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Schizophrenia Flashcards

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1
Q

What is Schizophrenia?

A

A serious mental disorder experienced by around 1% of the world’s population

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2
Q

Who is more likely to be diagnosed with Schizophrenia?

A

Men
City Dwellers
Lower Socio-Economic groups

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3
Q

When does Sz usually occur?

A

Late adolescence/early adulthood (around 20 years old)

  • it could occur any time
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4
Q

What are the characteristics of Sz?

A

There are no defining characteristics
We instead look for a cluster of symptoms that appear together and attempt to classify this as a disorder
The symptoms within a cluster might seem unrelated

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5
Q

How do we diagnose/classify Sz?

A

We identify a cluster of symptoms that appear together and attempt to classify them as Sz
There are 2 classification systems:
DSM - 5
ICD - 11

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6
Q

What does DSM-5 use to diagnose Sz?

A

1 or more positive symptom

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7
Q

What does ICD-11 use to diagnose Sz?

A

2 or more negative symptoms

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8
Q

Where in the world uses DSM-5 to classify and diagnose Sz?

A

USA

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9
Q

Where in the world uses ICD-11 (used to be ICD-10) to classify and diagnose Sz?

A

USA

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10
Q

What are the 2 types of symptoms of Sz?

A

Positive Symptoms
Negative Symptoms

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11
Q

How many Positive Symptoms are there?

A

2

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12
Q

How many Negative Symptoms are there?

A

2

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13
Q

What are the 2 positive symptoms?

A

Hallucinations
Delusions

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14
Q

What are positive symptoms?

A

Symptoms that reflect additional experiences beyond those of ordinary existence

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15
Q

What are Hallucinations?

A

Disturbances in our perception, or unusual sensory experiences

  • they are false perceptions with no basis in reality
  • they could be related to events in our environment
  • they could have no relationship with what the senses are picking up
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16
Q

What are examples of Hallucinations?

A

Auditory - hearing voices or criticisms
Visual - seeing distorted facial features or people/things that aren’t there
Touch

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17
Q

What are Delusions?

A

(also known as paranoia)
False, irrational beliefs with no evidence
- they are firmly held despite being irrational
- there are 3 main types

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18
Q

What are examples of 3 types of delusions?

A

Delusions of Control
Delusions of Grandeur
Delusions of Persecution

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19
Q

What are Delusions of Persecution?

A

The belief others want to harm/threaten/manipulate you

examples:
- believing rumours are spread about you
- believing someone is plotting to kill you
- believing you are being spied on

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20
Q

What are Delusions of Grandeur?

A

The belief you are an important, God-like individual with extraordinary powers

examples:
- believing you are Jesus Christ

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21
Q

What are Delusions of Control?

A

The belief something (usually aliens) has invaded your body and is in control

examples:
- spirits
- implanted radio transmission

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22
Q

What are Negative Symptoms?

A

Symptoms involving the loss of usual abilities and experiences
- declining in function or loss of normal function

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23
Q

What are 2 Negative Symptoms?

A

Speech Poverty
Avolition

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24
Q

What is Speech Poverty?

A

Changes in pattern of speech
- there is an emphasis on the reduction of the amount and quality of speech in Sz
- it can be accompanied by a delay in the person’s verbal response during conversation
- nowadays, it is described as Speech Disorganisation, which is where the focus is on incoherent speech, or changing topics mid sentence

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25
Q

What is Speech Disorganisation?

A

A more recent view of Speech Poverty, where emphasis is based more on incoherent speech and changing topics mid sentence

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26
Q

What is Avolition?

A

(also called apathy)
A reduction in, difficulty or inability to start and continue goal-related behaviour
- a sharply reduced motivation to carry out a range of activities
- can be mistaken for disinterest

examples:
- sitting alone doing nothing for hours
- no longer interested in anything
- no longer interested in activities they used to be enthusiastic for

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27
Q

Who researched Avolition?

A

Anderson (1982)

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28
Q

What did Anderson do?

A

Theorised 3 signs of Avolition

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29
Q

What are Anderson’s 3 signs of Avolition?

A
  • Poor hygiene or grooming
  • Lack of persistence in work or education
  • Lack of energy
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30
Q

Evaluate the Classification and Diagnosis of Sz

A

Bad - Low criterion validity
Chiniaux et al
- asked 2 psychologists to independently diagnose 100 patients using DSM and ICD
- one diagnosed 26 using DSM, and 44 using ICD
- one diagnosed 13 with DSM, and 24 with ICD
- This suggests Sz is either over or under diagnosed, according to the diagnostic system, so criterion validity is low
- It is easier to see 2 negative symptoms than 1 positive symptom, so it is easier to get a diagnosis with ICD than with DSM
- the lack of criterion validity might mean over or under diagnosis
- This matters because you are more likely to be diagnosed in Europe, suggesting some people might not be diagnosed when they need treatment, while others might be diagnosed and receive treatment they do not need

