Schizophrenia

Question 1

Diagnosis and classification of schizophrenia

Answer 1

-Medical approach states to diagnose a specific disorder we need to distinguish one disorder from another
-By identifying clusters of symptoms that occur together and classify this as one disorder
-2 major systems from classification of mental disorder: ICD -10 & DSM-5
-DSM-5 states positive symptoms must be present but for ICD, 2 more more negative symptoms are sufficient
-Previous editions of ICD and DSM recognised subtypes of schizophrenia but dropped them as they were inconsistent
E.g Paranoid schizophrenia person. Nah not show the same symptoms a few years later (hallucinations and delusion)

Question 2

Positive symptoms of Schizophrenia

Answer 2

-Additional experiences beyond ordinary existence
- Hallucinations and delusions
-Hallucinations: hearing voices , often criticism, seeing distorted facial expressions or people
-Delusions : Paranoia, irrational beliefs
E.g believing they are an important i historical, political or religious figure
-Having super powers, persecuted by government or aliens
-Believe their body is externally controlled

Question 3

Negative symptoms

Answer 3

-Loss of usual abilities and experiences
-Speech poverty and avolition
-Speech poverty : Delay in verbal responses
Speech disorganisation: Speech is incoherent and changes topic mid sentence
Speech disorganisation is a positive symptom in DSM-5 but speech poverty remains negative
-Avolition: Aka Apathy
Lack of motivation
Andreasen’s 3 signs of avolition:
Poor hygiene and grooming, lack of persistence in work or education and lack of energy

Question 4

Co- morbidity

Answer 4

Occurrence of two disorders or conditions together e.g schizophrenia and personality disorder
-When this happens validity is questioned of classifying two disorders desperately

Question 5

Symptom overlap

Answer 5

When two or more conditions share symptoms
When this happens validity is questioned of classifying the disorders separately

Question 6

Limitations of diagnosis and classification in schizophrenia

Answer 6

-Low validity
-Co-morbidity
-Gender bias
-Culture bias
-Symptom overlap

Question 7

Strengths of diagnosis and classification in Schizophrenia

Answer 7

-Good reliability

Question 8

Strength of diagnosis and classification in schizophrenia

Answer 8

-Good reliability
-Consistency
-Inter rater reliability and test retest reliability
-Osorio reported good reliability for diagnosis of schizophrenia in 180 individuals using DSM-5
-Pairs of interviewers achieved inter rater reliability of +.97 and test retest reliability of +.92
-Suggests the diagnosis of schizophrenia is consistently applied

Question 9

Low validity in diagnosis and classification of schizophrenia

Answer 9

-Lack of criterion validity
-Cheniaux had two psychiatrists independently assess the same 100 clients using ICD-10 and DSM-IV criteria and found 68 diagnosed with schizophrenia under ICD and 39 under DSM
-Sugetss schizophrenia is either over or under diagnosed according to the diagnostic system
-Suggests the criterion validity is low

Question 10

Low validity counterpoint in diagnosis and classification of schizophrenia

Answer 10

-In Osorio study there was good agreement between clinicians when they used two measures to diagnose schizophrenia both from DSM system
-Means the criterion validity is good provided it takes place within a single diagnostic system

Question 11

Co- morbidity weakness in diagnosis and classification of schizophrenia

Answer 11

-Buckley found 50% of individuals with schizophrenia also have depression
-47% have co-morbidity with substance for abuse
-23% with OCD
-Questions validity of diagnosis and classification as it might be a single condition
-Means schizophrenia may not exist as a distinct condition and is a problem in people who may have unusual cases of depression

Question 12

Gender bias weakness in diagnosis and classification of schizophrenia

Answer 12

-Fischer and Buchanan found men have been diagnosed with schizophrenia more than women (1.4:1)
-May be because women are less vulnerable than men and genetic factors
-Cotton found women are likely to be under diagnosed because they have closer relationships and hence get support
-Therefore women with schizophrenia function better than men
-This under diagnosis is gender bias and women may not be receiving treatment and services that may benefit them

