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schizophrenia Flashcards

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1
Q

define schizophrenia

A

a severe mental disorder where contact with reality and insights are impaired, an example of psychosis

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2
Q

positive symptoms

A

hallucinations and delusions

Atypical symptoms experiences in addition to normal experiences

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3
Q

hallucinations

A

they are sensory experiences that have neither no basis in reality or are distorted perceptions of things that are there.

most commonly = auditory - report hearing voices that instruct them to do something

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4
Q

delusions

A

involve beliefs that have no basis in reality.

delusions of persecution = others want to harm, threaten or manipulate you
delusions of grandeur = idea that you are an important individual
delusions of control = they are under the control of an force that has invaded their mind and/or body

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5
Q

negative symptoms

A

atypical experience that represent the loss of a usual experience

speech poverty and Avolition

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6
Q

speech poverty

A

involves reduced frequency and quality of speech

- characteristics by a lack of ability to produce fluent words - reflects slow or blocked thoughts

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7
Q

avolition

A

involves loss of motivation to carry out tasks and results in lowered activity levels
reduction, difficulty or inability to continue/ start goal directed behaviors

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8
Q

family dysfunction - schizophrenic mother

A
  • Psychodynamic explanation for schizophrenia
  • based on the accounts she heard from her patients about their childhood
  • Particular type of parent – cold, rejecting and controlling and tends to create a family climate that characterized by tension and secrecy
  • This creates distrust that later develops into paranoid delusions and schizophrenia
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9
Q

family dysfunction - double blind theory

A

family climate is important in the development of schizophrenia but communication styles

  • Developing child finds themselves stuck in situations where they fear doing the wrong thing
  • receive mixed messages about the situation
  • unable to communicate on the unfairness of the situation or seek clarification
  • Punished with the withdrawal of love
  • Leaves them to understand the world as a confusing and dangerous place = disorganized thinking and delusions
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10
Q

family dysfunction - expressed emotions

A
  • The level of emotions expressed towards a person with schizophrenia by their career/ family member
  • Usually, negative
  • Elements = verbal criticism accompanied by violence, hostility, and emotional overinvolvement
  • High level of EE directed toward them coursing a source of stress
  • Primary explanation for relapse in people with schizophrenia
  • However, stress can trigger the onset of schizophrenia in a person who is already vulnerable.
  • Diathesis stress model
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11
Q

cognitive explanation - dysfunctional explanation

A
  • focuses on the role of cognitive processes
  • Provide possible explanation of schizophrenia as a whole
  • Schizophrenia provides a disruption to normal thought processing (shown in symptoms)
  • Reduce thought processing in the ventral striatum associated with negative symptoms
  • Reduced processing of information in the temporal and cingulate gyri, associated with hallucinations
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12
Q

cognitive explanation -Metarepresentation dysfunction

A
  • Meta-representation = Cognitive ability to reflect on thoughts and behaviors that allows insight into our own intentions and goals
  • Dysfunction in meta-representative = disrupts our ability to recognize our own thoughts and actions as being their own not someone else’s.
  • Explain hallucinations and delusions
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13
Q

central control dysfunction - cognitive explanation

A
  • Central control dysfunction = issue with cognitive ability to suppress automatic responses while preforming deliberate actions.
  • Speech poverty and thought disorder could result from this inability to suppress automatic thought and speech triggers by other thoughts
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14
Q

Frith et al

A
  • Identify two kinds of dysfunctional thought processes
    1. Meta-representation
    2. Central control dysfunction
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15
Q

define antipsychotics

A

Antipsychotic = drugs used to reduce the intensity of symptoms, in particular the positive symptoms, of psychotic disorders like schizophrenia.

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16
Q

typical antipsychotics

A

Chlorpromazine – typical antipsychotic

  • Used to combat positive symptoms e.g., delusions and hallucinations
  • Used to reduce/block the effect of dopamine
  • Are a dopamine antagonist as they bind to dopamine receptors (D2), reducing their action and do not stimulate them.
  • Reduce dopamine in the mesolimbic system in the brain.
  • Ensuring the postsynaptic cells receive less dopamine, normalizing neurotransmitter levels.
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17
Q

atypical antipsychotics

A

Clozapine – atypical antipsychotic

  • Used to combat positive symptoms but may also benefit negative symptoms
  • work on the dopamine system but also block serotonin and glutamate receptors
  • temporarily occupy D2 receptors and then rapidly dissociating it to allow normal dopamine distribution (still receive less dopamine)
  • have lower level of side effects than typical antipsychotics
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18
Q

tardive dyskinesia

A

tardive dyskinesia

  • side effect of antipsychotics
  • repetitive involuntary movements cause by long -term or high dose of typical antipsychotics
19
Q

three major differences between typical and atypical antipsychotics

A
  • atypical have less of risk of extrapyramidal side effects such as tardive dyskinesia
  • research has indicted that atypical have a beneficial effect on negative symptoms
  • atypical are suitable for a treatment- resistant schizophrenia patient, that is they are more likely to work when typical have failed.
20
Q

