Schizophrenia Flashcards
What is a psychosis?
A severe mental health problem where the individual loses contact with reality.
What are the 2 types of symptoms in schizophrenia?
Positive
Negative
What are positive symptoms?
Additional experiences beyond those of ordinary existence.
What are negative symptoms?
The loss of usual abilities and experiences.
What are 2 examples of positive symptoms?
Hallucinations
Delusions
What are hallucinations?
Unusual scenery experiences.
Some hallucinations are related to events in the environment whereas others bare no relationship to what the senses are picking up e.g voices.
They can be experiences in relation to any sense.
what are delusions?
Irrational beliefs.
Common delusions include delusions of grandeur which involve being an important historical, political or religious figure.
Delusions commonly involve being persecuted e.g by the government or aliens or having superpowers.
Delusions can make a sufferer beehive in ways that make sense to them but seem bizarre to others.
What are 2 negative symptoms?
Speech poverty
Avolition
What are 2 negative symptoms?
Speech poverty
Abolition
What is speech poverty?
Patient uses as few words as possible.
The individual cannot express themselves effectively.
What is avolition?
Involves loss of motivation to carry out tasks and results in lowered activity levels, inability to make decision, have no enthusiasm, may lose interest in personal hygiene.
What are the 2 diagnosis classification systems?
ICD
DSM
What are the 5 main subtypes of schizophrenia according to ICD 10?
Disorganised type
Catatonic type
Paranoid type
Undifferentiated type
Residual type
What are some characteristics of disorganised schizophrenia?
- disorganised and now goal directed behaviour
- thought disturbances
- absence of expressed emotion
- mood swings
- social withdrawal
What are some characteristics of catatonic schizophrenia?
- sever motor abnormalities e.g unusual body language and gestures
- gesture repeatedly
- total immobility for hours at a time
What are some characteristics of paranoid schizophrenia?
- delusions
- argumentative
What are some characteristics of undifferentiated schizophrenia?
- included patients who do not clearly belong within any other category
- they show symptoms of schizophrenia but do not fit into the other types
What are the characteristics of residual schizophrenia?
- have not had an episode of schizophrenia during the past 6 months but still exhibit some symptoms
- their symptoms are not strong enough to merit putting them in other categories
- this type consists of patients who are experiencing mild symptoms
What are the evaluation points in diagnosis ands classification?
Reliability
Validity
Co-morbidity
Symptom overlap
Gender bias
Culture bias
What is reliability as an evaluation point in diagnosing and classifying schizophrenia?
Test-retest reliability - occurs when a clinician makes the same diagnosis on separate occasions form the same information.
Inter-rater reliability - occurs when different clinicians make identical, independent diagnoses of the same patient.
Cheniaux et al (2009) had two psychiatrists diagnose 100 patients using both the DSM and ICD criteria and found the inter - rater reliability was poor. E.g one psychiatrist diagnosed 26 with schizophrenia and the other diagnosed 13 according to the DSM.
Poor reliability is a weakness of diagnosis of schizophrenia.
The classification systems that diagnosis is based on is not perfect but they do provide practitioners with a common language which may facilitate research and ultimately lead to better understanding and treatment.
What is test-retest reliability?
Test-retest reliability - occurs when a clinician makes the same diagnosis on separate occasions form the same information.
What is inter-rater reliability?
Inter-rater reliability - occurs when different clinicians make identical, independent diagnoses of the same patient.
which study investigated reliability in the diagnosis of schizophrenia?
Cheniaux et al (2009) had two psychiatrists diagnose 100 patients using both the DSM and ICD criteria and found the inter - rater reliability was poor. E.g one psychiatrist diagnosed 26 with schizophrenia and the other diagnosed 13 according to the DSM.
What os validity in diagnosing and classifying schizophrenia?
The extant to which we were measuring what we are intending to measure.
What are the validity issues to consider when diagnosing and classifying schizophrenia?
Criterion validity - where different assessment systems (DSM/ICD) arrive at the same diagnosis for the same patient.
Reliability - a valid diagnosis must first be reliable although reliability in itself doesn’t guarantee validity.
