schizophrenia Flashcards

Question

evaluations of genetic theory in biological explanations for skitz

Answer 1

Identical/monozygotic schizophrenic twins are rare and as such the sample size is small for twin studies Concordance for MZ twins is 3X that of DZ twins BUT there is still 54% chance that one twin will not suffer from Schizophrenia. 46% concordance suggest high influence of Genotype.

Answer 2

Investigation of neurotransmitters can be carried out in three ways Evidence of metabolites in the blood or urine Examination of post mortem brain tissue Use of neuroimaging Neurotransmitters (dopamine) and the enzyme responsible for their metabolism have been investigated in search for an explanation for schizophrenia

Answer 3

It was thought that excessive dopamine was the cause of schizophrenic symptoms Evidence for this idea came from Healthy people taking drugs which increase dopaminergic activity in the brain Neuroleptic drugs that block dopaminergic reactions reduce psychotic symptoms However this theory was difficult to support as post mortem studies didn’t show consistent evidence of high dopamine levels It may have been that it was not the increase in dopamine levels that caused the symptoms but a heightened sensitivity of the receptors for dopamine that led to an abundance of the chemical and schizophrenic symptoms Post mortem studies have shown increased D2 receptors in the brains of people with schizophrenia than normal brains PET scans have shown increased D2 receptors in patients with schizophrenia

Answer 4

Not all sufferers have high levels of dopamine, modern drugs have little dopamine blocking activity High levels of dopamine in the mesolimbic system lead to positive symptoms High levels of dopamine in the mesocortical system are associated with negative symptoms. Kessler et al (2003) – differences in cortical dopamine levels were found between sufferers and non sufferers – suggesting its importance at onset

Answer 5

Issues with post mortem studies are cause or effect. Major antipsychotic drugs block dopamine receptors, to infer from this that dopamine hyperactivity is the major cause of schizophrenia is to oversimplify. We now have a greater understanding of the interaction between neurotransmitter systems and that mapping these pathways is only just being explored.

Answer 6

This looks at how the structure in a schizophrenic brain differ from that of a normal brain e.g. Size of anatomical structure hemispheric differences This is investigated using post mortem studies and scanning techniques e.g. fMRI.

Answer 7

Limbic system is a subcortical structure, include the hippocampus and amygdala. Significant cell loss has been found in the structure of the limbic system at post mortem Evidence of unusual connections in the hippocampus Corpus callosum is a large bundle of fibres which connects the two hemispheres. Gender differences in the thickening of the fibres is reversed in people with schizophrenia (Nasrallah 1986) Abnormal early brain development in the 3rd trimester of pregnancy is associated with cerebral cortex development. Pre natal disorders might occur at this point e.g. Organisation of synapses. In addition to this asymmetry of the hemispheres is less evident in patients with schizophrenia.

Answer 8

Research: Boos et al (2012) MRI scans on 155 Schizophrenic patients, 186 of their non schizophrenic siblings and 122 non related schizophrenics Schizophrenic patients had decreased grey matter and cortical thinning compared to other participants. Suggesting brain tissue differences are not due to genetics.

Answer 9

Attempts to link the structural changes to particular symptoms have not yet shown consistent findings Cause & effect??????? Environmental risk factors can contribute to the onset of schizophrenia whereas biological factors contribute towards a persons liability to develop schizophrenia Those who don’t respond to medication may have structural brain damage which does not allow the medication to work.

Answer 10

sees maladaptive family relationships as a source of stress which may lead to the onset of schizophrenia

Answer 11

1- high levels of interpersonal conflicts (arguments ) 2-difficulty communicating with each other 3-being excessively critical/ controlling

Answer 12

where a child is put in a contradictory situation by performing opposite behaviours to the instructions from their parent

Answer 13

families who consistently exhibit critism and hostility can exert a negative influence , especially upon recovering schizophrenics, they may react by relapsing and continuing to experience positive symptoms like hallucinations

Answer 14

schismatic | skewed

Answer 15

one parent is abnormally dominating , and the other submissive . the children are encouraged to follow the dominant partner which impairs their cognitive and social development

Answer 16

conflicts between partners sometimes fail to provide a supportive environment and appropriate role models

