3 - Schizophrenia

Question 1

Define schizophrenia

Answer 1

A mental disorder characterised by profound disruption of cognition and emotion. It is a type of psychosis in which thoughts and emotions are severely impaired. It affects an individual’s perceptions, emotions, language and sense of self.

Question 2

What is a psychosis?

Answer 2

A severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality

Question 3

What is a positive symptom?

Answer 3

A symptom that adds to everyday experiences. This may be an excess or distortion of normal functions eg: hearing voices, hallucinations, feeling like someone is spying on them.
They can be present without negative symptoms.

Question 4

What is a negative symptom?

Answer 4

A symptom that takes away from everyday experiences. This makes it difficult to carry on with day to day activities.

Question 5

What is a hallucination?
Is it a positive or negative symptom?
Give some examples

Answer 5

An unusual sensory experience that can relate to all senses. This can be linked to what is happening in the environment or completely unrelated. They may distort what is actually there.
Positive symptom.
Eg: warping faces, poster turning to obscenities, jeering voices, smelling gas.

Question 6

What is disorganised speech?
Is it a positive or negative symptom?
Give some examples

Answer 6

Disorganised speech reflects problems in organising thoughts. Derailment is one aspect of this - where a person may shift from topic to topic so that what they are saying doesn’t follow a coherent story.
Positive symptom.
Eg: “red change dog well”

Question 7

What are delusions?
Is it a positive or negative symptom?
Give some examples

Answer 7

Firm but false beliefs that can take many forms.
Positive symptom.
Eg: delusions of grandeur, paranoid delusions, a person may feel chosen to complete a secret mission, government sending messages in the paper, martians are trying to poison water.

Question 8

What is speech poverty?
What is it also known as?
Is it a positive or negative symptom?

Answer 8

Deficits in fluency of spoken language. Fewer words are spoken with less complex grammar. They also reflect blocked thoughts.
Alogia.
Negative symptom.

Question 9

Define avolition
Is it a positive or negative symptom?
Give some examples

Answer 9

Lack of motivation for self-goals/self-directed purposeful activities. Apathy is also a part of this, and can lead to doing nothing for ages.
Negative symptom.
Eg: poor hygiene and grooming, unable to maintain a job or education, constant lack of energy.

Question 10

State the 2 types of classification systems for schizophrenia.
Who published them?
What are their full names?
Where are they used?

Answer 10

DSMV (Diagnostic and Statistical Manual Edition 5).
Published by the American Psychiatric Association.
Used in the USA.

ICDX (International Classification of Disease Edition 10).
Published by the World Health Organisation.
Used in Europe.

Question 11

What are the requirements of the DSM-5 needed to diagnose someone with schizophrenia?

Answer 11

The following 3 categories:
A: symptoms - 2 or more from:
Delusions, disorganised speech, grossly disorganised or catatonic behaviour, hallucinations, negative symptoms eg: avolition, alogia etc.
B: social/occupational dysfunction - problems affecting work, personal relationships or self-care.
C: duration - approx. 6 months of disturbances with at least 1 month of symptoms from category A.

Question 12

How much of the global population are affected by schizophrenia?

Answer 12

Approximately 1%

Question 13

What gender is more commonly diagnosed with schizophrenia?

Answer 13

Men

Question 14

At what age are people commonly diagnosed with schizophrenia?

Answer 14

Late adolescence/early adulthood

Question 15

A good classification system…

Answer 15

Should help professionals to diagnose Sz and suggest treatment to alleviate symptoms

Question 16

If a diagnosis is not reliable…

Answer 16

It can’t be valid

Question 17

Define inter-rather reliability

Answer 17

Consistency between clinicians. Eg: if different clinicians look at the same set of symptoms, they should give the same diagnosis.

Question 18

Define test-retest reliability

Answer 18

Consistency over time. Eg: a person presenting the same set of symptoms should receive the diagnosis on different occasions.

Question 19

State 2 differences between DSM 5 and ICD 10

Answer 19

DSM 5: only 1 symptom needed for diagnosis.
ICD 10: 2 or more symptoms needed for diagnosis.
DSM 5: dropped subtypes of Sz when DSM 5 was published.
ICD 10: recognises subtypes of Sz. Eg: catatonic Sz.

Question 20

List the 3 studies that are evidence for poor reliability in diagnosis of schizophrenia

Answer 20

Rosenhan (‘73): on being sane in insane places
Copeland (‘71): cultural differences - USA and UK
Cheniaux (‘09): diagnosis of 100 patients by 2 psychiatrists

Question 21

Explain the procedure and findings of Rosenhan’s study on being sane in insane places. How did this show poor reliability in diagnosis?

