Paper 3 Schizophrenia

Question 1

What is a hallucination with an example? (Positive symptom)

Answer 1

Seeing,hearing or feeling something that isn’t there

Eg. Hearing voices

Question 2

What are delusions with an example? (Positive symptom)

Answer 2

Believing that you’re something that you aren’t

Eg. Believing you’re jesus

Question 3

What is meant by speech poverty with an example? (Negative symptom)

Answer 3

Lessening speech fluency in that there is a reduction in communication involving fewer word/sentences and not continuing a communication
Eg. “How did you feel about that” - “bad”

Question 4

What is meant by avolition with an example? (Negative symptom)

Answer 4

Reduction or inability take part in goal directed behaviour. You no longer take part in something you would normally do
Eg. Withdraw from socialising with friends, no longer go the pub

Question 5

What is catatonic behaviour?

Answer 5

Either excess mobility or a reduction in mobility such as emotional blunting such as minimal reaction

Question 6

Define dysfunctional thought processing?

Answer 6

Cognitive habits or beliefs that cause the individual to analyse/evaluate information inappropriately. It can lead to faulty schemas and thinking abnormality which can lead to a moral behaviour

Question 7

what are 3 examples of positive symptoms (type 1)?

Answer 7

hallucinations- seeing, hearing or feeling something that isn’t there eg. hearing voices
delusions- believing you’re something that you’re not/more than what you are eg. Jesus
catatonic behaviour- excess mobility

Question 8

what are 3 examples of negative symptoms (type 2)

Answer 8

speech poverty- lessening speech fluency, reduction in communication, fewer words/ sentences, not continuing a conversation
avolition- reduction or inability to take part in goal directed behaviour, don’t take part in goal directed behaviour, don’t take part in something you would normally do, become withdrawn eg. no longer going to the pub/socialising with friends
catatonic behaviour- reduction in mobility

Question 9

briefly describe 2 classification/diagnostic manuals?

Answer 9

ICD-10 the international classification of diseases, 10th edition, set out by WHO
DSM-V the diagnostic and statistical manual of mental health disorders, 5th edition (been upgraded), devised in North America as they wanted more detail in the psychiatric edition
*own cultures may have their own diagnostic manual due to culturally specific disorders

Question 10

describe the DSM in relation to sz?

Answer 10

the diagnostic criteria for a diagnosis of sz according to DSM is that the patient must meet 2 of the following criteria. the criteria includes delusion, beliefs that don’t correspond to reality, eg. you’re Jesus, hallucinations which can be auditory eg. hearing the voice of god or somatosensory, disorganised speech eg. jumping from one conversation of topic to another at random or incoherence, grossly disorganised or catatonic behaviour eg. patient suffers from periods of waxy immobility- one extreme to the other eg. heightened mobility such as rocking to no movement.

Question 11

define reliability?

Answer 11

the consistency of measurements

Question 12

define validity?

Answer 12

the accuracy of measurements

Question 13

in one sentence, briefly discuss issues of reliability and validity associated with the classification and diagnosis of sz?

Answer 13

if the classification systems of sz aren’t reliable then there is no guarantee that patients will receive a valid diagnosis. a consequence of this is that patients may not receive the appropriate treatment.

Question 14

describe the Rosenhan study?

Answer 14

pseudo patients told hospitals that they heard voices. Once in the hospital they were instructed to behave normally, secretly not take their medication, cooperate, follow the rules of the ward and make observations of real patients on the ward. The psychiatrist failed to detect sanity despite the fact they were clearly sane.

Question 15

briefly outline the genetic explanation for sz?

Answer 15

inherited predisposition, genetic vulnerability
concordance rate for mz twins is 48% vs dz twins 17% = closer the genetic relatedness the greater the chance of developing sz

Question 16

briefly evaluate the genetic explanation?

Answer 16

+Tienari adoption study

• sample size, rare to find twins with sz, increases the margin of error, reduces reliability hard to generalise
• nature nurture 100% DNA vs 48% rate, missing % = other factors, interactionist, stress diathesis

Question 17

briefly outline the dopamine hypothesis?

Answer 17

The original hypothesis suggested that the level of dopamine is responsible for SZ in that too much of the neurochemical dopamine can result in overactivity in the brain, resulting in positive symptoms. The revised theory suggest that it is not the level of dopamine that causes SZ but that the patient has more dopamine receptors that leads to more firing and over production of messages.

Question 18

briefly evaluate the dopamine hypothesis?

Answer 18

+ helped devise drug treatments - 1/3 patients don’t respond
+ supporting evidence from amphetamines
+ supporting evidence from autopsies

Question 19

briefly outline neural correlates?

Answer 19

Neural correlates are patterns of structure or activity in the brain that occur in conjunction with SZ. Individuals with SZ have abnormally large ventricles in the brain. Ventricles are fluid filled cavities in the brain that supply nutrients and remove waste. This means that the brains of schizophrenics are lighter than normal. The ventricles of a person with SZ are on average about 15% bigger than normal. Which suggests that structural brain abnormalities are a cause of schizophrenia as this suggests that because the brain functions differently, this could be the cause for the faulty thinking associated with disorder.

