Schizophrenia

Question 1

What is Sz

Answer 1

best described as a condition where personality loses its unity

Question 2

classification of mental disorder

Answer 2

The process of organising symptoms into categories based on which symptoms frequently cluster together

Question 3

What did stafford-clark say about sz

Answer 3

Sz is a generic name for a group of disorders characterised by a progressive disintegration of emotional stability, judgement, contact with and appreciation of reality

Question 4

What are the classification systems used for sz

Answer 4

-ICD-10
-DSM-5

Question 5

How do the Diagnostic manuals differ

Answer 5

the manuals differ in their classification of Sz
-DSM-5 patients must have a positive symptom
-ICD-10 patients must have 2+ negative

Question 6

Positive symptoms

Answer 6

Atypical symptoms experienced in addition to normal experiences

Question 7

What are positive symptoms

Answer 7

-Hallucinations: unusual sensory experiences that can be related to the environment or have no relationship to what the senses are picking up
-Delusions: irrational beliefs that can take any form and make a person behave in ways that make sense to them but seem bizarre to others

Question 8

Negative symptoms

Answer 8

Atypical experiences that represent the loss of a usual experience such as clear thinking

Question 9

What are negative symptoms

Answer 9

-speech poverty: involves reduced frequency and quality of speech
-Avolition: loss of motivation to carry out tasks and results in lowered activity levels

Question 10

What are different subtypes of sz

Answer 10

-paranoid sz
-hebephrenic sz- involves negative symptoms
-catatonic sz

Question 11

Which manual recognises different subtypes of sz

Answer 11

ICD-10

Question 12

What is the prevalence of sz

Answer 12

overall just less than 1% of the world suffer from sz

Question 13

What age does sz occur

Answer 13

onset of sz mostly occurs between 15 and 45

Question 14

Who has a higher prevalence rate

Answer 14

males, cities, working class

Question 15

What is a strength of the diagnosis of Sz (reliability)

Answer 15

-test-retest occurs when a practitioner makes the same diagnosis on separate occasions from the same information
-inter-rater occurs when several practitioners make the same diagnosis of the same patient
-Making a diagnosis with most mental disorders can be a problem as often there are no physical symptoms therefore the practitioner has to diagnose with the patients report
-In 180 cases inter-rater reliability was +0.97 and test-retest reliability was +0.92

Question 16

What is a limitation of diagnosis of sz (validity)

Answer 16

-concerns how accurate, meaningful and useful diagnosis is
-Validity of a psychotic diagnosis can be assessed by criterion validity
-If someone is diagnosed with sz they should show symptoms of sz
-Cheniaux had 2 psychiatrists independently assess the same 100 clients using ICD and DSM
68 were diagnosed using ICD and only 39 using DSM
-This suggests that sz is either under or over diagnosed and therefore has low criterion validity

Question 17

What is a counterpoint to low validity of diagnosis of sz

Answer 17

Criterion validity is good for diagnosis as long as the same diagnostic manual is used

Question 18

What is a limitation of diagnosis of sz (comorbidity)

Answer 18

-Its co-morbidity with other conditions
-if conditions occur together then this calls into question the validity of their diagnosis because they might actually be a single condition
-Sz is commonly diagnosed with other conditions
-a review found that about half of those diagnosed with sz also had a diagnosis of depression or substance abuse
-This is a problem because sz may not exists as a distinct condition

Question 19

What is a limitation of diagnosis of sz (gender bias)

Answer 19

-after the 1980s more men appear to have been diagnosed with sz than women.
-men may be genetically more vulnerable than women or there is a gender bias in the diagnosis of sz
-Women seem to function better than men with sz which may mean they are being under diagnosed
-this means women may not therefore be receiving treatment and services that might benefit them

Question 20

What is a limitation of diagnosis of sz (culture bias)

Answer 20

-African americans and english people of afro-caribbean origin are more likely to be diagnosed with sz
-not due to a genetic vulnerability but due to a cultural bias
-African cultures may be more accepting of symptoms such as hearing voices and therefore speak more freely about it to their psychiatrist, leading to more diagnosis
-incidence in the west indies and in great britain is about 1% but afro- caribbean living in GB are 7x more likely to be diagnosed sz.
-This suggest either the stress of living in GB causes sz or invalid diagnosis

Question 21

What is a limitation of diagnosis of sz (symptom overlap )

Answer 21

there is a considerable overlap of the symptoms in sz and in other conditions.
-I.E bipolar disorder
-This is an issue as Sz is a cluster of different symptoms