Question 13

Culture bias weakness in diagnosis and classification of schizophrenia

Answer 13

-People in Haiti believe voices are communications from ancestors
-Pinto and Jokes found Black-Caribbean British people are 9 times likely to be diagnosed than white British people though being black is not a genetic vulnerability
-Explanation from psychiatrists who are from a different cultural background
-Escobar found it leads to an over interpretation of symptoms in black British people
-Means Black British May be discriminated against by a culturally biased diagnostic system

Question 14

Symptom overlap weakness in diagnosis and classification of schizophrenia

Answer 14

-Both schizophrenia and biopolar involve positive symptoms such as delusions and negative such as avolition
-In terms of classification this suggests that schizophrenia and bipolar may not be two different conditions but variations of a single condition
-In terms of diagnosis this means schizophrenia may be hard to distinguish from bipolar
-As with co morbidity, symptom overlap means schizophrenia may not exist as a distinct condition and even if it is , it’s hard to diagnose.
So both classification and diagnosis are flawed

Question 15

Biological explanations for schizophrenia

Answer 15

-Genes : Family studies , candidate genes, role of mutation
-Neural correlates : Orignal dopamine hypothesis & updated versions of it

Question 16

Family studies in genetic explanations for schizophrenia

Answer 16

-Risk of schizophrenia increases with genetic similarity to a relative with the disorder
-Family members do share aspects of environment aswell as genes to correlation represents both
-However still gives support for importance of genes in schizophrenia

Question 17

Family studies evidence in genetic explanations for schizophrenia

Answer 17

-Gottesman : Risk of developing schizophrenia
-Identical twins: 48% (100% genes shared)
-Fraternal twins: 17% (50%)
-Children: 13% (50%)
-Siblings - 9% (50%)
-Parents 6% (50%)
-General population : 1%

Question 18

Candidate genes in genetic explanations for schizophrenia

Answer 18

-Polygenic (number of genes are involved )
- Genes involved code for neurotransmitters e.g dopamine
-Ripke combined all previous data from genome wide studies of schizophrenia
-He compared the genetic makeup of 37,000 schizophrenics to 113,000 controls and 108 separate genetic variations associated with an increased risk of schizophrenia
-Because studies have identified different candidate genes, schizophrenia is aetiologically heterogenous (different combinations of factors including genetic variation can lead to the condition)

Question 19

The role of mutation in genetic explanations for schizophrenia

Answer 19

-Can have a generic origin in the absence of a family history of the disorder
-Explanation by mutation in parental DNA which can be chased by radiation, poison or viral infection
-Brown found : Positive correlations between paternal age (associated with increased risk of sperm mutation) and risk of schizophrenia, increasing from 0.7% with fathers under 25 to over 2% in fathers over 50

Question 20

The original dopamine hypothesis in neural correlates explanations for schizophrenia

Answer 20

-Original hypothesis was based in the discovery that drugs used to treat schizophrenia (Antipsychotics which reduce dopamine) caused symptoms similar to Parkinson’s disease, associated with low dopamine (Seeman)
-Therefore schizophrenia may be the result of high levels of dopamine - hyperdopamineriga in subcortical areas of the brain
-An excess of dopamine receptors in pathways from the subcortex to the Broca’s area (responsible for speech) may explain speech poverty and or auditory hallucinations in schizophrenia

Question 21

Updated versions of the dopamine hypothesis

Answer 21

-David proposed the addition of cortical Hypodopaminergia - abnormally low dopamine in the brains cortex
-Low dopamine in the prefrontal cortex (responsible for thinking) could explain negative symptoms
-It is suggested that the cortical hypodopaminegia leads to subcortical hyperdopaminergia so both high and low levels of dopamine in different brain regions are a part of the updated version
-Current versions of the dopamine hypothesis try to explain the origins of abnormal dopamine function
-Howes suggests both genetic variations and early experiences of stress (psychological and physical) make people sensitive to cortical hypodopaminergia and hence subcortical hyperdopaminergia

