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PAPER 3 - PSYCHOLOGY > SCHIZOPHRENIA > Flashcards

SCHIZOPHRENIA Flashcards

1
Q

What percentage of the world has schizophrenia

A

1%

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2
Q

Who are more likely to have it
(3 things)

A

Men
City dwellers
Lower socio-economic groups

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3
Q

Name the two major systems for the classification of mental disorders

A
  1. World Health Organisation’s International Classification of Disease (ICD-10)
  2. The American Psychiatric Associations Diagnostic and Statistical manual edition 5 (DSM-5)
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4
Q

What is the difference between the DSM and ICD when diagnosing schizophrenia

A

The DSM requires at least one positive symptom to be present.
Two more negative symptoms are sufficient in ICD.

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5
Q

What have both classification systems stopped doing and why

A

Diagnosing subtypes of schizophrenia
Someone diagnosed with a subtype of schizophrenia may not show the same symptoms a few years later.

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6
Q

Name the two positive schizophrenia symptoms

A

Hallucinations
Delusions

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7
Q

Describe hallucinations and environment

A

Unusual sensory experiences.
Some hallucinations are related to the environment and others have no relationship to what the senses are picking up from the environment.

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8
Q

Describe delusions

A

Irrational beliefs.

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9
Q

What does the term positive symptoms mean

A

Atypical symptoms experienced in addition to normal experiences.
These are additional experiences beyond those of ordinary existence.

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10
Q

What do common delusions involve

A

Being an important historical, political or religious figure.
Persecution - by government or aliens
Having superpowers

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11
Q

What are negative symptoms

A

Atypical experiences that represent the loss of a usual experience such as a loss of clear thinking or the loss of motivation.
The loss of usual abilities and experiences.

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12
Q

Name the two negative symptoms

A

Speech poverty
Avolition

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13
Q

What is speech poverty

A

Changes in patterns of speech.
Reduction in the amount and quality or a delay in the persons verbal response during conversation.

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14
Q

What is speech disorganisation
How is it classed

A

Speech becomes incoherent or the speaker changes topic mid sentence.
It is a positive symptom.

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15
Q

What is avolition

A

Finding it difficult to begin or keep up with goal-directed activities.

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16
Q

Who identified the 3 signs of avolition (and year)

A

Nancy Andreasen (1982)

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17
Q

What are the 3 signs of avolition

A

Poor hygiene and grooming
Lack of persistence in work or education
Lack of energy

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18
Q

List the positives in diagnosis and classification

A

Good reliabilty

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19
Q

List the issues in diagnosis and classification

A

Low validity
Co-morbidity
Gender bias in diagnosis
Culture bias in diagnosis
Symptoms overlap

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20
Q

When is a psychiatric diagnosis deemed reliable?
State the two key words and describe

A

Inter-rater reliability
When different diagnosing clinicians reach the same diagnosis for the same individual

Test-retest reliability
When the same clinician reaches the same diagnosis for the same individual on two occasions.

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21
Q

How has DSM-5 affected reliability with schizophrenia diagnosis

A

Improved it

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22
Q

Who reported excellent reliability for the diagnosis of schizophrenia (year)

A

Flavia Osorio et al. (2019)

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23
Q

How many people did Flavia Osorio test
What were the results

A

180
Pairs of interviewers achieved inter-rater reliability of +.97 and test-retest reliability of +.92

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24
Q

What is one way to assess validity of a psychiatric diagnosis

A

Criterion validity

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25
Q

Who assessed criterion validity (year)

A

Elie Cheniaux (2009)

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26
Q

What did Elie Cheniaux do to test criterion validity?
What are the results?
What do the results mean?

A

She had two psychiatrists independently assess the same 100 clients using ICD-10 and DSM-IV criteria and found that 68 were diagnosed with schizophrenia under the ICD system and 39 under DSM.
This suggests that schizophrenia is either over or under diagnosed according to which system is used. This means criterion validity is low.

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27
Q

Who proved high criterion validity (year)
What did they prove? What does this mean?

A

Flavia Osorio (2019)
Found there was an excellent agreement between clinicians when they used two measures to diagnose schizophrenia both derived from the DSM system.
This means that the criterion validity for diagnosing schizophrenia is actually good provided it takes place within a single diagnostic system.

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28
Q

What is co-morbidity

A

The occurrence of two disorders or conditions together

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29
Q

Why is co-morbidity bad?

A

If conditions occur together then the validity of their diagnosis and classification is questioned.
The two conditions may actually be one.

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30
Q

Who proved high co-morbidity

A

Buckley at al.

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31
Q

What did Buckley et al find about co-morbidity

A

Half of those diagnosed with schizophrenia also has a diagnosis of depression or substance abuse.

