Schizophrenia Flashcards
(89 cards)
1
Q
What are the three symptoms associated with a split in the psyche?
A
- disorganised thought processes
- split between intellect and emotion
- split between intellect and external reality
2
Q
What are the five main symptoms of schizophrenia?
A
- auditory hallucinations
- delusions (of grandeur, of persecution)
- disordered thinking
- lack of control (alien power)
- emotional and volitional changes (‘flat’ emotions, little initiative, no energy)
3
Q
What did Wing argue?
A
For a distinction between primary (intrinsic to the disorder) and secondary (result from primary) symptoms.
4
Q
Name some primary symptoms.
A
Hallucinations, delusions, thought disorders, apathy, emotional blunting.
5
Q
Name some secondary symptoms and the two categories.
A
Social - unemployment, social drift, institutionalisation, rejection & prejudice.
Psychological - dependant, poor coping, depression, loss of confidence, no motivation.
6
Q
What are positive and negative symptoms?
A
Positive - additional to ‘normal’ behaviour or expression.
Negative - deficit in ‘normal’ behaviour patterns.
7
Q
What are type 1 and type 2 symptoms?
A
Type 1 (positive) - responsive to drug treatments, limbic system abnormalities. Type 2 (negative) - less responsive to drugs, abnormalities in frontal lobes and enlarged ventricles.
8
Q
What is the third cluster of symptoms?
A
There is no universal agreement about a simple positive/negative split between symptoms. It is argued that a third cluster - disorganised schizophrenia - exists, which is largely associated with chaotic speech and behaviour.
9
Q
How are the symptoms of schizophrenia described?
A
As being on a continuum, rather than a dichotomy.
10
Q
What is the issue with labelling people as having ‘schizophrenia’?
A
The term can be misleading, despite it being convenient. It is likely there are many different types of severe mental disorders that we currently call schizophrenia, when they have one thing in common; a loss of contact with reality.
11
Q
What is the DSM-IVR?
A
Diagnostic and Statistical Manual, 4th Edition Revised. Widely used for the diagnosis of abnormalities.
12
Q
What are; A characteristic, B and C symptoms?
A
A characteristic - two or more of the following each present for a one month period; delusions, hallucinations, disorganised speech, disorganised or catatonic behaviour, and negative symptoms (affective flattening, alogia).
B social/occupational dysfunction - one or more major areas of functioning such as work, interpersonal relations or self-care are markedly below the level achieved prior to the onset.
C duration - signs of the disturbance persist for at least six months. This period must include at least one month of symptoms (or less if treatment successful) that meet criterion A.
13
Q
What is alogia?
A
Speech that is dramatically reduced in content.
14
Q
What are the types of schizophrenia, and describe them>
A
Paranoid - one or more delusions, frequent auditory hallucinations. None of the following prominent; disorganised speech, disorganised/catatonic behaviour, flat/inappropriate behaviour.
Catatonic - two of the following are present; immobility (including waxy flexibility) or stupor, excessive motor activity, extreme negativism or mutism, posturing, stereotyped movements, prominent mannerisms/grimacing, echolalia or echopraxia.
Disorganised - all of the following are prominent; disorganised speech, disorganised behaviour, flat effect.
Undifferentiated - criterion A symptoms are present, but the criteria are not met for the paranoid, disorganised, or catatonic type.
Residual - absence of prominent delusions, hallucinations, disorganised speech, catatonic behaviour. There are negative symptoms, or two or more symptoms listed in criterion A in an attenuated form.
15
Q
What is echolalia?
A
Repetition of a word or phrase.
16
Q
What is echopraxia?
A
The repeating of gestures made by others.
17
Q
What are the three biological explanations of schizophrenia?
A
Genetics, neurochemical, and neuroanatomical.
18
Q
Overview of genetic explanation.
A
Schizophrenia tends to run in families, and studies show the closer the familial relationship, the higher the concordance. The general risk of schizophrenia in the population is 1%.
19
Q
What are the percentage risks for schizophrenia in relation to family? Who was this meta-analysis by?
A
Gottesman and Shields.
Your ______ has schizophrenia;
One parent - 5.6% Sibling - 10.1% Sibling and one parent - 12.9% Both parents - 46.3% Grandparent - 3.7%
20
Q
What type of studies do they use to unravel genetics and environment?
A
Adoption studies.
21
Q
Describe twin studies. Give evidence.