Predictive validity - if diagnosis leads to a successful treatment, the diagnosis is seen to be valid.
Descriptive validity - to be valid, patients with schizophrenia should differ in symptoms from patients with other disorders
Describe Rosenhan’s study into the validity of diagnosing schizophrenia (1973).
- eight volunteers who did not suffer with mental illnesses presented themselves to different mental hospitals, claiming to hear voices.
- the volunteers took between 7 and 52 days to be released, diagnoses as schizophrenia in remission.
- normal behaving were interpreted as signs of schizophrenia.
- he concluded that the diagnosis of schizophrenia lacks validity, as psychiatrists cannot distinguish between real and pseudo-patients.
Who did a study into the validity of diagnosing schizophrenia (1973)?
Rosenhan - ‘being sane in insane places’
What is co-morbidity in diagnosing schizophrenia?
- when two or more conditions occur together.
- there may be confusion over which actual disorder is being diagnosed.
- it has been reported that schizophrenics with co-morbid condiment are excluded from research and yet form the majority of patients. This suggests the research findings into the causes of schizophrenia can’t be generalised to most sufferers.
- this will have nock on effects as to what treatments patients receive.
- if conditions occur together a lot of the time then this calls into questions the validity of their diagnosis and classification.
What is symptom overlap in diagnosing schizophrenia?
- this occurs when two or more conditions share symptoms.
- where conditions share many symptoms this calls into question the validity of classifying the two disorders separately.
- there is considerable overlap between the symptoms of schizophrenia and other conditions e.g bipolar disorder (both involve delusions).
- this again calls into question the validity of both the classification and diagnosis of schizophrenia.
- misdiagnosis due to symptom overlap could lead to years of delay in receiving relevant treatment, during which time suffering and further degeneration can occur, as well as high levels of suicide.
What is gender bias in diagnosis of schizophrenia?
- it has been concluded that more men since the 1980’s have been diagnosed with schizophrenia.
- this at be due to genetic vulnerability of men.
- another example is gender bias in the diagnosis.
- female patients typically function better than men.
- their better interpersonal functioning may bias practitioners to under diagnose schizophrenia - their symptoms may be masked.
What is culture bias in diagnosing schizophrenia?
- culture bias concerns the over-diagnosis of other cultures as suffering from schizophrenia.
- rates in Africa snd the West Indies are not particularly high which suggests it is not due to genetic vulnerability.
- positive symptoms e.g hearing voices may be more acceptable in African cultures because of cultural beliefs in communication with ancestors - people are more ready to acknowledge such experiences.
- when reported to a psychiatrist from another culture, these experiences are likely to be seen as bizarre and irrational.
- Afro-Caribbean schizophrenics in Britain are more likely to be compulsory confined to secure hospitals then white schizophrenics - the argument being that most British psychiatrists are which are moe likely to perceive black schizophrenics as dangerous.
- the over diagnosis of schizophrenia in African Americans casts doubt on the validity of diagnosis.
What are the 3 elements of the biological explanation for schizophrenia?
Genetics
Abnormal dopamine functioning
Neural correlates
What is a candidate gene in the biological explanation for schizophrenia?
Several genes involved which increase overall vulnerability to developing schizophrenia e.g PCM1
What is an example of a candidate gene that could cause schizophrenia?
PCM1
Why is schizophrenia polygenic?
A number of genes each appear to cover a small increase risk of schizophrenia
Why is schizophrenia aetiologically heterogenous?
Different combinations of factors can lead to the condition.
What are used to assess concordance rates of developing schizophrenia?
Twin, families and adoption studies
What is a recent method of assessing genetic material in sufferers of schizophrenia?
Gene mapping
What are 2 strengths of genetics as a biological explanation for schizophrenia?
Gottesman and Shields (1976):
- reviewed 5 twin studies
- reported concordance rates of between 75% and 91% for MZ (identical) twins with severe forms of schizophrenia
- suggests that genetics plays a large role with chronic forms of the disorder
- however, no study has found an 100% concordance rate between MZ twins so schizophrenia can’t just be caused by generics, other factors such as the influence of social class and environmental influences must be considered
Torrey et al (1994):
- reviewed evidence from twin studies
- found that if one MZ twin develops schizophrenia, there’s a 28% chance that the other twin will do so
- supports the idea that schizophrenia is inherited
What are 2 weaknesses of genetics as part of the biological explanation of schizophrenia?
