Schizophrenia Flashcards
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
What is schizophrenia (Sz)?
Sz: a disorder in which a person has difficulty distinguishing what is real from what is in their imagination.
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Finish these sentences:
Sz is experienced by about [ ]% of the world’s population.
It is more commonly diagnosed in [ ], [ ]-[ ] and [ ] socio-eonomic groups.
The symptoms of Sz can interfere severly with everyday tasks, so that many people with Sz end up [ ] or [ ].
0/7 = 1
2/7 = 2
4/7 = 3
6/7 = 4
7/7 = 5
Sz is experienced by about 1% of the world’s population.
It is more commonly diagnosed in men, city-dwellers and lower socio-eonomic groups.
The symptoms of Sz can interfere severly with everyday tasks, so that many people with Sz end up homeless or hospialised.
0/7 = 1
2/7 = 2
4/7 = 3
6/7 = 4
7/7 = 5
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
What’s the difference between a classification and a diagnosis?
classification: identifying clusters of symptoms that occur together and classifying it as one disorder (e.g. hallucinations, delusions)
diagnosis: identifying symptoms a person has and deciding what disorder it is (e.g. schizophrenia)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Match up the following key terms to their definitions:
Co-morbidity
Gender bias
Culture bias
Symptom overlap
_______________________________________________________________________
A psychiatrist from one culture may misdiagnose people from a different cultural background.
When two disorders frequently occur together (e.g. Sz and bipolar disorder).
When disorders share the same symptoms which makes it difficult to distinguish between them.
When one gender is under diagnosed and/or one is over diagnosed (e.g. women may be underdiagnosed for Sz in the UK).
- Co-morbidity: When two disorders frequently occur together (e.g. Sz and bipolar disorder).
- Gender bias: When one gender is under diagnosed and/or one is over diagnosed (e.g. women may be underdiagnosed for Sz in the UK).
- Culture bias: A psychiatrist from one culture may misdiagnose people from a different cultural background.
- Symptom overlap: When disorders share the same symptoms which makes it difficult to distinguish between them.
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Define ‘positive’ and ‘negative’ symptoms.
positive symptoms: additional experiences beyond those of ordinary existence (add-ons) (e.g. hallucinations, delusions)
negative symptoms: loss of usual abilities and experiences (losses) (e.g. speech poverty, avolition)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline hallucinations as a positive symptom of Sz.
HALLUCINATIONS:
- unusual sensory experiences
- could be random, could be related to the individual’s environment
- commonly hearing voices (auditory) (often critic)
- can be any sense: tactile (feeling things crawling on you), visions (distorted facial expressions)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline delusions as a positive symptom of Sz.
DELUSIONS (also known as paranoia/irrational beliefs):
- make a person behave bizarrely
- e.g.) the individual believes they are in important historical figure like Napoléon or Jesus
e.g.) the individual believes they’re being persecuted by the government or aliens
- e.g.) the individual believes they have superpowers
- e.g.) the individual believes they are under external control
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline speech poverty as a negative symptom of Sz.
SPEECH POVERTY:
- a reduction in the quality and amount of speech
- changing topics mid-sentence, incoherent speech
- sometimes accompanied by a delay in a person’s responses in conversations
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline avolition as a negative symptom of Sz.
AVOLITION:
- a lack/struggle to keep up/begin goal-directed activity
- sharp reduction in motivation
- poor hygiene + grooming, lack of persistence in work/education, lack of energy (the 3 signs of avolition identified by Andreasen)
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding low reliability.
P: diagnoses have low reliability
E: Cheniaux et al (2009): when two psychiatrists independently assessed 100 clients using the ICD10 and DSM4, 68 were diagnosed according to the ICD10 system vs only 39 under the DSM4 system.
E: suggests the ICD10 and DSM4 were not reliable in the diagnosis of Sz; inconsistency between two classification systems; also suggests one is more valid than the other (produced a dramatically different number of diagnoses for the same disorder)
E: BUT: Osorio et al (2019) reported high inter-rater reliability (+0.97) and test-retest (+0.92) reliability using the DSM5 => latest version of DSM (DSM5) has high reliability due to empirical evidence and therefore we can trust this classification system for reliable diagnoses for Sz.