Question 22

what was Gottesman study on

Answer 22

Genetic basis of Sz

Question 23

what did Gottesman find

Answer 23

Ran a controlled study and found that the risk of an individual developing sz increased in line with genetic similarities to a relative with the disorder

Question 24

Dz twins and siblings share the same amount of DNA but have a different risk of developing Sz, why

Answer 24

-different shared environments due to age and other social factors

Question 25

Why can’t sz be 100% down to nature (Gottesman)

Answer 25

identical twins would have a 100% risk of developing sz. however it’s only 48% suggesting other factors influence sz such as the environment

Question 26

polygenetic

Answer 26

Sz is caused by more than one gene. Most likely those coding for neurotransmitters like dopamine

Question 27

aetiologically heterogeneous

Answer 27

different combinations of factors can cause it

Question 28

Ripke et al (study on candidate genes)

Answer 28

-Gathered data from genome wide study of sz
-37,000 sz patients genetic make up was compared to 113,000 controls
-108 separate genetic variations were associated with increased risk of sz
-genes associated with the risk included those coding the functioning of a number of neurotransmitters

Question 29

What is the role of mutation

Answer 29

-Sz can also have a genetic origin in the form of mutated parental DNA
-This could be caused radiation, poison or viral infection

Question 30

What evidence is there for mutation

Answer 30

Brown 2002 evidence carries from positive correlation between parental age (sperm mutation) and risk of sz

Question 31

neural correlates

Answer 31

Patterns of structure or activity in the brain that occur in conjunction with an experience and may be implicated in the origins of that experience.

Question 32

Dopamine

Answer 32

A neurotransmitter that generally has an excitatory effect and is linked to the sensation of pleasure. Unusually high levels are associated with schizophrenia and unusually low levels are associated with Parkinson’s disease.

Question 33

What is the original dopamine (DA) hypotheses

Answer 33

schizophrenia might be the result of high levels of DA (hyperdopaminergia, ‘hyper’ means ‘high’) in subcortical areas of the brain

Question 34

What is the original DA hypotheses based on

Answer 34

the discovery that drugs used to treat schizophrenia (antipsychotics, which reduce DA) caused symptoms similar to those in people with Parkinson’s disease, a condition associated with low DA levels

Question 35

What is the updated DA hypotheses

Answer 35

low DA in the prefrontal cortex (responsible for thinking) could explain cognitive problems i.e. negative symptoms of schizophrenia. It has also been suggested that cortical hypodopaminergia leads to subcortical hyperdopaminergia - so both high and low levels of DA in different brain regions

Question 36

What is a strength of the genetic explanation (research support)

Answer 36

-strength of the genetic explanation is the strong evidence base.
-Family studies such as Gottesman show that risk increases with genetic similarity to a family member with schizophrenia. -Adoption studies such as Tienari et al. (2004), show that biological children of parents with schizophrenia are at heightened risk even if they grow up in an adoptive family.
-A recent twin study by Hilker et al. (2018) showed a concordance rate of 33% for identical twins and 7% for non-identical twins.
-This shows that some people are more vulnerable to schizophrenia as a result of their genetic make-up.

Question 37

What is a limitation of the genetic explanation (environmental factors)

Answer 37

-limitation of the genetic explanation is there is clear evidence to show that environmental factors also increase the risk of developing schizophrenia.
-These include both biological and psychological influences.
-Biological risk factors include birth complications (Morgan et al. 2017) and smoking THC-rich cannabis in teenage years (Di Forti et al. 2015).
-Psychological risk factors include childhood trauma which leaves people more vulnerable to adult mental health problems in general but there is now evidence for a particular link with schizophrenia.
-In one study by Morkved et al. (2017), 67% of people with schizophrenia and related psychotic disorders reported at least one childhood trauma as opposed to 38% of a matched group with non-psychotic mental health issues.
-This means that genetic factors alone cannot provide a complete explanation for schizophrenia.

Question 38

What is a strength of the neural explanation (evidence for dopamine)

Answer 38

-strength is support for the idea that dopamine (DA) is involved in schizophrenia. -First, amphetamines increase DA and worsen symptoms in people with schizophrenia and induce symptoms in people without (Curran et al. 2004).
- Second, antipsychotic drugs reduce DA activity and also reduce the intensity of symptoms (Tauscher et al. 2014).
-Third, some candidate genes act on the production of DA or DA receptors.
-This strongly suggests that dopamine is involved in the symptoms of schizophrenia.