A
MZ twins have 100% genes in common, DZ have 50%. If schizophrenia was a purely genetic disorder, this would predict that when one twin has been diagnosed with schizophrenia the rate of concordance would be higher in MZ than DZ twins. This has shown to be the case in a met-analysis (Gottesman and Shields).
MZ concordance - 46%
DZ concordance - 14%
22
Q
Describe adoption studies. Give evidence.
A
These studies are typically of children adopted within two weeks of birth from their mother, who has schizophrenia. These children have no common genes with their adoptive family, where no one has schizophrenia. This, genes an environment are seperated.
Heston did a study of 47 mothers with schizophrenia, whose children were adopted within days to psychiatrically well mothers. He found the incidence of schizophrenia in the children to be 16%. This is well above the national average, suggesting a genetic influence.
23
Q
Evaluate the genetic explanation (5 points).
A
- The 46% concordance for MZ twins suggests a major contribution of genotype.
- Concordance for MZ twins is about three times that of DZ twins, but there is still a discordance rate of 40% which could show there is more of an environmental cause. However, half of the discordant group go on to develop a schizoid or similar disorder, thus if a broader definition of ‘schizophrenia’ is used, MZ concordance rate is higher.
- Twin studies haven always contained small samples due to the rare incidence of both twins and schizophrenia in the population.
- Evidence from normal twin pairs suggests that MZ twins are reared in a more similar environment than DZ twins, meaning nurture may explain the higher concordance for MZ twins.
- Findings from adoption studies suggests inheritance plays a part in schizophrenia and there may be a genetic predisposition to the disorder.
24
Q
Describe the neurochemical explanation of schizophrenia.
A
Investigation of neurotransmitters can be carried out in three ways; looking for evidence of metabolites in urine and blood, post-mortem in brain tissue, and neuroimaging techniques (PET scan).
The activity of neurotransmitters such as dopamine and the enzyme responsible for its metabolism (monoamine oxidase, MAO) has been investigated.
25
Describe the early (outdated) dopamine hypothesis. Give evidence.
It was first thought that excessive dopaminergic activity in the brain was the cause of schizophrenic symptoms. Evidence for this came from;
- Drugs that increase dopaminergic activity (amphetamines) result in psychotic symptoms.
- They also exacerbate psychotic symptoms in people with schizophrenia.
- Neuroleptic drugs that block the dopaminergic neurons reduce psychotic symptoms.
26
Describe the new and more accurate dopamine hypothesis. Give evidence.
The old hypothesis was difficult to support because post-mortem studies didn't show consistent evidence for an increased dopamine level. This led to the theory that it was really the heightened sensitivity of the receptors for dopamine in the brain that led to an abundance of the chemical and thus to schizophrenic symptoms. Evidence came from;
- Post-mortem studies have shown that there are more D2 (dopamine) receptors in the brains of people with schizophrenia than there are in normal brains.
- Studies using PET scans have reported a substantial increate in D2 receptors in patients with schizophrenia.
- Seeman used PET and found six times the density of D4 receptors in the brains of people with schizophrenia (D4 is a subtype of receptor, similar to D2).
27
Evaluate the neurochemical explanation (3 points).
1. It isn't clear whether the increase in D2 receptors found in post-mortems is the cause of the pathology or an effect of the neuroleptic drugs taken as it is known that such drugs are attracted to this particular receptor.
2. Neuroimaging studies by Pearlson were carried out on patients who had not been exposed to neuroleptic drugs, and thus ruled out the issue with post-mortem studies.
3. It is now clear that the neurotransmitter systems interact and that the mapping of these cortical pathways is only just being explored - other neurotransmitters could be involved, and it could actually be neurotransmitters interacting.
28
Briefly describe the history of the neuroanatomical explanation.
The brains of schizophrenics are compared to that of controls on various things such as size of anatomical structure, hemisphere differences and cell counts. Initially, any comparison could only be carried out in post-mortem which can be problematic; for example the neuroleptic drugs used to treat schizophrenia may have caused any abnormality found. New techniques (MRI) allow living brain images o be investigated and consistent chance in particular areas have been identified.
29
Describe the structure of the schizophrenic brain.
Limbic system - this is a subcortical structure that includes the hippocampus and amygdala. Significant cell loss has been found in these structures at post mortem in schizophrenic patients. These findings have been confirmed with more recent MRI scans. There is also evidence of unusual cell connections in the hippocampus.
Corpus callosum - this is a large bundle of fibres and connects the two hemispheres of the brain. Studies show that the gender differences in the thickening of these fibres in normal individuals are reversed in people with schizophrenia.