L: increased cred of DSM5 as a classification system for diagnosing Sz due to its reliability, but needs to be some more work done to ensure consistency across all classification systems to ensure the appropriate people are correctly diagnosed with Sz.
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding low validity.
P: diagnoses sometimes have low validity
E: Buckley et al found Sz is commonly diagnosed alongside other conditions (e.g. substance abuse) because it is a co-morbid disorder.
E: suggests our current diagnosis strategy provides an incomplete criteria for the symptoms of Sz to provide an accurate diagnosis (since Sz symptoms cannot be fully explained by just a diagnosis of Sz)
E: PLUS: some symptom overlap between Sz and other conditions (symptoms appear in both Sz and Bipolar disorder such as delusions and avolition); diagnosis of Sz is therefore not always accurate, could easily be confused/misdiagnosed for other disorders with very similar/the same symptoms
L: low validity for diagnosis of Sz suffers due to the incomplete explanation and criteria for what symptoms Sz encompasses
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding biased diagnoses (gender and cultural).
P: diagnoses are affected by gender and cultural biases
E: cultural bias: some symptoms have different meanings in different cultures, e.g. hearing voices in Haiti may be interpreted as communication from ancestors; plus British people of African-Caribbean heritage are 9x more likely to receive a diagnosis than White British people
E: PLUS: gender bias: men diagnosed more often than women (1.4(men):1(women)).
E: Sz inconsistently diagnosed between cultures and genders; those with a lower chance of being diagnosed (e.g. women) less likely to receive treatment they need to improve their QOL
L: reduced cred of diagnosis of Sz due to inconsistent diagnoses across cultures and genders
DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Briefly outline and evaluate one study of validity in relation to the diagnosis of schizophrenia. [4 marks]
ROSENHAN (1973)
AO1:
- 7 students visited 12 different asylums in USA
- all faked hearing voices “hollow, empty, thud”
- all were admitted to a ward as ‘insane’
- once inside they behaved normally, saying the symptom had gone away and they were fine
- none were detected as being pseudo-patients
AO3:
- strength: brought about a revision of the classification system to incorporate a more in-depth overview of mental disorders
OR
- limitation: brought about widespread distrust of psychiatrists to accurately diagnose mental disorders
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the original dopamine hypothesis as a neural correlate (explanation) of Sz.
- high levels of dopamine in subcortical regions in the brain
- subcortical hypERdopaminergia
- e.g.) excess of dopamine receptors in Boca’s area explains speech poverty as a symptom of Sz
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the updated dopamine hypothesisas a neural correlate (explanation) of Sz.
(- in addition to hypERdopaminergia)
- low levels of dopamine in cortex
- cortical hypOdopaminergia
- e.g.) defecit of dopamine in prefrontal cortex (thinking) could explain cognitive problems (-ve symptoms)
- cortical hypOdopaminergia leads to subcortical hypERdopaminergia
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
What acronym can we use to remember the original and updated dopamine hypotheses?
Only
Happy
Squirels
Bury
Seeds
Under
Large
Coarse
Pine
Cones
Original
High (=hyper)
Subcortical
Broca
Speech
Updated
Low (=hypo)
Cortex
Prefrontal
Cognitive
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Briefly outline one strength and one weakness of the dopamine hypotheses as a neural correlate (explanation) of Sz.
strength:
- research has shown that drugs that increase the levels of dopamine produce schizophrenic symptoms => shows higher levels of dopamine are linked to Sz symptoms which supports dopamine hypothesis
weakness:
- clozapine is the most effective drug at reducing Sz symptoms + acts on dopamine and serotonin => dopamine hypothesis isn’t a complete explanation if serotonin is also being acted on because this suggests that serotonin also has a role to play in Sz, which isn’t included in the dopamine hypothesis
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline family studies as a genetic explanation of Sz.
family studies:
- Gottesman (1991) large-scale family study: risk of Sz increases with genetic similarity to a relative with the disorder
- e.g.) aunt with Sz => 2% chance of developing Sz
- e.g.) sibling with Sz => 9% chance of developing Sz
- e.g.) identical twin with Sz => 48% chance of developing Sz
- family members tend to share aspects of their environment as well as may of their genes so the correlation represents them both, but family studies still give good support for the importance of genes in Sz
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline candidate genes as genetic explanation of Sz.
