Schizophrenia Flashcards
1
Q
Neurosis [definition]:
A
Mental health issues that fall just outside normal functioning but the individual is in touch with reality and knows they are ill
2
Q
Psychosis [definition]:
A
Mental health issues where an individual has lost touch with reality and is not on a continuum with normal mental health
3
Q
Positive symptoms [definition]:
A
Symptoms that appear to reflect an excess or distortion of normal functions
4
Q
Positive symptoms =
A
Type 1 = Distortion of normal functioning
5
Q
Negative symptoms [definition]:
A
Symptoms that appear to reflect a decrease or a loss of normal functioning
6
Q
Negative symptoms =
A
Type 2 = Lack of normal functioning
7
Q
What are the psychological explanations for schizophrenia? [2]:
A
- Family dysfunction
- Cognitive explanations
8
Q
Family dysfunction [explanation]:
A
It claims that schizophrenia is caused by abnormal patterns of communication within the family
9
Q
Which family dysfunction explanations refer to the onset of schizophrenia? [2]:
A
- The schizophrenogenic mother
- The double-blind theory
10
Q
Which family dysfunction explanation refers to the maintenance of schizophrenia?
A
Expressed emotion
11
Q
Double-blind theory [4]:
A
- Bateson et al (1956)
- Kids who frequently get contradictory messages from parents are more likely to get schiz
- e.g mum tells child she loves him but turns head away in disgust
- interactions prevent development of an internally coherent construction of reality which manifests as schiz symptoms
12
Q
Positive symptoms of schizophrenia [4]:
A
- Hallucinations
- Delusions
- Disorganised speech
- Grossly disorganised behaviour
13
Q
Negative symptoms of schizophrenia [4]:
A
- Speech poverty
- Avolition
- Affective flattening
- Anhedonia
14
Q
Disorganised speech [explanation]:
A
its a result of abnormal thought processes cus individual has problems organising their thoughts
15
Q
Grossly disorganised behaviour [explanation]:
A
Inability or motivation to start or complete it once it started
16
Q
Delusions [explanation]:
A
Bizarre beliefs that the schizophrenic thinks are real
17
Q
Speech poverty [explanation]:
A
lessening of speech fluency and productivity- thought to reflect slowing or blocked thought
18
Q
Avolition [explanation]:
A
A reduction of interests and desires as well as the desire to persist in goal-directed behaviour
19
Q
Affective flattening [explanation]:
A
A reduction in the range and intensity of emotional expression including facial expression and voice tone
20
Q
Anhedonia [explanation]:
A
Loss of interest in all or most activities, or a lack of reactivity to normally pleasurable stimuli
21
Q
Expressed emotion [explanation]:
A
Communication style where family members of patients talk about patient in hostile/critical manner
22
Q
Expressed emotion relapse rate [3]:
A
- Linszen et al (1997)
- Patient returning to family with high EE is 4x more likely to relapse than patient who has family with low EE
- suggests ppl with schiz have lower tolerance to intense environmental stimuli specifically intense emotional comments from family
23
Q
Expressed emotion- Kupiers et al
A
High EE relatives talk more and listen less
24
Q
Expressed emotion- Noll 2009 [2]:
A
- Negative emotional climate leads to stress beyond their impaired coping mechanisms, triggering a schiz episode
- Family environments that are supportive and emotionally undemanding may help reduce risk of relapse and reliance on antipsychotics
25
Cognitive explanation for delusions [2]:
- Durin the formation of delusions schizo's interpretations of events are controlled by inadequate info processing
- Perceives themselves as the central part of events (egocentric bias) so jumps to false conclusions about external events
26
Cognitive explanation for hallucinations [4]:
- Hallucinating ppl focus too much on auditory stimuli
- So have higher expectancy for the occurrence of a voice than others
- Schiz patients are more likely to mistake self-generated auditory experiences as an external source
- Errors are not corrected cus schema faulty
27
Family dysfunction AO3- Research support [4]:
+ Tienari et al (1994)
+ Adopted kids with schiz bio parents were more likely to have it than kids with non schiz bio parents
+ However, this only applied where adopted family was rated as disturbed
+ shows that circumstance matters bro
28
Family dysfunction AO3- Double blind research [3]:
+ Berger 1965
+Schizophrenics reported a higher recall of double blind statements from their mums then non schizos
+ suggests that there is a relationship between contradictions and schizo making research more valid
29
Family dysfunction AO3- Family therapy [4]:
+ Gibney (2006)
+ claims that double blind led to development of family therapy
+ Interactions can be organised constructively so they become health producing
+ reduces schizos more workers
30
Family dysfunction AO3- Ethical issues [3]:
- serious ethical concerns in blaming the family
- Especially cus there is lil evidence to support it
- Mother tends to be blamed most which has ethical implications on women in society
31
Cognitive explanations AO3- Practical applications [4]:
+ Yellowless et al
+ developed a machine that produced virtual hallucinations telling the patients to kys
+ Intention is to show schizos that their hallucinations are not real
+ Suggests understanding cognitive helps to create new treatments
32
Cognitive explanations AO3- Misses out
- Cognitive does not explain the cause of cognitive deficits or where they come from
- Suggests that adjustments need to be made to theory to be appropriate
33
Cognitive explanations AO3- Support from therapy success [3]:
+ Claim that schiz has its origin in faulty cognition is supported by success of cognitive therapies for schiz
+ Effectiveness of CBT demonstrated in the NICE review of treatments for schiz
+ Review found consistent evidence that it is relatively more effective than antipsychotics in reducing severity of symptoms
34
Cognitive explanations AO3- Reductionist [4]:
- reductionist
- Approach does not consider factors like genes
- schiz could be result of low neurotransmitter which then causes cognitive deficits
- suggests that cognitive is overly-simplistic so not appropriate
35
What does NICE stand for?