Question 22

Genetic explanation for schizophrenia strength

Answer 22

-Research support
-Gottesman shows risk increases with genetic similarity to a family member with schizophrenia
-Tiernari’s adoption studies show that biological children of schizophrenic parents are heightened risk even if adopted
-Hilkers twin study show a concordance rate of 33% for identical twins and 7% for non identical
-Shows genetic makeup is responsible for schizophrenia prone people

Question 23

Genetic explanation for schizophrenia weakness

Answer 23

-Environmental factors also increase risk of schizophrenia
-Environmental factors include biological and psychological influences
-Biological: Morgan found found risk factors include birth complications
Di Forti found smoking THC rich cannabis in teenage years
-Psychological: Childhood trauma leaves people more vulnerable to adult mental health problems
-Mørkved found 67% of people with schizophrenia and related psychotic disorders reported at least one child hood trauma opposed to 38% of a matched group with non psychotic mental health issues
-Means genetic factors alone cannot explain schizophrenia completely

Question 24

Dopamine hypothesis for schizophrenia strength

Answer 24

-Evidence that dopamine is involved in schizophrenia
-Curran found amphetamine increase dopamine and worsen symptoms in people with schizophrenia and induce symptoms in people without
-Tauscher found antipsychotic drugs reduce dopamine activity and reduce intensity of symptoms
-Some candidate genes act on the production of DA or DA receptors
Suggests dopamine is involved in the symptoms of schizophrenia

Question 25

Dopamine hypothesis for schizophrenia weakness

Answer 25

-Evidence for a central role of glutamate
-McCutcheon found Post mortem and live scanning studies consistently found raised levels of the neurotransmitter glutamate in several brain regions of schizophrenia
-Also several candidate genes for schizophrenia are believed to be involved in glutamate production or processing
-Means an equally strong case can be made for other neutrotransmitters

Question 26

Dopamine hypothesis strength (amphetamine)

Answer 26

Ten induced schizophrenia like symptoms using amphetamines and then relieved symptoms using drugs that reduce DA action

Question 27

Psychological explanations for schizophrenia

Answer 27

Family dysfunction & Cognitive explanations

Question 28

Family dysfunction explanations for schizophrenia

Answer 28

-The schizophrogenic mother
-Double bind theory
-Expressed emotion

Question 29

Cognitive explanations for schizophrenia

Answer 29

-Dysfunctional thinking
-Metarepresentation dysfunction
-Central control dysfunction

Question 30

The schizophregenic mother

Answer 30

-Fromm- Reichmann proposed a psychodynamic explanation based on accounts she heard from patients about their childhoods
-Cold rejecting and controlling mother that creates a tense and secretive character of family
-Leads to disgust that later develops in to paranoid delusions and ultimately schizophrenia
-Family climate

Question 31

Double Bind theory in family dysfunction explanations for schizophrenia (psychological )

Answer 31

-Bateson emphasised on role of communication style in a family aswell as family climate
-Developing child experiences fear of doing wrong but reviver mixed messages about what this is and feel unable to confront on unfairness or seek for clarification
-When they get it wrong , parents withdrawal love
-Leaves them understanding world is confusing and dangerous, thus disorganised thinking and paranoid delusions
-Bateson said this was not the main type of communication in schizophrenics family or the only factor in developing it, just a risk factor

Question 32

Expressed emotion in family dysfunction explanation for schizophrenia (psychological)

Answer 32

-By carers, often family members
-Verbal criticism of the person often with violence
-Hostility towards the person , including anger and rejection
-Emotional over involvement including needless self sacrifice
-These are serious sources of dress
-Primarily an explanation for relapses
-Suggested it can trigger the schizophrenia in a person who is already vulnerable, eg due to genetic makeup

Question 33

Dysfunctional thinking in cognitive explanations for schizophrenia (psychological )