candidate genes:
- Sz is polygenetic (lots of genes involved)
- the most likely genes are the ones coding for neurotransmitters (dopamine)
- Ripke et al (2014) combined all data from genome-wide studies of Sz, 108 separate genetic variations were associated with slightly increased risk of Sz
- Sz is aetiologically heterogeneous (different combinations of factors, including genetic variation, can lead to the condition)
- Benzel et al (2007): there are 3 genes that have been associated with excess dopamine in specific receptors, leading to positive symptoms such as delusions and hallucinations: COMT, DRD4, AKT1
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the role of mutation as genetic explanation of Sz.
mutation:
- Sz can have genetic origin despite the absence of a family history of it
- mutation in parental DNA caused by radiation, poison or viral infection
- positive correlations between paternal age (associated with increased risk of sperm mutation) and risk of Sz (0.7% risk with fathers under 25 and 2% with fathers over 50)
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one weakness of biological explanations of Sz, regarding biological reductionism.
P: One limitation of biological explanations of Sz is that they are considered biologically reductionist.
E: For example, the complex behaviour of Sz is being broken down into its constituent components and explained through genetic and neural processes.
E: This is a weakness because there is evidence that suggests that environmental factors also increase the risk of developing Sz including birth complications (Morgan et al, 2017) and smoking THC-rich cannabis in teenage years (Di Forti et al, 2015). Furthermore, Morkved et al (2017) found that 67% of people with Sz reported at least one childhood trauma as opposed to 38% of a matched control group with non-psychotic mental health issues. This suggests that, on their own, biological explanations do not provide a holistic and complete explanation for Sz.
E: Furthermore, the dopamine hypothesis takes the most reductionist level of explanation at the neurochemical level. Research from post-mortem and brain scanning studies demonstrate that other neurochemicals such as glutamate also seem to be abnormally higher in people with Sz (McCutcheon et al, 2020).
L: As a result, the credibility of biological explanations is reduced as they are not sufficient as stand-alone explanations.
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one strength of biological explanations of Sz, regarding real-world application.
P: One strength of biological explanations for Sz is that they have real-world application.
E: For example, one application of our understanding of the likely role of genes in schizophrenia is genetic counselling. If one or more potential parents have a relative with Sz, they risk having a child who would go on to develop Sz. For instance, based on Gottesman’s study, the child would have a 6% probability if the patient has a half-sibling with Sz. Genetic counselling involves informing potential parents of these probabilities so they can make informed choices about whether to have children who risk having a poor quality of life if they develop Sz.
E: However, the risk estimate provided by genetic counselling is just an average figure based on the whole population. It won’t really reflect the probability of that particular child going on to develop Sz because any given child will be exposed to a particular environment which also exposes the child to risk factors. For example a child’s risk of developing Sz would be higher than its genetic probability if they experience childhood trauma and go on to smoke cannabis in their teens. Therefore genetic counselling only provides an estimate of risk of the unborn child going on to develop Sz.
E: Furthermore, by examining the role of neurochemicals such as dopamine (DA), antipsychotics have been produced to attempt to regulate levels of dopamine for individuals with Sz. According to Taylor et al (2014), these drugs reduce DA activity and the intensity of the symptoms of those with Sz. This is a strength because it allows individuals suffering with Sz to have an improved quality of life and could potentially allow them to return to work and therefore contribute positively to the economy.
L: As a result, the credibility of biological explanations of Sz is increased as they provide practical applications to individuals.
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one weakness of biological explanations of Sz, regarding inconsistent evidence.
P: One limitation of biological explanations of Sz is that there is inconsistent evidence on the dopamine hypothesis from amphetamine psychosis.
E: For example, amphetamines (speed) can reproduce symptoms of Sz, which Tenn et al (2003) did in rats to then relieve the symptoms with drugs that reduce DA activity. In other research, amphetamines have been found to raise DA levels (Curran et al 2004) and amphetamines in high doses can produce auditory hallucinations that resemble those often seen in Sz. This evidence of a link between amphetamines and Sz symptoms supports the dopamine hypothesis.
E: However, other drugs that also increase DA levels (apomorphine) do not cause Sz-like symptoms (Dépatie and Lal, 2001). Also, Garson (2017) has challenged the idea that the symptoms of amphetamine psychosis closely mimic Sz. This is an issue because it suggests the relationship between dopamine and Sz is not well understood as evidence is contradictory.
