schizophrenia Flashcards
diagnosing schizophrenia (classification and symptoms) - ao1
there are two classification systems used to diagnose sz
- the dsm 5th edition (America)
- the icd 11th edition (Europe and others)
diagnosed based upon positive and negative symptoms,
dsm 5 - 2+ positive symptoms or 1 negative 1 positive for at least a month and extreme social withdrawal for 6 months
icd 11 - 1 postive 1 negative for one month
types of sz - crow (1980)
type 1 syndrome: more positive symptoms
type 2 syndrome: more negative symptoms
positive symptoms: excess/distortion of normal functions
- hallucinations, sensory experiences that have no basis or distorted perception, auditory, visual, olfactory, tactile
- delusions, paranoia, irrational bizarre beliefs that seem real, may believe they are under external control
- disorganised speech, result of abnormal thought process, problems organising thoughts show up in speech, derailment of topics or incoherent gibberish sentences.
negative symptoms: reduction/loss of normal functions
- speech poverty, alogia, changes in patterns of speech, delay in verbal responses, less complex syntax
- avolition, apathy, finding it difficult to begin of keep up with goal directed activity, lack of motivation, poor hygiene, work, lack of energy
- affective flattening, reduction in range of intensity of emotional expression, facial expression, voice tone, eye contact, body language
- anhedonia, loss of interest or pleasure in all/most activities, lack of reactivity to pleasurable stimuli, physical is inability to experience physical pleasures like food/bodily contact, social is inability to experience pleasure from interpersonal situations.
issues associated with the classification and diagnosis of schizophrenia - ao1
there are several issues with the classification and diagnosis of sz for example reliability, validity, co-morbidity, symptom overlap, gender bias, cultural bias.
reliability:
validity:
co-morbidity:
symptom overlap:
gender bias:
cultural bias:
issues associated with the classification and diagnosis of schizophrenia - ao3
genetic basis of schizophrenia - ao1
genetic basis of schizophrenia - ao3
neural correlates of schizophrenia - ao1
neural correlates of schizophrenia - ao3
psychological explanations of schizophrenia (family dysfunction) - ao1
psychological explanations of schizophrenia (family dysfunction) - ao3
psychological explanations of schizophrenia (cognitive explanations) - ao1
psychological explanations of schizophrenia (cognitive explanations) - ao3
biological therapies for schizophrenia (drugs) - ao1
biological therapies for schizophrenia (drugs) - ao3
psychological therapies for sz ao1 (cbt)
cbt - cognitive behavioural therapy
main psychological treatment used for sz
idea is that the beliefs, expectations, and cognitive assessments of self, the environment and the nature of personal problems will affect how individuals perceive themselves and others
takes place over a period of 5-20 sessions in groups or individually
antipsychotic drugs used first to reduce thought process so cbt is more effective
cbt then undertaken once every 10 days for 12 sessions to identify and alter irrational thinking
drawings used to display links between sufferers thoughts and actions and emotions
used to understand where symptoms are originating from
one approach is personal therapy - involves detailed evaluation of problems and experiences their trigger and consequences, and strategies used to cope. also used to tackle problems faced by discharged schizos to prevent relapses. techniques used like
- helping understand and make sense of how their irrational cognitions (delusion/hallucinations) impact on their feelings and behaviours
- distractions from intrusive thoughts
- challenging the meaning of intrusive thoughts
- increasing/decreasing social activity to distract from low mood
- normalisation
- using relaxation techniques
- positive self talk
psychological therapies for sz ao3 (cbt)
+ research support by Jauhar et al (2014), reviewed 34 studies of using CBT to treat SZ, showed clear evidence for small but significant effects on both positive and negative symptoms, therefore proven to be effective in treating sz
+ effectiveness of cbt is dependent on the stage of the disorder, cbt appears to be more effective when it is made available at certain stages of the disorder and the delivery has been adapted to the stage they individual is currently at. Addington and Addington (2005) found that in the initial acute phase pf sz, self reflection is not effective however following stabilisation of the psychotic symptoms, patients can benefit from group therapy sessions to help with normalisation.
- lack of availability of cbt and patients refusal to attend sessions, estimated only 1/10 individuals in the uk with sz have access to cbt, figure can be lower in certain areas of the uk. patients may also stop attending session on their own accord due to the uncomfortability of their thoughts being challenged leaving to a limitation on the effectiveness of cbt
- individual differences, cbt uses a wide range of techniques to help overcome symptoms, and these will vary widely from case to case. different studies will involve the use of different cbt techniques and patients with different symptoms, therefore it becomes difficult to assess the best technique and the true effectiveness of cbt on a sz patient.
psychological therapies for sz ao1 (family therapy)
family therapy takes place with families and the identified patient
it aims to improve quality of communication and interaction, increase tolerance levels and decrease criticism levels, decrease feeling of guilt and responsibility for causing the illness
usually takes between 9 months to a year
range of approaches to family therapy that align with the theories of family dysfunction
Pharoah (2010) identified a range of strategies that therapists can use to improve functioning of the family.
- reduce negative emotions, and levels of expressed emotions prevents negative feelings like guilt and stress causing a relapse
- improving family’s ability to help, encouragement to form a therapeutic alliance to all agree to aims of therapy, improve family beliefs and behaviour towards sz, family can achieve a balance between caring for patient and having own life.
Burbach (2018) proposed a model for working with families dealing with sz
phase 1: sharing basic information and providing emotional and practical support
phase 2: involves identifying resources in terms of what family members can and cannot offer
phase 3: aims to encourage mutual understanding, creates a safe place for all family members to express their feelings
phase 4: involves identifying unhelpful patterns of interaction like negative emotions of anger which make things more difficult
phase 5: skills training such as learning stress management techniques
phase 6: focuses on relapse prevention
phase 7: talks about maintenance for the future.
psychological therapies for sz ao3 (family therapy)
+ effectiveness, review of studies by McFarlane (2016) conclude that FT was one of the most consistently effective treatments available, relapse rates found to be reduced by about 50-60%
+ beneficial at all stages of sz
+ benefits all family members, not just for the patient, family provides the most care and this strengthens the functioning of the whole family, therefore lessening the negative impact on the family members, ft has wider benefits beyond obvious positive impact on patients
+ economical benefits to ft, ft associated with significant cost savings when offered to people with sz in addition to standard care, allows for a reduction in costs of hospitalisation because of lower relapse rates, carers would be likely able to work more with less chance of relapse
- lengthy process lasting up to a year, therefore situations may arise where participants want to stop the therapy, but in order to be effective, all family members must have active participation.
psychological therapies for sz ao1 (token economies)
token economies are reward systems that are used to manage the behaviour of patients with sz in hospital settings, especially those who have developed maladaptive behaviours.
psychological therapies for sz ao3 (token economies)
the interactionist approach in the onset and treatment of sz - ao1
the interactionist approach in the onset and treatment of sz - ao3
