Schizophrenia

Question 1

Gottesman

Answer 1

genetic basis of SZ
large scale family study - someone with an aunt with SZ has a 2% chance of developing it, increasing to 9% if the individual is a sibling and 48% if they’re an identical twin

Question 2

Ripke

Answer 2

candidates genes- genetic basis
combined all previous data from genome wide studies of SZ- genetic makeup of 37,000 people with a diagnosis of SZ was compared to that of 113,000 controls, 108 separate genetic variations were associated with slightly increased risk of SZ
suggests SZ is aetiologically heterogenous

Question 3

brown

Answer 3

the role of mutation- genetic basis
positive correlations between paternal age (associated with increased risk of sperm mutation) and risk of SZ increasing from around 0.7% with fathers under 25 and over 2% in fathers over 50

Question 4

Tienari

Answer 4

+research support for fam studies
show that biological children of parents with SZ are at a heightened risk even if they grow up in an adoptive family

Question 5

Hilker

Answer 5

+research support for fam studies
Showed a concordance rate of 33% for identical twins and 7% for not identical

-NOT 100%!

Question 6

Environmental factors - limitation of genetic basis

Answer 6

Birth complications - Morgan
smoking THC rich cannabis in teenage years - Di Forte
Psychological risks include childhood trauma which leaves people more vulnerable to adult mental health problems in general, but now evidence for a particular link with SZ - Morkved found that 67% of people with SZ and related psychotic disorders, reported at least one childhood trauma

Question 7

Fromm reichman

Answer 7

psychodynamic explanation for SZ based on accounts she heard from her patients about their childhood - schizophregenic mother
-cold, rejecting and controlling - created a family climate characterised by tension and secrecy - leading to distrust that develops into paranoid delusions and ultimately, SZ

Question 8

Bateson

Answer 8

double blind theory- child finds themselves trapped in situations where they deae they are doing the wrong thing, but receive mixed messages on what this is, and feel unable to comment on the unfairness of this situation or seek clarification. When they get it wrong, the child is punished by withdrawal of love - leaving them with a confused and dangerous view of the world - reflected in paranoid delusions

Question 9

Simon

Answer 9

dysfunctional thinking - cognitive explanation
-sz is characterised by disruption to normal thought processing - reduced thought processing in the ventral striatum, is associated with negative symptoms, whilst reduced processing of info in the temporal and cingulate gyri is associated with hallucinations

Question 10

Frith

Answer 10

identified two kinds of dysfunctional thought processes - metarepresentation -the cognitive ability to reflect on thoughts and behaviours- allowing insight into our own intentions and goals and the actions of others
dysfunction in metarepresentation would disrupt out ability yo recognise our own actions and thoughts as being carried out by ourselves rather than someone else (explaining hallucinations and delusions)
-central control dysfunction - issues with the cognitive ability to suppress automatic responses while we perform deliberate actions
-speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts - derailment of thoughts

Question 11

Read

Answer 11

+research support of family dysfunction - as shown by insecure attachment and exposure to childhood trauma, especially abuse
-according to a review by Read, adults with SZ are disproportionately likely to have an insecure attachment, particularly type C or D. Also reported 69% of women and 59% of men with SZ have a history of physical and/ or sexual abuse

-also use Morkved

Question 12

Stirling

Answer 12

+research support of cognitive explanations
compared performance on a range of cognitive tasks in 30 people with SZ and a control group of 30 without
Tass included the stroop task, where participants have to name the font-colours of colour-words, and suppress the tendency to read words aloud
people with SZ took over twice as long on average

Question 13

Thornley

Answer 13

+evidence of effectiveness in biological treatments
reviewed studies comparing the effects of chlorpromazine to control conditions
data from 13 trials showed that chlorpromazine was associated with better overall functioning and reduced symptom severity as compared to placebo

Question 14

Meltzer

Answer 14

+research supporting benefits of atypical antipsychotics
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

Question 15

Healy

Answer 15

-counters effectiveness of antipsychotics (Thornley and Meltzer)
-as most studies are of short-term effects and some successful trials have had their data published multiple times, exaggerating the size of the evidence base for positive effects
Also, the drugs usually have calming effects, meaning it is easy to demonstrate that they have some positive effects, but not that they reduce the severity of psychosis

Question 16

Pharoah

Answer 16

Family therapy -
reduces negative emotions - reduce levels of emotion generally but especially negative emotions such as anger and guilt which create stress - reducing stress is important to reduce the likelihood of relapse
improves family ability to help - therapist encourages family members to form a therapeutic alliance whereby they all agree on the aims of the study and the therapist tries to improve families beliefs about and behaviour towards SZ- additionally, an aim is to ensure that the family members achieve a balance between caring for the individual with SZ and maintaining their own lives