Biological reductionism:
- oversimplifying a complex disorder down to just genes may lead to a loss of validity
- explaining schizophrenia from a genetic basis does not include an analysis of the social context or the cognitive factors which might be implicated in the disorder
- the genetic explanation can only ever form part of an explanation
Consequences of assuming a genetic cause:
- this explanation may lead to feeling of family responsibility/blame for the onset schizophrenia
- even though it seems other factors are involved (it’s only a predisposition that is inherited) there may still be a feeling of biological determinism
- this could lead to a very pessimistic outlook on life and a feeling of no control
Dopamine has an ________ effect and is associated with the sensation of pleasure.
Excitatory
If too much dopamine is released into the synapse it can lead to the onset of _____________.
Schizophrenia
The original version of the dopamine hypothesis focussed on the possible role of _____ levels of dopamine in the sub cortex
High
What is hyperdopaminergia?
High levels of dopamine in the subcortex
What could be a sign of hyperdopaminergia?
Poverty of speech or experiencing auditory hallucinations
What do more recent versions of the dopamine hypothesis focus on?
Low levels of dopamine in the prefrontal cortex
What is hypodopaminergia?
Low levels of dopamine in the prefrontal cortex
What are 2 strengths of the dopamine hypothesis as part of the biological explanation for Schizophrenia?
Randrup and Munkvad (1966):
- created Schizophrenic-like behaviour in rats by giving them amphetamines, which activate the dopamine production
- they then reversed the effect by giving them neuroleptic drugs, which inhibit the release of dopamine
- this supports the hypothesis
Iverson (1979):
- reported that post-mortems on poeple who had Schizophrenia found excess dopamine in the limbic system
- suggesting the neurotransmitter is involved in the disorder
What are 2 weaknesses of the dopamine hypothesis as part of the biological explanation of Schizophrenia?
Lloyd et al (1984):
- believed that even if dopamine is a casual factor, it may be indirect mediated through environmental factors
- abnormal family circumstances can lead to high levels of dopamine which can trigger schizophrenic symptoms
- differences in the biochemistry of schizophrenics could be an effect rather than a cause of the disorder
Biological reductionism:
- oversimplifying a complex disorder downs to just neurotransmitters may leads to a loss of validity
- explaining Schizophrenia from a biological basis does not include an analysis of the social context or the cognitive factors which might be implicated in the disorder
- the biological explanation can only ever form part of an explanation
Activity in the ventral straitum is a neural correlate of _______ symptoms of schizophrenia.
Negative
What negative symptom is a neural correlate with activity in the ventral straitum?
Avolition
- avolition involves loss of motivation
- motivation involves anticipation of a reward
- the ventral straitum is believed to be involved in this anticipation of a reward
- abnormality of this area may be involved in development of avoilition
What did Juckel at al (2006) find about activity in the ventral straitum?
Found lower levels of activity in the ventral striatum in schizophrenics than controls. They also observed a negative correlation between activity levels in the Ventral straitum and the severity of overall symptoms
Reduced activity in the superior temporal gyrus and anterior cingulate gyrus is a neural correlate of __________ _______________ (positive symptom)
Auditory hallucination
Reduced activity in the _________ temporal gyrus and anterior __________ gyrus is a neural correlate of auditory hallucination (positive symptom).
Superior
Cingulate
What did Allen et al (2007) find about the neural correlate of auditory hallucinations?
Scanned the brains of patients experiencing auditory hallucinations and compared them to a control group whilst they identified pre-recorded speech as theirs or others.
Low activation levels in the superior temporal gyrus and anterior cingulate gyrus were found in the hallucination group.
This hallucination group also made more errors than the control group.
What is the strength of neural correlates?
Large amount of research linking structure/ activity in the brain with having schizophrenia.
