Schizophrenia Flashcards

Question

What is one strength the genetic explanation for schizophrenia

Answer 1

Twin studies – Hilker et al. (2018) found a concordance rate of 33% for MZ twins that shared schizophrenia compared to 7% of DZ twins that shared it ⚫ The difference is best explained by the amount of genes shared (100% vs 50%) ⚫ Adoption studies – Tienari et al. (2004) studied adopted children from Finland and found that of those that had schizophrenia, many of them had a biological mother that also had schizophrenia ⚫ This shows that even without being raised by a schizophrenic parent, you can still develop the disorder

Answer 2

Although research shows that genetics have a role in the development of schizophrenia, there is also a lot of evidence for environmental factors being involved ⚫ Examples include birth complications, childhood trauma and smoking cannabis during adolescence ⚫ Morkved et al. (2017) found that 67% of people with schizophrenia and other related psychotic disorders reported at least one experience of childhood trauma compared to 38% of a control group with non-psychotic disorders

Answer 3

Drugs used to reduce the intensity of symptoms of a psychotic disorder (usually positive ones) then used in combination with psychological therapies later on

Answer 4

Typical antipsychotics: used primarily for positive symptoms Atypical antipsychotics: also combat positive symptoms, but has benefits for negative symptoms

Answer 5

They work as dopamine antagonists. E.g. Chlorpromazin Antagonists are blockers – they block the activity of neurotransmitters Typical antipsychotics are dopamine antagonists which bind to D2 receptors on neurons, blocking their action (blocking transmission of dopamine) At first dopamine levels build up (because transmission is blocked) but over time, less and less dopamine is produced

Answer 6

Typical antipsychotics like chlorpromazine also work as a sedative (although not properly understood why) ⚫ They can be given to patients with other conditions to calm them

Answer 7

They typically target both dopamine and serotonin.

Answer 8

less extrapyramidal side effects, more beneficial for negative symptoms, better for treatment-resistant patients

Answer 9

Clozapine and Risperidone

Answer 10

1 Clozapine binds to D2 receptors, as well as serotonin and glutamate receptors 2This consequently improves mood and reduces anxiety and depression 3 As well as suicidal thoughts

Answer 11

It binds to more dopamine receptors than Clozapine so smaller doses are needed – and it can be taken in any form ⚫ Some evidence suggests it has fewer side effects than the other antipsychotics”

Answer 12

Lots of research compares relapse rates for antipsychotics and placebos Leucht et al. (2012) did a meta-analysis of 65 studies from 1959-2011, involving ~6000 stabilised patients They were stabilised with either typical/atypical drugs Some were taken off their medication and given a placebo instead Within 12 months, 64% given the placebo relapsed, compared to 27% who stayed on the antipsychotic drug

Answer 13

Typical antipsychotics are more likely to produce side effects than atypical ones Including dizziness, sleeplessness, weight gain, stiff jaw and itchy skin More long-term effects include tardive dyskinesia which Involves involuntary facial movements (blinking, grimacing) This is caused by dopamine supersensitivity The most serious side effect is neuroleptic malignant syndrome (NMS) which causes delirium, coma and sometimes death (up to 2% risk), suggested to be caused by the blocking of dopamine to the hypothalamus

Answer 14

drugs have led to many harmful side-effects, deaths and psychosocial consequences E.g. Chari et al. 2002 – covered a large out-of-court settlement for a patient suffering from tardive dyskinesia in the US Based on the Human Rights Act 1988, the patient was compensated for the side effects experienced Further suggesting that drug therapy may do more harm than good in real life

Answer 15

It is not fully understood why antipsychotic drugs work to reduce symptoms The use of drugs is heavily tied with the original dopamine hypothesis (that schizophrenia is caused by subcortical hyperdopamineria) but we now know that the original dopamine hypothesis is not the full explanation – the updated hypothesis suggests that low levels of dopamine in the cortex may also cause the condition Therefore, drugs that ultimately decrease dopamine levels overall should not work

