schizophrenia Flashcards
what does the term ‘schizophrenogenic’ mean
schizophrenia causing
what is family dysfunction (SZ)
psychologists have tempted to link childhood and adult experiences of living in a dysfunctional family to SZ the three explanations the schizophrenogenic mother double-bind theory expressed emotion (EE)
the schizophrenogenic mother (key ideas)
- they are cold, rejecting and controlling
- create tension and secrecy
- can lead to distrust, developing into paranoia and delusions
double-bind theory (key ideas)
- the communication style in family
- children feel trapped in situations and fearful of wrong doings, making them feel unable to comment on fairness
- children then get punished through withdrawal of love which leave the children confused
- can lead to disorganised thinking
expressed emotion (EE / key ideas)
level of (typically) negative emotions towards a patient by a carer
- verbal criticism, accompanied by violence
- hostility towards patient, anger, rejection
- emotional over-involvement in life
- high levels of EE in carer are a serious source of stress and prone to relapses. although they may already be vulnerable due to genetic makeup
cognitive explanations (overview)
- focuses on roles of mental processes
- reduced processing in the ventral striatum is associated with negative symptoms
reduced processing of info in the temporal and cingulate gyri is associated with hallucinations
Frith et al (1920)
identified two kinds of dysfunctional thought processing:
- metarepresentations
- central control
what is metarepresentations?
- ability to reflect on thoughts and behaviours
- interpret the actions of others
- dysfunction would disrupt our ability to recognise our own actions and thoughts
- explains hallucinations of voices and delusions
what is central control?
- ability to suppress the automatic responses whilst preforming deliberate actions instead
- disorganised speech and thought disorder could result from inability to suppress automatic thoughts and speech triggered by other thoughts.
drug theory AO1
most common treatment is anti psychotics
two main: typical anti and atypical anti
typical antipsychotics (1950s)
worked as a dopamine antagonist: chlorpromazine
Antagonists reduce action of neurotransmitter dopamine
by blocking dopamine receptors in synapses of the brain
this normalises the neurotransmission in keys areas of brain (reducing hallucinations)
chlorpromazine is sedative and is first given to people admitted to hospitals
atypical antipsychotics (1970s)
the aim was to improve the effectiveness of drugs in suppressing symptoms and minimising side effects
two types: clozapine and risperidone
clozapine AO1
developed 1960s but withdrawn in 1970s due to risk of agranulocytosis
it was then remarketed as it was tougher and more effective than TA (but patients do need regular blood tests)
binds to dopamine receptors and acts on serotonin and glutamate receptors
risperidone (1990s) AO1
aim was to produce a drug just as effective as czp but less side effects
small dosage initially given
binds most strongly to dopamine receptors
SZ drug therapy AO3 - evidence for effectiveness
research compared effects for chlorpromazine compared with a placebo (experiences were identical) and found that chlorpromazine was associated with better overall functioning and reduced symptom severity (relapse rate also lower). thus effective (30-50% effective in treatment-resistant cases where typical anti’s have failed.
Sz drug therapy AO3 - anti psychs depend on dopamine hypothesis
there’s evidence to suggest the hypothesis explanation is incomplete and that dopamine levels in parts of the brain other than the subcortex are too low rather than too high.
thus its not clear how anti psychs help SZ
SZ drug therapy AO3 - side effects mild-fatal
these include dizziness, itchy skin, weight gain. long term can result in tar dive dyskinesia (involuntary facial movements eg blinking). worse side effects like neuroplastic malignant syndrome caused by drug blockage in hypothalamus. however, atypical are made to reduce side effects but clozapine still needs regular blood tests for it to be dosed.
SZ drug therapy AO3 - the chemical cosh argument
they have been used in hospitals to calm patients and to be made easily cooperative. although being recommended by the national institute of health and clinical excellence, it is sometimes seen as human rights abuse. thus it is unethical (controlling) and takes away individual personality responsibility ( but they may not be able to give consent due to their position psychologically)
3 psychological therapies
CBT
family therapy
token economics
CBT AO1
based on cognitive and behavioural techniques
aim to deal with thinking (negative thoughts)
5-20 sessions
group / individual
aim to challenge rational thoughts
won’t get rid of symptoms but will help patient cope
how CBT helps
help to make sense of how their delusions/ hallucinations impact their feelings
understanding where behaviours come from
offering psychological explanations can reduce anxiety associated with symptoms
imp to know they’re not based on reality
family therapy AO1
improve quality of communication and interaction between family members
use double-bind theory and sz mother to recognise if family are the root
Pharoh et al identified strategies to help
- form alliance w family
- reduce stress of care giver
- ability of family to anticipate and solve problems
- help a family member achieve balance between patient and own life
- reduce anger and guilt in family
token economies AO1
reward system used to manage behaviour of patients- bad hygiene is a risk so modifying these habits improve the patient’s quality of life
tokens: coloured discs given to patients immediately for achieving certain tasks -immediacy is important as it prevents ‘delay discounting’, the reduced effect of a delay reward.
rewards: tokens can be swapped for tangible rewards, based on operant; conditioning. These may be sweets, magazines, services such as room cleaned.
