Schizophrenia Flashcards
(110 cards)
1
Q
Which organisation recommends that CBT is offered to all patients?
A
NICE
2
Q
What is the rationale of CBT?
A
Schizophrenia is caused or maintained by beliefs that patients have about their experiences
3
Q
What does CBT aim to do?
A
identify and change the beliefs held by patients which contribute to their symptoms
4
Q
How many sessions of CBT will a patient generally have?
A
between 12 and 20
5
Q
Which type of therapy did Jones et al (2012) review?
A
CBT
6
Q
Which review found that CBT was no more effective than other psychological treatments?
A
Jones et al (2012)
7
Q
What could account for the initial enthusiasm for CBT?
A
Weak blinding in original studies give false positive results, and the cost is relatively cheaper than other psychological treatments
8
Q
What 3 things make CBT an appropriate therapy?
A
Its lower cost (for the tax payer), its speed, and the absence of side effects (less dependency)
9
Q
Which therapy, developed by Ellis, is an example of CBT?
A
Rational Emotive Behavioural Therapy (REBT)
10
Q
What model does REBT follow?
A
The ABC model
11
Q
What does the ABC model stand for?
A
Activating event
Belief
Consequence
12
Q
What are the three steps of REBT?
A
Step 1- Patient identifies activating event and its consequence (eg voices and emotions
Step 2- Discussion of the patient’s beliefs which cause the consequence (eg voices control my life)
Step 3- Therapist encourages patient’s awareness that their belief is illogical by testing evidence for and against (eg giving instances in which the patient has controlled life over the voices)
13
Q
What are two other processes of REBT?
A
Normalisation (by which the patient is encouraged that their feelings are normal) and Decatastrophisation (by which patients’ feelings are placed on a continuum with those of ‘normal people’)
Both of these processes make recovery seem more likely and therefore less distant and more achievable
14
Q
On what 3 kinds of patient is ECT used?
A
Patients who are:
Catatonic
Suicidal
Pregnant
15
Q
What is the rationale of ECT?
A
Schizophrenia is caused by abnormality in neurotransmitter activity
16
Q
What is the aim of ECT?
A
To disrupt and correct the abnormal neurotransmitter activity
17
Q
What level of voltage is given during ECT?
A
70-130mv
18
Q
For how long is the electric current passed through the brain in ECT?
A
0.5-5 seconds
19
Q
What does the electric current stimulate in ECT?
A
a mini-seizure and electrical convulsions in the brain
20
Q
What is administered before the shock in ECT?
A
Anaesthetic and muscle relaxant
21
Q
How is the electric current applied to the brain in ECT?
A
Either unilaterally (two electrodes on one side) which is more common or bilaterally (an electrode on each side)
22
Q
If the current is applied unilaterally in ECT, which side of the brain is it?
A
Non-dominant cerebral hemisphere
23
Q
Which therapy did Tharyan & Adams (2009) review?
A
ECT
24
Q
How many RCTs of ECT did Tharyan & Adams (2009) include in their review?
A
26
25
What was the main finding of Tharyan & Adams (2009) review into ECT?
It leads to fewer relapses than sham ECT in the short term but not in the long term
26
Why is ECT still a worthwhile therapy even though it only works in the short term?
It can prevent suicide
| It can give time for other treatments to work
27
What did Greenhalgh et al (2005) find about ECT?
No decent evdience for effectiveness on catatonic Schizophrenia
28
What is the biggest short-term side effect of ECT?
Memory loss
29
What is the biggest issue of appropriateness of ECT?
Consent- most serious cases are often treated without consent
30
What has been improved in terms of appropriateness of ECT?
Procedures have been changed such that fractures which were common in earlier treatments are no longer a major side effect
31
What is an example of typical anti-psychotics?
Chlorpromazine
32
What is an example of an atypical anti-psychotic?
Clozapine
33
What is the use of Chlorpromazine (typical)?
To reduce positive symptoms of Schizophrenia
34
What is the rationale of Chlorpromazine (typical)?
That Schizophrenia results from excessive dopamine activity
35
What is the aim of Chlorpromazine (typical)?
To reduce dopamine activity at receptor sites
36
What is the process of Chlorpromazine (typical)?
It binds to dopamine receptors to block their action. This reduces release of dopamine.
37
What are the 3 main features that Clozapine (atypical) has that Chlorpromazine (typical) doesn't?
It targets negative symptoms
It blocks serotonin receptors
Fewer side effects
38
What is the use of Clozapine (atypical)?
To target positive and negative symptoms of Schizophrenia
39
What is the rationale of Clozapine (atypical)?
