SCHIZOPHRENIA Flashcards
What percentage of the world has schizophrenia
1%
Who are more likely to have it
(3 things)
Men
City dwellers
Lower socio-economic groups
Name the two major systems for the classification of mental disorders
- World Health Organisation’s International Classification of Disease (ICD-10)
- The American Psychiatric Associations Diagnostic and Statistical manual edition 5 (DSM-5)
What is the difference between the DSM and ICD when diagnosing schizophrenia
The DSM requires at least one positive symptom to be present.
Two more negative symptoms are sufficient in ICD.
What have both classification systems stopped doing and why
Diagnosing subtypes of schizophrenia
Someone diagnosed with a subtype of schizophrenia may not show the same symptoms a few years later.
Name the two positive schizophrenia symptoms
Hallucinations
Delusions
Describe hallucinations and environment
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.
Describe delusions
Irrational beliefs.
What does the term positive symptoms mean
Atypical symptoms experienced in addition to normal experiences.
These are additional experiences beyond those of ordinary existence.
What do common delusions involve
Being an important historical, political or religious figure.
Persecution - by government or aliens
Having superpowers
What are negative symptoms
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.
Name the two negative symptoms
Speech poverty
Avolition
What is speech poverty
Changes in patterns of speech.
Reduction in the amount and quality or a delay in the persons verbal response during conversation.
What is speech disorganisation
How is it classed
Speech becomes incoherent or the speaker changes topic mid sentence.
It is a positive symptom.
What is avolition
Finding it difficult to begin or keep up with goal-directed activities.
Who identified the 3 signs of avolition (and year)
Nancy Andreasen (1982)
What are the 3 signs of avolition
Poor hygiene and grooming
Lack of persistence in work or education
Lack of energy
List the positives in diagnosis and classification
Good reliabilty
List the issues in diagnosis and classification
Low validity
Co-morbidity
Gender bias in diagnosis
Culture bias in diagnosis
Symptoms overlap
When is a psychiatric diagnosis deemed reliable?
State the two key words and describe
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.
How has DSM-5 affected reliability with schizophrenia diagnosis
Improved it
Who reported excellent reliability for the diagnosis of schizophrenia (year)
Flavia Osorio et al. (2019)
How many people did Flavia Osorio test
What were the results
180
Pairs of interviewers achieved inter-rater reliability of +.97 and test-retest reliability of +.92
What is one way to assess validity of a psychiatric diagnosis
Criterion validity
Who assessed criterion validity (year)
Elie Cheniaux (2009)
What did Elie Cheniaux do to test criterion validity?
What are the results?
What do the results mean?
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.
Who proved high criterion validity (year)
What did they prove? What does this mean?
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.
What is co-morbidity
The occurrence of two disorders or conditions together
Why is co-morbidity bad?
If conditions occur together then the validity of their diagnosis and classification is questioned.
The two conditions may actually be one.
Who proved high co-morbidity
Buckley at al.
What did Buckley et al find about co-morbidity
Half of those diagnosed with schizophrenia also has a diagnosis of depression or substance abuse.
Why is co-morbidity an issue in diganosis
Schizophrenia may not exist as a distinct condition
Some people diagnosed with schizophrenia may just have unusual symptoms of depression.
Are men or woman more commonly diagnosed
Since when
Ratio - who found the ratio (year)
Since the 1980s men have been diagnosed more
1.4:1 - Fischer and Buchanan (2017)
What are two possible explanation for more men being diagnosed then women
What is more likely - who found this and year
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)
How is culture bias an issue with diagnosing schizophrenia
Hearing voices has different meanings in different cultures. In Haiti it is seen as communication from ancestors
Case study proving culture bias (name and year)
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.
Explanation for culture bias
Researcher and year
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)
What is symptom overlap
Occurs when two or more conditions share symptoms
Give an example of symptom overlap between schizophrenia and another condition
Schizophrenia and bipolar disorder involved both the positive symptom of delusions and negative symptom of avolition.
What does symptom overlap suggest
That two disorders may not be different but variations of a single condition.
What have family studies proved about the risk of schizophrenia
The risk increases in line with genetic similarity to a relative with the disorder.