Answer 16

Family dysfunction Cognitive explanations

Answer 17

Abnormal patterns of communication within the family, such as cold parenting, poor communication and high expressed emotion family dynamic are suggested to be risk factors for both the development and maintenance of schizophrenia

Answer 18

Schizophrenogenic mother (cold parenting) Double-bind theory (poor communication) Expressed emotion

Answer 19

This means ‘schizophrenia-causing’ This is a mother that is cold, rejecting and controlling She creates a family dynamic characterised by tension and secrecy

Answer 20

Bateson et al. (1972) 1. Children receive contradictory messages from parents E.g. verbal and non-verbal contrasts 2. Children then fear doing the wrong thing, even when they don’t understand what the wrong thing is (due to mixed messages) 3.They feel unable to protest about the unfairness of a situation, nor do they feel able to seek clarity on it 4.They learn that doing the wrong thing leads to a withdrawal of love , causing them to understand the world to be confusing and dangerous

Answer 21

EE refers to the level of emotion expressed towards the schizophrenic patient by family members/carers A high level of negative expressed emotion is suggested to be a significant source of stress and can trigger the onset of the disorder (in those already vulnerable), as well as relapse

Answer 22

Verbal criticism and sometimes violence towards the patient Hostility, anger and rejection Emotional over-involvement in the patient’s life

Answer 23

There is a range of research to suggest that issues within the family dynamic play a role in schizophrenia Insecure attachment – Read et al. (2005) found that adults with schizophrenia are disproportionately likely to have had insecure resistant or disorganised attachment as a child Abuse – Read also found that 69% of women and 59% of men have a history of physical and/or sexual abuse Trauma – Morkved et al. (2017) found that 67% of patients with a psychotic disorder reported at least one childhood trauma

Answer 24

there is little evidence to support specific explanations such as schizophrenogenic mother and double-bind theory Furthermore, research that does exist contradicts the explanations Liem (1974) found no differences in parental communications between schizophrenic and non-schizophrenic patients Hall and Levin’s (1980) meta analysis found no differences in contradictory statements made in families with and without a schizophrenic patient c:Research on these explanations come from clinical observation of individual patients and informal assessments of the mother’s personalities

Answer 25

Explanations that focus on mental processes (thinking, language, attention) to explain behaviour found to have dysfunctional thought processing

Answer 26

Impaired cognition can explain symptoms of schizophrenia E.g. reduced thought processing in the ventral striatum is associated with negative symptoms. Reduced processing in the temporal gyri (crease that separates the temporal lobe) is associated with positive symptoms.

Answer 27

Metarepresentation dysfunction Central control dysfunction

Answer 28

Frith et al. (1992)

Answer 29

Metarepresentation is one’s cognitive ability to reflect on thoughts and behaviours It allows us to have insight on our personal goals and intentions And allows us to interpret other people’s actions

Answer 30

A schizophrenic patient is likely to have dysfunctional metarepresentation which would disrupt the ability to recognise that their thoughts and actions are their own (and are not being carried out by someone else) This is used to explain delusions and hearing voices – failing to recognise that these processes are being projected into the mind by the self and not someone else

Answer 31

Central control refers to the ability to supress automatic responses whilst doing a deliberate task

Answer 32

A schizophrenic patient may have dysfunctional central control which can explain speech poverty and disorganised thoughts For example, delay to respond in a conversation may be due to an inability to supress other thoughts triggered by things mentioned in the conversation Any automatic thoughts triggered would disrupt the flow of conversation if they cannot be supressed

Answer 33

Stirling et al. (2006) gave the stroop test to 30 schizophrenic patients and 30 controls (the task was to say the colour of the font of the word rather than reading the word) The schizophrenic patients took twice as long as the control group to complete the task correctly – so? This suggests that those with schizophrenia struggled to supress the tendency to read the words instead of the colours, showing dysfunctional central control