National Institute for health and Care Excellence
36
Typical antipsychotic [definition]:
Dopamine antagonists that bind to but do NOT stimulate dopamine receptors so they reduce symptoms of schiz
37
Bio schiz theory =
Too much dopamine/ dopamine receptors
38
How do Typical antipsychotics work? [4]:
- bind to dopamine receptors but don't stimulate
- Particularly D₂ receptors on mesolimbic dopamine pathway, blocking d action
- This eliminates hallucinations and delusions within a few days
- Other symptoms may take weeks to diminish significantly
39
What is an example of a typical antipsychotic?
Chlorpromazine
40
Typical antipsychotics side effects [3]:
- Kapur et al (2000)
- estimates that 60-75% D₂ receptors on mesolimbic must be blocked for antipsychotics to work
- This means some D₂ receptors not in the pathway also have to be blocked leading to side effects
41
Why are Atypical antipsychotics better?
Carry a lower risk of extrapyramidal side effects than typical psychotics
42
Differences between Typical and Atypical antipsychotics
| [3]:
- Atypical have lower risk of side effects
- Atypical have a +ve effect on negative symptoms too
- Atypical are suitable for treatment-resistant patients
43
How do Atypical antipsychotics work? [3]:
- They block D₂ receptors on mesolimbic pathway
- They only TEMPORARILY occupy receptors then rapidly dissociate
- Means that there are lower levels of extrapyramidal side effects
44
What type of symptoms do Typical antipsychotics tackle?
Positive symptoms ONLY
45
Why do Atypical antipsychotics have a beneficial effect on negative symptoms too? [2]:
- They have a stronger affinity for serotonin receptors
| - Also have lower dopamine receptor affinity
46
Who described the schizophregenic mother?`
Fromm-Reichmann 1948
47
How is the shizophrenogenic mother described by Fromm-Reichmann?
Cold and domineering yet overprotective
48
How does the shizophrenogenic mother theory work? [3]:
- The mother's faulty communication methods are quite contradictory
- Cold/ rejecting but overprotective
- This leads to confusion in the child which leads them to doubting their own reality
49
Antipsychotics AO3- Side effects [3]:
- Very effective ones can have severe side effects
- Clozapine has been shown to be more effective than others
- but it targets multiple neurotransmitters, not just dopamine which can cause shit like loss of white blood cells
50
Antipsychotics AO3- Research support [3]:
+ Leucht et al (2012)
+ Meta analysis of 65 studies with placebo and antipsychotic
+ Witihin 12 months 64% placebo relapsed compared to 27% antipsychotic ppl
51
Antipsychotics AO3- Quality of life [2]:
+ Leads to better quality of life cus patients independent
| + positive impact on economy cus patients can return to work
52
Antipsychotics AO3- Root cause [2]:
- effective in dampening symptoms but do not ACC deal with root cause
- CBT may be more appropriate cus ACC deals with cause/ schemas
53
How CBT works for schiz [6]:
1. Assessment
2. Engagement
3. ABC model
4. Normalisation
5. Critical collaborative analysis
6. Developing alternative explanations
54
Assessment [3]:
- Patient expresses their thoughts abt experiences to therapist
- Realistic goals for therapy are discussed
- Uses patient's current distress as motivation for change
55
Engagement [2]:
- Therapist empathises with patient's perspective and their feelings of distress
- Stresses that explanations for distress can be developed together
56
ABC model [3]:
- Patient gives their explanation of the activating event (A)
- The event that causes emotional and behavioural (B consequences (C)
- The patients' beliefs of what caused (C) can then be rationalised, disputed and changed
57
Normalisation [3]:
- Patient told that many ppl go through hallucinations and delusions
- Reduces anxiety and the sense of isolation
- Patient feels less alienated and less stigmatised
58
Critical collaborative analysis [3]:
- Therapist uses gentle questioning to help patient understand illogical deductions & conclusions
- e.g. If ur voices r real y can't others hear em?