Answer 33

-Cognitive: Focuses on the role of mental processes
-Schizophrenia: Disruption to normal thought processing
-Reduced processing in ventral striatum is associated with negative symptoms
-Reduced processing in the temporal and cingulate gyri is associated with hallucinations (simon for both)
-Means this lower than usual level of information processing suggests cognition is likely to be impaired

Question 34

Metarepresentation dysfunction in cognitive explanations for schizophrenia (psychological )

Answer 34

-Frith identified Metarepresentation: the cognitive ability to reflect on thoughts and behaviour
-This allows us insight into our own intentions and goals and interpret actions of others
-Dysfunction in Metarepresentation disrupts ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else
-Explains hallucinations of hearing voices and delusions like thought insertion (thoughts projected in the mind by others)

Question 35

Central control dysfunction in cognitive explanations for schizophrenia (psychological)

Answer 35

-Fruith identified issues with the cognitive ability to suppress automatic responses while we perform deliberate actions
-Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts
-e.g derailment of thoughts because each word triggers associations and the person cannot suppress automatic responses to these

Question 36

Family dysfunction strength for schizophrenia

Answer 36

-Research support
-Indicators of family dysfunction include insecure attachment and exposure to childhood trauma especially abuse
-Read reviews adults with schizophrenia are more likely to have insecure attachment (type C or D)
-Read also reported that 69% of women and 59% of men with schizophrenia have a history of physical and or sexual abuse
-Mørkved found most adults with schizophrenia reported at least one childhood trauma, mostly abuse
-Strongly suggest that family dysfunction makes people more vulnerable to schizophrenia

Question 37

Family dysfunction for schizophrenia weakness

Answer 37

-Poor evidence base for explanations
-Despite a lot of evidence supporting the idea that childhood family based stress is associated with schizophrenia, there is almost none for schizophregenic mother and double bind
-These are based on clinical observation and informal assessment of their mothers personality’s, not systematic evidence
-Means that family explanations have not been able to account for the link between childhood trauma and schizophrenia
-Also socially sensitive (parent blaming )

Question 38

Cognitive explanations for schizophrenia Strength

Answer 38

-Research support for dysfunctional thought processing
-Stirling compared performance of the Stroop task with 30 schizophrenics and a control group of 30 non schizophrenics
-Task aims to suppress tendency to read words aloud
-As predicted by Frith, people with schizophrenia took twice as longer on average
-Means cognitive process of people with schizophrenia are impaired
-123.20 seconds for schizo
-58.12 for non

Question 39

Cognitive explanations for schizophrenia weakness

Answer 39

-Cognitive explanations only explain the proximal origins of symptoms
-Only explains what is happening Now to produce symptoms, opposed to distal explanations which focus on what initially caused the condition
-Distal could be genetic and family dysfunction
-However it Is unclear how generic variation or childhood trauma may lead to problems with Metarepresentation or central control
-Means cognitive theories on their own only provide partial explanations for schizophrenia

Question 40

Typical antipsychotics for schizophrenia

Answer 40

-Chlorpromazine
-Around since 1950s
-If taken orally must be a maximum of 1000g daily
-Doses are initially smaller and most peoples dosages are increased to a maximum of 400 to 800mg
-Tylival prescribed doses have declined over past 50 years (Liu and de Haan)

Question 41

Dopamine antagonists

Answer 41

-Strong association between chlorpromazine and dopamine hypothesis
-They work by acting as antagonists in the dopamine system
-Antagonists are chemicals which reduce action of neurotransmitters
-Dopamine antagonists work by blocking dopamine receptors in the synapses of the brain reducing the action of dopamine
-When one starts taking chlorpromazine, dopamine levels build up but then production is reduced
-According to the dopamine hypothesis, this dopamine antagonist effect normalises neurotransmissions in key areas of the brain, reducing symptoms like hallucinations

Question 42

Sedation effect of typical antipsychotics

Answer 42

-As well as having antipsychotic properties chlorpromazine is also an effective sedative.
-This is believed to be related to its effect on histamine receptors but it is not fully understood how this leads to sedation.
-Chlorpromazine is often used to calm individuals not only with schizophrenia but also with other conditions.
- This has often been done when patients are first admitted to hospitals and are very anxious.
-Syrup is absorbed faster than tablets so it tends to be given when chlorpromazine is used for its sedative properties.