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32
Q

Why is co-morbidity an issue in diganosis

A

Schizophrenia may not exist as a distinct condition
Some people diagnosed with schizophrenia may just have unusual symptoms of depression.

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33
Q

Are men or woman more commonly diagnosed
Since when
Ratio - who found the ratio (year)

A

Since the 1980s men have been diagnosed more
1.4:1 - Fischer and Buchanan (2017)

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34
Q

What are two possible explanation for more men being diagnosed then women
What is more likely - who found this and year

A

Woman are less vulnerable than men because of genetic factors.
More likely women are underdiagnosed as they have closer relationships with better support. Cotton et al (2009)

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35
Q

How is culture bias an issue with diagnosing schizophrenia

A

Hearing voices has different meanings in different cultures. In Haiti it is seen as communication from ancestors

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36
Q

Case study proving culture bias (name and year)

A

Pinto and Jones (2008) British people of African-Caribbean origin are up to 9x more likely to receive a diagnosis as white British people, although people living in African-Caribbean countries are not.

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37
Q

Explanation for culture bias
Researcher and year

A

Culture bias in diagnosis of clients by psychiatrists from a different cultural background.
Leads to an over interpretation of symptoms in black British people
Escobar (2012)

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38
Q

What is symptom overlap

A

Occurs when two or more conditions share symptoms

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39
Q

Give an example of symptom overlap between schizophrenia and another condition

A

Schizophrenia and bipolar disorder involved both the positive symptom of delusions and negative symptom of avolition.

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40
Q

What does symptom overlap suggest

A

That two disorders may not be different but variations of a single condition.

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41
Q

What have family studies proved about the risk of schizophrenia

A

The risk increases in line with genetic similarity to a relative with the disorder.

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42
Q

Who did the large scale family study on schizophrenia

A

Irving Gottesman (1991)

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43
Q

If someone has an aunt with schizophrenia what is the chance they have it
How about siblings
How about identical twins

A

2%
9%
48%

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44
Q

Why else does having a family member with schizophrenia increase your chances besides genetics
What does this mean

A

They share aspects of their environment
The correlation represents both

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45
Q

How many genes control schizophrenia

A

It is not a single gene but polygenic

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46
Q

What genes most likely impact schizophrenia

A

Those coding for neurotransmitters including dopamine

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47
Q

Who combined all the previous data from geome-wide studies of schizophrenia

A

Stephen Ripke et al (2014)

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48
Q

What did Stephen Ripke do

A

Compared the genetic makeup of-up of 37,000 people with a diagnosis of schizophrenia to 113,000 controls

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49
Q

What did Stephen Ripke find

A

That 108 separate genetic variations were associated with slightly increased risk of schizophrenia

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50
Q

Why is schizophrenia aetiologically heterogenous

A

Because different studies have identified different candidate genes
Different combinations of factors can lead to the condition

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51
Q

Can schizophrenia occur without family history

A

Yes

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52
Q

What is an explanation for schizophrenia occurring without family history

A

Mutation in parental DNA caused by radiation, poison or viral infection.

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53
Q

What is the evidence of mutation causing schizophrenia
Who found this

A

Positive correlation with age of the parent (associated with increased risk of sperm mutation) and risk of schizophrenia
Risk increases from around 0.7% with fathers under 25 to over 2% in fathers over 50

Brown et al (2002)

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54
Q

What are neural correlates

A

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

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55
Q

What is the best-known neural correlate of schizophrenia

A

Dopamine

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56
Q

How was the original hypothesis of dopamine and schizophrenia found
Who found it

A

Based on the discovery that drugs used to treat schizophrenia (antipsychotics which reduce DA) caused symptoms similar to parkinsons disease a disease associated with low DA levels.
Seeman (1987)

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57
Q

What dopamine levels are associated with schizophrenia (keyword)
Where are these levels occuring

A

High levels - hyperdopaminergia - in subcortical areas of the brain

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58
Q

How can dopamine levels explain speech poverty and auditory hallucinations

A

High levels of dopamine receptors in pathways from the sub cortex to the Broca’s Area (responsible for speech production)

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59
Q

Who updated the dopamine hypothesis and when

A

Kenneth Davis et al 1991

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60
Q

What did Kenneth Davis propose

A

The addition of cortical hypodopaminergia
Abnormally low DA in the brains cortex

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61
Q

How can low levels of dopamine explain cognitive problems

A

Low levels of DA in the prefrontal cortex which is responsible for thinking - negative symptoms

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62
Q

What can cortical hypodopaminergia lead to

A

It can lead to subcortical hyperdopaminergia so high and low levels of dopamine in different brain regions

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63
Q

What two factors can make some people more sensitive to cortical hypodopaminergia and subcortical hyperdopaminergia
Who states this

A

Genetic variations
Early experiences of stress, both psychological and physical
Howes et al (2017)

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64
Q

What is one strength of the the genetic explanation

A

It has a strong evidence base

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65
Q

Name and explain three studies that show a strong evidence base for genetic

A

Gottesman
Pekka Teinari et al. (2004)
Rikke Hilker et al. (2018)

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66
Q

What was Pekka Tienari et al. Study

A

Adoption study shows that biological children of parents with schizophrenia are at heightened risk even if they grow up in an adoptive family.