Answer 17

conflicts between parents result in competition for the affection of family members and a desire to take control and undermine the other parent

Answer 18

Kavanagh -reviewed 26 studies of expressed emotion. the mean relapse rate of schizophrenics who returned to high expressed emotion families was 48% compared with 21% for those who went to live with low expressed emotion families - supporting the idea that expressed emotion increases the risk of relapse patino - established 7 problems associated eith family dysfunction ( child abuse , parental overprotection , lack of warmth between parent and child, poor relationship between adults in the household) migrants who experienced at least 3 of these had 4x the normal level of vulnerability to developing schizophrenia - suggesting that family dysfunction increases the likelihood of life stressors triggering the onset of schizophrenia

Answer 19

- hard to establish cause and effect , having a schizophrenic within the household may cause family dysfunction rather than the other way around - supported by therapy, therapies which focus on reducing expressed emotion have lower relapse rates compared with other therapies - why don't all children in such families develop schizophrenia , this suggests that there must be other factors involved in its development which leaves us with gaps in the theory

Answer 20

Cognitive approaches examine how people think, how they process information. Researchers have focused on two factors which appear to be related to some of the experiences and behaviors of people diagnosed with schizophrenia. First, cognitive deficits which are impairments in thought processes such as perception, memory and attention. Second, cognitive biases are present when people notice, pay attention to, or remember certain types of information better than other.

Answer 21

hemsley- suggests there is a substantial breakdown in the relationship between memory and perception in schizophrenics, as a result people with schizophrenia are often unable to predict what will happen next, their concentration is poor , and they attend to unimportant or irrelevant aspects of the environment . their poor integration of memory and perception leads to disorganised thinking and behaviour McGuire - found that the larynx of pateints with schizophrenia was often active during the time they claimed to be experiencing auditory hallucinations, this suggest that they mistook their own inner speech for that of someone else's

Answer 22

- accounts for positive symptoms- the cognitive approach provides a reasonable account of many of the positive symptoms of skitz - generalisability- the self monitoring explanation accounts for the positive symptoms but not the negative symptoms . therefore it is likely that there are other factors that play a role in causing skitz that account for the presence of the negative symptoms. cause and effect artificiality , the research being experimental lacks realism and so may lack generalisibity to the skitz symptoms other factors . other factors with little relevance to cognitive deficits have been found to influence the development of skitz. it is not clear how or if genetic factors, stressful life events , and various social factors inter link with cognitive factors

Answer 23

typical | atypical

Answer 24

mainly treat positive symptoms and have severe side effects

Answer 25

act upon serotonin and dopamine receptions so they bare more widely used. can treat both positive and negative symptoms , however they can also have severe side effects

Answer 26

chlorpromazine | haloperidol

Answer 27

clozapine olanzapine aripiprazole

Answer 28

Generally speaking, antipsychotic medications work by blocking a specific subtype of the dopamine receptor, referred to as the D2 receptor. Older antipsychotics, known as conventional antipsychotics, block the D2 receptor and improve positive symptoms. Unfortunately, these conventional antipsychotics also block D2 receptors in areas outside of the mesolimbic pathway. This can result in a worsening of the negative symptoms associated with the illness. Conventional (typical) antipsychotic medications include chlorpromazine, haloperidol, trifluoperazine, perphenazine and fluphenazine. A second generation of antipsychotics, commonly referred to as the atypical antipsychotics, block D2 receptors as well as a specific subtype of serotonin receptor, the 5HT2A receptor. It is believed that this combined action at D2 and 5HT2A receptors treats both the positive and the negative symptoms. The atypical antipsychotics currently available include clozapine, risperidone, olanzapine, quetiapine, paliperidone and ziprasidone.

Answer 29

Non compliance is the way participants actions affect the effectiveness of the drug treatment For example:- Patients may not change their lifestyle in order for the drugs to take action (keeping same diet, continuing smoking or drinking alcohol) May got positive effects from the drugs e.g. immediately feel better and then discontinue their treatment as they feel they are cured Non compliance can also occur due to the side effects of the treatment. Patients may prefer to not take the drugs and suffer with schizophrenia and not the severe side effects of their drug.

