Schizophrenia Flashcards

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1
Q

Kraeplin

A

First identified schizophrenia calling it ‘dementia praecox’

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2
Q

Bleuler

A

Called the ‘dementia praecox’ schizophrenia as it means split mind

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3
Q

Prevalence of schizophrenia

A

Affects 1% of the population

Males= mid 20s
Females= early 30s

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4
Q

When are symptoms most severe

A

According to Bleulers 2000 schizophrenics the most severe is early adulthood in first 5 years of onset

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5
Q

% that recover from positive symptoms

A

40%

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6
Q

% that can make a full recovery if diagnosed early

A

20%

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7
Q

% of patients that suffer for rest of lives

A

40%

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8
Q

Positive symptoms of schizophrenia

A

Hallucinations
Delusions
Disorganised thinking and speech

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9
Q

Negative symptoms of schizophrenia

A

Speech poverty (alogia)
Flat effect
Avolition
Apathy

Innapropriate effect

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10
Q

Hallucinations

A

False sensory experiences (auditory and visual)

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11
Q

Delusions

A

False beliefs that aren’t based on facts that are hard to disprove. Persecution, grandeur and control

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12
Q

Disorganised thinking and speech

A

Thoughts drift from one thing to another (misty or hazy). Have trouble reading an article or watching TV. Words may become confused or jumbled.

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13
Q

Speech poverty (alogia)

A

Reduction in communication where it would be considered normal To communicate. Thought to result from other slowing of thoughts.

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14
Q

Flat affect

A

A reduction or flattening of emotions. The range and intensity of facial expressions, tone of voice and eye contact reduce. Body language becomes difficult too

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15
Q

Avolition

A

Lack of motivation and severe lack of initiative to accomplish tasks. Could neglect household chores and personal hygiene

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16
Q

Apathy

A

Difficulty in planning and setting goals. No interest in socialising or hobbies. A person doesn’t want to do anything and will sit in their house for hours or days

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17
Q

Innapropriate affect

A

Emotional expressions are unsuitable for the situation. When individuals appear to have lost the ability for emotions occur in a normal way. Affect is a reaction to their hallucinations

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18
Q

Diagnostic criteria

A

A. Characteristic symptoms
B. Social/occupational dysfunction
C. Duration
D. Schizoactive and mood disorder exclusion
E. Exclusion of knows organic cause
F. Relationship to Austism

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19
Q

Characteristic symptoms

A

2 or more of symptoms are present for 1 month

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20
Q

Social/occupational dysfunction

A

Impairment in one of the main areas of functionin for a significant period of time since the onset of the disturbance

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21
Q

Duration

A

Some signs of the disorder must last for a continuous period of time of at least 6 months. Which just include 1 month of symptoms that meat criteria A

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22
Q

Schizoaffective and mood disorder exclusion

A

Schizophrenia if Schizoaffective and mood disorder have been ruled out

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23
Q

Exclusion of known organic cause

A

The disturbance isn’t due to substance abuse

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24
Q

Relationship to autism

A

Need to rule out autism or history of autism

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25
Q

Co-morbidity

A

Simultaneous presence of 2 or more disorders at same time

Lowers the validity of classification

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26
Q

Buckley co-morbidity percentages

A

50% of schiz are depressed
29% of schiz have PTSD
23% of schiz have OCD
47% of schiz suffer from substance abuse

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27
Q

What does comorbidity do to classification

A

Comorbity lowers the validity of classification

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28
Q

Symptom pool

A

Collection of symptoms a culture associates with an illness

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29
Q

Copeland (1970)

A

Gave a description of a patient to 134 US and 194 British psychiatrists and found 69% of us diagnosed them with schizophrenia but only 2% of British did.