E: Furthermore, psychologists should be mindful about the conclusions made from amphetamine psychosis about dopamine levels as a lot of the research comes from animal studies which may not be generalisable to humans, since we have different psychological and cognitive systems and structures. Therefore the link between amphetamine psychosis and Sz may not be as close as some have suggested.
L: As a result, the credibility of the biological explanations of Sz is reduced since amphetamine psychosis is not particularly strong evidence to support the dopamine hypothesis.
DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Fill in the blanks:
The most common treatment for Sz involves the use of [ ] drugs. These drugs may be required on a [ ]-[ ] or [ ]-[ ] basis. They can typically be divided into two types and administered in [ ], [ ] or [ ] form:
- [ ] antipsychotics: these are [ ] drugs that have typically been used since the 1950s
- [ ] antipsychotics: these drugs have been used since the 1970s. They aim to improve the effectiveness of drugs in [ ] symptoms of psychosis AND minimise the [ ] [ ].
0/14 = 1
4/14 = 2
7/14 = 3
10/14 = 4
14/14 = 5
The most common treatment for Sz involves the use of antipsychotic drugs. These drugs may be required on a short-term or long-term basis. They can typically be divided into two types and administered in tablet, injection or syrup form:
- Typical antipsychotics: these are older drugs that have typically been used since the 1950s
- Atypical antipsychotics: these drugs have been used since the 1970s. They aim to improve the effectiveness of drugs in suppressing symptoms of psychosis AND minimise the side effects.
0/14 = 1
4/14 = 2
7/14 = 3
10/14 = 4
14/14 = 5
DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline the following pieces of information about Chlorpromazine:
- Typical or atypical?
- How is the drug administered? Typical Dosage?
- How does the drug work?
- Evidence for effectiveness?
- Side effects?
Typical or atypical?
- typical
How is the drug administered? Typical Dosage?
- tablet, syrup, injection
- general dosage 400-800mg
- if orally taken: max dosage of 100mg
How does the drug work?
- antagonistic to DA (reduces DA levels) because it blocks DA receptors in the brain
- initial build-up of DA => production decreases
- also effective in calming patients with Sz or other conditions (effective sedative due to histamine), e.g. in psychotic episode
Evidence for effectiveness?
- chlorpromazine associated with better overall functioning and reduced symptom severity in 1121 ptps (Thornley et al, 2003)
Side effects?
- dizziness, agitation, sleepiness/drowsiness, stiff jaw, itchy skin, weight gain
- most serious: neuroleptic malignant syndrome (NMS) (results in high temp, delirium, coma or even death)
DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline the following pieces of information about Clozapine:
- Typical or atypical?
- How is the drug administered? Typical Dosage?
- How does the drug work?
- Evidence for effectiveness?
- Side effects?
Typical or atypical?
- atypical
How is the drug administered? Typical Dosage?
- last resort (!) and must have regular blood tests if prescribed
- tablet or syrup
- generally 300-400mg per day
How does the drug work?
- antagonistic to DA (reduces DA levels) because it binds to the DA receptors in the brain
- initial build-up of DA => production decreases
- also targets serotonin and glutamate, which helps to improve mood + reduce depression and anxiety + may improve cognitive functioning
- typically prescribed to patients at high risk of suicide
Evidence for effectiveness?
- Meltzer (2012) 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
Side effects?
- caused deaths due to agranulocytosis (blood condition) so was stopped
- until discovered to be more effective than others
DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline the following pieces of information about Risperidone:
- Typical or atypical?
- How is the drug administered? Typical Dosage?
- How does the drug work?
- Side effects?
Typical or atypical?
- atypical
How is the drug administered? Typical Dosage?
- tablets, syrup or injection (which lasts 2 weeks)
- small, gradual daily dose to 4-8mg (max of 12mg)
How does the drug work?
- binds to DA receptors (and serotonin receptors) more strongly so is more effective in smaller doses
Side effects?
- fewer than other antipsychotics
DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline one strength of drug therapy as a biological treatment of Sz, regarding evidence for its effectiveness.
