Paper 3: Schizophrenia Flashcards
To discuss psychological explanations of Sz
AO1 (Family dysfunction)
AO1:
Schizophrenogenic mothers. Fromm-Reichmanns’s psychodynamic explanation. Mothers overprotective and rejecting and controlling. = distrust and paranioa. Although the mother seems self-sacrificing she actually uses the child to satisfy her own emotional needs
Double bind theory = Bateson > which suggested that schizophrenia is a reaction to a pathological parent presenting the child with a no win situation. How a child may be regularly trapped in situations where doing wrong thing. Receive conflicting measures of right/wrong i.e. one message contradicts another. Left confused. Can’t express feelings.
Expressed emotions (EE) - negative climate whereby these families 1) talk more and listen less; 2) are over involved; 3) critical and hostile. Leads to arousal and stress. Low tolerance of environmental stimuli and emotional comments/family interactions. Impaired coping mechanisms fail
To discuss psychological explanations of Sz
AO1 (Cognitive explanations)
AO1:
Dysfunctional thought processing = lower levels of info. processing some area of brain suggest cognition is impaired.
e.g. reducing stress in ventral striatum is associated with negative symptoms.
Metarepresentation leads to hallucinations = cognitive ability to reflect on thoughts + behaviour. Difficulty to recognise thoughts as our own. Hallucinations + Delusions.
Dysfunction of central control leads to speech poverty = Sz derailment of thoughts + spoken sentences as each word triggers automatic associations that cannot suppress.
To discuss psychological explanations of Sz
AO3 x2 (Cognitive explanations)
AO3 x1:
P - Evidence suggest info. processed differently in mind for Sz.
E/E - Study compared 30 patients with Sz with 18 controls on range of cognitive tasks including Stroop test. Sz’s took twice as long to name ink colours as control group.
L - Indictaes they were struggling to have central control and suppress automatic associations.
AO3 x2:
One weakness of the cognitive explanation is that there are problems with cause and effect.
E/E- Cognitive approaches do not explain the causes of cognitive deficits i.e. where the dysfunction comes from in the first place. Are the cognitive deficits causing the schizophrenic behaviour or is the schizophrenia the cause of the cognitive deficits? Links between symptoms and faulty cognitions are clear however, it is not possible to know the origin of those cognitions.
L- Therefore it is not possible to be certain that cognitive dysfunctions are the cause of the illness and not just an effect.
Counterargument: however, the cognitive approach has led to real-life applications in the form of treatments. Cognitive-based therapies like CBT are effective in the treatment of Sz. The effectiveness of this approach was shown by a meta-analysis conducted by NICE (2014). They found consistent evidence that when compared with antipsychotic medication, CBT was more effective in reducing symptoms and improving levels of social functioning. The fact that a treatment based on the explanation is effective provides support for the role of cognitions as a cause of schizophrenia.
To discuss drug treatments of Sz
AO1
AO1 (typical drugs):
- Combat positive symptoms.
- Temporarily occupy D2 receptors + rapid dissociating it to allow normal dopamine distribution.
- Cause Tardive dyskinesia (involuntary movement)
AO1 (Atypical drugs):
- Same except
- side effect is agranulocytosis
- Dopamine + serotonin recpetors
- Negative + positive symtoms
- More expensive
- Work on Dopamine system, but also block serotonin and glutamate receptors.
- E.g. Clozapine
To discuss drug treatments of Sz
AO3
AO3 x 1:
P - Drug therapy effective in reducing symptoms of Sz, especially positive.
E/E - cost effective. Normal lives outside institution. less 3% Sz in UK live in hospital due to medication.
L - drug treatment a result for many Sz’s. Allows people to live in a community.
AO3 x 2:
P - Drugs more effective than placebos
E/E - Letch found that patients remained on their antipsychotic medication were only 27% more like to have re-lapse compared to 64%.
L - Shows drugs are effective in preventing relapse
Counter: Ethical problems. If side effects e.g. death and social consequences are taken into account cost benefit approach most likely be negative. e.g. involuntary movement sufferer received large reward in US. Many see widespread use of antipsychotics fuelled by power of drug companies - huge profits.
AO3 x3:
P - Kapur estimate 60-70% D2 receptors be blocked for sufficiency in mesomblic pathway.
E/E - D2 receptors in other parts of brain so they also can be blocked cause side effects e.g. involuntary movements. - patient stop taking medication.
L - Blocking pathways may be harmful for someone
AO3 x4:
P -Atypical antipsychotics tend to not cause the movement problems found with typical antipsychotics
E/E - Lower chances of involuntary movements
Study found 30% patients on typical antipsychotics suffered from involuntary. compared to 5% on atypical.
L - atypical may be more appropriate in treatment on Sz due to fewer side effects.
Counter: Meta-analysis of atypicals, finding only two of atypical drugs were ‘slightly’ more effective than typical.
To discuss CBTp as a treatment of Sz
AO1
AO1:
- CBTp based on assumption that Sz patients can be helped by identifiying and changing their faulty conditions.