That Schizophrenia is a result of excessive dopamine activity and that an imbalance of other neurotransmitters such as serotonin is also linked
40
What is the aim of Clozapine (atypical)?
To target serotonin and dopamine receptors in the brain
41
What is the process of Clozapine (atypical)?
Block dopamine and serotonin receptors
42
What type of drug did Adams et al (2012) Cochrane review?
Chlorpromazine
43
What did Adams et al (2012) Cochrane review find?
Chlorpromazine is more effective than placebo across symptoms
44
For what percentage of patients are typical anti-psychotics effective?
60%
45
What did Essali et al (2009) Cochrane review compare?
Atypical and typical drugs
46
What did Essali et al (2009) Cochrane review find?
Clozapine had fewer relapses and more improvement in functioning and negative symptoms than typicals
47
What is the main problem with research into the effectiveness of drugs?
Drug companies bury unfavourable data and may exaggerate benefits
48
What are the major side effects of anti-psychotics?
Tardive dyskinesia, weight gain and sexual dysfunction
49
What percentage of anti-psychotic takers are affected by Tardive Dyskinesia?
20%
50
What percentage of anti-psychotic takers are affected by weight gain?
50%
51
What percentage of anti-psychotic takers are affected by sexual dysfunction?
50%
52
What is the major problem with the side effects of anti-psychotics in terms of appropriateness as a therapy?
They have social implications and may discourage patients from taking them (especially in young people)
53
What is the use of Family Intervention?
For family members and the patient
54
What is the rationale of Family Intervention?
Schizophrenia is maintained by high levels of EE ie communication and emotional problems
55
What is the aim of Family Intervention?
To reduce relapse by reducing levels of EE within families by providing them with practical coping skills
56
What does the process of Family Intervention involve?
1) Educating the family about Schizophrenia
2) Improving communication within the family
3) Developing cooperative and trusting relationships
4) Adjusting expectations of family members to avoid making patient guilty
5) Teaching them to recognise early signs of relapse
6) Creating social networks with other families of Schizophrenia patients
57
Which therapy did Leff et al (1982) study?
Family Intervention
58
What relapse rates did Leff et al (1982) found with and without Family Intervention?
the therapy reduced it from 78% to 14%
59
Pharoah et al (2012) reviewed how many RCTs?
53
60
Pharoah et al (2012) found positive results from family intervention therapy in which 3 areas?
Relapse, Hospital Admission and compliance with mediction
61
What problem has been found with the studies into Family Intervention carried out in China?
Major issues with bias- worries over proper application of random allocation (if you use this as an evaluative point make sure that you specify that it is a well documented issue and that you're not just making racist speculations)
62
What are the 3 elements of Expressed Emotion?
Hostility, Critical Comments and Emotional Over-involvement
63
Vaughn and Leff (1976) found what?
Relapse rates of 51% in high EE homes and 13% in low EE homes
Face-to-face time spent with relatives correlated with risk of relapse
64
Butzlaff et al (1989) did a meta-analysis of how many EE studies?
27
65
What did Butzlaff et al (1989) find?
Relapse rates of 65% in high EE homes and 35% in low EE homes
Effect size of 0.3
66
What is one major criticism of EE as an explanation of Schizophrenia?
EE could be a response to symptom severity rather than a cause thereof, which explains the correlation
67
Who did retrospective studies to track whether EE or symptoms occur first? What did they find?
King. Some elements are a response to rather than a cause of worsening symptoms.
68
What would be good to talk about in a conclusion about EE?
Causality goes in both directions
| Better prospective studies are needed to track direction of causality
69
What is L Dopa?
A drug used on Parkinson's patients which raises their dopamine levels
70
Recreational use of amphetamines can induce what?
Schizophrenia-like symptoms
71
What evidence is there that contradicts the idea that dopamine is the main cause of Schizophrenia?
Not all users of amphetamines and L Dopa develop the disorder and drug treatments that target dopamine do not help all patients
72
Who proposed the Final Common Pathway model?
Howes and Kapur
73
Where is the dopamine dysfunction, according to the Final Common Pathway model?
Pre-synaptic
74
What did Howes and Kapur (2012) find?
A meta-analysis of brain scans showed high rates of presynaptic dopamine dysfunction, whereas dysfunction in other areas were less pronounced
75
What, according to the Final Common Pathway Model, causes dopamine dysfunction?
An interaction of multiple factors, both genetic and environmental
76
To what is dopamine dysfunction specifically linked? What evidence is there for this?
Positive psychotic symptoms. Drugs that reduce positive symptoms all work on the dopamine symptom.