CBT

A

a method of treating mental disorders based on both cognitive and behavioral techniques. From the cognitive viewpoint the therapy aims to develop with thinking such as challenging negative thoughts. The therapy includes behavioral techniques.

21
Q

how to use CBT

A
  • Period of 5 – 20 sessions (Group or individual basis)
  • Deal with both thoughts and behavior
  • Help to sense how their irrational thoughts (delusions and hallucinations) impact their feelings and behavior.
  • Hugely helpful for symptoms like auditory hallucinations e.g hear voices, scared, therapist convince it comes from the malfunctioning speech center, therefore it can’t hurt them, feel less debilitating
  • Will not eliminate symptoms but help patients to cope with them – reduce distress and improve ability to function adequately
  • Can also help to teach them that the voice-hearing is an extension of ordinary experience of thinking in words – normalization
22
Q

evaluation of CBT - evidence of effectiveness

A

Jauhar et al reviewed 34 studies of using CBT with schizophrenia, concluding that there was clear evidence for small but significant effects on both positive and negative symptoms.
Other studies found a reduction in frequency and severity of auditory hallucinations
Clinical advice from NICE recommends CBT for schizophrenia, this means that both research and clinical experience support the benefits of CBT for schizophrenia

23
Q

evaluation of CBT - quality of effectiveness

A

limitation of CBT for schizophrenia is the wide range of techniques and symptoms included in studies.
CBT techniques and schizophrenia symptoms vary widely from one case to another
Thomas point out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms.
The overall modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms.
This makes it hard to say how effective CBT will be for a particular person with schizophrenia.

24
Q

family therapy

A

a psychological therapy carried out with all or some members of a family with the aim of improving the communications within the family and reducing the stress of living as a family.

25
Q

family therapy uses

A
  • Improves the quality of communication and interaction between family members
  • Act on the principles of the psychological theories – double blind and the schizophrenogenic mother
26
Q

pharoah et al - family therapy

A

identified a range of strategies that family therapists use to try to improve the functioning of a family that has a member with schizophrenia

  1. Reduces negative emotions – aims to reduce levels of expressed emotion, generally but especially negative emotions such as anger, guilt that create stress. But reducing stress they also reduce chance of relapse.
  2. Improve the family’s ability to help – encourage family members to form therapeutic alliance where they all agree on the aims of therapy. Also aims to improve the family’s belief and behavior around schizophrenia. Finally aims to achieve a balance between caring for someone with schizophrenia and maintaining their own lives
27
Q

family therapy model of practice

A

Burbach: proposed a model for working with families dealing with schizophrenia

  • Begins with sharing information, proving emotional and practical support.
  • Phase 2 = identifying resources family members can(not) offer
  • Phase 3 = encourage mutual relationships, safe space for all to express emotions
  • Phase 4 = involves identifying unhelpful patterns of interactions
  • Phase 5 = training new skills e.g., stress management techniques
  • Phase 6 = relapse prevention plan
  • Phase 7 maintenance for the future.
28
Q

evaluation of family therapy - evidence of effectiveness

A

A review of studies by McFarlane concluded that family therapy was one of the most consistently effective treatment available for schizophrenia
Relapse rates were found to reduce by around 50% to 60%
McFarlane also concluded that using family therapy as a treatment when mental health starts firsts declining is particularly promising. This is also shown be NICE recommending family therapy for everyone diagnosed with schizophrenia.
This means that family therapy is likely to be of benefit to people of starting to suffer with schizophrenia and individual that have had schizophrenia for a long time.

29
Q

family therapy evaluation - benefits the whole family

A

Therapy is beneficial for the individual struggling with schizophrenia and their family.
Lobban and Barrowclough concluded that these effects are important because families provide the bulk of the care for people with schizophrenia.
So, by strengthening the functioning of a whole family, family therapy lessens the negative impact of schizophrenia on other family members and strengthen the ability of the family to support the person with schizophrenia.
This means that family therapy has wider benefits beyond the obvious positive impact on the identified patient.

