-
Pro (3)
Reduce negative symptoms
Immediate reward introduced to promote positivity
Increases chances of being released from hospital.
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Chiang et al (2019)
there are other alternatives to token economies which are more positive alternatives (art therapy) which are lower risk of complaints and less controlling.
NICE (National institute for Care Excellence…)
163
What is one alternative to token economies that have over risk of complaints and less control
Chiang et al (2019): there are other alternatives to token economies which are more positive alternatives (art therapy) which are lower risk of complaints and less controlling.
NICE (National institute for Care Excellence…) also
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What is the interactionist approach to treating and explaining scz
An approach that acknowledges that there are biological psychological and societal factors int he development of scz.
Biological: genetic vulnerability and neurochemical/neuroogical abnormality
Psychological: stress from the events/daily family interaction
Interactionist - diathesis stress model
165
What are the biological and psychological factors inn the development of scz.
Biological: genetic vulnerability and neurochemical/neuroogical abnormality
Psychological: stress from the events/daily family interaction
166
What is the stressor in the traditional interactionist approach
STRESS = negative psychological experience
A vulnerability to scz opus a stress trigger are the requirements to develop the condition.
One or more underlying factors make a person particularly vulnerable To developing scz but the onset is triggered by the stress.
The interactionist approach
Meehls model : the schizogene (Polygenic)
Diathesis : vulnerability, entirely genetic
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What is the stressor in the modern diathesis understanding
This is now considered to be anything that triggers scz. Recent factors triggering an episode have been considered things such as:
cannabis use, which is a stressor as it increases risk of scz by up to seven times
It also interferes with the dopamine system, so it is a plausible stressor.
Because not everyone who smokes cannabis develops scz it makes more sense as a stressor leading to vulnerability.
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What is the diathesis in the modern understanding of scz
There is not one single schizogene that increases genetic vulnerability but multiple different ones. Modern views of diathesis include a range of factors beyond genetic, including trauma.
a neurodivergent model has been proposed, suggesting that early trauma alters the developing brain eg child abuse can seriously affect brain development.
The hypothalamic pituitary adrenal system can become over active making a person more vulnerable to later stress. Trauma is the diathesis not the stress in this modern theory.
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Tienari et al
Procedure: hospital records were reviewed for nearly 20k women admitted to Finish psychiatric hospitals between 1960-79
This was to identify those that had been diagnosed at least once.with scz.
They checked the list to identify those who had one or more of their offspring adopted. The resulting sample of 145 adopted offfspring (High risk group) then matched with sample of 158b adoptees with no genetic risk (low risk group)
Both groups were assessed after an interval of 12 yrs then 21 years. Family functioning was measure using the OPAS scale, measuring conflict, lack of empathy and insecurity.
Findings : of 303 adoptees, 14 developed scz over the course of the study.
11/14 of them were high risk and the 3 from low risk group.
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What do the results from Tienari et al mean
Being in a healthy adoptive family had a protective effect even for those with high genetic risk. In adoptees at high risk of scz, not in low risk, stress was a significant predictor of developement of scz.
This shows:
Genetic factors or adverse conditions in the womb can lead to a biological vulnerability and this can take form of biochemical or neuroanatomical abnormalities.
The biological vulnerability can lead to psychological vulnerability such as an inability to process information appropriately.
These cognitive difficulties become exacerbated by stressful life vents and therefore could go onto produce some psychotic symptoms o scz such as delusions and hallucinations.
The role of social factors in triggering dysfunctional thinking needs to be explored.
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What are two pronlems with this study
Problems with the study:
How do you assess an adoptive family functioning?
What is the cause and effect of stress? Is the family unhealthy;thy or are they unhealthy;thy due to the scz kid?
This would mean that stress could not be a cause of scz
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What is an interactionist treatment of scz
Interactionist treatments:
The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia and is therefore compatible with both biological and psychological treatment. In particular the model is associated with with combining antipsychotic meds and psychological therapies, CBTp.
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Tarrier et al (2004)
Studied 315 patients who were randomly allocated to either a medication and CBT group, a Control group or group with meds plus supportive counselling.
Patients in the 2 combination groups showed lower symptom levels than those in the control group (medication only) although there was no difference in rates of hospital re admission.
Studies like this show that there is a clear practical advantage to adopting an interactionist approach in the form of superior treatment outcomes and therefore highlight the importance of an interactionist approach.wh
