Schizophrenia

Question 1

What is schizophrenia

Answer 1

A severe mental disorder characterised by disruption of cognitive and emotional functioning.

Question 2

What does schizophrenia effect

Answer 2

Effects language, thoughts, perceptions, emotions and sense of self

Question 3

What is Type 1: Acute onset

Answer 3

Obvious positive symptoms appear suddenly after stressful events

Question 4

What is Type 2: chronic onset

Answer 4

Illness takes many years to develop, with gradual changes of increased disturbances and withdrawal occur. Characterised by negative symptoms

Question 5

What are the 7 types of schizophrenia

Answer 5

1. Disorganised - delusions, hallucinations and incoherent speech
2. Catatonic - total immobility, or rocking back and forth or cataleptic stupor (adoption of strange body language)
3. Paranoid - delusions of persecution
4. Undifferentiated- patients are placed in this category if they don’t fit into any other ones
5. Residual - patient has had schizophrenia in the past, but now doesn’t have enough symptoms to be classes as one. May have long term negative symptoms though
6. Simple - no delusions/hallucinations present, but negative symptoms and psychosis may be present
7. Post schizo-depression - they have had a schizophrenic episode and then followed by long term depressive episode

Question 6

What does the DSM 5 say you must have to schizophrenia

Answer 6

• 2 or more + (or one - and one +) symptoms like hallucinations for a period of one month and extreme social withdrawal for 6 months

Question 7

What does the ICD 11 say you must have to schizophrenia

Answer 7

• need to show one + positive and one - negative (or two -) for a least one month

Question 8

What are 5 types of hallucinations symptoms of SZ

Answer 8

1. Hallucinations - sensory experiences of stimuli that are distorted perceptions of things that are there
2. Auditory hallucinations - hears voices making comments at them
3. Visual hallucinations- seeing things which aren’t real
4. Olfactory - smelling things which aren’t real
5. Tactile - touching things which aren’t there

Question 9

Positive symptoms of sz

Answer 9

1. Hallucinations
2. Disorganised speech
3. Delusions
4. Disorganised/catatonic behaviour

Question 10

What are delusions (+ symptoms) and examples

Answer 10

Irrational, bizzare beliefs that seem real to that person.

Common delusions involve being an important historical, religious or political figure such as Jesus or Napoleon. Delusions also may involve being persecuted perhaps by government, aliens or even superpowers.

Question 11

What is disorganised speech

Answer 11

Individual has problems organising thoughts and this shows up in their speech. May deviate from one topic to the next.

Question 12

What is disorganised and catatonic behaviour

Answer 12

Inability or motivation to initiate or even complete a task Eg may lead to problems of personal hygiene or the person could be over active etc.

Catatonia refers to adopting rigid postures or aimless repetition of the same behaviour. (this symptom is diagnosed in the DSM but not ICD – extra symptom)

Question 13

Negative Symptoms of Schizophrenia

Answer 13

1. Speech poverty
2. Abolition
3. Affective flattening
4. Anhedonia

Question 14

What’s speech poverty

Answer 14

SZ is characterised by changes in patterns of speech – meaning the emphasis is on the reduction in the amount and quality of speech.

This is sometimes accompanied by a delay in the sufferer’s verbal responses during conversation.

Speech poverty may be seen in less complex syntax eg. Less clauses, shorter utterances etc.

Question 15

What is avolition (aka apathy) and signs of avolition

Answer 15

Described as finding it difficult to begin or keep up with goal-directed activity, i.e. actions performed in order to achieve a result. SZ suffers usually have sharp decrease in motivation

Andreason (1982) said poor hygiene, lack of persistence in work, or lack of energy are 3 signs of avoliton

Question 16

What’s affective flattening

Answer 16

A reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.

Question 17

What is anhedonia

Answer 17

Loss of interest, or pleasure in most activities, or a lack of reactivity to normally pleasurable stimuli.

Physical anhedonia is inability to experience physical pleasures like bodily contact and social anadenia is ability to experience pleasure from interpersonal situations

Question 18

What are 6 examples of issues associated with the classification and diagnosis of schizophrenia

Answer 18

1. Reliability.
2. Validity.
3. Comorbidity.
4. Symptom overlap.
5. Gender bias
6. Cultural bias

Question 19

What is reliability, and inter rather reliability

Answer 19

It’s the consistency of a measuring instrument like the DSM.

