schizophrenia Flashcards

Question

what is the problem with validity? What is the evidence/case studies to prove this ? What impact does this have on diagnosing ?

Answer 1

Leeds to the differential treatment of males and females based on stereotypes not real differences loring + powell- randomly selected 290 male and female psychiatrist to read two case studies of patient behaviour. Then asked to offer their judgement on individuals using the standard diagnostic criteria- when patients were described as males or no information about gender 56% of psychiatrists gave the diagnosis When patients were described as female, only 20% were given diagnosis This shows pronoun effects whether they are diagnosed which decreases validity "she" - diagnosis missed can't get access to treatment impacts functioning wrongly diagnosed impact on economy "he "- overdiagnosed negative stereotypes e.g. violent Self fulfilling prophecy

Answer 2

Comorbidity is the extent that two or more conditions or diseases occur simultaneously in a patient buckley et al- schizophrenia was also diagnosed with depression 50% of the time substance abuse 47% of the time PTSD 29% of the time Issue different conditions have different treatments - may not know which ones to treat and maybe more complex to treat- costing more money and taking longer

Answer 3

The dopamine hypothesis

Answer 4

claims that an excess of the neurotransmitter dopamine in certain regions is associated with positive symptoms of SZ To have abnormally high numbers of D2 receptors resulting in more dopamine

Answer 5

Amphetamine- dopamine agonist- normal individuals exposed to large doses of dopamine releasing drugs can develop characteristic symptoms of SZ. EG hallucinations and delusions Antipsychotic drugs - dopamine antagonist- block the activity of dopamine in the brain, alleviate symptoms of such as hallucinations and delusions

Answer 6

Davis and kahn- - positive symptoms are caused by an excess of dopamine in subcortical areas of the brain - Negative symptoms of schizophrenia to arise from deficit of dopamine in prefrontal cortex hyperdopaminergia- excess hypodopaminergia- low levels of

Answer 7

PET scans assess dopamine levels in schizophrenic and normal individuals and found lower levels of dopamine in prefrontal cortex of SZ patients

Answer 8

Patterns of structure and function in the brain that correlates with schizophrenic experience

Answer 9

Supporting evidence of successful drug therapy- Found that antipsychotic drugs were significantly more effective than the placebo in the treatment of positive and negative symptoms strength of neural correlates comes from support of influence of Gray matter deficit Patient with SZ - higher reduction in cortical grey matter volume over time

Answer 10

evidence for the dopamine hypothesis has been challenged claims that there is evidence against effectiveness of drugs Antipsychotic drugs do not alleviate hallucinations and illusions in one third of people - these are present despite levels of dopamine being normal Suggest that dopamine may not be the sole cause of positive symptoms maybe other explanations

Answer 11

Tends to run in families but only among individuals who are genetically related The risk of developing the disorder among individuals who have family members with SZ is higher than it is for those who do not No one gene is responsible for this disorder - polygenic condition Gottesman- Large scale family study Found that strong relationship between the degree of genetic similarity and the risk of sz Identical twins 48% Fraternal twins 17% Siblings 9%

Answer 12

It is an interaction approach to explaining behaviour Conditions are explained as a result of both an underlying vulnerability (diathesis) and a trigger

Answer 13

there is support from other twin studies- another study calculated that concordance rates for MZ twins were 40%- and for DZ twins 7%

Answer 14

does not take into account environmental factors SZ may be more to do with child rearing patterns - maybe due to expressed emotion in the family when families communicate in a hostile manner (critical and overconcerned) - siblings are exposed to the same environment so maybe due to family dysfunction rather than genetics Mz twins encounter more similar environments than DZ twins - MZ have a greater environmental similarity because they are more likely to do things together- same school same clothes- suffer from identity confusion Often treated as twins rather than two distinct individuals Concordance rates may reflect nothing more than situational factors

Answer 15

Antipsychotic drugs work by reducing the action of the neurotransmitter dopamine in areas associated with the symptoms of SZ

