Schizophrenia Flashcards

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1
Q

SCHIZOPHRENIA
What is schizophrenia?

A

A psychotic disorder marked by severely impaired thinking, emotions, and behaviour

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2
Q

CLASSIFYING MENTAL DISORDERS
Which manuals are used to classify mental disorders?

A

The DSM V or the ICD 10

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3
Q

CLASSIFYING MENTAL DISORDERS
What do both manuals require?

A

Symptoms to be present for a month

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4
Q

CLASSIFYING MENTAL DISORDERS
What does the DSM V require?

A

A more specific criteria; 2 or more symptoms

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5
Q

CLASSIFYING MENTAL DISORDERS
What does the ICD 10 require?

A

A broader approach to diagnosis

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6
Q

CLASSIFYING MENTAL DISORDERS
Which culture uses the DSM V?

A

America

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7
Q

CLASSIFYING MENTAL DISORDERS
Which countries use the ICD 10?

A

Anywhere that isn’t America

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8
Q

CLASSIFYING MENTAL DISORDERS
What type of functioning does schizophrenia include?

A

Excessive normal functioning

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9
Q

CLASSIFYING MENTAL DISORDERS
Describe diagnosis discrepancies between men and women

A

Women diagnosed 10 years later on average than men, who are most commonly diagnosed between 18 and 21

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10
Q

POSITIVE SYMPTOMS
What is a positive symptom of Schizophrenia?

A

Ones that enhance the typical experience of sufferers, and occurs in addition to their normal experiences

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11
Q

POSITIVE SYMPTOMS
Define a hallucination

A

A distorted view/perception of a real stimulus or stimulus that has no basis in reality

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12
Q

POSITIVE SYMPTOMS
What are the four types of hallucination?

A
  • Auditory
  • Visual
  • Tactile
  • Olfactory
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13
Q

POSITIVE SYMPTOMS
Define a delusion

A

A set of beliefs with no basis in reality, for example believing members of the royal family are trying to kidnap you

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14
Q

NEGATIVE SYMPTOMS
Define a negative symptom

A

Loss of normal functions due to increased serotonin and low levels of dopamine

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15
Q

NEGATIVE SYMPTOMS
Define alogia

A

Speech poverty, a frequent inability to find the right words

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16
Q

NEGATIVE SYMPTOMS
Define avolition

A

A reduction in interest

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17
Q

NEGATIVE SYMPTOMS
Define affective flattening

A

Flat emotions, such as no excitement at christmas or grief over a deceased pet

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18
Q

NEGATIVE SYMPTOMS
Define anhedonia

A

Physical or social loss of pleasure

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19
Q

CULTURAL BIAS AND RELIABILITY
What is the biggest sign of cultural bias?

A

The presence of two different diagnostic manuals

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20
Q

CULTURAL BIAS AND RELIABILITY
What did Copeland investigate?

A

Cultural differences in the diagnostic process

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21
Q

CULTURAL BIAS AND RELIABILITY
How did Copeland investigate cultural differences?

A

134 US psychiatrists V 194 GB psychiatrists given a definition of a patient

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22
Q

CULTURAL BIAS AND RELIABILITY
What were the results of Copeland’s study?

A

US 69% diagnosed schizophrenia
GB 2% diagnosed schizophrenia

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23
Q

CULTURAL BIAS AND RELIABILITY
What do Copeland’s findings suggest?

A

The diagnostic process is not reliable bc there are two different diagnostic manuals. People may not be given suitable treatment due to a wrong diagnosis.

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24
Q

RELIABILITY IN DIAGNOSIS
What must diagnosis be?

A

Repeatable - clinicians must be able to reach the same conclusions at two points in time (aka inter rater reliabilty)

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25
Q

RELIABILITY IN DIAGNOSIS
How is inter rater reliability measured?

A

The kappi score

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26
Q

RELIABILITY IN DIAGNOSIS
What is a score of 1?

A

Perfect inter rater reliability

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27
Q

RELIABILITY IN DIAGNOSIS
What is a score of 0?

A

No agreement

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28
Q

RELIABILITY IN DIAGNOSIS
What is generally considered a good score?