Juckel at al (2006)
Allen at al (2007)
Backs up the idea that there are some abnormality in specific brain areas in schizophrenics
What are the weaknesses of neural correlates? (3)
Inconsistencies in research findings:
- e.g some non- schizophrenics have enlarged ventricles but not all do.
- consideration must be given to environmental factors such as substance abuse and stress levels which may also have a damaging influence upon brain tissue.
Correlation problem:
- does the unusual activity in a region of the brain cause a symptom?
- e.g perhaps something wrong in the striatum is causing the negative symptoms or is it the symptoms themselves that are resulting in reduced activity in the straitum?
- there could be another factor causing the symptoms
- the existence of neural correlates tells us relatively little in itself
An unclear picture:
- it appears that schizophrenics who don’t reposed to medication mainly exhibits enlarged ventricles
- it could be the effect of suffering from schizophrenia that leads to physical brain damage rather than brain damage leading to schizophrenia
- it may be that schizophrenic patients who do not respond to medication do not do so because of structural brain damage doesn’t allow anti-psychotic medications to have a therapeutic effect in reducing symptom levels.
What are the 3 psychological explanations of family dysfunction as a cause of schizophrenia?
The schizophrenogenic mother
Double-bind theory
Expressed emotions
Describe the schizophrenogenic mother theory (Frieda-Fromm-Reichman, 1948).
Psychodynamic explanation for schizophrenia
Cold, rejecting and controlling
Family climate is characterised by tension and secrecy
Which approach is the schizophrenogenic mother theory?
Psychodynamic
How can does the schizophrenogenic mother lead to the development of schizophrenia?
The family climate is characterised by tension and secrecy which leads to distrust. This later develops into paranoid delusions which later develops into schizophrenia.
Who crated the schizophrenogenic mother theory?
Freida-Fromm-Reichmen 1948
Who created the double- bind theory?
Bateson et al (1972)
Describe the double-bind theory.
Emphasises the role of communication style within a family
Children often placed in contradictory situations by parents
Child fears doing the wrong thing
Feel unable to seek clarification
How does the double-bind theory explain how schizophrenia is developed?
Patient sees the world as confusing, uncertain and dangerous.
Reflected in symptoms like disorganised thinking and paranoid delusions
May also lead to negative reaction of social withdrawal and flat effect to escape these situations
What is expressed emotion as an expansion for schizophrenia?
Level of emotion, in particular negative emotion , expressed towards a patient by their carers
What are the elements of expressed emotion?
- verbal criticism of the patient, occasionally accompanied by violence
- hostility towards the patient, including anger and rejection
- emotional over-involvement in the life of the patient, including needless self- sacrifice
Expressed emotion is primarily an explanation for _______ in schizophrenia patients
Relapse
Expressed emotion is primarily an explanation for _______ in schizophrenia patients
Replace
How does expressed emotion link to the diathesis stress model?
Expressed emotion may be a source of stress that triggers onset of schizophrenia in a vulnerable person (e.g due to genetics) this is the diathesis stress model
What is the strength of family dysfunction?
Kavanagh (1992)
Reviewed 26 studies of expressed emotion, finding that the mean relapse rate for schizophrenics who returned to live with high expressed emotion families was 48% compared with 21% fro those who went to live with low expressed emotion families.
This supports the idea that expressed emotion increases the risk of relapse for recovering schizophrenics
What are the weaknesses of family dysfunction as an explanation for schizophrenia?
Problems with cause and effect:
Having a schizophrenic within a family can be problematic and stressful on family relationships.
Rather than dysfunctional families causing schizophrenia, having a schizophrenic within a family may lead to dysfunction
Selective bias:
Bateson’s idea of double bind has been accused of selective bias in focussing on aspects of interviews with schizophrenics that supported his claims.
This along with receptor evidence supporting a genetic link weakens the theory.
Lack of evidence and ‘parent blaming’ not helpful:
There is almost no evidence to support the importance of the schizophrenogenic mother or double bind.
Both these theories are based on clinical observations of patients and assessing the personality of mothers of patients for ‘crazy-making characteristics’ - not a reliable approach.
Dysfunctional family explanations can also lead to parent- blaming.