Answer 21

He tested reliability of mental health diagnosis and the effect of labelling diagnoses.
Patients were interviewed and reported symptoms - they were admitted into an asylum but once they were in their symptoms ended.
Findings:
Initial study - no pseudo-patients were suspected by staff. 12 diagnosed with Sz and 1 for manic depression.
Follow up study - all were genuine patients - 193 arrived - 41 rated as pseudo-patients by 2 members of staff. 23 by psychiatrists and 19 by both.

Question 22

Explain the procedure and findings of Copeland’s study on cultural differences. How does this show poor reliability in diagnosis?

Answer 22

It has cultural bias as he only looked at 2 Western societies and ignored all the other non-western societies.
USA and U.K. psychiatrists diagnosed Sz differently to each other.

Question 23

Explain the procedure and findings of Cheniaux et al’s study on diagnosis of 100 patients by 2 psychiatrists. How does this show poor reliability in diagnosis?

Answer 23

2 psychiatrists independently diagnosed 100 patients using DSM and ICD. The inter-roster reliability was poor - 1 psych diagnosed 26 people with Sz (DSM) but another (ICD) diagnosed 22. Then the 2nd DSM psychiatrist diagnosed 13 and the second ICD diagnosed 24.
There is no consistency between classification systems.

Question 24

Evaluate reliability in diagnosis and classification of schizophrenia

Answer 24

• Rosenhan’s study highlighted reliability problems in diagnosis. The study showed there was a lack of consistency in diagnosis. This is because most of the patient who got sent to hospitals didn’t actually have Sz but they still got admitted to the ward. This suggests that there is a lack of reliability in diagnoses. Demonstrates hows people’s expectations alter their diagnosis.
• cultural differences impact reliability (shown by Copeland). C.D also lower reliability of a diagnosis. This questions validity of the concept of Sz as it suggests that the understanding of it is not consistent across different cultures.
• reliability problems in DSM and ICD. Inter-rather reliability. Different psychologists come to different conclusions using the same diagnosis method. Both DSM and ICD have problems diagnosing Sz reliably. But Cheniaux only based this on 2 psychologists.
  + reliability of diagnosis has improved. Critics say we shouldn’t generalise. Research findings may not reflect day to day diagnoses. Inter-rather reliability can be strengthen by using standardised assessment that improves diagnosis reliability. Moore recent studies have shown that the overall concordance rate between diagnosis is improved to 98% according to Jakobsen et al (‘05). The issues may be reducing over time.

Question 25

Reliability is…

Answer 25

Consistency

Question 26

If diagnosis is not reliable, it affects patients because…

Answer 26

They may be diagnosed and ‘labelled’ inaccurately and receive the wrong treatment or none at all.

Question 27

Define validity

Answer 27

A test’s ability to measure what it is supposed to measure.

Question 28

If DSM and ICD are valid systems to classify and diagnose schizophrenia they will… (3 things)

Answer 28

Define symptoms in a way that allows clear and objective diagnosis,
Define schizophrenia in a way that practitioners can use consistently,
Define schizophrenia in a way that makes it distinct from other disorders.

Question 29

If the classification system lacks reliability, how will validity be affected?

Answer 29

A classification system cannot be valid if it is unreliable (a reliable system could still lack validity)

Question 30

State the 4 main issues that affect the validity of DSM and ICD for diagnosis of schizophrenia

Answer 30

Symptom overlap
Co-morbidity
Gender bias
Cultural bias

Question 31

Evaluate the validity of diagnosis and classification of schizophrenia

Answer 31

• symptom overlap - the idea of + and - symptoms was created to make it easier to diagnose Sz. Bipolar and Sz both involved delusions and avolition.
• co-morbidity - the concept that a single person can have more than one disorder at one time. Buckley (‘09) prompted that approx. Half of patients with Sz had depression or substance abuse. This is evidence for either the idea of co-morbidity of that one disorder instigates another. This decreases validity as it creates obscurities in diagnosis.
• cultural bias - people of African origin are more diagnosed - in tribes it’s praised to hear voices (symptom of Sz). When they come to the West these “blessings” are diagnosed.
• gender bias - Since 1980, more men have been diagnosed. Could be because we’re genetically vulnerable, or Cotton et al (‘09) found that female patients typically function better, more likely to work, have family relationships. Could explain why less have been diagnosed.