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30
Q

Overlapping symptoms

A

No schizophrenic specific symptoms means that a valid diagnosis is hard to achieve. As we can’t be sure that symptoms someone is experiencing is because that have schizophrenia. They could have Bipolar

Lowers validity of diagnosis

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31
Q

When was DSM classification system first published

A

1952

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32
Q

When was DSM V published

A

2013

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33
Q

Buckley- how many schiz are depressed

A

50%

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34
Q

Buckley- how many schiz have ptsd

A

29%

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35
Q

Buckley- how many schiz have OCD

A

23%

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36
Q

Buckley- how many schiz hade substance abuse

A

47%

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37
Q

Beck et al research (reliability)

A

A group of 153 patients with schizophrenia were each assessed by 2 different psychiatrists. Only agreed 54% of time - implying low interrater

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38
Q

A group of 153 patients with schizophrenia were each assessed by 2 different psychiatrists. Only agreed 54% of time - implying low interrater

A

Beck et al

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39
Q

2 ways of testing reliability

A

Test retest

Inter rater

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40
Q

Strengths of reliability for schiz

A

+ Farmer (standardised interview)
+improvements to DSM (stripped bizzare and nonbizzare)

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41
Q

A weakness weaknesses of reliability of schizophrenia diagnoses

A

-Copeland
-read

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42
Q

Read et al (overlapping symptoms)

A

13% of population hear voices but 1% are diagnosed w schizophrenia

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43
Q

Weaknesses of validity of schiz

A

-Buckley
-Konstantareas and hewitt
-Rosenhand

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44
Q

Cultural interpretations of schizophrenia symptoms affect classification

A

Research shows that religious and cultural groups can have a marked effect on perceptions of schizophrenia. What can be seen as insane in one culture may be seen as desired in another. Therefore this can complicate a valid classification of schizophrenia

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45
Q

Negative cultural attitudes to schizophrenia

A

Psychological distress and mental health issues attract different levels of stigma in different cultures that will clearly affect the diagnosis of schizophrenia. This implies that without being diagnosed people with schizophrenia will continue to suffer needlessly and unable to access treatment

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46
Q

Culture of the clinician effects the diagnosis of schizophrenia

A

The actual nationality/ culture of the clinician can create reliability and validity issues when diagnosing schizophrenia. For many reasons different cultures diagnose in different ways (Copeland)

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47
Q

Race discrimination is evident in diagnosing schiz

A

Research has implied that some nationalities or countries have considerably more cases of schizophrenia than others. It’s suggested that mental health professionals perceive diverse ethnic and cultural groups very differently. Implies that to avoid misdiagnosis, clinicians should be mindful of subtle prejudices

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48
Q

Weaknesses of cultural bias affecting classification of schizophrenia

A

-Malgady research (voices in head in Costa Rica)
-Copeland research

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49
Q

Strengths of cultural bias in diagnosis of schizophrenia

A

+ being aware can lead to training of psychologists in cultural differences
+ allows for different symptoms pools to be created (takes cultural norms into account)

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50
Q

Unreported facts between men and women when diagnosing schizophrenia

A

Men suffer more severe negative symptoms than women as well as suffering more from substance related disorders. Men are more likely to be involuntarily committed psychiatric wards than women (Goldstein)

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51
Q

Biased research (gender bias schizophrenia)

A

Some psychologists claim research into schizophrenia has neglected to use many female patients, questioning it’s usefulness and representativeness

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52
Q

Under diagnosing of female patients suffering from schizophrenia

A

Some research has suggested that women actually go under diagnosed in comparison to men. This could have far reaching consequences as it implies many women could be denied access to treatment and continue to suffer from the symptoms

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53
Q

Strengths of gender bias in schizophrenia

A

+prac app

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54
Q

3 biological explanations of schizophrenia

A

Genetic inheritance
Dopamine hypothesis
Neural correlates

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55
Q

Explain Genetic Inheritance of schizophrenia

A

No one gene is responsible for schizophrenia but several genes are involved
Ripke et al reported 108 genetic variants that could mediate a vulnerability to the disorder
Including variations to chromosomes 8 and 11 and the C4 gene
Havin some of these faulty genes can increase someone’s vulnerability to developing schizophrenia by inheriting biochemical imbalances or brain structure abnormalities

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56
Q

Ripke et al

A

reported 108 genetic variants that could mediate a vulnerability to the disorder
Including variations to chromosomes 8 and 11 and the C4 gene

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57
Q

Who reported 108 genetic variants that could mediate a vulnerability to the disorder
Including variations to chromosomes 8 and 11 and the C4 gene

A

Ripke et al

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58
Q

Tienari (biological schiz)

A

Adoption study in Finland with over 164 adopted kids whose biological mothers had been diagnosed with schizophrenia.