Question 39

What is a limitation of the neural explanation (glutamate)

Answer 39

-limitation of the dopamine hypothesis is evidence for a central role of glutamate. -Post-mortem and live scanning studies have consistently found raised levels of the neurotransmitter glutamate in several brain regions of people with schizophrenia (McCutcheon et al. 2020).
-In addition, several candidate genes for schizophrenia are believed to be involved in glutamate production or processing.
-This means that an equally strong case can be made for a role for other neurotransmitters.

Question 40

Family dysfunction

Answer 40

Psychologists have attempted to link SZ to childhood and adult experiences of living in a dysfunctional family.

Question 41

what are the three theories to do with family dysfunction

Answer 41

The schizophrenogenic mother

Double-bind theory

Expressed emotion

Question 42

The schizophrenogenic mother

Answer 42

Psychodynamic explanation based on childhood accounts by Fromm- Reichmann who said a particular type of parenting reoccurred ‘schizophrenogenic mother’

Question 43

Attributes of the schizophrenogenic mother

Answer 43

Cold

Rejecting

Critical

Controlling

Question 44

What does the schizophrenogenic mother cause

Answer 44

Creates a family environment of tension and secrecy
This parenting style leads to distrust that later develops into paranoid
delusions and ultimately SZ

Question 45

Who developed double bind theory

Answer 45

Bateson et al (1972)

Question 46

Double bind theory

Answer 46

Expanded on Fromm-Reichmanns work, and added to the idea of the
Family environment causing SZ. He emphasised the role of communication
style within a family.

Question 47

How is Sz developed according to double bind theory

Answer 47

Developing child fears doing wrong, but gets mixed messages about what
‘wrong’ is. They are unable to comment on unfairness of the situation or seek
clarification.

Question 48

What happens when a child is wrong according to the double bind theory

Answer 48

When they get it ‘wrong’ (frequently) child is punished by withdrawal of
love.

Question 49

Impact of the double bind theory

Answer 49

Child is confused, finds the world a frightening and dangerous place.

Results in paranoid delusions and disorganised thinking

Question 50

What does Bateson recognise

Answer 50

But, Bateson said this was a risk factor, and didn’t always exist in SZ
families.

Question 51

Expressed emotion

Answer 51

EE is the level of negative emotion expressed towards a SZ patient by
their family/carers.

Question 52

What are the elements of EE

Answer 52

Verbal Criticism – some time accompanied by violence

Hostility - anger and rejection

Emotional overinvolvement, needless self-sacrifice.

Question 53

What are high levels of EE are source of

Answer 53

Stress

Question 54

What is high EE an explanation for

Answer 54

This is an explanation of relapse rather than cause of SZ.

Question 55

How can high EE be an explanation for onset of sz

Answer 55

in vulnerable people this could trigger the onset of SZ.

Question 56

cognitive explanations of sz

Answer 56

These are explanations that focus on mental processes such as thinking, language and attention.

Question 57

What are the cognitive explanations for sz

Answer 57

-Dysfunctional thinking
-Metarepresentation dysfunction
-Central control dysfunction

Question 58

Dysfunctional thinking

Answer 58

-A cognitive explanation focuses on the role of mental processes.
-SZ is associated with several types of dysfunctional thought processing and this can provide a full explanation for SZ.
-SZ ‘s can have information processing that doesn’t accurately represent reality.

Question 59

What did Simon say about dysfunctional thinking

Answer 59

-SZ is characterised by disruption to normal thought processing.
-Reduced thought processing in the ventral striatum is associated with negative symptoms.
-Reduced processing of info in temporal and cingulate gyri are associated with hallucinations.

Question 60

Metarepresentation dysfunction

Answer 60

The inability to reflect on thoughts and behaviours

Question 61

What did Frith et al identify about metarepresentation dyfunction

Answer 61

Frith et al (1992) – identifies an inability to use meta representation in SZ patients. Therefore they cannot recognise their own actions and thoughts, and believe these are being carried out by someone other than themselves.
This explains auditory hallucinations and delusions like thought insertion.

Question 62

Central control dysfunction

Answer 62

-Frith also identifies inability to stop automatic responses while performing deliberate actions in SZ patients.
-Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts.

Question 63

What is an example of central control dysfunction

Answer 63

SZ patients can have derailment of thought because each word triggers associations, and the person cannot suppress automatic responses.

Question 64

What is a strength of family dysfunction (research support)

Answer 64

One strength of these explanations is evidence linking family dysfunction to schizophrenia. Indicators of family dysfunction include insecure attachment and exposure to childhood trauma, especially abuse. According to a review by Read et al. (2005) adults with schizophrenia are disproportionately likely to have insecure attachment, particularly Type C or D. Read et al. also reported that 69% of women and 59% of men with schizophrenia have a history of physical and/or sexual abuse. In the Merkved et al. (2017) study, on the previous spread, most adults with schizophrenia reported at least one childhood trauma, mostly abuse. This strongly suggests that family dysfunction makes people more vulnerable to schizophrenia.