Abnormal early brain development in the third trimester of pregnancy when the last stage of the development of the cerebral cortex occurs, is thought to be associated with schizophrenia. The two hemispheres of the brain are asymmetrical, particularly in the tempero-parietal region of the cortex. Bothe post-mortem and imaging studies have shown that this asymmetry is much less evident in patients with schizophrenia.
Brain imaging studies - have found significant differences in both structure and function of the schizophrenic brain.
Studies have shown that people with schizophrenia have reduced brain tissue and enlarged ventricles. A meta-analysis by Raz and Raz of studies comparing ventricular volume reported a significant increase in size in over half the sample and an overall effect size of 0.6. This may be linked to major functional abnormalities.
30
What is the study on the neuroanatomical explanation?
Suddath took fifteen discordant MZ twin pairs, only one of which was diagnosed with schizophrenia, were given MRI scans to determine any differences in brain structure. The co-twin with schizophrenia had a smaller bilateral hippocampus in 14 of the 15 pair, and the co-twin with schizophrenia had larger ventricles.
Conclusion: when genotype is controlled (100% concordance) there is significantly diminished brain volume in the twin with schizophrenia.
Issue: it is difficult to establish whether the smaller hippocampus found is cause or effect.
31
What is hypofrontality?
Imaging techniques can detect cerebral blood flow (CBF) in parts of the cortex. At rest, people with schizophrenia show evidence of underactivity in the tempero-frontal areas of the cortex. This is particularly evident in chronic patients.
32
Evaluate the neuroanatomical explanation (3 points).
1. Attempts to link structural chances to symptoms have not yet shown consistent findings. Lewis considered 18 studies and found no significant link between enlarged ventricles and negative symptoms associated with schizophrenia.
2. A variety of brain mechanisms seem to be implicated in schizophrenia but non is sufficiently understood for researchers to say it provides a causal link.
3. A number of environmental risk factors contribute to the onset of schizophrenia and it is more realistic to propose that biological factors contribute towards an individual's liability to develop schizophrenia.
33
What does the cognitive approach attempt to explain?
Specific symptoms, in particular positive symptoms such as hallucinations and delusions.
34
How does the cognitive approach explain hallucinations?
Up to 73% of people diagnosed with schizophrenia report experiencing auditory hallucinations. Bentall assumes that hallucinations occur when people mistake their own internal, mental or private events for external, publicly observable events - the imaginary world is mistaken for the real world. The five-factor model expands on this.
35
Explain the five-factor model.
Slade and Bentall proposed this theory, which explains the onset of such schizophrenia-type symptoms.
1. Stress-induced arousal. In times of stress we are in a heightened state of arousal and information is not processed effectively making it difficult to decide what is real.
[down to a cycle]
2. Predisposition. Some people hallucinate more easily. They have more suggestibility.
3. Environment. Influences hallucinatory responses (very quiet or noisy conditions).
4. Reinforcement. Hallucinations bring relief by reducing anxiety.
5. Expectancy. People see or hear what they believe exists.
36
Evaluate the five-factor model (3 points).
1. Sensory deprivation or noise stimulation are conditions associated with hallucinations which explains why sensory loss in older people makes them more likely to experience hallucinations.
2. (Reinforcement) is inconsistent with recent findings that show that hallucinations increase anxiety (Close and Garety).
3. (Expectancy) is supported by cross-cultural studies. In Puerto Rico individuals who experience hallucinations are visited by spirits, which is considered 'normal'. Such individuals are not regarded as mentally ill as may be the case in Western societies.
37
How does the cognitive approach describe delusions?
It is not always possible to distinguish between delusions and beliefs (the belief in God). It is more appropriate to look at delusions as being on a continuum with normality, and the individual's point on the continuum depends on "the degree of conviction in the belief, and the extent of preoccupation with that belief." (Strauss). You can suffer paranoia, but not be considered abnormal.
38
What are the two cognitive theories of delusion?
1. Delusions are the result of abnormal cognitions in reasoning, attention, memory etc. Bentall proposed that paranoia and persecutory delusions are a psychological defence against depression and low self-esteem. These defences are maintained by attention/memory biases; an external bias whereby negative outcomes are attributed to external causes. For example, following a negative event we attempt to explain discrepancies between our actual self and ideal self. "They didn't fire me, they were out to get me."
2. Delusions are the product of abnormal perceptions. Delusions are an adaptive and rational response to abnormal internal events such as hallucinations. Maher proposed a model to explain it (Maher's Anomalous Experience Model).
- The same cognitive processes lead to both delusional and abnormal beliefs.