Question 43

Atypical antipsychotics

Answer 43

-Simce 1970s
-Updated to Improve effectiveness in suppressing the symptoms of psychosis and to minimise the side effects
-Range of atypicals and they don’t work in the same way and some are not known how theu work
-Clozapine & Risperidone

Question 44

Clozapine

Answer 44

-Developed in 1960s and first trialled I’m 1970s
-Withdrawn in 1970s following deaths of some patients from a blood condition: agranulocytosis
-1980s they discovered to be more effective that typical antipsychotics thus remarketed as a treatment when other treatments failed
-Still used today but take regular blood tests to ensure no development of agranulocytosis
-Potential fatal side effects mean it is not available as an injection
-Daily dosage is 300- 450mg a day , less than chlorpromazine
-Clopazine binds to dopamine receptors like chlorpromazine but also acts on serotonin and glutamate receptors
-This is believed to reduce depression and anxiety and may improve cognitive functioning
-Sometimes prescribed when one is suicidal
-30 - 50% of people with schizophrenia attempt suicide at once point

Question 45

Risperidone

Answer 45

-Since 1990s to produce a drug as affective as clozapine but without serious side effects
-Taken in form of tablets,syrup or an injection that’s lasts for 2 weeks
-Small dose initially given of 4-8mg and maximum 12mg
-Binds to dopamine and serotonin receptors
-Binds to dopamine receptors more strongly than clozapine and more effective in smaller doses than most antipsychotics
-Evidence to suggest this leads to fewer side effects

Question 46

Drug therapy for schizophrenia strength

Answer 46

-Evidence for effectiveness
-Thornley reviewed studies comparing the effects of chlorpromazine to control conditions
-Data from 13 trials from 1121 participants showed that chlorpromazine was associated with better overall functioning and reduced symptom severity compared to a placebo
-Maltese concluded that clozapine is more effective than typical antipsychotics and other atypicals due to effectiveness in 30-50% treatment resistant cases where typical antipsychotics have failed
-Antipsychotics work

Question 47

Drug therapy for schizophrenia strength counter point

Answer 47

-Healy suggested serious flaws with evidence for effectiveness
-Found that most studies are of short term effects only and that some successful trials published data multiple times, exaggerating the side of the evidence for positive effects
-Also it’s powerful calming effects does not necessarily mean it reduces the severity of psychosis though it is easy to depict so
-Means evidence base for antipsychotic effectiveness is less impressive than it first appears

Question 48

Drug therapy for schizophrenia weakness (serious side effects)

Answer 48

-Typical antipsychotics side effects: Dizziness, agitation, sleepiness, stiff jaw , weight gain and itchy skin
-Long term use: Tardive dyskinesia caused by dopamine supersensitivity and causes involuntary face movements: Grimacing, blinking and lip smallcking
-Most serious side effect: Neuroleptic malignant syndrome (NMS). This is caused when drug blocks dopamine action in the hypothalamus, area in brain for regulation for a number of body systems
-Nms Symptoms: high temperature, delirium and coma though frequency is from less than 0.1% to just over 2%
-Individuals who experience such side effects may avoid making it ineffective

Question 49

Drug therapy for schizophrenia weakness (mechanism)

Answer 49

-Mechanism unclear
-Original dopamine hypothesis debunked as dopamine levels may be too low on top of too high in areas of brain
-Given, this means antipsychotics should not work
-Adds to the argument that they are ineffective
-Means some of antipsychotics may not be the best testament and some other factor is involved in their apparent success