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67
Q

What was Rikke Hilker et al. (2018) study

A

A twin study showing a concordance rate of 33% for identical twins and 7% for non-identical.

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68
Q

What is one limitation of the genetic explanation

A

There is clear evidence to show that environmental factors also increase the risk of developing schizophrenia

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69
Q

What two influences do environemntal factors include

A

Both biological and physical

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70
Q

Name the biological risk factors and the study’s for them

A

Birth complications Morgan et al. (2017) and smoking THC rich cannabis in teenage years Di Forti et al. 2015

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71
Q

Name the psychological risk factors and who studied it

A

Childhood trauma which leaves people more vulnerable to adult mental health problems.
Nina Morkved et al. (2017)

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72
Q

What did Nina Morkved find

A

That 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.

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73
Q

What is one strength for the evidence of dopamine

A

Support for the idea that dopamine is involved in

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74
Q

What do Amphetamines do and who discovered this

A

They increase DA and worsen symptoms in people with schizophrenia and induce symptoms in people without Curran et al. (2004)

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75
Q

What do antipsychotic drugs do and who discovered this

A

They reduce DA activity and therefore the intensity of symptoms Tauscher et al. (2014)

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76
Q

What can sometimes act on the production of DA or DA receptors
What does this suggest

A

Candidate genes
That dopamine is involved in the symptoms of schizophrenia

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77
Q

What is a limitation of the dopamine hypothesis

A

The evidence for a central role of glutamate.

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78
Q

How did they find the role of glutamate in schizophrenia
What is it
Who studied this

A

Post-mortem and live scanning have consistently found raised levels of the neurotransmitter in serveral brain regions
McCutcheon et al. (2020)

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79
Q

What is the link between schizophrenia genes and glutamate

A

Several candidate genes for schizophrenia are believed to be involved in glutamate production or processing.

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80
Q

Name the biological explanations for schizophrenia

A

The genetic basis
Neural correlates

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81
Q

Name the psychological explanations for schizophrenia

A

Family dysfunction
Cognitive explanations

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82
Q

What is family dysfunctions
How does it link to schizophrenia

A

Refers to processes within a family such as poor family communication, cold parenting, and high levels of expressed emotion.
These may be risk factors for both the development and maintenance of schizophrenia

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83
Q

What type of explanation is the schizophrenogenic mother

A

Psychodynamic

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84
Q

What is the schizophrenogenic mother

A

A cold, rejecting and controlling mother who tends to create a family climate characterised by tension and secrecy.

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85
Q

Who coined the schizophrenogenic mother
Where did it come from

A

Frieda Fromm-Reichmann (1948)
It was based on the accounts she heard from her patients about their childhoods.

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86
Q

What does the schizophrenogenic mother lead to in the child

A

Leads to distrust that later develops into paranoid delusions.

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87
Q

Who came up with the double-blind theory

A

Gregory Bateson et al. (1972)

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88
Q

What does the double-blind theory emphasise
What did Gregory make clear about his findings

A

The role of communication style within a family
That it is not the main communication style in the family and not the only factor just a risk factor

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89
Q

Explain the double-blind theory

A

A child fears of doing wrong.
They receive mixed messages about what doing wrong is
They feel unable to comment on the unfairness of the situation
When they get it wrong they are punished by withdrawal of love
This leaves them thinking the world is confusing and dangerous

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90
Q

What symptoms reflect the double blind theory

A

Disorganised thinking and paranoid delusions

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91
Q

What theory’s fall under family dysfunction

A

The schizophrenogenic mother
The double-blind theory
Expressed emotion

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92
Q

What is Expressed emotion (EE)

A

The level of emotion, in particular negative emotion, expressed towards a person with schizophrenia by their carers who are often family members.