P: evidence for its effectiveness
E: Thornley et al (2003) reviewed data from 13 trials of antipsychotics with a total of 1121 ptps, found chlorpromazine was associated with better overall functioning and reduced severity of symptoms compared to a placebo; Meltzer et al (2012): clozapine is more effective than other atypical and typical antipsychotics + it’s effective in 30-50% cases where other antispychotics had failed
E: antipsychotics are effctive at reducing symptoms and severity of Sz, increasing credibility for this form of treatment
E: Healy (2012): serious flaws with evidence for effectiveness: most studies only study short-term effects + some successful studies have been published multiple times (exaggerates the size of the evidence base); powerful calming effects might seem positive for those with seemingly reduced symptoms but doesn’t necessarily mean reduced severity of psychosis => supportive evidence is flawed
L: flawed supportive evidence => less valid support for drug therapy as treatment for Sz so reduced credibility for treatment
DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline one limitation of drug therapy as a biological treatment of Sz, regarding side effects.
P: likelihood of side effects from typical antipsychotics
E: typical antipsychotics associated with dizziness, sleepiness, itchy skin; most serious side effect is neuroleptic malignant syndrome (NMS) (when drug blocks dopamine action in hypothalamus (which regulates a number of body systems)) => delirium, coma, can be fatal
E: lots of side effects is counterintuitive; we try to improving QOL for patients with Sz by giving them drug therapy but their serious side effects reduce QOL by still interfering with their daily life, which reduces the credibility for drug therapy to help treat people with SZ
E: PLUS if side effects are so bad, patients may be discouraged from using them which then makes their symptoms worse and therefore renders the treatment ineffective in treating Sz => negative economical implications if wasting money on drug treatments but patients still can’t return to work
L: drug therapy can do more harm than good and so credibility is reduced for it as a treatment for Sz
DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline one limitation of drug therapy as a biological treatment of Sz, regarding the ethical concerns of their use.
P: ethical concerns of their use
E: widely believed that antipsychotics have been used in hospitals to calm people with Sz and make them easier for staff to work with rather than for benefits to the patients themselves (powerful sedative effects in chlorpromazine)
E: question of should we be using sedatives to calm patients who aren’t in a state where they can give their consent; staff are likely to be the only ones benefitting, sedation may do very little to reduce the symptoms for the patient
E: BUT calming people distressed by hallucinations and delusions may make them feel better which allows them to engage with alternative treatments (CBT)
L: when doing a cost-benefit analysis, benefits (helps staff and patients to engage in treatments) outweigh costs (lack of consent) and so credibility of drug therapy is increased due to its benefits in treating Sz, even indirectly (by calming them to engage in other treatments)
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline Fromm-Reichmann’s (1948) explanation for Sz: the Schizophrenogenic Mother.
SCHIZOPHRENOGENIC MOTHER
- psychodynamic explanation, based on accounts from her patients about their childhoods
- schizophrenogenic (literally translates to ‘Sz-causing’) mother is cold, rejecting and controlling and creates a family climate characterised by tension and secrecy
- this leads to distrust that later develops into paranoid delusions
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline Bateson et al’s (1972) explanation for Sz: the Double-Bind theory.
DOUBLE-BIND THEORY
- emphasises the role of communication style within a family
- a developing child regularly finds themselves trapped in situations where they fear doing the wrong thing
- they receive mixed messages about what the wrong thing is and feel unable to comment on the unfairness of the situation or seek clarification (incoherent version of reality caused by mixed messages)
- e.g. when a verbal behaviour contradicts the non-verbal behaviour etc.
- when they get it wrong, they are punished by withdrawal of love
- this leaves the developing child with an understanding that the world is a confusing and dangerous place which can lead to symptoms like disorganised thinking and paranoid delusions.
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline Expressed Emotion (EE) as an explanation for Sz.