A

0.7

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29
Q

RELIABILITY IN DIAGNOSIS
What was the DSM V’s kappi score?

A

Only 0.4

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30
Q

RELIABILITY IN DIAGNOSIS
What does the DSM V’s kappi score show?

A

There is significant variation between countries when diagnosing schizophrenia

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31
Q

VALIDITY: SYSTEM OVERLAP
What did Ellason and Ross point out?

A

People w schizophrenia have less schizophrenic symptoms than those diagnosed with D.I.D

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32
Q

VALIDITY: SYSTEM OVERLAP
What did Read find?

A

People w schizophrenia have sufficient symptoms of other disorders

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33
Q

VALIDITY: COMORBIDITY
What does Buckeley et al estimate?

A

50% of patients w schizophrenia have depressive symptoms

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34
Q

VALIDITY: COMORBIDITY
What did Swets et al find?

A

12% of patients w schizophrenia have OCD symptoms

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35
Q

VALIDITY: COMORBIDITY
What do the studies suggest?

A

It’s very common amongst all patients w schizophrenia to be misdiagnosed. Reduced the validity of diagnosis

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36
Q

GENDER BIAS
How did Coring and Powell investigate gender bias?

A

Randomly selected 290 male and female psychiatrists to read two case vignettes of patients behaviour and were asked to give a judgement using standard diagnostic criteria

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37
Q

GENDER BIAS
What were Coring and Powell’s findings

A
  • Male or unlabelled patient: 56%
  • Female patient: 20%
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38
Q

GENDER BIAS
What does Coring and Powell’s results suggest?

A

The diagnosis of Schizophrenia is influenced by the gender of the patient

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39
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
What is the key assumption?

A

Looking at sz from a biological basis. This can be explained by genetics. A degree of inheritability.

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40
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
Describe family studies

A

Gottesman investigated the genetic prevalence amongst the family. General pop: 1%, parents 6%, siblings 9%

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41
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
What do family studies suggest?

A

More genes you share more likely to inherit sz

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42
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
Describe adoption studies

A

Tienari found 6.7% of children adopted w sz biological mother had been diagnosed w schizophrenia themselves. Opposed to 2% of children diagnosed w no sz mother

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43
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
What do adoption studies suggest?

A

Genetic predisposition overrides environmental factors

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44
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
What percentage of DNA do twins share?

A

DZ (50% of same DNA) MZ (100% of same DNA)

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45
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
Describe twin studies

A

Gottesmas carried out meta-analysis and reviewed 40 studies that had investigated family history of sz. DZ twins 17% MZ twins 48%

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46
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
What do twin studies suggest?

A

Genetic predisposition - more genes more likely

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47
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
AO3 scientific credibility

A
  • Research evidence providing empirical facts
  • Joseph found 40% for MZ and 7.4% for DZ
  • Scientific credibility due to research
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48
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
AO3 deterministic

A
  • Overly stating role of nature
  • Highest concordance rate 48% MZ, strongest genetical link one can have
  • Leaves room for other explanations
  • OCD 87% which further belittles this figure
  • Biology not only explanation
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49
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
AO3 methodology issues

A

Twins are small sample size already, then a set of twins one w schizophrenia (at least) reduces even more. Can you therefore generalise?

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50
Q

BIO EXP FOR SZ: GENETICS NUMBER ONE
AO3 methodology issues

A

Twins are small sample size already, then a set of twins one w schizophrenia (at least) reduces even more. Can you therefore generalise?

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51
Q

BIO EXP NEUROTRANSMITTERS
What is the key assumption?

A

Biological basis for sz due to biochemical imbalances

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52
Q

BIO EXP NEUROTRANSMITTERS
What does the dopamine hypothesis claim?

A

Having an excess of dopamine in central regions of the brain is associated w positive symptoms of sz. It is thought this is due to abnormally high levels of D2 receptors on the receiving neuron

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53
Q

BIO EXP NEUROTRANSMITTERS
What does the dopamine hypothesis result in?

A

More dopamine binding so more neurons firing

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54
Q

BIO EXP NEUROTRANSMITTERS
What does amphetamine do?