The study found 11 of the sample whose biological mums had schizophrenia also had schizophrenia compared to 4 from a control group

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59
Q

Adoption study in Finland with over 164 adopted kids whose biological mothers had been diagnosed with schizophrenia. The study found 11 of the sample whose biological mums had schizophrenia also had schizophrenia compared to 4 from a control group

A

Tienari

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60
Q

Strengths of genetic explanations of schizophrenia

A

+ evidence from Joseph et al
+ Tienari

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61
Q

Weaknesses of genetic explanations of schizophrenia

A

-twin studies would be 100%
- family studies might validate environmental explanations better (imitation)
-biological reductionism and determinism

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62
Q

Full Dopamine hypothesis explained

A

Elevated levels of dopamine at key synaptic sites within the subcortical regions of the brain
Eg. The Mesolimbic pathway (pos) and mesocortical pathway (neg)
Excess of dopamine is a system overload where too many impulses are transmitted. Triggering positive symptoms

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63
Q

Randrup and munkvad

A

Have a sample of rats schizophrenic like behaviours by giving them dopamine agonists. The rats were given it to raise dopamine levels 3 times a day for 6 days - led to long lasting abnormalities like inability to filter out irrelevant sounds. This was reversed by antipsychotics

64
Q

Have a sample of rats schizophrenic like behaviours by giving them dopamine agonists.

A

Randrup and munkvad

The rats were given it to raise dopamine levels 3 times a day for 6 days - led to long lasting abnormalities like inability to filter out irrelevant sounds. This was reversed by antipsychotics

65
Q

Cochrane

A

Schizophrenia is 1% in both Britain and windies but Afro Caribbean men are several times more likely to be diagnosed in Britain

66
Q

Schizophrenia is 1% in both Britain and windies but Afro Caribbean men are several times more likely to be diagnosed in Britain

A

Cochrane

67
Q

Benzel et al

A

Identified Three genes COMT DRD4 AKT1 all associated with excess dopamine in specific D2 receptors leading to positive symptoms

68
Q

3 candidate genes for schizophrenia

A

COMT DRD4 AKT1

69
Q

Strengths of dopamine hypothesis

A

+ practical applications (can give dopamine agonists or antagonists) antagonists will block receptor site and increased reuptake
+scientifically adaptable (been thru several versions showing it’s more valid than stubborn theories such as family dysfunction)

70
Q

Weaknesses of dopamine hypothesis

A

-correlational
-Farde et al found no difference between schiz and normals people levels of dopamine which harms the credibility of the theory

71
Q

Chlorpromazine

A

Typical antipsychotic that blocks D2 receptor

72
Q

Typical antipsychotic that blocks D2 receptor

A

Chlorpromazine

73
Q

Original dopamine hypothesis

A

More dopamine was produced in the brain

74
Q

New dopamine hypothesis

A

Further research shows that schizophrenics had abnormally high number of D2 receptors

75
Q

Owen et al

A

Found a large number of dopamine receptors in brains of schizophrenics

76
Q

Found a large number of dopamine receptors in brains of schizophrenics

A

Owen et al

77
Q

How are positive symptoms of schizophrenia caused in dopamine hypothesis

A

Overactivity in mesolimbic pathway

78
Q

How are negative symptoms of schizophrenia caused in dopamine hypothesis

A

Lower dopamine activity in Mesocortical pathway

79
Q

Enlarged ventricles

A

Correlation between schizophrenia and enlarged ventricles with them having up to 15% larger ventricles

80
Q

Family dysfunction

A

Families do not have beneficial relationships and are constant sources of stress are thought to influence the onset of schizophrenia

81
Q

3 factors of a dysfunctional family

A
  1. High levels of interpersonal conflict
  2. Poor communication or difficulty in communication
  3. Being overly critical and controlling of children
82
Q

Double bind theory

A

Putting children into a confusing and contradictory situation
Eg one parent saying one thing but other parent saying opposite