- Delusions act as mini-theories to provide meaning and order to the world.
- Mini-theories are needed when events are not predictable (delusions structure an unpredictable world).
- Delusional explanations for unpredictable events bring relief.
- Beliefs are judged delusional by others when they are based on experiences that are not open to scrutiny.
39
Evaluate cognitive explanations (three points).
1. Delusions occur in a wide range of disorders where no prior history of cognitive impairment is evident. When normal individuals undergo abnormal experiences, delusions can occur. This supports the idea of a continuum.
2. Maher's model has provided a successful therapeutic model for delusions.
3. Points to the importance of attributional and reasoning biases that may contribute to the maintenance of delusions in schizophrenia. However, on their own, they are inadequate in explaining the onset of such a complex disorder.
40
What does the sociocultural approach focus on?
The wider social context in which the individual exists. For example, behaviour is seen as a result of societal or familial interactions.
41
How does Thomas Szasz view labelling?
Thomas Szasz claims that labelling someone with a mental illness is nothing more than the 'medicalisation of madness'. Using terms such as treatment, illness and diagnosis is a form of social control that robs individuals of their liberty. This excludes those who don't conform to our social and cultural norm.
42
Describe the labelling theory.
Scheff proposed that schizophrenia is a learned social role that is determined by the process of labelling. This theory proposes that an individual who breaks one or more residual rule is assigned a label. This influences the individual to behave in a manner that fits the label, but also determines how others react to that individual. Scheff says we all occasionally break residual rules, but when diagnosed as mentally ill people find it hard to fit back into normal society. When others begin to find out about the illness, they may be unable to find work, and if hospitalised the attention received reinforces their perception and expectations. This creates a self-fulfilling prophecy
43
What are residual rules?
Rules that are not formalised (do not steal) but include deviant behaviour in which we might all occasionally engage. Such residual rules are endless (don't talk to lamp posts).
44
What is a self-fulfilling prophecy?
An expectation that someone will behave in a certain way, as a result of which the person's behaviour turns out as expected because they begin to act in a way that will optimise the expected outcome.
45
What is the DSM-III?
Diagnostic and Statistical Manual, third edition.
46
What is the Rosenhan study on labelling theory?
A group of eight psychologically healthy pseudo-patients pretended that they could hear an unfamiliar voice which said empty, hollow and thud in order to gain admission to a variety of hospitals (USA). All patients were admitted, and seven received the diagnosis of schizophrenia. Once admitted, the patients behaved normally but reported a sense of powerlessness and fear, and their behaviour was interpreted by staff as schizophrenic. They had difficulty convincing staff that they were sane and were hospitalised for between 7 and 52 days. Normal behaviour was perceived as abnormal; a person writing notes was said to be displaying obsessive-compulsive writing behaviour. All patients were released with 'schizophrenia in remission'.
47
Evaluate labelling theory (4 points).
1. Rosenhan helped to improve the reliability of a diagnosis with the revision of the DSM-III. It demonstrated that psychiatric labels tend to become self-fulfilling prophecies.
2. It only accounts for how symptoms are maintained, it does not explain the cause.
3. Ignores compelling genetic evidence.
4. Seriously ill individuals with a range of debilitating symptoms exists and require help. It has been criticised of trivialising a very serious mental disorder.
48
What did Bateson propose? (Family dysfunction).
Communication between parents and offspring was sometimes contradictory. This is known as a 'double bind'. A parent might be saying one thing, but their body language says another. Children experiencing this learn not to trust their own feelings and perceptions as they can't trust those of others. They can grow up to mistrust all communications as is shown sometimes by people with paranoid schizophrenia.
49
What is family socialisation theory?
Families sometimes fail to provide a stable and supportive environment and appropriate role models.
50
What are the two abnormal family structures? Describe them.
Schismatic families - conflicts between parents result in competition for the affection of family members and a desire to talk control and undermine the other parent.
Skewed families - one partner is abnormally dominating and the other submissive. They are encouraged to follow the dominant partner, which impairs their cognitive and social development.
51
Evaluate familial dysfunction.
It is difficult to prove a casual relationship between family patterns and schizophrenia as it isn't possible to untangle cause and effect. It might be the parents reaction to a particularly difficult child that causes the family problems.
52
Explain what expressed emotion (EE) is.
Brown found that people with schizophrenia who were discharged from hospital and returned to parents or spouses fated worse than those returning to lodgings. High face to face contact was found to increase the risk of relapse, which is attributed to relatives' emotional over-involvement. This includes;
- emotion (positive and negative)
- hosility
- critical comments (tone of voice and content)
53
How does high/low EE affect schizophrenics?