A

Increase dopamine activity, leading to an increase in sz symptoms

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55
Q

BIO EXP NEUROTRANSMITTERS
How does amphetamine lead to an increase in sz symptoms?

A

Stimulating nerve cells containing dopamine, causing the synapse to be flooded w the neurotransmitter

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56
Q

BIO EXP NEUROTRANSMITTERS
What did Grilly 2002 say?

A

When parkinson sufferers take drug called ‘l-dopa’ which raises d levels, it causes them to develop sz like symptoms. This suggests there is a relationship bt dopamine and sz

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57
Q

BIO EXP NEUROTRANSMITTERS
Describe antipsychotic drugs

A

Block activity of dopamine in brain. By reducing the activity in neural pathways which use dopamine, you eliminate the symptoms

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58
Q

BIO EXP NEUROTRANSMITTERS
Who did the revised dopamine hypothesis

A

Davis and Kahn

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59
Q

BIO EXP NEUROTRANSMITTERS
What did Davis and Kahn propose?

A

Proposed positive symptoms due to an excess dopamine in the subcortical areas of the brain. The negative symptoms arise from a deficit of dopamine in pre-frontal cortex

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60
Q

BIO EXP NEUROTRANSMITTERS
Scientific credibility

A
  • Empirical evidence
  • Neural imaging: CAT and PET scans which can show physical differences bt sz and non sz patients
  • Patel et al found sz patients had higher levels of dopamine in prefrontal cortex compared to control group
  • This suggests that the concept of diff neural activity in sz to non sz is a plausible explanantion
61
Q

BIO EXP NEUROTRANSMITTERS
RWA

A
  • Cause, handle, reduce
  • Leucht meta analysis of 212 studies. All drugs tested were sig more effective than a placebo
  • Suggests can rule out psychosematic of drugs
62
Q

BIO EXP NEUROTRANSMITTERS
Determinism

A
  • Assumes all pp w sz have high dopamine levels
  • Not all patients been found to have this
  • Individual differences, environmental factors, unhealthy family dynamic
  • Bateson double blind exp
  • Suggest must be other explanations
62
Q

BIO EXP NEUROTRANSMITTERS
Determinism

A
  • Assumes all pp w sz have high dopamine levels
  • Not all patients been found to have this
  • Individual differences, environmental factors, unhealthy family dynamic
  • Bateson double blind exp
  • Suggest must be other explanations
62
Q

BIO EXP NEUROTRANSMITTERS
Determinism

A
  • Assumes all pp w sz have high dopamine levels
  • Not all patients been found to have this
  • Individual differences, environmental factors, unhealthy family dynamic
  • Bateson double blind exp
  • Suggest must be other explanations
63
Q

FAMILY DYSFUNCTION
Describe the double blind theory

A

Bateson 1956, sz is a consequence of abnormal patterns in family communication. The patient is a symptom of a family wide problem. They become ill to protect the stability of the family system.

64
Q

FAMILY DYSFUNCTION
In a double blind situation, what is a person given?

A

Mutually contradictory signals by another person, placing them in an impossible situation causing internal conflict. Sz symptoms represent an attempt to escape from the double blind.

65
Q

FAMILY DYSFUNCTION
Describe Read

A

Reviewed 42 studies. Concluded 69%of female inpatients and 59% of male had a history of childhood physical/sexual abuse

66
Q

FAMILY DYSFUNCTION
Positive of double blind

A

Berger found evidence of double blind communication by parents of sz patients compared to controls

67
Q

FAMILY DYSFUNCTION
Give the two negatives of double blind

A
  • LIEM et al compared communication patterns in families w and wout a sz member. Abnormality in parental communication response rather than cause
  • Validity issues: conclusions tend to be based on clinical obvs of patients, researcher bias.
68
Q

FAMILY DYSFUNCTION
What are expressed emotions categorized by?

A

Criticism, hostility, emotional overinvolvement (helicopter parenting)

69
Q

FAMILY DYSFUNCTION
What are communication patterns w high EE relatives usually categorised by?

A

Intense and negative verbal exchanges

70
Q

FAMILY DYSFUNCTION
What did Brown find?

