Schizophrenia Flashcards
What are the psychological explanations of sch?
Family dysfunction and Cognitive explanations.
What is family dysfunctions in sch?
Double bind theory - contradictory messages, prevents development of internal coherent construction of reality (positive symptoms)
Expressed emotion - negative emotional environment with high degree of criticism towards the individual leads to sch, patients returning to a high EE family is 4 times more likely to relapse, the sufferer will as a result have a low tolerance for intense environmental stimuli
What are the cognitive explanations of sch?
Dysfunctional thinking - focuses on issues with mental processes and the processing of info.
Metarepresentation dysfunction - the cognitive inability to reflect on our own thoughts and interpret the behaviour of others (some may believe their positive symptoms are a result of though insertion).
Central control dysfunction - the inability to suppress automatic responses - the sufferers experience though derailment as every word triggers an association which the sufferer is unable to suppress.
Evaluate family dysfunction and cognitive explanations.
Family dysfunction - Research support - according to. a review adults with SCH are disproportionately likely to have an insecure attachment, particularly type C or D. Also been reported that 69% of women and 59% of men with SCH have a history of physical and/or sexual abuse. Most adults with such have experienced trauma mostly abuse. Thus, family dysfunction makes people more vulnerable to SCH.
However, there is a poor evidence base for any of the explanations - though there is evidence that childhood family based stressed is associated with adult school there is almost none to support the importance of traditional family based theories such as the schizophrenic mother and the double bind. They are based on clinical observation and informal assessment of the personality of patients but has no systematic evidence.
Cognitive explanation - Research support - comparison performance on a range of tasks in 30 people with SCH and a control group of 30 without SCH. Included the stroop task which participants had to name the colour of a colour word and suppress the tendency to say them aloud. Found people with SCH took over twice as long as average to name the font colour, thus their cognition must be impaired.
However this explanation only explains the proximal origins of symptoms because they explain what is happening now to cause symptoms but not at what initially caused the condition (which is a distal explanation), distal explanations are family dysfunction and genetics. This means that cognitive theories alone only partially provide explanations for SCH.
What are typical and atypical antipsychotics?
Typical - works as an antagonist in the dopamine sustem as it blocks dopamine receptors and reduces positive symptoms (although it has extrapyramidal side effects). e.g. chlorpromazine
Atypical - e.g. Clozapine - acts on both the serotonin and glutamate receptors as well as the dopamine receptors, helps improve mood and positive symptoms, is good as 30/40% of sufferers attempt suicide.
Another example is Risperidone binds strongly to dopamine receptors and a bit to the serotonin receptors as well.
Evaluate typical and atypical antipsychotics.
Effectiveness - placebo evidence - meta-analysis of 65 studies involving 6000 patients found that within 12 months, the group who had not takes the APs had a relapse rate of 64% in comparison with 27%. Also Clozapine has been found to be more effective than typical APs as they are best in 30-50% of treatment resistant cases. However research only looked at short term effect and the data published may be exaggerated due to multiple publications.
Side effects - extrapyramidal side effects with typical APs which have effects on motor activity, there is also Tardive dyskinesia which is the involuntary movement of the mouth. Though rare some can get neuroleptic malignant syndrome which is the blockage of the dopamine receptors in the hypothalamus and can be caus delirium and coma.
Ethical issues - side effects are damaging, a sufferer of Tardive dyskinesia was awarded settlement due to article 3 of the Human Rights Act which said that ‘no one should be subjected to inhumane treatment’.
What are the psychological therapies for sch?
Family therapy and CBTp.
What is family therapy?
Recommended by NICE for all sufferers. as those in a family of high EE have high relapse rates. Aims to reduce relapse rates and improve the families ability to help. Burbach’s model - psychoeducation, relapse prevention planning and maintenance for the future.
Evaluate family therapy.
Effectiveness - KEY STUDY - Pharoah - reviewed 53 studies across the world and compared outcomes, found mixed findings or mental state, compliance with medication increased, social functioning showed some improvement for general functioning and relapse was reduced (which meant reduced hospital admission).
Further research found relapse was reduced by 50/60%.
