schizophrenia Flashcards
What is schizophrenia ?
SZ is a mental illness where contact and insight with reality is impaired and is an example of psychosis.
Positive symptoms are an excess/distortion of normal functions
What are the positive symptoms of schizophrenia?
Hallucinations
Delusions
Psychomotor disturbances such as pulling hair and rocking
Disordered thinking
Negative symptoms are the loss of normal functions and are usually harder to treat
What are the negative symptoms of SZ?
Affective flattening: Loss of emotive language and facial expressions
Alogia: Speech poverty, lack of words
Avoliation: Lack of motivation for everyday activities and becoming apathetic
What are some additional social and occupational dysfunctions that come with SZ?
Loss of ability to make friends, being unable to work and appearing lazy and unmotivated..
How would you diagnose SZ?
The use of the DSM and ICD which classify SZ when the supposed sufferer shows two symptoms and other social + occupational dysfunction for a month straight.
What does the psychological explanation of SZ propose?
The psychological explanation of SZ proposes that mental disorders arise from unresolved conflicts during childhood and are manifestations of imbalances between the ID, EGO and SUPEREGO.
How does the psychological explanation of SZ propose that SZ can be recovered from?
Disorders can be resolved when coming intro terms with the repressed ideas and conflicts.
What does the family dysfunction explanation of SZ propose? What are some features of schizophrenic parents?
The family dysfunction explanation proposes that maladaptive relationships and bad patterns of communications are a source of stress and can influence the development of schizophrenia.
These parents are called schizophrenic parents who have high levels of interpersonal conflict, difficulty communicating and are critical of their children.
How can he imbalance of the psychological personalities explain SZ?
What symptoms can this explain?
SZ is believed to be the result of regressing to the pre-ego stage where the ID is control which is the hedonistic part of our personality where we are unaware of wrongs and right and do not have a real awareness of the world. The individual will regress to a primitive state.
This can explain delusions.
Who proposed the idea of a schizophrenogenic mother and what characteristic will she have?
Reichman, who agreed with Freud that disordered families were the cause of SZ, 1948 believed that schizophrenogenic mothers influence the development of schizophrenia.
They are rejecting, but over protective, dominant, cold and moralistic.
How do Waring and Ricks contradict Reichmanns beliefs?
Waring and Ricks found that mothers of schizophrenics were anxious, shy and withdrawn which do not match with the characteristics proposed by Reichmann and additionally they believed that there was no clear difference between mothers of SZ and mothers of non-SZ which questions the cause and effect.
What is the double bind theory?
The double bind theory proposed by Bateson et al suggests that children who frequently receive contradictory messages from their parents and more likely to develop SZ as this prevents the development of a regular structure of reality and lead to symptoms such as affective flattening.
What is the expressed emotion (EE) explanation of SZ?
This theory suggests that a high level of expressed emotions. which could be the over involvement of family and critical talking of SZ, increase the relapse rates of schizophrenics due to stress.
What did Kalafi and Torabi find out regarding EE in Iran?
Kalafi and Torabi found that in Iran, where families have a high prevalence of EE, are one of the main reasons for relapse rates due to stress which can trigger an SZ episode.
Evaluate the family dysfunction explanation of SZ
+ Has positive implications, Hogarty developed a family therapy aimed to reduced the levels of expressed emotions within families and reduce family conflicts which have found to lower relapse rates.
+Berger found that Sz’s reported higher levels of double blind statements during their childhood than healthy induviudals
=Cause and effect is questionable, suggested by Warings and Ricks that there is no real difference between the mothers of SZ and non SZ
=Heavy blame placed on mothers, social implications
=Does not consider the biological explanation of SZ which may not be able to be controlled by the treatment of family problems
What does the cognitive explanation suggest about SZ?
The cognitive explanation suggests that maladaptive behaviour is the result of faulty/irrational thinking regarding a situation rather than the problem itself and you can recover from it by becoming rational and positive in your thinking.
Frith et al identified two dysfunctions involved in cognitive thought process to explain SZ symptoms. what is meta representation and what does it cause when disturbed?
Meta representation is the cognitive ability to reflect on ones own thoughts and behaviours to interpret their own actions and that of others.
