schizophrenia

Question 1

define antipsychotics

Answer 1

drugs used to reduce the intensity of symptoms

Question 2

define typical antipsychotics

Answer 2

have been around from the 1950s
the first generation of antipsychotics, they work as dopamine antagonists
orally dosage = 1000 mg maximum
initial dosages are much smaller 400 to 800 mg

Question 3

define atypical antipsychotics

Answer 3

drugs for schizophrenia developed after typical antipsychotics - target a range of neurotransmitters such as dopamine and serotonin

Question 4

is chlorpromazine typical or atypical

Answer 4

typical

Question 5

how is chlorpromazine administered

Answer 5

taken as tablets syrup or injection

Question 6

how is chlorpromazine effective

Answer 6

300 to 450 mg a day dosage
association between the drug and the dopamine hypothesis
an antagonist against the dopamine system reducing the action of a neurotransmitter. blocks the dopamine receptors in the synapse of the brain, reducing the action of potential. Initially the dopamine levels increase but then the production is reduced. the dopamine antagonist effect normalises neurotransmission in key areas of the brain reducing symptoms like hallucinations

Question 7

is chlozapine atypical or typical

Answer 7

atypical

Question 8

is risperidone atypical or typical

Answer 8

atypical

Question 9

how does clozapine work

Answer 9

binds to the dopamine receptors and acts on serotonin and glutamate receptors. it is believed this helped improve mood and reduce depression and anxiety improving cognitive functioning. - prescribed to those considered high risk of suicide - 30/50% of schizophrenia patients attempt suicide

Question 10

how does risperidone work

Answer 10

4 to 8 mg with a maximum of 12 mg
was developed to have the same effectiveness as Chlozapine but without the serious side effects.
binds to dopamine and serotonin receptors but binds more strongly to dopamine receptors than chlozapine so is effective in much smaller doses - some evidence this less to fewer Side effects

Question 11

evaluation of drug treatments - evidence for effectiveness

Answer 11

supports the idea atypical and typical antipsychotics are at least moderately effective. Thornley et al 2003 reviewed studies comparing chlorpromazine to control conditions of a placebo, data from 13 trails totalling 1121 participants showing chlorpromazine was associated with better overall functioning .
Meltzer 2012 conclude chlozapine is more effective and that it is 30-50% effective in treatment resistance cases where typical antipsychotics failed

Question 12

evaluation of drug treatments - serious side effects

Answer 12

typical antipsychotics associated with dizziness, sleepiness, weight gain etc - long term use can result in tardive dyskinesia caused by dopamine super sensitivity/ the most significant side effect was neuroleptic malignant syndrome

Question 13

evaluation of drug treatments - use of antipsychotics

Answer 13

evidence to show the dopamine hypothesis is not complete explanation for schizophrenia, and that in fact dopamine levels in parts of the brain other than the sub cortex are too low rather than too high. - if it is true then it is not clear how dopamine antagonists can help with the schizophrenia when they reduce dopamine activity

Question 14

define family dysfunction

Answer 14

abnormal processes within family such as poor family communication, cold parenting and high levels of expressed emotion. these ma be risk factors for both the development and maintenance of schizophrenia

Question 15

define the schizophrenogenic mother

Answer 15

Freida fromm-richmann 1948 propoaws. psychodynamic approach for schizophrenia based on childhood accounts. noted that many of her cases mentioned a particular type of parent- schizophrenogenic mother. this mother is cold, rejecting and controlling, tends to create a family climate characterised by tension and secrecy. leads to distrust the later develops to paranoid delusions

Question 16

define the double bind theory

Answer 16

Gregory et al 1972, agreed that family climate is important in the development of schizophrenia but emphasised the role of communication style within a family. The developing child regularly fins themselves trapped in situations where they fear doing the wrong thing, but received mixed messages about what this is and feel unable to commoner on the unfairness of the situation. when the child gets it wrong the child is punished through the withdrawal of love so leadings to them thinking the world is confusing and dangerous, reflected in paranoid delusions and disorganised thinking.

Question 17

define expressed emotion

Answer 17

is the level of negative emotion expressed towards a person with schizophrenia by their carers
-verbal criticism
-hostility towards a person
-emotional over-involvement
serious source of stress- primary explanation for the relapse in patients. may trigger the onset due to their genetic make-up

Question 18

cognitive explanation for schizophrenia

Answer 18

schizophrenia is associated with several types of abnormal information and these can provide possible explanations for schizophrenia. Schizophrenia is characterised by disruption to normal thought processing

Question 19

kinds of dysfunctional thought processing did Christopher frith et al 1992

metarepresentation

Answer 19

Christopher et al 1992
metarepresentation - the cognitive ability to reflect on thoughts and behaviour. this allows us insight into our intentions and goals. dysfunction in metarepresenation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else- this would explain hallucinations

Question 20

kinds of dysfunctional thought processing did Christopher frith et al 1992

central control

Answer 20

is the cognitive ability to suppress automatic responses while perform deliberate actions instead. disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts.

