Paper 3 - Schizophrenia - Psychological Explanations Flashcards

1
Q

What is the main theory in the psychological explanation?

A

Family dysfunction

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2
Q

What can Family Dysfunction be split into?

A

Family Relationships
Schizophrenogenic Mother
Double Blind Theory
Expressed Emotion

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3
Q

Explain family relationships

A

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 schizophrenia.

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4
Q

Explain without detail the Schizophrenogenic Mother?

A

This is the Freudian idea that a cold, dominant and created conflict mother causes schizophrenia to emerge in the child

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5
Q

What would a schizophrenogenic Mother be like?

A

These mothers were said to be
- Rejecting
- Overprotective
- Self sacrificing
- Moralistic about sex
- Fearful of intimacy

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6
Q

Explain Fully the Schizophrenogenic Mother?

A

This is the Freudian idea that a cold, dominant and created conflict mother causes schizophrenia to emerge in the child

These mothers were said to be rejecting, overprotective, self sacrificing moralistic about sex and fearful of intimacy
So it was thought that the distrust, resentfulness and instability caused by a mother creates a family environment of tension and secrecy. Which leads to distrust that latter develops into Paranoia delusions leading to schizophrenia.

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7
Q

What was Bateson the first to do?

A

Look at the family dynamic of people with diagnosis of schizophrenia

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8
Q

What type of family dynamic did Bateson emphasis?

A

Communication styles

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9
Q

What are double blinds?

A

Contradictory messages

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10
Q

What is Double Blind Theory

A

According to Bateson the children who frequently receives contradictory messages (double blinds) from their parents are more likely to develop schizophrenia
According to the theory these interactions prevent the development of an internally coherent construction of reality, and in the long run, this manifests itself as symptoms of schizophrenia

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11
Q

What is EE?

A

Expressed Emotion - EE is a family communication style in which members of a family of a psychiatric patients talk about the patient in a critical or hostile manner or in a way that indicates emotional over involvement or over concern with the patient if the behaviour

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12
Q

What is different about EE?

A

This theory explains relapses in patients
But it could trigger the development of schizophrenia due to increased stress levels (in someone who is already vulnerable)

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13
Q

Explain the theory of EE?

A

The idea is that if there is a high degree of EE (that is to say there is a high negative emotional climate) due to the family variable of dysfunctionality that would increase the chances of relapse

High EE may involve:
Critical comments through tone and content occasionally accompanied by violence
Hostility towards the patient, including anger and rejection
Emotional, over-involvement in the life of the patient including needless self sacrifice

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14
Q

What may high EE involve?

A

High EE may involve:
Hostile tone
Hostile comments
Occasional violence
Anger
Rejection
Emotional, over-involvement in the life of the patient including needless self sacrifice

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15
Q

Explain the positive evaluation of family relations as a risk factor?

A

• Read et al. (2005) reviewed 46 studies of child abuse and schizophrenia and concluded that 69% of adult women with a diagnosis of schizophrenia had a history of physical abuse, sexual abuse or both, in childhood. And Men was -59%
• Berry et al. (2008) adults with insecure attachments
are more likely to have schizophrenia.

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16
Q

What is a big disadvantage in much of this research in schizophrenia?

A

Methodological issues

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17
Q

Explain the negative evaluation: Methodological issues

A

Information gather from sufferers can’t be trusted as they may have had memories distorted by delusions not to mention SDB
• Tiernari et al. (2004) investigated children following a childhood experience(s) to see if these experiences predicted any adult characteristics. (But this research has low validity because children may be unable to understand the consequences/impact of their experiences

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18
Q

Explain the evaluations of the schizophrenogetic mother?

A

Its complete Rubish
• By the 1980s research had concluded that there was no such thing as a ‘Schizophrenogenic mother’.
• It had become apparent that only a small percentage of women who might arguably fit the criteria of schizophrenogenic mother had actually produced schizophrenic children.
• Conversely,peoplewithschizophreniawerefoundto have mothers who did not fit the criteria.
• The theory has been criticised for hindering progress in psychiatry and understanding of this complex disorder

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19
Q

Explain the evaluations of Double Blind Theory

A

• There is some support for • the theory, i.e. Berger (1965) found that people with schizophrenia reported a higher recall of double-bind statements by their mothers than controls.

• However, this evidence may not be reliable as patients’ recall may be affected by their schizophrenia

Other studies find little support for the theory:
• Liem(1994) and Hall and Levin (1980) found no difference in the patterns of parental communication in families with a child with schizophrenia in comparison to normal families.