Inter rather reliability is when 2 or more diagnosticians agree with the same diagnosis for the same individual – diagnosis would be done separately.

Question 20

What is a study that showed how poor reliability is a weakness of the diagnosis of schizophrenia

Answer 20

Cheniaux et al (2009) showed low inter rater reliability amongst diagnosticians.

He had two psychiatrists independently diagnose 100 SZ patients using both ICD and DSM criteria.

Inter-rater reliability was poor with one psychiatrist diagnosing 26 with SZ according to DSM and 44 according to ICD, and the other psychiatrist diagnosing 13 according to DSM and 24 according to ICD

Question 21

What is validity, and how do we assess things

Answer 21

Extent to which we are measuring what we intend to measure, for example, diagnosing SZ correctly based in the symptoms used in the manuals.

Asses them using criterion validity meaning dif assessment systems arrive at same diagnosis for the same patient (eg. Both using ICD and DSM)

Question 22

Evaluation of validity and reliability of classification systems (3-)

Answer 22

1. Rosenhan’s study (1973) supports the idea that the validity in the diagnosis of schizophrenia is low. Using 8 pseudo patients who were able to get themselves admitted in physictric hospitals by claiming they had auditory hallucinations. During their stay in the hospital, all patients behave normally and stayed for 7 to 52 days. All but one patient was discharged with SZ in remission. But this was an old study meeting. The diagnosis was much poor in the 1970s, as the DSM was not as reliable at the time.
2. Birchwood and Jackson (2001) found 20% of SZ patients show complete recovery and never have another schizophrenia episode, 10% show significant improvement, 30% show some improvement. 40% never really recover. Of the 40% that never recover, 10% are so affected that they commit suicide. This great variation in prognosis suggests very poor predictive validity. But, Mason (1997) found that new classification systems have improved predicative validity, especially when 6 month criteria for diagnosis was used, not on month
3. Another problem is that patients are more likely to be diagnosed when using ICD rather than DSM as shown in Cheniaux’s study. He used two diagnosticians to both diagnosed 100 SZ patient using ICD and DSM. Using the DSM and ICD, they classified 13 and 26 SZ patient, and and 24 and 44 SZ patients respectively. Thus, showing poor reliability.

Question 23

What is comorbidity?

Answer 23

When two mental conditions occur at the same time

Question 24

How is co morbidity a problem when classifying schizophrenia

Answer 24

Buckley et al. (2009) concluded that around half of the patients with SZ also have a diagnosis of depression (50%) or substance abuse (47%).

This gives a challenge for both classification and diagnosis of SZ. In terms of diagnosis, if half the patients are diagnosed with both SZ and depression, this suggests that we are not able to distinguish between both disorders very well.

Question 25

What is symptom overlap?

Answer 25

Overlap between symptoms of schizophrenia and other conditions like bipolar disorders

Question 26

How is symptom overlap a problem when classifying and diagnosing schizophrenia

Answer 26

Ellason and Ross (1995) show ppl with DID (Dissociative Identity Disorder) have more schizophrenic symptoms than people diagnosed with SZ. In fact, most people diagnosed with SZ have sufficient symptoms of other disorders that they could also receive at least one other diagnosis

Overlap would question validity of classification/diagnosis of SZ. For example, under the ICD, a patient may be diagnosed with SZ but under the DSM the same person will be diagnosed with bipolar disorder

Question 27

Is there gender bias in classification and diagnosis of schizophrenia

Answer 27

Longenecker et al (2010) reviewed SS studies since 1980, and found men more likely to get it than women.

There could be agenda in diagnosis as women seem to function better eg. good family relationships and more likely to work, thus less likely to be diagnosed as said as women show better interpersonal function.

So seems to be gender biased with more males getting diagnosed than females.

Question 28

Is there cultural bias in the diagnosis of SZ?

Answer 28

Pinto and Jones (2008) African-American and English ppl of Caribbean origin, and nine times more likely to be diagnosed. Maybe as positive symptoms of acid like auditory hallucinations may be acceptable in Africa due to cultural beliefs which are acceptable and not warranted to a diagnosis in Africa (SZ rates low in Africa) but in UK, more likely to be seen as positive symptom of SZ.