A

70% of neg comments aimed at sz were aimed at negative symptoms. They tend to be oppositional or conflictual in nature, and tone of voice is very important

71
Q

FAMILY DYSFUNCTION
Give the two positives of expressed emotions

A

Evidence: Kwipers found relapse more likely when family is high in expressed emotions. Linzen put this at 4x
RWA: family therapy

72
Q

FAMILY DYSFUNCTION
Give a negative of expressed emotions

A

Individual differences. Deterministic, not every family w a sz patient would be dysfunctional. Differing resilience levels

73
Q

COGNITIVE EXPLANATIONS FOR SZ
What is the key assumption?

A

Dysfunctional thought processing which effects behaviour

74
Q

COGNITIVE EXPLANATIONS FOR SZ
What can explain delusions and hallucinations?

A

A maladaptive blackbox: beck

75
Q

COGNITIVE EXPLANATIONS FOR SZ
Non sz people laughing and whispering on a bus

A

Nothing unusual happening - puts headphones in, minds own business

76
Q

COGNITIVE EXPLANATIONS FOR SZ
Sz person people laughing and whispering on a bus

A

Dysfunctional backbox - there is something wrong with me. Delusion = they are all laughing at me, then causes a scene

77
Q

COGNITIVE EXPLANATIONS FOR SZ
Non sz person changing a lightbulb

A

Flickering lights - realisation the bulb is dying - changes the bulb

78
Q

COGNITIVE EXPLANATIONS FOR SZ
Sz person changing a lightbulb

A

Flickering lights - someone is trying to send me a message - delusions of grandeur

79
Q

COGNITIVE EXPLANATIONS FOR SZ
What did Beck and Rector say?

A

Sz are unlikely to consider their blackbox as wrong

80
Q

COGNITIVE EXPLANATIONS FOR SZ
Self talk ‘I am a bad person’

A

Non sz, this is an internal event. For a sz this is external, someone else is telling them this. Results in people talking to themselves

81
Q

COGNITIVE EXPLANATIONS FOR SZ
What did Baker and Morrison say?

A

Sz misattribute self talk as an external voice

82
Q

COGNITIVE EXPLANATIONS FOR SZ
A03 research support

A

O’Carrol found 75% of sz patients report cognitive impairment in memory, attention, and motor skills. Dual task performance, limited cognitive capacity

83
Q

COGNITIVE EXPLANATIONS FOR SZ
A03 RWA

A

CBTp, ecological validity

84
Q

COGNITIVE EXPLANATIONS FOR SZ
A03 chicken and egg

A
  • Cause effect cannot be established
  • Descriptive explanation
  • Cause of repercussion
  • Not predictive
85
Q

BIOLOGICAL TREATMENTS FOR SZ
What is the key assumption?

A

Sz comes from a physical origin

86
Q

BIOLOGICAL TREATMENTS FOR SZ
How do all antipsychotics work?

A

Reducing dopamine transmission

87
Q

BIOLOGICAL TREATMENTS FOR SZ
What is the first main type of antipsychotic?

A

Typical (first generation) 1950

88
Q

BIOLOGICAL TREATMENTS FOR SZ
What is an example of a typical antipsychotic?

A

Chlorprozamine

89
Q

BIOLOGICAL TREATMENTS FOR SZ
What do all antipsychotics’ act as?

A

Dopamine antagonists

90
Q

BIOLOGICAL TREATMENTS FOR SZ
What do typical antipsychotics do?

A

Bind but don’t stimulate dopamine D2 receptors. By reducing stimulation of dopamine system, hallucination’s and delusions are eliminated

90
Q

BIOLOGICAL TREATMENTS FOR SZ
What do typical antipsychotics do?

A

Bind but don’t stimulate dopamine D2 receptors. By reducing stimulation of dopamine system, hallucination’s and delusions are eliminated

91
Q

BIOLOGICAL TREATMENTS FOR SZ
What do typical antipsychotics do?

A

Bind but don’t stimulate dopamine D2 receptors. By reducing stimulation of dopamine system, hallucination’s and delusions are eliminated

92
Q

BIOLOGICAL TREATMENTS FOR SZ
What is the main advantage of typical antipsychotics?