Bad - Low reliability
Chiniaux et al
- two researchers arrived at different results despite using the same classification system
- suggests the systems are not standardised, and there is no inter-rater reliability
- could mean some people are over or under diagnosed

Bad - Symptom Overlap
- There is a considerable overlap between symptoms of Sz and symptoms of other conditions, such as bipolar disorder
- Bipolar disorder also includes positive symptoms and negative symptoms
- In terms of classification, this could suggest they might be two variants of a single condition, rather than separate
- This could mean difficulty to distinguish and treat the two
- This matters because it may mean Sz does not exist as a distinct condition, and is hard to diagnose, so both classification and diagnosis is flawed

Bad - Co-morbidity
- If co-morbidity occurs a lot of the time, it questions the validity of diagnosis and classification as it might be a single condition
- People with Sz are often diagnosed with depression as well
- This could mean Sz does not exist as a single condition, which could mean the classification is flawed

Bad - Gender Bias
- More men are diagnosed than women
- This could be suggested by men being more vulnerable from genetics, but it is likely due to females having closer relationships, meaning they can get support
- This under-diagnosis could mean women are not receiving the treatment they need

Bad - Culture Bias
- Some symptoms (especially auditory hallucinations) have different meanings in different cultures e.g. communications with ancestors
- British people of African-Carribean origin are up to 9 times as likely to receive a diagnosis as British People
- Could suggest discrimination by a culturally-biased diagnostic system

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31
Q

How many Biological Explanations for Sz are there?

A

2

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32
Q

What are the 2 Biological Explanations for Sz?

A

The Genetic Basis of Sz
Neural Correlates of Sz

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33
Q

What are all the Biological Explanations for Sz?

A

Genetic Basis:
- family studies
- twin studies
- candidate genes

Neural Correlates:
- the original dopamine hypothesis
- the updated dopamine hypothesis
- abnormal ventral striatum
- abnormal superior temporal gyrus and anterior cingulate gyrus

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34
Q

What does the Genetic basis of Sz suggest?

A

Sz runs in families and is partly genetic

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35
Q

Why do we use Family Studies?

A

They indicate the chance of developing Sz based on genetic inheritance

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36
Q

What do Family Studies of Sz suggest?

A

The closer the genetic relationship to someone with Sz, the greater the chance of developing the disorder

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37
Q

Who researched family studies?

A

Gottesman

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38
Q

What did Gottesman do?

A

Conducted a large scale family and twin study to see the concordance rate of Sz

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39
Q

What did Gottesman find?

A

People with an aunt with Sz had a 2% chance of developing it

People with a sibling with Sz had a 9% chance of developing it

People with an identical twin with Sz had a 48% chance of developing it

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40
Q

What was the likelihood of developing Sz when they had an aunt with Sz? (Gottesman)

A

2%

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41
Q

What was the likelihood of developing Sz when they had a sibling with Sz? (Gottesman)

A

9%

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42
Q

What was the likelihood of developing Sz when they had an identical twin with Sz? (Gottesman)

A

48%

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43
Q

What does Gottesman’s concordance support?

A

Genotype influences on Sz
Phenotype influences on Sz

Also suggests genotype has a larger impact than phenotype due to the higher concordance for MZ twins than siblings

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44
Q

What does the Candidate genes explanation suggest about Sz?

A

Sz is polygenic as it has a number of genes involved

The most likely genes involved would be those coding for neurotransmitters such as Dopamine

Sz appears to be aetiologically heterogeneous as it may be caused by a different combination of genes

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45
Q

What is aetiologically heterogeneous?

A

Sz is likely caused by different combinations of genes

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46
Q

Who researched Candidate Genes in Sz?

A

Ripke et al

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47
Q

What did Ripke et al do?

A

A meta analysis of genome-wide studies of Sz
They compared the genetic make-up of 37,000 people with Sz to 113,000 controls

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48
Q

What did Ripke et al find?

A

108 separate genetic variations were associated with increased risk of Sz
Suggests Sz is aetiologically heterogeneous

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49
Q

What is the main Neural Correlate of Sz?

A

Neurotransmitter Dopamine (DA)

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50
Q

How is Dopamine a Neural Correlate of Sz?

A

It is important in the functioning of several brain systems that are correlated with symptoms of Sz
There are 2 hypotheses of how dopamine can cause or increase chances of Sz

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51
Q

What are Neural Correlates?

A

Measurements of the structure or function of the brain that correlates with an experience (schizophrenia)

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52
Q

How many Dopamine Hypotheses are there?

A

2

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53
Q

What does The Original Dopamine Hypothesis suggest?

A

Hyperdopaminergia:
- there are high levels of dopamine in the central areas of the brain (sub cortex)

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54
Q

What is The Original Dopamine Hypothesis based on?

A

The discovery that drug treatment for Sz caused similar symptoms to Parkinson’s Disease
Parkinson’s Disease is associated with low dopamine levels
This suggests there must have been originally high dopamine levels

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55
Q

What is an example of Hyperdopaminergia?