Question 29

Positive evaluation of classification and diagnosis (3+)

Answer 29

1. When a patient with a mental disorder that has numerous symptoms, it is simpler to incorporate the symptoms into a single diagnosis and makes communication better between mental health professionals
2. Treatments are often specific to certain disorders, so a reliable diagnosis can lead to appropriate therapy that will alleviate symptoms. Eg. SZ patients and anti-psychotic drugs
3. Although variation, there’s underlying biological abnormalities with SZ people. Hope that greater understanding of these abnormalities will lead to even more effective treatment.

Question 30

Gottesman (1991) family study

Answer 30

Gottesman (1991) found if both parents had SZ likely end of offspring having sz was 46%. if one parent had it likely had dropped the 13% thus showing the more closer you are genetically related, the more likely you are to get SZ

Question 31

Gottesman (1991) twin study

Answer 31

MZ, Twins share 100% of jeans, whereas DZ twins share, 50%. Thus, if schizophrenia is genetic, concordance rate should be much higher for MZ twins. Gottesman found 40% concordance rates for MZ and 17% concordance rates for DZ. Study shows that more genetically similar. You are more likely to get SZ.

But one negative is that if schizophrenia was based solely on genetics, concordance rate should be 100% , suggesting other factors also part in development

Question 32

What are candidates genes?

Ripke et al. (2014) study on candidates genes

Answer 32

There’s specific kind genes that seem to be associated with SZ eg. PCM1. But it’s now agreed that SZ is polygenic and there’s a combination of different jeans.

Ripke et al (2014) Compared genes of 37K SZ patients with 11 K control group. Found 108 separate genetic variations were associated with increased risk of SZ. These had connections to the functioning of neurontransmitters like dopamine.

Question 33

Evaluation of genetic basis of SZ (1+ 3-)

Answer 33

1. Large range of evidence to support genetic basis for SZ like findings from Gottesman and Ripke. For example, strength as it shows that if a child grows up in the family, we are both biological parents has SZ then chances of them getting it heighten compared to only if one parent has it, suggesting genes is important factor.
2. However, the problem with twin and family studies is separating nature (genes) from nurture (the environment). For example, MZ twins are normally reared together and sent to the same school, then makes it difficult to separate upbringing from genes. If we look at adoption studies that attempt to separate genes from the environment, children tend to be adopted by relatives who may still rear child similarly to biological parents – thus adoption studies may not always be a good comparison for the effects of nature and nurture.
3. SZ can take place in the absence of a family history. One explanation is that there may be a mutation in parental DNA, for example in paternal sperm cells. This can be caused by radiation, poison or infection. Brown et al’s. (2002) study showed a positive correlation between paternal age and increased risk of SZ increasing from around 0.7% with fathers under 25 to over 2% in fathers over 50. Suggests although no direct genes are involved, a person can still get SZ if their father was older at the time of fertilisation. This suggests that the role of nature and nurture may both play a part rather than just genes.
4. Genetic explanation of SZ is biologically reductionist as states one cause of SZ is simply your genes. Thus, insinuating if you possess the PCM1 gene then you will have SZ. This means that this explanation is ignoring other factors such as psychological factors and family upbringing which could be more important in explaining SZ – for example it has been found that certain parenting styles (e.g. the schizophrenogenic mother) in an individuals childhood could trigger symptoms of SZ in adulthood.

Question 34

What are neural correlates

Answer 34

Measurement of the structure or function of the brain that have a relationship with SZ especially different regions of the brain.

Also refers to how different neurotransmitters levels like dopamine, play part in SZ

Question 35

Evaluation of neural correlates (2+ 2-)

Answer 35

1. Research to support structural changes in the brain between SZ and non-SZ. Torrey (2002) using brain-imaging techniques, discovered that many schizophrenics have enlarged ventricles, cavities in the brain that supply nutrients and remove waste – the ventricles of a person with SZ are on average about 15% bigger than normal.
2. Research evidence can be validated through brain scanning, which is an objective method suggesting there is face validity to the neural correlates explanation as we can actually observe structural brain changes. This can also help tailor treatments that will reduce symptoms
3. Problem with looking at different brain regions is the fact individual differences in SZ patients and not all have deficits in the functioning of different brain regions.
4. Different brain regions involved in SZ, so maybe difficult to pinpoint which one is causing the symptoms. Plus maybe difficult to establish cause an effect in terms of neuroanatomy as evidence is correlational free example, did the suffer have abnormalities in a particular brain region and then get SZ what did the individual get SZ and then then show brain abnormalities.