Answer 34

A proximal explanation only goes as far to explain present circumstances as opposed to explaining how the circumstances developed in the first place (distal explanations) Biological and family dysfunction explanations can explain how symptoms of schizophrenia develop initially But cognitive explanations offer no insight on how dysfunctional thought processing develop initially Furthermore, cognitive explanations are difficult to link with the others – genetic variations nor childhood trauma can explain how dysfunctional thought processing develops

Answer 35

Aims to identify and correct irrational and maladaptive thoughts (e.g. delusions are due to faulty interpretations) Patients can be seen alone or in groups – and between 5-20 sessions – NICE recommend at least 16 CBT helps patients make links between their thoughts, feelings, behaviours and symptoms Enables alternative thought processing, distress reduction and improved functioning

Answer 36

Jauhar et al. (2014) did a review of 34 studies that used CBT to treat schizophrenic patients – they concluded that CBT has significant effects on both positive and negative symptoms Furthermore, Pontillo et al. (2016) found CBT to reduce both frequency and severity of symptoms in patients This validates the effectiveness of CBT It is also recommended by NICE – The National Institute of Health and Care Excellence – all patients with schizophrenia should be offered CBT Freeman et al. (2013) found that from those who are offered CBT, a significant number refuse or fail to turn up

Answer 37

Research has shown that CBT is only effective when made available at certain stages of the treatment Addington and Addington (2005) – claim that self-reflection isn’t appropriate during the initial phase of schizophrenia Only once symptoms are stabilized with antipsychotic medication can patients benefit from normalising their experience with CBT Furthermore, research has consistently shown that CBT is more effective on patients that have had longer experience with their symptoms

Answer 38

Despite being recommended by NICE, only around 1 in 10 patients in the UK get access to CBT for schizophrenia – the average is found to be even lower in some parts of the country Haddock et al. (2013) found that out of 187 randomly selected patients form North West England, only 6.9% had been offered CBT for schizophrenia Colling et al. (2017) found that 34.6% of patients received at least one session and 26.4% at least two sessions of CBT which is not the recommended amount

Answer 39

A psychological therapy carried out on some/all family members to improve communication and reduce stress in the family environment

Answer 40

A psychological therapy carried out on some/all family members to improve communication and reduce stress in the family environment Prioritised when there are persistent symptoms or a high risk of relapse Offered for between 3-12 months with at least 10 sessions Sessions aim to reduce EE, educate family members about schizophrenia and provide ways to support the patient

Answer 41

Burbach’s model of practice: Phase 1:sharing info, 2:identifying resources, 3: create a safe space for expression, 4:identify unhealthy communication, 5: stress management skills, 6: relapse prevention planning, 7: future maintenance

Answer 42

The NICE review of family therapy studies found that there is significant reduction in costs for standard care of patients This is because of lower relapse rates 🡪 less hospitalisation The cost of taking additional care of relapsed patients is much more expensive than family therapy Additionally, family therapy reduces relapse rates even after the intervention is completed – meaning even more money is being saved

Answer 43

Lobban et al. (2013) meta analysis on 50 family therapy studies that included intervention to support relatives 60% of studies reported a significant positive impact on relatives for at least one outcome category (problem-solving skills, relationship quality)

Answer 44

McFarlane - POSITIVE Lobban et al. (2013) - POSITIVE

Answer 45

A form of behaviour modification where desirable behaviours are encouraged via reinforcement A management technique based on operant conditioning

Answer 46

1. Neutral tokens given after functional tasks are completed (making bed, finishing meals) 2. tokens are then exchanged for a variety of rewards (e.g. TV, visits from family, etc.) 3. frequent exchange = frequent desirable behaviours

Answer 47

To correct bad habits developed due to prolonged hospitalisation Helps modify personal care (hygiene), condition-related behaviours (e.g. avolition) and social behaviour (interaction)