Question 65

What is a limitation of family dysfunction (explanations lack support)

Answer 65

One limitation of family explanations is the poor evidence base for any of the explanations. Although there is plenty of evidence supporting the idea that childhood family-based stress is associated with adult schizophrenia, there is almost none to support the importance of traditional family-based theories such as the schizophrenogenic mother and double bind. Both these theories are based on clinical observation of people with schizophrenia and also informal assessment of their mothers’ personalities, but not systematic evidence. This means that family explanations have not been able to account for the link between childhood trauma and schizophrenia.

Question 66

What is a strength of cognitive explanations of Sz (Research support)

Answer 66

One strength of cognitive explanations is evidence for dysfunctional thought processing. Stirling et al. (2006) compared performance on a range of cognitive tasks in 30 people with schizophrenia and a control group of 30 people without schizophrenia. Tasks included the Stroop task , in which participants have to name the font-colours of colour-words, so have to suppress the tendency to read the words aloud. As predicted by Frith et alis central control theory, people with schizophrenia took longer - over twice as long on average - to name the font-colours.This means that the cognitive processes of people with schizophrenia are impaired.

Question 67

What is a limitation of cognitive explanations of Sz (a proximal explanation)

Answer 67

One limitation of cognitive explanations is that they only explain the proximal origins of symptoms.
Cognitive explanations for schizophrenia are proximal explanations because they explain what is happening now to produce symptoms - as distinct from distal explanations which focus on what initially caused the condition. Possible distal explanations are genetic and family dysfunction explanations. What is currently unclear and not well-addressed is how genetic variation or childhood trauma might lead to problems with metarepresentation or central control. This means that cognitive theories on their own only provide partial explanations for schizophrenia.

Question 68

What are the therapies for Sz

Answer 68

-Biological – Psychosurgery, drugs (chemotherapy), ECT.
-Psychological – CBT, Family therapy, Token economies

Question 69

What are antisychotics for

Answer 69

Short term or long term use

Question 70

What are the two types of antipsychotic drugs

Answer 70

-typical
-atypical

Question 71

typical antipsychotics

Answer 71

around since 1950’s, e.g. Chlorpromazine, thought to work on the neurotransmitter dopamine system, by reducing the action of dopamine, blocks the receptor sites, can reduce symptoms like hallucinations, and also is a sedative.

Question 72

How does chlorpromazine work

Answer 72

acts as a dopamine antagonist. It acts against dopamine in this case blocking dopamine receptors at the postsynaptic receptor sites. This reduces the action of dopamine. Initially levels of dopamine build up in the synapse, but then production is reduced.

Question 73

What type of symptoms does chlorpromazine reduce

Answer 73

This dopamine antagonist effect normalises neurotransmission, reducing positive symptoms like hallucinations.

Question 74

Sedative effects of drug therapy (chlorpromazine)

Answer 74

As well as antipsychotic effects, Chlorpromazine is also a sedative. This is linked to its effects on histamine receptors. The drug is used to calm SZ patients and others.

Question 75

When is chlorpromazine usually administered

Answer 75

Used on initial admittance to hospital if very anxious.

Question 76

Atypical antipsychotics

Answer 76

around since 1960’s-80’s. Made to improve the effectiveness of drugs in supressing the symptoms of psychosis and minimise the side effects.

Question 77

Examples of Atypical antipsychotics

Answer 77

-Clozapine, taken if typical drugs fail, thought to work on dopamine, serotonin and glutamine receptors, improves mood so can reduce suicide risk.
-Risperidone, less side effects than Clozapine, binds to dopamine and serotonin sites.

Question 78

Ways to administer typical antipsychotics

Answer 78

tablets, syrups or injections

Question 79

Dosage of typical typical antipsychotics

Answer 79

-taken orally the maximum daily dosage is 1000mg
-initial dosage is smaller and for most people the dosage is increased to 400-800mg

Question 80

side effects of typical antipsychotics

Answer 80

dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin.
More serious side effects include tardive dyskinesia.
The most serious side effects include neuroleptic malignant syndrome which can lead to death

Question 81

side effects of clozapine

Answer 81

agranulocytosis-blood condition

Question 82

ways to administer clozapine

Answer 82

tablet or syrup

Question 83

dosage of clozapine

Answer 83

300-450mg

Question 84

ways to administer risperidone

Answer 84

tablet, syrup or injection (last up to 2 weeks)