Question 36

What is the dopamine hypothesis?

Answer 36

Claims excess of dopamine in certain regions of the brain is associated with positive symptoms of SZ. Thus messages from neurons that transmit dopamine fire, too easily and often leading to hallucinations..

Schizophrenics, I thought I have particularly high levels of D2 receptors on receiving neurons, resulting in more dopamine binding, and therefore more neurons firing .

Question 37

Evaluation of dopamine hypothesis (2+ 2-)

Answer 37

1. Evidence from drug research to support the hypothesis. This neural correlate explanation is supported through research as dopamine agonist like amphetamines tend increase dopamine levels and make SZ symptoms worse and produce similar symptoms in non-suffers.
2. Antipsychotic drugs which reduce the levels of dopamine support the idea that dopamine levels are high and SZ and can be reduced through drugs. Lindstroem et al. (1999) found chemicals needed to produce dopamine taken up faster in the brains of schizophrenics suggesting they produce more.
3. This could be criticised to be biologically, determined meaning individual has no control over this. Hypothesis cannot be seen as a cause of SZ as there are other biological/psychological factors that contribute like upbringing in terms of family dysfunction. Recent research has focused on attention of glutamate another neurotransmitter that has been implicated in SZ suggesting don’t mean might not be only neurotransmitter responsible for SZ.
4. There’s a number of neural correlates of SZ, like brain structure/neurotransmitters, but still number of questions are left unanswered. For example, does high or low levels of dopamine cause SZ. Eg. Theres correlations between high levels of dopamine and experiencing symptoms, but did the individual start having excess levels of dopamine in the brain region and start experiencing symptoms or did the individual first experience symptoms and then have high levels of dopamine. Thus neuro correlates explanation doesn’t really explain the cause an effect.

Question 38

What is family dysfunction? What are the three ways to explain it?

Answer 38

Psychologist have attempted to link as to childhood and adult experiences of living in dysfunctional families.

1. The schizophrenogenic mother
2. Double bind theory
3. Expressed emotion.

Question 39

What is schizophrenogenic mother and what does it lead too

Answer 39

Reichmann (1948) proposed a psychodynamic explanation for SZ based on the accounts she heard from her patients about their childhoods. She noted patients spoke about a particular type of parent - named the schizophrenogenic mother. The term ‘schizophrenogenic’ means ‘schizophrenia’ causing.

Characteristics of this type of mother are: cold, rejecting and controlling as well as creating a family climate full of secrecy and tension. This leads the child lacking trust in relationships, that later develop into paranoid delusions and developing SZ.

The schizophrenogenic mother is that in those type of families, the father is often passive and doesn’t really get involved in child upbringing.

Question 40

What is the double bind theory by Bateson et al (1972)

Answer 40

Stated family climate is important in development in SZ, but more focused on actual family communication.

Suggested children who frequently receive contradictory messages from parents, eg. If the child finds itself trapped in situations where they feared doing the wrong thing, but received mixed messages. So as a result the child is unable to comment about fairness of the situation or seek clarity.

Thus, the child usually gets it wrong and then punished by withdrawal of love. They feel confused about the world and see it as a dangerous place, reflected in that symptoms like paranoid delusions.

Question 41

What are expressed emotions?

Answer 41

The level of emotion, in particular negative emotion, expressed towards a patient by their carers.

EE includes verbal criticism of the patient , hostility, emotional of involvement in the life of the patient, needless self sacrifice

Question 42

What does high levels of expressed emotion cause?