Dysfunction in meta representation would disrupt our ability to recognise our own actions and percieve our actions being carried out by someone else rather than ourselves.
This can explain hallucinations of voice and delusions
Frith et al identified two dysfunctions involved in SZ, what is central control and what does it cause when disturbed?
Central control is the cognitive ability to suppress automatic responses while be preform deliberate actions.
Dysfunction in the central control can lead to disorganised speech and disordered thinking as you are unable to suppress automatic thoughts and speech and one thing is triggered by another.
What did Helmsly propose ? ( Cognitive theory )
Helmsly proposed the cognitive theory of SZ and stated that perception and memory combine regularly in healthy individuals however fail to do so in SZ sufferers.
SZ breaks down the connection between the two and therefore individuals with SZ are unable to [predict what will happen next as their schemas are not in tact and will be more likely to pay to unimportant aspects of the environment.
Evaluate the cognitive approach
+ Has led to the development of useful cognitive behavioural therapy which has been found useful in managing schizophrenic symptoms such as delusions
+ Supported by Bowie and Harvey as they discovered that cognitive impairments such as lack of attention and working memory are present throughout the course of SZ
= Cause and effect comes into question
= Reductionist approach as it does not consider the biological aspect
= Cannot explain positive symptoms such as affective flattening
What does the genetic explanation suggest about SZ?
The genetic explanation suggests that SZ is transmitted through hereditary means, and that Sz is a polygenic illness (cause through multiple genes)
How does Gottesman 1991 support the genetic explanation of SZ?
Gottesman discovered through meta analysis of 40 twin studies that the concordance rate of SZ in MZ twins is about 48% while in DZ it is 17%. Suggests that there is a genetic component involved.
How can CBT be used to treat SZ?
Cognitive behavioural therapy aims to treat SZ by using the principles of the cognitive explanation by challenging maladaptive thoughts through reality testing and identifying irrational thoughts and considering other possibilities.
For example by asking, It is possibility, but there could be other explanations, how do you know it is the mafia?
Provides a psychological explanation for their symptoms such as their delusions and hallucinations
What is personal therapy and what techniques do they use?
Personal therapy is a CBT approach therapy that involves only the patient and therapist who will recommend techniques to improve SZ symptoms .
For example, distractions from intrusive thoughts, increasing or decreasing social activity to improve low mood, relaxation techniques etc..
What is family therapy?
Family therapy is a psychotherapy which aims to reduce tensions and improve communications within families which will lower levels of expressed emotions and therefore relapse rates and additionally give insight to families on how to deal with Sz symptoms
What are some techniques Fiona Pharoh recommend to treat SZ via family therapy? What are some positives of these techniques? What is important during family therapy?
+ Reduce the stress for taking care of a SZ patient
+ Reduce anger and guilt
+ Help manage caring for a SZ while balancing their own lives
+ Improve their critical beliefs towards SZ
These techniques reduce stress and increase a patients compliance with medicine and lower relapse rates
Openness is an important factor in family therapy and essential for treatment
How can token economics be used to treat someone with SZ?
Token economics is a treatment baed on the principles of operant conditions
When a positive behaviour is shown, they will be rewarded with a token which can be exchanged later on which can help treat negative symptoms such as maladaptive behaviour.
They do not punish undesirable behaviour
Evaluate CBT as a treatment for SZ
+ Supports the case for combined treatment as it works very effectively when paired with drug therapy
Tarrier found that compared to drug therapy in isolation, schizophrenics had a large reduction in symptoms when paired with CBT
=Not suitable for all patients as not all SZ sufferers will be willing to engage with CBT, also it is a long process and may have a high drop out rate due to an SZ episode
= Trower et al reported that CBT does not actually get rid of SZ and its symptoms but only reframe them as less of a threat
Evaluate family therapy as a treatment for CBT
+ Has positive economic implications as therapy decreases relapse rates, less need to go back to psych wards and additionally parents can go to work as they are more likely to be able to manage their lives and the SZ symptoms
+ Useful for sufferers that lack insights of their illness as family members can inform the therapist their problems
=Effectiveness treatment is dependent on the openness of the family as they may be reluctant to share sensitive information
=Does not consider all individual differences
Evaluate token economics as a treatment for SZ
+ Facilities are more stable as the environment is therapeutic meaning staff and patient injuries decrease
+ Flexible source of treatment as it can be used to target and stamp in any positive type of improvement behaviours and meet different individual requirements based on what rewards they will exchange the tokens for
=Does not punish undesirable behaviour and good behaviour becomes dependent on the rewards, what will happen once the reward is not present in regular society
=Can be seen as dehumanising
What are the two types of drugs used to treat antipsychotics?
