Schizophrenia Flashcards

Question

what is hypervigilance?

Answer 1

(hallucinations) • Sz give excessive attention to auditory stimuli. leads to a higher expectation of a voice occurring in their env than a normal person. • struggle to see diff between imagination and real sensory perception, e.g., “What will other people think of me?” turns into a voice saying, “He is not a good person”. • A hallucinating Sz person is more likely to misattribute the source of a self generated auditory thought as an external source than non hallucinating.

Answer 2

(delusions) • Sz perceives themselves as the central component to events. They attribute irrelevant events to themselves & arrive at false conclusions. • Creates delusions e.g., muffled voices are people criticising them. • delusions = resistant to reality testing as they have ‘impaired insight’ to recognise the cognitive distortions and give rational alternatives.

Answer 3

(disorganised speech) • Inability to suppress automatic responses, whilst performing deliberate actions. • Tested through Stroop Test. Sz perform poorly on this compared to ‘normal’ controls. • Sz = disorganised speech (word salad) due to inability to suppress thoughts and speech triggered by another thought.

Answer 4

(hallucinations & delusions) • Cognitive ability to reflect on thoughts and feelings; having insight into our own intentions and goals & those of others. • Sz = cannot recognize own thoughts and actions as being ourselves. Seems to be someone external. • Explains auditory hallucinations & delusions (e.g., thought insertion)

Answer 5

**_Research support for validity of cognitive explanation for Sz_** - **_Ev_** - Delusional patients found to show various biases in their info processing, e.g., jumping to conclusions and lack of reality testing. Patients with hallucinations had more impaired self-monitoring that tended to experience their own thoughts as voices. Furthermore, CBTp found to be more effective in a NICE review than anti-psychotic drugs + improved social functioning + reduced symptom severity. - **_Ex_** - Sz tend to have more issues with meta- representation, egocentric bias and hypervigilance which causes some positive symptoms of Sz. Moreover, the fact that CBTp reduces these cognitive biases and reduces positive symptom severity more than drugs shows that Sz is more a cognitive cause rather than biologically created. - **_L_** - does not support explanation of negative Sz symptoms and it does not ‘cure’ Sz by removing symptoms completely. So, an interactionist approach to explaining Sz = needed, as argument is where did the cognitive biases originate from, and that is likely to be a genetic and neurological explanation (cognitive neuroscience). **_Research support for central control dysfunction _** - **_Ev_** -30 patients with Sz and 18 without Sz completed a Stroop test. Sz took 2 x longer to complete the Stroop test that non-Sz. - **_Ex_** - Sz have difficulty suppressing their cognitive automatic thoughts, and when trying to attend to the colour that the word is written in, the word itself is more a distractor, as it would be automatically thought about. explains why Sz have disorganised speech (word salad) as they cannot suppress the thoughts that automatically are produced from previous thoughts. Therefore, they are unable to selectively attend to the point of the conversations made. - **_L_** - study = making inferences about the internal mental process deficit that is occurring, from a reaction time in a Stroop test. We cannot be certain of what the internal process is in reality, and neither can the Sz patient report it (as it happens automatically, and they have less insight into their mental processes as a result of the Sz). **_ However, Cognitive explanation is reductionist_** - **_Ev_** - ignores other aspects that can account for Sz, e.g., social adversity, family dysfunction or genetics. It assumes that cognitive is the cause but does not explain how the thought processes become dysfunctional. - **_Ex_** - maybe cognitive explanation is more a symptom of other underlying causes. may be better explained through an integrated model. E.g., early vulnerability, such as genetics or birth complications, together with exposure to significant social stressors, sensitivity to dopamine and cognitive processing difficulties. These combined could result in both the positive and negative symptoms of Sz. - **_L_** -So, we should use a more interactionist explanation to fully explain Sz. This is how in modern times Sz is viewed (i.e., cognitive neuroscience).

Answer 6

drug therapy family therapy CBTp

Answer 7

Chlorpromazine (typical) Clozapine (atypical) Risperidone (atypical)

Answer 8

blocks dopamine D2 receptors by binding to them, reduces positive symptoms of hallucinations.