Who did the large scale family study on schizophrenia
Irving Gottesman (1991)
If someone has an aunt with schizophrenia what is the chance they have it
How about siblings
How about identical twins
2%
9%
48%
Why else does having a family member with schizophrenia increase your chances besides genetics
What does this mean
They share aspects of their environment
The correlation represents both
How many genes control schizophrenia
It is not a single gene but polygenic
What genes most likely impact schizophrenia
Those coding for neurotransmitters including dopamine
Who combined all the previous data from geome-wide studies of schizophrenia
Stephen Ripke et al (2014)
What did Stephen Ripke do
Compared the genetic makeup of-up of 37,000 people with a diagnosis of schizophrenia to 113,000 controls
What did Stephen Ripke find
That 108 separate genetic variations were associated with slightly increased risk of schizophrenia
Why is schizophrenia aetiologically heterogenous
Because different studies have identified different candidate genes
Different combinations of factors can lead to the condition
Can schizophrenia occur without family history
Yes
What is an explanation for schizophrenia occurring without family history
Mutation in parental DNA caused by radiation, poison or viral infection.
What is the evidence of mutation causing schizophrenia
Who found this
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)
What are neural correlates
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
What is the best-known neural correlate of schizophrenia
Dopamine
How was the original hypothesis of dopamine and schizophrenia found
Who found it
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)
What dopamine levels are associated with schizophrenia (keyword)
Where are these levels occuring
High levels - hyperdopaminergia - in subcortical areas of the brain
How can dopamine levels explain speech poverty and auditory hallucinations
High levels of dopamine receptors in pathways from the sub cortex to the Broca’s Area (responsible for speech production)
Who updated the dopamine hypothesis and when
Kenneth Davis et al 1991
What did Kenneth Davis propose
The addition of cortical hypodopaminergia
Abnormally low DA in the brains cortex
How can low levels of dopamine explain cognitive problems
Low levels of DA in the prefrontal cortex which is responsible for thinking - negative symptoms
What can cortical hypodopaminergia lead to
It can lead to subcortical hyperdopaminergia so high and low levels of dopamine in different brain regions
What two factors can make some people more sensitive to cortical hypodopaminergia and subcortical hyperdopaminergia
Who states this
Genetic variations
Early experiences of stress, both psychological and physical
Howes et al (2017)
What is one strength of the the genetic explanation
It has a strong evidence base
Name and explain three studies that show a strong evidence base for genetic
Gottesman
Pekka Teinari et al. (2004)
Rikke Hilker et al. (2018)
What was Pekka Tienari et al. Study
Adoption study shows that biological children of parents with schizophrenia are at heightened risk even if they grow up in an adoptive family.
What was Rikke Hilker et al. (2018) study
A twin study showing a concordance rate of 33% for identical twins and 7% for non-identical.
What is one limitation of the genetic explanation
There is clear evidence to show that environmental factors also increase the risk of developing schizophrenia
What two influences do environemntal factors include
Both biological and physical
Name the biological risk factors and the study’s for them
Birth complications Morgan et al. (2017) and smoking THC rich cannabis in teenage years Di Forti et al. 2015
Name the psychological risk factors and who studied it
Childhood trauma which leaves people more vulnerable to adult mental health problems.
Nina Morkved et al. (2017)
What did Nina Morkved find
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.
What is one strength for the evidence of dopamine
Support for the idea that dopamine is involved in
What do Amphetamines do and who discovered this
They increase DA and worsen symptoms in people with schizophrenia and induce symptoms in people without Curran et al. (2004)
What do antipsychotic drugs do and who discovered this
They reduce DA activity and therefore the intensity of symptoms Tauscher et al. (2014)
What can sometimes act on the production of DA or DA receptors
What does this suggest
Candidate genes
That dopamine is involved in the symptoms of schizophrenia
What is a limitation of the dopamine hypothesis
The evidence for a central role of glutamate.
How did they find the role of glutamate in schizophrenia
What is it
Who studied this
Post-mortem and live scanning have consistently found raised levels of the neurotransmitter in serveral brain regions
McCutcheon et al. (2020)
What is the link between schizophrenia genes and glutamate
Several candidate genes for schizophrenia are believed to be involved in glutamate production or processing.
Name the biological explanations for schizophrenia
The genetic basis
Neural correlates
Name the psychological explanations for schizophrenia
Family dysfunction
Cognitive explanations
What is family dysfunctions
How does it link to schizophrenia
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
What type of explanation is the schizophrenogenic mother
Psychodynamic
What is the schizophrenogenic mother
A cold, rejecting and controlling mother who tends to create a family climate characterised by tension and secrecy.
Who coined the schizophrenogenic mother
Where did it come from
Frieda Fromm-Reichmann (1948)
It was based on the accounts she heard from her patients about their childhoods.
