Sz studies

Question 1

What study would you use to evaluate typical antipsychotics?

Answer 1

Adams et al (2012)

Question 2

What did Adams et al (2012) do?

Answer 2

Cochrane review of 50 high quality randomly controlled trials found that chlorpromazine was more effective than a placebo

Question 3

For what percentage of patients are typical antipsychotics effective?

Answer 3

60%

Question 4

What percentage of typical antipsychotics users suffer from tardive dyskinesia as a side effect?

Answer 4

20%

Question 5

50% of typical antipsychotics users suffer from what side effects?

Answer 5

Weight gain and sexual dysfunction

Question 6

What study would you use to evaluate atypical antipsychotics?

Answer 6

Essali et al (2009)

Question 7

What did Essali et al (2009) do?

Answer 7

Cochrane review of RCTs found that clozapine led to fewer relapses and greater improvement in functioning and negative symptoms than typicals, and 34% of those who were not improved by typicals were improved by clozapine

Question 8

What is the main reason why atypicals are more appropriate than typicals?

Answer 8

They have fewer side effects

Question 9

What is ECT used for?

Answer 9

Catatonic, suicidal or pregnant patients

Question 10

What 2 studies would you use to evaluate ECT?

Answer 10

Tharyan and Adams (2009)

Greenhalgh et al (2005)

Question 11

What did Tharyan and Adams (2009) do?

Answer 11

Cochrane review of 26 RCTs found that ECT led to fewer relapses in the short term but not the long term

Question 12

What did Greenhalgh et al (2005) find?

Answer 12

No evidence supporting the use of ECT on catatonic patients

Question 13

What 3 issues undermine the appropriateness of ECT?

Answer 13

short term memory loss, historic breaking of bones (procedure has now improved to stop this) and the issue of consent

Question 14

What proportion of patients are resistant to all drugs?

Answer 14

1/4

Question 15

What did Cheniaux (2009) find?

Answer 15

34% diagnosis rate using ICD, >20% diagnosis rate with DCM

Question 16

What did Mojtabi and Nicholson (1995) find?

Answer 16

0.4 inter-rater reliability in whether or not a hallucination was bizarre - suggests open to interpretation

Question 17

What study would you use to back up Kleitman’s threat of procedure?

Answer 17

Cheniaux (2009)

Question 18

What study would you use to back up Kleitman’s threat of clinician?

Answer 18

Mojtabi and Nicholson (1995)

Question 19

What percentage agreement did Beck find between doctors in 1957?

Answer 19

54%

Question 20

What study would you use to show poor historic reliability of diagnosis?

Answer 20

Beck (1957)

Question 21

What study would you use to show improvements in reliability of diagnosis?

Answer 21

DSM III tests in the 1980s

Question 22

What did tests of DSM III in the 1980s find?

Answer 22

81% consistency

Question 23

What did they do to DSM to improve reliability?

Answer 23

Removed vague definitions and clarified number of symptoms needed for diagnosis

Question 24

What 3 studies would you use to evaluate family intervention?

Answer 24

NICE, Leff et al (1982), Pharoah et al (2012)

Question 25

What did the NICE study into family intervention find?

Answer 25

Relapse rates were 26% in therapy condition and 50% in control condition

Question 26

What did Leff et al (1982) find?

Answer 26

reduction of relapse rate from 78% to 14%

Question 27

What did Pharoah et al (2012) find?

Answer 27

Family intervention led to fewer hospital admissions, less relapse and better compliance with medication

Question 28

What study would you use to evaluate how far the effectiveness of family intervention has been shown to be valid?

Answer 28

Wu et al (2009)

Question 29

What did Wu et al (2009) find?

Answer 29

In interviews, only 10% of the studies seemed to use proper random allocation in interviews

Question 30

What study would you use to evaluate the appropriateness of family intervention?

Answer 30

McCreadie et al (1991)

Question 31

What did McCreadie et al (1991) find about family intervention?

Answer 31

Of those who were invited to therapy, 1/2 agreed. | Of those who agreed, 1/2 turned up

Question 32

What two things would you use to evaluate the effectiveness of CBT?

Answer 32

the fact that it's recommended by NICE as primary psychological treatment and Jones et al (2012)

Question 33

What did Jones et al (2012) find?

Answer 33

Cochrane review of RCTs found that CBT is no better than any other psychological treatment

Question 34

What would you use to assess appropriateness of CBT?

Answer 34

Lower cost, quick progress, no side effects (less dependency on therapist than other psychological therapies)

Question 35

What studies would you use to evaluate genetics?

Answer 35

Gottesman et al (1991) and adoption studies

Question 36

What did adoption studies in to Schizophrenia find?

Answer 36

0% development of Sz in adopted children whose biological mothers did not have the disorder 10% development of Sz in adopted children whose biological mothers DID have the disorder

Question 37

What did Gottesman et al (1991) find?

Answer 37

40% concordance rate in MZ twins | 15% concordance rate in DZ twins

Question 38

What is the problem with twin studies?

Answer 38

They work on the assumption that DZ and MZ twins share equal environments- but some research has shown that MZ twins share a more similar environment than DZ twins

Question 39

Gottesman et al (1991) didn't find 100% concordance with Mz twins. What does this show about the causation of Sz?

Answer 39

It cannot be fully genetic- there must be other factors

Question 40

What evidence supports the Final Common Pathway model?

Answer 40

Howes and Kapur (2012)

Question 41

What did Howes and Kapur (2012) do and find?

Answer 41

A meta analysis of brain scans showed that pre-synaptic dopamine dysfunction was common in Sz patients, and more prominent than other types of dopamine dysfunction

Question 42

What 3 facts undermine the involvement of dopamine in Sz?

Answer 42

Not all users of L Dopa and amphetamines develop the disorder, drugs that target dopamine are not effective on all Sz patients (1/4 are resistant) and dopamine is not involved in negative effects

Question 43

What studies would you use to evaluate Expressed emotion as an explanation for Schizophrenia?

Answer 43

Butzlaff et al (1989) and Vaughn and Leff (1976)

Question 44

What did Butzlaff et al (1989) do and find?

Answer 44

A Meta analysis of 27 studies found that there was a 65% relapse rate in homes with high expressed emotion and a 35% relapse rate in homes with low expressed emotion

Question 45

What did Vaughn and Leff (1976) find?

Answer 45

51% relapse rate in homes with high expressed emotion, 13% relapse rate in homes with low expressed emotion Face to face contact with relative correlated with relapse risk

Question 46

What is the problem when deliberating EE as an explanation?

Answer 46

Correlational research gives rise to ambiguous direction of causality- for example King found that EE can be a response to worsening symptoms instead of a cause

Question 47

What's the issue with using family intervention therapy studies as support for EE as an explanation for schizophrenia?

Answer 47

The use dubious random allocation and therefore their validity cannot be trusted

Question 48

What studies would you use to evaluate stressful life events as an explanation for schizophrenia?

Answer 48

Norman and Malla, Day's cross-cultural study and Ventura et al

Question 49

What did Norman and Malla find?

Answer 49

Correlation between symptom severity and stressful life events over time

Question 50

What did Day's cross cultural study find?

Answer 50

Results from America, Africa, Asia and Europe showed higher rates of stressful events in the 2 to 3 weeks preceding onset of schizophrenia BUT retrospective- what direction of causality? Sz causes stress?

Question 51

What did Ventura et al find?

Answer 51

This was a prospective study into the influence of stressful life events. It found that they preceded the onset of symptoms! but a tiny sample of just 20 participants

Question 52

What was the problem with Ventura et al as a study?

Answer 52

Only 20 participants