Answer 16

typical and atypical Typical are the first generation ones

Answer 17

In the 1950s Traditional antipsychotics Prescribed dose has declined

Answer 18

Chlorpromazine- it can be taken as tablets syrup or injection Administered daily initially doses are smaller and gradually to a max of 400 to 800 MG Prescribed doses have declined over the last 50 years

Answer 19

they bind but do not stimulate dopamine receptors thus blocking their action By reducing the action of dopamine it alleviates positive symptoms They have a sedative effect However blocking dopamine receptors can be harmful for the person as negative symptoms may get worse

Answer 20

There are lots of side-effects Loss of muscle movement in face - involuntary movements( tardive dyskinesia) found in 68% of patience and it is irreversible( significant ethical issues as didn't know would end up with an irreversible side-effect) Normally the side effects lead to people stopping taking the drug which leads to relapse so symptoms come back

Answer 21

Issues with informed consent- patience have no perception of reality Treats symptoms not cause -passive- can cause relapse Unclear on how they work - work better alongside therapy interactionist approach Chemical cosh- in hospital situations it is believed that people are to make them easier to work with rather than to make the patient better

Answer 22

Issues with informed consent- patience have no perception of reality Treats symptoms not cause -passive- can cause relapse Unclear on how they work - work better alongside therapy interactionist approach Chemical cosh- in hospital situations it is believed that people are to make them easier to work with rather than to make the patient better

Answer 23

The 1970s To maintain an improve effectiveness of drugs in suppressing symptoms and minimising side effects

Answer 24

clozapine Helps negative symptoms and regulate cognitive function Withdrawn for a while due to the death of some patients Discovered to be more effective than typical Tablet form and lower dose

Answer 25

These drugs temporarily blocked dopamine receptors then rapidly dissociate to allow normal dopamine transmission Also act on other neurotransmitters e.g. serotonin which also addresses negative symptoms

Answer 26

few side effects and typical and less serious so there's a reduced risk Blood condition -people on this drug have to take regular blood tests If it has side-effects people stop taking the drug and it causes relapse

Answer 27

issues with ethical issues no informed consent as they have no perception of reality Treat the symptoms not the cause means that patients don't look at the root Don't know why they work and only work in 75% of cases alongside other therapy Chemical cosh- hospitals may be given drugs to make them easier to work with rather than to make them better human rights abuse

Answer 28

family dysfunction cognitive explanations

Answer 29

abnormal patterns of communication within the family risk factor in the development of sz and relapsing 3 categories- double bind, sz mother, expressed emotion

Answer 30

when an individual receives two or more conflicting message- one contradicts other- one on verbal ( affection) level one on non verbal level ( mother is angry or hostile )

Answer 31

children who frequently receive contradictory messages from parents are more likely to develop sz prevents child from developing a construction of reality so manifests itself as sz- delusions affective flattening- don't know how to show emotions

Answer 32

reichmann- proposed psychodynamic based explanation sz mother is cold, rejecting and controlling and climate is characterised by tensions anxiety and secrecy by contrast father is passive - not involved leads to distrust - paranoid delusions

Answer 33

a family communication style in which members of family talk about patient in •critical or hostile manner verbal criticism •way that indicates emotional over involvement • high levels of EE influence relapse rates • 4x more likely to relapse in high EE

Answer 34

dysfunctional thought processing does not reflect reality evident in those who display delusions

Answer 35

relate irrelevant events to themselves and arrive at false conclusions unable to consider they may be wrong and can not substitute more realistic explanations

Answer 36

metarepresentation- cognitive ability to reflect on behaviour and thoughts metarepresentation dysfunction- disrupts ability to reflect - misunderstand the source of a self generated auditory experience with an external force can't recognise as own thoughts

Answer 37

research support - indicators of family dysfunction include insecure attachment and exposure to childhood trauma - John read- adults with sz are more likely to have insecure attachment - reported that 69% of women and 59% of men with sz have history of physical and or sexual abuse - strongly suggests FD makes more vulnerable to sz HOWEVER- poor evidence base for theories-sz mother and double bind