A

An excess of dopamine receptors in Broca’s area might be associated with speech poverty

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56
Q

What does The Updated Dopamine Hypothesis suggest?

A

Davis et al:
Hypodopaminergia:
- abnormally low dopamine in the brain’s cortex

  • Suggests perhaps both hyper- and hypo-dopaminergia in different brain regions are involved in Sz
  • Acknowledges that genes and stress might make some people more sensitive to cortical hypodopaminergia
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57
Q

What is an example of Hypodopaminergia?

A

Low dopamine in the prefrontal cortex (associated with thinking) could explain cognitive problems and negative symptoms

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58
Q

What is a Neural Correlate for Negative Symptoms?

A

Avolition:
- includes loss of motivation
- motivation involves anticipation of a reward
- anticipation of a reward is associated with Ventral Striatum
- suggests abnormality to the Ventral Striatum can cause Sz

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59
Q

What is a Neural Correlate for Positive Symptoms?

A

Auditory Hallucinations: Allen et al
- Brain-scanned patients with auditory hallucinations and compared them to a control group
- found the patients with hallucinations had lower activation levels in their Superior Temporal Gyrus and Anterior Cingulate Gyrus
- suggests low activity levels here is a neural correlate for auditory hallucinations

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60
Q

What did Allen et al do and find?

A

Brain scanned patients with auditory hallucinations and compared these to a control group

Found patients with auditory hallucinations had lower activity levels in the Anterior Cingulate Gyrus and Superior Temporal Gyrus

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61
Q

What areas of the brain are associated with positive and negative symptoms? (Neural Correlates)

A

Negative:
Ventral Striatum (avolition)

Positive:
Superior Temporal Gyrus
Anterior Cingulate Gyrus
(auditory hallucinations)

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62
Q

Evaluate Biological Explanations of Schizophrenia

A

Good - research support for Genetic Vulnerability
Gottesman:
- 2% aunt, 9% sibling, 48% MZ twin
Tienari:
- Suggested children of people with Sz are at heightened risk even when adopted by families with no history of Sz

  • suggests genes must be involved

Bad - must be environmental factors
Gottesman:
- only 48% concordance rate - should be 100%
- research has suggested environmental factors can increase the likelihood of Sz:
Childhood trauma (people are vulnerable to adult mental health issues)
Smoking THC-rich cannabis in teenage years

Good - research support for abnormal dopamine functioning in people with Sz (original Dopamine hypothesis)
Curran:
- dopamine antagonists (amphetamines) increase Dopamine
- high DA levels can make Sz symptoms worse, supporting high levels of DA
Lindstroem:
- chemicals needed to reduce DA are taken up faster in the brains of Sz sufferers, suggesting they produce more

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63
Q

What did Curran do?

A

Found Dopamine Antagonists such as amphetamines increase Dopamine levels, and they make Sz symptoms worse

This supports the idea that Sz sufferers have high levels of DA

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64
Q

What did Lindstroem do?

A

Found chemicals needed to reduce DA are taken up faster in the brains of Sz sufferers

This suggests they produce more

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65
Q

What did Tienari do?

A

Suggested children of people with Sz are still at heightened risk, even if they are adopted by families with no history of Sz

Supports genetic influence of Sz

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66
Q

What is the Biological Treatment of Sz?

A

Drug Therapy

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67
Q

What is the most common type of Drug Therapy for Sz?

A

Antipsychotics

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68
Q

Information about Antipsychotics:

A

Can be required short term or long term
Can be traditional (typical antipsychotics) or updated (atypical antipsychotics)
Some patients need a short course and will have no returning symptoms
Others might need them as lifelong treatments

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69
Q

Information about Typical Antipsychotics

A
  • Been around since 1950s
  • Can be taken as tablets, syrup or injections
  • Main one is Chlorpromazine:
  • Dosage is usually smaller and then gradually increased to a maximum of 400-800mg
  • Oral doses are up to 1000mg daily
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70
Q

What is the main Typical Antipsychotic?

A

Chlorpromazine

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71
Q

What type of Antipsychotic is Chlorpromazine?

A

Typical Antipsychotic

72
Q

How do Typical Antipsychotics work?

A

They are dopamine antagonists
- they reduce the action of the neurotransmitter dopamine
- they block dopamine receptors in the synapses of the brain to reduce its action
- the dopamine-antagonising effect normalises neurotransmission in key areas of the brain to reduce symptoms such as hallucinations

73
Q

What symptoms do Typical Antipsychotics reduce?

A

Hallucinations

74
Q

When was Chlorpromazine released?

A

1950s

75
Q

What is Chlorpromazine’s dosage?

A

400-800mg daily
Up to 1000mg

76
Q

How does Chlorpromazine work?

A
  • binds to dopamine receptors in the synapses of the brain to reduce its action
  • initially builds up dopamine levels and then reduces them
  • has effective sedative properties so can calm patients with Sz and other conditions
77
Q

How does Chlorpromazine work as a Sedative?