Question 85

dosage of risperidone

Answer 85

-small dose is initially given and build up to a typical dose of 4-8mg
-maximum is 12mg

Question 86

A strength of biological therapies of sz (evidence of effectiveness)

Answer 86

One strength of antipsychotics is evidence to support their effectiveness. There is a large body of evidence to support the idea that both typical and atypical antipsychotics are at least moderately effective in tackling the symptoms of schizophrenia.Thornley et al. (2003) reviewed studies comparing the effects of chlorpromazine to control conditions. Data from 13 trials with a total of 1121 participants showed that chlorpromazine was associated with better overall functioning and reduced symptom severity as compared to placebo. There is also evidence for the benefits of atypical antipsychotics. In a review Meltzer (2012) concluded that clozapine is more effective than typical antipsychotics and other atypical antipsychotics, and that it is effective in 30-50% of treatment-resistant cases where typical antipsychotics have failed. This means that, as far as we can tell, antipsychotics work.

Question 87

Counterpoint of evidence for effectiveness of biological therapies

Answer 87

Healy (2012) has suggested serious flaws with evidence for effectiveness. For example most studies are of short-term effects only and some successful trials have had their data published multiple times, exaggerating the size of the evidence base for positive effects. Also, because antipsychotics have powerful calming effects, it is easy to demonstrate that they have some positive effect on people experiencing the symptoms of schizophrenia. This is not the same as saying they really reduce the severity of psychosis. This means that the evidence base for antipsychotic effectiveness is less impressive than it first appears.

Question 88

A limitation of biological therapies (serious side effects)

Answer 88

One limitation of antipsychotic drugs is the likelihood of side effects. Typical antipsychotics are associated with a range of side effects including dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin. Long-term use can result in tardive dyskinesia, which is caused by dopamine supersensitivity and causes involuntary facial movements such as grimacing, blinking and lip-smacking. The most serious side effect of antipsychotics (particularly typical antipsychotics) is neuroleptic malignant syndrome (NMS). This is believed to be caused when the drug blocks dopamine action in the hypothalamus, an area in the brain associated with the regulation of a number of body systems. NMS results in high temperature, delirium and coma, and can be fatal. Estimates of its frequency range from less than 0.1% to just over 2%. This means that antipsychotics can do harm as well as good and individuals who experience these may avoid such treatments (which makes the treatment ineffective).

Question 89

A limitation of biological therapies for sz (mechanism unclear)

Answer 89

A further limitation of antipsychotics (typical and at least some atypical) is that we do not know why they work.
Our understanding of the mechanism by which antipsychotic drugs work is strongly tied up with the original dopamine hypothesis - the idea that symptoms of schizophrenia are linked to high levels of dopamine activity in the subcortex of the brain. However we now know that this original dopamine hypothesis is not a complete explanation for schizophrenia, and that in fact dopamine levels in other parts of the brain are too low rather than too high. If this is true then most antipsychotics should not work. Given that there are questions over the effectiveness of antipsychotics anyway this adds to the argument that in fact they are ineffective. This means that at least some of the antipsychotics may not be the best treatment to opt for - perhaps some other factor is involved in their apparent success.

Question 90

Cognitive behaviour therapy

Answer 90

CBT aims to deal with both thoughts (cognitions) and behaviour.

Question 91

how many CBT sessions do individuals usually take

Answer 91

It usually takes place over a period of 5-20 sessions (this is longer than for other conditions), either in groups or on an individual basis.

Question 92

How cognitive behaviour therapy helps

Answer 92

-Help a client make sense of how their irrational cognitions (such as delusions and hallucinations) impact on their feelings and behaviour.
-Just understanding where symptoms come from can be hugely helpful for those with symptoms like auditory hallucinations.
-This will not eliminate the symptoms of schizophrenia but it can make people better able to cope with them. This in turn reduces their distress and improves their ability to function adequately.

Question 93

Example of how CBT helps

Answer 93

For example, a client hears voices and believes the voices represent demonic forces, they will naturally be very afraid. If a therapist can convince them that the voice actually comes from the malfunctioning speech centre in their own brain and that it cannot hurt them if they ignore it, this is much less frightening and hence less debilitating.

Question 94

Normalisation

Answer 94

People hearing voices can also be helped by teaching them that voice-hearing is an extension of the ordinary experience of thinking in words

Question 95

How can delusions be challenged using CBT

Answer 95

a process of reality testing in which the person with schizophrenia and their therapist jointly examine the likelihood that beliefs are true. In some cases where delusions are resistant to reality testing CBT can still be used to tackle the anxiety and depression that result from living with schizophrenia.