Question 32

State the 3 studies that act as evidence that support a genetic influence on schizophrenia

Answer 32

Gottesman (1991) - family studies
Tiernari et al (200) - adoption studies in Finland
Ripke et al (2014) - Sz is polygenic

Question 33

Explain Gottesman’s study about genetic influence on schizophrenia

Answer 33

Family study: He found that as genetic similarity increases, so does the probability of sharing schizophrenia. This shows how genetic similarity and shared risk of schizophrenia are closely related.

Question 34

Explain Tienari et al’s study about genetic influence on schizophrenia

Answer 34

Adoption study in Finland: Children of schizophrenia sufferers still at heightened risk of schizophrenia if adopted into families with no history of schizophrenia. 164 adoptees who’s biological mothers had schizophrenia, and 197 without (control group). 11 adoptees (6.7%) developed schizophrenia compared to 4 (2%) from control group.

Question 35

Explain Ripke et al’s study about genetic influence on schizophrenia

Answer 35

Schizophrenia is polygenic: huge study combing all previous data from genome wide studies.
Genetic makeup of 37,000 patients compared to 113,000 countries.
108 separate genetic variations associated with increased risk of schizophrenia.

Question 36

Evaluate the genetic approach to explaining schizophrenia

Answer 36

+ multiple sources of evidence for genetic vulnerability (Gottesman, Tierani et al, Ripke et al).
+ positive correlation between paternal age and schizophrenia. Brown supports existence of genetics.
- psychological environment eg: stressful upbringing suggests biological explanations isn’t complete.
- Joseph (2014) said they stick schizophrenia orphans in selective places. This is contrary to popular beliefs that they aren’t selectively placed. But if foster families knew this, they wouldn’t want an Sz child.

Question 37

What is dopamine?

Answer 37

A neurotransmitter involved in several brain systems. It appears to be involved in schizophrenia. It has been suggested that both too little or too much dopamine might be associated with symptoms of schizophrenia and that this may depend on the area or the brain involved.

Question 38

Define hyperdopaminergia and hypodoperminergia.

Which is the original hypothesis and which is the more recent?

Answer 38

Hyperdopaminergia - concerns high levels of dopamine activity - original
Hypodoperminergia - concerns low levels of dopamine activity - more recent

Question 39

What area of the brain is involved, and what is the function in:
The original version of the dopamine hypothesis,
The more recent version of the dopamine hypothesis.

Answer 39

Original - subcortex/central areas. Eg: Broca’s area - brain function.
Recent - prefrontal cortex - thinking and decision making.

Question 40

What symptoms of schizophrenia may be involved in:
The original version of the dopamine hypothesis,
The more recent version of the dopamine hypothesis.

Answer 40

Original - poverty of speech or auditory hallucinations.

Recent - negative symptoms.

Question 41

State and explain the 2 dopamine pathways in the brain

Answer 41

Mesolimbic pathway - over activity and dopamine excess is associated with positive symptoms.
Mesocortical pathway - dopamine deficit is associated with negative symptoms.

Question 42

Evaluate the dopamine hypothesis and neural correlates of schizophrenia

Answer 42

+ research has shown that drugs increase levels of dopamine. Eg: amphetamines produce psychotic (schizophrenic symptoms). It shows dopamine charges lead to schizophrenia.
+ clozapine is the most effective drug at reducing schizophrenic symptoms. It acts on serotonin as well as dopamine. It shows that a drug can help lower the levels of dopamine in a person and this can help lower the levels of dopamine and this can help lower the strength of the symptoms a sufferer is going through.
- high levels of dopamine could actually be a symptom of schizophrenia. We don’t know if it’s cause or effect.
- an excess number of dopamine receptors have been found in Broca’s area which is linked to speech production and auditory hallucinations. This contradicts ideas that it aids brain function, acting as mixed evidence.

Question 43

What are neural correlates of schizophrenia?

Answer 43

Measurements of the brain that link/correlate with symptoms of schizophrenia. There are correlates for positive and negative symptoms and we can study them using brain imaging techniques such as fMRI and EEG scans.

Question 44

Neural correlates of negative symptoms of schizophrenia;
What part(s) of the brain is involved?
What symptoms are associated with this?
Explain the research involved in this - is the higher or lower levels of activity in the area(s) compared to controls?

Answer 44

The ventral system
Avolition and loss of motivation
Juckel et al (2006) - negative correlation between activity levels and severity of overall symptoms. Lower levels of activity were found in this area compared to controls.

Question 45

Neural correlates of positive symptoms of schizophrenia;
What part(s) of the brain is involved?
What symptoms are associated with this?
Explain the research involved in this - is the higher or lower levels of activity in the area(s) compared to controls?