EXPRESSED EMOTION (EE):
- the negative emotional climate that is characterised by a family communication style of criticism, hostility and emotional over-involvement
- criticism: negative comments said between family members
- hostility: any aggressive behaviour, such as threats
- emotional over-involvement: behaviour that involves interfering in other family members’ affairs; these family members can also seem overly moralistic (having a very strong sense of what is right and wrong)
- high levels of EE are more likely to influence the relapse rates of people recovering from Sz who return to their families after treatment; it’s the high stress levels that this EE creates that trigger a Sz episode
- these families may also feature secret alliances between members which encourage paranoid symptoms, such as delusions of persecution
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline one strength of family dysfunction as an explanation of Sz
possible strengths:
- Berger (1965): people with Sz reported a higher recall of double-bind statements by their mothers than people without the disorder
- Kalafi and Torabi: a negative emotional climate (overprotective mothers and rejecting fathers) led to a higher relapse rate in Sz
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline one limitation of family dysfunction as an explanation of Sz,
possible limitations:
- high EE among families could be a symptom rather than a cause since Sz individuals can be difficult to care for
- it implies that parents are responsible for the problems of their children (mixed messages) which is socially sensitive
- info from childhood experiences is gathered after the development of symptoms and a diagnosis of Sz = > individuals have a distorted view of reality so their memory of childhood experiences may also be distorted
PSYCHOLOGICAL TREATMENTS OF SCHIZOPHRENIA: FAMILY THERAPY
What is the aim of family therapy?
to improve the quality of communication and interaction between family members and the ‘identified patient’
PSYCHOLOGICAL TREATMENTS OF SCHIZOPHRENIA: FAMILY THERAPY
Outline Pharoah’s (2010) strategies for family therapy.
REDUCING EXPRESSED EMOTION (EE)
- therapists should aim to reduce the level of emotion generally but especially negative ones (anger and guilt, which can cause stress)
- reducing stress can reduce the likelihood of a relapse
FORM A THERAPEUTIC ALLIANCE
- family members should be encouraged to all agree on the aims of the therapy
- this may include improving the family’s beliefs about and behaviour towards Sz
BALANCE
- the therapist should also encourage the family members to achieve a balance in caring for the individual with Sz whilst maintaining their own lives
PSYCHOLOGICAL TREATMENTS OF SCHIZOPHRENIA: FAMILY THERAPY
Outline Burbach’s (2018) 7-phase model for working with families dealing with Sz.
- phase 1: sharing basic info and providing emotional and practical support (develops through progressively deeper levels)
- phase 2: identifying resources including what different family members can and cannot offer
- phase 3: encourages mutual understanding, creates a safe space for all family members to express their feelings
- phase 4: identifying unhelpful patterns of interaction
- phase 5: skills training, e.g. learning stress management techniques
- phase 6: relapse prevention planning
- phase 7: maintenance for the future
PSYCHOLOGICAL TREATMENTS OF SCHIZOPHRENIA: FAMILY THERAPY
Outline one strength of family therapy as a treatment for Sz, regarding evidence for effectiveness.
P: evidence for effectiveness
E: review of studies by McFarlane (2016): family therapy was one of the most consistently effective treatments available for Sz; relapse rates found to reduce typically by 50-60%; also effective to do family therapy as mental health initially starts to decline; clinical advice from NICE recommends family therapy for everyone with Sz
E: family therapy is likely beneficial for those with and before a diagnosis of Sz
E: However… not always appropriate to use if safeguarding concerns arise or if family is not available (dead or not in contact)
L: family therapy is a credible and effective treatment for Sz but cannot be universally applied due to safeguarding concerns or extenuating circumstances, so it’s limited in its application
PSYCHOLOGICAL TREATMENTS OF SCHIZOPHRENIA: FAMILY THERAPY
Outline one strength of family therapy as a treatment for Sz, regarding benefits for the whole family.
P: benefits to whole family
E: Lobban and Barrowclough (2016) reviewed evidence of effects of family therapy and concluded that the effects on the family are important because the family provide the bulk of the care
E: by strengthening the functioning of the whole family, family therapy lessens the negative impact of Sz on other family members and strengthens the ability of the family to support the person with Sz
E: BUT: negative implications for economy due to having to take all members out of work regularly and the costs of training and paying professionals to instigate and manage the sessions
L: overall, despite short-term negative economical implications, family therapy is a credible and effective treatment for Sz which benefits the whole family
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: COGNITIVE EXPLANATION
Outline metarepresentation as one of the dysfunctional thought processes outlined by Frith (1992).
METAREPRESENTATION: the cognitive ability to reflect on one’s own thoughts
- allows us insight into our own intentions and goals
- allows us to interpret the actions of others
- dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else (i.e. we know which thoughts are our own)
- this would explain hallucinations of hearing voices and delusions like thought insertion (having thoughts projected into one’s mind by others)
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: COGNITIVE EXPLANATION
Outline central control as one of the dysfunctional thought processes outlined by Frith (1992).