Answer 30

- Atypical drugs are better than typical - But atypical drugs are not free from side effects and have much more severe long term effects. Like all medications, antipsychotics have side effects. Side effects from blocking the D2 receptor can include tremors, inner restlessness, muscle spasms, sexual dysfunction and, in rare cases, tardive dyskinesia, a disorder that causes repetitive, involuntary, purposeless movements. These side effects are more often associated with the older conventional antipsychotics—which, again, may still work better for some people—but that is not to say that atypical medications don’t have side effects. Side effects associated with the atypical antipsychotics include weight gain, diabetes and lipid disorders. These side effects are more often associated with clozapine and olanzapine. - Typical drugs are more effective at treating positive symptoms - Development of schizophrenic drugs has taken the idea away that schizophrenia is madness and untreatable. - Reduction perspective – fails to include other causes for schizophrenia - Drug treatments are aimed at treating dopamine excess but other neurotransmitters are involved in the cause (Jevitt)

Answer 31

marder-reported that the atypical antipsychotic clozapine is as effective as typical antipsychotics in relieving the positive symptoms of schizophrenia, and is effective in approximately 30-61% of patients who are resistant to typical antipsychotics, suggesting it to be a superior form of treatment schooler et al- comparing effectiveness of typical of and atypical antipsychotics, found both effective in treating schizophrenia , with 75% of patents experiencing at least 20% reduction in symptoms . however 55% of those typical antipsychotics suffered relapse , compared with only 42% for typical treatments , with relapse occurring earlier in those taking typical drug treatment evaluation - exaggerated evidence for positive effects- chemical cosh argument

Answer 32

CBT is the main psychological treatment used with schizophrenia. The idea is that beliefs, expectation and cognitive assessments of the self, the environment and the nature of personal problems affect how individual perceive themselves and others, how problems are approached and how successful people are in coping and reaching goals. CBT thus aims to help schizophrenics by changing their maladaptive thinking and distorted perceptions seen as underpinning the disorder in order to modify hallucinations and delusional beliefs. CBT session occur every 10 days and last for a course of 12 sessions. This is a cognitive therapy, so drawings are used to illustrate links between thought’s actions and emotions. The cognative approach often uses models to illustrate cognitive processes e.g. Multi Store Model of memory.

Answer 33

coping strategy enhancement | cognitive therapy

Answer 34

* The aim of CSE is to teach the patient how to use coping strategies effectively to reduce the frequency and intensity of the episodes. There are 5 steps: * Asses the form and the content, assess the emotional response, assess the person thoughts that accompany the episode, assess any prior warning, assess the individuals coping strategies. Further steps include, education and rapport training and symptom targeting. Patients receiving CSE showed significant improvement in coping skills. Patients showed a 50% improvement in symptoms at a 6 month follow up. (Tarrier 1993) However studies often have a high dropout rate.

Answer 35

• Cognitive therapy is based on the idea that beliefs about the self and appraisal of events are responsible for negative affect(emotion). Therapy requires the thoughts and their effects to be shared and challenged, putting thoughts to reality testing . Two beliefs underpin the therapy: start with the least important belief, work with evidence for that belief not the belief itself. A verbal challenge of the evidence and presenting a more reasonable explanation The challenging reduces the patients conviction of the belief and raises their awareness of the link between the belief and emotions. Reality testing, planning and performing an activity which invalidates the belief. Research trials using cognitive therapy for delusions have demonstrated a 40% reduction in the severity of psychotic symptoms. Cognitive therapy led to a faster response to treatment when compared to drugs alone and also an improved recovery (Drury 1996).

Answer 36

Zimmerman (2005) – meta analysis of 50 studies of CBT, found only a small therapeutic effect of CBT on symptoms e.g. positive symptoms (the main focus of CBT). This questions whether CBT should be used for schizophrenia.

Answer 37

CBT is most effective when used in combination with antipsychotic drugs. CBT is not suitable for all patients, especially those with paranoid schizophrenia, because a trusting relationship needs to be built with the therapist. However, it may be suitable for patients who refuse drug treatment. Therapists need to be trained. CBT has fewer side effects than antipsychotic drugs but requires more input from the patient and is an expensive treatment.