Question 21

what two kinds of dysfunctional thought are there

Answer 21

central control

metarepresentation

Question 22

evaluation for psychological explanations

Answer 22

support for family dysfunction as a risk factor - read et al 2005 reviewed 46 studies of childhood abuse and schizophrenia concluded 69% adult women in-patients with a diagnosis of schizophrenia had a history of physical and or sexual abuse in childhood. was 59% in men. adults with insecure attachment to their primary carer are also more likely to have schizophrenia berry et al 2008
weak evidence- lack of evidence for schizophrenogenic mother or double bind theory. led to historical parent blaming, leads to trauma for their parents being blamed for their Childs condition
strong evidence for dysfunction information - Stirling et al 2006 compared 30 people with a diagnosis with 18 controls on a range of cognitive tasks including the troop test. in line with frith’s theory of central control dysfunction, people with schizophrenia took twice as long in the stroop test. however links between symptoms and faulty cognition are clear but doesnt mention the origins of conditions

Question 23

what is CBT

Answer 23

a method for treating mental disorders based on both cognitive and behavioural techniques. from the cognitive viewpoint the therapy aims to deal with thinking such as challenging negative thought. the therapy also includes behavioural techniques

Question 24

how CBT helps

Answer 24

Turkington et al 2004

people can be helped to make sense of their delusions and hallucinations impact on their feelings and behaviour.

Question 25

what is family therapy

Answer 25

a psychological therapy carried out with some or all of the members of a family

Question 26

how family therapy helps

Answer 26

helps to improve the quality of communication and interaction between family ember to reduce stress within the family that might contribute to a persons risk of relapse. in particular aims to reduce levels of expressed emotion

Question 27

what are the technqiues of family therapy

Answer 27

Fiona Pharaoh et al 2010 identify a range of strategies.

• forming a therapeutic alliance with all family members
• reduce the stress of caring for a relative with schizophrenia
• improving the ability of the family to anticipate and solve problems
• reduction fo anger and guilt
• helping family achieve a balance of caring and maintaining their own lives
• improving families beliefs about schizophrenia

Question 28

what are token economies

Answer 28

reward systems used to manage the behaviour of people with schizophrenia in particular those who have developed patterns of maladaptive behaviour through long periods of time in psychiatric hospitals
tokens- tokens are given immediately to patients when they have carried out desirable behaviour that has been targeted for reinforcements
rewards- although tokens have no values they can be swapped later for more tangible rewards.

Question 29

evaluation of psychological therapies -

Answer 29

ethical issues - token economies privileges become more available to patients with mild symptoms and less so for those with more severe symptoms of schizophrenia that prevent them from complying with desirable behaviours.
improve life but don’t cure - CBT allows a person to make sense of and in some case challenge their symptoms, family therapy helps by reducing stress of living with schizophrenia in a family
however this doesn’t cure it
evidence for effectiveness - Sameer Jauhar et al 2014, reviewed 34 studies of CBT for schizophrenia has a significanct but fairly small effect on both postitive and negative on symptoms

Question 30

define the diathesis-stress model

Answer 30

says that both a vulnerability to schizophrenia and a stress-trigger are necessary in order to develop the condition. one or more underlying factors make a person particularly vulnerable to developing schizophrenia but the onset of the condition is triggered by stress

Question 31

what is meehl’s diathesis-stress model

Answer 31

in the original 1962 model, diathesis vulnerability was entirely genetic the result of a ‘schizogene’. this led to the development of a biologically based schizotypic personality, one characteristic of which is sensitive to stress. according to Meehl if a person does not have the schizogene, then no amount of stress would lead to schizophrenia. However, in carriers of the gene, chronic stress through childhood, especially in the presence of a schizophrenogenic mother could result in the development

Question 32

the modern understanding of diathesis

Answer 32

now Clear many genes each appear to increase genetic vulnerability slight- not a single schizogene.
also include a range of factors beyond genetics including psychological trauma-so trauma becomes the diathesis rather than the stressor.
read et al 2000 suggested a neurodevelopment model which early trauma alters the developing brain. eg the hypothalamic-pituitary-adrenal can become over-active making the person much more vulnerable to later stress

Question 33

the modern understanding of stress

Answer 33

in the original, stress was seen as psychological in nature/
although psychological stress including that resulting from parenting may still be considered important, a modern definition includes anything that risks triggering schizophrenia
eg research into the risks of cannabis as it increases the risk of schizophrenia by up to 7 x as it interferes with the dopamine system

Question 34

treatment according to the interactionist model

Answer 34

acknowledges both biological and psychological factors
combines antipsychotic medication and psychological therapies, CBT
Turkington et al 2006 believes its acceptable to believe in biological causes and still practice CBT

Question 35

evaluation of the interactionist approach

Answer 35

role of vulnerability- evidence to support the dual role
Tienari et al 2004 investigates this, children adopted from 19,000 Finnish mothers with schizophrenia were followed up, the adoptive parenting style was assessed and compared to a control group- child rearing style of criticism and lack of empathy was implicated in the development but only if the children were at high genetic risk
original model is oversimple- a single schizogene and schizophrenic parenting is over simple - multiple genes increase the vulnerability to schizophrenia
support for effectiveness in treatment- tarrier et al 2004 315 people with schizophrenia were randomly allocated to a medication + CBT group-, medication + supportive counselling. people in the two combination groups showed lower symptoms than those only on medication although there was no difference ins rates of hospital transmission

Question 36

define positive symptoms of schizophrenia

Answer 36

atypical symptoms experiences in addition to normal experiences this includes hallucinations and delusions

Question 37

define hallucinations

Answer 37

sensory experiences of stimuli that either have no basis in reality or are a distorted perception of reality

Question 38

define delusions

Answer 38

beliefs that have no basis in reality

Question 39

define negative symptoms of schizophrenia

Answer 39

atypical experiences that represent the loss of a usual experience
includes avolition and speech poverty

Question 40

define speech poverty

Answer 40

reduced frequency and quality of speech

Question 41

define avolition

Answer 41

loss of motivation to carry out tasks and results in lower activity levels