What does the schizophrenogenic mother lead to in the child
Leads to distrust that later develops into paranoid delusions.
Who came up with the double-blind theory
Gregory Bateson et al. (1972)
What does the double-blind theory emphasise
What did Gregory make clear about his findings
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
Explain the double-blind theory
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
What symptoms reflect the double blind theory
Disorganised thinking and paranoid delusions
What theory’s fall under family dysfunction
The schizophrenogenic mother
The double-blind theory
Expressed emotion
What is Expressed emotion (EE)
The level of emotion, in particular negative emotion, expressed towards a person with schizophrenia by their carers who are often family members.
What are the 3 elements of EE
- Verbal criticism of the person, occasionally accompanied by violence
- Hostility towards the person, including anger and rejection
- Emotional overinvolvement in the life of the person, including needless self-sacrifice
What do these high levels of expressed emotion cause
Stress
What 2 impacts can EE have on a person
Cause a relapse in people with schizophrenia
Can trigger an onset of schizophrenia
What are the 3 cognitive explanations
Dysfunctional thinking
Metarepresentation dysfunction
Central Control dysfunction
What is cognitive explanations
Explanations that focus on mental processes such as thinking, attention and language
What is dysfunctional thought processing
Information processing that does not represent reality accurately and produces undesirable consequences
Reduced thought processing in the ___ is associated with negative symptoms
Reduced processing of information in the ___ and ___ is associated with hallucinations
Who stated this
Ventral striatum
Temporal and cingulate gyri
Simon et al. (2015)
what does lower than usual levels of information processing suggest
That cognition is likely to be impaired
Who discovered two types of dysfunctional thinking and what are they
Christopher Frith et al. (1992)
Metarepresentation dysfunction
Central control dysfunction
What is Metarepresentation dysfunction
The cognitive ability to reflect on thoughts and behaviour
What would dysfunction in Metarepresentation cause and what does it explain in schizophrenia
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)
What is central control dysfunction
The cognitive ability to suppress automatic responses while we perform deliberate actions
How is central control dysfunction expressed as a symptom
Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts
What is one strength of the family dysfunction theory
Evidence linking it to schizophrenia
What are the studies that support family dysfunctions link to schizophrenia
John Read et al. (2005)
Morkved et al (2017)
Explain John reads findings for family dysfunction
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.
What were Morkveds findings
Most has at least one childhood trauma, mostly abuse
What is one limitation of family explanations
The poor evidence base for any explanations
What two theories have almost no supporting evidence
What do these two theories fall under
Schizophrenogenic mother
Double blind
The importance of traditional family-based theories
What are the schizophrenogenic mother and double blind theory based on
What type of assessment is this and what do they lack
Both based on clinical observations
Informal assessment
No systematic evidence
What is a strength of cognitive explanations
Evidence for dysfunctional thought processing
Who’s research provides strong evidence for the cognitive explanations of dysfunctional thought processing
John Stirling et al (2006)
What was John Sterlings method when investigating cognitive explanations
Outline one task
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.
What was John Sterlings findings
People with schizophrenia took over twice as long on average to name the font-colours
What is a limitation of cognitive explanations
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.
Give two examples of possible distal explanations
Genetic
Family dysfunction
What is currently unclear and not addressed with genetic variation or childhood trauma
How they might lead to problems with Metarepresentation or central control
What is biological therapy for schizophrenia
Name the two types of antipsychotics
Drug therapy
Typical and atypical
What is the most common treatment for schizophrenia
Antipsychotic drugs.
What does a person with psychosis experience
Some loss of contact with reality, through hallucinations or delusions
What is the defining characteristic of schizophrenia
Psychosis
Do you take antipsychotics or life?
Can either be a short course then stop use without return of symptoms
Can be for life and without recurrence can occur
How can typical antipsychotics be taken
Tablets, syrup or by injection
If taken orally what is the maximum dose for typical antipsychotics
What is the usual case
1000mg
Initially doses are smaller and gradually increased to a max of 400-800mg
What are typical antipsychotics
Example
First generation of drugs
Chlorpromazine
What are atypical antipsychotics
Example
New generation of antipsychotics they typically target a range of neurotransmitters such as dopamine and serotonin.
Risperidone
There is a strong association between the use of typical antipsychotics and _____
The dopamine hypothesis
How does chlorpromazine work?
Acts as an antagonist in the dopamine system, reducing the action of neurotransmitters.