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93
Q

What are the 3 elements of EE

A
  1. Verbal criticism of the person, occasionally accompanied by violence
  2. Hostility towards the person, including anger and rejection
  3. Emotional overinvolvement in the life of the person, including needless self-sacrifice
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94
Q

What do these high levels of expressed emotion cause

A

Stress

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95
Q

What 2 impacts can EE have on a person

A

Cause a relapse in people with schizophrenia
Can trigger an onset of schizophrenia

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96
Q

What are the 3 cognitive explanations

A

Dysfunctional thinking
Metarepresentation dysfunction
Central Control dysfunction

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97
Q

What is cognitive explanations

A

Explanations that focus on mental processes such as thinking, attention and language

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98
Q

What is dysfunctional thought processing

A

Information processing that does not represent reality accurately and produces undesirable consequences

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99
Q

Reduced thought processing in the ___ is associated with negative symptoms
Reduced processing of information in the ___ and ___ is associated with hallucinations
Who stated this

A

Ventral striatum
Temporal and cingulate gyri
Simon et al. (2015)

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100
Q

what does lower than usual levels of information processing suggest

A

That cognition is likely to be impaired

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101
Q

Who discovered two types of dysfunctional thinking and what are they

A

Christopher Frith et al. (1992)
Metarepresentation dysfunction
Central control dysfunction

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102
Q

What is Metarepresentation dysfunction

A

The cognitive ability to reflect on thoughts and behaviour

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103
Q

What would dysfunction in Metarepresentation cause and what does it explain in schizophrenia

A

It would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else.
Hallucinations of hearing voices and delusions like thought insertion (positive)

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104
Q

What is central control dysfunction

A

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

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105
Q

How is central control dysfunction expressed as a symptom

A

Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts

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106
Q

What is one strength of the family dysfunction theory

A

Evidence linking it to schizophrenia

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107
Q

What are the studies that support family dysfunctions link to schizophrenia

A

John Read et al. (2005)
Morkved et al (2017)

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108
Q

Explain John reads findings for family dysfunction

A

Adults with schizophrenia are disproportionately likely to have insecure attachment, particularly type C or D
69% of women and 59% of men with schizophrenia have a history of physical and or sexual abuse.

109
Q

What were Morkveds findings

A

Most has at least one childhood trauma, mostly abuse

110
Q

What is one limitation of family explanations

A

The poor evidence base for any explanations

111
Q

What two theories have almost no supporting evidence
What do these two theories fall under

A

Schizophrenogenic mother
Double blind

The importance of traditional family-based theories

112
Q

What are the schizophrenogenic mother and double blind theory based on
What type of assessment is this and what do they lack

A

Both based on clinical observations
Informal assessment
No systematic evidence

113
Q

What is a strength of cognitive explanations

A

Evidence for dysfunctional thought processing

114
Q

Who’s research provides strong evidence for the cognitive explanations of dysfunctional thought processing

A

John Stirling et al (2006)

115
Q

What was John Sterlings method when investigating cognitive explanations
Outline one task

A

Compared a rage of cognitive tasks in 30 people with schizophrenia and a control group of 30.
Tasks included the stroop task in which participants have to name the font-colours of the colour-word, so have to suppress the tendency to read the words aloud.

116
Q

What was John Sterlings findings

A

People with schizophrenia took over twice as long on average to name the font-colours

117
Q

What is a limitation of cognitive explanations

A

They only explain the proximal origins of symptoms. They explain what is happening now to produce symptoms not like distal explanations which focus on what initially caused the condition.

118
Q

Give two examples of possible distal explanations

A

Genetic
Family dysfunction

119
Q

What is currently unclear and not addressed with genetic variation or childhood trauma

A

How they might lead to problems with Metarepresentation or central control

120
Q

What is biological therapy for schizophrenia
Name the two types of antipsychotics

A

Drug therapy
Typical and atypical

121
Q

What is the most common treatment for schizophrenia

A

Antipsychotic drugs.

122
Q

What does a person with psychosis experience

A

Some loss of contact with reality, through hallucinations or delusions

123
Q

What is the defining characteristic of schizophrenia

A

Psychosis

124
Q

Do you take antipsychotics or life?

A

Can either be a short course then stop use without return of symptoms
Can be for life and without recurrence can occur

125
Q

How can typical antipsychotics be taken

A

Tablets, syrup or by injection

126
Q

If taken orally what is the maximum dose for typical antipsychotics
What is the usual case

A

1000mg
Initially doses are smaller and gradually increased to a max of 400-800mg

127
Q

What are typical antipsychotics
Example

A

First generation of drugs
Chlorpromazine

128
Q

What are atypical antipsychotics
Example

A

New generation of antipsychotics they typically target a range of neurotransmitters such as dopamine and serotonin.
Risperidone

129
Q

There is a strong association between the use of typical antipsychotics and _____

A

The dopamine hypothesis

130
Q

How does chlorpromazine work?

A

Acts as an antagonist in the dopamine system, reducing the action of neurotransmitters.
It blocks the dopamine receptors in the synapses of the brain

131
Q

What happens when a patient first takes chlorpromazine

A

The dopamine levels build up

132
Q

As well as its antipsychotic properties chlorpromazine is also an effective ___
This is expected to be because of ___
Is this fully understood?