Question 20

briefly evaluate neural correlates?

Answer 20

+ scientific evidence, brain scans, objective, accurate, reliable
- cause and effect can’t be established, can’t be 100% sure the structural differences in the brain are the cause of sz or whether they’re the result of the disorder that could be listed on DSM as a symptom

Question 21

define family dysfunction?

Answer 21

abnormal processes within a family such as poor family communication, cold parenting and high levels of expressed emotion. these may be risk factors for both the development and maintenance of sz

Question 22

outline double bind theory?

Answer 22

The double bind theory suggests that the role of the communication style within a family plays a significant part in the onset of SZ. This is due to parents giving contradictory conflicting messages which in turn could cause confusion and thus, the disorganised thinking associated with SZ. For example, if a mother tells her son she loves him yet at the same time turns her head away in disgust. However, this is just a risk factor, not a standalone cause.

Question 23

outline EE?

Answer 23

EE suggests that a high degree of emotion, especially negative emotion expressed towards a patient by their carers can trigger schizophrenic relapses and episodes. For example, if a parent is overinvolved or critical this could lead to a hostile environment creating stress for the patient which in turn makes them less tolerable, triggering an episode. Therefore, this suggest that the higher the EE level, the higher the relapse rates.

Question 24

evaluate family dysfunction?

Answer 24

+supporting evidence Berger

• recall issues due to distorted thinking
• Liem found inconsistent evidence
• individual differences, not all high EE families have patients that relapse and not all low EE avoid relapse

Question 25

define dysfunctional thought processing?

Answer 25

cognitive habits or beliefs that cause the individual to analyse/evaluate information inappropriately. it can lead to faulty schemas and thinking abnormally which can lead to abnormal behaviour

Question 26

what is a delusion?

Answer 26

when a faulty schema leads to abnormal processing so that patients with SZ don’t have a true understanding of what is going on around them.

Question 27

what is a hallucination?

Answer 27

when the patient suffers from sensory overload so that they can’t focus and concentrate on certain information in the environment and thus that inability to distinguish between imagery and sensory based perception can in turn lead to them misinterpreting background noise.

Question 28

briefly evaluate the cognitive explanation?

Answer 28

+supporting evidence from the success of cognitive therapies eg. CBT
- not all patients respond effectively to talk therapy but more drug therapy
- the model of sz deals adequately with one aspect of the disorder, cognitive impairment but fails to explain/ignores other aspects eg. neurochemical changes
+ Howes and Murray addressed this problem with an integrated model of sz

Question 29

what happened before the 1950s?

Answer 29

drug treatments weren’t effective and patients were cared for in safe environments

Question 30

what was discovered in 1952?

Answer 30

dopamine was discovered which transformed the treatment of sz and these drugs are known an antipsychotics

Question 31

what’s an example of typical drugs?

Answer 31

chlorpromazine

Question 32

what’s an example of atypical drugs?

Answer 32

clozapine

Question 33

describe how typical drugs work?

Answer 33

Otherwise known as conventional or first generation drugs, these drugs are antagonists in that they bind with the D2 receptor sites and thus block the mesolimbic dopamine pathway which in turn reduces the stimulation of dopamine, leading to a reduction in positive symptoms such as hallucinations and delusions

Question 34

describe how atypical drugs work?

Answer 34

Otherwise known as second generation drugs, atypical drugs still block the D2 receptor sites but only temporarily. They block the site for a while then dissolve. They only affect specific receptor sites, not including areas of the brain associated with movement and movement problems like typical drugs. Atypical drugs also alter serotonin levels which therefore also reduces the negative symptoms associated with sz

Question 35

briefly evaluate drug therapies for the treatment of sz?

Answer 35

+supporting evidence for the effectiveness of both types (meta analysis)

• atypical more effective, treats both symptoms and less serve side effects
• supporting evidence Leucht
• serious side effects of typical drugs, permanent neurological damage = tardive dyskinesia, extrapyramidal

Question 36

what’s the aim of CBT?

Answer 36

aims to identify and challenge irrational thinking and beliefs, including delusions and hallucinations. It helps by showing patients how their delusions and hallucinations affect their feelings and behaviour

Question 37

what’s the aim of family therapy?

Answer 37

aims to improve family communication, reduce stress of living as a family and support carers which in turn should reduce the need of hospitalisation

Question 38

what’s the aim of token economy?

Answer 38

systems of secondary reinforcement used to improve the behaviour of patients by systematically rewarding desired behaviour

Question 39

describe CBT?

