schizophrenia Flashcards

Question

outline the genetic explanation for schizophrenia

Answer 1

Schizophrenia tends to run in families among relatives and not in-laws. The risk of developing the disorder among individuals who have family members with schizophrenia is higher than those who don't. Schizophrenia is also polygenic and therefore its more likely that different combinations

Answer 2

Family studies- Gottesman and shields children with 2 schizo parents had a concordance rate of 46%, children with 1 schizo parent had a concordance rate of 13% and siblings who had a schizo sibling had a concordance rate of 9% Twin studies- joseph calculated that the pooled data for all schizophrenic twins studies carried out showed a concordance rate for MZ twins of 40.4% and 7.4% of DZ twins

Answer 3

- excess of dopamine in the subcortical area particuluary the mesolimbic pathway of the brain is associated with the postitve symptoms beacuse an excess of dopamine causes neurons to fire too easily too often leading to hallicinations and delusions. Schizophrenics are thought to have abnormally high numbers of D2 receptors recieiving neurons resulting in more dopamine binding and therefore more neurons firing. It is also beleived that the negative symptoms of schizophrenics are caused by a deficit of dopamine in the prefrontal cortex

Answer 4

Supporting research: research has shown that drugs increase levels dopamine produce psychotic symptoms. Leucht et al meta analysis of 212 studies that had analysed the effectiveness of antipsychotics compared to placebo and found all drugs were more effective in treatment of positive and negative symptoms of schizophrenia achieved by normalising dopamine levels Criticisms: research has shown the clozapine is the most effective drug at reducing schizophrenia symptoms but it acts as serotonin and dopamine showing reduction. Noll said antipsychotic drugs don't work for 1/3 of people so lacks validity Opposing: high levels of dopamine could be a symptom of schizophrenia not a cause Usefulness: we can develop drugs to treat the symptoms schizophrenia as we know the dopamine is the cause of the symptoms Testability: scientific and reliable

Answer 5

Supporting research: Mz twins have 40.4% concordance rate of schizophrenia whereas Mz twins have 7.4%, twin studies, adoption studies, family studies Criticisms: environment can't be controlled in all of the studies for genes and Mz twins don't have 100% concordance rate. Opposing: psychological explanations e.g. upbringing/cognitive Usefulness: gene therapy and stop schizophrenia gene from expressing, preventative measures Testability; scientific and reliable

Answer 6

cognitive and family disfunction

Answer 7

Double bind theory: - when children receive 2 contradictory messages from their family makes them more likely to develop schizophrenia - They start to fear doing the wrong thing and feel unable to comment on the unfairness of the situation. - Leaves them with a confused understanding of the world and this is reflected in their symptoms like disorganised thinking and paranoid delusions Expressed emotion: Means there is a negative emotional climate where the families communication style is speaking more than listening EE can be verbal criticism, hostility and emotional over involvement in the family environment

Answer 8

Dysfunctional Central control: - Not being able to suppress autonomic responses while we perform deliberate actions and this can explain derailment and disorganised speech Meta representation: - The inability to reflect and understand thoughts and behaviour of yourself which explains the hallucinations of voices and delusions like thought insertion

Answer 9

Supporting research- -Support from Tierni et al showed that the illness only manifested in appropriate environmental conditions like an EE family -Berger- found schizophrenics could recall double bind statements from mothers more than non schizophrenics -Read et al reviewed 46 studies of child abuse and schizophrenia and found that 69% of adult women in patients and 59% of men with a diagnosis of schizophrenia had a history of physical abuse/ sexual abuse in childhood Criticisms- -Parent blaming -Deterministic/ individual differences -Reductionist environmentally -Liem found no differences in communication styles in families between SZ and non Opposing - -Biological explanations Mz twins and dopamine hypothesis Usefulness- -Help family not be too stressful for schizophrenics and provide an environment that will help the schizophrenic patient not relapse

Answer 10

Limitations: -Doesn't explain where the dysfunctional thought processes came from in the first place -Biological approach is stronger and more scientific like Mz twins having a 40.4% concordance rate -Howes and Murray address the problem of reductionism with an integrated model of schizophrenia and argue that the early vulnerability factors like genes paired with the exposure of social stressors is what causes schizophrenia. Strengths: -Sarin and Wallin research support- reviewed research relating to the cognitive model of schizophrenia and found supporting evidence for the claim that the positive symptoms have their origins in faulty cognition. For example, delusional patients were found to show various biases in their informational processing such as jumping to conclusions that lack reality -CBT can help limit the symptoms of schizophrenia by encouraging patients to evaluate the content of their delusions or of any voices and to consider the ways they might test the validity of their faulty beliefs. It was also shown in the NICE review that CBT was more effective in reducing symptom severity and improving levels of social functioning compared to drug treatments. So, we can say there are cognitive reasons for symptoms