A

Sedative
Its effect on histamine receptors
No

133
Q

What form of Chlorpromazine is given when used as a sedative and why

A

Syrup as it is absorbed faster

134
Q

What are the two atypical antipsychotics

A

Clozapine
Risperidone

135
Q

When was clozapine developed and trialed

A

1960s
1970s

136
Q

What happened to clozapine in the 1970s
Why

A

It was withdrawn
Due to deaths from a blood condition (agranulocytosis)

137
Q

What happened to clozapine in the 1980s
Why?

A

It was remarketed as a treatment to be used when others failed
It was discovered to be more effective than typical antipsychotics

138
Q

What do people taking clozapine have to do

A

Have their blood tested regularly

139
Q

How is clozapine not given
What is the typical dose

A

As an injection
300-450 mg daily

140
Q

What percentage if people with schizophrenia attempt suicide

A

30-50%

141
Q

Why is clozapine more effective
What else does it help with

A

It acts on serotonin and glutamate receptors
Improves mood and reduces depression and anxiety in patients

142
Q

When was Risperidone developed

A

1990s

143
Q

Why was Risperidone developed

A

An attempt to produce a drug as effective as clozapine but without serious side effects

144
Q

How can Risperidone be taken

A

Injection, syrup or tablets

145
Q

How long does an injection of Risperidone last

A

Around two weeks

146
Q

How is Risperidone administered
what is typical daily dose
What is max dose

A

Small does then build up
Typical dose is 4-8mg
12 mg

147
Q

What receptors is Risperidone believed to bind to
What is some positive evidence

A

Serotonin and dopamine
More effective in smaller doses
Evidence suggests there are fewer side effects

148
Q

What two studies support the effectiveness of antipsychotics

A

Ben Thornley et al. (2003)
Herbert Meltzer (2012)

149
Q

What did Ben Thornley do (antipsychotics)

A

Reviewed studies comparing the effects of chlorpromazine to control conditions

150
Q

What was ben Thornley findings (antipsychotics)

A

Data from 13 trials with a total of 1121 participants showed that chlorpromazine was associated with better overall functioning and reduced symptom severity compared to placebo.

151
Q

What did Herbert meltzer find? (Antipsychotics)
Fact

A

Concluded that clozapine is more effective than all other antipsychotics.
It is effective in 30-50% of cases where typical antipsychotics have failed.

152
Q

Who suggested flaws with evidence for antipsychotic evidence

A

David Healy (2012)

153
Q

What are David Healys suggested flaws with evidence for effectiveness of antipsychotics

A

Most studies are of short-term effects
Some successful trials have had their data published multiple times - exaggerated the size of evidence
As they have powerful calming effects it is easy to demonstrate some positives - not the same as saying they really reduce the severity.

154
Q

List the less serious typical antipsychotic side effects

A

Dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin

155
Q

What can long-term use of typical antipsychotics lead to

A

Tardive dyskinesia caused by dopamine super sensitivity and causes involuntary facial movements.

156
Q

What is the most serious side effect of typical antipsychotics - also in atypical antipsychotics

A

Neuroleptic malignant syndrome (NMS)

157
Q

What causes NMS

A

The drug blocking dopamine action in the hypothalamus

158
Q

What can NMS cause

A

High temperature, delirium, coma and can be fatal

159
Q

What are the chances of NMS

A

Frequency range from less than 0.1% to just over 0.2%

160
Q

What is a further limitation to typical and some atypical antipsychotics

A

We dont know why they work

161
Q

Explain why antipsychotics should not work in some cases

A

Dopamine levels in some parts of the brain a re too low in schizophrenia patients

162
Q

What are the two psychological therapy options for someone with schizophrenia

A

Cognitive behaviour therapy (CBT)
Family therapy

163
Q

How many sessions is CBT for someone with schizophrenia
Do they happen individually or in groups

A

5-20
Both

164
Q

Explain how CBT helps someone with schizophrenia

A

Can help make sense of how their irrational cognitions impact on their feelings and behaviour.
Understanding where symptoms come from can be helpful.

165
Q

How can CBT be aimed at helping someone who is hearing voices

A

Normalisation
By teaching them that voice-hearing is an extension of the ordinary experience of thinking in words.

166
Q

How can CBT be aimed at helping someone with delusions
Does this always work

A

Reality testing
The person with schizophrenia and their therapist jointly examine the likelihood that beliefs are true.
No delusions can be resistant but the CBT still helps tackle the anxiety and depression

167
Q

What is family therapy

A

A psychological therapy carried out with all or some members of a family with the aim of improving the communications within the family and reducing the stress of living as a family.

168
Q

Who identified a range of strategies that family therapists use

A

Fiona Pharoah et al. (2010)

169
Q

What are two of the stratergies used in family therapy

A

Reduces negative emotions
Improves the family’s ability to help

170
Q

How does reducing negative emotions help in family therapy

A

This reduces the levels of emotions especially the negative.
Reduces stress which is important as it reduces the likelihood of relapse

171
Q

How does family therapy improve the family’s ability to help

A

Can agree on collective aims
Improves the families beliefs about and behaviour towards schizophrenia
Ensures the family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.