Answer 45

Superior temporal gyrus and the anterior cingulate gyrus
Auditory hallucinations
Allen et al (2007) participants had to identify whether speech was there own or someone else’s. Lower levels of activity were found in these areas compared to controls.

Question 46

What is the prefrontal cortex’s function and role in schizophrenia?

Answer 46

Helps logical thinking and organisation thoughts.
Many people with schizophrenia have lower activity in this area which could be linked to delusions and disorganised thoughts.

Question 47

What are the visual cortex and auditory cortex’s functions and roles in schizophrenia?

Answer 47

Processes information received from the eyes and ears.
Schizophrenics have the same activity in these areas when they hallucinate as sane people do when they have genuine visual and auditory experiences.

Question 48

What is the basal ganglia’s function and role in schizophrenia?

Answer 48

Located deep inside the brain and affects movement and thinking skills.
Research has shown that this structure is larger in schizophrenics which could cause motor damage.

Question 49

What is the amygdala’s function and role in schizophrenia?

Answer 49

Responsible for basic feelings such as fear, lust and hunger.
This area is smaller in schizophrenics so can link to loss of emotion (affective flattening).

Question 50

Define affective flattening

Answer 50

Loss of emotion

Question 51

What is dopamine’s function and role in schizophrenia?

Answer 51

Responsible for feelings of pleasure and also affects thinking and movement.
Low levels in certain brain areas are linked to negative symptoms and a loss of pressure. High levels have also been linked to positive symptoms.

Question 52

1 positive evaluation point and 1 negative evaluation point for neural correlates of schizophrenia

Answer 52

+ there’s a range of supportive evidence. Goldman-Rakilc et al. found a role for low levels of dopamine in the prefrontal cortex. This shows supporting evidence that increases validity.
- the correlation-causation problem. We have no way of knowing neural correlates are correlation or causation. Eg: the correlation between levels of activity in the ventral striatum and negative symptoms of schizophrenia. Or there’s a 3rd factor involved. This reduces external validity.

Question 53

What is the biological treatment for schizophrenia?

Answer 53

Drug treatment

Question 54

The broad name for the type of drug used to treat symptoms of schizophrenia is…

Answer 54

Anti-psychotic

Question 55

What receptors in the brain do drugs affect?

Answer 55

Dopamine receptors

Question 56

What are the 2 types of anti-psychotics?

Answer 56

Typical anti-psychotics

Atypical anti-psychotics

Question 57

What are the example of a typical anti-psychotics and 2 examples of atypical anti-psychotics?

Answer 57

Chlorpromazine

Clozapine, risperidone

Question 58

Chlorpromazine:
Date use began
Form available
Dosage
Mode of action, are other neurotransmitters affected?
Symptoms treated and beneficial effects
Side effects

Answer 58

1950s
Tablets, syrup and injection. Syrup is quicker than tablets for sedative effects
400-800mg
Reduces dopamine levels, binds to dopamine receptors, no other neurotransmitters affected
Schizophrenia and bipolar symptoms, also acts as a sedative
Dry mouth, constipation, weight gain

Question 59

Clozapine:
Date use began
Form available
Dosage
Mode of action, are other neurotransmitters affected?
Symptoms treated and beneficial effects
Side effects

Answer 59

1970s
Tablet
450mg
Binds to dopamine, serotonin and glutamate receptors
Schizophrenic symptoms, improves mood, reduces depression. 30-50% of schizophrenics attempt suicide. This helps.
Constipation, muscle shrinkage, weight gain

Question 60

Risperidone:
Date use began
Form available
Dosage
Mode of action, are other neurotransmitters affected?
Symptoms treated and beneficial effects
Side effects

Answer 60

1990s
All 3
4-8mg
Binds to dopamine and serotonin receptors. More effective in smaller doses.
Schizophrenic, bipolar and autism symptoms.
Struggle to move, dizziness, other symptoms typical for anti-psychotic side effects.

Question 61

Explain evidence for effectiveness of typical antipsychotics in drug therapy for schizophrenia

Answer 61

Thornley et al (2003) reviewed chlorpromazine research. He examined effect of chlorpromazine by making comparisons to controls who received a placebo. 13 trials - 1121 participants showed the drug was associated with reduced severity of symptoms and better overall functioning. Chlorpromazine was also associated with a lower relapse rate.

Question 62

Explain evidence for effectiveness of atypical antipsychotics in drug therapy for schizophrenia

Answer 62

Meltzer (2012) concluded that clozapine was:
More effective than both typical antipsychotics and other artpical antipsychotics.
Effective in 30-50% of treatment resistant cases where typical antipsychotics have been ineffective.