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20
Q

Explain the positive evaluations of EE

However

A

Brown (1966)
• People recovering from schizophrenia and discharged from hospital were followed up over a 9-month period.
• Interviews with family members were conducted to determine the level of expressed emotion
• Families where expressed emotion (EE) levels were high resulted in 58% of people with schizophrenia returning to hospital for further treatment
Compared to only 10% of those from low expressed emotion families.

This shows that the relationship with a family can have a big impact
But it may be the other way around (cause and effect)

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21
Q

Negative evaluations of EE?

A

• It is unclear whether EE is a casual agent in the relapse rates or just a reaction to the patient’s renewed symptoms
• High EE communication patterns are not specific to schizophrenia (neuroses, eating disorders)

Methodological Issues in EE
There is more evidence in Western Families
EE is usually measured in 1 interview. This is very unreliable

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22
Q

What is the final general negative evaluation for the investment psychological approach?

A

Family Dysfunction is quite socially sensitive and unreliable

23
Q

Explain the general negative evaluation: Family Dysfunction is quite socially sensitive and unreliable

A

• Dysfunctional family explanations for schizophrenia have historically led to parent-blaming.
Parents, who have already suffered at seeing their child’s descent into schizophrenia underwent further trauma by receiving blame for the condition

• Harrington (2012) schizophrenogenic mother and double bind theories are based on observational studies, that assessed mothers’ personalities for ‘crazy-making characteristics’ (which are extremely subjective sugesting that the theories are Rubbish)

24
Q

What is the cognitive explanation of cognitive explanation of schizophrenia?
Where specifically?

A

Schizophrenia may be a result of dysfunctional thought processing in the Ventral Stratum

25
Q

What is the reason why schizophrenia can be categorised in a cognitive way?

A

Schizophrenia can be characterised by disturbance in language attention, through perception

26
Q

What justify the cognitive approach?

A

Lower levels in processing than usual suggests that cognition’s likely to be impaired

27
Q

What did Frith suggest?

A

Meta Cognition:
Frith suggested that people with schizophrenia fails to monitor their own thoughts correctly, misattributing them to the outside world

So when a person hears voices it is actually their own inner speech being misinterpreted, however, sufferers may believe that someone or something in the external world is communicating with them
Such processing problems in people with schizophrenia are sometimes referred to as alien control syndromes - this is because the sufferers feel as if external forces are influencing their thoughts and actions and they have no personal control

28
Q

What is dysfunction in the central control?

A

The cognitive inability to suppress automatic responses while we perform deliberate actions.

29
Q

Explain dysfunction in the central control

A

• Disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts.
• Derailment of thoughts and spoken sentences because each word triggers associations and the patient cannot suppress automatic responses to these.

30
Q

What is auditory selective attention?

A

This is when our brain selects information to pay attention to and ignores the rest – we are bombarded with information from the outside world yet our processing abilities are limited

31
Q

How could auditory selective attention explain schizophrenia?

A

The negative symptoms of Schizophrenia may be the result of cognitive strategies cope with overwhelming mental stimulation due to the fact that they have Auditory Selective Attention impairments

32
Q

What type of theory is Socio Cultural Theory?

A

Psychological theory

33
Q

Explain Socio Cultural Theory

A

• Harrison et al. (2001) people born in deprived areas were more likely to develop schizophrenia.
- poverty, unemployment and crowding
•But these are orrelational results that doesn’t show cause and effect.
• The social drift hypothesis: more likely to be in deprived area because having schizophrenia gives them a lower social status

34
Q

What are the positive evaluations for the cognitive approach?

A

Evidence to support dysfunctional information processing

35
Q

What are the negative evaluations of the cognitive approach?

A

Cognitive Approach General
Ignorance of Other Factors

36
Q

Explain the positive evaluation of the cognitive approach: Strong evidence to suggest dysfunctional informational processing

A

• Stirling et al. (2006) compared 30 patients with schizophrenia to 18 controls on a range of cognitive tasks.
Results indicated that, in line with Frith’s theory of central control dysfunction, patients took over twice as long to name the ink colours as controls

37
Q

Explain the negative evaluation of the cognitive approach: General

A

• The cognitive approach does describe how information processing is affected in schizophrenia - cognitive explanations describe the processes/maintenance of the disorder.
• What it does not do is provide a distal cause explanation
• Also, cognitive disturbances may be symptoms of the disorder rather than an explanation.