Answer 48

Glowacki et al. (2016) identified and reviewed 7 high quality studies published between 1999 and 2013 that tested the effectiveness of token economies on patients hospitalised with chronic mental disorders All studies showed a reduction in negative symptoms and a reduction in unwanted behaviours c:Reviews containing fairly small numbers of studies indicate that there is a file drawer problem This means that studies that show insignificant or mixed (unreliable) results are ‘filed away’ (so what?) This reduces the number of studies available for review, leaving a bias selection of ‘high quality’ studies to draw conclusions from

Answer 49

This means that studies that show insignificant or mixed (unreliable) results are ‘filed away’

Answer 50

Token economies give the professionals with authority the power to control their patients’ behaviour This can become problematic when target behaviours are not decided sensibly – e.g. staff can modify behaviours to fit their norms instead of their patients’ norms It can become easy to restrict patients of their rights to choose their norms and behaviours, as well as restricting pleasure altogether.

Answer 51

There are more pleasant and ethical alternatives to token economies – art therapy A review by Chiang et al. (2019) found art therapy to be a good alternative as it adopts a high-gain low-risk approach to managing schizophrenia (art therapy essentially allows patients to interpret their feelings and emotions without having to use words – helpful for making sense of hallucinations and delusions) this method does not come with the unpleasant experiences that come with other approaches like severe side effects (drugs) and ethical abuse (token economies).

Answer 52

A way of explaining behaviour using a range of factors, such as biological and psychological factors The interactionist approach to explaining schizophrenia acknowledges the role of biological, psychological and social factors to explain its development ⚫ (e.g. genetic vulnerability, stress and poor familial communication respectivel

Answer 53

The interactionist approach to explaining schii An interactionist approach to explain behaviour that suggests that a vulnerability and a stress-trigger are needed to develop a condition

Answer 54

the original model (Meehl’s model) and the modern mode

Answer 55

diathesis-stress model suggested that the diathesis for schizophrenia is purely genetic (schizogene) ⚫ This led to the development of a biologically based ‘schizotypic’ personality – characterised by sensitivity to stress ⚫ Furthermore, an individual without the schizogene would never develop schizophrenia, regardless of any stressful events

Answer 56

Diathesis – we now know there is no one ‘schizogene’ ⚫ Different variations of candidate genes only increase vulnerability to schizophrenia by a fraction ⚫ Early psychological trauma is also considered a diathesis now (rather than an environmental stressor)

Answer 57

Although still important, ‘stress’ in this model is now considered to include anything that risks triggering schizophrenia

Answer 58

Cannabis has been found to increase risk of developing schizophrenia by up to 7 times Many people that smoke cannabis do not develop schizophrenia, suggesting that most do not have the vulnerability for triggering it in the first plac

Answer 59

Therefore, antipsychotic medication is often combined with psychological therapies (most commonly CBT) Turkington et al. (2006) highlights that taking an interactionist approach to treatment doesn’t mean you cannot believe the cause of schizophrenia is purely biological or psychological

Answer 60

Hospital records were reviewed from 20,000 women from Finnish psychiatric hospitals between 1960-1979 ⚫ Identified two groups: ⚫ Low risk: 158 adoptees with a low biological risk ⚫ High risk: 145 adoptees with a high biological risk ⚫ Found that 14 had developed schz, 11 of those from the high risk group ⚫ Those with a healthy adoptive family did not develop schz, despite a high genetic risk

Answer 61

The model has been criticised for being too simplistic – there is no one schizogene or stressor that causes schizophrenia ⚫ There are multiple genes found to increase vulnerability to schizophrenia (they have very little effect on their own) ⚫ Stress can also come in many forms – stress can be biological

Answer 62

There has been support for the effectiveness of combined treatment ⚫ Biological and psychological treatments combined are more effective than biological treatment alone ⚫ Tarrier et al. (2004) – randomly allocated 315 patients to either medication+CBT, medication+counselling or medication only (control) ⚫ They found that both combined groups showed lower symptom levels than the control group

Schizophrenia Flashcards

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