83
Q

Putting children into a confusing and contradictory situation

A

Double bind theory

84
Q

Learned helplessness

A

Created by double bind and is created when people feel like they’re in a lose lose situation and feel powerless to do anything about it

Leads to Flatt affect in adulthood

85
Q

Family dysfunction mainly causes…

A

Flatt affect in adulthood

86
Q

Strengths of family dysfunction

A

+research support (Lidz)
+ family therapies
+Linssen

87
Q

Weaknesses of family dysfunction

A
  • Aetiological Fallacy
    -cause and affect
    -Liem
88
Q

Aetiological Fallacy

A

Mistaken way of thinking (mistake giving theory credit because practical application that came from it is good)

89
Q

Schizophrenogenic mother

A

Historical theory from 1950s that Blamed mother for lacking the necessary emotional support for their children.

90
Q

Characteristics of schizophrenogenic mother

A

Domineering, insensitive, controlling, overprotective as well as rejecting, refuses to acknowledge child’s independence

91
Q

Expressed emotion

A

HEE families express considerable emotions ( higher concern or higher hostility)

Focus on a families reaction to someone’s deteriorating mental state which can have a huge effect on the client

92
Q

Linszen

A

Found patients that return to a HEE household are 4x more likely to relapse

93
Q

Found patients that return to a HEE household are 4x more likely to relapse

A

Linszen

94
Q

Kuipes

A

Found HEE relatives talk more and listen less

95
Q

Found HEE relatives talk more and listen less

A

Kuipes

96
Q

Liem

A

Measured patterns of parental communication in families with schizophrenic child and found no difference compared with normal families (refutes double bind)

97
Q

Measured patterns of parental communication in families with schizophrenic child and found no difference compared with normal families (refutes double bind)

A

Liem

98
Q

Cognitive theory of schizophrenia

A

Faulty thought processes are responsible for the onset and maintenance of schizophrenia
Delusions are seen as occurring due to processing information irrationally

99
Q

Cognitive deficits

A

Impairments in thought processes such as perception, memory and attention

Difficulty understanding other people’s behaviours might explain some of the problems schiz ppl have.

100
Q

Cognitive bias

A

Present when people notice, pay attention to or remember certain types of information better than others (selective)
Can explain delusions (like persecution) and auditory hallucinations

101
Q

Strengths of cognitive approach to schizophrenia

A

+ lead to prac app (STARTUP)
+ research support (Stirling)

102
Q

Weaknesses of cognitive approach to schizophrenia

A

-cause and effect
-alternative explanations (biological is more valid - less inferences)

103
Q

Meta representation

A

How people monitor their thoughts

People with schizophrenia are thought to have dysfunction with thought processes. Leading to problems with attention memory.

Sufferers disrupt their own ability to recognise whether a behaviour is carried out by ourselves or others. (Hallucination is interpreted as someone speaking to us but is actually our own thoughts)

104
Q

How people monitor their thoughts

A

Meta representation

105
Q

Central control

A

Cognitive ability to suppress automatic thoughts

Could result in disorganised speech and thinking
Each work triggers associations which the patient cannot suppress automatic responses to

106
Q

Side effects to typical antipsychotics (chlorpromozine)

A

Dry mouth, urinary problems, constipation and visual disturbance

Low
Blood pressure

107
Q

Atypical antipsychotics

A

1990s
Modulates levels of dopamine in key pathway in brain.

Also work on seratonin and glutamine and relived negative symptoms aswell as positive

108
Q

Side effects of atypical antipsychotics
(Riseridone)

A

NMS
Weight gain

109
Q

Lidz

A

Looked at cases of 50 schizophrenic patients and investigated family backgrounds. 90% had seriously disturbed families. 60% of patients had 1 or both parents with a personality disorder
Skewed families

110
Q

Looked at cases of 50 schizophrenic patients and investigated family backgrounds

A

Lidz

Found 90% of patients had seriously disturbed families
60% had one or both parents with mood disorder
Typically came from skewed families

111
Q

Farmer

A

Found that a standardised interview technique such as the PSE increases the reliability of diagnosing schizophrenia because it focuses on the frequency and severity of symptoms.

112
Q

Who Found that a standardised interview technique such as the PSE increases the reliability of diagnosing schizophrenia because it focuses on the frequency and severity of symptoms.