Answer 42

High levels by the carers of the patients create serious stress, which may be a reason for the patient relapse. Express emotion can also be triggered for the onset SZ, especially if personal has genetic vulnerability to disorder

Question 43

Evaluation of family dysfunction as a risk factor (3+, 3-)

Answer 43

1. Tienari et al (1994) study shows adopted children who had SZ biological parents are more likely to have it themselves than those without them. But this only emerge in situations where the adopted family was rated as disturbed/dysfunctional. Does illness only manifest itself under appropriate environmental conditions and genetic vulnerability alone wasn’t sufficient family dysfunction is a contributing factor to SZ
2. Read et al. (2005)< reviewed 46 case, studies of child abuse, and SZ, found that 69% of adult women in patients with a diagnosed of said, had history of physical abuse, sexual abuse, or both in childhood. Men figure was 59%.
3. Evidence to support double bind theory. Berger (1965) found SZ’s patients reported high recall of double bind statements by mothers. But, the evidence may not be reliable as patients recall may be affected by the SZ. In other words because they have suffered from hallucinations and delusions , and just be assuming their mothers use more double bind statements and we don’t know if their memory has been affected
4. Evidence for family dysfunction for contributing factor isn’t very strong. Regarding the double-bind theory, Liem (1974) measured pattern of parental communication and families with child, and found no difference when compared to normal families
5. Altorfer et al (1998) suggested not all patients who live in high expressed emotion, families relapse and not all patients who live in low ones, avoid relapse. 1/4 of patient studied had no physiological response to stressful comments from their relatives showing evidence for EE as contributing factor is mixed
6. Family dysfunction explanation is environmental reductionist as it simplifies cause of SZ to family upbringing and ignores other factors. It’s been suggested that individuals who possess the PCM1 gene are more likely to become schizophrenic, so it’s important to look at a more holistic explanation of SZ.

Question 44

What are the two types of dysfunctional thought processing

Answer 44

Meta representation

Central control

Question 45

What is meta representation, and what happens if there’s dysfunction in it

Answer 45

Cognitive ability to reflect on thoughts and behaviour, enabling insight into our own intentions and goals, allowing us to interpret the actions of others.

Dysfunction would disrupt ability to recognise our own actions as our own rather than someone else’s. maybe explaining auditory hallucinations and delusions like thought insertions (Believing someone is putting thoughts into your head.)

Question 46

What is central control?

Answer 46

Cognitive ability to suppress automatic responses while we perform other actions. Speech, poverty and disorder may result from inability to ignore your own automatic thoughts.

SZ experience derailment of thoughts, and what they say, as theres too much going on in the thought processes, so they lose control of thoughts

Question 47

Evaluation of cognitive explanations for schizophrenia (2+ 2-)

Answer 47

1. Sterling et al. (2006) compared 30 SZ patients with 18 non-patient controls on range of cognitive tasks, the Stroop effect. This is when the colour word is written in a different colour and you have to say the actual colour of the word. Found S said patient took twice as long to say the colour of the word and the controls showing dysfunctional thought processing since they were struggling with separating the colour word from the actual word.
2. Another strength is success of cognitive behaviour therapy used alongside drugs to treat SZ. As it’s a thought disorder, drugs cannot completely treat disorder, so CBT will aim to question and challenge hallucinations.
3. It’s difficult to establish whether dysfunctional processing is a cause, or consequence of SZ. E.g. did the dysfunctional processing begin, and then the symptoms of SZ or vice versa
4. Cognitive explanations is problematic and that it fails to take into account. Biological factors and doesn’t acknowledge dysfunctional. Thought processing could also be due to abnormal dopamine levels. Explanation is therefore reductionist as it simplifies as SZ to being very basic.

Question 48

What are the two main types of antipsychotic drugs?

Answer 48

1. Typical.
2. Atypical.

Question 49

What are typical antipsychotics

Answer 49

Dopamine antagonist that work by reducing effects of dopamine and thus SZ symptoms. Drugs bind to, but don’t stimulate receptors, specifically, D2 receptors, thus blocking their action in reducing the positive symptoms of SZ.

Question 50

What is chlorpromazine?

Answer 50

It’s a typical antipsychotic, that’s been used around 1950. When first taken dome levels would build up, but then the production of dopamine reduce so, with reference to the dopamine hypothesis, this drug would normalise the dopamine production and transmission.

Question 51

What are atypical antipsychotics?

Answer 51

Emerging later, in the 1970s, they were used to improve upon effectiveness of typical ones and minimise side-effects. Have beneficial effects on negative symptoms.