Question 63

Evaluate drug therapy for schizophrenia

Answer 63

+ effective in reducing symptoms of Sz. Thornley’s research in typical anti-psychotics showed that the drug leads to better overall functions compared to a placebo. Meltzer’s research showed that chlorpromazine is 30-50% more effective than other drugs. People can be treated as outpatients not in hospitals, app.

• methodological problems with research into effectiveness. Healy showed that positive effects may be been exaggerated coz the data was published multiple times he also said studies that show neg symptoms weren’t always published. He also highlighted design flaws in research, meaning doctors don’t get a full picture of the drugs they prescribe, app.
• side effects (name some). Neuroplatic malignant syndrome can be fatal, ethics.
• ethics. Moritz et al (2013) used patient self-report to conclude that drugs dampened emotions, not treating symptoms. Chemical cosh. Human rights abuse.

Question 64

What is the chemical cosh argument?

Answer 64

Where the drugs are frequently used to make life easier to work with patients and not to ease symptoms

Question 65

State the 3 key features of family dysfunction as a psychological explanation of schizophrenia

Answer 65

Schizophrenogenic mother
Double-binds
Expressed emotion

Question 66

Explain what Fromm-Reichmann did (1948)

Answer 66

Looked at the backgrounds and childhood of her patients using a psychodynamic perspective. She found that patients experiencing symptoms of schizophrenia often had what she called ‘schizophrenogenic’ mothers.

Question 67

Define schizophrenogenic

Answer 67

Causes schizophrenia

Question 68

State 3 characteristics of a schizophrenogenic mother

Answer 68

Cold, rejecting and controlling

Question 69

Explain how schizophrenogenia can cause schizophrenia

Answer 69

Typical family climate characteristics include tension and secrecy.
This leads to distrust which develops into paranoid delusions, causing schizophrenia.

Question 70

What did Bateson do in 1956?

Answer 70

Emphasised the role of communication style within the family. He outlined the double-bind communication as a risk factor in schizophrenia - he was clear this wasn’t the only communication style in families where someone experiences symptoms of schizophrenia.

Question 71

Explain how the double-bind works

Answer 71

The type of communication the child receives mixed messages - this is a risk factor. The child’s feels fear of doing the wrong thing and feel unable to comment on the situation or ask for clarification. If the child gets it wrong, the child is punished by withdrawal of love. Associated symptoms of schizophrenia include feeling the world is confusing and dangerous, they may show disorganised thinking and paranoid delusions.

Question 72

Who came up with 2 key types of double bind communication between parents which could influence a child developing schizophrenia?
What are they?

Answer 72

Lidz (1973)
Marital schism
Marital skew

Question 73

What is a marital schism?

Answer 73

Where parents are emotionally distant, neither mother or father compromise, may be for children’s attention

Question 74

What is a marital skew?

Answer 74

Where one apprentice is dominant and the other is submissive and yielding to over-bearing dominance of the other.

Question 75

Define expressed emotion

Answer 75

EE refers to the level of emotion shown to a patient by their carers. This explanation suggests that high levels of negative expressed emotion act as a source of stress for patients.

Question 76

Summarise the key aspects of negative expressed emotion

Answer 76

Verbal criticism, sometimes with verbal hostility towards the patient, including anger and rejection.
Emotional over-involvement including needless self sacrifice.

Question 77

What is the expressed emotion explanation mainly used to explain in regard to schizophrenia?

Answer 77

Relapse of schizophrenia

Question 78

Explain how expressed emotion can be used to explain onset of symptoms of schizophrenia

Answer 78

It might explain onset because the source of stress can act as a trigger to someone who has a genetic vulnerability

Question 79

Evaluate family dysfunction as a psychological explanation of schizophrenia

Answer 79

+ research support - Read et al (2005) reviewed 46 studies of child abuse and schizophrenia. 69% of women and 59% of men with schizophrenia has physical or emotional trauma/abuse in childhood. Berry et al (2008) found that adults with insecure attachments to primary carers are mor likely to have schizophrenia. Reliability.

• lack of evidence. There’s lots of evidence to support broad principle, but not double bind or Szg mother. Both theories are based on clinical observation of patients and assessing personalities of mothers of patients for ‘crazy-making characteristics.’ Not approved by modern psychologists. Also, it naturally blames parents who are already suffering schizophrenic children. Ethics.
• independent differences in EE vulnerability - not all patients in high EE families relapse and visa versa. Altorfer et al (1998) found that 25% patients studied showed no psychological responses to stressful comments from relatives. Vulnerability to EE influences could be psychological. Lebell et al (1993) suggests that how patients appraise relative behaviour is important where it’s not perceived as negative/stressful, they can prosper. Reliability.
• no consideration for biology - bio and psych factors can separately produce the same symptoms. Are both outcomes really Sz? Although they can be viewed in terms of diathesis stress model - diathesis may be biological or psychological. Internal validity.