A

They work!

93
Q

BIOLOGICAL TREATMENTS FOR SZ
What did Leucht do?

A

Meta analysis of 65 studies 1959 - 2011, 6000 patients

94
Q

BIOLOGICAL TREATMENTS FOR SZ
What happened to the 6000 patients?

A

Some were taken off medication, replaced with a harmless placebo. Viewed for a whole year

95
Q

BIOLOGICAL TREATMENTS FOR SZ
How many of the placebo group relapsed?

A

64% compared to 27% for non placebo

96
Q

BIOLOGICAL TREATMENTS FOR SZ
What does Leucht’s study suggest?

A

Drugs do work for positive symptoms

97
Q

BIOLOGICAL TREATMENTS FOR SZ
What is an extrapyramidal side effect?

A

Muscular

98
Q

BIOLOGICAL TREATMENTS FOR SZ
Describe parkinsonism

A

Tremors, rigidity, slowness of movement, temporary paralysis

99
Q

BIOLOGICAL TREATMENTS FOR SZ
Describe dystonia

A

Involuntary muscle contractions

100
Q

BIOLOGICAL TREATMENTS FOR SZ
What is the issue with extrapyramidal side effects?

A

They are very visible

101
Q

BIOLOGICAL TREATMENTS FOR SZ
What do critics argue about typical drugs?

A

If side effects, death and psychological consequences are taken into account, cost benefit analysis would be mostly negative. Patients most likely stop taking them.

102
Q

BIOLOGICAL TREATMENTS FOR SZ
Give an example of an atypical drug

A

Clozapine

103
Q

BIOLOGICAL TREATMENTS FOR SZ
What do atypicals do?

A

Block dopamine and serotonin receptors

104
Q

BIOLOGICAL TREATMENTS FOR SZ
Give a positive of atypicals

A

Fewer side effects, particularly extra pyramidal symptoms

105
Q

BIOLOGICAL TREATMENTS FOR SZ
What are the side effects of atypicals?

A

Weight gain, diabetes, blood clots, stroke

106
Q

BIOLOGICAL TREATMENTS FOR SZ
What did crossley do?

A

Meta analysis of 15 studies

107
Q

BIOLOGICAL TREATMENTS FOR SZ
What did crossley examine?

A

Efficacy and side effects in early stages of treatment

108
Q

BIOLOGICAL TREATMENTS FOR SZ
What did crossley find?

A

No diff in efficiacy between the two

109
Q

BIOLOGICAL TREATMENTS FOR SZ
A03 MAT

A
  • Don’t require motivation or effort
  • Quicker than therapy
110
Q

BIOLOGICAL TREATMENTS FOR SZ
Give two negatives

A
  • Side effects
  • Treatment not cause
111
Q

FAMILY THERAPY
What is family therapy?

A

A range of interventions aimed at the family

112
Q

FAMILY THERAPY
What does NICE recommend?

A

All SZ patients should be offered it

113
Q

FAMILY THERAPY
What is the nature of family therapy?

A
  • 10 sessions
  • Aim to reduce levels of expressed emotions
  • Family given psychoeducation
  • Encouraged to be open about problems and listen
114
Q

FAMILY THERAPY
Research support

A

Leff compared family therapy w routine outpatient care. Relapse rates after 9 months:
- 50% routine care
- 8% family therapy

115
Q

FAMILY THERAPY
Give two negatives

A
  • Availability
  • Effort
116
Q

COGNITIVE TREATMENTS FOR SZ
What is the key assumption?

A

Info is processed, how thinking impacts behaviour

117
Q

COGNITIVE TREATMENTS FOR SZ
What does CBTp stand for?

A

Cognitive behaviour therapy psychosis

118
Q

COGNITIVE TREATMENTS FOR SZ
What is CBT p

A

Therapy which aims to help patient to identify and correct disordered/delusional thinking

119
Q

COGNITIVE TREATMENTS FOR SZ
What does NICE recommend?

A

At least 16 sessions

120
Q

COGNITIVE TREATMENTS FOR SZ
What does CBTp include?

