schizophrenia Flashcards
4 psychological explanations
- schizo mother
- double bind theory
- expressed emotions
- cog explanations
schizo mother research
-Freida fromm-reichmann
-accounts from clients about childhood identifying if they had a schizo mother (cold rejecting controlling) , leads to distrust = paranoid conclusions
double bind research
-Gregory Bateson et al
- emphasised family communication e.g mixed messages of right and wrong + child seeks clarification
- child punished when in wrong (conditional love)
- disorganised thinking = delusions
expressed emotion description
- negative emotions e.g verbal criticism, hostility, emotional over-involvement
- can lead to stress, cause schizo relapse e.g trigger genetics
cognitive explanation description
-distruprion of normal thought processing usually in ventral striatum and temporal gyri = impaired cognition
cog explanation research
-Christopher frith
Identified 2 kinds of dysfunctional thoughts
- metarepresentation = ability to recognise/reflect on own and others actions and thoughts
- central control = ability to suppress automatic responses - lack of this could cause disorganised speech and thought disorder
psychological explanations strengths
- support evidence combo whopper
- Stirling et al
- Read et al reviewed 46 studies of child abuse - 69% women + 59% men had schizo - HOWEVER - evidence is taken after symptom development - validity problem as makes recall less accurate
- compared 30 schizo people with 18 control on diff cog tasks - schizo people took twice as long in troop test - - cog theories can explain schizo causes
Psychological explanation weakness
- no support evidence for schizo mother or double bind these blame the parents - adds to already having to deal with child schizo - unethical
2 types of drug therapies
typical
atypical
Typical antipsychotics description
- since 1950s (chlorpromazine)
- strong association with dopamine hypothesis
how do typical antipsychotics work?
- specifically chlorpromazine
- act as antagonists by reducing neurotransmitter actions
- dopamine antagonists block dopamine receptors - reduces hallucinations
Atypical psychotics description
- since 1970s
- new to improve effectiveness
2 types of atypical antipsychotics
- clozapine - binds to dopamine receptors as well as acting on serotonin + glutamate receptors - improves mood and reduce depression
- risperidone - binds more strongly to dopamine than clozapine so more effective and fewer side effects
Drug Therapies strengths
-Ben Thornley et al
-reviewed studies comparing chlorpromazine to placebo - 13 trials + 1121 participants - chlorpromazine reduced symptoms and better overall functioning - 512 relapse rate lower
Drug Therapies Weaknesses
- Serious Side effects
- David Healy
- typical = dizziness, agitation, sleeplessness, itchy skin etc , typical long term = NMS (high temp, delirium + coma) 0.1% - 2%, Atypical have less side effects but have to have blood tests with clozapine
- problems with evidence for effectiveness -he suggested some successful data had been published multiple times so make look more positive +only asses short term effects - antipsychotics also have calming effect so impact looks better, doesn’t actually reduce psychosis
3 psychological therapies
- CBT
- Family Therapy
- Token economies
CBT description
- 5-20 sessions
- identify irrational thoughts + change them
- make sense of delusions and hallucinations
Family Therapy description
-Fiona Pharaoh et al
- aim to improve family communication + reduce stress
- strategies e.g = therapeutic alliance, caring for schizo relative, improve problem solving ability, reduction of anger + guilt etc
Token economies description
- reward systems to manage behaviour
- tokens (secondary reinforcers) given immediately after good behaviour then rewards given later
Psychological therapies strengths
- Jauhar et al
- Pharoah et al (combo)
- McMonagle + Sultana
- reviewed 34 CBT studies = significant but small effect on positive + neg symptoms
- reviewed family therapy studies - FT reduced hospital readmissions over a year + improved patient + family life quality - HOWEVER- studies inconsistent + had quality issues = FT evidence fairly weak
- reviewed token economy studies + found only 3 that used random allocation with only 110 patients - non had useful info on behaviour change - lack of support
Psychological therapies weaknesses
- improve but don’t cure
- ethical issues
- improves schizo manageability - CBT helps make sense + challenge schizo symptoms - FT reduces stress of living with schizo - TE help socially acceptable behaviour - these things are helpful but shouldn’t be confused with curing schizo - failure to cure schizo in psychological treatments
- TE is contoversial - more services for patients with mild rather than severe symptoms - severe = suffer discrimination + some families have challenged legality of this - reduced TE use in psychiatric systems
interactionist approach definition
acknowledges that there are biological, psychological and societal factor in schizo development
What does the diathesis stress model suggest?
-vulnerability to it and stress triggers is necessary to schizo development
Meehl’s diathesis stress model description
- vulnerability = entirely genetic (a single schizogene)
- no schizogene means no amount of stress can cause schizo to develop
The modern understanding of diathesis description
- many genes increase shcizo development not just one
- include genetics, psychological trauma (trauma = diathesis not the stressor)
The modern understanding of stress description
-anything that risks triggering schizo
Interactionist Model Treatment
-Turkington
- CBT is best for combining antipsychotics and psychological therapies
- (Turkington) CBT can still be used for biological causation of schizo to relieve symptoms HOWEVER can’t ignore psychological causation if CBT is psychological
- Britain uses antipsychotics + CBT but America took longer to adopt interactionist approach therefore only medication more popular in America
Interactionist Approach Strengths
- Evidence for role of vulnerability + triggers (Tienari et al)
- Support for effectiveness of combination of treatments (Nicholas Tarrier)
- investigated genetic vulnerability + parenting style, he used children adopted from 19,000 Finnish mothers - adoptive parents assessed for child rearing style - schizo rates compared to control group of adoptees with no genetic risk - child rearing style = low empathy can lead to schizo for genetic risk children - shows both factors included
- 315 schizo people randomly allocated to medication + CBT treatment/ medication + supportive counselling or a control group = combinations = lower symptoms than control - HOWEVER - no difference in hospital readmission rate - practical advantage
Interactionist Approach Weakness
- original diathesis-stress is over simple
- lack of diathesis stress model understanding
- multiple genes = increase schizo risk not one schizogene + stress can come in many forms - vulnerability can be from trauma + genetics (Houston et al) = childhood sexual trauma + cannabis was trigger - shows old diathesis = too simple
- strong evidence for underlying vulnerability + stress = schizo - HOWEVER - don’t fully understand mechanisms of how they produce symptoms