The drugs typical antipsychotics and atypical antipsychotics are used to treat SZ and reduce symptoms and live normal lives
What is clorpromazine? How does it work?
Clorpromazine is a typical antipsychotic which are generally used to treat positive symptoms of SZ such as hallucinations and delusions
It works antagonistically against the dopamine system by blocking dopamine receptors in the synapse, the level will initially increase and then be destroyed in the synapse
What are the side effects of clorpromazine?
Clorpromazine is an affective sedative which affects other neurotransmitter systems such as the serotonergic mechanisms
Side effects include a dry mouth, constipation and Hill 1986 found that 30% develop tardive dyskinesia which causes uncontrollable muscle movement and could become permanent
Evaluate the use of typical antipsychotics in treating SZ
+ Davidson et al found that typical antipsychotics side effects can lead to patients not wanting to take their medicine resulting in a relapse of symptoms
=Has led to enormous improvements on how patients were treated as out of 300,000 SZ sufferers in institutions, after the development of drug therapy, only 3% were permanent residents
What is the aetiology fallacy?
This suggests that although drugs can treat psychotic symptoms, it does not necessarily mean that disorders are caused by biological factors.
What are atypical antipsychotics?
Atypical antipsychotics are second generation antipsychotics that work similarly to first generation antipsychotics ( attach to dopamine receptors to prevent its excess release ).
What is clozapine and how does it work? What side effects can it pose?
Clozapine is an atypical antipsychotic and is more effective than typical antipsychotics as it can work on serotonin and glutamate receptors which improve mood and depression to improve cognitive functioning in the brain .
Although it produces less side effects than typical antipsychotics, it still has some side effects such as causing agranulocytosis which effects the blood and increase risks of strokes and cardiac death
Evaluate drug therapy as a whole
+ Production of atypical/ second generation antipsychotics led to less symptoms and shows how science is rapidly developing more effective treatments for SZ
+ Cheap and easy to use and is flexible by combining with CBT for the most effective treatment
+Positive economic implications by returning people into society and work
=Bad side effects can make people not want to take them, more relapse rates, if too much taken it can lead to very bad heath
=Dependent on the sufferers ability to take the drugs, may miss it due to a psychotic episode which can have very bad effects
e.g Davidson et al
What is the diathesis stress model of SZ?
The diathesis stress model proposes that both a venerability to SZ and a stress trigger are necessary for the development of SZ
What did Meehls model suggest about the interactionist approach to Sz?
Meehel suggested that the disposition to SZ was entirely genetic and caused by a schizogene which made the person more vunrable to stress and therefore more likely to develop SZ
Without the gene it is impossible to get SZ no matter how much stress
How is meehls model challeneged?
Recent research has found that Sz is a polygenic disease and cannot be determined by a singular gene as that is reductionist and also a disposition to Sz could also appear in the form of psychological factors such as trauma
What did Hogarty et al find about the interactionist approach to treatments?
Hogarty et al assessed 103 Sz paitents from high EE families recieving various treatments and found that those who had a combined treatment of both CBT and drug therapy had no relapse rates in the first year..
However!
A follow up study suggested that tis only delays relapse rather than prevent it
Evaluate the interactionist approach to SZ
+It is a holistic approach which combines all aspects meaning that less detail is missed when considering what can cause Sz, more reliable
+ Led to the most effective treatment of Sz, proposed by hogarty et al who found 0% relapse rates in the first year
+ does not attempt to simplify human behaviour
=A follow up study showed that it only delayed relapse rates not stop them suggesting that although combining all approaches are good, there still needs to be more research conducted on what is causing SZ
+ Cultural and gender differences