Answer 38

can be criticised for being retrospective- - evidence high but most of it based on info about childhood experiences gathered after diagnosis - symptoms may have distorted patients recall of child experiences -creates a problem with valadity socially sensitive - -blames the mother for child getting sz mother but not father also shows the traditional view of stay at home mother - research support into the studies needed and useful but socially sensitive - for parents already having to watch child suffer and then take responsibility and blame for causing it- psychological harm

Answer 39

supporting evidence for cog model- -stirling compared 30 patients with sz with 18 control group on cog task (naming ink colour of words) - patients took over 2x as long as control to suppress the impulse of reading word not colour -supports theory of central control dysfunction -shows processing differs - however issues with cause and effect support of the success of cog behaviour therapy and success of family therapy

Answer 40

fault to consider the biological approach- - only looks at one apperoach (reductionist) - if bio are valid, how do they fit with psychological - both bio and psych can seperately product same symptoms - raises question of whether both outcomes are really sz - diathesis stress model

Answer 41

 Cognitive exp = Delusions result from faulty interpretations of events. CBTp is therefore used to help the patient identify and correct/change these faulty interpretations.  CBTp patients are encouraged to trace back the origins of their symptoms to understand how they developed.  Reality testing: patients are encouraged to evaluate their own thoughts/beliefs against real-life to reduce distress.  NICE recommend at least 16 sessions (usually 1-1 but can be delivered in a small group).  CBTp is often used alongside drug therapy.

Answer 42

ABC framework: the patient gives their explanation of the activating events (A) that appear to cause their dysfunctional beliefs (B). The patients beliefs are then Disputed/Challenged for more positive/rational explanations.  Normalisation: Sz is ‘normalised’ to the patient – they are given information that many people have unusual experiences such as hallucinations and delusions under different circumstances (e.g. in situations of extreme stress) this reduces patients anxiety and the sense of isolation. If they feel less alienated and stigmatised, relapse will be more likely.  Critical collaborative analysis The therapist uses gentle questioning to help the patient understand illogical thoughts  Developing alternative explanations The patient develops their own alternative explanations for their previously unhealthy assumptions in cooperation with the therapist.

Answer 43

 Family intervention usually aimed at parents, siblings and partners of Sz sufferer to reduce relapse (due to research into high EE)  Garety et al. (2008): relapse rate for individuals who receive family therapy was 25% compared to 50% for those who receive standard care alone.  Family therapy aims to reduce EE - expressions of anger and guilt.  Provides family members with information about Sz, finding ways of supporting an individual with Sz and resolving practical problems.  Family therapy improves relationships because the therapist encourages family members (including the person with schizophrenia) to listen to each other and work towards solutions.  Typically offered for 3-12months with atleast 10 sessions – also often used in conjunction with drug therapy.

Answer 44

Family therapy uses a number of strategies:  Psychoeducation: educating the Sz patient and family members on the disorder so they can deal with it better - this reduces stress for family members and also reduces the Sz sufferers’ suspicions of their treatment.  Reducing the emotional climate: reducing anger/over involvement in the home and having reasonable expectations of Sz sufferer.  Helping family members achieve a balance between caring for the Sz patient and maintaining their own life.

Answer 45

 A form of behavioural therapy where clinicians set target behaviours that will improve the patients engagement in daily activities.  Tokens are rewarded whenever the patient engaged in one of their target behaviours (e.g. plastic token rewarded for domestic chores = movie)   Ayllon and Azrin (1968) gave Sz patients plastic tokens for behaviours such as carrying out domestic chores. These tokens were then exchanged for privileges such as being able to watch a movie. This procedure was effective in maintaining patients’ adaptive behaviours.

Answer 46

CC: the ‘neutral’ token must be presented alongside (associated with) or immediately before the reinforcing stimulus e.g. treat food or movie. By pairing the neutral token with the reinforcing stimulus the token will eventually acquire the reinforcing principles on its own. OC: Primary reinforcer = gives pleasure/comfort on its own (e.g. food/movie) Secondary reinforcer = initially have no value but acquire their reinforcing principles as they have been paired with the primary reinforcer.