They blocked D2 receptors like typical antipsychotics, but they only temporarily occupy the D2 receptors and then rapidly dissociate to allow normal dopamine and transmission. This rapid dissociation is thought to be responsible for the lower levels of side-effects.

Question 52

What is risperidone

Answer 52

Was invented in the 1990s, and is taken as tablets or an injection or syrup.

Binds to dopamine receptors but works better in binding then clozapine, leading to less side-effects. Therefore much smaller doses are required and evidence suggest this leads to fewer side effects than other antipsychotics.

Question 53

Evaluation of drug therapy (3+ 2-)

Answer 53

1. Thornley (2003) compare use of chlorpromazine with a placebo. Data from 13 trials showed it was associated with red reduce symptoms and better overall functioning plus data from three trials with over 500 people should relapse rate was low when chromosome was taken
2. Research evidence to support appropriate of atypical antipsychotics. Meltzer (2012) concluded, clozapine is more effective than typical antipsychotics and other atypical ones in treating SZ. Seen as effective in 30 to 50% of cases were typical antipsychotics had failed.
3. Evidence to support. The fact relapse rate are much lower when patients take antipsychotic drugs as opposed to placebos. Leucht et al (2012) carried meta analysis of 65 studies involving 6000 patients. Some were taken off antipsychotic medication and given placebo instead and within 12 months 64% of those patients have been given placebo relapsed, whereas only 27% relapse on the drugs.
4. Biggest weakness of drug therapy and treating acid is the side-effects. typical antipsychotic side-effects include dizziness, agitation weight gain an itchy skin. Side-effect of typical antipsychotics neuro malignant syndrome which could be a high temperatures and cause of death. Atypical drugs developed to overcome the side effects, but side effects still do exist.
5. Ethical issues related to use of drug therapy. Most profound ethical issue would be consent as many schizophrenic patients might not be in right frame of mind to give fully informed consent and as drugs do have severe side-effects, one could question the extent of the harm, and whether effects the drugs were reversible.

Question 54

What are the three main psychological therapies for schizophrenia?

Answer 54

1. CBT
2. Token economy.
3. Family therapy.

Question 55

What is CBTp and what are the 6 stages?

Answer 55

Cognitive behavioural therapy for psychosis.

1. Assessment - patient expresses thoughts, the therapist, and real estate goals are discussed
2. Engagement - therapist emphasises patient perspective and feelings of distress and stresses explanations for their distress can be developed.
3. ABC model - patient gives explanation of their activating event (A) that appear to cause emotional and behavioural (B) consequences (C). These beliefs can be rationalise and changed.
4. Normalisation - conveyor. Many people have unusual experiences like hallucinations, which reduces an anxiety and sense of isolation. Patient feels less alienated and stigmatised and recovery seems more likely.
5. Critical collaborative analysis - therapist uses gentle questioning to help patient understand, illogical, deductions and conclusions. E.g. ‘ if your voice is real, why can’t hear them.’
6. Developing alternative explanations - patient develops alternative explanations for previously unhealthy assumptions. if they aren’t forthcoming with healthy alternatives, new ideas can be constructed in cooperation with the therapist eg. positive self talk

Question 56

Evaluation of CBT (2+ 2-)

Answer 56

1. CBTp better in treating sz compared to antipsychotic medication alone. The NICE review of treatments found consistent evidence that CBTp was more effective in reducing rehospitalisation rate up to 18 months, following treatments ending. Also showing to be effective in reducing severity of symptoms as well as social function improvement.
2. Addington (2005) claims initial in acute phase of SZ, self reflection isn’t appropriate. But following stabilisation of psychotic symptoms patients can benefit from group base CBTp which can normalise experience by meeting similar individuals. Thus reach out shows individuals and more experience of SZ and greater realisations of their problems are most likely to benefit.
3. There is a lack of availability and patience refused to attend sessions. Estimated in the UK 1/10 with S actually have access to CBTp. Survey found that in north-west of England out of 187 SZ patients, only 7% were offered it, and those who were offered significant number failed or refused to attend therapy sessions, so limiting its effectiveness
4. There are problems with meta analysis of CBTp. Problems in this area which can reach unreliable conclusions about it is the failure it’s taken into account the quality of the studies. Free example, some failed to randomly allocate participants to CBTp or control conditions, while others fail to assess patient subsequent assessment of symptoms. Juni et al (2001) found clear evidence that problems associated with methodologically weak trials, translated into bias findings about the effectiveness of CBTp.