172
Q

Who proposed a model for working with families dealing with schizophrenia

A

Frank Burbach (2018)

173
Q

How does Burbachs model of practice start

A

Sharing basic information and providing emotional and practical support

174
Q

What is phase 2 of burbachs model of practice

A

Identifying resources including what different family members can and cannot offer.

175
Q

What is phase 3 of burbachs model of practice

A

Aims to encourage mutual understanding, creating a safe space for all family members to express their feelings.

176
Q

What is phase 4 of burbachs model of practice

A

Identifying unhelpful patterns of interaction

177
Q

What is phase 5 of burbachs model of practice

A

Skills training such as learning stress management techniques

178
Q

What is phase 6 burbachs model of practice

A

Looks at relapse prevention planning

179
Q

Phase 7 burbachs model of practice

A

Maintenance for the future

180
Q

What is one strength of CBT for schizophrenia

A

The evidence for its effectiveness

181
Q

What two studies support CBT for schizophrenia

A

Sameer Jauhar et al. (2014)
Maria Pontillo et al. (2016)

182
Q

What was Sameer Jauhar’s method and findings on evidence for effectiveness with CBT and schizophrenia

A

Reviewed 34 studies
Concluded that there is clear evidence for small but significant effects on both positive and negative symptoms

183
Q

What was Maria Pontillos findings

A

Found reductions in frequency and severity of auditory hallucinations.

184
Q

What organisation recommends CBT for schizophrenia

A

Clinical advice from NICE.

185
Q

What is one limitation of CBT for schizophrenia

A

Quality of evidence
The wide range of techniques and symptoms included in studies

186
Q

What case study highlights the lack in quality of evidence for CBT on schizophrenia

A

Neil Thomas (2015)

187
Q

What did Neil Thomas point out on CBT and schizophrenia

A

Different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms.

188
Q

Why is it hard to say how effective CBT will be for a particular person with schizophrenia

A

Modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms.

189
Q

Can CBT actually cure an individual of schizophrenia

A

No it can only improve the quality of life

190
Q

What is a strength of family therapy for schizophrenia

A

Evidence of its effectiveness

191
Q

Who reviewed studies on evidence of effectiveness for family therapy and schizophrenia

A

William McFarlane (2016)

192
Q

What did William McFarlane find on evidence of effectiveness for family therapy and schizophrenia

A

Concluded that family therapy was one of the most consistently effective treatments avaliable for schizophrenia.
Relapse rates were found reduced by 50-60%
Using it as mental health initially starts to decline is more promising.

193
Q

What organisation also recommends family therapy

A

NICE

194
Q

What is another strength of family therapy for schizophrenia

A

It benefits all the family

195
Q

Who reviewed evidence for benefits to whole family

A

Fiona lobban and Christine Barrowclough (2016)

196
Q

What did Fiona Lobban and Christine Barrowclough find on benefits to the whole family for family therapy

A

The effects on the rest of the family is important because families provide the bulk car for people with schizophrenia
By strengthening the functioning of the whole family there is less negative impact of schizophrenia on other family members.

197
Q

What are token economies

A

A form of behavioural modification where desirable behaviours are encouraged by the use of selective reinforcement

198
Q

Explain token economy through an example

A

People are given rewards (tokens) when they engage in socially desirable behaviours.
The tokens are secondary reinforcers.
They can exchange tokens food or privileges.
Food is the primary reinforcer.

199
Q

Who carried out the classic demonstration of a token economy

A

Teodoro Ayllon and Nathan Azrin (1968)

200
Q

Where did Ayllon and Azrin test token economies?

A

A ward of women with diagnosed schizophrenia

201
Q

What did Ayllon and Azrin do to test token economy

A

Every time the patients carried out a task they were given a plastic token embossed with the words ‘one gift’.
The tokens could then be swapped for ward privileges - being able to watch a film.

202
Q

What happened when Allyon and Azrin first implemented their token economy

A

The number of tasks carried out increased significantly

203
Q

What has happened to the usage of token economies
Why

A

Declined
Due to increased community-based care and the closure of psychiatric hospitals due to ethical issues being raised.