CENTRE CONTROL: the ability to suppress automatic responses while we perform deliberate actions
- speech poverty and thought disorder could result in the inability to suppress automatic thoughts and speech triggered by other thoughts
- e.g. people with Sz tend to experience derailment of thoughts because each word triggers associations and the person cannot suppress automatic responses to these
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: COGNITIVE EXPLANATIONS
Outline one strength of the cognitive explanations of Sz, regarding research support.
P: research support
E: Stirling et al (2006): 30 ptps with Sz performed poorly on cognitive tasks such as the Stroop task (ptps have to name the font-colour not the word, so have to suppress the tendency to read the word out loud) in comparison to a group of controls
E: supports central control dysfunction because people with Sz struggle to suppress the thought of saying the word instead of the colour the word is written in and so they say the incorrect answer or take 2x as long on average to name the font-colours
L: supports idea of impaired cognitive processes in ppl with Sz so increased cred for explanation
PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: COGNITIVE EXPLANATIONS
Outline one limitation of the cognitive explanations of Sz, regarding the proximal explanation.
P: proximal explanation (explains what is happening now to cause symptoms, not what initially caused the condition)
E: dysfunctional thinking could be a consequence of Sz rather than a cause, and we are unsure because such cognitive abilities are often retrospectively noticed
E: suggests something else could cause Sz in the first place and may be a factor that leads to distortions in cognition; genetic variation or childhood trauma might lead to problems with metarepresentation or central control but not enough research on it
E: PLUS: untestable/abstract concepts; weakens psychology’s scientific claim
L: reduced credibility of cog explanations due to the proximal explanation of abstract concepts
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Fill in the gaps:
Cognitive Behavioural Therapy (CBT) is commonly used to treat people with schizophrenia.
It usually takes places over a period of [ ]- [ ] sessions (this is [ ] than what is required for other conditions) and can be delivered on an [ ] basis or in groups.
CBT aims to deal with both [ ] (cognitions) and [ ].
Cognitive Behavioural Therapy (CBT) is commonly used to treat people with schizophrenia.
It usually takes places over a period of 5-20 sessions (this is longer than what is required for other conditions) and can be delivered on an individual basis or in groups.
CBT aims to deal with both thoughts (cognitions) and behaviours.
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Outline 5 ways in which CBT can help to treat Sz.
- helps clients to make sense of how their irrational cognitions (delusions, hallucinations) impact on their feelings and behaviours
- understanding where symptoms come from can he very helpful (natural fear response if client believes the voices are demonic, much less debilitating and frightening if therapist can convince them the voice comes from a malfunctioning speech centre in their own brain + they cannot hurt them if they ignore it); won’t eliminate symptoms but helps clients better cope with them => improves ability to function adequately
- clients taught that hearing voices is an extension of the ordinary experience of thinking in words (normalisation)
- delusions can be challenged: reality testing (Sz client + therapist examine likelihood that beliefs are true)
- in some cases where delusions are resistant to reality testing, CBT still tackles anxiety and depression resulting from Sz
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Outline the aim of Tarrier’s form of CBT for Sz known as coping strategy enhancement (CSE).
- CSE aims to develop and apply two effective coping strategies for each psychotic symptom (and the accompanying stress they produce.)
- Tarrier identified that Sz ppl were able to identify triggers for Sz episodes (e.g. certain people, being on their own, being put under stress) and had devised own coping strategies
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Outline the two types of coping strategies in Tarrier’s form of CBT for Sz known as coping strategy enhancement (CSE).
- cognitive strategies: distraction, concentrating on a specific task, positive self-talk
- behavioural strategies: relaxation techniques (breathing exercises), social withdrawal/increasing social contact (depends on person’s trigger), loud music to drown out voices, behavioural experiments
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Outline the two (or 2+1/2) parts of Tarrier’s form of CBT for Sz known as coping strategy enhancement (CSE).
1) develop rapport with client, identify triggers of psychotic symptoms, review existing coping strategies and develop new ones
2) target specific symptoms and find strategies to deal with them
- ptps have homework assignments to consolidate their learning of strategies between sessions
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Outline one piece of supportive evidence for Tarrier’s form of CBT for Sz known as coping strategy enhancement (CSE).