Answer 11

Drug therapies CBT Family therapy Token economy

Answer 12

antipsychotics help a person with a disorder function as well as possible in life and are usually recommended for initial treatment for the symptoms of schizophrenia and there are two types typical and atypical

Answer 13

Atypical antipsychotics: used to combat the positive symptoms but they are also claimed to have some beneficial effects on negative symptoms as well Have beneficial effects on negative symptoms like cognitive impairments and are suitable for treatment resistant patients Only temporarily occupy the D2 receptors and then rapidly dissociate to allow normal dopamine transmission that is thought to be responsible for the lower levels of extrapyramidal side effects Atypical antipsychotics have a stronger affinity for serotonin receptors and a lower affinity for D2 receptors and this explains the different effects of the atypical drugs on the negative symptoms

Answer 14

Typical antipsychotics: are primarily used to combat the positive symptoms such as hallucinations and thought disturbances- products of an overactive dopamine system Reduce the effects of dopamine by binding to the D2 receptors in the mesolimbic pathway to eliminate the hallucinations and delusions Leads to extrapyramidal side effects as it blocks dopamine receptors in other pathways in the brain and this can cause tardive dyskinesia, blurred vision, immobility, tremors and high BP

Answer 15

+ supporting research as Leucht et metanalysis of 65 studies published involving 6000 patients and all of them were either given an atypical or typical antipsychotic and some of them were then taken off of them ad given a placebo instead and 64% of those who had been given the placebo had relapsed compared to 27% of those who stayed on the antipsychotic. - Extrapyramidal side effects like movement problems for the patient and appear to impact the extrapyramidal area of the brain which helps control the motor centre and the most common are Parkinsons related symptoms and more than half of the patients taking typical antipsychotics experience these problems. Typical antipsychotics also cause low white blood cell which causes septicaemia counts which causes them to have to take regular blood tests must be taken - The prescription of antipsychotics reinforces the view that there is something wrong with them and this prevents the individual from thinking about possible stressors that might be possible for their condition and therefore reduces their motivation to look for possible solutions that might alleviate these stressors. + cheaper, easier and can be the first step required for other treatments like CBT

Answer 16

This form of therapy is called CBTp when used ot treat schizophrenia which was originally developed to provide treatment for residual symptoms that persist despite drug treatments. The CBT corrects faulty thoughts and provide coping strategies. Method of CBTp 1. Assessment where the patient expresses his or her thoughts about their experiences to the therapist and realistic goals are discussed 2. Engagement where the therapists empathises with the patients perspective and their feelings of distress 3. The ABC model where the patient gives their explanation of the activating events and irrational beliefs that appear to cause their emotional and behavioural consequences 4. Normalisation telling the patient that many people have unusual experiences such as hallucinations and delusions under maybe different circumstances reducing anxiety and sense the isolation and this makes the patient feel less alienated and stigmatised making recovery seem more possible 5. Critical collaborative analysis where the therapist uses gentle questioning to help the patient understand illogical deductions and conclusions 6. Developing alternative explanations where the patient develops thier own alternative explanations for their previously unhealthy assumptions and these healthier explanations might have been temporarily weakened by their dysfunctional thinking patterns

Answer 17

+ the NICE review of treatments for schizophrenia found consistent evidence that when compared to standard care CBTp was effective in reducing rehospitalisation rates up to 18 months treatment and was shown to be effective in reducing symptom severity - CBTp seems to be more effective in specific stages of the disorder Addington and Addington claim that in the initial acute phase schizophrenia, self-reflection is not appropriate, and CBT is more appropriate after initial drug treatment - Lack of availability of CBTp as there are not enough clinical psychologists are out there are the treatment requires 1 on 1 long term treatment - There are schizophrenic specific barriers to CBT like: negative symptoms making it hard to be motivated for change, hallucinations/delusions may make it difficult to remember to engage with the therapist, poor memory recall may make it difficult to remember to engage in homework tasks, patient must want to get rid of the voice and some build relations with the voice