BUT improvements may be result of medicine compliance rather than the actual therapy.
Economic benefit - NICE review found that it was cost effective as the cost of family therapy is offset by a reduction in hospitalisation for relapse. It reduces relapse rates for a significant number of time so that savings are higher. BUT it is also good for the whole family which outweighs the economic benefits, as the families overall stress is reduced.
What is CBTp?
Offered alongside drug treatment (As drugs have a calming effect) and they help people cope with symptoms . Goes through phases: e.g. engagement (empathising with patient), ABC model, Normalisation (explaining that everyone experiences unusual experiences) and critical collaborative analysis (gentle disputing and challenging).
Evaluate CBTp.
Effectiveness - NICE review found that when compared to drug treatment alone CBT was effective in reducing rehospitalisation rates and symptom severity. though most studies have used it in combination with the drug therapy therefore it is hard to disentangle the two. also may depend on the stage of sch as it may be more effective in later phases of the disorder rather than the start. small numbers of people for research as it was found that of 117 sufferers, only 13 were offered CBTp.
Quality of evidence is lacking - wide range of techniques and symptoms included in the studies, they very quite a lot (Thomas). Different studies involved people with a different combination of symptoms (so CBTp may have only been effective for those who have a specific symptom). Research also found that the most vigorous the study the weaker the effect of CBT.
May not provide cure - as improves quality of life but does not provide a ‘cure’ for the disorder as it is a largely biological condition. Although studies report significant reductions in severity of symptoms, suggests it does more than enhance coping.
What is a token economy?
A form of therapy where desirable behaviours are selectively reinforced (behaviour modification), the token are secondary reinforcers and the reward is the primary reinforces. Aims to improve socially desirable behaviour to allow institutionalised patients return to the community. Originally done by Allyon and Azrin.
Evaluate the use of a token economy.
Evidence of effectiveness - Glowacki et al - 7 published studies between 1999-2013 of patients with chronic mental health issues living in a hospital setting found a reduction in negative symptoms and a decline in the frequency of undesirable behaviours. A review of 13 studies which used a token economy reported its beneficial effects and concluded there is evidence to the effectiveness in increasing adaptive behaviour.
HOWEVER there is a bias as there was a very small sample used for these studies and the file drawer problem because of this which meant that there are only positive published findings as all the negative ones have been files away. The studies also tend to be uncontrolled.
Ethical issues of token economies - The use of them gives professionals the power to control other people, they impose their norms on others (this is an issue especially if not regarded sensitively). They may restrict the availability of pleasures - which gives the patients an overall worse time in hospital. Goes against a humans basic rights to food, privacy which cannot be violated regardless of positive consequences.
What is the interactionist approach to SCH?
Interactionist approach references to the nature nurture debate, this is the view that biological and psychological explanations work together so that behaviour is explained by this interaction. includes the diathesis stress model which explains mental disorders in terms of the interaction between biological vulnerability and environmental stressors which triggers the disorders - new version suggests that genetics and trauma can be the diathesis and stress. Originally proposed by Meehl who suggested there was a single ‘schizogene’ which was affected by the presence of a ‘schizophrenic mother’.
Evaluate the interactionist approach to SCH.
Research support - Tienari et al - reviewed records of 20,000 female patients in hospitals, 145 adopted away offspring and 158 without a schizophrenic mother. Independently assessed after 12 years then follow up after 21. Used the OPAS scale to rate family functioning. Found of 303 adoptees, 14 developed SCH (11 were from the high risk group), Adoptive family stress was a big indicator as to whether someone developed SCH.
However it is hard to see what stress is from the family and what is from the adoptee themselves.
Application to real world - combination of drug treatment and psychological therapies has been seen as a practical application. Both uses have been found to be effective as found that in groups where people were offered a combination of treatments were the only treatments which had lower symptoms.
Treatment-causation fallacy - a logical error pointed out that saying a successful treatment of medical disorders justified a particular explanation is wrong. It is like saying that taking paracetamol for a headache means that you had the headache because you didn’t take the paracetamol. Therefore we cannot assume the success of treatments means that the interactionist approach is correct.