Answer 9

Blocks D2 receptors: Reduces positive symptoms (hallucinations) Blocks serotonin & glutamate receptors: Reduces negative symptoms, e.g., avolition.

Answer 10

Blocks D2 & serotonin receptors. Reduces positive and negative symptoms of Sz.

Answer 11

**_Research support for effectiveness of typical anti psychotics_** - **_Ev_** - Chlorpromazine = 70% effective in reducing positive symptoms and another study found 1121 people had better quality of life/functioning. - **_Ex_** - typical anti-psychotics can be considered most effective in dealing with the most challenging positive symptoms of Sz (hallucinations & delusions), compared to atypicals like Clozapine where it is only has a 30- 50% effectiveness or Risperidone which is more effective (81%) for negative symptoms of Sz, thereby having less impact on the Sz quality of life than typicals. - **_L_** - but both typical and atypical have high relapse rate of around 45-41% from 6 months onwards after not taking them, except for Clozapine which is the lowest (9%) but is rarely prescribed due to a lack of effectiveness. However, even though typical anti-psychotics seem to be highly effectiveness in dealing with the most challenging symptoms of Sz, there is still 30% of people that it does not work for. **_serious side effects to taking drug therapies for Sz_** - **_Ev_** - Typical antipsychotics, Chlorprozamine, have serious side effects - Tardive Dyskinesia (like Parkinson’s disease) - disrupts motor movement. The person with Sz displays automatic repetitive motor movements of the mouth, tongue, hands, arms and legs. can give them unusual gait. - **_Ex_** - problematic - permanent. continues once drug has stopped being taken. Secondly the symptoms appear ‘odd’ to observer - can cause reactions amongst the general public, creating further stigma of person with Sz - difficult for them to continue with normal quality of life, gain employment, and increase their social functioning. Which is better the Sz symptoms or the tardive dyskinesia? either way the quality of life for the person is affected severely. - **_L_** - antipsychotics with ‘lesser’ side effects - Clozapine. Side effect of agranulocytosis can be managed to avoid ‘death’ from a blood disorder. Person does not have permanent effects from taking the drugs. but if not well managed and person stops attending regular blood tests, can be potentially very serious. Therefore, risperidone maybe the best option as there are no permanent side effects or risk of death. However, the seizures and unusual gait are debilitating. Again, calling into Q whether the drugs are replacing Sz symptoms with something equally as damaging for their quality of life. **_issues with why the drugs are prescribed to Sz patients_** - **_Ev_** - Chlorprozamine has sedative effects. This can make Sz patiens appear to have improved in their positive symptoms. However, in fact it is because of the sedative making the patients ‘calmer’ and more complaint. In fact, it may not have reduced the severity of the symptoms. It is just masking them. - **_Ex_** - Within hospital env, is it that the drug is being given as a treatment for positive symptoms of Sz or to gain a more complaint patients, easier to manage by the hospital staff. This is the chemical COSH argument. NICE highlighted that using drug therapies to calm patients is a human rights abuse. - **_L_** - most published studies have only assessed the short term impact, not the long term impact or the withdrawal effects from those that stop taking the medication. Cannot be certain drug therapies = effective in treating symptoms of Sz

Answer 12

- takes place in **people’s homes** and typically **two family therapists** will work with the **relatives and patient.** - lasts between **3-12 months** with sessions **every 2-4 weeks**. A **minimum of 10 sessions** are recommended by NICE. - relatives are **made more aware** of the info regarding psychosis and the particular diagnosis of patient. The therapist **encourages the relatives to ask questions** and learn more about the disorder. - Provides the whole family with **practical coping skills** which enables them to **manage the everyday difficulties** arising from having Sz in the family. - Family members **learn** more **constructive ways of communicating** and are encouraged to concentrate on any **good things** that happen rather than negative events. - the family and the patient are trained to **recognise the early signs of relapse** so that they can respond rapidly to reduce the severity of it.

