SCHIZOPHRENIA Flashcards
Pyschological explanations of schizo 2 theories
Family dysfunction and cognitive explanations
Family dysfunction PE
- schizophrenogenic mother
- double bind
- expressed emotion
Schizophrenogenic mother
FrommReichmann based on accounts of her patients from childhood. Mother is cold, rejecting and controlling and tendes to create tension and secrecy. Leads to distrust later on developing paranoid delusions.
Double bind
Emphasises role of communication. Fear doijg wrong thing but recurve mixed nessafes and cant seek clarification. When child get something wrong they are punished by withdrawal of love. Leaving them confused disorgsnised thinking and paranoid delusions. Risk factor
Expressed emotion
EE is levek if emotion expressed towards person by carers.
- verbal critisism
-hostility
-overinvolvement
Explanation for relapse but can trugger onset of schizo
Cognitive explanations
- dysfunctional thinking
- metarepresentation dysfunction
- central control dysfunction
Dsyfunctional thinking ventral striatum
Reduced thought processing in thr ventral striatum is accociated with negative symptoms
Dysfunctional thinking temprial and cingulate gyri
Reducest proccesing in temporal and cingulate gyri is assocaitrd with hallucinations
Metarepresentation dysfunction
Frith - cognitive ability to reflect on thoughts and behaviour. Insoght into own intentions and goals and others. Dysfunction would disrupt out ability to recognise out own actions and thoughts as being carried out by ourselves rather than somone else.
Central control dysfunction
Frith - issues with cognitive ability to suppress automatic responses while we performe delivrate actions. Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts.
What % of people does it affect
1%
When do symtoms start
15-45 most likely in men
Definition if schizo
Break from reality positive symptoms hallucinations and delusions negative symptoms avolition and speedh poverty
Avolition
Lack of purposeful, no energy and lack of sociability
Butzlaff and hooley PE
shower using meta analysis of 27 studies that relapse into schizo is more likely in familys with issues of exoressed emotion
Tienari PE
Studies biological children of schziophrenic mothers who had been adopted , fourn that 5.8% of adopted in healthy families developed schizo compared to 36.8% of children raised in dysfunctional families.
Firth evidence for cognitive explanations
30 schizo patients with various symptoms had PET scans. These scand showed reduction in blood flow in the frontal cortex with patienst with negative symptoms. Increase in blood flow in temporal love with patients with reality disortion
Stirling central conttol AO3
Stroop test on 30 patients with schzio and controls. Patients with schizo took twice as long ti name colour as controls due to dysfunctional thought processing
halluncinations
unusual sendory experiences
delusions
irrational beleifs
speech poverty
reduction in quality and amount of speech
avolition
loss of motivation. Lack of hygience, persistence and energy.
Ripke
108 seperate genetic variations associated with risk of schizo
dopamine hypothesis
high levels of dopamine in subcortical areas of the brain lead to positive symptoms and low levels lead to negative symptoms.
read PE
69% of women and 59% of men have experienced physical or sexual abuse in childhood
typical drugs
used since 1950s work as dopamine antagonists and include chlorpromazine.
antipsychotics
drugs to reduce intensity of symptoms of psychotic disorders
atypical drugs
target a range of neurotransmitters such as dopamine and seretonin eg clozapine and riperidone
chlorpromazine
dopamine antagonist. Reduces action of dopamine through blocking dopamine receptors in synpases of brain.Reduces positive symptoms.
clozapine
acts on seretonin and dopamine. Improves mood reducing deprssion and anxiety. Good as 30-50% of schizos commit suicide.
risperidone
less side effects than clozapine. Binds more strongly to dopamine receptors than cloazpine so more effective.
Thornley
reveiwed studies comparing effects of chlorpromazine to controls. More effective than placebo.
meltzer
clozapine is more effetive than typical antipsychotics and other atypicl
side effects typical
dizziness, sleepiness and weight gain
CBT
used to treat people with schizo aims to deal with both thoughts and behaviour
how CBT helps
make sense of their irrational cognitions and how it impacts their behaviour improves their ability to function.
family therapy
aims to improve quality of communication and interaction between members of family
pharoah
identified strategies that family therpaists use to try to improve functioning of a family that has a member with schizo. Reduce negative emotions and improve families ability to help
Burbach
proposed a model for working with families dealing with schizo.
phase 1 Burbach
sharing basic info and providing emotional and practical support
phase 2 burbach
involves identifying what diff family members can do
phase 3 burbach
encourage mutual understanding creating a safe space
phase 4 burbach
identifying unhelpful patterns of interaction
phase 5 burbach
skills training such as stress management techniques
phase 6 burbach
relapse prevention planning
phase 7 burbach
maintenance for future
Jauhar
reviewed 34 cbt studies and concluded cbt had a sinifciant but fairly small effect on posiitve and negative symptoms of schizo
mcmonagle and sultana
review of evidence for token economies found only one of 3 studies showed improvements in symptoms
defintion of token economies
reward systems used to manage behaviour of people with schizophrenia in partciualr those who devekloped patterns of maladaptive behaviour through spending long periods in hospitals.
ayllon and azrin
trailed token economy in ward of women. Tokens could be swapped for ward priviligedges. Number of tasks increased significantly.
institutionalisation develops due to
prolonged hospitilisation.
matson
identified 3 categories of institutional behaviour tackled by token economies: personal care, condition related behaviours an social behaviour.
what is involved in token economy
tokens are given out when a desired behaviour is carried out the tokens are swapped out for tangible rewards.
tokens are
secondary reinforcers and rewards are primary reinforcers
Glowacki
identified seven studies that showed a reduction in negative symptoms and decline in frequency of unwanted behaviours.
interactionist approach
vunerability + stress trigger
meehl’s model
vunerability was entirely genetic single schizogene.
Modern understanding of diathesis
polygenic. range of factors beyond genetic inc psychological trauma which can affect brain development
modern understanding of stress
stress includes anything that risks triggering schizophrenia. eg. cannabis increases risk up to 7 times.
Tardive dyskinesia
Uncontrollable muscle movemdntd
Bagnall
Compare typical and atypical drugs found atypical was far more effectuve in treating oversll symptoms clozapine was most effectuvd
How many people who take antipsychotic drugs relapse
2/3
Sensky
Showed that patients who resisted drug treatments had a reduction in positive and begatjve symptoms after 19 cbt sessions
Famiky therapy aims to
- reduce conflict
- refuce stress
- reduce self sacarfucs
- improve communication
- improve problem solving skills
Leff
8% releapsed after family therapy compares to 50% with standard outpatient care
Dickenson
Looked ar 13 token economy studies and it was effectuve in improving the adaptuve begaviour of people
Gottesman
Found concordance rate MZ 48% and 17% in DZ partky genetic but not 100%
Interactionist approach
- more valid
- research support
- nature nurture debate
- holistic
- over simplistic
- real world app
what % have schizo
1% more common in men
positive symptoms
hallucinations and delusions
hallucinations
sensory experiences
delusions
irrational beliefs
negative symptoms
speech poverty and avolition