It blocks the dopamine receptors in the synapses of the brain
What happens when a patient first takes chlorpromazine
The dopamine levels build up
As well as its antipsychotic properties chlorpromazine is also an effective ___
This is expected to be because of ___
Is this fully understood?
Sedative
Its effect on histamine receptors
No
What form of Chlorpromazine is given when used as a sedative and why
Syrup as it is absorbed faster
What are the two atypical antipsychotics
Clozapine
Risperidone
When was clozapine developed and trialed
1960s
1970s
What happened to clozapine in the 1970s
Why
It was withdrawn
Due to deaths from a blood condition (agranulocytosis)
What happened to clozapine in the 1980s
Why?
It was remarketed as a treatment to be used when others failed
It was discovered to be more effective than typical antipsychotics
What do people taking clozapine have to do
Have their blood tested regularly
How is clozapine not given
What is the typical dose
As an injection
300-450 mg daily
What percentage if people with schizophrenia attempt suicide
30-50%
Why is clozapine more effective
What else does it help with
It acts on serotonin and glutamate receptors
Improves mood and reduces depression and anxiety in patients
When was Risperidone developed
1990s
Why was Risperidone developed
An attempt to produce a drug as effective as clozapine but without serious side effects
How can Risperidone be taken
Injection, syrup or tablets
How long does an injection of Risperidone last
Around two weeks
How is Risperidone administered
what is typical daily dose
What is max dose
Small does then build up
Typical dose is 4-8mg
12 mg
What receptors is Risperidone believed to bind to
What is some positive evidence
Serotonin and dopamine
More effective in smaller doses
Evidence suggests there are fewer side effects
What two studies support the effectiveness of antipsychotics
Ben Thornley et al. (2003)
Herbert Meltzer (2012)
What did Ben Thornley do (antipsychotics)
Reviewed studies comparing the effects of chlorpromazine to control conditions
What was ben Thornley findings (antipsychotics)
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.
What did Herbert meltzer find? (Antipsychotics)
Fact
Concluded that clozapine is more effective than all other antipsychotics.
It is effective in 30-50% of cases where typical antipsychotics have failed.
Who suggested flaws with evidence for antipsychotic evidence
David Healy (2012)
What are David Healys suggested flaws with evidence for effectiveness of antipsychotics
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.
List the less serious typical antipsychotic side effects
Dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin
What can long-term use of typical antipsychotics lead to
Tardive dyskinesia caused by dopamine super sensitivity and causes involuntary facial movements.
What is the most serious side effect of typical antipsychotics - also in atypical antipsychotics
Neuroleptic malignant syndrome (NMS)
What causes NMS
The drug blocking dopamine action in the hypothalamus
What can NMS cause
High temperature, delirium, coma and can be fatal
What are the chances of NMS
Frequency range from less than 0.1% to just over 0.2%
What is a further limitation to typical and some atypical antipsychotics
We dont know why they work
Explain why antipsychotics should not work in some cases
Dopamine levels in some parts of the brain a re too low in schizophrenia patients
What are the two psychological therapy options for someone with schizophrenia
Cognitive behaviour therapy (CBT)
Family therapy
How many sessions is CBT for someone with schizophrenia
Do they happen individually or in groups
5-20
Both
Explain how CBT helps someone with schizophrenia
Can help make sense of how their irrational cognitions impact on their feelings and behaviour.
Understanding where symptoms come from can be helpful.
How can CBT be aimed at helping someone who is hearing voices
Normalisation
By teaching them that voice-hearing is an extension of the ordinary experience of thinking in words.
How can CBT be aimed at helping someone with delusions
Does this always work
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
What is family therapy
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.
Who identified a range of strategies that family therapists use
Fiona Pharoah et al. (2010)
What are two of the stratergies used in family therapy
Reduces negative emotions
Improves the family’s ability to help
How does reducing negative emotions help in family therapy
This reduces the levels of emotions especially the negative.
Reduces stress which is important as it reduces the likelihood of relapse
How does family therapy improve the family’s ability to help
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.
Who proposed a model for working with families dealing with schizophrenia
Frank Burbach (2018)
How does Burbachs model of practice start
Sharing basic information and providing emotional and practical support
What is phase 2 of burbachs model of practice
Identifying resources including what different family members can and cannot offer.
What is phase 3 of burbachs model of practice
Aims to encourage mutual understanding, creating a safe space for all family members to express their feelings.