Question 50

Psychological therapies for schizophrenia

Answer 50

Cognitive behaviour therapy and family therapy

Question 51

Cognitive behaviour therapy

Answer 51

-5-20 sessions in groups or individual basis
-Aims to deal with both thoughts (cognitions) and behaviour
-Helps a client make sense of how their irrational cognitions (delusions and hallucinations) impact their feelings and behaviour )
-Understanding the basis of their symptoms can help
-e.g therapist tells them their auditory hallucinations comes from the malfunctioning speech centre and are harmful
-Does not eliminate symptoms but better to cope
-Reduces distress and improves ability to function adequately
-Teaching that voice hearing is an extension of the ordinary experience of thinking in words = normalisation
-Delusions can be challenged by reality testing where therapist and person examine likelihood that beliefs are true
-Where delusions are resistant to realty testing CBT can still tackle the anxiety and depression

Question 52

Family therapy

Answer 52

-Identified patient who expressed family’s conflicts and the rest of the family
-Aims to improve quality of communication and interaction between family members
-Range of approaches to family therapy
-Included double bind and the schizophregenic mother
- Family therapy reduces negative emotions (reduced levels of EE) e.g anger and guilt that create stress , prone to relapse
-Family therapy improves family’s ability to help . By forming a therapeutic alliance agreeing on the aims of therapy, improving the families beliefs and behaviour towards schizophrenia and ensuring family members balance caring for schizophrenic and maintaining their own lives

Question 53

Family therapy a model of practice

Answer 53

-Burbach’s model
-Phase 1: sharing basic information and providing emotional and practical support
-Phase 2: Identifying resources including what different family members can and cannot offer
-Phase 3- Encourage mutual understating, creating a safe space for all family members to express their feelings
-Phase 4- Identifying unhelpful patterns of interaction
-Phase 5- Skills training e.g stress management techniques
-Phase 6- Relapse prevention planning
-Phase 7-Maintenance for future

Question 54

Cognitive behaviour therapy strength

Answer 54

-Evidence for effectiveness
-Jauhar reviewed 34 studies of CBT concluding there is clear evidence for small but significant effects in both positive and negative symptoms
-Pontillo found reductions in frequency and severity of auditory hallucinations
-Clinical advice from NICE (National institute for health and care excellence) recommends CBT for schizophrenia
-This means both research and clinical experience support the Benefits of CNT for schizophrenia

Question 55

Cognitive behaviour weakness

Answer 55

-Weak quality of evidence
-CBT techniques and schizophrenia symptoms vary widely
-Thomas pointed out that different studies have involved different CBT techniques and people with different combinations of positive and negative symptoms
-The overall modest benefits of CBT probably conceal a wide variety of effects of different CBT techniques on different symptoms
-Makes it hard to say how effective CBT will be for a particular person with schizophrenia
-Cure vs coping . Coping because psychological therapy doesn’t effect biological aspect. However some studies find reductions in severity of both positive and negative symptoms

Question 56

Family therapy strength

Answer 56

-Evidence of effectiveness
-McFarlane conducted that family therapy was one of the most consistently effective treatments available for schizophrenia
-Found that relapse rates reduced by 50-60%
-Also concluded use of family therapy when mental health initially declines is promising
-Clinical advice from NICE recommends family therapy for all schizophrenics
-Means family therapy is likely to benefit those of early and full schizophrenia

Question 57

Family therapy strength 2

Answer 57

-Benefits all family members
-Lobban and Barrowclough concluded that this is important because families provide the bulk care of people with schizophrenia
-By strengthening the functioning of a whole family, family therapy lessens the negative impact of schizophrenia on other family men she’s and strengthens the family’s ability to support the person with schizophrenia
-Means family therapy has wider benefits beyond the obvious identified patient
-Also saves the states money for medicine