Question 96

Family therapy

Answer 96

Takes place with families as well as the identified patient. The therapy aims to improve the quality of communication and interaction between family members. There is a range of approaches to family therapy for schizophrenia.

Question 97

identified patient

Answer 97

a term used in family therapy which describes one member of a dysfunctional family who expresses the family’s conflicts

Question 98

How family therapy helps

Answer 98

Pharoah et al. (2010) identified a range of strategies that family therapists use to try to improve the functioning of a family that has a member with schizophrenia.

Question 99

What are the strategies that family therapists use to improve family functioning

Answer 99

-Reduces negative emotions: Family therapy aims to reduce levels of expressed emotion (EE),Reducing stress is important to reduce the likelihood of relapse.

-Improves the family’s ability to help: The therapist encourages family members to form a therapeutic alliance whereby they all agree on the aims of therapy. A further aim is to ensure that family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.

Question 100

A model of practice for families dealing with Sz

Answer 100

Burbach (2018) has proposed a model for working with families dealing with schizophrenia.
Begins with sharing basic information and providing emotional and practical support.
Phase 2 involves identifying resources including what different family members can (and cannot) offer.
Phase 3 aims to encourage mutual understanding, creating a safe space for all family members to express their feelings.
Phase 4 involves identifying unhelpful patterns of interaction.
Phase 5 is about skills training such as learning stress management techniques.
Phase 6 looks at relapse prevention planning.
Phase 7 is maintenance for the future.

Question 101

How many phases are their in the model of practice for working with families dealing with Sz

Answer 101

7

Question 102

A strength of CBT (evidence for effectiveness)

Answer 102

One strength of CBT is the evidence for effectiveness. Jauhar (2014) reviewed 34 studies of using CBT with SZ, concluding there is small significant changes in both positive and negative symptoms.
Pontillo (2016)also found a reduction in frequency and severity of auditory hallucinations.
NICE (National Institute for Health and Care Excellent), recommends CBT for SZ.
Therefore both research and clinical experience support the benefits of CBT for SZ.

Question 103

A limitation of CBT (Quality of evidence)

Answer 103

One limitation of CBT for SZ is the wide range of techniques and symptoms included in studies. These vary widely from one case to another.
Thomas (2015) different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms.
The overall modest benefits of CBT for SZ probably conceal a wide variety of effects of different CBT techniques on different symptoms.
This therefore makes it hard to say how effective CBT for a particular patient with SZ will be.

Question 104

A strength of family therapy (evidence of effectiveness)

Answer 104

One strength of family therapy is the evidence for effectiveness. McFarlane (2016) reviewed studies and concluded that family therapy was one of the most consistently effective treatments for SZ. Relapse rates were found to be reduced typically by 50-60%.
He also concluded that using family therapy as mental health initially starts to decline is particularly promising.
Clinical trials from NICE recommends family therapy for everyone with a diagnosis of SZ.
This means that family therapy is likely to be beneficial to people with both early and ‘full-blown’ SZ.

Question 105

a strength of family therapy (benefits to whole family)

Answer 105

A further strength of family therapy is the benefits it brings to the whole family.
Lobban & Barrowclough (2016) concluded that these effects are important because families provide the bulk of the care for the SZ patient.
By strengthening the functioning of the whole family, family therapy lessens the negative impact of SZ on other family members and strengthens the ability of the family to support the person with SZ.
This therefore means that family therapy has wider benefits beyond the obvious positive impact on the SZ patient.

Question 106

Token economies

Answer 106

are reward systems used to manage the behaviour of people with schizophrenia, in particular those who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals.

Question 107

What are token economies based on

Answer 107

operant conditioning

Question 108

What type of reinforcers are tokens

Answer 108

Tokens are secondary reinforcers because they only have value once the person receiving them has learned that they can be used to obtain meaningful rewards, such as sweets or a walk outside

Question 109

What type of reinforcers are rewards

Answer 109

meaningful rewards are primary reinforcers. Those tokens that can be exchanged for a range of different primary reinforcers are particularly powerful secondary reinforcers.

Question 110

What is involved in a token economy?

Answer 110

-The idea is that tokens - in the form of coloured discs - are given immediately to individuals when they have carried out a desirable behaviour. Target behaviours are decided on an individual basis and it is important to know the person in order to identify the most appropriate target behaviours for them (Cooper et al. 2007).
-Although the tokens have no value in themselves they are swapped later for more tangible rewards. Having some form of immediate reward for target behaviour is important because delayed rewards are less effective. Tokens are therefore administered as soon as possible after a target behaviour.
-Rewards in a hospital setting might include objects like sweets or magazines, or access to activities like a film or a walk outside, or perhaps an appointment with a social worker to plan for life after hospitalisation.

