Schizophrenia Flashcards

Question

AO1 Dopamine hypothesis

Answer 1

-People with schizophrenia have high levels of dopamine in the mesolimbic pathway -Overactivity in the mesolimbic system causes the positive symptoms of schizophrenia -People with schizophrenia have lower levels of dopamine in the frontal cortex than usual -Underactivity in frontal cortex causes negative symptoms

Answer 2

Antagonistic ----> Reduce dopamine activity (Chlorpromazine)

Answer 3

Agonistic drugs ----> Increase dopamine activity (Risperidone)

Answer 4

Noll looked at studies in which Sz patients were given drugs which reduce levels of dopamine A review by Noll found that in 1/3 of patients, dopamine-reducing drugs did not prevent positive symptoms of schizophrenia. This is a limitation of the dopamine hypothesis.

Answer 5

One limitation of the dopamine hypothesis as an explanation for Sz is that there is contrary evidence from Noll et al. For example, Noll conducted a meta analysis of studies in which patients were given drugs which reduce dopamine levels. For 1/3 of patients, drugs which decreased levels of dopamine didn't stop positive symptoms such as hallucinations and delusions from being experienced by the patients. These findings indicate that high levels of dopamine are not the only cause of positive symptoms. This is a weakness because Noll's research indicates that there may be other factors influencing the development of Sz e.g. abnormal brain structure or family dysfunction, which aren't taken into account by the dopamine hypothesis. Therefore this weakens acceptance of the dopamine hypothesis as an explanation for Sz.

Answer 6

-Work by acting upon serotonin receptors as well as dopamine production systems and affect negative symptoms e.g. avolition -Side effects include weight gain and CVD -E.g. Chlorprozamine - It acts on multiple receptors

Answer 7

Atypical antipsychotics bind to dopamine receptors for a shorter period of time than typical antipsychotics. By allowing dopamine to still bind to the receptors from time-to-time, people who take atypical antipsychotics typically experience less side effects, because there is less disruption to dopamine activity in all areas of the brain

Answer 8

+ Patients prescribed with antipsychotics show improvements in comparison with patients who took a placebo. This shows that antipsychotics are effective in treating schizophrenia and that they are targeting the dopamine system -Patients prescribed antipsychotic drugs or antipsychotics + CBT. Those who took drugs + CBT showed better improvements in their symptoms in comparison to those who took drugs only. Suggests and interactionist approach may better treat schizophrenia

Answer 9

One weakness of antipsychotics as a treatment for Sz is that they produce unwanted side effects For example, these side effects can include extrapyramidal symptoms where patients lose control over movement (i.e. stiff, jerky movements) and cause excess problems like obesity and diabetes as antipsychotic drugs don't just influence the brain and spinal cord, but rather the whole body. This means antipsychotic drugs may reduce levels of dopamine where there isn't an imbalance, this causes unwanted side effects like low levels of dopamine in the motor cortex leads to stiff jerky movements Therefore these unwanted side effects from the antipsychotics reduce use of them as a treatment for Sz

Answer 10

One weakness of this treatment is that it fails to treat negative symptoms. For example, antipsychotics work by preventing dopamine from binding to receptors on the post synaptic neuron to prevent overactivity in the mesolimbic system. However, according to the dopamine hypothesis, negative symptoms such as avolition and speech poverty are not caused by overactivity in the mesolimbic system, rather they are caused by low levels of dopamine in the frontal cortex. Antipsychotic drugs dont increase the levels of dopamine in the frontal cortex, but decrease dopamine across the whole brain, meaning they dont treat the negative symptoms of Sz. This suggests that someone with negative symptoms wont be cured if they take antipsychotic medication, therefore indicating this treatment is not as effective as once thought, thus decreasing the use of antipsychotic drugs to treat Sz

Answer 11

One weakness of using drugs to treat Sz is that they don't actually cure the root cause of Sz. For example, antipsychotics have high relapse rates with up to 40% in the first year and then 15% in later years due to patients stopping their course of drugs because of the side effects and the impacts it has on quality of life. This is a weakness as it implies that drugs may not actually cure the root cause of Sz, rather just mask the symptoms in the short term by balancing levels of neurotransmitters. This indicates that other treatments such as CBT may be better at treating Sz, thus weakening acceptance of drug therapy as a treatment for Sz