Answer 13

**_Research support for Effectiveness_** - **_Ev_** - NCCMH, 2009: meta-analysis 32 studies, 2500 patients. Compared standard drug therapy to family therapy. Found lower relapse rate (26% family compared to 50% drug therapy), reduction in hospitalisation and lower severity of symptoms – up to 24 months. - **_Ex_** - family therapy = more effective than drug treatment. This reduction in relapse can even be found after 8 years (67%) compared to 88% for drugs. Meana family dysfunction is main cause, and that high dopamine is just a symptoms possibly from the family dysfunction. - **_L_** - but meta-analysis - methodology of the different studies would vary. Hence, it was not controlled as to whether they were also on drug treatment alongside the family therapy, which drug they were on and for how long. **_Issues with comparing family therapy to standard therapy_** - **_Ev_** - Most patients are undergoing standard drug treatment alongside family therapy, hence the comparison is not as valid. It would be more accurate to compare family therapy without medication, with standard drug treatment. - **_Ex_** - cannot be certain if it’s the drug combined with family therapy that is effective or whether it’s due solely to family therapy. Could be that the medication is needed to enable the patient with Sz to partake in the family therapy. The only way to eliminate this issue is to have a third group of family therapy only. This would allow more conclusive support to be gathered. - **_L_** - But, would be unethical to deny drug treatment to patients that would benefit from it. It is therefore unlikely that such a methodology could be conducted that would pass an ethics committee. **_treatment is more helping the family to deal with a SZ child rather than treating cause of SZ_** - **_Ev_** - Study of 103 Sz patients who lived in a high EE household. He found that 25% who had family therapy relapsed after 2 years, compared to 62% on medication only. - **_Ex_** - So, family therapy helps reduce relapse rate of Sz. But, not treating the cause, otherwise the family would stop patients from developing Sz in the first place, rather than measuring whether they get Sz symptoms back. - **_L_** - more expensive to run family therapy than drug treatments? Family therapy is run over a significant time period and involves paying for the time of 2 family therapists. However, this is a short-term cost, as in the long run it would be cheaper as the patient is less likely to need hospitalisation and the higher costs that this type of treatment would require.

Answer 14

**Assessment**: - Patient expresses their experiences and symptoms to the therapist. - Realistic goals for therapy are discussed. **Engagement**: - therapist provides a therapeutic environment and empathises with the patients perspective and feelings of distress. - Explanations for the distress can be developed here. **ABC model**: - Patient explains their (A)activating event that is the cause of their irrational (B)beliefs and causes the (C)consequence. - These beliefs can then be disputed and changed (logical, empirical disputing). **Normalisation**: - knowledge that other people experience the same things - greatly reduced feelings of isolation and anxiety as well as feeling less stigmatised. **Critical collaborative analysis**: - therapist uses gentle/non-threatening questioning. - needs to be trust and empathy between therapist and patient.

Answer 15

**_Research support for effectiveness_** - **_Ev_** - NICE compared standard drug therapy to CBTp. Found CBTp is better at reducing hospitalisations and symptom severity for up to 18 months after treatment than antipsychotic medication alone. - **_Ex_** - So, CBTp effectively treats Sz longer term than drug therapy and there are no side effects unlike drugs (e.g., tardive dyskinesia) which are permanent. Hence, would also save taxpayers money long term as there is no requirement to continually fund the treatment unlike drugs. CBTp provides Sz patient with higher quality of life long-term, allowing them to gain future employment and bring money back into the economy. - **_L_** - But CBTp is less effective with those Sz patients who have been recently diagnosed and in their initial acute phase of the disorder (more psychotic episodes). Harder for them to self-reflect and reality test. Hence CBTp not appropriate for all Sz patients. So, it may be more appropriate to use an interactionist treatment model of both drugs, CBTp and family therapy. The drug therapy would lessen the acute phase and enable Sz patients to engage more in CBTp and family therapy. Studies have supported this that when this is done there is a 0% relapse rate. **_effectiveness of CBTp may be overstated_** - **_Ev_** - Meta-analysis examined many CBTp programmes, found a small therapeutic effect. But, when assessment of the CBTp sessions was double blind, there was no effect of CBTp on Sz. - **_Ex_** - Therefore, it was more an investigator bias as the psychologists assessing the programmes had invested time and effort into their own patients, producing a confirmation bias. - **_L_** - But, meta-analysis may not have taken into account the methodologies used, e.g., the competence of the therapist, it was a double-blind study or if pps were randomly allocated to the CBTp or control group. **_However, there is a lack of availability in the UK_** - **_Ev_** - estimated 1/10 ppl with Sz can access CBTp in the UK. This is even lower in some counties, such as the North West only 7% of Sz patients have been offered CBTp. Out of those a significant number refuse or fail to attend, thus limiting the effectiveness even more. - **_Ex_** - important for the gov to provide more funding for mental health services. Without support from treatment programmes like CBTp, many people with Sz may end up homeless, self-medicating on illegal drugs and being victims of and/or committing crime to help fund their self-medication. - **_L_** - society has a duty of care to help those who are most vulnerable and unfortunately Sz is not seen by the majority in society as a disorder worthy of support.