- Main psychological treatment used with Sz, Nice (2014) recommends all Sz patients have it.
- Therapy helps to tackle the delusions and hallucinations
- Changes maladaptive thinking and distortive perceptions
AO1:
- Usually takes place every ten days for 12-16 sessions
- Can be in groups but typically one to one
- Offered alternative ways of explaining their symptoms
- Also given ‘homework’
To discuss CBTp as a treatment of Sz
AO3
AO3 x1:
P - Limitation is wide range of techniques and symptoms included in studies
E/E - CBT techniques and Sz symptoms vary widely from one case to another. N. THOMAS POINTS OUT THAT DIFFERENT STUDIES HAVE INVOLVED THE USE OF DIFFERENT CBT TECHNIQUES AND PEOPLE WITH DIFFERENT COMBINATION OF POSITIVE AND NEGATIVE SYMPTOMS. THE OVERALL MODEST BENEFITS OF CBT FOR SZ PROBABLY CONCEAL A WIDE VARIETY OF EFFECTS OF DIFFERENT CBT TECHNIQUES ON DIFFERENT SYMPTOMS.
L - Hard see effectiveness on particular person
AO3 x2:
P - Further strengths of its effectiveness with drugs
E/E - Tarrier, people with Sz receiving 20 sessions of CBT with drug therapy, more significant improvements than sufferers receiving drug. Lower drop out rates with CBT.
L - CBT and drugs together more effective
Counter: Hard to know wether combination of the two things or just CBT. No firm conclusion.
AO3 x3:
P - Strength, fewer side effects in comparison to drug therapy
E/E - sufferers not at risk of other psychical problems like Tardive dyskinesia or diabetes.
L - More expensive treatment In short term, but not in long term
AO3 x4:
P - Research of its effectiveness has been criticised
E/E - Meta analysis of 50 studies of CBT for Sz in last 20 years. Only small therapeutic effect on symptoms.
L - suggests CBT not as effective as orignally thought
Counter: Blind testing not used routinely in the research. Calls into question the research validity.
16 marker on the interactionist approach to Schizophrenia.
AO1 (Diathesis stress model)
- The interactionist approach involves taking into consideration both biological and psychological factors in the development of schizophrenia.
- This approach acknowledges that a range of factors are involved in the illness and encompasses the diathesis- stress model, where it is thought that schizophrenia is caused by a combination of biological and environmental factors. Schizophrenia is seen to be triggered when environmental stress combines with a biological vulnerability.
- The word diathesis means vulnerability, and in this context, stress means psychological experience.
- diathesis-stress model argues that both a vulnerability to schizophrenia (through genetics for example) and a stress trigger (say dysfunctional family dynamics) are
necessary for schizophrenia to develop. - Many factors, such as genetics or biochemistry can make a person vulnerable, but they will not develop schizophrenia without stress.
16 marker on the interactionist approach to Schizophrenia.
AO1 (treatment)
- A wealth of research has been conducted into the efficiency of different treatments for schizophrenia.
- However, some research (Guo et al. 2010) has indicated that combining treatments, both biological and psychological, is more effective.
- However, it is difficult to state which combination is superior as it is affected by each patient’s circumstances and needs.
- e.g. there is little point in combining drugs with family therapy if the patient has little contact with their relatives.
- In Britain, antipsychotic drugs are usually given first to reduce the patient’s symptoms so that any psychological treatment provided, usually in the form of CBT, has a better chance of being engaged with.
- It is unusual for a person with schizophrenia to be offered a psychological therapy alone.
- The USA doesn’t tend to adopt an interactionist approach and instead typically offers medication without any psychological treatments.
- It is rare for either country to offer a psychological treatment like CBT, without the use of medication.
- Turkington et al. (2006) argue that it is possible to think that schizophrenia is caused by biology and still offer a psychological treatment, as in doing so an interactionist approach has been adopted as both the biological and psychological symptoms are being treated.
- However, it makes little sense to argue that schizophrenia is purely biological in origin and that there is no psychological meaning to their symptoms, but then offer a psychological treatment.
- When adopting an interactionist approach to the treatment of schizophrenia, we are acknowledging the influence of diathesis and stress in causing the illness.
16 marker on the interactionist approach to Schizophrenia.
AO3
AO3 x 1:
P- evidence to support
E/E- study found that family history of schiz. pointed to a genetic link. When combined with a dysfunctional family risk of developing schiz. increased. also study positive correlation between birth complications a later risk schiz. due to damage to the hormone + neurotransmitter systems.
L- supports model as increased risk was due to an interaction of genetics + stress from the family dynamic/ later stressors.
Counter: it is not known precisely how risk factors i.e. how biological, environmental, psychological + social factors, contribute to the diathesis-stress interaction, as causes may differ between individual schizs.. approach weakened as do not understand mechanisms which the illness develops + how both vulnerability and stress produce it.
AO3 x 2:
P- original diathesis-stress model is over simplistic.