A

A behavioural element, develop coping strategies to improve functioning

121
Q

COGNITIVE TREATMENTS FOR SZ
Describe assessment

A

Patient identifies and expresses thought to therapist

122
Q

COGNITIVE TREATMENTS FOR SZ
What model is used after assessment?

A

The ABC model

123
Q

COGNITIVE TREATMENTS FOR SZ
Describe process of normalisation

A

Explain to patient we all have times of delusional thought

124
Q

COGNITIVE TREATMENTS FOR SZ
Describe critical analysis

A

Where is the evidence? etc if voices are real why can’t others hear them, offer alternative explanations

125
Q

COGNITIVE TREATMENTS FOR SZ
How many sessions do most people require?

A

8-20 sessions over the space of 6-12 months, usually last for about an hour

126
Q

COGNITIVE TREATMENTS FOR SZ
Sensky A03

A

Compared CBT with non specific befriending intervention. 9 month follow up evaluation lower relapse rates in CBT

127
Q

COGNITIVE TREATMENTS FOR SZ
Give two positives

A
  • No physical side effects
  • Gives patients more control over treatments
128
Q

COGNITIVE TREATMENTS FOR SZ
Give two negatives

A
  • Motivation
  • Accessibility
129
Q

TOKEN ECONOMY
When was this theory developed?

A

1970s

130
Q

TOKEN ECONOMY
What principle is this based upon?

A

Operant conditioning (if you reward a behaviour it will be repeated)

131
Q

TOKEN ECONOMY
What is this therapy mainly used on?

A

Institutionalised patients and is a method of helping them manage/control their impulses and behaviour

132
Q

TOKEN ECONOMY
What are patients given?

A

Coloured counters which can be handed in for privileges like cigarettes and watching TV

133
Q

TOKEN ECONOMY
What is the first step of the process?

A

Identify desirable behaviour eg getting dressed

134
Q

TOKEN ECONOMY
What is the second step of the process?

A

Tokens then offered immediately

135
Q

TOKEN ECONOMY
Give step three

A

Where tokens can be exchanged for privileges of a variety rather than one item, rates of response tend to be higher Sran and Borenno

136
Q

TOKEN ECONOMY
Give Allonby and Azron’s positive

A

Female patients w sz had been hospitalised for an average of 16 years, and were rewarded for actions like brushing hair or making beds. Focus on negative symptoms, on average 5-40 good acts increased.

137
Q

TOKEN ECONOMY
Give two negatives

A

Determinism, behaviour vs reward

138
Q

THE INTERACTIONIST EXPLANATION FOR SZ
What is the diathesis stress model?

A

A model for an interaction between biology and psychology

139
Q

THE INTERACTIONIST EXPLANATION FOR SZ
What does the DSM assume?

A

Genetic predisposition but environmental trigger

140
Q

THE INTERACTIONIST EXPLANATION FOR SZ
Diathesis genetic predisposition

A
  • Largely inherited, based on nature
  • Gottesman individual 1% twin 48%
  • Not 100%
141
Q

THE INTERACTIONIST EXPLANATION FOR SZ
Stress environmental factor

A
  • Family dysfunction
  • Double blind EE
  • Reference Batesman or Brown
  • Urban vs rural environment
142
Q

THE INTERACTIONIST EXPLANATION FOR SZ
Urban vs rural

A

Urban - city, lonely
Town - community feeling
More likely to develop sz in urban area therefore

143
Q

THE INTERACTIONIST EXPLANATION FOR SZ
What does the DSM explain?

A

Why there is no 100% concordance rate, biological but with individual differences

144
Q

THE INTERACTIONIST EXPLANATION FOR SZ
What is neither explanation?

A

Strong enough on it’s own, would be reductionist to assume only one. Nature and nurture

145
Q

THE INTERACTIONIST EXPLANATION FOR SZ
What does combining both explanations mean?

A

Strengths and weaknesses cancel out

146
Q

THE INTERACTIONIST EXPLANATION FOR SZ
What is the interactionist explanation more?

A

Holistic, acknowledges both factors. Considers relationship both share in development of sz. ID