30
Q

drug therapy - evidence for effectiveness

A

evidence that antipsychotic are moderately effective at tackling symptoms
compared the effect of taking chlorpromazine to a control group. - 13 trails 1121 participants
showed chlorpromazine associated with better overall function and reducing symptoms compared to placebo
clozapine -30-50% effective in treatment resistant case where typical antipsychotics failed

31
Q

drug therapy evaluation - serious side effects

A

typical antipsychotics are associated with a range of side effects dizziness, agitation, sleepiness, weight gain
long term results = tardive dyskinesia - dopamine super sensitivity and involuntary facial movement.
neuroleptic malignant syndrome - caused when the drug blocks dopamine action in the hypothalamus - result in coma, delirium, can be fatal - less than 0.1% to just over 2%
therefore - harm as well as do good

32
Q

CBT evaluation - evidence of effectiveness

A

meta analysis 34 studies of using CBT with schizophrenia
concluded that there is clear evidence for small but significant effect on both positive and negative symptoms.
other studies have found reduction in frequency and severity of auditory hallucinations. - also NICE recommends CBT for schizophrenia.

33
Q

CBT evaluation - quality of evidence

A

CBT for schizophrenia uses a wide range of techniques and symptoms included in studies
vary from case to case
psychologist point out that different studies have used different CBT techniques and people with different combinations of symptoms. the overall modest benefits of CBT schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms.

34
Q

token economies

A

a form of behavioral modification, where desirable behaviors are encouraged by the use of selective reinforcement.
for example people are given rewards when they engage in socially desirable behaviors.
tokens are secondary reinforces and can be exchanged for primary reinforces e.g. food or privileges

35
Q

rationale for token economies

A

institutionalization develops under circumstances of prolonged hospitalization - develop bad habits.
matson et al - 3 categories of institutional behavior commonly tackled by token economies; personal care, condition related behavior and social behavior
two major benefits; improve quality of life in hospital and normalizes behavior

36
Q

theoretical understanding of token economies

A

example of behavioral modification / therapy
based on operant conditioning.
token = secondary reinforcer
exchanged for a primary reinforcers
should be administrated together or in a close time period

37
Q

token economies evaluation - ethical issues

A

professional given considerable power to control behavior of the patient - inevitably involves imposing one person’s norms on to others.
especially problematic if the target behavior are not identified sensitively.
or restrict the amiability of pleasure to people who already experience distressing symptom - legal action from relatives

38
Q

token economies evaluation - evidence of effectiveness

A

psychologist identified 7 high quality studies published that examined the effectiveness of token economies for people with chronic mental health issues.
showed a reduction of negative symptoms and decline in frequency of unwanted behavior.

39
Q

interactionist approach

A

a way to explain the development of behavior in terms of a range of factors, including both biological and psychological ones. most importantly such factors don’t just add together but combine in a way that cant be predicted by each one separately

40
Q

meehl’s model - diathesis stress model

A

original model
diathesis was entirely genetic - single schizogene
led to the idea of a biologically based schizotypical personality- characteristic is sensitivity to stress -
schizogene + no stress = no schizophrenia
stressor - schizophregenic mother in childhood

41
Q

modern understanding of diathesis

A

polygenetic
no schizogene
range beyond the genetic to include psychological trauma
neurodevelopmental model - early trauma alters brain development e.g. hypothalumic - pituitary - adrenal system become over active

42
Q

modern understanding of stressors

A

used to only focus on parenting but now focuses on all trigger that may course schizophrenia
recent research = cannabis use - interferes with the dopamine system.

43
Q

interactionalist evaluations - diathesis and stress are complex

A

oversimplicity
orginal model - single gene (schizogene) and stressor was schizogenetic mother
but polygenetic mental health issue
stressors can be biological as well as psychological and diathesis as well.
cannabis- dopamine system

44
Q

interactionist evaluation - research support for vulnerability and trigger

A

research into the impact of both genetic vulnerability and psychological trigger - dysfunctional parenting
Finnish children adopted whose biological mothers had schizophrenia
compared to control group of adopted children without a family history - to assess child rearing styles
found high levels of criticism, hostility, and low levels of empathy were associated in the development of schizophrenia in the high risk group.
combination leds to schizophrenia

psychology (16 decks)

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