A

Farmer

113
Q

Konstantarea and Hewitt

A

Compared 14 male autistic patients with 14 male schizophrenia patients.

Found none of the schizophrenic patients had symptoms of autism but 50% of autistic patients had symptoms of schizophrenia. Showing support for symptom overlap

114
Q

Malgady

A

Different cultures interpret symptoms of mental disorders differently. In traditional Costa Rican culture hearing voices is interpreted as spirits talking to them but in the USA the phenomenon is a symptom of schizophrenia

115
Q

Who said Different cultures interpret symptoms of mental disorders differently. In traditional Costa Rican culture hearing voices is interpreted as spirits talking to them but in the USA the phenomenon is a symptom of schizophrenia

A

Malgady

116
Q

Loring and Powell

A

Randomly selected 290 male and female psychiatrists to read two cases. When the patient was described as male or no info given, they would be diagnosed 56% of the time. Whereas if they were described as female only 20% were diagnosed.

117
Q

Who Randomly selected 290 male and female psychiatrists to read two cases. When the patient was described as male or no info given, they would be diagnosed 56% of the time. Whereas if they were described as female only 20% were diagnosed. h

A

Loring and Powell

118
Q

Joseph

A

Found a 40% concordance rate in schizophrenia for MZ twins and 7% for DZ twins. The higher concordance rate for MZ twins indicates a genes have an influence over the development of schizophrenia

119
Q

Who Found a 40% concordance rate in schizophrenia for MZ twins and 7% for DZ twins. The higher concordance rate for MZ twins indicates a genes have an influence over the development of schizophrenia

A

Joseph

120
Q

Tienari

A

Finish 164 adopted kids whose biological mum had schizophrenia. Matched with kids whose mum didn’t have schizophrenia. The study found 11 of the sample also had schizophrenia compared to just 4 of the control group.

121
Q

Who studied 164 adopted finish kids whose biological mum had schizophrenia. Matched with kids whose mum didn’t have schizophrenia. The study found 11 of the sample also had schizophrenia compared to just 4 of the control group.

A

Tiernari

122
Q

Mcewen

A

Argues that nurturing influences can actually instigate the structural changes in the brain, making the explanation incomplete.

Children and adolescents brains are more sensitive to stressors and which can reshape the organisation of cortical regions, leading to schizophrenia

123
Q

Who Argues that nurturing influences can actually instigate the structural changes in the brain, making the explanation incomplete.

A

McEwen

124
Q

Butzlaff and hooley

A

completed a meta analysis of 26 studies and found that when patients suffering from schizophrenia returned to families with high EE they experienced more than twice the rate of relapse of schizophrenia

125
Q

Who completed a meta analysis of 26 studies and found that when patients suffering from schizophrenia returned to families with high EE they experienced more than twice the rate of relapse of schizophrenia

A

Butzlaff and hooley

126
Q

Stirling

A

Found that participants with schizophrenia took longer to complete a stroop test. Supporting the idea that schizophrenia sufferers have problems with their CMS (ability to suppress automatic thoughts)

127
Q

Davis

A

Analysed the results of 29 studies and found that relapse occurred in 55% of patients on a placebo drug competed too just 19% of those on antipsychotic medication.

128
Q

Analysed the results of 29 studies and found that relapse occurred in 55% of patients on a placebo drug competed too just 19% of those on antipsychotic medication.

A

Davis

129
Q

Analysed the results of 29 studies and found that relapse occurred in 55% of patients on a placebo drug competed too just 19% of those on antipsychotic medication.

A

Davis

130
Q

Startup

A

Recruited 90 patients who had schiz. 43 were given AP. And the rest were given AP and CBT
They found that 60% of CBT group showed clinical improvement. Compared to 40% of the AP group.

131
Q

Who Recruited 90 patients who had schiz. 43 were given AP. And the rest were given AP and CBT

A

Startup
They found that 60% of CBT group showed clinical improvement. Compared to 40% of the AP group.