Answer 12

A psychodynamic theory that suggests people with Sz get their paranoid delusions as a result of influence of a cold, rejecting and controlling mother The mother creates an atmosphere of stress, tension and secrecy in the family. This atmosphere triggers psychotic thinking

Answer 13

Children receive mixed and contradictory messages from their parents and this influences the onset of Sz

Answer 14

-A family communication style that involves criticism, hostility and emotional over involvement -Exaggerated involvement : Indicating the sufferer is a burden via self sacrifice 'I do so much for you it is hard for me' -Criticism and control of the individuals behaviour 'You dont know how to do anything, you need to listen to me' -Hostility towards parent, show anger and resentment

Answer 15

-Sz is associated with dysfunctional thought processing -Firth et al identified two types of dysfunctional processing: Meta representation and central control Central control: -Healthy individuals have the ability to supress automatic function. Patients have difficulty resisting automatic triggers -Disorganised speech ---> Inability to suppress automatic thoughts and speech triggered by their thoughts Meta representation: -In healthy individuals, they are able to reflect on thoughts and behaviour -Allows us insight into our own intentions and goals -In patients, failure to recognise actions and thoughts as being our own, Auditory hallucinations and thought insertions

Answer 16

-Sz patients get easily distracted and tend to over focus their attention on irrelevant details -Overall, patients display dysfunctional reasoning -This causes the patient to develop symptoms of Sz

Answer 17

-Jumping to conclusions bias: Make irrational assumptions based on very little evidence -Persecution bias: People believe that others are singling them out Can lead to delusions as dysfunctional attention causes them to over-focus on small irrelevant events. The patient's dysfunctional reasoning makes their explanation irrational, causing a delusional belief. Can lead to hallucinations as due to dysfunctional attention, people with Sz overfocus on things they imagine. Overfocusing on imagined events causes them to feel real. People with Sz struggle to tell the difference between things that they imagine and things that have actually happened.

Answer 18

-Patients start to become overwhelmed by their abnormal experiences, hallucinations or delusions -Patients want to avoid their abnormal experiences, hallucinations or delusions -Patients isolate themselves from the outside world.

Answer 19

Reviewed all the studies which examined the mental processes of people with Sz. E.g. Attention Found that dysfunctional mental processes occurred in 75% of patients. These included; abnormal attention processes, impaired working memory, lower IQ and impaired reasoning O'Carroll also found that people at risk of developing Sz, who went onto display Sz, also displayed dysfunctional mental processes Since the dysfunctional mental processes existed before the participants displayed symptoms, this suggests that there may be a cause and effect relationship.

Answer 20

One strength of this explanation is that their is research from Tienari et al who studied biological children of schizophrenic mothers who had been adopted. 5.8% of those adopted into psychologically healthy families developed Sz compared to 36.8% of children raised in dysfunctional families. This suggests that those raised in dysfunctional families are more likely to develop Sz than those raised in functional families, with the same genetic predisposition, which is what coincides with the theory thus strengthening our acceptance of it

Answer 21

Read et al reviewed 46 studies of child abuse and schizophrenia and found that 69% of adult women in-patients with Sz have a history of physical or sexual abuse in childhood. For men this was 59%. This suggests that early child hood traumatic experiences in a dysfunctional family led these patients to develop Sz, which is what coincides with the theory of family dysfunction. Counter However, for most studies where information about childhood experiences was gathered after the development of symptoms . The patients may be relying on inaccurate memories or they could have distorted the recall due to social desirability purposes

Answer 22

One strength of Double bind theory is that there is supporting research from Berger et al. For example, he found that Sz patients were able to recall significantly more double binds compared to non-Sz individuals. This is a strength as it suggests that double bind theory can be seen in real life to impact the development of Sz. Therefore this supporting research strengthens acceptance of the double bind theory, and family dysfunction as a whole, as an explanation for Sz HOWEVER, this research maybe invalid as Berger used a self report method by using interviews. This is a problem as self report methods often lack objectivity and can be inaccurate due to reconstructive memory and social desirability bias. Furthermore, If the interviewer asks a leading question, a participant would be responding to demand characteristics in the study, caused by investigator effects. Therefore this weakens acceptance of Berger's supporting research as it used non-scientific and unreliable methods to collect data

