Seminar 8 - Schizophrenia cont and the biopsychosocial approach Flashcards
(13 cards)
Biological factors
The brain
- suppression of default mode network absent
- weaker connections between brain areas
- hallucinations due to dysfunction of areas
Issued with neurotamsitters
- activity of dopamine
- domaine imbalance hypothesis
- glutamate linked to psychotic-like symptoms
Domaine
- contributes to movement control and promotes reinforcing effects off food, sec and abused drugs
- involved in sz and Parkison’s
Glutamate
- the principle excitatory neurotransmitter in the brain and spinal cord
- vitally involved in learning and implicated in sz
Dopamine
Reward and reinforcement
- responsible for feelings or euphoria
Motor movements
- implicated in movement disorders like Parkison’s
Produced in brainstem, but has projections which affect activation in the cortex (surface of the brain)
Overactivity of dopamine in midbrain regions
Underactivity of dopamine in cortical regions
Dopamine imbalance hypothesis
Lead to both positive and negative symptoms
- hallunctivnations/delusions result of overactivity in midbrain/brainstem
- lack of motivation/flat effect results of underactivity in cortex
Changed in activity results in more reactive thinking
- inability to stop influx of thoughts
- increased information flow resulting in more creative thinking
Antipsychotic medications
1954 discovery of chlorpromazine (Thorazine)
- reduces dopamine activity in the brain
- reduced agitation, hostility, aggression, hallucinations, delusions
- increases time between hospitalisations
- does not change negative symptoms and cogntive deficits
~ these are due to underactivity of domaine
~ early drugs only target overactivity of dopamine
Side effect of tardive dyskinesia (movement disorder) is due to fact dopamine is used for motor movements
Importance of dopamine
- imbalance of dopamine activity in the brain
- however, anti-dopamine drugs (e.g. typical antipsychotics) do not help upwards of 40% of those seeking treatment
- first-generation antipsychotics also produce tardive dyskinesia
- medications which block dopamine are somewhat effective
- drugs that increase dopamine cause sz-like symptoms
However:
- typical antipsychotic medication mainly target positive symptoms
- link between dopamine and sz may be more complicated
Atypical, second-generation antipsychotics:
- target specific dopamine receptors, not all types of dopamine
- produce less tardive dyskinesia
Equal to or sometimes more effective than typical, first-generation antipsychotics
Schizophrenia and the brain
Nicotine
- mimics acetylcholine in the brain (excitatory)
- improves negative symptoms (e.g. flat affect)
- stimulated under active parts of the cortex
~ 80% of sz patients smoke
~ self medication
Environmental origins of sz
- direct brain damage or injury during earl development
- prenatal complications
~ stress, immune responses, and starvation during pregnancy
~ winter with effect
Biopsychosocial model
Interaction between genetics (biology), personality (psychology), and the environment (social) and their impact on mental health
George Engel (1913-1999)
- suggested mental health should be understood from more than just biological perspective
Example:
- type 2 diabetes
~ biological explanation (resistance to insulin)
~ influenced by how the person eats and exercises)
- Depression and anxiety
~ biological markers (neurotransmitters, brain activity)
~ influenced by behavioural, social, and emotional factors
Biological influences
Biological influences of mental health varied
- only 50% of identical twin developing sz if other twin has it
- biology is important, but canon explain everything
- some clinical disorders don’t have reliable biological markers
Psychological factors
Potential psychological explanations for mental health
- personality approaches
- learned patterns of behaviours
For example:
- anxiety might be fear or punishment via operant conditioning
- sz might develop through observational learning of parents with disorder
- alcohol use disorder developing due to individual’s motivation to drink (e.g. to cope with stress or negative emotions)
Social factors
Stressors
- work
- family
- school
Social norms
- media
For example:
- being fired from your job
- parents going through divorce
- overwhelming workload from school
- social norms of beauty (e.g. anorexia nervosa)
Biopsychosocial model
Framework argues that each one of these factors is not sufficient to explain mental health
- the interaction between them can help us better understand mental health and clinical disorders
Applying the model
Interventions must address off three factors
- research suggests the combination of health status (biology), perceptions of health (psychology) and environmental barriers to health care (social and cultural factors) influence the likelihood of a patients engaging in seeking treatment
- interviews should not solely focus on the physical symptoms, but how mental health or clinical disorder might also affect client
Recognise relationships are central to treatment
Promote self-awareness among clients
Find out about the patient’s history and life circumstances
Decide which aspects of biological, psychological and social domains are most impactful on client’s health
Provide multidimensional treatment
Beyond clinical psychology
Biopsychosocial model of challenge and threat
- used similar approach to describe how we deal with the world around us on the daily basis (e.g. stressors)
BPS model of challenge/threat
Social factors
- features in the environment that promote stress
~ exa
~ interview
~ public speaking
~ social interactions
~ waiting for someone to make up their mind on what kind of cooking oil they want so you can move down the aisle in Tesco
Psychological factors
- how we interpret the situation
- evaluate importance of performance
- determine if we have the ability to succeed
~ if we have confidence in our ability + challenged
~ if we have no confidence in our ability = threatened
Biological factors
- how our body reacts
- cardiovascular system
~ blood flow (cardiac output)
~ blood pressure (peripheral resistance)