Question 80

What does the cognitive explanation of schizophrenia focus on?

Answer 80

The role of mental processes

Question 81

What is the ventral striatum’s role in the cognitive explanation of schizophrenia?

Answer 81

Reduced processing of this is associated with negative symptoms

Question 82

What are the temporal gyrus and cingulate gyrus’ roles in the cognitive explanation of schizophrenia?

Answer 82

Reduced processing of information in these areas are associated with hallucinations. This suggests cognition is impaired.

Question 83

What is the cognitive explanation of schizophrenia characterised by?

Answer 83

Disruption to normal processing and abnormal information processing

Question 84

State the 2 kinds of dysfunctional thought processing that could underlie some symptoms
Who theorised this?

Answer 84

Central control
Metarepresentation
Frith et al (1992)

Question 85

What is central control?

How is a kind of dysfunctional thought processing that could underlie some symptoms?

Answer 85

The cognitive ability to suppress automatic responses while we perform deliberate actions instead.
Disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts.

Question 86

What is metarepresentation?

How is it a kind of dysfunctional thought processing that could underlie some symptoms?

Answer 86

The cognitive ability to reflect on thoughts and behaviour.
This allows us insight into our own intentions and goals. Dysfunction in this would disrupt ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else. This would explain voice hallucinations and thought insertion (a type of delusion).

Question 87

Evaluate cognitive explanations of schizophrenia

Answer 87

+ Stirling et al (2006) found that info processing is different in Szs. He used the stroop test on 30 Szs and 18 controls. Szs took over twice as long. Reliability.
- biological and cofnivite explanation have been able to explain the same symptoms. Reliability
- only explains one aspect of the disorder (cognitive impairment) but no neurochemical changes. External validity
+ Sz symptoms include +ve symptoms associated with the mind (delusions and hallucinations). Reliability

Question 88

Define family therapy

Answer 88

Based on the family dysfunction of schizophrenia, this therapy works on the basis that certain factors lead to symptoms of schizophrenia eg: double bind communication and negative expressed emotion.

Question 89

What are the broad aims of family therapy?

How long does it last?

Answer 89

To involve families.
To improve quality of communication and interaction between family members.
To reduce stress that might add to risk of relapse and reduce levels of negative expressed emotion.
Duration: 3-12 months (minimum 10 sessions).

Question 90

State the 6 strategies used by family therapists.

Who developed these?

Answer 90

Pharaoh et al (2010).
1 - psychoeducation - helping the person and their careers to understand and be better able to deal with the illness.
2 - forming an alliance with relatives who care for the person with Sz.
3 - enhancing relatives’ ability to anticipate and solve problems.
4 - reducing expressions of anger and guilt by family members.
5 - maintains reasonable expectations among family members for patient performance.
6 - encouraging relatives to set appropriate limits whilst maintaining some degree of separation when needed.

Question 91

Explain Pharoah et Al’s meta-analysis:
How many studies?
Date?
From where?
What did it include?

Answer 91

53 studies of family therapy from 2002-2010 from Europe, Asia and North America.
He had measures of effectiveness and found the effect of family therapy on it compared to standard therapy.
Mental state - overall impression was mixed. Some reported improvement in overall mental state compared to those receiving standard care.
Compliance with medication - family interventions increased patients’ compliance.
Social functioning - general improvement, not much evidence of increased independent living or employment.
Relapse and re-admission - reduction in this in hospital during treatment and in the first 24 months after.

Question 92

What are the methodological problems with Pharoah et al’s study?

Answer 92

Lack of random allocation in China.
Wu et al suggest random allocation was not used.
Possible observer bias.
There were studies where no “blinding” was used to prevent observers knowing which condition participants were in.

Question 93

What did Gareth et al (2008) suggest?

Answer 93

That relapse rates of schizophrenics sit at approximately 25% when engaging in family therapy to reduce expressed emotion. This is compared to 50% relapse in those receiving standard care alone.

Question 94

What did the NICE review of family intervention studied (2009) show?

Answer 94

That use of therapies is associated with significant cost savings when offered to people in addition to standard care

Question 95

Evaluate family therapy; is this point related to effectiveness or appropriateness?