A
  • it is suggested it has an effect on histamine receptors but we are unsure of how this leads to sedation
  • it can calm patients with Sz and other conditions
  • used especially on initial admission as patients are anxious
  • taken in syrup form as it absorbs faster than tablets
78
Q

Information about Atypical Antipsychotics:

A
  • used since the 1970s
  • their development aimed to maintain/increase effectiveness of suppressing symptoms of psychosis while also minimising side-effects
  • lots do not work in the same way
  • we do not know how some of them work
  • main 2 are Clozapine and Risperidone
79
Q

What are 2 main Atypical Antipsychotics?

A

Clozapine
Risperidone

80
Q

About Clozapine:

A
  • Developed in 1960s and trialed in 1970s
  • Withdrawn in 1970s due to the death of some patients from a blood condition (agranulocytosis)
  • In 1980s it was found to be more effective than typical antipsychotics so it was used when other treatments failed
  • Still used today, but patients taking it have regular blood tests
  • Not available for injection due to deadly side-effects
  • Daily dosage is typically 300-400mg
  • Used when patients are thought to be suicidal
81
Q

How does Clozapine work?

A
  • it binds to dopamine receptors to limit the production
  • it also acts on serotonin and glutamate receptors to improve mood and cognitive functioning, and reduce depression
82
Q

What year was Clozapine released?

A

Trialed - 1960s
Released - 1970s
Withdrawn - 1970s
Re-Released - 1980s

83
Q

What is the dosage of Clozapine?

A

300-400mg

84
Q

What receptors does Clozapine act on?

A

Dopamine
Serotonin
Glutamate

85
Q

About Risperidone:

A
  • developed around 1990
  • developed to attempt to be as effective as Clozapine but with less serious side-effects
  • can be taken in tablet form, syrup form, or as an injection that lasts 2 weeks
  • a small dose is initially given, but dosage can be up to 12mg, and is usually around 4-8mg per day
86
Q

How does Risperidone work?

A

It binds to dopamine and serotonin receptors, and binds stronger than Clozapine, so it is more effective in smaller doses

87
Q

When was Risperidone released?

A

Around 1990

88
Q

What is the dosage of Risperidone?

A

4-8mg
up to 12mg

89
Q

Evaluate Chlorpromazine

A

Good:
- Syrup absorbs quickly, so it can be used as a sedative

Bad:
- Takes a while to work (it initially increases dopamine levels)
- May produce side-effects like depression, so it could lead to a co-morbidity where anti-depressants are needed as well

90
Q

Evaluate Clozapine

A

Good:
- Improves mood as well as regulating symptoms
- Can be used when other treatments fail

Bad:
- Severe side-effects, such as death and Tardive Dyskinesia

91
Q

Evaluate Risperidone

A

Good:
- Same effects as Clozapine but without side effects
- Fewer side effects
- Injections can last 2 weeks

Bad:
- Can have negative side effects

92
Q

What are side effects of Chlorpromazine?

A

Depression

Generic Typical Antipsychotics:
- dizziness
- agitation
- sleepiness
- jaw stiffness
- weight gain
- itchy skin

93
Q

What are side effects of Clozapine?

A
  • Death
  • Agranulocytosis (low white blood cells)
  • Tardive Dyskinesia (involuntary facial movements such as grimacing, blinking and lip-smacking)
94
Q

What are side effects of Risperidone?

A

Depression
Tardive Dyskinesia after long term use

95
Q

Evaluate the Biological Treatment of Schizophrenia

A

Good - evidence to support effectiveness
Typical:
- research compared effects of Chlorpromazine to control conditions with placebos
- used data from 113 trials with 1,121 participants
- found Chlorpromazine was associated with better overall functioning and reduced symptoms
Atypical:
- research found Clozapine is more effective than typical and other atypical antipsychotics
- it is effective in 30-50% of treatment-resistant cases where other antipsychotics have failed
- suggests they work

Bad - Likelihood of side effects
Typical:
- dizziness
- weight gain
- sleepiness
- jaw stiffness
- agitation
- itchy skin
Long-term use can lead to Tardive Dyskinesia
Atypical:
Clozapine can cause death
- suggests the treatment is harmful
- this could mean patients avoid this treatment, rendering them ineffective

Bad - Mechanism Unclear
- We do not understand why they work
- Our understanding comes from the Dopamine Hypothesis, but this is not a complete understanding of Sz as the new Dopamine Hypothesis suggests some DA levels are too low
- If this was the case, antipsychotics should not work
- This matters because it could mean the foundation on which the understanding of antipsychotics are based lacks validity, and so they might not be the best treatment option if we are unsure of how they work

96
Q

How many categories are in Psychological Explanations of Sz?

A

2:
Family Dysfunction
Cognitive Explanations

97
Q

What does Family Dysfunction include?