Question 57

What is the main aim of family therapy?

Answer 57

Provide support for carers in attempt to make family life, less stressful and reduce rehospitalisation

Question 58

How does family therapy work? What strategies may they use?

Answer 58

It’s offered for 3 to 12 months and at least 10 sessions.
Reduces level of expressed emotion and increases capacity for relatives to solve related problems

A. Psychoeducation meaning, helping the person and the terrorist to understand and be better able to deal with illness.

B. Forming alliance with relatives with care for person with SZ

C. Reducing emotional climate within family and burden.

D. Increasing relatives ability to solve anticipate problems.

E. Reducing expressions of anger/guilt by family member.

F. Maintain reasonable expectations among family members.

G. Encourage relatives to set appropriate limits, but maintain degree of separation when needed.

Question 59

Evaluation of family therapy (2+ 2-)

Answer 59

1. Economical benefits. e.g. the NICE review demonstrated family therapy is associated with significant cost savings when offered to people with SZ in addition to standard care. Or family therapy is offset by reduction in cost of hospitalisation due to lower relapse rates. Also evidence that family therapy reduces relapse rates for significant period of intervention, meaning the cost saving associated with family therapy would be even higher
2. Impact on family members is also advantageous. Logan et al (2013) analysed 50 family therapy studies that included intervention to support relatives. 60% reported significant positive impact on intervention on at least one outcome category for relatives like problem-solving skills. But methodological quality of many of these studies, poor making it difficult to distinguish effective from ineffective intervention.
3. Pharaoh’s study questions family therapy, effectiveness. States family therapy increasing patient compliance with medication which can lead to improvement and mental state and social functioning suggesting it’s effective as it teaches family mental about important taking medication but does this mean medication or the family therapy improve patient symptoms, so evidence family therapy is mixed
4. Problems with the lack of blinding in family therapy studies. E.g. in pharaoh study 10/53 studies reported in the matter analysis didn’t use any form of blinding meaning the raters were not blinded to the condition to which participants have been allocated. This meant they knew where the participants were attached to experimental/control conditions, creating rater bias. So they may reproduce allocated to the family therapy conditions are showing an improvement in symptoms rather than participants allocated to control conditions, so not telling us if family therapy is actually effective

Question 60

What is token economy?

Answer 60

A reward system used to manage behaviour of patients with SZ in hospital settings. It’s common for patients who are institutionalised to develop bad hygiene. For example, so changing these bad habits doesn’t kill as said, but improve the patient’s quality of life makes it more likely they can live outside the hospital setting.

Patient is given a token for carrying out good behaviour (positive reinforcement) which should encourage them to repeat behaviour.

Question 61

Evaluation of token economy (1+ 3-)

Answer 61

1. Dickerson et al. (2005) gives research support. Reviewed 13 studies using it and 11 reported beneficial effects that were directly attributable to use of token economy. He concluded the studies, provide evidence of its effectiveness in increasing adaptive behaviour of patients.
2. Ethical concerns were using it in psychiatric settings. e.g. to make reinforcement, effective clinicians may exercise control of important primary reinforces like food. Patient may exchange tokens if they display the target behaviour, but it’s generally accepted that all human beings have certain basic rights. They shouldn’t be violated regardless of positive consequences that might be gained through token economy
3. The program lacks ecological validity. Reducing negative symptoms has only been shown to work in hospital settings. In the real world, when people with schizophrenia are living in a community, who will give them token straight away to exchange for a tangible item, thus they cannot cannot be used in a real world community.
4. No real conclusive evidence for the programs working. Economy programs are not really used in the developed world. Critics would argue economies were only use hospitals to manage manage and control patience rather than treat their symptoms

Question 62

What is the interactionist approach

Answer 62

Approach that acknowledges there’s bio, psychological and society factors in SZ development.