Answer 39

Based on research evidence, NICE recommend at least on average 16 sessions in order for patients to see the most effective results, it involves the therapist and patient developing a positive relationship, one of trust where the patient can express themselves without fear of judgement. An initial assessment takes place where the patient expresses their thoughts about their experiences to the therapist. Realistic goals for therapy are discussed using the patients current distress as motivation for change. The therapist will apply Ellis’ ABC model where patients give their explanation of the activating events that appear to cause their emotional and behavioural consequences. The patients own beliefs, which are the cause of C, can then be rationalised, disputed and changed. Normalisation then occurs where patients are given information that many people have unusual experiences such as delusions under many different circumstances reduces anxiety and the sense of isolation. By placing psychotic experiences on a continuum with normal experiences the patient feels less alienated and stigmatised and the possibility of recovery seems more likely. Critical collaborative analysis is then where the therapist uses gentle questioning to help the patient understand deductions and conclusions without causing distress so that the therapist remains empathic and non judgemental. The patient then develops their own alternative explanations for their previously unhealthy assumptions these healthier explanations might have ben temporary weakened by their dysfunctional thinking patterns. If the patient isn’t forthcoming with alternative explanations, new ideas can be constructed in cooperation with the therapist.

Question 40

briefly evaluate CBT?

Answer 40

+supported by 2014 NICE review

• methodological issues with studies used to show the effectiveness of CBT
• issues of sampling, expensive so only 1 in 10 who could benefit from CBT get access to it, limited sample, hard to generalise
• individual difference’s, effectiveness is dependent on multiple factors, suitability for all patients, appropriateness

Question 41

describe family therapy?

Answer 41

Family therapy involves psychoeducation to help patients and their carers understand the disorder such as symptoms and to be more able in dealing with the illness, training and enhancing relatives ability to anticipate and solve problems. Family therapy aims to bring the family together, forming an alliance with relatives who care for the patient. During sessions the patient is encouraged to talk to their family and explain what sort of things they find helpful and what makes things worse for them so that everyone is ware of what’s going on. The therapy also aims to reduce the emotional climate within the family and the burden of care for family members so that family members can understand that in situations sometimes they need not react and take a step back and in order to reduce feelings of guilt as family members may feel somewhat responsible for the onset of their relatives disorder. The therapy also encourages relatives to set appropriate limits whilst maintaining some degree of separation when needed as relatives may be supportive bit sometimes find it difficult to address situations in which the patient is having an extreme outburst in which having clear boundaries may help overcome this confusion

Question 42

briefly evaluate family therapy?

Answer 42

• can it be used without drug treatment, meta analysis found its effective because it increases medication compliance
  -economic impact, cost savings, extra cost of therapy long term is offset by reduction in relapse admissions to hospitals
• supporting evidence from Pharoah
  + Lobban analysed 50 studies, found a positive effect on family members, beneficial to patients and relatives
  -methodological quality of the 50 studies was poor

Question 43

describe token economy?

Answer 43

Token economy is part of a treatment programme, based on the behavioural approach which encourages positive behaviour through rewards. Tokens such as plastic counters are paired with rewarding stimuli and so become secondary reinforcers for positive behaviour. The idea is that the patient will know what to do to receive these tokens so that the patient engages in these desirable behaviours such as brushing their teeth or showering or reduces inappropriate ones. As a result of the patient engaging in these target behaviours, the patients are given the tokens such as the plastic counters for the likes of dressing themselves. However, upon the basis of operant conditioning, it is essential that the patient is rewarded with the token straight away after they engage in the desirable behaviour so that the association between the behaviour and the reward can be made. The patient can then trade these tokens for access to desirable items or other privileges such as the privilege of access to watching the TV or being able to trade a token for a chocolate bar. Token economy is therefore used to manage the patients behaviour to improve their social function.

Question 44

briefly evaluate token economy?

Answer 44

+supporting evidence by Dickerson for the effectiveness in a psychiatric setting
- methodological issues of Dickerson’s study
- only works on psychiatric wards
+ethics, patient choses to participate
-ethics, manipulating behaviour
-individual differences, effectiveness is dependent on multiple factors, suitability for all patients,

Question 45

outline the diathesis stress model?

Answer 45

The biological explanation of sz states that sz is caused by a genetic component and that this may lead to a physiological change resulting in the disorder. The physiological explanation of sz suggest that environmental or cognitive factors cause the disorder such as faulty thinking or poor family communication. An alternative explanation should take an interactionist approach. The diathesis stress model suggests that sz is the result of an interaction between biological influences and environmental influences. This is because diathesis suggests a genetic predisposition, a genetic vulnerability to the disorder demonstrated in the fact that MZ twins who share 100% od DNA have a 48% chance of developing the disorder if the other twin has it. In addition to this, if an individual has an inherited vulnerability but has also experienced stress throughout their lifetime such as child trauma or problems with communication in families such as families with high EE levels, a individual is more likely to develop the disorder. However, some patients with SZ have no history of SZ and thus no genetic vulnerability which suggest that stress is a big determining factor in the onset of sz.

Question 46

briefly evaluate the diathesis stress model?

Answer 46

+ supporting evidence Tienari’s adoption study

• doesn’t account for individual differences, sz too complex a disorder, can’t predict behaviour
• treatment according to the model
• effectiveness of therapy alongside antipsychotics, recommended by NICE