CHADWICK (1992)
- helped an individual with Sz with a delusion that his thinking could influence the future
- but the individual failed to predict what would happen in 50 video clips shown to him which helped provide him with the evidence to show that his delusional beliefs were false
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Outline one strength of CBT as a treatment for Sz, regarding its effectiveness.
P: effective as a treatment
E: Jahuar et al (2014) reviewed 34 studies using CBT with Sz, found clear evidence that there is small but significant effects on +ve and-ve symptoms; other studies have focused on specific symptoms (Pontillo (2016)) and found reductions in frequency and severity of audiory hallucinations; clinical advice from NICE (2019) recommends CBT for Sz
E: both clinical and research studies have found CBT to be effective treatment for Sz; +ve implications for economy, ppl unwell with Sz can return to work following reduction in symptoms and return to society
E: BUT not 100% effective (‘small but significant effects on symptoms’); drugs could be more effective; chlorpromazine works on dopamine to reduce symptoms + acts as a sedative => helpful alternative if CBT coping strategies aren’t helping during a psychotic episode
L: credibility for CBT as treatment is increased to an extent
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Outline one limitation of CBT as a treatment for Sz, regarding its evidence for effectiveness being unclear.
P: evidence for effectiveness is unclear
E: Thomas (2015): different studies involve different CBT techniques + ppl with different combos of Sz symptoms’ overall modest benefits of CBT for Sz probably conceal a wide variety of effects of different techniques on different symptoms
E: every Sz case is different (symptoms and response to CBT); CBT isn’t one-size-fits-all => no general law to be made about its effectiveness (cases can’t be compared)
E: PLUS not universal treatment; ppl in height of psychosis will not be able to engage in rigorous discussion or identify triggers; combo of drugs (to first stabilise condition) then CBT would be best => CBT insufficient by itself
L: cred reduced due to unclear evidence of effectiveness (generalised evidence, neglects differences in cases)
COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA
Outline one limitation of CBT as a treatment for Sz, regarding whether or not it ‘cures’ Sz.
P: unclear how far CBT ‘cures’ Sz
E: may improve QOL but not cure; Sz appears to be a largely biological condition => psychological treatments just help them cope/their ability to live with Sz; enhancing ability to ignore auditory hallucinations isn’t the same as removing these symptoms
E: unclear whether CBT cures Sz or just enables ppl to live with Sz more easily
E: BUT studies show CBT has led to a significant reduction in +ve and -ve symptoms => more than enhance coping; number of studies have reported frequency and intensity of hallucinations can be reduced by CBT + the accompanying anxiety => may cure after all
L: on balance, may do more than teach coping skills and may be a partial cure for Sz
TOKEN ECONOMIES AS USED IN THE MANAGEMENT OF SCHIZOPHRENIA
Fill in the gaps:
Token economies are [ ] systems based on the principles of [ ] [ ].
They are used to [ ] the behaviour of people with schizophrenia who have developed patterns of [ ] behaviour from spending long periods of time in [ ] such as [ ] hospitals.
Where individuals have spent long periods of time in hospital they can become [ ]. This can lead to [ ] [ ] e.g. ceasing to maintain good hygiene or stop socialising with others. This is an understandable response to living without [ ].
Matson et al (2016) identify three categories of [ ] behaviour that are tackled through token economy systems including: [ ] care, [ ]-related behaviours (e.g. apathy) and social behaviour.
0/14 = 1
4/10 = 2
7/14 = 3
10/14 = 4
14/14 = 5
Token economies are reward systems based on the principles of operant conditioning.
They are used to manage the behaviour of people with schizophrenia who have developed patterns of maladaptive behaviour from spending long periods of time in institutions such as psychiatric hospitals.
Where individuals have spent long periods of time in hospital they can become institutionalised. This can lead to bad habits e.g. ceasing to maintain good hygiene or stop socialising with others. This is an understandable response to living without routine.
Matson et al (2016) identify three categories of institutional behaviour that are tackled through token economy systems including: personal care, condition-related behaviours (e.g. apathy) and social behaviour.
0/14 = 1
4/10 = 2
7/14 = 3
10/14 = 4
14/14 = 5
TOKEN ECONOMIES AS USED IN THE MANAGEMENT OF SCHIZOPHRENIA