204
Q

When were token economies used the most and why

A

60s and 70s
The norm for treating schizophrenia was long-term hospitalisation

205
Q

When does institutionalisation develop

A

Under circumstances of prolonged hospitalisation

206
Q

What is one outcome of institutionalisation
Why does it happen

A

People often develop bad habits - cease to maintain good hygiene or stop socialising with others.
Living without routine and small pleasures

207
Q

Who identified 3 categories of institutional behaviour tackled by token economies

A

Johnny Matson et al (2016)

208
Q

What are the 3 categories of institutional behaviour tackled by token economies

A

Personal care
Condition-related behaviours
Social behaviour

209
Q

What are the two major benefits of modifying institutional behaviour

A

Improved the persons quality of life within hospital settings
‘Normalises’ behaviour and makes it easier for people who have spent a time in hospital to adapt back into life in the community

210
Q

Why is it important to know the individual before implementing a token economy

A

Target behaviours are decided on an individual basis.
Need to know the person to decide the most appropriate target behaviours for them

211
Q

Who suggested individual target behaviours

A

Copper et al. (2007)

212
Q

Why are the tokens used and the individual isnt just given the main rewards

A

You need an immediate reward for target behaviour - delayed rewards are less effective.

213
Q

What are token economies an example of
What type of conditioning is it

A

Behaviour modification
Operant conditioning

214
Q

Why are tokens called secondary reinforces

A

They only have meaning once an individual finds out they can swap them for the primary

215
Q

When secondary reinforcers can be used for many different primary reinforcers what are they called

A

Generalised reinforcers

216
Q

Name one strength of token economies

A

Their evidence for their effectiveness

217
Q

What study provides evidence of the effectiveness of token economies

A

Krista Glowacki et al (2016)

218
Q

What did Glowacki do
(Dates)

A

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 hospital settings.

219
Q

What did Glowacki find in the studies - token economy

A

All studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours.

220
Q

What is a counterpoint for Glowacki’s findings
What key word problem can this lead to

A

7 studies is quite a small evidence base to support the effectiveness of a technique.
The file drawer problem

221
Q

What is the file drawer problem

A

Leads to a bias towards positive published findings because undesirable results have been ‘filed away’
A particular problem in reviews that include a small number of studies.

222
Q

Name the three limitations to token economies

A

Ethical issues
Existence of more pleasant and ethical alternatives
Hard to adjust to community life

223
Q

What are the ethical issues with token economies

A

It gives professionals power to control behaviour of patients
A big issue if target behaviours are not identified sensitively
Seriously ill people who already experience distressing symptoms have an even worse time as they are unable to receive pleasures.
Short-term reduction in quality of life.

224
Q

What is an alternative approach to token economies

A

Art therapy

225
Q

Who completed a review on art therapy

A

Mathew Chiang et al (2019)

226
Q

What did Mathew Chiang conclude (art therapy)

A

Might be a good alternative
Evidence base is regularly small and has some methodological limitations but shows that art therapy is a high-gain and low-risk approach

227
Q

The big positives of art therapy

A

No major risk of side effects or ethical abuse

228
Q

What other organisation recommends art therapy for people with schizophrenia

A

NICE

229
Q

What is the interactionist approach
What is it also called

A

An approach that acknowledges that there are biological, psychological and social factors in the development of schizophrenia.

The biosocial approach

230
Q

What 3 factors are involved in the development of schizophrenia
What is this approach called

A

Biological, psychological and social
Interactionist approach

231
Q

What are the biological factors involved with schizophrenia

A

Genetic vulnerability
Neurochemical and neurological abnormality

232
Q

What are the psychological factors for schizophrenia

A

Stress
Resulting from life events and daily hassles

233
Q

What are the social factors for schizophrenia

A

Poor quality interactions in the family

234
Q

What type of approach is the diathesis-stress model
Explain the diathesis-stress model

A

An interactionist approach to explaining behaviour
A model that states both an underlying vulnerability and stress-trigger are necessary to develop schizophrenia

235
Q

What does the diathesis-stress model suggest is the trigger

A

Stress

236
Q

Who made the original diathesis-stress model

A

Meehl (1962)

237
Q

Explain Meehl’s model

A

Vulnerability was entirely genetic as a result often of a single ‘schizogene’
If a person doesnt have the scizhogene then no amount of stress will lead to schizophrenia
If a person does have the gene and experiences chronic stress in childhood (schizophrenogenic mother) they may develop the disorder

238
Q

Who studies have helped the modern understanding of diathesis

A

Ripke et al. (2014)
Ingram and Luxton (2005)
John Read et al. (2001)

239
Q

Explain Ripke findings in terms of aiding modern diathesis

A

Proved that many genes each appear to increase genetic vulnerability only slightly.
There is not a single schizogene

240
Q

Explain Ingram and Luxton statement in terms of modern diathesis

A

There are a range of factors beyond the genetic, including psychological trauma
So trauma becomes the diathesis rather than the stressor

241
Q

Explain John Read’s proposal on modern diathesis
What is it called
Give an example

A

He proposed a neurodevelopmental model
Early trauma and severe enough trauma can seriously affect many aspects of brain development.
The hypothalamic-pituitary-adrenal (HPA) system can become overactive making them vulnerable to later stress.