Answer 95

+ increased compliance and reduced relapse - E
+ economic benefits NICE review 2009 showed cost savings when people received family therapy in addiction to standard care eg: lower hospital costs - A
+ Reduced stress also benefits other family members - A
+ ethical problems are reduced as families work together rather than therapist controlling situations - A
- methodological problems make it difficult to assess effectiveness of family therapy eg: how do you separate effects of other therapies? How long do the benefits last? Further follow up research is needed - E
- family therapy cannot claim to ‘cure’ Sz symptoms - E

Question 96

CBT stands for…
It was created by… who suggest…
The aim of it is…
This often involves…

Answer 96

Cognitive Behavioural Therapy
It was created by Beck who suggested that psychopathological conditions were a result of faulty thinking and irrational beliefs.
The aim of it is to identify the negative/irrational thoughts and then discuss them.
This often involves argument or discussion, and then the therapist helps the patient to consider realistic alternatives to their faulty beliefs.

Question 97

How does CBT work for schizophrenia?

Answer 97

Symptoms of schizophrenia addressed by CBT - irrational thoughts eg: delusions and hallucinations.
Role of therapist - help identify and change irrational thoughts through argument and discussion. Helps patient develop alternative beliefs and coping strategies. Helps reduce hallucinations and delusions. This reduces anxiety and distress.

Question 98

Explain the 3 key research studies of CBT

Answer 98

Tarkington et al (2004) - CBT has good effect on positive and negative symptoms of schizophrenia. Some aspects can be delivered by nurses in brief intervention programmes.
Jauhar (2014) - meta-analysis of 34 studies. CBT had a small but significant effect on positive and negative symptoms.
NICE (2014) (National Institute for Clinical Excellence) - CBT:
Was more effective than just medication,
Helped improve social functioning compared to people receiving standard care,
Reduces rehospitalisation for up to 18 months after ending treatment,
Can be effective when combined with medication.

Question 99

Evaluate CBT for schizophrenia

Answer 99

+ Jauhar et al reviewed 34 CBT studies and concluded that CBT has a significant but fairly small effect on both positive and negative symptoms - effectiveness.
- Only 1 in 10 in the UK benefit. Haddock et al (2013) in N.W. England - 187 randomly selected Szs, only 131 (6.9%) had been offered it. Freeman et al (2013) of those offered CBT, significant refuse/fail to attend therapy sessions.
+ comparison with drug treatment - CBT aims to make Sz more manageable and improve quality of life. However, there are problems separating effect of CBT and medication.
+ improving quality of life - patient has more active role in recovery. a CBT helps patients to manage and make more sense of their symptoms. Doesn’t cure Sz. This shows that CBT is appropriate, particularly when compared to side effect of drugs.
- challenging a person’s paranoia interferes with someone’s freedom of thought. Eg: challenging a patients’ belief in a highly controlling government, they can easily stray into modifying their politics.
- problems with meta-analyses - don’t account for study quality. Some studies don’t have random allocation or a control group. Juni et al (2001) said it leads to biased findings. Wykes et al (2008) found that more rigorous the study, the weaker CBT effect.

Question 100

What are token economies?

Answer 100

Systems used to manager rather than treat some symptoms of schizophrenia. They are based on behaviourist principles or operant conditioning.

Question 101

Give an overview of token economies. Include:
Setting,
Maladaptive behaviour developed,
Intended outcome/benefit.

Answer 101

Psychiatric hospitals, where patients have become institutionalised.
Not getting dressed, poor hygiene, social withdrawal, independence.
Improved quality of life, increased likelihood of living outside hospital setting.

Question 102

Evaluate token economies for schizophrenia

Answer 102

+ effectiveness - Dickerson et al (2005) reviewed 13 studies - 11 reported beneficial effects (but methodological drawbacks were noted) - application
+ appropriateness - patients’ behaviour becomes more socially acceptable promoting reintegration into society. Suitable for use in institutions - ethics, application
- effectiveness - McMonagle and Sultana (2009) could only find 3 studies with random allocation of patients to treatment and control GP’s. Only 1 study showed any improvement, and none gave any useful information about re-behaviour
- appropriateness - ethics. Clinicians may exercise control over Szs. However they stick to basic human rights that can’t be violated.

Question 103

What is the interactionist approach?

What is it also known as?

Answer 103

The bio-social approach
A broad approach to explaining schizophrenia which acknowledges a range of factors including biological and psychological factors that are involved in the illness.