What is phase 4 of burbachs model of practice
Identifying unhelpful patterns of interaction
What is phase 5 of burbachs model of practice
Skills training such as learning stress management techniques
What is phase 6 burbachs model of practice
Looks at relapse prevention planning
Phase 7 burbachs model of practice
Maintenance for the future
What is one strength of CBT for schizophrenia
The evidence for its effectiveness
What two studies support CBT for schizophrenia
Sameer Jauhar et al. (2014)
Maria Pontillo et al. (2016)
What was Sameer Jauhar’s method and findings on evidence for effectiveness with CBT and schizophrenia
Reviewed 34 studies
Concluded that there is clear evidence for small but significant effects on both positive and negative symptoms
What was Maria Pontillos findings
Found reductions in frequency and severity of auditory hallucinations.
What organisation recommends CBT for schizophrenia
Clinical advice from NICE.
What is one limitation of CBT for schizophrenia
Quality of evidence
The wide range of techniques and symptoms included in studies
What case study highlights the lack in quality of evidence for CBT on schizophrenia
Neil Thomas (2015)
What did Neil Thomas point out on CBT and schizophrenia
Different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms.
Why is it hard to say how effective CBT will be for a particular person with schizophrenia
Modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms.
Can CBT actually cure an individual of schizophrenia
No it can only improve the quality of life
What is a strength of family therapy for schizophrenia
Evidence of its effectiveness
Who reviewed studies on evidence of effectiveness for family therapy and schizophrenia
William McFarlane (2016)
What did William McFarlane find on evidence of effectiveness for family therapy and schizophrenia
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.
What organisation also recommends family therapy
NICE
What is another strength of family therapy for schizophrenia
It benefits all the family
Who reviewed evidence for benefits to whole family
Fiona lobban and Christine Barrowclough (2016)
What did Fiona Lobban and Christine Barrowclough find on benefits to the whole family for family therapy
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.
What are token economies
A form of behavioural modification where desirable behaviours are encouraged by the use of selective reinforcement
Explain token economy through an example
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.
Who carried out the classic demonstration of a token economy
Teodoro Ayllon and Nathan Azrin (1968)
Where did Ayllon and Azrin test token economies?
A ward of women with diagnosed schizophrenia
What did Ayllon and Azrin do to test token economy
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.
What happened when Allyon and Azrin first implemented their token economy
The number of tasks carried out increased significantly
What has happened to the usage of token economies
Why
Declined
Due to increased community-based care and the closure of psychiatric hospitals due to ethical issues being raised.
When were token economies used the most and why
60s and 70s
The norm for treating schizophrenia was long-term hospitalisation
When does institutionalisation develop
Under circumstances of prolonged hospitalisation
What is one outcome of institutionalisation
Why does it happen
People often develop bad habits - cease to maintain good hygiene or stop socialising with others.
Living without routine and small pleasures
Who identified 3 categories of institutional behaviour tackled by token economies
Johnny Matson et al (2016)
What are the 3 categories of institutional behaviour tackled by token economies
Personal care
Condition-related behaviours
Social behaviour
What are the two major benefits of modifying institutional behaviour
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
Why is it important to know the individual before implementing a token economy
Target behaviours are decided on an individual basis.
Need to know the person to decide the most appropriate target behaviours for them
Who suggested individual target behaviours
Copper et al. (2007)
Why are the tokens used and the individual isnt just given the main rewards
You need an immediate reward for target behaviour - delayed rewards are less effective.
What are token economies an example of
What type of conditioning is it
Behaviour modification
Operant conditioning
Why are tokens called secondary reinforces
They only have meaning once an individual finds out they can swap them for the primary
When secondary reinforcers can be used for many different primary reinforcers what are they called
Generalised reinforcers
Name one strength of token economies
Their evidence for their effectiveness
What study provides evidence of the effectiveness of token economies
Krista Glowacki et al (2016)
What did Glowacki do
(Dates)
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.
What did Glowacki find in the studies - token economy
All studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours.
What is a counterpoint for Glowacki’s findings
What key word problem can this lead to
7 studies is quite a small evidence base to support the effectiveness of a technique.
The file drawer problem
What is the file drawer problem
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.
Name the three limitations to token economies
Ethical issues
Existence of more pleasant and ethical alternatives
Hard to adjust to community life
What are the ethical issues with token economies
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.