A

The Schizophrenogenic Mother
Double-bind Theory
Expressed Emotion

98
Q

What does Cognitive Explanations include?

A

Dysfunctional Thinking
Meta Representation
Central Control

99
Q

What is Family Dysfunction?

A

The idea that abnormal processes within a family - such as poor communication - are seen as risk-factors for the development and maintenance of Sz

There are links between Sz and childhood/adulthood experiences of living in a dysfunctional family

100
Q

Who suggested the Schizophrenogenic Mother?

A

Fromm-Reichmann

101
Q

What did Fromm-Reichmann do?

A

Proposed a psychodynamic explanation for Sz based on the accounts she heard from her patients about their childhoods.
- many patients spoke about a particular type of parent, and she called this the ‘schizophrenogenic mother’

102
Q

What does Schizophrenogenic mean?

A

Schizophrenia-causing

103
Q

What qualities does a Schizophrenogenic Mother have?

A

They are:
- cold
- rejecting
- controlling

They create a family climate characterised by tension and secrecy

104
Q

How does Sz stem from a Schizophrenogenic Mother?

A

The child develops distrust which develops into paranoid delusions, such as delusions of persecution, which then ultimately leads to Sz

105
Q

Who suggested the Double Bind Theory?

A

Bateson et al

106
Q

What did Bateson et al do?

A

Agreed that family climate is important in developing Sz, but emphasised the role of the communication style within a family.

He theorised the Double Bind Theory

107
Q

How does the Double Bind Theory lead to Sz?

A

The developing child finds themselves trapped in situations where they fear doing the wrong thing, but they receive mixed messages of what the wrong thing is

They feel unable to comment on the unfairness of the situation or seek clarification

When they ‘get it wrong’ (which is often), the child is punished by withdrawn of love

This leaves them with a confusing and dangerous understanding of the world, which is reflected in symptoms like disorganised thinking and paranoid delusions

108
Q

What is Expressed Emotion?

A

The level of emotion (especially negative) that is expressed towards a person with Sz by their carers/family members

109
Q

What are examples of Expressed Emotion?

A
  • Verbal criticism of the person that can be accompanied by violence
  • Hostility towards the person, including anger and rejection
  • Emotional over involvement in their life, including needless self-sacrifice
110
Q

How does Expressed Emotion lead to Sz?

A

The high levels of emotion directed towards the individual are a serious source of stress

This is an explanation for relapses in people with Sz

The stress can also trigger the onset of Sz in a person who is already vulnerable due to genes

111
Q

What is Dysfunctional Thinking?

A

The idea that Sz is associated with several types of dysfunctional thought processing (disruption to normal mental processing), and they can be possible explanations for Sz

112
Q

What are examples of Dysfunctional Thinking? How does it lead to Sz?

A

Disruption to normal thought processing:
- Reduced processing in Ventral Striatum –> negative symptoms
- Reduced processing of information in Temporal and Cingulate Gyri –> hallucinations

The lower than usual level of information processing suggests cognition is likely to be impaired

113
Q

Who suggested Metarepresentation and Central Control Dysfunctions as Cognitive Explanations for Sz?

A

Frith et al

114
Q

What did Frith et al do?

A

Identified 2 kinds of Dysfunctional Thought Processes in people with Sz:
Metarepresentation Dysfunction
Central Control Dysfunction

115
Q

What is Metarepresentation?

A

The cognitive ability to reflect on thoughts and behaviour
It allows us insight into our own intentions and goals
It allows us to interpret the actions of others

116
Q

What is Metarepresentation Dysfunction?

A

Disruption in our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else

117
Q

How does Metarepresentation Dysfunction lead to/explain Sz?

A

It explains hallucinations of hearing voices and delusions like thought insertion (delusions of control) as people with Sz will not be able to recognise their own thoughts are carried out by themselves

118
Q

What is Central Control?

A

The cognitive ability to suppress automatic responses while we perform deliberate actions

119
Q

What is Central Control Dysfunction?

A

The inability to suppress automatic responses and thoughts triggered by other thoughts

120
Q

How might Central Control Dysfunction explain Sz?

A

Speech Poverty:
- could result from the inability to suppress speech triggered by other thoughts
- derailment of thoughts might happen as each word might trigger associations and the person cannot suppress automatic responses to these

121
Q

Evaluate Psychological Explanations for Schizophrenia

A

Family Dysfunction:

Good - Research support
Read
- indicators of family dysfunction include insecure attachment and exposure to childhood trauma such as abuse
- Read reviewed adults with Sz and found they are disproportionately likely to have insecure attachment (especially type C and D)
- Reported that 69% of women and 59% of men with Sz have a history of physical and/or sexual abuse
- suggests family dysfunction makes people more vulnerable to Sz

Bad - Explanations lack support
- although there is support for childhood family-based stress associating with adulthood Sz, there is almost no support for traditional theories such as Schizophrenogenic mother and Double Bind theory
- this suggests family explanations have not been able to account for the link between childhood trauma and Sz