Question 104

Give examples of biological factors in the interactionist approach

Answer 104

Genetic vulnerability, neurochemical and neurological abnormality

Question 105

Give examples of psychological factors in the interactionist approach

Answer 105

Stress from life events and daily hassles

Question 106

Give examples of societal factors in the interactionist approach

Answer 106

Eg: urbanisation

Question 107

Define diathesis

Answer 107

Vulnerability

Question 108

What does the diathesis-stress model attempt to explain?

Answer 108

How factors might interact to develop schizophrenia

Question 109

Define stress

Answer 109

Significant stressors

Question 110

Explain the original diathesis-stress explanation of schizophrenia.
When was it made?
Who made it?
Include the role of genetics and examples of important stressors.

Answer 110

Paul Meehl (1962) said that schizophrenia is entirely genetic - there is one schizogene. This led to the schizotypic personality. One of the characteristics is sensitivity to stress. Meehl: “if they don’t have the schizogene, no amount of stress can cause schizophrenia.”
Examples of important stressors: schizophrenogenic mother, chronic stress through childhood and adolescence.

Question 111

Explain the modern understanding of the diathesis-stress explanation of schizophrenia. Include:
The role of genetics,
Other vulnerabilities,
Psychological stressors,
Other stressors,
The role of cannabis.

Answer 111

Ripke et al (2014): there is no single schizogene. Schizophrenia is polygenic.
Ingram and Luxton (2005): range of factors include psychological trauma. Trauma becomes the diathesis, not the stressor.
Read et al (2001): proposed a neurodevelopmental model - early trauma alters brain development eg: child abuse can make the hypothalamic-pituitary-adrenal (HPA) system become over-active, which makes them more vulnerable to stress in later life.
Psychological stressors: anything that risks triggering schizophrenia.
Other stressors: Houston et al (2008): modern stress is anything that risks triggering schizophrenia.
Role of cannabis: it’s a stressor that increases Sz risk X7. It interferes with the dopamine system but people don’t develop it straight from cannabis so other vulnerability factors must be involved.

Question 112

Explain Tienari et al’s study as evidence to support the diathesis-stress explanation of schizophrenia. Include:
Date,
Aim,
Sample,
Method,
Findings,
Conclusions.

Answer 112

2004 - to investigate the role of genetic vulnerability and parenting style (as a trigger)
Sample: children adopted from 19,000 Finnish mothers with schizophrenia between 1960 and 1979.
Method: they assessed adoptive parents’ child rearing style then looked at children’s rates of schizophrenia and compared this to a control group of adoptees who had no genetic risk of schizophrenia.
Findings: in the group of adoptees with high genetic risk of Sz, parenting style was implicated in development of Sz. The parenting style implicated was characterised by high levels of criticism and conflict, and low levels of empathy. This was not the case for the control group with no genetic risk of developing Sz.
Conclusion: evidence suggests that genetic vulnerability and family related stress (triggers) are involved in development of Sz. Genetically vulnerable children appear more sensitive to parenting behaviour.

Question 113

State the 2 typical types of treatment used in the U.K. and the typical types of treatment used in the U.S.A. when using the interactionist approach to explaining schizophrenia

Answer 113

U.K: Anti-psychotic drugs, CBT

U.S.A: Anti-psychotic drugs and a psychological therapy eg: family therapy, CBT, token economies

Question 114

The interactionist approach to treatment in the U.S.A. differs to the U.K. in that…

Answer 114

Medication without psychological therapy is more common in America. This is because there has been greater conflict between biological and psychological approaches to treatment of schizophrenia in America. As a result, the system in America has been slower to adopt an interactionist approach.

Question 115

Evaluate the interactionist approach to schizophrenia

Answer 115

+ supporting evidence - Tienari et al study - reliability
+ evidence through treatment - Turkington et al (2006): it is not really possible to use a combo of treatments without adopting an interactionist approach. Studies show an advantage of using a combo. Tarrier et al study - reliability.
- difficulties in determining casual stress - debate over whether stress is close to Sz onset or early life. Hammen (1992): maladaptive methods of coping with childhood stress causes impaired development - they fail to develop effective coping skills. This compromises resilience and increase vulnerability - validity.
- the original diathesis-stress model is oversimplified - multiple genes increase vulnerability to Sz. There’s no schizogene. Stress can come in many forms, therefore vulnerability and stress don’t have 1 single source.

Question 116

Explain Terrier et al’s study

Answer 116

2004
315 patients were randomly allocated to a group:
Meds and CBT, meds and supportive counselling, just meds (control). Patients in combo groups showed lower symptom levels than those in control. Although, there was no difference found in hospital readmission rates.