Answer 47

NICE (2014): effectiveness of CBTp when used alongside medication (interactionist approach) at reducing re-hospitalisation -evidence for improvements in social functioning -positive on economy long term less hospitalisation

Answer 48

does CBT actually ‘cure’?? – as SZ appears to be largely biological… CBT may reduce severity of symptoms & enhance coping rather than ‘cure. effectiveness depends on the stage of the disorder (if the patient is suffering from a Sz episode, Hallucinations and delusions – can they engage with the treatment? Are they able to reality test?) - more likely to benefit after stabilisation of symptoms -delusions- won't trust - avolition- no effort -hallucinations- no concept of reality

Answer 49

PharoahFamily therapy improved patients mental state, led to increased compliance with medication and reduced relapse. - leads to improvements to mental state and social functioning due to effectiveness of drugs - less suspicious of family- med compliance economy/cost effective (link to reduced relapse, reduction in hospitalisation costs etc. - extra cost of family therapy is offset by a reduction in cost of relapse positive impact on all family members - - 60% reported a significant positive impact on relatives

Answer 50

issues with Pharoah’s methodology could have compromised their findings (lack of blinding – i.e. raters/researchers knew the therapy the patient received when rating their success.

Answer 51

Dickerson: review of token economy studies reported beneficial effects (i.e. increasing the adaptive behaviours of patients) Useful for reducing negative symptoms in psychiatric wards and hospital settings -13 studies, 11 showed beneficial effects

Answer 52

less useful in a community setting for outpatients (without 24 hour and monitoring the reward system isn’t appropriate). - within a ward staff can monitor but can't on the outside - positive results may not be maintained out of ward Ethical concerns – token economy requires clinicians control to reinforce patients. (Primary reinforcer = food, privacy, activities, does this violate their human rights?)

Answer 53

-considers combined effect of biological/ genetics vulnerability and the environment/ social factors - sees SZ as a result of an interaction between biological and environmental influences - whether or not the person develops SZ from inherited genetic vulnerability is partly determined by amount and level of stresses they experience in their life

Answer 54

- genetic basis and vulnerability - doesnt have to be genetic- could be early psychological that affected brain development - eg child abuse affects HPA system making them vulnerable to stress - polygenic and vulnerability increases the closer related you are to the individual with SZ - identical twins with someone with SZ greater risk than a sibling with it - however half of identical twins never get sz- shows can not be only factor - gottersman study-----

Answer 55

- environmental, social and psychological factors - trigger SZ - family dysfunction- double bind, high EE, sz mother - childhood trauma- those who experienced severe trauma before 16, 3x more likely to develop sz - urbanisation - risk of sz in urban areas 2x higher - cannabis incr risk of sz by up to 7x ( interferes with dopamine system)

Answer 56

EVIDENCE TO SUPPORT - Tienari- investigated the combination of genetic vulnerability and parenting style -found that a child rearing style of high criticism and conflict was associated with the development of sz but only for children with high genetic risk - support for interactionist TOO SIMPLISTIC - oversimplifies the complexities - taking a combined approach makes it difficult to understand how they work together - inability to estabish causation- researchers do not know actual mechanisms involved

Answer 57

- due to acknowledgements of both, both types of treatment - combines antipsychotics with psych therapies -standard practice in uk is to combine - evidence of the effectiveness of family therapy- halves relapse from 50- 25%

Answer 58

PRACTICAL APP TO HEALTH SERVICES - an abundance of research into effectiveness of using both - mental health services adopt multi disciplinary approach- a range of professionals work together to treat HOWEVER - implications on economy- combined costs more TREATMENT CAUSATION FALACY - questions effectiveness of interactionist approach on treatment - just because it works does not mean it was the original cause -eg alcohol reduces shyness but shyness not caused by lack of alcohol - does not provide causation explanation