Bad - Socially sensitive
- could blame the parents/carers
- particularly blames the mother

Cognitive Explanations:

Good - Research Support
Stirling
- compared performance on cognitive tasks in 30 people with Sz and a control group of 30 people without Sz
- tasks included the Stroop task, where they had to name the font-colours of colour-words, so they had to suppress the tendency to read the words aloud
- as predicted by Frith, people with Sz took longer (twice as long on average) to name the font colours
- supports the idea of cognitive impairment in Sz

Bad - Artificial tasks
- low mundane realism

Bad - Proximal Explanation
- they only explain what is happening now to produce symptoms, rather than what initially caused Sz
- could suggest the cognitive explanation is only a partial explanation for Sz as it limits our understanding

Bad - Confusion over basis of Sz
- cognitive explanation focuses more on Biological origins, and suggests it is a biological condition rather than a psychological condition
- suggests there is question over what type of condition Sz is, which could hinder our understanding and ability to provide treatments

122
Q

How many Psychological Treatments are there for Sz?

A

2

123
Q

What are the 2 Psychological Treatments for Sz?

A

Cognitive Behaviour Therapy
Family Therapy

124
Q

What can also be included in Psychological Treatments for Sz?

A

Management of Sz:
Token Economies

125
Q

What is Cognitive Behaviour Therapy?

A

The most common treatment of Sz
It aims to deal with thoughts (cognitions), and behaviour
It takes place over a period of 5-20 sessions in groups or individually
It helps patients identify irrational thoughts and tries to change them
It can include arguments and discussions of how likely the beliefs are to be true

126
Q

How does CBT help people with Sz?

A

It can make sense of how their irrational cognitions (hallucinations/delusions) impact their feelings and behaviour
- It can help provide an understanding of where the symptoms come from, which can be helpful for things such as auditory hallucinations as it can reduce fear as they can understand it is them and their faulty thinking, not a demon or alien
- It can help people cope better once they understand why they are experiencing their symptoms

127
Q

What techniques might CBT use to help people with Sz?

A

Normalisation:
Helping people hearing voices by assuring them it is an extension of the ordinary experience of thinking in words

Challenging:
Using reality testing to examine the likelihood that irrational beliefs from delusions are true

128
Q

Who can I use as a Case Example of CBT for Sz?

A

Turkington et al

129
Q

What did Turkington et al do?

A

Described an example of how CBT was used to challenge where a paranoid client’s delusions came from

130
Q

What was the example of Turkington?

A

Client has Delusions of Persecution:
the mafia are observing me and deciding how to kill me

Therapist:
you are obviously very frightened, there must be a good reason for this

Client:
do you think it’s the mafia?

Therapist:
It’s a possibility, but there could be other explanations. How do you know that it’s the mafia?

131
Q

What is Family Therapy?

A
  • A psychological treatment of Sz that takes place with the families and the identified patient
  • The identified patient is one member of the dysfunctional family who expresses the family’s conflicts
  • The therapy aims to improve the quality of communication and interaction between family members
132
Q

What do psychologists look at in Family Therapy?

A

Some look at the root cause of the conditions
Nowadays, therapists are more concerned with reducing the stress within a family as this can reduce relapse rates

133
Q

What is the aim of Family Therapy?

A

To reduce levels of Expressed Emotion

This will reduce stress for the patient so they are less likely to relapse

134
Q

What is the aim of CBT?

A

To identify irrational thoughts and try to change them by challenging them

135
Q

Who researched how Family Therapy works?

A

Pharoah et al

136
Q

Who suggested a model of practice for Family Therapy?

A

Burbach

137
Q

What did Pharaoh et al do?

A

Suggested a range of strategies that are used by family therapists to improve the functioning of a family member with Sz

138
Q

What are Pharaoh et al’s suggested strategies of Family Therapists?

A

Reduce Negative Emotions:
- reduces Expressed Emotion
- especially reduces negative emotions such as guilt
- reduces stress, increases compliance and reduces the likelihood of relapse

Improve the Family’s ability to help:
- encourages the family to form therapeutic alliances, including beliefs about Sz

139
Q

What are Pharaoh et al’s 2 main suggested Family Therapy Strategies?

A

Recude Negative Emotions
Improve the Family’s Ability to Help

140
Q

What did Burbach do?

A

Proposed a model for working with families dealing with Schizophrenia

141
Q

How many Phases of Family Therapy did Burbach suggest?

A

7

142
Q

What are Burbach’s suggested Phases of Family Therapy?

A

1) Share basic information and provide emotional support

2) Identify resources, including what each family member can offer

3) Encouraging mutual understanding and creating a safe space for all family members to express their feelings

4) Identifying unhelpful patterns of interaction

5) Learning stress-managing techniques

6) Looking at relapse prevention

7) Maintenance for the future

143
Q

What pneumonic can I use for Burbach’s model of practice?