E- idea that a single gene combined with a certain parenting style causes schiz. too simplistic. Multiple genes found increase the risk of developing. there is no single ‘schizogene’. stress not limited to just parenting style + family dynamics.
E- Houston et al. (2008) found vulnerability not limited to biology. childhood sexual trauma increased the risk of
developing the illness when the patient later used cannabis.
L- proposing that vulnerability + stress have one single cause and that each comes in one form is outdated + over simplistic.
AO3 x3:
P- research evidence that supports treating
E/E- found patients received a combination of
antipsychotics + psychological therapy whilst in the early stages had improved insight + social function. + less likely to relapse compared with patients taking just antipsychotics
L- value of combining biological and psychological treatments.
Counter: combining treatments not always a positive effect. found patients receiving CBT sometimes interpret side effects of their antipsychotic’s in delusional manner. led to them mistrusting + resisting any further treatment, indicating combining treats. cause further problems.
AO3 x4:
P- Combining treatments cost-effective.
E/E- Schiz. often has biological + psychological components. treatment via a combination is desirable. antipsychotics treat the biological, and the psychological treatments tackle the psychological.
L- combining treatments increase the initial cost of treatment, as the effectiveness increases i.e. get better quicker + stay better for longer, combination more cost effective in the long-run.
AO1:
Family therapy as a treatment?
- therapy improves the quality of communication and interaction between members
- Range of approaches in keeping with psychological theories like double-blind and the schitzophreginc mother
- Reduce negative emotions: aims reduce levels of expressed emotion (EE), i.e. reduce level of emotion generally but especially negative emotions e.g. anger and guilt which create stress. Reduce relapse
- Improves the family’s ability to help: therapist encourages members to form therapeutic alliance whereby agree on aims. Tries improve families’ beliefs about + behaviour towards Schitz. Further aim is ensure members achieve balance between caring for indivi with Schitz + maintaining own lives.
- Model of practice: Burbach proposed model. 1.Begins sharing basic info + providing emotional and practical support. Develop through progressively deeper levels. Phase 2 involves identifying resources including diff family members can (cannot) offer. Phase 3 aims encourage mutual understanding. Phase 4 involves identifying unhelpful patters of interaction. Phase 5 skills training e.g. learning stress management. Phase 6 relapse prevention and phase 7 maintenance for future
AO3:
Family therapy x1
There is evidence supporting the effectiveness of family therapy.
E/E- Pharoah et al. (2010) conducted a meta-analysis of 53 studies from Europe, Asia and the USA, to investigate the effectiveness of family therapy. The studies compared
the outcomes from family therapy to ‘standard’ care (e.g. drugs alone). It was found that family therapy increased a patient’s compliance with medication (that is they took their medication more easily and willingly) and there was a reduction in the risk of relapse and hospital admission during treatment and for 24 months after. McFarlane et al. (2003) also conducted a meta- analysis and confirmed that family therapy reduces relapse rates, leads to symptom reduction and improved relationships among family members, which leads to increased well-being for patients.
L-This suggests that the treatment is effective in reducing relapse and for a long time.
Counterargument: However, there is limited control of the extraneous variables, therefore it’s going to be low in internal validity. Experiments looking into the effectiveness of family therapy aren’t reliable, as they can’t be repeated to check for consistency.
AO3:
Family therapy x2
There are further strengths when it comes to Family therapy.
E/E- As well as decreasing relapse rates and lowering the need for hospitalisation, family therapy can educate family members to help manage a patient’s medication regime. This can decrease the need for medical help and therefore makes the treatment cost-effective. Although a combination of drug and family treatments is desirable, due to cost constraints, it is often not possible of offer a combination. Also, The Schizophrenia Commission (2012) estimates that family therapy is cheaper than standard care (drugs alone) by £1,004 a patient over three years, suggesting that it can save money. Furthermore, the extra cost of family therapy is offset by a reduction in costs of hospitalisation because of the lower relapse rates associated with the therapy.
L- This suggests that this treatment appears to be cost effective.
AO3:
Family therapy x3
Some critics of the therapy argue that the nature of the therapy causes problems.
E/E-With the emphasis on ‘openness’, there can be an issue with family members being reluctant to share information, as it may cause or reopen family tensions. Some might not even want to face up to the issues, which lowers the effectiveness of the treatment as without family members being honest and engaging fully, the treatment cannot tackle the faulty family communication.
L- Therefore this suggests that this therapy may not be as effective as initially thought.
AO3:
Family therapy x4
Another limitation of family therapy is evidence proving that it’s not worthwhile.
E/E- A study by Garety failed to show any better outcomes for patients given sessions of family therapy compared to those who simply had carers but no family therapy. Individuals in both groups were found to have unexpectedly low rates of relapse, contrasting markedly with the rates found in the “no carer” group. The researchers found that most of the carers in this study displayed relatively low rates of EE, which may affect widespread cultural changes in carers’ knowledge and attitudes towards Sz.
L- As a result, this evidence suggests that for many people family intervention may not improve outcomes further than a good standard of treatment as usual.