Parents have already suffered seeing their child’s decent into schizophrenia m they are also likely to bare lifelong responsibility for their care- then undergo further trauma by receiving blame.
This has lead to the decline of the schizophrenogenic mother and double bind theories.
Who crated the dysfunctional thought processing theory as part of the cognitive explanation for schizophrenia?
Frith at al (1992)
What are the 2 elements of the dysfunctional thought processing theory? (Cognitive explanation)
Metarepresentation
Central control
what is metarepresentation?
The cognitive ability to reflect on thoughts, behaviour and experience
Allows us to interprets the actions of others
What are the symptoms of dysfunction of metarepresentation?
Hearing voices
Thought insertion
Delusion of being persecuted
Describe the symptom of reporting to hear voices (dysfunction of metarepresentation).
Unable to distinguish speech heard externally from a thought generated in their own mind
Describe the symptom of the delusion of thought insertion (dysfunction of metarepresentation).
A patient believes their thoughts come from someone else
Describe the symptom of the delusions of being persecuted (dysfunction of metarepresentation).
We require metarepresentations to make judgements about other people’s intentions
What is central control?
The cognitive ability to suppress automatic responses to stimuli while we perform deliberate actions that reflect our wishes or intentions
What is the symptom of centra control problems?
Disorganised speech
Describe the symptom of disorganised speech (central control problems).
The inability to suppress automatic thoughts and speech triggered from other thoughts
‘Clagging’ - patient takes one word in a sentence and drifts from the sentence into words associated
What are the strengths of the cognitive explanation of schizophrenia?
Real life application in CBT:
- some studies have shown that CBT can be effective in schizophrenia, supporting an involvement of cognitive factors in the disorder
- highlighting metacognition as important indicates therapies will need to concentrate on improving metacognitive abilities
- therapies could be targeted at specific areas of metacognitive impairment to best suit the needs of the patient
- this may increase the effectiveness of treatment and allow sufferers to access a more ‘normal life’
Strong supporting evidence:
Stirling et al (2006):
- compared 30 schizophrenia patients with 18 controls on a range of cognitive tasks e.g the Stroop Test (name ink colours and stress the impulse to read the words)
- patients took twice as long to name the ink colours as the control group
- this supports Frith’s theory of central control dysfunction
What are the weaknesses of the cognitive explanation of schizophrenia?
Direction of causality:
-We have a mass of information concerning abnormal cognitions in schizophrenia but it remains unclear what causes what
- it is unsure wether cognitive factors are a cause or are a result of the neural correlates seen in schizophrenia
- firm conclusions are therefore difficult to reach
Blaming the individual:
- cognitive explanations can lead to blaming the individual - making them actively responsible for their symptoms
- in contrast to more biological explanations which people may feel there’s less control over
- this is unhelpful and can put even more stress on the sufferer
How many sessions does CBT usually take?
12-20
what is the aim of CBT?
To identity irrational thoughts, maladaptive thinking and distorted perceptions and try to challenge them
CBT may involve argument or ________ of how likely patients beliefs are to be true
Discussion
What technique is used in CBT to display the thinks between sufferers’ thoughts, actions and emotions?
Drawings
Delusions can be __________ so the patient can come to learn their beliefs are not based on reality
Challenged
What technique are these the elements of? A) identify activating event
B) exploring beliefs
C) recognising consequences
D) disputing irrational beliefs
E) restricted belief (effect)
Cognitive restructuring - ABCDE framework
What are the strengths of CBT to treat schizophrenia?
CBT + antipsychotics:
- evidence suggests that CBT plus antipsychotics is effective in treating schizophrenia and more effective than drugs or CBT alone - supports the case for combined treatments
- CBT helps make schizophrenia more manageable and improve quality of like
- allows patients to make sense of symptoms and sometimes challenge them
Tarrier (2005):
- reviewed 20 controlled trails of CBT using 739 patients, finding evidence of reduced symptoms (especially positive), lower relapse rates and speedier recovery rate
- these were short term benefits however, follow-ups needed to assess long term benefits
What are the weaknesses of using CBT to treat schizophrenia?