242
Q

What studies provide a modern understanding of stress

A

Houston et al. (2008)

243
Q

What does Houston state about the modern understanding of stress

A

It is anything that risks triggering schizophrenia

244
Q

What has recent research shown as a risk factor for a schizophrenic episode

A

Cannabis

245
Q

Explain cannabis in the diathesis-stress model

A

Cannabis is a stressor as it increases the risk of schizophrenia

246
Q

How much does cannabis increase the chance of schizophrenia

A

Increases the risk by up to 7 times according to dose

247
Q

Why might cannabis lead to schizophrenia
What is the counterargument
Counterargument again

A

May be because cannabis interferes with the dopamine system
Most people dont become schizophrenic after cannabis
This may be because they lack the requisite vulnerability factors

248
Q

What does the interactionist model suggest about the best treatment method

A

As it acknowledges both biological and psychological factors it is compatible with both biological and psychological treatments
The model is associated with combining antipsychotic medication and psychological therapies (CBT)

249
Q

Who made a statement on treatment according to the interactionist model

A

Douglas Turkington et al. (2006)

250
Q

What did Turkington state about treatment according to the interactionist model

A

It is perfectly possible to believe in biological causes of schizophrenia and still practice CBT to relieve psychological symptoms.
Must be made clear to the patient and clinician that both biological and psychological factors are at play to be successful.

251
Q

What is the difference between the US and UK approaches to treating schizophrenia

A

Medication without an accompanying psychological treatment is more common in the US.

252
Q

What is one strength of the interactionist approach

A

Evidence supporting the role of both vulnerability and triggers

253
Q

What study provides evidence for vulnerability and triggers in the interactionist approach

A

Pekka Tienari et al (2004)

254
Q

What did Tienari investigate for support for vulnerability and triggers
Who did it study
What was the test / comparison made

A

The impact of both genetic vulnerability and psychological trigger.
Followed 19,000 Finnish children whose biological mothers had been diagnosed with schizophrenia
In adulthood the high genetic risk group were compared to a control group of adoptees without a family history of schizophrenia (low genetic risk)

255
Q

What was Tienari’s findings for support for vulnerability and triggers

A

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.
Shows a combination leads to greatly increased risk of schizophrenia

256
Q

What is one limitation of the original diathesis-stress model

A

Oversimplicity
It portrayed diathesis as a single schizogene and stress as schizophrenogenic parenting.

257
Q

What study shows that stress should not be limited to dysfunctional parenting

A

James Houston et al. (2008)

258
Q

What can diathesis and stress also be influences by

A

Diathesis can also be influenced by psychological factors
Stress can be biological as well as psychological

259
Q

What was James Houston’s findings

A

Childhood sexual abuse emerged as the major influence underlying vulnerability to schizophrenia and cannabis use as the major trigger

260
Q

How many factors affect diathesis and stress
What type of factors
What does this support

A

Many factors
Both biological and psychological
Understanding of both diathesis and stress

261
Q

What is a further strength of the interactionist approach besides evidence supporting

A

The combination of biological and psychological treatment
A real-world application

262
Q

Who conducted a study showing the effectiveness of combined treatment for schizophrenia

A

Nicholas Tarrier et al. (2004)

263
Q

What was Nicholas Tarrier’s method in investigating the effectiveness of combined treatment
Number of participants

A

Randomly allocated 315 participants to either group:
1. Medication + CBT
2. Medication + counselling
3. Control group - medication only

264
Q

What was Tarrier’s results when investigating the effectiveness of combining biological and psychological treatments
Counterargument

A

Participants in the two combination group’s showed lower symptoms following the trial than the medication only group.
There was no difference in hospital readmissions.

265
Q

Who’s study pointed out treatment-causation fallacy

A

Matt Jarvis and Paul Okami (2019)

266
Q

Explain the treatment-causation fallacy via an example
What does this mean about interactionist explanations

A

Saying that a successful treatment for mental disorder justifies a particular explanation is the logical equivalent for saying that because alcohol reduces shyness, shyness is caused by lack of alcohol.
We cannot assume that the success of combined therapies means interactionist explanations are correct

267
Q

Why might family therapy be preferred to CBT

A

Economic benefits as it reduces relapse rates

268
Q

Why is schizophrenia more commonly diagnosed in urban than rural areas
How might it justify the interactionist approach

A

It assumes that urban living is more stressful than rural and therefore city living acts as a trigger

269
Q

What is the counterargument for urban living triggering stress for the interactionist approach

A

Schizophrenia may be more likely to be diagnosed in cities, or that people with a diathesis for schizophrenia (teenagers abused as children) tend to migrate to cities.

PAPER 3 - PSYCHOLOGY (4 decks)

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