Question 58

Developing token economies with schizophrenia

Answer 58

-Ayllon and Azrin trialled a token economy system in a ward of female schizoprenics
-Everytime they did something good as making bed or cleaning up they were rewarded with a token engraved with ‘one gift’ for an exchange of ward priveledges e.g watching film
-Number of tasks increased significantly
-System was used extensively in 1960s and 70s when the norm for treating schizophrenia was long term hospitalisation
-Use declined in the UK because of more comunity-based care and closure of psychiatric hospitals
-Also declined because of ethical issues with restricting rewards to people with mental disorders
-However token economies are still a standard approach to managing schizophrenia in the world

Question 59

Rationale for token economies

Answer 59

-Institutionlisation develops under prolonged hospitalisation
-One outcome is bad habits e.g stop hygiene or stop socialisation
-Matson identified 3 categories of institutionalised behaviour commonly tackled with token economies: Personal care, condition related behaviours (e.g apathy) and social behaviour
-No cure but benefits consist of:
1.Improves person’s quality of life within hospital setting e.g makeup for prideful in appearance person
2.’Normalises’ behaviour and makes it easier for people who hav e spent time in hospital to adapt back into life e.g making bed

Question 60

What is involved in a token economy

Answer 60

-Coloured disks given to desirable behaviour
-Cooper says it is important to know the person to identify target behaviours for them
-Swapped for later rewards
-Delayed rewards are not effecive so tokens are given
-e.g walk outside, sweets, magazines

Question 61

Theoretical understanding of token economies

Answer 61

-Example of behviour modification
-, A behavioural therapy based on operant conditioning
-Tokens are secondary reinforcers/generalised reinforcers
-Rewards are primary reinforcers

Question 62

Token enconomies strength

Answer 62

-Evidence for effectiveness
-Glowacki identified 7 high quality studies published between 1999 and 2013 that examined the effecitveness of token economies with schizophrenics and chronic mental health patients living in hospitals
-All studies showed reduction in negative symptoms and a decline in frequency of unwanted behaviours
-This supports values of token economies

Question 63

Token economies strength 1 counter

Answer 63

• 7 studies is small quite small evidence base
  -File drawer problem
  -Bias towards positive findngs because negatives have been ‘filed away’
  -Question in evidence for effectiveness of token economies

Question 64

Token economies weakness 1

Answer 64

-Ethical issues raised
-Gives profesionals considerable power to control the behaviour of people
-Imposes ones norms onto someonelse which is problematic if target behaviours are not identified senstitively
-e.g restricting pleasures like sweets to non desirable actioned people may entail even more disressing symptoms
-Actions may take legal action on these problems, enfrcing decline of token economy systems
-Means benefits of token systems may be outweighed by impact of personal freedom and short term reduction of quality of life

Question 65

Token economy weakness

Answer 65

-There are more pleasant and ethical alternatives
-Chiang concluded art therapy is a good alternative
-Evidence basse for this is regularly small and has methodological problems but has high-gain low-risk approach to managing schizophrenia
-Art therapy has no major risks or side effects or ethical abuse and is pleasant
-NICE guidelines reccomend art therapy
– Also token economies are hard to continue outside a hospital setting because target behaviours are not monitored and tokens cannot be given immediately
-

Question 66

The interactionist approach

Answer 66

-Aka Bioscocial approach
-Acknowledges there are biological,psychological and social factors in the development of schizophrenia
-Biological: Genetic vulnerability, neurochemical and neurological abnormality
-Psychological: Stress from life events and daily hassles
-Social factors: Poor quality interactions in the family

Question 67

The diatheses stress model (interactionist approach)

Answer 67

-One way to present an interactionist approach
-Diathesis means vulnerability
-Model says that both a vulnerability to schizophrenia and a stress trigger develops the disorder

Question 68

Meehl’s model

Answer 68

-Meehl created the original first diatheses stress model
- Model states diatheses (vulnerability) was entirely genetic, result of a single “schizogene”
-Led to the idea of a biologically based schizotypic personality , one characteristic which is sensitivity to stress
-Meehl states if a person lacks schizogene then no amount of stress will lead to schizophrenia
-However carriers of the gene, chronic stress through childhood and adolescence and in presence of schizophregenic mother could result in the development