Not suitable for all patients:
- those who are too disorientated, agitated or paranoid to from trusting alliances with practitioners
- CBT required self-awareness and willingness to engage with the process
-not all clients are suited to vigorous confrontation
Practical issues:
- length of therapy and the commitment needed to undertake ‘homework’ may not appeal to everyone
- this may lead to increased drop out rate before the treatment is completed
- this will reduce effectiveness
What assumption is family therapy based on?
That family dysfunction can play a role in the development of schizophrenia
Strategy used by family therapists to improve family functioning:
Forming a therapeutic alliance with ___ family members.
All
Strategy used by family therapists to improve family functioning:
Improving the ability of the family to anticipate and ______ problems.
Solve
Strategy used by family therapists to improve family functioning:
Helping family members achieve a _______ between caring for the individual with schizophrenia and maintaining their own lives.
Balance
Strategy used by family therapists to improve family functioning:
Helping family members achieve a _______ between caring for the individual with schizophrenia and maintaining their own lives.
Balance
Strategy used by family therapists to improve family functioning:
Reducing the ______ of caring for a relative with schizophrenia.
Stress
Who identified the strategies used by family therapists to improve family functioning?
Pharoah et al (2010)
what are 2 strengths of family therapy?
Family members may assist the patient:
- can be useful for patients who lack insight into their illness or cannot speak coherently about it - family members may be able to assist here
- family members have lots of useful information and insight into a patient’s behavior and moods and can often speak for them
- as well as decreasing relapse rates and lowering the need for hospitalisation, family therapy can educate family members to help manage a medication regime, decreasing the need for clinicians to do this - more cost effective
Younger patients:
- younger patients who still live at home with their families may particularly benefit from family therapy
- family therapy is a relatively cost-effective treatment compared to other treatments
- younger patients may like having family around to express their feelings
What are the 2 weaknesses of family therapy?
Pharoah et al (2010):
- reviewed evidence for the effectiveness of family therapy
- there is moderate evidence to show family therapy significantly reduces hospital re admission over the course of a year
- quality of life for patients and their families improves
- however, results of some studies are inconsistent
- evidence base for family theory seems quite weak
Reluctancy to share sensitive information:
- with emphasis on ‘openness’ there can be an issue with family members being reluctant to share sensitive information
- may reopen tensions
- some family members may also be reluctant to talk about or admit their problems
- this lowers the effectiveness of the treatment
What principles are token economies based off?
Operant conditioning
Token economies uses ______________ to encourage desirable behaviour.
Reinforcement
who is token economies particularly aimed at?
Those who have developed maladaptive behaviour through institutionalisation
What is the a primary reinforcer in a token economy?
The reward the tokens are swapped for
What are secondary reinforcers in token economies?
The token received
What are 2 strengths of token economies?
Can be tailored to individuals:
- can be tailored to meet the individual requirements of different patients (different target behaviours and rewards)
- the technique is therefore flexible
- but only works if patients are willing to engage with the programme and rewards must be motivating
Staff and patient interaction becomes more positive:
- token economies facilitate a safer and more stable therapeutic environment (staff and patient injuries reduce, less staff absenteeism and emergency incidents)
What are the 2 weaknesses of token economies?
Tokens may lead to dependency:
- patients only produce desired behaviour to receive a token
- problem transferring behaviour to the ‘outside world’ - everyday reinforcement is subtle and delayed - may lead to high re-admittance rates
- may only change behaviour in the short term as it doesn’t address underlying causes
Patronising:
- perception that it is humiliating/ patronising
- patients and clinicians may be reluctant to take part
What are the 2 types of drug therapies?
Typical
Atypical
What is an example of a typical drug treatment?
Chlorpromazine
What is an example of an atypical drug treatment?
Clozapine
How does chlorpromazine work?
Reduces dopamine activity by blocking dopamine receptors at the synapse
Chlorpromazine reduces _______ symptoms like hallucinations and delusions
Positive
Chlorpromazine is an effective s_________.
Sedative
What are some of the symptoms of chlorpromazine?