When EE is high in a household, patients are significantly more likely to relapse than if the patient lives in a family with low EE.
54
What is the study on EE?
Bebbington and Kuipers carried out a meta-analysis of 26 studies of the role of EE as a risk factor for relapse. Countries involved include UK, USA, Switzerland. Data relating to 1,346 patients were analysed to determine the proportion of EE families and the average relapse rate for people returning to high and low EE families. 52% of families were high EE and relapse in those high EE families averaged 50%. The low EE families had a relapse rate of 21%. However, it is difficult to establish cause and effect.
55
Evaluate the EE explanation (4 points).
1. The ability to predict the relapse rate from the EE measure up to 12 months following discharge is a strong indicator of the predictive validity of EE.
2. It's unclear whether EE is a casual agent in relapse rate or just a reaction to the patients behaviour. When a person begins to deteriorate, family involvement is likely to increase, along with family criticism and efforts to control the situation.
3. High EE communication patterns are not specific to schizophrenia; they are found in families with depressive illness and eating disorder This is also more evident in Western families.
4. There is a problem with how EE is measured, which is usually via one interview. This may not be sufficient to give an accurate picture of family interaction patterns.
56
What were the first anti-psychotic drugs called? What were they used to treat?
Neuroleptics were used to treat acute episodes of psychosis and prevent relapse.
57
How were neuroleptics tested?
A series of double-bind placebo trials, which showed a significant advantage for the active drug.
58
What in specific are neuroleptics used to treat, and what is the fail response rate?
They have a specific impact on the positive symptoms (hallucinations, delusions). Loebel found that 16% failed to recover within the first 12 months of treatment.
59
What are the new range of neuroleptics called?
Atypical neuroleptics.
60
Why are atypical neuroleptics used?
They prove effective on individuals who do not respond to older drugs. They also do not have side effects at normal doses, apart from occasional akathisia.
61
What is akathisia?
Extreme restlessness and agitation.
62
What is Clozapine?
Another drugs that proves effective where traditional neuroleptics have failed. 66% of people with stubborn symptoms respond within 12 months.
63
Give examples of drugs used.
Neuroleptics: chlorpromazine
| Atypical neuroleptics: Riperidone
64
Evaluate drug treatment (6 points).
1. Side effects of neuroleptics are distressing; muscular spasms, parkinsonism, tardive dyskinesia.
2. Clozapine is associated with the potentially fatal lowering of the blood counts. Other side effects are; sedation, hyper-salivation, weight gain.
3. Newer drugs don't lead to the distressing side effects, but are very expensive.
4. Neuroleptics are best at continual low dosage to control relapse. These drugs only extend intervals between relapse, and don't prevent it.
5. Neuroleptics have become popular as bimonthly injections, which ensure adherence to regimes to help prevent relapse. They only control, not cure, psychosis.
6. No evidence that neuroleptics are effective with negative symptoms.
65
What is a token economy?
A person is rewarded for a desirable behaviour by being given tokens. The more a person performs these behaviours, the more tokens they receive. The tokens can be exchanged for items that the person wants.
66
What type of treatment is a token economy?
Behavioural.
67
How is a token economy often used?
When medication has reduced psychotic episodes, other behaviours can be controlled using behaviour therapy. It can also be used to reverse the effects of hospitalisation.
68
What is the study by Paul and Lentz on behavioural treatment?
FIND - ASK WEBB
69
What is social skills training(SST)?
An approach that directly attempts to modify social behaviour of schizophrenics.
70
What underlying assumption does SST work with?
That people with schizophrenia are not equipped with the behaviours necessary for successful social interactions and interpersonal relationships.
71
What techniques are used in SST?
Modelling, reinforcement and role playing. It is highly structured and might include conservation skills, assertion, conflict management, medication, time use, recreational skills, survival skills and employment.
72
Describe an SST session.
About an hour, up to five times a week. There might be two trainers and ten patients and each session would concentr4ate on key competencies in an area of community functioning.
73
Evaluate SST (3 points).
1. Studies have found it to be effective in increasing patients ability, comfort and assertiveness in social situations.
2. Does not always generalise to real life. Shepherd found when assessing social functioning following SST in a number of naturalistic settings.
3. Behaviour therapy doesn't help alone with the distress of psychotic symptoms. There has been a move from discrete behavioural therapy to a more inclusive approach of cognitive and social perception skills.