A

Someone
Identified
Elvis
In
Las Vegas!
Rather
Funny!

144
Q

Evaluate Psychological Treatments of Schizophrenia

A

CBT:

Good - Evidence for effectiveness
Jauhar et al
- reviewed 34 studies using CBT with Sz and concluded there is clear evidence for small but significant effects on positive and negative symptoms
HOWEVER
Bad - Significance was only slight
- there is an argument that patients with Sz are likely unfit to participate effectively in CBT

Bad - Question of Cure?
- CBT improves quality of life for people with Sz, but it does not actually cure them
- Sz appears to be largely biological, so we would expect a psychological treatment to only improve their ability to live with Sz
- however, studies report significant reduction in severity of positive and negative symptoms, so this suggests it does more than just enhance coping

Family Therapy:

Good - Evidence of Effectiveness
Pharaoh et al
- reviewed family therapy and found moderate evidence for reduced hospital readmission
- this suggests family therapy improves the quality of life for patients and family

Bad - Inconsistent Findings
Pharaoh et al
- found results of different studies were inconsistent, and there were problems with some of the quality of the studies
- this suggests evidence for family therapy is fairly limited

Good - Benefits all family members
- therapy is beneficial for the identified patient and the families that provide the bulk of the care
- a review of evidence concluded these effects are important as families provide the bulk of the care
- by strengthening the functioning of a whole family, family therapy lessens the negative impact of Sz on other family members and strengthens the ability for the family to support the member with Sz
- this suggests family therapy has wider benefits beyond the obvious positive impact on the identified patient

145
Q

What is the management technique for Schizophrenia?

A

Token Economies

146
Q

What is the aim of Token Economies? (Sz)

A

To make behaviour more socially acceptable by encouraging desirable behaviours through reinforcement

147
Q

What are Token Economies? (Sz)

A

Reward systems used to manage the behaviour of people with Sz, especially those who have developed maladaptive behaviour from spending time in psychiatric hospitals

148
Q

Who demonstrated Token Economies for people with Schizophrenia?

A

Allyon and Azrin

149
Q

What did Allyon and Azrin do?

A

They demonstrated a token economy system in a ward of women with Sz diagnoses

150
Q

What was Allyon and Azrin’s procedure?

A

(On a ward of women with Sz)
They gave a plastic token embossed with ‘one gift’ to the participants every time they carried out a task such as making their bed or cleaning up

The tokens could be swapped for ward privileges, such as being able to watch a film,

151
Q

What were Allyon and Azrin’s findings?

A

The number of tasks carried out increased significantly

152
Q

What is the Rationale for Token Economies? (Sz)

A

Institutionalised behaviours can be tackled with Token Economies.
People who spend long times in Institutional psychiatric wards may develop bad hygiene or might stop socialising with others.
TE improve the quality of their personal care and social behaviour so they can prepare for life outside the hospital setting, and also improve their quality of life when in one.

153
Q

How do Token Economies work? (Sz)

A

Tokens are Secondary Reinforcers - they only have value once the patient learns it can be used to obtain rewards
Rewards are Primary Reinforcers - for example, sweets, magazines, films, walks outside etc.

Tokens (usually coloured disks) are given immediately when individuals carry out a desired behaviour
Target Behaviours are decided, and these can be decided on an individual basis based off their usual behaviour. They are behaviours to look for to reinforce with a Token.

The immediate reward for a target behaviour from the token is important as delayed rewards are not as effective

154
Q

What are Secondary Reinforcers in Token Economies?

A

The Tokens

155
Q

What are Primary Reinforcers in Token Economies?

A

The Rewards

156
Q

What are Target Behaviours in Token Economies?

A

Behaviours to look out for that should be rewarded.
They should be decided on an individual basis so that the same level of difficulty/effort is rewarded for each person

157
Q

What is the Theoretical Understanding of Token Economies?

A

It is Behaviour Modification - a behavioural therapy based on Operant Conditioning

Tokens are secondary reinforcers as they only have value once they are associated with meaningful rewards
Meaningful rewards are primary reinforcers
Tokens that can be exchanged for a range of different primary reinforcers are particularly powerful secondary reinforcers (also known as generalised reinforcers)

At the start of the TE programme, tokens and primary reinforcers should be administered together to help the association

158
Q

What theory is Token Economy based off?