Dry mouth
Urinatory problems
Constipation
Agitation
Sleepiness
Stiff jaw
Wight gain
Itchy sin
Visual disturbance
Low blood pressure
Problems with sexual function
Nasal congestion
What can long term use of chlorpromazine lead to?
Tardive dyskinesia
- causes involuntary and uncontrollable muscle movements
What can long term use of chlorpromazine lead to?
Tardive dyskinesia
What is an example an atypical drug?
Clozapine
How does clozapine work?
Clozapine binds to dopamine receptors just like chlorpromazine
Also acts on serotonin and glutamine receptors
Affects negative symptoms of the disorder
Clozapine reduces ________ symptoms
Negative
A ______ dose of atypical drugs are given. This means that it is less likely that symptoms will occur.
Smaller
What are some examples of side effects of clozapine?
Weight gain
Neuroleptic malignant syndrome
Increased risk of stroke
Sudden cardiac death
Blood clots
Diabetes
What are 2 strengths of antipsychotics to treat schizophrenia?
Herbert Meltzer (2012):
Concluded that clozapine is more effective than typical antipsychotics and other atypical psychotics
It is effective in 30-50% of treatment- resistant cases where typical antipsychotics have failed
Cheap:
Relatively cheap to produce, easy to administer and have positive effects on many sufferers - allowing them to live relatively normal lives outside mental institutions
Less than 3% of people with schizophrenia in the UK live permanently in hospital
What are 2 weaknesses of the use of antipsychotics to treat schizophrenia?
Side effects:
Some can be fatal
Long term use can result in tardive dyskinesia - caused by dopamine supersensitivity - gives involuntary facial moments e.g grimacing, blinking and lip smacking
High relapse rates:
Around 40% in the first year after treatment and 15% in later years generally due to patients stopping treatment because of side effects and the reduced quality of life they can bring
What does the interactionist approach acknowledge?
That there are biological, psychological and societal factors in the development of schizophrenia
Explain the diathesis stress model
Diathesis means vulnerability
Stress means negative psychological experience
The model says that both a vulnerability to schizophrenia and a stress-trigger are necessary to develop the condition
Describe the original diathesis stress model (Meehl’s model 1962)
Diathesis (vulnerability) was thought to be entirely genetic
This led to sensitivity to stress
If a person doesn’t have the schizogene no amount of stress would lead to schizophrenia
What did Meehl’s Diathesis stress model say about the schizogene?
If a person doesn’t have the schizogene no amount of stres would lead to schizophrenia
Describe the modern understanding of the Diathesis stress model.
Diathesis:
It is likely genetic factors are linked with faulty dopamingergic symptoms and to abnormal functioning of other neurotransmitters.
Psychological trauma can also be the Diathesis rather than the stressor (eg child abused can alter the developing brain)
Stress:
Anything that risks triggering schizophrenia.
Psychological stressors such as family dysfunction, substance abuse, critical life events.
Cannabis use - interferes with dopamine symptom
What is the interactionist stance on treatment?
It is possible to be believe in biological causes and still practice CBT.
In Britain it is standard practice to use CBT alongside antipsychotics.
CBT, family therapy and token economies are usually carried out while the patient takes antipsychotics
What are 2 weaknesses of the interactionist approach?
Original Diathesis stress model is over-simplistic:
- the classic model of the schizogene is known to be over-simple
- multiple genes are known to increase vulnerability
- no single schizogene
- vulnerability and stress done have one single cause
Combination of treatments:
- patients receiving CBT sometimes interpret side effects of simultaneous drug treatment in a delusional manner
- this increases their mistrust and resistance to further treatment
What are 2 strengths of the interactionist approach?
Effective combination of behavioural and cognitive therapies:
- cognitive therapists address disordered thinking allowing behavioural therapists to then be effective in teaching functional and social skills in real life
- without cognitive restructuring, patients are too disordered for behavioural therapies to be of any use
- however, cost of combination can be an issue
Barlow and Durand (2009)
- reported that a family history of schizophrenia couples with being part of a dysfunctional family elevated the risk of developing schizophrenia, supporting the Diathesis-stress model.
- the Diathesis being the genetic tendency and stress being the dysfunctional family