Answer 18

Family intervention has developed as a result of srudies of the family environment and its possible role in affecting schizophrenia. Research has consistently shown that schizophrenia has much to do with the relationship between the individual anf those who care for them. Poor relationships tend to result in relapse and the aim of family therapy is to provide support for carers in an attempt to make family life less stressful Family therapy is typically offered for a period of between 3 and 12 months and at least 10 sessions. Family based interventions are aimed at reducing the level of expressed emotion within the family as expressed emotion has been demonstrated to increase the likelihood of relapse The strategies include: 1. Reducing the emotional climate within the family and the burden of care for family members 2. Enhancing relatives ability to anticipate and solve problems 3. Reducing expression of anger and guilt by family members 4. Maintaining reasonable expectations among family members for patient performance

Answer 19

+ Pharoah et al meta analysis established that family therapy can be effective in improving clinical outcomes such as mental state and social functioning - but some suggest this is more to do with the fact it increases medical compliance + additional advantages as the family therapy has been showed by Lobban that 60% of these studies reported a significant positive impact of the intervention on at least one category - Garrety et al failed to show any better outcomes for patients given sessions of family therapy compared to those simply having carers. Individuals in both groups were found to have low relapse rates and that family intervention may not improve outcomes further than a goof standard of treatment as usual. - expensive and time consuming - only appropriate if family is high EE or double bind is occuring

Answer 20

The use of the token economy system based on the principles of operant conditioning was developed as a way of dealing with these negative symptoms and encouraging more positive behaviours. The behavioural principles employed in token economy systems are based on the theory of operant conditioning and the idea that the tokens are positive reinforcers There are 2 types of reinforcer: Primary reinforcers are anything that gives pleasure or remove unpleasant states and they don't depend on learning to acquire their reinforcing value Secondary reinforcers initially have no value to the individual but acquire their reinforcing properties as a result of being paired with primary reinforcers and the token is given out when a patient engages in a target behaviour For the reinforcer to be effective it must be given out immediately after the target behaviour otherwise the token will encourage another behaviour

Answer 21

+ research support from Dickerson et al who reviewed 13 studies of the use of token economies in the treatment of schizophrenia and 11 of these studies had reported beneficial effects and found overall the studies provided evidence of token economies being effective in increasing the adaptive behaviours of people with schizophrenia. - It could also be unethical as you are rewarding things that should be rights anyway like Tv and food treats + It is cost effective, easy and doesnt require training to implement - It wouldn't work in a real life setting as you cant keep tabs on them at all times and they may do undesirable behaviour and the rewards have to be appropriate for the patients

Answer 22

There are a number of different theories about the onset of schizophrenia and the diathesis stress model is a an explanation that proposes that the onset of schizophrenia is caused by a combination of genetics and the environment a person is exposed to According to the model there is a genetic component in schizophrenia that makes someone vulnerable and this is supported by the twin studies and the 40.4% concordance rates between Mz twins compared to the 7.4% with Dz twins. Then there is the stress part of the model where life experiences can trigger schizophrenia like childhood trauma and this is showed by Varese et al who found that children who experienced severe trauma before the ages of 16 were 3x more likely to develop schizophrenia

Answer 23

Key study: tiernari et al Procedure- hospital records reviewed for nearly 20,000 women admitted to psychiatric hospitals identifying those that had been diagnosed at least once with schizophrenia and this list was checked to find mothers who had more than one offspring adopted away. The resulting sample was 145 at high risk of schizophrenia and this was paired with a control group of 158 without genetic risk. Both groups of adoptees were independently assessed after an interval 12 yrs with a follow up after 21 yrs and they were interviewed and rated on the OPAS scale Findings: Of 303 adoptees 14 developed schizophrenia over the course of the study and 11 of these were from high risk groups and 3 from the low risk group

Answer 24

- Diathesis may not be exclusively genetic and there may be a link to brain damage instead of genetics like experiencing oxygen deprivation in labour making a person 4x more likely to get schizophrenia - Difficulties that the diathesis stress model is that Hammen argues that is the challenges a person faces that builds up their ability to develop effective coping skills and those who don't are more vulnerable to stress and mental illness - limitations of the Tiernari study is that the researcher identified that the assessment was of the family at one singular time and that the adoption may be the stressor and not the family + supports the usefulness of adopting an interactionalist approach from studies comparing the effectiveness of combinations of biological and psychological treatments and the isolated treatments the interactionalist treatments are more superior - Turkington et al argued that there is a good logical fit between the interactionalist approach and using combination treatments, but this could be causation fallacy and that it doesn't necessarily mean that it is correct

schizophrenia Flashcards

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