Question 111

Institutionalisation

Answer 111

develops under circumstances of prolonged hospitalisation.

Question 112

Outcome of institutionalisation

Answer 112

One outcome is that people often develop bad habits,e.g. they might cease to maintain good hygiene or perhaps stop socialising with others. This is an understandable response to living without the kind of routine and small pleasures we experience in everyday life.

Question 113

What categories of behaviour did Matson identify were commonly tackled in Token economies

Answer 113

Matson et al. (2016) identify three categories of institutional behaviour commonly tackled by means of token economies: personal care, condition-related behaviours (e.g. apathy) and social behaviour.

Question 114

how are Matsons behaviours modified to benefit individuals with Sz

Answer 114

-Improves the person’s quality of life within the hospital setting,e.g. make-up for someone who usually takes a lot of pride in their appearance or social interaction for a usually sociable person.
-‘Normalises’ behaviour and this makes it easier for people who have spent a time in hospital to adapt back into life in the community,e.g. getting dressed in the morning or making their bed.

Question 115

demonstration of a token economy carried out by Ayllon and Azrin

Answer 115

-They trialled a token economy system in a ward of women with a diagnosis of schizophrenia.
-Every time the participants carried out a task such as making their bed or cleaning up they were given a plastic token embossed with the words ‘one gift’.
-These tokens could then be swapped for ward privileges, for example being able to watch a film. The number of tasks carried out increased significantly.

Question 116

Why are token economies not commonly used now in the UK

Answer 116

Their use has now declined in the UK, partly because of the growth of community-based care and the closure of many psychiatric hospitals, but also because of the complex ethical issues raised by restricting rewards to people with mental disorders.
However token economies still remain a standard approach to managing schizophrenia in many parts of the world.

Question 117

A strength of token economies in treating Sz (evidence of effectiveness)

Answer 117

One strength of token economies for the management of schizophrenia is evidence for their effectiveness. Glowacki et al. (2016) identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues such as schizophrenia and involved patients living in a hospital setting. All the studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours.This supports the value of token economies.

Question 118

A counterpoint of evidence of effectiveness for token economies in treating Sz

Answer 118

However, 7 studies is quite a small evidence base to support the effectiveness of a technique. One issue with a small number of studies is the file drawer problem. This phenomenon leads to a bias towards positive published findings because undesirable results have been filed away. This is a particular problem in reviews that only include a small number of studies. This means that there is a serious question over the evidence for the effectiveness of token economies.

Question 119

A limitation of token economies in treating Sz (ethical issues)

Answer 119

One limitation with the use of token economies to manage schizophrenia is the ethical issues raised.
The use of token economies raises ethical issues because it gives professionals considerable power to control the behaviour of people in the role of patient. This inevitably involves imposing one person’s (or institution’s) norms on others, which is especially problematic if target behaviours are not identified sensitively. For example, someone who likes to look scruffy and get up late might have these personal freedoms curtailed. Perhaps more seriously, restricting the availability of pleasures (e.g. having sweets or seeing films) to people who don’t behave as desired means that seriously ill people, who are already experiencing distressing symptoms, have an even worse time. Legal action by families who see their relatives in this position has been a major factor in the decline in the use of token economies. This means that the benefits of token economies may be outweighed by their impact on personal freedom and short-term reduction in quality of life.

Question 120

The interactionist approach

Answer 120

Otherwise known as the biosocial approach.
This approach acknowledges that there are biological, psychological and societal factors in the development of SZ.

Question 121

Can you give any examples of what may be included as biological, psychological or societal factors

Answer 121

-genetic vulnerability
-stress
–poor quality interactions in the family

Question 122

Explaining the interactionist approach: the diathesis stress model.

Answer 122

Diathesis means vulnerability.
In this context stress simply means negative psychological experience.
The diathesis stress model says that both a vulnerability to SZ and a stress-trigger are necessary in order to develop the condition.

Question 123

Meehls model

Answer 123

In the original diathesis-stress model the diathesis was entirely genetic, the result of a ‘schizogene’.

Question 124

Which led to which type of personality?

Answer 124

led to the idea of a biologically based schizotypical personality

Question 125

What were these people with schizotypical personality sensitive to?

Answer 125

stress

Question 126

A person who is a carrier of the gene could develop SZ, what childhood stressor could cause this to develop?

Answer 126

-chronic stress in childhood and adolescence
-presence of sz mother

Question 127

The modern understanding of diathesis

Answer 127

It is now clear that many genes each appear to increase the genetic vulnerability slightly, there is no ‘schizogene’.