77
What evidence in there in animal studies for the Final Common Pathway model?
Environmental factors which are associated with increased risk of schizophrenia include lack of close friends. In animals studies, social isolation leads to dopamine dysfunction.
78
Norman and Malla's review of stressful life events found what?
Severity of symptoms over time correlates with life events
79
What did Day's cross-national study find?
There were higher rates of stressful events in the 2-3 weeks preceding the onset of schizophrenia
80
We can be fairly confident that there is a relationship between stressful life events and schizophrenia but...
we cannot be sure about causal direction- retrospective reporting gives rise to symptoms altering recall of events
81
Who did prospective research which showed that stressful events preceded the onset of symptoms of Schizophrenia and not vice versa?
Ventura et al
82
Describe the role of genetics in Schizophrenia
Genes build our brains; brains are the source of all our mental states; schizophrenia is a disorder of mental state
83
What is the diathesis-stress model?
The diathesis stress model suggests that genes put people at risk of developing schizophrenia and stressors determine whether and when one develops the disorder
84
What is the liability threshold model?
The Liability Threshold model proposes that there are a number of genes which each have a small contribution to the development of schizophrenia- in combination they cause someone to have it
85
Gottesman (1991) reviewed 40 twin studies and found what concordance rates?
40% for MZ twins and 15% for DZ twins
86
What evidence from twin studies tells us that Schizophrenia cannot be totally genetic?
MZ twins did not have 100% concordance rate
87
What were the results of adoptions studies by Heston (1996) into Schizophrenia?
Of adoptees whose Mothers had Schizophrenia, 10% also developed the disorder
Of a control group, none of whose Mothers had the disorder, no one developed Schizophrenia
88
Gottesman (1991) found what?
A concordance rate of 58% for 14 pairs of separated twins
89
What are Kleitman's 3 problems?
Differences in procedure, differences between clinicians, differences in presentation of patients
90
What is the problem with using different procedures in diagnosis? And what did Cheniaux find in relation to this?
Different classification systems have different specifications for diagnosis- most illustrative of this is DSM insists on symptoms for preceding 6 months, whereas ICD doesn't. Cheniaux et al (2009) found rates of diagnosis higher in ICD than using DSM because of this
91
Even if clinicians are using the same classification manuals, what can go wrong?
Phrases are open to interpretation
92
What did Mojtabi and Nicholson (1995) find?
Inter-rater reliability of 0.4 between clinician judgement of whether or not hallucinations were bizarre
93
What is the problem with patients presenting themselves differently?
Symptoms of Schizophrenia fluctuate considerably and this could affect whether there is a diagnosis. Also patients react to the doctor, and behave differently according to their mood
94
What inter-rater reliability did Beck (1967) find in two psychiatrists' diagnosis of 154 patients using DSM?
54%
95
What improvements were made in DSM III (1980)?
Removal of blurred boundaries and vague descriptions, clarifying how many and what types of symptoms were necessary
96
What percentage of diagnosis consistency was found in field studies for DSM III?
81%
97
What are the three types of validity?
Descriptive, aetiological, predictive
98
What is descriptive validity?
The extent to which schizophrenia can be defined as a separate distinct disorder
99
What has caused the descriptive validity of Schizophrenia to be called into question?
The diversity of symptoms- patients can have little in common with each other and yet have the same diagnosis
100
What is aetiological validity?
The extent to which a disorder's causation can be established
101
Why is the aetiological validity of schizophrenia questioned?
There is much disagreement about causes and mechanisms involved
102
What is predictive validity?
The extent to which we are able to describe how a disorder will progress
103
What are the problems with the predictive validity of schizophrenia?
1/3 remain chronically ill, 1/3 will recover from initial bouts and 1/3 are on and off affected
Reaction to treatment is very mixed
Prognosis is therefore unpredictable
104
What are delusions?
Fixed false beliefs resistant to change in the light of contradictory evidence
105
What are examples of delusions?
Delusions of reference, grandeur, persecution
| ALWAYS give an example of one of these when describing symptoms
106
What are hallucinations?
Perception-like experiences without external stimulus. Must be distinguished from religious experience. Usually auditory but can be visual and olfactory.
107
What is disorganized thinking?
Inferred from speech eg random topic changes, word sald
108
What is grossly disorganized behaviour?
Agitation and silliness
109
What is catatonic behaviour?
A marked decrease in reactivity to the environment eg rigid posture
110
What are negative symptoms?
Diminished emotional expression eg fewer hand gestures, less facial expression, reduced eye contact
Avolition- decrease in motivated self-initiated purposeful activities