38
Q

Explain the negative evaluation of the cognitive approach: Ignorance of Other Factors

A

• Both biological and psychological factors can separately produce the same symptoms.
• This raises the question of whether both outcomes are really schizophrenia.
• Diathesis- stress model

39
Q

What are the different psychological Therapies?

A

CBT
Family Therapies
Token Economy

40
Q

How many sessions does Schizophrenia CBT normally last?

A

5-20

41
Q

Explain the role of CBT in treating schizophrenia?

A

It may help patients to identify irrational thoughts and tries to change them
This may involve argument or discussion of how likely the beliefs are to be true, understanding where the beliefs come from (which could help reduce anxiety)
It may also help patients cope

42
Q

Explain the format of Family Therapy?

A

Family therapy usually takes place within the peoples homes and typically two family therapist will work with the relatives and patients
It lasts between 3-12 months with sessions every 2-4 weeks. A minimum of 10 sessions are recommended by NICE

43
Q

Explain how family therapy works?

A

The therapist works with the family and the patient to develop stratagies to cope better with the mental disorder and its symptoms
This helps make the patient make better progress and the relatives to feel more positive about, and more effective in, their supporting roles

This may also help the relatives become more aware of the information regarding psychosis and the symptoms of the specific diagnosis that their relative has given
The therapist encourages the relatives to ask questions and learn more about the disorder so they can properly understand the difficulties the patient faces

The patient will also be asked to explain their symptoms to the family as they are the experts in the situation

44
Q

What are the benefits of family therapies?

A

It forms a therapeutic alliances with all family members
It reduces the stress of caring for a relative with schizophrenia
It improves ability of the family to anticipate and solve problems
Reduction of anger and guilt
It helps to achieve a balance of caring for family and own life
It improves family’s belief and behaviours towards schizophrenia

45
Q

Explain how the token economy can be used to help treat schizophrenia?
Some bad some good

A

It may modify behaviour but won’t cure schizophrenia but it may cure quality of life which may make it more likely that they can leave the hospital

Tokens are secondary reinforcement, they only reinforce as they have value to the patient
Often patients are given litteral tokens that can be exchanged for rewards

46
Q

What are the positive evaluations of Psychological Therapies?

A

Evidence of the Effectiveness of CBT and Family Therapies
The Token Economy (Weak)
Alternatives

47
Q

What are the negative evaluations of Psychological Therapies?

A

Treatments don’t cure
Ethical issues - token economy
Ethical issues - CBT

48
Q

Explain the positive evaluations of Psychological Therapies: Evidence for the effectiveness of CBT and Family Therapies

A

• Jauhar et al. (2014) reviewed the results of 34 studies of CBT.
• Concluded that CBT had a significant but small effect on + and – symptoms
• Pharoah et al. (2010) reviewed family therapy.
- Moderate evidence that it significantly reduces hospital readmission and improved quality of life.

49
Q

Explain the positive evaluations of Psychological Therapies: Token Economy

A

• McMonagle and Sultana (2009) They reviewed a number of studies where patients were hospitalised with schizophrenia. These hospitals used a token economy.
Only one of the three studies showed improvement in symptoms
• Schizophrenia remains one of the harder mental health problems to treat

50
Q

Explain the positive evaluations of Psychological Therapies: Alternatives

A

• The national institute for Health and Clinical Excellence (NICE, 2014) recommends art therapy, particularly for negative symptoms
• Explore the patient’s inner world in a non- threatening way
• Compliance was high but not enough evidence of effectiveness

51
Q

Explain the negative evaluations of Psychological Therapies: Treatments don’t cure

A

Help make Schizophrenia more manageable and improve quality of life
• CBT allows patients to make sense of symptoms
• Family therapy reduces stress for family and patient
• Token economies make behaviour more socially acceptable so they can reintegrate with society
• All of the above fail to completely treat schizophrenia

52
Q

Explain the negative evaluations of Psychological Therapies: Ethical Issues - Token Economy

A

• Token economy – privileges etc. become more available to patients with mild symptoms and less so for those with severe symptoms that prevent them from complying with desirable behaviours
• This means severely ill patients suffer discrimination in addition to other symptoms

53
Q

Explain the negative evaluations of Psychological Therapies: Ethical Issues - CBT

A

• CBT – may involve challenging a person’s paranoia, but there is a thin line between challenging delusions and interfering with an individuals freedom of thoughts

54
Q

What is the social drift hypothesis?

A

Part of the Socio Cultural theory,
• The social drift hypothesis: more likely to be in deprived area because having schizophrenia gives them a lower social status