Answer 23

One strength of this explanation is that there is supporting research for high expressed emotions from Vaughn et al. For example, using the observational technique, he found that after leaving the hospital and being treated for Sz, Schizophrenics with families displaying high expressed emotion, were more likely to relapse into severe symptoms of Sz. This is a strength as it indicates that families in which there is high expressed emotion, schizophrenics are more likely to relapse into Sz, which is what coincides with the theory, thus strengthening acceptance of expressed emotion, and family dysfunction as a whole However, there is opposing research from Altofer et al. He found that not all families who displayed high levels of expressed emotion had children who developed schizophrenia. This suggests that expressed emotion may increase chances of developing Sz, rather than directly causing it, like these explanations suggest

Answer 24

Research linking family dysfunction and Sz can pose a moral dilemma. It can lead to parent blaming and adds insults to injury for the parents who are having to watch their child experience symptoms of Sz

Answer 25

One strength of the cognitive explanations of Sz is that they are supported by research from Stirling He compared 30 Sz patients with 18 controls on a range of cognitive tasks one of which included the Stroop test. This tests their ability to suppress words as patients name the colours of the words rather than the word itself. Patients with Sz took over twice as long as the control group to name the colours of the words. In psychologically healthy patients, they should be able to suppress the automatic function and recall the colour of the word. This provides real world evidence that , which coincides with what the theory of central control says, therefore strengthening our acceptance of it

Answer 26

One major issue with cog explanations of Sz such as dysfunctional thought processing is that it does not tell us anything about the origins of abnormal cognitions or the condition itself. E.g. The biological explanations of Sz state imbalance of neurotransmitters are responsible for hallucinations and disorganised speech. It could be that dysfunctional thought processes are merely a symptom of Sz rather than the cause itself which further undermines this explanation as it suggests we cant establish cause and effect between Sz and the symptoms This weakness our acceptance of these explanations as they are lacking in detail

Answer 27

If dysfunctional cognition can better characterise Sz this presents to us real world applications as we can look to construct a specific cognition deficit profile to help with the diagnosis of the disorder. Kane et al argued that including cognitive impairment within the diagnosis criteria for Sz would help improve the currently poor reliability in diagnosis for Sz. This could then help in creating more targeted treatment with cognitive enhancements being the goal. This strengthens acceptance as it indicates these explanations can be used to positively impact patients with Sz, reducing their symptoms, improving the quality of their life

Answer 28

-Patients are asked to trace back the origins of their symptoms and understand how they started -Helps patient understand where their symptoms come from -The sufferer is thought to recognise their own examples of delusional thinking -CBT challenges the patients interpretation of events, and helps them to change their habit of thinking about things in a pathological way

Answer 29

-Family therapy is a psychological therapy, involving both the families of schizophrenic patients and the patients themselves, which aims to reduce family conflict. -Aims to improve the quality of communication and interaction between family members -Links to double bind theory and Schizophrogenic mother, some therapists see family as root cause -Thus therapists reduce stress that may contribute to risk of patients relapse -3 Stages of family therapy: Educating families Teaching coping strategies Changing communication style

Answer 30

Conducted a review of studies where family therapy was paired with antipsychotics vs studies where antipsychotics were used alone FOUND THAT, compared to the control group, patients given family therapy were more likely to take their medication consistently and were less likely to relapse and go back into hospital. Some studies indicated that family therapy improved general mental health of the patients HOWEVER, some studies showed that family therapy didn't lead to improved mental health and didn't reduce the number of Sz symptoms

Answer 31

-Manage behaviour, especially institutionalised patients which developed maladaptive behaviour -Coloured discs are given to patients when they carry out a desirable behaviour that has been targeted for reinforcement -Tokens can then be swapped for more tangible things e.g. sweets, magazines -Based off the concepts from operant conditioning, as patients are learning through behaviours and their consequences