132
Q

Zimmerman

A

Found that CBT is useful at dealing with the stress that comes with positive symptoms. But may be less useful at treating negative symptoms of the disorder

133
Q

Leff

A

Tested the effectiveness of family therapy
Found that families involved in the intervention showed a decrease in critical comments directed towards the patient. Plus 78% of patients in the control group were readmitted to hospital compared to 14% of the experimental group.

134
Q

Who Tested the effectiveness of family therapy

A

Leff

Found that families involved in the intervention showed a decrease in critical comments directed towards the patient. Plus 78% of patients in the control group were readmitted to hospital compared to 14% of the experimental group.

135
Q

Vaughn and Leff

A

Researched schizophrenia pays its returning to high or low EE households. The effect of no medication on low EE was insignificant. In the High EE household relapse was 92% with no medication

136
Q

Allyon and Azrin

A

Set aside a ward of 45 schizophrenia patients. They screamed for long periods of time, assaultive and were mute. Following a system of TE they had dramatic improvements in selfcare. However when the system was removed these behaviours disappeared.

137
Q

Longnecker

A

Reviews studies and concluded since 1980 males have been diagnosed with schizophrenia more often than women

138
Q

Heterogeneous disorder

A

Symptoms can present themselves in very different ways

139
Q

Liberman

A

Compared the effectiveness of typical and atypical antipsychotics in 1400 patients and found 74% discontinued cof of side effects

140
Q

Compared the effectiveness of typical and atypical antipsychotics in 1400 patients and found 74% discontinued cof of side effects

A

Liberman

141
Q

Evaluations of drug therapy

A

+ Davis
+ non disruptive compared to cbt

-Liberman
-doenst tackle root cause (reductionism)

142
Q

Evaluations for CBT

A

+ startup
+tackles root cause with no side effects

-only good for mild to moderate
-expensive

143
Q

IPT

A

Integrated psychological therapy

Improve attention- may be taught to recognise and respond appropriately to social cues

Reality testing to remove patients false beliefs

144
Q

CSE

A

Coping strategy enhancement

Teaches better ways to manage the severity of their symptoms to reduce distress and impact on day to day functioning

Can include positive self talk and relaxation techniques

145
Q

Tarrier

A

Found 73% of their sample reported they were successful at managing their symptoms

146
Q

Tarrier

A

Found 73% of their sample reported they were successful at managing their symptoms

147
Q

Chadwick

A

Showed someone who thought he could determine the future 50 vids and asked him what would happen next

He got it wrong everytime leading him to see that he could not

148
Q

Family therapy

A

An attempt to fix the faulty and dysfunctional dynamic of a family

Tries to alter communication within a family and trains people to express emotion in a more beneficial way

149
Q

Ao1 family therapy

A

Improve positive and decrease negative forms of communication

Increase tolerance levels and decease criticism within family

Decrease feelings of guilt or responsibility

‘4 safe walls’

9-12 months

-educate family on disorder and push for openness

150
Q

Evaluations of family therapy

A

+ tackles cause of problem
+ decrease the chance of relapse aswell as educating the sufferer (leff)

-requires whole family to be 100% committed
-9 to 12 months

151
Q

Evaluations for token economy

A

+ ghipour
+ doesn’t treats anything just manages it

-not appliquable outside of institution
-patronising

152
Q

Gholipour

A

Found that token economy approach reduced negative symptom scores by 46%

153
Q

Diathesis stress model schiz

A

Dispatches is can be a biological factor or modern theories suggest even childhood trauma that can be triggered by a major life event or amalgamation of stress to cause schizophrenia

154
Q

Walker

A

Reported schizos have higher cortisol levels which is related to severity of symptoms

He found these stress increases heightened genetically influenced abnormalities in dopamine transmission triggering schizophrenia

Also found high stress was present before onset of schizophrenia

155
Q

Evaluation of interactinalist explanation of schiz

A

+ walker
+ prac ap

  • can’t see HOW they interact
156
Q

Guo

A

Patients who received a combo of AP and CBT had improved quality of life and better insight than just AP and they were also less likely to discontinue treatment

157
Q

Evaluations of interactionalist treatments

A

+GUO
+ more cost effective in long term as reduced relapse

-more expensive than single therapy
-patients can interpret side effects from drugs as CBT side effects creating mistrust and less effective therapies