Answer 16

- TES are based on operant and classical conditioning techniques and are used to manage beh within a psychiatric hospital setting. - Patients are given tokens (neutral stimulus) for doing behaviours that are adaptive, e.g., getting dressed, good hygiene. - The tokens (secondary reinforcer) can be exchanged for primary reinforcers, such as snacks, time outside the hospital, extra visits or phone calls. - Over time the Sz patient associates the token with the positive primary reinforcers, and it becomes a CS that makes the Sz patient feel rewarded on its own. - Beh shaping is used, to provide token for increasingly more complex behaviours, e.g., engaging in treatment and making meals for others. - Tokens are also taken away for ‘bizarre’ behaviours, e.g., talking out loud to themselves.

Answer 17

**_Research support for usefulness of TES_** - **_Ev_** - Meta-analysis of 13 studies and found 11/13 reported beneficial effects that were directly attributed to the TES. - **_Ex_** - TES is useful in managing Sz as it increased the number of adaptive beh’s in patients with Sz. - **_L_** - But, methodological issues with study, as different studies implemented the TES in different ways, to varying degrees of consistency. Also, the studies lacked a control group, so unclear if it’s the hospital setting or the TES that is responsible for the change in behaviour. **_There are issues with effectiveness in reducing negative symptoms long term_** - **_Ev_** - TES only been shown to work in hospital settings, in reducing negative symptoms of Sz. The studies did not assess the effectiveness once out of the hospital and in a community setting. - **_Ex_** - difficult to implement a TES in the community, where there is not 24-hour supervision. Staff cannot monitor the patient’s beh and reward appropriately. So, the TES in the community would be partially implemented. - **_L_** - unlikely the TES makes a permanent change in the beh of those with Sz but that they are changing beh for the extrinsic reason of achieving the token whilst in the hospital. So, it really is more a management of beh than a treatment of the negative symptoms of Sz. **_Criticism – ethical concerns over the use of TES_** - **_Ev_** - For a TES to work the clinicians have to have control over primary reinforcers such as food, or access to social support or activities to relieve boredom. If beh is maladaptive the right to these things are taken away by removing tokens. - **_Ex_** - Humans have basic human right to food, hygiene products, social support and stimulation. people with Sz are being punished for demonstrating Sz symptoms that they are not in control of, which is being classed as ‘bizarre behaviour’. This could just be increasing the stigma for the person with Sz, telling them that they need to comply with what society deems as normal. - **_L_** - So, given we accept that Sz has a biological component, should we be teaching compassion for the symptoms and an understanding of why they are having the symptoms they are, and accepting themselves rather than being made to comply to rules for extrinsic tokens. Use of TES for the management of Sz has fallen out of use because of a lack of clear efficacy, controlled studies and the ethical concerns surround it and its long term use.

Answer 18

distress stress model (DSM) modern diathesis stress model (epigenetics)

Schizophrenia Flashcards

(43 cards)