- Can be done without causing distress provided there is a relationship of trust between patient and therapist
59
Developing alternative explanations [2]:
- Patient develops their own alt explanations for previous unhealthy assumptions
- If patient don't got alt explanations new ideas can be built with the help of the therapist
60
CBT evaluation- Supported by NICE [3]:
+ NICE (2014) review of schiz treatments
+ CBT is more effective in reducing rehospitalisation rates up to 18 months than standard care
+ Means more appropriate than other treatments
61
CBT evaluation- Dependent on stage [4]:
- Effectiveness depends on stage of treatment
- Addington & Addington (2005)
- Claim that self-reflection/ CBT is not appropriate in initial acute phase
- So ppl who had schiz for longer benefit more
62
CBT evaluation- Lack of availibility [2]:
- in UK only 1/10 who would benefit get access to it
| - This means that it isn't really helpful if ppl don't have a chance to do it
63
How many sessions does CBT treatment require?
Done over 16 sessions
64
CBT evaluation- Motivation [2]:
- Requires motivation to do it
| - Thats a thing most schizophrenics don't have bruh
65
How does family therapy work? [3]:
- By reducing the levels of expressed emotion
- Also by increasing capacity of relatives to solve problems
- Reduces the incidence of relapse
66
Strategies used during family therapy [4]:
- Forming an alliance with relatives who care for patient
- Reducing emotional climate within family reduces burden
- Enhancing relatives' ability to anticipate problems
- Maintaining reasonable expectations within family
67
How long is family therapy?
3-12 months
68
Pharoah et al (2010) [4]:
- Reviewed 53 studies from europe, asia and north america on family therapies
- increased patient's compliance with medicine
- did not have an effect on social functioning and mixed feedback on effect on mental state
- Reduction in relapse and readmission 24 months after
69
Family therapy AO3- economic benefits [4]:
+ NICE review
+ Demonstrates that there are significant cost savings
+ XTRa cost of family therapy is offset by reduction in hospitalisation
+ Means that other ppl can be hospitalised/ treated for other things too
70
Family therapy AO3- Research support [3]:
+ Lobban et al (2013)
+ Analysed 50 family therapy studies
+ 60% reported a significant positive impact
71
Family therapy AO3- with drug therapies [3]:
- Anderson et al (1991)
- Relapse rate of 40% with drugs only, 20% withfamily therapy and 5% with both
- Suggests that a combination of both would be the most effective
72
Family therapy AO3- methodology [3]:
- 10/53 of the Pharoah et al studies did not use any form of blinding
- Another 16 did not mention whether blinding was used
- Lack of blinding makes the research less reliable as ppts may behave a certain way as they knew what was being studied
73
How do token economies work? [4]:
1. Tokens paired with rewarding stimuli and so become secondary reinforcers
2. Patient engages in target behaviours or reduces inappropriate ones
3. Patient is given tokens for behaviours
4. Patient trades these tokens for desirable items or privileges
74
How do you assign value to a token?
By repeatedly presenting it alongside or immediately before the reinforcing stimulus
75
Token economies AO3- difficult to see success [4]:
- Comer (2013)
- when toke economy system is introduced all patients are brought into the programme so no control group
- Patients improvements can only be compared to their past selves
- comparison may be misleadin/ not reliable
76
Token economies AO3- Hospital setting [4]:
- Corrigan (1991)
- difficult to administer tokens to out patients
- In hospital setting there is 24-hour care
- Positive results in ward settings may not be maintained beyond that environment
77
Token economies AO3- Research support [4]:
+ Dickerson et al (2005)
+ Reviewed 13 studies on token economy
+ 11/13 studies reported beneficial effects directly attributed to token economies
+ Overall token economies increase adaptive behaviours
78
Token economies AO3- w/o system {3]:
- Doesn't work when system is removed
- May not be the best treatment method to reduce relapse
- CBT more appropriate