What is an alternative approach to token economies
Art therapy
Who completed a review on art therapy
Mathew Chiang et al (2019)
What did Mathew Chiang conclude (art therapy)
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
The big positives of art therapy
No major risk of side effects or ethical abuse
What other organisation recommends art therapy for people with schizophrenia
NICE
What is the interactionist approach
What is it also called
An approach that acknowledges that there are biological, psychological and social factors in the development of schizophrenia.
The biosocial approach
What 3 factors are involved in the development of schizophrenia
What is this approach called
Biological, psychological and social
Interactionist approach
What are the biological factors involved with schizophrenia
Genetic vulnerability
Neurochemical and neurological abnormality
What are the psychological factors for schizophrenia
Stress
Resulting from life events and daily hassles
What are the social factors for schizophrenia
Poor quality interactions in the family
What type of approach is the diathesis-stress model
Explain the diathesis-stress model
An interactionist approach to explaining behaviour
A model that states both an underlying vulnerability and stress-trigger are necessary to develop schizophrenia
What does the diathesis-stress model suggest is the trigger
Stress
Who made the original diathesis-stress model
Meehl (1962)
Explain Meehl’s model
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
Who studies have helped the modern understanding of diathesis
Ripke et al. (2014)
Ingram and Luxton (2005)
John Read et al. (2001)
Explain Ripke findings in terms of aiding modern diathesis
Proved that many genes each appear to increase genetic vulnerability only slightly.
There is not a single schizogene
Explain Ingram and Luxton statement in terms of modern diathesis
There are a range of factors beyond the genetic, including psychological trauma
So trauma becomes the diathesis rather than the stressor
Explain John Read’s proposal on modern diathesis
What is it called
Give an example
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.
What studies provide a modern understanding of stress
Houston et al. (2008)
What does Houston state about the modern understanding of stress
It is anything that risks triggering schizophrenia
What has recent research shown as a risk factor for a schizophrenic episode
Cannabis
Explain cannabis in the diathesis-stress model
Cannabis is a stressor as it increases the risk of schizophrenia
How much does cannabis increase the chance of schizophrenia
Increases the risk by up to 7 times according to dose
Why might cannabis lead to schizophrenia
What is the counterargument
Counterargument again
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
What does the interactionist model suggest about the best treatment method
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)
Who made a statement on treatment according to the interactionist model
Douglas Turkington et al. (2006)
What did Turkington state about treatment according to the interactionist model
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.
What is the difference between the US and UK approaches to treating schizophrenia
Medication without an accompanying psychological treatment is more common in the US.
What is one strength of the interactionist approach
Evidence supporting the role of both vulnerability and triggers
What study provides evidence for vulnerability and triggers in the interactionist approach
Pekka Tienari et al (2004)
What did Tienari investigate for support for vulnerability and triggers
Who did it study
What was the test / comparison made
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)
What was Tienari’s findings for support for vulnerability and triggers
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
What is one limitation of the original diathesis-stress model
Oversimplicity
It portrayed diathesis as a single schizogene and stress as schizophrenogenic parenting.
What study shows that stress should not be limited to dysfunctional parenting
James Houston et al. (2008)
What can diathesis and stress also be influences by
Diathesis can also be influenced by psychological factors
Stress can be biological as well as psychological
What was James Houston’s findings
Childhood sexual abuse emerged as the major influence underlying vulnerability to schizophrenia and cannabis use as the major trigger
How many factors affect diathesis and stress
What type of factors
What does this support
Many factors
Both biological and psychological
Understanding of both diathesis and stress
What is a further strength of the interactionist approach besides evidence supporting
The combination of biological and psychological treatment
A real-world application
Who conducted a study showing the effectiveness of combined treatment for schizophrenia
Nicholas Tarrier et al. (2004)
What was Nicholas Tarrier’s method in investigating the effectiveness of combined treatment
Number of participants
Randomly allocated 315 participants to either group:
1. Medication + CBT
2. Medication + counselling
3. Control group - medication only
What was Tarrier’s results when investigating the effectiveness of combining biological and psychological treatments
Counterargument
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.
Who’s study pointed out treatment-causation fallacy
Matt Jarvis and Paul Okami (2019)
Explain the treatment-causation fallacy via an example
What does this mean about interactionist explanations
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
Why might family therapy be preferred to CBT
Economic benefits as it reduces relapse rates
Why is schizophrenia more commonly diagnosed in urban than rural areas
How might it justify the interactionist approach
It assumes that urban living is more stressful than rural and therefore city living acts as a trigger
What is the counterargument for urban living triggering stress for the interactionist approach
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.