Question 128

What do modern views of diathesis include?

Answer 128

a range of factors beyond the genetic

Question 129

What does this modern theory suggest is the diatheses instead of stress?

Answer 129

trauma

Question 130

What did Read (2001) propose about trauma and developing SZ?

Answer 130

a neurodevelopmental model in which early trauma alters the developing brain

Question 131

Which part of the brain may be responsible in making the person more vulnerable to later stress?

Answer 131

The hypothalamic pituitary adrenal system

Question 132

The modern understanding of stress

Answer 132

In the original model stress was seen as psychological in nature, and related to parenting. Although this may be important, a more modern definition of stress (in relation to diatheses stress) includes anything that risks triggering SZ.

Question 133

Where has recent research focussed its concerns on in terms of developing SZ?

Answer 133

cannabis use

Question 134

Why is cannabis deemed as a stressor for SZ?

Answer 134

it increases the risk of sz by up to 7 times according to dose

Question 135

What does cannabis do to the body that could cause SZ?

Answer 135

interferes with the dopamine system

Question 136

Is this cannabis use fully proven?

Answer 136

most people don’t develop sz after smoking cannabis presumably because they lack the vulnerability factors so it’s not fully proven

Question 137

Treatments according to the interactionists approach

Answer 137

The model acknowledges both the bio’ and psych’ explanations so logically both bio’ and psych’ treatments are compatible.
The model best combines both antipsychotic and CBT treatments.

Question 138

What does Turkington (2006) believe regards the treatment of SZ?

Answer 138

points out that it’s perfectly possible to believe in biological causes of sz and still practise CBT to relieve psychological symptoms

Question 139

What is the most common treatment for SZ IN the UK?

Answer 139

combination of antipsychotic drugs and CBT

Question 140

What is the most common treatment for SZ IN the US?

Answer 140

medication without accompanying psychological treatment

Question 141

What is a strength for the interactionist approach( support for vulnerability and triggers)

Answer 141

One strength of the interactionist approach to schizophrenia is evidence supporting the role of both vulnerability and triggers. In a large-scale study, Tienari et al. (2004) investigated the impact of both genetic vulnerability and a psychological trigger (dysfunctional parenting). The study followed 19,000 Finnish children whose biological mothers had been diagnosed with schizophrenia. In adulthood this high genetic risk group were compared to a control group of adoptees without a family history of schizophrenia (low genetic risk). Adoptive parents had been assessed for child-rearing style and it was found that high levels of criticism, hostility and low levels of empathy were strongly associated with the development of schizophrenia, but only in the high genetic risk group. This shows that a combination of genetic vulnerability and family stress can lead to greatly increased risk of schizophrenia.

Question 142

What is a limitation of the interactionist approach (diathesis and stress are complex)

Answer 142

One limitation of the original diathesis-stress model is over simplicity. It is now clear that the original model that portrayed diathesis as a single schizogene and portrayed stress as schizophrenogenic parenting is hopelessly simplistic. Multiple genes in multiple combinations influence diathesis. Stress also comes in many forms, including but not limited to dysfunctional parenting. In fact diathesis can also be influenced by psychological factors and stress can be biological as well as psychological. This is shown in a study by Houston et al. (2008), in which childhood sexual abuse emerged as the major influence on underlying vulnerability to schizophrenia and cannabis use as the major trigger. This means that there are multiple factors, both biological and psychological, affecting both diathesis and stress, supporting the modern understanding of both diathesis and stress.

Question 143

What is a strength of the interactionist approach (real world application)

Answer 143

One further strength of the interactionist approach is in the combination of biological and psychological treatments. A practical application of acknowledging biological and psychological factors in schizophrenia has been the combination of drug treatment and psychological therapies. Studies show that combining treatments enhances their effectiveness. For example Tarrier et al. (2004) randomly allocated 315 participants to
(1) medication + CBT, (2) medication + counselling, or (3) control group (medication only). Participants in the two combination groups showed lower symptoms following the trial than the medication-only group, though there was no difference in hospital readmission. This means that there is a clear practical advantage to adopting an interactionist approach to schizophrenia in terms of superior treatment outcomes.

Question 144

What is a counterpoint to real world application of the interactionist approach

Answer 144

Jarvis and Okami (2019) point out that saying that a successful treatment for mental disorder justifies a particular explanation is the logical equivalent of saying that because alcohol reduces shyness, shyness is caused by lack of alcohol. This logical error is called the treatment-causation fallacy. Therefore we cannot automatically assume that the success of combined therapies means interactionist explanations are correct.