Answer 38

used in institutions trains them to normal behaviours The main idea is that behavioral change can be achieved by awarding tokens for desired actions. These reinforcers are exchanged for benefits such as a film or a coffee. • The focus of a token economy is on shaping and positively reinforcing desired behaviors and NOT on punishing undesirable behaviors. The technique alleviates negative symptoms such as poor motivation, and nurses subsequently view patients more positively, which raises staff morale and has beneficial outcomes for patients. • It can also reduce positive symptoms by not rewarding them, but rewarding desirable behavior instead. Desirable behavior includes self-care, taking medication, work skills, and treatment participation.

Answer 39

Paul and Lentz (1977) Token economy led to better overall patient functioning and less behavioral disturbance, More cost effective (lower hospital costs) McMonagle and Sultana (2000) reviewed token economy regimes over a 15-year period, finding that they did reduce negative symptoms, though it was unclear if behavioral changes were maintained beyond the treatment programme. Upper and Newton (1971) found that the weight gain associated with taking antipsychotics was addressed with token economy regimes. Chronic schizophrenics achieved 3lbs of weight loss a week.

Answer 40

It is difficult to keep this treatment going once the patients are back at home in the community. Kazdin et al. Found that changes in behavior achieved through token economies do not remain when tokens are with¬drawn, suggesting that such treatments address effects of schizophrenia rather than causes. It is not a cure. There have also been ethical concerns as such a process is seen to be dehumanising, subjecting the patient to a regime which takes away their right to make choices. - gives them something to look forward to , improves standards of living and quality of life

Answer 41

``` success rates side effects cost of effectiveness effort levels affect on others relapse rates symptoms it treats ```

Answer 42

is a combination of treatments for the explanation aspect it combines genetics and family dysfunction the treatment combines medication and CBT

Answer 43

strengths - leads to more successful treatments weakness -hard to attribute success to any one approach , dont know which one works

Answer 44

cannon et al- reviewed available evidence to find a positive correlation between birth complications and a later vulnerability to developing schizophrenia with some indication of damage to hormone and neurotransmitter systems ,as well as the immune system . this again supports an interactionist explanation of schizophrenia, where biological vulnerabilities interact with later stressors to trigger the disorder

Answer 45

morrison and turkington- reported that drug treatment plus CBT produced better rates of symptoms reduction and relapse than drug treatments or CBT alone, demonstrating the effectiveness of an interaction of treatment

Answer 46

Family therapy – treatment of schizophrenia by alteration of communication systems within families. It is based on the idea that as family dysfunction can play a role in the development of schizophrenia, altering relationship and communication patterns within dysfunctional families, especially lowering expressed emotion, should help schizophrenics recover. This treatment involves the whole family. The family become the patient’s support network. Therapists meet regularly with the patient and family members, who are encouraged to talk openly about the patient’s symptoms, behaviour and progress with their treatment and how the patient’s illness affects them. Family members are taught to support each other and be care givers. There is an overall emphasis on “openness” with no details remaining confidential, although boundaries of what is and is not acceptable are drawn up in advance and form part of a document of informed consent. Family therapy if given for a set amount of time, 9 months -1 year, focusing on developing skills within family members that can be continued after therapy has ended.

Answer 47

1. Improve positive and decrease negative forms of communication 2. Increase tolerance levels and decrease criticism levels between family members 3. Decrease feeling of guilt and responsibility for causing the illness among family members

Answer 48

Pilling (2002) – meta analysis of several forms of psychological treatment for schizophrenia, including 18 studies of family therapy with 1467 patients, finding family therapy had the smallest patients who relapsed and the lowest number of hospital readmission as well as highest number of patients who complied with their medication regime.

Answer 49

Honesty if often difficult to deal with once outside the therapeutic setting Family therapy required patients to spend time with their family, so may be particularly beneficial to younger patients who still live at home Can be useful for patients who lack insight into their symptoms or cannot speak coherently about their illness. Family members can assist with this information It can be cost effective as relapse rates are fewer meaning less hospitalisation, less time for medical professionals. It places more emphasis and responsibility of the family which some family members may find difficult to cope with, lessening the effectiveness of the treatment. Some members may also be unwilling to participate.

schizophrenia Flashcards

(73 cards)