A

Operant Conditioning - learning through association

159
Q

Evaluate Token Economies as Management/Treatment for Schizophrenia

A

Bad - Ethical Issues
- it gives professionals significant power and control over the behaviour of the patients
- it imposes their norms and target behaviours onto others, which could be a problem if they are not identified sensitively
- restricting the availability of pleasures who don’t behave might mean that seriously ill and distressed people have a worse time
- there has been legal action from many families who see their relative in token economies, meaning there has been a decline in them
- this suggests the benefits of token economies might be outweighed by their impact on personal freedom and reduced quality of life

Bad - More Pleasant and Ethical Alternatives Exist
- token economies might be helpful for managing Sz, but there are other approaches that do not raise the same ethical issues
- a review suggested art therapy might be a good alternative
- although there is a small evidence base, it appears to show art therapy is a high-gain, low-risk approach to managing Sz
- it is a pleasant experience with no major risks of side effects or ethical abuses
- this suggests it might be a good alternative to token economies

Bad - Does not reflect the Real World
- they are difficult to continue once outside a hospital setting as target behaviours cannot be monitored as closely and tokens cannot be administered immediately
- the system of token economies does not reflect the real world, so it could be argued it does not prepare the patient for the real world
- this questions the value of token economies to manage behaviour of Sz

160
Q

What is the Interactionist Approach?

A

An approach that acknowledges the biological, psychological and social factors in the development of Sz

161
Q

What do Biological factors of Sz include? (interactionist approach)

A

Genetic Vulnerability
Neurochemical and Neurological abnormality

162
Q

What do Psychological factors of Sz include? (interactionist approach)

A

Stress

163
Q

What do Social factors of Sz include? (interactionist approach)

A

Poor family interactions

164
Q

What model do we use in the Interactionist Approach? (Sz)

A

The Diathesis Stress Model

165
Q

What is the Diathesis Stress Model?

A

An explanation of Schizophrenia that suggests there is a Diathesis (vulnerability) that needs a Stressor (trigger) in order for Sz to be developed

166
Q

What is a Diathesis? (Sz)

A

A vulnerability to Sz - e.g. through genes

167
Q

What is a Stress? (Sz)

A

A trigger from a negative experience - stress

168
Q

Who created the original Diathesis Stress Model?

A

Meehl

169
Q

What did Meehl do?

A

Theorised the original Diatheses-Stress Model

170
Q

What did Meehl believe in his original Diathesis-Stress Model?

A

Diathesis was entirely genetic, and was the result of a ‘Schizogene’
(This led to the development of the biologically based Schizotypic Personality)
He believed if someone did not have a Schizogene then no amount of stress would lead to Sz
However, in the carrier of the gene, chronic stress through childhood and adulthood such as the Schizophrenogenic Mother could result in developing Sz

171
Q

What is the Modern Understanding of Diathesis? (Sz)

A

Many genes each appear to increase Genetic Vulnerability, and there is no single Schizogene

Psychological trauma is also now seen as a diathesis rather than a stressor as it was found child abuse and early severe trauma alters the developing brain

172
Q

What is the Modern Understanding of Stress? (Sz)

A

Psychological stress (e.g. from parenting) is still considered important

Stress now also includes anything that risks triggering Sz,, such as Cannabis use as Cannabis interferes with the dopamine system
It was found Cannabis increases the risk of Sz by up to 7 times, however, most don’t develop Sz after smoking cannabis, so they must not have a vulnerability

173
Q

What is the Treatment for Sz suggested by the Interactionist Approach?

A

Combines both Biological and Psychological Treatments
It usually combines antipsychotic medication with therapies such as CBT
In Britain, it is standard to treat people with this combination, but in the US, it is more common to treat biologically without psychological treatment

174
Q

Who supports the Interactionist Treatment of Sz?

A

Turkington et al

175
Q

What did Turkington et al do?

A

Suggested it is possible to believe in the Biological cause of Sz and still practice CBT to relieve the Psychological Symptoms (adopt an interactionist approach)

176
Q

Evaluate the Interactionist Approach for Schizophrenia

A

Good - Evidence for the role of Vulnerability and Triggers
Tienari et al
- investigated the combination of genetic vulnerability and parenting style in adopted children from 19,000 Finnish Mothers who had been diagnosed with Sz
- compared them to a control group of adoptees without a family history of Sz
- adoptive mothers had been assessed for child-rearing style, and they found the condition with Sz mothers had high levels of criticism, hostility, and low levels of empathy, and this was associated with development of Sz in the high risk group
- this suggests a combination of genetic vulnerability and family stress can lead to risk of Sz

Bad - The Original Diathesis Stress model is over-simplistic
- the idea of one single schizogeny and a schizophrenic parenting style is over-simplistic
- it is now believed vulnerability can be caused by early trauma as well as genetic make-up, and stress can come in many forms
- multiple genes increase vulnerability as Sz is polygenic
- stress can come in multiple forms, it is not just dysfunctional parenting
- it has been shown childhood sexual trauma is a diathesis, and cannabis can be a trigger
- this suggests the idea of a biological diathesis and psychological stress is over simple, suggesting the original diathesis-stress model lacks validity

Good - Real world support
- more people are diagnosed with Sz in urban areas rather than rural areas
- this justifies the interactionist approach as it assumes urban living is more stressful, so it acts as a trigger
HOWEVER
- it could just mean people who suffered abuse (have a diathesis) migrate to cities to get away, and are more likely to be diagnosed there
- this could mean there is a question of if there is support for the interactionist approach of Sz

Psychology Paper 3 (6 decks)

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