Question 69

Modern understanding of diatheses (interactionist approach )

Answer 69

-Ripke states that many genes appear to increase genetic vulnerability slightly , no single “schizogene”
-Ingram and Luxton include range of factors beyond genetic including psychological trauma for the diatheses
-This means Trauma is the diathesis rather than the stressor
-Read proposed a neurodevelopmental model in which early trauma alters the developing brain
-e.g child abuse can affect many aspects of brain development
-e.g the Hypothalamic -pituitary- adrenal (HPA) system can become overacting making a person more vulnerable to later stress

Question 70

Modern understanding of stress

Answer 70

-Original diathesis stress model saw stress as a psychological in nature and related to parenting
-Now seen as anything that risks triggering schizophrenia (Houston)
-Recent research into factors triggering schizophrenia has concerned cannabis use
-In terms of diathesis stress model, cannabis is a stressor because is increases risk of schizophrenia up to 7 times according to dose
-May be because cannabis interferes with the dopamine system
-However most people do not develop schizophrenia after smoking because they lack the vulnerability factors

Question 71

Treatment according to interactionist model

Answer 71

-Advocates for both biological and psychological treatment
-Associated with combining antipsychotic medication and psychological therapies most commonly CBT
-Turkington points out it’s possible to believe in biological causes and still practice CBT to relieve psychological symptoms
-This requires the adoption of interactionist model
-Britain has standard practice to test people with combination of antipsychotic drugs and CBT
-Us has history of conflict between biological and psychological models and led to slower adoption of an interactionist approach
-So medication with psychosocial treatment is more common in the UK than US

Question 72

Interactionist approach strength

Answer 72

-Evidence for vulnerability and triggers
-Tienari’s large scale study investigated the impact of both genetic vulnerability and a psychological trigger (dysfunctional parenting)
-Study followed 19,000 Finnish children whose biological mothers had schizophrenia
-In adulthood this high genetic risk group were compared to a control group of adoptees with no family history of schizophrenia (low genetic risk)
-Adoptive parents were assessed for child rearing style
-Found that those who were hostile and low empathy were strongly associated with development of schizophrenia but only in high genetic risk group
-Shows that a combination of genetic vulnerability and family stress can lead to increased risk of schizophrenia

Question 73

Interactionist approach weakness

Answer 73

-Original Diathesis stress model is too simple
-Diatheses as a single schizogene and stress as schizophregenic parenting is too simple
-Multiple genes in multiple combinations influence diathesis and stress comes in many forms not limited to dysfunctional parenting
-Diathesis can be influenced by psychological factors and stress can be biological aswell as psychological
-Shown by Houston’s study where childhood sexual abuse emerged as the major influence on underlying vulnerability to schizophrenia and cannabis use as the major triggers
-Means there are multiple factors, both biological and psychological affecting both diathesis and stress supporting modern understanding of both Diathesis and stress

Question 74

Interactionist approach strength 2

Answer 74

-Real world application
-Applied to combination of drug treatment and psychology therapies
-Studies show that combing treatments enhances their effectiveness
-e.g Tarrier randomly allocated 315 participants To group of medication and CBT, group of medication and counselling or control group of only medication
-Participants in combination groups showed lower symptoms following the trial than medication only though there was no difference in hospital readmission
-Means there is a clear practical advantage to adopting and interactionist approach to schizophrenia in terms of superior treatment outcomes

Question 75

Interactionist approach strength 2 Counterpoint

Answer 75

Jarvis and Okami point out that saying that a successful treatment for mental disorder justifies a particular explanation is the logical equivalent of saying that because alcohol reduces shyness, shyness is caused by lack of alcohol. This logical error is called the Treatment-causation fallacy.
Therefore we cannot automatically assume that the success of combined therapies means interactionist explanations are correct.