Answer 32

One weakness is that only 1 in 10 actually get access to this form of therapy. For example, Haddock et al found that of 187 randomly selected schizophrenics, only 13 had been offered CBT and of those who were offered, many failed to attend or refused thus limiting the effectiveness of CBT as it requires a trained professional to deliver the sessions over a number of months making it costly + time consuming. Therefore this reduces use of CBT as a treatment for Sz as it may be the case that this form of therapy is not widely accessible for al schizophrenic patients

Answer 33

Moreover, the effectiveness of CBT depends on the skill level of the therapists themselves, meaning if the therapists has a low skill level, the CBT would be ineffective at reducing symptoms of Sz in a patient, thus weakening acceptance of the use of CBT to treat Sz. Perhaps drugs such as antipsychotics would be more effective as they dont depend on the skill level of a therapist, furthermore, they are cheaper and only need to be taken once, unlike CBT which requires multiple expensive sessions, suggesting drug treatments are a more attractive option than CBT.

Answer 34

One strength of CBT as a treatment of Sz is that there is supporting research from Sensky et al. For example, he found that patients who resisted drug treatments had a reduction in positive and negative symptoms after 19 sessions of CBT. Moreover, they continued to improve even 9 months after the treatment had ended. This indicates that CBT can be effective when drugs are not used, and they are also an improvement on drug therapies as drugs only reduce symptoms in the short run as they dont actually cure the root cause of the disorder, rather they mask the symptoms. Therefore this strengthens acceptance of the use of CBT to treat Sz.

Answer 35

One weakness of the use of CBT as a treatment for Sz is that the research indicates that age may well be a factor which determines the effectiveness of the treatment. For example, CBT may be less effective for older patients compared to younger patients as they may not engage well with this form of therapy. Perhaps it would be easier to treat these patients with drugs as that only requires them to take the drugs, not talk to and engage with a therapist. Therefore this indicates that CBT may not be an effective form of treatment for patients of all ages, unlike drug treatment, thus weakening acceptance of CBT as a treatment for Sz.

Answer 36

One weakness of this treatment is that it puts significant burden on the family members who are ill equipped to cope with the needs of Sz sufferer. Specialist care and intervention may be better suited by staff that better understand the symptoms and problems that are posed by Sz, hence the use of family members as a form of intervention may not be appropriate as this could cause an impact on their lives leading to greater stress as they try to manage another person's problems as well as their own. This indicates there is a methodological problem with this treatment as it may place a greater burden on the family members of the patient who dont have the mental capacity of facilities to deal with such problems which are posed by Sz, thus weakening acceptance of the theory

Answer 37

One strength is that there is support from Leff (1985) who looked at the aftercare of patients with schizophrenia. Of those that were provided with standard outpatient care, 50% had relapsed within 9 months, compared to only 8% who received family therapy. This provides support for the notion that family therapy is effective at reducing symptoms of Sz, thus strengthening acceptance of the use of this treatment for Sz. HOWEVER, after two years this had risen to 50% with family therapy and 75% with standard outpatient care. This suggests that the use of family therapy is helpful in reducing re-admission in the short term, but families may not be able to maintain positive patterns of behaviour over the long term, thus weaking acceptance in the long run.

Answer 38

One weakness is that Token economies dont directly treat symptoms of Sz, rather they only attempt to manage negative symptoms such as poor motivation, poor attention and social withdrawal. This suggests that this therapy may not be effective at treating positive symptoms such as hallucinations and delusions meaning other treatments would be required e.g. Drugs or CBT. Therefore this incomplete nature of token economies reduces use of them to treat Sz.

Answer 39

A second weakness of token economies is that they are not effective with severely unresponsive patients. For example, for those with very strong negative symptoms, this could be seen as a punishment for illness. This is a weakness as it means token economies alone can not be used to effectively treat symptoms of Sz, rather they could worsen the condition of the patient by making them think they are being punished for their problems, decreasing the chances the patient makes a healthy recovery. Therefore this weakens acceptance and use of token economies to treat individuals with Sz.

Answer 40

Lastly, the use of token economies can be considered unethical. For example, the use of Skinnerian principles is argued to be degrading to patients, effectively manipulating them as lab rats. This poses questions over the ethical legitimacy of the methods used by token economies. Hence, this ethical issue reduces acceptance of token economies to help treat Sz as they may use unethical methods to help treat patients.