Bio factors - genetic vuln, neurological abnormalities

Pysch factors - stress from life events, poor quality family interactions

Question 63

How does the diathesis explain the onset of SZ

Answer 63

Model states that both vulnerability to SZ and an stress-trigger are necessary to develop the condition.

One or more underlying factors make a person particularly vulnerable to developing SZ but the onset of the condition is triggered by stress.

Question 64

What is one exmaple off a stress trigger for SZ

Answer 64

Use of cannabis use makes it 7 times more likely for a person to develop schizophrenic symptoms, because cannabis interferes with the dopamine system.

Although most people don’t develop SZ through cannabis use most people don’t take cannabis but will develop SZ – this suggests that there are clearly other stressors which contribute to the development of SZ.

Question 65

what is treatment of SZ according to the interactionist approach

Answer 65

Model is associated with combining antipsychotic medication and psychological therapies such as CBT.

It is unusual to treat SZ using psychological therapies alone as SZ is a complex psychotic disorder.

So drug therapy will be first given to control the symptoms of SZ with token economy to manage the behaviour of patients with SZ. Then CBT and family therapy will precede this.

Question 66

Evaluation of interactionist approach (2+ 3-)

Answer 66

1. Tienari et al. (2004) studied children adopted away from schizophrenic mothers. The adoptive parents’ parenting styles were assessed and compared with a control group of adoptees with no genetic risk. A child-rearing style with high levels of criticism and conflict, and low levels of empathy was implicated in development of SZ but only for children with a high genetic risk.
2. usefulness of the interactionist approach in treatment of SZ. Tarrier et al. (2004) random 315 ppl to (1) medication and CBT group, or (2) medication and supportive counselling, or (3) control group. Ppl in groups 1 and 2 showed lower symptoms of those medication only.
3. Original diathesis stress model is simple. Multiple genes inc. vulnerability. There’s no schizogene. Researchers think stress can also include biological factors. Houston et al. (2008) found childhood sexual trauma was a diathesis and cannabis was a trigger. Shows old ideas of diathesis as biological and stress as psychological has turned out to be overly simple.
4. don’t know exactly how diathesis stress work. Evidence to suggest underlying vulnerability coupled with stress lead to schizophrenia. But we don’t understand the mechanisms by which symptoms of schizophrenia appear and how both vulnerability and stress produce them. This does not undermine support for the approach, but it does mean we have an incomplete understanding of the actual medication.
5. Turkington et al. (2006) argued fact that bio and pysch therapies r more effective than either on their own does not necessarily mean the interactionist approach to schizophrenia is correct. Similarly as drugs help doesn’t mean that SZ is biological in origin. This error of logic is called the treatment-causation fallacy. It means that the superior outcomes of combined therapies should not be over-interpreted.

Question 67

Consequences of dopamine hypothesis

Answer 67

1. Hyperdopaminergia in subcortex - states there’s high levels of activity of dopamine in the subcortex. E.g. an excess of dopamine receptors in the Brocas area could be associated with problems in speech.
2. Hypodopominergia in the cortex - focuses on lower levels of dopamine in the cortexof. Goldman-Rakic (2004) have focused on the role of low levels of dopamine in the prefrontal cortex on negative symptoms of SZ. (Pre-frontal cortex is responsible for decision-making/thinking)

Question 68

Pharaoh et al (2010) study into family therapy.

Procedure and findings

Answer 68

Procedure:
He reviewed 53 studies published between 2002–2010 to investigate the effectiveness or family intervention across areas such as Europe, Asia etc. Compared outcomes from family therapy to ‘ standard’ care (antipsychotic medication alone). Researchers concentrated on studies that were randomised controlled trials.

Findings:
- Some studies reported and improvement in the overall mental state where as some didn’t
- The use of family therapy increased patient compliance with medication
- Although appearing to show some improvement on general functioning, family intervention didn’t have much effect on more concrete outcomes like employment
- reduction in the risk of relapse and reduction in hospital admission during drug treatment in the 24 months after

Question 69

What do NICE suggest about family therapy?

Answer 69

They recommend that family therapy should be offered to all individuals diagnosed with SZ who are in contact with/live with family members.
Stress that such interventions should be a priority where there’s persistent symptoms of high risk of relapse.

Research showed SZ families that expressed high levels of criticism, hostility etc had more frequent relapses