schizophrenia Flashcards
Psychological approach 1: Family dysfunction explanations for sz
Family dysfunction explanations focus on the role of dysfunctional communication patterns within the family.
The first of these is the schizophrenogenic mother. This is a Freudian idea by Fromm-Reichman who described a cold, rejecting mother who creates conflict in the home with secrecy and distance. The leads to the child feeling distrust which leads to paranoid delusions.
A03 - The schizophrenogenic mother explanation has very little evidence to support it. By the 80s it was obvious that only a small percentage of women who might fit the criteria had actually produced sz children. This theory could also be argued to be rather damaging because it blamed mothers and therefore placed further trauma on mothers who were already suffering with ill children). Therefore, this explanation is not useful and rather socially sensitive.
Psychological approach 1: Family dysfunction explanations for sz 2
The 2nd explanation is the double bind theory. This explanation says that contradictory messages from parents (such as being punished for doing what was asked) leads to the child to being confused and lose grip on reality. This prevents them from forming a coherent sense of reality which is linked to delusions and social withdrawal.
There is however evidence to support the double bind explanation.
Berger found that sz ps recalled a higher number of double bind statements from their childhood from their mothers than non-sz ps. This suggests some role of double bind messages in the onset of sz. However, we should be very cautious when looking at evidence based on the recall of sz ps. Their recall may not be accurate for childhood experiences as it may be distorted by their disorder Therefore this is less convincing evidence for family dysfunction.
Psychological approach 1: Family dysfunction explanations for sz 3
The final explanation is expressed emotion. This is a communication style in the home which includes levels of certain emotions such as hostility, criticism and emotional over-involvement. This has been linked to relapse in sufferers returning to the home after treatment.
A03 - It is unclear whether expressed emotion is causal factor in relapse or whether it is a reaction to the patient’s behaviour. For example, if the individual starts to show symptoms again it would make sense that their parents might become emotionally over-involved. So it is difficult to make a conclusion about the role of expressed emotion in relapse.
These explanations ignore the role of biological factors in sz which research has suggested at least is an influence. Perhaps an interactionist approach would be a more complete explanation (a genetic vulnerability that is triggered by double bind statements in childhood/ expressed emotions in the home).
Psychological approach 2: The cognitive approach
The cognitive approach to explaining sz is interested in mental processes and it explains the symptoms of sz as abnormal information processing.
This approach does accept the role of biology. If activity in certain areas of the brain (the ventral striatum for example) is low, information in this area will not be processed well.
Frith identified 2 kinds of dysfunctional thought processing which could underlie some symptoms.
Metarepresentation means reflecting on thoughts and behaviour, understanding of our own and others’ behaviour. In sz it is thought to be dysfunctional, so sufferers might interpret their own thoughts as external voices (auditory hallucinations).
Another deficit is in central control which is the ability to suppress automatic impulses and act with intention. Deficits in central control will lead to disorganised speech and thoughts.
A03 - Stirling conducted research supporting the deficit of central control in sz. He compared ps with sz and a control group on the stroop test (where you have to supress your impulse and name the colour of the ink and not the colour that is written). Sz ps took over twice as long to do this task so this suggests that sz does involve a dysfunction of central control.
However, research may show a link between cognitive dysfunction and symptoms of sz but it doesn’t show that cognition causes the sz in the first place. This makes it less useful as a theory because it doesn’t tell us where sz started in the individual, so we cannot prevent it. The direction of causality is not clear between biology and cognitions. It is unclear whether levels of activity in the brain lead to the cognitions or whether the cognitions alter the brain chemistry.
Drug therapy
Antipsychotics are a type of medication taken as tablet/ syrup/ injection which work on neurotransmitter dopamine. Typical antipsychotics (developed in the 1950s eg chlorpromazine) are dopamine antagonists; they reduce DA activity in the brain by blocking DA receptors which reduces the severity of positive symptoms (hallucinations) and has a sedative effect.
A03 - Thornley compared the outcome for patients on typical antipsychotics and a placebo group. Chlorpromazine was found to be associated with better overall functioning and lower relapse rate. This suggests that typical antipsychotics are effective.
However, one limitation of typical antipsychotics is the side effects that patients can suffer with. Typical antipsychotics can result in tardive dyskinesia (involuntary twitching in the face and limbs). This discourages patients from continuing the medication which will reduce the effectiveness.
Drug Therapy 2
Atypical antipsychotics eg Clozapine were first developed in the 1970s. They also binds to DA receptors but also act on serotonin they works on negative symptoms linked to serotonin as well as dopamine. Risperidone was developed in the 1990s it also works on DA and serotonin. Smaller doses are needed because it binds more strongly to DA receptors, this reduces side effects.
A03 - Meltzer found that atypical antipsychotics (Clozapine) were more effective than typical antipsychotics. They were effective in 30-50% cases where typical antipsychotics had failed. This shows clear benefits of choosing atypical antipsychotics.
Atypical antipsychotics also have fewer side effects since they can be taken in smaller doses. They should therefore be more effective than typical since patients are unlikely to want to stop taking them.
However antipsychotics rely on DA hypothesis (hyperdopaminergia in particular) which has been criticised for being incomplete, other neurotransmitters may be involved (glutamate) and antipsychotics do not work on these so there may be more effective treatments out there. They also do not make sense with hypodopminergia.
Psychological treatments for sz
Cognitive behaviour therapy (CBT) can be administered in individual sessions or as part of a group. In general it aims to target irrational beliefs and change them. This may involve argument or discussion of how likely the beliefs are to be true. Patients will be encouraged to make sense of their hallucinations and delusions. It will not cure them but it will reduce the anxiety around these stressful symptoms. Family therapy involves a group discussion with the family of the patient. The aim is to reduce the likelihood of relapse by improving the quality of communication and interaction which should reduce the stress within the family. Pharoah suggested a range of strategies to improve the functioning of a family including reducing the stress of caring for a relative with sz, helping the family to anticipate and solve problems and reducing anger and guilt.
A03 - There is evidence to support the effectiveness of CBT. Jauhar reviewed 34 studies and found a significant but small effect on both positive and negative symptoms. This suggests that CBT can be used to help improve the lives of patients with sz.
There is mixed evidence for the effectiveness of family therapy. Pharoah reviewed evidence in to the effectiveness of family therapy and found it reduced hospital readmission but the results of other studies were inconsistent. This suggests that that there is only modest support for psychological therapies.
Psychological treatments may improve the quality of life for patients but do not cure sz. The aim of these therapies is to make the symptoms more manageable and to help patients cope with symptoms. This is worthwhile but of course a cure would be preferable.
The most effective treatment seems to be a combination of CBT with drug therapy. The drug therapy will reduce the severity of the symptoms and allow the patient to engage with the therapy. Tarrier found that a combination of the two was more effective than medication alone.