Question 17

Burbach

Answer 17

Family therapy
proposed a model for working with families dealing with SZ - begins with sharing basic information and providing emotional and practical support
then it develops through progressively deeper levels
phase 2 involved 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 interactions
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 18

Jauhar

Answer 18

+evidence of effectiveness in CBT
reviewed 34 studies using CBT with SZ, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms

Question 19

Pontillo

Answer 19

(used with Juahar)
-found reductions in frequency and severity of hallucinations from CBT
along with clinical advice from NICE - recommends CBT for SZ

Question 20

Thomas

Answer 20

-limitation of CBT for SZ
-wide range of techniques and symptoms included in the studies
-points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms
-hard to say how effective CBT will be for a particular person with SZ

Question 21

McFarlane

Answer 21

+evidence of effectiveness on family therapy
concluded that family therapy was one of the most consistently effective treatments available for SZ
-in particular relapse rates were found to be reduced by 50-60%
NICE clinical advice- also recommends family therapy for everyone with diagnosis of SZ

Question 22

Barrowclough

Answer 22

+support of fam therapy
Benefits whole family
-concluded that these effects are important because families provide the bulk of care for people with SZ- by strengthening the functioning of a whole family, family therapy lessens the negative impact of SZ on other family members and the families ability support the person w SZ
-family therapy has wider ebendits beyond the obvious positive impact on the identified patient

Question 23

Ayllon abd Azrin

Answer 23

Trialled a token economy system in a ward of women with SZ - every time the ppts 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, such as being able to watch a film
the number of tasks carried out increased signifactiantly
-token economies used extensively in 60s and 70s when the norm for treating SZ was long term hospitalisation - use has now declined in UK partly because of the growth of community-based care and closure of many psychiatric hospitals - and ethical issues

Question 24

Matson

Answer 24

identified 3 categories of institutional behaviour commonly tackled by means of token economy - personal care, condition-related behaviours (eg apathy) and social behaviour
-these bring 2 major benefits
1. improves persons quality if life within hospital setting
2.’normalises’ behaviour and makes it easier for people who have spent a long time in a hospital to adapt back into life in the community

Question 25

Glowaki

Answer 25

+evidence of effectiveness for token economies
-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 SZ and involved patient living in hospital settings
-all studies showed a reduction in negative symptoms and decline in frequency of unwanted behaviours

-however small scale -file drawer problem- bias

Question 26

Chiang

Answer 26

-alternative approaches - more pleasant and ethical
-review concluded that art therapy might be a better alternative as a high gain low risk approach to managing SZ

Question 27

Tienari

Answer 27

+support for vulnerability and triggers
-large scale study investigated the impact of both genetic vulnerability and psychological trigger (dysfunctional parenting) - study followed 19,000 Finnish children whose biological mothers had been diagnosed with SZ
-in adulthood this high genetic risk group were compared to a control group of adopted without family history of SZZ (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 SZ- but only in high genetic risk group

Question 28

Houston

Answer 28

-diathesis model as too simplistic
-multiple gene combinations and stress, and psychological factors can have impact
-showed that childhood sexual abuse emerged as the major influence on underlying vulnerability to SZ and cannabis use as the major influence

Question 29

Tarrier

Answer 29

+real world application of interactionist approach to SZ - use of biological and psychological treatments
-studies show that combining treatments enhances effectiveness
-randomly allocated 315 ppts to (1) medication + CBT (2) medication + counselling or (3) control (medication only)
-ppts in combination groups showed lower symptoms following the trial than medication only group

Question 31

cheniaux

Answer 31

low validity of diagnosis
-had 2 psychiatrists independently assess the same 100 clients using ICD-10 and DSM-5 criteria and found that 68 were diagnosed with SZ under the ICD system and 39 under DSM

Question 31

Osorio

Answer 31

+good reliability for diagnosis
-reported high reliability for the diagnosis of SZ in 180 individuals using the DSM-5
-pairs of interviews achieved inter rater reliability of +.97 test retest reliability +.92

Question 32

Cotton

Answer 32

-gender bias in diagnosis
found that women are under diagnosed because they have closer relationships and get support
or women are less vulnerable due to genetic factors

Question 33

Pinto and Jones

Answer 33

-culture bias in diagnosis
-hearing voices Haiti
found that British people of African Caribbean origin are p to 9 times as likely to receive a diagnosis as white people

Question 34

Curran and Tauscher

Answer 34

+evidence for dopamine in neural correlates in schizophrenia
-Amphetamunes increase DA and worsen symptoms in people with SZ and induce symptoms in those without
And antipsychotic dugs redice DA activity and also reduce the intensity of symptoms

Question 35

Mccutcheon

Answer 35

-glutamate - limitation of dopamine hypothesis
post mortem and live scanning studies have consistently found a raised level of glutamate in serveral regions of the brain for people with SZ