74
What is psychotherapy?
A generic term, which covers psychodynamic and cognitive therapies. They often rely on talking and listening.
75
What does cognitive-behavioural therapy focus on?
Individual symptoms such as delusions and hallucinations.
76
What is the study by Tarrier?
25 patients with schizophrenia who suffered hallucinations and/or delusions following a psychotic episode were interviewed. Details of the experiences were elicited, including when and where, and patients emotional reactions and their coping strategies.
One third identified 'triggers' to the symptoms; traffic noise, feeling anxious. 75% reported major distress and one third reported disruption to thinking and behaviour. 75% disclosed the use of distraction, positive self-talk, withdrawal or relaxation.
This relied on the client being able to recall and communicate effectively, which isn't possible in many cases of schizophrenia.
77
What did Tarrier's study lead to?
Teaching patients new coping strategies based on their personal strategies; coping strategy enhancement (CSE).
78
What is the aim of CSE?
To teach an individual to use coping strategies to reduce the frequency and intensity of psychotic symptoms.
79
What initial steps are taken in CSE?
Assess;
- form and content of psychotic experience
- emotional response
- person's thoughts accompanying the emotion
- prior warning or antecedent
- individual's current coping strategies
80
What two key components are used in CSE?
1. Education and rapport training. This creates an ambience and shared understanding for the client and therapist.
2. Symptom targeting. Usually once, for which there is already a coping strategy, which is enhanced and practised during the session. Homework is to asses use and effectiveness, and to make a record.
81
Evaluate CSE (2 points)/
1. Tarrier carried out a study investigating the effectiveness of CSE over problem-solving therapy in 49 patients taking medication who continued to experience hallucinations and delusions. Patients were randomly allocated to treatment conditions involving 10 one hour sessions. Both groups reported a 50% improvement in positive symptoms, compared with a control group. This was still evident in a six month follow up. However CSE patients had significant improvement in coping skills as well.
2. There is usually a high drop-out rate in treatment research. 47% dropped out of Tarrier's study.
82
What is cognitive therapy?
Supporters argue s is beliefs about the self an appraisal of events that are responsible for negative emotional effects. Therapy therefore requires these thoughts and affects to be elicited and challenged, which can involved 'reality testing'.
83
What are the two important principles in cognitive therapy?
1. Start with the least important belief.
| 2. Work with evidence for that belief, not the belief itself.
84
What three components does cognitive therapy include?
1. Verbal challenge of the evidence for the least significant belief. The therapist questions the client's delusional interpretation and puts forward a more reasonable one.
2. A reduction in conviction can occur. The client becomes aware of the link between events, beliefs, affect and behaviour.
3. Reality testing involves planning and performing an activity to invalidate a belief. Chadwick reported Nigel, who claimed to have the special power of knowing what people said before they said it. To test this video recorders were put on pause and Nigel said what was coming next. Out of 50 attempts, he got none right, and concluded he did not have that power.
85
Evaluate cognitive therapy (2 points).
1. Research trials for delusion therapy demonstrated a 40% reduction in the severity.
2. During a period of acute psychosis, cognitive therapy led to a faster response to treatment compared with drugs alone, and to improved recovery.
86
What was the anti-psychiatry movement?
In the 60s and 70s, there was a rejection of medical concept of mental illness and a preference for care in the community. Research emerged that hospitals could be detrimental to those with schizophrenia, as places were dehumanising and increased negative symptoms.
87
What is the current approach to community care?
It emphasises interventions between psychotic episodes to maintain the benefits of treatment and prevent relapse. Case management is an essential part. This places the responsibility for assessment and coordination on an individual or team. A client will be allocated to a named key worker - usually a community psychiatric nurse (CPN) - who has to assess and coordinate appropriate care.
88
What is the study by Stein and Test on community care?
A comparison of two groups of 65 individuals was made with one group receiving training in community living - social support networks, reducing dependency etc.
During the first 12 months, 58 of the control group were readmitted. However, when the programme ended, gains were gradually lost. Patients in community care were able to survive in the community, but were not cured.
A considerable financial and personnel investment is required for community care to be effective in the long term. This is a political issue that needs to be addressed.
89
Evaluate community care (4 points).
1. Some argue that quality of life can be improved at no extra cost.
2. Hospitals increase some of the symptoms, such as apathy and withdrawal, and stigmatise those with mental illness.
3. Critics argue that services are patchy and burden on family increases.
4. Failings in community care have been highlights, such as the murder of Jonathan Zito in an underground station in London.
